Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2010
ReviewPerioperative outcomes in hybrid versus conventional surgical coronary artery revascularisation.
A best evidence topic was written on perioperative outcomes in hybrid coronary revascularisation according to a structured protocol. The question addressed was 'In patients with stable multivessel coronary artery disease, does the use of hybrid coronary revascularisation compared to conventional and off-pump coronary artery bypass grafting (CABG) reduce perioperative morbidity and mortality?' Six hundred and twenty-three papers were found in the literature search. From these results, six comparative studies and one review paper appeared to be relevant. ⋯ In summary, these papers provide limited evidence of improved perioperative outcomes in both staged and simultaneous hybrid revascularisation compared to CABG. Weaknesses of the comparative studies include the lack of mid-term and long-term follow-up and the difficulty of generalising results from specialist units to general cardiac surgical practice. A large randomised control trial comparing hybrid revascularisation and coronary artery bypass with mid-term follow-up will be required to establish the clinical effectiveness of this procedure.
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Interact Cardiovasc Thorac Surg · Sep 2010
ReviewDo statins slow the process of calcification of aortic tissue valves?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether statins slow the process of calcification of aortic tissue valves. Altogether 207 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. ⋯ Two studies confirmed beneficial effects of statin therapy on valve hemodynamics or inflammatory damage in vivo, but another study, with significantly greater patients series, found lipid-lowering therapy futile in this clinical aspect. Currently, studies and their results are discordant, but statin therapy appears insufficient to result in better clinical outcomes. We conclude that even though the data is conflicting, statin therapy does not prevent SVD of bioprosthetic valves in the aortic position.
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Interact Cardiovasc Thorac Surg · Sep 2010
ReviewIn patients coming to theatre with an intra aortic balloon pump, is it better to turn it off or keep it on while on bypass?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients coming to theatre with an intra aortic balloon pump (IABP), is it better to turn it off or keep it on while on bypass?' Altogether 46 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. Nine of them were randomised controlled trials (RCTs). ⋯ Although several randomised control trials in this field have conveyed considerable benefit in terms of biochemical markers measured, none of them have resulted in better clinical outcomes in terms of reduction in major morbidity or mortality. This may be largely due to the small sample size in most of these studies. Seven out of 11 papers were published by same group of authors.
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Interact Cardiovasc Thorac Surg · Sep 2010
ReviewIn patients with severe active aortic valve endocarditis, is a stentless valve as good as the homograft?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients with severe active aortic valve endocarditis, is a stentless valve as good as a homograft?' The scientific literature was reviewed by searching Medline, using the OVID interface, from 1950 to March 2010. One hundred and eight papers were found. ⋯ He finds the reinfection rate to be lower for the homograft and stentless groups than for the patients treated with standard prostheses, respectively, 5.8%, 3.7% and 33%. The stentless valve offers a reinfection rate and postoperative echocardiographic data comparable to those achieved with homografts. Further follow-up is required to determine the stentless valve durability and long-term freedom from valve-related complications.
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Interact Cardiovasc Thorac Surg · Sep 2010
ReviewDoes the prophylactic administration of N-acetylcysteine prevent acute kidney injury following cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'does prophylactic administration of N-acetylcysteine (NAC) prevent acute kidney injury (AKI) following cardiac surgery?' More than 60 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ The RCTs have investigated the use of NAC to prevent AKI in low-risk patients, high-risk patients and high-risk patients with pre-existing chronic kidney disease. The meta-analyses and RCTs demonstrated that the prophylactic administration of NAC did not reduced the incidence of AKI, postoperative complications, postoperative interventions, mortality or length of ICU stay. We conclude that prophylactic administration of NAC does not prevent AKI or reduce mortality following cardiac surgery.