| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Letters to the Editor |
a Department of Cardiothoracic-Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
b Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
Received 16 January 2009; accepted 24 February 2009.
* Corresponding author. Address: Department of Cardiothoracic-Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan (Italy). Tel.: +39 02 52774505; fax: +39 02 55602262. (Email: castelvecchio.serenella{at}gmail.com).
Key Words: Left ventricular reconstruction • Surgical ventricular restoration • Aneurysmectomy
We read with interest the review article of Klein and co-workers [1] who provide interesting insights about the outcome of left ventricular reconstruction surgery using different surgical techniques. In their article, the authors used a pooled-data analysis from a subset of studies within the total amount of 62 articles retrieved. This analysis, which included a fuddled number of patients, was designed to compare different surgical techniques in respect of early and late outcome. The authors concluded that the endoventricular reconstruction (EVR) technique demonstrated a reduced risk for early and late mortality compared to the linear repair (LR) technique.
Pooled-data analysis is a powerful statistical tool aimed to achieve enough power from many underpowered studies. However, a prerequisite for this approach is that the choice of the technique should not be biased by different clinical conditions of the patients. The best practice should be pooling only data from randomized controlled trials, but we agree that they are practically absent in the literature. However, many studies included in this analysis were biased by a surgical choice of the technique based on different size and extension of the left ventricular aneurysm: the general attitude was to use a LR for lesions not affecting the interventricular septum, leaving the EVR to anteroseptal aneurysms with an important septal involvement [2–4]. We could retrieve 8 articles reporting a total of about 1000 patients where this bias was present.
Other studies compared the two techniques in consecutive periods of time, generally with the LR performed in the first years, and the EVR in the last [5]. Of course, many technical improvements apart from the surgical technique have been achieved in recent years, and this could introduce another source of bias. Finally, and most important, the comparison was made between institutions routinely performing LR or EVR. As a consequence, the results may reflect differences between different surgeons of different institutions rather than between surgical techniques.
As a matter of fact, we believe that pooling these data together may lead to conclusions that are unsupported by a sound statistical evidence.
It is our belief that, as the authors admit, the absence of large randomized controlled trials accounting for the different anatomy of the left ventricle presently makes it very difficult to draw a strong conclusion about the role of different surgical techniques in determining early and late outcome.
References
This article has been cited by other articles:
|
|
 |
|
  P. Klein, J. J. Bax, and R. J.M. Klautz Reply to Castelvecchio et al. Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 1111 - 1112. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
