bluuebunny/crossref_metadata_2025_split huggingface dataset:
P37 DIAGNOSIS AND TREATMENT OF HUMORAL REJECTION IN HEART–TRANSPLANT PATIENTS: SINGLE CENTER EXPERIENCE
Authors: Feccia M , Poggi E , Sinopoli S , Di Stefano G , Polizzi V , Musumeci F 
Published: May 2022

Abstract

Introduction
Heart Transplantation remains the gold standard treatment for Advanced Heart Failure patients. Antibody–mediated humoral rejection (AMR) is one of the main causes of medium and long–term morbility and mortality. Success, therefore, is strictly connected to the possibility of modulating immune response in the recipient through innovative diagnostic approaches of immunosuppression–therapy tailoring.

Method
Since 2019, San Camillo Hospital’s Heart Transplant Center in Rome has adopted a new integrated protocol for early diagnosis and treatment for humoral rejection which consists of clinical, instrumental and laboratory monitoring through Solid Phase Flow Cytometric Techniques in order to identify Donor Specific Anti–HLA antibodies (DSA) both fixing and not fixing complement (cytotoxicity).

Results
113 transplant patients were studied, resulted negative in prospective crossmatch at the time of surgery. Post–transplant DSA production has been monitored according to ISHLT guidelines in 1, 3, 6, 12 months’–time and, afterwards, once a year or after evidence of clinical symptoms or echocardiographic signs of graft disfunction associated always with biopsy. During the monitored period, 32 patients showed post–transplant DSA: 2 pz (6%) Class I, 16 (50%) Class II, DSA and the last 14 patients (44%) both Class I and II DSA. The capability of fixing complement (cytotoxicity) was evaluated in 19 patients. In 13 cases (68%) DSAs resulted positive for the specific test used (LSA–C1Q). In the aforementioned subgroup AMR incidence was of 23%; no AMR cases were found in the DSA C1q negative group. 3 patients showed clinical–functional deterioration and echocardiographic and bioptical alterations. Usage of apheretic treatment and re–modulation of immunosoppression therapy (FK, MMF or Everolimus) resulted in important reduction in DSAs amount, clinical recovery and echocardiocraphic signs of improvement.

Conclusions
The adopted protocol for monitoring and diagnosis of humoral rejection resulted in early identification of patients at higher risk of early graft failure. This leads to specific diagnostic and therapeutic strategies to improve long–term outcome.
P38 HEART FAILURE IN TRANSPLANTED HEART DUE TO TOXOCARA CANIS
Authors: Zanella L , Toscano G , Gerosa G 
Published: May 2022

Abstract
Toxocara Canis is a parasitic roundworm which cause zoonotic infections worldwide. It could affect heart causing myocarditis, pericarditis and Loffler’s endocarditis, with a clinical presentation ranged from asymptomatic to life threating conditions with heart failure. After heart transplantation, patients are immunosuppressed, therefore they could experience reactivation of hidden parasitosis like Toxocariasis. To our knowledge, some cases of Toxocara Canis affecting the heart have been described in literature, but there are no described cases of this infection in a transplanted heart. A 65–year–old woman underwent transplant heart surgery due to post–ischaemic dilatative cardiomyopathy. After transplantation she experienced supraventricular tachycardia, reduction of the new heart ejection fraction from 52% to 30% (Figure 1) requiring inotropic drug therapy and mild to severe mitral valve regurgitation due to ventricular dilatation. The unique finding was the presence of antibodies against Toxocara Canis in her blood and high level of immunoglobulin E. In addition, endomyocardial biopsy revealed a cystic intracellular inclusion. Specific therapy with albendazole and corticosteroids was immediately started: heart ejection fraction slowly grew up and mitral regurgitation became milder. Time correlation between Toxocara Canis antibodies positivity and worsening of heart ejection fraction, moreover the recovery with specific antibiotic therapy against this parasite, make us think that it could have been the cause of heart function deterioration in this patient. Often diagnostic findings of Toxocara Canis infection are not specific, heart damage seemed to be driven by direct invasion of the larvae and by immunological reaction. In conclusion, Toxocara Canis could be a cause of heart function deterioration after heart transplant. It should be considered in differential diagnosis of post–transplant heart failure.
P40 COVID 19: A NEW RISK FACTOR IN CARDIAC SURGERY?
Authors: Santise G , Mariniello A , Desoky A , Nardella S , Franciulli M , Iavazzo A , Maselli D 
Published: May 2022

Abstract

Introduction
Since the beginning of the actual pandemia, several patients with positive anamnesis for Covid 19, are undergoing a cardiac operation. Aim of the study is to analize if the Covid 19 past infection may impact on cardiac surgery outcome.

Method
All the patients with a history of Covid 19 positivity, who underwent a cardiac operation at the Clinica Mediterranea in Naples from the 1st of february 2021 to the 31st dicember 2021, have been included in the study. For those patients we evaluated the basal respiratory condition, with a chest Xray or CT scan, a pneumology consult and a spirometry if required. Postoperative outcome has been evaluated analizing ventilation time, intensive care and postoperative lenght of stay, acute renal failure, acute espiratory failure, postoperative complications and death.

Results
Thirtheen patients on 358 had a positive anamnesis for Covid19, but a negative swab at the admission. The mean time from the infection has been 5.1 +/– months, 5 patients have had poor or no symptoms, while the remnants moderate or sever ones with evidence of interstitial pneumonia, one patient had developed extrapulmonary complications (valvular thrombosis).
P41 ORAL ANTICOAGULATION AFTER REPAIR OF ACUTE TYPE A AORTIC DISSECTION: A REAL RISK ON LONG–TERM?
Authors: Vendramin I , Piani D , Lechiancole A , De Manna N , Bressan M , Sponga S , Puppato M , Muser D , Bortolotti U , Livi U 
Published: May 2022

Abstract

Objective
To analyse the effects of chronic oral anticoagulation on long–term outcomes after repair of type A acute aortic dissection and its influence on false lumen fate.

Methods
We studied 188 patients (median age 62 years; 74% males) who had repair of type A aortic dissection; patients receiving postoperative chronic oral anticoagulation (n = 59) were compared to those on antiplatelet therapy alone (n = 129).

Results
Median age was similar: 60 (18–79 years) vs 64 years (22–86) (p = 0.11); patients on anticoagulants were more frequently males (88% vs 67%, p = 0.003). After a median follow–up of 8.4 years (2 months to 30 years) 58 patients died, 18 for aortic–related causes, and 37 underwent aortic reintervention. After multivariable adjustment, anticoagulation showed no significant effect on long–term survival (HR 0.85, 95% CI 0.41–1.76; p = 0.66) neither on risk of reintervention (HR 0.55, 95% CI 0.27–1.15; p = 0.11). Analysis of 127 postoperative computed tomography scans showed a patent false lumen in 53% of anticoagulated vs 38% of not anticoagulated patients (p = 0.09); partially thrombosed in 8% vs 28% (p = 0.01) and thrombosed in 39% vs 34% (p = 0.63). In patients with a control computed tomography there were 6 late aortic–related deaths, 1 among patients anticoagulated and 5 in those who were not.

Conclusions
Chronic anticoagulation after repair of type A acute aortic dissection favours persistent late false lumen patency which is not a risk factor for late mortality or reoperation. Chronic anticoagulation can be administered safely to patients with repaired type A acute aortic dissection regardless of its specific indication.
P49 SURGICAL OPEN AORTA TRANSCATHETER VALVE IN VALVE IMPLANT FOR A MALFUNCTIONING AORTIC BIOPROSTHESIS
Authors: Del Prete G , Lixi G , Spina A , Loi B , Cirio E 
Published: May 2022

Abstract

Background
Most cases of aortic valve bioprosthesis degenerative disease are currently best managed by transcatheter aortic valve replacement (TAVR). Compared to redo surgery, advantages of TAVR include reduced invasiveness and a minimized prosthesis gradient; however, this approach is occasionally unfeasible due to the risk for coronary flow impairment or prosthesis stent dimensions unfit to accommodate an appropriately sized device. We present a case of an open TAVR after surgical leaflets excision of a failing aortic valve bioprosthesis.

Case Summary
A 76 years old female with type 2 diabetes, hypertension and dyslipidemia was referred to our institution for a malfunctioning 21 Carpentier Edwards pericardial aortic valve bioprosthesis implanted 9 years earlier. Patient was initially considered for a valve in valve TAVR. However, because of very low–lying coronary arteries origin at preoperative CT scan we estimated substantial chances for ostia impingement when prosthesis leaflets would have been stretched out by the deploying transcatheter device (Figure 1); although feasible, conventional redo surgery with bioprosthesis excision and re–suture was not preferred because of patients age and comorbidities; risk of damaging the aortic ring and wall including coronaries emergence when dissecting out the stent of the biopsosthesis and reimplanting a new one was also evaluated. We therefore opted for an hybrid procedure. After redo median sternotomy, careful dissection of adhesions, central Cardio–Pulmonary Bypass (CPB), aortic cross clamp and antegrade cardioplegia, a transverse aortotomy was done. The prosthesis was inspected and found grossly deteriorated: leaflets only were excised leaving the stent intact (Figure 2) and a 23 Sapien3 Ultra valve was carefully deployed under direct vision. Coronary ostia were checked and found patent. Myocardial ischemia and CPB times were 61 and 85 minutes respectively. Intensive care unit stay was 2 days. After a reassuring postoperative CT scan (Figure 3), patient was discharged home 11 days after surgery.

Conclusions
We found this approach a good compromise when dealing with challenging aortic valve reoperations, as it is associated to reduced surgical complexity and potential for less morbidity and mortality compared to conventional surgery when low coronary ostia make valve in valve TAVR unachievable.
P61 CORONARY ARTERY ECTASIA: AN ENEMY NOT TO BE UNDERESTIMATED IN ACUTE CORONARY SYNDROME
Authors: Chietera F , Ghetti G 
Published: May 2022

Abstract
Coronary artery ectasia is an abnormal dilatation of coronary arterial segment of at least 1.5 times that of a narrow normal coronary artery. Even if the overall incidence ranges between 4–9% of total angiography, it is correlated with poor outcome due to lower percutaneous procedural success, an higher incidence of no–reflow, distal embolization and stent thrombosis. We present two cases of high risk acute coronary syndrome patients with right coronary artery ectasia and different management in which intravascular ultrasound played a key role in determining interventional strategy.
Case #1 : 55–year–old man presented with STEMI after VT–induced cardiac arrest treated with CPR and DC–shock with subsequent ROSC. Coronary angiography showed thrombotic occlusion in the middle tract of the right coronary artery treated with thrombus aspiration and subsequent PTCA + DES from the proximal to the distal tract of the severely ectatic artery with apparent good final angiographic result. However, at the IVUS control performed to verify the possible need for an additional stent in the context of flow turbulence, malapposition of the stent to the proximal–middle tract was highlighted with an important amount of probably thrombotic material between the stent and the vessel wall. Post dilation was therefore performed with NC balloons with IVUS documentation of resolution of the malapposition.
Case #2: 59–year–old man hospitalized for NSTEMI. Coronary angiography showed severe left coronary ectasia in the absence of significant stenosis and subocclusive thrombus in the posterolateral branch of the right coronary artery with TIMI 2 flow in the context of diffuse CAE . A conservative strategy was undertaken with DAPT + LMWH due to the absence of symptoms and hemodynamic stability, as well as the associated high embolic risk. A follow–up coronary angiography was performed after one week of therapy with evidence of good recanalization of the branch (TIMI 3). IVUS control showed only minimal thrombotic component adhering to atherosclerotic plaque in the posterolateral branch with a MLA of 11.47 mm2 and a low percentage of stenosis (34.5%). A conservative strategy was therefore undertaken (DAPT 12 months).
ACS management in patients with CAE is still challenging and a standardized approach is difficult to please. Strategies should be individualized based on clinical presentation and anatomic characteristics but coronary imaging should be routinely performed in this context.
P63 OPTICAL COHERENCE TOMOGRAPHY–ANGIO CO–REGISTRATION (OCT–ACR) OF LEFT ANTERIOR DESCENDING IN PATIENT WITH ONGOING ANIGNA
Authors: Forlani D , Fulgenzi F , Di Marco M , D‘Alleva A , Magnano R , Pezzi L , Verrengia E , Vitulli P , Corazzini A , Paloscia L 
Published: May 2022

Abstract
We share the case of a 50–year old man, with no cardiovascular risk factor, presented in ER with ongoing angina and positive exercise stress testing. No clinical evidence of heart failure. EKG and echocardiogram was negative. He was referred for invasive coronary angiography, that showed severe stenosis of mid–LAD and moderate ostial LAD stenosis. Subsequent Optical Coherence Tomography–Angio Co–Registration (OCT–ACR) of Left Anterior Descending was performed. An EBU3.5 guiding catheter was engaged in the left coronary artery, and 8000 units of heparin administered. After a pre–dilatation with a semi–compliant balloon of mid LAD, a plaque rupture with thrombus was documented at mid–LAD and a fibro–lipidic plaque with a severe flow limitation (MLA&lt;4mm2) at the ostium, with no involvement of left main (Fig. 1b). Pre–dilatation with SC and NC balloon (2.5–3.5mm) was performed and then stented with a 4.0 × 26 mm DES. Finally, OCT confirmed correct stent expansion, achieving an excellent angiographic result, without carina shifting and compromise of the circ. Patient was discharged, asymptomatic. OCT–ACR guided PCI, taking advantage of its high spatial resolution, permits to plain better the PCI, establish correct stent size, evaluate early complications especially if left main or bifurcation are involved and thanks to co–registration also measurement of long axis of the vessel are facilitated.
P66 GENDER–RELATED DIFFERENCES IN CLINICAL OUTCOMES AFTER EITHER SINGLE OR DOUBLE LEFT MAIN BIFURCATION STENTING
Authors: Rigatelli G , Zuin M , Gianese F , Osti S , Bilato C , Roncon L 
Published: May 2022

Abstract

Background
We sought to examine the impact of gender differences in clinical outcomes at 3 years also comparing the role of double versus single stenting approach for the treatment of coronary unprotected LM bifurcation lesions.

Methods
We retrospectively analyzed both the procedural and medical data of patients referred to our hub center for complex LM bifurcation disease, treated using Cross–over provisional stenting, T or T–and–Protrusion (TAP), Culotte, and Nano–inverted–T (NIT) techniques between January1st, 2008 to May1st2018. The main outcome of the study was to evaluate the association between gender and target lesion failure (TLF) based on the different stenting technique used.

Results
Five hundred and sixty–seven patients (251 females, mean age 70.0±10 years, mean Syntax score 31.6±6.3) were evaluated. Cross–over, T or TAP, culotte and NIT techniques were performed in 171 (30.1%), 61 (10.7%), 98(17.2%) and 237 (41.8%) patients, respectively with no differences in baseline and peri–procedural items among gender. At a mean follow–up of 37.1±10.8 months (range 22.1–39.3 moths), the overall TLF rate, cardiovascular mortality and stent thrombosis were 12.1%, 3.1% and 1.0%, respectively. Female gender was associated with an increased rate of major bleeding when treated with double stent strategy (p = 0.02). No gender difference in TLF was noted among gender, independently from the stenting approach used.

Conclusions
Among patients with ULM bifurcation disease undergoing PCI, TLF rates were not different between genders at 3–year follow–up either using a single or double stent technique.
P68 PERCUTANEOUS REVASCULARIZATION OF CORONARY CHRONIC OCCLUSIONS IN THE ELDERLY: EFFICACY AND SAFETY
Authors: Mircoli L , Tonella T , Carugo S 
Published: May 2022

Abstract

Background
Percutaneous revascularization (PCI) of coronary total occlusions (CTO) is an effective treatment of refractory angina. This procedure presents higher procedural risks than routine PCI. For this reason PCI CTO is often not considered a viable option for elderly patients. The aim of the work is to evaluate the efficacy and safety of CTO PCI in a population over 75 years of age.

Materials and Methods
We considered patients undergoing CTO PCI from 2015 to 2021 in our center. Primary efficacy endpoint was the incidence of major adverse cardiovascular events (MACE) during follow–up in older subjects compared to younger subjects. Endpoints include target vessel revascularization (TVR), urgent non–target vessel revascularization, and cardiovascular death. Safety endpoints were considered complications intra–procedure, during hospitalization and 15 days after discharge. MACE–free survival rates were assessed with Kaplan–Meier analysis.

Results
127 patients were included, 30 aged more than 75 years (24%). The follow–up was 22 months. 86% were male. 32% were suffering from diabetes, 8% from chronic renal failure (creatinine &gt; 2 mg / ml), 76% from arterial hypertension, 40% were familiar with ischemic heart disease. No significant differences are reported in the distribution of risk factors between the two groups. The average age in younger group is 69 years compared to 79 in the elderly. In the follow–up, 16 MACE were found (1 death from cardiac arrest, 14 TVR, 1 non–target vessel revascularization). TVR was the most common endpoint, in 90% of cases this revascularization took place by election. Four events (13%) occurred in the group over 75 years and 12 cases (12%) in the other group (n = ns). Kaplan–Meier MACE–free survival rates were similar. Only 3 complications related to the procedure (2.5%) were reported and these are coronary perforations effectively managed in the hemodynamics room. The success rate of the revascularization procedure was similar (80% for those over 75 versus 82% for the younger group).

Conclusions
in our population age did not influence the efficacy and safety of CTO PCI which represents a valid option for refractory angina even in older patients.
P74 NEURAL INTERFACES TO MONITOR INTERVENTIONAL CARDIOLOGISTS’ MENTAL WORKLOAD: GAME–ON SAGA
Authors: Scala A , Campo G , Erriquez A , Tebaldi M , Tumscitz C , Penzo C , Talevi L , Biscaglia S 
Published: May 2022

Abstract
Interventional cardiologists’ mental workload may impact on their performance as well as on patients’ outcome. Nevertheless, little attention is paid to the monitoring and optimization of their mental status. Electroencephalogram (EEG)–based neural–interfaces can estimate mental fatigue and sleepiness through spectral analysis techniques and the amplitude of alpha waves is a widely validated indicator of mental engagement’s level. No data regarding neural interfaces are available for interventional disciplines. The present preliminary report is the first step of a project aimed at analysing and monitoring mental fatigue and sleepiness through variation of psychometrics and neurometrics in interventional cardiologists (NCT05041218). We prospectively recorded and analysed EEG signals from 7 interventional cardiologists in 129 consecutive procedures. Neurometrics have been acquired at the beginning of the shift, before and after each procedure performed during 127 valid Alpha Attenuation Protocols (AAP), a practical test to quantify sleepiness measuring alpha power during 2 cycle of eye opening/closing protocol. We collected alpha waves’ power measures obtained during resting condition (AA Coefficient–eyes open (AAC–eo), AAC–eyes closed (AAC–ec) and AAC–mean), related to fatigue, and AAC–ec/AAC–eo (AAC–ratio), related to sleepiness. From a two–months observation, the first interesting preliminary results emerged: i) AAC–mean, AAC–eo and AAC–ec showed an upward trend during the working day, reflecting an increase in mental fatigue (p &lt; 0.01 for all of them); ii) population–level psychometrics trend confirms the same tendency described by neurometrics, possibly reflecting a reduced awareness of the operator of his/her actual mental status (Figure 1, Figure 2). Developing a low cost and high feasibility device to monitor and analyse operator’s mental engagement level could be extremely appealing, considering the lack of data in literature and recent technology developments.
P75 PRELIMINARY FINDINGS OF THE DAVIDS REGISTRY (DYEVERT TO AVOID UNNECESSARY CONTRAST MEDIA DELIVERY DURING PCI SANREMO REGISTRY)
Authors: Vergni F , Arioti M , Boasi V , Sanchez F , Leoncini M , Ferrari F 
Published: May 2022

Abstract

Background
Contrast–induced acute kidney injury (CI–AKI) is a percutaneous coronary intervention’s (PCI) feared complication, linked to increased morbidity and mortality. Many risk factors have been identified. Amongst procedural variables contrast media (CM) volume is one of the most predictive. An easy–to–use and effective CM sparing device would represent a valuable tool in the cath–lab armamentarium.

Aim
To evaluate the effectiveness of the DyeVert Power XT system in reducing CM delivery during PCI in pts at high risk of CI–AKI, consequently reducing the risk itself. Methods We collected clinical, laboratory, instrumental, procedural and outcome data of 75 consecutive patients (pts) who underwent PCI with the use of the DyeVert system between September 2020 and December 2021. We also compared these data in two groups of patients, divided according to CI–AKI onset. Inclusion criteria were reduced estimated glomerular filtration rate (eGFR) – defined as creatinine clearance (CrCl) &lt;60 mL/min/m2 – and/or need for a complex PCI – chronic total occlusion (CTO), previous coronary artery bypass graft (CABG) or diffuse multivessel disease (MVD) – with the likelihood to receive a high amount of CM.

Results
Clinical data are shown in Table 1. Lab and instrumental data are shown in Table 2. Procedural data are shown in Table 3. In–hospital events are shown in Table 4. CI–AKI predictors at multivariate analysis are shown in Table 5. Median dose of CM delivered was 255 ml while CM spared with DyeVert was 110 ml (43% volume reduction, median 1 point reduction in Mehran score). Turning to outcomes 11 pts (14.7%) experienced AKI stage I according to Kidney Disease – Improving Global Outcomes (KDIGO) definition, whilst only 3 pts (4%) and 2 pts (2.7%) experienced stage 2 and 3 AKI. At follow–up there were 4 in–hospital deaths, none linked to deteriorating renal function.

Conclusions
DyeVert use was simple and effective in cutting delivered CM amount, with preserved image quality according to the operators judgement, however the reduction in Mehran score was not sufficient to affect risk class in pts experiencing CI–AKI versus those who did not.