G. Gerosa

University of Padova, Padova, Veneto, Italy

Are you G. Gerosa?

Claim your profile

Publications (110)192.03 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: LVADs activate the coagulation system, thus inducing a prothrombotic state which exposes the patient to thromboembolic risks. To prevent these events, antithrombotic treatment is necessary, but to avoid hemorrhagic complications, it is mandatory to calibrate therapy not only on patients, but also considering the different devices. Moreover, inflammatory status has been related to the occurrence of adverse events. Aim of this study was to investigate the impact on platelet activation and inflammatory response of two different continuous-flow LVADs: Jarvik 2000, an axial flow pump, versus HeartWare HVAD, a magnetically levitating centrifugal pump. Methods: We analyzed platelet counts, thromboelastometric (ROTEM®) and aggregometric (MultiPlate®) tests in 21 patients implanted with Jarvik and 18 with HeartWare between December 2008 and June 2013. Furthermore, we evaluated IL-6, C-reactive protein (CRP) and procalcitonin as markers of inflammation. Results: HeartWare patients showed significantly higher levels of platelets (p<.0001), Intem MCF (p<.0001), Extem MCF (p<.0001), Fibtem MCF (p=.006), TRAP (p<.0001) and COL (p=0.003) tests. We further observed in HVAD group a reduction of coagulation and platelet activation during follow-up. On the other hand, early IL-6 level was higher in Jarvik recipients, while CRP and procalcitonin were comparable. Conclusions: A different effect on hemostasis and inflammation was observed between the two pumps. HeartWare causes more pronounced activation of the coagulation system, which decreases over time. Jarvik is associated with an early inflammatory response. As a result, we usually treat HeartWare patients with both anticoagulant and antiplatelet drugs, while Jarvik patients are usually kept only on anticoagulation.
    28th Annual Meeting of the European Association for Cardio-Thoracic Surgery, Milan, Italy; 10/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Coronary allograft vasculopathy (CAV) involves both epicardial vessels and coronary microcirculation. Little is known about the effect of everolimus on coronary microvasculopathy in heart transplantation (HT). The aim of our study was to assess the pathological substrate of coronary flow reserve (CFR) impairment in HT patients and the effect of everolimus on microvascular remodeling and CFR. Methods We studied 28 HT patients with normal coronary angiograms (25 male, age at HT 54 ± 10 years). Immunosuppressive regimen consisted of cyclosporine and everolimus (10 patients) or mycophenolate mophetil (18 patients). They were evaluated with digital microscopy for morphometric analysis of fibrosis and microvascular remodeling. Coronary flow velocity in the left anterior descending coronary artery was detected using transthoracic Doppler echocardiography at rest and during adenosine infusion. CFR was the ratio of hyperaemic diastolic flow velocity (DFV) to resting DFV. A CFR ≤2.5 was considered abnormal and sign of coronary microvascular dysfunction. Results In patients with CFR ≤2.5 the thickness of the tunica media of intramyocardial arterioles was greater than in patients with CFR >2.5 (39 ± 2 vs 17 ± 3 μm; P = .02). Microvascular remodeling was significantly higher in patients with CFR ≤2.5 (72.7 ± 2.4 vs 50.4 ± 8.4%; P < .007). Capillary density and fibrosis were comparable between groups (157.2 ± 42.4 vs 175.7 ± 42.4 capillaries/mm2; P = .3; and 6.8 ± 5 vs 8.3 ± 4.9%; P = .4, respectively). The thickness of the tunica media of intramyocardial arterioles was lower in patients whose therapy included everolimus (15 ± 2 vs 32 ± 4 μm, P = .03) and CFR was higher (3.2 ± 0.5 vs 2.8 ± 0.9; P = .03). Conclusion The pathological substrate of reduced CFR in HT patients seems to be a hypertrophic remodeling of coronary arterioles. Everolimus appears to prevent such microvascular remodeling and preserve coronary flow reserve.
    Transplantation Proceedings 09/2014; 46(7):2339–2344. · 0.95 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Mechanical circulatory support (MCS) devices have been increasingly used for long-term support. We reviewed outcomes in all patients supported with a SynCardia total artificial heart (TAH) for more than one year to assess its safety in long term support.As of December 2011 all 47 patients who received the TAH from 10 centres worldwide were included in this retrospective study. Clinical data was collected on survival, infections, thromboembolic and hemorrhagic events, device failures, and antithrombotic therapy.The mean age of patients was 50 ± 1.57 year, the median support time was 554 days (range 365 - 1373 days). The primary diagnosis was dilated cardiomiopathy in 23 patients, ischemic in 15 and "other" in 9.After a minimum of one year of support, 34 patients (72%) were successfully transplanted, 12 patients (24%) died while on device support, and 1 patient (2%) is still supported. Five patients (10%) had a device failure reported. Major complications were as follows: systemic infections in 25 patients (53%), drive line infections in 13 patients (27%), thromboembolic events in 9 patients (19%) and hemorrhagic events in 7 patients (14%).SynCardia TAH has proven to be a reliable and effective device in replacing the entire heart. In patients who reached a minimum of one year of support, device failure rate is acceptable and only in two cases was the leading cause of death. Infections and hemorrhagic events were the major causes of death. Patients who remain supported beyond one year are still likely to survive to transplantation.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 08/2014; · 1.39 Impact Factor
  • [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. · 5.81 Impact Factor
  • Source
  • Source
  • Source
  • Source
    [Show abstract] [Hide abstract]
    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
  • [Show abstract] [Hide abstract]
    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.
  • XLIII Congresso Nazionale della Società Italiana di Cardiologia Pediatrica congiunto con la Sezione Pediatrica e delle Cardiopatie Congenite della Società Italiana di Chirurgia Cardiaca, Padua, Italy; 10/2013
  • [Show abstract] [Hide abstract]
    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
  • Source
    [Show abstract] [Hide abstract]
    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
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Ventricular assist device (VAD) therapy in heart failure is well established for temporary support as a bridge to transplantation. The haemodynamic fragility of these patients is well reported, and renal insufficiency, pulmonary hypertension, and chronic obstructive pulmonary disease stand out as risk factors. The aim of our study is to compare two different anaesthetic analgesic approaches during VAD implantation. Methods: Twelve patients with a mean age of 40 ± 12 years were supported with the HeartWare® LVAD for an average of 8 ± 4 months at our centre from January 2012 to February 2013. The same surgical technique (off-pump implantation, minimally invasive surgical approach) was applied. Six patients received the VAD with the aid of paravertebral analgesia associated with mild general anaesthesia (group A), while the remaining six patients were routinely anaesthetized (complete general anaesthesia). Results: Thoracic paravertebral-block analgesia allowed a fast postoperative weaning from mechanical ventilation and extubation in the operating room (OR) in four patients in group A (67%). The remaining two (33%) patients were extubated in the Intensive Care Unit 2 to 4 hours later. None of these patients required postoperative right ventricular support. No case of epidural haematoma was observed. In group B only one patient was similarly extubated in the OR (16.7%), while the others were extubated 6 to 24 hours later. Three patients required temporary right paracorporeal VAD support, further weaned and removed between 48 and 72 hours later. One patient (16.7%) died 7 days after implantation. Conclusions: Paravertebral analgesia may play a substantial role in VAD surgery favouring faster recovery and shorter hospital length of stay, important when patients at very high risk are considered.
    27th Annual Meeting of the European Association for Cardio-Thoracic Surgery, Vienna, Austria; 10/2013
  • [Show abstract] [Hide abstract]
    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
  • [Show abstract] [Hide abstract]
    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
  • Source
    [Show abstract] [Hide abstract]
    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
  • Source
    [Show abstract] [Hide abstract]
    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;
  • Source
  • Source
    [Show abstract] [Hide abstract]
    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
  • [Show abstract] [Hide abstract]
    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

Publication Stats

342 Citations
192.03 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