The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2018
Meta AnalysisEfficacy and effectiveness of on- versus off-pump coronary artery bypass grafting: A meta-analysis of mortality and survival.
Despite many studies comparing on- versus off-pump coronary artery bypass graft (CABG), there is no consensus as to whether one of these techniques offers patients better outcomes. ⋯ Evidence from RCTs showed no differences between the techniques, whereas rigorously adjusted observational studies (with >1.1 million patients) and the combined analysis indicated that off-pump CABG offers lower short-term mortality but poorer long-term survival. These results suggest that, in real-world settings, greater operative safety with off-pump CABG comes at the expense of lasting survival gains.
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J. Thorac. Cardiovasc. Surg. · Jan 2018
Meta AnalysisSystematic review and meta-analysis of chordal replacement versus leaflet resection for posterior mitral leaflet prolapse.
To compare outcomes of chordal replacement versus leaflet resection techniques for repair of isolated posterior mitral leaflet prolapse. ⋯ Chordal replacement may be associated with greater freedom from reoperation and may lead to improved postoperative left ventricular function compared with leaflet resection. However, these conclusions are supported primarily by data from unadjusted observational studies, and high-quality RCTs of chordal replacement versus leaflet resection are needed.
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J. Thorac. Cardiovasc. Surg. · Jan 2018
Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation.
Management of the aortic root is a challenge for surgeons treating acute type A aortic dissection. ⋯ Limited root repair was associated with increased risk of late reoperation after repair of acute type A aortic dissection. Surgeons with adequate experience may consider aortic root replacement in well-selected patients. However, given good outcomes after limited root repair, surgeons should not feel compelled to perform this more-complex operation.
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J. Thorac. Cardiovasc. Surg. · Jan 2018
Survival and long-term outcomes after mitral valve replacement in patients aged 18 to 50 years.
To provide long-term data on survival and major morbidity after mitral valve replacement in patients aged 18 to 50 years. ⋯ The significant survival benefit associated with mechanical mitral valve replacement in adults ≤50 years may be due to the practice of implanting bioprostheses in sicker patients or those judged less likely to comply with long-term medication despite adjustment for baseline characteristics in propensity score matching.