Papers by Federico Ranocchi
![Research paper thumbnail of [Non-bacterial thrombotic endocarditis: a rare case of recurrent embolic events]](https://a.academia-assets.com/images/blank-paper.jpg)
Italian Heart Journal Supplement Official Journal of the Italian Federation of Cardiology, Dec 1, 2002
Non bacterial thrombotic endocarditis is a rare disease. The real incidence is not known and seem... more Non bacterial thrombotic endocarditis is a rare disease. The real incidence is not known and seems to range from 0.9 to 9.3%. Generally it is associated with cancer and rarely diagnosed antemortem. We describe the case of a female patient who suffered from ictus cerebri and acute myocardial infarction. She was admitted with diagnosis of papillary fibroelastoma arising from the right aortic leaflet. Her past medical history was characterized by gastrectomy, splenectomy and partial pancreatectomy for gastric cancer. The patient underwent successful resection of the mass that was attached to the right leaflet of the aortic valve closed to the aortic annulus. The histopathological examination revealed a mass composed of only thrombotic material. At the follow-up 1 year later the patient was in good clinical conditions (NYHA functional class I). Transthoracic echocardiography showed a good ventricular function, a continent aortic valve without recurrent mass. The suspicion of non bacterial thrombotic endocarditis should be aroused when diagnosis of endocardial mass is made in patients with previous cancers.
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2015
During the past years, a rapid development and refinements of robotic heart valve techniques have... more During the past years, a rapid development and refinements of robotic heart valve techniques have led to consider robotic mitral valve (MV) surgery safe, effective, and durable. Robotic MV surgery has proven to be a cost-effective and cost-saving strategy in MV operations, being associated with reduced morbidity and mortality rates. We present a novel video-assisted transareolar approach to access the MV using the da Vinci Si HD telemanipulation system (Intuitive Surgical, Inc, Sunnyvale, CA USA). This technique is effective and reproducible, providing maximum patient satisfaction from both the clinical and cosmetic points of view.
Introduzione: Limiti di un efficace trattamento dello scompenso cardiaco avanzato sono l'eventual... more Introduzione: Limiti di un efficace trattamento dello scompenso cardiaco avanzato sono l'eventuale refrattarietà alla terapia medica ed il povero numero di donazioni disponibili per trapianto cardiaco. Attualmente, in pazienti instabili, i sistemi di assistenza ventricolare (VAD) offrono un'efficace soluzione come ponte al trapianto cardiaco. Riportiamo la nostra esperienza con l'uso di VAD a flusso continuo e pulsatile per supporto a medio e lungo termine. Metodi: Dal Marzo 2002 al Luglio 2008, presso la nostra unità operativa, 32 pazienti adulti candidati a trapianto cardiaco hanno avuto impiantato un sistema di assistenza ventricolare meccanica a medio-lungo termine. Assistenza isolata del ventricolo sinistro con un sistema intracorporeo (LVAD -Gruppo A) è stata eseguita in 22 pazienti (16 HeartMate II: 13 uomini, età 52±6.5 (range 41-64) anni; 6 HeartMate I XVE: 5 uomini, età 52.5± 9.1 (range 38-61) anni). Assistenza biventricolare (BVAD -Gruppo B) è stata eseguita in 10 pazienti (9 Thoratec paracorporeo; 7 uomini, età 46.5±11.9 (range 23-63 anni) e 1 Thoratec impiantabile; uomo, 42 anni). Indicazione all'impianto sono state cardiomiopatia (CMP) ischemica (n=17), CMP idiopatica (n=13), CMP restrittiva (n=1), CMP post-miocardite (n=1). Risultati: La durata media del supporto ventricolare è stata di 227±214.4 giorni nel Gruppo A (range: 1-665 giorni) e 85±72.6 giorni nel Gruppo B (range: 8-235 giorni). La mortalità precoce (a 30 giorni) è stata di 31.2% (10 pazienti). Cinque pazienti erano nel Gruppo A e 5 nel Gruppo B. La sepsi è stata la causa principale di morte. Il reintervento per sanguinamento si è reso necessario in 9 (28.1%) pazienti (6 nel Gruppo A e 3 nel Gruppo B). Eventi cerebrali maggiori, di natura emorragica, si sono avuti in 3 (9.3%) pazienti (1 del Gruppo A e 2 del Gruppo B). Altre complicanze sono state l'infezioni del cavo percutaneo di alimentazione (2 pazienti del Gruppo A) e la disfunzione di macchina (1 paziente Gruppo A, HeartMate I LVAS). In totale 19 (59.3%) pazienti sono stati trapiantati (13 pazienti del Gruppo A e 6 del Gruppo B) e 3 pazienti (9.3%) sono attualmente in attesa di trapianto (3 pazienti del Gruppo A). All'ultimo follow-up la sopravvivenza dopo trapianto è del 63.1% (8 pazienti del Gruppo A e 4 del Gruppo B). Conclusioni: I sistemi VAD risultano efficaci come ponte al trapianto cardiaco. La tecnologia attuale offre buoni risultati a medio-lungo termine. Questo supporta anche la possibilità di sfruttare tali dispositivi come supporto meccanico permanente in pazienti non trapiantabili. In futuro i sistemi VAD potrebbero diventare totalmente impiantabili e costituire una reale alternativa al trapianto cardiaco.
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2002
Non bacterial thrombotic endocarditis is a rare disease. The real incidence is not known and seem... more Non bacterial thrombotic endocarditis is a rare disease. The real incidence is not known and seems to range from 0.9 to 9.3%. Generally it is associated with cancer and rarely diagnosed antemortem. We describe the case of a female patient who suffered from ictus cerebri and acute myocardial infarction. She was admitted with diagnosis of papillary fibroelastoma arising from the right aortic leaflet. Her past medical history was characterized by gastrectomy, splenectomy and partial pancreatectomy for gastric cancer. The patient underwent successful resection of the mass that was attached to the right leaflet of the aortic valve closed to the aortic annulus. The histopathological examination revealed a mass composed of only thrombotic material. At the follow-up 1 year later the patient was in good clinical conditions (NYHA functional class I). Transthoracic echocardiography showed a good ventricular function, a continent aortic valve without recurrent mass. The suspicion of non bacteri...
Innovations (Philadelphia, Pa.), 2010
Objective: Video-assisted minimally invasive mitral valve surgery can be performed through differ... more Objective: Video-assisted minimally invasive mitral valve surgery can be performed through different approaches. The aim of the study was to report our early results and compare the external transthoracic aortic clamping with the endoaortic balloon occlusion techniques according to our experience. patients (103 women, aged 58.4 Ϯ 10.2 years) underwent video-assisted mitral valve surgery through a right thoracotomy. Cardiopulmonary bypass was instituted by femoral arterial and bicaval cannulation with active venous drainage and normothermia; cardioplegic arrest achieved with intermittent blood cardioplegia. In group A (93 patients, 68 women, aged 58.8 Ϯ 7.8 years, 72 MV replacement, 21 MV repair), aortic clamping was achieved using the external transthoracic aortic clamp. In group B (45 patients, 35 women, aged 58.1 Ϯ 11.4 years, 33 MV replacement, 12 MV repair), aortic clamping was achieved with endoaortic balloon occlusion. Results: Intraoperative procedure-associated problems were experienced in one patient (0.7%) in group A (one conversion to sternotomy for pleural adhesions and bad exposure). At a mean follow-up of 36 Ϯ 18 months, 135 patients (97.8%) were in New York Heart Association class I to II, with satisfactory echocardiographic follow-up. In group A, two patients had noncardiacrelated deaths. No perioperative deaths were observed in both groups. There were four (2.8%) transient ischemic attacks and one (0.7%) peripheral ischemic event (group A) during the early postoperative period. Mitral valve repair patients had a 5-year freedom from reoperation of 100% in both groups. There was no significant difference between the two groups regarding preop-erative variables, such as age, sex, New York Heart Association class, and left ventricular ejection fraction (P Ͼ 0.05). Postoperative levels of myocardial cytonecrosis enzymes (MB fraction, creatine kinase, and troponine I) as well as operative time, extracorporeal circulation, and aortic cross-clamping times or ventilation and intensive care unit times were not significantly different between the two groups (P Ͼ 0.05). More microembolic events were observed in group A than in group B (total 143.4 Ϯ 30.6 per patient vs 78.9 Ϯ 28.6 per patient) by means of continuous automated intraoperative transcranial Doppler evaluations (P Ͻ 0.05) applied to part of population. Conclusions: Both techniques proved safe and comparable with low risk of morbidity and mortality. Patients undergoing endoclamp technique resulted to be less subject to embolism.
Journal of Cardiovascular Medicine, 2011
A rare cause of valvular heart disease is the deposition of foreign material in the valvular tiss... more A rare cause of valvular heart disease is the deposition of foreign material in the valvular tissues, including material accumulating as a result of inborn errors of metabolism of the essential amino acids. Alkaptonuria can result in accumulation of homogentisic acid. We report the case of a patient with alkaptonuria undergoing surgery for aortic valve replacement.
Journal of cardiovascular medicine (Hagerstown, Md.), 2009
The excellent results with left ventricular assist devices (LVADs) have revolutionized the treatm... more The excellent results with left ventricular assist devices (LVADs) have revolutionized the treatment options for end-stage heart failure. The use of pulsatile devices is associated with significant comorbidity and limited durability. The axial-flow HeartMate II LVAD represents the new generation of devices. The clinical use of this pump resulted in superior outcomes. We review the HeartMate II technology, management, clinical usage and our experience. Between 3/2002 and 12/2008, 18 transplantable adult patients were supported on long-term HeartMate II LVAD at our institution (13 men, age 52 +/- 8.4 years, range: 31-64 years). Primary indications were: ischemic cardiomyopathy (CMP) (n = 13), idiopathic CMP (n = 5). All patients were in New York Heart Association (NYHA) Class IV heart failure. None of patients had prior open-heart surgery. Implantation via cannulation of the left ventricular apex and the ascending aorta was always elective. Mean support time was 217 +/- 212.3 days (ra...
Transplantation Proceedings, 2009
Background. The use of left ventricular assist devices (LVAD) is an accepted therapy for patients... more Background. The use of left ventricular assist devices (LVAD) is an accepted therapy for patients with refractory heart failure. The HeartMate II is a small (350 g), implantable, axial-flow pump (nonpulsatile flow), which is designed to support the left ventricle for extended periods of time. Here we have reported our initial single-center clinical experience with this device as a bridge to heart transplantation. Materials and Methods. Between March 2002 and December 2008, 18 transplantable adult patients were supported on long-term HeartMate II LVAS at our institution. The cohort included 15 men with an overall mean age of 52 Ϯ 8.4 years (range, 31-64 years). Primary indications for implantation were ischemic cardiomyopathy (CMP; n ϭ 13) and idiopathic CMP (n ϭ 5). All heart failure patients were New York Heart Association (NYHA) functional class IV. None of them had undergone prior open heart surgery. Implantation was performed via cannulation of the left ventricular apex and ascending aorta, and in each case was an elective procedure. Results. Mean support time was 217 Ϯ 212.3 days (range, 1-665 days). Early (30-day) mortality was 27.7% (n ϭ 5) due to multiple organ failure and sepsis as main causes of death. Bleeding requiring reoperation occurred in 6 cases (33.3%). Cerebral hemorrhage occurred in 1 case. There were 2 driveline infections and no device failure. Twelve subjects (66.6%) were successfully discharged home. Overall, 9 patients (50%) underwent transplantation and 3 are awaiting a suitable organ (2 were discharged home and 1 is in hospital). At latest follow-up, the survival rate after heart transplantation was 66.6% (n ϭ 6).
ASAIO Journal, 2011
The Levitronix CentriMag (Levitronix LLC, Waltham, MA) ventricular assist device (VAD) is a magne... more The Levitronix CentriMag (Levitronix LLC, Waltham, MA) ventricular assist device (VAD) is a magnetically levitated rotary pump designed for temporary extracorporeal support. Between February 2004 and May 2010, 42 consecutive adult patients were supported with Levitronix at our institution (32 men; age 62.3 ؎ 10.5 years, range: 31-76 years). Indications for support were (group A, n ؍ 37) failure to wean from the cardiopulmonary bypass in the setting of postcardiotomy (n ؍ 23), primary donor graft failure (n ؍ 4), or right ventricular failure after axial left VAD (LVAD) placement (n ؍ 10) and (group B, n ؍ 5) refractory heart failure after acute myocardial infarction. The mean support time was 11.2 ؎ 6.8 days (range: 3-43 days) in group A and 8.6 ؎ 4.3 days (range: 5-11 days) in group B. In the postcardiotomy cohort (group A), 11 (47.8%) patients were weaned from support as all were supported graft failure patients. Eight patients of axial LVAD cohort were weaned from right VAD (RVAD). One patient was bridged to heart transplantation (Htx). Thirteen (35.1%) patients died on support in group A. In group B, one patient was bridged to Htx and four died on support. In overall population, bleeding requiring reoperation occurred in 15 (35.7%) cases and cerebral major events in four (9.5%). There were no device failures. Of the 23 (54.7%) patients who recovered and were discharged home, 20 (47.6%) are presently alive, and additionally, two patients of both groups who were bridged to Htx (overall n ؍ 22, 52.3%). The Levitronix proved to be useful in patients previously considered nonsuitable for transplantation or long-term assist device. The device was technically easy to manage, and the results were encouraging. ASAIO Journal 2011; 57:247-253.
Artificial Organs, 2012
The novel Permanent Life Support (PLS; Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) as ... more The novel Permanent Life Support (PLS; Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) as peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support system has been investigated as treatment for patients with refractory cardiogenic shock (CS). Between January 2007 and July 2011, 73 consecutive adult patients were supported on peripheral PLS ECMO system at our institution (55 men; age 60.3 Ϯ 11.6 years, range: 23-84 years). Indications for support were failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n = 50) and primary donor graft failure (n = 8), post-acute myocardial infarction CS (n = 12), and CS on chronic heart failure (n = 3). Mean support time was 10.9 Ϯ 7.6 days (range: 2-34 days). Overall, 26 (35.6%) patients died on ECMO. Among survivors on ECMO, 44 (60.2%) patients were successfully weaned from support, and three (4.1%) were switched to a mid-long-term ventricular assist device. Thirty-three (45.2%) were successfully discharged. The following variables were significantly different if survivors and nonsurvivors on ECMO were compared: age (P = 0.04), female gender (P < 0.01), cardiopulmonary resuscitation before ECMO (P < 0.01), lactate level before ECMO (P = 0.01), number of platelets, fresh frozen plasma units, and packed red blood cells (PRBCs) transfused during ECMO support (P = 0.03, P = 0.02, and P < 0.01), blood lactate level (P = 0.01), and creatine kinase isoenzyme MB (CK-MB) relative index 72 h after ECMO initiation (P < 0.001), and multiple organ failure on ECMO (P < 0.01). Stepwise logistic regression identified blood lactate level and CK-MB relative index at 72 h after ECMO initiation, and number of PRBCs transfused on ECMO as significant predictors of mortality on ECMO (P = 0.011, odds ratio [OR] = 2.48; 95% confidence interval [CI] = 1.11-3.12; P = 0.012, OR = 2.81, 95% CI = 1.026-2.531; and P = 0.012, OR = 1.94, 95% CI = 1.02-5.21; respectively). Patients with an initial poor hemodynamic status could benefit by rapid peripheral installation of PLS ECMO. The blood lactate level, CK-MB relative index, and PRBCs transfused should be strictly monitored during ECMO support.
The Annals of Thoracic Surgery, 2003
Aortic root replacement with composite valve graft http://ats.ctsnetjournals.org/cgi/content/full... more Aortic root replacement with composite valve graft http://ats.ctsnetjournals.org/cgi/content/full/76/1/90 located on the World Wide Web at: The online version of this article, along with updated information and services, is Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association. Background. Composite valve graft replacement is currently the treatment of choice for a wide variety of lesions of the aortic root and the ascending aorta. In this study we report our experience with aortic root replacement using a composite graft. Methods. Between October 1978 and May 2001, 274 patients (79.6% male and 20.4% female) with a mean age of 53.5 years underwent composite graft replacement of the aortic root. One hundred sixty-one patients (70.8%) had annuloaortic ectasia and 46 (16.8%) aortic dissection. The classic Bentall technique was used in 94 patients (34.3%), the "button technique" in 172 patients (62.8%), and the Cabrol technique in 8 patients (2.9%).
The Journal of Thoracic and Cardiovascular Surgery, 2003
T racheomalacia, often secondary to congenital aortic arch abnormalities, can be caused by extern... more T racheomalacia, often secondary to congenital aortic arch abnormalities, can be caused by external compression of mediastinal mass, but its association with chronic aneurysms has not been previously reported. We present a case of severe respiratory insufficiency due to tracheomalacia. Main airway obstruction occurred immediately after aortic arch repair for luetic aneurysm and was treated successfully with temporary tracheobronchial stenting.
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Papers by Federico Ranocchi