Publications by authors named "Con Manganas"

26 Publications

  • Page 1 of 1

Serratia Marcescens Infective Endocarditis Complicated by Aortic Root Abscess and Aorta to Right Atrial Fistula.

Heart Lung Circ 2020 Nov 28. Epub 2020 Nov 28.

Department of Surgery, St George Hospital, Sydney, NSW, Australia.

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http://dx.doi.org/10.1016/j.hlc.2020.09.941DOI Listing
November 2020

Octogenarians and aortic valve surgery: surgical outcomes in the geriatric population.

Indian J Thorac Cardiovasc Surg 2020 Mar 6;36(2):134-141. Epub 2019 Sep 6.

St George Hospital, 1 Grey St, Kogarah, Sydney, New South Wales 2217 Australia.

Background: The era of percutaneous aortic valve intervention has challenged the continuing indication for surgical aortic valve replacement (SAVR).

Aim: The aim of this study is to evaluate clinical outcomes of the elderly patients who underwent surgical aortic valve replacement via median sternotomy, in order to assess the impact of surgery on patient outcomes and discharge destination.

Methods: The study involves a retrospective observational analysis in a single centre, including all octogenarian patients who underwent aortic valve surgery between January of 2011 and July of 2016. The study assessed pre-operative co-morbidities and post-operative outcomes, including long-term mortality and discharge destination following on from surgery.

Results: The mean age of patients was 82.7 years (± 2.9), 67% of whom were male. The mean EuroSCORE II was 8.1 (± 7.6). The most common pre-operative co-morbidities were dyslipidaemia (82%), hypertension (80%), and ischaemic heart disease (78.8%). The median length of stay was 10 days (± 6.9 days). Discharge home occurred in 71.8% of patients, with 21.2% of patients requiring transfer to a rehabilitation facility, and 1.2% of patients required placement into an aged care facility. There were five peri-operative deaths, equating to 5.9% of the cohort.

Conclusion: Despite high EuroSCORE II values for the majority of our patients, our data adds to overall suggestions that the octogenarian population can be considered eligible for SAVR and should not be excluded due to age alone. The use of the EuroSCORE II index more accurately predicts adequacy for treatment however does not entirely predict overall course of events, and proceduralist discretion should still be used.
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http://dx.doi.org/10.1007/s12055-019-00853-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525844PMC
March 2020

Semiquantification of Systemic Venous Admixture During Venovenous Extracorporeal Oxygenation Via Bicaval Double-Lumen Cannula in Critically Ill Patients.

ASAIO J 2020 01;66(1):23-31

Department of Cardiothoracic Surgery, St George Hospital, Kogarah, University of New South Wales, New South Wales, Sydney, Australia.

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is increasingly utilized in acute reversible cases of severe respiratory failure and as a bridge to lung transplantation. Venovenous extracorporeal membrane oxygenation using a bicaval double-lumen cannula (BCDLC) has several advantages over the traditional ECMO configuration; however, it also presents with several unique challenges. The assessment and quantification of venous admixture is difficult due to the specific position of BCDLC within the circulatory system. We describe the nature of the double-lumen bicaval venovenous ECMO cannula and relevant specific issues associated with monitoring complex details of oxygenation within different parts of circulation, including existing barriers for quantification of recirculation and venous admix. New conceptual approach to the quantification of venous admix is described. Right side echocardiographic contrast, when sequentially injected in separate superior vena cava (SVC) and inferior vena cava (IVC) venous basins, bypasses drainage ports of the catheter in double-lumen bicaval VV-ECMO configuration together with deoxygenated returning from the periphery venous blood. It was easily detectable entering right heart chambers by two- and three-dimensional echocardiography. Amount of bubbles from the agitated fluid contrast within right atrium indicates relative amount of venous admixture in relation to the returning from the oxygenator blood which is bubble free.
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http://dx.doi.org/10.1097/MAT.0000000000000943DOI Listing
January 2020

Aortic valve laceration following coronary angiography and percutaneous coronary intervention.

J Card Surg 2016 Nov 12;31(11):686-688. Epub 2016 Sep 12.

Department of Cardiology, St George Hospital, Sydney, Australia.

Valve complications following coronary angiography and percutaneous coronary interventions are rare. We report a case of an aortic valve laceration following cardiac catheterization and percutaneous coronary intervention, which required surgical valve replacement.
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http://dx.doi.org/10.1111/jocs.12846DOI Listing
November 2016

Patient Safety During Chest Drain Insertion-A Survey of Current Practice.

J Patient Saf 2016 Sep 21. Epub 2016 Sep 21.

From the *Cardiothoracic Surgical Unit, St George Hospital, Kogarah; and †Conjoint Associate Lecturer, University of New South Wales, Sydney, New South Wales, Australia.

Objectives: The aim of this study was to identify the degree of awareness of the current guidelines and common practices for pleural drain insertion.

Methods: A 10-item questionnaire was sent electronically to junior physicians from 4 different hospitals in the South Eastern Sydney and Illawarra Shoalhaven Local Health District. Participants were asked to give their level of experience and management practices for chest drain insertion.

Results: A total of 94 junior medical officers from 4 hospitals in the district completed the survey. More than 20% had never inserted a chest drain at the time; 72% had primarily learned from bedside teaching and peer learning, but 11% had no training at all. More than 50% of physicians felt that the biggest threat to the procedure was their own lack of confidence for drain insertion. Despite current guidelines, 25% insert chest drains routinely without the aid of ultrasound. A third of interviewees were aware of local guidelines but had not read them. Most physicians (86%) believe that formal standardized training should be available for junior physicians.

Conclusions: Our findings demonstrate the ongoing need for improved procedural training in chest drain insertion, with emphasis on mandatory thoracic ultrasound. We consider it important to continue to raise concern and awareness that chest drain insertion is not a harmless procedure, and further physician procedural competence is required.
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http://dx.doi.org/10.1097/PTS.0000000000000304DOI Listing
September 2016

Peripheral Cardiopulmonary Bypass under Local Anaesthesia for Tracheal Tumour Resection.

Heart Lung Circ 2015 Jul 20;24(7):e86-8. Epub 2015 Feb 20.

Cardiac Surgery Unit, St George Hospital, Kogarah, NSW, Australia.

A 63 year-old female was diagnosed with an adenoid cystic carcinoma causing near total tracheal lumen obstruction. The tumour was successfully resected using cardiopulmonary bypass via femoral vessels under local anaesthetic before induction to secure the airway and facilitate the operation.
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http://dx.doi.org/10.1016/j.hlc.2015.01.021DOI Listing
July 2015

Ruptured left ventricular false aneurysm following acute myocardial infarction: case report and review of the literature.

Heart Lung Circ 2014 Dec 4;23(12):e261-3. Epub 2014 Aug 4.

Cardiac Surgery Unit, St George Hospital, Kogarah.

False aneurysms of the left ventricle complicating acute myocardial infarction are rare. Given they are only contained by pericardial adhesions, they are prone to rupture and hence surgical repair is mandatory. We report a successful repair of a ruptured false aneurysm and then briefly review the current literature.
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http://dx.doi.org/10.1016/j.hlc.2014.07.069DOI Listing
December 2014

Should clopidogrel be discontinued before coronary artery bypass grafting for patients with acute coronary syndrome? A systematic review and meta-analysis.

J Thorac Cardiovasc Surg 2014 Dec 23;148(6):3092-8. Epub 2014 May 23.

Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.

Objective: Patients presenting with acute coronary syndrome (ACS) are treated with dual antiplatelet agents, including aspirin and clopidogrel, to prevent mortality and recurrent ischemia. However, those who require coronary artery bypass grafting (CABG) could have increased postoperative bleeding and bleeding-related adverse outcomes. The current guidelines on clinical management differ significantly. The present meta-analysis examined the evidence for clopidogrel in the treatment of patients presenting with ACS requiring CABG, with a focus on the timing of medication cessation before surgery.

Methods: A systematic review of 9 electronic databases was performed to identify all relevant studies with comparable outcomes for patients with ACS treated with clopidogrel before CABG. The endpoints included reoperation, major bleeding, mortality, and a composite endpoint of mortality and recurrent myocardial infarction.

Results: Five relevant studies were identified according to the predefined selection criteria. Patients who had received clopidogrel had a significantly lower incidence of composite endpoints than those who had not. However, patients who underwent CABG < 5 days after the last dose of clopidogrel had a significantly greater incidence of reoperation, major bleeding, and combined adverse outcomes than those who had had a washout period >5 days.

Conclusions: The results from the present meta-analysis suggest that patients who present with ACS should be treated with dual antiplatelet therapy, including clopidogrel. However, for patients subsequently referred for CABG, a minimum washout period of 5 days should be observed to minimize perioperative bleeding and bleeding-related complications, unless emergency indications exist. These results differ from those of previous studies and guidelines.
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http://dx.doi.org/10.1016/j.jtcvs.2014.04.054DOI Listing
December 2014

Systematic review of the cost-effectiveness of transcatheter aortic valve implantation.

J Thorac Cardiovasc Surg 2014 Aug 23;148(2):509-14. Epub 2013 Nov 23.

Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia. Electronic address:

Objective: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment to aortic valve replacement (AVR) for selected patients with severe aortic stenosis. The present systematic review was conducted to analyze the cost-effectiveness of this novel technique within reimbursed healthcare systems.

Methods: Two reviewers used 7 electronic databases from January 2000 to November 2012 to identify relevant cost-effectiveness studies of TAVI versus AVR or medical therapy. The primary endpoints were the incremental cost-effectiveness ratio (ICER) and the probability of cost-effectiveness. The eligible studies for the present systematic review included those in which the cost-effectiveness data were measured or projected for TAVI and either medical therapy or AVR. All forms of TAVI were included, and all retrieved publications were limited to the English language.

Results: Eight studies were included for quantitative assessment. The ICER for TAVI compared with medical therapy for surgically inoperable patients ranged from US$26,302 to US$61,889 per quality-adjusted life year gained. The probability of TAVI being cost-effective compared with medical therapy ranged from 0.03 to 1.00. The ICER values for TAVI compared with AVR for high-risk surgical candidates ranged from US$32,000 to US$975,697 per quality-adjusted life year gained. The probability of TAVI being cost-effective in this cohort ranged from 0.116 to 0.709.

Conclusions: Depending on the ICER threshold selected, TAVI is potentially justified on both medical and economic grounds compared with medical therapy for patients deemed to be surgically inoperable. However, in the high-risk surgical patient cohort, the evidence is currently insufficient to economically justify the use of TAVI in preference to AVR.
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http://dx.doi.org/10.1016/j.jtcvs.2013.10.023DOI Listing
August 2014

Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis.

Ann Cardiothorac Surg 2013 Jan;2(1):10-23

The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; ; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia;

Background: Transcatheter aortic valve implantation (TAVI) has emerged as an acceptable treatment modality for patients with severe aortic stenosis who are deemed inoperable by conventional surgical aortic valve replacement (AVR). However, the role of TAVI in patients who are potential surgical candidates remains controversial.

Methods: A systematic review was conducted using five electronic databases, identifying all relevant studies with comparative data on TAVI versus AVR. The primary endpoint was all-cause mortality. A number of periprocedural outcomes were also assessed according to the Valve Academic Research Consortium endpoint definitions.

Results: Fourteen studies were quantitatively assessed and included for meta-analysis, including two randomized controlled trials and eleven observational studies. Results indicated no significant differences between TAVI and AVR in terms of all-cause and cardiovascular related mortality, stroke, myocardial infarction or acute renal failure. A subgroup analysis of randomized controlled trials identified a higher combined incidence of stroke or transient ischemic attacks in the TAVI group compared to the AVR group. TAVI was also found to be associated with a significantly higher incidence of vascular complications, permanent pacemaker requirement and moderate or severe aortic regurgitation. However, patients who underwent AVR were more likely to experience major bleeding. Both treatment modalities appeared to effectively reduce the transvalvular mean pressure gradient.

Conclusions: The available data on TAVI versus AVR for patients at a higher surgical risk showed that major adverse outcomes such as mortality and stroke appeared to be similar between the two treatment modalities. Evidence on the outcomes of TAVI compared with AVR in the current literature is limited by inconsistent patient selection criteria, heterogeneous definitions of clinical endpoints and relatively short follow-up periods. The indications for TAVI should therefore be limited to inoperable surgical candidates until long-term data become available.
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http://dx.doi.org/10.3978/j.issn.2225-319X.2012.11.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741825PMC
January 2013

Systematic review of trimodality therapy for patients with malignant pleural mesothelioma.

Ann Cardiothorac Surg 2012 Nov;1(4):428-37

The Systematic Review Unit, Collaborative Research (CORE) Group, Sydney, Australia; ; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia; ; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia;

Background: Malignant pleural mesothelioma (MPM) is an aggressive form of cancer arising from the pleural mesothelium. Trimodality therapy (TMT) involving extrapleural pneumonectomy with neoadjuvant or adjuvant chemotherapy and adjuvant radiotherapy is a recognized treatment option with a curative intent. Despite encouraging results from institutional studies, TMT in the treatment of MPM remains controversial. The present systematic review aims to assess the safety and efficacy of TMT in the current literature.

Methods: A systematic review was performed using five electronic databases from 1 January 1985 to 1 October 2012. Studies were selected independently by two reviewers according to predefined selection criteria. The primary endpoint was overall survival. Secondary endpoints included disease-free survival, disease recurrence, perioperative morbidity and length of stay.

Results: Sixteen studies were included for quantitative assessment, including one randomized controlled trial and five prospective series. Median overall survival ranged from 12.8-46.9 months. Disease-free survival ranged from 10-16.3 months. Perioperative mortality ranged from 0-12.5%. Overall perioperative morbidity ranged from 50-82.6% and the average length of stay was 9-14 days.

Conclusions: Outcomes of patients who underwent TMT in the current literature appeared to be inconsistent. Four prospective series involving a standardised treatment regimen with neoadjuvant chemotherapy indicated encouraging results based on intention-to-treat analysis. However, a small study assessing the feasibility of conducting a randomized controlled trial for TMT versus conservative treatment reported poor short- and long-term outcomes for patients who underwent pneumonectomy. Overall, results of the present systematic review suggest TMT may offer acceptable perioperative outcomes and long-term survival in selected patients treated in specialized centers.
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http://dx.doi.org/10.3978/j.issn.2225-319X.2012.11.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741794PMC
November 2012

Right ventricular loop indicating malposition of J-wire introducer for double lumen bicaval venovenous extracorporeal membrane oxygenation (VV ECMO) cannula.

Heart Lung Circ 2014 Jan 21;23(1):e4-7. Epub 2013 Jun 21.

Department of Cardiothoracic Surgery, St. George Hospital, Australia.

The key to safe placement of a bicaval double lumen cannula for Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) is to visualise correct guide wire placement in the inferior vena cava (IVC), thus aiding subsequent correct advancement of the cannula. Transoesophageal (TOE) and transthoracic (TTE) echocardiography, as well as fluoroscopy, have been described as aiding imaging techniques. We report a case of guide wire malposition into the right ventricle, despite echocardiographic confirmation of guide wire position deep into the IVC. This malposition, if undetected, may have resulted in potential life threatening complications.
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http://dx.doi.org/10.1016/j.hlc.2013.05.643DOI Listing
January 2014

Reply to the editor.

J Thorac Cardiovasc Surg 2013 Apr;145(4):1147-1148

The Systematic Review Unit, Collaborative Research (CORE) Group, Sydney, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia; Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia.

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http://dx.doi.org/10.1016/j.jtcvs.2012.12.078DOI Listing
April 2013

Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients.

Interact Cardiovasc Thorac Surg 2013 Mar 20;16(3):244-9. Epub 2012 Nov 20.

Collaborative Research (CORE) Group, Sydney, Australia.

Objectives: This meta-analysis aimed to compare the perioperative outcomes of video-assisted thoracic surgery (VATS) with open thoracotomy for propensity score-matched patients with early-stage non-small cell lung cancer (NSCLC).

Methods: Four relevant studies with propensity score-matched patients were identified from six electronic databases. Endpoints included perioperative mortality and morbidity, individual postoperative complications and duration of hospitalization.

Results: Results indicate that all-cause perioperative mortality was similar between VATS and open thoracotomy. However, patients who underwent VATS were found to have significantly fewer overall complications, and significantly lower rates of prolonged air leak, pneumonia, atrial arrhythmias and renal failure. In addition, patients who underwent VATS had a significantly shorter length of hospitalization compared with those who underwent open thoracotomy.

Conclusions: In view of a paucity of high-level clinical evidence in the form of large, well-designed randomized controlled trials, propensity score matching may provide the highest level of evidence to compare VATS with open thoracotomy for patients with NSCLC. The present meta-analysis demonstrated superior perioperative outcomes for patients who underwent VATS, including overall complication rates and duration of hospitalization.
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http://dx.doi.org/10.1093/icvts/ivs472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568798PMC
March 2013

Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: a meta-analysis of randomized controlled trials.

J Thorac Cardiovasc Surg 2013 Aug 4;146(2):255-61. Epub 2012 Aug 4.

The Systematic Review Unit, The Collaborative Research Group, Sydney, Australia.

Introduction: The efficacy of coronary artery bypass graft (CABG) surgery for patients with ischemic heart disease is dependent on the patency of the selected conduit. The left internal thoracic artery is considered to be the best conduit for CABG. However, the preferred conduit between the radial artery (RA) and saphenous vein (SV) remains controversial. The present meta-analysis aims to establish the current level IA evidence on patency outcomes comparing the RA and SV.

Methods: Electronic searches were performed using 6 databases from their inception to March 2012. Two reviewers independently identified all relevant randomized controlled trials (RCTs) comparing patency outcomes of RA and SV grafts after CABG. Data were extracted and meta-analyzed according to angiographic end points at specified follow-up intervals.

Results: Five relevant RCTs were identified for inclusion in the present meta-analysis. Angiographic results indicated that the RA was significantly more likely to be completely patent and less likely to be associated with graft failure or complete occlusion at 4 years' follow-up and beyond. However, the RA was significantly more likely to be associated with string sign at 1 year of follow-up.

Conclusions: While acknowledging the limitations of heterogeneous surgical techniques, results from the present meta-analysis suggest potential superiority of the RA compared with the SV at midterm angiographic follow-up. However, the increased incidence of string sign associated with the RA is of potential clinical concern. Further research should be directed at correlating angiographic findings of string sign and graft failure to clinical symptoms and major adverse cardiac and cerebrovascular events at long-term follow-up.
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http://dx.doi.org/10.1016/j.jtcvs.2012.07.014DOI Listing
August 2013

A meta-analysis of unmatched and matched patients comparing video-assisted thoracoscopic lobectomy and conventional open lobectomy.

Ann Cardiothorac Surg 2012 May;1(1):16-23

The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; ; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; ; Department of Cardiothoracic Surgery, St. George Hospital, Sydney, NSW, Australia.

Background: Video-assisted thoracic surgery (VATS) for patients with early-stage non-small cell lung cancer (NSCLC) has been established as a safe and feasible alternative to open thoracotomy. This meta-analysis aims to assess the potential difference between unmatched and propensity score-matched cohorts who underwent VATS versus open thoracotomy in the current literature.

Methods: Three relevant studies with unmatched and propensity score-matched patients were identified from six electronic databases to examine perioperative outcomes after VATS lobectomy versus open thoracotomy for patients with early-stage NSCLC. Endpoints included perioperative mortality and morbidity, individual postoperative complications and duration of hospitalization.

Results: Results indicate that perioperative mortality was significantly lower for VATS compared to open thoracotomy in unmatched patients but no significant difference was detected amongst propensity score-matched patients. Similarly, the incidences of prolonged air leak and sepsis were significantly lower for VATS in the unmatched cohort, but not identified in the propensity score-matched cohort. In both the unmatched and matched groups, patients who underwent VATS were found to have a significantly lower overall perioperative morbidity rate, incidences of pneumonia and atrial arrhythmias, and a shorter duration of hospitalization in comparison to patients who underwent open thoracotomy.

Conclusions: The present meta-analysis indicates that VATS lobectomy has superior perioperative outcomes compared to open thoracotomy in both matched and unmatched cohorts. However, the extent of the superiority may have been overestimated in the unmatched patients when compared to propensity score-matched patients. Due to the limited number of studies with available data included in the present meta-analysis, these results are only of observational interest and should be interpreted with caution.
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http://dx.doi.org/10.3978/j.issn.2225-319X.2012.04.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741727PMC
May 2012

A systematic review and meta-analysis on pulmonary resections by robotic video-assisted thoracic surgery.

Ann Cardiothorac Surg 2012 May;1(1):3-10

The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; ; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia; ; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia.

Background: Pulmonary resection by robotic video-assisted thoracic surgery (RVATS) has been performed for selected patients in specialized centers over the past decade. Despite encouraging results from case-series reports, there remains a lack of robust clinical evidence for this relatively novel surgical technique. The present systematic review aimed to assess the short- and long-term safety and efficacy of RVATS.

Methods: Nine relevant and updated studies were identified from 12 institutions using five electronic databases. Endpoints included perioperative morbidity and mortality, conversion rate, operative time, length of hospitalization, intraoperative blood loss, duration of chest drainage, recurrence rate and long-term survival. In addition, cost analyses and quality of life assessments were also systematically evaluated. Comparative outcomes were meta-analyzed when data were available.

Results: All institutions used the same master-slave robotic system (da Vinci, Intuitive Surgical, Sunnyvale, California) and most patients underwent lobectomies for early-stage non-small cell lung cancers. Perioperative mortality rates for patients who underwent pulmonary resection by RVATS ranged from 0-3.8%, whilst overall morbidity rates ranged from 10-39%. Two propensity-score analyses compared patients with malignant disease who underwent pulmonary resection by RVATS or thoracotomy, and a meta-analysis was performed to identify a trend towards fewer complications after RVATS. In addition, one cost analysis and one quality of life study reported improved outcomes for RVATS when compared to open thoracotomy.

Conclusions: Results of the present systematic review suggest that RVATS is feasible and can be performed safely for selected patients in specialized centers. Perioperative outcomes including postoperative complications were similar to historical accounts of conventional VATS. A steep learning curve for RVATS was identified in a number of institutional reports, which was most evident in the first 20 cases. Future studies should aim to present data with longer follow-up, clearly defined surgical outcomes, and through an intention-to-treat analysis.
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http://dx.doi.org/10.3978/j.issn.2225-319X.2012.04.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741728PMC
May 2012

Drug-eluting stents versus coronary artery bypass graft surgery in left main coronary artery disease: a meta-analysis of early outcomes from randomized and nonrandomized studies.

J Thorac Cardiovasc Surg 2013 Mar 9;145(3):738-47. Epub 2012 Mar 9.

The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia.

Objective: The present meta-analysis aimed to compare the short-term safety and efficacy of drug-eluting stents and coronary artery bypass graft surgery for patients with left main coronary artery disease.

Methods: Fourteen relevant studies were identified from 5 electronic databases. End points included mortality, stroke, myocardial infarction, repeat revascularization, and major adverse cardiac and cerebrovascular events.

Results: Results indicate that all-cause mortality was similar between drug-eluting stents and coronary artery bypass grafting at 30 days and at follow-up beyond 1 year. Likewise, the incidence of myocardial infarction was similar between drug-eluting stents and coronary artery bypass grafting at 12 months and at follow-up beyond 1 year. However, drug-eluting stents were associated with a lower incidence of all-cause mortality at 12 months and a higher incidence of myocardial infarction at 30 days compared with coronary artery bypass grafting. Drug-eluting stents were consistently associated with a higher incidence of repeat revascularization, whereas coronary artery bypass grafting had a higher incidence of stroke. The incidence of major adverse cardiac and cerebrovascular events was similar between the 2 groups at 30 days but higher for drug-eluting stents at 12 months and beyond.

Conclusions: Patients treated by drug-eluting stents in randomized controlled trials and observational studies in the current literature are often a preselected subgroup with less complex lesions compared with the overall target population. Results drawn from these studies should be viewed with caution. Coronary artery bypass grafting is associated with a lower incidence of major adverse cardiac and cerebrovascular events at 1 year and beyond, and thus should be regarded as the standard of treatment. However, drug-eluting stents may have a role for selected patients with percutaneously amenable left main disease who are poor surgical candidates.
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http://dx.doi.org/10.1016/j.jtcvs.2012.02.004DOI Listing
March 2013

Early stenosis of Medtronic Mosaic bioprosthesis in the aortic position.

J Thorac Cardiovasc Surg 2012 Feb 20;143(2):e13-4. Epub 2011 Nov 20.

Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia.

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http://dx.doi.org/10.1016/j.jtcvs.2011.10.041DOI Listing
February 2012

Evaluation of arterial grafts prior to coronary bypass in pseudoxanthoma elasticum.

Heart Lung Circ 2011 Nov 8;20(11):726-7. Epub 2011 Sep 8.

Department of Vascular Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia.

Pseudoxanthoma elasticum is a rare, inherited connective tissue disorder associated with coronary and peripheral arterial disease and accelerated atherosclerosis in medium sized arteries. We describe 110-month symptom-free survival in a patient with pseudoxanthoma elasticum who underwent coronary bypass using the left internal mammary artery at 56 years of age. The vessel was evaluated pre-operatively with angiography to determine suitability, and he has not required further investigation or intervention due to lack of symptoms.
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http://dx.doi.org/10.1016/j.hlc.2011.08.007DOI Listing
November 2011

Limited excision of a right atrial lipoma.

Heart Lung Circ 2009 Oct 30;18(5):370-1. Epub 2008 Jul 30.

Department of Cardiothoracic Surgery, St George Hospital & the University of New South Wales, Gray Street, Kogarah, NSW 2217, Sydney, Australia.

A 67-year-old female presented with a 1-year history of exertional dyspnoea. Echocardiography showed a mass in the right atrium. Surgery revealed a lipoma on the interatrial septum, near the superior cavoatrial junction. This was excised leaving the atrial septum intact. Histopathology confirmed a benign lipoma. The patient improved symptomatically after surgery and no recurrence was seen after 1 year. These rare masses are the accumulation of mature adipose tissue, arising from the subepicardial layer. Due to benign pathology and slow growth, right atrial lipomas may be resected without interatrial septum resection, avoiding the potential complications of more radical surgery.
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http://dx.doi.org/10.1016/j.hlc.2008.04.007DOI Listing
October 2009

Levosimendan for patients with impaired left ventricular function undergoing cardiac surgery.

Interact Cardiovasc Thorac Surg 2006 Jun 23;5(3):322-6. Epub 2006 Mar 23.

Department of Cardiothoracic Surgery, Prince of Wales Hospital, Barker Street, Randwick, New South Wales, 2031, Australia.

The efficacy of levosimendan treatment for a low cardiac output status following cardiac surgery has not been established. Here, we review our initial experiences of the perioperative use of levosimendan. This study is a retrospective uncontrolled trial. Nine patients who underwent cardiac surgery, and developed a low cardiac output status resistant to conventional inotropic support, were given levosimendan. The mean preoperative ejection fraction was 35.2+/-3.4%. All patients were on concomitant inotropic agents and had previously undergone intra-aortic balloon pumping. Cardiac index increased immediately from 2.14+/-0.33 l/min/m(2) at baseline to 2.41+/-0.31 (P=0.02) at 1 h, rising to 2.67+/-0.43 (P<0.001) at 4 h after the loading dose was started. Similarly, the systemic vascular resistance index decreased from 2350+/-525 dynes/s/cm(-5)/m(2) at baseline to 1774+/-360 (P=0.002) at 4 h. In the case of all but one of the patients, either the dose of the concomitant inotropic support or the balloon pumping could be weaned down within 24 h after completion of the levosimendan infusion. No withdrawal of levosimendan was required. Levosimendan could constitute a new therapeutic option for postoperative low cardiac output.
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http://dx.doi.org/10.1510/icvts.2005.122390DOI Listing
June 2006

A tale of two toes.

Heart Lung Circ 2006 Aug 9;15(4):267-8. Epub 2006 Jun 9.

Prince Of Wales Hospital, Sydney, Australia.

Percutaneous closure of a patent foramen ovale (PFO) is increasingly being performed for patients with suspected paradoxical embolus. We report a rare case of a PFO occluder device related infective endocarditis.
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http://dx.doi.org/10.1016/j.hlc.2006.04.001DOI Listing
August 2006

A simple system to deliver blood cardioplegia.

Ann Thorac Surg 2005 Nov;80(5):1946-7

Department of Cardiothoracic Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia.

We describe a simple and inexpensive system designed to deliver blood cardioplegia either diluted or at the patient's hematocrit, with controlled temperature and additive concentration. This system can be applied to any pump set, and suits any strategy for clinical myocardial preservation.
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http://dx.doi.org/10.1016/j.athoracsur.2004.05.005DOI Listing
November 2005

Traumatic pulmonary arteriovenous malformation presenting with massive hemoptysis 30 years after penetrating chest injury.

Ann Thorac Surg 2003 Sep;76(3):942-4

Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia.

A 39-year-old man presented with massive hemoptysis requiring emergency double lumen endobronchial intubation, bronchial arteriography and embolization, and subsequent right lower lobectomy. He had suffered a shrapnel blast injury to the right chest as a 9-year-old boy. Pathology of the resected specimen revealed lodged metallic foreign body with traumatic arteriovenous malformation. We present this case to alert thoracic surgeons to this extremely rare clinical entity that can present itself many years after the penetrating trauma, which requires urgent surgery.
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http://dx.doi.org/10.1016/s0003-4975(03)00527-7DOI Listing
September 2003

Pseudoxanthoma elasticum: is the left internal mammary artery a suitable conduit for coronary artery bypass grafting?

Ann Thorac Surg 2002 Feb;73(2):652-3

Department of Cardiothoracic Surgery, The Prince of Wales Hospital, The University of New South Wales, Sydney, Australia.

Coronary artery revascularization remains a feasible and beneficial treatment for coronary artery disease in patients with pseudoxanthoma elasticum. Careful angiographic evaluation of the left internal mammary artery and coronary arteries is required in patients with pseudoxanthoma elasticum with suspected coronary artery disease. A nonstenosed left internal mammary artery at angiography may be used as a conduit for coronary artery revascularization; however, both the effect of harvest and anastomosis on the disease process in the left internal mammary artery and the long-term patency of left internal mammary artery grafts remain unknown.
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http://dx.doi.org/10.1016/s0003-4975(01)03011-9DOI Listing
February 2002