Subjects -> MEDICAL SCIENCES (Total: 8447 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (212 journals)
    - ANAESTHESIOLOGY (119 journals)
    - CARDIOVASCULAR DISEASES (330 journals)
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    - COMMUNICABLE DISEASES, EPIDEMIOLOGY (230 journals)
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CARDIOVASCULAR DISEASES (330 journals)                  1 2 | Last

Showing 1 - 200 of 330 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: 59)
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: 2)
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: 17)
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: 101)
Choroby Serca i Naczyń     Open Access   (Followers: 1)
Circulation     Hybrid Journal   (Followers: 252)
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: 66)
European Heart Journal - Cardiovascular Imaging     Hybrid Journal   (Followers: 10)
European Heart Journal - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 2)
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: 9)
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 Cardiology Hypertension     Open Access   (Followers: 1)
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)

        1 2 | Last

Similar Journals
Journal Cover
European Journal of Cardio-Thoracic Surgery
Journal Prestige (SJR): 1.681
Citation Impact (citeScore): 2
Number of Followers: 9  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1010-7940 - ISSN (Online) 1873-734X
Published by Oxford University Press Homepage  [411 journals]
  • 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult
           cardiac surgery: a tool to better clinical practice
    • Authors: Baker R; Nikolic A, Onorati F, et al.
      Pages: 207 - 209
      Abstract: Extracorporeal technologyBest practiceClinical practice guidelinesCardio-thoracic surgery
      PubDate: Thu, 16 Jan 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz358
      Issue No: Vol. 57, No. 2 (2020)
       
  • 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult
           cardiac surgery
    • Authors: Wahba A; Milojevic M, Boer C, et al.
      Pages: 210 - 251
      Abstract: TABLE OF CONTENTSABBREVIATIONS AND ACRONYMS  2121. METHODS SUMMARY  2122. INTRODUCTION  2133. TRAINING, EDUCATION AND SERVICE DELIVERY  213 3.1 Description of the evidence  2134. HEART–LUNG MACHINE HARDWARE  215 4.1 Console with pumps and holders  215   4.1.1 Description of the evidence  215 4.2 Monitoring  215   4.2.1 Description of the evidence  215 4.3 Safety features  216   4.3.1 Description of the evidence  216 4.4 Oxygen and air, carbon dioxide and volatile anaesthetics supply  216   4.4.1 Description of the evidence  216 4.5 Heater-cooler unit  217   4.5.1 Description of the evidence  217 4.6 Patient data management systems and quality improvement  217   4.6.1 Description of the evidence  2175. CARDIOPULMONARY BYPASS—THE DISPOSABLES  218 5.1 Cannulas  218   5.1.1 Arterial cannulation  218   5.1.2 Venous cannulation  219 5.2 Venting and suction devices  219   5.2.1 Description of the evidence  219 5.3 Reservoirs  219   5.3.1 Description of the evidence  219 5.4 Oxygenators  220   5.4.1 Description of the evidence  220 5.5 Pumps  220   5.5.1 Description of the evidence  221 5.6 Filters  221   5.6.1 Description of the evidence  221 5.7 Material and surface treatments  221   5.7.1 Description of the evidence  2226. PREPARATION FOR CARDIOPULMONARY BYPASS  222 6.1 Checklist  222   6.1.1 Description of the evidence  222 6.2 Preoperative assessment  223   6.2.1 Description of the evidence  2237. PROCEDURES DURING CARDIOPULMONARY BYPASS  223 7.1 Type of circuit  223   7.1.1 Description of the evidence  223 7.2 Carbon dioxide flush  224   7.2.1 Description of the evidence  224 7.3 Priming volume and autologous priming  224   7.3.1 Description of the evidence  225 7.4 Anticoagulation management  225   7.4.1 Interventions  225   7.4.2 Description of the evidence  225    7.4.2.1 Heparin dosage  225    7.4.2.2 Individualized heparin management  226    7.4.2.3 Measures to prevent heparin rebound  226    7.4.2.4 Protamine management  226    7.4.2.5 Interventions  226    7.4.2.6 Prevention of protamine overdosing  226    7.4.2.7 Alternative anticoagulation  226 7.5 Acid-base homeostasis and electrolyte management  227   7.5.1 Description of the evidence  227   7.5.2 Magnesium  228 7.6 Control of mean arterial blood pressure  228   7.6.1 Description of the evidence  228 7.7 Pump flow management  229   7.7.1 Description of the evidence  229 7.8 Pulsatile and continuous flow  230   7.8.1 Description of the evidence  230 7.9 Goal-directed haemodynamic therapy  230   7.9.1 Description of the evidence  230 7.10 Assisted drainage  231   7.10...
      PubDate: Wed, 02 Oct 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz267
      Issue No: Vol. 57, No. 2 (2019)
       
  • Beneficial effect of left atrial appendage closure during cardiac surgery:
           a meta-analysis of 280 585 patients
    • Authors: Martín Gutiérrez E; Castaño M, Gualis J, et al.
      Pages: 252 - 262
      Abstract: AbstractIn non-rheumatic atrial fibrillation (AF), left atrial appendage (LAA) is thought to be the source of embolism in 90% of the strokes. Thus, as recent clinical trials have shown the non-inferiority of percutaneous LAA closure (LAAc) in comparison to medical treatment, and despite a IIb recommendation in the latest guidelines for concomitant surgical LAAc, we sought to investigate the beneficial effect of LAAc in the surgical population. A meta-analysis model was performed comparing studies including any cardiac surgery with or without concomitant surgical LAAc reporting stoke/embolic events and/or mortality, from inception to January 2019. Twenty-two studies (280 585 patients) were included in the model. Stroke/embolic events both in the perioperative period [relative risk (RR) 0.66, 95% confidence interval (CI) 0.53–0.82; P = 0.0001] and during follow-up of >2 years (RR 0.67, 95% CI 0.51–0.89; P < 0.005) were significantly reduced in patients who underwent surgical LAAc (RR 0.71, 95% CI 0.58–0.87; P = 0.001). Regarding the rate of preoperative AF, LAAc showed protective effect against stroke/embolic events in studies with >70% preoperative AF (RR 0.64, 95% CI 0.53–0.77; P < 0.00001) but no benefit in the studies with <30% of preoperative AF (RR 0.77, 95% CI 0.46–1.28; P = 0.31). Postoperative mortality was also significantly lower in surgical patients with LAAc at the mid- and long-term follow-up. (RR 0.72, 95% CI 0.67–0.78; P < 0.00001; I2 = 0%). Based on these findings, concomitant surgical LAAc is associated with lower rates of embolic events and stroke in the postoperative period in patients with preoperative AF and also improves postoperative mortality in the mid- and long-term follow-up.
      PubDate: Mon, 11 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz289
      Issue No: Vol. 57, No. 2 (2019)
       
  • Myocardial protection: a forgotten modality
    • Authors: Allen B.
      Pages: 263 - 270
      Abstract: SummaryThe goals of a cardiac surgical procedure are both technical excellence and complete protection of cardiac function. Cardioplegia is used almost universally to protect the heart and provide a quiet bloodless field for surgical accuracy. Yet, despite the importance of myocardial protection in cardiac surgery, manuscripts or dedicated sessions at major meetings on this subject have become relatively rare, as though contemporary techniques now make them unnecessary. Nevertheless, septal dysfunction and haemodynamic support (inotropes, intra-aortic balloon pump, assist devices) are common in postoperative patients, indicating that myocardial damage following cardiac surgery is still prevalent with current cardioplegic techniques and solutions. This article first describes why cardiac enzymes and septal function are the ideal markers for determining the adequacy of myocardial protection. It also describes the underappreciated consequences of postoperative cardiac enzyme release or septal dysfunction (which currently occurs in 40–80% of patients) from inadequate protection, and how they directly correlate with early and especially late mortality. Finally, it reviews the various myocardial protection techniques available to provide a detailed understanding of the cardioplegic methods that can be utilized to protect the heart. This will allow surgeons to critically assess their current method of protection and, if needed, make necessary changes to provide their patients with optimal protection.
      PubDate: Tue, 30 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz215
      Issue No: Vol. 57, No. 2 (2019)
       
  • Left thoracotomy approach for off-pump coronary artery bypass grafting
           surgery: 15 years of experience in 2500 consecutive patients
    • Authors: Guida G; Guida G, Bruno V, et al.
      Pages: 271 - 276
      Abstract: AbstractOBJECTIVESOur goal was to describe the experience at 2 centres with off-pump coronary artery bypass grafting using a left thoracotomy.METHODSFrom January 2002 to December 2017, a total of 2528 consecutive patients (578 women, mean age 62.3 ± 9.1 years) were operated on using this technique. Data were collected prospectively and analysed retrospectively.RESULTSThere were no conversions to median sternotomy and 6 patients (0.2%) were converted to on-pump CABG. The mean number of grafts per patient was 2.8 ± 0. 9. The 30-day mortality rate was 1.0% (25 patients). Most patients were extubated in the operating theatre (97.3%), and 47 patients (1.9%) needed re-exploration for bleeding. Seven patients (0.3%) experienced a cerebrovascular event; 4 (0.3%) had a postoperative myocardial infarction; and 84 (3.4%) had new-onset atrial fibrillation. A total of 1510 patients (61.1%) were discharged from the hospital in the first 48 h after surgery. Long-term survival rates were 98.8%, 93.6% and 69.1% at 1, 5 and 10 years, respectively (central image). During the follow-up period, 60 patients (2.9%) were re-examined for recurrence of angina with a new coronary angiogram; of those, 24 (1.2%) required percutaneous coronary intervention and 11 (0.5%) had redo surgery.CONCLUSIONSA left thoracotomy is a safe alternative to a median sternotomy for coronary artery bypass grafting on the beating heart, with low early complications and good mid- and long-term results.
      PubDate: Mon, 17 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz180
      Issue No: Vol. 57, No. 2 (2019)
       
  • Predictors of early vein graft failure after off-pump coronary artery
           bypass grafting: angiocomputed tomographic results of 233 patients
    • Authors: Yang Y; Zhu Y, Tang C, et al.
      Pages: 277 - 284
      Abstract: AbstractOBJECTIVESLow saphenous vein graft (SVG) patency has become the bottleneck in surgical revascularization. This study aimed to identify the predictors of early vein graft failure (VGF) after off-pump coronary bypass grafting (OPCAB).METHODSA total of 233 patients who had OPCAB were postoperatively evaluated by coronary computed tomography angiography. Logistic regression analyses were performed to detect the predictors of early VGF (FitzGibbon-B/O) at both the patient and the graft level.RESULTSOverall FitzGibbon-A patency of SVG at 1 week after OPCAB was 94.1% (659/700). At the patient level, a patient who had at least 1 VGF was regarded as an event, and increased preoperative platelet count [odds ratio (OR) 9.848], quantity of perioperatively transfused red blood cells (RBC) (U, OR 1.544) and creatinine clearance rate (CCr) (ml/min, OR 1.037) were predictors of early VGF, whereas use of a left internal mammary artery graft was a protective factor (OR 0.348). At the graft level, when VGF was regarded as an event, increased preoperative platelet count (OR 17.450), CCr (ml/min, OR 1.034), quantity of perioperatively transfused RBC (U, OR 1.505) and endarterectomy (OR 5.499) were predictors of early VGF. Under the same circumstances, dual antiplatelet therapy (OR 0.419), recipient vessel diameter (mm, OR 0.052), graft run-off (ml/min, OR 0.949), preoperative RBC count (×1012, OR 0.576) and a side-to-side (when compared with end-to-side) anastomosis (OR 0.276) were protective factors. The patency of SVGs sutured to vessels with a larger diameter (>1.5 mm) was significantly higher than that of the others (96.6% vs 91.1%). SVGs with greater run-off (>25 ml/min for each anastomosis) were significantly more patent than others (95.1% vs 88.7%).CONCLUSIONSEarly SVG patency after OPCAB was satisfactory. Increased preoperative platelet count, more perioperative RBC transfusions and higher CCr were predictors of patients with early VGF, whereas use of a left internal mammary artery graft was a protective factor. Increased preoperative platelet count, higher CCr, more perioperative RBC transfusions and endarterectomy were predictors of VGF, whereas dual antiplatelet therapy, larger recipient vessel diameter, greater graft run-off, higher preoperative RBC count and side-to-side anastomosis were protective factors. Recipient diameter >1.5 mm and graft run-off >25 ml/min were cut-off values for detecting VGF.
      PubDate: Sat, 13 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz207
      Issue No: Vol. 57, No. 2 (2019)
       
  • Bilateral papillary muscle repositioning: successful repair of functional
           mitral regurgitation in dilative cardiomyopathy
    • Authors: Langer F; Kunihara T, Miyahara S, et al.
      Pages: 285 - 292
      Abstract: AbstractOBJECTIVESFunctional mitral regurgitation (FMR) in patients with non-ischaemic dilative cardiomyopathy (DCM) is associated with heart failure and poor outcome. Aggressively undersized annuloplasty as an annular solution for a ventricular problem ameliorates heart failure but may be associated with recurrent FMR and does not improve survival. We sought to analyse if moderately undersized annuloplasty with repositioning of both papillary muscles can lead to improved valve stability and outcome in patients with DCM and FMR.METHODSIn 66 patients with DCM-associated FMR (age 66 ± 12 years, ejection fraction 29 ± 6% and mean pulmonary artery pressure 35 ± 11 mmHg) and severe leaflet tethering (tenting height ≥10 mm) bilateral papillary muscle repositioning was added to moderately undersized ring annuloplasty (median size 30 mm). Concomitant surgery included tricuspid valve repair in 86% of patients and atrial ablation in 44%.RESULTSThe early mortality rate was 9%. Overall 5-year freedom from all-cause death, left ventricular assist device implantation or heart transplant was 58% (95% confidence interval 45–71%). Six patients underwent reoperation (redo repair n = 4). Reverse remodelling was observed during follow-up in 66% of patients with decreasing left ventricular end-diastolic diameters (66 ± 5 to 61 ± 12 mm; P < 0.001) and left ventricular end-systolic diameters (56 ± 9 to 51 ± 14 mm; P = 0.001). Subgroup analyses (partial versus complete ring, preoperative left ventricular end-diastolic diameters <65 mm vs left ventricular end-diastolic diameter ≥65 mm) documented similar survival rates. A competing risks regression analysis identified cerebral vascular disease (P = 0.01), use of a partial ring (P = 0.03) and absence of tricuspid valve repair (P = 0.03) as independent predictors of death.CONCLUSIONSThe combination of bilateral papillary muscle repositioning and moderately undersized ring annuloplasty leads to stable mid-term repair results and reverse remodelling in patients with DCM and FMR and severe leaflet tethering.
      PubDate: Tue, 30 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz204
      Issue No: Vol. 57, No. 2 (2019)
       
  • Risk factors and clinical significance of elevated mitral valve gradient
           following valve repair for degenerative disease
    • Authors: Tomšič A; Hiemstra Y, Arabkhani B, et al.
      Pages: 293 - 299
      Abstract: AbstractOBJECTIVESThe risk factors and clinical effect of elevated mitral valve (MV) gradients after valve repair for degenerative valve disease remain insufficiently understood.METHODSBetween January 2004 and December 2015, a total of 484 patients underwent valve repair for degenerative disease. A true-sized full annuloplasty ring was implanted in all cases. We analysed the effect of preoperative and intraoperative factors on the postrepair gradient. Additionally, we explored the effect of postrepair gradients on long-term outcomes.RESULTSOn linear regression analysis, postrepair MV gradients were associated with patient age (coefficient = −0.110, standard error = 0.005, P = 0.034), body surface area (coefficient = 0.905, standard error = 0.340, P = 0.008), implanted annuloplasty ring size (coefficient = −0.181, standard error = 0.018, P < 0.001) and the use of Physio I ring (coefficient = 0.414, standard error = 0.122, P = 0.001). On multivariable analysis, postrepair MV gradient was not associated with overall survival [hazard ratio (HR) 1.034, 95% confidence interval (CI) 0.889–1.203; P = 0.66] or freedom from atrial fibrillation (HR 0.849, 95% CI 0.682–1.057; P = 0.14), but did emerge as a risk factor for MV reintervention (HR 1.378, 95% CI 1.033–1.838; P = 0.029). Two out of 11 reinterventions were performed due to MV stenosis and in both patients, high postrepair gradients were seen readily on predischarge echocardiography.CONCLUSIONSFollowing valve repair for degenerative MV disease, elevated gradients occur even when true-sized annuloplasty is performed. The late clinical results of valve repair with elevated postrepair gradient are impaired and further studies are needed to explore preventive measures aimed at resolving the issue.
      PubDate: Sat, 15 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz178
      Issue No: Vol. 57, No. 2 (2019)
       
  • Annuloplasty ring dehiscence after mitral valve repair: incidence,
           localization and reoperation
    • Authors: Noack T; Kiefer P, Vivell N, et al.
      Pages: 300 - 307
      Abstract: AbstractOBJECTIVESMitral valve (MV) annuloplasty ring dehiscence with subsequent recurrent mitral regurgitation represents an unusual but challenging clinical problem. Incidence, localization and outcomes for this complication have not been well defined.METHODSFrom 1996 to 2016, a total of 3478 patients underwent isolated MV repair with ring annuloplasty at the Leipzig Heart Centre. Of these patients, 57 (1.6%) underwent reoperation due to annuloplasty ring dehiscence. Echocardiographic data, operative and early postoperative characteristics as well as short- and long-term survival rates after MV reoperation were analysed.RESULTSOccurrences of ring dehiscence were acute (<30 days), early (≤1 year) and late (>1 year) in 44%, 33% and 23% of patients, respectively. Localization of annuloplasty ring dehiscence was found most frequently in the P3 segment (68%), followed by the P2 (51%) and the P1 segments (47%). The 30-day mortality rate and 1- and 5-year survival rates after MV reoperation were 2%, 89% and 74%, respectively. During reoperation, MV replacement was performed in 38 (67%) and MV re-repair in 19 (33%) patients.CONCLUSIONSAnnuloplasty ring dehiscence is clinically less common, localized more frequently on the posterior annulus and occurs mostly acutely or early after MV repair. MV reoperation can be performed safely in such patients.
      PubDate: Thu, 01 Aug 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz219
      Issue No: Vol. 57, No. 2 (2019)
       
  • Isolated aortic insufficiency valve repair with external ring
           annuloplasty: a standardized approach
    • Authors: Zakkar M; Bruno V, Zacek P, et al.
      Pages: 308 - 316
      Abstract: AbstractOBJECTIVESAortic valve (AV) insufficiency with normal root and ascending aorta is most frequently treated by valve replacement with significant prosthetic-related complications and reduced life expectancy. We compared the outcomes of a new standardized isolated AV repair approach using an external aortic annuloplasty ring at the subvalvular level (single ring annuloplasty) and the role of an additional supravalvular ring at the sinotubular junction (double ring annuloplasty).METHODSSingle centre data were collected from the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) between 2003 and 2017. A total of 93 patients (56 single ring and 37 double ring) underwent isolated AV repair.RESULTSThe overall 30-day mortality rate and the need for a permanent pacemaker were 1% and 2%, respectively. The overall survival rate at 6 years was similar for sex- and age-matched members of the general population (89% vs 95%; P = 0.1) and did not differ between the double and single ring groups (82% vs 93%; P = 0.4) at 6 years. There were no thromboembolic or bleeding events in the entire cohort. However, at 6 years, the cumulative incidence of valve-related reintervention was 26% in the single ring annuloplasty group compared to 3% in the double ring annuloplasty (P = 0.02) group. Similarly, at 6 years, the cumulative incidence of moderate-to-severe (>2) aortic insufficiency was 30% in the single ring annuloplasty group compared to 0% in the double ring annuloplasty group (P = 0.007).CONCLUSIONSStandardized AV repair with external ring annuloplasty has a survival rate similar to that of the general population. The additional stabilization of the sinotubular junction with a second supravalvular ring (double ring annuloplasty) is associated with better outcomes compared to single subvalvular annuloplasty. It can be considered as a first line intervention for patients with isolated aortic insufficiency and pliable leaflets.
      PubDate: Wed, 10 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz193
      Issue No: Vol. 57, No. 2 (2019)
       
  • Outcomes of transported and in-house patients on extracorporeal life
           support: a propensity score-matching study
    • Authors: Lee H; Sung K, Suh G, et al.
      Pages: 317 - 324
      Abstract: AbstractOBJECTIVESPatients on extracorporeal life support (ECLS), like other critically ill patients, are transported to other institutions for various reasons. However, little has been reported concerning the characteristics and clinical outcomes of transported patients compared with those of in-house patients.METHODSA total of 281 adult patients received ECLS between January 2014 and August 2016. Patients who underwent cannulation at another institution by our team were excluded. Patients were divided into 2 groups: transported group (N = 46) and in-house group (N = 235). All 46 patients were safely transported without serious adverse events. The mean travel distance was 206±140 km, with a mean travel time of 78 ± 57 min. Following propensity score matching, 44 transported patients were matched to 148 in-house patients.RESULTSIn the matched population, the mean age was 48 ± 13 years in the transported group and 49 ± 17 years in the in-house group (P = 0.70). The ECLS type (venoarterial/venovenous) comprised 35/9 (79.5/20.5%) in the transported group and 119/29 (80.4/19.6%) in the in-house group (P = 0.93). Seventeen (38.6%) extracorporeal cardiopulmonary resuscitations were performed in the transported group and 59 (39.9%) were performed in the in-house group (P = 0.91). The incidence of limb ischaemia and acute kidney injury was higher in the transported group (P = 0.007 and P = 0.001, respectively). However, the rate of survival to discharge did not differ between the groups (63.6% in the transported group vs 64.2% in the in-house group, P = 0.94) and there was no difference in overall mortality (P = 0.99).CONCLUSIONSAlthough transported patients had more complications than in-house ECLS patients, clinical outcomes were comparable in the matched population. Transporting ECLS patients to an experienced centre may be justified based on our experience.
      PubDate: Thu, 22 Aug 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz227
      Issue No: Vol. 57, No. 2 (2019)
       
  • Impact of preoperative atrial fibrillation on thromboembolic events and
           pump thrombosis in long-term left ventricular assist device therapy
    • Authors: Pedde D; Soltani S, Stein J, et al.
      Pages: 325 - 330
      Abstract: AbstractOBJECTIVESPump thrombosis (PT) and thromboembolic events (TEs) remain major adverse events in left ventricular assist device (LVAD) therapy at an annual rate of 6–8% supported with the HeartWare HVAD and HeartMate II. PT and TEs are multifactorial events. Understanding the predisposing risk factors for PT and TE is paramount to define preventive strategies. Preoperative atrial fibrillation (AF) is considered a significant and potentially modifiable risk factor. This study investigates whether LVAD patients with AF exhibit a higher rate of PT and TE than those in sinus rhythm (SR).METHODSWe evaluated medical records of consecutive patients who underwent implantation of the HeartMate II (n = 195; 25.4%) and HeartWare HVAD (n = 574; 74.6%) at our institution between 2006 and 2015. Only visually confirmed PT was included in the study. TE was defined as any peripheral embolism or cerebral embolism according to the INTERMACS definitions.RESULTSSR was documented preoperatively in 211 patients (SR group) and AF in 558 patients (AF group). The median duration of support was 0.78 years in the AF group and 1.03 years in the SR group. The mean age was 60.27 years in the AF group and 52.04 years in the SR group. In the AF group, 83.0% of the patients were male, compared to 77.3% in the SR group. The cumulative incidence of PT in the SR group was 2.5% [95% confidence interval (CI) 0.3–4.7%] after 1 year and 5.7% (95% CI 2.2–9.2%) after 2 years, and in the AF group 4.9% (95% CI 3.0–6.7%) and 7.8% (95% CI 5.4–10.2%), respectively (P = 0.129). TEs were recorded in the SR group in 4.4% (95% CI 1.6–7.2%) after 1 year and in 6.3% (95% CI 2.8–9.8%) after 2 years, and occurred after a median support time of 214 days (range 120–768). In the AF group, the cumulative incidence was 8.4% (95% CI 6.0–10.7%) and 10.7% (95% CI 8.0–13.4%), respectively, after a median support time of 116 days (range 37–375), P-value = 0.163. In the multivariate analysis, event-free survival was not influenced by the preoperative SR [hazard ratio (HR) 0.86, 95% CI 0.68–1.1; P = 0.19].CONCLUSIONSOur study showed that the preoperative rhythm has no impact on survival, PT and TEs despite different preoperative risk factor profiles in the AF and SR group. Thus, the effect of a maze procedure, catheter ablation or left atrial appendage closure on PT and TE’s for AF patients during LVAD implantation is questionable. However, to obtain a definitive answer, a prospective study would be of value.
      PubDate: Tue, 16 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz201
      Issue No: Vol. 57, No. 2 (2019)
       
  • Venous thromboembolism prophylaxis in thoracic surgery patients: an
           international survey
    • Authors: Shargall Y; Brunelli A, Murthy S, et al.
      Pages: 331 - 337
      Abstract: AbstractOBJECTIVESVenous thromboembolic events (VTE) after thoracic surgery (TS) can be prevented with mechanical and chemical prophylaxis. Unlike other surgical specialties, TS lacks evidence-based guidelines. In the process of developing these guidelines, an understanding of the current prophylaxis methods practiced internationally is necessary and is described in this article.METHODSA 26-item survey was distributed to members of the European Society of Thoracic Surgeons (ESTS), American Association of Thoracic Surgery (AATS), Japanese Association for Chest Surgery (JACS) and Chinese Society for Thoracic and Cardiovascular Surgery (CSTCS) electronically or in person. Participants were asked to report their current prophylaxis selection, timing of initiation and duration of prophylaxis, perceived risk factors and the presence and adherence to institutional VTE guidelines for patients undergoing TS for malignancies.RESULTSIn total, 1613 surgeons anonymously completed the survey with an overall 36% response rate. Respondents were senior surgeons working in large academic hospitals (≥70%, respectively). More than 83.5% of ESTS, AATS and JACS respondents report formal TS thromboprophylaxis protocols in their institutions, but 53% of CSTCS members report not having such a protocol. The regions varied in the approaches utilized for VTE prophylaxis, the timing of initiation perioperatively and the use and type of extended prophylaxis. Respondents reported that multiple risk factors and sources of information impact their VTE prophylaxis decision-making processes, and these factors vastly diverge regionally.CONCLUSIONSThere is little agreement internationally on the optimal approach to thromboprophylaxis in the TS population, and guidelines will be helpful and vastly welcomed.
      PubDate: Tue, 30 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz191
      Issue No: Vol. 57, No. 2 (2019)
       
  • Impact of pulmonary function on pulmonary complications after
           robotic-assisted thoracoscopic lobectomy
    • Authors: Cao C; Louie B, Melfi F, et al.
      Pages: 338 - 342
      Abstract: AbstractOBJECTIVESPercentage-predicted forced expiratory volume in 1 s (FEV1) and diffusing capacity for carbon monoxide (DLCO), and their predicted postoperative (ppo) values are established prognostic factors for postoperative pulmonary complications after thoracotomy. However, their predictive value for minimally invasive pulmonary resections remains controversial. This study assessed the incidence of pulmonary complications after robotic lobectomy for primary lung cancer and analysed the predictive significance of FEV1 and DLCO.METHODSThis was a retrospective analysis of patients who underwent robotic lobectomy from 4 institutions. Descriptive and comparative analyses were performed for patients who experienced pulmonary complications versus patients who did not, in relation to FEV1 and DLCO values. To identify thresholds for increased complications, patients were categorized into groups of 10% incremental increases in FEV1 and DLCO, and their ppo values.RESULTSFrom November 2002 to April 2018, 1088 patients underwent robotic lobectomy. Overall, 169 postoperative pulmonary complications occurred in 141 patients. Male gender and Eastern Cooperative Oncology Group grade ≥1 were associated with increased pulmonary complications on univariable analysis. Patients who experienced pulmonary complications had increased mortality (2.1% vs 0.2%, P = 0.017) and longer hospitalizations (9 vs 4 days, P < 0.001). Pulmonary complications were associated when FEV1 ≤60% and DLCO ≤50%, and when ppo FEV1 or DLCO was ≤50%; ppo FEV1 ≤50% (P < 0.001) and ppo DLCO ≤50% (P = 0.031) remained statistically significant on multivariable analysis.CONCLUSIONSBoth FEV1 and DLCO were shown to be significant predictors of pulmonary complications. Furthermore, thresholds of percentage-predicted and ppo FEV1 and DLCO values were identified, below which pulmonary complications occurred significantly more frequently, suggesting their predictive values are particularly useful in patients with poorer pulmonary function.
      PubDate: Mon, 22 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz205
      Issue No: Vol. 57, No. 2 (2019)
       
  • Subxiphoid versus intercostal uniportal video-assisted thoracoscopic
           surgery for bilateral lung resections: a single-institution experience
    • Authors: Cai H; Xie D, Al Sawalhi S, et al.
      Pages: 343 - 349
      Abstract: AbstractOBJECTIVESSubxiphoid uniportal video-assisted thoracoscopic surgery (SUVATS) is a technically difficult and challenging operation that can help decrease pain around the incision after traditional intercostal uniportal video-assisted thoracoscopic surgery (IUVATS), and can also treat bilateral lesions through the same incision. We aimed to compare perioperative outcomes and pain scores after SUVATS and IUVATS in patients receiving synchronous treatment of bilateral lung lesions.METHODSPatients who received SUVATS and IUVATS bilateral lung resections from September 2014 to February 2018 were analysed. Ultimately a total of 381 cases were analysed after using one-to-one propensity score matching to match baseline characteristics between the 2 groups.RESULTSThe 381 patients included 56 with SUVATS and 325 with IUVATS. After matching, 54 SUVATS and 54 IUVATS cases were analysed. The 2 groups had similar preoperative factors and did not differ with respect to duration of chest tube placement, length of stay in hospital and incidence of postoperative complications. SUVATS was associated with a significantly longer operative time (212.3 vs 154.6 min, P < 0.001) and more blood loss (190.9 vs 72.7 ml, P < 0.001), lower pain score on the first day after operation (2.6 vs 3.0, P = 0.03) and before discharge (0.8 vs 1.4, P < 0.001). Furthermore, less patients in group SUVATS requested for additional analgesic therapy (P = 0.03).CONCLUSIONSCompared with IUVATS, despite the longer operative time and greater blood loss, SUVATS for bilateral lung lesions is a safe surgical procedure associated with significantly less postoperative pain and a similar incidence of postoperative complications in selected patients.
      PubDate: Tue, 16 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz206
      Issue No: Vol. 57, No. 2 (2019)
       
  • Prediction of complications after paediatric cardiac surgery
    • Authors: Zeng X; An J, Lin R, et al.
      Pages: 350 - 358
      Abstract: AbstractOBJECTIVESOur objectives were to identify the risk factors for postoperative complications after paediatric cardiac surgery, develop a tool for predicting postoperative complications and compare it with other risk adjustment tools of congenital heart disease.METHODSA total of 2308 paediatric patients who had undergone cardiac surgeries with cardiopulmonary bypass support in a single centre were included in this study. A univariate analysis was performed to determine the association between perioperative variables and postoperative complications. Statistically significant variables were integrated into a synthetic minority oversampling technique-based XGBoost model which is an implementation of gradient boosted decision trees designed for speed and performance. The 7 traditional risk assessment tools used to generate the logistic regression model as the benchmark in the evaluation included the Aristotle Basic score and category, Risk Adjustment for Congenital Heart Surgery (RACHS-1), Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery (STS-EACTS) mortality score and category and STS morbidity score and category.RESULTSOur XGBoost prediction model showed the best prediction performance (area under the receiver operating characteristic curve = 0.82) when compared with these risk adjustment models. However, all of these models exhibited a relatively lower sensitivity due to imbalanced classes. The sensitivity of our optimization approach (synthetic minority oversampling technique-based XGBoost) was 0.74, which was significantly higher than the average sensitivity of the traditional models of 0.26. Furthermore, the postoperative length of hospital stay, length of cardiac intensive care unit stay and length of mechanical ventilation duration were significantly increased for patients who experienced postoperative complications.CONCLUSIONSPostoperative complications of paediatric cardiac surgery can be predicted based on perioperative data using our synthetic minority oversampling technique-based XGBoost model before deleterious outcomes ensue.
      PubDate: Sat, 06 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz198
      Issue No: Vol. 57, No. 2 (2019)
       
  • Vocal cord paralysis after cardiovascular surgery in children: incidence,
           risk factors and diagnostic options
    • Authors: García-Torres E; Antón-Pacheco J, Luna-Paredes M, et al.
      Pages: 359 - 365
      Abstract: AbstractOBJECTIVESThe aim of this study was to assess the incidence of vocal cord paralysis (VCP) in children after cardiovascular surgery. The secondary aims were to identify the factors potentially associated with VCP and to assess the diagnostic utility of laryngeal ultrasound (US).METHODSThis study is a retrospective review of patients who underwent aortic repair, patent ductus arteriosus ligation and left pulmonary artery surgeries from 2007 to 2017. The following data were collected: patient demographics, gestational age, weight and age at surgery, comorbidities, cardiovascular anomaly and type of procedure, laryngoscopic and US evaluation results. Univariable and multivariable logistic regression models were used to identify the variables associated with VCP.RESULTSTwo hundred and six patients were included in the study. Seventy-two patients (35%) were preterm and 32.5% showed comorbidities. At surgery, median age and weight were 0.6 months [interquartile range (IQR) 0.3–2.1] and 3.0 kg (IQR 1.3–4.0), respectively. Postoperatively, symptomatic patients underwent endoscopic evaluation and VCP was detected in 25 cases (12.1%). Laryngeal US was performed in 8 of these showing an excellent diagnostic relationship. On univariable analysis, factors significantly associated with VCP were prematurity, young age and lower weight at surgery and the presence of comorbidities. The presence of comorbidities and weight at surgery exhibited a significant risk of developing VCP postoperatively on multivariable analysis.CONCLUSIONSVCP is not an unusual complication of cardiovascular surgery. Certain factors were associated with VCP development but only the presence of comorbidities and weight at surgery were statistically significant on multivariable analysis. Flexible laryngoscopy is the standard diagnostic technique and laryngeal US appears to be a reliable complement.
      PubDate: Fri, 05 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz190
      Issue No: Vol. 57, No. 2 (2019)
       
  • Long-term outcomes following repair of truncus arteriosus and interrupted
           aortic arch
    • Authors: Naimo P; Fricke T, Lee M, et al.
      Pages: 366 - 372
      Abstract: AbstractOBJECTIVESWe aim to evaluate the long-term outcomes following repair of truncus arteriosus with an interrupted aortic arch.METHODSWe reviewed all children (n = 24) who underwent repair of truncus arteriosus and an interrupted aortic arch between 1979 and 2018 in a single institution. The morphology of the interrupted aortic arch was type A in 5, type B in 18 and type C in 1.RESULTSThe median age at repair was 10 days and the median weight was 3.1 kg. Direct end-to-side anastomosis of the ascending and descending aorta was performed in 16 patients (67%, 16/24), patch augmentation in 5 patients (21%, 5/24) and direct anastomosis with the use of an interposition graft to the descending aorta in 2 patients (8%, 2/24). One patient, the first in the series, underwent interrupted aortic arch repair via subclavian flap aortoplasty prior to truncus repair. A period of deep hypothermic circulatory arrest was used in 16 patients, and isolated cerebral perfusion was used in 8 patients. The early mortality rate was 17% (4 out of 24 patients). There were no late deaths and overall survival was 83 ± 8% [95% confidence interval (CI) 61–93] at 20 years. Freedom from any reoperation was 33 ± 11% (95% CI 14–54) at 5 years and 13 ± 9% (95% CI 2–34) at 10 years. Six patients underwent 10 aortic reoperations. Freedom from aortic arch reoperation was 69 ± 11% (95% CI 42–85) at 10 and 20 years. Follow-up was 95% complete (19/20), with a median follow-up time of 20 years. At last follow-up, no clinically significant aortic arch obstruction was identified in any patient, and all patients were in New York Heart Association Class I/II.CONCLUSIONSRepair of truncus arteriosus with an interrupted aortic arch with direct end-to-side anastomosis results in good survival beyond hospital discharge. Although the long-term functional state of patients is good, reoperation rates are high.
      PubDate: Mon, 17 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz176
      Issue No: Vol. 57, No. 2 (2019)
       
  • Ascending aorta and aortic root replacement (with or without valve
           sparing) in early childhood: surgical strategies and long-term outcomes
    • Authors: Moreau de Bellaing A; Pontailler M, Bajolle F, et al.
      Pages: 373 - 379
      Abstract: AbstractOBJECTIVESAortic root and ascending aorta replacements (AARs) are rarely required in the paediatric population. We report here a series of AAR performed in young children using different surgical techniques.METHODSBetween 1995 and 2017, 32 children under the age of 10 years (median age 5.4 years) underwent AAR procedures at our institution. Twenty-two (69%) had a connective tissue disease (infantile Marfan syndrome or Loeys–Dietz syndrome). We performed 11 AAR using a composite graft with a mechanical prosthesis and 21 valve-sparing procedures (10 Yacoub operations and 11 David operations). Median follow-up for operative survivors was 7.7 years (interquartile range 4.2–12.8 years).RESULTSThe cardiac-related early mortality rate was 6%. Patient survival was 91% at both 1 and 10 years. Eleven survivors (38%), all with a status of post-valve-sparing procedure, required an aortic root reintervention with an aortic valve replacement after a median interval of 4.2 years. Interestingly, only patients with infantile Marfan syndrome tended to be associated with risk of reoperation.CONCLUSIONSAortic root and AARs are safe in young children whatever the surgical procedure. Aortic valve-sparing procedures show good long-term results except in children with infantile Marfan syndrome whose ineluctable aortic annulus dilatation or aortic valve regurgitation requires reintervention after a short period.
      PubDate: Thu, 01 Aug 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz210
      Issue No: Vol. 57, No. 2 (2019)
       
  • Right ventricular outflow tract reconstruction with the Labcor® stentless
           valved pulmonary conduit
    • Authors: Jussli-Melchers J; Scheewe J, Hansen J, et al.
      Pages: 380 - 387
      Abstract: AbstractOBJECTIVESThe right ventricular outflow tract reconstruction is a common necessity in congenital cardiac surgery. As homograft availability is limited, alternatives need to be evaluated. The Labcor® conduit consists of a porcine tricomposite valve assembled inside a bovine pericardium tube. This study presents intermediate-term results for its utilization for right ventricular outflow tract reconstruction.METHODSLabcor conduits were implanted in 53 patients (February 2009–July 2016). We analysed perioperative data, freedom from conduit failure and risk factors for conduit dysfunction.RESULTSThe most common diagnosis was Tetralogy of Fallot (n = 20, 37.7%). The median age at surgery was 10.0 [interquartile range (IQR) 4.9–14.3] years. Pulmonary artery plasty (n = 37, 69.8%) and augmentation of the right ventricular outflow tract (n = 16, 30.2%) were often part of the procedure. The median conduit size was 21 (range 11–25) mm. There was no in-hospital death. The median follow-up after surgery was 4.6 (IQR 3.4–5.6) years. Fourteen patients (27.5%) developed conduit failure with stenosis being the main cause. Freedom from conduit failure was 98.0% at 2 and 80.5% at 5 years. The median longevity of the conduit was 7.4 years (95% confidence interval 5.1–9.8 years). Younger age and smaller conduit size were related to conduit failure.CONCLUSIONSUtilization of the Labcor conduit revealed acceptable intermediate-term results. The conduit appeared to be functioning sufficiently well within the first 5 years in the majority of patients. The higher rate of failure concerning smaller conduits might be associated with somatic outgrowth; however, conduit degeneration as common and long-term outcome still needs to be evaluated.
      PubDate: Sat, 13 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz200
      Issue No: Vol. 57, No. 2 (2019)
       
  • Subacute/chronic type A aortic dissection: a retrospective cohort study
    • Authors: Wu J; Xie E, Qiu J, et al.
      Pages: 388 - 396
      Abstract: AbstractOBJECTIVESOur goal was to outline the clinical presentations, surgical treatment and outcomes of subacute/chronic type A aortic dissection (TAAD).METHODSA total of 1092 patients with TAAD were enrolled retrospectively and divided into 2 groups based on acuity of TAAD (181 subacute/chronic vs 911 acute cases of TAAD). Early and late outcomes were investigated and compared using propensity score matching.RESULTSThe top 3 symptoms for subacute/chronic TAAD were chest tightness (80/181, 44.2%), mild pain (65/181, 35.9%) and sweating (58/181, 32.0). Fifteen (15/181, 8.3%) patients were symptom-free. Typical symptoms of acute TAAD were less common in patients with subacute/chronic TAAD such as intense/sharp pain (48/181, 26.5%), tear-like pain (35/181, 19.3%) and radiating pain (30/181, 16.6%). Patients with subacute/chronic TAAD had better early and late survival rates, with an early mortality rate of 6.1% (11/181) compared to 11.6% (106/911) of those with acute TAAD (P = 0.038). Before propensity score matching, survival at 1, 3 and 5 years was 93.1% [95% confidence interval (CI) 89.4–96.9%], 88.4% (95% CI 83.1–93.9%) and 86.4% (95% CI 80.1–93.1%) for subacute/chronic TAAD and 86.9% (95% CI 84.7–89.2%), 82.6% (95% CI 79.9–85.3%) and 79.0% (95% CI 75.5–82.7%) for acute TAAD, respectively (P = 0.039). The propensity score matching analysis substantiated the foregoing results.CONCLUSIONSSubacute/chronic TAAD was clearly distinct from acute TAAD in terms of clinical presentations and had better early and late survival rates. Current surgical strategies for acute TAAD are applicable to subacute/chronic TAAD with excellent outcomes.
      PubDate: Tue, 16 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz209
      Issue No: Vol. 57, No. 2 (2019)
       
  • Chronic aortic dissection type A: simply an overlooked acute event'
    • Authors: Peterss S; Hagl C, Pichlmaier M.
      Pages: 397 - 398
      Abstract: AortaDissectionChronic
      PubDate: Tue, 30 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz218
      Issue No: Vol. 57, No. 2 (2019)
       
  • Additional frozen elephant trunk as a bailout for a misdeployed frozen
           elephant trunk in the false lumen in a patient with acute aortic
           dissection
    • Authors: Tamai K; Hori D, Yuri K, et al.
      Pages: 399 - 401
      Abstract: AbstractUsing a frozen elephant trunk (FET) in patients with acute aortic dissection is an effective method to induce aortic remodelling after surgery. A 40-year-old man with Stanford type A acute aortic dissection underwent emergency total arch replacement with FET. The FET was inserted into the descending aorta under direct vision. However, transoesophageal echocardiography after the deployment of the FET revealed that it was misdeployed in the false lumen. An additional FET was deployed in the true lumen to redirect the blood flow to the true lumen. The patient was discharged from the hospital without any major complications. Computed tomography 6 months after surgery revealed enhanced aortic remodelling without any signs of stent graft-induced new entry. Additional deployment of a FET into the true lumen could be an option for a misdeployed FET in the false lumen.
      PubDate: Tue, 30 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz213
      Issue No: Vol. 57, No. 2 (2019)
       
  • Successful off-pump surgical release for extrinsic compression of outflow
           graft obstruction of a left ventricular assist device
    • Authors: Ushijima T; Tanoue Y, Mitsuo H, et al.
      Pages: 402 - 403
      Abstract: AbstractA 36-year-old woman had received support with the Jarvik 2000 left ventricular assist device for 3 years. Cardiac computed tomography revealed outflow graft obstruction, which appeared as external compression of the outflow graft. The patient underwent surgical release of the obstruction after resternotomy. Yellow sediment had become encrusted in the enclosed space between the covering graft and outflow graft and appeared to have been derived from plasma contents. Successful release of the obstruction was achieved by cutting open the covering graft without cardiopulmonary bypass. Neither pump exchange nor outflow graft exchange was required. This off-pump surgery can be a beneficial procedure in terms of less invasiveness and good curability.
      PubDate: Tue, 13 Aug 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz225
      Issue No: Vol. 57, No. 2 (2019)
       
  • Left ventricular assist device implant and subsequent orthotopic heart
           transplant after chronic type B aortic dissection
    • Authors: Kagawa H; Ramani R, Keebler M, et al.
      Pages: 404 - 405
      Abstract: AbstractThe criteria for being placed on the list of the International Society for Heart and Lung Transplantation for an orthotopic heart transplant mention nothing about patients with aortic dissection. Nor are there any guidelines pertaining to the patient with type B aortic dissection. Herein, we report the case of a patient with chronic type B aortic dissection for whom we successfully performed a left ventricular assist device implant followed by an orthotopic heart transplant.
      PubDate: Sun, 25 Aug 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz226
      Issue No: Vol. 57, No. 2 (2019)
       
  • Antegrade transapical branch deployment for endovascular aortic-arch
           repair by in situ fenestration
    • Authors: Murakami T; Kishimoto N, Sohgawa E, et al.
      Pages: 406 - 408
      Abstract: AbstractA 76-year-old man presented with an aortic arch aneurysm and was considered a candidate for endovascular aortic arch repair by in situ fenestration. Alternative access routes were explored because of atherosclerotic disease of the descending aorta and bilateral carotid arteries. Transapical deployment of both an aortic and a branched stent grafts was successfully conducted without cerebral complications. The transapical access might have the potential to reduce the risks of complications related to large bore-sheath insertion to the carotid arteries.
      PubDate: Fri, 09 Aug 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz223
      Issue No: Vol. 57, No. 2 (2019)
       
  • Reply to Kim and Choi
    • Authors: Olsthoorn J; Heuts S, Maessen J, et al.
      Pages: 409 - 409
      Abstract: Mitral valve surgeryMinimally invasive mitral valve surgeryUnexpected anterior leaflet prolapse
      PubDate: Mon, 20 May 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz154
      Issue No: Vol. 57, No. 2 (2019)
       
  • How can we solve unexpected prolapse of the anterior leaflet during saline
           testing in mitral valve repair'
    • Authors: Kim N; Choi J.
      Pages: 409 - 409
      Abstract: Mitral valve repairUnexpected leaflet prolapse
      PubDate: Mon, 20 May 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz153
      Issue No: Vol. 57, No. 2 (2019)
       
  • Atrio-oesophageal fistula after the cryomaze procedure: the devil is in
           the details
    • Authors: Hysi I; Fabre O.
      Pages: 410 - 411
      Abstract: CryomazeAtrio-oesophageal fistulaTransoesophageal echo probe
      PubDate: Wed, 05 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz169
      Issue No: Vol. 57, No. 2 (2019)
       
  • Implications of haemodynamic monitoring during left ventricular assist
           device support
    • Authors: Imamura T.
      Pages: 410 - 410
      Abstract: CardioMEMSHeart failurePulmonary hypertension
      PubDate: Mon, 20 May 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz155
      Issue No: Vol. 57, No. 2 (2019)
       
  • Reply to Imamura
    • Authors: Veenis J; Brugts J.
      Pages: 410 - 410
      Abstract: Heart failureCardioMEMSTelemonitoringLeft ventricular assist deviceHeartMate3
      PubDate: Mon, 20 May 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz156
      Issue No: Vol. 57, No. 2 (2019)
       
  • Reply to Hysi and Fabre
    • Authors: Wang L; Milman S, Ng T.
      Pages: 411 - 411
      Abstract: Atrial ablationAtrio-oesophageal fistulaCryomaze procedureTransoesophageal echo
      PubDate: Wed, 05 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz170
      Issue No: Vol. 57, No. 2 (2019)
       
  • Tumour size: a non-negligible prognostic factor for patients with thymoma
    • Authors: Tian D; Huang H, Jiang K, et al.
      Pages: 411 - 412
      Abstract: ThymomaTumour sizePrognostic factor
      PubDate: Sun, 21 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz120
      Issue No: Vol. 57, No. 2 (2019)
       
  • Reply to Tian et al.
    • Authors: Okumura M.
      Pages: 412 - 412
      Abstract: ThymomaThymic epithelial tumourStage
      PubDate: Sun, 21 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ejcts/ezz121
      Issue No: Vol. 57, No. 2 (2019)
       
 
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