Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jan 2015
Randomized Controlled Trial Multicenter Study Comparative StudyPreoperative atrial fibrillation and outcome in patients undergoing on-pump or off-pump coronary bypass surgery: lessons learned from the GOPCABE trial.
Patients undergoing coronary bypass grafting (CABG) are at higher risk if they suffer from atrial fibrillation (AF). It was suggested that performing CABG without the use of cardiopulmonary bypass (off-pump) would reduce perioperative risk. We assessed the influence of preoperative AF on outcome in a randomized cohort of patients above the age of 75 undergoing either on-pump or off-pump CABG. ⋯ AF at admission is a significant risk factor for elderly patients undergoing coronary bypass grafting. However, this risk is not altered by performing bypass grafting off pump.
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Interact Cardiovasc Thorac Surg · Jan 2015
ReviewIs extended arch replacement justified for acute type A aortic dissection?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed is whether patients with acute type A aortic dissection have a better outcome after total arch replacement. Altogether, 138 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. ⋯ Evidence for long-term outcomes, albeit limited, has proved that better results of thrombosis of the false lumen can be achieved with a more extensive total arch repair. Although the literature shows no advantage of the total arch over a more limited approach, the more extensive approach may be required to achieve this goal when the entry tear extends to, or is localized in, this segment of the aorta. This suggests that a more extensive surgical strategy can be justified when it is based on circumstances, on the individual patient's clinical condition, and on the anatomical and pathological features of the dissection.
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Interact Cardiovasc Thorac Surg · Jan 2015
ReviewIs low serum albumin associated with postoperative complications in patients undergoing oesophagectomy for oesophageal malignancies?
A best evidence topic was written according to a structured protocol. The question addressed was: in patients undergoing oesophagectomy for oesophageal malignancy, is low serum albumin associated with postoperative complications? Altogether, 87 papers were found using the reported search, of which 16 demonstrated 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. ⋯ Instead, these studies found other factors responsible for postoperative complications such as: CRP, smoking, disease duration, malnutrition and low T-cell levels. Taken together, while low serum albumin is associated with postoperative complications, opinion regarding the prognostic value of low serum albumin and nutritional support remains conflicted. Because of the confounding factors encountered in these studies, the clinician should consider the finding of low serum albumin in patients, together with disease and surgical factors to provide optimal care for these patients.