European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Feb 2015
Total aortic arch replacement with frozen elephant trunk in acute type A aortic dissections: are we pushing the limits too far?†.
Acute type A aortic dissection (AADA) is a surgical emergency. In patients with aortic arch and descending aorta (DeBakey type I) involvement, performing a total aortic arch replacement with frozen elephant trunk (FET) for supposedly better long-term results is controversial. We hereby present our results. ⋯ Our results with FET in AADA show acceptable results. Total aortic arch replacement with an FET in AADA patients does demand high technical skills. In spite of this, we believe FET improves long-term outcomes in cases of AADA with intima tear or re-entry in the aortic arch or the descending aorta (DeBakey type I). Modern grafts with four side branches as well as sewing collars for the distal anastomosis have helped to further 'simplify' the FET implantation. However, such a strategy is not appropriate in all AADA cases; it should be implemented only in experienced centres and only if absolutely necessary.
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Eur J Cardiothorac Surg · Feb 2015
ReviewThe impact of anaemia and intravenous iron replacement therapy on outcomes in cardiac surgery.
Anaemia is common in patients with cardiac disease and also in those undergoing cardiac surgery. There is increasing evidence that preoperative anaemia is associated with increased patient morbidity and mortality following surgery. We performed a systematic literature review to assess the impact of anaemia and intravenous (IV) iron supplementation on outcomes in cardiac surgery. ⋯ Postoperative administration of IV iron therapy, either alone or in combination with erythropoietin, was not effective in raising Hb levels or reducing red cell concentrate transfusion. On the basis of currently available evidence, the effect of perioperative administration of IV iron to cardiac surgery patients, alone or in combination with erythropoietin, remains unproven. Well-designed and appropriately powered prospective randomized controlled trials are needed to evaluate perioperative iron supplementation in the context of cardiac surgery.
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Eur J Cardiothorac Surg · Feb 2015
Multicenter StudyMid-term results of aortic valve surgery in redo scenarios in the current practice: results from the multicentre European RECORD (REdo Cardiac Operation Research Database) initiative†.
Although commonly reported as single-centre experiences, redo aortic valve replacement (RAVR) has overall acceptable results. Nevertheless, trans-catheter aortic valve replacement has recently questioned the efficacy of RAVR. ⋯ RAVR achieves overall satisfactory results. Baseline risk factors and perioperative complications strongly affect outcomes and mandate improvements in perioperative management. New emerging strategies might be considered in selected high-risk cases.
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Eur J Cardiothorac Surg · Feb 2015
Surgeon-specific mortality data disguise wider failings in delivery of safe surgical services.
Feedback of clinical outcome data to clinicians can promote and enhance patient safety. Surgeon-specific mortality data (SSMD) have been released to the public for a number of specialties. This implies that one individual is culpable for all deaths. Debate continues about SSMD because of risk-averse behaviour. In the USA, improved outcome measures derived from phase of care mortality analysis (POCMA) and the failure to rescue (FTR) are replacing SSMD, but they have not been tested in Europe. ⋯ The study showed that most deaths cannot be prevented by the operating surgeon. They occurred through issues of patient comorbidity, lack of process or infrastructure. This casts doubt on SSMD publication alone as a tool for quality improvement. In contrast, POCMA and FTR highlight problems of process, and are more likely to promote advances in surgical care.
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Eur J Cardiothorac Surg · Feb 2015
Older age at the time of the Norwood procedure is a risk factor for early postoperative mortality†.
The Norwood procedure is commonly used as first-step palliation in children with hypoplastic left heart syndrome or related congenital malformations. In most cases, the operation is carried out during the first week of life. Excessive pulmonary blood flow in univentricular physiology can soon lead to compromised cardiac function and pulmonary hypertension and could have an influence on postoperative outcomes. ⋯ Age older than 20 days seems to be an independent risk factor for early postoperative mortality and fatal events after the Norwood procedure. Long-persisting excessive pulmonary blood flow and preoperative cardiac decompensation can be the reason for postoperative lethal pulmonary hypertensive crisis and compromised ventricular function.