Digital switchover in Europe

This article discusses the political, economic, technological and human aspects of the digital switchover in Europe and explores various policies for managing the process. The article first examines the advantages and drawbacks of digital switchover, and identifies a number of challenges and policy dilemmas of making switchover an achievable objective. It goes on to look at digital television adoption across Europe and assesses the effectiveness of free-to-air digital television to accelerate take-up. Finally, the article examines EU initiatives as well as national plans in digital switchover and proposes various measures for encouraging the take-up of digital services and therefore bringing forward the likely idea of analogue switch-off

The Role of the Patient-Prosthesis Mismatch after Aortic Valve Replacement: The Prognostic Significance

State of the art in term of aortic patient-prosthesis mismatc

The Role of the Patient-Prosthesis Mismatch after Aortic Valve Replacement: The Prognostic Signicance

Patient-Prosthesis Mismatch (PPM) represent a controversial issue in current clinical practice. e negative impact of PPM on patient prognosis a er aortic valve replacement has been reported in several studies showing increased all-cause and cardiac mortality. Moreover, it has been recently described the relationship between PPM and structural valve deterioration of biological prostheses. In patient at risk for PPM several issues should be considered, and in the current era cardiac surgery the preoperative planning should consider the di erent type of valve available and the di erent surgical technique that could be used to prevent it. e present editorial analyse the state of the art in term of PPM

A new device to treat mitral valve regurgitation: a proof of concept in bench test study

Mitral valve repair is typically performed by implanting a ring-like device at the valve annulus to reshape the annulus and to improve leaflet coaptation. In most cases, some additional procedures are needed, including leaflet resection and artificial chordae implantation. However, artificial chordae implantation could be technically challenging and postoperative left ventricular remodeling could increase the risk of recurrent mitral regurgitation. We propose an innovative annular device made of chromo-cobalt, finalized not only to reshape the annulus but also to enable anchoring of leaflets to a fixed intraventricular structure. Durability evaluation of the device was tested by applying eight radial force vectors equally spaced along the ring and related fatigue analysis. To evaluate the efficacy of the mitral valvuloplasty using the tested ring, the device was implanted in five adult swine hearts. Functional analysis of the ring was performed by measuring left ventricular pressure and fluid volume loss, following implantation in normal and dysfunctional mitral valve leaflets. Both fatigue and functional analysis showed satisfactory and promising results in terms of durability and efficacy of mitral valve repair. Because of its favorable durability and functional characteristics this device appears promising and provides good results in terms of valve competence, thus avoiding both manipulations of papillary muscles and interference in left ventricular hemodynamics. However, an in vivo test is mandatory to fully understand the impact of the device on subvalvular apparatus

EP28 PRIMARY MITRAL VALVE REGURGITATION: A retrospective analysis of mitral valve surgery and long term follow-up.

Abstract Background and aim: Surgery of mitral valve is one of the most evolving topic, especially for repair techniques and is often challenging for surgeons. We retrospectively evaluate the results of mitral valve repair (MVRep) or replacement (MVR) in primary MR. Methods: 165 consecutive patients (mean age 65 ± 12.5 years) between January 2014 and December 2018 underwent MVRep (89 pts, 54%) or MVR (76 pts, 46%). Mean EuroSCORE II was 3 ± 2%. 89 pts were severely symptomatic for dyspnea (53.9%). In all cases of MVRep a prosthetic ring was implanted; adjunctive procedure were a triangular (11%) or quadrangular resection (11%) and edge to edge (24%). A mechanical prosthesis were implanted in 60 pts (36%). Mean follow-up (95% complete, 157 patients) was 50.2 ± 17.9 months. Results: Overall in hospital mortality was 4.8%; 1.1% (1pts) and 9.2% (7 pts) for MVRep and MVR respectively. Three of these 8 patients were octogenarian and at high risk surgery with an EuroSCORE II>7%. Follow-up mortality was 6.3% (10 pts), cardiac death was 3.8%. 6 years survival was 90.7 ± 3%. Three patients (MVRep) underwent MVR for MR recurrence with a 6 years freedom from reoperation of 97.9 ± 1.2%. Freedom from symptoms was 89.6 ± 3.2%. No significantly differences was found between MVRep and MVR in terms of survival (logRank test, p = 0.61), reoperation (logRank test, p = 0.138) and symptoms (logRank test, p = 0.264). Conclusioni: MVRep appears to have lower in-hospital mortality than MVR (p = 0.025). Long term results showed excellent survival and comparable outcomes in terms of reintervention and relief of symptoms between MVRep and MVR. © 2018 Italian Federation of Cardiology - I.F.C. All rights reserved

An unexpected risk factor for early degeneration of biological aortic valve prostheses

Background. An alarming rate of early failure has been recently reported for the LivaNova (previously Sorin) Mitroflow (LivaNova, London, UK) bioprosthesis. Here, we aimed at verifying if this possible underperformance is confirmed in a large, single-center experience and identifying the risk factors associated with early deterioration. Methods. In all, 459 Mitroflow valves have been implanted from July 2009 to December 2013 (patients’ mean age 73 years; 204 women). Surviving patients have undergone yearly clinic and echocardiographic followup. Dysfunction was defined as moderate if the mean gradient was more than 30 mm Hg or severe if it exceeded 40 mm Hg. The population was divided on the basis of a dimensional mismatch, the model of the prosthesis (LX or DL: follow-up to 4 years), and patient’s age at the time of implantation. Results. Cumulative freedom from moderate valve dysfunction was 81% ± 3% at 60 months. It was lower with patient-prosthesis mismatch (71% ± 5% versus 92% ± 3%; p [ 0.0065) and with the more recent DL model (at 42 months: 78% ± 6% versus 96% ± 2%; p < 0.0001). Cumulative freedom from severe dysfunction was 93% ± 2% at 5 years. Again, it was inferior among patients with a mismatch (86% ± 4% versus 100%; p [ 0.0013) and for the DL model (42 months: 92.5% ± 3% versus 98.5% ± 1%; p [ 0.0309). Smaller prostheses showed higher rates of early degeneration. Conclusions. The LivaNova Mitroflow valve appears to be prone to early deterioration. Smaller size prostheses should be used cautiously and avoided with patient-prosthesis mismatch. The DL model anti calcification treatment seems unable to prevent early degeneration, and possibly contributes to even earlier failure

OC17 CORONARY ENDARTERECTOMY: AN OLD TOOL FOR PATIENTS CURRENTLY OPERATED ON CABG. LONG-TERM RESULTS, RISK FACTORS ANALYSIS.

Abstract Aims: Coronary endarterectomy (CE) may provide an useful adjunctive technique to coronary artery bypass grafting (CABG) in patients with diffusely coronary artery disease. Nevertheless, the incidence of complications remains still high, long-term results remain unclear, and no risk factors for late mortality have been still completely described. Methods: We retrospectively reviewed 90 consecutive patients (67 ± 8.2 years) undergoing isolated CABG in association with CE between. Mean follow-up was 75.1 ± 36.2 months (median 84 months) and it was 100% complete (6,755/6,755 pt-months). Results: Operative mortality was 4.4%, the incidence of perioperative myocardial infarction was 11%. Ten-years survival was 83.3% ± 4.1%, freedom from cardiac death 92.7% ± 2.9%, and freedom from major adverse cardiac and cerebrovascular events 58.2% ± 10.2%. Independent predictors of late mortality were age older than 70 years at time of the surgery (P = 0.018) and chronic obstructive pulmonary disease (P = 0.036). Ten-year freedom from cardiac death was better after CE on the LAD (93.2% ± 3.3%) in comparison to CE not on the LAD (74.6% ± 10.2%), although this difference did not reach statistical significance (P = 0.102). Conclusion: Although the incidence of perioperative myocardial infarction continues to be not negligible, in presence of diffusely diseased coronary artery vessels CE associated with CABG appears to be a feasible adjunctive surgical tool, conferring satisfactory early and long-term outcomes. CE on the LAD confers a high probability of freedom from late cardiac death. Patients older than 70 years and those affected by a primary respiratory disease represent a new challenge on which focusing attention for the increased risk of late death. © 2018 Italian Federation of Cardiology - I.F.C. All rights reserved