POSTICU PICS LIBRARY

PostICU Logo Icon.png

Search the PostICU Library

Select a keyword or keyword phrase related to the PICS topic that you would like to research.

PostICU Library Search Results

Name of Media:

Transcatheter aortic valve implantation for the treatment of patients with severe symptomatic aortic stenosis who are at intermediate surgical risk: Evidence Note 91

Type of Library Material:

Medical Professional Education

Brief description of media:

For patients with severe symptomatic aortic stenosis, surgical aortic valve replacement (SAVR) is the reference treatment where surgical risk is low. For those assessed by a heart team as being at increased surgical risk transcatheter aortic valve implantation (TAVI) is an alternative procedure. SAVR can be performed using different surgical approaches (full sternotomy and more minimally invasive procedures), different kinds of valves, and different kinds of valve anchoring techniques (sutured and sutureless). TAVI involves the insertion of a prosthetic valve, which functionally replaces the damaged aortic valve, using fluoroscopic and echographically guided minimally invasive procedures. The prosthetic valve is compressed within a dedicated delivery system and, once in place within the diseased aortic valve, its deployment allows its expansion and the compression of
the native diseased valve against the wall of the aorta. Depending on the anatomy of the patient and device characteristics, the procedure can be performed by one of four different approaches. The transfemoral (TF) route is the most common, whereas the others are performed when the anatomy of the patient precludes access via the TF route. These approaches are the subclavian/ transaxillary (S/T) approach, the transapical (TA) approach, and the transaortic (TAo) approach. Evidence note | 6 Data from randomised controlled trials (RCTs) in elderly patients at who are at high surgical risk indicate that TAVI is non-inferior or superior to SAVR2. This is reflected in SHTG advice on the use of TAVI in patients who are inoperable or at high surgical risk3, 4. This evidence review examines the evidence comparing outcomes of TAVI and SAVR in patients with severe aortic stenosis who are at intermediate surgical risk.

Is this COVID-19 Related Material:

No

Name of Media:

Transperitoneal versus retroperitoneal approach for elective open abdominal aortic aneurysm repair

Type of Library Material:

Medical Journal

Brief description of media:

Background

There has been a lot of debate in the surgical literature about the best way to surgically access the infrarenal abdominal aorta during an operation to repair an abdominal aortic aneurysm (AAA; a ballooning of an artery (blood vessel) which occurs in the major artery in the abdomen (aorta)). Two approaches are commonly used: the retroperitoneal (RP) approach and the transperitoneal (TP) approach. Both approaches appear to have advantages and disadvantages. Many trials comparing RP and TP aortic surgery have been published with conflicting results. The aim of this Cochrane review is to assess the effectiveness and safety of the TP versus RP approach for planned surgical open AAA repair on mortality, complications, hospital stay and blood loss.

Key results

We included four small randomized controlled trials (RCTs) (129 participants) after we searched the literature up to May 2015). There were no differences between RP and TP for death. Our analysis seems to show a trend that RP might increase the complications such as hematoma (swelling of clotted blood), chronic wound pain and abdominal wall hernia compared with TP but there were variations between the included trials. We found that RP led to lower blood loss, and shorter hospital stay and ICU stay compared with TP but there were no differences between the two approaches for operating time and aortic cross‐clamp time (length of time a surgical instrument, used to clamp the aorta and separate the circulation from the outflow of the heart, is used).

Quality of the evidence

Three of the four included trials had methodological weaknesses, such as unclear randomisation methods, and no reporting of blinding of the people assessing the outcome which compromised the value of their results. In addition, the included trials only included a small number of people, there were few outcomes reported, there was a relatively short follow‐up and there were inconsistencies between the included trials resulting in very low to low quality of the evidence. More large‐scale RCTs of the RP approach versus the TP approach for planned surgical open AAA repair are needed.

Is this COVID-19 Related Material:

No

Name of Media:

Traumatic rupture of the thoracic aorta: cohort study and systematic review

Type of Library Material:

Medical Research

Brief description of media:

Authors' objectives
To compare surgical techniques for traumatic rupture of the thoracic aorta.

Is this COVID-19 Related Material:

No

Additional PostICU Research & Information

Click here to learn more about the PostICU library.

PostICU Library Policy & Compliance Statement

PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

© 2020 by North American Help Services Alliance, Inc., d/b/a PostICU, a 501(c)3 Corporation All rights reserved. Terms of Service (General), Cookies PolicyTerms of Service for Mobile AppDisclaimers & Disclosures, and Privacy Policy.