Cannata Dott. Aldo

Pubblicazioni su PubMed

• Fulminant Lymphocytic Myocarditis During Pregnancy Treated With Temporary Mechanical Circulatory Supports and Aggressive Immunosuppression.
  Circ Heart Fail

  2022 Dec;15(12):e009810. doi: 10.1161/CIRCHEARTFAILURE.122.009810.
  
  Veronese Giacomo, Nonini Sandra, Cannata Aldo, Aresta Francesca, Olivieri Guido, Montrasio Elisa, De Caria Daniele, Perna Enrico, Calini Angelo, Bottiroli Maurizio, Cislaghi Francesca, Pedrazzini Giovanna, Baltaro Federica, Quattrocchi Giuseppina, Pedrotti Patrizia, Russo Claudio F, Garascia Andrea, Mondino Michele, Ammirati Enrico
  
  
  
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• Long-term effects of primary graft dysfunction after heart transplantation.
  J Card Surg

  2022 May;37(5):1290-1298. doi: 10.1111/jocs.16364.
  
  Settepani Fabrizio, Pedrazzini Giovanna L, Olivieri Guido M, Merlanti Bruno, Cannata Aldo, Lanfranconi Marco, Frigerio Maria, Russo Claudio F
  
  Abstract
  
  BACKGROUND:
  We studied the incidence of primary graft dysfunction (PGD), its impact on in-hospital and follow-up outcomes and searched for independent risk factors.
  
  METHODS:
  During an 18-year period, 508 individuals underwent heart transplantation at our institution. Patients were diagnosed with none, mild, moderate or severe PGD according to ISHLT criteria.
  
  RESULTS:
  Thirty-eight patients (7.5%) met the ISHLT criteria for mild PGD, 92 (18.1%) for moderate PGD and 23 (4.5%) for severe PGD. Patients were classified into none/mild PGD (77.4%) and moderate/severe PGD (22.6%) groups. In-hospital mortality was 12.4% (7.8% for none/mild PGD and 28.7% for moderate/severe PGD; p?.001). Survival at 1, 5, and 15 years was 85.5?±?1.9% versus 67.2?±?4.5%, 80?±?2.2% versus 63.5?±?4.7%, and 60.4?±?3.6% versus 45.9?±?8.4%, respectively (p?.001). Excluding the events occurring during the first month of follow-up, survival was comparable between the two groups (93.1?±?1.4% vs. 94.7?±?2.6 at 1 year and 65.6?±?3.8% vs. 70.4?±?10.4% at 15 years, respectively; p?=?.88). Upon multivariate logistic regression analysis preoperative mechanical circulatory support (odds ratio [OR]?=?5.86) and preoperative intra-aortic balloon pump (IABP) (OR?=?9.58) were independently associated with moderate/severe PGD.
  
  CONCLUSIONS:
  Our results confirm that PGD is associated with poor in-hospital outcome. The poor outcome does not extend beyond the first month of follow-up, with comparable survival between patients with none/mild PGD and moderate/severe PGD in the short and long-term. Mechanical circulatory support and preoperative IABP were found to be independent risk factors for moderate/severe PGD.
  
  © 2022 Wiley Periodicals LLC.
  
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• Successful recovery from severe inverted Takotsubo cardiomyopathy after liver transplantation: the efficacy of extracorporeal membrane oxygenation (ECMO).
  Minerva Anestesiol

  2022 Mar;88(3):199-201. doi: 10.23736/S0375-9393.21.16140-1.
  
  Lauterio Andrea, Bottiroli Maurizio, Cannata Aldo, DE Carlis Riccardo, Valsecchi Mila, Perricone Giovanni, Colombo Stefania, Buscemi Vincenzo, Zaniboni Matteo, Pedrazzini Giovanna, Mondino Michele, Russo Claudio, Fumagalli Roberto, DE Carlis Luciano
  
  
  
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• Nonoperative Management of a Recurrent Postoperative Inguinal Lymphatic Leak via Negative-Pressure Wound Therapy: A Case Report.
  Adv Skin Wound Care

  2021 Oct;34(10):1-3. doi: 10.1097/01.ASW.0000775928.63723.3b.
  
  Cannata Aldo, Ordanini Marco, Sesana Giovanni, Russo Claudio Francesco
  
  Abstract
  
  Lymphatic leaks are common following common femoral vessel exposure for cardiac surgical procedures. The management of this complication can be difficult and is often uncomfortable for the patient. This case report describes the successful nonoperative treatment of a recurrent lymphatic leak from an inguinal surgical wound via negative-pressure wound therapy. Negative pressure may be considered a minimally invasive, effective, and acceptable way to treat postoperative lymphatic leaks at the groin.
  
  Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
  
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• Mechanical Hemolysis Complicating Transcatheter Interventions for Valvular Heart Disease: JACC State-of-the-Art Review.
  J Am Coll Cardiol

  2021 May;77(18):2323-2334. doi: 10.1016/j.jacc.2021.03.295.
  
  Cannata Aldo, Cantoni Silvia, Sciortino Antonio, Bruschi Giuseppe, Russo Claudio Francesco
  
  Abstract
  
  Mechanical intravascular hemolysis is frequently observed following procedures on heart valves and uncommonly observed in native valvular disease. In most cases, its severity is mild. Nevertheless, it can be clinically significant and even life threatening, requiring multiple blood transfusions and renal replacement therapy. This paper reviews the current knowledge on mechanical intravascular hemolysis in valvular disease, before and after correction, focusing on pathophysiology, approach to diagnosis, and impact of other hematological conditions on the resultant anemia. The importance of a multidisciplinary management is underscored. Laboratory data are provided about subclinical hemolysis that is commonly observed following the implantation of surgical and transcatheter valve prostheses and devices. Finally, clinical scenarios are reviewed and current medical and surgical treatments are discussed, including alternative options for inoperable patients.
  
  Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
  
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• [Platypnea-orthodeoxia syndrome associated with patent foramen ovale and aortic root aneurysm].
  G Ital Cardiol (Rome)

  2020 Jul;21(7):562-563. doi: 10.1714/3386.33646.
  
  Bottiroli Maurizio, Vignati Gabriele, Cannata Aldo, Colombo Jacopo, Pinciroli Riccardo, Mondino Michele
  
  
  
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• On the definition of geometric orifice area.
  J Thorac Cardiovasc Surg

  2020 May;159(5):e303. doi: 10.1016/j.jtcvs.2019.11.138.
  
  Cannata Aldo, Russo Claudio Francesco
  
  
  
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• Focus on Very Late Hepatocellular Carcinoma Recurring After Liver Transplantation: A Case Report and Literature Review.
  Transplant Proc

  2019 Nov;51(9):2998-3000. doi: 10.1016/j.transproceed.2019.04.095.
  
  Invernizzi Federica, Maggi Umberto, Mazza Stefano, Baia Marco, Nosotti Mario, Mendogni Paolo, Muiesan Paolo, Cannata Aldo, Iavarone Massimo, Damarco Francesco, Lampertico Pietro, Donato Maria Francesca, Rossi Giorgio
  
  Abstract
  
  Hepatocellular carcinoma (HCC) recurring after liver transplantation (LT) is a major clinical concern, occurring in up to 20% and being the most frequent cause of death in this setting. Usually recurrence occurs within the first 2 years, whereas late and very late recurrences are rare. We report a 71-year-old woman with HCC recurrence after 25 years from LT, an event never reported before. Diagnosis was achieved with a progressive increase of alpha-fetoprotein (AFP) followed by a computed tomography scan, showing a mediastinal, upper diaphragmatic, right paracaval mass of 5 cm in size. The lesion was treated with a surgical approach involving a multidisciplinary team including hepatobiliary, thoracic, and cardiovascular surgeons. A sternotomy and mass removal was performed without the need of an extracorporeal bypass. A complete resection of the tumor was achieved, with a drop in AFP and without signs of recurrence after 1-year follow up. In conclusion, the possibility of late HCC recurrences after LT, despite being rare, underlines the need of a standardized, cost-benefit, optimal strategy of a long-term surveillance. From a surgical point of view, our case is unusual for the site and the character of the lesion, and for the absence of the need of an extracorporeal bypass during the operation.
  
  Copyright © 2019 Elsevier Inc. All rights reserved.
  
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• Emergency Intraoperative Implantation of ECMO for Refractory Cardiogenic Shock Arising During Liver Transplantation as a Bridge to Myocardial Surgical Revascularization.
  Transplantation

  2019 Oct;103(10):e317-e318. doi: 10.1097/TP.0000000000002826.
  
  Lauterio Andrea, De Carlis Riccardo, Cannata Aldo, Di Sandro Stefano, De Gasperi Andrea, Russo Claudio, De Carlis Luciano
  
  
  
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• Safety of centrifugal left ventricular assist device in patients previously treated with MitraClip system.
  Int J Cardiol

  2019 May;283():131-133. doi: 10.1016/j.ijcard.2019.02.039.
  
  Ammirati Enrico, Van De Heyning Caroline M, Musca Francesco, Brambatti Michela, Perna Enrico, Cipriani Manlio, Cannata Aldo, Mondino Michele, Moreo Antonella, De Bock Dina, Pretorius Victor, Claeys Marc J, Adler Eric D, Russo Claudio F, Frigerio Maria
  
  Abstract
  
  INTRODUCTION:
  No data regarding the safety of continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with previous MitraClip have been reported. Thus, it remains unknown whether an initial treatment strategy with MitraClip therapy might complicate future heart failure management in patients who are also considered for CF-LVAD.
  
  METHODS:
  We retrospectively identified 6 patients (median age of 62?years; 2 women) who had been treated with MitraClip, that were eventually implanted with a CF-LVAD (all Heartware HVAD) in 3 hospitals between 2013 and 2018.
  
  RESULTS:
  Patients were treated in 4 cases with 2 clips, and in 2 cases with 1 clip. Median time from MitraClip implantation to CF-LVAD implant was 282?days (interquartile range 67 to 493), and median time on CF-LVAD support was 401?days (interquartile range 105 to 492?days). Two patients underwent a heart transplant, 3 patients died on support, and 1 is alive on support. In all cases, there was a reduction of functional mitral regurgitation without MitraClip-related complications.
  
  CONCLUSIONS:
  Based on this small case series, implantation of a CF-LVAD appears safe in patients with a previously positioned MitraClip system, at least, with 1 or 2 clips in place, with no need for additional mitral valve surgery.
  
  Copyright © 2019 Elsevier B.V. All rights reserved.
  
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• HeartWare-HVAD for end-stage heart failure: a review of clinical experiences with ?50 patients.
  Expert Rev Med Devices

  2017 Jun;14(6):423-437. doi: 10.1080/17434440.2017.1325318.
  
  Botta Luca, De Chiara Benedetta, Macera Francesca, Cannata Aldo, Costetti Alessandro, Voltolini Alessandra, Moreo Antonella, Cipriani Manlio, Frigerio Maria, Russo Claudio Francesco
  
  Abstract
  
  Despite the improvements in medical and surgical treatments, the incidence of end-stage heart failure (ESHF) continues to increase. Different mechanical systems have been adopted to support failing left ventricles. Among continuous-flow devices, the HeartWare-HVAD was the first to use a centrifugal pump rather than an axial one. Areas covered: In this review article, we provide an overview of the HeartWare-HVAD as a ventricular assist device for ESHF, discussing indications, echocardiographic assessment, surgical techniques, outcomes, concerns and controversies. Scientific literature was reviewed with a MEDLINE search strategy combining 'HeartWare' or 'HVAD' with 'heart failure'. A total of 263 papers were found using the reported search. From these, 16 were identified to provide the best evidence on the subject reporting outcomes in ?50 patients. Expert commentary: HeartWare-HVAD is a minute device that provides full circulatory support in patients with ESHF. Its main indication remains bridge to heart transplantation (HTx). Median sternotomy is the preferred technique of implantation although less invasive procedures have been described. Early outcomes are satisfactory. Nevertheless, some fearing complications still occur during the mid- and long-term follow-up. Further technical developments and optimal medical management will guarantee better outcomes.
  
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• A prospective comparison of mid-term outcomes in patients treated with heart transplantation with advanced age donors versus left ventricular assist device implantation.
  Interact Cardiovasc Thorac Surg

  2016 Oct;23(4):584-92. doi: 10.1093/icvts/ivw164.
  
  Ammirati Enrico, Cipriani Manlio G, Varrenti Marisa, Colombo Tiziano, Garascia Andrea, Cannata Aldo, Pedrazzini Giovanna, Benazzi Elena, Milazzo Filippo, Oliva Fabrizio, Gagliardone Maria P, Russo Claudio F, Frigerio Maria
  
  Abstract
  
  OBJECTIVES:
  In Europe, the age of heart donors is constantly increasing. Ageing of heart donors limits the probability of success of heart transplantation (HTx). The aim of this study is to compare the outcome of patients with advanced heart failure (HF) treated with a continuous-flow left ventricular assist device (CF-LVAD) with indication as bridge to transplantation (BTT) or bridge to candidacy (BTC) versus recipients of HTx with the donor's age above 55 years (HTx with donors >55 years).
  
  METHODS:
  we prospectively evaluated 301 consecutive patients with advanced HF treated with a CF-LVAD (n = 83) or HTx without prior bridging (n = 218) in our hospital from January 2006 to January 2015. We compared the outcome of CF-LVAD-BTT (n = 37) versus HTx with donors >55 years (n = 45) and the outcome of CF-LVAD-BTT plus BTC (n = 62) versus HTx with donors >55 years at the 1- and 2-year follow-up. Survival was evaluated according to the first operation.
  
  RESULTS:
  The perioperative (30-day) mortality rate was 0% in the LVAD-BTT group vs 20% (n = 9) in the HTx group with donors >55 years (P = 0.003). Perioperative mortality occurred in 5% of the LVAD-BTT/BTC patients (n = 3) and in 20% of the HTx with donors >55 year group (P = 0.026). Kaplan-Meier curves estimated a 2-year survival rate of 94.6% in CF-LVAD-BTT vs 68.9% in HTx with donors >55 years [age- and sex-adjusted hazard ratio (HR) 0.25; 95% confidence interval (CI) 0.08-0.81; P = 0.02 in favour of CF-LVAD]. Considering the post-HTx outcome, a trend in favour of CF-LVAD-BTT was also observed (age- and sex-adjusted HR 0.45; 95% CI 0.17-1.16; P = 0.09 in favour of CF-LVAD), whereas CF-LVAD-BTT/BTC showed a similar survival at 2 years compared with HTx with donors >55 years, both censoring the follow-up at the time of HTx and considering the post-HTx outcome.
  
  CONCLUSIONS:
  Early and mid-term outcomes of patients treated with a CF-LVAD with BTT indication seem better than HTx with old donors. It must be emphasized that up to 19% of patients in the CF-LVAD/BTT group underwent transplantation in an urgent condition due to complications related to the LVAD. At the 2-year follow-up, CF-LVAD with BTT and BTC indications have similar outcome than HTx using old heart donors. These results must be confirmed in a larger and multicentre population and extending the follow-up.
  
  © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
  
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• Mitral valve endocarditis due to Abiotrophia defectiva in a 14th week pregnant woman.
  Interact Cardiovasc Thorac Surg

  2016 Jan;22(1):112-4. doi: 10.1093/icvts/ivv289.
  
  Botta Luca, Merati Roberto, Vignati Gabriele, Orcese Carlo Andrea, De Chiara Benedetta, Cannata Aldo, Bruschi Giuseppe, Fratto Pasquale
  
  Abstract
  
  Infective endocarditis during pregnancy carries a high mortality risk, both for the mother and for the foetus and requires a multidisciplinary team in the management of complicated cases. We report our experience with a 39-year old patient, affected by an acute active mitral endocarditis due to Abiotrophia defectiva at the 14th gestational week, strongly motivated to continue the pregnancy. Our patient successfully underwent mitral valve replacement with a normothermic high-flow cardiopulmonary bypass under continuous intraoperative foetal monitoring. Caesarean section occurred at the 38th gestational week. The delivery was uneventful and both the mother and child are doing well at the 16-month follow-up.
  
  © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
  
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• Direct Flow valve-in-valve implantation in a degenerated mitral bioprosthesis.
  EuroIntervention

  2016 Apr;11(13):1549-53. doi: 10.4244/EIJY15M07_05.
  
  Bruschi Giuseppe, Cannata Aldo, Barosi Alberto, Colombo Paola, Soriano Francesco, Nava Stefano, Montrasio Elisa, Botta Luca, Gagliardone Maria Pia, Klugmann Silvio, De Marco Federico
  
  Abstract
  
  AIMS:
  Mitral valve reoperations due to failing bioprostheses, in patients affected by multiple comorbidities, are associated with high morbidity and mortality. Transcatheter techniques may evolve as complementary approaches to surgery in these patients at high risk for surgery.
  
  METHODS AND RESULTS:
  We describe a case of Direct Flow 25 mm transcatheter valve implantation as valve-in-valve in a degenerated mitral bioprosthesis through a transapical approach in a 63-year-old man affected by dilated cardiomyopathy. The patient was affected by Carpentier-Edwards 29 mm severe regurgitation. The 25 mm Direct Flow bioprosthesis was advanced through the mitral bioprosthesis into the left atrium and then positioned using the three independent positioning wires. Transoesophageal echocardiography evidenced normal Direct Flow function with no paravalvular regurgitation and a low transmitral gradient of 4 mmHg.
  
  CONCLUSIONS:
  Our successful experience, characterised by a Heart Team approach and multidisciplinary patient care, demonstrated the technical feasibility and procedural safety of Direct Flow valve-in-valve mitral implantation.
  
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• Treatment solution by Botta et al.
  Interact Cardiovasc Thorac Surg

  2015 Jun;20(6):869-70. doi: 10.1093/icvts/ivv056.
  
  Botta Luca, Cannata Aldo, Bruschi Giuseppe, Martinelli Luigi
  
  
  
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• Pseudoaneurysm of the aortic isthmus involving a right aberrant subclavian artery long after multiple coarctation repairs.
  Interact Cardiovasc Thorac Surg

  2015 Jun;20(6):868-9. doi: 10.1093/icvts/ivv054.
  
  Botta Luca, Cannata Aldo, Bruschi Giuseppe, Martinelli Luigi
  
  
  
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• Left thoracotomy and descending aortic anastomosis for HeartWare implantation after previous coronary artery bypass graft and left ventriculotomy.
  Artif Organs

  2015 Mar;39(3):288-9. doi: 10.1111/aor.12360.
  
  Botta Luca, Cannata Aldo, Martinelli Luigi
  
  
  
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• Mid-term survival after continuous-flow left ventricular assist device versus heart transplantation.
  Heart Vessels

  2016 May;31(5):722-33. doi: 10.1007/s00380-015-0654-4.
  
  Ammirati Enrico, Oliva Fabrizio G, Colombo Tiziano, Russo Claudio F, Cipriani Manlio G, Garascia Andrea, Guida Valentina, Colombo Giulia, Verde Alessandro, Perna Enrico, Cannata Aldo, Paino Roberto, Martinelli Luigi, Frigerio Maria
  
  Abstract
  
  There is a paucity of data about mid-term outcome of patients with advanced heart failure (HF) treated with left ventricular assist device (LVAD) in Europe, where donor shortage and their aging limit the availability and the probability of success of heart transplantation (HTx). The aim of this study is to compare Italian single-centre mid-term outcome in prospective patients treated with LVAD vs. HTx. We evaluated 213 consecutive patients with advanced HF who underwent continuous-flow LVAD implant or HTx from 1/2006 to 2/2012, with complete follow-up at 1 year (3/2013). We compared outcome in patients who received a LVAD (n = 49) with those who underwent HTx (n = 164) and in matched groups of 39 LVAD and 39 HTx patients. Patients that were treated with LVAD had a worse risk profile in comparison with HTx patients. Kaplan-Meier survival curves estimated a one-year survival of 75.5 % in LVAD vs. 82.3 % in HTx patients, a difference that was non-statistically significant [hazard ratio (HR) 1.46; 95 % confidence interval (CI) 0.74-2.86; p = 0.27 for LVAD vs. HTx]. After group matching 1-year survival was similar between LVAD (76.9 %) and HTx (79.5 %; HR 1.15; 95 % CI 0.44-2.98; p = 0.78). Concordant data was observed at 2-year follow-up. Patients treated with LVAD as bridge-to-transplant indication (n = 22) showed a non significant better outcome compared with HTx with a 95.5 and 90.9 % survival, at 1- and 2-year follow-up, respectively. Despite worse preoperative conditions, survival is not significantly lower after LVAD than after HTx at 2-year follow-up. Given the scarce number of donors for HTx, LVAD therapy represents a valid option, potentially affecting the current allocation strategy of heart donors also in Europe.
  
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• Alternative transarterial access for CoreValve transcatheter aortic bioprosthesis implantation.
  Expert Rev Med Devices

  2015 May;12(3):279-86. doi: 10.1586/17434440.2015.1005605.
  
  Bruschi Giuseppe, De Marco Federico, Modine Thomas, Botta Luca, Colombo Paola, Mauri Silvia, Cannata Aldo, Fratto Pasquale, Klugmann Silvio
  
  Abstract
  
  Transcatheter aortic valve implantation (TAVI) is used to treat elderly patients with severe aortic stenosis who are considered extremely high-risk surgical candidates. The safety and effectiveness of TAVI have been demonstrated in numerous studies. The self-expanding CoreValve bioprosthesis (Medtronic Inc., Minneapolis, MN, USA) was the first transcatheter aortic valve to be granted the Conformité Européene (CE) mark in May 2007 for retrograde transfemoral implantation. However, TAVI patients are also often affected by severe iliofemoral arteriopathy. In these patients, the retrograde transfemoral approach carries a high risk of vascular injury, making this approach unusable. Alternative arterial access sites, such as the subclavian artery, the ascending aorta, and the carotid artery, have been used for retrograde implantation of the CoreValve bioprosthesis. In the present report, we present the procedural considerations, risks, and benefits of the different types of arterial access used to implant the CoreValve bioprosthesis.
  
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• Right anterior mini-thoracotomy direct aortic self-expanding trans-catheter aortic valve implantation: A single center experience.
  Int J Cardiol

  2015 Feb;181():437-42. doi: 10.1016/j.ijcard.2014.11.108.
  
  Bruschi Giuseppe, De Marco Federico, Botta Luca, Barosi Alberto, Colombo Paola, Mauri Silvia, Cannata Aldo, Morici Nuccia, Colombo Tiziano, Fratto Pasquale, Nonini Sandra, Soriano Francesco, Mondino Michele, Giannattasio Cristina, Klugmann Silvio
  
  Abstract
  
  OBJECTIVE:
  Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients with severe aortic stenosis at high risk for surgery. These patients are also often affected by severe iliac-femoral arteriopathy, rendering the trans-femoral approach unusable. We report our experience with the direct-aortic approach to treat these patients.
  
  METHODS:
  From May 2008 to November 2013 two hundred and thirty-two patients (131 female, 56%) with severe symptomatic aortic stenosis and no reasonable surgical option due to excessive risk were evaluated for TAVI at our department. Of these patients, 202 were deemed eligible for TAVI. Of this group, 50 underwent CoreValve implantation by the direct aortic approach through a right anterior mini-thoracotmy (28 female, 56%), mean age 81.2±6.9. A combined team of cardiologists, cardiac surgeons with expertise in hybrid procedures, and anesthetists performed all the procedures.
  
  RESULTS:
  Twenty-eight (56%) patients were female and 11 (22%) were redo at TAVI. We used a 23-mm CoreValve Evolute in 3 patients (6%), and the most used valve size was the 29mm in 46% of patients. Mean hemodynamic trans-aortic gradient was less than 5mmHg. The paravalvular regurgitation was ? grade 1 in 46 patients as assessed by peri-procedural transesophageal echocardiography (TEE). Seven patients (7/43, 16%) required a permanent pacemaker implantation; 30-day mortality was 6% (3 patients). Seven patients (14.8%) died during follow-up. Actuarial survival at 2years is 84.7±5.3%.
  
  CONCLUSIONS:
  Transcatheter aortic valve implantation with the direct aortic approach is safe and feasible, offering a new attractive option to treat selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, including those requiring a re-do procedure.
  
  Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
  
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• First case of trans-axillary direct flow implantation.
  Int J Cardiol

  2014 Dec;177(3):e176-8. doi: 10.1016/j.ijcard.2014.08.097.
  
  Bruschi Giuseppe, Botta Luca, Cannata Aldo, Colombo Paola, Barosi Alberto, Soriano Francesco, Bottiroli Maurizio, Nava Stefano, Klugmann Silvio, De Marco Federico
  
  
  
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• Current indications for heart transplantation and left ventricular assist device: a practical point of view.
  Eur J Intern Med

  2014 Jun;25(5):422-9. doi: 10.1016/j.ejim.2014.02.006.
  
  Ammirati Enrico, Oliva Fabrizio, Cannata Aldo, Contri Rachele, Colombo Tiziano, Martinelli Luigi, Frigerio Maria
  
  Abstract
  
  Heart transplantation (HTx) is considered the "gold standard" therapy of refractory heart failure (HF), but it is accessible only to few patients because of the paucity of suitable heart donors. On the other hand, left ventricular assist devices (LVADs) have proven to be effective in improving survival and quality of life in patients with refractory HF. The challenge encountered by multidisciplinary teams in dealing with advanced HF lies in identifying patients who could benefit more from HTx as compared to LVAD implantation and the appropriate timing. The decision-making is based on clinical parameters, imaging-based data and risk scores. Current outcome of HF patients supported by LVAD (2-year survival around 70%) is rapidly improving and leads the way to a new therapeutic strategy. Patients who have a low likelihood to gain access to the heart graft pool could benefit more from LVAD implantation (defined as bridge to transplantation indication) than from remaining on HTx waiting list with the likely risk of clinical deterioration or removal from the list because patients are no longer suitable for transplantation. LVAD has also demonstrated to be effective in patients who are not considered eligible candidates for HTx with a destination therapy indication. HTx should be reserved to those patients for whom the maximum clinical benefit can be expected, such as young patients with no comorbidities. Here we discuss the current listing criteria for HTx and indications to implant of LVAD for patients with refractory acute and chronic HF based on the guidelines and the practical experience of our center.
  
  Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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• Reply: To PMID 23566646.
  Ann Thorac Surg

  2014 Jan;97(1):379. doi: 10.1016/j.athoracsur.2013.07.106.
  
  Cannata Aldo, Martinelli Luigi
  
  
  
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• Redo mitral valve replacement through a right mini-thoracotomy with an unclamped aorta.
  Multimed Man Cardiothorac Surg

  2014 Aug;2014():. doi: mmu013.
  
  Botta Luca, Fratto Pasquale, Cannata Aldo, Bruschi Giuseppe, Merlanti Bruno, Brignani Christian, Bosi Mauro, Martinelli Luigi
  
  Abstract
  
  Redo cardiac surgery represents a clinical challenge due to a higher rate of perioperative morbidity and mortality. Mitral valve (MV) re operations can particularly be demanding in patients with patent coronary grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, leaks or thrombosis). In this article we describe our technique to manage complex mitral reoperations using a minimally invasive approach, moderate hypothermia and avoiding aortic cross-clamping. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of less invasive access and continuous myocardial perfusion. The advantage of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, reducing the risk of cardiac structures or patent graft injury. Moderate hypothermia and continuous blood perfusion can guarantee adequate myocardial protection particularly in the case of patent grafts, decreasing the dangers of an incomplete or imperfect aortic clamping at mild hypothermia and potential lesions due to demanding clamp placing. Complex MV reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space with an unclamped aorta.
  
  © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
  
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• Minimally invasive approach for redo mitral valve surgery.
  J Thorac Dis

  2013 Nov;5 Suppl 6(Suppl 6):S686-93. doi: 10.3978/j.issn.2072-1439.2013.10.12.
  
  Botta Luca, Cannata Aldo, Bruschi Giuseppe, Fratto Pasquale, Taglieri Corrado, Russo Claudio Francesco, Martinelli Luigi
  
  Abstract
  
  Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Mitral valve re-operations can be particularly demanding in patients with patent coronary artery bypass grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, perivalvular leaks, or thrombosis). Risk of graft injuries, hemorrhage, the presence of dense adhesions and complex valve exposure can make redo valve operations challenging through a median sternotomy. In this review article we provide an overview of minimally invasive approaches for redo mitral valve surgery discussing indications, techniques, outcomes, concerns and controversies. Scientific literature about minimally invasive approach for redo mitral surgery was reviewed with a MEDLINE search strategy combining "mitral valve" with the following terms: 'minimally invasive', 'reoperation', and 'alternative approach'. The search was limited to the last ten years. A total of 168 papers were found using the reported search. From these, ten papers were identified to provide the best evidence on the subject. Mitral valve reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space termed "mini" thoracotomy or "port access". The greatest potential benefit of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, avoiding the risk of injury to cardiac structures or patent grafts. Good percentages of valve repair can be achieved. Mortality is low as well as major complications. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of minimally invasive access and continuous myocardial perfusion. Less invasive trans-catheter techniques could be considered as the natural future evolution for management of structural heart disease and mitral reoperations. The safety and efficacy of these procedures has never been compared to open reoperations in a randomized trial, although published case series and comparisons to historical cohorts suggest that they are an effective and feasible alternative. Ongoing follow-up on current series will further define these procedures and provide valuable clinical outcome data.
  
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• A caval homograft for Budd-Chiari syndrome due to inferior vena cava obstruction.
  World J Hepatol

  2013 May;5(5):292-5. doi: 10.4254/wjh.v5.i5.292.
  
  Mancuso Andrea, Martinelli Luigi, De Carlis Luciano, Rampoldi Antonio Gaetano, Magenta Giovanni, Cannata Aldo, Belli Luca Saverio
  
  Abstract
  
  Transjugular intrahepatic portosystemic shunt (TIPS) is the standard treatment of Budd-Chiari syndrome (BCS) non responsive to medical therapy. However, patients with inferior vena cava (IVC) obstruction proximal to the atrium do not benefit from TIPS and a surgical approach is mandatory. We report the case of BCS due to intrapericardial IVC obstruction. We describe a novel surgical approach using a fresh caval homograft. An attempt to balloon dilatation of the IVC obstruction was complicated by right atrial disruption with tamponade and ventricular fibrillation. Lately, the patient successfully underwent a reconstruction of the cavo-atrial continuity by the interposition of a fresh caval homograft, a novel surgical approach never described before for BCS. Further follow-up revealed progressive reduction and resolution of ascites, and overall clinical improvement. IVC obstruction near to the atrium can be surgically approached with a new technique consisting in inferior vena cava resection and replacement with a caval homograft.
  
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• Impact of normalization strategy on cardiac expression of pro-inflammatory cytokines: evaluation of reference genes in different human myocardial regions after Left Ventricular Assist Device support.
  Cytokine

  2013 Aug;63(2):113-22. doi: 10.1016/j.cyto.2013.04.021.
  
  Caselli Chiara, D'Amico Andrea, Caruso Raffaele, Cabiati Manuela, Prescimone Tommaso, Cozzi Lorena, Cannata Aldo, Parodi Oberdan, Del Ry Silvia, Giannessi Daniela
  
  Abstract
  
  OBJECTIVE:
  New device therapies have expanded the strategies for treating heart failure (HF) patients. Unloading of the heart with a left ventricular assist device (LVAD) can lead to the reversal of many remodeling changes whose underlying mechanisms are not yet completely known. Molecular analysis might play a role in obtaining further insight into the regulatory mechanisms of this process. A critical step in an RT-PCR study is the selection of reference genes for data normalization. This study aimed to determine an optimal combination of stably expressed reference genes in different regions of the human heart in order to study the effects of LVAD implants on cardiac remodeling, and in particular to check their reliability on the evaluation of pro-inflammatory cytokine expression.
  
  DESIGN AND METHODS:
  We validated nine of the most commonly used reference genes in human myocardium samples obtained at heart transplantation from patients with LVAD implant (n=30 from a total of six patients) and from heart transplant (HT from a total of seven patients) recipients as controls (n=35). Samples from both left (LV) and right (RV) ventricles were analyzed. The normalization strategy was tested by analyzing mRNA expression of IL-6, IL-8 and TNF-?, whose protein levels were measured by immunometric assay.
  
  RESULTS:
  The most stable gene combinations changed according to the experimental groups (the LVAD and HT groups and the different myocardial regions). Considering all the cardiac samples as a whole, the three most stably expressed genes were PPIA, RPL13A, and YWHAZ (M=0.70). Using the best normalization strategy, a significant increase in IL-6, IL-8 mRNA expression was observed in LVAD samples compared to HT (p
  CONCLUSIONS:
  Our results underline the importance of always selecting reference genes for the specific system studied. The most appropriate normalization strategy is of pivotal importance for understanding the molecular mechanisms associated with the pathophysiology of HF, such as inflammation.
  
  Copyright © 2013 Elsevier Ltd. All rights reserved.
  
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• Limited changes in severe functional mitral regurgitation and pulmonary hypertension after left ventricular assist device implantation: a clue to consider concurrent mitral correction?
  Int J Cardiol

  2013 Jul;167(2):e35-7. doi: 10.1016/j.ijcard.2013.03.098.
  
  Ammirati Enrico, Musca Francesco, Cannata Aldo, Garascia Andrea, Verde Alessandro, Pacher Valentina, Moreo Antonella, Oliva Fabrizio, Martinelli Luigi, Frigerio Maria
  
  
  
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• Postsurgical intrapericardial adhesions: mechanisms of formation and prevention.
  Ann Thorac Surg

  2013 May;95(5):1818-26. doi: 10.1016/j.athoracsur.2012.11.020.
  
  Cannata Aldo, Petrella Duccio, Russo Claudio Francesco, Bruschi Giuseppe, Fratto Pasquale, Gambacorta Marcello, Martinelli Luigi
  
  Abstract
  
  Postsurgical intrapericardial adhesions are still considered an unavoidable consequence of cardiothoracic operations. They increase the technical difficulty and the risk of reoperations. The pathogenesis of postsurgical adhesions is a multistep process, and the main key players are (1) loss of mesothelial cells, (2) accumulation of fibrin in areas devoid of mesothelial cells, (3) loss of normal pericardial fibrinolysis, and (4) local inflammation. Today, very promising methods to reduce adhesions are available for clinical use. This report reviews the process of formation of adhesions and the methods to prevent them, classified according to the mechanism of action.
  
  Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
  
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• Giant true aneurysm of the right coronary artery button long after aortic root replacement.
  Eur J Cardiothorac Surg

  2013 May;43(5):e139-40. doi: 10.1093/ejcts/ezt057.
  
  Bruschi Giuseppe, Cannata Aldo, Botta Luca, Martinelli Luigi
  
  
  
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• Histological findings following use of CoSeal in a patient with a left ventricular assist device.
  Surg Innov

  2013 Dec;20(6):NP35-7. doi: 10.1177/1553350612443899.
  
  Cannata Aldo, Petrella Duccio, Gambacorta Marcello, Russo Claudio F, Bruschi Giuseppe, Martinelli Luigi
  
  Abstract
  
  Adhesions are a formidable challenge in patients undergoing reoperative cardiac surgery, particularly in those supported by an intracorporeal left ventricular assist device (LVAD) and undergoing heart transplantation. This report describes the pathological findings following the clinical use of a surgical sealant (CoSeal, Baxter Healthcare, Fremont, CA), in a patient who underwent LVAD implantation. On the treated surfaces, a minimal amount of adhesions were observed, whereas in untreated surfaces adhesions were present.
  
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• [Proposal for updated listing criteria for heart transplantation and indications to implant of left ventricular assist devices].
  G Ital Cardiol (Rome)

  2013 Feb;14(2):110-9. doi: 10.1714/1218.13523.
  
  Ammirati Enrico, Oliva Fabrizio, Colombo Tiziano, Botta Luca, Cipriani Manlio, Cannata Aldo, Verde Alessandro, Turazza Fabio M, Russo Claudio F, Paino Roberto, Martinelli Luigi, Frigerio Maria
  
  Abstract
  
  Heart transplantation (HTx) is considered to be the gold standard treatment for advanced heart failure (HF) but it is available only for a minority of patients, due to paucity of donor hearts (278 HTx were performed in 2011 in Italy). Patients listed for HTx have a prolonged waiting time (that is about 2.3 years in the 2006-2010 time period in Italy) that is superior compared with patients who receive HTx (median time around 6 months), to underline the presence of an allocation system that prioritizes candidates in critical conditions. Patients listed for HTx have a poor quality of life and their annual mortality is around 8-10%. Another 10-15% of HTx candidates are removed from the waiting list each year because they are no longer suitable for transplantation. On the other hand, continuous-flow left ventricular assist devices (LVADs) have been demonstrated to improve survival and quality of life of patients with advanced/refractory HF. LVAD therapy can represent a valid alternative to HTx, and it is recommended for patients with advanced HF in the recent edition of the European Society of Cardiology guidelines on HF management. In the United States, a larger number of centers compared with European ones started to apply a strategy of LVAD implant for many patients who meet clinical criteria for listing for HTx. Data from our center concerning the last 6 years of LVAD implant (51 implants since 2006) reported a 75.5% survival rate at 1 year. In Italian series, as in our center, current HTx survival is only slightly superior (83% survival rate at 1 year), based on data from the Italian National Transplant Center. We report a proposal for updated listing criteria for HTx and indications for LVAD implant in patients with advanced acute and chronic HF. Criteria for identifying suitable patients for HTx and/or LVAD considering the shortage of donors are discussed.
  
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• Heart transplantation: 25 years' single-centre experience.
  J Cardiovasc Med (Hagerstown)

  2013 Sep;14(9):637-47. doi: 10.2459/JCM.0b013e32835dbd74.
  
  Bruschi Giuseppe, Colombo Tiziano, Oliva Fabrizio, Botta Luca, Morici Nuccia, Cannata Aldo, Vittori Claudia, Turazza Fabio, Garascia Andrea, Pedrazzini Giovanna, Frigerio Maria, Martinelli Luigi
  
  Abstract
  
  OBJECTIVES:
  Heart transplantation (HTx) is still one of the most effective therapies for end-stage heart disease for patients with no other medical or surgical therapy. We report the results of our 25-year orthotropic HTx single-centre experience.
  
  METHODS:
  From November 1985, 905 orthotopic heart transplants have been performed at our centre. We exclude from the present analysis 13 patients who underwent re-transplantation and 14 pediatric cases (age at HTx
  RESULTS:
  The present study collected the data of 878 primary adult orthotopic HTx performed at our centre. Mean age at HTx was of 49.6?±?11.6 years. Mean donor age was 36.9?±?14.8 years. Hospital mortality was 11.6% (102 patients), early graft failure was the principal cause of death (58 patients) followed by infections (18 cases) and acute rejection (7 patients). Overall actuarial survival was 78.1% at 5 years and 63.8% and 47.5%, respectively, at 10 and 15 years from HTx. Mean survival was 10.74 years; 257 late deaths were reported (33.1%); main causes were neoplasm in 83 patients, and cardiac causes included coronary allograft vasculopathy in 78 patients. Freedom from any infection at 5, 10 and 15 years was 52.2, 44.1 and 40.1%, respectively. Freedom from rejection at 5 years was 36.2%, with 493 patients experiencing at last one episode of rejection, the majority occurring during the first 2 months after transplantation. The long-term survival of HTx recipients is limited in large part by the development of coronary artery vasculopathy and malignancies. In our experience freedom from coronary allograft vasculopathy at 10 years was 66.9%, and 85 patients underwent percutaneous coronary revascularization. In our study population, 44 patients experienced posttransplant lymphoproliferative disorder and 91 patients experienced a solid neoplasm, mean survival free from neoplasm was 12.23 years.
  
  CONCLUSION:
  Over the past four decades the field of HTx has evolved considerably, with improvements in surgical techniques and postoperative patients' care. A careful patient selection and treatment of candidates for transplantation as well as accurate clinical follow-up combined with real multidisciplinary teamwork that involved different heart failure specialists, allowed us to obtain our excellent long-term results.
  
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• Partial anomalous connection of both superior pulmonary veins.
  Ann Thorac Surg

  2012 Aug;94(2):649-51. doi: 10.1016/j.athoracsur.2011.10.082.
  
  Marianeschi Stefano M, Cannata Aldo, Uricchio Nicola, Pedretti Stefano, Vignati Gabriele
  
  Abstract
  
  Several patterns of anomalous pulmonary venous drainage have been described in the literature, and bilateral partial pulmonary anomalous vein connection (PAPVC) has been described as a rare congenital cardiac anomaly. We report an unusual type of bilateral PAPVC, involving both the superior right and left pulmonary veins draining into the left brachiocephalic vein in a young adult who was symptomatic with dyspnea and a dry cough.
  
  Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
  
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• Direct aortic access for transcatheter self-expanding aortic bioprosthetic valves implantation.
  Ann Thorac Surg

  2012 Aug;94(2):497-503. doi: 10.1016/j.athoracsur.2012.04.021.
  
  Bruschi Giuseppe, de Marco Federico, Botta Luca, Cannata Aldo, Oreglia Jacopo, Colombo Paola, Barosi Alberto, Colombo Tiziano, Nonini Sandra, Paino Roberto, Klugmann Silvio, Martinelli Luigi
  
  Abstract
  
  BACKGROUND:
  Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients with severe aortic stenosis at high risk for operation; however, these patients are also often affected by severe iliac-femoral arteriopathy that prohibits the transfemoral approach.
  
  METHODS:
  From May 2008 to January 2012, 400 patients were evaluated for TAVI at our center; of these, 141 patients (64 men; mean age 81.3±8 years) with severe symptomatic aortic stenosis and no reasonable surgical option due to excessive risk were eligible for CoreValve (137 patients; Medtronic Inc, MN) or Sapien (Edwards Lifesciences, CA) implantation. Twenty-five patients (all affected by severe peripheral vasculopathy, including five re-do procedures), with a mean The Society of Thoracic Surgeons mortality score 11%±6%, underwent CoreValve implantation directly from the ascending aorta through a right anterior minithoracotomy. This case series was reviewed to evaluate the clinical outcomes of these patients. A combined team of cardiologists, cardiac surgeons with expertise in hybrid procedures, and anesthetists performed all the procedures.
  
  RESULTS:
  In all patients after valve deployment, the mean aortic gradient immediately dropped to 5 mm Hg or less, and the angiographic grade aortic insufficiency was 1 or less in 22 patients. One patient was converted to the transfemoral approach due to an extremely fragile aortic wall, but the patient died of abdominal aorta aneurysm rupture on postoperative day 1. Procedural success was obtained in the remaining 24 patients. A left ventricle tear in 1 patient was successfully surgically treated. Four patients required a permanent pacemaker implantation. Thirty-day mortality was 8% (2 patients). All discharged patients improved their New York Heart Association functional class and functional capacity, and echocardiograms demonstrated good valve performance up to 2 years (mean valve gradient, 9 mm Hg). During follow-up, 1 patient died of cachexia and another of bone marrow aplasia.
  
  CONCLUSIONS:
  TAVI with the direct aortic approach is safe and feasible, offering a new attractive option to treat selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, including those requiring a re-do procedure, and has emerged as a valuable alternative route to transapical access.
  
  Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
  
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• Does the cardioplegic solution have an effect on early outcomes following heart transplantation?
  Eur J Cardiothorac Surg

  2012 Apr;41(4):e48-52; discussion e52-3. doi: 10.1093/ejcts/ezr321.
  
  Cannata Aldo, Botta Luca, Colombo Tiziano, Russo Claudio F, Taglieri Corrado, Bruschi Giuseppe, Merlanti Bruno, Frigerio Maria, Martinelli Luigi
  
  Abstract
  
  OBJECTIVE:
  The choice of cardioplegic solution for myocardial preservation in heart transplantation (HT) remains debated. We analysed our experience with three different cardioplegic solutions in adult HT performed during past 5 years, in terms of non-immunological intraoperative biventricular graft failure (BVF) and in-hospital mortality.
  
  METHODS:
  A total of 133 patients underwent HT at our hospital from January 2006 to December 2010. Patients were divided into three groups, according to the solution adopted in the donor: HTK-Custodiol (n = 61), Celsior (n = 38) and St Thomas (n = 34). For each patient, solution was chosen according to surgeon's preference.
  
  RESULTS:
  Recipient and donor mean age was 48.2 ± 12.7 and 43.8 ± 13.6 years, respectively. Twenty-four patients (18.0%) were in Status 1 at the transplant. The mean ischaemic time was 187.9 ± 52.6 min. Intraoperative BVF was observed in 18 cases (13.5%). Patients with BVF, and their respective donors, were older than the other patients (patients: 53.3 vs 47.4 years, P = 0.06; donors: 49.4 vs 42.9 years, P 0.06), and experienced significantly higher in-hospital mortality (47.3 vs 7.8%, P = 0.0001). The combination of patients aged 60 years or older with donors aged 60 years or older carried a mortality of 66.6% (6 out of 9). The three groups of patients did not differ significantly in terms of preoperative and intraoperative features and outcomes, including biventricular graft failure and death. At multivariate analysis, predictors of in-hospital death were a combination of both a recipient and a donor aged ? 60 years (OR 27.9), intraoperative BVF (OR 14.8) and previous cardiac surgery (OR 13.0). Cardioplegic solution did not predict mortality.
  
  CONCLUSIONS:
  We did not observe a significant effect of the kind of cardioplegic solution on the early HT outcomes. The combination between both a recipient and a donor aged ? 60 years, reoperation and BVF are strong predictors of in-hospital death.
  
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• Type 2 diabetes mellitus is associated with faster degeneration of bioprosthetic valve: results from a propensity score-matched Italian multicenter study.
  Circulation

  2012 Jan;125(4):604-14. doi: 10.1161/CIRCULATIONAHA.111.025064.
  
  Lorusso Roberto, Gelsomino Sandro, Lucà Fabiana, De Cicco Giuseppe, Billè Giuseppe, Carella Rocco, Villa Emmanuel, Troise Gianni, Viganò Mario, Banfi Carlo, Gazzaruso Carmine, Gagliardotto Pier, Menicanti Lorenzo, Formica Francesco, Paolini Giovanni, Benussi Stefano, Alfieri Ottavio, Pastore Matteo, Ferrarese Sandro, Mariscalco Giovanni, Di Credico Germano, Leva Cristian, Russo Claudio, Cannata Aldo, Trevisan Roberto, Livi Ugolino, Scrofani Roberto, Antona Carlo, Sala Andrea, Gensini Gian Franco, Maessen Jos, Giustina Andrea
  
  Abstract
  
  BACKGROUND:
  The present study was aimed at determining the impact of type 2 diabetes mellitus (DM) on postoperative bioprosthetic structural valve degeneration.
  
  METHODS AND RESULTS:
  Twelve Italian centers participated in the study. Patient data refer to bioprosthetic implantations performed from November 1988 to December 2009, which resulted in 6184 patients (mean age 71.3±5.4 years, 60.1% male) being enrolled. Of these patients, 1731 (27.9%) had type 2 DM. The propensity score-matching algorithm successfully matched 1113 patients with type 2 DM with the same number of no-DM patients. The postmatching standard differences were less than 0.1 for each of the covariates, and 64.2% of DM patients were matched. The early (30 days) mortality rate was 7.8% (n=87) versus 2.9% (n=33) in patients with or without type 2 DM (P
  CONCLUSIONS:
  Patients with type 2 DM undergoing bioprosthetic valve implantation are at high risk of early and long-term mortality, as well as of structural valve degeneration.
  
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• The role of the minimally invasive beating heart technique in reoperative valve surgery.
  J Card Surg

  2012 Jan;27(1):24-8. doi: 10.1111/j.1540-8191.2011.01358.x.
  
  Botta Luca, Cannata Aldo, Fratto Pasquale, Bruschi Giuseppe, Trunfio Salvatore, Maneggia Carla, Martinelli Luigi
  
  Abstract
  
  OBJECTIVE:
  We reviewed our experience to assess potential advantages of minimally invasive surgery without aortic clamping over conventional median sternotomy and cardioplegic arrest during reoperative valve surgery.
  
  METHODS:
  From August 2008 to August 2010, 22 reoperative valve procedures were performed through a minimally invasive approach without aortic cross-clamping [no-clamp group (NCG)]. Postoperative results were compared to a matched population in terms of sex, age, and type of surgery, and operated through median sternotomy with aortic cross-clamping and cardioplegic arrest [clamp group (CG)].
  
  RESULTS:
  We performed 17 mitral valve replacements (MVRs), one mitral valve repair, one MVR associated to a tricuspid plasty (TVP), and three isolated TVP in both groups. Cardiopulmonary bypass (CPB) time was 166 and 163 minutes in NCG and CG, respectively. Intra-aortic balloon pump was necessary in two (NCG) and three (CG) patients. Two patients died in both groups from multiorgan failure. Biochemical analysis showed no significant differences in perioperative lactate or creatine kinase-MB values.
  
  CONCLUSIONS:
  Redo valve surgery with an unclamped aorta is feasible, effective, and at least as safe as surgery using cardioplegic arrest. There was, however, no difference in biochemical or clinical outcomes from conventional surgery using aortic clamping and cardioplegic techniques.
  
  © 2011 Wiley Periodicals, Inc.
  
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• Orthotopic heart transplantation with donors greater than or equal to 60 years of age: a single-center experience.
  Eur J Cardiothorac Surg

  2011 Jul;40(1):e55-61. doi: 10.1016/j.ejcts.2011.02.013.
  
  Bruschi Giuseppe, Colombo Tiziano, Oliva Fabrizio, Morici Nuccia, Botta Luca, Cannata Aldo, Frigerio Maria, Martinelli Luigi
  
  Abstract
  
  OBJECTIVES:
  Heart transplantation is the best therapeutic option for patients suffering from end-stage heart failure, but donor organ availability still represents a major problem. This had led to a shift toward extended donor criteria. The aim of the present study is to analyze the short- and long-term results of heart transplantation in patients with donor age ? 60 years.
  
  METHODS:
  Since November 1985, 890 patients have been transplanted at our center. We consider, for the present study, only primary adult heart transplantations performed after 1990, totaling 761 patients, mean age at transplantation 49.8 years, and 616 patients being male (81%). We compare the short- and long-term results of patients transplanted with donors younger than 60 years or ? 60 years.
  
  RESULTS:
  Since 1990, at our center, 711 patients have been heart transplanted with a donor younger than 60 years, while 50 patients received a heart from a donor older than 60 years. No differences have been reported in the etiology of cardiomyopathy, previous surgery, or mean ischemic time. Patients transplanted with donors ? 60 years of age were significantly older compared to the younger donors' group. Donor cause of death was a cerebrovascular accident in 82% of donors ? 60 years versus 41% in younger donors. Patients' heart transplanted with donors ? 60 years had a higher incidence of acute graft failure with a hospital mortality of 32% (16 patients) significantly higher compared with 10.2% for the other group. No differences were noticed in the incidence of renal failure, acute rejection treated, coronary allograft vasculopathy, and neoplasm during long-term follow-up.
  
  CONCLUSIONS:
  It was possible to expand the cardiac donor pool by accepting allografts from donors ? 60 years of age in selected cases by performing a coronary angiogram. A meticulous donor evaluation and a careful risk assessment between the risk of death on the waiting list and probable increased hospital mortality are needed.
  
  Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
  
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• Veno-arterial extracorporeal membrane oxygenation using Levitronix centrifugal pump as bridge to decision for refractory cardiogenic shock.
  J Thorac Cardiovasc Surg

  2010 Dec;140(6):1416-21. doi: 10.1016/j.jtcvs.2010.07.083.
  
  Russo Claudio F, Cannata Aldo, Lanfranconi Marco, Bruschi Giuseppe, Milazzo Filippo, Paino Roberto, Martinelli Luigi
  
  Abstract
  
  OBJECTIVES:
  Cardiogenic shock still carries a very high mortality. We adopted veno-arterial extracorporeal membrane oxygenation using the Levitronix centrifugal pump (Levitronix LLC, Waltham, Massachusetts) as a first-line treatment of cardiogenic shock in a "bridge to decision" strategy. This article provides our experience of this clinical approach.
  
  METHODS:
  Since 1988, 160 ventricular assist devices have been implanted at our hospital for heart failure. Since 2005, 15 consecutive patients have been treated with veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock. Veno-arterial extracorporeal membrane oxygenation has been implanted either centrally or peripherally.
  
  RESULTS:
  Mean age was 44.7 ± 20.0 years (2-78 years). There were 5 women. Veno-arterial extracorporeal membrane oxygenation was implanted peripherally in 8 cases (53.4%) and centrally in the remaining 7 (46.6%). Mean veno-arterial extracorporeal membrane oxygenation duration was 11.5 ± 8.1 days (range, 1-30). No patient experienced any neurologic event or vascular complication at the cannulation site. Twelve patients (80%) were weaned from veno-arterial extracorporeal membrane oxygenation or bridged to either a long-term left ventricular assist device or heart transplantation. Three patients died during veno-arterial extracorporeal membrane oxygenation support secondary to multi-organ failure. Seven patients (46.6%) were discharged from the hospital, with a 100% survival at follow-up. The survivors include 2 patients affected by fulminant myocarditis, who were bridged to recovery, and 5 patients who were bridged to heart transplantation. Survivors were younger than nonsurvivors (mean age, 28.5 vs 58.8 years, respectively).
  
  CONCLUSIONS:
  In our experience, the use of veno-arterial extracorporeal membrane oxygenation as bridge to decision has been effective to promptly restore adequate systemic perfusion, allowing further time to evaluate myocardial recovery or candidacy for ventricular assist device or heart transplantation. Younger patients, with no or mild end-organ injury, had the best outcomes. Peripheral cannulation decreases the surgical trauma and makes emergency implantation possible, even in the intensive care unit.
  
  Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
  
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• The trans-subclavian retrograde approach for transcatheter aortic valve replacement: single-center experience.
  J Thorac Cardiovasc Surg

  2010 Oct;140(4):911-5, 915.e1-2. doi: 10.1016/j.jtcvs.2010.01.027.
  
  Bruschi Giuseppe, Fratto Pasquale, De Marco Federico, Oreglia Jacopo, Colombo Paola, Botta Luca, Cannata Aldo, Moreo Antonella, De Chiara Benedetta, Lullo Francesca, Paino Roberto, Martinelli Luigi, Klugmann Silvio
  
  Abstract
  
  OBJECTIVE:
  Aortic valve disease is the most common acquired valvular heart disease in adults. With the increasing elderly population, the proportion of patients with symptomatic aortic stenosis who are unsuitable for conventional surgery is increasing. Transcatheter aortic valve implantation has rapidly gained credibility as a valuable alternative to surgery to treat these patients; however, they often have severe iliac-femoral arteriopathy, which renders the transfemoral approach unusable. We report our experience with the trans-subclavian approach for transcatheter aortic valve implantation using the CoreValve (Medtronic CV Luxembourg S.a.r.l.) in 6 patients.
  
  METHODS:
  In May 2008 to September 2009, 6 patients (mean age of 82 ± 5 years), with symptomatic aortic stenosis and no reasonable surgical option because of excessive risk, were excluded from percutaneous femoral CoreValve implantation because of iliac-femoral arteriopathy. These patients underwent transcatheter aortic valve implantation via the axillary artery. Procedures were performed by a combined team of cardiologists, cardiac surgeons, and anesthetists in the catheterization laboratory. The CoreValve 18F delivery system was introduced via the left subclavian artery in 6 patients, 1 with a patent left internal thoracic to left anterior descending artery graft.
  
  RESULTS:
  Procedural success was obtained in all patients, and the mean aortic gradient decreased 5 mm Hg or less immediately after valve deployment. One patient required implantation of a permanent pacemaker. One patient required a subclavian covered stent implantation to treat a postimplant artery dissection associated with difficult surgical hemostasis. One patient was discharged in good condition but died of pneumonia 40 days after the procedure. All patients were asymptomatic on discharge, with good mid-term prosthesis performance.
  
  CONCLUSIONS:
  Transcatheter aortic valve implantation via a surgical subclavian approach seems safe and feasible, offering a new option to treat select, inoperable, and high-risk patients with severe aortic stenosis and peripheral vasculopathy.
  
  Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
  
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• Relationship between bicuspid aortic valve morphology and aortic wall degeneration: further evidence is emerging.
  Echocardiography

  2010 Sep;27(8):1028; author reply 1029. doi: 10.1111/j.1540-8175.2010.01265.x.
  
  Cannata Aldo, Russo Claudio Francesco, Martinelli Luigi
  
  
  
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• Destruction of the tricuspid septal leaflet: correction by bicuspidization.
  Ann Thorac Surg

  2010 Sep;90(3):1028-9. doi: 10.1016/j.athoracsur.2009.10.075.
  
  Russo Claudio F, Cannata Aldo, Lanfranconi Marco, Martinelli Luigi
  
  Abstract
  
  We describe a surgical technique to repair severe tricuspid valve regurgitation secondary to loss of the septal leaflet. Tricuspid valve competency is obtained by means of mobilization of the anterior and posterior leaflets.
  
  2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
  
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• Cavernous hemangioma replacing the septal leaflet of the tricuspid valve.
  J Card Surg

  2010 Sep;25(5):524-7. doi: 10.1111/j.1540-8191.2010.01064.x.
  
  Cannata Aldo, Russo Claudio F, Merlanti Bruno, Pedrotti Patrizia, Moreo Antonella, Botta Luca, Martinelli Luigi
  
  Abstract
  
  Heart valve hemangioma is a rare finding. Here, we report a case of a hemangioma completely replacing the septal leaflet of the tricuspid valve. Preoperative imaging studies and operative anatomy are described.
  
  © 2010 Wiley Periodicals, Inc.
  
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• Off-pump coronary revascularization in chronic dialysis-dependent patients: early outcomes at a single institution.
  J Cardiovasc Med (Hagerstown)

  2010 Jul;11(7):481-7.
  
  Bruschi Giuseppe, Colombo Tiziano, Botta Luca, Colombo Paola, Pelenghi Stefano, Trunfio Salvatore, Cannata Aldo, Merlanti Bruno, Paino Roberto, Klugmann Silvio, Martinelli Luigi
  
  Abstract
  
  INTRODUCTION:
  Atherosclerotic vascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease. Several authors reported that chronic dialytic patients have a high operative risk when submitted to coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB) whereas little information exists about off-pump myocardial revascularization in these patients.
  
  MATERIAL AND METHODS:
  Between January 2000 and December 2008, 17 consecutive patients (12 men, mean age of 62.3 +/- 12.3 years) with end-stage renal failure maintained on chronic hemodialysis underwent isolated off-pump CABG at our center. To evaluate this approach we compared the outcomes of off-pump revascularization with those obtained in the same period in 23 patients (20 men, mean age of 64.0 +/- 9.7 years), with the same preoperative features, who underwent conventional CABG on the arrested heart using CPB.
  
  RESULTS:
  Off-pump revascularization in end-stage renal disease patients showed a satisfactory incidence of mortality and morbidity rates. When compared with conventional CPB CABG group, off-pump patients had a lower incidence of bleeding, transfusions, ventilation support time, length of inotropic support and perioperative myocardial infarction. Also ICU and hospital stay and incidence of new-onset atrial fibrillation were lower in off-pump CABG patients.
  
  CONCLUSION:
  In our experience, avoidance of CPB in end-stage renal disease patients was associated with an acceptable incidence of postoperative complications and of major adverse events. Off-pump CABG is a safe and effective method of myocardial revascularization in chronically dialyzed patients that should strongly be taken in consideration when planning the surgical strategy in this selected cohort of patients, although multicentric prospective randomized controlled trials are strongly recommended.
  
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• Early expression of pro- and anti-inflammatory cytokines in left ventricular assist device recipients with multiple organ failure syndrome.
  ASAIO J

  2010 ;56(4):313-8. doi: 10.1097/MAT.0b013e3181de3049.
  
  Caruso Raffaele, Trunfio Salvatore, Milazzo Filippo, Campolo Jonica, De Maria Renata, Colombo Tiziano, Parolini Marina, Cannata Aldo, Russo Claudio, Paino Roberto, Frigerio Maria, Martinelli Luigi, Parodi Oberdan
  
  Abstract
  
  To assess whether the combined evaluation of total Sequential Organ Failure Assessment (t-SOFA) score and pro- and anti-inflammatory cytokine profiles early after left ventricular assist device (LVAD) implant discriminates patients at high risk for multiple organ failure syndrome (MOFS) in the first month post-LVAD, we analyzed plasma interleukin (IL)-6, IL-8, IL-10, IL-1ra, IL-1beta, tumor necrosis factor-alpha (TNF-alpha), and urine neopterin levels before (day 0) and at 4 hours, 1, 3, 7, 14, and 30 days after LVAD implant in 23 recipients. Eight patients died of MOFS between days 7 and 30 (nonsurvivors). At preimplant, only blood urea nitrogen and age were higher in nonsurvivors than survivors. At 4 hours, IL-8, IL-10, and IL1-ra levels were higher in nonsurvivors than in survivors; t-SOFA was also higher and peaked on day 3 in nonsurvivors. Only IL-8 levels on day 1 were significantly associated with a t-SOFA > or =10 on day 3 (odds ratio 1.10, 95% confidence interval 1.01-1.21, p = 0.04). Neopterin, marker of monocyte activation, increased significantly only in nonsurvivors (p
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• Beating heart mitral valve surgery: innovation or back to the past?
  J Card Surg

  2010 May;25(3):318; author reply 318-9. doi: 10.1111/j.1540-8191.2010.00998_1.x.
  
  Botta Luca, Cannata Aldo, Bruschi Giuseppe, Fratto Pasquale, Martinelli Luigi
  
  
  
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• The E-vita prosthesis for challenging operations on the thoracic aorta.
  Eur J Cardiothorac Surg

  2009 Dec;36(6):1084; author reply 1085. doi: 10.1016/j.ejcts.2009.06.023.
  
  Botta Luca, Cannata Aldo, Martinelli Luigi
  
  
  
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• Use of CoSeal in a patient with a left ventricular assist device.
  Ann Thorac Surg

  2009 Jun;87(6):1956-8. doi: 10.1016/j.athoracsur.2008.10.042.
  
  Cannata Aldo, Taglieri Corrado, Russo Claudio F, Bruschi Giuseppe, Martinelli Luigi
  
  Abstract
  
  A 45-year-old man with end-stage idiopathic dilatated cardiomyopathy had previously undergone two left anterolateral thoracotomies for implantation and explantation of a left ventricular epicardial lead for biventricular pacing. Because of worsening heart failure and a predicted long delay to heart transplantation, a left-ventricular assist device was implanted, with application of CoSeal surgical sealant (Baxter Healthcare Corp, Fremont, CA) on the cardiac surface. At re-sternotomy for heart transplantation, surgical dissection of the left-ventricular assist device was greatly facilitated by the presence of avascular, very loose adhesions. CoSeal (Baxter Healthcare Corp) seems to be useful for the inhibition of adhesion formation after left-ventricular assist device implantation, although further clinical experience with this approach is required.
  
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• Technique to prevent inadvertent paramedian sternotomy.
  J Card Surg

  2009 ;24(3):290-1. doi: 10.1111/j.1540-8191.2009.00830.x.
  
  Cannata Aldo, Russo Claudio Francesco, Vitali Ettore, Bruschi Giuseppe
  
  Abstract
  
  Previous reports documented the relationship between inadvertent paramedian sternotomy and postoperative sternal instability and dehiscence.We describe a modification of the technique of median sternotomy in order to prevent inadvertent paramedian sternotomy and related wound complications.
  
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• Prevention of limb ischemia and edema during peripheral venoarterial extracorporeal membrane oxygenation in adults.
  J Card Surg

  2009 ;24(2):185-7. doi: 10.1111/j.1540-8191.2009.00829.x.
  
  Russo Claudio F, Cannata Aldo, Vitali Ettore, Lanfranconi Marco
  
  Abstract
  
  Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a mechanical circulatory support indicated for the advanced treatment of refractory heart failure. The cannulation of the femoral vessels may be complicated by distal limb ischemia by arterial hypoperfusion and severe edema by venous obstruction. We describe a modified cannulation technique in order to prevent ischemia and edema of the inferior limb during VA-ECMO.
  
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• Aortic valve replacement dilemma: mechanical or biological prosthesis?
  J Thorac Cardiovasc Surg

  2008 Oct;136(4):1101-2; author reply 1102. doi: 10.1016/j.jtcvs.2008.05.025.
  
  Cannata Aldo, Russo Claudio Francesco, Taglieri Corrado
  
  
  
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• Is aortic wall degeneration related to bicuspid aortic valve anatomy in patients with valvular disease?
  J Thorac Cardiovasc Surg

  2008 Oct;136(4):937-42. doi: 10.1016/j.jtcvs.2007.11.072.
  
  Russo Claudio F, Cannata Aldo, Lanfranconi Marco, Vitali Ettore, Garatti Andrea, Bonacina Edgardo
  
  Abstract
  
  OBJECTIVE:
  Patients with bicuspid aortic valve are at increased risk for aortic complications.
  
  METHODS:
  A total of 115 consecutive patients with bicuspid aortic valve disease underwent surgery of the ascending aorta. We classified the cusp configuration by 3 types: fusion of left coronary and right coronary cusps (type A), fusion of right coronary and noncoronary cusps (type B), and fusion of left coronary and noncoronary cusps (type C). Histopathologic changes in the ascending aortic wall were graded (aortic wall score).
  
  RESULTS:
  We observed type A fusion in 85 patients (73.9%), type B fusion in 28 patients (24.3%), and type C fusion in 2 patients (1.8%). Patients with type A fusion were younger at operation than patients with type B fusion (51.3 +/- 15.5 years vs 58.7 +/- 7.6 years, respectively; P = .034). The mean ascending aorta diameter was 48.9 +/- 5.0 mm and 48.7 +/- 5.7 mm in type A and type B fusion groups, respectively (P = .34). The mean aortic root diameter was significantly larger in type A fusion (4.9 +/- 6.7 mm vs 32.7 +/- 2.8 mm; P
  CONCLUSION:
  In diseased bicuspid aortic valves, there was a statistically significant association between type A valve anatomy and a more severe degree of wall degeneration in the ascending aorta and dilatation of the aortic root at younger age compared with type B valve anatomy.
  
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• Bicuspid aortic valve: about natural history of ascending aorta aneurysms.
  Ann Thorac Surg

  2008 Jan;85(1):362-3.
  
  Cannata Aldo, Russo Claudio Francesco, Vitali Ettore
  
  
  
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• Surgical repair of left ventricle to coronary sinus fistula complicating mitral valve replacement.
  J Cardiovasc Med (Hagerstown)

  2007 Oct;8(10):864-5.
  
  Marianeschi Stefano Maria, Cannata Aldo, Catena Emanuele, Tarelli Giuseppe, Vitali Ettore
  
  Abstract
  
  We report the case of a 55-year-old female patient who underwent reoperation because of left ventricular to coronary sinus fistula following previous mitral valve replacement. The fistula was closed surgically with a patch of heterologous bovine pericardium. The postoperative course was uneventful and the patient is recovering well 12 months after the operation.
  
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• Asymptomatic aortic valve stenosis: to operate or not to operate?
  Ann Thorac Surg

  2007 Jul;84(1):355-6; author reply 356-7.
  
  Cannata Aldo, Fratto Pasquale, Vitali Ettore
  
  
  
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• Effectiveness of hyperbaric oxygen therapy for hearing loss after cardiac surgery.
  Ann Thorac Surg

  2007 May;83(5):e9-10.
  
  Bruschi Giuseppe, Tarelli Giuseppe, Colombo Paola, Cavallazzi Giuseppe, Cannata Aldo, Garatti Andrea, Vitali Ettore
  
  Abstract
  
  Sudden sensorineural hearing loss is a rare complication after cardiac surgery with extracorporeal circulation. We report a case of a 60-year-old man who experienced severe sensorineural hearing loss after Bentall procedure and recovery of normal hearing after 20 days of hyperbaric oxygen therapy.
  
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• About left atrial enlargement in dilated cardiomyopathy.
  J Am Soc Echocardiogr

  2007 Feb;20(2):210.
  
  Cannata Aldo, Russo Claudio Francesco, Vitali Ettore
  
  
  
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• Left ventricular support by axial flow pump: the echocardiographic approach to device malfunction.
  J Am Soc Echocardiogr

  2005 Dec;18(12):1422.
  
  Catena Emanuele, Milazzo Filippo, Montorsi Emanuela, Bruschi Giuseppe, Cannata Aldo, Russo Claudio, Barosi Alberto, Tarelli Giuseppe, Tartara Paolo, Paino Roberto, Vitali Ettore
  
  Abstract
  
  Axial flow pumps have gained increased acceptance in recent years as a bridge to heart transplantation and, more recently, as destination therapy. As left ventricular (LV) assist device dysfunction will be increasingly prevalent, the aim of our work was to introduce an echocardiographic management protocol as a guide to recognize the causes of pump failure. In this article we describe the echocardiographic approach to 5 episodes of malfunction of an axial flow pump (DeBakey, MicroMed Technology Inc, Houston, Tex) in 4 patients: 4 episodes caused by thrombosis of LV assist device and one caused by abnormal increase of systemic vascular resistance. In our experience, echocardiography played a pivotal role in clinical management of LV assist device failure. It allowed us to: assess patency and position of inflow and outflow cannulae; research the source of thromboembolic material; assess adequate LV filling and unloading; and optimize right ventricular function, volume replacement therapy, and pharmacologic support.
  
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• Preoperative assessment of the radial artery for coronary artery bypass grafting: is the clinical Allen test adequate?
  Ann Thorac Surg

  2005 Feb;79(2):570-2.
  
  Agrifoglio Marco, Dainese Luca, Pasotti Stefano, Galanti Andrea, Cannata Aldo, Roberto Maurizio, Parolari Alessandro, Biglioli Paolo
  
  Abstract
  
  BACKGROUND:
  The clinical Allen test (AT) is widely adopted as the only preoperative assessment of the hand collateral circulation before radial artery (RA) harvest as a coronary artery bypass graft. Nevertheless, in some cases it may be misleading because of clinically undetectable anatomic anomalies of the forearm arteries.
  
  METHODS:
  We evaluated the nondominant forearm arterial circulation by echo color Doppler (ECD) technique and by performing static and dynamic tests such as the AT, snuffbox test (SBT), and palmar arch test (PAT) in 150 patients who underwent elective coronary artery revascularization with a RA graft.
  
  RESULTS:
  Although the clinical AT was normal in all patients, in 8 patients (5.3%) preoperative ECD AT, SBT, and PAT did contraindicate RA harvesting. We did not harvest the RA in these patients. In the remaining 142 patients the RA was harvested. We did not observe any case of postoperative forearm or hand ischemia. We examined the blood flow to the hand in all patients at both 5 days and 24 months after surgery. In all patients ECD showed adequate hand perfusion and a significant increase of the peak flow velocity in the ulnar artery at both follow-up times.
  
  CONCLUSIONS:
  The clinical AT may be not sufficient to assess the hand collateral flow and the quality of the RA as a coronary artery bypass graft in at least 5% of patients. The ECD technique, performed during static and dynamic tests, does offer a safer and more objective preoperative noninvasive evaluation and it may have an important role also from the medicolegal point of view.
  
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• Autologous peripheral blood stem cell transplantation for myocardial regeneration: a novel strategy for cell collection and surgical injection.
  Ann Thorac Surg

  2004 Nov;78(5):1808-12.
  
  Pompilio Giulio, Cannata Aldo, Peccatori Fedro, Bertolini Francesco, Nascimbene Angelo, Capogrossi Maurizio C, Biglioli Paolo
  
  Abstract
  
  PURPOSE:
  Bone-marrow and peripheral blood-derived stem cells can be used as stimulators of myogenesis and angiogenesis. We describe an original technique for collection and surgical intramyocardial injection of peripheral blood-derived stem cells.
  
  DESCRIPTION:
  Stem cells are mobilized from the bone marrow by means of subcutaneous administration of Lenogastrim (Granocyte 34 [Aventis Pharma, Milan, Italy]) for 4 days. Then the day before the operation the peripheral blood-derived stem cells are collected by means of apheresis and processed in order to obtain the CD 133+ cells. Cells are injected into the myocardium in a beating heart in order to induce angiogenesis locally or myogenesis, or both. When necessary, off-pump coronary artery bypass grafting is previously accomplished.
  
  EVALUATION:
  Thus far we have investigated 4 patients (3 patients who have received off-pump peripheral blood stem cell injection and coronary bypass grafting through median sternotomies, and 1 patient who underwent cell transplant alone through a minimally-invasive transdiaphragmatic approach). No complications were noted at a mean of 4 months after surgery.
  
  CONCLUSIONS:
  This novel method of peripheral bone marrow stem cell collection and intramyocardial injection seems to be safe, feasible, and reproducible. However, there is need of further evidence to definitely assess safety issues and clinical results.
  
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• Endothelial progenitor cells: a potential versatile tool for the treatment of ischemic cardiomyopathies -- a clinician's point of view.
  Int J Cardiol

  2004 Jun;95 Suppl 1():S34-7.
  
  Pompilio Giulio, Capogrossi Maurizio C, Cannata Aldo, Galanti Andrea, Biglioli Paolo
  
  
  
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• Biological effects of coronary surgery: role of surgical trauma and CPB.
  Eur J Cardiothorac Surg

  2004 Sep;26(3):664; author reply 664-5.
  
  Cannata Aldo, Biglioli Paolo, Tremoli Elena, Parolari Alessandro
  
  
  
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• Long-term outcomes of the Carpentier-Edwards pericardial valve prosthesis in the aortic position: effect of patient age.
  J Heart Valve Dis

  2004 May;13 Suppl 1():S49-51.
  
  Biglioli Paolo, Spampinato Nicola, Cannata Aldo, Musumeci Antonino, Parolari Alessandro, Gagliardi Cesare, Alamanni Francesco
  
  
  
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• Upper and lower spinal cord blood supply: the continuity of the anterior spinal artery and the relevance of the lumbar arteries.
  J Thorac Cardiovasc Surg

  2004 Apr;127(4):1188-92.
  
  Biglioli Paolo, Roberto Maurizio, Cannata Aldo, Parolari Alessandro, Fumero Andrea, Grillo Francesco, Maggioni Marco, Coggi Guido, Spirito Rita
  
  Abstract
  
  OBJECTIVE:
  Thoracic and thoracoabdominal aortic repair are still complicated by spinal cord ischemia and paraplegia. The aim of the present article is to present the results of an anatomical study conducted by means of both postmortem injection of the vertebral artery and perfusion of the abdominal aorta.
  
  METHODS:
  The spinal cord blood supply was investigated in 51 Caucasian cadavers: in 40 cases a methylene blue solution was hand-injected into the vertebral artery, whereas in the remaining 11 cases the abdominal aorta was perfused with a methylene blue solution by means of a roller pump. The level and side of the arteria radicularis magna and the continuity of the anterior spinal artery were recorded.
  
  RESULTS:
  The anterior spinal artery was a continuous vessel without interruptions along the spinal cord in all 51 cases. The arteria radicularis magna level was variable, ranging from T9 to L5. The arteria radicularis magna arose from a lumbar artery in 36 cases (70.5%) and it was left-sided in 32 cases (62.7%).
  
  CONCLUSIONS:
  The anterior spinal artery constitutes an uninterrupted pathway between the vertebral arteries, the arteria radicularis magna, and the posterior intercostal and lumbar arteries. Moreover, the arteria radicularis magna arises from a lumbar artery in most of cases. Therefore, the sacrifice of the intercostal arteries during a thoracic aorta repair could be justified, at least from an anatomical standpoint. However, if an extended thoracoabdominal aortic repair is planned, it may be prudent to preserve the blood flow from the lumbar arteries.
  
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• Statins in coronary bypass surgery: rationale and clinical use.
  Ann Thorac Surg

  2003 Dec;76(6):2132-40.
  
  Werba José Pablo, Tremoli Elena, Massironi Paola, Camera Marina, Cannata Aldo, Alamanni Francesco, Biglioli Paolo, Parolari Alessandro
  
  Abstract
  
  Statin therapy prevents the first occurrence and recurrence of coronary events and reduces cardiovascular and general mortality in patients with coronary artery disease. These compounds modulate a variety of processes involved in the pathophysiology of arteriosclerosis and vascular graft disease by lipid-dependent and lipid-independent (pleiotropic) mechanisms. As a result, statins produce angiographic and clinical benefits in patients undergoing coronary bypass surgery. We review the present knowledge about the effects of statins on this pathologic condition and the evidence supporting an early treatment initiation.
  
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• Biological effects of off-pump vs. on-pump coronary artery surgery: focus on inflammation, hemostasis and oxidative stress.
  Eur J Cardiothorac Surg

  2003 Aug;24(2):260-9.
  
  Biglioli Paolo, Cannata Aldo, Alamanni Francesco, Naliato Moreno, Porqueddu Massimo, Zanobini Marco, Tremoli Elena, Parolari Alessandro
  
  Abstract
  
  Cardiopulmonary bypass (CPB) has been recognized as a cause of complex systemic inflammatory response, which significantly contributes to several adverse postoperative complications. In the last few years, off-pump coronary artery bypass grafting has gained widespread diffusion as an alternative technique to conventional on-pump coronary artery bypass grafting. Surgeons supporting off-pump surgery state that the avoidance of the CPB and myocardial ischemia-reperfusion significantly reduces the postoperative systemic inflammatory response and other biological derangements and, possibly, may improve the clinical outcomes. We review, here, the available evidence concerning possible differences between off-pump and on-pump procedures in terms of inflammation, hemostasis and oxidative stress. Consistent differences in the involvement of these systems are observed, but they are limited to the final steps of the surgical procedures and the early hours after. These findings suggest that the global surgical trauma may be as important, or even more, as the CPB in terms of systemic inflammatory and coagulation-fibrinolytic pathway activation. Further studies are needed in order to confirm this hypothesis.
  
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• Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials.
  Ann Thorac Surg

  2003 Jul;76(1):37-40.
  
  Parolari Alessandro, Alamanni Francesco, Cannata Aldo, Naliato Moreno, Bonati Luigi, Rubini Patrizia, Veglia Fabrizio, Tremoli Elena, Biglioli Paolo
  
  Abstract
  
  BACKGROUND:
  Off-pump coronary artery bypass (OPCAB) challenges the conventional on-pump coronary artery bypass grafting (CABG) as the standard of surgical therapy for coronary disease. The aim of this study is to assess the differences in clinical outcomes between CABG and OPCAB by meta-analysis of data published in randomized trials.
  
  METHODS:
  A literature search (Medline, Pubmed, Cochrane Controlled Trials Register, and the Cochrane Medical Editors Trial Amnesty of unpublished clinical trials) was done for the period starting from January 1990 until May 2002 and was supplemented with a manual bibliographic review for all peer-reviewed English language publications. A systematic overview (meta-analysis) of the randomized trials was done to define the risk of the composite end point (death, stroke, or myocardial infarction) in CABG versus OPCAB.
  
  RESULTS:
  A literature search yielded nine comparable randomized studies, for a total of 1090 patients, of whom 558 and 532 were randomly assigned to CABG and OPCAB, respectively. Meta-analysis of these studies showed a trend, albeit not statistically significant, toward reduction in the risk of the composite end point for patients who had OPCAB (odds ratio 0.48; 95% confidence interval 0.21 to 1.09; p = 0.08).
  
  CONCLUSIONS:
  Cumulative analysis of the few prospective randomized studies currently available found a potential clinical benefit of OPCAB, indicating that the avoidance of extracorporeal circulation might result in improved clinical outcomes. Further evidence, however, from large randomized trials is needed to assess potential advantages of OPCAB in terms of early outcomes.
  
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• [Autologous cellular cardiomyoplasty in humans: can we hit the mark?].
  Ital Heart J Suppl

  2002 Dec;3(12):1188-97.
  
  Pompilio Giulio, Cannata Aldo, Capogrossi Maurizio C, Alamanni Francesco, Pesce Maurizio, Germani Antonia, Biglioli Paolo
  
  Abstract
  
  Myocardial cell therapy is a new promising therapeutic option for patients with heart failure. In this paper, we review the main experimental evidences and the first clinical researches in this field. Moreover, a comment on the theoretical and practical aspects for a pilot clinical use and a glance to the future are also provided.
  
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• Acute effects of 17beta-estradiol on left internal mammary graft after coronary artery bypass grafting.
  Ann Thorac Surg

  2002 Sep;74(3):695-9.
  
  Polvani Gianluca, Marino Maria Rosa, Roberto Maurizio, Dainese Luca, Parolari Alessandro, Pompilio Giulio, Di Matteo Silvia, Fumero Andrea, Cannata Aldo, Barili Fabio, Biglioli Paolo
  
  Abstract
  
  BACKGROUND:
  Vasospasm of arterial conduits used for coronary surgical procedures is an important cause of postoperative graft failure. Mounting experimental evidence suggests that estrogen reverses acetylcholine-induced vasospasm of the coronary arteries in animals and humans. Estrogen also affects endothelium-derived constrictor factors. We therefore investigated the in vivo vasomotor responses to transdermal 17beta-estradiol of the left internal mammary artery (LIMA) grafted on the anterior descending coronary artery.
  
  METHODS:
  We studied 20 women, mean age of 62 +/- 7.2 years (range, 48 to 73 years), who had undergone cardiopulmonary bypass for coronary artery bypass grafting. They received transdermal 17beta-estradiol on the fifth day after operation. The diameter, cross-sectional area, and blood flow of the LIMA graft were measured by transthoracic color Doppler echography before (basal values) and after the transdermal administration of 50 microg of 17beta-estradiol (control).
  
  RESULTS:
  LIMA graft vasodilation after the administration of 17beta-estradiol was observed. A significant increase in diameter (2.06 +/- 0.4 mm versus 2.37 +/- 0.28 mm; p = 0.035) and cross-sectional area (3.45 +/- 1. 2 mm2 versus 4.24 +/- 1 mm2; p = 0.039) was registered. The LIMA graft mean flow increased by 49% (44.76 +/- 27.19 mL/min versus 56.62 +/- 27.69 mL/min), but this increase was not statistically significant (p = 0.06).
  
  CONCLUSIONS:
  The acute postoperative transdermal administration of 17beta-estradiol induced a significant increase of LIMA graft diameter and cross-sectional area in postmenopausal women who underwent coronary artery bypass grafting. The LIMA graft vasodilation was also associated with an improvement in LIMA blood flow.
  
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• Paraplegia after iatrogenic extrinsic spinal cord compression after descending thoracic aorta repair: case report and literature review.
  J Thorac Cardiovasc Surg

  2002 Aug;124(2):407-10.
  
  Biglioli Paolo, Roberto Maurizio, Cannata Aldo, Parolari Alessandro, Spirito Rita
  
  
  
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• Endothelial damage during myocardial preservation and storage.
  Ann Thorac Surg

  2002 Feb;73(2):682-90.
  
  Parolari Alessandro, Rubini Patrizia, Cannata Aldo, Bonati Luigi, Alamanni Francesco, Tremoli Elena, Biglioli Paolo
  
  Abstract
  
  Preservation and storage techniques represent two major issues in routine cardiac surgery and heart transplantation. Historically, these methods were conceived to prevent ischemic injury to myocardium after cardiac arrest during heart operations. Evidence shows that endothelium plays a critical role in the maintenance of normal heart function after cardiac operation, mainly by controlling the coronary circulation. Methods for preservation and storage, developed initially to protect cardiomyocyte function, may be deleterious for vascular endothelium and compromise myocardial protection. In this review article the present knowledge about endothelial injury secondary to preservation and storage techniques is discussed.
  
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