bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC42 MINIMALLY INVASIVE MITRAL VALVE SURGERY IN HIGH-RISK PATIENTS: 12-YEAR SINGLE CENTRE EXPERIENCE
Authors: Stura E. Cura , Ricci D. , Marchetto G. , Barbero C. , Qarra S. El , Boffini M. , Rinaldi M. 
Published: November 2018

Objective:
This study analyzed the results of 12-year experience with mini-invasive MV operations in high-risk patients.

Methods:
From 1/2006 to 2/2018, 153 patients with EuroSCORE ≥ 10 underwent minimally invasive MV surgery (13.0% of 1175): mean EuroSCORE was 12.0 ± 3.1 and Logistic was 30.7 ± 15.8, mean age was 73.6 ± 8.6, male were 32.7%. Comorbidities included: diabetes (23.5%), COPD (24.2%), chronic renal failure (28.1%), peripheral vasculopathy (16.3%), previous AMI (10.5%), neurological deficit (13.7%), active endocarditis (9.2%) and AF (63.4%). The mean EF was 50.7 ± 13.8 and 34.0% had pulmonary hypertension. In 71.2% had undergone previous cardiac surgery, in 11.1% were urgiences.

Results:
In 24.8% were mitral repair, associated procedures were TV procedures (20.3%) and AF-crioablation (5.3%). Mean cardiopulmonary and cross clamp time were respectively 133.8 ± 54.1 and 83.8 ± 28.5 minutes. The most utilized aortic clamp technique was endoreturn (58.8%). Conversions to sternotomy were 4.6%. Reoperation for bleeding occured in 11.8%. Postoperatively, in 2.6% were reported major neurologic complications, in 14% was necessary CVVH, in 5.2% PM implantation and in 6.5% tracheostomy. Mean, median intubation time, ICU and hospital stay were respectively 135.3 ± 833.9 (12)h, 9.7 ± 36.0 (2)days and 20.1 ± 39.1 (10)days. The 30-day mortality rate was 9.2%.

Conclusions:
mini-invasive approach allows acceptable morbidity and mortality in high-risk patients.
OC84 TRANSTHORACIC CLAMP AND ENDOAORTIC OCCLUSION FOR MINIMALLY INVASIVE CARDIAC SURGERY
Authors: Malvindi P.G. , Margari V. , Kounakis G. , Visicchio G. , Favale A. , Labriola C. , Carbone C. , Paparella D. 
Published: November 2018

Background and Aim:
Two techniques of aortic occlusion have been used in small thoracotomy cardiac surgery: transthoracic clamp (TTC) and endoaortic balloon occlusion (EAO). Both techniques present peculiar advantages and limitations whose current evidences are based on observational studies. We report our experience comparing early outcomes of these two techniques.

Methods:
235 consecutive patients underwent minimally invasive cardiac surgery through right mini-thoracotomy from January 2013 to March 2018.One-hundred forty-two patients were operated on with TTC, in 93 cases EAO was used. Mean age was 60.1 ± 13.6, patients with TTC were significantly older (62.4 ± 12.4 TTC vs. 56.1 ± 14.5 EAO, p = 0.0002); reoperations were carried out mostly with EAO (2% TTC vs. 12% EAO, p = 0.005). No differences were detected between the two techniques in terms of types of operation, CPB and cardioplegic arrest times.

Results:
Similar values of postoperative Troponin I and CK-Mb were recorded. New neurologic deficit occurred in 6 patients, 2 temporary deficit in the TTC patients and 4 strokes in the EAO group (p = 0.048). There was no case of aortic dissection, no patient suffered peripheral ischaemia. Overall hospital mortality was 2.1%, 1.4% in TTC and 3.2% in EAO (p = 0.62); hospital mortality, excluding redo-operations was 1.4%, 1.4% in TTC and 1.2% in EAO (p = 0.98).

Conclusions:
Both TTC and EAO provided to be safe.A higher rate of cerebral stroke was observed in the EAO group. However, the use of endo-aortic balloon inflation system showed technical advantages in avoiding tissue dissection and aortic manipulations. It remains our choice in redo operations.
OC19 DETERMINANTS OF FUNCTIONAL CAPACITY AFTER RESTRICTIVE ANNULOPLASTY FOR ISCHEMIC MITRAL REGURGITATION
Authors: Tamagnini G. , Pettinari M. , Amoroso F. , Van Kerrebroeck C. , Dion R.A. , Gutermann H. 
Published: November 2018

OBJECTIVE(S):
This study was designed to evaluate prevalence and determinants of reduced functional capacity, in patients who underwent restrictive mitral valve annuloplasty (RMA) for severe ischemic mitral regurgitation (IMR).

METHODS:
Between January 2008 and December 2015, 90 patients with severe ischemic mitral regurgitation underwent coronary artery bypass grafting and restrictive mitral valve annuloplasty. After a mean period of 3.5 +/- 2.4years, cardiopulmonary exercise testing (CPET) was performed to assess peak oxygen consumption (VO2 max).

RESULTS:
At five years, survival was 68.8+/-5.3%. The mean VO2 max was 17.4+/-4 ml/kg/min (76.3+/-2% of the age predicted) but varied widely (32% to 121% of predicted) and was markedly reduced (<80% of predicted) in 37 patients (63%). Linear regression identifiedkidney function (Creatinine clearance, p < 0.01), preoperative functional capacity (NYHA > 4, p = 0.01), triple vessel disease (p = 0.03), BMI (p < 0.01), preoperative left ventricular end-diastolic volume (p = 0.04) and left ventricular systolic diameter (p = 0.04) as independent determinants of reduced VO2 max. No patients needed a mitral valve reoperation, freedom from more than moderate mitral regurgitation was 83.5+/-6.7 % at 5 years.

CONCLUSIONS:
Even with a relative low rate of IMR recurrence, functional capacity quantitatively assessed by CPET is markedly reduced in nearly two out of three patients after restrictive mitral valve annuloplasty. Reduced peak VO2 is independently determined by patient comorbidity, extensive coronary disease, left ventricle dimensions and preoperative functional status, but not by recurrence of IMR.
OC44 VENTRICULAR TACHYCARDIA SURGICAL ABLATION IN REPAIRED TETRALOGY OF FALLOT PATIENTS
Authors: Caldaroni F. , Rito M. Lo , Varrica A. , Chessa M. , Micheletti A. , Pappone C. , Giamberti A. 
Published: November 2018

Background and Aim:
Arrhythmias are the main causes of mortality in repaired TOF patients and ventricular tachycardia, due to abnormal electrical conduction near patches and surgical incisions, is refractory to medical therapy.
The aim of the study is to evaluate the effectiveness of surgical ventricular RF ablation during pulmonary valve replacement.

Methods:
20 patients (median age 37,5 y) in 2004–2013 underwent re-operation for symptomatic pulmonary valve regurgitation with RF ablation, 28 (16–39) years after first repair. Inducible VT was demonstrated during preoperative electrophysiological study in all. Median QRS was 178 (100–268) ms. Right ventricular dilation and dysfunction were present in all, with moderate-to-severe tricuspid regurgitation in 20%. Eleven patients showed spontaneous ventricular arrhythmia, 5 had preoperative ICD, and one presented out-of-hospital cardiac arrest.
Surgical ablation of the slow-conducting isthmus between the VSD patch and the pulmonary annulus was performed with linear RF lesions. All patients underwent clinical evaluation, echocardiography and Holter-ECG at 1-3-6 months together with electrophysiological study after 6 months.

Results:
16 patients underwent RVOT reduction and 4 TV repair. Median follow-up of 6.5 years was complete. 1 patient with pulmonary artery occlusion died on V-V ECMO for respiratory failure. No late mortality was observed. Residual inducible VT was present in 3/19 patients, whom received ICD as primary prevention. Freedom from ventricular arrhythmia was respectively 94% and 89.5% at 1 and 5 years of follow-up.

Conclusion:
Pulmonary regurgitation and ventricular dysfunction are correlated with SCD. Ablation of slow-conducting isthmus between the pulmonary valve and VSD patch prevents ventricular arrhythmias.
OC74 THE FATE OF TRICUSPID VALVE AFTER TRANSATRIAL CLOSURE OF VENTRICULAR SEPTAL DEFETC
Authors: Giordano R. , Palumbo S. , Cioffi S. , Russolillo V. , Mucerino M. , Comentale G. , Cantinotti M. , Iannelli G. , Palma G. 
Published: November 2018

Background:
The transatrial repair of the ventricular septal defect (VSD) requires an adequate exposure of its rim. We retrospectively evaluated the impact of adopting the tricuspid valve incision (TVI) technique, either with detachment or radial incision, on the postoperative outcome of children undergoing surgical VSD repair.

Methods:
From January 2008 to September 2017 we retrospectively enrolled 141 patients, divided into two groups: 97 patients were subjected to TVI (68.8%) and 44 patients (31.2%) were not subjected to TVI. All patients received an echocardiogram upon discharge from the hospital and after 1 month, 3 months, 6 months and a year from the treatment.

Results:
No perioperative or late deaths resulted in our dataset. TVI was associated with a slightly longer cardio-pulmonary bypass and cross-clamp time but there were no differences in the surgical outcome between the two groups. Moreover, no differences occurred concerning residual VSD, atrioventricular block or tricuspid regurgitation at discharge. Echocardiograms at follow-up were available for 134 patients (95%) with a median of 5.3 years (range 0.5–9.3) and the degree of tricuspid regurgitation did not differ between groups. No patient required reoperation for tricuspid regurgitation or residual interventricular shunt. Finally, no difference was found even when comparing the two TVI subgroups.

Conclusions:
TVI should be used whenever intraoperative exposure of VSD is compromised in order to avoid a residual shunt and atrioventricular block. Here we show that this procedure does not significantly compromise the tricuspid function although a large, multicenter, randomized controlled trial is advised to validate this hypothesis.
OC06 BUILDING UP A MULTIDISCIPLINARY 360° MINIMALLY INVASIVE PROGRAM FOR AVR: OUR EXPERIENCE
Authors: Berretta P. , Wessella V. , Pierri M. , Fazzi D. , Cefarelli M. , Zingaro C. , Capestro F. , D’alfonso A. , Di Eusanio M. 
Published: November 2018

Aim:
The aim of this study was to report the first results of our multidisciplinary minimally invasive program to treat patients who require aortic valve replacement (AVR), which involves: 1) reduced chest incision (through upper ministernotomy or right anterior minithoracotomy), 2) sutureless or rapid deployment AVR, 3) minimally invasive extracorporeal circulation (MiECC) system and 4) ultra fast-track (UFT) anaesthesia.

Methods:
Data from 167 consecutive patients undergoing primary isolated aortic valve replacement through minimally invasive approaches (MIAVR) between October 2016 and April 2018 were prospectively collected. The mean age of the study population was 74 ± 9 years, and the average EuroSCORE II was 2.1 ± 1.2.

Results:
MIAVR was performed using sutureless or rapid deployment valves in 76 (45.5%) patients, MiECC system in 63 (37.7%), and UFT management in 67 (40.1%). Overall in-hospital mortality was 0.6% (n = 1). The rate of postoperative stroke and atrioventricular block requiring pacemaker implantation was 1.2% (n = 2) and 3.6% (n = 6), respectively. MiECC system was associated with reduced postoperative bleeding (requiring chest re-opening) compared with conventional cardio-pulmonary bypass circuits (0% vs. 5.8%, p = 0.05). The mean intensive care unit stay was 25 hours in UFT patients and 52.2 hours in no-UFT patients (p = 0.04). Hospital stay was similar between groups (UFT 6.9 days, no-UFT 13.9 days, p = 0.2).

Conclusions:
Our UFT mini AVR program is a multidisciplinary minimally approach that involves the latest best technologies and techniques for AVR. We believe it may considerably increase patient's comfort being associated with faster recovery and excellent hospital outcomes.
OC41 MID-TERM RESULTS OF TRANSCATHETER AORTIC VALVE IMPLANTATION BY TRANS-CAROTID APPROACH UNDER LOCO-REGIONAL ANAESTHESIA. SINGLE CENTER EXPERIENCE
Authors: Olivier M. , Aludaat C. , Di Cesare A. , Droandi G. , Amr G. , Torossian F. , Caplan B. , Poncet A. , Tassan S. , Metz D. , Ruggieri V.G. 
Published: November 2018

Background and Aim:
Trans-carotid access with loco-regional anesthesia has been developped as peripheral approach for transcatheter aortic valve implantation (TAVI) in alternative to transthoracic more invasive accesses for patients with transfemoral contraindications, high vascular risk and severe comorbidities. In this study, we report our experience and mid-term results in trans-carotid TAVI under loco-regional anesthesia by cervical block.

Methods:
Thirty patients were selected by the Heart Team of our institution for trans-carotid TAVI between September 2014 and December 2017. Mean age was 83.6 ± 6, 9 years old. the Logistic EuroSCORE was 21,7 ± 12,2, EuroSCORE 2 was 7.7 ± 5,2 and STS Score was 21,1 ± 8,8. The carotid approach was performed through a small low longitudinal cervicotomy with loco-regional anaesthesia by cervical block.

Results:
The transcatheter Edwards SAPIEN 3 valves (Edwards Lifesciences, Irvine, California) (n = 27; 90%) and the Medtronic Corvalve Evolut R (Medtronic, Inc., Mineapolis, Minnesota) (n = 3;10%) were used. All patients were successfully implanted. Two procedural not-access related deaths were registered, no vascular access complications occurred. There was one in-hospital minor stroke. Two patients required a pacemaker implantation for atrioventricular block. Post-operative echocardiogram showed satisfactory transvalvular gradients without significant paravalvular leak. At late follow-up (mean 12,3 ± 9,2 months) two non-cardiac deaths and one major stroke were registered and functional NYHA class improved.

Conclusions:
Carotid artery access for TAVI is a safe and feasible access compared to trans-apical and trans-aortic approaches. It can be realized under loco-regional anaesthesia with continuous clinical monitoring of neurological status. This approach should be considered a valid alternative for TAVI in patients with unfavourable vascular access.
OC07 CAN WE USE THE NEW INFANT JARVIK 2015 IN PATIENTS LESS THAN 8KG? A SIMULATION STUDY
Authors: Di Molfetta A. , Zielinski K. , Ferrari G. , Iacobelli R. , Perri G. , Filippelli S. , Darowski M. , Massetti M. , Amodeo A. 
Published: November 2018

Objective:
to study test the feasibility of implanting the Infant Jarvik 2015 in patients lower than 8 kg.

Methods:
The LVAD was tested in a hybrid simulator of the cardiovascular system reproducing specific haemodynamic for different patients weight (2–8 kg). For each weight, we tested the LVAD sensitivity to circulatory parameters (pheripheral resistance, left and right ventricular elastances, heart rate and heart filling) repeating for each experiment a pump ramp (10000–18000 rpm).

Results:
The increment of the pump speed causes a decrement (increment) of the left (right) atrial pressure, an increment (decrement) of the arterial systemic (pulmonary) pressure, an increment of the right ventricular pressure, a decrement (increment) of the left (right) ventricular volume, a decrement of the left ventricular cardiac output, an increment of the LVAD output and an increment of the right ventricular cardiac output (total cardiac output). Suction was observed for lower weight patients and for higher pump speed in the case of vasodilation, left ventricular recovery, bradycardia, right ventricular failure and left ventricular hypertrophy, while backflow was observed only in the case of left ventricular recovery at lower pump speed.

Conclusions:
the use of a hybrid circulatory permits to test innovative VAD and the sensitivity of the pump to different circulatory parameters. In this specific application, the Infant Jarvik 2015 was suitable for the implantation in lower weight patients because of the stability respect to the cardiocirculatory changes (low frequency of suction and backflow) and because of the capability of the device in maintaining an adequate patients haemodynamics.
OC22 ECLS IN PRIMARY REFRACTORY CARDIOGENIC SHOCK: IMPACT OF SHORT-TERM EXTRACORPOREAL MECHANICAL CIRCULATORY SUPPORT ON SURVIVAL
Authors: Tarzia V. , Bagozzi L. , Bellanti E. , Folino G. , Bortolussi G. , Tessari C. , Bianco R. , Guglielmi C. , Testolin L. , Rubino M. , Bottio T. , Gerosa G. 
Published: November 2018

Abstract

Background/Aim:
Previous studies have demonstrated dubious results of ECMO for the treatment of refractory cardiogenic shock (RCS) after 9 days of support. The use of short-term extracorporeal mechanical circulatory support (ST-MCS) has emerged in the last years. We therefore evaluate the outcome of patients that needed prolonged support and underwent ST-MCS implantation compared to conventional ECMO implantation.

Methods:
Between January 2009 and October 2017, 183 patients were treated with extracorporeal life support (ECLS) in our centre for primary RCS; we selected the 101 patients that exceed the 9 days of ECLS. 44 cases (44%) were treated exclusively with ECMO implantation (Group 1), while 57 cases (56%) underwent left ventricular or biventricular extracorporeal ST-MCS implantation (Group 2). Among these last patients, in 42 cases the ST-MCS was intended as upgrade of ECMO support.

Results:
Average duration of the support was 17 ± 9 days in the Group 1 and 13 ± 9 days in the Group 2 (p = 0.08), while mean rates support of the maximal theoretic flow were 62 ± 15% and 79 ± 20% (p < 0.01), respectively. 12 patients of first group and 9 patients of second one died during ECLS support (p = 0.12); 30-days survivals were 61% and 70% (p = 0.24) and rates of hospital discharge were 43% and 61% (p = 0.04), respectively. Kaplan-Meier analysis (Fig.1) demonstrates a better survival in Group 2 rather than in Group 1 (p = 0.04) at median follow-up of 16 ± 24 months.

Conclusions:
ST-MCS has proved to increase the survival respect single-stage ECMO in patients with primary RCS who need prolonged ECLS and full hemodynamic support.
OC39 META-ANALYSIS OF PERIPHERAL OR CENTRAL ECMO IN POSTCARDIOTOMY AND NON-POSTCARDIOTOMY SHOCK
Authors: Raffa G. , Kowalewski M. , Meani P. , Pilato M. , Lorusso R. 
Published: November 2018

Abstract

Background:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) application in post-cardiotomy shock (PCS) and non-PCS is increasing. VA-ECMO plays a critical role in the management of these patients, yet may be associated with serious complications.

Methods:
A systematic review of all available reports in the literature of patients receiving VA-ECMO, either directly or indirectly comparing central cannulation (right atrial to ascending aorta) versus peripheral cannulation (femoral vein to femoral artery or axillary artery) were analyzed. The primary endpoint was survival. Cerebrovascular events, limb complications, bleeding requiring reoperation, sepsis, continuous veno-venous hemofiltration, and transfusions, were also assessed in both groups.

Results:
Seventeen retrospective case series clearly describing the VA-ECMO access and including 1,691 patients with PC- and non-PCS were found. The peripheral approach was more commonly used (980 patients, 57.9%) than the central one. There was no difference in the analysis between the two techniques regarding all-cause mortality RR (Risk Ratio) 95 CIs (Confidence Intervals): 1.00 (0.94–1.08) I2 = 0%, P = 0.92. No statistical differences were found between peripheral and central VA-ECMO with regards to cerebrovascular events, limb complications, or sepsis rates. Peripheral cannulation, was associated with a significant reduction in the risk of bleeding (p = 0.02), continuous veno-venous hemofiltration (p = 0.03), transfusion of red blood cells units (p < 0.00001), fresh frozen plasma units (p = 0.0002) and platelets units (p < 0.00001).

Conclusions:
Peripheral and central VA-ECMO configurations showed comparable in-hospital survival in PCS and non-PCS. The risk of bleeding, continuous veno-venous hemofiltration and blood product transfusion was significantly lower with the peripheral cannulation strategy.
OC34 IMPACT OF CONTINUOUS FLOW LEFT VENTRICULAR ASSIST DEVICES AS BRIDGE TO TRANSPLANT ON GRAFT REJECTION AND DEVELOPMENT OF DONOR-SPECIFIC ANTIBODIES
Authors: Carrozzini M. , Bejko J. , Gambino A. , Tarzia V. , Cozzi E. , Gregori D. , Bottio T. , Gerosa G. 
Published: November 2018

Abstract

Background and Aim:
We analysed patients transplanted with and without previous continuous-flow left ventricular assist devices (CF-LVADs) to compare survival and rates of acute rejection, development of donor-specific antibodies (DSA) and chronic allograft vasculopathy (CAV).

Methods:
All consecutive patients aged>18 years, who underwent HTx at our Institution from Jan-2012 to Dec-2017 were included. Patients assisted with pulsatile LVADs or total artificial heart were excluded. Cellular rejection score – CRS and antibody rejection score – ARS (total number of rejections divided by the number of endo-myocardial biopsies performed) were calculated at 3, 6 and 12 months after HTx.

Results:
We included 149 patients with a mean age of 54 ± 12 years. Among these, 47 (32%) were implanted with a CF-LVAD (25 HeartWare, 20 Jarvik 2000 and 2 HeartMate III) before HTx (LVAD group) and 102 (68%) were not (No-LVAD group). Pre-HTx allo-sensitization records were comparable among groups. Mean time of follow up was 25 ± 18 months in LVAD group and 24 ± 22 months in No-LVAD (p = 0.58). Overall mortality was comparable among groups (19% LVAD vs 18% No-LVAD, p = 0.83; Kaplan-Meier log-rank p = 0.98). Cellular and antibody-mediated rejection occurred similarly among groups. Incidence of CAV was comparable (p = 0.77), as well. De-novo DSA developed in a significantly higher number of bridged cases (29% vs 9%, p = 0.03).

Conclusions:
Patients supported with a CF-LVAD showed similar rates of cellular and antibody-mediated rejection and CAV after heart transplant, compared with non-bridged patients. Despite development of de-novo DSA was more frequent in assisted patients, this did not translate in worsened clinical outcomes.
OC88 COMPARATIVE ANALYSIS OF PROTHROMBIN COMPLEX CONCENTRATE AND FRESH FROZEN PLASMA IN THE MANAGEMENT OF PERIOPERATIVE BLEEDING AFTER CORONARY ARTERY BYPASS GRAFTING
Authors: Salsano A. , Mariscalco G. , Santini F. , Ruggieri V.G. , Perrotti A. , Chocron S. , Gherli R. , Reichart D. , Demal T. , Faggian G. , Franzese I. , Dalén M. , Santarpino G. , Fischlein T. , Rubino A.S. , Maselli D. , Nardella S. , Nicolini F. , Saccocci M. , Gatti G. , Bounader K. , Rosato S. , Kinnunen E. , De Feo M. , Tauriainen T. , Onorati F. , Biancari F. 
Published: November 2018

Abstract

Background and Aim:
Recent studies suggested that prothrombin complex concentrate (PCC) might be more effective than fresh frozen plasma (FFP) to reduce red blood cell (RBC) transfusion requirement after cardiac surgery. The benefits and risks associated with the use of PCC over FFP have been investigated in this study including patients undergoing isolated coronary artery bypass grafting(CABG) from a prospective, multicenter registry.

Methods:
This is a comparative analysis of 416 patients who received postoperatively FFP and 119 patients who received PCC with or without FFP after isolated CABG.

Results:
Mixed-effects regression analyses adjusted for multiple covariates and participating centers showed that PCC significantly decreased RBC transfusion (67.2% vs. 87.5%, adjusted OR 0.319, 95%CI 0.136–0.752) and platelet transfusion requirements (11.8% vs. 45.2%, adjusted OR 0.238, 95%CI 0.097–0.566) compared with FFP. The PCC cohort received a mean of 2.7 ± 3.7 (median, 2.0, IQR 4) units of RBC and the FFP cohort received a mean of 4.9 ± 6.3 (median, 3.0, IQR 4) units of RBC (adjusted coefficient, -1.926, 95%CI -3.357–0.494). The use of PCC increased the risk of KDIGO acute kidney injury (41.4% vs. 28.2%, adjusted OR 2.300, 1.203–4.400), but not of KDIGO acute kidney injury stage 3 (6.0% vs. 8.0%, OR 0.850, 95%CI 0.258–2.796) when compared with the FFP cohort.

Conclusions:
These results suggest that the use of PCC compared with FFP may reduce the need of blood transfusion after CABG. In view of the observational nature of this study, these results should be considered hypothesis generating and need to be confirmed in randomized trials.