87 results on '"Nardella, S."'
Search Results
2. OC87 VALUE OF SCREENING ASYMPTOMATIC CAROTID ARTERY STENOSIS PRIOR TO CORONARY ARTERY BYPASS GRAFTING: ANALYSIS OF THE E-CABG REGISTRY
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Salsano, A., Santarpino, G., Santini, F., Nicolini, F., De Feo, M., Dalén, M., Fischlein, T., Perrotti, A., Reichart, D., Gatti, G., Onorati, F., Franzese, I., Faggian, G., Bancone, C., Chocron, S., Khodabandeh, S., Rubino, A.S., Maselli, D., Nardella, S., Gherli, R., Zanobini, M., Saccocci, M., Bounader, K., Rosato, S., Tauriainen, T., Mariscalco, G., Airaksinen, J., Ruggieri, V.G., and Biancari, F.
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- 2018
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3. OC88 COMPARATIVE ANALYSIS OF PROTHROMBIN COMPLEX CONCENTRATE AND FRESH FROZEN PLASMA IN THE MANAGEMENT OF PERIOPERATIVE BLEEDING AFTER CORONARY ARTERY BYPASS GRAFTING
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Salsano, A., Mariscalco, G., Santini, F., Ruggieri, V.G., Perrotti, A., Chocron, S., Gherli, R., Reichart, D., Demal, T., Faggian, G., Franzese, I., Dalén, M., Santarpino, G., Fischlein, T., Rubino, A.S., Maselli, D., Nardella, S., Nicolini, F., Saccocci, M., Gatti, G., Bounader, K., Rosato, S., Kinnunen, E., De Feo, M., Tauriainen, T., Onorati, F., and Biancari, F.
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- 2018
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4. P40 COVID 19: A NEW RISK FACTOR IN CARDIAC SURGERY?
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Santise, G, primary, Mariniello, A, additional, Desoky, A, additional, Nardella, S, additional, Franciulli, M, additional, Iavazzo, A, additional, and Maselli, D, additional
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- 2022
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5. Development of implantation substrates for the collection of radionuclides of medical interest produced via ISOL technique at INFN-LNL
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Ballan, M., primary, Vettorato, E., additional, Morselli, L., additional, Tosato, M., additional, Nardella, S., additional, Borgna, F., additional, Corradetti, S., additional, Monetti, A., additional, Lunardon, M., additional, Zenoni, A., additional, Di Marco, V., additional, Realdon, N., additional, and Andrighetto, A., additional
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- 2021
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6. Mini-extracorporeal circulation minimizes coagulation abnormalities and ameliorates pulmonary outcome in coronary artery bypass grafting surgery
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Zeitani, J, Buccisano, F, Nardella, S, Flaminio, M, Prati, P, Chiariello, G, Venditti, A, and Chiariello, L
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- 2013
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7. Infectious complications in patients receiving ticagrelor or clopidogrel before coronary artery bypass grafting
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Dalén, M., primary, Biancari, F., additional, Perrotti, A., additional, Mariscalco, G., additional, Onorati, F., additional, Faggian, G., additional, Franzese, I., additional, Salsano, A., additional, Santini, F., additional, Ruggieri, V.G., additional, Maselli, D., additional, Nardella, S., additional, Santarpino, G., additional, Fischlein, T., additional, Saccocci, M., additional, Zanobini, M., additional, Musumeci, F., additional, Gherli, R., additional, Rubino, A.S., additional, De Feo, M., additional, Bancone, C., additional, Nicolini, F., additional, Kinnunen, E.-M., additional, Tauriainen, T., additional, Reichart, D., additional, Demal, T., additional, Gatti, G., additional, Khodabandeh, S., additional, and Holm, M., additional
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- 2020
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8. Rehabilitation of the atrophic posterior maxilla with sinus grafting and oral implants: clinical outcome and a proposal of defect classification: 232
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Zaniboni, M, Nardella, S, and Chiapasco, M
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- 2007
9. Impact of preoperative thrombocytopenia on the outcome after coronary artery bypass grafting
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Nammas, W. (Wail), Dalén, M. (Magnus), Rosato, S. (Stefano), Gherli, R. (Riccardo), Reichart, D. (Daniel), Gatti, G. (Giuseppe), Onorati, F. (Francesco), Faggian, G. (Giuseppe), De Feo, M. (Marisa), Bancone, C. (Ciro), Chocron, S. (Sidney), Khodabandeh, S. (Sorosh), Santarpino, G. (Giuseppe), Rubino, A. S. (Antonino S.), Maselli, D. (Daniele), Nardella, S. (Saverio), Salsano, A. (Antonio), Gherli, T. (Tiziano), Nicolini, F. (Francesco), Zanobini, M. (Marco), Saccocci, M. (Matteo), Bounader, K. (Karl), D’Errigo, P. (Paola), Kiviniemi, T. (Tuomas), Kinnunen, E.-M. (Eeva-Maija), Perrotti, A. (Andrea), Airaksinen, J. (Juhani), Mariscalco, G. (Giovanni), Ruggieri, V. G. (Vito G.), Biancari, F. (Fausto), Nammas, W. (Wail), Dalén, M. (Magnus), Rosato, S. (Stefano), Gherli, R. (Riccardo), Reichart, D. (Daniel), Gatti, G. (Giuseppe), Onorati, F. (Francesco), Faggian, G. (Giuseppe), De Feo, M. (Marisa), Bancone, C. (Ciro), Chocron, S. (Sidney), Khodabandeh, S. (Sorosh), Santarpino, G. (Giuseppe), Rubino, A. S. (Antonino S.), Maselli, D. (Daniele), Nardella, S. (Saverio), Salsano, A. (Antonio), Gherli, T. (Tiziano), Nicolini, F. (Francesco), Zanobini, M. (Marco), Saccocci, M. (Matteo), Bounader, K. (Karl), D’Errigo, P. (Paola), Kiviniemi, T. (Tuomas), Kinnunen, E.-M. (Eeva-Maija), Perrotti, A. (Andrea), Airaksinen, J. (Juhani), Mariscalco, G. (Giovanni), Ruggieri, V. G. (Vito G.), and Biancari, F. (Fausto)
- Abstract
The impact of thrombocytopenia on postoperative bleeding and other major adverse events after cardiac surgery is unclear. This issue was investigated in a series of patients who underwent isolated coronary artery bypass grafting (CABG) from the prospective, multicenter E-CABG registry. Preoperative thrombocytopenia was defined as preoperative platelet count <150 × 10⁹/L and it was considered moderate-severe when preoperative platelet count was <100 × 10⁹/L. Multilevel mixed-effects regression analysis was performed to adjust the effect of thrombocytopenia on outcomes for baseline and operative covariates as well as for interinstitutional differences in patient-blood management. Among 7189 patients included in this analysis, 599 (8.3%) had preoperative thrombocytopenia. Patient with preoperative thrombocytopenia had an increased chest drainage output at 12 h (mean, 519 vs. 456 mL, adjusted coeff. 39, 95%CI 18–60) and rates of severe-massive bleeding (Universal Definition of Perioperative Bleeding (UDPB) severity grades 3–4: 12.7% vs. 8.1%, adjusted OR 1.47, 95%CI 1.11–1.93; E-CABG bleeding severity grades 2–3: 10.4% vs. 6.1%, adjusted OR 1.78, 95%CI 1.30–2.43). Thrombocytopenia was associated with an increased risk of hospital/30-day death (3.2% vs. 1.9%, adjusted OR 2.02, 95%CI 1.20–3.42), 1-year death (5.7% vs. 3.4%, adjusted HR 1.68, 95%CI 1.16–2.44), deep sternal wound infection (3.5% vs. 2.4%, adjusted OR 1.65, 95%CI 1.02–2.66), acute kidney injury (28.1% vs. 22.2%, OR 1.45, 1.18–1.78), and prolonged stay in the intensive care unit (mean, 3.6 vs 2.8 days, adjusted coeff. 0.74, 95%CI 0.40–1.09). Similar results were observed in a subset of patients with moderate-severe thrombocytopenia (51 patients, 0.7%). In particular, these patients had a markedly higher rate of acute kidney injury (40%, adjusted OR, 1.94, 95%CI 1.05–3.57), resternotomy for bleeding (7.8%, adjusted OR 3.49, 95%CI 1.20–10.21), and severe-massive bleeding (UDPB severity grades 3–4
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- 2019
10. Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in the Management of Perioperative Bleeding after Coronary Artery Bypass Grafting
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Salsano, A., Mariscalco, G., Santini, F., Ruggieri, V. G., Perrotti, A., Chocron, S., Gherli, R., Reichart, D., Demal, T., Faggian, G., Franzese, I., Dalén, M., Santarpino, G., Fischlein, T., Rubino, A. S., Maselli, D., Nardella, S., Nicolini, F., Saccocci, M., Gatti, G., Bounader, K., Rosato, S., Kinnunen, E., De Feo, M., Tauriainen, T., Onorati, F., and Biancari, F.
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- 2018
11. Variation in preoperative antithrombotic strategy, severe bleeding, and use of blood products in coronary artery bypass grafting:results from the multicentre E-CABG registry
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Biancari, F. (Fausto), Mariscalco, G. (Giovanni), Gherli, R. (Riccardo), Reichart, D. (Daniel), Onorati, F. (Francesco), Faggian, G. (Giuseppe), Franzese, I. (Ilaria), Santarpino, G. (Giuseppe), Fischlein, T. (Theodor), Rubino, A. S. (Antonino S.), Maselli, D. (Daniele), Nardella, S. (Saverio), Antonio, A. (Antonio), Nicolini, F. (Francesco), Zanobini, M. (Marco), Saccocci, M. (Matteo), Ruggieri, V. G. (Vito G.), Bounader, K. (Karl), Perrotti, A. (Andrea), Rosato, S. (Stefano), D’Errigo, P. (Paola), D’Andrea, V. (Vito), De Feo, M. (Marisa), Tauriainen, T. (Tuomas), Gatti, G. (Giuseppe), and Dalén, M. (Magnus)
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Antithrombotic ,P2Y12 ,Bleeding ,Blood transfusion ,Coronary artery bypass grafting ,Cardiac surgery - Abstract
Aims: No data exists on inter-institutional differences in terms of adherence to international guidelines regarding the discontinuation of antithrombotics and rates of severe bleeding in coronary artery bypass grafting (CABG). Methods and results: This is an analysis of 7118 patients from the prospective multicentre European CABG (E-CABG) registry who underwent isolated CABG in 15 European centres. Preoperative pause of P2Y12 receptor antagonists shorter than that suggested by the 2017 ESC guidelines (overall 11.6%) ranged from 0.7% to 24.8% between centres (adjusted P
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- 2018
12. OC11 CLINICAL FRAILTY SCALE AND OUTCOME AFTER CORONARY ARTERY BYPASS GRAFTING
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Saccocci, M., Reichart, D., Rosato, S., Nammas, W., Onorati, F., Dalen, M., Castro, L., Gherli, R., Gatti, G., Franzese, I., Faggian, G., De Feo, M., Khodabandeh, S., Santarpino, G., Rubino, A. S., Maselli, D., Nardella, S., Salsano, A., Nicolini, F., Zanobini, M., Bounader, K., Kinnunen, E., Tauriainen, T., Airaksinen, J., Seccareccia, F., Mariscalco, G., Ruggieri, V. G., Perrotti, A., and Biancari, F.
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- 2018
13. Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery:prospective, cohort study from the E-CABG registry
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Nicolini, F. (Francesco), Santarpino, G. (Giuseppe), Gatti, G. (Giuseppe), Reichart, D. (Daniel), Onorati, F. (Francesco), Faggian, G. (Giuseppe), Dalén, M. (Magnus), Khodabandeh, S. (Sorosh), Fischlein, T. (Theodor), Maselli, D. (Daniele), Nardella, S. (Saverio), Rubino, A. S. (Antonino S.), De Feo, M. (Marisa), Salsano, A. (Antonio), Gherli, R. (Riccardo), Mariscalco, G. (Giovanni), Kinnunen, E.-M. (Eeva-Maija), Ruggieri, V. G. (Vito G.), Bounader, K. (Karl), Saccocci, M. (Matteo), Chocron, S. (Sidney), Airaksinen, J. (Juhani), Perrotti, A. (Andrea), and Biancari, F. (Fausto)
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HbA1c ,diabetes ,CABG ,coronary artery bypass ,glycated hemoglobin - Abstract
Background: Patients with increased glycated hemoglobin (HbA1c) seem to be at increased risk of sternal wound infection (SWI) after coronary artery bypass grafting (CABG). However, it is unclear whether increased baseline HbA1c levels may affect other postoperative outcomes. Material and methods: Data on preoperative levels of HbA1c were collected from 2606 patients undergoing elective isolated CABG from 2015 to 2016 and included in the prospective, multicenter E-CABG registry. Results: The prevalence of HbA1c ≥ 53 mmol/mol (7.0%) among non-diabetics was 5.3%, among non-insulin dependent diabetics was 53.5% and among insulin dependent diabetics was 67.1% (p 75 mmol/mol (9.0%) among non-diabetics was 0.5%, among non-insulin dependent diabetics was 5.8% and among insulin dependent diabetics was 10.6% (p
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- 2018
14. Value of Screening Asymptomatic Carotid Artery Stenosis Prior to Coronary Artery Bypass Grafting: Analysis of the E-CABG Registry
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Salsano, A., Santarpino, G., Santini, F., Nicolini, F., De Feo, M., Dalén, M., Fischlein, T., Perrotti, A., Reichart, D., Gatti, G., Onorati, F., Franzese, I., Faggian, G., Bancone, C., Chocron, S., Khodabandeh, S., Rubino, A. S., Maselli, D., Nardella, S., Gherli, R., Zanobini, M., Saccocci, M., Bounader, K., Rosato, S., Tauriainen, T., Mariscalco, G., Airaksinen, J., Ruggieri, V. G., and Biancari, F.
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- 2018
15. Biomechanical–based torque reconstruction of the human shoulder joint in industrial tasks
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Caporaso, T., primary, Grazioso, S., additional, Nardella, S., additional, Ostuni, B., additional, Di Gironimo, G., additional, and Lanzotti, A., additional
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- 2019
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16. Assessment of upper limb muscle synergies for industrial overhead tasks: a preliminary study
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Grazioso, S., primary, Caporaso, T., additional, Palomba, A., additional, Nardella, S., additional, Ostuni, B., additional, Panariello, D., additional, Di Gironimo, G., additional, and Lanzotti, A., additional
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- 2019
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17. Early outcome of bilateral versus single internal mammary artery grafting in the elderly
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Rubino, A. S. (Antonino S.), Gatti, G. (Giuseppe), Reichart, D. (Daniel), Tauriainen, T. (Tuomas), De Feo, M. (Marisa), Onorati, F. (Francesco), Pappalardo, A. (Aniello), Chocron, S. (Sidney), Gulbins, H. (Helmut), Dalén, M. (Magnus), Svenarud, P. (Peter), Faggian, G. (Giuseppe), Franzese, I. (Ilaria), Santarpino, G. (Giuseppe), Fischlein, T. (Theodor), Maselli, D. (Daniele), Nardella, S. (Saverio), Gherli, R. (Riccardo), Ahmed, A. (Aamer), Santini, F. (Francesco), Salsano, A. (Antonio), Nicolini, F. (Francesco), Zanobini, M. (Marco), Saccocci, M. (Matteo), Ruggieri, V. G. (Vito G.), Bounader, K. (Karl), Mignosa, C. (Carmelo), D’Errigo, P. (Paola), Rosato, S. (Stefano), Airaksinen, J. (Juhani), Perrotti, A. (Andrea), Biancari, F. (Fausto), Rubino, A. S. (Antonino S.), Gatti, G. (Giuseppe), Reichart, D. (Daniel), Tauriainen, T. (Tuomas), De Feo, M. (Marisa), Onorati, F. (Francesco), Pappalardo, A. (Aniello), Chocron, S. (Sidney), Gulbins, H. (Helmut), Dalén, M. (Magnus), Svenarud, P. (Peter), Faggian, G. (Giuseppe), Franzese, I. (Ilaria), Santarpino, G. (Giuseppe), Fischlein, T. (Theodor), Maselli, D. (Daniele), Nardella, S. (Saverio), Gherli, R. (Riccardo), Ahmed, A. (Aamer), Santini, F. (Francesco), Salsano, A. (Antonio), Nicolini, F. (Francesco), Zanobini, M. (Marco), Saccocci, M. (Matteo), Ruggieri, V. G. (Vito G.), Bounader, K. (Karl), Mignosa, C. (Carmelo), D’Errigo, P. (Paola), Rosato, S. (Stefano), Airaksinen, J. (Juhani), Perrotti, A. (Andrea), and Biancari, F. (Fausto)
- Abstract
Background: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting. Methods: In all, 2,899 patients aged 70 years or older (855 [29.5%] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis. Results: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7% versus 1.6%, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7% versus 5.1%, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0% versus 2.2%, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0% versus 0.1%, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6% versus 1.3%, p = 0.009). Conclusions: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy.
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- 2018
18. Prognostic impact of asymptomatic carotid artery stenosis in patients undergoing coronary artery bypass grafting
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Santarpino, G. (Giuseppe), Nicolini, F. (Francesco), De Feo, M. (Marisa), Dalén, M. (Magnus), Fischlein, T. (Theodor), Perrotti, A. (Andrea), Reichart, D. (Daniel), Gatti, G. (Giuseppe), Onorati, F. (Francesco), Franzese, I. (Ilaria), Faggian, G. (Giuseppe), Bancone, C. (Ciro), Chocron, S. (Sidney), Khodabandeh, S. (Sorosh), Rubino, A. S. (Antonino S.), Maselli, D. (Daniele), Nardella, S. (Saverio), Gherli, R. (Riccardo), Salsano, A. (Antonio), Zanobini, M. (Marco), Saccocci, M. (Matteo), Bounader, K. (Karl), Rosato, S. (Stefano), Tauriainen, T. (Tuomas), Mariscalco, G. (Giovanni), Airaksinen, J. (Juhani), Ruggier, V. G. (Vito G.), Biancari, F. (Fausto), Santarpino, G. (Giuseppe), Nicolini, F. (Francesco), De Feo, M. (Marisa), Dalén, M. (Magnus), Fischlein, T. (Theodor), Perrotti, A. (Andrea), Reichart, D. (Daniel), Gatti, G. (Giuseppe), Onorati, F. (Francesco), Franzese, I. (Ilaria), Faggian, G. (Giuseppe), Bancone, C. (Ciro), Chocron, S. (Sidney), Khodabandeh, S. (Sorosh), Rubino, A. S. (Antonino S.), Maselli, D. (Daniele), Nardella, S. (Saverio), Gherli, R. (Riccardo), Salsano, A. (Antonio), Zanobini, M. (Marco), Saccocci, M. (Matteo), Bounader, K. (Karl), Rosato, S. (Stefano), Tauriainen, T. (Tuomas), Mariscalco, G. (Giovanni), Airaksinen, J. (Juhani), Ruggier, V. G. (Vito G.), and Biancari, F. (Fausto)
- Abstract
Objectives: The aim of this study was to evaluate the prognostic impact of untreated asymptomatic carotid artery stenosis (CS) in patients undergoing isolated coronary artery bypass grafting (CABG). Methods: This was a post hoc analysis of data from a prospective multicentre observational study. Patients without history of stroke or transient ischaemic attack from the multicentre E-CABG registry who were screened for CS before isolated CABG were included. Results: Among 2813 patients screened by duplex ultrasound and who did not undergo carotid intervention for asymptomatic CS, 11.1% had a stenosis of 50–59%, 6.0% of 60–69%, 3.1% of 70–79%, 1.4% of 80–89%, 0.5% of 90–99%, and 1.1% had carotid occlusion. In the screened population post-operative stroke occurred in 25 patients (0.9%), with an incidence of 1.5% among patients with CS ≥ 50% (n = 649). Pre-operative screening had not found a relevant CS in 15 of 25 patients suffering stroke after CABG. Brain imaging identified cerebral ischaemic injury in 20 patients, which was bilateral in five patients (25%), ipsilateral to a CS ≥ 50% in six (30%), and ipsilateral to a CS ≥ 70% in three (15%). In univariable analysis, the severity of CS was associated with a significantly increased risk of stroke (CS < 50%, 0.7%; 50–59%, 1.0%; 60–69%, 0.6%; 70–79%, 1.2%; 80–89%, 5.1%; 90–99%, 7.7%; occluded, 6.7%, p < .001). In multivariable analysis, a CS of 90–99% (OR 12.03, 95% CI 1.34–108.23) and the presence of an occluded internal carotid artery (OR 8.783, 95% CI 1.820–42.40) were independent predictors of stroke along with urgency of the procedure, severe massive bleeding according to the E-CABG classification, and the presence of a porcelain ascending aorta. Conclusions: Among screened patients with untreated asymptomatic patients, CS ≥ 90% was an independent predictor of post-operative stroke. As this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, pre-o
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- 2018
19. Clinical frailty scale and outcome after coronary artery bypass grafting
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Reichart, D. (Daniel), Rosato, S. (Stefano), Nammas, W. (Wail), Onorati, F. (Francesco), Dalén, M. (Magnus), Castro, L. (Liesa), Gherli, R. (Riccardo), Gatti, G. (Giuseppe), Franzese, I. (Ilaria), Faggian, G. (Giuseppe), De Feo, M. (Marisa), Khodabandeh, S. (Sorosh), Santarpino, G. (Giuseppe), Rubino, A. S. (Antonino S.), Maselli, D. (Daniele), Nardella, S. (Saverio), Salsano, A. (Antonio), Nicolini, F. (Francesco), Zanobini, M. (Marco), Saccocci, M. (Matteo), Bounader, K. (Karl), Kinnunen, E.-M. (Eeva-Maija), Tauriainen, T. (Tuomas), Airaksinen, J. (Juhani), Seccareccia, F. (Fulvia), Mariscalco, G. (Giovanni), Ruggieri, V. G. (Vito G.), Perrotti, A. (Andrea), Biancari, F. (Fausto), Reichart, D. (Daniel), Rosato, S. (Stefano), Nammas, W. (Wail), Onorati, F. (Francesco), Dalén, M. (Magnus), Castro, L. (Liesa), Gherli, R. (Riccardo), Gatti, G. (Giuseppe), Franzese, I. (Ilaria), Faggian, G. (Giuseppe), De Feo, M. (Marisa), Khodabandeh, S. (Sorosh), Santarpino, G. (Giuseppe), Rubino, A. S. (Antonino S.), Maselli, D. (Daniele), Nardella, S. (Saverio), Salsano, A. (Antonio), Nicolini, F. (Francesco), Zanobini, M. (Marco), Saccocci, M. (Matteo), Bounader, K. (Karl), Kinnunen, E.-M. (Eeva-Maija), Tauriainen, T. (Tuomas), Airaksinen, J. (Juhani), Seccareccia, F. (Fulvia), Mariscalco, G. (Giovanni), Ruggieri, V. G. (Vito G.), Perrotti, A. (Andrea), and Biancari, F. (Fausto)
- Abstract
Objectives: The aim of this study was to assess the impact of frailty on the outcome after coronary artery bypass grafting (CABG) and whether it may improve the predictive ability of European System for Cardiac Operative Risk Evaluation (EuroSCORE II). Methods: The Clinical Frailty Scale (CFS) was assessed preoperatively in patients undergoing isolated CABG from the multicentre E-CABG registry, and patients were stratified into 3 classes: scores 1–2, scores 3–4 and scores 5–7. Results: Of the 6156 patients enrolled, 39.2% had CFS scores 1–2, 57.6% scores 3–4, and 3.2% scores 5–7. Logistic regression adjusted for multiple covariates showed that the CFS was an independent predictor of hospital/30-day mortality [CFS scores 3–4, odds ratio (OR) 3.95, 95% confidence interval (CI) 2.19–7.14; CFS scores 5–7, OR 5.90, 95% CI 2.67–13.05] and resulted in an Integrated Improvement Index of 1.3 (P < 0.001) and a Net Reclassification Index of 55.6 (P < 0.001) for prediction of hospital/30-day mortality. Adding the CFS classes to EuroSCORE II resulted in an Integrated Improvement Index of 0.9 (P < 0.001) and Net Reclassification Index of 59.6 (P < 0.001) for prediction of hospital/30-day mortality with a significantly larger area under the receiver operating characteristics curve (0.809 vs 0.781, P = 0.028). The CFS was an independent predictor of mid-term mortality [CFS scores 3–4, hazard ratio (HR) 2.05, 95% CI 1.43–2.85; CFS scores 5–7, HR 3.05, 95% CI 1.83–5.06]. Conclusions: The CFS predicted early- and mid-term mortality in patients undergoing isolated CABG. Further studies are needed to evaluate whether frailty may improve the estimation of the operative risk of patients undergoing adult cardiac surgery.
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- 2018
20. CHANGES IN LEFT ATRIAL VOLUME DURING ECHOSTRESS IN PATIENTS UNDERGOING MITRAL VALVE PLASTIC CARDIAC SURGERY
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Tassone, E, Morabito, G, Carullo, G, Nardella, S, and Maselli, D
- Abstract
Mitral Regurgitation (MR) is characterized by a high morbidity and mortality that often finds a solution only in the reparative surgical treatment, in particular in presence of myxomatous degeneration that cause the prolapse of one or both leaflets. This results in an increase in diastolic pressure that leads to a progressive dilation of the left atrium. The increase in Left Atrium Volume Index (LAVI) during stress test represents a negative prognostic factor in the clinical evolution of many pathologies, such as ischemic heart disease, hypertrophic cardiomyopathy, heart failure. An increase in peak/rest LAVI >6.8 ml/m2 correlates with a higher incidence of heart failure decompensation, reduced left ventricular contractile reserve (LVCR), pulmonary congestion.We evaluate the effect of MR reparative surgery on the changes of LAVI during stress–echo. We enrolled 19 patients, 11 females and 8 males, affected by MR candidate to cardiac surgery. We performed a physical stress–echo test by using the ABCDE protocol suggested by the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI), before and after 12 weeks from surgery. During each test, the changes in LAVI (ΔLAVI) expressed as peak/rest difference in ml/m2 was measured. In addition, the prognostic score deriving from the sum of the ABCDE criteria was calculated, such as the LVCR (C parameter of the score) that represents a parameter of the force deriving from the hemodynamic changes during the test. In all patients we observed a significant reduction in ΔLAVI (8.4+0.5 mL/m2 vs 9.7+0.7 mL/m2; p<0.0001). In addition, there was a significant reduction in the ABCDE prognostic score (from 4.19+0.43 to 3.48+0.37; p=0.002), secondary to the increase in the LVCR observed approximately 3 months after surgery (from 1.77 mmHg/ml to 2.44 mmHg/ml, p<0.0001), as well as a significant reduction in pulmonary congestion during stress (B parameter). There were no significant changes in ejection fraction, wall motion score index–WMSI (A parameter), coronary reserve (D parameter) and heart rate reserve (E parameter).These data demonstrate for the first time that mitral valve plastic surgery is able to reduce the ΔLAVI during stress echocardiography in patients with severe MR. The surgical procedure also resulted in both an improvement in the LVCR and a reduction in the degree of pulmonary congestion, that ultimately led to an improvement in the ABCDE prognostic score.
- Published
- 2024
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21. 1-year outcomes after transfemoral transcatheter or surgical aortic valve replacement: Results from the Italian OBSERVANT study
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Tamburino, C, Barbanti, M, D'Errigo, P, Ranucci, M, Onorati, F, Covello, R, Santini, F, Rosato, S, Santoro, G, Fusco, D, Grossi, C, Seccareccia, F, Marra, S, D'Amico, M, Gaita, F, Moretti, C, De Benedictis, M, Aranzulla, T, Pistis, G, Reale, M, Bedogni, F, Brambilla, N, Ferrario, M, Ferrero, L, Vicinelli, P, Colombo, A, Chieffo, A, Ferrari, A, Inglese, L, Casilli, F, Ettori, F, Frontini, M, Antona, C, Piccaluga, E, Klugmann, S, De Marco, F, Tespili, M, Saino, A, Leonzi, O, Rizzi, A, Grisolia, E, Franceschini Grisolia, E, Isabella, G, Fraccaro, C, Bernardi, G, Bisceglia, T, Armellini, I, Vischi, M, Parodi, E, Vignali, L, Ardissimo, D, Marzocchi, A, Marrozzini, C, Cremonesi, A, Colombo, F, Giannini, C, Pierli, C, Iadanza, A, Meucci, F, Berti, S, Mariani, M, Tomai, F, Ghini, A, Violini, R, Confessore, P, Crea, F, Giubilato, S, Sardella, G, Mancone, M, Ribichini, F, Vassanelli, C, Dandale, R, Giudice, P, Vigorito, F, Liso, A, Specchia, L, Indolfi, C, Spaccarotella, C, Stabile, A, Gandolfo, C, Ussia, G, Comoglio, C, Dyrda, O, Rinaldi, M, Salizzoni, S, Micalizzi, E, Di Gregorio, O, Scoti, P, Costa, R, Casabona, R, Del Ponte, S, Panisi, P, Spira, G, Troise, G, Messina, A, Viganò, M, Aiello, M, Alfieri, O, Denti, P, Menicanti, L, Agnelli, B, Donatelli, F, Muneretto, C, Rambaldini, M, Gamba, A, Tasca, G, Ferrazzi, P, Terzi, A, Gelpi, G, Martinelli, L, Bruschi, G, Graffigna, A, Mazzucco, A, Pappalardo, A, Gatti, G, Livi, U, Pompei, E, Coppola, R, Gucciardo, M, Albertini, A, Caprili, L, Ghidoni, I, Gabbieri, D, La Marra, M, Aquino, T, Gherli, T, Policlinico, S, Di Bartolomeo, R, Savini, C, Popoff, G, Innocenti, D, Bortolotti, U, Pratali, S, Stefano, P, Blanzola, C, Glauber, M, Cerillo, A, Chiaramonti, F, Pardini, A, Fioriello, F, Torracca, L, Rescigno, G, De Paulis, R, Nardella, S, Musumeci, F, Luzi, G, Possati, G, Bonalumi, G, Covino, E, Pollari, F, Sinatra, R, Roscitano, A, Chiariello, L, Nardi, P, Lonobile, T, Baldascino, F, Di Benedetto, G, Mastrogiovanni, G, Piazza, L, Marmo, J, Vosa, C, De Amicis, V, Speziale, G, Visicchio, G, Spirito, R, Gregorini, R, Villani, M, Pano, M, Bortone, A, De Luca Tupputi Schinosa, L, De Cillis, E, Gaeta, R, Di Natale, M, Cassese, M, Antonazzo, A, Argano, V, Santaniello, E, Patanè, L, Gentile, M, Tribastone, S, Follis, F, Montalbano, G, Pilato, M, Stringi, V, Patanè, F, Salamone, G, Ruvolo, G, Pisano, C, Mignosa, C, Bivona, A, Cirio, E, Lixi, G, Maraschini, A, Badoni, G, Onorato, F, De Palma, R, Scandotto, S, Orlando, A, Copello, F, Borgia, P, Marchetta, F, and Porcu, R
- Subjects
aortic stenosis ,implantation ,intermediate risk ,transcatheter aortic valve ,Settore MED/23 - Chirurgia Cardiaca - Published
- 2015
22. Reduction of allogeneic red blood cell usage during cardiac surgery by an integrated intra- and postoperative blood salvage strategy: results of a randomized comparison
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Weltert, L, Nardella, S, Rondinelli, M, Pierelli, L, and DE PAULIS, R
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Male ,Postoperative Care ,Analysis of Variance ,Intraoperative Care ,Heart Diseases ,Operative Blood Salvage ,Cost-Benefit Analysis ,Settore MED/23 - Chirurgia Cardiaca ,Middle Aged ,Postoperative Complications ,Treatment Outcome ,Italy ,Humans ,Aged ,Erythrocyte Transfusion ,Female ,Follow-Up Studies ,Prospective Studies ,Cardiac Surgical Procedures - Abstract
The amount of allogeneic blood transfusion may relate to worse outcome in cardiac surgery. The reinfusion of red blood cells (RBCs) lost by patients, including those of chest drains, is a promising strategy to minimize allogeneic transfusions.To verify this hypotheis, 1047 cardiac surgery patients were randomly assigned to either traditional intraoperative blood salvage followed by chest drain insertion or intra- and postoperative strategy with the Haemonetics cardioPAT system. Allogeneic RBC transfusion rate (primary endpoint) and postoperative complications (secondary endpoint) were recorded at the time of discharge from the hospital and at first month follow-up visit, respectively.The cardioPAT arm received 1.20 units of allogeneic RBCs per patient, whereas the control group required 2.11 units per patient, and this difference proved to be highly significant (p=0.02). We observed a comparable 45-day mortality rate but a lower rate of deep vein thrombosis (p=0.04) and atrial fibrillation (p=0.04) in the cardioPAT arm.A significant reduction in patient exposure to allogeneic RBCs was observed in the cardioPAT system arm. Complications were slightly less frequent in the cardioPAT group. The use of the cardioPAT is a safe and effective strategy to reduce allogeneic RBC transfusions in cardiac surgery.
- Published
- 2013
23. Appropriateness of antibiotic prophylaxisfor surgery and implementation level of clinical governance: Results from an Italian experience
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Parente, P, primary, Colotto, M, additional, Nardella, S, additional, Iodice, L, additional, Treglia, S, additional, Campanella, P, additional, Murri, R, additional, Fantoni, M, additional, Ricciardi, W, additional, and de Belvis, AG, additional
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- 2013
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24. Different impact of sex on baseline characteristics and major periprocedural outcomes of transcatheter and surgical aortic valve interventions: Results of the multicenter Italian OBSERVANT Registry
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Onorati, Francesco, D'Errigo, Paola, Barbanti, Marco, Rosato, Stefano, Covello, Remo Daniel, Maraschini, Alice, Ranucci, Marco, Santoro, Gennaro, Tamburino, Corrado, Grossi, Claudio, Santini, Francesco, Menicanti, Lorenzo, Seccareccia, Fulvia, Badoni, Gabriella, Fusco, Danilo, De Palma, Rossana, Scondotto, Salvatore, Orlando, Anna, Copello, Francesco, Zanier, Loris, Zocchetti, Carlo, Cecchi, Mario, Borgia, Piero, Celentano, Egidio, Mauro, Aldo, De Luca, Giovanni, Marchetta, Fausto, Antonelli, Antonello, Porcu, Rosanna, Marra, S., D'Amico, M., Gaita, F., Moretti, C., De Benedictis, M., Aranzulla, T., Pistis, G., Reale, M., Bedogni, F., Brambilla, N., Colombo, A., Chieffo, A., Ferrari, A., Inglese, L., Casilli, F., Ettori, F., Frontini, M., Antona, C., Piccaluga, E., Klugmann, S., De Marco, F., Tespili, M., Saino, A., Franceschini Grisolia, E., Isabella, G., Fraccaro, C., Proclemer, A., Bisceglia, T., Armellini, I., Vischi, M., Parodi, E., Petronio, S., Giannini, C., Pierli, C., Iadanza, A., Santoro, G., Meucci, F., Tomai, F., Ghini, A., Sardella, Gennaro, Mancone, M., Ribichini, F., Vassanelli, C., Dandale, R., Giudice, P., Vigorito, F., Bortone, A., De Luca Tupputi Schinosa, L., De Cillis, E., Indolfi, C., Spaccarotella, C., Stabile, A., Gandolfo, C., Tamburino, C., Ussia, G., Rinaldi, M., Salizzoni, S., Grossi, C., Di Gregorio, O., Scoti, P., Costa, R., Casabona, R., Del Ponte, S., Panisi, P., Spira, G., Troise, G., Messina, A., Viganò, M., Aiello, M., Alfieri, O., Denti, P., Menicanti, L., Agnelli, B., Muneretto, C., Rambaldini, M., Gamba, A., Tasca, G., Ferrazzi, P., Terzi, A., Gelpi, G., Martinelli, L., Bruschi, G., Graffigna, A. C., Mazzucco, A., Pappalardo, A., Gatti, G., Livi, U., Pompei, E., Passerone, G., Bortolotti, U., Pratali, S., Stefano, P., Blanzola, C., Glauber, M., Cerillo, A., Chiaramonti, F., Pardini, A., Fioriello, F., Torracca, L., Rescigno, G., De Paulis, R., Nardella, S., Musumeci, F., Luzi, G., Possati, G., Bonalumi, G., Covino, E., Pollari, F., Sinatra, Riccardo, Roscitano, A., Chiariello, L., Nardi, P., Lonobile, T., Baldascino, F., Di Benedetto, G., Mastrogiovanni, G., Piazza, L., Marmo, J., Vosa, C., De Amicis, V., Villani, M., Pano, M. A., Cassese, M., Antonazzo, A., Patanè, L., Gentile, M., Tribastone, S., Follis, F., Montalbano, G., Pilato, M., Stringi, V., Patanè, F., Salamone, G., Ruvolo, G., Pisano, C., Mignosa, C., Bivona, A., Cirio, E. M., Lixi, G., Onorati, F., D'Errigo, P., Barbanti, M., Rosato, S., Covello, R. D., Maraschini, A., Ranucci, M., Santoro, G., Tamburino, C., Grossi, C., Santini, F., Menicanti, L., Seccareccia, F., Badoni, G., Fusco, D., De Palma, R., Scondotto, S., Orlando, A., Copello, F., Zanier, L., Zocchetti, C., Cecchi, M., Borgia, P., Celentano, E., Mauro, A., De Luca, G., Marchetta, F., Antonelli, A., Porcu, R., Marra, S., D'Amico, M., Gaita, F., Moretti, C., De Benedictis, M., Aranzulla, T., Pistis, G., Reale, M., Bedogni, F., Brambilla, N., Colombo, A., Chieffo, A., Ferrari, A., Inglese, L., Casilli, F., Ettori, F., Frontini, M., Antona, C., Piccaluga, E., Klugmann, S., De Marco, F., Tespili, M., Saino, A., Franceschini Grisolia, E., Isabella, G., Fraccaro, C., Proclemer, A., Bisceglia, T., Armellini, I., Vischi, M., Parodi, E., Petronio, S., Giannini, C., Pierli, C., Iadanza, A., Meucci, F., Tomai, F., Ghini, A., Sardella, G., Mancone, M., Ribichini, F., Vassanelli, C., Dandale, R., Giudice, P., Vigorito, F., Bortone, A., De Luca Tupputi Schinosa, L., De Cillis, E., Indolfi, C., Spaccarotella, C., Stabile, A., Gandolfo, C., Ussia, G., Rinaldi, M., Salizzoni, S., Di Gregorio, O., Scoti, P., Costa, R., Casabona, R., Del Ponte, S., Panisi, P., Spira, G., Troise, G., Messina, A., Vigano, M., Aiello, M., Alfieri, O., Denti, P., Agnelli, B., Muneretto, C., Rambaldini, M., Gamba, A., Tasca, G., Ferrazzi, P., Terzi, A., Gelpi, G., Martinelli, L., Bruschi, G., Graffigna, A. C., Pappalardo, A., Mazzucco, A., Livi, U., Pompei, E., Passerone, G., Bortolotti, U., Pratali, S., Stefano, P., Blanzola, C., Glauber, M., Cerillo, A., Chiaramonti, F., Pardini, A., Fioriello, F., Torracca, L., Rescigno, G., De Paulis, R., Nardella, S., Musumeci, F., Luzi, G., Possati, G., Bonalumi, G., Covino, E., Pollari, F., Sinatra, R., Roscitano, A., Chiariello, L., Nardi, P., Lonobile, T., Baldascino, F., Di Benedetto, G., Mastrogiovanni, G., Piazza, L., Marmo, J., Vosa, C., De Amicis, V., Villani, M., Pano, M. A., Cassese, M., Antonazzo, A., Patane, L., Gentile, M., Tribastone, S., Montalbano, G., Follis, F., Pilato, M., Stringi, V., Patane, F., Salamone, G., Ruvolo, G., Pisano, C., Mignosa, C., Bivona, A., Cirio, E. M., and Lixi, G.
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Aortic valve ,Registrie ,Age Factors ,Aged ,Aged, 80 and over ,Aortic Valve ,Aortic Valve Stenosis ,Blood Transfusion ,Chi-Square Distribution ,Comorbidity ,Female ,Heart Valve Prosthesis Implantation ,Hospital Mortality ,Humans ,Italy ,Linear Models ,Logistic Models ,Male ,Multivariate Analysis ,Odds Ratio ,Postoperative Complications ,Prospective Studies ,Registries ,Risk Assessment ,Risk Factors ,Severity of Illness Index ,Sex Factors ,Time Factors ,Treatment Outcome ,Cardiac Catheterization ,Health Status Disparities ,Surgery ,Medicine (all) ,Pulmonary and Respiratory Medicine ,Cardiology and Cardiovascular Medicine ,medicine.medical_treatment ,Sex Factor ,Aortic valve replacement ,80 and over ,Age Factor ,Myocardial infarction ,Multivariate Analysi ,education.field_of_study ,Ejection fraction ,medicine.anatomical_structure ,Aortic valve stenosis ,Cardiology ,Linear Model ,Human ,medicine.medical_specialty ,Logistic Model ,Time Factor ,Population ,Internal medicine ,medicine ,education ,business.industry ,Risk Factor ,Percutaneous coronary intervention ,Settore MED/23 - Chirurgia Cardiaca ,EuroSCORE ,medicine.disease ,Aortic Valve Stenosi ,Prospective Studie ,Postoperative Complication ,business - Abstract
Background: Despite the widespread use of transcatheter aortic valve implantation (TAVI), the role of sex on outcome after TAVI or surgical aortic valve replacement (AVR) has been poorly investigated. We investigated the impact of sex on outcome after TAVI or AVR. Methods: There were 2108 patients undergoing TAVI or AVR who were enrolled in the Italian Observational Multicenter Registry (OBSERVANT). Thirty-day mortality, major periprocedural morbidity, and transprosthetic gradients were stratified by sex according to interventions. Results: Female AVR patients showed a worse risk profile compared with male AVR patients, given the higher mean age, prevalence of frailty score of 2 or higher, New York Heart Association class of 3 or higher, lower body weight, and preoperative hemoglobin level (P ≤.02). Similarly, female TAVI patients had a different risk profile than male TAVI patients, given a higher age and a lower body weight and preoperative hemoglobin level (P ≤.005), but with a similar New York Heart Association class, frailty score, EuroSCORE (P = NS), a better left ventricular ejection fraction and a lower prevalence of left ventricular ejection fraction less than 30%, porcelain aorta, renal dysfunction, chronic obstructive pulmonary disease, arteriopathy, and previous cardiovascular surgery or percutaneous coronary intervention (P ≤.01). Women showed a smaller aortic annulus than men in both populations (P
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25. Diastolic properties of the Sorin Solo, ATS 3F, Edwards Prima Plus and medtronic freestyle stentless valves: An independent in-vitro comparison
- Author
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Weltert, L., Nardella, S., Girola, F., Scaffa, R., Bellisario, A., Daniele Maselli, and Paulis, R.
26. Infectious complications in patients receiving ticagrelor or clopidogrel before coronary artery bypass grafting
- Author
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Antonio Salsano, M. De Feo, Ciro Bancone, Francesco Onorati, Saverio Nardella, R. Gherli, Marco Zanobini, Magnus Dalén, Giuseppe Gatti, Giuseppe Santarpino, Andrea Perrotti, Till Demal, F. Musumeci, Theodor Fischlein, Ilaria Franzese, Giovanni Mariscalco, Fausto Biancari, Sorosh Khodabandeh, Vito G. Ruggieri, Daniele Maselli, Antonino S. Rubino, Matteo Saccocci, Eeva-Maija Kinnunen, T. Tauriainen, F. Santini, Francesco Nicolini, Giuseppe Faggian, Daniel Reichart, Manne Holm, Dalen, M., Biancari, F., Perrotti, A., Mariscalco, G., Onorati, F., Faggian, G., Franzese, I., Salsano, A., Santini, F., Ruggieri, V. G., Maselli, D., Nardella, S., Santarpino, G., Fischlein, T., Saccocci, M., Zanobini, M., Musumeci, F., Gherli, R., Rubino, A. S., De Feo, M., Bancone, C., Nicolini, F., Kinnunen, E. -M., Tauriainen, T., Reichart, D., Demal, T., Gatti, G., Khodabandeh, S., and Holm, M.
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Male ,Microbiology (medical) ,Ticagrelor ,medicine.medical_specialty ,Bypass grafting ,medicine.drug_class ,Antibiotics ,Coronary artery bypass grafting ,Preoperative Care ,medicine ,Humans ,Effect ,In patient ,cardiovascular diseases ,Coronary Artery Bypass ,Propensity Score ,Antibacterial activity ,Bactericidal ,Clopidogrel ,Infectious complications ,Aged ,Aged, 80 and over ,Cross Infection ,business.industry ,Incidence (epidemiology) ,Infectious complication ,General Medicine ,Middle Aged ,Surgery ,Europe ,Infectious Diseases ,medicine.anatomical_structure ,Propensity score matching ,Female ,business ,Platelet Aggregation Inhibitors ,medicine.drug ,Artery - Abstract
Summary The antiplatelet agent ticagrelor has recently been found to have bactericidal activity, demonstrated in vitro and in an in vivo mouse model, which warrants further clinical investigations. The aim of this study was to evaluate infectious complications after coronary artery bypass grafting in patients pre-operatively treated with ticagrelor or clopidogrel. In a multi-centre trial, all adult patients who were pre-operatively treated with ticagrelor or clopidogrel prior to isolated primary coronary artery bypass grafting were eligible. Propensity score matching was used. Outcome measures were any sternal wound infection, deep sternal wound infection, and any in-hospital use of postoperative antibiotics. Of 2311 patients who were included, 1293 (55.9%) received clopidogrel and 1018 (44.1%) ticagrelor pre-operatively. In both overall and propensity score matched analyses, ticagrelor was associated with a similar incidence of infectious complications compared to clopidogrel. Our findings do not support a clinically relevant bactericidal effect of ticagrelor in patients undergoing coronary artery bypass grafting.
- Published
- 2020
27. Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery: Prospective, cohort study from the E-CABG registry
- Author
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Andrea Perrotti, Francesco Onorati, Daniel Reichart, Antonio Salsano, Magnus Dalén, Riccardo Gherli, Juhani Airaksinen, Antonino S. Rubino, Vito G. Ruggieri, Sidney Chocron, Matteo Saccocci, Karl Bounader, Theodor Fischlein, Marisa De Feo, Giuseppe Santarpino, Saverio Nardella, Fausto Biancari, Daniele Maselli, Giovanni Mariscalco, Eeva-Maija Kinnunen, Francesco Nicolini, Giuseppe Faggian, Giuseppe Gatti, Sorosh Khodabandeh, Nicolini, F, Santarpino, G, Gatti, G, Reichart, D, Onorati, F, Faggian, G, Dalén, M, Khodabandeh, S, Fischlein, T, Maselli, D, Nardella, S, Rubino, A, De Feo, M, Salsano A, Gherli, R, Mariscalco, G, Kinnunen, Em, Ruggieri, Vg, Bounader, K, Saccocci, M, Chocron, S, Airaksinen, J, Perrotti, A, and Biancari, F.
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Male ,medicine.medical_specialty ,Coronary artery surgery ,Glycated Hemoglobin A ,HbA1c ,endocrine system diseases ,Coronary artery bypass ,030204 cardiovascular system & hematology ,Diabete ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,CABG ,Diabetes ,Glycated hemoglobin ,Acute Kidney Injury ,Aged ,Biomarkers ,Diabetes Mellitus ,Female ,Humans ,Postoperative Complications ,Registries ,Surgical Wound Infection ,Coronary Artery Bypass ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,Coronary artery bypa ,Medicine ,In patient ,030212 general & internal medicine ,Prospective cohort study ,ta3126 ,business.industry ,Acute kidney injury ,General Medicine ,medicine.disease ,Surgery ,medicine.anatomical_structure ,chemistry ,business ,Cohort study ,Artery - Abstract
Background: Patients with increased glycated hemoglobin (HbA1c) seem to be at increased risk of sternal wound infection (SWI) after coronary artery bypass grafting (CABG). However, it is unclear whether increased baseline HbA1c levels may affect other postoperative outcomes. Material and methods: Data on preoperative levels of HbA1c were collected from 2606 patients undergoing elective isolated CABG from 2015 to 2016 and included in the prospective, multicenter E-CABG registry. Results: The prevalence of HbA1c ≥ 53 mmol/mol (7.0%) among non-diabetics was 5.3%, among non-insulin dependent diabetics was 53.5% and among insulin dependent diabetics was 67.1% (p < 0.001). The prevalence of HbA1c > 75 mmol/mol (9.0%) among non-diabetics was 0.5%, among non-insulin dependent diabetics was 5.8% and among insulin dependent diabetics was 10.6% (p < 0.001). Baseline levels of HbA1c ≥ 53 mmol/mol (7.0%) was a significant predictor of any SWI (10.7% vs. 3.3%, adjusted p-value
- Published
- 2018
28. Assessment of upper limb muscle synergies for industrial overhead tasks: a preliminary study
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G. Di Gironimo, Stanislao Grazioso, Antonio Lanzotti, Dario Panariello, Teodorico Caporaso, Angela Palomba, S. Nardella, B. Ostuni, Grazioso, Stanislao, Caporaso, Teodorico, Palomba, Angela, Nardella, Stefano, Ostuni, Benedetta, Panariello, Dario, DI GIRONIMO, Giuseppe, Lanzotti, Antonio, Grazioso, S., Caporaso, T., Palomba, A., ...Di Gironimo, G., Lanzotti, A., Grazioso, S., Caporaso, T., Palomba, A., Nardella, S., Ostuni, B., Panariello, D., Di Gironimo, G., and Lanzotti, A.
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Robot kinematics ,wearable robots ,medicine.diagnostic_test ,Computer science ,Work (physics) ,Wearable computer ,muscle synergie ,Electromyography ,Exoskeleton ,body regions ,EMG ,Task analysis ,medicine ,Robot ,Overhead (computing) ,Simulation ,ComputingMethodologies_COMPUTERGRAPHICS - Abstract
Advanced measurement systems and techniques from neuroscience are used in this work to extrapolate reduced- order muscle activation patterns corresponding to the execution of overhead tasks classic of automotive industry. The approach is based on the analysis of electromyographic (EMG) signals measured from muscles of the upper limb. The preliminary experiments show that, for the selected tasks, one muscle synergy could account for > 98% of the total muscle activation. This approach might pave the way towards the development of bionic, synergy-based upper limb wearable robots for augmenting human performances in industrial workplaces. © 2019 IEEE.
- Published
- 2019
29. Variation in preoperative antithrombotic strategy, severe bleeding, and use of blood products in coronary artery bypass grafting: results from the multicentre E-CABG registry
- Author
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Theodor Fischlein, Giovanni Mariscalco, Vito D'Andrea, Ilaria Franzese, Marco Zanobini, Giuseppe Faggian, Karl Bounader, Riccardo Gherli, Antonio Salsano, Fausto Biancari, Francesco Onorati, Tuomas Tauriainen, Magnus Dalén, Antonino S. Rubino, Francesco Nicolini, Matteo Saccocci, Andrea Perrotti, Marisa De Feo, Vito G. Ruggieri, Giuseppe Santarpino, Paola D'Errigo, Stefano Rosato, Daniel Reichart, Giuseppe Gatti, Saverio Nardella, Daniele Maselli, Biancari, F, Mariscalco, G, Gherli, R, Reichart, D, Onorati, F, Faggian, G, Franzese, I, Santarpino, G, Fischlein, T, Rubino, A, Maselli, D, Nardella, S, Salsano, A, Nicolini, F, Zanobini, M, Saccocci, M, Ruggieri, Vg, Bounader, K, Perrotti, A, Rosato, S, D'Errigo, P, D'Andrea, V, De Feo, M, Tauriainen, T, Gatti, G, and Dalén, M.
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Excessive Bleeding ,Male ,medicine.medical_specialty ,P2Y12 ,coronary artery bypass grafting ,Blood Loss, Surgical ,Bleeding ,Antithrombotic ,Coronary artery bypass grafting ,Cardiac surgery ,Blood transfusion ,Aged ,Blood Transfusion ,Coronary Artery Disease ,Europe ,Female ,Fibrinolytic Agents ,Humans ,Incidence ,Practice Guidelines as Topic ,Preoperative Care ,Prospective Studies ,Thrombolytic Therapy ,Coronary Artery Bypass ,antithrombotic ,030204 cardiovascular system & hematology ,Preoperative care ,Coronary artery disease ,blood transfusion. Downloaded ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,Surgical ,bleeding ,cardiac surgery ,Medicine ,Blood Loss ,Prospective cohort study ,business.industry ,Health Policy ,Perioperative ,ta3121 ,medicine.disease ,Surgery ,Discontinuation ,Cardiology and Cardiovascular Medicine ,030228 respiratory system ,business ,Fibrinolytic agent - Abstract
Aims No data exists on inter-institutional differences in terms of adherence to international guidelines regarding the discontinuation of antithrombotics and rates of severe bleeding in coronary artery bypass grafting (CABG). Methods and results This is an analysis of 7118 patients from the prospective multicentre European CABG (E-CABG) registry who underwent isolated CABG in 15 European centres. Preoperative pause of P2Y12 receptor antagonists shorter than that suggested by the 2017 ESC guidelines (overall 11.6%) ranged from 0.7% to 24.8% between centres (adjusted P < 0.0001) and increased the rate of severe-massive bleeding [E-CABG bleeding grades 2-3, OR 1.66, 95% confidence interval (CI) 1.27-2.17; Universal Definition of Perioperative Bleeding (UDPB) bleeding grades 3-4, OR 1.50, 95% CI 1.16-1.93]. The incidence of resternotomy for bleeding (overall 2.6%) ranged from 0% to 6.9% (adjusted P < 0.0001), and surgical site bleeding (overall 59.6%) ranged from 0% to 84.6% (adjusted P = 0.003). The rate of the UDPB bleeding grades 3-4 (overall 8.4%) ranged from 3.7% to 22.3% (P < 0.0001), and of the E-CABG bleeding grades 2-3 (overall 6.5%) ranged from 0.4% to 16.4% between centres (P < 0.0001). Resternotomy for bleeding (adjusted OR 5.04, 95% CI 2.85-8.92), UDPB bleeding grades 3-4 (adjusted OR 6.61, 95% CI 4.42-9.88), and E-CABG bleeding grades 2-3 (adjusted OR 8.71, 95% CI 5.76-13.15) were associated with an increased risk of hospital/30-day mortality. Conclusions Adherence to the current guidelines on the early discontinuation of P2Y12 receptor antagonists is of utmost importance to reduce excessive bleeding and early mortality after CABG. Inter-institutional variation should be considered for a correct interpretation of the results in multicentre studies evaluating perioperative bleeding and use of blood products.
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- 2018
30. Impact of preoperative thrombocytopenia on the outcome after coronary artery bypass grafting
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Marco Zanobini, Riccardo Gherli, Francesco Nicolini, Saverio Nardella, Fausto Biancari, Antonio Salsano, Giovanni Mariscalco, Giuseppe Faggian, Wail Nammas, Vito G. Ruggieri, Daniel Reichart, Daniele Maselli, Tiziano Gherli, Tuomas Kiviniemi, Sidney Chocron, Giuseppe Santarpino, Sorosh Khodabandeh, Karl Bounader, Eeva-Maija Kinnunen, Andrea Perrotti, Stefano Rosato, Ciro Bancone, Francesco Onorati, Juhani Airaksinen, Paola D'Errigo, Magnus Dalén, Marisa De Feo, Giuseppe Gatti, Matteo Saccocci, Antonino S. Rubino, Nammas, W, Dalén, M, Rosato, S, Gherli, R, Reichart, D, Gatti, G, Onorati, F, Faggian, G, De Feo, M, Bancone, C, Chocron, S, Khodabandeh, S, Santarpino, G, Rubino, A, Maselli, D, Nardella, S, Salsano, A, Gherli, T, Nicolini, F, Zanobini, M, Saccocci, M, Bounader, K, D'Errigo, P, Kiviniemi, T, Kinnunen, Em, Perrotti, A, Airaksinen, J, Mariscalco, G, Ruggieri, Vg, and Biancari, F
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0301 basic medicine ,Male ,medicine.medical_specialty ,Bypass grafting ,coronary artery bypass grafting ,thrombocytopenia ,030204 cardiovascular system & hematology ,surgery ,03 medical and health sciences ,0302 clinical medicine ,Bleeding ,cardiac surgery ,platelets ,Hematology ,medicine ,Humans ,Platelet ,Prospective Studies ,Coronary Artery Bypass ,Adverse effect ,Aged ,ta3126 ,business.industry ,General Medicine ,ta3121 ,Thrombocytopenia ,Cardiac surgery ,Surgery ,030104 developmental biology ,medicine.anatomical_structure ,Preoperative Period ,Female ,business ,Artery - Abstract
The impact of thrombocytopenia on postoperative bleeding and other major adverse events after cardiac surgery is unclear. This issue was investigated in a series of patients who underwent isolated coronary artery bypass grafting (CABG) from the prospective, multicenter E-CABG registry. Preoperative thrombocytopenia was defined as preoperative platelet count
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- 2018
31. Clinical frailty scale and outcome after coronary artery bypass grafting
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Vito G. Ruggieri, Magnus Dalén, Marisa De Feo, Wail Nammas, L. Castro, Daniel Reichart, Giuseppe Faggian, Ilaria Franzese, Saverio Nardella, Francesco Nicolini, Marco Zanobini, Eeva-Maija Kinnunen, Antonio Salsano, Juhani Airaksinen, Sorosh Khodabandeh, Andrea Perrotti, Karl Bounader, Stefano Rosato, Matteo Saccocci, Riccardo Gherli, Antonino S. Rubino, Daniele Maselli, Giovanni Mariscalco, Giuseppe Santarpino, Fulvia Seccareccia, Fausto Biancari, Giuseppe Gatti, Francesco Onorati, Tuomas Tauriainen, Reichart, D, Rosato, S, Nammas, W, Onorati, F, Dalén, M, Castro, L, Gherli, R, Gatti, G, Franzese, I, Faggian, G, De Feo, M, Khodabandeh, S, Santarpino, G, Rubino, A, Maselli, D, Nardella, S, Salsano, A, Nicolini, F, Zanobini, M, Saccocci, M, Bounader, K, Kinnunen, Em, Tauriainen, T, Airaksinen, J, Seccareccia, F, Mariscalco, G, Ruggieri, Vg, Perrotti, A, and Biancari, F
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Frailty ,Clinical Frailty Scale ,Coronary artery bypass grafting ,Cardiac surgery ,Aged ,Coronary Artery Bypass ,Female ,Humans ,Middle Aged ,Prospective Studies ,Severity of Illness Index ,Treatment Outcome ,030204 cardiovascular system & hematology ,Logistic regression ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,Internal medicine ,Severity of illness ,medicine ,Prospective cohort study ,ta3126 ,Surgery ,Cardiology and Cardiovascular Medicine ,business.industry ,Hazard ratio ,General Medicine ,Odds ratio ,Confidence interval ,030228 respiratory system ,business - Abstract
OBJECTIVES The aim of this study was to assess the impact of frailty on the outcome after coronary artery bypass grafting (CABG) and whether it may improve the predictive ability of European System for Cardiac Operative Risk Evaluation (EuroSCORE II). METHODS The Clinical Frailty Scale (CFS) was assessed preoperatively in patients undergoing isolated CABG from the multicentre E-CABG registry, and patients were stratified into 3 classes: scores 1-2, scores 3-4 and scores 5-7. RESULTS Of the 6156 patients enrolled, 39.2% had CFS scores 1-2, 57.6% scores 3-4, and 3.2% scores 5-7. Logistic regression adjusted for multiple covariates showed that the CFS was an independent predictor of hospital/30-day mortality [CFS scores 3-4, odds ratio (OR) 3.95, 95% confidence interval (CI) 2.19-7.14; CFS scores 5-7, OR 5.90, 95% CI 2.67-13.05] and resulted in an Integrated Improvement Index of 1.3 (P
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- 2018
32. Incidence and prognostic impact of bleeding and transfusion after coronary surgery in low-risk patients
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Giuseppe Santarpino, Marco Zanobini, Tuomas Tauriainen, Filiberto Serraino, Carmelo Dominici, Riccardo Gherli, Marisa De Feo, Fausto Biancari, Francesco Musumeci, Francesca Fiorentino, Francesco Santini, Daniel Reichart, Sidney Chocron, Giuseppe Gatti, Antonio Salsano, Ciro Bancone, Francesco Nicolini, Antonino S. Rubino, Karl Bounader, Theodor Fischlein, Giuseppe Faggian, Giovanni Mariscalco, Matteo Saccocci, Jean Philippe Verhoye, Peter Svenarud, Luca Maschietto, Saverio Nardella, Vito G. Ruggieri, Francesco Onorati, Andrea Perrotti, Eeva-Maija Kinnunen, Magnus Dalén, Tiziano Gherli, Ilaria Franzese, Carmelo Mignosa, Daniele Maselli, Kinnunen, Em, De Feo, M, Reichart, D, Tauriainen, T, Gatti, G, Onorati, F, Maschietto, L, Bancone, C, Fiorentino, F, Chocron, S, Bounader, K, Dalén, M, Svenarud, P, Faggian, G, Franzese, I, Santarpino, G, Fischlein, T, Maselli, D, Dominici, C, Nardella, S, Gherli, R, Musumeci, F, Rubino, A, Mignosa, C, Mariscalco, G, Serraino, Fg, Santini, F, Salsano, A, Nicolini, F, Gherli, T, Zanobini, M, Saccocci, M, Ruggieri, Vg, Philippe Verhoye, J, Perrotti, A, and Biancari, F.
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Excessive Bleeding ,Male ,Registrie ,medicine.medical_specialty ,Blood transfusion ,Blood management ,Prognosi ,medicine.medical_treatment ,Tertiary Care Center ,Immunology ,030204 cardiovascular system & hematology ,Postoperative Hemorrhage ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Aged, Coronary Artery Bypass, Europe, Female, Humans, Incidence, Male, Middle Aged, Postoperative Hemorrhage, Prognosis, Prospective Studies, Risk Factors, Tertiary Care Centers, Blood Transfusion, Registries ,Medicine ,Humans ,Immunology and Allergy ,Blood Transfusion ,Prospective Studies ,Registries ,Coronary Artery Bypass ,Adverse effect ,Prospective cohort study ,Stroke ,Aged ,business.industry ,Coronary Artery Bypa ,Incidence ,Risk Factor ,Perioperative ,Hematology ,Middle Aged ,medicine.disease ,Prognosis ,Surgery ,Cardiac surgery ,Europe ,Prospective Studie ,Female ,030228 respiratory system ,business ,Human - Abstract
BACKGROUND Excessive bleeding and blood transfusion are associated with adverse outcome after cardiac surgery, but their mechanistic effects are difficult to disentangle in patients with increased operative risk. This study aimed to evaluate the incidence and prognostic impact of bleeding and transfusion of blood products in low-risk patients undergoing coronary artery bypass grafting (CABG). STUDY DESIGN AND METHODS Sixteen tertiary European centers of cardiac surgery contributed to the prospective European registry of CABG (E-CABG). The severity of bleeding was defined by the E-CABG bleeding severity classification and universal definition of perioperative bleeding (UDPB) classification. RESULTS Of 1213 patients with EuroSCORE II of less than 2% (mean, 1.1 ± 0.4%), 18.5% suffered from mild bleeding (E-CABG bleeding Grade 1) and 3.4% experienced severe bleeding (E-CABG bleeding Grade 2-3). Similarly, 19.7% had UDPB Class 2 and 5.9% had UDPB Classes 3 and 4. Mild and severe bleeding defined by the E-CABG and UDPB classifications were associated with an increased risk of several adverse events as adjusted by multiple covariates. The risk of death, stroke, and acute kidney injury was particularly increased in patients with severe bleeding. CONCLUSION Severe bleeding is rather uncommon in low-risk patients undergoing CABG, but it is associated with an increased risk of major adverse events. Prevention of excessive perioperative bleeding and patient blood management may improve the outcome of cardiac surgery also in low-risk patients.
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- 2017
33. Glycated Hemoglobin and Risk of Sternal Wound Infection After Isolated Coronary Surgery
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Daniel Reichart, Francesco Nicolini, Eeva-Maija Kinnunen, Carmelo Dominici, Luca Maschietto, Tuomas Tauriainen, Giuseppe Faggian, Vito G. Ruggieri, Saverio Nardella, Fausto Biancari, Giuseppe Gatti, Sidney Chocron, Matteo Saccocci, Giovanni Mariscalco, Giuseppe Santarpino, Daniele Maselli, Riccardo Gherli, Magnus Dalén, Theodor Fischlein, Peter Svenarud, Marisa De Feo, Francesco Santini, Aniello Pappalardo, Antonino S. Rubino, Francesco Onorati, Andrea Perrotti, Gatti, G, Perrotti, A, Reichart, D, Maschietto, L, Onorati, F, Chocron, S, Dalén, M, Svenarud, P, Faggian, G, Santarpino, G, Fischlein, T, Pappalardo, A, Maselli, D, Dominici, C, Nardella, S, Rubino, A, DE FEO, Marisa, Santini, F, Nicolini, F, Gherli, R, Mariscalco, G, Tauriainen, T, Kinnunen, Em, Ruggieri, Vg, Saccocci, M, and Biancari, F.
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Male ,medicine.medical_specialty ,Sternum ,Glycated Hemoglobin A ,Coronary surgery ,Coronary artery bypass grafting ,Glycosylated ,030204 cardiovascular system & hematology ,Gastroenterology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Glycated hemoglobin ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,Diabetes Mellitus ,Humans ,Surgical Wound Infection ,030212 general & internal medicine ,Elective surgery ,Risk factor ,Coronary Artery Bypass ,Glycemic ,Aged ,business.industry ,Hemoglobin A ,General Medicine ,Middle Aged ,medicine.disease ,Wound infection ,Surgery ,Increased risk ,chemistry ,Hemoglobin A1c ,Aged, Coronary Artery Bypass, Diabetes Mellitus, Female, Hemoglobin A, Glycosylated, Humans, Male, Middle Aged, Risk Factors, Surgical Wound Infection, Sternum ,Female ,Sternal wound infection ,Cardiology and Cardiovascular Medicine ,business - Abstract
Glycated hemoglobin (HbA1c) is a suspected risk factor for sternal wound infection (SWI) after CABG.Methods and Results:Data on preoperative HbA1c and SWI were available in 2,130 patients undergoing isolated CABG from the prospective E-CABG registry. SWI occurred in 114 (5.4%). Baseline HbA1c was significantly higher in patients with SWI (mean, 54±17 vs. 45±13 mmol/mol, P0.0001). This difference was also observed in patients without a diagnosis of diabetes (P=0.027), in insulin-dependent diabetic (P=0.023) and non-insulin-dependent diabetic patients (P=0.034). In the overall series, HbA1c70 mmol/mol (NGSP units, 8.6%) was associated with the highest risk of SWI (20.6% vs. 4.6%; adjusted OR, 5.01; 95% CI: 2.47-10.15). When dichotomized according to the cut-off 53 mmol/mol (NGSP units, 7.0%) as suggested both for diagnosis and optimal glycemic control of diabetes, HbA1c was associated with increased risk of SWI in the overall series (10.6% vs. 3.9%; adjusted OR, 2.09; 95% CI: 1.24-3.52), in diabetic patients (11.7% vs. 5.1%; adjusted OR, 2.69; 95% CI: 1.38-5.25), in patients undergoing elective surgery (9.9% vs. 2.7%; adjusted OR, 2.09; 95% CI: 1.24-3.52) and in patients with bilateral mammary artery grafts (13.7% vs. 4.8%; adjusted OR, 2.35; 95% CI: 1.17-4.69).Screening for HbA1c before CABG may identify untreated diabetic patients, as well as diabetic patients with suboptimal glycemic control, at high risk of SWI.
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- 2017
34. Performance of a novel sternal synthesis device after median and faulty sternotomy: mechanical test and early clinical experience
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Jacob Zeitani, Alessandro Salvati, Alfonso Penta de Peppo, Alessandra Bianco, Saverio Nardella, Antonio Scafuri, Luigi Chiariello, Fabio Bertoldo, Francesca Nanni, Zeitani, J., PENTA DE PEPPO, Alfonso, Bianco, A., Nanni, F., Scafuri, A., Bertoldo, F., Salvati, A., Nardella, S., and Chiariello, L.
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Pulmonary and Respiratory Medicine ,Male ,Models, Anatomic ,Ultimate load ,medicine.medical_specialty ,Sternum ,medicine.medical_treatment ,Settore ING-IND/22 - Scienza e Tecnologia dei Materiali ,Sensitivity and Specificity ,NO ,Novel Sternal Synthesis Device ,Paramedian incision ,Surgical Wound Dehiscence ,Tensile Strength ,Medicine ,Humans ,Thoracotomy ,Cardiac Surgical Procedures ,Aged ,Probability ,Aged, 80 and over ,Wound Healing ,business.industry ,Wound dehiscence ,Suture Techniques ,Biomechanics ,Settore MED/23 - Chirurgia Cardiaca ,Equipment Design ,Traction (orthopedics) ,Surgical Mesh ,medicine.disease ,Stainless Steel ,Surgery ,Biomechanical Phenomena ,Surgical mesh ,Female ,Stress, Mechanical ,Cardiology and Cardiovascular Medicine ,business ,Bone Wires ,Follow-Up Studies - Abstract
(Ann Thorac Surg 2008;85:287–93) © 2008 by The Society of Thoracic Surgeons Performance of a Novel Sternal Synthesis Device After Median and Faulty Sternotomy: Mechanical Test and Early Clinical Experience Jacob Zeitani, MD, PhDa,*, Alfonso Penta de Peppo, MDc, Alessandra Bianco, PhDb, Francesca Nanni, PhDb, Antonio Scafuri, MDa, Fabio Bertoldo, MDa, Alessandro Salvati, MDa, Saverio Nardella, MDa, Luigi Chiariello, MDa a Department of Cardiac Surgery, Science and Technology, Tor Vergata University, Italy, Rome b Department of Science and Technology, Tor Vergata University, Italy, Rome c Department of Cardiac Surgery, Second University of Naples, Naples, Italy Accepted for publication August 14, 2007. * Address correspondence to Dr Zeitani, Division of Cardiac Surgery, Tor-Vergata University, Viale Oxford 85, Rome, 00133, Italy (Email: zeitani@hotmail.com). Background: Reinforcement of chest closure may be required in patients with multiple risk factors of wound dehiscence. Performance of a light, size-adaptable closure reinforcement device (DSS: Sternal Synthesis Device; Mikai SpA, Vicenza, Italy) is presented. Methods: A longitudinal median or paramedian incision was performed in artificial sternal models: closure was accomplished with simple interrupted steel wires or reinforced with the DSS. Forces required for separation of the rewired sternal halves during a monotonic tensile test were analyzed. A high velocity traction cycles test was also adopted to simulate the impact of coughing. Results: After median incision, ultimate load values inducing break of the sternum models were 580 ± 35 N (Newton) in controls; failure of the test occurred at 1,200 ± 47 N in the reinforced group (p = 0.0002). More lateral displacement of sternal halves at increasing forces was observed in controls (p = 0.0001). After paramedian incision, ultimate load values inducing break of the constructs were lower in controls (220 ± 20 N vs 500 ± 25 N, p = 0.001), which also showed more lateral displacement of sternal halves than the reinforced group (p = 0.002). At the high velocity traction cycles test, the number of cycles required to break the models was lower in controls (2,250 ± 35 vs 3,855 ± 48 cycles, p = 0.0001). Preliminary clinical experience in 45 patients showed ease of implantation and low risk of complications. Conclusions: The proposed sternal reinforcement device provides substantial sternal support at electromechanical testing after median and faulty sternotomy and may hopefully prevent sternal wires migration and bone fractures in high risk patients. Related Article Invited commentary William D. Spotnitz Ann. Thorac. Surg. 2008 85: 293. [Extract] [Full Text] [PDF]
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- 2008
35. Decolonising the field of violence against women and girls: A scoping review and recommendations for research and programming.
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Lokot M, Pichon M, Kalichman B, Nardella S, Falconer J, Kyegombe N, and Buller AM
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- Female, Humans, Colonialism, Gender-Based Violence
- Abstract
In response to continuing legacies of colonialism, there is increasing recognition of the need to decolonise various fields of research and practice, including within work on violence against women and girls (VAWG). An emerging body of literature critiques how VAWG is framed, how prevention and response interventions may be imposed on communities as part of White Saviourism, and the existence of hierarchical approaches to data collection, analysis and interpretation. This scoping review is the first known attempt to describe global published and grey literature on colonialism and decolonisation within VAWG research and programming. We conducted an extensive search across databases and search engines including research studies, reports, commentaries and blogs, and identified 55 sources that focused on VAWG and related to the legacy of colonialism and/or decolonial approaches within the field. Included literature discussed the role of colonialism in shaping VAWG, referenced decolonial approaches to respond to VAWG and identified five key recommendations for VAWG research and practice: 1. Consider the context and power hierarchies within which VAWG occurs; 2. Incorporate community resources and perspectives into efforts to end VAWG; 3. Use methods and approaches to researching VAWG that centre perspectives and lived experience of communities; 4. Shift VAWG funding to local actors and ensure VAWG funding streams are more responsive to local needs and realities; and 5. Ensure local, contextually-relevant framings of feminisms inform decolonising of VAWG. We conclude that shifting towards a bottom-up approach to decolonising VAWG research and programming is essential to prevent decolonisation from being reduced to a buzzword. While literature explored the use of specific methods to decolonise research on VAWG, researchers need broader strategies to embed a decolonial perspective throughout the research process, transcending mere methodological adaptations. There is a need for VAWG research and programming to scrutinise structural inequities, particularly acknowledging how colonial practices entrenched within wider societal power structures impact the field of VAWG., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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36. "I Didn't Realize How Common it Was:" A Mixed-Methods Study Examining Changes in Perceptions of Sexual Assault, Sex and Consent, and Sexual Behavior as a Function of the #Metoo Movement.
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Ward SB, Nardella S, Hamilton KW, and Walsh K
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This mixed-methods study examined awareness and perceived legitimacy of the #MeToo movement and how #MeToo changed perceptions of sexual assault and consent, as well as sexual interactions, in the United States. Adults residing in the U.S. were recruited through CloudResearch to complete an online survey in 2021. Quantitative data from 680 participants ( M age = 45.8, 60% women, 77.4% White) indicated moderate awareness and perceived legitimacy of the #MeToo movement; Black, LGBQ+, and more politically liberal respondents had greater #MeToo awareness while younger, more liberal respondents, and those with greater rejection of rape myths rated #MeToo more legitimate. Among 354 participants ( M age = 45.0, 65.3% women, 76.4% White) who answered at least one open-ended question with regard to changes resulting from the #MeToo movement, thematic analysis revealed nine primary themes: (1) Describing change; (2) Change in understanding; (3) More cautious; (4) Wrong or requires reporting/punishment; (5) Gendered social norms; (6) Easier to talk about; (7) #MeToo rhetoric; (8) Consequences for survivors, and (9) Empowerment. Several sub-themes were identified among the primary themes and implications for sexual assault prevention and response were discussed. The study findings are contextualized by social constructionism, with a particular focus on gender-based power dynamics, contributing to a growing literature documenting the cultural impact of the #MeToo movement.
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- 2024
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37. Massive Thrombosis of Mitral Bioprosthesis Due to SARS-CoV-2 Infection.
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Librera M, Paolillo S, Carlomagno G, Santise G, Mariniello A, Nardella S, Briguori C, and Maselli D
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Thromboembolic events have been reported as frequent and fearsome complications in patients affected by SARS-CoV-2 infection. Patients undergoing cardiac valve replacement exhibit an increased risk of valve thrombosis, even with prosthetic biological valves, and especially in the first period after surgery. The management of these patients is challenging and requires prompt interventions. We report the case of a young woman infected by SARS-CoV-2 three months after double cardiac valve replacement that developed a massive prosthetic biological valve thrombosis despite optimal anticoagulant therapy.
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- 2022
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38. Micro-Invasive 3D Endoscopic Mitral Valve Surgery.
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Maselli D, Nardella S, Santise G, Iavazzo A, and Chiariello L
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- Endoscopy, Humans, Minimally Invasive Surgical Procedures methods, Sternotomy methods, Treatment Outcome, Cardiac Surgical Procedures, Mitral Valve diagnostic imaging, Mitral Valve surgery
- Abstract
Since its introduction in 1995, minimally invasive mitral valve surgery (MIMVS) has been shown to be a valid alternative to conventional sternotomy and several studies have reported excellent clinical outcomes. While MIMVS is now a commonly performed procedure, it is still difficult to standardize. We proprose here a "road to safer surgery", and offer some tips and tricks that could be useful in its learning and performance, and may help surgeons minimize the risk of major complications. With the introduction of 3D vision with a 3D videothoracoscope for 4K stereoscopic acquisition, a medical LCD ultra-HD monitor and active 3D glasses, it is possible to obtain a very realistic view of the surgical field and the mitral valve anatomy, while significantly reducing the learning curve. We describe the procedure step-by-step, with details from the pre-operative phase to the end of the operation. The procedure is structured in consecutive stages: patient induction and positioning, thoracoscopic access and port placement, surgical field exposure, and operative technique.
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- 2022
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39. State-of-Art on the Recycling of By-Products from Fruits and Vegetables of Mediterranean Countries to Prolong Food Shelf Life.
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Nardella S, Conte A, and Del Nobile MA
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Annually, 1.3 billion tons of food are wasted and this plays a major role in increasing pollution. Food waste increases domestic greenhouse gas emissions mainly due to the gas emissions associated with its production. Fruit and vegetable industrial by-products occur in the form of leaves, peel, seeds, pulp, as well as a mixture of them and represent the most abundant food waste. The disposal of agricultural by-products costs a large amount of money under certain governmental regulations. However, fruit and vegetable by-products are rich in valuable bioactive compounds, thus justifying their use as food fortifier, active food packaging or as food ingredients to preserve food quality over time. The present review collects the most recent utilization carried out at lab-scale on Mediterranean fruit and vegetable by-products as valid components to prolong food shelf life, providing a detailed picture of the state-of-art of literature on the topic. Bibliographic research was conducted by applying many keywords and filters in the last 10 years. Several scientific findings demonstrate that by-products, and in particular their extracts, are effectively capable of prolonging the shelf life of dairy food, fresh-cut produce, meat and fish-based products, oil, wine, paste and bakery products. All of the studies provide clear advances in terms of food sustainability, highlight the potential of by-products as a source of bioactive compounds, and promote a culture in which foods are intended to receive a second useful life. The same final considerations were also included regarding the current situation, which still limits by-products diffusion. In addition, a conclusion on a future perspective for by-products recycling was provided. The most important efforts have to be conducted by research since only a multidisciplinary approach for an advantageous investigation could be an efficient method to promote the scale up of by-products and encourage their adoption at the industrial level.
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- 2022
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40. Copper Coordination Chemistry of Sulfur Pendant Cyclen Derivatives: An Attempt to Hinder the Reductive-Induced Demetalation in 64/67 Cu Radiopharmaceuticals.
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Tosato M, Dalla Tiezza M, May NV, Isse AA, Nardella S, Orian L, Verona M, Vaccarin C, Alker A, Mäcke H, Pastore P, and Di Marco V
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- Copper Radioisotopes chemistry, Density Functional Theory, Models, Molecular, Molecular Conformation, Oxidation-Reduction, Coordination Complexes chemistry, Copper chemistry, Copper Radioisotopes analysis, Cyclams chemistry, Sulfur chemistry
- Abstract
The Cu
2+ complexes formed by a series of cyclen derivatives bearing sulfur pendant arms, 1,4,7,10-tetrakis[2-(methylsulfanyl)ethyl]-1,4,7,10-tetraazacyclododecane (DO4S), 1,4,7-tris[2-(methylsulfanyl)ethyl]-1,4,7,10-tetraazacyclododecane (DO3S), 1,4,7-tris[2-(methylsulfanyl)ethyl]-10-acetamido-1,4,7,10-tetraazacyclododecane (DO3SAm), and 1,7-bis[2-(methylsulfanyl)ethyl]-4,10-diacetic acid-1,4,7,10-tetraazacyclododecane (DO2A2S), were studied in aqueous solution at 25 °C from thermodynamic and structural points of view to evaluate their potential as chelators for copper radioisotopes. UV-vis spectrophotometric out-of-cell titrations under strongly acidic conditions, direct in-cell UV-vis titrations, potentiometric measurements at pH >4, and spectrophotometric Ag+ -Cu2+ competition experiments were performed to evaluate the stoichiometry and stability constants of the Cu2+ complexes. A highly stable 1:1 metal-to-ligand complex (CuL) was found in solution at all pH values for all chelators, and for DO2A2S, protonated species were also detected under acidic conditions. The structures of the Cu2+ complexes in aqueous solution were investigated by UV-vis and electron paramagnetic resonance (EPR), and the results were supported by relativistic density functional theory (DFT) calculations. Isomers were detected that differed from their coordination modes. Crystals of [Cu(DO4S)(NO3 )]·NO3 and [Cu(DO2A2S)] suitable for X-ray diffraction were obtained. Cyclic voltammetry (CV) experiments highlighted the remarkable stability of the copper complexes with reference to dissociation upon reduction from Cu2+ to Cu+ on the CV time scale. The Cu+ complexes were generated in situ by electrolysis and examined by NMR spectroscopy. DFT calculations gave further structural insights. These results demonstrate that the investigated sulfur-containing chelators are promising candidates for application in copper-based radiopharmaceuticals. In this connection, the high stability of both Cu2+ and Cu+ complexes can represent a key parameter for avoiding in vivo demetalation after bioinduced reduction to Cu+ , often observed for other well-known chelators that can stabilize only Cu2+ .- Published
- 2021
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41. Chemical purification of 111 Ag from isobaric impurity 111 Cd by solid phase extraction chromatography: a proof of concept study.
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Tosato M, Nardella S, Badocco D, Pastore P, Andrighetto A, Realdon N, and Di Marco V
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- Proof of Concept Study, Radioisotopes isolation & purification, Silver isolation & purification, Solid Phase Extraction methods
- Abstract
Silver-111 (
111 Ag, t1/2 = 7.47 d) is a β- emitter suitable for targeted cancer therapy due to favourable decay properties. The production of no-carrier added111 Ag via Isotope Separation On-Line (ISOL) technique is being investigated at the Legnaro National Laboratories of the Italian Institute of Nuclear Physics (ISOLPHARM project). Stable Cadmium-111 (111 Cd) is co-produced as isobaric contaminant, hence a chemical separation process must be developed to selectively harvest111 Ag. In this study, a chromatographic procedure employing the commercially available CL resin was investigated by using stable Ag+ and Cd2+ . Results indicate that CL resin allows to efficiently separate Ag+ from Cd2+ and recover the former with high yields., (Copyright © 2020 Elsevier Ltd. All rights reserved.)- Published
- 2020
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42. Long-term follow-up of Bentall procedure using the Perimount bioprosthesis and the Valsalva graft.
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Chirichilli I, Irace FG, D'Aleo S, Folino G, Weltert LP, Scaffa R, Nardella S, and De Paulis R
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Middle Aged, Reoperation, Replantation, Retrospective Studies, Time Factors, Aortic Valve surgery, Aortic Valve Stenosis surgery, Bioprosthesis, Blood Vessel Prosthesis Implantation methods, Heart Valve Prosthesis Implantation methods
- Abstract
Objectives: Bentall procedure is the gold standard for aortic root pathologies when valve repair is not feasible. The development of durable bioprosthetic valves and improved vascular conduits allowed the implementation of bioprosthetic composite grafts; hereby, we performed a retrospective analysis of long-term follow-up of Bentall procedure using the Valsalva graft and the Perimount Magna Ease prosthesis., Methods: From June 2000 to March 2019, 309 patients received an aortic root and valve replacement with a bioprosthetic composite graft. The mean age was 69 ± 6.9 years, and the majority were men (88%); most of them were affected by aortic stenosis (86%) and the mean aortic root diameter was 48.6 ± 5.5 mm., Results: Freedom from cardiac death was 76.8% [confidence interval (CI) 32.5-94.0] at 16 years. Freedom from thromboembolism, haemorrhage, structural valve deterioration and infective endocarditis was 98.2% (CI 96.0-98.9), 95.2% (CI 87.1-98.2), 87.5% (CI 63.2-97.1) and 79.6% (CI 45.3-95.6) at 16 years, respectively. Freedom from reoperation was 74.7% (CI 41.9-90.6)., Conclusions: These data indicate that, in experienced centres, the Bentall procedure is a safe and effective intervention. This is the first long-term follow-up that analyses the results after implantation of a composite graft made with the Perimount Magna Ease aortic valve and the Valsalva graft., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2020
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43. Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting.
- Author
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Biancari F, Santini F, Tauriainen T, Bancone C, Ruggieri VG, Perrotti A, Gherli R, Demal T, Dalén M, Santarpino G, Rubino AS, Nardella S, Nicolini F, Zanobini M, De Feo M, Onorati F, Mariscalco G, and Gatti G
- Subjects
- Aged, Aorta, Female, Humans, Male, Middle Aged, Coronary Artery Bypass, Intraoperative Complications prevention & control, Stroke prevention & control, Ultrasonography, Interventional
- Abstract
Background: Epiaortic ultrasonography (EAU) is a valid imaging method to detect atherosclerotic changes of the ascending aorta and to guide surgical strategies for the prevention of cerebral embolism in patients undergoing isolated coronary artery bypass grafting (CABG). However, its use is not widespread., Methods: The impact of EAU on the outcome after isolated CABG was investigated in patients from the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry. A systematic review and meta-analysis of the literature was performed to substantiate the findings of this observational study., Results: EAU was performed intraoperatively in 673 of 7241 patients (9.3%) from the E-CABG registry. In the overall series, the rates of stroke without and with aortic manipulation were 0.3% and 1.3%, respectively (P = .003). In 660 propensity score-matched pairs, EAU was associated with significantly lower risk of stroke (0.6% vs 2.6%, P = .007). A literature search yielded 5 studies fulfilling the inclusion criteria. These studies, along with the present one, included 11,496 patients, of whom 3026 (25.7%) underwent intraoperative EAU. Their rate of postoperative stroke was significantly lower than in patients not investigated with EAU (pooled rate, 0.6% vs 1.9%; risk ratio, 0.40; 95% confidence interval, 0.24-0.66; I
2 = 0%). On the basis of these pooled rates, the number needed to treat to prevent 1 stroke is 76.9., Conclusions: Avoiding aortic manipulation is associated with the lowest risk of stroke in patients undergoing CABG. When manipulation of the ascending aorta is planned, EAU is effective in guiding the surgical strategy to reduce the risk for embolic stroke in these patients., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)- Published
- 2020
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44. The HAS-BLED Score is Associated With Major Bleeding in Patients After Cardiac Surgery.
- Author
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Santise G, Nardella S, Migliano F, Testa A, and Maselli D
- Subjects
- Aged, Female, Follow-Up Studies, Humans, Incidence, Italy epidemiology, Male, Postoperative Hemorrhage blood, Postoperative Hemorrhage epidemiology, Predictive Value of Tests, Prospective Studies, Risk Factors, Blood Coagulation physiology, Cardiac Surgical Procedures adverse effects, Postoperative Hemorrhage diagnosis, Risk Assessment methods
- Abstract
Objective: The Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol (HAS-BLED) score has been developed to predict the risk of potential bleeding in anticoagulated patients affected by atrial fibrillation. The aim of this study was to test the hypothesis that the HAS-BLED score is associated with major bleeding also in patients after cardiac surgery., Design: Prospective, single-center nonrandomized study., Setting: Single hospital center., Participants: Patients., Interventions: Standard cardiac operation and analysis of major bleeding events. A total of 1,173 consecutive adult patients who underwent cardiac surgery were recruited. Major bleeding was defined according to the Bleeding Academy Research Consortium classification (3, 4, 5). Bleeding events were classified as early bleeding (within 48 hours after the operation) and late bleeding (after 48 hours and within 90 days, postoperatively). Patients were followed after the discharge for 120 days, through outpatient clinic visits and by phone calls., Measurement and Main Results: A total of 29 (2.5%) patients experienced early bleeding events (2.5%), while 34 (2.9%) experienced late bleeding events. Univariate and multivariable analysis did not find that the HAS-BLED score was associated with early bleeding, but it was associated significantly with late bleeding (odds ratio [OR], 1.86; 95% confidence intervals [CI] 1.32-2.62, and OR 1.67; 95% CI 1.19-2.35, respectively)., Conclusion: The HAS-BLED score is associated with increased risk of major bleeding events after cardiac surgery procedures. This may help to plan the standard anticoagulation/antiplatelet therapy in cardiac surgical patients with a higher HAS-BLED score., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
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45. Impact of preoperative thrombocytopenia on the outcome after coronary artery bypass grafting.
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Nammas W, Dalén M, Rosato S, Gherli R, Reichart D, Gatti G, Onorati F, Faggian G, De Feo M, Bancone C, Chocron S, Khodabandeh S, Santarpino G, Rubino AS, Maselli D, Nardella S, Salsano A, Gherli T, Nicolini F, Zanobini M, Saccocci M, Bounader K, D'Errigo P, Kiviniemi T, Kinnunen EM, Perrotti A, Airaksinen J, Mariscalco G, Ruggieri VG, and Biancari F
- Subjects
- Aged, Female, Humans, Male, Preoperative Period, Prospective Studies, Thrombocytopenia pathology, Coronary Artery Bypass adverse effects, Thrombocytopenia etiology
- Abstract
The impact of thrombocytopenia on postoperative bleeding and other major adverse events after cardiac surgery is unclear. This issue was investigated in a series of patients who underwent isolated coronary artery bypass grafting (CABG) from the prospective, multicenter E-CABG registry. Preoperative thrombocytopenia was defined as preoperative platelet count <150 × 10
9 /L and it was considered moderate-severe when preoperative platelet count was <100 × 109 /L. Multilevel mixed-effects regression analysis was performed to adjust the effect of thrombocytopenia on outcomes for baseline and operative covariates as well as for interinstitutional differences in patient-blood management. Among 7189 patients included in this analysis, 599 (8.3%) had preoperative thrombocytopenia. Patient with preoperative thrombocytopenia had an increased chest drainage output at 12 h (mean, 519 vs. 456 mL, adjusted coeff. 39, 95%CI 18-60) and rates of severe-massive bleeding (Universal Definition of Perioperative Bleeding (UDPB) severity grades 3-4: 12.7% vs. 8.1%, adjusted OR 1.47, 95%CI 1.11-1.93; E-CABG bleeding severity grades 2-3: 10.4% vs. 6.1%, adjusted OR 1.78, 95%CI 1.30-2.43). Thrombocytopenia was associated with an increased risk of hospital/30-day death (3.2% vs. 1.9%, adjusted OR 2.02, 95%CI 1.20-3.42), 1-year death (5.7% vs. 3.4%, adjusted HR 1.68, 95%CI 1.16-2.44), deep sternal wound infection (3.5% vs. 2.4%, adjusted OR 1.65, 95%CI 1.02-2.66), acute kidney injury (28.1% vs. 22.2%, OR 1.45, 1.18-1.78), and prolonged stay in the intensive care unit (mean, 3.6 vs 2.8 days, adjusted coeff. 0.74, 95%CI 0.40-1.09). Similar results were observed in a subset of patients with moderate-severe thrombocytopenia (51 patients, 0.7%). In particular, these patients had a markedly higher rate of acute kidney injury (40%, adjusted OR, 1.94, 95%CI 1.05-3.57), resternotomy for bleeding (7.8%, adjusted OR 3.49, 95%CI 1.20-10.21), and severe-massive bleeding (UDPB severity grades 3-4: 23.5%, adjusted OR 3.08, 95%CI 1.52-6.22; E-CABG bleeding severity grades 2-3: 23.5%, adjusted OR 4.43, 95%CI 2.15-9.15) compared to patients with normal preoperative platelet count. Mild preoperative thrombocytopenia is associated with increased risk of severe-massive bleeding, mortality, and other major adverse events after CABG. Such risks are markedly increased in patients with moderate-severe preoperative thrombocytopenia.- Published
- 2019
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46. Clinical frailty scale and outcome after coronary artery bypass grafting.
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Reichart D, Rosato S, Nammas W, Onorati F, Dalén M, Castro L, Gherli R, Gatti G, Franzese I, Faggian G, De Feo M, Khodabandeh S, Santarpino G, Rubino AS, Maselli D, Nardella S, Salsano A, Nicolini F, Zanobini M, Saccocci M, Bounader K, Kinnunen EM, Tauriainen T, Airaksinen J, Seccareccia F, Mariscalco G, Ruggieri VG, Perrotti A, and Biancari F
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Prospective Studies, Severity of Illness Index, Treatment Outcome, Coronary Artery Bypass mortality, Coronary Artery Bypass statistics & numerical data, Frailty classification, Frailty diagnosis, Frailty epidemiology
- Abstract
Objectives: The aim of this study was to assess the impact of frailty on the outcome after coronary artery bypass grafting (CABG) and whether it may improve the predictive ability of European System for Cardiac Operative Risk Evaluation (EuroSCORE II)., Methods: The Clinical Frailty Scale (CFS) was assessed preoperatively in patients undergoing isolated CABG from the multicentre E-CABG registry, and patients were stratified into 3 classes: scores 1-2, scores 3-4 and scores 5-7., Results: Of the 6156 patients enrolled, 39.2% had CFS scores 1-2, 57.6% scores 3-4, and 3.2% scores 5-7. Logistic regression adjusted for multiple covariates showed that the CFS was an independent predictor of hospital/30-day mortality [CFS scores 3-4, odds ratio (OR) 3.95, 95% confidence interval (CI) 2.19-7.14; CFS scores 5-7, OR 5.90, 95% CI 2.67-13.05] and resulted in an Integrated Improvement Index of 1.3 (P < 0.001) and a Net Reclassification Index of 55.6 (P < 0.001) for prediction of hospital/30-day mortality. Adding the CFS classes to EuroSCORE II resulted in an Integrated Improvement Index of 0.9 (P < 0.001) and Net Reclassification Index of 59.6 (P < 0.001) for prediction of hospital/30-day mortality with a significantly larger area under the receiver operating characteristics curve (0.809 vs 0.781, P = 0.028). The CFS was an independent predictor of mid-term mortality [CFS scores 3-4, hazard ratio (HR) 2.05, 95% CI 1.43-2.85; CFS scores 5-7, HR 3.05, 95% CI 1.83-5.06]., Conclusions: The CFS predicted early- and mid-term mortality in patients undergoing isolated CABG. Further studies are needed to evaluate whether frailty may improve the estimation of the operative risk of patients undergoing adult cardiac surgery., Clinicaltrials.gov Number: NCT02319083.
- Published
- 2018
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47. Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting.
- Author
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Santarpino G, Nicolini F, De Feo M, Dalén M, Fischlein T, Perrotti A, Reichart D, Gatti G, Onorati F, Franzese I, Faggian G, Bancone C, Chocron S, Khodabandeh S, Rubino AS, Maselli D, Nardella S, Gherli R, Salsano A, Zanobini M, Saccocci M, Bounader K, Rosato S, Tauriainen T, Mariscalco G, Airaksinen J, Ruggieri VG, and Biancari F
- Subjects
- Adult, Aged, Carotid Stenosis diagnosis, Coronary Artery Disease complications, Female, Humans, Male, Middle Aged, Prognosis, Risk Assessment, Risk Factors, Stroke etiology, Treatment Outcome, Carotid Stenosis surgery, Coronary Artery Bypass adverse effects, Coronary Artery Disease surgery, Endarterectomy, Carotid adverse effects
- Abstract
Objectives: The aim of this study was to evaluate the prognostic impact of untreated asymptomatic carotid artery stenosis (CS) in patients undergoing isolated coronary artery bypass grafting (CABG)., Methods: This was a post hoc analysis of data from a prospective multicentre observational study. Patients without history of stroke or transient ischaemic attack from the multicentre E-CABG registry who were screened for CS before isolated CABG were included., Results: Among 2813 patients screened by duplex ultrasound and who did not undergo carotid intervention for asymptomatic CS, 11.1% had a stenosis of 50-59%, 6.0% of 60-69%, 3.1% of 70-79%, 1.4% of 80-89%, 0.5% of 90-99%, and 1.1% had carotid occlusion. In the screened population post-operative stroke occurred in 25 patients (0.9%), with an incidence of 1.5% among patients with CS ≥ 50% (n = 649). Pre-operative screening had not found a relevant CS in 15 of 25 patients suffering stroke after CABG. Brain imaging identified cerebral ischaemic injury in 20 patients, which was bilateral in five patients (25%), ipsilateral to a CS ≥ 50% in six (30%), and ipsilateral to a CS ≥ 70% in three (15%). In univariable analysis, the severity of CS was associated with a significantly increased risk of stroke (CS < 50%, 0.7%; 50-59%, 1.0%; 60-69%, 0.6%; 70-79%, 1.2%; 80-89%, 5.1%; 90-99%, 7.7%; occluded, 6.7%, p < .001). In multivariable analysis, a CS of 90-99% (OR 12.03, 95% CI 1.34-108.23) and the presence of an occluded internal carotid artery (OR 8.783, 95% CI 1.820-42.40) were independent predictors of stroke along with urgency of the procedure, severe massive bleeding according to the E-CABG classification, and the presence of a porcelain ascending aorta., Conclusions: Among screened patients with untreated asymptomatic patients, CS ≥ 90% was an independent predictor of post-operative stroke. As this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, pre-operative screening of asymptomatic CS before CABG may not be justified., Clinical Trial Registration: https://clinicaltrials.gov. Unique identifier: NCT02319083., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
- Published
- 2018
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48. Variation in preoperative antithrombotic strategy, severe bleeding, and use of blood products in coronary artery bypass grafting: results from the multicentre E-CABG registry.
- Author
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Biancari F, Mariscalco G, Gherli R, Reichart D, Onorati F, Faggian G, Franzese I, Santarpino G, Fischlein T, Rubino AS, Maselli D, Nardella S, Salsano A, Nicolini F, Zanobini M, Saccocci M, Ruggieri VG, Bounader K, Perrotti A, Rosato S, D'Errigo P, D'Andrea V, De Feo M, Tauriainen T, Gatti G, and Dalén M
- Subjects
- Aged, Blood Loss, Surgical statistics & numerical data, Coronary Artery Disease surgery, Europe epidemiology, Female, Humans, Incidence, Male, Practice Guidelines as Topic, Prospective Studies, Blood Loss, Surgical prevention & control, Blood Transfusion standards, Coronary Artery Bypass, Fibrinolytic Agents adverse effects, Preoperative Care standards, Thrombolytic Therapy adverse effects
- Abstract
Aims: No data exists on inter-institutional differences in terms of adherence to international guidelines regarding the discontinuation of antithrombotics and rates of severe bleeding in coronary artery bypass grafting (CABG)., Methods and Results: This is an analysis of 7118 patients from the prospective multicentre European CABG (E-CABG) registry who underwent isolated CABG in 15 European centres. Preoperative pause of P2Y12 receptor antagonists shorter than that suggested by the 2017 ESC guidelines (overall 11.6%) ranged from 0.7% to 24.8% between centres (adjusted P < 0.0001) and increased the rate of severe-massive bleeding [E-CABG bleeding grades 2-3, OR 1.66, 95% confidence interval (CI) 1.27-2.17; Universal Definition of Perioperative Bleeding (UDPB) bleeding grades 3-4, OR 1.50, 95% CI 1.16-1.93]. The incidence of resternotomy for bleeding (overall 2.6%) ranged from 0% to 6.9% (adjusted P < 0.0001), and surgical site bleeding (overall 59.6%) ranged from 0% to 84.6% (adjusted P = 0.003). The rate of the UDPB bleeding grades 3-4 (overall 8.4%) ranged from 3.7% to 22.3% (P < 0.0001), and of the E-CABG bleeding grades 2-3 (overall 6.5%) ranged from 0.4% to 16.4% between centres (P < 0.0001). Resternotomy for bleeding (adjusted OR 5.04, 95% CI 2.85-8.92), UDPB bleeding grades 3-4 (adjusted OR 6.61, 95% CI 4.42-9.88), and E-CABG bleeding grades 2-3 (adjusted OR 8.71, 95% CI 5.76-13.15) were associated with an increased risk of hospital/30-day mortality., Conclusions: Adherence to the current guidelines on the early discontinuation of P2Y12 receptor antagonists is of utmost importance to reduce excessive bleeding and early mortality after CABG. Inter-institutional variation should be considered for a correct interpretation of the results in multicentre studies evaluating perioperative bleeding and use of blood products.
- Published
- 2018
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49. Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly.
- Author
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Rubino AS, Gatti G, Reichart D, Tauriainen T, De Feo M, Onorati F, Pappalardo A, Chocron S, Gulbins H, Dalén M, Svenarud P, Faggian G, Franzese I, Santarpino G, Fischlein T, Maselli D, Nardella S, Gherli R, Ahmed A, Santini F, Salsano A, Nicolini F, Zanobini M, Saccocci M, Ruggieri VG, Bounader K, Mignosa C, D'Errigo P, Rosato S, Airaksinen J, Perrotti A, and Biancari F
- Subjects
- Age Factors, Aged, Aged, 80 and over, Cohort Studies, Confidence Intervals, Coronary Artery Bypass adverse effects, Coronary Artery Disease diagnostic imaging, Female, Geriatric Assessment, Humans, Internal Mammary-Coronary Artery Anastomosis adverse effects, Male, Mammary Arteries transplantation, Odds Ratio, Postoperative Complications epidemiology, Postoperative Complications physiopathology, Prognosis, Propensity Score, Prospective Studies, Risk Assessment, Survival Rate, Treatment Outcome, Coronary Artery Bypass methods, Coronary Artery Disease mortality, Coronary Artery Disease surgery, Hospital Mortality trends, Internal Mammary-Coronary Artery Anastomosis methods
- Abstract
Background: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting., Methods: In all, 2,899 patients aged 70 years or older (855 [29.5%] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis., Results: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7% versus 1.6%, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7% versus 5.1%, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0% versus 2.2%, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0% versus 0.1%, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6% versus 1.3%, p = 0.009)., Conclusions: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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50. Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery: Prospective, cohort study from the E-CABG registry.
- Author
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Nicolini F, Santarpino G, Gatti G, Reichart D, Onorati F, Faggian G, Dalén M, Khodabandeh S, Fischlein T, Maselli D, Nardella S, Rubino AS, De Feo M, Salsano A, Gherli R, Mariscalco G, Kinnunen EM, Ruggieri VG, Bounader K, Saccocci M, Chocron S, Airaksinen J, Perrotti A, and Biancari F
- Subjects
- Acute Kidney Injury epidemiology, Aged, Biomarkers blood, Cohort Studies, Diabetes Mellitus blood, Female, Humans, Male, Registries, Surgical Wound Infection epidemiology, Coronary Artery Bypass, Glycated Hemoglobin analysis, Postoperative Complications epidemiology
- Abstract
Background: Patients with increased glycated hemoglobin (HbA1c) seem to be at increased risk of sternal wound infection (SWI) after coronary artery bypass grafting (CABG). However, it is unclear whether increased baseline HbA1c levels may affect other postoperative outcomes., Material and Methods: Data on preoperative levels of HbA1c were collected from 2606 patients undergoing elective isolated CABG from 2015 to 2016 and included in the prospective, multicenter E-CABG registry., Results: The prevalence of HbA1c ≥ 53 mmol/mol (7.0%) among non-diabetics was 5.3%, among non-insulin dependent diabetics was 53.5% and among insulin dependent diabetics was 67.1% (p < 0.001). The prevalence of HbA1c > 75 mmol/mol (9.0%) among non-diabetics was 0.5%, among non-insulin dependent diabetics was 5.8% and among insulin dependent diabetics was 10.6% (p < 0.001). Baseline levels of HbA1c ≥ 53 mmol/mol (7.0%) was a significant predictor of any SWI (10.7% vs. 3.3%, adjusted p-value: <0.001), deep SWI/mediastinitis (3.8% vs. 1.3%, adjusted p-value: 0.001) and acute kidney injury (27.4% vs. 19.8%, adjusted p-value: 0.042). These findings were confirmed in multilevel mixed effect logistic regression adjusted for participating centers. Among patients with diabetes, HbA1c ≥ 53 mmol/mol (7.0%) was predictive of SWI (11.1% vs. 4.8%, p = 0.001)., Conclusions: HbA1c is increased in a significant proportion of patients undergoing elective CABG and these patients are at higher risk of SWI. Less clear is the impact of increased HbA1c on other postoperative outcomes. These results do not support screening of HbA1c in patients without history of diabetes. Preoperative screening of HbA1c is valuable only to identify diabetics at risk of SWI., (Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
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