Publications by authors named "Laura S Fong"

15 Publications

  • Page 1 of 1

Postural orthostatic tachycardia syndrome following open thoracoabdominal aortic aneurysm repair.

J Surg Case Rep 2021 Feb 16;2021(2):rjab012. Epub 2021 Feb 16.

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

Postural orthostatic tachycardia syndrome (POTS) is a variant of cardiovascular autonomic disorder characterised by an excessive heart rate on standing and orthostatic intolerance. We present a rare case of a 38-year-old man who underwent open repair of a thoracoabdominal aortic aneurysm for a chronic Stanford type B aortic dissection whose recovery was complicated by POTS. He received blood transfusions and was commenced on metoprolol, fludrocortisone and ivabradine with significant improvement in his symptoms. Correct assessment of postoperative tachycardia including postural telemetry is the key to identifying this condition and its successful management.
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http://dx.doi.org/10.1093/jscr/rjab012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888977PMC
February 2021

Characterisation of Rare Left Partial Anomalous Pulmonary Venous Connection.

Heart Lung Circ 2020 Nov 20. Epub 2020 Nov 20.

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

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http://dx.doi.org/10.1016/j.hlc.2020.10.021DOI Listing
November 2020

Robotic approach to the porcelain aorta: staged transcatheter aortic valve replacement and robotically assisted coronary artery bypass.

ANZ J Surg 2020 Jul 20. Epub 2020 Jul 20.

Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.16183DOI Listing
July 2020

Should cardiac surgery be delayed in patients with uncorrected hypothyroidism?

Interact Cardiovasc Thorac Surg 2020 11;31(5):618-621

Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, NSW, Australia.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'should cardiac surgery be delayed in patients with uncorrected hypothyroidism?' A total of 1412 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There was limited high-quality evidence with the majority of the studies being retrospective. One propensity-matched analysis and 6 cohort studies provided the evidence that there was no significant difference in the rate of major adverse cardiac events including mortality based on thyroid status. However, hypothyroidism and subclinical hypothyroidism were associated with higher rates of postoperative atrial fibrillation. Based on the available evidence, we conclude that cardiac surgery should not be delayed to allow achievement of euthyroid status.
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http://dx.doi.org/10.1093/icvts/ivaa172DOI Listing
November 2020

Comparison of novel oral anticoagulants versus warfarin for post-operative atrial fibrillation after coronary artery bypass grafting.

Ann Med Surg (Lond) 2020 Oct 8;58:130-133. Epub 2020 Sep 8.

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

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does the use of Novel Oral Anticoagulants (NOACs) result in more complications than Warfarin for treatment of post-operative atrial fibrillation (AF) following coronary artery bypass grafting (CABG)?' Altogether more than 93 papers were found using the reported search with 4 studies representing the best evidence to answer the clinical question, including 1 randomised trial and 3 retrospective case-control studies. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Timing for initiation of anticoagulation was similar across the studies, with both demonstrating longer hospital stays and greater time to reach therapeutic anticoagulation in the warfarin cohort. Three studies reported similar safety between the two groups. One study revealed significantly more invasive interventions for pleural or pericardial effusions in the NOAC group, whilst in contrast another study demonstrated a higher rate of major bleeding in the warfarin cohort. Cost-analysis revealed that NOACs were overall more cost-effective compared to warfarin despite the higher cost for the medication itself. In conclusion, the use of NOACs after CABG for post-operative AF can be used as an alternative to warfarin, however, one should remain vigilant for possible pericardial or pleural effusions which may require reintervention. Further dedicated research and larger appropriately powered randomised control trials are needed to confirm the safety of NOACs in post-cardiac surgery patients.
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http://dx.doi.org/10.1016/j.amsu.2020.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493037PMC
October 2020

'Is totally endoscopic coronary artery bypass grafting compared with minimally invasive direct coronary artery bypass grafting associated with superior outcomes in patients with isolated left anterior descending disease?'

Ann Med Surg (Lond) 2020 Sep 11;57:264-267. Epub 2020 Aug 11.

Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is totally endoscopic coronary artery bypass grafting compared with minimally invasive direct coronary artery bypass grafting associated with superior outcomes in patients with isolated left anterior descending disease?' Altogether more than 118 papers were found using the reported search, of which 4 represented the best evidence to answer the clinical question, which included 2 prospective cohort studies and 2 retrospective observational studies. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. There is a significant variation within the MIDCAB and TECAB techniques amongst the studies-including the experience of the surgeon, use of cardiopulmonary bypass, patient selection, and target vessel grafting strategies-highlighting the complexity of comparing these two minimally invasive procedures. Operative times were comparable across all studies, with TECAB patients having higher transfusions rates and conversion rates to either a median sternotomy or MIDCAB procedure. Overall safety was comparable between the two cohort groups, with similar length of stay and 30-day mortality. However, the TECAB group were more likely to require re-operation for bleeding and reintervention for early revascularisation with greater total hospital costs than the MIDCAB patients. Based on the available evidence, we conclude that TECAB is associated with a higher rate of transfusions, conversion to median sternotomy or MIDCAB, early graft failure and reintervention compared to the MIDCAB approach. We advise caution in adopting a TECAB approach.
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http://dx.doi.org/10.1016/j.amsu.2020.07.060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453057PMC
September 2020

In patients undergoing dialysis who require a valve replacement is a bioprosthetic valve superior to a mechanical prosthesis in terms of long-term survival and morbidity?

Interact Cardiovasc Thorac Surg 2020 08;31(2):174-178

Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, NSW, Australia.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In [dialysis patients undergoing a valve replacement] is [a bioprosthetic valve superior to a mechanical prosthesis] for [long-term survival and morbidity]'. Altogether more than 501 papers were found using the reported search, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There was limited high-quality evidence with all studies being retrospective. One meta-analysis and four cohort studies provided the evidence that there was no significant difference in long-term survival based on prosthesis type. However, the majority of studies demonstrated a significantly higher rate of valve-related complications including bleeding and thromboembolism, and readmission to hospital in the mechanical valve prosthesis group, likely related to the requirement for long-term anticoagulation. We conclude that overall long-term survival in dialysis-dependent patients is poor. While prosthesis type does not play a significant contributing role to long-term survival, bioprosthetic valves were associated with significantly fewer valve-related complications. Based on the available evidence, a bioprosthetic valve may be more suitable in this high-risk group of patients as it may avoid the complications associated with long-term anticoagulation without any reduction in long-term survival.
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http://dx.doi.org/10.1093/icvts/ivaa084DOI Listing
August 2020

Outcomes of video-assisted thoracoscopic surgery lobectomy in septuagenarians.

ANZ J Surg 2020 05 29;90(5):752-756. Epub 2020 Apr 29.

Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.

Background: Spread of technology and increased surveillance have led to more patients with lung cancers being identified than ever before. Increasingly, patients from the elderly population are referred for surgery; however, many studies do not focus on this patient group. We reviewed the outcomes of septuagenarians who underwent lobectomy via an open thoracotomy (OT) or video-assisted thoracoscopic surgery (VATS) approach to determine whether the VATS approach would result in superior post-operative outcomes.

Methods: Between January 2010 and June 2016, a total of 96 patients aged 70 years or older underwent a lobectomy for non-small cell lung carcinoma. Patients who underwent resection for metastatic disease, small cell lung cancer or neuroendocrine tumour were excluded. Demographic details, early and late post-operative outcomes including post-operative arrhythmia, myocardial infarction, respiratory failure, cerebrovascular events, infection, prolonged air leak, delirium, readmission and 30-day mortality were studied. Mean follow-up duration was 23 ± 19.1 months.

Results: Seventy-five patients underwent lobectomy via a VATS approach and 21 patients underwent lobectomy via an OT approach. There was no 30-day mortality and no difference in overall survival between the two techniques (P = 0.25). There was no significant difference between the two techniques with regard to post-operative stroke, myocardial infarction, atrial fibrillation, pneumonia, delirium or bronchopleural fistula. VATS patients had a significantly shorter mean hospital length of stay (VATS 4.7 days, OT 9.3 days, P = 0.005).

Conclusion: Septuagenarians with non-small cell lung carcinoma can successfully undergo curative lung resection with a low incidence of post-operative complications.
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http://dx.doi.org/10.1111/ans.15788DOI Listing
May 2020

Complete atrioventricular septal defect repair in Australia: Results over 25 years.

J Thorac Cardiovasc Surg 2020 03 30;159(3):1014-1025.e8. Epub 2019 Aug 30.

Heart Centre for Children, Children's Hospital at Westmead, Sydney, Australia; The University of Sydney Children's Hospital Westmead Clinical, Children's Hospital at Westmead, Sydney, Australia.

Objectives: To evaluate whether the long-term outcomes of modified-single-patch (MSP) repair of complete atrioventricular septal defect are equivalent to double-patch (DP) repair with respect to survival and risk of reoperation for left atrioventricular valve regurgitation or left ventricular outflow tract obstruction.

Methods: All patients who underwent biventricular repair of complete atrioventricular septal defect in Australia from 1990 to 2015 using either a MSP or DP technique were identified. Demographic characteristic details, operative data, and outcomes were analyzed. A propensity score analysis was performed to balance the 2 treatment groups according to several baseline covariates. Survival and freedom from reintervention between the 2 groups were compared using Kaplan-Meier curves and log-rank tests.

Results: A total of 819 patients underwent repair of complete atrioventricular septal defect (252 MSP and 567 DP) during the study period. There was no significant difference in unmatched survival (P = .85) and event-free survival (P = .49) between MSP and DP repair. Propensity score matching resulted in a total of 223 matched pairs. Matched analysis found no difference in overall survival (P = .59) or event-free survival (P = .90) between repair techniques, with an estimated event-free survival at 5, 10, and 15 years of 83%, 83%, and 74% for DP and 83%, 80%, and 77% for the MSP group, respectively. There was no significant difference between repair techniques in reoperation for left atrioventricular valve regurgitation or left ventricular outflow tract obstruction or need for permanent pacemaker.

Conclusions: Overall and event free survival are similar following either MSP or DP repair of complete atrioventricular septal defect. There is no increased risk of reoperation for left ventricular outflow tract obstruction with the MSP technique.
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http://dx.doi.org/10.1016/j.jtcvs.2019.08.005DOI Listing
March 2020

Modified-Single Patch vs Double Patch Repair of Complete Atrioventricular Septal Defects.

Semin Thorac Cardiovasc Surg 2020 12;32(1):108-116. Epub 2019 Jul 12.

Discipline of Child and Adolescent Health, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia; Heart Centre for Children, The Children's Hospital at Westmead, Westmead, Australia.

Biventricular repair of complete atrioventricular septal defect (CAVSD) is largely achieved using the double-patch (DP) or modified single-patch (MSP) techniques in the current era; however, long-term results following MSP repair are not well defined. We aimed to compare long-term outcomes including reoperation and mortality after CAVSD repair using DP and MSP techniques, and identify the risk factors associated with adverse outcomes. A retrospective cohort study was performed including all patients who underwent CAVSD repair using DP and MSP techniques at our institution between 17 May 1990 and 14 December 2015. Demographic details, early (≤30 days) and late (>30 days) outcomes (reoperation, mortality) were studied. Competing risks analysis with cumulative incidence function was used for survival analyses. Overall, 273 consecutive patients underwent CAVSD repair (120 DP and 153 MSP) and 41 patients required reoperation during follow-up. Competing risks analysis showed no association between repair technique and reoperation (P = 1.0) or mortality (P = 0.9). Considering competing risks due to mortality, the cumulative incidence of reoperation at 5, 10, and 15 years was 14%, 17%, and 17% for DP and 12%, 13%, and 16% for MSP, respectively. Non-Down syndrome and moderate or greater left atrioventricular valve regurgitation were predictors for reoperation. Pulmonary artery banding was predictive of mortality, though strongly associated with earlier surgical era. Median follow-up duration was 8.0 years (interquartile range 3.9-20.8) for DP and 11.6 years (interquartile range 5.4-16.1) for MSP (P = 0.4). Event-free survival is similar after DP and MSP repair of CAVSD indicating either repair technique can be safely utilized.
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http://dx.doi.org/10.1053/j.semtcvs.2019.07.004DOI Listing
June 2020

Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects?

Interact Cardiovasc Thorac Surg 2019 03;28(3):427-431

The University of Sydney Children's Hospital Westmead Clinical School, Westmead NSW, Australia.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, 'Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects?'. A total of 634 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question, which included 1 meta-analysis and 8 cohort studies. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. There was limited high-quality evidence available, with all the included studies being retrospective and observational in nature. One meta-analysis and 8 cohort studies provided evidence that there was no significant difference in survival or other postoperative outcomes based on a surgical technique during follow-up ranging from 6 months to 4.2 years. Surgical reintervention for development of left ventricular outflow tract obstruction, left atrioventricular valve dysfunction or residual septal defects after the initial repair of complete atrioventricular septal defect was not significantly different between cohorts in almost all studies. Cardiopulmonary bypass and aortic cross-clamp times were significantly shorter with the modified single-patch repair compared to the double-patch repair in all studies that examined these variables, but this did not correspond to a difference in outcomes. We conclude, based on the available evidence, that the modified single-patch repair of complete atrioventricular septal defect is similar to the double-patch repair in terms of postoperative outcomes. However, this conclusion is limited by the retrospective nature of all studies, small cohort sizes and short durations of follow-up in addition to lack of statistical analysis in 1 study.
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http://dx.doi.org/10.1093/icvts/ivy261DOI Listing
March 2019

Surgical Management of Caseous Calcification of the Mitral Annulus.

Ann Thorac Surg 2017 Sep;104(3):e291-e293

Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia; Department of Cardiothoracic Surgery, St. John of God Hospital, Subiaco, Western Australia; School of Medicine Fremantle, The University of Notre Dame Australia, Fremantle, Western Australia; The Baird Institute, Newtown, New South Wales, Australia. Electronic address:

Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification; it can manifest with conduction abnormalities or systemic embolization. It typically involves the posterior mitral annulus, and surgery is indicated for severe mitral valve dysfunction, for embolic complications or when the diagnosis is not certain. We describe a structured approach to the surgical management of CCMA using bovine pericardium to repair the defect.
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http://dx.doi.org/10.1016/j.athoracsur.2017.04.039DOI Listing
September 2017

Intraoperative coronary angiography: a novel method.

Ann Thorac Surg 2014 Aug;98(2):730

Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia.

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http://dx.doi.org/10.1016/j.athoracsur.2014.03.046DOI Listing
August 2014

Liberal use of axillary artery cannulation for aortic and complex cardiac surgery.

Interact Cardiovasc Thorac Surg 2013 Jun 28;16(6):755-8. Epub 2013 Feb 28.

Department of Cardiothoracic Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.

Objectives: Axillary artery cannulation for cardiopulmonary bypass has been described previously as a safe and reliable technique, with a low risk of atheroemboli, avoidance of malperfusion in aortic dissection and facilitation of selective antegrade cerebral perfusion during hypothermic circulatory arrest. The aim of this study was to document the broad applicability of axillary cannulation and its associated morbidity and identify where it was not possible to use planned axillary cannulation.

Methods: A retrospective review of a single surgeon's 10-year experience of axillary cannulation using the side-graft technique in 184 consecutive patients (age 22-92 years) in aortic and complex cardiac surgery from July 2002 to June 2012.

Results: There were no intraoperative deaths and no major complications related to axillary artery use. There were six postoperative deaths unrelated to axillary artery cannulation. Six patients (3.3%) had minor complications as a direct result of axillary cannulation including seroma, haematoma, chronic pain and pectoralis major muscle atrophy. There were 10 cases where planned axillary cannulation was abandoned, due to inadequate size of the axillary artery in 8 patients and axillary artery dissection and morbid obesity in 1 patient each.

Conclusions: Axillary artery cannulation is an ideal arterial inflow site in cases where the ascending aorta is unsuitable as it is safe, reliable and reduces the risks of atheroembolization and malperfusion. Major complications are rare with this meticulous technique and it is our standard practice in complex cardiac and aortic surgery.
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http://dx.doi.org/10.1093/icvts/ivt056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653471PMC
June 2013

Right atrial Merkel cell tumour metastasis characterization using a multimodality approach.

Eur Heart J 2012 Sep 4;33(17):2205. Epub 2012 Mar 4.

Sydney Medical School, University of Sydney, NSW 2006, Australia.

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http://dx.doi.org/10.1093/eurheartj/ehs030DOI Listing
September 2012