bluuebunny/crossref_metadata_2025_split huggingface dataset:
ONE YEAR OUTCOME OF A NOVEL SELF-EXPANDING TAVR IMPLANTED IN A SURGICAL SETTING
Authors: Ferrisi C. , Cammardella A. G. , Russo M. , Natale E. , Manzara C. , Pergolini A. , Belloni F. , Ranocchi F. , Chello M. , Luzi G. 
Published: December 2024

Background and Aim:
Transcatheter aortic valve replacement (TAVR) represents the ideal alternative for aortic valve disease in elderly patients. The Navitor valve, a third generation self- expanding valve system from the Portico series, was designed to minimize TAVR complications. This study aimed to evaluate the outcome of patients with at least 12 months follow-up, undergone TAVR using Navitor valve.

Methods:
From September 2021 to August 2023, seventeen patients (age 85,7±3,7 y.o, 17,6% male) with severe aortic valve disease underwent transcatheter treatment.

Results:
A CT scan anatomic evaluation was performed in all patients (perimetral annulus 72,8 [68,3-77,8], annulus area 3,6 [3,3-4,1], maximum annulus size 26 [23,5-28], STJ 27 [26-30]). 15 patients required pre-dilation, using Osypka balloon. Size of implanted valve was generally high (median 27 [25-27]). In-hospital mortality was observed in 2 patients. Other adverse events included: 1 vascular complication (pseudoaneurysm), 2 permanent pacemaker implantations. No pericardial effusion or stroke occurred over a median length of stay of 3 days. At 1 year, no signs of structural valve degeneration were observed, with a mean gradient of 6,5 (6-9) mmHg, peak gradient of 11 (10-16) mmHg, valve area of 1,7 (1,6-1,9) cmq and no decline in LVEF. A total of 5 mild PVL were observed without clinical implications. No late clinical events occurred.

Conclusions:
TAVR with Navitor valve provides excellent short term results and good hemodynamic performance over the first year after implant. The acceptable rate of PVL and PMK implantation might represent an interesting finding to be investigated in larger studies.
COMPARISON OF SAVR VERSUS TAVR 5-YEAR MORTALITY IN REAL- WORLD SCENARIOS.
Authors: Scarpanti M. , Gastino E. , Dalbesio B. , Marin-Cuartas M. , Anselmi A. , Sousa Uva M. , Verhoye J. , Barili F. , Parolari A. 
Published: December 2024

Purpose:
While Randomized clinical trials (RCTs) are designed to provide evidence of efficacy, real world data (RWD) shows actual effectiveness. We designed a systematic review and meta-analysis of reconstructed time-to-event data (RTE) from propensity score matching studies comparing the effectiveness of TAVR vs SAVR to assess differences in 5-year mortality.

Methods:
Using MEDLINE, Embase and CENTRAL databases from 2007 to 2023, we performed a systematic review of the literature including propensity score matching studies comparing TAVR and SAVR. The primary endpoint was the composite of all-cause mortality at follow- up. The Hazard Ratio (HR) was considered as the effect size.

Results:
Twenty-one studies were included (39538 participants). TAVR showed a higher incidence of all-cause mortality (HR 1.39; 95% CI 1.33 – 1.46, p-value < 0.001), with a significant heterogeneity (random parameter θ = 0.85, p-value < 0.001). The analysis of HR trend over time showed that TAVR superiority to surgery is limited to the first month with a steep reversal afterwards. All-cause mortality in low-risk was significantly higher in TAVR (HR 1.33; 95% CI 1.06 – 1.67, p-value < 0.001). The HR trend in the low-risk group differed from the whole population as there was no advantage of TAVR.

Conclusions:
In real-word settings TAVR is associated with a significantly higher incidence of all-cause of death while maintaining a survival benefit only in the first month after implantation. These results indicate that TAVR effectiveness may not reflect the efficacy demonstrated by RCTs and pose a serious threat to their external validity.
CARDIAC SURGERY RESIDENTS’ LEARNING CURVE OF TRANSIT TIME FLOWMETRY AND HIGH FREQUENCY EPICARDIAL ULTRASOUND IN CORONARY SURGERY: THE LEARNERS STUDY
Authors: Cammertoni F. , Di Giammarco G. , Testa N. , Pavone N. , Bruno P. , Marcolini A. , D’Avino S. , Grandinetti M. , Olimpieri A. , Massetti M. 
Published: December 2024

Background and Aim:
Transit-time flowmetry (TTFM) and high frequency epicardial ultrasound (HFUS) allow intraoperative quality control in coronary surgery. Although excellent performance has been reported, their use is still limited due to a perceived complexity of the learning curve.

Methods:
The learning curve of cardiac surgery residents without previous experience was evaluated. A scoring system based on specific items was developed and an expert senior surgeon was used as benchmark. Upon reaching a pre-specified threshold score, residents were considered autonomous in the procedures and left the study.

Results:
The study is still ongoing. To date, 34 anastomoses in 14 patients (15 arterial grafts, 19 venous grafts) have been studied by 8 residents (4.3 anastomoses/resident). The pre-specified combined TTFM+HFUS cutoff score was reached by 3 out of 8 residents after a mean number of 2 cases (5.3 anastomoses/resident). The remaining 5 trainees who have not yet reached the primary end-point have studied 8 patients for a total number of 18 anastomoses (3.6 anastomoses/trainee). When analyzed separately, the secondary end-point TTFM cutoff score was reached more frequently (5/8 trainees, 2.6 anastomoses/trainee) than that of HFUS (3/8 trainees, 4.3 anastomoses/trainee).

Conclusions:
Preliminary data suggest that the TTFM and HFUS learning curve is not as steep as expected. Epicardial ultrasound could be less manageable than flowmetry but, with adequate pre-surgical training, residents can manage quickly. If the data were confirmed, the perceived complexity of TTFM and HFUS should no longer be claimed as a cause of a lack of use of these intraoperative procedures.
CAN TRANSCATHETER AORTIC VALVE IMPLANTATION BE PERFORMED WITHOUT ON-SITE CARDIAC SURGERY?
Authors: Lodo V. , Barbero C. , Zingarelli E. , Sorace R. , La Torre M. , Salizzoni S. , Centofanti P. , Rinaldi M. 
Published: December 2024

Introduction:
despite lower invasivity, transcatheter aortic valve implantation (TAVI) carries a potential risk of feared intra-operative complications. Emergent cardiac surgery (ECS) should be considered a truly life-saving procedure in case of TAVI-related complications. The aim of the present analysis is to assess the prevalence and post-procedural outcomes of surgical bailout during TAVI.

Methods:
patients undergoing TAVI from September 2017 to March 2023 were enrolled from two high volume cardiac centers. All the procedures had an on-site cardiac surgeon. The primary endpoint was in-hospital mortality of TAVI patients after ECS. Secondary endpoints were intra-operative and 1-year mortality, and post-procedural complications such as acute kidney injury (AKI), stroke, myocardial infarction (MI), conduction abnormalities, need for inotropic support and intensive care unit (ICU)/hospital length of stay (LOS).

Results:
During the study period 1347 TAVI were planned. 10 patients (0,74%) reported intra- procedural complications requiring ECS. Indications for open cardiac surgery included: type A dissection (n=2), aortic annulus rupture (n=1), left ventricle perforation (n=1), right ventricle perforation (n=2), mitral valve apparatus damage (n=2), prosthesis embolization (n=2). 4 patients (40%) required post-operative inotropic support. 1 case of stroke (10%) and 1 case of AKI (10%) were reported. 3 patients (30%) developed LBBB. Median ICU and hospital length-of-stay were 4,5 (2-7,75) days and 14 (8-22) days, respectively. 1 case (10%) of in- hospital mortality was reported. 1 out of 9 discharged patients died during follow-up period.

Conclusions:
the on-site heart surgeon represents a life-saving resource for TAVI centers, and it is mandatory to achieve good post-procedural outcomes.
HOW WORTHY CORONARY ARTERY BYPASS-GRAFT SURGERY IN OLD PATIENTS IS? TWENTY YEARS SINGLE CENTER EXPERIENCE.
Authors: Nania R. , Leone A. , Mariani C. , Campanini F. , Castagnini S. , Ruggiero A. , Snaidero S. , Nocera C. , Suarez S. Martin , Pacini D. 
Published: December 2024

Background:
Cardiac surgery in elderly patients is constantly growing, due to increase in life expectancy and quality of life. We retrospectively analyzed results of surgical revascularization in patients in their eighties.

Methods:
From January 2002 to December 2022, 3085 patients undergoing coronary artery bypass-graft were enrolled. Patients were divided in group I (age over 80) with 314 patients and group II (age under 80) 2462 patients.

Results:
In group I there were more female patients, less history of smoking, dialysis, acute myocardial infarction and percutaneous coronary interventions. Euroscore II was higher in group I and left main was more frequently involved. Group I showed a higher prevalence of revascularization with only great saphenous vein and off pump revascularization. In-hospital stay did not differ between the two groups (10.7± 7.1 vs 10.6 ± 6.6, p 0.8) even if neurological complications, prolonged mechanical ventilation (>48 h) and acute renal failure occurred more frequently in Group I. Inhospital mortality in group I was 4.1% vs 1.5% mostly related to complications rather than cardiac causes.

Conclusions:
Patients over eighty undergoing surgical revascularization show higher Euroscore, mainly due to the age but less comorbidities, reflecting strictly patient selection. Inhospital mortality is lower than 5%, slightly higher than younger patients. Most of deaths occurred due to non- cardiac complications which suggest the importance of preoperativepatient selection, exclusion of other therapeutic options and the relevance of postoperative care. Therefore, surgical revascularization remains a worthy option in selected elderly patients with good results.
THE PRIORITY STUDY - PREDICTING LONG TERM OUTCOMES AFTER ISOLATED CORONARY ARTERY BYPASS SURGERY
Authors: Porcedda F. , D’Errigo P. , Vitale N. , Baglio G. , Duranti G. , Lora Ronco L. , hafdhullah M. , Parolari A. , Barili F. , Rosato S. 
Published: December 2024

Aims:
The PRIORITY (PRedictIng long term Outcomes afteR Isolated coronary artery bypass surgerY) project aims to improve predictions for long-term outcomes after isolated coronary artery bypass grafting (CABG) by identifying pre-operative risk factors for 10-year mortality and MACCE.

Materials and Methods:
The project is an observational cohort study merging two prospective multicenter studies conducted in 2002-2004 and 2007-2008 on isolated CABG. Follow-up information was obtained through administrative databases and was truncated at 10 years after the intervention. The primary outcome was long term mortality and the secondary outcome a composite of Major Adverse Cardiac and Cerebrovascular Event (MACCE).

Results:
The study cohort included 10,989 patients with complete 10-year follow-up. We analyzed the relationship between 10-year all-cause mortality and major risk factors, which were LVEF <30% (HR 2.290, 95% CI 1.947-2.694), treated diabetes (HR 3.166, 95% CI 2.307-4.343), and cirrhosis (HR 3.898, 95% CI 2.087-7.281). Cox semi-parametric analysis showed that preoperative comorbidities and baseline characteristics relate to 10-year MACCE, with LVEF <30% (HR 1.606, 95% CI 1.390-1.855), dialysis (HR 2.522, 95% CI 1.873-3.396), and cirrhosis (HR 1.930, 95% CI 1.092-3.409) as high-risk factors. External validation of the reduced model demonstrated good calibration and discrimination (Integrated Time-dependent AUC 0.753).

Conclusion:
This predictive model provides a valuable tool for estimating 10-year mortality and MACCE in CABG patients. The strength of this model lies in its validation with an external cohort. Future prospective studies could further establish its utility, integrating it into clinical decision-making to improve patient care and optimize outcomes.
LEFT VENTRICULAR EJECTION FRACTION IN THE EARLY POST-OPERATIVE PHASE: COMPARATIVE RESULTS OF CRYSTALLOID AND BLOOD-BASED CARDIOPLEGIA SOLUTIONS
Authors: Coli M. , Zito F. , Ciani C. , Amicizia S. , Bianchini R. , Capuano F. , Roscitano A. , Merico E. , Spitaleri P. , Melina G. 
Published: December 2024

Background and Objective:
Cardioplegia solutions provide effective myocardial protection during on-pump cardiac surgery. Both cold crystalloid, such as Del Nido, and blood-based, such as Calafiore solutions are widely used. However, the impact of cardioplegia selection on early post-operative global systolic function has yet to be fully assessed. Therefore, this study aimed to investigate the outcome of left ventricular ejection fraction (LVEF) after different cardioplegia solutions in adult patients undergoing on- pump cardiac surgery.

Methods:
Adult patients undergoing on-pump cardiac surgery were included and divided into groups based on the selected cardioplegia, GROUP-1: Del Nido, GROUP-2: Calafiore. LVEF was assessed by echocardiographic evaluation before and after surgery, and the difference (delta) between these values was calculated. A multivariable linear regression was performed to estimate the effect of cardioplegia selection on the delta variation in LVEF (DLVEF).

Results:
This study included 212 patients, 28% female, median age of 70 years [IQR:63.0-74.0]. No significant differences in baseline characteristics were observed, except for peripheral vasculopathy (p=0.031). Additionally, the types of surgery performed were comparable between the two groups (p=0.909). Post-operative LVEF was 55% [IQR:51.0-60.0] in GROUP-1 and 57%[IQR:51.0-63.0] in GROUP-2(p=0.036), with a DLVEF of +1.01[-3.2-6.0] in GROUP-1 and -2.00 [IQR:-9.0-4.0] in GROUP-2(p<0.001). Multivariable regression analysis (R2 = 0.48) showed an increase β +3.21 in DLVEF in patients receiving Del Nido cardioplegia (p=0.002). No difference in early mortality was found between the two groups.

Conclusions:
This study shows Del Nido cardioplegia to be associated with a potential better preservation of LVEF in the early post-operative phase.
PREOPERATIVE PLANNING OF MINIMALLY INVASIVE MITRAL VALVE SURGERY THROUGH DEEP-LEARNING
Authors: Evangelista G. , Lyu S. , Simon A. , Berhoye J. P. , Haigron P. , Anselmi A. 
Published: December 2024

Background:
Minimally invasive mitral valve surgery is increasingly adopted worldwide. Patient selection and preoperative surgical planning are crucial to allow the best postoperative outcomes. We propose a novel preoperative planning approach based on Deep-learning techniques, aimed at the identification of the most appropriate thoracic access for minimally invasive mitral valve surgery in a patient-specific fashion.

Materials and Methods:
A public Deep-Learning medical segmentation with a public dataset (TotalSegmentator) was employed. Our algorithm consisted of four steps: localization of mitral valve, calculation of the distance from mitral valve and thoracic cage, calculation of the angle between mitral valve plane and surgeon’s exposition, absence/presence of ribs. We conducted a validation process guided by a cardiac surgeon.

Results:
The evaluation of the deep-learning derived planning was performed on the basis of differences in thoracic distances and of angular discrepancy vs. the semiautomatic method. Finally, we defined two interfaces to navigate among candidate working ports. In the first interface it is possible to give greater importance to the distance or the angle according to surgeon’s choice. In the second interface, this choice is fixed as a preliminary setting.

Conclusion:
This tool may help the surgeon to identify the most appropriate working port for minimally invasive mitral valve surgery, and to predict the features of different candidate thoracic accesses in individual patients. It can also help standardizing the preoperative planning and obtaining a faster learning curve for trainee surgeons. This work is seminal, and represents an initial step towards a comprehensive planning tool for this surgery.
DIGITAL HEALTH FOR HEART TRANSPLANT RECIPIENTS AND LVAD PATIENTS: A NEW PARADIGM OF HOME CARE
Authors: Tessari C. , Vecchiato M. , Gasperetti A. , Andreis M. , Francini Pesenti F. , Cavalli C. , Mastro F. R. , Pradegan N. , Bacich D. , Toscano G. , Tarzia V. , Gerosa G. 
Published: December 2024

Background and Aim:
Digital health through mobile applications and wearable devices can be a valid tool to improve outpatient follow-up. We started a program (CURE-AT-HOME) to promote healthy lifestyles, physical activity, dietary guidelines, and encouraging self-monitoring for heart transplant recipients (TCOp) within their first year post-transplant and for LVAD (Left-Ventricular-Assist- Device) patients (LVADp). This includes multidisciplinary approach and providing them with a multidisciplinary evaluation and a dedicated mobile App. The aim of this study is to present 6- month follow-up results.

Methods:
Observational study of clinical, instrumental, metabolic, and psychological outcomes at 6- month following the initiation of CURE-AT-HOME. Multidisciplinary assessments were conducted at baseline(T0) and every six months thereafter. At each timepoint, clinical parameters, cardiopulmonary exercise testing, metabolic profile, and questionnaires including SF-36 and HADS were assessed.

Results:
A total of 16 TCOp and 10 LVADp were enrolled (January2023-January2024), of which 10 TCOp and 6 LVADp reached 6-month follow-up(T6). Between T0 and T6, the median BMI of both groups remained within the normal range. Three TCOp were identified as having new- onset diabetes at T0 and were initiated on a specialized care. An increase in terms of relative VO2(TCOp:18.06vs20.13 ml/kg/min; LVADp:13.65vs13.83 ml/kg/min) and power output was observed (TCOp:94vs114 Watt; LVADp:76 vs 76.50 Watt), with an overall increase of 0.6 MET. At T6, a good quality of life was reported in both the physical and emotional components. These were no adverse events requiring hospitalization.

Conclusions:
The preliminary results of CURE-AT-HOME demonstrated an increase in functional capacity, a metabolic status and clinical improvement and enhanced quality of life in both groups.
HOW PREVIOUS PERCUTANEOUS CORONARY INTERVENTION (PCI) INFLUENCE OUTCOMES IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING (CABG)?
Authors: Saitto G. , D’Ovidio M. , 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:
Benefits of CABG, over Percutaneous Coronary Interventions (PCI) has become more firmly established in patients with diabetes, multivessel disease and impaired ventricular function. Given the spread of PCI, it is increasingly common to find a patient requiring CABG with previuos PCI (up to 20%), Robust data in patients undergoing CABG with previuos PCI is weak. The aim of the study is to investigate the impact of a previous PCI on the outcome of CABG in the real word.

Methods:
We retrospective analysed 20337 CABG operations performed in an Italian Region, Lazio, using a regional administrative dataset. Follow up were 100% completed and certified.

Results:
Between 2008 and 2022, a total of 20.337 patients were enrolled: 19148 had no previous PCI and 1189 with previous PCI. At baseline patients with previous PCI were younger (64+10 vs 67+9.5 yo, p<0.05), with an higher risk profile: diabetes (27.25 vs 21.61%, p<0.0001), cholesterol disorders (28,7% vs 17.46%, p<0.0001), hypertension (53.99 vs 36.72.6%, p<0.0001), COPD (4.96 vs 3.78%, p<0.0001), heart failure (11.61 vs 7.35%, p>0.0001). These data could be explained considering the failed PCI and so a higher profile risk.
Previous PCI was not associated with adverse outcomes in early and long term follow up, in all LVEF class. Long term results were remarkable in our series.

Conclusions:
Our data suggest that previous PCI, although the technical difficulties, could not be considered an independent for CABG that could guarantee a very low early and long term mortality, even in case of low LVEF.
TAKOTSUBO SYNDROME IN A PATIENT TRANSPLANTED WITH SCA: A CASE REPORT
Authors: Passaro M. , Palmieri L. , Mattucci I. , Marra C. , Amarelli C. , De Feo M. 
Published: December 2024

Introduction:
In patients undergoing orthotopic cardiac transplantation (OHT), the outcome following acute coronary syndrome (ACS) is significantly worse than in patients with native heart. However, there is a lack of data in the literature on the incidence and outcome of SCA in the absence of angiographically significant coronary disease (MINOCA).

Method:
A 75-year- old woman, who underwent OHT in 2010, entered the PS for oppressive chest pain associated with dyspnea and paresthesia in the upper left limb. The ECG of entry showed widespread abnormalities of ventricular recovery, with negative T waves in D1, aVL, V4-V6. The echocardiographic observation performed in PS showed a severe reduction of EF (38%) with acinesia of the toto apex and middle segments of the interventricular septum and posterior wall. In laboratory tests, increased levels of myocardionecrosis enzymes were observed.

Results:
The patient underwent coronary angiography, which concluded for “atheromasic epicardial coronaries, in the absence of angiographically significant lesions”. He performed cardiac NMR in the following days, which showed tissue characterization images compatible with the presence of diffuse phlogy involvement of the middle-ventricular segments of the left ventricle in the absence of necrosis areas. These morpho-functional and tissue elements were consistent with the clinical suspicion of stress-syndrome cardiomyopathy of Takotsubo.

Conclusions:
Takotsubo syndrome is a rare but possible cause of SCA in patients undergoing OHT. A possible cause has been identified in an altered reinnervation of the transplanted heart, with imbalance between sympathetic and parasympathetic nervous system and consequent excessive release of catecholamines.
WARM BLOOD CARDIOPLEGIA VERSUS COLD CRYSTALLOID CARDIOPLEGIA IN PATIENTS AFFECTED BY ACUTE CORONARY SYNDROMES UNDERGOING CORONARY ARTERY BYPASS GRAFTING
Authors: Nardi P. , Buioni D. , Bonavita F. , Franceschini G. , Cardenas J. , Fasano J. , De Felice L. , Greco N. , Bonarrigo S. , Olia S. , Ajello V. , D’Onofrio A. 
Published: December 2024

Aim:
We investigated in a single-center retrospective study early outcomes of intermittent warm blood and cold crystalloid St. Thomas cardioplegia in patients referred to CABG due to acute coronary syndromes.

Methods:
336 consecutive patients underwent isolated on-pump CABG (unstable angina=234, N-STE-MI=66, STE-MI=36). Cardiac arrest was obtained with warm blood cardioplegia (WBC-group=215) or cold crystalloid cardioplegia (CCC-group=121).

Results:
Baseline and preoperative characteristics including serum levels of CK-MB and C- Troponin-I enzymes were similar in two cardioplegia groups. As compared with CCC-group, required number of cardioplegia’s doses per-patient was higher in WBC group (2.6±0.8 vs 2.1±0.8; P<0.0001), despite lower number of distal coronary-artery anastomoses (2.8±0.7 vs 3.0±0.8; P=0.027), and shorter aortic cross-clamp time (60.0±20.5 vs 66.7±20.5 min.;P<0.01). Completeness of revascularization was similar (100% vs 98%). Operative mortality (3.3% vs 1.4%), low cardiac output syndrome (5.8% vs 4.6%), postoperative left-ventricular ejection fraction (0.52±0.07 vs 0.53±0.07) were similar. CK-MB and C-troponin-I releases were similar for two cardioplegia groups at time 0, 12 hours and 24 hours after CABG. C-Troponin-I and CK:MB releases at time 0, 12 and 24 hours were lower when WBC was repeated within 18 min. in comparison with 20–25 min. (P</=0.05,for all comparisons). As well as, CK-MB/CPK- total ratio>5% was significantly lower at 12 and 24 hours when WBC administration was repeated within 18 min. Cross-clamp time (64.2±21.6 vs 65.2±29.5 min.) did not significantly correlate with CK-MB/CPK-total ratio>5% compared with lower ratios.

Conclusions:
Both types of cardioplegia guarantee equivalent early outcomes in patients undergoing CABG for acute coronary syndromes. WBC allows better protection when administered in 18-minute re-dosing interval.