The Annals of thoracic surgery
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Meta Analysis
Meta-analysis of patients taking statins before revascularization and aortic valve surgery.
Statin intake before cardiac surgery is associated with favorable outcomes. We sought to analyze the evidence for statin pretreatment before isolated coronary artery bypass graft surgery and aortic valve replacement surgery. In this meta-analysis, we demonstrate beneficial results for the endpoints mortality, stroke, atrial fibrillation, and length of stay in hospital in 36,053 statin-pretreated coronary artery bypass graft surgery patients compared with control subjects retrieved from 32 studies, but fail to detect relevant advantages through preoperative statin therapy for 3,091 patients undergoing aortic valve replacement from four trials. Strict adherence to guidelines recommending statin treatment before CABG surgery is therefore mandatory.
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Review Meta Analysis Comparative Study
Association between obesity and postoperative atrial fibrillation in patients undergoing cardiac operations: a systematic review and meta-analysis.
In a systematic review and random-effects meta-analysis, we evaluated whether obesity is associated with postoperative atrial fibrillation (POAF) in patients undergoing cardiac operations. We selected 18 observational studies until December 2011 that excluded patients with preoperative AF (n=36,147). ⋯ The association between obesity and POAF did not vary substantially by type of cardiac operation, study design, or year of publication. POAF was significantly associated with a higher risk of stroke, respiratory failure, and operative death.
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Meta Analysis
Meta-analysis of organ damage after conversion from off-pump coronary artery bypass procedures.
The relative efficacy of off-pump and on-pump coronary revascularization is uncertain. A complication of off-pump surgery which is rarely considered is intraoperative conversion to cardiopulmonary bypass. ⋯ The underlying mechanisms need to be urgently elucidated. Prevention and treatment protocols for conversion warrant serious consideration and the risk of conversion may need to be discussed when obtaining informed patient consent.
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Review Meta Analysis
Skeletonized internal thoracic artery harvest improves prognosis in high-risk population after coronary artery bypass surgery for good quality grafts.
Skeletonization of the internal thoracic artery is supposed to achieve extra length with added advantages of decreased sternal complications. There is no agreement whether skeletonization affects grafts, main adverse cardiac events, mortality, or pulmonary function when compared with the conventional pedicled method. The aim of our study was to determine the effectiveness and safety of different harvesting techniques. ⋯ Skeletonized harvesting for the internal thoracic artery provides superiority to the quality of grafts with additional advantages of lesser trauma, producing fewer postoperative complications. Above all, skeletonized grafting in the high-risk population has a potential benefit in mortality and mainly adverse cardiac events.
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Meta Analysis
Off-pump coronary artery bypass may increase late mortality: a meta-analysis of randomized trials.
Although a lot of randomized trials of off-pump coronary artery bypass grafting (CABG) versus on-pump CABG were conducted, the majority of them reported only early outcomes. Previous meta-analyses of a few randomized trials found no differences for 1-year to 2-year mortality. ⋯ The results of our analysis suggest that off-pump CABG may increase late all-cause mortality by a factor of 1.37 over on-pump CABG. Longer term mortality from randomized trials of off-pump versus on-pump CABG is needed.