This page will be especially exciting and helpful to Students-in-Training and Young Surgeons. This page will provide richly illustrated articles on techniques in thoracic and cardiovascular surgery written by renowned surgeons from India, region and around the world. Each link page will present itself on cardiothoracic topics in adult cardiac, congenital, and general thoracic surgery. Each specialty of interest to the thoracic and cardiovascular surgeon will be explored through multiple approaches to a specific surgical challenge. Each article will be thoroughly illustrated with original line drawings, actual intraoperative photos, and supporting tables and graphs. Prof Nirmal Gupta and CSiI Open Learning Team
State-Of-The-Art Paper
March 14, 2013: The Heart Team of Cardiovascular Care David R. Holmes et al. J Am Coll Cardiol. 2013;61(9):903-907.
Evolving strategies of care under some cardiovascular conditions have identified the central role of the Heart Team in optimizing patient selection, procedural performance, and follow-up care and in enhancing the process of patient education and informed consent. The composition of this team may vary depending on the clinical setting and among institutions. The Heart Team approach is timely and has become mandatory in light of evolving options in therapeutics, in the resurgence of focus on patient-centered care, and for optimizing delivery of care and its reimbursement strategies. The heart team concept forms the heart of modern cardiovascular care.
March 14, 2013: The Heart Team of Cardiovascular Care David R. Holmes et al. J Am Coll Cardiol. 2013;61(9):903-907.
Evolving strategies of care under some cardiovascular conditions have identified the central role of the Heart Team in optimizing patient selection, procedural performance, and follow-up care and in enhancing the process of patient education and informed consent. The composition of this team may vary depending on the clinical setting and among institutions. The Heart Team approach is timely and has become mandatory in light of evolving options in therapeutics, in the resurgence of focus on patient-centered care, and for optimizing delivery of care and its reimbursement strategies. The heart team concept forms the heart of modern cardiovascular care.
Original article in NEJM
March 13, 2013: Effects of Off-pump and On-pump CABG at 1 year. CORONARY Investigators NEJM, Published on March 11, 2013.
Previously, the same investigators have reported that there was no significant difference at 30 days in the rate of a primary composite outcome of death, myocardial infarction, stroke, or new renal failure requiring dialysis between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). Now results on quality of life and cognitive function and on clinical outcomes at 1 year are being reported. At 1 year after CABG, there was no significant difference between off-pump and on-pump CABG with respect to the primary composite outcome, the rate of repeat coronary revascularization, quality of life, or neurocognitive function. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294.)
March 13, 2013: Effects of Off-pump and On-pump CABG at 1 year. CORONARY Investigators NEJM, Published on March 11, 2013.
Previously, the same investigators have reported that there was no significant difference at 30 days in the rate of a primary composite outcome of death, myocardial infarction, stroke, or new renal failure requiring dialysis between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). Now results on quality of life and cognitive function and on clinical outcomes at 1 year are being reported. At 1 year after CABG, there was no significant difference between off-pump and on-pump CABG with respect to the primary composite outcome, the rate of repeat coronary revascularization, quality of life, or neurocognitive function. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294.)
Pathbreaking Preliminary Communication
March 10, 2013: Prevalence of Regional Myocardial Thinning and Relationship With Myocardial Scarring in Patients With Coronary Artery Disease Published online JAMA 2013, March 6.Vol 309, No. 909-918. doi:10.1001/jama.2013.1381.
Regional left ventricular (LV) wall thinning is believed to represent chronic transmural myocardial infarction and scar tissue. However, recent case reports using delayed-enhancement cardiovascular magnetic resonance (CMR) imaging raise the possibility that thinning may occur with little or no scarring.
March 10, 2013: Prevalence of Regional Myocardial Thinning and Relationship With Myocardial Scarring in Patients With Coronary Artery Disease Published online JAMA 2013, March 6.Vol 309, No. 909-918. doi:10.1001/jama.2013.1381.
Regional left ventricular (LV) wall thinning is believed to represent chronic transmural myocardial infarction and scar tissue. However, recent case reports using delayed-enhancement cardiovascular magnetic resonance (CMR) imaging raise the possibility that thinning may occur with little or no scarring.
Important Meta-Analysis
March 8, 2013: Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis.
Published online BMJ 2013 January 16. doi: 10.1136/bmj.f55 & PMCID: PMC3546627
The benefits of β blockers in patients with heart failure with reduced ejection fraction seem to be mainly due to a class effect, as no statistical evidence from current trials supports the superiority of any single agent over the others. (Full Free Access Article)
March 8, 2013: Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis.
Published online BMJ 2013 January 16. doi: 10.1136/bmj.f55 & PMCID: PMC3546627
The benefits of β blockers in patients with heart failure with reduced ejection fraction seem to be mainly due to a class effect, as no statistical evidence from current trials supports the superiority of any single agent over the others. (Full Free Access Article)
March 7, 2013: The rationale for "Heart Team"decision-making for patients with stable complex coronary artery disease.
Corresponding author. Tel: +31 107034375, Email: a.kappetein@erasmusmc.nl
Abstract: Stable complex coronary artery disease can be treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy. Multidisciplinary decision-making has gained more emphasis over the recent years to select the most optimal treatment strategy for individual patients with stable complex coronary artery disease. However, the so-called ‘Heart Team’ concept has not been widely implemented. Yet, decision-making has shown to remain suboptimal; there is large variability in PCI-to-CABG ratios, which may predominantly be the consequence of physician-related factors that have raised concerns regarding overuse, underuse, and inappropriate selection of revascularization. In this review, we summarize these and additional data to support the statement that a multidisciplinary Heart Team consisting of at least a clinical/non-invasive cardiologist, interventional cardiologist, and cardiac surgeon, can together better analyse and interpret the available diagnostic evidence, put into context the clinical condition of the patient as well as consider individual preference and local expertise, and through shared decision-making with the patient can arrive at a most optimal joint treatment strategy recommendation for patients with stable complex coronary artery disease. In addition, other aspects of Heart Team decision-making are discussed: the organization and logistics, involvement of physicians, patients, and assisting personnel, the need for validation, and its limitations. (May require institutional or personal subscription to European Heart Journal)
Corresponding author. Tel: +31 107034375, Email: a.kappetein@erasmusmc.nl
Abstract: Stable complex coronary artery disease can be treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy. Multidisciplinary decision-making has gained more emphasis over the recent years to select the most optimal treatment strategy for individual patients with stable complex coronary artery disease. However, the so-called ‘Heart Team’ concept has not been widely implemented. Yet, decision-making has shown to remain suboptimal; there is large variability in PCI-to-CABG ratios, which may predominantly be the consequence of physician-related factors that have raised concerns regarding overuse, underuse, and inappropriate selection of revascularization. In this review, we summarize these and additional data to support the statement that a multidisciplinary Heart Team consisting of at least a clinical/non-invasive cardiologist, interventional cardiologist, and cardiac surgeon, can together better analyse and interpret the available diagnostic evidence, put into context the clinical condition of the patient as well as consider individual preference and local expertise, and through shared decision-making with the patient can arrive at a most optimal joint treatment strategy recommendation for patients with stable complex coronary artery disease. In addition, other aspects of Heart Team decision-making are discussed: the organization and logistics, involvement of physicians, patients, and assisting personnel, the need for validation, and its limitations. (May require institutional or personal subscription to European Heart Journal)
March 1, 2013: (Recent Advance in Endovascular Surgery) TEVAR
Matthew J. Kruse, MD and Ali Khoynezhad, MD Cedars-Sinai Medical Center, Division of Cardiothoracic Surgery, Los Angeles, CA USA
February 18, 2013 (Review): What are the current results of sutureless valves in high-risk aortic valve disease patients?
Amir H. Sepehripoura, Leanne Harlingb and Thanos Athanasioub Interact CardioVasc Thorac Surg (2012) 14 (5): 615-621. 2012
February 12, 2013: Stem cell treatment for acute myocardial infarction
David M Clifford, Sheila A Fisher3, Susan J Brunskill3, Carolyn Doree3, Anthony Mathur4, Suzanne Watt5, Enca Martin-Rendon1,*
Editorial Group: Cochrane Heart Group Published Online: 15 FEB 2012.
Editorial Group: Cochrane Heart Group Published Online: 15 FEB 2012.
February 9, 2013: Complications after aortic valve repair and valve-sparing procedures
By Michel Van Dyck, David Glineur, Laurent de Kerchove, Gébrine El Khoury
January 1, 2013: The Cardiovascular Hybrid OR-Clinical & Technical Considerations
By Georg Nollert, MD, Sabine Wich and Anne Figel
