162 results on '"Scandroglio AM"'
Search Results
2. Prevalence, Characteristics, Risk Factors, and Outcomes of Invasively Ventilated COVID-19 Patients with Acute Kidney Injury and Renal Replacement Therapy
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Fominskiy, E, Scandroglio, AM, Monti, G, Calabro, MG, Landoni, G, Dell'Acqua, A, Beretta, L, Moizo, E, Ravizza, A, Monaco, F, Campochiaro, C, Pieri, M, Azzolini, ML, Borghi, G, Crivellari, M, Conte, C, Mattioli, C, Silvani, P, Mucci, M, Turi, S, Tentori, S, Redaelli, MB, Sartorelli, M, Angelillo, P, Belletti, A, Nardelli, P, Nisi, FG, Valsecchi, G, Barberio, C, Ciceri, F, Serpa Neto, A, Dagna, L, Bellomo, R, Zangrillo, A, Fominskiy, E, Scandroglio, AM, Monti, G, Calabro, MG, Landoni, G, Dell'Acqua, A, Beretta, L, Moizo, E, Ravizza, A, Monaco, F, Campochiaro, C, Pieri, M, Azzolini, ML, Borghi, G, Crivellari, M, Conte, C, Mattioli, C, Silvani, P, Mucci, M, Turi, S, Tentori, S, Redaelli, MB, Sartorelli, M, Angelillo, P, Belletti, A, Nardelli, P, Nisi, FG, Valsecchi, G, Barberio, C, Ciceri, F, Serpa Neto, A, Dagna, L, Bellomo, R, and Zangrillo, A
- Abstract
BACKGROUND: There is no information on acute kidney injury (AKI) and continuous renal replacement therapy (CRRT) among invasively ventilated coronavirus disease 2019 (COVID-19) patients in Western healthcare systems. OBJECTIVE: To study the prevalence, characteristics, risk factors and outcome of AKI and CRRT among invasively ventilated COVID-19 patients. METHODS: Observational study in a tertiary care hospital in Milan, Italy. RESULTS: Among 99 patients, 72 (75.0%) developed AKI and 17 (17.7%) received CRRT. Most of the patients developed stage 1 AKI (33 [45.8%]), while 15 (20.8%) developed stage 2 AKI and 24 (33.4%) a stage 3 AKI. Patients who developed AKI or needed CRRT at latest follow-up were older, and among CRRT treated patients a greater proportion had preexisting CKD. Hospital mortality was 38.9% for AKI and 52.9% for CRRT patients. CONCLUSIONS: Among invasively ventilated COVID-19 patients, AKI is very common and CRRT use is common. Both carry a high risk of in-hospital mortality.
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- 2021
3. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy
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Grasselli, G, Zangrillo, A, Zanella, A, Antonelli, M, Cabrini, L, Castelli, A, Cereda, D, Coluccello, A, Foti, G, Fumagalli, R, Iotti, G, Latronico, N, Lorini, L, Merler, S, Natalini, G, Piatti, A, Ranieri, M, Scandroglio, A, Storti, E, Cecconi, M, Pesenti, A, Lorini, F, Ranieri, MV, Scandroglio, AM, LORINI, FERDINANDO LUCA, Grasselli, G, Zangrillo, A, Zanella, A, Antonelli, M, Cabrini, L, Castelli, A, Cereda, D, Coluccello, A, Foti, G, Fumagalli, R, Iotti, G, Latronico, N, Lorini, L, Merler, S, Natalini, G, Piatti, A, Ranieri, M, Scandroglio, A, Storti, E, Cecconi, M, Pesenti, A, Lorini, F, Ranieri, MV, Scandroglio, AM, and LORINI, FERDINANDO LUCA
- Abstract
Question What are the baseline characteristics and outcomes of patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to intensive care units (ICUs) in Lombardy, Italy? Findings In this retrospective case series that involved 1591 critically ill patients admitted from February 20 to March 18, 2020, 99% (1287 of 1300 patients) required respiratory support, including endotracheal intubation in 88% and noninvasive ventilation in 11%; ICU mortality was 26%. Meaning In this case series of critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed coronavirus disease 2019 (COVID-19), a high proportion required mechanical ventilation and ICU mortality was 26% as of March 25, 2020.Importance In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. Objective To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy. Design, Setting, and Participants Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020. Exposures SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs. Main Outcomes and Measures Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center
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- 2020
4. 2019 EACTS Expert Consensus on long-term mechanical circulatory support
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Potapov, EV, Antonides, Stan, Crespo-Leiro, M G, Combes, A, Farber, G, Hannan, MM, Kukucka, M, Jonge, N, Loforte, A, Lund, LH, Mohacsi, P, Morshuis, M, Netuka, I, Ozbaran, M, Pappalardo, F, Scandroglio, AM, Schweiger, M, Tsui, S, Zimpfer, D, Gustafsson, F, Eacts, Potapov, EV, Antonides, Stan, Crespo-Leiro, M G, Combes, A, Farber, G, Hannan, MM, Kukucka, M, Jonge, N, Loforte, A, Lund, LH, Mohacsi, P, Morshuis, M, Netuka, I, Ozbaran, M, Pappalardo, F, Scandroglio, AM, Schweiger, M, Tsui, S, Zimpfer, D, Gustafsson, F, and Eacts
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- 2019
5. Role of serum biomarkers in the diagnosis of infection in patients undergoing extracorporeal membrane oxygenation
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Pieri, M, Greco, T, Scandroglio, AM, De Bonis, M, Maj, G, Fumagalli, L, Zangrillo, A, and Pappalardo, F
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- 2012
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6. Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A (H1N1) pneumonia: the ECMOnet score
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Pappalardo F, Pieri M, Greco T, Patroniti N, Pesenti A, Arcadipane A, Ranieri VM, Gattinoni L, Landoni G, Holzgraefe B, Beutel G, Zangrillo A, Italian E.C.M.O.n.e.t. Scandroglio AM, Calabrò MG, Bove T, De Bonis M, Foti G, Bombino M, Peris A, Cianchi G, Pasquini A, Braschi A, Mojoli F, Zanierato M, Iotti GA, Belliato M, Carnevale L, Terragni P, Urbino R, Del Sorbo L, Fanelli V, Panarello G, Antonelli M, Bello G, Maviglia R, Lissoni A, Crotti S, Pietropaoli P, Rocco M, Morelli A, Frascaroli G, Caramelli F, Bruno F, Grasso S, Lorini L, Ori C., TUFANO, ROSALBA, IANNUZZI, MICHELE, Pappalardo, F, Pieri, M, Greco, T, Patroniti, N, Pesenti, A, Arcadipane, A, Ranieri, V, Gattinoni, L, Landoni, G, Holzgraefe, B, Beutel, G, Zangrillo, A, Lorini, F, Ranieri, Vm, Federico Pappalardo, Marina Pieri, Teresa Greco, Nicolò Patroniti, Antonio Pesenti, Antonio Arcadipane, V. Marco Ranieri, Luciano Gattinoni, Giovanni Landoni, Bernhard Holzgraefe, Gernot Beutel, Alberto Zangrillo, Scandroglio AM, Italian E. C. M. O. n. e. t., Calabrò, Mg, Bove, T, De Bonis, M, Foti, G, Bombino, M, Peris, A, Cianchi, G, Pasquini, A, Braschi, A, Mojoli, F, Zanierato, M, Iotti, Ga, Belliato, M, Carnevale, L, Terragni, P, Urbino, R, Del Sorbo, L, Fanelli, V, Panarello, G, Antonelli, M, Bello, G, Maviglia, R, Lissoni, A, Crotti, S, Pietropaoli, P, Rocco, M, Morelli, A, Frascaroli, G, Caramelli, F, Tufano, Rosalba, Iannuzzi, Michele, Bruno, F, Grasso, S, Lorini, L, and Ori, C.
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Adult ,Male ,medicine.medical_specialty ,ARDS ,medicine.medical_treatment ,ECMO -ARDS - H1N1 ,venovenous extracorporeal membrane oxygenation (VV ECMO) ,H1N1 virus ,Critical Care and Intensive Care Medicine ,Risk Assessment ,Veins ,Cohort Studies ,Influenza A Virus, H1N1 Subtype ,Acute respiratory distress syndrome ,ECMO ,Extracorporeal membrane oxygenation ,Mortality ,Multiple organ failure ,Female ,Humans ,Influenza, Human ,Prospective Studies ,Respiratory Distress Syndrome, Adult ,Survival Rate ,Extracorporeal Membrane Oxygenation ,Anesthesiology ,Influenza A Virus ,Medicine ,H1N1 Subtype ,MED/41 - ANESTESIOLOGIA ,Intensive care medicine ,Prospective cohort study ,Survival rate ,Respiratory Distress Syndrome ,business.industry ,medicine.disease ,Influenza ,ECMO: H1N1 ,Pneumonia ,surgical procedures, operative ,Respiratory failure ,business ,Cohort study ,Human - Abstract
PURPOSE: The decision to start venovenous extracorporeal membrane oxygenation (VV ECMO) is commonly based on the severity of respiratory failure, with little consideration of the extrapulmonary organ function. The aim of the study was to identify predictors of mortality and to develop a score allowing a better stratification of patients at the time of VV ECMO initiation. METHODS: This was a prospective multicenter cohort study on 60 patients with influenza A (H1N1)-associated respiratory distress syndrome participating in the Italian ECMOnet data set in the 2009 pandemic. Criteria for ECMO institution were standardized according to national guidelines. RESULTS: The survival rate in patients treated with ECMO was 68%. Significant predictors of death before ECMO institution by multivariate analysis were hospital length of stay before ECMO institution (OR=1.52, 95% CI 1.12-2.07, p=0.008); bilirubin (OR=2.32, 95% CI 1.52-3.52, p 
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- 2013
7. Angiotensin II infusion and markers of organ function in invasively ventilated COVID-19 patients
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Alberto Zangrillo, Chiara Sartini, Marina Pieri, Sergio Colombo, Maria Rosa Calvi, Giacomo Monti, Francesca Guzzo, Antonella Cipriani, Pasquale Nardelli, Rinaldo Bellomo, Giovanni Landoni, Paolo Beccaria, Alessandro Ortalda, Stefano Franchini, Ary Serpa Neto, Lorenzo Dagna, Gaetano Lombardi, Evgeny Fominskiy, Moreno Tresoldi, Marianna Sartorelli, Maria Grazia Calabrò, Andrea Assanelli, Anna Mara Scandroglio, Nicola Pasculli, Zangrillo, A, Colombo, S, Scandroglio, Am, Fominskiy, E, Pieri, M, Calabro, Mg, Beccaria, Pf, Pasculli, N, Guzzo, F, Calvi, Mr, Cipriani, A, Sartini, C, Nardelli, P, Ortalda, A, Lombardi, G, Sartorelli, M, Monti, G, Assanelli, A, Tresoldi, M, Dagna, L, Franchini, S, Neto, A, Bellomo, R, and Landoni, G
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Mechanical ventilation ,medicine.medical_specialty ,Mean arterial pressure ,Creatinine ,business.industry ,medicine.medical_treatment ,Odds ratio ,Angiotensin II ,Intensive care unit ,law.invention ,chemistry.chemical_compound ,Blood pressure ,chemistry ,law ,Internal medicine ,Cardiology ,medicine ,Renal replacement therapy ,business - Abstract
OBJECTIVE: The use of angiotensin II in invasively ventilated patients with coronavirus disease 2019 (COVID-19) is controversial. Its effect on organ function is unknown. DESIGN: Prospective observational study. SETTING: Intensive care unit (ICU) of a tertiary academic hospital in Milan, Italy. PARTICIPANTS: Adult patients receiving mechanical ventilation due to COVID-19. INTERVENTIONS: Use angiotensin II either as rescue vasopressor agent or as low dose vasopressor support. MAIN OUTCOME MEASURES: Patients treated before angiotensin II was available or treated in an adjacent COVID-19 ICU served as controls. For data analysis, we applied Bayesian modelling as appropriate. We assessed the effects of angiotensin II on organ function. RESULTS: We compared 46 patients receiving angiotensin II therapy with 53 controls. Compared with controls, angiotensin II increased the mean arterial pressure (median difference, 9.05 mmHg; 95% CI, 1.87–16.22; P = 0.013) and the Pao2/Fio2 ratio (median difference, 23.17; 95% CI, 3.46–42.88; P = 0.021), and decreased the odds ratio (OR) of liver dysfunction (OR, 0.32; 95% CI, 0.09–0.94). However, angiotensin II had no effect on lactate, urinary output, serum creatinine, C-reactive protein, platelet count, or thromboembolic complications. In patients with abnormal baseline serum creatinine, Bayesian modelling showed that angiotensin II carried a 95.7% probability of reducing the use of renal replacement therapy (RRT). CONCLUSIONS: In ventilated patients with COVID-19, angiotensin II therapy increased blood pressure and Pao2/Fio2 ratios, decreased the OR of liver dysfunction, and appeared to decrease the risk of RRT use in patients with abnormal baseline serum creatinine. However, all of these findings are hypothesis-generating only. TRIAL REGISTRATION: ClinicalTrials.gov NCT04318366.
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- 2021
8. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy
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Grasselli, Giacomo, Zangrillo, Alberto, Zanella, Alberto, Antonelli, Massimo, Cabrini, Luca, Castelli, Antonio, Cereda, Danilo, Coluccello, Antonio, Foti, Giuseppe, Fumagalli, Roberto, Iotti, Giorgio, Latronico, Nicola, Lorini, Luca, Merler, Stefano, Natalini, Giuseppe, Piatti, Alessandra, Ranieri, Marco Vito, Scandroglio, Anna Mara, Storti, Enrico, Cecconi, Maurizio, Pesenti, Antonio, Agosteo, Emiliano, Alaimo, Valentina, Albano, Giovanni, Albertin, Andrea, Alborghetti, Armando, Aldegheri, Giorgio, Antonini, Benvenuto, Barbara, Enrico, Belgiorno, Nicolangela, Belliato, Mirko, Benini, Annalisa, Beretta, Enrico, Bianciardi, Leonardo, Bonazzi, Stefano, Borelli, Massimo, Boselli, Enrico, Bronzini, Nicola, Capra, Carlo, Carnevale, Livio, Casella, Giampaolo, Castelli, Gianpaolo, Catena, Emanuele, Cattaneo, Sergio, Chiumello, Davide, Cirri, Silvia, Citerio, Giuseppe, Colombo, Sergio, Coppini, Davide, Corona, Alberto, Cortellazzi, Paolo, Costantini, Elena, Covello, Remo Daniel, De Filippi, Gianluca, Dei Poli, Marco, Della Mura, Federica, Evasi, Giulia, Fernandez-Olmos, Raquel, Forastieri Molinari, Andrea, Galletti, Marco, Gallioli, Giorgio, Gemma, Marco, Gnesin, Paolo, Grazioli, Lorenzo, Greco, Stefano, Gritti, Paolo, Grosso, Paolo, Guatteri, Luca, Guzzon, Davide, Harizay, Fabiola, Keim, Roberto, Landoni, Giovanni, Langer, Thomas, Lombardo, Andrea, Malara, Annalisa, Malpetti, Elena, Marino, Francesco, Marino, Giovanni, Mazzoni, Maurizio Giovanni, Merli, Guido, Micucci, Antonio, Mojoli, Francesco, Muttini, Stefano, Nailescu, Adriana, Panigada, Mauro, Perazzo, Paolo, Perego, Giovanni Battista, Petrucci, Nicola, Pezzi, Angelo, Protti, Alessandro, Radrizzani, Danilo, Raimondi, Maurizio, Ranucci, Marco, Rasulo, Frank, Riccio, Mario, Rona, Roberto, Roscitano, Claudio, Ruggeri, Patrizia, Sala, Antonello, Sala, Giuseppe, Salvi, Luca, Sebastiano, Pietro, Severgnini, Paolo, Sforzini, Ilaria, Sigurtà, Francesco Donato, Subert, Matteo, Tagliabue, Paola, Troiano, Carmine, Valsecchi, Roberto, Viola, Uberto, Vitale, Giovanni, Zambon, Massimo, Zoia, Elena, Grasselli, G, Zangrillo, A, Zanella, A, Antonelli, M, Cabrini, L, Castelli, A, Cereda, D, Coluccello, A, Foti, G, Fumagalli, R, Iotti, G, Latronico, N, Lorini, L, Merler, S, Natalini, G, Piatti, A, Ranieri, Mv, Scandroglio, Am, Storti, E, Cecconi, M, Pesenti, A (COVID-19 Lombardy ICU Network), Landoni, G, Ranieri, M, Scandroglio, A, Pesenti, A, and Lorini, F
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Artificial ventilation ,medicine.medical_specialty ,medicine.medical_treatment ,01 natural sciences ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Intensive care ,Internal medicine ,Settore MED/41 - ANESTESIOLOGIA ,Medicine ,030212 general & internal medicine ,0101 mathematics ,Positive end-expiratory pressure ,Original Investigation ,Mechanical ventilation ,SARS-CoV-2 ,business.industry ,010102 general mathematics ,Retrospective cohort study ,General Medicine ,medicine.disease ,Comorbidity ,Intensive care unit ,Respiratory failure ,SARS-CoV-2, ICU ,business - Abstract
Question What are the baseline characteristics and outcomes of patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to intensive care units (ICUs) in Lombardy, Italy? Findings In this retrospective case series that involved 1591 critically ill patients admitted from February 20 to March 18, 2020, 99% (1287 of 1300 patients) required respiratory support, including endotracheal intubation in 88% and noninvasive ventilation in 11%; ICU mortality was 26%. Meaning In this case series of critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed coronavirus disease 2019 (COVID-19), a high proportion required mechanical ventilation and ICU mortality was 26% as of March 25, 2020.Importance In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. Objective To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy. Design, Setting, and Participants Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020. Exposures SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs. Main Outcomes and Measures Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network. Results Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio(2) was greater than 50% in 89% of patients. The median Pao(2)/Fio(2) was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged = 64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P = .94). Median Fio(2) was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, -10% [95% CI, -14% to 6%]; P = .006), and median Pao(2)/Fio(2) was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, -8 to 22]; P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P < .001) and had lower Pao(2)/Fio(2) (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, -27 [95% CI, -42 to -12]; P = .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n = 786; age >= 64 years) had higher mortality than younger patients (n = 795; age
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- 2020
9. 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
10. Role of Survival Scores Before Left Ventricular Assist Device Implantation: The New CHRiSS Compared to the HeartMate II Score
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Friedrich Kaufmann, Anna Mara Scandroglio, Volkmar Falk, Thomas Krabatsch, Evgenij V. Potapov, Marina Pieri, Alberto Zangrillo, Scandroglio, Am, Pieri, M, Zangrillo, Alberto, Kaufmann, F, Falk, V, Potapov, E, and Krabatsch, T.
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Adult ,Male ,Risk ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Biomedical Engineering ,Biophysics ,Bioengineering ,030204 cardiovascular system & hematology ,Biomaterials ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,education ,Aged ,Retrospective Studies ,education.field_of_study ,Heartmate ii ,Receiver operating characteristic ,business.industry ,Significant difference ,Area under the curve ,Retrospective cohort study ,Bayes Theorem ,General Medicine ,Middle Aged ,Surgery ,ROC Curve ,Sample size determination ,Ventricular assist device ,Female ,Heart-Assist Devices ,business - Abstract
Risk stratification of patients are claimed to be useful before left ventricular assist device (LVAD) implantation and different scoring systems are available. The aim of the study was to validate the Cardiac Health Risk Stratification System (CHRiSS), based on Bayesian network analysis, and the HeartMate II score in our patient population. We retrospectively calculated the CHRiSS using a web-based application and the HeartMate II score of 105 adult patients who underwent consecutive HVAD (HeartWare International, Inc.) implantation as primary LVAD at our institution in a 12-month period (May 2014-April 2015). Survival was 83.8 % (3.6%) at 30 days, 77.8% (4.0%) at 90 days, and 72.8% (4.8%) at 6 months and 1 year. The area under the curve (AUC) of the receiver operating characteristics (ROC) curve for CHRiSS was 0.75 at 30 days, 0.66 at 90 days, and 0.65 at 6 months. The HeartMate II score had an AUC of 0.73 at 90 days. Comparison between the ROC curves of the two models calculated at 90 days showed no statistically significant difference (p = 0.48): CHRiSS presents a high positive predictive value (85 [80-91]), the opposite to the HeartMate II score, which has a high negative predictive value (91 [83.4-96.6]). In our population, application of the CHRiSS was valuable at 30 days, but the overall predictive value of both scores is not satisfactory. The CHRiSS model proved to be a promising tool, suggesting that, with greater sample size and a longer data collection period, it might potentially outperform the HeartMate II scoring system.
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- 2016
11. Volatile Agents in Medical and Surgical Intensive Care Units: A Meta-Analysis of Randomized Clinical Trials
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Giovanni Landoni, Carmine D. Votta, Anna Mara Scandroglio, Mattia Bellandi, Alberto Zangrillo, Laura Pasin, Giovanni Borghi, Martina Baiardo Redaelli, Luca Cabrini, Landoni, Giovanni, Pasin, L, Cabrini, L, Scandroglio, Am, Baiardo Redaelli, M, Votta, Cd, Bellandi, M, Borghi, G, and Zangrillo, Alberto
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medicine.medical_specialty ,Critical Care ,Sedation ,critically ill ,anesthesia ,intensive care ,mechanical ventilation ,sedation ,volatile agents ,Airway Extubation ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Intensive care ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Randomized Controlled Trials as Topic ,business.industry ,030208 emergency & critical care medicine ,Intensive care unit ,Clinical trial ,Intensive Care Units ,Anesthesiology and Pain Medicine ,Strictly standardized mean difference ,Meta-analysis ,Anesthetics, Inhalation ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVE:To comprehensively assess published randomized peer-reviewed studies related to volatile agents used for sedation in intensive care unit (ICU) settings, with the hypothesis that volatile agents could reduce time to extubation in adult patients.DESIGN:Systematic review and meta-analysis of randomized trials.SETTING:Intensive care units.PARTICIPANTS:Critically ill patients.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:The BioMedCentral, PubMed, Embase, and Cochrane Central Register databases of clinical trials were searched systematically for studies on volatile agents used in the ICU setting. Articles were assessed by trained investigators, and divergences were resolved by consensus. Inclusion criteria included random allocation to treatment (volatile agents versus any intravenous comparator, with no restriction on dose or time of administration) in patients requiring mechanical ventilation in the ICU. Twelve studies with 934 patients were included in the meta-analysis. The use of halogenated agents reduced the time to extubation (standardized mean difference = -0.78 [-1.01 to -0.55] hours; p for effect
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- 2016
12. Desflurane Versus Propofol in Patients Undergoing Mitral Valve Surgery
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Giovanni Landoni, E. Dedola, Alberto Zangrillo, Monica De Luca, Luigi Tritapepe, C. Marchetti, Giuseppe Crescenzi, Anna Mara Scandroglio, Maria Grazia Calabrò, Elena Bignami, Landoni, Giovanni, Calabro, Mg, Marchetti, C, Bignami, E, Scandroglio, Am, Dedola, E, De Luca, M, Tritapepe, L, Crescenzi, G, and Zangrillo, Alberto
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Male ,medicine.medical_specialty ,coronary artery bypass grafting ,desflurane ,mitral valve surgery ,preconditioning ,troponin ,Aged ,Biomarkers ,Clinical Protocols ,Female ,Follow-Up Studies ,Humans ,Isoflurane ,Middle Aged ,Mitral Valve ,Prospective Studies ,Statistics, Nonparametric ,Troponin I ,Anesthetics, Inhalation ,Anesthetics, Intravenous ,Propofol ,Cardiology and Cardiovascular Medicine ,Anesthesiology and Pain Medicine ,law.invention ,Coronary artery disease ,Desflurane ,law ,Internal medicine ,medicine ,Cardiopulmonary bypass ,biology ,business.industry ,medicine.disease ,Troponin ,medicine.anatomical_structure ,Anesthesia ,Anesthetic ,Cardiology ,biology.protein ,business ,medicine.drug ,Artery - Abstract
Objective: Myocardial ischemic damage is reduced by volatile anesthetics in patients undergoing coronary artery bypass graft surgery, but it is unknown whether this benefit exists in patients undergoing valvular surgery with ischemia-reperfusion injury related to cardioplegic arrest and cardiopulmonary bypass. This study compared cardiac troponin release in patients receiving either volatile anesthetics or total intravenous anesthesia for mitral valve surgery. Design: Randomized controlled study. Setting: University hospital. Participants: One hundred twenty patients undergoing mitral valve surgery. Interventions: Fifty-nine patients received the volatile anesthetic desflurane for 30 minutes before cardiopulmonary bypass, whereas 61 patients received a total intravenous anesthetic with propofol. All patients had an opioid-based anesthetic for the mitral valve surgery. Measurements and Main Results: Peak postoperative troponin I release was measured as a marker of myocardial necrosis after mitral valve surgery. Patient mean age was 60 years, and 54% were men. There was no significant (p = 0.7) reduction in median (25th-75th percentiles) postoperative peak troponin, 11.0 (7.5-17.4) ng/dL in the desflurane group versus 11.5 (6.9-18.0) ng/dL in the propofol group. A subgroup of patients with concomitant coronary artery disease had the expected reduction (p = 0.02) of peak troponin I in those receiving desflurane, 14.0 (9.7-17.3) ng/dL, when compared with patients receiving total intravenous anesthesia, 31.6 (15.7-52.0) ng/dL. Conclusions: Myocardial damage measured by cardiac troponin release was not reduced by volatile anesthetics in patients undergoing mitral valve surgery, whereas it was reduced in patients with concomitant coronary artery disease. (C) 2007 Elsevier Inc. All rights reserved.
- Published
- 2007
13. Reduction of hemodilution in small adults undergoing open heart surgery: a prospective, randomized trial
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Annalisa Franco, Giuseppe Crescenzi, Alberto Zangrillo, Federico Pappalardo, A. M. Scandroglio, C. Corno, Giuseppe Giardina, Giovanni Landoni, Pappalardo, Federico, Corno, C, Franco, A, Giardina, G, Scandroglio, Am, Landoni, Giovanni, Crescenzi, G, and Zangrillo, Alberto
- Subjects
Male ,medicine.medical_specialty ,Blood transfusion ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Hematocrit ,Extracorporeal ,law.invention ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Cardiopulmonary bypass ,Body Size ,Humans ,Blood Transfusion ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Coronary Artery Bypass ,Prospective cohort study ,Aged ,Advanced and Specialized Nursing ,Body surface area ,Hemodilution ,Cardiopulmonary Bypass ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,Surgery ,Treatment Outcome ,030228 respiratory system ,Anesthesia ,Female ,Cardiology and Cardiovascular Medicine ,business ,Safety Research ,Nadir (topography) - Abstract
Background. Given that there is an association between the degree of hemodilution during cardiopulmonary bypass (CPB) and postoperative complications, patients-outcome might be improved if the nadir hematocrit concentration is kept within an optimal range. Smaller patients are more likely to have a low hematocrit during CPB: this phenomenon may be related, at least partially, to the extreme hemodilution induced by a large fixed CPB priming volume. Methods. Forty patients with a body surface area (BSA) < 1.7 m2 undergoing open heart operations were randomized to either standard CPB with full prime volume (control group) or reduced prime extracorporeal circuit and vacuum-assisted venous drainage (VAVD) (study group). Results. There were no significant differences between the groups with respect to baseline characteristics, body surface area, hematologic profile and operative data. Clinical outcomes were similar. Nadir hematocrit and hemoglobin on bypass were significantly lower in the control group (22 ± 2.3 vs 24 ± 2.5%, p < 0.02 and 7.4 ± 0.7 vs 8 ± 0.9g/dl, p < 0.04, respectively). Postoperative chest tube drainage was significantly higher in the control group (272 ± 253vs 139 ± 84ml, p < 0.04). There was no difference in blood transfusion in the two groups (0.5 ± 1.14 v 1.0 ± 1.77 units of packed red blood cells (PRBC), p = 0.29). Conclusions. Lowering CPB priming volume by means of using a small oxygenator and vacuum-assisted venous drainage (VAVD) resulted in a significant decrease of intraoperative hemodilution. This technique should be strongly considered for patients with a small BSA (2) undergoing open heart surgery. Perfusion (2007) 22, 317—322.
- Published
- 2007
14. Percutaneous tracheostomy in patients on anticoagulants
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Luca Cabrini, Alberto Zangrillo, Pasquale Nardelli, Laura Pasin, Federico Pappalardo, Landoni Giovanni, Maria Grazia Calabrò, Elena Frati, Anna Mara Scandroglio, Tiziana Bove, Pasin, L, Frati, E, Cabrini, L, Landoni, G, Nardelli, P, Bove, T, Calabro, Mg, Scandroglio, Am, Pappalardo, F, and Zangrillo, A
- Subjects
Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Procedure related bleeding complication ,Percutaneous ,Procedure related bleeding complications ,Blood Loss, Surgical ,Antiplatelet therapies ,law.invention ,Tracheostomy ,Critically ill patients ,Retrospective Studie ,law ,Medicine ,Prospective cohort study ,education.field_of_study ,Anticoagulant ,General Medicine ,Anticoagulants, Antiplatelet therapies, Critically ill patients, Intensive Care Unit, Percutaneous tracheostomy, Procedure related bleeding complications ,Intensive care unit ,Percutaneous tracheostomy ,Intensive Care Units ,Critical Illne ,Original Article ,Female ,Critically ill patient ,Erratum ,Cardiology and Cardiovascular Medicine ,Human ,medicine.medical_specialty ,Anticoagulants ,Intensive Care Unit ,medicine.drug_class ,Critical Illness ,Population ,Low molecular weight heparin ,lcsh:RD78.3-87.3 ,Humans ,education ,Aged ,Retrospective Studies ,Antiplatelet therapie ,business.industry ,Retrospective cohort study ,Surgery ,Anesthesiology and Pain Medicine ,lcsh:Anesthesiology ,lcsh:RC666-701 ,business - Abstract
Aims: To determine if percutaneous tracheostomy is safe in critically ill patients treated with anticoagulant therapies. Settings and Design: Single-center retrospective study including all the patients who underwent percutaneous dilatational tracheostomy (PDT) placement over a 1-year period in a 14-bed, cardiothoracic and vascular Intensive Care Unit (ICU). Materials and Methods: Patients demographics and characteristics, anticoagulant and antiplatelet therapies, coagulation profile, performed technique and use of bronchoscopic guidance were retrieved. Results: Thirty-six patients (2.7% of the overall ICU population) underwent PDT over the study period. Twenty-six (72%) patients were on anticoagulation therapy, 1 patient was on antiplatelet therapy and 2 further patients received prophylactic doses of low molecular weight heparin. Only 4 patients had normal coagulation profile and were not receiving anticoagulant or antiplatelet therapies. Overall, bleeding of any severity complicated 19% of PDT. No procedure-related deaths occurred. Conclusions: PDT was proved to be safe even in critically ill-patients treated with anticoagulant therapies. Larger prospective studies are needed to confirm our findings.
- Published
- 2015
15. Effect of fenoldopam on use of renal replacement therapy among patients with acute kidney injury after cardiac surgery: a randomized clinical trial
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Maria Chiara Zucchetti, Bruno Persi, Marco Comis, Anna Mara Scandroglio, Federico Pappalardo, Gabriele Alvaro, E Maglioni, Daniela Pasero, Nicola Galdieri, Claudio Verdecchia, Bruno Amantea, Mario Frontini, Massimiliano Conte, Giovanni Landoni, Anna Maria Camata, Erika Dal Checco, Fabio Guarracino, Fulvio Pinelli, Maria Grazia Calabrò, Alberto Zangrillo, Massimo Renzini, Rubia Baldassarri, Rinaldo Bellomo, Tiziana Bove, Omar Saleh, Claudia Cariello, Antonio Pisano, Fabio Caramelli, Luana Faita, Gianluca Paternoster, Rosalba Lembo, Blanca Martinez, Giovanni Pala, Bove, T, Zangrillo, Alberto, Guarracino, F, Alvaro, G, Persi, B, Maglioni, E, Galdieri, N, Comis, M, Caramelli, F, Pasero, Dc, Pala, G, Renzini, M, Conte, M, Paternoster, G, Martinez, B, Pinelli, F, Frontini, M, Zucchetti, Mc, Pappalardo, Federico, Amantea, B, Camata, A, Pisano, A, Verdecchia, C, Dal Checco, E, Cariello, C, Faita, L, Baldassarri, R, Scandroglio, Am, Saleh, O, Lembo, R, Calabro, Mg, Bellomo, R, and Landoni, Giovanni
- Subjects
Fenoldopam ,business.industry ,medicine.medical_treatment ,Acute kidney injury ,General Medicine ,medicine.disease ,Interim analysis ,Placebo ,Intensive care unit ,law.invention ,Randomized controlled trial ,law ,Intensive care ,Anesthesia ,Medicine ,Renal replacement therapy ,business ,medicine.drug - Abstract
Importance No effective pharmaceutical agents have yet been identified to treat acute kidney injury after cardiac surgery. Objective To determine whether fenoldopam reduces the need for renal replacement therapy in critically ill cardiac surgery patients with acute kidney injury. Design, Setting, and Participants Multicenter, randomized, double-blind, placebo-controlled, parallel-group study from March 2008 to April 2013 in 19 cardiovascular intensive care units in Italy. We randomly assigned 667 patients admitted to intensive care units after cardiac surgery with early acute kidney injury (≥50% increase of serum creatinine level from baseline or oliguria for ≥6 hours) to receive fenoldopam (338 patients) or placebo (329 patients). We used a computer-generated permuted block randomization sequence for treatment allocation. All patients completed their follow-up 30 days after surgery, and data were analyzed according to the intention-to-treat principle. Interventions Continuous infusion of fenoldopam or placebo for up to 4 days with a starting dose of 0.1 μg/kg/min (range, 0.025-0.3 µg/kg/min). Main Outcomes and Measures The primary end point was the rate of renal replacement therapy. Secondary end points included mortality (intensive care unit and 30-day mortality) and the rate of hypotension during study drug infusion. Results The study was stopped for futility as recommended by the safety committee after a planned interim analysis. Sixty-nine of 338 patients (20%) allocated to the fenoldopam group and 60 of 329 patients (18%) allocated to the placebo group received renal replacement therapy ( P = .47). Mortality at 30 days was 78 of 338 (23%) in the fenoldopam group and 74 of 329 (22%) in the placebo group ( P = .86). Hypotension occurred in 85 (26%) patients in the fenoldopam group and in 49 (15%) patients in the placebo group ( P = .001). Conclusions and Relevance Among patients with acute kidney injury after cardiac surgery, fenoldopam infusion, compared with placebo, did not reduce the need for renal replacement therapy or risk of 30-day mortality but was associated with an increased rate of hypotension. Trial Registration clinicaltrials.gov Identifier:NCT00621790
- Published
- 2014
16. Cardiac index validation using the pressure recording analytic method in unstable patients
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Alberto Zangrillo, Giovanni Landoni, Fabrizio Monaco, Isotta Virzo, Valentina Paola Plumari, Giulia Maj, Elena Bignami, Massimiliano Nuzzi, Anna Mara Scandroglio, Giuseppina Maria Casiraghi, Zangrillo, Alberto, Maj, G, Monaco, F, Scandroglio, Am, Nuzzi, M, Plumari, V, Virzo, I, Bignami, E, Casiraghi, G, and Landoni, Giovanni
- Subjects
Inotrope ,Male ,medicine.medical_specialty ,Cardiac output ,medicine.medical_treatment ,Thermodilution ,Cardiac index ,Cardiac Output, Low ,Blood Pressure ,law.invention ,law ,Internal medicine ,medicine.artery ,Catheterization, Peripheral ,Medicine ,Humans ,Radial artery ,Cardiac Output ,Aged ,Intra-Aortic Balloon Pumping ,business.industry ,Pulmonary artery catheter ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Intensive care unit ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective: The authors investigated the accuracy and precision of the pressure recording analytic method (PRAM) in cardiac index measurement compared with thermodilution in unstable patients, a setting in which minimally invasive monitoring devices often fail. Design: Criterion standard. Setting: Intensive care unit. Patients: Thirty-two consecutive patients with low cardiac output syndrome treated with an intra-aortic balloon pump and/or high doses of inotropic drugs but without atrial fibrillation were studied after cardiac surgery. Interventions: None. Pulmonary and radial artery catheters were already in situ for clinical reasons. Measurements and Main Results: Four patients (12.5%) were excluded from the study because of artifacts caused by under- or overdamping of the arterial pressure monitoring system. The authors performed 3 injections of the thermal indicator in 5 minutes through the pulmonary artery catheter. Mean cardiac index values of 12 consecutive beats were considered for the PRAM. A significant correlation was found between the cardiac index assessed by thermodilution and PRAM (r = 0.72, p < 0.001). The mean bias between the 2 techniques was 0.072 +/- 0.41 L/min/m(2) with lower and upper 95% limits of confidence of -0.089 and 0.233 L/min/m(2), respectively. The percentage error was 30%. Sufficient agreement between the two techniques was evidenced by the Bland-Altman plot with only two points above the limits of agreement. Conclusions: This study showed that PRAM, a minimally invasive method for cardiac index assessment, is clinically useful even in unstable patients such as those receiving intra-aortic balloon pump and/or ongoing high doses of a inotropic drugs because of a low cardiac output syndrome but without atrial fibrillation. (C) 2010 Elsevier Inc. All rights reserved.
- Published
- 2009
17. Cardiac protection with volatile anesthetics in stenting procedures
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Anna Mara Scandroglio, Alberto Zangrillo, Antonio Colombo, Andrea Morelli, O. Fochi, Giovanni Landoni, Matteo Montorfano, Luigi Tritapepe, Giulia Maj, Landoni, Giovanni, Zangrillo, Alberto, Fochi, O, Mai, G, Scandroglio, Am, Morelli, A, Tritapepe, L, Montorfano, M, and Colombo, A.
- Subjects
Methyl Ethers ,medicine.medical_specialty ,Cardiotonic Agents ,Placebo ,Perioperative Care ,Sevoflurane ,law.invention ,Randomized controlled trial ,Interquartile range ,law ,Internal medicine ,Troponin I ,coronary stenting ,inhalation anesthetics ,myocardial ischemia ,myocardial preconditioning ,medicine ,Humans ,Single-Blind Method ,Coronary Artery Bypass ,Aged ,Interventional cardiology ,business.industry ,Perioperative ,Middle Aged ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Anesthesia ,Anesthetics, Inhalation ,Cardiology ,Stents ,Volatilization ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Artery - Abstract
Objective: Myocardial ischemic damage is reduced by volatile anesthetics in patients undergoing coronary artery bypass graft surgery. The authors tested the hypothesis that low-dose sevoflurane could decrease perioperative myocardial damage, as measured by cTnI release, when compared with placebo, in patients undergoing interventional cardiology procedures. Design: A single-blind, randomized controlled trial. Setting: A university hospital. Participants: Thirty patients undergoing stenting procedures (May 2005) were included in the present study. Interventions: The authors randomly assigned 16 patients to breathe sevoflurane (expired end-tidal concentration 1%) and 14 patients to breathe a placebo oxygen/air mix before stenting procedures. Measurements and Main Results: Postprocedural cardiac troponin I release was measured as a marker of myocardial necrosis. Sixteen patients had detectable cardiac troponin I levels after stenting procedures, with no difference between groups: 10 in the sevoflurane group (16 patients) versus 6 in the placebo group (14 patients) (p = 0.3). No difference in the amount of postprocedural median (interquartile range) cardiac troponin I release was noted between the sevoflurane group, 0.15 (0-4.73) ng/mL, and the placebo group, 0.14 (0-0.87) ng/mL (p = 0.4). Conclusions: Myocardial damage measured by cardiac troponin release was not reduced by the volatile anesthetic sevoflurane during interventional cardiology procedures in this study. (C) 2008 Elsevier Inc. All rights reserved.
- Published
- 2008
18. Anesthesiological management and outcome of 100 'beating heart' coronary artery bypass grafting
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Zangrillo A, Gerli C, Giovanni LANDONI, Sparicio D, Roberti A, Sottocorna O, Mantovani L, Am, Scandroglio, Crescenzi G, Zangrillo, Alberto, Gerli, C, Landoni, Giovanni, Sparicio, D, Roberti, A, Sottocorna, O, Mantovani, L, Scandroglio, Am, and Crescenzi, G.
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Male ,Postoperative Care ,Coronary Artery Bypass, Off-Pump ,Anticoagulants ,Middle Aged ,Respiration, Artificial ,Postoperative Complications ,Treatment Outcome ,Myocardial Revascularization ,Humans ,Anesthesia ,Female ,Prospective Studies ,Aged - Abstract
Obiettivo. Lo scopo del presente lavoro è decrivere la gestione anestesiologica e l’outcome della rivascolarizzazione coronarica a cuore battente.Metodi. È stato svolto uno studio prospettico, presso un ospedale universitario, su 100 pazienti adulti consecutive sottoposti a rivascolarizzazione coronarica a cuore battente. I punti salienti della gestione anestesiologica sono il mantenimento della stabilità emodinamica e del contributo diastolico atriale.Risultati. L’introduzione degli stabilizzatori meccanici ha migliorato le gestione di questi pazienti. L’incidenza di complicazioni è stata: mortalità ospedaliera 1%; infarto miocardico acuto 3%; sindrome da bassa gittata 2%; fibrillazione atriale 16%. L’incidenza di insufficienza renale acuta postoperatoria è stata limitata al 2% e in nessun caso si è reso necessario un trattamento sostitutivo renale. Non è stato registrato nessun evento neurologico. Solo il 19% dei pazienti ha ricevuto emotrasfusioni. Il 97% dei pazienti è stato estubato entro 12 h dalla fine dell’ intervento.Conclusioni. La strategia anestesiologica applicata, combinata a una buona tecnica chirurgica e all’uso di dispositivi innovativi, rende questo tipo di chirurgia sicura anche in pazienti ad alto rischio. AIM: The aim of this paper is to describe the anesthesiological management and the outcome of beating heart revascularization.METHODS: A prospective study has been performed in a tertiary teaching hospital on 100 consecutive patients undergoing off-pump coronary artery revascularization. The main features of anesthetic technique are the maintenance hemodynamic stability and atrial kick.RESULTS: Mechanical stabilisers shunts have improved the management of these patients. In hospital mortality was 1%, acute myocardial infarction 3%, low output syndrome 2%, atrial fibrillation 16%. Only 2% of patients had acute renal failure, but no patient needed renal replacement treatment. No neurologic event was noted. Only 19% of patients received blood transfusion. Ninety-seven % of patients were extubated within 12 h.CONCLUSIONS: The application of this anesthetic strategy combined with surgical skillful and new devices makes off-pump surgery safe also in high risk patients.
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- 2006
19. Myocardial damage prevented by volatile anesthetics: a multicenter randomized controlled study
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Alberto Zangrillo, Anna Mara Scandroglio, Giuseppe Crescenzi, Giacomo Aletti, Albino Leoni, Fabio Guarracino, Monica De Luca, Luigi Tritapepe, Giovanni Landoni, C. Marchetti, D. Maselli, Francesca Pompei, Guarracino, F, Landoni, Giovanni, Tritapepe, L, Pompei, F, Leoni, A, Aletti, G, Scandroglio, Am, Maselli, D, De Luca, M, Marchetti, C, Crescenzi, G, and Zangrillo, Alberto
- Subjects
Inotrope ,Male ,medicine.medical_specialty ,off-pump ,coronary artery bypass grafting ,Coronary Artery Bypass, Off-Pump ,Myocardial Reperfusion Injury ,cardiac anesthesia ,Desflurane ,Double-Blind Method ,preconditioning ,Internal medicine ,Troponin I ,medicine ,Humans ,volatile anesthetics ,cardiac biomarker ,troponin ,Propofol ,Aged ,biology ,Isoflurane ,business.industry ,Myocardium ,Heart ,Troponin ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Anesthesia ,Anesthetic ,Anesthetics, Inhalation ,Ischemic Preconditioning, Myocardial ,biology.protein ,Cardiology ,Anesthesia, Intravenous ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anesthesia, Inhalation ,Anesthetics, Intravenous ,medicine.drug - Abstract
Objective: The purpose of this study was to evaluate the effects of volatile anesthesia versus total intravenous anesthesia on cardiac troponin release in off-pump coronary artery bypass grafting (OPCAB). Design: The authors performed a multicenter randomized controlled study to compare cardiac troponin release in patients receiving either volatile anesthetics or total intravenous anesthesia for cardiac surgery on the beating heart, which is an excellent model of human myocardial ischemia. Setting: Three university hospitals. Participants: The authors randomly assigned 57 patients to desflurane (volatile anesthetic) and 55 patients to propofol (intravenous anesthetic) in addition to an opiate-based anesthesia for OPCAB. Interventions: The 2 groups of patients received either desflurane (volatile anesthetic) or propofol in addition to an opiate-based anesthesia for OPCAB. Peak postoperative troponin I release was measured as a marker of myocardial necrosis. Prolonged hospitalization was considered as a secondary outcome. Measurements and Main Results: Patient mean age was 69 years, and 82% were men. There was a significant (p < 0.001) reduction in postoperative median (25th-75th percentiles) peak of troponin I in patients receiving volatile anesthetics, 1.2 (0.9-1.9) ng/dL, compared with patients receiving total intravenous anesthesia, 2.7 (2.1-4.0) ng/dL. This myocardial protection resulted in a reduced (p = 0.04) number (percentage) of patients requiring postoperative inotropes, 20 (35%) versus 31 (56%), and a reduced number (percentage) of patients submitted to prolonged hospitalization ( 7 days), 7 (12%) versus 20 (36%) in the 2 groups (p = 0.005). One patient receiving total intravenous anesthesia died within 30 days of surgery. Conclusions: Myocardial damage measured by cardiac troponin release could be reduced by volatile anesthetics during OPCAB. Because patients underwent cardiac surgery on the beating heart, these results could have implications for cardiac patients undergoing noncardiac surgery. (C) 2006 Elsevier Inc. All rights reserved.
- Published
- 2006
20. Multivessel off-pump coronary artery bypass grafting in a nonagenarian: anesthesiologic management
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Crivellari M, Giovanni LANDONI, Bellotti F, Cedrati V, Am, Scandroglio, Boroli F, Gerli C, Zangrillo A, Crivellari, A, Landoni, Giovanni, Bellotti, F, Cedrati, V, Scandroglio, Am, Boroli, F, Gerli, C, and Zangrillo, Alberto
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Aged, 80 and over ,Male ,Electrocardiography ,Heart Block ,Coronary Artery Bypass, Off-Pump ,Humans ,Anesthesia ,Intraoperative Complications - Abstract
A 90-year-old male admitted with history of angina (three-vessel disease) on medical therapy for hypertension and chronic renal failure was scheduled for elective coronary artery bypass grafting (CABG). After standard premedication and monitoring anesthesia was induced with propofol and maintained with isoflurane. Middle dose opioids and atracurium were also given. Multivessel. revascularization was done trought median sternotomy and anastomoses were performed with the aid of coronary stabilization and shunting. Cerebral and renal perfusion were maintained with high arterial pressure (140/70 mmHg) and continuous infusion of fenoldopam (0.05 mu g kg(1) m(-1)). The perioperative period was uneventful. Elderly patients are at increased risk for mortality and morbidity after CABG. The procedure can be performed safely on elderly patients without using cardiopulmonary bypass and preventing cerebral and renal ipoperfusion. Descriviamo il caso clinico di un paziente di 90 anni, con un’anamnesi positiva per angina e per coronaropatia trivasale in terapia per ipertensione arteriosa ed insufficienza renale, che veniva ricoverato per intervento di bypass aorto coronarico in elezione. Dopo una premedicazione standard, l’induzione era ottenuta con fentanyl 5 µg kg-1, propofol 2 mg kg-1 e per facilitare l’intubazione endotracheale atracurium 0,5 mg kg-1. L’anestesia era mantenuta con propofol 2 mg kg-1 e boli refratti di fentanyl. Dopo il monitoraggio si procedeva quindi ad una sternotomia mediana e ad una rivascolarizzazione completa (4 vasi). Le anastomosi venivano confezionate con impiego di stabilizzatori e con il posizionamento di shunt. Durante l’intervento le perfusioni cerebrale e renale venivano mantenute rispettivamente con pressione arteriosa elevata (140/70 mmHg) e con somministrazione continua di fenoldopam (0,05 µg kg1 m-1). Non si sono verificati eventi patologici nella fase perioperatoria. I pazienti anziani sono esposti ad una maggiore mortalità e morbidità dopo un intervento di bypass aorto coronarico. La procedura può essere eseguita in sicurezza senza l’utilizzo del bypass cardio polmonare e prevenendo l’ipoperfusione cerebrale e renale. A 90-year-old male admitted with history of angina (three-vessel disease) on medical therapy for hypertension and chronic renal failure was scheduled for elective coronary artery bypass grafting (CABG). After standard premedication and monitoring anesthesia was induced with propofol and maintained with isoflurane. Middle dose opioids and atracurium were also given. Multivessel revascularization was done through median sternotomy and anastomoses were performed with the aid of coronary stabilization and shunting. Cerebral and renal perfusion were maintained with high arterial pressure (140/70 mmHg) and continuous infusion of fenoldopam (0.05 microg kg(1) m(-1)). The perioperative period was uneventful. Elderly patients are at increased risk for mortality and morbidity after CABG. The procedure can be performed safely on elderly patients without using cardiopulmonary bypass and preventing cerebral and renal ipoperfusion.
- Published
- 2006
21. A 20-joule electrical cardioversion applied directly to the heart elevates troponin I by at least 1.5 ng.mL-1
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Carlo Pappone, Anna Mara Scandroglio, Giovanni Landoni, Alberto Zangrillo, Giuseppe Crescenzi, Lorenzo G. Mantovani, Annalisa Franco, Maria Grazia Calabrò, Zangrillo, Alberto, Landoni, Giovanni, Crescenzi, G, Scandroglio, Am, Calabro, Mg, Mantovani, L, Franco, A, and Pappone, C.
- Subjects
medicine.medical_specialty ,business.industry ,Pain medicine ,Myocardium ,Troponin I ,Electric Countershock ,Joule ,General Medicine ,Electrical cardioversion ,Anesthesiology and Pain Medicine ,Internal medicine ,Anesthesiology ,Anesthesia ,Cardiology ,Medicine ,Humans ,business - Published
- 2005
22. Cardiac biomarker release after CABG with different surgical techniques
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Elena Bignami, Alberto Zangrillo, Anna Mara Scandroglio, Giacomo Aletti, Valeria Cedrati, Tiziana Bove, Giuseppe Crescenzi, Giovanni Landoni, Albino Leoni, Crescenzi, G, Cedrati, V, Landoni, Giovanni, Scandroglio, Am, Bignami, E, Bove, T, Leoni, A, Aletti, G, and Zangrillo, Alberto
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,law.invention ,law ,Internal medicine ,Troponin I ,Cardiopulmonary bypass ,Medicine ,Creatine Kinase, MB Form ,Humans ,Prospective Studies ,Coronary Artery Bypass ,Prospective cohort study ,Creatine Kinase ,Aged ,Ejection fraction ,Cardiopulmonary Bypass ,business.industry ,Middle Aged ,Intensive care unit ,Troponin ,Cardiac surgery ,Isoenzymes ,surgical procedures, operative ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Multivariate Analysis ,Cardiology ,Biomarker (medicine) ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Artery - Abstract
Objective: To investigate the release of cardiac biomarkers (troponin 1 and CK-MB) in patients undergoing coronary artery bypass graft (CABG) with or without cardiopulmonary bypass (CPB). Design: Prospective study. Setting: University tertiary hospital. Participants: Sixty-five consecutive patients undergoing coronary artery bypass grafting (greater than or equal to2 vessel disease, ejection fraction greater than or equal to0.35%, elective procedure). Interventions: Cardiac biomarkers were measured before surgery, at intensive care unit arrival, 4 and 18 hours after the end of the procedure. Measurements and Main Results: Cardiac biomarker release was higher in on-pump than in off-pump patients at every time point. On multivariate analysis, CPB (p < 0.0001), number of distal grafts (p = 0.005), and hypertension treatment (p = 0.03) were the only independent predictors of peak cardiac troponin release. Conclusions: Cardiac troponin 1 release after multivessel CABG is associated with the technique. Different values for the normal range should be considered. OPCABG is minimally invasive for the heart as far as myocardial marker release is concerned. (C) 2004 Elsevier Inc. All rights reserved.
- Published
- 2004
23. ECG changes after CABG: the role of the surgical technique
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Giuseppe Crescenzi, Giacomo Aletti, Federico Pappalardo, Alberto Zangrillo, Anna Mara Scandroglio, Giovanni Landoni, Valeria Cedrati, Elena Bignami, Crescenzi, G, Scandroglio, Am, Pappalardo, Federico, Landoni, Giovanni, Cedrati, V, Bignami, E, Aletti, G, and Zangrillo, Alberto
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,law.invention ,Electrocardiography ,law ,Internal medicine ,Troponin I ,Cardiopulmonary bypass ,medicine ,Odds Ratio ,Creatine Kinase, MB Form ,Humans ,cardiovascular diseases ,Myocardial infarction ,Postoperative Period ,Prospective Studies ,Coronary Artery Bypass ,Prospective cohort study ,Creatine Kinase ,Aged ,Mitral valve repair ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Intensive care unit ,Isoenzymes ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Logistic Models ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Artery - Abstract
Objective: The purpose of this study was to determine whether coronary artery bypass grafting (CABG) surgery on the beating heart (BH) is associated with reduction of R-wave potentials on the precordial leads on the surface electrocardiogram (ECG) as previously shown for CABG with cardiopulmonary bypass. Methods: Fifty-four patients undergoing CABG surgery at a single tertiary care university hospital were analyzed. Patients suffering a postoperative cardiac event (myocardial infarction) or nonspecific ECG changes were excluded. ECG results were recorded at arrival in the intensive care unit, after 4 and 18 hours postoperatively; simultaneously, myocardial cell damage biomarkers (CK-MB and cTnl) were assayed. A control group of 31 patients undergoing mitral valve repair was also evaluated. Results: Patients operated with the BH (OPCABG) technique did not show any decrease of R-wave amplitude at 0, 4, and 18 hours postoperatively; whereas those operated with CPB, both for coronary artery surgery and for mitral repair, had a similar extent and pattern of R-wave reduction. The release of myocardial necrosis markers was significantly lower in coronary artery patients operated with BH than in those operated with CPB; however, no statistically significant correlation between the ECG changes and release of myocardial cell damage markers was observed in any of the groups. Conclusions: The findings indicate, for the first time, that CABG surgery on the BH is not followed by any reduction of R-wave amplitude on precordial leads and confirms that the BH technique is associated with a lower release of myocardial cell damage markers. (C) 2004 Elsevier Inc. All rights reserved.
- Published
- 2004
24. Clinical significance of a new Q wave after cardiac surgery
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Alberto Zangrillo, Anna Mara Scandroglio, Tiziana Bove, Giuseppe Crescenzi, Ottavio Alfieri, Giacomo Aletti, Federico Pappalardo, Giovanni Landoni, Crescenzi, G, Bove, T, Pappalardo, Federico, Scandroglio, Am, Landoni, Giovanni, Aletti, G, Zangrillo, Alberto, and Alfieri, Ottavio
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Heart disease ,Myocardial Infarction ,Sensitivity and Specificity ,law.invention ,Electrocardiography ,Postoperative Complications ,law ,Internal medicine ,Troponin I ,medicine ,Creatine Kinase, MB Form ,Humans ,Myocardial infarction ,Postoperative Period ,Prospective Studies ,Cardiac Surgical Procedures ,Creatine Kinase ,Aged ,medicine.diagnostic_test ,biology ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Intensive care unit ,Troponin ,Cardiac surgery ,Isoenzymes ,Logistic Models ,Cardiology ,biology.protein ,Surgery ,Female ,Myocardial infarction diagnosis ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Objective: The appearance of new Q waves on the electrocardiogram (ECG) after cardiac surgery has been traditionally considered a sign of major myocardial tissue damage. The aim of this study was to investigate the clinical significance of new Q waves appearing following cardiac surgery and to correlate them with the release of myocardial cell damage biomarkers. Methods: 206 consecutive patients undergoing cardiac surgery were prospectively evaluated. A 12 lead ECG was recorded and cardiac troponin I and creatinekinase subtraction MB assayed the day before surgery, on arrival at the intensive care Unit. 4 and 18 h postoperatively and every morning until the fifth postoperative day. Results: The incidence of new Q waves was 7.3%. Patients with isolated ECG findings had an uneventful postoperative course; on the contrary, when ECG changes were coupled with the release of myocardial necrosis biomarkers, patients had a complicated postoperative course. Conclusions: The association of a new Q wave and high levels of myocardial necrosis biomarkers is strongly associated with postoperative cardiac events. On the contrary, the isolated appearance of a new Q wave has no impact on the postoperative cardiac outcome. (C) 2004 Elsevier B.V. All rights reserved.
- Published
- 2003
25. Argatroban anticoagulation for heparin induced thrombocytopenia in patients with ventricular assist devices
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Pappalardo, F., Scandroglio, A. M., Potapov, E., Stepanenko, A., Maj, G., Krabatsch, T., Alberto ZANGRILLO, Koster, A., Hetzer, R., Pappalardo, Federico, Scandroglio, Am, Potapov, E, Stepanenko, A, Maj, G, Krabatsch, T, Zangrillo, Alberto, Koster, A, and Hetzer, R.
- Subjects
Adult ,Male ,Sulfonamides ,Heparin ,Incidence ,Anticoagulants ,Middle Aged ,Postoperative Hemorrhage ,Arginine ,Thrombocytopenia ,Postoperative Complications ,Treatment Outcome ,Pipecolic Acids ,Thromboembolism ,Feasibility Studies ,Heart Transplantation ,Humans ,Female ,Partial Thromboplastin Time ,Heart-Assist Devices ,Hospital Mortality ,Infusions, Intravenous ,Aged ,Retrospective Studies - Abstract
Patients receiving implantation of ventricular assist devices (VAD) suffer a high incidence of heparin induced thrombocytopenia (HIT); the occurrence of this condition is associated with increased complications and worse outcomes. We report our experience in the management of patients who were diagnosed with HIT either before (HITpre) or after (HITpost) implantation of VAD with argatroban, a direct thrombin inhibitor.METHODS: This retrospective analysis assessed data of VAD patients diagnosed with HIT at Deutsches Herzzentrum Berlin between November 2005 and April 2009. Argatroban dose requirements, anticoagulation efficacy and adverse events (death, thromboembolism, bleeding) were recorded. Procedural success (discharge from the hospital, heart transplantation, or recovery of the failing heart) was also assessed.RESULTS: Twenty-seven patients were identified (11 HITpre, 16 HITpost). Argatroban was effective in obtaining adequate anticoagulation with a reduced dose regimen (0.02-0.42 mcg/Kg/min starting dose; 0.02-1.5 mcg/Kg/min maintenance dose). We noted 5 thromboembolic complications (18%), 6 cases of major bleeding (22%) and 5 deaths (18%), all cause composite adverse end point occurring in 40% of patients. Procedural success was obtained in 81% of patients (92% HITpre, 69% HITpost). As compared to historical controls of patients treated with lepirudin in the period 2000-2005, results were significantly improved.CONCLUSION: Argatroban anticoagulation is feasible in patients with HIT after VAD implantation, without increasing bleeding risk. Its impact in terms of survival should be reviewed also in the light of the technological improvements of assist devices.
26. Impella malrotation affects left ventricle unloading in cardiogenic shock patients.
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Baldetti L, Romagnolo D, Festi M, Beneduce A, Gurrieri D, Peveri B, Frias A, Gramegna M, Sacchi S, Cianfanelli L, Calvo F, Pazzanese V, Chieffo A, Ajello S, and Scandroglio AM
- Abstract
Aims: Impella malrotation-inlet orientation away from the left ventricular (LV) apex with normal console waveforms and proper device depth-is commonly observed and possibly associated worse haemodynamics. This study aimed to characterize the haemodynamic consequences of Impella malrotation in cardiogenic shock (CS) patients., Methods and Results: We included 100 CS patients (60 ± 12 years; 79.0% males) with available echocardiography during Impella support and pulmonary artery catheter assessment before and during (at 48 h) Impella support. Impella malrotation was identified in 36%. At 48 h, malrotation patients had higher pulmonary artery wedge pressure (PAWP, 16.0 ± 8.2 vs. 13.0 ± 4.6 mmHg; P = 0.033), higher systolic pulmonary artery pressure (PAP, 35.0 ± 11.3 vs. 29.5 ± 9.0 mmHg; P = 0.015), higher diastolic-PAP (19.3 ± 8.1 vs. 15.1 ± 6.1 mmHg; P = 0.007), higher mean-PAP (25.7 ± 9.1 vs. 20.8 ± 6.8 mmHg; P = 0.005), higher right atrial pressure (10.3 ± 4.8 vs. 7.7 ± 4.3 mmHg; P = 0.009), higher pulmonary vascular resistance index (4.78 ± 2.75 vs. 3.49 ± 1.94 WUm
2 ; P = 0.020) and higher pulmonary artery elastance (0.91 ± 0.60 vs. 0.67 ± 0.40 mmHg/mL; P = 0.045). Serum lactate at 48 h was higher in malrotation patients (6.63 ± 6.25 vs. 3.60 ± 4.21 mmol/L; P = 0.004). Malrotation patients presented larger LVEDD during support (52 ± 10 vs. 46 ± 11 mm; P = 0.006), higher rates of aortic regurgitation (AR, 86 vs. 56%; P = 0.004) and higher increase in AR severity (+0.94 ± 0.92 vs. + 0.46 ± 0.95; P = 0.016). No significant differences were found in major adverse outcomes., Conclusions: In CS patients, Impella malrotation is associated with suboptimal unloading of the LV, worse pulmonary haemodynamics and worse indexes of right ventricular afterload., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)- Published
- 2024
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27. Influence of implant strategy on the transition from temporary left ventricular assist device to durable mechanical circulatory support.
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Meyer AL, Lewin D, Billion M, Hofmann S, Netuka I, Belohlavek J, Jawad K, Saeed D, Schmack B, Rojas SV, Gummert J, Bernhardt A, Färber G, Kooij J, Meyns B, Loforte A, Pieri M, Scandroglio AM, Akhyari P, Szymanski MK, Moller CH, Gustafsson F, Medina M, Oezkur M, Zimpfer D, Krasivskyi I, Djordjevic I, Haneya A, Stein J, Lanmueller P, Potapov EV, and Kremer J
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- Humans, Male, Female, Retrospective Studies, Middle Aged, Aged, Treatment Outcome, Adult, Heart-Assist Devices, Heart Failure surgery, Heart Failure therapy
- Abstract
Objectives: Bridging from a temporary microaxial left ventricular assist device (tLVAD) to a durable left ventricular assist device (dLVAD) is playing an increasing role in the treatment of terminally ill patients with heart failure. Scant data exist about the best implant strategy. The goal of this study was to analyse differences in the dLVAD implant technique and effects on patient outcomes., Methods: Data from 341 patients (19 European centres) who underwent a bridge-to-bridge implant from tLVAD to dLVAD between January 2017 and October 2022 were retrospectively analysed. The outcomes of the different implant techniques with the patient on cardiopulmonary bypass, extracorporeal life support or tLVAD were compared., Results: A durable LVAD implant was performed employing cardiopulmonary bypass in 70% of cases (n = 238, group 1), extracorporeal life support in 11% (n = 38, group 2) and tLVAD in 19% (n = 65, group 3). Baseline characteristics showed no significant differences in age (P = 0.140), body mass index (P = 0.388), creatinine level (P = 0.659), the Model for End-Stage Liver Disease (MELD) score (P = 0.190) and rate of dialysis (P = 0.110). Group 3 had significantly fewer patients with preoperatively invasive ventilation and cardiopulmonary resuscitation before the tLVAD was implanted (P = 0.009 and P < 0.001 respectively). Concomitant procedures were performed more often in groups 1 and 2 compared to group 3 (24%, 37% and 5%, respectively, P < 0.001). The 30-day mortality data showed significantly better survival after an inverse probability of treatment weighting in group 3, but the 1-year mortality showed no significant differences among the groups (P = 0.012 and 0.581, respectively). Postoperative complications like the rate of right ventricular assist device (RVAD) implants or re-thoracotomy due to bleeding, postoperative respiratory failure and renal replacement therapy showed no significant differences among the groups. Freedom from the first adverse event like stroke, driveline infection or pump thrombosis during follow-up was not significantly different among the groups. Postoperative blood transfusions within 24 h were significantly higher in groups 1 and 2 compared to surgery on tLVAD support (P < 0.001 and P = 0.003, respectively)., Conclusions: In our analysis, the transition from tLVAD to dLVAD without further circulatory support did not show a difference in postoperative long-term survival, but a better 30-day survival was reported. The implant using only tLVAD showed a reduction in postoperative transfusion rates, without increasing the risk of postoperative stroke or pump thrombosis. In this small cohort study, our data support the hypothesis that a dLVAD implant on a tLVAD is a safe and feasible technique in selected patients., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2024
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28. Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro-axial flow pump: Insights from a large registry.
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Gallone G, Lewin D, Rojas Hernandez S, Bernhardt A, Billion M, Meyer A, Netuka I, Kooij JJ, Pieri M, Szymanski MK, Moeller CH, Akhyari P, Jawad K, Krasivskyi I, Schmack B, Färber G, Medina M, Haneya A, Zimpfer D, Nersesian G, Lanmueller P, Spitaleri A, Oezkur M, Djordjevic I, Saeed D, Boffini M, Stein J, Gustafsson F, Scandroglio AM, De Ferrari GM, Meyns B, Hofmann S, Belohlavek J, Gummert J, Rinaldi M, Potapov EV, and Loforte A
- Subjects
- Humans, Male, Female, Middle Aged, Retrospective Studies, Aged, Incidence, Stroke etiology, Stroke epidemiology, Heart Failure therapy, Ischemic Stroke etiology, Ischemic Stroke epidemiology, Treatment Outcome, Hemorrhagic Stroke etiology, Hemorrhagic Stroke epidemiology, Heart-Assist Devices adverse effects, Registries
- Abstract
Background: Stroke after durable left ventricular assist device (d-LVAD) implantation portends high mortality. The incidence of ischemic and hemorrhagic stroke and the impact on stroke outcomes of temporary mechanical circulatory support (tMCS) management among patients requiring bridge to d-LVAD with micro-axial flow-pump (mAFP, Abiomed) is unsettled., Methods: Consecutive patients, who underwent d-LVAD implantation after being bridged with mAFP at 19 institutions, were retrospectively included. The incidence of early ischemic and hemorrhagic stroke after d-LVAD implantation (<60 days) and association of pre-d-LVAD characteristics and peri-procedural management with a specific focus on tMCS strategies were studied., Results: Among 341 patients, who underwent d-LVAD implantation after mAFP implantation (male gender 83.6%, age 58 [48-65] years, mAFP 5.0/5.5 72.4%), the early ischemic stroke incidence was 10.8% and early hemorrhagic stroke 2.9%. The tMCS characteristics (type of mAFP device and access, support duration, upgrade from intra-aortic balloon pump, ECMELLA, ECMELLA at d-LVAD implantation, hemolysis, and bleeding) were not associated with ischemic stroke after d-LVAD implant. Conversely, the device model (mAFP 2.5/CP vs. mAFP 5.0/5.5: HR 5.6, 95%CI 1.4-22.7, p = 0.015), hemolysis on mAFP support (HR 10.5, 95% CI 1.3-85.3, p = 0.028) and ECMELLA at d-LVAD implantation (HR 5.0, 95% CI 1.4-18.7, p = 0.016) were associated with increased risk of hemorrhagic stroke after d-LVAD implantation. Both early ischemic (HR 2.7, 95% CI 1.9-4.5, p < 0.001) and hemorrhagic (HR 3.43, 95% CI 1.49-7.88, p = 0.004) stroke were associated with increased 1-year mortality., Conclusions: Among patients undergoing d-LVAD implantation following mAFP support, tMCS characteristics do not impact ischemic stroke occurrence, while several factors are associated with hemorrhagic stroke suggesting a proactive treatment target to reduce this complication., (© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
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- 2024
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29. Pulmonary artery elastance as a predictor of hospital mortality in heart failure cardiogenic shock.
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Baldetti L, den Uil CA, Fiore G, Gallone G, Romagnolo D, Peveri B, Cianfanelli L, Calvo F, Gramegna M, Pazzanese V, Sacchi S, Dias-Frias A, Ajello S, and Scandroglio AM
- Subjects
- Humans, Female, Male, Aged, Middle Aged, Prognosis, Heart Failure physiopathology, Heart Failure mortality, Retrospective Studies, Hemodynamics physiology, Follow-Up Studies, Hospital Mortality trends, Shock, Cardiogenic mortality, Shock, Cardiogenic physiopathology, Pulmonary Artery physiopathology
- Abstract
Aims: The initial bundle of cares strongly affects haemodynamics and outcomes in acute decompensated heart failure cardiogenic shock (ADHF-CS). We sought to characterize whether 24 h haemodynamic profiling provides superior prognostic information as compared with admission assessment and which haemodynamic parameters best predict in-hospital death., Methods and Results: All patients with ADHF-CS and with available admission and 24 h invasive haemodynamic assessment from two academic institutions were considered for this study. The primary endpoint was in-hospital death. Regression analyses were run to identify relevant predictors of study outcome. We included 127 ADHF-CS patients [65 (inter-quartile range 52-72) years, 25.2% female]. Overall, in-hospital mortality occurred in 26.8%. Non-survivors were older, with greater CS severity. Among admission variables, age [odds ratio (OR) = 1.06; 95% confidence interval (CI): 1.02-1.11; P
adj = 0.005] and CPIRAP (OR = 0.62 for 0.1 increment; 95% CI: 0.39-0.95; Padj = 0.034) were found significantly associated with in-hospital death. Among 24 h haemodynamic univariate predictors of in-hospital death, pulmonary elastance (PaE) was the strongest (area under the curve of 0.77; 95% CI: 0.68-0.86). PaE (OR = 5.98; 95% CI: 2.29-17.48; Padj < 0.001), pulmonary artery pulsatility index (PAPi, OR = 0.77; 95% CI: 0.62-0.92; Padj = 0.013) and age (OR = 1.06; 95% CI: 1.02-1.11; Padj = 0.010) were independently associated with in-hospital death. Best cut-off for PaE was 0.85 mmHg/mL and for PAPi was 2.95; cohort phenotyping based on these PaE and PAPi thresholds further increased in-hospital death risk stratification; patients with 24 h high PaE and low PAPi exhibited the highest in-hospital mortality (56.2%)., Conclusions: Pulmonary artery elastance has been found to be the most powerful 24 h haemodynamic predictor of in-hospital death in patients with ADHF-CS. Age, 24 h PaE, and PAPi are independently associated with hospital mortality. PaE captures ventricular (RV) afterload mismatch and PAPi provides a metric of RV adaptation, thus their combination generates four distinct haemodynamic phenotypes, enhancing in-hospital death risk stratification., (© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)- Published
- 2024
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30. The intelligent Impella: Future perspectives of artificial intelligence in the setting of Impella support.
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Consolo F, D'Andria Ursoleo J, Pieri M, Nardelli P, Cianfanelli L, Pazzanese V, Ajello S, and Scandroglio AM
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- Humans, Forecasting, Hemodynamics physiology, Heart-Assist Devices, Artificial Intelligence, Heart Failure therapy, Heart Failure physiopathology
- Abstract
Aims: Artificial intelligence (AI) has emerged as a potential useful tool to support clinical treatment of heart failure, including the setting of mechanical circulatory support (MCS). Modern Impella pumps are equipped with advanced technology (SmartAssist), enabling real-time acquisition and display of data related to both pump performance and the patient's haemodynamic status. These data emerge as an 'ideal' source for data-driven AI applications to predict the clinical course of an ongoing therapeutic protocol. Yet, no evidence of effective application of AI tools in the setting of Impella support is available. On this background, we aimed at identifying possible future applications of AI-based tools in the setting of temporary MCS with an Impella device., Methods: We explored the state of research and development at the intersection of AI and Impella support and derived future potential applications of AI in routine Impella clinical management., Results: We identified different areas where the future implementation of AI tools may contribute to addressing important clinical challenges in the setting of Impella support, including (i) early identification of the best suited pathway of care according to patients' conditions at presentation and intention to treat, (ii) prediction of therapy outcomes according to different possible therapeutic actions, (iii) optimization of device implantation procedures and evaluation of proper pump position over the whole course of support and (iv) prevention and/or rationale management of haemocompatibility-related adverse events. For each of those areas, we discuss the potential advantages, challenges and implications of harnessing AI-driven insights in the setting of MCS with an Impella device., Conclusions: Temporary MCS with an Impella device has great potential to benefit from the integration of AI-based tools. Such tools may indeed translate into groundbreaking innovation supporting clinical decision-making and therapy regulation, in particular in complex scenarios such as the multidevice MCS strategy., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
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- 2024
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31. Myocardial viability assessment during Impella support with 18-fluorodesoxyglucose PET imaging.
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Baldetti L, Busnardo E, Pazzanese V, Ricchetti G, Barone G, Sacchi S, Calvo F, Gramegna M, Pieri M, Ingallina G, Camici PG, Ajello S, and Scandroglio AM
- Abstract
Formal assessment of myocardial viability (MV) is challenging in acute myocardial infarction-related cardiogenic shock (AMI-CS) patients receiving Impella mechanical circulatory support, as the cardiac magnetic resonance gold standard technique is not feasible due to the metallic components of the device. 18-fluorodesoxyglucose metabolic myocardial positron emission tomography (
18 FDG-PET) may represent a valid and feasible alternative to obtain semi-quantitative and objective evidence of MV during Impella support. We hereby report the first series of sequential AMI-CS patients who received18 FDG-PET scanning to assess MV during Impella support to demonstrate the safety and feasibility of this approach. In this cohort no adverse events occurred during18 FDG-PET scans, and all images were of excellent quality. This study provides a pragmatic guidance on how to perform this imaging modality during Impella support and finally confirms the safety and feasibility of this advanced imaging method also in this vulnerable cohort of patients., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)- Published
- 2024
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32. [The pulmonary artery catheter in the intensive cardiac care unit].
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Baldetti L, Gentile P, Gori M, Scandroglio AM, Gasparetto N, Trambaiolo P, Valente S, and Marini M
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- Humans, Shock, Cardiogenic therapy, Coronary Care Units, Intensive Care Units, Hemodynamics, Catheterization, Swan-Ganz methods
- Abstract
More than 50 years after its introduction in clinical practice, the increase in the intensity of care offered by the cardiac intensive care units, the shift in the population of patients treated and the wider availability of circulatory supports, still makes the pulmonary artery catheter (PAC) an essential tool for diagnosis, monitoring and prognosis in patients suffering from cardiogenic shock. In this review, we will discuss how to identify those patients who can benefit most from its use, the configuration and the correct insertion technique of a PAC. A pragmatic guide will also be provided for the interpretation of the hemodynamic indexes (direct and calculated) that the PAC is able to reveal as well as a summary of the most common errors in reading or interpreting the pressure curves provided by the PAC. In this article, we will then present a practical guide on how to use the PAC in a modern cardiac intensive care unit.
- Published
- 2024
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33. Google's loss of pulse detection: Unwitnessed cardiac arrest 'witnessed' by a smartwatch.
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Scquizzato T, Landoni G, Consolo F, and Scandroglio AM
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- Humans, Cardiopulmonary Resuscitation methods, Heart Arrest etiology, Heart Arrest therapy, Mobile Applications, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: “TS is the Social Media Editor of Resuscitation. All other authors have no conflicts of interest to declare.”.
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- 2024
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34. Low Versus High Blood Pressure Targets in Critically Ill and Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
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D'Amico F, Pruna A, Putowski Z, Dormio S, Ajello S, Scandroglio AM, Lee TC, Zangrillo A, and Landoni G
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- Humans, Critical Illness mortality, Critical Illness therapy, Randomized Controlled Trials as Topic, Hypotension mortality, Blood Pressure
- Abstract
Objectives: Hypotension is associated with adverse outcomes in critically ill and perioperative patients. However, these assumptions are supported by observational studies. This meta-analysis of randomized controlled trials aims to compare the impact of lower versus higher blood pressure targets on mortality., Data Sources: We searched PubMed, Cochrane, and Scholar from inception to February 10, 2024., Study Selection: Randomized trials comparing lower versus higher blood pressure targets in the management of critically ill and perioperative settings., Data Extraction: The primary outcome was all-cause mortality at the longest follow-up available. This review was registered in the Prospective International Register of Systematic Reviews, CRD42023452928., Data Synthesis: Of 2940 studies identified by the search string, 28 (12 in critically ill and 16 in perioperative settings) were included totaling 15,672 patients. Patients in the low blood pressure target group had lower mortality (23 studies included: 1019/7679 [13.3%] vs. 1103/7649 [14.4%]; relative risk 0.93; 95% CI, 0.87-0.99; p = 0.03; I2 = 0%). This corresponded to a 97.4% probability of any increase in mortality with a Bayesian approach. These findings were mainly driven by studies performed in the ICU setting and with treatment lasting more than 24 hours; however, the magnitude and direction of the results were similar in the majority of sensitivity analyses including the analysis restricted to low risk of bias studies. We also observed a lower rate of atrial fibrillation and fewer patients requiring transfusion in low-pressure target groups. No differences were found in the other secondary outcomes., Conclusions: Based on pooled randomized trial evidence, a lower compared with a higher blood pressure target results in a reduction of mortality, atrial fibrillation, and transfusion requirements. Lower blood pressure targets may be beneficial but there is ongoing uncertainty. However, the present meta-analysis does not confirm previous findings and recommendations. These results might inform future guidelines and promote the study of the concept of protective hemodynamics., Competing Interests: Dr. Lee’s institution received funding from the Canadian Institutes of Health Research; he received funding from Fonds de Recherche Quebec—Sante. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
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- 2024
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35. A Randomized Trial of Intravenous Amino Acids for Kidney Protection.
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Landoni G, Monaco F, Ti LK, Baiardo Redaelli M, Bradic N, Comis M, Kotani Y, Brambillasca C, Garofalo E, Scandroglio AM, Viscido C, Paternoster G, Franco A, Porta S, Ferrod F, Calabrò MG, Pisano A, Vendramin I, Barucco G, Federici F, Severi L, Belletti A, Cortegiani A, Bruni A, Galbiati C, Covino A, Baryshnikova E, Giardina G, Venditto M, Kroeller D, Nakhnoukh C, Mantovani L, Silvetti S, Licheri M, Guarracino F, Lobreglio R, Di Prima AL, Fresilli S, Labanca R, Mucchetti M, Lembo R, Losiggio R, Bove T, Ranucci M, Fominskiy E, Longhini F, Zangrillo A, and Bellomo R
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Creatinine blood, Double-Blind Method, Infusions, Intravenous, Kidney drug effects, Renal Replacement Therapy, Acute Kidney Injury diagnosis, Acute Kidney Injury epidemiology, Acute Kidney Injury etiology, Acute Kidney Injury prevention & control, Amino Acids administration & dosage, Amino Acids adverse effects, Cardiac Surgical Procedures adverse effects, Cardiopulmonary Bypass adverse effects, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications prevention & control
- Abstract
Background: Acute kidney injury (AKI) is a serious and common complication of cardiac surgery, for which reduced kidney perfusion is a key contributing factor. Intravenous amino acids increase kidney perfusion and recruit renal functional reserve. However, the efficacy of amino acids in reducing the occurrence of AKI after cardiac surgery is uncertain., Methods: In a multinational, double-blind trial, we randomly assigned adult patients who were scheduled to undergo cardiac surgery with cardiopulmonary bypass to receive an intravenous infusion of either a balanced mixture of amino acids, at a dose of 2 g per kilogram of ideal body weight per day, or placebo (Ringer's solution) for up to 3 days. The primary outcome was the occurrence of AKI, defined according to the Kidney Disease: Improving Global Outcomes creatinine criteria. Secondary outcomes included the severity of AKI, the use and duration of kidney-replacement therapy, and all-cause 30-day mortality., Results: We recruited 3511 patients at 22 centers in three countries and assigned 1759 patients to the amino acid group and 1752 to the placebo group. AKI occurred in 474 patients (26.9%) in the amino acid group and in 555 (31.7%) in the placebo group (relative risk, 0.85; 95% confidence interval [CI], 0.77 to 0.94; P = 0.002). Stage 3 AKI occurred in 29 patients (1.6%) and 52 patients (3.0%), respectively (relative risk, 0.56; 95% CI, 0.35 to 0.87). Kidney-replacement therapy was used in 24 patients (1.4%) in the amino acid group and in 33 patients (1.9%) in the placebo group. There were no substantial differences between the two groups in other secondary outcomes or in adverse events., Conclusions: Among adult patients undergoing cardiac surgery, infusion of amino acids reduced the occurrence of AKI. (Funded by the Italian Ministry of Health; PROTECTION ClinicalTrials.gov number, NCT03709264.)., (Copyright © 2024 Massachusetts Medical Society.)
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- 2024
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36. Haptoglobin Administration for Intravascular Hemolysis: A Systematic Review.
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Baldetti L, Labanca R, Belletti A, Dias-Frias A, Peveri B, Kotani Y, Fresilli S, Calvo F, Fominskiy E, Pieri M, Ajello S, and Scandroglio AM
- Abstract
Introduction: Exogenous haptoglobin administration may enhance plasma-free hemoglobin (pfHb) clearance during hemolysis and reduce its end-organ damage: we systematically reviewed and summarized available evidence on the use of haptoglobin as a treatment for hemolysis of any cause., Methods: We included studies describing haptoglobin administration as treatment or prevention of hemolysis-related complications. Only studies with a control group reporting at least one of the outcomes of interest were included in the quantitative synthesis. Primary outcome was the change in pfHb concentration 1 h after haptoglobin infusion., Results: Among 573 articles, 13 studies were included in the review (677 patients, 52.8% received haptoglobin). Median initial haptoglobin intravenous bolus was 4,000 (2,000, 4,000) IU. Haptoglobin was associated with lower pfHb 1 h (SMD -11.28; 95% CI: -15.80 to -6.75; p < 0.001) and 24 h (SMD -2.65; 95% CI: -4.73 to -0.57; p = 0.001) after infusion. There was no difference in all-cause mortality between haptoglobin-treated patients and control group (OR 1.41; 95% CI: 0.49-4.95; p = 0.520). Haptoglobin was associated with a lower incidence of acute kidney injury (OR 0.64; 95% CI: 0.44-0.93; p = 0.020). No adverse events or side effects associated with haptoglobin use were reported., Conclusions: Haptoglobin administration has been used in patients with hemolysis from any cause to treat or prevent hemolysis-associated adverse events. Haptoglobin may reduce levels of pfHb and preserve kidney function without increase in adverse events., (© 2024 S. Karger AG, Basel.)
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- 2024
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37. Acute normovolemic hemodilution in cardiac surgery: Rationale and design of a multicenter randomized trial.
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Monaco F, Guarracino F, Vendramin I, Lei C, Zhang H, Lomivorotov V, Osinsky R, Efremov S, Gürcü ME, Mazzeffi M, Pasyuga V, Kotani Y, Biondi-Zoccai G, D'Ascenzo F, Romagnoli E, Nigro Neto C, Do Nascimento VTNDS, Ti LK, Lorsomradee S, Farag A, Bukamal N, Brizzi G, Lobreglio R, Belletti A, Arangino C, Paternoster G, Bonizzoni MA, Tucciariello MT, Kroeller D, Di Prima AL, Mantovani LF, Ajello V, Gerli C, Porta S, Ferrod F, Giardina G, Santonocito C, Ranucci M, Lembo R, Pisano A, Morselli F, Nakhnoukh C, Oriani A, Pieri M, Scandroglio AM, Kırali K, Likhvantsev V, Longhini F, Yavorovskiy A, Bellomo R, Landoni G, and Zangrillo A
- Subjects
- Humans, Single-Blind Method, Erythrocyte Transfusion methods, Male, Blood Loss, Surgical prevention & control, Female, Hemodilution methods, Cardiac Surgical Procedures methods, Cardiopulmonary Bypass methods
- Abstract
Background: Minimizing the use of blood component can reduce known and unknown blood transfusion risks, preserve blood bank resources, and decrease healthcare costs. Red Blood Cell (RBC) transfusion is common after cardiac surgery and associated with adverse perioperative outcomes, including mortality. Acute normovolemic hemodilution (ANH) may reduce bleeding and the need for blood product transfusion after cardiac surgery. However, its blood-saving effect and impact on major outcomes remain uncertain., Methods: This is a single-blinded, multinational, pragmatic, randomized controlled trial with a 1:1 allocation ratio conducted in Tertiary and University hospitals. The study is designed to enroll patients scheduled for elective cardiac surgery with planned cardiopulmonary bypass (CPB). Patients are randomized to receive ANH before CPB or the best available treatment without ANH. We identified an ANH volume of at least 650 ml as the critical threshold for clinically relevant benefits. Larger ANH volumes, however, are allowed and tailored to the patient's characteristics and clinical conditions., Results: The primary outcome is the percentage of patients receiving RBCs transfusion from randomization until hospital discharge, which we hypothesize will be reduced from 35% to 28% with ANH. Secondary outcomes are all-cause 30-day mortality, acute kidney injury, bleeding complications, and ischemic complications., Conclusion: The trial is designed to determine whether ANH can safely reduce RBC transfusion after elective cardiac surgery with CPB., Study Registration: This trial was registered on ClinicalTrials.gov in April 2019 with the trial identification number NCT03913481., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Three authors specified the following financial interests even if not related to this paper: Dr Ranucci declares the following financial interests: CSL Behring, Haemonetics, LFB, Werfen, Grifols. Dr Guarracino declares the following financial interests: Abbott, AOP Orphan, Edwards, Masimo, Orion, Viatris Dr Mazzeffi declares the following financial interests: consulting fees from Octapharma, Hemosonics, NovoNordisk, (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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38. Prolonged Impella 5.0/5.5 support within different pathways of care for cardiogenic shock: the experience of a referral center.
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Pieri M, Ortalda A, Altizio S, Bertoglio L, Nardelli P, Fominskiy E, Lapenna E, Ajello S, and Scandroglio AM
- Abstract
Aims: Impella 5.0 and 5.5 are promising low-invasive left ventricle (LV) temporary mechanical circulatory supports (tMCS) for cardiogenic shock due to LV mechanical unloading and are paired with powerful hemodynamic support. This study aimed to analyze data and destinies of patients supported with Impella 5.0/5.5 at a national referral center for cardiogenic shock and to assess the parameters associated with myocardial recovery and successful weaning., Methods: A single-center observational study was conducted on all patients treated with Impella 5.0 or 5.5 from March 2018 to July 2023., Results: A total of 59 patients underwent Impella 5.0/5.5 implantation due to profound cardiogenic shock, with acute myocardial infarction being the most frequent cause of shock (42 patients, 71%). The median duration of Impella support was 13 days (maximum duration of 52 days). Axillary cannulation was feasible in almost all patients, and 36% were mobilized during support. A total of 44 patients (75%) survived to the next therapy/recovery: 21 patients experienced recovery and 15 and 8 were bridged to long-term LVAD and heart transplantation, respectively. The global survival rate was 66%. The predictors of native heart recovery at multivariate analysis were the number of days on tMCS before upgrade to Impella 5.0/5.5 [hazard ratio (HR) 0.68 (0.51-9) p = 0.0068] and improvement of LVEF within the first 7-10 days of support [HR 4.72 (1.34-16.7), p = 0.016]., Conclusions: Transcatheter systems such as Impella 5.0/5.5 revolutionized the field of tMCS. Myocardial recovery is the primary clinical target. Its prognostication and promotion are key to ensure the most proficuous course for each patient from cardiogenic shock to long-term event-free survival., Competing Interests: MP, AO, SA, LB, PN, EF, and AS received speaker fees from Abiomed GmbH. MP received consultancy fees from Abiomed GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Pieri, Ortalda, Altizio, Bertoglio, Nardelli, Fominskiy, Lapenna, Ajello and Scandroglio.)
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- 2024
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39. Mixed Shock Complicating Cardiogenic Shock: Frequency, Predictors, and Clinical Outcomes.
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Baldetti L, Gallone G, Filiberti G, Pescarmona L, Cesari A, Rizza V, Roagna E, Gurrieri D, Peveri B, Nocera L, Cianfanelli L, Marcelli G, De Lio G, Boretto P, Angelini F, Gramegna M, Pazzanese V, Sacchi S, Calvo F, Ajello S, De Ferrari GM, Frea S, and Scandroglio AM
- Subjects
- Humans, Male, Female, Aged, Middle Aged, Prognosis, Risk Factors, Aged, 80 and over, Hemodynamics, Time Factors, Shock, Cardiogenic etiology, Shock, Cardiogenic mortality, Shock, Cardiogenic therapy, Shock, Cardiogenic physiopathology, Hospital Mortality
- Abstract
Background: Patients presenting with cardiogenic shock (CS) are at risk of developing mixed shock (MS), characterized by distributive-inflammatory phenotype. However, no objective definition exists for this clinical entity., Methods: We assessed the frequency, predictors, and prognostic relevance of MS complicating CS, based on a newly proposed objective definition. MS complicating CS was defined as an objective shock state secondary to both an ongoing cardiogenic cause and a distributive-inflammatory phenotype arising at least 12 hours after the initial CS diagnosis, as substantiated by predefined longitudinal changes in hemodynamics, clinical, and laboratory parameters., Results: Among 213 consecutive patients admitted at 2 cardiac intensive care units with CS, 13 with inflammatory-distributive features at initial presentation were excluded, leading to a cohort of 200 patients hospitalized with pure CS (67±13 years, 96% Society of Cardiovascular Angiography and Interventions CS stage class C or higher). MS complicating CS occurred in 24.5% after 120 (29-216) hours from CS diagnosis. Lower systolic arterial pressure ( P =0.043), hepatic injury ( P =0.049), and suspected/definite infection ( P =0.013) at CS diagnosis were independent predictors of MS development. In-hospital mortality (53.1% versus 27.8%; P =0.002) and hospital stay (21 [13-48] versus 17 [9-27] days; P =0.018) were higher in the MS cohort. At logistic multivariable analysis, MS diagnosis (odds ratio [OR], 3.00 [95% CI, 1.39-6.63]; P
adj =0.006), age (OR, 1.06 [95% CI, 1.03-1.10] years; Padj <0.001), admission systolic arterial pressure <100 mm Hg (OR, 2.41 [95% CI, 1.19-4.98]; Padj =0.016), and admission serum creatinine (OR, 1.61 [95% CI, 1.19-2.26]; Padj =0.003) conferred higher odds of in-hospital death, while early temporary mechanical circulatory support was associated with lower in-hospital death (OR, 0.36 [95% CI, 0.17-0.75]; Padj =0.008)., Conclusions: MS complicating CS, objectively defined leveraging on longitudinal changes in distributive and inflammatory features, occurs in one-fourth of patients with CS, is predicted by markers of CS severity and inflammation at CS diagnosis, and portends higher hospital mortality., Competing Interests: None.- Published
- 2024
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40. Organ donation after extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest in a metropolitan cardiac arrest centre in Milan, Italy.
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Bonizzoni MA, Scquizzato T, Pieri M, Delrio S, Nardelli P, Ortalda A, Dell'Acqua A, and Scandroglio AM
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- Humans, Italy epidemiology, Male, Female, Middle Aged, Aged, Retrospective Studies, Tissue Donors statistics & numerical data, Adult, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Tissue and Organ Procurement methods, Extracorporeal Membrane Oxygenation methods, Extracorporeal Membrane Oxygenation statistics & numerical data, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation statistics & numerical data
- Abstract
Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) may improve survival in refractory out-of-hospital cardiac arrest (OHCA) but also expand the donor pool as these patients often become eligible for organ donation. Our aim is to describe the impact of organ donation in OHCA patients treated with ECPR in a high-volume cardiac arrest centre., Methods: Rate of organ donation (primary outcome), organs harvested, a composite of patient survival with favourable neurological outcome or donation of ≥1 solid organ (ECPR benefit), and the potential total number of individuals benefiting from ECPR (survivors with favourable neurological outcome and potential recipients of one solid organ) were analysed among all-rhythms refractory OHCA patients treated with ECPR between January 2013-November 2022 at San Raffaele Hospital in Milan, Italy., Results: Among 307 adults with refractory OHCA treated with ECPR (95% witnessed, 66% shockable, low-flow 70 [IQR 58-81] minutes), 256 (83%) died during hospital stay, 33% from brain death. Donation of at least one solid organ occurred in 58 (19%) patients, 53 (17%) after determination of brain death and 5 (1.6%) after determination of circulatory death, contributing a total of 167 solid organs (3.0 [IQR 2.5-4.0] organs/donor). Overall, 196 individuals (29 survivors with favourable neurological outcome and 167 potential recipients of 1 solid organ) possibly benefited from ECPR. ECPR benefit composite outcome was achieved in 87 (28%) patients. Solid organ donation decreased from 19% to 16% in patients with low-flow <60 min and to 11% with low-flow <60 min and initial shockable rhythm., Conclusions: When ECPR fails in patients with refractory OHCA, organ donation after brain or circulatory death can help a significant number of patients awaiting transplantation, enhancing the overall benefit of ECPR. ECPR selection criteria may affect the number of potential organ donors., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘TS is the Social Media Editor of Resuscitation’., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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41. Microaxial Flow Pump in Infarct-Related Cardiogenic Shock.
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Baldetti L, Pieri M, and Scandroglio AM
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- Humans, Male, Myocardial Infarction complications, Heart-Assist Devices, Shock, Cardiogenic etiology, Shock, Cardiogenic mortality, Shock, Cardiogenic surgery, ST Elevation Myocardial Infarction complications
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- 2024
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42. Impella versus VA-ECMO for the treatment of patients with cardiogenic shock: the Impella Network Project - observational study protocol for cost-effectiveness and budget impact analyses.
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Ardito V, Rognoni C, Pieri M, Barbone A, Briguori C, Cigala E, Gerosa G, Iannaccone M, Loforte A, Marini M, Montalto A, Oreglia J, Pacini D, Pennacchi M, Pestrichella V, Porto I, Stefano P, Tarantini G, Valente S, Vandoni P, Tarricone R, and Scandroglio AM
- Subjects
- Humans, Prospective Studies, Retrospective Studies, Italy, Quality of Life, Multicenter Studies as Topic, Budgets, Observational Studies as Topic, Shock, Cardiogenic therapy, Shock, Cardiogenic economics, Cost-Benefit Analysis, Extracorporeal Membrane Oxygenation economics, Extracorporeal Membrane Oxygenation methods, Heart-Assist Devices economics
- Abstract
Introduction: The treatment of patients with cardiogenic shock (CS) encompasses several health technologies including Impella pumps and venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, while they are widely used in clinical practice, information on resource use and quality of life (QoL) associated with these devices is scarce. The aim of this study is, therefore, to collect and comparatively assess clinical and socioeconomic data of Impella versus VA-ECMO for the treatment of patients with severe CS, to ultimately conduct both a cost-effectiveness (CEA) and budget impact (BIA) analyses., Methods and Analysis: This is a prospective plus retrospective, multicentre study conducted under the scientific coordination of the Center for Research on Health and Social Care Management of SDA Bocconi School of Management and clinical coordination of Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute in Milan. The Impella Network stemmed for the purposes of this study and comprises 17 Italian clinical centres from Northern to Southern Regions in Italy. The Italian network qualifies as a subgroup of the international Impella Cardiac Surgery Registry. Patients with CS treated with Impella pumps (CP, 5.0 or 5.5) will be prospectively recruited, and information on clinical outcomes, resource use and QoL collected. Economic data will be retrospectively matched with data from comparable patients treated with VA-ECMO. Both CEA and BIA will be conducted adopting the societal perspective in Italy. This study will contribute to generate new socioeconomic evidence to inform future coverage decisions., Ethics and Dissemination: As of May 2024, most of the clinical centres submitted the documentation to their ethical committee (N=13; 76%), six centres received ethical approval and two centres started to enrol patients. Study results will be published in peer-reviewed publications and disseminated through conference presentations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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43. A rare case report of an acquired aortopulmonary artery fistula after Bentall procedure: multimodality imaging approach may be the key?
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Barki M, Sacchi S, Marcolin C, Ajello S, and Scandroglio AM
- Abstract
Background: The acquired communication between the aorta and the pulmonary artery is a rare and potentially life-threatening condition. Its diagnosis is challenging and may require a multimodality imaging approach., Case Summary: A 67-year-old Caucasian man, admitted for acute respiratory failure unresponsive to medical therapy and non-invasive ventilation, was diagnosed with an aortopulmonary fistula (APF) complicating a pseudoaneurysm of the aortic root. This condition developed after Bentall cardiac surgery, which entailed the use of a straight Dacron aortic graft coupled with a mechanical prosthesis. A multimodal imaging approach, combining echocardiography and computed tomography angiography, was diagnostic and supported the development of a surgical treatment strategy. The patient underwent successful surgical closure of the APF and correction of the aortic pseudoaneurysm., Discussion: Aortopulmonary fistula can result in rapid clinical deterioration if left untreated. The combination of echocardiography and computed tomography angiography techniques allowed for the diagnosis and surgical correction of the APF., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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44. The authors reply.
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Belletti A, Nardelli P, Fominskiy EV, Landoni G, and Scandroglio AM
- Abstract
Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest.
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- 2024
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45. Long-term quality of life, psychological distress, and caregiver burden in octogenarians with LVAD: A single-centre experience.
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D'Andria Ursoleo J, Pieri M, Calvo F, Altizio S, Gramegna M, Pontillo D, Ajello S, and Scandroglio AM
- Subjects
- Humans, Male, Female, Aged, Aged, 80 and over, Psychological Distress, Surveys and Questionnaires, Heart Failure psychology, Heart Failure surgery, Heart Failure therapy, Caregivers psychology, Heart-Assist Devices psychology, Quality of Life, Caregiver Burden psychology
- Abstract
With the general population aging, both life expectancy and the number of left ventricular assist device (LVAD) implantations in elderly patients are growing. Nevertheless, their perceived long-term quality of life, including psychological aspects, coupled with the respective caregiver's burden, remain under-reported. In light of the rising number of octogenarians with LVAD who necessitate broader healthcare provider involvement, we assessed the long-term quality of life, as defined by both the 36-item short-form health (SF-36) survey and the EuroQol 5 dimensions, 5-level questionnaire (EQ-5D-5L)-including the visual analog scale-in octogenarian LVAD patients who had received treatment at our institution. Additionally, we evaluated the psychological health of octogenarian LVAD patients using the psychological general well-being index (PGWBI), alongside their caregivers' well-being through the 22-item version of the Zarit Burden Interview (ZBI). Of 12 octogenarian LVAD patients, 5 were alive and willing to answer questionnaires. Mean age at implant was 74 ± 2 years. Median follow-up was 2464 (IQR = 2375-2745) days. Although variable, the degree of health and psychological well-being perceived by octogenarian patients with LVAD was "good." Interestingly, the burden of assistance reported by caregivers, though relevant, was greatly varied, suggesting the need to better define and address psychological long-term aspects related to LVAD implantation for both patients and caregivers with a broad-spectrum approach., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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46. A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device.
- Author
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Wert L, Stewart GC, Mehra MR, Milwidsky A, Jorde UP, Goldstein DJ, Selzman CH, Stehlik J, Alshamdin FD, Khaliel FH, Gustafsson F, Boschi S, Loforte A, Ajello S, Scandroglio AM, Tučanová Z, Netuka I, Schlöglhofer T, Zimpfer D, Zijderhand CF, Caliskan K, Dogan G, Schmitto JD, Maier S, Schibilsky D, Jawad K, Saeed D, Faerber G, Morshuis M, Hanuna M, Müller CS, Mulzer J, Kempfert J, Falk V, and Potapov EV
- Subjects
- Humans, Retrospective Studies, Tomography, X-Ray Computed, Heart-Assist Devices adverse effects, Heart Failure, Heart Transplantation
- Abstract
Background: The HeartMate 3 (HM 3; Abbott) left ventricular assist device (LVAD) has improved hemocompatibility-related adverse outcomes. In sporadic cases, external compression of the outflow graft causing obstruction (eOGO) can result from substance accumulation between the outflow graft and its bend relief. We sought to evaluate the prevalence, course, and clinical implications of eOGO in an international study., Methods: A multicenter retrospective analysis of HM 3 LVADs implanted between November 2014 and April 2021 (n = 2108) was conducted across 17 cardiac centers in 8 countries. We defined eOGO as obstruction >25% in the cross-sectional area in imaging (percutaneous angiography, computed tomography, or intravascular ultrasound). The prevalence and annual incidence were calculated. Serious adverse events and outcomes (death, transplantation, or device exchange) were analyzed for eOGO cases., Results: Of 2108 patients, 62 were diagnosed with eOGO at a median LVAD support duration of 953 (interquartile range, 600-1267) days. The prevalence of eOGO was 3.0% and the incidence at 1, 2, 3, 4, and 5 years of support was 0.6%, 2.8%, 4.0%, 5.2%, and 9.1%, respectively. Of 62 patients, 9 were observed, 27 underwent surgical revision, 15 underwent percutaneous stent implantation, 8 received a heart transplant, and 2 died before intervention. One patient underwent surgical revision and later stent implantation. The mortality with therapeutic intervention was 9/53 (17.0%)., Conclusions: Although uncommon, HM 3 LVAD-supported patients might develop eOGO with an increasing incidence after 1 year of support. Although engineering efforts to reduce this complication are under way, clinicians must maintain a focus on early detection and remain vigilant., (Copyright © 2022 The American Association for Thoracic Surgery. All rights reserved.)
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- 2024
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47. Impella as Bridge to Durable Left Ventricular Assist Device in Acute Myocardial Infarction Cardiogenic Shock Patients.
- Author
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Ajello S, Pieri M, Dormio S, Baldetti L, Altizio S, Consolo F, Nardelli P, Ortalda A, and Scandroglio AM
- Abstract
Implantation of durable left ventricular assist device (LVAD) in cardiogenic shock (CS) patients after acute myocardial infarction (AMI) poses specific challenges (small left ventricular size, acute infarct area, need for antithrombotic therapy, status Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 with impaired organ function and derangements in coagulation and inflammatory parameters) which may affect outcomes. We reviewed data of all AMI-CS patients who were implanted LVAD after Impella support at a referral center with the aim to analyze feasibility, timing, and outcomes of durable LVAD implantation after tMCS with Impella due to AMI-CS. Twenty-one patients were treated between 2013 and 2023: all were in Society for Cardiovascular Angiography & Interventions (SCAI) class D-E and INTERMACS 1-2 at presentation, median LV ejection fraction (EF) and LV end-diastolic diameter (EDD) were 15 (10-20)% and 57 (54-60) mm, respectively. Eleven patients (52%) were supported with Impella CP, seven with Impella 5.0 (33%), and three (14%) with Impella 2.5. Axillary cannulation was performed in nine patients (43%). Five patients (24%) had concomitant venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. Median duration of Impella support was 12 (8-14) days. Overall, the use of Impella was characterized by low rate of complications and allowed successful bridge to durable LVAD in all patients, with 100% 30 day survival rate., Competing Interests: Disclosure: M.P., S. Alticcio, P.N., A.O., and A.M.S. received speaker fee by Abiomed GmbH. M.P. received consultancy fee by Abiomed GmbH. The other authors have no conflicts of interest to report., (Copyright © ASAIO 2024.)
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- 2024
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48. Temporary mechanical circulatory support with Impella in cardiac surgery: A systematic review.
- Author
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Pieri M, D'Andria Ursoleo J, Nardelli P, Ortalda A, Ajello S, Delrio S, Fominskiy E, and Scandroglio AM
- Subjects
- Adult, Humans, Retrospective Studies, Stroke Volume, Ventricular Function, Left, Shock, Cardiogenic surgery, Shock, Cardiogenic etiology, Treatment Outcome, Cardiac Surgical Procedures adverse effects, Heart-Assist Devices adverse effects
- Abstract
Introduction: Perioperative cardiogenic shock (CS) in cardiac surgery is still burdened by a high mortality risk. The introduction of Impella pumps in the therapeutic armory of temporary mechanical circulatory support (tMCS) has potential implications to improve the management of complex cases, although it has never been systematically addressed. We performed a systematic review of the reported use of tMCS with Impella in cardiac surgery., Methods: We searched PubMed for all original studies on the Impella use in adult patients in cardiac surgery., Results: Nineteen studies (out of 151 identified by search string) were included. All studies were observational and all but one (95%) were retrospective. Seven studies focused on the implantation of Impella in the pre-operative setting (coronary or valvular surgery), either as a prophylactic device in high-risk cases (3 studies) or in patients with CS as stabilization tool prior to cardiac surgery procedure (4 studies). Three studies reported the use of Impella as periprocedural support for percutaneous valvular procedure, three as bridge to heart replacement, and six for postcardiotomy CS. Impella support had a low complication rate and was successful in supporting hemodynamics pre-, intra- and postoperatively. Most consistently reported data were left-ventricular ejection fraction at implant, short-term survival and weaning rate., Conclusions: tMCS with Impella in cardiac surgery patients is feasible and successful. It can be applied in selected cardiac surgery patients and presents advantages over other types of support. Systematic prospective studies are needed to standardize indications for implant and management of surgical issues, and to identify which patients may benefit., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2024
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49. Cat Scratch Endocarditis.
- Author
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De Cristofaro J, Sacchi S, Baldetti L, Calvo F, Gramegna M, Pazzanese V, Peveri B, Cianfanelli L, Ajello S, and Scandroglio AM
- Abstract
We reported a case of blood culture-negative infective endocarditis on a native valve, where the clinical presentation was exclusively related to extensive cerebral ischemia secondary to multiple systemic septic cardioembolic events. The cause was ascribed to subacute Bartonella henselae infection, presumably transmitted by cat scratch, documented by positive serologic findings., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)
- Published
- 2023
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50. Monitoring MCS patients on the intensive care unit: integrating haemodynamic assessment, laboratory data, and imaging techniques for timely detection of deterioration and recovery.
- Author
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Vandenbriele C, Baldetti L, Beneduce A, Belohlavek J, Hassager C, Pieri M, Polzin A, Scandroglio AM, and Møller JE
- Abstract
Monitoring of the patient supported with a temporary mechanical circulatory support (tMCS) is crucial in achieving the best possible outcome. Monitoring is a continuous and labour-intensive process, as cardiogenic shock (CS) patients can rapidly deteriorate and may require new interventions within a short time period. Echocardiography and invasive haemodynamic monitoring form the cornerstone of successful tMCS support. During monitoring, it is particularly important to ensure that adequate end-organ perfusion is achieved and maintained. Here, we provide a comprehensive overview of best practices for monitoring the CS patient supported by a micro-axial flow pump, veno-arterial extracorporeal membrane oxygenation, and both devices simultaneously (ECMELLA approach). It is a complex process that encompasses device control, haemodynamic control and stabilization, monitoring of interventions, and assessment of end-organ function. The combined, continuous, and preferably protocol-based approach of echocardiography, evaluation of biomarkers, end-organ assessment, and haemodynamic parameters is crucial in assessing this critically ill CS patient population., Competing Interests: Conflict of interest: C.V. received manuscript support from Abiomed, honoraria from Abiomed, and travel support from Abiomed. C.V. is supported by a research grant of the FWO-flanders (FKM 1803923N). J.B. is on a board for AstraZeneca and BoehringerIngelheim and received consulting fees from Abiomed, Getinge, Resuscitec, and Xenios. C.H. has received research grants from Novo Nordisk Foundation, Lundbeck Foundation, and Danish Heart Foundation and honoraria from Abiomed and is in an unpaid leadership role as Chair of the Danish Heart Foundation and board member of ESC. M.P. has received manuscript preparation support, consulting fees, and honoraria from Abiomed. A.P. has received manuscript preparation support from Abiomed, a research grant from the German Research Council, and honoraria from Abbott, Bayer, Bristol-Myers Squibb, Pfizer, Daiichi, and Medtronic. M.S. reports no disclosures or conflicts of interest. J.E.M. has received grants from Abiomed and Novo Nordic, honoraria from Abiomed, Boehringer Ingelheim, Abbott, and Orion, and travel support from Abiomed., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2023
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