Research

Cao C, Louie BE, Melfi F, Veronesi G, Razzak R, Romano G, Novellis P, Ranganath NK, Park BJ

Eur J Cardiothorac Surg 2019 Jul;

PMID: 31332434

Abstract

OBJECTIVES: Percentage-predicted forced expiratory volume in 1 s (FEV1) and diffusing capacity for carbon monoxide (DLCO), and their predicted postoperative (ppo) values are established prognostic factors for postoperative pulmonary complications after thoracotomy. However, their predictive value for minimally invasive pulmonary resections remains controversial. This study assessed the incidence of pulmonary complications after robotic lobectomy for primary lung cancer and analysed the predictive significance of FEV1 and DLCO.

METHODS: This was a retrospective analysis of patients who underwent robotic lobectomy from 4 institutions. Descriptive and comparative analyses were performed for patients who experienced pulmonary complications versus patients who did not, in relation to FEV1 and DLCO values. To identify thresholds for increased complications, patients were categorized into groups of 10% incremental increases in FEV1 and DLCO, and their ppo values.

RESULTS: From November 2002 to April 2018, 1088 patients underwent robotic lobectomy. Overall, 169 postoperative pulmonary complications occurred in 141 patients. Male gender and Eastern Cooperative Oncology Group grade ≥1 were associated with increased pulmonary complications on univariable analysis. Patients who experienced pulmonary complications had increased mortality (2.1% vs 0.2%, P = 0.017) and longer hospitalizations (9 vs 4 days, P < 0.001). Pulmonary complications were associated when FEV1 ≤60% and DLCO ≤50%, and when ppo FEV1 or DLCO was ≤50%; ppo FEV1 ≤50% (P < 0.001) and ppo DLCO ≤50% (P = 0.031) remained statistically significant on multivariable analysis.

CONCLUSIONS: Both FEV1 and DLCO were shown to be significant predictors of pulmonary complications. Furthermore, thresholds of percentage-predicted and ppo FEV1 and DLCO values were identified, below which pulmonary complications occurred significantly more frequently, suggesting their predictive values are particularly useful in patients with poorer pulmonary function.

Kitahara H, Edelman JJ, Thourani VH

Ann. Thorac. Surg. 2019 Jul;

PMID: 31344345

Abstract

Indja B, Woldendorp K, Black D, Bannon PG, Wilson MK, Vallely MP

Eur J Cardiothorac Surg 2020 Jan;57(1):18-27

PMID: 31219544

Abstract

OBJECTIVES: There are a number of minimally invasive approaches to revascularization of coronary artery disease that involve the left main or proximal left anterior descending artery; however, studies to date provide mixed results.

METHODS: A Bayesian network meta-analysis was performed to compare early and late postoperative outcomes between percutaneous coronary intervention with first- and second-generation drug-eluting stents (DESs), off-pump coronary artery bypass and minimally invasive direct coronary artery bypass (MIDCAB) in patients with involvement of left main or left anterior descending disease.

RESULTS: A total of 37 studies with 31 728 patients were included in the analysis. There were no significant differences in early mortality rates, strokes or myocardial infarctions (MIs). The long-term all-cause mortality rate was equivalent between the groups. Patients who had off-pump coronary artery bypass had fewer late MI compared with those who had first-generation DES (DES1) [odds ratio (OR) 0.38, 95% confidence interval (CI) 0.20-0.72] and MIDCAB (OR 0.41, 95% CI 0.17-0.97) and reduced late target vessel revascularization compared with DES1 (OR 0.17, 95% CI 0.09-0.32) and second-generation DES (DES2) (OR 0.32, 95% CI 0.14-0.72). The rate of late major adverse cardiac events was lower with off-pump coronary artery bypass compared with that with DES1 (OR 0.33, 95% CI 0.26-0.43) and DES2 (OR 0.62, 95% CI 0.45-0.90). The rate of late major adverse cardiac events with MIDCAB was lower than that with DES1 (OR 0.43, 95% CI 0.31-0.62) as was that with DES2 compared with DES1 (OR 0.53, 95% CI 0.39-0.70).

CONCLUSIONS: Surgical approaches to left main or proximal left anterior descending disease remain superior to first- or second-generation DES in terms of long-term freedom from MI and target vessel revascularization as well as improved overall long-term survival. Conflicting rates of late MI and target vessel revascularization in patients who underwent MIDCAB suggest disease in alternate vessels that may best be approached via hybrid techniques.

Wilson-Smith AR, Bogdanova Y, Roydhouse S, Phan K, Tian DH, Yan TD, Loforte A

Ann Cardiothorac Surg 2019 Jan;8(1):1-8

PMID: 30854307

Abstract

Background: Despite advances in management techniques and medical therapy, refractory cardiogenic shock remains a life-threatening condition with high mortality rates. The present systematic review and meta-analysis aims to explore the outcomes associated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) use in the setting of refractory cardiogenic shock, stratified per survivorship.

Methods: A literature search was performed using three electronic databases from the date of their inception up to June 2018. The literature search and subsequent data extraction were performed by two independent reviewers. Digitized survival data were extracted from Kaplan-Meier curves in order to re-create the original patient data using an iterative algorithm and were subsequently aggregated for analysis.

Results: Fifty-two studies were included, with 44 undergoing quantitative analysis. A total of 17,515 patients were identified, with a mean age of 58.4±9.4 years and a mean duration of ECMO support of 5.1±2.6 days; 68.7% of the patients were male. Aggregated survival rates at 1, 2, 3 and 5 years were 36.7%, 34.8%, 33.8% and 29.9%, respectively.

Conclusions: The present systematic review illustrates the expected survival results for VA-ECMO in the intermediate- to long-term. Extended follow-up and standardized reporting measures are urgently needed in order to carry out more definitive subgroup analyses.

McBride KE, Steffens D, Duncan K, Bannon PG, Solomon MJ

PLoS ONE 2019;14(3):e0213840

PMID: 30870503

Abstract

BACKGROUND: The use of robotic-assisted surgery (RAS) is becoming increasingly prevalent across a range of surgical specialties within public hospitals around Australia. As a result, it is critical that organisations consider workplace factors such as staff knowledge, attitudes and behaviours prior to the implementation of such new technology. This study aimed to describe the knowledge and attitudes of operating theatre staff from a large public tertiary referral hospital prior to the commencement of an RAS program.

METHODS: A cross-sectional survey of nursing, medical and support staff working in the operating theatre complex of a large public tertiary referral hospital was completed over a one-week period in June 2016. A 23-item questionnaire was utilised for data collection.

RESULTS: 164 (66%) theatre staff returned the surveys and were included in this study. The majority of medical staff reported being knowledgeable about RAS, whilst the majority of nursing and support staff did not. Overall the theatre staff were neutral about the potential benefits of RAS to patients. The majority of medical staff believed the implementation of RAS will increase the value of staff roles and job satisfaction, while nursing and support staff were uncertain about these benefits. All three staff groups were concerned about the impact of an RAS program on Workplace Health and Safety, and care and handling.

CONCLUSION: Operating theatre staff presented different knowledge and attitudes prior to the introduction of RAS. Whilst theatre staff were more favourable towards RAS than negative, they largely reserved their judgement about the new system prior to their own experiences. Collectively, these findings should be taken into consideration for training and support strategies prior to the implementation of a RAS program.

Edelman JJ, Kitahara H, Thourani VH

J. Thorac. Cardiovasc. Surg. 2019 Mar;

PMID: 30955957

Abstract

Carelli MG, Seco M, Bannon PG, Grieve SM

J Thorac Dis 2019 Mar;11(Suppl 3):S440-S442

PMID: 30997242

Abstract

Kitahara H, Edelman JJ, Thourani VH

J. Thorac. Cardiovasc. Surg. 2019 Mar;

PMID: 31014663

Abstract

Indja B, Woldendorp K, Vallely MP, Grieve SM

J Am Heart Assoc 2019 05;8(9):e010920

PMID: 31017035

Abstract

Background Silent brain infarcts ( SBI ) are increasingly being recognized as an important complication of cardiac procedures as well as a potential surrogate marker for studies on brain injury. The extent of subclinical brain injury is poorly defined. Methods and Results We conducted a systematic review and meta-analysis utilizing studies of SBI s and focal neurologic deficits following cardiac procedures. Our final analysis included 42 studies with 49 separate intervention groups for a total of 2632 patients. The prevalence of SBI s following transcatheter aortic valve implantation was 0.71 (95% CI 0.64-0.77); following aortic valve replacement 0.44 (95% CI 0.31-0.57); in a mixed cardiothoracic surgery group 0.39 (95% CI 0.28-0.49); coronary artery bypass graft 0.25 (95% CI 0.15-0.35); percutaneous coronary intervention 0.14 (95% CI 0.10-0.19); and off-pump coronary artery bypass 0.14 (0.00-0.58). The risk ratio of focal neurologic deficits to SBI in aortic valve replacement was 0.22 (95% CI 0.15-0.32); in off-pump coronary artery bypass 0.21 (95% CI 0.02-2.04); with mixed cardiothoracic surgery 0.15 (95% CI 0.07-0.33); coronary artery bypass graft 0.10 (95% CI 0.05-0.18); transcatheter aortic valve implantation 0.10 (95% CI 0.07-0.14); and percutaneous coronary intervention 0.06 (95% CI 0.03-0.14). The mean number of SBI s per patient was significantly higher in the transcatheter aortic valve implantation group (4.58 ± 2.09) compared with both the aortic valve replacement group (2.16 ± 1.62, P=0.03) and the percutaneous coronary intervention group (1.88 ± 1.02, P=0.03). Conclusions SBI s are a very common complication following cardiac procedures, particularly those involving the aortic valve. The high frequency of SBI s compared with strokes highlights the importance of recording this surrogate measure in cardiac interventional studies. We suggest that further work is required to standardize reporting in order to facilitate the use of SBI s as a routine outcome measure.

Kitahara H, Edelman JJ, Thourani VH

J. Thorac. Cardiovasc. Surg. 2019 Apr;

PMID: 31101351

Abstract