Publications (10) View all
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Article: Is bicaval orthotopic heart transplantation superior to the biatrial technique?
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ABSTRACT: A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the bicaval heart transplantation technique is superior to biatrial orthotopic heart transplantation (OHT). Altogether, 175 papers were found using the reported search, of which 20 presented 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. We conclude that many papers have documented the superiority of the bicaval technique over the biatrial technique for short-term outcomes. A meta-analysis of 41 papers on this topic found significant benefits for early atrial pressure, tricuspid valve regurgitation, return to sinus rhythm and even perioperative mortality. But for longer-term outcome, the largest series of 11,931 patients found no difference in survival between the two groups and the meta-analysis found no mortality differences at 1 or 3 years. The bicaval technique is also more demanding technically and has a slightly longer bypass and ischaemic time. The United Network for Organ Sharing (UNOS) database showed that in 2005 in the USA the bicaval technique has now become more popular than the biatrial technique (1083 procedures vs. 806).Interactive cardiovascular and thoracic surgery 06/2009; 9(2):333-42. -
Article: Is blood cardioplegia superior to crystalloid cardioplegia?
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ABSTRACT: A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether blood cardioplegia is clinically superior to crystalloid cardioplegia for myocardial protection. Altogether 501 papers were identified. We selected 22 papers that represented the best evidence to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. This is a difficult topic to review, as the techniques studied in the many trials performed vary widely. Factors which may vary include warm or cold blood cardioplegia, antegrade and retrograde administration, systemic hypothermia or normothermia, topical heart cooling, high and low potassium solutions, 'hot shots', warm induction, volume of cardioplegia, patient factors and bypass times. However, three papers stand out. The meta-analysis of 34 randomised trials by Prof Fremes (2006) found a significantly lower incidence of low output syndrome (LOS) and CK-MB release with blood cardioplegia. He found no differences in myocardial infarction or mortality. This meta-analysis was confounded, however, by the fact that he was unable to extract data on LOS and CK-MB from the two largest trials which contributed over half the patients in his paper and are significantly larger than all other studies. The first paper by Ovrum (2006) randomised 1440 patients to antegrade cold blood or crystalloid and found no clinical differences, and the second paper by Martin (1994) of 1001 patients compared warm blood to cold crystalloid but the study had to be stopped due to a high incidence of neurological events in the warm blood group. We reviewed a further 18 randomised trials reporting over 50 patients. Of these, 10 reported some statistically significant clinical outcomes in favour of blood cardioplegia and five reported statistically significant differences in enzyme release in favour of blood cardioplegia. A recent survey of UK practice found that 56% of surgeons use cold blood cardioplegia, 14% use warm blood cardioplegia, 14% use crystalloid cardioplegia, 21% use retrograde infusion and 16% do not use any cardioplegia. The papers presented in our review support most of these practices!Interactive cardiovascular and thoracic surgery 06/2008; 7(3):491-8. -
Article: What is the patency of the short saphenous vein when used for coronary artery bypass grafting?
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ABSTRACT: A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was what the patency of the short saphenous vein is, when used for coronary artery bypass grafting. Altogether 347 papers were found using the reported search, of which nine 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. We conclude that small reports give a two-year patency of 77% and a six-year patency of 65% and duplex studies show that the short saphenous vein may be from 2.8 mm to 4.2 mm in diameter. However, caution should be applied when considering these patency rates as they are derived from individual studies of <40 patients. The lesser saphenous vein may be considered as an alternative to brachial or cephalic vein in patients with unsuitable long saphenous vein, and unsuitable mammary, radial or gastroepiploic arteries.Interactive cardiovascular and thoracic surgery 12/2007; 6(6):783-5. -
Article: Is a stentless aortic valve superior to conventional bioprosthetic valves for aortic valve replacement?
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ABSTRACT: A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether a stentless valve is superior to conventional stented valves when tissue aortic valve replacement is performed. Altogether more than 515 papers were found using the reported search, of which 16 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. We conclude that stentless valves allow a larger effective orifice area valve to be implanted with a lower mean and peak aortic gradient postoperatively. At six months several studies and a meta-analysis have shown superior left ventricular mass regression in the stentless valve groups. However, by 12 months the stented valve groups catch up in terms of mass regression and this significance disappears. So the 'eminent speaker from the floor', was right with his statement, that there have been no definitively proven benefits for stentless valves.Interactive cardiovascular and thoracic surgery 11/2007; 6(5):665-72. -
Article: Should patients undergoing coronary artery bypass grafting with mild to moderate ischaemic mitral regurgitation also undergo mitral valve repair or replacement?
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ABSTRACT: A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether mitral valve repair at the time of coronary artery bypass grafting (CABG) in patients with coronary artery disease and mild to moderate mitral insufficiency improves short and long-term outcome. Altogether 465 papers were found using the reported search, of which 16 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that there is good evidence to suggest that moderate mitral regurgitation in patients undergoing isolated CABG adversely affects survival and mitral regurgitation does not reliably improve after CABG alone. Unfortunately, the evidence to support mitral valve repair at the time of CABG to improve long-term survival is still weak. On balance, patients with moderate ischaemic mitral regurgitation having CABG should have mitral repair at the same time, although the evidence to support this is weaker than one might like.Interactive cardiovascular and thoracic surgery 09/2007; 6(4):538-46.
