Matteo Attisani

Publications (11)20.97 Total impact

• Article: Advanced heart failure in critical patients (INTERMACS 1 and 2 levels): ventricular assist devices or emergency transplantation?

  Matteo Attisani, Paolo Centofanti, Michele La Torre, Massimo Boffini, Davide Ricci, Marco Ribezzo, Andrea Baronetto, Mauro Rinaldi
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  ABSTRACT: OBJECTIVE For patients in advanced heart failure, emergency transplantation or ventricular assist devices (VADs) are possible strategies. The aim of this single-centre, retrospective study was to evaluate early and long-term results for these two strategies. METHODS From 2005 to 2011, we analysed 49 INTERMACS level 1 and 2 patients, who were divided into the following two groups: group A comprised 26 patients on the waiting list for heart transplantation with urgent conditions; and group B comprised 23 patients who underwent VAD implantation as a bridge to candidacy. RESULTS In group A, 25 patients underwent transplantation. In group B, 19 patients were supported with left VAD and four with biventricular VAD. Of these 23 patients, 13 underwent transplantation (mean time 279 ± 196 days). The 30 day mortality was 42.3 and 4.3% in group A and B, respectively. Survival at 6 and 12 months was significantly better in group B than in group A (87 vs 53%, P = 0.018 at 6 months; and 77 vs 48%, P = 0.045 at 12 months). CONCLUSION Improved outcomes may justify the use of mechanical assistance devices as a bridge to candidacy or bridge to transplantation in INTERMACS 1 and 2 patients in order to avoid high-risk transplants. Evaluation of long-term multicentre outcomes is needed to assess future strategies.
  Interactive cardiovascular and thoracic surgery 07/2012; 15(4):678-84.
• Article: Successful replacement of a detached pedestal during support with Jarvik 2000.

  Paolo Centofanti, Matteo Attisani, Giovanni F Bosco, Andrè Khayat, Michele La Torre, Andrea Baronetto, Massimo Boffini, Mauro Rinaldi
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  ABSTRACT: Infection in patients supported with left ventricular assist devices (LVAD) is common and it can limit widespread implantation of mechanical assistance as destination therapy (DT). The infection-resistance power delivery system could improve longevity and quality of life. The Jarvik 2000 (Jarvik Heart, New York, NY, USA) driveline design showed a prolonged infection-free survival and a better quality of life compared to those patients supported with traditional LVAD with an abdominal cable. We report a singular driveline complication in a 71-year-old patient supported with a Jarvik 2000. A new retroauricular pedestal was successfully repositioned after the detachement of the first one.
  The International journal of artificial organs 02/2012; 35(2):152-5. · 1.86 Impact Factor
• Article: Rapid pacing for the off-pump insertion of the Jarvik left ventricular assist device.

  Paolo Centofanti, Michele La Torre, Matteo Attisani, Fabrizio Sansone, Mauro Rinaldi
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  ABSTRACT: We present our technique for the implantation of the Jarvik 2000 left ventricular assist device (Jarvik Heart, Inc, New York, NY) without cardiopulmonary bypass by the induction of rapid pacing that allows the insertion of the apical device into the left ventricle, minimizing blood loss and surgical complications. Although the off-pump implantation of left ventricular assist devices is not new, our experience of rapid pacing has not been previously reported to our knowledge.
  The Annals of thoracic surgery 10/2011; 92(4):1536-8. · 3.74 Impact Factor
• Article: Posterior ventricular septal defect in presence of cardiogenic shock: early implantation of the impella recover LP 5.0 as a bridge to surgery.

  Michele W La Torre, Paolo Centofanti, Matteo Attisani, Francesco Patanè, Mauro Rinaldi
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  ABSTRACT: Urgent repair (within 48 hr after diagnosis) of posterior ventricular septal defect in the presence of cardiogenic shock, consequent to acute myocardial infarction, is associated with a very high mortality rate. The use of left ventricular mechanical support devices has the potential to impart hemodynamic stability and to delay surgical treatment until such time as scar tissue forms around the defect, sufficient to hold a suture patch.From May 2004 through July 2007, 5 patients who were in cardiogenic shock as a consequence of acute posterior ventricular septal defect underwent early implantation of a transfemoral microaxial Impella® Recover® LP 5.0 Support System as mechanical support (bridge to surgery).The mean duration of support by the left ventricular assist device was 14.4 ± 6 days. No one died during assistance. The device reduced left-to-right shunting, systolic pulmonary artery pressure, central venous pressure, and pulmonary capillary wedge pressure. Liver, kidney, and lung function improved, and the 30-day mortality rate was 40%.Although this is a retrospective study of a very small patient population, without benefit of a control group, it is the first report of its kind. This initial experience using the Impella Recover 5.0 in cases of cardiogenic shock due to posterior ventricular septal defect suggests that this conservative approach is a feasible and safe way to improve hemodynamic conditions and delay surgery. Further clinical experience is needed to confirm these early results.
  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2011; 38(1):42-9. · 0.65 Impact Factor
• Article: Safety and effectiveness of low dosing of double antiplatelet therapy during long-term left ventricular support with the INCOR system.

  Matteo Attisani, Paolo Centofanti, Michele La Torre, Antonio Campanella, Fabrizio Sansone, Mauro Rinaldi
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  ABSTRACT: Adverse events due to anticoagulation and antiplatelet therapy during left ventricular assistance device (LVAD) support are very common, and every effort must be made to reduce their impact. We report our experience using a low dose of double antiplatelet therapy for patients provided with the INCOR LVAD system as a bridge to transplantation. Twelve patients (10 males, 35-60 years old) with acute or end-stage heart failure were included in this study. The mean follow-up was 10 months (cumulative 4.9 years). For antiplatelet therapy, we use an association of variable doses of aspirin and clopidogrel. The use of a platelet aggregation test (PAT) allows reducing the dose of the drugs to the minimum needed. The primary end point was to check the safety of the therapy, analyzing the incidence of major and minor bleeding complications. The secondary end point was to check the effectiveness of the therapy, evaluating the incidence of major and minor thromboembolic events. We had three (25%) cases of early postoperative mediastinal bleeding. On the contrary, no episodes of major bleeding occurred during the follow-up period. The rate of minor bleeding complications was low: 0.2 events per patient/year. The rate of major and minor thromboembolic events was acceptable (respectively 0.09 and 0.2 per patient/year). During LVAD support, double antiplatelet therapy with a low dose of aspirin and clopidogrel was safe and effective. PAT allows reducing the dose of antiplatelet drugs, avoiding complications related to excessive or insufficient dose administration.
  Journal of Artificial Organs 12/2010; 13(4):202-6. · 1.59 Impact Factor
• Article: Multiple splenic infarctions due to septic embolization in a patient supported with Berlin Heart-EXCOR biventricular assist device.

  Matteo Attisani, Paolo Centofanti, Michele La Torre, Mauro Rinaldi
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  ABSTRACT: Patients awaiting cardiac transplantation often require ventricular assist devices (VADs) due to instable circulatory condition. Device-related infections remain the 'Achilles heel' of mechanical circulatory support and wound complications after VAD placement are a formidable challenge to surgeons. Up to 25% of deaths in VAD patients are due to systemic sepsis, which occurs in 11-26% of patients and bacteria that are common pathogens including Staphylococcus, Pseudomonas, Enterococcus, and Candida. Sepsis, infection of implanted pump components, and infections of percutaneous drivelines continue to limit survival. The Berlin Heart-EXCOR VAD is a para-corporeal pulsatile system that has been successful in patients with severe biventricular dysfunction. We report a case of a 35-year-old male suffering from a postischemic cardiomyopathy who received an EXCOR biventricular assist device as a bridge to transplant. During the assistance the patient developed concomitant methicillin-resistant Staphylococcus aureus infection of implanted pump components which was resistant to conventional therapy. The patient developed sepsis with splenic infarctions due to septic embolization which was successfully treated with a heart transplant. In some extreme cases of VAD infections, such as this, the only therapeutic option is transplantation or device replacement.
  Interactive cardiovascular and thoracic surgery 12/2010; 12(3):497-9.
• Article: Images in cardio-thoracic surgery. Spontaneous coronary dissection due to isolated eosinophilic arteritis as a cause of urgent heart transplantation.

  Fabrizio Ceresa, Fabrizio Sansone, Matteo Attisani, Mauro Rinaldi
  European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 09/2009; 36(4):767. · 2.40 Impact Factor
• Article: Recurrent ventricular fibrillation due to coronary artery spasm immediately after ascending aorta replacement.

  Fabrizio Sansone, Sergio Trichiolo, Fabrizio Ceresa, Matteo Attisani, Andrea Berardo, Mauro Rinaldi
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  ABSTRACT: Coronary artery spasm (CAS) is a dangerous complication during cardiac surgery, causing arduous weaning of extracorporeal circulation (ECC) and myocardial tissue loss with consequent left and right ventricular dysfunctions. We describe the case of a 67-year-old man with hypertension and smoking habit, with ECG evidence of lateral myocardial ischemia without symptoms. On this basis, he was investigated with scintigraphy, which confirmed an anterior-lateral area of reversible ischemia and, subsequently, with angiography, which revealed just mild lesion (50%) of diagonal ramus associated with ascending aorta aneurysm: no sign of CAS was detected. Left ventricular function was normal, with mild hypokinesia of the apical segments and trivial aortic regurgitation. The patient underwent ascending aorta replacement with arduous ECC weaning due to CAS: exclusively, the use of intravenous administration of diltiazem led to the solution of this complication. Even if medical therapy is generally efficacious for this complication, the diagnosis is very complicated when it appears in the operating room immediately after cardiac surgery because of the lack of any useful device. The difficulty of diagnosis in the operating room might compromise patient outcome. In our opinion, when ECC weaning is complicated by several episodes of malignant tachyarrhythmia and there is the suspicion of underlying ischemic cause without other obvious causes, CAS must be considered and empirical therapy with calcium channel blockers should be used.
  Journal of Cardiovascular Medicine 06/2009; 10(10):810-2. · 1.51 Impact Factor
• Article: Mycotic pseudoaneurysm as aortic complication after heart transplantation.

  Francesco Patanè, Fabrizio Sansone, Antonio Campanella, Matteo Attisani, Mauro Rinaldi
  Transplant International 05/2009; 22(9):943-4. · 2.92 Impact Factor
• Article: Is surgery always mandatory for type A aortic dissection?

  Paolo Centofanti, Roberto Flocco, Fabrizio Ceresa, Matteo Attisani, Michele La Torre, Luca Weltert, Antonio Maria Calafiore
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  ABSTRACT: The International Registry of Aortic Dissections showed that 42% of the unoperated patients with type A acute aortic dissection were discharged from the hospital after intensive medical treatment. We analyzed our experience to identify a preoperative score for in-hospital mortality to propose an alternative strategy for type A acute aortic dissection. From 1980 to 2004, 616 consecutive patients with type A acute aortic dissection underwent surgery in our center. The preoperative univariate risk factors with a probability value less than 0.05 were entered into multivariate analysis. A risk equation was developed: predicted mortality = exp(beta 0 + sigma beta i X i)/[1 + exp(beta 0 + sigma beta i X i)]. Early mortality was 25.1% (154 of 616 patients). Five risk factors were identified: age, coma, acute renal failure, shock, and redo operation. The beta i values are age 0.023, shock 0.771, reoperation 0.595, coma 1.162, acute renal failure 0.778; the constant (beta 0) is -2.986. Our large, single-center experience allowed us to develop a mathematical model to predict 30-day mortality for type A acute aortic dissection. When the expected mortality is 58% or less, surgery is always indicated. When the predicted mortality is greater than 58%, the possibility of survival is similar, according to International Registry of Aortic Dissections data, for surgery and medical treatment. In such cases surgery can no longer be considered mandatory, and a careful evaluation of the individual patient is recommended to choose the more suitable strategy.
  The Annals of thoracic surgery 12/2006; 82(5):1658-63; discussion 1664. · 3.74 Impact Factor
• Article: Successful heart transplantation in Becker's muscular dystrophy.

  Francesco Patanè, Edoardo Zingarelli, Matteo Attisani, Fabrizio Sansone
  European Journal of Cardio-Thoracic Surgery 03/2006; 29(2):250. · 2.55 Impact Factor