bluuebunny/crossref_metadata_2025_split huggingface dataset:
RF29 IN-HOSPITAL OUTCOME AFTER EMERGENCY OR PROPHYLACTIC EXTRACORPOREAL LIFE SUPPORT DURING TRANSCATHETER AORTIC VALVE IMPLANTATION: A COMPREHENSIVE REVIEW OF THE LITERATURE
Authors: Raffa G. , Kowalewski M. , Meani P. , Follis F. , Turrisi M. , Delnoij T. , Gilbers M. , Heuts S. , Schreurs R. , Pilato M. , Maessen J. , Lorusso R. 
Published: November 2018

Abstract
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been used to deal with life-threatening complications as well as back-up or active cardiovascular support in high-risk procedures in patients undergoing transcatheter aortic valve implantation (TAVI). Electronic search was performed in PubMed and Medline electronic databases in order to identify studies with emergency or prophylactic V-A ECMO application in association with TAVI procedures. From November 2012 to November 2017, 14 relevant studies including 102 (1.9%) over 5,115 TAVI patients (prophylactic, n = 22 (0.4%); emergency n = 66 (1.3%); missing n = 14) were identified. The average age was 79 years and 39 were male. The reason for emergency V-A ECMO implant was detailed in 65 patients: left ventricle free wall rupture (21%), hemodynamic instability (19%), ventricular arrhythmias (10%), aortic annulus rupture (9%), coronary obstruction (9%), low left ventricular output (ejection fraction < 35%) (7%), uncontrollable bleeding (7%), severe aortic regurgitation (6%) and aortic dissection (2%). Femoral arterial and vein cannulation was the most common access for V-A ECMO institution. Major bleeding and vascular access complications were reported in 7 patients, respectively. The overall in-hospital survival was 72% (60% in the emergency- vs 100% in the prophylactic group).
V-A ECMO support should be available in any center performing TAVI, and provides effective mechanical circulatory support in emergency setting. The need of a back-up and strategies (algorithm) for prophylactic circulatory assistance should be carefully evaluated during the heart team discussion.
RF80 SUTURELESS AORTIC PERCEVAL BIOPROSTHESIS IMPLANTATION IN AORTIC VALVE DISEASE AND CONCOMITANT PROCEDURES: SINGLE CENTER EXPERIENCE WITH 121 PATIENTS
Authors: Concistrè G. , Chiaramonti F. , Bianchi G. , Margaryan R. , Santarelli F. , Gasbarri T. , Kallushi E. , Cerillo A.G. , Murzi M. , Farneti P. , Solinas M. 
Published: November 2018

Abstract

Background and Aim:
Perceval sutureless aortic bioprosthesis (LivaNova Group, Italy) represents an innovative approach for surgical aortic valve replacement (AVR), in order to facilitate prosthesis implantation and reduce operative time, specially in complex procedures. We described our experience in AVR and concomitant procedures with Perceval bioprosthesis implantation.

Methods:
From March 2011 to December 2017, 841 patients underwent AVR with sutureless aortic Perceval bioprosthesis at our Institution. Of these, 121 patients (mean age, 77 ± 6.3 years; female patients, 64%; mean logistic EuroSCORE, 18 ± 12.3%) underwent Perceval bioprosthesis implantation with concomitant procedures. The concomitant procedures were coronary artery bypass grafting (CABG) (n = 38), septal myectomy (n = 3), CABG + other procedures (n = 15), and 65 other procedures. Preoperative, periprocedural and echocardiographic parameters, as well as clinical outcomes, were analyzed.

Results:
In-hospital deaths occurred in 4 (3.3%) patients, one patient had cardiac death, and all patients were alive at a mean follow-up of 28.6 ± 12.4 months. Mean aortic cross-clamp and extracorporeal circulation times were 139.5 ± 46.6 and 92.4 ± 41 minutes, respectively. At follow-up, mean trasprosthetic gradient was 11.3 ± 5.3 mmHg. There were 3 mild paravalvular leaks and one Perceval replacement for endocarditis 10 months after implantantion. Events at follow-up included cerebral ischemia in one patient, and need of pacemaker implantation in 4 patients.

Conclusions:
Perceval sutureless AVR is a fast and safe procedure, specially in AVR with concomitant procedures, providing a good hemodynamic performance with excellent clinical results.
RF35 CALCIUM LOADING AS RISK FACTOR FOR CLINICAL MAJOR COMPLICATIONS AND SURVIVAL FOLLOWING TAVI PROCEDURES
Authors: Pollari F. , Cuomo M. , Vogt F. , Kalisnik J.M. , Söhn C. , Eckner D. , Fischlein T. , Pfeiffer S. 
Published: November 2018

Abstract

Background and aims:
Aortic valve calcium has been correlated with postoperative complications such as paravalvular leak or conduction disturbances. We aimed to assess relationship between AVC and onset and degree of other major clinical complications following TAVI according to VARC-2 criteria.

Methods:
We retrospectively analyzed preoperative contrast-enhanced CT scans of patients who underwent TAVI in our center between 2012 and 2016. Calcium volume was calculated through a dedicate software. Multivariate analysis (including aortic calcium volume, clinical as echocardiographic characteristics and intraoperative outcomes) was performed to evaluate the risk factors for stroke, perioperative myocardial infarction, bleeding, vascular complication, acute kidney injury (AKIN).

Results:
539 patients were eligible for the study. Four different prostheses models were routinely implanted (2 balloon-expandable, n = 398; 2 self-expandable, n = 141). Median calcium volume in the DLZ was 757 mm3 (IQR 734.2), with no significant differences among prosthesis. Following complications were observed: 30-days mortality 5.38%; AKIN stage1 = 5.01%; AKIN stage2 = 1.67%; AKIN stage3 = 4.45%; major vascular complications = 4.08%; minor vascular complications = 10.20%; life-threating bleeding = 2.60%; major bleeding = 11.32%; stroke = 1.48%; periprocedural myocardial infarct = 0.37%. In multivariate linear regression aortic calcification of non-coronary cusp has been found to be independent predictor of ischemic stroke (OR 1.002, 95%CI 1–1.0047, p = 0.022) and AKIN stage 1 (OR1.002, 95%CI 1.001–1.004, p = 0.008), while LVOT total calcium volume was an independent predictor of AKIN stage 2 (OR 1.004, 95%CI 1–1.007, p = 0.043). Univariate analysis showed no significant correlation of aortic calcification with perioperative myocardial infarction, bleeding and vascular complication.

Conclusions:
AVC is an independent predictor of post-interventional ischemic stroke and acute kidney injury following TAVI.
RF54 OCCLUDED CAROTID AXIS USED FOR TRANSCATHETER AORTIC VALVE REPLACEMENT
Authors: Droandi G. , Di Cesare A. , Poncet A. , Muccio S. , olivier M. , Duval S. , Brasselet C. , Ruggieri V.G. 
Published: November 2018

Abstract

Background and Aim:
Transcarotid TAVR under loco-regional anesthesia represents a new alternative peripheral route for patients without femoral or subclavian access options and poor candidates for thoracotomy. We report a case of a successful TAVR via left occluded carotid axis.

Methods:
A very frail class NYHA IV 83-year-old man with several comorbidities was referred for treatment of severe aortic stenosis. Transfemoral TAVR was excluded because of severe peripheral vascular disease. At Angio-CT scan both subclavians arteries and the ascending aorta were widely calcified. The right internal carotid artery (ICA) had 50% of stenosis. The left ICA was chronically occluded with permeability of ipsilateral common carotid artery (CCA). The Heart Team concluded that left CCA was the preferred conduit for TAVR. The procedure was performed under loco-regional anesthesia by cervical block and bilateral cerebral oximetry was continuously monitored. Left CCA was surgically exposed by low cervicotomy and a 3-minutes carotid clamping test was realized to evaluate patient's neurological status and oximetry. Aortic balloon valvuloplasty was performed and a 29-mm Edwards Sapien3 transcatheter aortic valve was deployed under 5-seconds rapid pacing at 180/min with excellent seating and no paravalvular leak.

Results:
The patient was monitored 12-hours in intensive care unit and transferred to rehabilitation clinic in second post-operative day. Any cerebrovascular or access-related complications occurred.

Conclusions:
In frail patients with femoral contraindication and associated occluded internal carotid axis, the ipsilateral common transcarotid access represents a safe approach for TAVR, even in presence of a non-significant contralateral carotid stenosis.
RF59 PERCEVAL SUTURELESS AORTIC VALVE PROSTHESIS: A PRECIOUS DEVICE TO SIMPLIFY COMPLEX PROCEDURES
Authors: Mikus E. , Pagliaro M. , Calvi S. , Panzavolta M. , Ramoni E. , Albertini A. 
Published: November 2018

Abstract

Background and aim:
The main feature of sutureless aortic valve implantation is the speed of insertion, thus making implantation easier for the surgeon. As a result, cross clamp times and myocardial ischemia may be reduced. The combined procedures with CABG can be done with a short cross clamp time and cardiopulmonary bypass times.
The aim of this study is to evaluate the effects of Percevall sutureless aortic valve prosthesis on surgical outcome in patients underwent combined procedures.

Methods:
We selected 36 consecutive patients who underwent Perceval implantation combined with coronary artery bypass and or other valve repair or replacement. Clinical, echocardiographic and in-hospital complications were obtained from chart review.

Results:
The mean age was 76.4 ± 9.8 (median 80) years old, 50% male. Eight of them were previous operated (Redo cardiac surgery22.2%), 3 treated with chronic kidney injury requiring dialysis (8.3%) and two had active endocarditis. Concomitant procedures included: coronary artery bypass (20 pts, 56%), mitral valve replacement or repair (11 pts, 31%), mitral and tricuspid repair/replacement (5 pts, 5%), tricuspid valve repair (1pt,3%) and mitral valve replacement associated to coronary artery bypass (2 pts, 5%). Patient operative risk, as estimated by logistic European System for Cardiac Operative Risk Evaluation, was 13.4 ± 12.8.

Conclusions:
Perceval sutureless aortic prosthesis facilitates reduced aortic cross-clamp and cardiopulmonary bypass times particularly in patients undergoing concomitant procedures allowing promising outcomes especially in high risk patients.
VD13 MITRAL VALVE REPAIR FOR HOCM
Authors: Francescato A. , Moriggia S. , Scorsin M. , Piacentini A. , Barbier P. , Gerosa G. , Lemma M.G. 
Published: November 2018

F, 57 yo, BSA = 1.7 sqm
NYHA class III, Metoprolol 100 mg/die

Pre-operative echo:
moderate-severe reduction of left ventricular longitudinal function, EDV = 50 ml/m2, EF = 80%, severe asymmetric left ventricular hypertrophy (interventricular septum23 mm), severe LVOT obstruction (122 mmHg), SAM ofMV anterior leaflet and chordae and secondary moderate to severe mitral regurgitation

Surgery:
Morrow's septal myomectomy down between the 2 papillary muscles via aortic and left atrial approach, mitral valve repair (anterior leaflet extension with bovine pericardial patch, no ring implantation)

Echo at discharge:
EDV = 33 ml/m2, EF = 57 %, mid-cavity obstruction = 25 mmHg, normal LV filling pressure, anterior leaflet elongation with billowing, no obstructionto LVOT, trace of mitral regurgitation
VD07 CAN A BENTALL PROCEDURE GET COMPLICATED?
Authors: Mangerini V. , Castrovinci S. , Territo S. , Torre S. , Agostara V. , Tortorici E. , Argano V. 
Published: November 2018

We present a case of a 61 years-old man with aortic dissection involving the arch and descending aorta 7 years after a Bentall and CABG procedure reoperated 3 years later for right button pseudoaneurysm.
In this video we show our surgical approach. CPB was established using direct brachiocephalic trunk and right atrial cannulation. A moderate hypotermic circulatory arrest (26°C) was utilized and once the aortic arch was opened, cerebral perfusion was achieved separately for the brachiocephalic trunk and for the left carotid and subclavian arteries.
A FET procedure was carried out using a 26/28 mm Thoraflex prosthesis. Distal reperfusion was resumed through the prosthesis side branch after distal anastomosis was completed. Left subclavian and left carotid arteries were reimplanted during rewarming. Once proximal anastomosis was completed, heart was restarted and brachiocefalic trunk reattached on a beating heart.
VD21 VALVE SPARING PROCEDURE IN BICUSPID AORTIC VALVE
Authors: Folesani G. , Amodio C. , Coco V. Lo , Alfonsi J. , Di Marco L. , Leone A. , Berardi M. , Barberio G. , Pacini D. , Di Bartolomeo R. 
Published: November 2018

We present a valve sparing operation performed in a 48-year-old male patient with a bicuspid aortic valve, moderate central regurgitation and 50 mm ascending aorta aneurysm.
Cardiopulmonary bypass was established by aortic arch and right atrium cannulation, the antegrade crystalloid cardioplegia was administered. The aortic valve was exposed and a fusion between the two coronary cusps identified (Sievers type 1).
We decided for a shaving resection of the median raphe with a free edge leaflet reinforcement by Gore-tex 6/0 continuous suture. The valve was then reimplanted in a 30 mm Valsalva graft conduit.
The procedure was finally completed with reimplantation of the coronary ostia and distal anastomosis, performed with the interposition of two teflon felts.
Intraoperative transesophageal echocardiogram confirmed the good surgical result.
The patient was discharged a week later with no major post-operative events and a trivial aortic insufficiency at the trans-thoracic echocardiography.
EP12 ENDOVASCULAR SURGERY FOR TREATMENT OF PARANEOPLASTIC OBSTRUCTION OF THE DESCENDING THORACIC AORTA
Authors: Di Tommaso E. , Di Tommaso L. , Scigliano F. , Mileo E. , Tozzi A. , Mannacio L. , Grande L. , Iannelli G. 
Published: November 2018

Background and Aim:
Rarely covered endovascular stent-grafts had been implanted in the thoracic aorta to perform the resection of the aortic wall infiltrated by an intrathoracic tumors. This we describe is a rare clinical case of a critical stenosis, for paraneoplastic syndrome, of descending thoracic aorta treated with TEVAR.

Methods:
A 61 years-old man, with an unknown history of tumor, was admitted in emergency with a diagnosis of critical stenosis of the descending thoracic aorta and visceral-organ and lower-limb malperfusion.
The CT scan showed a voluminous mass infiltrating and occluding the descending thoracic aorta far from left subclavian artery and celiac axis, extending for 80 mm, associated with a voluminous retroperitoneal mass.
A percutaneous biopsy performed after stent graft implantation, allowed to diagnose a retroperitoneal high grade undifferentiated pleomorphic sarcoma.

Results:
The procedure was performed in our hybrid operating room. Over a Back-up Meier wire and under fluoroscopy, through right common femoral artery, a Medtronic Valiant stent-graft was placed in the optimal position far from the celiac artery. To completely cover the stenotic tract the patient required one stent-graft. After stent-graft release, the paraneoplastic thrombus, mobilised from the descending aorta to the carrefour, was removed with a Fogarty catheter. The postoperative period was uneventful. Follow-up CT scan were performed at six months and showed complete patency of the descending thoracic aorta.

Conclusions:
The encouraging experience in the treatment of this patient indicate that endovascular surgery is a useful and less invasive alternative to open surgical operation for these uncommon disease too.
EP03 A GOOD BLOOD MANAGEMENT IS NOT AN OPTION. IT IS POSSIBLE TO TREAT AN AORTIC DISSECTION IN JEHOVAH'S WITNESSES IN EMERGENCY?
Authors: Barbato L. , Casabona R. , Mancuso S. , Schinco P. , Costa P. , Marra S. , Comoglio C. 
Published: November 2018

Background:
Jehovah's Witness are convinced that biblical passages prohibit the transfusion of allogeneic blood and the predeposit of autologous whole blood for subsequent reinfusion. Medical literature reports several cases of complex medical and surgical procedures performed successfully without the use of allogeneic blood transfusions or its main components. In order to avoid blood transfusions, it is essential to use clinical strategies to minimize blood loss, to save autologous whole blood (AWB), to enhance hematopoiesis and to optimize the tolerance of anemia

Methods:
Herein we present a case of 71 years old manwith acute aortic dissection in a Jehovah's Witness patient (JW). Is a rare condition. Respecting the patient's will, a surgical procedure in high-risk surgical emergencywas performed without the use of blood transfusions,but applying our “bloodless protocol”, which can be considered as an extreme patient blood management protocol (PBM), in which the aim is to avoid the need for transfusions.

Conclusion:
Scientific literature and our twenty-year-experience with JW patients allowed us to show how an adequate strategy, a concrete project and a multidisciplinary bloodlessteam can guarantee excellent results either in JW patients or alternatively in specific cases ofalteration of the coagulationsystem, even in emergency situations. A well-defined strategic plan can help reduce duration of hospitalization and hospital cost. This case report, suggests that high quality PBM could be reasonably extended to all patients admitted to hospital, with the vision that “we treat all patients like JWs”.
EP34 ROLE OF SPECIALIZED CENTRE AND TEAMWORK IN THE DIAGNOSIS OF MARFAN SYNDROME AND PREVENTION OF ACUTE AORTIC DISSECTION
Authors: Bertoldo F. , Pisano C. , Nardi P. , Donzelli C. , Laganà G. , Salehi B. , Sangiuolo F.C. , Bollero P. , De Maio F. , Mancino R. , Chiocchi M. , De Stefano A. , Cozza P. , Ruvolo G. , Novelli G. 
Published: November 2018

Objective:
Marfan patients had an increasing risk of aortic dissection related to the quality of the aortic wall. The aortic size is not a safe indicator to prevent aortic dissection. Other factors need to be consedered such as the morphology of the aortic root, the Valsalva sinus prolapse, genetic and clinical aspects. We analysed the role of a specialized centre and a good teamwork in improving Marfan syndrome diagnosis and optimizing surgical indications.

Materials and Methods:
We enrolled patients admitted to the Marfan Syndrome Centre of Tor Vergata University from March 2008 to December 2017. These patients have been evaluated by a teamwork composed by different figures: cardiologists, cardiac surgeons, oculists, orthopaedics, dentists, genetics and nurses.

Results:
From 1323 patients admitted, we enrolled a total of 460 patients. Of these 260 patients had Marfan Syndrome, 10 patients had Loeys-Dietz Syndrome and the others 190 were Marfan like. 95 patients underwent cardiac surgery. In particular 47% had a Bentall-DeBono Operation, 40% a David Operation and 13% other operations. An increasing number of surgical procedures has been observed in the years. Accordingly we noticed a reducing incidence of acute aortic dissection and sudden deaths in our patients.

Conclusions:
A specialized Centre of Rare Disease is very important in the management of Marfan's patients in order to improve the diagnosis, optimize surgical indications and prevent catastrophic complication like acute aortic dissection and rupture.
EP31 RAPID-DEPLOYMENT VERSUS TRANSCATHETER AORTIC VALVE: HEMODYNAMIC PERFORMANCE
Authors: Manzan E. , Prestipino F. , Miele M. , D’ascoli R. , Luzi G. 
Published: November 2018

Background and Aim:
For intermediate risk patients suffering from aortic valve stenosis, the search for the proper operative strategy and the ideal valve substitute is ongoing. In this so-called gray zone, both Rapid-Deployment (RDAV) and Transcatheter Aortic valves (TAV) are good alternatives to surgery. The aim of our study is to compare hemodynamic performance of balloon-expandable Edwards Sapien 3 TAV and Edwards Intuity Elite RDAV.

Methods:
As initial experience, till now, we enrolled 26 aortic valve replacements with Edwards Intuity Elite RDAV and 33 transapical TAV implantations with Edwards Sapien 3 prosthesis between March 2017 and March 2018. Early hemodynamic results of both valves were evaluated 7-day and 30-day after surgery, measuring trans-prosthesis peak and mean gradients at rest. T-test was used to compare valve hemodynamic performance.

Results:
According to Valve Academic Research Consortium 2 criteria, device success was 100% in both groups. No deaths nor conversion to conventional surgery occurred. In RDAV group, peak and mean gradients decreased over time significantly (Figure1A), while in TAV group, they remained stable over time (Figure1B). Comparing TAV and RDAV hemodynamic, 7-day after surgery RDAV peak and mean gradients were significantly higher than TAV gradients (Figure1C). At 30-day follow-up, RDAV and TAV peak and mean gradients were similar (Figure1D). No paravalvular leak has been reported in both groups till 30-day follow-up.

Conclusions:
TAV provides better gradients immediately after surgery, while at 30-day follow-up both RDAV and TAV present similar trans-prosthesis gradients at rest.
EP37 TECHNICAL PRECAUTIONS TO REDUCE THE PACEMAKER RATE AFTER SUTURELESS AORTIC VALVE REPLACEMENT: DID WE FIND THE KEY?
Authors: Santarpino G. , Moscarelli M. , Nicoletti A. , Gregorini R. , Fischlein T. 
Published: November 2018

Background and Aim:
The aim of this study is to evaluate the patients who have required a pacemaker implantation after a sutureless aortic valve implant, evaluating their clinical history and preoperative risk factors, the peri- and postoperative events that led to pacemaker implantation including “timing” of block and pacemaker implantation and the pacemaker-dependence at follow-up.

Methods:
The 512 patients who were discharged from our department after implantation of Perceval and implantation of the definitive pacemaker were re-contacted for clinical follow-up, echocardiography and for control of pacemaker function.

Results:
39 patients (7.6%) required new pacemaker implantation due to complete atrioventricular block. Preoperative presence RBBB (pacemaker vs no-pacemaker patients 33 vs 4.8%;P < 0.001) was identified as independent predictors of postoperative conduction disorders, also on multivariate analysis (odds ratio 11.3—C-statistic 0.74,CI 0.672–0.801; P = 0.0002). 21 patients (54%) were pace independent at follow up. In the “pacemaker patients group” no difference were recoded between pace-dependent and pace-independent at follow up (Table 1). Over the years, with the change in implant technique, the pacemaker implantation rate has decreased significantly: 12.2% to 5.5%, p = 0.04.

Conclusions:
Our study shows that the protective techniques for pacemaker implantation are effective and that learning curve can play a role in this rate. We are not able to find a difference between the “dependent” and “independent” pacemaker patients at follow up but we believe that the timing of implantation as well as the type of BAV onset can be prognostic on the recovery of the rhythm at follow up.