Sam Heuts

Sam studied medicine at Maastricht University, after which he pursued a PhD at the department of Cardiothoracic Surgery in preoperative planning of surgical procedures.  He gained a special interest in coronary surgery, imaging, and periprocedural myocardial injury. In line of this work, he received a Dekker grant (Dutch Heart Foundation, Clinical Scientist) in 2023.

Sam is the principal investigator of the PRIMARY trial (Dekker grant, Dutch Heart Foundation), evaluating the extent and impact of periprocedural myocardial injury. Also, together with colleagues, he developed a new method for the evaluation of the association between surgical volume and clinical outcomes, and he takes a special interest in Bayesian statistical inference.

Department of Cardiothoracic Surgery
P. Debeyeplein 25, 6229 HX Maastricht
P.O. Box 616, 6200 MD Maastricht

  • 2024
    • Ubben, J. F. H., Suverein, M. M., Delnoij, T. S. R., Heuts, S., Winkens, B., Gabrio, A., van der Horst, I. C. C., Maessen, J. G., Lorusso, R., van de Poll, M. C. G., & INCEPTION-investigators (2024). Early extracorporeal CPR for refractory out-of-hospital cardiac arrest - A pre-planned per-protocol analysis of the INCEPTION-trial. Resuscitation, 194, Article 110033. https://doi.org/10.1016/j.resuscitation.2023.110033
    • van der Heijden, C. A. J., Aerts, L., Chaldoupi, S.-M., van Cruchten, C., Kawczynski, M., Heuts, S., Bidar, E., Luermans, J. G. L. M., & Maesen, B. (2024). Hybrid atrial fibrillation ablation. Annals of Cardiothoracic Surgery, 13(1), 54-70. https://doi.org/10.21037/acs-2023-afm-0129
  • 2023
    • Mariani, S., Wang, I. W., van Bussel, B. C. T., Heuts, S., Wiedemann, D., Saeed, D., van der Horst, I. C. C., Pozzi, M., Loforte, A., Boeken, U., Samalavicius, R., Bounader, K., Hou, X., Bunge, J. J. H., Buscher, H., Salazar, L., Meyns, B., Herr, D., Matteucci, S., ... Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators (2023). The importance of timing in postcardiotomy venoarterial extracorporeal membrane oxygenation: A descriptive multicenter observational study. Journal of Thoracic and Cardiovascular Surgery, 166(6), 1670-1682.e33. https://doi.org/10.1016/j.jtcvs.2023.04.042
    • Heuts, S., Kawczynski, M., Sardari Nia, P., Maessen, J. G., Biondi-Zoccai, G., & Gabrio, A. (2023). Bayesian interpretation of non-inferiority in transcatheter versus surgical aortic valve replacement trials: a systematic review and meta-analysis. Interdisciplinary CardioVascular and Thoracic Surgery, 37(5), Article ivad185. https://doi.org/10.1093/icvts/ivad185
    • Kawczynski, M. J., van Kuijk, S. M. J., Olsthoorn, J. R., Maessen, J. G., Kats, S., Bidar, E., & Heuts, S. (2023). Type A aortic dissection: optimal annual case volume for surgery. European Heart Journal, 44(41), 4357-4372. Article ehad551. https://doi.org/10.1093/eurheartj/ehad551
    • Mariani, S., Schaefer, A.-K., van Bussel, B. C. T., Di Mauro, M., Conci, L., Szalkiewicz, P., De Piero, M. E., Heuts, S., Ravaux, J., van der Horst, I. C. C., Saeed, D., Pozzi, M., Loforte, A., Boeken, U., Samalavicius, R., Bounader, K., Hou, X., Bunge, J. J. H., Buscher, H., ... Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators (2023). On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation. Annals of Thoracic Surgery, 116(5), 1079-1089. https://doi.org/10.1016/j.athoracsur.2023.05.045
    • Heuts, S., Ceulemans, A., Kuiper, G. J. A. J. M., Schreiber, J. U., van Varik, B. J., Olie, R. H., Ten Cate, H., Maessen, J. G., Milojevic, M., & Maesen, B. (2023). Optimal management of cardiac surgery patients using direct oral anticoagulants: recommendations for clinical practice. European Journal of Cardio-Thoracic Surgery, 64(4), Article ezad340. https://doi.org/10.1093/ejcts/ezad340
    • Pölzl, L., Engler, C., Sterzinger, P., Lohmann, R., Nägele, F., Hirsch, J., Graber, M., Eder, J., Reinstadler, S., Sappler, N., Kilo, J., Tancevski, I., Bachmann, S., Abfalterer, H., Ruttmann-Ulmer, E., Ulmer, H., Griesmacher, A., Heuts, S., Thielmann, M., ... Gollmann-Tepeköylü, C. (2023). Association of High-Sensitivity Cardiac Troponin T With 30-Day and 5-Year Mortality After Cardiac Surgery. Journal of the American College of Cardiology, 82(13), 1301-1312. https://doi.org/10.1016/j.jacc.2023.07.011
    • Ubben, J. F. H., Heuts, S., Delnoij, T. S. R., Suverein, M. M., van de Koolwijk, A. F., van der Horst, I. C. C., Maessen, J. G., Bartos, J., Kavalkova, P., Rob, D., Yannopoulos, D., Belohlávek, J., Lorusso, R., & van de Poll, M. C. G. (2023). Extracorporeal cardiopulmonary resuscitation for refractory OHCA: lessons from three randomized controlled trials - the trialists' view. European Heart Journal: Acute Cardiovascular Care, 12(8), 540-547. Article zuad071. https://doi.org/10.1093/ehjacc/zuad071
    • Mariani, S., Heuts, S., van Bussel, B. C. T., Di Mauro, M., Wiedemann, D., Saeed, D., Pozzi, M., Loforte, A., Boeken, U., Samalavicius, R., Bounader, K., Hou, X., Bunge, J. J. H., Buscher, H., Salazar, L., Meyns, B., Herr, D., Matteucci, M. L. S., Sponga, S., ... Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators (2023). Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS-1 Multicenter Cohort Study. Journal of the American Heart Association, 12(14), Article e029609. https://doi.org/10.1161/JAHA.123.029609
    • Heuts, S., Mariani, S., van Bussel, B. C. T., Boeken, U., Samalavicius, R., Bounader, K., Hou, X., Bunge, J. J. H., Sriranjan, K., Wiedemann, D., Saeed, D., Pozzi, M., Loforte, A., Salazar, L., Meyns, B., Mazzeffi, M. A., Matteucci, S., Sponga, S., Sorokin, V., ... Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators (2023). The Relation Between Obesity and Mortality in Postcardiotomy Venoarterial Membrane Oxygenation. Annals of Thoracic Surgery, 116(1), 147-154. https://doi.org/10.1016/j.athoracsur.2023.03.025
    • Heuts, S., Lorusso, R., di Mauro, M., Jiritano, F., Scrofani, R., Antona, C., Dato, G. A., Centofanti, P., Ferrarese, S., Matteucci, M., Miceli, A., Glauber, M., Vizzardi, E., Sponga, S., Vendramin, I., Garatti, A., de Vincentiis, C., De Bonis, M., Pieri, M., ... GIROC Investigators (2023). Sheathless Versus Sheathed Intra-Aortic Balloon Pump Implantation in Patients Undergoing Cardiac Surgery. American Journal of Cardiology, 189(2), 86-92. https://doi.org/10.1016/j.amjcard.2022.11.033
    • Heuts, S., Gollmann-Tepeköylü, C., Denessen, E. J. S., Olsthoorn, J. R., Romeo, J. L. R., Maessen, J. G., van 't Hof, A. W. J., Bekers, O., Hammarsten, O., Pölzl, L., Holfeld, J., Bonaros, N., van der Horst, I. C. C., Davidson, S. M., Thielmann, M., & Mingels, A. M. A. (2023). Cardiac troponin release following coronary artery bypass grafting: mechanisms and clinical implications. European Heart Journal, 44(2), 100-112. https://doi.org/10.1093/eurheartj/ehac604
    • Daemen, J. H. T., Heuts, S., Rezazadah Ardabili, A., Maessen, J. G., Hulsewé, K. W. E., Vissers, Y. L. J., & de Loos, E. R. (2023). Development of Prediction Models for Cardiac Compression in Pectus Excavatum Based on Three-Dimensional Surface Images. Seminars in Thoracic and Cardiovascular Surgery, 35(1), 202-212. https://doi.org/10.1053/j.semtcvs.2021.11.006
    • Heuts, S., Schalla, S., Ramaekers, M. J. F. G., Bidar, E., Mihl, C., Wildberger, J. E., & Adriaans, B. P. (2023). Imaging surveillance for complications after primary surgery for type A aortic dissection. Heart, 109(2), 96-101. https://doi.org/10.1136/heartjnl-2022-320881
  • 2022
    • Denessen, E. J., Heuts, S., Daemen, J. H., van Doorn, W. P., Vroemen, W. H., Sels, J.-W., Segers, P., Van't Hof, A. W., Maessen, J. G., Bekers, O., Van Der Horst, I. C., & Mingels, A. M. (2022). High-Sensitivity Cardiac Troponin I and T Kinetics Differ following Coronary Bypass Surgery: A Systematic Review and Meta-Analysis. Clinical Chemistry, 68(12), 1564-1575. Article hvac152. https://doi.org/10.1093/clinchem/hvac152
    • Olsthoorn, J. R., Heuts, S., Houterman, S., Roefs, M., Maessen, J. G., Nia, P. S., & Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration (2022). Does concomitant tricuspid valve surgery increase the risks of minimally invasive mitral valve surgery? A multicentre comparison based on data from The Netherlands Heart Registration. Journal of Cardiac Surgery, 37(12), 4362–4370. https://doi.org/10.1111/jocs.17004
    • Sá, M. P., Jacquemyn, X., Tasoudis, P. T., Van den Eynde, J., Erten, O., Sicouri, S., Dokollari, A., Torregrossa, G., Kurz, S., Heuts, S., Nienaber, C. A., Coselli, J. S., & Ramlawi, B. (2022). Long-term outcomes of total arch replacement versus proximal aortic replacement in acute type A aortic dissection: Meta-analysis of Kaplan-Meier-derived individual patient data. Journal of Cardiac Surgery, 37(12), 4256-4266. https://doi.org/10.1111/jocs.16852
    • Ganizada, B., Heuts, S., Willems, C., Cortenraad, I., Tunnissen, W., Maessen, J. G., Bidar, E., & Natour, E. (2022). Aortic root replacement in severe left ventricular dysfunction: The added value of beating-heart surgery. Journal of Cardiac Surgery, 37(11), 3984-3987. https://doi.org/10.1111/jocs.16879
    • Olsthoorn, J. R., Heuts, S., Houterman, S., Maessen, J. G., Nia, P. S., & Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration (2022). Minimally invasive approach compared to resternotomy for mitral valve surgery in patients with prior cardiac surgery: retrospective multicentre study based on the Netherlands Heart Registration. European Journal of Cardio-Thoracic Surgery, 62(5), Article ezac420. https://doi.org/10.1093/ejcts/ezac420
    • Bos, K. H. J., Ariës, M. J. H., van der Leij, C., & Heuts, S. (2022). Congested: A Clinical Presentation of the Inferior Caval Vein Syndrome. American Journal of Respiratory and Critical Care Medicine, 206(5), 625-627. https://doi.org/10.1164/rccm.202201-0118IM
    • Heuts, S., Kawczynski, M. J., Maessen, J. G., & Bidar, E. (2022). Does early surgery result in improved long-term survival compared to watchful waiting in patients with asymptomatic severe aortic regurgitation with preserved ejection fraction?Interactive Cardiovascular and Thoracic Surgery, 35(2), Article ivac080. https://doi.org/10.1093/icvts/ivac080
    • Lorusso, R., Heuts, S., Jiritano, F., Scrofani, R., Antona, C., Actis Dato, G., Centofanti, P., Ferrarese, S., Matteuci, M., Miceli, A., Glauber, M., Vizzardi, E., Sponga, S., Vendramin, I., Garatti, A., de Vincentis, C., De Bonis, M., Ajello, S., Troise, G., ... Serraino, F. (2022). Contemporary outcomes of cardiac surgery patients supported by the intra-aortic balloon pump. Interactive Cardiovascular and Thoracic Surgery, 35(1), Article ivac091. https://doi.org/10.1093/icvts/ivac091
    • Olsthoorn, J. R., Heuts, S., Houterman, S., Maessen, J. G., & Sardari Nia, P. (2022). Effect of minimally invasive mitral valve surgery compared to sternotomy on short- and long-term outcomes: a retrospective multicentre interventional cohort study based on Netherlands Heart Registration. European Journal of Cardio-Thoracic Surgery, 61(5), 1099-1106. https://doi.org/10.1093/ejcts/ezab507
    • Heuts, S., Adriaans, B. P., Kawczynski, M. J., Daemen, J. H. T., Natour, E., Lorusso, R., Schalla, S., Maessen, J. G., Wildberger, J. E., Jacobs, M. J., Rylski, B., & Bidar, E. (2022). Editor's Choice – Extending Aortic Replacement Beyond the Proximal Arch in Acute Type A Aortic Dissection: A Meta-Analysis of Short Term Outcomes and Long Term Actuarial Survival. European Journal of Vascular and Endovascular Surgery, 63(5), 674-687. https://doi.org/10.1016/j.ejvs.2021.12.045
    • van Herpt, T. T. W., Timmermans, S. A. M. E. G., van Mook, W. N. K. A., van Bussel, B. C. T., van der Horst, I. C. C., Maessen, J. G., Natour, E., van Paassen, P., & Heuts, S. (2022). Postsurgical Thrombotic Microangiopathy and Deregulated Complement. Journal of Clinical Medicine, 11(9), Article 2501. https://doi.org/10.3390/jcm11092501
    • van der Heijden, C. A. J., Verheule, S., Olsthoorn, J. R., Mihl, C., Poulina, L., van Kuijk, S. M. J., Heuts, S., Maessen, J. G., Bidar, E., & Maesen, B. (2022). Postoperative atrial fibrillation and atrial epicardial fat: Is there a link?IJC Heart and Vasculature, 39, Article 100976. https://doi.org/10.1016/j.ijcha.2022.100976
    • de Loos, E. R., Daemen, J. H. T., Pennings, A. J., Heuts, S., Maessen, J. G., Hulsewe, K. W. E., & Vissers, Y. L. J. (2022). Minimally invasive repair of pectus excavatum by the Nuss procedure: The learning curve. Journal of Thoracic and Cardiovascular Surgery, 163(3), 828-837.e4. https://doi.org/10.1016/j.jtcvs.2020.11.154
    • Heuts, S., Makhoul, M., Mansouri, A. N., Taccone, F. S., Obeid, A., Belliato, M., Broman, L. M., Malfertheiner, M., Meani, P., Raffa, G. M., Delnoij, T., Maessen, J., Bolotin, G., & Lorusso, R. (2022). Defining and understanding the "extra-corporeal membrane oxygenation gap" in the veno-venous configuration: Timing and causes of death. Artificial Organs, 46(3), 349-361. https://doi.org/10.1111/aor.14058
    • Heuts, S., Denessen, E. J. S., Daemen, J. H. T., Vroemen, W. H. M., Sels, J. W., Segers, P., Bekers, O., Hof, A. W. J. V., Maessen, J. G., van der Horst, I. C. C., & Mingels, A. M. A. (2022). Meta-Analysis Evaluating High-Sensitivity Cardiac Troponin T Kinetics after Coronary Artery Bypass Grafting in Relation to the Current Definitions of Myocardial Infarction. American Journal of Cardiology, 163, 25-31. https://doi.org/10.1016/j.amjcard.2021.09.049
    • Heuts, S., van der Horst, I. C. C., & Mingels, A. (2022). Towards an improved definition of periprocedural myocardial infarction: The role of high-sensitivity cardiac troponins. Journal of Cardiac Surgery, 37(1), 162-164. https://doi.org/10.1111/jocs.16107
    • Laven, I. E. W. G., Daemen, J. H. T., Jansen, Y. J. L., Janssen, N., Franssen, A. J. P. M., Heuts, S., Maessen, J. G., van den Broek, F. J. C., Hulsewe, K. W. E., Vissers, Y. L. J., & de Loos, E. R. (2022). Thoracic surgery in the Netherlands. Journal of Thoracic Disease, 14(10), 4173-4186. https://doi.org/10.21037/jtd-22-482
  • 2021
    • Adriaans, B. P., Ramaekers, M. J. F. G., Heuts, S., Crijns, H. J. G. M., Bekkers, S. C. A. M., Westenberg, J. J. M., Lamb, H. J., Wildberger, J. E., & Schalla, S. (2021). Determining the optimal interval for imaging surveillance of ascending aortic aneurysms. Netherlands Heart Journal, 29(12), 623-631. https://doi.org/10.1007/s12471-021-01564-9
    • Segers, P., Hendriks, B. M. F., & Heuts, S. (2021). Deep Venous Thrombosis With Symptomatic Bilateral Pulmonary Embolism After Using an Infrapatellar Strap for Patellofemoral Pain in an Athletic Cardiothoracic Surgeon. Clinical Journal of Sport Medicine, 31(6), E509-E511. https://doi.org/10.1097/JSM.0000000000000859
    • Makhoul, M., Heuts, S., Mansouri, A., Taccone, F. S., Obeid, A., Mirko, B., Broman, L. M., Malfertheiner, M. V., Meani, P., Raffa, G. M., Delnoij, T., Maessen, J., Bolotin, G., & Lorusso, R. (2021). Understanding the "extracorporeal membrane oxygenation gap" in veno-arterial configuration for adult patients: Timing and causes of death. Artificial Organs, 45(10), 1155-1167. https://doi.org/10.1111/aor.14006
    • Heuts, S., & Nia, P. S. (2021). Periprocedural myocardial infarction: a web of definitions. European Journal of Cardio-Thoracic Surgery, 60(3), 443-447. https://doi.org/10.1093/ejcts/ezab306
    • Heuts, S., Ubben, J. F., Banks-Gonzales, V., Sels, J.-W., Lorusso, R., van Mook, W. N. K. A., & Delnoij, T. S. R. (2021). Nitric Oxide Ventilation Improves Recirculation and Right Ventricular Function During Veno-Venous Extracorporeal Membrane Oxygenation in a COVID-19 Patient. Journal of Cardiothoracic and Vascular Anesthesia, 35(9), 2763-2767. https://doi.org/10.1053/j.jvca.2020.09.137
    • Olsthoorn, J. R., Daemen, J. H. T., de Loos, E. R., Ter Woorst, J. F., van Straten, A. H. M., Maessen, J. G., Sardari Nia, P., & Heuts, S. (2021). Right Anterolateral Thoracotomy Versus Sternotomy for Resection of Benign Atrial Masses: A Systematic Review and Meta-Analysis. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 16(5), 426-433. Article 15569845211032230. https://doi.org/10.1177/15569845211032230
    • Nia, P. S., Olsthoorn, J. R., Heuts, S., van Kuijk, S. M. J., Vainer, J., Streukens, S., Schalla, S., Segers, P., Barenbrug, P., Crijns, H. J. G. M., & Maessen, J. G. (2021). Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data. European Journal of Cardio-Thoracic Surgery, 60(2), 263-273. https://doi.org/10.1093/ejcts/ezab065
    • Heuts, S., H Heijmans, J., La Meir, M., & Maesen, B. (2021). Does Left Atrial Appendage Exclusion by an Epicardial Clipinfluence Left Atrial Hemodynamics? Pilot Results of Invasive Intra-Cardiac Measurements. Journal of Atrial Fibrillation, 14(1), Article 20200479. https://doi.org/10.4022/jafib.20200479
    • Willers, A., Swol, J., Kowalewski, M., Raffa, G. M., Meani, P., Jiritano, F., Matteucci, M., Fina, D., Heuts, S., Bidar, E., Natour, E., Sels, J. W., Delnoij, T., & Lorusso, R. (2021). Extracorporeal Life Support in Hemorrhagic Conditions: A Systematic Review. Asaio Journal, 67(5), 476-484. https://doi.org/10.1097/mat.0000000000001216
    • Kowalewski, M., Zielinski, K., Gozdek, M., Raffa, G. M., Pilato, M., Alanazi, M., Gilbers, M., Heuts, S., Natour, E., Bidar, E., Schreurs, R., Delnoij, T., Driessen, R., Sels, J. W., van de Poll, M., Roekaerts, P., Pasierski, M., Meani, P., Maessen, J., ... Lorusso, R. (2021). Veno-Arterial Extracorporeal Life Support in Heart Transplant and Ventricle Assist Device Centres. Meta-analysis. Esc heart failure, 8(2), 1064-1075. https://doi.org/10.1002/ehf2.13080
    • Cerqueira, R. J., Heuts, S., Gollmann-Tepekoylu, C., Syrjala, S. O., Keijzers, M., Zientara, A., Jarral, O. A., Jacob, K. A., Haunschild, J., Ariyaratnam, P., Durko, A. P., Muller, P., Myers, P. O., Sadaba, J. R., & Lehtinen, M. L. (2021). Challenges and satisfaction in Cardiothoracic Surgery Residency Programmes: insights from a Europe-wide survey. Interactive Cardiovascular and Thoracic Surgery, 32(2), 167-173. https://doi.org/10.1093/icvts/ivaa248
  • 2020
    • Heuts, S., Sprooten, R. T. M., Heines, S. J. H., & Mees, B. M. E. (2020). Mechanical ventilation variability due to tracheal compression in a patient with a mycotic descending aortic aneurysm: an inverse correlation with blood pressure. European Journal of Cardio-Thoracic Surgery, 58(4), 864-866. https://doi.org/10.1093/ejcts/ezaa126
    • Chaldoupi, S.-M., Heuts, S., Vainer, J., & Maesen, B. (2020). Surgical Options to Tackle Coronary Artery Kinking in Thoracoscopic Left Atrial Appendage Clipping. Annals of Thoracic Surgery, 110(2), E119-E121. https://doi.org/10.1016/j.athoracsur.2019.12.039
    • Heuts, S., Adriaans, B. P., Rylski, B., Mihl, C., Bekkers, S. C. A. M., Olsthoorn, J. R., Natour, E., Bouman, H., Berezowski, M., Kosiorowska, K., Crijns, H. J. G. M., Maessen, J. G., Wildberger, J., Schalla, S., & Sardari Nia, P. (2020). Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection. Heart, 106(12), 892-897. https://doi.org/10.1136/heartjnl-2019-316251
    • Sardari Nia, P., Heuts, S., Daemen, J. H. T., Olsthoorn, J. R., Chitwood, W. R., & Maessen, J. G. (2020). The EACTS simulation-based training course for endoscopic mitral valve repair: an air-pilot training concept in action. Interactive Cardiovascular and Thoracic Surgery, 30(5), 691-698. https://doi.org/10.1093/icvts/ivz323
    • Kowalewski, M., Raffa, G., Zielinski, K., Meani, P., Alanazi, M., Gilbers, M., Heuts, S., Natour, E., Bidar, E., Schreurs, R., Delnoij, T., Driessen, R., Sels, J. W., van de Poll, M., Roekaerts, P., Maessen, J., Suwalski, P., & Lorusso, R. (2020). Baseline surgical status and short-term mortality after extracorporeal membrane oxygenation for post-cardiotomy shock: a meta-analysis. Perfusion, 35(3), 246-254. Article 0267659119865122. https://doi.org/10.1177/0267659119865122
    • Lorusso, R., Raffa, G. M., Heuts, S., Lo Coco, V., Meani, P., Natour, E., Bidar, E., Delnoij, T., & Loforte, A. (2020). Pulmonary artery cannulation to enhance extracorporeal membrane oxygenation management in acute cardiac failure. Interactive Cardiovascular and Thoracic Surgery, 30(2), 215-222. https://doi.org/10.1093/icvts/ivz245
    • Olsthoorn, J. R., Heuts, S., Maessen, J. G., & Sardari Nia, P. (2020). Reply to Kim and Choi. European Journal of Cardio-Thoracic Surgery, 57(2), 409. https://doi.org/10.1093/ejcts/ezz154