bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC59 PREVALENCE AND CLINICAL IMPACT OF SYSTEMIC INFLAMMATORY REACTION AFTER CARDIAC SURGERY
Authors: Squiccimarro E. , Malvindi P.G. , Guida P. , Margari V. , Kounakis G. , Visicchio G. , Favale A. , Raimondo P. , Dambruoso P. , Carbone C. , Labriola C. , Paparella D. 
Published: November 2018

Background and Aim:
The inflammatory reaction associated with cardiac surgery has been widely studied by means of laboratory biomarkers but rarely from a clinical perspective. Many anti-inflammatory treatments have failed to show clinical benefits. In 1992 the ACCP/SCCM conference defined the SIRS (table 1). Our aim is to verify the prevalence of clinically defined SIRS following heart surgery, to identify its predisposing factors and ascertain its impact on early outcome.

Methods:
We reviewed prospective data of 502 patients who underwent CPB-surgery. According to the mentioned criteria, we defined SIRS in the first day in ICU. We used an automated-matching procedure that for each SIRS-patient selected one without SIRS. A multivariate logistic regression model was used to evaluate the predisposition to develop postoperative-SIRS and its association with a composite outcome (death, TIA/stroke, renal replacement therapy, bleeding, IABP, stay in ICU > 96 hours).

Results:
142 patients (28.3%) were SIRS-positive. Propensity-score matched 114 patients. Post-CPB lactates and transfusion-rates were greater in SIRS-patients. Positivity to each SIRS-criteria was associated to the composite outcome for fever (OR2.09; 95%CI1.15–3.80; p = 0.016), heart rate (OR2.08; 95%CI1.23–3.52; p = 0.007), leucocytes (OR1.70; 95%CI0.99–2.91;p = 0.051) adjusting for preoperative creatinine clearance, LVEF and duration of the intervention. Correcting for univariate predictors, the presence of SIRS in the first post-operative day was associated to the composite outcome independently by SIRS preoperative variables.

Conclusions:
SIRS is a common phenomenon in Cardiac surgery and is frequently associated with some unfavorable clinical outcomes. Therefore, SIRS observed in the first 24 hours after surgery can be a target to improve clinical outcome.
OC11 CLINICAL FRAILTY SCALE AND OUTCOME AFTER CORONARY ARTERY BYPASS GRAFTING: AN ANALYSIS OF THE E-CABG REGISTRY
Authors: Saccocci M. , Reichart D. , Rosato S. , Nammas W. , Onorati F. , Dalen M. , Castro L. , Gherli R. , Gatti G. , Franzese I. , Faggian G. , De Feo M. , Khodabandeh S. , Santarpino G. , Rubino A.S. , Maselli D. , Nardella S. , Salsano A. , Nicolini F. , Zanobini M. , Bounader K. , Kinnunen E. , Tauriainen T. , Airaksinen J. , Seccareccia F. , Mariscalco G. , Ruggieri V.G. , Perrotti A. , Biancari F. 
Published: November 2018

Abstract

Objectives:
The aim of this study was to assess the impact of frailty on the outcome after coronary artery bypass grafting (CABG) and whether it mayimprove the predictive ability of EuroSCORE II.

Methods:
The Clinical Frailty Scale (CFS) was assessed preoperatively in patients undergoing isolated CABG from the multicenter E-CABG registry and patients were stratified in three classes: scores 1–2, scores 3–4 and scores 5–7.

Results:
Of 6156 patients enrolled, 39.2% had CFS scores 1–2, 57.6% scores 3–4, and 3.2% scores 5–7. Logistic regression adjusted for multiple covariates showed that the CFS was an independent predictor of hospital/30-day mortality (CFS scores 3–4, OR 3.95, 95%CI 2.19–7.14; CFS scores 5–7, OR 5.90, 95%CI 2.67–13.05) and resulted in an Integrated Improvement Index of 1.3 (p < 0.001) and a Net Reclassification Index of 55.6 (p < 0.001) for prediction of hospital/30-day mortality. Adding the CFS classes to EuroSCORE II resulted in an Integrated Improvement Index of 0.9 (p < p < 0.001) and Net Reclassification Index of 59.6 (p < p < 0.001) for prediction of hospital/30-day mortality, with a significantly larger area under the receiver operating characteristics curve (0.809 vs. 0.781, p = 0.028). The CFS was an independent predictor of mid-term mortality (CFS scores 3–4, HR 2.05, 95%CI 1.43–2.85; CFS scores 5–7, HR 3.05, 95%CI 1.83–5.06).

Conclusions:
The CFS predicted early and mid-term mortality in patients undergoing isolated CABG. Further studies are needed to evaluate whether frailty may improve the estimation of the operative risk of patients undergoing adult cardiac surgery.
OC36 IMPROVEMENT OF HAEMODYNAMIC AND RESPIRATORY PARAMETERS DURING COUPLED PLASMA FILTRATION AND ADSORPTION (CPFA) AND CORRELATION WITH CLEARANCE OF THE INFLAMMATORY MEDIATORS IN SEPTIC PATIENTS: A PROPENSITY MATCHED STUDY
Authors: Weltert L.P. , Turani F. , Falco M. , Scaffa R. , Salica A. , Bellisario A. , Chirichilli I. , De Paulis R. 
Published: November 2018

Abstract

Background and aim:
Sepsis is a severe complication in cardiac surgery, but data on new therapies are inconclusive and new tretments are warranted. Coupled plasma filtration adsorption (CPFA) is a new extracorporeal technology which combines plasma filtration and ultrafiltration. The aim of this study is to evaluate in septic patients submitted to CPFA:

Methods:
Overall coohort study and a propensity–matched analysys included 96 patients admitted to three ICU with a diagnosis of septic shock.
73 patients were submitted to CPFA and 23 patients to RRT.
In the CPFA group Heparine ev was used as anticoagulant in 22 patients and citrate in 11.
In the RRT group Heparine was used in all the patients.
IL-6, Procalcitonin, cardiorespiratory indices and SOFA score were compared before (T0) and at the end of the treatments (T1).

Results:
Of 73 patients submitted to CPFA 32 could be matched to the 22 septic patients who received RRT. 10 patients in the CPFA group experienced clotting of the adsorbing filter. Results are shown in table.

Conclusions:
Data from this study confirm that CPFA improves haemodynamics during septic shock. This improvement may be related to the reduction of IL-6 and of Procalcitonin. As shown in previous studies, clotting of the filter is an important problem. Anticoagulation with citrate may improve the patency of the circuit.
OC63 REQUEST REGISTRY: INTERIM RESULTS OF INTERNATIONAL MULTICENTRIC PROSPECTIVE REGISTRY FOR THE EVALUATION OF TRANSIT TIME FLOW MEASUREMENT AND INTRAOPERATIVE IMAGING IN CORONARY SURGERY
Authors: Di Giammarco G. , Taggart D.P. , Puskas J. , Marinelli D. , Wendt D. , Prieur T.M. , Trachiotis G. , Kieser T. , Head S.J. 
Published: November 2018

Abstract

Background and Aim:
Intraoperative graft failure is a well-recognized issue with a rate of 4–5% of incidence involving the 10% of patient submitted to CABG.Despite this evidence and the recommendation of international guidelines the routine use of intraoperative graft verification is low.The purpose of this multicentric prospective international registry was to assess the impact of routine use of Transit-Time Flow Measurement (TTFM) and High-Resolution Epicardial Ultrasonography (HR-ECUS) in CABG patients.

Methods:
The design of the study imposed to enroll 1000 patients in 7 centers (Italy,UK,USA,Canada,Germany,Netherlands) from 2015 to 2017.The inclusion criterium was the indication to isolated CABG operation in patient with at least 2-vessel disease.The study protocol and ethical approval was published in clinicaltrial.gov in February, 2015. The endpoints of the registry were: 1)any change in planned surgical procedure;2)type of change (aorta,coronary target, conduits,anastomosis);3)number and reason for the revision;4)in-hospital mortality and stroke.

Results:
total of 346 surgical strategy changes were registered in 249 (26%) patients.HR-ECUS leads to change in aorta manipulation sites in 10% of the patients,in coronary anastomotic site in 20% of the patients and the combined use of TTFM and HR-ECUS to 3% of intraoperative graft revision.The total number of adverse events was 1017 (22% mild,70% moderate,8% severe.The mortality rate was 0.5% with a stroke rate of 0.7%.

Conclusions:
In the hands of expert surgeons,high rate of optimal medical therapy use (> 70%) and state-of-the-art surgical procedure the intraoperative guidance and graft verification of HR-ECUS and TTFM were associated with a 3% of revision rate and low-level of in-hospital mortality and stroke.
OC47 MYOCARDIAL REVASCULARIZATION TECHNIQUE IN TAKAYASU'S ARTERITIS
Authors: Barbato L. , Grasso M.A. , Spagnolo S. 
Published: November 2018

Abstract

Background:
Takayasu arteritis is a vasculitis of the aorta and its major branches. The involvement of coronary arteries is not a rare occurrence. An optimal revascularization strategy for this disease has not been established. A diffusely diseased coronary artery has been a therapeutic challenge for cardiologists and surgeons. Long reconstruction is one of the Coronary Artery Bypass Grafting methods for treating diffusely diseased coronary arteries.

Methods:
We report the case of a 65-year-old patient with a claudicatio at 150–200 mt but also angina pectoris. A diffuse and critical disease of anterior descending coronary artery was found in the angiographic study. The surgical procedure was performed by reconstructing anterior descending artery with a saphenous vein patch associated with coronary aortic bypass in the left internal mammary artery.

Results:
The follow-up at 15 months showed excellent patency of coronary reconstruction with venous patch, a recovery of good ventricular function with the asymptomatic patient.

Conclusions:
The reconstruction of diffusely diseased coronary arteries with a patch of saphenous vein or mammary artery is a good technique, it is possible to guarantee a simultaneous revascularization of septal, diagonal and small lateral branches offering a wide coronary and myocardial reperfusion.The greatest advantage of this method is that the myocardium supplied by the side branches of the diffusely diseased coronary artery can be revascularized simultaneously.
Patch reconstruction can be performed with good early and midterm results.
OC76 THE MORE PROCEDURE (MININVASIVE, OPCAB, RAPID SURGICAL INTENSIVE CARE UNIT EXIT, EXTUBATION INTO THE OPERATING ROOM): OUR MININVASIVE APPROACH TO SURGICAL MYOCARDIAL REVASCULARIZATION
Authors: Colombino M. , Longobardi A. , Panza A. , Mastrogiovanni G. , Masiello P. , Del Negro G. , Rosapepe F. , Bisogno A. , Di Domenico A. , Iesu S. 
Published: November 2018

Abstract

Background and Aim:
To compete with PCI invasiveness, we adopted a composite surgical strategy which we called the MORE approach.

Methods:
Criteria for enrolment into the MORE study were haemodynamic stability and EF ≥ 45%. Criteria for operating room (OR) extubation were: normothermia, good cardiac output and no evidence of bleeding. From November 2016 to April 2018, 85 ACS patients underwent MORE technique: lower partial or a full sternotomy through a 10 cm skin Minincision; complete Off-pump revascularization; Rapid mobilization; Extubation into the OR.

Results:
Five patients failed OR extubation and 10 patients needed incision extension for poor coronary vessel exposure. We did not register any operative mortality, perioperative MI or CV events. Mean graft/patient ratio was 2.8. Early mobilization allowed 78 (92%) patients to be seated edge-of-bed after two hours. In the afternoon, 65 patients returned to the Coronary Intensive Care Unit. This rapid surgical intensive care unit (SICU) exit allowed 31 afternoon patients to be accommodated in the SICU bed, freed up by the morning cases. This offered economic benefits: taking up less ‘valuable bed space’ in the first operative day and increasing the number of the surgical procedures as a result of an improved SICU bed availability.

Conclusions:
MORE protocol allowed selected ACS OPCAB patients to be OR extubated, early mobilised and same-day discharged from the SICU. The minincision, avoiding excessive rib traction, reduced the postoperative pain and was a very well-accepted cosmetic bonus. The rapid SICU bed turnover allowed an overutilization of our present logistic facilities.
OC67 STAGED HYBRID EPICARDIAL-ENDOCARDIAL PROCEDURE IN PATIENTS WITH REFRACTORY PERSISTENT/LONG-STANDING PERSISTENT ATRIAL FIBRILLATION AND SEVERE LEFT ATRIAL DILATATION
Authors: Lapenna E. , Cireddu M. , Del Forno B. , Monaco F. , Nisi T. , Bargagna M. , Ajello S. , Gulletta S. , Melisurgo G. , Belluschi I. , D’Angelo G. , Giacomini A. , Pappalardo F. , Alfieri O. , Castiglioni A. , Bella P. Della , De Bonis M. 
Published: November 2018

Abstract

Background And Aim:
Treatment of persistent atrial fibrillation(AF) and severe left atrial(LA) dilatation is often unsuccessful, using both minimally invasive surgical or catheter procedures alone. To overcome the limitations of both techniques, we investigated the effectiveness of a staged hybrid method consisting in a right thoracoscopic ablation with the Cobra Fusion system, followed by a percutaneous Rhythmia system mapping/ablation, 2 months later.

Methods:
Twenty consecutive patients(age57 ± 7.6years, 17males, BMI 30 ± 3.0Kg/m2, LVEF52 ± 8.2%) with lone symptomatic, refractory, persistent (80%) or long-standing persistent (20%) AF and severely dilated LA (volume index 47 ± 8.9 ml/m2 at echocardiography, 73 ± 16.4 ml/m2 at CT scan) were treated with this staged approach. An Implantable Loop Recorder (ILR) was implanted at the end of the operation.

Results:
No hospital or late deaths occurred. The 1-year freedom from AF recurrence was 85 ± 8.0% and from AF recurrence off class I/III antiarrhythmic drugs (AADs) was 75 ± 9.7%. At 12 months, the proportion of patients in SR was 80%, of whom 73% were in stable SR off class I/III AADs. At last follow-up, no stroke and thromboembolic events were documented, all pts were in class EHRA I, LVEF improved from 52 ± 8.2% at baseline, to 58 ± 2.3% (p = 0.01) and median LA volume index decreased from 48 ml/m2 (IQR 43;53) to 33 ml/m2 (IQR 25;35)(p = 0.001).

Conclusions:
This staged hybrid approach yields promising results in selected patients with persistent/long-standing persistent AF and severely dilated left atrium who are at very high risk of AF recurrence. The LA mapping, the use of ILR monitoring and the clinical/echocardiographic follow-up performed in our dedicate AF center, further reinforce the reliability of these results.
VD05 BENTALL OPERATION IN BICUSPID VALVE AND ANOMALOUS LEFT CIRCUMFLEX CORONARY ARTERY: ANATOMICAL AND TECHNICAL IMPLICATIONS
Authors: Nicolardi S. , Scrascia G. , Mangia F. , Gallo A. , Amorese L. , Pano M. , Fellini P. , Rocco D. , Quacquaro A. Scotto di , Zaccaria S. , Greco C. Angelo , Casali G. 
Published: November 2018

Abstract
Bicuspid aortic valve (BAV) is often associated with coronary abnormalities. The finding of BAV associated with an anomalous circumflex coronary artery (ACCA) originating from the right Valsalva sinus (VS) and surrounding the non-coronary VS is however a rather rare occurrence. We report a case of successful Bentall operation with a composite button technique in a 56-year-old man with aortic root dilatation, BAV insufficiency and coexisting ACCA. In this case a 25 SJM composite graft was implanted in supraannular fashion rather than intraannular to avoid: 1) ACCA injury or obstruction of the proximal course near the annulus by suture ligation, 2) compression by prosthetic ring, 3) distortion of ACCA during ostia reimplantation. We demonstrated that attention to the anatomic relationship of ACCA to the aorta is crucial and prosthesis supraannular implantation technique allows a safe aortic root replacement.
VD01 A CASE OF “VERY” SIMULTANEOUS TRANSAPICAL TRANSCATHETER AORTIC AND MITRAL VALVE IMPLANTATION
Authors: Miele M. , Manzan E. , Prestipino F. , D’Ascoli R. , Luzi G. 
Published: November 2018

Abstract
The ever widening diffusion of biological prostheses and the achievement of higher mean age have focused attention on new possible scenario: off-label use of transcatheter valve implantation (TAVI) via a valve-in-valve procedure as an alternative strategy to standard surgery redo valve replacement.
We report the first simultaneous Transapical Transcatheter Aortic and Mitral Valve Implantation performed after contemporary wires positioning in aortic and mitral size. After apical puncture, soft and subsequent stiff guidewires were inserted trans-apically through the 2 prosthesis. The first wire was advanced through the aortic prosthesis and placed in femoral artery. The second one was inserted through the mitral prosthesis and placed in right superior pulmonary vein. The aortic prosthesis was introduced through a trans-apically placed sheath, positioned, and then deployed into the degenerated aortic bioprosthesis under fluoroscopic guidance. The same procedure was used for mitral prosthesis using the previous positioned wire.
VD06 BILATERAL STAGED THORACOSCOPIC SURGICAL TREATMENT OF LONE PERSISTENT ATRIAL FIBRILLATION WITH LEFT ATRIAL APPENDAGE THROMBOSIS
Authors: Vendramin I. , Rebellato L. , Dametto E. , Daleffe E. , Lechiancole A. , Livi U. 
Published: November 2018

Abstract

Particularity of the video:
Catheter ablation and minimally invasive surgical ablation have become accepted therapy for atrial fibrillation (AF). The presence of a thrombus in the left atrial appendage (LAA) is considered an exclusion criterion for both approaches and for LAA occlusion. The procedure described could represent a new mini-invasive method to treat AF and exclude the LAA.

Brief description:
We described a new mini-invasive procedure for a combined radiofrequency treatment of AF and exclusion of LLA with partial thrombosis through a bilateral thoracoscopic approach in a 71-years-old man with AF and partial thrombosis of the LAA. LAA was firstly secured by encircling its base with a 3/0 prolene Ethibinder™. Ablation was obtained by encircling the pulmonary veins origin with Estech-COBRAFusion™ device, delivering both bipolar and monopolar energy. LAA exclusion was finally achieved by deploying the Atricure-AtriClipPRO2™. Postoperative course was uneventful and the patient was discharged in sinus rhythm.
EP10 DIRECT AORTIC CROSS-CLAMPING IN REDO MITRAL VALVE SURGERY VIA RIGHT MINI-THORACOTOMY
Authors: Prestipino F. , Manzan E. , Miele M. , D’Ascoli R. , Luzi G. 
Published: November 2018

Abstract

Background And Aim:
Reoperative mitral valve surgery is burdened by a greater technical difficulty and a higher complications rate respect to first operation. When in a heart centre minimally invasive surgery has become routine, the application of this to reoperations may represent the way to greatly reduce the surgical risk. The objective of the study is to assess results within the last year of technically difficult reoperations in 10pts with mitral valve disease approached trough a 5–7 cm right mini-thoracotomy with direct cross clamping.

Methods:
Cardiopulmonary bypass was installed by cannulation of femoral vein (internal jugular vein in case of tricuspid concomitant surgery) and axillary or femoral artery. Aorta was partially isolated and directly cross-clamped by the same incision.

Results:
Patients enrolled had a median age 68 years (IQR I-III 61–75). Median time between last operation and reoperation was 7 years (IQR I-III 4–11): 1 patient underwent mitral valve repair, 9 patients to mitral valve replacement and 3 of these also received tricuspid annuloplasty. Median Euroscore I was 8.5 (IQR I-III 6.1–12). Median cross-clamp time was 68 min (IQR I-III 51–86) and median cardiopulmonary bypass time was 88 min (IQR I-III 68.8–119). 1 patient had a postoperative renal failure requiring CVVH and 1 patient underwent surgical reoperation for bleeding. There were no deaths at 30day follow-up.

Conclusions:
Direct aortic cross-clamping in minimally invasive mitral valve surgery reoperations is a safe procedure. The use of less invasive techniques in reoperations may minimize morbidity and mortality, without prolonging duration of cardiopulmonary bypass.
EP09 COMPARISON OF THREE DIMENSIONAL ECHOCARDIOGRAPHIC MEASUREMENTS AND IN VIVO ANALYSIS OF THE TRICUSPID VALVE DURING MITRAL VALVE SURGERY
Authors: Pettinari M. , De Kerchove L. , Pasquet A. , Vanoverschelde J. , El-Khoury G. 
Published: November 2018

Abstract

Background:
Tricuspid valve is a complex three dimensional structure. 2D and 3D echocardiography are the gold standard instruments to evaluate its function and anatomy. In vivo analysis and measurement of the annulus and leaflet are lacking. Aim of our study is to compare in vivo with 3D echocardiographic measurements of the tricuspid valve in patients treated for mitral valve disease.

Methods:
Among 139 patients treated for mitral valve disease, 37 had an intraoperative evaluation by 3D transoesophageal echocardiography and after exposure of the valve several pictures were taken to obtain annular and leaflet measurements. Echocardiographic annular measurements (area, perimeter, antero-septal and latero-posterior diameters) were obtained in six different moment of the cardiac cycle: early mid and late, systole and diastole. Maximal leaflets length and area were measured in end-systole and early diastole. The annular and leaflet measurement were extracted from the intraoperative pictures and compared to the echocardiographic finding by a Pearson correlation test.

Results:
Significant correlation were found between 3D echocardiography and in vivo measurement in term of valve area (p < 0.01, r = 0.77), perimeter (p < 0.01, r = 0.61), antero-septal (p < 0.01, r = 0.6) and latero-posterior diameter (p < 0.01, r = 0.64), anterior and posterior leaflet area (p < 0.01, r = 0.63), septal leaflet area (p < 0.01, r = 0.69), anterior (p = 0.03, r = 0.64) and posterior leaflet length (p = 0.03, t = 0.67).

Conclusion:
Our study demonstrates a moderate to good correlation between in vivo and 3D echocardiographic measurement of tricuspid valve annulus and leaflet. Further studies are needed to investigate their impact on recurrence of tricuspid valve insufficiency.
EP30 PULMONARY ENDARTERECTOMY: PROXIMAL VERSUS DISTAL LESIONS IN HIGH PULMONARY VASCULAR RESISTANCE COHORT
Authors: Gliozzi G. , Alfonsi J. , Mariani C. , Coppola G. , Berardi M. , Amodio C. , Fiorentino M. , Pacini D. , Galiè N. , Martin-Suarez S. , Di Bartolomeo R. 
Published: November 2018

Abstract

Background:
Pulmonary endarterectomy(PEA) is the treatment of choice in chronic thromboembolic pulmonary hypertension(CTEPH). High preoperative pulmonary vascular resistance (PVR) is the main negative prognostic factor. Location of obstructive lesions (proximal versus distal) only determines surgical accessibility.The aim of this study is to determine the impact of high PVR associated with distal disease.

Methods:
We retrospectively analyze the results of 149 PEA performed since 2003. Of this cohort 37.6% of patients had PVR≥800 dynes; of them, 5 had a distal angiographic profile (distal segmental and subsegmental involvement). We compare outcomes of proximal versus distal lesion.

Results:
In-hospital mortality of high PVR cohort was 19.6% (versus 6.4% of lower PVR p = 0.026; OR = 3.3;CI[1.2;9.6]). Patients with proximal anatomy died less than those with distal anatomy (8/51 versus 3/5). Distal lesions were risk factor for early (p = 0.04, OR = 11.4;CI[1.1;52.4]) but not for late mortality (p = 0.81); those patients also developed acute renal failure (p = 0.04;OR = 7.5;CI[1.1;121.7]) and need for extracorporeal membrane oxigenation (4/5 patients; p = 0.02;OR = 17.3;CI[1.7;174.3]). At 3 years and 10 years follow up, overall survival was 94.8% and 88.6% respectively (mean follow up time 71.7 ± 43.6 months). Freedom from persistent pulmonary hypertension is 88.9% at 10 years follow up.

Conclusions:
Our results demonstrate that patients with high PVR associated with distal lesions have even worse early outcomes than those with high PVR alone. Further studies regarding this finding are necessary to define if this population might benefit from other therapies like pulmonary angioplasty and/or medical treatment rather than PEA.