G Gerosa

University of Padova, Padova, Veneto, Italy

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Publications (95)128.75 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim of the present study was to investigate the relationship between CMV and EBV infection and the occurrence of antibody mediated rejection (AMR) in a cohort of adult heart transplant recipients (HTXs).
    Cardiovascular research. 07/2014; 103(suppl 1):S139.
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    ABSTRACT: Plaque hemorrhage, inflammation and microvessel density are key determinants of plaque vulnerability in native coronary atherosclerosis (ATS). This study investigates the role of intraplaque hemorrhage (IPH) and its relation with inflammation and microvessels in cardiac allograft vasculopathy (CAV) in posttransplanted patients. Seventy coronary plaques were obtained from 12 patients who died because of CAV. For each patient we collected both native heart and the allograft, at the time of transplantation and autopsy, respectively. Intralesion inflammation, microvessels and IPH were assessed semi-quantitatively. IPH was observed in 21/35 (60%) CAV lesions and in 8/35 (22.9%) native ATS plaques, with a strong association between fibrocellular lesions and IPH (p = 0.0142). Microvessels were detected in 26/35 (74.3%) of CAV lesions with perivascular leakage as sign of endothelial damage in 18/26 (69.2%). IPH was strongly associated with microvessels (p < 0.0001). Inflammation was present in 31/35 (88.6%) of CAV lesions. CAV IPH+ lesions were characterized by presence of both fresh and old hemorrhage in 12/21 (57.1%). IPH, associated with microvessel damage and inflammation, is an important feature of CAV. Fresh and old intralesion hemorrhage suggests ongoing remodeling processes promoting the lesion progression and vulnerability.
    American Journal of Transplantation 01/2014; 14(1):184-92. · 6.19 Impact Factor
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    ABSTRACT: Despite major advances in the treatment of heart failure over the past two decades, improving the natural history of this condition, heart failure continues to be a major source of morbidity and mortality. Although availability of heart donor for transplantation has declined over the past several years, innovations in ventricular assist device (VAD) technology has provided an alternative therapeutic option for patients with advanced heart failure. Initiated as a mechanical option to "bridge" critically ill patients awaiting transplantation, VADs are being increasingly deployed as "destination" devices to provide long-term support. With technical advances resulting in improved mechanical reliability, reduced postoperative morbidity and greater likelihood of patient acceptance, there is interest in expanding the applicability of VAD beyond the current indication, as destination therapy for severely ill patients who are not candidates for transplant. This review examines the rational as well as the technical details of the different generation of VADs for mechanical cardiac support, implanted either surgical or percutaneously. These devices are at various stages of development and clinical investigation. One or more of these newer devices is likely to emerge as an important development in the treatment of patients with advanced heart failure.
    Minerva cardioangiologica. 12/2013; 61(6):691-700.
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    ABSTRACT: With respect to the limited lifespan of glutaraldehyde(GA)- treated bioprostheses to date there is almost no alternative when heart valve replacement surgery is required and most advanced current research attempts to develop tissue engineered valve scaffolds to be implanted in vivo or after in vitro preconditioning and dynamic seeding with host cells. However the clinical outcomes of detergent-based cell-depleted tissue engineered xenogeneic constructs are still controversial. Therefore, we investigated whether the clinical drawbacks of GA-treated and decellularized bioprosthetic devices might be related to residual xenogenic epitope and/or to biocompatibility problems associated with by-produts of the detergent-based decellularizing process. Accordingly we determined the residual content of detergents and that of residual xenogenic antigens in both GAtreated and detergent-based preparations (five different procedures). The presence of residual detergents was detected in all the resulting scaffolds albeit in different concentration, the content of Taurodeoxycholate (TDOC) (novel method) being the lowest (0.06%) with respect to Deoxycholate (8.13%) as the highest. Conversely relevant amount of xenoantigen was also detected in almost all the current GA-treated as well as in most detergent-based cell-depleted preparations with the exception of the procedure based on Triton associated with Cholate (COL) or Taurodeoxycholate (TDOC). The results of this investigation indicate that the clinical outcome of both current bioprosthetic devices as well as of putative tissue engineering substitutes might be significantly affected by the presence non-negligible amounts of remnant xenogenic epitopes and of residual detergent, respectively.
    European journal of histochemistry: EJH 10/2013; 57(2):4. · 2.41 Impact Factor
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    ABSTRACT: Objectives: The role of extracorporeal membrane oxygenation (ECMO) in primary cardiogenic shock refractory to conventional therapy is well estab-lished. In this study we aimed to evaluate the impact of aetiology on patient outcomes. Methods: Between January 2009 and March 2013, 64 patients (52 male and 12 female, aged 50 ± 16 years) with refractory cardiogenic shock were treated with peripheral ECMO support. Thirty-seven cases (58%) were classified as "acute" (group A, acute myocardial infarction 39%, myocarditis 6%, pulmon-ary embolism 8%, post-partum 2%), while the remaining twenty-seven (42%) were due to an exacerbation of "chronic" heart failure (group B, dilated cardiomyopathy 30%, post-ischaemic cardiomyopathy 9%, congenital disease 3%). Results: In group B, 23 patients were bridged to either a left ventricular assist device (LVAD), (52%), or heart transplantation (33%). In group A, ECMO was used as bridge to transplantation in three patients (8%), bridge-to-bridge in nine patients (24%), and bridge to recovery in 18 patients (49%). One patient in both groups was bridged to conventional surgery. Recovery of cardiac func-tion was achieved only in group A (18 vs 0 patients, P = 0.0001). Mean flow during support ≤60% of the theoretical flow (BSA*2.4) was seen to be a signifi-cant predictor of successful weaning (P = 0.038). Overall average duration of ECMO support was 8.9 ± 9 (range 1-46) days. Nine patients (14%) died during ECMO support; 30-day overall survival was 80% (51/64 patients); 59% of patients were discharged, in whom survival at 48 months was 90%, with no dif-ferences between the two groups. Better survival was observed in patients supported for eight days or less (74% vs 36%, P = 0.038). Conclusions: In "chronic" heart failure ECMO represents a bridge to VAD or heart transplantation, while in "acute" settings it offers a considerable chance of recovery, thus often representing the only required therapy.
    27th Annual Meeting of the European Association for Cardio-Thoracic Surgery, Vienna, Austria; 10/2013
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    ABSTRACT: We report the case of a 68-year-old woman who underwent heart transplantation for hypertrophic cardiomyopathy. Two months after the transplant she developed mild fever and dyspnea with a marked drop in left ventricle ejection fraction of 31%. Coronary angiography was negative for cardiac allograft vasculopathy. Endomyocardial biopsy revealed ischemic damage with no evidence of acute cellular rejection, antibody-mediated rejection or viral myocarditis. A neoplastic process was suspected even though full-body computerized tomography was negative for malignancy. The patient died 4 months after transplantation. The autopsy showed acute antero-septal myocardial infarction due to a nodular epicardial EBV-related posttransplant lymphoproliferative disorder (PTLD) infiltrating the left anterior descending coronary artery with occlusive neoplastic thrombosis. We highlight two major aspects of this case: (1) the unusual occurrence of early PTLD involving the cardiac allograft and causing a fatal outcome, (2) the application of an immunological technique for HLA-DRB1 typing to posttransplant paraffin-embedded autopsy material to identify the recipient origin of this early malignancy, thus excluding a possible donor-transmitted neoplasm.
    American Journal of Transplantation 01/2013; · 6.19 Impact Factor
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    ABSTRACT: In emergency cases, rapid extracorporeal membrane oxygenation (ECMO) device initialization is able to drastically reduce the incidence of patient morbidity and/or mortality. Pre-assembled and ready-to-use ECMO circuits might save up to 30-60 critical minutes in patient management.Six ECMO circuits (Oxygenator D905 EOS with REVOLUTION™ pump and Sorin PTS) were assembled in the operating room in standard conditions and then placed at 37°C for 35 days in order to evaluate possible contamination and ingrowth of micro-organisms. Every 7 days after ECMO circuit assembly and wet-priming, samples of priming fluid were analyzed to verify the presence/absence of possible common contaminants (Enterobacteriaceae, Staphylococcus aureus and fungi). Moreover, two supplementary circuits, used as positive controls, were deliberately inoculated with a known concentration of a Escherichia coli strain and prime samplings carried out at different time-points to determine bacterial growth rate.Sterility was maintained in the ECMO circuits for up to 35 days.
    Perfusion 12/2012; · 0.94 Impact Factor
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    ABSTRACT: Background: Although vascular-calcification mechanisms are only partially understood, the role of circulating calcifying cells and non-collagenous bone matrix proteins in the bone-vascular axis is emerging. Despite that platelets represent a cellular interface between hemostasis, inflammation, and atherosclerosis and have a myeloid precursor, a possible involvement in the modulation of vascular calcification has been rarely investigated. We investigated if osteocalcin (OC) is released by platelets and described OC expression in patients with carotid artery occlusive disease. Methods: Expression and release of OC were determined by Western blot, immunofluorescence, FACS, and ELISA in human resting and activated platelets and megakaryocytes. Co-localization of platelet aggregates, macrophages, OC, and calcifications was studied in carotid endoarterectomy specimens and normal tissues. Results: Human platelets expressed OC and co-localized with CD63 in δ-granules. Upon activation with an endogenous mechanism, platelets released OC in the extracellular medium. Expression of OC in megakaryocytes suggested a lineage specificity. OC count in circulating platelets and the released amount were significantly higher in patients with carotid artery occlusive disease than in healthy controls (P<0.0001) despite similar serum levels. In atherosclerotic plaques OC strongly overlapped with CD41+ platelets in the early stage of calcification, but this wass not seen in normal tissues. CD68+OC+ cells were present at the periphery of the calcified zone. Conclusions: Given the active role played by platelets in the atherosclerotic process, the involvement of OC release from platelets in atherosclerotic lesions and the impact of genetic and cardiovascular risk factors in mediating bone-marrow preconditioning should be investigated further. © 2012 International Society on Thrombosis and Haemostasis.
    Journal of Thrombosis and Haemostasis 12/2012; · 6.08 Impact Factor
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    ABSTRACT: Cardiac valves are dynamic structures, exhibiting a highly specialized architecture consisting of cells and extracellular matrix with a relevant proteoglycan and glycosaminoglycan content, collagen and elastic fibers. Biological valve substitutes are obtained from xenogenic cardiac and pericardial tissues. To overcome the limits of such non viable substitutes, tissue engineering approaches emerged to create cell repopulated decellularized scaffolds. This study was performed to determine the glycosaminoglycans content, distribution, and disaccharides composition in porcine aortic and pulmonary valves and in pericardium before and after a detergent-based decellularization procedure. The fine structural characteristics of galactosaminoglycans chondroitin sulfate and dermatan sulfate were examined by FACE. Furthermore, the mechanical properties of decellularized pericardium and its propensity to be repopulated by in vitro seeded fibroblasts were investigated. Results show that galactosaminoglycans and hyaluronan are differently distributed between pericardium and valves and within heart valves themselves before and after decellularization. The distribution of glycosaminoglycans is also dependent from the vascular district and topographic localization. The decellularization protocol adopted resulted in a relevant but not selective depletion of galactosaminoglycans. As a whole, data suggest that both decellularized porcine heart valves and bovine pericardium represent promising materials bearing the potential for future development of tissue engineered heart valve scaffolds.
    Biochemistry Research International. 10/2012;
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    ABSTRACT: Scaffolds for tissue engineering must be designed to direct desired events such as cell attachment, growth, and differentiation. The incorporation of extracellular matrix-derived peptides into biomaterials has been proposed to mimic biochemical signals. In this study, three synthetic fragments of fibronectin, vitronectin, and stromal-derived factor-1 were investigated for the first time as potential adhesive sequences for cardiomyocytes (CMs) compared to smooth muscle cells. CMs are responsive to all peptides to differing degrees, demonstrating the existence of diverse adhesion mechanisms. The pretreatment of nontissue culture well surfaces with the (Arginine-Glycine-Aspartic Acid) RGD sequence anticipated the appearance of CMs' contractility compared to the control (fibronectin-coated well) and doubled the length of cell viability. Future prospects are the inclusion of these sequences into biomaterial formulation with the improvement in cell adhesion that could play an important role in cell retention during dynamic cell seeding.
    Tissue Engineering Part A 04/2012; 18(7-8):725. · 4.07 Impact Factor
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    ABSTRACT: Aim of the study was to evaluate a single center experience on hybrid treatment for thoracic aortic diseases, including aortic arch and ascending aorta endografting needing a total debranching from descending thoracic aorta and an antegrade endograft deployment from left ventricle. Between January 2004 and December 2010 48 patients underwent thoracic aorta endografting, with coverage of at least one supra-aortic artery, because of atherosclerotic, dissecting and post-traumatic aneurysms or complications of previous aortic surgery. Supra-aortic trunks revascularization was obtained from ascending aorta, common carotid arteries and, in three cases, from descending thoracic aorta since the unavailability of common inflow sites. In three cases the antegrade endograft introduction through left ventricle (transapical approach, 2 cases) or ascending aorta (one case) was the only possibility for a safe deployment. Three groups have been identified on the basis of the proximal landing zone. Group A (27 patients): zone 2; Group B (9 patients): zone 1; Group C (12 patients): zone 0. The 30 days mortality was respectively 7.4%, 0% and 16%. Post operative paraplegia occurred in the 7.4% of group A, respiratory insufficiency and infections were the main post-operative complications with an incidence reaching 30% in each group. Hybrid procedures on aortic arch represent a possible treatment for cases unfit for open surgery despite the complication rates and mortality are not negligible. In selected cases, the endografting can be extended up to beyond the landing zone 0 where an antegrade transventricular endograft deployment and a supra-aortic perfusion from descending thoracic aorta represent a feasible option.
    The Journal of cardiovascular surgery 04/2012; 53(2):143-51. · 1.51 Impact Factor
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    Tissue Engineering 04/2012; · 4.07 Impact Factor
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    ABSTRACT: Tissue engineered heart valves (TEHV) hold promise of ideal heart valve bioprostheses, avoiding inflammatory and immunological response, thromboembolism phenomena while capable of growth and repair. Xenogeneic biological matrices, as porcine heart valves, are considered the best choice for TEHV production considering both the anatomical structure and the presence of several trophic signals within the extracellular matrix (ECM). Unfortunately, not all the decellularization procedures (DP) used in TEHV production appear to be reliable and effective. The incomplete removal of both the xenogeneic alpha-Gal epitope (responsible for the hyperacute rejection) and/or the cytotoxic residues of detergents (hindering the cells penetrability within the matrix) is possibly related to the unsatisfactory clinical outcomes already experienced. We have determined the amount of residual detergent and carried out the evaluation of biocompatibility (by quantification of alpha-Gal leavings) in tissues decellularized according to established DPs. These DPs assumed to deliver promising results in literature, are focused on the action of detergents such as 1% deoxycholate (DOC)1, 0.5% DOC/0.5% sodium dodecyl sulphate (DOC-SDS)2 and 1% Triton X-100/0.4% cholate (TRICOL)3. As related to the removal of the alpha-Gal epitope only TRICOL ensures complete biocompatibility. In fact. 1% DOC leaves 43.3±1.2% of total antigen exposed, like the DOC-SDS procedure (49.1±0.8%, p>0.05). On the other hand, in 1% DOC DP 8.2±0.7% of the final acellularized tissue wet-weight was constituted by deoxycholate. The low amount of residual detergent in case of DOCSDS and TRICOL (0.31±0.02% and 0.11±0.04% respectively) was comparable even if the difference was significant (p=0.008). Removal of such detergents is critical as unconjugated bile acids, like DOC and cholate, have been shown to accelerate elastolysis and to support the precipitation of insoluble calcium salts in a physiological environment. In turn, due to immunological activation, the presence of alpha-Gal is likely to sustain a constant inflammatory state in the human organism too. For these reasons we believe that the monitoring of such parameters should become a routinely tool test in the development of the future THEVs. 1. Dohmen PM et al. Ann Thorac Surg 2007; 84:729-736. 2. Cebotari S et al. Artif Organs 2010; 34(3):206-210. 3. Gallo M et al. Artif Organs 2012; 36(6):E138-E150.
    European journal of histochemistry: EJH 01/2012; 56(supp2). · 2.41 Impact Factor
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    ABSTRACT: Introduction: In the last decade there was an expanding application of ventricular assist devices (VAD) due to a shortage of donor organs combined with the efficacy of these mechanical circulatory supports. The Jarvik 2000 is one of the most used worldwide. We report our experience of in-hospital intensive phase cardiac rehabilitation (CR) in pts who underwent Jarvik 2000 VAD implantation as destination therapy. Methods: In the period 2009-2011, 18 pts (3 females, mean age 66.6±5.8 yo) had been admitted to our CR unit, 65±52 [20-205] days after operation. They followed a structured rehabilitation programme that included 3 daily sessions on 6 days/week of respiratory exercises, aerobic training, calisthenics, plus physiotherapy and treatment of specific deficiencies, as well as psychological and dietary support. When possible, a six-minute walking test (6MWT) and a symptom limited cardiopulmonary exercise test (CPET) were performed at admission and at discharge. The Barthel scale (BI), measured at entry and at discharge, was used as autonomy index. Results: During the CR stay (mean 19±7 [5-39] days) 2 pts suffered of major gastrointestinal bleedings, requiring repeated blood transfusions, and had to be transferred before completing the rehabilitation protocol (both pts in the first year); in the last 3 years no major complications occurred in the CR unit and all pts completed the program. A mild hemolytic anemia was recognized in all pts (mean Hb level at discharge 10.2±1.3 g/dl). At the end of the CR period all pts enhanced independence and mobility (mean ?BI +11%) and were able to walk at least with the assistance of a stick. A 6MWT could be performed in 72% of pts (after 8±8 days) with a mean increment in the distance walked of 70.2±21.3 mt (p<0.05). In the same pts, the CPET demonstrated that they were able to sustain a light intensity work load (35.7±11.9 W; range 20-54 W), with a low maximum O2 consumption (12.4±3.4 ml/kg/min; range 7.4-19.8), close to the anaerobic threshold (11,3±2,8 ml/kg/min). Conclusions: Our experience with Jarvik 2000 VAD indicate that CR is feasible and safe in these patients allowing them to improve self autonomy and functional capacity; In this particular setting of patients, who usually have a lot of comorbidities and long periods of hospital stay before VAD implantation, It’s also a good tool to monitor the complications in the delicate phase after discharge from the acute departments.
    European Journal of Cardiovascular Prevention and Rehabilitation 01/2012; 19((Suppl 1)):S126. · 2.63 Impact Factor
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2011; 30(4).
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2011; 30(4).
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2011; 30(4).
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2011; 30(4).
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2011; 30(4).

Publication Stats

309 Citations
128.75 Total Impact Points

Institutions

  • 1993–2013
    • University of Padova
      • • Department of Cardiac, Thoracic and Vascular Sciences
      • • Department of Chemical Sciences
      • • Department of Medicine DIMED
      Padova, Veneto, Italy
  • 1994–2009
    • University-Hospital of Padova
      Padua, Veneto, Italy
  • 2000
    • Lerner Research Institute
      Cleveland, Ohio, United States
  • 1999
    • Paul Sabatier University - Toulouse III
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 1991
    • Heart of England NHS Foundation Trust
      Birmingham, England, United Kingdom
  • 1989
    • University of Verona
      Verona, Veneto, Italy