Statistical primer: basics of survival analysis for the cardiothoracic surgeon.

Survival analysis incorporates various statistical methods specific to data on time until an event of interest. While the event is often death, giving rise to the phrase 'survival analysis', the event might also be, for example, a reoperation. As such, it is sometimes referred to as 'time-to-event analysis'.

Statistical primer: a cost-effectiveness analysis.

Cost-effectiveness analyses (CEAs) of new treatment strategies are increasingly reported. This can be a part of a clinical trial or as a separate study. Governments and healthcare payers frequently require a CEA to decide whether a new treatment strategy will be reimbursed.

Role of percutaneous coronary intervention in the treatment of left main coronary artery disease.

Revascularization with coronary artery bypass graft surgery is the choice of therapy in patients with left main (LM) coronary artery stenosis. During the last decade, the introduction of drug-eluting stents, together with antiplatelet and antithrombotic treatments, has improved the outcome of percutaneous coronary interventions (PCIs) by reducing the number of repeat revascularizations and the risk of stent thrombosis. Many institutions inside and outside the United States have adopted stent treatment of unprotected LM coronary artery disease as a more routine strategy.

Patient selection for TAVI in 2014: is there a justification for treating low- or intermediate-risk patients? The surgeon's view.

The introduction of transcatheter aortic valve implantation (TAVI) has revolutionised the treatment of patients with symptomatic severe aortic valve stenosis (AS). In extreme and high-risk patients, randomised studies have shown the benefit of this new therapy. However, there are still a lot of unknowns, and the question has arisen whether it is justified to expand the indication of TAVI to other patient groups, especially intermediate-or even low-risk patients.

Influence of diabetes mellitus on long-term clinical and economic outcomes after coronary artery bypass grafting.

Background: China has the most patients with diabetes mellitus (DM) in the world and, annually, approximately 1 million Chinese become diabetic. We investigated both clinical and economic outcomes in a large Chinese cohort of diabetic patients undergoing coronary artery bypass graft surgery (CABG).

Methods: All 9,240 consecutive patients who underwent isolated, primary, elective CABG between January 1999 and December 2008 were included and analyzed for long-term major adverse cardiovascular and cerebrovascular events and economic outcomes up to 2 years after the procedure.

Coronary artery bypass grafting: Part 2--optimizing outcomes and future prospects.

Since first introduced in the mid-1960s, coronary artery bypass grafting (CABG) has become the standard of care for patients with coronary artery disease. Surprisingly, the fundamental surgical technique itself did not change much over time. Nevertheless, outcomes after CABG have dramatically improved over the first 50 years.

Failing surgical bioprosthesis in aortic and mitral position.

Bioprosthetic heart valves are preferentially selected over mechanical prostheses in the majority of patients undergoing valve replacement surgery. These bioprostheses are prone to structural degeneration, and hence an increasing number of patients are presenting with bioprosthetic failure requiring redo surgery. In selected high-risk cases, successful implantation of a transcatheter aortic valve (TAV) within the failing bioprosthetic surgical aortic valve (SAV) or mitral valve (SMV) has been performed.

Cost-effectiveness of transcatheter valvular interventions: economic challenges.

The unsustainable trend of rising healthcare costs necessitates difficult allocation decisions by governments, policymakers, and physicians. Consequently, recent advances in transcatheter valve therapies require not only clinical evaluation, but also careful economic evaluation. Under current indications, each year there are nearly 18,000 new candidates for transcatheter aortic valve implantation (TAVI) in European countries and an additional 9,200 in North America, with an estimated cost of more than $2 billion per year.

Multivessel coronary artery disease: quantifying how recent trials should influence clinical practice.

The majority (70%) of coronary revascularizations concern patients with multivessel disease (MVD). Treatment options include medical therapy, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). CABG surgery has been shown to improve survival compared with medical therapy.

The European Association for Cardio-Thoracic Surgery (EACTS) database: an introduction.

Objectives: Continuous monitoring of surgical outcomes through benchmarking and the identification of best practices has become increasingly important. A structured approach to data collection, coupled with validation, analysis and reporting, is a powerful tool in these endeavours. However, inconsistencies in standards and practices have made comparisons within and between European countries cumbersome.

Costs for surgical aortic valve replacement according to preoperative risk categories.

Background: The introduction of transcatheter aortic valve replacement (TAVR) led to more rigorous evaluation of surgical aortic valve replacement (SAVR) as a benchmark for TAVR. However, limited real-life cost data of SAVR are available. Therefore, the purpose of our study was to assess actual costs and resource utilization of SAVR in patients at different operating risk.

Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study.

Objectives: The purpose of this study was to evaluate the prevalence of aortic stenosis (AS) in the elderly and to estimate the current and future number of candidates for transcatheter aortic valve replacement (TAVR).

Background: Severe AS is a major cause of morbidity and mortality in the elderly. A proportion of these patients is at high or prohibitive risk for surgical aortic valve replacement, and is now considered for TAVR.

Transcatheter aortic valve replacement in Europe: adoption trends and factors influencing device utilization.

Objectives: The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy.

Background: Since its commercialization in 2007, the number of TAVR procedures has grown exponentially.

Methods: The adoption of TAVR was investigated in 11 European countries: Germany, France, Italy, United Kingdom, Spain, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland.

A systematic review of risk prediction in adult cardiac surgery: considerations for future model development.

Objectives: Risk prediction in adult patients undergoing cardiac surgery remains inaccurate and should be further improved. Therefore, we aimed to identify risk factors that are predictive of mortality, stroke, renal failure and/or length of stay after adult cardiac surgery in contemporary practice.

Methods: We searched the Medline database for English-language original contributions from January 2000 to December 2011 to identify preoperative independent risk factors of one of the following outcomes after adult cardiac surgery: death, stroke, renal failure and/or length of stay.

Costs of transcatheter versus surgical aortic valve replacement in intermediate-risk patients.

Background: Transcatheter aortic valve replacement (TAVR) offers a new treatment option for patients with aortic stenosis, but costs may play a decisive role in decision making. Current studies are evaluating TAVR in an intermediate-risk population. We assessed the in-hospital and 1-year follow-up costs of patients undergoing TAVR and surgical aortic valve replacement (SAVR) at intermediate operative risk and identified important cost components.

Towards excellence in revascularization for left main coronary artery disease.

Purpose Of Review: The aim of this article is to review the current revascularization strategies in patients presenting with unprotected left main coronary artery disease (LMCAD).

Recent Findings: Coronary artery bypass grafting (CABG) is the current standard of treatment for patients with LMCAD. The development and refinement of techniques increased the number of percutaneous coronary interventions (PCI) in LMCAD patients.

The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years.

Aims: Numerous studies have linked prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) to adverse outcomes. Its correlation with long-term survival has been described but with contradicting results. This systematic review and meta-analysis of observational studies aims to determine the hazard of PPM after AVR.

Appropriate coronary artery bypass grafting use in the percutaneous coronary intervention era: are we finally making progress?

Appropriate use criteria integrate guidelines, clinical trial evidence, and expert opinion in order to determine the most appropriate care for a range of distinct clinical scenarios. Inappropriate use estimates cannot be neglected. Approximately 12%-14% of all percutaneous coronary interventions and 1%-2% of all coronary artery bypass grafting procedures in patients with stable angina are deemed inappropriate.

Surgery in current therapy for infective endocarditis.

The introduction of the Duke criteria and transesophageal echocardiography has improved early recognition of infective endocarditis but patients are still at high risk for severe morbidity or death. Whether an exclusively antibiotic regimen is superior to surgical intervention is subject to ongoing debate. Current guidelines indicate when surgery is the preferred treatment, but decisions are often based on physician preferences.