bluuebunny/crossref_metadata_2025_split huggingface dataset:
EXTENSIVE VERSUS CONVENTIONAL TREATMENT FOR TYPE A AORTIC DISSECTION: PRELIMINARY RESULTS OF ASCYRUS MEDICAL DISSECTION STENT
Authors: Segreto A. , Pisano C. , Torre S. , Castrovinci S. , Amoncelli E. , Territo S. , Argano V. 
Published: December 2024

Background and Aim:
Acute type A aortic dissection (ATAAD) is a critical condition typically managed with high risks extensive surgical interventions, such as open aortic repair, especially for patients with complex anatomies or comorbidities. AMDS offers a less invasive, hybrid approach that stabilizes the true lumen and promotes aortic remodeling, potentially reducing the need for more complex surgery and rate of reintervention. This study compares preliminary outcomes between patients treated with AMDS in Zone 0 and those undergoing conventional surgical treatment such as Ascending aortic replacement ± hemiarch.

Methods:
Between August 2019 and August 2024 we treated 70 patients for ATAAD. Excluding 54 patients treated with arch replacement and reimplantation of epiaortic vessels, this retrospective analysis compares 8 patients treated with AMDS (AMDS group) and 8 patients treated with ascending aortic replacement ± hemiarch (control group). We collected data on demographics, clinical characteristics, procedural details, and postoperative outcomes.

Results:
The median age was 57 years for the AMDS group and 66.5 years for the control group. Although there was no significant difference in procedural times and in-hospital mortality between the groups we found a significant difference in aortic remodeling in the AMDS group on follow-up CT scans with complete or partial false lumen thrombosis.

Conclusions:
AMDS appears to be a promising alternative to conventional surgery for ATAAD, showing improved aortic remodeling despite similar in-hospital mortality rates. However, further studies with larger sample sizes and longer follow-up are needed to confirm the long-term safety and efficacy of AMDS in ATAAD management.
NON-ANATOMICAL DEBRANCH OF THE SUPRA-AORTIC VESSELS DURING COMPLEX AORTIC SURGERY: EARLY AND MID-TERM RESULTS
Authors: Faggi A. , Del Forno B. , Rinaldi E. , Pallotta R. , Azzola Guicciardi N. , Verzini A. , De Bonis M. , Alfieri O. , Castiglioni A. , Maisano F. 
Published: December 2024

Background:
Several surgical techniques have been proposed over the years to treat aortic arch pathology, confirming the complexity of this disease. Our conventional approach is the «debranch-first technique» combined to frozen elephant trunk procedure (FET). In addition, an extra- anatomical bypass between the left common carotid artery and subclavian artery (CSB) is performed prior the main surgery. The aim of this study was to investigate the early and midterm results of this two-step-based procedure.

Methods:
Between 2012 and 2024, 87 patients underwent FET. The main indications were degenerative aortic aneurysm (26%), chronic aortic dissection (66.6%) and acute aortic syndrome (7%). REDO Aortic Surgery was performed in 61 patients (70%). EuroSCORE II and STS score were 5.85% and 1.93%, respectively. 78 patients (90%) were submitted CSB, prior to FET procedure. Both axillary arteries were cannulated; debranching first technique was performed during the cooling of the patient and - after the aortic arch replacement by a custom-made graft – at last sutured to the aortic graft.

Results:
30-Days Mortality occurred in 12 patients (14%). 10 patients had a stroke (fatal for 2 patients). 5.8% suffered from a temporary spinal cord ischemia. The estimated 5-year overall survival was 64%. 23 patients were submitted to a second-step endovascular procedures (41%).

Conclusions:
The debranch – first technique with non- anatomical sovraortic vessels reimplantation and previous CSB represents a safe and effective method to address this complex pathology. A longer follow up is needed to confirm the goodness of this approach.
DOES ZONE 2 OR ZONE 3 PRODUCE BETTER OUTCOMES FOR TOTAL AORTIC REPLACEMENT WITH THE FROZEN ELEPHANT TRUNK TECHNIQUE? A METANALYSIS
Authors: Ahmadi-Hadad A. , Milione A. , Moldon H. J. , Soltaniardestani S. , Damiano A. , Calanni C. , Pacciolla A. , Lonardo E. , Comentale G. , Pilato E. 
Published: December 2024

Backgroung:
Frozen elephant trunk (FET) technique is a treatment for various pathologies of the thoracic aorta. The distal aortic anastomosis may be made at various points along the aortic arch, most often zone 3 but it is hypothesized that zone 2 may be safer. This meta-analysis aimed to compare short-term mortality and incidence of various adverse effects for FET procedures which used aortic zone 2 or aortic zone 3 as a starting point.

Methods:
Pubmed, Medline, and Embase were searched on the 6th March 2024 producing 253 results. Abstracts and then full texts were screened to identify 4 studies which met all criteria. Our protocol was registered in PROSPERO on the 25th May 2024 with registration number CRD42024550403. Data were extracted via custom computer code and analyzed with Revman.

Results:
Acute kidney injury (AKI) was significantly less likely to occur in procedures using zone 2 (RR: 0.66; p=0.003). Choice of zone 2 or zone 3 confers no statistically significant effects on risk of bleeding events (RR: 0.53; p=0.42); parapesis (RR: 0.97; p=0.96); paraplegia (RR: 0.52; p=0.25); 30-day mortality (RR: 0.48; p=0.31); stroke (RR: 0.51; p=0.10).

Conclusions:
AKI appears to be less likely in when distal anastomosis is made in zone 2. Otherwise, carrying out a distal anastomosis in aortic zone 2 or aortic zone 3 may be equally safe in terms of the outcomes analyzed. With neither option appearing to any statistically significant effect on short-term mortality, or incidence of stroke, paraplegia, or parapesaris.
IS THERE A ROLE FOR HEMOADSORPTION DURING CARDIOPULMONARY BYPASS AND CIRCULATORY ARREST IN ACUTE AORTIC DISSECTION SURGERY?
Authors: Gigliotti G. , Franzese I. , Fierro N. , Gripshi F. , Tassone M. R. , Sasso F. , Grassi P. , Mazzaro E. 
Published: December 2024

Background:
This retrospective single-center study evaluates the effects of hemadsorption with CytoSorb ® on the vasoactive and inotropic support in patients undergoing surgery for acute aortic dissection (AAD) with circulatory arrest.

Methods:
We enrolled 29 consecutive patients undergoing AAD surgery with Cytosorb®, between May 2022 and June 2024, and 33 consecutive patients previously treated without Cytosorb® (January 2018 – May 2022). The primary endpoint was the changes in vasoactive- inotropic score (VIS), which quantifies the degree of hemodynamic support. VIS and drugs’ doses were collected at 8 time-points from preoperative to 72 hours after surgery. Nonparametric tests were applied and p&lt;0.05 was settled for statistical significance.

Results:
Baseline characteristics did not differ between the two groups, except for the cardiopulmonary bypass temperature and circulatory arrest time, which are not significant related to drug request at linear regression. The median VIS showed a trend with two peaks, one early after cardiopulmonary bypass discontinuation and one 6 hours after surgery. The drugs’ doses and VIS were lower in Cytosorb® group at any time-points, with significant lower value of VIS from the ICU admission (p=0.026) to 24 hours after surgery (p=0.029). Nevertheless, there were no differences in clinical outcome (in-hospital mortality, p=1; hospital lengths of stay, p=0.1; postoperative highest creatinine value, p=0.05).

Conclusions:
Evidence on CytoSorb® during AAD surgery is poor. In this scenario, our results suggest an improved hemodynamic stability using CytoSorb®. However, many factors may compete to vasoactive request and further examination in large sample sizes are needed.
CARDIOROOT VS VALSALVA: A COMPARATIVE STUDY IN PATIENTS UNDERGOING DAVID WITH 4D FLOW METHOD
Authors: Tassi S. , Mariani C. , Azzini F. , Nania R. , Castagnini S. , Niro F. , Pulvirenti B. , Pacini D. 
Published: December 2024

Introduction:
This study compares the fluid dynamics of two vascular prostheses used in Tirone-David procedures, aiming to evaluate their performance in terms of blood flow patterns and hemodynamic parameters within the aortic root.

Matherial and Results:
This study compared twelve patients underwent valve-sparing surgery using either Valsalva Graft Terumo or CardioRoot Gentinge. The procedural success rate was 100%. All patients successfully underwent 4D magnetic resonance imaging. The bulk flow parameters evaluated were: peak velocity, Wall share stress, Volume of blood. Each parameter was evaluated on three sections: mid neo-sinus of Valsalva (P1), mid ascending aorta (P2), distal native ascending aorta (P3). No significant statistical difference was found in peak velocity, wall shear stress and blood volume at P1 P2 between the prostheses. The volume at P3 was statistically different (p-value=0.04), probably influenced by anatomical variability. Simulation of engineered models confirmed the presence of vorticity at level of the neo-sinuses of Valsalva without significant differences between the two different prostheses

Conclusion:
4D flow MRI and computational fluid dynamics simulations revealed similar flow patterns and hemodynamic characteristics within the aortic root, suggesting that both grafts offer comparable performance in terms of fluid dynamics. The statistical analysis data revealed no significant differences in flow, wall shear stress, or velocity between the two vascular grafts. Streamline observations showed similar turbulence patterns. These findings suggest that the choice of graft may have minimal impact on postoperative outcomes in valve- sparing surgery.
RELATIONSHIP BETWEEN DIABETES AND LONG-TERM OUTCOMES IN PATIENTS UNDERGOING ISOLATED CORONARY ARTERY BYPASS GRAFTING.
Authors: Vitale N. , barili F. , d’errigo P. , baglio G. , daprati A. , badoni G. , duranti G. , donatelli F. , parolari A. , rosato S. 
Published: December 2024

Background and Aim:
Diabetes is a known risk factor for coronary artery disease, but its impact after coronary artery bypass grafting (CABG) remains uncertain, with limited data on long-term outcomes. This study aims to assess how diabetes affects 10-year outcomes following CABG.

Methods:
The PRedictIng long term Outcomes afteR Isolated coronary arTery bypass surgery (PRIORITY) project is an observational cohort study that combines two prospective multicenter studies from 2002-2004 and 2007-2008 on isolated CABG. Follow-up data were gathered from administrative databases and extended up to 10 years post-surgery. Primary outcome was a composite of Major Adverse Cardiac and Cerebrovascular Events (MACCE). Baseline differences between patients with and without diabetes were adjusted using propensity score inverse probability of treatment. Time-to-event data were analyzed through Cox- regression and competing risk analysis.

Results:
The study included 10989 patients with complete follow-up information who had isolated CABG, with 32.3% having diabetes. Diabetic patients exhibited a higher 10-year risk for MACCE (weighted HR 1.22, 95% CI 1.17 - 1.27, p<0.001), mortality (HR 1.39, 95% CI 1.32 - 1.47, p<0.001), stroke (HR 1.33, 95% CI 1.21 - 1.47), and myocardial infarction (MI) (HR 1.16, 95% CI 1.07 - 1.25, p<0.001). However, diabetes was not linked to higher incidence of repeat revascularization (HR 1.03, 95% CI 0.95 - 1.12, p=0.41).

Conclusions:
Diabetic patients faced poorer outcomes, with a higher 10-year incidence of myocardial infarction and a lower rate of repeat revascularization, suggesting that diabetes may have a more detrimental effect on microvascular health rather than on the grafts.
THE IMPACT OF FEMALE GENDER ON EARLY AND LONG-TERM OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING SURGERY
Authors: Nardi P. , Altieri C. , Labriola V. , Latini E. , Cipullo F. , Salvati A. C. , Scognamiglio M. , Bassano C. , D’Onofrio A. 
Published: December 2024

Aim:
Data on female gender differences on clinical prognosis after coronary artery bypass grafting (CABG) are still controversial. We retrospectively evaluated the impact of women patients in comparison with men undergoing CABG on long-term outcome.

Methods:
Between December 2014 and March 2022, 1044 consecutive patients (162 females, 15.5%, 882 males, 84.5%) underwent isolated CABG. The mean follow-up was 40±27 (median 38) months. Logistic and Cox model analysis regressions were used to assess the risk of female gender and other variables, Kaplan-Meier estimates to assess survival rates.

Results:
Baseline characteristics were similar, Euroscore-2 was higher in women (3.23% vs 2.63%; P=0.04). There was no difference in the use of left internal mammary artery (95.5% vs 94.9%; P>0.80). Women did not have a significant higher operative mortality than men (n=5, 3.08% vs n=17, 1.93%; P=0.37). Independent predictors of early mortality were emergency CABG (P<0.0001), PCI within 30 days (P=0.002), and the higher Euroscore-2 (P=0.016). At 7.5 years, actuarial survival was 87%±3.6% for female gender vs 88%±1.9% for male gender, freedom from cardiac death 97%±1.8% vs 96.6%±1.0%, from MACE 87%±6.2% vs 90%±2.5% (P-values>0.5). Independent predictor of all-causes death and cardiac death was the advanced age (74 years in dead patients vs 64 years in survivors; P<0.0001). Female gender was not a predictor of neither operative mortality (P=0.34) nor worse long-term outcome (P=0.41).

Conclusions:
Women undergoing CABG do not appear to be associated with worse early prognosis. Freedom from late all-causes mortality, cardiac death and cardiac events are equally satisfactory, highlighting the positive protective effect of CABG over time also in women.
THE PROTECTIVE BENEFITS OF MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION IN CORONARY ARTERY BYPASS SURGERY: A SINGLE-CENTER EXPERIENCE
Authors: Snaidero S. , Mariani C. , Fabiani L. , Tammaro I. , Folesani G. , Barberio G. , Pacini D. 
Published: December 2024

Background and Aim:
Minimal invasive extracorporeal circulation (MiECC) is an advanced CPB technology that reduces complications compared to standard CPB. The study aims to evaluate the effectiveness of MiECC in coronary artery bypass (CABG) surgery, focusing on outcomes like inflammation, blood transfusion and organ protection.

Methods:
From April 2016 to June 2024, 63 patients underwent CABG procedure with MiECC at our center. A 1:1 propensity-matching algorithm was employed to match the patients with 63 patients who underwent CABG procedure with standard ECC. The variables used for matching were age, sex, BMI, LVEF, presence of diabetes mellitus, renal insufficiency, cross-clamp time and number of distal anastomosis.

Results:
Intra-operative outcomes demonstrated lower levels of lactates and glycemia in MiECC group with a statistical significance (2.1±0.8 vs 1.4±0.7, p<0.001 and 164±35.8 vs 124.4±31.5, p<0.001, respectively).
Early postoperative outcomes were similar between MiECC and standard ECC groups regarding renal and liver impairment and bleeding. LDH values were statistically inferior in MiECC group (419.9±239.8 vs 210.6±42.1, p<0.001). Needing of inotropes over 24-hours and MOF were higher in standard ECC group, without a statistical significance. 30-day mortality was higher in standard ECC group (3 vs 0, p=0.08).

Conclusions:
The use of MiECC for CABG surgery in our analysis showed a significant lower alteration in metabolic parameters such as lactate and blood glucose levels, suggesting a better overall patients’ perfusion during the procedure. Clinically, this translates in a shorter intubation time anf reduced ICU stay for the MiECC group.
LESS INVASIVE IMPLANTATION OF THIRD GENERATION LEFT VENTRICULAR ASSIST DEVICES: PRELIMINARY ANALYSIS
Authors: Loforte A. , Spitaleri A. , Monteleone G. , Abbà P. , Marro M. , Simonato E. , Sandoval A. , Gallone G. , Frea S. , Trompeo A. C. , Boffini M. , Rinaldi M. 
Published: December 2024

Background and Aim:
This study evaluates the short-term benefits of a less invasive surgical approach (LIS) compared to traditional full sternotomy (FS) for implanting third-generation left ventricular assist devices (LVADs).

Methods:
Out of 165 LVAD implantations at our institution, a retrospective analysis was performed on 115 centrifugal pumps recipients (HeartWare HVAD and HeartMate 3) between 2010 and 2023.

Results:
Of the 115 LVAD implants analyzed, 79% (n=91) were performed using FS, while 21% (n=24) used LIS. The LIS cohort was younger (median age 57 vs. 61 years, p=0.05) and more frequently received the HVAD device (83% vs. 17%, p=0.001). They presented with worse hemodynamic parameters and a higher frequency of moderate to severe tricuspid regurgitation (83.3% vs. 45.6%, p=0.001). Perioperatively, the LIS group had a lower use and shorter time of extracorporeal circulation (62% vs. 100%, p=0.001; median time 60 vs. 92.5 minutes, p=0.007), lower incidence of right heart failure (21.7% vs. 30.03%, p=0.044), and faster respiratory weaning (extubation at 48 hours, 70.8% vs. 52.7%, p=0.029). Additionally, no revision for bleeding was required (0% vs. 15.5%, p=0.014), and in-hospital mortality was lower (4.2% vs. 12.4%, p=0.003). At six months, the LIS group experienced fewer driveline infections (10.8% vs. 18.2%, p=0.05), cerebral events (4.6% vs. 6.9%, p=0.044), and pump thrombosis (0% vs. 1.4%, p=0.039).

Conclusions:
The less invasive surgical approach for LVAD implantation is a feasible and safe alternative to full sternotomy in selected patients.
HEART RE-TRANSPLANTATION: A SINGLE CENTER EXPERIENCE
Authors: Lechiancole A. , Copetti S. , Sponga S. , Benedetti G. , Di Lorenzo A. , Spagna E. , Rroshkodol A. , Vendramin I. 
Published: December 2024

Background and Aim:
Heart re-transplantation (re-HTx) represents a rare surgical option, due both to the shortage of donors and the complexity of re-HTx candidates. The aim of this study was to analyze the results of re-HTx.

Methods:
Out of 757 HTx performed in our Center, 34 were re-HTx. The re-HTx data, collected prospectively, were retrospectively analyzed. The primary endpoint was overall mortality, while secondary endpoints were postoperative complications.

Results:
The mean age of re-HTx recipients was 49±12 years. 22 patients (65%) were male. The most frequent comorbidities were: chronic renal failure (53%), dyslipidemia (26%), atrial fibrillation (24%), hypertension (18%), diabetes mellitus (15%). In 4 cases (12%) the re-HTx occurred within 2 weeks from the first HTx after severe graft failure, while in the remaining 30 patients (88%) the re-HTx occurred after 16±7 years, and the most frequent cause was coronary allograft vasculopathy. In 7 cases a combined kideny transplant was performed.
Grafts were preserved with ice (74%), normothermic perfusion (18%), and controlled hypothermia (9%). The average age of the donors was 40±15 years.
Overall 30-day mortality was 12% (n=4). The 5- and 10-year survival was 62% and 58%, respectively.
Postoperative use of IABP and ECMO was 9% and 6%, respectively. Grade>2 cell-mediated rejection occurred in 39% of patients, and infections were treated in 52%. Thirty-three percent of patients required ventilatory support >72 hours and 21% required hemodialysis.

Conclusions:
Re-HTx represents a valid treatment for patients with limited therapeutic options. However, shortage of organ availability requires careful patient selection combined with thorough perioperative management.
DRIVELINE INFECTION IN TWO CONTEMPORARY LEFT VENTRICULAR ASSIST DEVICES: A SINGLE CENTER RETROSPECTIVE ANALYSIS
Authors: Loforte A. , Monteleone G. , Spitaleri A. , Parrella B. , Aloi V. , Galanti G. A. , Abbà P. , Sandoval A. , Marro M. , Gallone G. , Boffini M. , Rinaldi M. 
Published: December 2024

Background and Aim:
Driveline infection (DLI) are common adverse events in left ventricular assist devices (LVADs) leading to severe complications and re-admissions.

Methods:
The study aims to characterize risk factors for DLI at 6 months postimplant. This single-center analysis included 137 LVAD consecutive patients (n=76 HeartMate3 [HM3], n=61 HeartWare [HVAD]; male 84.7%, mean age 59.4±8.7) implanted between 2010 and 2024. Demographics, clinical parameters, surgical strategies and outcomes were retrospectively analyzed.

Results:
At 6 months of LVAD support, 6.6% of patients were readmitted for DLI, 19% experienced DLI but were treated in the outpatient setting, and 74.4% had no DLI. Among DLI patients cohort at 6 months, the analysis showed an increased rate of pre-operative bloodstream infection (mostly Gram+ Cocci; 15.6% vs. 6.7% of no-DLI cohort, respectively, p=0.003), diabetes (28.1% vs. 20.2%, p=0.038), high BMI (25.8 vs. 23.8, p=0.05) and previous cardiac surgery (18.8 vs 11.5%, p=0.045). DLI occurred more frequently in the case of ‘-shape driveline tunnelling’ technique. HM3 patients showed less rate of DLI if ‘direct driveline tunnelling’ technique was adopted.

Conclusions:
DLI remains a delicate issue to address in LVAD recipients. Pre-operative risk factors should be properly weighted. ‘Direct tunnelling’ technique for driveline placement may represent a protective factor.
THE IMPACT OF CARDIAC ARREST RESUSCITATED DONORS ON HEART TRANSPLANTATION OUTCOMES
Authors: Santamaria V. , Snaidero S. , Londi F. , Castagnini S. , Bianco E. , Barberio G. , Di Marco L. , Martin Suarez S. , Pacini D. 
Published: December 2024

Background:
Heart transplantation (HTX) is the treatment of choice in patients with end-stage heart failure, even if it is still disadvantaged by lack of donor organs. The aim of this study was to compare heart transplant outcomes between recipients of hearts from cardiopulmonary-resuscitated (CPR+) donors and those from non-cardiopulmonary-resuscitated (CPR–) donors.

Methods:
This retrospective study included adults who underwent HTX at the University Hospital of Bologna from January 2006 to December 2023.We divided patients into two groups according to the history of cardiac arrest with an identified cause in donors (CPR+ vs CPR-). Survival rates were reported using Kaplan–Meier analysis and compared with the log-rank test.

Results:
A total of 402 patients were analyzed, 64 of which were transplanted with hearts from CPR+ donors. The 30-day mortality in the two groups were respectively 3.8%(CPR-) and 4.6%(CPR+). This difference was not statistically significant (p = 0.724). One and 5-year survival comparing the CPR- and CPR + groups was 82.7% versus 71.8% (p = 0.121) and 52.4% versus 48.7% (p = 0.548) respectively. There was no significant difference between the two groups in terms of postoperative incidence of renal dysfunction and intrahospital infection. Furthermore, no significant difference was found in needing of additional circulatory support with IABP or ECMO and frequency of donor organ failure.

Conclusions:
There is no evidence that cardiac transplantation outcomes and survival are adversely affected by a CPR in donors. Therefore, a history of CPR in donor should not preclude organ transplantability.