209 results on '"F. Donatelli"'
Search Results
2. PS1274 EPIDEMIOLOGY AND MANAGEMENT OF LATENT TUBERCULOSIS INFECTION IN ADULT PATIENTS WITH ACUTE LEUKEMIA OR APLASTIC ANEMIA: A RETROSPECTIVE MONOCENTER STUDY
- Author
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P. Barozzi, M. Luppi, F. Forghieri, M. Celli, A. Messerotti, C. Mussini, Ivana Lagreca, E. Colaci, L. Potenza, A. Gilioli, S. Iotti, F. Narni, D. Giusti, M. Codeluppi, D. Vallerini, L. Arletti, H. Catellani, Erica Franceschini, V. pioli, V. Nasillo, Monica Morselli, Rossana Maffei, F. Bettelli, Giovanni Riva, A. Paolini, C. Colasante, L. Galassi, R. Marasca, and F. Donatelli
- Subjects
Pediatrics ,medicine.medical_specialty ,Acute leukemia ,Adult patients ,Latent tuberculosis ,business.industry ,Epidemiology ,medicine ,Hematology ,Aplastic anemia ,medicine.disease ,business - Published
- 2019
3. Descartes: artes mecânicas e filosofia [Mechanica Arts and Philosophy]
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Marisa C. de O. F. Donatelli
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Philosophy ,General Medicine ,Humanities - Abstract
Neste trabalho, pretende-se abordar a defesa da utilidade do conhecimento em Descartes, considerando aquilo que o fi lósofo entende como ‘conhecimentos que sejam úteis à vida’, porém não a partir de um enfoque moral, mas com ênfase no planejamento de construção de máquinas e artefatos que, além de auxiliarem a ciência, facilitem o trabalho dos homens. Tal propósito pode ser encontrado em alguns textos do fi lósofo, dos quais se destaca o pequeno tratado sobre as mecânicas que compõem a carta a Huygens de 5 de outubro de 1637, as duas partes fi nais do Discurso do Método e o discurso X da Dióptrica. Com base em textos selecionados, e sem perder o caráter unificador da proposta cartesiana, enfatizar-se-á, tomando de empréstimo uma expressão de Nicolas Grimaldi, a “obsessão tecnológica” presente na obra do filósofo.
- Published
- 2012
4. [Repair of anterior mitral leaflet prolapse: state of the art]
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P, Fundarò, A, Moneta, G, Marchetto, F, Donatelli, and A, Grossi
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Mitral Valve Prolapse ,Humans ,Cardiac Surgical Procedures - Abstract
Surgical repair of anterior leaflet prolapse has evolved and widely expanded over the past decade. A number of surgical techniques have been developed. In this study a review of all reparative techniques has been provided. A classification has been proposed according to the involvement of valve components and, eventually, to graft employment. For each technique the following points have been detailed: a) advantages and drawbacks; b) likelihood of effective valve repair based on morpho-pathologic variability of degenerative mitral disease; c) long-term outcome as freedom from reoperation. The authors provide indications for early surgical anterior leaflet prolapse repair and recommend that surgeons should be familiar with many reparative procedures to select the right option and improve their operative results.
- Published
- 2000
5. [High-risk pulmonary surgery in potential candidates for a heart transplant]
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F, Donatelli, M, Pocar, G, Marchetto, A, Moneta, E, Villa, and A, Grossi
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Cardiomyopathy, Dilated ,Heart Failure ,Male ,Ventricular Dysfunction, Left ,Risk Factors ,Contraindications ,Heart Transplantation ,Humans ,Pulmonary Edema ,Lung Abscess ,Middle Aged ,Pneumonectomy - Abstract
Severe ventricular dysfunction and concomitant infection are considered absolute contraindications for major thoracic operations and immunosuppressive therapy, respectively. However, cardiac transplantation represents the first-choice treatment in advanced heart failure. We report the case of a patient with dilated cardiomyopathy and severe left ventricular dysfunction (ejection fraction = 25%), initially not considered as a potential heart transplant candidate due to the presence of a lung abscess. The patient subsequently underwent atypical pulmonary resection with intraoperative and perioperative intraaortic balloon counter-pulsation for circulatory support and was then listed for cardiac transplant. Pitfalls and intra/postoperative strategy, all of which are potentially important aspects in minimizing operative risk, are discussed.
- Published
- 1999
6. Six-and-half years' experience with the St. Jude BioImplant porcine prosthesis
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M, Triggiani, G, D'Ancona, S, Nascimbene, S, Benussi, F, Donatelli, G, Paolini, L, Galli, and A, Grossi
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Adult ,Male ,Reoperation ,Time Factors ,Swine ,Heart Valve Diseases ,Prosthesis Design ,Postoperative Complications ,Risk Factors ,Animals ,Humans ,Aged ,Probability ,Aged, 80 and over ,Bioprosthesis ,Endocarditis ,Equipment Safety ,Incidence ,Hemodynamics ,Thrombosis ,Middle Aged ,Prognosis ,Survival Analysis ,Prosthesis Failure ,Evaluation Studies as Topic ,Heart Valve Prosthesis ,Female ,Follow-Up Studies - Abstract
In this study, we reviewed our experience in heart valve replacement with the St. Jude BioImplant heart valve, which is a low-profile, low-pressure glutaraldehyde-fixed porcine prosthesis mounted on a flexible Delrin stent.During the period May 1989-January 1996, 117 patients were implanted with 132 BioImplant prostheses; three patients were lost to follow up and excluded from the series. Mean age was 67.5 +/- 9.8 years (range: 19 to 82 years); myocardial revascularization was performed in 22 (19.3%) patients. In-hospital mortality rate was 6% (7/117 patients). By January 1996, 114 patients (53 males, 61 females), in whom 59 aortic, 35 mitral, 15 mitro-aortic and five tricuspid prostheses had been implanted, were eligible for the analysis. Mean follow up was 40.4 +/- 21.7 months (range: 1 to 76 months).The survival probability of survivors was 72.1 +/- 6.5 at 77 months. Seventeen patients died during follow-up. The mean NYHA class improved from 3.1 +/- 0.6 preoperatively to 1.4 +/- 0.6 postoperatively. The freedom probabilities were respectively 89.5 +/- 5.3% from thromboembolism, 93.2 +/- 3.7% from infective endocarditis, 84.5 +/- 10.3% from structural dysfunction, 99.1 +/- 0.9% from non-structural dysfunction, and 80.1 +/- 10.2% from reoperation. The freedom probability for valve-related events was respectively 75.3 +/- 12.3%, 98.0 +/- 1.9% and 67.2 +/- 17.2% for patients who underwent mitral, aortic and mitro-aortic heart valve replacement (p = 0.05 comparing only patients who underwent mitral or aortic replacement); moreover the freedom probability from valve-related events was 71.6 +/- 11.2% in patients agedor = 65 years and 90.2 +/- 6.6% in patients aged65 years (p = 0.006).The BioImplant heart valve, in our experience, seems to be a valuable device which shows a mid-term performance similar to that of other porcine prostheses.
- Published
- 1997
7. [Transmyocardial laser revascularization in patients with peripheral coronary atherosclerosis. Indications and preliminary results]
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F, Donatelli, M, Triggiani, G, D'Ancona, A, Blasio, F, Santoro, G, Marchetto, S, Benussi, and A, Grossi
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Male ,Myocardial Revascularization ,Humans ,Female ,Coronary Artery Disease ,Laser Therapy ,Middle Aged ,Aged - Abstract
Surgical intervention for coronary artery disease (CAD) is determined by the viability of coronary artery branches. When peripheral coronary artery disease is present, conventional bypass grafting is not suitable. Research has recently been done on alternative methods such as transmyocardial laser revascularization (TMLR). TMLR works through the vascular connections that are present between the cardiac chambers and the myocardial muscle in the human heart. The creation of 1-mm transmural cardiotomies through a CO2 laser should improve myocardial perfusion.From February to June of 1996, twelve patients (9 males and 3 females with a mean age of 67.8 +/- 4.6) with CAD (mean n0 of diseased vessels 2.7), angina (mean CCS class 3.5 +/- 0.5), mean ejection fraction 47.8% and viable ischemic myocardium on scintiscan in segments without graftable coronary branches, underwent TMLR at our institute. Nine of the 12 patients also underwent associated CABG (mean number of anastomoses per patient: 2.5). Cardiopulmonary bypass was never used, since coronary anastomoses and laser cardiotomies were performed on the beating heart.Perioperative mortality was 2/12 (16.6%). Postoperative inotropic support and diuretic therapy was required in most cases. At a mean follow-up period of 4.2 months, all remaining patients are still alive: 5/10 are angina-free (CCS 0), 4/10 are in CCS class 1 and 1/10 is in CCS class 2 (mean 0.6 +/- 0.7).We believe that TMLR could be considered an effective mean to treat symptomatic myocardial ischemic disease in which coronary bypass grafting is not suitable. During the immediate postoperative period, contractile myocardial dysfunction occurs in a high percentage of patients treated using TMLR and consequently it would be worthwhile to invest in further research.
- Published
- 1997
8. Primary cardiac malignancy presenting as left atrial myxoma. Clinical and surgical considerations
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F, Donatelli, M, Pocar, A, Moneta, M A, Mariani, S, Pelenghi, M, Triggiani, F, Santoro, and A, Grossi
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Diagnosis, Differential ,Heart Neoplasms ,Echocardiography ,Humans ,Female ,Middle Aged ,Myxosarcoma ,Myxoma - Abstract
Primary heart neoplasms occur in 0.002-0.3% of autopsies: 30% are myxomas and 20-30% are malignancies, almost always sarcomas. Cardiac metastases are 10 to 40 times more frequent than primary heart cancer. We describe a case of a left atrial sarcoma erroneously diagnosed as myxomas preoperatively. Standard surgical indication for resection of cardiac myxomas is based on echocardiography. Because of the severity of cardiac malignant lesions than can mimic atrial myxomas at echocardiography, through preoperative investigation should be accomplished, best by magnetic resonance imaging. In case of suspected malignancy, total body computed tomography should be performed to avoid unnecessary cardiac operations in case of disseminated cancer. To date the only good medium and long-term results in the therapeutic management of heart sarcomas have been achieved by transplantation: the probable explanation is that criteria of surgical radicality should be those followed for soft tissue tumors located elsewhere in the organism.
- Published
- 1996
9. Identification of hibernating myocardium: a comparison between dobutamine echocardiography and study of perfusion and metabolism in patients with severe left ventricular dysfunction
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M A, Mariani, C, Palagi, F, Donatelli, G, Mengozzi, O, Biadi, G, Vanoli, C, Landoni, G, Paolini, G, Lucignani, and F, Fazio
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Male ,Technetium Tc 99m Sestamibi ,Tomography, Emission-Computed, Single-Photon ,Fluorine Radioisotopes ,Myocardium ,Reproducibility of Results ,Coronary Disease ,Heart ,Deoxyglucose ,Middle Aged ,Sensitivity and Specificity ,Ventricular Dysfunction, Left ,Echocardiography ,Fluorodeoxyglucose F18 ,Dobutamine ,Humans ,Tomography, Emission-Computed - Abstract
The distinction between fibrotic and viable myocardium is a key issue in patients with coronary artery disease and left ventricular dysfunction. Metabolic imaging with positron emission tomography (PET) and labeled tracers, along with the study of myocardial perfusion, is now available to identify hibernating myocardium. However, PET imaging of myocardial metabolism is a high-cost and time-consuming technique, and requires an on-site cyclotron. The aim of this study is to test the reliability of dobutamine echocardiography (DE) compared with PET imaging, for the identification of hibernating myocardium. In 16 patients, scheduled for myocardial revascularization, left ventricular shapes were divided in eight segments both for echocardiographic and nuclear study evaluation. All patients underwent a technetium 99m MIBI single-photon emission tomography stress-rest study of perfusion, a fluorine-18-labeled deoxyglucose (FDG(/PET study of metabolism, and a DE test (baseline, at a 5 micrograms/kg/min infusion of dobutamine for 8 minutes and at a 10 micrograms/kg/min dose for additional 8 minutes). Neither myocardial ischemia nor arrhythmia occurred during the DE test. Baseline echocardiograms showed 90 segments with wall motion abnormalities: wall motion impairment was decreased or reversed in 33 of 90 segments; it remained unchanged in 57 of 90 segments. In 32 of 33 segments considered viable on the basis of DE and in 21 of 57 segments with unchanged kinesis, some degree of FDG was detected. Thus, sensitivity and specificity of DE compared with nuclear studies was 60% and 97% respectively. Moreover, a good correlation and agreement (kappa = 0.51) between DE and the presence of FDG were found. We conclude that DE is a safe and reliable test for the screening of hibernating myocardium in patients with chronic coronary artery disease and left ventricular dysfunction.
- Published
- 1995
10. Measurement of cardiac troponin T and myosin to detect perioperative myocardial damage during coronary surgery
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M, Triggiani, F, Simeone, C, Gallorini, G, Paolini, F, Donatelli, G, Paolillo, A, Dolci, and A, Grossi
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Male ,Myocardial Ischemia ,Middle Aged ,Myosins ,Troponin ,Isoenzymes ,Postoperative Complications ,Troponin T ,Myocardial Revascularization ,Humans ,Female ,Intraoperative Complications ,Creatine Kinase ,Biomarkers ,Monitoring, Physiologic ,Retrospective Studies - Abstract
This study evaluated the use of monitoring blood levels of the isoenzyme of creatine phosphokinase, troponin T (tnT) and myosin in the detection of perioperative myocardial damage after coronary artery surgery. Serial blood samples were collected in 24 patients undergoing myocardial revascularization. The patients were retrospectively divided into three groups: group A with no changes in their electrocardiogram; group B showing non-specific signs of perioperative myocardial infarction such as deep and permanent T wave inversion; and group C with definite electrocardiographic signs of perioperative myocardial infarction (new persistent Q-waves and loss of R-waves). Group A (n = 17) demonstrated a mean(s.d.) troponin T peak blood level of 0.64(0.35) ng/ml at 12-24 h after surgery, a myosin peak of 1030(670) mu units/l at 3-6 days afterwards, and a creatine phosphokinase isoenzyme peak of 25.8(10.6) units/l. In group B (n = 5), mean(s.d.) troponin T levels were elevated to a peak of 4.8(3.9) ng/ml 24 h after intervention, while myosin rose to 2074(340) mu units/l 3-6 days after surgery and creatine phosphokinase isoenzyme reached 57.8(38) units/l. Group C (n = 2) had a mean(s.d.) troponin T peak of 4.8(2.6) ng/ml, a myosin peak of 2404(392) mu unit/l and a creatine phosphokinase isoenzyme peak of 88.5(20) units/l. Peak values of troponin T and myosin in groups B and C were statistically different from those in group A (P0.001). These results suggest that troponin T and myosin are reliable indicators of perioperative myocardial damage. In particular, troponin T may allow the differentiation of reversible from irreversible myocardial injury.
- Published
- 1994
11. [Myocardial revascularization in patients with impaired left ventricular function]
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M A, Mariani, F, Donatelli, S, Pelenghi, M, Triggiani, and A, Grossi
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Adult ,Male ,Tomography, Emission-Computed, Single-Photon ,Time Factors ,Myocardium ,Coronary Disease ,Heart ,Middle Aged ,Humans ,Female ,Coronary Artery Bypass ,Aged ,Follow-Up Studies ,Tomography, Emission-Computed - Abstract
From March 1988 to May 1993, 1,125 patients with coronary artery disease (CAD) underwent coronary surgery at our Institute. In the same period 74 patients (mean age 59 +/- 7 years; range 36-73) with left ventricular dysfunction (LVD) were referred for surgical decision making. All patients underwent [99mTc]MIBI/SPET to assess perfusion at rest and [99mTc]MIBI first pass radionuclide angiography to assess the ejection fraction (EF). In 44/74 patients we performed [18F]FDG/PET in fasting conditions and pharmacologic wash-out, in order to identify viable myocardium. We divided patients with LVD into 3 groups: Group A (30 patients) operated on without preoperative [18F]FDG/PET, Group B (37 patients) operated on with FDG uptake in segments with wall motion abnormalities, and Group C (7 patients) with no FDG uptake, who were excluded from coronary surgery; there was no significant difference among the 3 groups with respect to age, sex, CAD, risk factors and EF (Group A: 29.1% +/- 6.6%, range 16-39%; Group B: 30.8 +/- 5.6%, range 20-40%; Group C: 26.5 +/- 6.8%, range 18-37%). The study of perfusion and EF was repeated 6 months postoperatively in Group A and B. Left ventricular end-dyastolic pressure at cardiac catheterization was 19.9 +/- 5.1 mmHg, 20.4 +/- 4.7 mmHg and 26.8 +/- 9.2 mmHg in Group A, B and C, respectively. Myocardial protection was achieved according to the Buckberg protocol.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1994
12. Rest and exercise hemodynamics of stentless porcine bioprostheses in aortic position
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F, Donatelli, M, Triggiani, M A, Mariani, C, Nitti, A, Pancaldi, A, Castiglioni, and A, Grossi
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Bioprosthesis ,Male ,Time Factors ,Rest ,Hemodynamics ,Middle Aged ,Prosthesis Design ,Echocardiography, Doppler ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Female ,Stents ,Exercise ,Aged - Abstract
Mechanical and conventional stented bioprostheses, because of need for anticoagulants, hemodynamic characteristics and long-term durability, do not represent the optimal heart valve replacement device. In this study we compared the hemodynamic function of a stented aortic bioprosthesis (St Jude Bioimplant), implanted in 10 patients, with a stentless porcine aortic bioprosthesis (Biocor) implanted in 7 patients, by means of Doppler echocardiography early postoperative at rest (T1) and 6 months later at rest (T2a) and during exercise (T2b). Mean and peak systolic gradients across stentless porcine prostheses were significantly lower than across stented bioprostheses (T1 p = 0.008 and p = 0.004; T2a p0.0001 and p0.0001; T2b p0.0001 and p0.0001, respectively). Our results show that systolic and diastolic mechanical stress on biological components of a glutaraldehyde-fixed stentless porcine aortic bioprosthesis is much lesser than on stented bioprostheses. This feature has appeared evident at rest and much more after exercise testing. The reduction of systolic and diastolic stress is expected to determine lower calcification degree and longer durability of stentless porcine aortic bioprostheses. Moreover, aortic valve replacement by means of stentless bioprostheses allows the implantation of a 1 size (2 mm) larger device, appearing favourable especially in small aortic annulus. On the basis of these promising results we suggest that stentless bioprostheses are a valid alternative to stented bioprostheses for aortic valve replacement. However, patient population is too small and the follow-up is too short to draw a definite statement about long-term hemodynamic performance of this device.
- Published
- 1994
13. Successful treatment of coronary artery spasm following coronary artery bypass grafting
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F, Donatelli, M A, Mariani, M, Pocar, M, Triggiani, S, Pelenghi, and A, Grossi
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Male ,Electrocardiography ,Postoperative Complications ,Time Factors ,Nifedipine ,Coronary Vasospasm ,Humans ,Drug Therapy, Combination ,Coronary Artery Bypass ,Isosorbide Dinitrate ,Middle Aged ,Coronary Angiography ,Infusions, Intravenous - Abstract
A case of coronary artery spasm developed 6 hours after myocardial revascularization inducing both hemodynamic and electrocardiographic changes, is reported. The spasm was documented by coronary angiography, and it was not reversed by intracoronary infusion of isosorbide dinitrate. Intravenous infusion of nifedipine (initial dose of 0.0104 mg/min to final dose of 0.0208 mg/min), along with infusion of glyceronitrate (1.0 micrograms/kg/min) was able to significantly improve hemodynamic impairment and to reverse electrocardiographic changes in 12 hours. Coronary angiography, repeated in postoperative day 3, after 48 hours of continuous nifedipine infusion, showed a resolution of coronary spasm. There was no evidence of myocardial infarction as resulted from total CPK and MB isoenzyme release. Nifedipine infusion was gradually reduced as oral administration of slow release nifedipine (40 mg twice daily) was started. The combined intravenous infusion of glyceronitrate and nifedipine seems to be able to control and overcome coronary artery spasm following coronary surgery.
- Published
- 1993
14. [Myocardial revascularization in patients with compromised left ventricular function]
- Author
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M A, Mariani, F, Donatelli, S, Pelenghi, M, Zuccari, and A, Grossi
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Male ,Technetium Tc 99m Sestamibi ,Tomography, Emission-Computed, Single-Photon ,Fluorine Radioisotopes ,Chi-Square Distribution ,Myocardial Ischemia ,Heart ,Deoxyglucose ,Middle Aged ,Survival Analysis ,Ventricular Function, Left ,Italy ,Fluorodeoxyglucose F18 ,Risk Factors ,Myocardial Revascularization ,Humans ,Female ,Follow-Up Studies ,Tomography, Emission-Computed - Abstract
From March 1988 to March 1992, 69 patients with coronary artery disease (CAD) and left ventricular dysfunction (LVD) were referred to our Institute for surgical decision making. Sixty-nine (8.2%) had LVD. In 39/69 patients we performed the identification of viable myocardium with the use of [18F] FDG/PET in fasting conditions. We divided patients with LVD into 3 groups: Group A (30 patients) operated on without preoperative [18F] FDG/PET, Group B (32 patients) with FDG uptake in akinetic segments, and Group C (7 patients) with no FDG uptake; there was no significant difference among the 3 groups in age, sex, CAD, risk factors and ejection fraction EF (Group A: 29.1 +/- 6.6%, range 16-40; Group B: 32.9 +/- 6.5%, range 20-40; Group C: 26.5 +/- 6.8%, range 18-37). All patients underwent [99mTc] MIBI/SPET to assess perfusion at rest and [99mTc] MIBI first pass radionuclide angiography to assess the EF. The study of perfusion and EF was repeated 6 months postoperatively in Group A and B. Myocardial protection was achieved according to the Buckberg protocol. Operative results in Group A and B were respectively: in-hospital deaths 2 (6.6%) versus 0 (NS), perioperative myocardial infarction 1 (3.3%) versus 1 (3.1%) (NS), IABP 10 (33.3%) versus 4 (12.5%) (p = 0.048). Postoperative EF improved both in Group A (35.1 +/- 7.1%, range 20-50; p = 0.01) and in Group B (44.2 +/- 7.7%, range 26-62; p0.001). In Group C 6/7 patients were scheduled for heart transplantation according to standard criteria.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1993
15. [Repeat myocardial revascularization]
- Author
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E, Quaini, C, Russo, F, Donatelli, T, Colombo, E, Vitali, M, Lanfranchi, and A, Pellegrini
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Adult ,Male ,Reoperation ,Middle Aged ,Survival Rate ,Postoperative Complications ,Risk Factors ,Multivariate Analysis ,Humans ,Female ,Hospital Mortality ,Coronary Artery Bypass ,Aged ,Follow-Up Studies - Abstract
Eighty-two consecutive patients undergoing reoperation for coronary revascularization from January 1980 to November 1990 were reviewed to determine early and late results and predictors of survival. Seventy patients were male and 12 female; age ranged from 36 to 75 years (mean 56.4 +/- 8.1). All were symptomatic for angina. The mean interval between first and second operation was 62.8 +/- 47.8 months (range 1 to 220 months). Angiographic indications for reoperation were: graft failure (34.1%), progression of atherosclerosis in the native coronary circulation (6.1%) and combination of the two (59.8%). Mean ejection fraction was 45.9 +/- 10.2 (range 11 to 67). Surgical indication was elective in 79.3%, urgent in 14.6% and emergent in 6.1%; 199 grafts were performed (2.4 +/- 1 grafts/patient). Hospital mortality was 6.1% (5 cases). Late mortality was 5.2% (4 cases). Actuarial survival rate (including hospital mortality) was 87.9% at 3, 5 and 10 years. Multivariate analysis identified left main stenosis (p = 0.00001), family history of coronary disease (p = 0.003), urgent/emergency operation (p = 0.015) as predictors of increased in-hospital mortality; postoperative myocardial infarction (p = 0.002) and preoperative heart failure (p = 0.01) as predictors of increased late mortality. Follow-up of in-hospital survivors (mean interval 42.7 +/- 25.8 months, range 3 to 120 months) documented 27 cardiac major events (other than death) in 24 patients (32.9%). Actuarial rates of freedom from major cardiac events were 70%, 52.9% and 48.1% at 3, 5 and 10 years respectively. Multivariate analysis identified preoperative ejection fraction (p = 0.01) as predictor of recurrence of angina and preoperative heart failure (p = 0.02) as predictor of occurrence of cardiac major events.
- Published
- 1992
16. Aneurysm of an aberrant right subclavian artery. Report of a surgically treated case
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V, Gordini, M, Collice, E, Fedriga, A, Moreo, M, Morello, A, Porrini, and F, Donatelli
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cardiovascular system ,cardiovascular diseases ,Case Reports - Abstract
A 53-year-old man was admitted for treatment of an aberrant right subclavian artery aneurysm that had been diagnosed 5 years earlier and had recently begun to enlarge. The aneurysm, which involved the right subclavian artery from its origin, measured 47 mm in diameter and about 10 cm in length. Because of the lesion's size and friability, a 2-stage operation was performed. In the 1st stage, the right subclavian and right vertebral arteries were revascularized with double bypass grafts via a right cervical approach. In the 2nd stage, the patient was repositioned and a left thoracotomy incision was made. With the aid of left-heart bypass, the aorta was cross-clamped proximal and distal to the lesion, and the aneurysmal orifice was closed with a Dacron patch. The patient was discharged from the hospital on the 17th postoperative day and remains asymptomatic 24 months later. We recommend the 2-stage technique for similar cases because it prevents limb ischemia and reduces the risk of hemorrhagic and embolic complications.
- Published
- 1991
17. Mitral valve replacement with the SORIN valve. Long-term follow-up of 1,161 patients
- Author
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A, Pellegrini, T, Colombo, E, Quaini, C, Russo, E, Vitali, and F, Donatelli
- Subjects
Clinical Investigation - Abstract
From 1 March 1977 through 31 December 1987, 1,252 patients underwent mitral valve replacement with a SORIN-Biomedica 60° tilting-disc prosthesis at our institution. Hospital mortality was 7.3% (91 patients); prosthesis-related deaths, expressed as a percentage of hospital mortality, accounted for 12.1% of these early deaths. The 1,161 patients who survived hospitalization have been followed up for a total of 4,835 patient-years (range, 1 to 128 months; mean, 50.4 ± 27.3 months). Forty-three (3.7%) of these patients were lost to follow-up. The late mortality was 6.3% (1.5% ± 0.2% per patient-year), and the 10-year actuarial survival rate, excluding hospital mortality, was 89.1% ± 1.6%. The 10-year actuarial (and linearized) rates of freedom from valve-related complications were as follows: embolism, 94.4% ± 1.0% (0.93% ± 0.1% per patient-year); thrombosis of the prosthesis, 99.8% ± 0.1% (0.06% ± 0.03% per patient-year; hemorrhage, 93.7% ± 1.5% (0.95% ± 0.1% per patient-year); prosthetic valve endocarditis, 99.3% ± 0.3% (0.14% ± 0.05% per patient-year); reoperation, 90.6% ± 2.1% (1.1% ± 0.2% per patient-year); and overall complications, 76.6% ± 2.5% (2.9% ± 0.2% per patient-year). No structural deterioration was noted. These data not only confirm our previous reports concerning the reliability and durability of the SORIN prosthesis but also reveal a significant reduction, over the long term, in the overall incidence of valve-related complications. (Texas Heart Institute Journal 1991;18:16-23)
- Published
- 1991
18. [Emergencies in valvular surgery]
- Author
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P, Colombi, F, Donatelli, G, Pomé, E, Quaini, C, Rossi, and E, Vitali
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Adult ,Male ,Adolescent ,Heart Valve Diseases ,Middle Aged ,Heart Valves ,Postoperative Complications ,Heart Valve Prosthesis ,Humans ,Female ,Emergencies ,Child ,Aged ,Follow-Up Studies - Abstract
Ninety patients who underwent emergency cardiac valve surgery from January 1976 to December 1981 are reported. Patients were divided in two groups: those operated on native valves are included in group I; patients with prosthetic valves operated because of leakage or malfunction, in group II. In group I (57 patients) the aetiology was: rheumatic heart disease (34 cases); acute endocarditis (16 cases); sequelae of recent endocarditis (2 cases); luetic infection (1 case); sequelae of myocardial infarction (1 case); rupture of mitral chordae in mixomatous valve (3 cases). The emergency operation was prompted in 22 patients by cardiogenic shock, in 13 patients by intractable pulmonary edema, in 21 patients by low output syndrome, in one case by ventricular arrhythmias. In group II (33 cases) the causes of reoperation were: in 27 cases leakage (in 13 due to active endocarditis); in 6 cases variance of the occluder or thrombosis. The emergency originated in 12 cases from cardiogenic shock, in 11 cases from intractable pulmonary edema, in 9 cases from low output syndrome, in 1 case from ventricular arrhythmias. Twenty-six patients died perioperatively in group I and 17 in group II. Mean follow-up in group I was 26 months. Among 27 patients there were two deaths; 25 patients are alive and well (one has been reoperated again). Mean follow-up in group II was 21 months. Among the 15 patients observed there were 6 deaths (3 after re-reoperation); 9 patients are alive and well (one has been re-reoperated).' The Authors feel that surgery is mandatory in all such patients to ensure satisfying long term results, in spite of high perioperative mortality rate.
- Published
- 1983
19. [Maternal and fetal complications in 105 pregnancies in women with cardiac valve prosthesis]
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E, Quaini, E, Vitali, T, Colombo, and F, Donatelli
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Adult ,Pregnancy ,Heart Valve Prosthesis ,Embolism ,Pregnancy Complications, Cardiovascular ,Infant, Newborn ,Humans ,Female ,Hemorrhage ,Thrombosis ,Congenital Abnormalities - Published
- 1986
20. Pregnancy in patients with mechanical prosthetic heart valves. Our experience regarding 98 pregnancies in 57 patients
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E, Vitali, F, Donatelli, E, Quaini, G, Groppelli, and A, Pellegrini
- Subjects
Risk ,Pregnancy Complications, Cardiovascular ,Infant, Newborn ,Anticoagulants ,Hemorrhage ,Infant, Newborn, Diseases ,Congenital Abnormalities ,Abortion, Spontaneous ,Fetal Diseases ,Pregnancy ,Heart Valve Prosthesis ,Thromboembolism ,Humans ,Female - Abstract
Ninety-eight pregnancies in 57 patients with mechanical (ball or tilting disc) prosthetic heart valves are described. Sixty-one pregnancies developed in 36 patients with a mitral prosthesis, 12 pregnancies in 9 patients with an aortic prosthesis, 17 pregnancies in 10 patients with both mitral and aortic prostheses and 8 pregnancies in 2 patients with mitral and tricuspid prostheses. All patients were in I or in II NYHA class at conception and no significative change was noted during pregnancy. All the patients were treated with oral anticoagulant therapy at conception. Different kinds of antithrombotic and antiembolic prophylaxis were employed. There were 13 voluntary interruptions of pregnancy and 37 spontaneous abortions. In the 47 newborn 2 malformation complications (1 warfarin syndrome, 1 cleft palate) and 4 haemorrhagic complications (without sequelae) were noted. Two fatal thromboses of a mitral prosthesis occurred; systemic embolic complications were noted in 7 cases. These observations suggested different incidences of complications regarding the antithrombotic and anti-embolic prophylaxis. The authors point out the high risk of thrombotic and embolic complications and the low rate of successful outcome of pregnancy in these patients.
- Published
- 1986
21. [Heart surgery in the 8th decade]
- Author
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E, Quaini, T, Colombo, F, Donatelli, E, Vitali, E, Citterio, and A, Pellegrini
- Subjects
Male ,Humans ,Female ,Cardiac Surgical Procedures ,Aged - Published
- 1986
22. Results of heart valve replacement with the SORIN prosthesis
- Author
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T, Colombo, F, Donatelli, E, Quaini, E, Vitali, and A, Pellegrini
- Subjects
Prostheses - Abstract
From March 1977 to December 1981, 872 patients at our institution underwent valve replacement with a pyrolytic carbon tilting disc prosthesis manufactured in Italy by SORIN-Biomedica. To verify the performance characteristics of this prosthesis, we analyzed the intermediate-term results obtained over a cumulative total of 3,041 patient-years (pt-yr) of follow-up. Three hundred sixty-nine patients underwent mitral valve replacement (MVR), 309 had aortic valve replacement (AVR), and 194 had both mitral and aortic (double) valve replacement (DVR). Expressed in actuarial terms (% [+/- standard error of the mean] free of adverse events at 5 years) and in linearized terms (% pt-yr), respectively, valve-related complications occurred at the following rates: Thromboembolism, 89.9 +/- 1.9% and 2.1 +/- 0.4% pt-yr (MVR); 92.1 +/- 1.9% and 1.7 +/- 0.4% (AVR); 90.5 +/- 5.0% and 2.2 +/- 0.6% (DVR). Anticoagulant-related hemorrhage, 95.2 +/- 1.5% and 1.4 +/- 0.3% (MVR); 95.9 +/- 1.5% and 1.3 +/- 0.3% (AVR); 96.0 +/- 2.0% and 0.9 +/- 0.4% (DVR). Prosthetic valve endocarditis, 99.0 +/- 0.6% and 0.2 +/- 0.1% (MVR); 97.4 +/- 1.0% and 0.6 +/- 0.2% (AVR); 94.5 +/- 1.7% and 1.4 +/- 0.4% (DVR). Reoperation, 92.6 +/- 1.5% and 1.7 +/- 0.3% (MVR); 89.4 +/- 1.9% and 2.4 +/- 0.4% (AVR); 82.3 +/- 2.9% and 4.8 +/- 0.8% (DVR). The total valve-related morbidity and mortality was 79.6 +/- 2.6% and 4.9 +/- 0.6% (MVR); 79.7 +/- 2.6% and 5.1 +/- 0.6% (AVR); 70.5 +/- 4.0% and 7.7 +/- 1.1% (DVR). The 5-year actuarial survival rate without hospital mortality was 86.8 +/- 2.0% (MVR), 91.0 +/- 1.7% (AVR), and 78.8 +/- 3.7% (DVR). The intermediate-term survival and complication rates showed the performance of the SORIN prosthesis to be quite satisfactory.
- Published
- 1987
23. [Reinterventions on cardiac valve prosthesis]
- Author
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E, Quaini, E, Vitali, T, Colombo, E, Citterio, and F, Donatelli
- Subjects
Reoperation ,Risk ,Postoperative Complications ,Heart Valve Prosthesis ,Humans ,Follow-Up Studies - Abstract
From January 1978 to December 1984, 214 patients underwent a total of 243 reoperations for repair or replacement of a prosthetic heart valve. On the basis of the number of valve reoperations in the same anatomic position within the heart, the patients were divided into three groups. Overall hospital mortality was 23.4% (CL 20.3-26.7) in Group I (214 patients), 48% (CL 36.1-60.1) in Group II (25 patients), 25% (CL 3.3-62.6) in Group III (4 patients). Hospital mortality appeared to be related to urgency of reoperation (p less than 0.001 in Group I; p = 0.037 in Group II), primary indication for reoperation (p = 0.034 in Group I; p = 0.022 in Group II), association with other cardiac surgical procedures (p = 0.00253 in Group I). Hospital mortality in Group I was significantly higher (p = 0.0056) when reoperation was performed within one year after valve replacement. No significant differences in urgency and emergency rate were noted between reoperations on mechanical heart valves and bioprostheses. No significant differences in bleeding complications were noted between reoperations and initial valve replacement. Mean follow-up is 37.4 +/- 21.8 months (range 2 to 85 months). Actuarial survival rate is 82.8 +/- 3.1% at 1 year, 78.7 +/- 3.5% at 2 years and 71.5 +/- 5.1% at 5 years; 90.9% (CL 87.4-93.6) of the followed patients are in I or II NYHA class. The results appear to suggest that when significant (on clinical or instrumental criteria) prosthetic disfunction is diagnosed, reoperation should be undertaken early to minimize operative risk. The Authors point out that surgery in such patients also ensures satisfying long-term results.
- Published
- 1985
24. [Sarcoma of the ovary (anatomo-clinical case contribution)]
- Author
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G, Variati and G F, Donatelli
- Subjects
Adult ,Ovarian Neoplasms ,Humans ,Female ,Sarcoma ,Middle Aged ,Prognosis - Published
- 1966
25. Epigenetics and outcome prediction in heart transplantation after circulatory death: A clinical perspective.
- Author
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Benincasa G, Donatelli F, Strozziero MG, Miceli A, Coscioni E, and Napoli C
- Subjects
- Humans, Prognosis, Epigenesis, Genetic, Tissue Donors, Death, Heart Transplantation, Cardiovascular System, Tissue and Organ Procurement
- Published
- 2023
- Full Text
- View/download PDF
26. Case report of snaring-assisted TAVR under cerebral embolic protection: the "Chaperone" with "Top Hat" technique.
- Author
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Medda M, Casilli F, Bande M, Tespili M, and Donatelli F
- Abstract
Symptomatic severe aortic stenosis (AS) in patients with intermediate-to-high surgical risk is currently being treated with transcatheter aortic valve replacement (TAVR). We present a case of a TAVR in a severe calcific AS with porcelain aorta and 'gothic' aortic arch. Pre-operative thoraco-abdominal computed tomography angiography showed also severe calcification at the sinotubular junction with protruding huge calcified nodules extending in ascending aorta and multiple calcific stenosis of both iliac-femoral vessels, severely tortuous. The choice of the interventional access was not easy and the high risk of an acute intra-procedural brain event guided the procedural planning. To our knowledge, this is the first case of TAVR with complete cerebral protection with Triguard system device and 'snaring-assisted' valve advancement., Competing Interests: The 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., (© 2023 Medda, Casilli, Bande, Tespili and Donatelli.)
- Published
- 2023
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- View/download PDF
27. Case report: Self-expanding transcatheter valve implantation (Acurate Neo 2) in a very small native aortic annulus.
- Author
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Medda M, Casilli F, Bande M, Tespili M, and Donatelli F
- Abstract
Transcatheter aortic valve replacement (TAVR) is a treatment of choice in patients with symptomatic severe aortic valve stenosis (AS) and intermediate-to-high surgical risk. The presence of a small aortic annulus (SAA) has been associated with a higher incidence of prosthesis-patient mismatch (PPM) when surgical aortic valve replacement (sAVR) is performed. TAVR might be a treatment option offering better hemodynamics with a lower incidence of PPM. When a severe AS with a SAA is treated, TAVR-related risk as the coronary obstruction and the annulus rupture, must be also prevented. We present a case of a TAVR in a very small aortic annulus; to our knowledge, this is the smallest native aortic annulus treated percutaneously in a tricuspid stenotic aortic valve with a Self-Expanding Transcatheter Heart Valve (THV) Acurate Neo 2., Competing Interests: The 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., (© 2023 Medda, Casilli, Bande, Tespili and Donatelli.)
- Published
- 2023
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28. Artificial intelligence, big data and heart transplantation: Actualities.
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Palmieri V, Montisci A, Vietri MT, Colombo PC, Sala S, Maiello C, Coscioni E, Donatelli F, and Napoli C
- Subjects
- Humans, Big Data, Prognosis, Retrospective Studies, Artificial Intelligence, Heart Transplantation
- Abstract
Background: As diagnostic and prognostic models developed by traditional statistics perform poorly in real-world, artificial intelligence (AI) and Big Data (BD) may improve the supply chain of heart transplantation (HTx), allocation opportunities, correct treatments, and finally optimize HTx outcome. We explored available studies, and discussed opportunities and limits of medical application of AI to the field of HTx., Method: A systematic overview of studies published up to December 31st, 2022, in English on peer-revied journals, have been identified through PUBMED-MEDLINE-WEB of Science, referring to HTx, AI, BD. Studies were grouped in 4 domains based on main studies' objectives and results: etiology, diagnosis, prognosis, treatment. A systematic attempt was made to evaluate studies by the Prediction model Risk Of Bias ASsessment Tool (PROBAST) and the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD)., Results: Among the 27 publications selected, none used AI applied to BD. Of the selected studies, 4 fell in the domain of etiology, 6 in the domain of diagnosis, 3 in the domain of treatment, and 17 in that of prognosis, as AI was most frequently used for algorithmic prediction and discrimination of survival, but in retrospective cohorts and registries. AI-based algorithms appeared superior to probabilistic functions to predict patterns, but external validation was rarely employed. Indeed, based on PROBAST, selected studies showed, to some extent, significant risk of bias (especially in the domain of predictors and analysis). In addition, as example of applicability in the real-world, a free-use prediction algorithm developed through AI failed to predict 1-year mortality post-HTx in cases from our center., Conclusions: While AI-based prognostic and diagnostic functions performed better than those developed by traditional statistics, risk of bias, lack of external validation, and relatively poor applicability, may affect AI-based tools. More unbiased research with high quality BD meant for AI, transparency and external validations, are needed to have medical AI as a systematic aid to clinical decision making in HTx., 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., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2023
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29. Percutaneous treatment of abdominal aortic aneurysm and aortic valve stenosis with 'staged' EVAR and TAVR: a case series.
- Author
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Medda M, Casilli F, Bande M, Glauber M, Tespili M, Cirri S, and Donatelli F
- Subjects
- Aged, Humans, Treatment Outcome, Aortic Valve surgery, Risk Factors, Transcatheter Aortic Valve Replacement, Aortic Valve Stenosis complications, Aortic Aneurysm, Abdominal complications, Aortic Aneurysm, Abdominal surgery
- Abstract
Symptomatic aortic valve stenosis (AS) and abdominal aortic aneurysm (AAA) are critical clinical conditions, increasingly more prevalent with aging of the population. Calcific aortic stenosis is the most common structural cardiac disease in the elderly population, and medical management of severe aortic stenosis of the elderly population is associated with poor outcomes as compared to surgical treatment. Transcatheter aortic valve replacement (TAVR) is a treatment of choice in inoperable, often elderly, patients with symptomatic severe AS and in intermediate-to-high surgical risk patients. It is not yet clarified the incidence of AAA and its impact on procedural and clinical outcomes among patients undergoing TAVR. It is known that after AS resolution with aortic valve replacement or TAVR there is an increase in blood pressure that increases the risk of dissection or abdominal aortic aneurysm rupture if AAA repair is delayed. The purpose of this report is to describe the anatomical details and technical and procedural considerations when proposing totally endovascular strategies dedicated to the treatment of patients with AS and AAA., (© 2023. The Author(s).)
- Published
- 2023
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- View/download PDF
30. Cardiotoxicity, Cardioprotection, and Prognosis in Survivors of Anticancer Treatment Undergoing Cardiac Surgery: Unmet Needs.
- Author
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Palmieri V, Vietri MT, Montalto A, Montisci A, Donatelli F, Coscioni E, and Napoli C
- Abstract
Background: Anticancer treatments are improving the prognosis of patients fighting cancer. However, anticancer treatments may also increase the cardiovascular (CV) risk by increasing metabolic disorders. Atherosclerosis and atherothrombosis related to anticancer treatments may lead to ischemic heart disease (IHD), while direct cardiac toxicity may induce non-ischemic heart disease. Moreover, valvular heart disease (VHD), aortic syndromes (AoS), and advanced heart failure (HF) associated with CV risk factors and preclinical CV disease as well as with chronic inflammation and endothelial dysfunction may also occur in survivors of anti-carcer treatments., Methods: Public electronic libraries have been searched systematically looking at cardiotoxicity, cardioprotection, CV risk and disease, and prognosis after cardiac surgery in survivors of anticancer treatments., Results: CV risk factors and disease may not be infrequent among survivors of anticancer treatments. As cardiotoxicity of established anticancer treatments has been investigated and is frequently irreversible, cardiotoxicity associated with novel treatments appears to be more frequently reversible, but also potentially synergic. Small reports suggest that drugs preventing HF in the general population may be effective also among survivors of anticancer treatments, so that CV risk factors and disease, and chronic inflammation, may lead to indication to cardiac surgery in survivors of anticancer treatments. There is a lack of substantial data on whether current risk scores are efficient to predict prognosis after cardiac surgery in survivors of anticancer treatments, and to guide tailored decision-making. IHD is the most common condition requiring cardiac surgery among survivors of anticancer treatments. Primary VHD is mostly related to a history of radiation therapy. No specific reports exist on AoS in survivors of anticancer treatments., Conclusions: It is unclear whether interventions to dominate cancer- and anticancer treatment-related metabolic syndromes, chronic inflammation, and endothelial dysfunction, leading to IHD, nonIHD, VHD, HF, and AoS, are as effective in survivors of anticancer treatments as in the general population. When CV diseases require cardiac surgery, survivors of anticancer treatments may be a population at specifically elevated risk, rather than affected by a specific risk factor.
- Published
- 2023
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- View/download PDF
31. [SICI-GISE/SICOA Consensus document: Clinical follow-up of patients after acute coronary syndrome or percutaneous coronary intervention].
- Author
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Guarini P, Saia F, Sidiropulos M, Silverio A, Dellegrottaglie S, Scatteia A, De Stefano F, Tedeschi C, Dalla Vecchia LA, Cappelletti AM, Regazzoli D, Benassi A, Donatelli F, America R, Nosso G, Capranzano P, Oliva A, Piccolo R, Testa L, Attisano T, Battistina C, Contarini M, De Marco F, Fineschi M, Menozzi A, Musto C, Stefanini G, Tarantini G, Caiazza F, and Esposito G
- Subjects
- Humans, Stroke Volume, Follow-Up Studies, Consensus, Ventricular Function, Left, Treatment Outcome, Acute Coronary Syndrome diagnosis, Percutaneous Coronary Intervention
- Abstract
In the last decades, advances in percutaneous coronary intervention (PCI) strategies have significantly reduced the risk of procedural complications and in-hospital mortality of patients with acute coronary syndromes (ACS), thus increasing the population of stable post-ACS patients. This novel epidemiological scenario emphasizes the importance of implementing secondary preventive and follow-up strategies. The follow-up of patients after ACS or elective PCI should be based on common pathways and on the close collaboration between hospital cardiologists and primary care physicians. However, the follow-up strategies of these patients are still poorly standardized. This SICI-GISE/SICOA consensus document was conceived as a proposal for the long-term management of post-ACS or post-PCI patients based on their individual residual risk of cardiovascular adverse events. We defined five patient risk classes and five follow-up strategies including medical visits and examinations according to a specific time schedule. We also provided a short guidance for the selection of the appropriate imaging technique for the assessment of left ventricular ejection fraction and of non-invasive anatomical or functional tests for the detection of obstructive coronary artery disease. Physical and pharmacological stress echocardiography was identified as the first-line imaging technique in most of cases, while cardiovascular magnetic resonance should be preferred when an accurate evaluation of left ventricular ejection fraction is needed. The standardization of the follow-up pathways of patients with a history of ACS or elective PCI, shared between hospital doctors and primary care physicians, could result in a more cost-effective use of resources and potentially improve patient's long-term outcome.
- Published
- 2023
- Full Text
- View/download PDF
32. Big Data in cardiac surgery: real world and perspectives.
- Author
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Montisci A, Palmieri V, Vietri MT, Sala S, Maiello C, Donatelli F, and Napoli C
- Subjects
- Humans, Artificial Intelligence, Machine Learning, Electronic Health Records, Big Data, Cardiac Surgical Procedures methods
- Abstract
Big Data, and the derived analysis techniques, such as artificial intelligence and machine learning, have been considered a revolution in the modern practice of medicine. Big Data comes from multiple sources, encompassing electronic health records, clinical studies, imaging data, registries, administrative databases, patient-reported outcomes and OMICS profiles. The main objective of such analyses is to unveil hidden associations and patterns. In cardiac surgery, the main targets for the use of Big Data are the construction of predictive models to recognize patterns or associations better representing the individual risk or prognosis compared to classical surgical risk scores. The results of these studies contributed to kindle the interest for personalized medicine and contributed to recognize the limitations of randomized controlled trials in representing the real world. However, the main sources of evidence for guidelines and recommendations remain RCTs and meta-analysis. The extent of the revolution of Big Data and new analytical models in cardiac surgery is yet to be determined., (© 2022. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
33. Current Use of Oral Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation: Results from an Italian Multicenter Prospective Study-The ISNEP Study.
- Author
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De Stefano F, Benassi A, Cappelletti AM, Donatelli F, Regazzoli D, Tolaro S, Perego F, Silverio A, Scatteia A, Guarini P, Dellegrottaglie S, Mariani S, Pezzella E, Galasso G, Caiazza F, and On Behalf Of Isnep Investigators
- Abstract
Background: Atrial fibrillation (AF) is the most common heart arrhythmia, and its prevalence increases with age. Oral Anticoagulant Therapy (OAT) with non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) is essential to avoid thromboembolic events in AF. However, this treatment is associated with a high risk of bleeding and low adherence in elderly patients. Aim: The aim was to evaluate the real-world use of OAT in a population of patients aged ≥80 years in twenty-three Italian centers and to investigate the tolerance of and patient satisfaction with this therapy. Methods: The ISNEP Study is a multicenter cross-sectional study enrolling patients with AF and aged ≥80 years and treated with either NOACs or VKAs. A written questionnaire was administered to each patient to evaluate the adherence to and patient satisfaction with this therapy. Results: The study included 641 patients with a mean age of 85 (82−87) years. The use of NOACs was reported in 93.0% of cases, with the remaining 7.0% treated with VKAs. A history of stroke events was reported in five (11.1%) and one (0.2%) patients in the VKA and NOAC groups, respectively. The rate of referred ecchymosis/epistaxis was significantly higher in the VKA group compared to the NOAC group (p < 0.001). Patients receiving NOACs reported a substantial improvement in their quality of life compared to the VKA group. Conclusions: A small, but not negligible, proportion of elderly AF patients is still treated with VKAs. Patients treated with NOAC have a higher level of satisfaction with the therapy and complete adherence.
- Published
- 2022
- Full Text
- View/download PDF
34. The Role of T Cell Immunity in Monoclonal Gammopathy and Multiple Myeloma: From Immunopathogenesis to Novel Therapeutic Approaches.
- Author
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Lagreca I, Riva G, Nasillo V, Barozzi P, Castelli I, Basso S, Bettelli F, Giusti D, Cuoghi A, Bresciani P, Messerotti A, Gilioli A, Pioli V, Colasante C, Vallerini D, Paolini A, Maccaferri M, Donatelli F, Forghieri F, Morselli M, Colaci E, Leonardi G, Marasca R, Potenza L, Manfredini R, Tagliafico E, Trenti T, Comoli P, and Luppi M
- Subjects
- Disease Progression, Humans, T-Lymphocytes pathology, Monoclonal Gammopathy of Undetermined Significance pathology, Multiple Myeloma pathology, Multiple Myeloma therapy, Paraproteinemias therapy, Smoldering Multiple Myeloma
- Abstract
Multiple Myeloma (MM) is a malignant growth of clonal plasma cells, typically arising from asymptomatic precursor conditions, namely monoclonal gammopathy of undetermined significance (MGUS) and smoldering MM (SMM). Profound immunological dysfunctions and cytokine deregulation are known to characterize the evolution of the disease, allowing immune escape and proliferation of neoplastic plasma cells. In the past decades, several studies have shown that the immune system can recognize MGUS and MM clonal cells, suggesting that anti-myeloma T cell immunity could be harnessed for therapeutic purposes. In line with this notion, chimeric antigen receptor T cell (CAR-T) therapy is emerging as a novel treatment in MM, especially in the relapsed/refractory disease setting. In this review, we focus on the pivotal contribution of T cell impairment in the immunopathogenesis of plasma cell dyscrasias and, in particular, in the disease progression from MGUS to SMM and MM, highlighting the potentials of T cell-based immunotherapeutic approaches in these settings.
- Published
- 2022
- Full Text
- View/download PDF
35. Commentary: The importance of annulus in percutaneous mitral valve repair.
- Author
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Miceli A, Moneta AA, Donatelli F, and Glauber M
- Subjects
- Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Cardiac Surgical Procedures adverse effects, Heart Valve Prosthesis Implantation adverse effects, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency surgery
- Published
- 2022
- Full Text
- View/download PDF
36. Commentary: Urgent need for careful holistic assessment post-coronavirus disease 2019 (COVID-19) hospitalization: Crisis after crisis?
- Author
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Miceli A, Donatelli F, Glauber M, and Napoli C
- Subjects
- Hospitalization, Humans, SARS-CoV-2, COVID-19
- Published
- 2022
- Full Text
- View/download PDF
37. Clinical Comparison of a Novel Balloon-Expandable Versus a Self-Expanding Transcatheter Heart Valve for the Treatment of Patients with Severe Aortic Valve Stenosis: The EVAL Registry.
- Author
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Barki M, Ielasi A, Buono A, Maliandi G, Pellicano M, Bande M, Casilli F, Messina F, Uccello G, Briguglia D, Medda M, Tespili M, and Donatelli F
- Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an effective treatment option for patients with severe, symptomatic AS, regardless of the transcatheter heart valve (THV) implanted. Prior studies demonstrated a higher device success with lower paravalvular leak (PVL) using the balloon-expandable (BE) Sapien/XT THV vs. a self-expanding (SE) THV. However, few data are available on the performance of a novel BE THV., Purpose: to compare early clinical performance and safety of the newly available BE Myval THV (Myval, Meril Life Sciences Pvt. Ltd., India) vs. the commonly used SE (Evolut R, Medtronic) THV., Methods: A single-center, retrospective cohort analysis was performed with 166 consecutive patients undergoing TAVR from March 2019 to March 2021 for severe symptomatic AS treated with either the novel BE Myval or the SE Evolut R (ER) bioprosthesis. The primary endpoint was device success at day 30 according to the Valve Academic Research Consortium-3 (VARC-3). Secondary endpoints included 30-day all-cause mortality, cardiovascular mortality, more than mild PVL, permanent pacemaker implantation (PPI) rates and a composite of all-cause mortality and disabling stroke at 6 months., Results: Among the 166 included patients, 108 patients received the SE ER THV and 58 patients were treated with the BE Myval THV. At baseline, the two groups showed comparable demographic characteristics. The primary composite endpoint of early device success occurred in 55 patients (94.8%) in the BE Myval group and in 90 patients (83.3%) in the SE ER group (OR 3.667, 95% CI 1.094-12.14; p = 0.048). At day 30, the BE Myval THV group exhibited a significantly lower incidence of more than mild PVL (BE Myval 3.45% vs. SE ER 14.8%, OR 0.2, 95% CI 0.05-0.8; p = 0.0338), along with a lower rate of PPI (BE Myval 11% vs. SE ER 24.2%, OR 0.38, 95% CI 0.15-0.99; p = 0.0535). At the 6-month follow-up, the incidence of all-cause mortality and disabling stroke did not significantly differ between the two groups, while the incidence of PPI (BE Myval 11% vs. SE ER 27.5%, OR 0.32, CI 95% 0.1273-0.8; p = 0.02) and ≥moderate PVL (BE Myval 6.9% vs. SE ER 19.8%, OR 0.31, 95% CI 0.1-0.94; p = 0.0396) was significantly lower in the BE Myval group., Conclusions: In patients with severe symptomatic AS undergoing TAVR, the novel Myval BE THV provided a comparable performance to the well-known ER SE THV, and it was associated with a lower rate of PPI and ≥moderate PVL within 30 days and 6 months after the procedure. Randomized, head-to-head comparison trials are needed to confirm our results.
- Published
- 2022
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38. An Update on New Generation Transcatheter Aortic Valves and Delivery Systems.
- Author
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Santangelo G, Ielasi A, Pellicano M, Latib A, Tespili M, and Donatelli F
- Abstract
Over the last 15 years, the management of aortic valve disease has been changed by transcatheter aortic valve replacement, which has become the standard of care across the entire spectrum of surgical risk. As a result of continuous evolution of this technique, several next-generation transcatheter heart valves (THVs) have been developed to minimize procedural complications and improve patient outcomes. This review aims to provide an update on the new generation THVs and delivery systems.
- Published
- 2022
- Full Text
- View/download PDF
39. Trans-Catheter Valve-in-Valve Implantation for the Treatment of Aortic Bioprosthetic Valve Failure.
- Author
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Buono A, Maffeo D, Troise G, Donatelli F, Tespili M, and Ielasi A
- Abstract
Aortic valve-in-valve (ViV) procedure is a valid treatment option for patients affected by bioprosthetic heart valve (BHV) degeneration. However, ViV implantation is technically more challenging compared to native trans-catheter aortic valve replacement (TAVR). A deep knowledge of the mechanism and features of the failed BHV is pivotal to plan an adequate procedure. Multimodal imaging is fundamental in the diagnostic and pre-procedural phases. The main challenges associated with ViV TAVR consist of a higher risk of coronary obstruction, severe post-procedural patient-prosthesis mismatch, and a difficult coronary re-access. In this review, we describe the principles of ViV TAVR.
- Published
- 2022
- Full Text
- View/download PDF
40. Commentary: Acute type A aortic dissection: When sample size does matter.
- Author
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Miceli A, Donatelli F, and Galuber M
- Subjects
- Humans, Sample Size, Aortic Dissection diagnostic imaging, Aortic Dissection surgery, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm surgery
- Published
- 2022
- Full Text
- View/download PDF
41. Pre-existing cytopenia heralding de novo acute myeloid leukemia: Uncommon presentation of NPM1-mutated AML in a single-center study.
- Author
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Galassi L, Colasante C, Bettelli F, Gilioli A, Pioli V, Giusti D, Morselli M, Paolini A, Nasillo V, Lusenti B, Colaci E, Donatelli F, Catellani H, Pozzi S, Barbieri E, Del Rosso MN, Barozzi P, Lagreca I, Martinelli S, Maffei R, Riva G, Tenedini E, Roncati L, Marasca R, Potenza L, Comoli P, Trenti T, Manfredini R, Tagliafico E, Luppi M, and Forghieri F
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Humans, Leukemia, Myeloid, Acute etiology, Leukemia, Myeloid, Acute metabolism, Male, Middle Aged, Prognosis, Retrospective Studies, Anemia complications, Leukemia, Myeloid, Acute pathology, Neutropenia complications, Nucleophosmin genetics, Pancytopenia complications, Thrombocytopenia complications
- Published
- 2021
- Full Text
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42. Type A aortic dissection after transcatheter aortic valve replacement: is a surgical approach always needed?
- Author
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Santangelo G, Silvestro A, Medda M, Barki M, Maliandi G, Donatelli F, Tespili M, and Ielasi A
- Subjects
- Aged, 80 and over, Female, Heart Valve Prosthesis, Humans, Prosthesis Failure, Risk Adjustment methods, Severity of Illness Index, Watchful Waiting methods, Aortic Dissection diagnostic imaging, Aortic Dissection etiology, Aortic Dissection physiopathology, Aortic Dissection therapy, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency physiopathology, Aortic Valve Insufficiency surgery, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis surgery, Postoperative Complications diagnosis, Postoperative Complications physiopathology, Postoperative Complications therapy, Tomography, X-Ray Computed methods, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement instrumentation, Transcatheter Aortic Valve Replacement methods
- Published
- 2021
- Full Text
- View/download PDF
43. Non-Invasive Assessment of Left Ventricle Ejection Fraction: Where Do We Stand?
- Author
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Scatteia A, Silverio A, Padalino R, De Stefano F, America R, Cappelletti AM, Dalla Vecchia LA, Guarini P, Donatelli F, Caiazza F, and Dellegrottaglie S
- Abstract
The left ventricular (LV) ejection fraction (EF) is the preferred parameter applied for the non-invasive evaluation of LV systolic function in clinical practice. It has a well-recognized and extensive role in the clinical management of numerous cardiac conditions. Many imaging modalities are currently available for the non-invasive assessment of LVEF. The aim of this review is to describe their relative advantages and disadvantages, proposing a hierarchical application of the different imaging tests available for LVEF evaluation based on the level of accuracy/reproducibility clinically required.
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- 2021
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44. Cytomegalovirus reactivation after hematopoietic stem cell transplant with CMV-IG prophylaxis: A monocentric retrospective analysis.
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Gilioli A, Messerotti A, Bresciani P, Cuoghi A, Pioli V, Colasante C, Bettelli F, Giusti D, Forghieri F, Potenza L, Donatelli F, Giubbolini R, Galassi L, Marasca R, Banchelli F, D'Amico R, Pecorari M, Gennari W, Trenti T, Comoli P, Luppi M, and Narni F
- Subjects
- Adolescent, Adult, Antibodies, Viral immunology, Antiviral Agents administration & dosage, Antiviral Agents immunology, Cytomegalovirus genetics, Cytomegalovirus Infections immunology, Cytomegalovirus Infections virology, Female, Hematopoietic Stem Cell Transplantation statistics & numerical data, Humans, Male, Middle Aged, Pre-Exposure Prophylaxis, Recurrence, Retrospective Studies, Young Adult, Antibodies, Viral administration & dosage, Cytomegalovirus physiology, Cytomegalovirus Infections prevention & control, Hematopoietic Stem Cell Transplantation adverse effects, Immunoglobulin G administration & dosage, Virus Activation
- Abstract
Human cytomegalovirus (CMV) represents the most common viral infection after hematopoietic stem cell transplant (HSCT), mainly occurring as reactivation from latency in seropositive patients, with a different prevalence based on the extent and timing of seroconversion in a specific population. Here, we retrospectively analyzed a cohort of patients who underwent HSCT at our Institution between 2013 and 2018, all of whom were prophylactically treated with CMV-IG (Megalotect Biotest®), to define the incidence and clinical outcomes of CMV reactivation and clinically significant infection. CMV infection occurred in 69% of our patient series, mainly resulting from reactivation, and CMV clinically significant infection (CS-CMVi) occurred in 48% of prophylactically treated patients. CMV infection and CS-CMVi impacted neither on relapse incidence nor on overall survival nor on relapse-free survival. Moreover, a very low incidence of CMV end-organ disease was documented. CMV-IG used alone as prophylactic therapy after HSCT does not effectively prevent CMV reactivation., (© 2021 Wiley Periodicals LLC.)
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- 2021
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45. Cardiac Toxicity Associated with Cancer Immunotherapy and Biological Drugs.
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Montisci A, Vietri MT, Palmieri V, Sala S, Donatelli F, and Napoli C
- Abstract
Cancer immunotherapy significantly contributed to an improvement in the prognosis of cancer patients. Immunotherapy, including human epidermal growth factor receptor 2 (HER2)-targeted therapies, immune checkpoint inhibitors (ICI), and chimeric antigen receptor-modified T (CAR-T), share the characteristic to exploit the capabilities of the immune system to kill cancerous cells. Trastuzumab is a monoclonal antibody against HER2 that prevents HER2-mediated signaling; it is administered mainly in HER2-positive cancers, such as breast, colorectal, biliary tract, and non-small-cell lung cancers. Immune checkpoint inhibitors (ICI) inhibit the binding of CTLA-4 or PD-1 to PDL-1, allowing T cells to kill cancerous cells. ICI can be used in melanomas, non-small-cell lung cancer, urothelial, and head and neck cancer. There are two main types of T-cell transfer therapy: tumor-infiltrating lymphocytes (or TIL) therapy and chimeric antigen receptor-modified T (CAR-T) cell therapy, mainly applied for B-cell lymphoma and leukemia and mantle-cell lymphoma. HER2-targeted therapies, mainly trastuzumab, are associated with left ventricular dysfunction, usually reversible and rarely life-threatening. PD/PDL-1 inhibitors can cause myocarditis, rare but potentially fulminant and associated with a high fatality rate. CAR-T therapy is associated with several cardiac toxic effects, mainly in the context of a systemic adverse effect, the cytokines release syndrome.
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- 2021
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46. Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission.
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Montisci A, Palmieri V, Liu JE, Vietri MT, Cirri S, Donatelli F, and Napoli C
- Abstract
A steadying increase of cancer survivors has been observed as a consequence of more effective therapies. However, chemotherapy regimens are often associated with significant toxicity, and cardiac damage emerges as a prominent clinical issue. Many mechanisms sustain chemotherapy-induced cardiac toxicity: direct myocyte damage, arrhythmia induction, coronary vasospasm, and accelerated atherosclerosis. Anthracyclines are the most studied cardiotoxic drugs and represent a clinical model for cardiac damage induced by chemotherapy. In patients suffering from advanced heart failure (HF) because of chemotherapy-related cardiomyopathy, when refractory to optimal medical therapy, mechanical circulatory support or heart transplantation represents an effective treatment. Here, the main mechanisms of cardiac toxicity induced by cancer therapies are analyzed, with a focus on patients requiring intensive care unit (ICU) admission during the course of the disease because of acute cardiac toxicity, takotsubo syndrome, and acute-on-chronic HF in patients suffering from chemotherapy-induced cardiomyopathy. In a subset of patients, cardiac toxicity can be acute and life-threatening, leading to overt cardiogenic shock. The management of critically ill cancer patients poses a unique challenge and requires a multidisciplinary approach. Moreover, no etiologic therapy is available, and only supportive measures can be implemented., Competing Interests: The 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., (Copyright © 2021 Montisci, Palmieri, Liu, Vietri, Cirri, Donatelli and Napoli.)
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- 2021
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47. Neoantigen-Specific T-Cell Immune Responses: The Paradigm of NPM1-Mutated Acute Myeloid Leukemia.
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Forghieri F, Riva G, Lagreca I, Barozzi P, Bettelli F, Paolini A, Nasillo V, Lusenti B, Pioli V, Giusti D, Gilioli A, Colasante C, Galassi L, Catellani H, Donatelli F, Talami A, Maffei R, Martinelli S, Potenza L, Marasca R, Tagliafico E, Manfredini R, Trenti T, Comoli P, and Luppi M
- Subjects
- Animals, Humans, Immunotherapy methods, Leukemia, Myeloid, Acute genetics, Leukemia, Myeloid, Acute therapy, Mutation, Nuclear Proteins immunology, Nucleophosmin, Antigens, Neoplasm immunology, Leukemia, Myeloid, Acute immunology, Nuclear Proteins genetics, T-Lymphocytes immunology
- Abstract
The C-terminal aminoacidic sequence from NPM1-mutated protein, absent in normal human tissues, may serve as a leukemia-specific antigen and can be considered an ideal target for NPM1 -mutated acute myeloid leukemia (AML) immunotherapy. Different in silico instruments and in vitro/ex vivo immunological platforms have identified the most immunogenic epitopes from NPM1-mutated protein. Spontaneous development of endogenous NPM1-mutated-specific cytotoxic T cells has been observed in patients, potentially contributing to remission maintenance and prolonged survival. Genetically engineered T cells, namely CAR-T or TCR-transduced T cells, directed against NPM1-mutated peptides bound to HLA could prospectively represent a promising therapeutic approach. Although either adoptive or vaccine-based immunotherapies are unlikely to be highly effective in patients with full-blown leukemia, these strategies, potentially in combination with immune-checkpoint inhibitors, could be promising in maintaining remission or preemptively eradicating persistent measurable residual disease, mainly in patients ineligible for allogeneic hematopoietic stem cell transplant (HSCT). Alternatively, neoantigen-specific donor lymphocyte infusion derived from healthy donors and targeting NPM1-mutated protein to selectively elicit graft-versus-leukemia effect may represent an attractive option in subjects experiencing post-HSCT relapse. Future studies are warranted to further investigate dynamics of NPM1-mutated-specific immunity and explore whether novel individualized immunotherapies may have potential clinical utility in NPM1 -mutated AML patients.
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- 2021
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48. How to Improve Prognostication in Acute Myeloid Leukemia with CBFB-MYH11 Fusion Transcript: Focus on the Role of Molecular Measurable Residual Disease (MRD) Monitoring.
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Talami A, Bettelli F, Pioli V, Giusti D, Gilioli A, Colasante C, Galassi L, Giubbolini R, Catellani H, Donatelli F, Maffei R, Martinelli S, Barozzi P, Potenza L, Marasca R, Trenti T, Tagliafico E, Comoli P, Luppi M, and Forghieri F
- Abstract
Acute myeloid leukemia (AML) carrying inv(16)/t(16;16), resulting in fusion transcript CBFB-MYH11 , belongs to the favorable-risk category. However, even if most patients obtain morphological complete remission after induction, approximately 30% of cases eventually relapse. While well-established clinical features and concomitant cytogenetic/molecular lesions have been recognized to be relevant to predict prognosis at disease onset, the independent prognostic impact of measurable residual disease (MRD) monitoring by quantitative real-time reverse transcriptase polymerase chain reaction (qRT-PCR), mainly in predicting relapse, actually supersedes other prognostic factors. Although the ELN Working Party recently indicated that patients affected with CBFB-MYH11 AML should have MRD assessment at informative clinical timepoints, at least after two cycles of intensive chemotherapy and after the end of treatment, several controversies could be raised, especially on the frequency of subsequent serial monitoring, the most significant MRD thresholds (most commonly 0.1%) and on the best source to be analyzed, namely, bone marrow or peripheral blood samples. Moreover, persisting low-level MRD positivity at the end of treatment is relatively common and not predictive of relapse, provided that transcript levels remain stably below specific thresholds. Rising MRD levels suggestive of molecular relapse/progression should thus be confirmed in subsequent samples. Further prospective studies would be required to optimize post-remission monitoring and to define effective MRD-based therapeutic strategies.
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- 2021
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49. Veno-arterial Extracorporeal Membrane Oxygenation as Bridge to Heart Transplantation: The Way Forward.
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Montisci A, Donatelli F, Cirri S, Coscioni E, Maiello C, and Napoli C
- Abstract
Advanced heart failure (HF) represents a public health priority due to the increase of affected patients and the meaningful mortality. Durable mechanical circulatory support (MCS) and heart transplantation (HTx) are unique therapies for end-stage HF (ESHF), with positive early and long-term outcomes. The patients who underwent HTx have a 1-y survival of 91% and a median survival of 12-13 y, whereas the median survival of ESHF is <12 mo. Short-term MCS with veno-arterial extracorporeal membrane oxygenation (VA ECMO) can be used as a bridge to transplantation strategy. Patients bridged with VA ECMO have significantly lower survival in comparison with non-MCS bridged and left ventricular assist device-bridged patients. VA ECMO represents an effective, and sometimes unique, system to obtain rapid hemodynamic stabilization, but possible negative effects on patients' outcomes after HTx must be considered. Here, we discuss the use of VA ECMO as bridge to transplantation., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)
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- 2021
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50. Transcatheter Valve-in-Valve Implantation With a Novel Balloon-Expandable Device in Patients With Bioprosthetic Heart Valve Failure: A Case Series.
- Author
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Ielasi A, Buono A, Medda M, Casilli F, Bande M, Pellicano M, Glauber M, Donatelli F, and Tespili M
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- Aortic Valve diagnostic imaging, Aortic Valve surgery, Catheters, Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Prosthesis Design, Prosthesis Failure, Treatment Outcome, Aortic Valve Stenosis surgery, Bioprosthesis, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Transcatheter Aortic Valve Replacement
- Abstract
Trans-catheter valve-in-valve (ViV) is a treatment option for patients affected by bioprosthetic heart valve (BHV) failure. Both aortic and mitral ViV procedures present several challenges compared to native valve replacement. To date, no data concerning the balloon-expandable MyVal (Meril, Vapi, India) trans-catheter heart valve (THV) use in ViV procedure have been provided. In this case series, we described for the first time its use in five different BHV failures., Competing Interests: Declaration of competing interest Authors have no conflicts of interest to declare., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2021
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