bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC50 NEW ROLE OF REGENERATED OXIDIZED CELLULOSE IN TREATMENT OF DEEP STERNAL WOUND INFECTION
Authors: Scognamiglio M. , Conti M.C. , Chiariello L. , Desoky A. , Amendolara F. 
Published: November 2018

Abstract

Background and Aim:
Sternal surgical wound infections can be complicated in mediastinitis in 0.4% -2.4% of cases. Extensive necrosis of tissues and sternum requires demolitive interventions. We have developed a simple technique that reduce the trauma, thanks to regenerated oxidized cellulose haemostatic and antibacterial capabilities.

Methods:
Between January 1st, 2017 and March 1st, 2018, 631 interventions were performed in sternotomy. 10 patients had sternal wound complications, and 5 mediastinitis were diagnosed. All patients underwent an initial removal of the infected tissues and NPWT placement. Sternal and tissue samples were taken for culture diagnosis. Targeted antibiotic therapy was performed. Subsequently a partial pectoral muscles flap reconstruction was performed, the residual vacuum areas were filled with regenerated oxidized cellulose to minimize the use of the electrosurgical unit for hemostatic control, using his antibacterial capacity.

Results:
Antibiotic therapy duration was 15 +/- 3 days, hospital stay 20 days. The follow-up was 30 days and was 100% complete. No patient died. A severely obese patient with decompensated diabetes (preoperative glycated hemoglobin ≥ 6.5%) had a recurrence of wound infection. All the other patients presented a perfect surgical wound healing.

Conclusion:
Mediastinitis is a fearful and dramatic complication. Use of regenerated oxidised cellulose seems to facilitate sternal reconstruction, avoiding exceptional interventions such as full pectoral muscle flap or omentum flap. Acidic pH produced by the cellulose has bactericidal effect also in resistant strains such as MRSA. Preoperative glycated hemoglobin levels> 6.5% appear to be a predisposing factor for sternal wound infections and infection recurrences.
OC08 CHALLENGING CASES IN TRANSCATHETER VALVE REPLACEMENT'S ERA
Authors: Savini C. , Leone A. , Folesani G. , Gliozzi G. , Murana G. , Pacini D. , Saia F. , Palmerini T. , Marozzini C. , Costantino A. , Di Bartolomeo R. 
Published: November 2018

Abstract

Background:
Transcatheter valve replacement (TVR) improved the postoperative results of high risk patients.This less invasive option could be adopted to solve difficult and challenging cases.

Methods:
We report a selection of 6 cases carachterized by difficult decision making, where a TVR was performed in full sternotomy (n = 2), transapical (n = 2) or percutaneously (n = 2).

Results:
Case 1. 72 years-old-female with malfunction of mitro-aortic bioprosthesis and severe post-capillary pulmonary hypertension.We performed aortic valve replacement, open mitral valve-in-valve(ViV)TVR and tricuspid valve annuloplasty.
Case 2. 79 years-old-male in cardiogenic shock due to bioprosthesis cusp rupture.We performed urgent transfemoral aortic valve replacement.
Case 3. 76 years-old-female with endocarditis on mitral bioprosthesis, admitted with acute pulmonary oedema.Because of sudden deterioration of hemodynamics refractory to inotropes, we performed urgent transapical ViVTVR.
Case 4. 54 years-old-female with Ebstein anomaly, endocavitary pace-maker and diagnosis of tricuspidalic bioprosthesis detachment. We performed trans-jugular tricuspidalic ViVTVR upon percutaneous removal of electrodes
Case 5. 77 years-old-female with rheumatic mitro-aortic stenosis. Because of extensive calcifications of valvular annuli, we perform open mitro-aortic replacement with aortic Sorin Solo and Edwards Sapien 3 mitral bioprosthesis.
Case 6. 84 years-old-female with previous aortic valve mechanical replacement (1982) and biological mitral replacement (1999). Admitted with acute mitral prosthesis malfunction due to cusp rupture, requiring intra-aortic balloon pump positioning. We performed urgent transapical ViVTVR.
All patients were discharged in good clinical conditions.

Conclusions:
TVR may offer a feasible solution for extremely high risk patients, also in acute life-threatening valve disease.
VD14 OPEN SURGICAL TREATMENT OF GIANT CORONARY ARTERY ANEURYSMS
Authors: Matteucci M.L.S. , Cefarelli M. , Pierri M. , Capestro F. , Berretta P. , Di Eusanio M. 
Published: November 2018

Abstract
Aneurysmal coronary artery (CAA) disease, defined as a localized dilation measuring at least 1.3–2 times the diameter of a normal, adjacent segment, is seen in 0.3–5% of patients undergoing coronary angiography. However, we refer to “giant”-aneurysm only when it reaches a diameter greater than 50 mm. This condition is reported with a prevalence of 0.02–0.2%. Clinical sequelae include thrombus formation, distal embolization and fistula formation. Moreover, the blood flow and the irregular internal surface of the aneurysmal wall predispose the lesion to its development up to the dramatic rupture. Surgical correction is the preferred treatment. Other options include percutaneous intervention, with latex balloons and coil embolization, or conservative treatment with antiplatelet or anticoagulant medication. In this video we show the case of a 63-years old man, in apparent good condition, with giant aneurysms affected both right and circumflex coronary arteries. Surgical tactic included aneurysms plication with distal bypass grafting.
VD17 TAVI BY TRANS-CAROTID APPROACH
Authors: Droandi G. , Di Cesare A. , Muccio S. , Poncet A. , Ruggieri V.G. 
Published: November 2018

Abstract
The TAVI-procedure was performed under loco-regional anesthesia by cervical block.
The left common carotid artery (CCA) was surgically exposed by low small cervicotomy and a 3 minutes carotid clamping test was realized in order to evaluate patient's neurological status.
A 6-Fr sheath was inserted through the left CCA. The aortic stenosis was crossed using a JR4 catheter with a Terumo straight stiff guidewire. The catheter was pushed into the left ventricle and the guidewire exchanged with an Amplatz Super Stiff. The Edwards sheath was inserted through the left CCA and aortic balloon valvuloplasty was performed.
The Edwards Sapien3 transcatheter aortic valve was then advanced using Edwards Certitude delivery system across the calcified aortic valve. The prosthesis was deployed under rapid ventricular pacing at 180/min with excellent seating and no paravalvular leak.
The delivery catheter and the sheath were removed, the left CCA was closed and the clamp removed after de-airing.
EP18 INCIDENCE AND CLINICAL IMPACT OF POSTOPERATIVE MITRAL PATIENT-PROSTHESIS MISSMATCH
Authors: Sbaffi A. , Cuko E. , Pelenghi S. , Totaro P. 
Published: November 2018

Abstract

Aim:
The relevance of PPM following mitral valve replacement is still debated, as different studies, using different methods of evaluation, presented completely different results. The major aspect on this issue is that surgical options to prevent a potential mitral PPM is at high risk of postoperative major complications. In this study we sought to elucidate the real incidence of hemodinamically significant mitral PPM following MVR and the relevance of prosthesis size in causing PPM.

Materials and Methods:
126 patients undergoing MVR were enrolled. Incidence of mitral PPM, based on postoperative gradient, was evaluated for the cumulative populations and according the type of prosthesis used. For mechanical prosthesis the hemodynamic performances using Ony-X single size were specifically compared to the performances of standard Sorin (according different size). Clinical impact of mitral PPM in terms of significant different postoperative outcome was also evaluated.

Results:
Patients characteristics are summarized in fig 1a. Overall PPM incidence is summarized in fig 1b. No significant differences were showed in increased mean transprosthesis gradient between patients receiving biological or mechanical prosthesis (fig 1c). No significant differences were also shown in patients receiving mechanical prosthesis regardless the type of prosthesis (fig 1d). Finally no clinical impact in terms of unfavourable postoperative outcomes was showed in patients with hemodynamical PPM.

Conclusions:
Our single centre experience, based on in vivo postoperative measurement of hemodynamic performances of different mitral valve prosthesis clearly show that the real clinical relevance of mitral PPM is probably over-estimated.
EP02 A FOCUSED APPROACH CAN VIRTUALLY ELIMINATE THE INCIDENCE OF SYSTOLIC ANTERIOR MOTION AFTER MITRAL VALVE REPAIR
Authors: Pettinari M. , Amoroso F. , Tamagnini G. , Borsellino S. , Vankerrebroeck C. , Gutermann H. , Dion R. 
Published: November 2018

Abstract

Objective(s):
The incidence of systolic anterior motion(SAM) after mitral valve repair(MVRr) varies between 4 and 10% of cases. The combination of a small left ventricle(<45 mm), a high posterior leaflet(>15 mm), a narrow aorto-mitral angle(<120°), a narrow coaptation-septal distance(<25 mm) or an enlarged basal septum (≥15 mm) significantly increases the risk for SAM. Aim of this study was to evaluate the incidence of SAM in patients with a combination of at least two of these risk factors and report their echocardiographic/clinical outcomes.

Methods:
Between 2007 and 2014, 165 patients underwent MVRr for degenerative disease using classic Carpentier techniques. The annuloplasty was performed with a complete semi-rigid ring chosen using only the maximal height of the anterior leaflet as a reference. Preoperative echocardiography identified patients at intermediate risk(one risk factor only) or high risk(2 or more risk factors) for SAM.

Results:
Of these 165 patients, 22(13.3%) had an intermediate risk for SAM and 35(21.2%) a high risk. During the study period, we did not find any case of SAM, neither in the low risk group nor in the high risk group. At a median follow-up of 3.9 years, the survival did not differ among patients with no, intermediate or high risk of SAM(p = 0.6). Freedom from more than moderate mitral regurgitation at 4 years was also similar(no risk = 92.9%, low risk = 100% and high risk = 97.9%, p = 0.8).

Conclusions:
Even in patients with high risk of SAM, the incidence of this complication can be eliminated using a focused approach on annuloplasty ring sizing and posterior leaflet height.
EP35 SHOULD MODEL FOR END STAGE LIVER DISEASES (MELD) AND MELD-BASED SCORES BE ROUTINELY APPLIED TO PREOPERATIVE ASSESMENT OF PATIENT UNDERGOING VALVULAR CARDIAC SURGERY?
Authors: Celentano A. , Masiglat L.J.T. , Pelenghi S. , Totaro P. 
Published: November 2018

Abstract

Background:
MELD and MELD-based score have been introduced to assess the risk of complications in patients with chronic liver disease. We designed this study in order to evaluate the potential usefulness of routine application of MELD-based scores in patients undergoing cardiac surgery valve procedures in predicting postoperative major and minor liver-related complications.

Materials:
92 patients, without history of liver diseases and with normal liver function tests, undergoing valvular heart surgery were enrolled. Patients were subdivided in four groups: combined mitro-aortic surgery (Group A); Isolated AVR (Group B); Isolated MVR (Group C) and isolated MVP (Group D). Preoperatively, 4 MELB-based scores were calculated (MELD XI, modified IM, modMESO and modMELD-Na). Intra and inter-groups distributions of MELD-based scores, and the accuracy of 4 scores in predicting postoperative liver-related complications were analysed.

Results:
Preoperative MELD-based scores were slightly increased in Group C. Postoperative raise (>50%) of AST,ALT,GGT and LDH was showed in 71%,44%, 28% and 54 respectively with significant differences in group A and C. GGT raise did influenced the total hospital stay and all 4 scores showed a direct correlation between preoperative value and % of postoperative raise, especially MELD XI and modified IM (Fig 1a/b). Furthermore a preoperative high MELD-based score (especially MELD XI and modified IM) accurately predicted higher postoperative GGT increase (Fig 2a/b).

Conclusions:
Our study seems to confirm the usefulness of application of MELD-based scores in preoperative assessment of patients undergoing cardiac surgery. The clinical impact of postoperative transient liver function impairment needs to be further evaluate.
EP32 RESECT OR RESPECT: THE OUTCOME IN MITRAL VALVE REPAIR THROUGHT MINITORACOTHOMY
Authors: beggino C. , paris M. , nardozza M. , mikus E. , calvi S. , mammana L. , zulueta J.L. , del giglio M. 
Published: November 2018

Abstract

Background and aim:
Heart valve surgery through right anterior minithoracotomy proved excellent short-term and long-term-term results, becoming a feasible alternative to the sternotomy approach. Surgical repair is the gold standard therapy for mitral valve regurgitation. Recently, the valve sparing techniques has been established and it is preferred by many surgeons. The aim of this retrospective study is to show the results of mortality and freedom from reoperation in patients underwent mitral repair with a leaflet sparing or resection techniques.

Methods:
from January 2010 to February 2017, 366 patients underwent mitral valve repair; leaflet sparing technique was performed in 187patients (51%), resection in 179 patients (49%). Minitoracothomy was performed throught a 5 cm incision at the fourth intercostal space. We adopted an aortic central cannulation with a percutaneous peripheral venous cannulation. Aortic cross clamping was perfomed by a transcutaneous clamp at the second intercostal space. The mean follow-up was 35 mounths.

Results:
The mean age was 62,5 ± 12,8 years. The 30-day mortality was 0,27% (0% in leaflet sparing group). The follow up mortality was 0.82 % (0% in leaflet sparing group). At discharge moderate mitral regurgitation was present in 5 patient (2.7%) in leaflet sparing group, in 16 patients (8.9%) in the other group. Freedom from reintervention at 1 year was 97.9% in leaflet sparing group and 95,0% in the other one.

Conclusion:
this study shows that leaflet sparing techniques combined with minimally invasive access has good results in terms of mortality and freedom from reoperation.
EP24 MITRAL VALVE REPAIR AND EVOLUTION OF TECHNIQUES: A SINGLE-CENTER EXPERIENCE
Authors: Savini C. , Coppola G. , Murana G. , Ammar A. , Suarez S. Martin , Costantino A. , Votano D. , Coco V. Lo , Pacini D. , Di Bartolomeo R. 
Published: November 2018

Abstract

Background and aim:
In the last decades, mitral valve repair techniques evolved towards a respect rather than resect procedure. This is an overview of our single-center experience in mitral valve repair by comparing the conventional (Group 1) and the minimally invasive (Group 2) approach.

Methods:
Between January 2004 and March 2018, we analysed 609 patients who received isolated mitral valve repair.The sternotomy approach was used in 462 patients (75.9%), the mini-thoracotomy in 147 (24.1%).Specifically, there were 77 (12.6%) isolated annular implantations, 53.7% triangular/quandrangular resections, 32.7% implantations of Gore-Tex chords, 12.5% edge-to-edge techniques.The Gore-Tex chords implantation was more frequently used in patients of Group 2 than in Group 1 (48.3% versus 27.7%,p-value 0.001).In addition to our series, we performed 28 NeoChord procedures.

Results:
The trend of mitral valve repair in sternotomy approach or mini-thoracotomy is represented in Figure 1 along with the use of PTFE chords or French correction.Overall In-hospital mortality was 0.3% (2 patients), post-operative MACCE occurred in 1 patient. In 2 patients was necessary perioperative reoperation due to repair failure. Follow-up time was of 62.57 ± 36 months.Follow up death was 5.2%.

Conclusions:
The evolution of mitral valve repair techniques during the last years have increased simultaneously with the minimally invasive approach. Among the different techniques of repair,the chords implantation is becoming one of the most used and the era of French correction is slowly disappearing.The observed results of our series highlight this trend and come out in favour of the minimally invasive approach.
EP19 INFERIOR REVERSED J SHAPED MINI STERNOTOMY FOR MITRAL VALVE SURGERY
Authors: Masiello P. , Longobardi A. , Mastrogiovanni G. , Colombino M. , Panza A. , Cafarelli F. , Del Negro G. , Triggiani D. , Rosapepe F. , Iesu S. 
Published: November 2018

Abstract

Background and Aim:
To reduce the morbidity of mitral valve surgery, we present our mininvasive approach.

Methods:
From January 2017 to April 2018, 35 patients underwent mitral valve surgery using a partial lower sternotomy through a 9–12 cm longitudinal median skin incision and a left reversed “J-shaped” ministernotomy from the second intercostal space to the xiphoid. Mitral valve replacement was performed in 8 patients (22.8%), while mitral valve repair (using quadrangular resection, sliding plasty or butterfly technique in addition to intertrigonal annuloplasty band) in 27 patients (77.2%).

Results:
One patient (4.4%) required conversion to full sternotomy. Twenty-four patients (68.5%) were extubated within 6 hours of surgery, and 75% of patients spent less than 24 hours in the intensive care unit (ICU). Mean hospital length of stay was 7.2 +/- 3.4 days. Eighty percent of patients received no blood products. We did not register any operative mortality or re-exploration for bleeding. Morbidity included respiratory insufficiency in 3 patients (6.6%) and wound infection in 1 patients (2.2%).

Conclusions:
We chose the lower mini-sternotomy because the mitral valve exposure is very similar to that of the full sternotomy and enables repair with the same degree of success as the full sternotomy does. Furthermore, ease conversion to conventional surgery when needed make this technique preferable to the right minithoracothomy approach. The mininvasive approach, in addition to its cosmetic benefits, reduce the sternal trauma, avoid excessive rib traction, reduces the postoperative pain and allows early extubation, mobilization and discharge from the ICU.
RF05 AORTIC VALVE ENDOCARDITIS COMPLICATED BY AORTO-VENTRICULAR DISCONTINUITY
Authors: Malvindi P.G. , Margari V. , Mikus E. , Albertini A. , Coppola R. , Martinelli L. , Santarpino G. , Gregorini R. , Carbone C. , Speziale G. , Paparella D. 
Published: November 2018

Abstract

Background and Aim:
Aortic valve endocarditis remains a life threatening condition especially in case of extension of infection to the surrounding tissue. Aorto-ventricular discontinuity complicates the surgical procedures with worse short- and long-term outcomes. We aim to review patients’ characteristics and surgical results of this dreadful infective disease.

Methods:
we reviewed prospectively collected data from our central database looking at patients operated for infective aortic valve/prosthesis endocarditis complicated by pseudoaneurysm. We retrieved information of 35 patients operated on during the period 2011-2017.

Results:
Table 1 summarises demographic and preoperative data. Patients were relatively young, mostly male and most of them had a prior cardiac operation. Redo Bentall operation was performed in 32 cases, it was associated with other procedures in 7 patients: CABG (n = 2), MV surgery (n = 3), MVS + CABG (n = 1) and PVR (n = 1). Three patients underwent AVR: isolated (n = 1), plus MVR (n = 1), associated with ascending aorta replacement (n = 1). Unplanned CABG was necessary in 2 cases: for failure in coronary ostia reimplantation (n = 1) and myocardial ischaemia during CPB weaning (n = 1). The postoperative course was complicated in 29 cases. Nineteen patients sustained LCOS hesitating in MOFS and death in 6 cases. Two patients had major neurologic deficit (permanent cerebral stroke and coma). AKI complicated the course in 15 cases, CVVHD was necessary in 5 patients. Pre-discharge mortality was 23%.

Conclusions:
patients with complicated aortic valve endocarditis presented generally in a poor preoperative status. Complex aortic root surgery is the only life-saving procedure but it is still associated with high mortality and morbidity rate.
RF11 CALCIUM LOADING AS RISK FACTOR FOR POST IMPLANTATION LEAKAGE IN TAVI PROCEDURES
Authors: Pollari F. , Cuomo M. , Dell’Aquila A.M. , Vogt F. , Schwab J. , Kalisnik J.M. , Fischlein T. , Pfeiffer S. 
Published: November 2018

Abstract

Background and Aims:
To assess aortic valve calcification with a reproducible method and the performance of different prostheses in relation to the occurrence of paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) in a large single-center cohort.

Methods:
We retrospectively analyzed preoperative contrast-enhanced CT scans of patients who underwent TAVI in our center between 2009 and 2016. Calcium volume was calculated for each aortic cusp in the aortic valve (AV), in the left ventricular outflow tract (LVOT) and device-landing zone (DLZ). Multivariate analysis was performed to evaluate the risk factors for intraoperative PVL.

Results:
539 patients were included in the study (Edwards SapienXT, n = 192; Edwards Sapien3, n = 206; Medtronic CoreValve EvolutR, n = 44; Symetis Acurate, n = 97). Median calcium volume in the DLZ was 757 mm3 (IQR 734.2), with no significant differences among the four prosthesis groups. None of the patients had severe PVL. The overall incidence of mild-to-moderate PVL was 15.8%. On multiple linear regression analysis, DLZ calcification, non-coronary cusp in LVOT calcification, transapical access, and use of the CoreValve and Acurate prostheses were found to be independently associated with PVL. In contrast, degree of oversizing, and use of Sapien3 were independently associated with a lower incidence of PVL.

Conclusions:
DLZ and non-coronary cusp in LVOT calcification are independently associated with PVL occurrence after TAVI. Among prostheses, Sapien3 seems to be associated with a lower incidence of PVL regardless of calcium volume.
RF30 INTEGRATED PERCUTANEOUS AND MINIMALLY INVASIVE APPROACH FOR HEART VALVE SURGERY: THE “HYBRID WAY” TECHNIQUE
Authors: Cammertoni F. , Bruno P. , Mazza A. , Pavone N. , Farina P. , Perri G. , Iafrancesco M. , Nesta M. , Chiariello G. , Colizzi C. , D’Errico D. , Massetti M. 
Published: November 2018

Abstract

Background and Aim:
The aim of this study was to evaluate in-hospital and short-term results of our minimally invasive hybrid approach in a cohort of patients with isolated,double or triple heart valve disease.

Methods:
Between March 2014 and March 2018,we operated on 215 patients using a minimally invasive hybrid technique which includes limited skin incision,upper hemisternotomy,central arterial cannulation and peripheral percutaneous venous cannulation for the positioning of venous cannula,pulmonary artery vent and retrograde cardioplegia delivery line.

Results:
Of the total cohort,128 (59.5%) patients underwent aortic (AVS),77 (35.8%) mitral (MVS) and 10 (4.7%) combined aortic and mitral valve surgery (CVS).Median age was 72.5 (range:63.8–77),62 (54–71) and 66 (59.8–72) years for AVS,MVS and CVS,respectively.Endovent and Proplege (Edwards Lifesciences,Irvine,California,USA)were used in 63.3% and 32% patients of the AVS group,respectively.Mean (SD) cardiopulmonary bypass and aortic cross-clamp times were 115.2 (28.3),144.4 (42.6),182.0 (24.2) and 81.2 (21.8),97.8 (21.6) and 131.6 (15.9) minutes in the AVS,MVS and CVS group,respectively.Mean (SD) postoperative length of stay was 7.8 (5.9),7.3 (2.7) and 6.8 (1.1) days in the AVS,MVS and CVS group,respectively without any in-hospital deaths and low rate of complications.After a median follow-up of 16,13.5 and 14 months,survival was 99%,100% and 100% for the AVS,MVS and CVS group and echocardiography did not reveal any significant valvular dysfunction.

Conclusions:
Hybrid MIS appears to be feasible,safe and reliable with excellent in-hospital and short-term results.Key strength of this tecnique is the opportunity to perform all combinations of heart valves surgery with one single easy-learning surgical approach.