Purpose
Atrioventricular groove disruption (AVGD) or type I posterior ventricular rupture following mitral valve replacement (MVR) is a rare but catastrophic complication, with a mortality rate as high as 75%. Incidence ranges from 0,5% to 2%, with few series reported in the literature. We report our surgical experience in AVGD correction.

Methods
A single-center retrospective review of all consecutive patients with AVGD following MVR in the past eleven years was performed. Two surgical strategies have been applied, namely, the internal reapir with explantation of the prothesis, reconstruction of the AVG using a felt patch and prothesis reimplantation, and the the external approach using autologous or heterologous pericardial patch, felt-reinforced suturing and biological glue application. Both techniques implied reinstitution of cardiopulmonary bypass, cardioplegic arrest and complete decompression of the heart.

Results
Between January of 2007 and October of 2018, 395 patients underwent isolated MVR in our hospital and AVGD occured in 5 patients (1,3%). Average age in this subgroup of patients was 72,8 years (range, 66-80 years), and all female gender. Sixty percent (3 of 5) of the AVGD were early ruptures, detected intraoperatively and 2 patients (40%) had a delayed rupture diagnosed in the first postoperative day. Internal repair was performed in 3 patients: one delayed rupture and 2 early ruptures, one of the later combined with the external technique and an adicional safenous vein bypass grafting to the first obtuse marginal due to the injury of the circunflex artery. The external strategy was applied in the remainer 2 patients. An intraaortic ballon pump was used in 3 patients. Two patients died intraoperatively, both who underwent isolated internal repair, and survival rate at discharge was 60% (3 of 5). Currently, all three patients remain alive.

Conclusions
AVGD is a dreadful, highly lethal and, probably, an underestimated complication of MVR. The ideal repair technique remains a matter of debate. Patient individual evaluation and risk assessment are crucial in decision making. Despite our small serie of patients, we consider the external approach an effective repair strategy for rescue of AVGD.

Purpose
The aim of this study is to describe the first Brazilian experience with transeptal mitral valve implantation (TMViV) procedure.

Methods
From June 2016 to February 2019, 17 patients were submitted to transeptal TMViV procedure in fourteen patients in twelve Brazilians hospitals. The median age was 77 years old (interquartile range [IQR]: 69.5-82), median Society of Thoracic Surgeons risk score was 8.7% (IQR 7.2-17.8). All of them presented severe symptoms (NYHA?III) and five patients (29,4%) underwent to more than one previous thoracic surgery

Results
Overall technical success was obtained in all procedures. Echocardiographic assessment shows reduction in mean mitral valve gradient (pre-procedure 12±3,8mmHg, post-procedure 5,3±2,6mmHg, p<0,001), increase in mitral valve area (pre-procedure 1,06±0,59cm2, post-procedure 2,18±0,36cm2, p<0,001) sustained at 30 days evaluation. Right ventricular systolic pressure dropped immediately after the procedure and presented a further decrease at 30 days (pre-procedure 68,9±16,4mmHg, post-procedure 57,7±16,5mmHg; 30 days 50,9±18,7mmHg, p<0,001). The median follow-up duration was 162 days (IIQ,102-411), 87.5% patients had markedly improvement of symptoms (NYHA?II). One (5,9%) patient died immediately after the procedure due to important left ventricular outflow tract (LVOT) obstruction, another death occurred at 161 days after the intervention.

Conclusions
The first Brazilian experience of transeptal TMViV demonstrated the procedure safety and effectiveness with short hospitalization period and markedly improvement of symptoms at mid-term follow-up. LVOT obstruction is a potentially fatal complication, reinforcing the planning and patient selection importance.

Purpose
Cardiac surgery is being undertaken in a higher risk patient population with increasing potential for developing post-operative complications. Our aim was to investigate the incidence of patients undergoing emergency re-sternotomy on ICU following cardiac surgery, to identify markers of deterioration preceding re-sternotomy and determine their short-term outcomes.

Methods
An observational study was performed, in which all patients undergoing cardiac surgery at our Centre from March 2015 to July 2019 who underwent emergency re-sternotomy on the ICU were identified. Patient characteristics and types of surgery were noted. ICU charts were examined, causes for emergency re-sternotomy and outcomes were ascertained.

Results
63/8203 (0.77%) patients underwent emergency re-sternotomy on ICU following CABG (23) patients, CABG+valve (15), valve only (9) and other procedures (16); median age was 70years, 33(52%) were male, mean EuroScore was 11.6, 21(33.3%) had a LVEF <50%; 35/63(55.6%) were elective, 20(31.7%) urgent and 8(12.7%) emergency/salvage. 17(27%) patients had re-sternotomy within 6 hours, 15/63(23.8%) within 6-24 hours and 31/63(49.2%) after 24 hours of arrival on ICU. Survival was 9/17(52.9%) if re-sternotomy within 6 hours versus 5/15(33.3%) at 6-24 hours and 7/31(22.6%) after 24 hours; p=0.1. 40/63(63.5%) had re-sternotomy following a cardiac arrest and 23/63(36.5%) for acute haemodynamic instability. 14(22.2%) patients had tamponade, 15/63(23.8%) an active bleed and 10/63(15.9%) ventricular dysfunction. Prior to re-sternotomy 25/63(38%) had a worsening lactate/base deficit and 24/63(38%) increasing inotropic requirements. 10/63(15.9 %) developed hypoxic brain injury and 26/63(41.3%) required haemodialysis. 42/63(66.7%) patients died in hospital, 21 left alive but 2(9.5%) died within 1 month of discharge.

Conclusions
Emergency re-sternotomy on the ICU is associated with significant morbidity and mortality. Active bleeding and cardiac tamponade were the most common causes. Survival was greatest when re-sternotomy was performed within 6 hours of arrival on to ICU. Early intervention may mitigate need for resternotomy on the ICU and improve outcomes.

Purpose
Multiple guidelines recommend concomitant atrial fibrillation (AF) surgery to restore sinus rhythm, improve symptoms and potentially improve outcomes. We determined to what extent patients with AF undergoing cardiac surgery at our Institute received a concomitant AF procedure, what these procedures entailed, and whether patient outcomes were improved.

Methods
A retrospective review of 2984 patients undergoing cardiac surgery at our Institute between June 2017 and Jan 2019. Patients who were in pre-operative AF were identified. Patients who underwent a concomitant AF procedure (Group 1) were compared with those who did not (Group 2), with respect to patient characteristics and co-morbidity, surgical procedure performed, post-operative complications, hospital stay and early outcomes (in-hospital and at routine follow-up at 6 weeks). Comparison between the 2 Groups was by Chi squared test, T-test for Independent Means and a p value <0.05 was considered significant.

Results
313(10.5%) patients had pre-operative AF; paroxysmal (19.5%), persistent (11.8%), longstanding (14.4%), permanent (48.6%), unknown (5.8%). 116/313(37.1%) patients had a concomitant AF procedure: 101(87%) LAA occlusion alone, 13/116(11.2%) ?2 procedures of which 5 (4.3%) were a full Cox-Maze and LAA occlusion, and 2(1.7%) PV isolation alone. Group 2 patients were higher risk vs Group 1 with CRF (18.8% vs 8.6%), PVD (3.5% vs 0.9%), pulmonary hypertension (17.3% vs 7.3%), poor LV function (6.1% vs 1.9%) and redo surgery (8.9% vs 0.6%). Cardiac procedures performed with concomitant AF surgery: isolated valve replacement/repair 46/116(39.7%), double/triple valve surgery 31/116(26.7%) and isolated CABG 12/116(10.3%). Patients with paroxysmal or permanent AF underwent less concomitant AF procedures (6.7% vs 12.8% and 17.6% vs 31%, respectively). In-hospital mortality Group 2 10.6% vs 2.6% Group 1 (p=0.01).There were no differences between the two Groups regarding hospital stay and readmissions, PPM insertion, cerebral events, AF at discharge or follow-up.

Conclusions
Higher in-hospital mortality in Group 2 is more likely related to a higher risk patient cohort than patients not undergoing a concomitant AF ablation procedure. Better patient selection and a more complete AF treatment strategy may allow concomitant AF surgery to be offered to those patients most likely to benefit.

Purpose
The goal of this study is to review the results of surgical correction of aortic coarctation in neonates and infants, taking into consideration that there is still controversy concerning the ideal surgical repair technique.

Methods
This is a retrospective single center study. Our entire series of 82 children under the age of 12 months undergoing repair between January 1998 and December 2018 was reviewed.

Results
Regarding age of operation, 62%(n=51) were neonates and 38%(n=31) were infants (ages between 29 days and 1 year). Fifty three percent of patients (n=44) had simple coarctation and 47%(n=38) had complex coarctation with additional intracardiac anomalies, namely, ventricular septal defect (n=22), Shone’s syndrome (n=11), aortic arch hypoplasia (n=6), aortic valve stenosis (n=6) and great arteries transposition (n=4). Forty two percent (n=42) were repaired with a subclavian flap operation, 28%(n=23) with resection and end-to-end anastomosis, 10%(n=8) with extended end-to-end anastomosis and 11%(n=9) with other repair techniques (e.g. patch and reversed flap). Mean time of follow-up is 73 months. Peri-operative mortality (30 days) was 4,8% (n = 4) while overall mortality was 9,7% (n =8). Sixteen patients needed reintervention because of recoarctation, 13 were treated with balloon dilatation, 3 had to be reoperated. Rate of reintervention because or recoarctation was 12% (n=5) with subclavian flap and 35%(n=8) with end-to-end anastomosis.

Conclusions
Perioperative mortality occurred in 4 patients, all with complex coarctation. Reoperation for recoarctation occurred in 16 patients (19%). Rate of reintervention because or recoarctation was higher with end-to-end anastomosis technique.

Purpose
Coronary artery bypass grafting (CABG) surgery with the use of cardiopulmonary bypass is recognized as the gold standard for surgical myocardial revascularization, however the off-pump technique is associated with less perioperative complications but increased need for late reinterventions. We aim to compare short and long-term outcomes of these groups

Methods
A retrospective cohort based on a prospective collected data base from July of 2008 to August of 2017 at a cardiac surgical center in Bogotá, Colombia. 1030 patients that underwent isolated CABG were included, (378 on-pump versus 659 off-pump). Follow-up calls and medical record reviews were done to assess quality of life and clinical outcomes. A proportional hazard method evaluated differences between the rates of mortality at 30 days, myocardial infarction and the need of cardiac interventions in the two groups. A logistic regression analysis identified mortality predictors of operative and long-term mortality.

Results
Mean follow up of 4,8 years. The rate of mortality at 30 days was 11,9% in the on-pump group vs 8,2% in the off-pump group (hazard ratio, 1.20; 95% confidence interval [CI]: 0.8- 1.8 P = 0,37). The rate of postoperative myocardial infarction was 10.05% in the on-pump group vs 5.46% in the off-pump group (hazard ratio, 1.63; 95% CI: 1.00- 2.7 P = 0,048). The rate of need of postoperative cardiac intervention was 14.28% in the on-pump group vs 8.8% in the off- pump group (hazard ratio, 1.26; 95% CI: 0.8- 1.9 P = 0,24). Logistic regression analysis identified Cardiogenic shock (OR:5,7 P= 0.02), pre ejection fraction (OR:0,94 P=0,001), arrythmia (OR: 3,176 P= 0,045), and End-Stage Renal Disease (OR: 8,7 P=0,001) were a strong predictors for operative mortality, 2 of the 5 life dimensions (self-care and usual activities) assessed in the survey were higher in the off-pump group (P= 0,025).

Conclusions
The rate of postoperative myocardial infarction in the on-pump group was higher than the off-pump group. Cardiogenic shock, pre ejection fraction, arrythmia, and End-Stage Renal Disease were predictors for operative mortality in both groups. Finally, two dimensions of quality life were better in the off-pump group.

Purpose
Repair of complete atrio-ventricular septal defect (cAVSD) has excellent outcomes; however, some patients still suffer adverse events with excellent repair.

The clinical impression is that pre-operative cardiac and/or respiratory failure may lead to worse outcomes. This study is to establish if these patients are at increased risk.

Methods
Retrospective study of 73 patients who underwent cAVSD repair from 2013 to 2018.

We analyzed two groups of patients: Group 1. Admitted from home for planned surgery; Group 2. Acutely admitted to hospital in heart failure with/without chest infection requiring surgical repair prior to discharge. Patients requiring mechanical ventilation (MV) prior to surgery were subjected to further sub-analysis.

Outcome measures were 30-day mortality, in-hospital mortality >30 days and prolonged post-operative hospital stay (>21 days). Data are described as percentages and median with interquartile range (IQR).

Results
There were 52 patients in Group 1 and 21 in Group 2, of whom 12 required pre-operative mechanical ventilation.

There were no 30-day deaths. Overall, 6 patients (8%) died in-hospital at a median time of 108 days (33-169), of these 2 (4%) were in Group 1 and 4 (19%) in Group 2.

Univariate analysis showed a significant association between Group 2 and in-hospital death >30 days (p=0.042) and post-operative hospital stay > 21 days (p= 0.001)

Patients requiring pre-operative MV showed an even stronger association with in-hospital death >30 (p= 0.021) as well as post-operative hospital stay > 21 days (p= 0.001).

Univariate analysis showed that patient characteristics in Group 2 differed from those in Group 1 with regards to lower weight (p=0.04), younger age at operation (p=0.001), presence of pre-operative chronic lung disease (p=0.001), pre-operative respiratory tract infections (p=0.003) and pre-operative left ventricle impairment (p=0.001).

Conclusions
Patients requiring pre-operative admission for cardiac and/or respiratory failure, and in particular those requiring pre-operative mechanical ventilation, are at increased risk of prolonged post-operative hospital stay and post-operative mortality.

Purpose
Demonstrate what is the most common type of left atrial appendage and what is its relative risk for thrombus formation in patients with atrial fibrillation and mitral valve disease.

Methods
We analyzed 172 cases underwent mitral valve surgery and resection of the left atrial appendage in this observational and retrospective study, from January 1998 to April 2019. Most cases were rheumatic mitral valve disease (87.8%, 151/172). All cases had long-standing persistent atrial fibrillation. We investigate the distribution of the left atrial appendage morphology as well as its relative risk for thrombus formation in this pool of patients.

Results
Thrombus formation was present in 16.8% (29/172) inside the left atrial appendage. 9.8% (17/172) had preoperative stroke. Morphology of the left atrial appendage was cactus 35.4% (61/172), chicken wing 30.2% (52/172), windsock 16.8% (29/172), and cauliflower 14.5% (26/172). Relative risk for thrombus formation according to the morphology was for cauliflower 9.18 (95% CI, from 4.92 to 17.13, p < 0.0001), cactus 0.82 (95% CI, from 0.39 to 1.68, p = 0.5875), windsock 0.18 (95% CI, from 0.02 to 1.24, p = 0.0816), Chicken wing 0.07 (95% CI, from 0.01 to 0.53, p = 0.0095).





Conclusions
In patients with rheumatic mitral valve disease and long-standing persistent atrial fibrillation, the most common type of left atrial appendage was cactus. Nevertheless, the relative risk for thrombus formation was only important to cauliflower, with 9.18-fold higher than expected. This could have huge implications for further percutaneous and surgical strategies.

Purpose
Identify differences in perioperative and postoperative outcomes between minimally invasive “mini” thoracotomy approach and median sternotomy approach for valvular surgery. Most studies focus on a specific valvular procedure with low volume numbers. We wished to look at our whole experience of “mini” valvular surgery compared to median sternotomy.

Methods
From 6 June 2015 to 30 November 2018, 522 valvular cases were identified and separated by operative approach to sternotomy or “mini” thoracotomy group. Continuous variables were described with medians and interquartile ranges. Bivariate analysis was completed using the Kruskal-Wallis, chi square and Fisher’s exact test. Statistical significance is indicated by p < 0.05.

Results
197 sternotomy (MS), 325 thoracotomy (T). Length of stay was reduced in thoracotomy group (MS: 8 (6-12), T: 4 (3-5), p < 0.001). Operative time (MS: 287 [236-344), T: 177 [158-210]), bypass time (MS: 123 [94.8-166], T: 113 (97.8-132.2], p = 0.019), ventilator hours (MS: 7.9 [4-25.8], T: 1.1 [0-3.9]), and ICU hours (MS: 72.9 [46.6-142], T: 28.8 [24.5-52]) were reduced in thoracotomy group (p < 0.001 unless noted). See complications in Table 1.

Table 1: Complications
Sternotomy (N=197) Thoracotomy (n=325)
p

Pneumonia 8 (4%) 2 (1%) 0.008
Effusion 15 (8%) 2 (1%) <0.001
Pneumothorax 9 (5%) 4 (1%) 0.038
Reoperation 32 (16%) 10 (3%) <0.001
Stroke 7 (4%) 2 (1%) 0.03


Conclusions
Our experience shows “mini” approach to valvular procedures results in apparent reduction in operative, ICU, and overall time in hospital and reduced hospital resource utilization as well as reduced rates of specific postoperative complications. We plan to complete a propensity matched study to further validate these results in our cohort.

Purpose
Surgical sutureless aortic valves have the potential for shorter procedural times and could benefit patients with increased risk. This study describes the clinical outcomes in a single-center cohort of patients who underwent aortic valve replacement (AVR) with a sutureless Perceval (LivaNova, Milan,Italy) aortic bioprosthesis.

Methods
Between March 2015 to July 2019, 80 patients underwent surgical AVR with a sutureless bioprosthesis. The mean age was 75.3±8.4 years, 24 patients were octogenarian (30%), 3 patients were nonagenarian (3.8%), and 49 patients were female (61.3%). The mean STS score was 13.3±13.5% (range, 0.9 to 89.2%), 48 patients were high risk group (60%), and 18 patients were intermediate risk group (22.5%). Concomitant procedures were mitral valve surgery (n=11), coronary artery bypass grafting (n=9), graft replacement of ascending aorta (n=5), myectomy (n=3).

Results
The 30-day mortality was 2.8% (n=2). Fifty-six patients (70.0%) were transferred to general ward on 1stday after operation. At mean follow-up of 17.9 months (range, 0 to 50 months), the survival rate was 95.7%, and the mean transvalvular pressure gradient was decreased from 65.2±7.5 to 10.5 ± 1.1 mm Hg. The rate of complications was as follows: pacemaker 5.0% (4/80), transient ischemic attack 0%, other thromboembolic events 0%, and the rate of reoperation 0%. No valve thrombosis, migration, or structural valve deterioration occurred, and aortic regurgitation (more than trivial) did not develop in any patients in the follow-up period.

Conclusions
AVR with the sutureless bioprosthesis is associated with low mortality rates, excellent hemodynamic performance, and advantage of complex procedures. Especially, AVR with the sutureless bioprosthesis could be a good modality even in the high risk group or elderly patients.

Purpose
Chronic thromboembolic pulmonary hypertension (CTEPH) is a chronic complication of acute pulmonary embolism characterized by mean pulmonary artery pressure elevatioin ? 25 mmHg caused by intraluminal thrombi organisation, stenosis and occlusions of pulmonary artery branches and presence of peripheral vascular remodelation.

Methods
The treatment of choice is surgical pulmonary endarterectomy (PEA). PEA is performed in deep hypothermic cardiac arrest. The only center that specializes into the surgical treatment of patients with CTEPH in the Czech Republic is the Complex Cardiovascular Centre at the General Teaching Hospital in Prague. Between years 2004–2018 there were 332 patients operated.For inoperable patients and for patients with residual pulmonary hypertension after PEA pharmacotherapy with riociguat and balloon pulmonary angioplasty (BPA) is available.Between 2017 and 2018 52 patient were treated with BPA.

Results
Between 2003 and 2018 were diagnosed 518 patients with CTEPH in our centre. 365 (70 %) of patients were classified as operable, 332 were operated. Residual pulmonary hypertension was diagnosed in 25 % of patients 6 months after PEA. 10 patients with residual pulmonary hypertension and 42 non-operated patients were treated with BPA.

Conclusions
Centralization of CTEPH management is widely accepted. It is essential for correct diagnosis and availability of complex therapy (surgery, intravascular interventions, pharmacotherapy) of this disease. One experienced complex CTEPH centre is sufficient for this service in the Czech Republic (population of 10 million).

Purpose
Early results of repair of tetralogy of Fallot (TOF) were excellent. However, with long term follow up they may need repeated reinterventions.

We aim to o highlight the indications for reinterventions after TOF repair and how to decrease its incidence.

Methods
A retrospective review of all cases of TOF repaired between1985 to 2013 in our institution. A total of 557 patients were included. patients were classified into two groups;Group1(78% ) : who required transannular patch(TAP) and Group2 (22%) who had pulmonary valve sparing (PVS).The two groups were compared as regards to the need to reoperation or interventions after repair.

Results
Reinterventions or reoperations were done for one third (35.7%) of our all cohort with higher rate of reinterventions on TAP group 41.6% vs 16.4% in PVS ;p<0.001) with shorter freedom time (p<0.001). Cause for intervention in our series were: Reintervention for severe pulmonary regurgitation (PR ) was 11.5% with 14 % on TAP group versus 2.5 % on PVS with significant difference p ? 0.001. Reintervention for right ventricular out flow obstruction ( RVOTO) was 10.8% with 11.7% on TAP group versus 7.40% on PVS group with no significant difference P = 0.118. Reintervention for LPA stenosis was 18% with 21.6% on TAP group versus 5% on PVS group with significant difference P ? 0.001. Reintervention for RPA stenosis was 8.1% with 10.1% on TAP group versus 0.80% on PVS group with significant difference p ? 0.001.

Conclusions
Most common indications for reinterventions in our series were PR, RVOTO and pulmonary artery branch stenosis. PVS has a protective effect on long term RV geometry and function with a lower rate reinterventions .

Purpose
The number of aortic dissections has increased significantly year by year in China. However, we still lack the Chinese population database analysis of the characteristics of the disease and treatment status. This study will review the clinical data of the single center aortic dissection population and compare it with the IRAD and the Sino-RAD.

Methods
The clinical data of 1274 patients with aortic dissection diagnosed in our center (JS-Aorta) from 2014.1 to 2018.12 were collected. The preoperative basic data, surgical treatment information, postoperative mortality and complications were analyzed. The differences between the single-center regional population characteristics and the registration study database were compared and compared with the published papers of the International Registration Study (IRAD) and the Chinese Registration Study (Sino-RAD).

Results
This study enrolled 808 A-type (63.4%) and 466 B-type aortic dissections (36.6%) in our center (JS-Aorta), consistent with IRAD (66.7% A/33.3% B). The proportion of Sino-RAD enrolled in type B was significantly higher (42.9% A type / /57.1% type B). The mean ages of JS-Aorta and Sino-RAD were significantly younger than IRAD (55 years old vs 51 years old vs 62 years old, P<0.05). Pain is still the most important first symptom. Hypertensive population was significantly higher in JS-Aorta (85.1% vs 58.7% vs 72.1%, P<0.05). JS-Aorta was an average of 13.5 hours from onset to admission for all patients with acute type A aortic dissection, and 9.6 hours from admission to surgery. There was a significant difference in treatment rate and mortality between type A and dissection (JS-Aorta VS Sino-RAD vs IRAD, treatment rate: 95.2% vs 52.6% vs 82.2%, P<0.05; mortality 11.8% vs 5.3% vs 24.7%, P<0.05 ), the rate of type B dissection (internal intervention) and mortality were also significantly different (JS-Aorta VS Sino-RAD vs IRAD, treatment rate: 87.9% vs 78.7% vs 29.9%, P < 0.05; mortality 2.1 % VS 2.5% VS 9.1%, P<0.05).

Conclusions
The characteristics and treatment methods of aortic dissection in China are quite different from those in Europe and America. Sino-RAD as the only registration study in China, the enrollment patients have large bias and may not represent the overall situation in China.

Purpose
HVCS is a rare but serious life threating infection with a high mortality in the target population of underserved regions of southern Chile. The purposes of this study are to evaluate the initial experience of ECMO support in patients with a predicted mortality of 100% and to assess the complications associated with this treatment modality.

Methods
Nine patients with severe HCVS were supported with ECMO between November 2016 and July 2019. Mean Murray score was 2.5 (1.75 – 3.35), mean APACHE II score 24 (21-27), mean REPScore 4 (3-7). All patients presented with progressive ventricular dysfunction. 3 patients (33%) had acute renal failure and 3 patients (33%) had hepatic failure. Cannulation of the femoral vessels was performed on an emergency basis by a percutaneous approach in 5 (55.5%) and by an open technique in 4 (45.5%) patients. In addition, all patients were cannulated through the right internal yugular vein as a complement to the return cannula. A distal perfusion cannula was used in the femoral artery in all patients.

Results
Duration of ECMO averaged 8.8 days (range 2–12 hours). Complications from cannulation occurred in all patients: lower extremity ischemia of at least one toe in 5 patients (55.5%), severe bleeding in 1 (11%) patient, retroperitoneal hematoma in 1 (11%), no patient required a leg amputation. All patients required renal substitution therapy. 3 patients (33%) had an infection of the femoral cannulation site. 2 patients died (22%) due to multiorgan dysfunction and cerebral hemorrhage. The overall survival was 78%. All survivors recovered completely and were discharged from the hospital after a mean hospital stay of 22.8 days (21-39 days).



Conclusions
78% of the patients survived and recovered completely. The complications associated with this treatment may be attributed to the fact that all patients were in shock or in full cardiac arrest, and the procedure had to be done expeditiously. Earlier institution of ECMO may decrease the complication rates and improve the overall survival.

Purpose
We want to show the outcomes in our surgical experience in a cohort of patient’s whit chronic thromboembolic pulmonary hypertension who were treated with pulmonary thromboendarterectomy at high altitude, in Bogotá, a city located at 2640 meters above the sea level.

Methods
We analyzed all patients who underwent pulmonary thrombo-endarterectomyin an institution in Bogota between 2008 and June 2019. A descriptive analysis of the data was done, the continuous variables are expressed as mean ± standard deviation or median with interquartile range according to the result of the type of distribution according to the Shapiro – Wilk Normality test, categorical variables are presented as absolute frequencies and proportions. The survival time was determined after surgery, based on Kaplan-Meier. Patient follow-up was done in outpatient clinic, telephone and government web bases 96% complete,all analysis was performed in STATA 15

Results
In 11 years of systematic review, 59 patients were identified. Mean age 48 years +14,9, 57% female, NYHA functional class > II 81%, previous left ejection fraction median 52 (IQR 51-59), systolic pulmonary artery pressure 79 ( IQR 49-94), CPB time was 306 min (IQR 244-356) with median cross-clamp time of 42 +22 minutes. Outcomes median intensive care unit and hospital stays were 3 and 18 days respectively. Five in-hospital deaths 8.3%, surgical infection and mediastinitis were 1.7%, re operation for bleeding 5,1%. At follow up 96.3% were functional class I-II. Survival at 3 and 5 years was 89% and 84% respectively. The improvement in hemodynamics variables have statistical significance p value less than 0.05.

Conclusions
PEA is associated with an excellent long-term survival and a marked improvement. In our study we found improvement in hemodynamic results and 6-minute walk, decrease in lung resistances and improvement in quality of life. However there is limited available evidence to determine the effects of high altitude in these patients

Purpose
Bentall procedure is considered the gold standard in the treatment of patients requiring aortic root replacement. There are limited long-term outcomes published in Latina America, especially regarding survival and the need for aortic valve reoperation. We report our short and long-term results up to a 10-year follow-up.

Methods
A retrospective cohort based on a prospective collected data base from July of 2008 to January 2019 at cardiac surgical center in Bogotá, Colombia. Perioperative mortality, reoperation rate, aortic valve function (with in-hospital, 2, 6- and 12-months postoperative TT ECHO), long-term survival and quality of life were evaluated.

Results
A total of 181 patients underwent Bentall Procedure, 150 (82%) were male, aged 55 ±15, 51 A concomitant surgical procedure was performed in 51 (28%) patients, 36 (20%) CABG, 14 (8%) mitral valve replacement, pre ejection fraction was 50% (±30), the mean extracorporeal circulation time (127 ± 38 minutes) and the mean aortic cross-clamp time (107 ± 38 minute). The operative mortality was 11 (6%) with a reoperation rate for bleeding of 16 (8.8%). A total of 7 (4%) patients had endocarditis and 4 (2%) patients a SDV. The mean aortic gradient at 2, 6 and 12 months was 8 mmHg (6-10), 8 mmHg (5-11), and 5 mmHg (5-9). We had an 80% of a good quality of life perception. At univariate analysis, short-term mortality was associated with prolonged aortic cross-clamp time RR 0.98 (p=0,0001), use of bio prosthesis RR 0.14 (p=0,04) and postoperative failure renal RR 12,2 (p=0,002).

Conclusions
The Bentall procedure is an appropriate and safe surgical approach in our population. It is also a very durable operation with an excellent valve performance, low-rate of long-term reoperation and very good quality of life-perception.

Purpose
ECMO VA has the risk of increasing afterload of the left ventricle (LV) and other complications. In our country we don’t have IMPELLA for LV decompression. We use IABP and inotropics to achieve decompression. With this, we prevent intracardiac repercussions, severe dysfunction of the LV and failure of ECMO therapy

Methods
We use a retrospective observational cohort of patients, that had ECMO VA therapy and in which a mechanical unloading system of the left ventricle was used. We compare the progressive variations in hemodynamic state using these systems with several hemodynamic variables. We evaluate afterload changes in the left ventricle and stablish a relation between early mortality and mechanical unloading in ECMO VA therapy by comparing pulmonary artery pulsatibility index and ventricular power index

Results
A total of 25 clinical records of patients with ECMO VA were analyzed in which decompression of the left ventricle with balloon or Vent was used. The most frequent clinical diagnosis was myocardial infarction (44.4%) followed by postoperative thromboendarterectomy (11.1%). The most frequent type of cannulation was peripheral (61%) vs central (38%), balloon was used in 88.9% of cases and vent in 11.1%. The length of hospital stay showed an average of 23 days. 61.1% of the cases present renal failure KDIGO I (27.8%), 11.1% required dialysis. In ECMO weaning 38.9% patients died, early mortality (30 days) was 55.6%. Ejection fraction was evaluated in 3 periods. At the beginning with an average 60% (10% - 70%), on the first day 45% (10% - 55%) and on the final day of therapy 50% (10% - 60%).

Conclusions
The use of mechanical unloading devices such as IABP in ECMO VA therapy are useful to improve left ventricle performance and to avoid increasing afterload in absence of IMPELLA. In patients with veno-arterial ECMO therapy secondary to cardiogenic shock. We stablish a relationship between pulmonary artery pulsatibility index and mortality

Purpose
To assess the indication and safety of pediatric congenital heart disease treated via subaxillary mini thoracotomy, and summarize the experience in our center.

Methods
From January 2012 to September 2018, 160 children had been done congenital heart disease operationvia subaxillary mini thoracotomy(Group A), others were done operation via routine median sternotomy(Group B) among 261 children who suffered from atrial septal defect, ventricular septal defect and so on.Record the cardiopulmonary bypass time(CPB) time, aortic cross-clamp time, peri-operative bleeding,mechanical ventilation time, postoperative drainage, ICU monitoring time, motality rate and hospitalization expenses.

Results
All patients had been done operation successfully.CPB time and aortic cross-clamp time in Group A were longer than that in Group B, but have no significant difference(P>0.05). Peri-operative bleeding in Group A was smaller than that in Group B(P<0.05).Mechanical ventilation time, postoperative drainage and ICU monitoring time in Group A were smaller than that in Group B(P<0.05). No patient were died while in hospital in Group A or Group B.The hospitalization expenses in Group A was fewer than that in Group B (P<0.05).

Conclusions
Common pediatric congenital heart disease were done the corrective operation via subaxillary mini thoracotomy were safer, and it could get better results than routine median sternotomy, It could achieve the perfect combination of aesthetics and operation, but had no risk for the patients.

Purpose
The relationship between aortic stenosis and GI bleeding related to Heyde’s syndrome has been well-described, with treatment classically including surgical valve replacement. Treatment with transcatheter aortic valve replacement (TAVR) has been infrequently characterized. The current study was undertaken to examine outcomes of TAVR in Heyde’s syndrome patients.

Methods
Retrospective analysis of our institution’s transcatheter valve database was performed between January 2012 & June 2018 for all adult patients undergoing TAVR. Admitting diagnoses at the time of TAVR were queried for previous GI bleeding using International Classification of Diseases, Ninth & Tenth Revision codes (578.9 & K92.2, respectively). Identified cases were independently reviewed in the electronic medical record for confirmation of GI bleeding related to Heyde’s syndrome along with readmissions for recurrent GI bleeding and follow-up echocardiograms, where available. Descriptive statistics were utilized to summarize all available data.

Results
Overall, 1,904 patients underwent TAVR, of whom 33 were noted to have GI bleeding and reviewed. Of these, 7 had confirmed arteriovenous malformations on preoperative endoscopies, while 4 more had clinically significant hematochezia without identifiable source, for a final cohort of 11. All patients with identified malformations had endoscopic interventions prior to TAVR. Among all patients, GI bleeding was controlled with a mean Hgb 10.2 ± 0.8 and no active hematochezia at the time of TAVR. Anticoagulation and antiplatelet strategies varied among patients as shown in Table 1.

Median follow-up time was 381 (33-2112) days. All patients had successful device placements with none-mild paravalvular leaks on postoperative echocardiogram in 10 patients and a moderate paravalvular leak in one patient that reduced to mild at 1 month follow-up. Three patients had readmissions for recurrent GI bleeding post-procedure, and 2 of these occurred in the setting of escalating anti-platelet therapy.

Conclusions
Gastrointestinal bleeding due to Heyde’s syndrome may be successfully treated with transcatheter aortic valve replacement in selected patients. With expansion of TAVR to intermediate and now low-ri

Purpose
The treatment of the type B dissection is to close the primary tear to redirect the flow into the true lumen and depressurize the false lumen. But even closing the primary tear can be followed by a distal malperfusion. To try to avoid this complications we use the petticoat technique

Methods
Between June 2010 and June 2019 we treated 35 patients with type B aortic dissection. 32 patients with acute and 3 patients with subacute dissection. The mean age was 58,53y (31-81 years old) and mean follow up was 60 months. In all patients we use the petticoat technique and we use differents stent graft to cover the primary entry tear but we use the same bare stent distal to stent graft. In all patients we used the intravascular ultrasound to identify the primary entry tear,the reentry tears, to measurement the length and the diameter of the aorta.

Results
During all follow up we were able to identify one TIA immediately after the procedure but the patient recovered in 10 hours. One patient with a stroke but after one year the patient recovered. One patient with a paraplegia but this patient no recovered and two patient that dead 1 hour after procedure by reperfusion síndrome and in the 31 day by aorto-bronchial fistula . So after 30 days, the morbidity was 14.28% and the mortality was 3.5% and afther 60 monts the mortality 6.25% and morbidity 3.5% ( the patient with paraplegia). We could observe that the diameter of the true lumen increased while that of the false one decreased along of the length thoraco-abdominal aorta, Anatomicaly we don´t have any case with dilatation of aorta and we don´t have any case with some complication relationed with aorta.

Conclusions
In our short series are very favorable clinical and anatomic results with de PettiCoat technique. Long term data are needed to assess the overall efecctiveness of this treatment strategy

Purpose
Aortic Valve Replacement with Rapid Deployment prostheses (AVR-RD) for severe aortic stenosis is practised in the world since many years, however, only recently has been introduced in Argentina. Primary end-point: Postoperative mortality at 30 days and 6 months. Secondary end-points: technique-surgical results and early postoperative complications.

Methods
We performed a prospective study of a consecutive series of AVR-RD with Edwards Intuity®, between April 2018 to April 2019. Inclusion criteria: patients with severe aortic stenosis, and intermediate-high risk patients ruled out for TAVR. Exclusion criteria: aortic isolated regurgitation, endocarditis, ascending aortic or aortic root aneurysms.

Results
The STS PROM% of this cohort was 6.72% ± 4.02. The valve was successfully implanted in the entire group. Nine patients underwent simultaneous CABG. The approach was full sternotomy in 23 and mini-sternotomy in 7 patients. Cross-clamp time for isolated AVR: 45 ± 12.9 min; valve implantation time: 12.6 ± 4.7 min. Need of pacemaker implantation: 6.7% (n = 2). There was one case of mediastinits in an obese patient and was treated with vaccum assist. One patient presented stroke. Follow up at 6 months: no mortality. The medium gradient assessed by echocardiography was 9 ± 3-18 mmHg at 6-month.

Conclusions
The AVR-RD technique is feasible in intermediate-high risk patients with good initial results in terms of morbimortality and transvalvular gradients at 6 months.

Purpose
Anomalous aortic origin of a coronary artery with course between the great arteries is a rare condition and has been associated with myocardial ischemia, and sudden death. Despite being a congenital condition, it might present for the first time in the adulthood. There is no consensus regarding the management of this entity.

Methods
Retrospective review of 7 patients with anomalous origin of the right coronary artery diagnosed and treated at our institution from 2017 to 2018. There were 4 male patients; mean age was 55,5 years (range between 20 – 81), all 7 arteries had an interarterial course, 4 of them were intramural and one patient had a single coronary ostium with a common trunk with left coronary artery. The most common symptom was chest pain in 5 cases, followed by syncope in 4 patients. The diagnosis was established by coronary CTA in most of them.

Results
Five patients received surgical treatment, 2 patients had un-roofing procedure, 2 underwent CABG with RIMA and SVG each, and one patient had reimplantation of the right coronary artery. One of the CABG patients had concomitant coronary artery disease of the anomalous artery. The mean cardiopulmonary bypass time was 67 minutes (range between 58-83) and aortic cross clamp time was 45 minutes (range between 23 – 67). One patient had a TAVR without intervention to the RCA and the other one was treated medically. At a mean follow-up of 15 months (range between 12 – 18), there was no mortality. Six patients have remained asymptomatic, one patient had exertional chest pain recurrence probably secondary to RIMA graft occlussion. One patient had persistent dizziness possibly related to other causes although she resolved sincopal episodes. One patient was treated medically considering no ischemic compromise was found on stress SPECT.

Conclusions
Anomalous coronary arteries can be found incidentally or can express with a wide variety of symptoms. An interarterial trajectory, symptomatic patients or those with documented ischemia are critical features for considering surgery. Treatment should be individualized based on high versus low-risk profiles, the coronary artery involved and the anatomic pattern.

Purpose
The aim was to report the short- and middle-term patient outcomes based in our modified technique.

Methods
We examined the medical data and follow up of 24 patients from 2015 up to june 2019 but in fact 32 patients were operated using this improved technique. Because of insufficient information we excluded 8 patients. We have structured in an Excel database the age, gender, clinical diagnosis, indication for surgery, comorbidities concomitant procedures, staying in the ICU and hospital, plasma and blood intake, blood loss from the thoracal drains, aortic measurement before and different periods after the operation using angio CT with contrast, complications, morphologic type of aortic valve. All data were analyzed using Chi Square on SPSS 19.0

Results
Total bleeding after the operation was 450 ± 105 ml. The mean duration of intensive care unit and hospital stay were 3.17 ± 1.99 and 15.96 ± 6.71 days, respectively. Clamping time and CPB time were 111.25±18.87 and 142.5±24.0 min respectively. There was no postoperative mortality with 100% 3-years survival. No operation-related complications such as anticoagulant-related bleeding, valve or graft thrombosis, or coronary pseudoaneurysm were occurred during follow-up. The complications found after the operation were temperature, urinary infection, septicemia, AVC but none of them were correlated with a p<0.05.On the other hand we saw a correlation with a p value<0.05 between some of the variables.

Conclusions
In conclusion, the current study found that the modified Bentall procedure provided satisfactory results, including reduced operation and cardiopulmonary bypass time and reduced post operative bleeding in patients requiring aortic root replacement. Pseudoaneurysms, coronary events and prosthesis-related complications were not observed.

Purpose
To describe short and long term clinical outcomes of the surgical replacement of the ascending aorta with a graft and aortic valve with a prosthetic valve in patients who underwent elective treatment in a ten year period.

Methods
From our data base we selected, retrospectively, all patients of 18 years and over, with diagnosis of ascending aorta aneurysm and aortic valve disease, who underwent aortic valve and root replacement, specifically, Bentall procedure from January 2008 to December 2018, in an elective manner. All patients with a diagnosis of previous cardiac surgery, endocarditis, acute aortic syndrome, aortic arch disease, and emergency status were excluded.

Baseline characteristics, surgical variables, short and long term clinical outcomes were summarized by percentage and continuous variables by mean ± 1 standard deviation or median and 25th and 75th percentiles.

Results
We found 79 patients, age 43.6±14years, 17.7% female, weight 74±18 kg, height 1.69±0.1 meters and BMS 26.1±5.5. Marfan 5% Hypertension 38%, bicuspid valve 20%, Loeys-Dietz1%, dyslipidemia 10% and Beals-Hecht1% were found. Aortic valve disease: stenosis (4%), regurgitation (81%) and mixed disease (15%). The ejection fraction of the left ventricle 52.5±13%, 7.6% had <30% of LVEF. Diameters of aortic annulus 32±10mm and ascending aorta 64±17mm. Surgical variables: cardiopulmonary bypass time 200±57 minutes, aortic cross clamp 139±31 minutes. Concomitant CABG, mitral valve replacement, tricuspid valve replacement and mitro-tricuspid replacement in 18%, 3%, 4% and 1% respectively. 67% implanted mechanical valves, size of the ascending aorta graft 28.4±2mm. Clinical outcomes: surgical and in-hospital death 1% and 4%, surgical re-exploration 15%, deep wound infection 6%, pneumonia 7%, ICU and in-hospital length stay median 6 and 22 days respectively. Survival 1, 5 and 10 years are 96%, 94% and 78% respectively.

Conclusions
Surgical elective treatment in patients with aortic valve disease and ascending aortic aneurysm is a procedure with adequate short and long-term outcomes, which may be considered. We must address new investigation to describe outcomes in acute aortic syndromes scenario and valve preserve surgical treatment to compare with the group described.