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G Paone

Publications and source records attributed to G Paone.

At least 19 recordsLinked to original sources
PubMed2000

Passive epicardial containment prevents ventricular remodeling in heart failure.

BACKGROUND: We examined the effects of passive containment of the cardiac ventricles with a surgically placed epicardial prosthetic wrap on indexes of left ventricular (LV) remodeling in dogs with heart failure. METHODS: Heart failure (LV ejection fraction 30% to 40%) was produced in 12 dogs by intracoronary microembolization. Six dogs underwent mid-sternotomy and pericardiotomy with placement of a preformed-knitted polyester device (Acorn Cardiac Support Device [CSD], Acorn Cardiovascular, Inc, St. Paul, MN) snugly around the ventricles and anchored to the atrioventricular groove. Six dogs did not undergo surgery and served as controls. Dogs were followed for 3 months prior to sacrifice. RESULTS: In controls, LV end-diastolic volume increased after 3 months (67 +/- 12 versus 83 +/- 8 ml; p = 0.04), while in CSD-treated dogs, it decreased (68 +/- 10 versus 61 +/- 10 ml; p = 0.002). CSD-containment of LV size was associated with increased LV systolic fractional area of shortening, while in controls, fractional area of shortening decreased. CSD-treated dogs also showed amelioration of myocyte hypertrophy and attenuation of interstitial fibrosis compared to controls. CONCLUSIONS: In dogs with heart failure, passive epicardial containment of the ventricles with the Acorn CSD ameliorates LV remodeling and improves LV systolic function.

Animals↗
PubMed1999

Cytokine levels correlate with a radiologic score in active pulmonary tuberculosis.

Pulmonary tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. This microorganism is capable of inducing a delayed hypersensitivity reaction in the lung, with subsequent expression of the disease. This reaction depends on the presence of different cytokines that exert specific functions. The aim of this study was to evaluate the presence and the concentrations of nine different modulators in bronchoalveolar lavage fluid (BALF). For this purpose, 15 patients with active pulmonary tuberculosis were enrolled at the time of diagnosis, prior to institution of antituberculous therapy. All the patients demonstrated M. tuberculosis in the sputum, and their disease extention was defined by high-resolution computed tomography (HRCT) using a score which included the presence of six findings: miliary nodules, nodules < 10 mm, consolidation, ground glass, cavity and bronchial wall thickening. This score was more sensitive than an equivalent score calculated on the basis of chest radiology. HRCT score was calculated for each area of the two lungs in order to define the more and the less affected lung for each patient. The bronchoalveolar lavage (BAL) was performed in the more affected area for each lung. The HRCT total score for each washed area ranged between 1 and 15, and showed more significant differences between the more and less affected lungs (p = 0.0004) than those obtained with the individual radiologic findings (p ranged between 0.60 and 0. 004). The BAL concentrations of the nine cytokines evaluated for the more and less affected lungs were compared: interleukin-6 (IL-6), IL-8, IL-12, tumor necrosis factor-alpha (TNF-alpha), and interferon gamma (IFN-gamma) showed significant differences (p ranged between 0. 016 and 0.0007). In addition, each cytokine concentration was correlated with the HRCT score. Significant correlations were found with IL-12, IL-6, IL-8, IL-2, and TNF-alpha. The correlations between cytokines and HRCT total score were better than those observed with the individual radiologic findings. A correlation matrix for the different cytokines evaluated one against each other, has also been added to show common behavior of these modulators. A similar analysis was also performed for the radiologic abnormalities.

Adolescent↗
PubMed1998

Does age limit the effectiveness of clinical pathways after coronary artery bypass graft surgery?

BACKGROUND: Clinical pathways have been shown to be effective in reducing the length of hospital stay after isolated CABG. Few studies, however, have focused specifically on the outcomes of the pathways in regard to the elderly population. METHODS AND RESULTS: We reviewed our experience with 445 consecutive patients (299 < 70 years old [mean age, 58.2 +/- 0.5 years] and 146 > or = 70 years old [mean age, 75.6 +/- 0.3 years]) who underwent isolated CABG with the expectation of progressing through the same 5-day postoperative pathway. Preoperatively, the elderly had a smaller body surface area (1.87 +/- 0.02 versus 2.00 +/- 0.01; P < 0.001) and a higher incidence of female gender (45.9% versus 26.8%; P = 0.001), cerebrovascular disease (13.7% versus 7.0%; P = 0.022), congestive heart failure (22.6% versus 13.4%; P = 0.013), and 3-vessel coronary artery disease (76.7% versus 65.9%; P = 0.024). Postoperatively, the elderly had a higher incidence of red blood cell transfusion (28.8% versus 9.0%; P = 0.001), atrial fibrillation (37.6% versus 11.7%; P = 0.001), and overall rate of complications (46.6% versus 23.4%; P = 0.001). Mortality rate and length of stay were 5.5% and 7.9 +/- 0.4 days for the elderly versus 1.0% and 6.4 +/- 0.4 days for those < 70 years old (P = 0.004 and P = 0.008), respectively. Of those > or = 70 years old, 34% were discharged in < or = 5 days, 64% in < or = 7 days, and 82% in < or = 10 days versus 64%, 85%, and 93%, respectively, for younger patients (P = 0.001 for all). Multivariate analysis of preoperative variables identified age (P < 0.001), female gender (P < 0.001), hypertension (P = 0.017), chronic obstructive pulmonary disease (P = 0.002), preoperative intra-aortic balloon pumping (P = 0.002), and body surface area (P = 0.003) as significantly related to length of stay. However, when the postoperative variables found to be different by univariate analysis are added to the model, age is only marginally significant (P = 0.079), and red blood cell transfusion and atrial fibrillation are the strongest predictors of increased length of stay, along with intra-aortic balloon pumping and pneumonia (P < 0.001 for all). CONCLUSIONS: These data suggest that extraordinary modifications of clinical pathways are not needed for success with elderly patients. The increased length of stay is largely attributable to the increased incidence of atrial fibrillation.

Age Distribution↗
PubMed1998

Effect of payer status on outcomes of coronary artery bypass surgery in blacks.

BACKGROUND: Black patients with coronary artery disease have a higher mortality rate than white Americans. They also have a higher prevalence of hypertension, diabetes mellitus, and renal disease, which may have an effect on mortality rates. The deleterious effect of these comorbidities may be exacerbated by impaired access to secondary prevention strategies and longitudinal care. Therefore, the presence or absence of comprehensive care as indicated by payer status may then affect survival on surgically treated patients. In this study we examined the role of cardiovascular risk factors and insurance carrier status on early outcomes of coronary artery bypass grafting (CABG) surgery in blacks versus white Americans. METHODS AND RESULTS: From January 1990 to December 1996, 2776 patients (2003 men, 773 women; mean age 63 +/- 10 years), underwent isolated CABG in a multispecialty practice serving a major metropolitan population. There were 494 (17.8%) black patients and 2282 (82.2%) white patients. The proportion of black patients in each payer category was 17.8% commercial, 14.1% managed care, 52.9% Medicaid, and 19.5% Medicare. The effect of preoperative risk factors, including status of operation (elective, urgent, or emergent), sex, race, redo CABG, presence of renal disease, diabetes mellitus, congestive heart failure, myocardial infarction, the completeness of revascularization, age, and left ventricular ejection fraction were analyzed with the chi 2 test for categorical variables and the Student t test for age and ejection fraction. A multiple logistic regression analysis was performed to assess the effect of all variables on mortality rates simultaneously. Black patients had a higher incidence of diabetes mellitus, hypertension, and renal disease than white patients (P < 0.001). Overall, 30-day mortality rate was 2.5% (58 of 2282) in white patients versus 5.5% (25 of 494) for black patients (P < 0.003). Multivariate analysis showed that only emergency surgery status (OR 3.59, P < 0.01), redo CABG (OR 3.78, P < 0.001), hypertension (OR 2.32, P < 0.03), history of congestive heart failure (OR 2.1, P < 0.004), older age (OR 1.07, P < 0.001), and low ejection fraction (OR 0.98, P < 0.003) correlated with mortality rates. Race and payer status were not significant predictors of death. CONCLUSIONS: These data on CABG surgery in black patients suggest that early death is due to associated risk factors and not due to race or insurance payer status.

Black or African American↗
PubMed1998

Post-hepatitis primary disease does not influence 6-year survival after liver transplantation beyond 1 year.

Orthotopic liver transplantation (OLT) is used as a definitive treatment for end-stage liver disease and prolonged posttransplant survival has already been reported. The incidence of late mortality and graft morbidity is, however, not well defined and the role of primary viral disease in the long-term follow-up results is not clear. Data of posttransplant follow-up in 213 patients, 156 adults and 57 children, who survived at least 1 year were reviewed in order to define causes of graft dysfunction, graft loss and death. In 98 patients, 103 persistent graft dysfunctions were found. Thirty-four grafts were later lost [28 deaths and 6 successful retransplantations (re-OLT)]. The results were reviewed grouping patients according to their age and viral hepatitis status at the time of the transplantation. HBV-positive patients (51) showed 4 re-OLT (1 HBV), 3 liver-related deaths (2 HBV), 24 graft dysfunctions (8 HBV, 5 HCV), and 85.2% 6-year survival (based on 100% survival at 1 year). HCV-positive adults (28) showed 1 re-OLT, 3 HCV-related deaths, 24 graft dysfunctions (19 HCV), and 68.8% 6-year survival. HBV-HCV-positive patients (14) showed no graft loss and death, 10 graft dysfunctions (7 HCV, 1 HBV, 2 HBV-HCV), and 81.8% 6-year survival. HBV-HCV-negative adults (63) showed 3 non-hepatitis-related re-OLT, 5 liver-related deaths (2 HCV), 24 graft dysfunctions (6 HCV, 2 HBV), and 83.1% 6-year survival. HBV-HCV-negative children (49) showed no re-OLT, 1 HCV-related death, 14 graft dysfunctions (3 HCV), and 92.6% 6-year survival. HCV-positive children (8) showed 1 HCV-related re-OLT, 2 HCV-related deaths, 4 graft dysfunctions (3 HCV), and 81.3% 6-year survival. The main cause of graft dysfunction was hepatitis (45 HCV and 13 HBV), followed by technical complications (21), rejection (16), recurrent alcoholism (3), HIV infection (1), and unknown causes (4). In this long-term post-transplant follow-up series, viral hepatitis led to graft dysfunction in 58/103 (56.3%) cases, late graft failure was viral hepatitis-related in 11/ 20 (55%) cases, and, as a total, HCV infection was present in 45/58 (77.5%) cases of viral hepatitis-related graft damage. Looking at the timing of hepatitis-related graft failure, in 70% of cases death occurred after the 5th post-transplant year. In our experience, the occurrence of hepatitis, particularly HCV induced, was common and led to abnormal graft function, but the 6-year post-transplant survival (based on 100% survival at 1 year) in patients surviving for at least 1 year did not differ on the basis of the pretransplant viral hepatitis status. This finding may be consistent with the slow progression of the viral damage and longer follow-up results remain to be established. Nevertheless, data from the present study suggest that in long-term liver transplant survivors, the risk of deteriorating liver damage and eventual failure after 5 years remains only in those patients experiencing a viral hepatitis infection.

Adolescent↗
PubMed1998

A randomized, double-blind comparison of intravenous diltiazem and digoxin for atrial fibrillation after coronary artery bypass surgery.

BACKGROUND: Atrial fibrillation (AF) after coronary bypass graft surgery may result in hypotension, heart failure symptoms, embolic complications, and prolongation in length of hospital stay (LOHS). The purpose of this study was to determine whether intravenous diltiazem is more effective than digoxin for ventricular rate control in AF after coronary artery bypass graft surgery. A secondary end point was to determine whether ventricular rate control with diltiazem reduces postoperative LOHS compared with digoxin. METHODS AND RESULTS: Patients with AF and ventricular rate > 100 beats/min within 7 days after coronary artery bypass graft surgery were randomly assigned to receive intravenous therapy with diltiazem (n = 20) or digoxin (n = 20). Efficacy was measured with ambulatory electrocardiography (Holter monitoring). Safety was assessed by clinical monitoring and electrocardiographic recording. LOHS was measured from the day of surgery. Data were analyzed with the intention-to-treat principle in all randomly assigned patients. In addition, a separate intention-to-treat analysis was performed excluding patients who spontaneously converted to sinus rhythm. In the analysis of all randomly assigned patients, those who received diltiazem achieved ventricular rate control (> or = 20% decrease in pretreatment ventricular rate) in a mean of 10 +/- 20 (median 2) minutes compared with 352 +/- 312 (median 228) minutes for patients who received digoxin (p < 0.0001). At 2 hours, the proportion of patients who achieved rate control was significantly higher in patients treated with diltiazem (75% vs 35%, p = 0.03). Similarly, at 6 hours, the response rate associated with diltiazem was higher than that in the digoxin group (85% vs 45%, p = 0.02). However, response rates associated with diltiazem and digoxin at 12 and 24 hours were not significantly different. At 24 hours, conversion to sinus rhythm had occurred in 11 of 20 (55%) patients receiving diltiazem and 13 of 20 (65%) patients receiving digoxin (p = 0.75). Results of the analysis of only those patients who remained in AF were similar to those presented above. There was no difference between the diltiazem-treated and digoxin-treated groups in postoperative LOHS (8.6 +/- 2.2 vs 7.7 +/- 2.0 days, respectively, p = 0.43). CONCLUSIONS: Ventricular rate control occurs more rapidly with intravenous diltiazem than digoxin in AF after coronary artery bypass graft surgery. However, 12- and 24-hour response rates and duration of postoperative hospital stay associated with the two drugs are similar.

Aged↗
PubMed1998

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Aged↗
PubMed1998

Quality of history taking in patients with aortic dissection.

STUDY OBJECTIVES: Aortic dissection generally is an acute catastrophe. Rapid diagnosis is critical. We hypothesized that the quality of history taking contributes to the accuracy of diagnosis in patients with dissection. DESIGN: Retrospective chart review of 83 patients, whose diagnosis of aortic dissection was confirmed by autopsy, surgery, CT scan, echocardiogram, or angiogram. The quality of the initial history was reviewed using predetermined criteria. The physicians' initial clinical impressions were recorded. RESULTS: The examining physician correctly suspected aortic dissection after the initial clinical evaluation in 54 of 83 patients (65%). Only 33 of 78 patients with symptoms (42%) were asked about the quality, location, and onset of their pain, the three descriptors identified a priori as important. In 19 patients (24%), only zero or one descriptor was recorded. When all three questions were asked, dissection was suspected in 30 of 33 patients (91%); when zero, one, or two questions were asked, dissection was suspected in 22 of 45 patients (49%). CONCLUSION: Despite important advances in diagnostic imaging, accurate diagnosis of aortic dissection requires an accurate history. In our series, the quality of initial history was associated with the accuracy of the initial clinical impression in patients with aortic dissection.

Aortic Dissection↗
PubMed1997

The paradox of on-bypass transfusion thresholds in blood conservation.

BACKGROUND: While most reports on blood conservation define a specific transfusion trigger, few have primarily focused on the role of the predefined transfusion threshold in initiating blood utilization. This study was undertaken to test the hypothesis that rigid adherence to an arbitrarily defined protocol paradoxically increases homologous blood usage during isolated primary coronary artery bypass graft. METHODS AND RESULTS: Prospectively, 100 consecutive patients were transfused on bypass solely for low venous oxygen saturation (SvO2), ie, <55%, without regard to hematocrit (Hct), postoperative for Hct <20, or if clinically warranted. During bypass the lowest Hct value was <25% in 72 patients, <22% in 52 patients, <20% in 39 patients, <18% in 23 patients, and <15% in 2 patients. These data, then, represent the percentage of patients who would have received blood on bypass had each respective level been used as a trigger, and hence the minimum number of patients who would have been transfused overall. In this study only 13 patients received 2.2+/-0.3 U of red blood cells; 4 on bypass, 5 in the intensive care unit within 24 hours, and 4 on postoperative days 2 or 3. Of the 87 patients not transfused, 15 arrived in the intensive care unit with Hct <25%, 4 with Hct <22%. By postoperative day 1, there were 7 patients with Hct <25% and only 1 <22%, confirming that many of these patients would have been unnecessarily transfused had we adhered to any of the noted on-bypass transfusion triggers. There were no deaths, no strokes, one Q wave myocardial infarction, and one sternal infection. Postoperative blood loss and discharge Hct were 741+/-131 mL and 29.3+/-0.5 versus 573+/-27 mL and 29.1+/-1.0 in transfused and nontransfused patients (P=.24 and P=.88, respectively). CONCLUSION: These data suggest that avoiding use of a numerical on-bypass hematocrit trigger is safe and extremely effective in minimizing the use of homologous blood during isolated primary coronary artery bypass graft. Conversely, unless the chosen level is sufficiently low, ie, <15, setting arbitrary thresholds will paradoxically increase homologous blood utilization; data are mean+/-SEM.

Aged↗