Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2019
Bilateral internal thoracic artery versus single internal thoracic artery: a meta-analysis of propensity score-matched observational studies.
The lack of benefit in terms of mid-term survival and the increase in the risk of sternal wound complications published in a recent randomized controlled trial have raised concerns about the use of bilateral internal thoracic artery (BITA) in myocardial revascularization surgery. For this reason, we decided to explore the current evidence available on the subject by carrying out a meta-analysis of propensity score-matched studies comparing BITA versus single internal thoracic artery (SITA). PubMed, EMBASE and Google Scholar were searched for propensity score-matched studies comparing BITA versus SITA. ⋯ Compared with the SITA group, patients in the BITA group had a significantly higher risk of deep sternal wound infection (risk ratio 1.66; 95% CI 1.41-1.95) even when the pooled analysis was limited to matched populations in which BITA was harvested according to the skeletonization technique (risk ratio 1.37; 95% CI 1.04-1.79). The use of BITA provided a long-term survival benefit compared with the use of SITA at the expense of a higher risk of sternal deep wound infection. The long-term survival advantage of BITA is undetectable when compared with SITA plus radial artery.
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Interact Cardiovasc Thorac Surg · Mar 2019
Randomized Controlled TrialIntravenous iron does not effectively correct preoperative anaemia in cardiac surgery: a pilot randomized controlled trial.
Preoperative anaemia is a strong predictor of blood transfusion requirements and must be assessed for appropriate optimization before elective surgery. Iron therapy is a transfusion-sparing approach effective for increasing haemoglobin concentrations. However, its role in elective cardiac surgery and the optimal route of administration remain unknown. This single-centre, non-blinded, randomized, controlled trial compared the effectiveness of intravenous ferric carboxymaltose therapy with oral iron for anaemic patients undergoing elective cardiac surgery. ⋯ ISRCTN22158788.
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Interact Cardiovasc Thorac Surg · Mar 2019
Meta AnalysisNew sternal closure methods versus the standard closure method: systematic review and meta-analysis.
This study aimed to evaluate, by means of a systematic review, the efficiency of new methods for sternal closure in order to prevent sternal wound complications after sternotomy. ⋯ New sternal closure methods probably make little or no difference regarding the prevention of sternal complications in the postoperative period when compared to the standard closure method.
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Interact Cardiovasc Thorac Surg · Mar 2019
Review Case ReportsEpidural analgesia versus paravertebral block in video-assisted thoracoscopic surgery.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: In patients undergoing video-assisted thoracoscopic surgery, is paravertebral block (PVB) superior to epidural analgesia (EP) in terms of pain control and its postoperative complication rates? Altogether, 153 papers were found using the reporting search, of which 4 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. ⋯ PVB is associated with lower rates of postoperative complications compared to EP, specifically urinary retention (64% vs 34.6%, P = 0.0036) and hypotension (32% vs 7%, P = 0.0031; 21% vs 3%, P = 0.02). In summary, PVBs appear to offer an equivalent level of analgesic effect following video-assisted thoracoscopic surgery, with a more favourable side-effect profile, compared to EP. This does need to be contextualized in light of the scarcity of published material, with the available studies each containing a small number of participants.
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Interact Cardiovasc Thorac Surg · Mar 2019
Case ReportsType A intramural haematoma secondary to penetrating atherosclerotic ulcer of the ascending aorta.
Intramural haematoma and penetrating atherosclerotic ulcer belong to the group of acute aortic syndromes. The combined presentation of both intramural haematoma and a penetrating atherosclerotic ulcer in the ascending aorta is a very rare finding. ⋯ The diagnosis was confirmed intraoperatively and histopathologically. This case depicts the dynamic pathophysiological development of acute aortic syndromes and the finding that different entities of acute aortic syndromes may evolve or lead to another.