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Publisher: Oxford University Press   (Total: 370 journals)

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Showing 1 - 200 of 370 Journals sorted alphabetically
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 6, SJR: 0.881, h-index: 38)
Adaptation     Hybrid Journal   (Followers: 8, SJR: 0.111, h-index: 4)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 57, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 81, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 14, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 126, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 41, SJR: 1.441, h-index: 77)
American J. of Epidemiology     Hybrid Journal   (Followers: 152, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 18, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 15)
American journal of legal history     Full-text available via subscription   (Followers: 4, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 26, SJR: 0.824, h-index: 23)
American Literary History     Hybrid Journal   (Followers: 12, SJR: 0.185, h-index: 22)
Analysis     Hybrid Journal   (Followers: 24)
Annals of Botany     Hybrid Journal   (Followers: 35, SJR: 1.912, h-index: 124)
Annals of Occupational Hygiene     Hybrid Journal   (Followers: 26, SJR: 0.837, h-index: 57)
Annals of Oncology     Hybrid Journal   (Followers: 48, SJR: 4.362, h-index: 173)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 8, SJR: 0.642, h-index: 53)
Annals of Work Exposures and Health     Hybrid Journal  
AoB Plants     Open Access   (Followers: 4, SJR: 0.78, h-index: 10)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 19, SJR: 0.884, h-index: 31)
Applied Linguistics     Hybrid Journal   (Followers: 51, SJR: 1.749, h-index: 63)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 0.779, h-index: 11)
Arbitration Intl.     Full-text available via subscription   (Followers: 19)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 12)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 26, SJR: 0.96, h-index: 71)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 20)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 47, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 46, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 231, SJR: 4.643, h-index: 271)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 9, SJR: 1.646, h-index: 149)
Biometrika     Hybrid Journal   (Followers: 19, SJR: 2.801, h-index: 90)
BioScience     Hybrid Journal   (Followers: 28, SJR: 2.374, h-index: 154)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.213, h-index: 9)
Biostatistics     Hybrid Journal   (Followers: 16, SJR: 1.955, h-index: 55)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 135, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 65, SJR: 0.272, h-index: 20)
Brain     Hybrid Journal   (Followers: 61, SJR: 6.097, h-index: 264)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 45, SJR: 4.086, h-index: 73)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 50)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 33, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 25, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 502, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 80, SJR: 0.771, h-index: 53)
British Medical Bulletin     Hybrid Journal   (Followers: 7, SJR: 1.391, h-index: 84)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 26)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 3, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 54, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 9, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 10, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal  
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 11, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 39, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 16, SJR: 0.501, h-index: 19)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.436, h-index: 76)
Children and Schools     Hybrid Journal   (Followers: 6, SJR: 0.211, h-index: 18)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 3)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 19, SJR: 0.737, h-index: 11)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 8, SJR: 1.238, h-index: 15)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 11, SJR: 0.191, h-index: 8)
Classical Receptions J.     Hybrid Journal   (Followers: 17, SJR: 0.1, h-index: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 59, SJR: 4.742, h-index: 261)
Clinical Kidney J.     Open Access   (Followers: 4, SJR: 0.338, h-index: 19)
Community Development J.     Hybrid Journal   (Followers: 24, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 8, SJR: 0.371, h-index: 47)
Conservation Physiology     Open Access   (Followers: 2)
Contemporary Women's Writing     Hybrid Journal   (Followers: 11, SJR: 0.111, h-index: 3)
Contributions to Political Economy     Hybrid Journal   (Followers: 6, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Legal Problems     Hybrid Journal   (Followers: 25)
Current Zoology     Full-text available via subscription   (SJR: 0.999, h-index: 20)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 11, SJR: 1.068, h-index: 24)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 12)
Diplomatic History     Hybrid Journal   (Followers: 18, SJR: 0.296, h-index: 22)
DNA Research     Open Access   (Followers: 4, SJR: 2.42, h-index: 77)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 3)
Early Music     Hybrid Journal   (Followers: 13, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 52, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 46, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 12, SJR: 0.144, h-index: 3)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.791, h-index: 66)
Environmental Epigenetics     Open Access   (Followers: 1)
Environmental History     Hybrid Journal   (Followers: 25, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 9, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 15, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 47, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 9, SJR: 2.044, h-index: 58)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 1)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. Supplements     Hybrid Journal   (Followers: 8, SJR: 0.152, h-index: 31)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 7, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 147, SJR: 0.722, h-index: 38)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.09, h-index: 60)
European J. of Public Health     Hybrid Journal   (Followers: 22, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 12, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 26, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 37, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 13, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 8, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 20, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 25, SJR: 7.587, h-index: 150)
Fems Yeast Research     Hybrid Journal   (Followers: 13, SJR: 1.213, h-index: 66)
Foreign Policy Analysis     Hybrid Journal   (Followers: 21, SJR: 0.859, h-index: 10)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 0.903, h-index: 44)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.108, h-index: 6)
French History     Hybrid Journal   (Followers: 30, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 19, SJR: 0.119, h-index: 7)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.102, h-index: 3)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 10, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 31, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 25, SJR: 0.437, h-index: 13)
GigaScience     Open Access   (Followers: 3)
Global Summitry     Hybrid Journal  
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.692, h-index: 101)
Health and Social Work     Hybrid Journal   (Followers: 45, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 12, SJR: 0.814, h-index: 80)
Health Policy and Planning     Hybrid Journal   (Followers: 21, SJR: 1.628, h-index: 66)
Health Promotion Intl.     Hybrid Journal   (Followers: 20, SJR: 0.664, h-index: 60)
History Workshop J.     Hybrid Journal   (Followers: 27, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 23, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 9, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 76, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 16, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 58, SJR: 0.7, h-index: 21)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 54, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 9)
ILAR J.     Hybrid Journal   (Followers: 1, SJR: 1.099, h-index: 51)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.329, h-index: 26)
IMA J. of Management Mathematics     Hybrid Journal   (Followers: 2, SJR: 0.351, h-index: 20)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.661, h-index: 28)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 2.032, h-index: 44)
Industrial and Corporate Change     Hybrid Journal   (Followers: 8, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 29, SJR: 0.184, h-index: 15)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 8, SJR: 1.911, h-index: 90)
Interacting with Computers     Hybrid Journal   (Followers: 10, SJR: 0.529, h-index: 59)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 4, SJR: 0.743, h-index: 35)
Intl. Affairs     Hybrid Journal   (Followers: 51, SJR: 1.264, h-index: 53)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 26)
Intl. Health     Hybrid Journal   (Followers: 4, SJR: 0.835, h-index: 15)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 1.613, h-index: 111)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 32, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 59, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 122, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 3, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 28, SJR: 0.307, h-index: 15)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 8, SJR: 0.404, h-index: 18)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.457, h-index: 12)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.69, h-index: 79)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 8, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 32, SJR: 0.231, h-index: 21)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 13, SJR: 0.833, h-index: 12)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.052, h-index: 42)
Intl. Political Sociology     Hybrid Journal   (Followers: 26, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 17, SJR: 0.539, h-index: 17)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 7, SJR: 0.998, h-index: 28)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 36, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 17, SJR: 0.783, h-index: 38)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 1, SJR: 0.155, h-index: 4)
ITNOW     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 4)
J. of African Economies     Hybrid Journal   (Followers: 15, SJR: 0.647, h-index: 30)
J. of American History     Hybrid Journal   (Followers: 39, SJR: 0.286, h-index: 34)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 13, SJR: 1.038, h-index: 60)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 19, SJR: 2.157, h-index: 149)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 3, SJR: 0.563, h-index: 43)
J. of Biochemistry     Hybrid Journal   (Followers: 44, SJR: 1.341, h-index: 96)
J. of Chromatographic Science     Hybrid Journal   (Followers: 16, SJR: 0.448, h-index: 42)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.167, h-index: 11)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 34, SJR: 0.442, h-index: 16)
J. of Complex Networks     Hybrid Journal   (Followers: 1, SJR: 1.165, h-index: 5)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 11, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 40, SJR: 4.896, h-index: 121)
J. of Crohn's and Colitis     Hybrid Journal   (Followers: 9, SJR: 1.543, h-index: 37)
J. of Cybersecurity     Hybrid Journal   (Followers: 3)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 8, SJR: 0.69, h-index: 36)
J. of Design History     Hybrid Journal   (Followers: 15, SJR: 0.166, h-index: 14)
J. of Economic Entomology     Full-text available via subscription   (Followers: 6, SJR: 0.894, h-index: 76)
J. of Economic Geography     Hybrid Journal   (Followers: 34, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 23, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 19)
J. of Experimental Botany     Hybrid Journal   (Followers: 14, SJR: 2.798, h-index: 163)
J. of Financial Econometrics     Hybrid Journal   (Followers: 21, SJR: 1.314, h-index: 27)
J. of Global Security Studies     Hybrid Journal   (Followers: 2)
J. of Heredity     Hybrid Journal   (Followers: 3, SJR: 1.024, h-index: 76)
J. of Hindu Studies     Hybrid Journal   (Followers: 7, SJR: 0.186, h-index: 3)
J. of Hip Preservation Surgery     Open Access  
J. of Human Rights Practice     Hybrid Journal   (Followers: 20, SJR: 0.399, h-index: 10)
J. of Infectious Diseases     Hybrid Journal   (Followers: 40, SJR: 4, h-index: 209)
J. of Insect Science     Open Access   (Followers: 9, SJR: 0.388, h-index: 31)

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Journal Cover Interactive CardioVascular and Thoracic Surgery
  [SJR: 0.743]   [H-I: 35]   [4 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1569-9293 - ISSN (Online) 1569-9285
   Published by Oxford University Press Homepage  [370 journals]
  • eComment. Amiodarone-induced pulmonary toxicity in patients with atrial
           fibrillation undergoing lung resection
    • Authors: Spartalis M; Tzatzaki E, Schizas D, et al.
      Abstract: <span class="paragraphSection">We read with great interest the article by Kolokotroni <span style="font-style:italic;">et al.</span> [<a href="#ivx094-B1" class="reflinks">1</a>]. The authors concluded that current evidence obtained from retrospective studies and meta-analyses pointed out that amiodarone is a safe agent for prophylaxis or management of atrial fibrillation after lung resection and that there is no increase in pulmonary toxicity, even when pneumonectomy patients are involved. At the same time, they mention that there is only one paper regarding the association of amiodarone and lung toxicity in post-lung surgery patients. But is this the whole picture?</span>
      PubDate: 2017-04-25
  • eComment. The thoracic aorta as an antegrade inflow source for chronic
           mesenteric ischaemia
    • Authors: Mouawad NJ.
      Abstract: <span class="paragraphSection">It is with great interest that I read the best evidence topic by Barr and colleagues [<a href="#ivx083-B1" class="reflinks">1</a>] reviewing the published data on the use of the thoracic aorta as an inflow source for antegrade bypass to the mesenteric vessels in patients with chronic mesenteric ischaemia. Their literature search of specific query terms evaluated 737 articles of which only 5 utilized the thoracic aorta as the site for a proximal anastomosis, and provided the best evidence to answer the question posed. Relevant outcomes and related measures such as perioperative mortality, intraoperative and post-operative outcomes, graft patency and weight gain were evaluated. Thirty-five cases were identified within the 5 papers, and the data was appropriately subdivided into the ascending aorta or descending thoracic aorta as the inflow source.</span>
      PubDate: 2017-04-25
  • Spotlight on recently published EJCTS articles
    • PubDate: 2017-04-25
  • Ten-year results of the Freedom Solo stentless heart valve: excellent
           haemodynamics but progressive valve dysfunction in the long term
    • Authors: Sponga S; Barbera M, Pavoni D, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> Freedom Solo (FS) is a pericardial stentless heart valve showing excellent haemodynamic performance at mid-term. The aim of this study was to evaluate the long-term performance of such bioprostheses.<strong>METHODS:</strong> Between December 2004 and November 2009, 109 patients (31 men; mean age 76 ± 6 years) underwent aortic valve replacement with FS. Preoperatively, the mean NYHA class was 2.5 ± 0.7, the mean EuroSCORE II, 2.8 ± 2.5. Mean prosthesis size was 22.7 ± 1.9 mm; concomitant procedures were performed in 65 patients. Structural valve deterioration (SVD) was diagnosed according to the Valve Academic Research Consortium-2 definition.<strong>RESULTS:</strong> Two patients (1.8%) died within 30 days. Follow-up (72 ± 36 months) was 100% completed. The 1-, 5- and 10-year actuarial survival rates were 89, 73 and 42%, respectively, with 8 valve-related deaths; the actuarial freedom from SVD was 99, 93 and 76%. During 61 ± 39 months of follow-up, echocardiographic findings worsened progressively: At discharge, 3–5 and 7–9 years, the mean gradient was 8 ± 4, 12 ± 11 and 19 ± 19 mmHg (<span style="font-style:italic;">P</span> < 0.01); the indexed effective orifice area was 1.0 ± 0.2, 0.9 ± 0.2 and 0.8 ± 0.3 cm<sup>2</sup>/m<sup>2</sup> (<span style="font-style:italic;">P</span> < 0.01). Of the 13 patients who developed SVD, it was due to aortic stenosis in 11. SVD was a predictor of cardiovascular mortality at univariate analysis (HR 2.87, 1.12–7.29); 2 explanted prostheses showed massive calcium deposits with mean calcium and phosphorus contents of 234 ± 16 and 116 ± 7 mg/g dry weight, respectively.<strong>CONCLUSIONS:</strong> The FS bioprosthesis shows excellent mid-term clinical and haemodynamic results and offers an alternative to other valves, particularly in the case of a small aortic annulus. Worsening of FS performance was observed at late follow-up because of progressive SVD with stenosis, questioning whether it should be used in patients with a long life expectancy.</span>
      PubDate: 2017-02-23
  • Is surgical resection superior to bronchoscopic resection in patients with
           symptomatic endobronchial hamartoma?
    • Authors: Abdel Hady SM; Elbastawisy SE, Hassaballa AS, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Summary</div>A best evidence topic was written according to a structured protocol. The question addressed was: in surgically fit patients with biopsy proven symptomatic endobronchial hamartoma (EH), is surgical resection superior to bronchoscopic resection in terms of outcome. A total of 756 articles were identified using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. Three studies included patients who had either bronchoscopic or surgical treatment of EH in the same study. Modalities of surgery included performing a lobectomy, segmentectomy, bronchotomy and a pneumonectomy. Complete resection was 100% in the surgical group and ranged from 8% to 100% in the group treated bronchoscopically. Morbidity was present in 1 patient in a single study (6.6%) in the form of a pneumothorax after a bronchoscopic resection. No mortality was recorded in any study. A follow-up period of 16.2, 26 and up to 60 months showed recurrence of 26.7%, 12% and 0% respectively in the groups treated by bronchoscopy and no recurrence in the surgical group. Four studies looked at bronchoscopic treatment only for EH. Modalities of treatment included mechanical resection, laser, cryotherapy and Argon plasma coagulation. Complete resection ranged from 50–100% with patients achieving only partial resection requiring repeated endoscopic sessions. Morbidity was present in 3 out of the 4 studies; 1 case of pneumothorax in each of 2 studies (4.4% and 2%) and 25% morbidity rate in the third study (pneumothorax/airway stenosis). No mortality was present in any study. One study reported no recurrence after a median follow-up of 12.2 months, while another reported 50% recurrence, although the follow-up period was not stated. The final study included patients with EH treated only by surgical resection due to end stage lung damage caused by prolonged endobronchial obstruction. The majority of resections (71.4%) were in the form of lobectomies. Two major morbidities were recorded (28.5%) with no mortality. After a mean follow-up period of 7 years, no recurrences were recorded. To conclude, in biopsy proven symptomatic EHs, bronchoscopic treatment should be the first choice except in patients with end stage lung damage requiring surgical resection. Morbidity is low with pneumothorax the most common complication. Patients may require multiple sessions for complete removal as a significant recurrence rate is present, but is usually managed effectively by repeated bronchoscopic management.</span>
      PubDate: 2017-02-17
  • Hyperkalemic arrest and the aortic no-touch technique in minimally
           invasive atrial septal defect closure in adults
    • Authors: Tarui T; Watanabe G, Ishikawa N, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div>To avoid aortic cross-clamping and cardioplegic ischaemia, we propose the induction of hyperkalemic arrest and using aortic no-touch technique in minimally invasive atrial septal defect (ASD) closure. Twenty-eight patients were included in this study. After establishment of cardiopulmonary bypass, potassium was administered to induce hyperkalemic arrest. The mean dose of injected potassium was 1.2 ± 0.45 mEq/kg. Following the direct closure of the ASD, potassium was filtered out using a hemodialyzer. At the end of the operation, serum potassium was normalized to 4.1 ± 0.5 mEq/l. The mean arrest time was 11 ± 4.4 min without complications. Hyperkalemic arrest in combination with aortic no-touch technique is safe and efficacious in minimally invasive ASD closure.</span>
      PubDate: 2017-02-17
  • The effect of different mitral annuloplasty rings on valve geometry and
           annular stress distribution†
    • Authors: Skov S; Røpcke D, Tjørnild M, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> To characterize the remodelling effects and deformational forces of normosized rigid, semirigid and flexible mitral annuloplasty rings after implantation in healthy pigs.<strong>METHODS:</strong> Measurements were performed <span style="font-style:italic;">in vivo</span> with 80-kg porcine animals. Twenty-eight animals were randomized into a no ring group, a flexible ring group (Duran AnCore Ring, Medtronic, Minneapolis, MN, USA), a rigid ring group (Carpentier-Edwards Classic annuloplasty ring, Edwards Lifesciences, Irvine, CA, USA) and a semirigid ring group (Carpentier-Edwards Physio I annuloplasty ring, Edwards Lifesciences). Sonomicrometry crystals were implanted together with an annuloplasty ring and a dedicated mitral annular force transducer. The mitral annuloplasty rings were compared with respect to annular geometry and mitral annular forces.<strong>RESULTS:</strong> Cyclic changes in the mitral annulus (MA) circumference were significantly lower for all ring groups (flexible: 7 ± 3 mm, semirigid: 4 ± 2 mm and rigid: 2 ± 1 mm) compared to the no ring group (11 ± 5 mm), implying the remodelling capacity of all annuloplasty rings. The cyclic change of the MA area and the septa-lateral and inter-commissural distances were equal in the semirigid and rigid ring groups and significantly lower compared to the no ring and flexible ring groups, suggesting a stronger and equal remodelling effect in the semirigid and rigid ring groups. Forces measured in the transducer reflected the remodelling capacity of the annuloplasty rings and were in general lower for the semirigid and rigid ring groups compared to the no ring and flexible ring groups. Especially the forces in the inter-commissural direction were significantly reduced for the semirigid and rigid ring groups (semi-rigid: 1.4 ± 0.8 N, rigid: 1.2 ± 0.8 N) compared to the no ring and flexible ring groups (no ring: 3.0 ± 1.1 N, flexible: 3.4 ± 1.6 N).<strong>CONCLUSIONS:</strong> This study is the first to describe different remodelling effects and deformational forces of normosized mitral annuloplasty rings <span style="font-style:italic;">in vivo</span>. Insights into the relationship between the remodelling effects and the accumulated forces of different mitral annuloplasty rings may have implications for ring selections in an aetiology-based mitral valve repair strategy. We propose the application of such a biomechanical approach for quantitative comparison of mitral annuloplasty rings and for future innovations on a rational basis.</span>
      PubDate: 2017-02-16
  • Right ventricular outflow tract systolic function correlates with exercise
           capacity in patients with severe right ventricle dilatation after repair
           of tetralogy of Fallot
    • Authors: Luo S; Li J, Yang D, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> The relationship between exercise capacity and right ventricular (RV) components function in repaired tetralogy of Fallot patients with severely dilated right ventricles is poorly understood. The aim of this study was to characterize the exercise capacity and its relationship to RV global and components function in repaired tetralogy of Fallot patients with RV end-diastolic volume index  >150 ml/m<sup>2</sup>, a currently accepted threshold for pulmonary valve replacement.<strong>METHODS:</strong> The medical records and results of cardiac magnetic resonance imaging and cardiopulmonary exercise testing of 25 consecutive eligible patients were reviewed. Twenty age- and gender-matched normal subjects were enrolled as cardiac magnetic resonance control. End-diastolic, end-systolic and stroke volumes, and ejection fraction (EF) were determined for the total RV and its components.<strong>RESULTS:</strong> Of the 25 patients, 44% maintained normal exercise capacity. RV outlet EF was higher (<span style="font-style:italic;">P </span>= 0.02) and RV incisions smaller (<span style="font-style:italic;">P </span>= 0.04) in patients with normal exercise capacity than those with subnormal exercise capacity. Predicted peak oxygen consumption correlated better with the RV outflow tract EF than with the EF of other components of the RV or the global EF (<span style="font-style:italic;">r</span> = 0.59; <span style="font-style:italic;">P </span>= 0.002). Multivariate analysis showed the RV outflow tract EF to be the only independent predictor of exercise capacity (ß = 0.442; <span style="font-style:italic;">P</span> = 0.02).<strong>CONCLUSIONS:</strong> Exercise capacity is preserved in some tetralogy of Fallot patients with severe RV dilatation. RV outflow tract EF is independently associated with exercise capacity in such patients, and could be a reliable determinant of intrinsic RV performance.</span>
      PubDate: 2017-02-16
  • Isolated severe leftward displacement of the septum primum: anatomic and
           3D echocardiographic findings and surgical repair
    • Authors: Cuttone F; Hadeed K, Lacour-Gayet F, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Summary</div><strong>OBJECTIVES:</strong> Leftward displacement of the septum primum is usually described as associated with hypoplastic left heart syndrome or visceral heterotaxy. This rare malformation results in partially or totally anomalous pulmonary venous drainage with a normal connection of the pulmonary veins to the left atrium, depending on the degree of septal shift. We report the 3D echocardiographic and anatomic findings as well as the surgical repair in a series of isolated severe leftward displacement of the septum primum, responsible for totally anomalous pulmonary venous drainage.<strong>METHODS:</strong> Three patients presenting with situs solitus and extreme leftward displacement of the septum primum were included. All of the pulmonary veins drained anomalously into the anatomical right atrium, and the distance between the mitral valve and the abnormal septum primum was greatly reduced, compromising the size of the left atrial chamber, but with normal left ventricle diameters. Preoperative 3D echocardiographic findings are reported. We achieved a biventricular surgical repair in all cases. The atrial septation was accomplished using an autologous pericardial patch after removing the abnormal septal membrane.<strong>RESULTS:</strong> The postoperative course was free from any cardiovascular complications. Echocardiographic scans showed a harmonious reconstruction without pulmonary venous obstructions or stenosis.<strong>CONCLUSIONS:</strong> This article reports the severe leftward displacement of the septum primum presented as an isolated cardiac malformation; 3D transthoracic echocardiography allowed an accurate diagnosis of this malformation and helped in choosing the best surgical strategy.</span>
      PubDate: 2017-02-16
  • In patients undergoing lung resection is it safe to administer amiodarone
           either as prophylaxis or treatment of atrial fibrillation?
    • Authors: Kolokotroni S; Toufektzian L, Harling L, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Summary</div>A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether the administration of amiodarone is safe in patients undergoing lung resection either for prophylaxis or treatment of <span style="font-style:italic;">de novo</span> postoperative atrial fibrillation (POAF). A total of 30 papers were identified, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date, study type, country of publication, patient demographics, relevant outcomes and results were tabulated. Among the identified papers, there were 2 meta-analyses, 1 best evidence topic and 3 randomized studies, while the remainder were retrospective. When considering perioperative amiodarone for the prophylaxis of POAF, 3 randomized studies reported no significantly increased postoperative complications or amiodarone-related side effects. Mortality and length of hospital stay were similar in patients receiving amiodarone compared with either no amiodarone or other prophylactic antiarrhythmic medication. When considering amiodarone for the treatment of POAF, 1 study reported a significantly increased incidence of ARDS after anatomical lung resection (<span style="font-style:italic;">P</span> < 0.001). Two case series reported that patients developing POAF after lung resection and managed with amiodarone also had either none or acceptable rates of side effects, with no serious respiratory complications. Two retrospective and 1 prospective observational study reported that amiodarone used either for the treatment of POAF, or for prophylaxis against it, had similar rates of postoperative respiratory complications, length of hospital stay and mortality, compared with either no treatment or treatment with other prophylactic or therapeutic agents. In accordance with the Society of Thoracic Surgeons guidelines on prophylaxis and management of POAF in general thoracic surgery, these data suggest that amiodarone is a safe agent for the management of POAF after lung resection. Careful monitoring in patients treated with amiodarone after pneumonectomy should be considered because development of acute lung toxicity can increase length of hospital stay, morbidity and mortality. Further studies may also be needed to identify the subset of pneumonectomy patients at risk of pulmonary toxicity after use of amiodarone.</span>
      PubDate: 2017-02-14
  • Long-term pulmonary function after surgery for lung cancer
    • Authors: Kobayashi N; Kobayashi K, Kikuchi S, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> Many patients with lung cancer have been cured by surgical intervention. However, the long-term effects of lung resection on pulmonary function are unclear. Therefore, we investigated long-term pulmonary function after surgery.<strong>METHODS:</strong> We retrospectively reviewed the medical records of patients who underwent surgery for lung cancer between 2001 and 2009. A total of 445 patients who had survived more than 5 years since the surgery were included. The patients were divided into lobectomy, segmentectomy and partial resection groups. The time-dependent changes in pulmonary function were investigated.<strong>RESULTS:</strong> The percentages of the vital capacity and forced expiratory volume in 1 second (FEV<sub>1</sub>) at postoperative year (POY) 1 vs preoperative values were 92.9 ± 11.1% and 91.3 ± 13.0% in the lobectomy group, 95.9 ± 9.0% and 93.8 ± 10.5% in the segmentectomy group and 97.8 ± 7.3% and 98.1 ± 8.3% in the partial resection group, respectively. The values in the lobectomy group were significantly lower than those in the segmentectomy and partial resection groups. The percentages of vital capacity and FEV<sub>1</sub> at POY 5 vs preoperative values were 90.0 ± 11.5% and 86.2 ± 11.9% in the lobectomy group, 93.4 ± 9.8% and 91.1 ± 9.8% in the segmentectomy group and 94.3 ± 8.8% and 94.0 ± 8.0% in the partial resection group, respectively. The decrease in the rates from POY 1 to POY 5 were not significantly different among the procedures.<strong>CONCLUSIONS:</strong> Pulmonary function declined with pulmonary resection. After the patient recovered from the operation, pulmonary function decreased with time regardless of the surgical procedure.</span>
      PubDate: 2017-02-13
  • Attrition in patients with single ventricle and trisomy 21: outcomes after
           a total cavopulmonary connection
    • Authors: Polimenakos A; Subramanian S, ElZein C, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> Data are limited regarding the management of children with trisomy 21 (T21) syndrome and a functional single ventricle (FSV). We evaluated patients with T21 and a FSV who had a total cavopulmonary connection (TCPC).<strong>METHODS:</strong> From September 1999 to August 2012, 139 patients with a FSV underwent a TCPC. Sixty-five had unbalanced atrioventricular septal defect. Thirteen had T21. Three (of 13) had heterotaxy syndrome. The mean age at the Fontan operation was 27.6 ± 12.1 months.<strong>RESULTS:</strong> The initial procedure was pulmonary artery banding in 9 patients, systemic-to-pulmonary shunt in 2 and Damus–Kaye–Stansel/Norwood procedure in 2. Median follow-up was 69 months (interquartile range<sub>25–75,</sub> 21–99). There was 1 death after a Damus–Kaye–Stansel/Norwood procedure and one interstage death after a bidirectional Glenn procedure. Nine (of 11) survivors underwent a Fontan operation. A fenestrated Fontan procedure was the predominate operation in 78%. One patient was deemed unsuitable for a Fontan operation. There was 1 takedown and 1 late death after the Fontan operation. Heterotaxy syndrome did not affect outcome (<span style="font-style:italic;">P</span> > 0.05). There was no statistical difference in the pre-Fontan McGoon ratio, hospital length of stay, duration of pleural drainage and Fontan-related adverse events between patients with a dominant right ventricle and those with a left (<span style="font-style:italic;">P</span> > 0.05).<strong>CONCLUSIONS:</strong> A TCPC in patients with T21 and an FSV is associated with reproducible, satisfactory outcomes. An assisted-Glenn procedure with pulsatile pulmonary blood flow and a fenestrated Fontan may be associated with attenuated perioperative morbidity and late attrition.</span>
      PubDate: 2017-02-13
  • Propensity matched comparison of extrapleural pneumonectomy and
           pleurectomy/decortication for mesothelioma patients†
    • Authors: Kostron A; Friess M, Inci I, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> The objective of this retrospective study was to assess perioperative outcomes, overall survival and freedom from recurrence after induction chemotherapy followed by extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) in patients with mesothelioma in a propensity score matched analysis.<strong>METHODS:</strong> Between September 1999 and August 2015, 167 patients received multimodality treatment (platinum-based chemotherapy followed by EPP [<span style="font-style:italic;">n =</span> 141] or P/D [<span style="font-style:italic;">n =</span> 26]). We performed 2:1 propensity score matching for gender, laterality, epithelioid histological subtype and International Mesothelioma Interest Group (iMig) stage (52 EPP and 26 P/D).<strong>RESULTS:</strong> Postoperative major morbidity (48% vs 58%, <span style="font-style:italic;">P =</span> 0.5) was similar in both groups; however, the complication profile and severity were different and favoured P/D; the 90-day mortality (8% vs 0%, <span style="font-style:italic;">P =</span> 0.3) rate was lower in P/D although not statistically significant. Prolonged air leak (≥10 days) occurred in 15 patients (58%) undergoing P/D. The intensive care unit stay was significantly longer after EPP (<span style="font-style:italic;">P =</span> 0.001). Freedom from recurrence was similar for both groups (EPP: median 15 months, 95% confidence interval [CI]: 10–21; P/D: 13 months, 95% CI: 11–17) (<span style="font-style:italic;">P =</span> 0.2). Overall survival was significantly longer for patients undergoing P/D (median 32 months, 95% CI: 29–35) compared to EPP (23 months, 95% CI: 21–25) (<span style="font-style:italic;">P =</span> 0.031), but in the P/D group many cases were censored (73%) and the follow-up time was relatively short.<strong>CONCLUSIONS:</strong> P/D and EPP seem to have similar rates of major morbidity, although the profile of complications is different and more severe after EPP. Freedom from recurrence is comparable in both groups whereas improved overall survival needs to be confirmed in a large patient group with longer follow-up.</span>
      PubDate: 2017-02-10
  • Does perioperative chemotherapy improve survival in patients with
           resectable lung metastases of colorectal cancer?
    • Authors: Guerrera F; Falcoz P, Renaud S, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Summary</div>A best evidence topic was constructed according to a structured protocol. The question addressed was whether the administration of perioperative chemotherapy (CT) is effective in improving survival in patients with resectable lung metastases of colorectal cancer (CRC). Of the 44 papers found using a report search, 6 investigated the effect of perioperative CT (adjuvant-CT, preoperative-CT or both) on outcomes in patients undergoing lung metastasectomy for CRC. These 6 studies presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. Overall, none of the studies were successful in demonstrating that CT had an independent effect on overall survival in patients undergoing lung resection surgery for CRC metastasis. Indeed, beneficial outcomes have been shown in particular sub-groups of patients: multiple metastases, metachronous lung metastasis, low-risk patients, particular molecular marker expression and oxaliplatin-based regimen. All the studies indicated a benefit in disease-free survival or progression-free survival. Administration of tailored perioperative CT might be effective after an accurate patient selection. We conclude that the current evidence does not support the administration of unselective perioperative CT in patients with resectable lung metastases of colorectal cancer.</span>
      PubDate: 2017-02-10
  • Does cervical lymph node recurrence after oesophagectomy or definitive
           chemoradiotherapy for thoracic oesophageal squamous cell carcinoma benefit
           from salvage treatment?
    • Authors: Yuan X; Lv J, Dong H, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Summary</div>A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was ‘Does cervical lymph node recurrence after oesophagectomy or definitive chemoradiotherapy for thoracic oesophageal squamous cell carcinoma benefit from salvage treatment?’ Altogether, 659 articles were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these articles were tabulated. All were retrospective or institutional reports. Seven of the 8 articles suggested that cervical lymphadenectomy (LD) or multimodal treatment with LD and radiotherapy (RT)/chemoradiotherapy (CRT) was associated with good outcomes in patients with cervical lymph node (LN) recurrence after curative oesophagectomy for thoracic oesophageal squamous cell carcinoma (ESCC). Salvage cervical LD was the main treatment and could achieve locoregional disease control and prolonged survival. It was safe with no postoperative mortality, although minor LD complications such as recurrent laryngeal nerve palsy were observed. Most reports highlighted that a solitary cervical LN relapse after curative oesophagectomy could be considered a good prognostic indicator for salvage cervical LD or multimodal treatment. Patients with microscopic residual tumour after salvage cervical LD or suspected extensive metastasis might benefit from a combination of LD and CRT. One article described salvage RT alone, again with a positive effect on survival. Conversely, data suggested that salvage LD in patients after definitive CRT for thoracic ESCC was not likely to control locoregional disease.</span>
      PubDate: 2017-02-10
  • Coil embolization for pulmonary artery injury caused by chest tube
    • Authors: Shigefuku S; Kudo Y, Saguchi T, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div>Pulmonary artery injury caused by chest tube drainage is rare, but it requires prompt diagnosis to perform urgent surgical repair. We report that a 53-year-old man who suffered from pulmonary artery injury by chest tube drainage was successfully treated by coil embolization.</span>
      PubDate: 2017-02-10
  • Pathological investigation of graft-related oesophageal fistula
    • Authors: Yamamoto M; Nishimori H, Iguchi M, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div>Oesophageal fistulae after thoracic endovascular aneurysm repair (TEVAR) for thoracic aortic aneurysm (TAA) have been reported, although the causes are unknown. One hypothesis is that the structural configuration of the aortic aneurysm, as it protrudes towards the oesophagus, may affect oesophageal fistula formation. The pathological findings of an oesophageal fistula following TEVAR are reviewed here. This report presents the case of a 68-year-old man with a stent graft-related oesophageal fistula after TEVAR for TAA. The oesophageal fistula suddenly appeared on the 11th day after TEVAR, and oesophagectomy was performed, without stent graft extirpation. The pathological findings showed neutrophil infiltration from the adventitia to the mucosa and congestion in the capillaries of the oesophageal wall around the site of penetration and no bacterial infection. There have been reports with logical hypotheses about the causes of stent graft-related oesophageal fistulae. Our pathological findings support the theory that pressure necrosis or ischaemic insult by physical compression of a rigid thrombosed aneurysm may result in fistula formation. For descending aortic aneurysms that protrude toward the oesophagus, caution must be exercised to prevent oesophageal fistula formation after TEVAR.</span>
      PubDate: 2017-02-10
  • Left video-assisted thoracoscopic surgery for hemidiaphragm traumatic
           rupture repair
    • Authors: Nardini M; Jayakumar S, Elsaegh M, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div>Diaphragmatic laceration is not a rare condition after blunt thoraco-abdominal trauma following road traffic accidents. Diagnosis is sometime difficult and clinical presentation devious. Video-assisted thoracic surgery is a safe approach in order to confirm diagnosis and treat, like in this this case of an 86-year-old lady with grade IV injury.</span>
      PubDate: 2017-02-10
  • First experience with transfemoral transcatheter aortic valve implantation
           without prior balloon pre-dilatation using a latest generation
           repositionable and retrievable transcatheter heart valve†
    • Authors: Schaefer A; Harmel E, Seiffert M, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES</strong>: The aim of this study was to prove technical feasibility and document haemodynamic and clinical outcomes of transcatheter aortic valve implantation (TAVI) with the latest generation repositionable and retrievable Lotus™ transcatheter heart valve (THV) without prior balloon-aortic valvuloplasty (BAV). It has been demonstrated for self-expandable and balloon-expandable THV that implantation without prior BAV is not only feasible and safe but also results in lower fluoroscopy times and amounts of contrast agent while yielding non-inferior haemodynamic and clinical outcome. To date no reports exist for TAVI without BAV for the Lotus™ THV.<strong>METHODS</strong>: A consecutive patient series received direct transfemoral (TF)-TAVI without prior BAV using the Lotus™ valve system. Baseline, intraprocedural and acute follow-up data up to 30 days were retrospectively collected. Clinical endpoints were adjudicated in accordance with the updated standardized Valve Academic Research Consortium (VARC)-2 definitions.<strong>RESULTS</strong>: A total of 9 patients received direct TF-TAVI using the Lotus THV (77.7% female, 82.5 ± 5.3 years, logistic European System for Cardiac Operative Risk Evaluation I 14.2 ± 13.7%). Device success according to VARC-2 definitions was achieved in 100% (9/9) of the patients. Peak and mean transvalvular gradients as determined by transthoracic echocardiography prior to discharge decreased from 51.5 ± 17.3 to 24.4 ± 10.4 mmHg and 29.5 ± 9.6 to 13.2 ± 5.2 mmHg (both <span style="font-style:italic;">P </span><<span style="font-style:italic;"> </span>0.01). Effective orifice area increased from 0.9 ± 0.2 to 1.9 ± 0.3 cm<sup>2</sup> (<span style="font-style:italic;">P </span><<span style="font-style:italic;"> </span>0.01). No paravalvular leakage (PVL) ≥ moderate was detected. All-cause 30-day mortality was 11.1% (1/9), with one death due to ischaemic enteritis.<strong>CONCLUSIONS</strong>: In our series, TF-TAVI without prior BAV using this particular THV technical feasibility, no increased incidence of significant paravalvular leakage, and good haemodynamic and clinical outcome in selected patients. These results will have to be confirmed in larger patient numbers for further clinical evaluation and before general recommendations regarding patient selection can be made.</span>
      PubDate: 2017-02-06
  • Spinal cord protection during thoracoabdominal aortic replacement: spinal
           cord perfusion maintenance
    • Authors: Uchino G; Yunoki K, Sakoda N, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> Spinal cord protection during thoracoabdominal aortic surgery is challenging for surgeons. We performed thoracoabdominal replacement using a strategy for maintaining spinal cord perfusion pressure. Here, we report our experience with this procedure and the surgical outcomes.<strong>METHODS:</strong> Between January 2000 and December 2014, 130 patients [male: 91 (74.6%), female: 39 (25.4%); mean age: 66.6 ± 12.8 years] underwent thoracoabdominal replacement using cardiopulmonary bypass at Hiroshima Shimin Hospital, Japan. The surgical outcomes of these patients were analysed.<strong>RESULTS:</strong> The in-hospital mortality rate of all patients was 2.5%. The incidence of postoperative paraplegia was 3.8%. Aortic event-free survival rates at 1, 3 and 5 years were 98.2%, 93.9% and 80.7%, respectively.<strong>CONCLUSIONS:</strong> The present study suggests that our strategy for maintaining spinal cord perfusion pressure provides acceptable outcomes.</span>
      PubDate: 2017-02-06
  • Is the thoracic aorta a safe site for the proximal anastomosis for
           bypassing the mesenteric arteries in patients with chronic mesenteric
    • Authors: Barr J; Kokotsakis J, Velissarios K, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Summary</div>A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether the thoracic aorta is a safe site for the proximal anastomosis when bypassing the mesenteric arteries in patients with chronic mesenteric ischaemia. Five articles reported the use of the thoracic aorta as the site of proximal anastomosis in 35 patients with chronic mesenteric ischaemia. All of these studies were retrospective case reports or case series. The ascending aorta was the site for the proximal anastomosis in 7 patients with the descending thoracic aorta being used in the other 28 patients. The ascending aorta was used when there was disease of the descending thoracic aorta. Out of the 35 patients there was only 1 perioperative death (3%). Rates of graft patency and freedom from recurrent symptoms were excellent. The published literature supports the use of the thoracic aorta as an option for the site of the proximal anastomosis when bypass from elsewhere is not possible.</span>
      PubDate: 2017-02-06
  • Simultaneous arterial switch and totally anomalous pulmonary venous
           connection repair in a 5-hour-old child, complicated by pulmonary venous
    • Authors: Mykychak Y; Fedevych O, Maksymenko A, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div>A 5-hour-old boy underwent arterial switch operation and totally anomalous pulmonary venous connection repair. Subsequently developed severe pulmonary venous stenosis was successfully treated with hybrid balloon angioplasty.</span>
      PubDate: 2017-02-03
  • Perioperative outcomes of off-pump minimally invasive coronary artery
           bypass grafting with bilateral internal thoracic arteries under direct
    • Authors: Kikuchi K; Chen X, Mori M, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> We previously introduced techniques to harvest and use the right internal thoracic artery in minimally invasive coronary artery bypass grafting (CABG) via a single left thoracotomy for revascularization with bilateral internal thoracic arteries (BITA). We report our short-term outcomes of patients who underwent minimally invasive CABG using BITA and a single internal thoracic artery (SITA).<strong>METHODS:</strong> Consecutive patients who underwent minimally invasive CABG using BITA or SITA at a Japanese medical center between February 2012 and December 2015 were reviewed retrospectively. Preoperative, intraoperative and 30-day postoperative outcomes were analysed. Perioperative data for the SITA cohort is presented to provide a context in which the outcomes of the BITA cohort can be evaluated.<strong>RESULTS:</strong> A total of 25 and 37 patients underwent BITA and SITA revascularization, respectively. The mean duration of the operation was longer in the BITA group than in the SITA group (265 ± 104 vs 336 ± 73 min). There were no deaths in the BITA group and one death in the SITA group. There were no strokes in either cohort, and new haemodialysis was required in one patient in each group. All BITA grafts were harvested without major complications and were all patent on computed tomography angiograms 1 week following the operations.<strong>CONCLUSIONS:</strong> BITA can be safely harvested in a reproducible manner under direct vision via a small left thoracotomy. The potential advantages of minimally invasive CABG using BITA, although yet to be established, include a long-term survival benefit conferred by BITA grafts and elimination of the risk of sternal wound infection, in addition to the established advantages of minimally invasive coronary artery surgery. This approach has the potential for further optimization with hybrid revascularization strategies.</span>
      PubDate: 2017-01-31
  • Apical closure device for full-percutaneous transapical valve
           implantation: stress-test in an animal model†
    • Authors: Ferrari E; Demertzis S, Angelella J, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> Transapical valve implantation is traditionally performed through a left antero-lateral mini-thoracotomy. A self-expandable apical closure device has recently been developed for full-percutaneous transapical valve implantation. We performed haemodynamics stress-tests on an animal model to evaluate the sealing properties.<strong>METHODS:</strong> Under general anaesthesia 5 pigs (mean weight: 67 ± 6 Kg) received full heparinization (100 IU/Kg; activated clotting time >250 s and, through inferior mini-sternotomies, 21-Fr introducer sheaths for transapical aortic valve implantation (outer diameter: 25-Fr) were placed over-the-wire in the apexes. Delivery-catheters carrying folded occluders (SAFEX<sup>TM</sup> final design) were inserted in the introducer sheaths and plugs were then deployed under fluoroscopic guidance. Phase 1: after protamine injection, apical bleeding was monitored for 1 h with standard haemodynamics condition. Phase 2: we induced systemic hypertension with adrenaline infusion to test the sealing properties under stress. Animals were sacrificed after Phase 2 and hearts were removed and inspected.<strong>RESULTS:</strong> Five plugs were successfully introduced and deployed in 5 pig hearts. Plugs provided good apical sealing in each animal and a mean of 7 ± 4 ml of blood lost per animal was collected during Phase 1: haemodynamics remained stable and no plug dislodgement was detected (mean blood pressure: 52 ± 9 mmHg). During Phase 2, mean systolic and diastolic peak levels reached 268 ± 24 mmHg and 175 ± 17 mmHg, respectively, without plug dislodgment or bleeding. Post-mortem inspection showed good plug deployment and fixation without myocardial damage.<strong>CONCLUSIONS:</strong> The new apical occluder seals large-sized apical access sites in animal models also during induced systemic hypertension. This pilot study is a further step towards full-percutaneous transapical valve procedures in the clinical setting.</span>
      PubDate: 2017-01-31
  • Resection rate and operability of elderly patients with non-small cell
           lung cancer: Nationwide study from 1991 to 2014
    • Authors: Baldvinsson K; Oskarsdottir G, Orrason A, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> An increasing number of elderly patients are diagnosed with non-small cell lung cancer (NSCLC). We compared the surgical resection rate, operability and survival in this age group (≥75 years) to younger patients using centralized databases in Iceland.<strong>METHODS:</strong> The study population comprised all patients diagnosed with NSCLC in Iceland from 1991 to 2014. A total of 140 elderly patients (≥75 years) with NSCLC underwent pulmonary resection and were compared with 550 surgically resected patients less than 75 years, with respect to resection rate, short and long-term survival and complications of surgery. Reasons for exclusion from surgery were registered for elderly surgical candidates (stages IA–IIB).<strong>RESULTS:</strong> Surgical resection rate in the elderly group was 18% compared to 32% in the younger age group (<span style="font-style:italic;">P < </span>0.001). The most frequent reasons for not operating on elderly patients in stages IA–IIB were poor pulmonary function (58%), heart disease (17%) or multiple comorbidities (17%). The rate of major complications following surgery was comparable in the elderly versus the younger age group, 13 vs 11%, respectively (<span style="font-style:italic;">P =</span> 0.578). The same was true for 30 day mortality (2 vs 1%, <span style="font-style:italic;">P = </span>0.397). Five-year overall survival was 40% vs 44% (<span style="font-style:italic;">P = </span>0.019) and cancer-specific survival 51% vs 50% (<span style="font-style:italic;">P = </span>0.802).<strong>CONCLUSIONS:</strong> Elderly patients with resectable NSCLC according to stage are frequently excluded from surgery due to comorbid conditions. Although the operated patients may represent a selected group, their favourable 30-day and long-term survival indicate that more elderly patients with NSCLC could be operated on.</span>
      PubDate: 2017-01-31
  • A ferromagnetic surgical system reduces phrenic nerve injury in redo
           congenital cardiac surgery
    • Authors: Shinkawa T; Holloway J, Tang X, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div>A ferromagnetic surgical system (FMwand<sup>®</sup>) is a new type of dissection device expected to reduce the risk of adjacent tissue damage. We reviewed 426 congenital cardiac operations with cardiopulmonary bypass through redo sternotomy to assess if this device prevented phrenic nerve injury. The ferromagnetic surgical system was used in 203 operations (47.7%) with regular electrocautery and scissors. The preoperative and operative details were similar between the operations with or without the ferromagnetic surgical system. The incidence of phrenic nerve injury was significantly lower with the ferromagnetic surgical system (0% vs 2.7%, <span style="font-style:italic;">P </span>=<span style="font-style:italic;"> </span>0.031). A logistic regression model showed that the use of the ferromagnetic surgical system was significantly associated with reduced odds of phrenic nerve injury (<span style="font-style:italic;">P </span><<span style="font-style:italic;"> </span>0.001). </span>
      PubDate: 2017-01-31
  • Bow Hunter syndrome elicited by vertebral arterial occlusion after total
           arch replacement
    • Authors: Kitahara H; Takeda T, Akasaka K, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div>An 83-year-old man with arch aneurysm underwent total arch replacement with frozen elephant trunk and extra-anatomical left subclavian artery bypass. One year later, he felt dizziness associated with head rotation. The hypoplastic left vertebral artery was occluded by a thrombus extending from the left subclavian artery ligation site, and the dynamic stenosis of right vertebral artery by head rotation induced dizziness. He was diagnosed with Bow Hunter syndrome. Vertebral artery hypoplasia represents a possible cause of this rare complication. To the best of our knowledge, this is the first report describing Bow Hunter syndrome after total arch replacement.</span>
      PubDate: 2017-01-31
  • Coronary sinus injury resulting from endarterectomy during multivessel
           bypass surgery
    • Authors: Akay MH; Patel MK, Gregoric ID.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div>Coronary sinus injury is a very rare complication of cardiac surgery and is usually related to coronary sinus perfusion catheter placement for retrograde cardioplegia infusion. It can be either a catheter-related perforation or high-perfusion pressure-related injury to the coronary sinus. Primary repair of the coronary sinus or over-sewing are two possible options to resolve this complication. Decellularized extracellular matrix from porcine intestinal submucosa is widely used as an approved material for repairing cardiac structures. We report a case of coronary sinus stenosis resulting from coronary artery endarterectomy during multivessel coronary artery bypass surgery, causing injury to the proximal part of the middle cardiac vein (MCV). Closure of the MCV resulted in a coronary sinus obstruction that was bypassed with a CorMatrix tube graft from the coronary sinus of the MVC to the right atrium.</span>
      PubDate: 2017-01-30
  • eComment. Descendo-bifemoral bypass grafting with renal revascularization
           for complex obliterative arteriopathy
    • Authors: Mouawad NJ.
      Abstract: <span class="paragraphSection">I read with great interest the article by Kondov and colleagues on the management of complex reno-visceral aortic disease with associated obliterative arteriopathy [<a href="#ivx084-B1" class="reflinks">1</a>]. The authors describe a case series of 3 individuals who were ultimately managed with antegrade descendo-thoraco-bifemoral bypass and either synchronous or metachronous renal revascularization. I commend the authors on excellent outcomes including freedom from claudication with exertion, an amelioration in hypertension control, a decrease in creatinine levels and renal insufficiency as well as the resolution of haemodialysis needs in 1 patient.</span>
      PubDate: 2017-01-25
  • Descendo-bifemoral bypass grafting and renal artery revascularization to
           treat complex obliterative arteriopathy
    • Authors: Kondov S; Rylski B, Kari F, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES</strong>: Our goal was to describe a new standardized approach in patients with extensive obliterative arteriopathy aimed at distal revascularization and surgical kidney recruitment via descendo-bifemoral bypass grafting and renal artery revascularization.<strong>METHODS</strong>: Three patients with Leriche’s syndrome and either a compromised single kidney or unilateral significant renal artery stenosis were treated with a standardized surgical approach, restoration of distal perfusion via descendo-bifemoral bypass with synchronous (<span style="font-style:italic;">n</span> = 2) left-sided renal artery revascularization or metachronous (<span style="font-style:italic;">n</span> = 1) right-sided renal artery revascularization.<strong>RESULTS</strong>: The intended surgical aim was achieved successfully in all 3 cases. All patients showed a decline in serum creatinine levels. One patient who needed substitution therapy was free from dialysis 3 months after surgery. Additionally, blood pressure management was substantially reduced because uncontrolled peak systolic episodes were no longer observed and pharmacotherapeutic agents could be partially withdrawn.<strong>CONCLUSIONS</strong>: Distal revascularization and surgical kidney recruitment via descendo-bifemoral bypass and renal artery revascularization is a promising option to treat complex obliterative arteriopathy.</span>
      PubDate: 2017-01-25
  • Coronary artery bypass surgery in young adults: excellent perioperative
           results and long-term survival
    • Authors: Saraiva J; Antunes PE, Antunes MJ.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES</strong>: To analyse perioperative results, long-term survival and freedom from complications after coronary artery bypass grafting (CABG) in young adults.<strong>METHODS</strong>: A total of 163 patients, 40 years old or younger, had isolated CABG from January 1989 to December 2010. Pre- and perioperative demographic and clinical data were retrieved from a prospectively organised database. Follow-up data were obtained by letter or telephone interviews. The mean age of the patients was 37.6 ± 2.9 years and 146 were men (90%). Fifty-three patients (32.5%) had angina class III/IV; 106 (65.0%), previous myocardial infarction; and 23 (14.1%), impaired left ventricular function (ejection fraction <40%). Indication for surgery was 3-vessel disease in 101 cases (62.0%), 2-vessel disease in 30 (18.4%) and single-vessel disease in 32 (19.6%). The left main stem was affected in 16 patients (9.8%). The mean EuroSCORE II was 0.92 ± 0.71. A total of 417 grafts were constructed (mean 2.6 grafts/patient), 247 of which (59.2%) were arterial.<strong>RESULTS</strong>: There were no in-hospital deaths. The mean hospital stay was 7.1 ± 4.0 days. Four patients (2.5%) were lost to follow-up, which extended from 3 to 25 years (mean 15.1 ± 5.5 years). There were 22 late deaths, 72.7% of cardiac or unknown origin. The 5-, 10- and 20-year survival rates were 98.7 ± 10.9, 95.2 ± 1.8 and 79.4 ± 4.4%, respectively. Twenty-six patients (18.1%) had non-fatal cardiac adverse complications (myocardial infarct, percutaneous re-revascularization or class III/IV angina), for 5-, 10- and 20-year freedom from complications of 97.9 ± 1.2, 91.9 ± 2.5 and 65.7 ± 7.1%, respectively. Twenty-two patients (17.5%) needed re-revascularization, for 5-, 10- and 20-year freedom from re-revascularization of 97.6 ± 1.4, 91.9 ± 2.6 and 69.5 ± 6.7%, respectively.<strong>CONCLUSIONS</strong>: Despite the aggressive nature of coronary artery disease in young patients, perioperative death and morbidity rates are low, with good long-term survival and low rates of re-revascularization.</span>
      PubDate: 2017-01-25
  • Caveolin 2: a facultative marker of unfavourable prognosis in long-term
           patency rate of internal thoracic artery grafts used in coronary artery
           bypass grafting. Preliminary report
    • Authors: Malinska A; Podemska Z, Sujka-Kordowska P, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> Intimal hyperplasia leading to graft failure in patients undergoing coronary artery bypass grafting (CABG) is related to vascular smooth muscle cells (SMCs) proliferation. SMCs respond to a variety of mediators, the most important of which is platelet-derived growth factor (PDGF). The platelet-derived growth factor-induced cellular response has been shown to be mediated by caveolins. The aim of this study was to analyze CAV1-3 expression in internal thoracic artery (ITA) grafts used in CABG and correlate their expression with graft occlusion.<strong>METHODS:</strong> Six hundred patients undergoing CABG with the use of ITA grafts between 2008 and 2014 were enrolled into this prospective study. CAV1-3 expression in the ITA grafts was analyzed prior to graft transplantation into the coronary circulation via immunohistochemistry. Estimated caveolins expression pattern was then correlated with the occurrence of ITA graft failure observed within 24-months of surgery.<strong>RESULTS:</strong> Thirty-four patients developed ITA graft failure (subgroup A) and 566 study participants presented no adverse events (subgroup B). CAV1 and CAV3 expression levels in SMCs of the tunica media of the ITA grafts did not differ between the study subgroups and were not associated with the risk of graft failure. CAV2 was expressed within SMCs of the ITA grafts in 94.1% of the patients from subgroup A and 2.5% from subgroup B, and its expression was associated with ITA graft occlusion observed within 24-months after CABG.<strong>CONCLUSIONS:</strong> CAV2 expression in SMCs of the tunica media in autologous ITA transplants might indicate the risk of graft failure.</span>
      PubDate: 2017-01-25
  • Early to mid-term results after total cavopulmonary connection performed
           in the second decade of life
    • Authors: Metras A; Fouilloux V, Al-Yamani M, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> Total cavopulmonary connection (TCPC) performed in the second decade of life has rarely been studied. Thus, we investigated (bicentric study) early and late morbidity and mortality following completion of TCPC in these patients.<strong>METHODS:</strong> From January 1999 to June 2014, 63 patients (14.5 ± 2.9 years) underwent TCPC (extracardiac conduit). Palliation before completion was an isolated bidirectional cavopulmonary shunt (BCPS) in 3 patients or BCPS associated with additional pulmonary blood flow (APBF) that was either antegrade (Group 1) in 38 (63%) or retrograde (Group 2) in 22 (37%). Preoperative and perioperative data were reviewed retrospectively.<strong>RESULTS:</strong> Mean pulmonary arterial and ventricular end-diastolic pressures were 12.2 and 9.2 mmHg, respectively. Mean Nakata index was 279 ± 123 and 228 ± 87 mm<sup>2</sup>/m<sup>2</sup> in Groups 1 and 2, respectively (<span style="font-style:italic;">P </span>=<span style="font-style:italic;"> </span>0.01). Aortic cross-clamping was performed in 22 from Group 1 and 8 from Group 2 (<span style="font-style:italic;">P </span>=<span style="font-style:italic;"> </span>0.04). Mean follow-up was 4.57 years [0.8–15]. Nine patients had prolonged stays in the intensive care unit (>6 days). There were 1 early and 2 late deaths (non-cardiac related). Actuarial survival was 96% at 4 years. At last follow-up, single-ventricle function remained normal or improved in all patients (Group 1) compared to 82% in Group 2 (<span style="font-style:italic;">P </span>=<span style="font-style:italic;"> </span>0.02). New York Heart Association (NYHA) class had improved in both groups: 47 patients were NYHA class II and 16 class III preoperatively vs 50 class I and 10 class II postoperatively (<span style="font-style:italic;">P </span><<span style="font-style:italic;"> </span>0.001).<strong>CONCLUSIONS:</strong> Single-ventricle palliation with BCPS and APBF allowed completion of TCPC in the second decade of life, with encouraging mid-term results. However, BCPS with retrograde APBF was associated with single-ventricle dysfunction: thus, this technique needs to be used cautiously as long-lasting palliation.</span>
      PubDate: 2017-01-25
  • Blood flow competition after aortic valve bypass: an evaluation using
           computational fluid dynamics
    • Authors: Kawahito K; Kimura N, Komiya K, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> Aortic valve bypass (AVB) (apico-aortic conduit) remains an effective surgical alternative for patients in whom surgical aortic valve replacement or transcatheter aortic valve implantation is not feasible. However, specific complications include thrombus formation, possibly caused by stagnation arising from flow competition between the antegrade and retrograde flow, but this has not been fully investigated. The aim of this study was to analyse flow characteristics after AVB and to elucidate mechanisms of intra-aortic thrombus using computational fluid dynamics (CFD).<strong>METHODS:</strong> Flow simulation was performed on data obtained from a 73-year-old postoperative AVB patient. Three-dimensional cine phase-contrast magnetic resonance imaging at 3 Tesla was used to acquire flow data and to set up the simulation. The vascular geometry was reconstructed using computed tomography angiograms. Flow simulations were implemented at various ratios of the flow rate between the ascending aorta and the graft. Results were visualized by streamline and particle tracing.<strong>RESULTS:</strong> CFD demonstrated stagnation in the ascending aorta-arch when retrograde flow was dominant, indicating that the risk of thrombus formation exists in the ascending arch in cases with severe aortic stenosis and/or poor left ventricular function. Meanwhile, stagnation was observed in the proximal descending aorta when the antegrade and retrograde flow were equivalent, suggesting that the descending aorta is critical when aortic stenosis is not severe.<strong>CONCLUSIONS:</strong> Flow stagnation in the aorta which may cause thrombus was observed when retrograde flow was dominant and antegrade/retrograde flows were equivalent. Our results suggest that anticoagulants might be recommended even in patients who receive biological valves.</span>
      PubDate: 2017-01-24
  • Impact of gender on long-term outcomes after surgical repair for acute
           Stanford A aortic dissection: a propensity score matched analysis†
    • Authors: Sabashnikov A; Heinen S, Deppe A, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> Previous research suggests that female gender is associated with increased mortality rates after surgery for Stanford A acute aortic dissection (AAD). However, women with AAD usually present with different clinical symptoms that may bias outcomes. Moreover, there is a lack of long-term results regarding overall mortality and freedom from major cerebrovascular events. We analysed the impact of gender on long-term outcomes after surgery for Stanford A AAD by comparing genders with similar risk profiles using propensity score matching.<strong>METHODS:</strong> A total of 240 patients operated for Stanford A AAD were included in this study. To control for selection bias and other confounders, propensity score matching was applied to gender groups.<strong>RESULTS:</strong> After propensity score matching, the gender groups were well balanced in terms of risk profiles. There were no statistically significant differences regarding duration of cardiopulmonary bypass (<span style="font-style:italic;">P</span> = 0.165) and duration of aortic cross-clamp time (<span style="font-style:italic;">P</span> = 0.111). Female patients received less fresh frozen plasma (<span style="font-style:italic;">P</span> = 0.021), had shorter stays in the intensive care unit (<span style="font-style:italic;">P</span> = 0.031), lower incidence of temporary neurological dysfunction (<span style="font-style:italic;">P</span> < 0.001) and lower incidence of dialysis (<span style="font-style:italic;">P</span> = 0.008). There were no significant differences regarding intraoperative mortality (<span style="font-style:italic;">P</span> = 1.000), 30-day mortality (<span style="font-style:italic;">P</span> = 0.271), long-term overall cumulative survival (<span style="font-style:italic;">P</span> = 0.954) and long-term freedom from cerebrovascular events (<span style="font-style:italic;">P</span> = 0.235) with up to a 9-year follow-up.<strong>CONCLUSIONS:</strong> Considering patients with similar risk profiles, female gender per se is not associated with worse long-term survival and freedom from stroke after surgical aortic repair. Moreover, female patients might even benefit from a smoother early postoperative course and lower incidence of early postoperative complications.</span>
      PubDate: 2017-01-23
  • Closing the gap in paediatric ventricular assist device therapy with the
           Berlin Heart EXCOR® 15-ml pump†
    • Authors: De Rita F; Griselli M, Sandica E, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> The Berlin Heart EXCOR<sup>®</sup> (EXCOR) paediatric ventricular assist device is used worldwide for mechanical support of infants and small children with end-stage heart failure. A clinically important gap between the smallest EXCOR blood pump (10 ml) and the next larger size (25 ml) limited the choice of pump size in patients with a body surface area (BSA) between 0.33 and 0.5 m<sup>2</sup>. We present the first clinical experience from the early product surveillance (EPS) of the new EXCOR 15-ml blood pump.<strong>METHODS:</strong> After CE and U.S. Food and Drug Administration approval in January 2013, 20 patients with a mean age of 1.6 years (range 0.5–3.5 years) and a mean BSA of 0.45 m<sup>2</sup> (range 0.33–0.59 m<sup>2</sup>) were enrolled in the EPS. The main diagnosis was idiopathic cardiomyopathy in 13 patients; the majority (<span style="font-style:italic;">n = </span>16) of children were in INTERMACS level 1 or 2. Data from high-volume paediatric transplant centres were collected prospectively for a defined follow-up period of 60 days after device implantation.<strong>RESULTS:</strong> Mean time on the EXCOR 15-ml blood pump was 43 days; the survival rate was 100% at the end of the EPS period. Seven patients underwent a heart transplant from the device; 2 children were weaned; and 11 patients remained on support. Infection of cannula exit sites occurred in 3 patients. Two patients had minor thromboembolic strokes but made a complete neurological recovery.<strong>CONCLUSIONS:</strong> The new EXCOR 15-ml blood pump demonstrated optimal ventricular assist device support of children with a BSA of 0.33–0.5 m<sup>2</sup>.</span>
      PubDate: 2017-01-23
  • Triple valve surgery through a less invasive approach: early and mid-term
    • Authors: Risteski P; Monsefi N, Miskovic A, et al.
      Abstract: <span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>OBJECTIVES:</strong> A partial upper sternotomy has become established as a less invasive approach mainly for single and double valve surgery. This report evaluates the clinical outcomes of triple valve surgery performed through a partial upper sternotomy.<strong>METHODS:</strong> We reviewed the medical records of 37 consecutive patients (28 men, 76%) who underwent triple valve surgery through a partial upper sternotomy between 2005 and 2015. The patients’ mean age was 67 ± 17 years; 27 (73%) were in New York Heart Association Class III or IV. Aortic and mitral valve insufficiency was more common than stenosis. Ninety-three percent of surviving patients were followed for a mean period of 58 ± 24 months.<strong>RESULTS:</strong> Aortic valve procedures consisted of 24 (65%) replacements and 13 (35%) repairs. The mitral valve was repaired in 28 (76%) patients, whereas tricuspid valve repair was feasible in all patients. No conversion to full sternotomy was necessary. Myocardial infarction was not observed. Chest tube drainage was 330 ± 190 ml, and 4 patients required reopening for bleeding (1, 3%) or tamponade (3, 8%). One stroke was observed due to heparin-induced thrombocytopaenia after initial unremarkable neurological recovery. Early mortality included 5 (13.5%) patients. Actuarial survival at 5 years was 52 ± 10%.<strong>CONCLUSIONS:</strong> A partial upper sternotomy provides adequate exposure to all heart valves. We did not experience technical limitations with this approach. Wound dehiscence, postoperative bleeding, intensive care unit and hospital stay and early deaths were low compared to data from other published series of triple valve surgery through a full median sternotomy. Early and mid-term outcomes were not adversely affected by this less invasive approach.</span>
      PubDate: 2017-01-21
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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