M Viganò

Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Lombardy, Italy

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Publications (405)963.89 Total impact

  • E. Galmozzi, M. Viganò, P. Lampertico
    Alimentary Pharmacology & Therapeutics 05/2014; 39(10). · 4.55 Impact Factor
  • E Galmozzi, M Viganò, P Lampertico
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    ABSTRACT: Interferon lambda 3 (IFN-λ3) polymorphisms are the strongest genetic predictor of outcome of hepatitis C virus infection and of response to Pegylated interferon (PegIFN)-based therapy. Whether this holds true for hepatitis B virus (HBV) infection is matter of controversy. To review the association between host genomics and spontaneous or interferon-induced clearance of HBV with specific reference to the recently identified interleukin 28B gene now renamed IFN-λ3. A literature search was performed on MEDLINE, EMBASE and Web of Science for English articles and abstracts using free text words and combinations of the following terms 'IL28B', 'IFN lambda', 'genomics', 'hepatitis B virus', 'interferon' 'GWAS', 'treatment', 'SNPs', 'HLA', 'polymorphisms'. Genome-wide association studies convincingly demonstrated an association between SNPs in the HLA locus and spontaneous resolution of HBV infection in subgroups of Asian patients, yet no information is available for Caucasians. The preliminary observations of an association between IFN-λ3 SNP and virological and serological responses to IFN in both HBeAg-positive and -negative patients could not be replicated by subsequent studies. Yet, majority of studies performed so far suffer several limitations in terms of sample size, selection of the patients, endpoints of therapy, treatment strategies and duration of follow-up. While host genetics is associated with an increased likelihood of spontaneous clearance of HBV among genotype B/C patients, the relationship between IFN-λ3 polymorphisms and response to IFN has not been confirmed. Further studies in large cohorts of homogeneous patients are required, before this genetic test can be recommended in clinical practice.
    Alimentary Pharmacology & Therapeutics 01/2014; · 4.55 Impact Factor
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    ABSTRACT: Assessment of liver fibrosis is important in determining prognosis, disease progression and need for treatment in patients with chronic hepatitis B (CHB). Limitations to the use of liver biopsy in assessing fibrosis are well recognized, and noninvasive tests are being increasingly evaluated including transient elastography (TE) and serum markers such as the Enhanced Liver Fibrosis (ELF) test. We assessed performance of ELF and TE in detecting liver fibrosis with reference to liver histology in a cohort of patients with CHB (n = 182), and compared the performance of these modalities. Median age was 46 and mean AST 70 IU/L. Cirrhosis was reported in 20% of liver biopsies. Both modalities performed well in assessing fibrosis at all stages. Area under receiver operator characteristic (AUROC) curves for detecting METAVIR fibrosis stages F ≥ 1, F ≥ 2, F ≥ 3 and F4 were 0.77, 0.82, 0.80 and 0.83 for ELF and 0.86, 0.86, 0.90 and 0.95 for TE. TE performed significantly better in the assessment of severe fibrosis (AUROC 0.80 for ELF and 0.90 for TE, P < 0.01) and cirrhosis (0.83 for ELF and 0.95 for TE, P < 0.01). This study demonstrates that ELF has good performance in detection of liver fibrosis in patients with CHB, and when compared, TE performs better in detection of severe fibrosis/cirrhosis.
    Journal of Viral Hepatitis 08/2013; · 3.08 Impact Factor
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    ABSTRACT: We report a successful follow-up after 28 years of a woman with obliterative restrictive endomyocardial fibrosis (EMF) that underwent complete surgical decortication with simultaneous mitral and tricuspid bioprosthetic valve replacement in 1982 and underwent successful reoperation for the structural failure of biological prostheses after 25 years.
    Journal of Cardiac Surgery 06/2013; · 1.35 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the safety and performance of the Arrow CorAide left ventricular assist system (LVAS) (Arrow International, Reading, PA, USA), a continuous-flow left ventricular assist device, as bridge to transplantation or recovery as well as destination therapy in patients with New York Heart Association (NYHA) class IV heart failure. Twenty-one patients were implanted with the CorAide LVAS between February 2005 and February 2006 in a prospective, multicenter, nonrandomized trial. Seventeen patients (81%) survived to >180 days or to transplantation. The cumulative time on device was 16.58 patient years (range 23-796 days, median 192 days). No intraoperative technical issues were observed at the time of implantation. Of the 21 implants, nine patients died on device, two were converted to other devices, and 10 were transplanted. Three patient deaths were attributed to pump polymer coating delamination. Postmortem device inspection determined delamination of the polymer coating on the pump's internal surface to be the cause of the late hemolysis and sudden fatal pump stops. No embolic or driveline infection event was recorded. The automatic flow control algorithm functioned reliably throughout the trial. Primary performance trial endpoint was achieved with 81% survival to 180 days or transplantation. Delamination of the polymer coating on the internal surface of the pump with resultant hemolysis and pump stops was the sole major device event in this trial. Elimination of the polymer coating and replacement with an amorphous carbon coating has resolved this in preclinical testing, prior to initiation of further clinical testing of this device.
    Artificial Organs 10/2012; · 1.96 Impact Factor
  • Journal of Cardiac Surgery 08/2012; · 1.35 Impact Factor
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    ABSTRACT: Aortic valve-sparing (AVS) procedures have been introduced to treat ascending aorta dilatation and aortic valve insufficiency in the presence of preserved native aortic valve leaflets. Although the surgical technique has been standardized, the choice of best type and size of Dacron graft to be used remains a matter of debate. Herein are presented preliminary results based on a patient-specific finite element model aimed at optimizing the Dacron prosthesis size and shape. Previously, finite element analysis (FEA) has been applied to investigate medical problems and, in particular, to better evaluate the pathophysiology of the aortic root. To date, however, such methodology has not been applied to the patient-specific evaluation of AVS postoperative results. The framework of the FEA study included four steps: (i) the creation of a mathematic model of the patient's aortic root; (ii) the creation of a model for two different Dacron grafts (the standard straight graft and a Valsalva graft), with sizes of each type ranging from 24 to 30 mm; (iii) a virtual computer-based simulation of the AVS procedure, using each graft; and (iv) a virtual computer-based simulation of the diastolic closure of the repaired valve and an evaluation of post-implant physiology, based on three parameters: the height of coaptation ratio (H(C)R); the length of coaptation ratio (L(C)R); and the distance between the central point of coaptation and the ideal geometrical centre (D(C)). The simulation results of post-implant performance of the aortic valve revealed that both H(C)R and L(C)R were decreased as the graft size was increased, but no significant differences were identified between two types of graft. In contrast, the Valsalva graft, when compared to the standard straight graft, led to a significant reduction in D(C). The results in terms of H(C)R, L(C)R and D(C) recommended unequivocally, for the specific case under investigation, that a 30 mm straight graft and a 28 mm Valsalva graft would ensure the most physiological valve behavior for the patient under investigation. In evaluating the potential of a preoperative prediction of the optimal graft size, using FEA, the virtual simulation of the AVS procedure proved to be feasible and useful in predicting the postoperative physiology of the aortic root. In particular, this finite element model might have a clinical impact as may be used to optimize the surgeon's choice of prosthesis size.
    The Journal of heart valve disease 03/2012; 21(2):141-7. · 1.07 Impact Factor
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    ABSTRACT: The development of new immunosuppressive drugs for kidney transplantation resulted both in better short-term outcomes and in decreased metabolic, cardiovascular, and nephrotoxicity risk. Belatacept belongs to a new class of immunosuppressive drugs that selectively inhibits T-cell activation by preventing CD28 activation and by binding its ligands B7-1 and B7-2. The result is an inactivation of costimulatory pathways. A comparative analysis of the BENEFIT and BENEFIT-EXT datasets showed belatacept regimens resulted in better cardiovascular and metabolic risk profiles than did cyclosporin A (CsA) regimens: belatacept likewise outperformed CsA in terms of lower blood pressure and serum lipids and less new onset diabetes after transplantation. About 20% of belatacept-treated patients developed adverse effects which included anemia, pyrexia, neutropenia, diarrhea, urinary tract infection, headache, and peripheral edema. At present, belatacept does not seem to predispose patients to a higher rate of infection than CsA maintenance immunosuppression. The risk of posttransplant lymphoproliferative diseases was higher in Epstein-Barr virus (EBV)-seronegative patients than in EBV-seropositive patients, but the risk may be reduced by use of a less intensive regimen and avoidance of EBV-negative patients and of patients whose pretransplant EBV serology is unknown. Belatacept provides a new option for immunosuppressive therapy in kidney transplantation, but needs further evaluation in terms of the late effects that may derive from prolonged blockage of the costimulatory system and the induction of tolerance status.
    Biologics: Targets & Therapy 01/2012; 6:355-62.
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    ABSTRACT: The present study was aimed at determining the impact of type 2 diabetes mellitus (DM) on postoperative bioprosthetic structural valve degeneration. 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<0.001), respectively. Seven-year freedom from valve deterioration was significantly lower in patients with DM (73.2% [95% confidence interval, 61.6-85.5] versus 95.4% [95% confidence interval, 83.9-100], P<0.001). In Cox regression models with robust SEs that accounted for the clustering of matched pairs, DM was the strongest predictor of structural valve degeneration (hazard ratio 2.39 [95% confidence interval 2.28-3.52]). When we allowed for interaction between type 2 DM and other key risk factors, DM remained a significant predictor beyond any potentially associated variable. 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.
    Circulation 12/2011; 125(4):604-14. · 15.20 Impact Factor
  • Nicola Vistarini, Marco Aiello, Mario Viganò
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    ABSTRACT: Minimally invasive video-assisted surgery through a right minithoracotomy has become the standard surgical approach for several cardiac diseases at many major centers worldwide. In this article we review the existing literature on the subject and describe different operative techniques, application fields and clinical outcomes.
    Future Cardiology 11/2011; 7(6):775-87.
  • M Viganò, S Paggi, P Lampertico
    Alimentary Pharmacology & Therapeutics 10/2011; 34(7):818-9. · 4.55 Impact Factor
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    ABSTRACT: (J Card Surg 2011;26:629)
    Journal of Cardiac Surgery 09/2011; 26(6):629. · 1.35 Impact Factor
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    ABSTRACT: In the case of an acute aortic dissection, a surgical aortic procedure is usually the priority in order to restore the perfusion of vital organs. Afterwards, associated ischemic abdominal visceral lesions can be resected. For particular patients, it could be highly beneficial to perform the abdominal surgery before surgically addressing the aorta. The aim of this paper is to contribute to the therapeutic choice in cases of acute aortic dissection with acute abdomen. The case is reported of a 38-year-old patient, affected by an acute aortic dissection (Stanford type A) and peritonitis.Suspecting the necessity for a complex combined surgical procedure, the patient underwent emergency diagnostic laparoscopy, which showed an infarctual necrosis of the distal ileum and right colon. Therefore, he immediately underwent a wide right hemicolectomy. Afterwards, an ascending aortic substitution was performed.The patient was discharged on the 15th post-operative day, and he is doing well, 1 year and 3 months after the operation. In the case of an acute aortic dissection with acute abdomen, emergency laparoscopy is a precious surgical technique to identify criteria that can lead to therapeutic decisions, including timing.
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 08/2011; 17(6):631-3.
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    ABSTRACT: Elevated heart rate (HR) has been indicated as risk factor for cardiovascular disease. Experimental data support a role of HR in the progression and severity of atherosclerotic lesions. Sinus tachycardia is common in heart transplant patients due to the lack of autonomic control. This study assessed the role of HR in the development of cardiac allograft vasculopathy (CAV) in heart transplant recipients. Data from 244 allograft recipients were analyzed. Known factors affecting CAV and mean HR obtained from 24-hour recordings at 1 year (dichotomized at ≥90 beats/min) were tested in univariate and multivariable Cox analysis. During a median of 96 months, 60 patients (25%) experienced CAV. Surprisingly, HR < 90 but not ≥90 beats/min was significantly associated with an increased CAV development. Univariate analysis showed several predictors were associated with the end point; however, at multivariable analysis, only donor's age, chronic renal failure, and left ventricular end-diastolic wall thickness were significant predictors of CAV, with hazard ratios of 1.02 (95% confidence interval, 1.00-1.04), 1.90 (1.13-3.21), and 1.11 (1.00-1.22), respectively. A highly statistically significant difference in donor's age was found among patients with mean heart rate ≥90 or <90 beats/min (30 ± 13 vs 40 ± 14 years, p < 0.0001). In the denervated heart, sinus tachycardia is not a risk factor for coronary atherosclerosis. HR in heart transplant recipients reflects "intrinsic heart rate" and is a simple epiphenomenon of the donor's age.
    The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 08/2011; 30(12):1368-73. · 3.54 Impact Factor
  • International journal of cardiology 07/2011; 151(2):253-4. · 6.18 Impact Factor
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    ABSTRACT: Transient elastography has gained popularity to stage liver fibrosis in chronic viral hepatitis, however, diagnostic cut-offs for severe fibrosis in chronic hepatitis B are poorly defined. To evaluate an algorithm with two distinct cut-offs for positive and negative prediction of significant fibrosis and cirrhosis in chronic hepatitis B patients. Two cohorts of treatment-naïve patients with chronic hepatitis B (125 training and 92 validations) were consecutively and concurrently examined by percutaneous liver biopsy and transient elastography. Fibrosis was staged by Metavir (significant fibrosis = F ≥ 2; cirrhosis = F4) in ≥ 2 cm long liver tissue cores. A >13.1 kPa positive and a ≤ 9.4 kPa negative cut-off for cirrhosis had a >90% sensitivity and specificity, with an accuracy of 94%. The corresponding cut-offs for F ≥ 2 were >9.4 and ≤ 6.2 kPa, thus classifying 56% of patients with an overall accuracy of 90%. In the validation cohort, F4 and F ≥ 2 were predicted by the above transient elastography cut-offs with an overall accuracy >90%. In 165 patients with higher than upper limit of normal transaminase activity the dual cut-off algorithm of transient elastography was as accurate as in the 52 patients with normal alanine aminotransferase values in the prediction and exclusion of cirrhosis, only. A dual cut-off algorithm allowed for correctly classifying both significant fibrosis and cirrhosis in the majority of the patients with chronic hepatitis B, independent of alanine aminotransferase values, thus reducing the need for liver biopsy investigations.
    Alimentary Pharmacology & Therapeutics 06/2011; 34(3):353-62. · 4.55 Impact Factor
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    Journal of the American College of Cardiology 05/2011; 57(21):2205. · 14.09 Impact Factor
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    ABSTRACT: Chronic immunosuppressive therapy following solid organ transplantation has been correlated with an increased risk of posttransplantation neoplastic disease (PTND). In this study we evaluated PTND incidence and outcome at our institution over a 17-year period among patients receiving lung transplantation. Between February 1992 and December 2008, we performed 290 lung transplantations in 280 patients, including 139 single (48% with 5 retransplantations), and 151 double lung transplantations (52% with 5 retransplantations). Among the 280 patients, 2 had undergone previous double lung transplantation in other hospitals. Follow-up of transplant recipients was performed up to December 2009. Forty-two patients died in the hospital, producing a cumulative early (30-day) mortality rate of 15%. Among the 238 patients discharged from the hospital who entered our follow-up program, 36 (15%) experienced PTND. The mean time between transplantation and diagnosis was 47 ± 42 months, and patients' mean age at time of diagnosis was 55 ± 14 years. Overall freedom from PTND was 97%, 84%, and 73% at 1, 5, and 10 years, respectively. PTND was considered to be the direct cause of death in 11 patients (30%). Overall survival of patients with PTND at five years (45%) did not differ from the remainder of the transplanted population (46%). However, PTND became a relevant cause of death in the long-term (>5 years) follow-up. Our experience confirms that PTND was frequently diagnosed following lung transplantation. Even if PTND did not seem to significantly affect the survival of patients undergoing lung transplantation, it may become a significant cause of death among those surviving beyond 5 years.
    Transplantation Proceedings 05/2011; 43(4):1156-8. · 0.95 Impact Factor
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    ABSTRACT: We present postoperative and midterm (3 years) angiographic changes after removal of five (of six) occluded stents from the left anterior descending (LAD) coronary artery and its reconstruction with a 9-cm-long on-lay patching done with the left internal mammary artery.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 04/2011; 40(6):1529-30. · 2.40 Impact Factor
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    ABSTRACT: Ionescu-Shiley valve was withdrawn from clinical use in 1987 for its early structural failure after implantation. This was due to valve design rather than the natural properties of bovine pericardium itself. We describe the unexpected 25-year survival of an Ionescu-Shiley bioprosthesis in the mitral and tricuspid positions, implanted to treat endomyocardial fibrosis. This report makes 2 important points: (1) pannus overgrowth may be a favorable determinant of the durability of xenografts, and (2) bovine pericardial valves may have excellent hemodynamic performance and tissue durability for more than 20 years in the mitral position even in young patients.
    The Annals of thoracic surgery 04/2011; 91(4):e52-3. · 3.45 Impact Factor

Publication Stats

3k Citations
963.89 Total Impact Points


  • 2010–2013
    • Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
      • Gastroenterology 3
      Milano, Lombardy, Italy
    • Università degli Studi di Messina
      • Dipartimento di Medicina Clinica e Sperimentale
      Messina, Sicily, Italy
  • 1990–2012
    • Policlinico San Matteo Pavia Fondazione IRCCS
      • s.c. Cardiochirurgia
      Ticinum, Lombardy, Italy
  • 1989–2012
    • University of Pavia
      • Department of Diagnostic, Paediatric, Clinical and Surgical Science
      Ticinum, Lombardy, Italy
  • 2010–2011
    • Istituto Clinico Humanitas IRCCS
      Milano, Lombardy, Italy
  • 2008–2011
    • University of Milan
      • Department of Internal Medicine
      Milano, Lombardy, Italy
  • 1988–2010
    • Ospedale di San Raffaele Istituto di Ricovero e Cura a Carattere Scientifico
      Milano, Lombardy, Italy
  • 2009
    • Azienda Ospedaliera Città della Salute e della Scienza di Torino
      • Division of Cardiac Surgery - U
      Torino, Piedmont, Italy
  • 2004
    • Second University of Naples
      • Faculty of Medicine and Surgery
      Caserta, Campania, Italy
  • 2003
    • Azienda Sanitaria Locale della Provincia di Pavia
      Ticinum, Lombardy, Italy
  • 1991–2002
    • Istituto di Cura e Cura a Carattere Scientifico Basilicata
      Rionero in Vulture, Basilicate, Italy
  • 2001
    • University of Insubria
      Varese, Lombardy, Italy
    • Università degli Studi dell'Insubria
      Varese, Lombardy, Italy
  • 1997–2000
    • Fondazione Salvatore Maugeri IRCCS
      • Divisione di Cardiologia 1
      Ticinum, Lombardy, Italy
  • 1991–1997
    • Università degli Studi del Sannio
      Benevento, Campania, Italy