Clinical activity of the Foundation
The Foundation combines in a synergistic manner:
– the activities of diagnosis and patient-centered specializedcare,
– the clinical research activity, strongly oriented towards the physiopathologic approach to disease and towards the innovation in its treatment,
– training and education activities, aimed at maintaining our health personnel updated and at training ordinary students and residents in Medical Disciplines and Health Professions.
All of the activities are characterized by a multidisciplinary approach, basedon competencies which are essential for the modern management of pathology (bioengineering, medical, biotechnical, physical, chemical, etc.), and are supported by the most advanced technologies of investigation. This very particular approach guarantees a complete diagnostic treatment and the best possible outcome for the patient, based on individual conditions.
Description and analysis of 2014 activities
The Foundation constitutes the Specialized Hospital Center of the Tuscany Region; overall the activity carried out in its two Hospitals (Pisa and Massa) for the year 2014 can be synthesized as follows:
- 4,679 admissions in the cardiologic and cardio-surgical area, from the newborn to the elderly: the 60% of these patients can be defined as requiring specialized care, and another 37% as requiring highly specialized care;
- 1,404 cardiac surgeries: 1,133 in adults (over one third of these with a mini-invasive approach) and 271 in the kids and adults with congenital heart disease;
- 4,774 interventional cardiology procedures: 4,055 hemodynamic procedures (3,826 in adults and 229 in pediatric patients and adults with congenital heart disease) and 719 electrophysiology and cardiac stimulation procedures;
- 108,715 clinical visits (3,277 pediatric patients) with a marked increase in day-service activities with personalized treatment for specific pathologies, aimed at reducing the number of unnecessary admissions, and at guaranteeing a complete diagnostic investigation;
- 2,229 cardiac Magnetic Resonance Imaging (MRI) scans with a magnetic field of 1.5.0 Tesla at our Hospitalin Pisa;
- 1,282 neurologic MRI scans with a magnetic field of 3.0 Tesla at our Hospital in Pisa.
In general, our clinical activities can be characterized by:
- a high incidence of emergency admissions for the management of acute coronary syndrome and acute cardiovascular pathology, requiring an urgent cardio-surgical approach, thanks to integration with the health structures of the territory (Massa-Carrara, Viareggio, Pisa);
- a high degree of complexity of our clinical records (as stated, almost the totality of admissions was for specialized or highly specialized treatment), which is coupled with data regarding effectiveness and efficiency certified by regional and national agencies.
At our site in Pisa, the competencies in the cardiovascular fieldare strongly integrated with those in the fieldof pneumology, allowing the possibility of an integrated diagnostic and therapeutic approach for conditions with a high degree of complexity and urgency, such as end-stage heart failure, primitive and secondary lung hypertension, cardiorenal syndrome, and respiratory insufficiency.
With respect to primary and secondary prevention in clinical practice, day-service and hospital stay, diagnostic and research units in the fields of endocrinology, lipidology, and metabolism, the most modern approaches for evaluation and treatment of cardiovascular risk are employed, with special attention to the gender medicine.
The center, moreover, is characterized by diagnosis and treatment of rare cardiovascular diseases and/or diseases with characteristics of medical complexity and urgency (cardiac amyloidosis, genetic cardiomyopathies, myopericarditis, endocarditis, etc.).
Of particular importance are our results in the treatment of congestive heart failure, as certified by AGENAS, which considers the Foundation as a leading center in Italy: in 2013 (most recent certified data) the center recorded a 30-day mortality rate of 1.8%, compared to the national average of 10.5%.
The center is, furthermore, a regional point of reference for the diagnosis and treatment of hereditary dyslipidemia and for the treatment of LDL apheresis; in this area it is an avantgardecenter in assistance,bench-bedside research, and in clinical studies regarding new pharmacological therapies thanks to its participation in national and European networks in.
Thesurgical activities and almost the totality of thepediatric activities are performed in the hospital of Massa, where the intensive therapy units (adult and pediatric) are integrated by a neonatology unit.
Also in this casethe results certified by AGENAS are quite excellent: in 2013 the 30-day mortality rate for coronary artery bypass surgeries was equal to 0.8%, vs. the national average of 2.4%, while for operations like valvuloplasty or substitution of heart valves, the 30-day mortality rate stood at 1.1%, compared to the national average of 2.9%.
In the pediatric field, in the three-year period from 2012 to 2014, the 30-day mortality rate was below 1% (the average for European centers stands at around 3.5%).
In the field of the pediatric heart surgery, of particular interest is the contribution in the development of heart surgery without the use of hemoderivatives. In particular, this approach has led to extremely satisfying and encouraging results, and is being employed also in very young and light-weight patients. This technique, mediated by experience, necessary for ethical and religious reasons for some patients, is today used, when possible, for all pediatric patients needing heart surgery.
Moreover,a peculiarity of the center is the surgical activity regarding congenital or acquired pathologies of the trachea in pediatric patients. The extent of the clinical records and the results obtained make the center unique in this sector of surgery within the panorama of the national health system.
Of particular interest, finally, is the treatment of adult patients affected by congenital heart disease (so-called GUCH): these patients, in fact, present particular surgical-clinical problems that require the presence of trans-disciplinary expertise, which is not usually available within the same structure; the Foundation, in this regard, surely represents a point of reference, as heart surgeons and pediatric and adult cardiologists work side by side, flanked by an ever-growing activity of electrophysiology in the pediatric area, along with the presence of advanced imaging.
The diagnostic activity spans from newborns to the elderly, with important prenatal diagnosis in-utero of heart diseases, and – in collaboration with the local Health Unit –assistance, both pre- and post-partum, to women, not only coming from the Tuscany Region, having pregnancies with a prenatal diagnosis of fetal heart disease, and for the deliveryof patients withcardiopathies.
Imaging technologies supporting the activities of diagnosis and treatment in our two hospitals cover, thanks to instrumentation and competencies of a high level, all sectors of methodologies of investigation, from ultrasound to traditional radiology, CT and angio-CT, to techniques of nuclear medicine (with modern instrumentation with high resolution and low radio-exposure), PET and TC-PET, 1.5 and 3 Tesla MR (cardio-vascular and neurologic activity), and bone densitometry.
Functional investigations cover all methodologies of cardiovascular and pneumologic interest, while laboratory investigations go from clinical biochemistry (with laboratories equipped to permit dosage of neuroendocrine and cardiovascular biomarkers, as well as of conventional ones), to genetics and molecular medicine.
The complete computerization of the two structures, finally, makes the Foundation a paperless hospital andconstitutes a fundamental source of assistance for clinical and research activities. This is an important advantage for the patients, whose clinical data relative to examinations, check-ups, and previous admission to hospital, are immediately and constantly available