European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2004
Multicenter StudyLessons learned from the data analysis of the second harvest (1998-2001) of the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database.
The analysis of the second harvest of the STS Congenital Heart Surgery Database produced meaningful outcome data and several critical lessons relevant to congenital heart surgery outcomes analysis worldwide. ⋯ Lessons from this data harvest should improve congenital heart surgery outcome analysis.
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Eur J Cardiothorac Surg · Jul 2004
Case ReportsTreatment of acute heart failure in an infant after cardiac surgery using levosimendan.
An infant, 2 months old, underwent cardiac surgery because of congenital heart defects and pulmonary hypertension. Surgery was performed in hypothermia and cardiac standstill. On the second day after surgery the infant had to be resuscitated due to a combination of acute left-ventricular failure, pulmonary vascular hypertension and a slight right-to-left-shunt. A breakthrough in the treatment was achieved by using levosimendan to improve left-ventricular function and to decrease vascular resistance.
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Eur J Cardiothorac Surg · Jul 2004
Repair of atrioventricular valve regurgitation in the modified Fontan operation.
To evaluate the prevalence, impact and outcome of repair of atrioventricular valve regurgitation (AVVR) in Fontan patients. ⋯ Trivial to mild AVVR remains stable and their repair during the Fontan operation provides no additional benefits. Valve repair in patients with moderate to severe AVVR improved the regurgitation with comparable operative mortality and long-term outcome; however, similar benefits could be achieved without repair of the atrioventricular valve. We should not deny patients with similar AVVR the Fontan operation.
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Eur J Cardiothorac Surg · Jul 2004
The RACHS-1 risk categories reflect mortality and length of hospital stay in a large German pediatric cardiac surgery population.
The Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) was published in January 2002, based on 4370 operations registered by the Pediatric Cardiac Care Consortium. It is designed for being easily applicable also for retrospective analysis of hospital discharge data sets; the classification was not developed for patients with heart transplantations, ventricular assist devices or patients above 18 years. We apply this classification to our 2368 correspondent procedures that were performed consecutively on 2223 patients between June 1996 and October 2002 in Bad Oeynhausen and analyze its relation to mortality and length of hospital stay. ⋯ The RACHS-1 classification is applicable to European pediatric populations, too. Category Distribution, outcome class distinction capacity, distribution and mortality are similar. RACHS-1 is able to classify patients into significantly different groups concerning total and postoperative hospital stay duration, although there remains a large variability within the groups.
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Eur J Cardiothorac Surg · Jul 2004
Factors excercising an influence on recovery of hibernating myocardium after coronary artery bypass grafting.
Coronary artery bypass grafting (CABG) in patients with endstage coronary disease (CAD) significantly improves symptoms and prolongs life expectancy. Left ventricular function is also improved in some patients, but not in others. Factors which influence functional recovery of hibernating myocardium after revascularization are at present under investigation. ⋯ We conclude that in patients with endstage CAD myocardial recovery after coronary revascularization can be predicted using DE and MRI preoperatively. Myocardial regions without any potential of functional recovery show less adaptation (less pronounced myocardial cell hypertrophy), a more severe degree of myocardial architecture destruction and a higher degree of anti-apoptotic gene expression. We recommend a myocardial biopsy when DE and MRI are not favorable in a patient with end stage coronary artery disease referred to us with the option of heart transplantation or coronary bypass.