Simplifying Mitral Valve Repair with Novel Premeasured Chordal Loops.

The "respect" approach to surgical mitral valve repair, which involves implanting artificial neochordae, is gaining increased adoption. Surgeons are possibly prone to error in the manual construction of neochordae, which can lead to prolonged cross-clamp times. Novel systems such as Chord-X Pre-Measured Loops (On-X Life Technologies, Inc.

Multifocal primary intrapulmonary thymoma successfully resected via robotic-assisted thoracoscopic surgery.

Primary intrapulmonary thymoma (PIT) represents a rare subset of ectopic thymoma that arises solely from inside the pulmonary parenchyma. Multifocal PIT, where multiple isolated PIT origins coexist in the lungs, has only been confirmed in one previous case report, in which the patient died before surgical resection. These tumours are difficult to diagnose as imaging findings are non-specific, and non-invasive biopsy often yields inaccurate results.

Use of clinical quality indicators to improve lung cancer care in a regional/rural network of health services.

Problem: Optimal lung cancer care requires multidisciplinary team input, with access to specialised diagnostic and therapeutic services that may be limited in rural or regional areas and impact clinical outcomes. Clinical quality indicators can be used to measure the quality of care delivered to patients with lung cancer in a region and identify areas for improvement. We describe the implementation of internationally recognised clinical quality indicators for lung cancer care in the Barwon South Western region.

Deep sequencing of primary human lung epithelial cells challenged with H5N1 influenza virus reveals a proviral role for CEACAM1.

Current prophylactic and therapeutic strategies targeting human influenza viruses include vaccines and antivirals. Given variable rates of vaccine efficacy and antiviral resistance, alternative strategies are urgently required to improve disease outcomes. Here we describe the use of HiSeq deep sequencing to analyze host gene expression in primary human alveolar epithelial type II cells infected with highly pathogenic avian influenza H5N1 virus.

The Real-World Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Stenting in High-Risk Patients: Propensity Score-Matched Analysis of a Single-Centre Experience.

Background: There are limited economic evaluations comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multi-vessel coronary artery disease (MVCAD) in contemporary, routine clinical practice.

Objective: The aim was to perform a cost-effectiveness analysis comparing CABG and PCI in patients with MVCAD, from the perspective of the Australian public hospital payer, using observational data sources.

Methods: Clinical data from the Melbourne Interventional Group (MIG) and the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) registries were analysed for 1022 CABG (treatment) and 978 PCI (comparator) procedures performed between June 2009 and December 2013.

Minimally Invasive Aortic Valve Replacement Via Right Anterior Mini-Thoracotomy: Propensity Matched Initial Experience.

Background: Aortic valve replacement by way of a right anterior mini-thoracotomy (RAMT) has shown excellent results in terms of mortality and morbidity. The aim of the present study was to compare RAMT aortic valve replacement (AVR) with conventional full sternotomy in regards to early perioperative outcomes and mortality.

Methods: This was a retrospective, observational, cohort study of prospectively collected data from patients who underwent isolated, first time AVR between January 2013 and October 2016.

Comparison of pulmonary artery catheter, echocardiography, and arterial waveform analysis monitoring in predicting the hemodynamic state during and after cardiac surgery.

Objective: The aim of this trial was to determine whether Flotrac Vigileo™ (FV™) provides a reliable representation of the hemodynamic state of a cardiac surgical patient population when compared to pulmonary artery catheter (PAC) and echocardiography in the peril-operative period.

Design: This was a prospective observational trial comparing perioperative hemodynamic states using transesophageal echocardiography (TEE), transthoracic echocardiography (TTE), FV™ and PAC during and post cardiothoracic surgery.

Setting: Tertiary regional hospital Intensive Care Unit (ICU).

Massive symptomatic right-sided Bochdalek hernia in an adult man.

A 22-year-old man presented to a rural hospital in Australia with right-sided pleuritic chest pain, right shoulder pain and dyspnoea. The patient had been receiving chronic asthma therapy without improvement. CT of the chest was performed after an abnormal X-ray, incidentally revealing one of the largest documented right-sided diaphragmatic hernias, with left lung compression due to mediastinal shift.

A systematic review of cost-effectiveness of percutaneous coronary intervention vs. surgery for the treatment of multivessel coronary artery disease in the drug-eluting stent era.

Aims: The suitability of percutaneous coronary intervention (PCI), compared with coronary artery bypass grafting (CABG), for patients with complex multivessel coronary artery disease (MVCAD) remains a contentious topic. While the body of evidence regarding the clinical effectiveness of these revascularization strategies is growing, there is limited evidence concerning their long-term cost-effectiveness. We aim to critically appraise the body of literature investigating the cost-effectiveness of CABG compared with PCI using stents, and to assess the quality of the economic evidence available.

Retrograde Type A Aortic Dissection Treated with Continuous Perfusion "Branch-First" Aortic Arch Replacement Technique.

The development of thoracic endovascular aortic repair in recent years has revolutionised the way aortic disease is treated. However, there are potential complications associated with this which can be life threatening and pose a difficult challenge to manage. We present a case of retrograde ascending aortic dissection complicating thoracic endovascular aortic repair, and its repair using a technique of continuous perfusion "branch-first" aortic arch replacement.

Thermoreactive clips do not reduce sternal infection: a propensity-matched comparison with sternal wires.

Objectives: Sternal stability is essential to prevent serious infective complications after sternotomy. This paper examines whether nitinol thermoreactive clips reduce sternal wound infection rates in obese patients [body mass index (BMI) ≥30] compared with sternal wires.

Methods: All patients with BMI ≥30 undergoing cardiac surgery via median sternotomy between February 2008 and February 2013 in our institution were divided into two groups depending on sternal closure technique-sternal wires or thermoreactive clips.

Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: an updated systematic review and meta-analysis.

Background: Currently, the appropriateness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for patients with diabetes (DM) and multi-vessel disease (MVD) is uncertain due to limited evidence from few randomised controlled trials (RCTs). We aimed to compare the clinical effectiveness of CABG versus PCI-DES in DM-MVD patients using an evidence-based approach.

Methods: A systematic review and meta-analyses were conducted to compare the risk of all-cause mortality, myocardial infarction (MI), repeat revascularisation, cerebrovascular events (CVE), and major adverse cardiac or cerebrovascular events (MACCE).

Impact of socioeconomic status and rurality on early outcomes and mid-term survival after CABG: insights from a multicentre registry.

Background: We examined whether socioeconomic status and rurality influenced outcomes after coronary surgery.

Methods: We identified 14,150 patients undergoing isolated coronary surgery. Socioeconomic and rurality data was obtained from the Australian Bureau of Statistics and linked to patients' postcodes.

The operating surgeon is an independent predictor of chest tube drainage following cardiac surgery.

Objectives: Bleeding into the chest is a major cause of blood transfusion and adverse outcomes following cardiac surgery. The authors investigated predictors of bleeding following cardiac surgery to identify potentially correctable factors.

Design: Data were retrieved from the medical records of patients undergoing cardiac surgery over the period of 2002 to 2008.

A case of Kingella kingae endocarditis complicated by native mitral valve rupture.

We report a case of Kingella kingae endocarditis in a patient with a history of recent respiratory tract infection and dental extraction. This case is remarkable for embolic and vasculitic phenomena in association with a large valve vegetation and valve perforation. Kingella kingae is an organism known to cause endocarditis, however early major complications are uncommon.

Cardiovascular readmissions and excess costs following percutaneous coronary intervention in patients with chronic kidney disease: data from a large multi-centre Australian registry.

Background: Chronic kidney disease (CKD) is a well-established risk factor for adverse events in patients undergoing percutaneous coronary intervention (PCI). However, few data exists on the subsequent healthcare resource use and related incremental costs in this patient subgroup. The present study compares the rates of cardiac-related hospitalisations and the associated direct costs, post-PCI in patients with and without CKD.

Critical analysis of early and late outcomes after isolated coronary artery bypass surgery in elderly patients.

Background: The proportion of elderly (≥80 years) patients undergoing coronary artery bypass surgery (CABG) is increasing.

Methods: A retrospective analysis of data, collected by the Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program between June 2001 and December 2009 was performed. Isolated CABG was performed in 21,534 patients; of these, 1,664 (7.

Impact of prosthesis--patient mismatch after mitral valve replacement: a multicentre analysis of early outcomes and mid-term survival.

Background: Prosthesis-patient mismatch (PPM) is characterised by the effects of inadequate prosthesis size relative to body surface area (BSA). It is uncertain whether PPM after mitral valve replacement impacts upon clinical outcome. This was examined in an Australian population.

Training in mitral valve surgery need not affect early outcomes and midterm survival: a multicentre analysis.

Objective: Mitral valve surgery may be regarded as less favourable for training, due to greater mortality risk, technical complexity, and difficulty for the supervisor to observe. We examined this perception by reviewing a multicentre experience.

Methods: We analysed a multicentre database over a 7-year period containing 2216 isolated and combined mitral procedures.

An Australian risk prediction model for determining early mortality following aortic valve replacement.

Objective: To develop a multivariable logistic risk model for predicting early mortality following aortic valve replacement (AVR) in adults, and to compare its performance against existing AVR-dedicated models.

Methods: Prospectively collected data from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) database project were used. Thirty-five preoperative variables from AVR literature were considered for analysis by chi-square method and multiple logistic regression.

Quality control activities associated with registries in interventional cardiology and surgery.

Objective: To describe and outline audit and quality control activities of the multicentre interventional and cardiac surgery registry in Victoria as a potential model for a national registry.

Design, Setting, And Patients: The Melbourne Interventional Group (MIG) database is a prospective multicentre registry recording consecutive percutaneous coronary interventional (PCI) procedures across eight Victorian hospitals. Similarly, the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) database captures cardiac surgical activity across six Victorian hospitals.

Progress towards a National Cardiac Procedure Database--development of the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) and Melbourne Interventional Group (MIG) registries.

Since the call for a National Cardiac Procedures Database in 2001, much work has been accomplished in both cardiac surgery and interventional cardiology in an attempt to establish a unified, systematic approach to data collection, defining a common minimum dataset pertinent to the Australian context, and instituting quality control measures to ensure integrity and privacy of data. In this paper we outline the aims of the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) and the Melbourne Interventional Group (MIG) registries, and propose a comprehensive set of standardised data elements and their definitions to facilitate transparency in data collection, consistency between these and other data sets, and encourage ongoing peer-review. The aims are to improve outcomes for patients by determining key performance indicators and standards of performance for hospital units, to allow estimation of procedural risks and likelihood of outcomes for patients, and to report outcomes to relevant stake-holders and the public.

Does prior percutaneous coronary intervention adversely affect early and mid-term survival after coronary artery surgery?

Objectives: To determine the association between previous percutaneous coronary intervention (PCI) and results after coronary artery bypass graft surgery (CABG).

Background: Increasing numbers of patients undergoing CABG have previously undergone PCI.

Methods: We analyzed consecutive first-time isolated CABG procedures within the Australasian Society of Cardiac and Thoracic Surgeons Database from June 2001 to May 2008.