Papers by Giuseppe Faggian
Circulation, Oct 16, 2007
<jats:p> <jats:bold>BACKGROUND:</jats:bold> Cardioplegic arrest and subsequent ... more <jats:p> <jats:bold>BACKGROUND:</jats:bold> Cardioplegic arrest and subsequent reperfusion inevitably expose the heart to an iatrogenic ischemia/reperfusion injury (iIRI). We previously reported that iIRI caused mitochondria-initiated myocyte apoptosis, but also induction of urocortin (Ucn), an endogenous cardioprotective peptide. We also showed that Ucn induced PKCϵ-mediated opening of mitochondrial K <jats:sub>ATP</jats:sub> channels in isolated heart mitochondria. </jats:p> <jats:p> <jats:bold>AIM:</jats:bold> To investigate, in patients exposed to iIRI, the cardioprotective role and the mechanism of action of Ucn, with respect to PKCϵ expression, activation and relocation. </jats:p> <jats:p> <jats:bold>METHODS AND RESULTS:</jats:bold> Two sequential biopsies were obtained from the right atrium of 25 patients undergoing coronary artery bypass grafting at the start of grafting (internal control) and 10 mins after release of the aortic clamp. Mean values of ejection fraction, aortic cross-clamping time and number of grafts were 51±8; 48±8 mins; and 3.6±0.5 respectively. In hearts exposed to iIRI, RT-PCR and immunostaining showed Ucn induction at the mRNA (255% of basic levels, p&lt;0.05) and protein level (28±2.1% positive myocytes vs 3.1±0.6% of internal control; p&lt;0.01) respectively. iIRI also induced a selective increase of PKC-ϵ mRNA (225% of internal control; p&lt;0.05) and a two-fold overexpression of total PKCϵ isoform (assessed by Western blotting; p&lt;0.05), which paralleled a 2.9 fold increase in PKCϵ phosphorylation (p&lt;0.01). TUNEL positivity (&lt;0.1% and 2.9±0.7% positive myocytes pre- and post-iIRI respectively; p&lt;0.01) was only seen in Ucn-negative cells, and, of note, Ucn-positive myocytes showed concurrent mitochondrial relocation of phosphorylated PKCϵ, as documented by mitochondrial-activated PKCϵ colocalization, calculated by confocal microscopy with an image analyzer software (% overlap: 57±5 vs 11±2 in Ucn-negative cells; p&lt;0.01). Western blotting carried out in pools of cytosolic and mitochondrial fractions confirmed a 2.5 fold increase in mitochondrial localization of phosphorylated PKC-ϵ following iIRI (p&lt;0.05). </jats:p> <jats:p> <jats:bold>CONCLUSIONS</jats:bold> : In patients exposed to iIRI, Ucn expression in viable cells was selectively associated with phosphorylation and mitochondrial relocation of PKCϵ, suggesting a cardioprotective role for endogenous Ucn in the human heart. </jats:p>
Circulation, Oct 28, 2008
<jats:p> Cardioplegic arrest and subsequent reperfusion inevitably expose the heart to an i... more <jats:p> Cardioplegic arrest and subsequent reperfusion inevitably expose the heart to an iatrogenic ischemia/reperfusion injury (iIRI). We previously reported that iIRI caused myocyte induction of urocortin, an endogenous cardioprotective peptide. This study investigates in patients undergoing cardiac surgery the cardioprotective role and the mechanism of action of Ucn, with respect to PKCε expression, activation and relocation. Two sequential biopsies were obtained from the right atrium of 25 patients undergoing coronary artery bypass grafting at the start of grafting (internal control) and 10 minutes after release of the aortic clamp. In hearts exposed to iIRI, induction of Ucn was documented both at the mRNA (255% of basic levels; p &lt; 0.05) and protein level (four-fold increase; p &lt; 0.01). iIRI also induced a selective increase of PKC-ε mRNA (225% of internal control; p &lt; 0.05) and a two-fold overexpression of total PKCε (p &lt; 0.05), which paralleled a 2.9-fold increase in PKCε phosphorylation (p &lt; 0.01). Mitochondrial translocation of activated PKCε was only observed in post-cardioplegic samples, using both subcellular fractionation (p &lt; 0.05) and immunostaining techniques (p &lt; 0.05). Importantly, enhanced PKCε/mitochondria colocalization was selectively observed in viable myocytes, showing concurrently positive staining for urocortin (p &lt; 0.05). Finally, co-immunoprecipitation experiments documented an iIRI-enhanced physical interaction of phosphorylated PKCε with the Kir6.1 subunit of the K <jats:sub>ATP</jats:sub> channels (p &lt; 0.05). Following iIRI, urocortin expression in viable cells selectively colocalized with enhanced phosphorylation and mitochondrial relocation of PKCε, suggesting a cardioprotective role for endogenous Ucn. The physical interaction of activated PKCε with Kir6.1, enhanced by cardioplegic arrest, may represent a conjectural mechanism of urocortin-mediated cardioprotection. </jats:p>
The Annals of thoracic surgery, 1997
The Annals of thoracic surgery, 2015
Although more than a half century has elapsed since the introduction of cardiopulmonary bypass (C... more Although more than a half century has elapsed since the introduction of cardiopulmonary bypass (CPB), many issues remain debatable. Among these, one relates to linear versus pulsatile flow during CPB. Intuitively, a pulsatile flow regime is a more physiologic option, but whether it has a favorable or even unfavorable impact on the outcome has not been clarified yet. Accordingly, we read with great interest the study of Lundemoen and colleagues [1], where 8 pigs received intraaortic balloon pump (IABP)-induced pulsatile CPB perfusion. The results of this study showed that pulsatile perfusion is associated with a significant impairment of renal perfusion, suggesting IABP should be turned off during CPB. Splanchnic hypoperfusion during IABP support has been another matter of debate for many years [2]. The authors do not explain if balloon size was chosen according to body surface area of animals, and what temperature was registered during the experimental protocol, both profoundly impacting renal perfusion during CPB. In our previous work [3, 4], we found that IABPinduced pulsatile flow during normothermic CPB was associated with an improvement in both body perfusion and renal function. Although in the study by Lundemoen and colleagues the use of IABP resulted in impaired distal perfusion, we believe that the decision as to whether to turn on/off the IABP device should be based on a comprehensive evaluation of the patient conditions. In other words, coronary artery bypass graft patients receiving IABP prior to surgery usually suffer from ventricular dysfunction, peripheral vasculopathy involving also splanchnic vessels (so poorly resembling animal models), so the risk of postoperative renal failure depends from both visceral fluid-dynamics and transient perioperative low cardiac output periods. In these frail patients, perioperative coronary and visceral perfusion and a reduction in cardiac workload should be pursued in order to achieve a good postoperative outcome [2, 4]. The experimental findings of Lundemoen and colleagues add some interesting insights to the ongoing debate around pulsatile versus nonpulsatile perfusion. However, in our opinion, results are neither conclusive nor consistent with the clinical effect usually reported.
Circulation, 2015
Background— Distinct subpopulations of L-type calcium channels (LTCCs) with different functional ... more Background— Distinct subpopulations of L-type calcium channels (LTCCs) with different functional properties exist in cardiomyocytes. Disruption of cellular structure may affect LTCC in a microdomain-specific manner and contribute to the pathophysiology of cardiac diseases, especially in cells lacking organized transverse tubules (T-tubules) such as atrial myocytes (AMs). Methods and Results— Isolated rat and human AMs were characterized by scanning ion conductance, confocal, and electron microscopy. Half of AMs possessed T-tubules and structured topography, proportional to cell width. A bigger proportion of myocytes in the left atrium had organized T-tubules and topography than in the right atrium. Super-resolution scanning patch clamp showed that LTCCs distribute equally in T-tubules and crest areas of the sarcolemma, whereas, in ventricular myocytes, LTCCs primarily cluster in T-tubules. Rat, but not human, T-tubule LTCCs had open probability similar to crest LTCCs, but exhibited ...
The Journal of Thoracic and Cardiovascular Surgery, 2009
Objective: This study investigates the cardioprotective role and mechanism of action of urocortin... more Objective: This study investigates the cardioprotective role and mechanism of action of urocortin in patients undergoing cardiac surgery, with respect to protein kinase Ce expression, activation, and relocation. Background: Cardioplegic arrest and subsequent reperfusion inevitably expose the heart to iatrogenic ischemia/ reperfusion injury. We previously reported that iatrogenic ischemia/reperfusion injury caused myocyte induction of urocortin, an endogenous cardioprotective peptide. Methods: Two sequential biopsies were obtained from the right atrium of 25 patients undergoing coronary artery bypass grafting at the start of grafting (internal control) and 10 minutes after release of the aortic clamp. Results: In hearts exposed to iatrogenic ischemia/reperfusion injury, induction of urocortin was documented at both the mRNA (255% of basic levels; P < .05) and the protein (4-fold increase; P < .01) levels. Iatrogenic ischemia/reperfusion injury also induced a selective increase of protein kinase Ce mRNA (225% of internal control; P<.05) and a 2-fold overexpression of total protein kinase Ce (P<.05), which paralleled a 2.9-fold increase in protein kinase Ce phosphorylation (P < .01). Mitochondrial translocation of activated protein kinase Ce was observed only in postcardioplegic samples, using both subcellular fractionation (P < .05) and immunostaining techniques (P<.05). Enhanced protein kinase Ce/mitochondria colocalization was selectively observed in viable myocytes, showing concurrently positive staining for urocortin (P<.05). Finally, co immunoprecipitation experiments documented an iatrogenic ischemia/reperfusion injury-enhanced physical interaction of phosphorylated protein kinase Ce with the 6.1 inwardly rectifying potassium channel subunit of the K ATP channels (P < .05).
European Journal of Cardio-Thoracic Surgery, 2010
Objective: Over the last few years, there have been changes in both donor and recipient profiles ... more Objective: Over the last few years, there have been changes in both donor and recipient profiles in heart transplantation. Encouraging clinical outcome of marginal donors in candidates older than 60 years of age led us to allocate suboptimal donors for younger recipients as well. We reviewed our experience retrospectively so as to assess the impact of donor quality on heart transplantation. Methods: Among 181 patients who underwent heart transplantation between January 2000 and February 2009, there were 75 patients (41%) aged 61-70 years and 106 patients (59%) ranging in age between 18 and 60 years. According to the recipient's age, they were classified into four groups. The younger recipients (106 patients) had either optimal donors (70 patients, group 1) or marginal donors (36 patients, group 2). The older recipients (75 patients) had either marginal grafts (64 patients, group 3) or optimal grafts (11 patients, group 4). Sex distribution, cause of end-stage heart failure, preoperative pulmonary hypertension, pre-heart-transplantation clinical status or mean follow-up duration did not show any statistically significant difference among the four groups. Results: Overall, the 9-year actuarial survival rate was 78% AE 1%. The 30 days and 9-year actuarial survival rates were 94% AE 2% and 80% AE 1% in group 1; 86% AE 5% and 55% AE 12% in group 2; 90% AE 4% and 73% AE 7% in group 3; 99% AE 1% and 82% AE 7% in group 4 (P = 0.07). Comparison among the four groups did not show any statistical difference in terms of freedom from graft failure (P = 0.3), right ventricular failure (P = 0.3), acute rejection (P = 0.2), chronic rejection (P = 0.2), neoplasia (P = 0.5) and chronic renal failure (P = 0.2). Older recipients of marginal donors (group 3) had slightly higher prevalence of permanent pacemaker implants: eight permanent pacemakers versus two in group 2, and none in group 1 and group 4 (P = 0.4). Conclusions: Our results suggest that extended donor acceptance criteria may not compromise clinical outcome after heart transplantation. Further follow-up is warranted.
The Annals of Thoracic Surgery, 2007
Background. Left ventricular pseudoaneurysm from myocardial infarction is rare and is associated ... more Background. Left ventricular pseudoaneurysm from myocardial infarction is rare and is associated with a high risk of rapid enlargement and rupture. The pur- poses of this study were to describe its clinical presenta- tion, assess the accuracy of diagnostic imaging modali- ties, and determine operative and late surgical results. Methods. From January 1986 through December 2001, 30 patients aged 50
European Journal of Cardio-Thoracic Surgery, 2013
OBJECTIVES: Leukocyte filtration of blood cardioplegia (cLkF) is postulated to reduce ischaemia-r... more OBJECTIVES: Leukocyte filtration of blood cardioplegia (cLkF) is postulated to reduce ischaemia-reperfusion myocardial injury. Contradictory results have been published and few studies have addressed perioperative cytokine leakage and haemodynamic status after LkF. METHODS: Thirty patients undergoing isolated aortic valve replacement were randomized to cLkF (cLkF-Group) or to standard cold blood cardioplegia (S-Group). Troponin I (TnI) and lactate were sampled from the coronary sinus at reperfusion. Peripheral TnI and lactate were collected preoperatively at admission, and in the intensive care unit (ICU) at 8, 12, 36 and 60 h postoperatively. Cardiac index (CI), indexed systemic vascular resistances, cardiac cycle efficiency (CCE) and central venous pressure (CVP) were registered preoperatively, at admission to the ICU and at the 6th, 12th, 18th, 24th and 36th postoperative hour. IL-6, IL-8, TNF-alpha and IL-10 were sampled preoperatively, at reperfusion, on admission to the ICU and the 6th, 18th and 24th postoperative hours. RESULTS: The cLkF group showed lower TnI (2.4 ± 0.4 vs. 5.1 ± 0.8 μg/l, P = 0.0001) and lactate (0.9 ± 0.1 vs. 1.6 ± 0.2 mmol/l, P = 0.0001) from the coronary sinus at reperfusion. TnI levels (group-P = 0.0001, group × time-P < 0.0001) and lactate (group × time-P = 0.001) remained lower postoperatively after cLkF. Ventricular defibrillation at aortic declamping was less common in the cLkF-Group (33.3% vs. S-Group: 93.3%; P = 0.002). Cytokines demonstrated significant postoperative leakage (time-P = 0.0001 in both groups for IL-6, IL-8, TNFalpha, IL-10), with lower pro-inflammatory (IL-6 group-P = 0.0001, group × time-P = 0.0001; IL-8 group-P = 0.0001, group × time-P = 0.007; TNF-alpha group-P = 0.0001; group × time-P = 0.012) and higher anti-inflammatory cytokine secretion after cLkF (IL-10 group-P = 0.005). Perioperative haemodynamic indices proved to be similar between the two groups (group-P = NS for CI, SVRI, CCE and CVP). CONCLUSIONS: cLkF during blood cardioplegia attenuates myocardial ischaemia/reperfusion injury and reduces perioperative leakage of TnI, lactate and pro-inflammatory cytokines. These data did not result in a better haemodynamic status.
Journal of Clinical Medicine
Background: The role of pulsatile (PP) versus non-pulsatile (NP) flow during a cardiopulmonary by... more Background: The role of pulsatile (PP) versus non-pulsatile (NP) flow during a cardiopulmonary bypass (CPB) is still debated. This study’s aim was to analyze hemodynamic effects, endothelial reactivity and erythrocytes response during a CPB with PP or NP. Methods: Fifty-two patients undergoing an aortic valve replacement were prospectively randomized for surgery with either PP or NP flow. Pulsatility was evaluated in terms of energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE). Systemic (SVRi) and pulmonary (PVRi) vascular resistances, endothelial markers levels and erythrocyte nitric-oxide synthase (eNOS) activity were collected at different perioperative time-points. Results: In the PP group, the resultant EEP was 7.3% higher than the mean arterial pressure (MAP), which corresponded to 5150 ± 2291 ergs/cm3 of SHE. In the NP group, the EEP and MAP were equal; no SHE was produced. The PP group showed lower SVRi during clamp-time (p = 0.06) and lower PVRi after prot...
Journal of Clinical Medicine
Background: The aim of this research is to describe the performance over time of transcatheter ao... more Background: The aim of this research is to describe the performance over time of transcatheter aortic valve implantations (TAVIs) in a high-volume center with a contemporary, real-world population. Methods: Patients referred for TAVIs at the University Hospital of Verona were prospectively enrolled. By cumulative sum failures analysis (CUSUM), procedural-control curves for standardized combined endpoints—as defined by the Valve Academic Research Consortium-2 (VARC-2)—were calculated and analyzed over time. Acceptable and unacceptable limits were derived from recent studies on TAVI in intermediate and low-risk patients to fit the higher required standards for current indications. Results: A total of 910 patients were included. Baseline risk scores significantly reduced over time. Complete procedural control was obtained after approximately 125 and 190 cases for device success and early safety standardized combined endpoints, respectively. High risk patients (STS ≥ 8) had poorer outco...
Journal of Clinical Medicine
Despite current advances in perioperative care, intraoperative myocardial protection during cardi... more Despite current advances in perioperative care, intraoperative myocardial protection during cardiac surgery has not kept the same pace. High potassium cardioplegic solutions were introduced in the 1950s, and in the early 1960s they were soon recognized as harmful. Since that time, surgeons have minimized many of the adverse effects by lowering the temperature of the heart, lowering K+ concentration, reducing contact K+ time, changing the vehicle from a crystalloid solution to whole-blood, adding many pharmacological protectants and modifying reperfusion conditions. Despite these attempts, high potassium remains a suboptimalway to arrest the heart. We briefly review the historical advances and failures of finding alternatives to high potassium, the drawbacks of a prolonged depolarized membrane, altered Ca2+ intracellular circuits and heterogeneity in atrial-ventricular K+ repolarization during reanimation. Many of these untoward effects may be alleviated by a polarized membrane, and ...
Journal of Clinical Medicine
Background. Sternal wound complications are serious events that occur after cardiac surgery. Few ... more Background. Sternal wound complications are serious events that occur after cardiac surgery. Few studies have investigated the predictive value of chest X-ray radiological measurements for sternal complications. Methods. Several perioperative radiological measurements at chest X-ray and clinical characteristics were computed in 849 patients deemed at high risk for sternal dehiscence (SD) or More than Grade 1 Surgical Site Infection (MG1-SSI). Multivariable analysis identified independent predictors, whilst receiver operating characteristics (ROC) curve analyses highlighted cut-off values of radiological measurements for the prediction of both complications. Results. SD occurred in 8.8% of the patients, MG1-SSI in 6.8%. Chronic obstructive pulmonary disease (COPD) was the only independent predictor for SD (Odds Ratio, O.R. 12.1; p < 0.001); proximal sternal height (PSH) was the only independent protective factor (O.R. 0.58; p < 0.001), with a cut-off value of 11.7 mm (sensitivi...
International Journal of Molecular Sciences
During heart transplantation, donor heart leads to reduced oxygen supply resulting in low level o... more During heart transplantation, donor heart leads to reduced oxygen supply resulting in low level of high energy phosphate (HEP) reserves in cardiomyocyte. Lower HEP is one of the underlying reasons of cell death due to ischemia. In this study we investigated the role of Fingolimod (FTY720) in heart transplantation ischemia. Eight groups of Sprague-Dawley rats (n = 5 for each subgroup) were made, A1 and C1 were given FTY720 1 mg/kg while B1 and D1 were given normal saline. The hearts were implanted into another set of similar rats after preservation period of 1 h at 4–8 °C. Significantly higher Left ventricular systolic pressure (LVSP), dP/dT maximum (p < 0.05), dP/dT minimum (p < 0.05) were recorded in the FTY720 treated group after 24 h of reperfusion while after 1 h of reperfusion, there were no significant differences in LVSP, maximum and negative dP/dT, and Left ventricular end diastolic pressure (LVEDP) between the control and the FTY720-treated transplant groups. Coronary...
Cells
Fibrosis is a significant global health problem associated with many inflammatory and degenerativ... more Fibrosis is a significant global health problem associated with many inflammatory and degenerative diseases affecting multiple organs, individually or simultaneously. Fibrosis develops when extracellular matrix (ECM) remodeling becomes excessive or uncontrolled and is associated with nearly all forms of heart disease. Cardiac fibroblasts and myofibroblasts are the main effectors of ECM deposition and scar formation. The heart is a complex multicellular organ, where the various resident cell types communicate between themselves and with cells of the blood and immune systems. Exosomes, which are small extracellular vesicles, (EVs), contribute to cell-to-cell communication and their pathophysiological relevance and therapeutic potential is emerging. Here, we will critically review the role of endogenous exosomes as possible fibrosis mediators and discuss the possibility of using stem cell-derived and/or engineered exosomes as anti-fibrotic agents.
Antioxidants
Consumption of flavonoid-rich nutraceuticals has been associated with a reduction in coronary eve... more Consumption of flavonoid-rich nutraceuticals has been associated with a reduction in coronary events. The present study analyzed the effects of cocoa flavonols on myocardial injury following acute coronary ischemia-reperfusion (I/R). A commercially available cocoa extract was identified by chromatographic mass spectrometry. Nineteen different phenolic compounds were identified and 250 mg of flavan-3-ols (procyanidin) were isolated in 1 g of extract. Oral administration of cocoa extract in incremental doses from 5 mg/kg up to 25 mg/kg daily for 15 days in Sprague Dawley rats (n = 30) produced a corresponding increase of blood serum polyphenols and become constant after 15 mg/kg. Consequently, the selected dose (15 mg/kg) of cocoa extract was administered orally daily for 15 days in a treated group (n = 10) and an untreated group served as control (n = 10). Both groups underwent surgical occlusion of the left anterior descending coronary artery and reperfusion. Cocoa extract treatment...
International Journal of Molecular Sciences
Background: Sudden cardiac arrest is a major global health concern, and survival of patients with... more Background: Sudden cardiac arrest is a major global health concern, and survival of patients with ischemia–reperfusion injury is a leading cause of myocardial dysfunction. The mechanism of this phenomenon is not well understood because of the complex pathophysiological nature of the disease. Aim of the study was to investigate the cardioprotective role of fingolimod in an in vivo model of cardiac arrest and resuscitation. Methods: In this study, an in vivo rat model of cardiac arrest using extracorporeal membrane oxygenation resuscitation monitored by invasive hemodynamic measurement was developed. At the beginning of extracorporeal life support (ECLS), animals were randomly treated with fingolimod (Group A, n = 30) or saline (Group B, n = 30). Half of the animals in each group (Group A1 and B1, n = 15 each) were sacrificed after 1 h, and the remaining animals (Group A2 and B2) after 24 h of reperfusion. Blood and myocardial tissues were collected for analysis of cardiac features, i...
Circulation Journal
LGE was observed in this study with predominant involvement of the inferolateral myocardium of th... more LGE was observed in this study with predominant involvement of the inferolateral myocardium of the left ventricle (LV). In Anderson-Fabry disease it is suggested that increased wall stress and impaired resistance to physical stress are potential explanations for the typical inferolateral LGE involvement in such patients. 10 However, the reasons for the noticeable involvement of this region in male triathletes remain to be elucidated. Myocardial strain analysis using feature-tracking enables the analysis of global and segmental myocardial systolic contraction using standard cine CMR images. 11 It has shown that myocardial strain detects impaired systolic M yocardial fibrosis detected by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) occurs in a variable number of athletes, with studies reporting a prevalence between 0% and 50%. 1-7 The pattern of myocardial fibrosis in athletes suggests either an ischemic or non-ischemic genesis and several causes of non-ischemic fibrosis are currently discussed, including silent myocarditis, pulmonary artery pressure overload and repetitive myocardial microdamage. 8 A recent work reported a series of 83 triathletes with myocardial fibrosis detected in 17% of the male triathletes on LGE CMR, but in none of the female triathletes. 9 Non
The American Journal of Cardiology
The perioperative bleeding risk in patients receiving fondaparinux versus low-molecular weight he... more The perioperative bleeding risk in patients receiving fondaparinux versus low-molecular weight heparin before coronary artery bypass grafting has not been reported. We evaluated perioperative coronary artery bypass grafting-related bleeding in patients with acute coronary syndrome preoperatively treated with fondaparinux or low-molecular weight heparin. All patients with acute coronary syndrome from the prospective, European multicenter registry on Coronary Artery Bypass Grafting (E-CABG) preoperatively treated with fondaparinux or lowmolecular weight heparin undergoing isolated primary CABG were eligible. The primary outcome measure was severe or massive bleeding defined according to the Universal Definition of Perioperative Bleeding stratified by P2Y12 inhibitor discontinuation. Secondary outcome measures included three additional definitions of major bleeding used in cardiac surgery trials. Propensity score matching was performed to adjust for differences in pre-and perioperative covariates. 1525 patients were included, of whom 276 (18.1%) received fondaparinux and 1249 (81.9%) low-molecular weight heparin preoperatively. In the propensity score-matched cohort (245 pairs), the risk of major bleeding according to the Universal Definition of Perioperative Bleeding severe or massive bleeding (11.8 versus 9.0%, p = 0.285) and the three other major bleeding definitions was similar between the fondaparinux and low-molecular weight heparin cohorts. In conclusion, preoperative treatment with fondaparinux compared to low-molecular weight heparin was associated with similar incidence of perioperative bleeding in patients with acute coronary syndrome undergoing coronary artery bypass grafting.
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Papers by Giuseppe Faggian