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
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.
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Interact Cardiovasc Thorac Surg · Jul 2014
ReviewIn patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy a suitable alternative to thoracotomy and segmentectomy in terms of morbidity and equivalence of resection?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy a suitable alternative to thoracotomy and segmentectomy in terms of morbidity and equivalence of resection?' Altogether 232 papers were found as a result of the reported search, of which 7 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. ⋯ Unfortunately, at present there is no blinded randomized control trial comparing these two surgical methods. There is also no study comparing the utility of each method for differing anatomical locations of segments. This should be kept in mind when interpreting the results of the studies presented.
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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
Negative pressure therapy for post-sternotomy wound infections in young children.
Post-sternotomy wound infection remains a significant morbidity in congenital and paediatric cardiac surgery. However, the techniques used for this complication in children are not optimal in terms of mortality, morbidity and the use of medical resources. Negative pressure therapy is an effective modality in the treatment in adults, but reports of its use in children are limited. This study evaluated the use of negative pressure therapy in young children for post-sternotomy wound infections. ⋯ Negative pressure therapy is an effective treatment modality for wound infections in paediatric cardiac surgery and results in low morbidity, mortality and medical resource use.