bluuebunny/crossref_metadata_2025 huggingface dataset:
RF67 REDO MITRAL SURGERY AND HOSPITAL OUTCOME: A MULTICENTRE EXPERIENCE REGARDING SURGICAL FACTORS AND COMPLICATIONS
Authors: Franzese I. , Biagio L. San , Perrotti A. , Mariscalco G. , Francica A. , Lucarelli C. , De Feo M. , Santarpino G. , Salsano A. , Rubino A. , Gatti G. , Beghi C. , Mignosa C. , Pappalardo A. , Onorati F. , Santini F. , Faggian G.
Published: November 2018

Background and Aim:

Redo mitral surgery is an high risk procedure. Several preoperative conditions identify patients at unusual surgical risk. Few studies clarify technical issues and perioperative complications affecting early survival. The aim of this multicentre study is to determine predictors of adverse outcome among intraoperative factors and postoperative events.

Methods:

Operative mortality and major morbidity events from 832 redo mitral procedures, from January 2005 to December 2014 at eight European centres, were analysed. Statistical analysis was performed by the SPSS 13.0 program for Windows (SPSS, Inc., Chicago, IL, USA). Normally distributed continuous variables were compared using the unpaired t-test, not-normally distributed variables using the Mann–Whitney U-test and categorical variables using the χ2test. Only variables with a P < 0.10 at univariable analysis were included into the regression models.

Results:

Injury of a previous patent left internal mammary artery graft (LIMA) [odds ratio (OR) 4.2, 95% confidence interval (CI): 1.6–11.5; P = 0.005], major cardiovascular iatrogenic lesions at re-entry (OR 19.2, 95% CI: 9.2–39.9; P < 0.001), extracellular crystalloid cardioplegia (OR 7.3, 95% CI: 1.4–37.8; P = 0.018) and incremental cardiopulmonary bypass time (OR 1.1, 95% CI: 1.0–1.2; P = 0.001) independently predicted operative mortality.

Conclusion:

Operative mortality in redo mitral surgery is still significant. Injury of a previous LIMA graft identifies patients at higher. Prolonged cross-clamp times, extracellular crystalloid cardioplegia, massive transfusions, perioperative myocardial infarction, prolonged intubation also predict adverse early outcome. Combined antegrade + retrograde cardioplegia seems to be the only protective factor these high-risk patients.
RF51 MITRAL VALVE REPLACEMENT AFTER FAILED MITRACLIP
Authors: Del Forno B. , Lapenna E. , Giambuzzi I. , Trumello C. , Bargagna M. , Iaci G. , Ferrara D. , Castiglioni A. , De Bonis M. , Alfieri O.
Published: November 2018

Aim:

The aim of this study was to evaluate the immediate and follow-up results of mitral valve replacement on patients previously treated with unsuccessful MitraClip procedures.

Methods:

Between February 2012 and April 2018, fifteen consecutive patients (75 ± 8.2 years) underwent mitral valve replacement in our institution after failed percutaneous edge-to-edge mitral valve repair. The reasons of failure were acute leaflet rupture in three cases (20%), massive leaflets fibrosis causing severe stenosis in five patients (33%) and clips dislocation causing severe regurgitation in seven patients (47%). The calculated operative risk, using the EuroSCORE II, was 16 ± 11.8%. Nine patients (60%) were in NYHA Class III or IV and four patients (26%) were in a critical pre-operative state.

Results:

At 30 days, one patient died (6.7%). Nine patients (60%) required IABP for weaning from CPB. The length of hospital stay was a median of 10 days. The survived patients experienced a consistent reduction in pulmonary hypertension (pre-op 59 ± 14.3 vs post-op 46 ± 13.1 p < 0.0001). At 3-years follow-up, the overall survival was 56.3 ± 16.51. Seventy-five percent of patients were in NYHA class I/II.

Conclusion:

In our experience, high risk patients requiring mitral valve surgery after unsuccessful Mitraclip procedure may be operated with acceptable 30-days mortality and morbidity. In this light, this option should be always discussed after a failed Mitraclip, even in critical situation.
RF55 OFF PUMP MITRAL VALVE REPAIR WITH NEOCHORD SYSTEM: FROM PIONEERING TO CLINICAL PRACTICE
Authors: Albertini A. , Amoncelli E. , Zucchetta F. , Tripodi A. , Pagliaro M. , Calvi S. , Mikus E.
Published: November 2018

Background and aim:

Transapical off-pump mitral valve intervention with neochordae implantation is a novel, minimally invasive procedure for treatment of degenerative mitral valve regurgitation. The aim of this study is to describe our initial experience with this new technique and to describe the tip and tricks to improve the results.

Methods:

Patients were selected for NeoChord repair when Leaflet-to-Annulus Index (LAI) (defined as the ratio between the sum of anterior leaflet length (AML) and posterior leaflet length (PML) over antero-posterior length) was > 2 and mitral annulus inferior to 40 mm. Measurements were performed with 2D and 3D transesophageal echocardiography.

Results:

Between 2015 and 2018, at Salus Hospital and Maria Cecilia Hospital, a total of 35 patients were treated, (median age of 68 years and median EuroSCORE of 5.33). The majority of them (95%) presented a posterior leaflet prolapse, 2.5% with an anterior leaflet prolapse and 2.5% with a combined. Early procedural success was achieved in all patients.Two neochordae were implanted in 8 patients (22.85%), 3 in 17 (48.55%), 4 in 4 (11.45%), 5 in 4 (11.45%), 6 in 2 (5.7 %). During surgery a mean of 3.2 Couple of chordae were used. All intraoperative data and postoperative outcomes, in terms of intensive care unit stay, blood loss, transfusions have been analysed as well the echocardiography at discharge was analyzed.

Conclusions:

NeoChord repair is a safe procedure, and the early results are impressive. Our data are encouraging but for sure long term follow up and a correct patients selection are essential.
RF39 LEFT VENTRICULAR DYSFUNCTION AFTER MINIMALLY INVASIVE MITRAL VALVE SURGERY IN ASYMPTOMATIC PATIENTS: RISK FACTORS ANALYSIS
Authors: Bianchi G. , Margaryan R. , Solinas M.
Published: November 2018

Background:

Asymptomatic patients with severe MR and normal LV function are at risk of developingpost-operative left ventricular dysfunction.

Aim:

This study wants to elucidate risk factors for immediate and persistent newly developed dysfunction after surgery and its time course and potential triggers for an early and safe surgical intervention.

Methods:

From 2004 to 2016, 346 asymptomatic patiens aged 56 ± 12 years underwent mitral valve surgery through right lateral mini-thoracotomy (RLMT);

Results:

Preoperative LV ejection fraction (LVEF) was 63.9 ± 4.6 [60–83]. Clinical follow-up was 54 ± 34.4 [9.2 - 132.8] months. Decreased LV function was observed in 39 (11.3%) patients; LVESD was associated with post-operative LV dysfunction at uni- and multi-variate analysis. A threshold of 35 mm for LVESD was determined using ROC curve (AUC 0.74; sensitivity 71.8%, specificity 71%). At follow-up 10 patients did not recover a normal LV function. Survival at 60 and 120 months was 99.4% and 91.4%, respectively. An LVESD > = 35 mm was not associated with increased mortality nor reintervention on mitral valve. In patients that remained with a depressed LV function at follow-up (n = 10), LVESD was not a risk factor (p = 0.15) for mortality.

Conclusions:

LVESD could be useful to identify patients at risk of post-operative dysfunction; the proposed cut-off is lower than other proposed in literature and may indicate the need for earlier intervention; further analysis is required to elucidate the preoperative risk factors for late persistent LV dysfunction.
RF79 SURGERY OF GROWN UP CONGENITAL HEART DISEASE: EARLY OUTCOMES OF A COMPLEX PROBLEM
Authors: Angeli E. , Careddu L. , Petridis F.D. , Tonelli F. , Romano G. , Balducci A. , Assenza G. Egidy , Donti A. , Gargiulo G.D.
Published: November 2018

Background and Aim:

To evaluate early surgical results of grown-up congenital heart disease(GUCH) in a single center experience.

Methods:

A retrospective analysis of GUCH patients operated on from 2002 to 2016. Variables included: primary diagnosis, surgical procedures, intraoperative data, early postoperative results. Analysis of variables and mortality was performed with Square-Chi test and t-test when indicated.

Results:

409 operations were performed among 397 patients. Mean age at surgery was 38,2 ± 14,8 years. Main disease at operation was: septal defects in 30%, right ventricular outflow tract disease 29%, single ventricle 4%, valvular disease 28%, coronary arteries disease 5%, others4%. Seven patients were on heart transplant waiting list. Surgical procedures are described in table 1. In-hospital mortality was 1.7%. Age at operation and preoperative creatinine clearance, emergency procedure, prolonged by-pass time resulted as risk factors for intraoperative mortality(p = 0.007,0.009,0.003,0.002 respectively).

Conclusions:

A large number of GUCH patients lead a healthy life without any treatment, but some of them require cardiac surgery for primary repair, correction of residual or acquired pathologies, reoperation for sequelae following previous surgery or acquired heart disease. The complexity of this kind of population, due to the risk factors associated with it, therefore requires the need for adequate preoperative management, appropriate surgical planning and consequently a rigorous follow-up.
RF36 ISOLATED COARCTATION OF THE AORTA: 10 YEARS EXPERIENCE
Authors: Ghiselli S. , Carro C. , Cocchi M. , Muhoozi R.M. , Mauri L.D. , Marianeschi S.M.
Published: November 2018

Introduction:

Aortic coarctation (AoC) occurs in 5–7% of all congenital heart diseases. This retrospective study aims to describe mid and long-term outcomes of patients undergoing simple congenital AoC repair.

Methods:

We retrospectively reviewed 63 patients who underwent repair of AoC between 2008 and 2018. 40(63%) were neonates, 11 infants, 6 children, 6 adults. 29(46%) were males. 20 patients underwent end-to-end anastomosis and 33 extended end-to-end anastomosis, 8 prosthetic patch aortoplasty or prosthetic interposition grafting, 2 extra-anatomic bypass. 8 (12.7%) had bicuspid aortic valve. Patients were stratified by age and results were compared.

Results:

60% of interventions were performed in emergency. Mean operation time was 129.7 minutes, mean cross-clamp time was 24.3 ± 11.4. Almost all AoC repairs were in neonates and infants with resections/extended-resections and end-to-end anastomosis while in adults we preferred prosthetic patch plasty. Major post-operative complications occurred in 7.9% and minor in 12.7% of cases. Overall mortality was 3.2%. No statistically significant differences were observed in mortality or post-operative complications incidence among patients’ groups. Mean in hospital stay was 16.6 ± 16.1days, mean ICU length of stay was 4.3 ± 6.4days. Over a mean follow-up of 4.1years, 3.2% of patients reported complications: late hypertension and aortic aneurysms. A significant gradient (>20mmHg) has been founded during follow-up in 4/63(6.3%) pediatric patients but none among adults and none of them required reoperations. No late mortality was registered.

Conclusions:

Long-term results of our experience confirm that surgical repair of AoC can be performed safely. End-to-end anastomosis in neonates and infants achieves excellent results if performed before occurrence of hypertension or its complications.
RF58 PATENT DUCTUS ARTERIOSUS IN EARLY PRETERMS: SICILIAN AND CALABRIAN ON SITE EXPERIENCE
Authors: Manuri L. , Calvaruso D. , Guerra C. , Ferro G. , Campanella I. , Nicita G. , Grasso N. , Zanai R. , Trombetta B.M. , Sturiale M. , Fonte A. , Iorio F. , Reali S. , Agati S.
Published: November 2018

Introduction:

The selection of extremely preterm infants with persistent patent ductus arteriosus (PDA) for surgical ligation after the failure of pharmacologic closure remains controversial in neonatology. No randomized clinical trial has examined the efficacy of surgery compared with conservative management among infants with persistent hemodynamically significant PDA after nonsteroidal anti-inflammatory drug treatment. Although surgical closure definitely closes a persistent PDA, promotes early extubation and decreases the mortality rate, it is also associated with short-term adverse events, including post-PDA ligation cardiac syndrome, vocal cord paralysis, chylothorax, and pneumothorax. We report our interregional experience based on a 24 h dedicated “onsite team” that performs surgical procedures in regional NICU.

Methods:

As a part of the agreement between the “Bambino Gesù” Pediatric Hospital in Rome and the Sicily Health Region Government the Centro Cardiologico Pediatrico del Mediterraneo, became the only center of reference for the diagnosis and treatment of congenital heart disease in Sicily. Due to the extent of the territory and the extreme fragility of the preterm infant, surgical ligation of the PDA was conducted by a dedicated team, consisting of a cardiac surgeon, anesthetist and two operating room nurses, directly at the bedside in NICU. From May 2011 to May 2018, 78 on-site procedures were performed. Median gestational age was 26 weeks (range 24–32), median weight at birth 800 grams (range 570–1380), median weight at surgery 1000 grams (range 540–1600) with 62.3% of patients weighing less than 900 grams. All infants were treated with ligation when indomethacin or pacetamol failed or was contraindicated. In our population 56% attempted closure with Pedea, 12% with paracetamol. In the remaining cases, the pharmacological treatment was contraindicated due to the presence of comorbidity (for example III-IV grade cerebral hemorrhage, renal or hepatic insufficiency).

Results:

75% of treated patients have been discharged from the hospital and is still in follow up. No short-term adverse events were registered.

Conclusion:

in our experience we confirm that such an approach represent a valid and safe option for the baby and the whole medical team involved in medical and surgical procedure.
RF25 HYBRID PALLIATION ALLOWS THE HYPOPLASTIC LEFT VENTRICLE FOR A CHANCE OF BIVENTRICULAR REPAIR: ECHO-SURVEILLANCE ON LEFT HEART GROWTH
Authors: Oreto L. , Manuri L. , Calvaruso D. , Guerra C. , Ferro G. , Campanella I. , Nicita G. , Grasso N. , Zanai R. , Trombetta B.M. , Sturiale M. , Fonte A. , Iorio F. , Reali S. , Agati S.
Published: November 2018

Background:

Several parameters of LV adequacy are available, however, it is now clear that the timing of decision plays a crucial role in the fate of the borderline LV, because the longer the ventricle is allowed to grow, the higher the probability to achieve functional independence.

Aim of the study:

Our aim is to describe the growth potential of borderline left ventricles after pulmonary arteries banding (PAB) and arterial duct stenting (ADS).

Methods:

44 patients (mean weight 3 Kg, from 1,9 to 4,2 Kg), who were born with different hypoplastic LV variants underwent hybrid palliation at 3,6 days (1 to 7) in our institution between October 2011 and January 2018. We divided 36 patients into 3 groups according to the severity of LV hypoplasia: 14 pts with MA or MS and AoA, who are not supposed to show any growth of LH structures over time, 6 pts with IAoA and VSD whose LV is usually suitable for biventricular repair, and 16 pts with intermediate features. The latter group included pts with MS/AS, right unbalanced AVSD or Shone complex, all of them with severely underdeveloped LV, expressed by LV mass below -2 Z scores. Among this 16 pts we further distinguished three subgroups, according to the subsequent surgical treatment they underwent after the interstage period and potential LV growth: group 1 had single ventricle staged palliation (5 patients), group 2 biventricular repair (8 patients) and group 3 early death occurrence (3 patients). Two-dimensional echocardiograms of patients from group 1 and 2 were retrospectively reviewed, comparing examination recorded at birth with those obtained 4 months after hybrid palliation.

Results:

Aortic annulus, aortic root, mitral and tricuspid annulus, LV systolic and diastolic dimension, systo-diastolic volumes and mass, LV long-axis to heart long-axis ratio (LAR), transverse and distal arch and aortic isthmus diameters were used. LV mass and volumes are critically small in both groups at birth. Although a trend towards growth can be seen for almost all the analyzed parameters, a significant change of LV mass and volumes from pre- to post-hybrid procedure is evident in group 2, which is absent in group 1. Conversely, parameters like aortic annulus, aortic root and LAR in group 1, already at birth, were significantly smaller than they were in group 2.

Conclusion:

The goal in the treatment of borderline LV is to postpone the decision until the time LV has fully expressed its growth potential: then, many more biventricular repairs will be reached than at the time of first evaluation.
RF47 MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT (MIAVR) THROUGH A RIGHT ANTERIOR MINI THORACOTOMY IN A TOTALLY FREE OPERATIVE FIELD.
Authors: Cassese M. , Braccio M. , Spatuzza P.
Published: November 2018

Background:

MIAVR through a right anterior minithoracotomy has excellent results. This approach has technical challenges related to a smaller working space. The operation requires learning curve, longer operative time and is routinely performed only by skilled surgeons. We describe our technique for MIAVR through a right anterior mini thoracotomy, making the procedure simple and reproducible.

Methods:

From February 2016 we have performed MIAVR in 29 patients with aortic stenosis. A preoperative CT scan was performed for detailed operative planning. EndoVent pulmonary catheter was pre-positioned; in case of significant aortic regurgitation ProPlege peripheral retrograde cardioplegia device was used. A 6 centimeters incision was made over the 2 nd right intercostal space. The right mammarian vessels were divided and the 3 rd rib cartilage was transected. Working view was enhanced pulling the tip of the right appendage with a snare. Right femoral vessels were cannulated. CPB was started. A Chitwood clamp was inserted through a chest tube incision. After such a preparation, a complete free operative filed makes possible aortic valve replacement, using suturless prosthesis or standard valves, with CoreKnot ligation system

Results:

Mortality rate was 0%; aortic cross clamp time was 59 min (+/- 5 min). In 4 patients femoral cannulation was not possible and we performed a central percutaneous aortic cannulation. In 1 patient, at the end of the operation we had to convert to sternotomy due to bleeding from the epicardial wire insertion.

Conclusions:

A totally free operative field make MIAVR more “surgeon friendly” and reproducible.
RF43 LONG-TERM FOLLOW-UP OF SUTURELESS VERSUS TRANSCATHETER AORTIC VALVE IN ELDERLY PATIENT WITH AORTIC STENOSIS AT INTERMEDIATE RISK: THE EUROPEAN MULTI-INSTITUTIONAL STUDY
Authors: Muneretto C. , Solinas M. , Folliguet T. , Repossini A. , Di Bartolomeo R. , Savini C. , Concistrè G. , Santarpino G. , Di Bacco L. , Fischlein T.
Published: November 2018

Background and Aim:

This multi-institutional European study compares the long-term outcome of elderly patients with severe aortic stenosis at intermediate risk profile undergoing sutureless (SV) versus Transcatheter (TAVR) aortic valve implant.

Methods:

From 2008 to 2015, 967 elderly patients (>75 years old) at intermediate risk (STS score 4%-8%) and isolated aortic stenosis entered the study (SV = 481/TAVR = 486). After full matching Propensity Score, two matched groups of 470 (G1) and 468 (G2) patients were obtained. Primary endpoints included all-causedeath at 30-days and at 5-years. Secondary endpoints included early and 5-years incidence of composite adverse events (MACCEs: all-cause death, stroke, PM implant, MI, paravalvular leak ≥ 2 + , re-operation).

Results:

After matching there were no difference in major variables between groups. The 30-days mortality was significantly lower in SV group (G1 = 1.7% vs G2 = 6.2%;p = 0.006) as well as permanent PM implantation (G1 = 5.5% vs G2 = 11.7%,p = 0.004). Stroke/TIA cumulative incidence at five years was 1.7% (G1) and 4.8% (G2)(p = 0.020). Incidence of perivalvular leak ≥ grade II was in 0.85% in G1 and 7.4% in G2 (p < 0.001). At mean follow-up of 60 months, overall mortality and the incidence of MACCEs were significantly better in patients undergoing SV (G1 = 14.4 ± 2.7% vs G2 = 30.7 ± 3.3% p < 0.001) (G1 = 20.9 ± 4.9% vs G2 = 43.3 ± 5.1%,p < 0.001). Multivariable Cox Regression identified TAVR as independent predictor for mortality and MACCEs at 5-years (HR = 2.1,CI = 1.12-4.17,p = 0.002) (HR 2.9, CI:1.6-4.3, p < 0,001).

Conclusion:

Sutureless rapid deployment valves improved the outcomes of aortic stenosis elderly patients at intermediate risk profile. The use of TAVR in this subset population should be evaluated in further controlled randomized trial having sutureless valve as comparative cohort.
RF40 LEFT VENTRICULAR UNLOADING DURING ECMO: ATRIAL SEPTAL DEFECT VS IMPELLA. A SIMULATION STUDY
Authors: Perri G. , Filippelli S. , Di Molfetta A. , Iacobelli R. , Di Pasquale L. , Ferrari G. , Adachi I. , Vera R. Zera , Massetti M. , Amode A.
Published: November 2018

Aim:

VA ECMO causes increase of LV afterload. Realization of ASD or Implantation of Impella have been proposed for LV unloading in combination with VA ECMO. Our aim is to study haemodynamic changes in VA ECMO patients after Impella or ASD realization using numerical model of cardiovascular system.

Methods:

A previously developed lumped parameter model of human cardiovascular system was adopted to this specific study. Heart chambers are represented by variable elastance models, while peripheral sections are represented by windkessel models. ASD was modelled as resistance separating the two atria. VA ECMO and Impella were modelled starting from their pressure-flow characteristics. Baseline condition of patient undergoing VA ECMO implantation was reproduced starting form haemodynamic and echocardiographic data and then the effect of different size ASD or different Impella support were simulated.

Results:

Impella implantation on VA ECMO patient caused an increment of mean arterial pressure up to 67%, a decrement in mean pulmonary pressure up to 8%, a decrement in LV end systolic volume up to 11% with reduction up to 97% of LV cardiac output. The realization of a calibrated ASD reduces the LA pressure up to 19%, increases right atrial pressure up to 22%, increases the MAP up to 18%, decreases the LVESV up to 11%, increase the RV volume up to 33% and decreases the LVCO up to 55%.

Conclusion:

Simulations results showed a higher capability of Impella in LV unloading during VA ECMO in comparison to ASD with a concomitant lower right ventricular overload.
RF12 CLINICAL OUTCOME AND HEALTH RELATED QUALITY OF LIFE AFTER CRYOPRESERVED HOMOGRAFT IMPLANTATION FOR RIGHT VENTRICULAR OUTFLOW RECONSTRUCTION
Authors: Petridis F.D. , Angeli E. , Careddu L. , Romano G. , Tonelli F. , Balducci A. , Donti A. , Gargiulo G.D.
Published: November 2018

Background and Aim:

To evaluate long term clinical outcomes and a cross-sectional quality of life study, in congenital patients after right ventricular outflow tract (RVOT) reconstruction with cryopreserved pulmonary homograft (HG).

Methods:

110 patients (pts) undergone RVOT reconstruction with cryopreserved pulmonary HG from January 1995 to September 2014 were included in this retrospective review. Homograft's failure was diagnosed in presence of pulmonary valve peak gradient ≥50mmHg and/or moderate to severe degree of valve regurgitation. Mean diameter of HG implanted was 22 mm and donors’ mean age 39.1 ± 16.0years. Follow-up data included echocardiogram, cardiac MRI and clinical evaluation. The Short-Form-36 was presented to patients to assess perceived quality of life.

Results:

Mean age at surgery was 24.5 ± 15 years. Mean follow-up was10.1 ± 5 years. There was no perioperative mortality. At follow-up, 2 pts (1.8%) died due to non cardiac comorbidities. Homograft failure was observed in 6 pts (5,4%): 5 required percutaneous valve implantation, with a mean interval from the main procedure of 5.3 ± 2.1years and 1 pt required HG replacement after 7years for pseudoaneurysm formation. Freedom from reoperation was 92% and 84% at 5 and 15 years respectively. At follow-up reduction of RV dilatation was observed in 71%pts with ED-volume 98.5 ± 26.1 ml/mq, ES-volume 50.1 ± 16.1 ml/mq, RVEF50.7 ± 6.9% and LVEF59.2 ± 6.9%. HG initial diameter was not a significant prognostic factor for HG dysfunction.

Conclusions:

Cryopreserved pulmonary homograft represent a valid option in case of right ventricular outflow tract reconstruction, as it is associated with low failure rate and no mortality in the long term.
RF20 EVOLUTION OF SMALLEST INTRACORPOREAL CONTINUOUS FLOW LVAD: ROMA EXPERIENCE
Authors: Filippelli S. , Perri G. , Di Molfetta A. , Iacobelli R. , Toscano A. , Adorisio R. , Iodice F. , Di Chiara L. , Iorio F. , Amodeo A.
Published: November 2018

Objective:

Limitations of current VAD for smaller children with HF include use of para-corporeal device, high stroke risk and lack of portability precluding hospital discharge. We report our experience with smallest Jarvik LVAD prototype highlighting the evolution of this device.

Methods:

A 14-months-old child, weighting 5.6 Kg with DCM and mid-aortic syndrome and a 3 years-old baby, weighting 11 Kg with DCM underwent off-label Jarvik LVAD prototype implantation.

Results:

Patient 1. After 123 days of Berlin Heart EXCOR LVAD (10 ml) support, the patient developed mediastinitis. He underwent device removal and Levitronix LVAD implantation. After 25 days, we implanted Infant Jarvik 2000. On 13th post-operative day, for a suddenly pump electric blackout, he underwent urgently VA ECMO support and 12 days later, for infection recovery, a new 10ccml BH EXCOR LVAD was implanted. After 17 days of support, he was successfully transplanted and survived to hospital discharge. Patient 2. This child was supported for 166 days with a BH EXCOR LVAD, which was explanted for LV recovery. After 6 days, he developed recurrency of severe HF, needing new LVAD. Because of abdominal cannula site infection, he underwent Infant Jarvik 2015 prototype implantation. Actually, after 3 months of support, is still awaiting heart transplantation.

Conclusion:

Our pioneering experience showed the feasibility of new smallest Jarvik LVAD and could be considered in future as alternative therapeutic option for LVAD support even in low-weight patients. Further study and larger cohort of patients are necessary to confirm the safety of this new device.
RF31 IS ISOLATED TYPE I VENTRICULAR SEPTAL DEFECT STILL RARE IN ITALIAN POPULATION COMPARED TO ASIAN?
Authors: Grimaldi A.M. , Cassano V. , Troise D. , Lombardi M. , Vairo U. , Scalzo G.
Published: November 2018

Background:

Type I Ventricular Septal Defect (VSD) is less common in Western Countries (5-6% of all VSDs) than in Asia (30% of all VSDs) despite the incidence of VSD is similar (25-30% of all Congenital Heart Defects). In the last 2 years we operated on several isolated Type I VSDs.

Methods:

A retrospective study reviewing VSDs surgical repair from March 2016 to April 2018 was conducted. In total 14 patients received surgical correction of a isolated VSD. The diagnosis was made primarily on transthoracic 2-dimensional echocardiography,standard cardiac catherization. Patients with associated major cardiovascular anomalies were excluded. The classification of VSD type is according to the nomenclature for VSD reviewed by The Society of Thoracic Surgeons in 2000.

Results:

In 4 out of 14 patients Type I VSD was identified (28,5%),in 9 Type II (64,3%) and in 1 Type III (7,2%). Focusing on patients with Type I they were all female and surprisingly all Italian with no Asian relatives at all. Age at operation ranged from 2 to 13 months (mean 7,7 mo) and weight ranged from 3,8 to 10 kg (mean 6,8 kg). Surgical repair was done via transpulmonary arterial access. All patients are alive and well with no aortic nor pulmonary valve problems at 24 months of follow up.

Conclusions:

We are surprised to find out such a incidence of Type I VSD in Italian population. We are fully aware of the weak statistical power of our series so we look forward to propose an Italian multicenter study to verify the hypothesis of a changing incidence of Type I VSD in Italy.
RF88 TRANSFEMORAL BARE-METAL STENT FOR TREATMENT OF RESIDUAL AORTIC ARCH DISSECTION AFTER SURGICAL REPAIR OF ACUTE TYPE A AORTIC DISSECTION.
Authors: Mariniello A. , Di Tommaso L. , Di Tommaso E. , Giordano R. , Malio E. , Mannacio L. , Castellano G. , Iannelli G.
Published: November 2018

Background and aim:

Here we evaluate the usefulness of transfemoral uncovered stent implantation to avoid secondary conventional surgery for residual type A aortic dissection of aortic arch after ascending aorta replacement.

Methods:

From June 2009 to April 2015, 11 patients were treated with transfemoral implantation of uncovered stents in the aortic arch after surgical replacement of ascending aorta performed on average 4.7 ± 2.3 years earlier.. An enlarged dissected aortic arch or a dangerous median growth of more than 5 mm/yr or impending rupture presenting as chest pain were indications for treatment. The dissected aortic tracts diameter must not exceed 45 mm. 5 patients (45.5%) were treated with Djumbodies Dissection System, 6 patients (54.5%) with Jotec E-XL aortic stent.

Results:

There were no perioperative deaths or permanent neurologic complications. Primary procedural success was obtained in all patients and the residual type A aortic dissection in aortic arch was obliterated, with disappearance of the false lumen. Median ICU stay was 24 hours, post-operative hospital stay was 5.2 ± 1.4 days.

One death, not aortic related, occurred during follow-up period (mean 5.2 ± 1.9 years). Descending thoracic aorta diameter significantly increased in 3 patients (27.3%): one patient (9.0%) needed a secondary conventional surgery, the other 2 (18.2%) of a distal extension with PETTICOAT approach.

Conclusions:

Endovascular approach with uncovered metal bare stent is surely an evolving strategy to perform a purely endovascular treatment, indicated only for treatment of aortic arch with a diameter of less than 40 or 45 mm, to avoid progressive thoracic aortic dilatation and/or rupture.
RF04 AORTIC ARCH ANEURYSM: OUR SURGICAL EXPERIENCE
Authors: Maurizio R. , Kassem S. , Bonalumi G. , Ricciardi G. , Naliato M. , Salvi L. , Brambillasca C. , Bertera A. , Pedroletti D. , Alamanni F.
Published: November 2018

Background and aim:

The introduction of the so-called “branch first technique” in the field of aortic arch surgery allowed cardiac surgeons to eliminate the need of performing the operation very quickly, which is a relevant problem of the traditional techniques of aortic arch reconstruction. In addition, operations are now performed at moderate hypothermic rather than deep hypothermic core temperature. Thus, neurological complications occur with less frequency in the surgically managed patients.

Methods:

We use these new techniques to avoid the risks of traditional aortic arch surgery. The main innovative aspects of our procedure includes:

These modifications allow to preserve cerebral perfusion throughout the operation.

Results:

Our series is made up of 8 patients. We experienced neurological complications only in one patient with a previously implanted left carotid stent, probably due to a bad superior venous drainage.

Conclusions:

The modified “branch first technique” avoids the neurological risks of deep hypothermic circulatory arrest.

This is a preliminary work about the use of this technique. Thus, a large number of patients is required to confirm our actual good results.
RF08 BENTALL OPERATION WITH ON-X MECHANICAL CONDUIT: THE BOLOGNA EXPERIENCE
Authors: Murana G. , Mariani C. , Alfonsi J. , Fiorentino M. , Coppola G. , Folesani G. , Leone A. , Suarez S. Martin , Pacini D. , Di Bartolomeo R.
Published: November 2018

Background and aim:

The On-X prosthesis is the only mechanical aortic valve available in the market to have a proved safety and feasibility at lower INR regimen. The aims of this retrospective study were to evaluate the early and mid-term outcomes of the modified Bentall procedure with the O4n-X mechanical conduit.

Methods:

From January 2012 to December 2016, 108 consecutive patients (mean age 51.9 ± 12.5 years) underwent Bentall operation with On-X in our institution. Main indications were degenerative ascending aorta aneurysms (55.6%) and aortic dissections (20.4%). Seventeen (15.7%) were redo operations. Associated procedures were performed in 40 cases (37.0%); of them, 27 (25.0%) were complete or partial arch replacements. Mean follow-up time was 35.1 ± 16.1 months (97.1% complete). After 2015, a lower INR regimen of 1.5 to 2 was applied in association with aspirin.

Results:

Overall In-hospital mortality was 2.8%. Morbidity included: 1 stroke (0.9%), 2 acute kidney injuries (2.9%) and 5 re-thoracotomies for bleeding (4.6%). Actuarial survival at 5 years was 95.2 %. Freedom from aortic re-operation was 100%. At 5 years no thromboembolic or haemorrhagic events were observed and only 1 patient had an infective endocarditis (figure 1).

Conclusions:

The modified Bentall operation confirmed to be a safe and durable operation for the treatment of ascending aorta pathologies. The On-X conduit showed very satisfactory early results even in cases with unfavourable anatomy. This prosthesis also guarantees safe mid-term durability associated with a very low incidence of thromboembolism regardless of the lower INR regimen.
RF56 OPERATIVE AND SHORT-TERM RESULTS OF THE BENTALL OPERATION: RISK FACTORS ANALYSIS AND CLINICAL CONSIDERATIONS
Authors: Vacirca S.R. , Nardi P. , Bertoldo F. , Pisano C. , Ferrante M.S. , Ymeri K. , Bassano C. , Scafuri A. , Ruvolo G.
Published: November 2018

Background and Aim:

To analyse short-term results after the Bentall operation and get clinical considerations.

Methods:

One hundred and twenty-two patients (mean age 60.4 ± 15.8 years, 99 males,23 females) underwent Bentall operation from January 2015 to December 2017 for treatment of ascending aorta expansive aneurysm (i.e. degenerative aneurysm with tricuspid aortic valve, n = 69; bicuspid valve, n = 37; Marfan syndrome and other genetical disorders, n = 13; redo procedures n = 3). Associate procedures (i.e. coronary artery bypass grafting, mitral valve replacement, other) were performed in 26 patients (21.3%). Euroscore II was 4.7% ± 3.9%. Mean follow-up (99.2% complete) was 20 ± 10 months.

Results:

In-hospital mortality was 1.6% (1% for isolated Bentall). Three-year survival, freedom from cardiac death, from endocarditis, frome reoperation were 97 ± 1.2%, 99 ± 1.3%, 93 ± 5.1%, 98 ± 1.8%, respectively. No thromboembolism and major bleeding complications were observed. Independent predictors of all-cause death were preoperative higher left ventricular (LV) end-diastolic diameter (71.6 ± 12 vs 53.6 ± 8.6 mm; P = 0.009), LV end-systolic diameter (47.7 ± 9.2 vs 36.8 ± 7.9 mm; P = 0.02), lower LV ejection fraction (43.3 ± 15 vs 56.2 ± 8.7%; P = 0.015). Survival was 98.4 ± 1.6% after isolated Bentall, and 92 ± 5.4% after associated procdures (P = 0.04). As compared to preoperative values, clnical and echocardiography follow-up showed improvement of LV function and NYHA class.

Conclusions:

Excellent results can be expected after Bentall operation. Low rate of operative mortality and late complications, and significant improvement of clinical status make this operation the gold standard and the reference surgery therapy for the treatment of ascending aorta aneurysms. In presence of dilatation and dysfunction of the left ventricle, adequate medical treatment is necessary to improve survival.
RF02 ANOMALOUS AORTIC CORONARY ARTERY ORIGIN: A PARAMETRIC STRUCTURAL FINITE ELEMENT ANALYSIS AND COMPUTATIONAL SIMULATION.
Authors: Rito M. Lo , Formato G.M. , Auricchio F. , Frigiola A. , Giamberti A. , Conti M.
Published: November 2018

Background and aim:

In anomalous aortic origin of coronary arteries (AAOCA) underlying ischemic mechanism during high stress conditions have still to be elucidated. The study aims to understand the biomechanics of such a condition and in particular how the lumen of the AAOCA may narrow during aortic expansion.

Methods:

We create a parametric computer-aided designed (CAD) model of the aortic root and AAOCA origin and perform a static finite element analysis (FEA) on 10 models with different angles of take-off and intramural penetration at three different loading conditions (i.e. stress condition). The model is defined by twenty-three parameters describing aortic root geometry and allows to vary coronary position, take-off angle, degree of intramural penetration, and length of the intramural course to simulate the pathological conditions of AAOCA.

Results:

We show that the AAOCAs experience a reduced luminal expansion (LE) (LE = 1.85%, 5.98%, 10.42%) compared to the healthy ones (LE = 11.9%, 22.43%, 36.66%,) at 120-150-180 mmHg of aortic root pressure respectively. Acute angles of take-off lead to elongated ostia, with an eccentricity (e) that increases with aortic expansion (i.e. e = 0.72-0.69-0.66 at 120-150-180 mmHg, take-off angle = 35’ and 50% penetration).

Conclusions:

The study describes for the first time an idealized geometrical model as a proof of concept for static structural finite element simulations to assess the role of specific geometrical features on AAOCA physiopathology. The possible mechanism of lumen reduction in AAOCA can rely on biomechanical reasons and computational simulations may allow patient specific predictive model in future.
RF68 RENAL REPLACEMENT THERAPY WITH THE OXIRIS FILTER DECREASES INFLAMMATORY MEDIATORS AND IMPROVES CARDIORENAL FUNCTION IN SEPTIC PATIENTS: A PROPENSITY – MATCHED ANALYSYS AGAINST TRADITIONAL RENAL FILTRATION
Authors: Weltert L. , Turani F. , Falco M. , Candidi F. , Barchetta R. , D’Aleo S. , De Paulis R.
Published: November 2018

Background and aim:

Objective Renal Replacement Therapy (RRT) with oXiris filter is used in sepsis with Acute Kidney Injury (AKI) but few clinical studies compare the adsorbing effect of oXiris filter on the inflammatory mediators to traditional RRT.

The aim of this study is to Confirm whether oXiris decreases cytokines and procalcitonin in sepsis septic shock

Test if this effect is superior to RRT and if this translates into a better cardio renal response.

Methods: :

A Cohort of 73 patients admitted to three Intensive Care Units with a diagnosis of sepsis.

InterLeukin-6, Procalcitonin, Cardiorenal indices and SOFA-score were compared before (T0) and at the end of the treatments (T1).

Propensity Matching was performed including all pre-treatment variables, final cohorts resulted identical in all aspects. Of 50 patients submitted to oXiris filter 32 could be matched to 22 septic patients who received traditional RRT

Results: :

IL6 and Procalcitonin decreased significantly more in the oXiris group (p < 0,01)

MAP increased (p < 0,01) and noradrenaline dosage decreased in oXiris group (p < 0,01)

PaO2/FIO2 ratio, diuresis, SOFA improved in the oXiris group (p < 0,05)

Conclusions: :

In septic shock patients with Acute Kidney Injury, IL6 and procalcitonin decrease significantly more in the oXirs group then in the RRT group.

This is significantly associated with an improvement of the cardio-renal function and the clinical condition.

The study confirms that RRT with oXiris filter may be useful in sepsis where other convective diffusive techinques fail.
RF75 SHELHIGH BIOLOGICAL VALVED CONDUIT: 10-YEARS EXPERIENCE FOR AORTIC ROOT REPLACEMENT.
Authors: Ferrarese S. , Corazzari C. , Sella M. , Pariani E. , Cantore C. , Cappabianca G. , Beghi C.
Published: November 2018

Background:

Since 1968 Bentall and DeBono first described the technique for aortic root replacement with the reimplantation of the coronary arteries. This operation has been considered the gold standard in the surgical treatment of the ascending aorta and aortic valve disease. At the end of the 1990 s the Shelhigh No-React biological valved conduit was introduced in Europe for Bentall operation. The aim this study was to report the short and long term follow-up with the Shelhigh conduit.

Methods:

From 2001 to 2010, 45 patients (mean age 69.6 ± 6.9 years) underwent aortic root replacement with Shelhigh conduit. Endocarditis (2.2%), type A aortic dissection (20%), aneurysm (77.8%) were the most important indications for surgery. End-points were: survival at 1, 5 and 10years, conduit-related major complications and death, freedom from aortic root structural deterioration and reoperation.

Results:

The median follow-up was 8.9 years (0 to 14.6). The overall hospital mortality rate was 4 patients (8.9 %). The overall estimated survival rates at 1, 5 and 10 years were 86.4 ± 5.2, 81.8 ± 5.8 and 65.9 ± 7.6 respectively. Redo surgery was necessary in 5 cases (11.1 %); in 3 of them (6.7%) there was evidence of false aneurysm. The overall estimated freedom from reoperation at 1, 5 and 10 years was 95.1 ± 3.4, 92.6 ± 4.1 and 92.6 ± 4.1 respectively.

Conclusions:

In our experience the Shelhigh-NoReact biological valved conduit showed acceptable results. According to the literature, the high rate of aortic root related reoperation (6.7%) and early mortality (8.9%) may be explained by the clinical and demographic features of the studied group.
PROGNOSTIC METHODS OF INJURY SEVERITY ASSESSMENT FOR PREHOSPITAL EMERGENCY MEDICAL SERVICE
Authors: Ehrgashev O. N. , Makhnovskij A. I. , Miroshnichenko A. G. , Izotova O. G.
Published: November 2018

The article provides an overview of methods for injury severity predicting which can be used for prehospital emergency medical service.
PROBLEMS AND SPECIFICITY OF DIAGNOSTICS OF ACUTE HEART FAILURE IN PATIENTS WITH INTERMEDIATE EJECTION FRACTION AT THE НОSPITAL STAGE
Authors: Skorodumova E. G. , Kostenko V. A. , Skorodumova E. A. , Rysev A. V.
Published: November 2018

We analyzed ambulance diagnoses of patients with acute decompensation of heart failure with the background of the intermediate ejection fraction. In this category of patients acute decompensation of heart failure was diagnosed in-hospital, not associated with acute coronary syndrome, or other cardiological diseases. 78 variants of different diagnoses of referral of patients to the hospital at the prehospital stage were found, with a true diagnosis of acute decompensation of heart failure being established in only patients. All diagnoses were divided into 6 groups with the subsequent analysis of the causes of diagnostic errors.
HYPERGLYCEMIA IN ACUTE MYOCARDIAL INFARCTION: PROGNOSTIC MEANING AND NUTRITIVE CORRECTION
Authors: Аlekseenko O. V. , Luft V. M.
Published: November 2018

Currently the emergency medicine turned on the wide use of the special enteral nutritional cocktails like “Diabetes” to manage different types of hyperglycemia under various acute disorders. Under the conditions of resuscitation and intensive care unit (RICU) there looked into the possibility and efficacy of early monitoring of the hyperglycemia target values using the special enteral nutritional cocktails with the MI patients.
IMPROVEMENT THE RESULTS OF THE TREATMENT OF CASUALTIES IN ROAD ACCIDENTS WITH COMBINED MECHANICAL INJURES ON THE EXAMPLE OF THE REPUBLIC OF TATARSTAN
Authors: Anisimov A. Yu. , Isaeva I. V. , Bobij B. V.
Published: November 2018

Application of a new approach to the treatment of patients injured in the road accident allowed to improve efficiency of medical care.
Blockchains, Formulary Evaluations and Health Technology Assessment
Authors: Langley Paul , Martin Robert E
Published: November 2018

Blockchains have the potential, if appropriately implemented and managed, of contributing to a fundamental change in the application of techniques of health technology assessment in formulary decision making. Rather than continuing to rely on claims made by manufacturers that are non-evaluable, the introduction of blockchains as adjunct to the electronic medical record, meet an unmet medical need in enabling a platform for the real time assessment of claims. Rather than focusing the case for their product on lifetime cost-per-QALY models, which have no chance of ever being validated, the blockchain platform offers a low cost opportunity for claims evaluation. Manufacturers would be required to abandon the construction of imaginary cost-per-QALY worlds to support claims for pricing and formulary trier position, in favor of claims that can be evaluated and reported back to formulary committees in a short yet meaningful time horizon. Manufacturers would present a claims assessment protocol as part of the formulary submission package. If agreed with the formulary committee, the protocol would be implemented and managed through the patient blockchain membership. Claims would be monitored and evaluated in real time with a final report to the formulary committee in a matter of months. Lifetime imaginary claims for cost-per-QALY, set alongside willingness-to-pay thresholds, would be a thing of the past. Pricing decisions and formulary placement would reflect a robust evidence base and not just extrapolations from pivotal clinical trials.

 

Article Type: Commentary
Dataset Bias in the Natural Sciences: A Case Study in Chemical Reaction Prediction and Synthesis Design
Authors: Griffiths Ryan-Rhys , Schwaller Philippe , Lee Alpha
Published: November 2018

Datasets in the Natural Sciences are often curated with the goal of aiding scientific understanding and hence may not always be in a form that facilitates the application of machine learning. In this paper, we identify three trends within the fields of chemical reaction prediction and synthesis design that require a change in direction. First, the manner in which reaction datasets are split into reactants and reagents encourages testing models in an unrealistically generous manner. Second, we highlight the prevalence of mislabelled data, and suggest that the focus should be on outlier removal rather than data fitting only. Lastly, we discuss the problem of reagent prediction, in addition to reactant prediction, in order to solve the full synthesis design problem, highlighting the mismatch between what machine learning solves and what a lab chemist would need. Our critiques are also relevant to the burgeoning field of using machine learning to accelerate progress in experimental Natural Sciences, where datasets are often split in a biased way, are highly noisy, and contextual variables that are not evident from the data strongly influence the outcome of experiments.
Competitividad en Pymes bajo un esquema de trabajo en red y diferenciación del producto
Authors: Jesusu Jesus Alberto , Cuevas Tomas Jesus
Published: November 2018

La investigación, muestra el modelo de negocios de venta de alimentos elaborados en el momento sobre un vehículo que se pueda movilizar por un motor propio o también conocidos como Food Truks (FT), bajo la tendencia de la instalación o estacionamiento de varios de estos, en una misma plaza comercial ofertando comida gourmet. El documento demuestra la importancia de la cooperación y relación que existe entre este tipo de pequeñas y medianas empresas (Pymes) en Ciudad Juárez, Chihuahua (CJS), así como su tendencia a trabajar en red bajo un esquema de colaboración. Después de hacer referencia sobre algunas bases teóricas de competitividad y redes, se presentan resultados preliminares en los que se destacan las relaciones derivadas entre las empresas y actores, mostrando las principales consideraciones para trabajar bajo este modelo de red, así como aspectos de presentación, calidad e imagen de sus productos, como factores de diferenciación para la obtención de mejoras competitivas. Por otra parte, se elaboran una serie de recomendaciones considerando la región como unidad de análisis.