bluuebunny/crossref_metadata_2025_split huggingface dataset:
RE-REPAIR AFTER PREVIOUS MITRAL VALVE SURGERY
Authors: Sobrino Avellaneda G. A. , Barbero C. , Aloi V. , Capozza C. , Di Lorenzo D. , Salizzoni S. , Pocar M. , Rinaldi M. 
Published: December 2024

Background and Aim:
Evidences in the literature show that close to 20%of patients undergoing primary mitral valve (MV) surgery require reoperation on long-term follow-up, and significant proportion of this patients received a conservative operation. Aim of this study is to analyze outcome of patients undergoing a second MV repair operation.

Methods:
Patients who underwent redo MV repair between 2012 and 2024 were retrospectively analysed. Primary outcomes were mortality and freedom from MV reoperation at 30 days.

Results:
Twenty-seven patients were included. Mean age was 63 years and 20 (74%) were men. Progressive mitral valve degeneration was the most common cause of previous repair failure (88%). Median time to reoperation was 4,5 years. Re-repair was most commonly performed through a minimally invasive approach (81%) with the endo-aortic clamp (63%). MV annuloplasty was performed in the 70% of the cases, and artificial chords were implanted in the 59% of the cases. Re-exploration for bleeding, stroke, and acute renal dysfunction were reported in 1, 2, and 2 cases respectively. Thirty-day mortality was reported in 1 case, while 3 patients required a reoperations in the follow-up period.

Conclusions:
The emergence of MV repair as the preferred treatment for severe mitral regurgitation caused by degenerative disease has been accompanied by an increasing number of valve repair failures seen by surgeons. This report shows that MV re-repair is feasible and effective in high volume, high experienced centers in MV surgery.
MINIMALLY INVASIVE ISOLATED TRICUSPID VALVE SURGERY: LATE OUTCOME FROM A MULTICENTER STUDY
Authors: Russo M. , Mach M. , Pollari F. , Lio A. , Di Mauro M. , Taramasso M. , Berretta P. , Della Corte A. , Scrofani R. , Greco E. , Saitto G. , Sponga S. , Leviner D. , Vinciguerra M. , Troise G. , Bianchi G. , De Vincentiss C. , Ranocchi F. , Andreas M. 
Published: December 2024

Background and Aim:
To compare the long-term mortality and postoperative adverse events of minimally- invasive isolated tricuspid valve surgery (ITVS) to median sternotomy in an all comers registry.

Methods:
This retrospective observational study was conducted in the international multicenter SUR-TRI registry, which included patients who underwent isolated TV surgery in 15 different European centers.

Results:
This study included 476 patients (median age 58.1 years; 44.7% male) who underwent isolated TV surgery either using the minimally invasive approach (MICS; n=72) or median sternotomy (STERNO; n=404). While the reported cardiopulmonary bypass time was significantly longer in MICS (112 vs. 80 minutes; p<0.001), MICS patients less frequently required postoperative blood transfusions (31% vs. 51%; p=0.002), required significantly shorter intensive care (2 vs. 3 days; p<0.001) and had a shorter in-hospital stay (10 vs. 13 days; p=0.054). After surgery, patients were followed for a median of 46.4 (IQR: 9.3-91.4) months, during which 112 patients died (50 cardiac, 62 non-cardiac). Even after adjusting for baseline comorbidities (i.e. EuroSCORE II) and repair/replacement, the minimally invasive approach significantly reduced the risk of all-cause mortality (adjusted HR: 0.430 [95%CI: 0.228-0.819]; p=0.009). This benefit was primarily the result of a reduction in noncardiac mortality (adjusted HR: 0.194; p=0.006).

Conclusion:
Minimally invasive isolated tricuspid valve surgery may not only improve long- term survival, but also reduce postoperative complications and intensive care stay when compared to median sternotomy in suitable patients. Early timing associated with MICS, beating heart and repair strategy may significantly improve outcome of an upcoming procedure historically considered prohibitive.
PATIENT SELECTION AND OUTCOMES OF TRANSCATHETER TRICUSPID VALVE INTERVENTIONS WITH A DEDICATED HEART TEAM
Authors: Russo M. , Cammardella A. G. , Pergolini A. , Ciaramella P. , Candido F. , Cacioli G. , Menafra G. , Lio A. , Nicolo F. , Sbaraglia F. , Ranocchi F. 
Published: December 2024

Background and Aim:
Transcatheter procedures for the treatment of tricuspid valve regurgitation have been introduced as a valuable tool for the treatment of high-risk patients.

Methods:
Sixteen patients (2021-2024; median age 82 y.o, 70% female) with significant tricuspid regurgitation underwent transcatheter treatment. A dedicated structural valve team has been established for patient selection, treatment and strict follow-up.

Results:
All cases enrolled were considered at high-prohibitive surgical risk (Median TRI- SCORE 28%, range 8-64%). A strict evaluation of RV function was carried out with echocardiography and right heart catheterization. Device selection has been carried out according anatomic criteria, coaptation gap and main jet location. Nine patients presented a coaptation gap < 8.5 mm and were treated with edge-to-edge repair, three case exhibited severe annular dilation and were treated with annuloplasty and four remaining cases (not suitable for leaflets or annular techniques) were treated with etherotopic valve implantation. Procedural success was achieved in 93% of cases. Three patients died at 30 days, one for acute right heart failure, one for respiratory failure and a third for pneumonia. A significant improvement of functional status was reported at follow up intervals of 3-6 and 12 months (NYHA class 3±0.5 vs 1.5±0.5). Among patients who completed 1-year follow-up (75%) no late death or rehospitalization for heart failure were detected.

Conclusions:
Transcatheter tricuspid valve interventions represent a needed tool in the hands of the modern cardiac surgeon. Patient’s selection and surgical risk assessment are crucial to optimize outcome.
THORACIC ENDOVASCULAR SURGERY FOR SURGICAL MANAGEMENT OF T4 LUNG TUMOR WITH THORACIC AORTIC INVOLVEMENT
Authors: Lonardo E. , Mileo E. , Calanni Macchio C. , Pisapia G. , Damiano A. , Di Tommaso L. 
Published: December 2024

Objective:
Surgical treatment of primary lung T4 tumors is controversial especially when the cancer involves the descending thoracic aorta. We aimed to assess perioperative and midterm aortic related outcome of patients undergone aortic stent-graft implantation, followed by en- bloc surgical treatment of the involved aorta and lung cancer resection.

Methods:
From July 2017 to May 2020, we treated 5 patients, diagnosed with T4 lung cancer by the involvement of the descending thoracic aorta. When only the descending thoracic aorta is involved, a two stage procedure was considered, with aortic stent-graft implantation performed before tumor resection. One stage strategy, with stent-graft implantation carried out before thoracotomy, was preferred for patients with involvement of cardiac and/or other vascular mediastinal structures.

Results:
The mean age was 58.4 ± 6.2 years. All patients were affected by NSCLC. All five patients to completely cover the involved segment of aorta required a single stent-graft. Four patients underwent a two stages procedure. One patient, with involvement of the left inferior pulmonary vein, required a one stage en-bloc resection of the left lower lobe, aortic wall adventitia, left inferior pulmonary vein and reconstruction of the left atrial wall. Primary procedural success was achieved in all. At follow-up no patient developed aortic related complications. One patient died 2 years after surgery, due to local recurrence of the tumor.

Conclusions:
T4 lung resection combined with aortic stent-graft implantation can be safely performed. Postoperative and long-term outcome of these patients is related to the pulmonary disease, not to the aortic treatment.
ISTITUTIONAL MULTIDISCIPLINARY AORTIC TEAM: EARLY REPORT OF 18-MONTHS ACTIVITY
Authors: Totaro P. ,   O. B. O. Multidisciplinary Aortic Team
Published: December 2024

Introduction:
The growing complexity of cases of aortic pathology referred to the cardiac surgeon is making necessary to carry out increasingly accurate preoperative assessment to optimize operative management and postoperative outcomes. This has been recognized by guidelines that have expressly indicated the need for a multidisciplinary “Aortic Team”. Here we report the preliminary results of “Aortic Team” set up at our Hospital 18-months ago.

Materials and Methods:
Following the introduction of the outpatient clinic dedicated to thoracic aortic pathology we decided to discuss complex cases in a dedicated multidisciplinary meeting including figures from surgical, clinical and diagnostic medical fields. The peculiarity of our “Aortic Team” is, the participation of different specialties from the engineering-biomedical field. The planning of the meeting was finalized 1-2 week in advance in order to give all participants the opportunity to evaluate all the available documentation.

Results:
Since April 2023, when the “Aortic Team” was officially inaugurated, 15 meetings have been held on a monthly basis with discussion between 3-5 patients. Forty-four patients were discussed (for a total of 50 consultations). 7 patients received cardiac surgery indication, 4 hybrid indication, 11 a contraindication, 4 a vascular surgery indication, 14 indication to further follow up and 10 no indications. In 34 cases the key factor for final decision was the radiological interpretation and in 10 the anesthetist evaluation.

Conclusions:
The preliminary results of our study confirm the need for multidisciplinary consultation to optimize decision-making progress in complex cases of aortic pathology. The impact of new technologies in medical practice should no longer be ignored and the complete discussion of particularly complex cases must necessarily also include professionals from a field other than healthcare.
TOTAL ENDOVASCULAR AORTIC ARCH REPAIR WITH BRANCHED DEVICES: 7-YEAR EXPERIENCE
Authors: Andreis M. , Cibin G. , D’Onofrio A. , Piazza M. , Antonello M. , Caraffa R. , Gerosa G. 
Published: December 2024

Purpose:
Endovascular aortic arch stent grafting (Ar-TEVAR) with branched devices offers a less invasive alternative with promising early results. This study aims to evaluate early and long-term outcomes of Ar-TEVAR in high-risk patients.

Methods:
Between 2017 and 2024, 16 consecutive patients underwent Ar-TEVAR at our institution using the Nexus aortic-arch system and RelayBranch devices. Data were prospectively collected and retrospectively analyzed. The primary endpoint was overall survival; secondary endpoints included procedure-related reinterventions, stroke, paraplegia, and endoleaks. Patients were followed-up with clinical examinations and computed tomography angiography (CTA) at discharge, 6 months, and annually for up to 7 years.

Results:
The mean patient age was 74.1 ± 6.8 years, with a mean Euroscore II of 8.4 ± 2.3. Ten patients (62%) had a history of previous open repair for type A aortic dissection. The overall 30-day mortality rate was 12% (2 patients). At 30 days, secondary procedures were performed in 2 patients (12%). No major strokes or paraplegia were observed, while minor strokes occurred in 5 patients (30%). One patient (6%) experienced a type III endoleak. The median follow-up duration was 24 months (IQR 4-60). Overall survival rates were 73.4% at 12 months, 65.3% at 24-60 months, and 43.5% at 72 months.

Conclusions:
Ar-TEVAR with branched devices demonstrates good outcomes up to 7 years in a high-risk cohort, with no major strokes, no paraplegia, and a low incidence of endoleaks. This procedure is a viable option for patients, especially those with previous open ascending repair for type-A dissection.
OUTCOMES OF A MODIFIED FROZEN ELEPHANT TRUNK TECHNIQUE WITH DEBRANCH FIRST IN ACUTE AND CHRONIC AORTIC ARCH DISEASE
Authors: Montella A. P. , Mastrogiovanni G. , Masiello P. , Rubino A. S. , D’Oria V. , De Santo L. S. , De Feo M. , Iesu S. 
Published: December 2024

Backround and Aim:
Although Frozen Elephant Trunk has emerged as a valuable technique in aortic arch pathology it is still burdened by a high mortality and morbidity rate due to the technical complexity and clinical and anatomical substrates. We evaluated early hard outcomes in a surgical approach encompassing the following: 1) central cannulation of the right subclavian artery or the right axillary artery; 2) debranch-first approach (selective cannulation of left common carotid artery with single 8-mm dacron graft and the left subclavian artery for cerebral perfusion with single 10-mm dacron graft); 3) central venous cannulation of right atrium; 4) use of a home-made 4-branched perfusion circuit for extracorporeal circulation; 5) brachiocephalic artery clamping at 26–28°C and beginning of selective antegrade perfusion.

Methods:
Retrospective analysis of a prospectively collected database including 167 patients referred for FET (55%acute aortic dissections, 14.5% chronic aortic dissections, and 30.5% extended aneurysms, 67% males, 9.2% diabetes mellitus, 72% arterial hypertension, 8.2% chronic renal failure, 12% peripheral vasculopathy, 3% bicuspid aortic valve, 11.9% redo)

Results:
The average cardio-pulmonary bypass time, cross clamp time, cerebral and visceral perfusion time is 192, 102, 29 and 12 minutes, respectively. In-hospital mortality occurred in 16% (44% due to respiratory failure), spinal cord injury in 2.8% and stroke in 3.5% of patients.

Conclusion:
Debranch-first technique and cerebral protection through the trivascular perfusion strategy appear safe and effective in the treatment of complex arch pathology.
CRYSTALLOID VERSUS BLOOD CARDIOPLEGIA FOR SURGICAL REPAIR OF TYPE A AORTIC DISSECTION: EARLY AND LONG-TERM OUTCOMES
Authors: Pollari F. , Seven U. , Hitzl W. , Weber L. , Ledwon M. , Sirch J. , Bagaev E. , Fittkau M. , Fischlein T. 
Published: December 2024

Background:
Myocardial injury following surgery repair for type A aortic dissection (TAAD) is one of the most feared perioperative complications. The question of which is the most appropriate cardioplegic solution in this scenario remains debated. We aimed to compare the outcomes of patients who underwent surgery for TAAD according to the cardioplegic strategy.

Methods:
A retrospective observational study of all consecutive patients (n=393) who underwent surgery for TAAD in our institution between 2003 and 2020 was conducted. The type of cardioplegia (crystalloid histidine-tryptophan-ketoglutarate, “HTK” or blood cardioplegia, “Calafiore”) was at discretion of the surgeon. New onset of postoperative myocardial injury (defined as a 20-fold increase in Troponin T, “cTnT”, from baseline value), and all-cause 30-days and 1-year mortality were the outcomes. Continuous variables were compared using a generalized linear model (lognormal), while categorical variables were compared using two-tailed Chi-squared tests.

Results:
251 patients were eligible for the study: 230 received Calafiore, while 21 patients received HTK. Age (59.97 vs 63.14 years; p=0.26) and GERAADA-score (18.12 vs 15.53; p=0.3) were comparable between groups. Postoperative ICU- stay was significantly longer in Calafiore than HTK-group (10.98 days±11.76, vs 6.9 days ±7.99; p=0.041). Mortality differences were not statistically significant (30- days=18.7% vs 9.5%, p=0.385; 1-year=22.6% vs 9.5%, p=0.265). Mean peak postoperative cTnT level was slightly higher in HTK-group, but not statistically different (p=0.87). Incidence of new myocardial injury was 12% (n=28) in Calafiore and 9.5% (n=2) in the HTK group (p=1.0).

Conclusions:
No differences were found in patients undergoing surgery for TAAD according to cardioplegia solution. HTK cardioplegia may be a safe alternative to blood cardioplegia in these patients.
DETERMINANTS OF POSTOPERATIVE INFECTIONS AND IMPACT ON PERIOPERATIVE HEART TRANSPLANTATION OUTCOMES
Authors: Londi F. , Santamaria V. , Snaidero S. , Castagnini S. , Bellomare M. , Leone A. , Pagliaro M. , Martin-Suarez S. , Pacini D. 
Published: December 2024

Background and Aim:
Outcome of patients undergoing heart transplantation (HTX) can be severely affected by post- operative infections. The present study is aimed at identifying their determinants and at analyse short-term outcomes.

Methods:
Through a retrospective analysis, adults undergoing HTX at Bologna University Hospital from January 2013 to December 2023 (n=231) were either assigned to group 1 (n=63) or group 2 (n=168), according to a positive or negative postoperative infection history, respectively.

Results:
Among preoperative recipient characteristics, no significant difference regarding sex, obesity (defined as BMI >30 kg/m2), history of diabetes mellitus and of device or drive-line infection (in patients implanted with VAD) was found. Instead, incidence of postoperative infections was significantly higher in patients undergoing HTX on IABP (p=0.012), ECMO (p=0.036), mechanical ventilation (p=0.041) or with a history of cardiac surgery (p=0.002).
Furthermore, a significant difference in postoperative infection rates was observed among patients requiring postoperative early CRRT (p<0.001), ECMO (p=0.001) or surgical revision (p<0.001).
Moreover, patients developing postoperative infections had significantly longer ICU stay (p<0.001) and hospital stays (p<0.001).
Lastly, 30-day mortality was significantly higher among patients developing postoperative infections (p=0.037); 1-year mortality was, instead, not affected, with Kaplan-Meier survival analysis showing no significant difference (p=0.323 log-rank).

Conclusions:
A critical perioperative state appears linked to a higher rate of postoperative infections, which significantly affect short-term outcomes and length of hospitalization. No significant impact of postoperative infections on 1-year survival was identified.
HEART PRESERVATION WITH EX-SITU NORMOTHERMIC PERFUSION VERSUS COLD STORAGE: A PROPENSITY SCORE MATCHED ANALYSIS
Authors: Gliozzi G. , Sponga S. , Lechiancole A. , Copetti S. , Livi U. , Vendramin I. 
Published: December 2024

Background and Aim:
Heart preservation with normothermic perfusion (NP) is recommended in expected ischemic time longer than 4 hours, in complex redo recipient or in case of marginal donors. The aim of the retrospective review of our institutional heart transplantation (HTx) registry is the comparison of early outcomes of NP versus cold storage (CS).

Methods:
From January 2010 to July 2024, 335 consecutive HTx have been performed. Heart preservation was carried out with NP in 22.7% of cases (76/335), while with CS in 77.3% (259/335).After propensity score matching, 54 pairs with no significant residual imbalance were identified. Main early outcomes were compared between groups (NPmatched e CSmatched, respectively).

Results:
Mean age (57±10 years versus 57±11) and male gender (81.3% vs 80.8%) were similar between groups. Considering unmatched patients, NP showed higher rate of reintervention (50% vs 38%) and mechanical circulatory support (MCS)(23% vs 12%), but similar retransplantation (8% vs 6%); after matching these features resulted well-balanced. Considering matched cohort, graft ischemia time [129(110-149) min vs 248(212-268) min, p<0.05] and cardio-pulmonary bypass time [194(150-235) min vs 207(185-254) min] were significantly lower in NPmatched group (p<0.05). Severe primary graft dysfunction (7% vs 7%), dialysis (19% vs 15%), short-term MCS (11% vs 9%) and 30-day mortality (9% vs 7%) were similar (p>0.05). No differences emerged in terms of 1-year survival (75% vs 82%, log-rank 0.359).

Conclusions:
Heart preservation with NP allows a significative reduction in ischemic and cardiopulmonary bypass times. Inhospital outcomes are similar to CS, especially in high risk recipients and marginal donors, offering several logistical, technical and educational advantages.
OCCURRENCE AND SEVERITY OF PARAVALVULAR LEAK (PVL) IN ELDERLY PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) OR SURGICAL AORTIC VALVE REPLACEMENT (SAVR)
Authors: Matteucci M. , Garis S. , Ferrarese S. , Corazzari C. , Cappabianca G. , Masiglat J. , Dossi F. , Tamborini C. , Castiglioni B. , Musazzi A. 
Published: December 2024

Background:
TAVI is a rapidly evolving technology that has been shown to be a valuable alternative to SAVR in elderly patients. However, despite the progress made, there remain several potential TAVI limitations that need not to be minimized before implementing this approach. The current analysis aimed to examine the major outcomes of elderly patients treated with TAVI or SAVR focusing on PVL occurrence.

Methods:
We conducted a retrospective observational study of elderly patients (> 70 years) undergoing isolated TAVI or SAVR between January 2019 and December 2023 at our Institution. The incidence of PVL was the primary endpoint. 30-day mortality and in-hospital length of stay (HLOS) were the secondary outcomes.

Results:
271 patients were enrolled (mean age: 79 ± 5 years); the TAVI group included 140 subjects (mean age: 82 ± 4 years), whereas the SAVR group 131 patients (mean age: 82 ± 4 years). The EuroSCORE II was higher in the TAVI group than in the SAVR population (5.1% vs 2.7%, p<0.001). PVL occurrence (of any degree) was significantly lower after SAVR than after TAVI (15.3% vs 78.6%, p<0.001). The majority of PVL were mild in severity (75% and 71% respectively). 30-day mortality rate was numerically lower in the SAVR group than in TAVI (0.8% vs 3.6%, p=0.252). HLOS was comparable between the two groups (8.5 days for SAVR vs 8.2 days for TAVI).

Conclusions:
TAVI was associated with a higher occurrence of PVL compared with SAVR. Moderate PVL was also more prevalent among the TAVI group.
TIME-TO-EVENT ANALYSIS OF MORTALITY AND STROKE IN TRIALS COMPARING TRANS-CATHETER AND SURGICAL AORTIC VALVE IMPLANTATION WITH DIFFERENT RISK PROFILES.
Authors: Gastino E. , Scarpanti M. , Anselmi A. , Brophy J. , Boden W. , De Caterina R. , Sousa Uva M. , Almeida R. M. S. , Verhoye J. , Mandrola J. , Kaul S. , Barili F. , Parolari A. 
Published: December 2024

Background:
We compared the effectiveness of TAVI versus SAVR on a composite of death or stroke at 5-year follow-up within high, intermediate and low-risk profiles.

Methods:
From January 2007 to January 2024, we performed a systematic review of literature including randomized control trials (RCTs) comparing TAVI or SAVR with a minimum 1-year follow-up and reporting Kaplan-Meier analysis. The primary endpoint was the composite of all-cause mortality or stroke. Hazard ratios (HRs) and restricted mean survival time (RMST) differences within high, intermediate and low-risk profiles were estimated by reconstructing time-to-event data.

Results:
Seven trials were included (8418 participants). The incidence of composite endpoints increased with higher baseline risk profiles for both treatments. A time-variant effect was present with an early superiority of TAVI, as supported by a cumulative additional time-to-event of 0.73 months at 4 years driven by the high-risk group. The benefit of TAVI increased over time up to 5 years in high-risk patients (RMST difference 2.495. 95%CI: -0.019; 5.01. P-value 0.05). In intermediate and low-risk patients it showed a quadratic association with a smaller increase and attenuation of the observed benefit after 60 months (Low risk 0.813, 95%CI -0.177 1.802; p-value 0.107.
Intermediate risk 0.076, 95%CI -1.131 1.282, p-value 0.902).

Conclusions:
In RCTs comparing TAVI vs SAVR, the benefits of TAVI differ according to the patient’s risk category. The advantage of TAVI over surgery progressively increases up to 5 years in high-risk patients. At 5 years in low and intermediate-risk there are no significant observed benefits.