Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2014
Review Meta AnalysisThe effects of pre- and postoperative fibrinogen levels on blood loss after cardiac surgery: a systematic review and meta-analysis.
Fibrinogen concentrate is increasingly used in cardiac surgery when bleeding is anticipated or ongoing. Since randomized clinical studies to support this are lacking, it is relevant to know whether lower fibrinogen levels are associated with excessive bleeding. We performed a systematic review and meta-analysis to define the association between fibrinogen levels and blood loss after cardiac surgery. ⋯ Our meta-analysis indicated a significant but weak-to-moderate correlation between pre- and postoperative fibrinogen levels and postoperative blood loss in cardiac surgery. This moderate association calls for appropriate clinical studies on whether fibrinogen supplementation will decrease postoperative blood loss.
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Interact Cardiovasc Thorac Surg · Mar 2014
ReviewIs sternotomy superior to thoracotomy for modified Blalock-Taussig shunt?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is sternotomy approach superior to a thoracotomy approach for a modified Blalock-Taussig shunt procedure? More than 58 papers were found using the search as described below, of which 11 papers 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 sternotomy approach was associated with advantages like less pulmonary artery distortion, ease of technical performance, cosmetic advantage of a single sternotomy incision, ease of ligation of patent ductus, less phrenic nerve injury, less collateral formation in chest wall adhesions and less thoracotomy induced scoliosis. However, other papers studied either the sternotomy approach only or the thoracotomy approach and drew conclusions regarding risk factors for operative morbidity and mortality. We conclude that the sternotomy approach is beneficial to neonates and infants undergoing modified Blalock-Taussig shunt when compared with the conventional thoracotomy approach.
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Interact Cardiovasc Thorac Surg · Mar 2014
ReviewDesmopressin for reducing postoperative blood loss and transfusion requirements following cardiac surgery in adults.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in adult patients undergoing cardiac surgery requiring extracorporeal cardiopulmonary bypass (CPB), does administration of desmopressin acetate (DDAVP) reduce postoperative blood loss and transfusion requirements? Altogether 38 papers were found using the reported search, of which 19 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 evidence does not support the routine use of DDAVP in all cardiac surgery; indeed, it is clear that there is no significant reduction in postoperative blood loss or transfusion requirements with the administration of DDAVP in patients undergoing isolated coronary artery bypass grafting (CABG) in the absence of the features noted above. Given the absence of a clinically significant reduction in exposure to blood transfusion in unselected patients, we cannot recommend the routine use of DDAVP in patients exposed to CPB. However, DDAVP may reduce postoperative bleeding in patients who have received preoperative aspirin within 7 days of surgery, patients with CPB times in excess of 140 min and patients with demonstrable platelet dysfunction and should be used selectively in these subgroups.
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Interact Cardiovasc Thorac Surg · Mar 2014
One-stage repair of extensive aortic aneurysms: mid-term results with total or subtotal aortic replacement.
To retrospectively analyse the mid-term clinical results of one-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement. ⋯ One-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement is safe and effective. It is feasible with acceptable surgical risks and satisfactory results. It can eliminate the risk of remnant aortic aneurysm rupture in staged total aortic replacement and has satisfactory mid-term results.
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Interact Cardiovasc Thorac Surg · Mar 2014
Review Meta AnalysisComparing coronary artery bypass grafting with drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis.
Although drug-eluting stents (DESs) reduce the rate of target vessel revascularization compared with bare-metal stents, the results of DESs for patients with diabetes and multivessel coronary artery disease (CAD) in the DES era are inconsistent. This meta-analysis was undertaken to assess the efficacy and safety of coronary artery bypass grafting (CABG) compared with drug-eluting stent implantation in patients with diabetes mellitus and multivessel coronary artery disease. ⋯ Percutaneous coronary intervention with DES in patients with diabetes and multivessel CAD is safe, but has a high risk of long-term repeat revascularization. CABG should remain the standard procedure for diabetic patients with multivessel CAD.