bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP25 OPTIMAL OPERATIVE PLANNING AND HIGH-EXPERIENCE ARE PREDICTORS OF GOOD OUTCOMES IN PATIENTS UNDERGOING TRANS-APICAL VALVE IMPLANTATION
Authors: Prestipino F. , Manzan E. , Miele M. , D’Ascoli R. , Luzi G. 
Published: November 2018

Background and Aim:
With the improvement in surgical expertise and optimization of pre-operative cardiovascular imaging techniques, trans-apical (TA) valve implantation has become in expert hands a rapid and safe procedure, with low rates of complications and conversion to surgery. The aim of our study is to demonstrate that high experienced surgeon with > 500 procedures and optimal operative planning are predictors of good outcomes.

Methods:
We included 45 patients who underwent TA aortic or mitral valve implantation from March 2017 to March 2018 in our Centre. We evaluated early clinical and echocardiographic outcomes according to Valve Academic Research Consortium (VARC-2) definitions.

Results:
Median age was 80 year-old (IQR 77–82), median Logistic Euroscore was 5.8% (IQR 3.8–10). Three patients underwent TA mitral valve-in-valve implantation (TA-MVinV), 5 TA aortic valve-in-valve implantation (TA-AVinV) and 37 TA aortic valve implantation (TA-AVI), with 3 different prostheses (Figure1A). Device success was 100%. There were no intra-operative deaths nor conversions to conventional surgery. At 30-day follow up (FU), no deaths nor major cardiac/vascular complications occurred. We reported 1 stroke (2.2%) and 3 acute kidney injuries (6.7%), of which only 1 patient needed continuous veno-venous hemofiltration. Two patients (4.4%) presented transient conduction disturbances and 1 (2.2%) underwent permanent pacemaker implantation. Figure1B-C reports peak and mean gradients at 30-day FU.

Conclusions:
In heart valve Centers, experienced surgeons (>500 procedures) and optimal operative planning result in low mortality and complication rates after TA valve implantation.
EP04 A NEW TECHNIQUE FOR THE SUTURE OF THE HEADSET OF THE THORAFLEX PROSTHESIS IN CASE OF FET
Authors: Sansone F. , Ceresa F. , Pellegrini A. , Patanè F. 
Published: November 2018

Background and Aim:
We present our experience of Frozen Elephant Trunk (FET) using the Thoraflex Hybrid™ (Vascutek Ltd, UK) implanted by a modified technique for the distal suture of the headset.

Methods:
From January 2017 to now, 13 patients underwent FET. Four patients suffered from acute aortic dissection. Cardiopulmonary bypass (CPB) was established among femoral artery (9), aortic arch (2) or right subclavian artery (2) and the right atrium. Under moderate circulatory hypothermic arrest (MCHA-26°C) and selective antegrade cerebral perfusion (SACP), distal headset was sutured by 10 to 12 4/0 polypropylene Teflon felt stitches passed from the inner to outer of the aortic wall before the insertion of the device. After headset suture was completed, left subclavian artery was sutured and CPB restored through the lateral branch. Then, the proximal suture was completed and the coronary flow restored. Finally, on the beating heart, the other cerebral vessels were sutured.

Results:
Mean CPB was 206.4+37.7 minutes, MHA was 74.3±27.7 minutes and SACP was 85.2±28.6 minutes. In-hospital mortality was 1 (7.6%). No patients suffered of cerebrovascular accident. Three patients had acute renal failure requiring CVVH. After a mean follow up of 7.1±6.8 months all patients but one (died three months after surgery for MOF) are alive and none complication of the distal suture are reported.

Conclusions:
Our technique of distal suture by 10 to 12 4/0 polypropylene stitches instead of a continuous suture, makes the distal suture easier and may reduce the shear stress avoiding late complications such as pseudoaneurysms.
EP26 PRELIMINARY RESULTS OF LAST GENERATION SURGICAL BIOPROSTHESES IN SMALL AORTIC ANNULI: TRIFECTA VS INTUITY
Authors: Chiariello G.A. , Pasquini A. , Bruno P. , Colizzi C. , Ruggio A. , Nesta M. , Mazza A. , Iafrancesco M. , Cammertoni F. , Pavone N. , Perri G. , Massetti M. 
Published: November 2018

Background and Aim:
Aortic valve replacement (AVR) in patients with small aortic annulus is associated with increased risk of patient-prosthesis mismatch. Results of 19–21 Trifecta vs Intuity bioprostheses in patients with annular size <21 mm are compared.

Methods:
Between 2013 and 2017,we retrospectively analyzed 25 (22 women,76.8 ±6.6 years) Trifecta AVR patients vs 26 (23 women, 78.6 ± 4.7 years) Intuity AVR patients.Combined procedures and reinterventions were excluded.Body surface area, left ventricular mass index and Euroscore-II were not different (p:0.68, 0.92 and 0.96 respectively).

Results:
Cardiopulmonary-bypass time was 108.6 ± 22.5 and 84.4 ± 20.5 minutes(p: 0.012);aortic cross-clamp time was 79.3 ± 14.6 and 60.73 ± 15.3 minutes in the Trifecta and in the Intuity group respectively(p:0.001). There wasn’t significant difference in postoperative transvalvular gradients.Lenght of hospital stay and major complications were not significantly different between the two groups.Follow-up is still ongoing. At 3.5 ± 1.2 years,41.1% of patients were followed-up. Until now, no significant difference neither in term of mortality nor in major complications have been observed.Peak pressure gradients were 29.2 ± 11.5 and 20.7 ± 5.9 mmHg (p:0.04);mean 16.2 ± 6.4 and 11 ± 3.03 mmHg (p: 0.02).Effective orifice area (EOA) was 1.43 ± 0.24 and 1.3 ± 0.2 cm2(p:0.5).There is no significant difference in reverse cardiac remodeling (left ventricular mass index 134.4 vs 124.4 g/m2.p:0.43).

Conclusions:
Trifecta and Intuity prostheses provide excellent hemodynamic results in small aortic annulus AVR. Operative times with Intuity were significantly lower. EOA was similar in both groups,however Trifecta presented significantly higher gradients at follow-up. Preliminary data need to be confirmed: completion of follow-up (July 2018) could provide stronger evidence to these first surveys.
EP01 5-YEARS FOLLOW-UP OF AORTIC PROSTHESIS ENDOCARDITIS TREATED USING BIOINTEGRAL CONDUIT: A SINGLE-CENTER EXPERIENCE
Authors: Weltert L. , Chirichilli I. , D’Aleo S. , Guerrieri L. , Salica A. , Scaffa R. , Ricci A. , Bellisario A. , De Paulis R. 
Published: November 2018

Objective:
The treatment of complex prosthetic valve endocarditis (PVE) with aortic root abscess remains a surgical challenge. The aim of this study was to analyze the mid-term results of aortic root replacement using the Bioconduit BioIntegral in patient with a complex prosthesis endocarditis.

Methods:
From June 2013 to April 2018, 15 patients underwent a Bentall procedure with-BioIntegral Surgical graft, due to endocarditis of previous aortic prosthesis, with peri-prosthetic abscess in all patients. Partial to total prosthetic detachment was present in 14 patient (93,3%). The mean age was 68 ± 22 years. Active endocarditis was present in 10 patients (66%) with acute cardiac failure in 7 patients (46,6%) The mean logistic EuroScore was 45,27% ± 33,54%. Patients were prospectively followed and the mean follow-up was 13,4 months (range 0–58 months).

Results:
There were 4 early deaths (26,6%) due to Multiple Organ Failure while the overall actuarial late survival was 64%. None of the patients required cardiac reoperation. 3 patients (20%) needed PMK implantation due to a third-degree AV-block. No major bleeding or stroke were observed. No recurrence of endocarditis was observed, neither early nor late.

Conclusions:
This mid-term follow-up after aortic root replacement with BioIntegral Bioconduit revealed a safe and effective performance of the graft with no evidence of infective dehiscence or need of further cardiac reoperation. Although this study needs further results to be confirmed, this surgical option seems to be potentially promising for complex Prosthetic Valve Endocarditis (PVE) and aortic root abscess in this high-risk patient cohort.
RF52 MITRAL VALVE SURGERY IN OBESES: MINIMALLY INVASIVE COULD BE BETTER
Authors: Stura E. Cura , Ricci D. , Barbero C. , qarra S. El , Marchetto G. , Boffini M. , Rinaldi M. 
Published: November 2018

Objective:
obesity is become an important health problem in the Western world. The feasibility and efficacy of mitral surgery in very obese patients are controversial especially because of high risk of respiratory, infectious and wond complications.

Methods:
Between 1/2006 and 2/2018, 106 patients with BMI≥30 underwent minimally invasive MV surgery (9.0% of 1175): male were 50%, mean age was 63.4 ± 11.3, mean Euroscore was 6.3 ± 3.5 and Logistic was 11.1 ± 17.0. Comorbidities included: diabetes (26.4%), COPD (19.8%), chronic renal failure (17.0%), peripheral vasculopathy (5.7%), previous AMI (7.5%) and AF (47.2%). The mean EF was 54.9 ± 11.4 and 15.1% had pulmonary hypertension. In 22.6% had undergone previous cardiac surgery, in 4.7% were urgiences.

Results:
In 39.6% were mitral repair, associated procedures were TV procedures (10.4%) and AF-crioablation (17.0%). Mean cardiopulmonary and cross clamp time were respectively 142.2 ± 53.3 and 96.3 ± 33.5 minutes. The most utilized aortic clamp technique was endoreturn (61.3%). Conversions to sternotomy were 3.8%. Operative mortality was 0%. Reoperation for bleeding occured in 8.5%. Postoperatively, in 5.7% was necessary CVVH, in 3.8% PM implantation and in 2.8% tracheostomy. Only one patient suffered from major neurologic complications. Groin wound infection/linfocele occurred in 5.7% and in 2.8% was necessary a wound revision. Mean, median intubation time, ICU and hospital stay were respectively 45.4 ± 151.1 h (11 h), 3.8 ± 7.4days (1 day) and 12.0 ± 12.5days (8.0 days). The 30-day mortality rate was 5.7%.

Conclusions:
Minimally invasive approach appears to be safe, feasible and reproducible with low peri-operative morbidity expecially in obeses.
RF87 TRANSAPICAL OFF-PUMP MITRAL VALVE REPAIR WITH PTFE CHORD IMPLANTATION
Authors: Bardaro L. , Carrozzo A. , Albertini A. , Fattouch K. , Martinelli L. 
Published: November 2018

Background:
NeoChord DS-1000 system (NeoChord,Inc,Minneapolis, Minnesota)is a novel minimally invasive technique of mitral valve repair (MVR)consisting in off-pump beating heart transapical implantation of artificial neo-chordae under TEE guide.

Aim:
To evaluate the feasibility,safety and up to 12 months outcome of the NeoChord DS-1000 system in patients with primary mitral regurgitation (MR),due to leaflet(s) prolapse or flail.

Methods:
From July 2015 to November 2016,34 patients with severe primary MR were selected for transapical Neochordae implantation at 3 centers in Italy. Mitral Valve Academic Research Consortium (MVARC) procedural success criteria were evaluated in all patients at 30 days,6 and 12 months.

Results:
Mean age was 64.7 ± 11 years,mean STS repair score was 1.06%(IQR 0.46-1.12).25 patients had isolated P2 disease and 9 patients had other or multisegment disease involvement. MR ≤moderate at 30 days was achieved in 91%of patients. In hospital mortality was 2.9% for respiratory failure,and 2 patients had undergone conversion to traditional valve surgery for functional failure and residual significant MR. At discharge 80.6% patients had MR ≤mild and 17% patients had moderate MR.2 patients experienced early device failure with recurrent sever MR and had undergone additional valve surgery (at 61 and 129 days after implantation).22 patients reached 6 month follow up,all had MR ≤moderate and showed significant improvement in NYHA functional class (P < 0.005).10 patients reached 12 month follow up,all had MR ≤moderate and 90% had NYHA class I.

Conclusion:
Mitral valve repair with the NeoChord DS-1000 system for primary MR due to leaflet(s) prolapse or flail is feasible and safe.Its efficacy is maintained up to 1 year showing significant clinical benefit and functional class improvement.
RF69 REOPERATION AFTER ATRIO-VENTRICULAR SEPTAL DEFECTS CORRECTION
Authors: Deorsola L. , mattioda G. , Aidala E. , Cascarano M.T. , Valori A. , Napoleone C. Pace 
Published: November 2018

Background and aim:
Atrio-Ventricular Septal Defect (AVSD) encompasses a wide range of anatomical alternatives that make surgery and results very variable. We retrospectively reviewed our surgical experience with these patients, searching for outcome predictors.

Methods:
We investigated 202 patients, operated for AVSD Correction at our Institution since 1996. Complete and Partial AVSD were analyzed separately (Groups A and B respectively). Age, Down Syndrome, Left Superior Vena Cava, previous Pulmonary Banding and surgical technique were assessed to evaluate whether they could impact on results, survival and reoperation.

Results:
Complete AVSD was diagnosed in 113 patients (Group A) and partial in 89 (Group B).
Total mortality was 4.5% (Group A 7%, Group B 1%). Increased risk was associated with previous Pulmonary Banding in Group A (p < 0.001) and Cleft left open at surgery in Group B (p < 0.05).
Twenty-Three patients (11%) underwent reoperation (Group A 12%, Group B 10%) at a mean interval of 43 ± 49 months. All patients underwent mitral repair. Predictors of reoperation were presence of a left Superior Vena Cava in Group B (p < 0.01) and Cleft left open at surgery in both Groups (p < 0.05).

Conclusions:
Surgical results of AVSD repair are excellent, with low mortality and reoperation rate, without significant differences between Groups. A Cleft left open at surgery represents a strong predictor for reoperation.
RF64 PULMONARY VALVE SPARING STRATEGIES IN TETRALOGY OF FALLOT REPAIR: A SINGLE CENTER EXPERIENCE
Authors: Muhoozi R.M. , Ghiselli S. , Carro C. , Annoni G.A. , Marianeschi S.M. 
Published: November 2018

Background-Aim:
Transannular patch (TAP) repair of tetralogy of Fallot (TOF) leads to chronic volume overload and significant late morbidity mortality. The pulmonary valve (PV) sparing strategy reduces pulmonary regurgitation with better long-term prognosis. The aim of this study is to examine the determinants for a successful PV-sparing strategy, by exploring PV morphology, annulus diameter, Z-scores and right/left ventricle pressures (Prv/Plv) ratio.

Methods:
From January 2005 to May 2017, 79 patients underwent TOF repair. 55.7% were males and 44.3% females. Depending on PV Z-scores, annulus size and morphology of PV, 21(26.6%) patients, Group A, underwent valve-sparing TOF repair and 58(73.4%), Group B, TAP approach. Data were retrospectively examined.

Results:
The median age was 33.7months in Group A and 21.7months in Group B. Mean PV annulus and PV Z-score were respectively 10.2 ± 2.9 mm and -1.6 ± 1.6, in Group A, and 7.5 ± 3.3 mm and -3.4 ± 2.0, in Group B. Mean Prv/Plv ratio was 0.6 ± 0.1 in Group A and 0.5 ± 0.2 in Group B. Z-scores were significantly higher (p = 0.0001) in Group A, while incidence of post-operative complications and reoperations were higher in Group B (p = 0.006 and p = 0.001, respectively). In hospital and ICU length of stay were significantly shorter (p = 0.03; p = 0.01) in Group A. Median follow-up was 27.6months in Group A and 64.8months in B.

Conclusions:
PV-sparing approach, whenever feasible, preserves RV function, reduces post-operative complications, leading to better long-term prognosis. 4 feasibility indicators must be taken into account: pre-operative PV Z-score higher than -3, adequate PV morphology and annulus according to age and BSA and intra-operative Prv/Plv ratio <0.75.
RF16 EARLY ASPIRIN NON-RESPONDERS IDENTIFICATION BY ROUTINE USE OF AGGREGOMETRY TEST IN LVAD (LEFT VENTRICLE ASSIST DEVICE) PATIENTS REDUCES THE RISK OF PUMP THROMBOSIS.
Authors: Montalto A. , Comisso M. , Cammardella A. , Gherli R. , Palermo A. , Pulcinelli F. , Musumeci F. 
Published: November 2018

Introduction:
LVAD management is really challenging since inadequate anticoagulation treatment can lead to life threatening sistuations like ischemic stroke or pump thrombosis. Main intention of our study was to investigate if early identification of aspirin non responders can improve anticoagulation management and then reduce the risk of pump thrombosis.

Methods:
From december 2010 to may 2018 24 patients were implanted with HM II, 6 received an HVAD and 22 an HM 3. A target INR of 2.0 to 3.0 was maintained in all the patients. 100 mg aspirin were initiated only when a normal platelet function emerged at basal postoperative aggregometry. Aspirin non responders were early identified by repeating the aggregometry after seven days of administration and then clopidogrel 75 mg was used and platelet function tested again. Ticlopidine 250 mg was administrated when also clopidogrel was unsuccessful.

Results:
6 patients required modification in antiplatelet therapy. 3 patients (5%), 2 HVAD and 1 HM II, suffered from pump thromosis. 1 patient died as a consequence of large intracranial hemorragic event following thrombolitic treatment. 1 patient required pump exchange and in 1 patient thrombolitic infusion was conducted successfully.

Conclusions:
reported rates of pump thrombosis at 12 months for patients implanted with commonly used LVADs are 6 % to 12 % for axial - flow pumps and 8 % with centrifugal - flow devices. in our serie the reported 5 % overall incidence of pump thrombosis encourage the routine use of aggregometry test to early identify aspirin non responders.
RF46 MINI-ACCESS ISOLATED AORTIC VALVE REOPERATION WITH PERCEVAL SUTURELESS PROSTHESIS
Authors: Mikus E. , Pagliaro M. , Tripodi A. , Raviola E. , Calvi S. , Magnano D. , Albertini A. 
Published: November 2018

Background and aim:
Literature data regarding the use of upper “J” hemi-sternotomy in reoperative aortic valve replacement show a reduction in the biological trauma primarily due to the limited mediastinal tissues dissection avoiding excessive blood loss. Based on encouraging results reported for minimally invasive aortic valve replacement and with sutureless prosthesis we decided to use the Perceval valve in redo aortic valve replacement with minimally invasive approach.

Methods:
Seven patients underwent redo aortic valve replacement using a sutureless Perceval bio-prosthesis with a minimally invasive approach: four (57%) patients received upper hemisternotomy and three (43%) a right minithoracotomy. The median age was 75.9 ± 5 years and 5 of them (71.4% of the cohort) was male.Mean preoperative euroSCORE was 10.7 ± 1.2. Previous operation included: coronary artery bypass grafts (n°3), isolated aortic valve replacement (n°2), combined procedure (n°2).

Results:
The operation was performed with total central cannulation in 6 (86%) patients, in the seventh the ascending aorta was cannulated but a femoral venous percutaneous cannula was preferred for extreme frailty of the right atrium. Mean cardiopulmonary bypass and aortic cross clamp times were 56.6 ± 29.8 (median 47) and 44.3 ± 26.9 (median 33) minutes. No conversion to full sternotomy was required. There was no hospital mortality within 30 days of operation.

Conclusions:
Mini-access isolated aortic valve surgery with sutureless prosthesis is a reproducible, safe and effective procedure also in case of reoperation. It can improve the outcome by minimizing trauma, preventing postoperative complications and it could be an alternative to valve in valve in selected patients.
IS THERE A ROLE OF CARDIOMYOPATHY FOR RESIDUAL MITRAL REGURGITATION AND PULMONARY HYPERTENSION DURING LVAD SUPPORT?
Authors: Cannata A. , Costetti A. , Lanfranconi M. , Merlanti B. , Brenna D. , Gagliardone M.P. , Frigerio M. , Russo C.F. 
Published: November 2018

Background and aims:
It is unfrequent to observe residual mitral regurgitation (MR) during left ventricular assist device (LVAD) support. However, it could be associated to less reverse remodeling of the left ventricle (LV) and worse clinical outcomes. Study aim is to verify if cardiomyopathy is associated to residual 3-4 + MR and higher pulmonary pressures at one year after LVAD implant.

Methods:
We analysed data of 85 patients affected by idiopathic dilated (IDC; n = 42) or ischemic cardiomyopathy (IC; n = 43) who underwent intracorporeal LVAD implant at our hospital between 2007 and 2017. Mean age was 55.2 ± 8.5 years. Thoratec HeartMate II and Heartware HVAD were implanted in 54 (63.5%) and 31 (36.5%) patients, respectively. Nine patients (10.6%) died in-hospital following LVAD implant.

Results:
In study population the prevalence of 3-4 + MR decreased significantly at one year as compared to the preoperative assessment (54.1% vs 8.3%, p .0001). Both pulmonary capillary wedge pressure (24.7 vs 13,3mmHg, p.0001) and systolic pulmonary artery pressure (55.3 vs 36.1mmHg, p.0001) significantly decreased during support. At one year prevalence of residual 3-4 + MR was higher in patients affected by IDC than in patients affected by IC (11.9% vs 4.7%, p.19). LV end-diastolic diameter was higher among patients with residual 3-4 + MR (pre-implant:74,0 vs 70,6 mm, p.50; at one year:70,0 vs 65,2 mm, p.23).

Conclusions:
LVAD improves significant MR and pulmonary hypertension in most of patients. However, among patients affected by IDC prevalence of residual 3-4 + MR is higher and it associated to more dilated LV before and after implant.
RF90 USE OF IMPELLA IN OFF PUMP MYOCARDIAL REVASCULARIZATION WITH EF BELOW 30 %.
Authors: Pepino P. , Germano C. , Giordano S. , Provenzano R. , Oliviero P. , La Marca A. , Bellino I. , Di Benedetto G. , Giordano A. 
Published: November 2018

Background and Aim:
Patients undergoing coronary surgery are changed in the last years becoming a challenge for the cardiac surgeon not only for the quality of the coronary artery involved in the disease but mainly for the quality of patients in terms of low ejection fraction, elderly, COPD, kidney failure, Diabetes. Beating heart myocardial revascularization is a well established surgical technique but in case of very low EF (below 30%) there is a particular high surgical risk of conversion to on-pump surgery. The recently developed of Impella device (Abiomed, Danvers, MA) represent a compromise between circulatory support and limited invasiveness.

Methods:
Six patients, male, admitted for acute coronary syndrome with three vessels CAD with low ejection fraction were operated in our department. Impella Recover LP 5.0 device was inserted via surgical exposure of the right femoral artery in one case and an Impella recover LP 4,5 via percutaneous insertion of the femoral artery in five cases.

Results:
The myocardial revascularization was performed using a complete arterial revascularization. The device was left in for 48 Hours after the operation. All patients were discharged home after 9-10 days after admission and a follow up echocardiography performed six month up to two year after the operation showed an increase of the ejection fraction up to 40-45%.

Conclusions:
Use of the Impella Recover device for patients undergoing off pump CABG is feasible and safe, and appears a promising strategy to improve short- and long-term outcomes.