This study aimed to assess if clampless off-pump coronary artery bypass grafting (OPCAB) decreases the incidence of perioperative stroke (POS) rate and in-hospital mortality. The secondary aim was to evaluate 12-year rates of overall mortality. Between January 2003 to December 2015, data of 645 consecutive patients undergoing isolated CABG were retrospectively collected. 363 underwent aortic no-touch OPCAB (No-touch group) and 282 underwent OPCAB with the Heartstring device (HS group). In-hospital mortality and perioperative stroke rate as primary endpoint, as well as long-term follow-up outcome were analysed. In-hospital mortality was lower into No-touch group compared with HS group but without significant statistical difference (1.7 vs. 3.2%, p = 0.19, respectively); the rate of postoperative stroke was higher in No-touch group compared with HS group, although this difference did not reach statistically significance. Delirium was reported with higher presentation rate in HS group (3.9 vs. 0.8%, p = 0.01). Blood transfusions rate was higher in HS subjects (23.4 vs. 16.1%, p = 0.01). Intubation time, ICU, and hospital length of stay were increased in the HS group (p = 0.008, p = 0.001 and p = 0.003, respectively). Over a 12-year follow-up period, survival probabilities at 1, 5, and 10 years were 93.6 ± 1.3 vs. 93.2 ± 1.5, 80.4 ± 2.6 vs. 80.3 ± 2.2, and 57.9 ± 5 vs. 58.4 ± 3.8% in the No-touch and HS group, respectively (p = 0.97). In this retrospective study, clampless off-pump CABG lowers perioperative stroke rate whose incidence is, however, not inferior compared with No-touch technique, and no statistically significance was detected. Delirium has a higher presentation rate in clampless off-pump CABG.

We describe an unexpected complication in a 46-years-old man affected by ischemic cardiomyopathy who received a prolonged mechanical cardiac support by means of right transaxillary Impella 5.0. The postoperative course was complicated by recurrent septicemia from multi-durg resistant Acinetobacter baumanii. He underwent implantation of venoarterial extracorporeal membrane oxygenation because of refractory cardiac arrest, followed by Impella removal that has been complicated by embolic stroke. The likely source of the embolus was a large thrombus inside the innominate artery. After a long-standing right transaxillary device implantation, particularly in patients with intercurrent septic episodes, a CT angiographic scan should be planned to exclude arterial thrombosis before removal of the transarterial device.

Background: The “Organ Care System (OCS)- Heart”-TransMedics (TM) is the only clinical platform for ex-vivo perfusion of human donor hearts, preserving the graft in a warm beating state. AIM: To analyze results of HTX performed with OCS. Methods: From 2015 to 2018, 7 patients (mean age: 46y) received a donor heart (mean age: 39y) preserved with the OCS-Heart system. Ischemic, cardiopulmonary (CPB) bypass time and day-0/day-1 CK-MB levels (TM-group) were compared with those of 95 patients transplanted with the cold static storage (CSS-group). The OCS was used for expected long ischemic times or for adverse donor (cardiac arrest) or recipient (infected LVAD, ECMO and unusual anatomy) features. Results: Mean out-of-the-body perfusion time was 296 minutes. Overall ischemic time was 124 (TM-group) vs. 187 minutes in the CSS-group (P = 0.01). The OCS allowed to spare 159 minutes of estimated ischemia. D0/D1 CK-MB was 115 and 36 vs. 125 and 47 ng/ml in the CSS-group (P = NS). ICU stay was 20 days. Two patients died for hemorragic shock (LVAD recipient) and for multiorgan failure. One patient developed a severe right failure, treated by mechanical assistance, weaned after 8 days. Five recipients are alive at a mean FU of 18 months. Conclusions: Ex-vivo perfusion of donor hearts is technically safe and permits a significant reduction of the ischemic time. A trend toward reduction of myocardial damage was observed when compared to CSS. The real impact in unfavourable donor-recipient combination needs further investigations. A potential expansion of donors’pool is predictable with this innovative system.

Background and aim: The concept of Heart Team (HT) has been a major advancement for decision making in cardiovascular medicine. The aim of the study is to analyse trends of in-hospital mortality and case-mix among patients who underwent to isolated aortic valve replacement (iAVR) before and after HT institution. Methods: We analysed data of 1092 adult patients who underwent iAVR at our hospital between January 2005 and December 2016. They represented 12.3% of the overall surgical case-load of the same period. During the second-half of 2008 HT has been implemented at our hospital. Results: During 2005–2016 period in-hospital mortality following iAVR was 1,8%. In-hospital mortality decreased from 3,9% (2005–2008) to 0,8% (2009–2016) (p .0004). Mean number of iAVR/year increased from 75,5 (2005–2008) to 99,1 (2009–2016). The prevalence of octogenarians patients increased from 11,5% (2005–2008) to 16,5% (2009–2016) (p.00001); in-hospital mortality decreased from 8,8% to 1,5% (p .02) among them. Conclusions: Following the institution of HT at our hospital, we observed a significant decrease of in-hospital mortality following iAVR, also in elderly patients. Volume of iAVR and octogenarians patients significantly increased. It is likely that surgical results benefited from the discussion of cases and the availability of transcatheter techniques for high-risk patients.

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