bluuebunny/crossref_metadata_2025 huggingface dataset:
OC02 AUTOMATIC 3D-ECHO AORTIC ANNULUS MEASUREMENT FOR A PRECISE PREOPERATIVE TAVI PLANNING: IS IT ALREADY FEASIBLE?
Authors: Romagnoni C. , Gelpi G. , Contino M. , Rosa R. , Mangini A. , Antona C.
Published: November 2018

Background and aim:

Transcatheter aortic valve implantation is a wide-spreading technique.

The advent of recent softwares based on 3D transoesophageal echo is updating the role of ultrasound in the preoperative prosthesis sizing because of its potentiality to provide precise measurements of the aortic annulus avoiding X-ray and contrast material. Aim of this study is to verify the reliability of echo measurements.

Methods:

We enrolled 15 patients with severe aortic stenosis and 5 with healthy aortic valve. All patients underwent ECG-gated angio CT-scan and 3D transoesophageal echocardiogram. We blindly compared the two sets of data focusing on annulus and sinuses dimensions.

Results:

Statistically significant differences were found in aortic annulus diastolic maximum diameter and perimeter. Although not significant, the small differences highlighted in systole would have led to the choice of a different prosthesis size in 33% of the patients in case of CoreValve Evolut R, in 40% in case of Sapien 3 and in 60% in case of Lotus valve.

Conclusions:

Although not significant, the small differences between echo and CT measurements, if at the extremities of different size range, lead to a different transcatheter prosthesis size choice with potential relevant clinical effect.
OC09 CLINICAL AND HEMODYNAMIC OUTCOMES AFTER AORTIC VALVE REPLACEMENT WITH RAPID-DEPLOYMENT BIOPROSTHESES: RESULTS FROM AN ITALIAN NATIONAL REGISTRY
Authors: D’Onofrio A. , Tessari C. , Filippini C. , 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 (RDB) have been recently introduced into clinical practice. Aim of this multicenter retrospective study was to evaluate early and mid-term outcomes of aortic valve replacement (AVR) with RDB.

Methods:

Data from a National Registry that includes patients undergoing AVR with RDB in Italy were analyzed. Univariate and multivariable analysis were performed to identify independent predictors of mortality. Kaplan-Meier method was used for survival analysis.

Results:

A total of 1158 patients (21 centers, April 2012-March 2018) were included. Nearly one third of patients (368 patients, 31.7%) underwent combined operations and 487 (61.6%) of the 790 patients who underwent isolated AVR received a minimally invasive approach. Median cross-clamp time for isolated AVR was 58 minutes (IQR: 45–71). Device success was 97.8% (1132 patients). Permanent pace-maker implantation was 6.7% (78 patients). Thirty-day overall mortality occurred in 24 patients (2.1%). At discharge, trace-mild and moderate paravalvular leak were found in 98 (8.5%) and in 8 (0.7%) patients, respectively. Median follow-up was 351 days (IQR: 96–654). Figure 1A shows hemodynamic performance over time. Kaplan-Meier survival was 95.8 ± 0.6% and 88 ± 2.4% at 1 and 4 years, respectively (Fig. 1B). At follow-up, 1078 patients were in NYHA class 1–2 (98.4%). Multivariable analysis identified as independent predictors of mortality: age (OR:1.071, 95%CI: 1.006–1.139; p = 0.0307) and preoperative atrial fibrillation (OR:2.693, 95%CI: 1.204–6.022; p = 0.0158).

Conclusions:

RDB provide good early and mid-term clinical and hemodynamic outcomes. These devices may be considered as a reasonable alternative to conventional bioprostheses especially in minimally invasive or in combined operations.
OC15 CORONARY ARTERY BYPASS GRAFTING WITH ARTERIAL CONDUITS. LONG-TERM RESULTS FROM A MULTICENTRE REGISTRY
Authors: Nicolini F. , Fortuna D. , Agostinelli A. , Pacini D. , Gabbieri D. , Zussa C. , de Palma R. , Gherli T.
Published: November 2018

Background and aim of the study:

Conflicting results have been published on long-term outcomes of total arterial revascularization (TAR) in patients operated on coronary artery bypass grafting. The aim was to compare 10-year rates of overall mortality, cardiac related mortality, myocardial infarction, stroke, and repeat revascularization, in a cohort of patients younger than 70 years, treated with total arterial revascularization versus a conventional coronary artery bypass grafting performed with left internal mammary artery plus saphenous vein grafts.

Methods:

Two propensity score matched cohorts, each of 998 patients, undergoing isolated CABG at the regional public and private centers of Emilia-Romagna region (Italy) were used to compare long-term outcomes of 3780 patients<70 years, 2718 operated with traditional CABG and 1062 patients who received TAR.

Results:

Thirty-day mortality and morbidity were similar in both groups. The mean follow-up of the PS matched cohort was 8.1 ± 2.6 years. At 10 years, TAR patients reported significantly lower overall mortality (15.7% versus 19.6%; KM log-rank p = 0.02), and lower need for repeat revascularization with PCI (14.8% versus 17%, KM log-rank p = 0.04). No differences were reported between groups in terms of cardiac-related mortality, incidence of myocardial infarction, and stroke.

Conclusions:

At 10 years, after propensity score matching, TAR CABG reported better results in terms of cumulative rate of all-cause death, and repeat revascularization with PCI, and similar results in terms of cardiac death, myocardial infarction, and stroke, with respect to conventional CABG.
OC16 CORONARY ARTERY ENDARTERECTOMY DURING CORONARY ARTERY BYPASS GRAFTING: A SOLUTION FOR COMPLETE REVASCULARIZATION
Authors: malik L.
Published: November 2018

Background:

Coronary Artery Bypass Grafting (CABG) is one of the most frequently done cardiac surgical procedures. However, with the advancements in catheter-based interventional procedures, the category of patients taken up for CABG is gradually being restricted to more high-risk group. Performance of Off pump coronary artery bypass grafting (OPCAB) with concomitant coronary artery endarterectomy(CE) in patients with severe coronary disease provides more complete revascularization.We examined the technique and early outcomes of OPCAB with coronary endarterectomy (CE).

Materials and methods:

This is a single institutional retrospective study with 32 patients (26 males, 6 females) underwent concomitant off-pump CE and CABG from 1 october 2016 through 31 october 2017. which was about 11.26 % (32/284) of the OPCAB cases. Average number of coronary bypass grafts were 2.4 ± 0.8. 10 CE procedures were performed with saphenous vein patch. 7 involved left anterior descending artery (LAD) CE with left internal mammary artery (LIMA) conduits. The remaining 3 were diagonal branch artery (D1) CE with saphenous vein bypass conduits.

Results:

The incidence of postoperative MI was 9%. The 30-day mortality was 3.12% from complications of bowel ischaemia and three patients with septicaemia associated with prolonged intubation. The mean operating time was 138 ± 22 minutes.

Conclusion:

We have shown that the effect of OPCABG with CE appears to be safe and early outcomes are encouraging. Hence, diffuse disease requiring endarterectomy should not be considered a contraindication to OPCABG. Surgical skills and the suitability criteria of the patients are very important in this regard.
OC05 BLEEDING RISK PREDICTION IN CORONARY ARTERY BYPASS SURGERY
Authors: Salsano A. , Olivieri G.M. , Maestri F. , Natali R. , Miette A. , Soma F. , Vellucci M. , Sportelli E. , Buscaglia G. , Santini F.
Published: November 2018

Background And Aim:

Severe perioperative bleeding after coronary-artery bypass grafting(CABG) is associated with poor outcome. Recently new scores for prediction of severe bleeding have been developed. Aim of our study was to evaluate the reliability of 10 risk scores for bleeding in our cohort of CABG patients.

Methods:

An observational study included 337 consecutive patients who underwent isolated CABG from July2015 to January2018. Each bleeding risk score was calculated and analyzed through the c-statistic for Discrimination, the Hosmer-Lemeshow test for calibration.

Results:

The mean chest tube loss within the first 12 post-operative hours was 385.8 ± 222.0 ml. 1.7 ± 2.3 units of red blood cells per patient were transfused after the operation. Re-sternotomy for bleeding rate was 2.1%. The rate of severe-massive bleeding according to Universal Definition of Perioperative Bleeding(UDPB grades 3–4) classification was 15.1%. Overall in-hospital mortality was 2.6%. Mortality rates in patients with severe bleeding according to UDPB classification vs no-severe bleeding was 11.8% vs 1.1%(p < 0.0001) and UDPB 3–4 was associated with in-hospital mortality (OR 12.58,95% CI:3.20–61.29,p = 0.0005). Risk scores Discrimination was: 0.66 (0.58–0.74) for the ACTION, 0.63 (0.54–0.71) for the WILL-BLEED, 0.61 (0.52–0.67) for the TRACK, 0.59 (0.51–0.67) for the HEMORR2AGES, 0.59 (0.50–0.68) for the TRUST, 0.58 (0.49–0.66) for the ORBIT, 0.53 (0.443–0.621) for the HAS-BLED, 0.53 (0.43–0.62) for the CRUSADE, 0.52 (0.44–0.60) for the ATRIA and 0.51 (0.43–0.59) for the PAPWORTH. Calibration was adequate for all scores but the TRUST.

Conclusions:

In our cohort of CABG patients severe bleeding correlated with early mortality. While the ACTION score had the highest Discrimination, all the other scores analyzed successfully predicted severe perioperative bleeding after CABG.
OC81 TOTAL ARTERIAL CORONARY ARTERY REVASCULARIZATION USING BOTH INTERNAL MAMMARY ARTERIES WITH Y CONFIGURATION: LONG TERM RESULTS
Authors: Pagliaro M. , Mikus E. , Amoncelli E. , Zucchetta F. , Tripodi A. , Calvi S. , Albertini A.
Published: November 2018

Background and aim:

Bilateral internal mammary artery (BIMA) grafts are used for coronary revascularisation by only a minority of surgeons, despite a growing body of evidence suggesting improved survival when compared to use of only one internal mammary artery with additional saphenous vein grafts. Main disadvantages reported, consist in sternal wound infection, increased technical complexity. We report our experience discussing technical considerations and long term follow up.

Methods:

Between January 2010 and February 2017, 1038 patients with multivessel coronary artery disease underwent myocardial revascularization with bilateral internal mammary arteries (BIMA) adopting Y configuration (male = 877 [84.5%]; mean age 65.7 ± 8.7 years, range 36–87). More than 25 % were obese (body mass index > 30) N°261 and 32.5n% were affected by diabetes mellitus.

Results:

Both internal mammary arteries are harvested using a completely skeletonized technique. This minimizes chest wall trauma, achieves maximum length, and makes constructing the “Y” graft and performing subsequent sequential grafting easier. An off pump technique was preferred in 114 patients, for the remaining overall cardiopulmonary bypass was 68 ± 28.0 minutes and aortic cross clamping was 50 ± 20 minutes. (Skin to skin median 240 minutes). Thirty days mortality rate resulted 1.4% (15/1038). Other postoperative complications and follow up are collected and reported.

Conclusions:

data from literature reveals that use of bilateral mammary arteries is associated with improved long term survival, also in diabetic patients. The reported disadvantages as sternal dehiscence are actually not so relevant as well operations times are not so increased.
OC35 IMPORTANCE OF MULTIDICIPLINARY VAD TEAM FOR EARLY RECOGNITION OF MECHANICAL ASSISTANCE ADVERSE EVENTSIMPORTANCE
Authors: Contento C. , Vitalini E. , De Marco M. , Iaiza A. , Pietraforte L. , Montelto A. , Musumeci F.
Published: November 2018

Background and Aim:

Left ventricular assist device (LVAD) represents a valid alternative to heart transplant in patients who suffer from end stage heart failure but adverse events, involving both the internal and the external parts, can occur in ongoing patients and if not promptly diagnosed can be potentially fatal. Main intention is to report our approach to device malfunction.

Methods:

Over the past ten years in 90 patients a LVAD was implanted at our institution. Patient's LVAD parameters were monitored monthly. A VAD team including nurse, perfusionist, cardiac surgeon, provide 7/24 on call service to afford any emergency. The patients were trained to promptly identify the different alarm and to immediately communicate to the VAD team. According to the alarm severity a support was provided as early as possible and hospitalization was prescribed as mandatory in some case.

Results:

In 23 patients a device's part failure occurred. 12 required immediate hospitalization and intervention as consequence of different complications like showed in table 1. N. events Type of complication Intervention 4 Pump Thrombosis 3 Thrombolisis 1 Pump Exchange 5 Controller's Failure Controller Exchange 3 Driveline Fracture Hospidalization 3 HTX urgent 5 Batteries Clips broken Clip Exchange 6 Driveline's Outer Sheath Fracture Repair 1 System control power cables fracture Controller Exchange 1 Connector Nut rupture Controller Exchange.

Conclusions:

Early recognition and diagnosis of LVAD complications is mandatory. We support the utility of multidisciplinary VAD Team to guarantee an early identification and solution of VAD related problems.
OC56 OUTCOMES IN VAD-PATIENTS: A SINGLE CENTER EXPERIENCE
Authors: Cammardella A.G. , Comisso M. , Gherli R. , Contento C. , Vitalini E. , Montalto A. , Musumeci F.
Published: November 2018

Objectives:

we report our single-center experience with implantable ventricular assist devices.

Methods:

From March 2005 to December 2017, 89 consecutive patients underwent implantation of long-term ventricular assist devices (VADs). The mean age was 53.8 ± 10.3 with a clear prevalence of females (92.4%). Ischemic cardiomiopathy was the main etiological diagnosis (51.7%) and bridge to transplant represented the major indication to implant. The mean INTERMACS level was 2.4 ± 1. We implanted n = 3 Heartmate I XVE (3.4%), n = 51 Heartmate II (57.3%), n = 8 Heartware HVAD (9%), n = 3 HVAD as BIVAD (3.4%) and n = 24 Heartmate 3 (26.9%).

Results:

the overall in-hospital mortality was 13.5% (12 patients). Twelve patients (14.0%) needed temporary RVAD (Centrimag Levitronix) at the time of LVAD implantation. The mean VAD support time was 16.9 ± 14.0 months in group of patients who received transplantation (n = 35) and 16.4 ± 16.2 in group with no following transplantation (n = 54). The most common adverse events were driveline exit site or VAD infection (18%), gastrointestinal bleeding (9.1%), stroke (10.4%), late RVF requiring re-hospitalization (5.2%). Device malfunction (pump thrombosis or other) was observed in 9.1% (n = 7) of patients. The overall survival in VADs patient were 78.3%, 63.8% and 53.9% at 12, 24 and 72 months, respectively.

Conclusion:

our analysis on a single-center cohort of patients confirms utility and relative safety of VAD-therapy in advanced heart failure.
OC13 COMPARING SPRAYABLE HEMOSTAT/SEALANT ADJUNCT TO TRADITIONAL HEMOSTASIS AFTER CARDIAC REDO SURGERY: A RANDOMIZED SUTDY
Authors: Weltert L. , D’Aleo S. , Salica A. , Bellisario A. , Scaffa R. , Wolf L. Guerrieri , Chirichilli I. , De Paulis R.
Published: November 2018

Background:

Bleeding after cardiac surgery is a common, unresolved, and consequence-heavy. Despite meticulous hemostasis, some degree of diffuse bleeding (referred to microvascular bleeding) tends to persist at surgery completion. Several techniques to reduce post-operative bleeding have been attempted. We have utilized a thin sprayable layer of a hemostat/sealant (Tisseel, Baxter Healthcare, Deerfield, Illinois) to reduce post-operative blood loss This study (NCT02360800) compared the effectiveness of adjunct hemostat/sealant, applied via a compressed air spray, in sealing the microvascular bed prior to chest closure in cardiac redo surgery

Methods:

All patients undergoing any type of cardiac redo surgery between March 2015 to October 2017 were enrolled and allocated in a 1:3 ratio to adjunct hemostat/sealant spray or control (defined as no specific treatment for microvascular bleeding) A 1:2 best-neighbor propensity matching technique was then applied to obtain a matched cohort. Primary analyses: Post-operative bleeding at 3, 6, 9, 12 and 24 hours post-surgery Secondary analyses: allogeneic blood product transfusion during 4 post-operative days.

Results:

The study included 71 participants (17 adjunct hemostat/sealant; 54 control/no specific treatment) Of these, 54 propensity-matched subjects (17 adjunct hemostat/sealant; 34 control/no specific treatment) were analysed Hemostat/sealant use resulted in significantly lower post-operative blood loss at the 3, 6, 9, and 12 hour timepoints

Significantly lower amounts of blood products were transfused to the matched and unmatched hemostat/sealant vs. control cohort participants

Conclusion:

In patients undergoing cardiac redo surgery, adjunct hemostat/sealant spray use was associated with less post-operative blood loss and lower blood product transfusion utilization.
OC83 TRANSAORTIC SEPTAL MYECTOMY FOR OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY: THE POLICLINICO DI MONZA EXPERIENCE
Authors: Vaccari G. , Binaco I. , Zyryanov A. , Casati W. , Poggio D. , Spirito P. , Ferrazzi P.
Published: November 2018

Background:

In the American Heart Association Guidelines, transaortic septal myectomy is considered the preferred treatment for patients with obstructive hypertrophic cardiomyopathy (HCM) and heart failure symptoms unresponsive to medications. However, the inadequate number of surgeons and centers with large experience with myectomy in the USA and Europe limits patient access to surgery.

Aim and Methods:

To report the results of our myectomy program recently developed at the Hypertrophic Cardiomyopathy Center of the Policlinico di Monza, Italy. From July 2013 to March 2018, 316 consecutive patients with obstructive HCM underwent transaortic myectomy, mitral valve plasty and papillary muscles mobilization. Age ranged from 15 to 85 years, mean 54 ± 15. Preoperatively, 60 (19%) patients were in NYHA class II and 256 (81%) in class III-IV, all had LV outflow gradients ≥ 50 mmHg at rest or with physiologic provocation, and 90 (28%) had important mitral valve regurgitation.

Results:

Two patients died during hospitalization (0.6%). In the surviving patients, follow-up ranged from 1 to 51 months, mean 9 ± 11 months. At most recent evaluation, 6 (1.8%) patients had persistent severe symptoms (class III-IV), 8 (2.5%) had residual significant (≥ 30 mmHg) outflow gradient at rest, and 9 (2.8%) had moderate-to severe or severe mitral regurgitation.

Conclusions:

Our recently developed septal myectomy program was based on the experience with this procedure acquired by the senior surgeon at a different institution and the development of a multi-specialistic team collaborating in the program. Our positive results provide a precedent for future efforts to expand the access to surgical myectomy for patients with obstructive HCM.
OC50 NEW ROLE OF REGENERATED OXIDIZED CELLULOSE IN TREATMENT OF DEEP STERNAL WOUND INFECTION
Authors: Scognamiglio M. , Conti M.C. , Chiariello L. , Desoky A. , Amendolara F.
Published: November 2018

Background and Aim:

Sternal surgical wound infections can be complicated in mediastinitis in 0.4% -2.4% of cases. Extensive necrosis of tissues and sternum requires demolitive interventions. We have developed a simple technique that reduce the trauma, thanks to regenerated oxidized cellulose haemostatic and antibacterial capabilities.

Methods:

Between January 1st, 2017 and March 1st, 2018, 631 interventions were performed in sternotomy. 10 patients had sternal wound complications, and 5 mediastinitis were diagnosed. All patients underwent an initial removal of the infected tissues and NPWT placement. Sternal and tissue samples were taken for culture diagnosis. Targeted antibiotic therapy was performed. Subsequently a partial pectoral muscles flap reconstruction was performed, the residual vacuum areas were filled with regenerated oxidized cellulose to minimize the use of the electrosurgical unit for hemostatic control, using his antibacterial capacity.

Results:

Antibiotic therapy duration was 15 +/- 3 days, hospital stay 20 days. The follow-up was 30 days and was 100% complete. No patient died. A severely obese patient with decompensated diabetes (preoperative glycated hemoglobin ≥ 6.5%) had a recurrence of wound infection. All the other patients presented a perfect surgical wound healing.

Conclusion:

Mediastinitis is a fearful and dramatic complication. Use of regenerated oxidised cellulose seems to facilitate sternal reconstruction, avoiding exceptional interventions such as full pectoral muscle flap or omentum flap. Acidic pH produced by the cellulose has bactericidal effect also in resistant strains such as MRSA. Preoperative glycated hemoglobin levels> 6.5% appear to be a predisposing factor for sternal wound infections and infection recurrences.
OC08 CHALLENGING CASES IN TRANSCATHETER VALVE REPLACEMENT'S ERA
Authors: Savini C. , Leone A. , Folesani G. , Gliozzi G. , Murana G. , Pacini D. , Saia F. , Palmerini T. , Marozzini C. , Costantino A. , Di Bartolomeo R.
Published: November 2018

Background:

Transcatheter valve replacement (TVR) improved the postoperative results of high risk patients.This less invasive option could be adopted to solve difficult and challenging cases.

Methods:

We report a selection of 6 cases carachterized by difficult decision making, where a TVR was performed in full sternotomy (n = 2), transapical (n = 2) or percutaneously (n = 2).

Results:

Case 1. 72 years-old-female with malfunction of mitro-aortic bioprosthesis and severe post-capillary pulmonary hypertension.We performed aortic valve replacement, open mitral valve-in-valve(ViV)TVR and tricuspid valve annuloplasty.

Case 2. 79 years-old-male in cardiogenic shock due to bioprosthesis cusp rupture.We performed urgent transfemoral aortic valve replacement.

Case 3. 76 years-old-female with endocarditis on mitral bioprosthesis, admitted with acute pulmonary oedema.Because of sudden deterioration of hemodynamics refractory to inotropes, we performed urgent transapical ViVTVR.

Case 4. 54 years-old-female with Ebstein anomaly, endocavitary pace-maker and diagnosis of tricuspidalic bioprosthesis detachment. We performed trans-jugular tricuspidalic ViVTVR upon percutaneous removal of electrodes

Case 5. 77 years-old-female with rheumatic mitro-aortic stenosis. Because of extensive calcifications of valvular annuli, we perform open mitro-aortic replacement with aortic Sorin Solo and Edwards Sapien 3 mitral bioprosthesis.

Case 6. 84 years-old-female with previous aortic valve mechanical replacement (1982) and biological mitral replacement (1999). Admitted with acute mitral prosthesis malfunction due to cusp rupture, requiring intra-aortic balloon pump positioning. We performed urgent transapical ViVTVR.

All patients were discharged in good clinical conditions.

Conclusions:

TVR may offer a feasible solution for extremely high risk patients, also in acute life-threatening valve disease.
VD14 OPEN SURGICAL TREATMENT OF GIANT CORONARY ARTERY ANEURYSMS
Authors: Matteucci M.L.S. , Cefarelli M. , Pierri M. , Capestro F. , Berretta P. , Di Eusanio M.
Published: November 2018

Aneurysmal coronary artery (CAA) disease, defined as a localized dilation measuring at least 1.3–2 times the diameter of a normal, adjacent segment, is seen in 0.3–5% of patients undergoing coronary angiography. However, we refer to “giant”-aneurysm only when it reaches a diameter greater than 50 mm. This condition is reported with a prevalence of 0.02–0.2%. Clinical sequelae include thrombus formation, distal embolization and fistula formation. Moreover, the blood flow and the irregular internal surface of the aneurysmal wall predispose the lesion to its development up to the dramatic rupture. Surgical correction is the preferred treatment. Other options include percutaneous intervention, with latex balloons and coil embolization, or conservative treatment with antiplatelet or anticoagulant medication. In this video we show the case of a 63-years old man, in apparent good condition, with giant aneurysms affected both right and circumflex coronary arteries. Surgical tactic included aneurysms plication with distal bypass grafting.
VD17 TAVI BY TRANS-CAROTID APPROACH
Authors: Droandi G. , Di Cesare A. , Muccio S. , Poncet A. , Ruggieri V.G.
Published: November 2018

The TAVI-procedure was performed under loco-regional anesthesia by cervical block.

The left common carotid artery (CCA) was surgically exposed by low small cervicotomy and a 3 minutes carotid clamping test was realized in order to evaluate patient's neurological status.

A 6-Fr sheath was inserted through the left CCA. The aortic stenosis was crossed using a JR4 catheter with a Terumo straight stiff guidewire. The catheter was pushed into the left ventricle and the guidewire exchanged with an Amplatz Super Stiff. The Edwards sheath was inserted through the left CCA and aortic balloon valvuloplasty was performed.

The Edwards Sapien3 transcatheter aortic valve was then advanced using Edwards Certitude delivery system across the calcified aortic valve. The prosthesis was deployed under rapid ventricular pacing at 180/min with excellent seating and no paravalvular leak.

The delivery catheter and the sheath were removed, the left CCA was closed and the clamp removed after de-airing.
EP18 INCIDENCE AND CLINICAL IMPACT OF POSTOPERATIVE MITRAL PATIENT-PROSTHESIS MISSMATCH
Authors: Sbaffi A. , Cuko E. , Pelenghi S. , Totaro P.
Published: November 2018

Aim:

The relevance of PPM following mitral valve replacement is still debated, as different studies, using different methods of evaluation, presented completely different results. The major aspect on this issue is that surgical options to prevent a potential mitral PPM is at high risk of postoperative major complications. In this study we sought to elucidate the real incidence of hemodinamically significant mitral PPM following MVR and the relevance of prosthesis size in causing PPM.

Materials and Methods:

126 patients undergoing MVR were enrolled. Incidence of mitral PPM, based on postoperative gradient, was evaluated for the cumulative populations and according the type of prosthesis used. For mechanical prosthesis the hemodynamic performances using Ony-X single size were specifically compared to the performances of standard Sorin (according different size). Clinical impact of mitral PPM in terms of significant different postoperative outcome was also evaluated.

Results:

Patients characteristics are summarized in fig 1a. Overall PPM incidence is summarized in fig 1b. No significant differences were showed in increased mean transprosthesis gradient between patients receiving biological or mechanical prosthesis (fig 1c). No significant differences were also shown in patients receiving mechanical prosthesis regardless the type of prosthesis (fig 1d). Finally no clinical impact in terms of unfavourable postoperative outcomes was showed in patients with hemodynamical PPM.

Conclusions:

Our single centre experience, based on in vivo postoperative measurement of hemodynamic performances of different mitral valve prosthesis clearly show that the real clinical relevance of mitral PPM is probably over-estimated.
EP02 A FOCUSED APPROACH CAN VIRTUALLY ELIMINATE THE INCIDENCE OF SYSTOLIC ANTERIOR MOTION AFTER MITRAL VALVE REPAIR
Authors: Pettinari M. , Amoroso F. , Tamagnini G. , Borsellino S. , Vankerrebroeck C. , Gutermann H. , Dion R.
Published: November 2018

Objective(s):

The incidence of systolic anterior motion(SAM) after mitral valve repair(MVRr) varies between 4 and 10% of cases. The combination of a small left ventricle(<45 mm), a high posterior leaflet(>15 mm), a narrow aorto-mitral angle(<120°), a narrow coaptation-septal distance(<25 mm) or an enlarged basal septum (≥15 mm) significantly increases the risk for SAM. Aim of this study was to evaluate the incidence of SAM in patients with a combination of at least two of these risk factors and report their echocardiographic/clinical outcomes.

Methods:

Between 2007 and 2014, 165 patients underwent MVRr for degenerative disease using classic Carpentier techniques. The annuloplasty was performed with a complete semi-rigid ring chosen using only the maximal height of the anterior leaflet as a reference. Preoperative echocardiography identified patients at intermediate risk(one risk factor only) or high risk(2 or more risk factors) for SAM.

Results:

Of these 165 patients, 22(13.3%) had an intermediate risk for SAM and 35(21.2%) a high risk. During the study period, we did not find any case of SAM, neither in the low risk group nor in the high risk group. At a median follow-up of 3.9 years, the survival did not differ among patients with no, intermediate or high risk of SAM(p = 0.6). Freedom from more than moderate mitral regurgitation at 4 years was also similar(no risk = 92.9%, low risk = 100% and high risk = 97.9%, p = 0.8).

Conclusions:

Even in patients with high risk of SAM, the incidence of this complication can be eliminated using a focused approach on annuloplasty ring sizing and posterior leaflet height.
EP35 SHOULD MODEL FOR END STAGE LIVER DISEASES (MELD) AND MELD-BASED SCORES BE ROUTINELY APPLIED TO PREOPERATIVE ASSESMENT OF PATIENT UNDERGOING VALVULAR CARDIAC SURGERY?
Authors: Celentano A. , Masiglat L.J.T. , Pelenghi S. , Totaro P.
Published: November 2018

Background:

MELD and MELD-based score have been introduced to assess the risk of complications in patients with chronic liver disease. We designed this study in order to evaluate the potential usefulness of routine application of MELD-based scores in patients undergoing cardiac surgery valve procedures in predicting postoperative major and minor liver-related complications.

Materials:

92 patients, without history of liver diseases and with normal liver function tests, undergoing valvular heart surgery were enrolled. Patients were subdivided in four groups: combined mitro-aortic surgery (Group A); Isolated AVR (Group B); Isolated MVR (Group C) and isolated MVP (Group D). Preoperatively, 4 MELB-based scores were calculated (MELD XI, modified IM, modMESO and modMELD-Na). Intra and inter-groups distributions of MELD-based scores, and the accuracy of 4 scores in predicting postoperative liver-related complications were analysed.

Results:

Preoperative MELD-based scores were slightly increased in Group C. Postoperative raise (>50%) of AST,ALT,GGT and LDH was showed in 71%,44%, 28% and 54 respectively with significant differences in group A and C. GGT raise did influenced the total hospital stay and all 4 scores showed a direct correlation between preoperative value and % of postoperative raise, especially MELD XI and modified IM (Fig 1a/b). Furthermore a preoperative high MELD-based score (especially MELD XI and modified IM) accurately predicted higher postoperative GGT increase (Fig 2a/b).

Conclusions:

Our study seems to confirm the usefulness of application of MELD-based scores in preoperative assessment of patients undergoing cardiac surgery. The clinical impact of postoperative transient liver function impairment needs to be further evaluate.
EP32 RESECT OR RESPECT: THE OUTCOME IN MITRAL VALVE REPAIR THROUGHT MINITORACOTHOMY
Authors: beggino C. , paris M. , nardozza M. , mikus E. , calvi S. , mammana L. , zulueta J.L. , del giglio M.
Published: November 2018

Background and aim:

Heart valve surgery through right anterior minithoracotomy proved excellent short-term and long-term-term results, becoming a feasible alternative to the sternotomy approach. Surgical repair is the gold standard therapy for mitral valve regurgitation. Recently, the valve sparing techniques has been established and it is preferred by many surgeons. The aim of this retrospective study is to show the results of mortality and freedom from reoperation in patients underwent mitral repair with a leaflet sparing or resection techniques.

Methods:

from January 2010 to February 2017, 366 patients underwent mitral valve repair; leaflet sparing technique was performed in 187patients (51%), resection in 179 patients (49%). Minitoracothomy was performed throught a 5 cm incision at the fourth intercostal space. We adopted an aortic central cannulation with a percutaneous peripheral venous cannulation. Aortic cross clamping was perfomed by a transcutaneous clamp at the second intercostal space. The mean follow-up was 35 mounths.

Results:

The mean age was 62,5 ± 12,8 years. The 30-day mortality was 0,27% (0% in leaflet sparing group). The follow up mortality was 0.82 % (0% in leaflet sparing group). At discharge moderate mitral regurgitation was present in 5 patient (2.7%) in leaflet sparing group, in 16 patients (8.9%) in the other group. Freedom from reintervention at 1 year was 97.9% in leaflet sparing group and 95,0% in the other one.

Conclusion:

this study shows that leaflet sparing techniques combined with minimally invasive access has good results in terms of mortality and freedom from reoperation.
EP24 MITRAL VALVE REPAIR AND EVOLUTION OF TECHNIQUES: A SINGLE-CENTER EXPERIENCE
Authors: Savini C. , Coppola G. , Murana G. , Ammar A. , Suarez S. Martin , Costantino A. , Votano D. , Coco V. Lo , Pacini D. , Di Bartolomeo R.
Published: November 2018

Background and aim:

In the last decades, mitral valve repair techniques evolved towards a respect rather than resect procedure. This is an overview of our single-center experience in mitral valve repair by comparing the conventional (Group 1) and the minimally invasive (Group 2) approach.

Methods:

Between January 2004 and March 2018, we analysed 609 patients who received isolated mitral valve repair.The sternotomy approach was used in 462 patients (75.9%), the mini-thoracotomy in 147 (24.1%).Specifically, there were 77 (12.6%) isolated annular implantations, 53.7% triangular/quandrangular resections, 32.7% implantations of Gore-Tex chords, 12.5% edge-to-edge techniques.The Gore-Tex chords implantation was more frequently used in patients of Group 2 than in Group 1 (48.3% versus 27.7%,p-value 0.001).In addition to our series, we performed 28 NeoChord procedures.

Results:

The trend of mitral valve repair in sternotomy approach or mini-thoracotomy is represented in Figure 1 along with the use of PTFE chords or French correction.Overall In-hospital mortality was 0.3% (2 patients), post-operative MACCE occurred in 1 patient. In 2 patients was necessary perioperative reoperation due to repair failure. Follow-up time was of 62.57 ± 36 months.Follow up death was 5.2%.

Conclusions:

The evolution of mitral valve repair techniques during the last years have increased simultaneously with the minimally invasive approach. Among the different techniques of repair,the chords implantation is becoming one of the most used and the era of French correction is slowly disappearing.The observed results of our series highlight this trend and come out in favour of the minimally invasive approach.
EP19 INFERIOR REVERSED J SHAPED MINI STERNOTOMY FOR MITRAL VALVE SURGERY
Authors: Masiello P. , Longobardi A. , Mastrogiovanni G. , Colombino M. , Panza A. , Cafarelli F. , Del Negro G. , Triggiani D. , Rosapepe F. , Iesu S.
Published: November 2018

Background and Aim:

To reduce the morbidity of mitral valve surgery, we present our mininvasive approach.

Methods:

From January 2017 to April 2018, 35 patients underwent mitral valve surgery using a partial lower sternotomy through a 9–12 cm longitudinal median skin incision and a left reversed “J-shaped” ministernotomy from the second intercostal space to the xiphoid. Mitral valve replacement was performed in 8 patients (22.8%), while mitral valve repair (using quadrangular resection, sliding plasty or butterfly technique in addition to intertrigonal annuloplasty band) in 27 patients (77.2%).

Results:

One patient (4.4%) required conversion to full sternotomy. Twenty-four patients (68.5%) were extubated within 6 hours of surgery, and 75% of patients spent less than 24 hours in the intensive care unit (ICU). Mean hospital length of stay was 7.2 +/- 3.4 days. Eighty percent of patients received no blood products. We did not register any operative mortality or re-exploration for bleeding. Morbidity included respiratory insufficiency in 3 patients (6.6%) and wound infection in 1 patients (2.2%).

Conclusions:

We chose the lower mini-sternotomy because the mitral valve exposure is very similar to that of the full sternotomy and enables repair with the same degree of success as the full sternotomy does. Furthermore, ease conversion to conventional surgery when needed make this technique preferable to the right minithoracothomy approach. The mininvasive approach, in addition to its cosmetic benefits, reduce the sternal trauma, avoid excessive rib traction, reduces the postoperative pain and allows early extubation, mobilization and discharge from the ICU.
RF05 AORTIC VALVE ENDOCARDITIS COMPLICATED BY AORTO-VENTRICULAR DISCONTINUITY
Authors: Malvindi P.G. , Margari V. , Mikus E. , Albertini A. , Coppola R. , Martinelli L. , Santarpino G. , Gregorini R. , Carbone C. , Speziale G. , Paparella D.
Published: November 2018

Background and Aim:

Aortic valve endocarditis remains a life threatening condition especially in case of extension of infection to the surrounding tissue. Aorto-ventricular discontinuity complicates the surgical procedures with worse short- and long-term outcomes. We aim to review patients’ characteristics and surgical results of this dreadful infective disease.

Methods:

we reviewed prospectively collected data from our central database looking at patients operated for infective aortic valve/prosthesis endocarditis complicated by pseudoaneurysm. We retrieved information of 35 patients operated on during the period 2011-2017.

Results:

Table 1 summarises demographic and preoperative data. Patients were relatively young, mostly male and most of them had a prior cardiac operation. Redo Bentall operation was performed in 32 cases, it was associated with other procedures in 7 patients: CABG (n = 2), MV surgery (n = 3), MVS + CABG (n = 1) and PVR (n = 1). Three patients underwent AVR: isolated (n = 1), plus MVR (n = 1), associated with ascending aorta replacement (n = 1). Unplanned CABG was necessary in 2 cases: for failure in coronary ostia reimplantation (n = 1) and myocardial ischaemia during CPB weaning (n = 1). The postoperative course was complicated in 29 cases. Nineteen patients sustained LCOS hesitating in MOFS and death in 6 cases. Two patients had major neurologic deficit (permanent cerebral stroke and coma). AKI complicated the course in 15 cases, CVVHD was necessary in 5 patients. Pre-discharge mortality was 23%.

Conclusions:

patients with complicated aortic valve endocarditis presented generally in a poor preoperative status. Complex aortic root surgery is the only life-saving procedure but it is still associated with high mortality and morbidity rate.
RF11 CALCIUM LOADING AS RISK FACTOR FOR POST IMPLANTATION LEAKAGE IN TAVI PROCEDURES
Authors: Pollari F. , Cuomo M. , Dell’Aquila A.M. , Vogt F. , Schwab J. , Kalisnik J.M. , Fischlein T. , Pfeiffer S.
Published: November 2018

Background and Aims:

To assess aortic valve calcification with a reproducible method and the performance of different prostheses in relation to the occurrence of paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) in a large single-center cohort.

Methods:

We retrospectively analyzed preoperative contrast-enhanced CT scans of patients who underwent TAVI in our center between 2009 and 2016. Calcium volume was calculated for each aortic cusp in the aortic valve (AV), in the left ventricular outflow tract (LVOT) and device-landing zone (DLZ). Multivariate analysis was performed to evaluate the risk factors for intraoperative PVL.

Results:

539 patients were included in the study (Edwards SapienXT, n = 192; Edwards Sapien3, n = 206; Medtronic CoreValve EvolutR, n = 44; Symetis Acurate, n = 97). Median calcium volume in the DLZ was 757 mm3 (IQR 734.2), with no significant differences among the four prosthesis groups. None of the patients had severe PVL. The overall incidence of mild-to-moderate PVL was 15.8%. On multiple linear regression analysis, DLZ calcification, non-coronary cusp in LVOT calcification, transapical access, and use of the CoreValve and Acurate prostheses were found to be independently associated with PVL. In contrast, degree of oversizing, and use of Sapien3 were independently associated with a lower incidence of PVL.

Conclusions:

DLZ and non-coronary cusp in LVOT calcification are independently associated with PVL occurrence after TAVI. Among prostheses, Sapien3 seems to be associated with a lower incidence of PVL regardless of calcium volume.
RF30 INTEGRATED PERCUTANEOUS AND MINIMALLY INVASIVE APPROACH FOR HEART VALVE SURGERY: THE “HYBRID WAY” TECHNIQUE
Authors: Cammertoni F. , Bruno P. , Mazza A. , Pavone N. , Farina P. , Perri G. , Iafrancesco M. , Nesta M. , Chiariello G. , Colizzi C. , D’Errico D. , Massetti M.
Published: November 2018

Background and Aim:

The aim of this study was to evaluate in-hospital and short-term results of our minimally invasive hybrid approach in a cohort of patients with isolated,double or triple heart valve disease.

Methods:

Between March 2014 and March 2018,we operated on 215 patients using a minimally invasive hybrid technique which includes limited skin incision,upper hemisternotomy,central arterial cannulation and peripheral percutaneous venous cannulation for the positioning of venous cannula,pulmonary artery vent and retrograde cardioplegia delivery line.

Results:

Of the total cohort,128 (59.5%) patients underwent aortic (AVS),77 (35.8%) mitral (MVS) and 10 (4.7%) combined aortic and mitral valve surgery (CVS).Median age was 72.5 (range:63.8–77),62 (54–71) and 66 (59.8–72) years for AVS,MVS and CVS,respectively.Endovent and Proplege (Edwards Lifesciences,Irvine,California,USA)were used in 63.3% and 32% patients of the AVS group,respectively.Mean (SD) cardiopulmonary bypass and aortic cross-clamp times were 115.2 (28.3),144.4 (42.6),182.0 (24.2) and 81.2 (21.8),97.8 (21.6) and 131.6 (15.9) minutes in the AVS,MVS and CVS group,respectively.Mean (SD) postoperative length of stay was 7.8 (5.9),7.3 (2.7) and 6.8 (1.1) days in the AVS,MVS and CVS group,respectively without any in-hospital deaths and low rate of complications.After a median follow-up of 16,13.5 and 14 months,survival was 99%,100% and 100% for the AVS,MVS and CVS group and echocardiography did not reveal any significant valvular dysfunction.

Conclusions:

Hybrid MIS appears to be feasible,safe and reliable with excellent in-hospital and short-term results.Key strength of this tecnique is the opportunity to perform all combinations of heart valves surgery with one single easy-learning surgical approach.
RF29 IN-HOSPITAL OUTCOME AFTER EMERGENCY OR PROPHYLACTIC EXTRACORPOREAL LIFE SUPPORT DURING TRANSCATHETER AORTIC VALVE IMPLANTATION: A COMPREHENSIVE REVIEW OF THE LITERATURE
Authors: Raffa G. , Kowalewski M. , Meani P. , Follis F. , Turrisi M. , Delnoij T. , Gilbers M. , Heuts S. , Schreurs R. , Pilato M. , Maessen J. , Lorusso R.
Published: November 2018

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been used to deal with life-threatening complications as well as back-up or active cardiovascular support in high-risk procedures in patients undergoing transcatheter aortic valve implantation (TAVI). Electronic search was performed in PubMed and Medline electronic databases in order to identify studies with emergency or prophylactic V-A ECMO application in association with TAVI procedures. From November 2012 to November 2017, 14 relevant studies including 102 (1.9%) over 5,115 TAVI patients (prophylactic, n = 22 (0.4%); emergency n = 66 (1.3%); missing n = 14) were identified. The average age was 79 years and 39 were male. The reason for emergency V-A ECMO implant was detailed in 65 patients: left ventricle free wall rupture (21%), hemodynamic instability (19%), ventricular arrhythmias (10%), aortic annulus rupture (9%), coronary obstruction (9%), low left ventricular output (ejection fraction < 35%) (7%), uncontrollable bleeding (7%), severe aortic regurgitation (6%) and aortic dissection (2%). Femoral arterial and vein cannulation was the most common access for V-A ECMO institution. Major bleeding and vascular access complications were reported in 7 patients, respectively. The overall in-hospital survival was 72% (60% in the emergency- vs 100% in the prophylactic group).

V-A ECMO support should be available in any center performing TAVI, and provides effective mechanical circulatory support in emergency setting. The need of a back-up and strategies (algorithm) for prophylactic circulatory assistance should be carefully evaluated during the heart team discussion.
RF80 SUTURELESS AORTIC PERCEVAL BIOPROSTHESIS IMPLANTATION IN AORTIC VALVE DISEASE AND CONCOMITANT PROCEDURES: SINGLE CENTER EXPERIENCE WITH 121 PATIENTS
Authors: Concistrè G. , Chiaramonti F. , Bianchi G. , Margaryan R. , Santarelli F. , Gasbarri T. , Kallushi E. , Cerillo A.G. , Murzi M. , Farneti P. , Solinas M.
Published: November 2018

Background and Aim:

Perceval sutureless aortic bioprosthesis (LivaNova Group, Italy) represents an innovative approach for surgical aortic valve replacement (AVR), in order to facilitate prosthesis implantation and reduce operative time, specially in complex procedures. We described our experience in AVR and concomitant procedures with Perceval bioprosthesis implantation.

Methods:

From March 2011 to December 2017, 841 patients underwent AVR with sutureless aortic Perceval bioprosthesis at our Institution. Of these, 121 patients (mean age, 77 ± 6.3 years; female patients, 64%; mean logistic EuroSCORE, 18 ± 12.3%) underwent Perceval bioprosthesis implantation with concomitant procedures. The concomitant procedures were coronary artery bypass grafting (CABG) (n = 38), septal myectomy (n = 3), CABG + other procedures (n = 15), and 65 other procedures. Preoperative, periprocedural and echocardiographic parameters, as well as clinical outcomes, were analyzed.

Results:

In-hospital deaths occurred in 4 (3.3%) patients, one patient had cardiac death, and all patients were alive at a mean follow-up of 28.6 ± 12.4 months. Mean aortic cross-clamp and extracorporeal circulation times were 139.5 ± 46.6 and 92.4 ± 41 minutes, respectively. At follow-up, mean trasprosthetic gradient was 11.3 ± 5.3 mmHg. There were 3 mild paravalvular leaks and one Perceval replacement for endocarditis 10 months after implantantion. Events at follow-up included cerebral ischemia in one patient, and need of pacemaker implantation in 4 patients.

Conclusions:

Perceval sutureless AVR is a fast and safe procedure, specially in AVR with concomitant procedures, providing a good hemodynamic performance with excellent clinical results.