bluuebunny/crossref_metadata_2025 huggingface dataset:
RF35 CALCIUM LOADING AS RISK FACTOR FOR CLINICAL MAJOR COMPLICATIONS AND SURVIVAL FOLLOWING TAVI PROCEDURES
Authors: Pollari F. , Cuomo M. , Vogt F. , Kalisnik J.M. , Söhn C. , Eckner D. , Fischlein T. , Pfeiffer S.
Published: November 2018

Background and aims:

Aortic valve calcium has been correlated with postoperative complications such as paravalvular leak or conduction disturbances. We aimed to assess relationship between AVC and onset and degree of other major clinical complications following TAVI according to VARC-2 criteria.

Methods:

We retrospectively analyzed preoperative contrast-enhanced CT scans of patients who underwent TAVI in our center between 2012 and 2016. Calcium volume was calculated through a dedicate software. Multivariate analysis (including aortic calcium volume, clinical as echocardiographic characteristics and intraoperative outcomes) was performed to evaluate the risk factors for stroke, perioperative myocardial infarction, bleeding, vascular complication, acute kidney injury (AKIN).

Results:

539 patients were eligible for the study. Four different prostheses models were routinely implanted (2 balloon-expandable, n = 398; 2 self-expandable, n = 141). Median calcium volume in the DLZ was 757 mm3 (IQR 734.2), with no significant differences among prosthesis. Following complications were observed: 30-days mortality 5.38%; AKIN stage1 = 5.01%; AKIN stage2 = 1.67%; AKIN stage3 = 4.45%; major vascular complications = 4.08%; minor vascular complications = 10.20%; life-threating bleeding = 2.60%; major bleeding = 11.32%; stroke = 1.48%; periprocedural myocardial infarct = 0.37%. In multivariate linear regression aortic calcification of non-coronary cusp has been found to be independent predictor of ischemic stroke (OR 1.002, 95%CI 1–1.0047, p = 0.022) and AKIN stage 1 (OR1.002, 95%CI 1.001–1.004, p = 0.008), while LVOT total calcium volume was an independent predictor of AKIN stage 2 (OR 1.004, 95%CI 1–1.007, p = 0.043). Univariate analysis showed no significant correlation of aortic calcification with perioperative myocardial infarction, bleeding and vascular complication.

Conclusions:

AVC is an independent predictor of post-interventional ischemic stroke and acute kidney injury following TAVI.
RF54 OCCLUDED CAROTID AXIS USED FOR TRANSCATHETER AORTIC VALVE REPLACEMENT
Authors: Droandi G. , Di Cesare A. , Poncet A. , Muccio S. , olivier M. , Duval S. , Brasselet C. , Ruggieri V.G.
Published: November 2018

Background and Aim:

Transcarotid TAVR under loco-regional anesthesia represents a new alternative peripheral route for patients without femoral or subclavian access options and poor candidates for thoracotomy. We report a case of a successful TAVR via left occluded carotid axis.

Methods:

A very frail class NYHA IV 83-year-old man with several comorbidities was referred for treatment of severe aortic stenosis. Transfemoral TAVR was excluded because of severe peripheral vascular disease. At Angio-CT scan both subclavians arteries and the ascending aorta were widely calcified. The right internal carotid artery (ICA) had 50% of stenosis. The left ICA was chronically occluded with permeability of ipsilateral common carotid artery (CCA). The Heart Team concluded that left CCA was the preferred conduit for TAVR. The procedure was performed under loco-regional anesthesia by cervical block and bilateral cerebral oximetry was continuously monitored. Left CCA was surgically exposed by low cervicotomy and a 3-minutes carotid clamping test was realized to evaluate patient's neurological status and oximetry. Aortic balloon valvuloplasty was performed and a 29-mm Edwards Sapien3 transcatheter aortic valve was deployed under 5-seconds rapid pacing at 180/min with excellent seating and no paravalvular leak.

Results:

The patient was monitored 12-hours in intensive care unit and transferred to rehabilitation clinic in second post-operative day. Any cerebrovascular or access-related complications occurred.

Conclusions:

In frail patients with femoral contraindication and associated occluded internal carotid axis, the ipsilateral common transcarotid access represents a safe approach for TAVR, even in presence of a non-significant contralateral carotid stenosis.
RF59 PERCEVAL SUTURELESS AORTIC VALVE PROSTHESIS: A PRECIOUS DEVICE TO SIMPLIFY COMPLEX PROCEDURES
Authors: Mikus E. , Pagliaro M. , Calvi S. , Panzavolta M. , Ramoni E. , Albertini A.
Published: November 2018

Background and aim:

The main feature of sutureless aortic valve implantation is the speed of insertion, thus making implantation easier for the surgeon. As a result, cross clamp times and myocardial ischemia may be reduced. The combined procedures with CABG can be done with a short cross clamp time and cardiopulmonary bypass times.

The aim of this study is to evaluate the effects of Percevall sutureless aortic valve prosthesis on surgical outcome in patients underwent combined procedures.

Methods:

We selected 36 consecutive patients who underwent Perceval implantation combined with coronary artery bypass and or other valve repair or replacement. Clinical, echocardiographic and in-hospital complications were obtained from chart review.

Results:

The mean age was 76.4 ± 9.8 (median 80) years old, 50% male. Eight of them were previous operated (Redo cardiac surgery22.2%), 3 treated with chronic kidney injury requiring dialysis (8.3%) and two had active endocarditis. Concomitant procedures included: coronary artery bypass (20 pts, 56%), mitral valve replacement or repair (11 pts, 31%), mitral and tricuspid repair/replacement (5 pts, 5%), tricuspid valve repair (1pt,3%) and mitral valve replacement associated to coronary artery bypass (2 pts, 5%). Patient operative risk, as estimated by logistic European System for Cardiac Operative Risk Evaluation, was 13.4 ± 12.8.

Conclusions:

Perceval sutureless aortic prosthesis facilitates reduced aortic cross-clamp and cardiopulmonary bypass times particularly in patients undergoing concomitant procedures allowing promising outcomes especially in high risk patients.
VD13 MITRAL VALVE REPAIR FOR HOCM
Authors: Francescato A. , Moriggia S. , Scorsin M. , Piacentini A. , Barbier P. , Gerosa G. , Lemma M.G.
Published: November 2018

F, 57 yo, BSA = 1.7 sqm

NYHA class III, Metoprolol 100 mg/die

Pre-operative echo:

moderate-severe reduction of left ventricular longitudinal function, EDV = 50 ml/m2, EF = 80%, severe asymmetric left ventricular hypertrophy (interventricular septum23 mm), severe LVOT obstruction (122 mmHg), SAM ofMV anterior leaflet and chordae and secondary moderate to severe mitral regurgitation

Surgery:

Morrow's septal myomectomy down between the 2 papillary muscles via aortic and left atrial approach, mitral valve repair (anterior leaflet extension with bovine pericardial patch, no ring implantation)

Echo at discharge:

EDV = 33 ml/m2, EF = 57 %, mid-cavity obstruction = 25 mmHg, normal LV filling pressure, anterior leaflet elongation with billowing, no obstructionto LVOT, trace of mitral regurgitation
VD07 CAN A BENTALL PROCEDURE GET COMPLICATED?
Authors: Mangerini V. , Castrovinci S. , Territo S. , Torre S. , Agostara V. , Tortorici E. , Argano V.
Published: November 2018

We present a case of a 61 years-old man with aortic dissection involving the arch and descending aorta 7 years after a Bentall and CABG procedure reoperated 3 years later for right button pseudoaneurysm.

In this video we show our surgical approach. CPB was established using direct brachiocephalic trunk and right atrial cannulation. A moderate hypotermic circulatory arrest (26°C) was utilized and once the aortic arch was opened, cerebral perfusion was achieved separately for the brachiocephalic trunk and for the left carotid and subclavian arteries.

A FET procedure was carried out using a 26/28 mm Thoraflex prosthesis. Distal reperfusion was resumed through the prosthesis side branch after distal anastomosis was completed. Left subclavian and left carotid arteries were reimplanted during rewarming. Once proximal anastomosis was completed, heart was restarted and brachiocefalic trunk reattached on a beating heart.
VD21 VALVE SPARING PROCEDURE IN BICUSPID AORTIC VALVE
Authors: Folesani G. , Amodio C. , Coco V. Lo , Alfonsi J. , Di Marco L. , Leone A. , Berardi M. , Barberio G. , Pacini D. , Di Bartolomeo R.
Published: November 2018

We present a valve sparing operation performed in a 48-year-old male patient with a bicuspid aortic valve, moderate central regurgitation and 50 mm ascending aorta aneurysm.

Cardiopulmonary bypass was established by aortic arch and right atrium cannulation, the antegrade crystalloid cardioplegia was administered. The aortic valve was exposed and a fusion between the two coronary cusps identified (Sievers type 1).

We decided for a shaving resection of the median raphe with a free edge leaflet reinforcement by Gore-tex 6/0 continuous suture. The valve was then reimplanted in a 30 mm Valsalva graft conduit.

The procedure was finally completed with reimplantation of the coronary ostia and distal anastomosis, performed with the interposition of two teflon felts.

Intraoperative transesophageal echocardiogram confirmed the good surgical result.

The patient was discharged a week later with no major post-operative events and a trivial aortic insufficiency at the trans-thoracic echocardiography.
VD15 ROSS OPERATION IN AN INFANT
Authors: Careddu L. , Angeli E. , Romano G. , Petridis F.D. , Ciuca C. , Mastromarino V. , Donti A. , Gargiulo G.D.
Published: November 2018

The Ross procedure for replacement of a diseased aortic valve is effective in children where growth capability is essential. Long-term outcomes are generally excellent. Here, we present our technique of choice: the reimplantation of the pulmonary autograft and the implant of a pulmonary Homograft for RVOT replacement in an infant with congebital LVOT stenosis treated with percutaneous balloon angioplasty.
VD09 ENDOSCOPIC VEIN-GRAFT HARVESTING TECHNIQUE IN CORONARY-ARTERY BYPASS SURGERY
Authors: Zingaro C. , Cefarelli M. , Matteucci M.L.S. , Berretta P. , D’Alfonso A. , Di Eusanio M.
Published: November 2018

The saphenous vein graft is the most commonly used conduit in coronary artery bypass graft surgery. The use of less invasive techniques for vessel harvesting has consistently gained interest due to the advantages in terms of reduced trauma and wound complications. In particular, many studies have reported that endoscopic vein-graft harvesting reduces postoperative pain, the incidence of wound complications, and the length of hospital stay, as well as eliminating the need for a large longitudinal incision and increasing patient satisfaction. Over the last decade, our cardiac surgery dept. has gained a considerable experience (>1000 cases) with this endoscopic approach. Aims of this video is to illustrate two of the widely used endoscopic vein harvest devices: the VirtuoSaph Endoscopic Vein Harvesting System from Terumo (an open tunnel system) and VasoView System from Maquet Cardiovascular (a closed tunnel system).
EP12 ENDOVASCULAR SURGERY FOR TREATMENT OF PARANEOPLASTIC OBSTRUCTION OF THE DESCENDING THORACIC AORTA
Authors: Di Tommaso E. , Di Tommaso L. , Scigliano F. , Mileo E. , Tozzi A. , Mannacio L. , Grande L. , Iannelli G.
Published: November 2018

Background and Aim:

Rarely covered endovascular stent-grafts had been implanted in the thoracic aorta to perform the resection of the aortic wall infiltrated by an intrathoracic tumors. This we describe is a rare clinical case of a critical stenosis, for paraneoplastic syndrome, of descending thoracic aorta treated with TEVAR.

Methods:

A 61 years-old man, with an unknown history of tumor, was admitted in emergency with a diagnosis of critical stenosis of the descending thoracic aorta and visceral-organ and lower-limb malperfusion.

The CT scan showed a voluminous mass infiltrating and occluding the descending thoracic aorta far from left subclavian artery and celiac axis, extending for 80 mm, associated with a voluminous retroperitoneal mass.

A percutaneous biopsy performed after stent graft implantation, allowed to diagnose a retroperitoneal high grade undifferentiated pleomorphic sarcoma.

Results:

The procedure was performed in our hybrid operating room. Over a Back-up Meier wire and under fluoroscopy, through right common femoral artery, a Medtronic Valiant stent-graft was placed in the optimal position far from the celiac artery. To completely cover the stenotic tract the patient required one stent-graft. After stent-graft release, the paraneoplastic thrombus, mobilised from the descending aorta to the carrefour, was removed with a Fogarty catheter. The postoperative period was uneventful. Follow-up CT scan were performed at six months and showed complete patency of the descending thoracic aorta.

Conclusions:

The encouraging experience in the treatment of this patient indicate that endovascular surgery is a useful and less invasive alternative to open surgical operation for these uncommon disease too.
EP03 A GOOD BLOOD MANAGEMENT IS NOT AN OPTION. IT IS POSSIBLE TO TREAT AN AORTIC DISSECTION IN JEHOVAH'S WITNESSES IN EMERGENCY?
Authors: Barbato L. , Casabona R. , Mancuso S. , Schinco P. , Costa P. , Marra S. , Comoglio C.
Published: November 2018

Background:

Jehovah's Witness are convinced that biblical passages prohibit the transfusion of allogeneic blood and the predeposit of autologous whole blood for subsequent reinfusion. Medical literature reports several cases of complex medical and surgical procedures performed successfully without the use of allogeneic blood transfusions or its main components. In order to avoid blood transfusions, it is essential to use clinical strategies to minimize blood loss, to save autologous whole blood (AWB), to enhance hematopoiesis and to optimize the tolerance of anemia

Methods:

Herein we present a case of 71 years old manwith acute aortic dissection in a Jehovah's Witness patient (JW). Is a rare condition. Respecting the patient's will, a surgical procedure in high-risk surgical emergencywas performed without the use of blood transfusions,but applying our “bloodless protocol”, which can be considered as an extreme patient blood management protocol (PBM), in which the aim is to avoid the need for transfusions.

Conclusion:

Scientific literature and our twenty-year-experience with JW patients allowed us to show how an adequate strategy, a concrete project and a multidisciplinary bloodlessteam can guarantee excellent results either in JW patients or alternatively in specific cases ofalteration of the coagulationsystem, even in emergency situations. A well-defined strategic plan can help reduce duration of hospitalization and hospital cost. This case report, suggests that high quality PBM could be reasonably extended to all patients admitted to hospital, with the vision that “we treat all patients like JWs”.
EP34 ROLE OF SPECIALIZED CENTRE AND TEAMWORK IN THE DIAGNOSIS OF MARFAN SYNDROME AND PREVENTION OF ACUTE AORTIC DISSECTION
Authors: Bertoldo F. , Pisano C. , Nardi P. , Donzelli C. , Laganà G. , Salehi B. , Sangiuolo F.C. , Bollero P. , De Maio F. , Mancino R. , Chiocchi M. , De Stefano A. , Cozza P. , Ruvolo G. , Novelli G.
Published: November 2018

Objective:

Marfan patients had an increasing risk of aortic dissection related to the quality of the aortic wall. The aortic size is not a safe indicator to prevent aortic dissection. Other factors need to be consedered such as the morphology of the aortic root, the Valsalva sinus prolapse, genetic and clinical aspects. We analysed the role of a specialized centre and a good teamwork in improving Marfan syndrome diagnosis and optimizing surgical indications.

Materials and Methods:

We enrolled patients admitted to the Marfan Syndrome Centre of Tor Vergata University from March 2008 to December 2017. These patients have been evaluated by a teamwork composed by different figures: cardiologists, cardiac surgeons, oculists, orthopaedics, dentists, genetics and nurses.

Results:

From 1323 patients admitted, we enrolled a total of 460 patients. Of these 260 patients had Marfan Syndrome, 10 patients had Loeys-Dietz Syndrome and the others 190 were Marfan like. 95 patients underwent cardiac surgery. In particular 47% had a Bentall-DeBono Operation, 40% a David Operation and 13% other operations. An increasing number of surgical procedures has been observed in the years. Accordingly we noticed a reducing incidence of acute aortic dissection and sudden deaths in our patients.

Conclusions:

A specialized Centre of Rare Disease is very important in the management of Marfan's patients in order to improve the diagnosis, optimize surgical indications and prevent catastrophic complication like acute aortic dissection and rupture.
EP31 RAPID-DEPLOYMENT VERSUS TRANSCATHETER AORTIC VALVE: HEMODYNAMIC PERFORMANCE
Authors: Manzan E. , Prestipino F. , Miele M. , D’ascoli R. , Luzi G.
Published: November 2018

Background and Aim:

For intermediate risk patients suffering from aortic valve stenosis, the search for the proper operative strategy and the ideal valve substitute is ongoing. In this so-called gray zone, both Rapid-Deployment (RDAV) and Transcatheter Aortic valves (TAV) are good alternatives to surgery. The aim of our study is to compare hemodynamic performance of balloon-expandable Edwards Sapien 3 TAV and Edwards Intuity Elite RDAV.

Methods:

As initial experience, till now, we enrolled 26 aortic valve replacements with Edwards Intuity Elite RDAV and 33 transapical TAV implantations with Edwards Sapien 3 prosthesis between March 2017 and March 2018. Early hemodynamic results of both valves were evaluated 7-day and 30-day after surgery, measuring trans-prosthesis peak and mean gradients at rest. T-test was used to compare valve hemodynamic performance.

Results:

According to Valve Academic Research Consortium 2 criteria, device success was 100% in both groups. No deaths nor conversion to conventional surgery occurred. In RDAV group, peak and mean gradients decreased over time significantly (Figure1A), while in TAV group, they remained stable over time (Figure1B). Comparing TAV and RDAV hemodynamic, 7-day after surgery RDAV peak and mean gradients were significantly higher than TAV gradients (Figure1C). At 30-day follow-up, RDAV and TAV peak and mean gradients were similar (Figure1D). No paravalvular leak has been reported in both groups till 30-day follow-up.

Conclusions:

TAV provides better gradients immediately after surgery, while at 30-day follow-up both RDAV and TAV present similar trans-prosthesis gradients at rest.
EP37 TECHNICAL PRECAUTIONS TO REDUCE THE PACEMAKER RATE AFTER SUTURELESS AORTIC VALVE REPLACEMENT: DID WE FIND THE KEY?
Authors: Santarpino G. , Moscarelli M. , Nicoletti A. , Gregorini R. , Fischlein T.
Published: November 2018

Background and Aim:

The aim of this study is to evaluate the patients who have required a pacemaker implantation after a sutureless aortic valve implant, evaluating their clinical history and preoperative risk factors, the peri- and postoperative events that led to pacemaker implantation including “timing” of block and pacemaker implantation and the pacemaker-dependence at follow-up.

Methods:

The 512 patients who were discharged from our department after implantation of Perceval and implantation of the definitive pacemaker were re-contacted for clinical follow-up, echocardiography and for control of pacemaker function.

Results:

39 patients (7.6%) required new pacemaker implantation due to complete atrioventricular block. Preoperative presence RBBB (pacemaker vs no-pacemaker patients 33 vs 4.8%;P < 0.001) was identified as independent predictors of postoperative conduction disorders, also on multivariate analysis (odds ratio 11.3—C-statistic 0.74,CI 0.672–0.801; P = 0.0002). 21 patients (54%) were pace independent at follow up. In the “pacemaker patients group” no difference were recoded between pace-dependent and pace-independent at follow up (Table 1). Over the years, with the change in implant technique, the pacemaker implantation rate has decreased significantly: 12.2% to 5.5%, p = 0.04.

Conclusions:

Our study shows that the protective techniques for pacemaker implantation are effective and that learning curve can play a role in this rate. We are not able to find a difference between the “dependent” and “independent” pacemaker patients at follow up but we believe that the timing of implantation as well as the type of BAV onset can be prognostic on the recovery of the rhythm at follow up.
EP38 THE MOSAIC AORTIC BIOPROSTHESIS SHOWS EXCELLENT DURABILITY AT EXTENDED FOLLOW-UP
Authors: Falcetta G. , Celiento M. , Ravenni G. , Flagiello M. , Pratali S. , Bortolotti U.
Published: November 2018

Background and aim of the study:

Biological prostheses are widely employed for aortic valve replacement This study aims to evaluate the performance of the Mosaic porcine bioprosthesis in aortic position over two decades.

Material and methods:

From November 1995 to December 2016, 254 patients underwent aortic valve replacement with a Mosaic bioprosthesis. The mean age was 74 ± 9 years 14% being ≥ 80 years of age; 76% were males and 86% had pure or prevalent calcific aortic stenos. Mean preoperative functional class was 2.5 ± 1.0.

Results:

Overall hospital mortality was 5%. There were 107 late deaths only 15 being valve-related (0.72 ± 0.19 % pt-yrs). Actuarial survival at 15 years is 34 ± 7%. There were 14 embolic episodes with no cases of bioprosthetic thrombosis; freedom from thromboemboli is 88 ± 4% at 15 years. There were 8 cases of endocarditis with a freedom of 95 ± 2% at 15 years. Structural valve deterioration was observed in 4 patients who were successfully reoperated. Freedom from structural valve deterioration is 97 ± 2% at 15 and 96 ± 2 at 20 years. At last follow-up, 23 mm and 25 mm prostheses showed a mean gradient of 17 ± 6 mmHg and 15 ± 4 mmHg, respectively. In patients with aortic stenosis a significant reduction of left ventricular masses occurred.

Conclusions:

The Mosaic bioprosthesis has shown excellent durability over 2 decades of clinical use with a negligible incidence of valve degeneration and need for reoperation. Therefore it may be considered a valid option especially for elderly patients requiring aortic valve replacement.
RF57 OUTCOMES OF DIFFERENT REPAIR TECHNIQUES FOR FUNCTIONAL TRICUSPID VALVE REGURGITATION IN ADULT WITH CONGENITAL HEART DISEASE
Authors: Rito M. Lo , Grandinetti M. , Muzio G. , Varrica A. , Frigiola A. , Micheletti A. , Chessa M. , Giamberti A.
Published: November 2018

Objectives and aim:

Functional tricuspid valve (TV) regurgitation frequently affects adult with congenital heart disease (ACHD).The aim of our study was to analyze which surgical repair (suture plasty vs. ring plasty) offers the best post-operative and medium-term TV competence in ACHD.

Methods:

Retrospective study of ACHD patients that underwent TV repair at our institution (01/2000-12/2016). Patient's chart were reviewed to collect pre, post-operative and follow-up data. We compared efficacy of ring plasty with suture plasty in terms of early and medium-term regurgitation degree.

Results:

95 patients had functional TV regurgitation and underwent surgery. Median age was 41.2 years (IQR:29.8-55.6 years). Pre-operative TV regurgitation: mild (n = 6), moderate (n = 42), severe (n = 47). Surgical procedure were suture plasty (n = 53), ring anuloplasty (n = 34) and in 8 it was replaced. Median hospital stay was 12 days (IQR:8-18), 2 hospital deaths (2.1%). At discharge 13.2% of the suture plasty and 11.8% of the ring anuloplasty had moderate TV regurgitation, no one had severe. After a median follow-up of 4.6 years (IQR:1.4-8.9) there were 6 late deaths giving 89% survival (95%CI:79%-94%) at 5-10 years. No tricuspid valve reoperation were performed. On follow-up echocardiographic was available in 69 patients. Suture repair present a significantly higher incidence of moderate-severe regurgitation (Figure 1) compared to the ring anuloplasty (55%vs.27.6%,p = 0.023).

Conclusions:

Suture plasty and ring anuloplasty have comparable early postoperative results in terms of restoring valve competence. The use of prosthetic rings should be preferred to support the TV because it provides a significantly lower occurrence relevant regurgitation in the medium term.
ISOLATED AORTIC VALVE REPLACEMENT: DECADE TRENDS OF IN-HOSPITAL MORTALITY AND CASE-MIX FOLLOWING THE INSTITUTION OF THE HEART TEAM
Authors: Cannata A. , Bruschi G. , Merlanti B. , Costetti A. , Marchetti C. , Passini L. , Tata G. , Russo C.F.
Published: November 2018

Background and aim:

The concept of Heart Team (HT) has been a major advancement for decision making in cardiovascular medicine. The aim of the study is to analyse trends of in-hospital mortality and case-mix among patients who underwent to isolated aortic valve replacement (iAVR) before and after HT institution.

Methods:

We analysed data of 1092 adult patients who underwent iAVR at our hospital between January 2005 and December 2016. They represented 12.3% of the overall surgical case-load of the same period. During the second-half of 2008 HT has been implemented at our hospital.

Results:

During 2005–2016 period in-hospital mortality following iAVR was 1,8%. In-hospital mortality decreased from 3,9% (2005–2008) to 0,8% (2009–2016) (p .0004). Mean number of iAVR/year increased from 75,5 (2005–2008) to 99,1 (2009–2016). The prevalence of octogenarians patients increased from 11,5% (2005–2008) to 16,5% (2009–2016) (p.00001); in-hospital mortality decreased from 8,8% to 1,5% (p .02) among them.

Conclusions:

Following the institution of HT at our hospital, we observed a significant decrease of in-hospital mortality following iAVR, also in elderly patients. Volume of iAVR and octogenarians patients significantly increased. It is likely that surgical results benefited from the discussion of cases and the availability of transcatheter techniques for high-risk patients.
RF03 ANTITHROMBOTIC STRATEGIES AFTER HEARTMATE III IMPLANTATION: WHEN PREVENTION BECOMES OVERTREATMENT
Authors: Tarzia V. , Tessari C. , Fabozzo A. , Cavalli C. , Bocca T. , Pagnin C. , Volpe B. , Bottio T. , Gerosa G.
Published: November 2018

Background and aim:

Hemocompatibility of left ventricular assist devices (LVADs) represents one of their main target. Currently, third generation-fully-magnetically-levitated LVAD (HeartMate 3, HM3) has shown high hemocompatibility. Aim of this retrospective study was to evaluate the impact of different antithrombotic strategies in HM3 patients.

Methods:

Patients were monitored by clinical evaluation, classical laboratory, thromboelastometry (ROTEM) and aggregometry (Multiplate) in the postoperative period and at follow-up. Based on therapeutic options, our population (=25 patients, from November 2015 to March 2018) wad divided in: Group A (=15 patients, 60%) with antiplatelet + anticoagulant medications and Group B (=10 patients, 40%) with anticoagulant medication alone. Primary outcome was freedom from thromboembolic and/or hemorrhagic events. For the assessment of asymptomatic neurologic events, patients were explored with MiniMental-State-Examination (MMSE) and Brief-Neuropsychological-Examination 2 (ENB2).

Results:

At surgery, mean age was 61.5 ± 5.6 years and 4 patients (16%)were in INTERMACS profile 1, 15 (60%) in profile 2–3 and 6 (24%) in profile 4. Overall 10 patients (Group A = 9, 40% vs Group B = 1, 10%, p = 0.0177) had bleedings. In particular, cerebral hemorrhage in 1 (Group A), gastrointestinal bleeding in 5 (Group A), late onset chest bleeding in 2 (Group A), minor bleeding in 6 (5 Group A, 1 Group B). No thromboembolic events were reported. At follow-up ENB2 showed significant improvement of patients’ neuropsychological performance (p = 0.006), whereas MMSE results remained stable (p = 0.1).

Conclusions:

Heartmate 3 is a highly hemocompatible device. In our experience, anticoagulation alone is a safe and effective therapy as it prevents both thrombotic and hemorrhagic events.
RF17 EARLY DIAGNOSIS AND SURGICAL TREATMENT OF MIOCARDIAL BRIDGES IN CHILDREN
Authors: Viganò G. , Colaneri M. , Capestro A. , Marzullo R. , Iezzi F. , Pozzi M.
Published: November 2018

Background and Aim:

A myocardial bridge (MB) is a term for a segment of a coronary artery that takes a “tunneled” intramuscular course under a “bridge” of overlying myocardium. Although these congenital coronary anomalies can be asymptomatic and traditionally considered a benign condition with a good long-term prognosis, in many cases MBs are associated with heart rhythm disorder, myocardial infarction and sudden cardiac death, so that their impact on incidence of coronary insufficiency is indisputable. While described on autopsy for centuries, technological advances such as coronary computed tomography angiography and intravascular ultrasound have contributed greatly to our understanding of the anatomy, hemodynamic and pathophysiology. Surgical supra-arterial myotomy is the debridging procedure of choice to prevent myocardial infarction and sudden death in patients who remain symptomatic despite medical treatment.

Method:

We present our experience of 3 children (one 10 years old and other two 14 years old) with myocardial bridges who underwent surgical treatment. The diagnostic and operative techniques for each patient were evaluated. Mean follow up 1 year.

Results:

All patients underwent successful debridging through surgical supra-arterial myotomy on extracorporeal circuit and cardioplegic cardiac arrest. No early or late complications except a post-pericardiotomy syndrome in one patient resolved with medical treatment. At last follow up all patients are asymptomatic

Conclusion:

Based on our experience, early diagnosis and surgical intervention can yield satisfactory results in patients with myocardial bridges, with relief of symptoms. The operative procedures were associated with no early and late mortality and low complications.
RF96 WEANING IN CHILDREN WITH LEFT VENTRICULAR ASSIST DEVICE SUPPORT: A SINGLE CENTER EXPERIENCE
Authors: Iacobelli R. , Di Molfetta A. , Toscano A. , Drago F. , Adorisio R. , Perri G. , Filippelli S. , Di Chiara L. , amodeo A. , Iorio F. , Amodeo A.
Published: November 2018

AIM:

We reviewed our experience in children underwent LVAD placement and selected for weaning after evidence of cardiac improvement on LVAD as measured by seriate echocardiographic evaluation.

Methods:

From 2007 to 2018, 36 LVAD were implanted at our institution. Longitudinal echocardiographic data were available in 31 children who received LVAD during the study period with diagnosis of DCM and severe HF. Parameters were repeatedly measured by 2D and 2D Speckle Tracking-derived echocardiography at baseline, after LVAD placement and weekly until LVAD explantation.

Results:

4 (13%) children were considered for LVAD weaning. Median age and weight are 31 mos and 14.1 kg, with median duration of support of 188.5 days. Myocardial biopsies and virus assessment excluded myocarditis in all 4 cases. First patient supported with 25cc BH underwent off-pump test but failed for LVEF worsening. After 210 days of LVAD support, he underwent OHTx. Patient 2 after 21 days of support was successfully weaned with VAD explanted with LVEF of 50%, all ECHO parameters remaining stable at 7 mos FU. Patient 3 after 296 days of support with 15cc BH developpes LVEF > 45%, and LVAD was explanted, but died for neurological complication. Patient 4 after off-pump test underwent weaning from LVAD for 6 days only, then need new LVAD for HF recurrency

Conclusions:

Recovery in children on VAD is possible with potential greater capacity for reverse remodeling although the rate of cardiac recovery is low. Echocardiographic data are needed for detection of myocardial improvement during mechanical unloading.
RF94 VALVE-SPARING AORTIC ROOT REPLACEMENT: 15-YEARS BOLOGNA EXPERIENCE
Authors: Di Marco L. , Gliozzi G. , Mariani C. , Murana G. , Leone A. , Alfonsi J. , Fiorentino F. , Pacini D. , Di Bartolomeo R.
Published: November 2018

Background:

Valve-sparing aortic root replacement is an attractive option for aortic root aneurysms, avoiding valve prosthesis disadvantages and complications:the challenge for surgeons is to guarantee a durable aortic valve repair. In this study we present our early and long term results, identifying pre- and intra-operative risk factors for reoperation at follow up.

Methods:

From March 2002 to December 2017, 201 consecutive patients underwent conservative operation of the aortic valve and aortic root replacement, according to David reimplantation technique. Bicuspid aortic valve (BAV), Marfan syndrome and type A acute aortic dissection (AADA)-patients were included in the study. Patients were retrospectively evaluated with clinical and echocardiographic studies. Mean follow up time was 81.87 ± 59.74 months.

Results:

Mean age was 49.7 ± 15.2 years. Overall in-hospital mortality was 3%, if we consider only elective cases 0.5%. At discharge, aortic regurgitation was mild or lower in 87.1% of the patients. AADA (p = 0.000) and arch surgery (p = 0.004) are risk factors for early mortality. At 10 years, survival was 90.9%. At 5 years and 10 years, freedom from reoperation for severe aortic regurgitation was 92.7% and 86.2% respectively. Freedom from moderate to severe aortic regurgitation at 5 and 10 years was 97.2% and 84.4% respectively. At multivariate analysis, preoperative severe aortic regurgitation (p = 0.91), BAV (p = 0.32), Marfan syndrome (p = 0.10),cusps repair (p = 0.12) were not statistically significative risk factors.

Conclusions:

Our experience showed that aortic valve repair and valve-sparing aortic root surgery is a safe and effective procedure, and it can be performed with satisfactory short- and long-term results. It's important to refer the patients to high-volume center. We didn’t find risk factors for valve repair-failure.
RF10 BIO-BENTALL PROCEDURE: TEN YEAR EXPERIENCE
Authors: Albertini A. , Tripodi A. , Pagliaro M. , Raviola E. , Calvi S. , Mikus E.
Published: November 2018

Background and aim:

Since 1968 Bentall and De Bono described the surgical technique to treat aortic root pathology. The aim of this article is to describe our experience with a biological conduit for aortic root pathology.

Methods:

Between January 2007 and February 2017, 242 patients underwent the Bio-Bentall procedure at the authors’ Institution (203 male, 84% with a mean age of 66.7 ± 11 years) in elective (82%), urgency or emergency status. Twenty eight patients (11.6%) have been previously operated and eighteen patient were affected by type A acute dissection (0.7%). Follow up data were obtained from hospital and office records and from telephone contacts.

Results:

A full sternotomy was adopted in the majority of patients while a minimally invasive approach through a ministernotomy was chosen in 68, all elective cases (28%). In more than 50% the double sewing ring technique was chosen. Median cardiopulmonary bypass (CPB) and median cross-clamp time were respectively 112 and 95 min. The overall in-hospital mortality was 16/242, including 5 patients affected by type A dissection and 4 re-operation for active endocarditis. No patient died in the minimally invasive group. The 10-yr overall survival after discharge was analyzed and the degeneration of biological prosthesis studied showing encouraging result.

Conclusions:

Our experience shows that biological prosthesis inserted into the Dacron graft for aortic root replacement has a low mortality and good durability. In a selective population, minimally invasive surgery can play a key role.
RF28 INCIDENCE OF AORTITIS IN SURGICAL SPECIMENS OF THE ASCENDING AORTA: CLINICAL IMPLICATIONS AT FOLLOW-UP
Authors: De Martino A. , Ballestracci P. , Faggioni L. , Celiento M. , Pratali S. , Levantino M. , Morganti R. , Pucci A. , Bortolotti U.
Published: November 2018

Background and aim of the study:

Inflammation of the aortic wall may be responsible for the onset of aneurysms and dissections requiring surgical treatment. We evaluate the incidence of aortitis on a selected surgical population searching for any relationship with systemic diseases, verify early and late surgical results and provide clinical and radiological follow-up to determine factors potentially predicting progression and influencing late outcome.

Methods:

From 2009 to 2017, 237 patients underwent elective operations on the ascending aorta. Segments of the excised tissues were routinely sent for histological evaluation, providing adequate data in 178 (75%) for a clinical and pathological correlation. Patients with aortitis (Group 1) (n = 26) were compared with 152 with atherosclerotic or degenerative disease (Group 2).

Results:

Incidence of aortitis was 15%, being clinically isolated in 73%. In 24 patients (92%) a giant cell aortitis was found. Actuarial survival at 3 years is 88% in Group 1 and 98% in Group 2 and 74% and 98% at 5 years, respectively (p = 0.016). A control angio-computed tomography revealed an increased descending aorta diameter in 3 out of 14 late survivors. A positron emission tomography showed presence of arteritis in other vascular segments in 3 patients.

Conclusions:

Clinically isolated aortitis is extremely frequent in patients with inflammatory aortic disease. The diagnosis is often difficult and may be supported by routine pathological evaluation of surgical explants and by multimodality imaging. The latter should be employed to allow adequate patient follow-up and to disclose potential recurrences in untreated aortic segments.
RF44 OUTCOME AFTER BILATERAL INTERNAL MAMMARY ARTERY GRAFTING IN HIGH- AND LOW-VOLUME HOSPITALS: AN ANALYSIS OF THE E-CABG REGISTRY
Authors: Saccocci M. , Perotti A. , Reichart D. , Gatti G. , Faggian G. , Onorati F. , Feo M. De , Chocron S. , Dalen M. , Santarpino G. , Rubino A.S. , Maselli D. , Gherli R. , Salsano A. , Nicolini F. , Zanobini M. , Bounader K. , Seccareccia F. , Rosato S. , Tauriainen T. , Mariscalco G. , Ruggieri V.G. , Biancari F.
Published: November 2018

Background:

Bilateral internal mammary artery (BIMA) grafting is largely underutilized in patients undergoing coronary artery bypass grafting (CABG), partly because of the perceived increased complexity of the procedure. In this study we evaluated whether BIMA grafting can be safely performed also in centers in which this revascularization strategy is infrequently adopted.

Methods:

Out of 6783 patients from the prospective multicenter E-CABG study, who underwent isolated non-emergent CABG from January 2015 to December 2016, 2457 underwent BIMA grafting and their outcome was evaluated in this analysis.

Results:

The mean number of BIMA grafting per center was 82 cases/year and hospitals were defined as high- or low-volume according to this cutoff value. Six hospitals were considered as centers with high-volume of BIMA grafting (no. of procedures ranging from 120 to 267/year; overall: 2156; prevalence: 62.2%) and nine hospitals as centers with low-volume of BIMA grafting (no. of procedures ranging from 2 to 39/year; overall: 301; prevalence: 9.1%). Multilevel mixed-effects regression analysis showed that the low- and high-volume cohorts had similar outcomes. Propensity score one-to-one matching analysis of 292 pairs showed that the low-volume cohort had a significantly shorter intensive care unit stay (2.2 ± 2.3 vs. 2.9 ± 4.8 days, p = 0.020). The rates of in-hospital death (1.0% vs. 0.3%, p = 0.625), deep sternal wound infection/mediastinits (3.8% vs. 3.1%, p = 0.824) and 1-year survival (98.1% vs. 99.7%, p = 0.180) as well as other outcomes were similar between the high- and low-volume cohorts.

Conclusions:

BIMA grafting can be safely performed also in centers in which this revascularization strategy is infrequently performed.
RF86 THE TREATMENT OF ISCHEMIC MITRAL REGURGITATION WITH THE USE OF INCOMPLETE C RING ANNULOPLASTY: LONG-TERM RESULTS
Authors: Saitto G. , Nardi P. , Bertoldo F. , Pisano C. , Russo M. , Scafuri A. , Bassano C. , Pellegrino A. , Ruvolo G.
Published: November 2018

Background and Aim:

Surgical management of ischemic mitral regurgitation (IMR) is controversial, and in the setting of mitral valve repair (MVRep) the choice of the ring is still debated. We evaluate the results of MVRep with a semirigid incomplete C-ring in IMR.

Methods:

Between January 2006 and May 2014, 105 consecutive patients (mean age 69 ± 8 years, 75% males) underwent MVRep using an undersized C-ring during coronary artery bypass grafting to treat IMR. Mean logistic EuroSCORE was 14 ± 12%. Preoperative left ventricular ejection fraction was 43 ± 11%. Mean follow-up was 57 ± 35 months.

Results:

In-hospital mortality was 6.6% (7 patients). Predictor of in-hospital mortality was the duration of cardiopulmonary bypass (p < 0.05). Echocardiography performed at discharge showed a significant reduction of left ventricle end-diastolic diameter (p < 0.0001) and mitral regurgitation grade (p < 0.0001). Eight-year late death was 26% (26 patients), cardiac death 12%. Eight-year freedom from all-cause and cardiac death was 62 ± 7% and 83 ± 4%, respectively. In 7 patients (7%) recurrence of mitral regurgitation (>2 + ) was found. Freedom from recurrence of mitral regurgitation ≥ 2 and NYHA class > II were 89 ± 5% and 76 ± 9%, respectively. No patients underwent reoperation. Instable angina (p < 0.05), moderate-severe pulmonary hypertension (p < 0.0001) and left ventricle end-systolic diameter (p < 0.001) were independent predictors of long-term mortality.

Conclusions:

Despite the adverse prognosis of IMR, MVRep with semirigid C-ringassociated with coronary artery bypass showed satisfactory long-term survival, and low recurrence of mitral regurgitation/redo operation.
RF76 SHORT-TERM RESULTS IN ISOLATED BAV REPAIR VS SPARING PROCEDURES IN BAV
Authors: Rosa R. , Contino M. , Romagnoni C. , Mangini A. , Antona C.
Published: November 2018

Background and Aim:

Bicuspid aortic valve (BAV) is related to changes in the aortic wall (Fibrillin-1 deficiency, loss of integrity in matrix, disrupted architecture and reduced elasticity) that make it prone to develop a dilation. Therefore, repairing surgery of incompetent BAV is often associated with sparing techniques, to ensure a better stabilization of aortic root.

Methods:

In our fifteen-years experience (from April 2003 to April 2018), out of 327 aortic valve repair procedures, 95 (29.1%) were BAV, of which 21 (22.1%) associated with ascending aorta and/or root dilation ≥ 50 mm. In only 15 cases (15.8%), isolated repair was performed, in 35 (36.8%) repair and replacement of ascending aorta and in the remaining 45 (47.4%) a sparing operation.

Results:

At discharge, 52 patients (54.7%) showed absence of valvular regurgitation: of these, only 4 (7.7%) underwent to isolated repair, 20 (38.5%) to repair associated with ascending aorta replacement and 28 (53.8%) to root replacement.

A mild degree of insufficiency (1 + /4 + ) was observed in 39 cases (41.1%): 10 isolated plasty (66.7% of isolated BAV repair), 12 repair + ascending aorta replacement (34, 3%) and 17 sparing (37.8%).

In 3 patients (3.2%) a moderate jet resided (1 isolated repair and 2 repair + ascending aorta).

Conclusions:

Short-term results of isolated BAV repairs are excellent and in most cases the residual insufficiency is not significant (mild degree); when compared with sparing operations, we don’t see important difference, but further evaluation with long-term results must be done because of better stabilization of the whole aortic root in the second group.
RF06 THE CHOICE OF THE BEST PROSTHETIC VALVE IN CARDIAC OCHRONOSIS
Authors: Barbato L. , Musso P. , Baronetto A. , Trimboli S. , Casabona R. , Marra S. , Comoglio C. Dr ssa
Published: November 2018

Background:

Alkaptonuria is a rare autosomal genetic anomaly of the metabolism of tyrosine, and is characterized by the accumulation of homogentisic acid in the extracellular matrix with destruction of numerous tissues. Ocronosis is rarely associated with abnormalities of the cardiovascular system. The most common clinical manifestation is aortic valve stenosis. There is no specific therapy for alkaptonuria, limiting itself to the treatment of only the complications of the pathology.

Methods:

We report the case of a 69-year-old patient diagnosed with ochronosis following the detection of skin and scleral pigmentations. The patient was sent to our center with indication to replace the aortic valve for severe aortic stenosis after syncope episode.

Results:

Surgical intervention, the opening of the aorta, it is detected an abnormal blue-black pigmentation intima of the ascending aorta and aortic root with across where the flaps of the aortic valve and the anterior leaflet of the mitral valve. The aortic valve was replaced with a biological prosthesis No. 19. At follow up to twelve months, the patient is asymptomatic, at echocardiographic control the prosthetic valve appears normally functioning without signs of degeneration.

The surgical technique of aortic valve replacement is not different in these patients, but the choice of the best prosthetic valve in cardiac ochronosis is still a matter of debate. In fact, the problem still remains discussed the possible deposition of the blue-black pigment at the level of biological prosthesis with its rapid deterioration. Our preliminary observations must naturally be confirmed by carefully conducted prospective studies.
RF95 VENOUS VS ARTERIAL COMPOSITE Y-GRAFT IN CABG: A COMPUTATIONAL FLUID-STRUCTURE STUDY
Authors: Nicolo’ F. , Cagnoni G. , Guerciotti B. , Vergara C. , Ippolito S. , Quarteroni A. , Antona C. , Scrofani R.
Published: November 2018

Background and Aim:

Arterial or venous conduits used for Y-graft have different outcomes in terms of risk of restenosis and subsequent graft failure in coronary artery bypass grafting (CABG). The aim of the study was to investigate how the choice of the graft conduit predicts the risk of graft failure.

Methods:

We performed a computational fluid dynamics numerical simulation (FSI) analysis to describe the blood flow in the coronary arteries and grafts. Different Y-grafts with radial artery (RA) or saphenous vein (SV) were investigated by changing their mechanical properties (Young's modulus) and geometric characteristics. Coronary artery stenosis degree was also virtually varied, to assess the fluid behaviour in relation to the severity of the stenosis. Relative Residence Time (RRT) and Von Mises (VM) stresses were used as indicators of disturbed fluid-dynamic and for the analysis of the wall mechanics, respectively.

Results:

A more disturbed fluid-dynamic was observed for lower stenosis degree. Retrograde flow was present in the RA graft for the 50% and 70% stenosis degree. RRT values were higher in lower stenosis degree and both grafts. RRT and VM stresses were higher for the SV graft.

Conclusions:

Venous Y-graft is characterized by a more disturbed flow at the anastomosis site with a higher vessel's wall shear stress compared to the arterial one. Because of the potentially negative effects of competitive flow in low-grade native coronary artery stenosis, we confirm the better long-term patency in arterial CABG for critical coronary stenosis.