Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany.
Clin Res Cardiol. 2019 Sep;108(9):974-989. doi: 10.1007/s00392-019-01470-6. Epub 2019 Mar 30.
For the year 2018, more than 22,000 published references can be found in PubMed when entering the search term "cardiac surgery". As in the last 4 years, this review focusses on conventional cardiac surgery publications which provide important and interesting information especially relevant for non-surgical colleagues. Interventional techniques have been considered if they were published in the context of classic surgical techniques. We have again reviewed the fields of coronary revascularization and valve surgery and briefly touched on aortic surgery and surgery for terminal heart failure. For revascularization of complex coronary artery disease, bypass grafting was reconfirmed as gold standard and computer-tomographic angiography established equipoise for decision-making with classic angiography. For aortic valve treatment, some new longer-term outcomes from TAVI vs. SAVR trials confirmed equipoise of both treatments for high and medium risk. New information was provided for INR-management of mechanical aortic valves as well as long-term experiences for alternatives to mechanical valves (i.e., Ross and the relatively new Ozaki procedure). In the mitral and tricuspid field, prevalence data illustrate a significant amount of under-treatment for mitral and tricuspid valve regurgitation and evidence for life prolonging-effects of surgery. Finally, elongation of the ascending aorta was identified as new risk factor for aortic dissection and 2 years outcome of the newest generation of left ventricular assist devices demonstrate impressive improvements in outcome. While this article attempts to summarize the most pertinent publications, it does not expect to be complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery and a stimulus for in-depth reading.
2018 年,在 PubMed 中输入搜索词“心脏手术”,可以找到超过 22000 篇已发表的参考文献。与过去 4 年一样,本综述重点关注传统心脏外科学术出版物,这些出版物提供了重要且有趣的信息,尤其是对非外科同行而言。如果介入技术是在经典外科技术的背景下发表的,也将对其进行考虑。我们再次回顾了冠状动脉血运重建和瓣膜手术领域,并简要探讨了主动脉手术和终末期心力衰竭手术。对于复杂冠状动脉疾病的血运重建,旁路移植术再次被确认为金标准,计算机断层血管造影术与经典血管造影术在决策方面达到了平衡。对于主动脉瓣治疗,来自 TAVI 与 SAVR 试验的一些新的长期结果证实了两种治疗方法在高风险和中风险患者中的平衡。为机械主动脉瓣的 INR 管理以及机械瓣膜替代品(即 Ross 和相对较新的 Ozaki 手术)提供了新的信息。在二尖瓣和三尖瓣领域,流行数据说明了二尖瓣和三尖瓣反流治疗不足的情况,并提供了手术延长生命的证据。最后,升主动脉的延长被确定为主动脉夹层的新危险因素,新一代左心室辅助装置的 2 年结果显示出令人印象深刻的改善。虽然本文试图总结最相关的出版物,但并不期望其完整,也无法避免个人的解读。与近年来一样,它提供了一个浓缩的总结,旨在为心脏外科的最新决策提供“坚实的基础”,并为深入阅读提供动力。