Subjects -> MEDICAL SCIENCES (Total: 8677 journals)
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CARDIOVASCULAR DISEASES (338 journals)                  1 2 | Last

Showing 1 - 200 of 338 Journals sorted alphabetically
Acta Angiologica     Open Access   (Followers: 5)
Acta Cardiologica     Hybrid Journal   (Followers: 2)
Acute Cardiac Care     Hybrid Journal   (Followers: 8)
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: 60)
American Journal of Cardiology     Hybrid Journal   (Followers: 68)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 18)
American Journal of Hypertension     Hybrid Journal   (Followers: 29)
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 Circulation     Open Access   (Followers: 2)
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: 6)
Archives of Cardiovascular Diseases Supplements     Full-text available via subscription   (Followers: 4)
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)
Arrhythmia & Electrophysiology Review     Open Access   (Followers: 1)
Arteriosclerosis, Thrombosis and Vascular Biology     Full-text available via subscription   (Followers: 33)
Artery Research     Hybrid Journal   (Followers: 5)
ARYA Atherosclerosis     Open Access  
ASAIO Journal     Hybrid Journal   (Followers: 4)
ASEAN Heart Journal     Open Access   (Followers: 3)
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: 9)
BMC Cardiovascular Disorders     Open Access   (Followers: 22)
Brain Circulation     Open Access   (Followers: 1)
British Journal of Cardiology     Full-text available via subscription   (Followers: 18)
Canadian Journal of Cardiology     Hybrid Journal   (Followers: 18)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiac Electrophysiology Review     Hybrid Journal   (Followers: 2)
Cardiac Failure Review     Open Access   (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: 11)
Cardiology Clinics     Full-text available via subscription   (Followers: 14)
Cardiology in Review     Hybrid Journal   (Followers: 9)
Cardiology in the Young     Hybrid Journal   (Followers: 35)
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: 11)
Cardiopulmonary Physical Therapy Journal     Hybrid Journal   (Followers: 9)
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: 2)
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: 16)
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: 104)
Choroby Serca i Naczyń     Open Access   (Followers: 1)
Circulation     Hybrid Journal   (Followers: 270)
Circulation : Cardiovascular Imaging     Hybrid Journal   (Followers: 15)
Circulation : Cardiovascular Interventions     Hybrid Journal   (Followers: 19)
Circulation : Cardiovascular Quality and Outcomes     Hybrid Journal   (Followers: 12)
Circulation : Genomic and Precision Medicine     Hybrid Journal   (Followers: 17)
Circulation : Heart Failure     Hybrid Journal   (Followers: 28)
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: 10)
Clinical Hypertension     Open Access   (Followers: 5)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6)
Clinical Research in Cardiology     Hybrid Journal   (Followers: 5)
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: 3)
CorSalud     Open Access  
Critical Pathways in Cardiology     Hybrid Journal   (Followers: 5)
Current Cardiology Reports     Hybrid Journal   (Followers: 6)
Current Cardiology Reviews     Hybrid Journal   (Followers: 3)
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: 13)
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: 1)
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 Cardiology Review     Open Access   (Followers: 1)
European Heart Journal     Hybrid Journal   (Followers: 68)
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: 7)
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: 13)
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: 5)
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: 49)
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: 2)
High Blood Pressure & Cardiovascular Prevention     Full-text available via subscription   (Followers: 2)
Hypertension     Full-text available via subscription   (Followers: 24)
Hypertension     Open Access   (Followers: 2)
Hypertension in Pregnancy     Hybrid Journal   (Followers: 9)
Hypertension Research     Hybrid Journal   (Followers: 4)
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: 6)
International Cardiovascular Forum Journal     Open Access  
International Journal of Angiology     Hybrid Journal   (Followers: 2)
International Journal of Cardiology     Hybrid Journal   (Followers: 17)
International Journal of Cardiology Hypertension     Open Access   (Followers: 1)
International Journal of Cardiovascular and Cerebrovascular Disease     Open Access   (Followers: 3)
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: 33)
International Journal of the Cardiovascular Academy     Open Access  
Interventional Cardiology Clinics     Full-text available via subscription   (Followers: 2)
Interventional Cardiology Review     Open Access  
JACC : Basic to Translational Science     Open Access   (Followers: 6)
JACC : Cardiovascular Imaging     Hybrid Journal   (Followers: 19)
JACC : Cardiovascular Interventions     Hybrid Journal   (Followers: 21)
JACC : Heart Failure     Full-text available via subscription   (Followers: 16)
JAMA Cardiology     Hybrid Journal   (Followers: 31)

        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  [412 journals]
  • Thoracic surgeons’ insights: Improving thoracic surgery outcomes during
           the Coronavirus Disease 2019 pandemic
    • Authors: Chen K; Gao S, Liu L, et al.
      Pages: 207 - 209
      Abstract: Thoracic surgeryOutcome improvementCOVID-19 pandemic
      PubDate: Thu, 04 Jun 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa214
      Issue No: Vol. 58, No. 2 (2020)
  • Reorganization of thoracic surgery activity in a national high-volume
           comprehensive cancer centre in the Italian epicentre of coronavirus
           disease 2019
    • Authors: Bertolaccini L; Spaggiari L.
      Pages: 210 - 212
      Abstract: Coronavirus disease 2019Severe acute respiratory syndrome coronavirus 2Lung cancerThoracic surgeryHealth care reorganization
      PubDate: Thu, 09 Jul 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa234
      Issue No: Vol. 58, No. 2 (2020)
  • Safety for all: coronavirus disease 2019 pandemic and cardiac surgery: a
           roadmap to ‘phase’ 2
    • Authors: Parolari A; di Mauro M, Bonalumi G, et al.
      Pages: 213 - 216
      Abstract: Cardiac surgeryCoronavirus disease 2019Public health
      PubDate: Mon, 11 May 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa187
      Issue No: Vol. 58, No. 2 (2020)
  • The role of robotic totally endoscopic coronary artery bypass in the
           future of coronary artery revascularization
    • Authors: Torregrossa G; Balkhy H.
      Pages: 217 - 220
      Abstract: Totally Endoscopic Coronary Artery BypassMinimally GraftingMinimally invasive coronary artery bypass graftingMid-coronary artery bypass grafting
      PubDate: Mon, 20 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa104
      Issue No: Vol. 58, No. 2 (2020)
  • Mortality in trials on transcatheter aortic valve implantation versus
           surgical aortic valve replacement: a pooled meta-analysis of
           Kaplan–Meier-derived individual patient data
    • Authors: Barili F; Freemantle N, Pilozzi Casado A, et al.
      Pages: 221 - 229
      Abstract: AbstractOBJECTIVESThis meta-analysis of Kaplan–Meier-estimated individual patient data was designed to evaluate the effects of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) on the long-term all-cause mortality rate, to examine the potential time-varying effect and to model their hazard ratios (HRs) over time. Moreover, we sought to compare traditional meta-analytic tools and estimated individual patient data meta-analyses.METHODSTrials comparing TAVI versus SAVR were identified through Medline, Embase, Cochrane databases and specialist websites. The primary outcome was death from any cause at follow-up. Enhanced secondary analyses of survival curves were performed estimating individual patient time-to-event data from published Kaplan–Meier curves. Treatments were compared with the random effect Cox model in a landmark framework and fully parametric models.RESULTSWe identified 6 eligible trials that included 6367 participants, randomly assigned to undergo TAVI (3252) or SAVR (3115). According to the landmark analysis, the incidence of death in the first year after implantation was significantly lower in the TAVI group [risk-profile stratified HR 0.85, 95% confidence interval (CI) 0.73–0.99; P = 0.04], whereas there was a reversal of the HR after 40 months (risk-profile stratified HR 1.31, 95% CI 1.01–1.68; P = 0.04) favouring SAVR over TAVI. This time-varying trend of HRs was also confirmed by a fully parametric time-to-event model. Traditional meta-analytic tools were shown to be biased because they did not intercept heterogeneity and the time-varying effect.CONCLUSIONSThe mortality rates in trials of TAVI versus SAVR are affected by treatments with a time-varying effect. TAVI is related to better survival in the first months after implantation whereas, after 40 months, it is a risk factor for all-cause mortality.
      PubDate: Wed, 01 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa087
      Issue No: Vol. 58, No. 2 (2020)
  • Norwood procedure with right ventricle to pulmonary artery conduit: a
           single-centre 20-year experience
    • Authors: Kobayashi Y; Kotani Y, Kuroko Y, et al.
      Pages: 230 - 236
      Abstract: AbstractOBJECTIVESThe aim of this study was to evaluate the long-term outcomes of the Norwood procedure with right ventricle–pulmonary artery (RV–PA) conduit for hypoplastic left heart complex.METHODSA retrospective observational study was performed in 136 patients with hypoplastic left heart complex who underwent a Norwood procedure with RV–PA conduit between 1998 and 2017. The probabilities of survival, reintervention and Fontan completion were analysed.RESULTSStage 1 survival was 91.9% (125/136). Reintervention for PA stenosis was needed for 22% and 30% at stages 2 and 3, respectively, while 15% underwent reintervention for aortic arch recoarctation. Among 106 bidirectional Glenn survivors, 93 (68% of the total number of patients) had a Fontan completion, while 4 were not considered to be Fontan candidates. Risk factors for overall mortality included weighing <2.5 kg at the time of the Norwood procedure, intact atrium septum, total anomalous pulmonary vein connection and more than mild atrioventricular regurgitation at the time of the Norwood procedure. Overall survival was 80.9%, 72.3% and 62.8% at 1, 5 and 20 years, respectively.CONCLUSIONSProbabilities of survival and Fontan completion were acceptable under the current surgical strategy incorporating RV–PA Norwood procedure as the first palliation. Incorporating a strategy to maintain PA growth and ventricular function through the staged repair is of prime importance. Further studies are necessary to observe changes in atrioventricular regurgitation as well as in right ventricular function, in patients who require atrioventricular valve interventions during the staged Fontan completion.
      PubDate: Tue, 24 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa041
      Issue No: Vol. 58, No. 2 (2020)
  • Computed tomography-based surgical strategy for total anomalous pulmonary
           venous connection
    • Authors: Matsuhisa H; Oshima Y, Higuma T, et al.
      Pages: 237 - 245
      Abstract: AbstractOBJECTIVESWe used computed tomographic angiography (CTA)-based surgical planning to clarify the anatomical indications of sutureless repair technique for total anomalous pulmonary venous connection. The mid-term impact of the current surgical strategies was evaluated.METHODSOne hundred twelve patients underwent repair for total anomalous pulmonary venous connection. The study period was divided into era 1 (1996–2010, n = 56) and era 2 (2011–2018, n = 56). Patients with single ventricular heart (SVH) were included. In era 2, the indications for primary sutureless repair and branch pulmonary vein incision were based on CTA findings.RESULTSFor patients with biventricular heart, the 5-year survival was 69% and 97% in eras 1 and 2, respectively (P = 0.0024). For patients with SVH, the 5-year survival was 21% and 70% in eras 1 and 2, respectively (P = 0.0007). During the follow-up period, the evidence of post-repair pulmonary vein stenosis (PVS) was observed in 12 patients with biventricular heart [era 1, 8 patients (23%); era 2, 4 patients (13%)], and 14 patients with SVH [era 1, 6 patients (60%); era 2, 8 patients (36%)]. Using multivariable analysis, preoperative CTA was associated with improved survival in both biventricular heart and SVH and associated with post-repair PVS-free survival in SVH. Since 2011, 12 patients with post-repair PVS underwent multiple reintervention with 1 recorded death (5-year survival: 88%).CONCLUSIONSCTA-based surgical strategy for total anomalous pulmonary venous connection provided significant survival benefit. Although post-repair PVS could occur in era 2, aggressive reintervention appeared to be associated with improved survival and vein patency.
      PubDate: Wed, 12 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa028
      Issue No: Vol. 58, No. 2 (2020)
  • Long-term outcomes of pulmonary valve replacement in patients with
           repaired tetralogy of Fallot
    • Authors: Lee C; Choi E, Lee C.
      Pages: 246 - 252
      Abstract: AbstractOBJECTIVESThe objectives of this study were to evaluate long-term outcomes of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (TOF) and to identify the factors associated with adverse clinical events (ACEs).METHODSA total of 190 patients who underwent PVR between 1998 and 2015 after repair of TOF were retrospectively analysed. ACE was defined as all-cause death, heart transplantation or new-onset sustained arrhythmia. Univariable Cox proportional hazards regression analysis was used to identify the factors associated with ACE after PVR.RESULTSThe median age at PVR was 19 years. Preoperative magnetic resonance imaging (MRI) was performed in 143 (75%) patients, and the median right ventricular (RV) end-diastolic and end-systolic volume index was 164 and 82 ml/m2, respectively. The follow-up completeness was 94%, and the median follow-up duration was 9.8 years. The transplantation-free survival and freedom from ACE at 15 years was 95% and 90%, respectively. The factors associated with ACE were older age at PVR, older age at TOF repair, New York Heart Association functional class III or IV, presence of tachyarrhythmias, longer cardiopulmonary bypass time and concomitant arrhythmia surgery. In a subgroup analysis of 143 patients with preoperative MRI data, larger RV end-systolic volume index, larger left ventricular end-systolic volume index and lower left ventricular ejection fraction were associated with ACE.CONCLUSIONSLong-term outcomes of PVR in patients with repaired TOF were satisfactory. Proactive PVR before the onset of advanced symptoms, tachyarrhythmias and ventricular dysfunction may further improve the long-term survival of this patient population.
      PubDate: Tue, 11 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa030
      Issue No: Vol. 58, No. 2 (2020)
  • Bridge to recovery with Berlin Heart EXCOR in children <10 kg with
           dilated cardiomyopathy: a histological analysis
    • Authors: Tominaga Y; Ueno T, Kido T, et al.
      Pages: 253 - 260
      Abstract: AbstractOBJECTIVESThis study aimed to identify the histological characteristics associated with bridge to recovery using Berlin Heart EXCOR® (BHE) in paediatric patients <10 kg with dilated cardiomyopathy.METHODSOf the 10 consecutive patients <10 kg with dilated cardiomyopathy who underwent BHE implantation between 2013 and 2018, 4 patients showed improvement in left ventricular (LV) function, resulting in successful BHE explantation (recovery group). The remaining 6 patients showed persistent LV dysfunction and underwent heart transplantation (non-recovery group). The following variables were compared between the 2 groups: (i) histological findings in LV myocardium obtained at BHE implantation and (ii) LV function after BHE implantation assessed with echocardiography and cardiac catheterization.RESULTSThe degree of myocardial fibrosis was significantly lower, and the capillary vascular density was significantly higher in the recovery group than in the non-recovery group [16% (standard deviation 5.9%) vs 28% (5.9%), P = 0.021, and 65 (11) vs 43 (18) units/high-power field, P = 0.037, respectively]. The changes during 3 months after BHE implantation in LV diastolic dimension (z-score) and ejection fraction were significantly greater in the recovery group than in the non-recovery group [−9.6 (3.5) vs −3.6 (4.5), P = 0.045, and 36% (13%) vs 13% (13%), P = 0.032, respectively].CONCLUSIONSIn paediatric patients <10 kg with dilated cardiomyopathy, bridge to recovery with BHE implantation was achieved in patients with less injured LV myocardial histology at BHE implantation.
      PubDate: Thu, 13 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa033
      Issue No: Vol. 58, No. 2 (2020)
  • Intraoperative localization of cardiac conduction tissue regions using
           real-time fibre-optic confocal microscopy: first in human trial
    • Authors: Kaza A; Mondal A, Piekarski B, et al.
      Pages: 261 - 268
      Abstract: AbstractOBJECTIVESThe aim of this study was to evaluate the feasibility and safety of fibre-optic confocal microscopy (FCM) using fluorescein sodium dye for the intraoperative location of conduction tissue regions during paediatric heart surgery.METHODSThe pilot study included 6 patients undergoing elective surgery for the closure of isolated secundum atrial septal defect aged 30 days to 21 years. FCM imaging was integrated within the normal intraoperative protocol for atrial septal defect repair. Fluorescein sodium dye was applied on the arrested heart. FCM images were acquired at the atrioventricular node region, sinus node region and right ventricle (RV). Total imaging time was limited to 3 min. Any adverse events related to the study were recorded and analysed. Subjects received standard postoperative care. Trained reviewers (n = 9) classified, de-identified and randomized FCM images (n = 60) recorded from the patients as presenting striated, reticulated or indistinguishable microstructures. The reliability of reviewer agreement was assessed using Fleiss’ kappa.RESULTSThe FCM imaging instruments were integrated effectively into the cardiac surgery operating room. All adverse events found in the study were deemed expected and not related to FCM imaging. Reticulated myocardial microstructures were found during FCM imaging at atrioventricular node and sinus node regions, while striated microstructures were observed in RV. Reliability of agreement of reviewers classifying the FCM images was high (Fleiss’ kappa: 0.822).CONCLUSIONSFCM using fluorescein sodium dye was found to be safe for use during paediatric heart surgery. The study demonstrates the potential for FCM to be effective in identifying conduction tissue regions during congenital heart surgery.Clinical trial registration numberNCT03189134.
      PubDate: Fri, 21 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa040
      Issue No: Vol. 58, No. 2 (2020)
  • Moderate hypothermia with remote ischaemic preconditioning improves
           cerebral protection compared to deep hypothermia: a study using a
           surviving porcine model
    • Authors: Mustonen C; Honkanen H, Lehtonen S, et al.
      Pages: 269 - 276
      Abstract: AbstractOBJECTIVESThe optimal temperature management of hypothermic circulatory arrest is still controversial. Moderate hypothermia preserves cerebral autoregulation and shortens cardiopulmonary bypass (CPB) duration. However, moderate hypothermia alone has inferior organ protection to deep hypothermia, so adjuncts that increase the ischaemic tolerance are needed. Thus, we hypothesized that a combination of remote ischaemic preconditioning (RIPC) and moderate hypothermia would be superior to deep hypothermia alone.METHODSSixteen pigs were randomized to either RIPC or control groups (8 + 8). The RIPC group underwent 4 cycles of transient hind limb ischaemia. The RIPC group underwent cooling with CPB to 24°C, and the control group underwent cooling with CPB to 18°C, followed by a 30-min arrest period and subsequent rewarming to 36°C. Measurements of cerebral metabolism were made from sagittal sinus blood samples and common carotid artery blood flow. The permissible periods of hypothermic circulatory arrest were calculated based on these measurements. Neurological recovery was evaluated daily during a 7-day follow-up, and the brain was harvested for histopathological analysis.RESULTSSix pigs in the RIPC group reached normal neurological function, but none in the control group reached normal neurological function (P = 0.007). The composite neurological score of all postoperative days was higher in the RIPC group than in the control group [55 (52–58) vs 45 (39–51), P = 0.026]. At 24°C, the estimated permissible periods of hypothermic circulatory arrest were 21 (17–25) min in the RIPC group and 11 (9–13) min in the control group (P = 0.007).CONCLUSIONSRIPC combined with moderate hypothermia provides superior cerebral protection.
      PubDate: Wed, 01 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa065
      Issue No: Vol. 58, No. 2 (2020)
  • Relaxant and antiadrenergic effects of ranolazine in human saphenous vein
    • Authors: Marchio P; Guerra-Ojeda S, Aldasoro M, et al.
      Pages: 277 - 285
      Abstract: AbstractOBJECTIVESRanolazine improves vascular function in animal models. We evaluate the effects of ranolazine on vascular function and adrenergic response in human saphenous vein.METHODSRings from 53 patients undergoing coronary artery bypass grafting were mounted in organ baths. Concentration–response curves to ranolazine were constructed in rings precontracted with phenylephrine, endothelin-1, vasopressin, KCl and the thromboxane A2 analogue U-46619. In rings precontracted with phenylephrine, relaxation to ranolazine was tested in the absence and presence of endothelial factors inhibitors, K+ channel blockers and verapamil. The effects of ranolazine on frequency–response and concentration–response curves to phenylephrine were performed in the absence and presence of endothelial factors inhibitors and K+ channel blockers. Endothelial nitric oxide synthase, α1 adrenergic receptor and large conductance Ca2+-activated K+ channel protein expressions were measured by Western blotting.RESULTSRanolazine (10−9–10−4 M) produced a concentration-dependent relaxation only in rings precontracted with phenylephrine that was reduced by endothelial denudation, NG-nitro-l-arginine methyl ester (10−4 M), charybdotoxin (10−7 M) and verapamil (10−6 M). Ranolazine diminished adrenergic contractions induced by electrical field stimulation (2–4 Hz) and phenylephrine (10−9–10−5 M) that were prevented by tetraethylammonium (10−3 M) and charybdotoxin (10−7 M). Ranolazine significantly decreased α1 adrenergic receptor and increased large conductance Ca2+-activated K+ channel protein expression in the saphenous vein.CONCLUSIONSRanolazine diminishes the adrenergic vasoconstriction, acting as α1 antagonist, and by increasing large conductance Ca2+-activated K+ channel involvement. The relaxant effects of ranolazine are partially mediated by endothelial nitric oxide, large conductance Ca2+-activated K+ channels and the blockade of voltage-dependent Ca2+ channels.
      PubDate: Tue, 18 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa034
      Issue No: Vol. 58, No. 2 (2020)
  • Detrimental effects of cerebrospinal fluid pressure elevation on spinal
           cord perfusion: first-time direct detection in a large animal model
    • Authors: Haunschild J; von Aspern K, Khachatryan Z, et al.
      Pages: 286 - 293
      Abstract: AbstractOBJECTIVESCerebrospinal fluid (CSF) drainage is routinely utilized to mitigate perioperative and postoperative spinal cord ischaemia in open and endovascular thoraco-abdominal aortic aneurysm repair to prevent permanent paraplegia. Clinical decision-making in the vulnerable perioperative period, however, is still based on limited clinical and experimental data. Our aim was to investigate the isolated effect of CSF pressure elevation on spinal cord perfusion in an established large animal model.METHODSTen juvenile pigs with normal (native) arterial inflow (patent segmental arteries and collaterals) underwent iatrogenic CSF pressure elevation (×2, ×3, ×4 from their individual baseline pressure). Each pressure level was maintained for 30 min to mimic clinical response time. After the quadrupling of CSF pressure, the dural sac was slowly depressurized against gravity allowing CSF pressure to passively return to baseline values. Measurements were taken 30 and 60 min after normalization, and microspheres for regional blood flow analysis were injected at each time point.RESULTSSpinal cord perfusion decreased significantly at all mid-thoracic to lumbar cord segments at the doubling of CSF pressure and declined to values <53% compared to baseline when pressure was quadrupled. Normalizing CSF pressure led to an intense hyperperfusion of up to 186% at the cervical level and 151% within the lumbar region.CONCLUSIONSCSF pressure elevation results in a relevant impairment of spinal cord blood supply. Close perioperative and postoperative monitoring of CSF pressure is crucial for maintaining sufficient spinal cord perfusion. Radical and rapid withdrawal of CSF is followed by significant hyperperfusion in all spinal cord segments and may lead to ‘drainage-related’ iatrogenic reperfusion injury—aggravating the risk of delayed spinal cord injury—and should therefore be avoided.
      PubDate: Wed, 01 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa038
      Issue No: Vol. 58, No. 2 (2020)
  • Aortic dissection during pregnancy and postpartum in patients with Marfan
           syndrome: a 21-year clinical experience in 30 patients
    • Authors: Ma W; Zhu J, Chen Y, et al.
      Pages: 294 - 301
      Abstract: AbstractOBJECTIVESPregnancy-related aortic dissection (AoD) in Marfan syndrome is a lethal catastrophe. Due to its rarity and limited clinical experience, there is no consensus regarding the optimal management strategy. We seek to present our 21-year experience in such patients , focusing on management strategies and early and late outcomes.METHODSBetween 1998 and 2019, we managed 30 pregnant women with Marfan syndrome (mean age 30.7 ± 4.3 years) who sustained AoD at a mean of 28.3 ± 8.8 weeks of gestation (GWs). AoD was acute in 21 (70%), type A (TAAD) in 24 (80%) and type B (TBAD) in 6 (20%). Fourteen TAADs (58.3%, 14/24) and 2 TBADs (33.3%, 2/6) occurred in the third trimester or postpartum. The maximal aortic size was < 45 mm in 26.7% (8/30; 3 TAADs, 5 TBADs). Management strategy was based on the types of dissection and GWs (i.e. surgical versus medical treatment, surgery or delivery first).RESULTSTAADs were treated medically in 1 and surgically in 23. The timing of delivery and surgery were caesarean first at 35.4 ± 6.1 GWs in 7 (29.2%), followed by surgery after mean 46 days; single-stage C-section and surgery at 32.0 ± 5.0 GWs in 10 (41.7%); and surgery first at 18.0 ± 5.8 GWs in 6 (25%), followed by C-section after 20 days. Maternal and foetal mortality were 28.6% (2/7) and 14.3% (1/7), 10.0% (1/10) and 20.0% (2/10) and 16.7% (1/6) and 83.3% (5/6), respectively. Five TBADs (83.3%) were managed with C-section followed by surgery in 2 and medical treatment in 3. The respective maternal and foetal mortality were 50% (1/2) and 100% (2/2) and 33.3% (1/3) and 33.3% (1/3), respectively. One TBAD was managed surgically first followed by C-section, resulting in maternal survival and foetal death. Follow-up was complete in 95.8% (23/24) at 3.7 ± 2.9 years. Four late deaths occurred and reoperation was performed in 1 patient. Maternal and foetal survival were 64.3% and 54.1% at 6 years, respectively.CONCLUSIONSManagement of AoD in pregnant women with Marfan syndrome should be based on types of dissection (surgical versus medical) and gestational age (delivery or surgery first), which largely determine maternal and foetal survival. Aortic repair should be considered prior to conception in women with Marfan syndrome even at diameters smaller than recommended by current guidelines.
      PubDate: Tue, 07 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa048
      Issue No: Vol. 58, No. 2 (2020)
  • Preoperative renal malperfusion is an independent predictor for acute
           kidney injury and operative death but not associated with late mortality
           after surgery for acute type A aortic dissection
    • Authors: Nishigawa K; Fukui T, Uemura K, et al.
      Pages: 302 - 308
      Abstract: AbstractOBJECTIVESThis study was aimed to investigate the impact of preoperative renal malperfusion on early and late outcomes after surgery for acute type A aortic dissection (AAAD).METHODSOf 915 patients who underwent surgery for AAAD between September 2004 and September 2017, we enrolled 534 patients whose preoperative enhanced computed tomography images were retrospectively available in this study. Exclusion criteria were single kidney (n = 3) and dialysis-dependent preoperatively (n = 12). We compared early and late outcomes between patients who had preoperative renal malperfusion (n = 64) and those who did not have renal malperfusion (n = 470).RESULTSThe incidence of postoperative acute kidney injury, defined using the Kidney Disease: Improving Global Outcomes criteria, was higher in the renal malperfusion group than in the no renal malperfusion group (76.6% vs 39.4%; P < 0.001). Similarly, operative death was more frequently seen in the renal malperfusion group (12.5% vs 3.8%; P = 0.003). Multivariate analyses showed that renal malperfusion was the independent predictor for postoperative acute kidney injury [odds ratio 4.32, 95% confidence interval (CI) 2.25–8.67; P < 0.001] and operative death (odds ratio 3.08, 95% CI 1.02–8.86; P = 0.046). The median follow-up period in the hospital survivors was 3.3 years (interquartile range 2.1–6.7 years). The cumulative survival rate at 8 years was similar between the groups (74.6% in the renal malperfusion group and 76.0% in the no renal malperfusion group; P = 0.349).CONCLUSIONSPreoperative renal malperfusion is an independent predictor for postoperative acute kidney injury and operative death but not associated with late mortality after surgery for acute type A aortic dissection.
      PubDate: Tue, 17 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa063
      Issue No: Vol. 58, No. 2 (2020)
  • The Modified Arch Landing Areas Nomenclature predicts proximal endograft
           failure after thoracic endovascular aortic repair
    • Authors: Marrocco-Trischitta M; de Beaufort H, Piffaretti G, et al.
      Pages: 309 - 318
      Abstract: AbstractOBJECTIVESOur goal was to assess the value of the Modified Arch Landing Areas Nomenclature (MALAN) for thoracic endovascular aortic repair (TEVAR), in which each landing area (LA) is identified by a proximal landing zone and the type of arch (e.g. 0/I), as predictors of postoperative proximal endograft performance.METHODSA multicentre retrospective analysis was performed of patients treated with arch TEVAR (i.e. proximal landing zone 0–3) for various indications between 2007 and 2017. Patients were stratified by the MALAN classification into hostile LAs (i.e. 2/III and 3/III) and favourable LAs (i.e. 0/I–III, 1/I–III, 2/I–II and 3/I–II). Outcome criteria included composite proximal endograft failure (including type Ia endoleak, persistent false lumen perfusion at the level of the most proximal communication between the lumina in aortic dissections, endograft migration and retrograde dissection) and deaths from all causes. Competing risk analyses were performed.RESULTSA total of 359 patients (hostile LAs 133; favourable LAs 226) were identified. The median age was 71.0 (62.0–77.0); 78.3% were men. Proximal endograft failure occurred in 28/133 patients (21.1%) in the hostile LA group and in 12/226 (5.3%) in the favourable LA group. On multivariate analysis, hostile LAs were independently associated with proximal endograft failure (P < 0.0001). There was no other independent risk factor. Favourable LAs were associated with an increased mortality rate (P = 0.006), which could be attributed to the proximal LA subgroup (i.e. 0/I–III and 1/I–III) (P < 0.0001), in addition to age (P < 0.0001).CONCLUSIONSThe MALAN classification identifies hostile proximal landing zones for TEVAR, namely 2/III and 3/III LAs, which are associated with dismal proximal endograft performance. The MALAN appears to be an intuitive and valuable tool to improve the preoperative decision-making process.
      PubDate: Thu, 21 May 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa115
      Issue No: Vol. 58, No. 2 (2020)
  • A call to action becomes practice: cardiac and vascular surgery during the
           COVID-19 pandemic based on the Lombardy emergency guidelines
    • Authors: Bonalumi G; Giambuzzi I, Barbone A, et al.
      Pages: 319 - 327
      Abstract: AbstractOBJECTIVESDuring the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic, Northern Italy had to completely reorganize its hospital activity. In Lombardy, the hub-and-spoke system was introduced to guarantee emergency and urgent cardiovascular surgery, whereas most hospitals were dedicated to patients with coronavirus disease 2019 (COVID-19). The aim of this study was to analyse the results of the hub-and-spoke organization system.METHODSCentro Cardiologico Monzino (Monzino) became one of the four hubs for cardiovascular surgery, with a total of eight spokes. SARS-CoV-2 screening became mandatory for all patients. New flow charts were designed to allow separated pathways based on infection status. A reorganization of spaces guaranteed COVID-19-free and COVID-19-dedicated areas. Patients were also classified into groups according to their pathological and clinical status: emergency, urgent and non-deferrable (ND).RESULTSA total of 70 patients were referred to the Monzino hub-and-spoke network. We performed 41 operations, 28 (68.3%) of which were emergency/urgent and 13 of which were ND. The screening allowed the identification of COVID-19 (three patients, 7.3%) and non-COVID-19 patients (38 patients, 92.7%). The newly designed and shared protocols guaranteed that the cardiac patients would be divided into emergency, urgent and ND groups. The involvement of the telematic management heart team allowed constant updates and clinical discussions.CONCLUSIONSThe hub-and-spoke organization system efficiently safeguards access to heart and vascular surgical services for patients who require ND, urgent and emergency treatment. Further reorganization will be needed at the end of this pandemic when elective cases will again be scheduled, with a daily increase in the number of operations.
      PubDate: Thu, 25 Jun 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa204
      Issue No: Vol. 58, No. 2 (2020)
  • Optimal versus suboptimal mitral valve repair: late results in a matched
           cohort study
    • Authors: De Bonis M; Zancanaro E, Lapenna E, et al.
      Pages: 328 - 334
      Abstract: AbstractOBJECTIVESAfter mitral repair for degenerative mitral regurgitation (MR), no or mild (≤1+/4+) residual MR should remain. Occasionally patients are left with more than mild residual MR (>1+/4+) for a number of reasons. The aim of this study was to assess the late implications of such a suboptimal repair in a matched cohort study.METHODSFrom 2006 to 2013, a total of 2158 patients underwent mitral repair for degenerative MR in our institution. Fifty patients (2.3%) with residual MR >1+ at hospital discharge (study group) were matched up to 1:2 with 91 patients operated on during the same period who were discharged with MR ≤1+ (control group). The median follow-up was 8 years (interquartile range 6.3–10.1, longest 12.7 years). A comparative analysis of the outcomes in the 2 groups was performed.RESULTSOverall survival at 8 years was 87 ± 8% in the study group and 92 ± 3% in the control group (P = 0.23). There were 3 late deaths (6.0%) in the study group and 6 deaths (6.6%) in the control group. Freedom from reoperation was similar (P = 1.0). At 8 years the prevalence of MR ≥3+ was significantly higher in the study group (15.6% vs 2.1%, P < 0.001) as was the use of diuretics, beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers. Interestingly, even in the control group, a gradual progression of MR was observed because 13.3% of the patients had MR ≥2+ at 8 years with a significant increase over time (P < 0.001).CONCLUSIONSResidual MR more than mild at hospital discharge is associated with lower durability of mitral repair and the need for more medical therapy in the long term. However, even an initial optimal result does not completely arrest the progression of the degenerative process.
      PubDate: Thu, 16 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa103
      Issue No: Vol. 58, No. 2 (2020)
  • Pacemaker implantation after aortic valve replacement: rapid-deployment
           Intuity® compared to conventional bioprostheses
    • Authors: Herry M; Laghlam D, Touboul O, et al.
      Pages: 335 - 342
      Abstract: AbstractOBJECTIVESThe aim of this study was to compare the incidence of permanent pacemaker (PPM) implantation after aortic valve replacement by rapid-deployment bioprosthesis (RDB) and standard valve (Standard).METHODSAll patients undergoing aortic valve replacement between 2015 and 2018, in 1 centre, were included. A multivariate analysis on the whole cohort and then a propensity score matching were used to compare the 2 groups. The primary end point was PPM implantation.RESULTSWe studied 924 patients (256 RDBs and 668 Standards). Overall, 67 PPM were implanted, 37 (14.5%) in the RDB group and 26 (3.9%) in the Standard group (P < 0.0001, univariate analysis). The multivariate analysis in the unmatched population found 4 independent factors associated with PPM implantation: right bundle branch block with odds ratios (ORs 3.7, 95% CI 2.9–6.7; P < 0.0001), RDB (OR 3.6, 95% CI 2.0–6.2; P < 0.0001), age (OR 1.1, 95% CI 1.0–1.1; P < 0.006) and endocarditis (OR 3.4, 95% CI 1.0–11.0; P < 0.04). In the propensity score-matched RDB group (203 patients per group), 25 patients required PPM implantation versus 3 in the Standard group (12.3% vs 1.5%, P < 0.0001). RDBs also had more postoperative left bundle branch block and new onset of atrial fibrillation (30.2% vs 5.1%, P < 0.0001 and 34.0% vs 24.1%, P = 0.029). RDBs had lower operating times (in min): aortic cross-clamping = 62 (44–76.5) vs 72 (57.5–91.5) and cardiopulmonary bypass = 81 (63–98.5) vs 91 (75–112), P < 0.0001. There was no significant difference in other outcomes.CONCLUSIONSRDBs were associated with reduced operating times, increased risk of atrial fibrillation and PPM implantation as compared with standard aortic valves.
      PubDate: Thu, 26 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa068
      Issue No: Vol. 58, No. 2 (2020)
  • Is myocardial revascularization really necessary in patients with ≥50%
           but <70% coronary stenosis undergoing valvular surgery'
    • Authors: Del Forno B; Ascione G, Lapenna E, et al.
      Pages: 343 - 349
      Abstract: AbstractOBJECTIVESThe aim of this study is to evaluate the immediate and mid-term effects of omitting coronary artery bypass grafting in patients with moderate coronary artery stenosis who have a primary indication for valvular surgery.METHODSWe included 77 consecutive patients admitted to our Institution for aortic or mitral valve surgery between June 2012 and June 2017 in whom a de novo diagnosis of ≥50%, but <70% coronary stenosis was made. In this cohort, the myocardial revascularization was omitted. All these patients were free from angina and ischaemia on echo and ECG.RESULTSThere were no in-hospital deaths. In only 1 patient, acute myocardial infarction occurred postoperatively, which was immediately treated by percutaneous coronary intervention (PCI). The 6-year overall survival was 94.7 ± 2.59%. At 6 years, no cardiac deaths were recorded. At follow-up, 4 patients underwent elective PCI after a positive stress myocardial perfusion test. Only 1 patient underwent urgent PCI due to acute coronary syndrome. At 6 years, the cumulative incidence function of PCI, with death as competing risk, was 8 ± 3.9%.CONCLUSIONSIn our experience, moderate coronary stenosis, occasionally discovered at the time of valvular heart surgery, can be safely overlooked and do not need any further treatment at follow-up in the majority of cases. Our results open up the opportunity to apply this ‘intentional omission strategy’ in different situations, such as minimally invasive heart surgery, percutaneous procedures and complex patients.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa047
      Issue No: Vol. 58, No. 2 (2020)
  • Validation and update of the thoracic surgery scoring system
           (Thoracoscore) risk model
    • Authors: Die Loucou J; Pagès P, Falcoz P, et al.
      Pages: 350 - 356
      Abstract: AbstractOBJECTIVESThe performance of prediction models tends to deteriorate over time. The purpose of this study was to update the Thoracoscore risk prediction model with recent data from the Epithor nationwide thoracic surgery database.METHODSFrom January 2016 to December 2017, a total of 56 279 patients were operated on for mediastinal, pleural, chest wall or lung disease. We used 3 recommended methods to update the Thoracoscore prediction model and then proceeded to develop a new risk model. Thirty-day hospital mortality included patients who died within the first 30 days of the operation and those who died later during the same hospital stay.RESULTSWe compared the baseline patient characteristics in the original data used to develop the Thoracoscore prediction model and the validation data. The age distribution was different, with specifically more patients older than 65 years in the validation group. Video-assisted thoracoscopy accounted for 47% of surgeries in the validation group compared but only 18% in the original data. The calibration curve used to update the Thoracoscore confirmed the overfitting of the 3 methods. The Hosmer–Lemeshow goodness-of-fit test was significant for the 3 updated models. Some coefficients were overfitted (American Society of Anesthesiologists score, performance status and procedure class) in the validation data. The new risk model has a correct calibration as indicated by the Hosmer–Lemeshow goodness-of-fit test, which was non-significant. The C-index was strong for the new risk model (0.84), confirming the ability of the new risk model to differentiate patients with and without the outcome. Internal validation shows no overfitting for the new modelCONCLUSIONSThe new Thoracoscore risk model has improved performance and good calibration, making it appropriate for use in current clinical practice.
      PubDate: Wed, 01 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa056
      Issue No: Vol. 58, No. 2 (2020)
  • Surgical outcomes and prognosis of non-small-cell lung cancer in patients
           with chronic lung diseases: a retrospective analysis
    • Authors: Choi S; Park J.
      Pages: 357 - 364
      Abstract: AbstractOBJECTIVESLung cancer treatment in patients with chronic lung diseases is challenging because postoperative care is difficult and surgical outcomes are poorer than in patients with healthy lungs. This study aimed to examine postsurgical outcomes of patients with comorbid lung diseases treated for lung cancer.METHODSThis retrospective study enrolled 1526 patients who underwent curative surgical resection for non-small-cell lung cancer at a single centre between October 2008 and April 2017. Based on computed tomography findings, patients were assigned to 4 groups and their demographic characteristics, clinicopathological features, surgical outcomes and survival were compared.RESULTSThere were 1101 patients in group A, 266 patients in group B, 62 patients in group C and 97 patients in group D. In the chronic lung disease groups (B, C and D), there was a high percentage of smoking history (86.5%, 79.0% and 92.8%, respectively; P < 0.01). The occurrence rate of postoperative lung complications and operative mortality rates were higher in patients with chronic lung disease. Groups A, B, C and D contained 819 (74.4%), 159 (59.8%), 43 (69.4%) and 65 (67.0%) stage I patients, respectively (P < 0.01). The groups showed significant differences in overall survival and disease-free survival (all P < 0.01). The presence of combined pulmonary fibrosis and emphysema was the only significant negative prognostic factor for overall survival.CONCLUSIONSThe presence of comorbid chronic lung diseases might negatively affect prognosis in patients with non-small-cell lung cancer. The presence of combined pulmonary fibrosis and emphysema could be a negative prognostic factor in lung cancer treatment.
      PubDate: Thu, 12 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa060
      Issue No: Vol. 58, No. 2 (2020)
  • Fate of contralateral asymptomatic bullae in patients with primary
           spontaneous pneumothorax
    • Authors: Jang H; Lee J, Nam S, et al.
      Pages: 365 - 370
      Abstract: AbstractOBJECTIVESThis retrospective cohort study aimed to analyse the impact of asymptomatic blebs/bullae on the occurrence of primary spontaneous pneumothorax (PSP) by monitoring the natural course of contralateral blebs/bullae in patients with ipsilateral pneumothorax.METHODSFrom January 2003 to December 2017, 1055 patients [age 19.6 ± 3.98 years (mean ± standard deviation), 953 men] experiencing the first episode of unilateral PSP were enrolled in this study, excluding patients aged 30 years or more. The presence, number and maximal size of the blebs/bullae were investigated in contralateral asymptomatic lungs based on high-resolution computed tomography.RESULTSMultiple and single blebs/bullae were noted in contralateral lungs in 425 (40.3%) and 88 (8.3%) patients, respectively. The median follow-up period was 44.0 (interquartile range 71.5) months. The 1-, 3- and 5-year cumulative occurrence rates of PSP in contralateral lungs were 7.9%, 13.7% and 16.7%, respectively. On multivariable analysis, younger age [hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.12–1.27; P < 0.001) and multiple bullae (HR 4.42, 95% CI 3.06–6.38; P < 0.001) were independent risk factors for spontaneous pneumothorax in the contralateral lung. The 5-year cumulative occurrence rates of PSP were significantly higher in patients with multiple blebs/bullae than in those with no or a single bleb/bulla (28.2% vs 8.5%, respectively; P < 0.001).CONCLUSIONSAsymptomatic blebs/bullae often lead to PSP. If the patient is eligible for surgery for pneumothorax, preemptive surgery for contralateral bullae could be considered, especially in patients with multiple blebs/bullae.
      PubDate: Tue, 17 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa054
      Issue No: Vol. 58, No. 2 (2020)
  • Preclosing of the femoral artery allows total percutaneous venoarterial
           extracorporeal membrane oxygenation and prevents groin wound infection
           after lung transplantation
    • Authors: Pellenc Q; Girault A, Roussel A, et al.
      Pages: 371 - 378
      Abstract: AbstractOBJECTIVESIn lung transplantation (LT), femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) usually requires an open approach that may be associated with severe groin wound infection. In endovascular aortic procedures, preclosing of the femoral artery (PFA) with vascular closure devices allows the percutaneous insertion and withdrawal of large-bore cannulae. We sought to evaluate whether this innovative technique could be applied in the specific setting of LT to achieve total percutaneous VA-ECMO and decrease groin wound infection.METHODSWe conducted a retrospective study of a prospective database including patients who underwent LT in our centre from January 2011 to December 2017. Patients who underwent peripheral VA-ECMO using the PFA technique after January 2014 (PFA group, n = 106) were compared to those who underwent peripheral VA-ECMO using open cannulation and/or decannulation before January 2014 (non-PFA group, n = 48). The primary end point was the rate of technical success defined as total percutaneous VA-ECMO. Secondary end points included groin wound infections and delayed vascular complications.RESULTSThe PFA technique was technically successful in 98 patients (92.5%). As compared with the non-PFA group, the PFA group was characterized by a similar rate of vascular complications (16.6% vs 11.3%, P = 0.360) and a decreased rate of groin wound infection (18.9% vs 0%, P < 0.001). In multivariate analysis, risk factors associated with vascular complications following PFA included female sex, peripheral arterial disease and ECMO duration.CONCLUSIONSIn LT patients, PFA is associated with a high rate of total percutaneous VA-ECMO, thus preventing the occurrence of groin wound infection.
      PubDate: Fri, 21 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa039
      Issue No: Vol. 58, No. 2 (2020)
  • Early protein expression profile in bronchoalveolar lavage fluid and
    • Authors: Frick A; Verleden S, Ordies S, et al.
      Pages: 379 - 388
      Abstract: AbstractOBJECTIVESPrimary graft dysfunction (PGD) remains a major post-transplant complication and is associated with increased morbidity and mortality. Mechanisms evoking PGD are not completely clear, but inflammation plays a central role. We investigated the association between PGD and inflammatory proteins present in immediate postoperative bronchoalveolar lavage.METHODSAll double-lung recipients transplanted at our institution from 2002 to 2018 were included in our study. We retrospectively selected 80 consecutive lung transplant recipients with different PGD grades (n = 20 for each PGD grades 0–1 to 2–3). In bronchoalveolar lavage performed within the first 24 h after donor aortic cross-clamping following lung transplantation, concentrations of 30 cytokines, chemokines and growth factors were assessed by enzyme-linked immunosorbent assay (ELISA) and correlated with donor and recipient demographics and outcomes. For analysis, 2 groups were defined: ‘mild’ PGD (grade 0–1) and ‘severe’ PGD (grades 2–3).RESULTSSignificant differences between mild and severe PGD were found in 8 biomarkers [interleukin (IL)-6, IL-10, IL-13, eotaxin, granulocyte colony-stimulating factor, interferon γ, macrophage inflammatory protein 1α, surfactant protein D (SP-D); P < 0.05]. Increased IL-10 and IL-13, but none of the other proteins, were associated with short-term outcome (longer time to extubation; P = 0.005 and P < 0.0001; increased intensive care unit stay; P = 0.012 and P < 0.0001; and hospital stay; P = 0.041 and P = 0.002). There were no significant differences in donor and recipient characteristics between the groups.CONCLUSIONSExpression profiles of key inflammatory mediators in bronchoalveolar lavage fluid differed significantly between lung transplant recipients with severe versus mild PGD and correlated with clinical outcome variables. Further research should focus on the early mechanisms leading to PGD.
      PubDate: Wed, 08 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa043
      Issue No: Vol. 58, No. 2 (2020)
  • ‘Double layer’ frozen elephant trunk with balloon endoclamping: a
           technique to simplify the 2-stage open repair of thoraco-abdominal aortic
    • Authors: Di Eusanio M; Berretta P, Cefarelli M, et al.
      Pages: 389 - 391
      Abstract: AbstractStaged replacement of the aortic arch and thoraco-abdominal aorta (TAA) with a frozen elephant trunk followed by TAA repair is a valuable treatment for patients with chronic TAA dissection. However, in patients with an unclampable descending thoracic aorta, the retrieval of the trunk can be problematic and the proximal stent graft-to-graft anastomosis technically challenging. Here we present our ‘double layer’ frozen elephant trunk technique to treat patients with TAA dissection.
      PubDate: Thu, 12 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa070
      Issue No: Vol. 58, No. 2 (2020)
  • Feasibility of novel transapical off pump beating heart mitral valve
           repair in a patient with dextrocardia and situs inversus
    • Authors: Bhatia I; Chan D, Lam S, et al.
      Pages: 392 - 394
      Abstract: AbstractWe present a case to demonstrate the feasibility of transapical beating heart mitral valve repair in a patient with dextrocardia. This minimally invasive technique provides simple, safe and satisfactory mitral repair. The surgical technique, outcome and prognosis are not affected by the condition.
      PubDate: Tue, 10 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa059
      Issue No: Vol. 58, No. 2 (2020)
  • Modified sutureless repair using left atrial appendage flap for acquired
           left-sided pulmonary vein stenosis
    • Authors: Ito H; Mutsuga M, Tokuda Y, et al.
      Pages: 395 - 397
      Abstract: AbstractPulmonary vein stenosis is a well-known complication after radiofrequency catheter ablation of atrial fibrillation. Although surgical repair is indicated for younger patients and patients with multiple stenoses, the appropriate procedure for acquired pulmonary vein stenosis has not been established. In this study, we report the successful outcome of our modified sutureless technique using a left atrial appendage flap for left-sided pulmonary vein stenosis after radiofrequency catheter ablation.
      PubDate: Sat, 08 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa032
      Issue No: Vol. 58, No. 2 (2020)
  • Accidental finding of large aortic thrombus formation
    • Authors: Berger R; Tegtmeyer R, Schlensak C, et al.
      Pages: 398 - 398
      Abstract: Aortic thrombus
      PubDate: Fri, 27 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa088
      Issue No: Vol. 58, No. 2 (2020)
  • Use of a vascular plug to block an anomalous artery originating from the
           descending aorta in a patient with pulmonary sequestration
    • Authors: Guo Q; Zhong C, Yan J, et al.
      Pages: 399 - 399
      Abstract: Vascular plugPulmonary sequestration8-mm abnormal artery
      PubDate: Tue, 17 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa073
      Issue No: Vol. 58, No. 2 (2020)
  • Can machine learning-based prediction of complications after paediatric
           cardiac surgery improve patient outcomes'
    • Authors: Kim W; Ji S, Jang Y.
      Pages: 400 - 400
      Abstract: Paediatric cardiac surgeryComplication predictionMachine learning
      PubDate: Thu, 26 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa086
      Issue No: Vol. 58, No. 2 (2020)
  • Reply to Kim et al.
    • Authors: Li H; Zeng X, Duan H, et al.
      Pages: 400 - 401
      Abstract: Paediatric cardiac surgeryComplication predictionMachine learning
      PubDate: Wed, 25 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa084
      Issue No: Vol. 58, No. 2 (2020)
  • Reply to Nezic
    • Authors: Smith H; Ramsay T, Seely A.
      Pages: 401 - 402
      Abstract: Atrial fibrillationArrhythmiaPerioperative careOutcomesRisk analysis/modellingExternal validation
      PubDate: Thu, 12 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa072
      Issue No: Vol. 58, No. 2 (2020)
  • Assessing the performance of risk prediction models
    • Authors: Nezic D.
      Pages: 401 - 401
      Abstract: Risk prediction modelsOutcomesRisk analysis
      PubDate: Thu, 12 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa071
      Issue No: Vol. 58, No. 2 (2020)
  • Extracorporeal circulation and inflammation: a ‘mini-approach’
           alone is not enough!
    • Authors: Condello I; Santarpino G.
      Pages: 402 - 402
      Abstract: InflammationCardiopulmonary bypassMini-extracorporeal circulationCoronary artery bypass graftOff-pump
      PubDate: Wed, 01 Apr 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa082
      Issue No: Vol. 58, No. 2 (2020)
  • Reply to Maier et al
    • Authors: Hennon M; DeGraaff L, Demmy T, et al.
      Pages: 403 - 404
      Abstract: Nodal upstagingVideo-assisted thoracic surgeryRoboticThoracotomyOverall survival
      PubDate: Thu, 12 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa045
      Issue No: Vol. 58, No. 2 (2020)
  • Time to rethink the concept of nodal upstaging
    • Authors: Maier H; Ng C, Kroepfl V, et al.
      Pages: 403 - 403
      Abstract: Lung cancerMediastinal stagingVideo-assisted thoracic surgeryNodal upstaging
      PubDate: Thu, 12 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa052
      Issue No: Vol. 58, No. 2 (2020)
  • Should the left lower paratracheal lymph node always be dissected in
           patients with left-sided lung cancer'
    • Authors: Deng H; Wang T, Tang X.
      Pages: 404 - 404
      Abstract: Lymph node dissection4L lymph nodeLeft-sidedNon-small cell lung cancer
      PubDate: Thu, 26 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa095
      Issue No: Vol. 58, No. 2 (2020)
  • L4 lymph node dissection in left-side operable non-small-cell lung cancer:
           one size fits all'
    • Authors: Zhang X; Jiang Y, Zhang L.
      Pages: 404 - 405
      Abstract: Non-small-cell lung cancerL4 lymph node dissectionSurvival
      PubDate: Wed, 25 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa094
      Issue No: Vol. 58, No. 2 (2020)
  • Reply to Deng et al. and Zhang et al.
    • Authors: Yang H; Yang M.
      Pages: 405 - 406
      Abstract: Non-small-cell lung cancerLymph node dissectionSurgerySurvival
      PubDate: Thu, 26 Mar 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa096
      Issue No: Vol. 58, No. 2 (2020)
  • Is less more for early-stage non-small-cell lung cancer' Current
           evidence for performing segmentectomy
    • Authors: Deng H; Tang X.
      Pages: 406 - 406
      Abstract: SegmentectomyLobectomyEarly-stageNon-small-cell lung cancer
      PubDate: Mon, 24 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa044
      Issue No: Vol. 58, No. 2 (2020)
  • Reply to Deng and Tang
    • Authors: Winckelmans T; Decaluwé H, De Leyn P, et al.
      Pages: 406 - 407
      Abstract: Non-small-cell lung cancerSegmentectomyLobectomyLimited resection
      PubDate: Mon, 24 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa046
      Issue No: Vol. 58, No. 2 (2020)
  • Reply to Lococo et al.
    • Authors: Melek H; Ozer E, Bayram A, et al.
      Pages: 407 - 408
      Abstract: Pathological complete responseInduction treatmentNeoadjuvant treatmentLung resection
      PubDate: Thu, 27 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa014
      Issue No: Vol. 58, No. 2 (2020)
  • Non-small-cell lung cancer with pathological complete response after
           induction therapy followed by surgical resection: which is the pattern of
           failure and which are the future perspectives'
    • Authors: Lococo F; Chiappetta M, Cesario A, et al.
      Pages: 407 - 407
      Abstract: Locally advanced non-small-cell lung cancerInduction therapyPathological complete responseImmunotherapy
      PubDate: Thu, 27 Feb 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa013
      Issue No: Vol. 58, No. 2 (2020)
  • Corrigendum to ‘Mortality in trials on transcatheter aortic valve
           implantation versus surgical aortic valve replacement: a pooled
           meta-analysis of Kaplan–Meier-derived individual patient data’ Eur J
           Cardiothorac Surg 2020;58:221–9
    • Authors: Barili F; Freemantle N, Casado A, et al.
      Pages: 409 - 409
      Abstract: In the originally published version of this article the colours for TAVI and SAVR in the legend of the central image and figure 2 are inverted. The blue lines represent TAVI, the red ones SAVR. This has now been corrected in the article.
      PubDate: Sat, 16 May 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa157
      Issue No: Vol. 58, No. 2 (2020)
  • Corrigendum to ‘Retrospective 1-year outcome follow-up in 200 patients
           supported with HeartMate 3 and HeartWare left ventricular assist devices
           in a single centre’ [Eur J Cardiothorac Surg 2020;57:1160–5.]
    • Authors: Mueller M; Hoermandinger C, Richter G, et al.
      Pages: 410 - 410
      Abstract: In the originally published version of this article, the value of the 95% confidence interval in the last line of the results of the abstract and in the last paragraph of the main results section should read: 95% CI (0.58–0.767).
      PubDate: Wed, 15 Jul 2020 00:00:00 GMT
      DOI: 10.1093/ejcts/ezaa207
      Issue No: Vol. 58, No. 2 (2020)
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