bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC21 EARLY OUTCOMES OF MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT WITH RAPID DEPLOYMENT BIOPROSTHESES: INSIGHTS FROM AN ITALIAN NATIONAL REGISTRY.
Authors: Tessari C. , D’Onofrio A. , Diena M. , Solinas M. , Alamanni F. , Massetti M. , Livi U. , Di Eusanio M. , Mignosa C. , Russo C. , Rinaldi M. , Di Bartolomeo R. , Luzi G. , Antona C. , De Paulis R. , Salvador L. , Maselli D. , Portoghese M. , Alfieri O. , De Filippo C.M. , Bortolotti U. , Musumeci F. , Gerosa G. 
Published: November 2018

Background and Aim:
Rapid-deployment bioprostheses (RDBs) represent one therapeutic option for patients with aortic valve stenosis (AVS). Their theoretical advantages are the reduction of procedural times and the facilitation of minimally invasive operations. Aim of this retrospective multicenter study was to assess early outcomes of isolated aortic valve replacement (iAVR) with RDB performed through mini-sternotomy (MS).

Methods:
We analyzed data of iAVR through MS approach from a National Registry of RDB. Preoperative variables were defined according to Euroscore II system and postoperative outcomes were reported according to VARC-2 definitions.

Results:
From April 2012 to March 2018, 450 consecutive patients (21 centers) underwent iAVR through MS for AVS. Mean age was 74 ± 7.5 years and 231 (51.1%) were females. Logistic Euroscore I, Euroscore II and STS-PROM score were 6.7 ± 5.3%, 2.0 ± 1.4% and 2.2 ± 1.7%, respectively. Mean cardiopulmonary bypass and aortic cross-clamping times were 88.4 ± 30.4 minutes and 59.5 ± 20.8 minutes, respectively. Peripheral cannulation was performed in 243 cases (54%). Conversion to full-sternotomy occurred in 8 patients (1.8%). VARC device success was 98% (441 cases). Early mortality was 0.7% (3 patients). VARC major postoperative complications were 19 (4.2%) and 28 patients required new permanent pace-maker (6.2%). Postoperative echocardiography revealed a mean transprosthetic gradient of 11.3 ± 4.6 mmHg, a mean indexed AVA of 1.15 ± 0.32 cm2/m2 and a total of 27 (6%) paravalvular leaks (24 mild and 3 moderate).

Conclusions:
Our data suggest that RDBs allow performing iAVR using a minimally invasive approach with good perioperative clinical and hemodynamic outcomes, with a low rate of postoperative complications.
OC72 SURGICAL TREATMENT OF ISOLATED AORTIC STENOSIS IN OCTOGENARIAN PATIENTS: LONG-TERM RESULTS OF A CONSECUTIVE MONOCENTRIC SERIES
Authors: Daprati A. , Garatti A. , Parolari A. , Canziani A. , Mossuto E. , Farah A. Abu , Menicanti L. 
Published: November 2018

Background and Aim:
Aortic stenosis (Sao) is the most common cause of cardiac valve surgery in Europe. The aim of this study is to analyze the short- and long-term outcome of a consecutive population of octogenarian patients who underwent AVR for isolated severe Sao.

Methods:
Between January 2003 and December 2016, 270 consecutive patients (mean age = 83 ± 2 years, male = 36%) were operated on AVR for isolated Sao at our center. 28% of patients had symptoms of advanced heart failure (NYHA class III-IV), despite good left ventricular function (mean FE = 56 ± 11%). Long-term outcomes were analyzed by Kaplan-Meier. Potential predictors of hospital mortality and long-term outcomes were investigated by logistic regression and multivariate Cox analysis, respectively.

Results:
In most patients a biological prosthesis was implanted (90%). The mean time of CEC and aortic clamping were 69 ± 19 and 55 ± 15 minutes, respectively. As regards perioperative complications, the incidence of stroke, acute renal failure, mediastinitis and complete AV block (which required PM implantation) was 0.5%, 4.3%, 2.3% and 2.8% respectively. 30-day mortality was 2.5% (7 patients). The mean follow-up was 54 ± 36 months (range: 12–161). 85% of patients showed up in NYHA class I-II. Overall we recorded 70 deaths (25%), of which 39 (14%) due to cardiac cause.

Conclusions:
The surgical aortic valve replacement in octogenarian patients is an effective therapy, with excellent long-term results as a prognosis quoad vitam, with a good functional recovery and quality of life.
OC02 AUTOMATIC 3D-ECHO AORTIC ANNULUS MEASUREMENT FOR A PRECISE PREOPERATIVE TAVI PLANNING: IS IT ALREADY FEASIBLE?
Authors: Romagnoni C. , Gelpi G. , Contino M. , Rosa R. , Mangini A. , Antona C. 
Published: November 2018

Background and aim:
Transcatheter aortic valve implantation is a wide-spreading technique.
The advent of recent softwares based on 3D transoesophageal echo is updating the role of ultrasound in the preoperative prosthesis sizing because of its potentiality to provide precise measurements of the aortic annulus avoiding X-ray and contrast material. Aim of this study is to verify the reliability of echo measurements.

Methods:
We enrolled 15 patients with severe aortic stenosis and 5 with healthy aortic valve. All patients underwent ECG-gated angio CT-scan and 3D transoesophageal echocardiogram. We blindly compared the two sets of data focusing on annulus and sinuses dimensions.

Results:
Statistically significant differences were found in aortic annulus diastolic maximum diameter and perimeter. Although not significant, the small differences highlighted in systole would have led to the choice of a different prosthesis size in 33% of the patients in case of CoreValve Evolut R, in 40% in case of Sapien 3 and in 60% in case of Lotus valve.

Conclusions:
Although not significant, the small differences between echo and CT measurements, if at the extremities of different size range, lead to a different transcatheter prosthesis size choice with potential relevant clinical effect.
OC09 CLINICAL AND HEMODYNAMIC OUTCOMES AFTER AORTIC VALVE REPLACEMENT WITH RAPID-DEPLOYMENT BIOPROSTHESES: RESULTS FROM AN ITALIAN NATIONAL REGISTRY
Authors: D’Onofrio A. , Tessari C. , Filippini C. , Diena M. , Solinas M. , Alamanni F. , Massetti M. , Livi U. , Di Eusanio M. , Mignosa C. , Russo C. , Rinaldi M. , Di Bartolomeo R. , Luzi G. , Antona C. , De Paulis R. , Salvador L. , Maselli D. , Portoghese M. , Alfieri O. , De Filippo C.M. , Bortolotti U. , Musumeci F. , Gerosa G. 
Published: November 2018

Abstract

Background and Aim:
Rapid deployment bioprostheses (RDB) have been recently introduced into clinical practice. Aim of this multicenter retrospective study was to evaluate early and mid-term outcomes of aortic valve replacement (AVR) with RDB.

Methods:
Data from a National Registry that includes patients undergoing AVR with RDB in Italy were analyzed. Univariate and multivariable analysis were performed to identify independent predictors of mortality. Kaplan-Meier method was used for survival analysis.

Results:
A total of 1158 patients (21 centers, April 2012-March 2018) were included. Nearly one third of patients (368 patients, 31.7%) underwent combined operations and 487 (61.6%) of the 790 patients who underwent isolated AVR received a minimally invasive approach. Median cross-clamp time for isolated AVR was 58 minutes (IQR: 45–71). Device success was 97.8% (1132 patients). Permanent pace-maker implantation was 6.7% (78 patients). Thirty-day overall mortality occurred in 24 patients (2.1%). At discharge, trace-mild and moderate paravalvular leak were found in 98 (8.5%) and in 8 (0.7%) patients, respectively. Median follow-up was 351 days (IQR: 96–654). Figure 1A shows hemodynamic performance over time. Kaplan-Meier survival was 95.8 ± 0.6% and 88 ± 2.4% at 1 and 4 years, respectively (Fig. 1B). At follow-up, 1078 patients were in NYHA class 1–2 (98.4%). Multivariable analysis identified as independent predictors of mortality: age (OR:1.071, 95%CI: 1.006–1.139; p = 0.0307) and preoperative atrial fibrillation (OR:2.693, 95%CI: 1.204–6.022; p = 0.0158).

Conclusions:
RDB provide good early and mid-term clinical and hemodynamic outcomes. These devices may be considered as a reasonable alternative to conventional bioprostheses especially in minimally invasive or in combined operations.
OC15 CORONARY ARTERY BYPASS GRAFTING WITH ARTERIAL CONDUITS. LONG-TERM RESULTS FROM A MULTICENTRE REGISTRY
Authors: Nicolini F. , Fortuna D. , Agostinelli A. , Pacini D. , Gabbieri D. , Zussa C. , de Palma R. , Gherli T. 
Published: November 2018

Abstract

Background and aim of the study:
Conflicting results have been published on long-term outcomes of total arterial revascularization (TAR) in patients operated on coronary artery bypass grafting. The aim was to compare 10-year rates of overall mortality, cardiac related mortality, myocardial infarction, stroke, and repeat revascularization, in a cohort of patients younger than 70 years, treated with total arterial revascularization versus a conventional coronary artery bypass grafting performed with left internal mammary artery plus saphenous vein grafts.

Methods:
Two propensity score matched cohorts, each of 998 patients, undergoing isolated CABG at the regional public and private centers of Emilia-Romagna region (Italy) were used to compare long-term outcomes of 3780 patients<70 years, 2718 operated with traditional CABG and 1062 patients who received TAR.

Results:
Thirty-day mortality and morbidity were similar in both groups. The mean follow-up of the PS matched cohort was 8.1 ± 2.6 years. At 10 years, TAR patients reported significantly lower overall mortality (15.7% versus 19.6%; KM log-rank p = 0.02), and lower need for repeat revascularization with PCI (14.8% versus 17%, KM log-rank p = 0.04). No differences were reported between groups in terms of cardiac-related mortality, incidence of myocardial infarction, and stroke.

Conclusions:
At 10 years, after propensity score matching, TAR CABG reported better results in terms of cumulative rate of all-cause death, and repeat revascularization with PCI, and similar results in terms of cardiac death, myocardial infarction, and stroke, with respect to conventional CABG.
OC16 CORONARY ARTERY ENDARTERECTOMY DURING CORONARY ARTERY BYPASS GRAFTING: A SOLUTION FOR COMPLETE REVASCULARIZATION
Authors: malik L. 
Published: November 2018

Abstract

Background:
Coronary Artery Bypass Grafting (CABG) is one of the most frequently done cardiac surgical procedures. However, with the advancements in catheter-based interventional procedures, the category of patients taken up for CABG is gradually being restricted to more high-risk group. Performance of Off pump coronary artery bypass grafting (OPCAB) with concomitant coronary artery endarterectomy(CE) in patients with severe coronary disease provides more complete revascularization.We examined the technique and early outcomes of OPCAB with coronary endarterectomy (CE).

Materials and methods:
This is a single institutional retrospective study with 32 patients (26 males, 6 females) underwent concomitant off-pump CE and CABG from 1 october 2016 through 31 october 2017. which was about 11.26 % (32/284) of the OPCAB cases. Average number of coronary bypass grafts were 2.4 ± 0.8. 10 CE procedures were performed with saphenous vein patch. 7 involved left anterior descending artery (LAD) CE with left internal mammary artery (LIMA) conduits. The remaining 3 were diagonal branch artery (D1) CE with saphenous vein bypass conduits.

Results:
The incidence of postoperative MI was 9%. The 30-day mortality was 3.12% from complications of bowel ischaemia and three patients with septicaemia associated with prolonged intubation. The mean operating time was 138 ± 22 minutes.

Conclusion:
We have shown that the effect of OPCABG with CE appears to be safe and early outcomes are encouraging. Hence, diffuse disease requiring endarterectomy should not be considered a contraindication to OPCABG. Surgical skills and the suitability criteria of the patients are very important in this regard.
OC05 BLEEDING RISK PREDICTION IN CORONARY ARTERY BYPASS SURGERY
Authors: Salsano A. , Olivieri G.M. , Maestri F. , Natali R. , Miette A. , Soma F. , Vellucci M. , Sportelli E. , Buscaglia G. , Santini F. 
Published: November 2018

Abstract

Background And Aim:
Severe perioperative bleeding after coronary-artery bypass grafting(CABG) is associated with poor outcome. Recently new scores for prediction of severe bleeding have been developed. Aim of our study was to evaluate the reliability of 10 risk scores for bleeding in our cohort of CABG patients.

Methods:
An observational study included 337 consecutive patients who underwent isolated CABG from July2015 to January2018. Each bleeding risk score was calculated and analyzed through the c-statistic for Discrimination, the Hosmer-Lemeshow test for calibration.

Results:
The mean chest tube loss within the first 12 post-operative hours was 385.8 ± 222.0 ml. 1.7 ± 2.3 units of red blood cells per patient were transfused after the operation. Re-sternotomy for bleeding rate was 2.1%. The rate of severe-massive bleeding according to Universal Definition of Perioperative Bleeding(UDPB grades 3–4) classification was 15.1%. Overall in-hospital mortality was 2.6%. Mortality rates in patients with severe bleeding according to UDPB classification vs no-severe bleeding was 11.8% vs 1.1%(p < 0.0001) and UDPB 3–4 was associated with in-hospital mortality (OR 12.58,95% CI:3.20–61.29,p = 0.0005). Risk scores Discrimination was: 0.66 (0.58–0.74) for the ACTION, 0.63 (0.54–0.71) for the WILL-BLEED, 0.61 (0.52–0.67) for the TRACK, 0.59 (0.51–0.67) for the HEMORR2AGES, 0.59 (0.50–0.68) for the TRUST, 0.58 (0.49–0.66) for the ORBIT, 0.53 (0.443–0.621) for the HAS-BLED, 0.53 (0.43–0.62) for the CRUSADE, 0.52 (0.44–0.60) for the ATRIA and 0.51 (0.43–0.59) for the PAPWORTH. Calibration was adequate for all scores but the TRUST.

Conclusions:
In our cohort of CABG patients severe bleeding correlated with early mortality. While the ACTION score had the highest Discrimination, all the other scores analyzed successfully predicted severe perioperative bleeding after CABG.
OC81 TOTAL ARTERIAL CORONARY ARTERY REVASCULARIZATION USING BOTH INTERNAL MAMMARY ARTERIES WITH Y CONFIGURATION: LONG TERM RESULTS
Authors: Pagliaro M. , Mikus E. , Amoncelli E. , Zucchetta F. , Tripodi A. , Calvi S. , Albertini A. 
Published: November 2018

Abstract

Background and aim:
Bilateral internal mammary artery (BIMA) grafts are used for coronary revascularisation by only a minority of surgeons, despite a growing body of evidence suggesting improved survival when compared to use of only one internal mammary artery with additional saphenous vein grafts. Main disadvantages reported, consist in sternal wound infection, increased technical complexity. We report our experience discussing technical considerations and long term follow up.

Methods:
Between January 2010 and February 2017, 1038 patients with multivessel coronary artery disease underwent myocardial revascularization with bilateral internal mammary arteries (BIMA) adopting Y configuration (male = 877 [84.5%]; mean age 65.7 ± 8.7 years, range 36–87). More than 25 % were obese (body mass index > 30) N°261 and 32.5n% were affected by diabetes mellitus.

Results:
Both internal mammary arteries are harvested using a completely skeletonized technique. This minimizes chest wall trauma, achieves maximum length, and makes constructing the “Y” graft and performing subsequent sequential grafting easier. An off pump technique was preferred in 114 patients, for the remaining overall cardiopulmonary bypass was 68 ± 28.0 minutes and aortic cross clamping was 50 ± 20 minutes. (Skin to skin median 240 minutes). Thirty days mortality rate resulted 1.4% (15/1038). Other postoperative complications and follow up are collected and reported.

Conclusions:
data from literature reveals that use of bilateral mammary arteries is associated with improved long term survival, also in diabetic patients. The reported disadvantages as sternal dehiscence are actually not so relevant as well operations times are not so increased.
OC35 IMPORTANCE OF MULTIDICIPLINARY VAD TEAM FOR EARLY RECOGNITION OF MECHANICAL ASSISTANCE ADVERSE EVENTSIMPORTANCE
Authors: Contento C. , Vitalini E. , De Marco M. , Iaiza A. , Pietraforte L. , Montelto A. , Musumeci F. 
Published: November 2018

Abstract

Background and Aim:
Left ventricular assist device (LVAD) represents a valid alternative to heart transplant in patients who suffer from end stage heart failure but adverse events, involving both the internal and the external parts, can occur in ongoing patients and if not promptly diagnosed can be potentially fatal. Main intention is to report our approach to device malfunction.

Methods:
Over the past ten years in 90 patients a LVAD was implanted at our institution. Patient's LVAD parameters were monitored monthly. A VAD team including nurse, perfusionist, cardiac surgeon, provide 7/24 on call service to afford any emergency. The patients were trained to promptly identify the different alarm and to immediately communicate to the VAD team. According to the alarm severity a support was provided as early as possible and hospitalization was prescribed as mandatory in some case.

Results:
In 23 patients a device's part failure occurred. 12 required immediate hospitalization and intervention as consequence of different complications like showed in table 1. N. events Type of complication Intervention 4 Pump Thrombosis 3 Thrombolisis 1 Pump Exchange 5 Controller's Failure Controller Exchange 3 Driveline Fracture Hospidalization 3 HTX urgent 5 Batteries Clips broken Clip Exchange 6 Driveline's Outer Sheath Fracture Repair 1 System control power cables fracture Controller Exchange 1 Connector Nut rupture Controller Exchange.

Conclusions:
Early recognition and diagnosis of LVAD complications is mandatory. We support the utility of multidisciplinary VAD Team to guarantee an early identification and solution of VAD related problems.
OC56 OUTCOMES IN VAD-PATIENTS: A SINGLE CENTER EXPERIENCE
Authors: Cammardella A.G. , Comisso M. , Gherli R. , Contento C. , Vitalini E. , Montalto A. , Musumeci F. 
Published: November 2018

Abstract

Objectives:
we report our single-center experience with implantable ventricular assist devices.

Methods:
From March 2005 to December 2017, 89 consecutive patients underwent implantation of long-term ventricular assist devices (VADs). The mean age was 53.8 ± 10.3 with a clear prevalence of females (92.4%). Ischemic cardiomiopathy was the main etiological diagnosis (51.7%) and bridge to transplant represented the major indication to implant. The mean INTERMACS level was 2.4 ± 1. We implanted n = 3 Heartmate I XVE (3.4%), n = 51 Heartmate II (57.3%), n = 8 Heartware HVAD (9%), n = 3 HVAD as BIVAD (3.4%) and n = 24 Heartmate 3 (26.9%).

Results:
the overall in-hospital mortality was 13.5% (12 patients). Twelve patients (14.0%) needed temporary RVAD (Centrimag Levitronix) at the time of LVAD implantation. The mean VAD support time was 16.9 ± 14.0 months in group of patients who received transplantation (n = 35) and 16.4 ± 16.2 in group with no following transplantation (n = 54). The most common adverse events were driveline exit site or VAD infection (18%), gastrointestinal bleeding (9.1%), stroke (10.4%), late RVF requiring re-hospitalization (5.2%). Device malfunction (pump thrombosis or other) was observed in 9.1% (n = 7) of patients. The overall survival in VADs patient were 78.3%, 63.8% and 53.9% at 12, 24 and 72 months, respectively.

Conclusion:
our analysis on a single-center cohort of patients confirms utility and relative safety of VAD-therapy in advanced heart failure.
OC13 COMPARING SPRAYABLE HEMOSTAT/SEALANT ADJUNCT TO TRADITIONAL HEMOSTASIS AFTER CARDIAC REDO SURGERY: A RANDOMIZED SUTDY
Authors: Weltert L. , D’Aleo S. , Salica A. , Bellisario A. , Scaffa R. , Wolf L. Guerrieri , Chirichilli I. , De Paulis R. 
Published: November 2018

Abstract

Background:
Bleeding after cardiac surgery is a common, unresolved, and consequence-heavy. Despite meticulous hemostasis, some degree of diffuse bleeding (referred to microvascular bleeding) tends to persist at surgery completion. Several techniques to reduce post-operative bleeding have been attempted. We have utilized a thin sprayable layer of a hemostat/sealant (Tisseel, Baxter Healthcare, Deerfield, Illinois) to reduce post-operative blood loss This study (NCT02360800) compared the effectiveness of adjunct hemostat/sealant, applied via a compressed air spray, in sealing the microvascular bed prior to chest closure in cardiac redo surgery

Methods:
All patients undergoing any type of cardiac redo surgery between March 2015 to October 2017 were enrolled and allocated in a 1:3 ratio to adjunct hemostat/sealant spray or control (defined as no specific treatment for microvascular bleeding) A 1:2 best-neighbor propensity matching technique was then applied to obtain a matched cohort. Primary analyses: Post-operative bleeding at 3, 6, 9, 12 and 24 hours post-surgery Secondary analyses: allogeneic blood product transfusion during 4 post-operative days.

Results:
The study included 71 participants (17 adjunct hemostat/sealant; 54 control/no specific treatment) Of these, 54 propensity-matched subjects (17 adjunct hemostat/sealant; 34 control/no specific treatment) were analysed Hemostat/sealant use resulted in significantly lower post-operative blood loss at the 3, 6, 9, and 12 hour timepoints
Significantly lower amounts of blood products were transfused to the matched and unmatched hemostat/sealant vs. control cohort participants

Conclusion:
In patients undergoing cardiac redo surgery, adjunct hemostat/sealant spray use was associated with less post-operative blood loss and lower blood product transfusion utilization.
OC83 TRANSAORTIC SEPTAL MYECTOMY FOR OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY: THE POLICLINICO DI MONZA EXPERIENCE
Authors: Vaccari G. , Binaco I. , Zyryanov A. , Casati W. , Poggio D. , Spirito P. , Ferrazzi P. 
Published: November 2018

Abstract

Background:
In the American Heart Association Guidelines, transaortic septal myectomy is considered the preferred treatment for patients with obstructive hypertrophic cardiomyopathy (HCM) and heart failure symptoms unresponsive to medications. However, the inadequate number of surgeons and centers with large experience with myectomy in the USA and Europe limits patient access to surgery.

Aim and Methods:
To report the results of our myectomy program recently developed at the Hypertrophic Cardiomyopathy Center of the Policlinico di Monza, Italy. From July 2013 to March 2018, 316 consecutive patients with obstructive HCM underwent transaortic myectomy, mitral valve plasty and papillary muscles mobilization. Age ranged from 15 to 85 years, mean 54 ± 15. Preoperatively, 60 (19%) patients were in NYHA class II and 256 (81%) in class III-IV, all had LV outflow gradients ≥ 50 mmHg at rest or with physiologic provocation, and 90 (28%) had important mitral valve regurgitation.

Results:
Two patients died during hospitalization (0.6%). In the surviving patients, follow-up ranged from 1 to 51 months, mean 9 ± 11 months. At most recent evaluation, 6 (1.8%) patients had persistent severe symptoms (class III-IV), 8 (2.5%) had residual significant (≥ 30 mmHg) outflow gradient at rest, and 9 (2.8%) had moderate-to severe or severe mitral regurgitation.

Conclusions:
Our recently developed septal myectomy program was based on the experience with this procedure acquired by the senior surgeon at a different institution and the development of a multi-specialistic team collaborating in the program. Our positive results provide a precedent for future efforts to expand the access to surgical myectomy for patients with obstructive HCM.