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5. Cardiac surgery practice during the COVID-19 outbreak: A multicentre national survey

Author

Rubino, A. S., De Santo, L. S., Pisano, Adelaide, Mauro, M. D., Benussi, S., Borghetti, V., Castiglioni, A., Chiariello, L., Colli, A., De Bellis, Andrea, De Filippo, C. M., De Paulis, R., Di Benedetto, G., Di Eusanio, M., Faggian, G., Fiorani, B., Fratto, P. A., Giuffrida, A. G., Glauber, M., Iannelli, G., Iesu, S., Livi, U., Martinelli, G., Massetti, Massimo, Mastroroberto, P., Menicanti, L., Minniti, G., Miraldi, F., Montesi, G., Musumeci, F., Nicolini, Francesco, Napoleone, C. P., Panisi, P., Pappalardo, A., Patane`, F., Ragni, T., Rinaldi, M., Tribastone, S., Triggiani, M., Tritto, F. P., Zebele, C., Parolari, A., Gerosa, G., De Feo, M., Antonino, S. R., Luca Salvatore, D. S., Antonio, P., Michele, D. M., Stefano, B., Valentino, B., Alessandro, C., Luigi, C., Andrea, C., Antonio, D. B., Carlo Maria, D. F., Ruggero, D. P., Giuseppe, D. B., Marco, D. E., Giuseppe, F., Brenno, F., Pasquale, A. F., Angelo Giuseppe, G., Mattia, Giuseppe, Gabriele, I., Severino, Iolanda, Ugolino, L., Gianluca, M., Massimo, M., Pasquale, M., Lorenzo, M., Giuseppe, M., Fabio, M., Gianfranco, M., Francesco, M., Francesco, N., Carlo Pace, N., Paolo, P., Aniello, P., Francesco, P., Temistocle, R., Mauro, R., Salvatore, T., Michele, T., Francesco Paolo, T., Carlo, Z., Alessandro, P., Gino, G., Marisa, D. F., Pisano A., De Bellis A., Massetti M. (ORCID:0000-0002-7100-8478), Nicolini F., Mattia G., Severino I., Rubino, A. S., De Santo, L. S., Pisano, Adelaide, Mauro, M. D., Benussi, S., Borghetti, V., Castiglioni, A., Chiariello, L., Colli, A., De Bellis, Andrea, De Filippo, C. M., De Paulis, R., Di Benedetto, G., Di Eusanio, M., Faggian, G., Fiorani, B., Fratto, P. A., Giuffrida, A. G., Glauber, M., Iannelli, G., Iesu, S., Livi, U., Martinelli, G., Massetti, Massimo, Mastroroberto, P., Menicanti, L., Minniti, G., Miraldi, F., Montesi, G., Musumeci, F., Nicolini, Francesco, Napoleone, C. P., Panisi, P., Pappalardo, A., Patane`, F., Ragni, T., Rinaldi, M., Tribastone, S., Triggiani, M., Tritto, F. P., Zebele, C., Parolari, A., Gerosa, G., De Feo, M., Antonino, S. R., Luca Salvatore, D. S., Antonio, P., Michele, D. M., Stefano, B., Valentino, B., Alessandro, C., Luigi, C., Andrea, C., Antonio, D. B., Carlo Maria, D. F., Ruggero, D. P., Giuseppe, D. B., Marco, D. E., Giuseppe, F., Brenno, F., Pasquale, A. F., Angelo Giuseppe, G., Mattia, Giuseppe, Gabriele, I., Severino, Iolanda, Ugolino, L., Gianluca, M., Massimo, M., Pasquale, M., Lorenzo, M., Giuseppe, M., Fabio, M., Gianfranco, M., Francesco, M., Francesco, N., Carlo Pace, N., Paolo, P., Aniello, P., Francesco, P., Temistocle, R., Mauro, R., Salvatore, T., Michele, T., Francesco Paolo, T., Carlo, Z., Alessandro, P., Gino, G., Marisa, D. F., Pisano A., De Bellis A., Massetti M. (ORCID:0000-0002-7100-8478), Nicolini F., Mattia G., and Severino I.

Abstract

OBJECTIVES: Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals had to implement strategies to profoundly reshape both non-COVID-19 medical care and surgical activities. Knowledge about the impact of the COVID-19 pandemic on cardiac surgery practice is pivotal. The goal of the present study was to describe the changes in cardiac surgery practices during the health emergency at the national level. METHODS: A 26-question web-enabled survey including all adult cardiac surgery units in Italy was conducted to assess how their clinical practice changed during the national lockdown. Data were compared to data from the corresponding period in 2019. RESULTS: All but 2 centres (94.9%) adopted specific protocols to screen patients and personnel. A significant reduction in the number of dedicated cardiac intensive care unit beds (-35.4%) and operating rooms (-29.2%), along with healthcare personnel reallocation to COVID departments (nurses-15.4%, anaesthesiologists-7.7%), was noted. Overall adult cardiac surgery volumes were dramatically reduced (1734 procedures vs 3447; P 0.001), with a significant drop in elective procedures [580 (33.4%) vs 2420 (70.2%)]. CONCLUSIONS: This national survey found major changes in cardiac surgery practice as a response to the COVID-19 pandemic. This experience should lead to the development of permanent systems-based plans to face possible future pandemics. These data may effectively help policy decision-making in prioritizing healthcare resource reallocation during the ongoing pandemic and once the healthcare emergency is over. © 2021 The Author(s). Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Published
2021

7. Noninvasive Ventilation: Education and Training. A Narrative Analysis and an International Consensus Document

Author

Karim, H, Burns, K, Ciobanu, L, El-Khatib, M, Nicolini, A, Vargas, N, Hernández-Gilsoul, T, Skoczyński, S, Falcone, V, Arnal, J, Bach, J, De Santo, L, Lucchini, A, Steier, J, Purro, A, Petroianni, A, Sassoon, C, Bambi, S, Aguiar, M, Soubani, A, Taniguchi, C, Mollica, C, Berlin, D, Piervincenzi, E, Rao, F, Luigi, F, Ferrari, R, Garuti, G, Laier-Groeneveld, G, Fiorentino, G, Ho, K, Alqahtani, J, Luján, M, Moerer, O, Resta, O, Pierucci, P, Papadakos, P, Steiner, S, Stieglitz, S, Dikmen, Y, Duan, J, Bhakta, P, Iglesias, A, Corcione, N, Caldeira, V, Karakurt, Z, Valli, G, Kondili, E, Ruggieri, M, Raposo, M, Bottino, F, Soler-González, R, Gurjar, M, Sandoval-Gutierrez, J, Jafari, B, Arroyo-Cozar, M, Noval, A, Esquinas, A, Karim, Habib Md Reazaul, Burns, Karen E A, Ciobanu, Laura D, El-Khatib, Mohamad, Nicolini, Antonello, Vargas, Nicola, Hernández-Gilsoul, Thierry, Skoczyński, Szymon, Falcone, Vito Antonio, Arnal, Jean-Michel, Bach, John, De Santo, Luca Salvatore, Lucchini, Alberto, Steier, Joerg, Purro, Andrea, Petroianni, Angelo, Sassoon, Catherine S, Bambi, Stefano, Aguiar, Margarida, Soubani, Ayman O, Taniguchi, Corinne, Mollica, Corrado, Berlin, David A, Piervincenzi, Edoardo, Rao, Fabrizio, Luigi, Ferini-Strambi, Ferrari, Rodolfo, Garuti, Giancarlo, Laier-Groeneveld, Gerhard, Fiorentino, Giuseppe, Ho, Kwok M, Alqahtani, Jaber Saud, Luján, Manuel, Moerer, Onnen, Resta, Onofrio, Pierucci, Paola, Papadakos, Peter, Steiner, Stephan, Stieglitz, Sven, Dikmen, Yalim, Duan, Jun, Bhakta, Pradipta, Iglesias, Alejandro Ubeda, Corcione, Nadia, Caldeira, Vânia, Karakurt, Zuhal, Valli, Gabriele, Kondili, Eumorfia, Ruggieri, Maria Pia, Raposo, Margarida Simões, Bottino, Fabrizio, Soler-González, Rafael, Gurjar, Mohan, Sandoval-Gutierrez, José Luis, Jafari, Behrouz, Arroyo-Cozar, Marta, Noval, Ana Roca, Esquinas, Antonio M, Karim, H, Burns, K, Ciobanu, L, El-Khatib, M, Nicolini, A, Vargas, N, Hernández-Gilsoul, T, Skoczyński, S, Falcone, V, Arnal, J, Bach, J, De Santo, L, Lucchini, A, Steier, J, Purro, A, Petroianni, A, Sassoon, C, Bambi, S, Aguiar, M, Soubani, A, Taniguchi, C, Mollica, C, Berlin, D, Piervincenzi, E, Rao, F, Luigi, F, Ferrari, R, Garuti, G, Laier-Groeneveld, G, Fiorentino, G, Ho, K, Alqahtani, J, Luján, M, Moerer, O, Resta, O, Pierucci, P, Papadakos, P, Steiner, S, Stieglitz, S, Dikmen, Y, Duan, J, Bhakta, P, Iglesias, A, Corcione, N, Caldeira, V, Karakurt, Z, Valli, G, Kondili, E, Ruggieri, M, Raposo, M, Bottino, F, Soler-González, R, Gurjar, M, Sandoval-Gutierrez, J, Jafari, B, Arroyo-Cozar, M, Noval, A, Esquinas, A, Karim, Habib Md Reazaul, Burns, Karen E A, Ciobanu, Laura D, El-Khatib, Mohamad, Nicolini, Antonello, Vargas, Nicola, Hernández-Gilsoul, Thierry, Skoczyński, Szymon, Falcone, Vito Antonio, Arnal, Jean-Michel, Bach, John, De Santo, Luca Salvatore, Lucchini, Alberto, Steier, Joerg, Purro, Andrea, Petroianni, Angelo, Sassoon, Catherine S, Bambi, Stefano, Aguiar, Margarida, Soubani, Ayman O, Taniguchi, Corinne, Mollica, Corrado, Berlin, David A, Piervincenzi, Edoardo, Rao, Fabrizio, Luigi, Ferini-Strambi, Ferrari, Rodolfo, Garuti, Giancarlo, Laier-Groeneveld, Gerhard, Fiorentino, Giuseppe, Ho, Kwok M, Alqahtani, Jaber Saud, Luján, Manuel, Moerer, Onnen, Resta, Onofrio, Pierucci, Paola, Papadakos, Peter, Steiner, Stephan, Stieglitz, Sven, Dikmen, Yalim, Duan, Jun, Bhakta, Pradipta, Iglesias, Alejandro Ubeda, Corcione, Nadia, Caldeira, Vânia, Karakurt, Zuhal, Valli, Gabriele, Kondili, Eumorfia, Ruggieri, Maria Pia, Raposo, Margarida Simões, Bottino, Fabrizio, Soler-González, Rafael, Gurjar, Mohan, Sandoval-Gutierrez, José Luis, Jafari, Behrouz, Arroyo-Cozar, Marta, Noval, Ana Roca, and Esquinas, Antonio M

Abstract

Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients’ lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training. Literature search was conducted (MEDLINE: 1990 to June, 2018) to identify randomized controlled studies and systematic reviews with the results analyzed by a team of experts across the world through e-mail based communications. Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies with indirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implemented only in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIV education and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated. Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care using NIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developing countries

Published
2019

11. Optimizing the Safety Profile of Everolimus by Delayed Initiation in De Novo Heart Transplant Recipients: Results of the Prospective Randomized Study EVERHEART

Author

Potena, L., Pellegrini, C., Grigioni, F., Amarelli, C., Livi, U., Maccherini, M., Masciocco, G., Faggian, G., Lilla Della Monica, P., Gerosa, G., Marraudino, N., Corda, M., Boffini, M., De Santo, L. S., Tona, F., Poggio, D., Savini, C., Ambrogi, F., Bernazzali, S., D'Armini, A. M., Mattiucci, G., Rinaldi, M., Ribezzo, M., Porcu, M., Musumeci, F., Gambino, A., Maiello, C., Frigerio, M., Guzzi, G., Forni, A., and Capone, G.

Subjects
Male, medicine.medical_specialty, Pleural effusion, medicine.medical_treatment, 030204 cardiovascular system & hematology, 030230 surgery, Pericardial effusion, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Cumulative incidence, Everolimus, Prospective Studies, Prospective cohort study, Heart transplantation, Transplantation, business.industry, Original Clinical Science—General, medicine.disease, Surgery, Discontinuation, Heart Transplantation, Female, Immunosuppressive Agents, business, medicine.drug
Abstract

Background Although everolimus potentially improves long-term heart transplantation (HTx) outcomes, its early postoperative safety profile had raised concerns and needs optimization. Methods This 6-month, open-label, multicenter randomized trial was designed to compare the cumulative incidence of a primary composite safety endpoint comprising wound healing delays, pericardial effusion, pleural effusion needing drainage, and renal insufficiency events (estimated glomerular filtration rate ≤30/mL/min per 1.73 m2) in de novo HTx recipients receiving immediate everolimus (EVR-I) (≤144 hours post-HTx) or delayed everolimus (EVR-D) (4-6 weeks post-HTx with mycophenolate mofetil as a bridge) with reduced-dose cyclosporine A. Cumulative incidence of biopsy-proven rejection ≥ 2R, rejection with hemodynamic compromise, graft loss, or death was the secondary composite efficacy endpoint. Results Overall, 181 patients were randomized to the EVR-I (n = 89) or EVR-D (n = 92) arms. Incidence of primary safety endpoint was higher for EVR-I than EVR-D arm (44.9% vs 32.6%; P = 0.191), mainly driven by a higher rate of pericardial effusion (33.7% vs 19.6%; P = 0.04); wound healing delays, acute renal insufficiency events, and pleural effusion occurred at similar frequencies in the study arms. Efficacy failure was not significantly different in EVR-I arm versus EVR-D arm (37.1% vs 28.3%; P = 0.191). Three patients in the EVR-I arm and 1 in the EVR-D arm died. Incidence of clinically significant adverse events leading to discontinuation was higher in EVR-I arm versus EVR-D arm (P = 0.02). Conclusions Compared with immediate initiation, delayed everolimus initiation appeared to provide a clinically relevant early safety benefit in de novo HTx recipients, without compromising efficacy., The 6-month, open-label, multicenter randomized trial is designed to compare primary safety endpoints in de novo heart transplantation and delayed everolimus initiation seems to provide a clinically relevant early safety benefit compared to immediate initiation without compromising efficacy. Supplemental digital content is available in the text.

Published
2018

12. Non-invasive mechanical ventilation in postoperative patients: A clinical review [Ventilación mecánica no invasiva en el postoperatorio. Revisión clínica]

Author

Esquinas, A. M., Jover, J. L., Ubeda, A., Belda, F. J., Dominguez, A. A., Nacher, F. J. B., Gonzalez, R. C., Jimenez, P. A. C., Moreira, B. C., Mora, P. C., Saenz, M. C., Garcia, D. D., Duran, M. E., Ruiz, I. F., Cortes, J. G., Perez, F. G. -M., Zerpa, C. G., Mate, R. G., Hernandez, E. G., Iradier, P. H., Pinillos, J. L. J., Leon, C. V. L., Olaondo, L. L., Sanchez, M. L., Ocon, J. M., Paulino, A. M., Rodriguez, P. M., Betancor, N. O., Gomez, J. R. O., Ruiz, O. M. P., Abizanda, F. P., Astillero, I. P., Carbonell, A. P., Perez, A. R., Pascual, P. R., Martin, F. S., Pedros, V. T., Iglesias, A. U., Berlin, D. A., de Santo, L., Dikmen, Y., Karcz, M., Koksal, G., Mina, B., Morer, O., Pasin, L., Pelosi, P., Papadakos, P., Peris, A., and Zapata, D. I.

Subjects
Postoperative Care, Pulmonary Atelectasis, Transplantation, Surgical Procedures, Noninvasive Ventilation, Patient Selection, Abdominal surgery, Acute respiratory failure, Anesthesia, Non-invasive ventilation, Postoperative care, Bariatric Surgery, Humans, Pneumonia, Ventilator-Associated, Postoperative Complications, Randomized Controlled Trials as Topic, Respiratory Insufficiency, Risk Factors, Surgical Procedures, Operative, Pneumonia, Operative, Ventilator-Associated
Published
2015

13. Body protection in the surgery of aortic

Author

NAPPI, Gianantonio, DE SANTO L, DELLA CORTE, Alessandro, ROMANO G, TORELLA, Michele, DE FEO, Marisa, Nappi, Gianantonio, DE SANTO, L, DELLA CORTE, Alessandro, Romano, G, Torella, Michele, and DE FEO, Marisa

Published
2009

14. Body perfusion in the surgery of the aortic arch

Author

NAPPI, Gianantonio, De Santo L, DELLA CORTE, Alessandro, Romano G, Torella M, DE FEO, Marisa, Nappi, Gianantonio, De Santo, L, DELLA CORTE, Alessandro, Romano, G, Torella, M, and DE FEO, Marisa

Published
2009

18. Extracellular matrix and cardiac remodelling in post-ischemic end-stage human hearts

Author

MONTAGNANI, STEFANIA, POSTIGLIONE, LOREDANA, DI SPIGNA, GAETANO, CASTALDO, CLOTILDE, ARCUCCI, ALESSANDRO, De Santo L., Guerra G., Ladogana P., Vitale S., Cotrufo M., Montagnani, Stefania, Postiglione, Loredana, De Santo, L., DI SPIGNA, Gaetano, Castaldo, Clotilde, Guerra, G., Ladogana, P., Arcucci, Alessandro, Vitale, S., and Cotrufo, M.

Published
2007

19. Expression of the granulocyte macrophage-colony stimulating factor receptor (GM-CSFR) on human myocardiocytes from end-stage heart failure patients

Author

POSTIGLIONE, LOREDANA, MONTAGNANI, STEFANIA, CASTALDO, CLOTILDE, Ladogana P, Di Spigna G, Bruno EM, de Santo L, Rossi G., Postiglione, Loredana, Montagnani, Stefania, Ladogana, P, Castaldo, Clotilde, Di Spigna, G, Bruno, Em, de Santo, L, and Rossi, G.

Abstract

In remodeling ventricles, the progression of heart failure is associated with structural changes involving the extra-cellular matrix (ECM) and the cytoskeletal filament of myocardiocytes, associated with fibrosis, cellular damage and death, which lead to alterations in heart geometry, size and mechanical properties. Recently several observations have demonstrated the role of some cytokines and haemopoietic growth factors in the damage and regeneration mechanisms of cardiac tissue during acute myocardial infarction. After heart damage, the development of scarred tissue has been considered as the only reaction, since myocytes are thought to be terminally differentiated cells and thus unable to proliferate. On the contrary, recent studies in animal models and adult human hearts have shown that myocytes can proliferate before reaching their final size and that their proliferation may be stimulated and modulated by several factors. Against this background, we have investigated the expression of the receptor for GM-CSF, an haemopoietic growth factor, in healthy and end-stage human cardiac tissues, to clarify the possible role of GM-CSF and its receptor in the regenerative process of cardiac tissue in chronic cardiomyopathy. We have studied GM-CSFR expression on human cardiac tissue from explanted hearts of chronic patients with heart failure (ischemic and dilatative cardiomyopathy) and on cardiac biopsies from normal human hearts, by immunohistochemistry, cellular and molecular biology assays. Our results demonstrated the presence of GM-CSFRb in cardiac tissue; in particular GM-CSFRb positive cells were a constant finding in pathological cardiac tissues and significantly increased as compared to normal control tissues. At the moment we can only hypothesize that GM-CSF, like other growth factors, plays a role in apoptotic and/or ECM deposition processes as well as in the cytoskeleton modification in myocardium.

Published
2005

25. il rene nell'insufficienza cardiaca

Author

Frangiosa A, De Santo L, Cirillo M, Perna A, Iorio L, Cotrufo M, Frangiosa, A, De Santo, L, Cirillo, M, Perna, A, Iorio, L, and Cotrufo, M

Published
2003

29. Protesi vascolari aortiche

Author

COTRUFO M, VOSA C, DE SANTO L, VACCHIANO G, FEDELI P., SANTE', Pasquale, PALMIERI L, Cotrufo, M, Sante', Pasquale, Vosa, C, DE SANTO, L, Vacchiano, G, and Fedeli, P.

Published
2003

33. Le urgenze nel trapianto di cuore

Author

COTRUFO M, DE SANTO L, MAIELLO C, MARRA C, MARMO J., DE FEO, Marisa, Cotrufo, M, DE SANTO, L, Maiello, C, Marra, C, DE FEO, Marisa, and Marmo, J.

Published
2000

35. Le infezioni batteriche nel paziente con trapianto di cuore

Author

UTILI, Riccardo, ZAMPINO, Rosa, Mormone G, Tripodi MF, Ruggiero G, Cione P, Cuccurullo S, Maiello C, De Vivo F, Marra C, De Santo L, Cotrufo M., Utili, Riccardo, Zampino, Rosa, Mormone, G, Tripodi, Mf, Ruggiero, G, Cione, P, Cuccurullo, S, Maiello, C, De Vivo, F, Marra, C, De Santo, L, and Cotrufo, M.

Published
1999

36. The murder of Nicholas Green: organ donation 20 years later

Author

Green, R, De Rosa, G, Scarabelli, A, De Santo, L, Citterio, Franco, De Santo, Ng, Citterio, Franco (ORCID:0000-0003-0489-6337), Green, R, De Rosa, G, Scarabelli, A, De Santo, L, Citterio, Franco, De Santo, Ng, and Citterio, Franco (ORCID:0000-0003-0489-6337)

Abstract

xxx

Published
2014

38. A new biotechnological approach to reduce the increase of the protease concentration during extracorporeal blood circulation in hemodyalisis or cardiopulmonary bypass operations

Author

GRANO V., DIANO N., BENCIVENGA U., DE SANTO N. G., SALAMINO F., COTRUFO M., NAPPI G. A., DE SANTO L. S., COMPIANI M., CITTON C., OLIVA A., MITA D. G., CASADIO, RITA, S.G.PANDALAI, GRANO V., DIANO N., BENCIVENGA U., DE SANTO N.G., SALAMINO F., COTRUFO M., NAPPI G.A., DE SANTO L.S., CASADIO R., COMPIANI M., CITTON C., OLIVA A., and MITA D.G.

Published
2004

40. Protesi valvolari cardiache

Author

Fedeli, Piergiorgio, Cotrufo, M., Renzulli, A., Vosa, C., Cerasuolo, F., DE SANTO, L., and Vacchiano, G.

Published
2003

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