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Your search keyword '"De Palo, M."' showing total 6 results
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6 results on '"De Palo, M."'

1. Quadricuspid aortic valve repair with a modified-tricuspidization technique.

Author

D'Errico Ramirez A, Squiccimarro E, De Palo M, Acquaviva T, and Milano AD

Subjects
Female, Humans, Middle Aged, Treatment Outcome, Aortic Valve diagnostic imaging, Aortic Valve surgery, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency surgery, Quadricuspid Aortic Valve, Cardiac Surgical Procedures
Abstract

Introduction: Quadricuspid aortic valve (QAV) is an extremely rare developmental abnormality with an incidence of 0.006%. QAV is an incidental finding that in some patients (23%) may determine aortic regurgitation (AR). Altogether 16% of patients indeed require surgery with AR being the most frequent indication., Methods and Results: We describe a case report of a 46 year-old female affected by severe aortic regurgitation due to QAV successfully treated with a  modified-tricuspidization technique associated with cusp extension, prolapsing commissure suturing, and sub-commissural annuloplasty., Discussion: QAV repair represents an attractive perspective to overcome the drawbacks of either mechanical or biological prosthesis., (© 2022 The Authors. Echocardiography published by Wiley Periodicals LLC.)

Published
2022
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2. Minimally invasive heart valve surgery: influence on coagulation and inflammatory response.

Author

Paparella D, Rotunno C, Guida P, Travascia M, De Palo M, Paradiso A, Carrozzo A, and Rociola R

Subjects
Aged, Blood Transfusion statistics & numerical data, Female, Heart Valve Diseases blood, Humans, Incidence, Male, Middle Aged, Postoperative Hemorrhage epidemiology, Postoperative Hemorrhage therapy, Prospective Studies, Blood Coagulation physiology, Cardiac Surgical Procedures methods, Heart Valve Diseases surgery, Inflammation epidemiology, Minimally Invasive Surgical Procedures methods, Postoperative Hemorrhage blood, Thoracotomy methods
Abstract

Objectives: Minimally invasive valve surgery (MIVS) is associated with improved clinical outcome but longer cardiopulmonary bypass (CPB) time. The aim of the present study is to compare inflammatory and coagulation parameters in patients undergoing minimally invasive or standard valve surgery., Methods: A prospective non-randomized study was performed enrolling 79 patients undergoing mitral (20 right mini-thoracotomy and 18 standard sternotomy) and aortic valve (20 mini-sternotomy and 21 standard sternotomy) procedures. Blood samples were collected perioperatively to measure prothrombin fragment 1.2 (PF1.2, thrombin generation), plasmin antiplasmin complex (PAP, fibrinolysis), interleukin-6 (IL-6, inflammation). Plasma free haemoglobin (f-Hb) was assessed to evaluate haemolysis., Results: Patients in the minimally invasive group were younger and had less comorbidities CPB and cross-clamp times were comparable considering both aortic and mitral procedures, but longer in the mini-thoracotomy group. IL-6 and PAP were reduced in the minimally invasive group, particularly 2 h after CPB (respectively 102 ± 114 vs 34 ± 49 pg/ml, P < 0.001 and 2137 ± 1046 vs 1207 ± 675 ng/ml, P < 0.001), PF1.2 was also reduced during and after the operation (688 ± 514 vs 571 ± 470, P = 0.02; 1600 ± 1185 vs 1042 ± 548, P < 0.001; 1487 ± 676 vs 1042 ± 541). Despite the use of vacuum-assisted active venous drainage (VAVD) f-Hb was significantly reduced in the minimally invasive group. The other routine biomarkers such as C-reactive protein, fibrinogen and cTnI were also reduced in the minimally invasive group., Conclusions: In a selected cohort of patients MIVS is associated to reduced inflammatory reaction and coagulopathy, supporting the clinical evidence of reduced postoperative bleeding and lower transfusion rate. Our data offer further suggestion supporting the adoption of minimally invasive approaches., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Published
2017
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3. Acute kidney injury in high-risk cardiac surgery patients: roles of inflammation and coagulation.

Author

Scrascia G, Rotunno C, Simone S, Montemurno E, Amorese L, De Palo M, Castellano G, Pertosa GB, Gesualdo L, and Paparella D

Subjects
Acute Kidney Injury blood, Acute Kidney Injury diagnosis, Acute Kidney Injury physiopathology, Aged, Aged, 80 and over, Anemia blood, Anemia complications, Area Under Curve, Biomarkers blood, Female, Glomerular Filtration Rate, Humans, Inflammation blood, Inflammation diagnosis, Male, Oxidative Stress, Peptide Fragments blood, Predictive Value of Tests, Prospective Studies, Prothrombin, ROC Curve, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Acute Kidney Injury etiology, Blood Coagulation, Cardiac Surgical Procedures adverse effects, Cardiopulmonary Bypass adverse effects, Inflammation etiology, Inflammation Mediators blood, Kidney physiopathology
Abstract

Aims: Acute kidney injury (AKI) is a common complication following cardiac surgery. Cardiopulmonary bypass elicits coagulation and inflammation activation and oxidative stress, all involved in AKI but never simultaneously assessed. We aimed to evaluate relations between oxidative stress, inflammatory and coagulation systems activation and postoperative renal function in patients with normal preoperative renal function., Methods: Forty-one high-risk patients (EuroSCORE >6 and preoperative haemoglobin <12 g/dl in women and <13 g/dl in men) were prospectively enrolled. Prothrombin fragment 1.2 (coagulation marker), interleukin-6 and interleukin-10 (pro/anti-inflammatory markers) and 8-oxo-2'-deoxyguanosine (oxidative stress marker) were evaluated until postoperative day 5., Results: Patients were divided into two groups according to estimated glomerular filtration rate reduction observed postoperatively (reduction <25% in 26 patients: NO-AKI group; reduction >25% in 15 patients: AKI group). No differences were found for inflammatory markers. Oxidative stress slightly increased in the AKI group. Twenty-four hours after the operation prothrombin fragment 1.2 levels were significantly higher in the AKI group (506.6 ± 548 vs. 999 ± 704.1 pmol/l; P = 0.018), and they were independently associated with estimated glomerular filtration rate reduction, with an area under the receiving operating characteristic of 0.744., Conclusion: Thrombin generation is higher in patients with renal function worsening, and it is an independent risk factor for AKI in patients with anaemia, possibly leading to microcirculation impairment and tubular cells damage.

Published
2017
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4. Myocardial protection during minimally invasive cardiac surgery through right mini-thoracotomy.

Author

De Palo M, Guida P, Mastro F, Nanna D, Quagliara TA, Rociola R, Lionetti G, and Paparella D

Subjects
Adult, Aged, Arrhythmias, Cardiac blood, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac physiopathology, Arrhythmias, Cardiac prevention & control, Blood Transfusion methods, Cardiac Output, Low blood, Cardiac Output, Low etiology, Cardiac Output, Low physiopathology, Cardiac Output, Low prevention & control, Cardiac Surgical Procedures adverse effects, Creatine Kinase, MB Form blood, Female, Glucose therapeutic use, Heart drug effects, Heart physiology, Humans, Male, Mannitol therapeutic use, Middle Aged, Minimally Invasive Surgical Procedures adverse effects, Potassium Chloride therapeutic use, Procaine therapeutic use, Retrospective Studies, Thoracotomy adverse effects, Troponin I blood, Cardiac Surgical Procedures methods, Cardioplegic Solutions therapeutic use, Heart physiopathology, Heart Arrest, Induced methods, Minimally Invasive Surgical Procedures methods, Thoracotomy methods
Abstract

Background: Myocardial damage is an independent predictor of adverse outcome following cardiac surgery and myocardial protection is one of the key factors to achieve successful outcomes. Cardioplegia with Custodiol is currently the most used cardioplegia during minimally invasive cardiac surgery (MICS). Different randomized controlled trials compared blood and Custodiol cardioplegia in the context of traditional cardiac surgery. No data are available for MICS., Aim: The aim of this study was to compare the efficacy of cold blood versus Custodiol cardioplegia during MICS., Method: We retrospectively evaluated 90 patients undergoing MICS through a right mini-thoracotomy in a three-year period. Myocardial protection was performed using cold blood (44 patients, CBC group) or Custodiol (46 patients, Custodiol group) cardioplegia, based on surgeon preference and complexity of surgery., Results: The primary outcomes were post-operative cardiac troponin I (cTnI) and creatine kinase MB (CKMB) serum release and the incidence of Low Cardiac Output Syndrome (LCOS). Aortic cross-clamp and cardiopulmonary bypass times were higher in the Custodiol group. No difference was observed in myocardial injury enzyme release (peak cTnI value was 18±46 ng/ml in CBC and 21±37 ng/ml in Custodiol; p=0.245). No differences were observed for mortality, LCOS, atrial or ventricular arrhythmias onset, transfusions, mechanical ventilation time duration, intensive care unit and total hospital stay., Conclusions: Custodiol and cold blood cardioplegic solutions seem to assure similar myocardial protection in patients undergoing cardiac surgery through a right mini-thoracotomy approach.

Published
2017
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5. The Effects of Steroids on Coagulation Dysfunction Induced by Cardiopulmonary Bypass: A Steroids in Cardiac Surgery (SIRS) Trial Substudy.

Author

Paparella D, Parolari A, Rotunno C, Vincent J, Myasoedova V, Guida P, De Palo M, Margari V, Devereaux PJ, Lamy A, Alamanni F, Yusuf S, and Whitlock R

Subjects
Administration, Intravenous, Aged, Aged, 80 and over, Biomarkers blood, Blood Coagulation Tests, Double-Blind Method, Drug Administration Schedule, Female, Fibrinolysis drug effects, Glucocorticoids adverse effects, Humans, Italy, Male, Methylprednisolone adverse effects, Middle Aged, Ontario, Platelet Activation drug effects, Platelet Function Tests, Postoperative Hemorrhage blood, Postoperative Hemorrhage etiology, Risk Factors, Thrombin metabolism, Time Factors, Treatment Outcome, Blood Coagulation drug effects, Blood Loss, Surgical prevention & control, Cardiac Surgical Procedures adverse effects, Cardiopulmonary Bypass adverse effects, Glucocorticoids administration & dosage, Methylprednisolone administration & dosage, Postoperative Hemorrhage prevention & control
Abstract

Cardiopulmonary bypass (CPB) surgery, despite heparin administration, elicits activation of coagulation system resulting in coagulopathy. Anti-inflammatory effects of steroid treatment have been demonstrated, but its effects on coagulation system are unknown. The primary objective of this study is to assess the effects of methylprednisolone on coagulation function by evaluating thrombin generation, fibrinolysis, and platelet activation in high-risk patients undergoing cardiac surgery with CPB. The Steroids In caRdiac Surgery study is a double-blind, randomized, controlled trial performed on 7507 patients worldwide who were randomized to receive either intravenous methylprednisolone, 250 mg at anesthetic induction and 250 mg at initiation of CPB (n = 3755), or placebo (n = 3752). A substudy was conducted in 2 sites to collect blood samples perioperatively to measure prothrombin fragment 1.2 (PF1+2, thrombin generation), plasmin-antiplasmin complex (PAP, fibrinolysis), platelet factor 4 (PF4 platelet activation), and fibrinogen. Eighty-one patients were enrolled in the substudy (37 placebo vs 44 in treatment group). No difference in clinical outcome was detected, including postoperative bleeding and need for blood products transfusion. All patients showed changes of all plasma biomarkers with greater values than baseline in both groups. This reaction was attenuated significantly in the treatment group for PF1.2 (P = 0.040) and PAP (P = 0.042) values at the first intraoperative measurement. No difference between groups was detected for PF4. Methylprednisolone treatment attenuates activation of coagulation system in high-risk patients undergoing CPB surgery. Reduction of thrombin generation and fibrinolysis activation may lead to reduced blood loss after surgery., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Published
2017
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6. Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump: a randomized controlled trial

Author

Garg, Amit X, Chan, Matthew TV, Cuerden, Meaghan S, Devereaux, PJ, Abbasi, Seyed Hesameddin, Hildebrand, Ainslie, Lamontagne, Francois, Lamy, Andre, Noiseux, Nicolas, Parikh, Chirag R, Perkovic, Vlado, Quantz, Mackenzie, Rochon, Antoine, Royse, Alistair, Sessler, Daniel I, Shah, Pallav J, Sontrop, Jessica M, Tagarakis, Georgios I, Teoh, Kevin H, Vincent, Jessica, Walsh, Michael, Yared, Jean-Pierre, Yusuf, Salim, Whitlock, Richard P, Whitlock, R, Semelhago, L, Chu, V, Dyub, A, Cybulsky, I, Van Oosteen, R, Cordova, G, Quantz, MA, McKenzie, FN, Fox, S, Chase, L, Stevens, LM, Prieto, I, Basile, F, Finegan, BA, Bryden, C, Meyer, S, Chappell, A, Mazer, CD, Dixon, J, Yagnik, S, Crescini, C, Verma, S, Legare, JF, Greentree, D, Coutu, M, Teijeira, J, Wiley, W, Peniston, C, Teng, C, Rochon, AG, Lamarche, Y, Deschamps, A, Voisine, P, Dagenais, F, Singal, RK, Brown, CD, Kieser, TM, Robinson, R, Fremes, SE, Christakis, GT, Melvin, KN, Parsons, M, Zheng, H, Yu, J, Xu, W, Zhang, Q, Chen, C, Yu, H, Zeng, J, Zuo, Y, Liu, J, Zhang, T, Sun, Y, Song, D, Dong, H, Chen, M, Zhao, J, Tao, L, Huang, W, Cheng, Y, Long, YS, Lei, W, Zhang, W, Xu, MY, Qing, E, Xiao, YB, Karunakaran, J, Pillai, VV, Reddy, PB, Kundan, S, Jain, AR, Mallya, SS, Mehta, CB, Shukla, V, Kuruvila, K, Karthikeyan, G, Devagourou, V, Hote, MP, Airan, B, Padmanabhan, C, Srinivasan, M, Agarwal, SK, Pande, S, Rao, P Simha Mohan, Math, R, Shankar, BPR, Vaijyanath, PH, Nair, SK, Ayapati, DR, Kurz, A, Awais, A, Panjasawatwong, K, Kashy, BK, Huffmyer, JL, Scalzo, DC, Kazemi, A, Huang, KF, Parvathaneni, SV, Gardner, JC, Malik, MR, Eshraghi, Y, Kramer, RS, Essandoh, MK, Portillo, J, Ayad, SS, Akhtar, Z, Castresana, MR, Collard, CD, Rodriguez-Blanco, YF, Eaton, MP, Villar, JC, Umana, JP, Dominguez, CL, Alvarado, PA, Zuluaga, D, Abello, M, Sarquis, T, Vaquiro, E, Oliveros, CA, Manrique, EJ, Vasquez, S, Ortiz, LM, Holliday, J, Griffin, R, Royse, AG, Royse, CF, Williams, Z, Paparella, D, Rotunno, C, De Palo, M, Margari, V, Alfieri, O, Ferrara, D, Schiavi, D, Parolari, A, Myasoedova, VA, Daprati, A, De Feo, M, Bancone, C, Di Bartolomeo, R, Pacini, D, Ribezzo, M, Karimi, A, Salehiomran, A, Hajighasemi, A, Bina, P, Straka, Z, Hlavicka, J, Lukac, P, Vik, K, Mosna, F, Tsilimingas, NB, Simopoulos, VN, Tsolaki, F, Rivilla, MT, Galan, J, Nunez, JAF, Gonzalez, A, Ruiz, D, Orts Rodriguez, M, Issa, M, Vila Nova, DC, Maia, LN, Nakazone, MA, Lico e Cividanes, GV, Hajjar, LA, Neto, V Avila, Lucchese, FA, Stolf, NA, Hutschala, D, Ruetzler, K, Sima, B, Engelen, S, Borms, S, Van De Velde, M, Rex, S, De Hert, SG, Ho, AMH, Chan, MTV, Underwood, MJ, Deluca Bisurgi, D, Torres, D, and Buggy, DJ

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Anti-Inflammatory Agents, 030204 cardiovascular system & hematology, Methylprednisolone, Drug Administration Schedule, law.invention, 03 medical and health sciences, Medicine, General & Internal, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, General & Internal Medicine, Cardiopulmonary bypass, SIRS, Medicine, Humans, 030212 general & internal medicine, Cardiac Surgical Procedures, Glucocorticoids, Dialysis, Aged, Science & Technology, Cardiopulmonary Bypass, business.industry, STEROIDS, Research, Acute kidney injury, General Medicine, Perioperative, Acute Kidney Injury, Middle Aged, medicine.disease, Cardiac surgery, HIGH-DOSE DEXAMETHASONE, Anesthesia, Female, business, Life Sciences & Biomedicine, Kidney disease, medicine.drug
Abstract

BACKGROUND: Perioperative corticosteroid use may reduce acute kidney injury. We sought to test whether methylprednisolone reduces the risk of acute kidney injury after cardiac surgery. METHODS: We conducted a prespecified substudy of a randomized controlled trial involving patients undergoing cardiac surgery with cardiopulmonary bypass (2007-2014); patients were recruited from 79 centres in 18 countries. Eligibility criteria included a moderate-to-high risk of perioperative death based on a preoperative score of 6 or greater on the European System for Cardiac Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned (1:1) to receive intravenous methylprednisolone (250 mg at anesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo. Patients, caregivers, data collectors and outcome adjudicators were unaware of the assigned intervention. The primary outcome was postoperative acute kidney injury, defined as an increase in the serum creatinine concentration (from the preoperative value) of 0.3 mg/dL or greater (≥ 26.5 μmol/L) or 50% or greater in the 14-day period after surgery, or use of dialysis within 30 days after surgery. RESULTS: Acute kidney injury occurred in 1479/3647 patients (40.6%) in the methylprednisolone group and in 1426/3639 patients (39.2%) in the placebo group (adjusted relative risk 1.04, 95% confidence interval 0.96 to 1.11). Results were consistent across several definitions of acute kidney injury and in patients with preoperative chronic kidney disease. INTERPRETATION: Intraoperative corticosteroid use did not reduce the risk of acute kidney injury in patients with a moderate-to-high risk of perioperative death who had cardiac surgery with cardiopulmonary bypass. Our results do not support the prophylactic use of steroids during cardiopulmonary bypass surgery. Trial registration: ClinicalTrials.gov, no. NCT00427388. ispartof: CANADIAN MEDICAL ASSOCIATION JOURNAL vol:191 issue:9 pages:E247-E256 ispartof: location:Canada status: published

Published
2019

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