bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP38 THE MOSAIC AORTIC BIOPROSTHESIS SHOWS EXCELLENT DURABILITY AT EXTENDED FOLLOW-UP
Authors: Falcetta G. , Celiento M. , Ravenni G. , Flagiello M. , Pratali S. , Bortolotti U. 
Published: November 2018

Background and aim of the study:
Biological prostheses are widely employed for aortic valve replacement This study aims to evaluate the performance of the Mosaic porcine bioprosthesis in aortic position over two decades.

Material and methods:
From November 1995 to December 2016, 254 patients underwent aortic valve replacement with a Mosaic bioprosthesis. The mean age was 74 ± 9 years 14% being ≥ 80 years of age; 76% were males and 86% had pure or prevalent calcific aortic stenos. Mean preoperative functional class was 2.5 ± 1.0.

Results:
Overall hospital mortality was 5%. There were 107 late deaths only 15 being valve-related (0.72 ± 0.19 % pt-yrs). Actuarial survival at 15 years is 34 ± 7%. There were 14 embolic episodes with no cases of bioprosthetic thrombosis; freedom from thromboemboli is 88 ± 4% at 15 years. There were 8 cases of endocarditis with a freedom of 95 ± 2% at 15 years. Structural valve deterioration was observed in 4 patients who were successfully reoperated. Freedom from structural valve deterioration is 97 ± 2% at 15 and 96 ± 2 at 20 years. At last follow-up, 23 mm and 25 mm prostheses showed a mean gradient of 17 ± 6 mmHg and 15 ± 4 mmHg, respectively. In patients with aortic stenosis a significant reduction of left ventricular masses occurred.

Conclusions:
The Mosaic bioprosthesis has shown excellent durability over 2 decades of clinical use with a negligible incidence of valve degeneration and need for reoperation. Therefore it may be considered a valid option especially for elderly patients requiring aortic valve replacement.
RF57 OUTCOMES OF DIFFERENT REPAIR TECHNIQUES FOR FUNCTIONAL TRICUSPID VALVE REGURGITATION IN ADULT WITH CONGENITAL HEART DISEASE
Authors: Rito M. Lo , Grandinetti M. , Muzio G. , Varrica A. , Frigiola A. , Micheletti A. , Chessa M. , Giamberti A. 
Published: November 2018

Objectives and aim:
Functional tricuspid valve (TV) regurgitation frequently affects adult with congenital heart disease (ACHD).The aim of our study was to analyze which surgical repair (suture plasty vs. ring plasty) offers the best post-operative and medium-term TV competence in ACHD.

Methods:
Retrospective study of ACHD patients that underwent TV repair at our institution (01/2000-12/2016). Patient's chart were reviewed to collect pre, post-operative and follow-up data. We compared efficacy of ring plasty with suture plasty in terms of early and medium-term regurgitation degree.

Results:
95 patients had functional TV regurgitation and underwent surgery. Median age was 41.2 years (IQR:29.8-55.6 years). Pre-operative TV regurgitation: mild (n = 6), moderate (n = 42), severe (n = 47). Surgical procedure were suture plasty (n = 53), ring anuloplasty (n = 34) and in 8 it was replaced. Median hospital stay was 12 days (IQR:8-18), 2 hospital deaths (2.1%). At discharge 13.2% of the suture plasty and 11.8% of the ring anuloplasty had moderate TV regurgitation, no one had severe. After a median follow-up of 4.6 years (IQR:1.4-8.9) there were 6 late deaths giving 89% survival (95%CI:79%-94%) at 5-10 years. No tricuspid valve reoperation were performed. On follow-up echocardiographic was available in 69 patients. Suture repair present a significantly higher incidence of moderate-severe regurgitation (Figure 1) compared to the ring anuloplasty (55%vs.27.6%,p = 0.023).

Conclusions:
Suture plasty and ring anuloplasty have comparable early postoperative results in terms of restoring valve competence. The use of prosthetic rings should be preferred to support the TV because it provides a significantly lower occurrence relevant regurgitation in the medium term.
ISOLATED AORTIC VALVE REPLACEMENT: DECADE TRENDS OF IN-HOSPITAL MORTALITY AND CASE-MIX FOLLOWING THE INSTITUTION OF THE HEART TEAM
Authors: Cannata A. , Bruschi G. , Merlanti B. , Costetti A. , Marchetti C. , Passini L. , Tata G. , Russo C.F. 
Published: November 2018

Background and aim:
The concept of Heart Team (HT) has been a major advancement for decision making in cardiovascular medicine. The aim of the study is to analyse trends of in-hospital mortality and case-mix among patients who underwent to isolated aortic valve replacement (iAVR) before and after HT institution.

Methods:
We analysed data of 1092 adult patients who underwent iAVR at our hospital between January 2005 and December 2016. They represented 12.3% of the overall surgical case-load of the same period. During the second-half of 2008 HT has been implemented at our hospital.

Results:
During 2005–2016 period in-hospital mortality following iAVR was 1,8%. In-hospital mortality decreased from 3,9% (2005–2008) to 0,8% (2009–2016) (p .0004). Mean number of iAVR/year increased from 75,5 (2005–2008) to 99,1 (2009–2016). The prevalence of octogenarians patients increased from 11,5% (2005–2008) to 16,5% (2009–2016) (p.00001); in-hospital mortality decreased from 8,8% to 1,5% (p .02) among them.

Conclusions:
Following the institution of HT at our hospital, we observed a significant decrease of in-hospital mortality following iAVR, also in elderly patients. Volume of iAVR and octogenarians patients significantly increased. It is likely that surgical results benefited from the discussion of cases and the availability of transcatheter techniques for high-risk patients.
RF03 ANTITHROMBOTIC STRATEGIES AFTER HEARTMATE III IMPLANTATION: WHEN PREVENTION BECOMES OVERTREATMENT
Authors: Tarzia V. , Tessari C. , Fabozzo A. , Cavalli C. , Bocca T. , Pagnin C. , Volpe B. , Bottio T. , Gerosa G. 
Published: November 2018

Background and aim:
Hemocompatibility of left ventricular assist devices (LVADs) represents one of their main target. Currently, third generation-fully-magnetically-levitated LVAD (HeartMate 3, HM3) has shown high hemocompatibility. Aim of this retrospective study was to evaluate the impact of different antithrombotic strategies in HM3 patients.

Methods:
Patients were monitored by clinical evaluation, classical laboratory, thromboelastometry (ROTEM) and aggregometry (Multiplate) in the postoperative period and at follow-up. Based on therapeutic options, our population (=25 patients, from November 2015 to March 2018) wad divided in: Group A (=15 patients, 60%) with antiplatelet + anticoagulant medications and Group B (=10 patients, 40%) with anticoagulant medication alone. Primary outcome was freedom from thromboembolic and/or hemorrhagic events. For the assessment of asymptomatic neurologic events, patients were explored with MiniMental-State-Examination (MMSE) and Brief-Neuropsychological-Examination 2 (ENB2).

Results:
At surgery, mean age was 61.5 ± 5.6 years and 4 patients (16%)were in INTERMACS profile 1, 15 (60%) in profile 2–3 and 6 (24%) in profile 4. Overall 10 patients (Group A = 9, 40% vs Group B = 1, 10%, p = 0.0177) had bleedings. In particular, cerebral hemorrhage in 1 (Group A), gastrointestinal bleeding in 5 (Group A), late onset chest bleeding in 2 (Group A), minor bleeding in 6 (5 Group A, 1 Group B). No thromboembolic events were reported. At follow-up ENB2 showed significant improvement of patients’ neuropsychological performance (p = 0.006), whereas MMSE results remained stable (p = 0.1).

Conclusions:
Heartmate 3 is a highly hemocompatible device. In our experience, anticoagulation alone is a safe and effective therapy as it prevents both thrombotic and hemorrhagic events.
RF17 EARLY DIAGNOSIS AND SURGICAL TREATMENT OF MIOCARDIAL BRIDGES IN CHILDREN
Authors: Viganò G. , Colaneri M. , Capestro A. , Marzullo R. , Iezzi F. , Pozzi M. 
Published: November 2018

Background and Aim:
A myocardial bridge (MB) is a term for a segment of a coronary artery that takes a “tunneled” intramuscular course under a “bridge” of overlying myocardium. Although these congenital coronary anomalies can be asymptomatic and traditionally considered a benign condition with a good long-term prognosis, in many cases MBs are associated with heart rhythm disorder, myocardial infarction and sudden cardiac death, so that their impact on incidence of coronary insufficiency is indisputable. While described on autopsy for centuries, technological advances such as coronary computed tomography angiography and intravascular ultrasound have contributed greatly to our understanding of the anatomy, hemodynamic and pathophysiology. Surgical supra-arterial myotomy is the debridging procedure of choice to prevent myocardial infarction and sudden death in patients who remain symptomatic despite medical treatment.

Method:
We present our experience of 3 children (one 10 years old and other two 14 years old) with myocardial bridges who underwent surgical treatment. The diagnostic and operative techniques for each patient were evaluated. Mean follow up 1 year.

Results:
All patients underwent successful debridging through surgical supra-arterial myotomy on extracorporeal circuit and cardioplegic cardiac arrest. No early or late complications except a post-pericardiotomy syndrome in one patient resolved with medical treatment. At last follow up all patients are asymptomatic

Conclusion:
Based on our experience, early diagnosis and surgical intervention can yield satisfactory results in patients with myocardial bridges, with relief of symptoms. The operative procedures were associated with no early and late mortality and low complications.
RF96 WEANING IN CHILDREN WITH LEFT VENTRICULAR ASSIST DEVICE SUPPORT: A SINGLE CENTER EXPERIENCE
Authors: Iacobelli R. , Di Molfetta A. , Toscano A. , Drago F. , Adorisio R. , Perri G. , Filippelli S. , Di Chiara L. , amodeo A. , Iorio F. , Amodeo A. 
Published: November 2018

AIM:
We reviewed our experience in children underwent LVAD placement and selected for weaning after evidence of cardiac improvement on LVAD as measured by seriate echocardiographic evaluation.

Methods:
From 2007 to 2018, 36 LVAD were implanted at our institution. Longitudinal echocardiographic data were available in 31 children who received LVAD during the study period with diagnosis of DCM and severe HF. Parameters were repeatedly measured by 2D and 2D Speckle Tracking-derived echocardiography at baseline, after LVAD placement and weekly until LVAD explantation.

Results:
4 (13%) children were considered for LVAD weaning. Median age and weight are 31 mos and 14.1 kg, with median duration of support of 188.5 days. Myocardial biopsies and virus assessment excluded myocarditis in all 4 cases. First patient supported with 25cc BH underwent off-pump test but failed for LVEF worsening. After 210 days of LVAD support, he underwent OHTx. Patient 2 after 21 days of support was successfully weaned with VAD explanted with LVEF of 50%, all ECHO parameters remaining stable at 7 mos FU. Patient 3 after 296 days of support with 15cc BH developpes LVEF > 45%, and LVAD was explanted, but died for neurological complication. Patient 4 after off-pump test underwent weaning from LVAD for 6 days only, then need new LVAD for HF recurrency

Conclusions:
Recovery in children on VAD is possible with potential greater capacity for reverse remodeling although the rate of cardiac recovery is low. Echocardiographic data are needed for detection of myocardial improvement during mechanical unloading.
RF94 VALVE-SPARING AORTIC ROOT REPLACEMENT: 15-YEARS BOLOGNA EXPERIENCE
Authors: Di Marco L. , Gliozzi G. , Mariani C. , Murana G. , Leone A. , Alfonsi J. , Fiorentino F. , Pacini D. , Di Bartolomeo R. 
Published: November 2018

Background:
Valve-sparing aortic root replacement is an attractive option for aortic root aneurysms, avoiding valve prosthesis disadvantages and complications:the challenge for surgeons is to guarantee a durable aortic valve repair. In this study we present our early and long term results, identifying pre- and intra-operative risk factors for reoperation at follow up.

Methods:
From March 2002 to December 2017, 201 consecutive patients underwent conservative operation of the aortic valve and aortic root replacement, according to David reimplantation technique. Bicuspid aortic valve (BAV), Marfan syndrome and type A acute aortic dissection (AADA)-patients were included in the study. Patients were retrospectively evaluated with clinical and echocardiographic studies. Mean follow up time was 81.87 ± 59.74 months.

Results:
Mean age was 49.7 ± 15.2 years. Overall in-hospital mortality was 3%, if we consider only elective cases 0.5%. At discharge, aortic regurgitation was mild or lower in 87.1% of the patients. AADA (p = 0.000) and arch surgery (p = 0.004) are risk factors for early mortality. At 10 years, survival was 90.9%. At 5 years and 10 years, freedom from reoperation for severe aortic regurgitation was 92.7% and 86.2% respectively. Freedom from moderate to severe aortic regurgitation at 5 and 10 years was 97.2% and 84.4% respectively. At multivariate analysis, preoperative severe aortic regurgitation (p = 0.91), BAV (p = 0.32), Marfan syndrome (p = 0.10),cusps repair (p = 0.12) were not statistically significative risk factors.

Conclusions:
Our experience showed that aortic valve repair and valve-sparing aortic root surgery is a safe and effective procedure, and it can be performed with satisfactory short- and long-term results. It's important to refer the patients to high-volume center. We didn’t find risk factors for valve repair-failure.
RF10 BIO-BENTALL PROCEDURE: TEN YEAR EXPERIENCE
Authors: Albertini A. , Tripodi A. , Pagliaro M. , Raviola E. , Calvi S. , Mikus E. 
Published: November 2018

Background and aim:
Since 1968 Bentall and De Bono described the surgical technique to treat aortic root pathology. The aim of this article is to describe our experience with a biological conduit for aortic root pathology.

Methods:
Between January 2007 and February 2017, 242 patients underwent the Bio-Bentall procedure at the authors’ Institution (203 male, 84% with a mean age of 66.7 ± 11 years) in elective (82%), urgency or emergency status. Twenty eight patients (11.6%) have been previously operated and eighteen patient were affected by type A acute dissection (0.7%). Follow up data were obtained from hospital and office records and from telephone contacts.

Results:
A full sternotomy was adopted in the majority of patients while a minimally invasive approach through a ministernotomy was chosen in 68, all elective cases (28%). In more than 50% the double sewing ring technique was chosen. Median cardiopulmonary bypass (CPB) and median cross-clamp time were respectively 112 and 95 min. The overall in-hospital mortality was 16/242, including 5 patients affected by type A dissection and 4 re-operation for active endocarditis. No patient died in the minimally invasive group. The 10-yr overall survival after discharge was analyzed and the degeneration of biological prosthesis studied showing encouraging result.

Conclusions:
Our experience shows that biological prosthesis inserted into the Dacron graft for aortic root replacement has a low mortality and good durability. In a selective population, minimally invasive surgery can play a key role.
RF28 INCIDENCE OF AORTITIS IN SURGICAL SPECIMENS OF THE ASCENDING AORTA: CLINICAL IMPLICATIONS AT FOLLOW-UP
Authors: De Martino A. , Ballestracci P. , Faggioni L. , Celiento M. , Pratali S. , Levantino M. , Morganti R. , Pucci A. , Bortolotti U. 
Published: November 2018

Background and aim of the study:
Inflammation of the aortic wall may be responsible for the onset of aneurysms and dissections requiring surgical treatment. We evaluate the incidence of aortitis on a selected surgical population searching for any relationship with systemic diseases, verify early and late surgical results and provide clinical and radiological follow-up to determine factors potentially predicting progression and influencing late outcome.

Methods:
From 2009 to 2017, 237 patients underwent elective operations on the ascending aorta. Segments of the excised tissues were routinely sent for histological evaluation, providing adequate data in 178 (75%) for a clinical and pathological correlation. Patients with aortitis (Group 1) (n = 26) were compared with 152 with atherosclerotic or degenerative disease (Group 2).

Results:
Incidence of aortitis was 15%, being clinically isolated in 73%. In 24 patients (92%) a giant cell aortitis was found. Actuarial survival at 3 years is 88% in Group 1 and 98% in Group 2 and 74% and 98% at 5 years, respectively (p = 0.016). A control angio-computed tomography revealed an increased descending aorta diameter in 3 out of 14 late survivors. A positron emission tomography showed presence of arteritis in other vascular segments in 3 patients.

Conclusions:
Clinically isolated aortitis is extremely frequent in patients with inflammatory aortic disease. The diagnosis is often difficult and may be supported by routine pathological evaluation of surgical explants and by multimodality imaging. The latter should be employed to allow adequate patient follow-up and to disclose potential recurrences in untreated aortic segments.
RF44 OUTCOME AFTER BILATERAL INTERNAL MAMMARY ARTERY GRAFTING IN HIGH- AND LOW-VOLUME HOSPITALS: AN ANALYSIS OF THE E-CABG REGISTRY
Authors: Saccocci M. , Perotti A. , Reichart D. , Gatti G. , Faggian G. , Onorati F. , Feo M. De , Chocron S. , Dalen M. , Santarpino G. , Rubino A.S. , Maselli D. , Gherli R. , Salsano A. , Nicolini F. , Zanobini M. , Bounader K. , Seccareccia F. , Rosato S. , Tauriainen T. , Mariscalco G. , Ruggieri V.G. , Biancari F. 
Published: November 2018

Background:
Bilateral internal mammary artery (BIMA) grafting is largely underutilized in patients undergoing coronary artery bypass grafting (CABG), partly because of the perceived increased complexity of the procedure. In this study we evaluated whether BIMA grafting can be safely performed also in centers in which this revascularization strategy is infrequently adopted.

Methods:
Out of 6783 patients from the prospective multicenter E-CABG study, who underwent isolated non-emergent CABG from January 2015 to December 2016, 2457 underwent BIMA grafting and their outcome was evaluated in this analysis.

Results:
The mean number of BIMA grafting per center was 82 cases/year and hospitals were defined as high- or low-volume according to this cutoff value. Six hospitals were considered as centers with high-volume of BIMA grafting (no. of procedures ranging from 120 to 267/year; overall: 2156; prevalence: 62.2%) and nine hospitals as centers with low-volume of BIMA grafting (no. of procedures ranging from 2 to 39/year; overall: 301; prevalence: 9.1%). Multilevel mixed-effects regression analysis showed that the low- and high-volume cohorts had similar outcomes. Propensity score one-to-one matching analysis of 292 pairs showed that the low-volume cohort had a significantly shorter intensive care unit stay (2.2 ± 2.3 vs. 2.9 ± 4.8 days, p = 0.020). The rates of in-hospital death (1.0% vs. 0.3%, p = 0.625), deep sternal wound infection/mediastinits (3.8% vs. 3.1%, p = 0.824) and 1-year survival (98.1% vs. 99.7%, p = 0.180) as well as other outcomes were similar between the high- and low-volume cohorts.

Conclusions:
BIMA grafting can be safely performed also in centers in which this revascularization strategy is infrequently performed.
RF86 THE TREATMENT OF ISCHEMIC MITRAL REGURGITATION WITH THE USE OF INCOMPLETE C RING ANNULOPLASTY: LONG-TERM RESULTS
Authors: Saitto G. , Nardi P. , Bertoldo F. , Pisano C. , Russo M. , Scafuri A. , Bassano C. , Pellegrino A. , Ruvolo G. 
Published: November 2018

Background and Aim:
Surgical management of ischemic mitral regurgitation (IMR) is controversial, and in the setting of mitral valve repair (MVRep) the choice of the ring is still debated. We evaluate the results of MVRep with a semirigid incomplete C-ring in IMR.

Methods:
Between January 2006 and May 2014, 105 consecutive patients (mean age 69 ± 8 years, 75% males) underwent MVRep using an undersized C-ring during coronary artery bypass grafting to treat IMR. Mean logistic EuroSCORE was 14 ± 12%. Preoperative left ventricular ejection fraction was 43 ± 11%. Mean follow-up was 57 ± 35 months.

Results:
In-hospital mortality was 6.6% (7 patients). Predictor of in-hospital mortality was the duration of cardiopulmonary bypass (p < 0.05). Echocardiography performed at discharge showed a significant reduction of left ventricle end-diastolic diameter (p < 0.0001) and mitral regurgitation grade (p < 0.0001). Eight-year late death was 26% (26 patients), cardiac death 12%. Eight-year freedom from all-cause and cardiac death was 62 ± 7% and 83 ± 4%, respectively. In 7 patients (7%) recurrence of mitral regurgitation (>2 + ) was found. Freedom from recurrence of mitral regurgitation ≥ 2 and NYHA class > II were 89 ± 5% and 76 ± 9%, respectively. No patients underwent reoperation. Instable angina (p < 0.05), moderate-severe pulmonary hypertension (p < 0.0001) and left ventricle end-systolic diameter (p < 0.001) were independent predictors of long-term mortality.

Conclusions:
Despite the adverse prognosis of IMR, MVRep with semirigid C-ringassociated with coronary artery bypass showed satisfactory long-term survival, and low recurrence of mitral regurgitation/redo operation.
RF76 SHORT-TERM RESULTS IN ISOLATED BAV REPAIR VS SPARING PROCEDURES IN BAV
Authors: Rosa R. , Contino M. , Romagnoni C. , Mangini A. , Antona C. 
Published: November 2018

Background and Aim:
Bicuspid aortic valve (BAV) is related to changes in the aortic wall (Fibrillin-1 deficiency, loss of integrity in matrix, disrupted architecture and reduced elasticity) that make it prone to develop a dilation. Therefore, repairing surgery of incompetent BAV is often associated with sparing techniques, to ensure a better stabilization of aortic root.

Methods:
In our fifteen-years experience (from April 2003 to April 2018), out of 327 aortic valve repair procedures, 95 (29.1%) were BAV, of which 21 (22.1%) associated with ascending aorta and/or root dilation ≥ 50 mm. In only 15 cases (15.8%), isolated repair was performed, in 35 (36.8%) repair and replacement of ascending aorta and in the remaining 45 (47.4%) a sparing operation.

Results:
At discharge, 52 patients (54.7%) showed absence of valvular regurgitation: of these, only 4 (7.7%) underwent to isolated repair, 20 (38.5%) to repair associated with ascending aorta replacement and 28 (53.8%) to root replacement.
A mild degree of insufficiency (1 + /4 + ) was observed in 39 cases (41.1%): 10 isolated plasty (66.7% of isolated BAV repair), 12 repair + ascending aorta replacement (34, 3%) and 17 sparing (37.8%).
In 3 patients (3.2%) a moderate jet resided (1 isolated repair and 2 repair + ascending aorta).

Conclusions:
Short-term results of isolated BAV repairs are excellent and in most cases the residual insufficiency is not significant (mild degree); when compared with sparing operations, we don’t see important difference, but further evaluation with long-term results must be done because of better stabilization of the whole aortic root in the second group.