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Cardiac Surgery Evidence Update
18th July 2016
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To access full text you may have to log in to your NHS Athens account (click here to register for free). If full text is not available then please email us to request a copy.
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Do you have any research needs?
Please contact your Cardiac Surgery Librarian, Keith Nockels for any information and research assistance.
0116 258 5558 keith.nockels@uhl-tr.nhs.uk
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New and Updated Cochrane Systematic Reviews
Routine invasive strategies versus selective invasive strategies for unstable angina and non-ST elevation myocardial infarction in the stent era
Authors' conclusions: In the all-study analysis, the evidence failed to show appreciable benefit with routine invasive strategies for unstable angina and non-ST elevation MI compared to conservative strategies in all-cause mortality and death or non-fatal MI at six to 12 months. There was evidence of risk reduction in MI, refractory angina and re-hospitalisation with routine invasive strategies compared to conservative (selective invasive) strategies at six to 12 months follow-up. However, routine invasive strategies were associated with a relatively high risk (almost double the risk) of procedure-related MI, and increased risk of bleeding complications. This systematic analysis of published RCTs supports the conclusion that, in patients with UA/NSTEMI, a selectively invasive (conservative) strategy based on clinical risk for recurrent events is the preferred management strategy.
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Coronary artery bypass graft (CABG) surgery
Review of coronary-artery bypass grafting (N Engl J Med 2016 May 19)
Percutaneous coronary intervention (PCI)
- Obstructive sleep apnea associated with increased risk of major adverse cardiac and cerebrovascular events, including cardiovascular death, after PCI (Circulation 2016 May 24)
- CHA2DS2-VASC risk score predicts all-cause mortality and risk of nonfatal myocardial infarction at 1 and 5 years after PCI (Am J Cardiol 2016 May 1)
- residual angiographic disease may not be associated with increased risk of major adverse cardiac events at 1 year after functionally complete revascularization with fractional flow reserve guidance (J Am Coll Cardiol 2016 Apr 12)
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Other High Quality Research
Cardiac surgery (adult)
Cardiac troponins and volatile anaesthetics in coronary artery bypass graft surgery: A systematic review, meta-analysis and trial sequential analysis. http://www.ncbi.nlm.nih.gov/pubmed/26901389
CT Angiography for the Detection of Coronary Artery Stenoses in Patients Referred for Cardiac Valve Surgery: Systematic Review and Meta-Analysis. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27344418
Impact of antioxidant supplementations on cardio-renal protection in cardiac surgery: An updated and comprehensive meta-analysis and systematic review. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27344977
Latitude of the study place and age of the patient are associated with incidence of mediastinitis and microbiology in open-heart surgery: a systematic review and meta-analysis. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27330329
Obesity and postoperative atrial fibrillation in patients undergoing cardiac surgery: Systematic review and meta-analysis. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27179208
Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An updated systematic review and meta-analysis. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27293143
Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: Systematic review and meta-analysis. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27154820
Risk Factors Associated With Pressure Ulcer Formation in Critically Ill Cardiac Surgery Patients: A Systematic Review. PMID: http://www.ncbi.nlm.nih.gov/pubmed/26983066
A systematic review of pulse pressure variation and stroke volume variation to predict fluid responsiveness during cardiac and thoracic surgery. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27306799
Transthoracic and transoesophageal echocardiography: a systematic review of feasibility and impact on diagnosis, management and outcome after cardiac surgery. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27341788
TAVI
Impact of previous cardiac surgery on patients undergoing transcatheter aortic valve implantation: A meta-analysis. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27157867
Congenital heart conditions / Cardiac surgery (children)
The cost effectiveness of transesophageal echocardiography for pediatric cardiac surgery: a systematic review. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27177602
Fetal brain imaging in isolated congenital heart defects – a systematic review and meta-analysis. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27187181
Genetics of congenital heart disease. PMID: http://www.ncbi.nlm.nih.gov/pubmed/26872209
Implantable cardioverter-defibrillators in adults with congenital heart disease: a systematic review and meta-analysis. PMID: http://www.ncbi.nlm.nih.gov/pubmed/26873095
Infant deaths in the UK community following successful cardiac surgery: building the evidence base for optimal surveillance, a mixed-methods study. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27252995
Long-Term Survival of Individuals Born With Congenital Heart Disease: A Systematic Review and Meta-Analysis. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27312802
Is maternal smoking during pregnancy associated with an increased risk of congenital heart defects among offspring? A systematic review and meta-analysis of observational studies.
PMID: http://www.ncbi.nlm.nih.gov/pubmed/27126055
Neurodevelopmental outcomes following congenital heart surgery. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27214433
Prenatal Counselling for Congenital Anomalies: A Systematic Review. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27150825
Psychosocial functioning of parents of infants diagnosed with complex
congenital heart defect. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27214437
Universal Pulse Oximetry Screening for Early Detection of Critical Congenital Heart Disease. PMID: http://www.ncbi.nlm.nih.gov/pubmed/27279759
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Reports
National Congenital Heart Disease audit report 2012‐15
The Healthcare Quality Improvement Partnership has published the National Congenital Heart Disease Audit 2012-2015. The report shows survival for children undergoing cardiac procedures for congenital heart disease has continued to improve in recent years. It also shows that antenatal detection rates continue to improve.
National Audit of Percutaneous Coronary Interventions
HQIP has published the National Audit of Percutaneous Coronary Interventions Annual Public Report January 2014 - December 2014. This latest audit shows an increase from 26.9% to 75.3% in the use of a safer method of PCI (angioplasty) between 2007 and 2014.
Acute coronary syndrome guidance
The Scottish Intercollegiate Guidelines Network, Healthcare Improvement network has published Acute coronary syndrome guideline 148. This guideline provides recommendations on the management of patients with acute coronary syndrome. It covers presentation, assessment and diagnosis, initial management, reperfusion therapy, risk stratification and non-invasive testing, invasive investigation and revascularisation, early pharmacological intervention and treatment of hypoxia and cardiogenic shock and includes a checklist of information for patients
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NHS Behind the Headlines - media stories explained
Heart attacks linked to media statin reports ... reports mediaStudy says there's no link between cholesterol and heart disease
In the News...
The Independent Review of Children’s Cardiac Services in Bristol has published its final report. The full report is available to download from http://www.thebristolreview.co.uk/, where you will also find information about the review process and reviewers.
Understanding children’s heart surgery outcomes is a website presenting survival data from hospitals in the UK and Ireland. The data comes from the National Congenital Heart Disease Audit. It is possible to see the data for individual hospitals, and there is also information about what data is presented and how to interpret it. The work was funded by the NIHR. The site is at http://childrensheartsurgery.info/home.
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