Multilevel visuomotor control of locomotion in Drosophila.

Vision is critical for the control of locomotion, but the underlying neural mechanisms by which visuomotor circuits contribute to the movement of the body through space are yet not well understood. Locomotion engages multiple control systems, forming distinct interacting "control levels" driven by the activity of distributed and overlapping circuits. Therefore, a comprehensive understanding of the mechanisms underlying locomotion control requires the consideration of all control levels and their necessary coordination. Due to their small size and the wide availability of experimental tools, Drosophila has become an important model system to study this coordination. Traditionally, insect locomotion has been divided into studying either the biomechanics and local control of limbs, or navigation and course control. However, recent developments in tracking techniques, and physiological and genetic tools in Drosophila have prompted researchers to examine multilevel control coordination in flight and walking.

Photon pairs bi-directionally emitted from a resonant metasurface.

Metasurfaces are artificially structured surfaces able to control the properties of light at subwavelength scales. While, initially, they have been proposed as means to control classical optical fields, they are now emerging as nanoscale sources of quantum light, in particular of entangled photons with versatile properties. Geometric resonances in metasurfaces have been recently used to engineer the frequency spectrum of entangled photons, but the emission directivity was so far less studied. Here, we generate photon pairs via spontaneous parametric down conversion from a metasurface supporting a quasi-bound state in the continuum (BIC) leading to remarkable emission directivities. The pair generation rate is enhanced 67 times compared to the case of an unpatterned film of the same thickness and material. At the wavelength of the quasi-BIC resonance, photons are mostly emitted backwards, while their partners, spectrally detuned by only 8 nm, are emitted forwards. This behavior demonstrates fine spectral splitting of entangled photons and their bi-directional emission, never before observed in nanoscale sources. We expect this work to be a starting point for the efficient demultiplexing of photons in nanoscale quantum optics.

Flat-optics generation of broadband photon pairs with tunable polarization entanglement.

The concept of "flat optics" is quickly conquering different fields of photonics, but its implementation in quantum optics is still in its infancy. In particular, polarization entanglement, strongly required in quantum photonics, is so far not realized on "flat" platforms. Meanwhile, relaxed phase matching of "flat" nonlinear optical sources enables enormous freedom in tailoring their polarization properties. Here we use this freedom to generate photon pairs with tunable polarization entanglement via spontaneous parametric downconversion (SPDC) in a 400-nm GaP film. By changing the pump polarization, we tune the polarization state of photon pairs from maximally entangled to almost disentangled, which is impossible in a single bulk SPDC source. Polarization entanglement, together with the broadband frequency spectrum, results in an ultranarrow (12 fs) Hong-Ou-Mandel effect and promises extensions to hyperentanglement.

Resonant metasurfaces for generating complex quantum states.

Quantum state engineering, the cornerstone of quantum photonic technologies, mainly relies on spontaneous parametric downconversion and four-wave mixing, where one or two pump photons spontaneously decay into a photon pair. Both of these nonlinear effects require momentum conservation for the participating photons, which strongly limits the versatility of the resulting quantum states. Nonlinear metasurfaces have subwavelength thickness and allow the relaxation of this constraint; when combined with resonances, they greatly expand the possibilities of quantum state engineering. Here, we generated entangled photons via spontaneous parametric downconversion in semiconductor metasurfaces with high-quality factor, quasi-bound state in the continuum resonances. By enhancing the quantum vacuum field, our metasurfaces boost the emission of nondegenerate entangled photons within multiple narrow resonance bands and over a wide spectral range. A single resonance or several resonances in the same sample, pumped at multiple wavelengths, can generate multifrequency quantum states, including cluster states. These features reveal metasurfaces as versatile sources of complex states for quantum information.

HYBRID AORTIC ARCH SURGERY TO CREATE A LANDING ZONE IN THE ASCENDING AORTA.

INTRODUCTION: Thoracic Endovascular Aortic Repair (TEVAR) has enabled the treatment of aortic pathology that previously required open surgery, with higher morbidity and mortality. The need for a favorable landing zone (Lz), without compromising the patency of the supra-aortic vessels meant that Ishimaru Lz 2 was the most proximal technically feasible Lz. We developed a hybrid technique for the creation of a more proximal Lz in high risk patients - in the first stage, debranching/ rerouting of the supra-aortic vessels, with or without ascending aorta replacement, was performed; a few weeks later, a TEVAR with a LZ in the distal ascending aorta was performed. This technique allowed the avoidance of the more aggressive total arch and proximal descending aorta replacement (Elephant Trunk or Frozen Elephant Trunk - FET) in high risk patients. We reviewed all patients who underwent hybrid arch surgery in our Department to create a more proximal Lz that allowed safe TEVAR stent placement. From November 2007 to October 2019, 15 patients required hybrid surgery to achieve treatment - 9 by replacing the ascending aorta and debranching supra-aortic vessels and 6 by debranching and re-routing supra-aortic vessels to the native ascending aorta. All underwent computed tomography angiography within 30 days of surgery and had follow-up with annual appointments and imaging control. Patients average age was 65.5 (+/- 11.5) years, 73.3% being male. Average follow-up was 54.7 (+/- 46.2) months. The most common diagnosis was thoracic aortic aneurysm (66.7%), followed by chronic type B aortic dissection (20.0%), pen- etrating atherosclerotic ulcer (6.7%) and reintervention due to endoleak (EL, 6.7%). No in-hospital mortality was registered. ICU and hospital stay was 1.3 (0.8) days and 9.8 (10.3) days, respectively. Survival at 1- and 5- years was 84.6% and 65.8%, respectively. No EL was detected in 66.7% (n=10) of patients. Incidence of early EL was 20.0% (n=3), of which two-thirds had spontaneous resolution, and late EL was 13.3% (n=2). Endovascular reintervention was required in one patient. TEVAR in the context of hybrid surgery is associated with low morbidity and mortality, with a low incidence of EL and good early and long term survival.

Fast tuning of posture control by visual feedback underlies gaze stabilization in walking Drosophila.

Locomotion requires a balance between mechanical stability and movement flexibility to achieve behavioral goals despite noisy neuromuscular systems, but rarely is it considered how this balance is orchestrated. We combined virtual reality tools with quantitative analysis of behavior to examine how Drosophila uses self-generated visual information (reafferent visual feedback) to control gaze during exploratory walking. We found that flies execute distinct motor programs coordinated across the body to maximize gaze stability. However, the presence of inherent variability in leg placement relative to the body jeopardizes fine control of gaze due to posture-stabilizing adjustments that lead to unintended changes in course direction. Surprisingly, whereas visual feedback is dispensable for head-body coordination, we found that self-generated visual signals tune postural reflexes to rapidly prevent turns rather than to promote compensatory rotations, a long-standing idea for visually guided course control. Together, these findings support a model in which visual feedback orchestrates the interplay between posture and gaze stability in a manner that is both goal dependent and motor-context specific.

DeepEthogram, a machine learning pipeline for supervised behavior classification from raw pixels.

Videos of animal behavior are used to quantify researcher-defined behaviors of interest to study neural function, gene mutations, and pharmacological therapies. Behaviors of interest are often scored manually, which is time-consuming, limited to few behaviors, and variable across researchers. We created DeepEthogram: software that uses supervised machine learning to convert raw video pixels into an ethogram, the behaviors of interest present in each video frame. DeepEthogram is designed to be general-purpose and applicable across species, behaviors, and video-recording hardware. It uses convolutional neural networks to compute motion, extract features from motion and images, and classify features into behaviors. Behaviors are classified with above 90% accuracy on single frames in videos of mice and flies, matching expert-level human performance. DeepEthogram accurately predicts rare behaviors, requires little training data, and generalizes across subjects. A graphical interface allows beginning-to-end analysis without end-user programming. DeepEthogram's rapid, automatic, and reproducible labeling of researcher-defined behaviors of interest may accelerate and enhance supervised behavior analysis. Code is available at: https://github.com/jbohnslav/deepethogram.

Photon Pairs from Resonant Metasurfaces.

All-dielectric optical metasurfaces are a workhorse in nano-optics, because of both their ability to manipulate light in different degrees of freedom and their excellent performance at light frequency conversion. Here, we demonstrate first-time generation of photon pairs via spontaneous parametric-down conversion in lithium niobate quantum optical metasurfaces with electric and magnetic Mie-like resonances at various wavelengths. By engineering the quantum optical metasurface, we tailor the photon-pair spectrum in a controlled way. Within a narrow bandwidth around the resonance, the rate of pair production is enhanced up to 2 orders of magnitude, compared to an unpatterned film of the same thickness and material. These results enable flat-optics sources of entangled photons-a new promising platform for quantum optics experiments.

Entangled photons from subwavelength nonlinear films.

Miniaturized entangled photon sources, in particular based on subwavelength metasurfaces, are highly demanded for the development of integrated quantum photonics. Here, as a first step towards the development of quantum optical metasurfaces (QOMs), we demonstrate generation of entangled photons via spontaneous parametric down-conversion (SPDC) from subwavelength films. We achieve photon pair generation with a high coincidence-to-accidental ratio in lithium niobate and gallium phosphide nanofilms. By implementing the fiber spectroscopy of SPDC in nanofilms, we measure a spectrum with a bandwidth of 500 nm, limited only by the overall detection efficiency. The spectrum reveals vacuum field enhancement due to a Fabry-Perot resonance inside the nonlinear films. It also suggests a strategy for observing SPDC from QOM. Our experiments lay the groundwork for future development of flat SPDC sources, including QOM.

Breast cancer in very young women-a multicenter 10-year experience.

BACKGROUND: Breast cancer (BC) is the most prevalent cancer in adult young women in Europe. Although rare, it is one of the leading causes of death in this age group. The aim of this study is to characterize a cohort of young women regarding tumor stage, biology, treatment and survival. PATIENTS AND METHODS: We present a multicenter retrospective analysis of women <35 years of age, diagnosed with BC between 2008 and 2017. A total of 207 patients from five Portuguese centers were included, from whom 172 were eligible for analysis. Data were analyzed using IBM SPPSS statistics. RESULTS: Median age at diagnosis was 31 years. Fifty-one percent of tumors were hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative, 20% HR-positive/HER2-positive, 8% HR-negative/HER2-positive and 20% triple-negative BC. Twenty-two percent of patients were diagnosed in stage I, 26% stage II, 45% stage III and 6% had de novo metastatic cancer. Thirty-nine percent of patients were treated with neoadjuvant chemotherapy. Mean follow-up time was 64.9 months and overall survival at 5 years, of the entire cohort and metastatic patients, was 86.5% and 26%, respectively. CONCLUSIONS: In our study we found similar population characteristics to other cohorts <35 years of age. To our knowledge, this is one of the largest cohorts in very young women. BC in young women is an important issue and further studies are needed to provide better care and survivorship to patients.

Mapping axonal density and average diameter using non-monotonic time-dependent gradient-echo MRI.

White Matter (WM) microstructures, such as axonal density and average diameter, are crucial to the normal function of the Central Nervous System (CNS) as they are closely related with axonal conduction velocities. Conversely, disruptions of these microstructural features may result in severe neurological deficits, suggesting that their noninvasive mapping could be an important step towards diagnosing and following pathophysiology. Whereas diffusion based MRI methods have been proposed to map these features, they typically entail the application of powerful gradients, which are rarely available in the clinic, or extremely long acquisition schemes to extract information from parameter-intensive models. In this study, we suggest that simple and time-efficient multi-gradient-echo (MGE) MRI can be used to extract the axon density from susceptibility-driven non-monotonic decay in the time-dependent signal. We show, both theoretically and with simulations, that a non-monotonic signal decay will occur for multi-compartmental microstructures - such as axons and extra-axonal spaces, which were here used as a simple model for the microstructure - and that, for axons parallel to the main magnetic field, the axonal density can be extracted. We then experimentally demonstrate in ex-vivo rat spinal cords that its different tracts - characterized by different microstructures - can be clearly contrasted using the MGE-derived maps. When the quantitative results are compared against ground-truth histology, they reflect the axonal fraction (though with a bias, as evident from Bland-Altman analysis). As well, the extra-axonal fraction can be estimated. The results suggest that our model is oversimplified, yet at the same time evidencing a potential and usefulness of the approach to map underlying microstructures using a simple and time-efficient MRI sequence. We further show that a simple general-linear-model can predict the average axonal diameters from the four model parameters, and map these average axonal diameters in the spinal cords. While clearly further modelling and theoretical developments are necessary, we conclude that salient WM microstructural features can be extracted from simple, SNR-efficient multi-gradient echo MRI, and that this paves the way towards easier estimation of WM microstructure in vivo.

Frozen Elephant Trunk with E-Vita Open Hybrid Prosthesis for Surgical Correction of Multisegmental Thoracic Aortic Pathology: Review of Results.

INTRODUCTION: The Frozen Elephant Trunk (FET) surgery allows correction of ascending, arch and proximal descending aortic pathology, using a hybrid prosthesis at the same time. It is a complex intervention and requires a multidisciplinary team that, besides scheduling and performing the surgery, accompanies the patient (pt) throughout the postoperative period. OBJECTIVES: To review short and medium term clinical results with this technique. METHODS: Between January 2010 and September 2017, we operated 34 patients (pts) using FET. The surgery was performed under cardiopulmonary bypass (CPB) with cardio-circulatory arrest in deep hypothermia, always with bilateral antegrade selective cerebral protection and under noninvasive neuromonitorization. Antegrade and retrograde, hematic, cold, intermittent cardioplegia was used. All patients were followed in our outpatient clinic with imaging techniques. RESULTS: The mean age of the pts was 62.8 ± 11.5 years, 16 males. The mean follow-up period was 18.7 ± 16.1 months. Diagnoses were: chronic type A dissection 9 pts, ascending aortic aneurysm and distal arch 9 pts, pseudoaneurysm 1 pt, mega-aorta syndrome 11 pts. No pt was operated in acute situation. Seven pts (20.6%) were reoperations and in 4 pts (11.8%) associated cardiac procedures were required. The left subclavian was conserved in 24 pts (70.6%). CPB, aortic clamping and distal ischemia mean times were, respectively; 260, 149 and 54 minutes. Hospital mortality occurred in five pts (14.7%), 3 of which at the beginning of the series, due to mesenteric ischemia. The hospital morbidity consisted of: ventilator-associated pneumonia 3 pts (8.8%), stroke 2 pts (5.9%), perioperative infarction 1 pt (2.9%) and paraplegia 1 pt (2.9%). Seven pts (20.6%) required 9 endovascular re-interventions (TEVAR) in the distal descending aorta and in two of these an abdominal fenestrated endoprosthesis was implanted by the vascular team. Three pts presented early type IIB endoleaks, which resolved spontaneously in follow-up CT. Among the others there were no endoleaks and the expected involution of the aneurysmal sac and positive remodeling of the aorta was observed. All survivors are clinically stable, asymptomatic, in class NYHA I. CONCLUSION: The overall results are in line with the literature. Mesenteric ischaemia is the leading cause of in-hospital death. FET is a safe and effective intervention. The expandable segment of the hybrid prosthesis is an excellent landing zone to complete the procedure, when necessary, with the second stage TEVAR. Survivors acquire an excellent quality of life in the medium term. Clinical follow-up and lifelong imaging techniques are mandatory.

TEVAR - A Primary or Adjunct Procedure Helpful in the Surgical Correction of Complex Pathology of the Thoracic Aorta?

INTRODUCTION: Thoracic Endovascular Aortic Repair (TEVAR) made possible the treatment of aortic disease that previously could only be approached openly, associated with a considerable morbidity and mortality. However, it also brings new challenges influencing patient selection - favourable landing zone, good peripheral access, propensity for endoleak (EL) - that requires rigorous clinical and imaging follow- -up. OBJECTIVE: Review all patients that underwent TEVAR in our Department and assess morbidity and mortality. METHODS: From November 2007 to September 2017, 57 TEVAR were performed in our Department to 52 patients. All patients performed postoperative CT angiography within 30 days after surgery. Follow-up was carried in our Outpatient Clinic with annual imaging. Statistical analysis was performed with SPSSTM 22 (© IBM). RESULTS: Patients' mean age was 65.6 ± 10.3 years and 69.2% were male (n = 36). Mean follow-up was 48.1 ± 34.1 months. The most frequent surgical indication was thoracic aortic aneurysm (42.1%), followed by chronic type B aortic dissection (35.1%), pseudoaneurysm (10.5%), reintervention by EL (7.0%), penetrating aortic ulcer (3.5%) and traumatic dissection of the aorta (1.8%). Surgery was elective in 87.7% of cases and part of a dual stage strategy in 17.3%. In-hospital mortality was 3.9%. Survival at 1, 2 and 5 years was 87.9%, 85.6% and 71.5%, respectively. Reported complications were: need for endovascular reintervention 7.7%; complication of femoral access 7.7%; and cerebellar infarction 1.9%. Throughout follow-up, no EL was detected in 56.1% of patients. There was an incidence of early EL in 38.4%, of which 45.0% had spontaneous resolution, documented in subsequent CT scans. The most frequent was type IA (42.9%) that was also the one with the highest spontaneous resolution rate (62.5%). Mean time to diagnosis of late EL was 36.9 ± 21.4 months and occurred in 11.5% of patients, the most frequent being type IA (50.0%); there was no spontaneous resolution observed. In all cases of reintervention due to EL a good surgical result was obtained. CONCLUSION: TEVAR is a procedure with low morbidity and mortality, good long-term outcome and a relatively low incidence of EL. Most patients do not have EL during their follow-up and have an excellent survival. The most frequent early EL is type IA and about half resolve in the following months. Although rare, late EL did not present spontaneous resolution. The treatment of EL can easily be achieved with new intervention and excellent result.

Simplified Technique for Aortic Arch Replacement in Patients at High Risk for Frozen Elephant Trunk.

INTRODUCTION: Surgical approach of multisegmental pathology of the thoracic aorta, namely aortic arch / descending aorta is challenging. The Frozen Elephant Trunk (FET) has good results, with acceptable risk. However, in the subgroup of patients (pts) older than 75 years and with important comorbidities, the surgical risk is very high. OBJECTIVES: Review short-term results of this original, simplified and potentially hybrid technique developed in our Department for this subgroup of patients. METHODS: From January 2016 to September 2017, 10 pts were operated with this technique - mean age 70.2 ± 15.3 years, 7 males. The diagnoses were: 6 pts with aneurysmal disease and 4 pts with aortic dissection. Four pts had previous cardiac surgery. The surgical concept consists of 3 key points: 1) Use of a patient-tailored graft, built in a back-table, to replace the ascending aorta and arch, with side-branches proximally anastomosed to reroute the supra-aortic vessels, allowing a proximal, long Landing Zone for eventual TEVAR. 2) Debranching of the supra-aortic vessels. 3) Maintain bilateral anterograde selective cerebral perfusion. All pts were operated on cardiopulmonary bypass (CPB) with a period of hypothermic (24oC) cardiocirculatory arrest for the open distal anastomosis. Preservation of the left subclavian artery depended on paraplegia risk and was individually assessed preoperatively. In a second stage, a TEVAR was electively deployed in 2 patients. All patients were followed in our clinic and imaging clinic at 6 months and annually after surgery. RESULTS: Mean CPB, aortic cross clamping and visceral ischemia were, respectively, 196, 120 and 44 minutes. One pt died in- hospital due to bowel ischemia. Four pts had respiratory complications requiring prolonged ventilation. The mean ICU and hospital stay was, respectively, 7,8 and 23,6 days. The mean follow-up was 15.2 months and three pts died during this follow-up. One pt was re-hospitalized with deep sternal wound infection. Of the survivors, one had a stroke at 6 months postoperatively and the remainder are asymptomatic. The postoperative period of the 2 pts submitted to TEVAR was uneventful; to date, they remain surgically stable, without needing re-intervention. CONCLUSION: The technique is effective and avoids the burden of FET. The short-term results are encouraging but, in the long-term, they should be evaluated to determine their role among arch interventions, specially their value in relation to recent pure endovascular techniques with fenestrated or branched endoprosthesis. Long ICU and hospital stay points towards the implementation of measures and protocols to improve them.

Ascending Aorta Aneurysms in Octogenarians.

INTRODUCTION: Older age is often regarded as a relative contraindication for open surgery for aortic aneurysms. These individuals often have a greater comorbidity burden that predispose them for development of postoperative complications. The aim of our study is to evaluate the surgical outcomes of selected octogenarians after open aortic surgery. METHODS: We performed a retrospective observational study. We collected data from patients operated on by our team between January of 2012 to September of 2017. We performed univariate logistic regression and survival analysis to construct Kaplan Meier survival curves. RESULTS: We analysed data from 430 patients, and 31 patients fulfilled the inclusion criteria. 67.7% of the patients were male. The mean age was 81.5 ± 1.8 years. The preoperative comorbidities were hypertension (83.9%), aortic valve disease (54.8%), dyslipidaemia (48.4%), renal impairment (9.7%), type 2 diabetes mellitus (9.7%) and COPD (3.2%). As for the procedures performed the majority was aortic valve replacement and graft interposition (48.4%) followed by graft interposition (35.5%), ascending aorta and arch replacement (9.7%) and graft interposition and combined CABG (6.5%). 16.1% of the procedures were reoperations and 6.5% were performed as urgent. In-hospital mortality was 9.4% and 1-year survival was 77.4%. The mean survival time after surgery was 736.4 ± 530.3 days. As for complications, 22.6% developed respiratory complications, 6.5% had infectious complications and 3.2 developed renal and central nervous system complications. Older age was not related to early (p = 0.266) or late mortality (p = 0.779). There was no association between older age and longer ICU stay (p = 0.781) or total hospital stay (p = 0.985). CONCLUSIONS: Highly selected octogenarians benefit from surgery, having a similar rate of postoperative complications and survival, as described in the literature.

Cardiac Fibroelastoma: 10-Year Experience.

INTRODUCTION: Papillary fibroelastoma is one of the most common types of primary cardiac tumour. Though a rare pathology, its importance relates to its form of presentation, with stroke and sudden death, and the questions regarding its management. OBJECTIVES: To review the casuistic of cardiac tumours in our service, in special the papillary fibroelastomas. METHODS: clinical case series overviewing the period from 1st January 2008 to 30th September 2017. We analysed all patients submitted to cardiac surgery due to cardiac masses or tumours and verified all the pathology results to confirm the diagnosis. RESULTS: In the period selected, around 6500 surgeries were performed. Of those, 59 patients were operated on due to cardiac tumours. 81.4% were myxomas, 13.6% were papillary fibroelastomas, 3.4% were cardiac sarcomas and 1.7% were metastasis. Of the patients that had papillary fibroelastomas (n=8), 5 were male, and the mean age was 51.5 ± 16.2 years. 62.5% (n=5) had origin in the aortic valve and 37.5% (n=3) in the mitral valve. Regarding presentation, 3 patients presented with stroke, 2 patients had episodes of syncope and 3 patients were asymptomatic. After surgery, all patients remained asymptomatic and there was no evidence of recurrence. At the end of follow-up all patients were alive. CONCLUSION: Although a rare pathology, papillary fibroelastomas remain important due to their potential for embolization and cardiac chamber obstruction, therefore should be primarily treated with surgery.

Elective 2nd Stage TEVAR to Complete Frozen Elephant Trunk in the Surgical Correction of Complex Multisegmental Pathology of the Thoracic Aorta.

INTRODUCTION: Classical conventional surgery to treat multi-segmental thoracic aortic disease in two operative stages, sternotomy and left thoracotomy, is associated with significant mortality and complications. The Frozen Elephant Trunk (FET) associated with an endovascular procedure (TEVAR) allows an extensible and simplified surgical approach of the descending and thoracoabdominal aorta without increasing the risk. METHODS: Retrospective study of 8 patients (pts), 5 males, mean age 67.5 ± 4.2 years, with ascending and arch disease associated with descending aortic disease (chronic dissection 2 pts, aneurysmal disease 6 pts), treated between January 2014 and September 2017. All survivors are periodically followed up in our outpatient clinic with CT or MRI angiography. RESULTS: The average follow-up period is 18,7 ± 12,2 months. In the first stage (FET) - the left subclavian was conserved in all cases. In six of these pts, after an average period of 37 days, a TEVAR was performed, to complete the exclusion of the aneurysmal sac or the false lumen in the descending aorta. In 2 pts, the interval was longer and in the same intervention, a fenestrated endoprosthesis was implanted in the abdominal aorta by the vascular team. After TEVAR, mean ICU time was 16 hours and hospitalization was 5,2 days. One pt died in the 1st month post-intervention TEVAR + EVAR fenestrated. The remaining pts are stable and asymptomatic, in Class I NYHA, without endoleaks and with the expected involution of the aneurysmal sac and positive remodeling of the aorta. There were no cases of paraplegia or other neurological complications documented. CONCLUSION: This strategy is safe and effective. Clinical follow- -up associated with close postoperative imaging surveillance is required not only to determine the optimal interval between the two stages, which is dependent on the anatomy and underlying pathology of each patient, but also to identify possible complications. The quality of life of these pts in the medium-term is excellent.

Ascending Aorta Aneyrysms Over 70mm.

INTRODUCTION: Current guidelines suggest that patients with aortic diameter over 55-60 mm should undergo ascending aorta replacement, depending on associated valve pathology and other comorbidities. Studies show that the risk of aortic rupture over 60 mm is over 30%. Even though, we still receive in our practice patients that present with aneurysms of greater dimensions. The aim of our study is to evaluate the surgical outcomes of patients presenting with ascending aorta with diameter larger than 70 mm. METHODS: We performed a retrospective observational study. We collected data from patients operated on by our team between January of 2012 to September of 2017. We performed univariate logistic regression and survival analysis to construct Kaplan Meier survival curves. RESULTS: We analysed data from 430 patients, and 31 patients fulfilled the inclusion criteria. 64.5% of the patients were male. The mean age was 67.9 ± 12.9 years. The preoperative comorbidities were hypertension (64.5%), dyslipidaemia (45.2%), aortic valve disease (35.4%), renal impairment (9.7%) and COPD (3.2%). The average diameter was 82.3 ± 18.6 mm, with values ranging from 70 to 160 millimeters. As for the procedures performed the majority was interposition of prosthetic graft (45.2%), followed by aortic valve replacement and graft interposition (35.5%), Frozen Elephant Trunk (12.9%), tube interposition and combined CABG (3.2%) and aortic root replacement with graft interposition (3.2%). 9.7% of the procedures were reoperations and 9.7% were performed as urgent. In-hospital mortality was 3.2% and 1-year survival was 83.9%. The mean survival time after surgery was 1135.9 ± 777.1 days. As for complications, 29% developed respiratory complications, 9.7% had cardiac complications, 6.5% had central nervous system complications and 3.2% developed renal and vascular complications. Greater diameter was not associated with early (p = 0.929) or late mortality (p = 0.987). CONCLUSIONS: These results show that patients with aneurysms greater than 70 mm can be safely operated on, with no increase in complications in the postoperative period or greater mortality.