bluuebunny/crossref_metadata_2025_split huggingface dataset:
P25 SUBCUTANEOUS–ICD IN PATIENTS WITH HEART FAILURE: RESULTS FROM A MULTICENTER, EUROPEAN ANALYSIS
Authors: Schiavone M , Gasperetti A , Mitacchione G , Angeletti A , Vogler J , Laredo M , Breitenstein A , Gulletta S , Fastenrath F , Kaiser L , Compagnucci P , Palmisano P , Ricciardi D , Santini L , De Bonis S , Piro A , Pignalberi C , Pisanò E , Hakmi S , Arosio R , Casella M , Lavalle C , Badenco N , Della Bella P , Dello Russo A , Curnis A , Tondo C , Steffel J , Viecca M , Kuschyk J , Tilz R , Biffi M , Forleo G 
Published: May 2022

Abstract

Background
Data on patients with heart failure (HF) with a subcutaneous implantable cardioverter defibrillator (S–ICD) are scarce.

Objective
Aim of this study was to assess clinical outcomes of the S–ICD in HF patients in a real–world analysis from the largest European retrospective S–ICD registry (ELISIR).

Methods
All consecutive patients undergoing S–ICD implantation at several European institutions were used for the current analysis. The population was classified into two groups: the HF (classified as HF with reduced and mid–range ejection fraction – HFrEF and HFmrEF) vs the no–HF cohort. The primary outcome of the study was the inappropriate shock (IS) rate across the two cohorts. As secondary outcomes, appropriate shocks, cardiovascular mortality and device–related complications during follow–up were assessed

Results
A total of 1409 patients from the ELISIR registry were included; HF patients represented 57.3% of the entire cohort (n = 701, 86.9% HFrEF; n = 106,13.1% HFmrEF). Over a median follow–up of approximately 2 years, a total of 133 inappropriate shocks were observed in the entire cohort, without significant differences among the two groups (9.2% vs 9.8%, p = 0.689). 133 complex ventricular arrhythmias were adequately recognized and treated, with similar rates of appropriate shocks (9.2% vs 9.8%, p = 0.689). Inappropriate and effective shocks–free survival has been represented in Figure 1 (Kaplan–Meier estimates). At multivariate analysis (Figure 2), age (HR = 0.974 [0.955–0.992], p = 0.005), LVEF (HR = 0.954 [0.926–0.984], p = 0.003), arrhythmogenic right ventricular cardiomyopathy – ARVC (HR = 3.364 [1.206–9.384], p = 0.020) and smart pass + (HR = 0.321 [0.184–0.560], p &lt; 0.001) remained associated with inappropriate shocks. Moreover, a low number of patients (n = 76) experienced device–related complications, more frequently in the HF cohort (6.2% vs 3.8%, p = 0.031) with no significant differences regarding any specific outcome of interest: lead infection (1.1% vs 0.7%, p = 0.381), pocket infection (1.9% vs 0.8%, p = 0.107), pocket hematoma (3.2% vs 2.8%, p = 0.668).

Conclusion
The use of S–ICD in HF patients did not result in a higher rate of inappropriate shocks when compared to no–HF patients, even when stratifying for LVEF. Only age, LVEF, ARVC e Smart Pass algorithm were predictors of the primary outcome at multivariate analysis. Despite a lower overall rate of complications in the entire cohort, HF patients experienced device–related complications more frequently.
P36 THE ELDEST HEART TRANSPLANTED PATIENT IN EUROPE: 36 YEARS SURVIVAL AND STILL GOING ON
Authors: Pisani G , Cattadori B , D‘Armini A , Viganò M , Pellegrini C 
Published: May 2022

Abstract
Development of endomyocardial biopsy for acute rejection monitoring in the early Seventies, and above all use of cyclosporine in the clinical practice starting from 1980, introduced the modern era of heart transplantation. Following the initial positive outcomes, the first Italian transplant was performed in Padua by V.Gallucci on November 15th 1985. This pioneering success was rapidly repeated in Pavia, where M.Viganò performed the second transplant on Novembre 17th. Recipient was 20 years old man, suffering from dilated cardiomyopathy, on urgent transplant list. Cardiac index was 1.38 l/min/m2 and pulmonary vascular resistance 1.6 WU. Donor was a 14 years old boy died of brain injury. Total ischemic time was 125 minutes. Induction immunosuppression consisted of horse anti–lymphocyte immunoglobulins, whereas maintenance therapy included cyclosporine, azathioprine and steroids. Postoperative course was complicated by pericardial effusion and cholestatic jaundice. Later pulmonary aspergillosis occurred and due to the profound immunodepression was complicated by fungal localization at L2 vertebral body. The infection was treated with surgical removal of the secondary localization and amphotericin B administration. On December 6th severe acute rejection was found at biopsy and treated with i.v. steroid pulse. Length of ICU and hospital stay was 28 and 72 days, respectively. In 1998 HCV infection was detected and eradicated in 2017 with elbasvir/grazoprevir therapy. Complications of long term immunosuppressive treatment included dyslipidemia, myeloma and basal cell carcinoma. Due to long–term calcineurin inhibitors therapy progressive chronic renal failure occurred, leading to replacement therapy in 2015 and kidney transplantation in 2016. In 2015 the patient underwent percutaneous coronary intervention with stents implantation in two marginal branches and in the anterior descending artery in 2021. Everolimus was introduced to slow down progression of cardiac allograft vasculopathy. In 2020 he suffered from Covid–19, but the course of infection was uneventful being cough the only symptom. We report the eldest survivor after heart transplant in Europe. Our case demonstrates that despite early and long–term complications of immunosuppressive therapy, a careful and patient tailored management allowed an amazing outcome. Nowadays heart transplant remains the best treatment for end stage heart failure and allows to resume a nearly normal quality of life.
P44 PREDICTORS OF MORTALITY AFTER ACUTE TYPE A AORTIC DISSECTION REPAIR IN PATIENTS OF 70 YEARS OF AGE OR OLDER
Authors: Settepani F , Cappai A , Cannata A , Merlanti B , Carrozzini M , Olivieri G , Costetti A , Russo C 
Published: May 2022

Abstract

Objectives
The impact of age on outcomes of acute type A aortic dissection remains controversial. We sought to investigate 30–day and follow–up outcomes of acute type A aortic dissection repair in elderly patients. Survival anlysis was performed and independent risk factors for mortality were searched.

Methods
During a 21–year period (2000–2021), 102 patients of 70 years of age or older were emergently treated for acute type A aortic dissection at our institution. (mean age 75.1 ± 3.8 years, 53.9% male) Preoperative characteristics are displayed in Table I.

Results
Overall 30–day mortality (including operative mortality) was 21.6%. Mortality increased among patients presenting with atrial fibrillation (adjusted odds ratio 10.33, P = 0.02) and visceral malperfution (adjusted odds ratio 70.88, P = 0.005). Survival at 1, 5 and 10 years was 70.2 ± 4.6%, 50.9 ± 5.6% and 24.1 ± 5.6%, respectively (Figure 1). The need to perform concomitant coronary artery bypass grafting was the only independent risk factor for mortality during follow–up. (adjusted odds ratio 2.21, P = 0.04)

Conclusions
Thirty –day and follow–up mortality were extremely satisfactory in elderly patients undergoing acute type A dissection repair. We could detect significant disease and surgery–related risk factors for death. Patients presenting with atrial fibrillation or visceral malperfusion had the poorest 30–day outcome. The need to perform concomitant coronary artery bypass grafting, significantly increased the mortality during follow–up.
P52 “BIOPROSTHETIC AORTIC VALVE REPLACEMENT IN PATIENTS YOUNGER THAN 49”
Authors: Paduvakis I , Cerillo A , Stefàno P 
Published: May 2022

Abstract

Background
Biological prosthesis are increasingly been used in young patients to avoid anticoagulation. The Edwards Inspiris aortic bioprosthesis is extremely promising in this population, since it has shown reduced calcification of the prosthetic leaflets in preclinical and early clinical studies. Little data are available, however, in patients younger than 65. This study investigates the haemodynamic performance and clinical outcome of the Inspiris bioprosthesis in patients aged &lt; 50 years.

Methods and Results
Between may 2018 and December 2021, 58 patients aged 41 +/– 7,85 years underwent AVR with the Edwards Inspiris bioprosthesis at our institution. 23 of them (39.65%) were younger than 40, and 7 (12.06%) had a BMI &gt;30 kgm2. A minimally invasive approach was used in all isolated AVR patients. Associated procedures were performed in 25 (43.10%) patients. There were 10 redo patients (17,24%). Two patients died (3.45%). Major complications included bleeding (4), respiratory failure (1) and BAV requiring PMK (1). The mean follow up was 26,60 +/– 11,29 months (range 2–43). Late valve–related events included endocarditis (2) requiring reoperation. There were no thromboembolic events, valve thrombosis or SVD cases. At follow up, all except one patients reported a significant improvement of their symptomatic status (96.29% were in NYHA≤II) and quality of life. The mean interval to return to the normal activity was of 5.37±3.3 months.

Conclusion
Our study demonstrates excellent early haemodynamics and promising results at up to 3 years in a cohort of very young patients. Further studies with longer follow–up are needed
P53 SURGICAL CUTDOWN VERSUS PERCUTANEOUS ACCESS IN TRANSFEMORAL TAVI: A RETROSPECTIVE SINGLE–CENTER EXPERIENCE
Authors: Cammardella A , Russo M , Ranocchi F , Nicolò F , Pergolini A , Polizzi V , Musumeci F 
Published: May 2022

Abstract

Background
The transfemoral (TF) approach is the most common route in TAVI, but it is still associated with risk of bleeding and vascular complications. Nowadays, it is not evident a clear superiority of percutaneous (PC) versus surgical cutdown (SC) approach. The aim of our retrospective study is to compare the outcomes of the two different types of accesses.

Methods
From January 2018 to December 2021, 377 patients underwent TF–TAVI. The mean age was of 81,17 ± 8,62 years, with a percentage of female of 55,6%. The mean STS score was of 4,37 ± 2,28. The mean LVEF was of 57,22 ± 9,93%. Forty patients underwent a previous cardiac surgery. Seventeen valve–in–valve procedures were performed. The baseline clinical and echocardiographic data and operative features were prospectively collected. The primary endpoint was 30–day bleeding and vascular complications defined according to VARC–2 criteria. Secondary endpoints were clinical outcomes and in–hospital mortality. The PC group included 246 patients, while the SC group 128 patients.

Results
The baseline characteristics in the two groups were not statistically different, except for male sex (40,9% vs 52,3% p = 0.04) and NYHA Class III–IV (55,8% vs 25,7% p = 0.00) in PC and SC group, respectively (Table 1 and Table 2).

Conclusions
The rates of major vascular complications and major bleeding did not differ statistically between the two groups. The SC approach is associated with a significant lower rate of minor vascular complications, but a higher in–hospital mortality. The choice of the access should probably be based on the operator‘s experience and patient‘s vascular anatomy.
P56 SPONTANEOUS CORONARY ARTERY DISSECTIONS: ANALYSIS OF NON TRADITIONAL RISK FACTORS
Authors: Giacalone R , Ferretti M , Gurgoglione F , Noni M , Pelà G , Vezzani A , Cattabiani M , Benatti G , Tadonio I , Magnani G , Nicolini F , Niccoli G , Ardissino D , Vignali L , Solinas E 
Published: May 2022

Abstract

The etiology of spontaneous coronary dissection (SCAD) is not well defined and Non traditional risk factors (NT–RF) have assumed increasing interest, but few data are available. NT–RF include three categories: Sex–related (SR–NT–FR), Sex–predominant (SP–NT–RF) and Gender–related (GR–NT–RF). (Table 1)

Aim of the Study
The objective of our analysis was to evaluate the incidence of NT–RF in Parma SCAD registry population.

Material and methods
We reviewed 62 patients with SCAD enrolled between January 2013 through November 2021

Results
Traditional risk factors were less common: hypertension was the most prevalent (39 pts, 62.9%). When considering NT–RF, 51 patients (82%) had at least one of all, with at least one SR–RF (66%) or GR–RF (64,5%). Patients with NT–RF were younger at time of SCAD (mean age 53 vs 66; p = 0.027) and they were predominantly females (48 vs 7 pts, p = 0.004) (Table 2). No differences were found among NT–RF SCAD and nNT–RF SCAD patients by fibromuscular dysplasia, peripheral arterial disease and chronic kidney disease. Patients with SCAD more often presented with non ST–segment elevation myocardial infarction (43 pts, 72.6%) vs ST–segment elevation (17 pts, 27.4%). No differences in clinical presentation and angiographic characteristics were found among NT–RF and nNT–RF patients group. MACE occurred in 17.7% of patients of the overall study population, at a median follow–up of 23 (interquartile range: 11;57) months. When comparing the incidence of cardiovascular events in the 2 study groups there was a trend toward a higher prevalence of MACE in NT–RF group without statistical significance (NT–RF SCAD 19.6% – nNT–RF SCAD 9.1%; p = 0.4). (Table 3)

Conclusion
SCAD is an emerging cause of myocardial infarction in young and middle–aged women without the traditional cardiovascular risk profile. Although overall survival seems good, SCAD is a potentially malignant disease which can present with ventricular arrhythmias and sudden cardiac death. Risk estimation is difficult in women, due to the scarce validity of prediction models, therefore a great effort must be made by the clinical community for the widespread diffusion and use of models incorporating NT–RF. Acknowledgement of peculiar features of this disease could help clinicians and researchers to establish targeted interventions for cardiovascular primary prevention, early diagnosis and secondary prevention in women, including rehabilitation and stress management programmes.
P60 COVID–19 (YEAR 2021) AND ACUTE MYOCARDIAL INFARCTION‘ TIME–DEPENDENT NETWORK: HUB–HEMODYNAMIC UNIT‘S EXPERIENCES
Authors: Ragosa N , Aloia A , Grompone R , Giordano F , Bellarosa I , De Angelis E , Ferraioli D , Di Santi E 
Published: May 2022

Abstract

Objectives
The sudden SARS–CoV–2 emergency, has so far led to over 283 million infections and more than 5 million deaths globally, has put a strain on countries around the world. The result was a difficulty in accessing care both on an outpatient basis which resulted, in regione Campania, in a reduction in hospitalizations for ACS in the period Mar–Jun 2020 (1183) compared to the same period in 2019 (1862) (Agenas data ). The trend was inevitably reversed in the year 2021, with the new availability of access to treatment, due to both the reduction of restrictions and the vaccination coverage of the population, with a marked increase in hospitalizations for ACS as well as in the Hospital “ San Luca ”of Vallo della Lucania (Sa).

Methods
Cardiovascular diseases in 2021 are the leading cause of death in the world with 18.5 million lives lost a year and the leading cause also in Italy for both men (31.7%) and women (37.7%) ) with 230 thousand deaths certified by Istat, after 18 months of pandemic denounce a real war bulletin … The provincial cardiology network plays a fundamental role in the timeliness of the transfer to Hub centers such as the PO San Luca in the management of acute coronary syndromes.

Results
704 coronary angiography procedures and 118 emergency revascularizations (STEMI–NSTEMI at high risk Grace risk score&gt; 140). Periprocedural complications were recorded around 0.5% (35) in line with the literature‘s data, all manageable and related to the femoral or radial puncture access.

Conclusions
In the year 2021, due to the reduction of restrictions and the marked increase in vaccination coverage, there was an increase in the number of hospitalizations for ACS and consequently in the mechanical myocardial revascularizations performed in Emergency (Stemi and Nstemi at high risk with Grace Risk Score&gt; 140) probably linked to the lack of clinical–instrumental follow–up on an outpatient basis and day–hospital admissions in the year 2020 due to Covid–19 restrictions. At the Hemodynamics of the “San Luca” hospital (medium–volume center about 700 procedures / year), 118 emergency revascularisations were performed at 30.12.2021, compared to 82 in the same period of the year 2020.
P64 COVERED STENT IN A CHEST TRAUMA: CONGENITAL CORONARY ARTERIAL FISTULA OR TRAUMATIC CORONARY PERFORATION?
Authors: Marsico F , Carpinella G , Furbatto F , D‘Andrea D , Serino F , Madrid A , Ziviello F , Rumolo S , Crispo S , Mauro C 
Published: May 2022

Abstract
Coronary arterial fistula consists in a communication between a coronary artery and a cardiac cavity. It is tipically a congenital condition, but it can also be a result of invasive cardiac procedure. Although chest truama generally evolve to massive pericardial effusion, in some cases it can determine also a coronary perforation, with a consequent coronary arterial fistula. A 22–year–old male patient, with no cardiovascular history, was admitted after a road accident, reporting pelvis break, 17 costal break, and sternal break, with consequent chest pain. On admission the patient had a heart rate of 100 b.p.m. and a blood pressure of 130/80 mmHg. Elettrocardiogram (ECG) reported ST elevation in antero–septal derivations (V1–V4). Echocardiogram showed a global left ventricular (LV) ejection fraction of 55%, with an apical–septal akinesia, with a minimal anterior pericardial effusion, not emodinamically significant. So, an emergency coronary angiography was performed, showing a fistula of the distal segment of the left anterior discendent coronary (LAD). In this case there were two possible options, a previously unknown congenital coronary arterial fistula, or a traumatic coronary perforation, determining a coronary arterial fistula. Considering the possibility of a traumatic coronary perforation, with the consequent risk of rapid pericardial effusion worsening, the decision was to perform percutaneous coronary intervention (PCI) with a covered stent (Biotronik Papyrus 2.5 x 20 mm, 8 atm), with a good final result, with total occlusion of fistula. At 1 month follow up, the patient was asymptomatic for dyspnea or chest pain, with a heart rate of 70 b.p.m. and a blood pressure of 130/80 mmHg. ECG showed no anomalies in ST–T tract.
P85 THE SUPERPOWERS OF A REAL HEART TEAM: TAVR AND PERIOPERATIVE MANAGEMENT OF A PATIENT WITH COREA DISORDER
Authors: Saccocci M , Diego M , Villa E , Antonio M , Cirillo M , Luca B , Pero G , Buono A , Blasi S , Cuccia C , Troise G 
Published: May 2022

Abstract
Aortic stenosis is the most common valve disease in over75 years old patients.Managing the preoperative assessment and the perioperative course could be problematic in frailty patients.Having a real and solid multidisciplinary heart team(MDHT)is essential.This is how we succeeded in optimizing the treatment of 82–year–old patient affected by Huntington‘s disease(HD) and severe symptomatic aortic valve stenosis.HD is an autosomal–dominant progressive neurodegenerative pathology due to an expanded CAG repeat leading to a mutant protein(huntingtin) and it‘s usually characterized by chorea, dystonia, incoordination, and cognitive decline.Life expectancy in people with a late manifestation of the disorder can be long, raising the challenge of the treatment of concomitant pathology.Surgery was not indicated in this old and frail patient, but preoperative diagnostic imaging was compulsory to explore the possibility of transcatheter valve implantation. Chorea unintentional movements and dystonia make standard CTscan and angiographic analysis impossible.At our weekly institutional MDHT, we decided to overcome the technical difficulties putting the patient under general anesthesia. As we all know, multiple or very long sedations can be detrimental in frail patients.Confident in our solid multidisciplinary collaboration, we decided on an all–in–one procedure.On the procedure day, the patient was transferred to the hybrid OR.An anesthesiologist and a dedicated nurse induced the patient to general anesthesia.Intubated and with complete vital sign monitoring, the patient was moved back and forth to radiology to perform the angioCTscan.A cardiac surgeon and an interventional cardiologist analyzed the CT images deciding on a transfemoral 34mm Medtronic Evolut Pro+ bioprosthesis. The coronary angiography was performed with no evidence of significant stenosis. We proceed to commissural alignment and release of the bioprosthesis. The patient was extubated in the OR. Stable neurological status, total anesthesia time 140min. The patient was safely discharged home on the second postoperative day. Treating complex cases require multiple skills, well–established protocol, strong communication, and routine cooperation between all the involved professional figures. Therefore, the multidisciplinary heart team is not just an overused word without real significant;it is the only way to approach cardiovascular pathology in our everyday practice permitting us to have a real patient–centered vision.
P92 ADVANCED CIRCULATORY SUPPORT IN A PATIENT WITH ISCHEMIC HEART DISEASE, SEVERE AORTIC STENOSIS AND CARDIAC TAMPONADE
Authors: Crimi G , Zecchino S 
Published: May 2022

Abstract
The use of mechanical left ventricle assistance device in the context of severe aortic stenosis is far from routine. The clinical case we’re presenting highlights the possibility of achieving therapeutic success through appropriate patient selection and choice of the most useful strategy based on the clinical scenario. Our patient is a 70 years old man with several cardiovascular risk factors (DM2, hypertension, active smoker, overweight), CKD IV; his clinical history is characterized by NSTEMI in 2010, treated with PCI and subsequent implantation of 2 DES (on LAD and RM), and by an hospital admission in 2019 for AHF with diagnosis of severe AS. He refused any invasive treatment for underlying valvopathy. In January 2021, a dual–chamber pacemaker implant was required due to the finding of 3rd degree AV block: again, TAVI was refused. A few days after the last discharge, a new ER admission was necessary: the patients had dyspnea (NYHA III–IV) with severe EF depression (50–&gt;25%) and slight troponin elevation: no significant lesions were discovered by coronarography exam. The patient finally agreed to start examinations preparatory to TAVI. After resolution of AHF and approximately 14 days after coronarography, the patient developed pericardial effusion to tamponade, of possible uremic etiology: in addition to compression on the right chambers, echocardiography showed a further dramatic decline in EF (10–15%); despite placement of pericardial drainage and IABP, the initiation of advanced amine support and mechanical ventilation, the patient was classified Intermacs 2. Following a collegial discussion (interventional cardiologist, cardiac surgeon and anesthesiologist), it was decided to perform procedure in the cath–lab in order to undertake an advanced support strategy as birdge–to–therapy: – Valver valvuloplasty with increasing balloon size (18 mm – 20 mm – 23 mm – 25 mm). Rapid pacing was performed through previously implanted PMK, resulting in subsequent hemodynamic benefit (mean gradient 45–&gt;25 mmHg); – Placement of Impella CP (P8, output 3–3.2 L/min). The following post–procedural hospitalization, despite the need for antibiotic therapy and multiple transfusions, was characterized by a progressive hemodynamics improvement until feasibility of weaning from both mechanical and amine therapy and discharge to the rehabilitation center in anticipation of TAVR procedure, which will then be successfully performed in October 2021.