Left Atrial Appendage Exclusion Using the AtriClip Device: A Case Series.

BACKGROUND: Atrial fibrillation (AF) affects 1.5-2% of the population and is associated with a five-fold increased lifetime risk of stroke [1]. The left atrial appendage (LAA) is the source of embolic strokes in up to 90% of patients with non-valvular AF with clots in the left atrium [2]. METHODS: We reviewed the clinical notes and echocardiographic findings of 20 patients who underwent open cardiac surgery in which concurrent AtriClip (Atricure Inc, Westchester, OH, USA) device insertion was attempted at our institution from July 2013 to February 2015. This was to examine the safety and efficacy of LAA exclusion with clip devices during open cardiac surgery. Indications for LAA exclusion included a history or suspicion of atrial arrhythmia, left ventricular dilatation, or a history of transient ischaemic attacks. RESULTS: All 20 of the 20 participants had successful placement of the clip device (100% success rate). There were no adverse events related to the device and no perioperative mortality. There were three late deaths due to chronic obstructive pulmonary disease (COPD), leukaemia, and refractory congestive cardiac failure. No late device related complications were found on follow-up imaging in the remaining patients. CONCLUSIONS: The results of our study demonstrate the LAA exclusion during open cardiac surgery with the AtriClip device is safe, has a 100% success rate, and appears to be stable over time.

Mandibular reconstruction: meta-analysis of iliac- versus fibula-free flaps.

BACKGROUND: Free vascularized bone flaps are widely recognized as the optimal reconstruction for patients who undergo mandibular resection. The fibula-free flap is currently considered the gold standard, workhorse flap for mandibular reconstruction. Although previous studies have analysed individual success of each flap type, few have compared iliac- and fibula-free flaps. METHODS: A systematic review of the literature was conducted in line with the PRISMA protocol searching the PubMed and EBSCO databases. Twenty-four studies were included as per predetermined inclusion criteria. Double-arm random effect meta-analysis was conducted with STATA 12, and single-arm meta-analysis was conducted utilizing Meta-XL. RESULTS: The results of this meta-analysis confirm that there is no significant difference in total flap loss between fibula- and iliac-free flap reconstruction of mandibular defects. In terms of recipient site complication, there was a significantly higher risk of delayed healing and suture line breakdown in the iliac flap group (P = 0.05). Donor site complications showed a trend towards being higher in the fibula flap group. Osseointegrated dental implant loss in fibula flaps was higher than in iliac flaps (5.3% compared with 1.7%). CONCLUSION: Both iliac- and fibula-free flaps should be considered for use in mandibular reconstruction. We suggest the iliac crest as the first choice for mandibular angle or body defects (better contour match) or also defects requiring greater soft-tissue bulk for intra-oral lining. The fibula flap is best when bony length is required such as in subtotal or total mandibulectomy.

Video-assisted thoracoscopic surgery versus open thoracotomy for pulmonary metastasectomy: a systematic review.

BACKGROUND: Pulmonary metastasectomy has become a popular procedure for patients with pulmonary metastases. It can be achieved via the traditional open thoracotomy or the more recently developed video-assisted thoracoscopic surgery (VATS). However, there has been much debate as to which approach is better in terms of detection of pulmonary metastases and, in turn, survival and recurrence outcomes. We aim to compare the two different approaches in terms of survival and recurrence outcomes. METHODS: Medline and EMBASE databases were searched for relevant publications dated prior to May 2013. The bibliographies of the included articles were examined for additional relevant articles that were not included in the search. All publications reporting on overall survival and recurrence-free survival were included. The articles were carefully examined and data were extracted. STATA 12L and RevMan5.2 software were used to combine the data using the random effects model. RESULTS: A total of 1960 studies were identified through the search. Thirty-two articles had extractable data regarding overall survival and recurrence-free survival. However, only eight articles were included in the end as the other 24 articles had incomplete data. From the included articles, we found that the VATS group had slightly higher odds of 1-, 3- and 5-year overall survival with odds ratios of 1.53, 1.69 and 1.41, respectively, and also higher odds of 1-, 3- and 5-year recurrence-free survival with odds ratios of 1.29, 1.54 and 1.54, respectively. CONCLUSION: VATS offers a suitable alternative to open thoracotomy for the treatment of pulmonary metastases.