European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Dec 2015
Review Meta AnalysisNew-onset atrial fibrillation following coronary bypass surgery predicts long-term mortality: a systematic review and meta-analysis.
Atrial fibrillation (AF) is one of the most common postoperative complications following cardiac surgery. Recent evidence suggests that postoperative atrial fibrillation (POAF) may be more 'malignant' than previously thought, associated with follow-up mortality and morbidity. To evaluate the long-term survival of POAF versus No-POAF cohorts following coronary bypass surgery, the current meta-analysis with reconstructed individual patient data was performed. ⋯ Other complications including 30-day mortality, strokes, respiratory failure, pneumonia and hospitalization were significantly higher in the POAF group. New-onset AF following coronary bypass surgery is associated with significantly higher risk of mortality in short- and long-term follow-up. Current evidence suggests the need for stricter surveillance and monitoring of POAF following coronary bypass surgery.
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Eur J Cardiothorac Surg · Dec 2015
Multicenter StudyComprehensive rhythm evaluation in a large contemporary Fontan population†.
Rhythm disturbances are an important cause of morbidity in Fontan patients. Currently, the total cavopulmonary connection is performed by using the intra-atrial lateral tunnel (ILT) ('baffle ILT' or 'prosthetic ILT'), or the extracardiac conduit (ECC). The aim of the study was to evaluate rhythm abnormalities and compare the surgical techniques in a contemporary cohort. ⋯ The overall incidence of arrhythmia was low, although SND was frequently present in both Fontan groups. ILT patients had slower HRrecovery, and ILT patients with the more extensive baffle technique had more atrial arrhythmias and more sinus pauses. The significance of asymptomatic ventricular arrhythmias in this young population remains to be determined.
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Eur J Cardiothorac Surg · Dec 2015
Methodology manual for European Association for Cardio-Thoracic Surgery (EACTS) clinical guidelines.
The goal of all clinical guidelines is to assist patients and practitioners in making healthcare decisions. However, clinical guidelines have been questioned about their quality, transparency and independence. ⋯ Four key areas have been addressed: (i) selection of taskforce members and transparency of relations with the industry, (ii) methods for critical appraisal of medical evidence, (iii) rules for writing recommendations and (iv) review process. It is hoped that, by adopting this methodology, clinical guidelines produced by the EACTS will be well balanced, objective and, importantly, trusted by physicians and patients who benefit from their implementation.
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Eur J Cardiothorac Surg · Dec 2015
Meta Analysis Comparative StudyAxillary versus femoral arterial cannulation in type A acute aortic dissection: evidence from a meta-analysis of comparative studies and adjusted risk estimates.
There is a growing perception that femoral arterial cannulation (FAC), by reversing the flow in the thoracoabdominal aorta, may increase the risk of retrograde brain embolization, dissection and organ malperfusion in type A aortic dissection. Axillary artery cannulation (AXC) has been reported to improve operative outcomes by allowing antegrade blood flow. However, FAC still remains largely utilized as a consensus for the routine use of AXC has not yet been reached. ⋯ The present meta-analysis demonstrated that AXC is superior to FAC in reducing in-hospital mortality and the incidence of PND in patients operated on for type A acute aortic dissection.