Should you stand on the left or the right of a patient with dextrocardia who needs coronary surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was which side of the operating table you should stand on when carrying out surgical revascularization on a patient with dextrocardia. Altogether 40 papers were found using the reported search, of which 19 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers are tabulated. The side on which the operating surgeon stood was mentioned in 20 out of the 24 cases. Surgery was carried out from the conventional right side of the patient in 5 cases, while in 10 cases, it was carried out from the left side. The surgeon needed to switch sides to facilitate surgery in three cases. In addition, the right internal mammary artery (RIMA) was anastomosed to the left anterior descending artery (LAD) in 16 cases. Of these, surgery was carried out from the left side in 11 cases. The left internal mammary artery (LIMA) to LAD anastomosis was carried out in two cases, one of which was a free LIMA graft. In six cases, only vein grafts were used. Fourteen cases were carried out using cardiopulmonary bypass while 10 cases were carried out as off-pump cases with one conversion. The majority of patients were operated on from the left of the table. More cases were performed with the RIMA as the conduit of choice to the LAD.
Saad
Rasheed A
RA
Department of Cardio-thoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK. rasheed.saad@doctors.net.uk
Badr
Adel
A
Goodwin
Andrew T
AT
Dunning
Joel
J
D000368:Aged; D019985:Benchmarking; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D003914:Dextrocardia / Q000150:complications*; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D016896:Treatment Outcome