The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Review Meta AnalysisVolatile anesthetics in preventing acute kidney injury after cardiac surgery: a systematic review and meta-analysis.
Acute kidney injury is a common clinical complication of cardiac surgery. Volatile anesthetics have been shown to protect against it in animal experiments. Clinically, however, the effect of volatile anesthetics has been unclear. We conducted a systematic review and meta-analysis of randomized, controlled trials to explore whether volatile anesthetics could provide renal protection to patients undergoing cardiac surgery. ⋯ Current evidence shows that volatile anesthetics may provide renal protection in patients undergoing cardiac surgery and supports further randomized, controlled trials with larger sample sizes and high methodologic quality.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Review Meta AnalysisShould clopidogrel be discontinued before coronary artery bypass grafting for patients with acute coronary syndrome? A systematic review and meta-analysis.
Patients presenting with acute coronary syndrome (ACS) are treated with dual antiplatelet agents, including aspirin and clopidogrel, to prevent mortality and recurrent ischemia. However, those who require coronary artery bypass grafting (CABG) could have increased postoperative bleeding and bleeding-related adverse outcomes. The current guidelines on clinical management differ significantly. The present meta-analysis examined the evidence for clopidogrel in the treatment of patients presenting with ACS requiring CABG, with a focus on the timing of medication cessation before surgery. ⋯ The results from the present meta-analysis suggest that patients who present with ACS should be treated with dual antiplatelet therapy, including clopidogrel. However, for patients subsequently referred for CABG, a minimum washout period of 5 days should be observed to minimize perioperative bleeding and bleeding-related complications, unless emergency indications exist. These results differ from those of previous studies and guidelines.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Meta AnalysisLung volume reduction surgery since the National Emphysema Treatment Trial: study of Society of Thoracic Surgeons Database.
The National Emphysema Treatment Trial demonstrated that lung volume reduction surgery is an effective treatment for emphysema in select patients. With chronic lower respiratory disease being the third leading cause of death in the United States, this study sought to assess practice patterns and outcomes for lung volume reduction surgery on a national level since the National Emphysema Treatment Trial. ⋯ This study demonstrates the importance of patient selection and the need to develop consensus on appropriate benchmarks for mortality rates after lung volume reduction surgery. It underscores the need for dedicated centers to increasingly address the heavy burden of chronic lower respiratory disease in the United States in a multidisciplinary fashion, particularly for preoperative evaluation and postoperative management of emphysema.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Multicenter Study Comparative StudySociety of Thoracic Surgeons 2008 cardiac risk models predict in-hospital mortality of heart valve surgery in a Chinese population: a multicenter study.
The Society of Thoracic Surgeons 2008 cardiac surgery risk models have been developed for heart valve surgery with and without coronary artery bypass grafting. The aim of our study was to evaluate the performance of Society of Thoracic Surgeons 2008 cardiac risk models in Chinese patients undergoing single valve surgery and the predicted mortality rates of those undergoing multiple valve surgery derived from the Society of Thoracic Surgeons 2008 risk models. ⋯ The Society of Thoracic Surgeons 2008 cardiac surgery risk models performed well when predicting the mortality for Chinese patients undergoing valve surgery. The Society of Thoracic Surgeons 2008 models were suitable for single valve surgery in a Chinese population; estimates of mortality for multiple valve surgery derived from the Society of Thoracic Surgeons 2008 models were less accurate.