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Milojevic M, Sousa-Uva M, Marin-Cuartas M, Kaul S, Nikolic A, Mandrola J, Sádaba JR, Myers PO. Same evidence different recommendations: a methodological assessment of transatlantic guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2024:ezae184. [PMID: 38733575 DOI: 10.1093/ejcts/ezae184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/12/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES To identify methodological variations leading to varied recommendations between the American College of Cardiology (ACC)/American Heart Association (AHA) and the European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) valvular heart disease (VHD) Guidelines, and to suggest foundational steps towards standardizing guideline development. METHODS An in-depth analysis was conducted to evaluate the methodologies used in developing the Transatlantic Guidelines for managing VHD. The evaluation was benchmarked against the standards proposed by the Institute of Medicine. RESULTS Substantial discrepancies were noted in the methodologies utilized in development processes, including writing committee composition, evidence evaluation, conflict of interest management, and voting processes. Furthermore, despite their mutual differences, both methodologies also demonstrate notable deviations from the IOM standards in several essential areas, including literature review and evidence grading. These dual variances likely influenced divergent treatment recommendations. For example, the ESC/EACTS recommends transcatheter edge-to-edge repair (TEER) for patients ineligible for mitral valve surgery, while the ACC/AHA recommends TEER based on anatomy, regardless of surgical risk. ESC/EACTS guidelines recommend a mechanical aortic prosthesis for patients under 60, while ACC/AHA guidelines recommend it for patients under 50. Notably, the ACC/AHA and ESC/EACTS guidelines have differing age cut-offs for surgical over transcatheter aortic valve replacement (<65 and <75 years, respectively). CONCLUSIONS Variations in methodologies for developing CPGs have resulted in different treatment recommendations that may significantly impact global practice patterns. Standardization of essential processes is vital to increase the uniformity and credibility of CPGs, ultimately improving healthcare quality, reducing variability and enhancing trust in modern medicine.
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Affiliation(s)
- Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Miguel Sousa-Uva
- Department of Cardiothoracic Surgery, Hospital da Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Sanjay Kaul
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Aleksandar Nikolic
- Department of Cardiac Surgery, Acibadem-Sistina Hospital, Skopje, North Macedonia
| | - John Mandrola
- Baptist Health Louisville, Louisville, Kentucky, USA
| | - J Rafael Sádaba
- Cardiac Surgery Department, Hospital Universitario de Navarra, Spain
| | - Patrick O Myers
- Division of Cardiac Surgery, Lausanne University Hospital, Lausanne, Switzerland
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Sabik JF, Mehaffey JH, Badhwar V, Ruel M, Myers PO, Sandner S, Bakaeen F, Puskas J, Taggart D, Schwann T, Chikwe J, MacGillivray TE, Kho A, Habib RH. Multiarterial vs Single-Arterial Coronary Surgery: 10-Year Follow-up of 1 Million Patients. Ann Thorac Surg 2024; 117:780-788. [PMID: 38286204 DOI: 10.1016/j.athoracsur.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Although many options exist for multivessel coronary revascularization, controversy persists over whether multiarterial grafting (MAG) confers a survival advantage over single-arterial grafting (SAG) with saphenous vein in coronary artery bypass grafting (CABG). This study sought to compare longitudinal survival between patients undergoing MAG and those undergoing SAG. METHODS All patients undergoing isolated CABG with ≥2 bypass grafts in The Society of Thoracic Surgeons Adult Cardiac Surgery Database (2008-2019) were linked to the National Death Index. Risk adjustment was performed using inverse probability weighting and multivariable modeling. The primary end point was longitudinal survival. Subpopulation analyses were performed and volume thresholds were analyzed to determine optimal benefit. RESULTS A total of 1,021,632 patients underwent isolated CABG at 1108 programs (100,419 MAG [9.83%]; 920,943 SAG [90.17%]). Median follow-up was 5.30 years (range, 0-12 years). After risk adjustment, all characteristics were well balanced. At 10 years, MAG was associated with improved unadjusted (hazard ratio, 0.59; 95% CI 0.58-0.61) and adjusted (hazard ratio, 0.86; 95% CI, 0.85-0.88) 10-year survival. Center volume of ≥10 MAG cases/year was associated with benefit. MAG was associated with an overall survival advantage over SAG in all subgroups, including stable coronary disease, acute coronary syndrome, and acute infarction. Survival was equivalent to that with SAG for patients age ≥80 years and those with severe heart failure, renal failure, peripheral vascular disease, or obesity. Only patients with a body mass index ≥40 kg/m2 had superior survival with SAG. CONCLUSIONS Multiarterial CABG is associated with superior long-term survival and should be the surgical multivessel revascularization strategy of choice for patients with a body mass index of less than 40 kg/m2.
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Affiliation(s)
- Joseph F Sabik
- Division of Cardiac Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Marc Ruel
- Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - John Puskas
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David Taggart
- Department of Cardiac Surgery, Oxford University, Oxford, United Kingdom
| | - Thomas Schwann
- Department of Cardiovascular Surgery, University of Massachusetts - Bay State, Springfield, Massachusetts
| | - Joanna Chikwe
- Department of Cardiac Surgery, Cedars-Sinai Hospital, Los Angeles, California
| | | | - Abel Kho
- Department of Medicine, Northwestern University, Chicago, Illinois
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Heuts S, Myers PO, Siepe M. Letter by Heuts et al Regarding Article, "Fractional Flow Reserve-Guided PCI or Coronary Bypass Surgery for 3-Vessel Coronary Artery Disease: 3-Year Follow-Up of the FAME 3 Trial". Circulation 2024; 149:892-893. [PMID: 38466789 DOI: 10.1161/circulationaha.123.066934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, the Netherlands (S.H.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (S.H.)
| | - Patrick O Myers
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Switzerland (P.O.M.)
| | - Matthias Siepe
- Department of Cardiac Surgery, University Heart Center, University Hospital Bern, Switzerland (M.S.)
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Gaudino M, Flather M, Capodanno D, Milojevic M, Bhatt DL, Biondi Zoccai G, Boden WE, Devereaux PJ, Doenst T, Farkouh M, Freemantle N, Fremes S, Puskas J, Landoni G, Lawton J, Myers PO, Redfors B, Sandner S. European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery. Eur J Cardiothorac Surg 2024; 65:ezad415. [PMID: 38420786 DOI: 10.1093/ejcts/ezad415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 03/02/2024] Open
Abstract
Cardiac surgery may lead to myocardial damage and release of cardiac biomarkers through various mechanisms such as cardiac manipulation, systemic inflammation, myocardial hypoxia, cardioplegic arrest and ischaemia caused by coronary or graft occlusion. Defining perioperative myocardial infarction (PMI) after cardiac surgery presents challenges, and the association between the current PMI definitions and postoperative outcomes remains uncertain. To address these challenges, the European Association of Cardio-Thoracic Surgery (EACTS) facilitated collaboration among a multidisciplinary group to evaluate the existing evidence on the mechanisms, diagnosis and prognostic implications of PMI after cardiac surgery. The review found that the postoperative troponin value thresholds associated with an increased risk of mortality are markedly higher than those proposed by all the current definitions of PMI. Additionally, it was found that large postoperative increases in cardiac biomarkers are prognostically relevant even in absence of additional supportive signs of ischaemia. A new algorithm for PMI detection after cardiac surgery was also proposed, and a consensus was reached within the group that establishing a prognostically relevant definition of PMI is critically needed in the cardiovascular field and that PMI should be included in the primary composite outcome of coronary intervention trials.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Davide Capodanno
- Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - William E Boden
- VA New England Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - P J Devereaux
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Michael Farkouh
- Academic Affairs, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Stephen Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, USA
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick O Myers
- Department of Cardiac Surgery, CHUV-Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, NY, USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Gomes WJ, Marin-Cuartas M, Bakaeen F, Sádaba JR, Dayan V, Almeida R, Parolari A, Myers PO, Borger MA. The ISCHEMIA trial revisited: setting the record straight on the benefits of coronary bypass surgery and the misinterpretation of a landmark trial. Eur J Cardiothorac Surg 2023; 64:ezad361. [PMID: 37889258 DOI: 10.1093/ejcts/ezad361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES The ISCHEMIA trial is a landmark study that has been the subject of heated debate within the cardiovascular community. In this analysis of the ISCHEMIA trial, we aim to set the record straight on the benefits of coronary artery bypass grafting (CABG) and the misinterpretation of this landmark trial. We sought to clarify and reorient this misinterpretation. METHODS We herein analyse the ISCHEMIA trial in detail and describe how its misinterpretation has led to an erroneous guideline recommendation downgrading for prognosis-altering surgical therapy in these at-risk patients. RESULTS The interim ISCHEMIA trial findings align with previous evidence where CABG reduces the long-term risks of myocardial infarction and mortality in advanced coronary artery disease. The trial outcomes of a significantly lower rate of cardiovascular mortality and a higher rate of non-cardiovascular mortality with the invasive strategy are explained according to landmark evidence. CONCLUSIONS The ISCHEMIA trial findings are aligned with previous evidence and should not be used to downgrade recommendations in recent guidelines for the indisputable benefits of CABG.
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Affiliation(s)
- Walter J Gomes
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina and São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Rafael Sádaba
- Department of Cardiac Surgery, University Hospital of Navarra, Pamplona, Spain
| | - Victor Dayan
- Centro Cardiovascular Universitario, Montevideo, Uruguay
| | - Rui Almeida
- University Center Assis Gurgacz Foundation, Cascavel, Paraná, Brazil
| | - Alessandro Parolari
- Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, University of Milan, S. Donato Milanese, Italy
| | - Patrick O Myers
- Division of Cardiac Surgery, CHUV-Lausanne University Hospital, Lausanne, Switzerland
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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Hamilton BCS, Nguyen D, Grondin SC, Sadaba JR, Myers PO, Young CM, Calhoon JH, Moon MR, Colson YL, Keshavjee S, Nguyen TC. Global Makeup of Cardiothoracic Surgeons as Represented by Our Major Societies and Associations. Ann Thorac Surg 2023; 115:1052-1060. [PMID: 35934066 DOI: 10.1016/j.athoracsur.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/02/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prior efforts to capture the cardiothoracic surgery community rely on survey data with potentially biased or low response rates. Our goal is to better understand our community by assessing the membership directories from The Society of Thoracic Surgeons (STS), American Association for Thoracic Surgery (AATS), European Association for Cardio-Thoracic Surgery (EACTS), and Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS). METHODS Membership data were obtained from membership directories. Data for STS and EACTS were supplemented by the associations from their internal databases. The inclusion criterion was active membership; trainees and wholly incomplete profiles were excluded. RESULTS A total of 12 053 membership profiles were included (STS, 6365; EACTS, 3661; AATS, 1495; ASCVTS, 532). Membership is 7% female overall (EACTS, 9%; STS, 6%; AATS, 5%; ASCVTS, 3%), with a median age of 57 years (STS, 60 years; EACTS, 52 years). All societies had a broad scope of practice including members who practiced both adult cardiac and thoracic (20% overall), but most members practiced adult cardiac (31% overall; ASCVTS, 48%; AATS, 36%; EACTS, 30%; STS, 28%) and were in the late stage of their careers. CONCLUSIONS We present the makeup of our 4 major societies. We are global with a diversity of careers but concerning factors that require immediate attention. The future of our specialty depends on our ability to evolve, to promote the specialty, to attract trainees, and to include and promote female surgeons. It is crucial that we wake up to these issues, change the narrative, and create action on both individual and leadership levels.
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Affiliation(s)
- Barbara C S Hamilton
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California.
| | - Dang Nguyen
- Department of Biomedical Engineering, University of South Florida, Tampa, Florida
| | - Sean C Grondin
- Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - J Rafael Sadaba
- Department of Cardiac Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Patrick O Myers
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Carolyn M Young
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John H Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Texas
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri; Division of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas; Texas Heart Institute, Houston, Texas
| | - Yolonda L Colson
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Tom C Nguyen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California
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Barili F, Brophy JM, Ronco D, Myers PO, Uva MS, Almeida RMS, Marin-Cuartas M, Anselmi A, Tomasi J, Verhoye JP, Musumeci F, Mandrola J, Kaul S, Papatheodorou S, Parolari A. Risk of Bias in Randomized Clinical Trials Comparing Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2249321. [PMID: 36595294 PMCID: PMC9857525 DOI: 10.1001/jamanetworkopen.2022.49321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Recent European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines highlighted some concerns about the randomized clinical trials (RCTs) comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for aortic stenosis. Quantification of these biases has not been previously performed. OBJECTIVE To assess whether randomization protects RCTs comparing TAVI and SAVR from biases other than nonrandom allocation. DATA SOURCES A systematic review of the literature between January 1, 2007, and June 6, 2022, on MEDLINE, Embase, and Cochrane Central Register of Controlled Trials was performed. Specialist websites were also checked for unpublished data. STUDY SELECTION The study included RCTs with random allocation to TAVI or SAVR with a maximum 5-year follow-up. DATA EXTRACTION AND SYNTHESIS Data extraction was performed by 2 independent investigators following the PRISMA guidelines. A random-effects meta-analysis was used for quantifying pooled rates and differential rates between treatments of deviation from random assigned treatment (DAT), loss to follow-up, and receipt of additional treatments. MAIN OUTCOMES AND MEASURES The primary outcomes were the proportion of DAT, loss to follow-up, and patients who were provided additional treatments and myocardial revascularization, together with their ratio between treatments. The measures were the pooled overall proportion of the primary outcomes and the risk ratio (RR) in the TAVI vs SAVR groups. RESULTS The search identified 8 eligible trials including 8849 participants randomly assigned to undergo TAVI (n = 4458) or SAVR (n = 4391). The pooled proportion of DAT among the sample was 4.2% (95% CI, 3.0%-5.6%), favoring TAVI (pooled RR vs SAVR, 0.16; 95% CI, 0.08-0.36; P < .001). The pooled proportion of loss to follow-up was 4.8% (95% CI, 2.7%-7.3%). Meta-regression showed a significant association between the proportion of participants lost to follow-up and follow-up time (slope, 0.042; 95% CI, 0.017-0.066; P < .001). There was an imbalance of loss to follow-up favoring TAVI (RR, 0.39; 95% CI, 0.28-0.55; P < .001). The pooled proportion of patients who had additional procedures was 10.4% (95% CI, 4.4%-18.5%): 4.6% (95% CI, 1.5%-9.3%) in the TAVI group and 16.5% (95% CI, 7.5%-28.1%) in the SAVR group (RR, 0.27; 95% CI, 0.15-0.50; P < .001). The imbalance between groups also favored TAVI for additional myocardial revascularization (RR, 0.40; 95% CI, 0.24-0.68; P < .001). CONCLUSIONS AND RELEVANCE This study suggests that, in RCTs comparing TAVI vs SAVR, there are substantial proportions of DAT, loss to follow-up, and additional procedures together with systematic selective imbalance in the same direction characterized by significantly lower proportions of patients undergoing TAVI that might affect internal validity.
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Affiliation(s)
- Fabio Barili
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - James M. Brophy
- Department of Medicine, McGill Health University Center, Montreal, Quebec, Canada
| | - Daniele Ronco
- Department of University Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Patrick O. Myers
- Division of Cardiac Surgery, CHUV–Lausanne University Hospital, Lausanne, Switzerland
| | - Miguel Sousa Uva
- Department of Cardiac Surgery, Hospital Santa Cruz, Carnaxide, Portugal
- Department of Cardiac Surgery and Physiology, Porto University Medical School, Porto, Portugal
| | - Rui M. S. Almeida
- University Center Assis Gurgacz Foundation, Cascavel, Paraná, Brazil
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Amedeo Anselmi
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Rennes, Rennes, France
| | - Jacques Tomasi
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Rennes, Rennes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Rennes, Rennes, France
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Sanjay Kaul
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stefania Papatheodorou
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Alessandro Parolari
- Department of University Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
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Freemantle N, Myers PO, Siepe M. Do all roads lead to Rome? Critical reassessment of the individual patient meta-analysis on bypass grafts by Gaudino et al. Eur J Cardiothorac Surg 2022; 63:6905380. [PMID: 36519437 DOI: 10.1093/ejcts/ezac564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Nick Freemantle
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - Patrick O Myers
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Switzerland.,La Tour Hospital, Geneva, Switzerland
| | - Matthias Siepe
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
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Luc JGY, Pizano A, Udwadia F, Gupta S, Dairywala M, Joyce C, Robinson E, Rush G, Dunning J, Myers PO, Antonoff MB, Nguyen TC. Early effect of the COVID-19 pandemic on the North American cardiothoracic surgery job market. J Thorac Dis 2022; 14:3304-3313. [PMID: 36245601 PMCID: PMC9562543 DOI: 10.21037/jtd-22-320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022]
Abstract
Background The present study aims to report the early effect of the coronavirus disease 2019 (COVID-19) pandemic on the cardiothoracic surgery job market in North America. Methods The Cardiothoracic Surgery Network (CTSNet) job market database was queried, and patterns from January to May for 2019 versus January to May 2020 were compared for trends in job postings and job seekers. Results Our study is comprised of 395 cardiothoracic surgery job postings, of which 98% were positions located in North America and 63% were academic. The negative impact of the pandemic on the cardiothoracic surgery job market was greatest in the cardiothoracic/cardiovascular combined subspecialty, followed by congenital and adult cardiac surgery, whereas general thoracic surgery experienced an increase in proportion of jobs available. Despite an increase in views per job posted in 2020 vs. 2019 (532 vs. 290), employer views of job seeker curriculum vitae declined over the same time period in 2020 (January, 380 views/month to May, 3 views/month) compared to 2019 (January, 100 views/month to May, 54 views/month). Conclusions An analysis of job postings from CTSNet suggests a decline in job availability in the North American cardiothoracic surgical job market following declaration of the pandemic with acknowledgement that there is month to month variability and a supply-demand mismatch. The COVID-19 pandemic has had an unprecedented impact on our field, and the ultimate consequences remain unknown.
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Affiliation(s)
- Jessica G. Y. Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alejandro Pizano
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA
| | - Farhad Udwadia
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saurabh Gupta
- Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohammed Dairywala
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA
| | | | | | - Grahame Rush
- The Cardiothoracic Surgery Network, Chicago, IL, USA
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Patrick O. Myers
- Department of Cardiac Surgery, CHUV-Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tom C. Nguyen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, CA, USA
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Myers PO, Dayan V, Szeto WY, Thourani VH, Malaisrie SC, Moon MR, Prager RL, Ono M, Okita Y, Freemantle N, Milojevic M. Joint Surgical Associations (EACTS, LACES, ASCVTS, AATS, and STS) Position Statement Regarding the VARC-3 Definitions for Aortic Valve Clinical Research. Eur J Cardiothorac Surg 2022; 62:6549319. [PMID: 35298609 DOI: 10.1093/ejcts/ezac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patrick O Myers
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland.,La Tour Hospital, Geneva, Switzerland
| | - Victor Dayan
- Universidad de la Republica, Montevideo, Uruguay
| | | | | | | | - Marc R Moon
- Washington University School of Medicine, St Louis, MO, USA
| | | | | | | | - Nicholas Freemantle
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - Milan Milojevic
- Dedinje Cardiovascular Institute, Belgrade, Serbia.,Erasmus University Medical Center, Rotterdam, Netherlands
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Myers PO, Dayan V, Szeto WY, Thourani VH, Malaisrie SC, Moon MR, Prager RL, Ono M, Okita Y, Freemantle N, Milojevic M. Joint Surgical Associations (EACTS, LACES, ASCVTS, AATS, and STS) Position Statement Regarding the VARC-3 Definitions for Aortic Valve Clinical Research. Ann Thorac Surg 2022; 113:1767-1769. [DOI: 10.1016/j.athoracsur.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 12/20/2022]
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12
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Myers PO, Dayan V, Szeto WY, Thourani VH, Malaisrie SC, Moon MR, Prager RL, Ono M, Okita Y, Freemantle N, Milojevic M. Joint surgical associations (EACTS, LACES, ASCVTS, AATS, and STS) position statement regarding the VARC-3 definitions for aortic valve clinical research. J Thorac Cardiovasc Surg 2022; 163:1792-1794. [DOI: 10.1016/j.jtcvs.2021.12.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 01/07/2023]
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13
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Myers PO, Dayan V, Szeto WY, Thourani VH, Chris Malaisrie S, Moon MR, Prager RL, Ono M, Okita Y, Freemantle N, Milojevic M. Joint surgical associations (EACTS, LACES, ASCVTS, AATS, and STS) position statement regarding the VARC-3 definitions for aortic valve clinical research. Asian Cardiovasc Thorac Ann 2022; 30:265-268. [PMID: 35212555 DOI: 10.1177/02184923221083076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Patrick O Myers
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland; La Tour Hospital, Geneva, Switzerland; Universidad de la Republica, Montevideo, Uruguay; University of Pennsylvania, Philadelphia, PA, USA; Piedmont Heart Institute, Atlanta, GA, USA; Northwestern University, Chicago, IL, USA; Washington University School of Medicine, St Louis, MO, USA; University of Michigan Hospitals, Ann Arbor, MI, USA; University of Tokyo, Tokyo, Japan; Kobe University, Tokyo, Japan; Institute for Clinical Trials and Methodology, University College London, London, UK; Dedinje Cardiovascular Institute, Belgrade, Serbia; Erasmus University Medical Center, Rotterdam, Netherlands
| | - Victor Dayan
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland; La Tour Hospital, Geneva, Switzerland; Universidad de la Republica, Montevideo, Uruguay; University of Pennsylvania, Philadelphia, PA, USA; Piedmont Heart Institute, Atlanta, GA, USA; Northwestern University, Chicago, IL, USA; Washington University School of Medicine, St Louis, MO, USA; University of Michigan Hospitals, Ann Arbor, MI, USA; University of Tokyo, Tokyo, Japan; Kobe University, Tokyo, Japan; Institute for Clinical Trials and Methodology, University College London, London, UK; Dedinje Cardiovascular Institute, Belgrade, Serbia; Erasmus University Medical Center, Rotterdam, Netherlands
| | - Wilson Y Szeto
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland; La Tour Hospital, Geneva, Switzerland; Universidad de la Republica, Montevideo, Uruguay; University of Pennsylvania, Philadelphia, PA, USA; Piedmont Heart Institute, Atlanta, GA, USA; Northwestern University, Chicago, IL, USA; Washington University School of Medicine, St Louis, MO, USA; University of Michigan Hospitals, Ann Arbor, MI, USA; University of Tokyo, Tokyo, Japan; Kobe University, Tokyo, Japan; Institute for Clinical Trials and Methodology, University College London, London, UK; Dedinje Cardiovascular Institute, Belgrade, Serbia; Erasmus University Medical Center, Rotterdam, Netherlands
| | - Vinod H Thourani
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland; La Tour Hospital, Geneva, Switzerland; Universidad de la Republica, Montevideo, Uruguay; University of Pennsylvania, Philadelphia, PA, USA; Piedmont Heart Institute, Atlanta, GA, USA; Northwestern University, Chicago, IL, USA; Washington University School of Medicine, St Louis, MO, USA; University of Michigan Hospitals, Ann Arbor, MI, USA; University of Tokyo, Tokyo, Japan; Kobe University, Tokyo, Japan; Institute for Clinical Trials and Methodology, University College London, London, UK; Dedinje Cardiovascular Institute, Belgrade, Serbia; Erasmus University Medical Center, Rotterdam, Netherlands
| | - S Chris Malaisrie
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland; La Tour Hospital, Geneva, Switzerland; Universidad de la Republica, Montevideo, Uruguay; University of Pennsylvania, Philadelphia, PA, USA; Piedmont Heart Institute, Atlanta, GA, USA; Northwestern University, Chicago, IL, USA; Washington University School of Medicine, St Louis, MO, USA; University of Michigan Hospitals, Ann Arbor, MI, USA; University of Tokyo, Tokyo, Japan; Kobe University, Tokyo, Japan; Institute for Clinical Trials and Methodology, University College London, London, UK; Dedinje Cardiovascular Institute, Belgrade, Serbia; Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marc R Moon
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland; La Tour Hospital, Geneva, Switzerland; Universidad de la Republica, Montevideo, Uruguay; University of Pennsylvania, Philadelphia, PA, USA; Piedmont Heart Institute, Atlanta, GA, USA; Northwestern University, Chicago, IL, USA; Washington University School of Medicine, St Louis, MO, USA; University of Michigan Hospitals, Ann Arbor, MI, USA; University of Tokyo, Tokyo, Japan; Kobe University, Tokyo, Japan; Institute for Clinical Trials and Methodology, University College London, London, UK; Dedinje Cardiovascular Institute, Belgrade, Serbia; Erasmus University Medical Center, Rotterdam, Netherlands
| | - Richard L Prager
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland; La Tour Hospital, Geneva, Switzerland; Universidad de la Republica, Montevideo, Uruguay; University of Pennsylvania, Philadelphia, PA, USA; Piedmont Heart Institute, Atlanta, GA, USA; Northwestern University, Chicago, IL, USA; Washington University School of Medicine, St Louis, MO, USA; University of Michigan Hospitals, Ann Arbor, MI, USA; University of Tokyo, Tokyo, Japan; Kobe University, Tokyo, Japan; Institute for Clinical Trials and Methodology, University College London, London, UK; Dedinje Cardiovascular Institute, Belgrade, Serbia; Erasmus University Medical Center, Rotterdam, Netherlands
| | - Minoru Ono
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland; La Tour Hospital, Geneva, Switzerland; Universidad de la Republica, Montevideo, Uruguay; University of Pennsylvania, Philadelphia, PA, USA; Piedmont Heart Institute, Atlanta, GA, USA; Northwestern University, Chicago, IL, USA; Washington University School of Medicine, St Louis, MO, USA; University of Michigan Hospitals, Ann Arbor, MI, USA; University of Tokyo, Tokyo, Japan; Kobe University, Tokyo, Japan; Institute for Clinical Trials and Methodology, University College London, London, UK; Dedinje Cardiovascular Institute, Belgrade, Serbia; Erasmus University Medical Center, Rotterdam, Netherlands
| | - Yutaka Okita
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland; La Tour Hospital, Geneva, Switzerland; Universidad de la Republica, Montevideo, Uruguay; University of Pennsylvania, Philadelphia, PA, USA; Piedmont Heart Institute, Atlanta, GA, USA; Northwestern University, Chicago, IL, USA; Washington University School of Medicine, St Louis, MO, USA; University of Michigan Hospitals, Ann Arbor, MI, USA; University of Tokyo, Tokyo, Japan; Kobe University, Tokyo, Japan; Institute for Clinical Trials and Methodology, University College London, London, UK; Dedinje Cardiovascular Institute, Belgrade, Serbia; Erasmus University Medical Center, Rotterdam, Netherlands
| | - Nicholas Freemantle
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland; La Tour Hospital, Geneva, Switzerland; Universidad de la Republica, Montevideo, Uruguay; University of Pennsylvania, Philadelphia, PA, USA; Piedmont Heart Institute, Atlanta, GA, USA; Northwestern University, Chicago, IL, USA; Washington University School of Medicine, St Louis, MO, USA; University of Michigan Hospitals, Ann Arbor, MI, USA; University of Tokyo, Tokyo, Japan; Kobe University, Tokyo, Japan; Institute for Clinical Trials and Methodology, University College London, London, UK; Dedinje Cardiovascular Institute, Belgrade, Serbia; Erasmus University Medical Center, Rotterdam, Netherlands
| | - Milan Milojevic
- Division of Cardiac Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland; La Tour Hospital, Geneva, Switzerland; Universidad de la Republica, Montevideo, Uruguay; University of Pennsylvania, Philadelphia, PA, USA; Piedmont Heart Institute, Atlanta, GA, USA; Northwestern University, Chicago, IL, USA; Washington University School of Medicine, St Louis, MO, USA; University of Michigan Hospitals, Ann Arbor, MI, USA; University of Tokyo, Tokyo, Japan; Kobe University, Tokyo, Japan; Institute for Clinical Trials and Methodology, University College London, London, UK; Dedinje Cardiovascular Institute, Belgrade, Serbia; Erasmus University Medical Center, Rotterdam, Netherlands
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Cerqueira RJ, Heuts S, Gollmann-Tepeköylü C, Syrjälä SO, Keijzers M, Zientara A, Jarral OA, Jacob KA, Haunschild J, Ariyaratnam P, Durko AP, Muller P, Myers PO, Sadaba JR, Lehtinen ML. Challenges and satisfaction in Cardiothoracic Surgery Residency Programmes: insights from a Europe-wide survey. Interact Cardiovasc Thorac Surg 2021; 32:167-173. [PMID: 33236099 DOI: 10.1093/icvts/ivaa248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/03/2020] [Accepted: 09/27/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The increasing complexity of surgical patients and working time constraints represent challenges for training. In this study, the European Association for Cardio-Thoracic Surgery Residents' Committee aimed to evaluate satisfaction with current training programmes across Europe. METHODS We conducted an online survey between October 2018 and April 2019, completed by a total of 219 participants from 24 countries. RESULTS The average respondent was in the fourth or fifth year of training, mostly on a cardiac surgery pathway. Most trainees follow a 5-6-year programme, with a compulsory final certification exam, but no regular skills evaluation. Only a minority are expected to take the examination by the European Board of Cardiothoracic Surgery. Participants work on average 61.0 ± 13.1 h per week, including 27.1 ± 20.2 on-call. In total, only 19.7% confirmed the implementation of the European Working Time Directive, with 42.0% being unaware that European regulations existed. Having designated time for research was reported by 13.0%, despite 47.0% having a postgraduate degree. On average, respondents rated their satisfaction 7.9 out of 10, although 56.2% of participants were not satisfied with their training opportunities. We found an association between trainee satisfaction and regular skills evaluation, first operator experience and protected research time. CONCLUSIONS On average, residents are satisfied with their training, despite significant disparities in the quality and structure of cardiothoracic surgery training across Europe. Areas for potential improvement include increasing structured feedback, research time integration and better working hours compliance. The development of European guidelines on training standards may support this.
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Affiliation(s)
- Rui J Cerqueira
- Cardiovascular Research and Development Unit, University of Porto and Department of Cardiothoracic Surgery, University Hospital Center of São João, Porto, Portugal
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Simo O Syrjälä
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Marlies Keijzers
- Department of Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Alicja Zientara
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Omar A Jarral
- Department of Cardiothoracic Surgery, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Kirolos A Jacob
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | - Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Patrick Muller
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Patrick O Myers
- Department of Cardiac Surgery, CHUV-Lausanne University Hospital, Lausanne, Switzerland
| | | | - Miia L Lehtinen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Luc JGY, Färber G, Myers PO. Highlights from the 34th Annual Meeting of the European Association for Cardio-Thoracic Surgery. Artif Organs 2021; 45:E26-E37. [PMID: 33616275 DOI: 10.1111/aor.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Patrick O Myers
- Division of Cardiac Surgery, CHUV-Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Affiliation(s)
- Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Pietro Bajona
- Department of Cardiac Surgery, Allegheny Health Network, Drexel University College of Medicine, Pittsburgh, PA, USA
| | - Patrick O Myers
- Department of Cardiac Surgery, Lausanne University Hospital, Lausanne 1011, Switzerland.
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17
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Myers PO, Quintana E, Sadaba JR, Dayan V. TAVR in Healed Endocarditis: A Picture May Be Worth 1,000 Words. JACC Cardiovasc Interv 2020; 13:2709-2710. [PMID: 33213755 DOI: 10.1016/j.jcin.2020.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022]
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18
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Myers PO, Dave H, Kretschmar O, Sologashvili T, Pfister R, Prêtre R. Cylinder mitral and tricuspid valve replacement in neonates and small children. Eur J Cardiothorac Surg 2020; 58:964-968. [PMID: 32844202 DOI: 10.1093/ejcts/ezaa196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/15/2020] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Atrioventricular valve replacement in small children is associated with high morbidity and mortality. There are no prostheses available with a diameter ˂15 mm. This study reports our initial experience with a cylinder valve for mitral and tricuspid valve replacement in infants and small children. METHODS Our cylinder valve was hand-made for patients requiring atrioventricuclar valve replacement with an annulus of <15 mm. A 12-mm Contegra valve was prepared and placed inside a 14-mm Gore-Tex tube graft and sutured on both extremities. RESULTS Eight patients were included, with a median age of 6.9 months (range 1 day to 38 months). Four had mitral and 4 had tricuspid valve replacement. All implants were technically successful, with no significant regurgitation, no stenosis and no left ventricular outflow tract obstruction. There were 3 early deaths from low cardiac output, in patients with significant associated lesions (severe neonatal Ebstein's, pulmonary artery-intact ventricular septum, biventricular conversion from Norwood stage 1). Two patients required early reintervention: 1 for balloon dilatation for stenosis and 1 for reoperation for paravalvular leak. During follow-up, 2 patients had mitral valve replacement with a 16-mm mechanical valve at 9 and 20 months from the cylinder valve implantation. The remaining 2 patients are alive and well 2 years and 2 months after the procedure. CONCLUSIONS Cylinder valve replacement of atrioventricular valves was feasible without any technical issues. It was successful in getting out of a difficult situation and allows for somatic growth and implantation of a reasonably-sized mechanical prosthesis on the annulus.
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Affiliation(s)
- Patrick O Myers
- Division of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hitendu Dave
- Division of Cardiac Surgery, Zurich Children's University Hospital, Zurich, Switzerland
| | - Oliver Kretschmar
- Division of Pediatric Cardiology, Zurich Children's University Hospital, Zurich, Switzerland
| | - Tornike Sologashvili
- Division of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Division of Cardiac Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Raymond Pfister
- Division of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - René Prêtre
- Division of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Panos A, Mpellos K, Vlad S, Myers PO. Antegrade Cardioplegia Decannulation Made Simple With the Cor-Knot System: Technique and Tips After 20 Consecutive and Controlled Patients. Innovations (Phila) 2020; 15:494-496. [PMID: 32865452 DOI: 10.1177/1556984520951283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Closing the cardioplegia cannulation site can be challenging in minimally invasive video-assisted cardiac surgery. The Cor-Knot system is used to tie down valve sutures within the heart efficiently, although erosions to neighboring structures are reported. We hypothesized that a modification of the Cor-Knot system could enable safe hemostasis of the cardioplegia aortic root site and avoid erosions of the aorta or right atrium. This is a single-arm prospective study including 20 consecutive patients operated through a video-assisted method at our clinic between January 2019 and February 2019. At the end of the procedure, the suture was passed through a Cor-Knot device and crimped on a band of Teflon-felt. The two tips of the Teflon-felt toward the right atrium were put together and tightened with a 5/0 Prolene suture in order to protect the sharp ends of the device. Hemostasis was achieved using the technique in all 20 patients, with no requirement for further suture placement to ensure hemostasis of the cardioplegia cannulation site. The device was protected from the right atrial appendage and there was no bleeding. At 6-month follow-up, no patients required a reoperation for aortic or right atrial erosion. The Cor-Knot system was used off-label to close the cardioplegia cannulation site in minimally invasive surgery. This appears safe and effective in our initial 20-patient experience.
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Affiliation(s)
- Aristotelis Panos
- 537314 Cardiovascular Surgery, La Tour Hospital, Meyrin/Geneva, Switzerland
- Hygeia Hospital, Athens, Greece
- Cardiac Surgery, HUG, University Hospital Geneva, Switzerland
| | | | | | - Patrick O Myers
- 537314 Cardiovascular Surgery, La Tour Hospital, Meyrin/Geneva, Switzerland
- 30635 Cardiac Surgery, CHUV - University Hospital Lausanne, Switzerland
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20
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Berset SG, Dave H, Balmer C, Nowacka A, Pfister R, Myers PO, Prêtre R. Muscle-sparing aortic coarctation repair. JTCVS Tech 2020; 3:249-256. [PMID: 34317891 PMCID: PMC8302918 DOI: 10.1016/j.xjtc.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 11/10/2022] Open
Abstract
Objective Surgery for aortic coarctation repair provides excellent hemodynamic results but may be complicated by musculoskeletal issues. The purpose of the study was to determine the midterm results of a muscle-sparing surgical approach to aortic coarctation repair, with special emphasis on the repair and on the musculoskeletal changes associated with a posterior thoracotomy. Methods We included all children with aortic coarctation operated on with our minimally invasive approach between June 2002 and October 2004, with a follow-up of ≥4.5 years. Patients were assessed clinically and echocardiographically. The spine, left chest, and shoulder were assessed clinically and radiographically. Results Thirty-one children were included. The age at operation ranged from 1 day to 15 months and weight ranged from 980 g to 10 kg. All patients underwent an extended end-to-end anastomosis coarctation repair through a minimal (n = 19) or total-muscle sparing (n = 12) or extrapleural (n = 18) approach. Five patients had an additional enlargement procedure on the aortic arch. 27 patients had no residual or recurrent gradient. Four patients exhibited restenosis, for which 1 underwent a percutaneous angioplasty and 2 underwent surgical reintervention. All patients were free of hypertension. One patient had borderline values. The musculoskeletal assessment was normal in all but 3 patients. Two patients who underwent other subsequent thoracic surgeries developed thoracogenic scoliosis of moderate severity. A third patient had a left winged scapula. No rib fusion or intercostal space enlargement was found. Conclusions Compared with a conventional approach, our minimally invasive surgical approach led to excellent musculoskeletal outcomes without compromising the hemodynamic results.
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Affiliation(s)
- Stephanie G Berset
- Department of Internal Medicine, Vaud University Hospital, Lausanne, Switzerland
| | - Hitendu Dave
- Department of Cardiology, Zurich University Children's Hospital, Zurich, Switzerland
| | - Christian Balmer
- Department of Cardiology, Zurich University Children's Hospital, Zurich, Switzerland
| | - Anna Nowacka
- Department of Cardiovascular Surgery, Valais Hospital, Sion, Switzerland
| | - Raymond Pfister
- Department of Cardiovascular Surgery, Vaud University Hospital, Lausanne, Switzerland
| | - Patrick O Myers
- Department of Cardiovascular Surgery, Vaud University Hospital, Lausanne, Switzerland
| | - René Prêtre
- Department of Cardiovascular Surgery, Vaud University Hospital, Lausanne, Switzerland
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21
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Noble S, Myers PO, Hachulla AL, Huber C. Unsuccessful Transfemoral Tricuspid Valve-in-Ring Implantation: Case Report and Literature Review. CJC Open 2020; 1:330-334. [PMID: 32159129 PMCID: PMC7063646 DOI: 10.1016/j.cjco.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/19/2019] [Indexed: 11/22/2022] Open
Abstract
Transcatheter tricuspid valve-in-ring implantation has emerged as a potential alternative to surgery for high-risk patients with symptomatic severe tricuspid regurgitation that recurs after surgical ring repair. The worldwide experience remains limited. We report a case of unsuccessful transfemoral tricuspid valve-in-ring implantation (using an Edwards SAPIEN 3 valve, Edwards Lifesciences, Irvine, CA) and literature review. The rigidity, open shape, and open configuration of the ring may lead to imperfect positioning, resulting in severe paravalvular leak. Particular attention should be paid to sizing and wire position with respect to the ring while implanting the valve.
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Affiliation(s)
- Stéphane Noble
- Structural Cardiology Unit, Division of Cardiology, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
- Corresponding author: Dr Stéphane Noble, Structural Cardiology Unit, Division of Cardiology, Department of Medicine, University Hospital of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland. Tel.: +41 79 5533149; Fax: +41 22 372 72 29.
| | - Patrick O. Myers
- Cardiovascular Unit, Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - Anne-Lise Hachulla
- Cardiovascular Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Christoph Huber
- Cardiovascular Unit, Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
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22
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Vida VL, Triglia LT, Zanotto L, Zanotto L, Bertelli F, Padalino M, Sarris G, Protopapas E, Prospero C, Pizarro C, Cleuziou J, Myers PO, Prêtre R, Poncelet AJ, Meyns B, Van den Bossche K, Accord RE, Gil-Jaurena JM, Sakurai T, Stellin G. Late management of the aortic root after repair of tetralogy of Fallot: A European multicentre study. J Card Surg 2019; 35:40-47. [PMID: 31899837 DOI: 10.1111/jocs.14316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We sought to determine the indications, type, and outcomes of reoperations on the aortic root after repair of tetralogy of Fallot (TOF). METHODS Eleven centers belonging to the European Congenital Heart Surgeons Association contributed to the data collection process. We included 36 patients who underwent surgical procedures on the aortic root, including surgery on the aortic valve and ascending aorta, between January 1975 and December 2017. Original diagnoses included TOF-pulmonary stenosis (n = 18) and TOF-pulmonary atresia (n = 18). The main indications for reoperation were aortic insufficiency (n = 19, 53%), aortic insufficiency and dilatation of the ascending aorta (n = 10, 28%), aortic root dilatation (n = 4, 11%), and ascending aorta dilatation (n = 3, 8%). RESULTS The median age at reoperation was 30.4 years (interquartile range 20.3-45.3 years), and mechanical aortic valve replacement was the most common procedure performed. Five patients died early after reoperation (14%), and larger ascending aorta diameters were associated with early mortality (P = .04). The median age at the last follow-up was 41.4 years (interquartile range 24.5-51.6 years). Late death occurred in five patients (5/31, 16%). Most survivors (15/26, 58%) were asymptomatic at the last clinical examination (New York Heart Association, NYHA class I). The remaining patients were NYHA class II (n = 7) and III (n = 3). The most common symptoms were fatigue (n = 5), dyspnea (n = 4), and exercise intolerance (n = 3). CONCLUSIONS Reoperations on the aortic root are infrequent but may become necessary late after TOF repair. The main indications for reoperation are aortic insufficiency, either isolated or associated with a dilatation of the ascending aorta. The surgical risk at reoperation was high and the presence of ascending aorta dilation is related to higher mortality.
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Affiliation(s)
- Vladimiro L Vida
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Laura Torlai Triglia
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lucia Zanotto
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Francesco Bertelli
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Massimo Padalino
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - George Sarris
- Athens Heart Surgery Institute and Department of Paediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Eleftherios Protopapas
- Athens Heart Surgery Institute and Department of Paediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Carol Prospero
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Christian Pizarro
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Julie Cleuziou
- Department of Congenital and Paediatric Cardiac Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Patrick O Myers
- Division of Cardiovascular Surgery, University of Geneva, Geneva, Switzerland
| | - René Prêtre
- Cardiac Surgery Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital, Lausanne, Switzerland
| | - Alain J Poncelet
- Cardio-Vascular Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Bart Meyns
- Cardiac Surgery - UZ Leuven, Leuven, Belgium
| | | | - Ryan E Accord
- Pediatric and Congenital Cardio-Thoracic Surgery Unit, University Medical Center Groningen, Groningen, Netherlands
| | | | - Takahisa Sakurai
- Department of Cardiovascular Surgery, Chukyo Hospital, Nagoya, Japan
| | - Giovanni Stellin
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Myers PO, Nguyen-Tang T, Alibegovic-Zaza J, Inan I. Spontaneous haemorrhage on apixaban masquerading as obstructive cholangitis after heart surgery. Eur Heart J 2019; 40:3066. [PMID: 31071212 DOI: 10.1093/eurheartj/ehz286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patrick O Myers
- Department of Cardiac Surgery, CHUV-Lausanne University Hospitals, 46 rue du Bugnon, Lausanne, Switzerland.,Department of Cardiac Surgery, La Tour Hospital, 3 Ave J.-D. Maillard, Meyrin/Geneva, Switzerland
| | - Thai Nguyen-Tang
- Department of Gastroenterology, La Tour Hospital, 3 Ave J.-D. Maillard, Meyrin/Geneva, Switzerland
| | - Jasmina Alibegovic-Zaza
- Department of Cardiology, La Tour Hospital, 3 Ave J.-D. Maillard, Meyrin/Geneva, Switzerland
| | - Ihsan Inan
- Department of Visceral Surgery, La Tour Hospital, 3 Ave J.-D. Maillard, Meyrin/Geneva, Switzerland
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Myers PO. Commentary: Cerebral protection during pediatric circulatory arrest, from bench to bedside. J Thorac Cardiovasc Surg 2019; 158:891-892. [PMID: 31126644 DOI: 10.1016/j.jtcvs.2019.03.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 11/27/2022]
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Myers PO, Mokashi SA, Horgan E, Borisuk M, Mayer JE, del Nido PJ, Baird CW. Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease. J Thorac Cardiovasc Surg 2019; 157:329-340. [DOI: 10.1016/j.jtcvs.2018.08.077] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/03/2018] [Accepted: 08/01/2018] [Indexed: 11/30/2022]
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26
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Myers PO, Prêtre R. Aortic Valve Interventions in Children: Still Only Scratching the Surface. Semin Thorac Cardiovasc Surg 2018; 31:288-289. [PMID: 30472329 DOI: 10.1053/j.semtcvs.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
| | - René Prêtre
- Cardiac Surgery, CHUV, Lausanne, Switzerland.
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27
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Sologashvili T, Myers PO, Beghetti M, Prêtre R. Rotation of the outflow tracts. Interact Cardiovasc Thorac Surg 2018; 27:463-464. [PMID: 29590369 DOI: 10.1093/icvts/ivy087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/25/2018] [Indexed: 11/14/2022] Open
Abstract
The optimal treatment for transposition of the great arteries with stenosis along the pulmonary tract has always been a challenge. En bloc rotation of the truncus arteriosus has been proposed as an alternative method in this group of patients. We report a truncus turnover in a 3-month-old, 3.4 kg infant.
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Affiliation(s)
- Tornike Sologashvili
- Cardiac Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Centre Universitaire Romand de Chirurgie Cardiaque Pédiatrique et Cardiologie Pédiatrique, Geneva, Switzerland
| | - Patrick O Myers
- Cardiac Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Centre Universitaire Romand de Chirurgie Cardiaque Pédiatrique et Cardiologie Pédiatrique, Geneva, Switzerland
| | - Maurice Beghetti
- Centre Universitaire Romand de Chirurgie Cardiaque Pédiatrique et Cardiologie Pédiatrique, Geneva, Switzerland.,Pediatric Cardiology, Geneva University Children's Hospital, Geneva, Switzerland
| | - René Prêtre
- Centre Universitaire Romand de Chirurgie Cardiaque Pédiatrique et Cardiologie Pédiatrique, Geneva, Switzerland.,Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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28
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Sologashvili T, Wannaz L, Beghetti M, Aggoun Y, Prêtre R, Myers PO. Two-stage arterial switch for late-presenting transposition of the great arteries†. Interact Cardiovasc Thorac Surg 2018; 27:581-585. [DOI: 10.1093/icvts/ivy093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/25/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Laure Wannaz
- Department of Cardiac Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Maurice Beghetti
- Department of Pediatric Cardiology, Geneva Children’s Hospital, Geneva, Switzerland
| | - Yacine Aggoun
- Department of Pediatric Cardiology, Geneva Children’s Hospital, Geneva, Switzerland
| | - René Prêtre
- Department of Cardiac Surgery, CHUV, Lausanne, Clinique des Grangettes, Geneva, Switzerland
| | - Patrick O Myers
- Department of Cardiac Surgery, Geneva University Hospitals, Geneva, Switzerland
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29
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Baird CW, Myers PO, Piekarski B, Borisuk M, Majeed A, Emani SM, Sanders SP, Nathan M, Del Nido PJ. Photo-oxidized bovine pericardium in congenital cardiac surgery: single-centre experience. Interact Cardiovasc Thorac Surg 2017; 24:240-244. [PMID: 27677876 DOI: 10.1093/icvts/ivw315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/19/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Dye-mediated photo-oxidation of pericardium is an alternative method to chemical treatment with glutaraldehyde for cross-linking collagen, providing biostability of the patch material while avoiding late calcification and cytotoxicity. There are few data available, on using photo-oxidation-treated pericardium, in congenital cardiac surgery. This study reports the outcomes using Photofix™ bovine pericardium in neonates, infants, children and young adults undergoing paediatric cardiac surgery. Methods A total of 490 patches in 383 consecutive operations (364 patients) were used in the surgical repair of congenital heart defects at our institution from October 2008 to October 2011. Recorded variables included demographic data, age at operation, primary cardiac diagnosis, associated complications and number, type and location of patches placed and patch-related reintervention. Results Median age at operation was 5.3 years, ranging from <1 month to 56 years. The overall survival rate at late follow-up was 92%, and no deaths were related to failure of the tissue substitute. Two patients (0.5%) underwent reintervention late due to patch material failure: one for residual shunt after Rastelli repair and one for aneurysmal dilatation of a right ventricular outflow tract patch. The patch material was explanted in 8 patients at a mean of 20 months (range, 1-72 months) following implantation. Histological examination revealed mild to moderate inflammation with variable calcification. Conclusions Photo-oxidized bovine pericardium demonstrated excellent performance when used as a patch material in cardiovascular repair in children. Its handling characteristics and biocompatibility are consistent with a wide range of applications.
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Affiliation(s)
- Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Patrick O Myers
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Cardiovascular Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Breanna Piekarski
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Michele Borisuk
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Amara Majeed
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sitaram M Emani
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephen P Sanders
- Cardiac Registry, Boston Children's Hospital, Boston, MA, USA.,Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Pathology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Vida VL, Zanotto L, Zanotto L, Stellin G, Padalino M, Sarris G, Protopapas E, Prospero C, Pizarro C, Woodford E, Tlaskal T, Berggren H, Kostolny M, Omeje I, Asfour B, Kadner A, Carrel T, Schoof PH, Nosal M, Fragata J, Kozłowski M, Maruszewski B, Vricella LA, Cameron DE, Sojak V, Hazekamp M, Salminen J, Mattila IP, Cleuziou J, Myers PO, Hraska V. Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study. Ann Thorac Surg 2017; 104:899-906. [PMID: 28709661 DOI: 10.1016/j.athoracsur.2017.04.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/21/2017] [Accepted: 04/04/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type. METHODS Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]). RESULTS Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]). CONCLUSIONS Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required.
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Affiliation(s)
- Vladimiro L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Lucia Zanotto
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Georges Sarris
- Athens Heart Surgery Institute and Department of Pediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Eleftherios Protopapas
- Athens Heart Surgery Institute and Department of Pediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Carol Prospero
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Christian Pizarro
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Edward Woodford
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Thomas Tlaskal
- Children's Heart Centre, University Hospital Motol, Prague, Czech Republic
| | - Hakan Berggren
- Department of Molecular and Clinical Medicine, Children's Heart Center, The Queen Silvia's Children's Hospital, Göteborg, Sweden
| | - Martin Kostolny
- Great Ormond Street Hospital, Cardiothoracic Unit, London, UK
| | - Ikenna Omeje
- Great Ormond Street Hospital, Cardiothoracic Unit, London, UK
| | - Boulos Asfour
- Herma Heart Center, Medical College of Wisconsin, Wisconsin, USA
| | - Alexander Kadner
- Department for Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department for Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Paul H Schoof
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Matej Nosal
- Childrens Heart Centre Slovak Republic, Bratislava, Slovakia
| | - Josè Fragata
- Department of Cardiothoracic Surgery, Hospital de Santa Marta and Nova Medical School, Lisbon, Portugal
| | | | | | - Luca A Vricella
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, USA
| | - Vladimir Sojak
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Mark Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jukka Salminen
- Division of Pediatric Surgery, Department of Children and Adolescents, Helsinki University Hospital, Helsinki, Finland
| | - Ilkka P Mattila
- Division of Pediatric Surgery, Department of Children and Adolescents, Helsinki University Hospital, Helsinki, Finland
| | - Julie Cleuziou
- Department of Cardiovascular Surgery, German Heart Center Munich Technische Universität München, Munich, Germany
| | - Patrick O Myers
- Divison of cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Viktor Hraska
- Herma Heart Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Myers PO. Preserving the V-engine shape of the left ventricle with Melody mitral valve replacement in small children. J Thorac Cardiovasc Surg 2017; 153:151-152. [DOI: 10.1016/j.jtcvs.2016.08.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
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Myers PO, Beghetti M. Response by Myers and Beghetti to Letter Regarding Article, "Unrestrictive Aortopulmonary Window: Extreme Presentation as Non-Eisenmenger in a 30-Year-Old Patient". Circulation 2016; 134:e330-e331. [PMID: 27753617 DOI: 10.1161/circulationaha.116.024456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Patrick O Myers
- From Cardiovascular Surgery (P.O.M.), Pulmonary Hypertension Program (P.O.M., M.B.), and Unit of Pediatric Cardiology (M.B.), Children's University Hospital Geneva, Geneva, Switzerland
| | - Maurice Beghetti
- From Cardiovascular Surgery (P.O.M.), Pulmonary Hypertension Program (P.O.M., M.B.), and Unit of Pediatric Cardiology (M.B.), Children's University Hospital Geneva, Geneva, Switzerland
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Myers PO, Lador F, Beghetti M. eComment: How to define operability in pulmonary hypertension secondary to congenital heart disease? Interact Cardiovasc Thorac Surg 2016; 22:859. [PMID: 27231252 DOI: 10.1093/icvts/ivw131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patrick O Myers
- Pulmonary Hypertension Program, Cardiovascular Surgery, Pulmonology and Pediatric Cardiology, Geneva
| | - Frederic Lador
- Pulmonary Hypertension Program, Cardiovascular Surgery, Pulmonology and Pediatric Cardiology, Geneva
| | - Maurice Beghetti
- Pulmonary Hypertension Program, Cardiovascular Surgery, Pulmonology and Pediatric Cardiology, Geneva
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Myers PO, Lador F, Hachulla AL, Bouchardy J, Noble S, Licker M, Pache JC, Kalimanovaska-Ostric D, Djukic M, Kalangos A, Beghetti M. Unrestrictive Aortopulmonary Window: Extreme Presentation as Non-Eisenmenger in a 30-Year-Old Patient. Circulation 2016; 133:1907-10. [PMID: 27166350 DOI: 10.1161/circulationaha.115.020819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Patrick O Myers
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.).
| | - Frédéric Lador
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Anne-Lise Hachulla
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Judith Bouchardy
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Stéphane Noble
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Marc Licker
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Jean-Claude Pache
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Dimitra Kalimanovaska-Ostric
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Milan Djukic
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Afksendiyos Kalangos
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Maurice Beghetti
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
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Myers PO, Emani SM, Baird CW. Ring-reinforced Sano right ventricular to pulmonary artery conduit at Norwood stage I. Multimed Man Cardiothorac Surg 2016; 2016:mmv038. [PMID: 26768103 DOI: 10.1093/mmcts/mmv038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/06/2015] [Indexed: 11/13/2022]
Abstract
Reinterventions for proximal conduit obstruction or on the pulmonary arteries are frequent after Sano-modified stage I Norwood palliation of hypoplastic left heart syndrome. We report our experience with a modified Sano stage I, in which the right ventricle-to-pulmonary artery (PA) conduit used is reinforced by external rings to avoid collapse, and the conduit is inserted into the right ventricle through a limited ventriculotomy and 'dunked' into the ventricular cavity. In our experience, this modification was associated with fewer reinterventions or complications with the proximal anastomosis (P = 0.046 and 0.004), improved PA pulse pressure (9.1 ± 4.1 vs 4.8 ± 3.8 mmHg in controls, P < 0.001) and Nakata index (213 ± 76 vs 134 ± 68 mm(2)/m(2) in controls, P < 0.0001), although overall survival to a median of 20 months was not significantly different from controls. Right ventricular function at stage II-bidirectional Glen was marginally better in patients with the modified Sano conduit, however not to a significant level. Further evaluation of late ventricular function is currently ongoing.
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Affiliation(s)
- Patrick O Myers
- Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA Cardiovascular Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Sitaram M Emani
- Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Christopher W Baird
- Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Mootoosamy P, Jolou J, Myers PO, Walpoth BH, Kalangos A, Cikirikcioglu M. External Saphenous Vein Support Mesh Does Not Interfere with Transit-Time Flow Measurement on Venous Coronary Bypass Conduit: Clinical Confirmation. Innovations 2016. [DOI: 10.1177/155698451601100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Parmeseeven Mootoosamy
- Division of Cardiovascular Surgery, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - Jalal Jolou
- Division of Cardiovascular Surgery, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - Patrick O. Myers
- Division of Cardiovascular Surgery, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - Beat H. Walpoth
- Division of Cardiovascular Surgery, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - Afksendiyos Kalangos
- Division of Cardiovascular Surgery, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - Mustafa Cikirikcioglu
- Division of Cardiovascular Surgery, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
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Depboylu BC, Myers PO, Mootoosamy P, Jolou J, Vala D, Karaca S, Licker M, Kalangos A, Cikirikcioglu M. Does adoption of new technologies require high operative volume? Our results with sutureless aortic bioprostheses. J Cardiothorac Surg 2015. [PMCID: PMC4695718 DOI: 10.1186/1749-8090-10-s1-a296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Depboylu BC, Finci L, Myers PO, Karaca S, Vala D, Jolou J, Mootoosamy P, Licker M, Bendjelid K, Kalangos A, Cikirikcioglu M. Surgical treatment of type A Acute Aortic Dissection based on Geneva algorithm. J Cardiothorac Surg 2015. [PMCID: PMC4695693 DOI: 10.1186/1749-8090-10-s1-a313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Myers PO, Baird CW, Del Nido PJ, Pigula FA, Lang N, Marx GR, Emani SM. Neonatal Mitral Valve Repair in Biventricular Repair, Single Ventricle Palliation, and Secondary Left Ventricular Recruitment: Indications, Techniques, and Mid-Term Outcomes. Front Surg 2015; 2:59. [PMID: 26618162 PMCID: PMC4639623 DOI: 10.3389/fsurg.2015.00059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/29/2015] [Indexed: 01/11/2023] Open
Abstract
Objectives Although mitral valve repair is rarely required in neonates, this population is considered to be at high risk for adverse outcomes. The aim of this study was to review the indications for surgery, mechanisms, repair techniques, and mid-term outcomes of neonatal mitral valve repair. Methods The demographic, procedural, and outcome data were obtained for all neonates who underwent mitral valve repair from 2005 to 2012. The primary endpoints included mortality, transplantation, and mitral valve reoperation. Results Twenty patients were included during the study period. Median age at operation was 11 days (range: 3–25). Eleven patients (55%) presented with mitral stenosis, three had regurgitation (15%), and six had mixed mitral disease (30%). Nineteen of 20 patients had mild or less regurgitation on immediate postoperative imaging. During a median follow-up of 5 months (1 month–4.8 years), six patients died at a median of 33 months (7–41 months) from repair and one patient required orthotopic heart transplantation. Six patients required mitral valve reoperation, five for mitral valve re-repair, and one for mitral valve replacement. Freedom from death, transplantation, or mitral valve replacement was 84.2 ± 8.4% at 1 month, 71.3 ± 11% at 6 months, 64.1 ± 12% at 1 year, and 51.3 ± 15% at 2 years and was worse for patients presenting with mitral regurgitation compared to stenosis or mixed mitral valve disease. Conclusion Although mitral valve repair can be performed with acceptable immediate postoperative result, this procedure carries a high burden of late death and mitral valve reoperations.
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Affiliation(s)
- Patrick O Myers
- Cardiac Surgery, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Cardiovascular Surgery, Geneva University Hospitals and School of Medicine , Geneva , Switzerland
| | - Christopher W Baird
- Cardiac Surgery, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Pedro J Del Nido
- Cardiac Surgery, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Frank A Pigula
- Cardiac Surgery, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Nora Lang
- Cardiology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Gerald R Marx
- Cardiology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Sitaram M Emani
- Cardiac Surgery, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
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Myers PO, Hachulla-Lemaire AL, Murith N. Traumatic thoracic aortic rupture: Caught between a thoracic vertebral osteophyte and a hard place. J Thorac Cardiovasc Surg 2015; 150:1661-2. [PMID: 26341283 DOI: 10.1016/j.jtcvs.2015.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/08/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Patrick O Myers
- Division of Cardiovascular Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | | | - Nicolas Murith
- Division of Cardiovascular Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Tissot C, Didier D, Beghetti M, Kalangos A, Myers PO. Asymptomatic right circumflex aortic arch associated with ventricular septal defect and biscuspid aortic valve. Heart Surg Forum 2015; 18:E114-5. [PMID: 26115157 DOI: 10.1532/hsf.1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 06/19/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Anomalies of the aortic arch are frequent congenital malformations, which rarely form partial or complete vascular rings. A rare form of vascular ring is the encircling, or circumflex, aortic arch. CASE REPORT A 19-month-old boy, with no respiratory symptoms, was referred for ventricular septal defect (VSD) repair. Cardiac magnetic resonance imaging and echocardiography confirmed the perimembranous VSD, a bicuspid aortic valve with normal function, and showed a right-sided ascending aorta, bifurcating to the left behind the esophagus and trachea above the tracheal bifurcation, with a left-sided descending aorta, a left ligamentum arteriosum and aberrant left subclavian artery, realizing a circumflex aortic arch. The child underwent successful VSD repair and ligamentum arteriosum division, with an uneventful postoperative course. CONCLUSIONS Previous reports have described the association of circumflex aortic arch with VSD, but there is no previous report of its association with VSD and bicuspid aortic valve. Patients are usually symptomatic either preoperatively, or after VSD repair. For this reason, division of the ligamentum arteriosum, to open the vascular ring and free the trachea and esophagus from compression, should be performed in patients undergoing cardiac surgery for associated malformations.
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Affiliation(s)
- Cécile Tissot
- Pediatric Cardiology Unit, Geneva University Children's Hospital, Geneva.
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Myers PO, del Nido PJ, Bautista-Hernandez V, Marx GR, Emani SM, Pigula FA, Borisuk M, Baird CW. Biventricular repair for common atrioventricular canal defect with parachute left atrioventricular valve. Eur J Cardiothorac Surg 2015; 49:546-51; discussion 551-2. [PMID: 25838456 DOI: 10.1093/ejcts/ezv114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/25/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Parachute left atrioventricular (AV) valve can complicate repair of common atrioventricular canal (CAVC), and single-ventricle palliation is sometimes preferred. The goal of this study is to review our single institutional experience in biventricular repair in this patient group. METHODS The demographic, procedural and outcome data were obtained for all children who underwent biventricular repair for complete CAVC with parachute [single left ventricular (LV) papillary muscle] or forme fruste parachute left AV valve (closely spaced LV papillary muscles) from 2001 to 2012. Primary outcomes were survival, freedom from left AV valve stenosis (defined as an inflow gradient ≥7 mmHg and post-capillary pulmonary hypertension) and freedom from left AV valve replacement. RESULTS A total of 24 patients were included (21 parachutes, 3 forme frustes). There was 1 early death (4.2%). At discharge, no patient had more-than-mild regurgitation and 1 had stenosis. During a median follow-up of 3.7 years (IQR 4 months to 5 years), there were 2 late deaths (8.3%), 6 patients (25%) presented significant left AV valve stenosis and 2 patients (8.3%) required valve replacement. Freedom from stenosis was 95 ± 4.9% at 1 year, 83.1 ± 8.9% at 3 years, 64.7 ± 13.5% at 5 years and 51.7 ± 15.8% at 10 years. Complete cleft closure was not associated with a significantly different freedom from left AV valve reoperation (log-rank test, P = 0.89) or significant stenosis (P = 0.47). CONCLUSION Biventricular repair in parachute left AV valve and CAVC is feasible with acceptable mortality and freedom from stenosis. The burden of reoperation remains significant in this patient group.
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Affiliation(s)
- Patrick O Myers
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA Division of Cardiovascular Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Pedro J del Nido
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Victor Bautista-Hernandez
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gerald R Marx
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sitaram M Emani
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Frank A Pigula
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Michele Borisuk
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Panos A, Vlad S, Milas F, Myers PO. Is minimally invasive mitral valve repair with artificial chords reproducible and applicable in routine surgery? Interact Cardiovasc Thorac Surg 2015; 20:707-11. [DOI: 10.1093/icvts/ivv065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/27/2015] [Indexed: 11/13/2022] Open
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Myers PO, Murith N. Reply: To PMID 24996710. Ann Thorac Surg 2015; 99:745-6. [PMID: 25639432 DOI: 10.1016/j.athoracsur.2014.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 10/10/2014] [Accepted: 11/18/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Patrick O Myers
- Division of Cardiovascular Surgery, Geneva University Hospitals & Faculty of Medicine, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
| | - Nicolas Murith
- Division of Cardiovascular Surgery, Geneva University Hospitals & Faculty of Medicine, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
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Baird CW, Myers PO, Borisuk M, Pigula FA, Emani SM. Ring-reinforced Sano conduit at Norwood stage I reduces proximal conduit obstruction. Ann Thorac Surg 2014; 99:171-9. [PMID: 25441064 DOI: 10.1016/j.athoracsur.2014.08.078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 07/29/2014] [Accepted: 08/07/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reinterventions for proximal conduit obstruction or on the pulmonary arteries are frequent after the Sano-modified stage I Norwood palliation of hypoplastic left heart syndrome. We report our initial experience with a modified Sano technique using a ring-reinforced graft inserted transmurally through the right ventricle with a limited ventriculotomy. METHODS All patients who underwent the Sano-modified stage I Norwood procedure using a modified "dunked" technique from September 2010 to September 2012 at our institution were reviewed. An historical control group consisted of patients undergoing the traditional Sano right ventricle-to-pulmonary artery conduit anastomosed to the epicardium. The primary outcome measures included death, reintervention on the Sano and pulmonary arteries, and ventricular function. RESULTS The study included 29 patients. No patients required intervention on the Sano conduit, pulmonary arteries, or aortic arch before discharge after the stage I procedure. During a median follow-up of 20 months (range, 26 days to 3.3 years), survival was estimated at 96.6% ± 3.4% at 1 month and 86.2% ± 6.4% at the latest follow-up. One patient underwent heart transplantation. No interstage intervention was required on the proximal or distal Sano conduit. Intervention was required on the midportion of the conduit in 1 patient and on the pulmonary arteries in 3 patients. At the time of the bidirectional Glenn anastomosis, freedom from conduit and pulmonary artery intervention was estimated at 92.3% ± 7.4% and 90.1% ± 8.7%, respectively, and global right ventricular dysfunction was mild or less in 84% (16 of 19) of patients. CONCLUSIONS The ring-reinforced right ventricle-to-pulmonary artery Sano conduit transmurally inserted into the right ventricle provides acceptable results, with a low incidence of interstage reinterventions in patients undergoing stage I palliation.
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Affiliation(s)
- Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Patrick O Myers
- Division of Cardiovascular Surgery, Geneva University Hospitals and School of Medicine, Geneva, Switzerland
| | - Michele Borisuk
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Frank A Pigula
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sitaram M Emani
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Myers PO, Kalangos A. Letter by Myers and Kalangos regarding article, "fluttering thrombus in patent foramen ovale with paradoxical and cerebral embolism". Circulation 2014; 130:e163. [PMID: 25462829 DOI: 10.1161/circulationaha.114.009728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Patrick O Myers
- Cardiovascular Surgery, Geneva University Hospitals and School of Medicine, Geneva, Switzerland
| | - Afksendiyos Kalangos
- Cardiovascular Surgery, Geneva University Hospitals and School of Medicine, Geneva, Switzerland
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Baird CW, Myers PO, Borisuk M, Kalish B, Hofferberth S, Nathan M, Emani SM, del Nido PJ. Takedown of cavopulmonary shunt at biventricular repair. J Thorac Cardiovasc Surg 2014; 148:1506-11. [DOI: 10.1016/j.jtcvs.2014.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/08/2014] [Indexed: 12/14/2022]
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Myers PO, Cikirikcioglu M, Kalangos A. Biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street? BMC Surg 2014; 14:48. [PMID: 25087015 PMCID: PMC4131057 DOI: 10.1186/1471-2482-14-48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/24/2014] [Indexed: 01/29/2023] Open
Abstract
Background One third of patients with infective endocarditis will require operative intervention. Given the superiority of valve repair over valve replacement in many indications other than endocarditis, there has been increasing interest and an increasing number of reports of excellent results of valve repair in acute infective endocarditis. The theoretically ideal material for valve repair in this setting is non-permanent, “vanishing” material, not at risk of seeding or colonization. The goal of this contribution is to review currently available data on biodegradable materials for valve repair in infective endocarditis. Discussion Rigorous electronic and manual literature searches were conducted to identify reports of biodegradable materials for valve repair in infective endocarditis. Articles were identified in electronic database searches of Medline, Embase and the Cochrane Library, using a predetermined search strategy. 49 manuscripts were included in the review. Prosthetic materials needed for valve repair can be summarized into annuloplasty rings to remodel the mitral or tricuspid annulus, and patch materials to replace resected valvar tissue. The commercially available biodegradable annuloplasty ring has shown interesting clinical results in a single-center experience; however further data is required for validation and longer follow-up. Unmodified extra-cellular matrix patches, such as small intestinal submucosa, have had promising initial experimental and clinical results in non-infected valve repair, although in valve repair for endocarditis has been reported in only one patient, and concerns have been raised regarding their mechanical stability in an infected field. Summary These evolving biodegradable devices offer the potential for valve repair with degradable materials replaced with autologous tissue, which could further improve the results of valve repair for infective endocarditis. This is an evolving field with promising experimental or initial clinical results, however long-term outcomes are lacking and further data is necessary to validate this theoretically interesting approach to infective endocarditis.
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Affiliation(s)
- Patrick O Myers
- Cardiovascular Surgery, Geneva University Hospitals & Faculty of Medicine, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
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Myers PO, Gemayel G, Mugnai D, Murith N, Kalangos A. Endovascular Exclusion of Aortoesophageal Fistula After Coarctation Extraanatomical Bypass. Ann Thorac Surg 2014; 98:314-6. [DOI: 10.1016/j.athoracsur.2013.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/24/2013] [Accepted: 09/05/2013] [Indexed: 10/25/2022]
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