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Eur J Cardiothorac Surg 2004;25:243-245
© 2004 Elsevier Science NL

Review

Editorial comment

The potatoes and the bottle

Département Cardio-Vasculaire, L'Institut Mutualiste Montsouris, 42, Boulevard Jourdan, 75014 Paris, France

^* Tel.: +33-1-56-61-62-63; fax: +33-1-56-61-65-23

The first 300 words of the full text of this article appear below.

In a somewhat provocative article published in the present issue of the European Journal of Cardio-Thoracic Surgery, Myrmel, Lai and Miller question the quality of the publications concerning the treatment of acute aortic dissections through an apparently simple interrogation: can the principles of evidence-based medicine be applied to the treatment of aortic dissections? [1]

During a thorough search of the literature published during the last two decades, the authors have tried to find articles that could answer three questions by using the comparative, prospective, randomized, controlled methodology applied in evidence-based medicine:

1. is the use of routine circulatory arrest and "distal open anastomosis" better than simple cross-clamping?
   
2. does a persistent false lumen in the distal aorta have an adverse influence on long-term event-free survival?
   
3. is primary surgical or medical treatment preferable in terms of long-term event-free survival of acute type B dissections?
   

Obviously their search was very disappointing and they have found no article following those principles and allowing any unequivocal conclusion concerning those questions. They therefore conclude that, because the great majority of articles report observational studies, most of their recommendations for treatment options are weak and that no evidence exists favouring the use of an open distal anastomosis and the elimination of the distal false lumen during surgery of acute type A dissections, or medical therapy over surgical treatment in non-complicated type B dissections.

This article is rather intriguing not to say puzzling. Not only because it bears the signature of one prestigious surgeon with a large experience of acute aortic dissections and who has participated largely in the relevant literature, but also, more importantly, because it raises fundamental questions about the analyses of our therapeutic methods and the reports of those analyses in that particularly difficult surgical matter.

The principles of evidence-based medicine have been elaborated and . . . [Full Text of this Article]

Related Article

Can the principles of evidence-based medicine be applied to the treatment of aortic dissections?

Truls Myrmel, David T.M. Lai, and D. Craig Miller
Eur. J. Cardiothorac. Surg. 2004 25: 236-242. [Abstract] [Full Text] [PDF]