bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC31 HOW TO IDENTIFY THE APPROPRIATE LEFT VENTRICULAR ASSIST DEVICE CANDIDATE AMONG PATIENTS ON EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT
Authors: Loforte A. , Morshuis M. , Zimpfer D. , Pappalardo F. , Attisani M. , Riebandt J. , Ramjankhan F. , Donker D. , Jorde U. , Albert A. , Lichtenberg A. , Rinaldi M. , Saeed D. 
Published: November 2018

Background and Aim:
Implantation of long-term left ventricular assist devices (LVADs) in patients on veno-arterial membrane oxygenation (VA-ECMO) support is controversial. Aim of this study has been to report the experience of seven LVAD centers.

Methods:
Data of LVAD patients (2010–2017) at seven European institutions were reviewed. The only inclusion criteria was VA-ECMO before LVAD placement. Patients’ characteristics, intraoperative variables and postoperative course were analyzed thus eventually identifying predictors of mortality.

Results:
A total of 154 continuous flow LVAD patients (mean age 53.1 ± 12 years; 84% male) were identified. The VA-ECMO cannulation was peripheral in 92% of patients and 37% had received cardiopulmonary resuscitation prior to VA-ECMO implantation. Mean VA-ECMO duration prior to LVAD implantation was 7.1 ± 7 days. Cardiopulmonary bypass was adopted in 64% of patients for LVAD implantation. Major postoperative complications included right heart failure requiring temporary right ventricular device (RVAD) support (47%), bleeding requiring rethoracotomy (20%), respiratory failure (54%), renal failure (50%) and hepatic failure (31%). Thirty-day and 1-year survival was 84 and 62%, respectively. At univariate analysis age, lactate level, pH, white blood cells (WBC) count, pre-LVAD dialysis and Model for End-stage Liver Disease eXcluding INR (MELD-XI) score before implant were significant. Multivariate regression analysis identified pre-LVAD MELD-XI (OR 1,250, 95% CI 1,038–1,505; p = 0.019) as the only significant predictor of mortality.

Conclusions:
The outcome of LVAD patients on VA-ECMO support is limited by the high rate of major adverse events. Preoperative LVAD MELD-XI score seems to identify patients that will clearly not benefit from LVAD implantation.
OC68 SURGERY FOR ANOMALOUS AORTIC ORIGIN OF CORONARY ARTERIES (AAOCA). A MULTICENTER STUDY FROM THE EUROPEAN CONGENITAL HEART SURGEONS ASSOCIATION (ECHSA)
Authors: Padalino M. , Franchetti N. , Boccuzzo G. , Hazekamp M. , Carrel T. , Frigiola A. , Rito M. Lo , Horer J. , Cleuziou J. , Meyns B. , Fragata J. , Polimenakos A. , Francois K. , Veshti A. , Salminen J. , Rocafort A. Glez , Nosal M. , Guariento A. , Vida V. , Stellin G. 
Published: November 2018

Background and aims:
Anomalous aortic origin of coronary arteries (AAOCA) is a rare anatomical abnormality which is a consistent cause of sudden death in young people. There are no guidelines on either surgical indication or best surgical treatment. We sought to describe early and late outcomes in a large surgical series to evaluate safety and effectiveness of surgical procedures for AAOCA.

Methods:
This is a retrospective clinical multicenter study including patients undergoing surgical treatment for AAOCA since 1991. Patients with ONLY high coronary take off were excluded. Preoperative, intraoperative and postoperative data were retrieved from a common database. Anatomical characteristics evaluated were: AAORCA vs AAOLCA vs other anatomical variants (LAD or CX from anterior sinus, single coronary); Coronary course (interarterial, anterior to aorta, only intramural).

Results:
We included 157 patients undergoing AAOCA repair (median age 39.5 yrs, interquartile range 15–53). Symptoms were present in 136 (87 %). There were 106 AAORCA (67%); 36 AAOLCA (23%);15 other (10%). Surgical procedures were Unroofing (54%); Coronary reimplantation (19%); CABG (15%); Other (12%). Major postoperative complications occurred in 12.7%. Early death was 1.2%. At a median follow up time of 2 yrs (range 1 m -23 yrs) there were 4 late deaths; NYHA class was I-II in 92%; residual symptoms in 18%; adverse events in 8.2%.

Conclusions:
Surgery for AAOCA is low risk. Unroofing and coronary reimplantation are the most frequ with 0% operative mortality. Late adverse events occurrence (surgical, non surgical, SCD) is not negligible, and long term surveillance is mandatory.
OC60 PROPORTIONAL GEOMETRY FOR MITRAL REPAIR IN CHILDREN
Authors: Deorsola L. , Aidala E. , Cascarano M.T. , valori A. , Napoleone C. Pace 
Published: November 2018

BACKGROUND AND AIM:
Mitral repair in children is challenging and almost always the only chance: dimensions, anatomy and dysplasia are the main concerns. According to anatomical and literature data valve geometry seems based on well-defined dimensional proportions, determining valve shape and function. We applied these proportions during repair to assess whether they could make the procedure easier and improve results.

METHODS:
Eight patients underwent mitral repair between 2015 and 2018. Mean age was 93 ± 48 months and weight 26 ± 12 Kg. Six had congenital dysplasia, one a bileaflet prolapse in Loeys-Dietz Syndrome and one an acute endocarditis. Hypoplastic leaflets had an extension plasty, endocarditis a replacement of the anterior leaflet and bileaflet prolapse a posterior quadrangular resection. Chordal surgery and posterior annuloplasty with a pericardial strip were also employed. Proportional Geometry was used to estimate valve dimensions, leaflet extension/resection amount and annuloplasty entity.

RESULTS:
Mean annular dilatation was 8 mm, according to body weight or BSA, leaflet extension patch had a mean width of 8 mm and the annuloplasty strip a mean length of 53 mm. At intraoperative TE Echocardiography mitral valve appeared normal, with no or trivial regurgitation and no gradient. All patients had an uneventful postoperative course. Follow up is 100% complete and 3 years long. All patients show good clinical conditions, no symptoms and no or trivial mitral regurgitation.

CONCLUSIONS:
Proportional Geometrical rules standardize surgery and seem to help restoring a normal mitral anatomy, optimizing valve function and mechanical stresses and potentially improving surgical results.
OC66 ROAD-MAP FOR CONGENITAL HEART SURGERY PROGRAM IN-DEVELOPING COUNTRY
Authors: Iezzi F. , di Summa M. , Del Sarto P. , Munene J. 
Published: November 2018

Introduction:
We have summarized a 3-year project that has resulted in the establishment of a new congenital heart surgery program in collaboration with Kenyatta National Hospital of Nairobi - Kenya (Africa).
In 2013, we started with only 18 patients undergoing surgical interventions. This has grown to more than 70 cumulative surgical procedures in the following years, with ever decreasing mortality.

Materials and methods:
The first step is to select a site and collaborative partner that will have adequate hospital equipment and personnel and the potential for self-sustainability.
The next major step was the construction of surgical education teams that travel to the site for a 2-week educational mission twice a year.
Finally, our program behooves the medical staff at local centers to educate themselves and adopt the principles of cardiac programs of excellence by visiting established heart surgery institutions so that they can return to their own centers with newly acquired knowledge and strategies that will better serve their patients.

Discussion:
In summary, near a great humanitarian work, the program is important for sharing our program model of effectively delivering high-quality pediatric cardiac care to underserved regions

Conclusion:
By outlining the steps it takes to achieve a program that can assess, educate, and train local pediatric cardiac specialists in current diagnostic modalities and new surgical and interventional techniques to the point where they are able to treat patients without the assistance of international consultants.
OC48 MYOCARDIAL TISSUE ENGINEERING AND REGENERATION– IN VITRO EXPANSION OF ENDOTHELIAL CELL BY DIFFERENT VESSELS REVEALS THE BETTER AUTOLOGOUS CELLULAR SOURCE FOR TISSUE REPLACEMENT
Authors: Musolino G. , Valentina T. , Jiritano F. , Serraino G.F. , Garrasi C. , Malara N.M. , Mastroroberto P. , Mollace V. 
Published: November 2018

BACKGROUND AND AIM:
The development of cell-based therapies to assist/replace diseased tissue is one of the most promising initiatives in regenerative medicine. Human endothelial cells (HEC) can be used for various applications including molecular profiling as well as cell culture. Several complex techniques and culture media have been reported although with confounding results belonging todonor-to-donor variability and cellular source of derivation. Our results demonstrate the overcome of these limitations using soluble CD54 (sCD54) as additive to conventional culture medium.

METHODS:
Isolated primary fragment of different vessel types (left internal thoracic artery, radial artery and saphenous vein) were expanded in Ham's F12 DMEM, enriched with growth factors, Foetal Calf Serum and conditioned medium of Human Umbilical Vein Endothelial Cells (HUVEC) collected at different passages. Cytokines were analysed in order to identify the soluble factors correlating with better proliferation profile.

RESULTS:
sCD54 was found to induce the in vitro expansion of HEC independently from the vessels source and even in the absence of HUVEC-conditioned medium. The HECs cultivated in presence of sCD54 resulted positive for the expression of CD146 and negative for CD45, and with lower fibroblast contamination. Cells were capable to proliferate with an S phase of 25%, to produce VEGF and to give origin to vessel-like tubule in vitro. (Figure 1)

CONCLUSIONS:
sCD54 is an essential factor for the in-vitro expansion and differentiation of HEC, minimizing potential donor sample variability. Resulting primary cultures can be advantageous for tissue engineering in regenerative medicine and bio-nanotechnology applications.
OC14 CONCOMITANT TRANS-AORTIC TRANSCATHETER AORTIC VALVE IMPLANTATION AND COMPLETE OFF-PUMP CORONARY ARTERY REVASCULARIZATION IN HIGH-RISK PATIENTS
Authors: Casado A. Pilozzi , Raviola E. , Bonalumi G. , Tizzano F. , Le Houerou D. , Romano M. 
Published: November 2018

Treatment of concomitant aortic stenosis and coronary artery disease represents a challenge in elderly high-risk patients with unsuitable peripheral anatomy to percutaneous access for TAVI. Our aim was to investigate efficacy, safety and mid-term clinical outcomes of concomitant Trans-Aortic TAVI and OPCAB.

Methods:
Between April2011 and January2016, 41 patients underwent simultaneous Tao-TAVI through a median sternotomy and OPCAB. High surgical risk profile did not permit conventional AVR and surgical revascularisation. PCI was considered unsuitable, because of LAD-proximal lesions and/or high SYNTAX-score. Primary endpoints were mortality and cerebro-vascular event rate.

Results:
Mean age was 82.6 ± 4.1 years with logistic-EuroSCORE and STS-score 19.19 ± 13.58% and 6.28 ± 3.57%. Average number of distal anastomoses was 2.7; TAo-TAVI was performed using either Sapien XT or Sapien 3 devices in 85.4% and 14.6% respectively, with a success rate of 95.1%. None paravalvular leak (PVL) ≥2/4 was observed with mean prosthesis gradient of 9.6 ± 3.8 mmHg. Conversion to CPB was required in 4.9% and pace-maker implantation in 4.9%. No cerebro-vascular accident were noted neither in-hospital stay (14.9 ± 5.0 days) or during total follow up (mean 17,26 months). In-hospital mortality was 7,32% and survival rate at 6,18 months was 84,35% and 77,86%, respectively.

Conclusions:
Considering high surgical risk, Simultaneous TAo-TAVI and OPCAB have become realistic treatment alternative and could represent a reasonable option in high-risk patients with severe AS and CAD and unsuitable peripherical access, permitting CPB avoidance.
OC80 THE ROLE OF SURGICAL TECHNIQUE ON LONG-TERM OUTCOMES OF TETRALOGY OF FALLOT REPAIR: A MULTICENTER STUDY
Authors: Pradegan N. , Azzolina D. , Galletti L. , Napoleone C. Pace , Agati S. , Palma G. , Giordano R. , Marianeschi S. , Carro C. , Vida V.L. , Stellin G. , Padalino M.A. 
Published: November 2018

Abstract

Background and Aim:
to evaluate clinical outcomes of patients undergoing Tetralogy of Fallot (ToF) repair, focusing on the type of surgical strategy performed.

Methods:
a retrospective clinical review of patients undergoing ToF repair in six centers. Excluded were ToF with pulmonary atresia or aplasia, and double-outlet right ventricle.

Results:
between 1990 and 2015, 720 patients underwent ToF repair (M/F 57%/43%; median age 5,9months, IQ range 3,8–11,5); 132 (18%) had preoperative cyanotic spells; 111 (15%) received previous palliative surgery. Repair was achieved by transatrial approach (TA) in 433 patients (60,1%), and transventricular (TV) in the remaining ones. The pulmonary valve (PV) was saved in 249 (34,6%), while, in the remaining patients, RVOT reconstruction was performed by means of a transanular patch (60,8%), or a conduit (4,6%). Major postoperative complications occurred in 247 (34,0%). Early mortality was 3%.
At 20-year follow-up (completeness 86%), 10 (2%) patients died, 39 (7%) required surgical reoperation, and 72 (12%) an interventional procedure. There were no significant differences between TA and TV approaches, in terms of early mortality and onset of adverse events (interventional procedures, surgical reoperations and mortality) at follow-up. When PV was saved, there was a lower rate of postoperative complications and early mortality, and a lower rate of overall adverse events (Figure 1, p < 0,05).

Conclusions:
ToF repair in infancy is confirmed to be a safe procedure, with good late clinical outcomes. PV preservation at repair is associated with lower early morbidity and mortality, and a lower rate of adverse events at long-term follow up.
OC30 HEMOCOMPATIBILITY-RELATED ADVERSE EVENTS AND PHYSIOLOGICAL CIRCULATORY INTERFACE OF DIFFERENT GENERATION LEFT VENTRICULAR ASSIST DEVICES
Authors: Loforte A. , Montalto A. , Attisani M. , Mariani C. , Comisso M. , Baronetto A. , Fiorentino M. , Di Bartolomeo R. , Marinelli G. , Musumeci F. , Rinaldi M. 
Published: November 2018

Abstract

Background and Aim:
Aim of this study has been to assess the rate of hemocompatibility-related adverse events (HRAEs) of current generation centrifugal pumps and older axial continuous-flow (CF) left ventricular assist devices (LVADs).

Methods:
We identified 193 CF LVAD recipients at three institutions. We studied the quantitative estimates of freedom from HRAEs between 3 types of pumps, the HeartMate II (HMII,n = 56), the HeartMate 3 (HM3,n = 38) and the HeartWare HVAD (HVAD,n = 99). The net burden of HRAE was assessed by using the MOMENTUM 3 hemocompatibility score.

Results:
Survival free of any HRAE was achieved in 86% of the HM3 group, 64% of the HMII group and 52% in HVAD group (hazard ratio, 0.64; confidence interval, 0.40–0.95; p = 0.014). Using the hemocompatibility score, the HM3 group demonstrated less pump thrombosis requiring reoperation (0 versus 6 and 14 points, for HMII and HVAD, respectively, p = 0.002) or medically managed pump thrombosis (0 versus 4 points and 17 points, for HMII and HVAD, respectively, p = 0.001), and fewer nondisabling strokes (6 versus 14 and 30 points, for HMII and HVAD, respectively, p = 0.002). The net hemocompatibility score in the HM3 in comparison with the HMII and HVAD patients was 71 (0.66 ± 1.45 points/patient) versus 103 (0.86 ± 1.59 points/patient) and 157 (0.96 ± 1.71 points/patient), respectively (odds ratio, 0.66; confidence interval, 0.38–1.01; p = 0.063).

Conclusions:
In this analysis, HM3 had a more favorable physiological circulatory interface at 36 months in comparison with HMII and HVAD. This confirms the need to develop different clinical monitorings and coagulation management protocols when facing with various device platforms.
OC61 RANDOMIZED ANTICOAGULATION TRIAL IN OPCAB (RATIO TRIAL): PRELIMINARY RESULTS
Authors: Triggiani M. , Martino A.S. , Lemma M. , Mangini A. , Vanelli P. , Massi F. , Portoghese M. , Lamarca A. , Pepino P. , Troise G. , Messina A. , Pettinari M. , Lazzarini I. , Di Credico G. , Parrella P. , Antona C. 
Published: November 2018

Abstract

Background and aim:
To analyze quality of data and preliminary results of the first 100 patients enrolled in RATIO trial (low dose -LD 150 U/kg versus high dose -HD 300 U/kg heparinization with target ACT respectively of 250 and 400 seconds).

Methods:
ACT was recorded before anesthesia, 5’ after heparination, every 30’, 10’ after full protamine reversal. Primary endpoints were occurrence in the first 30 post-operative days of vascular events (death from vascular causes, perioperative myocardial infarction -PMI, stroke), or major bleeding events (redo for excessive bleeding, cardiac tamponade, transfusion ≥3 U of red cells or platelets).

Results:
Preoperative mean age, male-female index, LVEF, LM disease, and CAD extent did not differ significantly between LD (n.51) and HD group (n.49). DAPT was stopped respectively in 24/51 and 16/49 patients of LD and HD group (p = 0.3). Aspirin was continued throughout surgery respectively in 50/51 and 43/49 patients of LD and HD group (p = 0.5). The table summarizes intraoperative ACT values. No statistical difference was observed in primary cumulative endpoints: no stroke; 1 PMI in HD; 2 and 1 death - 2 and 1 redo for bleeding – 9 and 10 transfusions respectively in LD and HD groups. DAPT was prescribed postoperatively in 42/100 patients.

Conclusions:
Preliminary analysis seems to confirm the null hypothesis (LD and HD equally safe). LD does not seem to confer any advantage about bleeding. These results could be due to ACT curve in LD patients tending to exceed the target of 250 and to LD-HD curves almost overlapping.
OC26 EXTERNAL STENTING OF VEIN GRAFTS IN OFF PUMP CORONARY BYPASS SURGERY AND SEQUENTIAL GRAFTING: INTERMEDIATE RESULTS FROM A SINGLE CENTER PROSPECTIVE STUDY
Authors: Weltert L. , Guerrieri L. , Chirichilli I. , D’Aleo S. , Salica A. , Scaffa R. , Bellisario A. , De Paulis R. 
Published: November 2018

Abstract

Background:
External stenting of vein grafts has been shown to reduce graft disease by mitigating intimal hyperplasia and improving flow pattern in on-pump single vein graft context. Aim of study is to evaluate usability and clinical outcome of external stenting also in patients undergoing beating-heart sequential grafting receiving multiple external stents per patient.

Methods:
Thirty patients undergoing CABG had the venous grafts supported with VEST (VascularGraftSolutions, Israel) and were prospectively followed-up via phone call and/or visit every 6 months. Major Adverse Cardiac and Cerebrovascular Events (MACCE) were recorded. Planned follow-up is 5 years.

Results:
Mean age was 69.0, 86.7% were males, mean Euroscore and ejection fraction were 5.40% ± 4.92% and 56.8% ± 7.4. Veins were harvested in an open manner. Average number of grafts per patient was 3.2. Each patient had either single vein graft (n = 20), or sequential vein grafts (n = 10) supported with VEST. All patients were discharged alive from the hospital after surgery. One patient experienced transient ischemic attack during in-hospital stay and fully recovered before discharge.
Follow up was complete for all patients, mean follow time of 16 months (range 1–31 months). During the follow up period, MACCE rate were 0% and no additional adverse events were reported. CT angiography performed to patients arriving at 1 year follow-up confirmed all grafts were patent.

Conclusions:
External stenting of saphenous vein grafts is technically feasible in off pump CABG procedures and sequential grafting. Intermediate follow up of up to 30 months suggest that it's safe and not associated with major clinical events.
OC17 CORONARY ENDARTERECTOMY: AN OLD TOOL FOR PATIENTS CURRENTLY OPERATED ON CABG. LONG-TERM RESULTS, RISK FACTORS ANALYSIS
Authors: Nardi P. , Russo M. , Saitto G. , Bertoldo F. , Pisano C. , Vacirca S.R. , Bovio E. , Bassano C. , Pellegrino A. , Scafuri A. , Ruvolo G. 
Published: November 2018

Abstract

Aims:
Coronary endarterectomy (CE) may provide an useful adjunctive technique to coronary artery bypass grafting (CABG) in patients with diffusely coronary artery disease. Nevertheless, the incidence of complications remains still high, long-term results remain unclear, and no risk factors for late mortality have been still completely described.

Methods:
We retrospectively reviewed 90 consecutive patients (67 ± 8.2 years) undergoing isolated CABG in association with CE between. Mean follow-up was 75.1 ± 36.2 months (median 84 months) and it was 100% complete (6,755/6,755 pt-months).

Results:
Operative mortality was 4.4%, the incidence of perioperative myocardial infarction was 11%. Ten-years survival was 83.3% ± 4.1%, freedom from cardiac death 92.7% ± 2.9%, and freedom from major adverse cardiac and cerebrovascular events 58.2% ± 10.2%. Independent predictors of late mortality were age older than 70 years at time of the surgery (P = 0.018) and chronic obstructive pulmonary disease (P = 0.036). Ten-year freedom from cardiac death was better after CE on the LAD (93.2% ± 3.3%) in comparison to CE not on the LAD (74.6% ± 10.2%), although this difference did not reach statistical significance (P = 0.102).

Conclusion:
Although the incidence of perioperative myocardial infarction continues to be not negligible, in presence of diffusely diseased coronary artery vessels CE associated with CABG appears to be a feasible adjunctive surgical tool, conferring satisfactory early and long-term outcomes. CE on the LAD confers a high probability of freedom from late cardiac death. Patients older than 70 years and those affected by a primary respiratory disease represent a new challenge on which focusing attention for the increased risk of late death.
OC52 OCTOGENARIANS UNDERGOING OFF-PUMP AND ON-PUMP MULTIPLE CORONARY ARTERY BYPASS GRAFTING BENEFIT OF GOOD QUALITY OF LIFE AT MID-TERM FOLLOW-UP
Authors: Trinca F. , Martino A.S. , Galanti A. , Tasca G. , Giannico F. , Ambrosoni S. , Gamba A. , Triggiani M. 
Published: November 2018

Abstract

Aim of the study:
To review mid-term results of multiple off-pump and on-pump CABG in octogenarians (OPCABG-ONCABG).

Materials:
In the period 2012–2017 87/888 (9,8%) patients undergoing isolated multiple CABG were octogenarians (81,7 ± 1,6 years). In particular 32/87 (36.78%) underwent OPCABG. After propensity score analysis, 29 OPCABG patients were matched with 29 ONCABG.

Results:
Mean number of grafts was respectively 2,6 ± 0,6 and 2,1 ± 0,3 in ONCABG and OPCABG group (p = 0,001). In-hospital mortality and perioperative MI did not occur. 1 ONCABG patient suffered from a stroke. IABP was implanted in 1 patient in each group. Intraoperative blood transfusions did not differ significantly in the 2 groups (respectively 18/29–62,1% and 14/29–48,3% in ONCABG and OPCABG, p = 0,2). 1 ONCABG patient needed surgical revision for excessive bleeding. Mean intubation time was respectively 9,2 ± 4,58 and 9,8 ± 3,64 hours in ONCABG and OPCABG group (p = 0,6). Mean stay in ICU did not differ in the 2 groups (p = 0,4). Severe AKI occurred in 1 ONCABG patient requiring haemodialysis. Follow-up was 77.6% complete. At a mean follow-up of 2.7 ± 1.5 years 41/45 patients are alive (2 non cardiac death for each group). In table 1 is reported Kaplan-Meyer cumulative survival curve. Only 2/41 patients had a new hospital admission for NSTEMI and 39/41 are angina free.

Conclusion:
OPCABG and ONCABG are safe procedures even in elderly patients. Postoperative complications seem to be less frequent in OPCABG patients, but the difference is not significant. OPCABG received significantly lower number of grafts, but this does not seem to influence survival and angina recurrence.