bluuebunny/crossref_metadata_2025 huggingface dataset:
P21 AGE–RELATED DIFFERENCES AND ASSOCIATED OUTCOMES OF S–ICD: INSIGHTS FROM A LARGE, EUROPEAN, MULTICENTER REGISTRY
Authors: Schiavone M , Gasperetti A , Gulletta S , Vogler J , Fastenrath F , Breitenstein A , Laredo M , Mitacchione G , Palmisano P , Compagnucci P , Kaiser L , Denora M , Hakmi S , Angeletti A , De Bonis S , Picarelli F , Casella M , Steffel J , Ferro N , Guarracini F , Santini L , Pignalberi C , Piro A , Lavalle C , Russo G , Pisanò E , Viecca M , Curnis A , Badenco N , Ricciardi D , Dello Russo A , Tondo C , Kuschyk J , Della Bella P , Biffi M , Tilz R , Forleo G
Published: May 2022

Background

The subcutaneous implantable cardioverter defibrillator (S–ICD) has become an alternative to transvenous ICDs (TV–ICD) in patients who do not need pacing. To date, there is little evidence directly comparing the rates of inappropriate shocks (IAS) in young vs old S–ICD recipients.

Purpose

Aim of our study was to assess differences in device–related complications and inappropriate shocks (IS) between teenagers/young adults and adult recipients of a subcutabeous implantable cardioverter defibrillator (S–ICD) device.

Methods

Two propensity–matched cohorts of teenagers + young adults (≤ 30–year–old) and adults (> 30–year–old) were retrieved from the ELISIR registry. The primary outcome was the comparison of the inappropriate shock (IAS) rate; complications, freedom from sustained ventricular arrhythmic events, overall and cardiovascular mortality were deemed secondary outcomes.

Results

A total of 1491 patients were extracted from the ELISIR project. Teenagers + young adults represented 11.0% of the entire cohort. Two propensity–matched groups of 161 patients each were used for the analysis (Figure 1); median follow–up was 23.1 [13.2–40.5] months. 15.2% patients experienced inappropriate S–ICD shocks and 9.3% device related complications were observed with no age–related differences in IAS (16.1% vs 14.3%; p = 0.642) and complication rates (9.9% vs 8.7%; p = 0.701); Figure 2 shows a survival analysis from inappropriate shocks in the teen–ager/young adult cohort (red) and in the adult cohort (blue). At univariate analysis, young age was not associated with increased rates of IAS (HR 1.204 [0.675–2.148]: p = 0.529). At multivariate analysis (Figure 3), the use of SMART pass algorithm was associated to a strong reduction in IAS (aHR 0.292 [0.161–0.525]; p < 0.001), while ARVC was associated with higher rates of IAS (aHR 2.380 [1.205–4.697]; p = 0.012).

Conclusion

In a large multicentered European registry of patients with S–ICD, 11.0% of all recipients were teenagers or young adults. The use of S–ICD in teenagers/young adults resulted safe and effective, and the rates of complications and IAS between teenagers/young adults and adults were not significantly different. The only predictor of increased IAS was a diagnosis of ARVC.
P23 TIMING OF EJECTION FRACTION REASSESSMENT AFTER SACUBITRIL–VALSARTAN INITIATION FOR INDICATION TO DEFIBRILLATOR IMPLANTATION. A SINGLE CENTER EXPERIENCE
Authors: Leci E , Carinci V , Bugani G , Greco C , D‘Angelo C , Pecoraro A , Casella G
Published: May 2022

Background

Sacubitril/Valsartan (SV) has been validated for heart failure (HF) with reduced ejection fraction (EF) treatment. SV is effective on hard end–points as well as symptoms and heart remodeling. Present guidelines reccomend at least 3 month of optimized medical therapy (OMT). However, the best timing of EF assessment after SV initiation in order to proceed with defibrillator (ICD) implantation, is still unknown.

Purpose

Evaluate timing of improvement of EF after SV initiation in patients (pts) with systolic HF, candidates to primary prevention ICD implantation.

Methods

From 1 of february 2018, we evaluated retrospectively clinical and echocardiographic data of all consecutive pts with EF < 35% treated with SV and candidates to primary prevention ICD implantation. We evaluated clinical and echo follow up (Fup). Results have been analyzed with paired T–test.

Results

The study involved 95 pts (mean age 67±10 years, 70% male, ischaemic etiology 48%). Mean EF at enrollment was 30 ± 5% (ED vol 90 ±23 ml/m2; ES vol 62 ± 19 ml/m2, severe MR 23%) and NYHA III–IV 50%. In 58% pts reached the target dose of SV (97/103 mg bid). After a mean Fup of 6 months, mean EF of the study population increased to 37±7% (ED vol 80±19 ml/m2, ES vol 51±17 ml/m2, severe MR 5%, p < 0.001), and NYHA III–IV decreased to 8% (p = 0.01). Interestingly, thirty–one pts (32%) had their first Fup within 3 months and showed already an improvement [meanEF 28±5% to 35±6%; ΔEF 7±6%; NYHA III–IV 10 %]. Moreover, 49 pts (51%) had last Fup echo after 1 year (mean 13±6 months) and showed a further EF improvement (meanEF 41±8%; ΔEF 12±9%; p < 0.001).Sixteen pt (16%) underwent ICD (62%) or CRT–D (38%) implantation after 3±2 months of treatment and excluded from further FUP analysis. More favorable effects of treatment with SV were more evident in patient with non–ischaemic etiology of heart failure.

Conclusions

After SV initiation in systolic HF, favourable heart remodeling is clearly evident at 6 months FUP, but could be already observed after 3 months . These findings need to be validated from larger trials but suggest that the best timing of EF reassessment to decide for primary prevention ICD is likely between 3 and 6 months after SV initiation. However decision must be taken following close and individualized FUP for every patient, based on clinical characteristics and response to OMT.
P26 “FUNCTION FOLLOWS FORM”: THE ROLE OF THE CARDIAC MAGNETIC RESONANCE IN THE ARRHYTHMIC RISK STRATIFICATION IN PATIENTS WITH CARDIAC SARCOIDOSIS
Authors: Vetta G , Magnocavallo M , Della Rocca D , Mariani M , Piro A , Fedele F , Natale A , Chimenti C , Lavalle C
Published: May 2022

Background

Sarcoidosis is an inflammatory disorder characterized by non–caseating granulomatous infiltration in multiple organs, including the heart. The presence of granulomas within the myocardium can cause heart failure, atrio–ventricular block, ventricular arrhythmias (VA) and sudden cardiac death (SCD). Due to the patchy pattern of sarcoid infiltration, endomyocardial biopsy has a poor sensitivity and cardiac magnetic resonance (CMR) is becoming the gold standard imaging, detecting small area of myocardial fibrosis and scar using late gadolinium enhancement (LGE). The identification of LGE in patients with dilated cardiomyopathy is strongly associated with VA and SCD and similar findings were reported in cardiac sarcoidosis (CS) patients.

Methods

In order to assess the risk of VA and SCD related to LGE in the CS, we performed a meta–analysis including all the studies enrolling patients with suspected or confirmed CS undergoing CMR. We conducted a digital search in PubMed, Embase, Cochrane Database of Systematic Reviews, Web of Science, Scopus, and Google Scholar from inception through October 2021. Clinical outcomes of interest were arrhythmogenic events defined as VA (ventricular tachycardia or ventricular fibrillation), SCD or aborted SCD (appropriate ICD discharge) during follow–up.

Results

Eleven studies with a total of 1.123 CS patients (left ventricular ejection function [LVEF]: 59 ± 23%) with an appropriate follow–up were included in the final analysis. Overall, as depicted in the Figure 1, the identification of LGE at CMR was associated with a 13–fold increase risk in potentially lethal VA (R = 12.76, 95% CI [6.30–25.87]) than patients without LGE.

Conclusions

Our findings suggest that the presence of myocardial scarring as evidenced by the identification of LGE in CMR provides meaningful information about the arrhythmic risk stratification of CS patients.
P31 PERCUTANEOUS LEFT STELLATE GANGLION BLOCK AS PRE–TREATMENT STRATEGY FOR HIGH–RISK PATIENTS WHO ARE CANDIDATES FOR INVASIVE PROCEDURES POTENTIALLY ASSOCIATED WITH ADRENERGIC STIMULATION: AN HYPOTHESIS–GENERATING CASE REPORT
Authors: Casula M , Binaghi G , Mameli S , De Toni C , Scotto R , Schintu B , Scalone A , Tola G , Corda M
Published: May 2022

Introduction

Percutaneous left stellate ganglion block (PLSGB) has been reported as a safety and effective procedure for the management of refractory arrhythmic storm (AS). In this report we present a case of a man with refractory AS effectively treated with PLSGB, subsequently candidate for an invasive procedure potentially associated with adrenergic stimulation and propose the use of this technique as pre–treatment strategy in this clinical setting.

Case presentation

A 57–year–old man was admitted to our hospital for AS. Past medical history revealed that two years earlier he had been treated with primary percutaneous coronary intervention for ST–segment elevation myocardial infarction. Four months before admission he underwent coronary artery bypass graft surgery with concomitant mechanical mitral valve replacement, closure of an interventricular defect and, considering the severe left ventricular disfunction, he was implanted with an automatic defibrillator in primary prevention. At the time of admission, he was treated with lidocaine infusion with remission of arrhythmic events. Comprehensive diagnostic workup revealed no overt triggers for AS. Five days after admission, the patient experienced recurrence of ventricular arrhythmias (VA), refractory to amiodarone, lidocaine, and magnesium infusion, increased pacing rate, and sedation with dexmedetomidine. PLSGB was then attempted with the injection of lidocaine and ropivacaine using an anatomical approach with complete remission of arrhythmic events. After a week free from VAs, a new AS was observed and PLSGB was repeated using the same modality with complete arrhythmic resolution. Considering the advanced heart failure, the patient was candidate to heart transplantation (HT) and, before undergoing gastro– and colonoscopy required for inclusion in the HT program, with the aim to reduce the risk of VA recurrences triggered by potential adrenergic stimulation, we pre–treated the patient with PLSGB using only ropivacaine, with successful induction of temporary Horner syndrome (Fig. A). The endoscopy procedures were performed successfully with no VA events and the patient was then discharged waiting for HT.

Conclusion

We propose the use of PLSGB as a pre–treatment strategy for patients at high–risk of VAs who are candidates for invasive procedures potentially associated with adrenergic stimulation. This report could be hypotheses–generating for further studies on this topic.
P37 DIAGNOSIS AND TREATMENT OF HUMORAL REJECTION IN HEART–TRANSPLANT PATIENTS: SINGLE CENTER EXPERIENCE
Authors: Feccia M , Poggi E , Sinopoli S , Di Stefano G , Polizzi V , Musumeci F
Published: May 2022

Introduction

Heart Transplantation remains the gold standard treatment for Advanced Heart Failure patients. Antibody–mediated humoral rejection (AMR) is one of the main causes of medium and long–term morbility and mortality. Success, therefore, is strictly connected to the possibility of modulating immune response in the recipient through innovative diagnostic approaches of immunosuppression–therapy tailoring.

Method

Since 2019, San Camillo Hospital’s Heart Transplant Center in Rome has adopted a new integrated protocol for early diagnosis and treatment for humoral rejection which consists of clinical, instrumental and laboratory monitoring through Solid Phase Flow Cytometric Techniques in order to identify Donor Specific Anti–HLA antibodies (DSA) both fixing and not fixing complement (cytotoxicity).

Results

113 transplant patients were studied, resulted negative in prospective crossmatch at the time of surgery. Post–transplant DSA production has been monitored according to ISHLT guidelines in 1, 3, 6, 12 months’–time and, afterwards, once a year or after evidence of clinical symptoms or echocardiographic signs of graft disfunction associated always with biopsy. During the monitored period, 32 patients showed post–transplant DSA: 2 pz (6%) Class I, 16 (50%) Class II, DSA and the last 14 patients (44%) both Class I and II DSA. The capability of fixing complement (cytotoxicity) was evaluated in 19 patients. In 13 cases (68%) DSAs resulted positive for the specific test used (LSA–C1Q). In the aforementioned subgroup AMR incidence was of 23%; no AMR cases were found in the DSA C1q negative group. 3 patients showed clinical–functional deterioration and echocardiographic and bioptical alterations. Usage of apheretic treatment and re–modulation of immunosoppression therapy (FK, MMF or Everolimus) resulted in important reduction in DSAs amount, clinical recovery and echocardiocraphic signs of improvement.

Conclusions

The adopted protocol for monitoring and diagnosis of humoral rejection resulted in early identification of patients at higher risk of early graft failure. This leads to specific diagnostic and therapeutic strategies to improve long–term outcome.
P38 HEART FAILURE IN TRANSPLANTED HEART DUE TO TOXOCARA CANIS
Authors: Zanella L , Toscano G , Gerosa G
Published: May 2022

Toxocara Canis is a parasitic roundworm which cause zoonotic infections worldwide. It could affect heart causing myocarditis, pericarditis and Loffler’s endocarditis, with a clinical presentation ranged from asymptomatic to life threating conditions with heart failure. After heart transplantation, patients are immunosuppressed, therefore they could experience reactivation of hidden parasitosis like Toxocariasis. To our knowledge, some cases of Toxocara Canis affecting the heart have been described in literature, but there are no described cases of this infection in a transplanted heart. A 65–year–old woman underwent transplant heart surgery due to post–ischaemic dilatative cardiomyopathy. After transplantation she experienced supraventricular tachycardia, reduction of the new heart ejection fraction from 52% to 30% (Figure 1) requiring inotropic drug therapy and mild to severe mitral valve regurgitation due to ventricular dilatation. The unique finding was the presence of antibodies against Toxocara Canis in her blood and high level of immunoglobulin E. In addition, endomyocardial biopsy revealed a cystic intracellular inclusion. Specific therapy with albendazole and corticosteroids was immediately started: heart ejection fraction slowly grew up and mitral regurgitation became milder. Time correlation between Toxocara Canis antibodies positivity and worsening of heart ejection fraction, moreover the recovery with specific antibiotic therapy against this parasite, make us think that it could have been the cause of heart function deterioration in this patient. Often diagnostic findings of Toxocara Canis infection are not specific, heart damage seemed to be driven by direct invasion of the larvae and by immunological reaction. In conclusion, Toxocara Canis could be a cause of heart function deterioration after heart transplant. It should be considered in differential diagnosis of post–transplant heart failure.
P40 COVID 19: A NEW RISK FACTOR IN CARDIAC SURGERY?
Authors: Santise G , Mariniello A , Desoky A , Nardella S , Franciulli M , Iavazzo A , Maselli D
Published: May 2022

Introduction

Since the beginning of the actual pandemia, several patients with positive anamnesis for Covid 19, are undergoing a cardiac operation. Aim of the study is to analize if the Covid 19 past infection may impact on cardiac surgery outcome.

Method

All the patients with a history of Covid 19 positivity, who underwent a cardiac operation at the Clinica Mediterranea in Naples from the 1st of february 2021 to the 31st dicember 2021, have been included in the study. For those patients we evaluated the basal respiratory condition, with a chest Xray or CT scan, a pneumology consult and a spirometry if required. Postoperative outcome has been evaluated analizing ventilation time, intensive care and postoperative lenght of stay, acute renal failure, acute espiratory failure, postoperative complications and death.

Results

Thirtheen patients on 358 had a positive anamnesis for Covid19, but a negative swab at the admission. The mean time from the infection has been 5.1 +/– months, 5 patients have had poor or no symptoms, while the remnants moderate or sever ones with evidence of interstitial pneumonia, one patient had developed extrapulmonary complications (valvular thrombosis).
P41 ORAL ANTICOAGULATION AFTER REPAIR OF ACUTE TYPE A AORTIC DISSECTION: A REAL RISK ON LONG–TERM?
Authors: Vendramin I , Piani D , Lechiancole A , De Manna N , Bressan M , Sponga S , Puppato M , Muser D , Bortolotti U , Livi U
Published: May 2022

Objective

To analyse the effects of chronic oral anticoagulation on long–term outcomes after repair of type A acute aortic dissection and its influence on false lumen fate.

Methods

We studied 188 patients (median age 62 years; 74% males) who had repair of type A aortic dissection; patients receiving postoperative chronic oral anticoagulation (n = 59) were compared to those on antiplatelet therapy alone (n = 129).

Results

Median age was similar: 60 (18–79 years) vs 64 years (22–86) (p = 0.11); patients on anticoagulants were more frequently males (88% vs 67%, p = 0.003). After a median follow–up of 8.4 years (2 months to 30 years) 58 patients died, 18 for aortic–related causes, and 37 underwent aortic reintervention. After multivariable adjustment, anticoagulation showed no significant effect on long–term survival (HR 0.85, 95% CI 0.41–1.76; p = 0.66) neither on risk of reintervention (HR 0.55, 95% CI 0.27–1.15; p = 0.11). Analysis of 127 postoperative computed tomography scans showed a patent false lumen in 53% of anticoagulated vs 38% of not anticoagulated patients (p = 0.09); partially thrombosed in 8% vs 28% (p = 0.01) and thrombosed in 39% vs 34% (p = 0.63). In patients with a control computed tomography there were 6 late aortic–related deaths, 1 among patients anticoagulated and 5 in those who were not.

Conclusions

Chronic anticoagulation after repair of type A acute aortic dissection favours persistent late false lumen patency which is not a risk factor for late mortality or reoperation. Chronic anticoagulation can be administered safely to patients with repaired type A acute aortic dissection regardless of its specific indication.
P49 SURGICAL OPEN AORTA TRANSCATHETER VALVE IN VALVE IMPLANT FOR A MALFUNCTIONING AORTIC BIOPROSTHESIS
Authors: Del Prete G , Lixi G , Spina A , Loi B , Cirio E
Published: May 2022

Background

Most cases of aortic valve bioprosthesis degenerative disease are currently best managed by transcatheter aortic valve replacement (TAVR). Compared to redo surgery, advantages of TAVR include reduced invasiveness and a minimized prosthesis gradient; however, this approach is occasionally unfeasible due to the risk for coronary flow impairment or prosthesis stent dimensions unfit to accommodate an appropriately sized device. We present a case of an open TAVR after surgical leaflets excision of a failing aortic valve bioprosthesis.

Case Summary

A 76 years old female with type 2 diabetes, hypertension and dyslipidemia was referred to our institution for a malfunctioning 21 Carpentier Edwards pericardial aortic valve bioprosthesis implanted 9 years earlier. Patient was initially considered for a valve in valve TAVR. However, because of very low–lying coronary arteries origin at preoperative CT scan we estimated substantial chances for ostia impingement when prosthesis leaflets would have been stretched out by the deploying transcatheter device (Figure 1); although feasible, conventional redo surgery with bioprosthesis excision and re–suture was not preferred because of patients age and comorbidities; risk of damaging the aortic ring and wall including coronaries emergence when dissecting out the stent of the biopsosthesis and reimplanting a new one was also evaluated. We therefore opted for an hybrid procedure. After redo median sternotomy, careful dissection of adhesions, central Cardio–Pulmonary Bypass (CPB), aortic cross clamp and antegrade cardioplegia, a transverse aortotomy was done. The prosthesis was inspected and found grossly deteriorated: leaflets only were excised leaving the stent intact (Figure 2) and a 23 Sapien3 Ultra valve was carefully deployed under direct vision. Coronary ostia were checked and found patent. Myocardial ischemia and CPB times were 61 and 85 minutes respectively. Intensive care unit stay was 2 days. After a reassuring postoperative CT scan (Figure 3), patient was discharged home 11 days after surgery.

Conclusions

We found this approach a good compromise when dealing with challenging aortic valve reoperations, as it is associated to reduced surgical complexity and potential for less morbidity and mortality compared to conventional surgery when low coronary ostia make valve in valve TAVR unachievable.
P61 CORONARY ARTERY ECTASIA: AN ENEMY NOT TO BE UNDERESTIMATED IN ACUTE CORONARY SYNDROME
Authors: Chietera F , Ghetti G
Published: May 2022

Coronary artery ectasia is an abnormal dilatation of coronary arterial segment of at least 1.5 times that of a narrow normal coronary artery. Even if the overall incidence ranges between 4–9% of total angiography, it is correlated with poor outcome due to lower percutaneous procedural success, an higher incidence of no–reflow, distal embolization and stent thrombosis. We present two cases of high risk acute coronary syndrome patients with right coronary artery ectasia and different management in which intravascular ultrasound played a key role in determining interventional strategy.

Case #1 : 55–year–old man presented with STEMI after VT–induced cardiac arrest treated with CPR and DC–shock with subsequent ROSC. Coronary angiography showed thrombotic occlusion in the middle tract of the right coronary artery treated with thrombus aspiration and subsequent PTCA + DES from the proximal to the distal tract of the severely ectatic artery with apparent good final angiographic result. However, at the IVUS control performed to verify the possible need for an additional stent in the context of flow turbulence, malapposition of the stent to the proximal–middle tract was highlighted with an important amount of probably thrombotic material between the stent and the vessel wall. Post dilation was therefore performed with NC balloons with IVUS documentation of resolution of the malapposition.

Case #2: 59–year–old man hospitalized for NSTEMI. Coronary angiography showed severe left coronary ectasia in the absence of significant stenosis and subocclusive thrombus in the posterolateral branch of the right coronary artery with TIMI 2 flow in the context of diffuse CAE . A conservative strategy was undertaken with DAPT + LMWH due to the absence of symptoms and hemodynamic stability, as well as the associated high embolic risk. A follow–up coronary angiography was performed after one week of therapy with evidence of good recanalization of the branch (TIMI 3). IVUS control showed only minimal thrombotic component adhering to atherosclerotic plaque in the posterolateral branch with a MLA of 11.47 mm2 and a low percentage of stenosis (34.5%). A conservative strategy was therefore undertaken (DAPT 12 months).

ACS management in patients with CAE is still challenging and a standardized approach is difficult to please. Strategies should be individualized based on clinical presentation and anatomic characteristics but coronary imaging should be routinely performed in this context.
P63 OPTICAL COHERENCE TOMOGRAPHY–ANGIO CO–REGISTRATION (OCT–ACR) OF LEFT ANTERIOR DESCENDING IN PATIENT WITH ONGOING ANIGNA
Authors: Forlani D , Fulgenzi F , Di Marco M , D‘Alleva A , Magnano R , Pezzi L , Verrengia E , Vitulli P , Corazzini A , Paloscia L
Published: May 2022

We share the case of a 50–year old man, with no cardiovascular risk factor, presented in ER with ongoing angina and positive exercise stress testing. No clinical evidence of heart failure. EKG and echocardiogram was negative. He was referred for invasive coronary angiography, that showed severe stenosis of mid–LAD and moderate ostial LAD stenosis. Subsequent Optical Coherence Tomography–Angio Co–Registration (OCT–ACR) of Left Anterior Descending was performed. An EBU3.5 guiding catheter was engaged in the left coronary artery, and 8000 units of heparin administered. After a pre–dilatation with a semi–compliant balloon of mid LAD, a plaque rupture with thrombus was documented at mid–LAD and a fibro–lipidic plaque with a severe flow limitation (MLA<4mm2) at the ostium, with no involvement of left main (Fig. 1b). Pre–dilatation with SC and NC balloon (2.5–3.5mm) was performed and then stented with a 4.0 × 26 mm DES. Finally, OCT confirmed correct stent expansion, achieving an excellent angiographic result, without carina shifting and compromise of the circ. Patient was discharged, asymptomatic. OCT–ACR guided PCI, taking advantage of its high spatial resolution, permits to plain better the PCI, establish correct stent size, evaluate early complications especially if left main or bifurcation are involved and thanks to co–registration also measurement of long axis of the vessel are facilitated.
P66 GENDER–RELATED DIFFERENCES IN CLINICAL OUTCOMES AFTER EITHER SINGLE OR DOUBLE LEFT MAIN BIFURCATION STENTING
Authors: Rigatelli G , Zuin M , Gianese F , Osti S , Bilato C , Roncon L
Published: May 2022

Background

We sought to examine the impact of gender differences in clinical outcomes at 3 years also comparing the role of double versus single stenting approach for the treatment of coronary unprotected LM bifurcation lesions.

Methods

We retrospectively analyzed both the procedural and medical data of patients referred to our hub center for complex LM bifurcation disease, treated using Cross–over provisional stenting, T or T–and–Protrusion (TAP), Culotte, and Nano–inverted–T (NIT) techniques between January1st, 2008 to May1st2018. The main outcome of the study was to evaluate the association between gender and target lesion failure (TLF) based on the different stenting technique used.

Results

Five hundred and sixty–seven patients (251 females, mean age 70.0±10 years, mean Syntax score 31.6±6.3) were evaluated. Cross–over, T or TAP, culotte and NIT techniques were performed in 171 (30.1%), 61 (10.7%), 98(17.2%) and 237 (41.8%) patients, respectively with no differences in baseline and peri–procedural items among gender. At a mean follow–up of 37.1±10.8 months (range 22.1–39.3 moths), the overall TLF rate, cardiovascular mortality and stent thrombosis were 12.1%, 3.1% and 1.0%, respectively. Female gender was associated with an increased rate of major bleeding when treated with double stent strategy (p = 0.02). No gender difference in TLF was noted among gender, independently from the stenting approach used.

Conclusions

Among patients with ULM bifurcation disease undergoing PCI, TLF rates were not different between genders at 3–year follow–up either using a single or double stent technique.
P68 PERCUTANEOUS REVASCULARIZATION OF CORONARY CHRONIC OCCLUSIONS IN THE ELDERLY: EFFICACY AND SAFETY
Authors: Mircoli L , Tonella T , Carugo S
Published: May 2022

Background

Percutaneous revascularization (PCI) of coronary total occlusions (CTO) is an effective treatment of refractory angina. This procedure presents higher procedural risks than routine PCI. For this reason PCI CTO is often not considered a viable option for elderly patients. The aim of the work is to evaluate the efficacy and safety of CTO PCI in a population over 75 years of age.

Materials and Methods

We considered patients undergoing CTO PCI from 2015 to 2021 in our center. Primary efficacy endpoint was the incidence of major adverse cardiovascular events (MACE) during follow–up in older subjects compared to younger subjects. Endpoints include target vessel revascularization (TVR), urgent non–target vessel revascularization, and cardiovascular death. Safety endpoints were considered complications intra–procedure, during hospitalization and 15 days after discharge. MACE–free survival rates were assessed with Kaplan–Meier analysis.

Results

127 patients were included, 30 aged more than 75 years (24%). The follow–up was 22 months. 86% were male. 32% were suffering from diabetes, 8% from chronic renal failure (creatinine > 2 mg / ml), 76% from arterial hypertension, 40% were familiar with ischemic heart disease. No significant differences are reported in the distribution of risk factors between the two groups. The average age in younger group is 69 years compared to 79 in the elderly. In the follow–up, 16 MACE were found (1 death from cardiac arrest, 14 TVR, 1 non–target vessel revascularization). TVR was the most common endpoint, in 90% of cases this revascularization took place by election. Four events (13%) occurred in the group over 75 years and 12 cases (12%) in the other group (n = ns). Kaplan–Meier MACE–free survival rates were similar. Only 3 complications related to the procedure (2.5%) were reported and these are coronary perforations effectively managed in the hemodynamics room. The success rate of the revascularization procedure was similar (80% for those over 75 versus 82% for the younger group).

Conclusions

in our population age did not influence the efficacy and safety of CTO PCI which represents a valid option for refractory angina even in older patients.
P74 NEURAL INTERFACES TO MONITOR INTERVENTIONAL CARDIOLOGISTS’ MENTAL WORKLOAD: GAME–ON SAGA
Authors: Scala A , Campo G , Erriquez A , Tebaldi M , Tumscitz C , Penzo C , Talevi L , Biscaglia S
Published: May 2022

Interventional cardiologists’ mental workload may impact on their performance as well as on patients’ outcome. Nevertheless, little attention is paid to the monitoring and optimization of their mental status. Electroencephalogram (EEG)–based neural–interfaces can estimate mental fatigue and sleepiness through spectral analysis techniques and the amplitude of alpha waves is a widely validated indicator of mental engagement’s level. No data regarding neural interfaces are available for interventional disciplines. The present preliminary report is the first step of a project aimed at analysing and monitoring mental fatigue and sleepiness through variation of psychometrics and neurometrics in interventional cardiologists (NCT05041218). We prospectively recorded and analysed EEG signals from 7 interventional cardiologists in 129 consecutive procedures. Neurometrics have been acquired at the beginning of the shift, before and after each procedure performed during 127 valid Alpha Attenuation Protocols (AAP), a practical test to quantify sleepiness measuring alpha power during 2 cycle of eye opening/closing protocol. We collected alpha waves’ power measures obtained during resting condition (AA Coefficient–eyes open (AAC–eo), AAC–eyes closed (AAC–ec) and AAC–mean), related to fatigue, and AAC–ec/AAC–eo (AAC–ratio), related to sleepiness. From a two–months observation, the first interesting preliminary results emerged: i) AAC–mean, AAC–eo and AAC–ec showed an upward trend during the working day, reflecting an increase in mental fatigue (p < 0.01 for all of them); ii) population–level psychometrics trend confirms the same tendency described by neurometrics, possibly reflecting a reduced awareness of the operator of his/her actual mental status (Figure 1, Figure 2). Developing a low cost and high feasibility device to monitor and analyse operator’s mental engagement level could be extremely appealing, considering the lack of data in literature and recent technology developments.
P75 PRELIMINARY FINDINGS OF THE DAVIDS REGISTRY (DYEVERT TO AVOID UNNECESSARY CONTRAST MEDIA DELIVERY DURING PCI SANREMO REGISTRY)
Authors: Vergni F , Arioti M , Boasi V , Sanchez F , Leoncini M , Ferrari F
Published: May 2022

Background

Contrast–induced acute kidney injury (CI–AKI) is a percutaneous coronary intervention’s (PCI) feared complication, linked to increased morbidity and mortality. Many risk factors have been identified. Amongst procedural variables contrast media (CM) volume is one of the most predictive. An easy–to–use and effective CM sparing device would represent a valuable tool in the cath–lab armamentarium.

Aim

To evaluate the effectiveness of the DyeVert Power XT system in reducing CM delivery during PCI in pts at high risk of CI–AKI, consequently reducing the risk itself. Methods We collected clinical, laboratory, instrumental, procedural and outcome data of 75 consecutive patients (pts) who underwent PCI with the use of the DyeVert system between September 2020 and December 2021. We also compared these data in two groups of patients, divided according to CI–AKI onset. Inclusion criteria were reduced estimated glomerular filtration rate (eGFR) – defined as creatinine clearance (CrCl) <60 mL/min/m2 – and/or need for a complex PCI – chronic total occlusion (CTO), previous coronary artery bypass graft (CABG) or diffuse multivessel disease (MVD) – with the likelihood to receive a high amount of CM.

Results

Clinical data are shown in Table 1. Lab and instrumental data are shown in Table 2. Procedural data are shown in Table 3. In–hospital events are shown in Table 4. CI–AKI predictors at multivariate analysis are shown in Table 5. Median dose of CM delivered was 255 ml while CM spared with DyeVert was 110 ml (43% volume reduction, median 1 point reduction in Mehran score). Turning to outcomes 11 pts (14.7%) experienced AKI stage I according to Kidney Disease – Improving Global Outcomes (KDIGO) definition, whilst only 3 pts (4%) and 2 pts (2.7%) experienced stage 2 and 3 AKI. At follow–up there were 4 in–hospital deaths, none linked to deteriorating renal function.

Conclusions

DyeVert use was simple and effective in cutting delivered CM amount, with preserved image quality according to the operators judgement, however the reduction in Mehran score was not sufficient to affect risk class in pts experiencing CI–AKI versus those who did not.
P77 SIEMENS ARTIS VD11 ANGIOGRAPH‘S POTENTIAL WITH THE CLEARSTENT PROTOCOL IN PERFORMING PERCUTANEOUS CORONARY ANGIOPLASTY: FIRST EXPERIENCES
Authors: Ragosa N , Aloia A , Giordano F , Grompone R , Bellarosa I , Di Santi E , De Angelis E , Benvenga R , Ferraioli D , D‘Arco G , Matturro R , Di Lascio A
Published: May 2022

Objectives

The use of the CLEARstent image functions allows you to highlight fine structures, for example the expansion of a stent. Composite images are created by averaging several frames of a scene and considering the alignment of the markers of a stent. If an ECG signal is available, the cardiac phase is also considered. Using the CLEARstent function allows you to create special reference images from any scene or natively acquired fluoroscopic scene. The goal of CLEARstent images is to optimize the procedural result of mechanical cardiac revascularization and to improve the outcomes of treated patients.

Methods

The use of the Siemens Artis VD11 angiograph requires specific technical and medical knowledge and skills regarding, at least, radiation protection, safety procedures and patient safety. The people who work with the system, who use it and who move it must have acquired this knowledge and skills in their working life The application training was provided to the medical–technical–nursing staff of the Hemodynamics Unit of the “San Luca” PO of Vallo della Lucania “by qualified Siemens personnel. The application training offered by Siemens is binding before any use of the system

Results

701 coronary angiography procedures and 118 urgent revascularizations were performed at our Hemodynamics Unit in the period from 11/27–2020 to 12/21–2021, period of use of the aforementioned angiograph, 701 coronary angiography procedures and 118 revascularizations in an emergency pattern ( STEMI–NSTEMI at high risk). In all mechanical myocardial revascularization procedures, the opening and optimal positioning of the coronary stents were verified with the CLEARstent system. There was no periprocedural complication.

Conclusions

The CLEARstent system allows to highlight fine structures, for example hypo–expanded stents, creating special reference images from any negatively acquired fluoroscopic scene, consequently allowing optimal positioning and opening of a coronary stent. Therefore, it is inserted together with intracoronary imaging techniques (IVUS, OCT) as a further aid to guide percutaneous interventions in order to optimize the acute procedural outcome of PCI and to improve the clinical outcomes of treated patients.
P79 FIRST GENERATION BIORESORBABLE VASCULAR SCAFFOLD VS NEXT GENERATION BIORESORBABLE VASCULAR SCAFFOLD: SINGLE CENTER, LONG–TERM FOLLOW UP EXPERIENCE
Authors: Albani S , Pisano F , Bernardi A , Amato G , Bonino C , Biava L , Contu L , Pelloni E , Scacciatella P
Published: May 2022

Background

Previous randomized controlled trials demonstrated a higher rate of stent thrombosis with first generation (Absorb; Abbott Vascular, USA) bioresorbable vascular scaffold (BVS) implantation as compared with second–generation drug–eluting stent. Currently, with limited indications, others next generation BVS (NGB) are available (Magmaris; Biotronik AG, Switzerland and DESolve; Elixir Medical Corporation, USA). Real world long–term outcomes of such devices are limited.

Methods and Results

In our center from 27/09/2012 to 28/08/2018 in a cohort of 277 patients, a total of 259 BVS and 191 NGB (120 Magmaris and 71 DESolve) devices were implanted. The primary efficacy endpoint was a combined end point of target–lesion revascularization (TLR) and target lesion myocardial infarction (TLMI) the primary safety endpoint was scaffold thrombosis (ScT). At a median follow–up, of 83 months (interquartile range–IQR, 61–91 months) for BVS, and 48 months (IQR, 41–53.5 months) and 64.5 months (IQR, 58.5–69 months) for Magmaris and DESolve respectively, TLR/TLMI occurred in 17 patients (10.5%) in the BVS group and 4 patients (3.5%) in the NGB group (p value= 0.03), ScT occurred in 5 patient (3.1%) and 1 patient (0.9%), p–value=0.23, respectively. Median time of ScT occurrence in the BVS group was 12.5 months (IQR 9.75–16.75), ScT in the NGB group occurred after patient’s suspension of dual antiplatelet therapy 3 months later from the implantation date.

Conclusion

In a single center real world setting, the use of NGB appear safer compared to BVS at long–term follow–up.
P84 RENAL DENERVATION IN RESISTANT ARTERIAL HYPERTENSION: OUR CENTER‘S EXPERIENCE
Authors: De Vita E , Laurenzano E , Asparago S , Petruziello B , Quirino C , Ranauro A , Villari B
Published: May 2022

Introduction

The renal denervation procedure (RDN) represents an innovative alternative in patients with resistant arterial hypertension, in addition to medical therapy and lifestyle changes. This document presents our experience at the Cardiology department of the “Fatebenefratelli di Benevento” hospital where 19 effective RDN procedures were performed.

Methods

19 RDNs were performed at the “Fatebenefratelli di Benevento” Hospital in patients with resistant arterial hypertension (defined as failure to control blood pressure values using three or more drugs, including a diuretic). The long–term efficacy of the technique was evaluated by comparing blood pressure measurements using ECG–holter before and after the RDN (follow–up visit – 12 months). In addition, patients underwent a clinical–instrumental evaluation before the procedure and at the follow–up visit.

Results

The analysis of the collected data revealed a significant reduction in systolic, mean (p–value <0.001) and diastolic (p–value = 0.001) blood pressure. The mean variation was –13 ± 8 for systolic blood pressure, –7 ± 7 for diastolic blood pressure, and –11 ± 9 for mean pressure. The procedure was completed in all patients without peri–procedural and post–procedural complications. During the 12 months of observation, no fatal or non–fatal cardiovascular events, hospitalization or death from any cause were reported.

Conclusions

In our experience, renal denervation has been a safe and efficacy procedure in reducing blood pressure and the amount of drugs taken in high–risk cardiovascular patients with resistant arterial hypertension. It will be necessary to confirm the results benefits through a longer follow up.
P88 LEFT ATRIAL APPENDAGE CLOSURE DEVICE COMPLICATED BY LATE ONSET PERICARDIAL EFFUSION AND TAMPONADE: A CASE REPORT
Authors: Albani S , Pisano F , Berlier N , Pelloni E , Caterina B , Biava L , Contu L , Scacciatella P
Published: May 2022

Background

Late onset complications of left atrial appendage occlusion (LAAO) device procedure are anecdotal and there are no such complications reported in literature using Cardia Ultraseal (Cardia, USA).

Case Summary

We report the case of a 74–year–old Caucasian man affected by paroxysmal atrial fibrillation with significant bleeding risk (familiar thrombocytopenia, macroscopic hematuria episodes during therapy with direct oral anticoagulants, HAS–BLED risk score: 4) and ischemic risk as well (CHADSVASC score: 3). The patient was treated with LAAO device implantation for high bleeding risk. Subsequently, after 26 days from LAAO procedure, he was admitted to the emergency department for hematic cardiac tamponade. The patient was successfully treated with subxyphoidal pericardiocentesis in the acute phase, unfortunately cardiac arrest occurred during the transfer to the referral hospital for urgent cardiac surgery. Permanent neurological damage was reported and the patient died on day 28.

Discussion

There are several clinical and radiological aspects that may suggest a cause–effect relationship with the occurrence of hematic pericardial effusion and LAA occlusion device implantation: firstly the pericardial effusion was hematic and its occurrence was preceded by acute interscapular pain suggesting an acute pericardial irritation caused by the hematic effusion and secondly, the CT scan played an “indirect key role” excluding several causes of hematic pericardial effusion (such as aortic dissection and solid tumors that could infiltrate the pericardial membrane), thirdly there are no other anamnestic events that may be associated with this clinical manifestation (such as trauma). The low flexibility of the Cardia Ultraseal (Cardia, Inc., Eagan, MN, USA) nitinol mesh structure, as previously reported in others settings, may be associated to increased torque of the device by the beating heart. A bench test showed that the Ultrasept, a large–mashed device for interatrial defect closure, very similar to Ultraseal, needs a high compression force during implantation as a result of its low radial strength. In addition, compared to other devices, the bulb part is much larger. Consequently, when the device is deeply inserted in LAA, a higher surface area within the appendage wall is directly overlapped, having more chance of causing friction.All these aspects could be responsible of wall erosion.
P89 THE HEART TEAM SUCCESS: TAVI IN–VALVE IN A COMPLEX PATIENT
Authors: Vecchio C , Calderone D , Oreglia J , Nassiacos D
Published: May 2022

CG was a 80–years–old man with normal BMI, arterial hypertension and CAD family history.He suffered OSAS needs nocturnal cPAP, MGUS, colon diverticulosis and CKD in dialysis treatment since 2006 after right nephrectomy for adenocarcinoma and wrinkle left kidney for focal glomerulosclerosis since 1982.Note valvular heart disease with mitro–aortic insufficiency: in 6/2010 he performed aortic valve replacement with Carpentier Perimount 23 bioprosthesis, mitral annuloplasty with St Jude 28 ring and surgical revascularization with single graft on PDA coronary.During post–surgical period transients III degree AVB and AF were observed with subsequent restoration and stabilization in sinus rhythm.In 5/2011, thanks to Holter registration of stable sinus rhythm, VKA anticoagulation was stopped and only ASA continued.In 1/2013 well tolerated AF was found then VKA resumed.In 6/2016 during the follow up the echocardiogram showed hypertrophic and hypokinetic left ventricle, EF 45%, moderate biatrial dilatation, normofunctioning aortic bioprosthesis with mild aortic root and first ascending tract dilatation and successful mitral annuloplasty.In 3/2018 worsening exertional dyspnea with initial heart failure were documented and echocardiography showed aortic bioprosthesis degeneration with severe stenosis and mild intraprosthetic insufficiency, preserved EF, mild mitral steno–insufficiency, normal right sections with mild–moderate tricuspid insufficiency and mild pulmonary hypertension.In 6/2018 the subsequent coronary angiography evidenced venous graft occlusion and critical RCA stenosis treated by PTCA+DES Biofreedom in the middle segment: triple therapy with ASA, clopidogrel and VKA indicated for one month.One month later, in 7/2018 TAVI was performed on aortic bioprosthesis with Portico n.23 prosthesis: in the post–procedural phase mild anemia and positive FOB were found. The patient presented high both thrombotic and bleeding risk because of persistent AF, recently coronary reperfusion with DES and dialysis treatment so we decided to close left atrial appendage by Watchman system and keep on single antiplatelet therapy with ASA. Pre and post procedures dialysis treatments were performed without complications.Subsequent clinical and echocardiographic follow up without complications.The diagnostic–therapeutic iter sharing in Heart and multi–specialists team has favored the best timing of treatment and the success of procedures in a very high cardiovascular risk patient.
P93 THE POWER OF GROUP WORK IS THE STRENGTH OF A SUCCESS: TAVI!
Authors: Campolo G , Iacopino F
Published: May 2022

TAVI (Transcatheter Aortic Valve Implantation) is a procedure performed by a multidisciplinary team, preferably in a hybrid room where both interventional and cardiac surgery procedures are performed. This procedure is a splendid example of team work, where all the figures involved (hemodynamist, cardiac surgeon, anesthetist, sonographer and nurses) collaborate, each with a specific role, in the safe execution of the implantation of the transcatheter aortic valve in patients with high operative risk. Specifically, during the TAVI there are 4 nurses with very specific roles: CIRCULATING NURSE: • He/she welcomes the patient in pre–operating room (identification, checklist) • He/she transfers the patient to the hybrid room (positioning, etc.) • He/she supports the scrub nurse (materials, Pacemaker management) • He/she performs TIME–OUT and SIGN–OUTANESTHESIA NURSE: • He/she takes care of positioning all the monitoring instruments (ECG plates, defibrillator, etc. ..), finds all the venous accesses and supports the anesthetist (ventilation, intubation if necessary, EGA, ACT, etc …)SCRUB NURSE: • He/she collaborates with the hemodynamist in the execution of the procedure and in the management of sterile materials.CRIMPER NURSE: • He/she is responsible for the correct preparation of the valve and the material required for its assembly. This “new” competence of the nurse sees him engaged in the following activities: 1. preparation of the overbed table 2. preparation of catheters, introducers and any catheters for pre–dilatation (valvuloplasty) 3. preparation of valve delivery and positioning systems 4. valve washing 5. assembly and “crimping” of the valve

At the end of the procedure, the nurses carry out the compressive dressing of the arterial and venous accesses, monitor and verify the correct arterial haemostasis by promptly intervening on any vascular complications (haemorrhages, pseudoaneurysms). Since October 2017, our Center has carried out numerous procedures with intra–operative and post–operative results comparable to national data, thanks to the efforts and commitment of our Heart Team. TAVI turns out to be an excellent example of teamwork, where success is given by the synergy between the various professional figures that are essential to each other.