bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC51 NEW TECHNIQUE IN TYPE I ACUTE AORTIC DISSECTION FOR ARCH STABILIZATION AND FUTURE LANDING ZONE CREATION WITHOUT ARCH REPLACEMENT: THE SALERNO CANOE TECHNIQUE
Authors: Masiello P. , Longobardi A. , Panza A. , Mastrogiovanni G. , Cafarelli F. , Triggiani D. , Del Negro G. , Leone R. , Ruopolo C. , Iesu S. 
Published: November 2018

Background and Aim:
We present a simplified elephant trunk procedure to treat type I acute aortic dissections. This technique transfers the anastomotic site of a modified elephant trunk prosthesis from zone 3 to zone 0 (before anonymous trunk).

Methods:
From November 2015 to April 2018, 38 patients underwent an ascending aorta replacement for type I acute aortic dissection. In order to stabilize the arch and prepare a future landing zone, after the reconstruction of proximal and distal dissected aortic walls using inside and outside felt strips, we introduce into the aortic arch a Dacron prosthesis resected to create a “fenestration” under the supra-aortic branch vessels. The distal part of this prosthesis is left free floating into the descending aorta. The concave arch was also anchored to the prosthesis and through a catheter placed distally into the tube graft we perfused the thoracic aorta. Having the prosthesis a final shape of a canoe, we named the procedure “the Salerno Canoe Technique”.

Results:
Five patients died (13.2%). We observed a 5% reduction compared to our previous mortality. In one patient severe abdominal hypoperfusion due to secondary hypertensive false lumen was successful treated by an endovascular thoracic prosthesis landed proximally into the “canoe prosthesis”.

Conclusions:
Compared to conventional elephant trunk technique this procedure is simpler and less circulatory arrest time-consuming (only mean 12 min increase respect to ascending aorta replacement alone). It allows an extensive arch stabilization, a safe perfusion of the descending thoracic aorta and a landing zone for future endovascular procedures.
OC33 HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY SURGERY AND MITRAL SUBVALVULAR REMODELING: THE 2007–2017 IRCCS-ISMETT EXPERIENCE
Authors: Raffa G. , Morsolini M. , Turrisi M. , Romano G. , Falleta C. , Clemenza F. , Pilato M. 
Published: November 2018

BACKGROUND AND AIM:
To assess the role of the mitral valve apparatus (leaflets, chordae and papillary muscles (PM) in left ventricle outflow tract (LVOT) obstruction, and results of the surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) in a retrospective observational study.

METHODS:
Thirty-two consecutive patients (58 ± 12 years, M/F ratio: 17/15) undergoing HOCM surgery from 2007 to 2017 at our institute were reviewed. End points included the involvement of the mitral valve in LVOT obstruction, mortality, and change in clinical and echocardiographic characteristics after HOCM surgery.

RESULTS:
Secondary chordae tendineae tractioning the anterior mitral leaflet to the interventricular septum were detected in 82% of the patients. Anomalous, hypertrophied, and fused PM with muscularis trabeculae hypertrophy were found in 48%, 40%, and 31% of the patients, respectively. Four patients had posterior leaflet redundancy. Secondary chordae (93%), PM, and muscularis trabeculae resection (75%), and PM splitting and elongation (34%) were added variably to septal myectomy (100%). Nine procedures (28%) on mitral valve leaflets were performed, involving 6 posterior and 3 anterior mitral leaflets. Long-term follow up was 4 ± 2.8 years. There was no hospital mortality, and NYHA was reduced from 3 ± 0.6 to 1 ± 0.7 (p < 0.0001), the LVOT gradient from 91 ± 35 to 21 ± 17 mmHg (p < 0.0001), mitral valve regurgitation from grade 3 ± 1 to 1 ± 0.6 (p < 0.0001), and septum thickness from 19 ± 3 to 14 ± 2 mm (p < 0.0001).

CONCLUSIONS:
The mitral valve apparatus with all its components contribute variably to LVOT dynamic obstruction thus, surgical correction in addition to extended myectomy is recommended to achieve the best outcome.
OC28 FAILURE OF TRICUSPID ANNULOPLASTY FOR FUNCTIONAL TRICUSPID REGURGITATION. THE ROLE OF PREOPERATIVE TRICUSPID VALVE APPARATUS REMODELING
Authors: Foschi M. , Di Mauro M. , Iacò A. , Kheirallah H. , Alsaied M. , Alfonso J. , Tancredi F. , Gaudino M. , Calafiore A. 
Published: November 2018

Background:
To identify the determinants of both early and late tricuspid annuloplasty (TAP) failure.

Methods:
From May 2009 to December 2015, 688 patients undergoing TAP for functional tricuspid regurgitation (TR) at a single institution were included in the study. Inclusion criteria: MV disease requiring surgical intervention; no pathologic changes in TV leaflets; no previous TV repair; not requiring associated tricuspid valvuloplasty. In 423 patients, echocardiographic evaluation was performed both at discharge and after a median of 35 (22–58) months. Residual and Recurrence TR were defined as TR higher than mild. Logistic regression and Cox analysis were used as multivariable model for early and late failure. ROC curve was used to identify cutoffs

Results:
Residual TR after TAP was recorded in 54 (13%); Risk factors for residual TR were: preoperative severe TR regardless of tricuspid valve (TV) apparatus remodeling, mild or moderate TR in presence of TV apparatus remodeling, defined as coaptation depth ≥6.5 mm (sensitivity 55%; specificity 80%), tenting area ≥0.85 cm2 (52%; 75%), and tricuspid annulus ≥40 mm (60%; 72%). Recurrent TR was recorded in 85 (20%) cases, Five-year freedom from TR recurrence was 74.0 ± 3.0%. The following risk factors for recurrent TR were identified: residual TR (Figure), atrial fibrillation at follow-up, mild/ moderate TR with TV apparatus remodeling, severe TR.

Conclusions:
Prophylactic TAP should be encouraged among surgeons even earlier than guidelines recommend. Decision-making for the treatment of low-grade FTR at the time of left-sided valve surgery should take into consideration not only annular size, but also tethering severity.
OC27 FAILURE OF TRICUSPID ANNULOPLASTY FOR FUNCTIONAL TRICUSPID REGURGITATION. THE ROLE OF PREOPERATIVE AND LATE RIGHT VENTRICULAR REMODELING
Authors: Calafiore A. , Iacò A. , Kheirallah H. , Alsa M. , Alfonso J. , Tancredi F. , Foschi M. , Gaudino M. , Di Mauro M. 
Published: November 2018

Background and Aims:
To identify the role of preoperative and late right ventricular (RV) remodeling in tricuspid annuloplasty (TAP) late failure.

Methods:
From May 2009 to December 2015, 423 patients undergoing TAP received transthoracic echocardiographic evaluation both at discharge and after a median of 3 years. Recurrence TR were defined as TR higher than mild at follow up. Cox analysis was used as multivariable model for late failure.

Results:
Recurrent TR was recorded in 85 (20%) cases, Five-year freedom from TR recurrence was 74.0 ± 3.0%. Risk factors were residual TR, atrial fibrillation at follow-up, mild or moderate TR with TV apparatus /RV remodeling, severe TR, RV dilatation either preoperative or at follow-up. The entire cohort was divided into four groups: group A with neither preoperative nor at follow-up RV dilatation (149); group B with positive RV remodeling (134); group C with negative RV remodeling (n = 28)); and group D with persistent RV dilatation (n = 112). TR recurrence was recorded significantly higher in groups C and D (Figure). Risk factors for late RV dilatation were preoperative mild or moderate TR with TV apparatus or RV remodeling, preoperativesevere TR, preoperative left and right ventricular dysfunction.

Conclusions:
RV remodeling is one of the determinant after TAP and can be predicted on the basis of several preoperative echocardiographic parameters, including left and right ventricular function and TR severity. In these cases, the surgical approach should not be limited to TAP, but surgeons should consider alternative techniques or prosthesis implantation.
OC82 TRANSAORTIC MITRAL VALVE REPAIR FOR OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY: THE POLICLINICO DI MONZA EXPERIENCE
Authors: Binaco I. , Spirito P. , Vaccari G. , Zyrianov A. , Poggio D. , Grillo M. , Casati V. , Ferrazzi P. 
Published: November 2018

Background and Aim:
Abnormalities of mitral valve (MV) apparatus are known to contribute to left ventricular (LV) outflow obstruction in hypertrophic cardiomyopathy (HCM). Purpose of this study is to report our experience with MV repair in patients with obstructive HCM undergoing surgical septal myectomy.

Methods:
From July 2013 to March 2018, 316 consecutive patients with obstructive HCM underwent surgical septal myectomy. Of these patients, 298 (94.3%) had associated MV repair and only 18 (5.7%) had MV replacement due to severe leaflets calcification and intrinsic MV disease. Age ranged from 15 to 85 years, mean 54 ± 15. Each patient had an outflow gradient ≥50 mmHg at rest or with physiologic provocation and disabling symptoms unresponsive to medical therapy.

Results:
Transaortic papillary muscle mobilization and cutting of fibrotic and retracted secondary MV chordae was performed, in association with septal myectomy, in all study patients. Plication of a redundant anterior MV leaflet was performed in 119 (37%) patients, and of the posterior leaflet in 29 (9%). Two patients died during hospitalization (0.6%), 8 patients (2.8%) had a residual postoperative resting gradient ≥30 mmHg, 6 (1.9%) patients had persistent important functional limitation (NYHA III), and 9 (2.8%) residual moderate-to-severe MV regurgitation, at the first postoperative evaluation.

Conclusions:
In our large HCM study cohort, transaortic extensive and systematic repair of the MV apparatus, combined with septal myectomy, was associated with a particularly low perioperative mortality, and abolition of resting LV outflow obstruction, MV regurgitation and heart failure symptoms in the great majority of patients.
MORE THAN 10 YEARS SINGLE CENTRE EXPERIENCE WITH NORWOOD STAGE I PROCEDURE
Authors: Uricchio N. , Seddio F. , Marcora S. , Marrone C. , Ferrero P. , Preda L. , Papa M. , Ciuffreda M. , Didedda G.B. , Sadou Y. , Galletti L. 
Published: November 2018

The aim of our study is to report the results of 10 years, single centre experience, in the treatment of hypoplastic left heart syndrome.

Methods:
Between 2007 and 2017, 80 consecutive patients underwent Norwood Stage 1 procedure at our Institution. Sixty-six patients had HLHS, 5 had unbalanced AV Canal and 11 other single ventricle lesion with ductal dependent circulation and/or multilevel systemic obstruction. Twenty patients were staged by a previous bilateral pulmonary banding. All patients received patch reconstruction of aortic arch while pulmonary blood flow was accomplished by a BTS in 37 pts, RVPA conduit in 41 and a BCPA in 2.

Results:
Overall hospital survival was 74,5 %, increasing after 2012 (63% vs 85%): only one patient died in the last 30 consecutive patients. One year transplant free survival was 72%. At univariate analysis, age at operation, weight less than 2,5 kg, prenatal diagnosis, presence of aortic atresia, systemic AV valve regurgitation, obstruction in pulmonary veins and use of BTS instead of RVPA conduit were not associated with increase in-hospital mortality. Only the year of operation (after 2012) was associated with better survival. During the follow-up, 55 patients underwent BCPA as a second stage, 17 patients underwent Fontan completions and two patients had heart transplant.

Conclusions:
Beside limitation due to patient number that did not allow identification of mortality predictors our data suggest that in centres with strong commitment to Norwood procedure, hospital survival is improving continuously and is actually comparable to other complex biventricular lesions.
OC46 MYCOBACTERIUM CHIMAERA INFECTIONS FOLLOWING CARDIAC SURGERY IN ITALY: RESULTS FROM A NATIONAL SURVEY ENDORSED BY SICCH
Authors: Cappabianca G. , Paparella D. , D’Onofrio A. , Caprili L. , Minniti G. , Lanzafame M. , Parolari A. , Musumeci F. , Beghi C. 
Published: November 2018

Background:
A global outbreak of Mycobacterium Chimaera (MC) infections following cardiac surgery and linked to contaminated heater-cooler units (HCU) is currently ongoing. In 2017, since the status of this outbreak in Italy and the mitigation strategies adopted by adult cardiac surgery unit (ACSU) were not known, SICCH launched a national survey among Italian ACSUs.

Methods:
In Italy there are 90 ACSU across 20 regions. From May to Nov 2017 they were surveyed collecting data on a) patients diagnosed with MC infections b) ACSU workload c) used HCU models d) control measures adopted in theatres.

Results:
The response rate was 87.8%. The mean number of cardiac procedures at each ACSU was 508 ± 229/year and nationally the number of procedures/year exceeded 40k. In Italy 7 patients with MC infections following cardiac were reported since 2015: all had aortic or valve surgery as first procedure; the latency between first operation and infection was 2.8 ± 1.6 years. Mortality for patients requiring redo cardiac surgery was 50%. MC infections risk was 0.4–1 patient every 1000 cardiac procedures. The most common HCU model in Italy is the 3T HCU (70.9%). The most common control measures adopted were: implementing new HCU disinfection protocols, using sterile or filtrated water in the HCU and displacing HCU fans away from the patient: HCU replacement and microbiology testing were infrequent.

Conclusions:
In Italy the risk of contracting MC infections and the mortality reported are in line with other European countries; a significant heterogeneity exists on the mitigation strategies to prevent further MC inoculations.
OC71 SURGICAL TREATMENT FOR ISOLATED TRICUSPID VALVE INFECTIVE ENDOCARDITIS. 25-YEAR RESULTS
Authors: Di Mauro M. , Dato G. Actis , Barili F. , Corte A. Della , Ratta E. Della , Cugola D. , Galletti L. , Centofanti P. , Santini F. , Salsano A. , Rinaldi M. , Mancuso S. , Cappabianca G. , Beghi C. , De Vincentiis C. , Biondi A. , Livi U. , Sponga S. , Pacini D. , Murara G. , Di Bortalomeo R. , Scrofani R. , Cagnoni G. , Antona C. , Nicolini F. , Benassi F. , De Bonis M. , Pozzoli A. , Casali G. , Scrascia G. , Bortolotti U. , Falcetta G. , Musumeci F. , Gherli R. , Vizzardi E. , Salvador L. , Piccichè M. , Paparella D. , Margari V. , Troise G. , Villa E. , Dossena Y. , Lucarelli C. , Onorati F. , Faggian G. , Mariscalco G. , Maselli D. , Foschi M. , Parolari A. , Lorusso R. 
Published: November 2018

Background and Aim:
Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (IE), encompassing only 5–10% of cases, 90% of RSIE involves the tricuspid valve (TV). We sought to evaluate early and late mortality of patients with isolated TVIE.

Methods:
The National Registry for Surgical Treatment of Valve and Prosthesis Infective Endocarditis included 4084 patients from February 1999 to January 2018. From 1983 to 2018, isolated TVIE was surgically treated in 157 (3.8%). Mean age was 47 ± 16 (15–86 years); 25% were females 142 (90%) native tricuspid regurgitation; 7 (5%) native stenosis-insufficiency and 8 (5%) tricuspid prosthesis endocarditis (TPIE). 38% due to IVDU; 21% due to PMK/ICD leads; 1% due to vascular access for dialysis; in the remaining cases, the cause was unknown Staphilococcus aureus was the most common germ (45%); The primary end-point was long-term survival freedom from recurrence;

Results:
77 (49%) underwent TV repair, 72 (46%) TV replacement and 8 (5%) TV prosthesis replacement. Early mortality was 11% (17 patients); Expected mortality according to EndoSCORE was 12%; age (OR 1.06) and redo (OR 6.64) were risk factors. Median follow up was 229 months (172–286) Late deaths were 31;Recurrences were 4 (all dead). Survival at 10, 20 and 25-year were 66%, 60% and 44%, respectively. Risk factors were age (HR 1.06), fungine TVIE (HR 4.2), IVDU HR 4.90), redo (HR 4.4) and presence of leads (HR 3.0). No difference was found between repair and replacement (Figure)

Conclusions:
Patients with isolated TVIE undergoing surgical treatment show good early and late outcome.
OC85 TREATMENT OF AORTIC INSUFFICIENCY THROUGH AORTIC LEAFLETS REMODELLING: AN EXCELLENT ALTERNATIVE TO REPLACEMENT
Authors: Masat M. , Pantaleo A. , Calcara G.B. , Minniti G. , Camata A. , Polesello L. , Mondin F. , Possamai M. , Rivaben D. , Antonini-Canterin F. 
Published: November 2018

Background and Aim:
Aortic valve repair can be considered a valid alternative to replacement in patients with aortic regurgitation. Recent data report excellent results mainly for patients with aortic root dilatation associated with anatomically normal aortic valve. No data are up-to-date available about the results of the repair in patients with degenerative aortic valve (prolapse, thickness, perforation and/or retraction of the leaflets, congenital malformations). We analyzed retrospectively our data.

Methods:
From January 2011 to November 2017, we have treated 90 patients with degenerative aortic valve insufficiency (IA) through sugical remodelling of the aortic leaflets. The failure mechanism conditioned the choice of technique (shaving, correction of prolapse, raphe excision, use of pericardium, commissural re-orientation). Pre and postoperative transesophageal echocardiography as well as transthoracic echocardiography for follow-up were performed for each patient.

Results:
No in-hospital mortality was reported, two late deaths (2.22%)both for non cardiac cause. Three patiens (3.33%) needed, after repair, intraoperative aortic valve replacement while two (2.22%)at follow-up. Postoperative complications were low: 2 (2.22%)transient low output syndrome, 3 (3.33%)postoperative bleeding, 1 (1.11%)transient neurological deficit, 1 (1.11%)temporary renal failure, 3 (3.33%)acute myocardial ischemia. No thromboembolic and haemorragic events was referred, as well as endocarditis. Early or late recurrence of IA > 2 was detected in 4 pts (4,44%).

Conclusions:
Remodelling of the aortic valve leaflets represents an attractive and valid alternative to aortic valve replacement in patients with aortic valve insufficiency, mainly in young patients. In our experience the results are excellent in terms of short and middle term survival, postoperative complications and freedom from reoperation. It remains to be established if the remodeling of the cusps is comparable to the replacement of the valve in terms of late results.
OC01 AORTIC VALVE REPLACEMENT THROUGH A RIGHT MINI-THORACOTOMY: MORE THAN 600 PATIENTS FOR A SINGLE CENTER EXPERIENCE
Authors: Calvi S. , Mikus E. , Pagliaro M. , Magnano D. , Tripodi A. , Panzavolta M. , Albertini A. 
Published: November 2018

Background and aim:
Aortic valve replacement through a right mini-thoracotomy is a minimally invasive procedure developed during the last years. It is not frequently used because of a tiny operating field, limiting surgeon's view resulting in longer cardiopulmonary bypass and cross clamping times compared to the standard full sternotomy.

Methods:
We reviewed 604 patients (334 male 55% with median age of 75; range 16–93 years) who received an aortic valve replacement between January 2010 and April 2018 through a right mini-thoracotomy In the first 45 patients the aortic cannulation and clamping were performed through the right minithoracotomy while a vacuum assisted venous drainage was obtained percutaneously through the groin. A total central arterial and venous cannulation was than preferred. The maiority received an aortic valve replacement with a pericardial bioprothesis sutured using three 2–0 prolene running sutures.

Results:
Aortic replacement was performed through a 4 to 6 cm skin incision at the third intercostal space. 6 patients were a REDO cases. Overall median cardiopulmonary bypass and aortic cross clamping time was respectively 54 minutes (range 25–121) and 42 minutes (range 16–134). Median ventilation time and intensive care stay were 7 and 44 hours. Patients transfused were 42%. Hospital mortality was 1.4% (7/488).

Conclusions:
This single cenetr experience show that thanks to a standardized technique cardiopulmonary bypass and cross-clamping times comparable with the standard can be obtained and peripheral cannulation avoided. Advantages of this technique include early mobilization and rehabilitation, excellent aesthetic result and lower risk of wound complications.
OC57 PATIENT-PROSTHESIS MISMATCH ION ELDERLY WOMEN: THE BENEFICIAL IMPACT OF SUTURELESS VALVES VERSUS STENTED BIOPROSTHESIS
Authors: Bianchi G. , Concistrè G. , Margaryan R. , Laganà A. , Solinas M. 
Published: November 2018

Background:
Elderly women undergoing aortic valve surgery are at high risk to develop patient-prosthesis mismatch (PPM) due to their small body size and cardiac structures; sutureless valves can overcome this problem.

Aim:
this retrospective study aims to compare sutureless valves with stented bioprosthesis in terms of (PPM) occurrence.

Methods:
From July 2001 to September 2017, 442 female patients received 280 sutured bioprosthesis and 162 sutureless bioprosthesis in the same center. Projected effective orifice arean was used to calculate the indexed effective orifice area (iEOA). A 1:1 propensity matching model based on patients’ BSA yield 162 comparable pairs.

Results:
sutureless valve exhibited lower CPB time and cross-clamp time (sutured vs. suturelss: 106.7 ± 42.0 min vs 92.6 ± 29.1 min; 71.9 ± 28.8 min vs 58.4 ± 19.9 min; p < 0.001), less transfusion rate (sutured vs. sutureless: 26% vs 14%; p = 0.014), lower delirium (sutured vs. sutureless: 11% vs 9%) and higher EOA and iEOA (sutured vs. suturelss: 1.716 ± 0.313 cm2 vs 2.527 ± 0.324 cm2; 1.016 ± 0.20 cm2/m2 vs. 1.495 ± 0.221 cm2/m2; p > 0.001). At follow-up, sutureless valves had lower mean gradient (sutured vs suturelss: 15.96 ± 8.33 mmHg vs 12.38 ± 5.10mmHg; p = 0.049).

Conclusions:
in our series, sutureless valves allowed expedite surgery, lower incidence of post-operative delirium and less hours of mechanical ventilation; hospital stay and mortality did not differed. Sutureless valves are associated with no PPM and lower mean gradients at follow-up. When anatomically indicated, sutureless valves should be the prosthesis of choice in elderly women.