Aluminum Nitride Thin Film Piezoelectric Pressure Sensor for Respiratory Rate Detection.

In this study, we propose a low-cost piezoelectric flexible pressure sensor fabricated on Kapton® (Kapton™ Dupont) substrate by using aluminum nitride (AlN) thin film, designed for the monitoring of the respiration rate for a fast detection of respiratory anomalies. The device was characterized in the range of 15-30 breaths per minute (bpm), to simulate moderate difficult breathing, borderline normal breathing, and normal spontaneous breathing. These three breathing typologies were artificially reproduced by setting the expiratory to inspiratory ratios (E:I) at 1:1, 2:1, 3:1. The prototype was able to accurately recognize the breath states with a low response time (~35 ms), excellent linearity (R2 = 0.997) and low hysteresis. The piezoelectric device was also characterized by placing it in an activated carbon filter mask to evaluate the pressure generated by exhaled air through breathing acts. The results indicate suitability also for the monitoring of very weak breath, exhibiting good linearity, accuracy, and reproducibility, in very low breath pressures, ranging from 0.09 to 0.16 kPa. These preliminary results are very promising for the future development of smart wearable devices able to monitor different patients breathing patterns, also related to breathing diseases, providing a suitable real-time diagnosis in a non-invasive and fast way.

Frozen elephant trunk technique using hybrid grafts: 15-year outcomes from a single-centre experience.

OBJECTIVES: The purpose of the study is to compare the short- and long-term outcomes of the frozen elephant trunk (FET) technique based on 2 different hybrid grafts implanted from January 2007 to July 2022. METHODS: The study includes patients who underwent an elective or emergency FET procedure. Short-term, long-term mortality and freedom from thoracic endovascular aortic repair (TEVAR) were the primary end points. Analyses were carried out separately for the periods 2007-2012 and 2013-2022. RESULTS: Of the 367 enrolled, 49.3% received E-Vita Open implantation and 50.7% received Thoraflex Hybrid implants. Overall mean age was 61 years [standard deviation (SD) = 11] and 80.7% were male. The average annual volume of FET procedures was 22.7 cases/year. Compared to E-Vita Open, patients implanted with Thoraflex Hybrid grafts were more likely to receive distal anastomosis in zone 2 (68.3% vs 11.6%, P < 0.001) with a shorter stent portion, mean = 103mm (SD = 11.3) vs mean = 149 mm (SD = 12.7; P < 0.001) and they underwent a reduced visceral ischaemia time, mean = 42.5 (SD = 14.2) vs mean= 61.0 (SD = 20.2) min, P < 0.001. In the period 2013-2022, overall survival at 1, 2 and 5 years was 74.8%, 72.5% and 63.2% for Thoraflex and 73.2%, 70.7% and 64.1% for E-Vita, without significant differences between groups (log-rank test = 0.01, P = 0.907). Overall freedom from TEVAR at 1, 2 and 5 years was 66.7%, 57.6% and 39.3% for Thoraflex and 79%, 69.7% and 66% for E-Vita, with significant differences between groups (log-rank test = 5.28, P = 0.029). In a competing risk analysis adjusted for chronic/residual aortic syndromes and stent diameter, the Thoraflex group was more likely to receive TEVAR during follow-up (subdistribution hazard ratio SHR = 2.12, 95% confidence interval 1.06-4.22). CONCLUSIONS: The FET technique addresses acute and chronic arch disease with acceptable morbidity and mortality. Downstream endovascular reinterventions are very common during follow-up.

Distal stent graft-induced new entry (dSINE) after frozen elephant trunk: a scoping review.

Background: The introduction of hybrid total arch replacement with the frozen elephant trunk (FET) technique has improved the field of aortic surgery by allowing single-stage treatment of complex aortic pathologies. Although FET has been associated with favorable aortic remodeling, it is also associated with the potential development of distal stent graft-induced new entries (dSINEs). The aim of our review is to collect data about the incidence and the supposed conditions for the occurrence of dSINE after total hybrid arch replacement with FET technique. Methods: The literature review was performed using PubMed databases from inception to January 2022. A descriptive approach to detect and display supposed risk factors and predictors for dSINE occurrence has been adopted. Results: Eight studies summarized the state-of-the-art of dSINE in a total number of 544 FET procedures performed to treat acute and chronic aortic dissections. The scoping review showed dSINEs occurrence in 69 patients (12.7%). The mean time between surgery and the diagnosis ranged from 12.6 to 30.6 months. Most patients that developed dSINE received endovascular treatment, whereas a couple of them needed open surgery. According to our experience, from January 2007 to December 2021, in 225 FET procedures a total of 54 cases of dSINE, both with Thoraflex and E-vita grafts have been detected. The mean time between the surgical procedure and the diagnosis was 27.2±33.6 months. Conclusions: dSINEs are frequent complications after FET. Although not emergent, they require proper treatment. Due to dSINE's asymptomatic nature and potential harm, a rigorous follow-up including angio-computed tomography (CT) should be planned.

Innovative technologies to enhance oil recovery.

The processes for extracting and refining edible oils are well-established in industry at different scales. However, these processing lines encounter inefficiencies and oil losses when recovering crude or refined oil. Palm oil and olive oil extraction methods are used mainly as a combination of physical, thermal, and centrifugal methods to recover crude oil, which results in oil losses in the olive pomace or in palm oil effluents. Seed oils generally require a seed steam conditioning, and cooking stage, followed by physical oil recovery through an inefficient expeller. Most of the crude oil remaining in the expeller cake is then recovered by hexane. Crude seed oil is further refined in stages that also undergo oil losses. This chapter provides an overview of innovative technologies using microwave, ultrasound, megasonic and pulsed electric field energies, which can be used in the above-mentioned crude and refined oil processes to improve oil recovery. This chapter describes traditional palm oil, olive oil, and seed oil processes, as well as the specific process interventions that have been tested with these technologies. The impact of such technology interventions on oil quality is also summarized.

Modelling the Rheology of Olive Paste for Oil Extraction Plant Automation: Effects of the Crushing Process on the Rheology of Olive Pastes.

In extra virgin olive oil production, it is essential to obtain a well-prepared olive paste which allows not only the extraction of the oil drops from the olives, but also the achievement of a high-quality oil while maintaining high yields. This work addresses the problem of determining the effect of three crushing machines on the viscosity of the olive paste: a hammer crusher, a disk crusher and a de-stoner were tested. The tests were repeated on both the paste leaving each machine and the paste to which water was added; this was done with the main aim of considering the different dilutions of the paste while entering the decanter. A power law and the Zhang and Evans model were used to analyse the rheological behaviour of the paste. The experimental results allow validation of the two models with a high (more than 0.9) coefficient of determination between experimental and numerical data. The results also show that the pastes obtained with the two classic crushing methods (hammers and disks) are almost identical, with a packing factor of about 17.9% and 18.6%, respectively. Conversely, the paste obtained with the de-stoner entails higher viscosity values and a smaller solid packing factor, of about 2.8%. At 30% dilution with water, the volume of the solid concentration dropped to about 11.6% for the hammer and disc crushers, while for the de-stoner it only reached 1.8%. This behaviour is also reflected in the evaluation of yields, which were 6% lower with the de-stoner. No significant differences regarding the legal parameters of oil quality were found using the three different crushing systems. Finally, this paper establishes some fundamental pillars in the research for an optimal model for identifying the rheological behaviour of the paste as a function of the crusher used. Indeed, since there is an increasing need for automation in the oil extraction process, these models can be of great help in optimizing this process.

Antioxidant potential of the diet in Italian children with food allergies.

A reduced fruit and vegetable consumption, which implies a decreased intake of antioxidant compounds, seems to play a role in allergic diseases onset. Data on the antioxidant capacity of diet in children with food allergies, who are on an avoidance diet, are still lacking. This pilot study aims to assess the antioxidant potential of diet in Italian children with food allergies, compared to healthy children, using the oxygen radical absorbance capacity (ORAC) method. 95 children (54 with confirmed food allergies and 41 controls), with a median age of 7.8 years, were enrolled and underwent a nutritional assessment. Mean nutrient intakes were compared using the Mann-Whitney test. ORAC resulted significantly lower in allergic children (median 2,908, IQR: 1450;4,716) compared to control children (median 4,392, IQR: 2523;5,836; p = 0.049). Among micronutrients with antioxidant properties, vitamin A intakes were significantly higher in controls than in allergic children. Using Spearman's correlation, a moderate-to-strong correlation between ORAC and vitamin C, potassium and magnesium was observed (ρ = 0.648, p < 0.001; ρ = 0.645, p < 0.001; ρ = 0.500, p < 0.001, respectively). Iron, phosphorus, vitamin E and vitamin A intakes were also moderately-to-low correlated with ORAC values (ρ = 0.351, p < 0.001; ρ = 0.367, p < 0.001; ρ = 0.346, p < 0.001; and ρ = 0.295, p = 0.004, respectively). We hypothesize that the reduced antioxidant potential of the diet might be related to a reduced variety of the diet in children with food allergies. Our study suggests that the diet of children with food allergies has a lower antioxidant potential (expressed as ORAC value) compared to the diet of healthy children, regardless of the allergenic food excluded from the diet. This issue should be further investigated in prospective, powered studies.

Ten-year experience with sutureless Perceval bioprosthesis: single-centre analysis in 1157 implants.

AIMS: We describe long-term clinical and echocardiographic outcomes in the largest single-centre cohort of patients who underwent aortic valve replacement (AVR) with sutureless Perceval (CorCym, Italy) bioprosthesis. METHODS: Between March 2011 and March 2021, 1157 patients underwent AVR with Perceval bioprosthesis implantation. Mean age was 77 ±â€Š6 years (range: 46-89 years) and mean EuroSCORE II was 6.7 ±â€Š3.2% (range: 1.7-14.2%). Concomitant procedures were performed in 266 patients (23%). RESULTS: Thirty-day mortality was 1.38% (16/1157). Eight hundred and twenty of 891 (92%) isolated AVRs underwent minimally invasive surgery with a ministernotomy ( n  = 196) or right minithoracotomy ( n  = 624) approach. Cardiopulmonary bypass and aortic cross-clamp times were 81.1 ±â€Š24.3 and 50.6 ±â€Š11.7 min for isolated AVR and 144.5 ±â€Š34.7 and 96.4 ±â€Š21.6 min for combined procedures. At mean follow-up of 53.08 ±â€Š6.7 months (range: 1-120.5 months), survival was 96.5% and mean transvalvular pressure gradient was 13.7 ±â€Š5.8 mmHg. Left ventricular mass decreased from 152.8 to 116.1 g/m 2 ( P  < 0.001) and moderate paravalvular leakage occurred in three patients without haemolysis not requiring any treatment. Freedom from reoperation was 97.6%. Eight patients required surgical reintervention and 19 patients transcatheter valve-in-valve procedure for structural prosthesis degeneration at a mean of 5.6 years after first operation (range: 2-9 years). CONCLUSION: AVR with a Perceval bioprosthesis is associated with good clinical results and excellent haemodynamic performance in our 10-year experience. Structural degeneration rate of Perceval is comparable with other bioprosthetic aortic valves. Sutureless technology may reduce operative time especially in combined procedures and enable minimally invasive AVR.

Experimental Investigation of a New Modular Crusher Machine Developed for Olive Oil Extraction Plants.

The crushing system is crucial in the virgin olive oil (VOO) mechanical extraction process. The use of different crusher machines can highly influence the quality of the final product, mainly due to the phenolic and volatile content responsible for VOO sensory and health properties. An experimental investigation was conducted to evaluate the effect of the geometric features of a new model of crusher machine for olives. The crusher machine consists of interchangeable rotors: a rotor with hammers and a rotor with knives. The evaluation was carried out with the same fixed grid in stainless steel with 6 mm diameter circular holes. An evaluation was carried out on the impact of the crusher tools on the pit particle size and on the distribution of energy and temperature. The performance of the plant was also assessed in terms of process efficiency and olive oil quality. The results showed that the specific energy released by the tool per unit of product, calculated through both energy conservation and comminution theory, is about 25-27% higher in the case of hammers. Since the impact energy is mainly dissipated in the product as heat, the temperature reached during milling operations with the hammer crusher was also higher by the same percentage with respect to the knife crusher. This has important consequences on the quality of the product: the new knife rotor used in the crushing phase produced an improvement in VOO quality, relating mainly to sensory attributes and the health-enhancing properties of the final product. The ability of the crusher to break cell walls and vacuoles, thus releasing the oil contained therein, is comparable for the two different rotors.

How much should be covered a type B aortic dissection? Just do it, but don't forget about spinal cord protection.

Revascularization of the left subclavian artery (LSA) is considered a method of spinal cord protection from ischemia during thoracic endovascular aortic repair (TEVAR). Coverage of the artery of Adamkiewicz with TEVAR is usually well tolerated because of collateral pathways to this vessel, but on the other side, the LSA is crucial in this regard since it represents the primary source of collateral pathways. In our commentary, we wish to focus the discussion on the LSA revascularization and about the complexity of the anatomy of spinal cord supply in order to underline what have been already studied, analyzed, and recommended from the current guidelines.

Investigation on the Effects of a Pulsed Electric Field (PEF) Continuous System Implemented in an Industrial Olive Oil Plant.

The aim of this study was to investigate how the treatment of olive paste of the Picholine variety with pulsed electric fields (PEF) under real operating conditions in a large-scale olive oil extraction plant affects the extractability, chemical composition and sensory profile of the oils. The application of pulsed electric fields (PEF) as a non-thermal food processing technology is interesting for many food extraction processes. The results of this study show that pulsed electric fields can be used as a pretreatment before oil separation to increase the extractability of the process and improve the content of functional components. The application of pulsed electric field (PEF) treatment (2.4 kV/cm, 4 kJ/kg, 6 µs pulse width) to olive paste through a continuous system significantly increased the extractability and total concentration of phenols (especially oleuropein derivatives) compared to the control. In addition, the volatile compounds, α-tocopherol, the fatty acid profile and the main legal quality parameters of extra virgin olive oil (EVOO), including free acidity, peroxide values, extinction indices and sensory analysis, were evaluated. The pulsed electric fields (PEF) treatment did not modify these EVOO quality parameters, neither the α-tocopherol content nor the volatile profile. The sensory properties of EVOO were not affected as well as the PEF treatment showed a similar intensity of fruity and pungent attributes without any off-flavor according to the European Union legal standards. An increase in the bitter taste attribute was observed in the PEF oils. Consequently, this study demonstrates that pulsed electric fields (PEF) processing could be implemented in olive oil processing as pretreatment for improving the efficiency of the process.

Elective aortic arch surgery: cerebral perfusion flows and transient neurological dysfunctions.

AIMS: Selective antegrade cerebral perfusion technique is a method of cerebral protection used worldwide during aortic arch surgery. This study was designed to identify a potential correlation between perfusion flows and the development of postoperative transient neurological dysfunctions. METHODS: From January 2015 to May 2020, 175 patients underwent elective surgical replacement of the aortic arch using selective antegrade cerebral perfusion at the Cardiac Surgery Unit of Sant'Orsola Hospital in Bologna. Considering that patients who developed a permanent neurological dysfunction and those who died before a possible evaluation of neurological status were excluded, the study population included 160 patients. The perfusion flows were collected and analyzed. Univariate and multivariate analyses were performed to identify the statistical risk factors involved in the onset of transient neurological dysfunctions. RESULTS: The study population was divided into two groups: 138 patients (86.3%) without and 22 (13.8%) with postoperative transient neurological complications. Among the intra-operative parameters collected in the study, the univariate analysis showed that the indexed medium perfusion flow of selective antegrade cerebral perfusion was significantly lower in the transient neurological dysfunctions group (11.63 ±â€Š2.41 ml/kg/min vs 12.62 ±â€Š2.39 ml/kg/min, P -value = 0.03). The multivariate logistic regression analysis showed that the female gender ( P  = 0.004, OR = 4.816, IC = 1.636-14.174) was predictor of transient neurological dysfunctions. CONCLUSION: The results of the study showed that lower perfusion flows seem to be related to a higher probability of developing transient neurological dysfunctions. However, the analysis of a wider population is required to confirm these preliminary data.

Reoperations on the ascending aorta and aortic arch: A retrospective series of 453 patients.

OBJECTIVE: The study objective was to analyze the outcomes of reoperative thoracic aortic surgery at our institution from January 1986 to December 2018 to identify specific risk factors for early and late mortality. METHODS: Two groups of patients were identified: aortic root or ascending aorta repair (group 1: proximal repair, 218 patients, 48%) and arch surgery or descending thoracic aorta repair (group 2: distal repair, 235 patients, 52%). Primary end points were 30-day mortality, 10-year survival, and freedom from aortic reoperations. RESULTS: The 30-day mortality (6.4% vs 8.1%) and in-hospital mortality (8.3% vs 11.9%) were similar (P > .05) in the 2 groups. Multivariable analysis identified female gender (odds ratio, 8.60, P < .01), endocarditis (odds ratio, 2.96, P = .04), and cardiopulmonary bypass time (odds ratio, 1.02, P < .01) as risk factors for 30-day mortality. Mean follow-up time was 163 months (confidence interval, 147-179). Long-term survival at 1, 5, and 10 years was 91.2%, 79.4%, and 66.3% in the proximal repair group and 80.7%, 68.8%, the and 55.3% in distal repair group, respectively (P = .03). According to the indication, 1-, 5-, and 10-year survivals were 92.1%, 82.3%, and 68.8% in degenerative aneurysms; 82.7%, 72.4%, and 56.3% in residual dissections; 80.9%, 65.4%, and 50.3% in endocarditis and pseudoaneurysms; 69.2%, 52.7%, and 42.2% in acute type A aortic dissections, respectively (P < .01). Competing risk analysis showed a significantly different cumulative incidence of reoperation at 1, 5, and 10 years between the 2 groups: 0.50%, 0.50%, and 0.90%, respectively, for the proximal repair group, and 0.40%, 4.30%, and 7.70%, respectively, the for distal repair group (P < .01). CONCLUSIONS: In our experience, short- and long-term results of reoperative thoracic aortic surgery were satisfactory in chronic aneurysms but poor in aortic dissections, pseudoaneurysms, and active endocarditis. Reoperative aortic surgery carries a high risk, regardless of the anatomic extension of the procedure.

Adherence to the Mediterranean Diet and Risk of Metabolically Unhealthy Obesity in Women: A Cross-Sectional Study.

Some obese individuals do not present any metabolic alteration and are considered metabolically healthy (MHO). Adherence to high-quality dietary pattern may favor this phenotype. We aimed to evaluate the association between the adherence to the Mediterranean diet and risk of metabolically unhealthy obesity (MUO) in women. We conducted a cross-sectional study on 2,115 obese women. All patients underwent a medical examination, anthropometric evaluation, bioelectrical impedance, ultrasound measurements of abdominal visceral (VAT) and subcutaneous (SAT) fat, blood sampling and evaluation of adherence to the Mediterranean diet through MEDAS questionnaire. The diagnosis of MHO and MUO was made using the harmonized criteria. A multivariable logistic regression adjusted for age, BMI, fat free mass, ultrasound-estimated VAT:SAT ratio, marital status, education, past diet, antidepressant use, family history of diabetes and cardiovascular disease, menopausal status, smoking, and physical activity was used to assess the association between Mediterranean diet and MUO risk. The prevalence of MHO was 21.2% (N = 449). Compared to MUO women, MHO women were younger, had lower BMI and VAT, and had higher fat free mass and SAT. In the multivariable model, the adherence to the Mediterranean diet was not associated with the risk of MUO (OR = 0.91, 95%CI: 0.62; 1.34, P = 0.624). Given the impact of menopause on metabolic health we also carried out the analysis in pre- and post-menopausal women separately. Higher adherence to the Mediterranean diet was associated with a lower risk of MUO in postmenopausal women (OR = 0.55, 95%CI: 0.31; 0.96, P = 0.034). No association was found in premenopausal women (OR = 1.18, 95%CI: 0.70; 1.99, P = 0.532). In conclusion, adherence to the Mediterranean diet was associated with a better metabolic health in postmenopausal women. Further studies are needed to confirm the ability of the Mediterranean diet in promoting maintenance of the healthy phenotype and reversion from MUO.

"Why is frozen elephant trunk better than classical elephant trunk?"

The treatment of complex aortic arch disease, in chronic or acute setting, has always represented a fascinating challenge for the heart surgeon also because, often, the involvement of the aortic arch is associated with a simultaneous involvement of the ascending aorta and of the proximal portion of the descending thoracic aorta. In recent years, there have been many surgical and/or endovascular techniques and approaches in a single step or multiple steps proposed with the aim of treating and simplifying these complex conditions. The first procedure available for this purpose was the conventional elephant trunk technique, proposed by the German surgeon Hans Borst, back in 1983. In the following years, the technique has undergone modifications, up to what is nowadays considered its most modern evolution, represented by the frozen elephant trunk which allows managing the proximal descending thoracic aorta using the antegrade release of a self-expandable stent graft. In this review article, we try to analyze the advantages and drawbacks of both techniques from clinical and practical points of view.

How to mimic a type A intramural hematoma: A case of IgG4-related aortitis associated with cerebral hemorrhage.

IgG4-related aortitis is an inflammatory condition of the aorta, characterized by aortic wall thickening and periaortic soft-tissue involvement. Therefore, this condition can mimic an aortic intramural hematoma (IMH), due to similar radiological findings. We hereby report the case of an IgG4-related aortitis misdiagnosed as an IMH, associated with cerebral hemorrhage, possibly due to cerebral vascular system involvement.

A Real Case Study of a Full-Scale Anaerobic Digestion Plant Powered by Olive By-Products.

The anaerobic digestion plant studied in this paper is one of the first full-scale plants using olive oil by-products. This is a two-stage plant with a power of 100 kWe. Two tests were performed: the first on olive pulp and pitted pomace and the second on biomass consisting of 10% crushed cereal. In both cycles, the retention time was 40 days. The production of biogas was between 51 and 52 m3/h, with limited fluctuations. The specific production values of biogas indicate that a volume of biogas greater than 1 m3/kg was produced in both tests. The produced biogas had a methane percentage of about 60% and the specific production (over total volatile solids, TVS) of methane was of the order of 0.70 m3methane/kgTVS. FOS/Alk (ratio between volatile organic acids and alkalinity) was always lower than 1 and tended to decrease in the second digester, indicating a stable methanogenic phase and the proper working of the methanogenic bacteria in the second reactor. The concentration of incoming biomass TPC (total polyphenols content) can vary significantly, due to the seasonality of production or inadequate storage conditions, but all measured values of TPC, between 1840 and 3040 mg gallic acid kg-1, are considered toxic both for acidogenic and methanogenic bacteria. By contrast, during the process the polyphenols decreased to the minimum value at the end of the acidogenic phase, biogas production did not stop, and the methane percentage was high.

Prenatal Exposure to BPA: The Effects on Hepatic Lipid Metabolism in Male and Female Rat Fetuses.

Bisphenol A (BPA) is an organic chemical compound widely used for manufacturing plastics. BPA exposure originates principally from the diet, but it can also originate from dermal contact. In over 90% of individuals, including pregnant women, BPA is detectable in several body fluids. The effects of this exposure on the fetus are under active investigation in several research laboratories. The aim of our work was to study the impact of prenatal exposure to BPA in the liver of rat fetuses from a sex-dependent point of view. We particularly investigated the effects of prenatal BPA exposure on hepatic lipids because of their crucial role, not only for the liver, but also for the whole-body functions. Our results demonstrate that the liver of rat fetuses, in utero exposed to a very low dose of BPA (2.5 µg/kg/day), displays significant modulations with regard to proteins involved in cholesterol and fatty acid biosynthesis and trafficking. Moreover, an impact on inflammatory process has been observed. All these effects are dependent on sex, being observable only in female rat fetuses. In conclusion, this work demonstrates that maternal exposure to BPA compromises hepatic lipid metabolism in female offspring, and it also reveals the perspective impact of BPA on human health at doses currently considered safe.

Early outcome and mid-term survival after open arch repair using selective antegrade cerebral perfusion.

OBJECTIVES: The introduction of selective antegrade cerebral perfusion technique as method of cerebral protection improved the outcome of open arch surgery. The aim of this study was to report early outcomes using this technique. METHODS: Between 1997 and 2017, data were collected retrospectively for all patients who underwent surgical replacement of the aortic arch using selective antegrade cerebral perfusion (n = 938). To confirm the effectiveness of this cerebral protection method, early outcome and results were evaluated. RESULTS: The incidence of postoperative permanent neurological dysfunction was 6.4%. Overall hospital mortality was 11.9% (n = 112). On multivariable analysis, age >75 years, female gender, euroscore at increment of 1 point, chronic renal failure, extension of thoracic aorta replacement and CPB time emerged as independent risk factors for hospital mortality. The mid-term survival at 1, 5, 10 and 15 years was 92%, 78%, 60% and 49%, respectively. The competing risk analysis for permanent neurological dysfunction and aortic reoperations was performed excluding the patients who died during the hospital stay. The cumulative incidence of permanent neurological dysfunction and aortic reoperations was 2% at 3 years, 3% at 5 years, 6% at 10 years, 12% at 3 years, 15% at 5 years and 19% at 10 years, respectively. CONCLUSIONS: From the early 90s to the present day, the selective antegrade cerebral perfusion has confirmed to be a useful and "safe" method of brain protection in aortic arch surgery in terms of postoperative neurological complications.

Visceral malperfusion after Frozen Elephant Trunk in chronic aortic dissection: post-operative predictors and outcomes.

BACKGROUND: The aims of this study were to analyse the incidence of visceral malperfusion syndrome (MPS) following Frozen Elephant trunk operations in patients affected by chronic aortic dissection and the associated risk factors. METHODS: Between January 2007 and February 2019, 165 patients underwent surgery with FET for chronic aortic dissection. Post-operative computer tomography angiogram parameters (diameters, early post-operative false lumen enhancement and involving of aortic branches by the dissection) were collected and analysed to evaluate their impact on the occurrence of visceral malperfusion. RESULTS: Visceral (renal and mesenteric) MPS (with both clinical and radiological signs of MPS) was detected in 10 cases (6.1%). Post-operative visceral malperfusion was strongly related with in hospital mortality. The involvement of the visceral branches in the dissection was not a risk factor for visceral malperfusion occurrence, while a larger post-operative total aortic diameter at level of the coeliac trunk increased the risk of visceral MPS (OR 1.05; CI 1.002-1.102, p-value = 0.04). Furthermore, visceral MPS was associated to a complete thrombosis of the false lumen at level of the distal descending thoracic aorta. CONCLUSIONS: The development of post-operative MPS in frozen elephant trunk is strongly related to in-hospital mortality. The involvement of aortic branches by the dissection does not represent a real predictive risk factor for MPS, while early larger aortic diameters and false lumen thrombosis represent independent risk factors for MPS and in-hospital mortality.