Edelman JJ, Teoh J, Okiwelu NL, Hung J, Passage J
J. Am. Coll. Cardiol. 2013 Oct;62(18):e243
PMID: 24013045
Systematic review protocol: single-dose histidine-tryptophan-ketoglutarate vs. intermittent crystalloid or blood cardioplegia
Edelman JJ, Seco M, Dunne B, Matzelle SJ, Murphy M, Joshi P, Yan TD, Wilson MK, Bannon PG, Vallely MP, Passage J
Ann Cardiothorac Surg 2013 Sep;2(5):677
PMID: 24109584
Abstract
Systematic review protocol: robotically-assisted minimally invasive mitral valve surgery
Seco M, Cao C, Wilson MK, Vallely MP, Misfeld M, Mohr F, Yan TD
Ann Cardiothorac Surg 2013 Sep;2(5):678
PMID: 24109585
Abstract
Meta-analysis protocol: MitraClip system versus surgery for treatment of severe mitral regurgitation
Wan B, Rahnavardi M, Tian DH, Bannon PG, Yan TD
Ann Cardiothorac Surg 2013 Sep;2(5):679
PMID: 24109586
Abstract
A systematic review and meta-analysis on pulmonary resections by robotic video-assisted thoracic surgery
Cao C, Manganas C, Ang SC, Yan TD
Ann Cardiothorac Surg 2012 May;1(1):3-10
PMID: 23977457
Abstract
BACKGROUND: Pulmonary resection by robotic video-assisted thoracic surgery (RVATS) has been performed for selected patients in specialized centers over the past decade. Despite encouraging results from case-series reports, there remains a lack of robust clinical evidence for this relatively novel surgical technique. The present systematic review aimed to assess the short- and long-term safety and efficacy of RVATS.
METHODS: Nine relevant and updated studies were identified from 12 institutions using five electronic databases. Endpoints included perioperative morbidity and mortality, conversion rate, operative time, length of hospitalization, intraoperative blood loss, duration of chest drainage, recurrence rate and long-term survival. In addition, cost analyses and quality of life assessments were also systematically evaluated. Comparative outcomes were meta-analyzed when data were available.
RESULTS: All institutions used the same master-slave robotic system (da Vinci, Intuitive Surgical, Sunnyvale, California) and most patients underwent lobectomies for early-stage non-small cell lung cancers. Perioperative mortality rates for patients who underwent pulmonary resection by RVATS ranged from 0-3.8%, whilst overall morbidity rates ranged from 10-39%. Two propensity-score analyses compared patients with malignant disease who underwent pulmonary resection by RVATS or thoracotomy, and a meta-analysis was performed to identify a trend towards fewer complications after RVATS. In addition, one cost analysis and one quality of life study reported improved outcomes for RVATS when compared to open thoracotomy.
CONCLUSIONS: Results of the present systematic review suggest that RVATS is feasible and can be performed safely for selected patients in specialized centers. Perioperative outcomes including postoperative complications were similar to historical accounts of conventional VATS. A steep learning curve for RVATS was identified in a number of institutional reports, which was most evident in the first 20 cases. Future studies should aim to present data with longer follow-up, clearly defined surgical outcomes, and through an intention-to-treat analysis.
A meta-analysis of unmatched and matched patients comparing video-assisted thoracoscopic lobectomy and conventional open lobectomy
Cao C, Manganas C, Ang SC, Yan TD
Ann Cardiothorac Surg 2012 May;1(1):16-23
PMID: 23977459
Abstract
BACKGROUND: Video-assisted thoracic surgery (VATS) for patients with early-stage non-small cell lung cancer (NSCLC) has been established as a safe and feasible alternative to open thoracotomy. This meta-analysis aims to assess the potential difference between unmatched and propensity score-matched cohorts who underwent VATS versus open thoracotomy in the current literature.
METHODS: Three relevant studies with unmatched and propensity score-matched patients were identified from six electronic databases to examine perioperative outcomes after VATS lobectomy versus open thoracotomy for patients with early-stage NSCLC. Endpoints included perioperative mortality and morbidity, individual postoperative complications and duration of hospitalization.
RESULTS: Results indicate that perioperative mortality was significantly lower for VATS compared to open thoracotomy in unmatched patients but no significant difference was detected amongst propensity score-matched patients. Similarly, the incidences of prolonged air leak and sepsis were significantly lower for VATS in the unmatched cohort, but not identified in the propensity score-matched cohort. In both the unmatched and matched groups, patients who underwent VATS were found to have a significantly lower overall perioperative morbidity rate, incidences of pneumonia and atrial arrhythmias, and a shorter duration of hospitalization in comparison to patients who underwent open thoracotomy.
CONCLUSIONS: The present meta-analysis indicates that VATS lobectomy has superior perioperative outcomes compared to open thoracotomy in both matched and unmatched cohorts. However, the extent of the superiority may have been overestimated in the unmatched patients when compared to propensity score-matched patients. Due to the limited number of studies with available data included in the present meta-analysis, these results are only of observational interest and should be interpreted with caution.
A systematic review of transapical aortic valve implantation
Rahnavardi M, Santibanez J, Sian K, Yan TD
Ann Cardiothorac Surg 2012 Jul;1(2):116-28
PMID: 23977482
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) through a transapical approach (TAAVI) for severe aortic stenosis becomes the procedure of choice in cases where patients have peripheral artery disease and unfeasible access due to excessive atherosclerotic disease of the iliofemoral vessels and aorta. The present systematic review aimed to assess the safety, success rate, clinical outcomes, hemodynamic outcomes, and survival benefits of TAAVI.
METHODS: Electronic searches were performed in 6 databases from January 2000 to February 2012. The primary end points included feasibility and safety. Other end points included echocardiographic findings, functional class improvement, and survival.
RESULTS: After applying the inclusion and exclusion criteria, 48 out of 154 shortlisted potentially relevant articles were selected for assessment. Of these, 26 studies from 24 centers including total number of 2,807 patients were included for appraisal and data extraction. The current evidence on TAAVI for aortic stenosis is limited to observational studies. Successful TAAVI implantation occurred in >90% of patients. On average, the procedure took between 64 to 154 minutes to complete. The incidence of major adverse events included 30-day mortality (4.7-20.8%); cerebrovascular accident (0-16.3%); major tachyarrhythmia (0-48.8%); bradyarrhythmia requiring permanent pacemaker insertion (0-18.7%); cardiac tamponade (0-11%); major bleeding (1-17%); myocardial infarction (0-6%); aortic dissection/rupture (0-5%); moderate to severe paravalvular leak (0.7-24%); cardiopulmonary bypass support (0-15%); conversion to surgery (0-9.5%); and valve-in-valve implantation (0.6-8%). Mean aortic valve area improved from 0.4-0.7 cm(2) before TAAVI to 1.4-2.1 cm(2) after TAAVI. The peak pressure gradient across the aortic valve decreased from >70 mmHg to <20 mmHg after TAAVI. One-year survival ranged from 49.3% to 82% and the 3-year survival was 58% in 2 series.
CONCLUSIONS: TAAVI appears to be feasible with a reasonable safety and efficacy portfolio. Randomised controlled trials are required to compare transapical vs. transfemoral TAVI when both techniques are equally feasible.
