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Objective: The aim of this study was to develop a statistical model based on patient parameters to predict the length of stay (LOS) in the intensive care unit (ICU) following cardiac surgery in a single center., Design: Data were collected from patients admitted to the ICU following cardiac surgery over a 10-year period (2006-2016). Both the additive and logistic EuroSCORE were calculated, and logistic regression analysis was carried out to formulate a model relating the predicted LOS to the EuroSCORE. This model was used to stratify patients into short stay (less than 48 hours) or long stay (more than 48 hours)., Setting: ICU at Papworth Hospital, Cambridgeshire., Participants: A total of 18,377 consecutive patients who had been in ICU following cardiac surgery (coronary graft bypass surgery, valve surgery, or a combination of both)., Interventions: This was an observational study., Measurements and Main Results: The authors have shown that both the additive and logistic EuroSCORE can be used to stratify cardiac surgical patients in various predicted LOS in ICU. Further adjustments can be made to increase the number of patients correctly identified as either short stay or long stay. Comparison of the model predictions to the data demonstrated a high overall accuracy of 79.77%, and receiver operating characteristic curve analysis showed the area under the curve to be 0.7296., Conclusion: This analysis of an extensive data set shows that patient LOS in ICU after cardiac surgery in a single center can be predicted accurately using the simple cardiac operative risk scoring tool EuroSCORE. Using such predictions has the potential to improve ICU resource management., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)

Aims: Life-threatening complications occur during transcatheter aortic valve implantation (TAVI) which can require emergent cardiac surgery (ECS). Risks and outcomes of patients needing ECS during or immediately after TAVI are still unclear., Methods and Results: Incidence, risk factors, management, and outcomes of patients requiring ECS during transfemoral (TF)-TAVI were analysed from a contemporary real-world multicentre registry. Between 2013 and 2016, 27 760 patients underwent TF-TAVI in 79 centres. Of these, 212 (0.76%) patients required ECS (age 82.4 ± 6.3 years, 67.5% females, logistic EuroSCORE: 17.1%, STS-score 5.8%). The risk of ECS declined from 2013 (1.07%) to 2014 (0.70%) but remained stable since. Annual TF-TAVI numbers have more than doubled from 2013 to 2016. Leading causes for ECS were left ventricular perforation by the guidewire (28.3%) and annular rupture (21.2%). Immediate procedural mortality (<72 h) of TF-TAVI patients requiring ECS was 34.6%. Overall in-hospital mortality was 46.0%, and highest in case of annular rupture (62%). Independent predictors of in-hospital mortality following ECS were age > 85 years [odds ratio (OR) 1.87, 95% confidence interval (95% CI) (1.02-3.45), P = 0.044], annular rupture [OR 1.96, 95% CI (0.94-4.10), P = 0.060], and immediate ECS [OR 3.12, 95% CI (1.07-9.11), P = 0.037]. One year of survival of the 114 patients surviving the in-hospital period was only 40.4%., Conclusion: Between 2014 and 2016, the need for ECS remained stable around 0.7%. Left ventricular guidewire perforation and annular rupture were the most frequent causes, accounting for almost half of ECS cases. Half of the patients could be salvaged by ECS-nevertheless, 1 year of all-cause mortality was high even in those ECS patients surviving the in-hospital period., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.)

Objectives: Progressive loss of calibration of the original EuroSCORE models has necessitated the introduction of the EuroSCORE II model. Poor model calibration has important implications for clinical decision-making and risk adjustment of governance analyses. The objective of this study was to explore the reasons for the calibration drift of the logistic EuroSCORE., Methods: Data from the Society for Cardiothoracic Surgery in Great Britain and Ireland database were analysed for procedures performed at all National Health Service and some private hospitals in England and Wales between April 2001 and March 2011. The primary outcome was in-hospital mortality. EuroSCORE risk factors, overall model calibration and discrimination were assessed over time., Results: A total of 317 292 procedures were included. Over the study period, mean age at surgery increased from 64.6 to 67.2 years. The proportion of procedures that were isolated coronary artery bypass grafts decreased from 67.5 to 51.2%. In-hospital mortality fell from 4.1 to 2.8%, but the mean logistic EuroSCORE increased from 5.6 to 7.6%. The logistic EuroSCORE remained a good discriminant throughout the study period (area under the receiver-operating characteristic curve between 0.79 and 0.85), but calibration (observed-to-expected mortality ratio) fell from 0.76 to 0.37. Inadequate adjustment for decreasing baseline risk affected calibration considerably., Discussions: Patient risk factors and case-mix in adult cardiac surgery change dynamically over time. Models like the EuroSCORE that are developed using a 'snapshot' of data in time do not account for this and can subsequently lose calibration. It is therefore important to regularly revalidate clinical prediction models.

There is no doubt that the European Association for Cardio-Thoracic Surgery is a success story. In 2011, we celebrated the 25th anniversary of this professional organization. In 2012, we will celebrate the 25th anniversary of the European Journal of Cardio-Thoracic Surgery. In addition, two other journals have been initiated, Interactive CardioVascular and Thoracic Surgery and the Multimedia Manual of Cardio-Thoracic Surgery, and all of them can be accessed through CTSnet (www.ctsnet.org). The most recent development was the birth of EACTS House, and it was to celebrate the official opening of EACTS House on 10 February 2011, that we held the second Strategic meeting, 'EACTS in the Future'. On this occasion, the EACTS council and delegates of the EACTS Domains (Domain of Thoracic Disease, Domain of Vascular Disease, Domain of Congenital Cardiac Disease and Domain of Adult Cardiac Disease) came together with representative thoracic and cardio-vascular surgeons from North America, Asia and BRICS countries as well as senior managers from industry in order to decide where to go from there. As a basis for starting the discussions, a sector analysis of the activities of the Department of Cardio-Vascular Surgery at CHUV in Lausanne, Switzerland was performed in order to identify the trends in the activities of our group of surgeons by pulling the consolidated data for the period running from 1 January 1995 to 31 December 2010. Interestingly enough, the most frequent procedures like coronary artery bypass graft and valve repair/replacement did not increase despite a growing programme. In our setting, the compensation came mainly from vascular surgery and mechanical circulatory support. These data have to be put in perspective by the reports provided by the EACTS domain chairs in order to identify the challenges and opportunities for the future development of our specialties.

Increasing sub-specialization in the less-common conditions is leading to better outcomes for patients. Yet the way we provide the service has not changed. Is it time to consider doing things differently? Do we need to reconfigure service provision both within and between units?

Objective: The aim of the present paper was to report trends in Portuguese interventional cardiology from 1992 to 2003 and to compare these data with other European countries., Methods: Based on questionnaires distributed to and completed by Portuguese interventional cardiology centers we give an overview of the development of coronary interventions since 1992, when data were first collected. In 2003, 24,834 diagnostic catheterization procedures were performed, representing an increase of 315% in comparison to 1992. In 2003 the population-adjusted rate was 2483 coronary angiograms per million population. Coronary interventions increased by 1193% in comparison to 1992, with a total of 8465 procedures and a rate of coronary interventions of 848 per million population in 2003. Coronary stents were the most frequently used devices, with an increase from 53% in 1996 to 89% in 2003. The present rate of stent implantation in Portugal is similar to that in Europe and Spain, but the rate of use of drug-eluting stents in Portugal is one of the highest in Europe (55%). In 2003, multivessel percutaneous coronary interventions were performed in 24% of cases, with no significant increase during the last 10 years, and ad hoc interventions were performed in the course of diagnostic coronary angiography in 73 % of patients; glycoprotein IIb-IIIa inhibitors were used in 30% of procedures; percutaneous coronary interventions in patients with acute myocardial infarction accounted for 16% of all procedures; of the noncoronary interventions recorded, 49 percutaneous mitral valvuloplasties, 37 atrial septal defect closures and 15 patent foramen ovale closures were reported. The PCI rate per million population in Portugal was lower than the mean European rate (848 vs. 1194)., Conclusion: Interventional cardiology in Portugal and other European countries has been expanding since 1992. We would emphasize the high rate of reporting by laboratories, which enables the Registry to compile data that are highly representative of activity in Portugal since 1992.

Background and Aim of the Study: This study sought to elaborate the changing trends in valve surgery in Europe during the 1990s., Methods: The databases of different national surgical societies, registries and governments and international organizations were consulted and the data obtained were analyzed., Results: The population of Europe (excluding Russia, CIS and Turkey) increased by 2.29%, from 509.67 million in 1991 to 519.15 million in 2000. During this period, the volume of cardiac surgery increased in Europe by 101% to 413,520 operations (797 per 10(6) population). The volume of valve surgery increased by 63% to 85,076 (164 per 10(6) population). The largest volumes of valve surgery were performed in Germany, France, UK, Italy and Spain. The increase in valve surgery volume was maximum in the Baltic states (+287%) and least in Scandinavia (+30%). Valve surgery volume per center per year changed from 139 in 1991 to 140 in 2000. The increase in overall valve surgery volume was sustained by an increase in subsets of octogenarian patients, valve surgery combined with coronary artery surgery, and increased productivity of the emerging economies of countries such as the Czech Republic, Hungary and Poland. Valve surgery as a proportion of cardiac surgery in Europe changed from 25.95% in 1991 to 21% in 2000. In 2000, valve surgery with combined procedures constituted 6.7% of total cardiac surgical volume, but 32% of valve surgical output in Europe. Mechanical valves have continued to dominate and were used in 77% of cases in 2000. Increased use of bioprostheses in the elderly subset among affluent economies was balanced by an increased use of mechanical prostheses in younger patients in emerging facilities in the East and South. The capital-intensive innovations (viz. robotic valve surgery, minimally invasive valve surgery, bioengineered valves) found niches only in some West European centers. Catheter-based procedures did not fulfil their promise. Balloon aortic valve dilatation investigations decreased drastically by the end of the decade, and balloon mitral dilatations number. Conservative aortic valve surgery is not yet practiced widely across Europe, while mitral repair has become widely accepted in clinical parlance., Conclusion: Despite the greater political and economic integration of Europe, the pattern of valve surgery continues to remain extremely diverse within the continent.

Over the past decade, advancements in cardiac surgery occurred secondary to improvements in technology and the desire for a less invasive approach to operations in general. Minimally invasive cardiac surgery has progressed from partial sternotomy incisions to totally endoscopic open-heart procedures with robotic-assistance. There are 2 major companies that produce robotic equipment for use in cardiac surgery. These companies must undergo Food and Drug Association (FDA) mandated clinical trials on each cardiac surgical procedure, before it can be approved for public use. The surgeon must demonstrate clinical proficiency to operate the robotic equipment per FDA approved company testing. The use of computer (robotic) enhancement is well documented for coronary artery bypass grafting and selected cardiac valve procedures. Recent advancements are now being directed at congenital heart disease. The use of robotic-assisted totally endoscopic atrial septal defect closure is a tremendous advancement in congenital cardiac surgery. The future of robotic cardiac surgery will hopefully expand to cover more advanced valve procedures, congenital heart defects, and other procedures once robots are further modified for pediatric use.

Aims: The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution in different regions in Europe., Methods and Results: Questionnaires distributed to delegates of the national societies of cardiology represented in the European Society of Cardiology to be completed by local institutions and operators yielded that 1,452,751 angiograms and 452,019 PTCAs were performed in 1999. This is an increase of 28% and 16%, respectively, compared with 1998. Most of these increases are due to high relative increases in eastern European countries. The number of PTCAs per 106 inhabitants rose to 714 in 1999. Coronary stenting increased by 31% to about 313,000 stents implanted in 1999. Complication rates remained stable, the need for emergency coronary artery bypass grafting showing a further slight decrease to currently 0.3%., Conclusion: Interventional cardiology in Europe is still growing, mainly due to rapid growth in countries with lower socio-economical levels. In some central European countries a saturation seemed to be reached with only minor increases in procedures performed. Coronary stenting remains the only noteworthy and growing complement or alternative to balloon angioplasty.

In contrast to those of other cardiac diseases, the morbility and morbidity of congestive cardiac insufficiency are not on the decrease, in spite of significant progress in pharmacological treatments and due to the increased life expectancy of the population. Cardiac transplant is the therapy of choice when cardiac failure becomes pharmacologically intractable, but all over the developed world (not to mention the situation in the underdeveloped countries) the number of heart transplants has reached the limit set by the availability of donor organs. Sooner or later xenotransplants could solve this problem, but even if our most optimistic hopes regarding their development and reliability are met, xenotransplants would still carry the risk of anthropozoonotic viral infections. Finally, as suggested in a recent overview, the way to the long-lasting clinical use of mechanical circulatory support is a long and winding road. Other options are related to tissue or cell cardiac bioassistance. Cardiac-bio-assists are biological approaches to the remedy of progressive cardiac failure based on autologous or heterologous tissue or cell transplantation. Some of the work hypotheses are in pre-clinical evaluation (skeletal muscle ventricle), others are under preliminary (cardiomyoplasty, myocardium reduction, implants of myoblasts derived from skeletal muscle satellite cells and implants of embryonic or adult stem cell-derived myocardiocytes, cellular cardiomyoplasty) or advanced clinical testing (dynamic aortomyoplasty and dynamic cardiomyoplasty). Dynamic cardiomyoplasty is a surgical procedure which could support myocardial function when cardiac insufficiency would become pharmacologically intractable in the mid term. In this procedure a nonessential muscle, the latissimus dorsi (LD), is diverted from its normal role, transferred into the chest, wrapped around the heart (LD wrap), conditioned to fatigue and activated during systole to provide cardiac assistance. The mechanisms of its action are discussed and the risk of myodystrophic lesions of the LD wrap which could reduce the work capability of the pericardial muscle prosthesis remains. We are now addressing some of these issues by means of clinical research on the group of Italian patients of demand dynamic cardiomyoplasty, and by means of animal experiments aimed at the development and testing of new surgical, clinical and biotechnological approaches. In particular, we will discuss whether the increase in the muscle mass of the distal part of the transposed LD is desirable and feasible or if it is mandatory.

Unlabelled: During last twenty years dramatic changes took place in methods of paediatric catheterisation. Improvement of non-invasive diagnostic techniques resulted in decrease of indications of diagnostic cardiac catheterisation. On the other hand, cardiac catheterisation nowadays is frequently used as a method for treatment. During the period since 1976 till 2002 254 pediatric therapeutic cardiac catheterisation were performed at Vilnius University Heart Surgery Clinic: 142 Rashkind septostomies, 74 pulmonary artery balloon angioplasties (BA), 5 BA of recoarctation of aorta, 8 BA of pulmonary artery branch stenosis, 2 BA of conduits after Ross repair, 2 BA of conduits after Fontan procedure, 2 BA of Waterston-Cooley anastomoses and 2 BA for congenital aortic valve stenosis. During the period since 1999 till 2002 27 patients underwent successful transcatheter closure of PA, since 2002.10 coil occlusions of aortopulmonary collaterals, arteriovenous fistulae, venous-venous connections were performed. In 2001 2 transcatheter closures of ASD were performed. While comparing our data and data presented by European Registry of Cardiology, one can see that in 2000 the amount of ASD closures and PA valvuloplasties per million population was after than the amount of those procedures per million of population in Portugal, Greece, Austria, Croatia., Conclusion: The greater part of therapeutic paediatric catheterisation procedures is significantly cheaper than surgical repair. Complications are seldom.