Subjects -> MEDICAL SCIENCES (Total: 8359 journals)
    - ANAESTHESIOLOGY (119 journals)
    - CARDIOVASCULAR DISEASES (329 journals)
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    - FORENSIC SCIENCES (41 journals)
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    - PEDIATRICS (270 journals)
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    - RESPIRATORY DISEASES (102 journals)
    - RHEUMATOLOGY (76 journals)
    - SPORTS MEDICINE (78 journals)
    - SURGERY (393 journals)

CARDIOVASCULAR DISEASES (329 journals)                  1 2 | Last

Showing 1 - 200 of 329 Journals sorted alphabetically
Acta Angiologica     Open Access   (Followers: 5)
Acta Cardiologica     Hybrid Journal   (Followers: 2)
Acute Cardiac Care     Hybrid Journal   (Followers: 7)
Adipositas - Ursachen, Folgeerkrankungen, Therapie     Hybrid Journal  
AJP Heart and Circulatory Physiology     Hybrid Journal   (Followers: 12)
Aktuelle Kardiologie     Hybrid Journal   (Followers: 1)
American Heart Journal     Hybrid Journal   (Followers: 58)
American Journal of Cardiology     Hybrid Journal   (Followers: 67)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 17)
American Journal of Hypertension     Hybrid Journal   (Followers: 28)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anatolian Journal of Cardiology     Open Access   (Followers: 6)
Angiología     Full-text available via subscription  
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Angiology     Hybrid Journal   (Followers: 3)
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (Followers: 1)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 12)
AORTA     Open Access  
Archives of Cardiovascular Diseases     Full-text available via subscription   (Followers: 5)
Archives of Cardiovascular Diseases Supplements     Full-text available via subscription   (Followers: 3)
Archives of Cardiovascular Imaging     Open Access   (Followers: 2)
Archivos de cardiología de México     Open Access   (Followers: 1)
Argentine Journal of Cardiology (English edition)     Open Access   (Followers: 2)
Arquivos Brasileiros de Cardiologia     Open Access   (Followers: 1)
Arteriosclerosis, Thrombosis and Vascular Biology     Full-text available via subscription   (Followers: 32)
Artery Research     Hybrid Journal   (Followers: 4)
ARYA Atherosclerosis     Open Access  
ASAIO Journal     Hybrid Journal   (Followers: 3)
ASEAN Heart Journal     Open Access   (Followers: 2)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2)
Aswan Heart Centre Science & Practice Services     Open Access   (Followers: 1)
Atherosclerosis : X     Open Access  
Bangladesh Heart Journal     Open Access   (Followers: 3)
Basic Research in Cardiology     Hybrid Journal   (Followers: 10)
BMC Cardiovascular Disorders     Open Access   (Followers: 22)
Brain Circulation     Open Access   (Followers: 1)
British Journal of Cardiology     Full-text available via subscription   (Followers: 16)
Canadian Journal of Cardiology     Hybrid Journal   (Followers: 18)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiac Electrophysiology Review     Hybrid Journal   (Followers: 2)
Cardiocore     Full-text available via subscription   (Followers: 1)
Cardiogenetics     Open Access   (Followers: 3)
Cardiology     Full-text available via subscription   (Followers: 20)
Cardiology and Angiology: An International Journal     Open Access   (Followers: 1)
Cardiology and Therapy     Open Access   (Followers: 12)
Cardiology Clinics     Full-text available via subscription   (Followers: 14)
Cardiology in Review     Hybrid Journal   (Followers: 8)
Cardiology in the Young     Hybrid Journal   (Followers: 34)
Cardiology Journal     Open Access   (Followers: 6)
Cardiology Plus     Open Access   (Followers: 1)
Cardiology Research     Open Access   (Followers: 15)
Cardiology Research and Practice     Open Access   (Followers: 10)
Cardiopulmonary Physical Therapy Journal     Hybrid Journal   (Followers: 7)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Cardiothoracic Surgeon     Open Access   (Followers: 1)
CardioVasc     Full-text available via subscription   (Followers: 1)
Cardiovascular & Haematological Disorders - Drug Targets     Hybrid Journal   (Followers: 1)
Cardiovascular & Hematological Agents in Medicinal Chemistry     Hybrid Journal   (Followers: 2)
CardioVascular and Interventional Radiology     Hybrid Journal   (Followers: 15)
Cardiovascular and Thoracic Open     Open Access  
Cardiovascular Diabetology     Open Access   (Followers: 10)
Cardiovascular Drugs and Therapy     Hybrid Journal   (Followers: 14)
Cardiovascular Endocrinology & Metabolism     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering and Technology     Hybrid Journal   (Followers: 1)
Cardiovascular Intervention and Therapeutics     Hybrid Journal   (Followers: 5)
Cardiovascular Journal     Open Access   (Followers: 6)
Cardiovascular Journal of Africa     Full-text available via subscription   (Followers: 5)
Cardiovascular Journal of South Africa     Full-text available via subscription   (Followers: 1)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Cardiovascular Pathology     Hybrid Journal   (Followers: 4)
Cardiovascular Regenerative Medicine     Open Access  
Cardiovascular Research     Hybrid Journal   (Followers: 15)
Cardiovascular Revascularization Medicine     Hybrid Journal   (Followers: 1)
Cardiovascular System     Open Access  
Cardiovascular Therapeutics     Open Access   (Followers: 1)
Cardiovascular Toxicology     Hybrid Journal   (Followers: 6)
Cardiovascular Ultrasound     Open Access   (Followers: 5)
Case Reports in Cardiology     Open Access   (Followers: 7)
Catheterization and Cardiovascular Interventions     Hybrid Journal   (Followers: 3)
Cerebrovascular Diseases     Full-text available via subscription   (Followers: 3)
Cerebrovascular Diseases Extra     Open Access  
Chest     Full-text available via subscription   (Followers: 100)
Choroby Serca i Naczyń     Open Access   (Followers: 1)
Circulation     Hybrid Journal   (Followers: 247)
Circulation : Cardiovascular Imaging     Hybrid Journal   (Followers: 15)
Circulation : Cardiovascular Interventions     Hybrid Journal   (Followers: 17)
Circulation : Cardiovascular Quality and Outcomes     Hybrid Journal   (Followers: 11)
Circulation : Genomic and Precision Medicine     Hybrid Journal   (Followers: 15)
Circulation : Heart Failure     Hybrid Journal   (Followers: 26)
Circulation Research     Hybrid Journal   (Followers: 36)
Cirugía Cardiovascular     Open Access  
Clínica e Investigación en Arteriosclerosis     Full-text available via subscription  
Clínica e Investigación en arteriosclerosis (English Edition)     Hybrid Journal  
Clinical and Experimental Hypertension     Hybrid Journal   (Followers: 3)
Clinical Cardiology     Hybrid Journal   (Followers: 11)
Clinical Hypertension     Open Access   (Followers: 5)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6)
Clinical Research in Cardiology     Hybrid Journal   (Followers: 6)
Clinical Research in Cardiology Supplements     Hybrid Journal  
Clinical Trials and Regulatory Science in Cardiology     Open Access   (Followers: 4)
Congenital Heart Disease     Hybrid Journal   (Followers: 6)
Congestive Heart Failure     Hybrid Journal   (Followers: 4)
Cor et Vasa     Full-text available via subscription   (Followers: 1)
Coronary Artery Disease     Hybrid Journal   (Followers: 2)
CorSalud     Open Access  
Critical Pathways in Cardiology     Hybrid Journal   (Followers: 4)
Current Cardiology Reports     Hybrid Journal   (Followers: 7)
Current Cardiology Reviews     Hybrid Journal   (Followers: 4)
Current Cardiovascular Imaging Reports     Hybrid Journal   (Followers: 1)
Current Cardiovascular Risk Reports     Hybrid Journal  
Current Heart Failure Reports     Hybrid Journal   (Followers: 5)
Current Hypertension Reports     Hybrid Journal   (Followers: 6)
Current Hypertension Reviews     Hybrid Journal   (Followers: 6)
Current Opinion in Cardiology     Hybrid Journal   (Followers: 14)
Current Problems in Cardiology     Hybrid Journal   (Followers: 3)
Current Research : Cardiology     Full-text available via subscription   (Followers: 1)
Current Treatment Options in Cardiovascular Medicine     Hybrid Journal   (Followers: 1)
Current Vascular Pharmacology     Hybrid Journal   (Followers: 5)
CVIR Endovascular     Open Access   (Followers: 1)
Der Kardiologe     Hybrid Journal   (Followers: 2)
Echo Research and Practice     Open Access   (Followers: 2)
Echocardiography     Hybrid Journal   (Followers: 4)
Egyptian Heart Journal     Open Access   (Followers: 2)
Egyptian Journal of Cardiothoracic Anesthesia     Open Access  
ESC Heart Failure     Open Access   (Followers: 4)
European Heart Journal     Hybrid Journal   (Followers: 67)
European Heart Journal - Cardiovascular Imaging     Hybrid Journal   (Followers: 10)
European Heart Journal - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 3)
European Heart Journal - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart Journal : Acute Cardiovascular Care     Hybrid Journal   (Followers: 1)
European Heart Journal : Case Reports     Open Access   (Followers: 1)
European Heart Journal Supplements     Hybrid Journal   (Followers: 8)
European Journal of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9)
European Journal of Cardio-Thoracic Surgery Supplements     Full-text available via subscription   (Followers: 2)
European Journal of Cardiovascular Nursing     Hybrid Journal   (Followers: 5)
European Journal of Heart Failure     Hybrid Journal   (Followers: 14)
European Journal of Preventive Cardiology.     Hybrid Journal   (Followers: 6)
European Stroke Organisation     Hybrid Journal   (Followers: 3)
Experimental & Translational Stroke Medicine     Open Access   (Followers: 8)
Expert Review of Cardiovascular Therapy     Full-text available via subscription   (Followers: 3)
Folia Cardiologica     Open Access  
Forum Zaburzeń Metabolicznych     Hybrid Journal  
Frontiers in Cardiovascular Medicine     Open Access   (Followers: 1)
Future Cardiology     Hybrid Journal   (Followers: 6)
General Thoracic and Cardiovascular Surgery     Hybrid Journal   (Followers: 3)
Global Cardiology Science and Practice     Open Access   (Followers: 5)
Global Heart     Hybrid Journal   (Followers: 3)
Heart     Hybrid Journal   (Followers: 48)
Heart and Mind     Open Access  
Heart and Vessels     Hybrid Journal  
Heart Failure Clinics     Full-text available via subscription   (Followers: 2)
Heart Failure Reviews     Hybrid Journal   (Followers: 3)
Heart India     Open Access   (Followers: 2)
Heart International     Full-text available via subscription  
Heart Rhythm     Hybrid Journal   (Followers: 11)
Heart Views     Open Access   (Followers: 2)
HeartRhythm Case Reports     Open Access  
Hellenic Journal of Cardiology     Open Access   (Followers: 1)
Herz     Hybrid Journal   (Followers: 3)
High Blood Pressure & Cardiovascular Prevention     Full-text available via subscription   (Followers: 2)
Hypertension     Full-text available via subscription   (Followers: 23)
Hypertension in Pregnancy     Hybrid Journal   (Followers: 9)
Hypertension Research     Hybrid Journal   (Followers: 5)
Ibrahim Cardiac Medical Journal     Open Access  
IJC Heart & Vessels     Open Access   (Followers: 1)
IJC Heart & Vasculature     Open Access   (Followers: 1)
IJC Metabolic & Endocrine     Open Access   (Followers: 1)
Indian Heart Journal     Open Access   (Followers: 5)
Indian Journal of Cardiovascular Disease in Women WINCARS     Open Access  
Indian Journal of Thoracic and Cardiovascular Surgery     Hybrid Journal  
Indian Pacing and Electrophysiology Journal     Open Access   (Followers: 1)
Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery     Hybrid Journal   (Followers: 1)
Insuficiencia Cardíaca     Open Access  
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7)
International Cardiovascular Forum Journal     Open Access  
International Journal of Angiology     Hybrid Journal   (Followers: 2)
International Journal of Cardiology     Hybrid Journal   (Followers: 18)
International Journal of Cardiovascular and Cerebrovascular Disease     Open Access   (Followers: 2)
International Journal of Cardiovascular Imaging     Hybrid Journal   (Followers: 2)
International Journal of Cardiovascular Research     Hybrid Journal   (Followers: 6)
International Journal of Heart Rhythm     Open Access  
International Journal of Hypertension     Open Access   (Followers: 8)
International Journal of Hyperthermia     Open Access  
International Journal of Stroke     Hybrid Journal   (Followers: 30)
International Journal of the Cardiovascular Academy     Open Access  
Interventional Cardiology Clinics     Full-text available via subscription   (Followers: 2)
Interventional Cardiology Review     Full-text available via subscription  
JACC : Basic to Translational Science     Open Access   (Followers: 5)
JACC : Cardiovascular Imaging     Hybrid Journal   (Followers: 18)
JACC : Cardiovascular Interventions     Hybrid Journal   (Followers: 17)
JACC : Heart Failure     Full-text available via subscription   (Followers: 14)
JAMA Cardiology     Hybrid Journal   (Followers: 28)
JMIR Cardio     Open Access  
Jornal Vascular Brasileiro     Open Access  
Journal of Clinical & Experimental Cardiology     Open Access   (Followers: 5)
Journal of Arrhythmia     Open Access  
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal of Cardiac Failure     Hybrid Journal   (Followers: 1)

        1 2 | Last

Similar Journals
Journal Cover
Interactive CardioVascular and Thoracic Surgery
Journal Prestige (SJR): 0.762
Citation Impact (citeScore): 1
Number of Followers: 7  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1569-9293 - ISSN (Online) 1569-9285
Published by Oxford University Press Homepage  [410 journals]
  • Outcomes of mitral valve repair in acute native mitral valve infective
    • Authors: El Gabry M; Haidari Z, Mourad F, et al.
      Pages: 823 - 829
      Abstract: AbstractOBJECTIVESMitral valve repair (MVR) is considered the treatment of choice for mitral valve (MV) regurgitation. However, MVR in acute native MV infective endocarditis is technically challenging and not commonly performed. Our goal was to report our outcomes of MVR in acute native MV infective endocarditis.METHODSBetween January 2016 and December 2017, 35 patients presenting with acute native MV infective endocarditis underwent MVR. Primary end points were successful MVR and freedom from recurrent endocarditis. Secondary end point was the postoperative incidence of major adverse events.RESULTSThe mean age was 58 ± 13 years (74% men) and the median logistic EuroSCORE was 17.1%. Twenty patients underwent isolated MVR; the other 15 patients underwent concomitant procedures. MVR was performed with removal of the vegetation (vegectomy), limited resection of the infected tissue, direct closure of the defect, besides annuloplasty in all patients. Mean intensive care and hospital stays were 5 and 17 days, respectively. All-cause mortality was 11% (4/35) at 30 days and a total of 23% (8/35) within a follow-up period of 10 ± 7.7 months. Endocarditis recurred in 2 patients 15 and 8 months after surgery, respectively. Both underwent successful MV re-repair. Follow-up echocardiography indicated none-to-trace, mild or moderate regurgitation in 15, 10 and 2 patients, respectively.CONCLUSIONSAlthough MVR in acute native MV infective endocarditis is a complex procedure, it offers a treatment option for such patients with acceptable short-term results. Limited resection in addition to annuloplasty is our preferred method of repair. Nevertheless, long-term results in a larger cohort are still mandatory.
      PubDate: Thu, 01 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz187
      Issue No: Vol. 29, No. 6 (2019)
  • Left anterior descending artery revascularization with the right internal
           thoracic artery T-graft: the ‘reverse composite’ configuration
    • Authors: Ag-Rejuan Y; Pevni D, Nesher N, et al.
      Pages: 830 - 835
      Abstract: AbstractOBJECTIVESThe use of bilateral internal thoracic artery graft for myocardial revascularization has improved the long-term survival and decreased the rate of repeat interventions in patients. A key technical factor for complete arterial revascularization is sufficient length of the internal thoracic artery (ITA) graft. The purpose of this study was to compare early and long-term outcomes of ‘standard composite’ grafting and ‘reverse composite’ grafting. In the former, the left ITA (LITA) is connected to the left anterior descending artery, and the right ITA is connected end-to-side to the LITA for revascularization of the left circumflex artery. In ‘reverse composite’ grafting, the LITA is connected to the left circumflex artery, and the right ITA is connected end-to-side to the LITA, for revascularization of the left anterior descending artery.METHODSWe compared the outcomes of 1365 patients who underwent coronary artery bypass grafting in Tel-Aviv Sourasky Medical Centre, using bilateral ITA as standard composite versus ‘reverse composite’ grafts, between January 1996 and December 2011. A propensity score matching analysis compared 132 pairs of patients who underwent bilateral ITA by the 2 modes.RESULTSTwelve hundred and thirty patients underwent standard ‘composite’ grafts and 135 underwent ‘reverse composite’ grafts. Early mortality and early adverse effects did not differ significantly between the groups. After matching, the difference in late mortality between the groups was not statistically significant.CONCLUSIONSThis study suggests that revascularization of the left anterior descending with the right ITA, arising from an in situ LITA, is safe and provides early outcomes and long-term survival that are not significantly different from those of the standard composite grafting technique. However, there was evidence of better survival in the standard composite group.
      PubDate: Mon, 05 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz193
      Issue No: Vol. 29, No. 6 (2019)
  • Absence of perioperative excessive bleeding in on-pump coronary artery
           bypass grafting cases performed by residents
    • Authors: Mazur P; Litwinowicz R, Krzych Ł, et al.
      Pages: 836 - 843
      Abstract: AbstractOBJECTIVESOn-pump coronary artery bypass grafting (CABG) is associated with elevated bleeding risk. Our aim was to evaluate the role of surgical experience in postoperative blood loss.METHODSA propensity score-matched analysis was employed to compare on-pump CABG patients operated on by residents and specialists. End points included drainage volume and bleeding severity, as assessed by the Universal Definition of Perioperative Bleeding in cardiac surgery and E-CABG scale.RESULTSA total of 212 matched pairs (c-statistics 0.693) were selected from patients operated on by residents (n = 294) and specialists (n = 4394) between October 2012 and May 2018. Patients did not differ in bleeding risk. There were no statistically significant differences in postoperative 6-, 12- and 24-h drainages between subjects operated on by residents and specialists, and there was no between-group difference in rethoracotomy or transfusion rate. There were no differences in Universal Definition of Perioperative Bleeding or E-CABG grades. In June 2018, after a median follow-up of 2.8 years (range 0.1–5.7 years), the overall survival was 94%, with no differences between the patients operated on by residents (95%) and specialists (92%) (P = 0.27).CONCLUSIONSPatients undergoing on-pump CABG, when operated on by a resident, are not exposed to an elevated bleeding risk, as compared with patients operated on by experienced surgeons.
      PubDate: Wed, 21 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz195
      Issue No: Vol. 29, No. 6 (2019)
  • Do patients with the centrifugal flow HeartMate 3 or HeartWare left
           ventricular assist device have better outcomes compared to those with
           axial flow HeartMate II'
    • Authors: Florisson D; Conte S, De Bono J, et al.
      Pages: 844 - 851
      Abstract: AbstractA best evidence topic was written according to a structured protocol. The question addressed was ‘Do patients with centrifugal flow HeartMate 3 (HM3) or HeartWare left ventricular assist device (HVAD) have better outcomes compared to those with the axial flow HeartMate II (HMII)'’ Altogether 1791 papers were found using the reported search, of which 21 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. In publications reporting on MOMENTUM 3 randomized control trial (RCT), HM3 had better outcomes compared to HMII with a lower rate of pump thrombosis (1.1% vs 15.7%), stroke events (10.1% vs 19.2%) and ischaemic stroke (6.3% vs 13.4%) at 2-year follow-up. Markers of quality of life and functional capacity were comparable between the 2 devices at 6 months. In publications reporting on ENDURANCE RCTs, compared to HMII, patients with HVAD had poorer outcomes with an increased rate of sepsis (23.6% vs 15.4%), stroke (29.7% vs 12.1%) and right heart failure (38.5% vs 26.8%) postoperatively. Outcomes were improved for the HVAD group in a more recent RCT where strict blood pressure control was instigated postoperatively. Outcomes from retrospective studies comparing HMII with HVAD varied, with some publications reporting higher rates of right ventricular assist device use (29% vs 15%), gastrointestinal bleeding (30% vs 0%), cerebrovascular accident (44% vs 10%), transient ischaemic attack (5% vs 2%) and higher cumulative risk of infection and haemorrhagic cerebrovascular accident with HVAD. This is not consistent across these studies, and 9 studies including a systematic review reported no difference in any outcomes. In conclusion, patients with centrifugal flow HM3 have better outcomes than those with axial flow HMII. Although there is some variability in outcomes in retrospective studies, patients with centrifugal flow HeartWare HVAD have similar outcomes to those with axial flow HMII when strict blood pressure control is instigated postoperatively. By inference, centrifugal flow HM3 would appear to be the superior device, although all conclusions are based on 1 large (industry-sponsored) RCT.
      PubDate: Thu, 22 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz202
      Issue No: Vol. 29, No. 6 (2019)
  • Tranexamic acid and convulsive seizures after off-pump coronary artery
           bypass surgery: the role of renal insufficiency
    • Authors: Hulde N; Zittermann A, Deutsch M, et al.
      Pages: 852 - 854
      Abstract: AbstractThere is evidence that, in adult cardiac surgical patients undergoing on-pump procedures, tranexamic acid (TXA) dose-dependently increases the risk of convulsive seizure (CS). We aimed to investigate whether a single TXA bolus of 1 g influences the risk of CS in patients who were operated on without the use of cardiopulmonary bypass. In 2249 propensity-score-matched pairs who underwent off-pump coronary artery bypass grafting with or without TXA administration, the risk of CS was 0.5% and 0.3% in the TXA and non-TXA groups, respectively (P = 0.36). In the subgroups of patients with estimated glomerular filtration rates <30, 30–60 and >60 ml/min/1.73 m2, the risk of CS in the TXA group was 2.8%, 1.2% and 0.4%, respectively (P = 0.002), and in the non-TXA group 0.0%, 0.0% and 0.3%, respectively (P = 0.36). The risk of stroke, in-hospital mortality and 30-day mortality did not differ significantly between study groups (P-value >0.05). Our data indicate that in patients undergoing off-pump coronary artery bypass grafting, a single TXA bolus of 1 g generally does not increase the risk of CS. However, the presence and extent of renal insufficiency have a very significant impact on the incidence of CS even after single-dose TXA.
      PubDate: Tue, 13 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz188
      Issue No: Vol. 29, No. 6 (2019)
  • The association of melanoma-associated antigen-A gene expression with
           clinicopathological characteristics and prognosis in resected
           non-small-cell lung cancer: a meta-analysis
    • Authors: Wang Y; Lu Y, Li J, et al.
      Pages: 855 - 860
      Abstract: AbstractOur goal was to explore the association of melanoma-associated antigen-A (MAGE-A) gene expression with clinicopathological parameters and survival rates in patients with non-small-cell lung cancer (NSCLC) who had surgery. A systematic search of EMBASE, PubMed, Web of Science and The Cochrane Library databases was performed through 20 April 2019. The combined risk ratios (RRs) and hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs) were calculated to assess the association of MAGE-A gene expression with clinicopathological characteristics and prognosis of patients with resected NSCLC, respectively. All statistical analyses were performed with Stata software, version 12.0. A total of 9 articles involving 1538 patients were included in our meta-analysis; most of the studies were from Asian countries. The results indicated that the expression of the MAGE-A gene was significantly correlated with lymph node metastases (RR 1.21, 95% CI 1.09–1.34; P = 0.001), high tumour-node-metastasis stage (RR 1.24, 95% CI 1.12–1.38; P < 0.001), histological type (squamous cell carcinoma) (RR 1.82, 95% CI 1.15–2.87; P = 0.01), poor overall survival (HR 2.11, 95% CI 1.73–2.57; P < 0.001) and cancer-specific survival (HR 1.76, 95% CI 1.12–2.78; P = 0.015). MAGE-A gene expression is related to tumour development and metastasis and is more prevalent in squamous cell carcinomas of the lung; besides, it is an independent prognostic factor for patients with resected NSCLC.
      PubDate: Mon, 05 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz196
      Issue No: Vol. 29, No. 6 (2019)
  • Acute kidney injury after thoracic surgery: a proposal for a multicentre
           evaluation (MERITS)
    • Authors: Naruka V; Mckie M, Khushiwal R, et al.
      Pages: 861 - 866
      Abstract: AbstractOBJECTIVESBecause the mortality rate is very low in thoracic surgery, its use as a quality discriminator is limited. Acute kidney injury (AKI) is a candidate measure because it is associated with increased rates of morbidity and mortality and is partly preventable. The incidence of AKI after thoracic surgery is not well documented. We conducted an audit to determine the incidence and outcomes of AKI. This audit became a pilot project, and the results indicate the feasibility of a larger study.METHODSRetrospective data on renal function post-thoracic surgery were collected at a tertiary cardiothoracic unit over 12 months. Renal impairment was classified according to the Kidney Disease Improving Global Outcomes criteria.RESULTSOf 568 patients (mean = 59  ±  SD 18; 38% women), AKI was diagnosed in 86 (15.1%) within 72 h post-thoracic surgery based on the Kidney Disease Improving Global Outcomes staging system (stage 1, n = 55; stage 2, n = 25; stage 3, n = 6). Significant differences were found in postoperative length of stay (3 vs 5 days; P < 0.001) of patients with and without AKI. There was a significant difference between the age groups of patients with and without AKI (P < 0.05) in the open surgical group but not in the group having video-assisted thoracoscopic surgery (VATS). There was no significant difference in the mortality rates between patients with and without AKI.CONCLUSIONSThe incidence of AKI after thoracic surgery was 15.1%. AKI was associated with longer hospital stays and was more likely in ≥60-year-old patients after open surgery than after VATS. Reducing AKI could improve patient outcomes. We propose that AKI may be a useful quality measure in thoracic surgery. We are developing a multicentre audit based on this approach.
      PubDate: Thu, 08 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz184
      Issue No: Vol. 29, No. 6 (2019)
  • Clinical usefulness of prethymectomy plasmapheresis in patients with
           myasthenia gravis: a systematic review and meta-analysis
    • Authors: Reis T; Cataneo D, Cataneo A.
      Pages: 867 - 875
      Abstract: AbstractOBJECTIVESOur goal was to evaluate, through a systematic review, the efficacy of plasmapheresis in the preoperative preparation of the patient for a thymectomy for the treatment of myasthenia gravis.METHODSMEDLINE, Embase, LILACS, Scopus and CENTRAL databases were searched. The following outcomes were evaluated: myasthenic crisis, mortality, pneumonia, bleeding, use of mechanical ventilation, length of hospital stay and intensive care unit (ICU) stay. RevMan 5.3 software provided by the Cochrane Collaboration was used for the meta-analysis.RESULTSThe total number of patients evaluated in the 7 included studies was 360. Plasmapheresis during the preoperative period did not decrease the myasthenic crisis [risk ratio (RR) 0.36, 95% confidence interval (CI) 0.08–1.66; I2 = 44%; 5 studies, 243 patients]. There was also no change in the mortality rate (RR 0.7, 95% CI 0.11–4.62; I2 = 0%; 3 studies, 172 patients) or pneumonia cases (RR 0.28, 95% CI 0.07–1.09; I2 = 27%; 5 studies, 272 patients). Bleeding was greater in patients who underwent plasmapheresis (mean difference 34.34 ml; 95% CI 24.93–43.75; I2 = 0%). We evaluated the following outcomes: need for mechanical ventilation, hospital stay, ICU stay and mechanical ventilation, but these outcomes were not adequate to perform the meta-analysis due to the high heterogeneity among the studies. Subgroup analysis showed that plasmapheresis performed during the preoperative period in patients with severe disease (Osserman III and IV) decreased the myasthenic crisis postoperatively (RR 0.12, 95% CI 0.02–0.65; I2 = 63%).CONCLUSIONSPlasmapheresis may reduce the myasthenic crisis during the postoperative period in patients with severe disease but may produce little or no difference in patients with mild clinical expression of the disease.
      PubDate: Tue, 30 Jul 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz186
      Issue No: Vol. 29, No. 6 (2019)
  • Quality of life can be good after slide tracheoplasty for long-segment
           tracheal stenosis
    • Authors: Wray J; Ryde M, Butler C, et al.
      Pages: 876 - 882
      Abstract: AbstractOBJECTIVESThe objectives of this study were to measure ‘health-related quality of life’ (HRQoL) in children following slide tracheoplasty for long-segment tracheal stenosis (LSTS) and to explore the relationship of comorbidities and parental mental health with HRQoL outcomes.METHODSA cross-sectional study was undertaken with children who had undergone slide tracheoplasty. Participants included parents and children (age 5–15 years) recruited over a 13-month period, who were asked to complete validated measures of HRQoL, development and behaviour. Scores were compared to published norms.RESULTSForty-two children (male 69%; n = 29) were included; mean age was 5.3 (standard deviation 3.5) years and mean follow-up was 45 (range 4–179) months. Mean total HRQoL scores for children with repaired LSTS did not differ from those of healthy norms other than for children aged 13–23 months, but 10 children (24%) had scores >2 SD below the mean for healthy children. HRQoL was poorer in children with non-cardiac congenital comorbidities than in those with isolated LSTS (mean scores 60.34 ± 17.19 and 85.52 ± 12.19, respectively, P = 0.01). There was good agreement between children’s and parents’ scores, although children rated their HRQoL as better than their parents did. Anxious parents rated their children’s HRQoL as significantly worse than non-anxious parents (P<0.001).CONCLUSIONSOlder children with isolated LSTS can have excellent HRQoL after surgery. Younger children, at an earlier time point postoperatively, and those with non-cardiac congenital comorbidities have poorer HRQoL. Further longitudinal evaluation is required to identify psycho-social (including parental) predictors of outcome which may inform, or be amenable to, intervention.
      PubDate: Wed, 21 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz194
      Issue No: Vol. 29, No. 6 (2019)
  • Effect of postoperative haemoglobin variation on major cardiopulmonary
           complications in high cardiac risk patients undergoing anatomical lung
    • Authors: Patella M; Mongelli F, Minerva E, et al.
      Pages: 883 - 889
      Abstract: AbstractOBJECTIVESRecent evidence shows that permissive anaemia strategies are safe in different surgical settings. However, effects of variations in haemoglobin (Hb) levels could have a negative impact in high-risk patients. We investigated the combined effect of postoperative Hb concentration and cardiac risk status on major cardiopulmonary complications after anatomical lung resections.METHODSWe retrospectively analysed the records, collected in a prospective clinical database, of 154 consecutive patients undergoing anatomical lung resections at our institution (February 2017–February 2019). Hb levels were displayed as preoperative concentration, nadir Hb level before onset of complications and delta Hb (ΔHb). Cardiac risk was stratified according to the Thoracic Revised Cardiac Risk Index (ThRCRI). Univariable and multivariable logistic regression analyses were used to test the associations between patients, surgical variables and cardiopulmonary complications according to the European Society of Thoracic Surgeons definitions.RESULTSCardiopulmonary complications occurred in 63 patients (17%). In the fully adjusted multivariable model, higher values of ΔHb were associated with increased risk of complications [odds ratio (OR) 1.07; P < 0.001], along with higher ThRCRI classes (classes A–B versus C–D: OR 0.09; P < 0.001). Interaction terms with transfusion were not statistically significant, indicating that the harmful effect of ΔHb was independent. According to receiver operating characteristic curve analysis, a ΔHb of 29 g/l was found to be the best cut-off value for predicting complications.CONCLUSIONSIn our series, ΔHb, rather than nadir Hb, was associated with an increased risk of complications, particularly in patients with higher cardiac risk. Restrictive transfusion strategies should be carefully applied in patients undergoing lung resections and balanced according to individual clinical status.
      PubDate: Tue, 13 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz199
      Issue No: Vol. 29, No. 6 (2019)
  • Performance of the transoral circular stapler for oesophagogastrectomy
           after induction therapy
    • Authors: Wang L; Milman S, Ng T.
      Pages: 890 - 896
      Abstract: AbstractOBJECTIVESPatients undergoing oesophageal anastomosis may be at an increased risk for leak after induction therapy for oesophageal cancer, with intrathoracic leaks having significant morbidity. The outcomes of utilizing transoral circular stapler for the creation of a thoracic anastomosis have not been well studied in this patient population.METHODSPatients with oesophageal cancer undergoing induction chemotherapy/radiation followed by Ivor Lewis oesophagogastrectomy were evaluated. All thoracic anastomoses were constructed with transoral circular stapler. Primary outcomes evaluated were the rates of anastomotic leak and stricture.RESULTSOver 7 years, 87 consecutive patients were evaluated, among whom 69 (79%) were male. The median age was 63 years, median body mass index (BMI) was 27 kg/m2 and median age-adjusted comorbidity index was 5. Median operative blood loss was 400 ml and median operative time was 300 min. Major complications (grade ≥3) were seen in 19 (22%), including anastomotic leak in 2 (2.3%), both successfully treated with temporary covered metal stent. The median duration of hospital stay was 10 days, and 1 (1.2%) death was reported at 90 days due to cancer recurrence. Stricture occurred in 8 (9.2%), and median time to dilation was 109 days and median number of dilations was 1. Univariable analysis found BMI to be significantly higher in patients with an anastomotic leak versus those without (43 vs 27 kg/m2, P = 0.002). No variables were found to be predictive of anastomotic stricture.CONCLUSIONSThe use of the transoral circular stapler for thoracic anastomosis results in a consistent formation of the anastomosis, with low leak and stricture rates in the setting of induction chemotherapy/radiation. Leaks that do occur appear to be amenable to stent therapy.
      PubDate: Thu, 22 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz203
      Issue No: Vol. 29, No. 6 (2019)
  • Clinical outcomes of oesophagectomy in elderly versus relatively younger
           patients: a meta-analysis
    • Authors: Han Y; Liu S, Guo W, et al.
      Pages: 897 - 905
      Abstract: AbstractOBJECTIVESThe surgical efficacy of oesophagectomy for elderly patients (>80 years old) is still unclear. The aim of this meta-analysis was to compare the clinical outcomes of oesophagectomy between elderly and relatively younger patients.METHODSPubMed, EMBASE and the Cochrane Library were searched for relevant studies comparing the clinical outcomes of oesophagectomy for elderly and relatively younger patients. Odds ratios were extracted to obtain pooled estimates of the perioperative effect, and hazard ratios were extracted to compare survival outcomes between the 2 cohorts.RESULTSNine studies involving 4946 patients were included in this meta-analysis. For patients older than 80 years of age, in-hospital mortality [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.28–3.13; P = 0.002] and the incidence rates of cardiac (OR 1.55, 95% CI 1.10–2.20; P = 0.01) and pulmonary (OR 1.57, 95% CI 1.11–2.22; P = 0.01) complications were higher than those of relatively younger patients. The overall postoperative complication rate (OR 1.40, 95% CI 0.82–2.40; P = 0.22) and the incidence of anastomotic leak (OR 0.92, 95% CI 0.58–1.47; P = 0.73) were not significantly different between the 2 groups. Elderly patients had a worse overall 5-year survival rate (HR 2.66, 95% CI 1.65–4.28; P < 0.001) than that of relatively younger patients. The cancer-related 5-year survival rate of elderly patients was also lower than that of relatively younger patients (HR 3.37, 95% CI 2.36–4.82; P < 0.001).CONCLUSIONSCompared with relatively younger patients, elderly patients with oesophageal cancer undergoing oesophagectomy are at higher risk of in-hospital mortality and have lower survival rates. However, there is no conclusive evidence that the overall rate of complications is elevated in elderly patients.
      PubDate: Mon, 25 Nov 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz208
      Issue No: Vol. 29, No. 6 (2019)
  • Should surgical treatment of catamenial pneumothorax include diaphragmatic
    • Authors: Pathak S; Caruana E, Chowdhry F.
      Pages: 906 - 910
      Abstract: AbstractA best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether treatment with hormones or pleural symphysis is better than operative procedures such as diaphragmatic repair with mesh to surgically manage recurrent pneumothoraces in patients with catamenial pneumothorax. Diaphragmatic repair with synthetic meshes, hormonal treatment and pleural symphysis are all accepted interventions for the treatment of recurrent catamenial pneumothoraces; however, there is uncertainty over the best combination of treatment. Altogether, 396 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. However, it should be noted that the studies included were small in terms of sample size, and have demonstrated significant bias and surgical heterogeneity. Our literature review found that the recurrence rates of pneumothorax were greatly reduced in the treatment group where surgery and hormone therapy were combined (pooled average recurrence rate of 0%); however, the recurrence rates were significantly higher when these interventions were used alone: hormone therapy alone (58.5%), diaphragmatic repair alone (33.3%) and surgery alone (63.3%). Our results therefore demonstrate that a multimodality approach is required to reduce pneumothorax recurrence rates in patients with catamenial pneumothorax.
      PubDate: Thu, 22 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz205
      Issue No: Vol. 29, No. 6 (2019)
  • Comparing outcomes between valve-sparing root replacement and the Bentall
           procedure in proximal aortic aneurysms: systematic review and
    • Authors: Salmasi M; Theodoulou I, Iyer P, et al.
      Pages: 911 - 922
      Abstract: AbstractIn aortic root aneurysms, the challenge of a valve-sparing aortic root replacement (VSRR) procedure is to ensure durable aortic valve function without reintervention. Although the Bentall procedure defers the durability of valve function to the prosthesis, short- and long-term complications tend to be higher. The aim of this study was to compare the outcomes of VSRR and Bentall procedures in patients with aortic root aneurysms. A systematic literature review was conducted using PubMed regarding the outcomes of the Bentall procedure compared with those of VSRR from the inception of the 2 procedures until July 2018. Studies with short- and long-term comparative data were included. An initial search yielded 9517 titles. Thirty-four studies were finally included for meta-analysis (all retrospective, non-randomized), comprising 7313 patients (2944 valve-sparing and 4369 Bentall procedures) with no evidence of publication bias. Operative mortality was found to be significantly lower in the VSRR group [odds ratio (OR) 0.51, 95% confidence interval (CI) 0.37–0.70; P < 0.001] despite overall higher cardiopulmonary bypass and aortic cross-clamp times. The 5-year survival rate was also more favourable in the VSRR group (OR 1.93 95% CI 1.15–3.23; P < 0.05). Significantly lower rates of cerebral thromboembolism (OR 0.668, 95% CI 0.477–0.935; P = 0.019) and heart block (OR 0.386, 95% CI 0.195–0.767; P = 0.007) were also found after VSRR. There was no significant difference in rates of reoperation between the groups at long-term follow-up (OR 1.32, 95% CI 0.75–2.33; P = 0.336). Meta-regression of patient and operative covariates yielded no influence on the main outcomes (P > 0.05). These findings suggest that VSRR is an appropriate and potentially better treatment option for a root aneurysm when the aortic valve is repairable.
      PubDate: Wed, 28 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz211
      Issue No: Vol. 29, No. 6 (2019)
  • Patterns of aortic remodelling after total arch replacement with frozen
           elephant trunk for acute aortic dissection
    • Authors: Iida Y; Fujii S, Shimizu H, et al.
      Pages: 923 - 929
      Abstract: AbstractOBJECTIVESWe investigated the outcomes of total arch replacement with frozen elephant trunk (FET) for Stanford type A acute aortic dissection and the patterns of postoperative aortic remodelling from computed tomographic (CT) findings.METHODSFrom April 2015 to November 2018, we performed total arch replacement with FET for Stanford type A aortic dissection in 30 patients. Postoperative contrast-enhanced CT showed the position of the FET distal end, the number and the site of communications between the lumina and the presence or absence of aortic remodelling.RESULTSPrimary entry tear was found in the ascending aorta (n = 6), proximal arch (n = 6), aortic arch (n = 11) and distal arch (n = 7). The mean diameter and length of FET were 26 ± 2 and 84 ± 18 mm, respectively. Postoperative contrast-enhanced CT was performed in 26 patients. When the number of communications between the lumina was 0, complete aortic remodelling was achieved in all cases (n = 12). In the case of the most proximal tear in the descending aorta (n = 9), aortic remodelling was not recognized in 3 cases, and additional TEVAR was performed because of diameter enlargement. In the remaining 6 patients, neither aortic remodelling nor aortic diameter enlargement was recognized. When the most proximal tear was below the diaphragm (n = 5), aortic remodelling occurred up to the most proximal tear, but not in the periphery.CONCLUSIONSWe investigated the patterns of aortic remodelling after total arch replacement with FET for Stanford type A aortic dissection from postoperative CT findings. Regardless of the position of the most proximal tear in the descending aorta, aortic remodelling did not occur as long as the most proximal tear was located in the descending aorta. When the most proximal tear occurred in the descending aorta, TEVAR as a pre-emptive treatment can be effective in preventing postoperative aortic adverse events.
      PubDate: Wed, 31 Jul 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz185
      Issue No: Vol. 29, No. 6 (2019)
  • Postoperative liver dysfunction after total arch replacement combined with
           frozen elephant trunk implantation: incidence, risk factors and outcomes
    • Authors: Yang L; Li J, Wang G, et al.
      Pages: 930 - 936
      Abstract: AbstractOBJECTIVESThe authors aimed to clarify the incidence and risk factors of postoperative liver dysfunction (PLD) in patients undergoing total arch replacement combined with frozen elephant trunk implantation and to determine the association of PLD with short-term outcomes.METHODSData from 672 adult patients undergoing total arch replacement with frozen elephant trunk from January 2013 until December 2016 at Fuwai Hospital were analysed retrospectively. A multivariable logistic regression model was used to identify the risk factors for PLD.RESULTSThe overall incidence of PLD was 27.5%, which was associated with higher in-hospital mortality (PLD 4.9% vs No PLD 0.8%, P = 0.002) and 30-day mortality (PLD 9.2% vs No PLD 2.5%, P < 0.001) and a higher incidence of major adverse events (PLD 54.6% vs No PLD 23.4%, P < 0.001). In the multivariable analysis, preoperative hypotension [odds ratio (OR) 1.97, 95% confidence interval (CI) 1.14–3.41; P = 0.02), coronary artery disease (OR 2.64, 95% CI 1.17–5.96; P = 0.02), prolonged cardiopulmonary bypass duration (OR 1.01, 95% CI 1.00–1.01; P < 0.001), increased preoperative alanine transferase (OR 1.01, 95% CI 1.00–1.01; P < 0.001), preoperative platelet count <100 × 109/l (OR 3.99, 95% CI 1.74–9.14; P = 0.001) and increased intraoperative erythrocyte transfusion (OR 1.07, 95% CI 1.01–1.12; P = 0.02) were identified as independent risk factors for PLD.CONCLUSIONSPLD was associated with increased mortality and morbidity. Among the independent risk factors for PLD, cardiopulmonary bypass duration and erythrocyte transfusion could be modifiable. A skilled surgical team and an ideal blood protection strategy may be helpful to protect liver function.
      PubDate: Thu, 29 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz209
      Issue No: Vol. 29, No. 6 (2019)
  • Bicuspid aortic valve patients show specific epigenetic tissue signature
           increasing extracellular matrix destruction
    • Authors: Haunschild J; Schellinger I, Barnard S, et al.
      Pages: 937 - 943
      Abstract: AbstractOBJECTIVESPatients with a bicuspid aortic valve (BAV) have an increased risk for developing thoracic aortic aneurysm, which is characterized by the destruction of the elastic media of the aortic wall. Several important enzymes have been characterized to play key roles in extracellular matrix homeostasis, namely matrix metalloproteinases (MMPs). In this study, we investigated MMP-2 levels and their epigenetic regulation via the miR-29 family.METHODSAortic tissue samples from 58 patients were collected during cardiac surgery, of which 30 presented with a BAV and 28 with a tricuspid aortic valve. Polymerase chain reaction, western blot analysis and immunohistochemistry were performed to analyse MMP-2. In addition, enzyme-linked immunosorbent assay measurements were carried out to investigate both MMP-2 and tissue inhibitor of metalloproteinase-2 levels. To examine the epigenetic regulation of aortic extracellular matrix homeostasis, we furthermore studied the expression levels of miR-29 via qRT-PCR.RESULTSPatients with a BAV were significantly younger at the time of surgery, presented significantly less frequently with arterial hypertension and displayed more often with an additional valvular disease. On a molecular level, we found that MMP-2 is increased on gene and protein level in BAV patients. Tissue inhibitor of metalloproteinase-2 levels do not differ between the groups. Interestingly, we also found that only miR-29A is significantly downregulated in BAVs.CONCLUSIONSOur findings highlight the importance of MMP-2 in the context of extracellular matrix destruction in BAV patients. We present new evidence that miR-29A is a crucial epigenetic regulator of these pathomechanistic processes and might hold promise for future translational research.
      PubDate: Mon, 09 Sep 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz210
      Issue No: Vol. 29, No. 6 (2019)
  • Late surgical conversions after abdominal endovascular aortic repair:
           underlying mechanisms, clinical results and strategies for prevention
    • Authors: Juraszek A; Rylski B, Kondov S, et al.
      Pages: 944 - 949
      Abstract: AbstractOBJECTIVESOur goal was to report our results of late surgical conversion after endovascular aneurysm repair (EVAR).METHODSVariables analysed included baseline data, preinterventional anatomy, type of endovascular intervention, indications for conversion, operative technique, postoperative complications and follow-up survival rate.RESULTSBetween April 2011 and May 2018, 16 patients with late complications after EVAR underwent open surgical conversion at our institution. The mean age was 73.6 [standard deviation (SD) 8.9] years. There were 3 (18.8%) female patients. In 15 patients, the indication for primary EVAR was abdominal aortic aneurysm, and in 1 patient, chronic abdominal aortic dissection. Five patients underwent secondary EVAR service interventions for endoleak treatment between the index EVAR and the final secondary surgical conversion. Thirteen patients underwent surgery in an elective setting and 3 patients underwent emergency surgery. The mean time from EVAR to open surgical conversion was 6.31 (SD 4.0) years (range 1.2–16.0 years). The most common indication for conversion was endoleak formation (n = 12, 75%), followed by 3 cases of aortic rupture (1 patient with primary type 1 endoleak) and 2 cases of stent graft infection—1 with and 1 without an aortoduodenal fistula. One patient died during emergency open surgery of cardiopulmonary instability. Three patients developed postoperative renal dysfunction with recovery of their renal function before discharge. The in-hospital mortality rate was 12.5%. The median follow-up was 16.5 months (interquartile range 21 months). Freedom from death and aortic reintervention was 100%, respectively. After careful review of the index computed tomography scans for EVAR, the majority of failures could have been anticipated due to trade-offs with regard to length, diameter, morphology, shape and angulation of the proximal and/or distal landing zone.CONCLUSIONSDespite being a challenging operation, late surgical conversion after EVAR yields excellent results with regard to outcome and freedom from the need for further aortic interventions. An anticipative strategy adhering to current recommendations for using or refraining from using EVAR in patients with anatomical challenges will help reduce the need for secondary surgical conversions and keep them to minimum.
      PubDate: Thu, 29 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz207
      Issue No: Vol. 29, No. 6 (2019)
  • Long-term quality of life in adults following truncus arteriosus repair
    • Authors: Tay H; Naimo P, Huang L, et al.
      Pages: 950 - 954
      Abstract: OBJECTIVESTo date, few studies have assessed the quality of life following congenital cardiac surgery. In this study, we aimed at determining the quality of life after truncus arteriosus (TA) repair using the Short Form 36 questionnaire in adult survivors.METHODSSeventy-three patients (age >18 years) who underwent TA repair at the Royal Children’s Hospital, Australia were identified for the study. Of these, 42 patients (58%, 42/73) participated in the study and completed the Short Form 36 questionnaire. The results of the 8 domains and the derived health state summary score (Short Form Six Dimension, SF-6D) were compared with age-matched Australian population controls, and with patients who underwent the arterial switch operation (ASO).RESULTSCompared with the age-matched Australian population, 18- to 24-year-old TA patients (31%, 13/42) had lower scores in 6 of 8 domains; 25- to 34-year-old TA patients (36%, 15/42) scored lower in 5 of 8 domains; and 35- to 44-year-old TA patients (33%, 14/42) scored lower in 4 of 8 domains. SF-6D scores were not significantly different between TA patients and the age-matched Australian population. Compared with patients who underwent ASO, 18-to 24-year-old TA patients scored lower in 3 of 8 domains; and 25- to 34-year-old TA patients scored lower in 2 of 8 domains. There was no significant difference in SF-6D scores between TA and patients who underwent the ASO.CONCLUSIONSAdult survivors of TA have similar quality of life compared with age-matched Australian controls measured by SF-6D. Despite a higher reoperation rate in TA patients, they have similar quality of life compared with ASO patients.
      PubDate: Sun, 06 Oct 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz198
      Issue No: Vol. 29, No. 6 (2019)
  • Somatic and cerebral near infrared spectroscopy for the monitoring of
           perfusion during neonatal cardiopulmonary bypass
    • Authors: Bojan M; Bonaveglio E, Dolcino A, et al.
      Pages: 955 - 959
      Abstract: AbstractOBJECTIVESThe somatic-cerebral regional oxygen saturation (rSO2) gradient has the potential to reveal a low cardiac output state at an early stage, when systemic vascular resistance increases in order to maintain cerebral perfusion, and results in a drop in somatic rSO2. We hypothesized that during neonatal cardiopulmonary bypass (CPB), the somatic-cerebral rSO2 gradient can also signal poor perfusion, as assessed by an increase in lactate concentration.METHODSIn a retrospective review of neonatal bypass records, we investigated the association between the somatic-cerebral rSO2 gradient and serial lactate measurements. The somatic-cerebral rSO2 gradient, i.e. the area between the somatic and cerebral rSO2, was calculated for each CPB time interval between 2 lactate measurements, using the trapezoidal method. The association between the somatic-cerebral rSO2 gradient and lactate variation was explored using a mixed model for repeated measurements adjusted for the CPB temperature across intervals.RESULTSA total of 94 CPB intervals were analysed in 24 neonates, median age 6 days, median weight 3.1 kg. The median lactate variation per interval was +0.2 mmol l−1 (range −1.5 to +2.7), the median somatic-cerebral gradient was 0 (range −1229% min to +2049% min) and the median CPB temperature was 29.5°C (IQR 28.1–33.4). There was an independent association between the lactate increase and the somatic-cerebral rSO2 gradient (regression coefficient = −0.0006 ± 0.0002, P = 0.009).CONCLUSIONSA decrease in the somatic-cerebral rSO2 gradient was associated with an increase in lactate concentration, suggesting that the somatic-cerebral rSO2 gradient is a useful monitoring tool for the adequacy of perfusion during neonatal CPB.
      PubDate: Mon, 05 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz197
      Issue No: Vol. 29, No. 6 (2019)
  • Does transatrial-transpulmonary approach improve outcomes compared with
           transventricular approach in non-neonatal patients undergoing tetralogy of
           Fallot repair'
    • Authors: Ye X; Buratto E, Konstantinov I, et al.
      Pages: 960 - 966
      Abstract: AbstractA best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the transatrial-transpulmonary approach to tetralogy of Fallot repair in non-neonatal patients provides superior outcomes compared with the transventricular approach. Altogether, 175 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. Two randomized controlled trials (RCTs) and 3 observational studies showed that the transatrial approach resulted in better preservation of right ventricular (RV) function, whereas 4 observational studies showed no significant difference. Three observational studies showed better attenuation of RV dilatation, whereas 3 showed no difference. One RCT and 2 observational studies showed lower incidence of postoperative ventricular arrhythmias, while 1 RCT and 4 observational studies showed no difference. Two observational studies demonstrated greater freedom from reoperation, 1 RCT and 2 observational studies showed no difference, while 1 retrospective study observed a higher incidence of residual RV outflow tract obstruction and lower freedom from reoperation in infants. Two observational studies reported lower risk of requiring pulmonary valve replacement, whereas 2 reported no difference. Three observational studies reported superior exercise capacity, while 1 reported no difference. No difference in long-term survival was demonstrated. The results presented suggest that transatrial repair of tetralogy of Fallot confers superior or equivalent outcomes in terms of preservation of RV function and volume, ventricular arrhythmias, need for pulmonary valve replacement, and exercise capacity compared with transventricular repair. However, the incidence of residual RV outflow tract obstruction may be higher in infants undergoing transatrial repair.
      PubDate: Thu, 22 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz204
      Issue No: Vol. 29, No. 6 (2019)
  • Inflammatory myofibroblastic tumour in the right ventricle of a
           66-year-old man
    • Authors: Monzón Díaz D; Cuerpo Caballero G, Irabien Ortiz A, et al.
      Pages: 967 - 968
      Abstract: AbstractHerein, we present the case of a 66-year-old man with an inflammatory myofibroblastic tumour. An inflammatory myofibroblastic tumour is an extremely rare entity, with only 60 cases having been reported to date in the literature. The origin of this type of tumour is unknown and the treatment of choice is surgical resection. We present the surgical technique of our case and a review of the literature regarding this tumour. This is the first case described in a man above 60 years of age with a tumour located in the right ventricle.
      PubDate: Mon, 05 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz189
      Issue No: Vol. 29, No. 6 (2019)
  • Planned right ventricular support for combined heart–liver
    • Authors: Barac Y; McCartney S, Sudan D, et al.
      Pages: 969 - 970
      Abstract: AbstractRight ventricular dysfunction post heart transplantation (HTx) is a common problem and its likelihood to occur after combined heart–liver transplantation is even higher. The placement of an extracorporeal planned right ventricular assist device following the HTx during liver transplantation may assist in preventing this complication.
      PubDate: Tue, 30 Jul 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz183
      Issue No: Vol. 29, No. 6 (2019)
  • Ischaemic papillary muscle rupture without significant coronary artery
    • Authors: Kitada Y; Arakawa M, Miyagawa A, et al.
      Pages: 971 - 972
      Abstract: AbstractPapillary muscle rupture is a rare but life-threatening complication of myocardial infarction (MI). Here, we describe a case of papillary muscle rupture caused by a microscopic MI. A 76-year-old woman was referred to our institution, where she developed cardiac arrest upon admission. Severe mitral regurgitation was noted without significant coronary artery lesions. Emergency surgery was performed, and posteromedial papillary muscle rupture was observed. Postoperatively, cardiac magnetic resonance imaging revealed a microscopic MI of the posteromedial papillary muscle.
      PubDate: Mon, 05 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz201
      Issue No: Vol. 29, No. 6 (2019)
  • Antibiotic-loaded ceramic sternum for sternal replacement in a patient
           with deep sternal wound infection
    • Authors: Tricard J; Chermat A, Denes E, et al.
      Pages: 973 - 975
      Abstract: AbstractA 68-year-old man presented with destruction of his sternum after cardiac surgery. Classical management with multiple debridements, vacuum dressings and antibiotics failed. A replacement of his sternum was performed using an antibiotic-loaded porous alumina ceramic sternum. Despite the infected wound, the ceramic sternum did not get infected due to the high antibiotic concentration obtained locally. Two years after the surgery, no relapse occurred and the pulmonary function tests improved.
      PubDate: Wed, 31 Jul 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz182
      Issue No: Vol. 29, No. 6 (2019)
  • Mediastinal liposarcoma: a rare visceral mediastinal tumour
    • Authors: Krishnasamy S; Krishna Nair A, Hashim S, et al.
      Pages: 976 - 977
      Abstract: AbstractLiposarcoma is the second most common type of soft tissue malignancy in adults. They are malignant tumours with a mesenchymal origin. Mediastinal liposarcoma accounts for <1% of mediastinal tumours and 2% of liposarcoma. We report a patient with mediastinal liposarcoma who presented with cardiac tamponade, 25 years after the initial liposarcoma in the popliteal fossa.
      PubDate: Tue, 30 Jul 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz191
      Issue No: Vol. 29, No. 6 (2019)
  • Endovascular treatment of acute type A aortic dissection in a
           nonagenarian: stabilization of a short covered stent using a bare-metal
    • Authors: Wamala I; Heck R, Falk V, et al.
      Pages: 978 - 980
      Abstract: AbstractEndovascular treatment is a viable alternative therapy in high-risk patients with acute type A aortic dissection. However, the optimal endovascular treatment strategy is still evolving. Herein, we present a case of a 91-year-old man who successfully underwent repair of an ascending aortic dissection using a stent-in-stent technique. At 1-year follow-up, the stent demonstrated repair durability.
      PubDate: Thu, 22 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz206
      Issue No: Vol. 29, No. 6 (2019)
  • Left ventricular outflow tract obstruction by transatrial left ventricular
    • Authors: Nakahara Y; Kanemura T, Shioya M, et al.
      Pages: 981 - 982
      Abstract: AbstractTransatrial cannulation of the left ventricle was introduced as a safe and easy cannulation method for antegrade arterial return in type A aortic dissection. However, because of the paucity of clinical reports, little is known about the complications or shortcomings of this technique. Herein, we report a case of pulmonary haemorrhage resulting from left ventricular outflow obstruction, necessitating the exchange of the arterial cannulation site. Monitoring the jet of the arterial cannula with transoesophageal echocardiography and pulmonary artery pressure is mandatory for early detection of complications.
      PubDate: Wed, 31 Jul 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz190
      Issue No: Vol. 29, No. 6 (2019)
  • Intimal sarcoma in an ascending aortic Dacron graft mimicking a thrombus
    • Authors: Natsume K; Shiiya N, Tsuchida T, et al.
      Pages: 983 - 985
      Abstract: AbstractAlthough aortic sarcomas are extremely rare, they may arise in association with a Dacron graft. Here, we report a case of an intimal sarcoma in an ascending aortic Dacron graft implanted 17 years earlier. The patient presented with multiple cerebral infarctions; clinically, a thrombus was found to cause the embolic stroke. He successfully underwent re-replacement of the ascending aorta. Although the initial postoperative histopathological diagnosis was a thrombus, he died of multiple metastases of the malignant tumour after 5 months of the surgery. A histopathological re-evaluation of the explant using immunohistochemistry revealed that the mass was an intimal sarcoma.
      PubDate: Thu, 01 Aug 2019 00:00:00 GMT
      DOI: 10.1093/icvts/ivz192
      Issue No: Vol. 29, No. 6 (2019)
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