European Association Of Cardiothoracic Surgeons Research Articles

The Problem of the Choice of Revascularization in Combined Lesion of the Coronary and Carotid Arteries. Review of Current Recommendations and Article Series

This article provides data from the current Russian (National guidelines for the management of patients with diseases of the brachiocephalic arteries of 2013; Recommendations “Blockage and stenosis of the carotid artery” of the Ministry of Health of the Russian Federation, 2016) and foreign (European Society of Cardiology / European Society of Vascular Surgeons for Diagnosis and Treatment Peripheral Artery Diseases 2017; Recommendations for myocardial revascularization of the European Society of Cardiology and the European Association of Cardio-Thoracic Surgeons 2018) recommendations regarding the choice of a revascularization strategy for combined coronary and carotid artery disease. Conclusions are drawn about the unresolved issue. A literature review of the largest series of Russian articles by one institution devoted to this topic was carried out. Hospital and long-term outcomes have been demonstrated, as well as predictors of complications for various revascularization strategies. The stages of creation and the results of approbation of a new computer program for risk stratifi cation, which makes it possible to determine the mathematical probability of the development of unfavorable cardiovascular events during the implementation of various surgical tactics, taking into account the individual characteristics of the patient. A conclusion was made about the effectiveness of this development.

Clinical case of stent thrombosis four months after percutaneous coronary intervention

The article examines the reasons for restenosis of the Calypso stent with a bioresorbent coating three months after installation by 90–95% on the background of self-withdrawal of atorvastatin and ticagrelor. Recommendations for myocardial revascularization of the European Society of Cardiology and the European Association of Cardiothoracic Surgeons, dual antiplatelet therapy are presented. The problems of stent restenosis associated with various methods of percutaneous coronary intervention are discussed. The data of the Russian register RECORD‑3 on adherence to treatment with statins and antiplatelet agents after percutaneous coronary intervention are presented.

AORTIC STENOSIS, DIAGNOSIS, TREATMENT TACTICS. WHAT IS IMPORTANT FOR THE THERAPIST TO KNOW?

Aortic stenosis is the most common manifestation of valve heart disease, which requires surgical or endovascular intervention. The prevalence of degenerative aortic stenosis is increasing due to an aging population. The clinical course of aortic stenosis is characterized by a long-existing asymptomatic period. The progressive calcification of the valve cusps leads to the formation of a pressure gradient in the aorta, hemodynamic overload of the left ventricle, the development of myocardial hypertrophy, which contributes to the violation of diastolic function of the left ventricle. After the onset of symptoms of aortic stenosis, the two-year survival in patients who do not undergo surgical correction does not exceed 50 %. The Recommendations of the European Association of Cardiology and the European Association of Cardiothoracic Surgeons for the treatment of patients with valvular heart disease in 2017 discuss aspects of the diagnosis of aortic stenosis and the principles of choosing tactics for managing patients using surgical or catheter treatment methods. Depending on the severity of aortic stenosis, its clinical manifestations, age of patients, and associated pathology, surgical replacement of the aortic valve or its transcatheter implantation may be recommended. The use of drug therapy for aortic stenosis did not show the possibility of improving the prognosis. Drug therapy is used to treat heart failure, hypertension. Important tasks are the control of sinus rhythm and the prevention of thromboembolic complications.

Atrial fibrillation catheter ablation: an updated review of current guidelines and expert consensus documents.

Although atrial fibrillation (AF) is the most common cardiac arrhythmia, its management remains complex and depends on several variables. Over the past decade, catheter ablation has been widely used as an effective method for rhythm control in AF patients. Therefore, AF ablation has been the focus of many studies in recent years. Given the complexity of AF management and catheter ablation, several guidelines have been developed to regulate and direct management of AF patients. The European Society of Cardiology (ESC), together with the European Heart Rhythm Association (EHRA) and the European Association of Cardiothoracic Surgeons (EACTS), has been regulating the European guidelines, while the American Heart Association (AHA), along with the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS), is publishing the US guidelines. Additionally, HRS, EHRA, and the Society of Thoracic Surgeons, along with representatives from heart rhythm societies from different parts of the world, have developed an "expert consensus statement on catheter and surgical ablation of AF." This article reviews and compares the most recent guidelines and consensus document on AF catheter ablation.

CLEARING THE CAVITY: A CASE OF POSTPNEUMONECTOMY EMPYEMA

SESSION TITLE: Surgery cases SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/07/2018 04:45 PM - 05:45 PM INTRODUCTION: Post-pneumonectomy Empyema (PPE), is a rare but dangerous complication. Hypothesized to be the result of microbial infection via Bronchopleural fistula (BPF) vs. direct muco-cutaneous infection. Management of this pathology varies from debridement and antibiotics to thoracoplasty. Presented is a case of PPE in a patient who underwent pneumonectomy for the treatment of metastatic colorectal cancer. CASE PRESENTATION: A 53-year-old male with prior history of metastatic colorectal cancer treated with chemotherapy and managed surgically with right pneumonectomy four years prior presented to the emergency department with five days of worsening right sided chest pain, cough, fevers, and chills. On physical exam the patient was noted to have a right chest wall palpable mass with crepitation. A computed tomography angiogram of the chest was performed showing worsening accumulation of fluid in the prior known post-surgical hydropneumothorax. Additionally, new extension of air into the surrounding soft tissue was observed, a condition called pneumothorax neccesitans (Image 1). Antibiotics were started and a surgical chest tube was placed which drained foul-smelling purulent brown fluid. Polymicrobial cultures grew methicillin-resistant staphylococcus aureus, streptococcus anginosus, streptococcus mitus, bacteroides caccae, and fusobacterium species. Video assisted thorascopic surgery (VATS) was converted to thoracotomy with creation of Eloesser flap. While irrigating the hemithorax with saline copious bubbles were seen indicating a BPF. Post-operative course complicated by pseudomonal wound infection being treated with levaquin. DISCUSSION: PPE occurs in 2%-16%(1) of post-pneumonectomy patients. Although it is rare, mortality has been reported as high as 72%(2) and management can often be complicated. The majority of PPE are due to microbial infection via BPF. The presence of BPF in patients with PPE has been documented to be 80%-100%. Other theories include direct microbial invasion of the wound. Monomicrobial infections are more common than polymicrobial, with staphylococcus and streptococcus being the most frequent culprits. A 2015 expert consensus statement published by the European Association of Cardiothoracic Surgeons suggests that for simple PPE without fistulae, conservative management can be performed with pleural space irrigation, fenestration or VATS debridement alongside antibiotics. During VATS the surgeon has the opportunity to identify an underlying BPF for closure. In the case of BPF presence or complicated PPE intervention may require more invasive techniques such as thoracoplasty. (3) CONCLUSIONS: With a high mortality rate and complex management, PPE should be addressed swiftly and with cardiothoracic involvement at time of diagnosis. Drainage and antibiotics are the cornerstones to management but many cases require more expert invasive surgical intervention. Reference #1: Stern, Jean-Baptiste, Ludovic Fournel, Benjamin Wyplosz, Philippe Girard, Malik Al Nakib, Dominique Gossot, and Agathe Seguin-Givelet. "Early and delayed post-pneumonectomy empyemas: Microbiology, management and prognosis." The clinical respiratory journal (2017). Reference #2: Jadczuk, Eugeniusz. "Postpneumonectomy empyema." European journal of cardio-thoracic surgery 14, no. 2 (1998): 123-126. Reference #3: Scarci, Marco, Udo Abah, Piergiorgio Solli, Aravinda Page, David Waller, Paul Van Schil, Franca Melfi et al. "EACTS expert consensus statement for surgical management of pleural empyema." European journal of cardio-thoracic surgery 48, no. 5 (2015): 642-653. DISCLOSURES: No relevant relationships by Elizabeth Awerbuch, source=Web Response No relevant relationships by Anupam Gupta, source=Web Response no disclosure on file for Terence McGarry; No relevant relationships by Michael Megally, source=Web Response

2016 Annual report from the Italian VATS Group.

This report highlights the results of the Italian video-assisted thoracoscopic surgery (VATS) Group, launched in mid 2013, which now has a website and an established database with over 4000VATS lobectomy cases recruited from 67 thoracic surgery units across Italy. The year 2016 has been crucial for the following steps: inclusion of a dedicated biostatistician and a 'Survey Analysis & Data Quality Check'; the First Consensus Meeting with statements consequently adopted as Recommendations for the Italian Thoracic Surgery Society and published in a peer-reviewed journal; two papers published under the logo Italian VATS Group and seven abstracts accepted at annual international meetings (European Society of Thoracic Surgeons, European Association of Cardio-Thoracic Surgeons, European Lung Cancer Conference and European Respiratory Society); the institution of a Master Course on VATS lobectomy; the partnership with AME Publishing Company.

Prof. Frank C. Detterbeck: sharing and critical thinking

Founded in July, 2016, the Asia Society of Thoracic Surgeons (ASTS) recently gathered numerous experts from different international thoracic associations, like American Association of Thoracic Surgeons (AATS), Society of Thoracic Surgeons (STS), European Association of Cardiothoracic Surgeons (EACTS), International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS), Canadian Association of Thoracic Surgeons (CATS), etc., together to have an active and aspiring discussion and sharing about the better development of ASTS. During this time, the Editorial Office of AME Medical Journal ( AMJ ) seized the opportunity to have an interview with Prof. Frank C. Detterbeck, representative of the AATS ( Figure 1 ).

Prof. Hiran Fernando: interaction between peers is important

Founded in July, 2016, the Asia Society of Thoracic Surgeons (ASTS) recently gathered numerous experts from different international thoracic associations, like American Association of Thoracic Surgeons (AATS), Society of Thoracic Surgeons (STS), European Association of Cardiothoracic Surgeons (EACTS), International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS), Canadian Association of Thoracic Surgeons (CATS), etc., together to have an active and aspiring discussion and sharing about the better development of ASTS.

Prof. Colin Schieman: link to the novel technology and technique is important

Founded in July, 2016, the Asia Society of Thoracic Surgeons (ASTS) recently gathered numerous experts from different international thoracic associations, like American Association of Thoracic Surgeons (AATS), Society of Thoracic Surgeons (STS), European Association of Cardiothoracic Surgeons (EACTS), International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS), Canadian Association of Thoracic Surgeons (CATS), etc., together to have an active and aspiring discussion and sharing about the better development of ASTS. During this time, the Editorial Office of AME Medical Journal ( AMJ ) seized the opportunity to have an interview with Prof. Colin Schieman, representative of the CATS ( Figure 1 ).

Prof. Blair Marshall: creating value for everyone should be one of main goals for the thoracic association

Founded in July, 2016, the Asia Society of Thoracic Surgeons (ASTS) recently gathered numerous experts from different international thoracic associations, like American Association of Thoracic Surgeons (AATS), Society of Thoracic Surgeons (STS), European Association of Cardiothoracic Surgeons (EACTS), International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS), Canadian Association of Thoracic Surgeons (CATS), etc, together to have an active and aspiring discussion and sharing about the better development of ASTS. During this time, the Editorial Office of AME Medical Journal (AMJ) seized the opportunity to have an interview with Prof. Blair Marshall, member of many international thoracic associations (Figure 1).

Atrial fibrillation guidelines across the Atlantic: a comparison of the current recommendations of the European Society of Cardiology/European Heart Rhythm Association/European Association of Cardiothoracic Surgeons, the American College of Cardiology Foundation/American Heart Association/Heart Rhythm Society, and the Canadian Cardiovascular Society

Atrial fibrillation (AF), the most common sustained arrhythmia, has been a major focus for heart rhythm-related research in recent years. The evidence supporting recommendations for the management of AF has markedly increased since the publication of the 2006 ACC/AHA/ESC guidelines on AF (Supplementary material online). Therefore, the European Society of Cardiology (ESC), together with the European Heart Rhythm Association (EHRA) and the European Association of Cardiothoracic Surgeons (EACTS), mindful of a distinct regulatory, medico-legal and medical practice environment in Europe, published comprehensive new guidelines for the management of patients with AF in 2010,1,2 and a focused update of these guidelines in 2012.3 The Canadian Cardiovascular Society (CCS), based on similar considerations, published a full set of AF guidelines in 2011,4–6 which was updated in 2012.7 In parallel, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) issued two focused updates (Supplementary material online, references 7, 8) that were subsequently integrated into the previous 2006 ACC/AHA/ESC guidelines.8 While ACCF, AHA, and HRS have started to develop a completely new set of guidelines for AF, the present situation provides a unique opportunity to gather insight into the process that leads from new, published evidence to new recommendations. We, therefore, systematically compared the recommendations in the three sets of guidelines and tried to characterize the causes that resulted in differing recommendations. We systematically compared all recommendations published in the current versions of the guidelines of ESC, CCS, and ACCF/AHA/HRS, and classified all recommendations as identical/overlapping or differing. The ACCF/AHA/HRS and the ESC guidelines both use the same system to grade strength of recommendation and level of evidence, while the CCS guidelines use an adapted the Grading of Recommendations Assessment, Development and Evaluation (GRADE, www.gradeworkinggroup.org …

The Year in Cardiology 2012: valvular heart disease

Growth of the ageing population, advances in imaging techniques, newly available percutaneous interventions, and emphasis on the central role of the Heart Team in risk assessment and treatment selection1 combine to place valvular heart disease (VHD) at the centre of developments in cardiovascular medicine and surgery. However, VHD is poorly researched in comparison with other areas of cardiac disease, both at a basic scientific and clinical level. Until recently, there have been virtually no randomized controlled trials and international guidelines are largely based on expert consensus. Principal limitations to quality research are the diverse nature of patients with VHD, inability to identify individuals at the earliest stages of disease, and a lack of financial support and an appropriate investigational infrastructure. Guidelines attempt to address this evidence gap and a key publication this year was the joint European Society of Cardiology (ESC) and European Association of Cardiothoracic Surgeons (EACTS) Guidelines on the Management of VHD.2 This concise and practical document provides recommendations on patient evaluation and risk stratification for both surgical and interventional procedures, coupled with emphasis on multimodality imaging and recommendations from the European Association of Echocardiography on the quantification of valve lesions. Evidence-based implementation of surgical mitral valve repair and transcatheter aortic valve implantation (TAVI) feature strongly together with emphasis on the function of the multidisciplinary Heart Team in achieving optimal outcomes for this challenging group of patients. The pathophysiology of VHD is under-investigated and predictors of disease progression in individual patients poorly understood. Good quality studies examining medical treatment options in early disease are scarce and have been negative to date. Management of asymptomatic patients is therefore challenging and the subject of continuing controversy. Novel imaging strategies examining the relative contributions of valvular calcification and inflammation suggest new therapeutic targets and a means of assessing their …

Practice Considerations of Early Aspirin Administration following Coronary Artery Bypass Surgery

Thrombotic occlusion of saphenous vein grafts (SVG), the conduits most commonly used in coronary artery bypass grafting (CABG) surgery, causes significant morbidity and mortality. There is class 1A evidence that early aspirin administration following CABG reduces thrombotic SVG occlusion, as well as overall morbidity and mortality. The American Heart Association/American College of Cardiology and the European Association of Cardiothoracic Surgeons have issued guidelines recommending that 150 to 325 mg aspirin be administered within 6 hours following CABG. We carried out a clinical audit of our practice to identify any reasons for deviation from these standards of care and to implement any corrective measures. We prospectively collected data on 200 consecutive patients who underwent CABG to assess both the compliance in prescribing and administering aspirin and the effect on blood loss and transfusion requirements. Sixty-nine percent of patients received an aspirin loading dose 6 hours postoperatively. The reasons for nonadministration of aspirin were postoperative bleeding (10%), lack of a prescription despite aspirin being clinically indicated (13%), and a prescription for aspirin but no administration (9%). Reasons included inadequate handover between clinical teams (4%), aspirin loading ≤24 hours preoperatively (2%), and administration after the first 6 hours (3%). Our audit showed that early aspirin administration did not cause further bleeding or increase blood or blood product transfusion. We followed the recommendations in the majority of cases, but there is scope for improvement in this practice and a need to address "gray areas" not covered by the guidelines.