bluuebunny/crossref_metadata_2025 huggingface dataset:
OC49 NEW HEMODYNAMIC INDEX TO IDENTIFY DIFFERENT PROFILES IN PATIENTS IMPLANTED WITH HM3
Authors: Montalto A. , Piazza V. , Cammardella A. , Comisso M. , Contento C. , Vitalini E. , Musumeci F.
Published: November 2018

Introduction:

LVAD (Left Ventricle Assist Device) represents a valid alternative to heart transplantation in patients who suffer from end stage heart failure. The ventricular devices show a different performance related to preload, afterload and the fixed setted revolutions per minute (RPM). Our main intention was to introduce a new hemodynamic index that accounting for the RPM setted, can easily identify different hemodynamic profiles occurring during LVAD support.

Methods:

From november 2015 to march 2018, 19 patients implanted with HM 3 underwent ramp tests during right heart catheterization. Basal data were collected and Hemodynamic Index (HI) was calculated according to the following formula: HI = {[PAM - PCWP]/CVP}∗ {[RPM SETTED∗100]/MAX RPM} where the first term is the ratio between afterload and preload and the second term means the ratio between the RPM setted and the maximal rpm available.

Results:

Basal HI was 455 ± 142. In 8 patients (42%) an index less than 400 was found. Three main profiles could be identified. Profile 1 HI less than 300 and higher risk of right failure. Profile 2 HI between 300 and 600, requiring speed optimization, Profile 3 HI> 600 requiring afterload optimization. After a tailored therapy including speed and anti hypertensive optimization a better HI (583 ± 224)was obtained.

Conclusion:

RPM should be setted balancing an optimal unloading with adequate afterload and preload and accounting for the right ventricular function. We proposed a new hemodynamic index that integrating different variables can stratify patients in three main profiles according to which the best treatment can be provided.
OC73 SYSTEMATIC REVIEW OF THE PREDICTIVE ACCURACY OF POINT OF CARE TESTS OF COAGULOPATHY IN CARDIAC SURGERY
Authors: Corazzari C. , Monaghan A. , Tutino C. , Murphy G. , Beghi C.
Published: November 2018

Background:

Coagulopathic haemorrhage is a common and serious complication of cardiac surgery.

Timely diagnosis and treatment of coagulopathy is considered an important determinant of outcome. The aims of the review were to quantify and compare the predictive accuracy of POC tests in clinical use.

Methods:

Observational studies and randomized controlled trials that report measures of predictive accuracy for POC tests that are, or have been used clinically for the diagnosis and treatment of coagulopathic haemorrhage.

Results:

56 studies recruiting a total of 9123 participants, met the inclusion criteria for the qualitative analysis and 15 studies were included for quantitative analysis.

We have shown that the existing evidence is of insufficient quality to determine the predictive accuracy of point of care diagnostic tests.

The point estimates of the Summary AUCROC analyses and the analysis of sensitivity and specificity estimates from individual studies suggested that: Viscoelastic tests had low sensitivity and high specificity, Platelet Function Tests had low sensitivity and moderate specificity, and combined Viscoelastic and Platelet Function tests had high sensitivity and low specificity. However there was great uncertainty around all of these estimates and the 95% margins of uncertainty included values less 0.5 in every analysis. Calculated diagnostic odd ratios also indicated poor predictive accuracy for all of the groups.

Conclusions:

Coagulopathic haemorrhage remains a common and severe complication of cardiac surgery. A systematic review of available evidence did not demonstrate predictive accuracy for point-of-care tests in clinical use for the diagnosis of coagulopathy in cardiac surgery.
VD12 HYBRID TOTAL ENDOVASCULAR AORTIC REPAIR WITH CHIMNEY TECHNIQUE
Authors: Jiritano F. , Perri P. , Molinari V. , Esposito A. , Garrasi C. , Serraino G.F. , Intrieri F. , Mastroroberto P.
Published: November 2018

Total endovascular techniques, such as fenestrated and branched techniques, provide a less invasive and safer solution to aortic arch diseases in high risk patients. We report the case of a 69-year old Marfan's syndrome female with a post-dissection aortic arch aneurysm. Previously, the patient underwent Bentall procedure and an endovascular stenting for right renal artery aneurysm. Computed tomography angiography revealed a dissecting aneurysm of aortic arch and supra-aortic branches perfused by the true lumen. Hybrid repair of the dissection was considered primarily; however, the patient refused sternotomy. We fixed the aneurysm using TEVAR and used the chimney technique to reconstruct the supra-aortic vessels. Final control angiography confirmed complete exclusion of the aortic arch injury and the patency of the supra-aortic branches. We repaired also the abdominal aortic aneurysm performing an EVAR procedure. The patient is doing well after 3-months follow-up. Endovascular procedures can be used successfully for dissecting aortic aneurysm.
VD20 TWO-STAGES POSITIONING AND INFLATION OF THE BALLOON EXPANDING THE BIOPROSTHESIS IN TRANSCATHETER AORTIC VALVE IMPLANTATION IN A SMALL PORCELAIN AORTA
Authors: manzan E. , prestipino F. , miele M. , d’ascoli R. , luzi G.
Published: November 2018

We propose a two-stages positioning and inflation of the balloon expanding the Edwards SAPIEN 3 prosthesis during Transcatheter Aortic Valve Implantation (TAVI) in case of a small porcelain aorta, to avoid aortic root (AR) rupture.

We scheduled for Trans-apical TAVI an 85-year-old high-risk woman with a narrow and heavily calcified AR (19 × 20 mm at sino-tubular junction). A 23 mm Edwards Sapien3 prosthesis was directly implanted (without pre-valvuloplasty). First balloon-dilatation was performed in standard position till 70% of nominal inflation volume, in order to hook the prosthesis within the native calcified valve in the correct position. Then the balloon was completely deflated and withdrawn down into the left ventricle, with the distal tip just below the calcified and small aortic sino-tubular junction. In this position, a second balloon-dilatation was performed till 100% of nominal inflation volume to complete prosthesis expansion. Peri-operative trans-esophageal echocardiography showed no paravalvular leak and good trans-prosthesis gradients.
VD02 A ROLLER COASTER MEDIAN STERNOTOMY
Authors: Agostara V. , Torre S. , Mangerini V. , Territo S. , Castrovinci S. , Triolo F. , Argano V.
Published: November 2018

Pectus arcuatum, also known as Currarino-Silverman syndrome or pouter pigeon breast, is a rare disorder characterized by premature fusion of manubrio-sternal joint and the sternal segments. This condition may cause an abnormally short sternum with forward angulation at the Louis's angle resulting in a severely protruding upper sternum combined with depressed lower sternum.

Pectus arcuatum may be associated to cardiac diseases requiring surgery. Access to the heart may be complicated by the chest wall deformity.

In this video we present a case of a 75 years-old man who suffered from ACS-NSTEMI with coronary disease and pectus arcuatum. An off-pump single CABG using LIMA to LAD was peformed. SVG interposition was necessary due to difficult mammary harvesting in the protruding upper sternum. Here is shown the access to the mediastinum by an oscillating sternal saw, the application of a small sternal retractor, the pericardial opening and chest closure.
EP23 MINIMALLY INVASIVE MITRAL SURGERY THROUGH A RIGHT VERTICAL AXILLARY MINITHORACOTOMY: PRELIMINARY EXPERIENCE
Authors: Nicolardi S. , Mangia F. , Scrascia G. , Gallo A. , Amorese L. , Pano M. , Fellini P. , Rocco D. , Quacquaro A. Scotto di , Zaccaria S. , Greco C.A. , Casali G.
Published: November 2018

Background and Aim:

right antero-lateral minithoracotomy through the 3rd or 4th intercostal space is the classic approach for minimally invasive mitral surgery. We report our experience with an alternative and more cosmetic minimally invasive port-access through a right vertical axillary minithoracotomy (RVAMT).

Methods:

between July 2016 and April 2018, 60 patients (32 females and 28 males, mean age 66.2 ± 11.1 years) underwent mitral valve surgery through a RVAMT. Forty-six mitral valve repairs were performed, 4 associated to tricuspid repair. Only 14 pathological mitral valves have been replaced. RVAMT was performed by a 5–6 cm incision through the 4th intercostal space placed vertically along the antero-axillary line rather than antero-laterally along the intercostal space. All surgical procedures were performed without an endoscopic system.

Results:

mean CPB time and aortic cross clamp were 130.2 ± 26.1 minutes and 90.6 ± 16.6 minutes, respectively. There was no approach-related limitation to surgical exposure. Bleeding requiring surgical revision occurred in two patients. Median intensive care unit stay and mean mechanical ventilation time were 24 and 8.3 ± 5.4 hours, respectively. In-hospital mortality was 1.7% (1/60 patients). Overall survival at 6 months follow-up was 100%.

Conclusions:

RVAMT is a safe alternative, reproducible, cosmetic and minimally invasive approach for mitral valve surgery. It provides an optimal surgical viewing perpendicular to the mitral plane with satisfactory valve exposure and the possibility to perform surgery under direct vision. The cosmetic advantage of the RVAMT is the short incision under the armpit that is often invisible.
EP05 A RARE CASE OF SACCULAR SUPERIOR VENA CAVA ANEURYSM
Authors: Di Benedetto G. , Coronella G. , Giordano S. , Provenzano R. , Oliviero P. , La Marca A. , Bellino I. , Pepino P.
Published: November 2018

Background And Aim:

We present a rare case of SVC saccular aneurysm in a 60 year-old-female presenting at outpatient clinic with chest pain due to a recent chest trauma and occasional finding of mass at chest radiography. Considering the small amount of similar cases collected in literature we describe the diagnosis iter, surgical management and outcomes.

Methods:

Chest CT-scan was done with contrast showing a contrast filled mass adjacent to the ascending aorta (40 mm × 60 mm -neck diameter 30 mm). Off pump surgery was performed by SVC saccular aneurysm excision through a median sternotomy. After the pericardial incision and longitudinal right pleura opening to dissect the saccular aneurysm, the neck of the sac was encircled with silk 0 to exclude the aneurysm. After opening of the aneurismatic wall the aneurysm was resected and the aneurysmatic neck closed with a 4/0 prolene double running suture.

Results:

After an uneventful postoperative period of 24 hours in ICU the patient was discharged in 5th postoperative day on antiplatelet drugs. Ct-scan after surgery showed a regular profile of superior vena cava.

Conclusions:

CT scan is crucial to identify a contrast enhancing lesion adjacent to the ascending aorta. Fusiform aneurysm can be managed medically while saccular aneurysm needs surgical treatment in order to avoid complications due to pulmonary embolism and aneurysm rupture. Surgery can be performed safely off pump in case of not complicated aneurysm while has to be managed on pump in presence of thrombi, calcification or big neck dimension related to the aneurysmatic sac.
EP14 FLUID MANAGEMENT PROTOCOL APPLICATION WITH COLLOIDS ABOLITION REDUCES RE-EXPLORATION FOR BLEEDING AND BLOOD PRODUCTS USE IN CARDIAC SURGERY PATIENTS
Authors: Scrascia G. , Nicolardi S. , Panzera D. , Amorese L. , Pano M.A. , Mangia F. , Gallo A. , Fellini P. , Rocco D. , Cazzato M. , Quacquaro A. Scotto di , Zaccaria S. , Cucurachi M. , Greco C.A. , De Razza L.P. , Casali G.
Published: November 2018

Background and aim:

Colloids administration has been associated with post-operative acute kidney injury and bleeding. Aim of the study is to evaluate if the incidence of re-exploration for bleeding was modified by application of perioperative fluid management protocol with careful balanced crystalloids infusion and colloids administration abolition.

Methods:

We retrospectively analysed data collected in the Institutional database. 784 patients were considered in the analysis. 459 patients (Group A) underwent cardiac operations before perioperative fluid management protocol was strictly applied and 325 patients (Group B) underwent cardiac operations after protocol application.

Results:

No differences were found for pre-operative characteristics except for hypertension and NYHA class (higher in A Group). Intraoperative variables were similar in both groups. No differences were found between groups for post operative complications, except for the incidence of re-exploration for bleeding (4.3% vs 1.5%; p:0.02), time on mechanical ventilation (31.3 vs 13.4 hours; p:0.006), sternal wound infection (3.9 vs 0.3%; p:0.02), post-operative pneumonia incidence (2.9 vs 0%; p:0.01), mean RBC units transfused (3.8 vs 2.6 Units; p:0.03) and numbers of patients receiving fresh frozen plasma transfusions (13.7% vs 3.7%; p:0.02), which were higher in Group A.

Conclusions:

Fluid management protocol application and colloids avoidance significantly reduce re-exploration for bleeding and post-operative blood products use after cardiac surgery.
EP40 UNINTENTIONAL RETENTION OF FOREIGN OBJECTS IN SURGICAL SITES
Authors: Tiraforti S. , Cappelletti M.F. , Lorenzini M. , Biagini S. , Baroni M.
Published: November 2018

Background and Aim:

The unintentional retention of foreign objects in surgical patients represents a known event and is reported in literature, Italian Ministry of Health Recommendation No. 2, 2008 estimated that this occur once every 1000 - 3000 surgical procedures per year. The Recommendation provides a count of gauze and surgical instruments at the beginning and at the end of each surgical procedure. The material used in cardiac surgery comprises a variety of other small parts. We don’t know if these small parts are or not radiopaque, so we create a list of devices used to check if they were radiopaque or not. This information is useful for a possible radiographic post surgical check.

Methods:

In adult and pediatric cardiac surgery operating room, all the medical devices that are potentially at risk of retention have been reviewed, managing the indication on the label, and where not indicated, this information was provided with the manufacturer / distributor. In case it was not possible to find these information was performed a radiographic check of the materials.

Results:

A new list of material to be monitored in the pre- and post-procedure has been developed.

Conclusions:

Safety in the operating room is one of the main objectives in the quality and safety of patients. Future scenarios hope for continuous involvement by operators in detecting critical issues and signaling events by optimizing the pathways on health care.
EP15 HOW I DO IT: A BROADEN “COMMANDO PROCEDURE” FOR DESTRUCTIVE MITRO-AORTIC ENDOCARDITIS AND OTHER CHALLENGING SITUATIONS
Authors: Ricciardi G. , Bonalumi G. , Naliato M. , Cavallotti L. , Manganiello S. , Alamanni F.
Published: November 2018

Backgroound and aim:

The reconstruction of mitro-aortic continuity is an uncommon procedure occurring in around 1% of patients undergoing aortic valve replacement. It is performed more frequently in case of native (NVE) or prosthetic valve endocarditis (PVE). In case of PVE with para-valvular abscess, the infected tissue must be removed thoroughly to avoid risk of recurrent endocarditis [3]. A patch reconstruction is also required to implant new valves.

At Cleveland Clinic, these operations are referred to as “Commando operations”, an indicator of the procedure's challenges [4].

Methods:

We describe a successful broaden Commando procedure on a patient with a relapse of PVE of aortic valve and a destructive abscess of mitral annulus involving the interventricular septum, operated for the third time.

This case is part of a group of six patients treated at our Institution with extensive resection and reconstruction not only in case of infective disease, but also in presence of other conditions, such as cardiac tumors. In fact, in our series we adopted this procedure also for a locally invasive left atrial mixoma.

Results:

The last follow-up TT-Echo, performed at 1 year for all patients, shows normal functioning of newly implanted prosthetic valves, preserved LV function and no residual defects after reconstruction.

Conclusions:

A broaden Commando procedure can be adopted in case of disruption of the mitro-aortic curtain or cardiac tissues due to infective endocarditis or other causes, such as cardiac tumors.
RF48 MINIMALLY INVASIVE APPROACHES VIA RIGHT ANTERIOR MINITHORACOTOMY OR UPPER HEMI-STERNOTOMY FOR ISOLATED AORTIC VALVE REOPERATION: SINGLE CENTER EXPERIENCE
Authors: nardozza M. , paris M. , mikus E. , calvi S. , mammana L. , beggino C. , tamagnini G. , zulueta J.L. , del giglio M.
Published: November 2018

Objective:

Aortic valve replacement (AVR) after previous cardiac surgery is associated with an increased risk. This study compare the outcome after AVR through upper “J” ministernotomy or minithoracotomy versus standard full sternotomy in redo operation.

Methods:

We retrospectively reviewed 221 patients treated between October 2007 and November 2017; 91 (41%) had minimally invasive approach via right minithoracotomy (n°=11) or upper “J” ministernotomy (n°=80) and the remainings 130 (59%) had full sternotomy.

Results:

Mean age was 69.6 ± 12.0 years in minimally invasive group and 69.02 ± 13.0 for the full sternotomy group (p = 0.46).No differences in terms of body mass index (p = 0.70), left ventricular ejection fraction (p = 0.58) and EURO score (p = 0.32) between two groups. Intraoperative data and postoperative outcomes have been analyzed.

Mean cardiopulmonary bypass time and cross-clamp time were respectively 68.6 ± 23.9 min and 53.6 ± 20.9 in the minimally invasive group and 83.9 ± 41.7 min and 61.15 ± 26.7 in the full sternotomy group (p < 0,005); 64% of patients in minimally invasive group and 66% in sternotomy group underwent blood transfusions (p = 0.72). Post operative ventilation time was lower in patients treated with minimally invasive technique: median was 6 versus 11 hours (p = 0.93). Median intensive care unit stay for patients operated through a mini-invasive approach vs full sternotomy was very similar (2 vs 1,93 days; p = 0.90). In-hospital mortality in the minimally invasive group was 3,2% (3/91) compared to 4.6% for the full sternotomy group (6/130) (p = 0.70).

Conclusions:

Minimally invasive aortic valve reoperation proved to be as safe as standard procedure in terms of hospital morbidity and mortality rates.
VD10 FROZEN ELEPHANT TRUNK AND DAVID PROCEDURE BY USING THORAFLEX AND GORE HYBRID PROSTHESES IN A MARFAN PATIENT WITH ACUTE TYPE A AORTIC DISSECTION
Authors: Barberio G. , Di Marco L. , Murana G. , Leone A. , Berardi M. , Gliozzi G. , Folesani G. , Coppola G. , Pacini D. , Di Bartolomeo R.
Published: November 2018

We present the case of a 19-year-old Marfan patient with 53 mm ascending aorta aneurysm complicated by acute type A aortic dissection.

Cardiopulmonary bypass was established by cannulation of right femoral artery and right atrium. Moderate (25°C) hypotermic circulatory arrest was used and the aortic root prepared for reimplantation technique. At 25°C, the aortic arch was opened and the antegrade selective cerebral perfusion was established through cannulation of brachiocephalic trunk and left carotid artery. A 22/24 mm Thoraflex hybrid graft was used and distal anstomosis performed in arch zone 2. During the rewarming, the supraaortic vessels were separately reimplanted, using also a Gore 8 mm prosthesis for the left subclavian artery. The aortic valve was reimplanted in a 30 mm Valsalva conduit. The procedure was completed with the suture of the two vascular conduits. Post-operative echocardiogram showed a well-functioning aortic valve and angio CT scan showed a good surgical result.
VD11 FROZEN ELEPHANT TRUNK BY USING E-VITA PROSTHESES AND BENTALL PROCEDURE IN A GIANT DESCENDING THORACIC AORTA ANEURYSM
Authors: Alfonsi J. , Leone A. , Di Marco L. , Murana G. , Amodio C. , Berardi M. , Coppola G. , Fiorentino M. , Pacini D. , Di Bartolomeo R.
Published: November 2018

We present the case of a 54-year-old male patient with a 12 cm post-decoarctation aneurysm of the descending thoracic aorta with bicuspid aortic valve stenosis and ventricular septal defect.

Right femoral artery and bicaval cannulation were used for Cardiopulmonary bypass. Antegrade cerebral perfusion with moderate hypotermia (25°C) was achieved with the innominate and left carotid artery cannulation.

The aortic arch replacement was performed by using Frozen Elephant Trunk technique with a 40 mm E-Vita Open Plus prosthesis and a separated Plexus 4-branches prosthesis. The reimplantation of the left subclavian artery was performed by a 9 mm Gore hybrid vascular graft. A St.Jude 23 mm mechanical valve conduit was used for the Bentall procedure. The ventricular septal defect was closed with direct suture.

Cardiopulmonary bypass, aortic cross-clamp and cerebral perfusion times were 258,186 and 109 minutes, respectively. Post-operative course was uneventful and CT scan showed the good result of the procedure.
EP25 OPTIMAL OPERATIVE PLANNING AND HIGH-EXPERIENCE ARE PREDICTORS OF GOOD OUTCOMES IN PATIENTS UNDERGOING TRANS-APICAL VALVE IMPLANTATION
Authors: Prestipino F. , Manzan E. , Miele M. , D’Ascoli R. , Luzi G.
Published: November 2018

Background and Aim:

With the improvement in surgical expertise and optimization of pre-operative cardiovascular imaging techniques, trans-apical (TA) valve implantation has become in expert hands a rapid and safe procedure, with low rates of complications and conversion to surgery. The aim of our study is to demonstrate that high experienced surgeon with > 500 procedures and optimal operative planning are predictors of good outcomes.

Methods:

We included 45 patients who underwent TA aortic or mitral valve implantation from March 2017 to March 2018 in our Centre. We evaluated early clinical and echocardiographic outcomes according to Valve Academic Research Consortium (VARC-2) definitions.

Results:

Median age was 80 year-old (IQR 77–82), median Logistic Euroscore was 5.8% (IQR 3.8–10). Three patients underwent TA mitral valve-in-valve implantation (TA-MVinV), 5 TA aortic valve-in-valve implantation (TA-AVinV) and 37 TA aortic valve implantation (TA-AVI), with 3 different prostheses (Figure1A). Device success was 100%. There were no intra-operative deaths nor conversions to conventional surgery. At 30-day follow up (FU), no deaths nor major cardiac/vascular complications occurred. We reported 1 stroke (2.2%) and 3 acute kidney injuries (6.7%), of which only 1 patient needed continuous veno-venous hemofiltration. Two patients (4.4%) presented transient conduction disturbances and 1 (2.2%) underwent permanent pacemaker implantation. Figure1B-C reports peak and mean gradients at 30-day FU.

Conclusions:

In heart valve Centers, experienced surgeons (>500 procedures) and optimal operative planning result in low mortality and complication rates after TA valve implantation.
EP04 A NEW TECHNIQUE FOR THE SUTURE OF THE HEADSET OF THE THORAFLEX PROSTHESIS IN CASE OF FET
Authors: Sansone F. , Ceresa F. , Pellegrini A. , Patanè F.
Published: November 2018

Background and Aim:

We present our experience of Frozen Elephant Trunk (FET) using the Thoraflex Hybrid™ (Vascutek Ltd, UK) implanted by a modified technique for the distal suture of the headset.

Methods:

From January 2017 to now, 13 patients underwent FET. Four patients suffered from acute aortic dissection. Cardiopulmonary bypass (CPB) was established among femoral artery (9), aortic arch (2) or right subclavian artery (2) and the right atrium. Under moderate circulatory hypothermic arrest (MCHA-26°C) and selective antegrade cerebral perfusion (SACP), distal headset was sutured by 10 to 12 4/0 polypropylene Teflon felt stitches passed from the inner to outer of the aortic wall before the insertion of the device. After headset suture was completed, left subclavian artery was sutured and CPB restored through the lateral branch. Then, the proximal suture was completed and the coronary flow restored. Finally, on the beating heart, the other cerebral vessels were sutured.

Results:

Mean CPB was 206.4+37.7 minutes, MHA was 74.3±27.7 minutes and SACP was 85.2±28.6 minutes. In-hospital mortality was 1 (7.6%). No patients suffered of cerebrovascular accident. Three patients had acute renal failure requiring CVVH. After a mean follow up of 7.1±6.8 months all patients but one (died three months after surgery for MOF) are alive and none complication of the distal suture are reported.

Conclusions:

Our technique of distal suture by 10 to 12 4/0 polypropylene stitches instead of a continuous suture, makes the distal suture easier and may reduce the shear stress avoiding late complications such as pseudoaneurysms.
EP26 PRELIMINARY RESULTS OF LAST GENERATION SURGICAL BIOPROSTHESES IN SMALL AORTIC ANNULI: TRIFECTA VS INTUITY
Authors: Chiariello G.A. , Pasquini A. , Bruno P. , Colizzi C. , Ruggio A. , Nesta M. , Mazza A. , Iafrancesco M. , Cammertoni F. , Pavone N. , Perri G. , Massetti M.
Published: November 2018

Background and Aim:

Aortic valve replacement (AVR) in patients with small aortic annulus is associated with increased risk of patient-prosthesis mismatch. Results of 19–21 Trifecta vs Intuity bioprostheses in patients with annular size <21 mm are compared.

Methods:

Between 2013 and 2017,we retrospectively analyzed 25 (22 women,76.8 ±6.6 years) Trifecta AVR patients vs 26 (23 women, 78.6 ± 4.7 years) Intuity AVR patients.Combined procedures and reinterventions were excluded.Body surface area, left ventricular mass index and Euroscore-II were not different (p:0.68, 0.92 and 0.96 respectively).

Results:

Cardiopulmonary-bypass time was 108.6 ± 22.5 and 84.4 ± 20.5 minutes(p: 0.012);aortic cross-clamp time was 79.3 ± 14.6 and 60.73 ± 15.3 minutes in the Trifecta and in the Intuity group respectively(p:0.001). There wasn’t significant difference in postoperative transvalvular gradients.Lenght of hospital stay and major complications were not significantly different between the two groups.Follow-up is still ongoing. At 3.5 ± 1.2 years,41.1% of patients were followed-up. Until now, no significant difference neither in term of mortality nor in major complications have been observed.Peak pressure gradients were 29.2 ± 11.5 and 20.7 ± 5.9 mmHg (p:0.04);mean 16.2 ± 6.4 and 11 ± 3.03 mmHg (p: 0.02).Effective orifice area (EOA) was 1.43 ± 0.24 and 1.3 ± 0.2 cm2(p:0.5).There is no significant difference in reverse cardiac remodeling (left ventricular mass index 134.4 vs 124.4 g/m2.p:0.43).

Conclusions:

Trifecta and Intuity prostheses provide excellent hemodynamic results in small aortic annulus AVR. Operative times with Intuity were significantly lower. EOA was similar in both groups,however Trifecta presented significantly higher gradients at follow-up. Preliminary data need to be confirmed: completion of follow-up (July 2018) could provide stronger evidence to these first surveys.
EP01 5-YEARS FOLLOW-UP OF AORTIC PROSTHESIS ENDOCARDITIS TREATED USING BIOINTEGRAL CONDUIT: A SINGLE-CENTER EXPERIENCE
Authors: Weltert L. , Chirichilli I. , D’Aleo S. , Guerrieri L. , Salica A. , Scaffa R. , Ricci A. , Bellisario A. , De Paulis R.
Published: November 2018

Objective:

The treatment of complex prosthetic valve endocarditis (PVE) with aortic root abscess remains a surgical challenge. The aim of this study was to analyze the mid-term results of aortic root replacement using the Bioconduit BioIntegral in patient with a complex prosthesis endocarditis.

Methods:

From June 2013 to April 2018, 15 patients underwent a Bentall procedure with-BioIntegral Surgical graft, due to endocarditis of previous aortic prosthesis, with peri-prosthetic abscess in all patients. Partial to total prosthetic detachment was present in 14 patient (93,3%). The mean age was 68 ± 22 years. Active endocarditis was present in 10 patients (66%) with acute cardiac failure in 7 patients (46,6%) The mean logistic EuroScore was 45,27% ± 33,54%. Patients were prospectively followed and the mean follow-up was 13,4 months (range 0–58 months).

Results:

There were 4 early deaths (26,6%) due to Multiple Organ Failure while the overall actuarial late survival was 64%. None of the patients required cardiac reoperation. 3 patients (20%) needed PMK implantation due to a third-degree AV-block. No major bleeding or stroke were observed. No recurrence of endocarditis was observed, neither early nor late.

Conclusions:

This mid-term follow-up after aortic root replacement with BioIntegral Bioconduit revealed a safe and effective performance of the graft with no evidence of infective dehiscence or need of further cardiac reoperation. Although this study needs further results to be confirmed, this surgical option seems to be potentially promising for complex Prosthetic Valve Endocarditis (PVE) and aortic root abscess in this high-risk patient cohort.
RF52 MITRAL VALVE SURGERY IN OBESES: MINIMALLY INVASIVE COULD BE BETTER
Authors: Stura E. Cura , Ricci D. , Barbero C. , qarra S. El , Marchetto G. , Boffini M. , Rinaldi M.
Published: November 2018

Objective:

obesity is become an important health problem in the Western world. The feasibility and efficacy of mitral surgery in very obese patients are controversial especially because of high risk of respiratory, infectious and wond complications.

Methods:

Between 1/2006 and 2/2018, 106 patients with BMI≥30 underwent minimally invasive MV surgery (9.0% of 1175): male were 50%, mean age was 63.4 ± 11.3, mean Euroscore was 6.3 ± 3.5 and Logistic was 11.1 ± 17.0. Comorbidities included: diabetes (26.4%), COPD (19.8%), chronic renal failure (17.0%), peripheral vasculopathy (5.7%), previous AMI (7.5%) and AF (47.2%). The mean EF was 54.9 ± 11.4 and 15.1% had pulmonary hypertension. In 22.6% had undergone previous cardiac surgery, in 4.7% were urgiences.

Results:

In 39.6% were mitral repair, associated procedures were TV procedures (10.4%) and AF-crioablation (17.0%). Mean cardiopulmonary and cross clamp time were respectively 142.2 ± 53.3 and 96.3 ± 33.5 minutes. The most utilized aortic clamp technique was endoreturn (61.3%). Conversions to sternotomy were 3.8%. Operative mortality was 0%. Reoperation for bleeding occured in 8.5%. Postoperatively, in 5.7% was necessary CVVH, in 3.8% PM implantation and in 2.8% tracheostomy. Only one patient suffered from major neurologic complications. Groin wound infection/linfocele occurred in 5.7% and in 2.8% was necessary a wound revision. Mean, median intubation time, ICU and hospital stay were respectively 45.4 ± 151.1 h (11 h), 3.8 ± 7.4days (1 day) and 12.0 ± 12.5days (8.0 days). The 30-day mortality rate was 5.7%.

Conclusions:

Minimally invasive approach appears to be safe, feasible and reproducible with low peri-operative morbidity expecially in obeses.
RF87 TRANSAPICAL OFF-PUMP MITRAL VALVE REPAIR WITH PTFE CHORD IMPLANTATION
Authors: Bardaro L. , Carrozzo A. , Albertini A. , Fattouch K. , Martinelli L.
Published: November 2018

Background:

NeoChord DS-1000 system (NeoChord,Inc,Minneapolis, Minnesota)is a novel minimally invasive technique of mitral valve repair (MVR)consisting in off-pump beating heart transapical implantation of artificial neo-chordae under TEE guide.

Aim:

To evaluate the feasibility,safety and up to 12 months outcome of the NeoChord DS-1000 system in patients with primary mitral regurgitation (MR),due to leaflet(s) prolapse or flail.

Methods:

From July 2015 to November 2016,34 patients with severe primary MR were selected for transapical Neochordae implantation at 3 centers in Italy. Mitral Valve Academic Research Consortium (MVARC) procedural success criteria were evaluated in all patients at 30 days,6 and 12 months.

Results:

Mean age was 64.7 ± 11 years,mean STS repair score was 1.06%(IQR 0.46-1.12).25 patients had isolated P2 disease and 9 patients had other or multisegment disease involvement. MR ≤moderate at 30 days was achieved in 91%of patients. In hospital mortality was 2.9% for respiratory failure,and 2 patients had undergone conversion to traditional valve surgery for functional failure and residual significant MR. At discharge 80.6% patients had MR ≤mild and 17% patients had moderate MR.2 patients experienced early device failure with recurrent sever MR and had undergone additional valve surgery (at 61 and 129 days after implantation).22 patients reached 6 month follow up,all had MR ≤moderate and showed significant improvement in NYHA functional class (P < 0.005).10 patients reached 12 month follow up,all had MR ≤moderate and 90% had NYHA class I.

Conclusion:

Mitral valve repair with the NeoChord DS-1000 system for primary MR due to leaflet(s) prolapse or flail is feasible and safe.Its efficacy is maintained up to 1 year showing significant clinical benefit and functional class improvement.
RF69 REOPERATION AFTER ATRIO-VENTRICULAR SEPTAL DEFECTS CORRECTION
Authors: Deorsola L. , mattioda G. , Aidala E. , Cascarano M.T. , Valori A. , Napoleone C. Pace
Published: November 2018

Background and aim:

Atrio-Ventricular Septal Defect (AVSD) encompasses a wide range of anatomical alternatives that make surgery and results very variable. We retrospectively reviewed our surgical experience with these patients, searching for outcome predictors.

Methods:

We investigated 202 patients, operated for AVSD Correction at our Institution since 1996. Complete and Partial AVSD were analyzed separately (Groups A and B respectively). Age, Down Syndrome, Left Superior Vena Cava, previous Pulmonary Banding and surgical technique were assessed to evaluate whether they could impact on results, survival and reoperation.

Results:

Complete AVSD was diagnosed in 113 patients (Group A) and partial in 89 (Group B).

Total mortality was 4.5% (Group A 7%, Group B 1%). Increased risk was associated with previous Pulmonary Banding in Group A (p < 0.001) and Cleft left open at surgery in Group B (p < 0.05).

Twenty-Three patients (11%) underwent reoperation (Group A 12%, Group B 10%) at a mean interval of 43 ± 49 months. All patients underwent mitral repair. Predictors of reoperation were presence of a left Superior Vena Cava in Group B (p < 0.01) and Cleft left open at surgery in both Groups (p < 0.05).

Conclusions:

Surgical results of AVSD repair are excellent, with low mortality and reoperation rate, without significant differences between Groups. A Cleft left open at surgery represents a strong predictor for reoperation.
RF64 PULMONARY VALVE SPARING STRATEGIES IN TETRALOGY OF FALLOT REPAIR: A SINGLE CENTER EXPERIENCE
Authors: Muhoozi R.M. , Ghiselli S. , Carro C. , Annoni G.A. , Marianeschi S.M.
Published: November 2018

Background-Aim:

Transannular patch (TAP) repair of tetralogy of Fallot (TOF) leads to chronic volume overload and significant late morbidity mortality. The pulmonary valve (PV) sparing strategy reduces pulmonary regurgitation with better long-term prognosis. The aim of this study is to examine the determinants for a successful PV-sparing strategy, by exploring PV morphology, annulus diameter, Z-scores and right/left ventricle pressures (Prv/Plv) ratio.

Methods:

From January 2005 to May 2017, 79 patients underwent TOF repair. 55.7% were males and 44.3% females. Depending on PV Z-scores, annulus size and morphology of PV, 21(26.6%) patients, Group A, underwent valve-sparing TOF repair and 58(73.4%), Group B, TAP approach. Data were retrospectively examined.

Results:

The median age was 33.7months in Group A and 21.7months in Group B. Mean PV annulus and PV Z-score were respectively 10.2 ± 2.9 mm and -1.6 ± 1.6, in Group A, and 7.5 ± 3.3 mm and -3.4 ± 2.0, in Group B. Mean Prv/Plv ratio was 0.6 ± 0.1 in Group A and 0.5 ± 0.2 in Group B. Z-scores were significantly higher (p = 0.0001) in Group A, while incidence of post-operative complications and reoperations were higher in Group B (p = 0.006 and p = 0.001, respectively). In hospital and ICU length of stay were significantly shorter (p = 0.03; p = 0.01) in Group A. Median follow-up was 27.6months in Group A and 64.8months in B.

Conclusions:

PV-sparing approach, whenever feasible, preserves RV function, reduces post-operative complications, leading to better long-term prognosis. 4 feasibility indicators must be taken into account: pre-operative PV Z-score higher than -3, adequate PV morphology and annulus according to age and BSA and intra-operative Prv/Plv ratio <0.75.
RF16 EARLY ASPIRIN NON-RESPONDERS IDENTIFICATION BY ROUTINE USE OF AGGREGOMETRY TEST IN LVAD (LEFT VENTRICLE ASSIST DEVICE) PATIENTS REDUCES THE RISK OF PUMP THROMBOSIS.
Authors: Montalto A. , Comisso M. , Cammardella A. , Gherli R. , Palermo A. , Pulcinelli F. , Musumeci F.
Published: November 2018

Introduction:

LVAD management is really challenging since inadequate anticoagulation treatment can lead to life threatening sistuations like ischemic stroke or pump thrombosis. Main intention of our study was to investigate if early identification of aspirin non responders can improve anticoagulation management and then reduce the risk of pump thrombosis.

Methods:

From december 2010 to may 2018 24 patients were implanted with HM II, 6 received an HVAD and 22 an HM 3. A target INR of 2.0 to 3.0 was maintained in all the patients. 100 mg aspirin were initiated only when a normal platelet function emerged at basal postoperative aggregometry. Aspirin non responders were early identified by repeating the aggregometry after seven days of administration and then clopidogrel 75 mg was used and platelet function tested again. Ticlopidine 250 mg was administrated when also clopidogrel was unsuccessful.

Results:

6 patients required modification in antiplatelet therapy. 3 patients (5%), 2 HVAD and 1 HM II, suffered from pump thromosis. 1 patient died as a consequence of large intracranial hemorragic event following thrombolitic treatment. 1 patient required pump exchange and in 1 patient thrombolitic infusion was conducted successfully.

Conclusions:

reported rates of pump thrombosis at 12 months for patients implanted with commonly used LVADs are 6 % to 12 % for axial - flow pumps and 8 % with centrifugal - flow devices. in our serie the reported 5 % overall incidence of pump thrombosis encourage the routine use of aggregometry test to early identify aspirin non responders.
RF46 MINI-ACCESS ISOLATED AORTIC VALVE REOPERATION WITH PERCEVAL SUTURELESS PROSTHESIS
Authors: Mikus E. , Pagliaro M. , Tripodi A. , Raviola E. , Calvi S. , Magnano D. , Albertini A.
Published: November 2018

Background and aim:

Literature data regarding the use of upper “J” hemi-sternotomy in reoperative aortic valve replacement show a reduction in the biological trauma primarily due to the limited mediastinal tissues dissection avoiding excessive blood loss. Based on encouraging results reported for minimally invasive aortic valve replacement and with sutureless prosthesis we decided to use the Perceval valve in redo aortic valve replacement with minimally invasive approach.

Methods:

Seven patients underwent redo aortic valve replacement using a sutureless Perceval bio-prosthesis with a minimally invasive approach: four (57%) patients received upper hemisternotomy and three (43%) a right minithoracotomy. The median age was 75.9 ± 5 years and 5 of them (71.4% of the cohort) was male.Mean preoperative euroSCORE was 10.7 ± 1.2. Previous operation included: coronary artery bypass grafts (n°3), isolated aortic valve replacement (n°2), combined procedure (n°2).

Results:

The operation was performed with total central cannulation in 6 (86%) patients, in the seventh the ascending aorta was cannulated but a femoral venous percutaneous cannula was preferred for extreme frailty of the right atrium. Mean cardiopulmonary bypass and aortic cross clamp times were 56.6 ± 29.8 (median 47) and 44.3 ± 26.9 (median 33) minutes. No conversion to full sternotomy was required. There was no hospital mortality within 30 days of operation.

Conclusions:

Mini-access isolated aortic valve surgery with sutureless prosthesis is a reproducible, safe and effective procedure also in case of reoperation. It can improve the outcome by minimizing trauma, preventing postoperative complications and it could be an alternative to valve in valve in selected patients.
IS THERE A ROLE OF CARDIOMYOPATHY FOR RESIDUAL MITRAL REGURGITATION AND PULMONARY HYPERTENSION DURING LVAD SUPPORT?
Authors: Cannata A. , Costetti A. , Lanfranconi M. , Merlanti B. , Brenna D. , Gagliardone M.P. , Frigerio M. , Russo C.F.
Published: November 2018

Background and aims:

It is unfrequent to observe residual mitral regurgitation (MR) during left ventricular assist device (LVAD) support. However, it could be associated to less reverse remodeling of the left ventricle (LV) and worse clinical outcomes. Study aim is to verify if cardiomyopathy is associated to residual 3-4 + MR and higher pulmonary pressures at one year after LVAD implant.

Methods:

We analysed data of 85 patients affected by idiopathic dilated (IDC; n = 42) or ischemic cardiomyopathy (IC; n = 43) who underwent intracorporeal LVAD implant at our hospital between 2007 and 2017. Mean age was 55.2 ± 8.5 years. Thoratec HeartMate II and Heartware HVAD were implanted in 54 (63.5%) and 31 (36.5%) patients, respectively. Nine patients (10.6%) died in-hospital following LVAD implant.

Results:

In study population the prevalence of 3-4 + MR decreased significantly at one year as compared to the preoperative assessment (54.1% vs 8.3%, p .0001). Both pulmonary capillary wedge pressure (24.7 vs 13,3mmHg, p.0001) and systolic pulmonary artery pressure (55.3 vs 36.1mmHg, p.0001) significantly decreased during support. At one year prevalence of residual 3-4 + MR was higher in patients affected by IDC than in patients affected by IC (11.9% vs 4.7%, p.19). LV end-diastolic diameter was higher among patients with residual 3-4 + MR (pre-implant:74,0 vs 70,6 mm, p.50; at one year:70,0 vs 65,2 mm, p.23).

Conclusions:

LVAD improves significant MR and pulmonary hypertension in most of patients. However, among patients affected by IDC prevalence of residual 3-4 + MR is higher and it associated to more dilated LV before and after implant.
RF90 USE OF IMPELLA IN OFF PUMP MYOCARDIAL REVASCULARIZATION WITH EF BELOW 30 %.
Authors: Pepino P. , Germano C. , Giordano S. , Provenzano R. , Oliviero P. , La Marca A. , Bellino I. , Di Benedetto G. , Giordano A.
Published: November 2018

Background and Aim:

Patients undergoing coronary surgery are changed in the last years becoming a challenge for the cardiac surgeon not only for the quality of the coronary artery involved in the disease but mainly for the quality of patients in terms of low ejection fraction, elderly, COPD, kidney failure, Diabetes. Beating heart myocardial revascularization is a well established surgical technique but in case of very low EF (below 30%) there is a particular high surgical risk of conversion to on-pump surgery. The recently developed of Impella device (Abiomed, Danvers, MA) represent a compromise between circulatory support and limited invasiveness.

Methods:

Six patients, male, admitted for acute coronary syndrome with three vessels CAD with low ejection fraction were operated in our department. Impella Recover LP 5.0 device was inserted via surgical exposure of the right femoral artery in one case and an Impella recover LP 4,5 via percutaneous insertion of the femoral artery in five cases.

Results:

The myocardial revascularization was performed using a complete arterial revascularization. The device was left in for 48 Hours after the operation. All patients were discharged home after 9-10 days after admission and a follow up echocardiography performed six month up to two year after the operation showed an increase of the ejection fraction up to 40-45%.

Conclusions:

Use of the Impella Recover device for patients undergoing off pump CABG is feasible and safe, and appears a promising strategy to improve short- and long-term outcomes.
RF84 THE ROLE OF FLOW MEASUREMENT DURING AORTIC CROSS-CLAMP IN CORONARY SURGERY
Authors: Marinelli D. , Faragalli F. , Micucci D. , Mancini V. , Omar A. , Di Giammarco G.
Published: November 2018

Background and aim:

Transit-Time Flow Measurement (TTFM) verified by imaging represents a unique tool for the study of the physiopathology of coronary circulation.

We evaluate TTFM during aortic cross clamp comparing it with the MGF after protamine and to evaluate its relationship with previous myocardial infarction on the LAD territory.

Methods:

Retrospective analysis of TTFM values and clinical charts of 57 patients form June 2016 to April 2017.

Results:

The median MGF values measured during aortic cross-clamp are significantly higher than the MGF measured immediately after cross clamp release and after protamine administration (35 ml/min (20-53) vs 15 ml/min (11-22) vs 20 ml/min (13-29) respectively = 0.0003).

Thirteen patients (22%) had a previous MI on the LAD territory. There is a strong correlation between the flow of the graft on the LAD during aortic cross clamp compared to the flow immediately after the release of the clamp itself in case of previous myocardial infarction (MI). Fig 1 A-B)

Conclusions:

Flow measured during cardioplegic arrest and aortic cross clamp causes a significant increase in myocardial blood flow demand related to ischemia and very low coronary vascular resistance due to the absence of muscular contraction and arteriolar tone modification. Moreover, the MGF during aortic cross clamp is correlated to the MGF after clamp release in case of previous MI. The evaluation of scar extent using nuclear magnetic resonance can help to predict the expected flow after surgical revascularization.
RF27 IN SILICO COMPUTATIONAL MODELING AND CIRCULATING MICRORNA SIGNATURE OF ASCENDING THORACIC AORTIC ANEURYSMS
Authors: Pasta S. , Agnese V. , Bellavia D. , Raffa G. , Pilato M.
Published: November 2018

Background and Aim:

The development of ascending thoracic aortic aneurysm (ATAA) in patients with bicuspid aortic valve (BAV) is highly variable, and this makes surgical decision strategies particularly challenging. This study aims to investigate the correlation of computational hemodynamic and wall stresses with circulating miRNA analytes.

Methods:

We collected CT images and plasma samples of n.74 patients underwent aortic size evaluation at ISMETT IRCCS. ATAAs were classified according to aortic valve morphologies (BAV vs tricuspid aortic valve, TAV). Hemodynamic and structural variables of ATAAs were quantified via a computational model developed previously (Pasta et al J Biomech 2013). The miRNA profiling was assessed by reverse transcription polymerase chain reaction (RT-PCR), including n.47 miRNAs. Comparisons were performed among groups, and statistical analysis investigated correlations with clinical data.

Results:

Systolic shear stress was significantly increased at sino-tubular junction and ascending aorta of BAV patients when compared with TAV patients. Similarly, a statistically significant difference in BAV versus TAV patients was observed for the distribution of intramural stress. A significant difference was observed in the BAV-related expression level of miR-133a (p = 0.007), miR-155 (p = 0.032), miR-320 (#000536) (p = 0.033), miR-34a (#000425) (p = 0.029), miR-34a (#000426) (p = 0.002) when compared to those with TAV. This suggests that the plasma expression of these miRNAs was significantly affected by the bicuspid versus the tricuspid aortic valve.

Conclusions:

This study indicates that computational modeling for the predictions of quantitative hemodynamic variables combined with circulating miRNA profiling may lead to an improvement of the managment of patients with ATAAs.