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PREPARING A GOOD ABSTRACT Marko Turina University of Zurich Switzerland

Good abstract should: 1. 2. 3. 4.

Adhere to prescribed format Be innovative Carry a clear message Stand up to a thorough scientific scrutiny

Start your work by carefully reading instructions for abstract submission


Abstract format is well defined

Text may not reveal institutional affiliation

Abstract format is well defined

Material should not have been presented elsewhere

Text and title should be free from abbreviations

Common reason for rejection: Duplicate publication

All 6 conditions must be met to declare a publication as a duplicate one.

Definition of duplicate publication is well known, so avoid it! The publication will be considered as duplicate, or redundant, when: • Hypothesis is the same or similar. • Methods are identical. • Case material is similar, or somewhat larger. • Results are identical, or nearly so. • Several authors are common to both publications.

Be painstakingly honest in your data collection and analysis!

Beware of a deadly sin in scientific publishing, which can terminate your academic and professional career: Plagiarism This abuse has become too easy with “copy/paste� in WinWord.

By all means, avoid plagiarism: reviewers are experts, and there are electronic means of detecting duplicate submissions or “borrowed” material. Avoid “Copy and Paste” technique, even from your own material: use of this technique can result in your abstract declared as a duplicate publication!

Many journals use iThenticate routinely, to detect possible plagiarism

Simple plagiarism check with Google Scholar from a recent publication

Simple plagiarism check with Google Scholar: Quick results

In US, plagiarism is a punishable offense, with a governmental agency supervising research, and taking administrative actions.

Suspicion of data manipulation • Not a consecutive series (selected cases) • Strange time intervals (e.g. “March 2006 – June 2008”, why?) • Unusual inclusion and exclusion criteria (e.g. “Isolated MVR in patients with sinus rhythm”, or “AVR in male patients”) • Single surgeon’s experience from a large institution (“Where are other patients?”) • Excluding patients with some risk factors (e.g. reduced LVEF)

Retrospective study

Study beging

You want to perform a scientific study. What type of a study is possible for a CT surgeon?

• Experimental (laboratory) study: CT surgeons are nowadays poorly qualified for such work. • Retrospective study: becoming less popular, but most advances in CT surgery resulted from such studies. • Cohort study: scientifically higher rated, but lasts longer, and more difficult to perform. • Prospective study, if possible randomized. Highest level of scientific evidence, but unattainable for most CT surgeons: very complex and expensive, needs strong financial background. In double blind form, hardly possible in surgery. • Meta-analysis: needs a good statistician, but might give interesting results.

Levels of Evidence Level A

Level B

Level C

Levels of evidence • Randomized double blind studies are hardly possible in surgery. In internal medicine, use of placebo is possible and ethically permitted. • Randomized controlled studies suffer from differences between surgeons, and between various participating centres (some have better results than others). • Cohort studies and case control studies represent most of surgical scientific contributions. • Do not forget: practically all major advances in surgery came from case reports and case series: TGA surgery, mitral repair, OPCAB, etc.

Is there still a place for retrospective studies? Yes, when some conditions are met: •Consecutive series •All patients with a particular condition are included •Appropriate “Case Matching” is performed

Case matching statistics • Matching is a statistical technique which is used to evaluate the effect of a treatment by comparing the treated and the non-treated units when the treatment is not randomly assigned. • The goal of matching is, for every treated patient, to find one (or more) non-treated patients with similar characteristics against whom the effect of the treatment can be assessed.

SYNTAX Trial Design

62 EU Sites +

23 US Sites

Heart Team (surgeon & interventional cardiologist) Amenable for only one treatment approach

Amenable for both treatment options

Stratification: LM and Diabetes Randomized Arms

Two Registry Arms


CABG n=897


n=549 (66.3%)

s in the LM Subgroup •

vs LM

n=348 (33.7%) TCT 2011 •


TAXUS* n=903


n=546 (65.4%)

November 2011 • Serruys • Slide 25


n=357 (34.6%)

PCI n=198

CABG n=1077

TAXUS Express


Prospective (randomized) surgical study: some sobering facts • Such study is very difficult to perform in a single institution (not enough patients). • In each institution ethical committee approval is needed. • Must have a data collecting agency, data monitoring committee, and a core laboratory. • All these requirements make such a study extremely expensive: SYNTAX costs until now 70 – 100 million $. • Such surgical studies are not possible without financial and logistical support by the industry .

How do major associations select their abstracts? Each year EACTS alone receives ~ 1200 abstracts for ~ 250300 program slots.

Contrary to popular distrust, all major surgical associations (STS, AATS, EACTS) perform anonymous abstract selection (program committee is blinded to the authorship)

Abstract selection for EACTS meetings • Each abstract category has 5 – 8 experts. • Grading is always anonymous! • First round of electronic abstract grading results in preselection of good, possible, and useless abstracts. • Second round of grading (app. 40 – 50 % of remaining abstracts) is done by the program committee, first electronically, and finally during a face-face meeting of the committee. • During this meeting, anonymity is sometimes broken to simplify the selection (“Didn’t I hear this talk before?”) • Finally, program committee makes detailed program, with placing abstracts in sessions, and selecting chairmen and invited discussants.

Some examples from EACTS 2012meeting: good and bad abstracts

USE OF FIBRIN GLUE SEALANT FOR BRONCHIAL STUMP COMPARED WITH PLEURAL PATCH IN 100 CASES 1. Objective Development of bronchopleural fistula is a major complication following pulmonary resections,with its associated morbidity and mortality.Reinforcing the bronchial stump, with live pleural patch or application of fibrin sealant have been documented to reduce the incidence of bronchopleural fistula.This study compares the efficacy of pleural patch with fibrin sealant in reducing the development of complications and postoperative morbidity. 2. Methods Between jun 2010 and jan 2012, a total of 100 patients who underwent lung resections were randomly assigned to undergo pleural patch or application of fibrin sealant.The parameters like the duration for which thoracostomyl drainage was kept,incidence of postoperative prolonged air leak,development of bronchopleural fistula were assessed and compared. 3. Results Cases reinforced with fibrin sealant had less postoperative airleak,lower incidence of bronchopleural fistula reducing the postoperative morbidity,when compared with pleural patch 4. Conclusion But for the cost factor associated with fibrin sealant,in view of the significant reduction in postoperative morbidity and complications like bronchopleural fistula the sealant may be routinely used in lung resections irrespective of aetiology with favourable outcomes

Rejection: no numerical results

CURRENT STATUS OF ROBOT-ASSISTED CARDIAC SURGERY IN JAPAN 1. Objective Kanazawa University introduced the da Vinci surgical system (standard da Vinci, Intuitive Surgical inc., USA) in 2005, and we have been developing robot-assisted cardiac surgery in collaboration with the Tokyo Medical University. Our team performs robotic cardiac surgery, and we report the situation in Japan. 2. Methods The level was gradually increased with the introduction of more complicated procedures. For ischemic heart disease, we started from LIMA harvesting and bilateral IMA harvesting via left thoracic cavity. We then performed SVST/MVST (single/multi vessel small thoracotomy; Robotic MIDCAB) and TECAB (totally endoscopic CABG). For structural heart disease, such as ASD closure, mitral valve plasty, cardiac tumor resection, we performed totally endoscopic procedures via right thoracic cavity. 3. Results From Dec 2005 to March 2012, a total of 152 robotic procedures were performed (IMA harvesting 22, SVST 19, MVST 25, ASD closure 35, MV plasty 32, tumor resection 9). 4. Conclusion The majority of our cases were performed using the standard da Vinci. In 2009, the da Vinci S system was approved by the Japanese Ministry of Health, Labour and Welfare (MHLW) as a medical device; however, robot-assisted cardiac surgery has not yet been approved, which has been an obstacle to development. Because of this, Japanese clinical trials using the da Vinci S system started only in 2011.

Rejection: Name of institution! No results!

SURGICAL TREATMENT OF DIFFERENT TYPE OF ATRIAL FIBRILLATION: SINGLE CENTRE EXPERIENCE 1. Objective Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. This study examined the outcome of patients who underwent surgical ablation for AF, with a bipolar device, as a concomitant procedure during cardiac surgery. 2. Methods Between January 2010 and December 2011, 56 patients underwent surgical treatment for AF as a concomitant with other cardiac procedures. AVR 6(11%), MVRepair 11(20%), MVReplacement 1(2%), CABG 4(7%) and others 34(61%). Preoperatively 20(36%) were in paroxysmal AF, 26(46%) in persistent AF and 10(18%) in longstanding AF. 3. Results The average age was 64±12 years. The mean left atrium size was 51±8 mm. The mean time of ablation was 108±41 seconds for pulmonary vein isolation+ lesion set of the left appendage (PVI), 136±67seconds for PVI + box lesion set of the left atrium, and 150±75 seconds for Maze IV procedure. The mean aortic cross-clamp time was 95±42 min. Early postoperative atrial arrhythmias were documented in 23% of patients (n=13). Freedom from AF recurrence at 8 months was 82% (n=45). In the longstanding group, that receive a Maze IV freedom from AF was 100% (n=4/4). The mean f-up was 11±6 months. The left appendage was only ablate, and instead of that, the incidence of stroke was 1.8% (n=1), that occurred 14 months later surgical procedure. Hospital mortality was of 1.8%. 4. Conclusion Surgical ablation remains the gold standard of treatment of AF. The lesion pattern should be fundamental to treat the different type of AF. Ablation during cardiac surgery is simple and quick procedure and should be considered if indicated.

Only institutional experience, suitable for a local meeting

ANTEGRADE AND RETROGRADE ARTERIAL PERFUSION STRATEGY IN MINIMALLY INVASIVE MITRAL VALVE SURGERY: A PROPENSITY SCORE ANALYSIS ON 1280 PATIENTS 1. Objective The aim of the present study is to evaluate the impact of retrograde and antegrade arterial perfusion strategy on outcomes of minimally invasive mitral valve procedures 2. Methods Between 2003 and 2011, 1.280 consecutive patients underwent video-assisted mitral valve surgery at our institution. Retrograde perfusion was used in 260 (20.3%) and antegrade perfusion in 1020 (79.7%) Multivariate logistic regression analysis was used to assess outcomes, while adjusting for patient characteristics. Treatment selection bias was controlled by constructing a propensity score from core patient characteristics. The propensity score was the probability of receiving antegrade or retrograde arterial perfusion and was included along with the comparison variable in the multivariable analyses of outcome. 3. Results After adjusting for the propensity score, antegrade perfusion was associated with lower in-hospital mortality (1.3% vs 2.4%; P =.001), incidence of stroke (2% vs 4%; P =.01), postoperative delirium (3% vs 7%; P =.001), and pulmonary complications (8% vs 15%; P =.001). In multivariable analysis retrograde arterial perfusion (OR 4.3; p=0.02) and age>75 (OR 1.4; p=0.02) were confirmed to be independent predictors for neurologic events. Interaction modeling revealed that the only significant risk factor for neurologic event was the use of retrograde perfusion in older patients with peripheral aortic disease (OR 5.3; p=0.001). 4. Conclusion Antegrade arterial cannulation is safe and has become our preferred perfusion strategy or minimally invasive mitral valve procedure. Retrograde arterial perfusion is associated with an increased risk of neurologic events, especially in older patients with peripheral aortic disease.

Excellent abstract, important topic, good data analysis

BIMA GRAFTING REVERSES THE NEGATIVE INFLUENCE OF GENDER ON OUTCOMES OF CABG SURGERY 1. Objective Coronary artery bypass grafting (CABG) has higher hospital mortality (HM) in women compared with men. The influence of gender on long-term outcomes is less clearly defined. 2. Methods Retrospective analysis was conducted of 4584 consecutive CABG patients: 3674 men (1761 single internal mammary artery, SIMA; 1886 bilateral IMA, BIMA) and 937 women (608 SIMA and 329 BIMA). Propensity score optimal matching algorithm was used to create groups well-matched for baseline risk factors between men and women (SIMA: 602 men and 602 women; BIMA 328 men and 328 women). Cross-sectional follow-up (6 weeks to 32.1 years; mean 12.8) was 96.7% complete. 3. Results HM was higher in unmatched female (F) vs. male (M) patients (SIMA 36/608; 5.9% vs. 72/1761; 4.1%; BIMA 11/329; 3.3% vs. 47/1886; 2.5%; p=0.010). However, in matched groups the increased HM for F approached significance in SIMA but not BIMA patients. (SIMA M 21/602, 3.5%; F 35/602, 5.8%; p=0.055; BIMA M 12/328; 3.7%; F 11/328; 3.4%; p=0.832). When well-matched for baseline variables, F SIMA patients experienced prolonged survival compared with their M counterparts. (M vs. F, 20-year survival 17.0±2.0% vs. 26.4±2.3%; median 10.4 vs. 11.4; p=0.043.) However, long-term survival between matched M and F BIMA patients was comparable. (M vs. F, 20-year survival 31.3±3.6% vs. 30.1±3.6%; Median 13.7 vs. 13.7; p=0.790) 4. Conclusion When liberally applied, BIMA grafting ameliorates both the increased perioperative mortality in female patients and the reduced long-term survival of male patients, effectively reversing the negative influence of gender on both short and long term outcomes of CABG surgery.

Manuscript’s authorship: some advices • Settle all authorship problems before beginning to write the manuscript: you will save yourself a lot of trouble later. • First author is the researcher who performed most of the work, and/or wrote most of the manuscript. • Senior author is acknowledged to be the originator of the idea/hypothesis, or in charge of the group submitting the manuscript. • Having performed some or even a large part of surgeries described in the manuscript does not necessarily qualify for authorship, unless other criteria are met.

Highest chance of successful submission • Properly designed prospective randomized study • In non-randomized trials, apply proper statistical methods (e.g. propensity score, matching pairs). Statistician must be consulted, and he is one of the authors! • Meta-analysis has a good chance of acceptance. • Innovative work has a highest probability of acceptance: new techniques, ideas, experimental observations. • Attractive are manuscripts which question an established belief or a widely presumed “fact”. • Novel classification or guidelines guarantee highest number of citations in a short time.