European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 2015
Review Meta Analysis Comparative StudyA systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy.
There is a growing trend to perform off-bypass surgical ablation for atrial fibrillation (AF) because it is perceived to be safer and more effective than the Cox-Maze procedure with cardiopulmonary bypass (CPB) support. In this systematic review, we compared three minimally invasive stand-alone surgical ablation procedures for AF: the endocardial Cox-Maze procedure, epicardial surgical ablation and a hybrid epicardial surgical and catheter-based endocardial ablation procedure (hybrid procedure). Relevant studies were identified in MEDLINE and the Cochrane Database of Systematic Reviews according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ⋯ At 12 months, rates of sinus rhythm restoration were 93, 80 and 70%, and sinus restoration without anti-arrhythmic medications was 87, 72 and 71%, for Cox-Maze, epicardial and hybrid procedures, respectively. Of the three procedures, the minimally invasive Cox-Maze procedure with CPB support was most effective for the treatment of stand-alone AF and had important safety advantages in conversion to sternotomy and major bleeding. The minimally invasive Cox-Maze procedure with CPB support also demonstrated the potential for a higher success rate 12 months following the procedure.
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Eur J Cardiothorac Surg · Oct 2015
Randomized Controlled Trial Comparative StudyStopping antiplatelet medication before coronary artery bypass graft surgery: is there an optimal timing to minimize bleeding?
As the indication for antiplatelet medication expands, patients may be exposed to an increased risk of excessive blood loss when cardiac surgery is required. The optimal timing to stop acetylsalicylic acid (ASA) or ASA combined with clopidogrel (ASA+Clo) before surgery is the subject of controversy. ⋯ There is no clinically relevant effect on blood loss indicating an optimal stop day for ASA alone or in combination with Clo. Last use on Day -2 resulted in the reduction of percentage of patients receiving platelet transfusions, especially in the ASA+Clo group.
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Eur J Cardiothorac Surg · Oct 2015
Review Case ReportsBacterial pericarditis as a fatal complication after endobronchial ultrasound-guided transbronchial needle aspiration.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and effective diagnostic tool for mediastinal evaluation. The guidelines for mediastinal evaluation of lung cancer were recently revised for both endoscopic procedures and surgical medical staging, and EBUS-TBNA is expected to be used more often in lung cancer diagnosis and staging. The major complication rate reported in previous meta-analyses is very low at 0.07-.15%; however, the mortality rate has not been reported. We present 2 cases of acute bacterial pericarditis after EBUS-TBNA, with 1 case resulting in mortality, and we discuss the appropriate management.
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Eur J Cardiothorac Surg · Oct 2015
Observational StudyUsefulness of conventional pleural drainage systems to predict the occurrence of prolonged air leak after anatomical pulmonary resection.
One of the reported advantages of digital pleural drainage system is the possibility of predicting the occurrence of prolonged air leak (PAL) based on the recorded pleural pressures and/or air flow through chest tubes. Nevertheless, this fact has never been well supported. The objective of this investigation is to evaluate if the occurrence of PAL can accurately be predicted using clinical data and air leak measurements 24 h after lung resection on conventional pleural drainage system (CPDS). ⋯ The performance of this simple predictive model, without any electronic recording, warrants a larger multi-institutional study to validate its usefulness in clinical decision-making regarding the management of patients with air leak after lung resection.
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Eur J Cardiothorac Surg · Oct 2015
Index of prolonged air leak score validation in case of video-assisted thoracoscopic surgery anatomical lung resection: results of a nationwide study based on the French national thoracic database, EPITHOR.
The incidence rate of prolonged air leak (PAL) after lobectomy, defined as any air leak prolonged beyond 7 days, can be estimated to be in between 6 and 15%. In 2011, the Epithor group elaborated an accurate predictive score for PAL after open lung resections, so-called IPAL (index of prolonged air leak), from a nation-based surgical cohort constituted between 2004 and 2008. Since 2008, video-assisted thoracic surgery (VATS) has become popular in France among the thoracic surgical community, reaching almost 14% of lobectomies performed with this method in 2012. This minimally invasive approach was reported as a means to reduce the duration of chest tube drainage. The aim of our study was thus to validate the IPAL scoring system in patients having received VATS anatomical lung resections. ⋯ The IPAL score is valid for the estimation of the predictive risk of PAL after VATS lung resections. It may thus a priori be used to characterize any surgical population submitted to potential preventive measures.