A best evidence topic in cardio thoracic surgery was written according to a structured protocol. The question addressed whether cardiac re-transplantation can be performed with an acceptable survival in patients who suffer primary graft failure? Altogether 458 papers were found using the reported search, of which 18 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We conclude that while re-transplantation for graft coronary disease has a similar survival to patients undergoing primary transplantation, acute graft failure or rejection should be treated with a mechanical assist device, as acute re-transplantation is associated with an unacceptably high mortality.
Introduction
This study analyzes the outcome of a protocol-based surgical approach for
ventricular septal rupture (VSR). The study also clarifies the appropriate
time for intervention.
Methods
This is a single-center retrospective analysis of all VSR cases evaluated
between February 2006 and March 2020. Cases were managed using the same
protocol. Patients were divided into two cohorts - early (those in whom our
protocol was instituted within 24 hours of diagnosis) and delayed
(intervention between 24 hours and seven days after diagnosis). All-cause
mortality was considered as the outcome.
Results
The mean age of presentation was 60.1 years, and 75.9% of the patients were
men. Cardiogenic shock was the most common mode of presentation. Our
analysis validates that once a patient develops VSR, age, sex,
comorbidities, left ventricular function, and renal failure at the time of
presentation do not have a statistically significant impact on the outcome.
The sole factor to have an impact on the outcome was time of intervention.
All patients in the delayed cohort expired after surgery, which dragged the
overall mortality to 34.5%, whereas 95% of patients in the early cohort are
still on follow-up. The mortality in this group was 5% (P≤0.001).
Conclusion
Early surgical intervention has proven benefits over delayed approach.
Surgical intervention in the early part of the disease reduces the risk and
thus improves the outcome. The extreme rarity makes VSR an uncommon entity
among surgeons. A protocol-based approach makes the team adapt to this
unfamiliar situation better.
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