Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2019
Review Case ReportsDoes the use of an in situ or Y-configuration for bilateral internal thoracic arteries influence long-term survival, patency or repeat revascularization in coronary bypass surgery?
A best evidence topic was constructed according to a structured protocol. The question addressed was whether the configuration of bilateral internal thoracic arteries (BITAs) influences survival, patency or repeat revascularization in patients undergoing coronary artery bypass grafting. Five hundred and seventy-one papers were found using the reported searches, of which 8 represented the best evidence to answer the clinical question. ⋯ One systematic review found similar outcomes with respect to mortality, cardiac events and repeat revascularization with in situ and composite BITA. In summary, existing literature demonstrates no difference in clinical outcomes between composite and in situ graft configurations. Furthermore, the configuration of BITA does not affect mortality, graft patency or repeat revascularization.
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Interact Cardiovasc Thorac Surg · Feb 2019
Re-exploration for bleeding associated with increased incidence of the need for reintervention after coronary artery bypass graft surgery.
Re-exploration for bleeding after cardiac surgery increases the risk of other severe postoperative complications and early mortality. Patients re-explored for bleeding after coronary artery bypass grafting are potentially subject to threats to graft patency. Our goal was to assess the effects of re-exploration for bleeding regarding the incidence of coronary angiographies, the need for coronary reintervention and mortality during long-term follow-up. ⋯ Re-exploration for bleeding is associated with an increased risk for the need of repeat coronary reintervention during the first year after coronary artery bypass surgery.
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Interact Cardiovasc Thorac Surg · Feb 2019
Comparative StudyIs it worth repairing rheumatic mitral valve disease in children? Long-term outcomes of an aggressive approach to rheumatic mitral valve repair compared to replacement in young patients.
Contemporary experience in mitral valve (MV) repair for children with rheumatic heart disease (RHD) is limited, despite the potential advantages of repair over replacement. We reviewed our long-term outcomes of rheumatic MV repair and compared them with the outcomes of MV replacement in children with RHD. ⋯ Twenty-three years of follow-up shows that MV repair is superior to MMVR in children with RHD. Hence, the rheumatic MV should be repaired when technically feasible to maximize the survival and reduce the valve-related morbidity with comparable durability to MMVR.