European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 2014
Predictors of 30-day mortality and outcome in cases of myocardial infarction with cardiogenic shock treated by extracorporeal life support.
The twin aims of this study were to identify the independent predictors of 30-day mortality and to analyse the outcomes of patients with cardiogenic shock (CS) associated with acute myocardial infarction (AMI) and necessitating extracorporeal life support (ECLS). ⋯ Prompt ECLS support is an effective strategy and provides a reasonable chance of survival in patients with AMI associated with profound CS. As shown in our results pertaining to predictive risk factors for 30-day mortality, reducing the duration of end-organ ischaemia is the keystone to management of this patient population. A major remaining challenge will consist in preventing pulmonary oedema following peripheral ECLS.
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Eur J Cardiothorac Surg · Jan 2014
All anterior and bileaflet mitral valve prolapses are repairable in the modern era of reconstructive surgery.
Although mitral valve repair is the preferred treatment for degenerative mitral valve disease, valve replacement still remains prevalent, particularly in the setting of anterior leaflet prolapse. We sought to determine the feasibility and mid-term durability of a lesion-based surgical strategy applied systematically in a consecutive and nonexclusionary (all comers) series of patients with degenerative mitral valve disease and either isolated anterior leaflet or bileaflet prolapse. ⋯ A lesion-based surgical approach with an intention to repair all degenerative valves with anterior leaflet prolapse was applied to a consecutive series of patients with degenerative mitral valve disease. We were able to achieve a near-100% repair rate. Repair of all degenerative valves may be feasible with good mid-term durability, regardless of valve morphology, patient age or comorbidities.
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Eur J Cardiothorac Surg · Jan 2014
Is anti-platelet therapy needed in continuous flow left ventricular assist device patients? A single-centre experience.
We report our 5-year experience of continuous flow left ventricular assist device (LVAD) implantation without the use of anti-platelet therapy. ⋯ A fluindione regimen without aspirin in long-duration LVAD support appears to not increase thromboembolic events and could lead to a diminished risk of haemorrhagic stroke.
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Eur J Cardiothorac Surg · Jan 2014
Review Meta AnalysisPreoperative statin therapy in cardiac surgery: a meta-analysis of 90,000 patients.
The objective of this systematic literature review with meta-analysis was to determine the strength of evidence for a preoperative statin on the reduction of adverse postoperative outcomes in patients undergoing cardiac surgery. Randomized controlled (RCT) and observational trials were searched in online databases that reported about the effects of preoperative statin therapy on major adverse clinical outcomes after cardiac surgery. Analysed outcomes included early all-cause mortality, myocardial infarction, atrial fibrillation (AF), stroke and renal failure using a priori-defined criteria. ⋯ In addition, statin treatment before surgery was associated with a substantial reduction (P < 0.01) in the postoperative end-points AF (OR 0.71; 95% CI 0.61-0.82), new-onset AF (OR 0.68; 95% CI 0.54-0.85), stroke (OR 0.83; 95% CI 0.74-0.93), stay on intensive care unit (weighted mean difference [WMD] -0.14; 95% CI -0.23 to -0.03; P < 0.01) and in-hospital stay (WMD -0.57; 95% CI -0.76 to -0.38; P < 0.01). No statistical differences were found between groups with regard to myocardial infarction or renal failure. In conclusion, the current systematic review strengthens the evidence that preoperative statin therapy extends substantial clinical benefit to early postoperative outcomes in cardiac surgery patients.
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Eur J Cardiothorac Surg · Jan 2014
Randomized Controlled TrialAmiodarone is a cost-neutral way of preventing atrial fibrillation after surgery for lung cancer.
Our aim was to estimate the costs and health benefits of routinely administered postoperative amiodarone as a prophylactic agent in reducing the risk of atrial fibrillation in patients undergoing surgery for lung cancer. ⋯ For patients undergoing surgery for lung cancer, routine use of postoperative prophylactic intravenous bolus and five subsequent days of oral amiodarone therapy reduces the risk of atrial fibrillation in a cost-neutral manner.