Impact of Incomplete Revascularization on Long-term Survival Based on Revascularization Strategy.

BACKGROUND: This study investigated the impact of complete revascularization (CR) and incomplete revascularization (IR) on long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG) using multiple arterial graft (MAGs) or a single artery with saphenous vein grafts (SAGs). METHODS: Between January 2006 and December 2020, 12,625 patients underwent CABG and were divided into 4 groups: MAG CR (n = 1066), MAG IR (n = 286), SAG CR (n = 8360), and SAG IR (n = 2913). Inverse probability of treatment weighting based on the generalized propensity score was used to minimize imbalance between the groups. RESULTS: In the weighted cohort, median follow-up time was 8.35 years (interquartile range, 5.01-11.6 years). MAG CR was associated with similar long-term survival compared with MAG IR (hazard ratio [HR], 0.79; 95% CI, 0.60-1.03; P = .084). SAG CR was associated with improved long-term survival compared with SAG IR (HR, 0.67; 95% CI, 0.52-0.84; P = .01). MAG CR was associated with better long-term survival compared with SAG CR (HR, 0.45; 95% CI, 0.35-0.57; P < .001). Moreover, MAG IR was protective compared with SAG IR (HR, 0.62; 95% CI, 0.45-0.85; P = .033). Additional analysis was performed comparing perfect CR vs imperfect CR vs IR in MAG and SAG patients, separately. In the weighted sample of MAG, there were no differences in the long-term survival between perfect CR, imperfect CR, and IR. However, in the weighted sample of the SAG cohort, SAG perfect CR was associated with improved survival compared with SAG imperfect CR (HR, 0.81; 95% CI, 0.0.72-0.92; P = .001). Whereas, SAG perfect and imperfect CR were both associated with improved survival compared with SAG IR (HR, 0.51; 95% CI, 0.0.35-0.87; P = .006 and HR, 0.72; 95% CI, 0.64-0.82; P < .001), respectively. CONCLUSIONS: MAG CR is associated with better survival compared with SAG CR. If IR is inevitable, patients with MAG IR had better long-term survival compared with patients receiving SAG IR. Moreover, similar long-term survival is observed whether perfect CR, imperfect CR, or IR is achieved in the MAG population but not in SAG patients.

Impact of Second Arterial Conduit on Outcomes Following Coronary Bypass Grafting.

BACKGROUND: The aim of this study was to compare short-term outcomes and long-term survival in patients following coronary artery bypass grafting in whom second arterial conduit or saphenous vein was used as well as to find out the most optimal second arterial graft. METHODS: Between January 2006 and June 2018, 7,857 patients met the inclusion criteria and were divided into two groups: single internal thoracic artery (SITA) + Vein group (n = 7,140) and second arterial conduit group (n = 717), of these 537 patients received right internal thoracic artery (RITA) and 180 patients received radial artery (RA). We obtained 701 propensity-matched pairs for final comparison. Short-term outcomes included: 30-day mortality and major adverse cardiac and cerebral events (MACCE), reoperation for bleeding, and deep sternal wound infection (DSWI). The long-term outcome was all-cause mortality. RESULTS: No significant differences were observed between second arterial conduit versus SITA + Vein groups and between RITA versus RA groups in terms of 30-day mortality, 30-day MACCE, reoperation for bleeding, and incidence of DSWI in the matched cohort. The use of second arterial conduit was associated with a significant reduction in long-term mortality by 24% in the matched cohort (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.60-0.96; p = 0.02). RA and RITA as second arterial conduit had comparable long-term mortality (HR: 1.12; 95% CI: 0.69-1.82; p = 0.62). CONCLUSION: The use of second arterial conduit, irrespective of type, is safe and associated with improved long-term survival compared with the second venous aortocoronary graft.

Long-term outcomes of patients receiving right internal thoracic artery or radial artery as a second arterial conduit. A propensity score matching study.

OBJECTIVE: This study aimed to compare the long-term outcomes in propensity matched patients receiving right internal thoracic artery(RITA) or radial artery(RA) as second arterial conduit during coronary artery bypass grafting(CABG) with internal thoracic artery to the left anterior descending artery(LAD). METHODS: In this retrospective study, propensity score matching was performed including 1198 patients from 3 centers resulting in 389-pairs who received either RITA or RA. RESULTS: In the matched cohort, median follow-up time was 7.53 years(interquartile range, 4.35-11.81). Survival probabilities at 5, 10 and 15-years were 93.8% versus 94.5%, 81.2% versus 76.2% and 63.2% vs 62.5% in the RITA and RA groups, respectively(HR: 1.11; 95%CI;0.80-1.53; P = 0.533) Freedom from MACCE in the matched cohort at 5, 10 and 15-years were 92.0% versus 93.7%, 75.0% versus 73.8%, 72.2% and 46.9% vs 47.2% in the RITA and RA groups, respectively(HR: 0.96; 95%CI;0.74-1.26; P = 0.774). Subgroup analyses of the matched cohort showed comparable long-term outcomes in terms of MACCE at follow-up in patients with age older than 65-years, obese patients, diabetics, female patients and with impaired EF. As for target vessel revascularization, RITA and RA had comparable outcomes in terms of MACCE when the conduit was used to graft either the left coronary system or the right coronary system. CONCLUSIONS: The use of RITA or RA as second arterial conduit during CABG with internal thoracic artery to the LAD is safe and associated with comparable long-term clinical outcomes. The choice of optimal second arterial conduit should be guided mainly by patients' characteristics and surgeons' preferences.

Tolerance Modelling of Vibrations of a Sandwich Plate with Honeycomb Core.

Sandwich structures are commonly used in many branches of modern engineering, such as aerospace or naval constructions. In this work, a vibration analysis of such structures is performed with the use of an anlytical model based on a zig-zag hypothesis. Due to the assumed periodic microstructure, which may occure in any layer of the structure, the initial governing equations describing its dynamic behaviour may contain periodic, non-continuous coefficients. The main aim of the presented paper is to show an analytical solution to the issue of the vibration analysis of the mentioned structures. With the use of the tolerance averaging technique, the initial governing equations are transformed to the form with constant coefficients, which is convenient to solve using well-known mathematical methods. The derived model is a versatile solution for any type of periodically inhomogeneous sandwich plate, including sandwich plates with a honeycomb core. Eventually, in the calculation example, the application of the derived averaged model in the analysis of vibrations of such structures is presented and discussed. The convergence of results of the tolerance model and FEM analysis proves the correctness and superiority of the proposed solution.

Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry.

AIMS: Post-infarction ventricular septal defect (PIVSD) is a mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken. METHODS AND RESUTS: Patients treated with surgical or percutaneous repair of PIVSD (2010-2021) were identified at 16 UK centres. Case note review was undertaken. The primary outcome was long-term mortality. Patient groups were allocated based upon initial management (percutaneous or surgical). Three-hundred sixty-two patients received 416 procedures (131 percutaneous, 231 surgery). 16.1% of percutaneous patients subsequently had surgery. 7.8% of surgical patients subsequently had percutaneous treatment. Times from AMI to treatment were similar [percutaneous 9 (6-14) vs. surgical 9 (4-22) days, P = 0.18]. Surgical patients were more likely to have cardiogenic shock (62.8% vs. 51.9%, P = 0.044). Percutaneous patients were substantially older [72 (64-77) vs. 67 (61-73) years, P < 0.001] and more likely to be discussed in a heart team setting. There was no difference in long-term mortality between patients (61.1% vs. 53.7%, P = 0.17). In-hospital mortality was lower in the surgical group (55.0% vs. 44.2%, P = 0.048) with no difference in mortality after hospital discharge (P = 0.65). Cardiogenic shock [adjusted hazard ratio (aHR) 1.97 (95% confidence interval 1.37-2.84), P < 0.001), percutaneous approach [aHR 1.44 (1.01-2.05), P = 0.042], and number of vessels with coronary artery disease [aHR 1.22 (1.01-1.47), P = 0.043] were independently associated with long-term mortality. CONCLUSION: Surgical and percutaneous repair are viable options for management of PIVSD. There was no difference in post-discharge long-term mortality between patients, although in-hospital mortality was lower for surgery.

The Stability Analysis of Periodic Beams Interacting with Periodic Elastic Foundation with the Use of the Tolerance Averaging Technique.

In this paper a stability analysis of microperiodic beams resting on the periodic inhomogeneous foundation is carried out. The main issue of this considerations, which is the analytical solution to the governing equations characterised by periodic, highly oscillating and non-continuous coefficients, is overwhelmed by the application of the tolerance averaging technique. As a result of such application, the governing equation is transformed into a form with constant coefficients which can be solved using well-known mathematical methods. In several calculation examples, the convergence of the results of two derived averaged models is examined, as well as the convergence of the lowest value of the critical force parameter derived from the averaged models with the FEM model. The results prove the superiority of the presented analytical solution over the FEM analysis in the optimisation process.

Impact of Preoperative Aspirin on Long-Term Outcomes in Diabetic Patients Following Coronary Artery Bypass Grafting: a Propensity Score Matched Study.

INTRODUCTION: This study aimed to determine the effect of preoperative aspirin administration on early and long-term clinical outcomes in patients suffering from diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG). METHODS: In this observational study, a total of 315 patients were included and grouped according to the time interval between their last aspirin dose and the time of surgery; patients who had been continued aspirin intake with last administered dose ≤ 24-hours before CABG (n=144) and those who had been given the last dose of aspirin between 24 to 48 hours before CABG (n=171). RESULTS: Multivariable analysis showed that the continuation of preoperative aspirin intake ≤ 24 hours before CABG in patients with DM is associated with reduced incidence of 30-day major adverse cardiac and cerebral events (MACCE) (P=0.004) as well as reduced incidence of composite 30-day mortality/MACCE (P=0.012). During mean follow-up of 37±17.5 months, the unadjusted hazard ratio (HR) showed that aspirin ≤ 24 hours prior CABG in patients with DM significantly reduced the incidence of MACCE and composite of mortality/MACCE during follow-up (HR: 0.50; 95% confidence interval [CI]: 0.29-0.87; P=0.014 and HR: 0.61; 95% CI: 0.38-0.97; P=0.039, respectively). However, after propensity score (PS) matching, the PS-adjusted HR showed a non-significant trend towards the reduction of MACCE during follow-up (HR: 0.58; 95% CI: 0.31-1.06; P=0.081). CONCLUSION: Continuation of preoperative aspirin intake ≤ 24 hours before CABG in patients with DM is associated with reduced incidence of early MACCE, but without significant influence on long-term outcomes.

Impact of preoperative aspirin on long-term outcomes in diabetic patients following coronary artery bypass grafting: a propensity score matched study

Abstract Introduction: This study aimed to determine the effect of preoperative aspirin administration on early and long-term clinical outcomes in patients suffering from diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG). Methods: In this observational study, a total of 315 patients were included and grouped according to the time interval between their last aspirin dose and the time of surgery; patients who had been continued aspirin intake with last administered dose ≤ 24-hours before CABG (n=144) and those who had been given the last dose of aspirin between 24 to 48 hours before CABG (n=171). Results: Multivariable analysis showed that the continuation of preoperative aspirin intake ≤ 24 hours before CABG in patients with DM is associated with reduced incidence of 30-day major adverse cardiac and cerebral events (MACCE) (P=0.004) as well as reduced incidence of composite 30-day mortality/MACCE (P=0.012). During mean follow-up of 37±17.5 months, the unadjusted hazard ratio (HR) showed that aspirin ≤ 24 hours prior CABG in patients with DM significantly reduced the incidence of MACCE and composite of mortality/MACCE during follow-up (HR: 0.50; 95% confidence interval [CI]: 0.29-0.87; P=0.014 and HR: 0.61; 95% CI: 0.38-0.97; P=0.039, respectively). However, after propensity score (PS) matching, the PS-adjusted HR showed a non-significant trend towards the reduction of MACCE during follow-up (HR: 0.58; 95% CI: 0.31-1.06; P=0.081). Conclusion: Continuation of preoperative aspirin intake ≤ 24 hours before CABG in patients with DM is associated with reduced incidence of early MACCE, but without significant influence on long-term outcomes.

Early and long-term clinical outcomes after minimally invasive direct coronary artery bypass grafting versus off-pump coronary surgery via sternotomy in isolated proximal left anterior descending artery disease: A propensity score matching analysis.

BACKGROUND: This study was designed to compare short-term and long-term clinical outcomes of minimally invasive direct coronary artery bypass (MIDCAB) and off-pump coronary artery bypass grafting (OPCAB) via median sternotomy in patients with single-vessel left anterior descending (LAD) artery disease. METHODS: In this retrospective study, 194-patients met the inclusion criteria and were divided into the MIDCAB group (n = 111) and OPCAB via median sternotomy group (n = 83). Short-term outcomes included: in-hospital mortality, perioperative myocardial infarction (MI), perioperative cerebrovascular adverse events (CAEs), chest drainage, reoperation for bleeding, duration of surgery, ventilation time, deep wound infection, packed red blood cell (pRBC) transfusion and duration of hospital stay. The long-term outcomes included: all-cause mortality, the incidence of MI and stroke, target vessel revascularization (TVR) and composite of mortality/MI/stroke. Propensity score matching (PSM) was used to match patients between the groups. RESULTS: Before as well as after the PSM, no significant differences were observed between both groups in terms of in-hospital mortality, incidence of perioperative MI, incidence of CAEs, reoperation for bleeding, pRBC transfusions, deep wound infection and ventilation time. However, MIDCAB group had lower chest tube drainage and shorter hospital stay. On the other hand, OPCAB group had shorter time of surgery before as well as after PS matching. At 7-years, before and after PSM, freedom from all-cause mortality, MI, stroke, TVR as well as composite of mortality/MI/stroke were comparable between both groups. CONCLUSIONS: Short-term as well as long-term outcomes of MIDCAB in terms of mortality, MI, stroke, and target vessel revascularization are satisfactory and as safe and effective as OPCAB via sternotomy.

Timing Strategy of Preoperative Aspirin and Its Impact on Early Outcomes in Patients Undergoing Coronary Artery Bypass Grafting: A Propensity Score Matching Analysis.

BACKGROUND: Data are lacking regarding optimal discontinuation time of preoperative aspirin before coronary artery bypass grafting (CABG). We aimed at assessing the impact of aspirin discontinuation according to time intervals before CABG and its influence on early postoperative outcomes. METHODS: In this retrospective study, we enrolled 652 patients who underwent primary isolated nonemergent CABG between October 2014 and December 2017. Patients were assigned into groups according to the time interval between the last aspirin dose administration and the time of surgery. The first group comprised patients who were given aspirin ≤24-h before CABG (n = 304), whereas the second group consisted of patients who took aspirin between 24 and 48 h before CABG (n = 348). Efficacy endpoints included 30-d mortality rate, incidence of major adverse cardiac and cerebral events (MACCE) and composite rates of 30-d mortality/MACCE. Propensity score matching was used for final comparison. RESULTS: Overall, multivariate analysis showed that aspirin administration ≤24 h before CABG was associated with reduced 30-d mortality rate and MACCE by 75% and 57%, respectively. Before as well as after propensity score matching, multivariate analysis showed that aspirin administration ≤24-h before CABG was associated with reduced composite rates of 30-d mortality rate and MACCE by 55% and 59%, respectively. Subgroup analysis stratified by the type of surgery showed that aspirin administration ≤24-h significantly reduced composite rates of 30-d mortality/MACCE in patients after off-pump CABG. CONCLUSIONS: Preoperative administration of aspirin ≤24-h before CABG is associated with the reduction of postoperative mortality as well as MACCE. The evidence also suggests that aspirin administration ≤24-h is strongly associated with reduced composite rates of 30-d mortality/MACCE in patients submitted to off-pump CABG.

Association between preoperative aspirin and acute kidney injury following coronary artery bypass grafting.

OBJECTIVE: To test the hypothesis that preoperative aspirin administered within 24 hours before coronary artery bypass grafting (CABG) could reduce the incidence of postoperative acute kidney injury (AKI) following CABG. METHODS: In this retrospective study, 696 patients were assigned to groups according to the time interval between their last aspirin dose administration and the time of surgery. A total of 322 patients received aspirin ≤24 hours before CABG, and 374 patients received aspirin between 24 and 48 hours before CABG. The primary outcome was postoperative AKI of any stage as defined by the Kidney Disease Improving Global Outcomes criteria. Propensity score matching selected 274 pairs for the final comparison. RESULTS: Multivariable analysis showed that administration of aspirin within 24 hours of CABG was independently associated with reduction of AKI incidence by 36% (odds ratio, 0.64; 95% confidence interval, 0.45-0.91; P = .014). It was also noted that patients receiving their last aspirin dose ≤24 hours before CABG had a significantly higher glomerular filtration rate at discharge compared with patients who received aspirin between 24 and 48 hours before CABG. Propensity score matching analysis showed that patients receiving aspirin within 24 hours before CABG had a lower incidence of AKI compared with patients who discontinued aspirin between 24 and 48 hours before CABG (25.1% vs 36.8%; P = .004). CONCLUSIONS: Continuation of aspirin until the day of surgery, with the last aspirin dose administered ≤24 hours before CABG, is associated with a significant reduction of postoperative AKI.

Descriptive review of patent ductus arteriosus ligation by video-assisted thoracoscopy in pediatric population: 7-year experience.

BACKGROUND: Less invasive procedures such as video-assisted thoracoscopic surgery (VATS) are desirable for patent ductal artery (PDA) ligation when pharmacologic or conservative approaches fail. Studies done on VATS-PDA ligation showed better outcomes when compared to open thoracotomies, however, complication rates remain conflicting. Learning curve can be a postulated reason which may also precludes the acceptability. We therefore sought to report our single centered 7-year experience of PDA closure with VATS. METHODS: Single centered retrospective study of 127 patients who underwent PDA ligature with VATS from February 2012 to October 2018. The cohort was divided into two groups, i.e., 2012-2014 (early phase) and 2015-2018 (late phase) and were further compared. Early and late outcomes, including mortality and morbidity, were analyzed. RESULTS: The included patients had a mean age of 1.7 years. Among them, preterm infants accounted for 38.6%, there was no operative mortality. Six deaths (4.7%) occurred during in-hospital stay, predominantly in the neonatal intensive care unit (NICU) due to massive cerebral bleeding and cardiopulmonary failure. Overall conversion rate to thoracotomy was 16.5%. It decreased from 20% in early phase to less than 5% in late phase. Fifty patients (39.4%) required transfer to the NICU. The mean in-hospital stay for the remainders was only 2.2±1.6 days. All but two patients discharged home survived follow-up period without any adverse events and nobody among non-converted cases expressed concerns regarding chest deformity. A 5-year probability of survival estimated according to the Kaplan-Meier curve was 93.6%. CONCLUSIONS: VATS is a safe as well as efficient method for closure of PDA that ensures satisfactory late cosmetic results. Postoperative mortality and extended hospital stay may be attributed to prematurity. Although learning curve exists it does not affect the safety and late outcomes.

Conversion to thoracotomy of video-assisted thoracoscopic closure of patent ductus arteriosus.

INTRODUCTION: Posterolateral thoracotomy was the access of choice in surgical treatment of patent ductus arteriosus (PDA) for many years before the introduction of video-assisted thoracoscopic surgery (VATS). The latter is thought to reduce postoperative pain and improve musculoskeletal system status. However, it carries a potential risk of conversion to thoracotomy. AIM: To evaluate the rate, reasons and outcomes of VATS conversion to thoracotomy in surgical PDA patients. MATERIAL AND METHODS: From 2012 to 2017, 112 children were qualified for VATS closure of symptomatic PDA. Among them, 19 (16.9%) with the median age of 19.4 months required conversion to thoracotomy. The predominant reasons for conversion, early mortality and morbidity as well as late survival were evaluated. RESULTS: The overall conversion rate was 16.9% with an evident learning curve as it decreased significantly from more than 20% at the beginning to approximately 10% in the last 2 years. The predominant reasons were incomplete PDA closure (n = 6; 31.6%) followed by ductal bleeding after clip application (n = 5; 26.3%) and inadequate visualization (n = 5). One child died 48 h after the surgery due to acute cardiopulmonary failure (mortality 5.9%). All patients required postoperative chest tube insertion, and two of them developed postoperative pneumothorax. Neither deaths nor severe adverse events were noted throughout the follow-up period. CONCLUSIONS: The rate of VATS PDA closure conversion to standard thoracotomy features a learning curve. Although it must be considered as a serious complication, probably it does not negatively affect either early the mortality rate or long-term survival.

Is administration of dual-antiplatelet therapy beneficial for patients following off-pump coronary artery bypass grafting?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether administration of dual-antiplatelet therapy (DAPT) following off-pump coronary artery bypass grafting (OPCAB) would improve postoperative clinical outcomes or minimize the incidence of postoperative graft failure. In total, 101 papers were found using the reported search, 14 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. One meta-analysis and 3 randomized controlled trials showed that DAPT following OPCAB is associated with decreased incidence of saphenous vein graft occlusion. One randomized controlled trial and 4 observational studies showed no effect of DAPT on mortality following OPCAB, whereas 3 observational studies showed that DAPT decreased mortality. One meta-analysis and 4 observational studies showed that DAPT reduced the incidence of cardiac events following OPCAB. One randomized controlled trial and 4 observational studies showed that DAPT did not increase the incidence of major or minor bleeding complications following OPCAB. The results presented suggest that administration of DAPT in patients following OPCAB for at least 3 months improves saphenous vein graft patency and could be protective against recurrence of cardiac events, especially acute coronary syndrome, in comparison with aspirin monotherapy. The administration of DAPT following OPCAB is safe and is not associated with increased incidence of major or minor bleeding complications when compared with aspirin alone.

Surgical closure of patent ductus arteriosus in extremely low birth weight infants weighing less than 750 grams.

BACKGROUND: Patent ductus arteriosus (PDA) occurs more frequently in premature infants. Depending on the degree of prematurity, these children often have other serious comorbidities that could have a significant impact on surgical outcome. AIM: This study aimed to evaluate the clinical results of surgical ligation of PDA in extremely low body weight preterm infants with birth weight below 750 g, and to identify risk factors of mortality. METHODS: A total of 31 preterm infants with birth weight below 750 g and significant PDA were operated between 2006 and 2016 through posterolateral thoracotomy (n = 16) or with the use of video-assisted thoracoscopic method (n = 15). Mean weight at the time of surgery was 750.8 ± 104.7 g. The gestational age ranged from 22 to 32 weeks. Data were retrospectively analysed, and prospective 100% follow-up was performed. RESULTS: In-hospital mortality was 25.8% (n = 8). The type of surgery had no influence on the results. During the follow-up period lasting 5.2 ± 2.5 years, two other patients died. One-year and five-year probability of survival was 77.4% and 74.2%, respectively. The predominant cause of death was acute heart failure. All patients with preoperative renal dysfunction died in the postoperative period. Moreover, Cox regression analysis revealed renal dysfunction as an independent risk factor of early death. CONCLUSIONS: Preterm infants with birth weight less than 750 g and significant PDA are highly challenging patients. Despite the recent advances in perioperative management with neonates, surgery is still associated with a high early mortality rate irrespective of the applied method.

Does patient-prosthesis mismatch have a negative impact on outcomes following mitral valve replacement?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether patient-prosthesis mismatch (PPM) has a negative impact on patients undergoing mitral valve replacement in terms of postoperative mortality, incidence of postoperative pulmonary hypertension (PH) and higher transmitral gradients. Altogether 103 papers were found using the reported search, 18 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Overall, 8 studies with a total of 4812 patients reported that PPM has a significantly negative impact on long-term mortality, whereas 5 studies with a total of 1558 patients reported no effect on mortality. One study with a total of 2440 patients reported preoperative PH as the risk factor for increased mortality in the presence of moderate or severe PPM. Three studies evaluated the effect of PPM on postoperative PH and reported that PPM was associated with significantly increased postoperative PH. The majority of the studies reported that PPM was associated with higher peak or mean transmitral gradient and systolic pulmonary artery pressure. The results presented in these studies suggest that PPM in patients undergoing mitral valve replacement was associated with increased postoperative mean and peak transmitral gradient and higher postoperative systolic pulmonary artery pressure. PPM may be associated with increased long-term mortality. Severe PPM was directly associated with increased long-term mortality when compared with moderate or no PPM. Evidence suggests that PPM is associated with increased incidence of postoperative PH.

The use of preoperative aspirin in cardiac surgery: A systematic review and meta-analysis.

BACKGROUND: Despite the fact that aspirin is of benefit to patients following coronary artery bypass grafting (CABG), continuation or administration of preoperative aspirin before CABG or any cardiac surgical procedure remains controversial. Therefore, we performed a systematic review and meta-analysis to assess the influence of preoperative aspirin administration on patients undergoing cardiac surgery. MATERIALS AND METHODS: Medline database was searched using OVID SP interface. Similar searches were performed separately in EMBASE, PubMed, and Cochrane Central Registry of Controlled Trials. RESULTS: Twelve randomized controlled trials and 28 observational studies met our inclusion criteria and were included in the meta-analysis. The use of preoperative aspirin in patients undergoing CABG at any dose is associated with reduced early mortality as well as a reduced incidence of postoperative acute kidney injury (AKI). Low-dose aspirin (≤160 mg/d) is associated with a decreased incidence of perioperative myocardial infarction (MI). Administration of preoperative aspirin at any dose in patients undergoing cardiac surgery increases postoperative bleeding. Despite this effect of preoperative aspirin, it did not increase the rates of surgical re-exploration due to excessive postoperative bleeding nor did it increase the rates of packed red blood cell transfusions (PRBC) when preoperative low-dose aspirin (≤160 mg/d) was administered. CONCLUSIONS: Preoperative aspirin increases the risk for postoperative bleeding. However, this did not result in an increased need for chest re-exploration and did not increase the rates of PRBC transfusion when preoperative low-dose (≤160 mg/d) aspirin was administered. Aspirin at any dose is associated with decreased mortality and AKI and low-dose aspirin (≤160 mg/d) decreases the incidence of perioperative MI.

Thromboembolic complications after an ankle joint open fracture in a patient with a history of deep vein thrombosis in the lower limbs.

A 55-year-old patient was admitted to the Department of Orthopedics due to an open fracture in the right ankle joint. On the seventh day of hospitalization the patient experienced a transient ischemic attack. During the next day, dyspnea, chest pain and a 'rider' type pulmonary embolism in the pulmonary trunk occluding both pulmonary arteries and its branches were diagnosed. The patient was transferred to the Department of Cardiac Surgery. He underwent pulmonary embolectomy for massive pulmonary, right and left atrial embolism, and left ventricular embolism. ASD II was closed during this procedure. Ultrasonography with Doppler was performed 6 days after the surgery and revealed deep vein thrombosis, so the patient was transferred to the Department of Vascular Surgery for temporary inferior vena cava filter placement at the time of orthopedic surgery. The next day after implantation of the filter, the lower limb was operated on, and 14 days after orthopedic surgery, the vena cava filter was removed.

Minimally invasive thoracoscopic closure versus thoracotomy in children with patent ductus arteriosus.

BACKGROUND: Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Once diagnosed, an immediate pharmacologic or invasive treatment should be performed. The purpose of this work was to evaluate the safety and efficacy of surgical PDA ligation in children using video-assisted thoracoscopic surgery (VATS) in comparison with a conventional muscle-sparing posterolateral thoracotomy technique (MSPLT). MATERIALS AND METHODS: In this single-center, retrospective study 173 children qualified for surgical PDA closure were enrolled. Patients were divided according to their weight and type of surgery performed. The groups consisted of patients operated through thoracotomy (54%) or VATS (46%). Operative characteristics, cosmetic effect, postoperative complications and long-term survival were evaluated. RESULTS: Regardless of weight, fewer complications were noted in children after thoracoscopic clipping. Fifteen VATS patients required intraoperative conversion to thoracotomy; however, adverse sequelae were not observed. Aesthetics seemed to be the major complaint after conventional surgery. We did not observe any statistically significant differences in the long-term survival between both groups. CONCLUSIONS: Both techniques were shown to be safe and effective. Unsuccessfully performed thoracoscopic surgeries were safely converted to conventional thoracotomy. VATS, being a less invasive approach, leads to a better aesthetic effect and lower surgical complication rate.

What is the impact of preoperative aspirin administration on patients undergoing coronary artery bypass grafting?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether continuation of administration of preoperative aspirin until the day of coronary artery bypass grafting (CABG) could minimize postoperative mortality, prevalence of postoperative myocardial infarction (MI) with or without influence on postoperative bleeding, packed red blood cell (PRBC) transfusion and reoperation for bleeding. Altogether, 662 papers were found using the reported search, 7 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Seven studies, included in this review, consisted of five meta-analyses and two randomized controlled trials. One meta-analysis, involving 27 533 patients submitted to CABG, showed that the administration of preoperative aspirin decreased postoperative 30-day mortality by 27%. Another meta-analysis, including 1437 patients, showed that preoperative aspirin decreased the incidence of perioperative MI by 44%, the effect being even more pronounced with low-dose aspirin, which reduced the prevalence of perioperative MI by 63%. One RCT showed that preoperative aspirin is associated with reduced long-term hazard of MI or repeated revascularization. Four meta-analyses and two RCTs showed that preoperative aspirin is associated with increased postoperative bleeding, PRBC transfusion and reoperation for bleeding. However, this was not the case with preoperative administration of low-dose aspirin. The results presented in these studies suggest that preoperative aspirin administration in patients undergoing CABG has a significant benefit in reducing the incidence of perioperative MI and 30-day mortality rate, as well as reduced long-term hazard of MI or repeated revascularization. At a higher dose (>100 mg/day), postoperative bleeding, PRBC transfusion and reoperation for bleeding increased. However, with low-dose aspirin (≤100 mg/day), these benefits were not at the expense of increased postoperative bleeding or transfusion.