scholarly journals 177 Pedicled Or Skeletonized Bilateral Internal Mammary Artery Harvesting - A Meta- Analysis and Trial Sequential Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Iddawela ◽  
S L Mellor ◽  
S A Zahra ◽  
Y Khare ◽  
A Harky
Keyword(s):  
Sequential Analysis ◽  
Internal Mammary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Trial Sequential Analysis ◽  
Wound Infections ◽  
Cochrane Database ◽  
Internal Mammary ◽  
Risk Patients ◽  
Sternal Wound Infections

Abstract Objective There is varying evidence on the role of skeletonization of internal mammary artery in reducing the risk of sternal wound infections and ischemia following bilateral internal mammary artery grafting. We opt to compare post-operative clinical outcomes of skeletonized bilateral internal mammary artery versus pedicled bilateral internal mammary artery harvesting in patients undergoing coronary artery bypass surgery. Method A comprehensive electronic search was conducted using PubMed/MEDLINE, Scopus, EMBASE, Cochrane database and Google Scholar from inception until 15th June 2020. All studies directly comparing skeletonized and pedicled bilateral internal mammary artery harvesting were included. Meta-analysis and trial sequential analysis was conducted. Results Ten studies consisting of 3728 patients (2098 patients with skeletonized bilateral internal mammary artery grafting and 1630 patients with pedicled bilateral internal mammary artery grafting) were included. Pooled effects analysis and trial sequential analysis reported significantly lower risk of sternal wound infection with skeletonized bilateral internal mammary artery harvesting (OR 0.32, 95% CI 0.20 – 0.51, p < 0.00001). S-BIMA may be associated with lower late mortality, but more information is required to confirm this. Conclusions Skeletonization reduces the risk of sternal wound infections by preserving vasculature as much as possible. This makes it an important technique for use in bilateral internal mammary artery grafting for high-risk patients.

scholarly journals Operative and Oncological Outcomes Comparing Sentinel Node Mapping and Systematic Lymphadenectomy in Endometrial Cancer Staging: Meta-Analysis With Trial Sequential Analysis

2021 ◽  
Vol 10 ◽  
Author(s):  
Yu Gu ◽  
Hongyan Cheng ◽  
Liju Zong ◽  
Yujia Kong ◽  
Yang Xiang
Keyword(s):  
Endometrial Cancer ◽  
High Risk ◽  
Blood Loss ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Current Evidence ◽  
Trial Sequential Analysis ◽  
High Risk Patients ◽  
Oncological Outcomes ◽  
Risk Patients

ObjectiveTo evaluate the utility of sentinel lymph node mapping (SLN) in endometrial cancer (EC) patients in comparison with lymphadenectomy (LND).MethodsComprehensive search was performed in MEDLINE, EMBASE, CENTRAL, OVID, Web of science databases, and three clinical trials registration websites, from the database inception to September 2020. The primary outcomes covered operative outcomes, nodal assessment, and oncological outcomes. Software Revman 5.3 was used. Trial sequential analysis (TSA) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were performed.ResultsOverall, 5,820 EC patients from 15 studies were pooled in the meta-analysis: SLN group (N = 2,152, 37.0%), LND group (N = 3,668, 63.0%). In meta-analysis of blood loss, SLN offered advantage over LND in reducing operation bleeding (I2 = 74%, P<0.01). Z-curve of blood loss crossed trial sequential monitoring boundaries though did not reach TSA sample size. There was no difference between SLN and LND in intra-operative complications (I2 = 7%, P = 0.12). SLN was superior to LND in detecting positive pelvic nodes (P-LN) (I2 = 36%, P<0.001), even in high risk patients (I2 = 36%, P = 0.001). While no difference was observed in detection of positive para-aortic nodes (PA-LN) (I2 = 47%, P = 0.76), even in high risk patients (I2 = 62%, P = 0.34). Analysis showed no difference between two groups in the number of resected pelvic nodes (I2 = 99%, P = 0.26). SLN was not associated with a statistically significant overall survival (I2 = 79%, P = 0.94). There was no difference in progression-free survival between SLN and LND (I2 = 52%, P = 0.31). No difference was observed in recurrence. Based on the GRADE assessment, we considered the quality of current evidence to be moderate for P-LN biopsy, low for items like blood loss, PA-LN positive.ConclusionThe present meta-analysis underlines that SLN is capable of reducing blood loss during operation in regardless of surgical approach with firm evidence from TSA. SLN mapping is more targeted for less node dissection and more detection of positive lymph nodes even in high risk patients with conclusive evidence from TSA. Utility of SLN yields no survival detriment in EC patients.

Sternal Wound Infections

1993 ◽  
Vol 4 (3) ◽  
pp. 475-483
Author(s):  
Patricia L. Vaska
Keyword(s):  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Signs And Symptoms ◽  
Diabetic Patients ◽  
Wound Infections ◽  
Great Vessels ◽  
Internal Mammary ◽  
The Common ◽  
Sternal Wound Infections

Sternal wound infections are a major cause of morbidity and mortality in patients undergoing cardiac surgery. They occur in 1% to 3% of patients who undergo open-heart surgery and carry a 20% to 40% mortality rate. Sternal infections can range from minor, superficial infections to open mediastinitis with invasion of the sternum, heart, and great vessels. Staphylococcus species arc responsible for the majority of sternal infections, but environmental sources can cause infections by other organisms. The common signs and symptoms of mediastinitis are fever, leukocytosis, sternal instability, drainage, and pain. Several risk factors exist for sternal wound infection, with bilateral internal mammary artery bypass grafting in diabetic patients being the most common. Treatment entails surgical debridement with cither closed irrigation, open-wound packing, or muscle or omental flap procedures, as well as antibiotic therapy. Some simple procedures help limit the development of sternal infections in certain patients

scholarly journals Sternal wound infections and internal mammary artery grafts

1993 ◽  
Vol 106 (1) ◽  
pp. 181-182 ◽  
Author(s):  
A.G. Jayakrishnan ◽  
A. Allan ◽  
A.T. Forsyth ◽  
J.B. Desai
Keyword(s):  
Internal Mammary Artery ◽  
Wound Infections ◽  
Internal Mammary ◽  
Sternal Wound Infections
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