bluuebunny/crossref_metadata_2025 huggingface dataset:
PERANCANGAN APLIKASI SISTEM TATA KELOLA KEUANGAN DESA BERBASIS JAVA NETBEANS (Studi Kasus Pelaporan Realisasi Anggaran Pendapatan dan Belanja Desa di Desa Pupus)
Authors: Saputro Dedy Dwi Cahyo , Aliyadi Aliyadi , Setyawan Moh. Bhanu
Published: November 2018

Anggaran Pendapatan dan Belanja Desa, selanjutnya disebut APBDesa, adalah rencana keuangan tahunan Pemerintah Desa. Dalam hal keuangan desa, Pemerintah Desa wajib menyusun Laporan Realisasi Pelaksanaan APBDesa dan Laporan Pertanggungjawaban Realisasi Pelaksanaan APBDesa. Laporan ini dihasilkan dari suatu siklus pengelolaan keuangan desa, yang dimulai dari tahapan perencanaan, pelaksanaan dan penatausahaan; hingga pelaporan, pengawasan dan pertanggungjawaban pengelolaan keuangan desa. Desa Pupus belum memiliki sistem serta dukungan sarana dan prasarana untuk membantu Pemerintah Desa dalam pengelolaan keuangan dari Anggaran Pendapatan dan Belanja Desa (APBDesa) yang cepat, efektif dan efisien. Sistem Tata Kelola Keuangan Desa dirancang menggunakan Bahasa Pemrograman Java. Java merupakan bahasa pemrograman tingkat tinggi yang berorientasi objek, atau lazim disebut dengan istilah Objek Oriented Programming (OOP). Java bersifat multiplatform yang dapat dijalankan pada berbagai platform dan bersifat dinamis sehingga dapat beradaptasi dengan lingkungan yang sedang berkembang.
PERAN MADRASAH DALAM MENGHADAPI ERA GLOBALISASI DAN BUDAYA
Authors: Chaer Moh. Toriqul
Published: November 2018

The development of the madrasa in the context of modern it is quite interesting if it is linked with the phenomenon of globalization which brings significant changes to systems and madrasah curriculum which previously was the result of the development of the educational system individually and pretty loaded with Islamic education. Recent development shows that the madrasa has been doing adaptations with the demands of globalization, which became a milestone for the formation of "modern" madrasah with an image in contrast to the madrasa. In this context, the madrasa seems to not see globalization as a thing to be feared but should be faced.
USO DE BLOCKCHAIN EM SMART CONTRACTS LOGÍSTICOS: UMA REVISÃO SISTEMÁTICA
Authors: Ap. Petroni Benedito Cristiano , Monaco Elisangela , Gonçalves Rodrigo Franco
Published: November 2018

Revisões sistemática da literatura está se tornando cada vez mais comum nas mais variadas áreas de estudo. Este trabalho apresenta uma revisão sistemática da utilização da tecnologia Blockchain com Smart Contracts aplicado para a área de logística. A pesquisa foi baseada na execução de consultas através de strings de busca específicas em duas bases de conhecimentos renomadas na área científica. Verificou-se que, apesar da existência de um número considerado de artigos sobre o tema, especificamente a aplicação da tecnologia de Blockchain com Smart Contracts voltados para a área de logística ainda se apresenta com uma nova competência de estudos e aplicações empresariais. A pesquisa é baseada em buscas através de Strings mapeando especificamente a aplicação da tecnologia de Smart Contracts aplicados a logística. Verificou-se que apesar dos artigos encontrados abordarem o mesmo tema, há um grande número de propostas para a aplicação da tecnologia e um número pequeno de artigos quando se trata de artigos focando exclusivamente a aplicação da tecnologia. A partir dos resultados apresentados pode-se concluir que, as aplicações de Smart Contracts voltados para a área logística é um campo fértil para o desenvolvimento de inúmeras aplicações para as empresas e de pesquisas acadêmicas.
OC38 LONG-TERM OUTCOME AFTER BENTALL OPERATION AND VALVE SPARING AORTIC ROOT REPLACEMENT IN ELECTIVE PATIENTS: A SINGLE CENTRE EXPERIENCE
Authors: Meneguzzi M. , Lechiancole A. , Piani D. , Vendramin I. , Sponga S. , Mazzaro E. , Spagna E. , Tursi V. , Livi U.
Published: November 2018

Background and Aim:

In aortic root surgery, Bentall procedure has been considered the procedure of choice. Valve sparing root-replacement (VSRR) techniques have gained popularity, avoiding prosthetis-related complications. However, long-term data to support this tendency are still lacking, and most of the studies included emergency procedures, that could influence the outcome.

The primary end-point was survival. Secondary end-point was freedom from Major Adverse Events (MAEs), including death, aortic-valve reoperation, major haemorrhage, cerebrovascular events, aortic valve regurgitation (or dysfunction)>moderate.

Methods:

Data of patients who underwent Bentall operation and VSRR from 1990 to 2017 in our centre were analysed. Emergency operations were excluded. Aortic valve stenosis were excluded from Bentall group.

Results:

130 patients underwent Bentall operation (29 biological and 101 mechanical conduits). 98 patients underwent elective VSRR (64 reimplantation and 34 remodeling techniques). Among baseline and operative data, in Bentall group were more bicuspid valves p < 0.001, previous cardiac operations p = 0.04, lesser preoperative AF p = 0.05 and mean X-clamp time p = 0.001. Mean follow up duration was 158 and 76 months in Bentall and VSRR groups.

Univariate analysis for long-term mortality: Age (HR 1.07, 95%IC 1.04–1.11)

Univariate analysis for MAEs: Age (HR1.05, 95%IC 1.02–1.07), VSRR (HR 1.8, 95%IC 1.09–3.11)

Multivariate analysis for MAEs: Age (HR 1.04, 95%IC 1.02–1.07), VSRR (HR 1.7, 95%IC 1.016–2.91)

Conclusions:

Comparable long-term survival after Bentall operation and VSRR. Bentall operation seemed to offer better protection against MAEs than VSRR. VSRR procedures are technically demanding, and necessitate of a longer learning curve than the easily reproducible Bentall operation.
OC75 THE LONG TERM FATE OF CORONARY ARTERIES AFTER ARTERIAL SWITCH OPERATION FOR TRANSPOSITION OF THE GREAT ARTERIES
Authors: Angeli E. , Petridis F.D. , Careddu L. , Assenza G. Egidy , Tonelli F. , Mariucci E. , Ciuca C. , Gargiulo G.D. , Donti A.
Published: November 2018

Background and Aim:

To analyse the long-term patency of coronary arteries and correlated factors in a cohort of patients undergone arterial switch (ASO) operation in our institution.

Methods:

This is a retrospective study of operative and postoperative data of 191 patients who underwent ASO between 1991 and 2016. All patients underwent clinical, echocardiographic and angiographic evaluation during follow-up; dobutamine-stress and treadmill test were performed when indicated. Variables included were: complex native coronary anatomy (Yacoub types B-E), aorto-pulmonary relationship (anterior aorta vs. syde-by-syde) dimensional-mismatch, coronary reimplantation technique (direct-punch vs. trap-door technique). Univariate analysis was performed by chi-squared test and ANOVA when necessary.

Results:

191 patients have been studied by elective invasive cardiac coronary angiography after ASO at a mean time of 2.7 ± 2.1years without any significant procedure-related complication. Mean follow-up after the ASO was 12.9 ± 6.6years. Nine patients (4.7%) had angiographic signs of coronary stenosis or occlusion:8/9were asymptomatic. All details are reported in Table 1. Neither TGA anatomical features, nor coronary anatomy,nor reimplantation technique were identified as risk factors for occurrence of coronary artery obstruction (univariable analysis p values 0.159, 0.282, 0.49 respectively).

Conclusions:

Coronary obstruction after ASO is a silent and often overlooked complication. Patients may not show any symptoms or instrumental evidence of myocardial ischemia even with severe lesions, and the ordinary non-invasive diagnostic tools could be inadequate. Routine angiographic catheterization represents a secure and effective tool for follow-up ensuring early identification of coronary disease.

In our experience, the extended mobilization of coronary ostia to avoid abnormal coronary tension/distortion, even by the excision of small conal branches, has led to low incidence of coronary obstruction. Thanks to this, neither coronary complexity is a risk factor anymore
OC04 BASELINE ATRIAL STRAIN RELATES TO POST-SURGICAL FOLLOW UP IN SEVERE AORTIC STENOSIS
Authors: Lucarelli C. , Biagio L. San , Francica A. , Benfari G. , Abbasciano R.G. , Noni M. , Rossi A. , Zamboni M. , Onorati F. , Ribichini F. , Faggian G.
Published: November 2018

Background:

Diastolic dysfunction (DD) and left ventricular (LV) remodelling subsequent to increased afterload in severe aortic stenosis (AS) affect left atrial (LA) function. Aortic valve replacement (AVR) restores afterload and potentially reverse the LV modifications. However, no markers have been able to predict the LV remodelling and the post-surgical clinical events.

Aim:

to assess the relationship between baseline LA function and the diastolic function response and the clinical events following isolated AVR.

Methods:

patients undergoing AVR for AS were prospectively enrolled. A comprehensive transthoracic echocardiography was performed before surgery and at 1 year follow-up (FU). Baseline Peak atrial longitudinal and contraction strain (PALS, PACS) were obtained. During one year FU, cardiovascular (CV) events (death, hospital admission for heart failure, ischemic heart disease or atrial fibrillation [AF]) were registered.

Results:

Sixty-seven patients were enrolled, 72 ± 8years, female 56%, EF 60 ± 8%, E/e’ 13 ± 6, PALS 23 ± 8%. A normal/grade-I diastolic function was registered in only 19/67 (28%) at baseline, in contrast with 43/67 (64%) at 1-year echocardiographic FU (p < 0.0001). Normal/grade-1 diastolic function at FU was associated only with baseline PALS (OR:1.19[1.05–1.41], p = 0.02) and PACS (OR:1.24[1.06–1.50], p = 0.006) During a mean FU of 2.4 ± 0.4 years, 10 (14%) patients had CV events. Events occurred in older patients (74 ± 5 vs. 71 ± 9 years, p = 0.3), with similar EF (61 ± 6% vs. 62 ± 12%, p = 0.7), reduced PALS (20 ± 4% vs. 24 ± 6%, p = 0.04) and PACS (10 ± 3% vs. 13 ± 3%, p = 0.002).

Conclusions:

impaired baseline LA function is related with CV events and echocardiographic findings following AVR, identifying a subset of patients with increased CV risk.
OC45 MORPHOLOGICAL MODIFICATION OF THE AORTIC ANNULUS IN TRICUSPID AND BICUSPID VALVES AFTER AORTIC VALVE REIMPLANTATION PROCEDURE: AN ECG-GATED CT STUDY
Authors: Chirichilli I. , Irace F. , Weltert L.P. , Tsuda K. , Scaffa R. , Salica A. , Galea N. , De Paulis R.
Published: November 2018

Objective:

To evaluate the modifications of size and shape of the aortic annulus during cardiac cycle by ECG-gated CT study after reimplantation procedure, between native Bicuspid Aortic Valves (BAV) and Tricuspid Aortic Valves (TAV).

Patients/methods:

From October 2014 to April 2018, we selected 27 patients scheduled for aortic valve reimplantation, who underwent preoperative and postoperative ECG-gated contrast-enhanced CT scan of the aortic root. A CT-scan study with reconstructed transverse double oblique view of the aortic base in systole and diastole was obtained. Major (MD) and minor diameters (md), perimeter (P) and area (A) were measured. The shape of the aortic annulus was considered “circular” or “elliptic” according to the Ellipticity Index (EI) defined as MD/md ratio: a value ≥ 1.1 was considered as “elliptic”.

RESULTS:

In all TAV patients postoperative CT scan revealed a significant modification of the aortic annulus from elliptic to circular shape (from MD/md ratio 1.28 to 1.08 (p < 0.05)). Type 0 BAV maintained the original circular shape (from 1.07 to 1.04, p = 0.212) while type 1 BAV shoved an intermediate behaviour (from 1,14 to 1,11, p = 0.417).

Conclusions:

This study confirms the expected reduction in aortic annulus size following the reimplantation procedure. The annulus in TAV was forced from native elliptical to circular shape. Instead, it was preserved in type 0 BAV maintaining an almost perfect circular shape. Type 1 BAV seem to lay in a spectrum between the previous ones, showing a reduction trend in Ellipticity Index, but without statistical significance.
OC59 PREVALENCE AND CLINICAL IMPACT OF SYSTEMIC INFLAMMATORY REACTION AFTER CARDIAC SURGERY
Authors: Squiccimarro E. , Malvindi P.G. , Guida P. , Margari V. , Kounakis G. , Visicchio G. , Favale A. , Raimondo P. , Dambruoso P. , Carbone C. , Labriola C. , Paparella D.
Published: November 2018

Background and Aim:

The inflammatory reaction associated with cardiac surgery has been widely studied by means of laboratory biomarkers but rarely from a clinical perspective. Many anti-inflammatory treatments have failed to show clinical benefits. In 1992 the ACCP/SCCM conference defined the SIRS (table 1). Our aim is to verify the prevalence of clinically defined SIRS following heart surgery, to identify its predisposing factors and ascertain its impact on early outcome.

Methods:

We reviewed prospective data of 502 patients who underwent CPB-surgery. According to the mentioned criteria, we defined SIRS in the first day in ICU. We used an automated-matching procedure that for each SIRS-patient selected one without SIRS. A multivariate logistic regression model was used to evaluate the predisposition to develop postoperative-SIRS and its association with a composite outcome (death, TIA/stroke, renal replacement therapy, bleeding, IABP, stay in ICU > 96 hours).

Results:

142 patients (28.3%) were SIRS-positive. Propensity-score matched 114 patients. Post-CPB lactates and transfusion-rates were greater in SIRS-patients. Positivity to each SIRS-criteria was associated to the composite outcome for fever (OR2.09; 95%CI1.15–3.80; p = 0.016), heart rate (OR2.08; 95%CI1.23–3.52; p = 0.007), leucocytes (OR1.70; 95%CI0.99–2.91;p = 0.051) adjusting for preoperative creatinine clearance, LVEF and duration of the intervention. Correcting for univariate predictors, the presence of SIRS in the first post-operative day was associated to the composite outcome independently by SIRS preoperative variables.

Conclusions:

SIRS is a common phenomenon in Cardiac surgery and is frequently associated with some unfavorable clinical outcomes. Therefore, SIRS observed in the first 24 hours after surgery can be a target to improve clinical outcome.
OC11 CLINICAL FRAILTY SCALE AND OUTCOME AFTER CORONARY ARTERY BYPASS GRAFTING: AN ANALYSIS OF THE E-CABG REGISTRY
Authors: Saccocci M. , Reichart D. , Rosato S. , Nammas W. , Onorati F. , Dalen M. , Castro L. , Gherli R. , Gatti G. , Franzese I. , Faggian G. , De Feo M. , Khodabandeh S. , Santarpino G. , Rubino A.S. , Maselli D. , Nardella S. , Salsano A. , Nicolini F. , Zanobini M. , Bounader K. , Kinnunen E. , Tauriainen T. , Airaksinen J. , Seccareccia F. , Mariscalco G. , Ruggieri V.G. , Perrotti A. , Biancari F.
Published: November 2018

Objectives:

The aim of this study was to assess the impact of frailty on the outcome after coronary artery bypass grafting (CABG) and whether it mayimprove the predictive ability of EuroSCORE II.

Methods:

The Clinical Frailty Scale (CFS) was assessed preoperatively in patients undergoing isolated CABG from the multicenter E-CABG registry and patients were stratified in three classes: scores 1–2, scores 3–4 and scores 5–7.

Results:

Of 6156 patients enrolled, 39.2% had CFS scores 1–2, 57.6% scores 3–4, and 3.2% scores 5–7. Logistic regression adjusted for multiple covariates showed that the CFS was an independent predictor of hospital/30-day mortality (CFS scores 3–4, OR 3.95, 95%CI 2.19–7.14; CFS scores 5–7, OR 5.90, 95%CI 2.67–13.05) and resulted in an Integrated Improvement Index of 1.3 (p < 0.001) and a Net Reclassification Index of 55.6 (p < 0.001) for prediction of hospital/30-day mortality. Adding the CFS classes to EuroSCORE II resulted in an Integrated Improvement Index of 0.9 (p < p < 0.001) and Net Reclassification Index of 59.6 (p < p < 0.001) for prediction of hospital/30-day mortality, with a significantly larger area under the receiver operating characteristics curve (0.809 vs. 0.781, p = 0.028). The CFS was an independent predictor of mid-term mortality (CFS scores 3–4, HR 2.05, 95%CI 1.43–2.85; CFS scores 5–7, HR 3.05, 95%CI 1.83–5.06).

Conclusions:

The CFS predicted early and mid-term mortality in patients undergoing isolated CABG. Further studies are needed to evaluate whether frailty may improve the estimation of the operative risk of patients undergoing adult cardiac surgery.
OC36 IMPROVEMENT OF HAEMODYNAMIC AND RESPIRATORY PARAMETERS DURING COUPLED PLASMA FILTRATION AND ADSORPTION (CPFA) AND CORRELATION WITH CLEARANCE OF THE INFLAMMATORY MEDIATORS IN SEPTIC PATIENTS: A PROPENSITY MATCHED STUDY
Authors: Weltert L.P. , Turani F. , Falco M. , Scaffa R. , Salica A. , Bellisario A. , Chirichilli I. , De Paulis R.
Published: November 2018

Background and aim:

Sepsis is a severe complication in cardiac surgery, but data on new therapies are inconclusive and new tretments are warranted. Coupled plasma filtration adsorption (CPFA) is a new extracorporeal technology which combines plasma filtration and ultrafiltration. The aim of this study is to evaluate in septic patients submitted to CPFA:

Methods:

Overall coohort study and a propensity–matched analysys included 96 patients admitted to three ICU with a diagnosis of septic shock.

73 patients were submitted to CPFA and 23 patients to RRT.

In the CPFA group Heparine ev was used as anticoagulant in 22 patients and citrate in 11.

In the RRT group Heparine was used in all the patients.

IL-6, Procalcitonin, cardiorespiratory indices and SOFA score were compared before (T0) and at the end of the treatments (T1).

Results:

Of 73 patients submitted to CPFA 32 could be matched to the 22 septic patients who received RRT. 10 patients in the CPFA group experienced clotting of the adsorbing filter. Results are shown in table.

Conclusions:

Data from this study confirm that CPFA improves haemodynamics during septic shock. This improvement may be related to the reduction of IL-6 and of Procalcitonin. As shown in previous studies, clotting of the filter is an important problem. Anticoagulation with citrate may improve the patency of the circuit.
OC63 REQUEST REGISTRY: INTERIM RESULTS OF INTERNATIONAL MULTICENTRIC PROSPECTIVE REGISTRY FOR THE EVALUATION OF TRANSIT TIME FLOW MEASUREMENT AND INTRAOPERATIVE IMAGING IN CORONARY SURGERY
Authors: Di Giammarco G. , Taggart D.P. , Puskas J. , Marinelli D. , Wendt D. , Prieur T.M. , Trachiotis G. , Kieser T. , Head S.J.
Published: November 2018

Background and Aim:

Intraoperative graft failure is a well-recognized issue with a rate of 4–5% of incidence involving the 10% of patient submitted to CABG.Despite this evidence and the recommendation of international guidelines the routine use of intraoperative graft verification is low.The purpose of this multicentric prospective international registry was to assess the impact of routine use of Transit-Time Flow Measurement (TTFM) and High-Resolution Epicardial Ultrasonography (HR-ECUS) in CABG patients.

Methods:

The design of the study imposed to enroll 1000 patients in 7 centers (Italy,UK,USA,Canada,Germany,Netherlands) from 2015 to 2017.The inclusion criterium was the indication to isolated CABG operation in patient with at least 2-vessel disease.The study protocol and ethical approval was published in clinicaltrial.gov in February, 2015. The endpoints of the registry were: 1)any change in planned surgical procedure;2)type of change (aorta,coronary target, conduits,anastomosis);3)number and reason for the revision;4)in-hospital mortality and stroke.

Results:

total of 346 surgical strategy changes were registered in 249 (26%) patients.HR-ECUS leads to change in aorta manipulation sites in 10% of the patients,in coronary anastomotic site in 20% of the patients and the combined use of TTFM and HR-ECUS to 3% of intraoperative graft revision.The total number of adverse events was 1017 (22% mild,70% moderate,8% severe.The mortality rate was 0.5% with a stroke rate of 0.7%.

Conclusions:

In the hands of expert surgeons,high rate of optimal medical therapy use (> 70%) and state-of-the-art surgical procedure the intraoperative guidance and graft verification of HR-ECUS and TTFM were associated with a 3% of revision rate and low-level of in-hospital mortality and stroke.
OC47 MYOCARDIAL REVASCULARIZATION TECHNIQUE IN TAKAYASU'S ARTERITIS
Authors: Barbato L. , Grasso M.A. , Spagnolo S.
Published: November 2018

Background:

Takayasu arteritis is a vasculitis of the aorta and its major branches. The involvement of coronary arteries is not a rare occurrence. An optimal revascularization strategy for this disease has not been established. A diffusely diseased coronary artery has been a therapeutic challenge for cardiologists and surgeons. Long reconstruction is one of the Coronary Artery Bypass Grafting methods for treating diffusely diseased coronary arteries.

Methods:

We report the case of a 65-year-old patient with a claudicatio at 150–200 mt but also angina pectoris. A diffuse and critical disease of anterior descending coronary artery was found in the angiographic study. The surgical procedure was performed by reconstructing anterior descending artery with a saphenous vein patch associated with coronary aortic bypass in the left internal mammary artery.

Results:

The follow-up at 15 months showed excellent patency of coronary reconstruction with venous patch, a recovery of good ventricular function with the asymptomatic patient.

Conclusions:

The reconstruction of diffusely diseased coronary arteries with a patch of saphenous vein or mammary artery is a good technique, it is possible to guarantee a simultaneous revascularization of septal, diagonal and small lateral branches offering a wide coronary and myocardial reperfusion.The greatest advantage of this method is that the myocardium supplied by the side branches of the diffusely diseased coronary artery can be revascularized simultaneously.

Patch reconstruction can be performed with good early and midterm results.
OC76 THE MORE PROCEDURE (MININVASIVE, OPCAB, RAPID SURGICAL INTENSIVE CARE UNIT EXIT, EXTUBATION INTO THE OPERATING ROOM): OUR MININVASIVE APPROACH TO SURGICAL MYOCARDIAL REVASCULARIZATION
Authors: Colombino M. , Longobardi A. , Panza A. , Mastrogiovanni G. , Masiello P. , Del Negro G. , Rosapepe F. , Bisogno A. , Di Domenico A. , Iesu S.
Published: November 2018

Background and Aim:

To compete with PCI invasiveness, we adopted a composite surgical strategy which we called the MORE approach.

Methods:

Criteria for enrolment into the MORE study were haemodynamic stability and EF ≥ 45%. Criteria for operating room (OR) extubation were: normothermia, good cardiac output and no evidence of bleeding. From November 2016 to April 2018, 85 ACS patients underwent MORE technique: lower partial or a full sternotomy through a 10 cm skin Minincision; complete Off-pump revascularization; Rapid mobilization; Extubation into the OR.

Results:

Five patients failed OR extubation and 10 patients needed incision extension for poor coronary vessel exposure. We did not register any operative mortality, perioperative MI or CV events. Mean graft/patient ratio was 2.8. Early mobilization allowed 78 (92%) patients to be seated edge-of-bed after two hours. In the afternoon, 65 patients returned to the Coronary Intensive Care Unit. This rapid surgical intensive care unit (SICU) exit allowed 31 afternoon patients to be accommodated in the SICU bed, freed up by the morning cases. This offered economic benefits: taking up less ‘valuable bed space’ in the first operative day and increasing the number of the surgical procedures as a result of an improved SICU bed availability.

Conclusions:

MORE protocol allowed selected ACS OPCAB patients to be OR extubated, early mobilised and same-day discharged from the SICU. The minincision, avoiding excessive rib traction, reduced the postoperative pain and was a very well-accepted cosmetic bonus. The rapid SICU bed turnover allowed an overutilization of our present logistic facilities.
OC67 STAGED HYBRID EPICARDIAL-ENDOCARDIAL PROCEDURE IN PATIENTS WITH REFRACTORY PERSISTENT/LONG-STANDING PERSISTENT ATRIAL FIBRILLATION AND SEVERE LEFT ATRIAL DILATATION
Authors: Lapenna E. , Cireddu M. , Del Forno B. , Monaco F. , Nisi T. , Bargagna M. , Ajello S. , Gulletta S. , Melisurgo G. , Belluschi I. , D’Angelo G. , Giacomini A. , Pappalardo F. , Alfieri O. , Castiglioni A. , Bella P. Della , De Bonis M.
Published: November 2018

Background And Aim:

Treatment of persistent atrial fibrillation(AF) and severe left atrial(LA) dilatation is often unsuccessful, using both minimally invasive surgical or catheter procedures alone. To overcome the limitations of both techniques, we investigated the effectiveness of a staged hybrid method consisting in a right thoracoscopic ablation with the Cobra Fusion system, followed by a percutaneous Rhythmia system mapping/ablation, 2 months later.

Methods:

Twenty consecutive patients(age57 ± 7.6years, 17males, BMI 30 ± 3.0Kg/m2, LVEF52 ± 8.2%) with lone symptomatic, refractory, persistent (80%) or long-standing persistent (20%) AF and severely dilated LA (volume index 47 ± 8.9 ml/m2 at echocardiography, 73 ± 16.4 ml/m2 at CT scan) were treated with this staged approach. An Implantable Loop Recorder (ILR) was implanted at the end of the operation.

Results:

No hospital or late deaths occurred. The 1-year freedom from AF recurrence was 85 ± 8.0% and from AF recurrence off class I/III antiarrhythmic drugs (AADs) was 75 ± 9.7%. At 12 months, the proportion of patients in SR was 80%, of whom 73% were in stable SR off class I/III AADs. At last follow-up, no stroke and thromboembolic events were documented, all pts were in class EHRA I, LVEF improved from 52 ± 8.2% at baseline, to 58 ± 2.3% (p = 0.01) and median LA volume index decreased from 48 ml/m2 (IQR 43;53) to 33 ml/m2 (IQR 25;35)(p = 0.001).

Conclusions:

This staged hybrid approach yields promising results in selected patients with persistent/long-standing persistent AF and severely dilated left atrium who are at very high risk of AF recurrence. The LA mapping, the use of ILR monitoring and the clinical/echocardiographic follow-up performed in our dedicate AF center, further reinforce the reliability of these results.
VD05 BENTALL OPERATION IN BICUSPID VALVE AND ANOMALOUS LEFT CIRCUMFLEX CORONARY ARTERY: ANATOMICAL AND TECHNICAL IMPLICATIONS
Authors: Nicolardi S. , Scrascia G. , Mangia F. , Gallo A. , Amorese L. , Pano M. , Fellini P. , Rocco D. , Quacquaro A. Scotto di , Zaccaria S. , Greco C. Angelo , Casali G.
Published: November 2018

Bicuspid aortic valve (BAV) is often associated with coronary abnormalities. The finding of BAV associated with an anomalous circumflex coronary artery (ACCA) originating from the right Valsalva sinus (VS) and surrounding the non-coronary VS is however a rather rare occurrence. We report a case of successful Bentall operation with a composite button technique in a 56-year-old man with aortic root dilatation, BAV insufficiency and coexisting ACCA. In this case a 25 SJM composite graft was implanted in supraannular fashion rather than intraannular to avoid: 1) ACCA injury or obstruction of the proximal course near the annulus by suture ligation, 2) compression by prosthetic ring, 3) distortion of ACCA during ostia reimplantation. We demonstrated that attention to the anatomic relationship of ACCA to the aorta is crucial and prosthesis supraannular implantation technique allows a safe aortic root replacement.
VD01 A CASE OF “VERY” SIMULTANEOUS TRANSAPICAL TRANSCATHETER AORTIC AND MITRAL VALVE IMPLANTATION
Authors: Miele M. , Manzan E. , Prestipino F. , D’Ascoli R. , Luzi G.
Published: November 2018

The ever widening diffusion of biological prostheses and the achievement of higher mean age have focused attention on new possible scenario: off-label use of transcatheter valve implantation (TAVI) via a valve-in-valve procedure as an alternative strategy to standard surgery redo valve replacement.

We report the first simultaneous Transapical Transcatheter Aortic and Mitral Valve Implantation performed after contemporary wires positioning in aortic and mitral size. After apical puncture, soft and subsequent stiff guidewires were inserted trans-apically through the 2 prosthesis. The first wire was advanced through the aortic prosthesis and placed in femoral artery. The second one was inserted through the mitral prosthesis and placed in right superior pulmonary vein. The aortic prosthesis was introduced through a trans-apically placed sheath, positioned, and then deployed into the degenerated aortic bioprosthesis under fluoroscopic guidance. The same procedure was used for mitral prosthesis using the previous positioned wire.
VD06 BILATERAL STAGED THORACOSCOPIC SURGICAL TREATMENT OF LONE PERSISTENT ATRIAL FIBRILLATION WITH LEFT ATRIAL APPENDAGE THROMBOSIS
Authors: Vendramin I. , Rebellato L. , Dametto E. , Daleffe E. , Lechiancole A. , Livi U.
Published: November 2018

Particularity of the video:

Catheter ablation and minimally invasive surgical ablation have become accepted therapy for atrial fibrillation (AF). The presence of a thrombus in the left atrial appendage (LAA) is considered an exclusion criterion for both approaches and for LAA occlusion. The procedure described could represent a new mini-invasive method to treat AF and exclude the LAA.

Brief description:

We described a new mini-invasive procedure for a combined radiofrequency treatment of AF and exclusion of LLA with partial thrombosis through a bilateral thoracoscopic approach in a 71-years-old man with AF and partial thrombosis of the LAA. LAA was firstly secured by encircling its base with a 3/0 prolene Ethibinder™. Ablation was obtained by encircling the pulmonary veins origin with Estech-COBRAFusion™ device, delivering both bipolar and monopolar energy. LAA exclusion was finally achieved by deploying the Atricure-AtriClipPRO2™. Postoperative course was uneventful and the patient was discharged in sinus rhythm.
EP10 DIRECT AORTIC CROSS-CLAMPING IN REDO MITRAL VALVE SURGERY VIA RIGHT MINI-THORACOTOMY
Authors: Prestipino F. , Manzan E. , Miele M. , D’Ascoli R. , Luzi G.
Published: November 2018

Background And Aim:

Reoperative mitral valve surgery is burdened by a greater technical difficulty and a higher complications rate respect to first operation. When in a heart centre minimally invasive surgery has become routine, the application of this to reoperations may represent the way to greatly reduce the surgical risk. The objective of the study is to assess results within the last year of technically difficult reoperations in 10pts with mitral valve disease approached trough a 5–7 cm right mini-thoracotomy with direct cross clamping.

Methods:

Cardiopulmonary bypass was installed by cannulation of femoral vein (internal jugular vein in case of tricuspid concomitant surgery) and axillary or femoral artery. Aorta was partially isolated and directly cross-clamped by the same incision.

Results:

Patients enrolled had a median age 68 years (IQR I-III 61–75). Median time between last operation and reoperation was 7 years (IQR I-III 4–11): 1 patient underwent mitral valve repair, 9 patients to mitral valve replacement and 3 of these also received tricuspid annuloplasty. Median Euroscore I was 8.5 (IQR I-III 6.1–12). Median cross-clamp time was 68 min (IQR I-III 51–86) and median cardiopulmonary bypass time was 88 min (IQR I-III 68.8–119). 1 patient had a postoperative renal failure requiring CVVH and 1 patient underwent surgical reoperation for bleeding. There were no deaths at 30day follow-up.

Conclusions:

Direct aortic cross-clamping in minimally invasive mitral valve surgery reoperations is a safe procedure. The use of less invasive techniques in reoperations may minimize morbidity and mortality, without prolonging duration of cardiopulmonary bypass.
EP09 COMPARISON OF THREE DIMENSIONAL ECHOCARDIOGRAPHIC MEASUREMENTS AND IN VIVO ANALYSIS OF THE TRICUSPID VALVE DURING MITRAL VALVE SURGERY
Authors: Pettinari M. , De Kerchove L. , Pasquet A. , Vanoverschelde J. , El-Khoury G.
Published: November 2018

Background:

Tricuspid valve is a complex three dimensional structure. 2D and 3D echocardiography are the gold standard instruments to evaluate its function and anatomy. In vivo analysis and measurement of the annulus and leaflet are lacking. Aim of our study is to compare in vivo with 3D echocardiographic measurements of the tricuspid valve in patients treated for mitral valve disease.

Methods:

Among 139 patients treated for mitral valve disease, 37 had an intraoperative evaluation by 3D transoesophageal echocardiography and after exposure of the valve several pictures were taken to obtain annular and leaflet measurements. Echocardiographic annular measurements (area, perimeter, antero-septal and latero-posterior diameters) were obtained in six different moment of the cardiac cycle: early mid and late, systole and diastole. Maximal leaflets length and area were measured in end-systole and early diastole. The annular and leaflet measurement were extracted from the intraoperative pictures and compared to the echocardiographic finding by a Pearson correlation test.

Results:

Significant correlation were found between 3D echocardiography and in vivo measurement in term of valve area (p < 0.01, r = 0.77), perimeter (p < 0.01, r = 0.61), antero-septal (p < 0.01, r = 0.6) and latero-posterior diameter (p < 0.01, r = 0.64), anterior and posterior leaflet area (p < 0.01, r = 0.63), septal leaflet area (p < 0.01, r = 0.69), anterior (p = 0.03, r = 0.64) and posterior leaflet length (p = 0.03, t = 0.67).

Conclusion:

Our study demonstrates a moderate to good correlation between in vivo and 3D echocardiographic measurement of tricuspid valve annulus and leaflet. Further studies are needed to investigate their impact on recurrence of tricuspid valve insufficiency.
EP30 PULMONARY ENDARTERECTOMY: PROXIMAL VERSUS DISTAL LESIONS IN HIGH PULMONARY VASCULAR RESISTANCE COHORT
Authors: Gliozzi G. , Alfonsi J. , Mariani C. , Coppola G. , Berardi M. , Amodio C. , Fiorentino M. , Pacini D. , Galiè N. , Martin-Suarez S. , Di Bartolomeo R.
Published: November 2018

Background:

Pulmonary endarterectomy(PEA) is the treatment of choice in chronic thromboembolic pulmonary hypertension(CTEPH). High preoperative pulmonary vascular resistance (PVR) is the main negative prognostic factor. Location of obstructive lesions (proximal versus distal) only determines surgical accessibility.The aim of this study is to determine the impact of high PVR associated with distal disease.

Methods:

We retrospectively analyze the results of 149 PEA performed since 2003. Of this cohort 37.6% of patients had PVR≥800 dynes; of them, 5 had a distal angiographic profile (distal segmental and subsegmental involvement). We compare outcomes of proximal versus distal lesion.

Results:

In-hospital mortality of high PVR cohort was 19.6% (versus 6.4% of lower PVR p = 0.026; OR = 3.3;CI[1.2;9.6]). Patients with proximal anatomy died less than those with distal anatomy (8/51 versus 3/5). Distal lesions were risk factor for early (p = 0.04, OR = 11.4;CI[1.1;52.4]) but not for late mortality (p = 0.81); those patients also developed acute renal failure (p = 0.04;OR = 7.5;CI[1.1;121.7]) and need for extracorporeal membrane oxigenation (4/5 patients; p = 0.02;OR = 17.3;CI[1.7;174.3]). At 3 years and 10 years follow up, overall survival was 94.8% and 88.6% respectively (mean follow up time 71.7 ± 43.6 months). Freedom from persistent pulmonary hypertension is 88.9% at 10 years follow up.

Conclusions:

Our results demonstrate that patients with high PVR associated with distal lesions have even worse early outcomes than those with high PVR alone. Further studies regarding this finding are necessary to define if this population might benefit from other therapies like pulmonary angioplasty and/or medical treatment rather than PEA.
EP16 SURGICAL DRAINAGE OF PERICARDIAL EFFUSION VERSUS ULTRASOUND-GUIDED PERICARDIOCENTESIS: A SINGLE-CENTER EXPERIENCE
Authors: Fittipaldi O. , Colucci S. , Nappi A. , D’Alessandro F. , Rispo G. , De Notaris S. , Mollo A. , Garofalo G. , Triumbari F.
Published: November 2018

Background and Aim:

The treatment of pericardial effusion and cardiac tamponade is still far from its resolution. The aim of our study is to evaluate the results after surgical drainage of pericardial effusion and ultrasound-guided pericardiocentesis.

Methods:

From 2006 to 2016, 276 patients (pts)(males 55- 56.15% - females 121 - 43.84%) were admitted for surgical treatment of drainage of the pericardial cavity. The procedures were US-guided pericardiocentesis (UP) for 155 pts (56.15%), subxifoid pericardiotomy (PS) 119 pts (43.11%) Median sternotomy (S) 2 pts (0.72%), 3 pts (1.08%) who underwent UP in first instance they were converted to PS due to drainage difficulties, 2 pts (0.72%) for cardiac perforasion. The amount of liquid drained on average was 560 ml (300ml-2000 ml). The quality of the liquid was serous, serum, blood and purulent. In 10 pts (3.6%) the cytological examination of the liquid and of the pericardium fragment allowed to confirm the suspected diagnostic of tumor pathology.

Results:

All patients undergoing UP were discharged after 5 days while patients undergoing PS or S required a longer period of stay from 15 days to 45 days. All patients were given an anti-inflammatory drug belonging to the NSAID class for 14 days (Indomethacin or Paracetamol). Antibiotic therapy (third-generation cephalosporin) was administered to all patients for three days after the procedure.

Conclusions:

We consider gold standard procedure UP while we reserve the PS after failure of the UP, for patients who need diagnosis (oncology, nephrology), for post-surgical patients and relapses.
VD18 TRANSFEMORAL AORTIC VALVE REPLACEMENT IN A PATIENT WITH PREVIOUS TRANSCATHETER MITRAL VALVE-IN-VALVE: THE NEW ROLE OF THE “INTERVENTIONAL” CARDIAC SURGEON
Authors: Cammardella A.G. , Gherli R. , Polizzi V. , Ranocchi F. , Musumeci F.
Published: November 2018

On September 2014, a 76-year-old female patient presented with dyspnea. She underwent to mitral valve replacement with SJM 27 mm bioprosthesis valve in 2013. Other comorbidities included atrial fibrillation paroxysm and COPD. The echocardiography showed a degeneration of the bioprosthesis with severe regurgitation. Due to high surgical risk, we performed a transcatheter valve-in-valve replacement through left ventricular apical approach. Thus, we implanted an Edwards SAPIEN XT 26 mm into the bioprosthesis mitral valve. Echocardiography showed no MR and a 4 mmHg mean gradient. On February 2018, the patient was admitted with symptoms of progressive hearth failure. Echocardiography showed a severe aortic stenosis. Based on MDCT analysis, we proceeded with a TAVI (Edwards SAPIEN 3 23 mm) through transfemoral approach, with an optimal result. In the current scenario, we want to emphasize the growing role of the “interventional” cardiac surgeon in the treatment of all valve diseases.
EP29 PROGNOSTIC EFFECT OF ESTIMATED GLOMERULAR FILTRATION RATE IN PATIENTS UNDERGOING CARDIAC SURGERY
Authors: Pisano C. , Bertoldo F. , Russo M. , Marabese A. , Nardi P. , Pellegrino A. , Scafuri A. , Bassano C. , Ruvolo G.
Published: November 2018

Background:

Chronic kidney disease (CKD) has been found to be an independent risk factor for cardiovascular diseases onset. We investigated the association between initial renal function and clinical outcomes in patients undergoing cardiac surgery.

Methods:

This was a single- centre, retrospective cohort study of 284 patients underwent cardiac surgery in Tor Vergata University Hospital between Genuary 2017 and February 2018. Patients with eGFR <60 ml/min (Group 1) were compered with patients with eGFR >60 ml/min. A propensity match score has been applied to investigate the effect of ultrafiltration in patients with eGFR <60 ml/min underwent cardiac surgery

Results:

No significant differences have been observed in term of cardiac, pulmonary, renal and cerebral complications between the two groups. In hospital mortality was 16% in Group 1 and 5.3% in Group 2 (p-value 0.003). In patients with eGFR < 60 ml/min, the propensity match score analysis did not reveal any significant differences in terms of morbidity between untrafiltered and no ultrafiltered patients. The ultrafiltration increased the risk of mortality (9%vs 2%, p-value 0.045).

Conclusions:

an initial eGFR< 60 ml/min is associated with an incremental risk of mortality in patients undergoing cardiac surgery. The extracorporeal circulation does not seem have any worsening effect on the renal function after the operation. No benefits have been observed using ultrafiltration in patients with severe renal failure.
EP17 IMPACT OF A MODIFIED INTRAOPERATIVE SETTING FOR THE MANAGEMENT OF CIRCULATORY ARREST IN TYPE A ACUTE AORTIC DISSECTION
Authors: Vendramin I. , Piani D. , Lechiancole A. , Ferrara V. , Meneguzzi M. , Sponga S. , Livi U.
Published: November 2018

Background-aim:

Despite several recent reports show a trend towards a more extensive arch surgery for patients presenting with type A acute aortic dissection (TA-AAD), in-hospital mortality from IRAD remains high (13–17%). Our study aimed to evaluate the impact of a modified intraoperative setting for the management of circulatory arrest on short and mid-term outcomes in limited repair and complete arch surgery.

Methods:

From 1997 to 2017, 335 patients with TA-AAD were admitted at our Institution and divided into 3 groups according to the surgical strategy. GROUP-A: retrograde femoral artery perfusion- deep hypothermia (1977–2004;n = 144), GROUP-B: standard anterograde right axillary artery perfusion- moderate hypothermia (2005–2012;n = 102), GROUP-C: right axillary artery with modified monitoring and perfusion lines setting- moderate hypothermia (2013–2017;n = 89). Data was collected and analysed retrospectively.

Results:

Overall in-hospital mortality: 34.7% in Group-A (mean-age 61.5 ± 12.5years), 13.7% in Group-B (mean-age 63.8 ± 12.8years) and 5.6% in Group-C (mean-age 64.2 ± 11.1years) (p = 0.001). Concerning total-arch replacement, in-hospital mortality was 37% in Group-B vs 0% in Group-C (p = 0.001). Overall 1-year and 5-years survival: 56.3 ± 4.1% and 47.9 ± 4.2% in Group-A, 79.4 ± 4% and 69.6 ± 4.6% in Group-B, 89.5 ± 3.3% and 87.5 ± 3.8% in Group-C (p = 0.001). Group (p = 0.001), CEC-time (p = 0.003), re-exploration (p = 0.001), AKD (p = 0.049) and CVVH (p = 0.007) were predictors for in-hospital mortality in a univariate analysis, re-exploration (HR 4.2) and CVVH (HR 2.1) in a multivariate analysis, Group was a protective factor (HR = 0.25).

Conclusions:

In our experience current modified approach for the management of circulatory arrest seems to improve overall survival and decrease the risk of in-hospital mortality, showing excellent results especially in total arch replacement.
EP39 TYPE A INTRAMURAL HEMATOMA AND PENETRATING ATHEROSCLEROTIC ULCERS OF AORTA: EVALUATION AND MANAGEMENT
Authors: Fittipaldi O. , Nappi A. , D’Alessandro F. , Mollo A. , Colucci S. , Rispo G. , De Notaris S. , Garofalo G. , Triumbari F.
Published: November 2018

Background and Aims:

The aim of our study is to report our experience on the surgical treatment of intramural aortic hematoma (IMH) and penetrating atherosclerotic ulcers (PAU), as less common variants of “acute aortic syndromes”.

Methods:

From 2010 to 2015, 38 patients with a diagnosis of “acute aortic syndrome” underwent emergency surgery at our Center, of which 31 patients (81.57%), suffering from acute aortic dissection type A, 7 patients (18.42%), affected by IMH and a patient (2.63%) affected by IMH + PAU: All the patients affected by IMH and IMH + PAU underwent emergency surgery.

We analyzed the following parameters: General and hemodynamic clinical conditions; Presence of spontaneous breath or endotracheal intubation; Neurological conditions; Timing from diagnosis to surgical treatment; Intervention type performed; Time to wake up.

Results:

Survival at 30 days was 100%: 6 patients were discharged at home, about 3 weeks after surgery and 2 patients were transferred to Cardiorespiratory Rehabilitation Centers about 3 weeks after surgery, in satisfactory general clinical conditions.

Conclusions:

Preoperative conditions of the patients, early diagnosis and the timeliness of the surgical treatment represent, in our experience, determinant factors about clinical outcomes.
EP27 PRESENCE AND SIZE OF RENAL CYST INFLUENCE THE RISK OF ASCENDING AORTA ANEURYSM: BASE FOR A ROUTINE SCREENING?
Authors: Amoroso F. , Pettinari M. , Borsellino S. , Buttiens A. , Swinnen J. , Tamagnini G. , Van Kerrebroeck C. , Willems E. , Gutermann H.
Published: November 2018

Background and Aim:

Patients with thoracic aortic aneurysm had higher incidence of renal cyst (30 to 60%); on the contrary the incidence of aortic aneurysm in patients with renal cyst is not well understood. Aim of our study is to explore whether presence and characteristic of renal cyst influence the incidence of ascending aorta aneurysm.

Methods:

Among 4487 patient who had a chest and abdomen CT scan between 2006 and 2016, 604 were diagnosed with one or more renal cysts. Primary outcome was ascending aorta dilatation (AAD) was defined as maximal diameter ≥ 45 mm. Multivariate linear regression was used to identify the parameters influencing ascending aorta diameter.

Results:

Mean age was 74.1 years and 65.4% were male. Mean number of renal cyst was 5.9 and the mean maximal-cyst diameter was 30.5 mm. Prevalence of AAD was 6.1%. Mean ascending, arch and descending aorta diameters were 35.7 ± 4.9 mm, 30.4 ± 3.9 mm and 27.7 ± 3.8 mm respectively. Regression analysis identified abdominal aorta atherosclerosis or previous treatment, major diameter of the renal cyst, male, familiarity and age as predictors of ascending aorta diameter.

Conclusions:

Patients with renal cyst have a higher incidence of ascending aneurysm and their maximal diameter influence its diameter. This information could be the base to set a prospective screening program to early detect patients with ascending aorta aneurysm.
RF53 NON-ISCHEMIC CARDIOMYOPATHY IS ASSOCIATED WITH BETTER OUTCOMES IN PATIENTS WITH FUNCTIONAL MITRAL REGURGITATION UNDERGOING MITRACLIP IMPLANTATION
Authors: Garatti A. , De Marco F. , Tusa M. , Bedogni F. , Canziani A. , Parolari A. , Menicanti L.
Published: November 2018

Background:

To compare ischemic versus non-ischemic etiology in patients with functional mitral regurgitation(FMR) undergoing Mitraclip therapy.

Methods:

Among a consecutive series of 72 patients undergoing Mitraclip implantation(2013–2016) at our Institution, 57 patients with FMR[34 patients (mean age:73 ± 10 yrs) with ischemic cardiomyopathy(iCMP) and 23 patients (mean age:72 ± 9 yrs) with non-ischemic CMP(NiCMP)] constituted the study population. Clinical and echocardiographic assessment was performed preoperatively, at discharge and at follow-up. A composite end-point (CE) of death and/or HF admission at FU was calculated.

Results:

Preoperatively, all patients presented in advanced HF-class and low EF(28 ± 11%). Patients with iCMP showed higher rate of male gender, higher rate of CV risk factor and higher rate of previous cardiac surgery(p=.01) compared to NiCMP. Procedural success was similar in both group(92%), but ischemic patients had higher probability to receive two or more clips(p = .05). Postoperative complication(p = .43) as well as 30-days mortality(6% vs4%,p = .36) were similar in both group. Mean FU was 20 months(range 4–49). FU mortality(p = .05) and HF admission(p = .04) were significantly higher in iCMP. Two-years Kaplan-meier freedom from CE was significantly lower in iCMP(47% vs 82%, p = .001). Mitraclip was effective in reducing MR in both group with nearly 80% of patients with MR less than 2+ and NYHA class I-II at FU. Finally, in patients with iCMP, Mitraclip therapy was ineffective in preventing further LV dilatation and dysfunction.

Conclusion:

In high-risk HF patients, Mitraclip therapy showed satisfying results, with high success rate, low operative mortality and lower rate of complications, even if patients with iCMP had medium-term worse outcomes.