European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 2012
Review Meta AnalysisEstimating the risk of complications related to re-exploration for bleeding after adult cardiac surgery: a systematic review and meta-analysis.
The aim of this study was to evaluate the impact of re-exploration for bleeding after cardiac surgery on the immediate postoperative outcome. ⋯ This study suggests that re-exploration for bleeding after cardiac surgery carries a significantly increased risk of postoperative mortality and morbidity.
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Eur J Cardiothorac Surg · Nov 2011
Meta AnalysisAortic valve replacement for aortic stenosis in patients with concomitant mitral regurgitation: should the mitral valve be dealt with?
Co-existent mitral regurgitation may adversely influence both morbidity and mortality in patients undergoing aortic valve replacement for severe aortic stenosis. Whilst it is accepted that concomitant mitral intervention is required in severe, symptomatic mitral regurgitation, in cases of mild-moderate non-structural mitral regurgitation, improvement may be seen following aortic valve replacement alone, avoiding the increased risk of double-valve surgery. The exact benefit of such a conservative approach is, however, yet to be adequately quantified. ⋯ No significant change was seen in left-ventricular end-systolic diameter (p=0.10), septal thickness (p=0.17) or left atrial area (p=0.23). We conclude that despite reverse remodelling, concomitant moderate-severe mitral regurgitation adversely affects both early and late mortality following aortic valve replacement. Concomitant mitral intervention should therefore be considered in the presence of moderate mitral regurgitation, independent of the aetiology.
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Eur J Cardiothorac Surg · Aug 2011
Meta AnalysisSystematic evaluation of the flexible and rigid annuloplasty ring after mitral valve repair for mitral regurgitation.
Mitral annulus reconstruction is now a common surgical procedure for the treatment of mitral regurgitation. However, there are still controversies in the selection of materials for annuloplasty in the clinical controlled studies available. The purpose of the present systematic review of the literature is to address whether a flexible ring is superior to a rigid ring in terms of improvement in clinical and echocardiographic outcomes. ⋯ Except for the improvement in ejection fraction and preserving the mitral valve area effects in the flexible cases, it remains comparable with regard to overall survival, mortality, reoperation, regurgitant recurrence, and left ventricular performance between the flexible and rigid ring.
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Eur J Cardiothorac Surg · Jul 2011
Meta AnalysisGlucose-insulin-potassium therapy in adult patients undergoing cardiac surgery: a meta-analysis.
Glucose-insulin-potassium (GIK) has long been used as adjuvant treatment for patients with serious cardiovascular disease. Although many studies have reported their results based on GIK therapy in the setting of heart surgery, the outcomes remain controversial and inconclusive. The aim of this meta-analysis of randomized controlled trials (RCTs) was to determine the clinical effects of GIK in adult cardiac surgery patients. ⋯ Further analysis showed that diabetic patients were benefited from GIK with glycemic control, but not GIK infusion without glucose control. GIK significantly reduced myocardial injury and improved hemodynamic performance in patients undergoing cardiac surgery. Glycemic control with GIK might be required for cardiac surgery patients with diabetes.
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Eur J Cardiothorac Surg · Jun 2010
Review Meta AnalysisLessons from aprotinin: is the routine use and inconsistent dosing of tranexamic acid prudent? Meta-analysis of randomised and large matched observational studies.
In view of the safety concerns that led to the withdrawal of aprotinin, should antifibrinolytics be used indiscriminately in cardiac surgery? This meta-analysis examines the efficacy and safety profile of tranexamic acid, and in comparison to aprotinin. We identified randomised trials and large observational studies investigating the use tranexamic acid from January 1995 to January 2009 using Pubmed/Cochrane search engine and included them in a two-tier meta-analysis. There were 25 randomised trials and four matched studies with a total of 5411 and 5977 patients, respectively, reporting tranexamic acid use in varying dosages. ⋯ Compared to aprotinin, tranexamic acid has less effective blood-conserving effect and mortality risk. Given the potential to increase neurological complications, the current trend towards indiscriminate use of tranexamic acid for all cardiac patients needs to be re-evaluated. Further studies are needed to clarify the neurological risk, appropriate indications and dosing of tranexamic acid.