Gastrointestinal complications following on-pump cardiac surgery-A propensity matched analysis.

Background: Gastrointestinal complications following on-pump cardiac surgery are orphan but serious risk factors for postoperative morbidity and mortality. We aimed to assess incidence, perioperative risk factors, treatment modalities and outcomes.

Material And Methods: A university medical center audit comprised 4883 consecutive patients (median age 69 [interquartile range IQR 60-76] years, 33% female, median logistic EuroScore 5 [IQR 3-11]) undergoing all types of cardiac surgery including surgery on the thoracic aorta; patients undergoing repair of congenital heart disease, implantation of assist devices or cardiac transplantation were excluded.

Statistical primer: methodology and reporting of meta-analyses.

In modern medicine, the results of a comprehensive and methodologically sound meta-analysis bring the most robust, high-quality information to support evidence-based decision-making. With recent developments in newer meta-analytic approaches, iteration of statistical paradigms and software implementations, network and patient-level meta-analyses have recently gained popularity alongside conventional pairwise study-level meta-analyses. However, pitfalls are common in this challenging and rapidly evolving field of statistics.

Portal vein resection in advanced pancreatic adenocarcinoma: is it worth the risk?

Introduction: Portal vein resection represents a viable add-on option in standard pancreaticoduodenectomy for locally advanced ductal pancreatic adenocarcinoma, but is often underused as it may set patients at additional risk for perioperative and postoperative morbidity and mortality. We aimed to review our long-term experience to determine the additive value of this intervention for locally advanced pancreatic adenocarcinoma.

Patients And Methods: Single, university surgical center audit over a 13-year period; cohort comprised 221 consecutive patients undergoing pancreatic resection; in 47 (21 %) including portal vein resection.

Pancreas Cancer Surgery in Octogenarians - Should We or Should We Not?

Background/aim: In this study we aimed to determine if advanced age represents a risk factor for negative perioperative and long-term outcome in patients undergoing curative surgery ductal pancreatic adenocarcinoma surgery.

Patients And Methods: Two-hundred-twenty-one consecutive patients, twelve (6%) patients ≥80 years were included in the study. We assessed perioperative and long-term outcome and independent predictors for in-hospital mortality with Cox regression analysis.

Risk Factors for Sternal Wound Infection After Open Heart Operations Vary According to Type of Operation.

Background: This study evaluated whether risk factors for sternal wound infections vary with the type of surgical procedure in cardiac operations.

Methods: This was a university hospital surveillance study of 3,249 consecutive patients (28% women) from 2006 to 2010 (median age, 69 years [interquartile range, 60 to 76]; median additive European System for Cardiac Operative Risk Evaluation score, 5 [interquartile range, 3 to 8]) after (1) isolated coronary artery bypass grafting (CABG), (2) isolated valve repair or replacement, or (3) combined valve procedures and CABG. All other operations were excluded.

Statistical and data reporting guidelines for the European Journal of Cardio-Thoracic Surgery and the Interactive CardioVascular and Thoracic Surgery.

As part of the peer review process for the European Journal of Cardio-Thoracic Surgery (EJCTS) and the Interactive CardioVascular and Thoracic Surgery (ICVTS), a statistician reviews any manuscript that includes a statistical analysis. To facilitate authors considering submitting a manuscript and to make it clearer about the expectations of the statistical reviewers, we present up-to-date guidelines for authors on statistical and data reporting specifically in these journals. The number of statistical methods used in the cardiothoracic literature is vast, as are the ways in which data are presented.

Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications.

Objectives: To learn upon incidence, underlying mechanisms and effectiveness of treatment strategies in patients with central airway and pulmonary parenchymal aorto-bronchial fistulation after thoracic endovascular aortic repair (TEVAR).

Methods: Analysis of an international multicentre registry (European Registry of Endovascular Aortic Repair Complications) between 2001 and 2012 with a total caseload of 4680 TEVAR procedures (14 centres).

Results: Twenty-six patients with a median age of 70 years (interquartile range: 60-77) (35% female) were identified.

Minimized extracorporeal circulation does not impair cognitive brain function after coronary artery bypass grafting.

Objectives: Objective evaluation of the impact of minimized extracorporeal circulation (MECC) on perioperative cognitive brain function in coronary artery bypass grafting (CABG) by electroencephalogram P300 wave event-related potentials and number connection test (NCT) as metrics of cognitive function.

Methods: Cognitive brain function was assessed in 31 patients in 2013 with a mean age of 65 years [standard deviation (SD) 10] undergoing CABG by the use of MECC with P300 auditory evoked potentials (peak latencies in milliseconds) directly prior to intervention, 7 days after and 3 months later. Number connection test, serving as method of control, was performed simultaneously in all patients.

New insights regarding the incidence, presentation and treatment options of aorto-oesophageal fistulation after thoracic endovascular aortic repair: the European Registry of Endovascular Aortic Repair Complications.

Objectives: To review the incidence, clinical presentation, definite management and 1-year outcome in patients with aorto-oesophageal fistulation (AOF) following thoracic endovascular aortic repair (TEVAR).

Methods: International multicentre registry (European Registry of Endovascular Aortic Repair Complications) between 2001 and 2011 with a total caseload of 2387 TEVAR procedures (17 centres).

Results: Thirty-six patients with a median age of 69 years (IQR 56-75), 25% females and 9 patients (19%) following previous aortic surgery were identified.

Total surgical aortic arch replacement as a safe strategy to treat complex multisegmental proximal thoracic aortic pathology.

Objective: To analyse the results after elective open total aortic arch replacement.

Methods: We analysed 39 patients (median age 63 years, median logistic EuroSCORE 18.4) who underwent elective open total arch replacement between 2005 and 2012.

Long-term results after proximal thoracic aortic redo surgery.

Objective: To evaluate early and mid-term results in patients undergoing proximal thoracic aortic redo surgery.

Methods: We analyzed 60 patients (median age 60 years, median logistic EuroSCORE 40) who underwent proximal thoracic aortic redo surgery between January 2005 and April 2012. Outcome and risk factors were analyzed.

Thrombolysis of ischemic stroke from noncompaction in metabolic myopathy.

Background: Ischemic stroke has not been reported together with left ventricular hypertrabeculation/noncompaction (LVHT) and metabolic myopathy.

Methods And Results: In a 32-year-old woman with suspected metabolic myopathy, congenital AV-block, pacemaker implantation at the age of 20, and reduced systolic function, LVHT was detected on echocardiography. Shortly afterward, the patient had a left-sided ischemic stroke and underwent systemic thrombolysis with rTPA 3.

Long-term results after operations for active infective endocarditis in native and prosthetic valves.

Background: The objective of this study was to evaluate the midterm results of patients who underwent operations for active infective endocarditis.

Methods: Within a 10-year period, 141 patients with active infective endocarditis received surgical therapy. We assessed outcome, freedom from reinfection, and freedom from reintervention.

Targeting landing zone 0 by total arch rerouting and TEVAR: midterm results of a transcontinental registry.

Background: Landing zone 0, defined as a proximal landing zone in the ascending aorta, remains the last frontier to be taken. Midterm results of total arch rerouting and thoracic endovascular aortic repair (TEVAR) extending into landing zone 0 remain to be determined.

Methods: From 2003 to 2011, 66 patients (mean age, 70 years; 68% men) presenting with pathologic conditions affecting the aortic arch (atherosclerotic aneurysms [n = 48], penetrating ulcers [n = 6], type B dissections [n = 6], type B after type A dissections [n = 5], and anastomotic aneurysm [n = 1]) were treated in 5 participating centers.

What makes the difference between the natural course of a remaining type B dissection after type A repair and a primary type B aortic dissection?

Objectives: To analyse the outcome and need for intervention [surgery or thoracic endovascular aortic repair (TEVAR)] in patients after surgery for remaining type B dissection after type A repair and primary type B aortic dissection.

Methods: Within a 10-year period, 247 patients with remaining type B after type A, and 112 patients with primary type B aortic dissection were analysed. We assessed the clinical outcome as well as the need for intervention (surgery or TEVAR) within the aortic arch and the thoracoabdominal aorta as well as risk factors.

A new mechanism by which an acute type B aortic dissection is primarily complicated, becomes complicated, or remains uncomplicated.

Background: This study is to evaluate if different locations of the primary entry tear result in primary complicated, secondary complicated, or uncomplicated acute type B aortic dissection.

Methods: Sixty-five patients were analyzed. Patients were stratified according to the location of the primary entry tear.

The location of the primary entry tear in acute type B aortic dissection affects early outcome.

Objectives: The goal of the retrospective study was to relate the site of the primary entry tear in acute type B aortic dissections to the presence or development of complications.

Methods: A consecutive series of 52 patients referred with acute type B aortic dissection was analysed with regard to the location of the primary entry tear (convexity or concavity of the distal aortic arch) using the referral CT scans at the time of diagnosis. These findings were related to the clinical outcome as well as to the need for intervention.

Midterm results after endovascular treatment of acute, complicated type B aortic dissection: the Talent Thoracic Registry.

Objective: To assess the efficacy and midterm results of endovascular treatment of acute complicated type B dissection.

Methods: From January 1998 to March 2004, 29 patients (7 women and 22 men) with acute complicated aortic type B dissection (mean age, 61 years; range, 22-78), defined as aortic rupture, malperfusion, intractable pain, or uncontrolled hypertension, underwent endovascular stent graft placement with the Medtronic Talent device. Five patients (17%) had undergone previous surgery on the ascending aorta and/or aortic valve.

Mechanisms of symptomatic spinal cord ischemia after TEVAR: insights from the European Registry of Endovascular Aortic Repair Complications (EuREC).

Purpose: To test the hypothesis that simultaneous closure of at least 2 independent vascular territories supplying the spinal cord and/or prolonged hypotension may be associated with symptomatic spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR).

Methods: A pattern matching algorithm was used to develop a risk model for symptomatic SCI using a prospective 63-patient single-center cohort to test the positive predictive value (PPV) of prolonged intraoperative hypotension and/or simultaneous closure of at least 2 of 4 the vascular territories supplying the spinal cord (left subclavian, intercostal, lumbar, and hypogastric arteries). This risk model was then applied to data extracted from the multicenter European Registry on Endovascular Aortic Repair Complications (EuREC).

Antegrade selective cerebral perfusion and moderate hypothermia in aortic arch surgery: clinical outcomes in elderly patients.

Objectives: To evaluate the outcome in elderly patients (≥ 75 years) undergoing elective aortic arch surgery with the aid of selective antegrade cerebral perfusion (SACP) and moderate hypothermic circulatory arrest (HCA).

Methods: A series of 95 patients ≥ 75 years (median age 77 years, median EuroSCORE 28) undergoing elective aortic arch surgery with SACP and moderate HCA were analysed with regard to clinical outcome. Risk factors for serious adverse events (mortality, neurological injury) were determined.

Influence of temperature management on neurocognitive function in biological aortic valve replacement. A prospective randomized trial.

Aim: Aim of this study was to elucidate if postoperative neurocognitive function after biological aortic valve replacement (AVR) can be influenced by temperature management during cardiopulmonary bypass (CPB).

Methods: In this prospective randomized study, we measured the effect of mild hypothermic (32 °C, N.=30) vs.

Gender-related differences in patients undergoing mechanical aortic valve replacement with the CarboMedics valve.

Aim: The aim of this paper was to evaluate gender-related differences in patients undergoing mechanical aortic valve replacement with the CarboMedics valve.

Methods: During a 20 year period, 629 patients (median age 60 years) underwent mechanical aortic valve replacement with the CarboMedics valve. Of these, 215 patients were female (34%).

Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures.

Background: The aim of this study was to evaluate a new surgical concept for the treatment of graft infections after operation or endovascular treatment of thoracic, thoracoabdominal, and abdominal aortic diseases.

Methods: Between 2004 and 2011, 15 patients (mean age 72 ± 10 years, 87% men) with prosthetic graft or endovascular graft infection were treated with complete removal of the infected prosthetic material, extensive debridement of the surrounding tissues, and orthotopic vascular reconstruction with self-made xenopericardial tube grafts constructed from a patch. Perioperative and long-term outcomes were evaluated.