bluuebunny/crossref_metadata_2025 huggingface dataset:
OC54 OUTCOME OF A CONTINOUS FLOW PUMP (JARVIK 2000) AS BRIDGE TO TRANSPLANTATION OR DESTINATION THERAPY IN PEDIATRIC PATIENTS: SINGLE CENTER EXPERIENCE
Authors: Perri G. , Filippelli S. , Di Molfetta A. , Testa G. , Iodice F. , Adorisio R. , Iacobelli R. , Massetti M. , Amodeo A.
Published: November 2018

BACKGROUND:

Use of intra-corporeal ventricular assist devices (VAD) in children has become increasingly popular over the years. We describe our experience with “Jarvik 2000” LVAD both as destination therapy (DT) and as bridge to transplantation (BTT) in pediatric patients.

METHODS:

We reviewed 14 consecutive children assisted with “Jarvik 2000” LVAD for end stage heart failure from October 2010 to May 2018. Primary diagnosis was dilated cardiomyopathies (DCM) in Duchenne Muscular Dystrophy (DMD) in 7 patients and primary DCM in 7. Data collected include, age and weight at implantation, indication to support, post-operative complications and outcome.

RESULTS:

“Jarvik 2000” was implanted in 13 patients, while “Infant Jarvik” was used in 1. Mean age and weight at time of implantation were 15.5 years (0.9 - 17.4 yrs) and 45 kilograms (5 – 88 kg) respectively. Six patients with DMD DCM and one patient, with primary DCM and severe preexisting neurological, received LVAD as DT while in 7 children, all with primary DCM, the device have been used as BTT. In this group, at mean follow-up time of 27.4 ± 17 months, 4 death occurred, 2 for VAD- related cerebral bleeding. All BTT patients underwent successful transplantation and survived to hospital discharge while 1 child died after 1 months from OHtx due to lung infection.

CONCLUSIONS:

Jarvik 2000 LVAD can be successfully implanted in children as BTT or as DT. Thanks to versatility and reliability even in extreme condition, this device may be considered an alternative therapeutic option for pediatric end-stage heart failure.
OC43 MINIMALLY INVASIVE SURGICAL AORTIC VALVE REPLACEMENT VERSUS TRANSCATHETER AORTIC VALVE REPLACEMENT: A MULTI-CENTER MATCHED COMPARISON
Authors: Paparella D. , Santarpino G. , Malvindi P.G. , Moscarelli M. , Martinelli L. , Coppola R. , Comoglio C. , Albertini A. , Speziale G.
Published: November 2018

Backgrounds:

Several studies have compared transcatheter versus surgical aortic valve replacement. In the surgical arm the operations were predominantly performed with full sternotomy access. There is increasing evidence that a minimally invasive approach (mini-AVR) is a safe alternative to sternotomy and has demonstrated to reduce postoperative morbidity and inflammatory reaction. The aim of this study is to compare early outcome of patients undergone transcatheter aortic valve replacement (TAVR) or mini-AVR.

Methods:

Prospectively collected clinical and administrative data of 9 cardiac centers were reviewed. Between January 2011 and December 2016, 2407 patients underwent mini-AVR and 497 received TAVR. Additive EuroSCORE, age, gender and ejection fraction were utilized to account for disparities creating two matched groups for comparisons.

Results:

In the mini-AVR group 35.3% of the operations were performed through a right anterior mini-thoracotomy and 64.7% through a partial J sternotomy. In the TAVR group, procedures were predominantly performed through transfemoral access.

After matching, two groups of 325 patients each were analyzed with mean age of 80 ± 6 years and additive EuroSCORE of 8.6. No significant difference in mortality and stroke occurrence was observed. Patients in the mini-AVR group experienced more frequently blood transfusion, acute kideny injury and had longer hospital stay. Patients in TAVR group required more frequently permanent pace maker insertion.

Conclusion:

Our matched analysis identified patients with aortic valve pathology at intermediate/high risk. Mini-AVR and TAVR produced similar and satisfactory results. Minimally invasive aortic valve replacement should be utilized for future prospective comparisons between surgical and transcatheter aortic valve therapy.
OC87 VALUE OF SCREENING ASYMPTOMATIC CAROTID ARTERY STENOSIS PRIOR TO CORONARY ARTERY BYPASS GRAFTING: ANALYSIS OF THE E-CABG REGISTRY
Authors: Salsano A. , Santarpino G. , Santini F. , Nicolini F. , De Feo M. , Dalén M. , Fischlein T. , Perrotti A. , Reichart D. , Gatti G. , Onorati F. , Franzese I. , Faggian G. , Bancone C. , Chocron S. , Khodabandeh S. , Rubino A.S. , Maselli D. , Nardella S. , Gherli R. , Zanobini M. , Saccocci M. , Bounader K. , Rosato S. , Tauriainen T. , Mariscalco G. , Airaksinen J. , Ruggieri V.G. , Biancari F.
Published: November 2018

Background and aim:

The aim of this study was to evaluate the prognostic impact of asymptomatic carotid artery stenosis(CAS) in patients undergoing isolated coronary artery bypass grafting(CABG).

Methods:

Patients from the multicenter, prospective E-CABG registry without history of stroke or transient ischemic attack and screened by duplex ultrasound for CAS before isolated CABG were included in this analysis.

Results:

Among 2813 patients screened by duplex ultrasound for asymptomatic CAS, 11.1% had a CAS of 50–59%, 6.0% of 60–69%, 3.1% of 70–79%, 1.4% of 80–89%, 0.5% of 90–99%, and 1.1% had carotid occlusion. Postoperative stroke occurred in 25 patients (0.9%). Lesions were bilateral in five patients (25%) and ipsilateral to a CAS ≥50% in six patients (30%). In univariate analysis, the severity of CAS was associated with a significantly increased risk of stroke (p < 0.0001). In multivariate analysis, a CAS of 90–99%(OR 12.03, 95%CI 1.34–108.23) and the presence of an occluded internal carotid artery (OR 8.783, 95%CI 1.820–42.40) were independent predictors of stroke along with urgency of the procedure, severe-massive bleeding according to the E-CABG classification and the presence of a porcelain ascending aorta.

Conclusions:

Among patients with asymptomatic CAS, the risk of stroke is significant only in patients with a stenosis ≥90%. Since this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, preoperative screening of asymptomatic CAS before CABG may not be justified. Instead, avoiding manipulation of diseased ascending aorta and prevention of excessive bleeding may be more effective measures to prevent stroke after CABG.
OC23 ENDOSCOPIC VEIN HARVESTING A SINGLE CENTRE REVIEW: THE OXFORD EXPERIENCE
Authors: D’Alessio A. , Djordjevic J. , Krasopoulos G.
Published: November 2018

Background:

Endoscopic vein harvesting (EVH) has an increase central rule in CABG and recent studies has indicated the endoscopic technique as a safe and effective option. Nonetheless for many years there has been some controversy on the long term patency of the vein caused by endothelial damages, the technique has acknowledge advantages of low rate of wound infections, neuropathy and pain on the surgical site and a good cosmetic result and patient satisfactory. We reported a 2 years Oxford experience with EVH.

Methods:

We have retrospectively analysed from local database 518 patients that had endoscopic vein harvested at Oxford University Hospital from January 2017 to May 2018.

All the patient received a ultrasound of the legs to assess the quality and size of the veins prior to the operation. A small incision of 3 cm was made below knee and the vein was harvested with Maquet Vasoview Hemopro 2 then a comprisse bandage was placed

Results:

The group of patient that received EVH were mainly man, with associate comorbidities and was the 99% of the vein harvested in our center. The length and quality of conduits were assessed by the surgeon. There were no intraoperative complications and 1 conversion to open technique for equipment failure. There was 1 patient that developed sierus discharge. All patients expressed satisfaction and early mobilization.

Conclusion:

In our Experience the endoscopic vein harvesting is a very safe technique, with a low risk of complications, associate with a very good cosmetic results and patient satisfaction.
OC37 LESS INVASIVE LVAD PLACEMENT: A BEAUTIFUL FABLE OR AN ADVANTAGE? A SINGLE CENTER EXPERIENCE
Authors: sciacca S. , marco M. , turrisi M. , Stringi V. , Armaro A. , Mattiucci G. , Montalbano G. , Raffa G. , Pilato M.
Published: November 2018

Background:

Continuous flow left ventricular assist device (CF-LVAD) use has significantly increased in the last decade. The pumps currently available are smaller, more durable, and less traumatic on blood cells. The standard surgical implantation of CF-LVAD is via sternotomy,these have been implanted, with different, less invasive techniques (LITs). LITs have been reported to reduce incidence of cardiac tamponade or right ventricular failure at the time of implant and, but there is still a lack of evidence concerning its advantages.

Materials and Methods:

This data analysis compares the outcomes of two groups of patients who received an LVAD via two different surgical techniques: full sternotomy (FS) vs. LIT from 43 consecutive patients who received an LVAD from 2011 to 2016. Unpaired Mann-Whitney U-tests were used to compare continuous variables, and χ2 tests were used to compare categorical variables between the two groups.

Results:

The two groups’ characteristics were homogeneous We found no statistically significant differences in terms of survival and infective or neurologic complications. We found a statistically significant difference in early postoperative right ventricular failure (Fig.1), medication requirement (Fig.2), postoperative ICU length of stay, and hospital length of stay, with earlier postoperative recovery in the LIT group.

Conclusions:

Less invasive LVAD implantation has recently been proposed as an alternative surgical approach. This single center, retrospective study found a significant reduction in postoperative RVF, need for medications, and a faster postoperative recovery in the group of patients who received an LVAD with a LIT surgical approach.
OC70 SURGICAL TRANSCATHETER VALVE REPLACEMENT: BOLOGNA'S EXPERIENCE
Authors: Leone A. , Savini C. , Folesani G. , Pilato E. , Gliozzi G. , Pacini D. , Marozzini C. , Palmerini T. , Saia F. , Costantino A. , Votano D. , Di Bartolomeo R.
Published: November 2018

Background:

Transcatheter valve replacement (TVR) has become an effective solution for high risk patients, especially for those with valve prosthesis dysfunction.We report our ten year experience with early and late results.

Methods:

From November 2008 to May 2018,131 patients underwent surgical TVR in our center.All patients have been preoperatevely evaluated by the Heart team.Main comorbidities were: peripheral vascular disease in 51.1%, renal failure in 42% and pulmonary disease in 26%.There were 24.4% porcelain aorta and 27.5% of redo.Different prosthesis have been used: Medtronic Corevalve, Edwards Sapien, Jenavalve and Acurate symetis.There were 113 aortic, 15 mitral, 3 tricuspidalic valve disease treated respectively.Main surgical accesses were transapical in 93, transaortic in 31, left subclavian in 5 and full sternotomy in 2 patients.

Results:

Mean age was 81.1 ± 7.1, mean Euroscore was 9.9 ± 2.2 and STS score was 6.7 ± 5.4%.Overall early mortality was 6.1%.The global experience was divided into three periods as follow 2008–2012, 2013–2015 and 2016–2018 with a mortality rate of 10.4%, 7.3%, and 0% respectively.The only risk-factor for mortality was full sternotomy conversion (p = 0.001; OR = 60.5; CI[4.5;671.6]), necessary in 4 patients.The mean follow up time was 23.96 ± 26.28 months. Overall survival at 1 year, 3 years and 5 years was 84.2%, 61% and 41.6% respectively.Preoperative renal failure was risk factor for mortality at follow-up(p = 0.026;HR = 2.02;CI[1.09;3.75]).

Conclusions:

Surgical TVR confirmed to be an effective solution for high risk patients, with satisfactory results in terms of mortality and postoperative outcome. With the increase in experience, mortality rate progressively decreased.
OC86 USE OF “MICRODTTECT” DIRECTLY TO OPERATING BED: AN ENDOCARDITIC TEAM EXPERIENCE
Authors: Cagnoni G. , Rimoldi S.G. , Vanelli P. , Carnabuci A. , Scrofani R. , Mangini A. , Nicolò F. , Pagani C. , Gismondo M.R. , Antona C.
Published: November 2018

Background and Aim:

Negative blood cultures are of considerable concern in the management of infective endocarditis (IE) and therapy. The purpose of this study was to support the conventional routinary diagnosis based on culture-dependent methods (blood and cardiac valve culture methods) with the introduction of a device able to destroy microbial biofilms in order to improve diagnosis, therapeutic approach and patient outcome.

Methods:

One year and half prospective study of 40 patients (24 men, 16 women, mean age 66 years) underwent cardiac valve surgery. Samples were processed directly in the operating room using 0.1% dithiothreitol solution (MicroDTTect – 4i for infection, Monza - Italy). A comparison with sonication, traditional culture method and serological investigation were performed.

Results:

The use of MicroDTTect was successful in 5 out of 40 cases of IE. The detection of a the causative bacteria was possible as follow reported: methicillin-resistant S. aureus (2 cases), S. viridans, E. faecalis and P. mirabilis and S. aureus. Rickettsia conhori was serologically identified in one case only.

Conclusions:

MicroDTTect allowed the growth of biofilm producing bacteria as the true causative agents responsible for IE, thus facilitating appropriate antibiotic treatment. This study was developed in an effort to reduce the number of cases of IE with no causative agent, by implementing in routine the use of a completely closed system for detecting biofilm-related bacteria, thus reducing the risk of environmental contamination. Microbiological staff worked directly in the operating room to prepare samples and quickly have antibiogram.
OC79 THE ROLE OF PROCALCITONIN, C-REACTIVE PROTEIN AND WHITE BLOOD CELLS IN THE DIFFERENTIAL DIAGNOSIS BETWEEN SEPSIS AND SIRS IN CARDIAC SURGERY PATIENTS
Authors: Brugnetti D. , Reeve K. , Held U. , Löblein H. , Odavic D. , Häussler A. , Dzemali O. , Genoni M.
Published: November 2018

Background And Aim:

The aim of the study was to evaluate the role of procalcitonin (PCT), C-reactive protein (CRP) and white blood cells (WBC) in the differential diagnosis between sepsis and systemic inflammatory response syndrome (SIRS).

Methods:

We retrospectively analysed 2834 consecutive patients after cardiac surgery operated between January 2012 and December 2017. From the whole cohort we identified two groups based on the postoperative characteristics: patients with sepsis (44 patients) and patients with a diagnosis of SIRS (40 patients). From the two groups were excluded patients with endocarditis, patients treated preoperatively with corticosteroid, those who developed an infection in the ward and patients who died in the first 48 hours. Measurements of PCT, CRP and WBC were analysed for the first five postoperative days.

Results:

The mean values of PCT in patients with sepsis and SIRS were not statistically different at any time-point. CRP values were consistently higher in patients with sepsis from the third to the fifth postoperative day (p = 0.05, p = 0.00064 and p < 0.0001, respectively). In patients with sepsis, WBC mean values were lower in the first postoperative day (p = 0.0044), but higher in the fifth (p = 0.01).

Conclusions:

CRP is a reliable value in the challenging diagnosis between sepsis and SIRS after cardiac surgery, especially after the second postoperative day. On the contrary, preliminary results suggest that PCT and WBC are less useful to this differential diagnosis.
VD08 COMMISSURAL SYMMETRIC REPOSITIONING IN BICUSPID AORTIC VALVE SPARING SURGERY
Authors: Contino M. , Romagnoni C. , Rosa R. , Mangini A. , Antona C.
Published: November 2018

Particularity of the Video:

Bicuspid aortic valve, the most common congenital cardiac defect, is often associated to ascending aorta and root dilation. Since commissural orientation <160° is one of the principal risk factors for recurrent aortic insufficiency, our systematic approach consists of reimplantation with 180°-180° geometric configuration associated to aortic leaflets repair.

Brief Description:

The valve was bicuspid due to right-left coronary cusps fusion with a fibrotic raphe. Raphe and leaflets free margin shaving was performed within the native aortic root intact to improve cusp mobility and restore a normal motion. Reimplantation procedure was performed in the conventional fashion except for the peculiarity that the valve resuspension started with fixation of the two commissures in a 180°-180° symmetric configuration within the neo-root (Valsalva graft n.28) to the new predetermined sinotubular junction. Before completion of the surgery, the valve was re-assessed to correct any residual prolapse: both leaflets needed plicature.
EP28 PRIMARY MITRAL VALVE REGURGITATION: A RETROSPECTIVE ANALYSIS OF MITRAL VALVE SURGERY AND LONG TERM FOLLOW-UP
Authors: Saitto G. , Pisano C. , Nardi P. , Greci M. , Ferrante S. , Bertoldo F. , Pellegrino A. , Scafuri A. , Bassano C. , Ruvolo G.
Published: November 2018

Background and aim:

Surgery of mitral valve is one of the most evolving topic, especially for repair techniques and is often challenging for surgeons. We retrospectively evaluate the results of mitral valve repair (MVRep) or replacement (MVR) in primary MR.

Methods:

165 consecutive patients (mean age 65 ± 12.5 years) between January 2014 and December 2018 underwent MVRep (89 pts, 54%) or MVR (76 pts, 46%). Mean EuroSCORE II was 3 ± 2%. 89 pts were severely symptomatic for dyspnea (53.9%). In all cases of MVRep a prosthetic ring was implanted; adjunctive procedure were a triangular (11%) or quadrangular resection (11%) and edge to edge (24%). A mechanical prosthesis were implanted in 60 pts (36%). Mean follow-up (95% complete, 157 patients) was 50.2 ± 17.9 months.

Results:

Overall in hospital mortality was 4.8%; 1.1% (1pts) and 9.2% (7 pts) for MVRep and MVR respectively. Three of these 8 patients were octogenarian and at high risk surgery with an EuroSCORE II>7%. Follow-up mortality was 6.3% (10 pts), cardiac death was 3.8%. 6 years survival was 90.7 ± 3%. Three patients (MVRep) underwent MVR for MR recurrence with a 6 years freedom from reoperation of 97.9 ± 1.2%. Freedom from symptoms was 89.6 ± 3.2%. No significantly differences was found between MVRep and MVR in terms of survival (logRank test, p = 0.61), reoperation (logRank test, p = 0.138) and symptoms (logRank test, p = 0.264).

Conclusioni:

MVRep appears to have lower in-hospital mortality than MVR (p = 0.025). Long term results showed excellent survival and comparable outcomes in terms of reintervention and relief of symptoms between MVRep and MVR.
EP33 RISK FACTORS AND OUTCOME AFTER SURGICALLY TREATED TYPE A AORTIC DISSECTION
Authors: Ferrarese S. , Laporta A. , Corazzari C. , Matteucci M. , Cappabianca G. , Beghi C.
Published: November 2018

Aim:

Preoperative and intraoperative metabolic state, expressed by lactatemia, may influence outcome even in severe vascular damage and major surgery. The aim of the study is the identification of risk factors, included lactatemia, for postoperative complications, 30 days mortality and long term mortality in patients surgically treated for type A aortic dissection.

Methods:

A total of 75 consecutive patients operated on for type A aortic dissection from January 2013 to December 2017, were considered for three end-points: postoperative complications, 30 days mortality and long term mortality. Univariate analysis, logistic regression, Cox proportional hazard logistic regression and Kaplan-Meier analysis were conducted.

Results:

Operative mortality was 0%. Determinants of complicated postoperative stay were identified as preoperative neurological damage and oligo-anuria; 30-days mortality (8 patients, 10.7%) was related to preoperative and intraoperative hyperlactatemia (>4mmol/L, preoperative critical hemodynamic state and permanent postop neurological damage; long term mortality (16 patients, 21.3%, follow-up max 1857, median 785 days) resulted associated with age, renal failure and intraoperative hyperlactatemia (>8 mmol/L). A subanalysis identified renal failure to be related to intraoperative hyperlactatemia (>8mmol/L). No significant role has been found for CPB and cross-clamp time.

Conclusions:

Mortality rate was low. Age, renal failure, preoperative and intraoperative hyperlactatemia, preoperative critical status and preoperative and postoperative neurological damage resulted associated with poor outcome. The role of metabolic state, expressed by lactatemia, is directly and indirectly emerging as a crucial factor influencing the outcome. Although it is expression of a catastrophic vascular event, effort has to be made to minimize metabolic stress.
RF07 AORTIC VALVE REPLACEMENT WITH SUTURELESS PERCEVAL BIOPROSTHESIS IN RIGHT ANTERIOR MINITHORACOTOMY APPROACH: SINGLE CENTER EXPERIENCE WITH 461 IMPLANTS
Authors: Concistrè G. , Bianchi G. , Chiaramonti F. , Margaryan R. , Santarelli F. , Gasbarri T. , Kallushi E. , Cerillo A.G. , Murzi M. , Farneti P. , Solinas M.
Published: November 2018

Background and Aim:

Minimally invasive approach (MIA) reduces mortality and morbidity in patients referred for aortic valve replacement (AVR). Sutureless technology facilitates MIA. We describe our experience with sutureless Perceval (LivaNova, Italy) aortic bioprosthesis in right anterior minithoracotomy (RAMT) approach.

Methods:

Between March 2011 and December 2017, 841 patients underwent AVR with Perceval bioprosthesis. 461 patients were operated through RAMT approach. Considering only isolated AVR (530), Perceval in RAMT approach was performed in 87% of patients. Prosthesis sizes implanted were: S (n = 67), M (n = 147), L (n = 218) and XL (n = 29). Concomitant procedures were mitral valve surgery (n = 5), tricuspid valve repair (n = 1), mitral valve repair and tricuspid valve repair (n = 1), and miectomy (n = 2). Mean age was 77.2 ± 6.5, 61.12 % patients were female, and mean logistic EuroSCORE was 12.7 ± 9.9.

Results:

The 30-day mortality was 0.65% (3/461). Cardiopulmonary bypass and aortic cross-clamp times were 82.3 ± 30.8 and 52 ± 21.6 minutes for stand-alone procedures. In 3 patients appeared early moderate paravalvular leakage required reoperations. Permanent pacemaker implantation within the first 30 days was necessary in 5% of patients. At mean follow-up of 28.6 ± 12.4 months, survival was 97%, freedom from reoperation was 98%, and mean transvalvular pressure gradient was 11.7 ± 5 mmHg.

Conclusions:

AVR with Perceval bioprosthesis in RAMT approach is a safe and feasible procedure associated with low mortality and excellent hemodynamic performance. Sutureless technology facilitates RAMT approach.
RF82 TEN YEARS UNITED KINGDOM EXPERIENCE IN SURVIVAL FOR SURGICAL TAVI APPROACHES
Authors: D’Auria F. , Myat A. , Trivedi U. , Hildick-Smith D.
Published: November 2018

Background and Aim:

Compare morbidity and mortality (M&M) of different surgical TAVI access alternative to the surgical femoral.

Methods:

2,863 pts underwent surgical TAVI from Jan 2007 to Jan 2017 in the 33 UK TAVI Centers. Primary outcome is long-term survival up to Jul 2017. Secondary outcomes are procedural/in-hospital (in-H) complications, in-H, 30-day, and 1-year mortality. Statistical analysis by SPSS 20.0 and Stata 12.1.

Results:

2,863 pts, Surgical Femoral (SF) = 1,150 + Trans Apical (TA) = 1,216 + Direct Aortic (DA) = 207 + Subclavian (SC) = 290. In-H mortality lowest in SF. Among no-SF, only SC not significantly different from SF, whereas TA and DA associated with higher mortality. Unadjusted Kaplan-Meier survival chart shows long-term survival significantly greater in SC than DA and TA. No difference in survival between TA and DA, both of which with significantly lower long-term survival than SF. Unadjusted survival rate of surgical SC cohort not significantly different from SF. Hemofiltration and long length hospitalization most common in AD and TA compared to SC and SF. Permanent PMK greater in SC and SF than in TA and DA. A comparison of M&M in the two quarters 2007–2011 vs. 2012–2016 also carried out.

Conclusions:

This is the largest study of survival in surgical TAVI access routes from UK National dataset. SC is the only non-SF approach for which survival is not significantly different from SF. SC may represent the safest non-femoral access route for TAVI and it is the safest surgical route until now experienced.
VD04 AORTIC ROOT REPLACEMENT WITH “FRENCH CUFF” TECHNIQUE: A CHALLENGING REDO CASE
Authors: Cefarelli M. , Berretta P. , Pierri M. , Capestro F. , D’Alfonso A. , Di Eusanio M.
Published: November 2018

Arch repair interventions with zone 0 (or zone 1) distal anastomosis and arch vessels reimplantation with separate branches are increasingly performed. However, if on the one hand this technique both simplifies distal suturing and minimizes the risk of recurrent nerve injury, on the other, it complicates secondary root interventions due to the encumbrance of the arch vessel branches in the mediastinum that make chest re-opening, arterial cannulation and aortic clamping more hazardous and problematic.

With this video we would like to share the approach we adopted for a redo Bentall intervention in a 66 years old male patient presenting with a chronically dissected aneurysmal root and severe aortic regurgitation. One year earlier and in our institution, the patient had undergone an ascending aorta and total arch replacement with zone 1 distal anastomosis and separate reimplantation of arch vessels for type A acute aortic dissection.
EP06 ANTEGRADE TRANSAPICAL TEVAR IN ACUTE AORTIC RUPTURE
Authors: Agostinelli A. , Borrello B. , Carino D. , Gripshi F. , Molardi A. , Nicolini F.
Published: November 2018

Background and Aim:

TEVAR has become the first choice treatment of thoracic aortic rupture. However, in some cases standard retrograde delivery can be prevented by severe aorto-ilio-femoral vascular disease. For these high-risk patients, left ventricular apex can be a valid alternative to achieve vascular access for stent-graft antegrade delivery. Here we report our experience and mid-term results with trans-apical TEVAR (Ta-TEVAR) in case of thoracic aortic rupture

Methods:

Since 2012 we performed Ta-TEVAR in six patients with acute aortic syndrome. Indication for urgent/emergent TEVAR was post-traumatic aortic injury in 2 patients, contained rupture in 3 patients and penetrating aortic ulcer with signs of impeding rupture in the last patient. In five patients standard retrograde delivery was prevented by severe and calcific ilio-femoral occlusive disease and in one patient with traumatic aortic transection due to severe polytrauma, by acute ischemia of both lower limbs following Resuscitative Endovascular Balloon Occlusion of the Aorta. Antegrade TEVAR through left ventricular apex in left anterior minithoracotomy was performed in all cases.

Results:

Successful deployment of the stent graft was achieved in all patients. No case of hemodynamic instability or bleeding from the cardiac apex was noted during the procedures. No case endo-leak or aorta-related mortality was noted during the follow-up (range 9–68 months).

Conclusion:

In patient with thoracic aortic rupture and unfeasible standard retrograde TEVAR, the trans-apical approach can be used safely even in an emergency setting. Study with bigger cohorts and longer follow up are necessary to further evaluate this alternative approach.
EP08 CALCIUM LOADING AS RISK FACTOR FOR CONDUCTION DISTURBANCE AFTER TAVI
Authors: Pollari F. , Großmann I. , Cuomo M. , Vogt F. , Marianowicz J. , Jessl J. , Fischlein T. , Pfeiffer S.
Published: November 2018

Background and aims:

To assess the contribution of aortic valve calcification to the occurrence of transient or permanent atrioventricular (AV) block and the need for permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) in a large single-center cohort.

Methods:

We retrospectively analyzed preoperative contrast-enhanced multidetector computed tomography (MDCT) scans of patients who underwent TAVI in our center between 2012 and 2016. Calcium volume was calculated for each aortic cusp above (aortic valve), and below (left ventricular outflow tract, LVOT) the basal plane. Clinical and procedural data as well as preoperative ECGs were evaluated. Multivariate analysis was performed to evaluate risk factors for AV block and need for PPI.

Results:

A total of 470 patients were included in the study (Edwards SapienXT, n = 157; Edwards Sapien3, n = 185; Medtronic CoreValve, n = 27; Medtronic CoreValve EvolutR, n = 12; Medtronic Engager, n = 5; Symetis Acurate, n = 84). Overall incidence of post-procedural AV block was 12.5% (n = 59) and 8.9% (n = 42) of patients underwent PPI. On multiple linear regression analysis, preprocedural right bundle branch block (RBBB), QRS duration and LVOT calcification beneath the non-coronary cusp were found to be independently associated both with new-onset AV block and PPI. Considering only patients with postprocedural AV block, RBBB was the only predictor of postoperative PPI (odds ratio 8.82, 95% confidence interval 1.008–77.25; p = 0.049).

Conclusions:

LVOT non-coronary cusp calcification is independently associated with both AV block and PPI after TAVI. RBBB may play a role in discriminating transient from permanent AV block.
EP21 KNOWLEDGE TRANSFER IN AORTIC VALVE REPAIR: EXPERIENCE AND LITERATURE-GUIDED SURGICAL TECHNIQUES EVOLUTION
Authors: Contino M. , Romagnoni C. , Rosa R. , Mangini A. , Antona C.
Published: November 2018

Background and Aim:

Aortic Valve Repair procedures underwent surgical evolution during the last 20 years. New acquisition obtained from personal experimental research and comparison with other surgical teams experience are at the basis of this training.

Methods:

From 2003 to 2017 we performed 328 aortic valve repair procedures with optimal short and long term results. We analyzed our surgical techniques for 15 years to fully understand the importance of personal experience and knowledge transfer by literature analysis and meeting participation in our technical approach evolution. In particular, we tried to identify some specific milestones as important scientific communication that modify our surgical techniques choice.

Results:

We analyzed the techniques described in the 2 graphs by c2 and Fisher exact test, when appropriated and the relevance of personal and common experience. Significance level p ≤ 0.00001 confirmed the surgical evolution showed by graphs.

Conclusions:

Continuous literature analysis and meeting participation permitted a world wide standardization in order to ensure optimal results.
RF50 MINIMALLY INVASIVE VIDEO-ASSISTED MITRAL VALVE SURGERY: THE IMPACT OF AORTIC CLAMPING TECHNIQUE
Authors: Mozzillo R.A. , De Bellis A. , Greco E. , Baldascino F. , Spadafora A. , Fimiani L. , Cioffi M. , Affatato A. , Grimaldi M.G. , Caruso A.
Published: November 2018

Background and aim:

Aim of the study is evaluate the clinical outcome,in a single center experience,of endo-aortic or transthoracic clamp strategy,in minimally invasive video-assisted mitral valve surgery (MIMVS).

Materials and methods:

We retrospectively analyzed 55 patients underwent to MIMVS between 2014 and 2018. We used in 33 patients endo-aortic balloon occlusion technique(EAC) with Intraclude© and in 22 transthoracic clamp technique(TTC) with Cygnet©.

Results:

Surgical operations were in 23 patients mitral repair and in 32 mitral replacement.There were no differences between groups for CPB-time(137 ± 37 EAC vs 141 ± 39 TTC, p-value = 0,866) and clamping-time(87 ± 31 vs 90 ± 21,p-value = 0,329);incidence of peri-operative acute myocardial infarction was null,even if the post-operative CPK-MB are out of normal range.The 24h-blood loss was higher in EAC-group(817 ± 506 vs 550 ± 214,p-value = 0,001),but at the beginning of experience.Postoperative complication included 1stroke in EAC-group and 1TIA in TTC-group(p-value = 0,769);we didn’t assess differences the INVOS values during surgery in those patients.Overall operative mortality was 1,8%(0 in EAC and 1 in TTC),due to not cardiac cause.The post-operative Echo showed mitral regurgitation, classified as 1+ or less, in 6 patients(5 in EAC vs 1 in TTC).One patient underwent to reoperation due to mitral repair failure.Peripheral vascular complication or aortic dissection were not observed in this series.No differences were found between both groups in rate of blood transfusions,atrial fibrillation,AKI,PNX,in-hospital stay,ICU-stay.

Conclusion:

MIMVS with endo-aortic balloon and trans-thoracic clamp technique are safe and effective.We did not observe an increased risk of stroke or vascular complication in endo-balloon group; our goal is use MIMVS as standard of care in all mitral valve surgery.
RF89 TWENTY-YEAR OF MINIMALLY INVASIVE SURGERY FOR ATRIAL SEPTAL DEFECTS: TECHNICAL EVOLUTION AND RESULTS
Authors: Vida V. , Zanotto L. , Zanotto L. , Tessari C. , Pittarello D. , Padalino M. , Stellin G.
Published: November 2018

Background:

We evaluate the results of our 20-year experience with minimally invasive surgical approaches (MISA) for closing ostium secundum atrial septal defects (ASD II), focusing on technical evolution and efficacy.

Methods:

We included 538 patients who underwent surgical ASD II closure by using MISA.

Results:

MISA included: right-anterior mini-thoracotomy (RAMT)(n = 335, 62%), mid-line mini-sternotomy (MS) (135, 25%) and right-lateral mini-thoracotomy (RLMT) (n = 68, 13%). Central cannulation was employed in 374 patients (69%), while a remote cardiopulmonary bypass with peripheral cannulation in the remaining 164 patients (30%). Five patients (0.9%) had major postoperative complications requiring further surgical intervention. All patients were discharged in good clinical conditions, without any significant residual intra-cardiac defect. A decrease of the length of hospitalization (p < 0.001) and hospital costs (p = 0.009) was demonstrated by year of surgery. At a median follow-up of 12.1 years (IQR 0.6–14 years), all patients are in good clinical conditions with no limitation to physical activity. The overall satisfaction rate for the cosmetic result of MISA was 97% (524/538 patients)(99% in the last 5 years, 99/100 patients).

Conclusions:

MISA for closing ASD II proved safe and effective. A continuous evolution of MISA in our Institution was characterized by a progressive miniaturization of surgical accesses, reduced hospitalization and eventually reduced hospital costs.
RF63 PROSPECTIVE EVALUATION OF VENTRICULAR LOADING TREND IN PEDIATRIC PATIENTS WITH PULSATILE FLOW LVAD
Authors: Di Molfetta A. , Iacobelli R. , Filippelli S. , Perri G. , Massetti M. , Amodeo A.
Published: November 2018

Aim:

The aim of this study was to describe the echocardiographic trend of left ventricular (LV) and right ventricular (RV) function after implantation of a pulsatile flow left ventricular assist device (LVAD) in children.

Methods:

From 2013 to 2016, we prospectively evaluated 13 consecutive pediatric Berlin Heart EXCOR LVAD patients. Clinical and echocardiographic data were collected at baseline, within 24 h after implantation and monthly until LVAD explant.

Results:

Median age and weight at the implantation was 8 (4–23) months and 5 (4.6–8.3) kg at the time of implantation, respectively. All were affected by dilated cardiomyopathy. Average LVAD support time was 226.2 ± 121.2 days. Nine (70%) were transplanted, 4 (30%) died. LV end-systolic and end-diastolic volumes were reduced until the follow up of two months (P = 0.019 and P = 0.001). A progressive increase in RV dimensions was observed. After 4 months of follow up, RV fractional area change worsening was statistically related with the deterioration of LV unloading (P = 0.0036). Four patients needed prolonged inotropic support for RV failure.

Conclusion:

Pulsatile LVAD in pediatrics is followed by an early and mid-term LV unloading, as expressed by a decrease in LV volumes and diameters at echocardiogram. The effects of unloading do not remain stable at long term follow up. RV function improved in the acute phase, but a progressive dilatation of RV was noted over time. In some patients, RV failure might lead to the need of an increase of inotropic support at long term follow up.
RF13 CONGENITAL CORONARY ARTERY ANOMALIES: 10-YEARS EXPERIENCE IN A SINGLE CENTER
Authors: Viganò G. , Colaneri M. , Capestro A. , Marzullo R. , Iezzi F. , Pozzi M.
Published: November 2018

Background and Aim:

Congenital coronary artery anomalies (CCAA) represent a relatively rare heterogeneous group of congenital disorder. They are increasingly recognized due to the improvement of non-invasive imaging techniques. Continuous and profound changes are taking place regarding prevalence, definition, classification, risk of SCD, diagnostic and treatment of those anomalies.

Methods:

We retrospective reviewed our experience (from 2008 to 2017) in 21 patients with CCAA, which were classified as coronary artery arising from the contralateral sinus of Valsalva with intramural or interarterial course (9), coronary artery arising from the pulmonary artery (6), single ostium (1), coronary arteriovenous fistula (2), and myocardial bridges (3). 76% of patients were younger than 30 years of age with a M:F ratio of 1.6:1. The anatomic features, diagnostic and operative techniques for each defect were evaluated.

Results:

Anomalous origins from the wrong sinus (AOWS) was the most common anomaly (42,8%). No operative procedures were associated with early or late mortality in all the categories. During follow-up most patients were asymptomatic with good results at follow-up imaging.

Conclusions:

Spectrum of CCAA subtypes has changed, among our patients AOWS was the most common anomaly. Based on our experience, early diagnosis and surgical intervention can yield satisfactory results in patients with CCAA, with most experiencing relief of symptoms.
RF14 CONSEQUENCES OF PRESSURE OVERLOAD AS DETECTED BY LEFT ATRIAL AND VENTRICULAR STRAIN IN PATIENTS WITH SEVERE AORTIC STENOSIS
Authors: Lucarelli C. , Biagio L. San , Francica A. , Benfari G. , Noni M. , Abbasciano R.G. , Rossi A. , Zamboni M. , Onorati F. , Ribichini F. , Faggian G.
Published: November 2018

Background:

Severe aortic stenosis (AS) exposes the left ventricle (LV) to an increased afterload, leading to concentric remodelling and subsequent diastolic dysfunction (DD). Fibrosis is the histological key feature. However, none of the conventional echocardiographic parameters is able to reveal the extent of LV remodelling.

Aim:

to evaluate the ability of speckle tracking echocardiography in detecting LV remodelling in AS patients.

Methods:

patients undergoing aortic valve replacement (AVR) for severe symptomatic AS were prospectively enrolled. Standard transthoracic echocardiography was performed before surgery. Global LV longitudinal and circumferential strain (GLS, GCS), peak atrial longitudinal and contraction strain (PALS, PACS) were measured. LV septal biopsies to assess fibrosis were performed during surgery.

Results:

Forty-three consecutive patients were enrolled, with a mean age 73 ± 6years, 58% female. Ejection fraction (EF) 61 ± 7%, aortic valve area (AVA) 0.72 ± 18 cm2, mean gradient (MG) 51 ± 14 mmHg. LV fibrosis was 22 ± 11%. Global longitudinal strain (GLS) 15 ± 4%, peak atrial longitudinal strain (PALS) 24 ± 6%, peak atrial contraction strain (PACS) 12 ± 4%. The only parameters associated with LV fibrosis were MG (r = 0.45, p = 0.004), GLS (r = 0.37, p = 0.02), PALS (r = 0.43, p = 0.004) and PACS (r = 0.35, p = 0.02). After adjusting for GLS and MG, PALS (p = 0.01) and PACS (p = 0.02) were independent predictors of LV fibrosis. The combination of PALS and GLS was the strongest predictor of LV fibrosis.

Conclusions:

speckle tracking echocardiography provides additional information to characterise the LV remodelling over conventional parameters. Our findings suggest that consequences of pressure overload in AS impact both on ventricular and atrial function, possibly acting through different pathophysiological mechanisms.
RF22 EXTRA-ANATOMIC BYPASS IN AN INFANT WITH SEVERE AORTIC ARCH AND THORACIC DESCENDING AORTA THROMBOSIS
Authors: Hoxha S. , Poretti G. , sandrini C. , barozzi L. , murari A. , prioli A. , pilati M. , rossetti L. , faggian G. , Luciani G.B.
Published: November 2018

Background:

Aortic arch thrombosis in neonates and infants is a rare and potentially life threatening condition. The initial management usually entails anticoagulation or thrombolysis, but in some cases surgery is needed.

Objective:

The aim of this report is to describe a rare case of an infant with aortic arch and thoracic descending aortic thrombosis.

Clinical Presentation:

A 2 month-old and 4.1 kg infant was admitted to our department with clinical signs of heart failure and feeble femoral pulse. Echo examination showed severe ventricular dysfunction and signs of aortic arch thrombosis. Due to hemodynamic instability, the patient was intubated and inotropes were started. A CT-Scan was performed, which confirmed the diagnosis.

Management:

Medical therapy failed to resolve the problem. Therefore, rescue surgical operation was indicated. The infant underwent extra-anatomic bypass via a postero-lateral thoracotomy with a 4 mm Goretex graft placed between the left caroted artery and the descending aorta. The post-operative course was uneventful and the infant was discharged after 2 months with appropriate anticoagulation therapy. At 14 months after surgery, the patient had severe hypertension (165 mmHg). A CT-Scan was performed and showed patency of the by-pass. Cardiac Cath study demonstated a DP of 50 mmHg. Echo showed a good cardiac function with persistent hypertrophy. The patent was scheduled for surgery and underwent total aortic arch replacement with aortic arch homograft.

Conclusions:

The present anecdotal experience suggests that various types of extra-anatomic bypass may be used as rescue and potentially definitive therapy to manage aortic arch thrombosis in infancy.
RF45 LOW BIRTH WEIGHT NEONATES AND CHD: IS CARDIAC SURGERY ASSOCIATED WITH WORSE OUTCOME?
Authors: Cadonati C. , Seddio F. , Ferrero P. , Uricchio N. , Marcora S. , Sadou Y. , Marrone C. , Bonanomi E. , Mangili G. , Galletti L.
Published: November 2018

Background and Aim:

Congenital heart diseases often occur in low birth weight and preterm neonates. The aim of our study was to investigate the relationship between different strata of low weight at surgery and outcomes, and between gestational age and outcomes of cardiac surgery in low weight neonates treated at our institution.

Methods:

We retrospectively reviewed hospital records of neonates treated from January 2007 to November 2017. Inclusion criteria were body weight ≤ 2500 g at time of surgery for congenital heart disease, excluding isolated ductus arteriosus closure and pacemaker implantation. The outcomes investigated were 30-days and late mortality, major complications and need for reintervention. 84 patients met our criteria.

Results:

There were 10 early deaths; overall survival was 73% (23 pts died). 35 patients (42%) had major complications. 19 (23%) patients needed a reintervention. Weight at surgery, gestational age, type of operation and single or biventricular physiology did not influence neither mortality (early or late) nor morbidity (reintervention or complication). Mortality was significantly higher when extra-corporeal circulation was used (P < 0,01); this can be related with more severe diagnosis and type of surgery.

Conclusions:

Despite the common thought that low weight and prematurity are associated with increased mortality, according to our results surgery for congenital heart diseases can be performed on low weight and preterm neonates with acceptable outcomes.
RF61 PREDICTING THE PRESSURE OF THE TOTAL CAVO-PULMONARY CONNECTION: CLINICAL TESTING OF A MATHEMATICAL EQUATION
Authors: Di Molfetta A. , Rotella S. , Gagliardi M.G. , Carotti A. , Massetti M. , Amodeo A. , Guccione P.
Published: November 2018

Introduction:

Among the factors which determine Fontan outcome, the total cavo-pulmonary pressure plays a fundamental role. Some authors advocate the use of a dedicated formula to predict the Fontan pressure. The aim of this work is to test the predictive and the clinical value of the mentioned formula through a retrospective clinical study.

Methods:

Data of all patients undergoing pre-Fontan catheterization and Fontan completion at our institution were collected. Pre-Fontan catheterization data were used to calculate the predicted Fontan pressure. Predicted values were compared to the pressure measured in the acute phase after the Fontan completion and correlated to patients’ clinical outcomes.

Results:

124 Fontan patients were retrospectively enrolled with a median age at the Fontan of 35.00 [31.00- 41.25] months, median weight of 13.00 [11.68-14.10] Kg. Fontan conduct was fenestrated in 78 patients. Fontan failure (composite of death, need for transplant, takedown) was observed in 11. A statistically significant correlation between measured and predicted data for the overall population (p = 0.0114) but with a poor correlation coefficient (r2 = 0.014). In the case of Fontan predicted pressure lower than 17.59 mmHg, the formula was able to identify a good clinical outcome in the acute phase with a sensitivity of 92% and specificity of 31%.

Conclusion:

The proposed formula showed a poor capability in estimating the actual pressure into the Fontan system and in identifying patients needing fenestration. However, a cut-off value lower than 17.59 mmHg showed a fair sensitivity to identify patients with a good acute clinical outcome.
RF24 HETEROTAXY SYNDROME WITH SIGNLE VENTRICLE PHYSIOLOGY: SINGLE CENTER EXPERIENCE
Authors: Careddu L. , Angeli E. , Petridis F.D. , Romano G. , Tonelli F. , Assenza G. Egidy , Donti A. , Gargiulo G.D.
Published: November 2018

Objective:

Treatment of infants with functional single-ventricle and heterotaxy syndrome is challenging due to multistage palliation with high operative mortality and morbidity. We report our experience.

Methods:

Between 1996 and 2017, 20 patients with heterotaxy syndrome underwent their first palliative surgery and form the study population. All relevant preoperative, operative and follow-up data were analyzed retrospectively.

Results:

Fourteen (70%) patients required neonatal palliation including a modified Blalock-Taussig shunt (n = 11; 55%), Norwood procedure (n = 1; 5%) or pulmonary artery banding (n = 2; 10%); two patients underwent TAPVC repair during first-stage palliative operation. In the remaining 6 patients (30%), primary bidirectional cavopulmonary anastomosis (BCPA) was the initial palliative surgery. 13 patients underwent BCPA operation as second-stage palliation, whereas one died in the interstage period. Nowadays, 12 of these patients have already undergone total cavopulmonary connection (TCPC) as a third-stage operation after BCPA. In case of Kawashima operation, median time interval before TCPC was 7 years (min 4 years; max 8 years).

Mean follow-up time was 9,6 ± 7,9 years. One patient died during long-term follow-up after TCPC. Overall survival for the entire cohort following first surgery were 94,4% at 1 and 5 years and 82,6% at 10 years.

Conclusions:

Despite recent advances, the management of infants with heterotaxy syndrome with single-ventricle physiology is still a challenge for pediatric cardiac surgeons with high described morbidity and mortality. Conversely, in our experience overall mortality is inferior compared to other single-center reports and these patients may expect satisfying mid-to-long term survival. Further studies are needed to assess long-term morbidity.