bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC55 OUTCOME OF HEART TRANSPLANTATION WITH MARGINAL DONORS: COLD STORAGE VS NORMOTHERMIC PERFUSION
Authors: Sponga S. , Ferrara V. , Beltrami A. , Bonetti A. , Cantarutti C. , Caragnano A. , Esposito G. , Lechiancole A. , Guzzi G. , Meneguzzi M. , Nalon S. , Ortolani F. , Piani D. , Livi U. 
Published: November 2018

Abstract

Background and aim:
The ex-vivo normothermic perfusion in Heart Transplantation (HTx) allows to expand the donor pool by reducing the ischemic time and providing graft evaluation. Aim of the study was to compare the traditional cold storage (CS) and ex-vivo normothermic perfusion (EVP) in HTx employing marginal donors.

Methods:
From 2011 to 2018, 88 HTx employing marginal donors (age>55 years; expected ischemic time>4 h; LVEF<50%; IVS>14 mm; drug abuse; cardiac arrest; CAD) in standard recipients has been performed, 69 (78%) grafts maintained in CS vs. 19 (22%) in EVP. Endomyocardial biopsies were collected at time of organ retrieval, before implantation and after aortic declamping.

Results:
No pre-operative differences were found in the two groups. Three organs (16%) were considered not suitable for HTx after EVP, avoiding possible Primary Graft Failure. EVP group showed a better outcome: a 5-year survival of 100% vs. 94.2%, 83% and 72% at 30-day, 1 and 5 years respectively in CS group (p = 0.10); less overall complications (50% vs. 89.9%, p < 0.01), IABP need (0 vs. 23.2%, p = 0.02), shorter mechanical ventilation (24 vs. 48 hours, p = 0.04) and ICU stay (5 vs. 6 days, p = 0.07). In CS group, endomyocardial biopsies showed a tendency for more prominent myocardial damage after heart reperfusion, especially underlined by mitochondrial and organelles dysfunction.

Conclusions:
EVP permits a safe evaluation of marginal donors, excluding not suitable grafts. Moreover, allows to reduce complications and to obtain optimal survival after HTx. Pathological findings show a tendency for better myocardial protection, confirming clinical results.
OC49 NEW HEMODYNAMIC INDEX TO IDENTIFY DIFFERENT PROFILES IN PATIENTS IMPLANTED WITH HM3
Authors: Montalto A. , Piazza V. , Cammardella A. , Comisso M. , Contento C. , Vitalini E. , Musumeci F. 
Published: November 2018

Abstract

Introduction:
LVAD (Left Ventricle Assist Device) represents a valid alternative to heart transplantation in patients who suffer from end stage heart failure. The ventricular devices show a different performance related to preload, afterload and the fixed setted revolutions per minute (RPM). Our main intention was to introduce a new hemodynamic index that accounting for the RPM setted, can easily identify different hemodynamic profiles occurring during LVAD support.

Methods:
From november 2015 to march 2018, 19 patients implanted with HM 3 underwent ramp tests during right heart catheterization. Basal data were collected and Hemodynamic Index (HI) was calculated according to the following formula: HI = {[PAM - PCWP]/CVP}∗ {[RPM SETTED∗100]/MAX RPM} where the first term is the ratio between afterload and preload and the second term means the ratio between the RPM setted and the maximal rpm available.

Results:
Basal HI was 455 ± 142. In 8 patients (42%) an index less than 400 was found. Three main profiles could be identified. Profile 1 HI less than 300 and higher risk of right failure. Profile 2 HI between 300 and 600, requiring speed optimization, Profile 3 HI> 600 requiring afterload optimization. After a tailored therapy including speed and anti hypertensive optimization a better HI (583 ± 224)was obtained.

Conclusion:
RPM should be setted balancing an optimal unloading with adequate afterload and preload and accounting for the right ventricular function. We proposed a new hemodynamic index that integrating different variables can stratify patients in three main profiles according to which the best treatment can be provided.
OC73 SYSTEMATIC REVIEW OF THE PREDICTIVE ACCURACY OF POINT OF CARE TESTS OF COAGULOPATHY IN CARDIAC SURGERY
Authors: Corazzari C. , Monaghan A. , Tutino C. , Murphy G. , Beghi C. 
Published: November 2018

Abstract

Background:
Coagulopathic haemorrhage is a common and serious complication of cardiac surgery.
Timely diagnosis and treatment of coagulopathy is considered an important determinant of outcome. The aims of the review were to quantify and compare the predictive accuracy of POC tests in clinical use.

Methods:
Observational studies and randomized controlled trials that report measures of predictive accuracy for POC tests that are, or have been used clinically for the diagnosis and treatment of coagulopathic haemorrhage.

Results:
56 studies recruiting a total of 9123 participants, met the inclusion criteria for the qualitative analysis and 15 studies were included for quantitative analysis.
We have shown that the existing evidence is of insufficient quality to determine the predictive accuracy of point of care diagnostic tests.
The point estimates of the Summary AUCROC analyses and the analysis of sensitivity and specificity estimates from individual studies suggested that: Viscoelastic tests had low sensitivity and high specificity, Platelet Function Tests had low sensitivity and moderate specificity, and combined Viscoelastic and Platelet Function tests had high sensitivity and low specificity. However there was great uncertainty around all of these estimates and the 95% margins of uncertainty included values less 0.5 in every analysis. Calculated diagnostic odd ratios also indicated poor predictive accuracy for all of the groups.

Conclusions:
Coagulopathic haemorrhage remains a common and severe complication of cardiac surgery. A systematic review of available evidence did not demonstrate predictive accuracy for point-of-care tests in clinical use for the diagnosis of coagulopathy in cardiac surgery.
VD12 HYBRID TOTAL ENDOVASCULAR AORTIC REPAIR WITH CHIMNEY TECHNIQUE
Authors: Jiritano F. , Perri P. , Molinari V. , Esposito A. , Garrasi C. , Serraino G.F. , Intrieri F. , Mastroroberto P. 
Published: November 2018

Abstract
Total endovascular techniques, such as fenestrated and branched techniques, provide a less invasive and safer solution to aortic arch diseases in high risk patients. We report the case of a 69-year old Marfan's syndrome female with a post-dissection aortic arch aneurysm. Previously, the patient underwent Bentall procedure and an endovascular stenting for right renal artery aneurysm. Computed tomography angiography revealed a dissecting aneurysm of aortic arch and supra-aortic branches perfused by the true lumen. Hybrid repair of the dissection was considered primarily; however, the patient refused sternotomy. We fixed the aneurysm using TEVAR and used the chimney technique to reconstruct the supra-aortic vessels. Final control angiography confirmed complete exclusion of the aortic arch injury and the patency of the supra-aortic branches. We repaired also the abdominal aortic aneurysm performing an EVAR procedure. The patient is doing well after 3-months follow-up. Endovascular procedures can be used successfully for dissecting aortic aneurysm.
VD20 TWO-STAGES POSITIONING AND INFLATION OF THE BALLOON EXPANDING THE BIOPROSTHESIS IN TRANSCATHETER AORTIC VALVE IMPLANTATION IN A SMALL PORCELAIN AORTA
Authors: manzan E. , prestipino F. , miele M. , d’ascoli R. , luzi G. 
Published: November 2018

Abstract
We propose a two-stages positioning and inflation of the balloon expanding the Edwards SAPIEN 3 prosthesis during Transcatheter Aortic Valve Implantation (TAVI) in case of a small porcelain aorta, to avoid aortic root (AR) rupture.
We scheduled for Trans-apical TAVI an 85-year-old high-risk woman with a narrow and heavily calcified AR (19 × 20 mm at sino-tubular junction). A 23 mm Edwards Sapien3 prosthesis was directly implanted (without pre-valvuloplasty). First balloon-dilatation was performed in standard position till 70% of nominal inflation volume, in order to hook the prosthesis within the native calcified valve in the correct position. Then the balloon was completely deflated and withdrawn down into the left ventricle, with the distal tip just below the calcified and small aortic sino-tubular junction. In this position, a second balloon-dilatation was performed till 100% of nominal inflation volume to complete prosthesis expansion. Peri-operative trans-esophageal echocardiography showed no paravalvular leak and good trans-prosthesis gradients.
VD02 A ROLLER COASTER MEDIAN STERNOTOMY
Authors: Agostara V. , Torre S. , Mangerini V. , Territo S. , Castrovinci S. , Triolo F. , Argano V. 
Published: November 2018

Abstract
Pectus arcuatum, also known as Currarino-Silverman syndrome or pouter pigeon breast, is a rare disorder characterized by premature fusion of manubrio-sternal joint and the sternal segments. This condition may cause an abnormally short sternum with forward angulation at the Louis's angle resulting in a severely protruding upper sternum combined with depressed lower sternum.
Pectus arcuatum may be associated to cardiac diseases requiring surgery. Access to the heart may be complicated by the chest wall deformity.
In this video we present a case of a 75 years-old man who suffered from ACS-NSTEMI with coronary disease and pectus arcuatum. An off-pump single CABG using LIMA to LAD was peformed. SVG interposition was necessary due to difficult mammary harvesting in the protruding upper sternum. Here is shown the access to the mediastinum by an oscillating sternal saw, the application of a small sternal retractor, the pericardial opening and chest closure.
EP23 MINIMALLY INVASIVE MITRAL SURGERY THROUGH A RIGHT VERTICAL AXILLARY MINITHORACOTOMY: PRELIMINARY EXPERIENCE
Authors: Nicolardi S. , Mangia F. , Scrascia G. , Gallo A. , Amorese L. , Pano M. , Fellini P. , Rocco D. , Quacquaro A. Scotto di , Zaccaria S. , Greco C.A. , Casali G. 
Published: November 2018

Abstract

Background and Aim:
right antero-lateral minithoracotomy through the 3rd or 4th intercostal space is the classic approach for minimally invasive mitral surgery. We report our experience with an alternative and more cosmetic minimally invasive port-access through a right vertical axillary minithoracotomy (RVAMT).

Methods:
between July 2016 and April 2018, 60 patients (32 females and 28 males, mean age 66.2 ± 11.1 years) underwent mitral valve surgery through a RVAMT. Forty-six mitral valve repairs were performed, 4 associated to tricuspid repair. Only 14 pathological mitral valves have been replaced. RVAMT was performed by a 5–6 cm incision through the 4th intercostal space placed vertically along the antero-axillary line rather than antero-laterally along the intercostal space. All surgical procedures were performed without an endoscopic system.

Results:
mean CPB time and aortic cross clamp were 130.2 ± 26.1 minutes and 90.6 ± 16.6 minutes, respectively. There was no approach-related limitation to surgical exposure. Bleeding requiring surgical revision occurred in two patients. Median intensive care unit stay and mean mechanical ventilation time were 24 and 8.3 ± 5.4 hours, respectively. In-hospital mortality was 1.7% (1/60 patients). Overall survival at 6 months follow-up was 100%.

Conclusions:
RVAMT is a safe alternative, reproducible, cosmetic and minimally invasive approach for mitral valve surgery. It provides an optimal surgical viewing perpendicular to the mitral plane with satisfactory valve exposure and the possibility to perform surgery under direct vision. The cosmetic advantage of the RVAMT is the short incision under the armpit that is often invisible.
EP05 A RARE CASE OF SACCULAR SUPERIOR VENA CAVA ANEURYSM
Authors: Di Benedetto G. , Coronella G. , Giordano S. , Provenzano R. , Oliviero P. , La Marca A. , Bellino I. , Pepino P. 
Published: November 2018

Abstract

Background And Aim:
We present a rare case of SVC saccular aneurysm in a 60 year-old-female presenting at outpatient clinic with chest pain due to a recent chest trauma and occasional finding of mass at chest radiography. Considering the small amount of similar cases collected in literature we describe the diagnosis iter, surgical management and outcomes.

Methods:
Chest CT-scan was done with contrast showing a contrast filled mass adjacent to the ascending aorta (40 mm × 60 mm -neck diameter 30 mm). Off pump surgery was performed by SVC saccular aneurysm excision through a median sternotomy. After the pericardial incision and longitudinal right pleura opening to dissect the saccular aneurysm, the neck of the sac was encircled with silk 0 to exclude the aneurysm. After opening of the aneurismatic wall the aneurysm was resected and the aneurysmatic neck closed with a 4/0 prolene double running suture.

Results:
After an uneventful postoperative period of 24 hours in ICU the patient was discharged in 5th postoperative day on antiplatelet drugs. Ct-scan after surgery showed a regular profile of superior vena cava.

Conclusions:
CT scan is crucial to identify a contrast enhancing lesion adjacent to the ascending aorta. Fusiform aneurysm can be managed medically while saccular aneurysm needs surgical treatment in order to avoid complications due to pulmonary embolism and aneurysm rupture. Surgery can be performed safely off pump in case of not complicated aneurysm while has to be managed on pump in presence of thrombi, calcification or big neck dimension related to the aneurysmatic sac.
EP14 FLUID MANAGEMENT PROTOCOL APPLICATION WITH COLLOIDS ABOLITION REDUCES RE-EXPLORATION FOR BLEEDING AND BLOOD PRODUCTS USE IN CARDIAC SURGERY PATIENTS
Authors: Scrascia G. , Nicolardi S. , Panzera D. , Amorese L. , Pano M.A. , Mangia F. , Gallo A. , Fellini P. , Rocco D. , Cazzato M. , Quacquaro A. Scotto di , Zaccaria S. , Cucurachi M. , Greco C.A. , De Razza L.P. , Casali G. 
Published: November 2018

Abstract

Background and aim:
Colloids administration has been associated with post-operative acute kidney injury and bleeding. Aim of the study is to evaluate if the incidence of re-exploration for bleeding was modified by application of perioperative fluid management protocol with careful balanced crystalloids infusion and colloids administration abolition.

Methods:
We retrospectively analysed data collected in the Institutional database. 784 patients were considered in the analysis. 459 patients (Group A) underwent cardiac operations before perioperative fluid management protocol was strictly applied and 325 patients (Group B) underwent cardiac operations after protocol application.

Results:
No differences were found for pre-operative characteristics except for hypertension and NYHA class (higher in A Group). Intraoperative variables were similar in both groups. No differences were found between groups for post operative complications, except for the incidence of re-exploration for bleeding (4.3% vs 1.5%; p:0.02), time on mechanical ventilation (31.3 vs 13.4 hours; p:0.006), sternal wound infection (3.9 vs 0.3%; p:0.02), post-operative pneumonia incidence (2.9 vs 0%; p:0.01), mean RBC units transfused (3.8 vs 2.6 Units; p:0.03) and numbers of patients receiving fresh frozen plasma transfusions (13.7% vs 3.7%; p:0.02), which were higher in Group A.

Conclusions:
Fluid management protocol application and colloids avoidance significantly reduce re-exploration for bleeding and post-operative blood products use after cardiac surgery.
EP40 UNINTENTIONAL RETENTION OF FOREIGN OBJECTS IN SURGICAL SITES
Authors: Tiraforti S. , Cappelletti M.F. , Lorenzini M. , Biagini S. , Baroni M. 
Published: November 2018

Abstract

Background and Aim:
The unintentional retention of foreign objects in surgical patients represents a known event and is reported in literature, Italian Ministry of Health Recommendation No. 2, 2008 estimated that this occur once every 1000 - 3000 surgical procedures per year. The Recommendation provides a count of gauze and surgical instruments at the beginning and at the end of each surgical procedure. The material used in cardiac surgery comprises a variety of other small parts. We don’t know if these small parts are or not radiopaque, so we create a list of devices used to check if they were radiopaque or not. This information is useful for a possible radiographic post surgical check.

Methods:
In adult and pediatric cardiac surgery operating room, all the medical devices that are potentially at risk of retention have been reviewed, managing the indication on the label, and where not indicated, this information was provided with the manufacturer / distributor. In case it was not possible to find these information was performed a radiographic check of the materials.

Results:
A new list of material to be monitored in the pre- and post-procedure has been developed.

Conclusions:
Safety in the operating room is one of the main objectives in the quality and safety of patients. Future scenarios hope for continuous involvement by operators in detecting critical issues and signaling events by optimizing the pathways on health care.
EP15 HOW I DO IT: A BROADEN “COMMANDO PROCEDURE” FOR DESTRUCTIVE MITRO-AORTIC ENDOCARDITIS AND OTHER CHALLENGING SITUATIONS
Authors: Ricciardi G. , Bonalumi G. , Naliato M. , Cavallotti L. , Manganiello S. , Alamanni F. 
Published: November 2018

Abstract

Backgroound and aim:
The reconstruction of mitro-aortic continuity is an uncommon procedure occurring in around 1% of patients undergoing aortic valve replacement. It is performed more frequently in case of native (NVE) or prosthetic valve endocarditis (PVE). In case of PVE with para-valvular abscess, the infected tissue must be removed thoroughly to avoid risk of recurrent endocarditis [3]. A patch reconstruction is also required to implant new valves.
At Cleveland Clinic, these operations are referred to as “Commando operations”, an indicator of the procedure's challenges [4].

Methods:
We describe a successful broaden Commando procedure on a patient with a relapse of PVE of aortic valve and a destructive abscess of mitral annulus involving the interventricular septum, operated for the third time.
This case is part of a group of six patients treated at our Institution with extensive resection and reconstruction not only in case of infective disease, but also in presence of other conditions, such as cardiac tumors. In fact, in our series we adopted this procedure also for a locally invasive left atrial mixoma.

Results:
The last follow-up TT-Echo, performed at 1 year for all patients, shows normal functioning of newly implanted prosthetic valves, preserved LV function and no residual defects after reconstruction.

Conclusions:
A broaden Commando procedure can be adopted in case of disruption of the mitro-aortic curtain or cardiac tissues due to infective endocarditis or other causes, such as cardiac tumors.
RF48 MINIMALLY INVASIVE APPROACHES VIA RIGHT ANTERIOR MINITHORACOTOMY OR UPPER HEMI-STERNOTOMY FOR ISOLATED AORTIC VALVE REOPERATION: SINGLE CENTER EXPERIENCE
Authors: nardozza M. , paris M. , mikus E. , calvi S. , mammana L. , beggino C. , tamagnini G. , zulueta J.L. , del giglio M. 
Published: November 2018

Abstract

Objective:
Aortic valve replacement (AVR) after previous cardiac surgery is associated with an increased risk. This study compare the outcome after AVR through upper “J” ministernotomy or minithoracotomy versus standard full sternotomy in redo operation.

Methods:
We retrospectively reviewed 221 patients treated between October 2007 and November 2017; 91 (41%) had minimally invasive approach via right minithoracotomy (n°=11) or upper “J” ministernotomy (n°=80) and the remainings 130 (59%) had full sternotomy.

Results:
Mean age was 69.6 ± 12.0 years in minimally invasive group and 69.02 ± 13.0 for the full sternotomy group (p = 0.46).No differences in terms of body mass index (p = 0.70), left ventricular ejection fraction (p = 0.58) and EURO score (p = 0.32) between two groups. Intraoperative data and postoperative outcomes have been analyzed.
Mean cardiopulmonary bypass time and cross-clamp time were respectively 68.6 ± 23.9 min and 53.6 ± 20.9 in the minimally invasive group and 83.9 ± 41.7 min and 61.15 ± 26.7 in the full sternotomy group (p < 0,005); 64% of patients in minimally invasive group and 66% in sternotomy group underwent blood transfusions (p = 0.72). Post operative ventilation time was lower in patients treated with minimally invasive technique: median was 6 versus 11 hours (p = 0.93). Median intensive care unit stay for patients operated through a mini-invasive approach vs full sternotomy was very similar (2 vs 1,93 days; p = 0.90). In-hospital mortality in the minimally invasive group was 3,2% (3/91) compared to 4.6% for the full sternotomy group (6/130) (p = 0.70).

Conclusions:
Minimally invasive aortic valve reoperation proved to be as safe as standard procedure in terms of hospital morbidity and mortality rates.
VD10 FROZEN ELEPHANT TRUNK AND DAVID PROCEDURE BY USING THORAFLEX AND GORE HYBRID PROSTHESES IN A MARFAN PATIENT WITH ACUTE TYPE A AORTIC DISSECTION
Authors: Barberio G. , Di Marco L. , Murana G. , Leone A. , Berardi M. , Gliozzi G. , Folesani G. , Coppola G. , Pacini D. , Di Bartolomeo R. 
Published: November 2018

We present the case of a 19-year-old Marfan patient with 53 mm ascending aorta aneurysm complicated by acute type A aortic dissection.
Cardiopulmonary bypass was established by cannulation of right femoral artery and right atrium. Moderate (25°C) hypotermic circulatory arrest was used and the aortic root prepared for reimplantation technique. At 25°C, the aortic arch was opened and the antegrade selective cerebral perfusion was established through cannulation of brachiocephalic trunk and left carotid artery. A 22/24 mm Thoraflex hybrid graft was used and distal anstomosis performed in arch zone 2. During the rewarming, the supraaortic vessels were separately reimplanted, using also a Gore 8 mm prosthesis for the left subclavian artery. The aortic valve was reimplanted in a 30 mm Valsalva conduit. The procedure was completed with the suture of the two vascular conduits. Post-operative echocardiogram showed a well-functioning aortic valve and angio CT scan showed a good surgical result.
VD11 FROZEN ELEPHANT TRUNK BY USING E-VITA PROSTHESES AND BENTALL PROCEDURE IN A GIANT DESCENDING THORACIC AORTA ANEURYSM
Authors: Alfonsi J. , Leone A. , Di Marco L. , Murana G. , Amodio C. , Berardi M. , Coppola G. , Fiorentino M. , Pacini D. , Di Bartolomeo R. 
Published: November 2018

We present the case of a 54-year-old male patient with a 12 cm post-decoarctation aneurysm of the descending thoracic aorta with bicuspid aortic valve stenosis and ventricular septal defect.
Right femoral artery and bicaval cannulation were used for Cardiopulmonary bypass. Antegrade cerebral perfusion with moderate hypotermia (25°C) was achieved with the innominate and left carotid artery cannulation.
The aortic arch replacement was performed by using Frozen Elephant Trunk technique with a 40 mm E-Vita Open Plus prosthesis and a separated Plexus 4-branches prosthesis. The reimplantation of the left subclavian artery was performed by a 9 mm Gore hybrid vascular graft. A St.Jude 23 mm mechanical valve conduit was used for the Bentall procedure. The ventricular septal defect was closed with direct suture.
Cardiopulmonary bypass, aortic cross-clamp and cerebral perfusion times were 258,186 and 109 minutes, respectively. Post-operative course was uneventful and CT scan showed the good result of the procedure.