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Article ; Online: The role of the diagnostic wedge resection in the era of segmentectomy.

Cowen, Michael E / Gooseman, Michael R

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2023 Volume 64, Issue 4

MeSH term(s)	Humans ; Pneumonectomy ; Carcinoma, Non-Small-Cell Lung/surgery ; Lung Neoplasms/diagnosis ; Lung Neoplasms/surgery ; Lung Neoplasms/pathology ; Neoplasm Staging
Language	English
Publishing date	2023-10-16
Publishing country	Germany
Document type	Letter ; Comment
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezad346
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Article: The benefits of combining the latest technology in thoracic surgery.

Gooseman, Michael R / Tentzeris, Vasileios / Cowen, Michael E

Journal of thoracic disease

2023 Volume 15, Issue 9, Page(s) 5256–5257

Language	English
Publishing date	2023-08-09
Publishing country	China
Document type	Journal Article
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd-23-754
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Article: Patient reported outcomes in thoracic trauma-lesson learned from thoracic oncology.

Gooseman, Michael R / Cowen, Michael E / Tentzeris, Vasileios / Qadri, Syed S A / Brunelli, Alessandro / Pompili, Cecilia

Journal of thoracic disease

2023 Volume 15, Issue 8, Page(s) 4151–4153

Language	English
Publishing date	2023-07-26
Publishing country	China
Document type	Editorial
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd-23-576
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Article ; Online: Intermittent Cross-Clamp Fibrillation Versus Cardioplegic Arrest During Coronary Surgery in 6,680 Patients: A Contemporary Review of an Historical Technique.

Ariyaratnam, Priyadharshanan / Cale, Alexander / Loubani, Mahmoud / Cowen, Michael E

Journal of cardiothoracic and vascular anesthesia

2019 Volume 33, Issue 12, Page(s) 3331–3339

Abstract: Objective: Myocardial management during on-pump coronary artery bypass grafting (CABG) surgery includes aortic cross-clamping followed by fibrillation (XCF) and aortic cross-clamping followed by diastolic cardioplegia (cardioplegia). The authors wished ... ...

Abstract	Objective: Myocardial management during on-pump coronary artery bypass grafting (CABG) surgery includes aortic cross-clamping followed by fibrillation (XCF) and aortic cross-clamping followed by diastolic cardioplegia (cardioplegia). The authors wished to compare in-hospital and survival outcomes between these procedures. Design: A retrospective observational study utilizing propensity matching. Setting: Tertiary Referral Centre for Heart Surgery. Participants: A total of 8,875 consecutive patients undergoing CABG surgery between August 1999 and February 2018. Interventions: After 1:1 matching, the authors had 3,340 patients in the cardioplegia group and 3,340 in the XCF group. Measurements and main results: Baseline characteristics were not significant between the matched cardioplegia and XCF groups. The XCF group had shorter pump times (61.8 minutes +/-26.8 v 74.7 minutes +/-29.5, p < 0.0001) and shorter cross-clamp times (27.80 minutes +/-10.5 v 44.44 minutes +/-18.0, p < 0.0001) compared with the cardioplegia group despite a similar median number of distal anastomoses (3 v 3, p = 0.08). After surgery, atrial arrhythmias (32% v 36%, p = 0.01) and inotropic requirement (25% v 28%, p = 0.006) were less in the XCF group compared with the cardioplegia group, respectively. Other postoperative outcomes (such as mortality and cerebrovascular events) were not statistically different. There was a mean survival advantage in using cardioplegia compared with XCF (15.4 years versus 14.7 years, log-rank, p = 0.014; 10-year survival 64% v 61% and 18-year survival 38% v 34%). Conclusion: This is the largest analysis of XCF. XCF does not adversely affect in-hospital outcomes. Long-term results demonstrate cardioplegic arrest may convey a survival advantage that would preclude routine XCF in the modern era.
MeSH term(s)	Aged ; Atrial Fibrillation/epidemiology ; Atrial Fibrillation/etiology ; Coronary Artery Bypass/adverse effects ; Coronary Artery Disease/surgery ; Female ; Follow-Up Studies ; Forecasting ; Heart Arrest/epidemiology ; Heart Arrest/etiology ; Heart Arrest, Induced/methods ; Humans ; Incidence ; Male ; Postoperative Complications ; Retrospective Studies ; Survival Rate/trends ; United Kingdom/epidemiology
Language	English
Publishing date	2019-07-19
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2019.07.126
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Article ; Online: Impact of lung cancer screening on surgical stage distribution and surgical practice: a regional analysis of patients operated in and out of a screening program.

Gooseman, Michael R / Tentzeris, Vasileios / Bulliment, Kerry L / Qadri, Syed S A / Callister, Matthew E J / Milton, Richard / Chaudhuri, Nilanjan / Tcherveniakov, Peter / Papagiannopoulos, Kostas / Cowen, Michael E / Brunelli, Alessandro

Interdisciplinary cardiovascular and thoracic surgery

2023 Volume 38, Issue 2

Abstract: Objectives: The aim of this study was to assess variations in surgical stage distribution in 2 centres within the same UK region. One centre was covered by an active screening program started in November 2018 and the other was not covered by screening.!# ...

Abstract	Objectives: The aim of this study was to assess variations in surgical stage distribution in 2 centres within the same UK region. One centre was covered by an active screening program started in November 2018 and the other was not covered by screening. Methods: Retrospective analysis of 1895 patients undergoing lung resections (2018-2022) in 2 centres. Temporal distribution was tested using Chi-squared for trends. A lowess curve was used to plot the proportion of stage 1A patients amongst those operated over the years. Results: The surgical populations in the 2 centres were similar. In the screening unit (SU), we observed a 18% increase in the proportion of patients with clinical stage IA in the recent phase compared to the early phase (59% vs 50%, P = 0.004), whilst this increase was not seen in the unit without screening. This difference was attributable to an increase of cT1aN0 patients in the SU (16% vs 11%, P = 0.035) which was not observed in the other unit (10% vs 8.2%, P = 0.41). In the SU, there was also a three-fold increase in the proportion of sublobar resections performed in the recent phase compared to the early one (35% vs 12%, P < 0.001). This finding was not evident in the unit without screening. Conclusions: Lung cancer screening is associated with a higher proportion of lung cancers being detected at an earlier stage with a consequent increased practice of sublobar resections.
Language	English
Publishing date	2023-11-25
Publishing country	England
Document type	Journal Article
ISSN	2753-670X
ISSN (online)	2753-670X
DOI	10.1093/icvts/ivad193
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Article ; Online: Survival of cardiorespiratory arrest after coronary artery bypass grafting or aortic valve surgery.

Ngaage, Dumbor L / Cowen, Michael E

The Annals of thoracic surgery

2009 Volume 88, Issue 1, Page(s) 64–68

Abstract: Background: Study objectives were to (1) report the clinical profile of and outcome for patients who experience a cardiorespiratory arrest after coronary artery bypass grafting or aortic valve replacement, and (2) identify factors associated with ... ...

Abstract	Background: Study objectives were to (1) report the clinical profile of and outcome for patients who experience a cardiorespiratory arrest after coronary artery bypass grafting or aortic valve replacement, and (2) identify factors associated with improved probability of survival. Methods: We identified 108 consecutive patients who had cardiorespiratory arrest after coronary artery bypass grafting or aortic valve replacement between April 1999 and June 2008. We studied the characteristics of arrests and survivors, and performed a multivariate logistic analysis to determine features associated with survival to hospital discharge. Results: Cardiac arrest (n = 86) was more common than respiratory arrest (n = 13; unknown cause, n = 9). Cardiorespiratory arrest occurred with decreasing frequency from the day of surgery. Ventricular fibrillation or tachycardia was the dominant mechanism of cardiac arrest (70% versus 17% for asystole versus 13% for pulseless electrical activity), and the principal causes were postoperative myocardial infarction (n = 46; 53%) and tamponade or bleeding (n = 21; 24%). Resternotomy was performed in 45 patients (52%), cardiopulmonary bypass reinstituted in 14 (16%), and additional grafts constructed in 5 (6%). The causes of respiratory arrest were mainly pulmonary (n = 8) and neurologic (n = 5). Survival to hospital discharge was better for respiratory arrest (69%) than for cardiac arrest (50%). Older age, ejection fraction less than 0.30, and postoperative myocardial infarction decreased the probability of survival. Conclusions: Ventricular fibrillation or tachycardia was the most common mechanism, and myocardial infarction, the predominant precipitating cause of cardiac arrest after coronary artery bypass grafting or aortic valve replacement. Despite aggressive resuscitation, outcome is poor. Young patients with good left ventricular function had a better probability of survival if they did not suffer a postoperative myocardial infarction.
MeSH term(s)	Age Factors ; Aged ; Aged, 80 and over ; Analysis of Variance ; Aortic Valve/surgery ; Cause of Death ; Cohort Studies ; Coronary Artery Bypass/adverse effects ; Coronary Artery Bypass/methods ; Female ; Follow-Up Studies ; Heart Arrest/etiology ; Heart Arrest/mortality ; Heart Arrest/therapy ; Heart Valve Prosthesis Implantation/adverse effects ; Heart Valve Prosthesis Implantation/methods ; Hospital Mortality/trends ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/diagnosis ; Postoperative Complications/mortality ; Probability ; Registries ; Retrospective Studies ; Risk Assessment ; Statistics, Nonparametric ; Survival Analysis ; Survivors/statistics & numerical data
Language	English
Publishing date	2009-07
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2009.03.042
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Article ; Online: Changing clinical profiles and in-hospital outcomes of octogenarians undergoing cardiac surgery over 18 years: a single-centre experience†.

Habib, Ahmed M / Hussain, Azhar / Jarvis, Martin / Cowen, Michael E / Chaudhry, Mubarak A / Loubani, Mahmoud / Cale, Alex / Ngaage, Dumbor L

Interactive cardiovascular and thoracic surgery

2019 Volume 28, Issue 4, Page(s) 602–606

Abstract: Objectives: With an ageing population, increasing numbers of octogenarians are undergoing high-risk cardiac surgery. We examine the changing characteristics and in-hospital outcomes for octogenarians over an 18-year period.: Methods: Clinical data ... ...

Abstract	Objectives: With an ageing population, increasing numbers of octogenarians are undergoing high-risk cardiac surgery. We examine the changing characteristics and in-hospital outcomes for octogenarians over an 18-year period. Methods: Clinical data from our prospective database for all octogenarians who had cardiac surgery from March 1999 through May 2016 were reviewed. We examined trends, risk profiles and in-hospital outcomes over 3 eras, namely early (1999-2004), middle (2005-2010) and late (2011-2016). A multivariable analysis was performed to identify independent predictors for adverse outcomes. Results: There were 1022 patients aged 80-94 years in our study cohort. The octogenarian population increased progressively from early to late eras (4.5%, n = 255 vs 7.1%, n = 321 vs 9.3%, n = 446), as the average logistic EuroSCORE predicted mortality (9% vs 9.7% vs 10.1%, P < 0.01). On the contrary, observed mortality declined substantially (9.4% vs 7.8% vs 4.7%, P = 0.04) over this period. While cardiac morbidity and respiratory comorbidities were more prevalent in the late era, chronic renal failure was more frequent in the early era. Over time, more procedures were performed electively (P = 0.05). Common operations across all eras were coronary artery bypass grafting (CABG), aortic valve replacement and CABG + aortic valve replacement. Emergency operation [odds ratio (OR) 4.96, 95% confidence interval (CI) 1.51-16.35; P < 0.01], poor ejection fraction (OR 3.38, 95% CI 1.80-6.32; P < 0.01) and bypass time (OR 1.01, 95% CI 1.00-1.02; P < 0.01) were predictors of in-hospital mortality. The late era of surgery (OR 0.41, 95% CI 0.23-0.73; P < 0.01) was associated with reduced mortality risk. Conclusions: The operative outcome in this growing surgical population is steadily improving despite the increasing prevalence of comorbidities, and surgery should be performed electively as much as possible.
MeSH term(s)	Age Factors ; Aged, 80 and over ; Cardiac Surgical Procedures/methods ; Female ; Follow-Up Studies ; Forecasting ; Heart Diseases/mortality ; Heart Diseases/surgery ; Hospital Mortality/trends ; Humans ; Incidence ; Inpatients ; Male ; Postoperative Complications/epidemiology ; Prospective Studies ; Treatment Outcome
Language	English
Publishing date	2019-01-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivy293
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Article ; Online: Short- and long-term outcomes of pneumonectomy in a tertiary center.

Qadri, Syed S A / Chaudhry, Mubarak A / Cale, Alex / Cowen, Michael E / Loubani, Mahmoud

Asian cardiovascular & thoracic annals

2016 Volume 24, Issue 3, Page(s) 250–256

Abstract: Background: Surgery is the most important therapeutic modality for lung cancer. Surgical outcomes are normally reported as 30-day or 90-day mortality or 5-year survival; 10-year survival is rarely mentioned in national data or international studies.: ... ...

Abstract	Background: Surgery is the most important therapeutic modality for lung cancer. Surgical outcomes are normally reported as 30-day or 90-day mortality or 5-year survival; 10-year survival is rarely mentioned in national data or international studies. Methods: Three hundred and six patients (79% male) underwent pneumonectomy, mainly for lung cancer, from January 1998 to February 2013. Their short- and long-term outcomes up to September 2014 were analyzed retrospectively. The mean age was 64 years (range 22-82 years) and 24% were aged ≥70 years. Thoracoscore was used to calculate the risk of hospital mortality. Results: Operative mortality was 4.5% whereas predicted mortality was 8%. The operative mortality for cancer patients was 3.3%; the national mortality for lung cancer is 6.5%. Only 2 patients died in hospital after a pneumonectomy in the last 5 years. Half of the patients who died in hospital were ≥70 years old; 29% (4 patients) died after urgent operations for nonmalignant disease. Overall 5- and 10-year survival was 32% and 20%. Median and mean survival was 26 and 57 months, respectively. Long-term survival was better in females aged <70 years, in left pneumonectomy patients, and in those with squamous cell lung cancer. Conclusion: Our mortality for pneumonectomy was 50% less than the national mortality rate and significantly lower than that predicted by the Thoracoscore for lung cancer. This confirms that pneumonectomy is still an effective modality for the treatment of lung cancer, with low operative mortality and good long-term survival, especially in younger patients.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Decision Support Techniques ; England ; Female ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms/mortality ; Lung Neoplasms/pathology ; Lung Neoplasms/surgery ; Male ; Middle Aged ; Pneumonectomy/adverse effects ; Pneumonectomy/mortality ; Postoperative Complications/mortality ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Tertiary Care Centers ; Time Factors ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2016-03
Publishing country	England
Document type	Journal Article
ZDB-ID	1400468-9
ISSN	1816-5370 ; 0218-4923
ISSN (online)	1816-5370
ISSN	0218-4923
DOI	10.1177/0218492316629851
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Article ; Online: The Left Thoracotomy Approach for Oncologic Esophageal Resection Is Still Relevant for the Modern Surgical Trainee.

Ariyaratnam, Priyadharshanan / Alibhai, Agha / Saleh, Ahmed / Rusling, Leslie / Cowen, Michael E

The Annals of thoracic surgery

2015 Volume 100, Issue 4, Page(s) 1515–1516

MeSH term(s)	Esophageal Neoplasms/mortality ; Esophageal Neoplasms/surgery ; Esophagectomy/methods ; Female ; Humans ; Laparoscopy/methods ; Male ; Thoracoscopy/methods
Language	English
Publishing date	2015-10
Publishing country	Netherlands
Document type	Comment ; Letter
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2015.04.008
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Article ; Online: WITHDRAWN: Is there life after the Mesothelioma and Radical Surgery trial? Does extrapleural pneumonectomy still have a role in the management of pleural mesothelioma? A 13-year, single-center experience.

Qadri, Syed S A / Cale, Alex / Loubani, Mahmoud / Chaudhry, Mubarak A / Cowen, Michael E

The Journal of thoracic and cardiovascular surgery

2014

Abstract: This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy. ...

Abstract	This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Language	English
Publishing date	2014-01-15
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.2014.01.007
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