The Annals of thoracic surgery
-
Randomized Controlled Trial Multicenter Study Comparative Study
On-pump versus off-pump coronary artery bypass surgery: cost-effectiveness analysis alongside a multisite trial.
Questions have been raised about the costs and outcomes for patients receiving on-pump and off-pump coronary artery bypass graft surgery. As part of the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) multisite trial, a cost-effectiveness analysis was performed to compare on-pump versus off-pump patients' quality-adjusted life-years and costs at 1 year. ⋯ At 1 year, off-pump coronary artery bypass graft surgery was more expensive than on-pump when late off-pump-to-on-pump conversions were included. Excluding late conversions, there was no difference in quality-adjusted life-years or costs.
-
Review Meta Analysis Comparative Study
Association between obesity and postoperative atrial fibrillation in patients undergoing cardiac operations: a systematic review and meta-analysis.
In a systematic review and random-effects meta-analysis, we evaluated whether obesity is associated with postoperative atrial fibrillation (POAF) in patients undergoing cardiac operations. We selected 18 observational studies until December 2011 that excluded patients with preoperative AF (n=36,147). ⋯ The association between obesity and POAF did not vary substantially by type of cardiac operation, study design, or year of publication. POAF was significantly associated with a higher risk of stroke, respiratory failure, and operative death.
-
Randomized Controlled Trial Comparative Study
Primary endpoints of the biventricular pacing after cardiac surgery trial.
This study sought to determine whether optimized biventricular pacing increases cardiac index in patients at risk of left ventricular dysfunction after cardiopulmonary bypass. Procedures included coronary artery bypass, aortic or mitral surgery and combinations. This trial was approved by the Columbia University Institutional Review Board and was conducted under an Investigational Device Exemption. ⋯ Cardiac index did not increase significantly overall but increased 29% after aortic valve surgery. Mean arterial pressure increased with pacing at 3 time points. Additional studies are needed to distinguish rate from resynchronization effects, emphasize atrioventricular delay optimization, and examine clinical benefits of temporary postoperative pacing.
-
Multicenter Study Comparative Study
Current cardioplegia practice in pediatric cardiac surgery: a North American multiinstitutional survey.
There are a wide variety of reported techniques with few comparative trials and no current data available by which surgeons can compare their myopreservation strategies across the specialty. We therefore surveyed congenital heart surgeons to develop a profile of current practice. ⋯ Myocardial protection techniques still remained highly variable among congenital heart surgeons. This survey demonstrates that there is a perception that del Nido and Custodiol solutions can offer appropriate myocardial protection for longer intervals with decreased repeat dosing. An observational study correlating markers of postoperative myocardial performance with myocardial preservation strategies should be considered.
-
Comparative Study
Minimally invasive and conventional aortic valve replacement: a propensity score analysis.
The study aimed to compare the short-term results of aortic valve replacement through minimally invasive and sternotomy approaches. ⋯ Our experience shows that mini-access isolated aortic valve surgery is a reproducible, safe, and effective procedure and reduces assisted ventilation duration, the need for blood product transfusion, and incidence of post-surgery atrial fibrillation.