Journal of cardiac surgery
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Meta Analysis Comparative Study
Meta-analysis of randomized controlled trials on the treatment of unprotected left main coronary artery disease: one-year outcomes with coronary artery bypass grafting versus percutaneous coronary artery intervention with drug-eluting stent.
Coronary artery bypass surgery (CABG) is the standard treatment for left main coronary artery (LMCA) disease. However, percutaneous coronary intervention using drug-eluting stents (DES-PCI) is now widely used and is associated with improved outcomes following coronary revascularization. The goal of this study was to assess early outcomes associated with CABG and DES-PCI among patients with LMCA disease through a meta-analysis of randomized controlled trials. ⋯ DES-PCI is a safe alternative to CABG for the management of LMCA disease. However, CABG was superior to DES-PCI in terms of MACCE and need for target vessel revascularization at one year. Thus, CABG remains the standard of care for the treatment of LMCA disease.
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Review Case Reports
Aortic valve replacement in patients with systemic mastocytosis.
Systemic mastocytosis is a hematologic disorder with important perioperative implications. A variety of stimuli and medications can cause severe anaphylaxis in these patients. We report successful preoperative, intraoperative, and postoperative management of a patient with systemic mastocytosis who underwent an aortic valve replacement and review the literature pertaining to cardiac surgery in these patients.
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Clinical Trial
Factors predicting early- and long-term survival in patients undergoing extracorporeal membrane oxygenation (ECMO).
Extracorporeal membrane oxygenation (ECMO) is an established treatment option in patients with cardiogenic shock and respiratory dysfunction. We assessed outcomes of ECMO, as well as predictors of ECMO weaning and survival, in patients treated in our institution over the past five years. ⋯ Early ECMO application before catastrophic clinical deterioration and weaning as soon as possible may enhance overall survival.
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Comparative Study
Have changes in ECMO technology impacted outcomes in adult patients developing postcardiotomy cardiogenic shock?
Extracorporeal membrane oxygenation (ECMO) technology has undergone several advancements over the last decade. We sought to compare current ECMO technology to older ones to determine how these technological improvements have impacted outcomes in patients suffering from postcardiotomy cardiogenic shock (PCS). Between 2005 and 2010, 49 patients received ECMO as support for PCS following elective cardiac surgery. ⋯ Similar trends were detected in hospital survival (Gp 1 = 27.3%, Gp 2 = 27.3%, and Gp 3 = 33.3%). Technology did impact oxygenator durability with Gp 1 requiring seven (63.6%) oxygenator exchanges compared to zero (0.0%) in Gp 2 and two (7.4%) in Gp 1. While advancements in ECMO technology have resulted in improved oxygenator durability, outcomes in patients requiring such support for PCS continue to be poor.
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Clinical Trial
Assessing the immediate and sustained effectiveness of circular epicardial surgical ligation of the left atrial appendage.
Obliterating the left atrial appendage from systemic circulation in patients with atrial fibrillation has been proposed to reduce thromboembolic events. The goal of this study was to assess the effectiveness of a circular method of epicardial surgical ligation in obliterating the left atrial appendage and maintaining sustained exclusion. ⋯ Epicardial suture ligation of the left atrial appendage resulted in successful intra-operative exclusion on TEE; however, a significant portion of patient's demonstrated communication of contrast on CT. This is suggestive of incomplete long-term exclusion. The clinical significance of reduction in left atrial appendage orifice area and volume with a persistent communication requires further study.