European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 2009
Multicenter StudyThe Chinese coronary artery bypass grafting registry study: how well does the EuroSCORE predict operative risk for Chinese population?
The European System for Cardiac Operative Risk Evaluation (EuroSCORE) model is a widely used risk prediction algorithm for cardiac surgery in China due to lack of a local model, although its validation has never been tested. The aim of this study was to assess the performance of the logistic EuroSCORE when applied in the Chinese Coronary Artery Bypass Grafting Registry database, which is representative of adult cardiac surgery in China. ⋯ EuroSCORE model does not accurately predict outcomes in this group of Chinese CABG patients. Therefore, caution should be exercised when using it for risk prediction in China. Creation of a new model, which accurately predicts outcomes in Chinese CABG patients, is warranted.
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Eur J Cardiothorac Surg · Jan 2009
Aortic root replacement in children: a word of caution about valve-sparing procedures.
Evaluate the results of various surgical procedures used for aortic root replacement in children with aortic root aneurysm. ⋯ (1) composite valve graft aortic root replacement provides excellent long-term results in children with aortic root aneurysm due to connective tissue disorder. This remains the first choice procedure in patients with more than minimal aortic insufficiency, with distorted aortic leaflets or needing concomitant mitral valve replacement. (2) Valve-sparing remodeling surgery yields disappointing results and should probably be abandoned in the pediatric population. (3) Valve-sparing reimplantation repair may achieve superior outcome but needs further evaluation.
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Eur J Cardiothorac Surg · Jan 2009
Randomized Controlled Trial Comparative StudyA method to distinguish between gaseous and solid cerebral emboli in patients with prosthetic heart valves.
The difficulty of distinguishing solid from air emboli using transcranial Doppler has limited its use in situations where both types of emboli can occur, such as in mechanical heart valve patients. To make transcranial Doppler clinically useful, a method must be found to distinguish benign air bubbles from the more damaging solid particulates. Since inhalation of 100% oxygen reduces the amount of air bubbles in mechanical heart valve patients, the ultrasonic features of the remaining emboli would be characteristic of solid particulates. ⋯ The use of a signal intensity cut-off offers adequate discrimination of the embolic composition in mechanical heart valve patients. Future studies evaluating prophylactic treatments of thrombosis in these patients should assess the predictive value of this intensity threshold and their potential association with outcome indicators and procoagulant markers.
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Eur J Cardiothorac Surg · Jan 2009
Randomized Controlled Trial Comparative StudyComparison of the single or double chest tube applications after pulmonary lobectomies.
Draining of the chest cavity with two chest tubes after pulmonary lobectomy is a common practice. This study aimed to investigate whether using two tubes after a pulmonary lobectomy is more effective than using a single tube. ⋯ Insertion of two chest tubes is not more effective than the insertion of a single chest tube after pulmonary lobectomy. Moreover, using a single tube is in fact more effective than using two tubes in that it causes less postoperative pain and less pleural fluid loss.
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Eur J Cardiothorac Surg · Jan 2009
Randomized Controlled TrialPresence of coronary collaterals is associated with a decreased incidence of cognitive decline after coronary artery bypass surgery.
Coronary artery bypass grafting (CABG) is associated with significant cerebral morbidity, usually manifested as cognitive decline or stroke. The underlying mechanism leading to cognitive decline is still unclear. Presence of coronary collateral arteries, which may reflect an overall better cardiovascular condition, recently appeared to relate to a better cardiac outcome after CABG. In this study, we investigated the hypothesis that presence of coronary collaterals is associated with less cognitive decline after coronary artery bypass grafting. ⋯ In patients undergoing first-time coronary artery bypass grafting, presence of coronary collaterals is associated with a decreased risk of cognitive decline at both 3 and 12 months of follow-up. This trend persists at 5-year follow-up. Preoperative differences in the cardiac vascular condition may therefore predict cognitive outcome in patients undergoing coronary artery bypass grafting.