LIMA to LAD grafting returns patient survival to age-matched population: 20-year outcomes of MIDCAB surgery.

Objectives: Previous studies have demonstrated the safety and excellent short-term and mid-term survival after minimally invasive direct coronary artery bypass (MIDCAB). We reviewed the long-term outcomes up to 20 years, including overall survival and freedom from reintervention.

Methods: Consecutive patients who underwent MIDCAB between February 1997 and August 2020 were identified.

In patients with lung cancer is combined endobronchial ultrasound and endoscopic ultrasound superior to conventional mediastinoscopy in staging the mediastinum?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In patients with lung cancer, is combined endobronchial ultrasound and endoscopic ultrasound (EBUS + EUS) superior to cervical mediastinoscopy (CM) in staging the mediastinum?' Altogether more than 110 papers were found, of which one meta-analysis, two RCTs, and two cohort studies represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.

Correlation of ventricular septal defect height and outcomes after complete atrioventricular septal defect repair.

Objectives: There are limited data available on the height of the ventricular component of the septal deficiency (VSD) in patients undergoing complete atrioventricular septal defect (CAVSD) repair. VSD height may influence optimal choice of repair strategy with potential consequences for long-term outcomes. We aimed to measure VSD height using 2-dimensional echocardiography and review its association with postoperative outcomes.

Does lung cancer screening with low-dose computerized tomography improve survival?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Does lung cancer screening with low-dose computerised tomography (LDCT) improve survival?' More than 963 papers were found, of which 8 randomized control trials and 1 meta-analysis represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated.

How to do it: Plasmapheresis via venoarterial extracorporeal membrane oxygenation circuit for thyroid storm.

Thyrotoxicosis-induced cardiomyopathy is a rare complication occurring in <1% of the population, which can require mechanical circulatory support (VA-ECMO) as a bridge to anti-thyroid therapies. Therapeutic plasma exchange (TPE) is an alternative treatment used to rapidly reduce thyroid hormone levels in refractory cases of thyrotoxic crisis without clinical improvement from other therapies. We describe a novel technique of facilitating plasmapheresis via a VA-ECMO circuit in a 26-year-old man with thyroid storm and subsequent circulatory collapse.

Predictors of reoperation and mortality after complete atrioventricular septal defect repair.

Objectives: Previous studies investigating risk factors associated with reoperation or mortality after repair of complete atrioventricular septal defect (CAVSD) often have not included sizeable cohorts undergoing modified single-patch repair. Both double patch and modified single-patch techniques have been widely used in Australia since the 1990s. Using a large multi-institutional cohort, we aimed to identify risk factors associated with reoperation or mortality following CAVSD repair.

Postural orthostatic tachycardia syndrome following open thoracoabdominal aortic aneurysm repair.

Postural orthostatic tachycardia syndrome (POTS) is a variant of cardiovascular autonomic disorder characterised by an excessive heart rate on standing and orthostatic intolerance. We present a rare case of a 38-year-old man who underwent open repair of a thoracoabdominal aortic aneurysm for a chronic Stanford type B aortic dissection whose recovery was complicated by POTS. He received blood transfusions and was commenced on metoprolol, fludrocortisone and ivabradine with significant improvement in his symptoms.

Venoarterial Extracorporeal Membrane Oxygenation for Ruptured Sinus of Valsalva Aneurysm.

Sinus of Valsalva aneurysm rupture is a potentially fatal condition that requires urgent surgical intervention. We report a case of right sinus of Valsalva aneurysm rupture into the right atrium in a patient with a monocuspid aortic valve successfully managed with femoral venoarterial extracorporeal membrane oxygenation after pulseless electrical activity cardiac arrest to facilitate complete surgical repair. The patient made a full recovery and was discharged home with no neurologic deficit and had no limitations at the 1-year follow-up.

Should cardiac surgery be delayed in patients with uncorrected hypothyroidism?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'should cardiac surgery be delayed in patients with uncorrected hypothyroidism?' A total of 1412 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.

Comparison of novel oral anticoagulants versus warfarin for post-operative atrial fibrillation after coronary artery bypass grafting.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does the use of Novel Oral Anticoagulants (NOACs) result in more complications than Warfarin for treatment of post-operative atrial fibrillation (AF) following coronary artery bypass grafting (CABG)?' Altogether more than 93 papers were found using the reported search with 4 studies representing the best evidence to answer the clinical question, including 1 randomised trial and 3 retrospective case-control studies. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated.

'Is totally endoscopic coronary artery bypass grafting compared with minimally invasive direct coronary artery bypass grafting associated with superior outcomes in patients with isolated left anterior descending disease?'.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is totally endoscopic coronary artery bypass grafting compared with minimally invasive direct coronary artery bypass grafting associated with superior outcomes in patients with isolated left anterior descending disease?' Altogether more than 118 papers were found using the reported search, of which 4 represented the best evidence to answer the clinical question, which included 2 prospective cohort studies and 2 retrospective observational studies. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated.

In patients undergoing dialysis who require a valve replacement is a bioprosthetic valve superior to a mechanical prosthesis in terms of long-term survival and morbidity?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In [dialysis patients undergoing a valve replacement] is [a bioprosthetic valve superior to a mechanical prosthesis] for [long-term survival and morbidity]'. Altogether more than 501 papers were found using the reported search, of which five represented the best evidence to answer the clinical question.

Outcomes of video-assisted thoracoscopic surgery lobectomy in septuagenarians.

Background: Spread of technology and increased surveillance have led to more patients with lung cancers being identified than ever before. Increasingly, patients from the elderly population are referred for surgery; however, many studies do not focus on this patient group. We reviewed the outcomes of septuagenarians who underwent lobectomy via an open thoracotomy (OT) or video-assisted thoracoscopic surgery (VATS) approach to determine whether the VATS approach would result in superior post-operative outcomes.

Complete atrioventricular septal defect repair in Australia: Results over 25 years.

Objectives: To evaluate whether the long-term outcomes of modified-single-patch (MSP) repair of complete atrioventricular septal defect are equivalent to double-patch (DP) repair with respect to survival and risk of reoperation for left atrioventricular valve regurgitation or left ventricular outflow tract obstruction.

Methods: All patients who underwent biventricular repair of complete atrioventricular septal defect in Australia from 1990 to 2015 using either a MSP or DP technique were identified. Demographic characteristic details, operative data, and outcomes were analyzed.

Modified-Single Patch vs Double Patch Repair of Complete Atrioventricular Septal Defects.

Biventricular repair of complete atrioventricular septal defect (CAVSD) is largely achieved using the double-patch (DP) or modified single-patch (MSP) techniques in the current era; however, long-term results following MSP repair are not well defined. We aimed to compare long-term outcomes including reoperation and mortality after CAVSD repair using DP and MSP techniques, and identify the risk factors associated with adverse outcomes. A retrospective cohort study was performed including all patients who underwent CAVSD repair using DP and MSP techniques at our institution between 17 May 1990 and 14 December 2015.

Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, 'Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects?'. A total of 634 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question, which included 1 meta-analysis and 8 cohort studies.

Surgical Management of Caseous Calcification of the Mitral Annulus.

Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification; it can manifest with conduction abnormalities or systemic embolization. It typically involves the posterior mitral annulus, and surgery is indicated for severe mitral valve dysfunction, for embolic complications or when the diagnosis is not certain. We describe a structured approach to the surgical management of CCMA using bovine pericardium to repair the defect.

Liberal use of axillary artery cannulation for aortic and complex cardiac surgery.

Objectives: Axillary artery cannulation for cardiopulmonary bypass has been described previously as a safe and reliable technique, with a low risk of atheroemboli, avoidance of malperfusion in aortic dissection and facilitation of selective antegrade cerebral perfusion during hypothermic circulatory arrest. The aim of this study was to document the broad applicability of axillary cannulation and its associated morbidity and identify where it was not possible to use planned axillary cannulation.

Methods: A retrospective review of a single surgeon's 10-year experience of axillary cannulation using the side-graft technique in 184 consecutive patients (age 22-92 years) in aortic and complex cardiac surgery from July 2002 to June 2012.