bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE PROGNOSTIC IMPACT OF HEART FAILURE WITH PRESERVED EJECTION FRACTION IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING
Authors: Scarpanti M. , Garatti A. , Gastino E. , Buttiglione G. , D’Ovidio M. , Canziani A. , Daprati A. , de Vincentiis C. , Parolari A. , Menicanti L. 
Published: December 2024

Background and Aim:
Despite hard evidence in favour of surgical myocardial revascularization (CABG) in patients with ischemic heart failure (HF) and reduced ejection fraction (HFrEF), data in patients with HF and preserved EF (HFpEF) are scarce. We aim to determine the prognostic role of preserved versus reduced EF on the outcomes of patients with ischemic HF undergoing CABG.

Methods:
Between 2005 and 2018, 4079 consecutive patients with multivessel CAD underwent isolated, on-pump CABG at a single institution. Preoperative HF was ascertained according to clinical data. Preserved LV function was defined as EF ≥ 50%. Accordingly, our population was divided into 4 groups: Group I (noHFpEF, 65%), Group II (HFpEF, 5%), Group III (noHFrEF, 24%), and Group IV (HFrEF, 6%).

Results:
HFpEF and noHFpEF presented with a similar preoperative clinical profile, while the incidence of comorbidities increased in rEF patients. Perioperative morbidity was similar between HFpEF and noHF patients, but postoperative complications increased with rEF. 30-day mortality was comparable between group I and II, but significantly increased in Group III and IV (from 1.2% up to 5%). Finally, HFpEF showed a 10-years survival comparable to Group III, but significantly reduced when compared to Group I. 10-year freedom from MACE was comparable between Group I and II, and significantly higher than Group III and IV.

Conclusions:
In our experience, HFpEF patients undergoing CABG showed excellent perioperative results while proving a similar risk profile, moreover their long- term outcomes are, as expected, worse than noHFpEF patients and yet significantly better compared to HFrEF patients.
EARLY AND MID-TERM RESULTS OF MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS (MIDCAB) SURGERY
Authors: Margari V. , Squiccimarro E. , Visicchio G. , Kounakis G. , Pascarella C. , Carbone C. , Paparella D. 
Published: December 2024

Background and Aim:
This study aimed to evaluate the early and mid-term outcomes of minimally invasive direct coronary artery bypass (MIDCAB) surgery for isolated left anterior descending artery (LAD) disease, with a primary focus on revascularization-free survival.

Methods:
A retrospective analysis was conducted on 155 consecutive patients who underwent MIDCAB at Santa Maria Hospital, Bari, Italy, between May 2017 and December 2023. All patients received a direct anastomosis of the left internal thoracic artery (LITA) to the LAD, with sequential grafting performed for those with concurrent diagonal artery disease. The primary endpoint was revascularization-free survival, while secondary endpoints included early postoperative outcomes and mortality. Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards models were employed for statistical analysis.

Results:
The median follow-up duration was 36 months [12-48]. No 30-day postoperative deaths occurred. The 5-year revascularization-free survival rate was 87.6% [81.3-94.7], and the overall 5-year survival rate was 90.5% [85.1-96.2]. Predictors of the primary endpoint were preoperative New York Heart Association (NYHA) class III (HR 5.898, p=0.030) and postoperative atrial fibrillation (HR 3.405, p=0.018). The incidence of complications was low, with no cerebrovascular events reported.

Conclusion:
MIDCAB for isolated LAD disease is safe, with satisfactory postoperative outcomes and excellent mid-term survival. These findings align with existing literature, underscoring the procedure’s reproducibility. Further multicenter studies are needed to validate these results and compare MIDCAB with other revascularization strategies.
EARLY RESULTS OF MULTIVESSEL MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING
Authors: Margari V. , Squiccimarro E. , Visicchio G. , Kounakis G. , Pascarella C. , Carbone C. , Paparella D. 
Published: December 2024

Background:
Minimally Invasive coronary artery bypass grafting (MICS CABG) and Hybrid Revascularization (HR) are alternatives to sternotomy to reduce the procedure’s invasiveness. We aimed to assess the early and mid-term outcomes of MICS CABG.

Methods:
We retrospectively reviewed multivessel MICS CABG patients at Santa Maria Hospital, Bari, from 2017-2024. The primary outcome was 30-day and follow-up mortality.

Results:
Sixty-one patients underwent MICS CABG via left mini-thoracotomy, with mean 2.3±0.5 distal anastomoses using the left internal thoracic artery (LITA), right ITA (RITA), radial artery, or saphenous vein. Five MICS CABG patients (8.2%) had HR. More than half of MICS CABG cases were performed with planned peripheral cardiopulmonary bypass (CPB), without cross-clamping the Aorta. Of the total cohort, 26 patients (42.6%) received endoscopic MICS CABG, using 3D thoracoscopy for ITAs harvesting via bilateral ports in the 2nd, 3rd, and 4th IS, employing peripheral CPB and aortic clamping by Chitwood clamp at the second IS, with cardioplegia delivery via a 4 cm right anterior mini-thoracotomy. Distal anastomoses were performed via left anterior mini-thoracotomy, with subxiphoid manipulation of the emptied heart. Transit time flowmetry was used in all cases. No conversion to sternotomy was needed. No thirty-day mortality occurred, median ventilation was 4 [2-5] hours, and Intensive Care Unit-stay was 1 [1-2] days. All patients received graft evaluation via computerized tomography before hospital discharge. Mean follow-up was 2.9±1.9 years (max 5 years), with no deaths and 4 (1.9%) follow-up PCI.

Conclusion:
MICS CABG is safe and provides excellent early and mid-term outcomes.
VENOUS EXTERNAL SUPPORT (VEST) ENHANCED CABG: MID TERM CLINICAL FOLLOW UP OF A MULTICENTRIC STUDY
Authors: Weltert L. P. , Sandner S. , Centofanti P. , Fusca S. , Plijakova M. , Lodo V. 
Published: December 2024

Objectives:
The main objective of this multicentric study is to evaluate the mid-term clinical outcome in coronary artery bypass grafting (CABG) patients, and specifically need for repeat revascularizations associated with VEST supported saphenous vein graft (SVG), compared with unsupported SVG.

Methods and results:
397 patients underwent CABG in a multicentric real-world setting, with or without concomitant procedures, with at least one SVG supported with an external stent. Patients were followed for major adverse cardiac and cerebral events (MACCE) for a mean duration of 30(1-101) months. Overall, 469 external stents were implanted accounting for 71.7% of all 654 vein grafts. Revascularization rates in territories which were grafted with non- stented SVGs were significantly higher (4.32%) than the rates in territories grafted with an externally stented SVG (1.28%) during the index procedure (p=0.015). Freedom from MACCE at 1,3 and 5 years was 95.1% (SE 0.011), 85.4% (SE 0.021), and 82.4% (SE 0.030) respectively.

Conclusions:
VEST-enhanced CABG is safe and feasible in real world routine practice which includes on and off pump CABG, sequential grafting, and concomitant valve surgery. Mid term clinical follow up suggests that VEST enhanced CABG is associated with low revascularization rates, and these interventional procedures are mostly to non-VESted SVG territories.
ASSOCIATION OF SYSTEMIC INFLAMMATORY REACTION AFTER CARDIAC SURGERY WITH INCREASED 30-DAY MORTALITY: A MACHINE LEARNING APPROACH FOR RISK PREDICTION
Authors: Squiccimarro E. , Lorusso R. , Consiglio A. , Margari V. , Piancone F. , Haumann R. G. , Rociola R. , Whitlock R. P. , Paparella D. 
Published: December 2024

Background and Aim:
Systemic inflammation (SIRS) characterizes the postoperative course of cardiac surgery, worsening patient outcomes in its most relevant form. We investigated the impact of SIRS on 30-day mortality and developed a machine-learning model for SIRS prediction.

Methods:
A retrospective evaluation of patients who underwent cardiac surgery from 2016- 2020 in a single hospital was performed. SIRS was assessed 12 hours post-surgery using the ACCP/SCCM criteria. A multivariate logistic model identified SIRS predictors. SIRS-positive patients were matched 1:1 with SIRS-negative ones. The effect of SIRS on mortality was investigated within the propensity-matched cohort. Baseline Risk (BRM) and Procedure- adjusted Risk (PARM) Random Forest Models were trained, optimized, and calibrated. Models’ performance was assessed via cross-validation (CV), using the AUC as a benchmark metric.

Results:
A total of 1908 patients were included. SIRS incidence was 28.7%, and 30-day mortality was 4.6%. Propensity scoring matched 483 patient pairs. SIRS was significantly associated with mortality (OR 2.77; 95%CI 1.40-5.47, p=0.003). SIRS mediated a proportion of its intraoperative predictors’ impact on mortality: 24.3% for anemia, 9.9% for vasopressors, 4.0% for hyperlactatemia (p<0.001). The BRM produced an AUC 0.77±0.04 in the 5-fold CV and an AUC 0.73 (95%CI 0.70-0.85) on the test set, whereas the PRM culminated in an AUC 0.81±0.02 in the CV and 0.82 (95%CI 0.76-0.85) on the test-set (DeLong p<0.001).

Conclusion:
Clinically-defined SIRS after cardiac surgery is associated with 30-day mortality. Machine learning allows to predict SIRS effectively, and paves the way for research exploring targeted interventions to prevent/mitigate its negative effects.
FIVE-YEAR REAL-WORLD EUROPEAN RESULTS WITH A NOVEL AORTIC BIOPROSHESIS IN PATIENTS WITH OR WITHOUT CHRONIC KIDNEY DYSFUNCTION
Authors: Onorati F. , Francica A. , Perrone F. , Theron A. , Grabenwoger M. , Lucchese G. , Pacini D. , Fiore A. , Klein P. , Luciani G. B. 
Published: December 2024

Background and Aim:
The durability of bioprostheses in patients with advanced stage of chronic kidney disease (CKD) is not well established. Early bioprosthetic degeneration in these patients is strictly linked to secondary hyperparathyroidism with dystrophic calcification, which is demonstrated to start since CKD stage 3. The INSPIRIS Resilia (IR) valve was designed to improve durability through innovative tissue preservation technology, but in patients with CKD has not been evaluated yet.
This study reports 5-year clinical outcomes and bioprosthetic performance (focusing on SVD staged according to VARC-3) in young patients with CKD undergoing SAVR in a multicenter real-world Registry.

Methods:
From 2017 to 2023, clinical and echocardiographic data of patients receiving IR prostheses for isolated or combined AVR were prospectively collected at 7 European Cardiac Centers. 498 patients were included: 421 with CKD stage 1 or 2, 68 with CKD stage 3 or 4, and 9 on dialysis.

Results:
Patients with CKD ≥3 had multiple comorbidities, higher incidence of preoperative endocarditis and more frequent reoperation after previous AVR.
They exhibit a significantly higher 5-year all-cause mortality (p=0.003) and tend to have higher cardiovascular mortality (p=0.056). In a real-world setting, IR valve shows stable haemodynamics with no signs of progression of intra-prosthetic regurgitation up to 5-year follow up. Outcomes were comparable between CKD groups, with non statistical differences in terms of SVD 2 and 3, prosthetic valve endocarditis throughout the follow up.

Conclusions:
In young patients undergoing SAVR with an advanced stage CKD, IR showed good outcomes over a five-year follow-up period.
EARLY EXPERIENCE IN AORTIC VALVE REPAIR WITH GEOMETRIC RING
Authors: Maraschioni G. , La Torre M. W. , Abbà P. , Ferrante L. , Spitaleri A. , Loforte A. , Boffini M. , Rinaldi M. 
Published: December 2024

Introduction:
Aortic valve repair (AVr) with geometric ring aims to restore proper valve function by preserving native leaflets and providing stability to dilated annulus.

Methods:
We analysed retrospectively all AVr procedures for aortic regurgitation (AR) with geometric ring annuloplasty at our division between January 2022 and August 2024.

Results:
During the study period, 59 patients underwent AVr using a geometric ring, among them 51 were male and the mean age was 49,3 years (± 17,4). The aortic valve was tricuspid in 28 patients and bicuspid in 31 (52,5%). The bicuspid cohort was younger, with more dilated annulus and left ventricle. 54 patients (91,5%) needed additional cusp repair with either plication of the cusps (79,6%) or shaving (55,9%). In few cases fenestrations closure or cusps reconstruction were necessary. Concomitant surgical procedures were performed in 30 patients (57,6%), including ascending aorta replacement (28,8%) and mitral valve surgery (20,3%). Aortic valve replacement was required in two patients at the time of AVr because of significant residual AR; one was a prior AVr with suture annuloplasty. Mean length–of–stay in ICU and in hospital were 1 and 6.7 days. No significant complications were reported, nor intra–operative and in–hospital mortality. At an average follow-up of 8 months (max 30 months), 86% of the patients had no significant AR, mean aortic gradient was 12.7 mmHg (± 5,6). Only three patients (5,1%) required subsequent aortic valve replacement.

Conclusion:
Considering our initial learning curve, geometric ring annuloplasty for AR is a safe and reproducible procedure with promising short-term results.
PERCUTANEOUS BALLOON OCCLUSION OF LVAD OUTFLOW CANNULA TO EVALUATE MYOCARDIAL FUNCTION RECOVERY
Authors: Loforte A. , Spitaleri A. , Monteleone G. , Parrella B. , Abbà P. , Galanti G. A. , Sandoval A. , Gallone G. , Conrotto F. , Pidello S. , Trompeo A. C. , Boffini M. , Rinaldi M. 
Published: December 2024

Off-pump trials to evaluate myocardial recovery in patients with idiopathic dilated cardiomyopathy (DCMP) supported by continuous-flow pumps might be more challenging than with pulsatile-flow devices because of retrograde flow through the left ventricular assist device (LVAD). The estimated recovery rate is about 5% within five years.
We present the case of a young girl suffering with chemotoxic cardiomyopathy. She developed cardiogenic shock and was initially bridged from extracorporeal life support (ECLS) to a durable LVAD. After two years of LVAD support, echocardiography at low RPMs showed evidence of reverse remodeling. However, significant regurgitation through the pump during right heart catheterization (RHC) would have prevented an optimal assessment of myocardial function, therefore an off-pump trial and percutaneous balloon occlusion of LVAD outflow cannula was conducted in a hybrid operating room to evaluate the chance of pump explant.
SIX-YEAR RESULTS OF THE NEWEST GENERATION PERICARDIAL VALVES IN PATIENTS YOUNGER THAN 65 YEARS OLD: REAL-WORLD DATA FROM A MULTICENTER REGISTRY
Authors: Onorati F. , Francica A. , Perrone F. , Porto A. , Geisler D. , Caruso V. , Mariani C. , Pacini D. , Lucchese G. , Grabenwöger M. , Theron A. , Luciani G. B. 
Published: December 2024

Background and Aim:
Structural valve degeneration (SVD) remains the «Achille heel» of biological prostheses and younger age at implantation has been shown to accelerate this process. Current ESC/EACTS guidelines recommend biological prostheses in patients over 65 for aortic valve replacement. This study analyse the six-year results in ≤65 years old patients receiving new generation of bovine pericardial valve Inspiris Resilia prosthesis in the aortic position.

Methods:
From 2017 to 2023, clinical and echocardiographic data of patients receving IR prosthesis for isolated or combined AVR were prospectively collected at 7 European Cardiac Surgery Centers. 1871 patients were included: 1257 (67.2%) aged ≤65 years, 614 (32.8%) aged >65 years.
Primary endopint was six- year freedom from structural valve deterioration «SVD» (staged according to VARC-3 criteria). Secondary endpoints were prosthetic haemodynamics at various time point, freedom from prosthesis explant for SVD, non-SVD issues, infective endocarditis and cardiovascular mortality.

Results:
Patients ≤65 years receiving INSPIRIS RESILIA valve in aortic position had higher six-year freedom from any stage of structural valve deterioration, comparable to those of > 65 year old patients. Stable prosthetic haemodynamic values were reported over time in both populations. Only 1.5% of valve were explanted, with endocarditis being the primary cause. Only 4 cases underwent reintervention due to severe SVD, and no difference in six-year freedom from explant for SVD was reported between ≤65 and >65 years old patients.

Conclusions:
This large multicenter registry showed that the INSPIRIS RESILIA valve has good durability in ≤65 years old patients over a six-year follow-up period.
CTSCAN EQUIVALENT OF HARLEQUIN SYNDROME FOLLOWING ECMO IMPLANTATION MIMICKING AORTIC DISSECTION
Authors: Sciacca C. , Musto M. , Degani A. , Pellegrini C. , Pelenghi S. , Totaro P. 
Published: December 2024

Introduction:
Extra-corporeal-membrane-oxygenation (ECMO) is a frequent rescue treatment for acute cardiac dysfunction and/or sudden cardiac arrest. CT scan is frequently scheduled following ECMO implant and, unfortunately, flow artifacts could be difficult to discern from severe pathologic conditions such as pulmonary embolism or acute aortic dissection (AAD). Here we reviewed our series of ECMO-patients undergoing acute CTscan in order to evaluate a potential dramatic mistake in CT scan interpretation in patients in ECMO.

Materials and Methods:
Out of 58 ECMO implanted at our Division, in the last 12-month, 6 patients received early CT-scan. We reviewed all ct scan and we analysed potential flow artifacts leading to misdiagnosis during CTscan report. CT scan report were compared to hemodynamical and clinical status.

Results:
Out of 6 patients receiving contrast-CTscan following ECMO implantation, in 2 patients signs of AAD were reported. In case 1 suspicious of AAD from aortic root was diagnosed following ECMO implantation in cath-lab. Following favourable clinical course and ECMO weaning, CTscan showed no-sign of AAD. In case 2 AAD was diagnosed following ECMO implantation due to sudden cardiac arrest but was not confirmed at TE- Echo. Patient died within 48hour without necroscopical assessment.

Conclusion:
Following ECMO implantation, cardiac recovery, can cause ejection of poorly oxygenated blood, leading to selective distal hypoxia. This phenomenon, was named Harlequin syndrome. CTscan equivalent of harlequin syndrome could be a dissection-like image which has to be recognized by experienced radiologist at time of early CT report to avoid potential drastic consequence.
ANALYSIS OF CLINICAL AND ECHOCARDIOGRAPHIC OUTCOMES IN PATIENTS UNDER 70 YEARS OF AGE WHO UNDERWENT BIOLOGICAL AORTIC VALVE REPLACEMENT: INSPIRIS RESILIA VS. PERIMOUNT MAGNA EASE
Authors: Nassar E. , D’Errico Ramirez A. , Saiydoun G. , Alqdeimat I. , Ruggieri V. G. 
Published: December 2024

Background:
The INSPIRIS-RESILIA-aortic-prosthesis, made from bovine-pericardial- tissue, features an expandable-stent for easier future TAVI and anti-calcification-properties. Mid-term-outcome reports are still insufficient. This study compares midterm, clinical, and echocardiographic performance between patients implanted with the INSPIRIS-valve and those with the CE-Perimount-MAGNA-EASE-valve.

Methods:
This study is a retrospective-single-centre study. All patients received biological- prostheses, with or without additional procedures, through full-sternotomy, and follow-up included survival, complications, and hospital stay length. The primary outcome was all-cause- mortality one year post-AVR, with secondary-outcomes including gradients, EF, reintervention rates, and postoperative complications. Data were analyzed using descriptive statistics, and PS- matching was used to adjust for baseline differences.

Results:
We included 300 patients, who were implanted with INSPIRIS (n=52), or ME (n=248) between January 2018 and May 2023. After matching each group included 52 patients. The INSPIRIS-group consisted of younger patients with fewer comorbidities compared to the ME-group, which had higher rates of PAD, preoperative AF, and PTCA. Postoperative- outcomes showed the ME-group had higher transfusion rates (INSPIRIS: 46,1% vs ME: 69,2%, P = 0.017), longer CPB-times (INSPIRIS 93 ± 22, ME 109,51 ± 35,05 P=0,004), and a higher, but not statistically significant, reoperation-rate. Mid-term-results showed no significant difference in survival, SVD, or transvalvular-mean-gradient at 1 year (INSPIRIS 11,3 ± 3,56, ME 11,2 ± 4,1, P=0,9), and 3 years (INSPIRIS 12,9 ± 3,7, ME 12,9 ± 3,6, P=0,7).

Conclusion:
Surgical-AVR using the INSPIRIS-valve exhibited comparable safety and satisfactory mid-term-outcomes, with hemodynamic performance similar to the ME-valve. This study demonstrates favorable clinical results and good hemodynamics at 3 years.
INTRODUCING PHASE OF CARE MORTALITY ANALYSIS (POCMA) IN AN ITALIAN CARDIAC SURGERY CENTRE
Authors: Bortolussi G. , Gastino E. , Buttiglione G. , Scarpanti M. , Vitale N. , Porcedda F. , Garatti A. , Menicanti L. , De Vincentiis C. 
Published: December 2024

Background and Aim:
Phase of Care Mortality Analysis (POCMA) is a method for analysing deaths following cardiac surgery.
The first aim is to identify the “seminal event” (SE), defined as the most proximal component in the sequence of care, starting a cascade of deterioration culminating in death.
Secondly, the phase (time period in relation to the operation) where SE took place is ascertained.
Last, the SE is classified as avoidable, when protocols/pathways are available to prevent or rescue and the system lacks the resources; unavoidable when there is a >50% likelihood that the SE could not have been prevented.

Methods:
Between January 2023 and September 2024, each case of in-hospital death following cardiac surgery was discussed at a dedicated monthly multi-disciplinary team (MDT) meeting, and classified according to POCMA. All healthcare providers involved in patient’s care were invited to participate.

Results:
Average number of MDT participants was 15 ±4,5, the majority of whom were cardiac surgeons.
Patients: n=72; age 73 ±9 years; female n=33 (46%); EuroScore2 mean 21 ±19, median 11 (IQR 6). Only 26 (36%) of cases consisted of an isolated procedure, while the rest were combined.
POCMA: Preoperatory 23,6% (judgement 70%); Intraoperative 15,3% (surgeon 33%, stroke 25%); Postop ICU 33% (respiratory care 40%, catastrophe 24%, ICU care 20%); Postop Ward 18% (catastrophe 66%). Avoidable SE n=38 (53%).

Conclusions:
This is the first reported experience with POCMA for internal audit in cardiac surgery in Italy. Issues emerged from MDT discussion, particularly avoidable SE, prompted initiatives aimed at quality improvement.