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Article ; Online: Concomitant Mitral Valve Repair vs Replacement During Surgical Ventricular Restoration for Ischemic Cardiomyopathy.

Arafat, Amr A / Alghamdi, Rawan / Alfonso, Juan J / Shalaby, Mostafa A / Alotaibi, Khaled / Pragliola, Claudio

2023 Volume 75, Issue 4, Page(s) 331–339

Abstract: There is no consensus regarding mitral valve management during surgical ventricular restoration (SVR) for ischemic cardiomyopathy. We compared the impact of SVR with mitral valve repair (MVr) vs replacement (MVR) on postoperative outcomes and long-term ... ...

Abstract	There is no consensus regarding mitral valve management during surgical ventricular restoration (SVR) for ischemic cardiomyopathy. We compared the impact of SVR with mitral valve repair (MVr) vs replacement (MVR) on postoperative outcomes and long-term survival in ischemic cardiomyopathy and mitral regurgitation patients. This study included 112 patients who underwent SVR from 2009 to 2018 with MVr (n = 75) or MVR (n = 37). Patients who had MVR had higher Euro SCORE II, dyspnea class, a lower ejection fraction, higher pulmonary artery systolic pressure, higher grade of preoperative mitral and tricuspid regurgitation, and higher end-diastolic and end-systolic diameters. Intra-aortic balloon pump was more commonly used in patients with MVR. Hospital mortality occurred in 7 (9.33%) patients in the MVr group vs 3 (8.11%) in the MVR group (P > .99). Freedom from rehospitalization at 1, 5, and 7 years was 87%, 76%, and 70% in the MVr group and 83%, 61%, and 52% in the MVR group (P = .191). Survival at 1, 5, and 7 years was 88%, 78%, and 74% in the MVr group and 88%, 56%, and 56% in the MVR group (P = .027). Adjusted survival did not differ between groups.MVr or MVR are valid options in patients undergoing SVR, with good long-term outcomes.
MeSH term(s)	Humans ; Mitral Valve/surgery ; Heart Valve Prosthesis Implantation/adverse effects ; Treatment Outcome ; Myocardial Ischemia/complications ; Myocardial Ischemia/surgery ; Mitral Valve Insufficiency/surgery ; Cardiomyopathies/surgery
Language	English
Publishing date	2023-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	80040-5
ISSN	1940-1574 ; 0003-3197
ISSN (online)	1940-1574
ISSN	0003-3197
DOI	10.1177/00033197231154353
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Article ; Online: Peripheral Pulmonary Artery Stenosis Is Not a Contraindication to a Single-ventricle Pathway.

Al-Khaldi, Abdulaziz / Alsahari, Atif / Alotay, Abdulmajeed / Momenah, Tarek / Alfonso, Juan J

The Annals of thoracic surgery

2021 Volume 113, Issue 5, Page(s) 1563–1568

Abstract: Background: The presence of peripheral pulmonary artery stenosis (PPAS) involving lobar and/or segmental pulmonary artery (PA) branches might preclude proceeding to a single-ventricle pathway. We adopted a strict strategy for PA rehabilitation and ... ...

Abstract	Background: The presence of peripheral pulmonary artery stenosis (PPAS) involving lobar and/or segmental pulmonary artery (PA) branches might preclude proceeding to a single-ventricle pathway. We adopted a strict strategy for PA rehabilitation and surgical reconstruction in patients who are unable to progress to a single-ventricle pathway. Methods: We conducted a retrospective review of 22 patients with single-ventricle physiology who underwent surgical reconstruction for PPAS from April 2008 to March 2020. Our surgical approach was single stage in 15 patients (68.2%) and 2 stage in 7 patients (31.8%) depending on the presence or absence of PA hypoplasia distal to the PPAS. Results: The PPAS was type 3 (lobar) in 19 patients (86.4%) and type 4 (segmental) in 3 patients (13.6%). The mean number of PA angioplasties performed was 8 ± 5.6 per patient. There was no mortality in this series with a median of 52 months (range, 8-143) of follow-up. Twenty patients (90.9%) were able to progress in the single-ventricle pathway with 12 patients (54.5%) undergoing a Fontan operation and 8 patients (36.4%) achieving bidirectional Glenn shunt and awaiting a Fontan operation. Two patients (9.1%) were not suitable to progress to the single-ventricle pathway because of elevated PA pressure. All patients who achieved cavopulmonary connection were alive and asymptomatic with no signs of elevation of PA pressure. No patient required further reinterventions for the PA. Conclusions: PPAS is not a contraindication for single-ventricle palliation. With careful planning and aggressive early surgical reconstruction, most of these patients can successfully progress to cavopulmonary connections.
MeSH term(s)	Contraindications ; Fontan Procedure ; Heart Defects, Congenital/complications ; Heart Defects, Congenital/surgery ; Heart Ventricles/abnormalities ; Heart Ventricles/surgery ; Humans ; Infant ; Pulmonary Artery/surgery ; Retrospective Studies ; Stenosis, Pulmonary Artery/surgery ; Treatment Outcome ; Univentricular Heart ; Vascular Diseases
Language	English
Publishing date	2021-04-01
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2021.03.059
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Article ; Online: Late outcomes of surgical reconstruction of peripheral pulmonary arteries.

Al-Khaldi, Abdulaziz / Abuzaid, Ahmad D / Tamimi, Omar / Alsahari, Atif / Alotay, Abdulmajeed / Momenah, Tarek / Alfonso, Juan J

The Journal of thoracic and cardiovascular surgery

2021 Volume 163, Issue 4, Page(s) 1448–1457.e6

Abstract: Objective: The ideal management of peripheral pulmonary artery stenosis is still controversial. We adopted a primary surgical approach to this complex lesion with excellent early outcomes. In this study, we analyzed our late outcomes.: Methods: We ... ...

Abstract	Objective: The ideal management of peripheral pulmonary artery stenosis is still controversial. We adopted a primary surgical approach to this complex lesion with excellent early outcomes. In this study, we analyzed our late outcomes. Methods: We performed a retrospective review of 91 patients with biventricular anatomy who underwent peripheral pulmonary artery reconstruction from March 2008 to July 2020. Our surgical approach included either a single-stage complete repair through median sternotomy or a 2-stage repair through sternotomy/left thoracotomy, depending on the degree of distal involvement of the left pulmonary artery branches. Results: Median age was 26 months. Syndromic etiology was established in 54 patients (59.3%) versus nonsyndromic etiology in 37 patients (40.7%). Single-stage repair was achieved in 68 patients (74.7%). There were 2 (2.2%) in-hospital mortalities. The mean right ventricular to aortic systolic pressure ratio decreased from 1.07 ± 0.20 preoperatively to 0.32 ± 0.07 immediately postoperatively (P < .001), representing a 70.1% reduction. At 1-year postoperative catheterization, the mean right ventricular to aortic systolic pressure ratio was 0.28 ± 0.05 (P < .001 compared with immediately postoperative value). With a median follow-up of 68 months (IQR, 39-117.5 months), there was no late mortality after discharge. All patients were active and asymptomatic on the most recent follow-up. There were no early or late reinterventions on pulmonary arteries. Conclusions: Late outcomes of surgical reconstruction of peripheral pulmonary arteries are excellent and durable in various pathologies (syndromic and nonsyndromic) with a significant reduction in right ventricular to aortic systolic pressure ratio, low mortality, and no reintervention.
MeSH term(s)	Blood Pressure ; Child, Preschool ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Male ; Pulmonary Artery/surgery ; Retrospective Studies ; Stenosis, Pulmonary Artery/surgery ; Systole ; Time-to-Treatment ; Ventricular Function, Right
Language	English
Publishing date	2021-09-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2021.07.057
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Article ; Online: Late Outcomes After Pulmonary Arterial Reconstruction in Patients With Arterial Tortuosity Syndrome.

Al-Khaldi, Abdulaziz / Momenah, Tarek / Alsahari, Atif / Alotay, Abdulmajeed / Alfonso, Juan J / Abuzaid, Ahmad / Alwadai, Abdullah

The Annals of thoracic surgery

2021 Volume 113, Issue 5, Page(s) 1569–1574

Abstract: Background: Surgical pulmonary artery reconstruction in patients with arterial tortuosity syndrome has excellent outcomes. In this study, we report our late outcomes after more than a decade of experience with such complex interventions.: Methods: We ...

Abstract	Background: Surgical pulmonary artery reconstruction in patients with arterial tortuosity syndrome has excellent outcomes. In this study, we report our late outcomes after more than a decade of experience with such complex interventions. Methods: We conducted a retrospective review of 33 arterial tortuosity syndrome patients who underwent pulmonary artery reconstruction. The mean preoperative right ventricular to left ventricular pressure ratio was 1.19 ± 0.2. Our surgical approach included either a single-stage complete repair through a median sternotomy (17 patients) or a two-stage repair through sternotomy/left thoracotomy (16 patients), depending on the degree of distal involvement in the left pulmonary artery. Results: Median age was 36 months. All patients had distal segmental peripheral pulmonary artery stenosis. Thirty patients (90.1%) were symptomatic before surgery. There was one hospital death due to viral pneumonia 78 days after the surgery (in-hospital mortality 3%). The mean right ventricular to left ventricular pressure ratio decreased to 0.31 ± 0.07 early postoperatively (P < 0.001), representing a 74% reduction compared with preoperative values. Follow-up was 100% complete for all hospital survivors (32 of 33) with a mean follow-up of 70.42 ± 43.32 months (range, 2 to 143). There was no late mortality or need for reintervention (surgical or catheter based) after hospital discharge. In late postoperative catheterization, the mean right ventricular to left ventricular pressure ratio was 0.27 ± 0.05 (P = .003 compared with early postoperative value). All patients were asymptomatic on their most recent follow-up. Conclusions: A strategy of complete surgical reconstruction of all stenotic pulmonary artery segments in patients with arterial tortuosity syndrome is recommended for sustainable successful outcomes more than a decade later.
MeSH term(s)	Arteries/abnormalities ; Child, Preschool ; Follow-Up Studies ; Humans ; Hypertension, Pulmonary ; Infant ; Joint Instability ; Pulmonary Artery/surgery ; Retrospective Studies ; Skin Diseases, Genetic ; Stenosis, Pulmonary Artery/surgery ; Treatment Outcome ; Vascular Malformations
Language	English
Publishing date	2021-04-01
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2021.03.063
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Article ; Online: del Nido Cardioplegia in Adult Patients: A Propensity-Matched Study of 102 Consecutive Patients.

Pragliola, Claudio / Hassan, Essam / Ismail, Huda / Al Otaibi, Khalid / Alfonso, Juan J / Algarni, Khaled D

Heart, lung & circulation

2019 Volume 29, Issue 9, Page(s) 1405–1411

Abstract: Background: Paediatric del Nido cardioplegia (DNC) has been tested in selected populations of low-risk adult patients. This study examined its use in an unselected medium-to-high-risk adult population and compared the results with a propensity-matched ... ...

Abstract	Background: Paediatric del Nido cardioplegia (DNC) has been tested in selected populations of low-risk adult patients. This study examined its use in an unselected medium-to-high-risk adult population and compared the results with a propensity-matched population that received intermittent warm blood cardioplegia (IWBC). Methods: Data from the last 1,000 consecutive adult patients who underwent a variety of surgical procedures under cardioplegic arrest with the use of IWBC or DNC between 2016 and 2018 were propensity score matched on preoperative clinical and demographic variables. Two (2) main populations were 102 patients who received DNC and another set of matched 102 patients from a total of 1,000 patients who received IWBC, along with a subgroup with an ejection fraction (EF) ≤40% (EFDNC vs EFIWBC). Postoperative outcomes were mortality, peak troponin T, postoperative EF%, and aortic cross-clamp time. Results: There were no preoperative differences amongst the groups in the main cohort (Euroscore II: DNC 4.1±8, IWBC 4.0±7; EF%: DNC 47±10, IWBC 47±11) and in the subgroup (EF%: EFDNC 32±6%, EFIWBC 32±6%; p=0.45). There were also no differences in three of the outcomes. A significant postoperative improvement was noticed in the EF% in the DNC (32±6% 95% CI 29-34 to 39±12 95% CI 34-44; p=0.001) in the EFDNC group. Conclusions: This initial experience of del Nido cardioplegia proved to be effective in a variety of challenging pathologies in adult populations.
MeSH term(s)	Adult ; Cardiac Surgical Procedures/methods ; Female ; Heart Arrest, Induced/methods ; Heart Diseases/diagnosis ; Heart Diseases/therapy ; Humans ; Male ; Middle Aged ; Propensity Score ; Retrospective Studies ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	2019-12-09
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2020980-0
ISSN	1444-2892 ; 1443-9506
ISSN (online)	1444-2892
ISSN	1443-9506
DOI	10.1016/j.hlc.2019.08.019
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Article: Stent graft deployment in haemodialysis fistula: patency rates in partially thrombosed aneurysm and residual thrombi.

García-Medina, José / Maldonado-Cárceles, Ana B / García-Alfonso, Juan J / Árense-Gonzalo, Julián J / Torres-Cantero, Alberto M

Clinical kidney journal

2020 Volume 14, Issue 3, Page(s) 814–819

Abstract: Background: Current evidence is insufficient to determine the contribution of stent grafts as treatment in partially thrombosed aneurysms or residual wall-adherent thrombi in arteriovenous fistulae (AVFs) for haemodialysis. The overall purpose of this ... ...

Abstract	Background: Current evidence is insufficient to determine the contribution of stent grafts as treatment in partially thrombosed aneurysms or residual wall-adherent thrombi in arteriovenous fistulae (AVFs) for haemodialysis. The overall purpose of this study was to analyse patency rates of post-interventional covered stent deployment in those cases. We also assessed if patency rates differed when fistulas were punctured through the stent during dialysis sessions. Methods: We conducted a retrospective study between 2006 and 2014 analysing post-intervention primary patency rates using the Kaplan-Meier log-rank test. Multivariate Cox proportional regression models were performed to determine if cannulation within the stent graft area was a potential risk factor for occlusion, by adjusted hazard ratio (HR). Results: A total of 27 procedures were included in the study. Primary patency rates (%) after stent deployment at 3, 6, 12, 24, 36 and 72 months were, respectively: total 59, 32, 32, 21, 11 and 5; stent puncture 53, 21, 21, 16, 5 and 0; and no stent puncture 80, 80, 80, 40, 40 and 40. Cannulation through the stent graft was not significantly associated with increased risk of obstruction in multivariate analysis (HR = 3.01; P = 0.286). Conclusion: Stent graft treatment may be a feasible procedure in partially thrombosed aneurysms and residual thrombi in AVF. Although fistulas punctured through the stent presented lower patency rates, this practice was not associated with a higher risk of obstruction. Giving the impossibility of comparing with similar approaches, further studies are needed to confirm or refute the advantages of this procedure.
Language	English
Publishing date	2020-02-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2655800-2
ISSN	2048-8513 ; 2048-8505
ISSN (online)	2048-8513
ISSN	2048-8505
DOI	10.1093/ckj/sfz193
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Article ; Online: Degree of right ventricular dysfunction dictates outcomes after tricuspid valve repair concomitant with left-side valve surgery.

Algarni, Khaled D / Arafat, Amr / Algarni, Abdulaziz D / Alfonso, Juan J / Alhossan, Abdulaziz / Elsayed, Abdelhameed / Kheirallah, Hatim M / Albacker, Turki B

General thoracic and cardiovascular surgery

2020 Volume 69, Issue 6, Page(s) 911–918

Abstract: Objectives: The effect of different degrees of right ventricular (RV) dysfunction on long-term outcomes after tricuspid valve repair is the subject of ongoing research. We sought to evaluate the effect of preoperative RV dysfunction on mortality and ... ...

Abstract	Objectives: The effect of different degrees of right ventricular (RV) dysfunction on long-term outcomes after tricuspid valve repair is the subject of ongoing research. We sought to evaluate the effect of preoperative RV dysfunction on mortality and recurrence of tricuspid regurgitation (TR) after tricuspid valve repair for secondary TR concomitant with left-side valve surgery. Methods: This is a retrospective study, including 548 patients who underwent repair of secondary TR (2009-2017) at a single institution. Patients were grouped according to preoperative right ventricular (RV) systolic function into three groups; normal RV function (group 1, n = 451), mild RV dysfunction (group 2, n = 60) and moderate/severe RV dysfunction (group 3, n = 37). Study endpoints were mortality and recurrence of TR. Results: Group 3 was associated with the highest hospital mortality (10.2%, p = .06). Predictors of moderate or higher grade TR were NYHA class (HR 2.1, p = 0.03); preoperative TR grade (HR 1.9, p < 0.01), mild RV dysfunction (HR 2.4, p < 0.01), isolated RV dilatation (HR 2.0, p < 0.01), and flexible TV repair prostheses (HR 2.4, p = 0.01). Predictors of mortality were renal impairment (HR 3.0, p < 0.01), ejection fraction (HR 0.97, p = 0.02), pulmonary artery systolic pressure (HR 1.02, p = 0.02), preoperative TR grade (HR 1.7, p < 0.01), and moderate/severe RV dysfunction (HR 3.1, p = 0.01). Conclusion: Compared to normal and mild degree of RV dysfunction, moderate and severe RV dysfunction were independent predictors of poor long-term survival. Isolated RV dilatation increased the recurrence of TR. RV dysfunction and dilatation could be indications of tricuspid valve repair.
MeSH term(s)	Humans ; Neoplasm Recurrence, Local ; Retrospective Studies ; Treatment Outcome ; Tricuspid Valve/diagnostic imaging ; Tricuspid Valve/surgery ; Tricuspid Valve Insufficiency/diagnostic imaging ; Tricuspid Valve Insufficiency/surgery ; Ventricular Dysfunction, Right/etiology
Language	English
Publishing date	2020-11-06
Publishing country	Japan
Document type	Journal Article
ZDB-ID	2376888-5
ISSN	1863-6713 ; 1863-6705
ISSN (online)	1863-6713
ISSN	1863-6705
DOI	10.1007/s11748-020-01536-7
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Zs.A 1173: Show issues

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Article ; Online: A new device to maintain the sternum open.

Calafiore, Antonio M / Awadi, Mohammed A / Alfonso, Juan J / Foschi, Massimiliano / Di Mauro, Michele

Journal of cardiac surgery

2017 Volume 32, Issue 9, Page(s) 574–575

MeSH term(s)	Cardiac Surgical Procedures/instrumentation ; Humans ; Sternotomy/instrumentation
Language	English
Publishing date	2017-09-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.13196
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Article ; Online: Early failure of tricuspid annuloplasty. Should we repair the tricuspid valve at an earlier stage? The role of right ventricle and tricuspid apparatus.

Calafiore, Antonio M / Foschi, Massimiliano / Kheirallah, Hatim / Alsaied, Mojtaba Mohammed / Alfonso, Juan J / Tancredi, Fabrizio / Gaudino, Mario / Di Mauro, Michele

Journal of cardiac surgery

2019 Volume 34, Issue 6, Page(s) 404–411

Abstract: Background: We sought to identify subgroups of patients at a higher probability of tricuspid annuloplasty (TAP) failure early after surgery.: Methods: From May 2009 to December 2015, 688 patients undergoing TAP for functional tricuspid regurgitation ( ...

Abstract	Background: We sought to identify subgroups of patients at a higher probability of tricuspid annuloplasty (TAP) failure early after surgery. Methods: From May 2009 to December 2015, 688 patients undergoing TAP for functional tricuspid regurgitation (FTR) at a single institution were included in the study. In all patients, a complete transthoracic echocardiographic evaluation of right ventricle (RV) and tricuspid valve (TV) apparatus was collected. Results: Twenty-six patients (3.8%) died within the first 30 days of surgery. Residual TR after TAP was recorded in 85 (12.4%), moderate in 80 (11.7%) and severe in 5 (0.7%). Preoperative TV apparatus remodeling was associated with residual TR; in particular, the following cutoffs were identified: TV coaptation depth ≥6.5 mm, tenting area ≥0.85 cm Conclusions: Prophylactic TAP should be encouraged among surgeons even earlier than guidelines recommend, and decision-making for the treatment of low-grade FTR at the time of left-sided valve surgery should take into consideration not only annular size but also tethering severity and RV dilatation.
MeSH term(s)	Adult ; Aged ; Cardiac Valve Annuloplasty/methods ; Cohort Studies ; Echocardiography ; Female ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/pathology ; Humans ; Male ; Middle Aged ; Probability ; Severity of Illness Index ; Time Factors ; Treatment Failure ; Tricuspid Valve/diagnostic imaging ; Tricuspid Valve/pathology ; Tricuspid Valve/surgery ; Tricuspid Valve Insufficiency/mortality ; Tricuspid Valve Insufficiency/surgery ; Ventricular Remodeling
Language	English
Publishing date	2019-04-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.14042
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Article ; Online: Surgical mitral plasticity for chronic ischemic mitral regurgitation.

Calafiore, Antonio M / Totaro, Antonio / De Amicis, Vincenzo / Pelini, Piero / Pinna, Giovanni / Testa, Nicola / Alfonso, Juan J / Mazzei, Valerio / Sacra, Cosimo / Gaudino, Mario / Di Mauro, Michele

Journal of cardiac surgery

2020 Volume 35, Issue 4, Page(s) 772–778

Abstract: Background and aim of the study: The outcome of mitral valve (MV) repair for chronic ischemic mitral regurgitation (IMR) is suboptimal, due to the high recurrence rate of moderate or severe mitral regurgitation (MR) during follow-up. The MV adapts to ... ...

Abstract	Background and aim of the study: The outcome of mitral valve (MV) repair for chronic ischemic mitral regurgitation (IMR) is suboptimal, due to the high recurrence rate of moderate or severe mitral regurgitation (MR) during follow-up. The MV adapts to new MR increasing its area to cover the enlarged annular area (mitral plasticity). As this process is often incomplete, we aimed to evaluate if augmenting the anterior leaflet (AL) and cutting the second-order chords (CC) together with restrictive mitral annuloplasty, a strategy we call "surgical mitral plasticity," could improve the midterm results of MV repair for IMR. Materials and methods: From November 2017 to October 2019, 22 patients with chronic IMR underwent surgical mitral plasticity. Mean age was 73 ± 7 years and six were female. Mean ejection fraction was 32% ± 11%, IMR grade was moderate in 10 and severe in 12. Mean clinical and echocardiographic follow-up was 12 ± 6 months. Results: There was no early death, and one patient died 6 months after surgery. Ejection fraction improved from 32% ± 15% to 40% ± 6% (P = .031). IMR was absent or mild in all patients, and none showed recurrent moderate or more IMR. Tenting area decreased significantly from 2.5 ± 0.5 to 0.5 ± 0.3 cm² and coaptation length increased from 1.9 ± 0.7 to 7.8 ± 1.6 mm. All patients were in New York Heart Association class I or II. Conclusions: Mitral plasticity, if uncomplete, is ineffective in preventing IMR to become significant. Surgical mitral plasticity, by completing incomplete process of MV adaptation, has a strong rationale, which however needs to be validated with longer follow-up.
MeSH term(s)	Aged ; Aged, 80 and over ; Chronic Disease ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Mitral Valve Annuloplasty/methods ; Mitral Valve Insufficiency/surgery ; Recurrence ; Treatment Outcome
Language	English
Publishing date	2020-03-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.14487
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In stock of ZB MED Cologne/Königswinter

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Full text online

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Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito