Roberto Chiesa

Università Vita-Salute San Raffaele, Milano, Lombardy, Italy

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Publications (429)

  • A. Kahlberg · R. Miloro · A.M. Ferrante · [...] · R. Chiesa
    Article · Sep 2016
  • G. Melissano · L. Bertoglio · A. Kahlberg · [...] · R. Chiesa
    Article · Sep 2016
  • Source
    Andrea Kahlberg · Matteo Montorfano · Tommaso Cambiaghi · [...] · Roberto Chiesa
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: To present stent-graft treatment of parietal thrombus in the ascending aorta. Case report: A 64-year-old man with no history of vascular disease developed a right cerebral hemisphere transient ischemic attack and was diagnosed with mural thrombosis of the ascending aorta involving the greater curvature just proximal to the origin of the innominate artery. He was treated for 2 months with anticoagulants, but new imaging studies showed significant increase in the size of the thrombus and an irregular aspect. The thrombus was excluded from the aortic blood flow by deployment of a custom-made stent-graft in the ascending aorta, with embolic protection of the right internal carotid artery. At 6 months, the patient was well, and the thrombus in the ascending aorta appears to be completely excluded by the stent-graft. Conclusion: In highly selected cases, custom-made thoracic stent-grafts may be used for stabilization and exclusion of symptomatic ascending aorta parietal thrombosis to prevent progression and recurrent embolization.
    Full-text Article · Aug 2016 · Journal of Endovascular Therapy
  • Roberto Chiesa · Efrem Civilini · Germano Melissano · [...] · Enrico Rinaldi
    Chapter · Aug 2016
  • Roberto Chiesa · Efrem Civilini · Enrico Maria Marone · [...] · Yamume Tshomba
    Chapter · Aug 2016
  • Daniele Mascia · Sthefano A Gabriel · Andrea Kahlberg · [...] · Roberto Chiesa
    [Show abstract] [Hide abstract] ABSTRACT: Background: Our aim is to report our single center experience with extracranial carotid artery aneurysms (ECAA) open repair. Methods: A retrospective review was performed including the perioperative and postoperative data of all patients who underwent ECAA repair between 2008 and 2015. The operative technique was based on aneurysm size, anatomical features and operative risk. Results: Fourteen patients (6 men and 8 women, mean age ± 60.5 years) were admitted for ECAA. Thirteen patients (92.8%) were submitted to ECCA open repair while in one patient (7.2%) conservative treatment was realized. Bilateral lesions and concomitant internal carotid artery (ICA) kinking was observed in 2 cases (13%). Seven patients (54%) were asymptomatic at diagnosis and ECCA localization involved ICA in 9 cases (69.2%). Aneurysmectomy with end-to-end anastomosis was perfomed in 2 cases (15.3%), patch arterioplasty in 2 cases (15.3%), prosthetic graft interposition in 3 cases (23.0%), autologous vein graft bypass in 2 cases (15.3%) and artery ligation with distal ICA arteriorraphy in one case (7.6%). No perioperative deaths, major neurological complications and surgical reinterventions were recorded. Overall survival at a mean follow-up of 19.6 months (range, 0-52 months) was 100%. Conclusions: ECAA open repair represents a safe surgical option, with lower prevalence of complications and no need for reintervention in high volume centers.
    Article · Jun 2016 · The Journal of cardiovascular surgery
  • Article · Jun 2016
  • Source
    E. Marin · M.V. Diamanti · M. Boffelli · [...] · R. Chiesa
    [Show abstract] [Hide abstract] ABSTRACT: Anodic spark deposition is particularly spread as coating treatment of titanium in biomedical applications, as it allows to improve both durability and biocompatibility of titanium and its alloys. This work proposes an analysis of different surface treatments on titanium, where surface etching in HF prior to anodizing and final alkali etching of the anodic oxide are chosen as possible methods to alter surface roughness, crystal structure and chemical composition. Anodizing was performed at two different voltages to produce different morphologies and crystal phases. Larger and more regular porosity was obtained at higher voltages, together with the formation of sodium titanates. While the HF pre-treatment only affected surface roughness but not surface chemistry, the NaOH post treatment promoted the formation of Na2TiO3 especially on high voltage formed oxides. This was identified as the cause for a larger presence of radical species, which modify surface bioactivity and produce a bacteriostatic effects of the treatments reported in previous biological studies.
    Full-text Article · Jun 2016
  • Yamume Tshomba · Daniele Mascia · Marco Leopardi · [...] · Roberto Chiesa
    Article · Jun 2016
  • Andrea Kahlberg · Enrico Rinaldi · Gabriele Piffaretti · [...] · Roberto Chiesa
    [Show abstract] [Hide abstract] ABSTRACT: Objective: This study investigated the frequency, clinical features, therapeutic options, and results of aortoenteric fistulas (AEFs) developing after endovascular abdominal aortic repair (EVAR). Methods: Eight Italian centers with an EVAR program participated in this retrospective multicenter study and collected data on AEFs that developed after a previous EVAR. Results: A total of 3932 patients underwent EVAR between 1997 and 2013 at the participating centers. During the same period, 32 patients presented with an AEF during EVAR follow-up, 21 with original EVAR performed for atherosclerotic aneurysmal disease (ATS group) and 11 with the original EVAR performed for a postsurgical pseudoaneurysm (PSA group). The incidence of AEF development after EVAR was 0.46% in the ATS group and 3.9% in the PSA group. Anastomotic PSA as the indication to EVAR (P < .0001) and urgent/emergency EVAR (P = .01) were significantly associated with AEF development. Median time between EVAR and the AEF diagnosis was 32 months (interquartile range, 11-75 months) for the ATS group and 14 months (interquartile range, 10.5-21.5 months) for the PSA group. Among five AEF patients treated conservatively, two (40%) died, at 7 and 15 months, and the remaining three were alive at a median follow-up of 12 months. The AEF was treated surgically in 27 patients, including aortic stent graft explantation in all cases, in situ aortic reconstruction in 14 (52%), and extra-anatomic bypass in 13 (48%). Perioperative mortality was 37% (10 of 27). No additional aortic-related death was recorded in operated-on patients at a median follow-up of 28 months. Conclusions: Late AEFs rarely occur during EVAR follow-up, but the risk is significantly increased when EVAR is performed for PSA after previous aortic surgery and EVAR is performed as an emergency. Conservative and surgical treatment of post-EVAR AEF are both associated with high mortality. However, beyond the perioperative period, surgical correction of AEFs appears to be durable at midterm follow-up.
    Article · Jun 2016 · Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
  • Article · Jun 2016
  • Germano Melissano · Daniele Mascia · Sthefano A Gabriel · [...] · Roberto Chiesa
    [Show abstract] [Hide abstract] ABSTRACT: Background: describe our experience with endovascular and open repair of hepatic artery aneurysms (HAA). Methods: A retrospective review of 26 patients (18 males and 8 females; mean age: 62+/- 9 years) who underwent surgical open repair of HAA between 1998 and 2015 was performed. Indications to open or endovascular procedure was based on aneurysm size, anatomical features and operative risk. Results: Aneurysm size ranged between 2 and 17 cm (mean value: 3.3 cm). Endovascular treatment was performed in 9 patients (34.6%) while open repair in 17 (65.4%). Endovascular procedures included 5 (55.5%) coils embolization and 4 (44.5%) endograft exclusion. Open repair included 9 (53%) aneurysmectomies with end-to-end anastomosis, 7 (41.1%) aneurysmectomies and bypass grafting and 1 (5.9%) simple ligation. In the surgical group, one case of respiratory insufficiency and one myocardial infarction were observed. A 7 cm pseudoaneurysm was found during followup for an hepatic artery aneurysm treated 8 years before: the patient underwent re-laparotomy and artery ligation. In the endovascular group, a stent-graft thrombosis occurred and one case of aneurysm repercussion after coils embolization was found at 48 months follow-up: both patients were treated by means of surgical conversion with aorto-hepatic bypass. Conclusions: Endovascular and open repair are both effective in the treatment of HAA. Type of treatment selection is individualized based on patients' clinical status, aneurysm location and the presence of hepatic collateral circulation.
    Article · May 2016 · The Journal of cardiovascular surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Objective: The risk of severe perioperative bradyarrhythmias in patients with chronic left bundle branch, or bifascicular block, and an additional first-degree atrioventricular block undergoing carotid endarterectomy (CEA) has never been specifically addressed. In this study, we aimed to investigate whether these conduction abnormalities entail an increased risk of hemodynamic compromise during CEA, and the role of temporary transvenous pacemaker (TTVPM) implantation as a prophylactic measure in this subgroup of patients. Methods: Between June 2006 and June 2013, 37 CEAs were performed in 31 patients (29 men, mean age 76 ± 6 years), in whom a TTVPM was implanted for a trifascicular block. Thirty-seven concurrent, consecutive patients operated for other vascular pathologies also with a prophylactic TTVPM for an asymptomatic trifascicular block served as controls. Adverse events were considered: pacemaker activation, block progression, bradycardia ≤ 40 beats/min, asystole. Results: Study and control groups were overall comparable. No perioperative mortality was recorded. All patients undergoing CEA were asymptomatic for syncope preoperatively. Among them, in 34 cases indication for TTVPM was based on preoperative EKG, and in 4 a pacemaker activation was recorded. Three additional patients were also included in the study group in whom TTVPM was implanted due to the occurrence of adverse advents, and not prophylactically. In 2 of these, severe bradycardia with eventual asystole occurred intraoperatively. In both cases the procedure was discontinued, and re-scheduled for the following day after a TTVPM was implanted. In the last additional case, the patient had a block progression on day 1 after an uneventful CEA, and was emergently treated with a TTVPM. Overall, 7 adverse events were recorded in the study group, and none in the control group (P < . 011 ). Morbidity in the CEA group also included 1 myocardial infarction, 1 minor stroke, 1 surgical revision for cervical hematoma, 1 new-onset atrial fibrillation, 1 femoral artery pseudoaneurysm. Conclusions: In our experience, TTVPM implantation was a clinically useful adjunct in patients with trifascicular block submitted to CEA, as compared to other vascular surgical procedures. However, the risks inherent to CEA in this subgroup of patients suggest that surgical treatment may not be warranted for those with asymptomatic carotid disease.
    Article · May 2016 · Annals of Vascular Surgery
  • C. Ferrer · P. Cao · P. De Rango · [...] · R. Chiesa
    [Show abstract] [Hide abstract] ABSTRACT: Objective The aim of this study was to investigate outcomes of patients treated with endovascular repair (ER) with the use of fenestrated and branched stent grafts or open surgery (OS) for thoracoabdominal aortic aneurysm (TAAA) in a current series of patients. Methods All TAAA patients undergoing repair at three centers between January 2007 and December 2014 were included in a prospective database. Patients were stratified according to treatment by ER or OS, and outcomes were compared using propensity score matching (1:1). Covariates included age, sex, aneurysm extent, hypertension, coronary disease, chronic pulmonary disease, diabetes, and renal function. The primary end points were mortality and paraplegia. Secondary end points included any spinal cord ischemia (SCI), renal and respiratory insufficiency, and a composite of these complications or death at 30 days. All-cause survival and freedom from reintervention were compared in the two groups. Results Of 341 patients, 84 (25%) underwent ER and 257 underwent OS (75%). After propensity score matching (65 patients per group), no significant differences were observed in rates of 30-day mortality (7.7% in ER and 6.2% in OS; P = 1) and paraplegia (9.2% and 10.8%; P = 1). Any SCI, renal insufficiency, and respiratory insufficiency were 12.3% and 20% (P =.34), 9.2% and 12.3% (P =.78), and 0% and 12.3% (P =.006) in ER and OS, respectively. The incidence of the composite end point was significantly lower in ER patients (18.5% in ER vs 36.0% in OS; P =.03). According to Kaplan-Meier estimates, all-cause survival at 24 months was 82.8% in ER and 84.9% in OS, with rates unchanged at 42 months (P =.9). Rates of freedom from reintervention were 91.0% vs 89.7% at 24 months and 80.0% vs 79.9% at 42 months in ER vs OS, respectively (P =.3). Conclusions A propensity score analysis in patients with TAAA undergoing repair suggests an early benefit from ER compared with OS with regard to the composite end point because of reduced 30-day respiratory complications. No significant differences were found in SCI and renal insufficiency at 30 days and in survival and reintervention rates at midterm.
    Article · May 2016
  • Source
    Germano Melissano · Yamume Tshomba · Daniele Mascia · [...] · Roberto Chiesa
    [Show abstract] [Hide abstract] ABSTRACT: Background: to characterize indications, describe repair methods and report outcomes of patients undergoing late open conversion (LOC) after thoracic endovascular aortic repair (TEVAR). Methods: From to 1999 to 2015, 65 patients underwent redo procedures after TEVAR at our Institution. Thirty patients underwent LOC. The average time from the index TEVAR to LOC was 57 months (range 2-98 months). Indication to LOC was progression of distal aortic disease in nine patients (30%), stent-graft infection/fistulization in ten (33.3%), retrograde dissection in six (20%), endoleak in three (10%), device migration/failure in two (6.7%). Left heart bypass and cerebrospinal fluid drainage were used in 22 (73.3%) and 16 (53.3%) cases, respectively. In 17 patients (56.6%) thoracic stent-graft was only partially removed and the proximal anastomosis was performed including the native aorta, the stent-graft and the surgical graft. Biological flap coverage with intercostal muscle flap was used in six of infected cases. Results: Overall perioperative mortality rate was 16.6% (5 patients) - 20% in the subgroup of patients with stent-graft infection/fistulization (2 pts) and 33% in the subgroup with retrograde dissection (2 pts). Respiratory failure was the most common complication with seven cases (23.3%). Paraplegia was observed in one patient (3.3%). At a mean follow up of 19 months (range, 5-63) there was one aortic-related death for aorto-esophageal fistula. Conclusions: Open conversion after TEVAR was feasible leaving in site the proximal segment of the thoracic stent-graft in most of the cases. The risk of death and morbidity was higher in case of infection, fistula and retrograde dissection.
    Full-text Article · Apr 2016 · The Journal of cardiovascular surgery
  • Marco Leopardi · Yamume Tshomba · Alessandro Castiglioni · [...] · Roberto Chiesa
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: To report an uncommon case of chimney stent-graft migration in the aortic arch. Case report: A 29-year-old man presented with chronic left arm hyposthenia after late displacement and thrombosis of a left subclavian artery (LSA) chimney graft that migrated retrogradely into the innominate artery 2 years after deployment. The self-expanding LSA chimney was placed during a redo procedure to repair a pseudoaneurysm and type I endoleak after an index emergency thoracic endovascular aortic repair for traumatic aortic rupture 1 year earlier. The patient was successfully treated in an elective procedure via a median sternotomy, with arch aortotomy under circulatory arrest to remove the proximal end of the thrombosed chimney graft from the ostium of the innominate trunk. Three months later, a left carotid-to-subclavian bypass was performed to restore flow to the left arm. Conclusion: Migration of the proximal end of an overly long chimney graft that moved freely in the aortic arch exposed the patient to a high risk of stroke and death. Because of the high-risk situation, open repair under circulatory arrest was elected to remove the proximal end of the chimney graft, with no major complications.
    Article · Apr 2016 · Journal of Endovascular Therapy
  • [Show abstract] [Hide abstract] ABSTRACT: Background: To investigate the differences in length of hospital stay (LOS) between patients receiving an enhanced recovery after surgery (ERAS) approach and patients receiving conventional perioperative care in elective infrarenal abdominal aortic aneurysm (AAA) repair. Secondary endpoints were the difference in postoperative pulmonary, renal, cardiovascular and gastrointestinal complications, unplanned intensive care unit admission, surgical reintervention and in-hospital mortality between groups. Methods: In this retrospective observational study, data of all patients undergoing open infrarenal AAA repair between June 2009 and December 2014 were recorded. After excluding the first month, we propensity matched 2:1 patients operated on before and after the introduction of an ERAS program (started in September 2012). Results: A total of 1,034 elective open infrarenal AAA repairs were performed during the study period. Six-hundred and sixty-three patients who underwent surgery between June 2009 - September 2012 received standard perioperative care and were propensity matched with 371 patients who underwent surgery between October 2012-December 2014 after implementing ERAS approach in September 2012 in 13 patients. A statistically significant reduction in LOS (6.0 [5.5-6.5] vs 5.5 [5.4-6.5] days; p=0.021) and pulmonary complications (9.6% vs 4.7%; p=0.014) in the ERAS group were recorded. Other postoperative complications, need for unplanned intensive care unit admission, need for surgical reintervention and in-hospital mortality were similar between groups. Conclusions: An ERAS program is effective in reducing LOS and pulmonary complications after elective infrarenal AAA repair.
    Article · Apr 2016 · The Journal of cardiovascular surgery
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    F. Ravanetti · R. Chiesa · M. C. Ossiprandi · [...] · A. Cacchioli
    [Show abstract] [Hide abstract] ABSTRACT: In implantology, as an alternative approach to the use of antibiotics, direct surface modifications of the implant addressed to inhibit bacterial adhesion and to limit bacterial proliferation are a promising tactic. The present study evaluates in an in vivo normal model the osteogenic response and the osteointegration of an anodic spark deposition nanostructured titanium surface doped with gallium (ASD + Ga) in comparison with two other surface treatments of titanium: an anodic spark deposition treatment without gallium (ASD) and an acid etching treatment (CTR). Moreover the study assesses the osteoprotective potential and the antibacterial effect of the previously mentioned surface treatments in an experimentally-induced peri-implantitis model. The obtained data points out a more rapid primary fixation in ASD and ASD + Ga implants, compared with CTR surface. Regarding the antibacterial properties, the ASD + Ga surface shows osteoprotective action on bone peri-implant tissue in vivo as well as an antibacterial effect within the first considered time point. Graphical Abstract
    Full-text Article · Mar 2016 · Journal of Materials Science Materials in Medicine
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    A Cochis · B Azzimonti · R Sorrentino · [...] · R Chiesa
    [Show abstract] [Hide abstract] ABSTRACT: This paper contains original data supporting the antibacterial activities of Gallium (Ga3+)-doped pro-osteointegrative titanium alloys, obtained via Anodic Spark Deposition (ASD), as described in “The effect of silver or gallium doped titanium against the multidrug resistant Acinetobacter baumannii” (Cochis et al. 2016) [1]. In this article we included an indirect cytocompatibility evaluation towards Saos2 human osteoblasts and extended the microbial evaluation of the Ga3+ enriched titanium surfaces against the biofilm former Escherichia coli and Staphylococcus epidermidis strains. Cell viability was assayed by the Alamar Blue test, while bacterial viability was evaluated by the metabolic colorimetric 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay. Finally biofilm morphology was analyzed by Scanning Electron Microscopy (SEM). Data regarding Ga3+ activity were compared to Silver.
    Full-text Article · Jan 2016 · Data in Brief
  • Andrea Kahlberg · Enrico Rinaldi · Yamume Tshomba · [...] · Roberto Chiesa
    [Show abstract] [Hide abstract] ABSTRACT: Background: To investigate the predictors of blood count changes and coagulation parameters alterations after thoracic aortic endovascular repair (TEVAR). Methods: 50 patients (41 males, age 72 ± 7 years) submitted between 2007 and 2009 to elective TEVAR for non-dissecting aortic lesions, without major associated surgical procedures, were analyzed. Blood count and coagulation parameters were recorded pre-operatively and daily up to postoperative day 5. The volume of new thrombus formed after TEVAR (TV) was calculated comparing pre- and post-operative computed tomography scans with a semi-automatic method by two independent examiners. Pre- intra-, and post-operative variables, including TV, were tested for a possible effect on changes in laboratory values and transfusion requirements using a stepwise multiple regression model analysis. Results: In the multivariable model, TV and associated surgical procedures were significantly associated with maximum platelets decrease (P = 0.021, and P = 0.029, respectively), while only TV remained a significant predictor for maximum prothrombin time increase (P = 0.003). Maximum aneurysm diameter (P = 0.041), procedural time (P = 0.027), and TV (P = 0.047) were also significant predictors of transfusion requirement. Conclusions: TEVAR is associated with consumption of platelets and coagulative factors, which seems to be associated with the amount of perioperative aneurysm thrombosis. The latter may also help to predict perioperative transfusion requirement.
    Article · Jan 2016 · The Journal of cardiovascular surgery

Publication Stats

6k Citations

Institutions

  • 2010-2012
    • Università Vita-Salute San Raffaele
      Milano, Lombardy, Italy
  • 1994-2010
    • Politecnico di Milano
      • • Department of Chemistry, Materials and Chemical Engineering "Giulio Natta"
      • • Department of Bioengineering
      Milano, Lombardy, Italy
  • 1999-2008
    • San Raffaele Scientific Institute
      Milano, Lombardy, Italy
  • 2003
    • Istituto Ortopedico Rizzoli
      • Laboratory of Preclinical and Surgical Studies
      Bolonia, Emilia-Romagna, Italy
  • 2001
    • Università degli Studi di Torino
      • Department of Medical Science
      Torino, Piedmont, Italy