The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Feb 2012
Comparative StudyAcute renal dysfunction does not develop more frequently among octogenarians compared to septuagenarians after cardiac surgery.
We tested the hypothesis that octogenarians develop more frequently renal dysfunction compared with septuagenarians after cardiac surgery. ⋯ Octogenarians do not develop acute kidney failure more frequently than their matched septuagenarian counterparts. They can be operated on at an acceptable risk for morbidity and mortality. Preoperative impaired renal function is associated with higher risk for mortality in septuagenarians.
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Thorac Cardiovasc Surg · Feb 2012
Daily-Mean-SOFA, a new derivative to increase accuracy of mortality prediction in cardiac surgical intensive care units.
Sequential organ failure assessment (SOFA) score is widely used in many cardiac surgical intensive care units (ICUs). Its derivatives (mean and maximum values) are known to be more accurate than the original daily values of SOFA itself. However, they were designed for research purposes and could be calculated only after ICU discharge. We aimed to develop a reliable derivative that can be easily calculated daily (Daily-Mean-SOFA) for aiding daily-decision-making and resource allocation. ⋯ The Daily-Mean-SOFA is a reliable derivative for daily risk stratification in cardiac ICUs. Due to its accuracy and daily availability, it may be used for risk-directed therapy in cardiac ICUs.
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Thorac Cardiovasc Surg · Feb 2012
Case ReportsAortic leaflet replacement with fresh autologous pericardium: at 17-year follow-up.
Fresh autologous pericardium is an alternative aortic valve substitute for children; however, the data were scarce and mixing. We presented a case of a 2-year-old boy who underwent right coronary leaflet replacement with fresh autologous pericardium and ventricular septal defect correction. At 17-year follow-up, the valve was in good condition and the patient remained asymptomatic without any medication.
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Thorac Cardiovasc Surg · Feb 2012
Implantation of left ventricular epicardial leads in cardiosurgical patients with impaired cardiac function--a worthwhile procedure in concomitant surgical interventions?
Cardiac resynchronization therapy (CRT) by means of multisite biventricular pacing is an effective therapeutic option for the treatment of severe heart failure. The present study estimates how many open heart-surgery patients could benefit from the implantation of permanent left ventricular (LV) pacing leads. After routine preoperative screening, epicardial electrodes were implanted in selected patients. Lead performance and outcomes were investigated. ⋯ A small group of cardiac surgery patients may benefit from LV-lead implantation during concomitant procedures. A protocol for responder identification is useful. Existing devices should be upgraded to CRT systems. As CRT-ICD implantation is frequent, the additional costs and time are justified.
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Thorac Cardiovasc Surg · Dec 2011
Case ReportsEndobronchial valve for secondary pneumothorax in a severe emphysema patient.
Secondary pneumothorax represents a challenging problem in patients with chronic obstructive pulmonary disease, due to their compromised health status. In this case, an endobronchial one-way valve was inserted in the left lower lobe by flexible bronchoscopy, resulting in a complete resolution of air leak and lung reexpansion. Endobronchial valve could represent a new option for the management of persistent air leak in patients not suitable for surgical procedures.