bluuebunny/crossref_metadata_2025_split huggingface dataset:
AGE EFFECT ON EARLY AND LATE VARC-3 OUTCOMES IN REDO AORTIC VALVE REPLACEMENT: A MULTICENTER STUDY
Authors: Pradegan N. , Lena T. , Garufi L. , Addonizio M. , Bifulco O. , Longinotti L. , Andreis M. , Di Eusanio M. , Mangino D. , De Paulis R. , Gerosa G. 
Published: December 2024

Background and Aim:
Redo aortic valve replacement (re-AVR) is usually associated to increased operative mortality compared to primary aortic valve surgery. Limited data are available regarding the effect of age on outcomes after re-AVR. We aimed to analyze clinical outcomes after re-AVR with a focus on age effect.

Materials and Methods:
All adults who underwent re-AVR between January 2015-December 2022 at 4 Centers were retrospectively analyzed. Primary endpoints were VARC-3 periprocedural and >30-day death. Univariable Cox analysis was employed to assess the effect of age on survival outcome.

Results:
215 patients (male 136 -63%-, median age 69, IQR 59-75) were included. Previous biological prostheses were used in 164 cases (76%). Median EuroSCORE II was 4.8% (IQR 3.0-8.1%). Causes of reintervention were: structural valve deterioration=100 (47%), endocarditis=87 (40%), paravalvular leak=14 (6%). Combined surgery (aortic valve + other) occurred in 99 patients (46%). Urgent operations occurred in 43 patients (20%). A biological prosthesis was implanted in 159 cases (74%). VARC-3 periprocedural death occurred in 22 cases (10%). Age did not affect VARC-3 periprocedural death (HR 0.87, CI 95% 0.53-1.42, p=0.42). At follow-up (median=4 years, IQR 2-5), overall survival was 81% (CI 75-86) and 77%(CI 71-84) at 3 and 5 years, respectively. Age at re-AVR>70-year was a risk factor for VARC-3 death>30 days (HR 2.64, CI 95% 1.04-6.71, p=0.0012).

Conclusions:
Re-AVR is associated to increased mortality. Age does not affect VARC-3 periprocedural death, but patients ≥70 years are at significantly increased risk of mortality>30 days. Age might become a selection criterium for reAVR.
INFLUENCE OF SURGICAL EXPERTISE ON REPAIR OF ACUTE TYPE A AORTIC DISSECTION. A PROPENSITY SCORE MATCHED ANALYSIS.
Authors: Piani D. , Sponga S. , Lechiancole A. , Gliozzi G. , Copetti S. , Vendramin I. 
Published: December 2024

Objective:
We aimed to verify whether in patients with acute type A aortic dissection the results of aortic repair are significantly influenced by surgeon expertise.

Methods:
199 patients with acute type A aortic dissection were divided in two groups: those operated by expert (n=138) and those by not-expert aortic surgeons (n=61) all being members of the aortic team. Early outcomes in both groups were evaluated and compared. A propensity score matching analysis was applied to obtain two similar populations.

Results:
The clinical presentation was more compromised in patients operated by expert than by not-expert surgeons: 36% vs 16% being hemodynamically instable (p=0.005) and 22% vs 5% having focal neurological damage (p=0.003). Intraoperative setting was similar among the two groups, with axillary artery cannulation being almost routinely used. Expert surgeons performed more frequently arch surgery (40% vs 26%, p=0.06). Operative times were also similar with median cardiopulmonary bypass time of 203 minutes for expert and 201 minutes for not-expert surgeons, respectively (p=0.88). Median in-hospital stay was shorter for patients operated by not-expert that by expert surgeons (10 and 17 days, p=0.04). After propensity score matching, mortality was still not significantly different between expert and not-expert surgeons (5% versus 12%, p=0.43).

Conclusions:
Outcomes of patients with acute type A aortic dissection were satisfactory even when surgery was performed by not-expert surgeons included in an aortic team organization.
SHORT-TERM OUTCOMES OF HEART TRANSPLANT FROM DONATION AFTER CIRCULATORY DEATH VERSUS DONATION AFTER BRAIN DEATH.
Authors: Maffei I. , Marani F. , Mazzeo G. , Raimondi Lucchetti M. , Marogna L. , Francica A. , Galeone A. , San Biagio L. , Onorati F. , Luciani G. B. 
Published: December 2024

Background and Aim:
This study aims to compare the short-term outcomes of heart transplant (HT) from donors who died from brain death (DBD) versus those who died from circulatory death (DCD).

Methods:
This study includes adult patients who underwent HT from January 2023 to July 2024. Recipient characteristics, operative times, postoperative data, and length of hospital stay were compared.

Results:
A total of 34 patients were included (n=5 DCD, n=29 DBD). The two groups had similar median age (DBD 59 vs DCD 57; p=0.4). The cold ischemia time (DBD 170 min, DCD 84 min; p=0.002), cardiopulmonary bypass (DBD 156 min, DCD 171 min; p 0.6), cross-clamping (DBD 73 min, DCD 75 min; p=0.66), and total surgery time (DBD 390 min, DCD 318 min; p=0.05) were compared. No differences in median postoperative Vasoactive-Inotropic Score (p=0.94), duration of invasive ventilation (p=0.18), postoperative dialysis (p=0.22), major infections (p=0.19), and cellular rejection (>/=2) at the first biopsy post-transplant (DBD 34%, DCD 20%; p=0.47) were found. Finally, no differences were noted concerning ICU stay or overall hospital stay (p=0.2 and 0.3, respectively).

Conclusions:
Our results indicate that the ischemia time and the overall duration of the procedure were lower in the HT from DCD compared to DBD (potentially due to heart retrieval from DCD more often done in the same institution of the recipients, and the lower number of reintervention). First results indicate no differences in short term outcome between HT from DCD and DBD.
RISK FACTORS IN POSTOPERATIVE DELIRIUM IN CARDIAC SURGERY: MULTICENTER OBSERVATIONAL STUDY
Authors: Mercuri C. , Mele M. , Pastorelli M. , Peyer M. T. , Zaghis L. , Ceccotti F. , Elegante J. , Bosco V. , Comentale G. , Cozato G. , Doldo P. , Froio A. , Matroroberto P. , Mazzoccoli E. , Mipatrini A. , Nisticò T. A. , Perrone M. , Sbalchiero E. , Scettro M. , Zampieri E. , Pucciarelli G. , Reitano B. , Pispola J. , Cicala M. , Simeone S. 
Published: December 2024

Background and Aim:
Post-cardiac surgery delirium is serious complication that affects post-operative care and patient’s quality of life. Literature has poor knowledge about the environmental and clinical risk factors of subjects undergoing cardiac surgery and the onset of delirium. Aim’s study is to identify structural and clinical factors associated with the onset of post-operative delirium in cardiac surgery.

Method:
229 patients in ICU’s cardiac surgery after cardiac surgery were enrolled in this multicenter observational study. Predictors of delirium were identified through alinear regression model.

Result:
Patient’s sample mean age of 73 years (SD=8.9), predominantly male (84.3%) and married (68.5%). Majority of patients had undergone bypass (72.9%), while 27.1% had undergone valve or endoprosthetic surgery. Logistic regression model showed that patient age, duration Vmechanically-assisted ventilation, time to exposure to artificial light, longer duration of extracorporeal circulation, blood transfusion and the presence of sleep disorders were predictors about the onset of delirium.

Conclusion:
Risk factors associated to development of delirium are multifactorial. Post- cardiac surgery delirium is potentially preventable with adequate identification of risk factors by nurses. Correctly identifying all the factors predisposing the onset of delirium can help to design a model for early identification and intervention on preventable factors.
TRANS-CATHETER CLOSURE OF NATIVE AORTIC VALVE WITH AMPLATZER OCCLUDER IN A LVAD PATIENT: STILL A RELIABLE OPTION?
Authors: Loforte A. , Spitaleri A. , Monteleone G. , Abbà P. , Parrella B. , De Laurentis A. , Sandoval A. , Gallone G. , Omedè P. , Pidello S. , Trompeo A. C. , Boffini M. , Rinaldi M. 
Published: December 2024

Severe aortic regurgitation (AR) may occur in left ventricular assist device (LVAD) recipients. Its development is associated with increased morbidity and mortality due to timely ineffective left ventricular unloading. The optimal treatment strategy for AR remains debated, as redo open-heart surgery still results to be a high-risk procedure.
We describe the case of a 68-year-old man presenting with severe AR in a native aortic valve following continuous flow LVAD (CF-LVAD) implantation, who was not suitable for transcatheter aortic valve implantation (TAVI). Initially, he was treated by closing the aortic valve with a percutaneous aortic valve occluder (Amplatzer device) in the hybrid operating room. Ninety days later AR relapsed and he subsequently underwent surgical aortic valve replacement.
STERNAL CERCLAGE BAND SYSTEM: PRELIMINARY RESULTS OF PADUA EXPERIENCE
Authors: Tessari C. , Crea D. , Micciolo M. , Tarzia V. , Gerosa G. 
Published: December 2024

Background:
Sternotomy is considered the gold standard incision in cardiac surgery. After surgery, the two sternal halves must be tightly reapproximated for proper healing, avoiding instability and wound infection. Stainless steel wires represent the gold standard, but ultra high moleculare weight polyethylene (UHMWPE) bands have been introduced into clinical practice due to their elasticity, stiffness and strength.

Aim:
To report our center’s experience with UHMWPE band system

Methods:
Prospective observational study including patients undergoing cardiac surgery through median sternotomy. Endpoints: severe complications (mediastinitis, osteomyelitis) and mild complications (superficial dehiscence).

Results:
In 21 patients (15 males, median age 65) band system was used (9 CABG, 2 AVR, 1 MVR, 2 MVP, 2 AAR, 5 combined), from 03/08/2023 to 14/12/2023. Median BMI was 26.4Kg/m2. Diabetes was present in 4 (19%), BPCO in 1 (4.8%), asthma in 1 (4.8%), active smoking in 8 (38%), osteoporosis in 2 (9.5%). Median length of hospitalization was 21 days. Both overall mortality and mortality related to the band system was null. There was no case of severe complications, of surgical revision for band-related bleeding or of re-osteosynthesis with steel wires. There were 2 (9.5%) cases of superficial dehiscence with bone instability, one of which complicated by infection and need for antibiotic. Both of them underwent closure through tightening of the same bands. Other 6 patients had only minor superficial dehiscence, without bone instability, and needed mild medications during outpatient visits.

Conclusions:
The band system is a solid and efficient method for sternal closure after median sternotomy.
SURGERY FOR NEONATES WITH UNIVENTRICULAR PHYSIOLOGY: DATA FROM THE EUROPEAN CONGENITAL HEART SURGEONS ASSOCIATION CONGENITAL DATABASE
Authors: Cattapan C. , Guariento A. , Bleiweis M. , Tobota Z. , Maruszewski B. , Jacobs J. , Sarris G. , Vida V. 
Published: December 2024

Background and Aim:
Patients with univentricular physiology pose a particular challenge, especially during the neonatal period. This study aimed to evaluate the outcomes of cardiac surgery in neonates with univentricular congenital heart disease (uCHD) over the past decade, using data from the European Congenital Heart Surgeons Association Congenital Database (ECHSA-CD).

Methods:
All neonates with uCHD who underwent Norwood Operation or Hybrid palliation within the first 30 days of life were selected from the ECHSA-CD database (January 2013 to December 2022). Patients who underwent exclusively percutaneous procedures were excluded. The primary outcome was operative mortality (death within the first 30 days post-operation or during the same hospitalization). Logistic regression was used to conduct a multivariable analysis.

Results:
A total of 2,700 neonatal patients with single ventricle physiology were identified in the ECHSA-CD during the study period. Hypoplastic left heart syndrome (HLHS) was the most common diagnosis (2,150/2,700=79.6%). Norwood Operation was performed in 2,115/2,700=78.3% patients and Hybrid procedure in 585/2,700=21.7% patients. While Hybrid procedure patients exhibited higher operative mortality than Norwood Operation in the overall population (182/585=31.1% vs 525/2,115=24.8%; p=0.002), this trend was reversed in patients with a body weight ≤2.5 kg (30/94=31.9% vs 38/75=50.7%, respectively; OR=0.46 (0.24-0.85) p=0.01). Patients with HLHS showed higher mortality compared to other types of uCHD (581/2,150=27.0% vs 126/550=22.9%; p=0.05).

Conclusions:
uCHD remains a significant challenge in congenital heart surgery, associated with notable mortality, especially in low-birth weight neonates.
CAN CORONARY ANATOMY INFLUENCE THE OUTCOME OF ARTERIAL SWITCH OPERATION FOR TRANSPOSITION OF THE GREAT ARTERIES?
Authors: Mangerini V. F. , Vaglio M. , Orioli V. , Careddu L. , Berardi M. , Petridis F. D. , Ragni L. , Egidy Assenza G. , Agulli M. , Schirru S. , Gargiulo G. D. , Angeli E. 
Published: December 2024

Background and Aim:
ASO is choice procedure for TGA correction. The transfer of coronary artery origins is the crucial part of this operation, especially in presence of coronary anomalies that increase complexity and have an effect on postoperative outcomes. The study’s aim is to analyze the relationship between coronary anomalies and postoperative outcome.

Methods:
We retrospectively reviewed 233 pts who underwent ASO from 01/2001 to 10/2023. At operation, median age was 18,28±49,85 days and median weight 3235,97±729,99 gr. The study included TGA simple (n=158) and complex (n=75). Coronary anatomy is classified according to the Yacoub classification. The surgical technique used for coronary transplantation is trap-door technique, sometimes button technique also. The median follow-up is 8,5±6,6 years.

Results:
86 (36,9%) patients had coronary anomalies. REDO was performed in 31 (13,5%) pts, not related to the coronary arteries. 5 (2,6%) pts had a coronary stenosis, 1 required PCI. There were 4 (1.9%) in-hospital deaths (no post-discharge deaths). Overall survival was 98,1%, 97.9% and 96,8% at 1, 5 and 10 years. Coronary anatomy didn’t influence early postoperative mortality, instead intramural coronary artery and button technique coronary transplantation significantly increased mortality.

Conclusions:
ASO remains the choice procedure also for TGA with coronary anomalies with excellent in-hospital and post-discharge outcomes in terms of overall survival and freedom from reoperation. Improvements in preoperative imaging and increased surgeon experience decrease mortality associated with abnormal coronary patterns. Furthermore, pts with intramural coronary artery have higher risk for adverse postoperative outcome and must be monitored carefully.
RIGHT VENTRICULAR OUTFLOW TRACT RECONSTRUCTION WITH BIOPULMONIC CONDUIT: A WORD OF CAUTION
Authors: Mangerini V. F. , Bartolacelli Y. , Careddu L. , Berardi M. , Egidy Assenza G. , Ragni L. , Orioli V. , Petridis F. D. , Gargiulo G. D. , Angeli E. 
Published: December 2024

Background:
The most cost-benefit and affordable conduit to reconstruct right ventricle outflow tract (RVOT) is the pulmonary homograft, which is limited by the procurement and size availability. Xenograft is a good performance alternative, but the dysfunction due to progressive stenosis or regurgitation can be more frequently experienced. Aim of this study is to evaluate the mid-term outcome of Biopulmonic pulmonary conduits.

Methods:
From 08/2016 to 01/2021, 34 patients underwent RVOT reconstruction with Biopulmonic conduit, a porcine pulmonic bioprosthesis. We collected demographic data and clinical characteristics of patients and, for mid-term follow-up, freedom from conduit failure defined as stenosis or regurgitation resulting in surgical conduit change or percutaneous pulmonary valve implantation.

Results:
Mean follow-up was 14.65±14.1 months (IQR 3.8-19.8) with a freedom from conduit failure of 58,9% at 19 months. Mean gradient moved from 13.2±8.6 mmHg at 1 month to 26.3±19.6 mmHg at 12 months after surgery (p=0.0367). 11 patients (32.3%) required pulmonary valve replacement, 9 patients were treated with percutaneous valve implantation, 2 patients required surgery of whom one for endocarditis. Corticosteroid therapy in the post-operative period, used to treat pericardial effusion or no infective fever, showed to reduce the conduit dysfunction (p=0.0135).

Conclusions:
Biopulmonic conduit showed a high failure rate due to a suspected inflammatory reaction. This type of conduit should be used in selected patients and deep control of inflammatory markers is recommended.
30 YEARS OF EXPERIENCE ON GROWN-UP CONGENITAL HEART DISEASE
Authors: Maldi M. , Ghiselli S. , Arceri L. , Marianeschi S. M. 
Published: December 2024

Background:
Congenital heart diseases (CHD) represent the main cause of mortality associated with defects in newborns. Due to last decades developments, 95% of children with CHD are reported to survive to adulthood. This wide population of adults, known as GUCH, now significantly exceeds the pediatric population and is continuously increasing.

Methods/Results:
We retrospectively enrolled 807 GUCH patients, aged 18 years and over, who underwent cardiac surgery between January 1993 and December 2022. Data were analyzed dividing the group into two equal periods (eras) of 15 years. Totally 836 procedures were performed on 807 patients: 574 procedures on 561 patients in the first era and 262 operations on 246 patients in the second. Mean age was 41.6 years in the first era and 36.3 years in the second. Patients undergoing operations presented with increasingly complex defects in second era. Moderate and complex diseases increased from 38.5% and 6.8% to 61.5% and 19.5%, respectively (p=0.0001 and p=0.06); simple defects were 54.7% in first era and 19.0% in second (p<0.0001). Mean Aristotle score increased from 4.9 to 6.1.

Conclusions:
The spectrum of surgery in adult CHD changed significantly over decades. We noted a significant increase of reoperations from first to second era. Surgery changed from primary repair of septal defects to complex reoperations as treatment of residual defects or sequelae of the initial pathology or previous treatment. In upcoming years, we expect that acquired heart disease will mix with adult CHD and with the onset of newer pathologies deriving from their primary surgery.
SINGLE-CENTER EXPERIENCE OF NORWOOD PROCEDURE FOR HYPOPLASTIC LEFT HEART SYNDROME: BLALOCK-TAUSSIG SHUNT OR RIGHT VENTRICLE–PULMONARY ARTERY CONDUIT?
Authors: Ruffini A. , Perri G. , Brancaccio G. , Cetrano E. , Albanese S. , Trezzi M. , Filippelli S. , D’Inzeo V. , Carotti A. , Galletti L. 
Published: December 2024

Background and Aim:
Norwood procedure is used as first stage palliation in hypoplastic left heart syndrome (HLHS) or other single-ventricle lesions with systemic outflow obstruction. Evolution of this technique was focused to define the source of pulmonary blood supply. Aim of this study was to compare early and late results of Norwood using either Blalock- Taussig (BT) shunt or a right ventricle–pulmonary artery (RV-PA) conduit.

Methods:
A retrospective review of 76 patients, who underwent Norwood procedure from February 2013 to July 2024 at Bambino Gesù Children’s Hospital, was done. 24 infants received a RV-PA conduit while in 43 a BT shunt was used. 9 patients, who underwent Comprehensive Norwood after hybrid approach, were excluded. We assessed difference in surgical operative time, in-hospital mortality rates and progression to later stages of palliation.

Results:
No significant differences between two groups in mortality, hospitalization, or surgical operative time occurred. In BT group, 32 patients underwent subsequently Glenn procedure (in 11 associated to pulmonary artery enlargement and in 2 with tricuspid valve repair) and 17 advanced to Fontan palliation; in this group 3 underwent heart transplants. In RV-PA conduit group, 15 patients underwent Glenn procedure (associated in 3 to pulmonary artery plasty and in 7 to tricuspid valve repair) and 1 progressed to Fontan palliation. None needed heart transplant.

Conclusions:
There is no clear advantage of one approach over the other based on our result. Further research is needed, as Sano technique was introduced at our Center more recently compared to traditional BT shunt.
КОРМОВЫЕ И МЕТАБОЛИЧЕСКИЕ ФАКТОРЫ ФОРМИРОВАНИЯ ЖИРНОКИСЛОТНОГО СОСТАВА МОЛОКА У КОРОВ
Authors: Харитонов Е.Л. , Панюшкин Д.Е. 
Published: December 2024

Цель работы − систематизация литературных и собственных данных по проблеме повышения эффективности процессов молокообразования при использовании липидов в рационе и получения молочной продукции с заданными диетическими свойствами. Основными причинными факторами изменчивости состава молочного жира являются стадия лактации, кормление, сезон года и генотип животного. Количественное соотношение образующихся жирных кислот у коров зависит от условий кормления и запасов депонированного жира. Основные факторы, обусловливающие трансформацию кормового жира в преджелудках - это липолиз, биогидрогенизация, синтез жирных кислот микроорганизмами рубца. Производство молока контролируемого состава может быть одним из способов повышения ценности молока, предназначенного для специальных рынков. Поэтому необходимо принимать специальные меры по защите полиненасыщенных жирных кислот в рубце. Добавление в рацион “защищенных” жирных кислот значительно повышает процентное соотношение изомеров C18:1, n 9, С18:2, n 6 и C18:3, n 3, при этом снижается доля насыщенных жирных кислот, особенно C16 и C14, в молочном жире. Одной из причин возросшего спроса потребителей на коровье молоко явилось обнаружение полезных для здоровья человека эффектов у жирных кислот с сопряжёнными связями (conjugated linoleic acid − CLA), особенно цис-9, транс-11 линолевой кислоты, содержащейся в коровьем молоке. Самыми богатыми природными источниками CLA являются мясо и молоко жвачных животных. В говядине и в коровьем молоке содержание CLA (цис-9,транс-11 линолевой кислоты) составляет около 0,62% и 0,83% от всех жирных кислот соответственно, в молозиве − 0,3%. Молочные продукты (сливочное масло), производимые из CLA-обогащённого молока, обладают улучшенными питательными и физико-химическими свойствами, а также способствуют снижению содержания в крови человека липопротеинов низкой плотности, что предотвращает развитие атеросклероза. Даны практические рекомендации по использованию жировых добавок в кормлении крупного рогатого скота.