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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: 59, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 84, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 15, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 129, 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: 158, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 21, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 15)
American J. of Legal History     Full-text available via subscription   (Followers: 4, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 27, 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: 47, 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: 21)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 12)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 27, 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: 48, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 300, 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: 142, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 67, 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: 34, 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: 517, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 81, 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: 27)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 3, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 56, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 11, 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: 40, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 17, 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: 21, 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: 60, 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: 7, 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: 14, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 56, 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: 13, 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: 10, 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: 49, 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: 8, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 154, 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: 27, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 39, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 11, 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: 32, 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: 47, 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: 21, 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: 78, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 18, 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: 5, 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: 27)
Intl. Health     Hybrid Journal   (Followers: 5, 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: 129, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 4, 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: 30, 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: 37, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 18, 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: 13, 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: 43, 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: 12, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 41, 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: 36, 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: 18)
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: 3)
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]   [5 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. Neoadjuvant treatment for advanced thymomas: Is downstaging
           realistic when opting for thoracoscopic surgery'
    • Authors: Tampaki E; Tampakis A, Tomos P, et al.
      Abstract: We read with great interest the recent publication of Odaka and colleagues regarding open versus thoracoscopic thymectomy (TT). The authors provide stimulating arguments in favour of using thoracoscopic procedures also in patients with large-sized thymomas in terms of decreased invasiveness and feasibility [1], whereas they bring up excellent discussion topics on the subject.
      PubDate: 2017-06-23
  • eComment. Management of deep sternal wound infections after cardiac
           surgery: Towards development of new substrates for sustained multiagent
           delivery release profiles
    • Authors: Christina Tampakia E; Lardinois D, Tampakis A.
      Abstract: We read with great interest the recent publication of Martin and colleagues regarding topically applying 2 antibiotics in deep sternal wound infections (DSWI) of patients undergoing cardiac surgery [1].
      PubDate: 2017-06-23
  • eComment. The quest for elusive causative microbiological agents of
           infectious ascending aortitis
    • Authors: Mestrovic T.
      Abstract: Establishing a swift diagnosis of acute aortitis is cumbersome, challenging, and often delayed due to the non-specific and vague initial clinical presentation; therefore Saddoughi et al. should be congratulated for successfully tackling rarely encountered (and potentially fatal) infectious aortitis of the ascending aorta. Unfortunately, there was no identifiable aetiology in their report, although neutrophilic infiltrate within the aortal wall and other histopathological findings were highly suggestive of infectious origin.
      PubDate: 2017-06-23
  • eComment. Uniportal VATS: the great potential of the technique
    • Authors: Nachira D; Meacci E, Congedo M, et al.
      Abstract: We congratulate Stamenovic for his interesting paper [1] on a particular approach for diaphragmatic surgery.
      PubDate: 2017-06-23
  • Spotlight on recently published EJCTS articles
    • PubDate: 2017-06-23
  • Transfemoral aortic valve replacement prior to HeartMate II left
           ventricular assist device exchange
    • Authors: Sharma S; Tchantchaleishvili V, Briasoulis A, et al.
      Abstract: Ventricular assist deviceTransfemoral aortic valve replacement
      PubDate: 2017-04-18
  • Corrigendum to: “Glial fibrillary acidic protein plasma levels are
           correlated with degree of hypothermia during cardiopulmonary bypass in
           congenital heart disease surgery” [Interact CardioVasc Thorac Surg 2017]
    • Authors: Vedovelli L; Padalino M, D’Aronco S, et al.
      Abstract: The first author’s name was incorrect in the Funding paragraph. It has been corrected to: L. Vedovelli.
      PubDate: 2017-04-17
  • Double fixation for abdominal aortic aneurysm repair using AFX body and
           Endurant proximal aortic cuff: mid-term results
    • Authors: Matsagkas MI; Kouvelos G, Spanos K, et al.
      Abstract: Our goal was to evaluate the use of an AFX main body combined with an Endurant proximal aortic cuff to treat selected patients with an abdominal aortic aneurysm (AAA) associated with anatomical challenges, such as a small distal aortic diameter and a hostile aortic neck. A retrospective analysis of prospectively collected data from 2 vascular institutions identified 14 elective patients with an AAA (all men, 73.5 ± 5.1 years) treated with the AFX main body combined with an Endurant proximal aortic cuff. Patients had a small distal aortic diameter (median 19 mm) and a short or angulated proximal aortic neck (median length 20 mm, range 9–26 mm, median angulation 41.5°, range 23–80°). Six patients (42.9%) had an aortic neck that did not meet the indications for use of the AFX proximal aortic cuff. Primary technical success was achieved in all patients with no 30-day device-related complications or deaths. During a median follow-up period of 13 months (range 6-28 months), no re-intervention was needed. The diameter of the aneurysmal sac decreased from 57.6 ± 5.6 mm preoperatively to 50.4 ± 4.9 mm (P < 0.001) postoperatively. There were no aneurysm-related deaths or ruptures. No migration, disconnection or type I or III endoleak was observed. In 5 of the 6 patients, the initial type II endoleak spontaneously resolved during follow-up, whereas that in the remaining patient persisted without any change in the diameter of the aneurysmal sac. In patients with complex AAA anatomical configurations combining a hostile aortic neck and a narrow aortic bifurcation, the use of an AFX main body combined with an Endurant proximal aortic cuff seems to be feasible with favourable mid-term results.
      PubDate: 2017-04-17
  • Cardiac autotransplantation for repair of left ventricular rupture after
           mitral valve replacement
    • Authors: Ni B; Zheng X, Zhang S, et al.
      Abstract: Left ventricular rupture is an infrequent but potentially fatal complication of mitral valve replacement. Here, we report a case of large posterior mid-ventricular rupture following mitral valve replacement, which was successfully treated by a sandwich style repair and autotransplantation.
      PubDate: 2017-04-17
  • Native aortic valve thrombosis in patient with protein S deficiency
    • Authors: Masaki N; Ogasawara T, Matsuki K.
      Abstract: Native aortic valve thrombosis is an extremely rare condition, the causes of which include previous aortic valve diseases, endocarditis, valvular injury by a catheter intervention and an underlying hypercoagulative state. Its diagnosis is important for preventing life-threatening embolic complications. Here, we report a case of native aortic valve thrombosis and recurrent systemic embolism in a patient with protein S deficiency, a disorder associated with a hypercoagulative state.
      PubDate: 2017-04-16
  • Short-term mechanical circulatory support for cardiogenic shock in severe
           peripartum cardiomyopathy: La Pitié-Salpêtrière experience
    • Authors: Bouabdallaoui N; Demondion P, Leprince P, et al.
      Abstract: OBJECTIVES: Mechanical circulatory support (MCS) is a valuable option in the setting of cardiogenic shock (CS), although MCS use in severe forms of peripartum cardiomyopathy (PPCM) is underreported. We aimed to investigate maternal outcomes under MCS for refractory CS complicating PPCM.METHODS: We retrospectively reviewed 10 consecutive patients (2010–2015) meeting diagnosis criteria of PPCM that were managed with peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO) for severe CS.RESULTS: Median age was 29 years (range 20–36), and median left ventricular (LV) ejection fraction was 10% (range 5–30). All patients received femoro–femoral cannulation. All patients were implanted after delivery. Central rescue cannulation was considered in 5 patients in the setting of peripheral ECMO-related complications. Median peripheral support duration was 4 days (range 2–25), median central support duration was 51 days (range 9–180). Five patients died under central support. Three patients were successfully explanted after LV recovery, and 2 were successfully transplanted.CONCLUSIONS: Peripheral VA-ECMO, and prompt conversion to central rescue cannulation when necessary have to be considered in the management of severe cases of PPCM. Nevertheless, refractory CS in this specific population remains a life-threatening condition despite aggressive management.
      PubDate: 2017-04-16
  • Support of the aortic wall: a histological study in sheep comparing a
           macroporous mesh with low-porosity vascular graft of the same polyethylene
           terephthalate material
    • Authors: Van Hoof L; Verbrugghe P, Verbeken E, et al.
      Abstract: OBJECTIVES: Wrapping with various materials was an early treatment for aortic aneurysms. Wrapping with low-porosity vascular grafts has been associated with graft migration and vascular erosion. An alternative is to use a macroporous mesh (MPM) made of the same polymer (polyethylene terephalate). We compared the histological outcome 1 year after wrapping sheep aortas with low-porosity grafts versus MPM fabrics.METHODS: The 2 different fabrics were wrapped around the aorta of 3 sheep. After 1 year the aortas were excised. The 2 wrapped segments of aorta were compared with each other and control aorta. Histological examinations and measurements were made of the layers of the aortic wall in 36 prespecified locations in each of the 3 sheep.RESULTS: Both fabrics were consistently surrounded by foreign body reaction and well-vascularized fibrosis. This was more pronounced with the low-porosity vascular graft material which was poorly incorporated and caused buckling at the transition between wrapped and unwrapped aorta. Conversely, the MPM was fully incorporated, resulting in a composite mesh/biological aortic wall. There was reduction of medial thickness with both materials but it was locally more extreme due to the corrugations in the vascular graft material. The findings were consistent between sampled locations and were similar in the 3 animals.CONCLUSIONS: The different porosity and rigidity of the materials influences their incorporation into the aortic wall. The incorporation of the pliable MPM precludes the complications of migration and erosion which are seen after wrapping with low-porosity prosthetic vascular graft material.
      PubDate: 2017-04-16
  • Non-invasive assessment of cerebral oxygen metabolism following surgery of
           congenital heart disease
    • Authors: Neunhoeffer F; Sandner K, Wiest M, et al.
      Abstract: OBJECTIVES: Cerebral protection is a major issue in the treatment of infants with complex congenital heart disease. We tested a new device combining tissue spectrometry and laser Doppler flowmetry for non-invasive determination of cerebral oxygen metabolism following cardiac surgery in infants.METHODS: We prospectively measured regional cerebral oxygen saturation cSO2 and microperfusion (rcFlow) in 43 infants 12–24 h following corrective (n = 30) or palliative surgery (n = 13) of congenital heart defects. For comparison, cerebral blood flow (CBF) was determined by colour duplex sonography of the extracranial cerebral arteries. Cerebral fractional tissue oxygen extraction, approximated cerebral metabolic rate of oxygen (aCMRO2) and cerebral metabolic rate of oxygen (CMRO2) were calculated.RESULTS: cSO2 was lower [54.6% (35.7–64.0) vs 59.7% (44.5–81.7); P < 0.01] after neonatal palliation, while rcFlow [69.7 AU (42.5–165.3) vs 77.0 AU (41.2–168.1); P = 0.06] and cerebral fractional tissue oxygen extraction [0.34 (0.24–0.82) vs 0.38 (0.17–0.55); P = 0.63] showed a trend towards lower values. We found a positive correlation between aCMRO2 and CMRO2 (r = 0.27; P = 0.03). aCMRO2 was significantly lower after neonatal palliation [4.0 AU (2.1–6.3) vs 4.9 AU (2.2–15.6); P = 0.02].CONCLUSIONS: According to our experience, combined photospectrometry and laser Doppler flowmetry enable non-invasive assessment of cerebral oxygen metabolism. The method promises new insights into perioperative cerebral perfusion following palliation or corrective surgery in infancy.
      PubDate: 2017-04-16
  • Direct sternal administration of Vancomycin and Gentamicin during closure
           prevents wound infection †
    • Authors: Andreas M; Muckenhuber M, Hutschala D, et al.
      Abstract: OBJECTIVES: Deep sternal wound infection is still a major complication in patients undergoing cardiac surgery. We previously identified mammary artery harvesting as a risk factor for decreased antibiotic tissue penetration. In addition, other risk factors including diabetes may inhibit sufficient tissue penetration of perioperative antibiotic prophylaxis. A novel closure protocol applying 2 topical antibiotics and further recommendations for sternal wiring was introduced at our department to decrease the incidence of sternal wound infections.METHODS: A 12-month period prior to (March 2013–February 2014) and after (July 2014–June 2015) the introduction of a novel sternal closure protocol was studied. All sternal wound infections resulting from an operation during this period were analysed. The closure protocol consisted of the intra-sternal application of vancomycin and the subcutaneous application of gentamicin. Furthermore, we increased the number of sternal wires for more uniform distribution of lateral forces.RESULTS: Patients in both groups were comparable regarding demographic data and risk factors. Fifty-three out of 919 patients operated prior to the protocol change developed an infection (5.8%). The introduction of the novel sternal closure protocol reduced this number to 19 out of 932 patients (2.0%; P < 0.001). A binary regression including common risk factors revealed a strong independent risk reduction by the novel protocol (OR 0.322, P < 0.001). The number of sternal wires was not significant in this analysis.CONCLUSIONS: The topical application of 2 antibiotic agents significantly reduced sternal wound infection. However, the results of this trial should be confirmed in a randomized trial.
      PubDate: 2017-04-10
  • Long-term results of modified sandwich repair of aortic root in 151
           patients with acute type A aortic dissection
    • Authors: Tang Y; Liao Z, Han L, et al.
      Abstract: OBJECTIVES: Acute type A aortic dissection frequently induces aortic root disease; however, the optimal surgical strategy for aortic root dissection remains a challenge. The objective of this study was to introduce a novel technique for reconstruction of type A dissection to improve patient prognosis.METHODS: We performed a retrospective review of 791 consecutive patients with acute type A aortic dissection between January 2003 and July 2015. Among these patients, 151 were selected (72% men, age 51.7 ± 9.8 years) to have the modified sandwich repair of aortic root dissection.RESULTS: The in-hospital mortality rate of the 151 patients was 6.6% (10/151). During a mean follow-up period of 52.7 ± 28.6 months, the survival rate was 100, 89.1 and 69.7% at 1, 5 and 10 years, respectively. Echocardiography and computed tomographic angiography were performed every year to monitor the pathological change in the aortic root. Freedom from severe aortic regurgitation at 5 years was 100%. No patients required reintervention due to dissection or pseudoaneurysm of the proximal aortic root.CONCLUSIONS: Aortic valve resuspension and repair of the sinus of Valsalva with the modified sandwich technique using Teflon felt strips for acute type A dissection could be reliable and effective.
      PubDate: 2017-04-06
  • Open-square technique using a novel pre-cuffed, spiral-ringed conduit for
           the Norwood procedure
    • Authors: Ozawa T; Katayama Y, Shiono N, et al.
      Abstract: To avoid stenotic conduit events, 2 modifications were added to Norwood reconstruction with a right ventricle-to-pulmonary artery conduit: open-square insertion of a proximal conduit end and use of a pre-cuffed, spiral-ringed conduit. Three consecutive patients treated with this technique successfully underwent bidirectional Glenn with no stenotic events. These modifications are beneficial and safe.
      PubDate: 2017-04-06
  • Intima migration from the iliac artery to a debranched graft after
           thoracic endovascular aortic repair
    • Authors: Kihara K; Tashiro M, Nishimori H, et al.
      Abstract: An 84-year-old woman underwent single-debranched thoracic endovascular aortic repair for aortic aneurysm. A few hours later, malperfusion of the left upper extremity occurred. Surgical exploration revealed a tubular-shaped intima packed in the debranched graft. As computed tomography showed localized dissection in the right external iliac artery probably due to access route injury, the intima roll was thought to have migrated from the iliac artery. This extremely rare case is described in detail with a discussion of the potential mechanism.
      PubDate: 2017-04-06
  • Fatal case of accidental perforation of ileum by pace wires during
           coronary bypass grafting
    • Authors: Simonsen C; Lass T, Bleeg RC.
      Abstract: In many centres, epicardal pace wires are routinely implanted during coronary artery bypass surgery to treat postoperative tachy- and brady-arrhythmias. We describe the case of an 88-year-old male, with severe comorbidity, who underwent a successful CABG, but incurred an unacknowledged iatrogenic perforation of the ileum with the placement of an epicardial pace wire. The patient developed septic shock and multi organ failure despite intra-abdominal surgical interventions and intensive care therapy, and died 6 days after CABG.
      PubDate: 2017-04-06
  • Transapical transcatheter mitral valve-in-valve implantation versus
           minimally invasive surgery for failed mitral bioprostheses †
    • Authors: Murzi M; Berti S, Gasbarri T, et al.
      Abstract: OBJECTIVES: The aim of this study was to compare early outcomes and survival of patients undergoing minimally invasive mitral valve replacement through a right anterior minithoracotomy (MIMVR) versus patients undergoing transcatheter transapical mitral valve-in-valve (M-VIV) implantation for a failed mitral bioprostheses.METHODS: From 2005 to 2015, 61 patients with a failed mitral bioprosthesis underwent either MIMVR (n = 40 patients, 65.6%) or M-VIV implantation (n = 21, 34.4%) at our institution. The groups were compared in terms of early outcomes and survival rates. Treatment selection bias was controlled by a propensity score and was included along with the comparison variable in the multivariable analyses of outcome.RESULTS: Patients with M-VIV implantation were older (P = 0.03), had more pulmonary hypertension (P = 0.02) and a higher EuroSCORE (P = 0.001). In-hospital mortality was 7.5% (n = 3) in the MIMVR group and 4.7% (n = 1) in the M-VIV group [odds ratio (OR) = 2.46; P = 0.512]. Incidence of stroke was 12.5% (n = 5) in the MIMVR group vs 4.7% (n = 1) in the M-VIV group (OR = 0.887; P = 0.935). No significant differences were noted in postprocedural complications, even after adjusting the results for the propensity score. M-VIV patients had shorter stays in the intensive care unit and in the hospital (P = 0.02). In the M-VIV group, 28% (n = 7) had less than mild paravalvular leakage, whereas no patients had mild paravalvular leakage in the MIMVR group (P < 0.001). Finally, the 2-year survival rates were 86 ± 1% vs 87 ± 1% in patients undergoing MIMVR compared with those undergoing M-VIV implantation, respectively (P = 0.1).CONCLUSIONS: In selected patients, M-VIV can be performed safely with results comparable with those of surgical therapy.
      PubDate: 2017-04-06
  • Temporary mechanical circulatory support after orthotopic heart
           transplantation: a single-centre experience
    • Authors: Tchantchaleishvili V; Wood KL, Carlson LA, et al.
      Abstract: OBJECTIVES: There are various strategies in the use of temporary mechanical circulatory support following orthotopic heart transplant (OHT). We sought to examine the outcomes following different temporary mechanical circulatory support strategies for acute graft failure.METHODS: Patients who received an OHT between 2001 and 2015 at a single institution were retrospectively reviewed. Patients were divided into 2 groups based on the need for temporary mechanical circulatory support (TMCS).RESULTS: A total of 9.9% (19 of 192) of patients required TMCS following OHT. There were no significant differences in the preoperative demographics between groups. Six patients (32%) required a biventricular assist device, 9 patients (47%) required a right ventricular assist device and 4 patients (21%) required a veno-arterial extracorporeal membrane oxygenator. Perioperative morbidity was comparable between all groups. Our entire TMCS cohort had 94.7% 30-day and 61.1% 1-year survival. When compared with the OHT patients with no TMCS (97.1% at 30 days and 92.8% at 1 year), survival was inferior in TMCS patients (P = 0.01 at 30 days, P < 0.001 at 1 year, P < 0.001 overall).CONCLUSIONS: Acute graft failure requiring TMCS has inferior overall survival. Larger, multi-institutional studies are needed to further elucidate these differences and identify the best TMCS mode.
      PubDate: 2017-04-05
  • New technique of diaphragmatic plication by means of uniportal
           video-assisted thoracoscopic surgery
    • Authors: Stamenovic D.
      Abstract: Diaphragmatic plication has been a well employed method for the treatment of diaphragmatic eventration and/or paralysis. Uniportal thoracoscopic procedures seem to offer substantial benefit in terms of postoperative pain and cosmesis with similar outcomes as other surgical techniques. A 60-year-old female patient was referred to our clinic for the surgical treatment of diaphragmatic eventration of an unknown cause. The patient was referred to our institution from another hospital, where she had undergone a femoro-popliteal and crural bypass which was unsuccessful, requiring amputation of her leg. Following surgery, she was unable to breath spontaneously without any specific reason. Cranial magnetic resonance imaging showed no pathology and the neurologists did not have a diagnosis for her comatose state. There was consensus in both hospitals that surgical plication of her elevated diaphragm might be the only option for respiratory improvement. We performed a double-lined diaphragmatic plication procedure by means of uniportal video-assisted thoracic surgery technique with CO2 insufflation using GelPort. Despite the time-consuming adhesiolysis and the need for lung suturing at the end of the procedure, the operative time was 120 min. Oxygenation remarkably improved after the operation, yet the patient remained in comatose state. She was referred back to the hospital where she had initially begun her therapy for further recovery.
      PubDate: 2017-04-03
  • Outcomes of patients who declined surgery for acute Stanford type A aortic
           dissection with patent false lumen of the ascending aorta †
    • Authors: Kitamura T; Torii S, Horai T, et al.
      Abstract: OBJECTIVES: This study aimed to evaluate the outcomes of patients who did not undergo initial aortic surgery for acute Stanford type A aortic dissection with a patent false lumen of the ascending aorta.METHODS: Inpatient and outpatient records were retrospectively reviewed.RESULTS: We identified 195 patients with acute type A aortic dissection with a patent ascending false lumen between January 1998 and March 2016. Of these, 137 underwent aortic surgery, 16 died before surgery and 42 declined aortic surgery. The ages of the patients who underwent and those who declined aortic surgery were 60.0 ± 10.6 years and 72.3 ± 12.4 years, respectively. The mortality rate of those who underwent and those who declined aortic surgery was 15 and 62% at 30 days and 19% and 67 at 90 days, respectively (P < 0.0001). In the 58 patients who did not undergo initial aortic surgery, the maximum aortic diameter was correlated with survival (P = 0.0037). At follow-up (3.7 ± 4.5 years; range 0–16.4 years), survival at 1, 5 and 10 years in those who underwent and those who declined initial aortic surgery was 78, 68 and 49%, and 29, 24 and 12%, respectively (P < 0.0001).CONCLUSIONS: In this study of patients with acute Stanford type A aortic dissection with a patent false lumen of the ascending aorta, the mortality of those who declined initial aortic surgery was 62% at 30 days and 67% at 90 days, respectively, and a smaller aortic diameter was significantly associated with better survival.
      PubDate: 2017-04-03
  • Mid-term results of bicuspid aortic valve repair guided by morphology and
           function assessment
    • Authors: Fattouch K; Moscarelli M, Castrovinci S, et al.
      Abstract: OBJECTIVES: Bicuspid aortic valve (BAV) is frequently associated with aortic insufficiency (AI) due to cusp disease and/or aortic root dilatation. Based on functional classification and morphology, a systematic surgical approach was used for aortic valve repair (AVr).METHODS: From 2004 to 2014, 152 consecutive patients (mean age 55 ± 7 years) with BAV underwent AVr with or without concomitant aortic root surgery. Cusp pathology was treated with central plication in 60 (39.5%) patients, free edge reinforcement in 45 (29.6%), triangular resection in 28 (18.4%) and pericardial patch in 19 (12.5%). Aortic root dilatation was corrected with valve sparing reimplantation in 65 patients. Mean follow-up was 68 ± 36 months.RESULTS: In-hospital death was 1.3%. Overall 5-year survival was 88.6 ± 3.6%. Freedom from recurrent ≥ grade 2 AI requiring reoperation at 5-year was 93 ± 3.1%. Five-year freedom from reintervention was 98.4 ± 1.6%, 93.3 ± 6.4% and 82.6 ± 9.6 in the group of patients treated with AVr and reimplantation technique, AVr and subcommissural plasty and AVr repair alone (log-rank P = 0.005). Commissural orientation <160°, type 2 Siever’s BAV and preoperative annulus diameter >29 mm were identified as predictors for recurrent ≥ grade 2 AI.CONCLUSIONS: BAV repair could be achieved with low incidence of recurrent AI, especially when concomitant annulus stabilization was performed. Systematic preoperative morphological and functional characteristics of the aortic valve should be carried out in order to reduce the risk of repair failure.
      PubDate: 2017-04-03
  • Does the fissureless technique decrease the incidence of prolonged air
           leak after pulmonary lobectomy'
    • Authors: Li S; Lv W, Zhou K, et al.
      Abstract: A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether the fissureless technique can reduce the incidence of prolonged air leak (PAL) after pulmonary lobectomy. Altogether 18 papers were found using the reported search, of which 1 prospective randomized study and 4 retrospective cohort studies represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Four studies demonstrated that the fissureless technique used in pulmonary lobectomy was superior to conventional lobectomy in terms of preventing PAL and shortening the time to air leak cessation. One study showed no difference in PAL formation between these 2 procedures. The definitions for PAL as defined by duration was >5 days in 4 studies and >7 days in 1 study. Current evidence demonstrates that the fissureless technique can significantly decrease the development of PAL and time to air leak cessation after pulmonary lobectomy.
      PubDate: 2017-03-31
  • Improvements in left ventricular twist mechanics following myectomy for
           hypertrophic cardiomyopathy with mid-ventricular obstruction
    • Authors: Adhyapak SM; Menon PG, Rao Parachuri VV.
      Abstract: We aimed to evaluate left ventricle twist mechanics in mid-ventricular obstructive and apical type of hypertrophic cardiomyopathy and changes induced by myectomy. We studied 3 consecutive patients by cardiac magnetic resonance preoperatively and 6 weeks after myectomy. We calculated the apical and basal rotations at the base and apex respectively. All 3 patients underwent myectomy by the standard described technique. The basal rotations remained the same, while there was an improvement in the maximal apical rotation from 0.385 ± 0.3975° to 0.9086 ± 1.1751°. In hypertrophic cardiomyopathy with mid-ventricular obstruction and apical hypertrophy, there is decreased apical rotation, which improves after myectomy.
      PubDate: 2017-03-31
  • Preventive left main and right coronary artery stenting to avoid coronary
           ostia occlusion in high-risk stentless valve-in-valve transcatheter aortic
           valve implantation
    • Authors: Maggio S; Gambaro A, Scarsini R, et al.
      Abstract: Transcatheter aortic valve implantation is becoming an attractive and promising alternative to redo surgery for aortic bioprosthetic valves degeneration, especially in high-risk patients. However, valve-in-valve transcatheter aortic valve implantation itself carries some procedural risks and potential challenges that interventionists must be aware of. An accurate preprocedural planning is fundamental for the prevention of potentially fatal complications. This case describes a novel strategy of simultaneous right and left coronary artery stenting preventing bilateral coronary obstruction in a patient with a stentless surgical aortic valve and extremely low origin of the 2 coronary arteries.
      PubDate: 2017-03-31
  • Severe aortic regurgitation after implantation of a sutureless valve
           prosthesis using an automatic knot fastener device
    • Authors: Balan R; Mogilansky C, Larsen A, et al.
      Abstract: We report the case of severe aortic regurgitation 8 months after implantation of a 25-mm sutureless pericardial aortic valve prosthesis. On echocardiography, the regurgitation was suspected to be paravalvular. The sutureless prosthesis had been implanted using an automatic knot fastener device, which renders the suture tails less pliable because of the metal clip that is crimped around the suture. The patient was reoperated, a paravalvular leak was not observed. The sutureless prosthesis was explanted and a conventional biologic valve prosthesis was implanted instead. On examination of the explanted valve prosthesis, a perforation was observed in one of the leaflets. The leaflet perforation was in alignment with one of the knots produced by the automatic knot fastener. Obviously, the leaflet had hit the knot repeatedly which had caused the perforation. We conclude that knots produced by an automatic fastener device have the potential to cause leaflet perforation.
      PubDate: 2017-03-31
  • Surgical retrieval of a degenerated Sapien 3 valve after 29 months
    • Authors: Malvindi P; Carbone C, Labriola C, et al.
      Abstract: A 70-year-old man developed heart failure due to severe mixed disease of a degenerated transcatheter aortic valve prosthesis. The patient underwent retrieval of the transcatheter aortic valve and implantation of a 25-mm bioprosthesis through a redo sternotomy.
      PubDate: 2017-03-31
  • Five-year evolution of mild aortic regurgitation following transcatheter
    • Authors: Buzzatti N; Castiglioni A, Agricola E, et al.
      Abstract: OBJECTIVES: To assess the follow-up evolution and impact of mild aortic regurgitation (1 + AR) following transcatheter aortic valve implantation (TAVI).METHODS: We evaluated the follow-up outcomes and AR evolution of 558 patients affected by native aortic stenosis who underwent TAVI with residual AR ≤ 1+.RESULTS: No residual AR was found in 294 (52.7%) patients, whereas 1 + AR was found in 264 (47.3%) patients. At 5.5 years, freedom from all-cause mortality (56.9% vs 53.5%), cardiac mortality (75.0% vs 74.3%) and heart failure (70.0% vs 63.9%) were similar between no-AR and 1 + AR groups, respectively (all P > 0.05). New York Heart Association Class I–II was found in 88.9% vs 82.4% of patients respectively (P = 0.013). Freedom from AR ≥3+ at 5.5 years was 98.6% in the no-AR group vs 82.5% in the 1 + AR group (log-rank <0.001). Residual 1 + AR was found to be an independent predictor of increased follow-up AR ≥3+ (P = 0.012). In 1 + AR group, higher left ventricle mass index independently predicted increased cardiac death [hazards ratio (HR) 1.01, confidence interval (CI) 1.00–1.02, P = 0.036] and heart failure rate (HR 1.01, CI 1.00–1.02, P = 0.002), while larger native aortic annulus perimeter predicted follow-up AR ≥ 3+ (HR 1.12, CI 1.02–1.22, P = 0.016).CONCLUSIONS: 5 years after TAVI, a higher progression of paravalvular AR to Grade ≥3+ together with worse symptoms were found in patients with residual 1 + AR compared with no-AR, although no marked difference in survival was observed. These findings raise further concerns about 1+ residual AR after TAVI, especially in the perspective of expanding indications to younger low-risk patients. Mechanisms that cause progression of paravalvular AR after TAVI remain to be clarified.
      PubDate: 2017-03-31
  • Cerebral circulation estimated by laser speckle flowgraphy in retrograde
           femoral arterial perfusion during minimally invasive cardiac surgery
    • Authors: Kitahara H; Kanda H, Kimura F, et al.
      Abstract: OBJECTIVES: Laser speckle flowgraphy (LSFG) is a novel modality to assess blood flow of the optic nerve head (ONH), which is reported to be a surrogate marker of cerebral microcirculation. We conducted LSFG measurements during minimally invasive cardiac surgery with retrograde femoral arterial perfusion and evaluated its feasibility and usability as a neuromonitor.METHODS: We prospectively enrolled 7 patients who underwent mitral valve repair through a right minithoracotomy with retrograde femoral arterial perfusion. LSFG was used to analyse the ONH blood flow based on examinations of the mean blur rate (MBR). The MBR was measured after the induction of anaesthesia (time 1); after the initiation of cardiopulmonary bypass (time 2); during cardiac arrest (time 3) and after the termination of cardiopulmonary bypass (time 4).RESULTS: All procedures were performed successfully, and there were no neurovascular complications or deaths. LSFG measurements were easily and uneventfully conducted without any related complications. The MBR was 11.2 ± 2.3 at time 1, 11.1 ± 1.8 at time 2, 11.3 ± 1.7 at time 3 and 13.6 ± 3.5 at time 4. Statistically, the MBR at time 4 was significantly higher than those at all other times (P < 0.05).CONCLUSIONS: LSFG measurements were safely conducted during minimally invasive cardiac surgery and assessed ONH blood flow quantitatively. We consider this modality to be easy to manipulate and less operator dependent, resulting in good reproducibility. The results are well visualized and compared quantitatively. Our result suggests that LSFG might be an accurate neuromonitor.Clinical trial registration: 15102-2.
      PubDate: 2017-03-27
  • Epicardial clip occlusion of the left atrial appendage during cardiac
           surgery provides optimal surgical results and long-term stability †
    • Authors: Kurfirst V; Mokráček A, Čanádyová J, et al.
      Abstract: OBJECTIVES: Occlusion of the left atrial appendage (LAA) has become an integral and important part of the surgical treatment of atrial fibrillation. Different methods of surgical occlusion of the LAA have been associated with varying levels of short- and long-term success for closure. The purpose of this study was to evaluate long-term results of epicardial placement and endocardial occlusion in patients undergoing cardiac operative procedures.METHODS: A total of 101 patients (average age 65.7 years) undergoing cardiac operative procedures with the epicardial AtriClip Exclusion System of the LAA were enrolled in the study. The AtriClip was placed via a sternotomy or a thoracotomy or from a thoracoscopic approach. Postoperative variables, such as thromboembolic events, clip stability and endocardial leakage around the device, were examined by transoesophageal echocardiography (TEE) and/or computed tomography.RESULTS: Perioperative clip implantation was achieved in 98% of patients. TEE and/or computed tomography conducted during the follow-up period, comprising 1873 patient-months with a mean duration of 18 ± 11 months, revealed no clip migration, no leakage around the device and no clot formation near the remnant cul-de-sac. During the follow-up period, 4 of the cardiac patients experienced transitory ischaemic attacks, whereas no patient experienced a cerebrovascular attack.CONCLUSIONS: The Epicardial AtriClip Exclusion System of the LAA appears to be a feasable and safe operative method with a high success rate. Long-term follow-up confirmed clip stability, complete occlussion of the LAA and absence of any atrial fibrilation-related thromboembolic events. These results need to be confirmed by a larger, multicentre study.
      PubDate: 2017-03-27
  • Video-assisted thoracic surgery mediastinal germ cell metastasis resection
    • Authors: Nardini M; Jayakumar S, Migliore M, et al.
      Abstract: Thoracoscopy can be safely used for dissection of masses in the visceral mediastinum. We report the case of a 31-year-old man affected by metastatic germ cell tumour and successfully treated with a 3-port posterior approach video-assisted thoracic surgery.
      PubDate: 2017-03-24
  • Thoracoscopic thymectomy is a feasible and less invasive alternative for
           the surgical treatment of large thymomas
    • Authors: Odaka M; Tsukamoto Y, Shibasaki T, et al.
      Abstract: OBJECTIVES: Thoracoscopic surgery is widely used for the surgical treatment of thymoma. However, large-sized thymomas are typically treated using open surgery. This study evaluated the feasibility of performing thoracoscopic thymectomy (TT) for thymoma ≥50 mm.METHODS: A retrospective review was conducted on 135 patients who underwent TT or open thymectomy (OT) for Masaoka stage I–IVa thymoma between 1996 and 2014.RESULTS: Patients were first divided into two groups based on thymoma size: thymoma ≥50 mm and thymoma <50 mm groups. There was no significant difference in the 5-year disease-free survival (DFS) between the groups (P = 0.5352). Patients in the thymoma ≥50 mm group were further subdivided into TT and OT groups. The length of postoperative hospital stay was significantly shorter in the TT group than in the OT group (5 vs 14 days, P < 0.0001), with significantly fewer postoperative complications (6 patients vs 14 patients, P = 0.0008). There was no significant difference in the 5-year DFS between patients with thymoma ≥50 mm in the TT and OT groups (P = 0.3501). Finally, patients undergoing TT were further subdivided into thymoma ≥50 mm and thymoma <50 mm groups and, no significant difference in the 5-year DFS was found between these groups (P = 0.6661). Masaoka stages III–IV, but not thymoma size, were an independent prognostic factor for DFS.CONCLUSIONS: These results demonstrate the decreased invasiveness and feasibility of TT for large-sized thymomas.
      PubDate: 2017-03-23
  • Rapid-deployment aortic valve replacement for severe aortic stenosis:
           1-year outcomes in 150 patients †
    • Authors: Theron A; Ravis E, Grisoli D, et al.
      Abstract: OBJECTIVES: This study aimed to evaluate the safety and effectiveness of rapid-deployment aortic valve replacement (RDAVR) for severe aortic stenosis (AS).METHODS: All consecutive patients with severe AS who underwent RDAVR with the EDWARDS INTUITY bioprosthesis were prospectively included in a single-centre, cohort study between July 2012 and April 2015. Clinical examination and transthoracic echocardiography were performed preoperatively and at 1-month and 1-year follow-up.RESULTS: We included 150 patients: mean age 76.8 ± 6.2 years, 68.7% male and mean EuroSCORE II 3.4 ± 3.7%. Implantation was successful in all: 103 (68.7%) had isolated aortic valve replacement (AVR) and 47 (31.3%) had concomitant procedures. For isolated AVR, mean cross-clamp and cardiopulmonary bypass times were 37.6 ± 13.3 and 59.9 ± 20.4 min, respectively. Overall, the 1-year Kaplan–Meier survival rate was 97.1% (95% confidence interval 92.4–98.9%). At 1 year, stroke occurred in 5 patients (3.34%), myocardial infarction in 1 (0.69%), endocarditis in 1 (0.69%), early explantation in 1 (0.67%), pacemaker implantation in 8 (5.6%) and Grade 2 periprosthetic regurgitation in 4 (3.2%; no grade 3 of 4). There were significant decreases from baseline (P < 0.001) in the proportion at New York Heart Association Class III/V (35.3–4.1%), mean gradient (54.9 ± 17.3 mmHg to 11.3 ± 4.8 mmHg) and mean left ventricular mass index (160.3 ± 44.8 g/m2 to 118.5 ± 39.4 g/m2). Mean indexed effective orifice area at 1 year was 1.02 ± 0.37 cm2/m2. Ten patients (6.6%) had severe patient–prosthesis mismatch.CONCLUSIONS: RDAVR for severe AS provided favourable outcomes over 1 year.
      PubDate: 2017-03-23
  • Sutureless aortic bioprosthesis
    • Authors: Martínez-Comendador J; Castaño M, Gualis J, et al.
      Abstract: Aortic valve replacement (AVR) is the treatment of choice for aortic valve disease, with excellent results reported in the short- and long-term follow-up. Due to the increasing number of patient comorbidities and older age, various technical alternatives have been developed such as transcatheter aortic valve implantation and, more recently, sutureless valve bioprostheses. For patients with very high surgical risk, transcatheter implantation is becoming the top therapeutic option. However, the percutaneous technique still has major disadvantages including those related to implantation without excision of the diseased native valve without direct view of the annulus, which increases the probability of developing perivalvular leaks and a high percentage of atrioventricular block. Due to the need for aggressive crimping of pericardial layers, there is uncertainty about their long-term durability. A new technique for AVR using sutureless bioprosthesis has recently been developed. The main advantages of this technique are the excellent haemodynamic performance and fast deployment under direct view, thereby avoiding the knotting of surgical stitches, which is especially advantageous in more technically demanding procedures (e.g. minimally invasive surgery, calcified aortic root and reoperations). The good clinical results of these valves have been supported by scientific evidence, making it a feasible option for patients who are candidates for AVR using biologic prosthesis, especially for those with mid-high surgical risk for standard AVR and percutaneous transcatheter valve implantation. In this article, we review the latest evidence on these new prostheses, including their advantages and possible disadvantages.
      PubDate: 2017-03-21
  • Hybrid treatment of a huge complex aortic pseudo-aneurysm subsequent to a
    • Authors: Rizza A; Barletta V, Palmieri C, et al.
      Abstract: Endovascular treatment of pseudo-aneurysms subsequent to a pre-existing aortic coarctation is becoming a well-accepted technical solution especially in patients presenting anatomical challenges involving the aortic arch. We report the case of a 65-year-old woman with a huge pseudo-aneurysm of the descending thoracic aorta. Diagnostic imaging assessment documented also the presence of an aneurysmatic aberrant right subclavian artery. Due to patient’s anatomical arterial condition, we decided to treat the aneurysm applying a hybrid approach.
      PubDate: 2017-03-20
  • Acute aortitis of the ascending aorta
    • Authors: Saddoughi SA; Abel MD, Maleszewski JJ, et al.
      Abstract: We report a rare presentation of focal non-aneurysmal aortitis with mural thrombus of the ascending aorta. This was successfully treated with surgical resection and intravenous antibiotics. Pathology of the surgical specimen suggests that this was likely infectious aortitis, but the source of infection has not been identified.
      PubDate: 2017-03-20
  • Robotic mitral valve repair: a European single-centre experience †
    • Authors: Navarra E; Mastrobuoni S, De Kerchove L, et al.
      Abstract: OBJECTIVES: We report the outcomes of robotic valve repair for degenerative mitral regurgitation (MR) in our Institution.METHODS: Between February 2012 and July 2016, 134 patients underwent robotic mitral valve (MV) repair with the da Vinci Si system. All the operations were performed through a mini-thoracotomy in the fourth right intercostal space, cardiopulmonary bypass and mild hypothermia. The clinical and echocardiographic follow-up was 100% complete.RESULTS: There was no hospital death. The mean cross-clamp and cardiopulmonary bypass time were 112±23 and 159±33 min, respectively. Pre-discharge echocardiograms showed none-to-mild residual MR in all patients. Median follow-up was 24.1 months. We observed 1 early and 4 late reoperations on the MV for an overall freedom from reoperation of 98.2% and 94.1% at 12 and 36 months, respectively. Furthermore, echocardiographic follow-up revealed freedom from recurrence of MR greater than Grade 1+ of 92.5% and 80.7% at 12 and 36 months, respectively. Nevertheless freedom from recurrence of MR greater than Grade 2+ was 97.2% at 12 and 36 months.CONCLUSIONS: Robotic MV repair is a feasible and safe option for the treatment of degenerative MR in selected patients with excellent perioperative outcomes. Early and midterm results are remarkable and are associated with low risk of late recurrence of MR and reoperation. Long-term follow-up is needed to confirm the durability of valve repair.
      PubDate: 2017-03-20
  • The obesity paradox is still there: a risk analysis of over 15 000
           cardiosurgical patients based on body mass index
    • Authors: Hartrumpf M; Kuehnel R, Albes JM.
      Abstract: OBJECTIVES: Obesity is an ever-growing problem in contemporary cardiac surgery. Although it accounts for many perioperative comorbidities, it has not been shown to increase mortality. Body mass index (BMI) is therefore not considered in the European System for Cardiac Operative Risk Evaluation (EuroSCORE). We sought to confirm whether this holds true for our own single-centre patient population.METHODS: Data from 15 314 consecutive patients receiving major cardiac surgery at our institution were analysed. Gender, age, BMI, EuroSCORE, urgency, redo status and all-cause in-hospital mortality were derived from our database. Mortality was grouped into 4 BMI categories. We created a logistic regression model to identify predictors of mortality.RESULTS: There were 11 034 males and 4280 females. Categorical mortality was 8.79% (underweight), 7.04% (normal weight), 5.16% (overweight), 6.30% (obese), rendering an inverse J-shaped pattern known as obesity paradox. Univariable regression detected significant predictors of mortality: rising age, female gender, urgent procedures, redo surgery (P < 0.001). BMI was no predictor (P = 0.575) but became significant with the multivariable analysis (P = 0.004). Its effect on mortality was exclusively indirect, being mediated through age (P < 0.001). Receiver-operating characteristics curve analysis also confirmed that BMI did not qualify as a risk factor. However, the overweight category was a predictor of lower mortality.CONCLUSIONS: Our findings from >15 000 patients confirm the obesity paradox showing the least mortality in the overweight group. They support the current EuroSCORE model in that BMI is no independent predictor of early mortality. However, such patients still carry the risk of comorbidities. Likewise, special care is required with underweight patients who show the highest in-hospital mortality.
      PubDate: 2017-03-18
  • Chylous pericardial effusion after pulmonary lobectomy
    • Authors: Yang W; Luo C, Liu Z, et al.
      Abstract: Chylous pericardial effusion is a rarely reported complication of lung cancer surgery. Here, we report a case of an elderly man who suffered chylous pericardial effusion after radical right upper lung resection for cancer. The massive chylous effusion first occurred in the pericardium, drained to the right chest after the drainage of the hydropericardium and subsequently moved back to the pericardium again. Lymphoscintigraphy examination indicated that a chylous fistula was present in the plane of the tracheal carina. After failure to control the chylous effusion with conservative medical treatment, the patient underwent video-assisted thoracic surgery through the left chest for thoracic duct ligation and pericardial fenestration. The patient was ultimately discharged without recurrence of the effusion after surgical treatment. This case report discusses the possible mechanism of chylopericardium after lung cancer surgery and suggests some strategies to prevent postoperative chylous pericardial effusion.
      PubDate: 2017-03-17
  • Coronary endarterectomy with coronary artery bypass graft decreases graft
           patency compared with isolated coronary artery bypass graft: a
    • Authors: Song Y; Xu F, Du J, et al.
      Abstract: OBJECTIVES: This meta-analysis aims to assess the graft patency quantitatively and statistically.METHODS: Eleven observational studies were identified by systematic literature search, incorporating 3311 patients undergoing coronary endarterectomy (CE) + coronary artery bypass graft (CABG) and 3990 undergoing isolated CABG, which were analysed using random-effects modelling. Heterogeneity, quality of scoring and risk of bias were assessed and reangiographic outcomes were documented.RESULTS: Adjunctive CE decreased graft patency [odds ratios = 0.43, 95% confidence interval [0.29–0.63], z = 4.33, P < 0.0001] with moderate heterogeneity, while the baseline demographics differed considerably.CONCLUSIONS: Whether CE remains a viable option to CABG requires novel studies collecting corresponding data from bench to bedside. To achieve satisfactory efficacy, surgeons should carefully weigh possible benefits and adverse effects of CE and prepare the surgical strategy adequately.
      PubDate: 2017-03-17
  • Concomitant therapy: off-pump coronary revascularization and transcatheter
           aortic valve implantation
    • Authors: Ahad S; Wachter K, Rustenbach C, et al.
      Abstract: OBJECTIVES: Significant coronary artery disease (CAD) is common among patients evaluated for transcatheter aortic valve implantation (TAVI). Only little data exist on outcome of patients undergoing concomitant off-pump coronary revascularization and TAVI. The goal of this study was to analyse the impact of concomitant off-pump revascularization on early clinical outcome and 2-year follow-up of patients undergoing TAVI.METHODS: A total of 70 patients with significant CAD and aortic valve stenosis were included between January 2011 and January 2016. Decision to perform concomitant off-pump coronary revascularization and TAVI was made by the interdisciplinary heart team according to the SYNTAX score. Prospectively assigned data were analysed retrospectively and follow-up was performed up to 2 years.RESULTS: Mean age was 82.2 ± 4.0 years and 43 (61.4%) patients were male. Mean logistic European system for cardiac operative risk evaluation and Society of Thoracic Surgeons European system for cardiac operative risk evaluation score were 35.9 ± 21.9% and 12.2 ± 7.9%, respectively. SYNTAX score was 29.0 ± 12.9. Access site for TAVI was transapical in 60.0% and transaortic in 40.0%. Procedural success was 94.3%. Eighty percent of the patients had none or trace paravalvular leakage after TAVI. Severe complications requiring consecutive surgical aortic valve replacement occurred in 2 patients (2.9%). The use of cardiopulmonary bypass due to haemodynamic instability or conversion to surgical aortic valve replacement was necessary in 7 patients (10.0%). Stroke occurred in 1 patient (1.4%). Re-exploration for bleeding was necessary in 6 patients (8.6%). Thirty-day mortality was 14.3%. Two-year survival was 68.4% (95% confidence interval: 55.7–81.1%).CONCLUSIONS: Simultaneously performed complete off-pump coronary revascularization is a feasible and valid option in patients with significant CAD undergoing TAVI.
      PubDate: 2017-03-10
  • A successful transdiaphragmatic shunting for a late and recurrent
           pericardial effusion following coronary bypass
    • Authors: Themelin N; Cappeliez S, Houben J, et al.
      Abstract: Although pericardial effusion (PE) is common after cardiac surgery, late and recurrent cardiac tamponade that occurs more than 5–7 days after coronary artery bypass grafting is an infrequent complication. Moreover, the treatment of PE resistant to medical therapy, percutaneous drainage and pleuro-pericardial window remains a therapeutic challenge. We report the case of a recalcitrant PE with high-daily volume outflow drainage, finally treated with success, with a transdiaphragmatic pleuro-peritoneal shunting by laparoscopic approach.
      PubDate: 2017-02-16
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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