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Objective: To test the hypothesis that preoperative aspirin administered within 24 hours before coronary artery bypass grafting (CABG) could reduce the incidence of postoperative acute kidney injury (AKI) following CABG., Methods: In this retrospective study, 696 patients were assigned to groups according to the time interval between their last aspirin dose administration and the time of surgery. A total of 322 patients received aspirin ≤24 hours before CABG, and 374 patients received aspirin between 24 and 48 hours before CABG. The primary outcome was postoperative AKI of any stage as defined by the Kidney Disease Improving Global Outcomes criteria. Propensity score matching selected 274 pairs for the final comparison., Results: Multivariable analysis showed that administration of aspirin within 24 hours of CABG was independently associated with reduction of AKI incidence by 36% (odds ratio, 0.64; 95% confidence interval, 0.45-0.91; P = .014). It was also noted that patients receiving their last aspirin dose ≤24 hours before CABG had a significantly higher glomerular filtration rate at discharge compared with patients who received aspirin between 24 and 48 hours before CABG. Propensity score matching analysis showed that patients receiving aspirin within 24 hours before CABG had a lower incidence of AKI compared with patients who discontinued aspirin between 24 and 48 hours before CABG (25.1% vs 36.8%; P = .004)., Conclusions: Continuation of aspirin until the day of surgery, with the last aspirin dose administered ≤24 hours before CABG, is associated with a significant reduction of postoperative AKI., (Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Data are lacking regarding optimal discontinuation time of preoperative aspirin before coronary artery bypass grafting (CABG). We aimed at assessing the impact of aspirin discontinuation according to time intervals before CABG and its influence on early postoperative outcomes., Methods: In this retrospective study, we enrolled 652 patients who underwent primary isolated nonemergent CABG between October 2014 and December 2017. Patients were assigned into groups according to the time interval between the last aspirin dose administration and the time of surgery. The first group comprised patients who were given aspirin ≤24-h before CABG (n = 304), whereas the second group consisted of patients who took aspirin between 24 and 48 h before CABG (n = 348). Efficacy endpoints included 30-d mortality rate, incidence of major adverse cardiac and cerebral events (MACCE) and composite rates of 30-d mortality/MACCE. Propensity score matching was used for final comparison., Results: Overall, multivariate analysis showed that aspirin administration ≤24 h before CABG was associated with reduced 30-d mortality rate and MACCE by 75% and 57%, respectively. Before as well as after propensity score matching, multivariate analysis showed that aspirin administration ≤24-h before CABG was associated with reduced composite rates of 30-d mortality rate and MACCE by 55% and 59%, respectively. Subgroup analysis stratified by the type of surgery showed that aspirin administration ≤24-h significantly reduced composite rates of 30-d mortality/MACCE in patients after off-pump CABG., Conclusions: Preoperative administration of aspirin ≤24-h before CABG is associated with the reduction of postoperative mortality as well as MACCE. The evidence also suggests that aspirin administration ≤24-h is strongly associated with reduced composite rates of 30-d mortality/MACCE in patients submitted to off-pump CABG., (Copyright © 2019 Elsevier Inc. All rights reserved.)

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether patient-prosthesis mismatch (PPM) has a negative impact on patients undergoing mitral valve replacement in terms of postoperative mortality, incidence of postoperative pulmonary hypertension (PH) and higher transmitral gradients. Altogether 103 papers were found using the reported search, 18 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Overall, 8 studies with a total of 4812 patients reported that PPM has a significantly negative impact on long-term mortality, whereas 5 studies with a total of 1558 patients reported no effect on mortality. One study with a total of 2440 patients reported preoperative PH as the risk factor for increased mortality in the presence of moderate or severe PPM. Three studies evaluated the effect of PPM on postoperative PH and reported that PPM was associated with significantly increased postoperative PH. The majority of the studies reported that PPM was associated with higher peak or mean transmitral gradient and systolic pulmonary artery pressure. The results presented in these studies suggest that PPM in patients undergoing mitral valve replacement was associated with increased postoperative mean and peak transmitral gradient and higher postoperative systolic pulmonary artery pressure. PPM may be associated with increased long-term mortality. Severe PPM was directly associated with increased long-term mortality when compared with moderate or no PPM. Evidence suggests that PPM is associated with increased incidence of postoperative PH.

Background: Despite the fact that aspirin is of benefit to patients following coronary artery bypass grafting (CABG), continuation or administration of preoperative aspirin before CABG or any cardiac surgical procedure remains controversial. Therefore, we performed a systematic review and meta-analysis to assess the influence of preoperative aspirin administration on patients undergoing cardiac surgery., Materials and Methods: Medline database was searched using OVID SP interface. Similar searches were performed separately in EMBASE, PubMed, and Cochrane Central Registry of Controlled Trials., Results: Twelve randomized controlled trials and 28 observational studies met our inclusion criteria and were included in the meta-analysis. The use of preoperative aspirin in patients undergoing CABG at any dose is associated with reduced early mortality as well as a reduced incidence of postoperative acute kidney injury (AKI). Low-dose aspirin (≤160 mg/d) is associated with a decreased incidence of perioperative myocardial infarction (MI). Administration of preoperative aspirin at any dose in patients undergoing cardiac surgery increases postoperative bleeding. Despite this effect of preoperative aspirin, it did not increase the rates of surgical re-exploration due to excessive postoperative bleeding nor did it increase the rates of packed red blood cell transfusions (PRBC) when preoperative low-dose aspirin (≤160 mg/d) was administered., Conclusions: Preoperative aspirin increases the risk for postoperative bleeding. However, this did not result in an increased need for chest re-exploration and did not increase the rates of PRBC transfusion when preoperative low-dose (≤160 mg/d) aspirin was administered. Aspirin at any dose is associated with decreased mortality and AKI and low-dose aspirin (≤160 mg/d) decreases the incidence of perioperative MI., (© 2017 Wiley Periodicals, Inc.)

Background: Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Once diagnosed, an immediate pharmacologic or invasive treatment should be performed. The purpose of this work was to evaluate the safety and efficacy of surgical PDA ligation in children using video-assisted thoracoscopic surgery (VATS) in comparison with a conventional muscle-sparing posterolateral thoracotomy technique (MSPLT)., Materials and Methods: In this single-center, retrospective study 173 children qualified for surgical PDA closure were enrolled. Patients were divided according to their weight and type of surgery performed. The groups consisted of patients operated through thoracotomy (54%) or VATS (46%). Operative characteristics, cosmetic effect, postoperative complications and long-term survival were evaluated., Results: Regardless of weight, fewer complications were noted in children after thoracoscopic clipping. Fifteen VATS patients required intraoperative conversion to thoracotomy; however, adverse sequelae were not observed. Aesthetics seemed to be the major complaint after conventional surgery. We did not observe any statistically significant differences in the long-term survival between both groups., Conclusions: Both techniques were shown to be safe and effective. Unsuccessfully performed thoracoscopic surgeries were safely converted to conventional thoracotomy. VATS, being a less invasive approach, leads to a better aesthetic effect and lower surgical complication rate., (Copyright © 2016 Elsevier Inc. All rights reserved.)

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether continuation of administration of preoperative aspirin until the day of coronary artery bypass grafting (CABG) could minimize postoperative mortality, prevalence of postoperative myocardial infarction (MI) with or without influence on postoperative bleeding, packed red blood cell (PRBC) transfusion and reoperation for bleeding. Altogether, 662 papers were found using the reported search, 7 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Seven studies, included in this review, consisted of five meta-analyses and two randomized controlled trials. One meta-analysis, involving 27 533 patients submitted to CABG, showed that the administration of preoperative aspirin decreased postoperative 30-day mortality by 27%. Another meta-analysis, including 1437 patients, showed that preoperative aspirin decreased the incidence of perioperative MI by 44%, the effect being even more pronounced with low-dose aspirin, which reduced the prevalence of perioperative MI by 63%. One RCT showed that preoperative aspirin is associated with reduced long-term hazard of MI or repeated revascularization. Four meta-analyses and two RCTs showed that preoperative aspirin is associated with increased postoperative bleeding, PRBC transfusion and reoperation for bleeding. However, this was not the case with preoperative administration of low-dose aspirin. The results presented in these studies suggest that preoperative aspirin administration in patients undergoing CABG has a significant benefit in reducing the incidence of perioperative MI and 30-day mortality rate, as well as reduced long-term hazard of MI or repeated revascularization. At a higher dose (>100 mg/day), postoperative bleeding, PRBC transfusion and reoperation for bleeding increased. However, with low-dose aspirin (≤100 mg/day), these benefits were not at the expense of increased postoperative bleeding or transfusion., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)