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Introduzione: La disfunzione epato-renale costituisce un fattore di rischio per mortalità e morbidità postoperatoria nei candidati a trapianto. Il MELD-XI (Model of End-Stage Liver Disease Excluding INR) score rappresenta un valido strumento per valutare in anticipo i pazienti affetti da scompenso cardiaco avanzato. Scopo della nostra analisi è stato valutare l’impatto, come fattore prognostico, di valori progressivamente maggiori del MELD-XI score nei pazienti sottoposti a trapianto di cuore. Metodi: Fra gennaio 2000 ed agosto 2016 un totale di 425 pazienti consecutivi sono stati sottoposti a trapianto presso la nostra unità operativa. I dati di questa coorte di pazienti, dopo stratificazione in base al MELD-XI score (MELD-XI 18), sono stati analizzati per descrivere i risultati a breve ed a lungo termine. Risultati: I pazienti con MELD-XI score >18 sono caratterizzati da condizioni cliniche preoperatorie critiche, che determinano un rischio di mortalità precoce maggiore (HR 1.45 [1.11-1.67], p 18 è rispettivamente 63% e 47%, contro il 72% e 59% del gruppo di controllo (MELD-XI, Introduction: Preoperative liver and renal dysfunction remain surgical risk factors for both postoperative morbidity and mortality. The ‘Model of End-Stage Liver Disease Excluding INR’ score (MELD-XI) calculation may help as predictor in patients with advanced heart failure. We analyzed the impact of progressive elevated MELD-XI values among heart transplant recipients at our institution. Methods: The data of a total of 425 consecutive adult patients who underwent heart transplantation, between January 2000 and August 2018, have been reviewed and divided into three cohorts according to preoperative MELD-XI calculations (MELD-XI 18). Early and late outcomes have been analyzed. Results: Patients with MELD-XI score >18 had a more critical clinical condition preoperatively and resulted to have a higher risk of early mortality (HR 1.45 [1.11-1.67], p 240 minutes resulted the strongest predictors of early mortality (p0.001). The 5-y and 10-y survival for MELD-XI >18 cohort was 63% and 47% versus 72% and 59% in the control group (MELD-XI

Extensive thoracic aortic disease due to chronic dissection can be treated with hybrid approach replacing the aortic arch and stenting the first portion of descending aorta. We evaluate perfusion changes in the aorta with CT scan focusing on endoleaks, thrombosis of the false lumen and aortic diameter modification.

Objectives In this study, a propensity-matching analysis was used to compare biological versus mechanical composite valve graft implantation for early mortality and morbidities and for late complications including the need for aortic reintervention. Methods Between 1978 and 2011, 1112 consecutive patients underwent a complete aortic root replacement using either a biological Bentall (BB, n = 356) or a mechanical Bentall (MB, n = 756) valve conduit. Preoperative data were stratified according to the type of valve graft, and treatment bias was addressed by propensity score analysis. Results Two homogeneous groups of 138 patients were obtained. Hospital mortality between them was comparable (MB = 7.2% and BB = 5.8%, P = 0.6). They also had similar results after a mean follow-up time of 40 ± 38 months. Propensity-adjusted Cox-regression analysis showed no relationship between the type of prosthesis and all-cause mortality at follow-up (hazards ratio: 0.88; 95% confidence interval: 0.50-2.14; P = 0.4). Freedom from proximal aortic reintervention at 1, 5 and 7 years was 99.1 ± 0.9% in the MB group compared with 98.4 ± 1.1%, 93.0 ± 3.2% and 93.0 ± 3.2% in the BB group (long-rank P = 0.07). Conclusions The Bentall procedure is a safe and reproducible treatment for ascending aorta pathologies. The choice of either a mechanical or a biological valve graft seems to have no influence on early and late midterm adverse outcomes including need for aortic reinterventions.

Background This study assessed the early and long-term results of arch operations performed after a prior aortic operation. Methods From 1994 to 2014, 154 consecutive patients (mean age, 59.7 years) underwent an aortic arch repair, after a previous aortic operation, at our institution. Antegrade selective cerebral perfusion was used in all cases. Chronic postdissection aortic aneurysm (87 [56.5%]) and degenerative aneurysm (43 [27.9%]) represented the most common indications for surgical intervention. A complete arch replacement was performed in 119 patients (77.3%), an associated root repair in 70 (45.5%), and the frozen elephant trunk technique was used in 55 (35.7%). Results Hospital mortality was 11.7% (n = 18). Postoperative permanent neurologic dysfunction occurred in 10 patients (6.4%). On multivariate analysis, cardiopulmonary bypass time (odds ratio, 1.02 per minute; p = 0.005) emerged as the only independent predictor of hospital death. Follow-up was 100% complete. The estimated survival at 1, 5, and 10 years was 79.6%, 69.9%, and 46.8%, respectively. Freedom from reoperation was 75.6% at 5 years and 54.6% at 10 years. Cox regression identified chronic postdissection aortic aneurysm (odds ratio, 4.2; p = 0.006) to be the only independent predictor of aortic reintervention. Late survival was comparable between degenerative aneurysm patients and the Italian population matched for age and sex (standardized mortality ratio, 1.9; p = 0.1). Longevity was reduced in patients operated on for chronic postdissection aortic aneurysm (standardized mortality ratio, 6.3; p Conclusions Arch operations after a previous open aortic repair can be performed with acceptable mortality and good long-term outcomes. Complete aortic resection did not increase hospital deaths and was associated with a low need for aortic reinterventions at follow-up.

Objectives Aortic root replacement using a composite graft is the treatment of choice for a large variety of aortic root conditions with a diseased aortic valve. The objective of the current study was to evaluate the long-term results of this procedure. Methods Between 1978 and 2010, 1045 patients aged 58.7 ± 13.6 years underwent aortic root composite graft replacement using the following techniques: 95 Bentall operation; 926 the “button technique;” 24 the Cabrol technique. A mechanical composite valve graft was implanted in 69.6% of the patients. Six-hundred and thirty-five patients (62.3%) had annuloaortic ectasia and 162 (15.5%) had aortic dissection. Results Early mortality was 5.3% (55/1045). Independent risk factors for early mortality at logistic regression analysis were age ≥70 years (P = .051; odds ratio [OR], 2.97), New York Heart Association III-IV (P = .052; OR, 1.88), reoperation (P = .021; OR, 2.36), urgency/emergency (P = .003; OR, 3.09), mitral valve replacement (P = .001; OR, 6.01), or coronary artery bypass grafting (CABG) (P

Objectives: Although antegrade selective cerebral perfusion (ASCP) provides good brain protection during aortic arch surgery, the issue of distal organ protection during circulatory arrest remains to be clarified. The aim of the study was to retrospectively evaluate the outcome of aortic arch surgery using ASCP at different temperatures, focusing on visceral functions (VFs). Methods: Three hundred and thirty-four patients underwent elective aortic arch surgery using ASCP from November 1996 to March 2011. Those patients without early postoperative low cardiac output syndrome were included. VFs were evaluated by comparing preoperative and postoperative creatinine, aspartate amino transferase, alanine amino transferase and bilirubin. Univariate and multivariate analysis were performed. Results: Three hundred and four patients represent the cohort of the study. Deeper systemic hypothermia (≤25°C) (Group A) was used in 194 patients (63.8%) and moderate hypothermia (>25°C) (Group B) in 110 patients (36.2%). The 30-day mortality rate was 3.6% in Group B and 5.2% in Group A (P = NS). Permanent neurological deficits occurred in 4 (3.6%) and in 14 patients (7.2%) of Group A and Group B, respectively (P = NS). Postoperative renal insufficiency requiring dialysis occurred in 6 patients (5.4%) in Group A and in 15 patients (7.7%) in Group B, the differences were not statistically significant. Biochemical markers of VFs increased in the postoperative period without differences between groups. At the multivariate analysis, cardiopulmonary bypass time >180 min (odds ratio (OR) = 2.16) was the only significant risk factor for renal dysfunction with or without liver dysfunction, while cardiopulmonary bypass time longer than 180min (OR = 2.28) and hypothermia higher than 25°C (OR = 0.54) were found to be independently related to liver dysfunction. Conclusions: Our results confirmed that ASCP with moderate hypothermia at 26°C is a safe method for brain protection. Moreover, during circulatory arrest, moderate hypothermia also offers good protection of visceral organs and it should be preferred for limited periods (