bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMPARATIVE EFFICACY OF SUBVALVULAR PROCEDURE VERSUS ISOLATED ANNULOPLASTY IN MITRAL VALVE REPAIR: A META- ANALYSIS ON MORTALITY AND MITRAL REGURGITATION RECURRENCE
Authors: Giambuzzi I. , Messi P. , Maccarana A. , Di Mauro M. , Bonalumi G. 
Published: December 2024

Introduction:
The aim of this meta-analysis is to identify if adding subvalvular procedure (SVP) in mitral valve repair in functional mitral regurgitation (MR) improves the result in contrast to isolated annuloplasty (AN).

Methods:
A literature search in PubMed, Cochrane Library, and ClinicalTrials.gov covered January 2010 to August 2024, focusing on ischemic and functional mitral disease, mitral valve repair, and surgical techniques. Inclusion criteria followed PRISMA guidelines with the primary objective to compare early and late mortality and MR recurrence. Screening involved independent assessments with a PRISMA flowchart. Bias was evaluated with ROBINS-E, quality with the modified Newcastle-Ottawa scale, and heterogeneity with I2 statistics, controlling for high-quality studies only as sensitivity analysis.

Results:
A total of 1904 papers were found with a traditional research and 164 with the Umbrella research. After screening, 14 studies were included, for a total of 999 patients, of which 519 (51.95%) underwent AN and 480 (48.05%) underwent adjunctive SVP. There was no difference in early mortality (OR 0.91, CI95% 0.46-1.8, p=0.87, I2=0), in late mortality (OR 1.24, CI95% -0.17-0.60, p=0.28, I2=0) nor post operative complications (OR 0.7, CI95% 0.35- 1.39, p=0.3035, I2= 70.63) but in the SVP group there was a significant reduction in MR recurrence with OR 0.48, CI95% 0.33-0.71, p = 0.0002, I2=0. No publication bias was found, even if 9 studies (64.29%) showed high risk of bias with ROBINS-E tool.

Conclusions:
SVP are associated with lower rates of MR recurrence, without modifying mortality nor immediate post-operative complications.
A MULTIDISCIPLINARY APPROACH TO RARE AND GENETIC AORTIC DISEASE
Authors: Corigliano K. , Grandinetti M. , Mazzenga G. , Cammertoni F. , Nesta M. , Pavone N. , Bruno P. , Amodeo A. , Massetti M. 
Published: December 2024

Background and Aim:
Considering the increasing number of genetical diagnosis regarding connective tissue syndromes (Marfan, Ehlers-Danlos, Loeys-Dietz), there is an increasing attention about young patients developing acute aortic syndromes, which can be catastrophic at times. Care of these patients represents a major challenge, due to the variability in timing and severity of the clinical presentation, also determined by the underlying genetic substrate.

Methods:
In this retrospective study we consider two groups of patients with known connective tissue disease who underwent aortic surgery and were followed at our institution: Group A and Group B, composed by 31 (from 2014 to 2024) and 36 patients (from 2000 to 2010), respectively. We retrieved data of all enrolled patients from the electronic archives of the Institution. Patients’ follow-up data were collected at 8-year average post-intervention.

Results:
There were no differences between the two groups regarding diagnosis, presence of preoperative risk factors and mortality at follow-up. Re-operation or urgent hospitalization were more frequent in Group B by 16.4% than in Group A (32.4%; N:12 vs 16%; N:5; p= 0.047). There was greater adherence to follow-up (and risk factors control) rate in Group A than Group B (p=0.038).

Conclusions:
A clinical pathway for rare genetic aortic disease is mandatory. Our team includes dedicated cardiac and vascular surgeons, cardiologists, genetics, radiologists, obstetrics, anesthesiologists. We created a shared tailored clinical protocol for these patients’ needs. Our preliminary experience showed that novel multidimensional approach plays a key role in clinical surveillance of this peculiar population.
EARLY AND LONG-TERM OUTCOMES OF FROZEN ELEPHANT TRUNK IN MARFAN SYNDROME: THE BOLOGNA EXPERIENCE.
Authors: Bianco E. , Murana G. , Castagnini S. , Snaidero S. , Di Marco L. , Pacini D. 
Published: December 2024

Introduction:
Endovascular procedures in patients with Marfan syndrome are controversial. This study evaluates the early and long-term outcomes of the frozen elephant trunk procedure in these patients.

Materials and Methods:
From 2007 to 2022, 27 patients with Marfan syndrome underwent FET at our institution. Outcomes were analyzed retrospectively.

Results:
Mean age was 42.8 ± 13.5 years; 74.1% were male. Most procedures were reoperations (81.5%), with 74.1% previously treated for proximal aortic disease. Indications included residual type A aortic dissection (48.1%), chronic type B dissection (22.2%), degenerative aneurysm (11.1%), and acute type A and type B dissections (3.7% and 11.1%). Combined procedures were performed in 48.1% of case, with a total of 37% root replacements, such as Bentall or David procedure. Permanent and transient neurological deficits affected 3 (11.1%) and 2 (7.4%) patients, respectively; paraplegia occurred in 1 patient (3.7%). In- hospital mortality was 11.1%, comprising patients who underwent emergency surgery. Long- term survival rates at 1 and 5 years were 85.4% and 74.6%. During follow up, stent graft–induced new entry (SINE) was developed in 14.8%. TEVAR extension was required in 33.3% and open surgery in 14.8%. Freedom from TEVAR at 1 and 5 years was respectively 66.7% and 61.1%, while from open surgery was 90.5% and 77.6%.

Conclusions:
Frozen elephant trunk can be considered a promising option in patients with Marfan syndrome requiring arch replacement. During follow-up a straight surveillance is necessary to early detect distal aortic pathologies.
EVALUATION OF RIGHT VENTRICULAR SYSTOLIC FUNCTION AFTER CORONARY ARTERY BYPASS GRAFTING: THE IMPACT OF DEL NIDO CARDIOPLEGIA.
Authors: Romeo M. G. , Parisi V. , Conte M. , Baiano S. , Pilato E. 
Published: December 2024

Background and Aim:
We aimed to investigate the effects on postoperative right ventricular systolic function (RSVF) using different cardioplegic solutions and to evaluate the efficacy of Del Nido cardioplegia (DNC), compared with conventional crystalloid cardioplegia (CC), in adult patients undergoing coronary artery bypass grafting (CABG). TAPSE is a reliable, rapidly measurable, and easily replicable echocardiographic parameter for assessing longitudinal RVSF and, consequently, postoperative outcome in CABG surgery. RVSF is a major determinant of postoperative surgical outcome, so estimating the impact of cardioplegic solution on the reduction of ischemic damage is crucial.

Methods:
Our retrospective study included 118 patients treated with CABG. The population, homogeneous in terms of age, comorbidities, ejection fraction and operative timing, was divided into two groups according to the type of cardioplegia used during extracorporeal circulation (ECC): Group 1 consisting of 57 patients using CC, Group 2 consisting of 61 patients using DNC. RVSF was evaluated by echocardiography, assessing the tricuspid annular plane systolic excursion (TAPSE) pre and post-operatively.

Results:
Both groups showed a normal pre-operative TAPSE value (CC: 23 ± 2 mm vs DNC: 22.7 ± 2,4 mm; p=0.51). Postoperatively, in both groups the TAPSE was significantly reduced, as expected (CC: 13,3 ± 1,96 mm vs DNC: 14,7 ± 2,9 mm). Comparing the post-operative TAPSE value between groups, Group 2 showed a significantly higher value than Group 1 (p=0.003).

Conclusions:
The use of DNC in patients undergoing CABG improves short-term RVSF outcome, compared with the CC solution. In DNC-treated patients, the postoperative TAPSE showed a better RVSF.
EARLY EXPERIENCE IN THE EXPLANTATION OF PERCUTANEOUS AORTIC VALVES DUE TO ENDOCARDITIS OR VALVE DEGENERATION
Authors: Mikus E. , Fiorentino M. , Sangiorgi D. , Calvi S. , Tenti E. , Tremoli E. , Tripodi A. , Savini C. 
Published: December 2024

Background:
The rise in transcatheter aortic valve implantation (TAVI) has increased the need for surgical removal of degenerated or infected TAVI valves. However, reports on TAVI removal are limited. This study presents our initial experience with surgical explantation of percutaneous aortic valves.

Materials and Methods:
Between 2017 and March 2024, a total of 8 patients underwent surgical removal of a percutaneous aortic valve at our institution due to either degeneration or endocarditis. The explanted valves included balloon-expandable prosthesis (n=3), self-expandable and mechanically expandable prosthesis (n=5).

Results:
The patient cohort consisted of 8 males with a mean age of 71.5 years (IQR 63.25–79.0). Half of the patients (4, 50%) were diagnosed with acute endocarditis. Previously implanted TAVI devices included Boston Scientific Acurate Neo (12.5%), Boston Scientific Lotus (50%), Edwards Sapien (25%), and Meril Myval (12.5%). Median preoperative EuroSCORE II was 8.04 (IQR 4.97-10.53). Surgical interventions included isolated aortic valve replacement in 6 patients, a Bentall procedure in 1, and a Commando procedure in 1. One patient had a minimally invasive approach. Median CPB time was 126.5 minutes (IQR 89.0-183.5), and median aortic cross-clamp time was 77.5 minutes (IQR 64.0-146.5). Median ventilation time was 9 hours (IQR 5.75-13.5), and the median ICU stay was 2.5 days (IQR 2-3). No major postoperative complications were observed, and no hospital mortality occurred.

Conclusions:
This study shows that surgical removal of percutaneous aortic valves is feasible and safe in a high-risk cohort. As TAVI valve issues increase, refining techniques and collecting more data is crucial.
HYBRID REVASCULARIZATION WITHIN MIDCAB PANORAMA: LONG- TERM FOLLOW-UP LOOKING AT MINOTAUR
Authors: Torre T. , Pozzoli A. , Valgimigli M. , Leo L. A. , Muretti M. , Toto F. , Ferrari E. , Demertzis S. , Pedrazzini G. 
Published: December 2024

Introduction:
Hybrid Coronary Revascularization (HCR) in the setting of minimally invasive direct coronary artery bypass (MIDCAB) constitutes an effective solution in myocardial revascularization, coniugating the best of both revascularization procedures. Data on antiaggregation management are still lacking. MINOTAUR trial aims at evaluate the feasibility of cangrelor as bridging therapy.

Methods:
From February 2013 to August 2024 a total of 2100 patients underwent surgical coronary artery revascularization at our institution, of whom, 103 (4.9%) received left anterior mini-thoracotomy access (MIDCAB), either isolated (N=85) or in combination with percutaneous coronary intervention to pursue a hybrid strategy (N=18, HCR group). All patients received left internal mammary (LIMA) to left anterior descending artery (LAD) grafting.

Results:
After a median follow-up of 80 months (range 3.1-155 months), the MIDCAB cardiac mortality has been 0%. Overall mortality was 3%, with one in-hospital death and two additional late deaths. Conversion to sternotomy happened in 2 patients (1.9%) and surgical re- explorations occurred in 5 patients (4.8%), of whom three for bleeding and two for graft failure. In the HCR group, 13 patients (72%) received percutaneous revascularization (PCI) after MIDCAB, with a mean of 1.6 ± 0.6 treated vessels and 2.2 ± 0.9 drug-eluting stents implantation. The last 3 patients were enrolled in the MINOTAUR trial.

Conclusions:
MIDCAB, isolated or in association with HCR is associated with encouraging mid- and long-term results, in selected patients presenting multivessel disease and discussed within a dedicated heart-team. The MINOTAUR trial will define the best approach to manage the antiaggregation strategy.
LOWER VALUES OF INTRAOPERATIVE CORONARY GRAFTS TRANSIT TIME FLOW MEASUREMENTS OBSERVED IN FEMALE GENDER DO NOT AFFECT EARLY OUTCOME AFTER CABG
Authors: Nardi P. , Buioni D. , Labriola V. , Viscogliesi C. , Agneni F. , Scognamiglio M. , Salvati A. C. , Altieri C. , Boumis M. , Bassano C. , D’Onofrio A. 
Published: December 2024

Background and Aim:
Intraoperative transit time flow measurement (TTFM) of left internal thoracic (L-ITA) and saphenous vein (SV) grafts can improve clinical outcome after CABG. We have retrospectively investigated if there were differences in female and male gender on TTFM–flow (mL/min) and pulsatility index (PI-value)– after CABG, and early outcome.

Methods:
Between September 2022 and September 2023, TTFM was performed in 101 consecutive patients (21 females, 20%, 80 males, 80%) undergoing CABG, isolated (n=75) or associated with other procedures (n=26).

Results:
No differences were observed in age (66.2±11 vs 66.9±9 years), Euroscore-2 (4.2±3 vs 3.8±3), left ventricular ejection fraction (54±8% vs 52±9%) (P>0.5, for all comparisons). Associated procedures were more frequently performed in females (47.6% vs 20%; P<0.05). Left anterior descending artery (1.4±0.2 vs 1.6±0.2 mm; P=0.001), obtuse marginal branch (1.3±0.2 vs 1.5±0.3 mm; P<0.05), right posterior artery (1.2±0.2 vs 1.4±0.3 mm; P<0.05) diameters were smaller in females. TTFM flow of L-ITA or SV grafts on the left anterior descending artery (28±9 vs 38±18 mL/min; P<0.05), obtuse marginal branch (27±15 vs 42±28 mL/min; P<0.05), right posterior descending artery (29±11 vs 36±19 mL/min; P>0.5) was lower in females. No PI-value differences were observed in the coronary arteries territories (3.9±0.8 vs 3.7±0.9; 3.8±0.5 vs 3.9±1; 3.5±0.9 vs 3.3±1) (P-values>0.5). There were no operative major cardio-vascular complications; respiratory failure occurred in 3 male patients.

Conclusions:
Our data show that female patients have smaller coronaries and lower TTFM values than men, but no difference in PI-values. However, clinical results are similar.
SEX DIFFERENCES IN LONG TERM OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING: GOOD THINGS COME TO THOSE WHO WAIT
Authors: Saitto G. , Mariangela D. , Cammardella A. , Comisso M. , Russo M. , Chirichilli I. , Nicolò F. , Irace F. , Tramontin C. , Lio A. , Pinnarelli L. , Davoli M. , Ranocchi F. 
Published: December 2024

Aim:
Coronary artery bypass grafting (CABG) is the most commonly performed cardiac surgery globally. The aim of the study is to investigate outcome of CABG according to participant sex in the real word.

Methods:
We retrospective analysed 20337 CABG operations performed in an Italian Region, Lazio, using a regional administrative dataset.

Results:
Between 2008 and 2022, 16983 male and 3354 female patients underwent CABG and were analysed. At baseline male patients had lower left ventricle ejection fraction (LVEF <30% 3.52% vs 2.68; 30<LVEF<50 34.19% vs 31%; LVFE >50% 62,2% vs 66,2%, p<0.0001) but with a lower risk profile: female patients were older (70+9 vs 66+9.5 yo, p<0.05), more diabetics (28 vs 20%, p<0.0001), cholesterol disorders (20,5% vs 17.6%, p<0.0001), obesity (2.6 vs 1.6%, p<0.0001), anemia (3.6 vs 1.7%, p<0.0001), arterial hypertension (43.3 vs 36.6%, p<0.0001) and heart failure symptoms (10,1 vs 7,1%, p>0.0001).
Even if early mortality (30d) was higher in female vs male patients (3.1% vs 1.9%, p<0.05), long term survival was higher in women at 5 and 10y respectively 88 vs 87% and 73 vs 70%.

Conclusions:
Our data suggest that female sex could be associated to a higher profile risk and 30d mortality after CABG but in the long term could be protective.
SEE IT BEST: A PROPENSITY-MATCHED ANALYSIS OF ULTRASOUND- GUIDED VERSUS BLIND FEMORAL ARTERY PUNCTURE IN BALLOON- EXPANDABLE TAVI
Authors: Gennari M. , Agrifoglio M. , Maccarana A. , Severgnini G. , Iennaco V. 
Published: December 2024

Background:
Currently, transcatheter aortic valve implantation (TAVI) is the standard procedure recommended for patients over 75 years of age with symptomatic aortic valve stenosis. Percutaneous transfemoral (TF) access is the main route used to perform the procedure. Among periprocedural complications, access-related ones are the most frequent, potentially leading to prolonged in-hospital stays and transfusions.

Methods:
We performed a retrospective analysis of prospectively collected data on consecutive patients undergoing TF- TAVI with the latest generation balloon-expandable transcatheter valve between 2013 and 2022.

Results:
A total of 600 patients were analyzed, differentiating the population between ultrasound-guided and blind common femoral artery puncture. Valve Academic Research Consortium 3 (VARC-3)criteria were used to report at 30 days and follow-up. In our propensity-matched comparison of the two groups, we found a strong reduction in access- related complications in the echo-guided group, particularly in terms of reduction of major and minor bleedings. We also found a significant trend in reduction of local complications, such as pseudoaneurysms, hematomas, arterio-venous fistulas, dissection of the femoral or iliac arteries, and stenosis.

Conclusions:
Although there is a lack of consensus on the role of ultrasound guided puncture, we found better outcomes for patients having an echo-guided puncture of the main access, particularly with regard to access-related complications, early mobilization, and early discharge home.
GIANT RIGHT CORONARY ARTERY ANEURYSM: LIFE-SAVING SURGICAL TREATMENT IN AN UNEXPECTEDLY ASYMPTOMATIC PATIENT
Authors: Musto M. , Totaro P. , Imò D. , Pelenghi S. 
Published: December 2024

Introduction:
Coronary artery aneurysm (CAA) is defined as a dilation exceeding the diameter of an adjacent referent portion by more than 1.5 times. In rare circumstances CAA can be defined as giant, when exceed 8-20 mm. Here we report a rare case of a casual diagnosis of asymptomatic giant right coronary artery aneurysm who underwent successful surgical treatment.

Case report:
A 66 y.o. male was referred with a giant mediastinic mass revealed at a CT scan. The patient claimed to be asymptomatic. Pre-operative evaluation included: a) TT-Echocardiography showing a big ovalar mass next to the atrioventricular groove with blood flow from RCA; b) Ecg-gated-CTscan which showed a big (14x12.5 cm) contrast-enhanced mass arising from the RCA confirmed at c) coronary angiography. After careful Heart Team evaluation, surgical correction by mean of aneurism ligation, was deemed to be the only treatment option.

Surgical Treatment:
CPB was established via right axillary artery and peripheral femoral vein cannulation. Median sternotomy allowed the exposition of the huge aneurysm, nourished by the right coronary artery, with a complete dislocation of aorta. Surgical correction included aneurysm incision, exclusion of all communications and ligation. CABG on RCA was not necessary. Following uneventful course, post-operative CT scan showed no evidence of active blood reperfusion to the aneurysmatic remnant.

Conclusion:
CAAs are rare but potentially catastrophic conditions. Once the diagnosis is made, despite the lack of agreed consensus, early treatment with accurate preoperative evaluation is pivotal in order to optimize the outcome.
BEATING HEART REPAIR OF POST-INFARCTION VENTRICULAR PSEUDOANEURYSM: A CASE REPORT
Authors: Iavazzo A. , Longobardi A. , Chivasso P. , Colombino M. , Mariniello A. , Pirozzi F. , Vassallo M. G. , Bonadies A. , Coscioni E. 
Published: December 2024

Background and Aim:
Left Ventricular Pseudoaneurysm (LVPA) is a rare but disastrous complication of myocardial infarction. Urgent surgical repair is required to avoid catastrophic rupture and it’s is necessary in order to exclude the pseudoaneurysm to preserve the LV geometry and function. Beating heart repair can be successfully performed in specific patients.

Methods:
A 71-years old male patient with a history of systemic hypertension, cigarette smoking, hyoercholesterolemia, peripheral arterial disease, presented with a 48-hours progressive epigastric pain. The diagnosis of anterior STEMI was made and the patient was referred for early coronary angiography, which revealed an occlusion of the left anterior descending artery and a PTCA with a stent implantation was successfully performed. Two days later, the echocardiography showed an apical free wall defect, suspicious of a small LVPA. An MRI confirmed the diagnosis and the patient was admitted to cardiac surgery department. A beating heart repair of the LVPA was performed. A 2-0 Prolene purse-string suture was done at the apex of the left ventricle between the viable myocardium and the infarcted tissues. The exclusion of the pseudoaneurysm was performed using two suture lines (U-shaped single stitches and a continuous 2-0 Prolene suture reinforced by Teflon strips) with the apposition of a bovine pericardial patch.

Results:
Postoperative echocardiography showed the successful exclusion of the psudoaneurysm, confirmed by a one-month-post- intervention MRI.

Conclusions:
Beating heart repair of post-infarction left ventricular pseudoaneurysm is a new, feasible and simple approach and provides good short and middle-term results in selected patients.
THE NOT-WEIGHT-BASED DOSING STRATEGY OF DELNIDO CARDIOPLEGIA IS SAFE AND EFFECTIVE IN ACHIEVING MYOCARDIAL PROTECTION IN CARDIAC SURGERIES WITH STANDARD AND PROLONGED CROSS-CLAMP: PRELIMINARY RESULTS FROM I.R.DE.N. REGISTRY
Authors: Ferraro S. , Calanni C. , Damiano A. , Barbaro M. , Cotugno M. , Comentale G. , Pilato E. 
Published: December 2024

Background:
The use of delNido cardioplegia in adult cardiac surgery is increasing, with studies evaluating its safety yielding mixed results. Despite good perioperative outcomes, some suggest higher long-term postoperative mortality. Key debates include dosing strategies, with some centers using weight-based dosing and others following delNido’s protocol of a single 1000 ml dose for patients over 70 kg. This study reports on the outcomes of a standard dosing and redosing protocol in patients undergoing isolated or combined coronary artery bypass grafting (CABG) with normal and prolonged cross-clamp times.

Methods:
A retrospective single-center analysis was carried out on 207 patients who underwent isolated or combined CABG. The patients were divided into groups according to the type of cardioplegia (delNido vs. cold blood), and perioperative outcomes were compared. This analysis included patients with cross-clamp times longer than 80 minutes.

Results:
There were no baseline or preoperative risk profile differences between the groups. Although delNido patients had a slightly higher median cross-clamp time, both groups were similar in terms of postoperative troponin release, ICU and hospital stays, and 12-month survival. The delNido group required less inotropic support, both in terms of duration (p<0.001) and total dose (p=0.015). However, among patients with prolonged cross-clamp times, there were no differences in survival or postoperative outcomes.

Conclusions:
The delNido cardioplegia, using a non-weight-based protocol, appears to be safe and effective for myocardial protection in cardiac surgeries, including those with standard and prolonged cross-clamp times.