Modified Single-Patch versus Two-Patch Repair for Atrioventricular Septal Defect: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 10 (5) ◽  
pp. 616-623 ◽  
Author(s):  
Rohit S. Loomba ◽  
Saul Flores ◽  
Enrique G. Villarreal ◽  
Ronald A. Bronicki ◽  
Robert H. Anderson
Keyword(s):  
Cardiopulmonary Bypass ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Postoperative Outcomes ◽  
Patch Repair ◽  
End Points ◽  
Cardiopulmonary Bypass Time ◽  
Cross Clamp Time ◽  
Significant Difference

Background: We performed a meta-analysis of studies to determine whether the modified single-patch technique offers benefits when compared to the two-patch repair. The postoperative outcomes examined in this study were cardiopulmonary bypass time, cross-clamp time, duration of mechanical ventilation, intensive care unit length of stay, total hospital length of stay, need for reoperation, need for reoperation for left ventricular outflow tract obstruction or left atrioventricular valve regurgitation, need for pacemaker implantation, and mortality during follow-up. Methods: A review was conducted to identify studies comparing a modified single-patch repair versus two-patch repair. A fixed-effects model was utilized for end points with low heterogeneity and a random-effects model for end points with significant heterogeneity. Meta-regression was also performed to determine the influence of other factors on the variables of interest. Results: A total of 964 unique manuscripts were screened, with 10 being included in the final analyses. There were a total of 724 patients, with 353 (49%) having undergone repair utilizing a modified single-patch repair. Mean age at repair for modified single-patch repair and two-patch repair was 8.81 and 9.03 months, respectively. Significant differences were noted in cardiopulmonary bypass time and cross-clamp time with mean difference of −28.53 and −22.69 minutes, respectively. In comparison to the two-patch repair, both times were decreased in modified single-patch repair. No significant difference was noted in any other variables. Conclusions: Modified single-patch repair for atrioventricular septal defects requires less cardiopulmonary bypass and cross-clamp time but does not significantly impact the examined postoperative outcomes.

scholarly journals Transannular Patch Repair of Tetralogy of Fallot With or Without Monocusp Valve Reconstruction: A Meta-analysis

2020 ◽  
Author(s):  
Xiaodong Wei ◽  
Tiange Li ◽  
Yunfei Ling ◽  
Zheng Chai ◽  
Zhongze Cao ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Length Of Stay ◽  
Tetralogy Of Fallot ◽  
Meta Analysis ◽  
Patch Repair ◽  
Perioperative Outcomes ◽  
Aortic Cross Clamp Time ◽  
Aortic Cross Clamp ◽  
Transannular Patch ◽  
Valve Reconstruction

Abstract Background: Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases. Pulmonary regurgitation is the most common and severe comorbidity after transannular patch (TAP) repair of TOF patients. It has not been confirmed whether a TAP repair with monocusp valve reconstruction would benefit TOF patients in perioperative period compared to those without monocusp valve reconstruction. The purpose of the study is to review and analyze all clinical studies that have compared perioperative outcomes of TOF patients undergoing TAP repair with or without monocusp valve reconstruction and conduct a preferable surgery.Methods: Eligible studies were identified by searching the electronic databases. The primary outcome was perioperative mortality. Secondary outcomes included cardiopulmonary bypass time, aortic cross-clamp time, ventilation duration, ICU length of stay, hospital length of stay, and perioperative right ventricular outflow tract (RVOT) pressure gradient. The meta-analysis and forest plots were drawn using Review Manager 5.3. Statistically significant was considered when p-value ≤ 0.05. Results: Eight studies were included which consisted of 7 retrospective cohort study and 1 randomized controlled trial. The 8 studies formed a pool of 526 TOF patients in total, in which are 300 undergoing TAP repair with monocusp valve reconstruction (monocusp group) compared to 226 undergoing TAP repair without monocusp valve reconstruction (non-monocusp group). It demonstrated significant differences between two groups in perioperative cardiopulmonary bypass time (21.86, 95% CI 16.51-27.21), perioperative aortic cross-clamp time (11.20, 95% CI 1.06 - 21.34), mean length of ICU stay (-1.55, 95% CI -3.90 - -0.81), and the degree of perioperative PR (OR=0.02, 95% CI 0.00 - 0.15).Conclusion: Transannular patch repair with monocusp valve reconstruction seems to have significant advantages on some perioperative outcomes of TOF patients. Large, multicenter, randomized, prospective studies focusing on differences between TAP repair with and without monocusp valve reconstruction are needed.

What was the impact of the introduction of extracardiac completion for a single center performing total cavopulmonary connections?

2004 ◽  
Vol 14 (2) ◽  
pp. 140-147 ◽  
Author(s):  
Christian Schreiber ◽  
Martin Kostolny ◽  
Joachim Weipert ◽  
Klaus Holper ◽  
Manfred Vogt ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Total Cavopulmonary Connection ◽  
Cardiopulmonary Bypass Time ◽  
Cross Clamp Time ◽  
Significant Difference ◽  
The Mean ◽  
The Impact ◽  
Cavopulmonary Connection

Background:Creation of an extracardiac cavopulmonary connection has been proposed as a superior alternative to the lateral intracardiac tunnel for the completion of total cavopulmonary connection.Methods and results:We made a retrospective review of our experience with 125 patients undergoing a total cavopulmonary connection between June 1994 and January 2003. Our experience with the extracardiac connection for completion began in 1999. Since 1994, we have constructed an intracardiac tunnel in 50 patients, and an extracardiac connection in 75. Of the total number, 83 had undergone an earlier partial cavopulmonary connection. Additional intracardiac procedures were performed in 43 patients at time of completion, in 25 of those undergoing extracardiac completion, and in 18 of the patients having an intracardiac procedure. The mean size of the tube used for completion was 19 mm. The mean cross-clamp time for placement of the intracardiac tunnel was 77 min, with a median of 80.5 min, and a mean cardiopulmonary bypass time of 139 min, with a median of 131 min. For construction of the extracardiac connection, a mean cross-clamp time in 24 of the 75 patients was 54 min, with a median of 54 min. Mean cardiopulmonary bypass time for all the patients with an extracardiac connection was 100 min, with a median of 88 min. Reoperations were needed in 10 patients, 6 having intracardiac and 4 extracardiac procedures. Of these, 5 were early and 5 late, including one take down. None of the patients died after these interventions. Taken overall, 8 patients died, with 5 early deaths. In the multivariable analysis, cardiopulmonary bypass time of more than 120 min, atrioventricular valvar replacement, and banding of the pulmonary trunk prior to the total cavopulmonary connection, all reached statistical significance for early death, whereas only heterotaxy syndrome remained as the sole risk factor for late death. There was no significant difference in survival between the modifications used.Discussion:Whereas we could not identify any clinical superiority for the extracardiac approach in the short-term, the concept of extracardiac completion has helped to simplify the overall procedure. Longer follow-up will be required to elucidate any potential advantages.

Standardizing Robotic Lobectomy

2017 ◽  
Vol 12 (2) ◽  
pp. 77-81 ◽  
Author(s):  
John F. Lazar ◽  
Laurence N. Spier ◽  
Alan R. Hartman ◽  
Richard S. Lazzaro
Keyword(s):  
Lung Cancer ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Meta Analysis ◽  
Stage I ◽  
Clinical Staging ◽  
Perioperative Outcomes ◽  
Vats Lobectomy ◽  
End Points ◽  
Nodal Upstaging

Objective Single-surgeon cohorts assessing robotically assisted video-assisted thoracic (RA-VATS) lobectomy have reported good outcomes, but there are little data regarding multiple surgeons applying a standard technique in separate hospitals. The purpose of this study was to show how a standardized robotic technique is both safe and reproducible between surgeons and institutions. Methods From July 1, 2012, to October 1, 2013, patients undergoing RA-VATS lobectomy for both benign and malignant disease were identified from a prospectively collected database of two thoracic surgeons from different hospitals within the same healthcare system and retrospectively analyzed. Each surgeon employed an identical “rule of 10” completely port-based approach through all 128 cases. The primary end points of the study were in-hospital and 30-day mortality. Secondary end points were differences in morbidity and perioperative outcomes between the two surgeons based on their “rule of 10” technique. Results A total of 128 cases were performed with 121 lobectomies, 3 bilobectomies, and 4 pneumonectomies for both malignant and benign disease. Each surgeon had 64 cases without a single in-hospital or 30-day mortality. Overall morbidity was 16.4%. Each surgeon had one readmission and take back to operating room (a washout and a mechanical pleurodesis). The most common complication was prolonged air leak (38.1%, 8/21 patients). There was no statistical difference in length of stay, complications, severity of illness, and clinical staging between the two surgeons. There was a significant difference in resected lymph nodes (11.79 vs 14.45, P = 0.0086). Compared with published national meta-analysis on RA-VAT lobectomies, there was a significantly reduced length of stay (4.2 vs 6 days, P = 0.0436) and bleeding (0.8 vs 1.8%, P = 0.0003). Nodal upstaging from cN0 to pN1 was 8% and cN0 to pN2 was 2% for an overall nodal upstaging of 10% for stage I nonsmall cell lung cancer. Conclusions By standardizing how a robotic lobectomy is performed, we were able to show that RA-VATS lobectomy is safe and may allow for the expansion of minimally invasive lobectomy to surgeons who otherwise have failed to adopt traditional VATS. When compared with the most recent national meta-analysis, we had reduced morbidity, mortality, bleeding, and length of stay. Robotic nodal upstaging for stage I nonsmall lung cancer was consistent with larger multicenter study. We hope that these results will help lead to the standardization robotic lobectomy and a larger multisurgeon/institutional study that could pave the way for greater adoption of minimally invasive lobectomy.

scholarly journals Does tricuspid valve detachment improve outcomes compared with the non-tricuspid valve detachment approach in ventricular septal defect closure?

2020 ◽  
Author(s):  
Yunfei Ling ◽  
Xiaohui Bian ◽  
Yue Wang ◽  
Yongjun Qian
Keyword(s):  
Cardiopulmonary Bypass ◽  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
The Other ◽  
Cardiopulmonary Bypass Time ◽  
Significant Difference ◽  
Ventricular Septal Defect Closure ◽  
Valve Detachment

Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the tricuspid valve detachment (TVD) approach to ventricular septal defect repair provides superior outcomes compared with the non-TVD approach. Altogether more than 54 papers were found using the reported search, of which 10 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. A total of 2059 participants were enrolled in the 10 studies, including 2 prospective studies and 8 retrospective studies. Six studies demonstrated a longer cardiopulmonary bypass time or aortic clamp time in the TVD group, whereas 4 studies showed no difference. Only 1 study reported a lower incidence of trivial tricuspid regurgitation in the TVD group, whereas the other 9 studies showed no significant difference. One study showed that a higher incidence of residual shunting occurred in those patients who had indications for TVD but did not perform detachment during surgery. No difference in postoperative residual shunting was demonstrated in the other 9 studies. We conclude that surgeons should be reassured that if TVD is required to repair the ventricular septal defect, although it may lead to longer cardiopulmonary bypass time and cross-clamp times, outcomes are equivalent in terms of the degree of tricuspid regurgitation and incidence of the residual ventricular septal defect.

scholarly journals Short-term results of bilateral internal mammary arterial grafting for patients aged 60–75 years – a retrospective study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Yilong Guo ◽  
Xiaoqi Wang ◽  
Shuwu He ◽  
Yue Shu ◽  
Tianguang Wang ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Pulsatility Index ◽  
Graft Function ◽  
Operation Time ◽  
Left Ventricular ◽  
Short Term ◽  
Artery Graft ◽  
Significant Difference ◽  
Internal Mammary

Abstract Background Bilateral internal mammary artery (BIMA) grafting has a good long-term survival rate and graft patency rate, but it is only recommended in young patients due to its high technical requirements and high incidence of sternal complications. Previous studies indicated that BIMA grafting has a significant benefit in patients aged 50–59 years, but this benefit does not extend to patients aged > 60 years. Thus, this study was designed to analyse the immediate artery graft function, short-term (3 months) results, and experience in preventing sternal complications for BIMA grafting in elderly patients (60–75 years old). Methods Clinical records and echocardiographic and coronary artery computed tomography angiography data of 155 patients who underwent BIMA grafting for coronary artery disease between 2015 and 2017 in our hospital were analysed retrospectively to summarise the operative experience and short-term (3 months) results. Patients were divided into two groups: Group A (n = 95), aged < 60 years and Group B (n = 60), aged 60–75 years. The operation time, aortic clamp time, and cardiopulmonary bypass time of these two groups were compared to analyse the operation difficulty and the flow and pulsatility index were compared to analyse the immediate artery graft function. The left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) of these two groups were compared to analyse heart function. Results There were no significant differences in the operation time, aortic clamp time, and cardiopulmonary bypass time as well as the flow and pulsatility index between these two groups (P > 0.05). There was no significant difference in the incidence of sternal wound complications, graft occlusion, and other common complications 3 months post-BIMA grafting between these two groups (P > 0.05). Furthermore, there was no significant difference in LVEDD and LVEF between the groups 3 months post-operation (P > 0.05). Conclusions BIMA grafting was safe and effective for older patients (60–75 years). Similar to younger patients (< 60 years), BIMA grafting in elderly patients (60–75 years) can also achieve a satisfactory short-term (3 months) result. Thus, advanced age (60–75 years) should not be a contraindication for BIMA grafting.

scholarly journals Derangements in Coronary Calcium Score and Left Ventricular Global Longitudinal Strain in Patients Post Left Breast Radiotherapy

2020 ◽  
Author(s):  
Tochi Okwuosa ◽  
Andres Palomo ◽  
Thelma Dangana ◽  
Anel Yakupovich ◽  
Sanjib Basu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Longitudinal Strain ◽  
Meta Analysis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Screening Methods ◽  
Breast Radiotherapy ◽  
Goodness Of Fit Test ◽  
Significant Difference ◽  
Historical Controls

Abstract Background Radiotherapy is a common treatment for breast cancer, with unintended long-term CV consequences; and no consensus on adequate CV screening methods to prevent future events. We aimed to assess the use of coronary artery calcium (CAC) and left ventricular global longitudinal strain (GLS) to identify those at risk for CVD due to radiotherapy. Methods Using data from an urban cancer registry, we enrolled 17 women (mean age 62 years) with left-sided breast cancer from 1999-2003, treated with radiotherapy. Agatston CAC score was measured by CT scan; and GLS by echocardiography. Logistic regression was used to compare study CAC scores with historical controls using age- and race-matched (Multi-Ethnic Study of Atherosclerosis) MESA CAC calculator [derived from MESA cohort from 6 US communities, free of clinical CVD at baseline (2000-2002) https://www.mesa-nhlbi.org ]; and GLS with historical controls from prior meta-analysis with defined normal GLS values ( Yingchoncharoen et al). Results The Hosmer-Lemeshow goodness of fit test reported a significant lack of fit (p < 0.02) compared with the expected probability of non-zero CAC in the historical controls from MESA. The mean GLS of -20.6% (95% CI: -21.50%, -19.79%), and was not statistically different when compared with the average of the historical controls. However, there was a significant difference of GLS compared to the meta-analysis using a one-sample T test with P=0.03. Conclusion We found that women post left sided breast radiotherapy had higher CAC presence without significant difference in mean GLS, compared with historical controls from the MESA database and prior GLS meta-analysis.

scholarly journals Effect of febuxostat on left ventricular diastolic function in patients with asymptomatic hyperuricemia: a sub analysis of the PRIZE Study

2021 ◽  
Author(s):  
Kenya Kusunose ◽  
Hisako Yoshida ◽  
Atsushi Tanaka ◽  
Hiroki Teragawa ◽  
Yuichi Akasaki ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Group Treatment ◽  
Troponin I ◽  
Treatment Time ◽  
Lifestyle Modification ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Control Group ◽  
Increased Risk ◽  
Significant Difference

AbstractHyperuricemia is related to an increased risk of cardiovascular events from a meta-analysis and antihyperuricemia agents may influence to cardiac function. We evaluated the effect of febuxostat on echocardiographic parameters of diastolic function in patients with asymptomatic hyperuricemia as a prespecified endpoint in the subanalysis of the PRIZE study. Patients in the PRIZE study were assigned randomly to either add-on febuxostat treatment group or control group with only appropriate lifestyle modification. Of the 514 patients in the overall study, 65 patients (31 in the febuxostat group and 34 in the control group) who had complete follow-up echocardiographic data of the ratio of peak early diastolic transmitral flow velocity (E) to peak early diastolic mitral annular velocity (e′) at baseline and after 12 and 24 months were included. The primary endpoint was a comparison of the changes in the E/e′ between the two groups from baseline to 24 months. Interestingly, e′ was slightly decreased in the control group compared with in the febuxostat group (treatment p = 0.068, time, p = 0.337, treatment × Time, p = 0.217). As a result, there were significant increases in E/e′ (treatment p = 0.045, time, p = 0.177, treatment × time, p = 0.137) after 24 months in the control group compared with the febuxostat group. There was no significant difference in the serum levels of N-terminal-pro brain natriuretic peptide and high-sensitive troponin I between the two groups during the study period. In conclusions, additional febuxostat treatment in patients with asymptomatic hyperuricemia for 24 months might have a potential of preventable effects on the impaired diastolic dysfunction.

scholarly journals A Cohort of Gender-Based Outcomes in Hepatitis B and C after Cardiac Surgery

2020 ◽  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Hepatitis B ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cardiopulmonary Bypass Time ◽  
Predictors Of Mortality ◽  
Significant Difference ◽  
Gender Based ◽  
And Gender

Objective: Our research article aimed to determine if six-month mortality amongst hepatitis B and C patients undergoing cardiac surgery varied according to gender, post-operatively. Secondarily, we highlighted the significant differences among the two genders in their pre-operative, operative, and post-operative characteristics and deduced significant predictors of mortality. Methods: We obtained approval from the International Review Board of the Dow University of Health Sciences, and conducted a retrospective study targeting hepatitis B and C patients who had undergone cardiac surgery between January 2013 to October 2018 at the Ruth Pfau Civil Hospital, Karachi, Pakistan. The data was analysed using the Statistical Package for Social Sciences (Version 20.0). The population was divided into two groups, based on gender. Chi-squared test was used to compare categorical variables and odd ratios with 95% confidence interval were also computed. Differences in continuous variables were assessed using independent T-test or Mann-Whitney U test. Results: There was no significant difference in six-month mortality between the genders, with a 22.5% mortality in males and 20.0% mortality in females. Post-operatively, males had higher creatinine (p=0.003) levels but females tended to have a longer ward stay (p=0.032). On multivariate logistic regression, duration of intubation (aOR=1.131, 95% CI: 1.002-1.275), cardiopulmonary bypass time (aOR=1.030, 95% CI: 1.002-1.059) and duration of ward stay (aOR=1.100, 95% CI: 1.031-1.175) were found to be significant predictors of mortality. Conclusion: There is no association between six-month mortality and gender among hepatitis B and C patients undergoing cardiac surgery. Additionally, duration of intubation, cardiopulmonary bypass time and duration of ward stay are significant predictors of six-month mortality.

scholarly journals Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

2020 ◽  
Vol 38 (12) ◽  
pp. 3139-3153 ◽  
Author(s):  
F. Wessels ◽  
M. Lenhart ◽  
K. F. Kowalewski ◽  
V. Braun ◽  
T. Terboven ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Radical Cystectomy ◽  
Readmission Rate ◽  
Postoperative Ileus ◽  
Meta Analysis ◽  
Fluid Management ◽  
Early Mobilization ◽  
Cochrane Library ◽  
Gum Chewing ◽  
Significant Difference

Abstract Purpose Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and specific measures. Materials and methods A systematic review and meta-analysis on EPs in RC were performed using the databases MedLine, Cochrane Library, Web of science, and Google Scholar. The specific ERAS measures of the protocols were extracted, analyzed, and compared. Pooling of available outcome data was performed for length of stay, complications, readmission rate, and time to defecation. Results The search yielded a total of 860 studies of which 25 studies were included in qualitative and 22 in quantitative analysis. Oral bowel preparation (BP) was omitted in 24/25 (96%) EPs, optimized fluid management was administered in 22/25 (88%) EPs and early mobilization (postoperative day 1) in 21/25 (84%). Gum chewing (n = 12, 46%), metoclopramide (n = 11, 44%), and alvimopan (n = 6, 24%) were the most common measures to prevent postoperative ileus. Our meta-analysis revealed a significant benefit in favor of EPs for the outcome parameters length of stay [mean difference (MD) − 3.46 d, 95% confidence interval (CI) − 4.94 to − 1.98, p < 0.01], complications [Odds ratio (OR) = 0.76, 95% CI 0.61–0.94, p = 0.01] and time to defecation (MD − 1.37 d, 95% CI − 2.06 to − 0.69, p < 0.01). Readmission rate did not show a significant difference (OR = 0.73, 95% CI 0.52–1.03, p = 0.07). Conclusion Current EPs focus on omitting oral BP, early mobilization, and optimized fluid management while they differ in methods preventing postoperative ileus. Our meta-analysis revealed a benefit in introducing these protocols into clinical practice.

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