bluuebunny/crossref_metadata_2025 huggingface dataset:
THE PROTECTIVE BENEFITS OF MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION IN CORONARY ARTERY BYPASS SURGERY: A SINGLE-CENTER EXPERIENCE
Authors: Snaidero S. , Mariani C. , Fabiani L. , Tammaro I. , Folesani G. , Barberio G. , Pacini D.
Published: December 2024

Background and Aim:

Minimal invasive extracorporeal circulation (MiECC) is an advanced CPB technology that reduces complications compared to standard CPB. The study aims to evaluate the effectiveness of MiECC in coronary artery bypass (CABG) surgery, focusing on outcomes like inflammation, blood transfusion and organ protection.

Methods:

From April 2016 to June 2024, 63 patients underwent CABG procedure with MiECC at our center. A 1:1 propensity-matching algorithm was employed to match the patients with 63 patients who underwent CABG procedure with standard ECC. The variables used for matching were age, sex, BMI, LVEF, presence of diabetes mellitus, renal insufficiency, cross-clamp time and number of distal anastomosis.

Results:

Intra-operative outcomes demonstrated lower levels of lactates and glycemia in MiECC group with a statistical significance (2.1±0.8 vs 1.4±0.7, p<0.001 and 164±35.8 vs 124.4±31.5, p<0.001, respectively).

Early postoperative outcomes were similar between MiECC and standard ECC groups regarding renal and liver impairment and bleeding. LDH values were statistically inferior in MiECC group (419.9±239.8 vs 210.6±42.1, p<0.001). Needing of inotropes over 24-hours and MOF were higher in standard ECC group, without a statistical significance. 30-day mortality was higher in standard ECC group (3 vs 0, p=0.08).

Conclusions:

The use of MiECC for CABG surgery in our analysis showed a significant lower alteration in metabolic parameters such as lactate and blood glucose levels, suggesting a better overall patients’ perfusion during the procedure. Clinically, this translates in a shorter intubation time anf reduced ICU stay for the MiECC group.
LESS INVASIVE IMPLANTATION OF THIRD GENERATION LEFT VENTRICULAR ASSIST DEVICES: PRELIMINARY ANALYSIS
Authors: Loforte A. , Spitaleri A. , Monteleone G. , Abbà P. , Marro M. , Simonato E. , Sandoval A. , Gallone G. , Frea S. , Trompeo A. C. , Boffini M. , Rinaldi M.
Published: December 2024

Background and Aim:

This study evaluates the short-term benefits of a less invasive surgical approach (LIS) compared to traditional full sternotomy (FS) for implanting third-generation left ventricular assist devices (LVADs).

Methods:

Out of 165 LVAD implantations at our institution, a retrospective analysis was performed on 115 centrifugal pumps recipients (HeartWare HVAD and HeartMate 3) between 2010 and 2023.

Results:

Of the 115 LVAD implants analyzed, 79% (n=91) were performed using FS, while 21% (n=24) used LIS. The LIS cohort was younger (median age 57 vs. 61 years, p=0.05) and more frequently received the HVAD device (83% vs. 17%, p=0.001). They presented with worse hemodynamic parameters and a higher frequency of moderate to severe tricuspid regurgitation (83.3% vs. 45.6%, p=0.001). Perioperatively, the LIS group had a lower use and shorter time of extracorporeal circulation (62% vs. 100%, p=0.001; median time 60 vs. 92.5 minutes, p=0.007), lower incidence of right heart failure (21.7% vs. 30.03%, p=0.044), and faster respiratory weaning (extubation at 48 hours, 70.8% vs. 52.7%, p=0.029). Additionally, no revision for bleeding was required (0% vs. 15.5%, p=0.014), and in-hospital mortality was lower (4.2% vs. 12.4%, p=0.003). At six months, the LIS group experienced fewer driveline infections (10.8% vs. 18.2%, p=0.05), cerebral events (4.6% vs. 6.9%, p=0.044), and pump thrombosis (0% vs. 1.4%, p=0.039).

Conclusions:

The less invasive surgical approach for LVAD implantation is a feasible and safe alternative to full sternotomy in selected patients.
LEFT VENTRICULAR PSEUDOANEURYSM: PLANNING A SURGICAL CORRECTION WITH VIRTUAL CT HEART NAVIGATION
Authors: Pin M. , Zucchetta F. , Savini C.
Published: December 2024

Left ventricular (LV) pseudoaneurysm is a rare and fatal complication of myocardial infarction that needs promptly surgical management. In the last years, 3D visualization of cardiac anatomy has reached high levels of detail for surgical planning, aiding surgeon to perform faster, sharper and more efficient operations. The case we present is an example of how powerful CT scan evaluation can be in the hand of a cardiac surgeon while planning a challenging procedure such as closing a wide tear at the base of the LV. In our video, direct 3D-heart-navigation is provided by a dedicated software (Acquarius I-intuition) where complex anatomical features are analyzed. The type of ventricular access, materials and patch dimension, spatial orientation of the patch itself to maintain LV chamber geometry and its anchoring suture lines are chosen based on CT images. The operation is then summarized throughout multiple intraventricular shots depicting the most important surgical steps.
HEART RE-TRANSPLANTATION: A SINGLE CENTER EXPERIENCE
Authors: Lechiancole A. , Copetti S. , Sponga S. , Benedetti G. , Di Lorenzo A. , Spagna E. , Rroshkodol A. , Vendramin I.
Published: December 2024

Background and Aim:

Heart re-transplantation (re-HTx) represents a rare surgical option, due both to the shortage of donors and the complexity of re-HTx candidates. The aim of this study was to analyze the results of re-HTx.

Methods:

Out of 757 HTx performed in our Center, 34 were re-HTx. The re-HTx data, collected prospectively, were retrospectively analyzed. The primary endpoint was overall mortality, while secondary endpoints were postoperative complications.

Results:

The mean age of re-HTx recipients was 49±12 years. 22 patients (65%) were male. The most frequent comorbidities were: chronic renal failure (53%), dyslipidemia (26%), atrial fibrillation (24%), hypertension (18%), diabetes mellitus (15%). In 4 cases (12%) the re-HTx occurred within 2 weeks from the first HTx after severe graft failure, while in the remaining 30 patients (88%) the re-HTx occurred after 16±7 years, and the most frequent cause was coronary allograft vasculopathy. In 7 cases a combined kideny transplant was performed.

Grafts were preserved with ice (74%), normothermic perfusion (18%), and controlled hypothermia (9%). The average age of the donors was 40±15 years.

Overall 30-day mortality was 12% (n=4). The 5- and 10-year survival was 62% and 58%, respectively.

Postoperative use of IABP and ECMO was 9% and 6%, respectively. Grade>2 cell-mediated rejection occurred in 39% of patients, and infections were treated in 52%. Thirty-three percent of patients required ventilatory support >72 hours and 21% required hemodialysis.

Conclusions:

Re-HTx represents a valid treatment for patients with limited therapeutic options. However, shortage of organ availability requires careful patient selection combined with thorough perioperative management.
DRIVELINE INFECTION IN TWO CONTEMPORARY LEFT VENTRICULAR ASSIST DEVICES: A SINGLE CENTER RETROSPECTIVE ANALYSIS
Authors: Loforte A. , Monteleone G. , Spitaleri A. , Parrella B. , Aloi V. , Galanti G. A. , Abbà P. , Sandoval A. , Marro M. , Gallone G. , Boffini M. , Rinaldi M.
Published: December 2024

Background and Aim:

Driveline infection (DLI) are common adverse events in left ventricular assist devices (LVADs) leading to severe complications and re-admissions.

Methods:

The study aims to characterize risk factors for DLI at 6 months postimplant. This single-center analysis included 137 LVAD consecutive patients (n=76 HeartMate3 [HM3], n=61 HeartWare [HVAD]; male 84.7%, mean age 59.4±8.7) implanted between 2010 and 2024. Demographics, clinical parameters, surgical strategies and outcomes were retrospectively analyzed.

Results:

At 6 months of LVAD support, 6.6% of patients were readmitted for DLI, 19% experienced DLI but were treated in the outpatient setting, and 74.4% had no DLI. Among DLI patients cohort at 6 months, the analysis showed an increased rate of pre-operative bloodstream infection (mostly Gram+ Cocci; 15.6% vs. 6.7% of no-DLI cohort, respectively, p=0.003), diabetes (28.1% vs. 20.2%, p=0.038), high BMI (25.8 vs. 23.8, p=0.05) and previous cardiac surgery (18.8 vs 11.5%, p=0.045). DLI occurred more frequently in the case of ‘-shape driveline tunnelling’ technique. HM3 patients showed less rate of DLI if ‘direct driveline tunnelling’ technique was adopted.

Conclusions:

DLI remains a delicate issue to address in LVAD recipients. Pre-operative risk factors should be properly weighted. ‘Direct tunnelling’ technique for driveline placement may represent a protective factor.
THE IMPACT OF CARDIAC ARREST RESUSCITATED DONORS ON HEART TRANSPLANTATION OUTCOMES
Authors: Santamaria V. , Snaidero S. , Londi F. , Castagnini S. , Bianco E. , Barberio G. , Di Marco L. , Martin Suarez S. , Pacini D.
Published: December 2024

Background:

Heart transplantation (HTX) is the treatment of choice in patients with end-stage heart failure, even if it is still disadvantaged by lack of donor organs. The aim of this study was to compare heart transplant outcomes between recipients of hearts from cardiopulmonary-resuscitated (CPR+) donors and those from non-cardiopulmonary-resuscitated (CPR–) donors.

Methods:

This retrospective study included adults who underwent HTX at the University Hospital of Bologna from January 2006 to December 2023.We divided patients into two groups according to the history of cardiac arrest with an identified cause in donors (CPR+ vs CPR-). Survival rates were reported using Kaplan–Meier analysis and compared with the log-rank test.

Results:

A total of 402 patients were analyzed, 64 of which were transplanted with hearts from CPR+ donors. The 30-day mortality in the two groups were respectively 3.8%(CPR-) and 4.6%(CPR+). This difference was not statistically significant (p = 0.724). One and 5-year survival comparing the CPR- and CPR + groups was 82.7% versus 71.8% (p = 0.121) and 52.4% versus 48.7% (p = 0.548) respectively. There was no significant difference between the two groups in terms of postoperative incidence of renal dysfunction and intrahospital infection. Furthermore, no significant difference was found in needing of additional circulatory support with IABP or ECMO and frequency of donor organ failure.

Conclusions:

There is no evidence that cardiac transplantation outcomes and survival are adversely affected by a CPR in donors. Therefore, a history of CPR in donor should not preclude organ transplantability.
ONE YEAR OUTCOME OF A NOVEL SELF-EXPANDING TAVR IMPLANTED IN A SURGICAL SETTING
Authors: Ferrisi C. , Cammardella A. G. , Russo M. , Natale E. , Manzara C. , Pergolini A. , Belloni F. , Ranocchi F. , Chello M. , Luzi G.
Published: December 2024

Background and Aim:

Transcatheter aortic valve replacement (TAVR) represents the ideal alternative for aortic valve disease in elderly patients. The Navitor valve, a third generation self- expanding valve system from the Portico series, was designed to minimize TAVR complications. This study aimed to evaluate the outcome of patients with at least 12 months follow-up, undergone TAVR using Navitor valve.

Methods:

From September 2021 to August 2023, seventeen patients (age 85,7±3,7 y.o, 17,6% male) with severe aortic valve disease underwent transcatheter treatment.

Results:

A CT scan anatomic evaluation was performed in all patients (perimetral annulus 72,8 [68,3-77,8], annulus area 3,6 [3,3-4,1], maximum annulus size 26 [23,5-28], STJ 27 [26-30]). 15 patients required pre-dilation, using Osypka balloon. Size of implanted valve was generally high (median 27 [25-27]). In-hospital mortality was observed in 2 patients. Other adverse events included: 1 vascular complication (pseudoaneurysm), 2 permanent pacemaker implantations. No pericardial effusion or stroke occurred over a median length of stay of 3 days. At 1 year, no signs of structural valve degeneration were observed, with a mean gradient of 6,5 (6-9) mmHg, peak gradient of 11 (10-16) mmHg, valve area of 1,7 (1,6-1,9) cmq and no decline in LVEF. A total of 5 mild PVL were observed without clinical implications. No late clinical events occurred.

Conclusions:

TAVR with Navitor valve provides excellent short term results and good hemodynamic performance over the first year after implant. The acceptable rate of PVL and PMK implantation might represent an interesting finding to be investigated in larger studies.
COMPARISON OF SAVR VERSUS TAVR 5-YEAR MORTALITY IN REAL- WORLD SCENARIOS.
Authors: Scarpanti M. , Gastino E. , Dalbesio B. , Marin-Cuartas M. , Anselmi A. , Sousa Uva M. , Verhoye J. , Barili F. , Parolari A.
Published: December 2024

Purpose:

While Randomized clinical trials (RCTs) are designed to provide evidence of efficacy, real world data (RWD) shows actual effectiveness. We designed a systematic review and meta-analysis of reconstructed time-to-event data (RTE) from propensity score matching studies comparing the effectiveness of TAVR vs SAVR to assess differences in 5-year mortality.

Methods:

Using MEDLINE, Embase and CENTRAL databases from 2007 to 2023, we performed a systematic review of the literature including propensity score matching studies comparing TAVR and SAVR. The primary endpoint was the composite of all-cause mortality at follow- up. The Hazard Ratio (HR) was considered as the effect size.

Results:

Twenty-one studies were included (39538 participants). TAVR showed a higher incidence of all-cause mortality (HR 1.39; 95% CI 1.33 – 1.46, p-value < 0.001), with a significant heterogeneity (random parameter θ = 0.85, p-value < 0.001). The analysis of HR trend over time showed that TAVR superiority to surgery is limited to the first month with a steep reversal afterwards. All-cause mortality in low-risk was significantly higher in TAVR (HR 1.33; 95% CI 1.06 – 1.67, p-value < 0.001). The HR trend in the low-risk group differed from the whole population as there was no advantage of TAVR.

Conclusions:

In real-word settings TAVR is associated with a significantly higher incidence of all-cause of death while maintaining a survival benefit only in the first month after implantation. These results indicate that TAVR effectiveness may not reflect the efficacy demonstrated by RCTs and pose a serious threat to their external validity.
CARDIAC SURGERY RESIDENTS’ LEARNING CURVE OF TRANSIT TIME FLOWMETRY AND HIGH FREQUENCY EPICARDIAL ULTRASOUND IN CORONARY SURGERY: THE LEARNERS STUDY
Authors: Cammertoni F. , Di Giammarco G. , Testa N. , Pavone N. , Bruno P. , Marcolini A. , D’Avino S. , Grandinetti M. , Olimpieri A. , Massetti M.
Published: December 2024

Background and Aim:

Transit-time flowmetry (TTFM) and high frequency epicardial ultrasound (HFUS) allow intraoperative quality control in coronary surgery. Although excellent performance has been reported, their use is still limited due to a perceived complexity of the learning curve.

Methods:

The learning curve of cardiac surgery residents without previous experience was evaluated. A scoring system based on specific items was developed and an expert senior surgeon was used as benchmark. Upon reaching a pre-specified threshold score, residents were considered autonomous in the procedures and left the study.

Results:

The study is still ongoing. To date, 34 anastomoses in 14 patients (15 arterial grafts, 19 venous grafts) have been studied by 8 residents (4.3 anastomoses/resident). The pre-specified combined TTFM+HFUS cutoff score was reached by 3 out of 8 residents after a mean number of 2 cases (5.3 anastomoses/resident). The remaining 5 trainees who have not yet reached the primary end-point have studied 8 patients for a total number of 18 anastomoses (3.6 anastomoses/trainee). When analyzed separately, the secondary end-point TTFM cutoff score was reached more frequently (5/8 trainees, 2.6 anastomoses/trainee) than that of HFUS (3/8 trainees, 4.3 anastomoses/trainee).

Conclusions:

Preliminary data suggest that the TTFM and HFUS learning curve is not as steep as expected. Epicardial ultrasound could be less manageable than flowmetry but, with adequate pre-surgical training, residents can manage quickly. If the data were confirmed, the perceived complexity of TTFM and HFUS should no longer be claimed as a cause of a lack of use of these intraoperative procedures.
CAN TRANSCATHETER AORTIC VALVE IMPLANTATION BE PERFORMED WITHOUT ON-SITE CARDIAC SURGERY?
Authors: Lodo V. , Barbero C. , Zingarelli E. , Sorace R. , La Torre M. , Salizzoni S. , Centofanti P. , Rinaldi M.
Published: December 2024

Introduction:

despite lower invasivity, transcatheter aortic valve implantation (TAVI) carries a potential risk of feared intra-operative complications. Emergent cardiac surgery (ECS) should be considered a truly life-saving procedure in case of TAVI-related complications. The aim of the present analysis is to assess the prevalence and post-procedural outcomes of surgical bailout during TAVI.

Methods:

patients undergoing TAVI from September 2017 to March 2023 were enrolled from two high volume cardiac centers. All the procedures had an on-site cardiac surgeon. The primary endpoint was in-hospital mortality of TAVI patients after ECS. Secondary endpoints were intra-operative and 1-year mortality, and post-procedural complications such as acute kidney injury (AKI), stroke, myocardial infarction (MI), conduction abnormalities, need for inotropic support and intensive care unit (ICU)/hospital length of stay (LOS).

Results:

During the study period 1347 TAVI were planned. 10 patients (0,74%) reported intra- procedural complications requiring ECS. Indications for open cardiac surgery included: type A dissection (n=2), aortic annulus rupture (n=1), left ventricle perforation (n=1), right ventricle perforation (n=2), mitral valve apparatus damage (n=2), prosthesis embolization (n=2). 4 patients (40%) required post-operative inotropic support. 1 case of stroke (10%) and 1 case of AKI (10%) were reported. 3 patients (30%) developed LBBB. Median ICU and hospital length-of-stay were 4,5 (2-7,75) days and 14 (8-22) days, respectively. 1 case (10%) of in- hospital mortality was reported. 1 out of 9 discharged patients died during follow-up period.

Conclusions:

the on-site heart surgeon represents a life-saving resource for TAVI centers, and it is mandatory to achieve good post-procedural outcomes.
HOW WORTHY CORONARY ARTERY BYPASS-GRAFT SURGERY IN OLD PATIENTS IS? TWENTY YEARS SINGLE CENTER EXPERIENCE.
Authors: Nania R. , Leone A. , Mariani C. , Campanini F. , Castagnini S. , Ruggiero A. , Snaidero S. , Nocera C. , Suarez S. Martin , Pacini D.
Published: December 2024

Background:

Cardiac surgery in elderly patients is constantly growing, due to increase in life expectancy and quality of life. We retrospectively analyzed results of surgical revascularization in patients in their eighties.

Methods:

From January 2002 to December 2022, 3085 patients undergoing coronary artery bypass-graft were enrolled. Patients were divided in group I (age over 80) with 314 patients and group II (age under 80) 2462 patients.

Results:

In group I there were more female patients, less history of smoking, dialysis, acute myocardial infarction and percutaneous coronary interventions. Euroscore II was higher in group I and left main was more frequently involved. Group I showed a higher prevalence of revascularization with only great saphenous vein and off pump revascularization. In-hospital stay did not differ between the two groups (10.7± 7.1 vs 10.6 ± 6.6, p 0.8) even if neurological complications, prolonged mechanical ventilation (>48 h) and acute renal failure occurred more frequently in Group I. Inhospital mortality in group I was 4.1% vs 1.5% mostly related to complications rather than cardiac causes.

Conclusions:

Patients over eighty undergoing surgical revascularization show higher Euroscore, mainly due to the age but less comorbidities, reflecting strictly patient selection. Inhospital mortality is lower than 5%, slightly higher than younger patients. Most of deaths occurred due to non- cardiac complications which suggest the importance of preoperativepatient selection, exclusion of other therapeutic options and the relevance of postoperative care. Therefore, surgical revascularization remains a worthy option in selected elderly patients with good results.
THE PRIORITY STUDY - PREDICTING LONG TERM OUTCOMES AFTER ISOLATED CORONARY ARTERY BYPASS SURGERY
Authors: Porcedda F. , D’Errigo P. , Vitale N. , Baglio G. , Duranti G. , Lora Ronco L. , hafdhullah M. , Parolari A. , Barili F. , Rosato S.
Published: December 2024

Aims:

The PRIORITY (PRedictIng long term Outcomes afteR Isolated coronary artery bypass surgerY) project aims to improve predictions for long-term outcomes after isolated coronary artery bypass grafting (CABG) by identifying pre-operative risk factors for 10-year mortality and MACCE.

Materials and Methods:

The project is an observational cohort study merging two prospective multicenter studies conducted in 2002-2004 and 2007-2008 on isolated CABG. Follow-up information was obtained through administrative databases and was truncated at 10 years after the intervention. The primary outcome was long term mortality and the secondary outcome a composite of Major Adverse Cardiac and Cerebrovascular Event (MACCE).

Results:

The study cohort included 10,989 patients with complete 10-year follow-up. We analyzed the relationship between 10-year all-cause mortality and major risk factors, which were LVEF <30% (HR 2.290, 95% CI 1.947-2.694), treated diabetes (HR 3.166, 95% CI 2.307-4.343), and cirrhosis (HR 3.898, 95% CI 2.087-7.281). Cox semi-parametric analysis showed that preoperative comorbidities and baseline characteristics relate to 10-year MACCE, with LVEF <30% (HR 1.606, 95% CI 1.390-1.855), dialysis (HR 2.522, 95% CI 1.873-3.396), and cirrhosis (HR 1.930, 95% CI 1.092-3.409) as high-risk factors. External validation of the reduced model demonstrated good calibration and discrimination (Integrated Time-dependent AUC 0.753).

Conclusion:

This predictive model provides a valuable tool for estimating 10-year mortality and MACCE in CABG patients. The strength of this model lies in its validation with an external cohort. Future prospective studies could further establish its utility, integrating it into clinical decision-making to improve patient care and optimize outcomes.
LEFT VENTRICULAR EJECTION FRACTION IN THE EARLY POST-OPERATIVE PHASE: COMPARATIVE RESULTS OF CRYSTALLOID AND BLOOD-BASED CARDIOPLEGIA SOLUTIONS
Authors: Coli M. , Zito F. , Ciani C. , Amicizia S. , Bianchini R. , Capuano F. , Roscitano A. , Merico E. , Spitaleri P. , Melina G.
Published: December 2024

Background and Objective:

Cardioplegia solutions provide effective myocardial protection during on-pump cardiac surgery. Both cold crystalloid, such as Del Nido, and blood-based, such as Calafiore solutions are widely used. However, the impact of cardioplegia selection on early post-operative global systolic function has yet to be fully assessed. Therefore, this study aimed to investigate the outcome of left ventricular ejection fraction (LVEF) after different cardioplegia solutions in adult patients undergoing on- pump cardiac surgery.

Methods:

Adult patients undergoing on-pump cardiac surgery were included and divided into groups based on the selected cardioplegia, GROUP-1: Del Nido, GROUP-2: Calafiore. LVEF was assessed by echocardiographic evaluation before and after surgery, and the difference (delta) between these values was calculated. A multivariable linear regression was performed to estimate the effect of cardioplegia selection on the delta variation in LVEF (DLVEF).

Results:

This study included 212 patients, 28% female, median age of 70 years [IQR:63.0-74.0]. No significant differences in baseline characteristics were observed, except for peripheral vasculopathy (p=0.031). Additionally, the types of surgery performed were comparable between the two groups (p=0.909). Post-operative LVEF was 55% [IQR:51.0-60.0] in GROUP-1 and 57%[IQR:51.0-63.0] in GROUP-2(p=0.036), with a DLVEF of +1.01[-3.2-6.0] in GROUP-1 and -2.00 [IQR:-9.0-4.0] in GROUP-2(p<0.001). Multivariable regression analysis (R2 = 0.48) showed an increase β +3.21 in DLVEF in patients receiving Del Nido cardioplegia (p=0.002). No difference in early mortality was found between the two groups.

Conclusions:

This study shows Del Nido cardioplegia to be associated with a potential better preservation of LVEF in the early post-operative phase.
PREOPERATIVE PLANNING OF MINIMALLY INVASIVE MITRAL VALVE SURGERY THROUGH DEEP-LEARNING
Authors: Evangelista G. , Lyu S. , Simon A. , Berhoye J. P. , Haigron P. , Anselmi A.
Published: December 2024

Background:

Minimally invasive mitral valve surgery is increasingly adopted worldwide. Patient selection and preoperative surgical planning are crucial to allow the best postoperative outcomes. We propose a novel preoperative planning approach based on Deep-learning techniques, aimed at the identification of the most appropriate thoracic access for minimally invasive mitral valve surgery in a patient-specific fashion.

Materials and Methods:

A public Deep-Learning medical segmentation with a public dataset (TotalSegmentator) was employed. Our algorithm consisted of four steps: localization of mitral valve, calculation of the distance from mitral valve and thoracic cage, calculation of the angle between mitral valve plane and surgeon’s exposition, absence/presence of ribs. We conducted a validation process guided by a cardiac surgeon.

Results:

The evaluation of the deep-learning derived planning was performed on the basis of differences in thoracic distances and of angular discrepancy vs. the semiautomatic method. Finally, we defined two interfaces to navigate among candidate working ports. In the first interface it is possible to give greater importance to the distance or the angle according to surgeon’s choice. In the second interface, this choice is fixed as a preliminary setting.

Conclusion:

This tool may help the surgeon to identify the most appropriate working port for minimally invasive mitral valve surgery, and to predict the features of different candidate thoracic accesses in individual patients. It can also help standardizing the preoperative planning and obtaining a faster learning curve for trainee surgeons. This work is seminal, and represents an initial step towards a comprehensive planning tool for this surgery.
DIGITAL HEALTH FOR HEART TRANSPLANT RECIPIENTS AND LVAD PATIENTS: A NEW PARADIGM OF HOME CARE
Authors: Tessari C. , Vecchiato M. , Gasperetti A. , Andreis M. , Francini Pesenti F. , Cavalli C. , Mastro F. R. , Pradegan N. , Bacich D. , Toscano G. , Tarzia V. , Gerosa G.
Published: December 2024

Background and Aim:

Digital health through mobile applications and wearable devices can be a valid tool to improve outpatient follow-up. We started a program (CURE-AT-HOME) to promote healthy lifestyles, physical activity, dietary guidelines, and encouraging self-monitoring for heart transplant recipients (TCOp) within their first year post-transplant and for LVAD (Left-Ventricular-Assist- Device) patients (LVADp). This includes multidisciplinary approach and providing them with a multidisciplinary evaluation and a dedicated mobile App. The aim of this study is to present 6- month follow-up results.

Methods:

Observational study of clinical, instrumental, metabolic, and psychological outcomes at 6- month following the initiation of CURE-AT-HOME. Multidisciplinary assessments were conducted at baseline(T0) and every six months thereafter. At each timepoint, clinical parameters, cardiopulmonary exercise testing, metabolic profile, and questionnaires including SF-36 and HADS were assessed.

Results:

A total of 16 TCOp and 10 LVADp were enrolled (January2023-January2024), of which 10 TCOp and 6 LVADp reached 6-month follow-up(T6). Between T0 and T6, the median BMI of both groups remained within the normal range. Three TCOp were identified as having new- onset diabetes at T0 and were initiated on a specialized care. An increase in terms of relative VO2(TCOp:18.06vs20.13 ml/kg/min; LVADp:13.65vs13.83 ml/kg/min) and power output was observed (TCOp:94vs114 Watt; LVADp:76 vs 76.50 Watt), with an overall increase of 0.6 MET. At T6, a good quality of life was reported in both the physical and emotional components. These were no adverse events requiring hospitalization.

Conclusions:

The preliminary results of CURE-AT-HOME demonstrated an increase in functional capacity, a metabolic status and clinical improvement and enhanced quality of life in both groups.
HOW PREVIOUS PERCUTANEOUS CORONARY INTERVENTION (PCI) INFLUENCE OUTCOMES IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING (CABG)?
Authors: Saitto G. , D’Ovidio M. , Cammardella A. , Comisso M. , Russo M. , Chirichilli I. , Nicolò F. , Irace F. , Tramontin C. , Lio A. , Pinnarelli L. , Davoli M. , Ranocchi F.
Published: December 2024

Aim:

Benefits of CABG, over Percutaneous Coronary Interventions (PCI) has become more firmly established in patients with diabetes, multivessel disease and impaired ventricular function. Given the spread of PCI, it is increasingly common to find a patient requiring CABG with previuos PCI (up to 20%), Robust data in patients undergoing CABG with previuos PCI is weak. The aim of the study is to investigate the impact of a previous PCI on the outcome of CABG in the real word.

Methods:

We retrospective analysed 20337 CABG operations performed in an Italian Region, Lazio, using a regional administrative dataset. Follow up were 100% completed and certified.

Results:

Between 2008 and 2022, a total of 20.337 patients were enrolled: 19148 had no previous PCI and 1189 with previous PCI. At baseline patients with previous PCI were younger (64+10 vs 67+9.5 yo, p<0.05), with an higher risk profile: diabetes (27.25 vs 21.61%, p<0.0001), cholesterol disorders (28,7% vs 17.46%, p<0.0001), hypertension (53.99 vs 36.72.6%, p<0.0001), COPD (4.96 vs 3.78%, p<0.0001), heart failure (11.61 vs 7.35%, p>0.0001). These data could be explained considering the failed PCI and so a higher profile risk.

Previous PCI was not associated with adverse outcomes in early and long term follow up, in all LVEF class. Long term results were remarkable in our series.

Conclusions:

Our data suggest that previous PCI, although the technical difficulties, could not be considered an independent for CABG that could guarantee a very low early and long term mortality, even in case of low LVEF.
TAKOTSUBO SYNDROME IN A PATIENT TRANSPLANTED WITH SCA: A CASE REPORT
Authors: Passaro M. , Palmieri L. , Mattucci I. , Marra C. , Amarelli C. , De Feo M.
Published: December 2024

Introduction:

In patients undergoing orthotopic cardiac transplantation (OHT), the outcome following acute coronary syndrome (ACS) is significantly worse than in patients with native heart. However, there is a lack of data in the literature on the incidence and outcome of SCA in the absence of angiographically significant coronary disease (MINOCA).

Method:

A 75-year- old woman, who underwent OHT in 2010, entered the PS for oppressive chest pain associated with dyspnea and paresthesia in the upper left limb. The ECG of entry showed widespread abnormalities of ventricular recovery, with negative T waves in D1, aVL, V4-V6. The echocardiographic observation performed in PS showed a severe reduction of EF (38%) with acinesia of the toto apex and middle segments of the interventricular septum and posterior wall. In laboratory tests, increased levels of myocardionecrosis enzymes were observed.

Results:

The patient underwent coronary angiography, which concluded for “atheromasic epicardial coronaries, in the absence of angiographically significant lesions”. He performed cardiac NMR in the following days, which showed tissue characterization images compatible with the presence of diffuse phlogy involvement of the middle-ventricular segments of the left ventricle in the absence of necrosis areas. These morpho-functional and tissue elements were consistent with the clinical suspicion of stress-syndrome cardiomyopathy of Takotsubo.

Conclusions:

Takotsubo syndrome is a rare but possible cause of SCA in patients undergoing OHT. A possible cause has been identified in an altered reinnervation of the transplanted heart, with imbalance between sympathetic and parasympathetic nervous system and consequent excessive release of catecholamines.
WARM BLOOD CARDIOPLEGIA VERSUS COLD CRYSTALLOID CARDIOPLEGIA IN PATIENTS AFFECTED BY ACUTE CORONARY SYNDROMES UNDERGOING CORONARY ARTERY BYPASS GRAFTING
Authors: Nardi P. , Buioni D. , Bonavita F. , Franceschini G. , Cardenas J. , Fasano J. , De Felice L. , Greco N. , Bonarrigo S. , Olia S. , Ajello V. , D’Onofrio A.
Published: December 2024

Aim:

We investigated in a single-center retrospective study early outcomes of intermittent warm blood and cold crystalloid St. Thomas cardioplegia in patients referred to CABG due to acute coronary syndromes.

Methods:

336 consecutive patients underwent isolated on-pump CABG (unstable angina=234, N-STE-MI=66, STE-MI=36). Cardiac arrest was obtained with warm blood cardioplegia (WBC-group=215) or cold crystalloid cardioplegia (CCC-group=121).

Results:

Baseline and preoperative characteristics including serum levels of CK-MB and C- Troponin-I enzymes were similar in two cardioplegia groups. As compared with CCC-group, required number of cardioplegia’s doses per-patient was higher in WBC group (2.6±0.8 vs 2.1±0.8; P<0.0001), despite lower number of distal coronary-artery anastomoses (2.8±0.7 vs 3.0±0.8; P=0.027), and shorter aortic cross-clamp time (60.0±20.5 vs 66.7±20.5 min.;P<0.01). Completeness of revascularization was similar (100% vs 98%). Operative mortality (3.3% vs 1.4%), low cardiac output syndrome (5.8% vs 4.6%), postoperative left-ventricular ejection fraction (0.52±0.07 vs 0.53±0.07) were similar. CK-MB and C-troponin-I releases were similar for two cardioplegia groups at time 0, 12 hours and 24 hours after CABG. C-Troponin-I and CK:MB releases at time 0, 12 and 24 hours were lower when WBC was repeated within 18 min. in comparison with 20–25 min. (P</=0.05,for all comparisons). As well as, CK-MB/CPK- total ratio>5% was significantly lower at 12 and 24 hours when WBC administration was repeated within 18 min. Cross-clamp time (64.2±21.6 vs 65.2±29.5 min.) did not significantly correlate with CK-MB/CPK-total ratio>5% compared with lower ratios.

Conclusions:

Both types of cardioplegia guarantee equivalent early outcomes in patients undergoing CABG for acute coronary syndromes. WBC allows better protection when administered in 18-minute re-dosing interval.
THE EXPANDING ROLE OF 16S RIBOSOMAL RNA PCR IN THE MANAGEMENT OF PATIENTS WITH INFECTIVE ENDOCARDITIS UNDERGOING CARDIAC SURGERY
Authors: Cammertoni F. , Pavone N. , Bruno P. , Calabrese M. , Scoppettuolo G. , Lombardo A. , Fiori B. , D’Acierno E. , Cutrone G. , Massetti M.
Published: December 2024

Background and Aim:

Molecular tests on blood are effective in identifying the causative organism and they are recommended when blood cultures are negative. However, the role of molecular tests on the surgically excised valve is still unclear.

Methods:

In this prospective, observational, single center study, we enrolled 100 consecutive patients with infective endocarditis who underwent cardiac surgery between April 2020 and June 2023. Results of preoperative blood cultures (BC), valve culture (VC), 16 s ribosomal RNA and histopathologic analysis of surgical samples were collected.

Results:

The mean age of the study population was 60±12.5 years. Overall, BC VC and 16srRNA were positive in 83%, 47%, and 76% of cases, respectively. Sensitivity of both valve culture and 16srRNA decreased significantly with prolonged preoperative antibiotic therapy. Of note, 16srRNA was the only positive result in 7% of cases, allowing aetiological diagnosis. In 33% of patients, the VC test was negative while the molecular test was positive. In these cases, histopathological analysis showed acute inflammation in most cases. In 12.5%, the molecular test clarified discrepancies between blood and valve cultures.

Conclusions:

Molecular test showed higher diagnostic sensitivity than VC, even after 28 days of preoperative antibiotic therapy. Besides identifying the pathogen in 7% of cases with negative culture results, the molecular test demonstrated utility in other crucial situations. When VCs were negative, combining molecular testing and histopathological analysis they allowed the identification of patients who could benefit from prolonged antibiotic therapy. In addition, molecular testing solved discrepancy between blood culture and valve culture results.
AORTIC VALVE REPLACEMENT VERSUS BALLOON EXPANDABLE AND SELF EXPANDABLE TRANSCATHETER AORTIC VALVE IMPLANTATION IN LOW-RISK PATIENTS
Authors: Lodo V. , Italiano E. G. , Weltert L. , Zingarelli E. , Viscido C. , Buono G. , Centofanti P.
Published: December 2024

Background and Aim:

in patients with symptomatic aortic stenosis, TAVI has emerged as an attractive alternative to surgery. However, TAVI carries an increased risk of conduction abnormalities and para-valvular leak (PVL) which may generate some concerns with the extension of TAVI indication to patients with longer life-expectancy. The aim of this study is to compare post-procedural outcomes and 5-year survival of low-risk patients who underwent SAVR vs balloon expandable (BE) or self expandable (SE) TAVI

Methods:

542 patients, undergoing SAVR (n=221), BE TAVI (n=150) or SE TAVI (n= 171), from 09/2017 to 12/2022 were enrolled. Elegible patients were aged between 70 and 85 years with low surgical risk and isolated severe AS. The primary end-point was 5-year all cause mortality. To compare patients with similar baseline characteristics a propensity score matching was performed

Results:

before matching, TAVI patients were older and with a higher Euroscore II. SAVR patients showed a significantly higher incidence of post-procedural AKI, whereas SE patients had a higher incidence of conduction abnormalities, stroke and PVL than surgical and BE TAVI patients. After matching, surgical and BE TAVI patients showed a lower incidence of stoke (2,3%-0%vs6,3%, p=0,045), LBBB (0/18,2%vs25%, p<0,001) and PVL (0/2,4%vs8,1%, p=0,017) when compared to SE TAVI. 5-year mortality was significantly higher in SE TAVI patients when compared to surgical patients, while no significant difference was reported between BE TAVI and SAVR patients.

Conclusion:

BE prosthesis should be considered the prosthesis of choice for patients with long life-expectancy requiring a transcatheter procedure.
SURGERY FOR HEART VALVE DISEASE SECONDARY TO NEUROENDOCRINE TUMORS
Authors: Iennaco V. , Zanobini M. , Biancari F.
Published: December 2024

Background:

Neuroendocrine tumors (NET) are known to be associated with development of heart valve disease, the Hedinger syndrome. This is due to the release of vasoactive substances inducing endocardial plaques of fibrous tissues. The disease may be associated with increased mortality.

Methods:

Herein we analyzed the early and mid-term outcomes of patients who underwent surgery for NET-related heart valve disease at our Institution from March 2019 to March 2024.

Results:

The present study includes 11 consecutive patients with a mean age of 66.2±7.0 years, of whom eight (72.7%) patients were females. Ten patients underwent replacement of the tricuspid valve, and 6 patients underwent replacement of the pulmonary valve. None of the patients underwent surgery for aortic valve or mitral valve disease. One patient underwent concomitant coronary surgery. One (9.0%) patient died during the index hospitalization because of sepsis. None of the other patients experienced neurological complications, severe bleeding or stage 3 acute kidney disease. At 3-year, all-cause mortality was 57.6%.

Conclusions:

Surgery for NET-related heart valve disease is associated with relatively low risk of early mortality and morbidity, but in this series more than half of patients have died at 3-year.
POSTINFARCTION VENTRICULAR SEPTAL DEFECT: RISK FACTORS FOR WORSE OUTCOME, A MULTICENTRIC INTERNATIONAL STUDY.
Authors: Di Marco L. , Cavalli G. G. , Nania R. , Affronti A. , Matteucci M. , Pollari F. , Pacini D. , Castagnini S. , Piperata A. , Sponga S. , Coppetti S. , Vendramin I.
Published: December 2024

Background and Aim:

Even in the percutaneous coronary intervention era, surgery still remains the treatment of choice of ischemic ventricular septal defect. Most of the previous data come from single centre studies. The aim of our study was to investigate risk factors for worse outcome.

Methods:

We conducted a retrospective, multi-center study. One-hundred eleven patients from four centers, who underwent surgery for a post-myocardial infarction ventricular septal defect in the period 2001-2021, were enrolled. The study was conducted on behalf of the Gruppo Italiano di Ricerca sugli Outcome in Cardiochirurgia.

Results:

Early timing of surgery (p-value 0.248), concomitant surgical intervention (p-value 0.121), pre- operative cardiac arrest (p-value 0.150), emergency surgery (p-value 0.888) were not statistically associated with a worse outcome. Serum creatinine (p-value 0.025), pre-operative implant of intra-aortic balloon pump (p-value 0.015) and, notably, bleeding during the first 48 hours (p- value0.026) were higher in the in-hospital death group. Overall, in-hospital mortality was 39% (44 patients).

Conclusions:

Despite high risk and high mortality rate, surgery still remains the treatment of choice for post- infarction ventricular septal defect. Bypassing the bias of a single centre evaluation, our results seem to suggest that regardless of the institution, early surgery, concomitant surgical procedure, emergency surgery, pre-operative cardiac arrest are not linked to a worse outcome, while renal impairment, pre-operative intra-aortic balloon pump and bleeding during the first 48 hours are related to in-hospital mortality.
LATE CLINICAL AND HEMODYNAMIC COMPARISON OF TWO INNOVATIVE AORTIC VALVE BIOPROSTHESES: INSPIRIS RESILIA VS AVALUS
Authors: Mazza A. , Chiariello G. A. , Villa E. , Bruno P. , D’Avino S. , Cutrone G. , D’Acierno E. , Pasquini A. , Massetti M.
Published: December 2024

Background:

In recent years, the increasing use of biological prostheses for surgical aortic valve replacement (AVR), has led to the development of new devices with improved hemodynamics and expected durability.

Methods:

In this observational retrospective two-center cohort study, two innovative bioprostheses, INSPIRIS Resilia and AVALUS were analyzed. We analyzed early and 3.2-year follow-up results in terms of safety, clinical outcome and hemodynamic performance.

Results:

From November 2017 to February 2023, 178 patients underwent AVR with INSPIRIS Resilia (N=88) or AVALUS (N.=90) bioprosthesis. The 30-day and mid-term mortality was comparable (1% vs. 3%, P=0.1 and 7% vs. 5%, P=0.7, respectively). Valve-related mortality was observed in one AVALUS patient. 5% patients of the AVALUS group developed prosthetic endocarditis and two of them died after reoperation. No other cases of prosthetic endocarditis were observed. No cases of structural valve degeneration or significant paravalvular leak were detected at follow-up. Median follow-up peak pressure gradient was 22 vs. 20 mmHg (P=0.5) and the mean pressure gradient was 13 vs. 14 mmHg (P=0.9) for Inspiris and AVALUS, respectively. The effective orifice area (EOA) and indexed EOA were 1.4 cm2 vs. 1.3 cm2 (P=0.4) and 0.7 vs. 0.6 cm2/m2 (P=0.5), respectively. Indexed left ventricular mass regression was -32 vs. -50 g/m2 for the Inspiris and AVALUS groups, respectively (P=0.001)

Conclusions:

INSPIRIS Resilia and AVALUS bioprostheses were reliable with comparable results in terms of safety, clinical outcome and hemodynamic performance. After statistical adjustment, AVALUS was associated with better left ventricular mass reduction. Long-term follow-up would provide definitive comparative results.
EARLY RESULTS OF MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT VIA PARTIAL STERNOTOMY OR RIGHT THORACOTOMY: INSIGHTS IN ACUTE KIDNEY INJURY
Authors: Squiccimarro E. , Margari V. , Visicchio G. , Kounakis G. , Pascarella C. , Carbone C. , Paparella D.
Published: December 2024

Background and Aim:

Minimally Invasive Aortic Valve Replacement (MI-AVR) offers outcomes comparable to conventional sternotomy, with increased adoption due to fewer complications. Comparisons between partial sternotomy (PS) and right thoracotomy (RT) in MI-AVR are limited. This study aims to compare the short-term clinical outcomes of these two approaches.

Methods:

We retrospectively reviewed patients who underwent isolated MI-AVR at Santa Maria Hospital, Bari, from 2017-2023. The primary outcome was 30-day mortality. Secondary outcomes included early postoperative results, acute kidney injury (AKI) as per KDIGO classification, and other complications. Multivariate logistic regression identified predictors of AKI, presented as odds ratios (OR) with 95% confidence intervals (CI).

Results:

Among 334 patients, 289 (86.5%) underwent PS, and 45 (13.5%) received RT. The overall 30-day mortality was 0.9%, with no difference between groups. AKI occurred in 40 cases (12.0%): 39 in the PS (13.5%) and 1 in the RT groups (2.2%) (p=0.026). Most AKIs (60%) were stage 1. The multivariate model showed a borderline non-significant association between PS and AKI (OR 6.77, p=0.064). The PS group had a higher median area under the creatinine concentration-time curve (AUC) (1.64 vs. 1.21 mg/dL, p=0.005) and C-Reactive Protein AUC, despite shorter cardiopulmonary bypass (73 vs. 86 min, p=0.029) and cross- clamp times (50 vs. 63 min, p=0.001). Other major complications did not differ between groups.

Conclusion:

MI-AVR is safe and has satisfactory short-term outcomes. A non-significant trend suggested an association between PS and AKI, potentially due to higher postoperative inflammation, warranting further investigation.
SEX-RELATED DIFFERENCES AND SYSTEMIC INFLAMMATORY RESPONSE IN CARDIAC SURGERY AND CARDIOPULMONARY BYPASS
Authors: Squiccimarro E. , Lorusso R. , Margari V. , Labriola C. , Piancone F. , Rociola R. , Whitlock R. P. , Paparella D.
Published: December 2024

Background:

Women experience worse outcome after cardiac surgery, possibly linked to distinct inflammatory patterns. We ascertained how sex affects systemic inflammatory reaction syndrome (SIRS) and outcome in heart surgery patients.

Methods:

A retrospective evaluation of prospectively collected data from patients who had undergone cardiac surgery from 2018 to 2020 in a single hospital was performed. SIRS was defined as per the American College of Chest Physicians/Society of Critical Care Medicine. Multivariate logistic models were used to identify predictors of SIRS and of a composite outcome including death, transient ischemic attack/stroke, renal replacement therapy, bleeding, postcardiotomy extracorporeal membrane oxygenation or intra-aortic balloon pump, and a ICU stay >96 hours. A structural equation modeling was applied to separate the direct influence of SIRS predictors on the composite outcome from the SIRS-mediated effects.

Results:

A total of 1,005 consecutive patients were included, 299 (29.8%) were female. SIRS incidence was 28.1%, 128 (12.7%) patients experienced the composite outcome. Female sex was associated with SIRS (OR 1.56; 95% CI 1.12-2.18, p=0.009) and the composite endpoint (OR 1.72; 95% CI 1.10-2.69, p=0.017). Other common predictors were baseline left ventricular impairment and intraoperative hyperlactatemia. SIRS mediated 50.8% of the effect of sex on the outcome, 17.0% of that due to left ventricular dysfunction, and 30.9% of the effect caused by intraoperative hyperlactatemia.

Conclusions:

Female sex independently predicts postoperative SIRS and poorer outcome. Systemic inflammation, preoperative anemia and procedural hyperlactatemia are key factors in the complex mechanisms through which female sex appears to worsen outcome after cardiac surgery.