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Objectives: Our goal was to establish a prediction score and protocol for the preoperative prediction of significant coronary artery disease (CAD) in patients with rheumatic valvular heart disease., Methods: Using multivariate logistic regression analysis, we validated the model based on 490 patients without a history of myocardial infarction and who underwent preoperative screening coronary angiography. Significant CAD was defined as ≥50% narrowing of the diameter of the lumen of the left main coronary artery or ≥70% narrowing of the diameter of the lumen of the left anterior descending coronary artery, left circumflex artery or right coronary artery., Results: Significant CAD was present in 9.8% of patients. Age, smoking, diabetes mellitus, diastolic blood pressure, low-density lipoprotein cholesterol and ischaemia evident on an electrocardiogram were independently associated with significant CAD and were entered into the multivariate model. According to the logistic regression predictive risk score, preoperative coronary angiography is recommended in (i) postmenopausal women between 50 and 59 years of age with ≥9.1% logistic regression predictive risk score; (ii) postmenopausal women who are ≥60 years old with a logistic regression predictive risk score ≥6.6% and (iii) men ≥50 years old whose logistic regression predictive risk score was ≥2.8%. Based on this predictive model, 246 (50.2%) preoperative coronary angiograms could be safely avoided. The negative predictive value of the model was 98.8% (246 of 249)., Conclusions: This model was accurate for the preoperative prediction of significant CAD in patients with rheumatic valvular heart disease. This model must be validated in larger cohorts and various populations.

Objectives: The best surgical strategy for acute Stanford Type A aortic dissection (aTAAD) involving the arch remains controversial. Here, we report on the satisfactory results following aTAAD repair using a novel arch fenestrated stent graft., Methods: From December 2014 to December 2015, 42 aTAAD patients (27 male and 15 female) underwent ascending aorta replacement and fenestrated stent graft implantation. The fenestrated stent graft was implanted into the true lumen of the aortic arch and proximal descending aorta, with the fenestration opening located at the ostia of 3 head vessels in the arch. The proximal end of the stent graft was anastomosed to the distal end of the Dacron tube graft that replaced the proximal ascending aorta. All patients underwent contrast-enhanced computed tomography angiography prior to discharge and during follow-up., Results: The average cardiopulmonary bypass duration was 213 ± 49 min, aortic cross-clamp duration was 133 ± 39 min and unilateral cerebral perfusion and lower body arrest duration was 27 ± 8 min. There were 2 in-hospital deaths due to circulation failure (mortality 4.8%). During a mean follow-up period of 7.4 ± 3.2 months, 1 patient with Behçet's disease died of aortic root pseudoaneurysm. The 39 surviving patients underwent contrast-enhanced computed tomography scans at 3, 6 and 12 months, which indicated increasing false-lumen thrombosis., Conclusions: In aTAAD patients, the use of the novel arch fenestrated stent graft achieved excellent aortic remodelling of the aortic arch and descending aorta without any increase in the morbidity and mortality., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)