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Abstract 2278: Long Term Clinical Follow-up and Graft Patency of Off-pump vs On-pump Coronary Artery Surgery in Patients with ST-Segment Elevation Myocardial Infarction
- Khalil Fattouch,
- Giuseppe Runza,
- Roberta Sampognaro,
- Massimo Midiri and
- Giovanni Ruvolo
Circulation Volume 118, Issue suppl_1828 October 2008

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Off-pump coronary artery bypass grafting is better than on-pump in patients with STEMI underwent surgery within 2 days from onset of symptoms. Surgeons may be reluctant to use OPCAB due to concerns about completeness of myocardial revascularization and graft patency. The aim of this study was to assess long-term clinical outcomes and graft patency in this kind of patients. Participants in two previous randomized studies performed in our institution including 207 STEMI patients underwent emergent or urgent CABG within 48 hours from onset of symptoms were followed after surgery to assess graft patency and major adverse cardiac-related events (MACE). There were 145 patients operated in on-pump and 62 patients in off-pump. Patency was assessed by multidetector computed tomography coronary angiography (MDCTA) with a 64-slice scanner. Two blinded observers classified proximal, body and distal segments of each graft as occluded or not, or grade of stenosis. Clinical follow-up was obtained by our cardiologists. Overall early mortality was 5.3% (11 pts). Percentage of early mortality were 6.7% and 1.6% in on- and off-pump group respectively (p<0.05). Follow-up was obtained in all 196 survivors and was 100% complete. Overall late deaths occurred in 14 patients (7%) without statistical significant difference between both groups; of the remaining 182, 168 (92.3 %) had MDCTA scans (108 pts in on-pump vs 60 pts in off-pump). Patency was studied in 335 grafts in on-pump and 156 grafts in off-pump. Mean duration of follow-up were 38±16 months and 37±14 months for on- and off-pump, respectively. Overall, 449/491 (91.5%) of grafts were patent. Percentages of overall grafts classified as patent were similar in on-pump and off-pump groups (307/335, 91.6% and 142/156, 91% respectively) and for arterial and vein grafts separately. There were also no differences between groups in the incidence of late death and MACE. Long term graft patency and MACE are similar with on-pump vs off-pump CABG in high risk STEMI patients when operation was performed by experienced surgeons. Supported by this results and by low early mortality in off-pump group, we suggests strictly the use of off-pump CABG in this type of patients.
Multiparametric Cardiac Magnetic Resonance Survey in Children With Thalassemia Major: A Multicenter Study
- Maddalena Casale,
- Antonella Meloni,
- Aldo Filosa,
- Liana Cuccia,
- Vincenzo Caruso,
- Giovanni Palazzi,
- Maria Rita Gamberini,
- Lorella Pitrolo,
- Maria Caterina Putti,
- Domenico Giuseppe D’Ascola,
- Tommaso Casini,
- Antonella Quarta,
- Aurelio Maggio,
- Maria Giovanna Neri,
- Vincenzo Positano,
- Cristina Salvatori,
- Patrizia Toia,
- Gianluca Valeri,
- Massimo Midiri and
- Alessia Pepe
Circulation: Cardiovascular Imaging Volume 8, Issue 81 August 2015

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Background—Cardiovascular magnetic resonance (CMR) plays a key role in the management of thalassemia major patients, but few data are available in pediatric population. This study aims at a retrospective multiparametric CMR assessment of myocardial iron overload, function, and fibrosis in a cohort of pediatric thalassemia major patients.Methods and Results—We studied 107 pediatric thalassemia major patients (61 boys, median age 14.4 years). Myocardial and liver iron overload were measured by T2* multiecho technique. Atrial dimensions and biventricular function were quantified by cine images. Late gadolinium enhancement images were acquired to detect myocardial fibrosis. All scans were performed without sedation. The 21.4% of the patients showed a significant myocardial iron overload correlated with lower compliance to chelation therapy (P<0.013). Serum ferritin ≥2000 ng/mL and liver iron concentration ≥14 mg/g/dw were detected as the best threshold for predicting cardiac iron overload (P=0.001 and P<0.0001, respectively). A homogeneous pattern of myocardial iron overload was associated with a negative cardiac remodeling and significant higher liver iron concentration (P<0.0001). Myocardial fibrosis by late gadolinium enhancement was detected in 15.8% of the patients (youngest children 13 years old). It was correlated with significant lower heart T2* values (P=0.022) and negative cardiac remodeling indexes. A pathological magnetic resonance imaging liver iron concentration was found in the 77.6% of the patients.Conclusions—Cardiac damage detectable by a multiparametric CMR approach can occur early in thalassemia major patients. So, the first T2* CMR assessment should be performed as early as feasible without sedation to tailor the chelation treatment. Conversely, late gadolinium enhancement CMR should be postponed in the teenager age.

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Abstract 2278: Long Term Clinical Follow-up and Graft Patency of Off-pump vs On-pump Coronary Artery Surgery in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Multiparametric Cardiac Magnetic Resonance Survey in Children With Thalassemia Major: A Multicenter Study

Abstract