Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2012
Comparative StudyPrediction of postoperative atrial fibrillation in a large coronary artery bypass grafting cohort.
The objective of this study was to identify and evaluate predictors of postoperative atrial fibrillation (POAF) in a large coronary artery bypass grafting (CABG) cohort. This was a single centre study of 7115 consecutive patients with preoperative sinus rhythm who underwent isolated CABG between January 1996 and December 2009. Independent risk factors for POAF were identified with multiple logistic regression. ⋯ The final prediction model was moderate (area under curve, 0.62; 95% confidence interval, 0.61-0.64). Patients with POAF had more postoperative complications, including a higher incidence of stroke and increased length of hospital stay. In conclusion, several risk factors for POAF were identified, but the moderate value of the prediction model confirms the difficulty of identifying patients at high risk of developing POAF after CABG.
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Interact Cardiovasc Thorac Surg · May 2012
Very low survival rates after non-traumatic lower limb amputation in a consecutive series: what to do?
The aim of this retrospective study was to evaluate factors potentially influencing short- and long-term mortality in patients who had a non-traumatic lower limb amputation in a university hospital. A consecutive series of 93 amputations (16% toe/foot, 33% trans-tibial, 9% through knee and 42% trans-femoral) were studied. Their mean age was 75.8 years; 21 (23%) were admitted from a nursing home and 87 (92%) were amputated due to a vascular disease and/or diabetes. ⋯ Further, the risk of not surviving increased with 7% per each additional year the patient got older. Of concern, almost one-third of patients died within 1 month. This may be unavoidable, but a multidisciplinary, optimized, multimodal pre- and postoperative programme should be instituted, trying to improve the outcome.
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Interact Cardiovasc Thorac Surg · May 2012
ReviewIs remote ischaemic preconditioning of benefit to patients undergoing cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether remote ischaemic preconditioning (RIPC) is of benefit to patients undergoing cardiac surgery. Altogether, more than 264 papers were found using the reported search, 16 of which represented the best evidence to answer the clinical question. ⋯ Marked reduction in cardiac necrosis markers was also found in several smaller RCTs concerning coronary artery bypass grafting (CABG) patients receiving RIPC preoperatively: with cold crystalloid cardioplegia (44.5% reduction), with cross-clamping and fibrillation (43% reduction) and with cold blood cardioplegia (42.4% reduction). The proof of concept trials summarized here give some early evidence that RIPC may potentially provide some reduction in myocardial injury. If confirmed, in future clinical studies this technique may one day lead to a method to reduce reperfusion injury in clinical practice.
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Interact Cardiovasc Thorac Surg · May 2012
ReviewWhat are the current results of sutureless valves in high-risk aortic valve disease patients?
A best evidence topic was written according to a structured protocol. The question addressed was whether sutureless aortic valves have a clinical and haemodynamic benefit in high-risk patients with aortic valve disease. A total of 307 papers were found using the reported searches; of which, six represented the best evidence to answer the clinical question. ⋯ Owing to the lack of comparative studies analysing the outcomes of sutureless and conventional aortic valves, we compared these results with the recently published PARTNER Trial (Transcatheter vs. Surgical Aortic-Valve Replacement in High-Risk Patients), and it can be shown that the outcomes of sutureless aortic valves compare favourably with conventional valves in terms of mortality, neurological deficit, renal failure and post-operative bleeding. However, there is increased incidence of endocarditis and PVLs, together with raised mean valve gradients, perhaps owing to the mechanical properties and deployment techniques of sutureless aortic valves.
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Interact Cardiovasc Thorac Surg · May 2012
ReviewIs routine stress ulcer prophylaxis of benefit for patients undergoing cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. We address whether routine pharmacological stress ulcer prophylaxis is of benefit for patients undergoing cardiac surgery. One hundred and fifty-six papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. ⋯ Two prospective cohort studies that examined the use of PPI in conjunction with clopidogrel in patients with coronary artery disease concluded that there was no association with an increase in major adverse cardiovascular events with the use of PPIs. We conclude that the current evidence is marginally in favour of the use of prophylactic PPIs. However, this is associated with an increased risk of hospital-acquired pneumonia.