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Research designs for cardiothoracic surgeons: part 1 - a primer for evidence-based practice. 心胸外科医生的研究设计:第一部分--循证实践入门。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-10-04 DOI: 10.1007/s12055-024-01836-0
H Shafeeq Ahmed

Understanding research designs is crucial for cardiothoracic surgeons to enhance their clinical practice and decision-making. This article provides a comprehensive overview of different research study types, including observational and experimental studies, and their relevance to cardiothoracic surgery. Detailed explanations of cohort, case-control, and cross-sectional studies, as well as various types of randomized controlled trials, are presented. Key terms and concepts like bias, validity, and reliability are discussed. Practical case examples from the literature illustrate the application of these research designs, aiding clinicians in selecting the appropriate study design for their research questions.

了解研究设计对于心胸外科医生提高临床实践和决策水平至关重要。本文全面概述了不同的研究类型,包括观察性研究和实验性研究,以及它们与心胸外科的相关性。文章详细解释了队列研究、病例对照研究、横断面研究以及各种类型的随机对照试验。还讨论了偏倚、有效性和可靠性等关键术语和概念。文献中的实际案例说明了这些研究设计的应用,帮助临床医生为其研究问题选择合适的研究设计。
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引用次数: 0
Caps, masks, aprons, and gloves - necessary evils? 帽子、口罩、围裙和手套--必要之恶?
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-08-24 DOI: 10.1007/s12055-024-01822-6
Om Prakash Yadava
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引用次数: 0
Looking ahead: Incorporation of objective assessment methods, surgical simulation and 3D-printed models to improve technical skills of a cardiac surgeon in training in the Indian context. 展望未来:结合客观评估方法、手术模拟和 3D 打印模型,提高印度受训心脏外科医生的技术技能。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-07-22 DOI: 10.1007/s12055-024-01789-4
Sudipto Bhattacharya
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引用次数: 0
One year outcomes following of carotid endarterectomy in different age groups: Russian multicenter study. 不同年龄组颈动脉内膜切除术后一年的疗效:俄罗斯多中心研究。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-06-19 DOI: 10.1007/s12055-024-01753-2
Anton Kazantsev, Alexander Korotkikh, Roman Leader, Sergey Artyukhov, Lyudmila Roshkovskaya, Vladimir Unguryan, Maxim Chernyavin, Belov Yury

Introduction: This is a retrospective analysis of the results of carotid endarterectomy (CEA) in different age groups.

Methods: This cohort, comparative, retrospective, open-label study for the period from 2008 to 2020 included 7248 patients with hemodynamically significant stenoses of the internal carotid artery (ICA), who underwent CEA. According to the classification of the World Health Organization, patients were divided into groups depending on age: up to 44 years-young age (n = 84); 45-60 years-middle age (n = 1635); 61-75-elderly age (n = 4817); over 75 years-senile age (n = 712).

Results: In terms of the frequency of hospital complications, the group of patients over 75 years of age experienced the largest number of cardiovascular events. One year after surgery, there were no significant differences in the incidence of complications between groups: death (group 1, 1.2%; group 2, 0.5%; group 3, 0.4%; group 4, 1%; p = 0.14), myocardial infarction (group 1, 1.2%; group 2, 0.3%; group 3, 0.14%; group 4, 0.3%; p = 0.12), stroke (group 1, 0%; group 2, 0.3%; group 3, 0.1%; group 4, 0.4%; p = 0.32).

Conclusion: The largest number of adverse cardiovascular events after CEA are observed among patients over 75 years of age, which is due to the high frequency of multivessel coronary lesions, atrial fibrillation, and the severity of the comorbidities. One year after surgery, there were no significant differences in the incidence of complications between groups.

简介:这是一项对不同年龄组颈动脉内膜切除术(CEA)结果的回顾性分析:这是一项对不同年龄组颈动脉内膜剥脱术(CEA)效果的回顾性分析:这项2008年至2020年的队列、比较、回顾性、开放标签研究纳入了7248例颈内动脉(ICA)血流动力学显著狭窄的患者,他们都接受了颈动脉内膜剥脱术(CEA)。根据世界卫生组织的分类,患者按年龄分为:44岁以下-年轻组(84人);45-60岁-中年组(1635人);61-75岁-老年组(4817人);75岁以上-高龄组(712人):就住院并发症的发生频率而言,75岁以上年龄组患者经历的心血管事件最多。术后一年,各组并发症发生率无明显差异:死亡(第 1 组,1.2%;第 2 组,0.5%;第 3 组,0.4%;第 4 组,1%;P = 0.14)、心肌梗死(第 1 组,1.2%;第 2 组,0.3%;第 3 组,0.14%;第 4 组,0.3%;P = 0.12)、中风(第 1 组,0%;第 2 组,0.3%;第 3 组,0.1%;第 4 组,0.4%;P = 0.32):CEA术后发生心血管不良事件最多的是75岁以上的患者,这是因为多支血管冠状动脉病变、心房颤动和严重的合并症发生率较高。术后一年,两组患者的并发症发生率无明显差异。
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引用次数: 0
Women in cardiothoracic surgery. 心胸外科的女性。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-07-30 DOI: 10.1007/s12055-024-01801-x
Abha Chandra
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引用次数: 0
An inverted left atrial appendage-when it gives a surprise on the table. 倒置的左心房阑尾--当它在手术台上给人惊喜时。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-04-06 DOI: 10.1007/s12055-024-01726-5
Ancy Robinson, Thiruvenkitasamy Nareshkumar, Madhava Rao Bathala

A newly identified left atrial (LA) mass on a post-repair intraoperative transoesphageal echocardiogram (TEE), following a left ventricle (LV) thrombectomy, will make the surgical team wonder-whether a part of the thrombus has been dislodged into the LA or what else could it be? This report is about a 34-year-old male who underwent LV thrombectomy, for whom the post cardiopulmonary bypass intra-operative TEE showed a new LA mass that turned out to be an inverted left atrial appendage on exploration.

左心室(LV)血栓切除术后,术中经蝶窦超声心动图(TEE)新发现的左心房(LA)肿块会让手术团队感到疑惑--是否部分血栓移位到了LA,或者是其他什么原因?本报告涉及一名接受左心室血栓切除术的 34 岁男性,他在心肺旁路术后的术中 TEE 显示新的 LA 包块,探查后发现是左心房阑尾倒置。
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引用次数: 0
Comparison of a coronary bypass surgery using a combination of both on-pump beating heart and cardioplegic arrest with conventional coronary bypass surgery using cardioplegic arrest on-pump. 使用泵上心脏跳动和心脏停搏相结合的冠状动脉搭桥手术与使用泵上心脏停搏的传统冠状动脉搭桥手术的比较。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-05-29 DOI: 10.1007/s12055-024-01754-1
Mehmet Ali Sahin, Erkan Kuralay

Objective: Antegrade cardioplegia may cause maldistribution in patients with multivessel coronary artery disease. Surgically bypassing large epicardial vessels before the cross-clamp and then administering cardioplegia from both the aortic root and the anastomosed grafts significantly prevent maldistribution and provide better cardiac protection.

Methods: This study included 80 patients, all older than 70 years with an ejection fraction between 25 and 35%. Patients were equally divided into two groups. Distal anastomoses to some of large epicardial coronary arteries were performed before the cross-clamp was placed. Grafted veins were attached to multi-perfusion set ports. Then, cross-clamping was performed, and the multi-perfusion set was disconnected from the aortic cannula and attached to the cardioplegia route. Antegrade cardioplegia was administered to both the aortic root and saphenous vein grafts. After all distal anastomoses were completed, the cross-clamp was removed, and the multi-perfusion set was connected to the aortic cannula again. Conventional coronary bypass techniques were used in group 2 patients.

Results: Inotropic agents were administered in 12 patients in group 1 and 29 patients in group 2 (p < 0.001). The average troponin I value in coronary sinus blood was 1.05 ± 0.8 ng/mL in group 1 and 3.12 ± 0.7 ng/mL in group 2 (p < 0.001). The average lactate value in coronary sinus blood was 1.15 ± 0.55 mmol/L in group 1 and 3.7 ± 2.4 mmol/L in group 2 (p < 0.001). Six patients died in the early postoperative period in group 2 (p = 0.028).

Conclusion: The current technique considerably reduces cross-clamping time and allows better distribution of the cardioplegic solution, preserving myocardium. Reduced coronary sinus lactate and troponin I levels also indicate better myocardial protection.

目的:在多支血管冠状动脉疾病患者中,前向心脏麻痹可能会导致分布不良。在交叉钳夹前通过手术绕过大的心外膜血管,然后从主动脉根部和吻合移植物处给予心脏麻痹,可显著防止分布不良,并提供更好的心脏保护:这项研究包括 80 名患者,年龄均在 70 岁以上,射血分数在 25% 至 35% 之间。患者平均分为两组。在放置交叉钳之前,对一些大的心外膜冠状动脉进行远端吻合。移植的静脉连接到多灌注装置端口。然后,进行交叉钳夹,将多灌注装置与主动脉插管断开,并连接至心脏麻痹途径。对主动脉根部和隐静脉移植物进行前向心脏麻痹。完成所有远端吻合后,移除交叉夹钳,将多灌注装置再次连接到主动脉插管上。第二组患者采用常规冠状动脉搭桥技术:结果:第 1 组有 12 名患者使用了肌力药物,第 2 组有 29 名患者使用了肌力药物(P P P = 0.028):结论:目前的技术大大缩短了交叉钳夹时间,并能更好地分配心脏麻痹溶液,保护心肌。冠状窦乳酸和肌钙蛋白 I 水平的降低也表明心肌得到了更好的保护。
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引用次数: 0
Bicuspid Aortic Valve dilemma: TAVI or SAVR? Insights from the NOTION-2 trial. 二尖瓣主动脉瓣困境:TAVI 还是 SAVR?NOTION-2 试验的启示。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-08-05 DOI: 10.1007/s12055-024-01809-3
Pradeep Narayan

The Nordic Aortic Valve Intervention-2 (NOTION-2) trial is the first randomized controlled trial to compare transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in low-risk patients, specifically focusing on relatively younger patients and those with bicuspid valves. It randomized 370 patients (mean age 71 years) to assess outcomes at 1 year. Results indicated a higher composite primary endpoint rate for TAVI (10.2%) compared to SAVR (7.1%) in the overall cohort, with even more pronounced differences in patients with bicuspid valves (14.3% for TAVI vs. 3.9% for SAVR). The risk of death or disabling stroke at 1 year was also three times higher with TAVI.

北欧主动脉瓣干预-2(NOTION-2)试验是第一项比较低风险患者经导管主动脉瓣植入术(TAVI)和外科主动脉瓣置换术(SAVR)的随机对照试验,特别关注相对年轻的患者和双尖瓣患者。该研究对 370 名患者(平均年龄 71 岁)进行了随机分组,以评估 1 年后的疗效。结果显示,在整个队列中,TAVI(10.2%)的复合主要终点率高于 SAVR(7.1%),而在双尖瓣患者中差异更为明显(TAVI 为 14.3%,SAVR 为 3.9%)。TAVI术后1年死亡或致残性中风的风险也比SAVR术高3倍。
{"title":"Bicuspid Aortic Valve dilemma: TAVI or SAVR? Insights from the NOTION-2 trial.","authors":"Pradeep Narayan","doi":"10.1007/s12055-024-01809-3","DOIUrl":"10.1007/s12055-024-01809-3","url":null,"abstract":"<p><p>The Nordic Aortic Valve Intervention-2 (NOTION-2) trial is the first randomized controlled trial to compare transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in low-risk patients, specifically focusing on relatively younger patients and those with bicuspid valves. It randomized 370 patients (mean age 71 years) to assess outcomes at 1 year. Results indicated a higher composite primary endpoint rate for TAVI (10.2%) compared to SAVR (7.1%) in the overall cohort, with even more pronounced differences in patients with bicuspid valves (14.3% for TAVI vs. 3.9% for SAVR). The risk of death or disabling stroke at 1 year was also three times higher with TAVI.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"40 5","pages":"645-647"},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11329489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A histology and immunochemistry study comparing open versus close and open-method endoscopic saphenous vein harvesting. 一项组织学和免疫化学研究,比较了开放式与密闭式和开放式内窥镜大隐静脉采集法。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1007/s12055-024-01752-3
Sivakumar Krishnasamy, Raja Amin Raja Mokhtar, Ahmad Farouk Musa, Xian Pei Cheong, Toh Yen Fa

Background: The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to reduce wound pain and infection, compared with open saphenous vein harvesting (OSVH) techniques. There are still controversies regarding this technique. The aim of our study is to investigate the endothelial preservation of saphenous vein (SV) grafts harvested by different techniques. Further observations were made for harvesting and closure time, incision length and effect of pressure distension of the veins to the vein endothelium.

Methods: Prospective observational study of sixty human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin-eosin and Cluster of Differentiation 31 (CD 31) staining. Saphenous vein was harvested endoscopically either by closed CO2 (carbon dioxide) ESVH, open CO2 ESVH or OSVH harvesting technique. Demographic data and intra-operative data were collected. Two saphenous vein samples were collected from each patient to compare differences before and after distension of the veins. Both haematoxylin-eosin and immunohistochemistry slides were imaged by a high-resolution slide scanning system.

Results: Open CO2 ESVH group showed the highest number of endothelial detachments. Mean scoring of the immunohistochemistry method using the CD31 antibody was much lower in the open CO2 ESVH group (33.25% ± 28.71, P < 0.0003). This represents a more poorly preserved endothelial cells in the Open CO2 ESVH than the closed CO2 ESVH. Closure time and incision lengths were significantly shorter in both ESVH groups compared to the OSVH group. Significant low scores of immunohistochemistry for samples were seen in distended veins (39.0% ± 30.08, p = 0.004). The OSVH in random sample B, which represents the conduit that will be used, had a far better endothelium preservation and less endothelial detachment when compared to ESVH.

Conclusion: We observed more endothelial detachment in the open CO2 ESVH group, due to lack of subcutaneous tissue separation, poor visualization and traction stress across the wall of the saphenous vein. The closed CO2 ESVH group had more endothelial cells preserved, but the OSVH group fared the best with the least number of endothelial cell detachment and a higher score of CD31 antibody.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01752-3.

背景:据报道,与开放式大隐静脉采集(OSVH)技术相比,内窥镜大隐静脉采集(ESVH)可减少伤口疼痛和感染。但关于这项技术仍存在争议。我们的研究旨在调查通过不同技术采集的隐静脉(SV)移植物的内皮保存情况。我们还进一步观察了采集和闭合时间、切口长度以及静脉压力扩张对静脉内皮的影响:方法:对 60 例人体大隐静脉移植物进行前瞻性观察研究,通过血红素-伊红和分化簇 31(CD 31)染色评估内皮的保存情况。通过闭合式二氧化碳ESVH、开放式二氧化碳ESVH或OSVH采集技术在内窥镜下采集隐静脉。收集人口统计学数据和术中数据。为比较静脉扩张前后的差异,从每位患者身上采集了两份隐静脉样本。通过高分辨率玻片扫描系统对血红素-伊红和免疫组化玻片进行成像:结果:开放 CO2 ESVH 组的内皮脱落数量最多。使用 CD31 抗体的免疫组化法的平均评分在开放式 CO2 ESVH 组要低得多(33.25% ± 28.71,P 0.0003)。这表明开放式 CO2 ESVH 比闭合式 CO2 ESVH 的内皮细胞保存更差。与 OSVH 组相比,ESVH 两组的闭合时间和切口长度都明显较短。膨胀静脉样本的免疫组化得分明显偏低(39.0% ± 30.08,P = 0.004)。随机样本 B 中的 OSVH(代表将使用的导管)与 ESVH 相比,内皮保存更好,内皮脱落更少:我们在开放式二氧化碳 ESVH 组观察到更多的内皮脱落,这是由于皮下组织分离不足、可视性差以及大隐静脉壁上的牵引应力造成的。闭合式二氧化碳 ESVH 组保留了更多的内皮细胞,但 OSVH 组的情况最好,内皮细胞脱落最少,CD31 抗体得分更高:在线版本包含补充材料,可在 10.1007/s12055-024-01752-3上查阅。
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引用次数: 0
Delayed traumatic left ventricular pseudoaneurysm: diagnostic challenges and surgical management. 延迟性外伤性左心室假性动脉瘤:诊断难题与手术治疗。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-04-01 DOI: 10.1007/s12055-024-01729-2
Rahul Bhushan, Arun Kengalapura Ramesh, Vijay Grover

Left ventricular (LV) pseudoaneurysms are uncommon, with traumatic cases being particularly rare. We present a case of a 26-year-old male with a delayed presentation of a traumatic LV pseudoaneurysm, 2 years post-blunt chest trauma. The patient experienced New York Heart Association (NYHA) grade 2 dyspnea, which prompted the investigation. Imaging studies, including X-ray, echocardiogram, and cardiac computed tomography (CT), revealed a large pseudoaneurysm arising from the LV apex, containing intramural thrombus. The surgical intervention involved the closure of the communicating orifice and on-lay pericardial patch placement. This case emphasizes the diagnostic challenges and successful management of traumatic LV pseudoaneurysms. Early detection through imaging and prompt surgical intervention led to a favorable outcome. This report contributes to understanding post-traumatic pseudoaneurysms and underscores the importance of a multidisciplinary approach in their management. Further studies are needed to refine diagnostic and treatment strategies for this rare condition.

左心室假性动脉瘤并不常见,外伤性病例尤其罕见。我们为您介绍一例外伤性左心室假性动脉瘤的病例,患者 26 岁,男性,钝性胸部外伤后 2 年才出现。患者出现纽约心脏协会(NYHA)2 级呼吸困难,这促使我们进行了调查。包括X光、超声心动图和心脏计算机断层扫描(CT)在内的影像学检查显示,左心室顶端出现一个巨大的假性动脉瘤,内含壁内血栓。手术治疗包括关闭沟通口和铺设心包补片。该病例强调了外伤性左心室假性动脉瘤的诊断挑战和成功治疗。通过影像学检查及早发现并及时进行手术治疗,最终取得了良好的疗效。本报告有助于了解创伤后假性动脉瘤,并强调了多学科方法在其管理中的重要性。还需要进一步的研究来完善这种罕见疾病的诊断和治疗策略。
{"title":"Delayed traumatic left ventricular pseudoaneurysm: diagnostic challenges and surgical management.","authors":"Rahul Bhushan, Arun Kengalapura Ramesh, Vijay Grover","doi":"10.1007/s12055-024-01729-2","DOIUrl":"10.1007/s12055-024-01729-2","url":null,"abstract":"<p><p>Left ventricular (LV) pseudoaneurysms are uncommon, with traumatic cases being particularly rare. We present a case of a 26-year-old male with a delayed presentation of a traumatic LV pseudoaneurysm, 2 years post-blunt chest trauma. The patient experienced New York Heart Association (NYHA) grade 2 dyspnea, which prompted the investigation. Imaging studies, including X-ray, echocardiogram, and cardiac computed tomography (CT), revealed a large pseudoaneurysm arising from the LV apex, containing intramural thrombus. The surgical intervention involved the closure of the communicating orifice and on-lay pericardial patch placement. This case emphasizes the diagnostic challenges and successful management of traumatic LV pseudoaneurysms. Early detection through imaging and prompt surgical intervention led to a favorable outcome. This report contributes to understanding post-traumatic pseudoaneurysms and underscores the importance of a multidisciplinary approach in their management. Further studies are needed to refine diagnostic and treatment strategies for this rare condition.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"40 5","pages":"621-625"},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11329469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Indian Journal of Thoracic and Cardiovascular Surgery
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