bluuebunny/crossref_metadata_2025_split huggingface dataset:
P296 WHAT IF CARDIAC SURGEONS PERFORM TRANS–CATHETER AORTIC VALVE INTERVENTIONS?
Authors: Malvindi P , Berretta P , Capestro F , Galeazzi M , Bifulco O , Alfonsi J , Cefarelli M , Zingaro C , Pierri M , D‘Alfonso A , Di Eusanio M 
Published: May 2023

Abstract

Background and aim
Aim of this study is to present the results of our aortic valve interventions program embedding surgical (SAVR) and trans–catheter treatment, both in the hands of cardiac surgeons.

Methods
Data of patients who had isolated aortic valve interventions during the period 2016–2022 were reviewed. SAVR was performed mainly through a minimally invasive approach . TAVI included either TF or TA access procedures, all performed in a cardiac surgery theatre with fluoroscopy equipment.

Results
During the study period, 1435 patients underwent isolated aortic valve intervention: 1022 surgical AVR (665 mini AVR, 357 FS) and 413 TAVI (333 TF and 80 TA). TAVI were introduced during 2018 and gained a wider application over the years with the progressive adoption of awake procedures and fully percutaneous access (Figure 1). The global volume of aortic valve procedures increased of 38% comparing the full–years 2021 with 2018 (295 vs 213 cases). Multivariable logistic regression showed that TAVI was significantly associated with increased age, female gender, a higher rate of comorbidities and lower LVEF. Overall in–hospital mortality was 0.6% – mini AVR 0.3%, FS 0.3%, TF TAVI 1% and TA TAVI 3%. Permanent neurologic injury was recorded in 0.7% of the patients. Permanent PM implantation was higher after TAVI (87/413 vs 32/1022 patients who had surgical AVR).

Conclusions
TAVI procedures can be safely performed by cardiac surgeons. The expertise in both surgical and trans–catheter treatment translated in the possibility of treating aortic valve disease in a higher volume of patients including older and comorbid patients with excellent early results.
P298 TRANS–AXILLARY ACCESS AS AN ALTERNATIVE ROUTE IN TRANSCATHETER AORTIC VALVE IMPLANTATION
Authors: De Michele G , Moscarella E , Acerbo V , Raucci G , Scherillo G , Signore G , Rotolo F , Scialla F , Cesaro A , Calabrò P 
Published: May 2023

Abstract

Background
Transcatheter aortic valve replacement (TAVR) is the main procedure for treating severe aortic stenosis in patients considered at high surgical risk. Generally, this procedure is performed through percutaneous femoral arterial access. The presence of anatomical variants or peripheral atherosclerotic pathology sometimes necessitates the use of alternative vascular accesses, including access through the axillary artery. Data from a meta–analysis involving 1793 patients who underwent TAVR through trans axillary or transapical access showed a statistically significant reduction in 30–day mortality in the former group. We wait for future randomized trials to confirm the consistency of these data.

Clinical case
71–year–old man, smoker, hypertensive and dyslipidaemic. In 2018, he underwent bilateral aorta–iliac–femoral bypass surgery for severe lower limb arteriopathy. Due to the onset of angina and dyspnea at rest, he went to the ER where a diagnosis of NSTEMI was made. On echocardiogram, there was evidence of severe high–gradient aortic stenosis while coronary angiography showed 80% RCA stenosis in the middle tract. Because of the high surgical risk (EUROSCORE II: 12%) and the evidence of bilateral femoral artery occlusion on CT–angiography, the Heart Team concluded to perform TAVR through percutaneous left trans–axillary access with concomitant percutaneous coronary revascularization. Obtained the backup access on the left radial artery, PTCA+DES was performed on RCA through the right radial access with subsequent placement of a pigtail catheter in the non–coronary sinus of Valsalva. Once the temporary pacemaker had been placed through the right femoral vein, an angio–guided puncture of the left axillary artery was performed with placement of the 14 Fr introducer for implantation of the Medtronic Evolut R 26 mm aortic biological prosthesis. Post–procedure ultrasound examination showed a residual mean aortic valve gradient of 17 mmHg with evidence of a small periprosthetic leak. Seven days after the procedure, the patient was discharged, asymptomatic and in good hemodynamic compensation without vascular complications.

Conclusions
Trans–axillary arterial access should be considered a viable alternative to transfemoral access for the performance of TAVR.
P300 AORN A. CARDARELLI NAPOLI/ FEDERICO II UNIVERSITY INTERHOSPITAL PROTOCOL: TAVI IN A COMPLEX SCENARIO
Authors: Furbatto F , Carpinella G , D‘Andrea D , Moscato R , Serino F , Mauro C 
Published: May 2023

Abstract
Rational: In order to provide the best treatment for patients affected by severe aortic stenosis at intermediate–high surgical risk, since more than 3 years an interhospital protocol beetween the Cardiology, UTIC and Cath–lab department of AORN A. Cardarelli of Naples, a center without cardiac surgery, and the cath–lab of the department of Cardiovascular Emergencies, Clinical Medicine and Ageing Medicine of AOU Federico II, is active. The agreement provides the carrying out of a TAVI procedures for patients hospitalized at the A. Cardarelli, by transfering them with a resuscitation ambulance to the Federico II cath–lab, and subsequent return to the department of origin after the execution of the interventional procedure. Case report: 85 year old lady with hypertension, moderate–severe chronic respiratory failure and atrial fibrillation treated with NOAC, is admitted in the emergency room for acute pulmonary edema and contextual diagnosis of severe aortic stenosis is made. After clinical stabilization, the TAVI program is started: both an angio–CT scan and a coronary angiography are carried out, with the detection of a critical calcified stenosis involving left main branch and proximal LAD and a chronic occlusion of Cx branch. Multidisciplinary evaluation and collegial evaluation with the colleagues from the Federico II University are carried out, and indication is given to TAVI with contextual PTCA of LM and LAD critical stenosis. A joint procedure of PTCA with 2 DES and TAVI with Evolute R 29 valve is then carried out in a single session at the Federico II University of Naples and after post–procedural observation, the patient is transferred back to the UTIC of A. Cardarelli for hospitalization. During the hospital stay, no procedural complications are reported and the patient is discharged 4 days after in good clinical conditions; a triple therapy with NOAC and DAPT is started, continuing it for 1 month with subsequent suspension of ASA and carrying on therapy with NOAC + Clopidogrel. At 1 and 6 months clinical follow–up, the patient is stable and well compensated, without significant clinical complications and with NYHA class 2.

Conclusions
The results of these years–experience, highlight the feasibility and safety of this strategy, making it possible to plan and carry out TAVI procedures even in centers that do not have onsite cardiac surgery, considering the growing indications for TAVI and the subsequent increase of patients who need this procedure
P306 MANAGEMENT OF MASSIVE EMBOLIZATION OF STRATIFIED THROMBUS FROM A CORONARY ANEURYSM: A CASE OF MUTUAL CAMOUFLAGE
Authors: Allievi L , Mircoli L , Barbieri L , Colombo F , Tumminello G , Carugo S 
Published: May 2023

Abstract

Introduction
We report the intraprocedural, post–procedural management and long–term therapeutic strategy in a case of an acute coronary syndrome caused by occlusion of a posterior interventricular branch (IVP) originating from a segment of the right coronary artery with a normal diameter, but, affected by an aneurysm with an extensive stratified thrombotic formation that embolized during the procedure. Case description: 47–year–old man, a heavy smoker, comes to the emergency room about 24 hours after the onset of constant chest pain. ECG: basically, within the limits. Echocardiogram: mild concentric hypertrophy. Mild infero–basal hypokinesia. Blood tests: troponin 355 pg/ml –&gt; 854 pg/ml (pre–coronarography). On coronary angiography, occlusion of the interventricular branch posterior to the ostium originates from a segment of the right coronary artery of apparently normal diameter. The angioplasty procedure caused the mobilization of extensive parietal thrombotic formation adhering to the distal section of the right coronary artery and in the proximal section of the posterior atrioventricular branch with massive embolization of the posterolateral branches, revealing the presence of a coronary ectasia in the same site, not visible before thrombus mobilization.

Discussion
The goal of intraprocedural management was to obtain reperfusion of the embolized branches by numerous passages of the manual thromboaspirator and numerous balloon inflations on the embolized branches, without placing stents. The antithrombotic therapeutic strategy was dual antiplatelet therapy (DAPT) with acetylsalicylic acid/ticagrelor 90 mgx2, Tirofiban in the first 12 hours and anticoagulation with enoxaparin (8000 IUx2).

Conclusions
Coronary angiography at 7 days showed complete disappearance of residual thrombotic formations. The choice of long–term pharmacological strategy was only DAPT with an extension program of over 12 months with ticagrelor 60x2 even though the Pegasus criteria were not present.
P309 DIFFERENT KINETICS OF NT–PROBNP AND SST2 HIGHLIGHT DIFFERENT THERAPEUTIC PATHWAYS OF SACUBITRIL/VALSARTAN
Authors: Mapelli M , Mattavelli I , Salvioni E , Bonomi A , Palermo P , Banfi C , Paolillo S , Biondi M , Agostoni P 
Published: May 2023

Abstract

Background
N–terminal pro–B–type natriuretic peptide (NT–proBNP) and soluble interleukin 1 receptor–like 1 ST2 (sST2) are biomarkers used to grade heart failure with reduced ejection fraction (HFrEF) severity. The first is associated with the patient’s hemodynamic status, while the second is indicative of the inflammatory component and of myocardial fibrosis and both are potential targets of HFrEF treatment. Aim of the study: The aim of this study was to assess the kinetics of these biomarkers after treatment with sacubitril/valsartan in HFrEF.

Methods
We analyzed blood samples of HFrEF patients at baseline (before sacubitril/valsartan treatment), after 1, 2, 3 months (respectively after a month taking the 24/26 – 49/51 – 97/103mg doses), and 6 months after the maximum tolerated dose was reached (end–study).

Results
We obtained samples from 34 HFrEF patients (age 65.9±9.0, 74% males). NT–proBNP and sST2 values progressively and significantly reduced up to 21%±33 and 9%±16, respectively, with a greater reduction for NT–proBNP (p&lt;0.05). Specifically, NT–proBNP reduced from 1286 [609–3205] to 877 [437–1866] pg/mL and sST2 from 29.3 [19.5–34.1] to 20.4 [15.6–28.9] ng/mL, p&lt;0.05 in both cases). The reduction of the two biomarkers over time occurred with statistically significant different kinetics: deferred for sST2 and faster for NT–proBNP. No significant changes in renal function and potassium levels were recorded.

Conclusions
These findings suggest that, in HF patients, sacubitril/valsartan effects on the cardiovascular system share a double pathway: a first, hemodynamic, faster pathway and a second, non–hemodynamic, delayed pathway. Both likely contribute to the sacubitril/valsartan benefits in HFrEF.
P320 AN UNUSUAL CASE SYNCOPE DUE TO SILENT CORONARY VASOSPASM
Authors: Somaschini A , Astuti M , Cordone S , Botta M , Ghione M , Buscaglia E , Cornara S , Bellone P 
Published: May 2023

Abstract

Background
Variant angina is a condition due to a transient vasospasm of the epicardial coronary arteries, which usually causes chest pain episodes and may be associated with dangerous arrhythmias. A non–negligible subset of patients can also experience silent myocardial ischemia, defined as objective documentation of myocardial ischemia in the absence of angina or equivalents. This condition is associated with increased cardiac mortality and incidence of acute cardiac events. Description of the case. A 65–years–old man was admitted to our Emergency Department for syncope. He reported palpitations before the event without chest pain. ECG showed biphasic T waves in V2–V6 (Fig 1A), troponin values were normal. Immediately after admission in our coronary care unit for monitoring, he developed dynamic ST segment elevation with signs of inferior and posterior transmural ischemia (Fig 1B) and non–sustained polymorphic ventricular tachycardias (Fig 2), being symptomatic only for palpitations. ECG abnormalities and symptoms quickly resolved after intra–venous nitrates administration. Coronary angiography was performed showing a critical non–occlusive (85%) fixed stenosis at the proximal right coronary artery (Fig 3 A). The lesion was treated by angioplasty and stenting (Fig 3 B) and the patients was discharged on dual anti–platelet therapy, statins and oral high–dose calcium–channel antagonist.

Discussion
This case underlines first the importance of searching for high–risk features in patients with syncope of non–obvious origin: our patient reported palpitations and ECG changes consistent with myocardial ischemia (even with normal troponin values and echocardiographic findings). A peculiarity of our case is that the patient did not complaint any chest pain despite the presence of ST elevation, a condition known as silent ischemia. The transient nature of ECG modification and ventricular arrhythmias, their dramatic response to nitrates and coronary angiography findings were suggestive of silent vasospasm. Coronary vasospasm induces transient myocardial ischemia and may cause ventricular arrhythmias which in turn can cause syncope due to transient cerebral hypoperfusion or, when sustained, even cardiac arrest and sudden death. We did not perform provocative test with acetylcholine or ergonovine due to the likely vasospastic origin of myocardial ischemia and to their potential risks, especially in the presence of non–sustained plymorphic ventricular tachycardias.
P326 FALSE POSITIVE BONE–SCINTIGRAPHY IN ELDERLY HYPERTROPHIC CARDIOMYOPATHY
Authors: Vernile A , Ajmone F , Ballatore F , Maggio E , Mancuso G , Ciaramella P , Chimenti C , Velardo R , Alfarano M , Vizza C , Cristina C 
Published: May 2023

Abstract
Differential diagnosis of cardiomyopathies with hypertrophic phenotype is crucial because some secondary forms of cardiac hypertrophy can be susceptible of specific treatment aimed to revert and/or stabilize the increase in wall thickness.A positive nuclear scintigraphy with hydroxy bisphosphonate bone tracer (99mTc–HPD)is believed to have high sensitivity and specificity for the diagnosis of transthyretin (TTR) amyloid cardiomyopathy. An 85–year–old man with systemic arterial hypertension was admitted because of pre–syncope associated to evidence at Holter monitoring of both bradiarrhythmias(1st degree AV block with PR interval of 300 ms and several episodes of 2nd degree Mobitz type 1 AV block with electrical pause &gt;3 s) and tachyarrhythmias.He suffered from a bilateral carpal tunnel syndrome that underwent surgery 2 years earlier.Routine laboratory tests were normal except for elevated cardiac troponin HS(0.295 mcg/L,nv &lt; 0.014 mcg/L) and N–terminal pro–BNP (384.3 pg/mL,nv = 0–254 pg/mL).Because of clinical suspicion of senile amyloidosis,nuclear scintigraphy with hydroxy bisphosphonate bone tracer(99mTc–HPD)was performed,that revealed a grade 3 myocardial uptake.Serum–urine immunofixation and immunoglobulin free light–chain was negative for monoclonal gammopathy.Neurological examination was unremarkable Genetic test did not show TTR mutation.Thus,a diagnosis of wild–type TTR cardiac amyloidosis was suggested.The patient,in view of Tafamidis treatment,underwent a LV endomyocardial biopsy.Six specimens were drawn from the LV,cut and processed for histology,immunohistochemistry,and transmission electron microscopy. Unexpectedly,histology failed to confirm amyloid deposition but revealed the presence of severely hypertrophied disarrayed cardiomyocytes fragmented in short runs by interstitial and replacement fibrosis,denoting a sarcomeric hypertrophic cardiomyopathy.Congo red staining at polarized light scored negative for areas of apple–green florescence.Immunohistochemistry form transthyretin,kappa/lambda light chain and SAA was negative.Transmission electron microscopy failed to demonstrate the presence of rigid unbranched amyloid fibrils.Thus,a final diagnosis of hypertrophic cardiomyopathy was reached. Coclusion:A positive cardiac signal of bone scintigraphy can occur in other pathologic settings.Future studies are needed to investigate the incidence of false–positive TTR cardiac amyloidosis to bone scintigraphy compared with endomyocardial biopsy.
P329 MANAGEMENT OF ADVANCED AND TERMINAL HEART FAILURE IN AN ELDERLY PATIENT WITH REDUCED EJECTION FRACTION
Authors: Verga F , Orso F , Salucci C , D‘Errico G , Perini E , Vatri M , Poletti E , Cagnoni C , Corti G , Di Bari M , Ungar A , Baldasseroni S 
Published: May 2023

Abstract
Heart failure (HF), despite new therapeutic strategies, remains a condition characterized by an inauspicious prognosis and poor quality of life. The management of advanced and then terminal SC proves to be a current challenge, especially in elderly patients. A.C, 87 years old is autonomous and cognitively intact (BADL preserved 5/6, MMSE 28/30). In June ‘21 femur fracture complicated by cerebral hemorrhage (no relics) and anterior STEMI (FE 25%). Not performed coronarography (contraindication to antiplatelet therapy). Discharged to NYHA II with ARNI, MRA and beta blocker. After 1 month hospitalized for HF in the course of AF, performed infusion of levosimendan. In September ‘21 taken over by our "HF clinic" with progressive titration of therapy and insertion of SGLT2–i. In January ‘22 due to precarious clinical compensation (NYHA III–IV) progressive increase in furosemide dosage and undertaken sequential nephron blockade with metolazone, with good response. Given advanced–HF situation, performed Levosimendan infusions under DH regimen (8 h; 0.05–&gt;0.2 mcg/Kg/min; three times every 2 weeks) with clinical stabilization. In April, hospitalization for decompensation flare–up with worsening creatinine (0.8 &gt;&gt;&gt;2 mg/dL). On discharge, given the precarious compensation, activated the "Hospital–Territory Rapid Intervention Group" with home diuretic infusions and stabilization of the clinical picture and subsequent new referral from the "heart failure clinic" with monthly FU. By November 2022, clinical (NYHA IV with diuretic resistance), cognitive and functional (MMSE 22/30, BADL preserved 2/6) worsening. Evaluated as an end–stage scenario (in the absence of further treatment options), family interview was performed, home nursing service activated for infusions of furosemide, and referred to the palliative care service to assist the patient in the terminal phase of illness at home (Fig. 1).

Conclusion
in order to ensure the best quality of life in the terminal phase of the disease, the management of advanced SC in the elderly patient must involve individualization of the care pathway, through multidimensional assessment of the patient and sharing of goals at the different stages: from intensive FU with optimization of therapy in the early stages to early activation of home and palliative care services in the more advanced stages.
P331 ANALYSIS OF THE CLINICAL AND THERAPEUTIC CHARACTERISTICS OF PATIENTS ADMITTED TO THE HEART FAILURE CLINIC IN THE PERIOD APRIL–SEPTEMBER 2022. ORGANIZED BY THE ANMCO AREA CARDIO RENO METABOLICA
Authors: Benvenuto M , Iacoviello M , Fabiani D , Gronda E 
Published: May 2023

Abstract
In recent years, the pharmacological treatment of HFrEF has undergone considerable development. Two pharmacological classes in particular have been shown to significantly reduce cardiovascular events and hospitalizations: ARNI and SGLT2i. The objective of this observational study was to provide "real word" data on the effective use of these drugs, the efficacy, safety and tolerability of their simultaneous administration. We analyzed 82 patients admitted to our clinic over a period of 6 months and reported their clinical characteristics and the effective therapies administered. The data of 82 patients, 64% male, with an average age of 70.5 years were analysed. 49% with ischemic heart disease, 54% hypertension and 31% type 2 diabetes mellitus. Of these, 47.5% with HFrEF, 21% with HFmrEF, and the remaining 30% with HFpEF. At the time of visit, 19.5% of patients had a GFR &lt;59 mL/min/1.73m2. 31% of the patients were in NYHA Class III. We then analyzed the drug therapies provided. Assuming that a very high percentage of patients were taking beta blockers and MRA (91% and 79% respectively), we found that about 72% of patients were on concomitant therapy with a renin angiotensin system inhibitor (51% ARNI, 21% ACEI/ARBs). Among the 51% of patients in ARNI, as many as 32% took the minimum dose of the drug (24/26mg bid), 11% the intermediate dose (49/51mg bid) and only the 8% the maximum recommended dosage (97/103 mg bid). In the group of patients with HFrEF, 10% were not on ARNI therapy or this drug had been discontinued during the follow–up (92% for hypotension, 8% for ARF on IRC). As for gliflozines, 46% of the patients analyzed were on SGLT2i therapy (and of these, approximately 70% had HFrEF). 30% of the total patients were in concomitant therapy with ARNi and SGLT2i (62% of patients affected by HFrEF).

Conclusions
most of our outpatients are affected by HFrEF, they benefit from the best pharmacological strategy recommended by the most recent international guidelines . The simultaneous administration of ARNI and SGLT2i is not burdened by significant adverse events. None of our patients discontinued SGLT2i therapy since there were no adverse effects related to drug administration.