bluuebunny/crossref_metadata_2025 huggingface dataset:
A MULTIDISCIPLINARY APPROACH TO RARE AND GENETIC AORTIC DISEASE
Authors: Corigliano K. , Grandinetti M. , Mazzenga G. , Cammertoni F. , Nesta M. , Pavone N. , Bruno P. , Amodeo A. , Massetti M.
Published: December 2024

Background and Aim:

Considering the increasing number of genetical diagnosis regarding connective tissue syndromes (Marfan, Ehlers-Danlos, Loeys-Dietz), there is an increasing attention about young patients developing acute aortic syndromes, which can be catastrophic at times. Care of these patients represents a major challenge, due to the variability in timing and severity of the clinical presentation, also determined by the underlying genetic substrate.

Methods:

In this retrospective study we consider two groups of patients with known connective tissue disease who underwent aortic surgery and were followed at our institution: Group A and Group B, composed by 31 (from 2014 to 2024) and 36 patients (from 2000 to 2010), respectively. We retrieved data of all enrolled patients from the electronic archives of the Institution. Patients’ follow-up data were collected at 8-year average post-intervention.

Results:

There were no differences between the two groups regarding diagnosis, presence of preoperative risk factors and mortality at follow-up. Re-operation or urgent hospitalization were more frequent in Group B by 16.4% than in Group A (32.4%; N:12 vs 16%; N:5; p= 0.047). There was greater adherence to follow-up (and risk factors control) rate in Group A than Group B (p=0.038).

Conclusions:

A clinical pathway for rare genetic aortic disease is mandatory. Our team includes dedicated cardiac and vascular surgeons, cardiologists, genetics, radiologists, obstetrics, anesthesiologists. We created a shared tailored clinical protocol for these patients’ needs. Our preliminary experience showed that novel multidimensional approach plays a key role in clinical surveillance of this peculiar population.
EARLY AND LONG-TERM OUTCOMES OF FROZEN ELEPHANT TRUNK IN MARFAN SYNDROME: THE BOLOGNA EXPERIENCE.
Authors: Bianco E. , Murana G. , Castagnini S. , Snaidero S. , Di Marco L. , Pacini D.
Published: December 2024

Introduction:

Endovascular procedures in patients with Marfan syndrome are controversial. This study evaluates the early and long-term outcomes of the frozen elephant trunk procedure in these patients.

Materials and Methods:

From 2007 to 2022, 27 patients with Marfan syndrome underwent FET at our institution. Outcomes were analyzed retrospectively.

Results:

Mean age was 42.8 ± 13.5 years; 74.1% were male. Most procedures were reoperations (81.5%), with 74.1% previously treated for proximal aortic disease. Indications included residual type A aortic dissection (48.1%), chronic type B dissection (22.2%), degenerative aneurysm (11.1%), and acute type A and type B dissections (3.7% and 11.1%). Combined procedures were performed in 48.1% of case, with a total of 37% root replacements, such as Bentall or David procedure. Permanent and transient neurological deficits affected 3 (11.1%) and 2 (7.4%) patients, respectively; paraplegia occurred in 1 patient (3.7%). In- hospital mortality was 11.1%, comprising patients who underwent emergency surgery. Long- term survival rates at 1 and 5 years were 85.4% and 74.6%. During follow up, stent graft–induced new entry (SINE) was developed in 14.8%. TEVAR extension was required in 33.3% and open surgery in 14.8%. Freedom from TEVAR at 1 and 5 years was respectively 66.7% and 61.1%, while from open surgery was 90.5% and 77.6%.

Conclusions:

Frozen elephant trunk can be considered a promising option in patients with Marfan syndrome requiring arch replacement. During follow-up a straight surveillance is necessary to early detect distal aortic pathologies.
EVALUATION OF RIGHT VENTRICULAR SYSTOLIC FUNCTION AFTER CORONARY ARTERY BYPASS GRAFTING: THE IMPACT OF DEL NIDO CARDIOPLEGIA.
Authors: Romeo M. G. , Parisi V. , Conte M. , Baiano S. , Pilato E.
Published: December 2024

Background and Aim:

We aimed to investigate the effects on postoperative right ventricular systolic function (RSVF) using different cardioplegic solutions and to evaluate the efficacy of Del Nido cardioplegia (DNC), compared with conventional crystalloid cardioplegia (CC), in adult patients undergoing coronary artery bypass grafting (CABG). TAPSE is a reliable, rapidly measurable, and easily replicable echocardiographic parameter for assessing longitudinal RVSF and, consequently, postoperative outcome in CABG surgery. RVSF is a major determinant of postoperative surgical outcome, so estimating the impact of cardioplegic solution on the reduction of ischemic damage is crucial.

Methods:

Our retrospective study included 118 patients treated with CABG. The population, homogeneous in terms of age, comorbidities, ejection fraction and operative timing, was divided into two groups according to the type of cardioplegia used during extracorporeal circulation (ECC): Group 1 consisting of 57 patients using CC, Group 2 consisting of 61 patients using DNC. RVSF was evaluated by echocardiography, assessing the tricuspid annular plane systolic excursion (TAPSE) pre and post-operatively.

Results:

Both groups showed a normal pre-operative TAPSE value (CC: 23 ± 2 mm vs DNC: 22.7 ± 2,4 mm; p=0.51). Postoperatively, in both groups the TAPSE was significantly reduced, as expected (CC: 13,3 ± 1,96 mm vs DNC: 14,7 ± 2,9 mm). Comparing the post-operative TAPSE value between groups, Group 2 showed a significantly higher value than Group 1 (p=0.003).

Conclusions:

The use of DNC in patients undergoing CABG improves short-term RVSF outcome, compared with the CC solution. In DNC-treated patients, the postoperative TAPSE showed a better RVSF.
PIEZOELECTRIC-ASSISTED AORTIC VALVE REPAIR
Authors: Spitaleri A. , Barbero C. , Pocar M. , Loforte A. , Brenna D. , Trichiolo S. , Maraschioni G. , La Torre M. W. , Rinaldi M.
Published: December 2024

Several techniques of aortic valve (AV) repair have shown safety and efficacy. One of the main contraindications to AV repair is still the presence of cusps calcification. Piezoelectric effect can be used to selectively cut calcium while sparing surrounding soft tissues addressing also complex valves with calcified cusps. Here we present a case of a 55-year-old woman with diagnosis of severe AV regurgitation and dilated ascending aorta who was suitable for aortic valve repair. The trans-esophageal echocardiography (TEE) showed a tricuspid AV with severe regurgitation and a partial fusion of right and non-coronary cusps with mild calcification of the raphe, which could compromise a successful repair. The raphe was shaved with a piezoelectric scalpel until a pliable surface was obtained and post-procedural TEE showed a trivial residual AV regurgitation. This tool can help surgeons to face also complex cases considered not suitable for a conservative technique.
EARLY EXPERIENCE IN THE EXPLANTATION OF PERCUTANEOUS AORTIC VALVES DUE TO ENDOCARDITIS OR VALVE DEGENERATION
Authors: Mikus E. , Fiorentino M. , Sangiorgi D. , Calvi S. , Tenti E. , Tremoli E. , Tripodi A. , Savini C.
Published: December 2024

Background:

The rise in transcatheter aortic valve implantation (TAVI) has increased the need for surgical removal of degenerated or infected TAVI valves. However, reports on TAVI removal are limited. This study presents our initial experience with surgical explantation of percutaneous aortic valves.

Materials and Methods:

Between 2017 and March 2024, a total of 8 patients underwent surgical removal of a percutaneous aortic valve at our institution due to either degeneration or endocarditis. The explanted valves included balloon-expandable prosthesis (n=3), self-expandable and mechanically expandable prosthesis (n=5).

Results:

The patient cohort consisted of 8 males with a mean age of 71.5 years (IQR 63.25–79.0). Half of the patients (4, 50%) were diagnosed with acute endocarditis. Previously implanted TAVI devices included Boston Scientific Acurate Neo (12.5%), Boston Scientific Lotus (50%), Edwards Sapien (25%), and Meril Myval (12.5%). Median preoperative EuroSCORE II was 8.04 (IQR 4.97-10.53). Surgical interventions included isolated aortic valve replacement in 6 patients, a Bentall procedure in 1, and a Commando procedure in 1. One patient had a minimally invasive approach. Median CPB time was 126.5 minutes (IQR 89.0-183.5), and median aortic cross-clamp time was 77.5 minutes (IQR 64.0-146.5). Median ventilation time was 9 hours (IQR 5.75-13.5), and the median ICU stay was 2.5 days (IQR 2-3). No major postoperative complications were observed, and no hospital mortality occurred.

Conclusions:

This study shows that surgical removal of percutaneous aortic valves is feasible and safe in a high-risk cohort. As TAVI valve issues increase, refining techniques and collecting more data is crucial.
EXTERNAL STENTING FOR SAPHENOUS VEIN GRAFTS IN CORONARY ARTERY BYPASS GRAFTING: A SINGLE-CENTER EXPERIENCE
Authors: Garofalo G. , Olevano C. , Santaniello E. , Numis F. , Miele M. , Colucci S. , Nappi A. , Rispo G. , Mollo A. , Fiorani B.
Published: December 2024

The saphenous vein is a commonly used conduit in coronary artery bypass grafting. This work aims to assess our experience with the external stenting of vein grafts with Venous External SupporT (VEST) device (Vascular Graft Solutions, Tel Aviv, Israel) in patients undergoing coronary artery bypass grafting (CABG). We selected twelve consecutive patients receiving a total of 13 individual saphenous vein grafting with VEST system. Nine patients received individual saphenous vein graft to the right coronary artery/posterior descending artery (PDA); three patients received individual saphenous vein graft to the left coronary obtuse marginal artery and one patient received individual saphenous vein bypass in both left and right territory. Harvesting of greater saphenous vein was performed with the ligature of using 3/0 silk suture or titanium micro-clips to prevent inadvertent avulsions during the position of the device and, therefore possible bleedings. A mark was placed every 5 cm along the vein to measure the length of the graft. All saphenous vein-to-aorta proximal anastomosis were performed using single aortic cross clamping technique to reduce aortic manipulation. At mean follow-up time of 2 years the graft patency assessed by CT coronary angiogram (CTCA) was 100%. External stenting of saphenous vein grafts has been shown to mitigate saphenous vein graft remodeling, reduce diffuse intimal hyperplasia, and improve lumen uniformity of saphenous vein grafts. In our opinion external stenting for saphenous vein grafts is a safe and easily reproducible option.
HYBRID REVASCULARIZATION WITHIN MIDCAB PANORAMA: LONG- TERM FOLLOW-UP LOOKING AT MINOTAUR
Authors: Torre T. , Pozzoli A. , Valgimigli M. , Leo L. A. , Muretti M. , Toto F. , Ferrari E. , Demertzis S. , Pedrazzini G.
Published: December 2024

Introduction:

Hybrid Coronary Revascularization (HCR) in the setting of minimally invasive direct coronary artery bypass (MIDCAB) constitutes an effective solution in myocardial revascularization, coniugating the best of both revascularization procedures. Data on antiaggregation management are still lacking. MINOTAUR trial aims at evaluate the feasibility of cangrelor as bridging therapy.

Methods:

From February 2013 to August 2024 a total of 2100 patients underwent surgical coronary artery revascularization at our institution, of whom, 103 (4.9%) received left anterior mini-thoracotomy access (MIDCAB), either isolated (N=85) or in combination with percutaneous coronary intervention to pursue a hybrid strategy (N=18, HCR group). All patients received left internal mammary (LIMA) to left anterior descending artery (LAD) grafting.

Results:

After a median follow-up of 80 months (range 3.1-155 months), the MIDCAB cardiac mortality has been 0%. Overall mortality was 3%, with one in-hospital death and two additional late deaths. Conversion to sternotomy happened in 2 patients (1.9%) and surgical re- explorations occurred in 5 patients (4.8%), of whom three for bleeding and two for graft failure. In the HCR group, 13 patients (72%) received percutaneous revascularization (PCI) after MIDCAB, with a mean of 1.6 ± 0.6 treated vessels and 2.2 ± 0.9 drug-eluting stents implantation. The last 3 patients were enrolled in the MINOTAUR trial.

Conclusions:

MIDCAB, isolated or in association with HCR is associated with encouraging mid- and long-term results, in selected patients presenting multivessel disease and discussed within a dedicated heart-team. The MINOTAUR trial will define the best approach to manage the antiaggregation strategy.
LOWER VALUES OF INTRAOPERATIVE CORONARY GRAFTS TRANSIT TIME FLOW MEASUREMENTS OBSERVED IN FEMALE GENDER DO NOT AFFECT EARLY OUTCOME AFTER CABG
Authors: Nardi P. , Buioni D. , Labriola V. , Viscogliesi C. , Agneni F. , Scognamiglio M. , Salvati A. C. , Altieri C. , Boumis M. , Bassano C. , D’Onofrio A.
Published: December 2024

Background and Aim:

Intraoperative transit time flow measurement (TTFM) of left internal thoracic (L-ITA) and saphenous vein (SV) grafts can improve clinical outcome after CABG. We have retrospectively investigated if there were differences in female and male gender on TTFM–flow (mL/min) and pulsatility index (PI-value)– after CABG, and early outcome.

Methods:

Between September 2022 and September 2023, TTFM was performed in 101 consecutive patients (21 females, 20%, 80 males, 80%) undergoing CABG, isolated (n=75) or associated with other procedures (n=26).

Results:

No differences were observed in age (66.2±11 vs 66.9±9 years), Euroscore-2 (4.2±3 vs 3.8±3), left ventricular ejection fraction (54±8% vs 52±9%) (P>0.5, for all comparisons). Associated procedures were more frequently performed in females (47.6% vs 20%; P<0.05). Left anterior descending artery (1.4±0.2 vs 1.6±0.2 mm; P=0.001), obtuse marginal branch (1.3±0.2 vs 1.5±0.3 mm; P<0.05), right posterior artery (1.2±0.2 vs 1.4±0.3 mm; P<0.05) diameters were smaller in females. TTFM flow of L-ITA or SV grafts on the left anterior descending artery (28±9 vs 38±18 mL/min; P<0.05), obtuse marginal branch (27±15 vs 42±28 mL/min; P<0.05), right posterior descending artery (29±11 vs 36±19 mL/min; P>0.5) was lower in females. No PI-value differences were observed in the coronary arteries territories (3.9±0.8 vs 3.7±0.9; 3.8±0.5 vs 3.9±1; 3.5±0.9 vs 3.3±1) (P-values>0.5). There were no operative major cardio-vascular complications; respiratory failure occurred in 3 male patients.

Conclusions:

Our data show that female patients have smaller coronaries and lower TTFM values than men, but no difference in PI-values. However, clinical results are similar.
SEX DIFFERENCES IN LONG TERM OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING: GOOD THINGS COME TO THOSE WHO WAIT
Authors: Saitto G. , Mariangela D. , 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:

Coronary artery bypass grafting (CABG) is the most commonly performed cardiac surgery globally. The aim of the study is to investigate outcome of CABG according to participant sex in the real word.

Methods:

We retrospective analysed 20337 CABG operations performed in an Italian Region, Lazio, using a regional administrative dataset.

Results:

Between 2008 and 2022, 16983 male and 3354 female patients underwent CABG and were analysed. At baseline male patients had lower left ventricle ejection fraction (LVEF <30% 3.52% vs 2.68; 30<LVEF<50 34.19% vs 31%; LVFE >50% 62,2% vs 66,2%, p<0.0001) but with a lower risk profile: female patients were older (70+9 vs 66+9.5 yo, p<0.05), more diabetics (28 vs 20%, p<0.0001), cholesterol disorders (20,5% vs 17.6%, p<0.0001), obesity (2.6 vs 1.6%, p<0.0001), anemia (3.6 vs 1.7%, p<0.0001), arterial hypertension (43.3 vs 36.6%, p<0.0001) and heart failure symptoms (10,1 vs 7,1%, p>0.0001).

Even if early mortality (30d) was higher in female vs male patients (3.1% vs 1.9%, p<0.05), long term survival was higher in women at 5 and 10y respectively 88 vs 87% and 73 vs 70%.

Conclusions:

Our data suggest that female sex could be associated to a higher profile risk and 30d mortality after CABG but in the long term could be protective.
SEE IT BEST: A PROPENSITY-MATCHED ANALYSIS OF ULTRASOUND- GUIDED VERSUS BLIND FEMORAL ARTERY PUNCTURE IN BALLOON- EXPANDABLE TAVI
Authors: Gennari M. , Agrifoglio M. , Maccarana A. , Severgnini G. , Iennaco V.
Published: December 2024

Background:

Currently, transcatheter aortic valve implantation (TAVI) is the standard procedure recommended for patients over 75 years of age with symptomatic aortic valve stenosis. Percutaneous transfemoral (TF) access is the main route used to perform the procedure. Among periprocedural complications, access-related ones are the most frequent, potentially leading to prolonged in-hospital stays and transfusions.

Methods:

We performed a retrospective analysis of prospectively collected data on consecutive patients undergoing TF- TAVI with the latest generation balloon-expandable transcatheter valve between 2013 and 2022.

Results:

A total of 600 patients were analyzed, differentiating the population between ultrasound-guided and blind common femoral artery puncture. Valve Academic Research Consortium 3 (VARC-3)criteria were used to report at 30 days and follow-up. In our propensity-matched comparison of the two groups, we found a strong reduction in access- related complications in the echo-guided group, particularly in terms of reduction of major and minor bleedings. We also found a significant trend in reduction of local complications, such as pseudoaneurysms, hematomas, arterio-venous fistulas, dissection of the femoral or iliac arteries, and stenosis.

Conclusions:

Although there is a lack of consensus on the role of ultrasound guided puncture, we found better outcomes for patients having an echo-guided puncture of the main access, particularly with regard to access-related complications, early mobilization, and early discharge home.
GIANT RIGHT CORONARY ARTERY ANEURYSM: LIFE-SAVING SURGICAL TREATMENT IN AN UNEXPECTEDLY ASYMPTOMATIC PATIENT
Authors: Musto M. , Totaro P. , Imò D. , Pelenghi S.
Published: December 2024

Introduction:

Coronary artery aneurysm (CAA) is defined as a dilation exceeding the diameter of an adjacent referent portion by more than 1.5 times. In rare circumstances CAA can be defined as giant, when exceed 8-20 mm. Here we report a rare case of a casual diagnosis of asymptomatic giant right coronary artery aneurysm who underwent successful surgical treatment.

Case report:

A 66 y.o. male was referred with a giant mediastinic mass revealed at a CT scan. The patient claimed to be asymptomatic. Pre-operative evaluation included: a) TT-Echocardiography showing a big ovalar mass next to the atrioventricular groove with blood flow from RCA; b) Ecg-gated-CTscan which showed a big (14x12.5 cm) contrast-enhanced mass arising from the RCA confirmed at c) coronary angiography. After careful Heart Team evaluation, surgical correction by mean of aneurism ligation, was deemed to be the only treatment option.

Surgical Treatment:

CPB was established via right axillary artery and peripheral femoral vein cannulation. Median sternotomy allowed the exposition of the huge aneurysm, nourished by the right coronary artery, with a complete dislocation of aorta. Surgical correction included aneurysm incision, exclusion of all communications and ligation. CABG on RCA was not necessary. Following uneventful course, post-operative CT scan showed no evidence of active blood reperfusion to the aneurysmatic remnant.

Conclusion:

CAAs are rare but potentially catastrophic conditions. Once the diagnosis is made, despite the lack of agreed consensus, early treatment with accurate preoperative evaluation is pivotal in order to optimize the outcome.
BEATING HEART REPAIR OF POST-INFARCTION VENTRICULAR PSEUDOANEURYSM: A CASE REPORT
Authors: Iavazzo A. , Longobardi A. , Chivasso P. , Colombino M. , Mariniello A. , Pirozzi F. , Vassallo M. G. , Bonadies A. , Coscioni E.
Published: December 2024

Background and Aim:

Left Ventricular Pseudoaneurysm (LVPA) is a rare but disastrous complication of myocardial infarction. Urgent surgical repair is required to avoid catastrophic rupture and it’s is necessary in order to exclude the pseudoaneurysm to preserve the LV geometry and function. Beating heart repair can be successfully performed in specific patients.

Methods:

A 71-years old male patient with a history of systemic hypertension, cigarette smoking, hyoercholesterolemia, peripheral arterial disease, presented with a 48-hours progressive epigastric pain. The diagnosis of anterior STEMI was made and the patient was referred for early coronary angiography, which revealed an occlusion of the left anterior descending artery and a PTCA with a stent implantation was successfully performed. Two days later, the echocardiography showed an apical free wall defect, suspicious of a small LVPA. An MRI confirmed the diagnosis and the patient was admitted to cardiac surgery department. A beating heart repair of the LVPA was performed. A 2-0 Prolene purse-string suture was done at the apex of the left ventricle between the viable myocardium and the infarcted tissues. The exclusion of the pseudoaneurysm was performed using two suture lines (U-shaped single stitches and a continuous 2-0 Prolene suture reinforced by Teflon strips) with the apposition of a bovine pericardial patch.

Results:

Postoperative echocardiography showed the successful exclusion of the psudoaneurysm, confirmed by a one-month-post- intervention MRI.

Conclusions:

Beating heart repair of post-infarction left ventricular pseudoaneurysm is a new, feasible and simple approach and provides good short and middle-term results in selected patients.
THE NOT-WEIGHT-BASED DOSING STRATEGY OF DELNIDO CARDIOPLEGIA IS SAFE AND EFFECTIVE IN ACHIEVING MYOCARDIAL PROTECTION IN CARDIAC SURGERIES WITH STANDARD AND PROLONGED CROSS-CLAMP: PRELIMINARY RESULTS FROM I.R.DE.N. REGISTRY
Authors: Ferraro S. , Calanni C. , Damiano A. , Barbaro M. , Cotugno M. , Comentale G. , Pilato E.
Published: December 2024

Background:

The use of delNido cardioplegia in adult cardiac surgery is increasing, with studies evaluating its safety yielding mixed results. Despite good perioperative outcomes, some suggest higher long-term postoperative mortality. Key debates include dosing strategies, with some centers using weight-based dosing and others following delNido’s protocol of a single 1000 ml dose for patients over 70 kg. This study reports on the outcomes of a standard dosing and redosing protocol in patients undergoing isolated or combined coronary artery bypass grafting (CABG) with normal and prolonged cross-clamp times.

Methods:

A retrospective single-center analysis was carried out on 207 patients who underwent isolated or combined CABG. The patients were divided into groups according to the type of cardioplegia (delNido vs. cold blood), and perioperative outcomes were compared. This analysis included patients with cross-clamp times longer than 80 minutes.

Results:

There were no baseline or preoperative risk profile differences between the groups. Although delNido patients had a slightly higher median cross-clamp time, both groups were similar in terms of postoperative troponin release, ICU and hospital stays, and 12-month survival. The delNido group required less inotropic support, both in terms of duration (p<0.001) and total dose (p=0.015). However, among patients with prolonged cross-clamp times, there were no differences in survival or postoperative outcomes.

Conclusions:

The delNido cardioplegia, using a non-weight-based protocol, appears to be safe and effective for myocardial protection in cardiac surgeries, including those with standard and prolonged cross-clamp times.
MINIMALLY INVASIVE AORTIC VALVE SURGERY WITH VENOUS WALL-LESS CANNULAS: PERFORMANCES AND SAFETY PROFILE
Authors: Torre T. , Pozzoli A. , Schraemli M. , Toto F. , Muretti M. , Demertzis S. , Ferrari E.
Published: December 2024

Introduction:

Techniques for venous cannulation during aortic minimally invasive surgery (MICS) evolved significantly. Aim of this study is to report the institutional experience with virtually wall-less venous cannulas during MICS aortic surgery.

Methods:

Transfemoral venous cannulation with Smart cannulas was performed in consecutive patients undergoing aortic MICS (isolated or in combination with other procedures). Target venous flow drainage (2.4 L/mq, Cardiac Index) and maximal suction performance without vacuum assistance were measured along with complications.

Results:

Since 2017, the Smartcannula was successfully positioned in all 75 patients (65.3 ± 11.8 years, 56 males) undergoing aortic MICS. The size measured 680 mm in length was adopted in all but two patients, who received the 530 mm Smartcannula. Regarding the surgical access, it was a superior mini-sternotomy in 75 patients (57 AVR, 10 bio-Bentall, 8 isolated ascending aorta and hemi-arch replacement). For a body height of 169.22 ± 24.83 cm and a body weight of 80.55 ± 15.21 kg, the calculated body surface area was 1.93 ± 0.22 mq. Expected target flow of 4.63 ± 0.53, whereas the achieved flow accounted for 5.85 ± 0.88 l/min (increase of 19.79%, in respect to target flow) without adopting vacuum, in all cases.

Conclusion:

The performance of self-expanding smart cannulas for venous drainage during aortic MICS proved to be extremely satisfactory, with a high safety profile. The drainage is optimal without vacuum in this setting, suggesting a steady superior flow over traditional rigid wall cannulas and confirming the efficacy during their routinary use.
RECONSTRUCTION OF LEFT VENTRICLE OUTFLOW TRACT AFTER ENDOCARDITIS: HOW WE DO IT
Authors: Ballan G. , Pantaleo A. , Calcara G. B. , Guerra G. , Cavicchiolo A. G. , Minniti G.
Published: December 2024

Backgrounds and aim:

One of the most widely adopted and complex procedures to treat Infective Endocarditis (IE) is the Commando technique. We propose a retrospective survival analysis with a different procedure performed in our center: the reconstruction of the whole left ventricle outflow tract (LVOT) with a pericardial cylindrical patch.

Methods:

We selected patients admitted from 2004 to 2023. Cases had LVOT or aortic root abscess, both on native or prosthetic valves with or without mitral valve involvement. We focused on aortic clamp time, cardiopulmonary bypass time, overall survival (OS) and event free survival (EFS).

Results:

We found 80 consecutive patients. Mean age at surgery was 63 years old. Sixty-one percent had already required heart surgery. Prosthetic valve involvement was found in 52% of the population. At the time of the procedure, the average EF was 58%. Mean aortic-clamp time was 145,2 minutes and the average cardiopulmonary bypass time was 188,6 minutes. One-year OS and EFS was respectively 78,75% and 98,75%. Only 2 patients (1,6%) needed additional heart surgery in the first year after the procedure.

Conclusions:

The literature reports for Commando and hemi-Commando technique a cardiopulmonary bypass time of 250 minutes and an aortic-clamp time of 200 minutes, which are both longer than those reported in our experience. One year OS, EFS and reintervention rates are comparable to the available data in literature. This study has some limitations, still it would be worthy of further prospective case-control study to validate this less demolitive and apparently equally effective technique.
SURGICAL TREATMENT OF BENIGN CARDIAC TUMORS: A 33-YEAR SINGLE-CENTER EXPERIENCE.
Authors: Buttiglione G. , Garatti A. , Gastino E. , Scarpanti M. , Canziani A. , Daprati A. , De Vincentiis C. , Parolari A. , Menicanti L.
Published: December 2024

Background:

Primary cardiac tumors are extremely uncommon and the majority (80%) can be classified as benign. Myxoma is the most common histotype accounting for 50% of benign cardiac tumors (BCT). This study aims to present our 33-year experience in treating benign cardiac tumors, describing their epidemiological characteristics, and the surgical outcome for each specific subtype.

Methods:

Between January 1990 and December 2023, 176 patients (73 males, mean age 63±10 years) with benign cardiac tumors underwent surgery. We performed a retrospective analysis of the three most common benign subtype: solid myxomas, papillary myxomas and fibro-elastomas. Tumors were detected through Echocardiogram, CT scan and magnetic resonance imaging (MRI). Long-term survival and freedom from tumor recurrence were assessed with Kaplan- Meier analysis.

Results:

Among clinical presentations, most patients were asymptomatic (55%), while Heart failure (HF) symptoms were evident in 26% of patients, especially if presenting with solid myxomas. The most common origin site of myxomas was the left atrium (74%). All patients had complete excision and 31% underwent combined procedures. Postoperative complications were similar in all tumor subtypes, except for stroke which was significantly higher in papillary myxoma and fibroelastoma type. Overall 30-day mortality was 1.7%, without any differences among study groups. Overall cumulative survival showed no significant differences among tumor subtypes. Myxomas showed no significant long-term recurrence, while fibroelastoma showed a 10% recurrence at 20 years.

Conclusions:

In our experience, complete surgical excision is the gold standard therapy for benign cardiac tumors, with excellent short and long-term outcomes regardless of tumor type.
EARLY RESULTS OF TOTALLY ENDOSCOPIC AORTIC VALVE SURGERY IN TAVI-AGE POPULATION
Authors: Zoni D. , Cresce G. D. , Tropea I. , Sanesi V. , Salvador L.
Published: December 2024

Background and Aim:

From EACTS guidelines, TAVI is preferred treatment choice in specific population’s characteristic, age is the major factor in TAVI favour. Study’s aim is to evaluate if Totally Endoscopic Aortic Valve Surgery (EAVS) has satisfactory early results in TAVI-Age population

Methods:

We performed a retrospective, single-center study of all patients undergone Totally EAVS from April 2014 to August 2024. Inclusion criteria were age > 18 y.o., totally endoscopic approach, AV surgery with or without concomitant procedure. Patient were stratified by age (18 – 74 years, > 75 years). Multivariable regression analysis was used to evaluate early outcomes.

Results:

577 patients undergone Totally EAVS, 447 (77.5%) were in the 18-74 years group, 130 (22.5%) in the > 75 years group. Regression analysis was adjusted for confounders. Before adjustment the 18 -74 y.o. population had lower hospitalization stay (medians days) (5 vs 6, p=0.003), all cause mortality (0.5% vs 4.4%, p=0.01), stroke (0.8% vs 4.5%, p=0.045), pacemaker implantation (2.9% vs 9.1%, p=0.01), ICU time (medians, hours) (24 vs 37, p=0.001). After adjustment 30-day mortality (OR 5.38, p=0.17), hospitalizations stay (beta - 0.29, p=0.71), ICU time (beta -0.24, p=0.98) did not differ. Pace-maker implantation (OR 2.66, p=0.08) and stroke (OR 4.86, p=0.06) were close to statistical significance.

Conclusions:

Totally EAVS in > 75 y.o. population had no difference in ICU time, hospital stay, mortality. A closely significant higher risk of stroke and pace-maker implantation was noted. Totally EAVS in TAVI-Age population has satisfactory early results and could be considered as alternative approach.
Analysis and Prediction of Consumer Decision-making Process of Live Broadcast Marketing under the Background of Digital Economy
Authors: Xu Yingzi
Published: December 2024

Under the background of digital economy, live broadcast marketing has become an important marketing method in the era of digital economy because of its high interactivity, real-time communication effect and accurate user positioning. Based on this, this paper puts forward four research hypotheses, that is, the quality of live broadcast content, the personal charm of anchor, the interaction between live broadcasts and the live broadcast preferential activities all have a positive impact on consumers’ purchase decision. In order to verify these hypotheses, a detailed questionnaire was designed, and 1,650 valid questionnaires were distributed and successfully recovered through the online platform. Using SPSS software to analyze the data, the results show that the quality of live broadcast content and preferential activities have the most significant influence on consumers’ purchase decision, and the anchor’s personal charm and interaction between live broadcasts also show positive influence. Factor analysis further identifies five key factors: live broadcast content and quality, anchor influence, discount and promotion, social interaction and experience and shopping convenience. Based on the above findings, this paper constructs a multiple linear regression model to predict consumers’ purchase intention in live broadcast marketing. The goodness of fit test of the model shows that the R² value is 0.782, indicating that the model has good explanatory power for the data. Through residual analysis and Q-Q plot verification, the model meets the basic assumptions of linear regression and the prediction results are reliable. Finally, the study proposed comprehensive optimization suggestions for live broadcast marketing strategies, including improving the quality of live streaming content, cultivating the personal charm of hosts, enhancing the interactivity of live streaming rooms, and planning live streaming promotional activities reasonably. This article not only enriches the theoretical research on consumer behavior in the digital economy, but also provides practical guidance for enterprises to formulate effective live broadcast marketing strategies.
Prediction of mud cake formation for shield tunneling based on cutterhead opening parameters
Authors: Rong Xuening , Wang Nannan , Han Aimin , Ji Chaoling , Li Tong
Published: December 2024

During the shield tunneling, mud cake is one of the most common causes of cutterhead failure. Mud cake formation is a typical nonlinear process. Although the mud cake may block partial or all of the cutterhead opening, the relationship between mud cake and opening parameters has not been investigated. In this study, a prediction model of mud cake formation based on cutterhead opening is developed. The shapes of central and peripheral opening are quantified by central angle, central length, average peripheral width and standard deviation. The geological type is considered as another input parameter. A dataset of 151 real shield machines is normalized. The state of mud cake is labeled to train a model based on support vector machine (SVM). The proposed model is validated against the dataset and three other engineering cases in varied cities. Mutual relationship between mud cake and opening parameters is also investigated. It is shown that opening parameters play important roles in mud cake formation. Increasing central opening angle is an effective method to avoid mud caking. The risk of mud cake is rather small for the central angle larger than 80°. For higher length of central opening, the central angle can be even smaller. By checking the opening parameters, the risk of mud cake can be reduced before actual excavation.
Renal Stone Formation in Spaceflight
Authors: Hong Jun Hao , Cable Gordon
Published: December 2024

The microgravity environment of space increases bone resorption in astronauts, increasing urinary calcium excretion. Dehydration may also occur due to decreased fluid intake and increased fluid loss through insensible losses and space motion sickness. These factors increase the risk of renal stone formation. Renal stones can cause sudden incapacitating pain, requiring immediate treatment. Definitive treatment options are currently unavailable in space, necessitating a return to Earth. Thus, preventative strategies should be employed.

Dietary intake of calcium, oxalate and sodium should be controlled. Citrate intake can help decrease stone formation risk but may not be readily available in space. Potassium-magnesium citrate can be used as a supplement. Exercise and bisphosphonates help significantly mitigate bone mass loss due to microgravity but is inadequate to completely prevent stone formation risk. Thiazides have been trialed with good effect.

Various countermeasures have been investigated for general use and in spaceflight. They can potentially be used to mitigate stone formation risks in future missions. Risk of stone formation can be monitored using urinary biochemistry analyte normograms. These risk mitigation strategies can be employed in the general public to prevent recurrences and manage stone formation risks.
Efficacy of entomopathogenic nematodes present in Việt Nam against brown marmorated stink bug (Halyomorpha halys) under laboratory conditions
Authors: Dao Thi H. T. , Nguyen H. T. , Beattie G. A. C. , Holford P. , Trinh P. Q. , Bui P. T. , Tran H. T. T. , Nguyen V. D. , Le H. N. , Phung H. S.
Published: December 2024

The brown marmorated stink bug (Halyomorpha halys), a native of Asia, has become an invasive pest in North America and Europe. Given the severity of H. halys and the need for better and environmentally-friendly control methods for this pest, we evaluated the virulence four entomopathogenic nematode species (Heterorhabditis indica, Oscheius myriophilus, Steinernema eapokense and Steinernema pakistanense) that occur naturally in soils in southern Việt Nam and compared them with that of a commercially available strain of S. carpocapsae. We report for the first time the pathogenicity of Oscheius myriophilus towards BMSB. The commercial strain of S. carpocapsae was most virulent against BMSB. However, the strain of S. pakistanense isolated from soil in southern Việt Nam has potential for the biological control of this pest. To achieve this potential, further work is needed including evaluation in the field and with the formulation of the nematode inoculum.
From Anti-Racism to Critical Race Theory in Ontario Public Schools
Authors: Tyndall Regan , Raza Kashif
Published: December 2024

The distortion of Critical Race Theory (CRT) in American popular media has spread to Canada, where the word “race” has traditionally been avoided in education, but where incidents involving race and “anti-racism” now garner considerable attention. We outline CRT in education and the context surrounding anti-racism work in Ontario. We then analyze important initiatives, such as Ontario’s proposed Bill 16 and the Hamilton-Wentworth District School Board’s “Learn. Disrupt. Rebuild.” module, in terms of their relevance within the CRT theoretical framework. Basic qualitative content analysis shows that the much-discussed provincial-level Bill 16 does not reflect the tenets of CRT—despite what its opponents, notably organizations such as Parents As First Educators (PAFE), have argued. However, the district-level “Learn. Disrupt. Rebuild.” initiative does reflect some tenets of CRT. This latter equity initiative is suggested as a model, starting from the local level in school districts, that other Canadian educators supportive of CRT should feel justified in following, as progressive Canadian districts move from anti-racism towards the next phase of district reform.
The Racial Mosaic: A Pre-History of Canadian Multiculturalism, by D. R. Meister. Reviewed by Adesoji Babalola.
Authors: Babalola Adesoji
Published: December 2024

Review of The Racial Mosaic: A Pre-History of Canadian Multiculturalism by D. R. Meister. Reviewed by Adesoji Babalola.
Caracterización de la logística del Ejército Nacional de Colombia y su actualidad conceptual
Authors: Cáceres García Jairo Andrés , Barrios Torres Sergio
Published: December 2024

El capítulo analiza los hitos históricos y eventos significativos que han moldeado la estructura de la logística militar del Ejército Nacional de Colombia, con el fin de identificar las características esenciales que definen el sistema logístico actual y su papel crucial en el desarrollo y el mantenimiento de las operaciones militares. Para cumplir este objetivo, se hace un examen retrospectivo de los eventos históricos relevantes que han contribuido a la organización y progreso de la logística militar en el Ejército Nacional de Colombia. Se recopilan datos pertinentes, se examinan documentos institucionales y se revisan registros históricos para identificar los momentos clave que han influido la configuración actual del sistema de gestión logística. Los resultados destacan la importancia y la relevancia de la evolución de la logística dentro de la Fuerza como elemento central para lograr éxitos operativos y garantizar el funcionamiento y la capacidad de sostenimiento
Caracterización de la logística en la Armada Nacional de Colombia
Authors: Farfán Espitia Luisa Fernanda , Osorio Dussan Luis Hernando
Published: December 2024

El capítulo identifica y caracteriza los atributos fundamentales que definen la logística naval para comprender cómo despliega su función en entornos marítimos, lacustres y fluviales, así como evidenciar su papel en la gestión y operación de sistemas logísticos en estos escenarios. Con este propósito se analizan las diferentes facetas de la logística naval, examinando sus momentos históricos, el desarrollo de sus operaciones y el relato evolutivo de las acciones logísticas en entornos marítimos. La metodología consistió en un estudio de datos y revisión bibliográfica especializada sobre el impacto y la eficacia de la logística naval en múltiples actividades. Los resultados revelan la importancia de la logística naval en el soporte y sostenimiento de las operaciones de la Armada Nacional en entornos desafiantes. Asimismo, se evidencia cómo la logística naval ha posibilitado el transporte marítimo eficiente y las operaciones navales estratégicas de abastecimiento y distribución, para lo cual ha vinculado de manera integral actividades portuarias y de seguridad marítima. Finalmente, se destaca la capacidad de la logística naval para proporcionar los medios necesarios para el desarrollo exitoso de las operaciones navales, incluso en condiciones adversas donde los recursos y los aprovisionamientos son limitados.
Desde la ventana Historia y escenas de la cuarentena
Authors: Silva Manuel , Bohórquez Miguel , Bravo Pedrosa Mónica
Published: December 2024

Desde la ventana. Historias y escenas de la cuarentena es una constelación de textos y dibujos producidos durante la cuarentena decretada en Colombia y en otros países, debido a la expansión de Covid-19 en 2020. La conjunción de gráfica y escritura fluye por las fronteras que hay entre el sueño, la imaginación y la memoria; entre la crónica, los apuntes del diario y el microrrelato. Dicho en otros términos, las palabras y las líneas dan cuenta de cómo eso, que por convención llamamos realidad, se dejó ver e imaginar con otras formas y figuras durante la pandemia.
Rational and Intuitive Decision-making Styles, Critical Thinking Dispositions and Associated Factors of Nurses
Authors: Kaplan Ali , Özdemir Cevriye
Published: December 2024

Background: Nurses often use the clinical decision-making mechanism. This mechanism is influenced by critical thinking and rational and intuitive decision-making styles. This study’s aim was to determine the levels of rational and intuitive decision-making styles and critical thinking disposition of nurses. Method: It is a prospective and cross-sectional descriptive study. Data were collected between May and August 2023. The study included 355 nurses working at two major hospitals in one of the largest cities in the Central Anatolia region. The data were gathered using a questionnaire consisting of a personal information form, Critical Thinking Disposition Scale and Rational and Intuitive Decision-making Styles Scale.Results: The Critical Thinking Disposition Scale and Rational Decision-making Styles Scale scores of the nurses were above the average and the Intuitive Decision-making Styles Scores were close to the average. A positive and significant correlation has been found between nurses’ critical thinking dispositions and levels of rational and intuitive decision making. In addition, the linear regression analysis shows nurses’ critical thinking tendencies affect their rational decision-making and intuitive decision-making styles.Conclusion: These findings suggest strengthening nurses’ critical thinking could improve both their rational and intuitive decision-making skills, thereby improving patient care outcomes by making effective clinical judgements.
A cobertura da triagem neonatal e as características sociodemográficas no Brasil, segundo dados da Pesquisa Nacional da Saúde – 2019
Authors: Xavier Juliana Cantele , Passos Camila Mendes dos , Penna Juliane Firmino Conte , Gualberto Géssica Teixeira , Gomes Maria Luiza Cacemiro , Abijaude Wesley , Teixeira Ísis Milani de Sousa , Quintão Gabrielly Vaillant , Prado Mara Rúbia Maciel Cardoso do , Prado Júnior Pedro Paulo do
Published: December 2024

Objetivo: Descrever as coberturas dos rastreamentos da triagem neonatal no Brasil, a partir dos dados da Pesquisa Nacional da Saúde (PNS), e correlacionar com variáveis sociodemográficas. Métodos: Pesquisa quantitativa e descritiva, para a qual utilizou-se uma subamostra de dados coletados pela PNS de 2019. Foram analisadas frequências absolutas e relativas, além de seus intervalos de confiança. As coberturas dos testes e o recebimento de resultados foram estimados, considerando os estratos demográficos de idade, raça/cor, renda, região e área. Diferenças de prevalência foram avaliadas pelo teste Qui-quadrado de Pearson, com significância de 5%. Resultados: Observou-se uma maior proporção de crianças negras, de baixa renda, residentes no Norte e Nordeste e em área urbana. A menor cobertura encontrada foi de 61,9% para o teste do coraçãozinho. Houve variação na cobertura em tempo preconizado e acesso aos resultados. Identificaram-se iniquidades na cobertura, no acesso em tempo preconizado e no acesso aos resultados.  Menores coberturas foram associadas a raça/cor, renda, região e área de moradia. A cobertura para triagem neonatal completa foi de 49,1%. Conclusão: O acesso ao teste do pezinho foi superior aos demais. O estudo também revelou disparidades sociodemográficas na triagem neonatal no Brasil, destacando a urgência de fortalecer as políticas intersetoriais.
O uso da Inteligência Artificial na Medicina: os benefícios e desafios da parceria homem-tecnologia na saúde
Authors: Gomes Sophia Artiaga , Montanini Júlia França , Rocha Sobrinho Hermínio Maurício da
Published: December 2024

Objetivo: Descrever as maneiras que as ferramentas de Inteligência Artificial (IA) influenciam a Medicina, seus benefícios e desafios, expondo ferramentas já existentes na área e abordando amplamente tanto o cuidado do paciente quanto o cotidiano dos profissionais da saúde. Revisão bibliográfica: Os benefícios da IA são significativos, predominantemente nas áreas de diagnósticos precoces via análise de exames de imagem, planejamento de tratamentos personalizados, previsão prognóstica, gestão em saúde e contribuições para uma Medicina mais eficaz, sempre em parceria com o profissional humano. Ademais, foram expostas diversas ferramentas, tanto em desenvolvimento quanto já disponíveis para o uso popular, assim como as empresas responsáveis por cada uma e suas respectivas funções, com fim de exemplificar os avanços tecnológicos já existentes. Contudo, ainda há dificuldades éticas, legais e operacionais que precisam ser superadas para a integração efetiva e em massa das tecnologias baseadas em IA na prática. Considerações finais: O impacto da IA na Medicina é inegável, sendo essencial a realização de mais estudos clínicos que comprovem e aprofundem o entendimento sobre a influência dessa nova tecnologia, garantindo que seus benefícios sejam maximizados e seus desafios adequadamente enfrentados.