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
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 · Sep 2015
Review Meta Analysis Comparative StudyOutcomes of mitral valve repair compared with replacement in patients undergoing concomitant aortic valve surgery: a meta-analysis of observational studies.
Long-term superiority of mitral valve (MV) repair compared with replacement is well established in degenerative MV disease. In rheumatic heart disease, its advantages are unclear and it is often performed in conjunction with aortic valve (AV) replacement. Herein, we performed a systematic review and meta-analysis comparing outcomes of MV repair vs replacement in patients undergoing concomitant AV replacement. ⋯ In a separate analysis of studies with exclusively rheumatic patients (n = 1106), the early as well as late mortality benefit of MV repair was lost (RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P = 0.199, respectively), whereas the MV reoperation rate became significantly higher (RR: 5.10, 95% CI: 1.62-16.05, P = 0.005) with MV repair. In patients undergoing concomitant mitral and AV surgery, MV repair is associated with improved early and late survival without any increased risk for mitral valve reoperation. However, in patients with rheumatic heart disease MV repair does not impart any survival advantage while the risk for MV reoperation remains significantly higher.
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Eur J Cardiothorac Surg · Sep 2015
Review Meta Analysis Comparative StudyOutcomes of mitral valve repair compared with replacement in patients undergoing concomitant aortic valve surgery: a meta-analysis of observational studies.
Long-term superiority of mitral valve (MV) repair compared with replacement is well established in degenerative MV disease. In rheumatic heart disease, its advantages are unclear and it is often performed in conjunction with aortic valve (AV) replacement. Herein, we performed a systematic review and meta-analysis comparing outcomes of MV repair vs replacement in patients undergoing concomitant AV replacement. ⋯ In a separate analysis of studies with exclusively rheumatic patients (n = 1106), the early as well as late mortality benefit of MV repair was lost (RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P = 0.199, respectively), whereas the MV reoperation rate became significantly higher (RR: 5.10, 95% CI: 1.62-16.05, P = 0.005) with MV repair. In patients undergoing concomitant mitral and AV surgery, MV repair is associated with improved early and late survival without any increased risk for mitral valve reoperation. However, in patients with rheumatic heart disease MV repair does not impart any survival advantage while the risk for MV reoperation remains significantly higher.
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Eur J Cardiothorac Surg · May 2015
ReviewThe European Registry for Patients with Mechanical Circulatory Support (EUROMACS): first annual report.
The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was founded on 10 December 2009 with the initiative of Roland Hetzer (Deutsches Herzzentrum Berlin, Berlin, Germany) and Jan Gummert (Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany) with 15 other founding international members. It aims to promote scientific research to improve care of end-stage heart failure patients with ventricular assist device or a total artificial heart as long-term mechanical circulatory support. Likewise, the organization aims to provide and maintain a registry of device implantation data and long-term follow-up of patients with mechanical circulatory support. ⋯ EUROMACS is the only European-based Registry for Patients with Mechanical Circulatory Support with rapid increase in institutional and individual membership. Because of the expeditious data input, the European Association for Cardiothoracic Surgeons saw the need to optimize the data availability and the significance of the registry to improve care of patients with mechanical circulatory support and its potential contribution to scientific intents; hence, the beginning of their alliance in 2012. This first annual report is designed to provide an overview of EUROMACS' structure, its activities, a first data collection and an insight to its scientific contributions.