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Jahangiri M.,St Georges Hospital | Bilkhu R.,St Georges Hospital | Borger M.,Columbia University | Falk V.,German Heart Center Berlin | And 6 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2016

OBJECTIVES: The publication of surgeon-specific data has been controversial. To assess the profession's opinion, a forum was organized at the 2015 EACTS meeting followed by a questionnaire of the value of surgeon-specific outcome and its impact. METHODS: A series of presentations were made including assessments of quality and safety in one major European country, the relationship between volume and outcome, the role of guidelines, the effect of publication of results on training, and discussion for and against publication of surgeon-specific data. A questionnaire was given to all attendees at the forum on the value of surgeon-specific data and their impact on the specialty. RESULTS: The questionnaire was completed by 118 attendees. Of the total, 69% felt that mortality is a surrogate for quality and that it should be reported at the hospital and unit level as opposed to the individual surgeon level, but 81% wished there were different criteria for quality outcome. Of the total, 91% felt that the individual surgeons' data should be collected but not published in public portals, and that publication produces risk-averse behaviour; 65% felt that it hinders innovation; 86% felt that EuroSCORE II is not reliable in identifying high-risk patients and the same number felt that it has affected entry into the specialty. CONCLUSIONS: The information that is collectable will be published, but we can control the way in which it is published and presented. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


PubMed | Hospital Cruz Vermelha, German Heart Center Berlin, Hempsons, Hospital Clinic Of Barcelona and 4 more.
Type: Journal Article | Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery | Year: 2016

The publication of surgeon-specific data has been controversial. To assess the professions opinion, a forum was organized at the 2015 EACTS meeting followed by a questionnaire of the value of surgeon-specific outcome and its impact.A series of presentations were made including assessments of quality and safety in one major European country, the relationship between volume and outcome, the role of guidelines, the effect of publication of results on training, and discussion for and against publication of surgeon-specific data. A questionnaire was given to all attendees at the forum on the value of surgeon-specific data and their impact on the specialty.The questionnaire was completed by 118 attendees. Of the total, 69% felt that mortality is a surrogate for quality and that it should be reported at the hospital and unit level as opposed to the individual surgeon level, but 81% wished there were different criteria for quality outcome. Of the total, 91% felt that the individual surgeons data should be collected but not published in public portals, and that publication produces risk-averse behaviour; 65% felt that it hinders innovation; 86% felt that EuroSCORE II is not reliable in identifying high-risk patients and the same number felt that it has affected entry into the specialty.The information that is collectable will be published, but we can control the way in which it is published and presented.


PubMed | Stanford University, Craigavon Cardiac Center, Freeman Hospital and Institute of Cellular Medicine, Örebro University and 20 more.
Type: Journal Article | Journal: Lancet (London, England) | Year: 2016

Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main coronary artery disease.In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1:1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial infarction. Exclusion criteria were ST-elevation myocardial infarction within 24 h, being considered too high risk for CABG or PCI, or expected survival of less than 1 year. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, any repeat coronary revascularisation, and stroke. Non-inferiority of PCI to CABG required the lower end of the 95% CI not to exceed a hazard ratio (HR) of 135 after up to 5 years of follow-up. The intention-to-treat principle was used in the analysis if not specified otherwise. This trial is registered with ClinicalTrials.gov identifier, number NCT01496651.Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat. Kaplan-Meier 5 year estimates of MACCE were 29% for PCI (121 events) and 19% for CABG (81 events), HR 148 (95% CI 111-196), exceeding the limit for non-inferiority, and CABG was significantly better than PCI (p=00066). As-treated estimates were 28% versus 19% (155, 118-204, p=00015). Comparing PCI with CABG, 5 year estimates were 12% versus 9% (107, 067-172, p=077) for all-cause mortality, 7% versus 2% (288, 140-590, p=00040) for non-procedural myocardial infarction, 16% versus 10% (150, 104-217, p=0032) for any revascularisation, and 5% versus 2% (225, 093-548, p=0073) for stroke.The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease.Biosensors, Aarhus University Hospital, and participating sites.


Cuculi F.,Oxford Heart Center | Banning A.P.,Oxford Heart Center | Abizaid A.,Instituto Dante Pazzanese Of Cardiologia | Bartorelli A.L.,University of Milan | And 12 more authors.
EuroIntervention | Year: 2011

Aims: Performing percutaneous coronary intervention (PCI) to multiple coronary lesions during the same procedure has potential economic and social advantages. However comprehensive outcome data of real world practice in a large population is limited. We aimed to compare short- and long-term outcomes between patients with multi-vessel coronary artery disease who either underwent single- or multivessel PCI within the e-SELECT registry. Methods and results: The e-SELECT registry combines data collected at 320 medical centres in 56 countries where patients received CYPHER Select® or CYPHER Select® Plus sirolimus-eluting stent (SES). Rates of myocardial infarction and major adverse cardiac event (MACE) (defined as any death, myocardial infarction or target lesion revascularisation) were compared between patients undergoing single-vessel versus multivessel PCI. A total of 15,147 patients who satisfied the inclusion criteria were included in the e-SELECT registry. Two thousand two hundred and seventy-eight (2,278) subjects (15%) underwent multivessel PCI and 12,869 (85%) had single-vessel PCI. The mean age was higher in the multivessel PCI group (63 vs. 62 years, p<0.001) and there was a higher prevalence of diabetes mellitus (32.4 vs. 30.0%, p=0.02). Lesions were more complex in the single-PCI group while pre- and post-dilatation were less common in the multivessel PCI group. Myocardial infarction within the first 30 days post PCI was more common in the multivessel PCI group (1.9 vs. 0.8%, p<0.001) and most of the infarctions were periprocedural (1.3 vs. 0.6%, p=0.001). Mortality and myocardial infarction at one-year were higher in the multivessel PCI group resulting in a significantly higher MACE (6.1 vs. 4.6%, p=0.005). Conclusions: Overall procedural and one year outcomes were excellent for both single- and multivessel procedures. However despite lower lesion complexity, performing multivessel PCI was associated with higher rates of periprocedural myocardial infarction and MACE when compared to single-vessel PCI in the e-SELECT registry. © Europa Edition 2011. All rights reserved.


Zeinah M.,Ain Shams University | Zeinah M.,Oxford Heart Center | Elghanam M.,Ain Shams University | Benedetto U.,Oxford Heart Center
Egyptian Heart Journal | Year: 2016

Background: Post-operative atrial fibrillation (POAF) is amongst the most common complications following cardiac surgery. Current guidelines recommend oral beta-blockers as a first-line medication to prevent POAF. However, the ideal choice of beta-blocker is unclear, making a comprehensive review crucial. We aimed to provide a clinically useful summary of the results of a multiple-treatment meta-analysis of randomized controlled trials (RCT). Methods and Results: A MEDLINE/PubMed search was conducted to identify eligible RCTs. Efficacy (POAF prevention rate) and acceptability (dropout for side effect rate) outcomes were investigated. A frequentist approach to network meta-analysis using the graph-theoretical method was implemented to obtain network estimates. A total of 16 trials were included in the final analysis and 4727 subjects were investigated. Network estimates showed that betaxolol (OR 0.36; 95%CI 0.25-0.52), carvedilol (OR 0.36; 95%CI 0.23-0.58) and sotalol (OR 0.38; 95%CI 0.30-0.50) were more effective than propranolol (OR 0.51; 95%CI 0.27-0.95), metoprolol (OR 0.72; 95%CI 0.58-0.90) and atenolol (OR 0.81; 95%CI 0.42-1.56) in reducing the incidence of POAF when compared to placebo. Amongst beta-blockers investigated, carvedilol showed the best safety profile being associated with the lowest risk of patient dropped out for side effect (OR 1.14; 955CI 0.36-3.61). No evidence of heterogeneity/inconsistency was found in the whole network for both efficacy (P = 0.8) and acceptability (P = 0.4) outcomes. Conclusion: Overall, carvedilol was found to be effective in preventing POAF while maintaining a good safety profile. © 2015 The Authors.


Forfar C.,John Radcliffe Hospital | Ruparelia N.,Oxford Heart Center
Medicine (United Kingdom) | Year: 2014

Percutaneous pericardiocentesis is most commonly carried out as an emergency procedure when cardiac tamponade is suspected, but has an important role in the diagnosis of a pericardial effusion of unknown aetiology. The technical considerations of pericardiocentesis are outlined including peri-procedural patient monitoring and post-procedure care. © 2014 Published by Elsevier Ltd.


Kadlec J.,Norwich University | Hucin B.,University Hospital Motol | Tlaskal T.,University Hospital Motol | Westaby S.,Oxford Heart Center
Interactive Cardiovascular and Thoracic Surgery | Year: 2010

The authors report a case of tumoral calcinosis (TC) in a six-month-old infant, which developed within the thoracotomy scar from previous aortic coarctation repair. After initial resection of the lesion, the child returned with a large mass of TC restricting movement of the left shoulder. Repeated total resection was successful with no recurrence in 12 months' follow-up. This is the first report of TC that developed in a postoperative scar and is unusual in its recurrence and aggressive growth. Pathogenesis, diagnosis and treatment of this rare event is discussed. © 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.


Adlam D.,University of Leicester | Forfar J.C.,Oxford Heart Center
Medicine (United Kingdom) | Year: 2014

Pericardial diseases are common but rigorous large-scale or randomized studies of current clinical practice remain limited. This article outlines a current and practical approach to the clinical assessment and investigation of pericarditis, pericardial effusions and constrictive pericarditis. The management of these conditions is discussed in line with best practice. Limited clinical trial data underlines the importance of bedside and investigative skills in assessing both the function and form of this organ and the treatment options. © 2014 Elsevier Ltd.


Banning A.P.,Oxford Heart Center
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery | Year: 2013

The development of percutaneous valve replacement has broadened the procedural interface between interventional cardiologists and their cardiothoracic surgical colleagues. Our relationship is no longer restricted to the arena of coronary artery disease, and opportunities now exist to share the care of large numbers of high surgical risk patients with severe aortic stenosis. These complex professional relationships have a mutual dependence and many shared objectives that should be centred upon the optimal care of cardiac patients. However, the continuing evolution of technology demands that these relationships evolve with time. A failure to understand this need for mutual change and increased cooperation has previously led to a sense of competition and Departmental separation between cardiac intervention and surgery. These fractured relationships ultimately limit the quality of care that we deliver to our patients.


PubMed | Oxford Heart Center
Type: Journal Article | Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery | Year: 2012

The development of percutaneous valve replacement has broadened the procedural interface between interventional cardiologists and their cardiothoracic surgical colleagues. Our relationship is no longer restricted to the arena of coronary artery disease, and opportunities now exist to share the care of large numbers of high surgical risk patients with severe aortic stenosis. These complex professional relationships have a mutual dependence and many shared objectives that should be centred upon the optimal care of cardiac patients. However, the continuing evolution of technology demands that these relationships evolve with time. A failure to understand this need for mutual change and increased cooperation has previously led to a sense of competition and Departmental separation between cardiac intervention and surgery. These fractured relationships ultimately limit the quality of care that we deliver to our patients.

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