Disclaimer. The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written. Health professionals are encouraged to take them fully into account when exercising their clinical judgement. The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient's guardian or carer. It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

No abstract

Current data from nonrandomized studies suggest that TEVAR may reduce early death, paraplegia, renal insufficiency, transfusions, reoperation for bleeding, cardiac complications, pneumonia, and length of stay compared with open surgery. Sustained benefits on survival have not been proven.

Concordant changes between MMP-expression and fibrosis during mitral valve disease, both in LA and RA, suggest involvement of MMPs in structural atrial remodeling. AF itself did not contribute to altered fibrosis or MMP-expression in the LA. The association between AF and RA changes may be precipitated by greater hemodynamic load due to tricuspid regurgitation in these patients.

Despite the high prevalence of preoperative anxiety and depressive symptoms in older patients with cardiac surgery, no association was found with postoperative delirium.

Guidelines and Expert Consensus Documents summarize and\ud evaluate all available evidence with the aim of assisting\ud physicians in selecting the best management strategy for an\ud individual patient suffering from a given condition, taking\ud into account the impact on outcome and the risk benefit\ud ratio of diagnostic or therapeutic means. Guidelines are no\ud substitutes for textbooks and their legal implications have\ud been discussed previously. Guidelines and recommendations should help physicians to make decisions in their daily\ud practice. However, the ultimate judgement regarding the\ud care of an individual patient must be made by his/her\ud responsible physician(s).\ud The recommendations for formulating and issuing ESC\ud Guidelines and Expert Consensus Documents can be found\ud on the ESC website (http://www.escardio.org/knowledge/\ud guidelines/rules).\ud Members of this Task Force were selected by the European\ud Society of Cardiology (ESC) and the European Association for\ud Cardio-Thoracic Surgery (EACTS) to represent all physicians\ud involved with the medical and surgical care of patients\ud with coronary artery disease (CAD). A critical evaluation\ud of diagnostic and therapeutic procedures is performed\ud including assessment of the risk benefit ratio. Estimates\ud of expected health outcomes for society are included,\ud where data exist. The level of evidence and the strength\ud of recommendation of particular treatment options are\ud weighed and graded according to predefined scales, as\ud outlined in Tables 1 and 2.\ud The members of the Task Force have provided disclosure\ud statements of all relationships that might be perceived as\ud real or potential sources of conflicts of interest. These\ud disclosure forms are kept on file at European Heart House,\ud headquarters of the ESC. Any changes in conflict of interest\ud that arose during the writing period were notified to the ESC.\ud The Task Force report received its entire financial support\ud from the ESC and EACTS, without any involvement of the\ud pharmaceutical, device, or surgical industry.\ud ESC and EACTS Committees for Practice Guidelines are\ud responsible for the endorsement process of these joint\ud Guidelines. The finalized document has been approved by all\ud the experts involved in the Task Force, and was submitted to\ud outside specialists selected by both societies for review. The\ud document is revised, and finally approved by ESC and EACTS and subsequently published simultaneously in the European\ud Heart Journal and the European Journal of Cardio-Thoracic\ud Surgery.\ud After publication, dissemination of the Guidelines is of\ud paramount importance. Pocket-sized versions and personal\ud digital assistant-downloadable versions are useful at the\ud point of care.\ud Some surveys have shown that the intended users are\ud sometimes unaware of the existence of guidelines, or simply\ud do not translate them into practice. Thus, implementation\ud programmes are needed because it has been shown that\ud the outcome of dis...

For coronary artery disease with unprotected left main stem (LMS) stenosis, coronary artery bypass grafting (CABG) is traditionally regarded as the "standard of care" because of its well-documented and durable survival advantage. There is now an increasing trend to use drug-eluting stents for LMS stenosis rather than CABG despite very little high-quality data to inform clinical practice. We herein: 1) evaluate the current evidence in support of the use of percutaneous revascularization for unprotected LMS; 2) assess the underlying justification for randomized controlled trials of stenting versus surgery for unprotected LMS; and 3) examine the optimum approach to informed consent. We conclude that CABG should indeed remain the preferred revascularization treatment in good surgical candidates with unprotected LMS stenosis.

The early survival is neither improved nor worsened by single, multiple, sequential or complete arterial coronary reconstruction. The late survival is modestly improved with the use of an arterial graft to a major vessel, preferably but not exclusively to the anterior descendens, except for patients with limited life-expectancy. Differences in time-related survival with and without an arterial graft are nearly the same across all levels of ejection fraction. No late beneficial or detrimental effect was identified with more extensive use of arterial reconstructive surgery in multisystem disease.