EJCTS to be online only

 

23rd September 2020
European Journal of Cardio-Thoracic Surgery

Dear Member,

In October this year European Journal of Cardio-Thoracic Surgery (EJCTS) will be joining Interactive CardioVascular and Thoracic Surgery (ICVTS) to become an online-only publication. Times are changing and so are we!  We now live in a digital world where both researchers and readers expect information to be easy to find and fast to access – from any device in any location – and online journals fulfill this need.

We understand that some of you may miss receiving your monthly copy of EJCTS, but after much debate we have decided that moving to online-only is the right thing to do, for EACTS and for our readers all over the world.

Here is a summary of our thinking, for your convenience:

  • By moving to online-only, EACTS can focus its efforts on improving the online journals, which in turn will deliver faster and more effective access to research information.
  • The EJCTS and ICTVS journal homepages are about to be significantly upgraded, making articles even more accessible than ever before.  Additional new functionality is timetabled for launch early next year.
  • Video can be a vitally important component of the papers EJCTS publishes.  Our online journals offer the specialty-focused video and sound content that is so often an essential element of a research article.
  • And finally, online-only journals save paper and plastic and eliminate the cost of distribution. We have become painfully conscious of the environmental cost of printing thousands of journals every month and we believe that this is unsustainable, in every sense of the word.

We hope you will support us in this decision and we look forward to announcing the launch of our new online journal homepages and improved functionality very soon.

With best wishes,

Friedhelm Beyersdorf                                                         Matthias Siepe
Editor-in-Chief                                                                     Incoming Editor-in-Chief

UPDATE: Coronavirus | COVID-19

Updated: 24 July 2020

We would like to acknowledge and pay tribute to so many EACTS members and others in the wider cardiothoracic community who are selflessly supporting COVID-19 patients.  People are making significant personal sacrifices to support the global effort to combat the pandemic and we salute you.

This unique period in our lives demonstrates not only the importance of world class clinical expertise but also the role that solidarity, friendship and collegiate team working play to protect and save lives.  We recognise the very challenging circumstances that many EACTS members are working in and we thank you for your professionalism and dedication.

34th Annual Meeting
The Annual Meeting in Barcelona has been adapted for our times.  This year you can attend in person and also, amazingly, through a revolutionary new online experience, THE EACTS PORTAL – suddenly Zoom is obsolete!

Registration is now open!  Please note that there will not be an on-site registration desk, you must register online via our membership and registration system.  If you need any assistance, please contact registration@eacts.co.uk (registration process not supported on ‘phones or tablets).

EACTS Academy Programme
In order to protect the health and safety of our delegates, faculty and Industry partners, the EACTS Council has taken the difficult decision to cancel all planned Academy courses for the remainder of 2020.  We plan to resume our Academy programme in 2021.

Online training
While we pause EACTS Academy courses, there is a wealth of online content to supplement your education and training requirements during this period.

  • EACTS Journals are available online.  If you’re an EACTS member, access the issues online with your @OUPMedicine login.
  • MMCTS provides 320+ step-by-step video demonstrations of surgical procedures.  Find online tutorials across the CT subspecialties here: Https://Mmcts.Org/
  • Oxford University Press has made content from online resources and leading journals freely accessible to assist researchers, medical professionals, policy makers, and others who are working to address this health crisis: Https://Academic.Oup.Com/Journals/Pages/Coronavirus
  • We will also be highlighting additional content that you may find helpful during this time

Contacting EACTS
We have also taken action to support the health and safety of EACTS staff. We are encouraging colleagues to work from home.  Our Windsor office in the UK is closed until further notice to EACTS members and visitors.  You can continue to contact the office about EACTS related queries by emailing: Info@Eacts.Co.Uk. 

Hope for the future
Across the globe health professionals are working together to overcome the COVID-19 pandemic, helping patients and saving lives.  Our thoughts are with all those supporting patients.  We will of course emerge from this global crisis and, when we do, we hope the world remembers the importance of expert healthcare and friendship.

Stay safe and follow official advice.

The 34th Annual Meeting will be virtual only

The 34th Annual Meeting
will be virtual only

3 August 2020

Dear Colleagues,

We have made the difficult decision to postpone the “live in person” part of the Annual Meeting in Barcelona and transition to a virtual format through the EACTS Portal only. The decision was made due to the escalating uncertainty related to the Coronavirus outbreak and to safeguard the safety of our members and the broader community we serve.

The innovative EACTS Portal will continue to provide an opportunity to attend the Annual Meeting sessions and connect with friends and colleagues, all in a safe learning environment with an inspiring scientific programme as well as a fully featured virtual exhibition hall where you can talk with exhibitors, see their latest products, and download information.

With this new technology, it is just like being right there in person.

 If you are a Physician or Industry representative , there are 3 options to attend:

      1. Existing EACTS members receive free access.
      2. Non-Members can apply for EACTS membership for an annual fee of €250, and receive free access.
      3. Non-Members who do not wish to join EACTS can register for the Annual Meeting for €300 plus applicable VAT.

All Nurses will receive complimentary registration.

If you are a Resident, Perfusionist, or other Allied Health professional , there are 3 options to attend:

      1. Existing EACTS members receive free access.
      2. Non-Members can apply for EACTS membership for an annual fee of €125, and receive free access.
      3. Non-Members who do not wish to join EACTS can register for the Annual Meeting for €150 plus applicable VAT.

 

Disclaimer: This year, EACTS are piloting an Artificial Intelligence translation tool and as this is new for us all, there may be some mistakes. Please help us to improve and share your feedback.

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EACTS Annual Meeting 2020 – Registration now open

Update: The 34th Annual Meeting will be virtual only – learn more…

 

Join us in Barcelona for the 34th  EACTS Annual Meeting 

2020 is a year like no other.  The  cardiothoracic community  has played an important part in tackling COVID-19 and many of you have made personal sacrifices in order to support patients on the frontline. This year – more than ever – the EACTS Annual Meeting is an opportunity  for the cardiothoracic community to come together in friendship, solidarity and collaboration.

Registration is now open for the 34th  EACTS Annual Meeting which takes place in the coastal city of Barcelona between 8-10 October.

The EACTS Annual Meeting provides the very latest developments from industry and research, coupled with opportunities for hands-on training and skills development. It offers a year’s worth of world-class education in three days!

Work is already underway to develop an exciting programme and further details will be issued by the EACTS  Programme  Committee shortly. With so many of our members on the front line of this pandemic, there will be important stories to tell, valuable data to analyse and information to share. The meeting is an opportunity to explore the lessons learnt from COVID-19.

The  EACTS Annual Meeting adapted  for  our times 

The impact of COVID-19 has changed our world considerably. Our primary concern throughout the meeting will be the health and safety of all delegates and exhibitors. We will be adapting the way we run the event so that important measures such as social distancing can be practised. Although some countries are slowly emerging from lockdown, the  situation is changing regularly and we will remain watchful. We are monitoring  international  best practice and will of course observe official Spanish guidance. We will provide more detailed guidance for delegates nearer the time.

Book with confidence

We are working very hard to ensure the EACTS Annual Meeting can be run as planned, but please be assured if the pandemic means that the EACTS Annual Meeting has to be cancelled, we will refund your booking fee.

More content available digitally 

We all look forward to the EACTS Annual Meeting but we do recognise  that some heart teams may be particularly busy this autumn because so many procedures have been deferred during the height of the pandemic.  We  are exploring ways to ensure that more elements of the EACTS  Annual Meeting  will be  available digitally this year. So  if you are unable to travel to Barcelona, you  will be able to  tap into some elements online.  We will provide more information about this in due course.

Call for Abstract deadline

We are encouraging abstracts for the EACTS Annual Meeting. Given the coronavirus pandemic, we are naturally respectful that many people will have significant commitments to patients and families, and therefore we have given more time for people to prepare submissions.

The extended deadline for Annual Meeting abstracts is 31st May 2020.

Hope for the Future

The EACTS Annual Meeting provides us all with hope for the future: hope  that we can meet friends and colleagues again, and share our combined experiences. The EACTS Annual Meeting also serves an educational purpose and it is only through groundbreaking science and education that we will continue to protect our populations and  save lives.

We would love to see you in Barcelona.

How to register

We strongly encourage all visitors to register  online  in order to take advantage of our early registration rates. The early registration discount is available until 1st July 2020. Don’t miss out!

Registration is now open here 

Melissa Allison joins EACTS

5 March 2020

After twenty years in the cardiovascular industry, today Melissa Allison joins the European Association for Cardio-Thoracic Surgery (EACTS) as Executive Director and Chief Operating Officer. Melissa will take responsibility for the day to day management of EACTS, based in Windsor, UK, and will work with the Secretary General, Professor Domenico Pagano.

Melissa is re-locating from Amsterdam, Holland, where most recently she has been Vice President, Marketing and Education (Europe, Middle East and Africa), with AtriCure successfully spearheading new education programmes and reshaping the company’s brand presence. Melissa brings an excellent knowledge of the cardiothoracic sector and has a successful track record working with industry partners and clinicians across the heart team including cardiologists, electrophysiologists and surgeons.

EACTS Executive Director and Chief Operating Officer, Melissa Allison, said:

“I am thrilled to be joining EACTS and am looking forward to this exciting new challenge. I am looking forward to working with colleagues and international partners to deliver world class education programmes and other wide-ranging services for EACTS members.”

Professor Domenico Pagano, EACTS Secretary General, said:

“I am delighted that Melissa is joining our Association from industry and I am looking forward to working with her. Melissa has a strong commitment to education, and the dynamic education programmes she has developed are highly regarded. She has significant experience in the sector, has worked at international level and already knows many of the industry partners, surgeons, cardiologists and other members of the heart team with whom we work. Melissa will play a vital role supporting our staff, help deliver our strategic vision and ensure the Association goes from strength to strength.”

-ENDS-

EACTS statement | BBC Newsnight investigation

19 February 2020

The European Association for Cardiothoracic Surgery (EACTS) has issued a statement following the BBC Newsnight programme (aired on 18 February 2020) saying:

“The allegations in BBC Newsnight’s investigation are disturbing and underline the need for the recommendations on left main disease in the 2018 Myocardial Revascularization Guidelines to be reviewed urgently by an independent group. In the meantime, we recommend that patients seek the advice of the multidisciplinary heart team at their hospital before deciding which treatment option is most appropriate for them. The latest revelations corroborate the EACTS Council decision of December 2019 to withdraw support from the recommendations on left main disease in the 2018 Myocardial Revascularization Guidelines.” 

To watch the piece, please visit the BBC Newsnight YouTube channel here: www.youtube.com/watch?v=lxWwyVCcrEs

Statement – letter to EXCEL trial principal investigators

7 January 2020 

On behalf of the Council of EACTS, the Secretary General has written to the principal investigators of the EXCEL trial to offer assistance to resolve the concerns that have been raised about the trial. EACTS has highlighted the importance of making the individual patient data available for independent analysis. In the interests of patient safety, urgent action is required to re-establish the validity of the EXCEL trial in order to provide safe clinical recommendations.

In December 2019, the EACTS Council withdrew its support for the recommendations on left main coronary artery disease of the 2018 joint ESC-EACTS Myocardial Revascularization Guidelines. We also wrote to the ESC inviting our colleagues to work with us jointly to consider the evidence available and develop updated recommendations as a matter of urgency. We await their response.

See the letter from the Secretary General here.

 

 

Changing Evidence, Changing Practice

In December 2019 the EACTS Council withdrew its support for the recommendations on left main coronary artery disease of the 2018 joint ESC-EACTS Myocardial Revascularization Guidelines. Here we explain why.  

19 December 2019

Introduction

The pursuit of new innovations and techniques to provide optimal care to patients is both welcome and vital. Without advances in practice, we would not improve quality of life and save as many lives as we do. However patient safety is paramount and that is why there are well established practices to assess the results of clinical trials that support the preparation of clinical guidelines which provide the advice on which clinicians depend to identify optimal treatment. Withdrawing support from guidelines in this fashion is unprecedented for our Association. It was a decision taken by the whole Council with considerable care. This article explains what we did and why.

The guideline in question was prepared in 2018 by representatives from both the European Society of Cardiology (ESC) and the European Association for Cardiothoracic Surgery (EACTS), who had considered a range of evidence including the reported outcomes from the EXCEL trial to develop the recommendations for the treatment of patients with left main coronary artery disease (LMCAD) and stable angina which form part of the joint 2018 ESC-EACTS Myocardial Revascularization Guidelines.

 

EACTS Council made three important decisions

At our Council meeting on 7 December 2019 three important decisions were taken regarding the guidelines.

  1. Council withdrew its support from the current recommendations on treatment of left main disease in the 2018 joint ESC-EACTS Myocardial Revascularization Guidelines. This decision was based on a range of scientific, statistical and professional issues that had been raised.
  2. Council wanted to ensure members were notified and it was agreed to publicise the decision widely.
  3. Council also requested that the ESC was invited immediately to participate in a new joint taskforce to review the LMCAD recommendations in the guidelines.

 

All the decisions were agreed unanimously.

Prior to the Council meeting, the BBC’s Newsnight programme contacted both EACTS and the ESC with revelations about the EXCEL trial. The BBC asked Professor Nick Freemantle, from the Institute of Clinical Trials and Methodology at University College London, to examine their findings. Professor Freemantle shared his analysis of the current evidence and the new findings with the EACTS Council. To help inform their decisions, the EACTS Council was able to consider Professor Freemantle’s comprehensive statistical analysis alongside several matters of scientific and professional propriety, including those raised by the BBC, which questioned the robustness of both the content and the guideline process.

Following the Council meeting, we proactively issued a statement so that members and clinicians knew the Council had removed its support for the LMCAD recommendations in the 2018 ESC-EACTS Myocardial Revascularization Guidelines.

So what evidence underpinned the 2018 Guideline recommendations?

The recommendations in the 2018 ESC-EACTS Myocardial Revascularization Guidelines for the treatment of LMCAD were based on SYNTAX score terciles and the conclusions were:

  1. There was class IA evidence to support CABG in all groups, the highest level of recommendation.
  2. In patients with SYNTAX score <22, PCI was equivalent to CABG. Class IA recommendation.
  3. In patients with SYNTAX 23-32, the evidence for PCI was less clear. Class IIaA recommendation.
  4. In patients with SYNTAX scores >33, PCI was not recommended. Class IIIA.

These recommendations are the same as those published in 2014, which were derived from short-term outcome data and an underpowered subgroup analysis of the SYNTAX trial.

The scientific evidence underpinning the 2018 decisions was based mostly on 3 studies (see references 1-3).

  1. The patient level meta-analysis of randomised trials of CABG versus PCI (3) using up to 5-year all-cause death as the primary endpoint showed that for the overall cohort PCI was associated with a significant survival disadvantage (Hazard Ratio [HR] 1.20, 95% confidence intervals [CI] 1.06-1.37; P=0.0038). A subgroup analysis for patients with LMCAD was reported to have similar outcomes for PCI and CABG. However, this conclusion is scientifically questionable given the non-significant interaction (P=0.12) for the LMCAD subgroups. Thus, the correct scientific interpretation is that the result for the overall cohort applies also for the LMCAD subgroup (4, 5). The patient level meta-analysis was evaluated by the task force in its pre-publication status and shared with the reviewers a short time before the publication of the guidelines; this questions whether sufficient time for scrutiny had been allowed.
  2. The NOBLE trial (2) showed a more frequent occurrence of the primary composite endpoint (all-cause death, non-procedural myocardial infarction (MI), stroke and repeat revascularisation in the PCI than in the CABG group (HR 1.48, 95% CI 1.11-1.96; P=0.007). There was no difference in all cause mortality.
  3. The EXCEL trial which studied patient with SYNTAX Score <32 (1), reported that at 3-year follow up the primary composite endpoint (all-cause death, stroke, or MI) occurred with similar frequency in the CABG and the PCI groups (HR 1.00, 95% CI 0.79-1.26; P=0.98). This was interpreted as showing that PCI was not inferior to CABG.

 

But the evidence available has changed

Our primary concern is patient safety and given there is new emerging evidence, there are multiple reasons for adapting to these different circumstances and reviewing the LMCAD recommendations of the guideline:

  1. More complete understanding of the 3-year data from EXCEL (1) using the standard definition of a myocardial infarction (UDMI) has reversed the perceived advantage/non-inferiority of PCI compared with CABG for LMCAD disease. These data were presented by the BBC but have not been published.
  2. The 5-year data from EXCEL (10) have now demonstrated a significant survival advantage for CABG over PCI for this group of patients.

 

And the BBC has also highlighted the following issues

The recent BBC Newsnight investigation has raised several additional concerns with regards to the EXCEL trial and the guideline process:

  1. To date, the trial authors have not published the trial outcome data using the universal definition of myocardial infarction (UDMI) despite stating they would report the findings.

 EXCEL has attracted controversy since its inception (6), particularly around the definition of MI. There is a standard Universal Definition of MI (UDMI) (7), which was included in the EXCEL protocol as a prespecified secondary endpoint. This definition has the advantage of being endorsed by most cardiovascular organizations, including the ESC, ACC, AHA and regulators. The BBC reported that the EXCEL investigators adopted a new definition for this complication (MI) which would increase the apparent occurrence of peri-operative MI after CABG, leading to results appearing to favor the PCI option. This could only be acceptable if its findings proved to be consistent with those using the UDMI, hence the importance of the secondary endpoint. The protocol of the study was not amended to reflect the decision not to publish – to date, this represents a breach of the CONSORT and Good Clinical Practice Guidelines (ICH E9) (8, 9).

  1. 35% increased risk of death in the PCI group

The BBC received data for the 3-year outcomes, including the hitherto unpublished secondary outcome using the UDMI, which provided a qualitatively different outcome. In an analysis shared by the BBC, when UDMI is used PCI is associated with substantially worse outcomes at 3 years with a significantly higher risk of MI than CABG (HR 1.79, 95% CI 1.25-2.57; P=0.002). When UDMI is used in the composite primary end-point with all-cause death and stroke, PCI is associated with a 40% increased risk for this (HR 1.40, 95% CI 1.09-1.81; P=0.009). This analysis is predictive of the published 5-year EXCEL results (10) which show a 35% increased risk of death in the PCI group, (Odds Ratio 1.38, 95% CI 1.03-1.85).

  1. Emerging mortality data have not been shared

The BBC revealed there were emerging data available to the EXCEL data safety monitoring board (DSMB) indicating an increased mortality for the PCI group. In its news coverage, the BBC considered why these data were not made available to those on the guideline task force. Had all the information described above been available to the task force, the conversation around the choice of guideline recommendation would probably have been different. It is of note that some of the EXCEL investigators were also members of the guidelines task forces.

  1. Alleged conflicts of interest

 Public concerns have arisen over commercial conflicts of interests among both the authors and some members of the guideline committees. The BBC identified that one third of the authors of the guidelines had significant relevant commercial conflicts of interests, including at least one holding a patent for drug-eluting stents. These potential conflicts were not available to the guideline task force members during the writing of the recommendations or to the reviewers (although they had been seen by the guideline chairs) and were published at the same time as the guidelines.

Restoring confidence in our recommendations

Producing clinical guidelines provides an important opportunity for scrutinizing the available clinical evidence. For this reason, the guideline process must take care to minimize bias and the potential influence of conflict of interests. The methodology for developing “Guidelines we can Trust” is well described by The Institute of Medicine (IOM)(11) which recommends steps to minimize bias by using systematic literature search around predefined clinical questions, a transparent management of COIs, the use of statistical methodologists to prepare evidence tables and guide the interpretation of data, and more recently the use of the GRADE collaboration system (12).

The 2018 joint ESC-EACTS guideline task force did not use this methodology as it was not adopted at the time.

The way forward is clear. If vested interests add complexity to the resolution, these must be swept aside by professional, scientific and analytical integrity in the interests of our patients.

Therefore, we have taken the following action to restore confidence in the guidelines.

  1. We have written to the ESC inviting our colleagues to work with us jointly to consider the evidence available and develop updated recommendations as a matter of urgency.
  2. In order to ensure the trustworthiness of the guidelines, we propose to adhere to the Institute of Medicine gold standard principles for developing clinical recommendations.
  3. We have invited Professor Schuenemann, Director of the DeGroote Cochrane Canada Centre and Mc Master Grade Centre, to oversee the process.

The guidelines for myocardial revascularization must be reviewed urgently. By working together collaboratively and transparently, we can restore confidence in our clinical recommendations and send a strong signal to the public that patients’ interests are at the centre of all we do and say.

D. Pagano.

Secretary General of EACTS, on behalf of the EACTS Council

-ENDS-

REFERENCES

  1. Stone GW, Sabik JF, Serruys PW, Simonton CA, Généreux P, Puskas J, et al. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med. 2016;375(23):2223-35.
  2. Makikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet. 2016;388(10061):2743-52.
  3. Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet. 2018;391(10124):939-48.
  4. Freemantle N, Ruel M, Gaudino MFL, Pagano D. On the pooling and subgrouping of data from percutaneous coronary intervention versus coronary artery bypass grafting trials: a call to circumspection. Eur J Cardiothorac Surg. 2018;53(5):915-8.
  5. Yusuf S, Wittes J, Probstfield J, Tyroler HA. Analysis and interpretation of treatment effects in subgroups of patients in randomized clinical trials. JAMA. 1991;266(1):93-8.
  6. Ruel M, Falk V, Farkouh ME, Freemantle N, Gaudino MF, Glineur D, et al. Myocardial Revascularization Trials. Circulation. 2018;138(25):2943-51.
  7. Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. Eur Heart J. 2007;28(20):2525-38.
  8. Rennie D. CONSORT revised–improving the reporting of randomized trials. JAMA. 2001;285(15):2006-7.
  9. European Medicines Agency. ICH E9 statistical principles for clinical trials. https://www.ema.europa.eu/en/ich-e9-statistical-principles-clinical-trials. (15 December 2019, data last accessed).
  10. Stone GW, Kappetein AP, Sabik JF, Pocock SJ, Morice M-C, Puskas J, et al. Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease. N Engl J Med. 2019;381(19):1820-30.
  11. Institute of Medicine Committee on Data Standards for Patient S. In: Aspden P, Corrigan JM, Wolcott J, Erickson SM, editors. Patient Safety: Achieving a New Standard for Care. Washington (DC): National Academies Press (US)

Copyright 2004 by the National Academy of Sciences. All rights reserved.; 2004.

  1. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401-6.

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