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• Reply to ji et Al.

  Authors: Hanna D Golab, Ricardo H Boks, Johanna J M Takkenberg, Ad J J C Bogers

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 41(6):1408-9.

• Corrigendum to 'Is flexible bronchoscopy necessary to confirm the position of double-lumen tubes before thoracic surgery?'[Eur J Cardiothorac Surg 2011;40:912-18].

  Authors: Mario de Bellis, Rosanna Accardo, Massimo Di Maio, Carmine La Manna, Giovanni Battista Rossi, Maria Caterina Pace, Vincenzo Romano, Gaetano Rocco

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 41(6):1411.

• Univentricular heart and Fontan staging: analysis of factors impacting on body growth.

  Authors: Katrien François, Thierry Bové, Joseph Panzer, Katya De Groote, Kristof Vandekerckhove, Hans De Wilde, Daniel De Wolf

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 41(6):e139-45.

  The optimal timing of the Fontan staging for a univentricular heart and its impact on growth remains debateable. In a Fontan cohort, the influence of staged interventions and patient factors onThe optimal timing of the Fontan staging for a univentricular heart and its impact on growth remains debateable. In a Fontan cohort, the influence of staged interventions and patient factors on somatic development was explored. We reviewed 64 total cavopulmonary connection (TCPC) patients treated since 1992. Serial anthropometric parameters recorded from birth to the latest follow-up (mean 12.5 ± 6.1 years) and at each intervention [neonatal surgery, bidirectional cavopulmonary anastomosis (BCPA), TCPC, catheter treatment] were converted to z-scores. The influence of saturation, heart failure treatment and surgery intervals on growth was determined. The mean z-scores for weight and height changed significantly at each surgery up to the TCPC (-0.3 ± 1.2 and 0 ± 1 at birth, -1.3 ± 1.9 and -0.9 ± 1.7 at neonatal surgery, -2.1 ± 1.2 and -1.6 ± 1.3 at the BCPA, -1.2 ± 1.3 and -0.7 ± 1.4 at the TCPC for weight and height, respectively; P < 0.05 for each interval), with the largest decline before the BCPA, and the most marked improvement before the TCPC. Z-scores did not change significantly after the TCPC. Younger age at the BCPA had a positive influence on the weight z-score at the TCPC (P < 0.05); somatic growth at the latest follow-up (FU) was negatively influenced by heart failure treatment (P < 0.05). Body growth is severely impaired in Fontan patients. A close interstage follow-up between the first surgery and the BCPA must be targeted at optimizing nutritional support to counter the important growth retardation occurring before the BCPA. The better catch-up growth at the TCPC when the BCPA is performed earlier in life supports the current trend to perform the BCPA at a younger age. Heart failure treatment after a Fontan completion is independently associated with decreased late somatic development.

• Pulmonary endarterectomy: outcomes in patients aged >70.

  Authors: Marius Berman, Gillian Hardman, Linda Sharples, Joanna Pepke-Zaba, Karen Sheares, Steven Tsui, John Dunning, David P Jenkins

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 41(6):e154-60.

  Advanced age is not a barrier to cardiac surgery, with reports demonstrating excellent outcomes, but the effect of age on more complex surgery has not been studied. We assessed the outcomes ofAdvanced age is not a barrier to cardiac surgery, with reports demonstrating excellent outcomes, but the effect of age on more complex surgery has not been studied. We assessed the outcomes of pulmonary endarterectomy (PEA) surgery in patients aged >70. A retrospective review of consecutive patients who underwent PEA between January 2006 and March 2011 at a national referral centre. The total cohort was dichotomized according to age on the day of surgery, either below or above 70 years. Outcomes were in-hospital mortality, overall survival and the length of ICU and hospital stays. Four hundred and eleven patients underwent PEA during the 5-year period. The mean age was 56.9 years (range, 17-84 years). The in-hospital mortality was 14 of 308 (4.6%) for patients <70 years compared with 8 of 103 (7.8%) for patients ≥70 years (P = 0.21). The overall survival at 1, 2 and 3 years was 91.4, 89.9 and 87.7% in the <70-year old group and 85.9, 84.1 and 84.1% in the >70-year old group (log-rank test, P = 0.07), respectively. The length of ICU and in-hospital stays was longer in the >70-year old group, by 1 and 2 days, respectively (P = 0.005 and 0.001). PEA surgery in patients ≥70 years is safe and carries a comparable risk of early mortality in younger patients, but there is an increase in resource use due to longer ICU and hospital stays. Advanced age should be taken into consideration when assessing suitability for PEA, but age per se should not be a contraindication to surgery.

• Reply to martinod.

  Authors: Alain Wurtz, Ilir Hysi, Christophe Zawadzki, Marie-Christine Copin

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 41(6):1410.

• Retracted: Open-heart surgery in patients with liver cirrhosis [Eur J Cardiothorac Surg 2007;31:1094-8].

  Authors: Yong An, Ying-Bin Xiao, Qian-Jin Zhong

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 41(6):1412.

• Assessment of aortopulmonary collateral flow and pulmonary vascular growth using a 3.0 T magnetic resonance imaging system in patients who underwent bidirectional Glenn shunting.

  Authors: Rong-Pin Wang, Chang-Hong Liang, Mei-Ping Huang, Hui Liu, Qi-Ping Deng, Ming-Fang Yang

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 41(6):e146-53.

  To explore the feasibility of evaluating the aortopulmonary collateral flow (APCF) and pulmonary vascular growth of patients who underwent bidirectional Glenn shunting (BGS) using phase-contrastTo explore the feasibility of evaluating the aortopulmonary collateral flow (APCF) and pulmonary vascular growth of patients who underwent bidirectional Glenn shunting (BGS) using phase-contrast magnetic resonance imaging (PC-MRI) and contrast-enhanced magnetic resonance imaging (CE-MRI). Blood flow measurements of the great vessels of the body were recorded in 22 post-BGS patients using 3.0 T PC-MRI. Right and left pulmonary blood flow (Q(P)), stroke volume (SV) of the ascending aorta (Q(S)), blood flow of descending aorta (Q(d)) and venous return of the superior and inferior venae cavae (Q(V)) per minute were calculated using the Report Card software. APCF was equal to the difference between Q(S) and Q(V). The parameters for pulmonary vascular growth were assessed using CE-MRI. The relationship between pulmonary vascular growth and APCF was evaluated using correlation analysis. A comparative analysis was conducted between the MRI results and the results of five cases who underwent cardiac catheterization and 10 cases who underwent angiography. Estimated APCF ranged from 0.23 to 1.63 l/(min/m(2)), accounting for 5-44% of Q(S). Morphologic abnormalities such as pulmonary stenosis, dilatation and thrombosis were clearly visualized through CE-MRI. Significant differences in individual pulmonary artery growth were observed. A significant negative correlation was found between APCF and the pulmonary artery index (PAI; r = -0.461, P = 0.031) when the McGoon rate was 2.04 ± 0.59 and the PAI was 253.27 ± 85.86 mm(2)/m(2). Good consistency or relativity was found between cardiac catheterization, angiography and MRI. Assessing the APCF and parameters for pulmonary vascular growth in patients who underwent BGS is feasible using 3.0 T PC-MRI integrated with CE-MRI, which may play an important role in clinical and therapeutic decision-making and prognostic evaluation.

• Is a radially self-expanding valved stent with neochordal support enough for better fixation in the mitral position?

  Authors: Murat Tavlasoglu

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

• The clinical outcome of non-small cell lung cancer patients with adjacent lobe invasion: the optimal classification according to the status of the interlobar pleura at the invasion point.

  Authors: Yoichi Ohtaki, Tomoyuki Hishida, Junji Yoshida, Genichiro Ishii, Akikazu Kawase, Keiju Aokage, Mitsuyo Nishimura, Kanji Nagai

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

  OBJECTIVES: The aim of this study was to analyse the survival of non-small cell lung cancer (NSCLC) patients with adjacent lobe invasion (ALI) with emphasis on the interlobar fissure status at theOBJECTIVES: The aim of this study was to analyse the survival of non-small cell lung cancer (NSCLC) patients with adjacent lobe invasion (ALI) with emphasis on the interlobar fissure status at the tumour invasion point. METHODS: We retrospectively evaluated 2097 consecutive patients with surgically resected NSCLC from July 1993 through April 2006. Of these, 90 (4.3%) patients had tumours with ALI. We divided ALIs into two types by histological examination using elastic stains: direct ALI beyond the incomplete fissure (ALI-D, n = 18) and ALI across the interlobar fissure (ALI-A, n = 72), and compared the clinicopathological features and survival. RESULTS: The patients with ALI demonstrated an intermediate survival between T2a and T2b tumours (5-year overall survival: T2a, 61.0%; ALI, 59.6%; T2b, 49.2%). There were distinct survival differences between the patients with ALI-A and ALI-D (5-year overall survival: ALI-D, 85.7%; ALI-A, 52.0%; P = 0.010). The survival of patients with ALI-A was not statistically different from that of patients with T2b tumours, regardless of the tumour size (P = 0.846). The survival of the patients with ALI-D did not statistically differ from those with T1a or T1b tumours (P = 0.765 and 0.418, respectively). CONCLUSIONS: Our results indicate that the interlobar fissure status affects the survival of the patients with ALI. ALI should be examined by elastic stains and only ALI-A should be classified as true ALI. We propose that ALI-A tumours with a size of ≤5 cm should be assigned to T2b, but ALI-D tumours do not require an adjustment of the T descriptor.

• Usefulness of chest images for the assessment of pectus excavatum before and after a Nuss repair in adults.

  Authors: Ti-Hei Wu, Tsai-Wang Huang, Hsian-Her Hsu, Shih-Chun Lee, Ching Tzao, Huang Chang, Yeung-Leung Cheng

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

  OBJECTIVES: The aim of this study was to evaluate whether chest radiographs could offer useful information for the assessment of pectus excavatum (PE) before and after Nuss repair in adults. METHODS:OBJECTIVES: The aim of this study was to evaluate whether chest radiographs could offer useful information for the assessment of pectus excavatum (PE) before and after Nuss repair in adults. METHODS: A total of 154 adults, with a mean age of 24.0 ± 5.0 years (range, 18-44 years), who underwent a Nuss repair of PE, with a mean follow-up of 42 months (range, 14-71 months), were included in this retrospective study. Sixty-two of these patients were also evaluated after the pectus bar removal, with a mean follow-up of 13 months (range, 6-44 months). The preoperative and postoperative imaging modalities were compared. RESULTS: The preoperative mean Haller indices measured on computed tomography (CT) and chest radiographs were 4.61 ± 1.58 (range, 2.6-11.9) and 3.82 ± 1.17 (range, 2.0-10.2), respectively. The Pearson correlation coefficient between the two parameters was 0.757. The postoperative mean Haller index measured on chest radiographs was 2.86 ± 0.56 (range, 1.7-5.4) and showed statistically significant improvement compared with the preoperative index (P < 0.001). The mean sternovertebral (SV) distances detected on preoperative and postoperative (>6 months after surgery) lateral chest radiographs were 7.67 ± 1.89 cm (range, 2.5-12.9 cm) and 9.89 ± 1.80 cm (range, 4.6-15.0 cm), respectively, showing statistically significant improvement (P < 0.001). The mean sternovertebral (SV) distance in patients after the bar removal detected on lateral chest radiographs was 9.25 ± 2.14 cm, also showing statistically significant improvement compared with the preoperative value (P < 0.001). CONCLUSIONS: Haller indices measured using chest radiographs and CT showed a strong correlation. Therefore, chest radiographs can be used as an alternative tool for the preoperative evaluation of PE. The Nuss operation significantly improved SV distances detected on lateral chest radiographs. Lateral chest radiographs can be used as a simple modality for the objective quantitative assessment of the anatomic results and follow-up of the Nuss operation in adults.

• Preoperative pulmonary rehabilitation in patients with lung cancer and chronic obstructive pulmonary disease.

  Authors: Duilio Divisi, Cinzia Di Francesco, Gabriella Di Leonardo, Roberto Crisci

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

  OBJECTIVES: Impaired cardiopulmonary reserve is the main cause of inoperability in non-small-cell lung cancer (NSCLC). This study aims to evaluate the role of a preoperative pulmonary rehabilitationOBJECTIVES: Impaired cardiopulmonary reserve is the main cause of inoperability in non-small-cell lung cancer (NSCLC). This study aims to evaluate the role of a preoperative pulmonary rehabilitation (PPR) programme in the improvement of functional parameters, which can enable an increase in the number of patients eligible for surgery. METHODS: From January 2008 to June 2011, we observed a uniform group of 27 patients with NSCLC and chronic obstructive pulmonary disease (COPD). It showed: (i) a body mass index of 21.5 ± 2 kg/m&sup2;; (ii) forced expiratory volume in 1 s (FEV(1)) of 1.14 ± 0.7 l; (iii) maximal peak of oxygen consumption (VO(2)max) of 12.9 ± 1.8 ml/kg/min; (iv) carbon monoxide diffusing capacity (DLCO) of 72 ± 3% predicted; (v) stage IB of lung cancer. All patients underwent a 4-week PPR programme, 6 days a week and were re-evaluated before inclusion for surgery. RESULTS: The rehabilitation programme was completed by all patients and extended by 2 weeks in nine patients, in order to obtain a further functional improvement. A statistically significant increase has been in the values of PaO(2) (60 ± 10 vs. 82 ± 12 mmHg), of VO(2)max (12.9 ± 1.8 vs. 19.2 ± 2.1 ml/kg/min, P = 0.00001) and of FEV(1) (1.14 ± 0.7 vs. 1.65 ± 0.8 l, P = 0.02). All patients underwent a lobectomy, with a postoperative morbidity of 15%. CONCLUSIONS: A 4 to 6-week PPR programme prepares the NSCLC and COPD patients properly for the surgical approach, reducing the functional limitations of inoperability.

• Is alternative cardiac surgery an option in adults with congenital heart disease referred for thoracic organ transplantation?

  Authors: Andrew Robert Harper, David Steven Crossland, Gianluigi Perri, John Jude O'Sullivan, Milind Pralhad Chaudhari, Stephan Schueler, Massimo Griselli, Asif Hasan

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

  OBJECTIVES: We analysed the outcomes of adults with congenital heart disease (ACHD) referred for thoracic organ transplantation who underwent non-transplant cardiac surgery as an alternativeOBJECTIVES: We analysed the outcomes of adults with congenital heart disease (ACHD) referred for thoracic organ transplantation who underwent non-transplant cardiac surgery as an alternative management option. METHODS: Adult patients with congenital heart disease assessed for heart or heart-lung transplant were identified from the departmental database. A retrospective analysis of the medical records, transplant assessment data and surgical notes was carried out. RESULTS: One hundred and twenty-six patients were assessed between January 2000 and July 2011. Non-transplant cardiac surgery was performed in 14 (11%) patients. There were nine males with a median age of 37 years (range 21-42). The patients can be divided into four subgroups [left-sided lesions (n = 4), right-sided lesions (n = 3), systemic right ventricle (n = 5) and Fontan circulation (n = 2)]. Surgical procedures performed were: relief of systemic obstructive/regurgitant lesions ± endocardial fibroelastosis resection (n = 4, three pulmonary vascular resistance >6 Wood units), correction of right-sided regurgitant/stenotic lesions (n = 3), ventricular assist device for patients with a systemic right ventricle (n = 5) and re-fashioning of the Fontan pathway (n = 2). There were two early (5 and 30 days) and three late deaths (64, 232 and 374 days) with a 1-year mortality of 28%. None of the deaths occurred in patients with a two-ventricle circulation and atrio-ventricular concordance. Nine patients are alive at a median of 433 days (range 204-2456). The New York Heart Association class has improved in all survivors by at least one class at 3 and 6 months (P = 0.004 and 0.003). CONCLUSIONS: Alternative cardiac surgery can be undertaken in selected patients with ACHD referred for cardiopulmonary transplantation with a low mortality in patients with two ventricles and a systemic left ventricle. Ventricular assist devices carry a significant mortality in patients with a systemic right ventricle, although this offers a valuable palliation when there are no other options. The medium and long-term results are awaited.

• The causes of re-operation in the Ross procedure.

  Authors: Sahin Bozok, Mert Kestelli, Gokhan Ilhan, Banu Lafci

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

• Reoperations after paediatric Ross operation.

  Authors: Mark G Hazekamp

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

• Pulmonary position cryopreserved homograft in non-Ross patients: how to improve the results?

  Authors: David M Kalfa, Anderson Loundou, Yveline Nouaille de Gorce, Alain Fraisse, Dominique R Metras, Loïc Macé, Bernard Kreitmann

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

  OBJECTIVES: The outcomes of homografts (HGs) in the reconstruction of the right ventricular outflow tract (RVOT) in non-Ross patients are often considered disappointing, compared with Ross patients;OBJECTIVES: The outcomes of homografts (HGs) in the reconstruction of the right ventricular outflow tract (RVOT) in non-Ross patients are often considered disappointing, compared with Ross patients; and the risk factors for HG degeneration are still controversial. The objective of this study was to determine the durability and prognostic factors related to the HGs implanted in non-Ross patients and to propose potential ways to improve the results. METHODS: A retrospective study (1993-2010) included 115 consecutive non-Ross patients who received a HG for RVOT reconstruction. The median age at implantation was 2.8 years (4 days-58 years). The main heart defects were pulmonary atresia with ventricular septal defect (n = 40; 34%), truncus arteriosus (n = 28; 24%) and tetralogy of Fallot (n = 23; 20%). Thirty-eight percent had preoperative pulmonary hypertension. A low-dose corticosteroid therapy was used during the postoperative period in patients displaying a HG-related inflammatory response (no septic context) (n = 11). The median diameter of the implanted HG was 22 mm (range 9-30 mm). The median age of the HG donor was 14 years (range 0.5-65 years). ABO compatibility rules were not systematically respected for the HG implantation: 43% of the implanted HGs were ABO compatible with the recipient. The endpoints were HG stenosis (peak gradient ≥20 mmHg), regurgitation (moderate or severe), dysfunction (peak gradient ≥ 50 mmHg or regurgitation moderate or severe) and failure (explantation or balloon dilation). RESULTS: Freedom from HG explantation and failure were 89 and 80% at 5 years, and 76 and 69% at 10 years, respectively. HG donor age <30 years [hazard ratio (HR): 2; P = 0.012], preoperative pulmonary hypertension (HR: 3; P = 0.02) and HG mismatch (HR: 5; P = 0.04) were multivariate risk factors for HG stenosis, regurgitation and failure, respectively. HG diameter <22 mm was a multivariate risk factor for HG regurgitation (HR: 8; P < 0.001), dysfunction (HR: 9; P = 0.02) and failure (HR: 5; P = 0.03). ABO incompatibility increased the risk of HG stenosis (HR: 4; P = 0.009) and dysfunction (HR: 2; P = 0.04). The use of corticosteroids significantly protected against the risk of HG regurgitation (HR: 0.08; P = 0.04) in the multivariate analysis. CONCLUSIONS: The cryopreserved HG implanted to reconstruct the RVOT in non-Ross patients remains one of the most acceptable options in this specific non-Ross population. The outcomes of HGs in non-Ross patients might be improved by implanting an ABO-compatible HG with an adapted diameter, coming from a donor >30 years and by optimizing the perioperative afterload of the HG.

• Reply to Terzi et al.

  Authors: Lianqi Bai

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

• Long-term results of the arterial switch operation for ventriculo-arterial discordance.

  Authors: Hong-Gook Lim, Woong-Han Kim, Jeong Ryul Lee, Yong Jin Kim

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

  OBJECTIVES: The arterial switch operation (ASO) has become the standard surgical procedure for transposition of the great arteries (TGA) or variants with an excellent early outcome. However, thereOBJECTIVES: The arterial switch operation (ASO) has become the standard surgical procedure for transposition of the great arteries (TGA) or variants with an excellent early outcome. However, there are concerns regarding neopulmonary stenosis, neoaortic regurgitation (neoAR) associated with neoaortic root dilatation and coronary artery disease. METHODS: A total of 220 early survivors of the ASO were included in this retrospective study between November 1987 and June 2011. The median age and weight at operation were 13 days (0-1768 days) and 3.52 kg (1.69-19 kg), respectively. The indications for the ASO included TGA with intact ventricular septum in 113 patients, TGA with ventricular septal defect in 90 and Taussig-Bing anomaly in 17 patients. The median follow-up period was 103.2 months (0.4-277.4 months). Statistical analyses with the Kaplan-Meier and Cox proportional hazards models were performed. RESULTS: The actuarial late survival rate and freedom from reoperation at 23 years were 96.6 ± 1.3 and 81.9 ± 3.8%, respectively. Twenty-four (10.9%) patients underwent reoperations for right ventricular outflow tract obstruction in 10 patients, neoAR in four and coronary artery stenosis in three, etc. Freedom from neoAR of Grades IV, III and II at 23 years was 90.2 ± 6.6, 70.9 ± 9.6 and 20.3 ± 5.5%, respectively. The risk factors for neoAR were size discrepancy of the great arteries, aortic root dilatation after the ASO and follow-up duration after the ASO. NeoAR was significantly correlated with the size of aortic sinus and aortic sinotubular junction over time. Freedom from pulmonary stenosis (PS) of ≥36 and ≥20 mmHg at 23 years was 34.8 ± 18.0 and 17.7 ± 9.6%, respectively. The risk factors for PS were Taussig-Bing and arch anomalies. Coronary artery evaluation was performed in 95 (43.2%) patients with angiography, computed tomography or single-photon emission computed tomography, and five (5.3%) patients had abnormal coronary morphology or perfusion. Three patients underwent reoperation for coronary artery stenosis, and two had reversible perfusion defects in various regions, which were clinically not significant. Freedom from coronary events was 88.1 ± 6.4% at 22 years. A risk factor for coronary events was the single coronary artery. CONCLUSIONS: The survival and functional outcomes of the ASO were excellent in the long-term. Strict serial surveillance is required to evaluate the long-term functional outcome of the ASO, particularly in a high-risk anatomy.

• Arterial switch operation: is the glass half full or half empty?

  Authors: Pascal R Vouhé

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

• Erythropoietin protects the systolic function of neonatal hearts against ischaemia/reperfusion injury.

  Authors: Karlos Alexandre Souza Vilarinho, Pedro Paulo Martins de Oliveira, Mário José Abdalla Saad, Pirooz Eghtesady, Lindemberg Mota Silveira Filho, Reinaldo Wilson Vieira, Orlando Petrucci

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

  OBJECTIVES: The effect of erythropoietin (EPO) on neonatal hearts is not well understood. The current hypothesis is that EPO has protective effects against ischaemia-reperfusion when administeredOBJECTIVES: The effect of erythropoietin (EPO) on neonatal hearts is not well understood. The current hypothesis is that EPO has protective effects against ischaemia-reperfusion when administered prior to ischaemia induction. METHODS: Systolic and diastolic indices, as well as the Akt and extracellular-regulated kinase (Erk) signalling pathways, were studied in vivo using a neonatal pig heart model. Regional ischaemia was induced for 45 min by the ligation of the left anterior descending artery, followed by 90 min of reperfusion. The treatment groups consisted of: (i) untreated controls, (ii) treatment with EPO 3 min prior to ischaemia and (iii) treatment with EPO 24 h before ischaemia. Sophisticated myocardial contractility indices were assessed by pressure/volume loops of the left ventricle. The Akt and Erk pathways were evaluated via a western blot. RESULTS: Elastance was found to be higher in the group receiving EPO 3 min prior to ischaemia. In addition, preload recruitable stroke work was higher for both groups receiving EPO prior to ischaemia when compared with controls. The time constant of the isovolumic relaxation and end-diastolic pressure-volume relationship did not differ between the three groups after 90 min of reperfusion. Furthermore, EPO treatment enhanced phosphorylation of Akt, but not Erk, and EPO-treated animals showed lower levels of apoptosis-related proteins. CONCLUSIONS: EPO had a protective effect on neonatal systolic function after ischaemia/reperfusion injury, but no effect on diastolic function. This cardioprotective effect might be mediated by the activation of the Akt pathway.

• Statistical methods for survival analysis in oesophageal cancer.

  Authors: Vinay P Rao

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

• Early and late prognostic implications of coronary artery bypass timing after myocardial infarction.

  Authors: Dumbor L Ngaage, Franco Sogliani, Augustine Tang

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

  OBJECTIVES: The optimal timing of coronary artery bypass grafting (CABG) after myocardial infarction (MI) is still controversial. With advances in perioperative care and myocardial protection, CABGOBJECTIVES: The optimal timing of coronary artery bypass grafting (CABG) after myocardial infarction (MI) is still controversial. With advances in perioperative care and myocardial protection, CABG is not infrequently undertaken sooner. Although CABG soon after MI is associated with high morbidity and mortality, the impact of CABG timing on late survival is not clear. METHODS: We analysed prospectively collected data for 8320 patients who underwent primary CABG from 1996 through 2010. Operative outcomes and late survival were compared between patient categories based on MI-to-CABG days: groups A (0-30, n = 658), B (31-60, n = 734), C (>90, n = 2698) and D (no MI, n = 4230). The effect of the timing of surgery on survival was determined using multivariate and Kaplan-Meier analyses. RESULTS: As the MI-to-CABG interval increased, the frequency of urgent/emergency operations decreased and hospital mortality (A, 3.5% vs. B, 2.6% vs. C, 1.2%, vs. D, 1.1%, P < 0.0001) steadily declined. In general, patients who had CABG within 90 days of MI had more cardiac morbidity and comorbidities. Expectedly, therefore, postoperative organ system dysfunction (cardiac, renal, respiratory and neurological) was more frequent in these groups. Reoperation for bleeding was similar for all groups, but blood product transfusion decreased as the MI-to-CABG days increased. The 10-year survival improved with the MI-to-CABG interval (A, 72.2% vs. B, 73.4% vs. C, 75.8% vs. D, 81.4%, P < 0.0001). By multivariate analysis, the MI-to-CABG interval was not a risk factor for operative or late mortality. However, less frequent left internal mammary artery use, non-elective surgery and high blood transfusion rates were all more often associated with shorter MI-to-CABG intervals. CONCLUSIONS: Early and late mortality risk for CABG declines with increasing intervals from MI for reasons indirectly linked to the timing of surgery. Our findings emphasize the importance of preoperative organ system optimization and consistent left internal mammary artery use, regardless of the proximity of surgery to MI or the exigency of surgery.

• The heart team approach to acute type A dissection: a new paradigm in the era of the integrated Penn classification and the Essen concept.

  Authors: John G T Augoustides, Prakash A Patel, Joseph S Savino, Joseph E Bavaria

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

• Aortic stenosis in octogenarians and other high-risk groups: what can surgical valve replacement offer?

  Authors: Manuel J Antunes

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

• The beauty of the differences.

  Authors: Ottavio Alfieri

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

• Foetal cardiac interventions: overview and perspectives in 2012.

  Authors: Thomas Kohl

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

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