European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Nov 2009
An initial evaluation of post-cardiopulmonary bypass acute kidney injury in swine.
Acute kidney injury (AKI) post-cardiac surgery is associated with mortality rates approaching 20%. The development of effective treatments is hindered by the poor homology between rodent models, the mainstay of research into AKI, and that which occurs in humans. This pilot study aims to characterise post-cardiopulmonary bypass (CPB) AKI in an animal model with potentially greater homology to cardiac surgery patients. ⋯ The porcine model of post-CPB AKI shows significant homology to AKI in cardiac surgical patients. It links functional, urinary and histological measures of kidney injury and may offer novel insights into the mechanisms underlying post-CPB AKI.
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Eur J Cardiothorac Surg · Nov 2009
Multicenter StudyAn adjusted EuroSCORE model for high-risk cardiac patients.
To verify the accuracy and precision of the logistic European system for cardiac operative risk evaluation (EuroSCORE) in high-risk cardiac surgery patients and to develop and externally validate a new system of recalibration. ⋯ Recalibration of the logistic EuroSCORE in high-risk patients is needed due to its tendency to overestimate the mortality risk. The application of a variable correction factor results in a better performance, increased precision, with unaltered balanced accuracy.
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Eur J Cardiothorac Surg · Nov 2009
Clinical TrialRisk factors of atrial fibrillation following off-pump coronary artery bypass graft surgery: predictive value of C-reactive protein and transfusion requirement.
Considering the role of inflammatory reaction on the pathogenesis of atrial fibrillation (AF), the aim of this study is to investigate perioperative risk factors of AF, as well as to validate the predictive value of high-sensitive C-reactive protein (hsCRP), and transfusion requirement following off-pump coronary bypass surgery (OPCAB) in a prospective and observational trial. ⋯ Prophylactic strategies aimed at AF reduction may also be considered especially in patients with increased transfusion requirement, which showed highest predictive value for postoperative AF.
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Eur J Cardiothorac Surg · Nov 2009
Comparative StudyUse of aprotinin in cardiac surgery: effectiveness and safety in a population-based study.
The effectiveness and safety of aprotinin use in cardiac surgery have been questioned. More data reflecting everyday clinical practice from large-scale, unselected populations are needed. We compared the effectiveness and safety of aprotinin in cardiac surgery with those of tranexamic acid in a follow-up study using the population-based Danish health-care databases. ⋯ Aprotinin treatment was associated with an increased use of plasma and platelet transfusion and an increased risk for postoperative dialysis, but not with other adverse outcomes, including short-term mortality.
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Eur J Cardiothorac Surg · Nov 2009
Aprotinin in cardiac surgery patients: is the risk worth the benefit?
Aprotinin is the only Food and Drug Administration-approved agent to reduce haemorrhage related to cardiac surgery and its safety and efficacy has been extensively studied. Our study sought to compare the efficacy, early and late mortality and major morbidity associated with aprotinin compared with e-aminocaproic acid (EACA) in cardiac surgery operations. ⋯ Aprotinin decreases the rate of postoperative blood transfusion and haemorrhage-related re-exploration, but increases the risk of in-hospital cardiac arrest and late mortality after cardiac surgery when compared to EACA. Cumulative evidence suggests that the risk associated with aprotinin may not be worth the haemostatic benefit.