bluuebunny/crossref_metadata_2025 huggingface dataset:
THE INFLUENCE OF EMOTIONAL QUOTIENT TOWARD STUDENTS INDEPENDENCE LEARNING AND COMPREHENION OF MATHEMATICS CONCEPT
Authors: Jannah Tri Khoirul Jannah Khoirul , Nurhidayah Dwi Avita
Published: November 2018

The purpose of the research to: (1) describe the influence of emotional quotient toward students independence learning, (2) describe the influence of emotional quotient toward students comprehension of mathematics concept of Grade VII students in MTs. Ma'arif Darul Fattah Terpatih Galak Slahung Ponorogo. This research is quantitative researh was using survey method with population is all of student Grade VII in MTs. Ma'arif Darul Fattah with total of all student is 48 students. Then, students were choosed randomly for the sample with total 24 students. The data collection technique in this research are questionnaire and test, whereas the research instrument were using questionnaire of emotional quotient and independence learning also question test about comprehension of mathematics concept. The data analysis technique were using descriptive statistics and inferential statistics with analysis of simple regresion which assisted by computer program SPSS Statistics 17.0 for Windows. The result of this reseach indicates that have an significant influence between emotional quotient toward independence learning. Whereas not have an significant influece between emotional quotient toward comprehension of mathematics.
THE IMPLEMENTATION OF CREATIVE WRITING ON ELT (ENGLISH LANGUAGE TEACHING) TO INSPIRE SENIOR HIGH SCHOOL STUDENTS’ WRITING ACTIVITIES IN ELEVENTH GRADE OF MAN 2 PONOROGO IN ACADEMIC YEAR 2017/2018
Authors: Febriana Novia Ella , Harmanto Bambang , Maghfiroh Ana
Published: November 2018

This purpose of this thesis is describing the effect of the implementation of creative writing on ELT (English Language Teaching) to inspiring the students’ writing activities in Eleventh Grade of MAN 2 Ponorogo in Academic Year 2017/2018.The subject of this research is the student of Eleventh Grade of MAN 2 Ponorogo. This research provide classroom action research  method which doing the observations about the students’ writing learning activities before and after the research and monitoring the development of the students’ tasks by guiding them in creative writing. The researcher also makes the interview with the students’ experienced when they’re conducting writing activities.  The data comes from students’ interviews and observation conducts to students’ writing paper, which one that they are finding problems in finding ideas than the other students within their understanding to find the ideas. This study will show you how creative writing will improve the students’ ideas and also provide their abilities to stay in their way of writing; they can also find their style in writing. Creative writing also produce their energy in order to find new discovery in the topic they had been chosen. It also guide them to be discipline, confident, imaginative, be a planner, because they will make their deadline a project of writing, they also try to be a pioneer, not a plagiarism. The researcher suggestion about this research were the student should  read intensively to increase their vocabularies, doing the example of the task for more understanding about the lesson, and the last the teacher should apply the various the teaching method to motivate the student in learning English.
Optimalisasi Sumber Dana Pada Amal Usaha Muhammadiyah Wilayah Gorontalo
Authors: Radjak Lukfiah I. , Lantowa Felmi D.
Published: November 2018

This study aims to determine and analyze the optimization of funding sources at a business charity Muhammadiyah (AUM) Gorontalo region with a long-term goal is the accountable financial management in AUM. This research was conducted on AUM in Gorontalo Region using descriptive qualitative approach. Data collection is done through observation, interview, and documentation. Based on the results of the study can be seen in the financial management AUM financial management has been based on ART Muhammadiyah in accordance with Article 7 paragraph 2 AD Muhammadiyah and for the system of recording each AUM different this is seen in terms of recording financial statements of the overall business charity that became the sample research, the only one implementing the system of recording based on PSAK No. 45 namely Muhammadiyah University of Gorontalo and if in review in terms of optimization of fund sources from the business charity that the research sample has not been optimal in the source of funds because it still relies solely from government and college grants for college level and not optimal in developing a business unit which will increase the source of business charity funds.
Implementasi Pengaturan Karakter, Fisik dan Jenis Kelamin Janin (dalam Kajian Tradisi, Sains dan Islam)
Authors: Saputro Anip Dwi
Published: November 2018

Considering each cell between the reproductive cells contain half the amount contained in the cell body and assigned to him, the existence of post-law partner is one sign of the greatness of God in creating his creatures. This is due to the merging of both male and female reproductive cells to form the zygote, then fulfilled the specified number of chromosomes to the human species, creating diversity in character between both parents and children are increasingly enrich life and make it more alive. This diversity also prove absolusitas power of God that is designing such a process that occurs in the zygote so out of humans, animals, plants as new creatures like its predecessor in several different characters and in some other characters. In humans each body cell contains 46 chromosomes arranged in 23 pairs that are similar in terms of shape, but different in terms of structure and gene carried by each chromosome. The amount of raw character (fixed) in the cells of male and female, although there are differences in the chromosomes specified for sex. Male body cell contains 44 chromosomes, plus two chromosomes of sex are not similar, because one of them labeled masculine (Y), and the other is labeled feminine (X). with the same composition, a woman's body cells contain 44 chromosomes, in addition to the two chromosomes of sex, but they both feminism (X, X). With this process, each human character has a pair of genes, one derived from the father and predecessor, while the other comes from the mother and predecessor. Gen stronger will dominate, and the character of this gene is hereinafter referred to as the dominant character. Being weaker genes will disappear and step aside for a while to appear again later in the next generation. Therefore, the character who brought termed recessive character. Thus, the character of the child may be different from the character of his brothers, or parents or predecessors.
Refleksi Psikologi Islami dalam Dunia Psikologi di Indonesia
Authors: Nurjan Syarifan
Published: November 2018

Movement of Islamic psychology development is an effort that has a commitment to bring the contribution of Islam to humanity. The working of Islamic psychology is to formulate theory, whose characteristics are logical and objective (measurable). After the theory is formulated, it is ready to be researched. Here the researcher makes a hypothesis. If the results of research suitable with the theory built, then it is be a solid science and ready to be applied. The development of Islamic psychology into a scientific paradigm needed considerable time, hard effort, and the accumulation results of thought, results of research, and the results of many people's implementation. The development of Islamic psychology theory, be prosecuted that knowledge based on the Islamic view (from the holy book, the universe, and the human self) is constructed, so it can be classified into a solid science. Islamic psychology is intended to make human empowerment, so that the quality of human life increases. Islamic psychology reminds us that human should be understood as being multi-dimensional. In the perspective of Islamic psychology, humans not only physical, psychological (cognitive, affective), social, but also moral-spiritual.
Realitas Kehidupan Islami dalam Novel Surat Kecil untuk Tuhan Karya Agnes Davonar (Kajian Mimetik)
Authors: Anisah Zulfatun
Published: November 2018

The value of Islamic education is occupied in everyday life, depicted also in literary works. One of them is the novel "Little Letter to God". The Islamic values contained in the novel reflect the values of life. On the social values depicted kinship attitudes interwoven between humans, mutual help-help, and mutual cooperation with each other. The value of education is also depicted according to the teachings of the Prophet Muhammad is seriously in search of knowledge until death to pick human. Moral education can also be used as a reference. Wise in dealing with any event or fate. Do not blame others when he / she gets the accident. Able to deal with various problems with a spacious heart. In addition, the value of religiosity in the novel SKUT reflects that in initiating any activity should be based on prayer, and sincere in receiving trials and destiny
RANCANG BANGUN PEMBUATAN APLIKASI TIC (TOURIST INFORMATION CENTER) PONOROGO BERBASIS ANDROID MENGGUNAKAN SIG DAN WEB SERVER
Authors: Maghribi Charisma Audia , Aliyadi Aliyadi , Buntoro Ghulam Asrofi
Published: November 2018

Penelitian ini menghasilkan Aplikasi TIC (Tourist Information Center) Ponorogo dengan Menggunakan SIG dan Web Server. TIC Ponorogo merupakan sebuah aplikasi berbasis android yang menggunakan dukungan google maps sehingga mampu memberikan kemudahan mengenai informasi pada wisatawan tentang tempat wisata, penginapan, rumah makan, pusat oleh-oleh dan disertai dengan rute menuju ke tempat tersebut. Dengan menggunakan aplikasi ini diharapkan pengguna bisa terbantu menemukan tempat wisata, kuliner, berita dan kebudayaan serta informasi lainya tentang Kabupaten Ponorogo dengan memanfaatkan GPS dan internet.
SENTIMEN ANALISIS TWITTER TERHADAP PENYELENGGARAAN GOJEK TRAVELOKA LIGA 1 INDONESIA
Authors: Setyobudi Wahyu , Alwi Aslan , Astuti Indah Puji
Published: November 2018

Sepakbola adalah olahraga yang sangat disukai di Indonesia. Salah satu cara masyarakat Indonesia menikmati sepakbola adalah dengan menyaksikan Liga sepakbola dalam negeri. Selain mengandung unsur hiburan bagi masyarakat juga memiliki unsur ekonomi yang menjanjikan. Gojek Traveloka Liga 1 adalah nama resmi Liga sepakbola yang berjalan di Indonesia. Dengan fakta tersebut maka dapat menimbulkan berbagai opini dari masyarakat terhadap berlangsungnya Liga. Salah satu media untuk mengungkapkan opini dari masyarakat adalah Twitter. Maka dari itu dilakukanlah proses Sentimen Analis dengan bahasa R dengan bantuan software R Studio untuk mengetahui persepsi masyarakat. Data diperoleh dari Twitter dengan metode crawling. Data yang diperoleh berjumlah 1000 buah twett berbahasa Indonesia. Kemudian dilakukan proses pembentukan wordcloud untuk mengetahui topik yang dibicarakan yang diwakili oleh kata yang muncul. Kata “liga” dan “indonesia ” terlihat dominan, disusul kata “persib”, “pssi”, “resmi”, “bopi”,”regulasi”, “gojek”, “traveloka”, dan “timnas”. Lalu dilakukan proses sentimen analis maka diketahui sentimen netral sebanyak 545, positif 192, negatif 143.
PEMBUATAN GAME 2D BERJUDUL “SI BUJANG GHANONG” SEBAGAI SARANA EDUKASI BAGI MASYARAKAT MENGGUNAKAN CONSTRUCT 2
Authors: Kurniadani Wakit , Aliyadi Aliyadi , Fajaryanto Adi
Published: November 2018

Dalam dunia game, ad banyak jenis game yang beredar di masyarakat. Di era modern ini game yang paling laris atau di gemari adalah game android, karena sudah meratanya teknologi android sekarang ini. Game adventure merupakan salah satu game yang di gemari, dilihat dari penjualan situs game , game adventure termasuk game yang di gemari. Di era modern ini banyak game yang mementingkan sifat hiburan saja tanpa mementingkan sisi edukasi, Reog merupakan kebudayaan asli masyarakat ponorogo, dan turun-temurun terus dilestarikan. Di lihat dari segi pementasan di setiap acara rakyat pasti ada pertunjukan Reog, bahkan di setiap tahunya di selenggarakan FNRP (Festival Nasional Reog Ponorogo). Construct 2 merupakan Software pembuat game tanpa menggunakan skrip bahasa pemograman, karena Construct 2 sudah berbentuk objek, jadi pengguna cupup mengatur atribut suatu objek. Game berjenis Edukasi sangat menari di jadikan bahan ajar, dan untuk menjawab kemajuan zaman modern ini tanpa harus meniggalkan pengetahuan sejarah.
PENGARUH PENGGUNAAN TIGA METODE INJECTOR CLEANER TERHADAP EMISI GAS BUANG DAN KONSUMSI BAHAN BAKAR PADA HONDA VARIO INJEKSI 125
Authors: Supriyatmojo Bagus Dwi Seno Kuncoro , Putra Wawan Trisnadi , Winangun Kuntang
Published: November 2018

Dalam penelitian ini akan meneliti tentang bagaimana pengaruh penggunaan tiga metode injector cleaner terhadap emisi gas buang dan konsumsi bahan bakar khususnya pada Honda Vario Injeksi 125. Metode pengumpulan data dilakukan dengan melakukan eksperimen secara langsung pada unit instrumen dan alat ukur yang sesuai pada masing – masing pengujian. Pada hasil penelitian diketahui bahwa metode direct injector cleaner memberikan pengaruh peningkatan konsumsi bahan bakar sebesar 20% dibanding penggunaan metode pembersih injector cleaner fluid dan ultrasonic injector cleaner. Penurunan gas CO hingga 0,11 % dihasilkan oleh metode direct injector cleaner pada 6000 rpm. Penurunan kandungan HC terendah dihasilkan oleh metode Ultrasonic injector cleaner dengan angka 60 ppm pada putaran mesin 6000 rpm. Kandungan CO2 yang dihasilkan metode direct injector cleaner lebih  stabil dibanding denganmetode injector cleaner fluid, dan ultrasonic injector cleaner
PERANCANGAN INTERNET OF THINGS (IOT) UNTUK MONITORING SUHU BUDIDAYA JAMUR
Authors: Muklis Risky Khoirul , Prasetyo Angga , Mustikasari Dyah
Published: November 2018

Pada zaman yang moderen ini jamur merupakan salah satu komoditi pangan yang sangat unggul. Akan tetapi permasalahannya suhu udara di dataran rendah tidaklah setabil dan cenderung panas, maka untuk menjaga dan memonitoring keadaan tersebut di butuhkan sentuhan teknologi internet of thing (IoT). Penulis memanfaatkan Rasberry pi sebagai micro controler, dan komponen pendukung sensor DHT22 sebagai pembaca suhu kemudian aquator-nya berupa seprayer dan blower sebgai pendinginan. Untuk user interface-nya penulis menggunkan aplikasi Telegram yang mengirimkan pesan notifikasi tentang keadaan suhu.
Nuevas localizaciones para Schenkia elegans (Samp.) Z. Díaz (Gentianaceae) en Andalucía Occidental con apuntes sobre su demografía.
Authors: Díaz Lifante Zoila María , García Llamas Carmen , Díaz Fernández José , Andrés Camacho Cristina
Published: November 2018

Se confirma la presencia de esta especie singular de la tribu Chironieae (Gencianáceas), reconocida en 2012 para la obra Flora Iberica, en nuevas localizaciones en la provincia de Huelva, así como por primera vez en la provincia de Sevilla. Esto permite ampliar el conocimiento de su área de distribución, con carácter actualmente disyunto, y promover su búsqueda en otros lugares con hábitat similar para ratificar su status de endemicidad. Se ofrece información demográfica de estas nuevas localizaciones encaminada a plantear alguna medida de protección especial para la conservación de esta especie.Palabras clave: Gentianaceae, flora, endemismo, conservación, corología, Península Ibérica, Andalucía. New locations for Schenkia elegans (Samp.) Z. Díaz (Gentianaceae) in Western Andalusia with demographic notesKey words: Gentianaceae, flora, endemism, conservation, chorology, Iberian Peninsula, Andalusia.
IMPACT OF THE NEW RETAIL CONCEPTS ON LOGISTICS STRATEGY
Authors: Waker Robert Ari , Nääs Irenilza De Alencar , Duarte Arias Gilson , Papalardo Fabio
Published: November 2018

Retail has undergone several transformations over the years. The main reason is due to the digital transformation that is occurring in business, changing all processes and, as a consequence, consumer behavior. This new retail model, much more interactive and integrated, is taking over the market. Retail distribution systems are considered multi- or omni- channel systems when consumers can place orders to buy products: online, physically and online in the stores. Nowadays, most companies try to increase their sales using this recent business model called omni-channel retailing. This is changing the way companies sell their products. These changes can be seen both in the internal logistics of retailers and in the structure and processes of the supply chain. It integrates two existing distribution systems: the retail distribution system and the consumer distribution system. The current study aims to understand this model that integrates the digital and offline and raise its key implications for the strategies applied in logistics.
GESTÃO DE RESÍDUOS DE SERVIÇOS DE SAÚDE
Authors: De Andrade José Henrique , Costa Marcela Avelina Bataghin , Bataghin Fernando Antonio , Soares Thereza Maria Zavarese , Fávero Juliane Angelina
Published: November 2018

O presente trabalho tem como objetivo discutir a gestão dos resíduos de serviços de saúde à luz da regulamentação vigente e das práticas e desafios observados em um Hospital Universitário (HU) do interior do Estado de São Paulo. Os Resíduos de Serviços de Saúde (RSS) fazem parte dos Resíduos Sólidos Urbanos (RSU) e, apesar da sua baixa participação em termos de volume dos RSU, geram elevada preocupação em virtude dos altos riscos à saúde e ao meio ambiente. A fim de atingir o objetivo proposto, foram realizados uma revisão da literatura sobre os temas de interesse e um estudo de caso no setor de logística do HU objeto de estudo. Como principais resultados, observou-se que o HU objeto de estudo adota práticas alinhadas à regulamentação e legislação vigente, cumprindo-as satisfatoriamente, porém apresenta desafios relacionados à segregação dos resíduos, engajamento e conscientização dos envolvidos e melhor estruturação do grupo de trabalho, desafios esses, que, se solucionados, podem contribuir significativamente para a otimização da gestão dos RSS.
MONITORAMENTO EM TEMPO REAL DO ÍNDICE OEE
Authors: Mazur Isis , Rosa Aline , Da Silva Adriano Maniçoba , Tanaka Wilson Yoshio , Zampini Eugênio De Felice
Published: November 2018

Atualmente, a competitividade do mercado exige que as organizações busquem melhorias em seus processos e o OEE (Overall Equipment Effectiveness) tornou-se uma ferramenta importante na busca da eficiência do processo quando combinado com outras tecnologias. Este estudo teve como objetivo investigar o efeito do monitoramento do OEE em tempo real no processo de tomada de decisão em uma empresa. Utilizou-se de uma pesquisa exploratória e o um estudo de caso de uma empresa de fabricação de brinquedos, onde se verificou que a adoção do sistema de monitoramento em tempo real foi importante para a melhoria na tomada de decisões, pois permitiu o monitoramento rápido e dinâmico, bem como a possibilidade de priorizar melhorias nos processos de produção.
OC20 EARLY AND LONG-TERM RESULTS OF LATE REOPERATION AFTER REPAIRED ACUTE TYPE A AORTIC DISSECTION
Authors: Piani D. , Vendramin I. , Lechiancole A. , Ferrara V. , Meneguzzi M. , Sponga S. , Livi U.
Published: November 2018

Background and Aim:

Repaired type-A acute aortic dissection (TA-AAD) is a life-threating disease with unpredictable long-term evolution and prognosis. The aim of this study is to analyse causes, timing, and results of reoperation after primary surgery for TA-AAD.

Methods:

Between 1977 and 2017, 37 patients (mean age 60 ± 14 years, 86% male) underwent late reoperation for complicated repaired TA-AAD at our Institution. Data was collected and analysed retrospectively.

Results:

Mean time of late reoperation was 64 ± 70 months. First procedures were ascending aorta±emiarch replacement in 30 patients (7 AVR, 1 valve sparing) and ascending aorta + arch surgery in 7 patients (2 AVR, 1 valve sparing). In-hospital mortality was 5.4% (1 patient for infection and 1 for haemorrhagic shock). Overall survival was 86.1 ± 5.8 at 1 year, 68.8 ± 8.4% at 5 years, with a mean follow-up of 53 ± 50 months. Indications for redo-surgery were: pseudoaneurysm of the bulb/residual ascending aorta (12), chronic dissection of the arch/descending aorta (21), severe aortic insufficiency (4). Six patients (86%) previously operated for total arch replacement underwent TEVAR as staged procedure (0% mortality) and 11 patients (37%) previously operated of ascending aorta±emiarch underwent total arch replacement (none in-hospital death).

Conclusions:

In our experience surgical reoperation for repaired acute type-A aortic dissection can be safely performed and offers good results even in the long-term. Furthermore, the endovascular approach, as part of a staged procedure for the treatment of residual descending aortic dissection, allows to achieve excellent long-term outcome with low operative risk.
OC62 REDO MITRAL SURGERY AND HOSPITAL OUTCOME: IMPACT OF FAILED MITRAL VALVE REPAIR
Authors: Franzese I. , Biagio L. San , Gatti G. , Perrotti A. , Mariscalco G. , Milano A.D. , De Feo M. , Rubino A. , Santarpino G. , Salsano A. , Lucarelli C. , Francica A. , Beghi C. , Mignosa C. , Pappalardo A. , D’Errigo P. , Santini F. , Onorati F. , Faggian G.
Published: November 2018

Background and Aim:

Mitral valve repair is the gold standard for mitral valve regurgitation, even if failed mitral repairs (FMR) have been reported. The aim of this study was to evaluate the impact of FMR on early outcome after redo mitral surgery.

Methods:

Operative mortality and major morbidity events from 920 redo mitral procedures at nine European centres were analysed. Statistical analysis was performed by the SPSS 13.0 program for Windows (SPSS, Inc., Chicago, IL, USA). To identify indipendent predictors of operative deaths, variables with a P < 0.10 at univariable analysis were included in the regression models. All the outcome parameters were then adjusted by propensity matching, to compare similar cohorts of patients with FMR or diseased native mitral valves and similar cohorts of patients with FMR and malfunctioning prostheses.

Results:

FMR did not impact mortality at multivariable analysis (P = 0.64). Propensity-matched cohorts of FMR and native mitral valves showed no differences in mortality (P = 0.69). A preoperative Global Initiative for Chronic Obstructive Lung Disease score >2 chronic lung disease (COPD) (OR 15.2, P < 0.01), left ventricular ejection fraction <30% (odds ratio (OR) 21.5, P = 0.005), major injury to cardiovascular structures at re-entry (OR 27.2, P < 0.01) or to patent left internal mammary artery-coronary artery bypass graft (OR 7.6, P = 0.03) predicted mortality in the FMR population.

Conclusions:

A failed mitral repair does not impact hospital outcome of redo surgery. Severe left ventricular dysfunction, COPD and injury at re-entry predict adverse early outcome.
OC31 HOW TO IDENTIFY THE APPROPRIATE LEFT VENTRICULAR ASSIST DEVICE CANDIDATE AMONG PATIENTS ON EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT
Authors: Loforte A. , Morshuis M. , Zimpfer D. , Pappalardo F. , Attisani M. , Riebandt J. , Ramjankhan F. , Donker D. , Jorde U. , Albert A. , Lichtenberg A. , Rinaldi M. , Saeed D.
Published: November 2018

Background and Aim:

Implantation of long-term left ventricular assist devices (LVADs) in patients on veno-arterial membrane oxygenation (VA-ECMO) support is controversial. Aim of this study has been to report the experience of seven LVAD centers.

Methods:

Data of LVAD patients (2010–2017) at seven European institutions were reviewed. The only inclusion criteria was VA-ECMO before LVAD placement. Patients’ characteristics, intraoperative variables and postoperative course were analyzed thus eventually identifying predictors of mortality.

Results:

A total of 154 continuous flow LVAD patients (mean age 53.1 ± 12 years; 84% male) were identified. The VA-ECMO cannulation was peripheral in 92% of patients and 37% had received cardiopulmonary resuscitation prior to VA-ECMO implantation. Mean VA-ECMO duration prior to LVAD implantation was 7.1 ± 7 days. Cardiopulmonary bypass was adopted in 64% of patients for LVAD implantation. Major postoperative complications included right heart failure requiring temporary right ventricular device (RVAD) support (47%), bleeding requiring rethoracotomy (20%), respiratory failure (54%), renal failure (50%) and hepatic failure (31%). Thirty-day and 1-year survival was 84 and 62%, respectively. At univariate analysis age, lactate level, pH, white blood cells (WBC) count, pre-LVAD dialysis and Model for End-stage Liver Disease eXcluding INR (MELD-XI) score before implant were significant. Multivariate regression analysis identified pre-LVAD MELD-XI (OR 1,250, 95% CI 1,038–1,505; p = 0.019) as the only significant predictor of mortality.

Conclusions:

The outcome of LVAD patients on VA-ECMO support is limited by the high rate of major adverse events. Preoperative LVAD MELD-XI score seems to identify patients that will clearly not benefit from LVAD implantation.
OC68 SURGERY FOR ANOMALOUS AORTIC ORIGIN OF CORONARY ARTERIES (AAOCA). A MULTICENTER STUDY FROM THE EUROPEAN CONGENITAL HEART SURGEONS ASSOCIATION (ECHSA)
Authors: Padalino M. , Franchetti N. , Boccuzzo G. , Hazekamp M. , Carrel T. , Frigiola A. , Rito M. Lo , Horer J. , Cleuziou J. , Meyns B. , Fragata J. , Polimenakos A. , Francois K. , Veshti A. , Salminen J. , Rocafort A. Glez , Nosal M. , Guariento A. , Vida V. , Stellin G.
Published: November 2018

Background and aims:

Anomalous aortic origin of coronary arteries (AAOCA) is a rare anatomical abnormality which is a consistent cause of sudden death in young people. There are no guidelines on either surgical indication or best surgical treatment. We sought to describe early and late outcomes in a large surgical series to evaluate safety and effectiveness of surgical procedures for AAOCA.

Methods:

This is a retrospective clinical multicenter study including patients undergoing surgical treatment for AAOCA since 1991. Patients with ONLY high coronary take off were excluded. Preoperative, intraoperative and postoperative data were retrieved from a common database. Anatomical characteristics evaluated were: AAORCA vs AAOLCA vs other anatomical variants (LAD or CX from anterior sinus, single coronary); Coronary course (interarterial, anterior to aorta, only intramural).

Results:

We included 157 patients undergoing AAOCA repair (median age 39.5 yrs, interquartile range 15–53). Symptoms were present in 136 (87 %). There were 106 AAORCA (67%); 36 AAOLCA (23%);15 other (10%). Surgical procedures were Unroofing (54%); Coronary reimplantation (19%); CABG (15%); Other (12%). Major postoperative complications occurred in 12.7%. Early death was 1.2%. At a median follow up time of 2 yrs (range 1 m -23 yrs) there were 4 late deaths; NYHA class was I-II in 92%; residual symptoms in 18%; adverse events in 8.2%.

Conclusions:

Surgery for AAOCA is low risk. Unroofing and coronary reimplantation are the most frequ with 0% operative mortality. Late adverse events occurrence (surgical, non surgical, SCD) is not negligible, and long term surveillance is mandatory.
OC60 PROPORTIONAL GEOMETRY FOR MITRAL REPAIR IN CHILDREN
Authors: Deorsola L. , Aidala E. , Cascarano M.T. , valori A. , Napoleone C. Pace
Published: November 2018

BACKGROUND AND AIM:

Mitral repair in children is challenging and almost always the only chance: dimensions, anatomy and dysplasia are the main concerns. According to anatomical and literature data valve geometry seems based on well-defined dimensional proportions, determining valve shape and function. We applied these proportions during repair to assess whether they could make the procedure easier and improve results.

METHODS:

Eight patients underwent mitral repair between 2015 and 2018. Mean age was 93 ± 48 months and weight 26 ± 12 Kg. Six had congenital dysplasia, one a bileaflet prolapse in Loeys-Dietz Syndrome and one an acute endocarditis. Hypoplastic leaflets had an extension plasty, endocarditis a replacement of the anterior leaflet and bileaflet prolapse a posterior quadrangular resection. Chordal surgery and posterior annuloplasty with a pericardial strip were also employed. Proportional Geometry was used to estimate valve dimensions, leaflet extension/resection amount and annuloplasty entity.

RESULTS:

Mean annular dilatation was 8 mm, according to body weight or BSA, leaflet extension patch had a mean width of 8 mm and the annuloplasty strip a mean length of 53 mm. At intraoperative TE Echocardiography mitral valve appeared normal, with no or trivial regurgitation and no gradient. All patients had an uneventful postoperative course. Follow up is 100% complete and 3 years long. All patients show good clinical conditions, no symptoms and no or trivial mitral regurgitation.

CONCLUSIONS:

Proportional Geometrical rules standardize surgery and seem to help restoring a normal mitral anatomy, optimizing valve function and mechanical stresses and potentially improving surgical results.
OC66 ROAD-MAP FOR CONGENITAL HEART SURGERY PROGRAM IN-DEVELOPING COUNTRY
Authors: Iezzi F. , di Summa M. , Del Sarto P. , Munene J.
Published: November 2018

Introduction:

We have summarized a 3-year project that has resulted in the establishment of a new congenital heart surgery program in collaboration with Kenyatta National Hospital of Nairobi - Kenya (Africa).

In 2013, we started with only 18 patients undergoing surgical interventions. This has grown to more than 70 cumulative surgical procedures in the following years, with ever decreasing mortality.

Materials and methods:

The first step is to select a site and collaborative partner that will have adequate hospital equipment and personnel and the potential for self-sustainability.

The next major step was the construction of surgical education teams that travel to the site for a 2-week educational mission twice a year.

Finally, our program behooves the medical staff at local centers to educate themselves and adopt the principles of cardiac programs of excellence by visiting established heart surgery institutions so that they can return to their own centers with newly acquired knowledge and strategies that will better serve their patients.

Discussion:

In summary, near a great humanitarian work, the program is important for sharing our program model of effectively delivering high-quality pediatric cardiac care to underserved regions

Conclusion:

By outlining the steps it takes to achieve a program that can assess, educate, and train local pediatric cardiac specialists in current diagnostic modalities and new surgical and interventional techniques to the point where they are able to treat patients without the assistance of international consultants.
OC48 MYOCARDIAL TISSUE ENGINEERING AND REGENERATION– IN VITRO EXPANSION OF ENDOTHELIAL CELL BY DIFFERENT VESSELS REVEALS THE BETTER AUTOLOGOUS CELLULAR SOURCE FOR TISSUE REPLACEMENT
Authors: Musolino G. , Valentina T. , Jiritano F. , Serraino G.F. , Garrasi C. , Malara N.M. , Mastroroberto P. , Mollace V.
Published: November 2018

BACKGROUND AND AIM:

The development of cell-based therapies to assist/replace diseased tissue is one of the most promising initiatives in regenerative medicine. Human endothelial cells (HEC) can be used for various applications including molecular profiling as well as cell culture. Several complex techniques and culture media have been reported although with confounding results belonging todonor-to-donor variability and cellular source of derivation. Our results demonstrate the overcome of these limitations using soluble CD54 (sCD54) as additive to conventional culture medium.

METHODS:

Isolated primary fragment of different vessel types (left internal thoracic artery, radial artery and saphenous vein) were expanded in Ham's F12 DMEM, enriched with growth factors, Foetal Calf Serum and conditioned medium of Human Umbilical Vein Endothelial Cells (HUVEC) collected at different passages. Cytokines were analysed in order to identify the soluble factors correlating with better proliferation profile.

RESULTS:

sCD54 was found to induce the in vitro expansion of HEC independently from the vessels source and even in the absence of HUVEC-conditioned medium. The HECs cultivated in presence of sCD54 resulted positive for the expression of CD146 and negative for CD45, and with lower fibroblast contamination. Cells were capable to proliferate with an S phase of 25%, to produce VEGF and to give origin to vessel-like tubule in vitro. (Figure 1)

CONCLUSIONS:

sCD54 is an essential factor for the in-vitro expansion and differentiation of HEC, minimizing potential donor sample variability. Resulting primary cultures can be advantageous for tissue engineering in regenerative medicine and bio-nanotechnology applications.
OC14 CONCOMITANT TRANS-AORTIC TRANSCATHETER AORTIC VALVE IMPLANTATION AND COMPLETE OFF-PUMP CORONARY ARTERY REVASCULARIZATION IN HIGH-RISK PATIENTS
Authors: Casado A. Pilozzi , Raviola E. , Bonalumi G. , Tizzano F. , Le Houerou D. , Romano M.
Published: November 2018

Treatment of concomitant aortic stenosis and coronary artery disease represents a challenge in elderly high-risk patients with unsuitable peripheral anatomy to percutaneous access for TAVI. Our aim was to investigate efficacy, safety and mid-term clinical outcomes of concomitant Trans-Aortic TAVI and OPCAB.

Methods:

Between April2011 and January2016, 41 patients underwent simultaneous Tao-TAVI through a median sternotomy and OPCAB. High surgical risk profile did not permit conventional AVR and surgical revascularisation. PCI was considered unsuitable, because of LAD-proximal lesions and/or high SYNTAX-score. Primary endpoints were mortality and cerebro-vascular event rate.

Results:

Mean age was 82.6 ± 4.1 years with logistic-EuroSCORE and STS-score 19.19 ± 13.58% and 6.28 ± 3.57%. Average number of distal anastomoses was 2.7; TAo-TAVI was performed using either Sapien XT or Sapien 3 devices in 85.4% and 14.6% respectively, with a success rate of 95.1%. None paravalvular leak (PVL) ≥2/4 was observed with mean prosthesis gradient of 9.6 ± 3.8 mmHg. Conversion to CPB was required in 4.9% and pace-maker implantation in 4.9%. No cerebro-vascular accident were noted neither in-hospital stay (14.9 ± 5.0 days) or during total follow up (mean 17,26 months). In-hospital mortality was 7,32% and survival rate at 6,18 months was 84,35% and 77,86%, respectively.

Conclusions:

Considering high surgical risk, Simultaneous TAo-TAVI and OPCAB have become realistic treatment alternative and could represent a reasonable option in high-risk patients with severe AS and CAD and unsuitable peripherical access, permitting CPB avoidance.
OC80 THE ROLE OF SURGICAL TECHNIQUE ON LONG-TERM OUTCOMES OF TETRALOGY OF FALLOT REPAIR: A MULTICENTER STUDY
Authors: Pradegan N. , Azzolina D. , Galletti L. , Napoleone C. Pace , Agati S. , Palma G. , Giordano R. , Marianeschi S. , Carro C. , Vida V.L. , Stellin G. , Padalino M.A.
Published: November 2018

Background and Aim:

to evaluate clinical outcomes of patients undergoing Tetralogy of Fallot (ToF) repair, focusing on the type of surgical strategy performed.

Methods:

a retrospective clinical review of patients undergoing ToF repair in six centers. Excluded were ToF with pulmonary atresia or aplasia, and double-outlet right ventricle.

Results:

between 1990 and 2015, 720 patients underwent ToF repair (M/F 57%/43%; median age 5,9months, IQ range 3,8–11,5); 132 (18%) had preoperative cyanotic spells; 111 (15%) received previous palliative surgery. Repair was achieved by transatrial approach (TA) in 433 patients (60,1%), and transventricular (TV) in the remaining ones. The pulmonary valve (PV) was saved in 249 (34,6%), while, in the remaining patients, RVOT reconstruction was performed by means of a transanular patch (60,8%), or a conduit (4,6%). Major postoperative complications occurred in 247 (34,0%). Early mortality was 3%.

At 20-year follow-up (completeness 86%), 10 (2%) patients died, 39 (7%) required surgical reoperation, and 72 (12%) an interventional procedure. There were no significant differences between TA and TV approaches, in terms of early mortality and onset of adverse events (interventional procedures, surgical reoperations and mortality) at follow-up. When PV was saved, there was a lower rate of postoperative complications and early mortality, and a lower rate of overall adverse events (Figure 1, p < 0,05).

Conclusions:

ToF repair in infancy is confirmed to be a safe procedure, with good late clinical outcomes. PV preservation at repair is associated with lower early morbidity and mortality, and a lower rate of adverse events at long-term follow up.
OC30 HEMOCOMPATIBILITY-RELATED ADVERSE EVENTS AND PHYSIOLOGICAL CIRCULATORY INTERFACE OF DIFFERENT GENERATION LEFT VENTRICULAR ASSIST DEVICES
Authors: Loforte A. , Montalto A. , Attisani M. , Mariani C. , Comisso M. , Baronetto A. , Fiorentino M. , Di Bartolomeo R. , Marinelli G. , Musumeci F. , Rinaldi M.
Published: November 2018

Background and Aim:

Aim of this study has been to assess the rate of hemocompatibility-related adverse events (HRAEs) of current generation centrifugal pumps and older axial continuous-flow (CF) left ventricular assist devices (LVADs).

Methods:

We identified 193 CF LVAD recipients at three institutions. We studied the quantitative estimates of freedom from HRAEs between 3 types of pumps, the HeartMate II (HMII,n = 56), the HeartMate 3 (HM3,n = 38) and the HeartWare HVAD (HVAD,n = 99). The net burden of HRAE was assessed by using the MOMENTUM 3 hemocompatibility score.

Results:

Survival free of any HRAE was achieved in 86% of the HM3 group, 64% of the HMII group and 52% in HVAD group (hazard ratio, 0.64; confidence interval, 0.40–0.95; p = 0.014). Using the hemocompatibility score, the HM3 group demonstrated less pump thrombosis requiring reoperation (0 versus 6 and 14 points, for HMII and HVAD, respectively, p = 0.002) or medically managed pump thrombosis (0 versus 4 points and 17 points, for HMII and HVAD, respectively, p = 0.001), and fewer nondisabling strokes (6 versus 14 and 30 points, for HMII and HVAD, respectively, p = 0.002). The net hemocompatibility score in the HM3 in comparison with the HMII and HVAD patients was 71 (0.66 ± 1.45 points/patient) versus 103 (0.86 ± 1.59 points/patient) and 157 (0.96 ± 1.71 points/patient), respectively (odds ratio, 0.66; confidence interval, 0.38–1.01; p = 0.063).

Conclusions:

In this analysis, HM3 had a more favorable physiological circulatory interface at 36 months in comparison with HMII and HVAD. This confirms the need to develop different clinical monitorings and coagulation management protocols when facing with various device platforms.
OC61 RANDOMIZED ANTICOAGULATION TRIAL IN OPCAB (RATIO TRIAL): PRELIMINARY RESULTS
Authors: Triggiani M. , Martino A.S. , Lemma M. , Mangini A. , Vanelli P. , Massi F. , Portoghese M. , Lamarca A. , Pepino P. , Troise G. , Messina A. , Pettinari M. , Lazzarini I. , Di Credico G. , Parrella P. , Antona C.
Published: November 2018

Background and aim:

To analyze quality of data and preliminary results of the first 100 patients enrolled in RATIO trial (low dose -LD 150 U/kg versus high dose -HD 300 U/kg heparinization with target ACT respectively of 250 and 400 seconds).

Methods:

ACT was recorded before anesthesia, 5’ after heparination, every 30’, 10’ after full protamine reversal. Primary endpoints were occurrence in the first 30 post-operative days of vascular events (death from vascular causes, perioperative myocardial infarction -PMI, stroke), or major bleeding events (redo for excessive bleeding, cardiac tamponade, transfusion ≥3 U of red cells or platelets).

Results:

Preoperative mean age, male-female index, LVEF, LM disease, and CAD extent did not differ significantly between LD (n.51) and HD group (n.49). DAPT was stopped respectively in 24/51 and 16/49 patients of LD and HD group (p = 0.3). Aspirin was continued throughout surgery respectively in 50/51 and 43/49 patients of LD and HD group (p = 0.5). The table summarizes intraoperative ACT values. No statistical difference was observed in primary cumulative endpoints: no stroke; 1 PMI in HD; 2 and 1 death - 2 and 1 redo for bleeding – 9 and 10 transfusions respectively in LD and HD groups. DAPT was prescribed postoperatively in 42/100 patients.

Conclusions:

Preliminary analysis seems to confirm the null hypothesis (LD and HD equally safe). LD does not seem to confer any advantage about bleeding. These results could be due to ACT curve in LD patients tending to exceed the target of 250 and to LD-HD curves almost overlapping.
OC26 EXTERNAL STENTING OF VEIN GRAFTS IN OFF PUMP CORONARY BYPASS SURGERY AND SEQUENTIAL GRAFTING: INTERMEDIATE RESULTS FROM A SINGLE CENTER PROSPECTIVE STUDY
Authors: Weltert L. , Guerrieri L. , Chirichilli I. , D’Aleo S. , Salica A. , Scaffa R. , Bellisario A. , De Paulis R.
Published: November 2018

Background:

External stenting of vein grafts has been shown to reduce graft disease by mitigating intimal hyperplasia and improving flow pattern in on-pump single vein graft context. Aim of study is to evaluate usability and clinical outcome of external stenting also in patients undergoing beating-heart sequential grafting receiving multiple external stents per patient.

Methods:

Thirty patients undergoing CABG had the venous grafts supported with VEST (VascularGraftSolutions, Israel) and were prospectively followed-up via phone call and/or visit every 6 months. Major Adverse Cardiac and Cerebrovascular Events (MACCE) were recorded. Planned follow-up is 5 years.

Results:

Mean age was 69.0, 86.7% were males, mean Euroscore and ejection fraction were 5.40% ± 4.92% and 56.8% ± 7.4. Veins were harvested in an open manner. Average number of grafts per patient was 3.2. Each patient had either single vein graft (n = 20), or sequential vein grafts (n = 10) supported with VEST. All patients were discharged alive from the hospital after surgery. One patient experienced transient ischemic attack during in-hospital stay and fully recovered before discharge.

Follow up was complete for all patients, mean follow time of 16 months (range 1–31 months). During the follow up period, MACCE rate were 0% and no additional adverse events were reported. CT angiography performed to patients arriving at 1 year follow-up confirmed all grafts were patent.

Conclusions:

External stenting of saphenous vein grafts is technically feasible in off pump CABG procedures and sequential grafting. Intermediate follow up of up to 30 months suggest that it's safe and not associated with major clinical events.
OC17 CORONARY ENDARTERECTOMY: AN OLD TOOL FOR PATIENTS CURRENTLY OPERATED ON CABG. LONG-TERM RESULTS, RISK FACTORS ANALYSIS
Authors: Nardi P. , Russo M. , Saitto G. , Bertoldo F. , Pisano C. , Vacirca S.R. , Bovio E. , Bassano C. , Pellegrino A. , Scafuri A. , Ruvolo G.
Published: November 2018

Aims:

Coronary endarterectomy (CE) may provide an useful adjunctive technique to coronary artery bypass grafting (CABG) in patients with diffusely coronary artery disease. Nevertheless, the incidence of complications remains still high, long-term results remain unclear, and no risk factors for late mortality have been still completely described.

Methods:

We retrospectively reviewed 90 consecutive patients (67 ± 8.2 years) undergoing isolated CABG in association with CE between. Mean follow-up was 75.1 ± 36.2 months (median 84 months) and it was 100% complete (6,755/6,755 pt-months).

Results:

Operative mortality was 4.4%, the incidence of perioperative myocardial infarction was 11%. Ten-years survival was 83.3% ± 4.1%, freedom from cardiac death 92.7% ± 2.9%, and freedom from major adverse cardiac and cerebrovascular events 58.2% ± 10.2%. Independent predictors of late mortality were age older than 70 years at time of the surgery (P = 0.018) and chronic obstructive pulmonary disease (P = 0.036). Ten-year freedom from cardiac death was better after CE on the LAD (93.2% ± 3.3%) in comparison to CE not on the LAD (74.6% ± 10.2%), although this difference did not reach statistical significance (P = 0.102).

Conclusion:

Although the incidence of perioperative myocardial infarction continues to be not negligible, in presence of diffusely diseased coronary artery vessels CE associated with CABG appears to be a feasible adjunctive surgical tool, conferring satisfactory early and long-term outcomes. CE on the LAD confers a high probability of freedom from late cardiac death. Patients older than 70 years and those affected by a primary respiratory disease represent a new challenge on which focusing attention for the increased risk of late death.
OC52 OCTOGENARIANS UNDERGOING OFF-PUMP AND ON-PUMP MULTIPLE CORONARY ARTERY BYPASS GRAFTING BENEFIT OF GOOD QUALITY OF LIFE AT MID-TERM FOLLOW-UP
Authors: Trinca F. , Martino A.S. , Galanti A. , Tasca G. , Giannico F. , Ambrosoni S. , Gamba A. , Triggiani M.
Published: November 2018

Aim of the study:

To review mid-term results of multiple off-pump and on-pump CABG in octogenarians (OPCABG-ONCABG).

Materials:

In the period 2012–2017 87/888 (9,8%) patients undergoing isolated multiple CABG were octogenarians (81,7 ± 1,6 years). In particular 32/87 (36.78%) underwent OPCABG. After propensity score analysis, 29 OPCABG patients were matched with 29 ONCABG.

Results:

Mean number of grafts was respectively 2,6 ± 0,6 and 2,1 ± 0,3 in ONCABG and OPCABG group (p = 0,001). In-hospital mortality and perioperative MI did not occur. 1 ONCABG patient suffered from a stroke. IABP was implanted in 1 patient in each group. Intraoperative blood transfusions did not differ significantly in the 2 groups (respectively 18/29–62,1% and 14/29–48,3% in ONCABG and OPCABG, p = 0,2). 1 ONCABG patient needed surgical revision for excessive bleeding. Mean intubation time was respectively 9,2 ± 4,58 and 9,8 ± 3,64 hours in ONCABG and OPCABG group (p = 0,6). Mean stay in ICU did not differ in the 2 groups (p = 0,4). Severe AKI occurred in 1 ONCABG patient requiring haemodialysis. Follow-up was 77.6% complete. At a mean follow-up of 2.7 ± 1.5 years 41/45 patients are alive (2 non cardiac death for each group). In table 1 is reported Kaplan-Meyer cumulative survival curve. Only 2/41 patients had a new hospital admission for NSTEMI and 39/41 are angina free.

Conclusion:

OPCABG and ONCABG are safe procedures even in elderly patients. Postoperative complications seem to be less frequent in OPCABG patients, but the difference is not significant. OPCABG received significantly lower number of grafts, but this does not seem to influence survival and angina recurrence.
OC55 OUTCOME OF HEART TRANSPLANTATION WITH MARGINAL DONORS: COLD STORAGE VS NORMOTHERMIC PERFUSION
Authors: Sponga S. , Ferrara V. , Beltrami A. , Bonetti A. , Cantarutti C. , Caragnano A. , Esposito G. , Lechiancole A. , Guzzi G. , Meneguzzi M. , Nalon S. , Ortolani F. , Piani D. , Livi U.
Published: November 2018

Background and aim:

The ex-vivo normothermic perfusion in Heart Transplantation (HTx) allows to expand the donor pool by reducing the ischemic time and providing graft evaluation. Aim of the study was to compare the traditional cold storage (CS) and ex-vivo normothermic perfusion (EVP) in HTx employing marginal donors.

Methods:

From 2011 to 2018, 88 HTx employing marginal donors (age>55 years; expected ischemic time>4 h; LVEF<50%; IVS>14 mm; drug abuse; cardiac arrest; CAD) in standard recipients has been performed, 69 (78%) grafts maintained in CS vs. 19 (22%) in EVP. Endomyocardial biopsies were collected at time of organ retrieval, before implantation and after aortic declamping.

Results:

No pre-operative differences were found in the two groups. Three organs (16%) were considered not suitable for HTx after EVP, avoiding possible Primary Graft Failure. EVP group showed a better outcome: a 5-year survival of 100% vs. 94.2%, 83% and 72% at 30-day, 1 and 5 years respectively in CS group (p = 0.10); less overall complications (50% vs. 89.9%, p < 0.01), IABP need (0 vs. 23.2%, p = 0.02), shorter mechanical ventilation (24 vs. 48 hours, p = 0.04) and ICU stay (5 vs. 6 days, p = 0.07). In CS group, endomyocardial biopsies showed a tendency for more prominent myocardial damage after heart reperfusion, especially underlined by mitochondrial and organelles dysfunction.

Conclusions:

EVP permits a safe evaluation of marginal donors, excluding not suitable grafts. Moreover, allows to reduce complications and to obtain optimal survival after HTx. Pathological findings show a tendency for better myocardial protection, confirming clinical results.