Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Nov 2013
Multicenter StudyThe influence of seasons and lunar cycle on hospital outcomes following ascending aortic dissection repair.
The effect of the lunar cycle and seasonal variation on ascending aortic dissection surgery outcomes is unknown. We investigated these temporal effects on risk-adjusted hospital mortality and then on the length of stay (LOS) following surgery for survivors. ⋯ Season had no effect on mortality or LOS following aortic dissection repair, while patient age significantly increased the odds of death. The full-moon cycle appeared to reduce the odds of death, and the full-moon cycle, along with being male and requiring a concomitant cardiac procedure, was associated with shorter LOS.
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Interact Cardiovasc Thorac Surg · Nov 2013
Mediastinal staging in daily practice: endosonography, followed by cervical mediastinoscopy. Do we really need both?
In patients with lung cancer, endosonography has emerged as a minimally invasive method to obtain cytological proof of mediastinal lymph nodes, suspicious for metastases on imaging. In case of a negative result, it is currently recommended that a cervical mediastinoscopy be performed additionally. However, in daily practice, a second procedure is often regarded superfluous. The goal of our study was to assess the additional value of a cervical mediastinoscopy, after a negative result of endosonography, in routine clinical practice. ⋯ In patients with a high probability of mediastinal metastases, based on imaging, and negative endosonography, cervical mediastinoscopy should not be omitted, not even when the aspirate seems representative.
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Interact Cardiovasc Thorac Surg · Nov 2013
Review Meta AnalysisA meta-analysis of randomized trials for repeat revascularization following off-pump versus on-pump coronary artery bypass grafting.
To determine whether repeat revascularization rates are increased following off-pump coronary artery bypass grafting (CABG), we performed a meta-analysis of randomized controlled trials of off-pump vs on-pump CABG. Databases including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through March 2013 using web-based search engines (PubMed, OVID). Studies considered for inclusion met the following criteria: the design was a prospective randomized controlled clinical trial; the study population was patients undergoing CABG; patients were randomly assigned to off-pump vs on-pump CABG and outcomes included repeat revascularization rates at ≥1 year. ⋯ In general, exclusion of any single trial from the analysis did not substantively alter the overall result of our analysis. There was no evidence of significant publication bias. The results of our analysis suggest that off-pump CABG may increase repeat revascularization rates by 38% over on-pump CABG.
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Interact Cardiovasc Thorac Surg · Nov 2013
Multicenter Study Clinical TrialAortic valve replacement in geriatric patients with small aortic roots: are sutureless valves the future?
Aortic valve replacement (AVR) in geriatric patients (>75 years) with small aortic roots is a challenge. Patient-prosthesis mismatch and the long cross-clamp time necessary for stentless valves or root enlargement are matters of concern. We compared the results of AVR with sutureless valves (Sorin Perceval), against those with conventional biological valves. ⋯ This study highlights the advantages of sutureless valves for geriatric patients with small aortic roots reflected by shorter cross-clamp and CPB times, even though most of these patients were operated on via a minimally invasive access. Moreover, due to the absence of a sewing ring, these valves are also almost stentless, with greater effective orifice area (EOA) for any given size. This may potentially result in better haemodynamics even without the root enlargement. This is of advantage, as several studies have shown that aortic root enlargement can significantly increase the risks of AVR. Moreover, as seen in this series, these valves may also enable a broader application of minimally invasive AVR.
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Interact Cardiovasc Thorac Surg · Nov 2013
ReviewIs stereotactic ablative radiotherapy equivalent to sublobar resection in high-risk surgical patients with stage I non-small-cell lung cancer?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Is stereotactic ablative radiotherapy equivalent to sublobar resection in high-risk surgical patients with Stage I non-small cell lung cancer?'. Altogether over 318 papers were found, of which 18 represented the best evidence to answer the clinical question. ⋯ Thirty-day mortality following SABR was 0%, while predicted 30-day mortality following a lung resection, using the thoracoscore predictive model ranges between 1 and 2.6%. Treatment for early-stage NSCLC should be tailored to individual patients. SABR is an acceptable alternative to SLR in high-risk patients but comparative data are required.