Ciro Mastroianni

Pierre and Marie Curie University - Paris 6, Lutetia Parisorum, Île-de-France, France

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Publications (16)30.33 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Extracorporeal life support (ECLS) devices provide temporary mechanical circulatory assistance and are usually implanted under emergency conditions in critical patients. If weaning off ECLS is not possible, heart transplantation or implantation of long-term mechanical circulatory support (LTMCS) is required. The purpose of our study was to evaluate the bridge-to-bridge (BTB) concept. Between 1 January 2004 and 1 August 2010, 97 patients were assisted by LTMCS. The implantation was the first-line intervention in 48 patients (the bridge group), and was performed after a period of ECLS support in 49 others (the BTB group). The long-term survival rate was 51.6%, with a mean follow-up of 30.7 months, and there were no differences for biological parameters between the two groups. Patients in the BTB group whose condition was initially more severe, improved under ECLS support, and those in whom biological parameters did not revert to normal died after LTMCS. Risk factors for mortality in the BTB group were total bilirubin and lactate before LTMCS, and alkaline phosphatase before ECLS support. The BTB concept allows the implementation of LTMCS in severe patients, for whom it was not originally envisaged, with the same long-term survival as in first-line settings. ECLS in the evolution of patients is predictive of survival after LTMCS. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2015; · 2.40 Impact Factor
  • G. Lebreton, C. Mastroianni, P. Leprince
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    ABSTRACT: L’extracorporeal membrane oxygenation (ECMO) veinoartérielle périphérique permet de restaurer en urgence une hémodynamique et une perfusion tissulaire. La configuration la plus utilisée est la canulation de l’artère et de la veine fémorale. La technique de référence est un abord chirurgical des vaisseaux fémoraux canulés selon la technique de Seldinger. L’abord chirurgical est rapide, peut être réalisé sous anesthésie locale, au lit du patient (y compris sous massage cardiaque externe) et permet d’une part une canulation sécurisée des vaisseaux et une bonne hémostase, et d’autre part la mise en place d’un dispositif de reperfusion de membre. La mise en place de l’ECMO est importante, car elle conditionne à la fois l’efficacité de l’assistance et la survenue de complications immédiates ou retardées pouvant engager directement le pronostic vital du patient. Aussi l’implantation ne se limite-t-elle pas à la mise en place d’une canule artérielle et d’une canule veineuse. Elle nécessite une rigueur et une expertise chirurgicale pour assurer une assistance efficace, des suites simples et préparer la décanulation. Les complications sont nombreuses et parfois fatales, ce qui motive une prise en charge par des équipes rompues aux techniques d’assistance circulatoire et capables d’intervenir en urgence pour traiter ces complications. Abstract Peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) allows to secure patient’s hemodynamics and tissue perfusion. The most recommended route is the surgical canulation of the femoral artery and femoral vena using the Seldinger technique. Surgical implementation is rapid, can be performed under local anaesthetics, at the bedside, and even under cardiac massage. It allows safe cannulation of the vessels, good haemostasis, and reperfusion of the cannulated limb. ECMO implementation conditions further ECMO efficiency and possible onset of immediate as well as delayed life-threatening complications. ECMO implementation is not limited to cannula placement but requires surgical expertise to guarantee ECMO efficiency and simple postoperative course and facilitate further decannulation. Complications are numerous and can be even fatal, requiring management by trained teams available for emergent intervention and able to treat any ECMO complication.
    Réanimation 12/2014; 22(S3):603-610.
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    ABSTRACT: La conduite d’une assistance circulatoire temporaire par extracorporeal membrane oxygenation (ECMO) veinoartérielle est délicate et expose le patient à de nombreuses complications pouvant engager le pronostic vital, parfois très brutalement. La gestion de ces complications impose une accessibilité en urgence à un plateau médicotechnique lourd et à des compétences pluridisciplinaires (réanimateurs, chirurgiens cardiothoraciques et perfusionnistes). De plus, l’ECMO n’assure qu’une assistance temporaire en attente de récupération ou d’une alternative thérapeutique. En absence de récupération, une stratégie thérapeutique faisant discuter la transplantation cardiaque et/ou l’assistance circulatoire de longue durée doit être rapidement définie et réévaluée quotidiennement en fonction de l’évolution du patient. Une prise en charge par des équipes médicochirurgicales expérimentées et rompues aux techniques d’implantation et de conduite de ces assistances, mais également à la gestion de leurs complications (y compris en extrême urgence), apparaît comme une condition nécessaire à la prise en charge de ces patients dans des conditions satisfaisantes de sécurité. Abstract Management of venoarterial extracorporeal membrane oxygenation (ECMO) is difficult and exposes the patient to the onset of life-threatening complications, sometimes occurring even suddenly. Treating ECMO complications requires available medico-technical support with multidisciplinary competences including intensivists, cardio thoracic surgeons, and perfusionnists. ECMO allows temporary life support as bridge to recovery or to alternative therapies. In the absence of recovery, the indication of heart transplantation or long-term assist device implementation should be considered and regularly revaluated on a daily basis in relation to patient’s improvement. Thus, ECMO management by experienced medico-surgical team is mandatory to guarantee ECMO-treated patients’ safety.
    Réanimation 12/2014; 22(S3):618-625.
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    ABSTRACT: Aim: Biventricular support can be achieved using paracorporeal ventricular assist devices (p-BiVAD) or the Syncardia temporary total artificial heart (t-TAH). The purpose of the present study was to compare survival and morbidity between these devices. Methods: Data from 2 French neighboring hospitals were reviewed. Between 1996 and 2009, 148 patients (67 p-BiVADs and 81 t-TAH) underwent primary, planned biventricular support. There were 128 (86%) males aged 44±13 years. Results: Preoperatively, p-BiVAD recipients had significantly lower systolic and diastolic blood pressures, more severe hepatic cytolysis and higher white blood cell counts than t-TAH recipients. In contrast, t-TAH patients had significantly higher rates of pre-implant ECLS and hemofiltration. Mean support duration was 79±100 days for the p-BiVAD group and 71±92 for t-TAH group (P=0.6). Forty two (63%) p-BiVAD recipients were bridged to transplantation (39, 58%) or recovery (3, 5%), whereas 51 (63%) patients underwent transplantation in the t-TAH group. Death on support was similar between groups (p-BiVAD, 26 (39%); t-TAH, 30 (37%); P=0.87). Survival while on device was not significantly different between patient groups and multivariate analysis showed that only preimplant diastolic blood pressure and alanine amino-transferase levels were significant predictors of death. Post-transplant survival in the p-BiVAD group was 76±7%, 70±8%, and 58±9% at 1, 3, and 5 years after transplantation, respectively, and was similar to that of the t-TAH group (77±6%, 72±6%, and 70±7%, P=0.60). Conclusion: Survival while on support and up to 5 years after heart transplantation was not significantly different in patients supported by p-BiVADs or t-TAH. Multivariate analysis revealed that survival while on transplantation was not affected by the type of device implanted.
    The Journal of cardiovascular surgery 01/2014; · 1.37 Impact Factor
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    ABSTRACT: Purpose: Impella 5.0 is a short-term left ventricle assist device (LVAD), inserted retrograde into the left ventricle across the aortic valve through a surgical peripheral access. Impella has been utilized for various indications but in the setting of bridge-to-bridge application there are limited reports. Methods: We performed a retrospective observational analysis of Impella utilization at our institution as bridge to long-term LVADs. The primary end-point was survival during Impella support. Results: Between December 2010 and February 2012, we implanted 20 Impella in patients with cardiogenic shock and, among these, 5 were implanted as bridge to long-term LVADs. In this latter group, mean age at the time of implantation was 44 ± 15.6 (range 27-68) years and there was a prevalence of males (80%). Etiology of cardiogenic shock was: decompensated anthracycline-induced cardiomyopathy (n = 1), myocardial infarction (n = 4). There was no major bleeding requiring surgical revision or infectious complications at the right axillary access. One patient required Impella replacement due to a pump stop. After a mean period of 14.2 ± 9.0 (range 6-27) days of Impella support, patients were switched to a long-term LVAD (Jarvik 2000, n = 2; HeartMate II, n = 3). One patient died 70 days after implantation of the long-term LVAD due to multi-organ failure, while the remaining patients are still alive after a mean period of follow-up of 108.6 ± 66.2 (range 19-191) days. Conclusions: Our experience shows that an Impella 5.0 implanted through the right axillary artery approach is a valid option as bridge to long-term LVADs.
    The International journal of artificial organs 08/2013; · 1.45 Impact Factor
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    Cristiano Amarelli, Ciro Mastroianni, Nicolas Brechot
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 07/2013; 59(4):367. · 1.39 Impact Factor
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    ABSTRACT: BACKGROUND: The SynCardia temporary total artificial heart (t-TAH) provides complete circulatory support by replacing both native cardiac ventricles and all cardiac valves. METHODS: We performed a retrospective analysis of demographics, clinical characteristics and survival of patients bridged to transplantation using the SynCardia t-TAH (SynCardia Systems Inc, Tucson, AZ). RESULTS: From 2000 to 2010, the SynCardia t-TAH was implanted in 90 consecutive patients (80 males; mean age, 46 ± 13 years) suffering cardiogenic shock secondary to idiopathic (n = 40, 46%) or ischemic (n = 24, 27%) cardiomyopathy or other causes. Before implantation, 7 (9%) patients had cardiac arrest, 27 (33%) were on ventilator, and 18 (22%) were on extracorporeal life support. Pre-implant creatinine values were 1.7 ± 0.97 mg/dL and total bilirubin levels were 45 ± 32 μmol/L; mean duration of support was 84 ± 102 days. Thirty-five (39%) patients died while on support after a mean of 62 ± 107 days. Actuarial survival on device was 74% ± 5%, 63% ± 6%, and 47% ± 8% at 30, 60, and 180 days after implantation. While on support, 9 (10%) patients suffered stroke, 13 (14%) had mediastinitis, and 35 (39%) required surgical reexploration for bleeding, hematoma, or infection. Multivariate analysis revealed that older recipient age and preoperative mechanical ventilation were risk factors for death while on support. Fifty-five (61%) patients were transplanted after a mean of 97 ± 98 days of support. Actuarial survival rates were 78% ± 6%, 71% ± 6%, and 63% ± 8% at 1, 5, and 8 years after transplantation. CONCLUSIONS: The SynCardia t-TAH provided acceptable survival to transplantation rates with a remarkably low incidence of neurologic events. Posttransplant survival was similar to that of patients undergoing primary heart transplantation in France.
    The Annals of thoracic surgery 04/2013; · 3.45 Impact Factor
  • Cristiano Amarelli, Ciro Mastroianni, Nicolas Brechot
    ASAIO Journal 01/2013; 59(4):367. · 1.39 Impact Factor
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    ABSTRACT: We present the case of a patient with cardiac tamponade secondary to late intrapericardial migration of a disrupted ventriculo-atrial shunt (VAS). A 48-year old woman was referred for cardiac tamponade. She had a history of congenital hydrocephalus with implantation of a VAS (Codman(®)) in 1994. The initial neurological examination was normal. Tomodensitometry showed a discontinuity of the VAS at the cervical level with its distal part floating in the pericardium. Immediate surgery through sternotomy allowed the draining of the pressurized translucid liquid. The distal part of the VAS was extracted and the perforation site on the right ventricle was sutured. The patient showed no neurological trouble 3 months after operation. Surprisingly, cardiac tamponade was not related to bleeding but to the accumulation of translucid liquid whose gross aspect and biochemistry were very suggestive of cerebrospinal fluid (CSF). We hypothesize that a fibrin sheath had developed around the VAS at the time of its disconnection and acted as a fibrous tunnel allowing continued CSF drainage through its distal part. Surgical strategies to prevent late VAS disconnection should be considered at the time of implantation.
    Interactive Cardiovascular and Thoracic Surgery 12/2012; · 1.11 Impact Factor
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    ABSTRACT: During 2009, pandemic influenza A (H1N1) affected France and several patients developed influenza A (H1N1)-associated acute respiratory distress syndrome. The use of extracorporeal membrane oxygenation (ECMO) could be advocated as therapeutic solution. We present our experience with ECMO utilized in patients with influenza A (H1N1)-associated respiratory failure. We conducted a retrospective observational analysis of our experience with veno-venous ECMO for 2009 influenza A (H1N1)-associated respiratory failure. We have excluded from our study all not confirmed cases of influenza A (H1N1). Veno-venous ECMO was always instituted using a percutaneous cannulation technique. Mechanical circulatory support was maintained until respiratory function recovery. Between October 2009 and February 2010, we performed veno-venous ECMO support in 12 patients with influenza A (H1N1)-associated respiratory failure. Mean age was 33 ± 12 years (14-63 years) and there was a prevalence of female sex. Median time from influenza A (H1N1) onset to mechanical ventilation (MV) initiation was 6 days (1-17 days); median time from MV to veno-venous ECMO support was 3 days (1-20 days). Six patients (50%) suffered ventilator-associated pneumonia during ECMO support. Eight patients (66.6%) suffered significant haemorrhage requiring transfusion of more than 2 packed red cells. In two patients (16.6%), there was a thrombosis of the inferior vena cava and one of them experienced pulmonary embolism. Mean duration of ECMO support was 23 ± 14 days (3-47 days); mean duration of mechanical ventilatory support was 24 ± 21 days (6-70 days). ECMO was weaned in 10 patients (83.3%) and all these patients are still alive after a period of follow-up of 13.8 ± 1.12 months (11.03-14.83 months). Two patients (in-hospital mortality of 16.6%) died under ECMO support for refractory septic shock. Veno-venous ECMO for 2009 H1N1-associated respiratory failure gives good results with a very low mortality rate. The use of a mobile unit is a safe procedure and may improve survival of patients who might not be otherwise eligible for transfer to our institution. Larger studies are however required in order to optimize and refine the best treatment strategy in this subgroup of patients.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2012; 41(3):691-5. · 2.40 Impact Factor
  • International journal of cardiology 07/2011; 155(2):e27-8. · 6.18 Impact Factor
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    ABSTRACT: Leukocytes in allogeneic blood transfusions cause several immunomodulatory events. This before-and-after cohort study evaluated clinical outcomes after adoption of prestorage leukoreduction program for blood transfusions, with particular focus on acute kidney injury. One thousand thirty-four consecutive patients who underwent on-pump coronary artery bypass grafting between January 2004 and December 2007 were included. Propensity score analysis for transfusion was performed in the whole population; patients who were actually transfused were then divided according to leukoreduction. From these 2 groups, 147 pairs matched for propensity score were considered to evaluate with bivariate and multivariable analyses the effects of leukoreduction, with all-cause in-hospital mortality and morbidity as main outcomes. Unadjusted in-hospital mortalities were 6.6% for the entire cohort and 44.2% for those with acute kidney injury. In the matched population, after introduction of leukoreduction, mortality rates decreased to 5.4% (vs 11.4%) and acute kidney injury (RIFLE [Risk, Injury, Failure, Loss of function, End-stage renal disease] class R or greater) dropped from 51.7% to 41.5% (relative risk -20%, P < .045). No difference emerged regarding other major complications. At multivariable analysis, intra-aortic balloon pump, RIFLE score, and propensity score for transfusion proved independent predictors of in-hospital mortality. Intra-aortic balloon pump and nonleukodepleted transfusion emerged as independent predictors of acute kidney injury. Multivariable analysis on the overall cohort of transfused patients confirmed that nonleukodepleted transfusion was an independent predictor of acute kidney injury. Leukoreduction of allogeneic blood products is associated with decreased acute kidney injury and mortality in highly transfused patients.
    The Journal of thoracic and cardiovascular surgery 07/2010; 140(1):188-95. · 3.41 Impact Factor
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    ABSTRACT: Superimposed acute right ventricular dysfunction in the setting of preexisting pulmonary hypertension is a nearly fatal complication after heart transplantation. The optimal treatment modality remains a matter of debate. Recently, sildenafil citrate, a nonselective pulmonary vasodilator, has gained popularity in the treatment of pulmonary hypertension in transplant candidates. Herein we have presented a series of 13 patients in whom sildenafil was used to treat right ventricular dysfunction and pulmonary hypertension as detected by transesophageal echocardiography and Swan-Ganz right heart catheterization after heart transplant. Their characteristics were mean age 49+/-11.4 years; 38.4% with previous cardiac procedures, 30.8% status I, basal pulmonary vascular resistance index 10.4+/-4.6 WoodU, mean transpulmonary gradient 18.7+/-5.4 mmHg. In addition to conventional inodilator support, we administered 1 to 3 mg per kilogram of sildenafil. Complete hemodynamic measurements were obtained before and after the institution of the therapy and at 1-month follow-up. Within the first 72 hours, acute right ventricular dysfunction resolved in all cases without untoward side effects or significant systemic impact. Sildenafil significantly decreased the transpulmonary gradient and pulmonary vascular resistance index relative to baseline values; 5.6+/-1.82 versus 10.4+/-4.6 WU, (P< .05), 13.5+/-3.4 mm Hg versus 18.7+/-5.4 mm Hg (P< .05), respectively. Improved indices of right ventricular function were observed on echocardiographic monitoring. After 1 month, sildenafil treatment was discontinued. Management of acute right ventricular dysfunction in heart transplant recipients with pulmonary hypertension using sildenafil proved safe and effective.
    Transplantation Proceedings 07/2008; 40(6):2015-8. · 0.95 Impact Factor
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    ABSTRACT: Clinical studies indicate that indices of glomerular filtration rate (GFR) as serum creatinine or creatinine clearance can predict the risk of death in congestive heart failure (CHF) and in heart transplantation. The study reports data on creatinine clearance before and after heart transplantation in 160 patients followed-up for 5 years at our Unit. Pre-transplant creatinine clearance averaged 83.5+/-32 mL/min x 1.73 m(2) and was not significantly associated with 5-year mortality. Creatinine clearance significantly decreased after heart transplantation with a linear trend up to 3 years for patients with complete follow-up. Data suggest that the relation between kidney function and mortality after heart transplantation is affected by several confounders with inclusion of cause of heart disease, co-morbidity, anemia, and post-transplant decrease in kidney function.
    Seminars in Nephrology 12/2005; 25(6):413-8. · 2.94 Impact Factor
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    ABSTRACT: This retrospective single-center report sought to evaluate the relation of immunosuppressive regimen with the incidence and characteristics of cytomegalovirus (CMV) infection from 1999 to 2003. Immunosuppression consisted of cyclosporine microemulsion (Neoral), azathioprine (AZA), and prednisolone associated with either thymoglobulin or ATG high-dosage induction from 1999 to 2000 (AZA, 64 patients [AZA-Thymo = 38 patients and AZA-ATG 26 patients]), or cyclosporine microemulsion (Neoral), mycophenolate mofetil (MMF), and prednisolone with low-dose thymoglobulin induction from 2001 onward (n = 52 patients). Ganciclovir preemptive therapy was guided by pp65 antigenemia monitoring without CMV prophylaxis. The study groups were homogeneous with respect to major perioperative risk factors. Comparing the two AZA subgroups no difference emerged as to percentage of pp65 antigenemia-positive, preemptively treated patients reflecting CMV disease incidence and relapses. AZA-Thymo patient showed significantly shorter time to first positive pp65-antigenemia and higher viral load (AZA-Thymo vs AZA-ATG, P = .004 and P = .009). The two subgroups did not differ with regard to incidence of rejection, superinfection, and graft coronary disease. By shifting from AZA to MMF no difference emerged as to incidence and characteristics of CMV infections, but there was a significant reduction in acute rejection and superinfection (AZA vs MMF P = .001 and P = .008). The distinct immunological properties of thymoglobulin versus ATG significantly altered the pattern of CMV expression. MMF with reduced-dose induction did not engender a higher CMV morbidity.
    Transplantation Proceedings 07/2005; 37(6):2684-7. · 0.95 Impact Factor
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    ABSTRACT: This analysis is a retrospective characterization of evolving patterns in donor and recipient risk factors for early and late outcomes (survival and freedom from rejection) along with determinants of hospital and 1-year mortality after heart transplantation over a 15-year experience in a single center. Profiles and outcomes were evaluated for procedures performed between 1988 and 1995 (group A, n = 105) versus 1996 and 2003 (group B, n = 218). The following parameters were considered: pretransplant diagnosis, recipient age UNOS status, donor age, total postretrieval ischemic time, donor/recipient size match, and degree of myocardial necrosis at biopsy. Recipients in group B were significantly more compromised as demonstrated by UNOS status (11.4% vs 19.3%; P =.05) and pretransplant pulmonary vascular resistance (2.3 +/- 1.5 vs 3.1 +/- 1.5; P =.04). Marginal donors were more frequently used for group B procedures (21.9% vs 47.7%; P <.0001). Outcomes were significantly more favorable among group B patients in terms of hospital mortality (18.1% vs 10.6%; P =.046), and 1- and 5-year actuarial survival (72.4% vs 83.4%, 60% vs 73.3%, respectively; P =.006). Analysis of the causes of death disclosed a significant reduction in fatal events due to graft failure and acute rejection in group B. No difference emerged with regard to actual freedom from acute rejection. Determinants of hospital mortality were pretransplant diagnosis, UNOS status, donor age, and cardioplegic solution. Transplant era, recipient age, infectious episodes, and ischemic necrosis at biopsy were risk factors for 1-year mortality. We conclude that despite extensive usage of marginal donors and selection of worse candidates, significantly better outcomes were achieved due to improvements in global management strategies.
    Transplantation Proceedings 04/2004; 36(3):627-30. · 0.95 Impact Factor

Publication Stats

88 Citations
30.33 Total Impact Points


  • 2011–2015
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
  • 2013
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      • Service d’Anesthésie Réanimation
      Lutetia Parisorum, Île-de-France, France
  • 2010
    • Monaldi Hospital
      Napoli, Campania, Italy
  • 2008
    • Second University of Naples
      • Faculty of Medicine and Surgery
      Caserta, Campania, Italy