The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Sep 2018
Randomized Controlled TrialEffect of Sustained Use of Aspirin until the Time of Surgery on Outcomes following Coronary Artery Bypass Grafting: A Randomized Clinical Trial.
The topic of aspirin (acetylsalicylic acid, ASA) use in coronary artery disease patients planned for coronary artery bypass grafting during perioperative period is among the most disputed issues in cardiac surgery. We designed a study to weigh the risks and benefits of continued ASA ingestion until the time of surgery. ⋯ Sustained ASA use until the day of surgery in patients planned for elective isolated CABG can result in excessive bleeding, increased rate of reexploration, and need for more PRBC transfusion without any proven beneficial effect on reducing unfavorable postoperative outcomes. Hence, we recommend discontinuing ASA between 3 and 5 days before non-urgent CABG while keeping it on in nonelective circumstances.
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Thorac Cardiovasc Surg · Sep 2018
Randomized Controlled Trial Multicenter Study Comparative StudyThe COSTA Study: Sternal Closure in High-Risk Patients - A Prospective Randomized Multicenter Trial.
Median sternotomy in patients with risk factors for wound healing is associated with high rates of postoperative wound infections and sternum instability. ⋯ According to these data, there is no statistically significant difference between Sternal Talon closure and wire cerclage in reducing the incidence of mediastinitis and superficial SSI after primary closure of median sternotomy in high-risk patients.
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Thorac Cardiovasc Surg · Sep 2018
Randomized Controlled Trial Multicenter Study Comparative StudyOff-Pump Coronary Artery Bypass Grafting and Stroke-Exploratory Analysis of the GOPCABE Trial and Methodological Considerations.
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (off-pump CABG) may reduce severe adverse events including stroke. ⋯ Within recent prospective randomized multicenter trials off-pump CABG did not result in lower stroke rates. The possible intrinsic benefit of off-pump CABG may be offset by the complexity of the operative therapy as well as the multiple pathomechanisms involved in perioperative stroke.
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Thorac Cardiovasc Surg · Sep 2018
Comparative StudyCurrent Status of Off-pump Coronary Artery Bypass Grafting in Patients with Multiple Coronary Artery Disease Compared with On-pump Coronary Artery Bypass Grafting: The Korean National Cohort Study.
Despite advance in off-pump coronary artery bypass (OPCAB) grafting, there are large debating issues regarding survival benefit between OPCAB and on-pump coronary artery bypass grafting (CABG). The aim of this study is to address appropriateness of OPCAB approach in patients with ischemic heart disease having multiple vessels using South Korea national cohort data. ⋯ In this study, we found that OPCAB was associated with better survival rates and renal preservation compared with on-pump CABG.