Publications by authors named "Manuel J Antunes"

184 Publications

Rheumatic heart disease: The role of global cardiac surgery.

J Card Surg 2021 May 3. Epub 2021 May 3.

International Children's Heart Fund, Minneapolis, Minnesota, USA.

Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high-income countries due to timely detection and treatment of acute rheumatic fever, RHD remains highly prevalent in low- and middle-income countries (LMICs) and among indigenous and disenfranchised populations in high-income countries. As a result, over 30 million people in the world have RHD, of which approximately 300,000 die each year despite this being a preventable and treatable disease. In LMICs, such as in Latin America, sub-Saharan Africa, and Southeast Asia, access to cardiac surgical care for RHD remains limited, impacting countries' population health and resulting economic growth. Humanitarian missions play a role in this context but can only make a difference in the long term if they succeed in training and establishing autonomous local surgical teams. This is particularly difficult because these populations are typically young and largely noncompliant to therapy, especially anticoagulation required by mechanical valve prostheses, while bioprostheses have unacceptably high degeneration rates, and valve repair requires considerable experience. Devoted and sustained leadership and local government and public health cooperation and support with the clinical medical and surgical sectors are absolutely essential. In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.15597DOI Listing
May 2021

Commentary: Mitral Stenosis After Undersized Annuloplasty for Secondary Mitral Regurgitation. Physics Can't Be Wrong.

Authors:
Manuel J Antunes

Semin Thorac Cardiovasc Surg 2021 Apr 17. Epub 2021 Apr 17.

Clinic of Cardiothoracic Surgery, Faculty of Medicine, University of Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.semtcvs.2021.03.025DOI Listing
April 2021

Commentary: The aortic valve after rheumatic mitral valve surgery. Remarkably stable!

Authors:
Manuel J Antunes

J Thorac Cardiovasc Surg 2021 Mar 18. Epub 2021 Mar 18.

Clinic of Cardiothoracic Surgery, Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2021.03.048DOI Listing
March 2021

Current status of the treatment of degenerative mitral valve regurgitation.

Rev Port Cardiol 2021 Apr 19;40(4):293-304. Epub 2021 Mar 19.

Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Electronic address:

Degenerative mitral valve disease (myxomatous degeneration or fibroelastic deficiency) is the most common indication for surgical referral to treat mitral regurgitation. Mitral valve repair is the procedure of choice whenever feasible and when the results are expected to be durable. Posterior leaflet prolapse is the commonest lesion, found in up to two-thirds of patients. It is the easiest to repair, particularly when limited to one segment. In these cases, rates of repairability and procedural success approach 100%, and there is now ample evidence that the immediate and long-term results are better than those of valve replacement. Notably, minimally invasive valvular procedures, surgical or interventional, have attracted increasing interest in the last decade. When performed by experienced groups, mitral valve repair is unrivaled irrespective of the severity of lesions, from simple to complex, which leaflets are involved, and the type of degenerative involvement (myxomatous or fibroelastic). Its results should be viewed as the benchmark for other present and future technologies. By contrast, percutaneous mitral valve repair is still in its infancy and its results so far fall short of those of surgical repair. Nevertheless, continued investment in transcatheter procedures is of great importance to enable development and improved accessibility, particularly for patients who are considered unsuitable for surgery. In this review, we analyze the current status of management of degenerative mitral valve disease, discussing mitral valve anatomy and pathology, indications for intervention, and current surgical and transcatheter mitral valve procedures and results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.repc.2020.10.011DOI Listing
April 2021

Risk-Prediction Model for Transfusion of Erythrocyte Concentrate During Extracorporeal Circulation in Coronary Surgery.

Braz J Cardiovasc Surg 2021 Mar 1. Epub 2021 Mar 1.

Department of Cardiothoracic Surgery, University of Coimbra Faculty of Medicine, Coimbra, Portugal.

Introduction: Our objective was to identify preoperative risk factors and to develop and validate a risk-prediction model for the need for blood (erythrocyte concentrate [EC]) transfusion during extracorporeal circulation (ECC) in patients undergoing coronary artery bypass grafting (CABG).

Methods: This is a retrospective observational study including 530 consecutive patients who underwent isolated on-pump CABG at our Centre over a full two-year period. The risk model was developed and validated by logistic regression and bootstrap analysis. Discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow (H-L) test, respectively.

Results: EC transfusion during ECC was required in 91 patients (17.2%). Of these, the majority were transfused with one (54.9%) or two (41.8%) EC units. The final model covariates (reported as odds ratios; 95% confidence interval) were age (1.07; 1.02-1.13), glomerular filtration rate (0.98; 0.96-1.00), body surface area (0.95; 0.92-0.98), peripheral vascular disease (3.03; 1.01-9.05), cerebrovascular disease (4.58; 1.29-16.18), and hematocrit (0.55; 0.48-0.63). The risk model developed has an excellent discriminatory power (AUC: 0,963). The results of the H-L test showed that the model predicts accurately both on average and across the ranges of deciles of risk.

Conclusion: A risk-prediction model for EC transfusion during ECC was developed, which performed adequately in terms of discrimination, calibration, and stability over a wide spectrum of risk. It can be used as an instrument to provide accurate information about the need for EC transfusion during ECC, and as a valuable adjunct for local improvement of clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21470/1678-9741-2020-0322DOI Listing
March 2021

Commentary: Reoperations for mitral stenosis after mitral valve repair: We are still learning.

Authors:
Manuel J Antunes

J Thorac Cardiovasc Surg 2021 03 26;161(3):947-948. Epub 2020 Dec 26.

Faculty of Medicine, Clinic of Cardiothoracic Surgery, University of Coimbra, Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2020.12.063DOI Listing
March 2021

Reply: Aortic root enlargement, again and again.

Authors:
Manuel J Antunes

J Thorac Cardiovasc Surg 2021 02 10;161(2):e158-e159. Epub 2020 Dec 10.

Faculty of Medicine, Cardiothoracic Surgery Clinic, University of Coimbra, Coimbra, Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2020.10.143DOI Listing
February 2021

Quadricuspid aortic valve with a hidden left ostium: Case report and literature review.

Rev Port Cardiol 2021 Jan 10;40(1):63.e1-63.e5. Epub 2020 Dec 10.

Center of Cardiothoracic Surgery, University Hospital and Medical School, Coimbra, Portugal.

Quadricuspid aortic valve (QAV) is a rare congenital condition that frequently progresses to aortic regurgitation with clinical impact in adulthood. Surgical treatment is required in the fifth to sixth decade of life in about one fifth of patients. We describe the case of a 64-year-old woman with regular cardiological follow-up for severe aortic valve regurgitation who had suffered recent clinical and echocardiographic deterioration. Conventional open surgery was indicated. During the procedure, a QAV with leaflet retraction and central orifice was observed. The aortic valve was successfully replaced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.repc.2018.04.012DOI Listing
January 2021

The Global Burden of Rheumatic Heart Disease: Population-Related Differences (It is Not All the Same!).

Authors:
Manuel J Antunes

Braz J Cardiovasc Surg 2020 12 1;35(6):958-963. Epub 2020 Dec 1.

Clinic of Cardiothoracic Surgery, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

Rheumatic heart disease (RHD) remains the most common cardiovascular disease in young adults and adolescents in need of heart surgery in low- and middle-income countries (LMICs). The mean age of patients is 20-25 years, often much younger. By contrast, the few patients with chronic RHD in developed countries present a mean age of around 55 years. It is absolutely fundamental to differentiate these two types of population. Pathology, lesions and surgical methods are different, and the results should not be compared. It is not all the same! A certain enthusiasm for mitral repair has recently surged, with several reports showing excellent results in children and young adults, resulting from the renewed interest of cardiac surgeons, also based on new and modified techniques developed in the meantime. While surgery is easily accessible to patients in developed countries, the situation in LMICs is often dramatic, with countries where there is a complete absence of or few surgical facilities absolutely unable to meet gigantic demands. Many foreign surgical teams conduct humanitarian missions in several of these countries. They are just a "drop of water in the ocean" of needs. In some cases, however, these missions led to the establishment of local teams that now work independently and, in some cases, outperform the foreign teams still visiting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21470/1678-9741-2020-0514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731852PMC
December 2020

Commentary: Repair of degenerative mitral regurgitation: Science, art, or both?

Authors:
Manuel J Antunes

J Thorac Cardiovasc Surg 2020 Oct 10. Epub 2020 Oct 10.

Faculty of Medicine, Clinic of Cardiothoracic Surgery, University of Coimbra, Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2020.10.012DOI Listing
October 2020

Contemporary Diagnosis and Management of Rheumatic Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart Association.

Circulation 2020 Nov 19;142(20):e337-e357. Epub 2020 Oct 19.

The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIR.0000000000000921DOI Listing
November 2020

Aortic valve repair: creativity is making the complicated simple.

Authors:
Manuel J Antunes

Kardiol Pol 2020 09 25;78(9):837-838. Epub 2020 Sep 25.

University Clinic of Cardiothoracic Surgery and Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.15609DOI Listing
September 2020

Commentary: Rheumatic mitral valve repair: Where is the real word?

Authors:
Manuel J Antunes

J Thorac Cardiovasc Surg 2020 Aug 3. Epub 2020 Aug 3.

Faculty of Medicine, Clinic of Cardiothoracic Surgery, University of Coimbra, Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2020.07.084DOI Listing
August 2020

Reply: The bad guy: Left ventricular function, size, or both?

Authors:
Manuel J Antunes

J Thorac Cardiovasc Surg 2020 Aug 11. Epub 2020 Aug 11.

Faculty of Medicine, Clinic of Cardiothoracic Surgery, University of Coimbra, Coimbra, Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2020.06.133DOI Listing
August 2020

The 'wait for symptoms' strategy in asymptomatic severe aortic stenosis.

Heart 2020 Dec 3;106(23):1792-1797. Epub 2020 Aug 3.

Klinik für Thorax- und Herz- Gefäßchirurgie, Universität des Saarlandes, Saarbrucken, Germany.

Calcific aortic stenosis is a prevalent and worrisome healthcare problem. The therapeutic approach in asymptomatic aortic stenosis is not well established. We argue that the natural history of this disease is based on old incomplete studies with many limitations. Likewise, studies suggesting that replacement, either surgical or percutaneous, improves prognosis in asymptomatic patients with severe aortic stenosis have important drawbacks and do not support this strategy as the treatment of choice. Despite the lack of evidence, some groups recommend early valve replacement in patients with severe asymptomatic aortic stenosis. There are five ongoing randomised trials which will shed light on this topic. Our conclusion is that unless a randomised study changes the evidence, valve replacement cannot be recommended in asymptomatic patients with severe aortic stenosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/heartjnl-2020-317323DOI Listing
December 2020

Tricuspid annuloplasty: Too many, too few? Virtue may be in the middle!

Authors:
Manuel J Antunes

J Card Surg 2020 Aug 11;35(8):1901-1904. Epub 2020 Jul 11.

Clinic of Cardiothoracic Surgery, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

Background: Significant secondary tricuspid regurgitation, often accompanied by right ventricular dilation and dysfunction, occurs in a significant proportion of patients submitted to surgery for severe mitral valve disease. It appears a vicious circle that is not interrupted by the treatment of the left heart valve alone, hence it requires concomitant intervention on the tricuspid valve.

Aims: In this commentary I will discuss a paper published in this issue of the Journal by Calafiore et al from Riyadh - Saudi Arabia, reporting a retrospective study that evaluated the influence of preoperative right ventricular and tricuspid valve (TV) remodeling on the fate of tricuspid annuloplasty (TA) and RV in 423 patients undergoing TA for functional TR operated on from May 2009 to December 2015 at their institution.

Materials & Methods: Current guidelines and other consensus documents recommend that tricuspid valve surgeryshould be considered (class IIa) in patients with mild/moderate secondary regurgitation and/or significant annular dilatation. However, rates of tricuspid annuloplasty performed during operations to left-heart valves are very variable, depending also on the etiology of the mitral disease.

Results & Discussion: Different methods of annuloplasty are used by the surgical community - suture, rings, bands - with widely variable results with regard to the recurrence of regurgitation and long-term survival. Not all these techniques are standardised and this may also be a cause for the disparate results.

Conclusion: In the absence of randomized studies, which are highly unlikely to be undertaken in this situation, more information is required from large series with longer follow-ups.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.14843DOI Listing
August 2020

Enlargement of the narrow aortic root: Fear of what?

Authors:
Manuel J Antunes

J Card Surg 2020 Sep 11;35(9):2165-2167. Epub 2020 Jul 11.

Clinic of Cardiothoracic Surgery, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

Prosthesis-patient mismatch (PPM) associated with aortic valve replacement, especially of aortic stenosis, is a common problem. Severe PPM is known to increase perioperative morbidity and mortality and to negatively affect late survival. Surgical enlargement of the narrow aortic root enlargement (ARE) is now increasingly accepted as a method of facilitating implantation of a larger valve prosthesis, hence decreasing the risk of PPM. There are diagnostic methods and tables that help to predict the risk of this complication and assist in the planning of the surgery. Still, many surgeons are afraid or reluctant to perform ARE because of potential technical complications of a procedure perceived to increase the complexity of the surgery. However, these procedures have been proven safe and effective, and are at the reach of almost any cardiac surgeon, including less experienced ones. In addition, there are modifications to the techniques that make them even simpler and more reproducible.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.14725DOI Listing
September 2020

Professor John Barlow - The Legend.

Authors:
Manuel J Antunes

Rev Port Cardiol 2020 May 4;39(5):233-236. Epub 2020 Jun 4.

Cardiothoracic Surgery, Faculty of Medicine, Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.repc.2020.05.001DOI Listing
May 2020

Cardiac allograft vasculopathy: Incidence and predictors in a single-center cohort.

Rev Port Cardiol 2020 Apr 26;39(4):205-212. Epub 2020 May 26.

Centro Hospitalar da Universidade de Coimbra, Coimbra, Portugal.

Introduction And Aims: Cardiac allograft vasculopathy (CAV) is one of the most significant complications after orthotopic heart transplantation. We aimed to investigate the incidence and predictors of CAV in a large cohort of orthotopic heart transplantation patients.

Methods: We conducted a retrospective analysis on a prospective cohort of 233 patients who underwent transplantation between November 2003 and May 2014. Baseline clinical data and invasive coronary angiograms (n=712) performed as part of the follow-up program were analyzed by two independent investigators.

Results: We included 157 male and 45 female patients with a median age of 66 years. A third of patients had previous ischemic heart disease, 30% peripheral arterial disease, 37% hypertension and 47% dyslipidemia, and 17% were smokers. Acute moderate or severe rejection occurred in 42 patients during the first year. Over a median follow-up of 2920 days, 18% were diagnosed with CAV, with an incidence of 2.91 cases per 100 person-years. Predictors of CAV were previous ischemic heart disease (HR 2.32, 95% CI 1.21-4.45, p=0.01), carotid artery disease (HR 2.44, 95% CI 1.27-4.71, p<0.01), and donor age (HR 1.04, 95% CI 1.00-1.07, p=0.01).

Conclusion: In a single-center cohort of orthotopic heart transplantation patients, predictors of CAV were previous ischemic heart disease, carotid artery disease and donor age.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.repc.2019.10.007DOI Listing
April 2020

Repair of the rheumatic mitral valve: Is the controversy over?

Authors:
Manuel J Antunes

Asian Cardiovasc Thorac Ann 2020 09 13;28(7):374-376. Epub 2020 May 13.

Faculty of Medicine, University of Coimbra, Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0218492320927316DOI Listing
September 2020

Commentary: Low left ventricular ejection fraction in coronary artery bypass grafting: Accept or control factors determining survival?

Authors:
Manuel J Antunes

J Thorac Cardiovasc Surg 2020 Apr 6. Epub 2020 Apr 6.

Faculty of Medicine, Clinic of Cardiothoracic Surgery, University of Coimbra, Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2020.03.111DOI Listing
April 2020

The role of surgery in infective endocarditis revisited.

Authors:
Manuel J Antunes

Rev Port Cardiol 2020 03 13;39(3):151-153. Epub 2020 Apr 13.

Clinic of Cardiothoracic Surgery; Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.repc.2020.03.009DOI Listing
March 2020

Closed mitral commissurotomy-a cheap, reproducible and successful way to treat mitral stenosis.

Authors:
Manuel J Antunes

J Thorac Dis 2020 Mar;12(3):146-149

Clinic of Cardiothoracic Surgery, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jtd.2019.12.118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138996PMC
March 2020

Systematic review and meta-analysis of surgical outcomes comparing mechanical valve replacement and bioprosthetic valve replacement in infective endocarditis.

Ann Cardiothorac Surg 2019 Nov;8(6):587-599

Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain.

Background: Infective endocarditis (IE) is an infection involving either native or prosthetic heart valves, the endocardial surface of the heart or any implanted intracardiac devices. IE is a rare condition affecting 3-15 patients per 100,000 population. In-hospital mortality rates in patients with IE remain high at around 20% despite treatment advances. There is no consensus recommendation favoring either bioprosthetic valve or mechanical valve implantation in the setting of IE; patient age, co-morbidities and preferences should be considered selecting the replacement prosthesis.

Methods: A systematic review and meta-analysis of studies reporting the outcomes of patients undergoing bioprosthetic or mechanical valve replacement for infective endocarditis with data extracted for overall survival, valve reinfection rates and valve reoperation.

Results: Eleven relevant studies were identified, with 2,336 patients receiving a mechanical valve replacement and 2,057 patients receiving a bioprosthetic valve replacement. There was no significant difference for overall survival between patients treated with mechanical valves and those treated with bioprosthetic valves [hazard ratio (HR) 0.94, 95% confidence interval (CI): 0.73-1.21, P=0.62]. There was no significant difference in reoperation rates between patients treated with a bioprosthetic valve and those treated with a mechanical valve (HR 0.82, 95% CI: 0.34-1.98, P=0.66) and there was no significant difference in the rate of valve reinfection rates (HR 0.95, 95% CI: 0.48-1.89, P=0.89).

Conclusions: The presence of infective endocarditis alone should not influence the decision of which type of valve prosthesis that should be implanted. This decision should be based on patient age, co-morbidities and preferences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/acs.2019.10.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892732PMC
November 2019

Commentary: Bleeding events with novel bioprostheses: Still a mystery.

Authors:
Manuel J Antunes

J Thorac Cardiovasc Surg 2019 Oct 24. Epub 2019 Oct 24.

Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2019.10.052DOI Listing
October 2019

Commentary: Aortic root enlargement, a useful and reproducible way to a larger prosthesis.

Authors:
Manuel J Antunes

J Thorac Cardiovasc Surg 2020 10 24;160(4):924-925. Epub 2019 Sep 24.

Center of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2019.09.049DOI Listing
October 2020

The Age of The Surgeon: How Old Is Too Old?

Authors:
Manuel J Antunes

Acta Med Port 2019 Jun 28;32(6):413-414. Epub 2019 Jun 28.

Cardiothoracic Surgeon. Coimbra; Emeritus Professor. Faculty of Medicine. University of Coimbra. Coimbra. Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20344/amp.12160DOI Listing
June 2019

Commentary: Mitral valvuloplasty rings: Do they make the difference?

Authors:
Manuel J Antunes

J Thorac Cardiovasc Surg 2020 05 30;159(5):1775-1776. Epub 2019 May 30.

Faculty of Medicine, Clinic of Cardiothoracic Surgery, University of Coimbra, Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2019.05.022DOI Listing
May 2020

The conundrum of mitral valve etiology and the association with clinical outcomes.

Kardiol Pol 2019 05 24;77(5):505-506. Epub 2019 May 24.

University Hospital, Coimbra, Portugal

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.14843DOI Listing
May 2019

Surgery for symptomatic aortic stenosis in the elderly: Still an excellent option.

Authors:
Manuel J Antunes

Rev Port Cardiol 2019 04 18;38(4):259-260. Epub 2019 May 18.

Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.repc.2019.05.001DOI Listing
April 2019