The Annals of thoracic surgery
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Meta Analysis Comparative Study
Off-pump versus on-pump coronary revascularization: meta-analysis of mid- and long-term outcomes.
Early outcomes for off-pump coronary artery bypass grafting (OPCAB) have been extensively compared with on-pump coronary revascularization (ONCAB); however, the long-term effects of OPCAB continue to be debated. This study aims to compare the mid-term (>1year; ≤5 years) and long-term (>5 years) survival and major adverse cardiovascular and cerebrovascular events of OPCAB versus ONCAB. ⋯ This analysis demonstrates comparable mid-term mortality and mid- to long-term morbidity between OPCAB and ONCAB. On-pump coronary artery bypass grafting may be associated with improved long-term survival when all study types are analyzed; however, analysis of only randomized controlled trials and propensity-matched studies demonstrates comparable long-term mortality between OPCAB and ONCAB.
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Comparative Study
Better short-term outcome by using sutureless valves: a propensity-matched score analysis.
Sutureless aortic valve prostheses have the potential of shortening ischemic time. However, whether shorter operative times may also result in improved patient outcomes and have an effect on hospital costs remains to be established. ⋯ A shorter procedural time in the sutureless group is associated with better clinical outcomes and reduced hospital costs.
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Observational Study
Contemporary midterm echocardiographic outcomes of Bentall procedure and aortic valve sparing root replacement.
Valve sparing root replacement (VSRR) and aortic valve repair (AVr) is an attractive treatment option compared with composite valve and root replacement (Bentall procedure) for patients with aortic root dilatation with or without aortic valve disease. While aortic valve preservation reduces the risk of valve-related complications, little is known about echocardiographic differences at follow-up between these 2 strategies. ⋯ Valve sparing root replacement with AV repair provides similar mid-term echocardiographic and clinical outcomes compared with the Bentall.
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Multicenter Study
Postoperative atrial fibrillation significantly increases mortality, hospital readmission, and hospital costs.
New-onset postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery. However, the magnitude of POAF on length of stay, resource utilization, and readmission rates remains an area of clinical interest. The purpose of this study was to examine the risk-adjusted impact of POAF on measures of mortality, hospital resources, and costs among multiple centers. ⋯ New onset POAF is associated with increased risk-adjusted mortality, hospital costs, and readmission rates. Protocols to reduce the incidence of POAF have the potential to significantly impact patient outcomes and the delivery of high-quality, cost-effective patient care.
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Multicenter Study
Hospital variation in mortality from cardiac arrest after cardiac surgery: an opportunity for improvement?
Among all postoperative complications, cardiac arrest after cardiac surgical operations has the greatest association with mortality. However, hospital variation in the ability to rescue after cardiac arrest is unknown. The purpose of this study was to characterize the impact of cardiac arrest on mortality and determine the relative impact of patient, operative, and hospital factors on failure to rescue (FTR) rates and surgical mortality after cardiac arrest. ⋯ Significant hospital variation exists in cardiac surgical mortality and FTR rates after cardiac arrest. Institutional factors appear to confer the strongest influence on the likelihood for mortality after cardiac arrest compared with patient and operative factors. Identifying best practice patterns at the highest performing centers may serve to improve surgical outcomes after cardiac arrest and improve patient quality.