33 results on '"Fabrizio Monaco"'
Search Results
2. Mitral Repair With Complete Rings or Posterior Bands in Barlow Disease: Long-term Results
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Benedetto Del Forno, Davide Carino, Arturo Bisogno, Angelica Rizzello, Elisabetta Lapenna, Guido Ascione, Federica Gramegna, Giuseppe Iaci, Eustachio Agricola, Fabrizio Monaco, Ottavio Alfieri, Alessandro Castiglioni, Francesco Maisano, Michele De Bonis, Del Forno, Benedetto, Carino, Davide, Bisogno, Arturo, Rizzello, Angelica, Lapenna, Elisabetta, Ascione, Guido, Gramegna, Federica, Iaci, Giuseppe, Agricola, Eustachio, Monaco, Fabrizio, Alfieri, Ottavio, Castiglioni, Alessandro, Maisano, Francesco, and De Bonis, Michele
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Complete rings or posterior bands are both commonly used during mitral valve repair, but which one ensures the best long-term outcome in patients with Barlow disease is a topic of debate. This study evaluated whether the type of annuloplasty device affects the long-term durability of the repair.We selected 296 consecutive patients with severe mitral regurgitation due to Barlow disease who underwent edge-to-edge mitral repair at our institution between 2004 and 2013. For the edge-to-edge repair, a complete semirigid ring was used in 151 patients, whereas a posterior flexible band was used in 145 patients. The clinical and echocardiographic outcomes of both groups were compared at long-term follow-up.At 14 years, the overall survival was 87.3% ± 2.79% in the ring group and 94.1% ± 2.30% in the band group (P = .056). The incidence of mitral valve reintervention was 4.9% ± 1.95% in the ring group and 5.5% ± 2.53% in the band group (P = .371) at 14 years. The incidence of recurrence of mitral regurgitation ≥3+ and ≥2+ was 8.3% ± 2.64% in the ring group and 8.7% ± 3.07% in the band group (P = .991) and 26.5% ± 4.23% in the ring group and 17.4% ± 3.26% in the band group (P = .697), respectively. Mitral regurgitation ≥1+ at discharge was the only independent predictor of reoperation and recurrence of mitral regurgitation ≥3+ in the long-term.In patients with Barlow disease undergoing edge-to-edge mitral valve repair, the type of annuloplasty device does not influence the long-term results. Achieving an optimal immediate result remains the key to maintain the stability of the repair at long-term.
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- 2023
3. Left Ventricular Unloading With an IABP in Patients Undergoing Ventricular Tachycardia Ablation With ECMO Support
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Fabrizio Monaco, Paolo Della Bella, Alberto Zangrillo, Silvia Ajello, Anna Mara Scandroglio, Nora Di Tomasso, Elisabetta Fumagalli, Giovanni Landoni, Giulio Melisurgo, Maria Grazia Calabrò, Allegra Arata, Caterina Cecilia Lerose, Antonio Frontera, Monaco, F., Ajello, S., Calabro, M. G., Melisurgo, G., Landoni, G., Arata, A., Lerose, C. C., Fumagalli, E., Tomasso, N. D., Frontera, A., Scandroglio, A. M., Della Bella, P., and Zangrillo, A.
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medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Afterload ,030202 anesthesiology ,Internal medicine ,catheter ablation ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,Intra-aortic balloon pump ,mechanical circulatory support ,Intra-Aortic Balloon Pumping ,Ejection fraction ,business.industry ,Dilated cardiomyopathy ,extracorporeal membrane oxygenation ,medicine.disease ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,intra-aortic balloon pump ,Ventricle ,Tachycardia, Ventricular ,Cardiology ,Heart-Assist Devices ,ventricular tachycardia ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective: The authors investigated the preprocedural predictors of postprocedural intra-aortic balloon pump (IABP) need in patients undergoing transcatheter ventricular tachycardia (VT) ablation on venoarterial (VA) extracorporeal membrane oxygenation (ECMO). Design: Observational study. Setting: Hybrid operating room and intensive care unit of a teaching hospital. Patients: Participants were 121 consecutive patients with unstable VT undergoing transcatheter ablation with VA-ECMO. Interventions: In patients with postprocedural echocardiographic, radiographic, or hemodynamic signs of increased left ventricle afterload, an IABP was positioned. Measurements and Main Results: Patients in the IABP group were more frequently on angiotensin-converting enzyme inhibitors (58% v 37%; p = 0.03) and had lower median baseline ejection fraction (25% v 28% p = 0.05), larger end-diastolic diameter (69.7 mm ± 13.0 v 65.7 mm ± 11.3; p = 0.03), and more frequent ischemic etiology as the reason for dilated cardiomyopathy (76% v 47%; p = 0.04,) when compared with patients not requiring IABP. Postoperatively, the IABP group required longer mechanical ventilation (24 hours [20-56.5] v 23 hours [15-28]; p = 0.003), intensive care unit stay (78 hours [46-174] v 48 hours [24-72]; p < 0.001), and continuous renal replacement therapy (13.3% v 1.3%; p = 0.006). By multivariate analysis, end-diastolic diameter (odds ratio [OR]:1.08; confidence interval [CI]: 1.00-1.16; p = 0.049), ischemic dilated cardiomyopathy (OR: 8.40; CI: 2.15-32.88; p = 0.002), and more-than-moderate mitral regurgitation (OR: 4.83; CI: 1.22-19.22; p = 0.025) were independent predictors of need for IABP. Conclusions: The need for an IABP to unload the left ventricle can be predicted by ventricular size, medium-severe mitral valvular defect, and ischemic etiology of the dilated cardiomyopathy.
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- 2021
4. Venoarterial Extracorporeal Membrane Oxygenation Support in Lung Cancer Resection
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Fabrizio Monaco, Pierluigi Novellis, Alberto Zangrillo, Francesca Rossetti, Giovanni Landoni, Vanesa Gregorc, Angelo Carretta, Giulia Veronesi, Novellis, Pierluigi, Monaco, Fabrizio, Landoni, Giovanni, Rossetti, Francesca, Carretta, Angelo, Gregorc, Vanesa, Zangrillo, Alberto, and Veronesi, Giulia
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Pulmonary and Respiratory Medicine ,Lung cancer surgery ,medicine.medical_specialty ,ARDS ,business.industry ,Dilated cardiomyopathy ,Perioperative ,medicine.disease ,Surgery ,surgical procedures, operative ,Cardiothoracic surgery ,Heart failure ,medicine.artery ,Pulmonary artery ,medicine ,Respiratory function ,Cardiology and Cardiovascular Medicine ,business - Abstract
Cardiovascular comorbidities often prevent patients with otherwise resectable early-stage lung cancer from undergoing surgery due to prohibitive peri-operative risk. Here we describe the first intraoperative use of venoarterial (VA) ECMO in a stage cIIA lung cancer patient with arterial infiltration and severe post-ischemic dilated cardiomyopathy (EF 23%) undergoing left upper lobectomy with pulmonary artery angioplasty. Providing intra-operative cardiovascular and respiratory function support, VA-ECMO represents a suitable option for patients with heart failure, ensuring adequate hemodynamic profile and reducing the risk of complications. These otherwise inoperable patients can thus be offered a potentially curative surgical resection of the malignancy. Surgery is the standard treatment for patients with early-stage lung cancer 1. However, several patients with advanced heart failure may be excluded from surgery due to prohibitive perioperative risk. Providing circulatory and respiratory support, extracorporeal membrane oxygenator (ECMO) may represent a suitable option for such patients 2. While there is a published experience on intraoperative use of veno-venous (VV) ECMO, primarily in thoracic surgery 3, an extremely limited number of reports considered the use of venoarterial (VA)-ECMO in patients undergoing non-cardiac surgery 45. VA-ECMO is currently indicated in patients with cardiovascular failure and concomitant cardiac pump dysfunction, as in post-operative ARDS associated with septic shock 4; outside the intensive care unit, the use of pre-emptive VA-ECMO has traditionally been limited to patients undergoing elective ventricular tachycardia ablation and structural heart procedures5. Here we report the first case of intraoperative use of VA-ECMO in a patient with resectable lung cancer and ischemic heart disease with prohibitive left ventricular function, and describe the benefits of this new indication.
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- 2022
5. Long-term outcome of perioperative low cardiac output syndrome in cardiac surgery: 1-year results of a multicenter randomized trial
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Luca Brazzi, Fabio Guarracino, Valery Likhvantsev, Rosalba Lembo, Giovanni Landoni, Martina Crivellari, Eugenio Garofalo, Gianluca Paternoster, A Mara Scandroglio, Vadim Pasyuga, Nora Di Tomasso, Alberto Zangrillo, Maria Grazia Calabrò, Antonio Pisano, Fabrizio Monaco, Alessandro Belletti, Vladimir V. Lomivorotov, Alessandro Bianchi, Evgeny Fominskiy, Marat N Abubakirov, Evgeny Grigoryev, Andrey Yavorovskiy, Alessandro Oriani, Zangrillo, Alberto, Lomivorotov, Vladimir V, Pisano, Antonio, Calabrò, Maria Grazia, Belletti, Alessandro, Brazzi, Luca, Grigoryev, Evgeny V, Guarracino, Fabio, Monaco, Fabrizio, Garofalo, Eugenio, Crivellari, Martina, Likhvantsev, Valery V, Fominskiy, Evgeny V, Paternoster, Gianluca, Yavorovskiy, Andrey, Pasyuga, Vadim V, Oriani, Alessandro, Lembo, Rosalba, Bianchi, Alessandro, Scandroglio, A Mara, Abubakirov, Marat N, Di Tomasso, Nora, and Landoni, Giovanni
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Male ,medicine.medical_specialty ,Mean arterial pressure ,Cardiotonic Agents ,Levosimendan ,Cardiac Output, Low ,Low-cardiac output syndrome ,Critical Care and Intensive Care Medicine ,Placebo ,law.invention ,03 medical and health sciences ,Postoperative Complications ,Catecholamines ,0302 clinical medicine ,Double-Blind Method ,law ,Internal medicine ,medicine ,Cardiopulmonary bypass ,Humans ,Hemodynamic management ,Myocardial infarction ,Mortality ,Risk factor ,Simendan ,business.industry ,Cardiovascular Surgical Procedures ,Age Factors ,030208 emergency & critical care medicine ,Perioperative ,Middle Aged ,Cardiac surgery ,medicine.disease ,Survival Analysis ,Treatment Outcome ,030228 respiratory system ,Catecholamine ,Cardiology ,Female ,business ,medicine.drug - Abstract
Purpose Perioperative myocardial dysfunction occurs frequently in cardiac surgery, and is a risk factor for morbidity and mortality. Levosimendan has been suggested to reduce mortality of patients with perioperative myocardial dysfunction. However, long-term outcome data on its efficacy in cardiac surgery are lacking. Materials and methods Cardiac surgery patients with perioperative myocardial dysfunction were randomized to levosimendan or placebo, in addition to standard inotropic care. One-year mortality data were collected. Results We randomized 506 patients (248 to levosimendan 258 to placebo). At 1-year follow-up, 41 patients (16.5%) died in the levosimendan group, while 47 (18.3%) died in the placebo group (absolute risk difference −1.8; 95% CI −8.4 to 4.9; P = .60). Female sex, history of chronic obstructive pulmonary disease, previous myocardial infarction, serum creatinine, hematocrit, mean arterial pressure, and duration of cardiopulmonary bypass were independently associated with 1-year mortality. Conclusions Levosimendan administration does not improve 1-year survival in cardiac surgery patients with perioperative myocardial dysfunction. One-year mortality in these patients is 17%. Six predictive factors for long-term mortality were identified. Study registration number NCT00994825 ( ClinicalTrials.gov ).
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- 2020
6. Differences in Biomarkers Pattern Between Severe Isolated Right and Left Ventricular Dysfunction After Cardiac Surgery
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Alberto Zangrillo, Alessandro Oriani, Jun Hyun Kim, Moad Alaidroos, Ambra Licia Di Prima, Fabrizio Monaco, Caterina Cecilia Lerose, Giovanni Landoni, Margherita Licheri, Kim, J. H., Lerose, C. C., Landoni, G., Di Prima, A. L., Licheri, M., Oriani, A., Alaidroos, M., Zangrillo, A., and Monaco, F.
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medicine.medical_specialty ,Bilirubin ,Ventricular Dysfunction, Right ,anesthesia ,030204 cardiovascular system & hematology ,liver ,law.invention ,Ventricular Dysfunction, Left ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,030202 anesthesiology ,law ,Internal medicine ,Intensive care ,medicine ,Cardiopulmonary bypass ,Humans ,Cardiac Surgical Procedures ,Alanine transferase ,intensive care ,Cardiopulmonary Bypass ,cardiac dysfunction ,business.industry ,right ventricular failure ,left ventricular failure ,Repeated measures design ,ventricular dysfunction ,Perioperative ,cardiopulmonary bypa ,Cardiac surgery ,Anesthesiology and Pain Medicine ,chemistry ,Cardiology ,biomarker ,Biomarker (medicine) ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
To find out if there are any differences in biomarkers between severe isolated right ventricular (RV) dysfunction and severe isolated left ventricular (LV) dysfunction after cardiac surgery using cardiopulmonary bypass.Observational study.Teaching hospital.A total of 46 patients who had severe isolated RV or LV dysfunction after cardiac surgery.The authors collected perioperative clinical and biomarker data.Severe isolated RV dysfunction patients (n = 20) had higher postoperative direct bilirubin (p = 0.030), total bilirubin (p = 0.044), glucose (p = 0.011), and international normalized ratio (INR) (p = 0.050) by repeated measure analysis of variance when compared with patients with severe isolated LV dysfunction (n = 26). The RV group also showed lower preoperative alanine transferase (19.3 ± 1.5 v 32.7 ± 4.2, p = 0.001), higher 4-hour INR (1.5 ± 0.3 v 1.4 ± 0.2, p = 0.008), and higher 48-hour INR (1.8 ± 0.4 v 1.4 ± 0.1, p0.001). None in the LV group died, whereas 4 patients in the RV group died (all of them had preoperative atrial fibrillation and underwent double valve replacement surgery).The authors observed biomarkers differences between severe isolated RV dysfunction and severe isolated RV dysfunction.
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- 2020
7. Editor's Choice – A Rotational Thromboelastometry Driven Transfusion Strategy Reduces Allogenic Blood Transfusion During Open Thoraco-abdominal Aortic Aneurysm Repair: A Propensity Score Matched Study
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Cristina Mattioli, Monica De Luca, Pasquale Nardelli, Germano Melissano, Margherita Licheri, Carlotta Notte, Fabrizio Monaco, Alberto Zangrillo, Gaia Barucco, Roberto Chiesa, Monaco, F., Barucco, G., Nardelli, P., Licheri, M., Notte, C., De Luca, M., Mattioli, C., Melissano, G., Chiesa, R., and Zangrillo, A.
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Male ,Pulmonary complication ,medicine.medical_specialty ,Blood transfusion ,Cost-Benefit Analysis ,medicine.medical_treatment ,Blood Loss, Surgical ,030204 cardiovascular system & hematology ,030230 surgery ,Plasma ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Clinical Protocols ,Blood product ,Rotational thromboelastometry ,Transfusion algorithm ,medicine ,Coagulation testing ,Humans ,Intraoperative Complications ,Propensity Score ,Thoraco-abdominal aortic aneurysm ,Aortic Aneurysm, Thoracic ,business.industry ,Patient Selection ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Thrombelastography ,Surgery ,Thromboelastometry ,Treatment Outcome ,Italy ,Propensity score matching ,Female ,Hospital cost ,Fresh frozen plasma ,Erythrocyte Transfusion ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
Objective: Open repair of thoraco-abdominal aortic aneurysm (TAAA) is a challenging procedure, associated with high rates of peri-operative bleeding and blood product transfusions. A large intra-operative volume transfusion has been associated with higher in hospital mortality and prolonged mechanical ventilation. A propensity score matched study was carried out to assess whether the introduction of a rotational thromboelastometry (ROTEM) based transfusion strategy reduces allogenic blood transfusion and affects morbidity in patients undergoing open TAAA repair. Methods: All patients undergoing open TAAA repair at the San Raffaele Scientific Institute between 2009 and 2017 were included. Until 2016, a protocol based on estimated blood loss and conventional coagulation tests was used. After March 2016 a ROTEM guided transfusion protocol was developed and adopted. To account for selection bias, propensity score matching was performed. Results: Five hundred and forty-seven consecutive patients were included. After propensity score matching, 77 patients in the ROTEM algorithm group were successfully matched with 77 patients in the standard algorithm group. Patients managed with ROTEM received fewer red blood cells units (3.5 [range 0–11] vs. 4 [range 0–17]; p = .026) and a lower volume of fresh frozen plasma (286 ± 496 vs. 2,050 ± 1,120; p < .001). In addition, fewer patients received fresh frozen plasma (35% vs. 97%; p < .001). Patients in the ROTEM group showed a significant decrease in the occurrence of pulmonary complications (44% vs. 83%; p = .01). Cost analysis showed a relevant reduction of per-patient expense after the introduction of ROTEM (€834 ± €577 vs. €1,285 ± €851; p < .001) Conclusion: A ROTEM guided transfusion strategy significantly limited the quantity of transfused blood products during open TAAA repair, improving clinical outcomes while reducing costs, allowing for better resource distribution in a setting where blood loss is relevant.
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- 2019
8. Predictors of Intensive Care Unit Admission in Patients Undergoing Lead Extraction: A 10-Year Observational Study in a High-Volume Center
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Alberto Zangrillo, Paolo Della Bella, Fabrizio Monaco, Andrea Radinovic, Nora Di Tomasso, Giuseppe D'Angelo, Giovanni Landoni, Patrizio Mazzone, Francesco Melillo, Pasquale Nardelli, Monaco, Fabrizio, Di Tomasso, Nora, Landoni, Giovanni, Nardelli, Pasquale, Radinovic, Andrea, Melillo, Francesco, D'Angelo, Giuseppe, Della Bella, Paolo, Zangrillo, Alberto, and Mazzone, Patrizio
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Male ,Pacemaker, Artificial ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,intensive care unit ,cardiac implantable electronic device ,law.invention ,03 medical and health sciences ,Patient safety ,Patient Admission ,0302 clinical medicine ,030202 anesthesiology ,law ,Humans ,Medicine ,Medical history ,procedural sedation and analgesia ,Device Removal ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Cardiac reserve ,Retrospective cohort study ,Odds ratio ,Middle Aged ,general anesthesia ,mortality ,Intensive care unit ,lead extraction ,Defibrillators, Implantable ,Intensive Care Units ,Anesthesiology and Pain Medicine ,Procedural sedation and analgesia ,Emergency medicine ,Female ,Observational study ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Hospitals, High-Volume - Abstract
To identify reliable predictors of periprocedural intensive care unit (ICU) admission after transvenous lead extraction (LE) in a high-volume center.Retrospective observational study.University tertiary-care hospital.All patients undergoing LE at San Raffaele Scientific Institute, Milan, Italy, from 2005 to 2015.LE procedures were performed in the electrophysiology laboratories with a cardiac operating room on standby between the end of the morning surgical case and before the start of the afternoon surgical case. Most procedures were conducted with the patient under procedural sedation and analgesia. After LE, patients were admitted either to the ward or to the ICU. Medical history and intraprocedural data were recorded.Of the 389 procedures performed during the study period, 50 patients (13%) were admitted to the ICU owing to persistent hemodynamic instability or intraoperative complications requiring endotracheal intubation. Complete procedural success was achieved in 370 patients (95%), and the clinical success rate was 98.4%. No deaths were recorded. Five complications requiring emergency surgery (1.3%) were reported. Preprocedural right ventricular dysfunction (odds ratio (OR) 7.41; confidence interval 1.85-29.7; p0.01) and the need for general anesthesia (OR 12; confidence interval 1.49-97.06; p = 0.019) were independent predictors of ICU admission.Preoperative identification of patients who need ICU admission after LE is crucial to increase patient safety and decrease hospital costs. Severe right ventricular dysfunction and need for general anesthesia identify patients with low cardiac reserve who are at increased risk for ICU admission after the procedure.
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- 2019
9. Predictors of Advanced Conduction Disturbances Requiring a Late (≥48 H) Permanent Pacemaker Following Transcatheter Aortic Valve Replacement
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Matteo Pagnesi, Claudio Montalto, Marco Ancona, Akihito Tanaka, Azeem Latib, Josep Rodés-Cabau, Francesco Giannini, Paolo Della Bella, Stefano Garducci, Damiano Regazzoli, Richard J. Jabbour, Matteo Montorfano, Fabrizio Monaco, Letizia Bertoldi, Antonio Colombo, Gabriele Paglino, Antonio Mangieri, Manuela Giglio, Satoru Mitomo, Alaide Chieffo, and Giuseppe Lanzillo
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medicine.medical_specialty ,education.field_of_study ,business.industry ,Left bundle branch block ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,Right bundle branch block ,Single Center ,medicine.disease ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Valve replacement ,Internal medicine ,Cohort ,medicine ,Cardiology ,030212 general & internal medicine ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,education ,business - Abstract
Objectives This study sought to determine predictors of advanced conduction disturbances requiring late (≥48 h) permanent pacemaker replacement (PPM) after transcatheter aortic valve replacement (TAVR). Methods Data of consecutive patients were identified by retrospective review of a TAVR database of a single center in Milan, Italy, between October 2007 and July 2015. We defined delta PR (ΔPR) and delta QRS (ΔQRS) interval as the difference between the last PR and QRS length available 48 h after TAVR and the baseline PR and QRS length. Results Overall population included 740 patients. We excluded 78 patients who already had a PPM and 51 patients who received a PPM Conclusions This analysis showed that baseline right bundle branch block and the amount of increase of PR length after TAVR are independent predictors of late (≥48 h) advanced conduction disturbances requiring PPM replacement after TAVR in this cohort. A simple ECG analysis could help in detecting potentially lethal advanced conduction disturbances that could occur more than 48 h after TAVR.
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- 2018
10. Single-Antiplatelet Therapy in Patients with Contraindication to Dual-Antiplatelet Therapy After Transcatheter Aortic Valve Implantation
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Alaide Chieffo, Marco Ancona, Roberto Mattioli, Claudio Montalto, Antonio Colombo, Richard J. Jabbour, Letizia Bertoldi, Ottavio Alfieri, Luca A. Ferri, Matteo Montorfano, Matteo Pagnesi, Fabrizio Monaco, Damiano Regazzoli, Francesco Giannini, Akihito Tanaka, Azeem Latib, Eustachio Agricola, Antonio Mangieri, Manuela Giglio, Mangieri, Antonio, Jabbour, Richard J., Montalto, Claudio, Pagnesi, Matteo, Regazzoli, Damiano, Ancona, Marco B., Giannini, Francesco, Tanaka, Akihito, Bertoldi, Letizia, Monaco, Fabrizio, Agricola, Eustachio, Giglio, Manuela, Mattioli, Roberto, Ferri, Luca, Montorfano, Matteo, Chieffo, Alaide, Alfieri, Ottavio, Colombo, Antonio, and Latib, Azeem
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Male ,medicine.medical_specialty ,Transcatheter aortic ,Hemorrhage ,030204 cardiovascular system & hematology ,Risk Assessment ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Pharmacotherapy ,Aortic valve replacement ,Retrospective Studie ,Risk Factors ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,030212 general & internal medicine ,Contraindication ,Retrospective Studies ,Aged, 80 and over ,Dose-Response Relationship, Drug ,business.industry ,Platelet Aggregation Inhibitor ,Risk Factor ,Contraindications ,Incidence ,Incidence (epidemiology) ,Thrombosis ,Retrospective cohort study ,medicine.disease ,Surgery ,Treatment Outcome ,Italy ,Echocardiography ,Thrombosi ,Cardiology ,Drug Therapy, Combination ,Female ,Postoperative Complication ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business ,Platelet Aggregation Inhibitors ,Human - Abstract
There is limited evidence to support decision-making regarding discharge antiplatelet therapy after transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the outcome of patients discharged on single-antiplatelet therapy (SAPT) or dual-antiplatelet therapy (DAPT) after TAVI. Consecutive patients were identified by retrospective review of a dedicated TAVI database of a single high-volume center in Milan, Italy, from January 2009 to May 2015. Our primary end point was the rate of net adverse clinical events defined as a composite of all-cause mortality, major bleeding requiring hospitalization, cerebrovascular accidents, redo-TAVI or surgical aortic valve replacement, and valve thrombosis. A total of 439 patients were included in the final analysis; 108 patients were discharged on SAPT and 331 on DAPT. Reasons for discharge SAPT included high risk of bleeding (n = 33; 31%), postprocedural bleeding (n = 42; 39%), thrombocytopenia (n = 20; 18%), vascular complications (n = 13; 12%). The mean length of DAPT was 5.2 ± 2.7 months. Patients discharged in SAPT had a higher incidence of life-threatening bleeding during the index hospitalization. At follow-up, no differences were observed in the incidence of net adverse clinical event, all-cause or cardiovascular mortality, and cerebrovascular events. A similar rate of valve thrombosis was reported in both groups. In conclusion, prescribing only SAPT after TAVI in selected patients was not associated with an increased risk of events and may be an acceptable alternative to DAPT in elderly patients at high risk of bleeding.
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- 2017
11. Mechanical Ventilation During Cardiopulmonary Bypass
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Alessandro Belletti, Marcello Guarnieri, Ottavio Alfieri, Ilaria Giambuzzi, Cinzia Trumello, Fabrizio Monaco, Elena Bignami, and Francesco Saglietti
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ARDS ,medicine.medical_specialty ,medicine.medical_treatment ,Atelectasis ,030204 cardiovascular system & hematology ,Lung injury ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,law ,Internal medicine ,Cardiopulmonary bypass ,medicine ,Humans ,Mechanical ventilation ,Cardiopulmonary Bypass ,Intraoperative Care ,business.industry ,medicine.disease ,Respiration, Artificial ,respiratory tract diseases ,Cardiac surgery ,Pneumonia ,Anesthesiology and Pain Medicine ,Respiratory failure ,Anesthesia ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
DESPITE PROGRESS IN perioperative management, postoperative pulmonary complications (PPCs) still are a leading cause of morbidity and mortality in cardiac surgery. About 25% of patients with no severe cardiac dysfunction who undergo cardiac surgery experience significant respiratory impairment for at least 1 week after the intervention. Post-cardiac surgery PPCs clinically range from fever with productive cough to acute respiratory distress syndrome (ARDS), requiring prolonged mechanical ventilation (MV) and showing reduced survival. Cardiopulmonary bypass (CPB) is necessary for the majority of procedures in cardiac surgery, making CPB-related lung damage inevitable. Inflammatory response after CPB, exclusion of lung tissue from perfusion and ventilation, and atelectasis due to airway collapse are the most important factors implicated in CPB-related lung injury. Cardiac anesthesiologists commonly need to address post-cardiac surgery respiratory failure and PPCs, such as pneumonia, atelectasis, pleural effusion, diaphragm dysfunction, and ventilation-associated pneumonia, which carry a high burden of morbidity and mortality. Regardless of any specific complication, impairment of gas exchange, reflected by a reduction in the PaO2/FIO2 ratio (the ratio between arterial blood oxygen partial pressure and inspired air oxygen fraction), frequently occurs after cardiac surgery and has been associated with poor hospital outcome, although accurate validation of this parameter in this setting is lacking. A PaO2/FIO2 value of 300 or less indicates reduced efficiency in alveolar-capillary membrane performance. A detailed definition of PPCs can be found in Table 1. The aim of this review was to summarize the evidence in the literature concerning CPB-related lung dysfunction and to show how MV strategies might prevent respiratory insufficiency after cardiac surgery.
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- 2016
12. Severe Mitral Stenosis and Persistent Left Appendage Thrombosis
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Giuseppe Lanzillo, Matteo Pagnesi, Giuseppe Seresini, Fabrizio Monaco, Azeem Latib, Satoru Mitomo, Marco Ancona, Damiano Regazzoli, Antonio Colombo, Richard J. Jabbour, Antonio Mangieri, Stefano Stella, and Matteo Montorfano
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medicine.medical_specialty ,Percutaneous ,business.industry ,Mitral valvuloplasty ,macromolecular substances ,030204 cardiovascular system & hematology ,Severe obesity ,medicine.disease ,Balloon ,Thrombosis ,Surgery ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,medicine.anatomical_structure ,Neurocognitive Dysfunction ,Mitral valve ,cardiovascular system ,medicine ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 58-year-old woman with rheumatic mitral valve disease was referred to our institution for percutaneous balloon mitral valvuloplasty (PBMV), as surgery was precluded because of severe obesity and neurocognitive dysfunction. Transesophageal echocardiography before planned PBMV confirmed severe
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- 2018
13. Long-Term Outcomes After Transcatheter Aortic Valve Implantation from a Single High-Volume Center (The Milan Experience)
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Eustachio Agricola, Filippo Figini, Nicola Buzzatti, Fabrizio Monaco, Neil Ruparelia, Akihito Tanaka, Ottavio Alfieri, Azeem Latib, Damiano Regazzoli, Alessandro Castiglioni, Stefano Stella, Antonio Mangieri, Matteo Montorfano, Francesco Giannini, Alessandro Sticchi, Micaela Cioni, Pietro Spagnolo, Hiroyoshi Kawamoto, Antonio Colombo, Marco Ancona, Alaide Chieffo, Ruparelia, Neil, Latib, Azeem, Buzzatti, Nicola, Giannini, Francesco, Figini, Filippo, Mangieri, Antonio, Regazzoli, Damiano, Stella, Stefano, Sticchi, Alessandro, Kawamoto, Hiroyoshi, Tanaka, Akihito, Agricola, Eustachio, Monaco, Fabrizio, Castiglioni, Alessandro, Ancona, Marco, Cioni, Micaela, Spagnolo, Pietro, Chieffo, Alaide, Montorfano, Matteo, Alfieri, Ottavio, and Colombo, Antonio
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Registrie ,Male ,Aortic valve ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Prosthesis ,0302 clinical medicine ,Retrospective Studie ,Risk Factors ,Hospital Mortality ,Registries ,030212 general & internal medicine ,Aged, 80 and over ,education.field_of_study ,Medicine (all) ,Mortality rate ,Survival Rate ,Treatment Outcome ,medicine.anatomical_structure ,Italy ,Aortic Valve ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Human ,medicine.medical_specialty ,Time Factor ,Transcatheter aortic ,Population ,Lower risk ,Follow-Up Studie ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,education ,Aged ,Retrospective Studies ,business.industry ,Risk Factor ,Retrospective cohort study ,Aortic Valve Stenosis ,Aortic Valve Stenosi ,Surgery ,Log-rank test ,business ,Hospitals, High-Volume ,Follow-Up Studies - Abstract
Transcatheter aortic valve implantation (TAVI) is now the treatment of choice for patients with symptomatic aortic stenosis who are inoperable or with high surgical risk. Data with regards to contemporary clinical practice and long-term outcomes are sparse. To evaluate temporal changes in TAVI practice and explore procedural and long-term clinical outcomes of patients in a contemporary "real-world" population, outcomes of 829 patients treated from November 2007 to May 2015, at the San Raffaele Scientific Institute, Milan, Italy, were retrospectively analyzed. Median follow-up was 568 days, with the longest follow-up of 2,677 days. Overall inhospital mortality was 3.5%. During the study period, there was a trend toward treating younger, lower risk patients. Overall mortality rates were 3.5% (30 days), 14% (1 year), 22% (2 years), 29% (3 years), 37% (4 years), 47% (5 years), 53% (6 years), and 72% (7 years). The survival probability at 5 years was significantly higher in patients treated through the transfemoral (TF) route compared to other vascular access sites (log rank p
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- 2016
14. Liberal transfusion strategy improves survival in perioperative but not in critically ill patients. A meta-analysis of randomised trials
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Alberto Zangrillo, Filomena Regina Barbosa Gomes Galas, Fabrizio Monaco, Alessandro Putzu, Alexander Karaskov, Evgeny Fominskiy, Giovanni Landoni, A. M. Scandroglio, Ludhmila Abrahão Hajjar, Fominskiy, E, Putzu, A, Monaco, F, Scandroglio, Am, Karaskov, A, Galas, Fr, Hajjar, La, Zangrillo, Alberto, and Landoni, Giovanni
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medicine.medical_specialty ,Randomization ,Blood transfusion ,Critical Care ,business.industry ,Critical Illness ,medicine.medical_treatment ,MEDLINE ,Perioperative ,Odds ratio ,Survival Analysis ,Perioperative Care ,law.invention ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Randomized controlled trial ,law ,Meta-analysis ,medicine ,Number needed to treat ,Humans ,Blood Transfusion ,Intensive care medicine ,business ,Randomized Controlled Trials as Topic - Abstract
BACKGROUND: Guidelines support the use of a restrictive strategy in blood transfusion management in a variety of clinical settings. However, recent randomized controlled trials (RCTs) performed in the perioperative setting suggest a beneficial effect on survival of a liberal strategy. We aimed to assess the effect of liberal and restrictive blood transfusion strategies on mortality in perioperative and critically ill adult patients through a meta-analysis of RCTs.METHODS: We searched PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, Transfusion Evidence Library, and Google Scholar up to 27 March 2015, for RCTs performed in perioperative or critically ill adult patients, receiving a restrictive or liberal transfusion strategy, and reporting all-cause mortality. We used a fixed or random-effects model to calculate the odds ratio (OR) and 95% confidence interval (CI) for pooled data. We assessed heterogeneity using Cochrane's Q and I(2) tests. The primary outcome was all-cause mortality within 90-day follow-up.RESULTS: Patients in the perioperative period receiving a liberal transfusion strategy had lower all-cause mortality when compared with patients allocated to receive a restrictive transfusion strategy (OR 0.81; 95% CI 0.66‒1.00; P=0.05; I(2)=25%; Number needed to treat=97) with 7552 patients randomized in 17 trials. There was no difference in mortality among critically ill patients receiving a liberal transfusion strategy when compared with the restrictive transfusion strategy (OR 1.10; 95% CI 0.99‒1.23; P=0.07; I(2)=34%) with 3469 patients randomized in 10 trials.CONCLUSION: According to randomized published evidence, perioperative adult patients have an improved survival when receiving a liberal blood transfusion strategy.
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- 2015
15. Levosimendan reduces mortality in patients with severe sepsis and septic shock: A meta-analysis of randomized trials
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Alberto Zangrillo, Nora Di Tomasso, Giovanna Frau, Alessandro Oriani, Elena Bignami, Valery Likhvantsev, Alessandro Putzu, Vladimir V. Lomivorotov, Giovanni Landoni, Fabrizio Monaco, Monica De Luca, Zangrillo, Alberto, Putzu, A, Monaco, F, Oriani, A, Frau, G, De Luca, M, Di Tomasso, N, Bignami, E, Lomivorotov, V, Likhvantsev, V, and Landoni, Giovanni
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Male ,Inotrope ,Mean arterial pressure ,Cardiotonic Agents ,Cardiac index ,Critical Care and Intensive Care Medicine ,law.invention ,Norepinephrine ,Randomized controlled trial ,law ,Dobutamine ,Sepsis ,Intensive care ,Humans ,Medicine ,Simendan ,Randomized Controlled Trials as Topic ,business.industry ,Septic shock ,Hydrazones ,Levosimendan ,Middle Aged ,medicine.disease ,Shock, Septic ,Pyridazines ,Anesthesia ,Female ,business ,medicine.drug - Abstract
Purpose There is controversy about the use of inotropes in the treatment of severe sepsis and septic shock. The objective of this study was to evaluate if levosimendan, as compared with standard inotropic therapy (eg, dobutamine), reduces mortality in septic patients. Materials and Methods BioMedCentral, PubMed, EMBASE, and the Cochrane Central Register were searched for pertinent studies, up to 1st May 2015. Randomized trials on the use of levosimendan in patients with severe sepsis and septic shock were included if reporting mortality data. The primary outcome was mortality, whereas secondary outcomes were blood lactate, cardiac index, total fluid infused, norepinephrine dosage, and mean arterial pressure. Results Seven studies for a total of 246 patients were included in the analysis. Levosimendan was associated with significantly reduced mortality compared with standard inotropic therapy (59/125 [47%] in the levosimendan group and 74/121 [61%] in the control group; risk difference=−0.14, risk ratio=0.79 [0.63-0.98], P for effect=.03, I 2 = 0%, numbers needed to treat=7). Blood lactate was significantly reduced in the levosimendan group, whereas cardiac index and total fluid infused were significantly higher in the levosimendan group. No difference in mean arterial pressure and norepinephrine usage was noted. Conclusions In patients with severe sepsis and septic shock, levosimendan is associated with a significant reduction in mortality compared with standard inotropic therapy. A large ongoing multicenter randomized trial will have to confirm these findings.
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- 2015
16. A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Reducing Mortality
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Sartini, Chiara, primary, Lomivorotov, Vladimir, additional, Pieri, Marina, additional, Lopez-Delgado, Juan Carlos, additional, Baiardo Redaelli, Martina, additional, Hajjar, Ludhmila, additional, Pisano, Antonio, additional, Likhvantsev, Valery, additional, Fominskiy, Evgeny, additional, Bradic, Nikola, additional, Cabrini, Luca, additional, Novikov, Maxim, additional, Avancini, Daniele, additional, Riha, Hynek, additional, Lembo, Rosalba, additional, Gazivoda, Gordana, additional, Paternoster, Gianluca, additional, Wang, Chengbin, additional, Tamà, Simona, additional, Alvaro, Gabriele, additional, Wang, Chew Yin, additional, Roasio, Agostino, additional, Ruggeri, Laura, additional, Yong, Chow-Yen, additional, Pasero, Daniela, additional, Severi, Luca, additional, Pasin, Laura, additional, Mancino, Giuseppe, additional, Mura, Paolo, additional, Musu, Mario, additional, Spadaro, Savino, additional, Conte, Massimiliano, additional, Lobreglio, Rosetta, additional, Silvetti, Simona, additional, Votta, Carmine Domenico, additional, Belletti, Alessandro, additional, Di Fraja, Diana, additional, Corradi, Francesco, additional, Brusasco, Claudia, additional, Saporito, Emanuela, additional, D'Amico, Alessandro, additional, Sardo, Salvatore, additional, Ortalda, Alessandro, additional, Riefolo, Claudio, additional, Fabrizio, Monaco, additional, Zangrillo, Alberto, additional, Bellomo, Rinaldo, additional, and Landoni, Giovanni, additional
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- 2019
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17. First-in-Human Implantation of a Direct Flow Medical Valve in a Radiolucent Mitral Annuloplasty Ring
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Eustachio Agricola, Andrea Blasio, Fabrizio Monaco, Ottavio Alfieri, Matteo Montorfano, Pietro Spagnolo, Azeem Latib, Antonio Colombo, Alessandro Castiglioni, Latib, A, Montorfano, M, Agricola, E, Castiglioni, A, Blasio, A, Monaco, F, Spagnolo, P, Alfieri, Ottavio, and Colombo, A.
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mitral valve ,Cardiac Catheterization ,valve-in-valve ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,valve-in-ring ,Echocardiography, Three-Dimensional ,Valve in ring ,Prosthesis Design ,Direct flow ,Mitral annuloplasty ring ,Recurrence ,transcatheter valve implantation ,Internal medicine ,Mitral valve ,Multidetector Computed Tomography ,medicine ,Humans ,cardiovascular diseases ,Mitral Annuloplasty ,Aged ,Heart Valve Prosthesis Implantation ,Mitral regurgitation ,business.industry ,Mitral Valve Insufficiency ,direct flow valve ,First in human ,Valve in valve ,Echocardiography, Doppler, Color ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Heart Valve Prosthesis ,Retreatment ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Recurrent mitral regurgitation (MR) may occur after mitral annuloplasty and reoperation may be associated with significant morbidity and mortality. Recently, transcatheter mitral valve-in-ring procedures via the transvenous, transatrial, and transapical routes have been shown to be a feasible
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- 2015
18. Hypertrophic Left Ventricle With Small Cavity and Severe Aortic Angulation
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Alessandro Castiglioni, Damiano Regazzoli, Daisuke Hachinohe, Paolo Del Sole, Fabrizio Monaco, Matteo Montorfano, Azeem Latib, Antonio Colombo, Francesco Giannini, Vittorio Romano, Antonio Mangieri, Marco Ancona, Francesco Ancona, and Antonio Esposito
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Perforation (oil well) ,Stroke volume ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,medicine.anatomical_structure ,Aortic valve area ,Valve replacement ,Ventricle ,Heart failure ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
An 87-year-old woman presented with worsening symptoms of heart failure. Echocardiography revealed paradoxical low-flow aortic stenosis (mean gradient 34 mm Hg; aortic valve area 0.9 cm2, indexed stroke volume 31 ml/m2) together with small left ventricular (LV) cavity and septal hypertrophy. The
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- 2018
19. Reducing Mortality in Acute Kidney Injury Patients: Systematic Review and International Web-Based Survey
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Giovanni, Landoni, Tiziana, Bove, Andrea, Székely, Marco, Comis, Reitze N, Rodseth, Daniela, Pasero, Martin, Ponschab, Marta, Mucchetti, Maria L, Azzolini, Fabio, Caramelli, Gianluca, Paternoster, Giovanni, Pala, Luca, Cabrini, Daniele, Amitrano, Giovanni, Borghi, Antonella, Capasso, Claudia, Cariello, Anna, Carpanese, Paolo, Feltracco, Leonardo, Gottin, Rosetta, Lobreglio, Lorenzo, Mattioli, Fabrizio, Monaco, Francesco, Morgese, Mario, Musu, Laura, Pasin, Antonio, Pisano, Agostino, Roasio, Gianluca, Russo, Giorgio, Slaviero, Nicola, Villari, Annalisa, Vittorio, Mariachiara, Zucchetti, Fabio, Guarracino, Andrea, Morelli, Vincenzo, De Santis, Paolo A, Del Sarto, Antonio, Corcione, Marco, Ranieri, Gabriele, Finco, Alberto, Zangrillo, Rinaldo, Bellomo, Landoni, G., Bove, T., Székely, A., Comis, M., Rodseth, R.N., Pasero, D., Ponschab, M., Mucchetti, M., Azzolini, M.L., Caramelli, F., Paternoster, G., Pala, G., Cabrini, L., Amitrano, D., Borghi, G., Capasso, A., Cariello, C., Carpanese, A., Feltracco, P., Gottin, L., Lobreglio, R., Mattioli, L., Monaco, F., Morgese, F., Musu, M., Pasin, L., Pisano, A., Roasio, A., Russo, G., Slaviero, G., Villari, N., Vittorio, A., Zucchetti, M., Guarracino, F., Morelli, A., De Santis, V., Del Sarto, P.A., Corcione, A., Ranieri, M., Finco, G., Zangrillo, A., Bellomo, R., Landoni, G, Bove, T, Székely, A, Comis, M, Rodseth, Rn, Pasero, D, Ponschab, M, Mucchetti, M, Azzolini, Ml, Caramelli, F, Paternoster, G, Pala, G, Cabrini, L, Amitrano, D, Borghi, G, Capasso, A, Cariello, C, Carpanese, A, Feltracco, P, Gottin, L, Lobreglio, R, Mattioli, L, Monaco, F, Morgese, F, Musu, M, Pasin, L, Pisano, A, Roasio, A, Russo, G, Slaviero, G, Villari, N, Vittorio, A, Zucchetti, M, Guarracino, F, Morelli, A, De Santis, V, Del Sarto, Pa, Corcione, A, Ranieri, M, Finco, G, Zangrillo, A, and Bellomo, R
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renal failure ,short term survival ,patient monitoring ,medicine.medical_treatment ,health care survey ,acute renal injury ,hetastarch ,bacterial peritoniti ,Comorbidity ,hemodynamic monitoring ,health belief ,law.invention ,hemofiltration ,contrast induced nephropathy ,burn patient ,law ,consensu ,burn ,web vote ,angiography ,randomized controlled trial (topic) ,hepatorenal syndrome ,physician ,continuous hemodiafiltration ,article ,Acute kidney injury ,Acute Kidney Injury ,continuous infusion ,Intensive care unit ,human immunoglobulin ,clinical practice ,vasopressin, acute kidney failure ,multiple myeloma ,perioperative hemodynamic optimization ,priority journal ,human albumin ,meta analysis (topic) ,nadroparin ,multicenter study (topic) ,sepsi ,Cardiology and Cardiovascular Medicine ,renal replacement therapy ,Reducing mortality in acute kidney injury patients: systematic review and international web-based surve ,radiation injury ,Human ,medicine.drug ,medicine.medical_specialty ,consensus conference ,Contrast-induced nephropathy ,self report ,anesthesia ,survival ,Perioperative Care ,acute kidney failure, acute renal injury, anesthesia, consensus, consensus conference, critical care, mortality, renal failure, survival, web vote ,terlipressin ,critically ill patient ,acute kidney failure ,Monitoring, Intraoperative ,acetylcysteine ,Hemofiltration ,medicine ,Humans ,systematic review, acute kidney failure ,fenoldopam ,furosemide ,Hemodynamic ,Renal replacement therapy ,Intensive care medicine ,plasmapheresi ,Internet ,continuous hemofiltration ,liver cirrhosi ,Septic shock ,business.industry ,hepatorenal syndrome type 1 ,Hemodynamics ,Perioperative ,citric acid ,bleeding ,medicine.disease ,mortality ,web vote, Acute Kidney Injury ,fluid balance ,heart surgery ,drug efficacy ,critical care ,early intervention ,Anesthesiology and Pain Medicine ,hemodialysi ,consensus ,Health Care Surveys ,septic shock ,Terlipressin ,business ,periangiography hemofiltration - Abstract
"OBJECTIVE: To identify all interventions that increase or reduce mortality in patients with acute kidney injury (AKI) and to establish the agreement between stated beliefs and actual practice in this setting.. . DESIGN AND SETTING: Systematic literature review and international web-based survey.. . PARTICIPANTS: More than 300 physicians from 62 countries.. . INTERVENTIONS: Several databases, including MEDLINE/PubMed, were searched with no time limits (updated February 14, 2012) to identify all the drugs/techniques/strategies that fulfilled all the following criteria: (a) published in a peer-reviewed journal, (b) dealing with critically ill adult patients with or at risk for acute kidney injury, and (c) reporting a statistically significant reduction or increase in mortality.. . MEASUREMENTS AND MAIN RESULTS: Of the 18 identified interventions, 15 reduced mortality and 3 increased mortality. Perioperative hemodynamic optimization, albumin in cirrhotic patients, terlipressin for hepatorenal syndrome type 1, human immunoglobulin, peri-angiography hemofiltration, fenoldopam, plasma exchange in multiple-myeloma-associated AKI, increased intensity of renal replacement therapy (RRT), CVVH in severely burned patients, vasopressin in septic shock, furosemide by continuous infusion, citrate in continuous RRT, N-acetylcysteine, continuous and early RRT might reduce mortality in critically ill patients with or at risk for AKI; positive fluid balance, hydroxyethyl starch and loop diuretics might increase mortality in critically ill patients with or at risk for AKI. Web-based opinion differed from consensus opinion for 30% of interventions and self-reported practice for 3 interventions.. . CONCLUSION: The authors identified all interventions with at least 1 study suggesting a significant effect on mortality in patients with or at risk of AKI and found that there is discordance between participant stated beliefs and actual practice regarding these topics.. . "
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- 2013
20. Thoracic Epidural Anesthesia Improves Early Outcome in Patients Undergoing Cardiac Surgery for Mitral Regurgitation: A Propensity-Matched Study
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Camilla Biselli, Monica De Luca, Fabrizio Monaco, Rosalba Lembo, Giovanni Landoni, Remo Daniel Covello, Alberto Zangrillo, Monaco, F, Biselli, C, Landoni, Giovanni, De Luca, M, Lembo, R, Covello, Rd, and Zangrillo, Alberto
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Anesthesia, Epidural ,Male ,medicine.medical_specialty ,Critical Care ,Endpoint Determination ,medicine.medical_treatment ,Anesthesia, General ,Ventricular Function, Left ,Postoperative Complications ,Interquartile range ,Monitoring, Intraoperative ,Intensive care ,Humans ,Medicine ,In patient ,Cardiac Surgical Procedures ,Propensity Score ,Adverse effect ,Aged ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Postoperative Care ,Mechanical ventilation ,Mitral regurgitation ,Mitral valve repair ,Models, Statistical ,business.industry ,Mitral Valve Insufficiency ,Middle Aged ,Respiration, Artificial ,Cardiac surgery ,Surgery ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Sample Size ,Anesthesia ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
"OBJECTIVE: There are no large studies that investigate the effect of thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) in patients undergoing valvular surgery. The authors hypothesized that TEA might improve clinically relevant endpoints in patients with primary mitral regurgitation.. . DESIGN: Propensity-matched study.. . SETTING: Cardiac surgery.. . PARTICIPANTS: Patients scheduled for mitral valve repair or replacement were studied.. . INTERVENTIONS: A propensity model was constructed to match 33 patients receiving TEA combined with GA with 33 patients receiving standard GA alone.. . MEASUREMENTS AND MAIN RESULTS: Overall, the TEA group suffered fewer adverse events than the GA group: 10 (30%) v 23 (10%) with p = 0.002. In particular, the TEA group had a lower incidence of pulmonary events, 6 (18%) v 15 (45%) with p = 0.02, and of cardiac events, 8 (24%) v 16 (49%) with p = 0.04. Median (interquartile) time on mechanical ventilation was reduced in the TEA group, 11 (9-15) v 17 (12-36) with p = 0.007.. . CONCLUSIONS: This propensity-matched study suggested that TEA might be advantageous in patients undergoing surgery for mitral regurgitation. "
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- 2013
21. TCT-154 Patient and Healthcare System Benefits of Contemporary Transcatheter Aortic Valve Implantation (TAVI) Practice
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Fabrizio Monaco, Stefano Stella, Alessandro Sticchi, Francesco Giannini, Pietro Spagnolo, Antonio Colombo, Damiano Regazzoli, Nicola Buzzatti, Matteo Montorfano, Neil Ruparelia, Eustachio Agricola, Michele De Bonis, Filippo Figini, Alaide Chieffo, Ottavio Alfieri, Azeem Latib, and Antonio Mangieri
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,Internal medicine ,Cardiology ,Medicine ,High surgical risk ,business ,Symptomatic aortic stenosis ,Cardiology and Cardiovascular Medicine ,Surgery ,Healthcare system - Abstract
TAVI is now the treatment of choice for patients presenting with severe symptomatic aortic stenosis who are deemed to be inoperable or of high surgical risk. During the last few years, rapid improvements have been made to TAVI devices coupled with greater operator and institutional experience. We
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- 2015
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22. Recombinant Activated Factor VII Increases Stroke in Cardiac Surgery: A Meta-analysis
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Davide Nicolotti, Federico Pappalardo, Fabrizio Monaco, Alberto Zangrillo, Giovanni Landoni, Elena Frati, Giuseppe Biondi-Zoccai, Martin Ponschab, Elena Bignami, Ponschab, M, Landoni, Giovanni, Biondi Zoccai, G, Bignami, E, Frati, E, Nicolotti, D, Monaco, F, Pappalardo, Federico, and Zangrillo, Alberto
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Reoperation ,Risk ,medicine.medical_specialty ,Blood Loss, Surgical ,anesthesia ,bleeding ,cardiac surgery ,fviia ,recombinant factor vii ,stroke ,surgical revision ,Postoperative Complications ,Refractory ,Humans ,Medicine ,Blood Transfusion ,Vascular Diseases ,Cardiac Surgical Procedures ,Intraoperative Complications ,Stroke ,Randomized Controlled Trials as Topic ,Clinical Trials as Topic ,business.industry ,Incidence (epidemiology) ,Transfusion Reaction ,Odds ratio ,Perioperative ,Factor VII ,medicine.disease ,Recombinant Proteins ,Cardiac surgery ,Clinical trial ,Anesthesiology and Pain Medicine ,Meta-analysis ,Anesthesia ,Patient Safety ,Cardiology and Cardiovascular Medicine ,business - Abstract
"Objectives: Recombinant activated factor VII (rFVIIa) is used in various surgical procedures to reduce the incidence of major blood loss and the need for re-exploration. Few clinical trials have investigated rFVIIa in cardiac surgery. The authors performed a meta-analysis focusing on the rate of stroke and surgical re-exploration. Design: Meta-analysis. Setting: Hospitals. Participants: A total of 470 patients. Interventions: None. Measurements and Main Results: Four investigators independently searched PubMed and conference proceedings including backward snowballing (ie, scanning of reference of retrieved articles and pertinent reviews) and contacted international experts. A total of 470 patients (254 receiving rFVIIa and 216 controls) from 6 clinical trials (2 randomized, 3 propensity matched, and 1 case matched) were included in the analysis. The use of rFVIIa was associated with an increased rate of stroke (12/254 [4.7%] in the rFVIIa group v 2/216 [0.9%] in the control arm, odds ratio [OR] = 3.69 [1.1-12.38], p = 0.03) with a nonsignificant reduction in rate of surgical re-exploration (13% v 42% [OR = 0.27 (0.04-1.9), p = 0.19]). The authors observed a trend toward an increase of overall perioperative thromboembolic events (19/254 [7.5%] in the rFVIIa group v 10/216 [5.6%] in the control arm [OR = 1.84 (0.82-4.09), p = 0.14]). No difference in the rate of death was observed. Conclusions: The administration of rFVIIa in cardiac surgery patients could result in a significant increase of stroke with a trend toward a reduction of the need for surgical re-exploration. The authors do not recommend routine use in cardiac surgery patients. rFVIIa may be considered with caution in patients with refractory life-threatening bleeding. (C) 2011 Elsevier Inc. All rights reserved."
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- 2011
23. Cardiac Index Assessment by the Pressure Recording Analytic Method in Unstable Patients With Atrial Fibrillation
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Davide Nicolotti, Fabrizio Monaco, Federico Pappalardo, Giovanni Landoni, Marina Pieri, Luigi Barile, Giulia Maj, Giulio Melisurgo, Alberto Zangrillo, Maj, G, Monaco, F, Landoni, Giovanni, Barile, L, Nicolotti, D, Pieri, M, Melisurgo, G, Pappalardo, Federico, and Zangrillo, Alberto
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Male ,medicine.medical_specialty ,Cardiac output ,Thermodilution ,Cardiac index ,Bolus (medicine) ,Interquartile range ,Monitoring, Intraoperative ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Prospective Studies ,Cardiac Output ,Cardiac Surgical Procedures ,Prospective cohort study ,Aged ,business.industry ,Atrial fibrillation ,Middle Aged ,Arterial catheter ,medicine.disease ,Blood Pressure Monitors ,Cardiac surgery ,Anesthesiology and Pain Medicine ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
"Abstract. OBJECTIVE: Most-Care (powered by the pressure-recording analytic method [PRAM]; Vytech HealthTM, Padova, Italy) is a minimally invasive cardiac output monitoring. This system already has been studied and validated in cardiac surgery and in children. It already showed a correlation with thermodilution methods in hemodynamically unstable patients. The purpose of this study was to confirm the reliability of cardiac index determinations by Most-Care in unstable patients with atrial fibrillation.. . DESIGN: A prospective study.. . SETTING: A teaching hospital.. . PARTICIPANTS: Forty-nine patients.. . INTERVENTIONS: Simultaneous cardiac index measurements by bolus thermodilution and by PRAM from a standard arterial access (radial and femoral) were obtained. The thermodilution cardiac index was calculated as the mean of 3 separate measurements. Because PRAM is a beat-to-beat monitoring system, the mean cardiac index of 12 consecutive beats was considered for the analysis. Correlations were calculated and differences compared by Bland-Altman analysis.. . MEASUREMENTS: Eight patients were excluded because the signal was altered by the arterial catheter resonance so that the study described the remaining 41 patients. The overall estimates of cardiac index measured by PRAM did not show agreement with the reference cardiac index by thermodilution (mean difference = 0.136 L\/min\/m(2) [0,43 L\/min\/m(2)-0.15 L\/min\/m(2)], with an upper limit of agreement of 1.94 L\/min\/m(2) and a lower limit of agreement of -1.665 L\/min\/m(2), respectively). The median (interquartile) value of cardiac index assessed by thermodilution was 2.42 L\/min\/m(2) (2.21-2.98 L\/min\/m(2)), and by PRAM it was 2.48 L\/min\/m(2) (1.80-3.00 L\/min\/m(2), p = 0.6).. . CONCLUSIONS: The authors concluded that PRAM did not compare well with thermodilution in unstable patients with atrial fibrillation.. . "
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- 2011
24. Percutaneous Direct Annuloplasty With Edge-to-Edge Technique for Mitral Regurgitation: Replicating a Complete Surgical Mitral Repair in a One-Step Procedure
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Marco Ancona, Matteo Pagnesi, Francesco Ancona, Azeem Latib, Fabrizio Monaco, Damiano Regazzoli, Antonio Colombo, Paolo Del Sole, Satoru Mitomo, Eustachio Agricola, Antonio Mangieri, Matteo Montorfano, Giuseppe Lanzillo, Ozan M. Demir, Mangieri, Antonio, Colombo, Antonio, Demir, Ozan M., Agricola, Eustachio, Ancona, Francesco, Regazzoli, Damiano, Ancona, Marco B., Mitomo, Satoru, Lanzillo, Giuseppe, Del Sole, Paolo A., Monaco, Fabrizio, Pagnesi, Matteo, Montorfano, Matteo, and Latib, Azeem
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Male ,Cardiac Catheterization ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,Percutaneous ,medicine.medical_treatment ,Echocardiography, Three-Dimensional ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Mitral valve ,Mitral valve annuloplasty ,medicine ,Humans ,Fluoroscopy ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,Cardiac catheterization ,Mitral regurgitation ,medicine.diagnostic_test ,business.industry ,MitraClip ,Mitral Valve Insufficiency ,Combined approach ,Surgery ,medicine.anatomical_structure ,Surgery, Computer-Assisted ,cardiovascular system ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Surgical treatment of functional mitral regurgitation (MR) is usually based on the correction of both annular dilation and leaflet disease to minimize the risk of recurrence of MR at follow-up. This combined approach may also represent an interesting strategy during transcatheter mitral valve repair systems. We report a successful case of combined Cardioband (Edwards Lifesciences, Irvine, California) and MitraClip (Abbott, Santa Clara, California) implantation for the treatment of functional MR, with good acute and medium-term clinical and echocardiographic outcomes. Le traitement chirurgical de l'insuffisance mitrale secondaire (IM) repose généralement sur la correction de la dilatation annulaire et de la maladie des feuillets pour minimiser le risque de récurrence de l'IM durant le suivi. Cette approche combinée peut également représenter une stratégie intéressante durant l'implantation par catheter de dispositifs pour la réparation de la valve mitrale. Nous rapportons le cas d'une implantation réussie de Cardioband (Edwards Lifesciences, Irvine, Californie) et de MitraClip (Abbott, Santa Clara, Californie) dans le traitement d'une IM secondaire, avec de bons résultats cliniques et échocardiographiques à court et à moyen terme.
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- 2018
25. Epidural Anesthesia in Elderly Patients Undergoing Coronary Artery Bypass Graft Surgery
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Monica De Luca, Giuseppe Crescenzi, Elena Bignami, Fabrizio Monaco, Giovanna Frau, Concetta Rosica, Giovanni Landoni, Alberto Zangrillo, Crescenzi, G, Landoni, Giovanni, Monaco, F, Bignami, E, De Luca, M, Frau, G, Rosica, C, and Zangrillo, Alberto
- Subjects
Anesthesia, Epidural ,Male ,medicine.medical_specialty ,Anesthesia, General ,law.invention ,Interquartile range ,law ,Natriuretic Peptide, Brain ,medicine ,Humans ,Coronary Artery Bypass ,Aged ,Ejection fraction ,business.industry ,Incidence (epidemiology) ,Odds ratio ,Cabg surgery ,Length of Stay ,Intensive care unit ,Peptide Fragments ,Confidence interval ,Surgery ,Intensive Care Units ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Elective Surgical Procedures ,Case-Control Studies ,Anesthesia ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Objectives: The purpose of this study was to evaluate the effects of thoracic epidural anesthesia on postoperative Nterminal pro B-natriuretic peptide (NT-proBNP) release in elderly patients undergoing elective coronary artery bypass graft (CABG) surgery. Design: A case-matched, nonrandomized study. Setting: A university hospital, single institution. Participants: 46 consecutive and 46 control patients. Interventions: Ninety-two elderly patients (>65 years old) undergoing elective CABG surgery were recruited. Forty-six patients receiving general and epidural anesthesia were case matched (preoperative medications, ejection fraction, and cornorbidities) with 46 control subjects receiving general anesthesia. The primary outcome measure was postoperative NT-proBNP release. The preoperative or intraoperative variables significantly associated with an intensive care unit stay longer than 4 days were determined by logistic regression. Measurements and Main Results: The median (interquartile range) plasma concentrations of NT-proBNP before surgery were 402 (115-887 pg/mL) in the epidural group versus 508 (228-1,285 pg/mL) in the general anesthesia group (p = 0.9), whereas 24 hours after surgery it increased to 1846 (1,135-3,687 pg/mL) versus 5,005 (2,220-11,377 pg/mL) (p = 0.001), respectively. There were more patients (p = 0.043) in the control group (9/46 = 19.5%) than in the thoracic epidural anesthesia group (4/46 = 8.8%) with an intensive care unit stay longer than 4 days. The absence of preoperative beta-blocker therapy (odds ratio = 3.94; 95% confidence interval, 1.123-13.833; p = 0.03) and of an epidural catheter (odds ratio = 3.91; 95% confidence interval, 1.068-14.619; p = 0.04) were the only preoperative and intraoperative variables independently associated with a prolonged intensive care unit stay. Conclusions: Epidural anesthesia added to general anesthesia for CABG surgery significantly attenuates NT-proBNP release in elderly patients and reduces the incidence of prolonged intensive care unit stay. (C) 2009 Elsevier Inc. All rights reserved.
- Published
- 2009
26. Esmolol Reduces Perioperative Ischemia in Cardiac Surgery: A Meta-analysis of Randomized Controlled Studies
- Author
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Alberto Zangrillo, Stefano Turi, Giuseppe Crescenzi, Alessandro Oriani, Francesco Distaso, Fabrizio Monaco, Elena Bignami, Giovanni Landoni, Zangrillo, Alberto, Turi, S, Crescenzi, G, Oriani, A, Distaso, F, Monaco, F, Bignami, E, and Landoni, Giovanni
- Subjects
Propanolamines ,Anesthesiology and Pain Medicine ,Myocardial Ischemia ,Humans ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,Perioperative Care ,Randomized Controlled Trials as Topic - Abstract
Objective: beta-Blockers were associated with a reduction of mortality and morbidity in noncardiac surgery until recently when the POISE trial showed that beta-blockers could be harmful in the perioperative period because of hypotension and bradycardia. Esmolol is an ultra-short-acting beta-blocker mostly used in emergency and high-risk patients. The authors performed a meta-analysis to evaluate the clinical effects of esmolol in cardiac surgery. Design: Meta-analysis. Setting: Hospitals. Participants: A total of 778 patients from 20 randomized trials. Interventions: None. Measurements and Main Result. Three investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment and comparison of esmolol versus other drugs, placebo, or standard of care in cardiac surgery. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no data on clinical out comes. The use of esmolol was associated with a significant reduction of myocardial ischemia episodes (15/122 [12.2%] in the esmolol group v 36/140 [25.7%] in the control arm, odds ratio [OR] =0.42 [0.23-0.79], p = 0.007) and development of arrhythmias after cardiopulmonary bypass (15/65 [23.07%] v 23/64 [35.9%], OR = 0.42 [0.18-1.01], p = 0.05). The authors did not find a reduction in the use of inotropic drugs in esmolol-treated patients (29/153 [18.9%] v 48/146 [32.8%], OR = 0.43 [0.16-1.10], p = 0.08). Esmolol-treated patients had more episodes of bradycardia (19/129 [14.72%] v 3/133 [2.25%], OR = 5.49 [2.21-13.62], p = 0.0002) and hypotension (28/113 [24.77%] v 14/119 [11.76%], OR = 2.73 (0.83-9.04], p = 0.10). Conclusions: Esmolol reduces the incidence of myocardial ischemia and arrhythmias in cardiac surgery. An increase in bradycardia was noted as well. (C) 2009 Elsevier Inc. All rights reserved
- Published
- 2009
27. TCT-694 Early Outcomes With Direct Flow Medical Versus 1°-Generation Transcatheter Aortic Valve Devices: A Single-Center Propensity-Matched Analysis
- Author
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Claudia Montanaro, Antonio Colombo, Alaide Chieffo, Vasileios F. Panoulas, Fabrizio Monaco, Eustachio Agricola, Paola Spatuzza, Filippo Figini, Ottavio Alfieri, Matteo Montorfano, Pietro Spagnolo, Azeem Latib, Maurizio Taramasso, Gennaro Giustino, and Katsumasa Sato
- Subjects
Medtronic corevalve ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,Internal medicine ,Propensity score matching ,medicine ,Cardiology ,business ,Single Center ,Cardiology and Cardiovascular Medicine ,Direct flow ,Edwards sapien - Abstract
The aim of this study was to compare TAVI outcomes with the new-generation Direct Flow Medical (DFM) versus the Medtronic CoreValve (MCV) and Edwards SAPIEN XT (ESV) devices. From November 2007 to March 2014 all consecutive patients who underwent transfemoral TAVI with DFM, MCV or ESV in our center
- Published
- 2014
- Full Text
- View/download PDF
28. Effect of blood transfusion strategy on mortality in cardiac surgery: a meta-analysis of randomized controlled trials
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Alberto Zangrillo, Giovanni Landoni, Evgeny Fominskiy, Martina Crivellari, Luca Lucchetta, Laura Pasin, Alberto Castella, Fabrizio Monaco, and Gianluca Paternoster
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medicine.medical_specialty ,Blood transfusion ,business.industry ,medicine.medical_treatment ,Cardiac surgery ,law.invention ,Surgery ,Anesthesiology and Pain Medicine ,Randomized controlled trial ,law ,Meta-analysis ,Anesthesia ,medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2015
29. Left atrial appendage closure without general anaesthesia
- Author
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Fabrizio Monaco, Carmine D. Votta, Valentina Camarda, Evgeny Fominskiy, Alessandro Oriani, M Baiardo Redaelli, R Capucci, Juan Carlos Lopez-Delgado, Nicola Villari, and Alberto Zangrillo
- Subjects
Appendage ,medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Left atrial ,business.industry ,Closure (topology) ,Medicine ,General anaesthesia ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Published
- 2016
30. Thyroglobulin biosynthesis in a larval (ammocoete) and adult freshwater lamprey (Lampetra planeri B1.)
- Author
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Fabrizio Monaco, Jean Roche, Alessandro La Posta, and M Andreoli
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Larva ,Physiology ,media_common.quotation_subject ,medicine.medical_treatment ,Lamprey ,Thyroid ,General Medicine ,Biology ,biology.organism_classification ,Biochemistry ,medicine.anatomical_structure ,Lampetra ,medicine ,Thyroglobulin ,Metamorphosis ,Leucine ,Molecular Biology ,media_common ,Endostyle - Abstract
1. The biosynthesis of 18-19S thyroglobulin has been studied in a larval and adult freshwater lamprey (Lampetra planeri Bl.). 2. In vivo and in vitro experiments have been performed by injecting into the coelomic cavity or by incubating branchial region labeled constituents of Tg of higher vertebrates (125I, [3H]leucine and various [3H]carbohydrates). 3. Larvae (ammocoetes) and adults incorporate all labels into thyroglobulin (18-19S Tg), containing a small proportion of labeled T3 and T4, as identified by paper chromatography, and very minute amounts of stable iodine. 4. In adults, the biosynthesis of 18-19S Tg proceeds much more rapidly and the labels are incorporated in higher percentage than in larvae. 5. The demonstration of the biosynthesis of the specific thyroid protein, 18-19S Tg, in larvae indicates that the biochemical mechanism of hormonogenesis is present in larval endostyle before the morphological differentiation of thyroid cells and follicles occurring during metamorphosis. 6. Some 18-19S Tg is apparently stored in the endostyle.
- Published
- 1978
31. Enzymatic deglycosylation of human thyroglobulin: fluorescence studies
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Giganti G, Settimio Grimaldi, D. Pozzi, S Lio, Fabrizio Monaco, R De Pirro, and Roberto Verna
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endocrine system ,Conformational change ,endocrine system diseases ,Protein Conformation ,medicine.medical_treatment ,Biophysics ,Centrifugation ,In Vitro Techniques ,Thyroglobulin ,Biochemistry ,Structure-Activity Relationship ,chemistry.chemical_compound ,Protein structure ,Structural Biology ,medicine ,Humans ,Iodotyrosine ,Molecular Biology ,Glycoproteins ,Quenching (fluorescence) ,Tryptophan ,Carbohydrate ,Spectrometry, Fluorescence ,chemistry ,Acrylamide ,Apoproteins - Abstract
The interaction between the carbohydrate and the amino acid residues in human thyroglobulin has been studied. Previous reports showed that the removal of the two terminal carbohydrates of the complex chains leads to an increase in thyroglobulin binding to thyroid membranes. In our study, after enzymatic release with glycosidases of the sugar moieties from thyroglobulin, a time-dependent decrease in tryptophan fluorescence has been observed. This decrease was also associated with a shift in the emission peak from 335 to 340 nm. The strong quenching of tryptophan emission was also accompanied by a decrease in the exposure of tryptophan residues, as shown by a Stern-Volmer analysis with the neutral quencher acrylamide. These data, together with the increase in fluorescence of the dansylated deglycosylated thyroglobulin, strongly suggest that a significant conformational change of thyroglobulin follows the deglycosylation of the protein.
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- 1988
32. Defective Thyroglobulin Synthesis in an Experimental Rat Thyroid Tumor
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Jacob Robbins and Fabrizio Monaco
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endocrine system ,endocrine system diseases ,biology ,Sialyltransferase ,medicine.medical_treatment ,Mannose ,Orosomucoid ,Cell Biology ,Biochemistry ,Fetuin ,Fucose ,Sialic acid ,chemistry.chemical_compound ,chemistry ,Thyroid peroxidase ,biology.protein ,medicine ,Thyroglobulin ,Molecular Biology ,hormones, hormone substitutes, and hormone antagonists - Abstract
The incorporation of carbohydrates has been studied in vitro in the experimental rat thyroid tumor 1-1C2. The uptake of N-[3H]acetylmannosamine, a precursor of sialic acid, is less than 5% of that in normal thyroid gland; no label is found in 19 S thyroglobulin or its precursors either in the soluble or in the solubilized proteins. N-[3H]Acetylglucosamine is incorporated at a slower rate than in normal thyroid gland and is present in the membrane-bound thyroglobulin; there is no conversion into sialic acid in the soluble thyroglobulin of tumor as occurs in normal thyroid. [14C]Mannose and [14C]galactose are incorporated at an almost normal rate and [14C]fucose, at a subnormal rate; they are present mainly in the particle-bound proteins as ∼18 S thyroglobulin and its precursors. Measurement of sialyltransferase activity showed that, with desialylated thyroglobulin as acceptor, the 22,000–105,000 x g pellet of tumor contains ∼3% of normal sialyltransferase activity, and the soluble fraction contains ∼25% of normal activity. Desialylated fetuin and orosomucoid are generally better acceptors than desialylated thyroglobulin for tumor sialyltransferase. The findings indicate that defective thyroglobulin release and absence of incorporation of sialic acid into thyroglobulin coexist in this tumor. The very low activity of thyroglobulin-specific sialyltransferase activity in the tumor particulate fraction accounts for the failure of sialic acid incorporation into thyroglobulin and may explain the defect in thyroglobulin release.
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- 1973
33. Thyroid hormone formation in thyroglobulin synthesized in the Amphioxus (Branchiostoma lanceolatum pallas)
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Roberto De Pirro, M Andreoli, Jean Roche, Roberto Dominici, and Fabrizio Monaco
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endocrine system ,medicine.medical_specialty ,endocrine system diseases ,Physiology ,medicine.medical_treatment ,Biochemistry ,chemistry.chemical_compound ,Biosynthesis ,In vivo ,Thyroid peroxidase ,Internal medicine ,medicine ,Molecular Biology ,Branchiostoma lanceolatum ,biology ,Lactoperoxidase ,Thyroid ,General Medicine ,biology.organism_classification ,In vitro ,Endocrinology ,medicine.anatomical_structure ,chemistry ,biology.protein ,Thyroglobulin - Abstract
1. 1. Thyroglobulin (Tg) biosynthesis in the endostyles of Amphioxus ( Branchiostoma lanceolatum Pallas) has been demonstrated. 2. 2. The protein molecule shows characteristics similar to those of Tg from ammocoetes of fresh-water lampreys, sedimenting with a coefficient of 17-19S and incorporating in vivo 125 I. 3. 3. Iodothyronine synthesis occurs in thyroglobulin in animals incorporating 125 I both after in vivo and after in vitro iodination with lactoperoxidase in presence of labelled iodide. 4. 4. Labelled T3 and T4 are present in the Tg molecule of Amphioxus as in control mammalian Tg and practically in the same molecular rates. 5. 5. Thus thyroid hormones are present in thyroglobulin included in the cells of endostyles. 6. 6. It is shown that in evolution of Chordates the synthesis of thyroglobulin, as the site of formation of thyroid hormones, preceeds the morphological differentiation of thyroid cells and the folliclular organization out (fishes) or into the thyroid glands of higher vertebrates.
- Published
- 1981
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