bluuebunny/crossref_metadata_2025_split huggingface dataset:
RF58 PATENT DUCTUS ARTERIOSUS IN EARLY PRETERMS: SICILIAN AND CALABRIAN ON SITE EXPERIENCE
Authors: Manuri L. , Calvaruso D. , Guerra C. , Ferro G. , Campanella I. , Nicita G. , Grasso N. , Zanai R. , Trombetta B.M. , Sturiale M. , Fonte A. , Iorio F. , Reali S. , Agati S. 
Published: November 2018

Introduction:
The selection of extremely preterm infants with persistent patent ductus arteriosus (PDA) for surgical ligation after the failure of pharmacologic closure remains controversial in neonatology. No randomized clinical trial has examined the efficacy of surgery compared with conservative management among infants with persistent hemodynamically significant PDA after nonsteroidal anti-inflammatory drug treatment. Although surgical closure definitely closes a persistent PDA, promotes early extubation and decreases the mortality rate, it is also associated with short-term adverse events, including post-PDA ligation cardiac syndrome, vocal cord paralysis, chylothorax, and pneumothorax. We report our interregional experience based on a 24 h dedicated “onsite team” that performs surgical procedures in regional NICU.

Methods:
As a part of the agreement between the “Bambino Gesù” Pediatric Hospital in Rome and the Sicily Health Region Government the Centro Cardiologico Pediatrico del Mediterraneo, became the only center of reference for the diagnosis and treatment of congenital heart disease in Sicily. Due to the extent of the territory and the extreme fragility of the preterm infant, surgical ligation of the PDA was conducted by a dedicated team, consisting of a cardiac surgeon, anesthetist and two operating room nurses, directly at the bedside in NICU. From May 2011 to May 2018, 78 on-site procedures were performed. Median gestational age was 26 weeks (range 24–32), median weight at birth 800 grams (range 570–1380), median weight at surgery 1000 grams (range 540–1600) with 62.3% of patients weighing less than 900 grams. All infants were treated with ligation when indomethacin or pacetamol failed or was contraindicated. In our population 56% attempted closure with Pedea, 12% with paracetamol. In the remaining cases, the pharmacological treatment was contraindicated due to the presence of comorbidity (for example III-IV grade cerebral hemorrhage, renal or hepatic insufficiency).

Results:
75% of treated patients have been discharged from the hospital and is still in follow up. No short-term adverse events were registered.

Conclusion:
in our experience we confirm that such an approach represent a valid and safe option for the baby and the whole medical team involved in medical and surgical procedure.
RF25 HYBRID PALLIATION ALLOWS THE HYPOPLASTIC LEFT VENTRICLE FOR A CHANCE OF BIVENTRICULAR REPAIR: ECHO-SURVEILLANCE ON LEFT HEART GROWTH
Authors: Oreto L. , Manuri L. , Calvaruso D. , Guerra C. , Ferro G. , Campanella I. , Nicita G. , Grasso N. , Zanai R. , Trombetta B.M. , Sturiale M. , Fonte A. , Iorio F. , Reali S. , Agati S. 
Published: November 2018

Background:
Several parameters of LV adequacy are available, however, it is now clear that the timing of decision plays a crucial role in the fate of the borderline LV, because the longer the ventricle is allowed to grow, the higher the probability to achieve functional independence.

Aim of the study:
Our aim is to describe the growth potential of borderline left ventricles after pulmonary arteries banding (PAB) and arterial duct stenting (ADS).

Methods:
44 patients (mean weight 3 Kg, from 1,9 to 4,2 Kg), who were born with different hypoplastic LV variants underwent hybrid palliation at 3,6 days (1 to 7) in our institution between October 2011 and January 2018. We divided 36 patients into 3 groups according to the severity of LV hypoplasia: 14 pts with MA or MS and AoA, who are not supposed to show any growth of LH structures over time, 6 pts with IAoA and VSD whose LV is usually suitable for biventricular repair, and 16 pts with intermediate features. The latter group included pts with MS/AS, right unbalanced AVSD or Shone complex, all of them with severely underdeveloped LV, expressed by LV mass below -2 Z scores. Among this 16 pts we further distinguished three subgroups, according to the subsequent surgical treatment they underwent after the interstage period and potential LV growth: group 1 had single ventricle staged palliation (5 patients), group 2 biventricular repair (8 patients) and group 3 early death occurrence (3 patients). Two-dimensional echocardiograms of patients from group 1 and 2 were retrospectively reviewed, comparing examination recorded at birth with those obtained 4 months after hybrid palliation.

Results:
Aortic annulus, aortic root, mitral and tricuspid annulus, LV systolic and diastolic dimension, systo-diastolic volumes and mass, LV long-axis to heart long-axis ratio (LAR), transverse and distal arch and aortic isthmus diameters were used. LV mass and volumes are critically small in both groups at birth. Although a trend towards growth can be seen for almost all the analyzed parameters, a significant change of LV mass and volumes from pre- to post-hybrid procedure is evident in group 2, which is absent in group 1. Conversely, parameters like aortic annulus, aortic root and LAR in group 1, already at birth, were significantly smaller than they were in group 2.

Conclusion:
The goal in the treatment of borderline LV is to postpone the decision until the time LV has fully expressed its growth potential: then, many more biventricular repairs will be reached than at the time of first evaluation.
RF47 MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT (MIAVR) THROUGH A RIGHT ANTERIOR MINI THORACOTOMY IN A TOTALLY FREE OPERATIVE FIELD.
Authors: Cassese M. , Braccio M. , Spatuzza P. 
Published: November 2018

Background:
MIAVR through a right anterior minithoracotomy has excellent results. This approach has technical challenges related to a smaller working space. The operation requires learning curve, longer operative time and is routinely performed only by skilled surgeons. We describe our technique for MIAVR through a right anterior mini thoracotomy, making the procedure simple and reproducible.

Methods:
From February 2016 we have performed MIAVR in 29 patients with aortic stenosis. A preoperative CT scan was performed for detailed operative planning. EndoVent pulmonary catheter was pre-positioned; in case of significant aortic regurgitation ProPlege peripheral retrograde cardioplegia device was used. A 6 centimeters incision was made over the 2 nd right intercostal space. The right mammarian vessels were divided and the 3 rd rib cartilage was transected. Working view was enhanced pulling the tip of the right appendage with a snare. Right femoral vessels were cannulated. CPB was started. A Chitwood clamp was inserted through a chest tube incision. After such a preparation, a complete free operative filed makes possible aortic valve replacement, using suturless prosthesis or standard valves, with CoreKnot ligation system

Results:
Mortality rate was 0%; aortic cross clamp time was 59 min (+/- 5 min). In 4 patients femoral cannulation was not possible and we performed a central percutaneous aortic cannulation. In 1 patient, at the end of the operation we had to convert to sternotomy due to bleeding from the epicardial wire insertion.

Conclusions:
A totally free operative field make MIAVR more “surgeon friendly” and reproducible.
RF43 LONG-TERM FOLLOW-UP OF SUTURELESS VERSUS TRANSCATHETER AORTIC VALVE IN ELDERLY PATIENT WITH AORTIC STENOSIS AT INTERMEDIATE RISK: THE EUROPEAN MULTI-INSTITUTIONAL STUDY
Authors: Muneretto C. , Solinas M. , Folliguet T. , Repossini A. , Di Bartolomeo R. , Savini C. , Concistrè G. , Santarpino G. , Di Bacco L. , Fischlein T. 
Published: November 2018

Background and Aim:
This multi-institutional European study compares the long-term outcome of elderly patients with severe aortic stenosis at intermediate risk profile undergoing sutureless (SV) versus Transcatheter (TAVR) aortic valve implant.

Methods:
From 2008 to 2015, 967 elderly patients (>75 years old) at intermediate risk (STS score 4%-8%) and isolated aortic stenosis entered the study (SV = 481/TAVR = 486). After full matching Propensity Score, two matched groups of 470 (G1) and 468 (G2) patients were obtained. Primary endpoints included all-causedeath at 30-days and at 5-years. Secondary endpoints included early and 5-years incidence of composite adverse events (MACCEs: all-cause death, stroke, PM implant, MI, paravalvular leak ≥ 2 + , re-operation).

Results:
After matching there were no difference in major variables between groups. The 30-days mortality was significantly lower in SV group (G1 = 1.7% vs G2 = 6.2%;p = 0.006) as well as permanent PM implantation (G1 = 5.5% vs G2 = 11.7%,p = 0.004). Stroke/TIA cumulative incidence at five years was 1.7% (G1) and 4.8% (G2)(p = 0.020). Incidence of perivalvular leak ≥ grade II was in 0.85% in G1 and 7.4% in G2 (p < 0.001). At mean follow-up of 60 months, overall mortality and the incidence of MACCEs were significantly better in patients undergoing SV (G1 = 14.4 ± 2.7% vs G2 = 30.7 ± 3.3% p < 0.001) (G1 = 20.9 ± 4.9% vs G2 = 43.3 ± 5.1%,p < 0.001). Multivariable Cox Regression identified TAVR as independent predictor for mortality and MACCEs at 5-years (HR = 2.1,CI = 1.12-4.17,p = 0.002) (HR 2.9, CI:1.6-4.3, p < 0,001).

Conclusion:
Sutureless rapid deployment valves improved the outcomes of aortic stenosis elderly patients at intermediate risk profile. The use of TAVR in this subset population should be evaluated in further controlled randomized trial having sutureless valve as comparative cohort.
RF40 LEFT VENTRICULAR UNLOADING DURING ECMO: ATRIAL SEPTAL DEFECT VS IMPELLA. A SIMULATION STUDY
Authors: Perri G. , Filippelli S. , Di Molfetta A. , Iacobelli R. , Di Pasquale L. , Ferrari G. , Adachi I. , Vera R. Zera , Massetti M. , Amode A. 
Published: November 2018

Aim:
VA ECMO causes increase of LV afterload. Realization of ASD or Implantation of Impella have been proposed for LV unloading in combination with VA ECMO. Our aim is to study haemodynamic changes in VA ECMO patients after Impella or ASD realization using numerical model of cardiovascular system.

Methods:
A previously developed lumped parameter model of human cardiovascular system was adopted to this specific study. Heart chambers are represented by variable elastance models, while peripheral sections are represented by windkessel models. ASD was modelled as resistance separating the two atria. VA ECMO and Impella were modelled starting from their pressure-flow characteristics. Baseline condition of patient undergoing VA ECMO implantation was reproduced starting form haemodynamic and echocardiographic data and then the effect of different size ASD or different Impella support were simulated.

Results:
Impella implantation on VA ECMO patient caused an increment of mean arterial pressure up to 67%, a decrement in mean pulmonary pressure up to 8%, a decrement in LV end systolic volume up to 11% with reduction up to 97% of LV cardiac output. The realization of a calibrated ASD reduces the LA pressure up to 19%, increases right atrial pressure up to 22%, increases the MAP up to 18%, decreases the LVESV up to 11%, increase the RV volume up to 33% and decreases the LVCO up to 55%.

Conclusion:
Simulations results showed a higher capability of Impella in LV unloading during VA ECMO in comparison to ASD with a concomitant lower right ventricular overload.
RF12 CLINICAL OUTCOME AND HEALTH RELATED QUALITY OF LIFE AFTER CRYOPRESERVED HOMOGRAFT IMPLANTATION FOR RIGHT VENTRICULAR OUTFLOW RECONSTRUCTION
Authors: Petridis F.D. , Angeli E. , Careddu L. , Romano G. , Tonelli F. , Balducci A. , Donti A. , Gargiulo G.D. 
Published: November 2018

Background and Aim:
To evaluate long term clinical outcomes and a cross-sectional quality of life study, in congenital patients after right ventricular outflow tract (RVOT) reconstruction with cryopreserved pulmonary homograft (HG).

Methods:
110 patients (pts) undergone RVOT reconstruction with cryopreserved pulmonary HG from January 1995 to September 2014 were included in this retrospective review. Homograft's failure was diagnosed in presence of pulmonary valve peak gradient ≥50mmHg and/or moderate to severe degree of valve regurgitation. Mean diameter of HG implanted was 22 mm and donors’ mean age 39.1 ± 16.0years. Follow-up data included echocardiogram, cardiac MRI and clinical evaluation. The Short-Form-36 was presented to patients to assess perceived quality of life.

Results:
Mean age at surgery was 24.5 ± 15 years. Mean follow-up was10.1 ± 5 years. There was no perioperative mortality. At follow-up, 2 pts (1.8%) died due to non cardiac comorbidities. Homograft failure was observed in 6 pts (5,4%): 5 required percutaneous valve implantation, with a mean interval from the main procedure of 5.3 ± 2.1years and 1 pt required HG replacement after 7years for pseudoaneurysm formation. Freedom from reoperation was 92% and 84% at 5 and 15 years respectively. At follow-up reduction of RV dilatation was observed in 71%pts with ED-volume 98.5 ± 26.1 ml/mq, ES-volume 50.1 ± 16.1 ml/mq, RVEF50.7 ± 6.9% and LVEF59.2 ± 6.9%. HG initial diameter was not a significant prognostic factor for HG dysfunction.

Conclusions:
Cryopreserved pulmonary homograft represent a valid option in case of right ventricular outflow tract reconstruction, as it is associated with low failure rate and no mortality in the long term.
RF20 EVOLUTION OF SMALLEST INTRACORPOREAL CONTINUOUS FLOW LVAD: ROMA EXPERIENCE
Authors: Filippelli S. , Perri G. , Di Molfetta A. , Iacobelli R. , Toscano A. , Adorisio R. , Iodice F. , Di Chiara L. , Iorio F. , Amodeo A. 
Published: November 2018

Objective:
Limitations of current VAD for smaller children with HF include use of para-corporeal device, high stroke risk and lack of portability precluding hospital discharge. We report our experience with smallest Jarvik LVAD prototype highlighting the evolution of this device.

Methods:
A 14-months-old child, weighting 5.6 Kg with DCM and mid-aortic syndrome and a 3 years-old baby, weighting 11 Kg with DCM underwent off-label Jarvik LVAD prototype implantation.

Results:
Patient 1. After 123 days of Berlin Heart EXCOR LVAD (10 ml) support, the patient developed mediastinitis. He underwent device removal and Levitronix LVAD implantation. After 25 days, we implanted Infant Jarvik 2000. On 13th post-operative day, for a suddenly pump electric blackout, he underwent urgently VA ECMO support and 12 days later, for infection recovery, a new 10ccml BH EXCOR LVAD was implanted. After 17 days of support, he was successfully transplanted and survived to hospital discharge. Patient 2. This child was supported for 166 days with a BH EXCOR LVAD, which was explanted for LV recovery. After 6 days, he developed recurrency of severe HF, needing new LVAD. Because of abdominal cannula site infection, he underwent Infant Jarvik 2015 prototype implantation. Actually, after 3 months of support, is still awaiting heart transplantation.

Conclusion:
Our pioneering experience showed the feasibility of new smallest Jarvik LVAD and could be considered in future as alternative therapeutic option for LVAD support even in low-weight patients. Further study and larger cohort of patients are necessary to confirm the safety of this new device.
RF31 IS ISOLATED TYPE I VENTRICULAR SEPTAL DEFECT STILL RARE IN ITALIAN POPULATION COMPARED TO ASIAN?
Authors: Grimaldi A.M. , Cassano V. , Troise D. , Lombardi M. , Vairo U. , Scalzo G. 
Published: November 2018

Background:
Type I Ventricular Septal Defect (VSD) is less common in Western Countries (5-6% of all VSDs) than in Asia (30% of all VSDs) despite the incidence of VSD is similar (25-30% of all Congenital Heart Defects). In the last 2 years we operated on several isolated Type I VSDs.

Methods:
A retrospective study reviewing VSDs surgical repair from March 2016 to April 2018 was conducted. In total 14 patients received surgical correction of a isolated VSD. The diagnosis was made primarily on transthoracic 2-dimensional echocardiography,standard cardiac catherization. Patients with associated major cardiovascular anomalies were excluded. The classification of VSD type is according to the nomenclature for VSD reviewed by The Society of Thoracic Surgeons in 2000.

Results:
In 4 out of 14 patients Type I VSD was identified (28,5%),in 9 Type II (64,3%) and in 1 Type III (7,2%). Focusing on patients with Type I they were all female and surprisingly all Italian with no Asian relatives at all. Age at operation ranged from 2 to 13 months (mean 7,7 mo) and weight ranged from 3,8 to 10 kg (mean 6,8 kg). Surgical repair was done via transpulmonary arterial access. All patients are alive and well with no aortic nor pulmonary valve problems at 24 months of follow up.

Conclusions:
We are surprised to find out such a incidence of Type I VSD in Italian population. We are fully aware of the weak statistical power of our series so we look forward to propose an Italian multicenter study to verify the hypothesis of a changing incidence of Type I VSD in Italy.
RF88 TRANSFEMORAL BARE-METAL STENT FOR TREATMENT OF RESIDUAL AORTIC ARCH DISSECTION AFTER SURGICAL REPAIR OF ACUTE TYPE A AORTIC DISSECTION.
Authors: Mariniello A. , Di Tommaso L. , Di Tommaso E. , Giordano R. , Malio E. , Mannacio L. , Castellano G. , Iannelli G. 
Published: November 2018

Background and aim:
Here we evaluate the usefulness of transfemoral uncovered stent implantation to avoid secondary conventional surgery for residual type A aortic dissection of aortic arch after ascending aorta replacement.

Methods:
From June 2009 to April 2015, 11 patients were treated with transfemoral implantation of uncovered stents in the aortic arch after surgical replacement of ascending aorta performed on average 4.7 ± 2.3 years earlier.. An enlarged dissected aortic arch or a dangerous median growth of more than 5 mm/yr or impending rupture presenting as chest pain were indications for treatment. The dissected aortic tracts diameter must not exceed 45 mm. 5 patients (45.5%) were treated with Djumbodies Dissection System, 6 patients (54.5%) with Jotec E-XL aortic stent.

Results:
There were no perioperative deaths or permanent neurologic complications. Primary procedural success was obtained in all patients and the residual type A aortic dissection in aortic arch was obliterated, with disappearance of the false lumen. Median ICU stay was 24 hours, post-operative hospital stay was 5.2 ± 1.4 days.
One death, not aortic related, occurred during follow-up period (mean 5.2 ± 1.9 years). Descending thoracic aorta diameter significantly increased in 3 patients (27.3%): one patient (9.0%) needed a secondary conventional surgery, the other 2 (18.2%) of a distal extension with PETTICOAT approach.

Conclusions:
Endovascular approach with uncovered metal bare stent is surely an evolving strategy to perform a purely endovascular treatment, indicated only for treatment of aortic arch with a diameter of less than 40 or 45 mm, to avoid progressive thoracic aortic dilatation and/or rupture.
RF04 AORTIC ARCH ANEURYSM: OUR SURGICAL EXPERIENCE
Authors: Maurizio R. , Kassem S. , Bonalumi G. , Ricciardi G. , Naliato M. , Salvi L. , Brambillasca C. , Bertera A. , Pedroletti D. , Alamanni F. 
Published: November 2018

Background and aim:
The introduction of the so-called “branch first technique” in the field of aortic arch surgery allowed cardiac surgeons to eliminate the need of performing the operation very quickly, which is a relevant problem of the traditional techniques of aortic arch reconstruction. In addition, operations are now performed at moderate hypothermic rather than deep hypothermic core temperature. Thus, neurological complications occur with less frequency in the surgically managed patients.

Methods:
We use these new techniques to avoid the risks of traditional aortic arch surgery. The main innovative aspects of our procedure includes:
These modifications allow to preserve cerebral perfusion throughout the operation.

Results:
Our series is made up of 8 patients. We experienced neurological complications only in one patient with a previously implanted left carotid stent, probably due to a bad superior venous drainage.

Conclusions:
The modified “branch first technique” avoids the neurological risks of deep hypothermic circulatory arrest.
This is a preliminary work about the use of this technique. Thus, a large number of patients is required to confirm our actual good results.
RF08 BENTALL OPERATION WITH ON-X MECHANICAL CONDUIT: THE BOLOGNA EXPERIENCE
Authors: Murana G. , Mariani C. , Alfonsi J. , Fiorentino M. , Coppola G. , Folesani G. , Leone A. , Suarez S. Martin , Pacini D. , Di Bartolomeo R. 
Published: November 2018

Background and aim:
The On-X prosthesis is the only mechanical aortic valve available in the market to have a proved safety and feasibility at lower INR regimen. The aims of this retrospective study were to evaluate the early and mid-term outcomes of the modified Bentall procedure with the O4n-X mechanical conduit.

Methods:
From January 2012 to December 2016, 108 consecutive patients (mean age 51.9 ± 12.5 years) underwent Bentall operation with On-X in our institution. Main indications were degenerative ascending aorta aneurysms (55.6%) and aortic dissections (20.4%). Seventeen (15.7%) were redo operations. Associated procedures were performed in 40 cases (37.0%); of them, 27 (25.0%) were complete or partial arch replacements. Mean follow-up time was 35.1 ± 16.1 months (97.1% complete). After 2015, a lower INR regimen of 1.5 to 2 was applied in association with aspirin.

Results:
Overall In-hospital mortality was 2.8%. Morbidity included: 1 stroke (0.9%), 2 acute kidney injuries (2.9%) and 5 re-thoracotomies for bleeding (4.6%). Actuarial survival at 5 years was 95.2 %. Freedom from aortic re-operation was 100%. At 5 years no thromboembolic or haemorrhagic events were observed and only 1 patient had an infective endocarditis (figure 1).

Conclusions:
The modified Bentall operation confirmed to be a safe and durable operation for the treatment of ascending aorta pathologies. The On-X conduit showed very satisfactory early results even in cases with unfavourable anatomy. This prosthesis also guarantees safe mid-term durability associated with a very low incidence of thromboembolism regardless of the lower INR regimen.