Force et al.[7], 2006 |
- From January 2003 to March 2005 |
- Single-center retrospective cohort study |
- Mean DCC time 5.3 days (3-7). |
- DCC can be employed safely and outcomes are similar to PCC |
- Total 28 LTx |
- Comparison of DCC vs. PCC |
- In DCC: |
- May also provide a treatment option for patients in whom PGD develops |
> DCC, N=8 (25%) |
- DCC technique: Esmark bandaging in 7 and active sternal retraction in 1 patient |
More tracheostomy |
- May lead to a decreased mortality for this high-risk patient population |
> PCC, N=20 |
|
More hospitalization |
|
- Indications N/a |
|
More PGD |
|
|
|
More CPB use |
|
|
|
Longer CPB time |
|
|
|
Similar infections |
|
|
|
Operative mortality = 0% |
|
D'Cunha et al.[13], 2010 |
- From October 2006 to February 2008 |
- Case series |
- Mean DCC time 5.4 days (4-9) |
- DCC is very favorable |
- 5 cases of DCC |
- DCC technique: Esmarch dressing in all patients |
- Mean hospital stay 41 days (26-62) |
- Potentially avoids ECMO and its complications |
- Indications: |
|
- No surgical infection |
|
> Respiratory and hemodynamic instability, N=3 |
|
- No allograft failure |
|
> Bleeding, N=2 |
|
- 19-month survival 80% |
|
Shigemura et al.[4], 2014 |
- From January 2004 to December 2011 |
- Single-center retrospective cohort study |
- Mean DCC time = 4.5 days (1-18) |
- DCC can be safely performed with acceptable procedure-related risks |
- Total 873 LTx: |
- Comparison of DCC vs. PCC |
- In DCC: |
- DCC should not be considered a sub-optimal option after LTx |
> DCC, N=90 (10.3%) |
- Also comparison of DCC techniques |
More operation time |
- DCC strategies would contribute to decreasing the risk of PGD without increasing procedure-related risks |
> PCC, N=783 |
- DCC techniques: |
More early postoperative bleeding |
|
- Indications: |
> Simple skin closure (DCC-1), N=52 |
More PGD |
|
> Acute lung edema, N=40 |
> Esmark bandage (DCC-2), N=30 |
More acute rejection |
|
> OLA, N=38 |
> Active sternal retraction with rib spreader (DCC-3), N=8 |
More 30- and 90-day mortality |
|
> Coagulopathy/bleeding, N=29 |
|
No more infection |
|
> Hemodynamic instability, N=18 |
|
- In technical comparison: |
|
|
|
> DCC-1 similar to PCC |
|
|
|
> Decreases PGD (9.6% vs. 26%) |
|
|
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> Improve survival and functional status |
|
|
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> DCC-2 and DCC-3 increase mortality |
|
Aguilar et al.[9], 2017 |
- From January 1 2010 to July 31 2014 |
- Single-center retrospective cohort study |
- Median DCC time = 2 days. |
- DCC is an independent risk factor for surgical site infection after LTx |
- 232 LTx |
- Comparison of DCC vs. PCC. |
- In DCC: |
- DCC is necessary in selected patients |
> DCC, N=67 (29%) |
- Technique: |
More infection (19% vs. 5%) |
|
> PCC, N=165 |
> Simple skin closure, N=59 |
More grades 2 and 3 PGD |
|
- Indications: |
> Rubber fish device to cover the wound, N=8 |
More intraoperative CPB |
|
> Bleeding |
|
More ischemic time |
|
> OLA |
|
More ICU time |
|
> Severe pulmonary edema |
|
Similar mortality |
|
> Hemodynamic instability |
|
|
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Rafiroiu et al.[8], 2018 (Abstract) |
- From January 2009 to January 2016. |
- Single-center retrospective cohort study |
- Mean DCC time = 4.6±2.3 days |
- Patients requiring DCC represent a high-risk group of patients undergoing LTx |
- 770 LTx |
- Comparison of DCC vs. PCC |
- In DCC: |
- DCC is not associated with increased risk of infection, morbidity, and mortality |
> DCC, N=51 (7%) |
- Technique: |
No more infection |
|
> PCC, N=719 |
> A composite material use |
Prolonged intubation |
|
- 47 pairs of DCC and PCC patients were included according to a greedy matching algorithm. |
|
More stroke |
|
- Indications: |
|
More permanent dialysis |
|
> Severe coagulopathy |
|
Similar survival |
|
> Intolerance to PCC due to hypoxia or cardiac tamponade |
|
|
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Yeginsu et al. |
- From December 2016 to January 2019 |
- Single-center retrospective cohort study |
-Mean DCC time = 3 days (2-4). |
- DCC is a safe and effective option in the management of size mismatch due to OLA |
- 60 LTx |
- Comparison of DCC vs. PCC |
- In DCC: |
- DCC may be associated with increased risk of infection |
> 20 DCC (33%) |
- Technique: |
Prolonged extubation time |
- Further studies are needed to evaluate the value of other options in the management of size mismatch as well |
> 40 PCC |
> Simple skin closure |
Prolonged ICU time |
|
- Excluded, N=16 |
|
More wound infection |
|
- 16 DCC and 28 PCC were included |
|
No more major complications |
|
Indications: |
|
No more acute rejection |
|
> Only OLA |
|
Similar median survival |
|