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Background: Robot-assisted coronary bypass (RCAB) surgery has been proposed as an alternative to conventional coronary artery bypass grafting (C-CABG) for managing coronary heart disease, but the evidence on its performance compared to other existing treatments is unclear. The aim of this study was to assess, through a systematic review of comparative studies, the safety and clinical effectiveness of RCAB compared to C-CABG and other minimally invasive approaches for the treatment of coronary heart disease. Methods: We conducted a systematic review of primary studies in the English-language literature comparing RCAB to existing treatment options (C-CABG, minimally invasive direct coronary artery bypass [MIDCAB] and port-access coronary artery bypass [PA-CAB]) following Cochrane Collaboration guidelines. Meta-analyses were performed where appropriate. Results: We reviewed 13 studies: 11 primary studies of RCAB (v. C-CABG in 7, v. MID-CAB in 3 and v. PA-CAB in 1) and 2 multicentre database studies (RCAB v. non-RCAB). The overall quality of the evidence was low. Most studies showed no significant benefit of RCAB over other treatments in a majority of outcome variables. Meta-analyses showed that RCAB had lower rates of pneumonia or wound infection than C-CABG, and shorter intensive care unit length of stay than C-CABG or MIDCAB. Individual studies showed that RCAB had some better outcomes than C-CABG (ventilation time, transfusion, postoperative pain, hospital length of stay) or MIDCAB (transfusion, postoperative pain, time to return to normal activities, physical functioning and hospital length of stay). The review of the database studies showed that RCAB was statistically superior to non-RCAB approaches in postoperative pain, renal failure, transfusion, reoperation for bleeding, stroke and hospital length of stay; however, the difference between the 2 groups in several of these outcomes was small. Conclusion: Although the findings from this review of comparative studies of RCAB appear promising and suggest that RCAB may offer some benefits to patients, in the absence of randomized controlled trials, these results should be interpreted cautiously. Contexte : Le pontage aortocoronarien assiste par robot (PACAR) a ete propose comme solution de rechange au pontage aortocoronarien classique (PACC) pour la prise en charge des coronaropathies, mais on manque de donnees probantes claires comparant son efficacite a celle d'autres traitements. La presente etude visait a evaluer, dans le cadre d'une revue sys-tematique d'etudes comparatives, la surete et l'efficacite clinique du PACAR, comparative-ment a celles du PACC et d'autres interventions a effraction minimale visant le traitement des coronaropathies. Methodes : Nous avons realise une revue systematique d'etudes primaires publiees en anglais comparant le PACAR a d'autres options therapeutiques (PACC, pontage aortocoro-narien direct a effraction minimale [PACDEM] et pontage aortocoronarien par voie percu-tanee [PACVP]) selon les lignes directrices de la Collaboration Cochrane, et avons realise des meta-analyses lorsque c'etait approprie. Resultats : Nous avons retenu 13 etudes : 11 etudes primaires sur le PACAR (compara-tivement a 7 etudes sur le PACC, a 3 etudes sur le PACDEM et a 1 etude sur le PACVP) et 2 etudes multicentriques fondees sur des bases de donnees (PACAR contre tout autre type de PAC). Dans l'ensemble, les donnees probantes etaient considerees de faible qualite. Selon la plupart des etudes, le PACAR ne presentait aucun avantage significatif par rapport aux autres traitements, et ce, pour la majorite des issues. Les meta-analyses ont montre que le PACAR etait associe a des taux de pneumonie et d'infection de la plaie plus faibles que le PACC, de meme qu'a une duree d'hospitalisation en soins intensifs plus courte que le PACC et le PACDEM. Des etudes individuelles ont montre que le PACAR donnait lieu a de meilleures issues pour certains parametres que le PACC (temps de ventilation, besoin de transfusion, douleur postoperatoire et duree d'hospitalisation) et que le PACDEM (besoin de transfusion, douleur postoperatoire, temps necessaire pour la reprise des activites normales, fonctionnement physique et duree d'hospitalisation). La revue des etudes fondees sur des bases de donnees a indique que le PACAR etait supe-rieur, sur le plan statistique, aux autres types de PAC en ce qui a trait a la douleur postoperatoire, a l'insuffisance renale, au besoin de transfusion, a la realisation d'une autre chirurgie en raison de saignements, a l'accident vasculaire cerebral et a la duree d'hospitalisation; cependant, pour plusieurs de ces parametres, les differences entre les 2 groupes etaient petites. Conclusion : Bien que les resultats de cette revue d'etudes comparatives sur le PACAR semblent prometteurs et laissent penser que cette intervention comporte des avantages pour les patients, ils devraient etre interpretes avec prudence etant donne l'absence d'etudes cliniques randomisees., Traditionally, coronary artery bypass grafting (CABG) was performed via conventional sternotomy and with a cardiopulmonary machine (i.e., conventional coronary artery bypass grafting [median sternotomy] [on pump] [C-CABG(on)]). Later, off-pump techniques [...]

INTRODUCTION Smokers undergoing total joint replacement (TJR) are more likely to develop infections and be re-admitted than non-smokers. The primary purpose of this study was to evaluate the effectiveness of standardized preoperative referral to a community-based pharmacist-led smoking cessation program compared to usual care for patients undergoing TJR. Secondarily, we evaluated the use of the smoking cessation program. METHODS A pre-post quasi-experimental study was conducted at a central intake clinic that prepares approximately 3000 TJR patients annually. Participants were recruited at a mean of 13±11.1 weeks preoperatively and provided informed consent. Participants in the 'pre' observational phase (OP) received usual care for smoking cessation. For 'post' intervention phase (IP) participants, a referral was sent to a community-based pharmacist-led smoking cessation program. Smoking status was validated on study entry using exhaled carbon monoxide. Participants' smoking status was re-assessed using self-reported point prevalence abstinence at 6 months post-recruitment. RESULTS We enrolled 120/150 (80%) potential OP candidates and 104/286 (36%) potential IP candidates. The groups were similar on study entry; overall, the mean age of participants was 58.7±9.1 years and 103 (47%) were male. They reported medium nicotine dependence with 37±11.6 mean years smoked. At 6 months post-recruitment, 8 (7%) OP participants self-reported 30-day point prevalence abstinence compared to 21 (20%) IP participants (p=0.003). Only 58 (56%) IP participants complied with the pharmacist referral, with 19 (33%) of those seeing the pharmacist reporting point prevalence abstinence at 6 months compared to only 2 (4%) of the 45 participants who did not see the pharmacist (p<0.001). CONCLUSIONS Referral to a community smoking cessation program as preoperative standard of care is feasible and can enhance long-term quit rates, but voluntary participation led to low recruitment to the program. [ABSTRACT FROM AUTHOR]

Purpose: To determine if a non-exercise algorithm-derived assessment of cardiorespiratory fitness (CRFA) accurately predicted estimated values obtained using a six-minute walk test (CRF6MWD) and the Duke Activity Status Index (CRFDASI).Methods: Following research ethics board approval, an observational cohort study was conducted in selected, consenting patients undergoing elective surgery. Participants completed questionnaires assessing their self-reported exercise capacity. Their height, weight, waist circumference, and vital signs were measured. A six-minute walk test was performed twice with a 45-min rest interval between tests. The correlation between CRFA and both CRF6MWD and CRFDASI was determined.Results: Two hundred forty-two participants were included. Mean age was 62 (range 45-88 yr); 150 (62%) were male, 87 (36%) self-reported walking or jogging > 16 km per week, and 49 (20%) were current smokers. The CRFA and CRF6MWD were highly correlated (Pearson r = 0.878; P < 0.001). CRFA and CRFDASI were less strongly correlated (Pearson r = 0.252; P < 0.001). Among patients capable of walking > 427 m in the six-minute walk test, CRFA, CRF6MWD, and CRFDASI were equivalent.Conclusion: A non-exercise algorithm can estimate cardiorespiratory fitness in patients presenting for elective surgery. The variables required to compute CRFA can be obtained in a clinic setting without the need to engage in formal exercise testing. Further evaluation of CRFA as a predictor of long-term outcome in patients is warranted. [ABSTRACT FROM AUTHOR]

Background: Smoking is an undertreated risk factor for coronary artery disease (CAD) and is associated with adverse outcomes after myocardial infarction. Aims of our study were to determine if management of CAD by medical therapy (MT) alone or with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) influence smoking status at one year following angiography and if a change in smoking status at one year influences long term survival. Methods: Prospective cohort study using the APPROACH registry. Two cohorts were examined: (1) 11,334 patients who returned a one year follow-up questionnaire; (2) 4,246 patients propensity-matched based on their post-angiography treatment - MT or revascularization (RV). Multivariate modeling and survival analysis were used. Results: In the propensity-matched cohort, quit rates at one year were greater among CABG patients (68%) than PCI (37%) or MT patients (47%). Smokers in the RV group, who self-reported quitting at one year, had a significantly reduced mortality compared to those who continued to smoke. Conclusions: CABG patients were more likely to quit smoking than those treated with MT alone or PCI. Quitting smoking was associated with improved long-term survival; smoking remains a key risk factor for mortality in patients with CAD. These data underscore the importance of nicotine addiction management in patients with CAD and the need to emphasize cessation particularly in those patients undergoing MT or PCI. [ABSTRACT FROM AUTHOR]

Objective: To determine the feasibility of implementing cessation interventions in Syria. Methods: We randomized 50 smokers to either a brief or intensive behavioral cessation intervention. Adherence to treatment and cessation through 3 months postcessation were calculated. Results: Adherence in the intensive group was only moderate and was associated with smoking for more years and higher self-efficacy. Cessation rates in the brief and intensive intervention groups were 16% and 4%, respectively. Nicotine dependence predicted abstinence at 3 months. Conclusion: Important barriers to cessation included perceived dependence, lack of access to pharmacotherapy, poor social support, and water pipe smoking. [ABSTRACT FROM AUTHOR]

Objective: Robot-assisted surgery is a minimally invasive approach for repairing the mitral valve. This study aimed to assess its safety and clinical efficacy when compared with conventional sternotomy, partial sternotomy, and right minithoracotomy., Methods: A systematic review of peer-reviewed studies comparing robot-assisted mitral valve repair with conventional sternotomy, partial sternotomy, and right minithoracotomy was conducted following Cochrane Collaboration guidelines. Meta-analyses were performed where possible., Results: The search strategy yielded 15 primary studies, of which 12 compared robot-assisted with conventional sternotomy, 2 compared robot-assisted with partial sternotomy, and 6 compared robot-assisted with right minithoracotomy. The overall quality of evidence was low, and there was a lack of data on long-term outcomes. Individual studies and pooled data demonstrated that robotic procedures were comparable to conventional sternotomy and other minimally invasive approaches with respect to the rates of stroke, renal failure, reoperation for bleeding, and mortality. Robot-assisted mitral valve repair was superior to conventional sternotomy with reduced atrial fibrillation, intensive care unit and hospital stay, pain, time to return to normal activities, and physical functioning at 1 year. However, robot-assisted mitral valve repair had longer cardiopulmonary, aortic cross-clamp, and procedure times compared with all other surgical approaches., Conclusions: Based on current evidence, robot-assisted mitral valve repair is comparable to other approaches for safety and early postoperative outcomes, despite being associated with longer operative times. Ideally, future studies will be randomized controlled trials that compare between robot-assisted surgery, conventional surgery, and other minimally surgery approaches focusing on hard clinical outcomes and patient-reported outcomes.