bluuebunny/crossref_metadata_2025_split huggingface dataset:
VD19 TRANS-FEMORAL IMPLANT OF A BALLOON EXPANDABLE AORTIC VALVE IN A LEAKING SUTURELESS SELF-EXPANDABLE VALVE
Authors: Loforte A. , Coppola G. , Amodio C. , Folesani G. , Saia F. , Taglieri N. , Marozzini C. , Savini C. , Pacini D. , Di Bartolomeo R. 
Published: November 2018

Abstract
We report the case of a 83-year-old woman affected by aortic valve stenosis who underwent a minimally invasive Perceval S (size M) implantation. Intraoperative monitorings ruled out any any valvular leakage or valve dislocation. On postoperative day 3, a trans-thoracic echocardiography revealed a severe aortic valvular regurgitation with an isolated partial collapse of the basal ring at the right coronary sinus, as confimed by additional imagings.
Transfemoral percutaneous Edwards Sapien XT 23 mm was successfully deployed as aortic valve in-valve (A-ViV) interventionwith excellent result.
Despite the suspicious of a sutureless prosthesis mismatch or an uncorrect placement of the Perceval S, we consistently suppose that the preoperative severe septal hypertrophy exacerbated by postoperative edema might have played a significant role in the eventual dynamic sutureless valve infolding.
This report confirms the rare but possible sutureless vave related adverse events which may be corrected by the current transcatheter A-ViV procedures.
VD16 SUTURELESS MINIAVR WITH RIGHT ANTERIOR THORACOTOMY AND ULTRA FAST TRACK ANAESTHESIA: OUR MULTIDISCIPLINARY APPROACH IN ANCONA
Authors: Berretta P. , Cefarelli M. , Zingaro C. , Pierri M. , Capestro F. , Di Eusanio M. 
Published: November 2018

Abstract
While anatomical and clinical indications to transcatheter aortic valve interventions are expanding, surgical aortic valve replacement continues to progress as demonstrated by improving clinical outcomes in contemporary patients’ cohorts. However, mainly due to the availability of significantly less invasive trans-catheter cardiac interventions, patients’ expectations have dramatically changed in the last decade with reduced trauma and fast recovery being now strongly valued. An increasing employment of minimally invasive multidisciplinary approaches that call surgeons, anaesthesiologists, perfusionists, nurses and physiotherapists to more efficacious collaborative efforts becomes so crucial to minimize surgical invasiveness as well as to decrease the psychological impact of surgery and fasten patient's return to pre-operative lifestyle. With this video we would like to share our multidisciplinary approach to aortic valve replacement. This involves a right anterior mini-thoracotomy, the implantation of a sutureless Livanova Perceval S valve and ultra fast track anaesthetic protocols.
EP20 INTRACARDIAC MASSES: PROTOCOL EVOLUTION OVER 15 YEARS IN A HIGH VOLUME REFERRAL CENTER
Authors: Saccocci M. , Ricciardi G. , Corona S. , Previtali I. , Zanobini M. , Pepi M. , Alamanni F. 
Published: November 2018

Abstract

Background:
Intracardiac masses are not such uncommon findings in daily clinical routine. They can be essentially subdivided into tumors, thrombi, anatomical variation and infective vegetations. The 75 % of Primary cardiac tumors are benign and are mainly represented by myxomas; while the 25% remnants are subdivided between sarcomas (95%) and lymphomas (5%). Clinical presentation is often non-specific leading to delay in diagnosis. This study aims to analyze outcomes and evolution of the protocol management of tertiary high volume referral center over the last 15yrs.

Methods:
We retrospectively analyzed 83 consecutive patients who underwent surgical removal of intracardiac mass from January 2004 to January 2018. All the patients underwent preoperative transthoracic echocardiography. Cardiac CTscan, endomyocardial biopsy, and MRI were performed in selected cases. Symptoms presentation, Implantation site, macroscopic description and histological classification was collected. Preoperative Multidisciplinary team discussion was carried out for all elective cases. Different surgical techniques have been used according to type and localization of the lesions. Follow-up was performed by phone calls +/- TT-Echo and clinical visits.

Results:
Perioperative mortality was 0%. The percentage of the different type of masses, origins, and aspect are reported in the figure.

Conclusion:
TTE remains the first-line diagnosis method. In the modern era, intracardiac masses can benefit from multi-imaging preoperative assessment to maximize diagnosis accuracy and to choose the most appropriate surgical technique and approach. Optimal surgical excision technique is crucial. To achieve excellent outcomes dedicated referrals centers are needed. An interdisciplinary approach is essential: oncologists, echocardiographists, and surgeons must cooperate closely.
EP13 EVOLUTIONARY AND CYCLICAL CHANGES IN CARDIAC SURGERY
Authors: Picichè M. , Dato G. Actis , Lorusso R. , Salvador L. 
Published: November 2018

Abstract

Background and aim:
The analysis of modern models and criteria discloses that current cardiac surgery often recalls the past. The aim of this study is to investigate whether historical knowledge is an important tool for research in aortic valve surgery and myocardial revascularization.

Methods:
PubMed, Scopus and Sciencedirect analysis of past and current literature were adopted to compare previous and current ideas.

Results:
In 1922, Graham and Allen introduced a cardioscope and a knife through the subclavian artery, or the left ventricular apex, to divide calcified aortic valve leaflets. This technique is a precursor of TAVI. The concept of sutureless prosthesis existed in the fifties and sixties. Hufnagel routinely implanted sutureless prostheses in the descending thoracic aorta to treat aortic insufficiency. The sutureless Magovern-Cromie valve has been implanted in orthotropic position from 1964 onward.
The Sen's technique of trans-ventricular tunnels is a precursor of laser trans-myocardial revascularization. The Italian technique of internal mammary arteries ligature to treat angina pectoris, dating back to 1939 (Fieschi), and to the 50’ (Battezzati) was rediscovered, following 50 years of silence, in 2010. Endovascular occlusion of the mammary arteries by embolization has been suggested to treat patients suffering from angina not amenable to conventional revascularization techniques.

Conclusions:
Knowledge of old ideas and experiments, released from the technological constraints of their time, can be useful in current research. Ingenious theories that have fallen by the wayside can be brought back and explored again. History is a cycle. Heart valve surgery and myocardial revascularization are no exception.
EP11 DOES TYPE OF CARDIOPLEGIA AFFECT THE INCIDENCE OF POSTOPERATIVE PAROXYSMAL ATRIAL FIBRILLATION IN PATIENTS UNDERGOING CARDIAC SURGERY?
Authors: Nardi P. , Scafuri A. , Bertoldo F. , Pisano C. , Bernardini A. , Bassano C. , Pellegrino A. , Ruvolo G. 
Published: November 2018

Abstract

Background and Aim:
Paroxysmal atrial fibrillation (PAF) is the most frequent complication following cardiac surgery. Despite high incidence, its etiology remains uncler. Aim of our investigation was to analyze retrospectively the pathogenetic role of different types of cardioplegia on the onset of PAF.

Methods:
Sixty-hundred and sixty patients underwent on-pump cardiac surgery between January 2015 and October 2016. Redo operations and emergency surgery were excluded. The types of cardiolplegic solution administered were warm blood cardioplegia (Calafiore, n = 480), cold crystalloid extracellular cardioplegia (St. Thomas, n = 71), cold crystalloid intracellular cardioplegia (Custodiol, n = 109). The way of admistation was antegrade for all types of cardioplegic solution.

Results:
The incidence of postoperative PAF was 36.2% (239 patients). Two-hundred patients were initially treated by mens of amiodarone infusion that successfully allowed cardioversion in 167 cases (83.5%); in the other 39 patients were initially administered other drugs (i.e. verapamil e.v./per os, beta-blokers per os). A relation between the type of cardioplegic solution and the onset of postoperative PAF was not found (Calafiore, n = 180, 37.5%; St. Thomas, n = 22, 31%; Custodiol, n = 37, 34%; p = NS). Advanced age at operation (71.3 ± 8.7 vs. 65.7 ± 11 years) was the only independent predictor of PAF (p < 0.001). Non-coronary surgery was found as risk factor for PAF at the univariate analysis only (p < 0.01).

Conclusions:
The use of different type of cardioplegic solutions, and at different temperatures, does not correlate with the onset of postoperative PAF. Initial treatment strategy with amiodarone infusion allows pharmacological cardioversion of PAF in over 80% of cases.
RF15 DOES RE-DO AORTIC VALVE SURGERY STILL HAVE A ROLE IN THE ERA OF TRANS-CATHETER AORTIC VALVE IMPLANTATION?
Authors: Greco R. , Hill E. , Jin X. , Renna M. , Djordjevic J. , Petrou M. 
Published: November 2018

Abstract

Background and aim:
Re-do aortic valve replacements (AVR) have higher mortality and morbidity compared to first time AVR. Trans-catheter aortic valve implantation (TAVI) is an option for high-risk patients. The aim of the study is to present our experience with re-do aortic procedures.

Method:
Retrospective review of 80 patients (mean age 51.8 ± 18.73) who underwent re-do aortic valve procedures (2008–2017). 41 (51.2%) had re-do AVR and 39 (48.8%) re-do complex aortic surgery (28 root, 23 ascending and 6 hemiarch).

Results:
Mean Euroscore II was 8.3% (higher in the complex group 12 vs 5%). 19% of patients had a mechanical valve implanted as result of previous surgery. Indication for reoperation was: infective endocarditis in 19 (23.8%) (12 root abscess), bio-prosthesis degeneration in 10 (12.5%), mechanical valve dysfunction in 4 (5%), aortic aneurysm, pseudoaneurysm and dissection in 28 (35%), root/homograft degeneration in 22 (27.5%), patient-prosthesis mismatch in 3 (3.8%), paravalvular leak in 5 (6.2%), native valve disease in 20 (25%). 65.4% of patient had significant AR and 37,5% required concomitant procedures. IH mortality was 2.5% (0% re-do AVR vs 5.1% re-do complex).

Conclusion:
A large number of patients presented with contraindications for TAVI: age < 60 (61%), previous mechanical valve (18.8%), significant AR (65.4%), infective endocarditis (23.8%), need for complex aortic procedure (49%) or concomitant surgery (37.5%). The number of patients that would actally benefit from TAVI procedures is overestimated. Re-do aortic surgery remains the only treatment for such challenging cases and can be performed with acceptably low mortality and morbidity.
VD03 AN INTERESTING COMPLICATION FROM BROOKLYN
Authors: Territo S. , Mangerini V. , Agostara V. , Torre S. , Castrovinci S. , Giarratana G. , Bono M. , Argano V. 
Published: November 2018

We present a 68 years-old lady with ascending aortic pseudoaneurysm discovered by CT-angio 11 years after CABG in the States. Three out of 4 grafts were patent. Once the aorta was opened we found a localised chronic dissection likely originating from previous aortic cannulation site.
In this video we show chest reopening, aneurysm isolation and cannulation in the arch and right atrium. Aortic clamp was applied high, aneurysm was opened and the dissected aorta resected, keeping 4 top-ends attached to the aortic wall as an island. Cardioplegia was given into aortic root and selectively into venous grafts. An interposition 26 mm vascular conduit was anastomosed to sino-tubular junction and distal ascending aorta. After unclamping, the island containing top-ends was reattached to vascular conduit by 10 mm interposition graft.
EP36 SUTURELESS AORTIC BIOPROSTHESIS IS ASSOCIATED WITH IMPROVEMENT OF EJECTION FRACTION IN PATIENTS WITH PREOPERATIVE LEFT VENTRICULAR DYSFUNCTION
Authors: Concistrè G. , Bianchi G. , Chiaramonti F. , Santarelli F. , Gasbarri T. , Kallushi E. , Cerillo A.G. , Murzi M. , Margaryan R. , Farneti P. , Solinas M. 
Published: November 2018

Background and Aim:
Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of sutureless Perceval (LivaNova, Italy) aortic bioprosthesis on LVEF and clinical outcomes in patients with baseline left ventricular dysfunction underwent isolated aortic valve replacement.

Methods:
Between March 2011 and August 2017, 803 patients underwent AVR with Perceval bioprosthesis implantation. Fifty-two patients had preoperative LVEF ≤ 45%. Mean age of these patients was 77 ± 6 years, twenty-four patients were female (46%), and mean logistic EuroSCORE was 17.7 ± 10.2%. Perceval bioprosthesis was implanted in 9 REDO operations. In 43 patients (83%), AVR was performed in minimally invasive surgery with an upper ministernotomy (n = 13) or right anterior minithoracotomy (n = 30).

Results:
One patient died in-hospital. Cardiopulmonary bypass and aortic cross-clamp times were 98 ± 26 minutes and 61 ± 19 minutes, respectively. At mean follow-up of 33 ± 20 months (range: 1–75 months), survival was 90%, freedom from reoperation was 100%, and mean transvalvular pressure gradient was 11 ± 5 mmHg. LVEF improved from 37 ± 7% preoperatively to 43 ± 8% at discharge (p < 0.01) and further increased to 47 ± 9% at follow-up (p = 0.06), and moderate paravalvular leakage occurred in one patient without hemolysis not requiring any treatment.

Conclusions:
AVR with sutureless aortic bioprosthesis implantation in patients with preoperative left ventricular dysfunction demonstrated a significant immediate and early improvement in LVEF.
EP07 AORTIC VALVE REPAIR TECHNIQUES: AN EARLY EXPERIENCE FROM A SINGLE UK CENTRE
Authors: Greco R. , Jin X. , Petrou M. 
Published: November 2018

Background and aim:
Aortic valve repair (AVr) is an evolving area with only few European centres reporting a large volume experience. Very few other surgical units have adopted this approach, even in patients with pure aortic regurgitation (AR). Our aim is to report our early experience with AVr techniques.

Method:
59 patients with a mean age of 49 years (range 19–85) underwent AVr for either primary (cusp prolapse or perforation) or secondary (aortic root and/or ascending aneurysms) AR. 14 patients had a bicuspid aortic valve. Standard repair techniques were used including: sub-commissural annuloplasty, STJ remodelling, free-edge plication, commissural resuspension, raphe resection, free-edge reinforcement and VSRR.

Results:
All patients underwent successful AVr including 1 patient who required a 2nd pump run. The post-bypass TOE demonstrated no/trace AR in 49 (83%) cases, mild central AR in 8 (13.6%) and mild eccentric AR in only 2 (3.4%) cases. 30 day survival was 100%. 2 patients suffered post-operative strokes, none required PPM insertion. At a mean clinical follow-up of 4.7 ± 2.7 years all patients are alive and well. Echo follow-up (2.3 ± 1.9 y) showed: no or trace AR in 25 patients (42.4%), mild AR in 22 patients (37.3%), moderate AR in 11 patients (18.6%), severe AR in 1 patient (1.7%), who underwent re-do AVR 5 years after VSRR. Freedom from re-operation was 87% at 8 years.

Conclusion:
Despite achieving an excellent immediate (post-bypass) technical result, we remain cautious about the long-term durability of AVr procedures. We therefore continue to carefully evaluate AVr in our practice.
RF09 BEST OF BOTH WORLDS: DIRECT-VISION BALLON-EXPANDABLE TRANSCATETHER PROSTHESIS WITH EXCISION OF ANTERIOR MITRAL LEAFLET TO TREAT SEVERE STENOSIS IN BIG MITRAL ANNULAR CALCIFICATION PATIENTS
Authors: Weltert L. , D’Aleo S. , Chirichilli I. , Wolf L. Guerrieri , Ricci A. , Scaffa R. , Salica A. , Bellisario A. , De Paulis R. 
Published: November 2018

Background and aim:
The mitral annular calcification (MAC) is one of the most demanding and exciting challenges for the cardiac surgeon. Numerous surgical techniques to approach MAC have been described, and many include decalcification and annular reconstruction. The aim of this study is to describe an alternative method of treatment of the MAC, performing surgical implant of a prosthesis designed for the percutaneous implant in aortic position under direct vision and to define the applicability criteria.

Methods:
Preoperative evaluation is a key point to define the possible treatment options of the MAC. The CT-scan is the fundamental tool that allows quantification of calcium and its possible extension in the underlying myocardium. An indispensable criterion is that the calcification interests the annulus in an almost completely circumferential manner, in such a way as to allow a safe deployment prosthesis.

Results:
We report a surgical approach to manage MAC and avoid calcium debridement by using a prosthesis designed for TAVI procedures. The anulus is measured with an Egar dilator and part of the anterior mitral leaflet is removed which creates room for a bigger implant. An Edwards SAPIEN 3 Transcatheter Heart Valve is implanted in the mitral annulus under direct vision and then the crimped valve is deployed with a manual inflation device. Inflation of the ventricle with saline allows to identify any valvular leaks and correct them by placement of one or more stitches.

Conclusions:
This technique seems a safe and effective solution for treating the MAC in selected cases.
RF72 RIGHT VENTRICLE EVALUATION BY CARDIAC MAGNETIC RESONANCE BEFORE AND AFTER MITRAL VALVE SURGERY
Authors: Pettinari M. , Lazam S. , De Kerchove L. , Pasquet A. , Gerber B. , Vanoverschelde J. , El-Khoury G. 
Published: November 2018

Introduction:
There has been growing attention for the development of functional tricuspid regurgitation (TR) and right ventricular dysfunction after left-sided valve surgery. The fate of right ventricle function after mitral valve surgery is still not well defined. Our study aims to describe the evolutions of RV volumes and function evaluated by cardiac magnetic resonance (CMR) after mitral valve surgery in patients with less then severe tricuspid regurgitation.

Methods:
Sixty patients undergoing mitral valve surgery (58 for degenerative and 2 for functional disease) were analysed by CMR preoperative and at 6 months. Two patient with severe tricuspid regurgitation and 6 who received a tricuspid annuloplasty were exclude, with 52 patients remained for the analysis. Indexed end-diastolic and systolic volumes (RVEDVi and RVESVi) ejection fraction (RVEF) and stroke volume (RVSV) were the primary outcomes of the study. Multivariate linear regression was used to identify risk factors related to the right ventricle volumes and function improvement.

Results:
Mean age was 57+/-21 years and 40 patients were male. In the global population RVEDVi(83.5 ml/m2 vs 80.1 ml/m2, p < 0.01), RVESVi(43.4 ml/m2 vs 38.6 ml/m2, p < 0.01) and RV ejection fraction(48.3% vs 52.4%, p < 0.01) improved significantly while the stroke volume(78.1 ml vs 79.7 ml, p = 0.6) did not. Preoperative RVESVi(p < 0.01) and RVEDVi were the most significant predictors of improvement in volumes after surgery(p < 0.01).

Conclusion:
Mitral valve surgery seems to have a positive effect on right ventricle volumes and function improve after surgery for mitral valve disease in patients with less than severe tricuspid regurgitation without other prophylactic procedure.
RF18 EDGE TO EDGE PROCEDURE AS AN ALTERNATIVE TO QUADRANGOLAR RESECTION OF ISOLATED PROLAPSE OF POSTERIOR MITRAL LEAFLET
Authors: Bortolami A. , Fucci C. , de Cicco G. , Latini L. , di Matteo D. , Aquino T.M. , Prencipe A. , Coletti G. 
Published: November 2018

Backgruond and Aim:
We present our casuistry links to prolapse/flail of P2 LPM in mitral regurgitation treated with edge-to-edge technique when contraindicated to quadrangolar resection.
We hereby present our experience using a modified edge-to-edge technique to address this peculiar MR.

Methods:
From January 1999 to January 2015, 89 consecutive patients (mean age 56 ± 14,56, 53 males) affected by prolapse/flail of P2 LPM in mitral regurgitation. Preoperative transesophageal echo (TEE) in all the cases showed prolapse/flail of P2 LPM when it exists a controindication to quadrangolar resection like: extensive resection 52%, posterior anulus calcification 23%, hypertrofic/small ventricle 27%. In all the patients, a doble orifice valve (DOV) repair with annuloplasty was performed. Intra-operative TEE and postoperative transthoracic echocardiography (TTE) were carried out to evaluate results of the DOV repair.

Results:
There was no in-hospital death. At intra-operative TEE, the two orifices showed a mean total valve area of area 3,06 ± 0,63 cm with no residual regurgitation or trivial and no sign of valve stenosis (Grad med 3,73 ± 1,66; Grad max 11,02 ± 7,48). At follow up (from 1999 to 2015) we appreciated a freedom from reoperation 97%(fig.1) and survival 95% (Fig. 1).

Conclusions:
We consider edge to edge a valid alternative in pts with prolapse/flail of P2 in LPM when exist: extensive resection that may determinate a residual mitral regurgitation by LPM retraction, posterior anulus calcification that may determinate no possibility of annular plication and hypertrofic/small ventricle for high risk of persistent SAM.
RF49 MINIMALLY INVASIVE SURGERY: KEY HOLE APPROACH
Authors: Rosa R. , Vanelli P. , Contino M. , Romagnoni C. , Cagnoni G. , Antona C. 
Published: November 2018

Background and Aim:
Minimally invasive surgery through right minithoracotomy is routinely performed in mitral valve repair and the current tendency is to further simplify the procedure and reduce invasiveness and trauma on tissues for faster postoperative recovery.

Methods:
In our experience, 175 patients underwent minithoracotomy (52,3% males) from August 2012 to May 2018. In the last 6 months, 7 patients were selected for “Key Hole Surgery” through a 3-3,5 cm periareolar incision along the convexity of the right areola; the thoracoscopy was positioned on anterior axillar line in the same right intercostal space.

Results:
The endoscopic vision was always obtimal, ensuring an effective control in repairing procedures. A complete ring was always implanted; according to the features and mechanism of mitral regurgitation, in some cases we performed a resection of the posterior leaflet, in other cases we preferred a “respect-no-resect” approach (even chordal traslocation).

Conclusions:
Compared to anterolateral minithoracotomy, the advantages of this approach are a minor trauma (often caused by intercostal retraction), better control of postoperative pain and better result from the aesthetic point of view, because the incision exploits the hyperchromy of the periareolar area making the scar almost invisible. The indirect disadvantages of the procedure are related to the fact that such a limited incision does not permit central cannulation and aortic cross-clamping, from which the need of a femoral peripheral cannula and the use of the device Intraclude for aortic clamping are derived; this guarantees a “no-touch-aorta” intervention and great reduction of risk of post-operative bleeding.