Assuntos
Valva Aórtica/cirurgia , Bioprótese , Ponte Cardiopulmonar/métodos , Constrição , Próteses Valvulares Cardíacas/normas , Invenções , Substituição da Valva Aórtica Transcateter/instrumentação , Ensaios Clínicos como Assunto , Humanos , Melhoria de Qualidade , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/métodos , Substituição da Valva Aórtica Transcateter/tendências , Resultado do TratamentoRESUMO
Obesity has been identified as a risk factor for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). However, no studies have addressed the influence of race on this association. A total of 13,594 patients undergoing first-time, isolated CABG without preoperative AF between 1992 and 2011 were included in our study. The association between body mass index and POAF was compared by race. Relative risk and 95% CIs were computed using maximum likelihood log-binomial regression. Increasing levels of body mass index were associated with higher POAF risk after CABG in black but not white patients (pinteraction = 0.0009).
Assuntos
Fibrilação Atrial/etnologia , Negro ou Afro-Americano , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Obesidade/complicações , População Branca , Idoso , Índice de Massa Corporal , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/etnologia , Feminino , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Análise de Regressão , Estudos Retrospectivos , Fatores de RiscoRESUMO
Robotic surgery has been applied to various fields in cardiac surgery. Despite excellent results published in the literature, critics have questioned procedure reproducibility, increased cost, and the real patient benefit. We reviewed 5 recent articles to show that robotic cardiac surgery likely will play an important role in the new era of cardiac surgery.
RESUMO
The mitral valve has been traditionally approached through a median sternotomy. However, significant advances in surgical optics, instrumentation, tissue telemanipulation, and perfusion technology have allowed for mitral valve surgery to be performed using progressively smaller incisions including the minithoracotomy and hemisternotomy. Due to reports of excellent results, minimally invasive mitral valve surgery has become a standard of care at certain specialized centers worldwide. This meta-analysis quantifies the effects of minimally invasive mitral valve surgery on morbidity and mortality compared with conventional mitral surgery and demonstrates equivalent perioperative mortality (1641 patients, odds ratio (OR) 0.46, 95% confidence interval 0.15-1.42, p=0.18), reduced need for reoperation for bleeding (1553 patients, OR 0.56, 95% CI 0.35-0.90, p=0.02) and a trend towards shorter hospital stays (350 patients, weighted mean difference (WMD) -0.73, 95% CI -1.52 to 0.05, p=0.07). These benefits were evident despite longer cardiopulmonary bypass (WMD 25.81, 95% CI 13.13-38.50, p<0.0001) and cross-clamp times (WMD 20.91, 95% CI 8.79-33.04, p=0.0007) in the minimally invasive group. Case-control studies show consistently less pain and faster recovery compared to those having a conventional approach. Data for minimally invasive mitral valve surgery after previous cardiac surgery are limited but consistently demonstrate reduced blood loss, fewer transfusions and faster recovery compared to reoperative sternotomy. Long-term follow-up data from multiple cohort studies are also examined revealing equivalent survival and freedom from reoperation. Thus, current clinical data suggest that minimally invasive mitral valve surgery is a safe and a durable alternative to a conventional approach and is associated with less morbidity.