Search

This document outlines aspects of innovation considered relevant for HS and proposes general actions for an Exploitation plan. Innovation is an essential component of the strategic objectives of E-RIHS. It encompasses novel research actions, offer of unique access services and provision of smart tools. Exploiting innovation, for the benefit of the E-RIHS ecosystem and the society, requires a number of actions along the innovation chain, including the presence of an efficient monitoring and evaluation system, appropriate knowledge and technology transfer channels, proper IPR protection and efficient communication with key stakeholders both in the public and the private sectors. An overall systematic approach to the above will ensure success and sustainability of ERIHS as an innovator and as a leader in the global HS landscape. This document is Deliverable 6.2, elaborated in the context of project IPERION HS, WP-06: Innovation and Exploitation, Task 6.4: Exploitation Plan. The analysis for the work presented herein was based on extensive interactions between the co-authors and builds upon a number of documents produced in the context of IPERION HS and E-RIHS PP (in particular Deliverable 9.4: Innovation Agenda).

Background:Transthoracic echocardiography (TTE) cannot reliably exclude left atrial (LA) thrombi prior cardiac surgery. LA trombi have been shown to be associated with an increased stroke rate. TEE has a sensitive and specificity of 100% in detection of LA and left atrial appendage (LAA) thrombi in contrast to TTE which has limitations when assessing the presence of masses or thrombi in the left atrium.Case report:We report the case of a 60-year-old woman scheduled for aortic and mitral replacement. Her history includes atrial fibrillation and ischemic stroke. Chronic anticoagulation was suspended five days before surgery and low molecular weight heparin began. The intraoperative TEE revealed a new 20x30 mm diameter pedunculated mass in LAA protruding to LA. Preoperative TTE had been performed 2 months before, showing any mass inside. This made the surgeon was very cautious in the left atrial opening because the possibility of thrombus embolization.Discussion:According to the latest guidelines, TEE should be used in all open heart procedures in order to: (1) confirm and refine the preoperative diagnosis, (2) detect new or unsuspected pathology, (3) adjust the anesthetic and surgical plan accordingly, and (4) assess the results of surgical intervention. Our case confirms the importance of detection of new findings prior the operation which changes the surgical procedure and planning.Thrombi appear as echogenic mass protruding into the main cavity, and are generally broad and pedunculated base, they mostly are stationary. It should make us suspect its presence whenever there are stasis phenomena such as atrial fibrillation and mitral stenosis. Thrombogenic risk increases with decreasing LAA velocities: 40 cm/s (1%). The flow velocities in LAA as may incur indication surgery ligation.The withdrawal of the anticoagulation, can cause thrombosis in this area and therefore its substitution for HLMW is necessary although not always prevent from a new thrombus.Conclusions:TEE should be used in all open heart procedures.Intraoperative TEE gives the possibility to detect new pathologies that changes the surgical procedure.

OBJECTIVES: We aim to describe our experience in coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass by comparing intraoperative and postoperative outcomes. METHODS: From January 1993 to June 2013, 3097 patients underwent consecutive emergency and scheduled CABG surgery. A total of 1770 patients underwent on-pump CABG (ONCABG) and 1327 off-pump CABG (OPCABG). A propensity score matching was performed to identify appropriate matched-pair patients; univariable and multivariable logistic regression analyses were performed to assess significant predictors of hospital and 30-day morbidity and mortality composite end-points. Morbidity composite end-point was defined as any renal, pulmonary, cardiovascular and neurological complication that occurred during hospital stay. We collected all-cause mortality data during the study period. RESULTS: We identified 1004 patients in each group. There were no significant differences in thirty day mortality, 2.8 vs 3.8%, in OPCABG and ONCABG, respectively (P = 0.21). Cardiovascular, neurological, respiratory and renal complications were more frequent in the ONCABG group: 13.9 vs 8.7% (P < 0.001), 3.9 vs 2.2% (P = 0.03), 13.5 vs 7.5% (P < 0.001), 7.1 vs 5.3% (P = 0.095), respectively. The long-term all-cause mortality rate was 12.3 vs 12.9% in the OPCABG versus ONCABG group (P = 0.42), respectively. In both uni- and multivariable analysis preoperative renal failure, chronic obstructive pulmonary disease and ONCABG were independent predictors of mortality and morbidity composite end-points. CONCLUSIONS: OPCABG is associated with less postoperative morbimortality and shorter hospital and intensive care unit length of stay. ONCABG resulted as an independent predictor of morbidity and mortality composite end-point. No statistically significant differences were observed in long-term all-cause mortality between groups.