bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE EXPANDING ROLE OF 16S RIBOSOMAL RNA PCR IN THE MANAGEMENT OF PATIENTS WITH INFECTIVE ENDOCARDITIS UNDERGOING CARDIAC SURGERY
Authors: Cammertoni F. , Pavone N. , Bruno P. , Calabrese M. , Scoppettuolo G. , Lombardo A. , Fiori B. , D’Acierno E. , Cutrone G. , Massetti M. 
Published: December 2024

Background and Aim:
Molecular tests on blood are effective in identifying the causative organism and they are recommended when blood cultures are negative. However, the role of molecular tests on the surgically excised valve is still unclear.

Methods:
In this prospective, observational, single center study, we enrolled 100 consecutive patients with infective endocarditis who underwent cardiac surgery between April 2020 and June 2023. Results of preoperative blood cultures (BC), valve culture (VC), 16 s ribosomal RNA and histopathologic analysis of surgical samples were collected.

Results:
The mean age of the study population was 60±12.5 years. Overall, BC VC and 16srRNA were positive in 83%, 47%, and 76% of cases, respectively. Sensitivity of both valve culture and 16srRNA decreased significantly with prolonged preoperative antibiotic therapy. Of note, 16srRNA was the only positive result in 7% of cases, allowing aetiological diagnosis. In 33% of patients, the VC test was negative while the molecular test was positive. In these cases, histopathological analysis showed acute inflammation in most cases. In 12.5%, the molecular test clarified discrepancies between blood and valve cultures.

Conclusions:
Molecular test showed higher diagnostic sensitivity than VC, even after 28 days of preoperative antibiotic therapy. Besides identifying the pathogen in 7% of cases with negative culture results, the molecular test demonstrated utility in other crucial situations. When VCs were negative, combining molecular testing and histopathological analysis they allowed the identification of patients who could benefit from prolonged antibiotic therapy. In addition, molecular testing solved discrepancy between blood culture and valve culture results.
AORTIC VALVE REPLACEMENT VERSUS BALLOON EXPANDABLE AND SELF EXPANDABLE TRANSCATHETER AORTIC VALVE IMPLANTATION IN LOW-RISK PATIENTS
Authors: Lodo V. , Italiano E. G. , Weltert L. , Zingarelli E. , Viscido C. , Buono G. , Centofanti P. 
Published: December 2024

Background and Aim:
in patients with symptomatic aortic stenosis, TAVI has emerged as an attractive alternative to surgery. However, TAVI carries an increased risk of conduction abnormalities and para-valvular leak (PVL) which may generate some concerns with the extension of TAVI indication to patients with longer life-expectancy. The aim of this study is to compare post-procedural outcomes and 5-year survival of low-risk patients who underwent SAVR vs balloon expandable (BE) or self expandable (SE) TAVI

Methods:
542 patients, undergoing SAVR (n=221), BE TAVI (n=150) or SE TAVI (n= 171), from 09/2017 to 12/2022 were enrolled. Elegible patients were aged between 70 and 85 years with low surgical risk and isolated severe AS. The primary end-point was 5-year all cause mortality. To compare patients with similar baseline characteristics a propensity score matching was performed

Results:
before matching, TAVI patients were older and with a higher Euroscore II. SAVR patients showed a significantly higher incidence of post-procedural AKI, whereas SE patients had a higher incidence of conduction abnormalities, stroke and PVL than surgical and BE TAVI patients. After matching, surgical and BE TAVI patients showed a lower incidence of stoke (2,3%-0%vs6,3%, p=0,045), LBBB (0/18,2%vs25%, p<0,001) and PVL (0/2,4%vs8,1%, p=0,017) when compared to SE TAVI. 5-year mortality was significantly higher in SE TAVI patients when compared to surgical patients, while no significant difference was reported between BE TAVI and SAVR patients.

Conclusion:
BE prosthesis should be considered the prosthesis of choice for patients with long life-expectancy requiring a transcatheter procedure.
SURGERY FOR HEART VALVE DISEASE SECONDARY TO NEUROENDOCRINE TUMORS
Authors: Iennaco V. , Zanobini M. , Biancari F. 
Published: December 2024

Background:
Neuroendocrine tumors (NET) are known to be associated with development of heart valve disease, the Hedinger syndrome. This is due to the release of vasoactive substances inducing endocardial plaques of fibrous tissues. The disease may be associated with increased mortality.

Methods:
Herein we analyzed the early and mid-term outcomes of patients who underwent surgery for NET-related heart valve disease at our Institution from March 2019 to March 2024.

Results:
The present study includes 11 consecutive patients with a mean age of 66.2±7.0 years, of whom eight (72.7%) patients were females. Ten patients underwent replacement of the tricuspid valve, and 6 patients underwent replacement of the pulmonary valve. None of the patients underwent surgery for aortic valve or mitral valve disease. One patient underwent concomitant coronary surgery. One (9.0%) patient died during the index hospitalization because of sepsis. None of the other patients experienced neurological complications, severe bleeding or stage 3 acute kidney disease. At 3-year, all-cause mortality was 57.6%.

Conclusions:
Surgery for NET-related heart valve disease is associated with relatively low risk of early mortality and morbidity, but in this series more than half of patients have died at 3-year.
POSTINFARCTION VENTRICULAR SEPTAL DEFECT: RISK FACTORS FOR WORSE OUTCOME, A MULTICENTRIC INTERNATIONAL STUDY.
Authors: Di Marco L. , Cavalli G. G. , Nania R. , Affronti A. , Matteucci M. , Pollari F. , Pacini D. , Castagnini S. , Piperata A. , Sponga S. , Coppetti S. , Vendramin I. 
Published: December 2024

Background and Aim:
Even in the percutaneous coronary intervention era, surgery still remains the treatment of choice of ischemic ventricular septal defect. Most of the previous data come from single centre studies. The aim of our study was to investigate risk factors for worse outcome.

Methods:
We conducted a retrospective, multi-center study. One-hundred eleven patients from four centers, who underwent surgery for a post-myocardial infarction ventricular septal defect in the period 2001-2021, were enrolled. The study was conducted on behalf of the Gruppo Italiano di Ricerca sugli Outcome in Cardiochirurgia.

Results:
Early timing of surgery (p-value 0.248), concomitant surgical intervention (p-value 0.121), pre- operative cardiac arrest (p-value 0.150), emergency surgery (p-value 0.888) were not statistically associated with a worse outcome. Serum creatinine (p-value 0.025), pre-operative implant of intra-aortic balloon pump (p-value 0.015) and, notably, bleeding during the first 48 hours (p- value0.026) were higher in the in-hospital death group. Overall, in-hospital mortality was 39% (44 patients).

Conclusions:
Despite high risk and high mortality rate, surgery still remains the treatment of choice for post- infarction ventricular septal defect. Bypassing the bias of a single centre evaluation, our results seem to suggest that regardless of the institution, early surgery, concomitant surgical procedure, emergency surgery, pre-operative cardiac arrest are not linked to a worse outcome, while renal impairment, pre-operative intra-aortic balloon pump and bleeding during the first 48 hours are related to in-hospital mortality.
LATE CLINICAL AND HEMODYNAMIC COMPARISON OF TWO INNOVATIVE AORTIC VALVE BIOPROSTHESES: INSPIRIS RESILIA VS AVALUS
Authors: Mazza A. , Chiariello G. A. , Villa E. , Bruno P. , D’Avino S. , Cutrone G. , D’Acierno E. , Pasquini A. , Massetti M. 
Published: December 2024

Background:
In recent years, the increasing use of biological prostheses for surgical aortic valve replacement (AVR), has led to the development of new devices with improved hemodynamics and expected durability.

Methods:
In this observational retrospective two-center cohort study, two innovative bioprostheses, INSPIRIS Resilia and AVALUS were analyzed. We analyzed early and 3.2-year follow-up results in terms of safety, clinical outcome and hemodynamic performance.

Results:
From November 2017 to February 2023, 178 patients underwent AVR with INSPIRIS Resilia (N=88) or AVALUS (N.=90) bioprosthesis. The 30-day and mid-term mortality was comparable (1% vs. 3%, P=0.1 and 7% vs. 5%, P=0.7, respectively). Valve-related mortality was observed in one AVALUS patient. 5% patients of the AVALUS group developed prosthetic endocarditis and two of them died after reoperation. No other cases of prosthetic endocarditis were observed. No cases of structural valve degeneration or significant paravalvular leak were detected at follow-up. Median follow-up peak pressure gradient was 22 vs. 20 mmHg (P=0.5) and the mean pressure gradient was 13 vs. 14 mmHg (P=0.9) for Inspiris and AVALUS, respectively. The effective orifice area (EOA) and indexed EOA were 1.4 cm2 vs. 1.3 cm2 (P=0.4) and 0.7 vs. 0.6 cm2/m2 (P=0.5), respectively. Indexed left ventricular mass regression was -32 vs. -50 g/m2 for the Inspiris and AVALUS groups, respectively (P=0.001)

Conclusions:
INSPIRIS Resilia and AVALUS bioprostheses were reliable with comparable results in terms of safety, clinical outcome and hemodynamic performance. After statistical adjustment, AVALUS was associated with better left ventricular mass reduction. Long-term follow-up would provide definitive comparative results.
EARLY RESULTS OF MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT VIA PARTIAL STERNOTOMY OR RIGHT THORACOTOMY: INSIGHTS IN ACUTE KIDNEY INJURY
Authors: Squiccimarro E. , Margari V. , Visicchio G. , Kounakis G. , Pascarella C. , Carbone C. , Paparella D. 
Published: December 2024

Background and Aim:
Minimally Invasive Aortic Valve Replacement (MI-AVR) offers outcomes comparable to conventional sternotomy, with increased adoption due to fewer complications. Comparisons between partial sternotomy (PS) and right thoracotomy (RT) in MI-AVR are limited. This study aims to compare the short-term clinical outcomes of these two approaches.

Methods:
We retrospectively reviewed patients who underwent isolated MI-AVR at Santa Maria Hospital, Bari, from 2017-2023. The primary outcome was 30-day mortality. Secondary outcomes included early postoperative results, acute kidney injury (AKI) as per KDIGO classification, and other complications. Multivariate logistic regression identified predictors of AKI, presented as odds ratios (OR) with 95% confidence intervals (CI).

Results:
Among 334 patients, 289 (86.5%) underwent PS, and 45 (13.5%) received RT. The overall 30-day mortality was 0.9%, with no difference between groups. AKI occurred in 40 cases (12.0%): 39 in the PS (13.5%) and 1 in the RT groups (2.2%) (p=0.026). Most AKIs (60%) were stage 1. The multivariate model showed a borderline non-significant association between PS and AKI (OR 6.77, p=0.064). The PS group had a higher median area under the creatinine concentration-time curve (AUC) (1.64 vs. 1.21 mg/dL, p=0.005) and C-Reactive Protein AUC, despite shorter cardiopulmonary bypass (73 vs. 86 min, p=0.029) and cross- clamp times (50 vs. 63 min, p=0.001). Other major complications did not differ between groups.

Conclusion:
MI-AVR is safe and has satisfactory short-term outcomes. A non-significant trend suggested an association between PS and AKI, potentially due to higher postoperative inflammation, warranting further investigation.
SEX-RELATED DIFFERENCES AND SYSTEMIC INFLAMMATORY RESPONSE IN CARDIAC SURGERY AND CARDIOPULMONARY BYPASS
Authors: Squiccimarro E. , Lorusso R. , Margari V. , Labriola C. , Piancone F. , Rociola R. , Whitlock R. P. , Paparella D. 
Published: December 2024

Background:
Women experience worse outcome after cardiac surgery, possibly linked to distinct inflammatory patterns. We ascertained how sex affects systemic inflammatory reaction syndrome (SIRS) and outcome in heart surgery patients.

Methods:
A retrospective evaluation of prospectively collected data from patients who had undergone cardiac surgery from 2018 to 2020 in a single hospital was performed. SIRS was defined as per the American College of Chest Physicians/Society of Critical Care Medicine. Multivariate logistic models were used to identify predictors of SIRS and of a composite outcome including death, transient ischemic attack/stroke, renal replacement therapy, bleeding, postcardiotomy extracorporeal membrane oxygenation or intra-aortic balloon pump, and a ICU stay >96 hours. A structural equation modeling was applied to separate the direct influence of SIRS predictors on the composite outcome from the SIRS-mediated effects.

Results:
A total of 1,005 consecutive patients were included, 299 (29.8%) were female. SIRS incidence was 28.1%, 128 (12.7%) patients experienced the composite outcome. Female sex was associated with SIRS (OR 1.56; 95% CI 1.12-2.18, p=0.009) and the composite endpoint (OR 1.72; 95% CI 1.10-2.69, p=0.017). Other common predictors were baseline left ventricular impairment and intraoperative hyperlactatemia. SIRS mediated 50.8% of the effect of sex on the outcome, 17.0% of that due to left ventricular dysfunction, and 30.9% of the effect caused by intraoperative hyperlactatemia.

Conclusions:
Female sex independently predicts postoperative SIRS and poorer outcome. Systemic inflammation, preoperative anemia and procedural hyperlactatemia are key factors in the complex mechanisms through which female sex appears to worsen outcome after cardiac surgery.
BIOLOGICAL PROSTHESES IN PATIENTS YOUNGER THAN 65 YEARS OLD: A PROPENSITY-SCORE MATCHING ANALYSIS BETWEEN THE TWO MOST IMPLANTED BOVINE PERICARDIAL VALVES.
Authors: Perrone F. , Francica A. , Onorati F. , Denora M. T. , Maffei I. , Luciani G. B. 
Published: December 2024

Background and Aim:
The latest ESC/EACTS guidelines recommend the use of biological prostheses in patients over 65 years old for aortic valve replacement. However, in recent years, there has been an increasing use of bioprosthetic valves in younger patients as well. This study aimed to compare the six-year results in ≤65 years old patients receiving the last two generation of bovine pericardial valves (Perimount Magna Ease and Inspiris Resilia) in the aortic position.

Methods:
From 2017 to 2023, clinical and echocardiographic data of patients receiving PME and IR prosthesis for isolated or combined AVR were prospectively collected at our Institution. Propensity score (PS) matching was performed to compare the groups at 6-years follow-up.

Results:
A total of 2053 patients were included: 1602 PME and 451 IR. After propensity score matching, 224 pairs of patients with similar risk profiles were compared. IR valve showed good six–year freedom from explant, endocarditis and stroke comparable to PME valve. However, causes of cardiovascular mortality should be better assessed in PME patients (Log-rank test p=0.028). Infective Endocarditis was the main cause of valve explant in both cohorts (46.7% in PME vs 53.3% in IR). After an initial lower transproshtetic mean gradients and peak velocity in IR valves, PME and IR valve showed comparable hemodynamic from 1 to 6 years of follow- up.

Conclusions:
In patients under 65 years of age, the new generation of IR prostheses showed good clinical and echocardiographic results similar to those of PME prostheses; however, with lower cardiovascular mortality at 6 years.
SURGICAL MANAGEMENT OF ANOMALOUS AORTIC ORIGIN OF THE CORONARY ARTERY (AAOCA): A 20 YEARS SINGLE CENTER EXPERIENCE
Authors: Messina C. , Corrado C. , Rosato A. , Anglese S. , Reali M. , Varrica A. , Frigiola A. , Giamberti A. , Lo Rito M. 
Published: December 2024

Background and Aim:
Surgical repair of anomalous aortic origin of coronary artery (AAOCA) needs to be patient’s tailored to reduce early and late complications. We aim to assess the results of 21-years AAOCA surgical repair in a dedicated program.

Methods:
All consecutive AAOCA patients underwent surgical repair (01/2013- 09/2024). We collected anatomical operative and post-operative data, focusing on early complications and late outcomes.

Results:
From a cohort of 237 AAOCA subjects referred, 69 (29%) underwent surgical repair at a median age of 39,7 years (range: 5-71 years). The surgical techniques were unroofing of the intramural segment (n=53), osteoplasty (n=5), anatomical repair (n=4) CABG (n=3), transconal repair (n=1), external debridging of subpulmonary course (n=3). No early or late mortality was depicted. Early complications included unplanned CABG (n=1) a right coronary laceration requiring patch repair (n=1) and acute pericarditis requiring pericardiectomy (n=1). All patients were discharged in good clinical conditions, with no evidence of aortic valve regurgitation. After a mean follow-up of 4.5±3.98 years, the occurrence of late overall complications was rare, with only 1 case of RCA stenosis after unroofing treated with stenting; meanwhile we observed post-surgical pericarditis (n=3) treated medically 1 case of distal RCA spontaneous dissection.

Conclusions:
When tailored to the specific patient anatomy, surgical treatment of AAOCA may significantly reduce early and late complications. Surgery is safe when performed in large-volume centers, although the very long-term fate of a repaired coronary segment in young adults in terms of stenosis recurrence is still unknown.
LONG TERM OUTCOME OF TETRALOGY OF FALLOT AND COMPLETE ATRIOVENTRICULAR SEPTAL DEFECT REPAIR: SINGLE CENTRE EXPERIENCE
Authors: Perri G. , Brancaccio G. , Filippelli S. , Trezzi M. , Cetrano E. , Iacobelli R. , D’Inzeo V. , Galletti L. 
Published: December 2024

Background:
We report our experience following surgical repair of Complete Atrioventricular Septal Defect (cAVSD) with Tetralogy of Fallot (TOF) over a 30 years period, focusing particularly in approach used for right ventricular outflow tract reconstruction (RVOTR).

Methods:
Between 1992 and 2023, 47 children with primary diagnosis of cAVSD/TOF were treated in our Institution; 39 had Down’s syndrome (81%). All except 6 had diagnosis of Rastelli’s type C. Median age and weight at surgery were 25 mos (range 4 – 224) and 12.5 Kg (range 3.5 – 83). 22 patients received initial palliation while 25 underwent direct repair. cAVSD was treated in all by double-patch technique while RVOT obstruction was relieved by transannular patch (TAP) in 21 cases (43.7%), infundibular patch in 12 (25%), and valve conduit in 11 (31,3%). Primary outcome were survival and freedom from reintervention

Results:
No hospital deaths occurred. Overall survival was 93.75% and 87,5% at 5 and 10 years respectively. Six patients died during follow-up, 3 after palliation before complete repair. Amongst 44 patients underwent repair, 24 (54%) need reintervention: 10 previously treated with conduit (91.6%), 6 (50%) with infundibular patch and 8 (35%) with TAP. Most common reintervention was conduit replacement (41,6%), followed by mitral valve surgery (20.8%).

Conclusions:
TOF with cAVSD can be repaired at low risk with favourable long-term outcome. Primary repair, when feasible, should be preferred in order to avoid inter- stage mortality. Transannular patch is a valid alternative for RVOTR because improve long-term outcome and prevents multiple conduit replacement
THE BOLOGNA’ SCORE: A NOVEL RISK STRATIFICATION TOOL FOR ADULT WITH CONGENITAL HEART DISEASE UNDERGOING HEART TRANSPLANTATION
Authors: Orioli V. , Careddu L. , Mangerini V. F. , Berardi M. , Petridis F. D. , Agulli M. , Ragni L. , Assenza G. E. , Rucci P. , Gargiulo G. D. , Angeli E. 
Published: December 2024

Background:
Grown-up congenital heart disease patients (GUCHs) represent an expanding population characterized by higher early post heart transplant mortality compared with the population without congenital heart disease. Aim of our study was to identify potential preoperative risk factors and to develop a risk-score that could complement the pre-transplant assessment of GUCHs.

Methods:
From 2009 to 2024, 33 GUCHs underwent heart transplantation. Spearman’s correlation coefficient or Kendall’s tau were used to examine bivariate relationship between pre-transplant variables and mortality. Variables were explored using a correlation matrix: positive or negative correlations greater than 0.30 in absolute value were highlighted. ROC analysis was performed to evaluate predictive ability of the variables and score. Optimal cut-offs were identified by Youden’s J index. Moreover, ROC analysis was used to compare our score with the score proposed by Seese et al.

Results:
Seven predictors resulted associated with mortality: sodiemia (p=0.024), haemoglobin (p=0.013), haematocrit (p=0.007), FEV1 (p=0.068), systolic pulmonary artery pressure (PAP, p=0.037), diastolic-PAP (p=0.011) and mean-PAP (p=0.013). Overall survival in patients with Bologna’ score greater than 3 was 75%, 63% and 63%, while in patients with Bologna’ score lower than 3 was 88%, 83% and 83% at 1,5 and 10 years respectively(log-rank=0.037). ROC analysis comparing the two scores revealed a better accuracy of the Bologna score (AUC=0.730) than Seese’s score (AUC=0.488).

Conclusions:
Mortality in GUCHs is not only influenced by cardiac pathology but by the patient’s overall compensation picture. The developed population-specific risk-score showed to be predictive for mortality and could be used in the pre-transplant evaluation of GUCHs.
A MODIFIED END-TO-SIDE APPROACH FOR AORTIC ARCH RECONSTRUCTION IN NEONATES YIELDS OUTSTANDING OUTCOMES
Authors: Hafdhullah M. , Varrica A. , Abrami G. , Reali M. , Lo Rito M. , Torchio F. , Giamberti A. , Parolari A. , Tarus A. 
Published: December 2024

Background and Aim:
This study focuses on evaluating the outcomes of a modified end-to-side aortic arch reconstruction for treating hypoplastic aortic arch with or without coarctation of the aorta and interrupted aortic arch via sternotomy in infants.

Methods:
This study retrospectively reviewed 60 infants who underwent modified end- to-side reconstruction at our institution between January 2020 and January 2024. The study evaluated mortality, morbidity and reinterventions.

Results:
A total of 60 patients (32 males) were included in this study. Mean age at surgery was 49 days. Patients were divided into: group A, arch anomalies with or without ASD and/or VSD; group B (55%) arch anomalies associated with TGA, single ventricle physiology, DORV, CAVC, MV stenosis and subaortic stenosis. Three patients (6.2%) died during postoperative period, all from group B. Incidence of postoperative complications was 30%, wound dehiscence (9%), acute neurological lesions (8%) and vocal cord paralysis (6%). Bronchial compression was not observed in any patient. Three patients required early reoperations due to residual valvular dysfunction. Mean CPB time was 152 minutes, mean aortic cross-clamp time was78 minutes and mean antegrade cerebral perfusion time was 40 minutes.

Conclusion:
Modified end-to-side technique in neonates is safe and effective with favorable outcomes. This approach reduces the incidence of some common complications by minimizing the tension on the anastomosis, reducing ovalization of the aortic lumen, thereby reducing future reobstruction; it prevents compression on the left bronchus and protects the left recurrent laryngeal nerve from inadvertent injuries. Selective cerebral perfusion is a key factor in minimizing acute brain injuries.