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1.
Heart ; 98(1): 60-4, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21990387

RESUMEN

Objective Endoscopic vein harvesting (EVH) is increasingly used as an alternative to open vein harvesting (OVH) for coronary artery bypass graft (CABG) surgery. Concerns about the safety of EVH with regard to midterm clinical outcomes following CABG have been raised. The objective of this study was to assess the impact of EVH on short-term and midterm clinical outcomes following CABG. Design This was a retrospective analysis of prospectively collected multi-centre data. A propensity score was developed for EVH and used to match patients who underwent EVH to those who underwent OVH. Setting Blackpool Victoria Hospital, Plymouth Derriford Hospital and the University Hospital of South Manchester were the main study settings. Patients There were 4709 consecutive patients who underwent isolated CABG using EVH or OVH between January 2008 and July 2010. Main outcome measures The main outcome measure was a combined end point of death, repeat revascularisation or myocardial infarction. Secondary outcome measures included in-hospital morbidity, in-hospital mortality and midterm mortality. Results Compared to OVH, EVH was not associated with an increased risk of the main outcome measure at a median follow-up of 22 months (HR 1.15; 95% CI 0.76 to 1.74). EVH was also not associated with an increased risk of in-hospital morbidity, in-hospital mortality (0.9% vs 1.1%, p=0.71) or midterm mortality (HR 1.04; 95% CI 0.65 to 1.66). Conclusions This multi-centre study demonstrates that at a median follow-up of 22 months, EVH was not associated with adverse short-term or midterm clinical outcomes. However, before the safety of EVH can be clearly determined, further analyses of long-term clinical outcomes are required.


Asunto(s)
Puente de Arteria Coronaria/métodos , Procedimientos Endovasculares/métodos , Infarto del Miocardio/cirugía , Revascularización Miocárdica/métodos , Vena Safena/trasplante , Recolección de Tejidos y Órganos/métodos , Anciano , Puente de Arteria Coronaria/mortalidad , Procedimientos Endovasculares/mortalidad , Métodos Epidemiológicos , Femenino , Hospitalización , Humanos , Masculino , Infarto del Miocardio/mortalidad , Revascularización Miocárdica/mortalidad , Recolección de Tejidos y Órganos/mortalidad , Resultado del Tratamiento
2.
Eur J Cardiothorac Surg ; 21(4): 611-4; discussion 614-5, 2002 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-11932155

RESUMEN

OBJECTIVE: Positron emission tomography (PET) scanning is more sensitive at detecting metastatic disease than conventional radiological techniques. For patients with pulmonary metastatic melanoma, we investigate if PET scanning to detect occult extra pulmonary disease prior to thoracotomy and metastectomy is associated with improved survival compared to patients staged by conventional radiology. METHODS: Between November 1984 and December 1999, 121 patients (90 males, 31 females) have undergone a thoracotomy and pulmonary metastectomy for metastatic melanoma. The age range was 19-84 years (mean 57, median 59). In every case all palpable nodules were removed and the diagnosis confirmed histologically. A total of 68 (56%) patients had a PET scan preoperatively, 53 (44%) underwent conventional or nuclear imaging. Patients with only radiologically isolated pulmonary disease are included. RESULTS: Survival is 100% complete and totals 238 pt/years (mean 2.2 years, median 1.4 years). Survival (+/-SE) at 1, 3, 5 and 7 years for all patients is 68% (+/-4.5) (n=67), 36.6% (+/-5.2) (n=27), 22.1% (+/-4.8) (n=15) and 13.5% (+/-4.2) (n=7), respectively. Survival (+/-SE) was significantly better at 3 and 5 years in patients who underwent a PET scan preoperatively (Log rank P=0.002). There was no significant difference in survival by 7 years. CONCLUSIONS: There is a significant survival benefit associated with excluding extra pulmonary disease using a PET scan prior to thoracotomy and metastectomy. We recommend that PET scanning be used in the investigation of patients with pulmonary metastatic melanoma prior to metastectomy.


Asunto(s)
Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/secundario , Melanoma/mortalidad , Melanoma/secundario , Tomografía Computarizada de Emisión , Humanos , Pulmón/irrigación sanguínea , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Melanoma/diagnóstico por imagen , Cuidados Preoperatorios , Estudios Retrospectivos , Estadística como Asunto , Análisis de Supervivencia , Factores de Tiempo , Tomografía Computarizada por Rayos X
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