Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Nov 2012
ReviewHow does the right gastroepiploic artery compare with the saphenous vein for revascularization of the right coronary artery?
A best evidence topic was written according to a structured protocol. The question addressed was 'is the saphenous vein graft or right gastroepiploic artery a better conduit for revascularization of the right coronary artery?' One hundred and five articles were found using a designated search, of which 10 articles were found to represent the best available evidence to answer the clinical question. Of these 10 articles, two were reports of a randomized controlled trial and represented the highest level of evidence, whereas eight articles were retrospective observational studies. ⋯ The randomized evidence suggested that the saphenous vein had better early (6-month) and mid-term (3-year) graft patency than the right gastroepiploic artery when used for right coronary artery revascularization. The use of the saphenous vein was also found to be predictive of superior graft function using multivariate regression; however, a more recent propensity score analysis identified gastroepiploic-right coronary grafts to yield superior very long-term (>10 years) clinical outcomes. Overall, based on the best quality evidence and in view of technical limitations and flow characteristics of the right gastroepiploic artery, it appears that saphenous vein grafts may offer superior outcomes for revascularization of the right coronary artery in most cases, and should be preferentially used.
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Interact Cardiovasc Thorac Surg · Nov 2012
Comparative StudyDiagnostic accuracy of 16- versus 64-slice multidetector computed tomography angiography in the evaluation of coronary artery bypass grafts: a comparative study.
Multidetector computed tomography (MDCT) angiography, which is used for native coronary vessels and bypass graft (CABG) imaging is a non-invasive test. Here, we aimed to compare the diagnostic accuracy of 16- and 64-slice MDCT for graft patency and stenosis. ⋯ This study showed that the 16-slice has a diagnostic accuracy comparable with the 64-slice system for graft patency and can still be used for this purpose if newer systems with improved performance are not available on-site. On the other hand, by the virtue of better image quality, the 64-slice MDCT demonstrates significant graft lesions with higher sensitivity.
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Interact Cardiovasc Thorac Surg · Nov 2012
Case ReportsSurgical management of superior vena cava syndrome after failed endovascular stenting.
The superior vena cava syndrome encompasses a constellation of symptoms and signs resulting from obstruction of the superior vena cava. We report a successful surgical management after failed endovascular stenting for superior vena cava syndrome, caused by a postradiation fibrosis after conventional radiotherapy for breast cancer. We emphasize the rarity of this uncommon surgical procedure and the bailout procedure for failed angioplasty and intravascular stenting. Key points of superior vena cava syndrome and its management are discussed.
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Interact Cardiovasc Thorac Surg · Nov 2012
Six-year prospective audit of 'scoop and run' for chest-reopening after cardiac arrest in a cardiac surgical ward setting.
The aim of the study was to identify which cardiac surgical ward patients benefit from 'scoop and run' to the operating room for chest reopening. ⋯ The key determinant of a favourable 'scoop and run' outcome was whether the arrest occurred during daytime or night-time hours (P < 0.05). Despite a median time to chest opening of 22 min, all five survivors were discharged neurologically intact. The median time from surgery in these survivors was 4 days. Because of the risk of hypoxic brain damage, 'scoop and run' should be restricted to patients suffering witnessed arrests. The study has potential implications for resuscitation training and out-of-hours medical staffing in cardiothoracic hospitals.