No abstract

A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. The New England journal of medicine, 350 (1). pp. 21-8.

A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. The New England journal of medicine, 350 (1). pp. 21-8.

Background: Morbidity is defined as a state of being unhealthy or of experiencing an aspect of health that is "generally bad for you", and postoperative morbidity linked to paediatric cardiac surgery encompasses a range of conditions that may impact the patient and are potential targets for quality assurance. Methods: As part of a wider study, a multi-disciplinary group of professionals aimed to define a list of morbidities linked to paediatric cardiac surgery that was prioritised by a panel reflecting the views of both professionals from a range of disciplines and settings as well as parents and patients. Results: We present a set of definitions of morbidity for use in routine audit after paediatric cardiac surgery. These morbidities are ranked in priority order as acute neurological event, unplanned re-operation, feeding problems, the need for renal support, major adverse cardiac events or never events, extracorporeal life support, necrotising enterocolitis, surgical site of blood stream infection, and prolonged pleural effusion or chylothorax. It is recognised that more than one such morbidity may arise in the same patient and these are referred to as multiple morbidities, except in the case of extracorporeal life support, which is a stand-alone constellation of morbidity. Conclusions: It is feasible to define a range of paediatric cardiac surgical morbidities for use in routine audit that reflects the priorities of both professionals and parents. The impact of these morbidities on the patient and family will be explored prospectively as part of a wider ongoing, multi-centre study.

Reoperation on the aortic valve is rarely necessary, even late after an ASO, but a significant number of patients do have late aortic regurgitation and continue to need observation.

OBJECTIVES: A variety of surgical approaches and techniques are used for isolated coarctation repair. We have retrospectively reviewed our results of isolated repair of coarctation over the last 20 years, to establish whether the approach affects clinical outcome and the need for re-intervention. METHODS:Two hundred and eighty-eight patients who underwent isolated repair for coarctation of the aorta at Birmingham Children's Hospital between 1991 and 2010 were enrolled in this study. Chart review and the Departmental database were used to determine demographics, operative details and complications. RESULTS:The majority of patients (n = 237, 82%) underwent surgical repair via thoracotomy techniques, whereas median sternotomy was used in patients where there was associated arch hypoplasia (n = 51, 18%). For all 288 patients, median age at operation was 24 days (range 0-14 years). Between 1991 and 2000, ten patients (6%) underwent repair through midline sternotomy, increasing to 41 patients (36%) between 2001 and 2010. Overall early mortality was 1% and late mortality was 3%. There was a statistically higher reintervention rate (16%) in the decade 1991-2000, compared to 5% in the period 2001-10 (P = 0.02). In patients with hypoplastic arch, the midline approach has a lower re-intervention rate than thoracotomy (P < 0.001). CONCLUSIONS:In our institution, there has been a trend in recent years towards increased use of median sternotomy to repair the aortic arch, which has been associated with a reduced rate of re-intervention. The midline sternotomy approach for coarctation with arch hypoplasia significantly reduces the risk of re-coarctation.

No abstract

This study evaluates the current clinical evidence of Negative Pressure Wound Therapy with Instillation and dwell time (NPWTi‐d) to establish its clinical application and efficacy. MEDLINE, EMBASE, and CENTRAL databases were searched from 1946 to July 2019 for studies reporting clinical outcomes on wounds treated with NPWTi‐d. The primary outcome was proportion of wounds with complete healing. The secondary outcomes were mean time for healing, NPWTi‐d settings, cost, length of stay, and adverse events. Thirteen articles were included with a total of 624 wounds in 542 patients involving wounds of various aetiology. The pooled proportion of wound that achieved complete healing was 93.65% (95%CI: 84.02‐99.04). Normal saline was the most commonly used instillation solution with the mean dwell time of 14.23 minutes (95%CI: 10.88‐17.59) and instillation cycle every 4.17 ± 2.32 hourly. The mean therapy duration was 10.69 days (95%CI: 10.46‐10.91) with daily cost of $194.80. The mean hospital stay was 18.1 days (95%CI: 17.20‐19.00). There were no severe adverse effects reported. NPWTi‐d is an adjuntive therapy to aid complete healing of the vast majority of wounds. However, the current data are limited by the lack of level 1 evidence.