Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2014
ReviewWhat is the optimal revascularization technique for isolated disease of the left anterior descending artery: minimally invasive direct coronary artery bypass or percutaneous coronary intervention?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, 'What is the optimal revascularization technique for isolated disease of the left anterior descending artery (LAD) in terms of patient survival, morbidity such as myocardial infarction (MI) and need for repeat target vessel revascularization: minimally invasive direct coronary artery bypass graft (MIDCAB) or percutaneous coronary intervention (PCI)?' Altogether 504 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. Outcome parameters that were used in the assessment include the incidence of major adverse cardiovascular or cerebral events (MACCEs), mortality and the rate of repeat target vessel revascularization. ⋯ However, retrospective data have shown that average length of hospital stay was longer in the MIDCAB group (7.4 ± 3.2 vs 3.4 ± 3.5 days; P < 0.001). We conclude that there are obvious proven benefits with MIDCAB, namely in terms of a reduced need for repeat target vessel revascularization and incidence of MACCE, and one study has even shown that there is a long-term survival benefit in 'real-world' clinical practice. However, given that there is a lack of well-powered randomized controlled trial and long-term follow-up data to prove a mortality benefit in support of MIDCAB, patients requiring revascularization of isolated proximal LAD stenosis and being considered for percutaneous coronary intervention should be discussed in a multidisciplinary team setting prior to intervention.
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Interact Cardiovasc Thorac Surg · Jul 2014
ReviewReview of the evidence supports role for routine prophylaxis against postoperative supraventricular arrhythmia in patients undergoing pulmonary resection.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Is there an indication for routine prophylaxis against postoperative supraventricular arrhythmia in patients undergoing pulmonary resection surgery?' Altogether almost 150 papers were found as a result of the reported search, of which 14 represented the best evidence to reach conclusions regarding the issues of interest for this review. The major outcome of interest that was investigated was the incidence of supraventricular arrhythmia (SVA), notably atrial fibrillation (AF). ⋯ We conclude that there is an indication for routine prophylaxis against postoperative supraventricular arrhythmia in patients undergoing pulmonary resection. However, further data are needed to ascertain the impact of said anti-arrhythmic medications on the length of postoperative hospital stay, intensive care unit stay and cost. Those patients deemed high-risk need to be promptly identified, so the anti-arrhythmic therapy can be tailored to the cohort thus optimizing on cost and safety.
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Interact Cardiovasc Thorac Surg · Jul 2014
Comparative StudyThe cost impact of short-term ventricular assist devices and extracorporeal life support systems therapies on the National Health Service in the UK.
The objective of the study was to assess the cost of using different blood pumps for short-term ventricular assist device (VAD) and extracorporeal life support (ECLS) systems for cardiac and cardiorespiratory failure in the UK. ⋯ CentriMag® and PediVAS® blood pumps can lead to significant cost savings to the National Health Service, when used instead of other pumps for short-term VAD or ECLS treatment.
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Interact Cardiovasc Thorac Surg · Jul 2014
Case ReportsDouble lung procurement from a donor supported by a left ventricular assist device.
Over the past several years, the selection criteria for marginal donor lungs have been extended. However, brain-dead patients with implanted mechanical circulatory support systems have not yet been considered as potential organ donors for lung transplantation. Our report presents the first successful procurement and transplantation of donor lungs from a patient supported by a left ventricular assist device. ⋯ The subsequent sequential bilateral lung transplantation was performed without complications. Postoperative course and follow-up were uneventful. This case demonstrates the feasibility of lung transplantations from organ donors supported by a mechanical circulatory support system.
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Interact Cardiovasc Thorac Surg · Jul 2014
ReviewDoes off-pump coronary artery bypass graft surgery have a beneficial effect on long-term mortality and morbidity compared with on-pump coronary artery bypass graft surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass grafting (CABG) surgery offered superior long-term outcomes compared with on-pump CABG surgery. Best evidence papers were considered to be those that had a follow-up period of ≥5 years, had >50 patients in either cohort, did not utilize concomitant interventions nor comprised low-risk, high-risk or sub-population groups. ⋯ Other long-term indicators such as cardiovascular or cerebrovascular events or neuro-psychological outcomes were similar between the two groups. Despite these conclusions, the evidence is limited by substantial variability in patient selection and study methods. The CORONARY (coronary artery bypass surgery off- or on-pump revascularization study) trial recently presented results, which showed no significant differences in composite outcomes at 1 year; it will be interesting to observe whether these comparable outcomes are maintained for a much longer time frame.