ࡱ> oqni b,bjbj .tHfHfb$  dddddxxxx|xS.(-------${013-d-dd .~"~"~"dd-~"-~"~"r~,pv-Ч89 v,-#.0S.,zG4t!:G4v-G4dv-H~"[--!S.G4  *: Insert your Title here, eg: Are stentless valves superior for aortic valve replacement? Put your Name here eg: Antonios Kallikourdis1, Samuel Jacob1. Joel Dunning2 Insert your institution here e.g. : Department of Cardio-thoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK Department of Cardiothoracic Surgery, James Cook University Hospital , Middlesbrough, UK Put your contact details here: Corresponding Author: Joel Dunning Department of Cardiothoracic Surgery James Cook University Hospital Middlesbrough, UK E-mail:  HYPERLINK "mailto:joeldunning@doctors.org.uk" joeldunning@doctors.org.uk Tel/fax: +44-7801-548122 Word count: (up to 3000) Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was Insert your question here. Altogether more than insert number here papers were found using the reported search, of which insert number here represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Insert a good summary of the evidence here. We conclude that insert your conclusion(s) here, this is usually identical to your clinical bottom line at the end of the paper and you can cut and paste the clinical bottom line here if you wish Key Words: review; Take MeSH words from the search strategy if you can Introduction A best evidence topic was constructed according to a structured protocol. This is fully described in the ICVTS [1] Dont edit this and remember to keep reference 1 in Three-part question Along the lines of PICO [Patient group, intervention, comparison (if there is one) and outcome or outcomes]- example: In [patients undergoing bioprosthetic aortic valve replacement] is [a stented or a stentless valve] superior [for achieving left ventricular recovery] 3-Clinical scenario This should be in the form of a clinical dilemma, such as may be discussed during an MDT or the planning stages of surgery e.g.: A 74-year-old male patient requires aortic valve replacement for severe aortic stenosis. He chooses a tissue valve after appropriate counselling, but while reviewing his echocardiography dimensions, you are concerned that he may have small annular dimensions. At the aortic valve multidisciplinary team meeting, one of your colleagues suggests the patient would gain better haemodynamics with a stentless valve, but you are both unsure whether this would translate into clinical and measurable benefit, such as left ventricular recovery. You resolve to check the literature for evidence. Search strategy The terms depend on whether you use Pubmed or Ovid. Examples: Medline 1950 to May 2007 using OVID interface: [aortic valve replacement.mp OR exp aortic valve/] AND [Stentless.mp OR Stented.mp] Or Medline using Pubmed interface: [(aortic valve) AND (surgery OR replacement)] AND [stentless OR stented]. If this gives a high number of papers, you can further narrow down by adding (for example) AND [outcomes]. If the outcomes are specific, these could be searched for directly in the third search term(s). Two of the authors should perform the search and selection, to ensure all relevant papers are screened, and that the search is reproducible, by the reviewers or editor, for example. 5- Search outcome X (insert total found with search) papers were found using the reported search. From these y (insert total selected for discussion )papers were identified that provided the best evidence to answer the question. These are presented in table 1. 6-Results Insert your results here AFTER you have added all your chosen papers to the table (see below). We usually go straight in and discuss all or most of the papers and then come to conclusions. You have 3000 words for the whole paper from the Summary to the Clinical bottom line, including the references and table, therefore try not to duplicate findings in the table and in the text. You do not need to do a preamble or background information. Knowledge of the subject should be assumed. Here is an example that you should delete: Kunadian et al [2] in 2007 performed a meta-analysis of all the randomised controlled trials that we identified. They found that the effective orifice area and the mean and peak aortic valve gradients were significantly superior to the conventional stented valves used as controls across the 10 studies. In addition they showed that at 6 months the left ventricular mass index reduced significantly more in the stentless valve group. However by 12 months the patients in the stented valve groups had caught up with the stentless valve groups in terms of mass regression and there was no longer a significant difference. No mortality or symptomatic benefits were demonstrated. They also aggregated the times taken to perform the 2 types of operation. Overall there was a mean increase in the cross clamp time of 23 minutes and a 29 minute increase in the bypass time. Ali et al [3] showed that, both stented and stentless bioprosthesis are associated with excellent clinical and haemodynamic outcomes 1 year after AVR. Comparable haemodynamic and LVM regression can be achieved using a second-generation stented pericardial bioprosthesis. However, in patients with reduced ventricular function preoperatively (left ventricular ejection fraction [LVEF] <60%), there was a significantly greater improvement in LVEF from baseline to 1 year in stentless valve recipients. Etc. for each paper Williams et al [11] studied left ventricular mass using magnetic resonance imaging (MRI) at 1 week, 6 months, and 32 months. At 32 months, measurement in diastole showed a reduction of 38% (P<.01) in the stentless group compared with 20% (P = ns) in the stented group, and measurements in systole showed a 23% (P<.01) and 13% (P = ns) reduction, respectively. This study confirms that a larger stentless valve can be implanted into a given size of aortic annulus with superior residual aortic valve gradients. 7. Clinical bottom line This should be a succinct and catchy clinical bottom line, hopefully with strong recommendations, if there is strong evidence. We really dont like the words further research is needed, please just make a conclusion based on your Best Evidence. You can cut and paste this into the conclusion of the abstract. Here is an example: Stentless valves allow a larger effective orifice area valve to be implanted with a lower mean and peak aortic gradient post-operatively. At 6 months several studies and a meta-analysis have shown superior left ventricular mass regression in the stentless valve groups. However by 12 months the stented valve groups catch up in terms of mass regression and this significance disappears. No clinical benefits in terms of symptoms or mortality have so far been shown. On average a stentless valve requires a 23 minute longer cross-clamp time and a 29 minute longer bypass time. References References should go before the table. Make sure that all authors are included and not just the first 3 or 6 with an et al. This is to aid with reviewing papers from the same institutions but with different first authors. The format will need to be edited (back to 6 authors) at the proof stage. The format is as below: [1] Dunning J, Prendergast B, Mackway-Jones K. Towards evidence-based medicine in cardiothoracic surgery: best BETS. Interact CardioVasc Thorac Surg 2003;2:405-409. [2] Bakhtiary F, Schiemann M, Dzemali O, Wittlinger T, Doss M, Ackermann H, Moritz A, Kleine P. Stentless bioprosthesis improve postoperative coronary flow more than stented prostheses after valve replacement for aortic stenosis. J Thorac Cardiovasc Surg 2006;131:883 8. Etc Table You should always start doing your paper here. Dont do anything else until the table is finished. With regard to the table do not cut and paste long passages from the abstract. Try to find the key 1 to 4 outcomes, then put in the actual figures that the papers report. Try not to use the words X was significantly higher than Y or similar. Try to say Outcome X - mean 34, SD 20 Outcome Y - mean 40 SD 10, p=0.43 Obviously if you are putting in a guideline you will have to put in their text. This is okay. Any queries just fill in the table and put in a query in red and send it to me. Use the comments column to comment on the quality of the paper or any conflicting results/conclusions. Cut out the example data here and paste your own in: Table 1: Best Evidence Papers Author, date, journal and country, study type (level of evidence) Patient groupOutcomesKey resultsCommentsSmith et al (1985) J Thorac Cardiovasc Surg, Japan (2) RCT (level II)70 patients (age >65 years) - Group A stentless (n=34) - Group B stented (n=36)Early haemodynamics (EOA)A (1.07 +/- 0.4 cm2/m2) B (0.87 +/- 0.3 cm2/m2) p <0.05More males in group B No difference in ITU stay despite longer CPB and XC times etc. LV mass regression (ED LV wall thickness pre-op to post-op)A (15.6 to 11.8mm) B (14.8 to 13.2mm) P<0.005CPB timeA (148.5+/-30.9 min) B (118.6+/-36.3 min) p=0.0001etc..  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[ @VerdanaC.,*{ @Calibri Light?=*Cx Courier New;WingdingsA$BCambria Math"1hTuTuAA!94P$P$KqHP ?Lp2!xxW"E cIs the stentless valve a better choice than stented bioprosthetic valve in aortic valve replacementC LAMB Judy Gaillard    Oh+'0$8 P\ |  dIs the stentless valve a better choice than stented bioprosthetic valve in aortic valve replacementC LAMB Normal.dotmJudy Gaillard2Microsoft Office Word@F#@R79@R79 ՜.+,D՜.+, hp  SHIELDHILL CASTLEAP$ dIs the stentless valve a better choice than stented bioprosthetic valve in aortic valve replacementdIs the stentless valve a better choice than stented bioprosthetic valve in aortic valve replacement TitreTitle 8@ _PID_HLINKSA|g"mailto:joeldunning@doctors.org.uk  !"#$%&'()*+,-./0123456789:<=>?@ABDEFGHIJKLMNOPQRSTUVWXYZ[\]_`abcdeghijklmpRoot Entry FЧ89rData ;1TableCc4WordDocument.tSummaryInformation(^DocumentSummaryInformation8fCompObjr  F Document Microsoft Word 97-2003 MSWordDocWord.Document.89q