bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC24 ENDOVASCULAR SURGERY FOR ACUTE THORACIC AORTIC SYNDROMES
Authors: Di Tommaso E. , Di Tommaso L. , Iavazzo A. , Smimmo R. , Giordano R. , Pilato E. , Saccenti A. , Iannelli G. 
Published: November 2018

Background and Aim:
Surgery of thoracic aortic emergencies is challenging and carries significant high morbidity and mortality rate. In the last decade, Thoracic EndoVascular Aortic Repair (TEVAR) has shown improved early and late outcome, mostly in emergency. To assess early and long-term results after TEVAR for thoracic aortic emergencies we retrospectively reviewed our experience.

Methods:
From March 2001 to March 2018, out of 289 patients undergone TEVAR, we retrospectively reviewed 191 patients, 164 (85.9%) men; aged from 19 to 84 years, treated in urgent/emergent conditions: 51 patients (26.7%) for contained or free rupture of degenerative aneurysms, 118 (61.8%) for complicated acute or chronic type B aortic dissections and 22 (11.5%) for traumatic aortic injuries.

Results:
The overall 30 days mortality was 4.4% (8 patients). Open surgical conversion was not required.. Periprocedural complications included arterial rupture or dissection (5.7%; 11 patients) and TIA/stroke (1.6%; 3 patients). Left subclavian artery (LSA) overstenting was achieved in 79 patients (41.3%). Follow-up ranged from 2 to 204 months and included clinical examinations and serial CT-scan. There were 8 late deaths aorta-related (4.4%). A secondary endovascular procedure was required in 13 pts (7.1%). One patient (0.5%), with retrograde aortic dissection, required open surgery. No patient with LSA overstenting required a secondary revascularization or showed subclavian steal phenomenon.

Conclusions:
The early and mid-term technical and clinical results supports the safety and effectiveness of thoracic endovascular surgery in patients with acute aortic syndromes too. More cases and longer follow-up are required.
OC53 OPERATIVE RISK OF CARDIAC SURGERY FOR ADULT PATIENTS WITH CONGENITAL HEART DISEASE IN THE ADULT
Authors: Vida V. , Zanotto L. , Zanotto L. , Sarris G. , Maruszewski B. , Tobota Z. , Ebels T. , Padalino M. , Gregori D. , Stellin G. 
Published: November 2018

Background and aim:
Advances in paediatric cardiac surgical and medical care have led to vastly increased survival of patients with congenital heart disease (CHD). We would like to explore and analyse data from the European Congenital Heart Surgeons Association (ECHSA) database with the aim of evaluating the risk of surgery for treating adult patients with CHD.

Methods:
We included in our study data from 19589 surgical procedures. We excluded 1389 procedured including hemodynamic procedures, anesthesiologist procedures). Outcome included early and late mortality according to the main surgical procedure.

Results:
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Conclusions:
Surgical risk for adult patients with CHD is low, either considering early and late mortality. Mortality continue to be high for particular categories of patients.
OC64 RESULTS OF PRIMARY ARTERIAL SWITCH OPERATION AFTER 21 DAYS OF AGE FOR TRANSPOSITION OF GREAT ARTERIES WITH INTACT VENTRICULAR SEPTUM
Authors: Rito M. Lo , Basile D.P. , Micheletti A. , Frigiola A. , Carminati M. , Giamberti A. 
Published: November 2018

Background and aim:
Late arterial switch operation (ASO) for transposition of great arteries (TGA) with intact ventricular septum comes at higher post-operative risk if performed after 3 weeks of age due to left ventricle (LV) deconditioning. We aim to evaluate results of ASO performed after 21 days of life (late) in relation to repair performed in the first 21 days of life (early).

Methods:
Retrospective single center study in all patients with TGA and intact ventricular septum who underwent ASO (May 2004-February 2016). Patients were divided in early repair (age ≤ 21 days) and late repair (age > 21 days). Differences were assessed with Chi-squared, Man-Whitney test, and student t-Test accordingly to sample size and variable type.

Results:
Patients included were 137 (male = 93 pts); 55 patients (40%) were in the late repair group and 35 pts (63.7%) had “banana shaped” LV. In the early group (n = 82 pts) 3 pts (3.6%) had “banana shaped” LV. Overall hospital mortality was 8% (n = 11) with no statistical differences between the two groups (late = 5% vs. early = 10%, p = 0.364). In the late repair 13% required postoperative ECMO compared to 7.5% in the early repair although not statistically different (p = 0.295). Post-operative left ventricular dysfunction at discharge occurred in 6 patients with no differences among groups (p = 0.536).

Conclusions:
Arterial switch operation after 21 days of age can be achieved with good hospital survival although need of postoperative ECMO support is higher due to transitory LV dysfunction without impacting in patients survival.
OC65 RIGHT MINI-THORACOTOMY APPROACH FOR ATRIAL SEPTAL DEFECT CLOSURE AND PARTIAL ANOMALOUS PULMONARY VENOUS RETURN CORRECTION
Authors: Dalbesio B. , Barbero C.F. , Lodo V. , Qarra S. El , Scarongella R. , Napoleone C. Pace , Ricci D. , Rinaldi M. 
Published: November 2018

Objective:
Over the last 20 years, right mini-thoracotomy cardiac surgery has confirmed its feasibility and effectiveness with remarkable early and long-terms outcomes. As a consequence of the excellent results reached, interest in minimal invasive cardiac surgery is rising also in the case of grown-up congenital heart disease patients. The rational is to minimize surgical trauma, accelerate recovery, reduce the rate of wound complications and hospital-related infections, and improve cosmetic outcomes. Aim of this study is to evaluate feasibility and effectiveness of the right mini-thoracotomy approach applied to patients with diagnosis of atrial septal defect (ASD) and partial anomalous pulmonary venous return (PAPVR).

Methods:
Patients with ASD and PAPVR undergoing right mini-thoracotomy cardiac surgery at our Department between November 2006 and January 2018 were retrospectively reviewed.

Results:
During the study period 17 patients underwent ASD closure with pericardial patch and PAPVR correction with anomalous vessels addressing into left atrium through right mini-thoracotomy and retrograde arterial perfusion (Table 1). Aortic clamping was achieved through endoaortic balloon in 13 out of 17 patients (76.5%) and through trans-thoracic clamp in 4 out of 17 patients (23.5%). No cases of conversion to full sternotomy, nor intra-operative vascular complications or re-exploration for bleeding were recorded. No cases of stroke nor cases of 30-day mortality were reported.

Conclusions:
Right mini-thoracotomy is nowdays the standard approach for ASD closure and PAPVR correction at our Department. Results of this case series show that it is an effective and reproducible alternative to median sternotomy.
OC18 CURRENT OUTCOME OF VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENTATION IN NEONATES AND INFANTS USING MAGNETIC LEVITATION CENTRIFUGAL PUMPS
Authors: Hoxha S. , Murari A. , Sandrini C. , Poretti G. , Barozzi L. , Prioli A. , Pilati M. , Rossetti L. , Faggian G. , Luciani G.B. 
Published: November 2018

Background:
Outcomes using first generation centrifugal pumps has been controversial, thus latest generation centrifugal pumps were developed in order to overcome mechanical properties of old era devices.

Objective:
The aim of this study was to assess the safety and efficacy of V-A ECMO for cardiac indications using standard and latest generation magnetic levitation centrifugal pumps.

Methods:
Between 09/2002 and 01/2017, 40 neonates and infants were supported using V-A ECMO for cardiac indication. There were 27 male and 13 female, with median age of 23 days (4 dys-12 mon) and a median body weight of 3.2 kg (1.9–12 kg; 11/40 < 2.5 kg).

Results:
Median duration of support was 72 h (24–672 h), with an overall weaning rate of 82% (33/40). Overall survival to discharge was 48% (19/40). Risk factors for hospital mortality included lower (<2.5 kg) body weight (p = 0.02) and rescue ECMO after cardiac repair (p = 0.03). During a median follow-up of 52 months (range 1–97 months), there were 4 (10%) late deaths and 2 late survivors with neurological sequelae. Comparison of weaning rate (5/7 versus 28/33, p = NS) and prevalence of renal failure requiring dialysis (4/7 versus 16/33, p = NS) were comparable between SP and ML ECMO groups. Patients supported with ML had a trend toward higher hospital survival (1/7 versus 18/33, p = 0.05) and significantly higher late survival (0/7 versus 15/33, p = 0.02).

Conclusions:
The present experience shows that V-A ECMO for cardiac indications using latest generation centrifugal pumps may further improve end-organ recovery, hospital and late survival, even in very low body weight newborn
OC54 OUTCOME OF A CONTINOUS FLOW PUMP (JARVIK 2000) AS BRIDGE TO TRANSPLANTATION OR DESTINATION THERAPY IN PEDIATRIC PATIENTS: SINGLE CENTER EXPERIENCE
Authors: Perri G. , Filippelli S. , Di Molfetta A. , Testa G. , Iodice F. , Adorisio R. , Iacobelli R. , Massetti M. , Amodeo A. 
Published: November 2018

BACKGROUND:
Use of intra-corporeal ventricular assist devices (VAD) in children has become increasingly popular over the years. We describe our experience with “Jarvik 2000” LVAD both as destination therapy (DT) and as bridge to transplantation (BTT) in pediatric patients.

METHODS:
We reviewed 14 consecutive children assisted with “Jarvik 2000” LVAD for end stage heart failure from October 2010 to May 2018. Primary diagnosis was dilated cardiomyopathies (DCM) in Duchenne Muscular Dystrophy (DMD) in 7 patients and primary DCM in 7. Data collected include, age and weight at implantation, indication to support, post-operative complications and outcome.

RESULTS:
“Jarvik 2000” was implanted in 13 patients, while “Infant Jarvik” was used in 1. Mean age and weight at time of implantation were 15.5 years (0.9 - 17.4 yrs) and 45 kilograms (5 – 88 kg) respectively. Six patients with DMD DCM and one patient, with primary DCM and severe preexisting neurological, received LVAD as DT while in 7 children, all with primary DCM, the device have been used as BTT. In this group, at mean follow-up time of 27.4 ± 17 months, 4 death occurred, 2 for VAD- related cerebral bleeding. All BTT patients underwent successful transplantation and survived to hospital discharge while 1 child died after 1 months from OHtx due to lung infection.

CONCLUSIONS:
Jarvik 2000 LVAD can be successfully implanted in children as BTT or as DT. Thanks to versatility and reliability even in extreme condition, this device may be considered an alternative therapeutic option for pediatric end-stage heart failure.
OC43 MINIMALLY INVASIVE SURGICAL AORTIC VALVE REPLACEMENT VERSUS TRANSCATHETER AORTIC VALVE REPLACEMENT: A MULTI-CENTER MATCHED COMPARISON
Authors: Paparella D. , Santarpino G. , Malvindi P.G. , Moscarelli M. , Martinelli L. , Coppola R. , Comoglio C. , Albertini A. , Speziale G. 
Published: November 2018

Backgrounds:
Several studies have compared transcatheter versus surgical aortic valve replacement. In the surgical arm the operations were predominantly performed with full sternotomy access. There is increasing evidence that a minimally invasive approach (mini-AVR) is a safe alternative to sternotomy and has demonstrated to reduce postoperative morbidity and inflammatory reaction. The aim of this study is to compare early outcome of patients undergone transcatheter aortic valve replacement (TAVR) or mini-AVR.

Methods:
Prospectively collected clinical and administrative data of 9 cardiac centers were reviewed. Between January 2011 and December 2016, 2407 patients underwent mini-AVR and 497 received TAVR. Additive EuroSCORE, age, gender and ejection fraction were utilized to account for disparities creating two matched groups for comparisons.

Results:
In the mini-AVR group 35.3% of the operations were performed through a right anterior mini-thoracotomy and 64.7% through a partial J sternotomy. In the TAVR group, procedures were predominantly performed through transfemoral access.
After matching, two groups of 325 patients each were analyzed with mean age of 80 ± 6 years and additive EuroSCORE of 8.6. No significant difference in mortality and stroke occurrence was observed. Patients in the mini-AVR group experienced more frequently blood transfusion, acute kideny injury and had longer hospital stay. Patients in TAVR group required more frequently permanent pace maker insertion.

Conclusion:
Our matched analysis identified patients with aortic valve pathology at intermediate/high risk. Mini-AVR and TAVR produced similar and satisfactory results. Minimally invasive aortic valve replacement should be utilized for future prospective comparisons between surgical and transcatheter aortic valve therapy.
OC87 VALUE OF SCREENING ASYMPTOMATIC CAROTID ARTERY STENOSIS PRIOR TO CORONARY ARTERY BYPASS GRAFTING: ANALYSIS OF THE E-CABG REGISTRY
Authors: Salsano A. , Santarpino G. , Santini F. , Nicolini F. , De Feo M. , Dalén M. , Fischlein T. , Perrotti A. , Reichart D. , Gatti G. , Onorati F. , Franzese I. , Faggian G. , Bancone C. , Chocron S. , Khodabandeh S. , Rubino A.S. , Maselli D. , Nardella S. , Gherli R. , Zanobini M. , Saccocci M. , Bounader K. , Rosato S. , Tauriainen T. , Mariscalco G. , Airaksinen J. , Ruggieri V.G. , Biancari F. 
Published: November 2018

Abstract

Background and aim:
The aim of this study was to evaluate the prognostic impact of asymptomatic carotid artery stenosis(CAS) in patients undergoing isolated coronary artery bypass grafting(CABG).

Methods:
Patients from the multicenter, prospective E-CABG registry without history of stroke or transient ischemic attack and screened by duplex ultrasound for CAS before isolated CABG were included in this analysis.

Results:
Among 2813 patients screened by duplex ultrasound for asymptomatic CAS, 11.1% had a CAS of 50–59%, 6.0% of 60–69%, 3.1% of 70–79%, 1.4% of 80–89%, 0.5% of 90–99%, and 1.1% had carotid occlusion. Postoperative stroke occurred in 25 patients (0.9%). Lesions were bilateral in five patients (25%) and ipsilateral to a CAS ≥50% in six patients (30%). In univariate analysis, the severity of CAS was associated with a significantly increased risk of stroke (p < 0.0001). In multivariate analysis, a CAS of 90–99%(OR 12.03, 95%CI 1.34–108.23) and the presence of an occluded internal carotid artery (OR 8.783, 95%CI 1.820–42.40) were independent predictors of stroke along with urgency of the procedure, severe-massive bleeding according to the E-CABG classification and the presence of a porcelain ascending aorta.

Conclusions:
Among patients with asymptomatic CAS, the risk of stroke is significant only in patients with a stenosis ≥90%. Since this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, preoperative screening of asymptomatic CAS before CABG may not be justified. Instead, avoiding manipulation of diseased ascending aorta and prevention of excessive bleeding may be more effective measures to prevent stroke after CABG.
OC23 ENDOSCOPIC VEIN HARVESTING A SINGLE CENTRE REVIEW: THE OXFORD EXPERIENCE
Authors: D’Alessio A. , Djordjevic J. , Krasopoulos G. 
Published: November 2018

Abstract

Background:
Endoscopic vein harvesting (EVH) has an increase central rule in CABG and recent studies has indicated the endoscopic technique as a safe and effective option. Nonetheless for many years there has been some controversy on the long term patency of the vein caused by endothelial damages, the technique has acknowledge advantages of low rate of wound infections, neuropathy and pain on the surgical site and a good cosmetic result and patient satisfactory. We reported a 2 years Oxford experience with EVH.

Methods:
We have retrospectively analysed from local database 518 patients that had endoscopic vein harvested at Oxford University Hospital from January 2017 to May 2018.
All the patient received a ultrasound of the legs to assess the quality and size of the veins prior to the operation. A small incision of 3 cm was made below knee and the vein was harvested with Maquet Vasoview Hemopro 2 then a comprisse bandage was placed

Results:
The group of patient that received EVH were mainly man, with associate comorbidities and was the 99% of the vein harvested in our center. The length and quality of conduits were assessed by the surgeon. There were no intraoperative complications and 1 conversion to open technique for equipment failure. There was 1 patient that developed sierus discharge. All patients expressed satisfaction and early mobilization.

Conclusion:
In our Experience the endoscopic vein harvesting is a very safe technique, with a low risk of complications, associate with a very good cosmetic results and patient satisfaction.
OC37 LESS INVASIVE LVAD PLACEMENT: A BEAUTIFUL FABLE OR AN ADVANTAGE? A SINGLE CENTER EXPERIENCE
Authors: sciacca S. , marco M. , turrisi M. , Stringi V. , Armaro A. , Mattiucci G. , Montalbano G. , Raffa G. , Pilato M. 
Published: November 2018

Abstract

Background:
Continuous flow left ventricular assist device (CF-LVAD) use has significantly increased in the last decade. The pumps currently available are smaller, more durable, and less traumatic on blood cells. The standard surgical implantation of CF-LVAD is via sternotomy,these have been implanted, with different, less invasive techniques (LITs). LITs have been reported to reduce incidence of cardiac tamponade or right ventricular failure at the time of implant and, but there is still a lack of evidence concerning its advantages.

Materials and Methods:
This data analysis compares the outcomes of two groups of patients who received an LVAD via two different surgical techniques: full sternotomy (FS) vs. LIT from 43 consecutive patients who received an LVAD from 2011 to 2016. Unpaired Mann-Whitney U-tests were used to compare continuous variables, and χ2 tests were used to compare categorical variables between the two groups.

Results:
The two groups’ characteristics were homogeneous We found no statistically significant differences in terms of survival and infective or neurologic complications. We found a statistically significant difference in early postoperative right ventricular failure (Fig.1), medication requirement (Fig.2), postoperative ICU length of stay, and hospital length of stay, with earlier postoperative recovery in the LIT group.

Conclusions:
Less invasive LVAD implantation has recently been proposed as an alternative surgical approach. This single center, retrospective study found a significant reduction in postoperative RVF, need for medications, and a faster postoperative recovery in the group of patients who received an LVAD with a LIT surgical approach.
OC70 SURGICAL TRANSCATHETER VALVE REPLACEMENT: BOLOGNA'S EXPERIENCE
Authors: Leone A. , Savini C. , Folesani G. , Pilato E. , Gliozzi G. , Pacini D. , Marozzini C. , Palmerini T. , Saia F. , Costantino A. , Votano D. , Di Bartolomeo R. 
Published: November 2018

Abstract

Background:
Transcatheter valve replacement (TVR) has become an effective solution for high risk patients, especially for those with valve prosthesis dysfunction.We report our ten year experience with early and late results.

Methods:
From November 2008 to May 2018,131 patients underwent surgical TVR in our center.All patients have been preoperatevely evaluated by the Heart team.Main comorbidities were: peripheral vascular disease in 51.1%, renal failure in 42% and pulmonary disease in 26%.There were 24.4% porcelain aorta and 27.5% of redo.Different prosthesis have been used: Medtronic Corevalve, Edwards Sapien, Jenavalve and Acurate symetis.There were 113 aortic, 15 mitral, 3 tricuspidalic valve disease treated respectively.Main surgical accesses were transapical in 93, transaortic in 31, left subclavian in 5 and full sternotomy in 2 patients.

Results:
Mean age was 81.1 ± 7.1, mean Euroscore was 9.9 ± 2.2 and STS score was 6.7 ± 5.4%.Overall early mortality was 6.1%.The global experience was divided into three periods as follow 2008–2012, 2013–2015 and 2016–2018 with a mortality rate of 10.4%, 7.3%, and 0% respectively.The only risk-factor for mortality was full sternotomy conversion (p = 0.001; OR = 60.5; CI[4.5;671.6]), necessary in 4 patients.The mean follow up time was 23.96 ± 26.28 months. Overall survival at 1 year, 3 years and 5 years was 84.2%, 61% and 41.6% respectively.Preoperative renal failure was risk factor for mortality at follow-up(p = 0.026;HR = 2.02;CI[1.09;3.75]).

Conclusions:
Surgical TVR confirmed to be an effective solution for high risk patients, with satisfactory results in terms of mortality and postoperative outcome. With the increase in experience, mortality rate progressively decreased.
OC86 USE OF “MICRODTTECT” DIRECTLY TO OPERATING BED: AN ENDOCARDITIC TEAM EXPERIENCE
Authors: Cagnoni G. , Rimoldi S.G. , Vanelli P. , Carnabuci A. , Scrofani R. , Mangini A. , Nicolò F. , Pagani C. , Gismondo M.R. , Antona C. 
Published: November 2018

Abstract

Background and Aim:
Negative blood cultures are of considerable concern in the management of infective endocarditis (IE) and therapy. The purpose of this study was to support the conventional routinary diagnosis based on culture-dependent methods (blood and cardiac valve culture methods) with the introduction of a device able to destroy microbial biofilms in order to improve diagnosis, therapeutic approach and patient outcome.

Methods:
One year and half prospective study of 40 patients (24 men, 16 women, mean age 66 years) underwent cardiac valve surgery. Samples were processed directly in the operating room using 0.1% dithiothreitol solution (MicroDTTect – 4i for infection, Monza - Italy). A comparison with sonication, traditional culture method and serological investigation were performed.

Results:
The use of MicroDTTect was successful in 5 out of 40 cases of IE. The detection of a the causative bacteria was possible as follow reported: methicillin-resistant S. aureus (2 cases), S. viridans, E. faecalis and P. mirabilis and S. aureus. Rickettsia conhori was serologically identified in one case only.

Conclusions:
MicroDTTect allowed the growth of biofilm producing bacteria as the true causative agents responsible for IE, thus facilitating appropriate antibiotic treatment. This study was developed in an effort to reduce the number of cases of IE with no causative agent, by implementing in routine the use of a completely closed system for detecting biofilm-related bacteria, thus reducing the risk of environmental contamination. Microbiological staff worked directly in the operating room to prepare samples and quickly have antibiogram.