European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jun 2010
Comparative Study Controlled Clinical TrialUnilateral cerebral perfusion: right versus left.
Unilateral cerebral perfusion for brain protection is gaining increasing interest, although the pathways of collateral flow as well as many aspects of the surgical strategy regarding optimal perfusion pressure, flow and temperature remain unclear. This study evaluates the differences between right- and left-sided unilateral cerebral perfusion, if any, especially with regard to neurovascular monitoring findings and clinical outcome. ⋯ Unilateral cerebral perfusion under mild hypothermia is an efficient method of cerebral protection. The advantage of the right-sided perfusion in which two brain-supplying arteries are perfused could not be verified.
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Eur J Cardiothorac Surg · Jun 2010
Clinical TrialModified thromboelastography evaluation of platelet dysfunction in patients undergoing coronary artery surgery.
Anti-platelet therapy is associated with increased perioperative bleeding. Although current guidelines call for its caessation 5-10 days prior to cardiac surgery, this could constitute an increased risk of preoperative myocardial infarction. The optimal safe period from discontinuation of anti-platelet therapy to surgery is as yet unknown for the individual patient. We investigated whether preoperative thromboelastography (TEG) with platelet mapping could predict bleeding tendency in patients (on recent anti-platelet therapy) undergoing coronary artery bypass grafting (CABG). ⋯ TEG with platelet mapping is able to predict excessive postoperative blood loss among patients who underwent CABG and recent anti-platelet therapy. The prevalence of non-responsiveness to anti-platelet therapy, including clopidogrel, is higher in patients undergoing coronary artery bypass grafting than in the general population. In this study, aspirin-induced platelet dysfunction did not influence postoperative blood loss.
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Eur J Cardiothorac Surg · Jun 2010
The fate of the aortic root after early repair of tetralogy of Fallot.
Late aortic root dilatation is a growing concern in patients operated on for tetralogy of Fallot (ToF). This longitudinal follow-up study sought to evaluate the changes in the aortic root dimensions in relation to body growth, assuming that early repair of tetralogy of Fallot might prevent late aortic dilatation. ⋯ The initially dilated aortic root in tetralogy of Fallot normalises in size at the level of the annulus and sinotubular junction within 7 years after early repair. This process seems delayed at the level of the aortic sinuses, although the indexed root diameter shows significant regression over time. These results suggest that early repair of ToF abrogates the enlargement of the aortic root, validating one aspect of the need for tetralogy correction at a young age.
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Eur J Cardiothorac Surg · Jun 2010
Correction of leaflet prolapse extends the spectrum of patients suitable for valve-sparing aortic root replacement.
Preservation of the native aortic valve in patients requiring aortic root replacement avoids the need for lifelong anticoagulation and potentially offers greater durability than a bio-prosthetic valve. Such techniques have generally been applied to patients with early grades of aortic regurgitation (AR) and less severe aortic root dilatation where leaflets have been minimally stretched. We reviewed our experience with these techniques and in particular the durability of the addition of leaflet prolapse correction in patients with more advanced aortic root pathology compared to those with non-prolapsing leaflets. ⋯ Patients with large aortic root aneurysms and advanced AR often have stretched leaflets that will prolapse and lead to early failure if only root geometry is corrected. With the addition of leaflet prolapse correction, we have shown equivalent durability to those without stretched leaflets. This has allowed valve preservation in a sizable subgroup who would otherwise have received prosthetic valves. Greater patient numbers and longer follow-up are needed to fully validate this approach.
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Eur J Cardiothorac Surg · Jun 2010
Congenital heart disease: interrelation between German diagnosis-related groups system and Aristotle complexity score.
The Disease-Related Groups (DRGs) system postulates that inpatient stays with similar levels of clinical complexity are expected to consume similar amounts of resources. This, applied to surgery of congenital heart disease, suggests that the higher the complexity of procedures as estimated by the Aristotle complexity score, the higher hospital reimbursement should be. This study analyses how much case-mix index (CMI) generated by German DRG 2009 version correlates with Aristotle score. ⋯ ACC score correlates almost perfectly with corresponding cost-weights (CMI) generated by the German DRG 2009. It could therefore be used as the basis for hospital reimbursement to compensate in conformity with procedures' complexity. Extrapolated CMI in this series would be 9.264. Modulation of reimbursement according to surgical performance could be established and thus 'reward' quality in congenital heart surgery.