bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP16 SURGICAL DRAINAGE OF PERICARDIAL EFFUSION VERSUS ULTRASOUND-GUIDED PERICARDIOCENTESIS: A SINGLE-CENTER EXPERIENCE
Authors: Fittipaldi O. , Colucci S. , Nappi A. , D’Alessandro F. , Rispo G. , De Notaris S. , Mollo A. , Garofalo G. , Triumbari F. 
Published: November 2018

Abstract

Background and Aim:
The treatment of pericardial effusion and cardiac tamponade is still far from its resolution. The aim of our study is to evaluate the results after surgical drainage of pericardial effusion and ultrasound-guided pericardiocentesis.

Methods:
From 2006 to 2016, 276 patients (pts)(males 55- 56.15% - females 121 - 43.84%) were admitted for surgical treatment of drainage of the pericardial cavity. The procedures were US-guided pericardiocentesis (UP) for 155 pts (56.15%), subxifoid pericardiotomy (PS) 119 pts (43.11%) Median sternotomy (S) 2 pts (0.72%), 3 pts (1.08%) who underwent UP in first instance they were converted to PS due to drainage difficulties, 2 pts (0.72%) for cardiac perforasion. The amount of liquid drained on average was 560 ml (300ml-2000 ml). The quality of the liquid was serous, serum, blood and purulent. In 10 pts (3.6%) the cytological examination of the liquid and of the pericardium fragment allowed to confirm the suspected diagnostic of tumor pathology.

Results:
All patients undergoing UP were discharged after 5 days while patients undergoing PS or S required a longer period of stay from 15 days to 45 days. All patients were given an anti-inflammatory drug belonging to the NSAID class for 14 days (Indomethacin or Paracetamol). Antibiotic therapy (third-generation cephalosporin) was administered to all patients for three days after the procedure.

Conclusions:
We consider gold standard procedure UP while we reserve the PS after failure of the UP, for patients who need diagnosis (oncology, nephrology), for post-surgical patients and relapses.
EP29 PROGNOSTIC EFFECT OF ESTIMATED GLOMERULAR FILTRATION RATE IN PATIENTS UNDERGOING CARDIAC SURGERY
Authors: Pisano C. , Bertoldo F. , Russo M. , Marabese A. , Nardi P. , Pellegrino A. , Scafuri A. , Bassano C. , Ruvolo G. 
Published: November 2018

Background:
Chronic kidney disease (CKD) has been found to be an independent risk factor for cardiovascular diseases onset. We investigated the association between initial renal function and clinical outcomes in patients undergoing cardiac surgery.

Methods:
This was a single- centre, retrospective cohort study of 284 patients underwent cardiac surgery in Tor Vergata University Hospital between Genuary 2017 and February 2018. Patients with eGFR <60 ml/min (Group 1) were compered with patients with eGFR >60 ml/min. A propensity match score has been applied to investigate the effect of ultrafiltration in patients with eGFR <60 ml/min underwent cardiac surgery

Results:
No significant differences have been observed in term of cardiac, pulmonary, renal and cerebral complications between the two groups. In hospital mortality was 16% in Group 1 and 5.3% in Group 2 (p-value 0.003). In patients with eGFR < 60 ml/min, the propensity match score analysis did not reveal any significant differences in terms of morbidity between untrafiltered and no ultrafiltered patients. The ultrafiltration increased the risk of mortality (9%vs 2%, p-value 0.045).

Conclusions:
an initial eGFR< 60 ml/min is associated with an incremental risk of mortality in patients undergoing cardiac surgery. The extracorporeal circulation does not seem have any worsening effect on the renal function after the operation. No benefits have been observed using ultrafiltration in patients with severe renal failure.
EP17 IMPACT OF A MODIFIED INTRAOPERATIVE SETTING FOR THE MANAGEMENT OF CIRCULATORY ARREST IN TYPE A ACUTE AORTIC DISSECTION
Authors: Vendramin I. , Piani D. , Lechiancole A. , Ferrara V. , Meneguzzi M. , Sponga S. , Livi U. 
Published: November 2018

Background-aim:
Despite several recent reports show a trend towards a more extensive arch surgery for patients presenting with type A acute aortic dissection (TA-AAD), in-hospital mortality from IRAD remains high (13–17%). Our study aimed to evaluate the impact of a modified intraoperative setting for the management of circulatory arrest on short and mid-term outcomes in limited repair and complete arch surgery.

Methods:
From 1997 to 2017, 335 patients with TA-AAD were admitted at our Institution and divided into 3 groups according to the surgical strategy. GROUP-A: retrograde femoral artery perfusion- deep hypothermia (1977–2004;n = 144), GROUP-B: standard anterograde right axillary artery perfusion- moderate hypothermia (2005–2012;n = 102), GROUP-C: right axillary artery with modified monitoring and perfusion lines setting- moderate hypothermia (2013–2017;n = 89). Data was collected and analysed retrospectively.

Results:
Overall in-hospital mortality: 34.7% in Group-A (mean-age 61.5 ± 12.5years), 13.7% in Group-B (mean-age 63.8 ± 12.8years) and 5.6% in Group-C (mean-age 64.2 ± 11.1years) (p = 0.001). Concerning total-arch replacement, in-hospital mortality was 37% in Group-B vs 0% in Group-C (p = 0.001). Overall 1-year and 5-years survival: 56.3 ± 4.1% and 47.9 ± 4.2% in Group-A, 79.4 ± 4% and 69.6 ± 4.6% in Group-B, 89.5 ± 3.3% and 87.5 ± 3.8% in Group-C (p = 0.001). Group (p = 0.001), CEC-time (p = 0.003), re-exploration (p = 0.001), AKD (p = 0.049) and CVVH (p = 0.007) were predictors for in-hospital mortality in a univariate analysis, re-exploration (HR 4.2) and CVVH (HR 2.1) in a multivariate analysis, Group was a protective factor (HR = 0.25).

Conclusions:
In our experience current modified approach for the management of circulatory arrest seems to improve overall survival and decrease the risk of in-hospital mortality, showing excellent results especially in total arch replacement.
EP39 TYPE A INTRAMURAL HEMATOMA AND PENETRATING ATHEROSCLEROTIC ULCERS OF AORTA: EVALUATION AND MANAGEMENT
Authors: Fittipaldi O. , Nappi A. , D’Alessandro F. , Mollo A. , Colucci S. , Rispo G. , De Notaris S. , Garofalo G. , Triumbari F. 
Published: November 2018

Background and Aims:
The aim of our study is to report our experience on the surgical treatment of intramural aortic hematoma (IMH) and penetrating atherosclerotic ulcers (PAU), as less common variants of “acute aortic syndromes”.

Methods:
From 2010 to 2015, 38 patients with a diagnosis of “acute aortic syndrome” underwent emergency surgery at our Center, of which 31 patients (81.57%), suffering from acute aortic dissection type A, 7 patients (18.42%), affected by IMH and a patient (2.63%) affected by IMH + PAU: All the patients affected by IMH and IMH + PAU underwent emergency surgery.
We analyzed the following parameters: General and hemodynamic clinical conditions; Presence of spontaneous breath or endotracheal intubation; Neurological conditions; Timing from diagnosis to surgical treatment; Intervention type performed; Time to wake up.

Results:
Survival at 30 days was 100%: 6 patients were discharged at home, about 3 weeks after surgery and 2 patients were transferred to Cardiorespiratory Rehabilitation Centers about 3 weeks after surgery, in satisfactory general clinical conditions.

Conclusions:
Preoperative conditions of the patients, early diagnosis and the timeliness of the surgical treatment represent, in our experience, determinant factors about clinical outcomes.
EP27 PRESENCE AND SIZE OF RENAL CYST INFLUENCE THE RISK OF ASCENDING AORTA ANEURYSM: BASE FOR A ROUTINE SCREENING?
Authors: Amoroso F. , Pettinari M. , Borsellino S. , Buttiens A. , Swinnen J. , Tamagnini G. , Van Kerrebroeck C. , Willems E. , Gutermann H. 
Published: November 2018

Background and Aim:
Patients with thoracic aortic aneurysm had higher incidence of renal cyst (30 to 60%); on the contrary the incidence of aortic aneurysm in patients with renal cyst is not well understood. Aim of our study is to explore whether presence and characteristic of renal cyst influence the incidence of ascending aorta aneurysm.

Methods:
Among 4487 patient who had a chest and abdomen CT scan between 2006 and 2016, 604 were diagnosed with one or more renal cysts. Primary outcome was ascending aorta dilatation (AAD) was defined as maximal diameter ≥ 45 mm. Multivariate linear regression was used to identify the parameters influencing ascending aorta diameter.

Results:
Mean age was 74.1 years and 65.4% were male. Mean number of renal cyst was 5.9 and the mean maximal-cyst diameter was 30.5 mm. Prevalence of AAD was 6.1%. Mean ascending, arch and descending aorta diameters were 35.7 ± 4.9 mm, 30.4 ± 3.9 mm and 27.7 ± 3.8 mm respectively. Regression analysis identified abdominal aorta atherosclerosis or previous treatment, major diameter of the renal cyst, male, familiarity and age as predictors of ascending aorta diameter.

Conclusions:
Patients with renal cyst have a higher incidence of ascending aneurysm and their maximal diameter influence its diameter. This information could be the base to set a prospective screening program to early detect patients with ascending aorta aneurysm.
RF53 NON-ISCHEMIC CARDIOMYOPATHY IS ASSOCIATED WITH BETTER OUTCOMES IN PATIENTS WITH FUNCTIONAL MITRAL REGURGITATION UNDERGOING MITRACLIP IMPLANTATION
Authors: Garatti A. , De Marco F. , Tusa M. , Bedogni F. , Canziani A. , Parolari A. , Menicanti L. 
Published: November 2018

Background:
To compare ischemic versus non-ischemic etiology in patients with functional mitral regurgitation(FMR) undergoing Mitraclip therapy.

Methods:
Among a consecutive series of 72 patients undergoing Mitraclip implantation(2013–2016) at our Institution, 57 patients with FMR[34 patients (mean age:73 ± 10 yrs) with ischemic cardiomyopathy(iCMP) and 23 patients (mean age:72 ± 9 yrs) with non-ischemic CMP(NiCMP)] constituted the study population. Clinical and echocardiographic assessment was performed preoperatively, at discharge and at follow-up. A composite end-point (CE) of death and/or HF admission at FU was calculated.

Results:
Preoperatively, all patients presented in advanced HF-class and low EF(28 ± 11%). Patients with iCMP showed higher rate of male gender, higher rate of CV risk factor and higher rate of previous cardiac surgery(p=.01) compared to NiCMP. Procedural success was similar in both group(92%), but ischemic patients had higher probability to receive two or more clips(p = .05). Postoperative complication(p = .43) as well as 30-days mortality(6% vs4%,p = .36) were similar in both group. Mean FU was 20 months(range 4–49). FU mortality(p = .05) and HF admission(p = .04) were significantly higher in iCMP. Two-years Kaplan-meier freedom from CE was significantly lower in iCMP(47% vs 82%, p = .001). Mitraclip was effective in reducing MR in both group with nearly 80% of patients with MR less than 2+ and NYHA class I-II at FU. Finally, in patients with iCMP, Mitraclip therapy was ineffective in preventing further LV dilatation and dysfunction.

Conclusion:
In high-risk HF patients, Mitraclip therapy showed satisfying results, with high success rate, low operative mortality and lower rate of complications, even if patients with iCMP had medium-term worse outcomes.
RF67 REDO MITRAL SURGERY AND HOSPITAL OUTCOME: A MULTICENTRE EXPERIENCE REGARDING SURGICAL FACTORS AND COMPLICATIONS
Authors: Franzese I. , Biagio L. San , Perrotti A. , Mariscalco G. , Francica A. , Lucarelli C. , De Feo M. , Santarpino G. , Salsano A. , Rubino A. , Gatti G. , Beghi C. , Mignosa C. , Pappalardo A. , Onorati F. , Santini F. , Faggian G. 
Published: November 2018

Background and Aim:
Redo mitral surgery is an high risk procedure. Several preoperative conditions identify patients at unusual surgical risk. Few studies clarify technical issues and perioperative complications affecting early survival. The aim of this multicentre study is to determine predictors of adverse outcome among intraoperative factors and postoperative events.

Methods:
Operative mortality and major morbidity events from 832 redo mitral procedures, from January 2005 to December 2014 at eight European centres, were analysed. Statistical analysis was performed by the SPSS 13.0 program for Windows (SPSS, Inc., Chicago, IL, USA). Normally distributed continuous variables were compared using the unpaired t-test, not-normally distributed variables using the Mann–Whitney U-test and categorical variables using the χ2test. Only variables with a P < 0.10 at univariable analysis were included into the regression models.

Results:
Injury of a previous patent left internal mammary artery graft (LIMA) [odds ratio (OR) 4.2, 95% confidence interval (CI): 1.6–11.5; P = 0.005], major cardiovascular iatrogenic lesions at re-entry (OR 19.2, 95% CI: 9.2–39.9; P < 0.001), extracellular crystalloid cardioplegia (OR 7.3, 95% CI: 1.4–37.8; P = 0.018) and incremental cardiopulmonary bypass time (OR 1.1, 95% CI: 1.0–1.2; P = 0.001) independently predicted operative mortality.

Conclusion:
Operative mortality in redo mitral surgery is still significant. Injury of a previous LIMA graft identifies patients at higher. Prolonged cross-clamp times, extracellular crystalloid cardioplegia, massive transfusions, perioperative myocardial infarction, prolonged intubation also predict adverse early outcome. Combined antegrade + retrograde cardioplegia seems to be the only protective factor these high-risk patients.
RF51 MITRAL VALVE REPLACEMENT AFTER FAILED MITRACLIP
Authors: Del Forno B. , Lapenna E. , Giambuzzi I. , Trumello C. , Bargagna M. , Iaci G. , Ferrara D. , Castiglioni A. , De Bonis M. , Alfieri O. 
Published: November 2018

Aim:
The aim of this study was to evaluate the immediate and follow-up results of mitral valve replacement on patients previously treated with unsuccessful MitraClip procedures.

Methods:
Between February 2012 and April 2018, fifteen consecutive patients (75 ± 8.2 years) underwent mitral valve replacement in our institution after failed percutaneous edge-to-edge mitral valve repair. The reasons of failure were acute leaflet rupture in three cases (20%), massive leaflets fibrosis causing severe stenosis in five patients (33%) and clips dislocation causing severe regurgitation in seven patients (47%). The calculated operative risk, using the EuroSCORE II, was 16 ± 11.8%. Nine patients (60%) were in NYHA Class III or IV and four patients (26%) were in a critical pre-operative state.

Results:
At 30 days, one patient died (6.7%). Nine patients (60%) required IABP for weaning from CPB. The length of hospital stay was a median of 10 days. The survived patients experienced a consistent reduction in pulmonary hypertension (pre-op 59 ± 14.3 vs post-op 46 ± 13.1 p < 0.0001). At 3-years follow-up, the overall survival was 56.3 ± 16.51. Seventy-five percent of patients were in NYHA class I/II.

Conclusion:
In our experience, high risk patients requiring mitral valve surgery after unsuccessful Mitraclip procedure may be operated with acceptable 30-days mortality and morbidity. In this light, this option should be always discussed after a failed Mitraclip, even in critical situation.
RF55 OFF PUMP MITRAL VALVE REPAIR WITH NEOCHORD SYSTEM: FROM PIONEERING TO CLINICAL PRACTICE
Authors: Albertini A. , Amoncelli E. , Zucchetta F. , Tripodi A. , Pagliaro M. , Calvi S. , Mikus E. 
Published: November 2018

Background and aim:
Transapical off-pump mitral valve intervention with neochordae implantation is a novel, minimally invasive procedure for treatment of degenerative mitral valve regurgitation. The aim of this study is to describe our initial experience with this new technique and to describe the tip and tricks to improve the results.

Methods:
Patients were selected for NeoChord repair when Leaflet-to-Annulus Index (LAI) (defined as the ratio between the sum of anterior leaflet length (AML) and posterior leaflet length (PML) over antero-posterior length) was > 2 and mitral annulus inferior to 40 mm. Measurements were performed with 2D and 3D transesophageal echocardiography.

Results:
Between 2015 and 2018, at Salus Hospital and Maria Cecilia Hospital, a total of 35 patients were treated, (median age of 68 years and median EuroSCORE of 5.33). The majority of them (95%) presented a posterior leaflet prolapse, 2.5% with an anterior leaflet prolapse and 2.5% with a combined. Early procedural success was achieved in all patients.Two neochordae were implanted in 8 patients (22.85%), 3 in 17 (48.55%), 4 in 4 (11.45%), 5 in 4 (11.45%), 6 in 2 (5.7 %). During surgery a mean of 3.2 Couple of chordae were used. All intraoperative data and postoperative outcomes, in terms of intensive care unit stay, blood loss, transfusions have been analysed as well the echocardiography at discharge was analyzed.

Conclusions:
NeoChord repair is a safe procedure, and the early results are impressive. Our data are encouraging but for sure long term follow up and a correct patients selection are essential.
RF39 LEFT VENTRICULAR DYSFUNCTION AFTER MINIMALLY INVASIVE MITRAL VALVE SURGERY IN ASYMPTOMATIC PATIENTS: RISK FACTORS ANALYSIS
Authors: Bianchi G. , Margaryan R. , Solinas M. 
Published: November 2018

Background:
Asymptomatic patients with severe MR and normal LV function are at risk of developingpost-operative left ventricular dysfunction.

Aim:
This study wants to elucidate risk factors for immediate and persistent newly developed dysfunction after surgery and its time course and potential triggers for an early and safe surgical intervention.

Methods:
From 2004 to 2016, 346 asymptomatic patiens aged 56 ± 12 years underwent mitral valve surgery through right lateral mini-thoracotomy (RLMT);

Results:
Preoperative LV ejection fraction (LVEF) was 63.9 ± 4.6 [60–83]. Clinical follow-up was 54 ± 34.4 [9.2 - 132.8] months. Decreased LV function was observed in 39 (11.3%) patients; LVESD was associated with post-operative LV dysfunction at uni- and multi-variate analysis. A threshold of 35 mm for LVESD was determined using ROC curve (AUC 0.74; sensitivity 71.8%, specificity 71%). At follow-up 10 patients did not recover a normal LV function. Survival at 60 and 120 months was 99.4% and 91.4%, respectively. An LVESD > = 35 mm was not associated with increased mortality nor reintervention on mitral valve. In patients that remained with a depressed LV function at follow-up (n = 10), LVESD was not a risk factor (p = 0.15) for mortality.

Conclusions:
LVESD could be useful to identify patients at risk of post-operative dysfunction; the proposed cut-off is lower than other proposed in literature and may indicate the need for earlier intervention; further analysis is required to elucidate the preoperative risk factors for late persistent LV dysfunction.
RF79 SURGERY OF GROWN UP CONGENITAL HEART DISEASE: EARLY OUTCOMES OF A COMPLEX PROBLEM
Authors: Angeli E. , Careddu L. , Petridis F.D. , Tonelli F. , Romano G. , Balducci A. , Assenza G. Egidy , Donti A. , Gargiulo G.D. 
Published: November 2018

Background and Aim:
To evaluate early surgical results of grown-up congenital heart disease(GUCH) in a single center experience.

Methods:
A retrospective analysis of GUCH patients operated on from 2002 to 2016. Variables included: primary diagnosis, surgical procedures, intraoperative data, early postoperative results. Analysis of variables and mortality was performed with Square-Chi test and t-test when indicated.

Results:
409 operations were performed among 397 patients. Mean age at surgery was 38,2 ± 14,8 years. Main disease at operation was: septal defects in 30%, right ventricular outflow tract disease 29%, single ventricle 4%, valvular disease 28%, coronary arteries disease 5%, others4%. Seven patients were on heart transplant waiting list. Surgical procedures are described in table 1. In-hospital mortality was 1.7%. Age at operation and preoperative creatinine clearance, emergency procedure, prolonged by-pass time resulted as risk factors for intraoperative mortality(p = 0.007,0.009,0.003,0.002 respectively).

Conclusions:
A large number of GUCH patients lead a healthy life without any treatment, but some of them require cardiac surgery for primary repair, correction of residual or acquired pathologies, reoperation for sequelae following previous surgery or acquired heart disease. The complexity of this kind of population, due to the risk factors associated with it, therefore requires the need for adequate preoperative management, appropriate surgical planning and consequently a rigorous follow-up.
RF36 ISOLATED COARCTATION OF THE AORTA: 10 YEARS EXPERIENCE
Authors: Ghiselli S. , Carro C. , Cocchi M. , Muhoozi R.M. , Mauri L.D. , Marianeschi S.M. 
Published: November 2018

Introduction:
Aortic coarctation (AoC) occurs in 5–7% of all congenital heart diseases. This retrospective study aims to describe mid and long-term outcomes of patients undergoing simple congenital AoC repair.

Methods:
We retrospectively reviewed 63 patients who underwent repair of AoC between 2008 and 2018. 40(63%) were neonates, 11 infants, 6 children, 6 adults. 29(46%) were males. 20 patients underwent end-to-end anastomosis and 33 extended end-to-end anastomosis, 8 prosthetic patch aortoplasty or prosthetic interposition grafting, 2 extra-anatomic bypass. 8 (12.7%) had bicuspid aortic valve. Patients were stratified by age and results were compared.

Results:
60% of interventions were performed in emergency. Mean operation time was 129.7 minutes, mean cross-clamp time was 24.3 ± 11.4. Almost all AoC repairs were in neonates and infants with resections/extended-resections and end-to-end anastomosis while in adults we preferred prosthetic patch plasty. Major post-operative complications occurred in 7.9% and minor in 12.7% of cases. Overall mortality was 3.2%. No statistically significant differences were observed in mortality or post-operative complications incidence among patients’ groups. Mean in hospital stay was 16.6 ± 16.1days, mean ICU length of stay was 4.3 ± 6.4days. Over a mean follow-up of 4.1years, 3.2% of patients reported complications: late hypertension and aortic aneurysms. A significant gradient (>20mmHg) has been founded during follow-up in 4/63(6.3%) pediatric patients but none among adults and none of them required reoperations. No late mortality was registered.

Conclusions:
Long-term results of our experience confirm that surgical repair of AoC can be performed safely. End-to-end anastomosis in neonates and infants achieves excellent results if performed before occurrence of hypertension or its complications.