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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: 9, SJR: 0.111, h-index: 4)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 60, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 86, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 18, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 151, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 38, SJR: 1.441, h-index: 77)
American J. of Epidemiology     Hybrid Journal   (Followers: 173, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 25, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 20)
American J. of Legal History     Full-text available via subscription   (Followers: 9, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 28, SJR: 0.824, h-index: 23)
American Literary History     Hybrid Journal   (Followers: 13, SJR: 0.185, h-index: 22)
Analysis     Hybrid Journal   (Followers: 23)
Annals of Botany     Hybrid Journal   (Followers: 35, SJR: 1.912, h-index: 124)
Annals of Occupational Hygiene     Hybrid Journal   (Followers: 28, 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: 18, SJR: 0.884, h-index: 31)
Applied Linguistics     Hybrid Journal   (Followers: 53, 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: 14)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 31, 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: 46, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 51, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 285, 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: 20, SJR: 2.801, h-index: 90)
BioScience     Hybrid Journal   (Followers: 30, 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: 165, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 65, SJR: 0.272, h-index: 20)
Brain     Hybrid Journal   (Followers: 66, SJR: 6.097, h-index: 264)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 47, 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: 35, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 27, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 576, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 87, 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: 30)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 4, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 59, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 10, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 11, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal   (Followers: 2)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 12, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 45, 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: 4)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 22, SJR: 0.737, h-index: 11)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 9, 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: 24, SJR: 0.1, h-index: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 62, SJR: 4.742, h-index: 261)
Clinical Kidney J.     Open Access   (Followers: 3, SJR: 0.338, h-index: 19)
Community Development J.     Hybrid Journal   (Followers: 25, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 9, 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: 5, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Legal Problems     Hybrid Journal   (Followers: 27)
Current Zoology     Full-text available via subscription   (Followers: 1, SJR: 0.999, h-index: 20)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 10, SJR: 1.068, h-index: 24)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 13)
Diplomatic History     Hybrid Journal   (Followers: 19, SJR: 0.296, h-index: 22)
DNA Research     Open Access   (Followers: 5, SJR: 2.42, h-index: 77)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 3)
Early Music     Hybrid Journal   (Followers: 15, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 38, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 55, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 14, 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: 3)
Environmental History     Hybrid Journal   (Followers: 28, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 9, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 16, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 52, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 8, 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: 7, 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: 179, 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: 23, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 11, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 29, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 41, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 13, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 10, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 22, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 27, SJR: 7.587, h-index: 150)
Fems Yeast Research     Hybrid Journal   (Followers: 14, SJR: 1.213, h-index: 66)
Foreign Policy Analysis     Hybrid Journal   (Followers: 23, SJR: 0.859, h-index: 10)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 15, 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: 32, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 20, 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: 14, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 35, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 27, SJR: 0.437, h-index: 13)
GigaScience     Open Access   (Followers: 3)
Global Summitry     Hybrid Journal   (Followers: 1)
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.692, h-index: 101)
Health and Social Work     Hybrid Journal   (Followers: 55, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 14, SJR: 0.814, h-index: 80)
Health Policy and Planning     Hybrid Journal   (Followers: 23, 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: 30, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 27, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 9, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 80, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 19, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 64, SJR: 0.7, h-index: 21)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 55, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 12)
ILAR J.     Hybrid Journal   (Followers: 2, 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: 1, 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: 9, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 33, 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: 11, 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: 52, SJR: 1.264, h-index: 53)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 31)
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: 34, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 63, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 170, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 5, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 29, 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: 9, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 35, 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: 34, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 18, 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: 40, 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: 48, SJR: 0.286, h-index: 34)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 14, SJR: 1.038, h-index: 60)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 14, SJR: 2.157, h-index: 149)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 4, SJR: 0.563, h-index: 43)
J. of Biochemistry     Hybrid Journal   (Followers: 42, SJR: 1.341, h-index: 96)
J. of Chromatographic Science     Hybrid Journal   (Followers: 18, 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: 36, 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: 13, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 43, SJR: 4.896, h-index: 121)
J. of Crohn's and Colitis     Hybrid Journal   (Followers: 10, SJR: 1.543, h-index: 37)
J. of Cybersecurity     Hybrid Journal   (Followers: 3)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 10, SJR: 0.69, h-index: 36)
J. of Design History     Hybrid Journal   (Followers: 18, 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: 24, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 24, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 21)
J. of Experimental Botany     Hybrid Journal   (Followers: 14, SJR: 2.798, h-index: 163)
J. of Financial Econometrics     Hybrid Journal   (Followers: 23, SJR: 1.314, h-index: 27)
J. of Global Security Studies     Hybrid Journal   (Followers: 4)
J. of Heredity     Hybrid Journal   (Followers: 4, SJR: 1.024, h-index: 76)
J. of Hindu Studies     Hybrid Journal   (Followers: 8, 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: 41, 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]
           criteria for the treatment of patients with severe aortic stenosisA report
           of the American College of Cardiology Appropriate Use Criteria Task Force,
           American Association for Thoracic Surgery, American Heart Association,
           American Society of Echocardiography, European Association for
           Cardio-Thoracic Surgery, Heart Valve Society, Society of Cardiovascular
           Anesthesiologists, Society for Cardiovascular Angiography and
           Interventions, Society of Cardiovascular Computed Tomography, Society for
           Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons
    • Authors: ; Bonow R, Brown A, et al.
      First page: 306
      Abstract: The American College of Cardiology collaborated with the American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Valve Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons to develop and evaluate Appropriate Use Criteria (AUC) for the treatment of patients with severe aortic stenosis (AS). This is the first AUC to address the topic of AS and its treatment options, including surgical aortic valve replacement and transcatheter aortic valve replacement.A number of common patient scenarios experienced in daily practice were developed along with assumptions and definitions for those scenarios, which were all created using guidelines, clinical trial data and expert opinion in the field of AS. The ‘2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines’ [1] and its 2017 focused update paper [2] were used as the primary guiding references in developing these indications. The Writing Group identified 95 clinical scenarios based on patient symptoms and clinical presentation, and up to 6 potential treatment options for those patients. A separate, independent Rating Panel was asked to score each indication from 1 to 9, with 1–3 categorized as ‘Rarely Appropriate’, 4–6 as ‘May Be Appropriate’ and 7–9 as ‘Appropriate’.After considering factors such as symptom status, left ventricular function, surgical risk, and the presence of concomitant coronary or other valve disease, the Rating Panel determined that either surgical aortic valve replacement or transcatheter aortic valve replacement is appropriate in most patients with symptomatic AS at intermediate or high surgical risk; however, situations commonly arise in clinical practice in which the indications for surgical aortic valve replacement or transcatheter aortic valve replacement are less clear, including situations in which one form of valve replacement would appear reasonable when the other is less so, as do other circumstances in which neither intervention is the suitable treatment option.The purpose of this AUC is to provide guidance to clinicians in the care of patients with severe AS by identifying the reasonable treatment and intervention options available based on the myriad clinical scenarios with which patients present. This AUC document also serves as an educational and quality improvement tool to identify patterns of care and reduce the number of rarely appropriate interventions in clinical practice.
      PubDate: Mon, 15 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx389
  • Spotlight on recently published ICVTS articles
    • First page: 488
      PubDate: Mon, 15 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx482
  • The great debate flashes: surgery versus stereotactic body radiotherapy as
           the primary treatment of early-stage lung cancer
    • Authors: Weder W; Moghanaki D, Stiles B, et al.
      First page: 295
      Abstract: Stereotactic body radiotherapy is gaining favour as an alternative therapeutic modality to surgery for patients with early-stage lung cancer. An exponential increase of contributions in the literature has generated a bulk of discordant evidence supporting therapeutic choice for the treatment of fit and medically inoperable patients. This ‘Great Debate Flashes’ paper aims at producing an up-to-date, concise and user-friendly review of the arguments that surgeons and radiation oncologists bring forward in the discussions with patients and colleagues.
      PubDate: Thu, 21 Dec 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx410
  • The European Registry for Patients with Mechanical Circulatory Support
           (EUROMACS) of the European Association for Cardio-Thoracic Surgery
           (EACTS): second report
    • Authors: de By T; Mohacsi P, Gahl B, et al.
      First page: 309
      Abstract: OBJECTIVESThe European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was founded in Berlin, Germany. EUROMACS is supported fully by the European Association for Cardio-Thoracic Surgery (EACTS) and, since 2014, has functioned as a committee of the EACTS. The purpose of having the EUROMACS as a part of the EACTS is to accumulate clinical data related to long-term mechanical circulatory support for scientific purposes and to publish annual reports.METHODSParticipating hospitals contributed surgical and cardiological pre-, peri- and long-term postoperative data of mechanical circulatory support implants to the registry. Data for all implants performed from 1 January 2011 to 31 December 2016 were analysed. Several auditing methods were used to monitor the quality of the data. Data could be provided for in-depth studies, and custom data could be provided at the request of clinicians and scientists. This report includes updates of patient characteristics, implant frequency, mortality rates and adverse events.RESULTSFifty-two hospitals participated in the registry. This report is based on 2947 registered implants in 2681 patients. Survival of adult patients (>17 years of age) with continuous-flow left ventricular assist devices with a mean follow-up of 391 days was 69% (95% confidence interval 66–71%) 1 year after implantation. On average, patients were observed for 12 months (median 7 months, range 0–70 months). When we investigated for adverse events, we found an overall event rate per 100 patient-months of 3.56 for device malfunction, 6.45 for major bleeding, 6.18 for major infection and 3.03 for neurological events within the first 3 months after implantation.CONCLUSIONSCompared to the first EUROMACS report, the number of participating hospitals increased from 21 to 52 (+148%), whereas the number of registered implants more than tripled from 825 to 2947 (+257%). The increase in the number of participating hospitals led us to increase the quality control measures through data input control, on-site audits and statistical analyses.
      PubDate: Fri, 29 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx320
  • Endovascular treatment of non-dissected ascending aorta disease: a
           systematic review
    • Authors: Wang C; Regar E, Lachat M, et al.
      First page: 317
      Abstract: SummarySevere ascending aorta disease includes aneurysms, pseudoaneurysms (ascending aorta pseudoaneurysms), penetrating aortic ulcers and Type A aortic dissections. Surgical replacement of the aortic root, ascending aorta or aortic arch is the common treatment for severe ascending aortic disease involving the root, the ascending aorta and/or the arch. Despite good surgical results, there is still a risk for morbidity and mortality following surgery for ascending aorta replacement when elderly patients or patients at high risk for surgery are concerned. Less invasive endovascular treatments for ascending aorta repair are under evaluation, and some reports appeared in the available literature in the last decade. However, clinical series or randomized studies are not yet available, and the use of these techniques is still questionable. In this study, we analysed the outcomes of reported cases of endovascular treatment for ascending aorta disease, excluding Type A aortic dissection. We reviewed reports published until February 2017, and we evaluated the employed technology, the devices, the procedural steps and the outcomes. A total of 26 articles reported 67 patients (mean age 65 ± 17 years) who received endovascular treatment for ascending aorta disease: aneurysms, ascending aorta pseudoaneurysms, penetrating aortic ulcers, intramural haematoma, thrombosis, iatrogenic coarctation and aortic rupture. Complications included endoleak (9 cases), stroke (3 cases), non-ST-elevation myocardial infarction (1 case) and splenic infarction (1 case). Three patients required conversion to open surgery, and 1 patient underwent endovascular reintervention. Early mortality was 2.9%. As an alternative treatment for ascending aorta disease in selected high-risk patients, the endovascular repair will gain popularity, but further analysis is required.
      PubDate: Mon, 18 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx308
  • Chewing 50 times per bite could help to resume oral feeding on the first
           postoperative day following minimally invasive oesophagectomy
    • Authors: Zhu Z; Li Y, Zheng Y, et al.
      First page: 325
      Abstract: OBJECTIVESIn our previous study, early oral feeding following McKeown minimally invasive oesophagectomy (MIE) has been shown to be a safe and a feasible approach for early recovery of intestinal function and an improvement of quality of life. This study investigates the effect of ‘chewing 50 times per bite’ on early oral feeding following MIE.METHODSBetween May 2016 and December 2016, we retrospectively analysed 95 cases of oesophageal carcinoma in patients who underwent MIE in our department. All patients received instructions for a ‘chewing 50 times per bite’ method for solid food intake on postoperative day (POD) 1. The primary end-points were the incidence of pneumonia and anastomotic leakage rate. In addition, postoperative nutritional status was studied.RESULTSOverall, 95 patients willingly started oral nutrition on POD 1. The rates of anastomotic leakage and pneumonia incidence were 2.1% and 7.4%, respectively. The caloric intake means on POD 1, POD 3 and POD 5 were 1388 ± 184, 1549 ± 206 and 1522 ± 203 respectively, which were 78%, 88% and 77% of the mean caloric requirements, respectively. There were no significant differences in protein index values between the preoperative measurements and the hospital discharge measurements.CONCLUSIONSThe ‘50 chewing times per bite’ solid food intake method on POD 1 in patients with MIE was shown to be feasible and safe, because the application of this method helps to convert solid food into liquid nutrition. More importantly, we demonstrated that it is possible for patients to be able to eat at will on Day 1 following MIE.
      PubDate: Wed, 23 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx291
  • Long-segment pulmonary artery resection to avoid pneumonectomy: long-term
           results after prosthetic replacement
    • Authors: D’Andrilli A; Maurizi G, Ciccone A, et al.
      First page: 331
      Abstract: OBJECTIVESResection of a long pulmonary artery (PA) segment infiltrated by tumour and reconstruction by conduit interposition or wide patch is a challenging but feasible option to avoid pneumonectomy. Our goal was to report the long-term results of our experience with this type of operation using various techniques and materials.METHODSBetween 1991 and 2015, 24 patients underwent sleeve resection of a long PA segment or extended resection (>2.5 cm) of 1 aspect of the circumference of the PA associated with lobectomy for centrally located lung cancer. Materials used for conduit reconstruction (20 patients) included pulmonary vein in 12 patients, autologous pericardium in 4, porcine pericardium in 3 and bovine pericardium in 1. Patches used in 4 patients consisted of porcine pericardium (2 patients) and pulmonary vein (2 patients).RESULTSTwenty-three patients underwent left upper lobectomy without associated bronchoplasty. One patient underwent bronchovascular left upper sleeve lobectomy. The postoperative morbidity rate was 29.1%. No complications related to the reconstructive procedure occurred. There were no postoperative deaths. Complete patency of the reconstructed PA was shown in all patients by postoperative contrast computed tomography performed every 6 months. Pathological tumour stage ranged from I to IIIA. Five-year overall survival and disease-free survival rates were 69.9% and 52.7%, respectively, at a median follow-up of 41 months.CONCLUSIONSResection of the long PA segment followed by conduit or wide patch reconstruction is a feasible, safe and effective option to avoid pneumonectomy. Different biological materials can be used to provide adequate tissue characteristics; the choice is made on a case-by-case basis. Long-term results confirm the oncological reliability of this operation.
      PubDate: Thu, 28 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx353
  • Preoperative short-term plus postoperative physical therapy versus
           postoperative physical therapy alone for patients undergoing lung cancer
           surgery: retrospective analysis of a nationwide inpatient database
    • Authors: Uda K; Matsui H, Fushimi K, et al.
      First page: 336
      Abstract: OBJECTIVESThe aim of this study is to determine whether physical therapy (PT) within 3 days before lung cancer surgery combined with postoperative PT reduces 30-day mortality and the incidence of postoperative pulmonary complications (PPCs) compared with postoperative PT alone.METHODSThis retrospective cohort study, using the Japanese Diagnosis Procedure Combination database, included patients aged ≥18 years who underwent non-small-cell lung cancer surgery and received PT on postoperative Day 1 or 2 between 2010 and 2015. Thirty-day mortality and incidence of PPCs (pneumonia, aspiration pneumonia and respiratory failure) were compared between patients who received preoperative PT within 3 days combined with postoperative PT and those who received postoperative PT alone using 1:1 propensity score matching.RESULTSOf 21 259 eligible patients, 6374 matched pairs were analysed by propensity score matching. There was no significant difference in 30-day mortality between postoperative PT with and without preoperative PT (0.2% vs 0.2%, P = 0.55; risk difference −0.05%, 95% confidence interval −0.2% to 0.1%) and no difference in the incidence of PPCs (2.4% vs 2.0%, P = 0.15; risk difference −0.4%, 95% confidence interval −0.9% to 0.1%).CONCLUSIONSPreoperative short-term plus postoperative PT for lung cancer surgery did not significantly reduce 30-day mortality or incidence of PPCs compared with postoperative PT alone in patients undergoing lung cancer surgery.
      PubDate: Fri, 18 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx301
  • Pathological lymph node involvement is not a predictor of adverse outcomes
           in patients undergoing thoracoscopic lobectomy for lung cancer†
    • Authors: Abah U; Casali G, Batchelor T, et al.
      First page: 342
      Abstract: OBJECTIVESAs the practice of video-assisted thoracoscopic surgery (VATS) lobectomy gains widespread acceptance, the complexity of procedures attempted increases and the stage of tumour that may be safely approached remains controversial. We examined the impact of nodal involvement with respect to perioperative outcomes after VATS lobectomy.METHODSAll patients listed for VATS lobectomy for non-small-cell lung cancer at our institution from 2012 to 2016 were analysed. Bronchoplastic or chest wall resections and tumours over 7 cm were considered a contraindication to a thoracoscopic approach.RESULTSOf the 489 patients identified, 97 (19.8%) patients had pathological nodal involvement. The overall conversion rate was 6.1%, reoperation rate was 5.3% and readmission rate was 5.9%. Median hospital stay was 5 days, 30-day mortality was 0.6% and 90-day mortality was 1.6%. No significant difference was identified between the nodal-negative or -positive groups in terms of preoperative demographics, hospital stay, postoperative complications, conversion rate, reoperation rate or readmission rate. Univariate logistic regression identified gender, Thoracoscore, dyspnoea score, performance status, chronic obstructive pulmonary disease, previous stroke, preoperative lung function and non-adenocarcinoma as predictors of postoperative complications. A multivariate model including nodal status identified Thoracoscore (odds ratio 1.57, 95% confidence interval 1.16–2.18; P < 0.001) and preoperative transfer factor (odds ratio 0.97, 95% confidence interval 0.96–0.98; P < 0.001) as the only predictors of complications.CONCLUSIONSIn non-small-cell lung cancer patients with pathological hilar or mediastinal lymph node involvement, VATS lobectomy can be safely performed, as there does not appear to be an adverse effect on the incidence of perioperative complications, length of stay or readmissions.
      PubDate: Tue, 29 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx297
  • Early outcomes of robotic versus uniportal video-assisted thoracic surgery
           for lung cancer: a propensity score-matched study
    • Authors: Yang S; Guo W, Chen X, et al.
      First page: 348
      Abstract: OBJECTIVESBoth robotic-assisted thoracic surgery (RATS) and uniportal video-assisted thoracic surgery (UVATS) are minimally invasive surgical techniques used for treatment of lung cancer. However, no research studies comparing early outcomes between RATS and UVATS have been reported.METHODSNon-small-cell lung cancer patients treated with RATS or UVATS at our institution from January 2015 to September 2016 were enrolled. Early outcomes were compared after propensity score-matched analysis using 4 factors: age, gender, tumour size and operative procedure.RESULTSA total of 153 patients were included in this study: 76 patients underwent RATS and 77 patients underwent UVATS. After propensity score-matched analysis, each group included 69 cases. The comparison of the 2 groups showed that there were no significant differences in operative time, postoperative hospital stay, chest tube duration, analgesic usage, complications or the number of resected lymph nodes. However, RATS caused less intraoperative blood loss (P = 0.037) and more dissected lymph node stations (P = 0.014).CONCLUSIONSJudging from the short-term outcomes, both RATS and UVATS are safe and feasible for non-small-cell lung cancer treatment. In particular, RATS is better able to reduce bleeding and complete lymphadenectomy than UVATS.
      PubDate: Wed, 30 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx310
  • Single-stage localization and removal of small lung nodules through
           image-guided video-assisted thoracoscopic surgery
    • Authors: Hsieh M; Fang H, Lin C, et al.
      First page: 353
      Abstract: OBJECTIVESThis case series illustrates the feasibility of single-stage image-guided video-assisted thoracoscopic surgery for simultaneous localization and removal of small solitary pulmonary nodules (SPNs). The procedure was performed in a hybrid operating room using C-arm cone-beam computed tomography equipped with a laser-guided navigation system.METHODSBetween October 2016 and January 2017, 12 consecutive patients presenting with SPNs underwent image-guided video-assisted thoracoscopic surgery. The feasibility and safety of the procedure were assessed through a retrospective review of the patients’ clinical charts.RESULTSThe median size of SPNs was 5.5 mm [interquartile range (IQR) 4−6 mm], whereas their median distance from the pleural surface was 11.7 mm (IQR 6−11.3 mm). All of the lesions were visible on intraoperative C-arm cone-beam computed tomography images, and localization was successful in 10 patients; thereafter, complete thoracoscopic resection was successfully performed. The median time required for the localization of SPNs was 45.5 min (IQR 36−60 min), whereas the median radiation exposure (expressed through the skin absorbed dose) was 223.2 mGy (IQR 180.3−321.3 mGy). Lesion localization was unsuccessful in 2 cases because to the development of pneumothorax induced by needle puncture. In such cases, a utility thoracotomy was required for the identification of SPNs. There was no operative mortality, and the median length of postoperative stay was 4 days (IQR 3.8–4 days).CONCLUSIONSThe results of our case series support the feasibility of image-guided video-assisted thoracoscopic surgery for detection and removal of SPNs. Future efforts should be tailored to decrease localization time and minimize radiation exposure.
      PubDate: Wed, 23 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx309
  • Multicentric evaluation of the impact of central tumour location when
           comparing rates of N1 upstaging in patients undergoing video-assisted and
           open surgery for clinical Stage I non-small-cell lung cancer†
    • Authors: Decaluwé H; Petersen R, Brunelli A, et al.
      First page: 359
      Abstract: OBJECTIVESLarge retrospective series have indicated lower rates of cN0 to pN1 nodal upstaging after video-assisted thoracic surgery (VATS) compared with open resections for Stage I non-small-cell lung cancer (NSCLC). The objective of our multicentre study was to investigate whether the presumed lower rate of N1 upstaging after VATS disappears after correction for central tumour location in a multivariable analysis.METHODSConsecutive patients operated for PET-CT based clinical Stage I NSCLC were selected from prospectively managed surgical databases in 11 European centres. Central tumour location was defined as contact with bronchovascular structures on computer tomography and/or visibility on standard bronchoscopy.RESULTSEight hundred and ninety-five patients underwent pulmonary resection by VATS (n = 699, 9% conversions) or an open technique (n = 196) in 2014. Incidence of nodal pN1 and pN2 upstaging was 8% and 7% after VATS and 15% and 6% after open surgery, respectively. pN1 was found in 27% of patients with central tumours. Less central tumours were operated on by VATS compared with the open technique (12% vs 28%, P < 0.001). Logistic regression analysis showed that only tumour location had a significant impact on N1 upstaging (OR 6.2, confidence interval 3.6–10.8; P < 0.001) and that the effect of surgical technique (VATS versus open surgery) was no longer significant when accounting for tumour location.CONCLUSIONSA quarter of patients with central clinical Stage I NSCLC was upstaged to pN1 at resection. Central tumour location was the only independent factor associated with N1 upstaging, undermining the evidence for lower N1 upstaging after VATS resections. Studies investigating N1 upstaging after VATS compared with open surgery should be interpreted with caution due to possible selection bias, i.e. relatively more central tumours in the open group with a higher chance of N1 upstaging.
      PubDate: Wed, 27 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx338
  • Postoperative complications and prognosis after lobar resection versus
           sublobar resection in elderly patients with clinical Stage I
           non-small-cell lung cancer
    • Authors: Tsutani Y; Tsubokawa N, Ito M, et al.
      First page: 366
      Abstract: OBJECTIVESThe study aimed to investigate the outcomes of sublobar resection in elderly patients with non-small-cell lung cancer.METHODSA total of 205 patients aged ≥75 years were identified from 794 consecutive patients who underwent complete surgical resection for clinical Stage I non-small-cell lung cancer. The outcomes of lobectomy and sublobar resection were compared. Propensity scores were estimated for multivariable analyses and matching.RESULTSSublobar resection (n = 99) was more frequently performed than lobectomy (n = 106) in older patients (P = 0.027) and those with lower maximum standardized uptake on positron emission tomography (P < 0.001), lower T stage (P < 0.001), lower %vital capacity (P = 0.007) and lower %diffusing capacity of the lungs for carbon monoxide (P = 0.025). Severe (≥Grade IIIa) postoperative complications occurred more frequently with lobectomy (11 of 106 procedures, 10.4%) than with sublobar resection (5 of 99, 5.1%; P = 0.16). In propensity score-adjusted multivariable analysis, lobectomy was an independent predictive factor for severe postoperative complications (odds ratio 3.49, 95% confidence interval 1.01–12.05; P = 0.048). Overall survival (OS) was not significantly different following lobectomy (5-year OS 67.2%) or sublobar resection (5-year OS 73.9%; P = 0.93). In multivariable analysis, the surgical procedure was not an independent predictive factor for OS (lobectomy: hazard ratio 1.03, 95% confidence interval 0.49–2.16; P = 0.94).CONCLUSIONSSublobar resection may be the optimal procedure in elderly patients with clinical Stage I non-small-cell lung cancer and is associated with less severe postoperative complications than lobectomy and similar OS.
      PubDate: Wed, 06 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx296
  • Invasive features of small-sized lung adenocarcinoma adjoining
           emphysematous bullae
    • Authors: Toyokawa G; Shimokawa M, Kozuma Y, et al.
      First page: 372
      Abstract: OBJECTIVESRadiologically small-sized adenocarcinomas are special entities of lung cancer, as their radiological and pathological invasiveness determines the surgical procedures applied; however, the clinicopathological features of small-sized lung adenocarcinoma adjoining cystic airspaces (Ca-ADJ) have yet to be fully clarified. The aim of this study was to elucidate the clinicopathological characteristics, including the programmed death ligand 1 (PD-L1) expression, in patients with Ca-ADJ ≤3.0 cm.METHODSA total of 283 patients with resected adenocarcinoma, whose radiological tumour size was ≤3.0 cm without lymph node or distant metastases on preoperative high-resolution computed tomography, were analysed for their clinicopathological and radiological features. Furthermore, the PD-L1 expression was evaluated by immunohistochemistry using an anti-human PD-L1 rabbit monoclonal antibody (clone SP142).RESULTSAmong the 283 patients, 31 (11.0%) patients were reported to have Ca-ADJ. The Fisher’s exact test demonstrated that Ca-ADJ was significantly associated with male gender (P < 0.001), a history of smoking (P < 0.001), a high consolidation/tumour ratio (P = 0.026), advanced pathological stage (P < 0.001), the presence of pleural (P < 0.001) and vessel invasion (P < 0.001), histological invasive subtypes (P < 0.001) and wild-type epidermal growth factor receptor (P = 0.001). The patients with Ca-ADJ had a significantly higher maximum standardized uptake value than those without Ca-ADJ (8.4 vs 4.1, P < 0.001). Furthermore, Ca-ADJ was significantly associated with the PD-L1 expression (P < 0.001). Log-rank test showed that patients with Ca-ADJ had a significantly shorter disease-free survival than those without Ca-ADJ (P = 0.001).CONCLUSIONSThis study showed that patients with radiologically small-sized Ca-ADJ might exhibit radiologically and pathologically invasive features.
      PubDate: Tue, 29 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx295
  • A novel model uses metabolic and volumetric parameters to predict less
           invasive lung adenocarcinomas†
    • Authors: Ishikawa Y; Kojima F, Yoshiyasu N, et al.
      First page: 379
      Abstract: OBJECTIVESThis study aimed to develop a prediction model for less invasive lesions of pathological Stage IA adenocarcinomas.METHODSWe retrospectively evaluated 121 lesions from 114 patients with pathological Stage IA adenocarcinoma who underwent surgery after fluorodeoxyglucose positron emission tomography and high-resolution computed tomography. Less invasive lesions were adenocarcinoma in situ and minimally invasive adenocarcinoma. The 3D parameter, solid tumour ratio, was the volume ratio of the solid part to the whole tumour. The 2D parameter was the consolidation-to-tumour ratio. The maximum standardized uptake value (SUVmax) in fluorodeoxyglucose positron emission tomography was the metabolic parameter. A volumetric analysis programme semiautomatically measured these 3 parameters. The cut-off values were 0.5, 0.125 and 1.0 for the consolidation-to-tumour ratio, solid tumour ratio and SUVmax, respectively. Multivariable logistic regression analysis was used to select the prediction model parameters.RESULTSThere were 34 (28.1%) less invasive lesions. A consolidation-to-tumour ratio <0.5 was an insignificant predictive factor for less invasive lesions in the multivariable analysis. The prediction model had a total score of 3 points: 1 point for SUVmax <1.0 and 2 points for the solid tumour ratio <0.125. The area under the receiver operating characteristic curve in this model was 0.86 (95% confidence interval 0.78–0.94). The total score indicated 89.5% probability of possessing less invasive lesions.CONCLUSIONSThe solid tumour ratio and SUVmax effectively predicted less invasive lesions in early-stage lung adenocarcinomas. The prediction model generated by volumetric and metabolic parameters showed higher predictive power in this clinical setting.
      PubDate: Wed, 09 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx273
  • Spinal ischaemia after thoracic endovascular aortic repair with left
           subclavian artery sacrifice: is there a critical stent graft length'
    • Authors: Kari F; Saravi B, Krause S, et al.
      First page: 385
      Abstract: OBJECTIVESThoracic endovascular aortic repair (TEVAR) is used for treatment of thoracic aortic pathologies, but the covered stent graft can induce spinal ischaemia depending on the length used. The left subclavian artery contributes to spinal cord collateralization and is frequently occluded by the stent graft. Our objective was to investigate the impact of covered stent graft length on the risk of spinal ischaemia in the setting of left subclavian artery sacrifice.METHODSTwenty-six pigs (German country race, mean body weight 36 ± 4 kg) underwent simulated descending aortic TEVAR via left lateral thoracotomy, with left subclavian artery and thoracic segmental artery occlusion in normothermia. Animals were assigned to treatment groups according to simulated stent graft length: TEVAR to T8 (n = 4), TEVAR to T9 (n = 4), TEVAR to T10 (n = 4), TEVAR to T11 (n = 7) and TEVAR to T12 (n = 1) and a sham group (n = 6). End points included spinal cord perfusion pressure, cerebrospinal fluid pressure and spinal cord blood flow using fluorescent microspheres.RESULTSThere were no group differences in spinal cord perfusion pressure drop or in spinal cord perfusion pressure regeneration potential at 3 h after the procedure: from a baseline average of 75 mmHg (95% confidence interval 71–83 mmHg) to 73 mmHg (67–75 mmHg) at 3 h in Group T10 versus from a baseline average of 67 mmHg (95% CI 50–81 mmHg) to 65 mmHg (95% confidence interval 48–81 mmHg) in Group T8. There were no differences in the spinal cord blood flow courses over time in the different groups nor was there any difference in cerebrospinal fluid pressure levels and cerebrospinal fluid pressure dynamics between groups. However, we did observe local blood flow distribution to the spinal cord that was inhomogeneous depending on the distance between the simulated stent graft end and the first thoracic anterior radiculomedullary artery.CONCLUSIONSThe risk of spinal ischaemia after serial segmental artery occlusion does not depend on the distal extent of the aortic repair alone. Future attempts to allow patient risk stratification for spinal ischaemia need to focus on anterior radiculomedullary artery anatomy together with the extent of planned aortic repair.
      PubDate: Thu, 24 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx285
  • Efficacy of esmolol cardioplegia during hypothermic ischaemia
    • Authors: Nishina D; Chambers D.
      First page: 392
      Abstract: OBJECTIVESCardioplegic arrest using a polarizing solution has been shown to have beneficial advantages for cardioprotection compared with depolarizing (potassium-based) arrest; most studies, however, have looked at normothermic ischaemia with short infusion intervals (every 10–15 min). This study examines the protective efficacy of an esmolol-based cardioplegia during hypothermic arrest, together with a prolonged infusion interval (30 min) for increased clinical feasibility.METHODSIsolated Langendorff-perfused hearts were subjected to arrest with St Thomas’ Hospital cardioplegia (STH2), or esmolol cardioplegia (single- or multidose infusion at 32°C) for 60-min, 90-min or 120-min global ischaemia at 32°C, and recovery of function (left ventricular developed pressure) measured. A further study examined the protective efficacy of multidose esmolol cardioplegia compared with hypothermia alone at temperatures of 20°C, 28°C and 32°C compared with 37°C for 120 min of ischaemia.RESULTSEsmolol cardioplegic arrest with multidose infusion at 32°C significantly improved recovery of function (left ventricular developed pressure) compared with 32°C STH2, at each ischaemic duration (88 ± 3 vs 66 ± 3% at 60 min, 82 ± 3 vs 51 ± 3% at 90 min and 73 ± 6 vs 49 ± 4% at 120 min; P < 0.05). At various hypothermic temperatures, esmolol cardioplegia significantly improved protection compared with hypothermia alone (88 ± 4%, 88 ± 3% and 72 ± 3% vs 60 ± 3%, 30 ± 2% and 15 ± 1% at 20°C, 28°C and 32°C, respectively; P < 0.05); however, at 37°C, there was no difference in protection. Contracture during ischaemia mirrored the effects of left ventricular developed pressure recovery.CONCLUSIONSEsmolol cardioplegia (a polarizing solution), used as a multidose infusion during hypothermia, significantly improved cardioprotection compared with the depolarizing STH2. An increased infusion interval of 30 min indicates improved clinical feasibility.
      PubDate: Sat, 02 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx311
  • Recipient treatment with acetylcholinesterase inhibitor donepezil
           attenuates primary graft failure in rats through inhibiting
           post-transplantational donor heart ischaemia/reperfusion injury
    • Authors: Yuan X; Teng X, Wang Y, et al.
      First page: 400
      Abstract: OBJECTIVESIschaemia/reperfusion injury may have deleterious consequences on heart transplantation. The underlying causes such as inflammation may also contribute to the pathogenesis of primary or chronic graft failure. We hypothesize that donepezil (DO), a reversible acetylcholinesterase inhibitor that increases cholinergic receptor activation, may protect the transplanted heart through increasing the level of acetylcholine, which in turn inhibits systemic inflammation in the recipients.METHODSFirst, Lewis–Lewis heart transplantation model was successfully established, and 75 rats were randomly assigned into 3 groups: the DO group (received single dose of intragastric DO treatment), the donepezil + methyllycaconitine group (α7 nicotinic acetylcholine receptor inhibitor) and the control group. Ten rats per group were sacrificed at 24 h after drug administration, whereas the rest of the groups were observed 1 month after surgery. The status of inflammation, survival of the graft and function of the graft were examined.RESULTSSerum tumour necrosis factor α level was significantly lower in the donepezil group when compared with the control group 24 h after first drug administration; this trend was maintained for 1 month (P < 0.001). Furthermore, DO inhibited CD11b/18-positive cell infiltration (P < 0.001) and myocardiocyte apoptosis (as shown by the percentage of terminal deoxynucleotidyl transferase-mediated 2ʹ-deoxyuridine 5ʹ-triphosphate-biotin nick-end labelling-positive nuclei, P = 0.039) in the recipient rats at 24 h after the first drug administration. The percentage of cardiac grafts that survived for 1 month in rats given DO alone was significantly higher (80.0%, 33.3% and 26.7% in the DO, donepezil + methyllycaconitine and control groups, respectively, P = 0.014); the fractional shortening value of the DO group was significantly higher than that in the other 2 groups (29.25 ± 1.84%, 17.92 ± 3.69% and 17.07 ± 2.99% in the DO, donepezil + methyllycaconitine and control group, respectively, P < 0.001). The collagen volume fraction was lower in the DO group than in the other 2 groups (P < 0.001).CONCLUSIONSOur results reveal that treatment of the recipient with DO protects the donor hearts for 1 month after transplantation through suppressing the signalling pathway of inflammation. These results suggest that DO is a novel and clinically feasible strategy to protect the donor heart in transplantation in the long term.
      PubDate: Fri, 18 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx289
  • Small-sized conduits in the right ventricular outflow tract in young
           children: bicuspidalized homografts are a good alternative to standard
    • Authors: François K; De Groote K, Vandekerckhove K, et al.
      First page: 409
      Abstract: OBJECTIVESDownsizing a homograft (HG) through bicuspidalization has been used for more than 2 decades to overcome the shortage of small-sized conduits for reconstruction of the right ventricular outflow tract (RVOT) in young children. Our goal was to investigate the durability of bicuspidalized HGs compared with other small HGs.METHODSA retrospective analysis of 93 conduits ≤20 mm, implanted over 23 years, was performed. The end-points were survival, structural valve degeneration and conduit replacement. The conduits comprised 40 pulmonary HGs, 12 aortic HGs, 17 bicuspidalized HGs and 24 xenografts.RESULTSThe median age, mean conduit diameter and z-value at implantation were 1.4 (interquartile range 0.3–3) years, 16.5 ± 2.7 mm and 2.8 ± 1.3, respectively. Valve position was heterotopic in 59 patients and orthotopic in 34 patients. At a mean follow-up period of 7.6 ± 5.9 years, the hospital survival rate was 89%. Freedom from explant at 5 and 10 years was 83 ± 5% and 52 ± 6%, respectively. Freedom from structural valve degeneration was 79 ± 5% at 5 years and 47 ± 6% at 10 years [68 ± 8% for pulmonary HG, 42 ± 16% for bicuspidalized HG, 31 ± 15% for aortic HG and 20 ± 9% for xenografts (log rank P < 0.001)]. Multivariable analysis indicated an increased risk for structural valve degeneration with smaller conduit size (hazard ratio 0.79, 95% confidence interval 0.67–0.94; P < 0.008), extra-anatomic position (hazard ratio 2.71, 95% confidence interval 1.33–5.50; P = 0.006) and the use of xenografts compared with non-downsized pulmonary HGs (hazard ratio 4.90, 95% confidence interval 2.23–10.76; P < 0.001).CONCLUSIONSAppropriately sized pulmonary HGs remain the most durable option for a right ventricular outflow tract conduit in young children. However, when a small pulmonary HG is unavailable, bicuspidalization offers a valid alternative, preferable to xenograft conduits, at mid-term follow-up.
      PubDate: Tue, 03 Oct 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx354
  • Cerebral strokes in children on intracorporeal ventricular assist devices:
           analysis of the EUROMACS Registry
    • Authors: Schweiger M; Miera O, de By T, et al.
      First page: 416
      Abstract: OBJECTIVESLittle is known about cerebral strokes in paediatric patients supported by intracorporeal continuous-flow ventricular assist devices.METHODSWe retrospectively investigated patients younger than 19 years of age who were treated with an intracorporeal continuous-flow ventricular assist device in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) database. The patients were stratified by body surface area in Group 1 [<1.2 m2 (n = 13)] and Group 2 [≥1.2 m2 (n = 38)]. Cerebral strokes, both ischaemic and haemorrhagic, were studied.RESULTSOf the 2941 patients with ventricular assist device (VAD) implants listed in the database, 124 (4%) patients were less than 19 years of age. Fifty-one of them (2%) were supported with a continuous-flow ventricular assist device. Group 1 (6 female and 7 male) had a mean age (±SD) of 9 ± 2.3 years compared with 15.6 ± 1.8 years in Group 2 (21 female and 17 male). Three (23%) patients died in Group 1 on VAD support, whereas 5 (13%) patients died in Group 2 (P = 0.21; log-rank test). Seven (54%) patients with a VAD in Group 1 and 17 (45%) patients in Group 2 underwent transplantation (P = 0.29); of these, 1 (8%) patient recovered (Group 1) with subsequent device explantation. The other patients, 2 in Group 1 and 16 in Group 2, were still on device support at the time of the analysis. There were no cerebral strokes in Group 1, but 4 cerebral strokes (11% of Group 2, 8% of a total of 51 patients in Groups 1 and 2 combined) occurred in Group 2 (3 patients died; P = 0.26; log-rank test). Taken together, the incidence of cerebral strokes in this paediatric cohort of patients with an intracorporeal VAD was 0.1 per patient-year.CONCLUSIONSThe incidence of cerebral strokes in children with intracorporeal VADs (0.1 per patient-year) seems to be low irrespective of the body surface area.
      PubDate: Mon, 25 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx342
  • Five-year results of patients supported by HeartMate II: outcomes and
           adverse events
    • Authors: Hanke J; Rojas S, Mahr C, et al.
      First page: 422
      Abstract: OBJECTIVESImproved outcomes over the past decade have increased confidence of physicians and patients in extended duration of left ventricular assist device (LVAD) support. This single-centre cohort study reports 5-year outcomes with the HeartMate II (HMII) LVAD.METHODSWe describe a cohort of 89 patients who received a HMII LVAD between February 2004 and December 2010. The causes of death and adverse events were assessed by examination of medical records. A total of 202.74 patient-years were analysed.RESULTSAfter 5 years, of the 89 patients, 15 patients remained on device therapy, 39 patients died, 28 patients underwent heart transplantation and 7 patients underwent explantation of the HMII for recovery. One year after the HMII implantation, there was a survival of 71% in the study cohort. In the following years, the survival rate was 65% in the 2nd year, 63% in the 3rd year, 56% in the 4th year and 54% after 5 years of LVAD support. Ten LVAD exchanges were performed in 8 (11%) patients. Currently (March 2017), 12 patients still remain on their original device. The longest ongoing patient on the HMII has been supported for over 11 years (4097 days). The most common adverse events were bleeding (68%; 1.5837 events per patient-year) and LVAD infection [49%; 1.0666 events per patient-year]. Seven cases of pump thrombosis were described (8%; 0.1131 events per patient-year).CONCLUSIONSThis is the first single-cohort study to describe a 5-year survival of HMII patients on extended duration of support. A 5-year survival of 54% was observed in this single-centre cohort.
      PubDate: Sat, 02 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx313
  • Adding vancomycin to perioperative prophylaxis decreases deep sternal
           wound infections in high-risk cardiac surgery patients
    • Authors: Reineke S; Carrel T, Eigenmann V, et al.
      First page: 428
      Abstract: OBJECTIVESPerioperative prophylaxis with cephalosporins reduces sternal wound infections (SWIs) after cardiac surgery. However, more than 50% of coagulase-negative staphylococci, an important pathogen, are cephalosporin resistant. The aim of this study was to determine the impact of adjunctive vancomycin on SWIs in high-risk patients.METHODSWe conducted a pre- and postintervention study in an academic hospital. Preintervention (2010–2011), all patients received prophylaxis with 1.5 g of cefuroxime for 48 h. During the intervention period (2012–2013), high-risk patients additionally received 1 g of vancomycin. High-risk status was defined as body mass index ≤18 or ≥ 30 kg/m2, reoperation, renal failure, diabetes mellitus, chronic obstructive pulmonary disease or immunosuppressive medication. Time series analysis was performed to study SWI trends and logistic regression to determine the effect of adding vancomycin adjusting for high-risk status.RESULTSA total of 3902 consecutive patients (n = 1915 preintervention and n = 1987 postintervention) were included, of which 1493 (38%) patients were high-risk patients. In the high-risk group, 61 of 711 (8.6%) patients had SWI before and 30 of 782 (3.8%) patients after the intervention. Focusing on deep SWI (DSWI), 33 of 711 (4.6%) patients had DSWI before and 13 of 782 (1.7%) patients afterwards; the absolute risk difference of 2.9% yielded a number-needed-to-treat of 34 to prevent 1 DSWI. Corrected for high-risk status, adding vancomycin significantly reduced the overall SWI rate (odds ratio 0.42, 95% confidence interval 0.26–0.67; P < 0.001) and the subset of DSWI (odds ratio 0.30, 95% confidence interval 0.14–0.62; P = 0.001). The rate of SWI in low-risk patients remained unchanged.CONCLUSIONSAdding vancomycin to standard antibiotic prophylaxis in high-risk patients significantly reduced DSWI after cardiac surgery.
      PubDate: Mon, 16 Oct 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx328
  • Outcomes of surgery for infective endocarditis: a single-centre experience
           of 801 patients
    • Authors: Said S; Abdelsattar Z, Schaff H, et al.
      First page: 435
      Abstract: OBJECTIVESInfective endocarditis (IE) remains a life-threatening disease, despite the improvement in diagnostic and therapeutic measures. We reviewed our outcomes for all adults who underwent surgery for endocarditis at our centre.METHODSBetween January 1995 and December 2013, 801 patients [586 men (73%)] underwent surgery for IE. Mean age was 60 ± 14.7 years. Native endocarditis (NE) was present in 372 patients (46%), and 379 (47%) patients had active IE. The mean follow-up period was 4.6 ± 4.75 years (maximum 20 years).RESULTSSingle-valve endocarditis was present in 551 (69%) patients (392 aortic and 159 mitral). Multivalve involvement was present in 250 (31%) patients. Preoperative stroke was present in 149 (19%) patients, while 62 (8%) patients were on dialysis prior to surgery. Valve repair was possible in 122 (15%) patients, while 679 (85%) patients underwent valve replacement. Mechanical valves were used in 312 (39%) patients. Aortic homografts were used in 84 (10%) patients. Early mortality occurred in 64 (8%) patients. Overall survival at 5, 10 and 20 years was 68%, 45% and 8.4%, respectively. Postoperative stroke occurred in 16 (2%) patients, while 59 (7%) patients required new dialysis postoperatively. Multivariate analysis revealed active IE (P = 0.002), preoperative dialysis (P = 0.007), previous coronary artery bypass grafting (P = 0.001), root abscess (P = 0.006) and tricuspid valve or multivalve involvement (P = 0.002) to be predictors of early mortality. The need for dialysis (P < 0.001), previous coronary artery bypass grafting (P < 0.001) and mitral valve (P = 0.002) and tricuspid valve/multivalve involvement (P < 0.001) were significant predictors of late mortality.CONCLUSIONSActive IE is associated with high perioperative mortality especially with multivalve and aortic root involvement. Preoperative stroke has no impact on perioperative mortality. Long-term survival for those who survived the immediate postoperative period is satisfactory, and mechanical valves are associated with the best long-term survival.
      PubDate: Tue, 03 Oct 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx341
  • Ten-year experience of endocardial linear infarct exclusion technique for
           ischaemic cardiomyopathy
    • Authors: Ohira S; Yamazaki S, Numata S, et al.
      First page: 440
      Abstract: OBJECTIVESTo report the mid-term results of our surgical ventricular restoration procedure, called the endocardial linear infarct exclusion technique (ELIET), for ischaemic cardiomyopathy.METHODSFrom 2006 to 2015, 43 consecutive patients who underwent surgical ventricular restoration with ELIET for ischaemic cardiomyopathy were retrospectively analysed.RESULTSThe mean age of patients at surgery was 65.3 ± 9.2 years and EuroSCORE II was 13.7 ± 12.0% (median 9.3%). The mean number of distal anastomoses of coronary artery bypass was 2.8 ± 1.5. A concomitant mitral procedure was performed in 58.1% of patients. The hospital mortality rate was 11.6% (5 patients). The ejection fraction was improved from 24.1 ± 9.2% to 31.7 ± 8.2% in 2 weeks after surgery. The end-systolic left ventricular volume index was effectively reduced, irrespective of performing a concomitant mitral procedure (reduction rate, ELIET: 35.6% vs ELIET + mitral: 39.2%). After ELIET, the sphericity index of the left ventricle did not worsen, and the conicity index was significantly improved. The 5-year estimated rates of survival and freedom from cardiac events were 71.3 ± 7.9 and 61.1 ± 8.3%, respectively. A concomitant mitral procedure was significantly associated with cardiac events based on univariate Cox hazard analysis.CONCLUSIONSThis study showed that ELIET can effectively reduce the ventricular volume and create an ellipsoidal left ventricle.
      PubDate: Mon, 25 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx343
  • No improvements in long-term outcome after coronary artery bypass grafting
           with arterial grafts as a second conduit: a Swedish nationwide registry
    • Authors: Janiec M; Dimberg A, Nazari Shafti T, et al.
      First page: 448
      Abstract: OBJECTIVESCoronary artery bypass grafting using saphenous vein grafts (SVGs) in addition to the left internal mammary artery (IMA) graft is vitiated by poor long-term patency of the vein grafts. Hypothetically, the increased use of arterial grafts could confer even better outcomes. Our goal was to evaluate results after coronary artery bypass grafting in Sweden, where arterial grafts were used as a second conduit.METHODSWithin the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, we identified patients who had coronary artery bypass grafting from 2001 to 2015 using the IMA and the SVG, the radial artery (RA) or the additional IMA [bilateral IMA (BIMA)] as a second conduit. Deaths, postoperative incidence of coronary angiography and need for reintervention were recorded, and multivariable adjusted hazard ratios were calculated for different types of grafts.RESULTSThe study population comprised 46 343 cases of IMA + SVG, 1036 cases of IMA + RA and 862 cases of BIMA. The mean follow-up time (SD) was 9.3 (4.2) years for IMA + SVG, 10.7 (4.1) years for IMA + RA grafts and 5.5 (5.0) years for the BIMA graft. The adjusted hazard ratio for death was (95% confidence interval) 1.01 (0.89–1.14) for IMA + RA and 0.87 (0.72–1.06) for BIMA grafts compared with IMA + SVG. The adjusted hazard ratio for the first angiographic examination was (95% confidence interval) 0.96 (0.84–1.10) for IMA + RA and 1.13 (0.95–1.35) for BIMA grafts. The adjusted hazard ratio for the need for reintervention was (95% confidence interval) 0.91 (0.75–1.09) for IMA + RA and 1.26 (1.00–1.58) for BIMA grafts.CONCLUSIONSPatients who had arterial grafts as second conduits did not demonstrate a better outcome in any of the studied end-points. Radial artery grafts seem to be preferable to BIMA grafts as an alternative to an SVG.
      PubDate: Mon, 28 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx280
  • A second arterial conduit to the circumflex circulation significantly
           improves survival after coronary artery bypass surgery
    • Authors: Luthra S; Leiva-Juárez M, John A, et al.
      First page: 455
      Abstract: OBJECTIVESConventional coronary artery bypass surgery involves the use of a single left internal mammary artery to the left anterior descending artery and saphenous vein grafts reserved for other sites. This retrospective propensity-matched study investigated the impact of a second arterial conduit to the left-sided circulation on early and long-term survival after coronary artery bypass surgery.METHODSData were retrospectively collected from 2004 to 2014 for all revascularizations with at least 1 arterial and/or 1 venous graft to the circumflex circulation, in addition to an internal mammary artery to the left anterior descending artery. Propensity-matched groups were created based on baseline characteristics. Hazard functions were estimated using Cox multivariable regression, and the Kaplan–Meier survival curves were compared between the matched cohorts.RESULTSA total of 1226 patients with a venous conduit to the left-sided circulation were successfully matched to an equal number of patients with an arterial conduit. Regression analysis identified a second arterial conduit, logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE), pulmonary disease, left ventricular ejection fraction, New York Heart Association (NYHA) Class and previous myocardial infarction as significant predictors of survival. A second arterial graft to the left circumflex circulation was a predictor of improved survival (hazard ratio 0.64, 95% confidence interval 0.51–0.80; P < 0.001). There were significant early and late survival benefits (arterial vs venous: 98.2% vs 96.3%, P = 0.003 at 1 year; 82.4% vs 62.2%, P < 0.001 at 10 years) from a second arterial conduit to the circumflex circulation.CONCLUSIONSThere are significant early and late incremental survival benefits from a second arterial conduit to the circumflex circulation.
      PubDate: Tue, 12 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx337
  • Meta-analysis of sutureless technology versus standard aortic valve
           replacement and transcatheter aortic valve replacement
    • Authors: Qureshi S; Boulemden A, Szafranek A, et al.
      First page: 463
      Abstract: OBJECTIVESAortic valve replacement (AVR) using sutureless technology is a feasible alternative in surgical patients. Comparative evidence against established strategies such as conventional AVR and transcatheter AVR is lacking, limiting the assessment of safety and efficacy.METHODSMedline search for available evidence was undertaken. The outcomes analysed were 30-day mortality, risk for stroke, myocardial infarction, renal failure, paravalvular leak and need for permanent pacemaker. Odds ratios were pooled using fixed- and random-effect models. A trial sequential analysis was undertaken to assess the statistical reliability of cumulative evidence.RESULTSTwelve studies of moderate methodological quality were included. Sutureless AVR was associated with at least 30% reduction in 30-day mortality versus transcatheter AVR [odds ratio (95% confidence interval) 0.40 (0.25, 0.62); P < 0.001] primarily in the low- and intermediate-risk population and a similar reduction in the risk for paravalvular leak [0.13 (0.09, 0.17); P < 0.001]. There was no reduction in the risk for 30-day mortality versus conventional AVR [1.03 (0.56, 1.88); P = 0.93]. There was evidence in favour of conventional AVR with at least 50% risk reduction in pacemaker implantation against sutureless technology. There was absence of either benefit or harm vis-à-vis risk for renal injury or stroke due to lack of required information size.CONCLUSIONSCurrent evidence suggests risk reduction in 30-day mortality with sutureless AVR versus transcatheter AVR but is inconclusive versus standard AVR in matched patients. Robust randomized evidence is lacking to lend support to any potential recommendation.
      PubDate: Tue, 12 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx307
  • Stented CorMatrix® conduit to bypass benign superior vena caval
    • Authors: Ali J; Dunning J.
      First page: 472
      Abstract: Surgical venous bypass is an effective treatment option in the management of benign superior vena caval obstruction. Here, we present CorMatrix® as a novel conduit choice, supported internally by an endovascular stent in an attempt to prevent stenosis and reduce reintervention rate following surgical bypass.
      PubDate: Wed, 30 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx303
  • Venovenous extracorporeal membrane oxygenation for the management of
           contralateral iatrogenic bronchus perforation during lower bilobectomy
    • Authors: Radakovic D; Lazarus M, Leyh R, et al.
      First page: 475
      Abstract: Tracheobronchial rupture by a double-lumen endobronchial tube is a rare but life-threatening complication. We report a case of bronchial rupture during contralateral bilobectomy. Venovenous extracorporeal membrane oxygenation support was instituted via the right femoral vein and the internal jugular vein with the patient in the left lateral decubitus position. Sleeve resection of the ruptured bronchus was performed. The patient was successfully discharged home. Rapid institution of venovenous extracorporeal membrane oxygenation is helpful to manage this intraoperative complication.
      PubDate: Tue, 22 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx312
  • An intra-aortic floating metastatic malignancy of unknown primary origin
    • Authors: Kuroda Y; Uchida T, Hayashi J, et al.
      First page: 477
      Abstract: A 69-year-old man with sudden strong back pain was transported to our hospital by ambulance. The computed tomography scan revealed an intra-aortic floating mass with a stalk arising from the descending aortic wall, which was thought to be a thrombus. The floating mass displayed the characteristics of a thrombus rather than a neoplastic tumour on magnetic resonance imaging scan. Under extracorporeal circulation, the descending aorta was cut open, and the mass was resected. Subsequently, a stent graft was placed to cover the abnormal aortic intima to prevent recurrent thrombus formation. The pathological diagnosis revealed an adenocarcinoma, not a thrombus. We could not detect the origin of malignancy despite additional examinations. Brain metastasis developed, and the patient died of recurrent pneumonia and urinary tract infection. These findings emphasize the importance of a precise plan of action for rare diseases.
      PubDate: Tue, 29 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx306
  • Remodelling of the aorta after a catheter-induced acute aortic dissection
    • Authors: Antoniou A; Ntalas I, Gupta A, et al.
      First page: 479
      Abstract: Iatrogenic acute aortic dissection during percutaneous coronary intervention is an extremely rare but critical complication. Although sealing the entry point with a coronary stent is an option to treat localized dissections, more extensive cases may require surgical intervention. We present a case of Type A aortic dissection that occurred during an angioplasty of a chronically occluded right coronary artery. Despite the extent of the dissection, a ‘watch-and-wait’ strategy was chosen, and repeated imaging a few days later revealed that the aorta had been remodelled to its normal anatomy.
      PubDate: Tue, 12 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx315
  • A rare case of acute postoperative tamponade: huge retrocardiac blood
           collection mimicking normal atria on transthoracic echocardiogram
    • Authors: López-Menéndez J; Miguelena J, Esteban A, et al.
      First page: 482
      Abstract: Postoperative complicationsMediastinal bleedingCardiac tamponadeValve surgeryCardiogenic shock
      PubDate: Tue, 12 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx316
  • Destruction and intrapulmonary migration of a rib after pulmonary
    • Authors: Moyano M; Sánchez-Palencia Ramos A, Ruiz Zafra J.
      First page: 483
      Abstract: Pulmonary aspergillosisThoracic wall destructionIntrapulmonary rib migration
      PubDate: Wed, 06 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx329
  • Pulmonary wedge resection for Stage I non-small-cell lung cancer: possible
           alternative strategy to lobectomy
    • Authors: Sawabata N.
      First page: 484
      Abstract: Lung cancerWedge resectionMargin distance
      PubDate: Fri, 03 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx370
  • Reply to Sawabata
    • Authors: Dziedzic R.
      First page: 484
      Abstract: Sublobar resectionLung cancerLobectomySegmentectomyWedge resection
      PubDate: Fri, 03 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx372
  • An alternative idea to an alternative technique
    • Authors: Gaeta R; Famà F.
      First page: 485
      Abstract: Scimitar syndromeCardiopulmonary bypassAlternative technique
      PubDate: Thu, 07 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx331
  • Reply to Gaeta and Famà
    • Authors: Federici D; Montesi G, Ghitti D, et al.
      First page: 485
      Abstract: Scimitar syndromeCardiopulmonary bypassIntracaval baffle repair
      PubDate: Thu, 07 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx332
  • Arguing over shadows'
    • Authors: Kalra A; Reardon M.
      First page: 486
      Abstract: Transcatheter aortic valve replacementPropensity analysisAortic stenosisValve
      PubDate: Thu, 14 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx322
  • Reply to Kalra et al.
    • Authors: Barili F; Freemantle N, Folliguet T, et al.
      First page: 486
      Abstract: TAVRPropensity analysisValves
      PubDate: Thu, 14 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ejcts/ezx323
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