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


Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.


The goal of this study was to investigate alternative strategies to the sternal resection in the treatment of post-sternotomy osteomyelitis. We report our experience in the treatment of chronic infection of median sternotomy following open heart surgery without sternal resection.

Concepts: Sternum, Cardiothoracic surgery, Cardiac surgery


Reoperation for failing stentless aortic valve replacement is a technically demanding procedure that has traditionally been tackled in one of two ways: either root replacement or the more conservative option of implanting a stented valve within the valve. We sought to determine the relative operative risks, follow-up status and medium to long-term survival of these two methods.

Concepts: Derivative, Left ventricle, Aortic valve, Valve, Valve Corporation, Aortic valve replacement, Aortic insufficiency


A 36-year old woman presented with a 5-year history of progressive dysphagia. The barium swallow of the oesophagus revealed an oblique extrinsic defect consistent with an aberrant right subclavian artery. A computed tomography angiogram confirmed the diagnosis. Surgical correction is indicated for dysphagia lusoria in association with an aberrant right subclavian artery. The patient underwent surgical repair through the right supraclavicular approach, which provided a good exposure. We describe the use of this approach, which avoids the possible complications of thoracotomy or sternotomy in the surgical management of dysphagia lusoria.

Concepts: Medical imaging, Common carotid artery, Brachiocephalic artery, Subclavian vein, Vertebral artery, Subclavian artery, Aberrant subclavian artery


We report a case with a very rare complication of transcatheter aortic valve implantation. Rupture of the NovaFlex balloon (Edwards transfemoral balloon catheter) occurred during the inflation of the Edwards SAPIEN valve, resulting in dissection of the right common and external iliac arteries during withdrawal of the balloon catheter. The NovaFlex balloon is a part of the Edwards NovaFlex XT transfemoral delivery system.

Concepts: Right-wing politics, External iliac artery, Aortic valve, Internal iliac artery, Arteries, Iliac artery, Iliac vein, X-Force


The classic Morrow technique for hypertrophic obstructive cardiomyopathy (HOCM) in patients with simultaneous obstruction of left ventricular (LV) midcavity and right ventricular outflow tract (RVOT) combined with extreme left ventricular hypertrophy, is not effective. A new technique for HOCM surgical correction in patients with severe hypertrophy is proposed.

Concepts: Cardiology, Cardiomyopathy, Left-wing politics, Left ventricular hypertrophy, Hypertrophic cardiomyopathy, Political spectrum, Hypertrophy


We report a novel surgical strategy for the resection of a rare type of posterior mediastinal tumour in a young patient. A melanotic schwannoma arose from the left thoracic sympathetic chain, adjacent to the origin of the artery of Adamkiewicz. Successful excision of this tumour via a minimally invasive approach without arterial or spinal cord injury was possible with the aid of neurological monitoring using spinal-evoked potentials.

Concepts: Blood, Hospital, Heart, Surgery, Minimally invasive, Mediastinal tumor, Mediastinum, Thoracic cavity


Several techniques exist for the repair of complex pectus excavatum. The placement of retrosternal metal bars improves the results by reducing the recurrence rate, but entails several possible risks, complications and disadvantages. A new method, specifically conceived for the repair of severe, asymmetric forms in adult patients, is reported. The corrected bone is fixed in the proper position by two, patient-customized, titanium struts, externally screwed to the manubrium and sternal body. Any retrosternal bar is thus avoided, reducing possible complications, without hampering the chest wall dynamic. In this particularly difficult issue, this technique provides long-term good functional, mechanical and cosmetic results and does not entail a second surgery for struts removal.

Concepts: Heart, Pectus excavatum, Chest, Sternum, Pectus carinatum, Adult, Moral hazard, Fee tail


Air embolism is a rare complication of computed tomography (CT)-guided preoperative marking of peripheral pulmonary nodules. Here, we describe a new CT-guided marking method, which allows the quick intraoperative identification of peripheral pulmonary nodules and avoids this complication. This method does not require piercing of the pulmonary parenchyma and uses an 18-gauge indwelling catheter and a central venous catheter with a guidewire. Between July 2009 and January 2013, 16 patients underwent this procedure and could be intraoperatively diagnosed without any air embolisms. No postoperative complications were observed in this series. We believe that this simple technique is effective and will not cause severe complications.

Concepts: Lung, Central venous catheter, Catheter, Catheters, Peripheral venous catheter, Parenchyma, Embolism, Air embolism


OBJECTIVES: Atrial fibrillation (AF) is a significant risk factor for embolic stroke originating from the left atrial appendage (LAA). This is the first report of long-term safety and efficacy data on LAA closure using a novel epicardial LAA clip device in patients undergoing cardiac surgery. METHODS: Forty patients with AF were enrolled in this prospective ‘first-in-man’ trial. The inclusion criterion was elective cardiac surgery in adult patients with AF for which a concomitant ablation procedure was planned. Intraoperative transoesophageal echocardiography (TEE) was used to exclude LAA thrombus at baseline and evaluate LAA perfusion after the procedure, while computed tomography (CT) was used for serial imagery workup at baseline, 3-, 12-, 24- and 36-month follow-up. RESULTS: Early mortality was 10% due to non-device-related reasons, and thus 36 patients were included in the follow-up consisting of 1285 patient-days and mean duration of 3.5 ± 0.5 years. On CT, clips were found to be stable, showing no secondary dislocation 36 months after surgery. No intracardial thrombi were seen, none of the LAA was reperfused and in regard to LAA stump, none of the patients demonstrated a residual neck >1 cm. Apart from one unrelated transient ischaemic attack (TIA) that occurred 2 years after surgery in a patient with carotid plaque, no other strokes and/or neurological events demonstrated in any of the studied patients during follow-up. CONCLUSION: This is the first prospective trial in which concomitant epicardial LAA occlusion using this novel epicardial LAA clip device is 100% effective, safe and durable in the long term. Closure of the LAA by epicardial clipping is applicable to all-comers regardless of LAA morphology. Minimal access epicardial LAA clip closure may become an interesting therapeutic option for patients in AF who are not amenable to anticoagulation and/or catheter closure. Further data are necessary to establish LAA occlusion as a true and viable therapy for stroke prevention. CLINICAL TRIAL REGISTRATION: The trial is registered at, reference: NCT00567515.

Concepts: Heart, Stroke, Atrial fibrillation, Transient ischemic attack, Avicenna, Thrombus, Left atrial appendage occlusion, Left atrial appendage