bluuebunny/crossref_metadata_2025 huggingface dataset:
EP11 DOES TYPE OF CARDIOPLEGIA AFFECT THE INCIDENCE OF POSTOPERATIVE PAROXYSMAL ATRIAL FIBRILLATION IN PATIENTS UNDERGOING CARDIAC SURGERY?
Authors: Nardi P. , Scafuri A. , Bertoldo F. , Pisano C. , Bernardini A. , Bassano C. , Pellegrino A. , Ruvolo G.
Published: November 2018

Background and Aim:

Paroxysmal atrial fibrillation (PAF) is the most frequent complication following cardiac surgery. Despite high incidence, its etiology remains uncler. Aim of our investigation was to analyze retrospectively the pathogenetic role of different types of cardioplegia on the onset of PAF.

Methods:

Sixty-hundred and sixty patients underwent on-pump cardiac surgery between January 2015 and October 2016. Redo operations and emergency surgery were excluded. The types of cardiolplegic solution administered were warm blood cardioplegia (Calafiore, n = 480), cold crystalloid extracellular cardioplegia (St. Thomas, n = 71), cold crystalloid intracellular cardioplegia (Custodiol, n = 109). The way of admistation was antegrade for all types of cardioplegic solution.

Results:

The incidence of postoperative PAF was 36.2% (239 patients). Two-hundred patients were initially treated by mens of amiodarone infusion that successfully allowed cardioversion in 167 cases (83.5%); in the other 39 patients were initially administered other drugs (i.e. verapamil e.v./per os, beta-blokers per os). A relation between the type of cardioplegic solution and the onset of postoperative PAF was not found (Calafiore, n = 180, 37.5%; St. Thomas, n = 22, 31%; Custodiol, n = 37, 34%; p = NS). Advanced age at operation (71.3 ± 8.7 vs. 65.7 ± 11 years) was the only independent predictor of PAF (p < 0.001). Non-coronary surgery was found as risk factor for PAF at the univariate analysis only (p < 0.01).

Conclusions:

The use of different type of cardioplegic solutions, and at different temperatures, does not correlate with the onset of postoperative PAF. Initial treatment strategy with amiodarone infusion allows pharmacological cardioversion of PAF in over 80% of cases.
RF15 DOES RE-DO AORTIC VALVE SURGERY STILL HAVE A ROLE IN THE ERA OF TRANS-CATHETER AORTIC VALVE IMPLANTATION?
Authors: Greco R. , Hill E. , Jin X. , Renna M. , Djordjevic J. , Petrou M.
Published: November 2018

Background and aim:

Re-do aortic valve replacements (AVR) have higher mortality and morbidity compared to first time AVR. Trans-catheter aortic valve implantation (TAVI) is an option for high-risk patients. The aim of the study is to present our experience with re-do aortic procedures.

Method:

Retrospective review of 80 patients (mean age 51.8 ± 18.73) who underwent re-do aortic valve procedures (2008–2017). 41 (51.2%) had re-do AVR and 39 (48.8%) re-do complex aortic surgery (28 root, 23 ascending and 6 hemiarch).

Results:

Mean Euroscore II was 8.3% (higher in the complex group 12 vs 5%). 19% of patients had a mechanical valve implanted as result of previous surgery. Indication for reoperation was: infective endocarditis in 19 (23.8%) (12 root abscess), bio-prosthesis degeneration in 10 (12.5%), mechanical valve dysfunction in 4 (5%), aortic aneurysm, pseudoaneurysm and dissection in 28 (35%), root/homograft degeneration in 22 (27.5%), patient-prosthesis mismatch in 3 (3.8%), paravalvular leak in 5 (6.2%), native valve disease in 20 (25%). 65.4% of patient had significant AR and 37,5% required concomitant procedures. IH mortality was 2.5% (0% re-do AVR vs 5.1% re-do complex).

Conclusion:

A large number of patients presented with contraindications for TAVI: age < 60 (61%), previous mechanical valve (18.8%), significant AR (65.4%), infective endocarditis (23.8%), need for complex aortic procedure (49%) or concomitant surgery (37.5%). The number of patients that would actally benefit from TAVI procedures is overestimated. Re-do aortic surgery remains the only treatment for such challenging cases and can be performed with acceptably low mortality and morbidity.
VD03 AN INTERESTING COMPLICATION FROM BROOKLYN
Authors: Territo S. , Mangerini V. , Agostara V. , Torre S. , Castrovinci S. , Giarratana G. , Bono M. , Argano V.
Published: November 2018

We present a 68 years-old lady with ascending aortic pseudoaneurysm discovered by CT-angio 11 years after CABG in the States. Three out of 4 grafts were patent. Once the aorta was opened we found a localised chronic dissection likely originating from previous aortic cannulation site.

In this video we show chest reopening, aneurysm isolation and cannulation in the arch and right atrium. Aortic clamp was applied high, aneurysm was opened and the dissected aorta resected, keeping 4 top-ends attached to the aortic wall as an island. Cardioplegia was given into aortic root and selectively into venous grafts. An interposition 26 mm vascular conduit was anastomosed to sino-tubular junction and distal ascending aorta. After unclamping, the island containing top-ends was reattached to vascular conduit by 10 mm interposition graft.
EP36 SUTURELESS AORTIC BIOPROSTHESIS IS ASSOCIATED WITH IMPROVEMENT OF EJECTION FRACTION IN PATIENTS WITH PREOPERATIVE LEFT VENTRICULAR DYSFUNCTION
Authors: Concistrè G. , Bianchi G. , Chiaramonti F. , Santarelli F. , Gasbarri T. , Kallushi E. , Cerillo A.G. , Murzi M. , Margaryan R. , Farneti P. , Solinas M.
Published: November 2018

Background and Aim:

Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of sutureless Perceval (LivaNova, Italy) aortic bioprosthesis on LVEF and clinical outcomes in patients with baseline left ventricular dysfunction underwent isolated aortic valve replacement.

Methods:

Between March 2011 and August 2017, 803 patients underwent AVR with Perceval bioprosthesis implantation. Fifty-two patients had preoperative LVEF ≤ 45%. Mean age of these patients was 77 ± 6 years, twenty-four patients were female (46%), and mean logistic EuroSCORE was 17.7 ± 10.2%. Perceval bioprosthesis was implanted in 9 REDO operations. In 43 patients (83%), AVR was performed in minimally invasive surgery with an upper ministernotomy (n = 13) or right anterior minithoracotomy (n = 30).

Results:

One patient died in-hospital. Cardiopulmonary bypass and aortic cross-clamp times were 98 ± 26 minutes and 61 ± 19 minutes, respectively. At mean follow-up of 33 ± 20 months (range: 1–75 months), survival was 90%, freedom from reoperation was 100%, and mean transvalvular pressure gradient was 11 ± 5 mmHg. LVEF improved from 37 ± 7% preoperatively to 43 ± 8% at discharge (p < 0.01) and further increased to 47 ± 9% at follow-up (p = 0.06), and moderate paravalvular leakage occurred in one patient without hemolysis not requiring any treatment.

Conclusions:

AVR with sutureless aortic bioprosthesis implantation in patients with preoperative left ventricular dysfunction demonstrated a significant immediate and early improvement in LVEF.
EP07 AORTIC VALVE REPAIR TECHNIQUES: AN EARLY EXPERIENCE FROM A SINGLE UK CENTRE
Authors: Greco R. , Jin X. , Petrou M.
Published: November 2018

Background and aim:

Aortic valve repair (AVr) is an evolving area with only few European centres reporting a large volume experience. Very few other surgical units have adopted this approach, even in patients with pure aortic regurgitation (AR). Our aim is to report our early experience with AVr techniques.

Method:

59 patients with a mean age of 49 years (range 19–85) underwent AVr for either primary (cusp prolapse or perforation) or secondary (aortic root and/or ascending aneurysms) AR. 14 patients had a bicuspid aortic valve. Standard repair techniques were used including: sub-commissural annuloplasty, STJ remodelling, free-edge plication, commissural resuspension, raphe resection, free-edge reinforcement and VSRR.

Results:

All patients underwent successful AVr including 1 patient who required a 2nd pump run. The post-bypass TOE demonstrated no/trace AR in 49 (83%) cases, mild central AR in 8 (13.6%) and mild eccentric AR in only 2 (3.4%) cases. 30 day survival was 100%. 2 patients suffered post-operative strokes, none required PPM insertion. At a mean clinical follow-up of 4.7 ± 2.7 years all patients are alive and well. Echo follow-up (2.3 ± 1.9 y) showed: no or trace AR in 25 patients (42.4%), mild AR in 22 patients (37.3%), moderate AR in 11 patients (18.6%), severe AR in 1 patient (1.7%), who underwent re-do AVR 5 years after VSRR. Freedom from re-operation was 87% at 8 years.

Conclusion:

Despite achieving an excellent immediate (post-bypass) technical result, we remain cautious about the long-term durability of AVr procedures. We therefore continue to carefully evaluate AVr in our practice.
RF09 BEST OF BOTH WORLDS: DIRECT-VISION BALLON-EXPANDABLE TRANSCATETHER PROSTHESIS WITH EXCISION OF ANTERIOR MITRAL LEAFLET TO TREAT SEVERE STENOSIS IN BIG MITRAL ANNULAR CALCIFICATION PATIENTS
Authors: Weltert L. , D’Aleo S. , Chirichilli I. , Wolf L. Guerrieri , Ricci A. , Scaffa R. , Salica A. , Bellisario A. , De Paulis R.
Published: November 2018

Background and aim:

The mitral annular calcification (MAC) is one of the most demanding and exciting challenges for the cardiac surgeon. Numerous surgical techniques to approach MAC have been described, and many include decalcification and annular reconstruction. The aim of this study is to describe an alternative method of treatment of the MAC, performing surgical implant of a prosthesis designed for the percutaneous implant in aortic position under direct vision and to define the applicability criteria.

Methods:

Preoperative evaluation is a key point to define the possible treatment options of the MAC. The CT-scan is the fundamental tool that allows quantification of calcium and its possible extension in the underlying myocardium. An indispensable criterion is that the calcification interests the annulus in an almost completely circumferential manner, in such a way as to allow a safe deployment prosthesis.

Results:

We report a surgical approach to manage MAC and avoid calcium debridement by using a prosthesis designed for TAVI procedures. The anulus is measured with an Egar dilator and part of the anterior mitral leaflet is removed which creates room for a bigger implant. An Edwards SAPIEN 3 Transcatheter Heart Valve is implanted in the mitral annulus under direct vision and then the crimped valve is deployed with a manual inflation device. Inflation of the ventricle with saline allows to identify any valvular leaks and correct them by placement of one or more stitches.

Conclusions:

This technique seems a safe and effective solution for treating the MAC in selected cases.
RF72 RIGHT VENTRICLE EVALUATION BY CARDIAC MAGNETIC RESONANCE BEFORE AND AFTER MITRAL VALVE SURGERY
Authors: Pettinari M. , Lazam S. , De Kerchove L. , Pasquet A. , Gerber B. , Vanoverschelde J. , El-Khoury G.
Published: November 2018

Introduction:

There has been growing attention for the development of functional tricuspid regurgitation (TR) and right ventricular dysfunction after left-sided valve surgery. The fate of right ventricle function after mitral valve surgery is still not well defined. Our study aims to describe the evolutions of RV volumes and function evaluated by cardiac magnetic resonance (CMR) after mitral valve surgery in patients with less then severe tricuspid regurgitation.

Methods:

Sixty patients undergoing mitral valve surgery (58 for degenerative and 2 for functional disease) were analysed by CMR preoperative and at 6 months. Two patient with severe tricuspid regurgitation and 6 who received a tricuspid annuloplasty were exclude, with 52 patients remained for the analysis. Indexed end-diastolic and systolic volumes (RVEDVi and RVESVi) ejection fraction (RVEF) and stroke volume (RVSV) were the primary outcomes of the study. Multivariate linear regression was used to identify risk factors related to the right ventricle volumes and function improvement.

Results:

Mean age was 57+/-21 years and 40 patients were male. In the global population RVEDVi(83.5 ml/m2 vs 80.1 ml/m2, p < 0.01), RVESVi(43.4 ml/m2 vs 38.6 ml/m2, p < 0.01) and RV ejection fraction(48.3% vs 52.4%, p < 0.01) improved significantly while the stroke volume(78.1 ml vs 79.7 ml, p = 0.6) did not. Preoperative RVESVi(p < 0.01) and RVEDVi were the most significant predictors of improvement in volumes after surgery(p < 0.01).

Conclusion:

Mitral valve surgery seems to have a positive effect on right ventricle volumes and function improve after surgery for mitral valve disease in patients with less than severe tricuspid regurgitation without other prophylactic procedure.
RF18 EDGE TO EDGE PROCEDURE AS AN ALTERNATIVE TO QUADRANGOLAR RESECTION OF ISOLATED PROLAPSE OF POSTERIOR MITRAL LEAFLET
Authors: Bortolami A. , Fucci C. , de Cicco G. , Latini L. , di Matteo D. , Aquino T.M. , Prencipe A. , Coletti G.
Published: November 2018

Backgruond and Aim:

We present our casuistry links to prolapse/flail of P2 LPM in mitral regurgitation treated with edge-to-edge technique when contraindicated to quadrangolar resection.

We hereby present our experience using a modified edge-to-edge technique to address this peculiar MR.

Methods:

From January 1999 to January 2015, 89 consecutive patients (mean age 56 ± 14,56, 53 males) affected by prolapse/flail of P2 LPM in mitral regurgitation. Preoperative transesophageal echo (TEE) in all the cases showed prolapse/flail of P2 LPM when it exists a controindication to quadrangolar resection like: extensive resection 52%, posterior anulus calcification 23%, hypertrofic/small ventricle 27%. In all the patients, a doble orifice valve (DOV) repair with annuloplasty was performed. Intra-operative TEE and postoperative transthoracic echocardiography (TTE) were carried out to evaluate results of the DOV repair.

Results:

There was no in-hospital death. At intra-operative TEE, the two orifices showed a mean total valve area of area 3,06 ± 0,63 cm with no residual regurgitation or trivial and no sign of valve stenosis (Grad med 3,73 ± 1,66; Grad max 11,02 ± 7,48). At follow up (from 1999 to 2015) we appreciated a freedom from reoperation 97%(fig.1) and survival 95% (Fig. 1).

Conclusions:

We consider edge to edge a valid alternative in pts with prolapse/flail of P2 in LPM when exist: extensive resection that may determinate a residual mitral regurgitation by LPM retraction, posterior anulus calcification that may determinate no possibility of annular plication and hypertrofic/small ventricle for high risk of persistent SAM.
RF49 MINIMALLY INVASIVE SURGERY: KEY HOLE APPROACH
Authors: Rosa R. , Vanelli P. , Contino M. , Romagnoni C. , Cagnoni G. , Antona C.
Published: November 2018

Background and Aim:

Minimally invasive surgery through right minithoracotomy is routinely performed in mitral valve repair and the current tendency is to further simplify the procedure and reduce invasiveness and trauma on tissues for faster postoperative recovery.

Methods:

In our experience, 175 patients underwent minithoracotomy (52,3% males) from August 2012 to May 2018. In the last 6 months, 7 patients were selected for “Key Hole Surgery” through a 3-3,5 cm periareolar incision along the convexity of the right areola; the thoracoscopy was positioned on anterior axillar line in the same right intercostal space.

Results:

The endoscopic vision was always obtimal, ensuring an effective control in repairing procedures. A complete ring was always implanted; according to the features and mechanism of mitral regurgitation, in some cases we performed a resection of the posterior leaflet, in other cases we preferred a “respect-no-resect” approach (even chordal traslocation).

Conclusions:

Compared to anterolateral minithoracotomy, the advantages of this approach are a minor trauma (often caused by intercostal retraction), better control of postoperative pain and better result from the aesthetic point of view, because the incision exploits the hyperchromy of the periareolar area making the scar almost invisible. The indirect disadvantages of the procedure are related to the fact that such a limited incision does not permit central cannulation and aortic cross-clamping, from which the need of a femoral peripheral cannula and the use of the device Intraclude for aortic clamping are derived; this guarantees a “no-touch-aorta” intervention and great reduction of risk of post-operative bleeding.
RF73 RIGHT VENTRICULAR OUTFLOW TRACT RECONSTRUCTION IN PEDIATRIC CARDIAC SURGERY: FEDERICO II 10-YEARS EXPERIENCE
Authors: Comentale G. , Palumbo S. , Mucerino M. , Giordano R. , Cioffi S. , Russolillo V. , Busillo L. , Lopez G. , Mitrano L. , Simeone S. , Palma G.
Published: November 2018

Background and Aim:

Surgical repair of congenital heart defects involving reconstruction of the right ventricle outflow tract sometimes requires implantation of a right ventricle to pulmonary artery (RV-PA) conduit. To date, the ideal conduit is yet to be found so different kinds of prosthesis are usually used. It will be presented the 10-years experience with the different PA-RV conduits used at our institution.

Methods:

From 2007 to 2018, 92 RV-PA conduit implant procedures were performed on 75 children (58 Contegra®, 12 Fresh Homografts and 22 Hancock®). Clinical data were retrospectively collected from medical records and then they were matched for comparison using propensity score. Pediatric Risk of Mortality score, the day of withdrawal of inotropic drugs, the length of the intensive care unit stay and of the hospital stay were used to assess postoperative morbidity.

Results:

No significant difference was observed when considering the operative data for anesthesia, the intraoperative inotropic support, the perioperative complication rate or the postoperative morbidity and mortality. Length of surgery, of cardiopulmonary bypass, of aortic clamping and the intraoperative and postoperative blood loss was significantly lower in the Homograft group. There were no differences in the reoperation free survival between Contegra® and Hancock® groups but a significantly higher reoperation free survival was observed in Homograft group.

Conclusion:

RV-PA conduit replacement can be achieved with a low surgical morbidity or mortality with any type of conduit but Homografts seem to be related to a better intraoperative and postoperative outcomes especially due to their long life.
RF38 LATE PREDICTORS OF MITRAL REGURGITATION RECURRENCE AFTER SURGERY FOR FUNCTIONAL MITRAL REGURGITATION IN ISCHEMIC HEART FAILURE: FIX THE LEFT VENTRICLE TO IMPROVE MITRAL REPAIR DURABILITY.
Authors: Saitto G. , Garatti A. , Castelvecchio S. , Canziani A. , Parolari A. , Mossuto E. , Daprati A. , Menicanti L.
Published: November 2018

Background and aim:

to analyse predictors of functional mitral regurgitation recurrence (MRR) after Surgical Ventricular Reconstruction (SVR) and mitral annuloplasty in ischemic heart failure (EF < 35%).

Methods:

Between January 2001 and March 2016, a consecutive series of 172 patients (mean age 64 ± 8 years) was operated of SVR and mitral annuloplasty for anterior [AR = 128 (74%)] or posterior [PR = 44 (26%)] post-ischemic remodeling and functional MR. Echocardiographic follow-up (mean: 51 months) was available in 131 patients. MR grade >2 was defined as MR recurrence (MRR). Independent predictors of MRR were calculated with univariate (Kaplan-Meier) and multivariate (Cox regression) analysis.

Results:

MRR occurred in 27 patients (18%), and was significantly associated with higher 5-years mortality (52% vs 18%, p < .001) and HF readmission rate (55% vs 22%, p < .001). MRR was significantly lower in posterior compared to anterior remodelling (9%vs 18%, p = .03). Left ventricle volumes (ΔESV = -29%; ΔEDV = -22%) were significantly reduced both in patient without or with MRR, but the latter exhibited a significant post SVR sphericalization (ΔSpher Index: +37%vs +7%; p = .01), which significantly correlates with increased mitral tenting area (R2 = 0.36; 3.5 cmq vs 2.6 cmq; p = .002). Multivariate Cox regression analysis showed anterior remodeling (p = .01) and Sphericity Index (p = .01) as independent predictors of MRR. ROC analysis identified a cut-off value of 0.66 (sensibility = 78%; specificity = 67%) for SpherI (3-years freedom from MRR: 54% vs 18%,p = .001).

Conclusions:

In functional MR and ischemic HF, SVR improves long-term durability of mitral annuloplasty, especially in posterior remodelling. LV sphericalization and anterior remodeling correlate to higher probability of MRR at follow-up so, in this settings, valve replacement rather than repair should be considered.
RF65 PULSE OXIMETER USEFULNESS FOR BLOOD PRESSURE MONITORING IN PATIENTS IMPLANTED WITH LVAD (LEFT VENTRCLE ASSIST DEVICE)
Authors: palermo A. , montalto A. , gherli R. , cammardella A. , contento C. , piazza V. , musumeci F.
Published: November 2018

BACKGROUND AND AIM:

The measurement of blood pressure (BP) in patients with CF-VADs can present unique challenges because traditional BP measurement by auscultation or automated cuff is less reliable.

We tested the efficacy of blood pressure estimation by using the Sphygmomanometry combined with finger pulse oximetry.

METHODS:

51 patients, 24 implanted with HM II, 4 implanted with HVAD, 23 implanted with HM3 were prospectively studied during follow up period and mean arterial pressure was estimated by using 3 different methodologies; ultrasound doppler, pulse oximeter and automated blood pressure cuff. For each method 3 consecutive evaluations were conducted in 3 follow-up visits.

RESULTS:

For each patient 9 different evaluations were obtained, 3 for each method. The overall success rate was 100% for blood pressure assessment conducted with doppler and pulse oximeter, 80% - 87% the rate for automated monitor evaluations. 100 was the percentage of three successfull consecutive measurements for the first two methodologies and 60 the percentage for the last one. Pearson's correlation analysis showed a good correlation when measurements of doppler and pulse oximeter were compared. High variability emerged between estimations obtained by using automated monitor and poor correlation was found when this method was compared with doppler an pulse oximeter.

CONCLUSION:

According to our results pulse oximeter method showed high success rate and a good correlation level with the standard proedure. Our data encourage the use of oximter for domiciliary blood pressure assessment in patients implanted with continuous flow device.
RF66 RAMP TEST TO OPTIMIZE HEMODYNAMIC PROFILE IN PATIENTS IMPLANTED WITH LVAD (LEFT VENTRICLE ASSIST DEVICE)
Authors: Montalto A. , Piazza V. , Fiammetta A. , Cammardella A. , Comisso M. , Gherli R. , Contento C. , Palermo A. , Musumeci F.
Published: November 2018

Background and Aim:

Pump speed optimization in patients implanted with Left Ventricle Assist Device epresents a main challenge during follow-up. we describe our study that tested whether invasive hemodynamic ramp test can optimize the patient hemodynamic profile.

Methods:

Frrom january 2015 to march 2018, 35 patients, 18 implanted with HM3, 14 with HM II and 3 implanted with HVAD, underwent ramp test during right heart catheterization. Basal hemodynamic data including central venous pressure (CVP), pulmonary artery systolic, diastolic and mean pressure (PAPS, PAPD, PAPM), pulmonary capillary wedge pressure (PCWP) were measured. hemodynamic parameters, blood pressure and echocardiography data were valuated at up to 4 speed settings. speed changes were in steps of 200 revolutions per minute (RPM) for HM3 and HVAD and 400 RPM for HMII.

Results:

Only 30 % of patients had normal PCWP at their basal RPM setting. Going from the lowest to the highest speeds, cardiac output improved (total change 1,28 +/- 0,3 l/min) and PCWP decreased by 1,9 +/- 0,73 mm Hg/step . CVP and systolic blood pressure did not change significantly with RPM. RPM were adjusted based on test results to achieve CVP and PCWP as close to normal limits as possible, an optimal hemodynamic profile represented by PCWP > 15 mm Hg, CVP < 10 mm Hg, PAM (mean arterial pressure) ranging 75–85 mmHg was obtained in all the patients.

Conclusions:

Use of hemodynamic ramp test in patients implanted with LVAD, provides objective means of optimizing RPM, obtaining an optimal left ventricle unloading
RF93 UTILITY OF SIMPLIFIED ACUTE PHYSIOLOGY SCORE II AS OUTCOME'S PREDICTOR FOR TAVI
Authors: Pollari F. , Cuomo M. , Vogt F. , Kalisnik J.M. , Dormann C. , Jessl J. , Fischlein T. , Pfeiffer S.
Published: November 2018

Background:

Simplified Acute Physiology Score (SAPS) II is a prognostic score for predicting outcome of critically ill patients on admission in intensive care units (ICU). Our aim is to assess its utility in Transcatheter aortic valve implantation (TAVI).

Methods:

We retrospectively analyzed data from patients, who underwent a TAVI procedure from 2010 up to October 2016. Patients who survived TAVI were extubated in the hybrid-room according to our fast track protocol and thereafter admitted to intensive care unit, where SAPSII was prospectively calculated. Following outcomes were investigated: length of ICU-, hospital-stay and 30-day mortality.

Results:

699 TAVI procedures were performed in 696 patients. For 599 (229 TA, 370 TF) SAPSII was disposable. Logistic Euroscore in TA group was significantly higher than in TF group (29.66% ± 16.1 vs 22.59% ± 15.16, p < 0.05). In the TA group, mean SAPSII was 29.73 ± 11.27 (range 13–101) with an observed 30-day mortality of 7%. Mean ICU and hospital stay were 3.98 ± 6.6 and 14.28 ± 8.85 days respectively. Pearson's test showed a significant correlation only between SAPSII and hospital-stay (p = 0.03). In the TF group, mean SAPSII was 30.82 ± 11.27 (range 12–98) with an observed 30-day mortality of 2.7%. Mean ICU- and hospital-stay were 1.63 ± 3 and 11.33 ± 8.14 days respectively. Pearson's test showed no significant correlation. Hosmer-Lemeshow test was not significant in both groups, but ROC curve showed a very poor discrimination (TF group AUC = 0.594 ± 0.089 – TA group AUC = 0.587 ± 0.068).

Conclusions:

SAPSII does not correlate with 30-days-mortality and ICU stay in TAVI patients. A correlation between SAPSII and hospital-stay has been found only in TA-TAVI patients.
RF21 EVOLUTION OF VENTRICULAR ENERGETICS IN THE DIFFERENT STAGES OF PALLIATION OF HYPOPLASTIC LEFT HEART SYNDROME: A RETROSPECTIVE CLINICAL STUDY.
Authors: Di Molfetta A. , Iacobelli R. , Rocchi M. , Bellisari F. Cobianchi , Gagliardi M.G. , Carotti A. , Massetti M. , Amodeo A. , Guccione P.
Published: November 2018

Introduction:

Hyperplastic left heart syndrome (HLHS) patients are palliated by creating a Fontan-type circulation passing from different surgical stages. The aim of this work is to describe the evolution of ventricular energetics parameters in HLHS patients during the different stages of palliation.

Methods:

We conducted a retrospective clinical study enrolling all HLHS patients surgically treated with hybrid procedure and/or Norwood and/or Bidirectional Glenn (BDG) and/or Fontan operation from 2011 to 2016 collecting echocardiographic and hemodynamic data. Measured data were used to calculate energetic variables such as ventricular elastances, external and internal work, ventriculo-arterial coupling and cardiac mechanical efficiency.

Results:

From 2010 to 2016, a total of 29 HLHS patients undergoing cardiac catheterization after hybrid (n = 7) or Norwood (n = 6) or Glenn (n = 8) or Fontan (n = 8) procedure were retrospectively enrolled. Ventricular volumes were significantly higher in the Norwood circulation than in the hybrid circulation (p = 0.03) with a progressive decrement from the first stage to the Fontan completion. Ventricular elastances were lower in the Norwood circulation than in the hybrid circulation and progressively increased passing from the first stage to the Fontan completion. The arterial elastance and Rtot increased in the Fontan circulation. The ventricular work progressively increased. Finally, the ventricular efficiency improves passing from the first to the last stage of palliation.

Conclusion:

The use of ventricular energetic parameters could lead to a more complete evaluation of such complex patients to better understand their adaptation to different pathophysiological conditions.
RF26 HYDROGEL MYOCARDIAL INJECTION AS USEFUL STRATEGY TO PREVENT CARDIAC REMODELING: A SYSTEMATIC REVIEW AND META-ANALYSIS, IN MODELS OF HEART FAILURE
Authors: Di Franco S. , Alfieri A. , Moriello N. Schiano , Amarelli C. , Pace C. , Passavanti M.B. , Fiore M.
Published: November 2018

Background:

The main objective of this systematic review (PROSPERO ID 96223) is to determine the advantage in hydrogel-based treatment to achieve sustained improvement of cardiac function in heart failure (HF), compared to drug therapy or placebo in clinical and experimental models of HF. The association between different types of hydrogel and myocardial function impairment, performance status and injection-induced complications, is analysed.

Methods:

Literature search has been performed using computer-assisted databases (MEDLINE, EMBASE, CENTRAL and JBI database of systematic reviews and implementation reports).

The search strategy and the search string (“hydrogel” AND “heart”) has been formulated following the PICO method.

Outcomes aim to assess myocardial improved function as: myocardial thickness by post-mortem analysis measurement, end-diastolic volumes (left and right ventricles), 30 days mortality, post-mortem analysis of myocardial composition, dimensions and histological and immunohistochemical changes.

A standardised, pre-piloted form has been used to extract data from the included studies for assessment of study quality and evidence synthesis.

Risk of bias and study quality (ie. CAMARDES-checklist) have been assessed by two review authors and resolving incongruencies through discussion with a third author.

Results:

We provide a narrative synthesis of the findings from the included studies, structured around the type of intervention, target population characteristics, type of outcome and intervention content.

Conclusions:

Hydrogels injection for cardiac tissue repair seems to be a promising therapeutic approach in miocardial infarction (MI) treatment, nowadays under clinical evaluation. Hydrogels effectiveness in limiting extension and expansion of ischemic injury, resulting in improved MI survival rates, in now under investigation.
RF23 FROM STENOSIS TO DISPLACEMENT AND LEAKAGE, TRANSCATHETER AORTIC VALVE-IN-VALVE PROCEDURE: FIRST PORTICO© IN PORTICO© EXPERIENCE
Authors: Spadafora A. , Di Franco S. , Caruso A. , Capasso F. , De Bellis A.
Published: November 2018

Background:

Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients affected by severe aortic stenosis who are considered high-risk surgical candidates with multiple comorbidities. The TAVI approach is minimally invasive, requiring local anaesthesia and mild sedation.

Case summary:

We describe, to our knowledge, the first case of a Portico® TAVI system (St. Jude Medical, St. Paul, MN) implantation made on a previous Portico® valve installed to solve displacement and leakage of the first prosthetic valve.

A 71-year-old woman affected by several comorbidities (diabetes mellitus type 1, hypertension, cryptogenic cirrhosis) and severe aortic regurgitation, as a consequence of displacement and leakage of a Portico® valve previously implanted, was admitted to our hospital for aortic prosthesis replacement. After Heart Team evaluation, according to the patient general conditions (NHYAclass III; Euro-Score II, 1,5%; STS-score mortality, 12,95%, Clinical Frialty Scale 6), to the previous transcatheter implantation of a 25 mm Ø Portico® sheathless valve (St. Jude Medical, Minneapolis, MN) with subsequent displacement and leakage, it was chosen to repair the valve leakage by second TAVI intervention and second 25 mm Ø Portico® valve implantation instead of standard surgical open procedure, achieving surgical risks reduction. Subsequent and serial follow-up evaluations are satisfactory revealing, normal ventricular kinesis, preserved ejection function, normal aortic valve function (mean gradient of 6 mmHg) and no paravalvular regurgitation.

Conclusion:

Portico® in Portico® transcatheter aortic valve implantation may be a valid solution to sheathless aortic valve leakage in complex patients. However, an evaluation of the procedure, in further cases, is required.
RF91 USE OF NIRS AND REFLECTANCE PULSE OXIMETRY AS A MONITORING IN DISTAL PERFUSION OF THE LIMB DURING PERIPHERAL ECMO.
Authors: contento C. , de marco M. , vitalini E. , pietraforte L. , iaiza A.
Published: November 2018

Background and aim:

One of the biggest complications in patients treated with venoarterial ECMO is lower extremity ischemia, site of the peripheral cannulation.

The ELSO database reports a 5% incidence of ischemic leg complications in patients with peripheral va-ECMO, leading to leg amputation in 1% of cases.

The objective of the study is to optimize the perfusion of the cannulated limb for the reduction of the incidence of ischemia, pacing a distal perfusion catheter (8 Fr) in the superficial femoral artery, before the insertion of the deep femoral artery and monitoring of tissue oxygen saturation by NIRS and reflectance pulse oxymetry.

Methods:

Our study includes the analysis of the experience on a group of 9 patients in which tissue saturation was monitored by NIRS (group A) and another group that includes patients on whom the distal flow of the limb has been periodically detected by Eco Doppler SD2, without monitoring of tissue saturation (group B).

Results:

In the experience of group B a late diagnosis of ischemia of the cannulated limb was found despite the distal perfusion. In group A NIRS monitoring allowed to readily diagnose a hypoperfusion, detected with a variation of saturation > 10% with respect to the tissue saturation of the contralateral limb and the basal value, resolving it with the immediate repositioning distal perfusion cannula.

Conclusions:

We conclude that transcutaneous NIRS and reflectance pulse oximetry may be an effective non-invasive method for continuous monitoring of leg perfusion in patients treated with peripheral ECMO and distal limb reperfusion.
RF33 IS THE DIAMETER OF THE AORTA A SAFE PARAMETER FOR CARDIAC SURGERY INDICATION IN AORTIC ANEURYSMS?
Authors: Bassano C. , Vacirca S.R. , Colella D. , Bertoldo F. , Pugliese M. , Ferrante M.S. , Ragni F. , Nardi P. , Scafuri A. , Ruvolo G.
Published: November 2018

Background and Aim:

Acute aortic dissection is a life-threatening condition and its prevention is based on elective surgery on patients with known risk factors (connective tissue disorders or chronic degenerative expansive aneurysm). International guidelines suggest elective prophylactic surgery at a diameter of 55 mm in non-syndromic patients.

The aim of our study was to verify if current guidelines for elective surgery are effectively reliable in order to prevent acute aortic syndrome.

Materials and methods:

From April 2005 to March 2018, at the Cardiac Surgery Division of the Tor Vergata University of Rome, 326-patients underwent emergency cardiac surgery for type A acute aortic dissection. The whole series was based on the all-camers cohort. The diameter of the dissected aorta, including the true and false lumen, was evalueted preoperatively by CT scan and intraoperatively by means transesophageal echocardiographic examination.

Results:

This analysis has documented an average diameter of 54 ± 9 mm of dissected ascending aorta. In particular the 50th and 75th percentiles of patients was 53 mm and 60 mm, respectively. In 65% of patients the diameter of the dissected aorta was ≤ 55 mm.

Conclusions:

Since the dissected aorta is necessary bigger than the native vessel, the international criteria for elective surgery seem to be inadequate to prevent acute aortic syndrome in a large portion of non-syndromic patients with normal or event dilated proximal aorta. Other factor beside aortic diameter should be identified to improve the efficacy of patients’ selection for elective surgery.
RF42 LONG TERM RESULTS OF SEPTAL MYECTOMY IN OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY: OUR THIRTY YEAR HISTORY.
Authors: Saitto G. , Grimaldi F. , Varrica A. , Biondi A. , Garatti A. , Parolari A. , De Vincentiis C. , Menicanti L.
Published: November 2018

Background and aim:

The objective of this study was to evaluate the early and long-term results of surgical myectomy in a consecutive series of patients operated for obstructive hypertrophic cardiomyopathy (HOCM).

Methods:

Between January-1989 and March-2014, 79 patients (mean age 50 ± 22 years, 48% males) with HOCM underwent surgical myectomy at our Institution. Nine patients had a history of paroxismal atrial fibrillation (11.3%). Sixty-three patients were symptomatic for dyspnoea (79.7%), twenty-one patients (26.5%) for angina, and twenty-one patients experienced a syncope (26.5%). The mean left ventricular outflow tract gradient was 59 ± 28 mmHg and mean preoperative LVEF was 66% ± 8%. Systolic anterior motion was present in 67 patients (76%) and mitral regurgitation ≥ 2 + in 51 (57%).

Results:

Mitral valve repair and replacement was performed in 7 (8.7%) and 11 (13.7%) patients.In-hospital mortality was 1.2%. Echocardiography performed at discharge showed a mean left ventricular outflow tract gradient and LVEF of 11 ± 10 and 61% ± 6% respectively. Systolic anterior motion was present in 13 patients (14%) and residual mitral regurgitation ≥ 2 + in 6 patients (7.5%). During follow up (mean 129 ± 73 months)overall mortality and cardiac-related mortality were 16.4% and 5% respectively. In six cases an ICD was implanted (7.6%) and only 3 patients were severely symptomatic for dyspnea. At 15 years freedom from all cause and cardiac death were respectively 63 ± 8% and 89 ± 10%, freedom from recurrence of NYHA class > II were 89 ± 11%. Freedom from reintervention was 100%.

Conclusions:

In our experience, long-term follofxRF42
RF74 SAFETY AND EFFICACY OF BIATRIAL VS LEFT ATRIAL APPROACHES IN PATIENTS UNDERGOING CONCOMITANT ATRIAL FIBRILLATION ABLATION DURING CARDIAC SURGERY: A META-ANALYSIS
Authors: Cappabianca G. , Corazzari C. , Tutino C. , Musazzi A. , Ferrarese S. , Beghi C.
Published: November 2018

Background:

the latest STS guidelines recommend concomitant AF ablation not only during mitral surgery (Class I, Level A) but also during other cardiac surgery procedures (Class I, Level B) for patients with atrial fibrillation (AF). Nevertheless, it is still unclear if limiting the lesion set to the left atrium (LA) yields similar safety and efficacy compared to a biatrial (BA) approach.

Methods:

Pubmed, Scopus and WOS were searched from their inception to April 2018: 23 studies comparing BA vs. LA approaches for concomitant AF ablation (3, randomized, 5 propensity-adjusted, and 15 observational) including 6216 patients, were identified. Of these, 9 studies (1236 patients) focused on mitral surgery as main procedure.

Results:

Freedom from AF was significantly higher in the BA group at 6 months (OR 1.38, CI 1.08-1.76, p = 0.01) and one year (OR 1.53, CI 1.05-2.23, p = 0.03), but also permanent pacemaker (PPM) implants (OR 1.62, CI 1.17 – 2.24, p = 0.004) and reopening for bleeding (OR 1.83, CI 1.01 – 3.31, p = 0.05) were higher in the BA group. In the mitral surgery subgroup, BA approach was superior in terms of one year freedom from AF but no significant differences were found regarding PPM implants and postoperative bleeding.

Conclusions:

BA AF ablation seems more effective than LA approach achieving sinus rhythm at one year; on the other hand a LA approach may be preferable in patients with higher risk of bleeding (i.e. dual antiplatelet, complex surgery) and in procedures with a substantial risk of AV block.
RF41 LIQUID BIOPSY FORCARDIAC TUMORS
Authors: Santise G. , Maselli D. , Mignogna C. , PIrrone K. , Mollace V. , Donato G. , Malara N.
Published: November 2018

Background:

Cardiac tumors are a small percentage of cardiac disease. They are mostly identified and diagnosed by echocardiography. Anyway, histological diagnosis can be obtained after surgical resection. The possibility of knowing the nature of the tumor before the surgery would be beneficial to plan the appropriate strategy.

We applied a specific liquid biopsy procedure on peripheral blood, to verify the hypothesis that cells becoming from the tumor circulate in the bloodstream and can be isolated and cultured.

Method:

In six patients with echocardiographic diagnosis of cardiac mass, we collected 5 ml of peripheral blood the day before surgery. The blood was processed following the procedure previously reported1-2. Cellular suspension isolated from the blood were seeded on chamber slides and cultivated for 14 days, and then the cellular growth were analyzed by cytometry and cells morphology by hematoxylin eosin staining. The results have been compared with the histological diagnosis made by two blinded pathologists on the surgical specimen.

Results:

In two cases the diagnosis made with the liquid biopsy was cardiac mixoma, in two angiosarcoma and in the last two fibroelastome. The five patients were sent to surgery and the traditional histological diagnosis confirmed the results of liquid biopsy.

Conclusion:

The liquid biopsy appear to be safe and effective to reach a correct diagnosis. This can be useful to plan the correct strategy in case of cardiac masses.

Reference

1. J Biol Regul Homeost Agents. 2014 Oct-Dec;28 (4):717-31.

2. J Transl Med. 2016 May 12;14 (1):133. doi: 10.1186/s12967-016-0876-y
RF83 THE ROLE OF CHRONIC SUPERIOR CAVAL SYNDROME AND STENOSIS OF JUGULAR VEINS IN NEURODEGENERATIVE DISEASES. SURGICAL TREATMENT AND PRELIMINARY RESULTS.
Authors: Spagnolo S. , Barbato L. , Grasso M.A. , Spagnolo P.
Published: November 2018

Background:

In the case of a stenosis of the superior vena cava, the cerebrospinal venous circulation (CSVC) normally flows in the jugular and brachiocephalic veins and, through the upper intercostal veins and the mammary veins, it reaches the azygos and the inferior vena cava.

Recent studies have shown that in the presence of a stenosis of the superior vena cava (SVC), venous blood can invert the direction of its flow and move towards the CSVC.

To confirm this hypothesis, we describe the angiographic status of two patients with stenosis of the SVC.

Methods:

First case. A 67-year-old-woman undergoing reconstructive surgery for an ascending aortic aneurysm. The postoperative period, the patient presented a progressive appearance of an upper left anterior oedema with significant swelling of the neck suspecting a brachiocephalic vein stenosis.

Second case. A 52-year-old-male with a collar of stokes oedema, turgor of the jugular veins, congestion of the face and conjunctiva and marked venous circle of the thorax. An echo-colordoppler examination revealed thrombosis of the SVC due to the placement of a central venous catheter with reflux into the right jugular vein. An injection of contrast into the right basilar vein confirmed that there was a stenosis of the SVC.

Conclusion:

Both patients underwent surgery and angiographic controls performed after stenosis removal showed normalization of the direction of blood flow from the cerebral venous loop to the superior vena cava. Patients with neurodegenerative diseases present alteration of the venous system, therefore a surgical correction could determine a possible clinical improvement.
RF77 IGM-ENRICHED-IMMUNOGLOBULINS ASSOCIATED WITH EMIC 2 FILTER IN TREATMENT OF EARLY SEPTIC SHOCK AFTER CARDIAC SURGERY: A CASE SERIES
Authors: Paternoster G. , Vitiello M. , Pittella G. , Dielo C. , Luzi G.
Published: November 2018

Septic shock after cardiac surgery is rare,with a prevalence between 0,39% and 2.5% (1). and mortality, from 65% to 79%. Reducing the time to diagnosis and early extracorporeal treatement is a crucial factor for reducing mortality (1) We assessed the effectiveness of IgM Enriched Immunoglobulins associated with 72 hours of CRRT with Emic2 in post-cardio surgical septic shock patients. We tested IL 6, Procalcitonin, WBC and Enodotixin Activity before treatment and at 24,48 and 72 hours. We tested SOFA score Inotropic Score and Ventricular arterial coupling (Ea/Ees) measured badside with iElastance2017®

This experience confirm that Pentaglobin® with Emic2 in early septic shock is safe and reduce concentration of major cytokines and endotoxin activity. It seems to be useful in reducing sofa Score and Inotropic Score and in improving Cardiovascular performance Further larger assessment can be advised for confirmation.

Paternoster. JCVA 2016 (773.780)

Benedetto J T C Surg. 2010, 646-70.

Wand P One Aug 9,2016
Malaysian Siam Music in Northern Malaysia and Its Representation
Authors: Tassanawongwara Chayuti
Published: November 2018

Some of the Thais were left behind in some parts of the land which once a Thailand’s territory. In the colonialism era, after Kelantan, Terangganu, Perlis and Kedah were annexed to Malaysia several decades ago by British, the Malaysian Siam who have chosen to stay put became the citizens of Malaysia despite being defined as Thais. The livelihood conditions of different nationalities are vital tools to distinguish one ethnic race from others. The first Malaysian Siam who ventured their way from South Thailand to settle in the land known as Melayu can be traced as far back as 300-500 years ago during the reign of King Boromma Trailokanat of Ayudhya era. There was an evidence of migration from then North Thailand downwards to the land of Melayu and inhabited at Sai Buri town. Today, the Malaysian Siams are densely populated across Kelantan, Perak, Perlis and Kedah. In this regard, it is a hard decision to choose the appropriate tools to represent the cultural identity. Music, in all possibilities, could be a likely solution to representation of cultural identity by importing them from its land of origin to reflect the unity of Thai people and the Malaysian Siam. Once the music is allowed to make its impact in protecting the identity of the Thai. This paper shall redound to the representation of Malaysian Siam in northern Malaysia, locally states of Perlis and Kedah, especially music in current use. The paper shall thoroughly present the result of analysis how the Malaysian Siam uses music to strengthen their cultural identity by the process of representation through a focusing on the theory of liminality.
Seni Musik Hadrah Putri di Pondok Pesantren Al Munawwir Krapyak
Authors: INDRAWAN ANDRE , ANDARI SUSANTI , - SURYATI
Published: November 2018

Hadrah Music in Pondok Pesantren Al Munawwir Krapyak. This study investigates an Islamic musical genreknown as the Hadrah, practiced by female students of the Pondok Pesantren (Islamic boarding school) Al Munawwir.It is based on an ethnomusicological fi eld research conducted between May 2007 and September 2008.Thisstudy fi nds that basic song form is exist in the Hadrah’s songs while their lyrics are mostly taken from classical as wellas popular Islamic poem collections. Although the Hadrah song was performed by melodic ornamental improvisationtechniques that normally applied in reciting the Qur’an, the singer always try to follow the Arabic reading rulescarefully. This fi nding has given us an indication that in order to achieve a good result of musical production, aswell, the Hadrah singers have to master not only the art of Holy Qur’an recitation but also Arabic language fl uency.The female Hadrah is normally performed as a religious entertainment in the school’s traditions, such as anniversaryand graduation celebrations.
Iringan Kuda Lumping Ngesti Budaya
Authors: - SUBUH , PRASETYO YUNI
Published: November 2018

Musical accompaniment of Ngesti Budaya horse dance. This article describes and analyzes a unique formperformance, presentation structure and growth of accompaniment of Ngesti Budaya horse dance through a descriptiveanalysis method. This dance represents a performing art owning characteristic, colour and also typical motion.One of the typical characteristic or element of this genre is a role of its musical accompaniment. Musical accompanimentalways accommodates dance movement pattern, assuring dance character, nguripke joget and develop;building dance plot atmosphere. At its growth, musical accompaniment does not only accompany dance, but withvarious its till can become important shares of dance and have to position is same in its presentation.