bluuebunny/crossref_metadata_2025 huggingface dataset:
ÍNDICE DE USO CORRECTO DE LOS PUNTOS ECOLÓGICOS
Authors: Ortíz Rivera Luis Gabriel , Maldonado Zárate Nury Patricia , Arias Bautista Esperanza
Published: November 2018

La concentración del dióxido de carbono en la atmósfera aumenta el “Efecto Invernadero” por la actividad humana al usar hidrocarburos en la transformación productiva. A continuación presentamos el resultado bajo el método de observación, realizado para identificar buenas prácticas de “separación de residuos en la fuente”, que involucró las tripletas de recolección de residuos: orgánicos, plásticos y ordinarios, entre 130 participantes observados aleatoriamente, con: un 64% mujeres y 36% hombres; entre ellos un 83% jóvenes y 17% adultos, en los pisos dos y once del edificio en la zona de restaurante. Se observó que un 52% hacen uso correcto del “punto ecológico”. El método  plicado supera en el resultado al de otras inspecciones que se realizan por registro de datos (formatos), proporcionando un resultado más real y de acuerdo con una encuesta aplicada anteriormente, a donde el 85% de los encuestados respondió que conoce el código de color para uso del “Punto ecológico”; se concluye que el usuario dimensiona un índice muy diferente a la realidad observada. El método de observación, además de ser una técnica sencilla, se constituye en una manera diferente para medir el nivel de conocimiento que la comunidad posee en cuanto a la separación eficaz de residuos en la fuente.
REQUIREMENTS TO PUBLISH
Authors: INVESTICGA Revista
Published: November 2018

The Journal of Research in Administrative Management and Information Sciences INVESTICGA is an online annual publication created by the Administrative Management Center of the Capital District Regional, for the educational community (apprentices, instructors, administrative personnel, businessmen and external people) to have a space to publish articles of reflection,research and revision, product of the projects carried out that generate new knowledge and contribute to a practical development.
RANCANG BANGUN APLIKASI E-BUDGETING UNTUK MENGONTROL ANGGARAN PENDAPATAN DAN BELANJA UNIVERSITAS MURIA KUDUS BERBASIS WEB (STUDI KASUS FAKULTAS TEKNIK UNVIERSITAS MURIA KUDUS)
Authors: Khoirul Anwar Rully , Listyorini Tri
Published: November 2018

Universitas sebagai institusi tertinggi penyelenggara pendidikan tertinggi sudah seharusnya mampu mengelola keuangan dengan sebaik – baiknya. Namun dewasa ini masih sering ditemukan kendala di lapangan. Hal ini dikarenakan belum adanya system yang mampu untuk mengelola keuangan tersebut, sehingga masih banyak sekali masalah yang dihadapi oleh universitas diantaranya permasalahan dalam hal pengarsipan, pendataan rencana anggaran, hingga hilangnya dokumen fisik karena system yang ada masih manual. Bermula dari hal dibuatlah aplikasi Rancang Bangun Aplikasi E-Budgeting untuk mengontrol Anggaran Pendapatan dan Belanja Universitas Muria Kudus berbasis Web (Studi Kasus Fakultas Teknik Unviersitas Muria Kudus). Diharapkan dengan aplikasi ini dapat mengatasi permasalahan tersebut.
OPTIMASI KETEBALAN LAPISAN RECAST, KEKASARAN PERMUKAAN DAN LAJU PENGERJAAN MATERIAL PADA PROSES PEMESINAN WIRE-EDM MENGGUNAKAN METODE TAGUCHI-GREY FUZZY
Authors: Rupajati Pathya , Samosir Perak , Rasyid M. Kurniadi
Published: November 2018

Proses wire-electrical discharge machining (wire-EDM) sering digunakan dalam industri manufaktur. Parameter pemesinan yang terdapat dalam wire-EDM di antaranya, arc on time, on time, servo voltage dan wire feed. Pengaturan level yang tidak tepat dalam proses ini akan menyebabkan lapisan recast dan kekasaran permukaan yang tinggi serta laju pengerjaan material yang rendah. Metode optimasi Taguchi dikombinasikan dengan grey fuzzy merupakan metode yang digunakan dalam penelitian ini. Rancangan perobaan pada penelitian ini menggunakan matriks orthogonal array L9 karena memvariasikan empat parameter proses pemesinan dengan masing-masing menggunakan tiga level. Replikasi pada eksperimen ini dilakukan sebanyak dua kali. Karakteristik kualitas respon untuk tebal lapisan recast dan kekasaran permukaan adalah semakin kecil semakin baik, sedangkan untuk laju pengerjaan material adalah semakin tinggi semakin baik. Hasil penelitian ini menunjukkan bahwa wire feed dan on time merupakan parameter proses yang paling signifikan dalam menghasilkan multirespon yang optimal. Hasil kombinasi parameter proses yang menghasilkan kualitas respon yang optimal adalah arc on time diseting pada 3 A, on time diseting pada 8 µs, servo voltage diseting pada 100 V dan wire feed diseting pada 60 mm/min.
UJI PERFORMA MOTOR BENSIN BERBASIS PROGRAM LABVIEW
Authors: Supriyana Nana , Mastur Mastur
Published: November 2018

Performa motor bensin ditunjukan dalam data Torsi dan Daya, berbagai cara dilakukan untuk memperoleh data performa motor bensin mengukur output pada komponen crankshaft, temperatur saluran masuk dan saluran keluar ruang bakar dan temperatur lingkungan. Kegiatan penelitian bertujuan untuk memperoleh data performa pada motor bensin 4 langkah menggunakan software LabVIEW dan Data Aquisition menggunakan NI DAQ USB 6008 produk National Instrumen sebagai pengolah data. Penggunaan beberapa komponen seperti sensor putaran jenis induksi proximity, sensor temperatur dan sensor induksi tegangan tinggi, komponen penguat tegangan sensor dengan Roller Dynamometer Inertia tipe chassis. Hasil data performa motor bensin berupa Torsi dan Daya dapat terbaca pada alat uji dynamometer data Torsi mulai terbaca pada putaran 3750 RPM dengan nilai sekitar 10,65 Nm dan nilai maksimal pada putaran 7574 RPM sebesar 14,84 Nm sedangkan data Daya pada putaran 3750 sebesar 5,6 HP dan nilai maksimal pada putaran 8500 RPM dengan nilai sebesar 16,9 HP. Hasil penelitian tersebut memperlihatkan penggunaan software LabVIEW pada uji performa motor bensin tidak jauh berbeda dengan karakteristik yang dimiliki motor bensin.
THE EFFECT OF MIND MAPPING LEARNING MODEL AND CONTEXTUAL TEACHING AND LEARNING (CTL) TO CONCEPT UNDERSTANDING STUDENTS AT SMP NEGERI 1 PULUNG
Authors: Jeviana Dhika , Hernadi Julan
Published: November 2018

This research aims to know: (1) the effect of Mind Mapping learning model to the concept understanding students (2) the effect of Contextual Teaching and Learning model to concept understanding students (3) which is better between of Mind Mapping Learning Model and Contextual Teaching and LearningModel to concept understanding students.This research a quasi-experimental research with population covering all seventh grade students of SMP Negeri 1 Pulung that is consisted of five classes. From five classes, classes VIIC and VIIE were randomly choosen as the sample. Then two classes were taken randomly to determine the type of treatment to be given. Class VIIC was taught by using the Mind Mapping Learning Model and class VIIE was taught by Contextual Teaching and Learning Model. The data collection techniques were a test while the instrument used to collect understanding concept test.The data collection techniques to know is there any understanding concept students is given of treatment Mind Mapping Learning Model betterthan understanding concept students is given of treatment Contextual Teaching and Learning Model  by t-test.The result show that at the significance level of 0.05, concept understanding students more taught by using the Mind Mapping Learning Model was better  than Contextual Teaching and Learning Model.
THE USE OF VLOGGING TO IMPROVE THE STUDENTS’ SPEAKING SKILL
Authors: Rahmawati Ayu , Harmanto Bambang , Indriastuti Niken Reti
Published: November 2018

The subject of this research was the students at the 11th grade IPA 3 of SMA Muhammadiyah 1 Ponorogo in the academic year 2016/2017, which consisted of 28 students. The research was started on April 04th 2017 until April 27th 2017. The research was conducted for two cycles and six meetings. The purpose of this research was to find out whether vlogging improve students’ speaking skill at the 11th grade of SMA Muhammadiyah 1 Ponorogo in the academic year of 2016/2017. This research was conducted by the researcher and the collaborator. The researcher took a part as a teacher who taught English and the collaborator took a part in this research as observer. The researcher used three instruments. The instruments were observation checklist, questionnaire, and test. The researcher observed the students’ activeness and interest using observation checklist, observed the students’ responses using questionnaire sheet, and measured the students’ speaking skill using test. The form of the test was oral test. The result of observation checklist showed that the classroom situation more conducive. The students were active and interested in the teaching and learning process. The result of questionnaire showed that the students became more interested, confident, and enjoy practice to speaking English by using vlogging. The result of the test showed the improvement from cycle I up to cycle II. The students’ score percentage in cycle I was 53.57%. Meanwhile, the students’ score percentage in cycle II was 100%. The researcher concluded that the implementation of vlogging to improve the students’ speaking skill at the 11th grade IPA 3 of SMA Muhammadiyah 1 Ponorogo in the academic year 2016/2017 was successful.
KONSISTENSI AKSIOMA-AKSIOMA TERHADAP ISTILAH-ISTILAH TAKTERDEFINISI GEOMETRI HIPERBOLIK PADA MODEL PIRINGAN POINCARE
Authors: Pratama Febriyana Putra , Hernadi Julan
Published: November 2018

This research aims to know the interpretation the undefined terms on Hyperbolic geometry and it’s consistence with respect to own axioms of Poincare disk model. This research is a literature study that discusses about Hyperbolic geometry. This study refers to books of Foundation of Geometry second edition by Gerard A. Venema (2012), Euclidean and Non Euclidean Geometry (Development and History)  by Greenberg (1994), Geometry : Euclid and Beyond by Hartshorne (2000) and Euclidean Geometry: A First Course by M. Solomonovich (2010). The steps taken in the study are: (1) reviewing the various references on the topic of Hyperbolic geometry. (2) representing the definitions and theorems on which the Hyperbolic geometry is based. (3) prepare all materials that have been collected in coherence to facilitate the reader in understanding it. This research succeeded in interpret the undefined terms of Hyperbolic geometry on Poincare disk model. The point is coincide point in the Euclid on circle . Then the point onl γ is not an Euclid point. That point interprets the point on infinity. Lines are categoried in two types. The first type is any open diameters of   . The second type is any open arcs of circle. Half-plane in Poincare disk model is formed by Poincare line which divides Poincare field into two parts. The angle in this model is interpreted the same as the angle in Euclid geometry. The distance is interpreted in Poincare disk model defined by the cross-ratio as follows. The definition of distance from  to  is , where  is cross-ratio defined by  . Finally the study also is able to show that axioms of Hyperbolic geometry on the Poincare disk model consistent with respect to associated undefined terms.
PENGEMBANGAN MEDIA PEMBELAJARAN INTERAKTIF PADA POKOK BAHASAN DIMENSI DUA UNTUK MENINGKATKAN MOTIVASI BELAJAR SISWA KELAS XI SMK AL-INABAH PONOROGO
Authors: Okzolatavina Dina , Merona Senja Putri
Published: November 2018

This research aimed to produce learning media using Macromedia Flash in subject discussion dimension 2. Other than that to find out the feasibility of interactive learning media based on criteria of validity, practicality and effectiveness. This learning media be developed because lack of student motivation and the absence of learning support media. This research is a development research. This development research use Plomp development model which consists 4 phases, there are (1) the initial investigation phase, (2) design phase, (3) realization/construction phase, (4) test, evaluation, and revision phase. The subject of the validity trial consisted of 1 media expert and 11 student of 11th grade multimedia SMK A-Inabah and for the subject of the effectiveness trial is 11 student of 11th grade multimedia SMK A-Inabah. Data collection tchniqyes using questionnaries. And the instruments used to collect data included media expert validation sheets, expert material validation sheet, teacher response questionnaire, student response questionnaire, and student learning motivation questionnaire on mathematics. Data analysis techniques are used to analyze validity and practicality in the form of quantitative data analysis and then converted to qualitative data. While to analyze the effectiveness of learning media using Wilcoxon non-parametric test. The result of this development study resulted that validity values of media experts and material experts meet the good criteria. For the practicality value from the teacher respondents meet the good criteria while from the students respondents meet the very well criteria. For the results of effectiveness shows that    and so  is rejected. Its means that students learning motivation after using media is better than students learning motivation before using the media. So that it can be concluded that the interactive learning media developed have fulfilled the validity, practicality, and effectiveness criteria
SMART CARD SYSTEM PENGATUR DAN PENGENDALI PENGGUNAAN DAYA LISTRIK DI LABORATORIUM TEKNIK ELEKTRO UNIVERSITAS MUHAMMADIYAH PONOROGO
Authors: Laistulloh Dika Fikri , Kurniawan Edy , Nurcahya Eka Dwi
Published: November 2018

Perkembangan teknologi automasi saat ini telah dirasakan dalam semua aspek kehidupan manusia. Kemudahan dan keamanan yang ditawarkan dalam teknologi juga berdampak positif, khususnya dalam aspek energi listrik. Jaringan instalasi listrik di laboratorium dituntut harus memiliki standart instalasi listrik yang bagus. Di lab Elektro Universitas Muhammadiyah Ponorogo. Saat ini masih menggunakan sistem laboratorium parallel (satu laboratorium untuk beberapa praktikum). Panel-Panel per praktikum yang ada dalam system laboratorium parallel ini terhubung pada satu sumber listrik. Hal ini dilakukan karna jumlah mahasiswa elektro yang jumlahnya sedikit. Sistem laboratorium parallel ini menimbulkan konsumsi daya berlebih yang terbuang sia-sia sehingga konsumsi listrik menjadi boros. Sistem instalasi listriknya yang masih menggunakan saklar manual pada umumnya dirasa kurang praktis dan efisien. Untuk itu teknologi Radio Frequency Identification (RFID) dapat digunakan untuk fungsi saklar yang sudah otomatis dan juga memiliki kode. Pada system ini RFID digunakan sebagai “ smart card “ untuk mengatur kelistrikan, instalasi listrik ruangan, serta peralatan dan modul praktikum dalam satu ruangan Laboratorium. Penggunaannya hanya untuk kalangan terbatas. Hal ini dilakukan untuk meningkatkan kenyamanan, efisiensi, security, dan juga pengembangan system teknologi agar lebih inovatif.
SISTEM INFORMASI GEOGRAFIS POTENSI WISATA KABUPATEN MAGETAN BERBASIS ANDROID
Authors: Kartikasari Devi , Masykur Fauzan , Nurfitri Khoiru
Published: November 2018

Sistem Informasi Geografis (SIG) berbasis android untuk wisata merupakan aplikasi SIG berbasis mobile dengan mengintegrasikan Global Positioning System (GPS). Penelitian ini menghasilkan sebuah aplikasi Sistem Informasi Geografis Potensi Wisata di Kabupaten Magetan berbasis Android. Aplikasi ini terhubung langsung dengan Google Maps. Tujuan sistem ini dibangun untuk memberikan informasi lokasi wisata di Kabupaten Magetan dengan mudah dan sederhana karena dapat dioperasikan dimanapun user berada menggunakan piranti mobile device berbasis android. Pengguna sistem ini dibagi menjadi dua yaitu admin dan user umum. Pengguna Admin dapat melakukan olah data yang meliputi edit data, hapus data dan tambah data terkait dengan wisata, kuliner, hotel, serta lokasinya. Sedangkan pengguna umum dapat melihat dan mencari lokasi wisata, kuliner, hotel, dan lokasi. Aplikasi ini berhasil dijalankan pada smartphone Android. Aplikasi yang dibuat dapat terintegrasi dengan GPS smartphone secara baik. Aplikasi ini berhasil menyajikan informasi wisata dan lokasi terdekat dari posisi pengguna.
O PAPEL DAS PRÁTICAS DA UNIVERSIDADE SUSTENTÁVEL NA CONSTRUÇÃO DAS CIDADES INTELIGENTES E SUSTENTÁVEIS
Authors: Guimarães Claudio Scheidt , H. Bonilla Silvia
Published: November 2018

A pesquisa realizada para confecção do presente artigo tem como objetivo principal abordar as práticas das universidades sustentáveis, apontando como o conhecimento recebido nestas universidades, as práticas vivenciadas e o comprometimento com a comunidade contribuem para formação de cidadãos conscientes e ativos em prol da construção de cidades inteligentes. Essas atividades, próprias de uma universidade que opera dentro dos paradigmas de uma universidade sustentável, não constituem apenas um diferencial estratégico, mas um potencial de contribuição ativo e com várias abordagens para contribuir na criação de cidades inteligentes e sustentáveis. A linha de pensamento adotada no presente trabalho tem como base primeiramente na análise das características diferenciais das práticas nas Universidades Sustentáveis, seguida da identificação dos requerimentos apresentados para uma cidade se tornar inteligente e sustentável. Na sequência, é feita uma análise para correlacionar as características das primeiras que irão contribuir para as segundas, e como isso pode ser operacionalizado. Foi mostrado a partir de estudos de caso e resultados da literatura que as duas vertentes de soluções, propostas e ações para implementar uma Cidade Inteligente e Sustentável podem ser integradas as práticas de uma Universidade Sustentável. Este perfil de universidade estaria mais familiarizado e engajado com a pesquisa e inovação direcionada a solução de problemas reais. Esses problemas reais podem ser tanto de índole interna do campus, como a promoção de práticas sustentáveis quanto provenientes de interação com a comunidade, poder público e stakeholders.
OC03 AXILLARY VERSUS FEMORAL ARTERY CANNULATION IN AORTIC ARCH SURGERY: A SINGLE CCENTRE EXPERIENCE
Authors: Di Marco L. , Berardi M. , Leone A. , Murana G. , Coppola G. , Votano D. , Amodio C. , Folesani G. , Pacini D. , Di Bartolomeo R.
Published: November 2018

Background and Aim:

The best strategy of arterial cannulation during aortic arch replacement is still debated. We reported our experience with the Axillary and Femoral artery cannulation, comparing the incidence of major neurological events and in-hospital mortality.

Methods:

Between 1996 and 2016, 938 consecutive patients (pts) underwent arch replacement in our center. We included only two groups of patients, according to the type of arterial cannulation: Axillary group with 282 pts and Femoral group with 409 pts. Baseline characteristics of the patients are reported in Table 1.

Results:

The hemiarch replacement was performed more often in Femoral group (57.2% vs 38.3%, p = .001). The Femoral cannulation was the most commonly used in urgent/emergent cases (56% vs 36.9%, p = .001). Cardiopulmonary bypass time (Axillary: 216.08 ± 61.47 vs Femoral: 203.78 ± 63.69; p = .001), Cross-Clamp Time (141.12 ± 47.5 vs 132.71 ± 49.10; p = .016), Circulatory Arrest Time (2.51 ± 1.74 vs 4.26 ± 2.49; p = .001) and antegrade selective cerebral perfusion time (69.19 ± 34.46 vs 58.84 ± 34.94; p = .001) were longer in Axillary group. Hospital mortality was similar between the two groups (12.1% vs 13.9%, p = .546) as well as for permanent neurological deficit (6.7% vs 7.3%, p = .881). Transient neurological deficit is significantly higher in the Axillary group (17.4% vs 11.0%, p = .022).

Conclusions:

Our study confirms that Axillary and Femoral artery cannulations were associated with similar outcomes after aortic arch surgery. The Axillary cannulation was used more frequently in complex repair of the aortic arch, while the Femoral can be still considered a viable option, especially in urgent/emergent cases.
OC12 CLINICAL OUTCOMES OF PERSONALISED EXTERNAL AORTIC ROOT SUPPORT SURGERY: THE OXFORD EXPERIENCE
Authors: Greco R. , Jin X. , Hill E. , Petrou M.
Published: November 2018

Background and aim:

Personalized external aortic root support (PEARS) is a novel technique for prophylactic treatment of moderate aortic dilatation. A replica of the patient's root and ascending aorta is constructed by combining MRI imaging and 3D printing. The ExoVasc stent is surgically implanted around the aorta. We present the Oxford clinical experience with PEARS.

Method:

7 patients (age 33.68 ± 16.04 years), 5 (71.4%) male, with Marfan Syndrome and root dilatation underwent ExoVasc stent implant. 5 procedures were performed in Oxford (JRH) and 2 in other UK centres as part of our proctoring programme (2012–2017). 3 patients underwent isolated PEARS surgery and 4 had concomitant mitral valve repair.

Results:

All patients underwent successful ExoVasc implant. Cardio-pulmonary bypass (CPB) was not required for isolated procedures. In the 4 combined cases, most of the stent implant was performed before and after CPB (mean CPB 145.75 ± 9.90 minutes). One patient required a second CPB run to revise the repair. No patient suffered major complications or required transfusions. Mean post-operative ICU and hospital LOS were 1.4 ± 1.4 and 5.7 ± 1.4 days. Pre-discharge and follow-up echo confirmed successful mitral valve repair. MRI follow-up at 3.94 ± 1.45 years of the first 5 patients showed no progression of the root and ascending aorta diameters. An incidental isolated type B dissection was found 3 years after surgery.

Conclusion:

PEARS represents an attractive alternative to extensive prophylactic surgery (i.e. valve sparing aortic root replacement) particularly for patients with MFS who required concomitant mitral surgery.
OC51 NEW TECHNIQUE IN TYPE I ACUTE AORTIC DISSECTION FOR ARCH STABILIZATION AND FUTURE LANDING ZONE CREATION WITHOUT ARCH REPLACEMENT: THE SALERNO CANOE TECHNIQUE
Authors: Masiello P. , Longobardi A. , Panza A. , Mastrogiovanni G. , Cafarelli F. , Triggiani D. , Del Negro G. , Leone R. , Ruopolo C. , Iesu S.
Published: November 2018

Background and Aim:

We present a simplified elephant trunk procedure to treat type I acute aortic dissections. This technique transfers the anastomotic site of a modified elephant trunk prosthesis from zone 3 to zone 0 (before anonymous trunk).

Methods:

From November 2015 to April 2018, 38 patients underwent an ascending aorta replacement for type I acute aortic dissection. In order to stabilize the arch and prepare a future landing zone, after the reconstruction of proximal and distal dissected aortic walls using inside and outside felt strips, we introduce into the aortic arch a Dacron prosthesis resected to create a “fenestration” under the supra-aortic branch vessels. The distal part of this prosthesis is left free floating into the descending aorta. The concave arch was also anchored to the prosthesis and through a catheter placed distally into the tube graft we perfused the thoracic aorta. Having the prosthesis a final shape of a canoe, we named the procedure “the Salerno Canoe Technique”.

Results:

Five patients died (13.2%). We observed a 5% reduction compared to our previous mortality. In one patient severe abdominal hypoperfusion due to secondary hypertensive false lumen was successful treated by an endovascular thoracic prosthesis landed proximally into the “canoe prosthesis”.

Conclusions:

Compared to conventional elephant trunk technique this procedure is simpler and less circulatory arrest time-consuming (only mean 12 min increase respect to ascending aorta replacement alone). It allows an extensive arch stabilization, a safe perfusion of the descending thoracic aorta and a landing zone for future endovascular procedures.
OC33 HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY SURGERY AND MITRAL SUBVALVULAR REMODELING: THE 2007–2017 IRCCS-ISMETT EXPERIENCE
Authors: Raffa G. , Morsolini M. , Turrisi M. , Romano G. , Falleta C. , Clemenza F. , Pilato M.
Published: November 2018

BACKGROUND AND AIM:

To assess the role of the mitral valve apparatus (leaflets, chordae and papillary muscles (PM) in left ventricle outflow tract (LVOT) obstruction, and results of the surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) in a retrospective observational study.

METHODS:

Thirty-two consecutive patients (58 ± 12 years, M/F ratio: 17/15) undergoing HOCM surgery from 2007 to 2017 at our institute were reviewed. End points included the involvement of the mitral valve in LVOT obstruction, mortality, and change in clinical and echocardiographic characteristics after HOCM surgery.

RESULTS:

Secondary chordae tendineae tractioning the anterior mitral leaflet to the interventricular septum were detected in 82% of the patients. Anomalous, hypertrophied, and fused PM with muscularis trabeculae hypertrophy were found in 48%, 40%, and 31% of the patients, respectively. Four patients had posterior leaflet redundancy. Secondary chordae (93%), PM, and muscularis trabeculae resection (75%), and PM splitting and elongation (34%) were added variably to septal myectomy (100%). Nine procedures (28%) on mitral valve leaflets were performed, involving 6 posterior and 3 anterior mitral leaflets. Long-term follow up was 4 ± 2.8 years. There was no hospital mortality, and NYHA was reduced from 3 ± 0.6 to 1 ± 0.7 (p < 0.0001), the LVOT gradient from 91 ± 35 to 21 ± 17 mmHg (p < 0.0001), mitral valve regurgitation from grade 3 ± 1 to 1 ± 0.6 (p < 0.0001), and septum thickness from 19 ± 3 to 14 ± 2 mm (p < 0.0001).

CONCLUSIONS:

The mitral valve apparatus with all its components contribute variably to LVOT dynamic obstruction thus, surgical correction in addition to extended myectomy is recommended to achieve the best outcome.
OC28 FAILURE OF TRICUSPID ANNULOPLASTY FOR FUNCTIONAL TRICUSPID REGURGITATION. THE ROLE OF PREOPERATIVE TRICUSPID VALVE APPARATUS REMODELING
Authors: Foschi M. , Di Mauro M. , Iacò A. , Kheirallah H. , Alsaied M. , Alfonso J. , Tancredi F. , Gaudino M. , Calafiore A.
Published: November 2018

Background:

To identify the determinants of both early and late tricuspid annuloplasty (TAP) failure.

Methods:

From May 2009 to December 2015, 688 patients undergoing TAP for functional tricuspid regurgitation (TR) at a single institution were included in the study. Inclusion criteria: MV disease requiring surgical intervention; no pathologic changes in TV leaflets; no previous TV repair; not requiring associated tricuspid valvuloplasty. In 423 patients, echocardiographic evaluation was performed both at discharge and after a median of 35 (22–58) months. Residual and Recurrence TR were defined as TR higher than mild. Logistic regression and Cox analysis were used as multivariable model for early and late failure. ROC curve was used to identify cutoffs

Results:

Residual TR after TAP was recorded in 54 (13%); Risk factors for residual TR were: preoperative severe TR regardless of tricuspid valve (TV) apparatus remodeling, mild or moderate TR in presence of TV apparatus remodeling, defined as coaptation depth ≥6.5 mm (sensitivity 55%; specificity 80%), tenting area ≥0.85 cm2 (52%; 75%), and tricuspid annulus ≥40 mm (60%; 72%). Recurrent TR was recorded in 85 (20%) cases, Five-year freedom from TR recurrence was 74.0 ± 3.0%. The following risk factors for recurrent TR were identified: residual TR (Figure), atrial fibrillation at follow-up, mild/ moderate TR with TV apparatus remodeling, severe TR.

Conclusions:

Prophylactic TAP should be encouraged among surgeons even earlier than guidelines recommend. Decision-making for the treatment of low-grade FTR at the time of left-sided valve surgery should take into consideration not only annular size, but also tethering severity.
OC27 FAILURE OF TRICUSPID ANNULOPLASTY FOR FUNCTIONAL TRICUSPID REGURGITATION. THE ROLE OF PREOPERATIVE AND LATE RIGHT VENTRICULAR REMODELING
Authors: Calafiore A. , Iacò A. , Kheirallah H. , Alsa M. , Alfonso J. , Tancredi F. , Foschi M. , Gaudino M. , Di Mauro M.
Published: November 2018

Background and Aims:

To identify the role of preoperative and late right ventricular (RV) remodeling in tricuspid annuloplasty (TAP) late failure.

Methods:

From May 2009 to December 2015, 423 patients undergoing TAP received transthoracic echocardiographic evaluation both at discharge and after a median of 3 years. Recurrence TR were defined as TR higher than mild at follow up. Cox analysis was used as multivariable model for late failure.

Results:

Recurrent TR was recorded in 85 (20%) cases, Five-year freedom from TR recurrence was 74.0 ± 3.0%. Risk factors were residual TR, atrial fibrillation at follow-up, mild or moderate TR with TV apparatus /RV remodeling, severe TR, RV dilatation either preoperative or at follow-up. The entire cohort was divided into four groups: group A with neither preoperative nor at follow-up RV dilatation (149); group B with positive RV remodeling (134); group C with negative RV remodeling (n = 28)); and group D with persistent RV dilatation (n = 112). TR recurrence was recorded significantly higher in groups C and D (Figure). Risk factors for late RV dilatation were preoperative mild or moderate TR with TV apparatus or RV remodeling, preoperativesevere TR, preoperative left and right ventricular dysfunction.

Conclusions:

RV remodeling is one of the determinant after TAP and can be predicted on the basis of several preoperative echocardiographic parameters, including left and right ventricular function and TR severity. In these cases, the surgical approach should not be limited to TAP, but surgeons should consider alternative techniques or prosthesis implantation.
OC82 TRANSAORTIC MITRAL VALVE REPAIR FOR OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY: THE POLICLINICO DI MONZA EXPERIENCE
Authors: Binaco I. , Spirito P. , Vaccari G. , Zyrianov A. , Poggio D. , Grillo M. , Casati V. , Ferrazzi P.
Published: November 2018

Background and Aim:

Abnormalities of mitral valve (MV) apparatus are known to contribute to left ventricular (LV) outflow obstruction in hypertrophic cardiomyopathy (HCM). Purpose of this study is to report our experience with MV repair in patients with obstructive HCM undergoing surgical septal myectomy.

Methods:

From July 2013 to March 2018, 316 consecutive patients with obstructive HCM underwent surgical septal myectomy. Of these patients, 298 (94.3%) had associated MV repair and only 18 (5.7%) had MV replacement due to severe leaflets calcification and intrinsic MV disease. Age ranged from 15 to 85 years, mean 54 ± 15. Each patient had an outflow gradient ≥50 mmHg at rest or with physiologic provocation and disabling symptoms unresponsive to medical therapy.

Results:

Transaortic papillary muscle mobilization and cutting of fibrotic and retracted secondary MV chordae was performed, in association with septal myectomy, in all study patients. Plication of a redundant anterior MV leaflet was performed in 119 (37%) patients, and of the posterior leaflet in 29 (9%). Two patients died during hospitalization (0.6%), 8 patients (2.8%) had a residual postoperative resting gradient ≥30 mmHg, 6 (1.9%) patients had persistent important functional limitation (NYHA III), and 9 (2.8%) residual moderate-to-severe MV regurgitation, at the first postoperative evaluation.

Conclusions:

In our large HCM study cohort, transaortic extensive and systematic repair of the MV apparatus, combined with septal myectomy, was associated with a particularly low perioperative mortality, and abolition of resting LV outflow obstruction, MV regurgitation and heart failure symptoms in the great majority of patients.
MORE THAN 10 YEARS SINGLE CENTRE EXPERIENCE WITH NORWOOD STAGE I PROCEDURE
Authors: Uricchio N. , Seddio F. , Marcora S. , Marrone C. , Ferrero P. , Preda L. , Papa M. , Ciuffreda M. , Didedda G.B. , Sadou Y. , Galletti L.
Published: November 2018

The aim of our study is to report the results of 10 years, single centre experience, in the treatment of hypoplastic left heart syndrome.

Methods:

Between 2007 and 2017, 80 consecutive patients underwent Norwood Stage 1 procedure at our Institution. Sixty-six patients had HLHS, 5 had unbalanced AV Canal and 11 other single ventricle lesion with ductal dependent circulation and/or multilevel systemic obstruction. Twenty patients were staged by a previous bilateral pulmonary banding. All patients received patch reconstruction of aortic arch while pulmonary blood flow was accomplished by a BTS in 37 pts, RVPA conduit in 41 and a BCPA in 2.

Results:

Overall hospital survival was 74,5 %, increasing after 2012 (63% vs 85%): only one patient died in the last 30 consecutive patients. One year transplant free survival was 72%. At univariate analysis, age at operation, weight less than 2,5 kg, prenatal diagnosis, presence of aortic atresia, systemic AV valve regurgitation, obstruction in pulmonary veins and use of BTS instead of RVPA conduit were not associated with increase in-hospital mortality. Only the year of operation (after 2012) was associated with better survival. During the follow-up, 55 patients underwent BCPA as a second stage, 17 patients underwent Fontan completions and two patients had heart transplant.

Conclusions:

Beside limitation due to patient number that did not allow identification of mortality predictors our data suggest that in centres with strong commitment to Norwood procedure, hospital survival is improving continuously and is actually comparable to other complex biventricular lesions.
OC46 MYCOBACTERIUM CHIMAERA INFECTIONS FOLLOWING CARDIAC SURGERY IN ITALY: RESULTS FROM A NATIONAL SURVEY ENDORSED BY SICCH
Authors: Cappabianca G. , Paparella D. , D’Onofrio A. , Caprili L. , Minniti G. , Lanzafame M. , Parolari A. , Musumeci F. , Beghi C.
Published: November 2018

Background:

A global outbreak of Mycobacterium Chimaera (MC) infections following cardiac surgery and linked to contaminated heater-cooler units (HCU) is currently ongoing. In 2017, since the status of this outbreak in Italy and the mitigation strategies adopted by adult cardiac surgery unit (ACSU) were not known, SICCH launched a national survey among Italian ACSUs.

Methods:

In Italy there are 90 ACSU across 20 regions. From May to Nov 2017 they were surveyed collecting data on a) patients diagnosed with MC infections b) ACSU workload c) used HCU models d) control measures adopted in theatres.

Results:

The response rate was 87.8%. The mean number of cardiac procedures at each ACSU was 508 ± 229/year and nationally the number of procedures/year exceeded 40k. In Italy 7 patients with MC infections following cardiac were reported since 2015: all had aortic or valve surgery as first procedure; the latency between first operation and infection was 2.8 ± 1.6 years. Mortality for patients requiring redo cardiac surgery was 50%. MC infections risk was 0.4–1 patient every 1000 cardiac procedures. The most common HCU model in Italy is the 3T HCU (70.9%). The most common control measures adopted were: implementing new HCU disinfection protocols, using sterile or filtrated water in the HCU and displacing HCU fans away from the patient: HCU replacement and microbiology testing were infrequent.

Conclusions:

In Italy the risk of contracting MC infections and the mortality reported are in line with other European countries; a significant heterogeneity exists on the mitigation strategies to prevent further MC inoculations.
OC71 SURGICAL TREATMENT FOR ISOLATED TRICUSPID VALVE INFECTIVE ENDOCARDITIS. 25-YEAR RESULTS
Authors: Di Mauro M. , Dato G. Actis , Barili F. , Corte A. Della , Ratta E. Della , Cugola D. , Galletti L. , Centofanti P. , Santini F. , Salsano A. , Rinaldi M. , Mancuso S. , Cappabianca G. , Beghi C. , De Vincentiis C. , Biondi A. , Livi U. , Sponga S. , Pacini D. , Murara G. , Di Bortalomeo R. , Scrofani R. , Cagnoni G. , Antona C. , Nicolini F. , Benassi F. , De Bonis M. , Pozzoli A. , Casali G. , Scrascia G. , Bortolotti U. , Falcetta G. , Musumeci F. , Gherli R. , Vizzardi E. , Salvador L. , Piccichè M. , Paparella D. , Margari V. , Troise G. , Villa E. , Dossena Y. , Lucarelli C. , Onorati F. , Faggian G. , Mariscalco G. , Maselli D. , Foschi M. , Parolari A. , Lorusso R.
Published: November 2018

Background and Aim:

Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (IE), encompassing only 5–10% of cases, 90% of RSIE involves the tricuspid valve (TV). We sought to evaluate early and late mortality of patients with isolated TVIE.

Methods:

The National Registry for Surgical Treatment of Valve and Prosthesis Infective Endocarditis included 4084 patients from February 1999 to January 2018. From 1983 to 2018, isolated TVIE was surgically treated in 157 (3.8%). Mean age was 47 ± 16 (15–86 years); 25% were females 142 (90%) native tricuspid regurgitation; 7 (5%) native stenosis-insufficiency and 8 (5%) tricuspid prosthesis endocarditis (TPIE). 38% due to IVDU; 21% due to PMK/ICD leads; 1% due to vascular access for dialysis; in the remaining cases, the cause was unknown Staphilococcus aureus was the most common germ (45%); The primary end-point was long-term survival freedom from recurrence;

Results:

77 (49%) underwent TV repair, 72 (46%) TV replacement and 8 (5%) TV prosthesis replacement. Early mortality was 11% (17 patients); Expected mortality according to EndoSCORE was 12%; age (OR 1.06) and redo (OR 6.64) were risk factors. Median follow up was 229 months (172–286) Late deaths were 31;Recurrences were 4 (all dead). Survival at 10, 20 and 25-year were 66%, 60% and 44%, respectively. Risk factors were age (HR 1.06), fungine TVIE (HR 4.2), IVDU HR 4.90), redo (HR 4.4) and presence of leads (HR 3.0). No difference was found between repair and replacement (Figure)

Conclusions:

Patients with isolated TVIE undergoing surgical treatment show good early and late outcome.
OC85 TREATMENT OF AORTIC INSUFFICIENCY THROUGH AORTIC LEAFLETS REMODELLING: AN EXCELLENT ALTERNATIVE TO REPLACEMENT
Authors: Masat M. , Pantaleo A. , Calcara G.B. , Minniti G. , Camata A. , Polesello L. , Mondin F. , Possamai M. , Rivaben D. , Antonini-Canterin F.
Published: November 2018

Background and Aim:

Aortic valve repair can be considered a valid alternative to replacement in patients with aortic regurgitation. Recent data report excellent results mainly for patients with aortic root dilatation associated with anatomically normal aortic valve. No data are up-to-date available about the results of the repair in patients with degenerative aortic valve (prolapse, thickness, perforation and/or retraction of the leaflets, congenital malformations). We analyzed retrospectively our data.

Methods:

From January 2011 to November 2017, we have treated 90 patients with degenerative aortic valve insufficiency (IA) through sugical remodelling of the aortic leaflets. The failure mechanism conditioned the choice of technique (shaving, correction of prolapse, raphe excision, use of pericardium, commissural re-orientation). Pre and postoperative transesophageal echocardiography as well as transthoracic echocardiography for follow-up were performed for each patient.

Results:

No in-hospital mortality was reported, two late deaths (2.22%)both for non cardiac cause. Three patiens (3.33%) needed, after repair, intraoperative aortic valve replacement while two (2.22%)at follow-up. Postoperative complications were low: 2 (2.22%)transient low output syndrome, 3 (3.33%)postoperative bleeding, 1 (1.11%)transient neurological deficit, 1 (1.11%)temporary renal failure, 3 (3.33%)acute myocardial ischemia. No thromboembolic and haemorragic events was referred, as well as endocarditis. Early or late recurrence of IA > 2 was detected in 4 pts (4,44%).

Conclusions:

Remodelling of the aortic valve leaflets represents an attractive and valid alternative to aortic valve replacement in patients with aortic valve insufficiency, mainly in young patients. In our experience the results are excellent in terms of short and middle term survival, postoperative complications and freedom from reoperation. It remains to be established if the remodeling of the cusps is comparable to the replacement of the valve in terms of late results.
OC01 AORTIC VALVE REPLACEMENT THROUGH A RIGHT MINI-THORACOTOMY: MORE THAN 600 PATIENTS FOR A SINGLE CENTER EXPERIENCE
Authors: Calvi S. , Mikus E. , Pagliaro M. , Magnano D. , Tripodi A. , Panzavolta M. , Albertini A.
Published: November 2018

Background and aim:

Aortic valve replacement through a right mini-thoracotomy is a minimally invasive procedure developed during the last years. It is not frequently used because of a tiny operating field, limiting surgeon's view resulting in longer cardiopulmonary bypass and cross clamping times compared to the standard full sternotomy.

Methods:

We reviewed 604 patients (334 male 55% with median age of 75; range 16–93 years) who received an aortic valve replacement between January 2010 and April 2018 through a right mini-thoracotomy In the first 45 patients the aortic cannulation and clamping were performed through the right minithoracotomy while a vacuum assisted venous drainage was obtained percutaneously through the groin. A total central arterial and venous cannulation was than preferred. The maiority received an aortic valve replacement with a pericardial bioprothesis sutured using three 2–0 prolene running sutures.

Results:

Aortic replacement was performed through a 4 to 6 cm skin incision at the third intercostal space. 6 patients were a REDO cases. Overall median cardiopulmonary bypass and aortic cross clamping time was respectively 54 minutes (range 25–121) and 42 minutes (range 16–134). Median ventilation time and intensive care stay were 7 and 44 hours. Patients transfused were 42%. Hospital mortality was 1.4% (7/488).

Conclusions:

This single cenetr experience show that thanks to a standardized technique cardiopulmonary bypass and cross-clamping times comparable with the standard can be obtained and peripheral cannulation avoided. Advantages of this technique include early mobilization and rehabilitation, excellent aesthetic result and lower risk of wound complications.
OC57 PATIENT-PROSTHESIS MISMATCH ION ELDERLY WOMEN: THE BENEFICIAL IMPACT OF SUTURELESS VALVES VERSUS STENTED BIOPROSTHESIS
Authors: Bianchi G. , Concistrè G. , Margaryan R. , Laganà A. , Solinas M.
Published: November 2018

Background:

Elderly women undergoing aortic valve surgery are at high risk to develop patient-prosthesis mismatch (PPM) due to their small body size and cardiac structures; sutureless valves can overcome this problem.

Aim:

this retrospective study aims to compare sutureless valves with stented bioprosthesis in terms of (PPM) occurrence.

Methods:

From July 2001 to September 2017, 442 female patients received 280 sutured bioprosthesis and 162 sutureless bioprosthesis in the same center. Projected effective orifice arean was used to calculate the indexed effective orifice area (iEOA). A 1:1 propensity matching model based on patients’ BSA yield 162 comparable pairs.

Results:

sutureless valve exhibited lower CPB time and cross-clamp time (sutured vs. suturelss: 106.7 ± 42.0 min vs 92.6 ± 29.1 min; 71.9 ± 28.8 min vs 58.4 ± 19.9 min; p < 0.001), less transfusion rate (sutured vs. sutureless: 26% vs 14%; p = 0.014), lower delirium (sutured vs. sutureless: 11% vs 9%) and higher EOA and iEOA (sutured vs. suturelss: 1.716 ± 0.313 cm2 vs 2.527 ± 0.324 cm2; 1.016 ± 0.20 cm2/m2 vs. 1.495 ± 0.221 cm2/m2; p > 0.001). At follow-up, sutureless valves had lower mean gradient (sutured vs suturelss: 15.96 ± 8.33 mmHg vs 12.38 ± 5.10mmHg; p = 0.049).

Conclusions:

in our series, sutureless valves allowed expedite surgery, lower incidence of post-operative delirium and less hours of mechanical ventilation; hospital stay and mortality did not differed. Sutureless valves are associated with no PPM and lower mean gradients at follow-up. When anatomically indicated, sutureless valves should be the prosthesis of choice in elderly women.
OC21 EARLY OUTCOMES OF MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT WITH RAPID DEPLOYMENT BIOPROSTHESES: INSIGHTS FROM AN ITALIAN NATIONAL REGISTRY.
Authors: Tessari C. , D’Onofrio A. , Diena M. , Solinas M. , Alamanni F. , Massetti M. , Livi U. , Di Eusanio M. , Mignosa C. , Russo C. , Rinaldi M. , Di Bartolomeo R. , Luzi G. , Antona C. , De Paulis R. , Salvador L. , Maselli D. , Portoghese M. , Alfieri O. , De Filippo C.M. , Bortolotti U. , Musumeci F. , Gerosa G.
Published: November 2018

Background and Aim:

Rapid-deployment bioprostheses (RDBs) represent one therapeutic option for patients with aortic valve stenosis (AVS). Their theoretical advantages are the reduction of procedural times and the facilitation of minimally invasive operations. Aim of this retrospective multicenter study was to assess early outcomes of isolated aortic valve replacement (iAVR) with RDB performed through mini-sternotomy (MS).

Methods:

We analyzed data of iAVR through MS approach from a National Registry of RDB. Preoperative variables were defined according to Euroscore II system and postoperative outcomes were reported according to VARC-2 definitions.

Results:

From April 2012 to March 2018, 450 consecutive patients (21 centers) underwent iAVR through MS for AVS. Mean age was 74 ± 7.5 years and 231 (51.1%) were females. Logistic Euroscore I, Euroscore II and STS-PROM score were 6.7 ± 5.3%, 2.0 ± 1.4% and 2.2 ± 1.7%, respectively. Mean cardiopulmonary bypass and aortic cross-clamping times were 88.4 ± 30.4 minutes and 59.5 ± 20.8 minutes, respectively. Peripheral cannulation was performed in 243 cases (54%). Conversion to full-sternotomy occurred in 8 patients (1.8%). VARC device success was 98% (441 cases). Early mortality was 0.7% (3 patients). VARC major postoperative complications were 19 (4.2%) and 28 patients required new permanent pace-maker (6.2%). Postoperative echocardiography revealed a mean transprosthetic gradient of 11.3 ± 4.6 mmHg, a mean indexed AVA of 1.15 ± 0.32 cm2/m2 and a total of 27 (6%) paravalvular leaks (24 mild and 3 moderate).

Conclusions:

Our data suggest that RDBs allow performing iAVR using a minimally invasive approach with good perioperative clinical and hemodynamic outcomes, with a low rate of postoperative complications.
OC72 SURGICAL TREATMENT OF ISOLATED AORTIC STENOSIS IN OCTOGENARIAN PATIENTS: LONG-TERM RESULTS OF A CONSECUTIVE MONOCENTRIC SERIES
Authors: Daprati A. , Garatti A. , Parolari A. , Canziani A. , Mossuto E. , Farah A. Abu , Menicanti L.
Published: November 2018

Background and Aim:

Aortic stenosis (Sao) is the most common cause of cardiac valve surgery in Europe. The aim of this study is to analyze the short- and long-term outcome of a consecutive population of octogenarian patients who underwent AVR for isolated severe Sao.

Methods:

Between January 2003 and December 2016, 270 consecutive patients (mean age = 83 ± 2 years, male = 36%) were operated on AVR for isolated Sao at our center. 28% of patients had symptoms of advanced heart failure (NYHA class III-IV), despite good left ventricular function (mean FE = 56 ± 11%). Long-term outcomes were analyzed by Kaplan-Meier. Potential predictors of hospital mortality and long-term outcomes were investigated by logistic regression and multivariate Cox analysis, respectively.

Results:

In most patients a biological prosthesis was implanted (90%). The mean time of CEC and aortic clamping were 69 ± 19 and 55 ± 15 minutes, respectively. As regards perioperative complications, the incidence of stroke, acute renal failure, mediastinitis and complete AV block (which required PM implantation) was 0.5%, 4.3%, 2.3% and 2.8% respectively. 30-day mortality was 2.5% (7 patients). The mean follow-up was 54 ± 36 months (range: 12–161). 85% of patients showed up in NYHA class I-II. Overall we recorded 70 deaths (25%), of which 39 (14%) due to cardiac cause.

Conclusions:

The surgical aortic valve replacement in octogenarian patients is an effective therapy, with excellent long-term results as a prognosis quoad vitam, with a good functional recovery and quality of life.