bluuebunny/crossref_metadata_2025_split huggingface dataset:
RF73 RIGHT VENTRICULAR OUTFLOW TRACT RECONSTRUCTION IN PEDIATRIC CARDIAC SURGERY: FEDERICO II 10-YEARS EXPERIENCE
Authors: Comentale G. , Palumbo S. , Mucerino M. , Giordano R. , Cioffi S. , Russolillo V. , Busillo L. , Lopez G. , Mitrano L. , Simeone S. , Palma G. 
Published: November 2018

Background and Aim:
Surgical repair of congenital heart defects involving reconstruction of the right ventricle outflow tract sometimes requires implantation of a right ventricle to pulmonary artery (RV-PA) conduit. To date, the ideal conduit is yet to be found so different kinds of prosthesis are usually used. It will be presented the 10-years experience with the different PA-RV conduits used at our institution.

Methods:
From 2007 to 2018, 92 RV-PA conduit implant procedures were performed on 75 children (58 Contegra®, 12 Fresh Homografts and 22 Hancock®). Clinical data were retrospectively collected from medical records and then they were matched for comparison using propensity score. Pediatric Risk of Mortality score, the day of withdrawal of inotropic drugs, the length of the intensive care unit stay and of the hospital stay were used to assess postoperative morbidity.

Results:
No significant difference was observed when considering the operative data for anesthesia, the intraoperative inotropic support, the perioperative complication rate or the postoperative morbidity and mortality. Length of surgery, of cardiopulmonary bypass, of aortic clamping and the intraoperative and postoperative blood loss was significantly lower in the Homograft group. There were no differences in the reoperation free survival between Contegra® and Hancock® groups but a significantly higher reoperation free survival was observed in Homograft group.

Conclusion:
RV-PA conduit replacement can be achieved with a low surgical morbidity or mortality with any type of conduit but Homografts seem to be related to a better intraoperative and postoperative outcomes especially due to their long life.
RF38 LATE PREDICTORS OF MITRAL REGURGITATION RECURRENCE AFTER SURGERY FOR FUNCTIONAL MITRAL REGURGITATION IN ISCHEMIC HEART FAILURE: FIX THE LEFT VENTRICLE TO IMPROVE MITRAL REPAIR DURABILITY.
Authors: Saitto G. , Garatti A. , Castelvecchio S. , Canziani A. , Parolari A. , Mossuto E. , Daprati A. , Menicanti L. 
Published: November 2018

Background and aim:
to analyse predictors of functional mitral regurgitation recurrence (MRR) after Surgical Ventricular Reconstruction (SVR) and mitral annuloplasty in ischemic heart failure (EF < 35%).

Methods:
Between January 2001 and March 2016, a consecutive series of 172 patients (mean age 64 ± 8 years) was operated of SVR and mitral annuloplasty for anterior [AR = 128 (74%)] or posterior [PR = 44 (26%)] post-ischemic remodeling and functional MR. Echocardiographic follow-up (mean: 51 months) was available in 131 patients. MR grade >2 was defined as MR recurrence (MRR). Independent predictors of MRR were calculated with univariate (Kaplan-Meier) and multivariate (Cox regression) analysis.

Results:
MRR occurred in 27 patients (18%), and was significantly associated with higher 5-years mortality (52% vs 18%, p < .001) and HF readmission rate (55% vs 22%, p < .001). MRR was significantly lower in posterior compared to anterior remodelling (9%vs 18%, p = .03). Left ventricle volumes (ΔESV = -29%; ΔEDV = -22%) were significantly reduced both in patient without or with MRR, but the latter exhibited a significant post SVR sphericalization (ΔSpher Index: +37%vs +7%; p = .01), which significantly correlates with increased mitral tenting area (R2 = 0.36; 3.5 cmq vs 2.6 cmq; p = .002). Multivariate Cox regression analysis showed anterior remodeling (p = .01) and Sphericity Index (p = .01) as independent predictors of MRR. ROC analysis identified a cut-off value of 0.66 (sensibility = 78%; specificity = 67%) for SpherI (3-years freedom from MRR: 54% vs 18%,p = .001).

Conclusions:
In functional MR and ischemic HF, SVR improves long-term durability of mitral annuloplasty, especially in posterior remodelling. LV sphericalization and anterior remodeling correlate to higher probability of MRR at follow-up so, in this settings, valve replacement rather than repair should be considered.
RF65 PULSE OXIMETER USEFULNESS FOR BLOOD PRESSURE MONITORING IN PATIENTS IMPLANTED WITH LVAD (LEFT VENTRCLE ASSIST DEVICE)
Authors: palermo A. , montalto A. , gherli R. , cammardella A. , contento C. , piazza V. , musumeci F. 
Published: November 2018

BACKGROUND AND AIM:
The measurement of blood pressure (BP) in patients with CF-VADs can present unique challenges because traditional BP measurement by auscultation or automated cuff is less reliable.
We tested the efficacy of blood pressure estimation by using the Sphygmomanometry combined with finger pulse oximetry.

METHODS:
51 patients, 24 implanted with HM II, 4 implanted with HVAD, 23 implanted with HM3 were prospectively studied during follow up period and mean arterial pressure was estimated by using 3 different methodologies; ultrasound doppler, pulse oximeter and automated blood pressure cuff. For each method 3 consecutive evaluations were conducted in 3 follow-up visits.

RESULTS:
For each patient 9 different evaluations were obtained, 3 for each method. The overall success rate was 100% for blood pressure assessment conducted with doppler and pulse oximeter, 80% - 87% the rate for automated monitor evaluations. 100 was the percentage of three successfull consecutive measurements for the first two methodologies and 60 the percentage for the last one. Pearson's correlation analysis showed a good correlation when measurements of doppler and pulse oximeter were compared. High variability emerged between estimations obtained by using automated monitor and poor correlation was found when this method was compared with doppler an pulse oximeter.

CONCLUSION:
According to our results pulse oximeter method showed high success rate and a good correlation level with the standard proedure. Our data encourage the use of oximter for domiciliary blood pressure assessment in patients implanted with continuous flow device.
RF66 RAMP TEST TO OPTIMIZE HEMODYNAMIC PROFILE IN PATIENTS IMPLANTED WITH LVAD (LEFT VENTRICLE ASSIST DEVICE)
Authors: Montalto A. , Piazza V. , Fiammetta A. , Cammardella A. , Comisso M. , Gherli R. , Contento C. , Palermo A. , Musumeci F. 
Published: November 2018

Background and Aim:
Pump speed optimization in patients implanted with Left Ventricle Assist Device epresents a main challenge during follow-up. we describe our study that tested whether invasive hemodynamic ramp test can optimize the patient hemodynamic profile.

Methods:
Frrom january 2015 to march 2018, 35 patients, 18 implanted with HM3, 14 with HM II and 3 implanted with HVAD, underwent ramp test during right heart catheterization. Basal hemodynamic data including central venous pressure (CVP), pulmonary artery systolic, diastolic and mean pressure (PAPS, PAPD, PAPM), pulmonary capillary wedge pressure (PCWP) were measured. hemodynamic parameters, blood pressure and echocardiography data were valuated at up to 4 speed settings. speed changes were in steps of 200 revolutions per minute (RPM) for HM3 and HVAD and 400 RPM for HMII.

Results:
Only 30 % of patients had normal PCWP at their basal RPM setting. Going from the lowest to the highest speeds, cardiac output improved (total change 1,28 +/- 0,3 l/min) and PCWP decreased by 1,9 +/- 0,73 mm Hg/step . CVP and systolic blood pressure did not change significantly with RPM. RPM were adjusted based on test results to achieve CVP and PCWP as close to normal limits as possible, an optimal hemodynamic profile represented by PCWP > 15 mm Hg, CVP < 10 mm Hg, PAM (mean arterial pressure) ranging 75–85 mmHg was obtained in all the patients.

Conclusions:
Use of hemodynamic ramp test in patients implanted with LVAD, provides objective means of optimizing RPM, obtaining an optimal left ventricle unloading
RF93 UTILITY OF SIMPLIFIED ACUTE PHYSIOLOGY SCORE II AS OUTCOME'S PREDICTOR FOR TAVI
Authors: Pollari F. , Cuomo M. , Vogt F. , Kalisnik J.M. , Dormann C. , Jessl J. , Fischlein T. , Pfeiffer S. 
Published: November 2018

Background:
Simplified Acute Physiology Score (SAPS) II is a prognostic score for predicting outcome of critically ill patients on admission in intensive care units (ICU). Our aim is to assess its utility in Transcatheter aortic valve implantation (TAVI).

Methods:
We retrospectively analyzed data from patients, who underwent a TAVI procedure from 2010 up to October 2016. Patients who survived TAVI were extubated in the hybrid-room according to our fast track protocol and thereafter admitted to intensive care unit, where SAPSII was prospectively calculated. Following outcomes were investigated: length of ICU-, hospital-stay and 30-day mortality.

Results:
699 TAVI procedures were performed in 696 patients. For 599 (229 TA, 370 TF) SAPSII was disposable. Logistic Euroscore in TA group was significantly higher than in TF group (29.66% ± 16.1 vs 22.59% ± 15.16, p < 0.05). In the TA group, mean SAPSII was 29.73 ± 11.27 (range 13–101) with an observed 30-day mortality of 7%. Mean ICU and hospital stay were 3.98 ± 6.6 and 14.28 ± 8.85 days respectively. Pearson's test showed a significant correlation only between SAPSII and hospital-stay (p = 0.03). In the TF group, mean SAPSII was 30.82 ± 11.27 (range 12–98) with an observed 30-day mortality of 2.7%. Mean ICU- and hospital-stay were 1.63 ± 3 and 11.33 ± 8.14 days respectively. Pearson's test showed no significant correlation. Hosmer-Lemeshow test was not significant in both groups, but ROC curve showed a very poor discrimination (TF group AUC = 0.594 ± 0.089 – TA group AUC = 0.587 ± 0.068).

Conclusions:
SAPSII does not correlate with 30-days-mortality and ICU stay in TAVI patients. A correlation between SAPSII and hospital-stay has been found only in TA-TAVI patients.
RF21 EVOLUTION OF VENTRICULAR ENERGETICS IN THE DIFFERENT STAGES OF PALLIATION OF HYPOPLASTIC LEFT HEART SYNDROME: A RETROSPECTIVE CLINICAL STUDY.
Authors: Di Molfetta A. , Iacobelli R. , Rocchi M. , Bellisari F. Cobianchi , Gagliardi M.G. , Carotti A. , Massetti M. , Amodeo A. , Guccione P. 
Published: November 2018

Introduction:
Hyperplastic left heart syndrome (HLHS) patients are palliated by creating a Fontan-type circulation passing from different surgical stages. The aim of this work is to describe the evolution of ventricular energetics parameters in HLHS patients during the different stages of palliation.

Methods:
We conducted a retrospective clinical study enrolling all HLHS patients surgically treated with hybrid procedure and/or Norwood and/or Bidirectional Glenn (BDG) and/or Fontan operation from 2011 to 2016 collecting echocardiographic and hemodynamic data. Measured data were used to calculate energetic variables such as ventricular elastances, external and internal work, ventriculo-arterial coupling and cardiac mechanical efficiency.

Results:
From 2010 to 2016, a total of 29 HLHS patients undergoing cardiac catheterization after hybrid (n = 7) or Norwood (n = 6) or Glenn (n = 8) or Fontan (n = 8) procedure were retrospectively enrolled. Ventricular volumes were significantly higher in the Norwood circulation than in the hybrid circulation (p = 0.03) with a progressive decrement from the first stage to the Fontan completion. Ventricular elastances were lower in the Norwood circulation than in the hybrid circulation and progressively increased passing from the first stage to the Fontan completion. The arterial elastance and Rtot increased in the Fontan circulation. The ventricular work progressively increased. Finally, the ventricular efficiency improves passing from the first to the last stage of palliation.

Conclusion:
The use of ventricular energetic parameters could lead to a more complete evaluation of such complex patients to better understand their adaptation to different pathophysiological conditions.
RF26 HYDROGEL MYOCARDIAL INJECTION AS USEFUL STRATEGY TO PREVENT CARDIAC REMODELING: A SYSTEMATIC REVIEW AND META-ANALYSIS, IN MODELS OF HEART FAILURE
Authors: Di Franco S. , Alfieri A. , Moriello N. Schiano , Amarelli C. , Pace C. , Passavanti M.B. , Fiore M. 
Published: November 2018

Background:
The main objective of this systematic review (PROSPERO ID 96223) is to determine the advantage in hydrogel-based treatment to achieve sustained improvement of cardiac function in heart failure (HF), compared to drug therapy or placebo in clinical and experimental models of HF. The association between different types of hydrogel and myocardial function impairment, performance status and injection-induced complications, is analysed.

Methods:
Literature search has been performed using computer-assisted databases (MEDLINE, EMBASE, CENTRAL and JBI database of systematic reviews and implementation reports).
The search strategy and the search string (“hydrogel” AND “heart”) has been formulated following the PICO method.
Outcomes aim to assess myocardial improved function as: myocardial thickness by post-mortem analysis measurement, end-diastolic volumes (left and right ventricles), 30 days mortality, post-mortem analysis of myocardial composition, dimensions and histological and immunohistochemical changes.
A standardised, pre-piloted form has been used to extract data from the included studies for assessment of study quality and evidence synthesis.
Risk of bias and study quality (ie. CAMARDES-checklist) have been assessed by two review authors and resolving incongruencies through discussion with a third author.

Results:
We provide a narrative synthesis of the findings from the included studies, structured around the type of intervention, target population characteristics, type of outcome and intervention content.

Conclusions:
Hydrogels injection for cardiac tissue repair seems to be a promising therapeutic approach in miocardial infarction (MI) treatment, nowadays under clinical evaluation. Hydrogels effectiveness in limiting extension and expansion of ischemic injury, resulting in improved MI survival rates, in now under investigation.
RF23 FROM STENOSIS TO DISPLACEMENT AND LEAKAGE, TRANSCATHETER AORTIC VALVE-IN-VALVE PROCEDURE: FIRST PORTICO© IN PORTICO© EXPERIENCE
Authors: Spadafora A. , Di Franco S. , Caruso A. , Capasso F. , De Bellis A. 
Published: November 2018

Background:
Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients affected by severe aortic stenosis who are considered high-risk surgical candidates with multiple comorbidities. The TAVI approach is minimally invasive, requiring local anaesthesia and mild sedation.

Case summary:
We describe, to our knowledge, the first case of a Portico® TAVI system (St. Jude Medical, St. Paul, MN) implantation made on a previous Portico® valve installed to solve displacement and leakage of the first prosthetic valve.
A 71-year-old woman affected by several comorbidities (diabetes mellitus type 1, hypertension, cryptogenic cirrhosis) and severe aortic regurgitation, as a consequence of displacement and leakage of a Portico® valve previously implanted, was admitted to our hospital for aortic prosthesis replacement. After Heart Team evaluation, according to the patient general conditions (NHYAclass III; Euro-Score II, 1,5%; STS-score mortality, 12,95%, Clinical Frialty Scale 6), to the previous transcatheter implantation of a 25 mm Ø Portico® sheathless valve (St. Jude Medical, Minneapolis, MN) with subsequent displacement and leakage, it was chosen to repair the valve leakage by second TAVI intervention and second 25 mm Ø Portico® valve implantation instead of standard surgical open procedure, achieving surgical risks reduction. Subsequent and serial follow-up evaluations are satisfactory revealing, normal ventricular kinesis, preserved ejection function, normal aortic valve function (mean gradient of 6 mmHg) and no paravalvular regurgitation.

Conclusion:
Portico® in Portico® transcatheter aortic valve implantation may be a valid solution to sheathless aortic valve leakage in complex patients. However, an evaluation of the procedure, in further cases, is required.
RF91 USE OF NIRS AND REFLECTANCE PULSE OXIMETRY AS A MONITORING IN DISTAL PERFUSION OF THE LIMB DURING PERIPHERAL ECMO.
Authors: contento C. , de marco M. , vitalini E. , pietraforte L. , iaiza A. 
Published: November 2018

Background and aim:
One of the biggest complications in patients treated with venoarterial ECMO is lower extremity ischemia, site of the peripheral cannulation.
The ELSO database reports a 5% incidence of ischemic leg complications in patients with peripheral va-ECMO, leading to leg amputation in 1% of cases.
The objective of the study is to optimize the perfusion of the cannulated limb for the reduction of the incidence of ischemia, pacing a distal perfusion catheter (8 Fr) in the superficial femoral artery, before the insertion of the deep femoral artery and monitoring of tissue oxygen saturation by NIRS and reflectance pulse oxymetry.

Methods:
Our study includes the analysis of the experience on a group of 9 patients in which tissue saturation was monitored by NIRS (group A) and another group that includes patients on whom the distal flow of the limb has been periodically detected by Eco Doppler SD2, without monitoring of tissue saturation (group B).

Results:
In the experience of group B a late diagnosis of ischemia of the cannulated limb was found despite the distal perfusion. In group A NIRS monitoring allowed to readily diagnose a hypoperfusion, detected with a variation of saturation > 10% with respect to the tissue saturation of the contralateral limb and the basal value, resolving it with the immediate repositioning distal perfusion cannula.

Conclusions:
We conclude that transcutaneous NIRS and reflectance pulse oximetry may be an effective non-invasive method for continuous monitoring of leg perfusion in patients treated with peripheral ECMO and distal limb reperfusion.
RF33 IS THE DIAMETER OF THE AORTA A SAFE PARAMETER FOR CARDIAC SURGERY INDICATION IN AORTIC ANEURYSMS?
Authors: Bassano C. , Vacirca S.R. , Colella D. , Bertoldo F. , Pugliese M. , Ferrante M.S. , Ragni F. , Nardi P. , Scafuri A. , Ruvolo G. 
Published: November 2018

Background and Aim:
Acute aortic dissection is a life-threatening condition and its prevention is based on elective surgery on patients with known risk factors (connective tissue disorders or chronic degenerative expansive aneurysm). International guidelines suggest elective prophylactic surgery at a diameter of 55 mm in non-syndromic patients.
The aim of our study was to verify if current guidelines for elective surgery are effectively reliable in order to prevent acute aortic syndrome.

Materials and methods:
From April 2005 to March 2018, at the Cardiac Surgery Division of the Tor Vergata University of Rome, 326-patients underwent emergency cardiac surgery for type A acute aortic dissection. The whole series was based on the all-camers cohort. The diameter of the dissected aorta, including the true and false lumen, was evalueted preoperatively by CT scan and intraoperatively by means transesophageal echocardiographic examination.

Results:
This analysis has documented an average diameter of 54 ± 9 mm of dissected ascending aorta. In particular the 50th and 75th percentiles of patients was 53 mm and 60 mm, respectively. In 65% of patients the diameter of the dissected aorta was ≤ 55 mm.

Conclusions:
Since the dissected aorta is necessary bigger than the native vessel, the international criteria for elective surgery seem to be inadequate to prevent acute aortic syndrome in a large portion of non-syndromic patients with normal or event dilated proximal aorta. Other factor beside aortic diameter should be identified to improve the efficacy of patients’ selection for elective surgery.
RF42 LONG TERM RESULTS OF SEPTAL MYECTOMY IN OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY: OUR THIRTY YEAR HISTORY.
Authors: Saitto G. , Grimaldi F. , Varrica A. , Biondi A. , Garatti A. , Parolari A. , De Vincentiis C. , Menicanti L. 
Published: November 2018

Background and aim:
The objective of this study was to evaluate the early and long-term results of surgical myectomy in a consecutive series of patients operated for obstructive hypertrophic cardiomyopathy (HOCM).

Methods:
Between January-1989 and March-2014, 79 patients (mean age 50 ± 22 years, 48% males) with HOCM underwent surgical myectomy at our Institution. Nine patients had a history of paroxismal atrial fibrillation (11.3%). Sixty-three patients were symptomatic for dyspnoea (79.7%), twenty-one patients (26.5%) for angina, and twenty-one patients experienced a syncope (26.5%). The mean left ventricular outflow tract gradient was 59 ± 28 mmHg and mean preoperative LVEF was 66% ± 8%. Systolic anterior motion was present in 67 patients (76%) and mitral regurgitation ≥ 2 + in 51 (57%).

Results:
Mitral valve repair and replacement was performed in 7 (8.7%) and 11 (13.7%) patients.In-hospital mortality was 1.2%. Echocardiography performed at discharge showed a mean left ventricular outflow tract gradient and LVEF of 11 ± 10 and 61% ± 6% respectively. Systolic anterior motion was present in 13 patients (14%) and residual mitral regurgitation ≥ 2 + in 6 patients (7.5%). During follow up (mean 129 ± 73 months)overall mortality and cardiac-related mortality were 16.4% and 5% respectively. In six cases an ICD was implanted (7.6%) and only 3 patients were severely symptomatic for dyspnea. At 15 years freedom from all cause and cardiac death were respectively 63 ± 8% and 89 ± 10%, freedom from recurrence of NYHA class > II were 89 ± 11%. Freedom from reintervention was 100%.

Conclusions:
In our experience, long-term follofxRF42
RF74 SAFETY AND EFFICACY OF BIATRIAL VS LEFT ATRIAL APPROACHES IN PATIENTS UNDERGOING CONCOMITANT ATRIAL FIBRILLATION ABLATION DURING CARDIAC SURGERY: A META-ANALYSIS
Authors: Cappabianca G. , Corazzari C. , Tutino C. , Musazzi A. , Ferrarese S. , Beghi C. 
Published: November 2018

Background:
the latest STS guidelines recommend concomitant AF ablation not only during mitral surgery (Class I, Level A) but also during other cardiac surgery procedures (Class I, Level B) for patients with atrial fibrillation (AF). Nevertheless, it is still unclear if limiting the lesion set to the left atrium (LA) yields similar safety and efficacy compared to a biatrial (BA) approach.

Methods:
Pubmed, Scopus and WOS were searched from their inception to April 2018: 23 studies comparing BA vs. LA approaches for concomitant AF ablation (3, randomized, 5 propensity-adjusted, and 15 observational) including 6216 patients, were identified. Of these, 9 studies (1236 patients) focused on mitral surgery as main procedure.

Results:
Freedom from AF was significantly higher in the BA group at 6 months (OR 1.38, CI 1.08-1.76, p = 0.01) and one year (OR 1.53, CI 1.05-2.23, p = 0.03), but also permanent pacemaker (PPM) implants (OR 1.62, CI 1.17 – 2.24, p = 0.004) and reopening for bleeding (OR 1.83, CI 1.01 – 3.31, p = 0.05) were higher in the BA group. In the mitral surgery subgroup, BA approach was superior in terms of one year freedom from AF but no significant differences were found regarding PPM implants and postoperative bleeding.

Conclusions:
BA AF ablation seems more effective than LA approach achieving sinus rhythm at one year; on the other hand a LA approach may be preferable in patients with higher risk of bleeding (i.e. dual antiplatelet, complex surgery) and in procedures with a substantial risk of AV block.