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Article ; Online: Con: Pulsatile Flow During Cardiopulmonary Bypass.

Paternoster, Gianluca / Scolletta, Sabino

Journal of cardiothoracic and vascular anesthesia

2023 Volume 37, Issue 11, Page(s) 2374–2377

MeSH term(s)	Humans ; Cardiopulmonary Bypass ; Pulsatile Flow
Language	English
Publishing date	2023-07-07
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2023.07.002
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Article ; Online: Levosimendan's ability on veno-arterial extracorporeal membrane oxygenation weaning: Evidence says yes!

Marabotti, Alberto / Bertini, Pietro / Paternoster, Gianluca / Landoni, Giovanni / Guarracino, Fabio

The International journal of artificial organs

2023 Volume 46, Issue 4, Page(s) 193–194

MeSH term(s)	Humans ; Extracorporeal Membrane Oxygenation ; Simendan/therapeutic use ; Shock, Cardiogenic
Chemical Substances	Simendan (349552KRHK)
Language	English
Publishing date	2023-02-01
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80456-3
ISSN	1724-6040 ; 0391-3988
ISSN (online)	1724-6040
ISSN	0391-3988
DOI	10.1177/03913988221145502
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Article ; Online: History and Pioneers of Cardiac Anesthesia in Italy.

Landoni, Giovanni / Paternoster, Gianluca

Journal of cardiothoracic and vascular anesthesia

2019 Volume 33, Issue 12, Page(s) 3383–3385

Abstract: The first use of extracorporeal circulation in Italy occurred in 1951 in Turin. In the 1960s only 12 heart surgery centers were using extracorporeal circulation to treat patients, and health professionals had to complete their training abroad. During the ...

Abstract	The first use of extracorporeal circulation in Italy occurred in 1951 in Turin. In the 1960s only 12 heart surgery centers were using extracorporeal circulation to treat patients, and health professionals had to complete their training abroad. During the last 50 years, Italian cardiac anesthesia has become a branch of major importance, and it has experienced a constantly growing number of active centers and professionals. Today, about 50,000 cardiac surgeries are performed every year in approximately 100 centers. Many results have been achieved during this period, thanks to the contribution of several pioneers. In this article, the history of Italian cardiac anesthesia and the role of Italian anesthesiologists in the development of this subspecialty in Italy and Europe are reviewed.
MeSH term(s)	Anesthesia, Cardiac Procedures/history ; Anesthesiology/history ; Cardiology/history ; History, 20th Century ; History, 21st Century ; Humans ; Italy
Language	English
Publishing date	2019-03-12
Publishing country	United States
Document type	Historical Article ; Journal Article ; Review
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2019.03.015
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Article ; Online: Cryoglobulinemia: the "cold" problem in cardiac surgery, a single-center experience and a literature review.

Raimondo, Pasquale / Intini, Gianmarco / Lauletta, Gianfranco / Teora, Valentina / Lenoci, Sergio Domenico / Rubino, Giovanni / Villani, Maria Arcangela / Armenise, Agnese / Stripoli, Antonia / Colantuono, Giuseppe / Di Bari, Nicola / Fiore, Giuseppe / Paternoster, Gianluca / Grasso, Salvatore

Journal of anesthesia, analgesia and critical care

2024 Volume 4, Issue 1, Page(s) 6

Abstract: Cardiac surgery with cardiopulmonary bypass (CBP) is essential for different cardiac procedures in order to perform surgery with a clear sight field.To safely perform surgery with CPB and preserve brain, kidney, and patient tissue from ischemic damage, ... ...

Abstract	Cardiac surgery with cardiopulmonary bypass (CBP) is essential for different cardiac procedures in order to perform surgery with a clear sight field.To safely perform surgery with CPB and preserve brain, kidney, and patient tissue from ischemic damage, cold cardioplegia, and mild to deep hypothermia are induced during the operation.Cryoglobulinemia is a hematological/infective-related disease (in certain cases idiopathic) in which temperature-dependent antibodies tend to aggregate and form emboli in the vascular system causing tissue damage if exposed to low temperature.The patient with cryoglobulinemia (known and unknown) can be at risk of a major ischemic event during CPB and induced hypothermia.This article's aim is to evaluate the present scientific literature in order to understand how, in years, the therapeutic or preventive approach, is evolving, and to analyze and make improvements to the management of a cryoglobulinemic patient who must undergo elective or emergency cardiac surgery.In the last part of our article, we expose our single-center experience during a 32-month-long period of survey.In all cases, our medical team (anesthesiologists, perfusionists, and cardiac surgeons) opted for a normothermic cardiopulmonary bypass to lower the risk of cryoglobulin-associated complications.In our experience, along with therapeutic intervention to lower the cryoglobulin titer, normothermic management of cardiopulmonary bypass is as safe as hypothermic management.Notwithstanding our results, further studies with a larger population are needed to confirm this perioperative management in a cardiac surgery setting.
Language	English
Publishing date	2024-01-25
Publishing country	England
Document type	Journal Article ; Review
ISSN	2731-3786
ISSN (online)	2731-3786
DOI	10.1186/s44158-024-00141-x
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Article ; Online: Sepsis After Cardiac Surgery: From Pathophysiology to Management.

Paternoster, Gianluca / Guarracino, Fabio

Journal of cardiothoracic and vascular anesthesia

2016 Volume 30, Issue 3, Page(s) 773–780

MeSH term(s)	Biomarkers ; Cardiac Surgical Procedures/adverse effects ; Fluid Therapy ; Humans ; Sepsis/diagnosis ; Sepsis/etiology ; Sepsis/therapy
Chemical Substances	Biomarkers
Language	English
Publishing date	2016-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2015.11.009
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Article: Mini-thoracotomy in redo mitral valve surgery: safety and efficacy of a standardized procedure.

Prestipino, Filippo / D'Ascoli, Riccardo / Nagy, Ádám / Paternoster, Gianluca / Manzan, Erica / Luzi, Giampaolo

Journal of thoracic disease

2021 Volume 13, Issue 9, Page(s) 5363–5372

Abstract: Background: Re-operative mitral valve surgery is sometimes burdened by a greater technical difficulty and a higher complications rate than the first operation. Minimally invasive cardiac surgery has become routine, and it could significantly reduce the ... ...

Abstract	Background: Re-operative mitral valve surgery is sometimes burdened by a greater technical difficulty and a higher complications rate than the first operation. Minimally invasive cardiac surgery has become routine, and it could significantly reduce the surgical risk in redo surgery. The objective of our retrospective observational study is to assess the results of cardiac reoperations in patients with mitral valve disease approached trough a 5-7 cm right mini-thoracotomy. Methods: From February 2017 to December 2019, 65 patients underwent re-operative mitral valve surgery in our institution. Cardiopulmonary bypass (CPB) was started by cannulation of the femoral and jugular vein and femoral artery or alternatively right axillary artery. Patients enrolled had a mean age of 66.6±11.5 years. Patients were divided into three groups based on the procedure adopted: external aortic cross-clamp (EAC), EndoAortic balloon occlusion (EABO) and ventricular fibrillation (VF). Major complications were evaluated and compared with a propensity matched population of patients undergoing elective isolated mitral valve surgery via right minithoracotomy (MVS). Results: The average time between last operation and reoperation was 7.1±3.4 years. Fourteen patients (21%) underwent mitral valve repair and 51 patients (78%) underwent mitral valve replacement; 9 patients (14%) received tricuspid valve surgery. There was no statistically significant difference in CPB time between the groups. Seven patients (11%) had a postoperative renal failure, 5 patients (8%) underwent surgical reopening for bleeding; incidence of post-operative stroke and pace-maker implantation was 3% for both. No deaths were registered during in-hospital stay and at 30-days echocardiographic control all patients respect the criterions of device success according with MVARC. Propensity matched patients of group redo had a longer CPB time (100.8±42.7 versus 72.8±16.7 min, P<0.001) and cross-clamp time (71.9±30.7 versus 59±10.7 min, P<0.001) respect to first operation mitral valve surgery patients. Conclusions: Minimally invasive mitral valve redo surgery is a safe procedure. Less invasive techniques in redo surgery could minimize morbidity and mortality without prolonging the duration of CPB.
Language	English
Publishing date	2021-10-07
Publishing country	China
Document type	Journal Article
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd-21-667
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Article ; Online: ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis.

Bertini, Pietro / Guarracino, Fabio / Falcone, Marco / Nardelli, Pasquale / Landoni, Giovanni / Nocci, Matteo / Paternoster, Gianluca

Journal of cardiothoracic and vascular anesthesia

2021 Volume 36, Issue 8 Pt A, Page(s) 2700–2706

Abstract: Objective: To analyze the survival rates of patients with COVID-19 supported with extracorporeal membrane oxygenation (ECMO) and compare the survival rates of patients with COVID-19 supported with ECMO to patients with influenza supported with ECMO.: ... ...

Abstract	Objective: To analyze the survival rates of patients with COVID-19 supported with extracorporeal membrane oxygenation (ECMO) and compare the survival rates of patients with COVID-19 supported with ECMO to patients with influenza supported with ECMO. Design: A systematic review and meta-analysis to assess the impact of ECMO as supportive therapy of COVID-19. Setting: The authors performed a search through the Cochrane, EMBASE, and MEDLINE/PubMed databases from inception to February 19, 2021, for studies reporting hospitalized patients with COVID-19 managed with ECMO. Participants: A total of 134 studies were selected, including 6 eligible for the comparative meta-analysis of COVID-19 versus influenza. Interventions: The authors pooled the risk ratio and random effects model. Measurements and main results: The primary endpoint was the overall mortality of patients with COVID-19 receiving ECMO. Of the total number of 58,472 patients with COVID-19 reported, ECMO was used in 4,044 patients. The analysis suggested an overall in-hospital mortality of 39% (95% CI 0.34-0.43). In the comparative analysis, patients with COVID-19 on ECMO had a higher risk ratio (RR) for mortality when compared to influenza patients on ECMO: 72/164 (44%) v 71/186 (38%) RR 1.34; 95% CI 1.05-1.71; p = 0.03. Conclusions: ECMO could be beneficial in patients with COVID-19, according to the authors' meta-analysis. The reported mortality rate was 39%. This systematic analysis can provide clinical advice in the current era and ongoing pandemic.
MeSH term(s)	COVID-19/therapy ; Extracorporeal Membrane Oxygenation ; Hospital Mortality ; Humans ; Influenza, Human/epidemiology ; Influenza, Human/therapy ; Pandemics
Language	English
Publishing date	2021-11-12
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review ; Research Support, Non-U.S. Gov't
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2021.11.006
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Article ; Online: Venovenous Extracorporeal Membrane Oxygenation in Awake Non-Intubated Patients With COVID-19 ARDS at High Risk for Barotrauma.

Paternoster, Gianluca / Bertini, Pietro / Belletti, Alessandro / Landoni, Giovanni / Gallotta, Serena / Palumbo, Diego / Isirdi, Alessandro / Guarracino, Fabio

Journal of cardiothoracic and vascular anesthesia

2022 Volume 36, Issue 8 Pt B, Page(s) 2975–2982

Abstract: Objectives: To assess the efficacy of an awake venovenous extracorporeal membrane oxygenation (VV-ECMO) management strategy in preventing clinically relevant barotrauma in patients with coronavirus disease 2019 (COVID-19) with severe acute respiratory ... ...

Abstract	Objectives: To assess the efficacy of an awake venovenous extracorporeal membrane oxygenation (VV-ECMO) management strategy in preventing clinically relevant barotrauma in patients with coronavirus disease 2019 (COVID-19) with severe acute respiratory distress syndrome (ARDS) at high risk for pneumothorax (PNX)/pneumomediastinum (PMD), defined as the detection of the Macklin-like effect on chest computed tomography (CT) scan. Design: A case series. Setting: At the intensive care unit of a tertiary-care institution. Participants: Seven patients with COVID-19-associated severe ARDS and Macklin-like radiologic sign on baseline chest CT. Interventions: Primary VV-ECMO under spontaneous breathing instead of invasive mechanical ventilation (IMV). All patients received noninvasive ventilation or oxygen through a high-flow nasal cannula before and during ECMO support. The study authors collected data on cannulation strategy, clinical management, and outcome. Failure of awake VV-ECMO strategy was defined as the need for IMV due to worsening respiratory failure or delirium/agitation. The primary outcome was the development of PNX/PMD. Measurements and main results: No patient developed PNX/PMD. The awake VV-ECMO strategy failed in 1 patient (14.3%). Severe complications were observed in 4 (57.1%) patients and were noted as the following: intracranial bleeding in 1 patient (14.3%), septic shock in 2 patients (28.6%), and secondary pulmonary infections in 3 patients (42.8%). Two patients died (28.6%), whereas 5 were successfully weaned off VV-ECMO and were discharged home. Conclusions: VV-ECMO in awake and spontaneously breathing patients with severe COVID-19 ARDS may be a feasible and safe strategy to prevent the development of PNX/PMD in patients at high risk for this complication.
MeSH term(s)	Barotrauma/epidemiology ; Barotrauma/etiology ; COVID-19/complications ; COVID-19/therapy ; Extracorporeal Membrane Oxygenation/methods ; Humans ; Respiratory Distress Syndrome/diagnostic imaging ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/therapy ; Wakefulness
Language	English
Publishing date	2022-03-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2022.03.011
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Article ; Online: Beneficial effects of levosimendan to wean patients from VA-ECMO: a systematic review and meta-analysis.

Bertini, Pietro / Paternoster, Gianluca / Landoni, Giovanni / Falcone, Marco / Nocci, Matteo / Costanzo, Diego / Brizzi, Giulia / Romani, Matteo / Esposito, Andrea / Guarracino, Fabio

Minerva cardiology and angiology

2022 Volume 71, Issue 5, Page(s) 564–574

Abstract: Introduction: Patients with refractory cardiogenic shock can benefit from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The use of levosimendan in VA-ECMO patients may facilitate weaning and enhance survival.: Evidence acquisition: ... ...

Abstract	Introduction: Patients with refractory cardiogenic shock can benefit from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The use of levosimendan in VA-ECMO patients may facilitate weaning and enhance survival. Evidence acquisition: MEDLINE, Scopus, Web of Science, and Cochrane were searched from inception to October 10 Evidence synthesis: Ten observational studies, including a total of 987 patients, were identified. Levosimendan was associated with successful weaning (362/448) compared with controls (328/539) (OR 2.37, 95% CI 1.71-3.28; P=0.01) and reduced mortality (144/433 vs. 258/507) (nine studies, OR 0.53, 95% CI 0.36-0.78; P=0.01) compared with control. Conclusions: Levosimendan was associated with successful weaning and increased survival in VA-ECMO patients. Randomized trials should confirm these findings.
MeSH term(s)	Humans ; Simendan/therapeutic use ; Extracorporeal Membrane Oxygenation/adverse effects ; Shock, Cardiogenic/drug therapy ; Shock, Cardiogenic/etiology
Chemical Substances	Simendan (349552KRHK)
Language	English
Publishing date	2022-06-10
Publishing country	Italy
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	3059238-0
ISSN	2724-5772
ISSN (online)	2724-5772
DOI	10.23736/S2724-5683.22.06054-9
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Article ; Online: Macklin effect on baseline chest CT scan accurately predicts barotrauma in COVID-19 patients.

Paternoster, Gianluca / Belmonte, Gianfranco / Scarano, Enrico / Rotondo, Pietro / Palumbo, Diego / Belletti, Alessandro / Corradi, Francesco / Bertini, Pietro / Landoni, Giovanni / Guarracino, Fabio

Respiratory medicine

2022 Volume 197, Page(s) 106853

Abstract: Purpose: To validate the role of Macklin effect on chest CT imaging in predicting subsequent occurrence of pneumomediastinum/pneumothorax (PMD/PNX) in COVID-19 patients.: Materials and methods: This is an observational, case-control study. ... ...

Abstract	Purpose: To validate the role of Macklin effect on chest CT imaging in predicting subsequent occurrence of pneumomediastinum/pneumothorax (PMD/PNX) in COVID-19 patients. Materials and methods: This is an observational, case-control study. Consecutive COVID-19 patients who underwent chest CT scan at hospital admission during the study time period (October 1st, 2020-April 31st, 2021) were identified. Macklin effect accuracy for prediction of spontaneous barotrauma was measured in terms of sensitivity, specificity, positive (PPV) and negative predictive values (NPV). Results: Overall, 981 COVID-19 patients underwent chest CT scan at hospital arrival during the study time period; 698 patients had radiological signs of interstitial pneumonia and were considered for further evaluation. Among these, Macklin effect was found in 33 (4.7%), including all 32 patients who suffered from barotrauma lately during hospital stay (true positive rate: 96.9%); only 1/33 with Macklin effect did not develop barotrauma (false positive rate: 3.1%). No barotrauma event was recorded in patients without Macklin effect on baseline chest CT scan. Macklin effect yielded a sensitivity of 100% (95% CI: 89.1-100), a specificity of 99.85% (95% CI: 99.2-100), a PPV of 96.7% (95% CI: 80.8-99.5), a NPV of 100% and an accuracy of 99.8% (95% CI: 99.2-100) in predicting PMD/PNX, with a mean advance of 3.2 ± 2.5 days. Moreover, all Macklin-positive patients developed ARDS requiring ICU admission and, in 90.1% of cases, invasive mechanical ventilation. Conclusions: Macklin effect has high accuracy in predicting PMD/PNX in COVID-19 patients; it is also an excellent predictor of disease severity.
MeSH term(s)	Barotrauma/complications ; Barotrauma/diagnostic imaging ; COVID-19/complications ; COVID-19/diagnostic imaging ; Case-Control Studies ; Humans ; Mediastinal Emphysema/diagnostic imaging ; Mediastinal Emphysema/epidemiology ; Mediastinal Emphysema/etiology ; Pneumothorax/epidemiology ; Tomography, X-Ray Computed
Language	English
Publishing date	2022-04-20
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	1003348-8
ISSN	1532-3064 ; 0954-6111
ISSN (online)	1532-3064
ISSN	0954-6111
DOI	10.1016/j.rmed.2022.106853
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