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SATS 2014 S e p t e m b e r 3 - 5, 2 014 G o t h e n b u rg - Swe d e n 6th Joint Conference in Cardiothoracic Surgery & The Swedish Thoracic Meeting (Svenska Thoraxmötet) PROGRAM & ABSTRACTS www.sats2014.com Scandinavian Association for Thoracic Surgery Scandinavian Society of Extra Corporeal Technology Scandinavian Association of Thoracic Nurses Swedish Association for Cardiothoracic Surgery Swedish Association for Cardiothoracic Anesthesiology and Intensive Care CONTENTS CONTENTS Organisation SATS 2014 4 Welcome to SATS 2014 5 Practical information 6 Map of important locations 7 Venue8 Social events 9 Program10-13 Oral abstracts 14-18 Poster abstracts 19-21 Oral presentations 23-59 Poster presentations 61-93 Exhibition area & Floor plan Author index 96 98-103 Sponsors107 Program at a glance 108 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 3 WELCOME TO SATS 2014 ORGANIZATION SATS 2014 Congress President Anders Jeppsson Local Organizing Committee Monica Andersson Anna-Maria Börjesson Göran Dellgren Christina Edvinsson Jakob Gäbel Caroline Ivarsson Anders Jeppsson Hasse Karlsson Ulla Nathorst-Westfelt Andreas Nygren HelenaRexius Christine Roman-Emanuel Carola Wallbäck Anne Westerlind Svetlana Bannova Address Sahlgrenska University Hospital, Department of Cardiothoracic Surgery Gothenburg SE-413 45 Sweden Congress Secretariat Malmö Kongressbyrå Norra Vallgatan 16 211 25 Malmö Tel+4640258550 [email protected] 4 Scientific Committee SATS Dan Lindblom Odd Geiran Christian Möller Fausto Biancari Tomas Gudbjartsson Jan van der Linden Anders Jeppsson KA Kirkebøen Scientific Committee SCANSECT Anne Louise Bellaiche Micael Appelblad Peter Fast Nielsen Vivian Hoyland Liney Simonardottir Scientific Committee SATNU Marita Ritmala-Castrén Lotte Brahe Kari Hanne Gjeilo Helga Hallgrimssdottir Susanna Ågren Welcome to SATS 2014 On behalf of the Organizing Committee I wish you welcome to Gothenburg and the SATS/SCANSECT/SATNU Annual Meeting! This is the sixth Scandinavian joint meeting for all professional categories working with cardiothoracic patients. We have done our very best to make your stay in Gothenburg enjoyable and inspirational. Our ambition has been to make the conference a vibrant meeting with an excellent scientific program and extensive opportunities for cross talks and interactions. We cover most areas of cardiothoracic surgery, care and perfusion and are confident that you will enjoy all the symposia, lectures and abstracts presentation. In addition, we hope that you will find the social program pleasant. Once again, Welcome to Gothenburg! Anders Jeppsson Chairman of the Organizing committee Websites www.mkon.se/sats_2014 www.scandinavian-ats.org www.scansect.org www.satnu.org Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 5 PRACTICAL INFORMATION MAP OF IMPORTANT LOCATIONS General Language: English is the official language of the meeting. Registration fee: Registration includes access to all scientific sessions, the Get-together party, the exhibition area and coffee and tea during breaks. Participation in the Banquet dinner is not included in the registration fee. Name badge: Name badge must be worn at all times during the congress to ensure access to all scientific sessions and the exhibition area. Certificate of attendance Please go to registration desk if you wish to obtain a certificate of attendance. Mobile phones: Mobile phones must be switched off during the sessions. No smoking: The venue is a non smoking area. Lunch and coffee breaks: Will be served at the exhibition area. Internet: Free access for all delegates in the conference area. Social program: Get together party; Wednesday, September 3rd, 18.00-20.00 at the exhibition area, Svenska Mässan (Conference Venue), Dress code: Informal, Pre-registration is mandatory. Banquet dinner at Rondo; Thursday, September 4th, 19.30 at the Rondo (Liseberg) Dress code: Informal, Pre-registration is mandatory. Venue: Svenska Mässan Mässans gata 20 412 51 Göteborg +46 31 708 80 00 6 CENTRAL STATION SCANDIC HOTEL OPALEN Hotel HOTEL GOTHIA TOWERS Hotel SVENSKA MÄSSAN Venue RONDO Banquet dinner Taxi: Taxi Göteborg +46 31 65 00 00 Taxi Kurir +46 31 27 27 27 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 7 VENUE SOCIAL EVENTS Get together party Wednesday, September 3rd, 18.00-20.00 The exhibition area, Svenska Mässan (Conference Venue) Note: Pre-registration is mandatory Dress code: Informal Venue The Swedish Exhibition & Congress Centre’s (Svenska Mässan) unique location in the city makes it easy and convenient to visit us. The City of Gothenburg welcomes you to mingle with friends and colleagues at the Get together party in the exhibition area. A light meal and drinks will be served. From the Central Station Take a number 2, 4 or 13 tram from Drottningtorget. You can also take a number 5 tram from Brunnsparken. The trams stop at Korsvägen opposite the Swedish Exhibition & Congress Centre and Gothia Towers. From Landvetter Airport The airport bus stops at Korsvägen opposite the Swedish Exhibition & Congress Centre. From Gothenburg City Airport (Säve Airport) The airport bus stops at Nils Ericssonsplatsen/Central Station. You can take a tram from there, as described above. By car On arriving in Gothenburg, turn off at the ”Mässan Scandinavium Liseberg” sign. Park in the multi-storey car park at Focus shopping centre, next to the Swedish Exhibition & Congress Centre. There is a foot bridge from here to the Swedish Exhibition & Congress Centre. Banquet dinner at Rondo Thursday, September 4th, 19.30 Location: Rondo (Liseberg) Pre-registration is mandatory, tickets available at the Registration desk. Dress code: Informal E6 motorway, southbound from Stockholm/Oslo or northbound from Malmö. E20 motorway, southbound from Stockholm/Oslo or northbound from Malmö. Highway 40 from Borås and highway 45 from Karlstad. 8 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 9 PROGRAM PROGRAM Thursday, September 4 Wednesday, September 3 Time Hall K2 18.00-20.00 Get together party and registration at Svenska Mässan 12.10-13.10 Lunch & exhibition Thursday, September 4 13.10-14.10 SATS oral abstract session 1 Time Exhibition Hall Time Hall K2 07.15-08.00 Breakfast symposium: Antiplatelet therapy and cardiac surgery Silver sponsor: AstraZeneca Moderators: Hanne Ravn & Tomas Gudbjartsson 13.50-14.10 How to manage patients on vaECMO in intensive care Lars Algotsson, Lund, Sweden ECMO - when is the right choice palliative care Maria Linde, Stockholm, Sweden Pro-Con debate ECMO programs should have a perfusionist on-call ”in-house” PRO: Gro Sörensen, Oslo, Norway CON: Daniel Bengtsson, Gothenburg, Sweden 09.30-10.00 Coffee & exhibition 10.00-10.45 Designing the future treatment of Heart valve disease SATNU oral abstract SCANSECT oral abstract session 1 14.20-15.20 SATS oral abstract session 2 SATNU oral abstract session 2 SCANSECT oral abstract session 2 15.20-15.50 Coffee & exhibition 15.50-16.35 Clarence Crafoord’s Memorial Lecture Moderator: Anders Holmgren Hans-Joachim Schäfers Homburg, Germany Exhibition Hall In second floor - Foyer In second floor - Foyer 16.45-17.30 Poster session - SATS Poster session - SATNU Poster session - SCANSECT Time Hall K2 Hall K3 Hall K1 Transcatheter valve-in-valve implantation: first-line treatment for degenerated bioprosthesis Lenard Conradi, Hamburg, Germany 17.30-18.30 General assembly General assembly SACTS SFTAI Award symposium 19.30 Aortic valve replacement in the advent of rapid deployment Valves Bruno K. Podesser, Poelten, Austria 10 SCANSECT lecture Moderators: Else Loholdt Nygreen & Christina Edvinsson Time Gold sponsor: Edwards Lifescience 10.50-12.10 SATNU lecture Moderators: Anita Tracey & Christine Roman-Emanuel session 1 08.00-09.30 ECMO: An update Moderators: Helena Rexius & Göran Dellgren vaECMO - this is how it should be done and why Christof Schmid, Regensburg, Germany Hall K1 Aortic dissection with What do we know about fear of movement deep hypothermia and in heart disease? cerebral perfusion William DeBois Maria Bäck New York, USA Gothenburg, Sweden Dual antiplatelet therapy in patients with acute coronary syndrome Oscar Braun, Lund, Sweden Perioperative handling of cardiac surgery patients on dual antiplatelet therapy Anders Jeppsson, Gothenburg, Sweden Hall K3 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Banquet dinner at Rondo, Liseberg Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 11 PROGRAM PROGRAM Friday, September 5 Time Hall K2 Friday, September 5 Time Hall K2 Hall K3 Hall K1 08.00-08.45 Breakfast symposium Silver sponsor: Sorin Group 11.40-12.15 General assembly SATS General assembly SCANSECT General assembly SATNU Acute kidney injury in cardiac surgery Marco Ranucci Milano, Italy 12.15-13.00 Lunch & exhibition Update II Moderators: Lisa Ternström & Bjarni Torfasson Update III Moderators: Sven-Erik Ricksten & Lena Jidéus Accidental hypothermia Benedict Kjaergaard, Aalborg, Denmark CABG in patients <50 years Fausto Biancari, Oulu, Finland Ex vivo lung perfusion: The surgeons’s view Andreas Wallinder, Gothenburg, Sweden Left ventricle remodelling Theis Tönnessen, Oslo, Norway No-touch vein grafts Domingos Souza, Örebro, Sweden Stem cells and the heart Karl-Henrik Grinnemo, Stockholm, Sweden Postoperative wound infections Tomas Gudbjartsson, Reykjavik, Iceland 09.00-10.00 SATS symposium Aortic aneurysm surgery Moderators: Jakob Gäbel & Arnar Geirsson The Stockholm experience Christian Olsson, Stockholm, Sweden Thoracoabdominal aneurysms Odd Geiran Oslo, Norway Hall K3 Hall K1 Hall R31 SATNU lecture Moderators: Anita Tracey & Christine Roman-Emanuel SCANSECT lecture Moderators: Linda Önsten & Daniel Bengtsson Patient experience after transplantation Marta Edin Gothenburg, Sweden Blood saving management William DeBois, New York, USA Thoracic aneurysms: The future? Håkan Roos, Gothenburg, Sweden Monitoring of coagulation and platelet function in pediatric cardiac surgery Birgitta Romlin, Gothenburg, Sweden Physiotherapy lecture 13.00-14.00 Update I Moderators: Hans Lidén & Andreas Nygren Physiological and psychological effects of exercise training after heart surgery Åsa Cider, Gothenburg, Sweden 14.10-15.10 10.00-10.30 Coffee & exhibition Time Hall K2 Hall K3 Hall K1 10.30-11.30 Advanced valve surgery Moderator: Stefan Thelin & Fausto Biancari Lung surgery Moderators: Martin Silverborn & Klaus Kirnö Bleeding & Haemostasis Moderators: Mari-Liis Kaljusto & Gabriella Lindvall Ischemic mitral regurgitation Hans-Joachim Schäfers, Homburg, Germany Biscuspid aortic valves Christian Olsson, Stockholm, Sweden Minimal invasive valve surgery Per Wierup, Lund, Sweden 12 Surgery for lung cancer Tomas Gudbjartsson, Reykjavik, Iceland VATS lobectomy Mamdoh Al-Ameri, Stockholm, Sweden The THOR registry Ulf Hermansson, Linköping, Sweden Eva Berglin Memorial Symposium Moderators: Anders Albåge & Henrik Scherstén Performance of the Cox-Maze procedure - a large surgical ablation center´s experience Niv Ad, Falls Church, USA How should the new anticoagulants and platelet inhibitors be handled? Anders Jeppsson, Gothenburg, Sweden Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Surgical treatment of endocarditis Gunnar Svensson, Gothenburg, Sweden The development of atrial fibrillation surgery - 50 years of experience James L Cox, Denver, USA Why does it bleed? Hanne Ravn, Copenhagen, Denmark Strategies to reduce bleeding in cardiac surgery Marco Ranucci, Milan, Italy TAVI: An update Truls Råmunddal, Gothenburg, Sweden 15.10 Closure Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 13 ORAL ABSTRACTS ORAL ABSTRACTS Thursday, September 4 10.5011.00 Hall K2 13.10-14.10 Hall K2 SATS oral abstract session 1 Moderators: Dan Lindblom & Viebeke Hjortdal Moderators: Elisabeth Ståhle & Rune Haaverstad Indications and outcomes of emergency and salvage coronary artery bypass grafting Tomas Andri Axelsson, Anders Jeppsson, Tomas Gudbjartsson, Reykjavik, Iceland, Gothenburg, Sweden O2 Monoamine oxidase-inhibition enhances recovery after experimental cardiac arrest Vilma Vuohelainen, Mari Hamalainen, Timo Paavonen, Sari Karlsson, Eeva Moilanen Ari Mennander, Tampere, Finland 11.1011.20 O3 Re-exploration for bleeding is an independent predictor of mortality in cardiac surgery patients also beyond the immediate postoperative period Victoria Fröjd, Anders Jeppsson, Gothenburg, Sweden 11.2011.30 O4 Major depression is associated with worse survival after coronary artery bypass surgery Malin Stenman, Martin Holzmann, Ulrik Sartipy, Stockholm, Sweden 11.3011.40 O5 Adjusted calculation model regarding heparin and protamine in connection with cardiopulmonary bypass Gunilla Kjellberg, Gabriella Lindvall, Stockholm, Sweden 11.4011.50 O6 Acute coronary angiography for myocardial ischemia after coronary artery bypass grafting Karin Hultgren, Anders Andreasson, Tomas Axelsson, Per Albertsson, Vincenzo Lepore, Anders Jeppsson, Gothenburg, Sweden, Reykjavik, Iceland 11.5012.00 O7 Age dependent trends in preoperative co morbidity and mortality in isolated coronary artery bypass graft surgery, a nationwide study Kristinn Thorsteinsson, Jan Jesper Andreasen, Kirsten Fonager, Charlotte Mérie, Christian Torp Pedersen, Aalborg, Denmark O8 Thursday, September 4 Award session 11.0011.10 12.0012.10 14 O1 10.50-12.10 Is intra-aortic counterpulsation during CPB beneficial for microvascular tissue perfusion? Steinar Lundemoen, Venny Lise Kvalheim, Øyvind Sverre Svendsen, Arve Mongstad, Knut Sverre Andersen, Ketil Grong, Paul Husby, Bergen, Norway Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Health-related quality of life 12 years after coronary artery bypass graft surgery Matti Hokkanen, Heini Huhtala, Jari Laurikka, Otso Järvinen. Tampere, Finland 13.1013.20 O9 13.2013.30 O10 Favorable long-term outcome of CABG with LIMA to the LAD and great saphenous vein to the right and circumflex branches Hera Johannesdottir, Jonas A Adalsteinsson, Tomas A Axelsson, Linda O Arnadottir, Dadi Helgason, Helga R Gardarsdottir, Arnar Geirsson, Gudmundur Thorgeirsson, Tomas Gudbjartsson. Reykjavik, Iceland 13.3013.40 O11 A meta-analysis of resource consumption and clinical outcomes following endoscopic vein harvesting and open vein harvesting for coronary artery bypass grafting Lars Oddershede, Jan Jesper Andreasen. Aalborg, Denmark 13.4013.50 O12 Late survival after aortic valve replacement with the Perimount versus the Mosaic bioprosthesis Natalie Glaser, Anders Franco-Cereceda, Ulrik Sartipy. Stockholm, Sweden 13.5014.00 O13 Native valve endocarditis is not associated with reduced short or longterm survival when compared to conventional valve surgery Per Vikholm, Rafael Astudillo, Petter Schiller, Laila Hellgren. Uppsala, Sweden. 14.0014.10 O14 Thirty years of heart transplantation in Gothenburg: a long-term follow-up study Göran Dellgren, Bert Andersson, Sven-Erik Ricksten, Hans Liden, Sven-Erik Bartfay, Jakob Gäbel, Entela Bolano, Helena Rexius, Henrik Schersten, Kristjan Karason. Gothenburg, Sweden Thursday, September 4 14.20-15.20 Hall K2 SATS oral abstract session 2 Moderators: Hans Henrik Kimose & Anne Westerlind 14.2014.30 O15 Heparin and protamine titration does not improve haemostasis after adult cardiac surgery Vladimir Radulovic, Anna Laffin, Kenny Hansson, Erika Backlund, Fariba Baghaei, Anders Jeppsson. Gothenburg, Sweden 14.3014.40 O16 Norepinephrine infusion to maintain arterial blood pressure during anaesthesia induction reduces the pressure dependent decrease in haematocrit Tor Damén, Andreas Nygren. Gothenburg, Sweden Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 15 ORAL ABSTRACTS Thursday, September 4 14.20-15.20 Hall K2 Thursday, September 4 14.20-15.20 Hall K3 SATS oral abstract session 2 SATNU oral abstract session 2 Moderators: Hans Henrik Kimose & Anne Westerlind Moderators: Lotta Brahe, Karin Falk-Brynhildsen & Helga Hallgrimsdottir 14.4014.50 O17 Treatment of esophageal perforation in octogenarians: a multicenter study Halla Vidarsdottir, Tomas Gudbjartsson, Ari Mennander, Kari Kuttila, Mikael Viktorzon, Enrico Tarantino, Jon Arne Søreide, Asgaut Viste, Luigi Bonavina, Biancari Fausto. Reykjavik, Iceland; Tampere, Finland; Oulu, Finland; Turku, Finland; Vaasa, Finland; St Etienne, France; Stavanger, Norway; Bergen, Norway; Milano, Italy 14.5015.00 O18 Efficacy of triclosan-coated sutures for lowering the rate of sternal wound infections: a double-blind randomized trial Steinn Steingrimsson, Linda Thimour-Bergström, Henrik Scherstén, Örjan Friberg, Tomas Gudbjartsson, Anders Jeppsson. Reykjavik, Iceland; Gothenburg, Sweden; Örebro, Sweden. 15.0015.10 O19 Long-term follow-up of postoperative cardiac rhythm in 319 Swedish patients after the Cox Maze III procedure Anders Albåge, Birgitta Johansson, Göran Kennebäck, Göran Källner, Henrik Scherstén, Lena Jidéus. Uppsala, Sweden; Gothenburg, Sweden; Stockholm, Sweden. 15.1015.20 O20 Long-term clinical follow-up in 339 Swedish patients after the Cox Maze III procedure: Postoperative quality-of-life evaluation Lena Jidéus, Birgitta Johansson, Göran Kennebäck, Göran Källner, Henrik Scherstén, Anders Albåge. Uppsala, Sweden; Gothenburg, Sweden; Stockholm, Sweden. Thursday, September 4 16 ORAL ABSTRACTS 13.50-14.10 Hall K3 14.2014.30 023 Coronary artery disease patients’ fears after coronary angiography Mervi Roos, Päivi Åstedt-Kurki, Anja Rantanen, Meeri Koivula. Tampere, Finland 14.3014.40 024 Self-reported physical activity and lung function two months after cardiac surgery Marcus Jonsson, Charlotte Urell, Margareta Emtner, Elisabet Westerdahl. Örebro, Sweden; Uppsala, Sweden. 14.4014.50 025 Pain management after lung surgery Maria Frödin, Margareta Stomberg-Warren. Gothenburg, Sweden 14.5015.00 O26 Health related quality of life in lung surgery patients Susanne Karlsson, Anna Enström, Isabel Capitao De Lemos Ribeiro, Soudabeh Babaei, Martin Silverborn, Anders Jeppsson, Helena Rexius, Christine Roman Emanuel. Gothenburg, Sweden 15.0015.10 O27 Prevention of central line-associated infections in intensive care – a systematic literature review Cecilia Fält. Örebro, Sweden 15.1015.20 O28 Implementation of new evidence in clinical practice: Sustained reduction in surgical site infections after coronary artery bypass grafting Linda Thimour-Bergström, Christine Roman Emanuel, Henrik Scherstén, Anna Enström, Anna-Lena Andersson, Kerstin Theander, Angelica Hardenklo, Sara Nilsson, Katarina Nilsson, Anders Jeppsson. Gothenburg, Sweden Thursday, September 4 13.50-14.10 Hall K1 SATNU oral abstract session 1 SCANSECT oral abstract session 1 Moderators: Anita Tracey & Christine Roman-Emanuel Moderators: Else Loholdt Nygreen & Christina Edvinsson 13.5014:00 O21 Lifestyle after cardiac rehabilitation: Did the message come across, and was it feasible? ; An analysis of patients’ narratives Marie Veje Knudsen, Sussie Laustsen, Annemette Krintel Petersen, Sanne Angel. Aarhus, Denmark. 14:0014:10 022 Efficacy of tele-training in exercise-based cardiac rehabilitation Annemette Krintel Petersen, Sussie Laustsen. Aarhus, Denmark Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 13.5014:00 O29 Heart transplantation of a newborn Linda Önsten, Maria Tellin. Gothenburg, Sweden. 14:0014:10 O30 An implantable left ventricular device as bridge to transplantation in a pediatric patient Maria Tellin, Linda Önsten. Gothenburg, Sweden. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 17 POSTER ABSTRACTS POSTER PRESENTATIONS ORAL ABSTRACTS Thursday, September 4 14.20-15.20 Hall K1 Thursday, September 4 SCANSECT oral abstract session 2 16.45-17.30 In Exhibition Hall Poster abstract - SATS Moderators: Liney Simonardottir & Kerstin Björk GROUP 1: Moderator: Tomas Gudbjartsson 14.2014.30 O31 Tepid antegrade intermittent blood cardioplegia versus intermittent crossclamping with Lidoflazine in CABG Koen Kairet, Dina De Bock, Inez Rodrigus. Antwerp, Belgium. 14.3014.40 O32 Characterization of aortic root pressure during administration of blood and crystalloid cardioplegia. Ahmed Sarfan, Hans-Henrik Kimose, Peter Fast Nielsen, Jon Kristensen. Tilst, Denmark. 14.4014.50 O33 How much vacuum - from vacuum assisted venous drainage - can membrane oxygenators withstand? Kent Nygaard. Oslo, Norway. 14.5015.00 O34 The influence of protamine test dose on ACT Camilla Nyeng, Roar Stenseth. Trondheim, Norway. 15.0015.10 O35 Improved quality of retransfused residual blood from the cardio-pulmonary bypass circuit with Ringer wash-in technique Anki Olsson, Joakim Alfredsson, Sören Berg. Karlskrona, Sweden; Linköping, Sweden. 15.1015.20 O36 Mean arterial pressure in relation to cerebral ischemia and kidney injury Carina Dyhr Joergensen, Line Larsen. Odense, Denmark. P1 Innovative approaches to catheter based stent valve implantations Henrik Ahn, Jacek Baranowski, Lars-Göran Dahlin, Niels-Erik Nielsen Linköping, Sweden P2 An implantable pressure sensor for wireless monitoring of intracardiac pressure - first in man study Henrik Ahn, Jacek Baranowski, Baz Delshad, Irina Myasnikova Linköping, Sweden P3 Comparison of outcome after PCI and CABG in patients with chronic kidney disease stage 3B to stage 5. Anna Lautamäki, Tuomas Kiviniemi, Fausto Biancari, Jarmo Gunn. Turku, Finland. P4 Outcome of myocardial revascularisation in patients younger than 50 Linda Osk Árnadóttir, Tomas A Axelsson, Dadi Helgason, Hera Johannesdottir, Jonas A Adalsteinsson, Arnar Geirsson, Axel F Sigurdsson, Tomas Gudbjartsson. Reykjavik, Iceland P5 Should bilateral internal mammary artery grafting be offered universally during off-pump coronary artery bypass grafting? Kamales Kumar Saha, Ajay Kumar, Mandar M Deval, Kakalee K Saha, Lukash Jagdale, Rinu V Jacob, Ratnaprabha Adsul, Shibban K Kaul. Mumbai, India P6 Cardiopulmonary bypass stabilizes cytokine filtration after coronary artery bypass surgery Vesa Toikkanen, Timo Rinne, Riina Nieminen, Eeva Moilanen, Jari Laurikka, Helena Porkkala, Matti Tarkka, Ari Mennander. Tampere, Finland P7 Nicorandil infusion during off-pump coronary artery bypass grafting reduces incidence of intra-aortic balloon pump insertion in patients with left ventricular dysfunction Kamales Kumar Saha, Ajay Kumar, Mandar M Deval, Rsm P Kaushal, Kakalee K Saha, Rinu V Jacob, Lukash Jagdale, Shibban K Kaul. Mumbai, India P8 A 5-year single center experience in IABP treatment Emmi Saura, Jarmo Gunn, Jukka Savola. Turku, Finland. P9 Euroscore 2 – Evaluation of performance in 1701 Indian patients. Jacob Jamesraj, Benjamin Ninan, Rajan Sethurathnam, Kurian Valikapathalil, Anbarasu Mohanraj, Suresh Kumar. Madras, India. GROUP 2: Moderator: Anders Ahlsson 18 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 P10 Favorable long-term survival in patients undergoing aortic valve replacement compared to the Icelandic population of same age and gender – Results from a whole nation study Sindri Aron Viktorsson, Daði Helgason, Andri Wilberg Orrason, Thor Aspelund, Arnar Geirsson, Tómas Guðbjartsson. Reykjavik, Iceland P11 Antibiotic prophylaxis by teicoplanin and risk of acute kidney injury in cardiac surgery Daniel P. Olsson, Martin J. Holzmann, Ulrik Sartipy. Stockholm, Sweden. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 19 POSTER ABSTRACTS POSTER PRESENTATIONS POSTER ABSTRACTS PRESENTATIONS Thursday, September 4 16.45-17.30 In Exhibition Hall P12 Surgical treatment of aortic prosthetic valve endocarditis: A twenty year single centre experience Sossio Perrotta, Anders Jeppsson, Gunnar Svensson. Gothenburg, Sweden P13 One year after aortic valve replacement: the influence of postoperative cognitive decline on daily living. Sabrina Kastaun, Martin Juenemann, Niko Schwarz, Mesut Yeniguen, Markus Schoenburg, Thomas Walther, Tibo Gerriets. Bad Nauheim, Germany; Giessen, Germany. P14 BiVAD versus LVAD as bridge to transplantation. A single centre experience Sven-Erik Bartfay, Hans Lidén, Mikael Holmberg, Kristjan Karason, Jakob Gäbel, Bengt Redfors, Göran Dellgren. Gothenburg, Sweden. Thursday, September 4 16.45-17.30 P25 Cardiac remodelling in a new pig model and chronic heart failure. Assessment of left ventricular functional, metabolic and structural changes using PET, CT and echocardiography Christoffer Stark, Miikka Tarkia, Tommi Vähäsilta, Antti Saraste, Timo Savunen. Turku, Finland. P26 A novel experimental model of global cerebral ischemia and reperfusion. Rickard Lindblom, Thomas Tovedal, Bo Norlin, Irina Alafuzoff, Stefan Thelin. Uppsala, Sweden Thursday, September 4 16.45-17.30 In second floor - Foyer Poster abstract - SATNU P15 Pulmonary alveolar proteinosis successfully treated with whole-lung lavage under general anaesthesia – a case report Ragnheidur Martha Johannesdottir, Felix Valsson, Steinn Jonsson, Hronn Hardardottir, Einar Bjornsson, Tomas Gudbjartsson. Reykjavik, Iceland. Moderators: Unni Kleppe & Aase Lange P16 Pulmonary metastasectomy from colorectal cancer in South of Sweden Halla Vidarsdottir, Alaa Abdulahad, Per Magnus Jönsson. Lund, Sweden P27 P17 Surgery for carcinoid heart disease Janica Kallonen, Magnus Dalén, Peter Svenarud, Torbjörn Ivert. Stockholm, Sweden Factors associated with blood transfusion in adult elective cardiac surgery Morvarid Akbarin. Uppsala, Sweden P28 Cardiac rehabilitation improves health-related quality of life Sussie Laustsen, Annemette Krintel Petersen. Aarhus, Denmark P29 Self-reported sleep and insomnia, and sleep and wake pattern, in octogenarians after surgical or transcatheter aortic valve replacement Hege Andersen Amofah, Anders Broström, Bengt Fridlund, Björn Bjorvatn, Rune Haaverstad, Karl Ove Hufthammer, Karel K.J Kuiper, Tone M Norekvål. Bergen, Norway; Jönköping, Sweden; Linköping, Sweden. P30 Intensive care unit stressors from a patient’s perspective. - A systematic literature review Camilla Johansson. Örebro, Sweden P18 Outcomes of acute type A aortic dissection repairs in Iceland 1992 - 2013 Inga Hlif Melvinsdottir, Bjarni A Agnarsson, Thorarinn Arnorsson, Gunnar Myrdal, Tomas Gudbjartsson, Arnar Geirsson. Reykjavik, Iceland GROUP 3: Moderator: Jari Laurikka P19 Homograft banking – an assessment of last 5 years performance. Jacob Jamesraj, Benjamin Ninan, Roy Varghese, Ejaz Sheriff, Kurian Valikapathalil, Anbarasu Mohanraj, Suresh Kumar. Madras, India. Poster abstract - SCANSECT P20 Microvascular fluid exchange during IABP-induced pulsatile CPB perfusion Steinar Lundemoen, Venny Lise Kvalheim, Arve Mongstad, Knut Sverre Andersen, Ketil Grong, Paul Husby. Bergen, Norway P21 Prediction of 30-day mortality after Transcatheter Aortic Valve Implantation: a comparison of logistic EuroSCORE, STS score, and EuroSCORE II Malin Johansson, Shahab Nozohoor, Igor Zindovic, Johan Nilsson, Per Ola Kimblad, Johan Sjögren. Lund, Sweden. Moderator: Micael Appelblad P31 Cerebral oxygen saturation during pulsatile and non-pulsatile cardiopulmonary bypass in patients with carotid stenosis Thomas Tovedal, Stefan Thelin, Fredrik Lennmyr. Uppsala, Sweden P22 Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery: a prospective observational study. Fanny Schierenbeck, Maarten W.N. Nijsten, Anders Franco-Cereceda, Jan Liska. Stockholm, Sweden; Groningen, the Netherlands. P32 Heparin and protamine titatrion vs standard ACT-based dosing in routine cardiac surgery: a cost analysis Anna Laffin, Vladimir Radulovic, Kenny Hansson, Erika Backlund, Fariba Baghaei, Anders Jeppsson. Gothenburg, Sweden P23 Intravenous glutamate reduces the need for inotropes in patients with heart failure after CABG for acute coronary syndrome Rolf Svedjeholm, Bashir Tajik, Mårten Vidlund, Farkas Vanky, Jonas Holm, Örjan Friberg, Erik Håkanson. Linköping, Sweden; Örebro, Sweden. P33 Isolated limb perfusion Kerstin Björk. Gothenburg, Sweden P34 Ex vivo lung perfusion: The perfusionists view Christoffer Hansson. Gothenburg, Sweden P24 CA9 deposition is associated with increased ascending aortic dilatation Petteri Muola, Eetu Niinimaki, Seppo Parkkila, Hannu Haapasalo, Timo Paavonen, Ari Mennander. Tampere, Finland. 20 In Exhibition Hall Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 21 ORAL PRESENTATIONS O1 ORAL ABSTRACTS PAGE 23-59 Indications and outcomes of emergency and salvage coronary artery bypass grafting Tomas Andri Axelsson, Anders Jeppsson, Tomas Gudbjartsson, Reykjavik, Iceland, Gothenburg, Sweden Objective: When coronary artery bypass grafting (CABG) is started before the beginning of the next working day after decision to operate it is defined as emergent but as salvage CABG when the patient requires cardiopulmonary resuscitation en route to the operating theatre. Our objective was to investigate the incidence and indications for these operations and to evaluate their postoperative outcomes. Materials and methods: A retrospective analysis of all emergency and salvage CABG operations at the Sahlgrenska University Hospital and Landspitali University Hospital between 2006-2013. Results: A total of 310 patients fulfilled the criterias for emergency (95%) or salvage (5%) CABG. Most patients were males (71%) with a mean age of 67 years and mean EuroSCORE II 6.9%. All patients had an acute coronary syndrome; 42% had a STEMI and 39% NSTEMI. Most patients had persistent ECG changes, leakage of cardiac enzymes or unstable angina unresponsive to medical treatment (76%). Hemodynamic instability preoperatively requiring inotrope drugs or IABP occurred in 19% of patients and 5% of patients required cardiopulmonary resuscitation en route to the operating theatre. Reoperation for bleeding was required in 16% of cases, postoperative stroke occurred in 4% and 8% required de novo dialysis for acute kidney injury. Hospital mortality for emergency and salvage operations was 13% and 85%, respectively. Overall survival at 5-years was 73%. Conclusions: Emergency and salvage CABG is usually performed because of ongoing myocardial ischemia or symptoms unresponsive to medical treatment. Hospital mortality is high but much lower in emergency operations compared to salvage operations. 22 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 23 ORAL PRESENTATIONS O2 O3 Monoamine oxidase- inhibition enhances recovery after experimental cardiac arrest Re-exploration for bleeding is an independent predictor of mortality in cardiac surgery patients also beyond the immediate postoperative period Vilma Vuohelainen, Mari Hamalainen, Timo Paavonen, Sari Karlsson, Eeva Moilanen Ari Mennander, Tampere, Finland Background: Myocardial infarction (MI) is a devastating entity after cardiac arrest due to permanent ischemia-reperfusion injury. The molecular pathway leading to myocardial cellular destruction after MI may include monoamine oxidases. We experimentally investigated whether Moclobemide, a monoamine oxidase inhibitor, enhances myocardial recovery after cardiac arrest and MI. Methods: 53 syngeneic Fisher rats underwent heterotopic cardiac transplantation to induce reversible ischemia reperfusion after cardiac arrest (Controls). 23 rats also underwent permanent ligation of the left anterior descending coronary artery (LAD) to yield MI after cardiac arrest. 31 rats with or without MI were treated with subcutaneous moclobemide 10mg/kg/day. Microdialysis for intramyocardial metabolism, histology and qRT-PCR for high mobility group box-1 (HMBG1) and hemioxygenase-1 (HO-1) were performed to investigate for myocardial recovery. Results: Reflecting metabolic activity after cardiac arrest and reperfusion, pyruvate and glutamate increased in MI treated with moclobemide vs moclobemide alone (29.19±3.42 vs 13.86±3.80 M, p=0.028 and 25.64±8.93 vs 7.93±0.57 M, p=0.006). Myocardial inflammation increased in MI vs Controls after 1 hour (0.80±0.20 vs 0.00±0.00, PSU, p=0.003), but decreased after 5 days in MI treated with moclobemide vs MI alone (2.00±0.26 vs 0.80±0.37, PSU, p=0.033). Indicating myocardial recovery, increased cellularity of remote intramyocardial arteries, HMBG1 and HO-1 expressions, decreased in MI treated with moclobemide vs MI alone (2.53±0.21 vs 0.60±0.25, PSU, p=0.004 and 1.34±0.11 vs 1.75±0.09, FC, p=0.028 and 10.41 ±4.48 vs 9.57±1.87, FC, p=0.047). Conclusions: Moclobemide enhances myocardial recovery; inhibition of remote myocardial changes after MI and cardiac arrest may be achieved by aiming treatment against monoamine oxidase. 24 ORAL PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Victoria Fröjd, Anders Jeppsson, Gothenburg, Sweden Background: Bleeding remains a severe complication after cardiac surgery. Excessive bleeding or cardiac tamponade may necessitate re-exploration. We sought to describe the association between reexploration and early and midterm mortality and to identify independent predictors for re-exploration. Methods: All 5435 cardiac operations 2009-2013 at our institution were included in a retrospective observational study. Re-explorations and mortality was registered. Mean follow-up was 29 months, range 0-60. Preoperative and intraoperative factors associated with re-exploration were identified with logistic regression. Results: 330 patients (6.0 %) were re-explored. Thirty-day (7.5 vs 2.6%, p<0.001) and 60-day mortality (11.2 vs 3.3%, p<0.001) were markedly higher in re-explored patients. The odds ratio (OR) for 30 day and 60 day mortality in patients that were re-explored was 3.06 (95% confidence interval 1.97-4.77, p<0.001) and 3.76 (2.58-5.47, p<0.001). OR’s remained statistically significant also after adjustment for preoperative EuroSCORE, age, gender and type of procedure (1.67 (1.02-2.73), p=0.04 and 2.24 (1.483.40), p<0.001). Re-exploration was a significant predictor also for mortality after 60 days (unadjusted OR 2.01 (1.35-2.99), p=0.001; adjusted OR 1.69 (1.12-2.53), p=0.012). Independent predictors for reexploration were EuroSCORE (OR 1.13 (1.09-1.16), p<0.001) and aortic cross-clamp time (OR 1.006 per minute (1.003-1.009), p<0.001). Conclusions : Re-exploration for bleeding or tamponade is an independent predictor for both early and mid-term mortality after cardiac surgery. The risk increases approximately two fold after adjustment for other risk factors. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 25 ORAL PRESENTATIONS O4 O5 Major depression is associated with worse survival after coronary artery bypass surgery Adjusted calculation model regarding heparin and protamine in connection with cardiopulmonary bypass Malin Stenman, Martin Holzmann, Ulrik Sartipy, Stockholm, Sweden Background: The primary aim was to study the association between preoperative depression and longterm survival following coronary artery bypass grafting (CABG). Our secondary objective was to analyze the association between depression and cardiovascular events or all-cause mortality. Methods: In a nationwide population-based cohort study all patients who underwent CABG in Sweden between 1997 and 2008 were included from the SWEDEHEART registry. Individual level data was cross-linked from other national Swedish registers. Depression status and outcomes were obtained from the National Patient Register. Results: The study population was 56064 patients who underwent primary isolated non-emergent CABG. We identified 324 (0.6%) patients with depression prior to CABG. During a mean follow-up of 7.5 years 114 (35%) patients with depression died, compared with 13767 (25%) patients in the control group. Depression was significantly associated with increased mortality and the combined endpoint of death or rehospitalization for myocardial infarction, heart failure, or stroke; multivariable adjusted hazard ratios (95% confidence intervals) 1.65 (1.37-1.99) and 1.61 (1.38-1.89). Conclusions: We found a strong and significant association between depression and long-term survival in patients with established ischemic heart disease who underwent CABG. Depression was also associated with an increased risk for a combination of death or rehospitalization for heart failure, myocardial infarction or stroke. 26 ORAL PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Gunilla Kjellberg, Gabriella Lindvall, Stockholm, Sweden Background: Heparin dosage during cardiopulmonary bypass (CPB) is commonly calculated from bodyweight. For reversal, traditional protamine dosage is 1.0 to 1.3 mg of protamine/100 units of heparin. With an empirically developed algorithm, the HeProCalc program, heparin and protamine doses are calculated and suggested during the cardiopulmonary bypass procedure. The primary aim of this study was to investigate whether HeProCalc-based dosage of heparin can reduce protamine usage compared with traditional dosage. The secondary aim was to investigate whether HeProCalc-based dosage of protamine will affect the amount of postoperative bleeding. Patients and methods : We consecutively randomized 40 patients into two groups. In the control group, traditional heparin and protamine dosages based on body weight were given. In the study group the HeProCalc program was used, which calculates the heparin bolus dose from weight, height, and baseline Activated Clotting Time (ACT), calculates eventual additive doses and suggests protamine dose at termination of CPB. Results: We analyzed the results from 37 patients, after exclusion of 3 patients. Despite equal doses of heparin in both groups, significantly lower doses of protamine were given in the HeProCalc group vs. the control group 211 mg vs. 330 mg (p < 0,001). Postoperative bleeding was lower in the study group 480 ml, vs. 694 ml (p= 0.046). Conclusions: With the HeProCalc program lower protamine doses than with conventional calculations was sufficient to neutralize heparin after CPB, and also resulted in less postoperative bleeding. The results support previous studies showing an adverse anticoagulant effect of excess protamine doses. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 27 ORAL PRESENTATIONS O6 O7 Acute coronary angiography for myocardial ischemia after coronary artery bypass grafting Age dependent trends in preoperative co morbidity and mortality in isolated coronary artery bypass graft surgery, a nationwide study Karin Hultgren, Anders Andreasson, Tomas Axelsson, Per Albertsson, Vincenzo Lepore, Anders Jeppsson, Gothenburg, Sweden, Reykjavik, Iceland Kristinn Thorsteinsson, Jan Jesper Andreasen, Kirsten Fonager, Charlotte Mérie, Christian Torp Pedersen, Aalborg, Denmark Background: Coronary angiography is the golden standard to distinguish between graft-related and graft–unrelated myocardial ischemia after coronary artery bypass grafting. The aim of this study was to describe our experience with acute coronary angiography after CABG. Objectives: The purpose of this study was to examine trends in the incidence of age dependent preoperative co-morbidity and mortality following coronary artery bypass grafting (CABG) over time, as an increasing proportion of older patients is being referred to surgery. Methods: 4446 patients (mean age 68 ± 9 years, 22% women) who underwent CABG surgery from 2007 to 2012 were included in a retrospective observational study. The prevalence of acute angiography after CABG was calculated and indications, findings and measures registered. Outcome variables were compared between patients that underwent angiography and those who did not. Methods: A retrospective nationwide registry study. All patients who underwent CABG between January 1996 and December 2012 in Denmark were included. A multivariate Cox proportional hazard model was constructed for 30 day mortality. Kaplan-Meier method was used to estimate 30 day, 1 and 5 year mortality. Results: 87 patients (2.0%) underwent acute coronary angiography. Patients undergoing angiography had ECG- changes (92%), UCG-alterations (48%), hemodynamic instability (28%), angina (15%) or arrhythmia (13%). Positive findings (occlusion, stenosis, graft kinking or spasm) were detected in 69% of the cases, 87% of these had one or more affected grafts. A combination of ECG-modifications and hemodynamic instability had the strongest association with a positive finding (88%), while ECGmodifications alone where associated with a positive finding in only 62%. A new revascularization procedure was performed after angiography in 45% of the cases, either with PCI (36%) or CABG (64%). 30-day mortality (6.9 vs. 2.0%, p=0.002) was significantly higher among angiography patients. Results: A total of 38.830 patients were identified, 1.488 were >80 years of age. Overall 30 day mortality was 2.6%, increasing with age (1.1% in pt. < 60 years and 7.6% in octogenarians). Mortality in different age groups at 1 and 5 years were, 2.2% and 7.3% (age < 60 years) and 13.9 and 35.8% (age > 80 years). A trend towards decreasing short and long term mortality was observed during the study period in all age groups except octogenarians, which was stable. During the same period there was an increase in comorbidity, increasing with age. Age was the main predictor of 30 day mortality, e.g. age > 80 years (HR 5.96, 95% CI 4.57-7.77). Conclusion: Positive findings are revealed in about 70% of the acute coronary angiographies after CABG. Only ECG-changes as indication for angiography has a weak association with positive findings. Postoperative myocardial ischemia leading to acute coronary angiography is associated with increased mortality. 28 ORAL PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Conclusion: Even if patients undergoing CABG are getting older and are having more comorbidities than previously, the 30 day mortality has been decreasing over time. Octogenarians have substantial higher 30 day mortality than younger patients but can be operated with acceptable risk and good longterm results. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 29 ORAL PRESENTATIONS O8 O9 Is intra-aortic counterpulsation during CPB beneficial for microvascular tissue perfusion? Health-related quality of life 12 years after coronary artery bypass graft surgery Steinar Lundemoen, Venny Lise Kvalheim, Øyvind Sverre Svendsen,Arve Mongstad, Knut Sverre Andersen, Ketil Grong, Paul Husby, Bergen, Norway Matti Hokkanen, Heini Huhtala, Jari Laurikka, Otso Järvinen. Tampere, Finland Background: Recent studies have focused on the benefits of using IABP preoperatively in high-risk patients admitted to CABG surgery. Continuation of IABP during CPB has also been suggested with the aim to achieve pulsatile CPB flow during surgery. This study evaluates the impact of IABPpulsed CPB-perfusion on hemodynamics and microvascular tissue perfusion above and below the IABP-balloon. Background: Improvement in quality of life (QoL) and survival benefit are the primary indications for coronary artery bypass graft (CABG) surgery. The profile of patients undergoing CABG has altered towards higher age with more preoperative comorbidities. Thus, the importance of QoL over the quantity of life among elderly patients is getting more emphasized. Methods: 16 pigs received a 25cc IABP catheter remaining in turned-off-position (NP-group, n=8) or switched to an automatic 80 beats/min-mode during CPB (PP-group, n=8). Flow and pressure were obtained above and beneath the IABP-balloon. Organ perfusion was evaluated by microspheres. Intracranial pressure and metabolism (microdialysis) was followed continuously. Methods: Comprehensive data on 508 patients who underwent isolated CABG were prospectively collected. The RAND-36 Health survey (RAND-36) was used as an indicator of QoL. All assessments were made preoperatively and repeated 1 year and 12 years later. The follow-up of the study cohort was complete in 95% and 84 % of the alive patients at 1 year and 12 years, respectively. Analysis was based mainly on three age groups: ≤64 (282 patients), 65-74 years (175 patients) and ≥75 (51 patients). Results: IABP-pulsed CPB-perfusion, as assessed at 30min on CPB, increased proximal aortic pressure (P<0.05), carotid artery blood flow (P<0.001) and myocardial perfusion (P<0.01), whereas distal aortic pressure decreased (P<0.001) with preserved femoral arterial flow. The decrease of distal aortic pressure was more pronounced in the PP-group than in the NP-group throughout 180 min CPB (P<0.001) and was associated with a 75 % decrease of renal tissue perfusion (P<0.001) in the PP-group. During non-pulsed perfusion the respective parameters remained essentially unchanged compared to pre-CPB-levels. Results: Thirty-day, 1-year and 10-year survival rates were 98%, 97% and 79%, respectively. Twelve years after the surgery significant improvement was seen in all but one RAND-36 dimensions of the QoL (general health, p=0,76). All age groups showed improvements in RAND-36 Physical Component Summary (PCS) and Mental Component summary (MCS) scores compared to the preoperative values. The youngest subgroup maintained their health status best whereas older subgroups had more pronounced decrease in their PCS and MCS scores. Conclusions: Using IABP to achieve pulsatile perfusion during CPB contributed significantly to impaired tissue perfusion of the kidneys. Assessment of the perfusion pressure distal to the balloon should be addressed if this perfusion strategy is performed. 30 ORAL PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Conclusions: Despite an ongoing natural deterioration 12 years after the CABG, there was significant improvement in most dimensions of the QoL in comparison to the preoperative values. The elderly gain less long-term benefit from CABG regarding to the QoL. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 31 ORAL PRESENTATIONS O10 O11 Favorable long-term outcome of CABG with LIMA to the LAD and great saphenous vein to the right and circumflex branches A meta-analysis of resource consumption and clinical outcomes following endoscopic vein harvesting and open vein harvesting for coronary artery bypass grafting Hera Johannesdottir, Jonas A Adalsteinsson, Tomas A Axelsson, Linda O Arnadottir, Dadi Helgason, Helga R Gardarsdottir, Arnar Geirsson, Gudmundur Thorgeirsson, Tomas Gudbjartsson. Reykjavik, Iceland Lars Oddershede, Jan Jesper Andreasen. Aalborg, Denmark Objective: Long-term results following CABG have not been well documented in whole populations. By using centralized registries in Iceland we studied long-term complications and survival in a large cohort of CABG patients. Background: The greater saphenous vein is still frequently used as a conduit for coronary artery bypass grafting (CABG). However, it remains uncertain whether endoscopic vein harvesting (EVH) is costeffective compared to open vein harvesting (OVH). Therefore, the present study performed a systematic review, with meta-analysis, of outcomes relating to resource consumption and clinical effectiveness following EVH and OVH to enable assessment of cost-effectiveness. Materials: Between 2001 and 2012 1622 consecutive patients (mean age 66 yrs, 82% males, mean EuroSCOREst 4.7) underwent CABG at our institution. LIMA was used for the LAD (94% of patients) and the great saphenous vein for the right and circumflex branches +/- sequential bypass to diagonal branches. 23% of the procedures were performed off-pump. Long-term complications were registered from centralized registries and included: myocardial infarction, stroke, need for re-PCI or reCABG and death. The complication-rate was calculated for each of them and all end-points combined (MACCE), using the Kaplan-Meier method. Prognostic factors were defined with Cox regression analysis. Mean follow-up was 5.7 years. 32 ORAL PRESENTATIONS Methods: A systematic search was performed in five databases. OVH was defined as the use of open harvesting techniques using a single continuous incision, and all studies comparing EVH to OVH for CABG were eligible. Results: Overall survival at 1, 5 and 10 years postoperatively was 96%, 90% and 73%, respectively. The rate of MACCE was 8% at one year and 20% at 5 years. At 5 years, 4.9% of the patients had been diagnosed with stroke, 1.5% with myocardial infarction, 6% had undergone PCI and only 4 patients (0.3%) re-CABG. Independent variables predicting MACCE were EuroSCORE, acute renal failure and postoperative bleeding. The same variables predicted long-term survival in addition to age, diabetes and year of the operation. Results: Analysis showed that EVH was associated with increased duration of surgery, no difference in the length of stay in intensive care units, a reduced total length of stay in hospital, a reduced need for antibiotic treatment for their leg wound infection, a reduced need for follow-up visit(s) at general practitioners/out-patient clinics, a reduced need for visit(s) by the homecare nurses, a reduced need for revision(s) of the leg wound, a reduced need for readmission(s) related to leg wounds complications and no difference in repeat cardiac catheterization(s). Furthermore, EVH reduced pain intensity approximately five days postoperatively, but not 30 days postoperatively. No difference was seen in the odds of postoperative stroke, mid-term myocardial infarction and the recurrence of chest pain. Likewise, no difference was observed in the rate of mid-term all-cause mortality. Conclusion: Long-term outcome following CABG in Iceland is favorable, with 5-year survival of 90% and 80% 5-year freedom from MACCE. Conclusions: We conclude that EVH provided safe clinical outcomes compared to OVH while reducing the short-term postoperative resource consumption. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 33 ORAL PRESENTATIONS O12 O13 Late survival after aortic valve replacement with the Perimount versus the Mosaic bioprosthesis Native valve endocarditis is not associated with reduced short or longterm survival when compared to conventional valve surgery Natalie Glaser, Anders Franco-Cereceda, Ulrik Sartipy. Stockholm, Sweden Background: The objective was to compare late survival after aortic valve replacement (AVR) with a Perimount or Mosaic bioprosthesis. Secondary objectives were to compare early mortality, the rate of reoperations, and the effect of prosthesis-patient mismatch (PPM) on late survival. Methods: The design was a population-based cohort study including all patients who underwent AVR with a Perimount or Mosaic bioprosthesis at our institution between 2002 and 2010. Baseline and operative characteristics, and clinical outcomes were collected from patient charts and national registers. The primary outcome was all-cause mortality. We analyzed the unadjusted and multivariable adjusted association between valve type and late survival. Results: In total 1219 patients received the Perimount (N=864) or the Mosaic (N=355). During a mean follow-up of 4.2 and 6.9 years, there were 193 and 177 deaths in the Perimount and Mosaic groups, respectively. The unadjusted 1-, 5- and 8-year survival was 93%, 78%, and 63% in the Perimount group and 92%, 80% and 57% in the Mosaic group (p= 0.971). There was no significant association between valve choice and all-cause mortality in the multivariable analysis (HR 0.85; 95% CI 0.65 to 1.11). Freedom from aortic valve reoperations was similar between the groups. No significant association was found between severe PPM and late mortality. Conclusions: We found no significant difference in late survival after AVR with a Perimount compared to a Mosaic bioprosthesis. Even though severe PPM was more common in the Mosaic group, it did not affect the late survival or the frequency of reoperations. 34 ORAL PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Per Vikholm, Rafael Astudillo, Petter Schiller, Laila Hellgren. Uppsala, Sweden. Background: Timing of surgery among patients with native infective endocarditis is continously debated and there is growing evidence for surgery earlier in the disease process. The aim of this study was to evaluate the risk associated with the infective valve disease per see as compared to a conventional valve surgery population. Methods: All patients who met the Duke criteria for native valve infective endocarditis and underwent surgery at the Uppsala Academic Hospital from 1996 to 2012 was evaluted (n=140). A matched control cohort from patients who underwent conventional valve surgery patients was created and mortality and morbidity rates were compared. Results: A total of 140 patients (mean age 55 years) underwent surgery for infective endocarditis. Of these patients, 104/140(74%) were men, 52/140(37%) were in New York Heart Functional Class IV, and 102/140 (73%) underwent aortic valve replacement. There was no difference between groups regarding operative variables, need for intra aortic ballon pump or intensive care unit stay. Patients with infective endocarditis were more likely to recieve a bioprosthesis (p<0.01) and had an increased risk for transfusion of blood, OR 7.2 (3.4-16.7). There was no diffrence in 30-day mortality among groups. Survivalrates at 5-years were equal at 74%(67-82) for patients with infective endocarditis and 80%(72-88) for patients undergoing conventional surgery, OR 1.19(0.77-1.83). Survival at 10 years was comparable at 54% (44-67) and 62%(31-64), respectively. Conclusions: When compared to a matched control cohort undergoing conventional heart valve surgery, surgery for native valve endocarditis was not associated with reduced early or late mortality. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 35 ORAL PRESENTATIONS O14 O15 Thirty years of Heart Transplantation in Gothenburg: a long-term follow-up study Heparin and protamine titration does not improve haemostasis after adult cardiac surgery Göran Dellgren, Bert Andersson, Sven-Erik Ricksten, Hans Liden, Sven-Erik Bartfay, Jakob Gäbel, Entela Bolano, Helena Rexius, Henrik Schersten, Kristjan Karason. Gothenburg, Sweden Vladimir Radulovic, Anna Laffin, Kenny Hansson, Erika Backlund, Fariba Baghaei, Anders Jeppsson. Gothenburg, Sweden Aim: Heart transplantation (HTx) has become the standard treatment for patients with end-stage heart failure. The aim of this study was to report long-term outcome after HTx in Gothenburg. Background: Impaired haemostasis after cardiac surgery may contribute to postoperative bleeding complications. We hypothesized that heparin and protamine dosing based on individual titration curves would improve postoperative haemostasis in comparison to standard dosing. Material and Methods: During the period 1984 and 2014 a total of 580 HTx were performed in 566 patients (mean age 43±17 years, range 83 days-71 years, 75% male). The main indications for HTx were non-ischemic cardiomyopathy (CM) (49%), ischemic heart disease (28%), congenital heart disease (9%), retransplantation (3%), restrictive CM (2%), valvular heart disease (2%), and miscellaneous (7%). Mean follow-up was 7.8±6.9 years (median 6.9, IQR 1.8–12.6, interval 0-27) and no patients were lost to follow-up. Results: Long-term survival for HTx patients was 86±1%, 76±2%, 61±2%, and 46±3% at 1, 5, 10 and 15 years of follow-up, respectively. Patients transplanted more recently had a significantly better survival (p<0.001). Long-term survival for HTx patients during the latest time era was 92±2% and 83±3% at 1 and 5 years of follow-up, respectively (Figure). Ten-year survival in patients bridged with mechanical circulatory support, in children and following retransplantation will be reported in detail. Older patients had a significantly worse survival (p< 0.001). Still, patients older than 60 years of age had a 10-year survival of 69±7%. Conclusions: Patients treated with HTx during the last decade show improved survival rates as compared with those transplanted earlier. Survival in patients bridged with mechanical circulatory support, in children and following retransplantation were good and comparable with that reported from other large centres. 36 ORAL PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Methods: Sixty patients scheduled for first time elective CABG or valve surgery were included in a prospective randomized study. The patients were randomized to heparin and protamine dosing with Hepcon HMS Plus device or to standard - weight and activated clotting time based dosing. Biomarkers of thrombin generation potential (calibrated automated thrombogram), coagulation (thromboelastometry), and heparin effect (anti-Xa activity) were assessed before and 10 minutes, 2 hours and 4 hours after cardiopulmonary bypass. Primary endpoint was endogenous thrombin potential two hours after surgery. In addition, total heparin and protamine doses, postoperative bleeding volume and transfusions were registered. Results: Endogenous thrombin potential and coagulation deteriorated in both groups after surgery without statistically significant intergroup differences. There were no significant differences between the titration group and the standard dosing group in total heparin dose (37150 ± 8734 vs 37167 ± 11573 IU, p=0.99), total protamine dose (319 ± 96 vs 314 ± 58 mg, p=0.78), heparin effect, postoperative bleeding (475 (300-1070) vs 495 (150-1460) ml/12h, p=0.81) or transfusions between the groups. Conclusion: Perioperative heparin and protamine dosing based on individual titration curves does not improve hemostasis after cardiac surgery. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 37 ORAL PRESENTATIONS ORAL PRESENTATIONS O16 O17 Norepinephrine infusion to maintain arterial blood pressure during anaesthesia induction reduces the pressure dependent decrease in haematocrit. Treatment of esophageal perforation in octogenarians: a multicenter study Tor Damén, Andreas Nygren. Gothenburg, Sweden Halla Vidarsdottir, Tomas Gudbjartsson, Ari Mennander, Kari Kuttila, Mikael Viktorzon, Enrico Tarantino, Jon Arne Søreide, Asgaut Viste, Luigi Bonavina, Biancari Fausto. Reykjavik, Iceland; Tampere, Finland; Oulu, Finland; Turku, Finland; Vaasa, Finland; St Etienne, France; Stavanger, Norway; Bergen, Norway; Milano, Italy Background: The arterial blood pressure affects the ratio between filtration and reabsorption of fluids in the circulating blood volume and thereby the haematocrit. During induction of anaesthesia both blood pressure and haematocrit decreases. The aim of the study was to evaluate if maintaining blood pressure with norepinephrine during anaesthesia induction reduces the decrease in haematocrit. Background: Esophageal perforation (EP) is associated with significant mortality and morbidity, and this may markedly increase with advanced age. The aim of this multicenter study was to investigate this in patients >80 yrs of age. Methods: Twenty patients, aged 66±11years, scheduled for CABG surgery were included after informed consent and local ethics committee approval. Ten were randomized to receive norepinephrine in the dose needed to maintain pre-anaesthesia blood pressure and ten were randomized to control group and received vasopressor only if mean arterial pressure decreased below 60 mmHg. Arterial blood gas was analysed every ten minutes. Anaesthesia was monitored by BIS, cerebral oximetry, ECG ST-analysis and endtidal gas levels. No fluids were infused. Results: Pre-anaesthesia mean arterial blood pressure was 99 ± 6 mmHg. 60 minutes after induction the haemoglobin level decreased 6.9 ± 2.1% in the control group compared with 2.5 ± 2.3% in the norepinephrine group. Ten minutes after ECC start the haemoglobin level was 44.3±7 g/l lower than baseline in the control group and 33.9±2,8 g/l in the norepinephrine group. No adverse effects were seen. Methods: All patients >80 yrs treated for EP between 2000-2013 in 9 European centers. Demographics, etiology, treatment, complications and overall survival were registered. Results: 33 patients were treated for EP (age 84.8±3.4 yrs, 63,6 % males). The etiology was iatrogenic in 75.8% cases, Boerhaave’s-syndrome in 12.1%, and foreign-body ingestion in 12.1%. Ten patients were treated conservatively, 1 with EndoclipTM , 11 with stent-grafting and 11 with surgical repair. Surgical repair consisted of repair on drain in 1 patient, primary repair in 7 patients, and esophagectomy in 2 patients. One patient who underwent stent grafting was converted to surgical repair. Thirteen patients (39.4%) died during the 30-day and/or in-hospital stay; 3 (30.0%) after conservative treatment, 1 after EndoclipTM-treatment, 5 (45.5%) after stent-grafting and 4 patients (36.4%) died after surgical repair (p=0.55). Early survival with salvaged esophagus was 42.4% (conservative treatment: 70.0%, stent grafting: 54.5%, and surgical repair: 54.5%, respectively, p=0.56). Estimated glomerular filtration rate <60 mL/minute/1.73 m2 (70.0% vs 25.0%, p=0.04) and sepsis (100% vs 32.1%, p=0.05) at presentation were associated with increased risk of early mortality in univariate analysis. Conclusions: Esophageal perforation in octogenarians is associated with high early mortality irrespective of the treatment method used. The mortality is threefold higher than recently published for patients under the age of 80 yrs treated in the same 9 institutions during the same period. Conclusion: The group with maintained arterial blood pressure by norepinephrine had a lower decrease in haemoglobin level during anaesthesia induction. This can partly be explained by the pressure dependent filtration/reabsorption of interstitial fluids. 38 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 39 ORAL PRESENTATIONS ORAL PRESENTATIONS O18 O19 Efficacy of triclosan-coated sutures for lowering the rate of sternal wound infections: a doubleblind randomized trial Long-term follow-up of postoperative cardiac rhythm in 319 Swedish patients after the Cox Maze III procedure Steinn Steingrimsson, Linda Thimour-Bergström, Henrik Scherstén, Örjan Friberg, Tomas Gudbjartsson, Anders Jeppsson. Reykjavik, Iceland; Gothenburg, Sweden; Örebro, Sweden. Anders Albåge, Birgitta Johansson, Göran Kennebäck, Göran Källner, Henrik Scherstén, Lena Jidéus. Uppsala, Sweden; Gothenburg, Sweden; Stockholm, Sweden. Background: Surgical site infection (SSI) is a serious complication following cardiac surgery. Triclosancoated sutures have been shown to reduce the rate of SSI in various surgical wounds, including wounds after vein harvesting in CABG patients. We evaluated the rate of SSI in sternotomy wounds comparing wound closure with triclosan-coated and conventional sutures. Background: The Cox Maze III procedure (CM-III) is the gold standard of surgical treatment of atrial fibrillation (AF). Excellent short term results regarding return of sinus rhythm have been reported but long-term outcomes are unknown in Sweden. The aim was to evaluate present rhythm in a large national cohort of CM-III patients with very long follow-up. Methods: This is a prospective randomized double-blind single center study performed at the Sahlgrenska University Hospital. A total of 358 patients undergoing cardiac surgery were randomized to sternal wound closure with either triclosan-coated sutures (Vicryl Plus and Monocryl Plus, Ethicon, Somerville, NJ, USA) (n=179) or identical sutures without triclosan (n=179). A total of 6 patients were excluded from analysis. Patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). The groups were compared with main focus on SSI meeting the Center for Disease Control criteria Results: The demographics in both groups were comparable. SSI of the sternotomy wound was diagnosed in 43 patients; 23 (12.8%) sutured with triclosan-coated sutures compared to 20 (11.2%) sutured without triclosan (p=0.63). Most infections were superficial (n=36, 10.1%) while 7 (2.0%) were deep sternal wound infections. The most commonly identified pathogens were Staphylococcus aureus (45%) and coagulase-negative staphylococci (36%), with positive cultures obtained in 33 out of 43 patients with SSI. There were no differences in patients diagnosed with SSI compared to those without infection, except that body mass index of infected patients was statistically higher. Conclusions: Skin closure with triclosan-coated sutures did not reduce the rate of sternal SSIs following cardiac surgery. Methods: A total of 536 patients undergoing CM-III 1994-2009 in 4 centers were analyzed for pre, peri- and early postoperative characteristics. At follow-up, 54 patients had died and 20 were ineligible due to foreign location. In total, 462 patients were contacted with a survey concerning cardiac symptoms and present rhythm. In all, 319 patients (69%), 252 men/67 women, mean age 67 yrs (45-87), returned a current 12-lead ECG obtained from their primary health care provider. Of these, 127/192 patients had paroxysmal/non-paroxysmal AF preoperatively and 264 (83%) underwent stand-alone CM-III. In-hospital major complications occurred in 17%. All ECGs were analyzed by an independent senior electrophysiologist. Results: Cardiac rhythm as assessed by ECG is presented below. Mean follow-up time was 111 months (36-223). In 36 patients >75 years, 31 (86%) had sinus rhythm, nodal rhythm or AAI-/DDD-pacing. Of 11 patients with the longest follow-up (183-223 months) only one was in AF (9%). Rhythm N=319 (%) Sinus rhythm 218 (68) Nodal rhythm 25 (8) Atrial fibrillation 37 (12) Atrial flutter 4 (1.3) Other 1 (0.3) Pacing Total 51 (16) AAI 24 (8) VVI 12 (4) DDD 15 (5) Conclusion: In single-moment ECG assessment over 9 years after CM-III, >80% of the patients are in sinus-, nodal-, or atrial paced rhythm. Despite uncertainty of survey non-responders, these results indicate a very long lasting positive effect of the Cox Maze III procedure. 40 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 41 ORAL PRESENTATIONS O20 O21 Long-term clinical follow-up in 339 Swedish patients after the Cox Maze III procedure: Postoperative quality-of-life evaluation Lifestyle after cardiac rehabilitation: Did the message come across, and was it feasible? ; An analysis of patients’ narratives Lena Jidéus, Birgitta Johansson, Göran Kennebäck, Göran Källner, Henrik Scherstén, Anders Albåge. Uppsala, Sweden; Gothenburg, Sweden; Stockholm, Sweden. Marie Veje Knudsen, Sussie Laustsen, Annemette Krintel Petersen, Sanne Angel. Aarhus, Denmark. Objective: The original Cox Maze III procedure (CM-III) is the gold standard of surgical treatment of atrial fibrillation. Excellent short term results have been reported but long-term outcomes are unknown in Sweden. The aim was to evaluate very long-term postoperative quality-of-life (QoL) in a large national cohort of CM-IIII patients. Methods: A total of 536 patients undergoing CM-III between 1994-2009 in 4 operating centers were analyzed for pre-, peri- and early postoperative characteristics. Of these, 462 were available for a survey regarding QoL evaluation, using the validated SF-36 protocol. The questionnaire was returned by 339 patients (73%). There were 267 men/72 women, mean age of 67 yrs (range 45-90) at follow-up. Preoperatively, 133/206 patients had paroxysmal/non-paroxysmal AF with a mean duration of 8.0±6.0 yrs. In all, 279 patients (82%) underwent CM-III as a stand-alone procedure. In-hospital complications occurred in 59 patients (17%), predominantly reoperation for bleeding and pericardial drainage. Results: Mean follow-up time was 110 months (range 36-223) with only 13% in atrial fibrillation/flutter assessed by 12-lead ECG. The QoL scores were divided into gender and compared to the same age group of the general population. In the female group, all eight scales in the SF-36 Health Survey were equal with those of the general population. In the male group, the physical scores were significantly higher compared to the general population of the same age. Conclusion: This long-term follow-up, over 9 years after Cox Maze III procedure, showed QoL scores equal or better compared to the same age group of the general population late after surgery. 42 ORAL PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Background: Lifestyle following heart disease is considered important in preventing and reducing cardiovascular risk factors. Cardiac rehabilitation is therefore focused on potential lifestyle changes. Further insight into patients’ perspective on lifestyle after cardiac rehabilitation is needed as changing habits is a complex matter. The objective of this study was to explore the characteristics of lifestyle after cardiac rehabilitation. Methods: A phenomenological-hermeneutic approach with qualitative interviews was performed in 20 patients completing a hospital-based cardiac rehabilitation programme in 2012 at Aarhus University Hospital, Denmark. The patients were diagnosed with ischemic heart disease, heart failure or left heart valve disease. The interviews were performed six months after completing cardiac rehabilitation. The interviews were analysed using the interpretation theory by Ricoeur. Results: The variation in reaction to cardiac rehabilitation were: 1) considering prior lifestyle to be appropriate, maybe with minor adjustments, 2) acknowledging the need for and incorporating a changed lifestyle, and 3) reconciling or feeling guilt when unable to adhere. Conclusions: Participation in the cardiac rehabilitation programme was a positive experience, but had minor influence on long-term adherence to lifestyle changes. The core issue was whether the participants were capable of incorporating the recommendations in their everyday lives. The important thing in establishing new routines was whether they aroused interest, and whether the experience of changes was perceived necessary and manageable. In future cardiac rehabilitation this insight into patients’ perspective can contribute to support the patients in managing life following heart disease. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 43 ORAL PRESENTATIONS ORAL PRESENTATIONS O22 O23 Efficacy of Tele-training in Exercise-based Cardiac Rehabilitation Coronary artery disease patients’ fears after coronary angiography Annemette Krintel Petersen, Sussie Laustsen. Aarhus, Denmark Mervi Roos, Päivi Åstedt-Kurki, Anja Rantanen, Meeri Koivula. Tampere, Finland Background: Supervised exercise-based cardiac rehabilitation (ECR) is known to improve physical capacity and reduce morbidity and mortality. Unfortunately, participation rates are low, especially among the working age population. To enhance these patients to participate, ECR in self-imposed surroundings is needed. However, it is unknown if home-based supervised ECR tele-training is effective. The aim of this study was to assess the efficacy of supervised Background: The majority of coronary artery disease (CAD) patients have fears. Objects of fears are often concrete, such as a fear of pain or a fear of death. Women are more afraid than men and women have more anxiety related emotions than men. tele-training on physical capacity and muscle strength. Methods: A follow-up study on cardiac patients undergoing left heart valve surgery or percutaneous coronary intervention referred to supervised tele-training at Aarhus University Hospital. The tele-training was 3 sessions/week for 12 weeks. Patients were instructed to exercise with moderate to high intensity for at least 20 minutes per training-session. Exercise intensity was defined on the basis of a maximal cardio-pulmonary exercise test, and registered on a web-portal. Before and after 12 weeks tele-training maximum oxygen uptake and muscle strength was measured. Results: Preliminary results from 10 patients showed a median training frequency of 3 times per week. We found a significant increase in maximum oxygen uptake of 251 ml o2/min, 95% CI (8-494) following tele-training, (p= 0,042), and in maximum work capacity of 30 Watt 95% CI (13-47), (p = 0,0031). There were no changes in muscle strength. Results on thirty patients will be presented at the conference. The purpose of the study was to describe the intensity of fear in patients after coronary angiography and the factors related to the fear. Methods: The study group constituted of 219 CAD patients from one university hospital in Finland. The data were collected by the questionnaire. Fears were measured by the CAD Patients Fear Scale. The data were analyzed statistically. Results: 49 % of CAD patients rated their fear as low fear, 37 % medium fear and 7 % high fear. Of CAD patients after coronary angiography, 7 % had no fear. The object of the highest fear was the dependence on others’ care or help. The second highest object was the deterioration of health. Objects of the lowest fears of CAD patients were coping with everyday life and the fear of coronary artery angiography. Women were significantly more afraid than men. Those who had known their diagnosis six month or over had significantly more fears than those who had known their diagnosis less than six month. Conclusions: According to the results almost one out of ten CAD patients had high fear after coronary angiography. The results can be utilized in the development of patient education in patient with CAD. Conclusion: This study demonstrates promising results in improving physical capacity among cardiac patients referred to ECR tele-training. Further analyses are needed to identify whether similar effect can be identified on muscle strength. 44 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 45 ORAL PRESENTATIONS O24 Self-reported physical activity and lung function two months after cardiac surgery Marcus Jonsson, Charlotte Urell, Margareta Emtner, Elisabet Westerdahl. Örebro, Sweden; Uppsala, Sweden. Background: Physical activity has well-established positive health-related effects. Sedentary behaviour has been associated with postoperative complications and mortality after cardiac surgery. Patients undergoing cardiac surgery often suffer from impaired lung function postoperatively. The association between physical activity and lung function in cardiac surgery patients has not previously been reported. Methods: Patients undergoing cardiac surgery were followed up two months postoperatively. Physical activity was assessed on a four-category scale (sedentary, moderate activity, moderate regular exercise, and regular activity and exercise), modified from the Swedish National Institute of Public Health’s national survey. Formal lung function testing was performed preoperatively and two months postoperatively. Results: The sample included 283 patients (82% male). Two months after surgery, the level of physical activity had increased (p < 0.001) in the whole sample. Patients who remained active or increased their level of physical activity had significantly better recovery of lung function than patients who remained sedentary or had decreased their level of activity postoperatively in terms of vital capacity (94 ± 11% of preoperative value vs. 91 ± 9%; p = 0.03), inspiratory capacity (94 ± 14% vs. 88 ± 19%; p = 0.008), and total lung capacity (96 ± 11% vs. 90 ± 11%; p = 0.01). ORAL PRESENTATIONS O25 Pain Management after Lung Surgery Maria Frödin, Margareta Stomberg-Warren. Gothenburg, Sweden Background: Pain management is an integral part of nursing and nurses have a responsibility to effectively manage patients’ pain and acts as patients’ advocate in this matter. Pain impede early postoperative mobilization, inhibits effective coughing and deep breathing which increases the risk of postoperative complications. The aim of this study was to explore patients’ experience of pain after lung surgery and evaluate patients´ satisfaction of the postoperative pain management. Methods: A descriptive design was used studying 51 participants undergoing lung surgery, consecutively included during 6 months, at a department of Vascular and Cardio-thoracic Surgery in Sweden. Results: The incidence of postoperative moderate pain varied between 36%-58% among participants and severe pain between 11%-26% during the hospital stay. Thirty-nine percent had more pain than expected. After three months, 20% experienced moderate pain and 4% experienced severe pain. After six months, 16% experienced moderate pain. The desired quality goal of care was not fully achieved. Conclusions: A large number of patients experienced moderate and severe pain postoperatively and more than one third had more pain than expected. However, most of the patients were satisfied with the pain management. The findings confirm the severity of experienced pain after lung surgery and facilitate the apparent need for continued improvement in postoperative pain management after lung surgery. Conclusions: An increased level of physical activity, compared to preoperative level, was reported as early as two months after surgery. Our data shows that there could be a significant association between physical activity and recovery of lung function after cardiac surgery. The relationship between objectively measured physical activity and postoperative pulmonary recovery needs to be further examined to verify these results. 46 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 47 ORAL PRESENTATIONS O26 O27 Health Related Quality of Life in lung surgery patients Prevention of central line-associated infections in intensive care – a systematic literature review Susanne Karlsson, Anna Enström, Isabel Capitao De Lemos Ribeiro, Soudabeh Babaei, Martin Silverborn, Anders Jeppsson, Helena Rexius, Christine Roman Emanuel. Gothenburg, Sweden Cecilia Fält. Örebro, Sweden Background: More than 1500 patients undergo lung surgery in Sweden every year. Little is known about health related quality of life (hrQoL) in lung surgery patients. Furthermore, it is unknown which factors that influence hrQoL in these patients. We investigated hrQoL in lung surgery patients before and after the operation in relation to gender, age, and diagnosis. Methods: 159 patients (mean age 61±14 years, 53% women) accepted for lung surgery were included in a prospective observational study. The questionnaire EQ5D which measures five aspects of hrQoL (mobility, self-care, usual activity, pain/discomfort and anxiety/depression) was distributed to the patients before and three months after the operation. EQ5D reports total hrQoL on a scale from 0-1 where 1 is full health. In addition, self-assessed QoL was registered at the same time points with EQVAS score (ranging from 0-100 where 100 is full health). Results: Median EQ5D score was 0.85 (interquartile range 0.73-1.00) before surgery and 0.80 (0.73-1.00) three months after surgery (p=0.33) and EQ-VAS score was 80 (70-90) and 80 (65-90), respectively (p=0.86). Gender, age and diagnosis did not influence pre- and postoperative EQ5D and EQ-VAS score. There were significant correlations between EQ5D score and EQ VAS score both before (r=0.50, p<0.001) and after surgery (r=0.70, p<0.001). Conclusions: HrQoL in lung surgery patients appears acceptable in the majority of patients both before and three months after surgery. In a three month perspective, the operation did not change HrQoL. Pre- and postoperative hrQoL were not influenced by age, gender and diagnosis. 48 ORAL PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Introduction: Approximately 1.4 million people of the world population is estimated annually to be affected by a healthcare-associated infection. In intensive care, the incidence of healthcare-associated infections is twice as high compared to other health care and a central line-associated infection is counted as a preventable adverse event. Sweden’s municipalities and county councils (SKL) engaged in 2008 an initiative to reduce medical injuries. The goal is to halve the incidence of healthcare-associated infections before year-end 2014/2015, but the last measurements shows that the goal is not yet reached. The aim was to identify and describe nursing interventions that may reduce the risk of central lineassociated infections. Method: Systematic literature review according to SBU guidelines. Searches were made in the databases CINAHL and PubMed as well as manual searches. The result is based on 47 articles. Results: The study identified six key findings: 1) education, feedback, and information about central line- associated infections 2) checklists 3) chlorhexidinebathing of patients 4) different types of central venous catheters 5) injection valves, three-way stopcocks and disinfection and 6) different types of joints, realignment procedures and conversion materials. Conclusion: Recurrent education, feedback and information on maintenance of central line and prevention of central line-associated infections decreased central line-associated infections. Making use of the checklist with insertion and the maintenance of central line was also showed to reduce central line-associated infections. Chlorhexidine dressings, chlorhexidine sponge (inserted at the insertion site) as well as daily hygiene care with chlorhexidine bathing has also proven to be effective methods. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 49 ORAL PRESENTATIONS ORAL PRESENTATIONS O28 O29 Implementation of new evidence in clinical practice: Sustained reduction in surgical site infections after coronary artery bypass grafting Heart transplantation of a newborn Linda Thimour-Bergström, Christine Roman Emanuel, Henrik Scherstén, Anna Enström, Anna-Lena Andersson, Kerstin Theander, Angelica Hardenklo, Sara Nilsson, Katarina Nilsson, Anders Jeppsson. Gothenburg, Sweden Background: Surgical site infection (SSI) after vein harvesting are among the most common complications in coronary artery bypass grafting (CABG). During 2009-2011 a prospective randomized double-blind study was performed at our clinic, which showed that leg-wound closure with triclosancoated sutures reduces the prevalence of SSI after open vein harvesting (Thimour- Bergström L et al. Eur J Cardiothor Surg 2013). After the study triclosan-coated sutures were implemented as standard treatment at our institution. In the present study we investigated whether the demonstrated reduction in SSI was maintained after the study was completed. Methods: After triclosan-coated sutures were introduced as standard treatment, a joint follow-up project with clinical and research representatives was initiated. A group of nurses interviewed at least 15 CABG patients per month by telephone 60 days after surgery. The telephone interviews followed a structured questionnaire with enquiries about symptoms of leg wound and sternal infections, and antibiotic treatment. Linda Önsten, Maria Tellin. Gothenburg, Sweden. Heart transplantation in children and especially newborns is unusual due to the lack of suitable donor organs. When studying literature, mortality is frequent among this children waiting for organs.In this case report we share the first experience of heart transplantation in a newborn child at our institution. A boy was born in 35 plus 5 weeks of pregnancy and was delivered with emergency Caesarian section because of a serious infection in the mother. Birth weight was 2.6 kg and the child had poor Apgar values at birth that did not recover significantly. Investigation was started immediately and showed reduced ventricular function and ECMO treatment was initiated. During the time on ECMO the patient had several complications including renal failure, epidural hematoma and bleeding from abdomen necessitating surgical treatment. After 24 days on ECMO and several attempts of weaning, the patient was put on urgent call for heart transplantation. After 24 days on ECMO a matching and blood group compatible heart was offered and the boy was transplanted. The early postoperative period was uncomplicated. The boy has now been followed for three years and so far the course has been uneventful in terms of cardiac function. Results: 203 patients (mean age 68 years, 81% men) were included in the follow-up from March 2012 to February 2013. The prevalence of leg wound SSI in the follow-up was 11.3% which should be compared with 10.9% (p=0.89) in the triclosan and 18.2 % (p=0.048) in the no-triclosan-group in the randomized trial. The incidence of sternal SSI in the follow-up (8.4%) tended to be lower than in the triclosan group in the randomized trial (13.4%, p=0.11). Conclusion: Leg-wound closure with triclosan-coated sutures in CABG patients reduces the incidence of SSI. The lower incidence of SSI has been sustained in clinical practice. 50 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 51 ORAL PRESENTATIONS ORAL PRESENTATIONS O30 O31 An implantable left ventricular device as bridge to transplantation in a pediatric patient Tepid antegrade intermittent blood cardioplegia versus intermittent cross-clamping with Lidoflazine in CABG Maria Tellin, Linda Önsten. Gothenburg, Sweden. Pediatric patients suffering from heart failure have less treatment alternatives than adult patients. The most used ventricular assist devices (VAD) in children are the Excor system. Patients on such devices are bound to stay in the hospital until recovery or heart transplantation. In this case an implantable LVAD was used in a 10-year old girl with severe heart failure. The girl was born in week 34+4 with tachycardia. The patient developed heart failure and was on medication for several years .An unsuccessful ablation attempt was made. At the age of 10 years the patient’s condition worsened with fever, short of breath and tachycardia. When the arrhythmia was converted to sinus rhythm the patient´s condition worsened further and ECMO-treatment was started. After 5 days on ECMO a Heart-Ware LVAD was implanted. An implantable LVAD could be used since the patient had a body surface area of 1.19 m2. This treatment would enable the patient to be discharged from the hospital while waiting for recovery or heart transplantation. After an unsuccessful attempt to wean the pump the patient was put on the waiting list for heart transplantation. The decision of urgent call was taken after a life-threatening allergic reaction due to antibiotic treatment. A suitable heart was offered and the patient was transplanted after 17 months on LVAD. Koen Kairet, Dina De Bock, Inez Rodrigus. Antwerp, Belgium. Background: This study evaluated the myocardial protective effects of tepid antegrade intermittent blood cardioplegia (BCP) versus intermittent cross-clamping with Lidoflazine (ICC) in isolated coronary bypass surgeries. Until now, intermittent crossclamping with Lidoflazine, has proven to deliver good cardioprotection in our center. Methods: Over a 24-month period, all patients with LVEF ≥50%, EuroSCORE II <10% and no severe systemic disease undergoing elective or urgent on-pump coronary artery bypass surgery were prospectively consecutive randomized to receive either tepid blood cardioplegia or intermittent crossclamping with Lidoflazine. Results: Altogether, 445 patients were included (ICC = 265, BCP = 180). The groups were comparable in all demographic variables, operative risk and distal anastomoses. Operation, CPB and cross-clamp time were significant longer in the BCP-group, due to the single clamping. The need for defibrillation after aortic declamping was higher in the ICP-group (ICC 0.109±0.0192 vs. BCP 0.039±0.0145; p=0.007). cTnI levels were significantly lower in the BCP-group (ICC 3.63±0.27µg/L vs. BCP 7.75±1.11µg/L; p<0.001). No statistically significant differences were seen concerning postoperative angina, myocardial infarction, stroke, mortality or non-fatal cardiac arrhythmias. There were significant more cases of new arrhythmias in the ICC-group (p=0.020), as well as cardiac decompensation (p=0.037). During most of this period the patient was discharged from hospital but came in for weekly controls. This case report illustrates that it is feasible to use implantable LVADs in selected pediatric patients. 52 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Conclusion: Our results indicate that blood cardioplegia affords better myocardial protection than intermittent cross-clamping with Lidoflazine in low-risk patients undergoing isolated CABG. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 53 ORAL PRESENTATIONS O32 O33 Characterization of aortic root pressure during administration of blood and crystalloid cardioplegia. How much vacuum -from vacuum assisted venous drainage- can membrane oxygenators withstand? Ahmed Sarfan, Hans-Henrik Kimose, Peter Fast Nielsen, Jon Kristensen. Tilst, Denmark. Background: Cardioplegic solutions (blood and crystalloid) are introduced into the coronary arteries to arrest the heart and protect the myocardium during cardiac surgery. The optimal infusion pressure for cardioplegic delivery is unknown and may vary for crystalloid and blood based solution. Some studies suggest that the aortic root pressure (ARP) should be between 80-100 mmHg to achieve a good myocardial protection. The aim of the present study was to investigate and characterize the aortic root pressure during administration of blood and crystalloid cardioplegia in patients undergoing open heart surgery. Methods: 14 adult patients with 3 vessel disease, undergoing elective coronary artery bypass grafting were included. All patients alternately received cold antegrade blood and crystalloid cardioplegia, in random order. The blood cardioplegia was given by a roller pump, and crystalloid by pressure bag. In the lines of both systems, we measured the proximal pressure, the distal pressure and the aortic root pressure during delivery of supplementary doses. All 3 pressures were measured after 20, 35 and 50 seconds. Also Hct, MAP, CVP, Tp and flow were recorded. Mean pressures were calculated, and compared. Results: ARP was significantly higher during administration of blood cardioplegia. The mean ARP for blood cardioplegia was 53.3 mmHg while it was 35.8 mmHg during administration of crystalloid cardioplegia. p-value of (0.005). Pressure loss were higher in crystalloid- than in blood delivery line. Conclusion: Administration of cold blood cardioplegia is associated with higher, and maybe more appropriate aortic root pressure than crystalloid, in our hospital setup. 54 ORAL PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Kent Nygaard. Oslo, Norway. Introduction: Vacuum assisted venous drainage (VAVD) is widely used to enhance venous blood return from patients undergoing cardiopulmonary bypass (CPB). This vacuum can accidentally reach the oxygenator of the heart-lung machine and draw gas bubbles into the blood compartment. This is known as bubble transgression (BT) and may cause air emboli in the arterial blood line. In order to avoid BT and minimize the risk of patient injury, knowledge of oxygenator resistivity to vacuum load is critical. Thus, the main aim of this thesis is to investigate how much vacuum a membrane oxygenator can withstand before BT appears. Material and methods: We investigated four different adult oxygenators: Quadrox-i, Affinity Fusion, Capiox RX25 and Inspire 6M. Vacuum levels from 0 mmHg to -100 mmHg in 10 mmHg steps were applied to the blood reservoir and allowed to reach the oxygenator through a non-occlusive roller pump. An ultrasonic clinical bubble counter, Gampt BCC 200, was used to count bubbles on the arterial line. Results and Conclusion: We have observed BT caused by VAVD-vacuum as low as -20 mmHg in the blood reservoir. We have observed massive air ingress in oxygenators caused by VAVD-vacuum as low as -30 mmHg in the blood reservoir. Any level of vacuum in the blood compartment of an oxygenator implies a risk of BT. There is a difference between the oxygenators regarding vacuum tolerance. The Quadrox-i and Inspire 6M have a higher threshold for massive air ingress. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 55 ORAL PRESENTATIONS O34 O35 The influence of protamine test dose on ACT Improved quality of retransfused residual blood from the cardio-pulmonary bypass circuit with Ringer wash-in technique Camilla Nyeng, Roar Stenseth. Trondheim, Norway. Background: Because of serious but rare haemodynamic/anaphylactic reactions to protamine a small test dose is given in our centre. The use of the cardiotomy suction (CS) also after this test dose is standard routine. Methods: 20 patients undergoing on-pump coronary artery bypass graft (CABG) surgery were investigated. Perfusion was performed with heparin coated circuits using a rollerpump and full dose heparinization (300-400 IU/kg) with a target activated coagulation time (ACT) of 480 seconds (s). After end of cardiopulmonary bypass and venous decannulation all blood was sucked out of the mediastinal cavity before a protamine test dose of 50 mg was given. 3minutes later a blood sample from both the CS line and the patients arterial line for ACT measurement was collected. Results: ACT decreased from 539 (± SD 54) s before the protamine test dose was given to 412 (±SD 52) s in the CS line and to 356 (± SD 54) s in the patient’s arterial line after the protamine test dose. There was a significant difference in ACT between the CS line and the patient’s arterial line with a more pronounced reduction in the arterial line (p<0.005). A more pronounced decrease in the arterial ACT was seen in older patients (p=0,036). Conclusion: As CS line ACT remained well above 300 seconds in all patients and according to previous recomendations of a satety limit of 300 s our practice may be a safe routine. Larger protamine doses before stopping the CS suction should be avoided. 56 ORAL PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Anki Olsson, Joakim Alfredsson, Sören Berg. Karlskrona, Sweden; Linköping, Sweden. Background: During cardiac surgery the residual blood in the cardiopulmonary bypass (CPB) circuit is often retransfused. A common technique is to empty the blood into an infusion bag and give it to the patient as a standard infusion (STI). An alternative way is to wash it in through the heart-lung machine with Ringer’s acetate (RWI). Our aim was to assess possible differences in blood quality between the two techniques. Methods: 40 patients undergoing coronary artery bypass graft surgery with CPB were randomly assigned to receive the residual blood either as a STI or through the RWI procedure. The hemostatic quality of the residual blood was assessed by measuring platelet function (impedance aggregometry), coagulation variables, hemoglobin and platelets. Results are mean ± SD, non-parametric tests were used. Results; Total hemoglobin and platelet levels were comparable with the two methods. Platelet aggregation in the STI blood was significantly lower compared to the RWI-blood with the activators ADP (24±17 vs 47±20; p=0.00), TRAP (50±31 vs 75±39; p=0.035) and COL (26±16 vs 34±25; p=0.00). The STI blood had higher amounts of free hemoglobin (1221±48 vs 614±245 mg/L; p=0.00) and D-dimer (0.89 ± 0.75 vs 0.51±0.48; p=0.00). Fibrinogen levels were comparable (STI 1.8 ± 0.6 vs RWI 1.9 ± 0.5 g/l; p=0.055) as were plasmin-antiplasmin and thrombin-antithrombin complex levels. Conclusions, Residual blood retransfused through RWI had better platelet function, lower free hemoglobin content and lower fibrinogen degradation products. Retransfusion through the CPB circuit with RWI technique preserved blood quality better than standard infusion. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 57 ORAL PRESENTATIONS O36 Mean arterial pressure in relation to cerebral ischemia and kidney injury Carina Dyhr Joergensen, Line Larsen. Odense, Denmark. Background: There is a lack of consensus regarding determination of an optimal mean arterial perfusion pressure (MAPP) during cardiac surgery on CPB in order to ensure optimal organ perfusion. At the cardiac thoracic department, University Hospital Odense, CPB is conducted at pressures of 40-60 mmHg. Analysing available research literature led to a concern in relation to these pressures regarding cerebral and kidney protection. For this reason, we hypothesized that conduct of CPB at MAPP below 60 mmHg could lead to cerebral ischemia and impaired kidney function. Methods: 11 low risk patients undergoing elective CABG on CPB were randomized to either a LP group receiving a MAPP of 40-60 mmHg (n=5) or a HP group receiving a MAPP of 60-80 mmHg (n=6). The impact of MAPP strategies in regard to cerebral ischemia and kidney function was assessed by measuring rSO2, S100Beta and creatinine. Results were analysed using simple comparison with t-test and Fisher´s exact test. A p-value of <0.05 was considered statistical significant. Results: The groups were comparable regarding demographical and clinical factors. Significant differences were observed regarding MAPP, use of norepinephrine, intraoperative rSO2 left side, lowest haematocrit and creatinine 24 hours postoperative. No significant difference was obtained regarding S100Beta. Conclusion: We were not able to conclude that conduct of CPB at MAPP below 60 mmHg leads to cerebral ischemia and impaired kidney function. However, we discovered a trend towards patients with a large difference from their normal mean arterial pressure and MAPP, are at higher risk of cerebral ischemia. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 59 POSTER PRESENTATIONS P1 Innovative approaches to catheter based stent valve implantations Henrik Ahn, Jacek Baranowski, Lars-Göran Dahlin, Niels-Erik Nielsen, Linköping, Sweden POSTER ABSTRACTS PAGE 61-95 Background: TAVI is currently an established procedure for treatment of aortic stenosis in selected patients. With increasing team experience and further development of the technology it has been possible to expand catheter-based implantations to other indications. Methods: We have used the Sapien™ stent valve in 2 patients (pts) with stenotic biological mitral prostheses, in 2 degenerated biological mitral prostheses with regurgitation, in 2 pts with native calcified valve lesion, in 1 pt with stenotic homograft, in 1 pt with degenerated biological tricuspid valve, and in 1 pt with mitral annuloplasty ring. The first 2 pts were done by transapical approach via a small thoracotomy, and the homograft approached by the transfemoral route. In 5 pts the stent introducer was inserted in the femoral vein and by transseptal puncture and dilatation the stent valve was introduced into the left atrium. The guidewire was captured by a lasso wire inserted in the left ventricle (LV) and brought out percutaneously. This maneuver gave us a stable system for accurate valve placement. Results: The transapical approach was technically cumbersome for anatomical reasons. One of the procedures was complicated but eventually successful. The patient died 2 days later due to multiorgan failure. The mitral valve implantations by the transvenous approach combined with LV apical puncture were all successful without bleeding complications and without mortality. Two of the pts needed permanent pacemaker after the procedure. Conclusion: The standard TAVI technology can be used to expand the indications for catheter based stent valve implantations. 60 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 61 POSTER PRESENTATIONS P2 P3 An implantable pressure sensor for wireless monitoring of intracardiac pressure - first in man study Comparison of outcome after PCI and CABG in patients with chronic kidney disease Stage 3B to Stage 5 Henrik Ahn, Jacek Baranowski, Baz Delshad, Irina Myasnikova, Linköping, Sweden Background: In heart failure patients a sudden increase of filling pressure can provide an early warning of an exacerbation and give opportunity to interfere medically before development of clinical symptoms. A new sensor, Titan (ISSYS Inc., Michigan, US) consists of two major parts: an implantable, telemetric sensor and readout electronics. Using radio frequency magnetic telemetry, the reader both transmits power to the sensing implant and communicate with it. Methods: 7 consecutive patients received the sensor. The left ventricular (LV) implants were done in conjunction with transapical TAVI were we exposed the apex of the left ventricle through a small thoracotomy. The left atrial (LA) implant was introduced in the end of and open chest operation through the incision in the border between LA and the right upper pulmonary vein. A separate pressure line in the LA or LV was used for reference measurements. Results: The implant procedure was done at the end of the operation and was successful in all cases and finished within 10 min. There were no adverse events associated with the implant during a total time of 863 days. The longest follow-up time for two of the patients is about 6 months. We observed good correspondence of the pressure values from the implant and the reference catheter without need for a calibration procedure. There was a significant linear correlation between the two modalities (r=0.94, n=78). Conclusions: This new wireless sensor can give accurate and reproducible intracardiac pressure values. 62 POSTER PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Anna Lautamäki, Tuomas Kiviniemi, Fausto Biancari, Jarmo Gunn. Turku, Finland. Background: Patients with chronic kidney disease (CKD) are generally considered at an increased risk for cardiovascular events. The aim of the present study was to compare outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with eGRF under 45 ml/min/m2. Methods: This is a retrospective study which enrolled 110 patients with coronary artery disease (CAD) undergoing PCI and 148 patients with (CAD) undergoing isolated CABG in 2007-2010. All patients had from stage ≥3b chronic kidney diseases (eGFR < 45 ml/min/m2). Results: Overall survival in CABG patients was 51.2 (±2.5) months and 41.5 (± 2.7) months in PCI patients (P=0.07). When stratified according to eGFR (under and over 30 ml/min/m2) survival was better for CABG (Log rank p=0.043). Overall freedom from major adverse cardiac and cerebrovascular events (MACCE) was 65% after CABG and 28% after PCI (p=0.042). On Cox regression PCI was an independent predictor of overall mortality (HR 1.74, 95% CI 1.08-2.78) and cardiac mortality (HR 2.01, 95% CI 1.13-3.56). Conclusion: Patients with CKD have a high rate of mortality and morbidity after PCI and CABG. However, it seems that in the long term, patients with severe renal dysfunction (eGRF < 30 ml/min/ m2) might benefit from surgical revascularization. Therefore, patients with severe renal impairment need to be viewed as candidates for CABG when considering different treatment options. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 63 POSTER PRESENTATIONS P4 P5 Outcome of myocardial revascularisation in patients younger than 50 Should bilateral internal mammary artery grafting be offered universally during off-pump coronary artery bypass grafting? Linda Osk Árnadóttir, Tomas A Axelsson, Dadi Helgason, Hera Johannesdottir, Jonas A Adalsteinsson, Arnar Geirsson, Axel F Sigurdsson, Tomas Gudbjartsson. Reykjavik, Iceland Introduction: Majority of patients are around 70 when they undergo coronary artery bypass grafting (CABG). We investigated the outcome of CABG in patients younger than 50, focusing on early complications, operative mortality and long-term survival. Material: A retrospective study on 1626 patients that underwent CABG in Iceland 2001-2012. Hundred patients aged 50 years or younger were compared to 1526 older patients. Results: The male:female ratio,risk factors and extension of coronary artery disease were comparable in both groups, as was the proportion of patients with left main disease. Left ventricular ejection fraction was significantly lower in the younger patients (52 vs. 55%, p=0.004) and more of them had a recent myocardial infarction (41 vs. 27%, p=0.003). Minor complications were less common in the younger group (30 vs. 50%, p<0.001), especially new onset atrial fibrillation (14 vs. 35%, p<0,001). Chest tube output was also less in the younger group (853 vs. 999 ml, p=0.015) and they received fewer units of packed red cells (1.3 vs. 2.8, p<0.001). However, the incidence of major complications was comparable (6 vs. 11%, p=0.13), the same was true for 30 day mortality (1 vs. 3%, p=0.5). Mean hospital stay was 2 days shorter for younger patients (p<0.001). There was a non-significant trend for improved diseasespecific survival for the younger patients, or 96% vs. 90% 5-year survival (p=0.06). Conclusion: Younger patients undergoing CABG have fewer minor complications than older patients, their hospital stay is shorter and transfusions less common. Their long-term disease-specific survival also appears to be improved. 64 POSTER PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Kamales Kumar Saha, Ajay Kumar, Mandar M Deval, Kakalee K Saha, Lukash Jagdale, Rinu V Jacob, Ratnaprabha Adsul, Shibban K Kaul. Mumbai, India Objective: Long term benefit of bilateral internal mammary grafts (BIMA) is well established. Still there is reluctance amongst surgeons to adopt routine BIMA grafting. We have used BIMA grafting routinely. The objective of this study is to analyze our early result of BIMA grafting. Methods: All cases of isolated consecutive unselected CABG operated by the first author were included in this retrospective study. BIMA were used in-situ – one was used to graft LAD and the other was used as inflow for a composite graft with radial artery which was used for bypassing all vessels other than LAD. . Results: BIMA was used in 528 patients out of 556 (94.96%). Incidence of early death was 1.3% (7/556), stroke 0.4% (2/556), reoperation for bleeding 0.2%(1/556). Deep sternal wound infection was not seen in any patient but 9 patients (1.6%) had superficial wound infection-which healed with dressing. Conclusion: BIMA grafting is often avoided in diabetic, female, obese, old age and other high risk patients. We have used BIMA in 95% of our unselected OPCAB patients without any major deep sternal infection. The low incidence of major infection in our OPCAB patients with BIMA grafting may be attributed to the preserved immunity because of absence of inflammatory response and less use of blood and blood product. In addition routine use skeletonized BIMA may have contributed. Low stroke rate justifies aortic-no-touch technique. Our limited experience has proved BIMA grafting during OPCAB can be easily adopted routinely with excellent early result. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 65 POSTER PRESENTATIONS POSTER PRESENTATIONS P6 P7 Cardiopulmonary bypass stabilizes cytokine filtration after coronary artery bypass surgery Nicorandil infusion during off-pump coronary artery bypass grafting reduces incidence of intraaortic balloon pump insertion in patients with left ventricular dysfunction Vesa Toikkanen, Timo Rinne, Riina Nieminen, Eeva Moilanen, Jari Laurikka, Helena Porkkala, Matti Tarkka, Ari Mennander. Tampere, Finland Background: Cardiopulmonary bypass (CPB) decreases pulmonary vascular resistance, a denominator of vascular endothelial integrity. We investigated whether CPB impacts pulmonary filtration of cytokines after CABG with modified ventilation. Methods: Representative pulmonary artery and radial artery blood samples at five different time points from 47 patients undergoing CABG with CPB and modified ventilation or without CPB were procured for the evaluation of the pro-inflammatory cytokines (interleukin (IL) 6 and IL8) and the anti-inflammatory IL10. The simultaneous pulmonary arterial (PA) and radial arterial (RA) blood IL6, IL8, IL10, IL6-to-IL10 and IL8-to-IL10 ratios were calculated to evaluate the pulmonary filtration capacity (PA/ RA). Kamales Kumar Saha, Ajay Kumar, Mandar M Deval, Rsm P Kaushal, Kakalee K Saha, Rinu V Jacob, Lukash Jagdale, Shibban k Kaul. Mumbai, India Objective: Off-pump coronary artery bypass grafting (OPCAB) in patients with left ventricular (LV) dysfunction has proven advantage. However, it carries risk of emergency conversion to cardiopulmonary bypass (CPB). We have successfully used intra-aortic balloon pump (IABP) to prevent conversion to CPB. The objective of the present study is to evaluate if intravenous Nicorandil infusion reduces the incidence of intra-operative IABP insertion during OPCAB. Methods: Consecutive cases of isolated OPCAB performed by a single surgeon were studied. Patients were divided in two groups. First group did not receive Nicorandil and second group received intraoperative Nicorandil infusion (started in the operating room after central line insertion). Results: PA/ RA IL6 and PA/ RA IL8 ratios (p= 0.001 and p= 0.05, respectively) decreased, while PA/ RA IL10 ratio (p= 0.001) increased in patients without CPB as compared with patients with CPB. PA/ RA IL6-to-IL10 and PA/ RA IL8-to-IL10 ratios decreased in patients without CPB, while they remained relatively constant in patients with CPB despite modified ventilation (0.43 ± 0.04 and 0.44 ± 0.05 vs 1.14 ± 0.03 and 0.92 ± 0.02, respectively, p= 0.001). Results: 375 patients were included in the study. 4 patients in the no Nicorandil group and 3 patients in Nicorandil group were on preoperative IABP and hence excluded from the study. After routine use of Nicorandil infusion, incidence of IABP insertion during OPCAB decreased from 12.4% (21/169) to 2.9% (6/206)(table 1). Conclusion: The resting hemodynamic state during CABG with CPB stabilizes cytokine filtration response despite modified ventilation as compared with patients without CPB. The relaxed lungs may stabilize the endothelial arterial bed leading to a controlled filtration of inflammatory cytokines in patients with CPB. Conclusions: Nicorandil infusion significantly (p= 0.007) reduced the incidence of IABP insertion. In patients with LV dysfunction (EF< 30%), this difference (p=0.008)assumes a special significance as OPCAB is considered high-risk in this subset. Nicorandil is an inexpensive drug and the reduction in cost of surgery by avoiding IABP insertion is an added advantage. We could not find any report of use of Nicorandil infusion during OPCAB. We recommend routine use of Nicorandil infusion during OPCAB which may result in favorable patient outcomes. 66 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 67 POSTER PRESENTATIONS POSTER PRESENTATIONS P8 P9 A 5-year single center experience in IABP treatment Euroscore 2 – Evaluation of performance in 1701 Indian patients. Emmi Saura, Jarmo Gunn, Jukka Savola. Turku, Finland. Jacob Jamesraj, Benjamin Ninan, Rajan Sethurathnam, Kurian Valikapathalil, Anbarasu Mohanraj, Suresh Kumar. Madras, India. Background: Intra-aortic balloon pump (IABP) treatment is used as an adjunct for hemodynamic compromise perioperatively in cardiac surgery and in hemodynamic shock of other etiology. Epidemiological data on long term survival of patients treated with IABP is scarce. Methods: Population of 223 consecutive patients treated with IABP at a tertiary hospital’s ICU. 203 patients had underwent cardiac surgery and 20 patients were nonoperative. Data on perioperative treatment and baseline values as well as data on mortality up to 1 year was obtained from the hospital registry. Results: Mean age was 66±10 years. 30 –day mortality was 23.2% overall, 37.8% for nonoperative patients and 22.1% for surgical patients. 1 –year mortality was 26.3% overall, 55% for nonperative patients and 24.5% for surgical patients. 1 –year mortality was lowest for isolated CABG patients (15.3%). There were 14 (6.3%) complications requiring operative treatment (ischaemia, bleeding or infection). 1 –year survival for 30 –day survivors was 96.9 %. Predictors of 30 –day mortality on Cox regression were critical preoperative state, non-CABG surgery and nonoperative treatment. Predictors of 1 –year mortality were the same and a history of cardiac surgery. Timing of IABP insertion (preoperative, intraoperative, postoperative) in surgical patients did not predict mortality and mortality was similar for all timing groups. Background: Scoring systems designed to predict mortality in cardiac surgical patients have been evolving over the last few decades. The EuroSCORE 2 is one such developed from data input from around the globe. We evaluated its performance in 1701 Indian patients and compared it to the Additive and Logistic EuroSCORE 1 and Adjusted Parsonnet Score. Methods: 1701 consecutive cardiac surgical patients operated on by all surgeons at our institute from October 2011 to December 2012 were studied. The EuroSCORE 2, Additive and Logistic EuroSCORE 1 and Adjusted Parsonnet score were calculated and a CUSUM (cumulative sum) plot with observed mortality was made. The graph plotted on an Excel sheet demonstrated the correlation. Results: The EuroSCORE 2 underpredicted mortality (predictability coefficient 0.63) whereas the Additive and Logistic EuroSCORE overpredicted mortality (predictability coefficient of 1.79 and 1.67 respectively). The Adjusted Parsonnet Score with a predictability coefficient of 1.24 correlated best with the observed mortality. Conclusion: EuroSCORE 2 needs to be modified with more appropriate scores for the risk factors used. This will ensure a more credible risk prediction. Conclusions: IABP treatment is safe with few serious complications. Timing of IABP placement is not related to survival. Survival at 1 year follow-up is excellent after an initially high mortality for cardiac surgical patients treated for hemodynamic compromise with aortic counterpulsation. 68 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 69 POSTER PRESENTATIONS POSTER PRESENTATIONS P10 P11 Favorable long-term survival in patients undergoing aortic valve replacement compared to the Icelandic population of same age and gender – Results from a whole nation study Antibiotic prophylaxis by teicoplanin and risk of acute kidney injury in cardiac surgery Daniel P. Olsson, Martin J. Holzmann, Ulrik Sartipy. Stockholm, Sweden. Sindri Aron Viktorsson, Daði Helgason, Andri Wilberg Orrason, Thor Aspelund, Arnar Geirsson, Tómas Guðbjartsson. Reykjavik, Iceland Objective: Using centralized registries we compared long-term survival in Icelandic patients following aortic valve replacement (AVR) for aortic stenosis (AS) with the Icelandic population. Material and methods: Included were 366 AVR-patients (age 70.1 yrs, 62.8% males) operated for AS at Landspitali 2002-2011. Concomitant CABG was performed in 54% of cases. Overall survival was estimated and compared with Icelanders of the same age and gender, using information from National Statistics Iceland. Short-term complications and 30-day mortality were also analyzed. Median followup was 4.7 yrs. Results: Bioprosthesis was used in 81.4% of the patients and the mean prosthesis-size was 25.1 mm. Mean EuroSCORE-II was 3.8% and peak-gradient 69.9 mmHg. Atrial fibrillation (67.6%) and acute renal injury (22.7%) were the most common complications. Fifty-five patients (15.0%) needed reoperation for bleeding. The 30-day operative mortality was 6.0% and overall survival at 1- and 5-year was 91.8% and 82.3%, respectively. The 1- and 5-year estimated survival of Icelanders was 96.3% and 77%, respectively. The AVR-group had worse early survival, mainly related to operative deaths. However, 2 years later, the survival curves diverged and 5-year survival was significantly better in the AVR group (log-rank test, p=0.014). Conclusions: Although short-term complications are significant, this study shows long-term survival following AVR for AS is better to that of the Icelandic population of the same age and gender. The reason for this survival benefit is unknown. These results demonstrate the validity of AVR as an excellent treatment option for AS, offering normalization of patients’ life expectancy. 70 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Background: The objective was to investigate the risk of acute kidney injury (AKI) associated with antibiotic prophylaxis with teicoplanin in cardiac surgery. Methods: All adult patients who underwent cardiac surgery at our institution between January 1, 2010 and July 31, 2013, were eligible for the study. Data was gathered from patient charts and national registers. The primary endpoint AKI was defined according to the Acute Kidney Injury Network criteria stage 1, as an increase of postoperative serum creatinine by ≥26 mikromol/L (≥0.3 mg/dL) or a relative increase of ≥50% compared to the preoperative value. The risk for AKI associated with teicoplanin prophylaxis was estimated by multivariable logistic regression. We also performed subgroup and sensitivity analyses. Results: We included 2809 patients, and 1753 (62%) received a combination of teicoplanin and cloxacillin for antibiotic prophylaxis. The remaining 1056 (38%) patients received only cloxacillin and constitute the control group. AKI occurred in 32% (n=343) in the teicoplanin group compared to 29% (n=517) in the control group. There was a significant association between antibiotic prophylaxis with teicoplanin and AKI; multivariable adjusted odds ratio (OR): 1.41 (95% confidence interval (CI) 1.181.70). There was a dose-dependent relationship; 600 mg OR: 1.48 (95% CI 1.17-1.87), and 400 mg OR: 1.34 (95% CI 1.06-1.71). The findings were confirmed in several subgroup analyses. Conclusions: Antibiotic prophylaxis with teicoplanin was associated with an increased risk of AKI after cardiac surgery. The risk of acute kidney injury was higher in women, and in patients with impaired renal function. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 71 POSTER PRESENTATIONS POSTER PRESENTATIONS P12 P13 Surgical treatment of aortic prosthetic valve endocarditis: A twenty year single centre experience One Year after Aortic Valve Replacement: the Influence of Postoperative Cognitive Decline on Daily Living. Sossio Perrotta, Anders Jeppsson, Gunnar Svensson. Gothenburg, Sweden Sabrina Kastaun, Martin Juenemann, Niko Schwarz, Mesut Yeniguen, Markus Schoenburg, Thomas Walther, Tibo Gerriets. Bad Nauheim, Germany; Giessen, Germany. Background: Aortic prosthetic valve endocarditis remains a life-threatening disease despite progress in diagnostic methods, and in surgical and medical treatment. We report outcome after operations for aortic prosthetic valve endocarditis at our institution during the past twenty years. Methods: Eighty-seven operations in 84 patients between 1993 and 2013 were included in a retrospective study. An aortic homograft was used in 56 cases (64%), a mechanical prosthesis in 20 (23%) and a biological valve in 11 (13%). Early and late complications and mortality was compared between operations during the first and second decade. Predictors for mortality were identified with Cox regression. Mean follow-up was 5.5 years (range 0-20). Severe perioperative complication included dialysis, perioperative stroke, pacemaker implantation, myocardial infarction and tracheotomy. Results: Ten patients (11.5%) died in-hospital and severe perioperative complications occurred in 36 patients (41%). Overall cumulative survival at five and ten years was 80% and 65%, respectively. Three patients (3.4%) had a recurrent episode of endocarditis requiring surgery. During the second decade inhospital mortality tended to be lower (6.9 vs 21%, p=0.057) and cumulative survival was significantly higher (89 vs 64% at five years, p=0.008). Age, reoperation for bleeding, and severe perioperative complication were independent predictors for mortality. Conclusion: Aortic prosthetic valve endocarditis is associated with a high early complication rate and a substantial early mortality. Patients that survive the immediate postoperative period have a satisfactory long term survival and the risk for recurrent endocarditis requiring surgery is low. The results have markedly improved during the last decade. 1 Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany 2 Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany Background: We reported that postoperative cognitive decline (POCD) has a perceivable influence on daily living 3 months after aortic valve replacement and is more often noticed by relatives than by patients themselves. Now, we reviewed the one-year outcome. Methods: In addition to a neuropsychological examination, we previously interviewed 82 patients with a cognitive failure questionnaire (s-CFQ) and 62 close relatives with the CFQ-for-others (f-CFQ) before and 3 months after surgery. Up until one year, we enlarged the original sample (108 patients, 85 relatives) and re-interviewed the entire group. Results: Not only relatives (p = 0.026) but also patients themselves experienced the cognitive decline 3 months after surgery (p = 0.009). After one year, the s-CFQ no longer differed between baseline and postoperative scores. However, the assessment by others still tended to be worse (p = 0.051) with a moderate effect size. In patients with ‘change to worse’ in the f-CFQ at one-year follow-up, declined cognitive results in non-verbal learning (p = 0.021) could be observed 3 months postoperative. Correlations between subjective deficits and neuropsychological change scores could only be found in the 3-month assessment by others. Conclusions: Our data show a considerable impact of POCD on daily living, which is perceivable for both patients and relatives. Long-term information on cognitive decline by relatives stronger coincides with objective measurements suggesting it to be a more reliable source. Moreover, continuation of enrolment increased the statistical power, underlining the necessity of an adequate sample size to detect the influence of POCD on everyday-life. 72 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 73 POSTER PRESENTATIONS POSTER PRESENTATIONS P14 P15 BiVAD versus LVAD as bridge to transplantation. A single centre experience Pulmonary alveolar proteinosis successfully treated with whole-lung lavage in general anesthesia – a case report Sven-Erik Bartfay, Hans Lidén, Mikael Holmberg, Kristjan Karason, Jakob Gäbel, Bengt Redfors, Göran Dellgren. Gothenburg, Sweden. Background: Evaluation of right heart function and the determination of the need for BiVAD instead of LVAD are challenging. The aim of our study was to describe the characteristics and outcome of BiVAD and LVAD patients as bridge to heart transplantation (BTT) from our institution. Methods: We reviewed prospectively collected data for patients (n=23) who received MSC as BTT during 2010-2012. A total of 11 patients with biventricular heart failure were treated with “de novo” BiVAD (Excor, Berlin Heart) and 12 patients with LV failure received LVAD (HM II, Thoratec). Clinical characteristics, hemodynamic data, echocardiographic findings and outcome are compared between groups. Also, two different RV risk failure scores were calculated for all patients. Results: There was no difference in survival to HTx between the BiVAD and LVAD groups (10/11 patients (91%) vs 10/12 (82%). However, BiVAD patients were younger, more often female and had more frequently non-ischemic heart failure than those in the LVAD group. BiVAD patients were also more often in INTERMACS level 1-2. BiVAD patients had lower CO/CI and signs of more compromised RV function measured by invasive hemodynamics and echocardiography. BiVAD patients also displayed higher risk scores for RV failure. Three LVAD patients developed significant RV failure after implantation, which in two cases required RVAD support. Ragnheidur Martha Johannesdottir, Felix Valsson, Steinn Jonsson, Hronn Hardardottir, Einar Bjornsson, Tomas Gudbjartsson. Reykjavik, Iceland. Introduction: Pulmonary alveolar proteinosis (PAP) is a rare lung disease where lipoproteins derived from surfactant accumulate in the distal airways and alveoli. This causes dyspnea with characteristic perihilar consolidations on chest X-ray and computed tomography (CT). In 90% of cases the cause of PAP is unknown. First line treatment is whole lung lavage (WLL). Here we report the first case of PAP diagnosed and treated with WLL in Iceland. Case: A 30 year old male was admitted to our hospital because of progressive dyspnea, low grade fever and weight loss over 4 months. Chest X-ray and CT showed diffuse bilateral interstitial and alveolar infiltrates and spirometry showed a restrictive pattern. Transbronchial lung biopsy revealed PASpositive material and foamy macrophages diagnostic for PAP. Over the next days his symptoms worsened with severe dyspneaand productive cough. His respiratory rate was 40/minute and SaO2 90% at best on high flow oxygen. WLL was performed under general anesthesia. The patient was intubated with a double-lumen endotrachel tube and positioned in a 90 degree lateral position, and WLL performed in two seperate session. The left lung was lavaged first with 15L of 37°C saline 12 days later the right lung was lavaged with 18L. Two years later the patient is almost symptom free, chest X-ray shows minimal consolidations and lung function has improved substantially on spirometry. Conclusions: This case shows how advanced PAP can be successfully treated with WLL. PAP should be considered in patients with unexplained dyspnea and consolidations on chest X-ray. Conclusion: We have shown that the use of a BiVAD system as BTT may result in excellent outcome. Although BiVAD patients are sicker than those receiving LVAD only survival rates are similar. 74 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 75 POSTER PRESENTATIONS P16 POSTER PRESENTATIONS P17 Pulmonary metastasectomy from colorectal cancer in South of Sweden Halla Vidarsdottir, Alaa Abdulahad, Per Magnus Jönsson. Lund, Sweden Surgery for carcinoid heart disease Janica Kallonen, Magnus Dalén, Peter Svenarud, Torbjörn Ivert. Stockholm, Sweden Background: Colon cancer is the third most common cancer in both men and women in Sweden. A large part of patients treated for colorectal cancer are later diagnosed with recurrent disease, most often metastases in the liver or lungs. Pulmonary metastases can be removed surgically; however, the survival benefit has been debated. The aim of this study was to study surgical outcome of pulmonary metastasectomy in south of Sweden. Methods: Data on all consecutive patients that underwent complete resection of pulmonary colorectal metastases from 1st of January 2000 to 31st of December 2011 at Skane University Hospital were reviewed retrospectively. Average follow up was 47 months. Survival was estimated with Kaplan Meier. Results: Total of 149 patients underwent metastasectomy during the study period (age 67.5 yrs., range, 37.4-84.4 yrs., 63.1% males). 64 with colon (43%) and 85 with rectal cancer (57%). 39 patients were operated during the first half of the study period compared to 110 during the second half. The diseasefree-interval was 21 months median (range, 0-1269). 22 patients had synchronous metastases. 8 patients had undergone prior metastasectomy of the liver and further 39 patients underwent metastasectomy from the liver after pulmonary metastasectomy. 107 patients (72%) had solitary and 27 (18%) had two pulmonary nodules; other patients having multiple nodules. 97 patients were operated with thoracotomy and 45 patients with VATS. Wedge resection (n=119) and lobectomy (n=31) were the most common procedures. 6 patients were operated with both lobectomy and a wedge resection. 31 patients were operated for recurrent pulmonary metastases. 30 days mortality was 0%. 1 year and 5 year survival was 95.3 and 51.1% respectively. Background. Carcinoid heart disease is rare and caused by neuroendocrine tumor metastases. The myocardium can be directly infiltrated or vaso-active substances can be secreted by the primary tumor lead to deposition of fibrous tissue causing incompetent heart valves. Patients. We report four patients with carcinoid heart disease age 45 to 63 years who had a primary intestinal tumor and cardiac involvement. Results. Two patients operated for intramyocardial tumor masses were clinically well without cardiac symptoms three and five years after the operation, respectively. Two further patients were operated on for incompetent heart valves, one of whom had an atrial septal defect and quadruple valve surgery. Conclusions. Open heart surgery in patients with carcinoid heart disease requires particular care to avoid perioperative hemodynamic instability. An affected heart valve usually has to be replaced because of extensive pathology. In patients treated with somatostatin analogues the long-term prognosis is good despite presence of intramyocardial tumor. Conclusion: The number of pulmonary metastasectomies is increasing. Surgical outcome was good with 0% surgical mortality and with 5 year survival of 51% in this highly selected group of patients. 76 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 77 POSTER PRESENTATIONS P18 P19 Outcomes of Acute Type A Aortic Dissection Repairs in Iceland 1992 - 2013 Homograft banking – an assessment of last 5 years performance. Inga Hlif Melvinsdottir, Bjarni A Agnarsson, Thorarinn Arnorsson, Gunnar Myrdal, Tomas Gudbjartsson, Arnar Geirsson. Reykjavik, Iceland Jacob Jamesraj, Benjamin Ninan, Roy Varghese, Ejaz Sheriff, Kurian Valikapathalil, Anbarasu Mohanraj, Suresh Kumar. Madras, India. Background: Acute type A aortic dissection is a life-threatening disease associated with significant morbidity and mortality. It requires an emergency surgery and is one of the most challenging conditions that cardiothoracic surgeons encounter. This study presents for the first time the outcome of acute type A aortic dissection repairs in Iceland. Background: Our homograft bank has been active in harvest, preparation, banking and distribution of homografts and a five year assessment is presented. Methods: Retrospective review of medical records from Landspítali University Hospital revealed that 41 patients underwent a type A aortic dissection repair from 1992 – 2013. Data was gathered about known risk factors, signs and symptoms, type of the operation performed, morbidity and mortality rate. Results: Majority of the operations (70.7%) was performed in the second half of the study period. The mean age was 60.0 years and 68.2% of the patients were men. 65.9% had evidence of ascending aortic aneurysm with mean size of 54.7 mm. Malperfusion syndrome was apparent in 63.4% and the mean Euroscore II was 8.9. Hypothermic circulatory arrest was used in 22.0% of the cases and 73.2% underwent a replacement of the ascending aorta. Reoperations rates for post-op bleeding was 36.8% and mean stay at the ICU was 10.3 days. 30-day mortality rate was 21.9% (9 patients). Conclusion: The outcomes of emergency repairs of type A aortic dissection in Iceland is comparable to other countries. The rate of morbidity is high, especially reoperations due to excessive post-op bleeding but hospital mortality is acceptable. The number of operations increased substantially over the second half of the study period, for which reasons are unknown. 78 POSTER PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Methods: 136 hearts and 78 blood vessels were harvested from June 2009 till April 2014 from brain dead donors. 13 hearts were discarded due to macroscopic disease. The hearts were dissected under laminar flow. Valved conduits both aortic and pulmonary were prepared. Specimens for culture both before and after washing in Hank’s balanced salt solution were taken. The homografts were sized and sterilized in antibiotic cocktail for 72 hours. They were packed in dimethyl sulfoxide, cryoplaned and preserved in vapours of liquid nitrogen at -140 C. The homografts were issued in a dry shipper and were thawed on table for use. Results: 246 valved conduits and 78 blood vessels were processed. 16 were discarded (packaging errors 6, unused 6 and 4 had bacterial growth). 157 were used in patients and 83 are in storage. Of the 157, 3 had bacterial growth and the recipients were treated. There was no incidence of fungal growth. None of the recipients had clinical evidence of infection. Tetrology with absent pulmonary valve (36.8%) and Truncus arteriosus (17.9%) were common indications for use. Conclusions: The protocols in place are efficient. The rates of bacterial contamination seem reasonable. The homografts have been used in a variety of complex heart diseases by multiple hospitals in the region suggesting the bank has been used optimally. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 79 POSTER PRESENTATIONS P20 P21 Microvascular fluid exchange during IABP-induced pulsatile CPB perfusion Prediction of 30-day mortality after Transcatheter Aortic Valve Implantation: a comparison of logistic EuroSCORE, STS score, and EuroSCORE II Steinar Lundemoen, Venny Lise Kvalheim, Arve Mongstad, Knut Sverre Andersen, Ketil Grong, Paul Husby. Bergen, Norway Background: CPB is associated with fluid overload and formation of tissue edema that may affect postoperative vital organ function. Pulsatile CPB flow is considered to be beneficial. We evaluated microvascular fluid exchange in a porcine model where CPB-pulsatility was generated with IABP. Methods: 16 pigs, about 33kgs, undergoing normothermic CPB for 3hrs, were randomized to 25cc IABP-induced, automatic pulsatile flow (80 beats/min, PP-group, n=8) after start of bypass or nonpulsatile CPB flow only (NP-group, n=8). Fluid need, COP (colloid osmotic pressure) in plasma and interstitial fluid, hematocrit, total tissue water content, arterial and venous hemodynamic parameters were measured and FER (fluid extravasation rate) and plasma volume calculated. Results: After start of CPB MAP (mean arterial pressure) of the PP group increased whereas a decrease was observed in the NP group. At 180 minutes, MAP was 70.9 ± 2.7 mm Hg and 55.9 ± 2.7mm Hg, respectively, (P = .004). Central venous pressure (right atrium) decreased in the NP group (P = .002), but remained stable in the PP-group. Hematocrit and COP in plasma and interstitial fluid decreased similarly in both groups. Plasma volume remained essentially preserved in the PP-group, but contracted in the NP-group during bypass (P = .02). No significant differences were obtained in FER. However, FER of the PP group tended overall to stay slightly higher when compared to the NP group. Conclusion: No significant differences in FER were present between IABP-induced pulsed and nonpulsed CPB in this experimental setup. 80 POSTER PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Malin Johansson, Shahab Nozohoor, Igor Zindovic, Johan Nilsson, Per Ola Kimblad, Johan Sjögren. Lund, Sweden. Background: The logistic EuroSCORE and the STS score have been used for selection of suitable TAVI patients, but the predictive ability is unsatisfying. Our aim was to evaluate the performance of the EuroSCORE II in predicting 30-day mortality after TAVI in comparison to the logistic EuroSCORE and the STS scoring system. Methods: Between January 2008 and April 2013, 123 consecutive patients underwent TAVI (transapical, n=85; transfemoral, n=38). Calibration and discriminatory ability was evaluated for three risk scores models (logistic EuroSCORE, STS score, EuroSCORE II) and compared for prediction of 30-day mortality using the Hosmer-Lemeshow test for goodness-of-fit and receiver operating characteristics curve analysis. Results: The overall 30-day mortality was 4.1% (5/123). Predicted mortality was 25.0±15.7% by logistic EuroSCORE, 7.3±6.9% by STS score, and 7.8±8.7% by EuroSCORE II. The observed/expected mortality ratio was 0.16 for logistic EuroSCORE, 0.56 for STS score, and 0.52 for EuroSCORE II. The area under curve was 0.69 (95% CI 0.54-0.84) for the logistic EuroSCORE, 0.60 (95% CI 0.38-0.82) for the STS score, and 0.66 (95% CI 0.46-0.86) for the EuroSCORE II. Conclusions: In the present study, we found that the EuroSCORE II predict 30-day mortality more accurately for the TAVI cohort compared to the more established logistic EuroSCORE and compares on par at present with the STS-score. However, there were no differences in the discriminatory power between the models. We believe that in lack of a more TAVI-oriented risk stratification system, the EuroSCORE II may be a valuable adjunct in the clinical setting. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 81 POSTER PRESENTATIONS P22 P23 Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery: a prospective observational study. Intravenous glutamate reduces the need for inotropes in patients with heart failure after CABG for acute coronary syndrome Fanny Schierenbeck, Maarten W.N. Nijsten, Anders Franco-Cereceda, Jan Liska. Stockholm, Sweden; Groningen the Netherlands. Rolf Svedjeholm, Bashir Tajik, Mårten Vidlund, Farkas Vanky, Jonas Holm, Örjan Friberg, Erik Håkanson. Linköping, Sweden; Örebro, Sweden. Introduction: Lactate is a marker of hypoperfusion and may be used for risk assessment in critically ill patients. Although evidence suggests that repeated lactate measurements are of clinical interest, how and when lactate should be analyzed is controversial. Intravascular microdialysis provides a novel method for the continuous monitoring of lactate, which may be clinically beneficial in critically ill patients. Methods: Circulating lactate levels were continuously monitored in 80 patients undergoing cardiac surgery using either a separate single-lumen microdialysis catheter (Eirus SLC®, Maquet Critical Care, Solna, Sweden) or a triple-lumen central venous catheter (Eirus TLC®, Maquet Critical Care, Solna, Sweden) with an integrated microdialysis function. The catheter was placed with the tip positioned in the superior vena cava. As a reference, arterial blood gas samples were taken every hour, and the lactate levels were analyzed in a blood gas analyzer. Results: A total of 1601 paired microdialysis-arterial blood gas lactate samples were obtained. Bland Altman analysis showed a bias (mean difference) ±limits of agreement (±1.96SD) of 0.02±0.42 mmol/L. The regression coefficient was 0.98 (p-value 0.0001). Conclusions: Central venous microdialysis is an accurate and reliable method for continuous blood lactate monitoring in patients undergoing cardiac surgery. The system may be useful for early lactateguided therapy in critically ill patients. 82 POSTER PRESENTATIONS Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Background: In a double-blind randomized clinical trial (GLUTAMICS-ClinicalTrials.gov Identifier: NCT00489827), intravenous glutamate was associated with a risk reduction exceeding 50% for developing severe circulatory failure after isolated CABG for acute coronary syndrome (ACS). Here our aim was to investigate if glutamate also influenced the need or use of inotropes. Methods: Post hoc analysis of 824 patients in the GLUTAMICS-trial operated with isolated CABG for ACS. ICU-records were retrospectively scrutinized including hourly registration of inotropic drug infusion, dosage and total duration during the operation and postoperatively. Results: ICU-records were available for 171 out of 177 patients who received inotropes perioperatively. Only 26% of the patients treated with inotropes fulfilled study criteria for postoperative heart failure at weaning from CPB or later in the ICU. Inotropes were mainly given preemptively to facilitate weaning from CPB or to treat postoperative circulatory instability (bleeding, hypovolemia). With the exception of significantly lower need of epinephrine there were only trends towards lower need of other inotropes overall in favor of glutamate. In patients treated with inotropes (glutamate n=17; placebo n=13) who fulfilled criteria for left ventricular failure at weaning from CPB the average duration of inotropic treatment (34±20 v 80±77 hours; p= 0.014) and the number of inotropes used (1.35 ±0.6 v 1.85±0.7; p=0.047) were lower in the glutamate group. Conclusions: Intravenous glutamate had a limited effect on inotrope use overall in patients undergoing CABG for ACS whereas a substantial and significant effect was observed in patients with left ventricular failure at weaning from CPB. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 83 POSTER PRESENTATIONS POSTER PRESENTATIONS P24 P25 CA9 deposition is associated with increased ascending aortic dilatation Cardiac remodelling in a new pig modeö og chronic heart failure. Assessment of left ventricular functional, metabolic and structural cahnges using PET,CT and echocardiography Petteri Muola, Eetu Niinimaki, Seppo Parkkila, Hannu Haapasalo, Timo Paavonen, Ari Mennander. Tampere, Finland. Christoffer Stark, Miikka Tarkia, Tommi Vähäsilta, Antti Saraste, Timo Savunen. Turku, Finland. Background: Inflammatory factors defining ascending aortic wall stiffness and elasticity may attribute to aortic wall dilatation. Arterial wall carbonic anhydrase 9 (CA9) deposits during inflammation indicates angiogeneic activation. We studied whether CA9 deposits are associated with inflammatory remodeling of the ascending aorta in patients undergoing surgery for aortic dilatation. Methods: Aortic wall histology and immunohistochemistry for CA9, leukocytes, T- and B-lymphocytes, plasma cells, macrophages, endothelial cells, smooth muscle cells, cell proliferation, elastase and VanGieson-staining were performed to 30 selected patients that underwent surgery for ascending aorta, and the samples were grouped according to presence of CA9 deposits. Results: 20 out of 30 patients had CA9 deposits mainly within the adventitia, whereas 10 patients lacked CA9 deposits. Adventitial inflammation, mainly consisting of macrophages and plasma cells, were increased in CA9 positivity as compared with CA9 negativity (p < 0.01). The mean diameter of the ascending aorta at the sinotubular junction was 59 ± 2 mm for all patients, and was significantly increased in patients with CA9 positivity as compared with CA9 negativity (63 ± 3 vs 53 ± 2, mm, p < 0.02). Receiver operating characteristic curve analysis confirmed the association of CA9 positivity with increased ascending aortic dilatation (AUC 0.766; S.E. 0.090; p = 0.020; 95% C.I. 0.590-0.941). However, root dilatation was equally present in CA9 positive and CA9 negative patients (50% and 60%, respectively). Conclusions: Positive CA9 suggests carbonic anhydrase activity during ascending aortic dilatation. Intervening with CA9 may add an armament against aortic dilatation and extension of surgery. 84 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Background: The aim of the study was to characterize the myocardial functional, metabolic and structural changes in a novel pig model of chronic myocardial infarction (MI) and heart failure (HF) Methods and Results: Male 12-week-old farm pigs had either sham operation (control, n=9) or simultaneous 2-step occlusion of the left anterior descending (LAD) coronary artery with distal ligation and implantation of a proximal ameroid constrictor (HF, n=13). Three months after operation, cardiac output and wall stress were measured by transthoracic Doppler echocardiography. Left ventricle (LV) volumes and mass were measured by computed tomography (CT). Myocardial perfusion was evaluated by [15O]water and oxygen consumption was measured using [11C]acetate positron emission tomography (PET) and efficiency of myocardial work was calculated. Histology was studied to detect MI, hypertrophy and fibrosis. Animals in the HF group had anterior MI scar involving 29±14 % of the LV. CT showed larger LV diastolic volume and lower ejection fraction in HF pigs than sham-operated pigs (252±84 vs.145±17 mL, P=0.003 and 40±8 vs. 63±4 %, P<0.001, respectively). Perfusion and oxygen consumption were clearly decreased in the infarcted myocardium. Perfusion and oxygen consumption in the remote noninfarcted myocardium were preserved in HF pigs. Global LV work and efficiency of forward work were significantly lower in HF than control pigs and these were associated with increased wall stress. Histology showed myocyte hypertrophy in the remote segments. Conclusions: This chronic post-infarction model of HF is suitable for long-term imaging studies evaluating LV remodeling and changes in oxidative metabolism. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 85 POSTER PRESENTATIONS P26 A novel experimental model of global cerebral ischemia and reperfusion. Rickard Lindblom, Thomas Tovedal, Bo Norlin, Irina Alafuzoff, Stefan Thelin. Uppsala, Sweden Background: Irreversible neurological injuries are a major complication of complex cardiovascular surgery. There is no specific treatment available. Experimental studies suggest that the brain, like other organs can be prevented from developing permanent injury following ischemia if given adequate reperfusion. Methods: Pigs (50kg) were operated with a median sternotomy. All major arteries to the brain were freely dissected. A 16Fr cannula was inserted in the right femoral artery for drainage and a 10Fr cannula in the right internal thoracic artery for arterial supply. Catheters were inserted in the parietal cortex for microdialysis, into the lateral ventricle for pressure measurement and in the sagittal sinus for sampling. Central and peripheral hemodynamic parameters were continually measured. Global normothermic ischemia was achieved by clamping all cerebral blood supply for 30 minutes after which all clamps were removed and cerebral circulation was resumed. The intervention group received 20 minutes of controlled reperfusion using extra-corporeal circulation after the 30 minute ischemia, before unclamping. Results: All animals survived the experimental protocol. Global brain ischemia was achieved as confirmed by drop in central arterial pressure (<10mmHg) and a massive catecholamine surge with pronounced tachycardia (>200bpm) and hypertension (systolic blood-pressure 250-300mmHg). Cerebral blood-flow of 750ml/minute could be achieved using ECC circuit. Conclusions: An active strategy aiming to treat ischemic CNS injury is plausible on selected patients undergoing cardiovascular surgery, as the standard operative strategy isolates and cannulates the major CNS vessels. However the exact protocol for an active reperfusion remains to be elucidated. The current model provides a mean for these studies. 86 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 POSTER PRESENTATIONS P27 Factors associated with blood transfusion in adult elective cardiac surgery Morvarid Akbarin. Uppsala, Sweden Background: Blood transfusions are sometimes necessary to replace large volume of blood loss, maintain oxygenation of tissues and achieve hemostasis in cardiac surgery. In the past decades, research has shown that blood transfusion is an independent risk factor for increased mortality, peri-operative infection, multiple organ failure and increased need for intensive care in both surgical as medical patients. The aim of the study was to identify factors that were associated with blood transfusions for elective cardiac surgery in adult. Method: A prospective descriptive design was used, with a total of 530 patients participating in the study. Patients have undergone elective bypass surgery valve surgery or both with sternotomy and extra corporal circulation (ECC) for one year from April 2012 till April 2013. Results: The results of the study demonstrated a difference between male and female patients, where 80% of female patients, undergone operation received blood transfusion whereby among male patients was only 25%. Preoperative hemoglobin (Haemoglobulin), ECC time, ventilations time, body mass index (BMI) , and intensive care (TIVA) mortality were independent variables which had a significant conjunction to whether they received blood transfusion or not. Conclusion: Preoperatively patients with low preoperative hemoglobin and low BMI were identified as high-risk patients. Interoperable patients identified as those with long ECC time and ventilator time and finally as result in need of reoperation and ultimately blood transfusion. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 87 POSTER PRESENTATIONS AWARDS Abstract awards SATS 2014 P28 Cardiac rehabilitation improves health-related quality of Life SATS St. Jude Medical Award for best abstract $5000 SATS Award for an outstanding contribtution €2000 SATNU Award for best poster: Congress fee for SATS 2015 Award for best oral presentation: Congress fee for SATS 2015 and €500 Co-sponsors: MAQUET & Medela SCANSECT Sussie Laustsen, Annemette Krintel Petersen. Aarhus, Denmark Background: Health-related Quality of Life (HQoL) among patients with heart disease is poor compared to people with other chronic diseases. One of the aims of cardiac rehabilitation (CR) is therefore to improve patients’ HRQoL. In Denmark, 12 weeks of CR is recommended for the majority of heart diagnoses. The effect of CR on HRQoL is not well understood; thus, the purpose of this study was to investigate the effect of a 12-week CR programme on HRQoL. Methods: A follow-up study using the validated questionnaire SF-36 among patients attending CR at Aarhus University Hospital in Denmark. CR was interdisciplinary and complied with recommendations from the Danish Health and Medicines Authority. Patients filled in the questionnaire before (baseline) and after 12 weeks of CR. Primary outcome was difference in physical (PCS) and mental (MCS) HRQoL. Analyses were stratified by gender and age. Results: We found a significant increase in PCS of 23%, 95% CI (16-31%) and MCS of 12%, 95% CI (5-18). There were no differences between genders. Patients <65 years enhanced their PCS significantly more that those being ≥ 65 years (p<0.05). For MCS there was no difference between age groups. Conclusion: This study supports previous findings that physical and mental HRQoL of patients with heart disease improves following a 12-week CR programme. Gender played no role, but younger age was related to higher increase in physical HRQoL but not in mental HRQoL. Further controlled studies are needed to verify whether the CR caused this effect. Best first time perfusionist paper presentation €1500 Best first time perfusionist peper presentation/ Best perfusion school graduation paper presentation Sponsor Sorin Group €1000 Best case report presentation Sponsor Maquet €500 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 89 POSTER PRESENTATIONS POSTER PRESENTATIONS P29 P30 Self-reported sleep and insomnia, and sleep and wake pattern, in octogenarians after surgical or transcatheter aortic valve replacement Intensive Care Unit Stressors from a patient’s perspective. - A systematic literature review Camilla Johansson. Örebro, Sweden Hege Andersen Amofah, Anders Broström, Bengt Fridlund, Björn Bjorvatn, Rune Haaverstad, Karl Ove Hufthammer, Karel K.J Kuiper, Tone M Norekvål. Bergen, Norway; Jönköping, Sweden; Linköping, Sweden. Background: Octogenarians with aortic stenosis (AS) is an increasing group of patients admitted for surgical aortic valve replacement (SAVR) or transcutaneous aortic valve implantation (TAVI). Although sleep is important for recovery after sickness, sleep in the post-operative phase has been scarcely studied. Aims were therefore to determine self-reported sleep and insomnia as well as sleep and wake pattern in octogenarians with AS undergoing interventional procedures. Methods: A prospective cohort study included patients of age 80+ undergoing SAVR or TAVI. Data were collected at baseline and during the first 5 post-operative days. Standardized questionnaires were used to register sleep and insomnia, whereas actigraphy was used to register the sleep and wake pattern. Results: All patients described more difficulties initiating sleep, maintaining sleep and non-restorative sleep post-operatively compared to baseline. Both SAVR and TAVI patients had less insomnia during the first night (9% vs 27%), although it increased during the post-operative period (38% vs 23% for the fifth night). The sleep and wake pattern was poor post-operatively. Mean total sleep time at night was 5.7 hours, sleep efficiency 71% and sleep time day was 9.4 hours. Both patients after SAVR and TAVI had more sleep time during day than at night, but patients having SAVR slept significantly more than patients having TAVI (p<0.001). Conclusion: Improvement of the sleep at night and activity level during the day should be sought. Further research is needed to identify predictors of poor sleep followed by intervention studies to improve sleep and daytime activity in these patients. 90 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Background: In an intensive care unit, patients who are seriously ill and injured are cared for by being under continual monitoring and treatment. Intensive care patients are subjected to physical as well as psychological stress, when untreated can have both physical and emotional consequences. Aim: The aim of this study was to describe intensive care unit stressors from a patient’s perspective. Method: The method of choice was a systematic literature study in which quantitative articles from different parts of the world were included. Result: The stressors that ranked highest in each article have been compiled, presented and described according to three categories: physical stressors, emotional stressors and social stressors. The highest ranking stressors were: pain, thirst, being intubated, sleep deprivation and loss of control over one’s own body and situation. Conclusion: Intensive care patients are during their care, exposed to many factors in their surroundings that may cause negative stress. An awareness of these stressors together with a more evidencebased nursing may contribute to an improved intensive care environment and minimize the negative consequences for the patient as well as lower healthcare costs for society. Keywords: intensive care patients, perceptions, stress, stressors Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 91 POSTER PRESENTATIONS POSTER PRESENTATIONS P31 P32 Cerebral oxygen saturation during pulsatile and non-pulsatile cardiopulmonary bypass in patients with carotid stenosis Heparin and protamine titration vs standard ACT-based dosing in routine cardiac surgery: a cost analysis Thomas Tovedal, Stefan Thelin, Fredrik Lennmyr. Uppsala, Sweden Anna Laffin, Vladimir Radulovic, Kenny Hansson, Erika Backlund, Fariba Baghaei, Anders Jeppsson Gothenburg, Sweden Pulsatile and non-pulsatile cardiopulmonary bypass (CPB) flow may influence the cerebral oxygenation differently in patients with or without carotid stenosis. The records of twenty patients who had undergone CPB using both flow modes were examined. Patients with (n = 10) and without (n = 10) carotid stenosis were distinguished forming two groups. The pulse mode settings were similar in all patients, and CPB periods of 6 - 8 minutes were studied for each flow mode during aortic cross-clamp. Standard peroperative monitoring including regional cerebral oxygen saturation (rSO2) by nearinfrared light spectroscopy (NIRS) was used. The mean arterial pressure (MAP) and rSO2 were lower with pulsatile CPB flow than with non-pulsatile flow. The slopes did not reveal any significant changes over time within the observations periods. In conclusion, the MAP was lower with pulsatile flow than with non-pulsatile flow, and the same was true for rSO2, however these parameters showed no correlation. Pulsatile CPB flow offered no apparent advantages compared with non-pulsatile flow in patients with carotid stenosis, in terms of regional cerebral oxygen saturation. Background: Evidence suggests that heparin/protamine titration reduces protamine usage and transfusion requirements compared to standard ACT-based doing and thus is cost effective, despite higher initial costs for device and cartridges. We used data from a randomized study in routine cardiac surgery patients to compare costs between heparin/protamine titration and standard dosing. Methods: Sixty patients scheduled for first time elective CABG or valve surgery were included in a prospective randomized study. The patients were randomized to heparin and protamine dosing with Hepcon HMS Plus device or to standard - weight and activated clotting time based dosing. Institutional costs for cartridges (titration 48 €; standard 27€), heparin (3€/5000IU), and protamine (34€/100mg) were compared between the two groups. Device costs were not included. Protamine dosing in the titration group was based on the last analysis just before weaning bypass. Results: There were no significant differences between the titration group and the standard dosing group in total heparin dose (37150 ± 8734 vs 37167 ± 11573 IU, p=0.99) or total protamine dose (319 ± 96 vs 314 ± 58 mg, p=0.78),total protamine dose (319 ± 96 vs 314 ± 58 mg, p=0.78), Transfusion of blood products did not differ significantly between the two groups. Total costs for cartridges, heparin and protamine was 179€ in the titration group and 156€ in the ACT-group Conclusion: Perioperative heparin and protamine dosing based on individual titration curves is associated with an increase in costs of approximately 23€ per patient. 92 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 93 POSTER PRESENTATIONS 94 POSTER PRESENTATIONS P33 P34 Isolated limb perfusion Kerstin Björk. Gothenburg, Sweden Ex vivo lung perfusion: The perfusionists view Christoffer Hansson. Gothenburg, Sweden Please see abstract in the poster exhibition. Please see abstract in the poster exhibition. Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 95 5x 2x3 EXHIBITOR LIST BP 2x3 2x3 H05:21 H04:22 ters Pos 2x3 fé Buf Prospect Kf01:68 2x2 Prospect Kf01:70 2x2 Prospect Kf01:72 2x2 H05:23 H04:24 96 1 H00:24 H00:20 2x2 2x2 Entré H01:02 4x6 H02:01 H02:11 H01:16 3x2 3x2 5x4.5 2x3 Dessa dörrar är vanligtvis inte öppna! Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 H10:02 2x3 2x3 2x3 Lecture hall: K1, K2 & K3 K 31 2 H10:08 30 2nd floor 7 5 4 3 29 sshall sal 6 H10:12 23 10 9 8 Abbott Laboratories, Abbott Vascular 2 AstraZeneca AB 6, 7 Baxter Medical AB 8 Berlin Heart GmbH 24 ConvaTec Sweden AB 17 Covidien Sverige AB33 CSL Behring AB26 DePuy Synthes14 Edwards Lifscience 27 Haemonetics Scandinavia AB 18 JenaValve Technology GmbH 25 Join Tech Medical AB 11 KCI Medical AB 15 KEBOMED22 MAQUET10 Medela Medical AB 3 Mediplast12 Medistim AB19 Medtronic 34 Nonin Medical 23 Octapharma Nordic AB 1 Orion Pharma AB13 Roche Diagnostics 21 Scanlan International Inc. 9 Sorin Group29 St Jude Medical Sweden AB 4 Takeda Pharma5 Terumo Sweden AB28 Triolab AB16 Vingmed AB30, 31 Utbyggn. 2,8m högt 34 Buffé H01:12 Reserverad yta 28 2x3 11 H10:20 27 (Får ej blockeras) 13 12 2x3 Pers.ingång Kongressfoajé 14 H10:04 25 26 32 15 H02:19 H01:20 3x2 3x2 Information & Registration 2x3 17 16 H10:22 Reception H10:30 19 18 Väskmonter Vattenautomat Internethörna med fast bakvägg Reception 3.5x1.5 Uthämtning av väskor Kf01:46sponsormonter med rollups 20 22 24 21 23 4x6 ters Pos AB Svenska VingmedPLAN EXHIBITION AREA & FLOOR Kf01:46 DePuy Synthes Prospect 6x2 Mediplast Orion Pharma Kf01:40 Kf01:84 CSL Kf01:34 AB 6x2 Behring AB 3x3 Kf01:38 x2 Kf01:82 3x2 3x3 Prospect Kf01:84 CSL Buffé Behring AB 3x3 Kf01:82 3x3 Edwards Buffé ience 78 H05:29 H04:30 2x2 2x2 Kf01:7 2x2 Prospect Kf01:72 2x2 Sweden AB Triolab AB Kf01:56 fé Kf01:52 Buf 3x2 3x2 Kf01:46 6x2 H04:31 2x2 DePuy Synthes Kf01:40 6x2 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 97 AUTHOR INDEX AUTHOR INDEX Abdulahad, Alaa P16 Damén, Tor O16 Adsul, Mrs Ratnaprabha P5 Dellgren, Göran P14, O14 Adalsteinsson, Jonas A Agnarsson, Bjarni A P4, O10 P18 Ahn, HenrikP1, P2 Akbarin, Morvarid P27 Albertsson, Per O6 Alafuzoff, Irina Albåge, Anders Alfredsson, Joakim Amofah, Hege Andersen Andersen, Knut Sverre Andersson, Anna-Lena Andersson, Bert Andreasen, Jan Jesper Andreasson, Anders Angel, Sanne Arnadottir, Linda O Árnadóttir, Linda Osk Arnorsson, Thorarinn Aspelund, Thor Astudillo, Rafael Axelsson, Tomas Axelsson, Tomas A Axelsson, Tomas Andri Babaei, Soudabeh Backlund, Erika Baghaei, Fariba Baranowski , Jacek Bartfay, Sven-Erik Berg, Sören Biancari, Fausto Bjornsson, Einar Bjorvatn, Bjørn Bolano, Entela Bonavina, Luigi Broström, Anders Capitao De Lemos Ribeiro, Isabel Dahlin, Lars-Göran Dalén, Magnus 98 P26 O19, O20 O35 P29 O8, P20 O28 O14 O7 O6 O21 O10 P4 P18 P10 O13 O6 P4, O10 O1 O26 O15, P32 O15, P32 P1, P2 P14, O14 O35 P3 P15 P29 O14 O17 P29 O26 P17 P1 De Bock, Dina Delshad, Baz Deval, Mandar M Emtner, Margareta Enström, Anna Fast Nielsen, Peter Fausto, Biancari Fonager, Kirsten Franco-Cereceda, Anders Friberg, Örjan Fridlund, Bengt Frödin, Maria Fröjdh, Victoria Fält, Cecilia Gardarsdottir, Helga R Geirsson, Arnar Gerriets, Tibo Glaser, Natalie Grong, Ketil Guðbjartsson, Tómas Gunn, Jarmo Gäbel, Jakob Haapasalo, Hannu Haaverstad, Rune Hamalainen, Mari Hansson, Kenny Hardardottir, Hronn Hardenklo, Angelica Helgason, Dadi Hellgren, Laila Hokkanen, Matti Holm, Jonas Holmberg, Mikael Holzmann, Martin Holzmann, Martin J. Hufthammer, Karl Ove Huhtala, Heini Hultgren, Karin O31 P2 P5, P7 O24 O26, O28 O32 O17 O7 O12, P22 O18, P23 P29 O25 O3 O27 O10 P4, P10, O10, P18 P13 O12 O8, P20 O1, P4, O10, P15, P18, O17, O18, P10 P3, P8 P14, O14 P24 P29 O2 O15, P32 P15 O28 P4, P10 , O10 O13 O9 P23 P14 O4 P11 P29 O9 O6 99 AUTHOR INDEX Husby, Paul O8, P20 Kuttila, Kari O17 Ivert, Torbjörn P17 Källner, Göran O19, O20 Håkanson, Erik Jacob, Rinu V Jagdale, Lukash Jamesraj, Jacob Jeppsson, Anders Jesper Andreasen, Jan Jidéus, Lena Joergensen, Carina Dyhr Johannesdottir, Hera Johannesdottir, Ragnheidur Martha Johansson, Birgitta Johansson, Camilla Johansson, Malin Jonsson, Marcus Jonsson, Steinn Juenemann, Martin Järvinen, Otso Jönsson, Per Magnus Kairet, Koen Kallonen, Janica Karason, Kristjan Karlsson, Sari Karlsson, Susanne Kastaun, Sabrina Kaul, Shibban K Kaushal, Rsm P Kennebäck, Göran Kimblad, Per Ola Kimose, Hans-Henrik Kiviniemi, Tuomas Kjellberg, Gunilla Knudsen, Marie Veje Koivula, Meeri Krintel Petersen, Annemette Kristensen, Jon Kuiper, Karel K.J. Kumar, Ajay Kumar, Suresh 100 AUTHOR INDEX P23 P5, P7 P5, P7 P9, P19 O1, O3, O6, P12, O15, O18, O26, O28, P32 O11 O19, O20 O36 P4, O10 P15 O19, O20 P30 P21 O24 P15 P13 O9 P16 O31 P17 P14, O14 O2 O26 P13 P5, P7 P7 O19, O20 P21 O32 P3 O5 O21 O23 O22, P28 O32 P29 P5, P7 P9, P19 Kvalheim, Venny Lise Laffin, Anna Larsen, Line Laurikka, Jari Laustsen, Sussie Lautamäki, Anna Lennmyr, Fredrik Lepore, Vincenzo Lidén, Hans Lindblom, Rickard Lindvall, Gabriella Liska, Jan Lundemoen, Steinar Melvinsdottir, Inga Hlif Mennander, Ari Mérie, Charlotte Mohanraj, Anbarasu Moilanen, Eeva Mongstad, Arve Muola, Petteri Myasnikova, Irina Myrdal, Gunnar Nielsen, Niels-Erik Nieminen, Riina Niinimaki, Eetu Nijsten, Maarten W.N. Nilsson, Johan Nilsson, Katarina Nilsson, Sara Ninan, Benjamin Norekvål, Tone M. Norlin, Bo Nozohoor, Shahab Nyeng, Camilla Nygaard, Kent Nygren, Andreas Oddershede, Lars Olsson, Anki O8, P20 O15, P32 O36 P6, O9 O21, O22, P28 P3 P31 O6 P14, O14 P26 O5 P22 O8, P20 P16 O2, P6, O17, P24 O7 P9, P17 O2, P6 O8, P20 P24 P2 P18 P6 P1 P24 P22 P21 O28 O28 P9, P19 P29 P26 P21 O34 O33 O16 O11 O35 101 AUTHOR INDEX Olsson, Daniel P. P11 Paavonen, Timo O2, P24 Svenarud, Peter O7 Svensson, Gunnar O21 Tajik, Bashir O15, P32 Tarkia, Miikka P14 Tellin, Maria O14 Thelin, Stefan O31 Thorgeirsson, Gudmundur O23 Toikkanen, Vesa P5, P7 Urell, Charlotte O32 Valsson, Felix P8 Varghese, Roy P25 Vidlund, Mårten P22 Viktorsson, Sindri Aron P13 Viste, Asgaut P9 Vähäsilta, Tommi P4 Westerdahl, Elisabeth P21 Zindovic, Igor O18 Önsten, Linda, Orrason, Andri Wilberg Parkkila, Seppo Pedersen, Christian Torp Perrotta, Sossio Petersen, Annemette Krintel Porkkala, Helena Radulovic, Vladimir Rantanen, Anja Redfors, Bengt Rexius, Helena Riksten, Sven-Erik Rinne, Timo Rodrigus, Inez Roman Emanuel, Christine Roos, Mervi Saha, Kakalee K Saha, Kamales Kumar Saraste, Antti Sarfan, Ahmed Sartipy, Ulrik Saura, Emmi Savola, Jukka Savunen, Timo Scherstén, Henrik Schierenbeck, Fanny Schiller, Petter Schoenburg, Markus Schwarz, Niko Sethurathnam, Rajan Sheriff, Ejaz Sigurdsson, Axel F Silverborn, Martin Sjögren, Johan Stark, Christoffer Steingrimsson, Steinn Stenman, Malin Stenseth, Roar Stomberg-Warren, Margareta 102 AUTHOR INDEX P10 Svedjeholm, Rolf P23 P24 Svendsen, Øyvind Sverre O8 P12 Søreide, Jon Arne P6 Tarantino, Enrico O23 Tarkka, Matti O14, O26 Theander, Kerstin P6 Thimour-Bergström, Linda O26, O28 Thorsteinsson, Kristinn P5, P7 Tovedal, Thomas P25 Valikapathalil, Kurian O4, P11, O12 Vanky, Farkas P8 Vidarsdottir, Halla O14, O18, O19, O20, O28 Vikholm, Per O13 Viktorzon, Mikael P13 Vuohelainen, Vilma P19 Walther, Thomas O26 Yeniguen, Mesut P25 Åstedt-Kurki, Päivi P17 P12 O17 P23 O17 P25 P6 O30 O28 P26, P31 O18, O28 O10 O7 P6 P26, P31 O24 P9, P19 P15 P23 P19 P16, O19 P23 O13 P10 O17 O17 O2 P25 P13 O24 P13 P21 O23 O29 O4 O34 O25 103 NOTES 104 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 NOTES Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 105 NOTES EXHIBITORS Abbott Laboratories, Abbott Vascular AstraZeneca AB Baxter Medical AB Berlin Heart GmbH ConvaTec SwedenAB Covidien Sverige AB CSL Behring AB DePuy Synthes Edwards Lifscience Haemonetics Scandinavia AB 106 Scandinavian Conference in Cardiothoracic Surgery, Gothenburg, Sweden, September, 2014 JenaValve Technology GmbH Join Tech Medical AB KCI Medical AB KEBOMED MAQUET Medela Medical AB Mediplast Medistim AB Medtronic Nonin Medical Octapharma Nordic AB Orion Pharma AB Roche Diagnostics Scanlan International Inc. Sorin Group St Jude Medical Sweden AB Takeda Pharma Terumo Sweden AB Triolab AB Vingmed AB 107 PROGRAM AT A GLANCE Time Get together party and registration at Svenska Mässan Exhibition Hall Wednesday, September 3 18.00-20.00 Time Breakfast symposium: Antiplatelet therapy and cardiac surgery Hall K2 Thursday, September 4 07.15-08.00 Dual antiplatelet therapy in patients with acute coronary syndrome Perioperative handling of cardiac surgery patients on dual antiplatelet therapy vaECMO - this is how it should be done and why 08.00-09.30 ECMO: An update How to manage patients on vaECMO in intensive care ECMO - when is the right choice palliative care Pro-Con debate ECMO programs should have a perfusionist on-call ”in-house” 09.30-10.00 Coffee & exhibition Aortic valve replacement in the advent of rapid deployment Valves 10.00-10.45 Designing the future treatment of Heart valve desiase 12.10-13.10 10.50-12.10 SATS oral abstract session 1 Lunch & exhibition Award symposium SATNU lecture SCANSECT lecture Transcatheter valve-in-valve implantation: first-line treatment for degenerated bioprosthesis 13.10-14.10 Aortic dissection with deep hypothermia and cerebral perfusion 14.20-15.20 Coffee & exhibition SATS oral abstract session 2 Poster session - SCANSECT SCANSECT oral abstract session 2 SCANSECT oral abstract session 1 What do we know about fear of movement in heart disease? 15.20-15.50 Clarence Crafoord’s Memorial Lecture Poster session - SATNU SATNU oral abstract 15.50-16.35 Poster session - SATS General assembly SFTAI 13.50-14.10 16.45-17.30 General assembly SACTS session 1 17.30-18.30 Banquet dinner at Rondo, Liseberg SATNU oral abstract session 2 19.30 Acute kidney injury in cardiac surgery Breakfast symposium Hall K2 Friday, September 5 Time 08.0008.45 09.00-10.00 SATS symposium Aortic aneurysm surgery The Stockholm experience Thoracoabdominal aneurysms Thoracic aneurysms: The future? 10.00-10.30 Coffee & exhibition General assembly SATS SATNU lecture Hall K3 Blood saving management SCANSECT lecture Hall K1 Physiotherapy lecture Hall R31 Lung surgery Why does it bleed? Bleeding & Haemostasis Patient experience after transplantation Surgery for lung cancer How should the new anticoagulants and platelet inhibitors be General assembly SCANSECT Update III General assembly SATNU The THOR registry Update II Strategies to reduce bleeding in cardiac surgery VATS lobectomy Monitoring of coagulation and platelet function in pediatric cardiac surgery Physiological and psychological effects of exercise training after heart surgery 10.30-11.30 Advanced valve surgery Ischemic mitral regurgitation Biscuspid aortic valves 11.40-12.15 Lunch & exhibition Minimal invasive valve surgery 12.15-13.00 Surgical treatment of endocarditis TAVI: An update Left ventricle remodelling No-touch vein grafts CABG in patients <50 years Ex vivo lung perfusion: The surgeons’s view Postoperative wound infections Closure Performance of the Cox-Maze procedure - a large surgical ablation center´s experience The development of atrial fibrillation surgery - 50 years of experience Eva Berglin Memorial Symposium Stem cells and the heart Accidental hypothermia 13.00-14.00 Update I 14.10-15.10 15.10 Layout by Malmö Kongressbyrå AB - Charlotta Ekheim
