Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2011
Multicenter StudyCharacteristics, management and outcomes of patients with acute coronary syndrome and prior coronary artery bypass surgery: findings from the second Gulf Registry of Acute Coronary Events.
To evaluate the baseline demographic/clinical characteristics, in-hospital treatment and outcomes among patients with or without prior coronary artery bypass graft surgery (CABG) presenting as acute coronary syndrome (ACS) from six Middle East countries. ⋯ ACS patients from Middle East countries with prior CABG have adverse baseline characteristics, reported higher GRACE risk score, multivessel disease, more severe LV dysfunction, cardiogenic shock, in-hospital major bleeding, but with less incidence of STEMI with less prominent surge of cardiac biomarkers. However, there was no significant difference in mortality during hospitalization, at 30 days and at one year between ACS patients with and without prior CABG. The reasons for this 'risk-mortality' paradox need to be further evaluated.
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Interact Cardiovasc Thorac Surg · Nov 2011
Multicenter Study Comparative StudyMechanical versus chemical pleurodesis for management of primary spontaneous pneumothorax evaluated with thoracic echography.
The current study is designed to compare the effectiveness of brushing the pleura vs. instillation of minocycline for the management of primary spontaneous pneumothorax, and to assess the sensitivity of echography in defining areas of defects. Blebectomy and pleurodesis were carried out thoracoscopically on 84 patients. In group A (42 patients), abrasions were induced using a sponge on a long ring forceps. ⋯ The patients in group B demonstrated a trend towards a decreased rate of prolonged air leaks (2% vs. 5%; P=0.100). Thus, pleurodesis by instillation of minocycline as a part of thoracoscopy is more effective than brushing the pleura. Thoracic echography is a highly sensitive method for assessing the effectiveness of pleurodesis.
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Interact Cardiovasc Thorac Surg · May 2011
Multicenter StudyProcedural, 30-day and one year outcome following CoreValve or Edwards transcatheter aortic valve implantation: results of the Belgian national registry.
We report clinical outcomes following transcatheter aortic valve implantation (TAVI), using the CoreValve revalving system (18 Fr transfemoral or subclavian) or the Edwards Sapien valve (22 Fr transfemoral or 24 Fr transapical) as part of a Belgian prospective non-randomized multicentre registry. All 15 Belgian centres performing TAVI participated to this registry (seven exclusively Edwards Sapien, eight exclusively CoreValve). All consecutive high-risk symptomatic patients with severe aortic stenosis were evaluated by a heart team and screened for eligibility for TAVI. ⋯ One-month mortality was both related to cardiac and non-cardiac reasons. Overall one-year survival was 78% in the CoreValve transfemoral treated patients, 100% in the CoreValve subclavian treated patients, 82% in the Edwards transfemoral treated patients and 63% in the Edwards transapical treated patients. This mid-term mortality was mainly related to age-related, non-cardiac complications.
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Interact Cardiovasc Thorac Surg · Mar 2011
Randomized Controlled Trial Multicenter Study Comparative StudyCost-effectiveness of ablation surgery in patients with atrial fibrillation undergoing cardiac surgery.
This study was performed to assess the cost-effectiveness of concomitant ablation surgery (AS) compared to regular cardiac surgery in atrial fibrillation (AF) patients over a one-year follow-up. Cost analysis was performed from a societal perspective alongside a prospective, randomised, double-blinded, multicentre trial. One hundred and fifty patients with documented AF were randomly assigned to undergo cardiac surgery with or without AS. ⋯ The incremental cost-effectiveness ratio is €73,359 per QALY. The acceptability curve showed that, even in the case of a maximum threshold value of €80,000 per QALY gained, the probability of AS being more cost-effective than regular cardiac surgery did not reach beyond 50%. Concluding that concomitant AS in AF is not cost-effective after a one-year follow-up compared to regular cardiac surgery.
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Interact Cardiovasc Thorac Surg · Mar 2011
Multicenter Study Comparative StudyDoes the technique of distal anastomosis influence clinical outcomes in acute type A aortic dissection?
The purpose of this study was to evaluate clinical outcomes of two different surgical techniques for the repair of acute type A dissection: open distal anastomosis under deep hypothermic circulatory arrest (DHCA) compared with distal aortic clamping on hypothermic cardiopulmonary bypass (ACPB). Between January 2000 and July 2008, 82 patients underwent DHCA and 42 had ACPB. Major morbidity, operative mortality and five-year actuarial survival were compared between groups. ⋯ No significant differences in operative mortality, major morbidity and actuarial five-year survival were observed between DHCA and ACPB. There are some practical technical advantages if the distal anastomosis is performed in an open manner. More studies are required to determine the fate of the false lumen between the two techniques.