Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2014
ReviewDoes ambroxol confer a protective effect on the lungs in patients undergoing cardiac surgery or having lung resection?
A best evidence topic in perioperative care was written according to a structured protocol. The question addressed was 'Does ambroxol confer a protective effect on the lung in patients undergoing cardiac surgery or having lung resection?' A total of 247 papers were found using the reported search, of which 7 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 were tabulated. ⋯ We conclude that perioperative application of ambroxol, a versatile mucoactive drug, particularly in high doses, is associated with lower PPCs, especially in high-risk patients with fundamental lung disease such as COPD. Large doses of ambroxol are correlated with even lower PPCs after lung resection. We recommend that routine intravenous ambroxol should be used in large doses in high-risk patients in the perioperative period to reduce the risk of PPCs.
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Interact Cardiovasc Thorac Surg · Jun 2014
Review Meta AnalysisA review with meta-analysis of observational studies for survival following off-pump coronary artery bypass versus drug-eluting stent implantation.
To determine whether off-pump coronary artery bypass (OPCAB) improves survival over drug-eluting stent (DES) implantation, we performed a review with meta-analysis of exclusive OPCAB versus DES. Databases including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through October 2013 using Web-based search engines (PubMed and OVID). Studies that met the following criteria were considered for inclusion: the design was a randomized controlled trial or observational comparative study; the study population was patients with any coronary artery disease; patients were assigned to OPCAB versus DES and outcomes included all-cause mortality at ≥1 years. ⋯ In general, exclusion of any single study from the analysis did not substantially alter the overall result of our analysis. There was no evidence of significant publication bias. In conclusion, OPCAB may not improve survival over DES despite greater number of treated vessels in OPCAB than in DES or greater number of distal anastomosis in OPCAB than that of implanted stents in DES.
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Interact Cardiovasc Thorac Surg · Jun 2014
ReviewHow does elective laparoscopic abdominal aortic aneurysm repair compare to endovascular aneurysm repair?
A best evidence topic in surgery was written according to a structured protocol. The question addressed was how elective laparoscopic abdominal aortic aneurysm (AAA) repair compared to endovascular aneurysm repair (EVAR) in terms of survival. There were 229 papers found using the reported search, with 8 papers (5 prospective studies, 1 retrospective study, 1 randomized trial and 1 systematic review) representing the best evidence to answer the question proposed. ⋯ While the evidence suggests that EVAR is less invasive, it does not always significantly alter the postoperative course or length of hospital stay for patients. We conclude from the evidence available that elective laparoscopic AAA repair may have a role in those patients who are unsuitable for EVAR. Unfortunately, few studies exist directly comparing these two techniques, and those that do are subject to limitations, for example, study population bias, small sample sizes and a lack of comparison in the literature between the common AAA repair techniques.
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Interact Cardiovasc Thorac Surg · Jun 2014
A simple way to treat mitral valve prolapse: chordal replacement using a new mitral leaflet retractor.
The most difficult aspect of chordal replacement during mitral valve repair is to determine the correct length of the new chordae. A simple technique of chordal replacement was developed employing the new mitral leaflet retractor that enables easy adjustment of the length of artificial chordae. ⋯ We have reported the chordal replacement using the new double-headed mitral leaflet retractor. Our leaflet retractor is a convenient tool representing an easy creation of artificial chordae in mitral valve repair.
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Interact Cardiovasc Thorac Surg · Jun 2014
Observational StudyTime from cardiac catheterization to cardiac surgery: a risk factor for acute kidney injury?.
Acute kidney injury can occur after cardiac catheterization and cardiac surgery. The negative effects of the contrast media and cardiopulmonary bypass on renal function may be additive when performed in close succession. The results in the literature are, however, conflicting. ⋯ The time from cardiac catheterization to cardiac surgery is not a risk factor for the development of postoperative acute kidney injury even in patients with other risk factors. Surgical intervention should not be delayed in emergency or urgent cases. The optimization of renal function seems to be the correct strategy in clinically stable patients with risk factors for acute kidney injury.