Redo Coronary Artery Bypass Grafting in the era of Advanced PCI.

OBJECTIVE: To review the evidence behind the role and relevance of redo coronary artery bypass grafting (CABG) in the current practice of percutaneous coronary intervention (PCI). METHODS: A comprehensive electronic literature search was performed to identify articles that discuss the practice of PCI and redo CABG in patients that require coronary revascularization. All relevant studies are summarized in narrative manner to reflect current indications and preference. RESULTS: The advancement in utilization of PCI has reduced the rate of redo CABG in patients with previous CABG that requires revascularization of an already treated coronary disease or a new onset of coronary artery stenosis. Redo CABG is associated with satisfactory perioperative outcomes but higher mortality at immediate postoperative period when compared to PCI. CONCLUSION: Redo CABG patients are less likely to develop comorbidities associated with revascularisation, but the operative mortality is higher and long-term survival rates are similar in comparison to PCI. There is a need for further research into the role of redo CABG in the current advanced practice of PCI.

Redo Coronary Artery Bypass Grafting in the era of Advanced PCI

Abstract Objective: To review the evidence behind the role and relevance of redo coronary artery bypass grafting (CABG) in the current practice of percutaneous coronary intervention (PCI). Methods: A comprehensive electronic literature search was performed to identify articles that discuss the practice of PCI and redo CABG in patients that require coronary revascularization. All relevant studies are summarized in narrative manner to reflect current indications and preference. Results: The advancement in utilization of PCI has reduced the rate of redo CABG in patients with previous CABG that requires revascularization of an already treated coronary disease or a new onset of coronary artery stenosis. Redo CABG is associated with satisfactory perioperative outcomes but higher mortality at immediate postoperative period when compared to PCI. Conclusion: Redo CABG patients are less likely to develop comorbidities associated with revascularisation, but the operative mortality is higher and long-term survival rates are similar in comparison to PCI. There is a need for further research into the role of redo CABG in the current advanced practice of PCI.

Left Atrial or Transeptal Approach for Mitral Valve Surgery: A Systematic Review and Meta-analysis.

To compare outcomes of mitral valve surgery through conventional left atriotomy and transeptal approach (TS). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Primary outcomes were operative mortality and permanent pacemaker (PPM) implantation; secondary outcomes were new onset of atrial fibrillation (AF), stroke and operative times. Sixteen articles met the inclusion criteria with 4537 patients. Cardiopulmonary bypass was longer with TS (weighted mean differences - 16.44 minutes [-29.53, -3.36], P = 0.01). Rates of PPM implantation (risk ratio 0.65 [0.47, 0.89], P = 0.007) and new onset AF (risk ratio 0.87 [0.78, 0.97], P = 0.02) were higher with TS. Subgroup analysis of isolated mitral valve surgery cohort showed no difference in operative times, mortality, new onset of AF, stroke, and PPM implantation. There is equal outcomes between both approaches during isolated mitral valve surgery; however, TS was associated with longer operative times and higher postoperative AF and PPM rates when pooling combined procedures. A large randomized controlled trial is required to confirm those findings.

Skeletonized or Pedicled Harvesting of Left Internal Mammary Artery: A Systematic Review and Meta-analysis.

We sought to compare clinical outcomes in skeletonized versus pedicled left internal mammary artery (LIMA) grafts in elective coronary artery bypass grafting through a systematic review and meta-analysis. A comprehensive electronic literature search of PubMed, Ovid, Embase, and Scopus was conducted from inception to January 2020. Only short-term (30 days) studies which compared both techniques have been included in our analysis. Primary outcomes were post anastomosis flow rate and sternal wound infection rate (SWI); secondary outcomes were conduit length, acute myocardial infarction and 30-day mortality. Thirteen articles with a total of 6222 patients met the inclusion criteria. Except for the prevalence of diabetes mellitus being significantly lower in the skeletonized cohort (odds ratio [OR] 0.77 95% confidence interval [CI] [0.61, 0.97], P = 0.03), there were no differences in the preoperative demographics between the 2 groups. The skeletonized LIMA conduit was significantly longer when compared to the pedicled conduit (weighted mean difference -2.64 cm 95% CI [-3.71, -1.56], P < 0.0001). SWI rates were not significantly different in the skeletonized versus pedicled LIMA group (OR 0.71 95% CI [0.47, 1.06], P = 0.10). New onset of acute myocardial infarction and 30-day mortality rate was similar in the 2 groups (OR 1.04 and 0.97, respectively, P > 0.05 in both). The postanastomoses flow rate was higher in skeletonized LIMA (Weighted Mean Difference -11.51 mL/min 95% CI [-20.54, -2.49], P < 0.01). Harvesting the LIMA using the skeletonized technique is associated with higher postanastomosis flow rates and longer conduit lengths; with no difference in SWI and mortality rates when compared to the pedicled technique. We suggest that this technique should be adopted, particularly for BITA harvesting. However, further research is needed to provide clearer indications for both methods.

Coronary artery bypass grafting: Factors affecting outcomes.

INTRODUCTION: Coronary artery bypass grafting forms the bulk of a cardiac surgeon's workload. An extensive amount of research has been undertaken to improve the outcomes of this procedure. This literature review aimed to summarize key areas that influence coronary artery bypass grafting in modern day practice. METHODS: A comprehensive electronic search was done using PubMed, Ovid, SCOPUS, Embase and google scholar from inception to July 2020. Articles were included if they discussed factors affecting outcomes in coronary bypass grafting (CABG). Case reports, expert opinion, and editorials were excluded. RESULTS: There are many factors that influence and predict outcomes following coronary artery bypass surgery. Age, diabetes, and isolated systolic hypertension were preoperative factors with strong correlation to mortality and morbidity rates post CABG. In addition to these, the degree of renal failure and heart failure correlated with poorer operative results. The use of the left internal mammary artery has transformed outcomes and has proven advantage over venous conduit use. Newer minimal invasive techniques have the potential to further optimize outcomes. CONCLUSION: The numerous and complex factors which impair outcomes following CABG need to be further researched and addressed using larger trials and possible optimization of multi-disciplinary team approach to further improve long term outcomes.

The use of a non-medicated dressing for superficial-partial thickness burns in children: a case series and review.

BACKGROUND: Cutimed® Sorbact® is a dressing marketed as having antimicrobial properties and easy application without the threat of antibiotic resistance and difficult accessibility. There is little evidence on the clinical outcomes of the use of Cutimed® Sorbact® in adults and currently no evidence of use of Cutimed® Sorbact® on superficial-partial thickness burn injuries in children. OBJECTIVE: To summarise the clinical outcome of burn wounds in children with superficial-partial thickness burns in which Cutimed® Sorbact® was used. METHOD: An observational case series was conducted in Edendale Hospital, Pietermaritzburg, South Africa over the course of four weeks. Patients where included if they were aged < 10 years and had a ⩽ 15% superficial-partial burn. The primary outcome measure was time to 95% re-epithelialisation. Secondary outcome measures included wound complications, adverse healing and number of dressing changes. RESULTS: Ten patients (five girls, five boys; age range = 11 months-8 years) were included in this case series. All participants had a type VI Fitzpatrick skin type and 80% of burns were hot water burns. Of all patients treated with Cutimed® Sorbact®, 50% healed within seven days, 70% within 14 days and 100% within 21 days. There was only one wound complication noted in this study and there was no adverse healing in any burn wounds. The mean number of dressing changes was 1.4 (range = 1-2) and length of hospital stay was in the range of 0-11 days (mean = 5.1 days). CONCLUSION: Cutimed® Sorbact® is a safe, useful and cost-effective dressing that should be used as an alternative for superficial-partial burns in children.

Blowing the whistle: Perceptions of surgical staff and medical students in a public South African hospital.

Whistleblowing is defined as raising a concern about wrong doing and has gained prominence in the UK National Health Service (NHS) following the publication of the Francis Report (the report of the Mid-Staffordshire NHS Foundation Trust Public Inquiry) in 2013. The report revealed that lack of diligence and a reluctance to speak out about poor practice amongst staff had contributed to increased patient morbidity and mortality. In the wake of this report, a new framework was introduced by the NHS to help workers raise concerns regarding other staff and poor working practices in general. Nevertheless, it has been suggested that this new framework has not helped to increase whistleblowing or prevented staff who do raise concerns from being penalised. Furthermore, it has been claimed that such implementations will encourage defensive medicine and reduce the willingness of staff to report concerns, despite the important role of whistleblowing in helping to prevent catastrophic events and improve care. Further research is required to understand why healthcare professionals are reticent regarding whistleblowing. Moreover, while some research in the nursing and allied health community exists, this study is important as it adds to the limited evidence amongst medical students and staff in general.

The role of prophylactic antiepileptic drugs for seizure prophylaxis in meningioma surgery: A systematic review.

Meningiomas are the commonest type of primary brain tumours. Whilst most patients are seizure-free prior to surgery, antiepileptic drugs are frequently administered to reduce the risk of developing post-operative seizures. However, evidence to support their efficacy in providing this outcome is sparse. To this end, we performed a systematic review to assess the impact of prophylactic antiepileptic drugs on post-operative epilepsy rates in seizure-naïve patients undergoing craniotomy for resection of meningiomas. The literature search was performed using PubMed for studies published between January 1990 and November 2016. The total number of patients in each study was extracted and divided into cohorts according to administration of prophylactic antiepileptic drugs. Clinical characteristics, study type and post-operative epilepsy rates were recorded. A total of 11 studies involving 1143 patients met the selection criteria. There was no statistically significant difference in the number of patients who developed post-operative epilepsy in the cohort that received prophylactic antiepileptic drugs (20 of 766; 2.6%) and the cohort that did not (10 of 377; 2.7%) (Chi-square test; P=0.96). A detailed meta-analysis could not be performed due to the insufficiency in data reported. Based on the results of this systematic review, the routine use of antiepileptic drugs for seizure prophylaxis in seizure-naïve patients undergoing meningioma resection could not be substantiated. However, limitations of a systematic review should be considered on interpretation. High quality prospective randomised controlled trials are required to definitively answer this important clinical question.

Surveying opinions of 149 registrants to the Research Registry: Awareness of and attitudes towards research registration.

BACKGROUND: Research registration is an important ethical principle in the Declaration of Helsinki, however, progress to increase registration has been slow. Understanding the attitudes of users towards registries may provide insights into increase research registration. In this survey-based study, we sought to gain insight from users of a single global research registry, the Research Registry® (www.researchregistry.com). METHODS: A Google Forms survey was created and emailed to all users of the Research Registry® (n = 1432). Multiple choice and free-text answers were analyzed using descriptive statistics and thematic analysis respectively. RESULTS: From 925 contactable registrations, 149 (16.1%) completed the survey. The most commonly registered study type was retrospective cohort (32.2%). 23 registrations (15.4%) were made during the planning or conception of the study, whereas 67 (45.0%) registered at the time of journal submission, or during the peer review process. Of those that declared whether they had performed unregistered research or not, 51 (45.5%) participants had previously performed unregistered research. Registrants were most commonly made aware of the Research Registry® through submission to the International Journal of Surgery (IJS) family of journals (n = 57, 47.5%). Survey participants identified the most important features of registration to be its convenience, including the ease, time and cost of registration. Thematic analysis revealed the most common motive for registration to be as a mandatory requirement of journal submission, and that registration can be improved by simplification of the registration process. CONCLUSION: Registries must focus on engaging their network of users to ensure that research registration is a dynamic process. They need to adopt a user-centered and agile approach to their development, with a strong focus on "customer service". Moreover, by working in partnership with journals, it is possible to improve compliance with registration.