European Journal of Cardio-Thoracic Surgery (EUR J CARDIO-THORAC)

Publisher: European Association for Cardio-thoracic Surgery; European Society of Thoracic Surgeons, Oxford University Press (OUP)

Journal description

The primary aim of the European Journal of Cardio-Thoracic Surgery is to provide a medium for the publication of high-quality original scientific reports documenting progress in cardiac and thoracic surgery. The journal publishes reports of significant clinical and experimental advances related to surgery of the heart, the great vessels and the chest. Special emphasis is placed on contribution from the European countries. The journal is supported by a number of leading European societies. The European Journal of Cardio-Thoracic Surgery welcomes original articles, editorials, case reports, how-to-do-it reports, reviews, Images in cardio-thoracic Surgery, and Letters to the Editor. Papers are submitted to a peer review by the members of Editorial and Advisory Board and by other invited reviewers. Selected papers from the annual meetings of the European Association for Cardio-Thoracic Surgery are printed in the journal.

Current impact factor: 3.30

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 3.304
2013 Impact Factor 2.814
2012 Impact Factor 2.674
2011 Impact Factor 2.55
2010 Impact Factor 2.293
2009 Impact Factor 2.397
2008 Impact Factor 2.181
2007 Impact Factor 2.011
2006 Impact Factor 2.106
2005 Impact Factor 1.802
2004 Impact Factor 1.616
2003 Impact Factor 1.465
2002 Impact Factor 1.451
2001 Impact Factor 1.676
2000 Impact Factor 1.187
1999 Impact Factor 1.134
1998 Impact Factor 0.759
1997 Impact Factor 0.857
1996 Impact Factor 0.952
1995 Impact Factor 0.59
1994 Impact Factor 0.634
1993 Impact Factor 0.612
1992 Impact Factor 0.527

Impact factor over time

Impact factor

Additional details

5-year impact 2.85
Cited half-life 6.60
Immediacy index 1.08
Eigenfactor 0.03
Article influence 1.09
Website European Journal of Cardio-Thoracic Surgery website
Other titles European journal of cardio-thoracic surgery (Online), EJCTS
ISSN 1010-7940
OCLC 38908313
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Oxford University Press (OUP)

  • Pre-print
    • Archiving status unclear
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 3 years embargo
  • Conditions
    • Pre-print can only be posted prior to acceptance
    • Pre-print must be accompanied by set statement (see link)
    • Pre-print must not be replaced with post-print, instead a link to published version with amended set statement should be made
    • Pre-print on author's personal website, employer website, free public server or pre-prints in subject area
    • Post-print on Institutional repositories or Central repositories
    • Published source must be acknowledged with citation
    • Must link to publisher version
    • Set phrase to accompany archived copy (see policy)
    • Publisher's version/PDF cannot be used
    • Publisher last contacted on 19/02/2015
    • This policy is an exception to the default policies of 'Oxford University Press (OUP)'
  • Classification
    ​ white

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To assess the feasibility, safety and postoperative wound pain of single-incision thoracoscopic surgery (SITS) for Stage I lung cancer in patients who had previously undergone surgery compared with conventional video-assisted thoracoscopic surgery (c-VATS). Methods: Lobectomy by SITS (60) and c-VATS (20) was performed for Stage I lung cancer between 2011 and 2014. In SITS, an ∼5-cm small incision was placed at the fourth or fifth intercostal space from the anterior to posterior axillary line. C-VATS was performed via three or four ports using trocars only. The evaluation items were general operative outcomes, pain stress using the Numeric Rating scale (NRS) on postoperative days 3, 7 and 30, and some pathological symptoms related to the neuropathic wound pain through the operative course. The number of days of use of analgesic agents was also evaluated for 1 month after surgery. Results: SITS showed similar perioperative outcomes (postoperative hospital stay, blood loss, surgical time, drainage duration, creatine phosphokinase (CPKmax), creactive protein (CRPmax) and frequency of postoperative complications) to those of c-VATS. Additionally, the average NRS in SITS decreased on postoperative days 7 and 30 (Day 7: 2.4 ± 0.4 vs 4.2 ± 0.3, P = 0.041, Day 30: 1.7 ± 0.4 vs 3.3 ± 0.3, P = 0.038) and the number of days analgesic agents were administered was also reduced (SITS: 8.1 ± 0.9 vs c-VATS 13.1 ± 1.2 days, P = 0.045). The frequency of allodynia, hyperalgesia, hypaesthesia and numbness was significantly reduced in the SITS group. Conclusions: Although conclusive evidence has not yet been obtained, SITS is more minimally invasive in regard to postoperative wound pain compared with c-VATS. This procedure should be considered as a treatment option for early-stage lung cancer.
    European Journal of Cardio-Thoracic Surgery 09/2015; DOI:10.1093/ejcts/ezv320
  • European Journal of Cardio-Thoracic Surgery 09/2015; DOI:10.1093/ejcts/ezv319
  • European Journal of Cardio-Thoracic Surgery 09/2015; DOI:10.1093/ejcts/ezv329
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    ABSTRACT: Objectives: Open stent grafting for extended aortic repair has been widely carried out around their world. We reported the effectiveness of a new device as an open stent graft for extended aortic repair. Methods: A new device was used as an open stent graft in this study. The graft part of the device has a woven structure made of Nitinol wire, a superelastic/shape-memory alloy. The subjects of this study were patients aged 20-84 with aneurysms (n = 38) or aortic dissection (n = 22) in the thoracic aorta, including the distal aortic arch and the proximal descending aorta. This study was a multicentre, non-blinded study. The follow-up period was 36 months. Results: Three subjects (5.0%) died during hospitalization due to multiorgan failure. Spinal cord injury (SCI) was observed in 4 subjects (6.7%): paraplegia in 1 and paraparesis in 3 subjects. The 3-year survival rate was 76.7% overall: 68.4% for the subjects diagnosed as having aortic aneurysms (the aortic aneurysm group) and 90.9% for those having aortic dissection (the aortic dissection group). For the aortic aneurysm group, thrombus formation in the aortic aneurysm was observed in 97% of the patients 6 months after operation, and in 100% 12 months after operation. Meanwhile, for the aortic dissection group, with regard to the false lumen of aortic dissection, thrombus formation was observed in 94% of the patients 6 months after operation, in 94% 12 months after operation and in 100% 24 months after operation. Expansion of the aortic aneurysm sac was observed in 2 subjects (6.1%). Among these 2 subjects, endoleak was observed in 1 subject, which was improved by additional thoracic endovascular aortic repair. Conclusions: The safety and effectiveness of this investigational device was verified over a period up to 36 months after operation. A long-term follow-up would be necessary to further verify the effectiveness of the device in the future.
    European Journal of Cardio-Thoracic Surgery 09/2015; DOI:10.1093/ejcts/ezv310
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    ABSTRACT: Objective: To develop a clinically risk-adjusted financial model to estimate the cost associated with a video-assisted thoracoscopic surgery (VATS) lobectomy programme. Methods: Prospectively collected data of 236 VATS lobectomy patients (August 2012-December 2013) were analysed retrospectively. Fixed and variable intraoperative and postoperative costs were retrieved from the Hospital Accounting Department. Baseline and surgical variables were tested for a possible association with total cost using a multivariable linear regression and bootstrap analyses. Costs were calculated in GBP and expressed in Euros (EUR:GBP exchange rate 1.4). Results: The average total cost of a VATS lobectomy was €11 368 (range €6992-€62 535). Average intraoperative (including surgical and anaesthetic time, overhead, disposable materials) and postoperative costs [including ward stay, high dependency unit (HDU) or intensive care unit (ICU) and variable costs associated with management of complications] were €8226 (range €5656-€13 296) and €3029 (range €529-€51 970), respectively. The following variables remained reliably associated with total costs after linear regression analysis and bootstrap: carbon monoxide lung diffusion capacity (DLCO) <60% predicted value (P= 0.02, bootstrap 63%) and chronic obstructive pulmonary disease (COPD; P = 0.035, bootstrap 57%). The following model was developed to estimate the total costs: 10 523 + 1894 × COPD + 2376 × DLCO < 60%. The comparison between predicted and observed costs was repeated in 1000 bootstrapped samples to verify the stability of the model. The two values were not different (P > 0.05) in 86% of the samples. A hypothetical patient with COPD and DLCO less than 60% would cost €4270 more than a patient without COPD and with higher DLCO values (€14 793 vs €10 523). Conclusions: Risk-adjusting financial data can help estimate the total cost associated with VATS lobectomy based on clinical factors. This model can be used to audit the internal financial performance of a VATS lobectomy programme for budgeting, planning and for appropriate bundled payment reimbursements.
    European Journal of Cardio-Thoracic Surgery 08/2015; DOI:10.1093/icvts/ivv204.148
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    ABSTRACT: Objectives: To compare the recurrence rate of primary spontaneous pneumothorax (PSP) after uniportal video assisted thoracic surgery (VATS) bullectomy and mechanical pleurodesis in patients managed with a regulating pressure drainage system compared and those managed with a traditional one. Methods: Retrospective propensity score case-matched analysis of 174 consecutive patients submitted to uniportal VATS bullectomy and mechanical pleural abrasion (2007-13) in two centres. Definition of recurrence: Recurrent PSP requiring new treatment (i.e. aspiration, chest tube reinsertion, reoperation) within 12 months from the operation. All patients were managed with a single 24-Fr chest tube. Group 1 (106 patients): Tube connected to a traditional device (T) maintained on wall suction (-20 cmH2O) for 48 h. Group 2 (68 patients): Tube connected to a regulating pressure device (R) set at -20 cmH2O for 48 h. Chest tube removal criteria: No air leak (no bubbling or air flow <20 ml/min for at least 8 h) and pleural effusion <200 ml/day. Propensity score case-matching analysis was performed using the following variables: Age, gender, height, weight, side of operation, dystrophic score, length of stapled parenchyma. Results: The two groups of 68 pairs were well matched for baseline and surgical characteristics. Patients of Group 2 (R) showed a significantly lower incidence of recurrence rate compared with matched counterparts (T) (3, 4.4 vs 10, 14%, P = 0.041). There were no differences in persistent air leak incidence, chest tube duration or hospital stay between the groups. Group 2 had a higher 48-h output of pleural effusion compared with Group 1 (P < 0.0001). Conclusions: By stabilizing the pleural pressure at the preset values, novel regulating pressure devices may enhance pleurodesis, leading to a reduced incidence of PSP recurrences after uniportal VATS bullectomy and pleural abrasion.
    European Journal of Cardio-Thoracic Surgery 08/2015; DOI:10.1093/icvts/ivv204.137
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    ABSTRACT: Objectives: Breath composition may be suggestive of different conditions. E-nose technology has been used to profile volatile organic compounds (VOCs) pattern in the breath of patients compared with that of healthy individuals. BIOsensor-based multisensorial system for mimicking NOse, Tongue and Eyes (BIONOTE) technology differs from Cyranose® based on a set of separate transduction features. On the basis of our previously published experience, we investigated the discriminating ability of BIONOTE in a high-risk population enrolled in a lung cancer screening programme. Methods: One hundred individuals were selected for BIONOTE based on the attribution to the high-risk category (i.e. age, smoking status, chronic obstructive pulmonary disease status) of the University Campus Bio-Medico lung screening programme. We used a measure chain consisting of (i) a device named Pneumopipe (EU patent: EP2641537 (A1):2013-09-25) able to catch exhaled breath by an individual normally breathing into it and collect the exhalate onto an adsorbing cartridge; (ii) an apparatus for thermal desorption of the cartridge into the sensors chamber and (iii) a gas sensor array which is part of a sensorial platform named BIONOTE for the VOCs mixture analysis. Partial least square (PLS) has been used to build up the model, with Leave-One-Out cross-validation criterion. Each breath fingerprint analysis costs €10. Results: The overall sensitivity and specificity were 86 and 95%, respectively, delineating a substantial difference between patients and healthy individuals. Conclusions: Our preliminary data show that BIONOTE technology may be used to reduce false-positive rates resulting from lung cancer screening with low-dose computed tomography in a cost-effective fashion. The model will be tested on a larger number of patients to confirm the reliability of these results.
    European Journal of Cardio-Thoracic Surgery 08/2015; DOI:10.1093/icvts/ivv204.41
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    ABSTRACT: Objectives: Psychological distress associated with cancer treatment is an emerging issue in the management of cancer patients. The aim of this study was to identify the prevalence of postoperative anxiety and depression after surgical treatment for lung cancer, and to assess the risk factors associated with these phenomena. Methods: Patients who underwent curative surgical resection for primary lung cancer were included in this study. Patients with complex treatment histories (recurrent or metastatic lung cancer or neoadjuvant treatment) and those taking psychiatric medication were excluded. We prospectively evaluated the degrees of pre- and postoperative anxiety and depression using a Hospital Anxiety Depression Scale questionnaire. The relationships between clinical and patient factors and anxiety and depression after surgical treatment for lung cancer were assessed. Results: A total of 278 patients were enrolled. The mean age was 62 years. Thoracoscopic resection was performed in 246 patients (89%). The prevalence rates of preoperative anxiety and depression were 8% (n = 22) and 12% (n = 32), and changed to 9% (n = 26) and 19% (n = 54) postoperatively (P = 0.37 and <0.001, respectively). Gender, age, marital status, advanced clinical stage, alcohol abuse, smoking status, length of hospital stay, pulmonary function and preoperative comorbidities were not associated with postoperative anxiety and depression. Multivariate analysis revealed that thoracotomy was a risk factor for postoperative anxiety after adjusting for preoperative anxiety (odds ratio [OR] = 4.5, P = 0.002). Thoracotomy (OR = 3.4, P = 0.009), postoperative dyspnoea (OR = 4.8, P < 0.001), severe pain (OR = 3.9, P = 0.001) and diabetes mellitus (OR = 3.0, P = 0.012) were identified as risk factors for postoperative depression after adjusting for preoperative depression. Twenty-four patients were referred to mental health professionals and provided with supportive psychotherapy or pharmacological intervention. Of these, 14 patients (56%) were diagnosed with an adjustment disorder. Conclusions: Postoperative psychological distress and, in particular, depression increased after surgical treatment for lung cancer. Postoperative anxiety and depression were aggravated by residual symptoms after surgery. Careful psychological evaluation and appropriate management are required to improve patients' quality of life after lung cancer surgery.
    European Journal of Cardio-Thoracic Surgery 08/2015; DOI:10.1093/icvts/ivv204.79
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    ABSTRACT: To implement internal monitoring using a risk-adjusted model specific for video-assisted thoracoscopic surgery (VATS) lobectomy. Retrospective analysis on prospectively collected data of 348 patients submitted to VATS lobectomy (August 2012-August 2014). Baseline and surgical variables were tested for a possible association with postoperative cardiopulmonary complications. Logistic regression and bootstrap resampling analyses were used to develop the risk-adjusted model to obtain the predicted morbidity of 50 consecutive patients (September 2014-November 2014). A risk-adjusted control chart was constructed to track down practice variation during this period. Patients were ordered by date of operation and assigned a score represented by the individual predicted morbidity: the plotted line goes up in case of absence of complications and goes down by the predicted morbidity minus 1 in case of complications. Over time, if outcomes are as expected based on the risk-adjusted model, the plotted line will tend to be close to zero. Cardiopulmonary complications and in-hospital/30-day mortality rates were 14% (47 cases) and 1.8% (6 cases), respectively. Age (P = 0.006, coefficient 0.55, bootstrap frequency 76%) and predicted postoperative forced expiratory volume in 1 s (ppoFEV1) (P < 0.001, coefficient -0.38, bootstrap frequency 98%) remained independently associated with cardiopulmonary morbidity after logistic regression and bootstrap analyses. The following risk logit model for cardiopulmonary morbidity after VATS lobectomy was generated: -3.17 -0.038XppoFEV1 +0.55Xage. The risk-adjusted control chart showed a downward trend indicating a worse than expected performance in the audited period. The present analysis offers a methodological template for VATS lobectomy that helps to evaluate the surgical programme. It aims to give a real-time monitoring with the possibility to confront the performance of the centre with the population-specific expectancies. Moreover, being reactive with time, this method allows early detection of underperformance and implementation of critical change in clinical practice. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    European Journal of Cardio-Thoracic Surgery 08/2015; DOI:10.1093/icvts/ivv204.39
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    ABSTRACT: Objectives: The objective of this analysis was to evaluate the incidence and risk factors of recurrent air leak (RAL) occurring soon after pulmonary lobectomy based on electronic airflow measurements. Methods: A prospective observational analysis of 129 consecutive patients managed with a single chest tube connected with an electronic chest drainage system. The incidence and timing of RAL among patients who had an air leak sealed within the first 24 postoperative hours was recorded. Stepwise logistic regression and bootstrap analyses were used to test the association of several baseline and surgical variables with RAL. Results: A total of 95 patients (68%) had their air leak stopped within 24 h after the operation. Twelve patients had RAL (13%) after the first stop. All RALs occurred within the first 24 h from operation. Logistic regression showed that the presence of moderate-to-severe chronic obstructive pulmonary disease [COPD; forced expiratory volume in 1 s (FEV1) <80% and FEV1/forced vital capacity ratio <0.7] was an independent risk factor associated with RAL (P = 0.02, bootstrap frequency 83%). Seven of 27 (26%) patients with COPD had RAL, a proportion significantly higher than in patients without COPD (5 of 68, 7.3%, P = 0.03). Conclusions: A large proportion of patients with COPD developed RAL. In this high-risk group, we advise against chest tube removal in the first 24 h after operation, even in the case of absence or cessation of air leak.
    European Journal of Cardio-Thoracic Surgery 08/2015; DOI:10.1093/icvts/ivv204.20
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    ABSTRACT: Acute type A aortic dissection (TAAD) is a life-threatening emergency and requires immediate surgical intervention. We propose a novel finite element multi-dimensional modelling (FE-MDM) technique to identify aortic tears preoperatively to aid surgical preplanning. Thirty-two patients with TAAD were included in this retrospective study. Computed tomography (CT) scans were imported using the segmentation software and reconstruction resulted in modelling of single TAAD components: aortic wall, false lumen, true lumen, gap in the flap and blood in both lumens. CT scans were processed by interpreters who were blinded to the clinical data and then were compared with operative findings. The models were assessed and compared regarding localization and size of the entry tear with the intraoperative findings. Image set data were retrieved from CT scans. Surgical inspection confirmed the localization of the tear obtained by the model in all patients with a 100% chance prediction (P < 0.0001) in all patients. With the simulation of the guided-cannulation, it was possible to place the cannula in the ascending aorta in 100% of patients (P < 0.0001 vs surgery). Using the virtual volume model, the chance of inserting into the false lumen was 0% (P < 0.0001). There was a strong correlation between the virtual volume model and cannulation in the true lumen (r = 0.88, P < 0.0001). The FE-MDM technique of aortic dissection is helpful in identifying the site of the tear and may be considered as an additional tool in surgical preplanning. It may also enhance the efficiency of deep hypothermic circulatory arrest in patients with single entry sites in the ascending aorta and it may facilitate direct cannulation of the ascending aorta. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    European Journal of Cardio-Thoracic Surgery 07/2015; DOI:10.1093/ejcts/ezv299
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    ABSTRACT: OBJECTIVES Optimal cerebral and visceral protection is crucial in aortic arch surgery. The main method for this protection has traditionally been deep hypothermic circulatory arrest (DHCA). Recently, antegrade cerebral perfusion with moderate hypothermia has become the preferred strategy for adult patients and some children undergoing aortic arch surgery. Continuous cerebral perfusion should reduce the incidence of neurological complications, but the degree of damage to organs and systems resulting from the lack of blood flow distal to the aortic arch remains unclear. Here, we aimed to evaluate the efficacy and safety of methods of protecting the brain and internal organs during aortic arch surgery in infants.
    European Journal of Cardio-Thoracic Surgery 07/2015; DOI:10.1093/ejcts/ezv235
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    ABSTRACT: Objectives: Aortic valve insufficiency (AI) following left ventricular assist device (LVAD) implantation can potentially limit the success of mechanical circulatory support. We examined the prevalence of significant AI in the new generation of LVADs and analysed the role of aortic valve opening in the development of AI in these patients. Methods: Currently, 102 patients that received a continuous flow LVAD (cf-LVAD) between July 2009 and December 2013 are being treated in our outpatient clinic with an HeartWare ventricular assist device (HVDA) (n = 77) or HeartMate II (HMII, n = 25) and were included and analysed in a retrospective study. The mean age of the 12 female and 90 male patients was 54 ± 12 years. Ischaemic cardiomyopathy was diagnosed in 40% of patients. Echocardiographic measurements were reviewed before and after implantation. AI was considered significant if it was more than mild. Results: Mean LVAD support duration was 572 ± 437 days. Significant AI was found in 32 patients (31.4%). De novo AI occurred in mean after 183 ± 246 days of support. One patient presented severe AI and received an aortic valve replacement. A permanently closed aortic valve correlates with a greater prevalence of AI when compared with intermittent or complete opening of aortic valve (P = 0.004). Aetiology of the cardiomyopathy and the type of device had no influence on the development of AI. Smaller left ventricle end-diastolic diameter and lower body surface area were significantly associated with the development of aortic insufficiency in our cohort. Conclusion: Aortic insufficiency has a high prevalence following assist device continuous flow support. Echocardiographic parameters are an integral part of ambulatory care of these patients and can guide the optimal setting for LVAD. An aortic valve that does not open should be avoided in order to prevent AI. Patients with HMII or HVAD did not show any differences terms of the prevalence of aortic insufficiency prevalence.
    European Journal of Cardio-Thoracic Surgery 06/2015; DOI:10.1093/ejcts/ezv204
  • European Journal of Cardio-Thoracic Surgery 04/2015; 48(3). DOI:10.1093/ejcts/ezv109