bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC79 THE ROLE OF PROCALCITONIN, C-REACTIVE PROTEIN AND WHITE BLOOD CELLS IN THE DIFFERENTIAL DIAGNOSIS BETWEEN SEPSIS AND SIRS IN CARDIAC SURGERY PATIENTS
Authors: Brugnetti D. , Reeve K. , Held U. , Löblein H. , Odavic D. , Häussler A. , Dzemali O. , Genoni M. 
Published: November 2018

Abstract

Background And Aim:
The aim of the study was to evaluate the role of procalcitonin (PCT), C-reactive protein (CRP) and white blood cells (WBC) in the differential diagnosis between sepsis and systemic inflammatory response syndrome (SIRS).

Methods:
We retrospectively analysed 2834 consecutive patients after cardiac surgery operated between January 2012 and December 2017. From the whole cohort we identified two groups based on the postoperative characteristics: patients with sepsis (44 patients) and patients with a diagnosis of SIRS (40 patients). From the two groups were excluded patients with endocarditis, patients treated preoperatively with corticosteroid, those who developed an infection in the ward and patients who died in the first 48 hours. Measurements of PCT, CRP and WBC were analysed for the first five postoperative days.

Results:
The mean values of PCT in patients with sepsis and SIRS were not statistically different at any time-point. CRP values were consistently higher in patients with sepsis from the third to the fifth postoperative day (p = 0.05, p = 0.00064 and p < 0.0001, respectively). In patients with sepsis, WBC mean values were lower in the first postoperative day (p = 0.0044), but higher in the fifth (p = 0.01).

Conclusions:
CRP is a reliable value in the challenging diagnosis between sepsis and SIRS after cardiac surgery, especially after the second postoperative day. On the contrary, preliminary results suggest that PCT and WBC are less useful to this differential diagnosis.
VD08 COMMISSURAL SYMMETRIC REPOSITIONING IN BICUSPID AORTIC VALVE SPARING SURGERY
Authors: Contino M. , Romagnoni C. , Rosa R. , Mangini A. , Antona C. 
Published: November 2018

Abstract

Particularity of the Video:
Bicuspid aortic valve, the most common congenital cardiac defect, is often associated to ascending aorta and root dilation. Since commissural orientation <160° is one of the principal risk factors for recurrent aortic insufficiency, our systematic approach consists of reimplantation with 180°-180° geometric configuration associated to aortic leaflets repair.

Brief Description:
The valve was bicuspid due to right-left coronary cusps fusion with a fibrotic raphe. Raphe and leaflets free margin shaving was performed within the native aortic root intact to improve cusp mobility and restore a normal motion. Reimplantation procedure was performed in the conventional fashion except for the peculiarity that the valve resuspension started with fixation of the two commissures in a 180°-180° symmetric configuration within the neo-root (Valsalva graft n.28) to the new predetermined sinotubular junction. Before completion of the surgery, the valve was re-assessed to correct any residual prolapse: both leaflets needed plicature.
EP28 PRIMARY MITRAL VALVE REGURGITATION: A RETROSPECTIVE ANALYSIS OF MITRAL VALVE SURGERY AND LONG TERM FOLLOW-UP
Authors: Saitto G. , Pisano C. , Nardi P. , Greci M. , Ferrante S. , Bertoldo F. , Pellegrino A. , Scafuri A. , Bassano C. , Ruvolo G. 
Published: November 2018

Abstract

Background and aim:
Surgery of mitral valve is one of the most evolving topic, especially for repair techniques and is often challenging for surgeons. We retrospectively evaluate the results of mitral valve repair (MVRep) or replacement (MVR) in primary MR.

Methods:
165 consecutive patients (mean age 65 ± 12.5 years) between January 2014 and December 2018 underwent MVRep (89 pts, 54%) or MVR (76 pts, 46%). Mean EuroSCORE II was 3 ± 2%. 89 pts were severely symptomatic for dyspnea (53.9%). In all cases of MVRep a prosthetic ring was implanted; adjunctive procedure were a triangular (11%) or quadrangular resection (11%) and edge to edge (24%). A mechanical prosthesis were implanted in 60 pts (36%). Mean follow-up (95% complete, 157 patients) was 50.2 ± 17.9 months.

Results:
Overall in hospital mortality was 4.8%; 1.1% (1pts) and 9.2% (7 pts) for MVRep and MVR respectively. Three of these 8 patients were octogenarian and at high risk surgery with an EuroSCORE II>7%. Follow-up mortality was 6.3% (10 pts), cardiac death was 3.8%. 6 years survival was 90.7 ± 3%. Three patients (MVRep) underwent MVR for MR recurrence with a 6 years freedom from reoperation of 97.9 ± 1.2%. Freedom from symptoms was 89.6 ± 3.2%. No significantly differences was found between MVRep and MVR in terms of survival (logRank test, p = 0.61), reoperation (logRank test, p = 0.138) and symptoms (logRank test, p = 0.264).

Conclusioni:
MVRep appears to have lower in-hospital mortality than MVR (p = 0.025). Long term results showed excellent survival and comparable outcomes in terms of reintervention and relief of symptoms between MVRep and MVR.
EP33 RISK FACTORS AND OUTCOME AFTER SURGICALLY TREATED TYPE A AORTIC DISSECTION
Authors: Ferrarese S. , Laporta A. , Corazzari C. , Matteucci M. , Cappabianca G. , Beghi C. 
Published: November 2018

Abstract

Aim:
Preoperative and intraoperative metabolic state, expressed by lactatemia, may influence outcome even in severe vascular damage and major surgery. The aim of the study is the identification of risk factors, included lactatemia, for postoperative complications, 30 days mortality and long term mortality in patients surgically treated for type A aortic dissection.

Methods:
A total of 75 consecutive patients operated on for type A aortic dissection from January 2013 to December 2017, were considered for three end-points: postoperative complications, 30 days mortality and long term mortality. Univariate analysis, logistic regression, Cox proportional hazard logistic regression and Kaplan-Meier analysis were conducted.

Results:
Operative mortality was 0%. Determinants of complicated postoperative stay were identified as preoperative neurological damage and oligo-anuria; 30-days mortality (8 patients, 10.7%) was related to preoperative and intraoperative hyperlactatemia (>4mmol/L, preoperative critical hemodynamic state and permanent postop neurological damage; long term mortality (16 patients, 21.3%, follow-up max 1857, median 785 days) resulted associated with age, renal failure and intraoperative hyperlactatemia (>8 mmol/L). A subanalysis identified renal failure to be related to intraoperative hyperlactatemia (>8mmol/L). No significant role has been found for CPB and cross-clamp time.

Conclusions:
Mortality rate was low. Age, renal failure, preoperative and intraoperative hyperlactatemia, preoperative critical status and preoperative and postoperative neurological damage resulted associated with poor outcome. The role of metabolic state, expressed by lactatemia, is directly and indirectly emerging as a crucial factor influencing the outcome. Although it is expression of a catastrophic vascular event, effort has to be made to minimize metabolic stress.
RF07 AORTIC VALVE REPLACEMENT WITH SUTURELESS PERCEVAL BIOPROSTHESIS IN RIGHT ANTERIOR MINITHORACOTOMY APPROACH: SINGLE CENTER EXPERIENCE WITH 461 IMPLANTS
Authors: Concistrè G. , Bianchi G. , Chiaramonti F. , Margaryan R. , Santarelli F. , Gasbarri T. , Kallushi E. , Cerillo A.G. , Murzi M. , Farneti P. , Solinas M. 
Published: November 2018

Abstract

Background and Aim:
Minimally invasive approach (MIA) reduces mortality and morbidity in patients referred for aortic valve replacement (AVR). Sutureless technology facilitates MIA. We describe our experience with sutureless Perceval (LivaNova, Italy) aortic bioprosthesis in right anterior minithoracotomy (RAMT) approach.

Methods:
Between March 2011 and December 2017, 841 patients underwent AVR with Perceval bioprosthesis. 461 patients were operated through RAMT approach. Considering only isolated AVR (530), Perceval in RAMT approach was performed in 87% of patients. Prosthesis sizes implanted were: S (n = 67), M (n = 147), L (n = 218) and XL (n = 29). Concomitant procedures were mitral valve surgery (n = 5), tricuspid valve repair (n = 1), mitral valve repair and tricuspid valve repair (n = 1), and miectomy (n = 2). Mean age was 77.2 ± 6.5, 61.12 % patients were female, and mean logistic EuroSCORE was 12.7 ± 9.9.

Results:
The 30-day mortality was 0.65% (3/461). Cardiopulmonary bypass and aortic cross-clamp times were 82.3 ± 30.8 and 52 ± 21.6 minutes for stand-alone procedures. In 3 patients appeared early moderate paravalvular leakage required reoperations. Permanent pacemaker implantation within the first 30 days was necessary in 5% of patients. At mean follow-up of 28.6 ± 12.4 months, survival was 97%, freedom from reoperation was 98%, and mean transvalvular pressure gradient was 11.7 ± 5 mmHg.

Conclusions:
AVR with Perceval bioprosthesis in RAMT approach is a safe and feasible procedure associated with low mortality and excellent hemodynamic performance. Sutureless technology facilitates RAMT approach.
RF82 TEN YEARS UNITED KINGDOM EXPERIENCE IN SURVIVAL FOR SURGICAL TAVI APPROACHES
Authors: D’Auria F. , Myat A. , Trivedi U. , Hildick-Smith D. 
Published: November 2018

Abstract

Background and Aim:
Compare morbidity and mortality (M&M) of different surgical TAVI access alternative to the surgical femoral.

Methods:
2,863 pts underwent surgical TAVI from Jan 2007 to Jan 2017 in the 33 UK TAVI Centers. Primary outcome is long-term survival up to Jul 2017. Secondary outcomes are procedural/in-hospital (in-H) complications, in-H, 30-day, and 1-year mortality. Statistical analysis by SPSS 20.0 and Stata 12.1.

Results:
2,863 pts, Surgical Femoral (SF) = 1,150 + Trans Apical (TA) = 1,216 + Direct Aortic (DA) = 207 + Subclavian (SC) = 290. In-H mortality lowest in SF. Among no-SF, only SC not significantly different from SF, whereas TA and DA associated with higher mortality. Unadjusted Kaplan-Meier survival chart shows long-term survival significantly greater in SC than DA and TA. No difference in survival between TA and DA, both of which with significantly lower long-term survival than SF. Unadjusted survival rate of surgical SC cohort not significantly different from SF. Hemofiltration and long length hospitalization most common in AD and TA compared to SC and SF. Permanent PMK greater in SC and SF than in TA and DA. A comparison of M&M in the two quarters 2007–2011 vs. 2012–2016 also carried out.

Conclusions:
This is the largest study of survival in surgical TAVI access routes from UK National dataset. SC is the only non-SF approach for which survival is not significantly different from SF. SC may represent the safest non-femoral access route for TAVI and it is the safest surgical route until now experienced.
VD04 AORTIC ROOT REPLACEMENT WITH “FRENCH CUFF” TECHNIQUE: A CHALLENGING REDO CASE
Authors: Cefarelli M. , Berretta P. , Pierri M. , Capestro F. , D’Alfonso A. , Di Eusanio M. 
Published: November 2018

Arch repair interventions with zone 0 (or zone 1) distal anastomosis and arch vessels reimplantation with separate branches are increasingly performed. However, if on the one hand this technique both simplifies distal suturing and minimizes the risk of recurrent nerve injury, on the other, it complicates secondary root interventions due to the encumbrance of the arch vessel branches in the mediastinum that make chest re-opening, arterial cannulation and aortic clamping more hazardous and problematic.
With this video we would like to share the approach we adopted for a redo Bentall intervention in a 66 years old male patient presenting with a chronically dissected aneurysmal root and severe aortic regurgitation. One year earlier and in our institution, the patient had undergone an ascending aorta and total arch replacement with zone 1 distal anastomosis and separate reimplantation of arch vessels for type A acute aortic dissection.
EP06 ANTEGRADE TRANSAPICAL TEVAR IN ACUTE AORTIC RUPTURE
Authors: Agostinelli A. , Borrello B. , Carino D. , Gripshi F. , Molardi A. , Nicolini F. 
Published: November 2018

Background and Aim:
TEVAR has become the first choice treatment of thoracic aortic rupture. However, in some cases standard retrograde delivery can be prevented by severe aorto-ilio-femoral vascular disease. For these high-risk patients, left ventricular apex can be a valid alternative to achieve vascular access for stent-graft antegrade delivery. Here we report our experience and mid-term results with trans-apical TEVAR (Ta-TEVAR) in case of thoracic aortic rupture

Methods:
Since 2012 we performed Ta-TEVAR in six patients with acute aortic syndrome. Indication for urgent/emergent TEVAR was post-traumatic aortic injury in 2 patients, contained rupture in 3 patients and penetrating aortic ulcer with signs of impeding rupture in the last patient. In five patients standard retrograde delivery was prevented by severe and calcific ilio-femoral occlusive disease and in one patient with traumatic aortic transection due to severe polytrauma, by acute ischemia of both lower limbs following Resuscitative Endovascular Balloon Occlusion of the Aorta. Antegrade TEVAR through left ventricular apex in left anterior minithoracotomy was performed in all cases.

Results:
Successful deployment of the stent graft was achieved in all patients. No case of hemodynamic instability or bleeding from the cardiac apex was noted during the procedures. No case endo-leak or aorta-related mortality was noted during the follow-up (range 9–68 months).

Conclusion:
In patient with thoracic aortic rupture and unfeasible standard retrograde TEVAR, the trans-apical approach can be used safely even in an emergency setting. Study with bigger cohorts and longer follow up are necessary to further evaluate this alternative approach.
EP08 CALCIUM LOADING AS RISK FACTOR FOR CONDUCTION DISTURBANCE AFTER TAVI
Authors: Pollari F. , Großmann I. , Cuomo M. , Vogt F. , Marianowicz J. , Jessl J. , Fischlein T. , Pfeiffer S. 
Published: November 2018

Background and aims:
To assess the contribution of aortic valve calcification to the occurrence of transient or permanent atrioventricular (AV) block and the need for permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) in a large single-center cohort.

Methods:
We retrospectively analyzed preoperative contrast-enhanced multidetector computed tomography (MDCT) scans of patients who underwent TAVI in our center between 2012 and 2016. Calcium volume was calculated for each aortic cusp above (aortic valve), and below (left ventricular outflow tract, LVOT) the basal plane. Clinical and procedural data as well as preoperative ECGs were evaluated. Multivariate analysis was performed to evaluate risk factors for AV block and need for PPI.

Results:
A total of 470 patients were included in the study (Edwards SapienXT, n = 157; Edwards Sapien3, n = 185; Medtronic CoreValve, n = 27; Medtronic CoreValve EvolutR, n = 12; Medtronic Engager, n = 5; Symetis Acurate, n = 84). Overall incidence of post-procedural AV block was 12.5% (n = 59) and 8.9% (n = 42) of patients underwent PPI. On multiple linear regression analysis, preprocedural right bundle branch block (RBBB), QRS duration and LVOT calcification beneath the non-coronary cusp were found to be independently associated both with new-onset AV block and PPI. Considering only patients with postprocedural AV block, RBBB was the only predictor of postoperative PPI (odds ratio 8.82, 95% confidence interval 1.008–77.25; p = 0.049).

Conclusions:
LVOT non-coronary cusp calcification is independently associated with both AV block and PPI after TAVI. RBBB may play a role in discriminating transient from permanent AV block.
EP21 KNOWLEDGE TRANSFER IN AORTIC VALVE REPAIR: EXPERIENCE AND LITERATURE-GUIDED SURGICAL TECHNIQUES EVOLUTION
Authors: Contino M. , Romagnoni C. , Rosa R. , Mangini A. , Antona C. 
Published: November 2018

Background and Aim:
Aortic Valve Repair procedures underwent surgical evolution during the last 20 years. New acquisition obtained from personal experimental research and comparison with other surgical teams experience are at the basis of this training.

Methods:
From 2003 to 2017 we performed 328 aortic valve repair procedures with optimal short and long term results. We analyzed our surgical techniques for 15 years to fully understand the importance of personal experience and knowledge transfer by literature analysis and meeting participation in our technical approach evolution. In particular, we tried to identify some specific milestones as important scientific communication that modify our surgical techniques choice.

Results:
We analyzed the techniques described in the 2 graphs by c2 and Fisher exact test, when appropriated and the relevance of personal and common experience. Significance level p ≤ 0.00001 confirmed the surgical evolution showed by graphs.

Conclusions:
Continuous literature analysis and meeting participation permitted a world wide standardization in order to ensure optimal results.
RF50 MINIMALLY INVASIVE VIDEO-ASSISTED MITRAL VALVE SURGERY: THE IMPACT OF AORTIC CLAMPING TECHNIQUE
Authors: Mozzillo R.A. , De Bellis A. , Greco E. , Baldascino F. , Spadafora A. , Fimiani L. , Cioffi M. , Affatato A. , Grimaldi M.G. , Caruso A. 
Published: November 2018

Background and aim:
Aim of the study is evaluate the clinical outcome,in a single center experience,of endo-aortic or transthoracic clamp strategy,in minimally invasive video-assisted mitral valve surgery (MIMVS).

Materials and methods:
We retrospectively analyzed 55 patients underwent to MIMVS between 2014 and 2018. We used in 33 patients endo-aortic balloon occlusion technique(EAC) with Intraclude© and in 22 transthoracic clamp technique(TTC) with Cygnet©.

Results:
Surgical operations were in 23 patients mitral repair and in 32 mitral replacement.There were no differences between groups for CPB-time(137 ± 37 EAC vs 141 ± 39 TTC, p-value = 0,866) and clamping-time(87 ± 31 vs 90 ± 21,p-value = 0,329);incidence of peri-operative acute myocardial infarction was null,even if the post-operative CPK-MB are out of normal range.The 24h-blood loss was higher in EAC-group(817 ± 506 vs 550 ± 214,p-value = 0,001),but at the beginning of experience.Postoperative complication included 1stroke in EAC-group and 1TIA in TTC-group(p-value = 0,769);we didn’t assess differences the INVOS values during surgery in those patients.Overall operative mortality was 1,8%(0 in EAC and 1 in TTC),due to not cardiac cause.The post-operative Echo showed mitral regurgitation, classified as 1+ or less, in 6 patients(5 in EAC vs 1 in TTC).One patient underwent to reoperation due to mitral repair failure.Peripheral vascular complication or aortic dissection were not observed in this series.No differences were found between both groups in rate of blood transfusions,atrial fibrillation,AKI,PNX,in-hospital stay,ICU-stay.

Conclusion:
MIMVS with endo-aortic balloon and trans-thoracic clamp technique are safe and effective.We did not observe an increased risk of stroke or vascular complication in endo-balloon group; our goal is use MIMVS as standard of care in all mitral valve surgery.
RF89 TWENTY-YEAR OF MINIMALLY INVASIVE SURGERY FOR ATRIAL SEPTAL DEFECTS: TECHNICAL EVOLUTION AND RESULTS
Authors: Vida V. , Zanotto L. , Zanotto L. , Tessari C. , Pittarello D. , Padalino M. , Stellin G. 
Published: November 2018

Background:
We evaluate the results of our 20-year experience with minimally invasive surgical approaches (MISA) for closing ostium secundum atrial septal defects (ASD II), focusing on technical evolution and efficacy.

Methods:
We included 538 patients who underwent surgical ASD II closure by using MISA.

Results:
MISA included: right-anterior mini-thoracotomy (RAMT)(n = 335, 62%), mid-line mini-sternotomy (MS) (135, 25%) and right-lateral mini-thoracotomy (RLMT) (n = 68, 13%). Central cannulation was employed in 374 patients (69%), while a remote cardiopulmonary bypass with peripheral cannulation in the remaining 164 patients (30%). Five patients (0.9%) had major postoperative complications requiring further surgical intervention. All patients were discharged in good clinical conditions, without any significant residual intra-cardiac defect. A decrease of the length of hospitalization (p < 0.001) and hospital costs (p = 0.009) was demonstrated by year of surgery. At a median follow-up of 12.1 years (IQR 0.6–14 years), all patients are in good clinical conditions with no limitation to physical activity. The overall satisfaction rate for the cosmetic result of MISA was 97% (524/538 patients)(99% in the last 5 years, 99/100 patients).

Conclusions:
MISA for closing ASD II proved safe and effective. A continuous evolution of MISA in our Institution was characterized by a progressive miniaturization of surgical accesses, reduced hospitalization and eventually reduced hospital costs.
RF63 PROSPECTIVE EVALUATION OF VENTRICULAR LOADING TREND IN PEDIATRIC PATIENTS WITH PULSATILE FLOW LVAD
Authors: Di Molfetta A. , Iacobelli R. , Filippelli S. , Perri G. , Massetti M. , Amodeo A. 
Published: November 2018

Aim:
The aim of this study was to describe the echocardiographic trend of left ventricular (LV) and right ventricular (RV) function after implantation of a pulsatile flow left ventricular assist device (LVAD) in children.

Methods:
From 2013 to 2016, we prospectively evaluated 13 consecutive pediatric Berlin Heart EXCOR LVAD patients. Clinical and echocardiographic data were collected at baseline, within 24 h after implantation and monthly until LVAD explant.

Results:
Median age and weight at the implantation was 8 (4–23) months and 5 (4.6–8.3) kg at the time of implantation, respectively. All were affected by dilated cardiomyopathy. Average LVAD support time was 226.2 ± 121.2 days. Nine (70%) were transplanted, 4 (30%) died. LV end-systolic and end-diastolic volumes were reduced until the follow up of two months (P = 0.019 and P = 0.001). A progressive increase in RV dimensions was observed. After 4 months of follow up, RV fractional area change worsening was statistically related with the deterioration of LV unloading (P = 0.0036). Four patients needed prolonged inotropic support for RV failure.

Conclusion:
Pulsatile LVAD in pediatrics is followed by an early and mid-term LV unloading, as expressed by a decrease in LV volumes and diameters at echocardiogram. The effects of unloading do not remain stable at long term follow up. RV function improved in the acute phase, but a progressive dilatation of RV was noted over time. In some patients, RV failure might lead to the need of an increase of inotropic support at long term follow up.