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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 European Journal of Cardio-Thoracic Surgery
  [SJR: 1.568]   [H-I: 104]   [8 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1010-7940 - ISSN (Online) 1873-734X
   Published by Oxford University Press Homepage  [370 journals]
  • Transatlantic Editorial on transcatheter aortic valve replacement
    • Authors: Thourani VH; Borger MA, Holmes D, et al.
      Pages: 1 - 13
      Abstract: Aortic stenosis (AS) is the most common acquired valve disease in elderly patients, with a prevalence of 2.8% in those 75 years or older [1]. As the general population ages [2], it is reasonable to expect that the number of patients seeking treatment for AS also will increase in the coming years. Surgical aortic valve replacement (SAVR) remains the most effective treatment for AS and can be performed with excellent results [3–7]. However, elderly patients increasingly are presenting with multiple comorbidities, making them either high- or extreme-risk surgical candidates. Transcatheter aortic valve replacement (TAVR) was developed as an alternative to SAVR for patients at high operative risk. Since the introduction of this transformative technology in 2002, TAVR has been found to be superior to standard medical therapy at 5 years in inoperable patients [8]. In addition, mid-term results have revealed that TAVR is equivalent or has superior survival compared with SAVR in high-risk operative patients [9, 10]. These findings, combined with the minimal invasive nature of TAVR, have resulted in an explosion in the number of these procedures performed in North America and Europe [11, 12]. A similar marked experience in the number of TAVR-related clinical studies also has been observed in the last few years, with several recent clinical trials even investigating the use of TAVR in intermediate- and low-risk patients [13, 14].
      PubDate: 2017-06-21
      DOI: 10.1093/ejcts/ezx196
      Issue No: Vol. 52, No. 1 (2017)
  • Short-term mechanical circulatory support as a bridge to durable left
           ventricular assist device implantation in refractory cardiogenic shock: a
           systematic review and meta-analysis
    • Authors: den Uil CA; Akin S, Jewbali LS, et al.
      Pages: 14 - 25
      Abstract: SummaryShort-term mechanical circulatory support (MCS) is increasingly used as a bridge to decision in patients with refractory cardiogenic shock. Subsequently, these patients might be bridged to durable MCS either as a bridge to candidacy/transplantation, or as destination therapy. The aim of this study was to review support duration and clinical outcome of short-term MCS in cardiogenic shock, and to analyse application of this technology as a bridge to long-term cardiac support (left ventricular assist device, LVAD) from 2006 till June 2016. Using Cochrane Register of Trials, Embase and Medline, a systematic review was performed on patients with cardiogenic shock from acute myocardial infarction, end-stage cardiomyopathy, or acute myocarditis, receiving short-term MCS. Studies on periprocedural, post-cardiotomy and cardiopulmonary resuscitation support were excluded. Thirty-nine studies, mainly registries of heterogeneous patient populations (n = 4151 patients), were identified. Depending on the device used (intra-aortic balloon pump, TandemHeart, Impella 2.5, Impella 5.0, CentriMag and peripheral veno-arterial extracorporeal membrane oxygenation), mean support duration was (range) 1.6–25 days and the mean proportion of short-term MCS patients discharged was (range) 45–66%. The mean proportion of bridge to durable LVAD was (range) 3–30%. Bridge to durable LVAD was most frequently performed in patients with end-stage cardiomyopathy (22 [12–35]%). We conclude that temporary MCS can be used to bridge patients with cardiogenic shock towards durable LVAD. Clinicians are encouraged to share their results in a large multicentre registry in order to investigate optimal device selection and best duration of support.
      PubDate: 2017-05-03
      DOI: 10.1093/ejcts/ezx088
      Issue No: Vol. 52, No. 1 (2017)
  • Comparison of surgical approach and extent of resection for Masaoka-Koga
           Stage I and II thymic tumours in Europe, North America and Asia: an
           International Thymic Malignancy Interest Group retrospective database
           analysis †
    • Authors: Fang W; Yao X, Antonicelli A, et al.
      Pages: 26 - 32
      Abstract: OBJECTIVES: Surgeons at different institutions worldwide choose different types of operations for thymic tumours. It is not known whether these differences affect the outcomes of the patients.METHODS: A total of 1430 patients with Masaoka-Koga pathological Stage I–II thymic tumours without myasthenia gravis or pre-treatment were identified from the International Thymic Malignancy Interest Group retrospective database. Outcomes of patients from 3 major continents (Europe, North America and Asia) were compared.RESULTS: Patients from the 3 continents were comparable in gender and performance status. More European patients had more paraneoplastic syndromes; North American patients had the smallest tumour sizes and less adjuvant therapy; and Asian patients were younger and had more Stage I disease but higher grade tumours. Partial thymectomy was performed more often in Asian patients (31.7%) than in European (2.4%) and North American (5.4%; P < 0.001) patients. The median approach (sternotomy/clamshell) was the major approach in Europe (75.3%) and North America (76.6%). In contrast, the median approach was applied significantly less frequently in Asia (45.6%, P < 0.001); unilateral open (thoracotomy/hemi-clamshell, 23.3%) and minimally invasive approaches (video-assisted thoracoscopic surgery/robot, 31.1%) were used more often with similar rates of complete resection. The 10-year overall survival rate was 82% for Europe, 78% for North America and 90% for Asia (P = 0.005), respectively. The 10-year cumulative recurrence rates were similar among the geographic groups (European 0.08, North American 0.07, and Asian 0.06, P = 0.61). Age was the only independent predictive factor for overall survival (P < 0.001, HR = 1.089, 95% CI 1.056–1.123) in multivariable analysis. Types B3 and thymic carcinoma (P = 0.003, HR = 3.932, 95% CI 1.615–9.576) were independent risk factors for increased recurrence.CONCLUSIONS: This study shows that the selection of the surgical approach and the extent of resection for Stage I and II thymic tumours differ by geographic region. However, these differences seem to have little impact on outcomes.
      PubDate: 2017-02-28
      DOI: 10.1093/ejcts/ezx042
      Issue No: Vol. 52, No. 1 (2017)
  • Comparison of clinical features and survival between thymic carcinoma and
           thymic carcinoid patients
    • Authors: Zhao Y; Gu H, Fan L, et al.
      Pages: 33 - 38
      Abstract: OBJECTIVES: Thymic carcinoma (TC) and thymic carcinoid (TCD) are aggressive thymic epithelial neoplasms with a poor prognosis. Due to rarity, little is known about their comparative clinical characteristics, treatment outcomes and patterns of relapse.METHODS: A retrospective cohort study was performed on 287 patients with TC and 56 patients with TCD who were treated at the Shanghai Chest Hospital between February 2003 and April 2014. Patient demographics, tumour stage, treatment, pathologic findings and postoperative outcomes were compared between the two tumour types using both multivariable Cox regression analysis and propensity-matched analysis.RESULTS: Compared to patients with TC, significantly more patients with TCD were male, had larger tumours, and displayed a greater proportion of lymph node metastases. However, overall survival was similar (60.7% 5-year survival for TC, 80.7% for TCD, P = 0.159), as was disease-free survival (41.1% 5-year survival for TC, 37.6% for TCD, P = 0.696) and patterns of relapse. Multiple Cox regression analysis identified younger patients [hazard ratio (HR) 1.018; 95% confidence interval (CI) 1.000–1.035; P = 0.047], more completeness of resection (HR 1.424; 95% CI 1.105–1.836; P = 0.006), adjuvant radiotherapy (HR 0.455; 95% CI 0.276–0.751; P = 0.002), and no adjuvant chemotherapy (HR 1.799; 95% CI 1.017–3.183; P = 0.044) as independent factors predicting better overall survival. Completeness of resection (HR 1.258; 95% CI 1.022–1.548; P = 0.031) and TNM stage (HR 1.479; 95% CI 1.107–1.977; P = 0.008) were independent predictors of disease-free survival. Propensity matching produced 46 patients in each group and no significant difference on overall survival or disease-free survival was found.CONCLUSIONS: Patients with TCD have discrete features but share a similar clinical course to those with TC. The importance of complete resection in both of these thymic malignancies is emphasized. Further investigation at multiple centers with the longer follow-up data is required to substantiate our conclusion.
      PubDate: 2017-04-17
      DOI: 10.1093/ejcts/ezx037
      Issue No: Vol. 52, No. 1 (2017)
  • Growth patterns of pulmonary metastases: should we adjust resection
           techniques to primary histology and size' †
    • Authors: Welter S; Arfanis E, Christoph D, et al.
      Pages: 39 - 46
      Abstract: OBJECTIVES: Safety margins in pulmonary metastasectomy are not yet well defined. We hypothesize that histological subtype, size of the lesion and local growth characteristics must be taken into consideration during metastasectomy. This study was conducted to examine and classify growth patterns at resection margins and define the relationships between aggressive local growth, metastasis size and local recurrence to direct metastasectomy.METHODS: Histologic sections of pulmonary metastases were prospectively collected and haematoxylin–eosin stains were systematically evaluated and classified by their pattern of lung tissue infiltration. Logistic regression was used to model the association between the subgroups of colorectal, renal cell and epithelial cancers and melanomas and sarcomas.RESULTS: From 183 patients, 412 lung specimens were removed, which contained 459 pulmonary metastases. We found that 58% of all lesions had microscopic signs of aggressive local dissemination. The metastases showed histology-specific patterns of local growth: sarcoma was associated with pleural infiltration; colorectal metastases with interstitial spread and aerogenous spread of floating cancer cell clusters; and melanoma with perivascular growth and with lymph vessel involvement. Aggressive patterns of growth had an increasing probability of around 3% for each additional millimetre of metastasis diameter. Local intrapulmonary recurrence was significantly more common in association with interstitial growth and pleural penetration as well as safety margins <7 mm.CONCLUSIONS: Approximately 40% of all lung metastases have a smooth surface and might be resected with small margins. Growth characteristics within the lung differ with the histologic subtype and safety margins should generally increase with the size of the metastasis.
      PubDate: 2017-04-11
      DOI: 10.1093/ejcts/ezx063
      Issue No: Vol. 52, No. 1 (2017)
  • Short-term preoperative exercise therapy does not improve long-term
           outcome after lung cancer surgery: a randomized controlled study †
    • Authors: Karenovics W; Licker M, Ellenberger C, et al.
      Pages: 47 - 54
      Abstract: OBJECTIVES: Poor aerobic fitness is a potential modifiable risk factor for long-term survival and quality of life in patients with lung cancer. This randomized trial evaluates the impact of adding rehabilitation (Rehab) with high-intensity interval training (HIIT) before lung cancer surgery to enhance cardiorespiratory fitness and improve long-term postoperative outcome.METHODS: Patients with operable lung cancer were randomly assigned to usual care (UC, n = 77) or to intervention group (Rehab, n = 74) that entailed HIIT that was implemented only preoperatively. Cardiopulmonary exercise testing (CPET) and pulmonary functional tests (PFTs) including forced vital capacity (FVC), forced expiratory volume (FEV1) and carbon monoxide transfer factor (KCO) were performed before and 1 year after surgery.RESULTS: During the preoperative waiting time (median 25 days), Rehab patients participated to a median of 8 HIIT sessions (interquartile [IQ] 25–75%, 7–10). At 1 year follow-up, 91% UC patients and 93% Rehab patients were still alive (P = 0.506). Pulmonary functional changes were non-significant and comparable in both groups (FEV1 mean −7.5%, 95% CI, −3.6 to −12.9 and in KCO mean 5.8% 95% CI 0.8–11.8) Compared with preoperative CPET results, both groups demonstrated similar reduction in peak oxygen uptake (mean −12.2% 95% CI −4.8 to −18.2) and in peak work rate (mean −11.1% 95% CI −4.2 to −17.4).CONCLUSIONS: Short-term preoperative rehabilitation with HIIT does not improve pulmonary function and aerobic capacity measured at 1 year after lung cancer resection.TRIAL REGISTRY:; No. NCT01258478;
      PubDate: 2017-04-17
      DOI: 10.1093/ejcts/ezx030
      Issue No: Vol. 52, No. 1 (2017)
  • Association of circulating tumour cells with early relapse and 18
           F-fluorodeoxyglucose positron emission tomography uptake in resected
           non-small-cell lung cancers †
    • Authors: Bayarri-Lara CI; de Miguel Pérez D, Cueto Ladrón de Guevara A, et al.
      Pages: 55 - 62
      Abstract: OBJECTIVES: More than 20% of lung cancer patients develop a recurrence, even after curative resection. We hypothesized that relapse may arise from the dissemination of circulating tumour cells (CTCs). This study evaluates the significance of CTC detection as regards the recurrence of non-small-cell lung cancer (NSCLC) in surgically resected patients. Secondly, we investigated the association between CTCs and the uptake of 18F-fluorodeoxyglucose (FDG) by the primary tumour on a positron emission tomographic (PET) scan.METHODS: In this single-centre prospective study, blood samples for analysis of CTCs were obtained from 102 patients with Stage I–IIIA NSCLC both before (CTC1) and 1 month after (CTC2) radical resection. CTCs were isolated using immunomagnetic techniques. The presence of CTCs was correlated with the maximum standardized uptake value (SUVmax) measured on preoperative FDG PET/computed tomographic scans. Recurrence free survival (RFS) analysis was performed.RESULTS: CTCs were detected in 39.2% of patients before and in 27.5% 1 month after the operation. The presence of CTCs after the operation was significantly correlated with SUVmax on PET scans, pathological stage and surgical approach. Only SUVmax was an independent predictor for the presence of CTC2 on multivariate analysis. Postoperative CTCs were significantly correlated with a shorter RFS (P = 0.005). In multivariate analysis, the presence of CTC2 was associated with RFS, independent of disease staging.CONCLUSIONS: Detection of CTCs 1 month after radical resection might be a useful marker to predict early recurrence in Stage I–III NSCLC. The SUVmax value of the primary tumour on preoperative PET scans was associated with the presence of CTC 1 month after the operation.
      PubDate: 2017-03-20
      DOI: 10.1093/ejcts/ezx049
      Issue No: Vol. 52, No. 1 (2017)
  • Pleurectomy–decortication in malignant pleural mesothelioma: are
           different surgical techniques associated with different outcomes'
           Results from a multicentre study †
    • Authors: Marulli G; Breda C, Fontana P, et al.
      Pages: 63 - 69
      Abstract: OBJECTIVES: The potential benefit of surgery for malignant pleural mesothelioma (MPM), especially concerning pleurectomy/decortication (P/D), is unclear from the literature. The aim of this study was to evaluate the outcome after multimodality treatment of MPM involving different types of P/D and to analyse the prognostic factors.METHODS: We reviewed 314 patients affected by MPM who were operated on in 11 Italian centres from 1 January 2007 to 11 October 2014.RESULTS: The characteristics of the population were male/female ratio: 3.7/1, and median age at operation was 67.8 years. The epithelioid histotype was observed in 79.9% of patients; neoadjuvant chemotherapy was given to 57% of patients and Stage III disease was found following a pathological analysis in 62.3% of cases. A total of 162 (51.6%) patients underwent extended P/D (EP/D); 115 (36.6%) patients had P/D and 37 (11.8%) received only a partial pleurectomy. Adjuvant radiotherapy was delivered in 39.2% of patients. Median overall survival time after surgery was 23.0 [95% confidence interval (CI): 19.6–29.1] months. On multivariable (Cox) analysis, pathological Stage III–IV [P = 0.004, hazard ratio (HR):1.34; 95% CI: 1.09–1.64], EP/D and P/D (P = 0.006, HR for EP/D: 0.46; 95% CI: 0.29–0.74; HR for P/D: 0.52; 95% CI: 0.31–0.87), left-sided disease (P = 0.01, HR: 1.52; 95% CI: 1.09–2.12) and pathological status T4 (P = 0.0003, HR: 1.38; 95% CI: 1.14–1.66) were found to be independent significant predictors of overall survival.CONCLUSIONS: Whether the P/D is extended or not, it shows similarly good outcomes in terms of early results and survival rate. In contrast, a partial pleurectomy, which leaves gross tumour behind, has no impact on survival.
      PubDate: 2017-04-12
      DOI: 10.1093/ejcts/ezx079
      Issue No: Vol. 52, No. 1 (2017)
  • Preoperative predictors of conversion in thoracoscopic surgery for pleural
           empyema †
    • Authors: Jagelavicius Z; Jovaisas V, Mataciunas M, et al.
      Pages: 70 - 75
      Abstract: OBJECTIVES: Thoracoscopy is an effective treatment method for pleural empyema; however, it is still not well defined as to which patient subgroups could benefit from it the most. The aim of the study was to identify preoperative factors that could facilitate selecting appropriate surgical intervention and to evaluate early postoperative period.METHODS: Seventy-one patients were prospectively included in the study, which was conducted from January 2011 to June 2014. Thoracoscopic surgery for Stage II/III pleural empyema was performed in all patients. Thoracoscopy failed in 18 (25.4%) patients, requiring conversion to thoracotomy. The preoperative factors that could possibly predict conversion were analysed.RESULTS: Obliterated pleural space (12 patients) and failure to achieve lung re-expansion (6 patients) were the main reasons for conversion. Multivariable logistic regression analysis demonstrated that each day of illness [odds ratio 1.1 (95% confidence interval 1.0–1.2], P = 0.004] and frank pus [odds ratio 4.4 (95% confidence interval 1.2–15.3), P = 0.021] were independent predictors of conversion. Using receiver-operating characteristic analysis, it was determined that the duration of illness had a high predictive value for conversion [area under the curve 0.8 (95% confidence interval 0.7–0.9), P < 0.001]. The cut-off value for duration of illness was 16 days (sensitivity 94.4%, specificity 54.7%). The conversion group had a significantly greater need for postoperative intensive care unit stay (P = 0.022) but a lower rate of reoperations (P = 0.105).CONCLUSIONS: Duration of illness and frank pus discovered during thoracocentesis can help in selecting the patient for appropriate intervention. Earlier surgery for pleural empyema can reduce the rate of conversion and reoperation.
      PubDate: 2017-03-27
      DOI: 10.1093/ejcts/ezx054
      Issue No: Vol. 52, No. 1 (2017)
  • Scoliosis after pectus excavatum correction: does it improve or
           worsen' †
    • Authors: Chung J; Park H, Kim K.
      Pages: 76 - 82
      Abstract: OBJECTIVES: Scoliosis is associated with pectus excavatum. However, the change in the degree of scoliosis after pectus excavatum correction has not been clarified. This study examined how the correction of pectus excavatum influences the status of pre-existing scoliosis.METHODS: A total of 779 pectus excavatum patients operated between 2007 and 2011 using the pectus bar were retrospectively analysed. Preoperative severity and postoperative change of scoliosis in accordance with the severity of pectus excavatum were evaluated. Cobb angle, Haller index and sternal tilt degree were measured from pre- and postoperative whole-spine anteroposterior radiographs and chest computed tomography.RESULTS: Sixty-three (8%) patients had scoliosis (Cobb angle >10°). No significant correlation was noted between postoperative changes in Cobb angle, Haller index or sternal tilt angle. Preoperative severity of scoliosis showed a positive correlation with postoperative changes in Cobb angle (r = 0.527, P < 0.001). In analyses between groups with mild and moderate scoliosis (Cobb angle <15° and >15°, respectively), the mean postoperative Cobb angle was decreased in mild scoliosis (−2.88°) but was increased in moderate scoliosis (3.86°; P < 0.001). Regarding the ‘improvement’ and ‘aggravation’ of scoliosis after pectus correction, preoperative severity of scoliosis was the only significant factor in univariable and multivariable analysis.CONCLUSIONS: Pectus excavatum repair using a pectus bar may improve scoliosis, but when the preoperative Cobb angle exceeds 15°, scoliosis may be aggravated. Therefore, pectus excavatum with concomitant moderate scoliosis requires extra caution during repair. This preliminary result suggests further investigation into the effect of chest cage remodelling on spine dynamics.
      PubDate: 2017-03-07
      DOI: 10.1093/ejcts/ezx041
      Issue No: Vol. 52, No. 1 (2017)
  • Intraoperative coronary revision but not coronary pattern is associated
           with mortality after arterial switch operation †
    • Authors: Trezzi M; Polito A, Albano A, et al.
      Pages: 83 - 89
      Abstract: OBJECTIVES: We sought to determine differences in baseline characteristics and clinical outcomes in a consecutive series of patients undergoing arterial switch operation (ASO), assessing the effect of coronary anatomy on postoperative mortality, both overall and adjusted for surgical era.METHODS: From January 2000 to May 2015, 283 consecutive patients underwent ASO for transposition of the great arteries. A total of 103 patients (36.4%) had an associated ventricular septal defect and 23 (8.1%) had an aortic arch obstruction. Coronary anomalies were present in 119 (42%) patients.RESULTS: Overall survival was 93.0 ± 1% at 15 years (19 events). Intraoperative revision of the coronary anastomosis was required in 8 patients (2.8%) due to inability to wean from cardiopulmonary bypass (CPB) or post-CPB myocardial ischaemia. Surgical revision was neither related to the underlying coronary anatomy (χ2 = 0.681, P = 0.4091) nor to the surgical era (χ2 = 0.682, P = 0.4090). Univariable analysis suggested decreased mortality rate for infants who underwent surgery during 2008 or later (P = 0.01). In multivariable analysis, intraoperative coronary button revision was the only predictor of mortality [P < 0.001, hazard ratio (HR) 12.01, 95% confidence interval (CI) 3.85–37.49], whereas surgical era (before 2008) failed to achieve statistical significance (P = 0.057, HR 2.19, 95% CI 0.96–12.04).CONCLUSIONS: In the recent era, unusual coronary patterns do not affect survival following ASO, whereas intraoperative coronary button revision is a predictor of mortality. Preventive strategies aimed towards intraoperative detection of impaired coronary perfusion are useful tools that might be considered for all patients in order to improve outcomes.
      PubDate: 2017-03-18
      DOI: 10.1093/ejcts/ezx055
      Issue No: Vol. 52, No. 1 (2017)
  • Single coronary artery and neonatal arterial switch operation: early and
           long-term outcomes †
    • Authors: Gerelli S; Pontailler M, Rochas B, et al.
      Pages: 90 - 95
      Abstract: OBJECTIVES: The presence of single coronary artery (CA) in the arterial switch operation (ASO) for neonatal treatment with transposition of the great arteries (TGA) has been reported to be an independent risk factor for early death after surgical repair and late reintervention. The study objective was to evaluate the mortality and the CA stenosis risk at early and long term in neonatal ASO for TGA and single CA.METHODS: Between January 1987 and January 2010, 979 neonates underwent an ASO, of which 73 had a single CA (7.5% of all cohort): right ostium with posterior left CA loop was the most frequent pattern (63%), followed by left ostium with an anterior right CA loop (26%). Mean age at operation was 9.3 ± 5.7 days. Mean follow-up was 9.8 years (range: 1–20 years).RESULTS: Eight patients (11%) died, 6 of coronary-related death. Overall, survival was 90.1 ± 1.9% at 1 year and 88.6% ± 3.8% at 2, 5, 10 and 15 years, respectively. Independent risk factor for mortality was associated surgery before 2001. Freedom from coronary events was 91.6 ± 3.3% at 1 year and 88.7 ± 3.8% at 5, 10 and 15 years respectively. No patients required late reintervention for CA surgery or angioplasty.CONCLUSIONS: All coronary-related death occurred within the first 6 months after ASO, and all patients but 1 were operated before 2001. In our experience, it appears that a single CA is not any more a risk factor for early and late mortality after ASO for TGA. Mortality has drastically reduced since 2001 and is now close to that found in TGA with standard coronary patterns. The acquired experience shared between the surgeons and the institution offsets the undeniable surgical difficulty.
      PubDate: 2017-03-07
      DOI: 10.1093/ejcts/ezx046
      Issue No: Vol. 52, No. 1 (2017)
  • Surgery for prosthetic valve endocarditis: a retrospective study of a
           national registry †
    • Authors: Della Corte A; Di Mauro M, Actis Dato G, et al.
      Pages: 105 - 111
      Abstract: OBJECTIVES: We described clinical–epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design.METHODS: Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study.RESULTS: Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980–2000, 2001–08 and 2009–14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P < 0.001), consistent with increasing mean patient age (56 ± 14, 64 ± 15, 65 ± 14 years, respectively, P < 0.001) and median logistic EuroSCORE (14%, 21%, 23%, P = 0.025). Older age, female sex, preoperative serum creatinine >-2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P = 0.03), renal insufficiency (OR = 2.1; P = 0.05), triple valve surgery (OR = 6.9; P = 0.004) and shock (OR = 4.5; P < 0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P < 0.001), Enterococcus (OR = 2.3; P = 0.01) and female sex (OR = 1.5; P = 0.03) independently predicted complications, whereas ejection fraction was protective.CONCLUSIONS: PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient’s haemodynamic status and microbiological factors.
      PubDate: 2017-03-13
      DOI: 10.1093/ejcts/ezx045
      Issue No: Vol. 52, No. 1 (2017)
  • Which technique of cusp repair is durable in reimplantation procedure'
    • Authors: Tanaka H; Takahashi H, Inoue T, et al.
      Pages: 112 - 117
      Abstract: OBJECTIVES: We aimed to ascertain the durability of cusp repair techniques used in reimplantation procedures.METHODS: Between 2000 and 2015, 249 patients (mean age, 49 ± 17 years) with aortic insufficiency underwent the reimplantation procedure. The pathology was acute aortic dissection in 24 and non-dissection in 225 patients. Preoperative aortic regurgitation (AR) was absent in 9, 1+ in 19, 2+ in 20, 3+ in 71 and 4+ in 120 patients. The mean aortic root and ascending aortic diameters were 47 ± 9 mm and 38 ± 7 mm, respectively. The following techniques of cusp repair were used: none (83), central plication (130), free margin reinforcement (57) and patch repair (19). Annual echocardiography was performed. Freedom from moderate aortic insufficiency and aortic valve reoperation were calculated by the Kaplan–Meier method. Factors influencing the freedom from moderate or severe AR were calculated by proportional hazard analysis.RESULTS: Mean follow-up period was 56 ± 44 months. Freedom from moderate or severe AR was 82%±3% and 77% ± 4% at 5 and 8 years, respectively, whereas freedom from aortic valve reoperation was 93%±8% and 87% ± 3% at 5 and 8 years, respectively. Recurrent AR and infection were causes of reoperation in 13 and 3 patients, respectively. Preoperative cusp prolapse, technique of free margin reinforcement used and patch repair were significant factors for recurrent AR by proportional hazard analysis. Central plication was not a significant factor for recurrent AR.CONCLUSIONS: Preoperative cusp prolapse was a risk factor, whereas central plication was not a risk factor for recurrent AR. Free margin reinforcement had a positive effect, whereas patch repair had a negative effect on aortic valve durability.
      PubDate: 2017-05-11
      DOI: 10.1093/ejcts/ezx034
      Issue No: Vol. 52, No. 1 (2017)
  • Early surgery versus conventional treatment for asymptomatic severe aortic
           regurgitation with normal ejection fraction and left ventricular
    • Authors: Wang Y; Jiang W, Liu J, et al.
      Pages: 118 - 124
      Abstract: OBJECTIVES: The management of patients with asymptomatic severe aortic regurgitation (AR) remains controversial. The aim of the present study was to assess and compare the clinical results between early surgery and conventional treatment for asymptomatic severe AR in patients with normal left ventricular (LV) systolic function and LV dilatation.METHODS: This retrospective cohort study included 230 consecutive patients with severe AR with left ventricular ejection function (LVEF ≥50%) and left ventricular end-diastolic dimension (LVEDD >70 mm) from 2003 to 2014. A total of 154 patients received early aortic valve replacement (AVR), whereas 76 patients received conventional treatment at the discretion of the surgeon. Overall and cardiovascular survival rates were evaluated between 2 groups with propensity score analysis.RESULTS: The patients had a mean age of 54.3 ± 14.1 years; 60.4% were men. Mean LVEF and LVEDD were 58.3 ± 7.7% and 75.3 ± 5.2 mm, respectively. Kaplan–Meier analysis revealed that early AVR was associated with better 10-year cardiovascular (P = 0.037) survivals in the overall population. In the 62 propensity score-matched pairs, early AVR was still associated with a significantly better 10-year overall survival (P = 0.018). Furthermore, patients who underwent early AVR had significantly improved 3-, 5- and 10-year cardiovascular survival rates of 98.3, 96.2 and 93.6%, respectively, compared with 93.5, 88.3 and 80.0% for those in the conventional treatment group (P = 0.008).CONCLUSIONS: Compared with conservative management, early AVR is associated with an improved long-term outcome in patients with asymptomatic severe AR with LVEF ≥50% and LVEDD >70 mm. These data provide new evidence to strongly support current guidelines, which recommend a strategy of early operative intervention.
      PubDate: 2017-02-17
      DOI: 10.1093/ejcts/ezx018
      Issue No: Vol. 52, No. 1 (2017)
  • Long-term results (up to 14 years) of the clover technique for the
           treatment of complex tricuspid valve regurgitation †
    • Authors: De Bonis M; Lapenna E, Di Sanzo S, et al.
      Pages: 125 - 130
      Abstract: OBJECTIVES: To report the long-term results of the clover technique for the treatment of complex forms of tricuspid regurgitation (TR).METHODS: Ninety-six consecutive patients (mean age 60 ± 16.4, left ventricular ejection fraction 58 ± 8.8%) with severe or moderately-severe TR due to important leaflets prolapse/flail (81 patients), tethering (13 patients) or mixed (2 patients) lesions underwent clover repair combined with annuloplasty. The aetiology of TR was degenerative in 74 cases (77.1%), post-traumatic in 9 (9.4%) and secondary to dilated cardiomyopathy in 13 (13.5%). All patients but 3 (96.8%) underwent ring (59 patients, 61.5%) or suture (34 patients, 35.4%) annuloplasty. Concomitant procedures (mainly mitral surgery) were performed in 82 patients (85.4%).RESULTS: Hospital mortality was 7.2%. At hospital discharge 92 (95.8%) patients had no or mild TR. Follow-up was 98% complete (median 9 years, interquartile range 5.1; 10.9). At 12 years the overall survival was 71.6 ± 7.22% and the cumulative incidence function of cardiac death with non-cardiac death as competing risk 16 ± 4.1% [95% confidence interval (95% CI) 9.5–25.7]. At 12 years the cumulative incidence function of TR ≥ 3+ and TR ≥ 2+ with death as competing risk were 1.2 ± 1.2% (95% CI 0.1–5.8) and 28 ± 7.7% (95% CI 14.3–43.5), respectively. Preoperative left ventricular ejection fraction (hazard ratio 0.9, CI 0.9–1, P = 0.05) and previous cardiac surgery (hazard ratio 2.7, 95% CI 1–7.1, P = 0.03) were predictors of recurrent TR ≥ 2+ at univariable but not at multivariable analysis.CONCLUSIONS: Complex forms of TR due to severe prolapse or tethering of the leaflets can be effectively treated with the clover technique with very satisfactory long-term results and extremely low recurrence of severe TR.
      PubDate: 2017-02-23
      DOI: 10.1093/ejcts/ezx027
      Issue No: Vol. 52, No. 1 (2017)
  • Minimally invasive or conventional edge-to-edge repair for severe mitral
           regurgitation due to bileaflet prolapse in Barlow’s disease: does the
           surgical approach have an impact on the long-term results' †
    • Authors: De Bonis M; Lapenna E, Del Forno B, et al.
      Pages: 131 - 136
      Abstract: OBJECTIVES: To evaluate whether the adoption of a right minithoracotomy operative approach had an impact on the long-term results of edge-to-edge (EE) repair compared to conventional sternotomy in patients with Barlow’s disease and bileaflet prolapse.METHODS: We assessed the long-term results of 104 patients with Barlow’s disease treated with a minimally invasive EE technique. An equal number of patients had a conventional median sternotomy EE repair for the same disease and were used as a control group. The inverse probability of treatment weighting was used to create comparable distributions of the covariates that were significantly different at baseline in the two groups. We performed a comparative analysis of the groups.RESULTS: No hospital deaths were observed. Follow-up was 99.5% complete (median 11.3 years). The cumulative incidence function (CIF) of cardiac death at 12 years, with noncardiac death as a competing risk, showed no difference between the two groups (P = 0.87). At 12 years, the CIF of recurrent MR ≥ 3+, with death as the competing risk, was 7% in the sternotomy group and 5% in the minimally invasive group (P = 0.30), and the CIF of recurrence of MR ≥ 2+ was 15 and 14%, respectively (P = 0.63). The type of surgical approach was not a predictor of cardiac death, reoperation, recurrent MR ≥ 3+ or recurrent MR ≥ 2+.CONCLUSIONS: A minimally invasive approach does not have a negative impact on the effectiveness and long-term durability of the EE repair for bileaflet prolapse in Barlow’s disease. Long-term outcomes are excellent, and valvular performance remains stable over time with no evidence of mitral stenosis.
      PubDate: 2017-04-11
      DOI: 10.1093/ejcts/ezx032
      Issue No: Vol. 52, No. 1 (2017)
  • Does implantation of a single clip provide reliable durability after
           transcatheter mitral repair' †
    • Authors: Buzzatti N; Denti P, La Canna G, et al.
      Pages: 137 - 142
      Abstract: OBJECTIVES: A single MitraClip implant is often considered enough to achieve adequate mitral regurgitation (MR) reduction. The aim of this study was to compare MR recurrence in patients with an initial optimal result treated with a single clip versus those treated with two clips.METHODS: From October 2008 to May 2016, 322 patients were treated with the MitraClip procedure at our institution. We retrospectively selected all patients treated for functional MR (FMR) and degenerative MR (DMR) aetiologies with residual MR ≤1+, excluding patients who required >2 clips. FMR and DMR were analysed separately.RESULTS: In FMR, a single clip was used in 45 patients and 2 clips in 99 patients. The single clip group had smaller coaptation depth (1.1 ± 0.3 vs 1.3 ± 0.3 mm, P = 0.022) and jet extension (10.5 ± 2.1 vs 13.0 ± 3.6 mm, P = 0.026) as well as left ventricular end-diastolic diameter (64.4 ± 7.3 vs 69.0 ± 7.9 mm, P = 0.001). Freedom from MR ≥ 3+ after 4 years was 71.9 ± 8.9% in patients receiving a single clip vs 88.0 ± 5.2% in those receiving 2 clips, single clip use being an independent predictor of MR recurrence (HR 3.48, CI 1.24–9.81, P = 0.018). In DMR, a single clip was deployed in 24 patients and 2 clips in 30 patients. The single clip group had a smaller flail gap (3.6 ± 0.7 vs 6.8 ± 2.5, P = 0.002). Freedom from MR ≥ 3+ after 2 years was 82.5 ± 8% in patients with a single clip vs 100% in those with 2 clips, P = 0.014. The residual mitral area was reduced in patients with 2 clips compared with those with single clip, both in FMR (P = 0.015) and DMR (P = 0.039), but it was not associated with increased death rate during the follow-up period (all P > 0.05).CONCLUSIONS: Despite favourable anatomical characteristics and an optimal initial result, implantation of a single clip was associated with an increased recurrence of MR compared with that of 2 clips, both in FMR and in DMR. Caution should be exercised with the implantation of a single clip.
      PubDate: 2017-02-27
      DOI: 10.1093/ejcts/ezx044
      Issue No: Vol. 52, No. 1 (2017)
  • Biological versus mechanical Bentall procedure for aortic root
           replacement: a propensity score analysis of a consecutive series of 1112
           patients †
    • Authors: Pantaleo A; Murana G, Di Marco L, et al.
      Pages: 143 - 149
      Abstract: OBJECTIVES: In this study, a propensity-matching analysis was used to compare biological versus mechanical composite valve graft implantation for early mortality and morbidities and for late complications including the need for aortic reintervention.METHODS: Between 1978 and 2011, 1112 consecutive patients underwent a complete aortic root replacement using either a biological Bentall (BB, n = 356) or a mechanical Bentall (MB, n = 756) valve conduit. Preoperative data were stratified according to the type of valve graft, and treatment bias was addressed by propensity score analysis.RESULTS: Two homogeneous groups of 138 patients were obtained. Hospital mortality between them was comparable (MB = 7.2% and BB = 5.8%, P = 0.6). They also had similar results after a mean follow-up time of 40 ± 38 months. Propensity-adjusted Cox-regression analysis showed no relationship between the type of prosthesis and all-cause mortality at follow-up (hazards ratio: 0.88; 95% confidence interval: 0.50–2.14; P = 0.4). Freedom from proximal aortic reintervention at 1, 5 and 7 years was 99.1 ± 0.9% in the MB group compared with 98.4 ± 1.1%, 93.0 ± 3.2% and 93.0 ± 3.2% in the BB group (long-rank P = 0.07).CONCLUSIONS: The Bentall procedure is a safe and reproducible treatment for ascending aorta pathologies. The choice of either a mechanical or a biological valve graft seems to have no influence on early and late midterm adverse outcomes including need for aortic reinterventions.
      PubDate: 2017-04-11
      DOI: 10.1093/ejcts/ezx070
      Issue No: Vol. 52, No. 1 (2017)
  • Remnant aortic remodelling in younger patients after acute type I aortic
           dissection surgery
    • Authors: Kim J; Ro S, Kim J, et al.
      Pages: 150 - 155
      Abstract: OBJECTIVES: To study the influence of age on remnant aortic remodelling after acute DeBakey type I aortic dissection (AD) surgery.METHODS: Between January 1999 and December 2013, 118 acute type I AD patients (26 aged <50 years, Group A; 92 aged ≥50 years, Group B) with either ascending or ascending hemiarch replacement in whom preoperative and >1-month postoperative chest computed tomography (CT) were available were included.RESULTS: At median CT follow-up of 35.1 (interquartile range, 14.1–65.2) months, the aortic dimensions in Group A increased significantly from the baseline values at the root, arch and descending thoracic aorta levels at 40.8 ± 5.3 mm to 43.1 ± 6.5 mm (P = 0.010), 36.8 ± 7.1 mm to 40.7 ± 8.8 mm (P = 0.043) and 36.7 ± 6.8 mm to 42.8 ± 11.4 mm (P = 0.009), respectively. In Group B, only the descending thoracic aorta had increased significantly from the baseline at 37.8 ± 4.8 mm to 40.7 ± 9.4 mm (P = 0.002). Linear regression analysis showed a significant correlation between younger age and aortic size increase, especially at the aortic sinus level. No significant between-group differences in mortality and reoperation rates were seen during the follow-up of 45.0 ± 33.6 months vs 44.1 ± 31.7 months, respectively.CONCLUSIONS: A significantly greater tendency for the remnant aorta to undergo more rapid and generalized adverse remodelling was seen in younger patients after acute type I AD surgery.
      PubDate: 2017-04-06
      DOI: 10.1093/ejcts/ezx057
      Issue No: Vol. 52, No. 1 (2017)
  • Genetic abnormalities in bicuspid aortic valve root phenotype: preliminary
           results †
    • Authors: Girdauskas E; Geist L, Disha K, et al.
      Pages: 156 - 162
      Abstract: OBJECTIVES: Genetic defects associated with bicuspid aortopathy have been infrequently analysed. Our goal was to examine the prevalence of rare genetic variants in patients with a bicuspid aortic valve (BAV) with a root phenotype using next-generation sequencing technology.METHODS: We investigated a total of 124 patients with BAV with a root dilatation phenotype who underwent aortic valve ± proximal aortic surgery at a single institution (BAV database, n = 812) during a 20-year period (1995–2015). Cross-sectional follow-up revealed 63 (51%) patients who were still alive and willing to participate. Systematic follow-up visits were scheduled from March to December 2015 and included aortic imaging as well as peripheral blood sampling for genetic testing. Next-generation sequencing libraries were prepared using a custom-made HaloPlex HS gene panel and included 20 candidate genes known to be associated with aortopathy and BAV. The primary end-point was the prevalence of genetic defects in our study cohort.RESULTS: A total of 63 patients (mean age 46 ± 10 years, 92% men) with BAV root phenotype and mean post-aortic valve replacement follow-up of 10.3 ± 4.9 years were included. Our genetic analysis yielded a wide spectrum of rare, potentially or likely pathogenic variants in 19 (30%) patients, with NOTCH1 variants being the most common (n = 6). Moreover, deleterious variants were revealed in AXIN1 (n = 3), NOS3 (n = 3), ELN (n = 2), FBN1 (n = 2), FN1 (n = 2) and rarely in other candidate genes.CONCLUSIONS: Our preliminary study demonstrates a high prevalence and a wide spectrum of rare genetic variants in patients with the BAV root phenotype, indicative of the potentially congenital origin of associated aortopathy in this specific BAV cohort.
      PubDate: 2017-04-06
      DOI: 10.1093/ejcts/ezx065
      Issue No: Vol. 52, No. 1 (2017)
  • Mid-term results of bilateral lung transplant with postoperatively
           extended intraoperative extracorporeal membrane oxygenation for severe
           pulmonary hypertension †
    • Authors: Salman J; Ius F, Sommer W, et al.
      Pages: 163 - 170
      Abstract: OBJECTIVES: In severe pulmonary hypertension, diastolic dysfunction of the left ventricle causes significant morbidity and mortality after lung transplantation, which may be successfully reversed using a protocol based on perioperative veno-arterial extracorporeal membrane oxygenation (ECMO) and early extubation. Here, we present echocardiographic data and mid-term outcomes.METHODS: The records of lung transplanted patients at our institution between May 2010 and January 2016 were retrospectively reviewed. Echocardiography data were collected preoperatively, at discharge, 3 and 12 months after transplantation.RESULTS: During the study period, 717 patients underwent lung transplantation at our institution, 38 (5%) patients being transplanted for severe pulmonary hypertension. All patients underwent bilateral lung transplantation on veno-arterial ECMO cannulated in the groin, through a sternum sparing thoracotomy in 36 (95%) patients. Extubation was performed early, after a median of 2 days, and awake ECMO was extended for at least 5 days after transplantation. The survival at 3 months, 1 year and 5 years was not different in comparison to patients transplanted for other underlying diseases (P = 0.45). At 1 year, tricuspid valve regurgitation had disappeared in all patients. The median of the left ventricular end-diastolic dimension improved from 40 (32–44) mm preoperatively to 45 (44–47) mm at 12 months after lung transplantation (P < 0.05). The median of the proximal right ventricular outflow diameter decreased to 25 (23–27) mm after 12 months, compared to 48 (43–51) mm preoperatively (P < 0.05).CONCLUSIONS: The routine application of a prophylactic postoperative veno-arterial ECMO protocol in patients with severe pulmonary hypertension undergoing lung transplantation decreases postoperative mortality and favours achievement of normal cardiac function after 1 year.
      PubDate: 2017-03-02
      DOI: 10.1093/ejcts/ezx047
      Issue No: Vol. 52, No. 1 (2017)
  • Ex vivo administration of trimetazidine improves post-transplant lung
           function in pig model †
    • Authors: Cosgun T; Iskender I, Yamada Y, et al.
      Pages: 171 - 177
      Abstract: OBJECTIVES:Ex vivo lung perfusion (EVLP) is not only used to assess marginal donor lungs but is also used as a platform to deliver therapeutic agents outside the body. We previously showed the beneficial effects of trimetazidine (TMZ) on ischaemia reperfusion (IR) injury in a rat model. This study evaluated the effects of TMZ in a pig EVLP transplant model.METHODS: Pig lungs were retrieved and stored for 24 h at 4°C, followed by 4 h of EVLP. Allografts were randomly allocated to 2 groups (n = 5 each). TMZ (5 mg/kg) was added to the prime solution prior to EVLP. After EVLP, left lungs were transplanted and recipients were observed for 4 h. Allograft gas exchange function and lung mechanics were recorded hourly throughout reperfusion. Microscopic lung injury and inflammatory and biochemical parameters were assessed.RESULTS: There was a trend towards better oxygenation during EVLP in the TMZ group (P = 0.06). After transplantation, pulmonary gas exchange was significantly better during the 4-h reperfusion period and after isolation of the allografts for 10 min (P < 0.05). Tissue thiobarbituric acid levels, myeloperoxidase activity and protein concentrations in bronchoalveolar lavage samples were significantly lower in the TMZ group at the end of EVLP (P < 0.05).CONCLUSIONS:Ex vivo treatment of donor lungs with TMZ significantly improved immediate post-transplant lung function. Further studies are warranted to understand the effect of this strategy on long-term lung function.
      PubDate: 2017-05-09
      DOI: 10.1093/ejcts/ezx053
      Issue No: Vol. 52, No. 1 (2017)
  • Can we make recovered donor lungs look brand-new again'
    • Authors: Ordies S; Neyrinck A, Van Raemdonck D.
      Pages: 178 - 179
      Abstract: Lung transplantationLung donorEx vivo lung perfusion
      PubDate: 2017-05-09
      DOI: 10.1093/ejcts/ezx139
      Issue No: Vol. 52, No. 1 (2017)
  • Myocardial energy metabolism and ultrastructure with polarizing and
           depolarizing cardioplegia in a porcine model †
    • Authors: Aass T; Stangeland L, Chambers DJ, et al.
      Pages: 180 - 188
      Abstract: OBJECTIVES: This study investigated whether the novel St. Thomas’ Hospital polarizing cardioplegic solution (STH-POL) with esmolol/adenosine/magnesium offers improved myocardial protection by reducing demands for high-energy phosphates during cardiac arrest compared to the depolarizing St. Thomas’ Hospital cardioplegic solution No 2 (STH-2).METHODS: Twenty anaesthetised pigs on tepid cardiopulmonary bypass were randomized to cardiac arrest for 60 min with antegrade freshly mixed, repeated, cold, oxygenated STH-POL or STH-2 blood cardioplegia every 20 min. Haemodynamic variables were continuously recorded. Left ventricular biopsies, snap-frozen in liquid nitrogen or fixed in glutaraldehyde, were obtained at Baseline, 58 min after cross-clamp and 20 and 180 min after weaning from bypass. Adenine nucleotides were evaluated by high-performance liquid chromatography, myocardial ultrastructure with morphometry.RESULTS: With STH-POL myocardial creatine phosphate was increased compared to STH-2 at 58 min of cross-clamp [59.9 ± 6.4 (SEM) vs 44.5 ± 7.4 nmol/mg protein; P < 0.025], and at 20 min after reperfusion (61.0 ± 6.7 vs 49.0 ± 5.5 nmol/mg protein; P < 0.05), ATP levels were increased at 20 min of reperfusion with STH-POL (35.4 ± 1.1 vs 32.4 ± 1.2 nmol/mg protein; P < 0.05). Mitochondrial surface-to-volume ratio was decreased with polarizing compared to depolarizing cardioplegia 20 min after reperfusion (6.74 ± 0.14 vs 7.46 ± 0.13 µm2/µm3; P = 0.047). None of these differences were present at 180 min of reperfusion. From 150 min of reperfusion and onwards, cardiac index was increased with STH-POL; 4.8 ± 0.2 compared to 4.0 ± 0.2 l/min/m2 (P = 0.011) for STH-2 at 180 min.CONCLUSIONS: Polarizing STH-POL cardioplegia improved energy status compared to standard STH-2 depolarizing blood cardioplegia during cardioplegic arrest and early after reperfusion.
      PubDate: 2017-03-02
      DOI: 10.1093/ejcts/ezx035
      Issue No: Vol. 52, No. 1 (2017)
  • Catheter-based tricuspid valve replacement: first experimental data of a
           newly designed bileaflet stent graft prosthesis †
    • Authors: Lausberg HF; Gryszkiewicz R, Kuetting M, et al.
      Pages: 189 - 196
      Abstract: OBJECTIVES: Moderate or severe degree tricuspid valve regurgitation (TVR) is associated with high rates of morbidity and mortality. Surgical correction as the only therapeutic option offers unsatisfactory results. Recently, several interventional procedures have been introduced clinically in a limited cohort. We present our initial experiments with an innovative interventional valved stent graft for treatment of TVR.METHODS: A newly designed porcine pericardium-covered nitinol stent graft with a lateral bicuspid valve was adapted to size in a cadaver study. After haemodynamic testing in an ex vivo perfusion setup, vascular access, valve delivery and function were investigated in an ovine animal model (n = 7).RESULTS: The device was implanted successfully in all animals. Vascular access was established surgically via the femoral vein without any vascular complications. Angiography demonstrated the correct position of the device with proper sealing of both venae cavae in 6 animals. In 1 extremely large animal, the position of the device was considered too cranial but still acceptable. Correct valve function was verified in all animals by both angiography and echocardiography. There were no persistent arrhythmias other than during valve implant. All animals survived the implant procedure and were sacrificed electively.CONCLUSIONS: This study demonstrated that this new valved stent graft could be delivered safely with correct positioning and valve function in this ovine model. Further long-term studies in animals implanted with the device after creation of tricuspid regurgitation are necessary to prove the haemodynamic benefit of this procedure.
      PubDate: 2017-04-18
      DOI: 10.1093/ejcts/ezx084
      Issue No: Vol. 52, No. 1 (2017)
  • Excision of epicardial cyst originating from the left ventricle using
           video-assisted thoracoscopic surgery without cardiopulmonary bypass
    • Authors: Kim Y; Kim J, Choi S, et al.
      Pages: 197 - 198
      Abstract: Pericardial cysts are occasionally encountered and successfully excised using video-assisted thoracoscopic surgery (VATS). However, cardiac cysts originating from the epicardium are extremely rare. Herein, we report an epicardial cyst that was completely excised using VATS. The epicardial cyst had a feeding vessel from the left ventricle and was considered to originate from the left ventricle. To the best of our knowledge, this case is the first to report excision of an epicardial cyst using VATS.
      PubDate: 2017-03-21
      DOI: 10.1093/ejcts/ezx067
      Issue No: Vol. 52, No. 1 (2017)
  • Complete dehiscence and embolization of tricuspid valve annuloplasty ring
           into left pulmonary artery
    • Authors: Jefkins M; Atoui R.
      Pages: 199 - 199
      Abstract: Endocarditis Valvular heart disease Annuloplasty Cardiac surgery Dehiscence
      PubDate: 2017-02-06
      DOI: 10.1093/ejcts/ezx012
      Issue No: Vol. 52, No. 1 (2017)
  • Total intravenous anaesthesia with local anaesthesia for controlling pain
           after spontaneous ventilation video-assisted thoracic surgery: is it a
           viable strategy'
    • Authors: Fiorelli A; Santini M.
      Pages: 200 - 200
      Abstract: Spontaneous ventilation video-assisted thoracic surgeryTotal intravenous anaesthesiaLocal anaesthesia
      PubDate: 2017-04-04
      DOI: 10.1093/ejcts/ezx093
      Issue No: Vol. 52, No. 1 (2017)
  • Reply to Fiorelli and Santini
    • Authors: Guo Z He J.
      Pages: 200 - 201
      Abstract: ThoracoscopySpontaneous ventilationTotal intravenous anaesthesiaLocal anaesthesia
      PubDate: 2017-04-04
      DOI: 10.1093/ejcts/ezx094
      Issue No: Vol. 52, No. 1 (2017)
  • Management of patients with transposition of the great arteries and intact
           interventricular septum †
    • Authors: Gopalakrishnan A; Krishnamoorthy K, Mohanan Nair K, et al.
      Pages: 201 - 201
      Abstract: Transposition of the great arteriesArterial switch operationLeft ventricular regression
      PubDate: 2017-04-21
      DOI: 10.1093/ejcts/ezx109
      Issue No: Vol. 52, No. 1 (2017)
  • Spotlight on recently published ICVTS articles
    • Pages: 202 - 202
      PubDate: 2017-06-21
      DOI: 10.1093/ejcts/ezx220
      Issue No: Vol. 52, No. 1 (2017)
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