European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Apr 2006
Multicenter StudyCurrent percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease. Insights from the SYNTAX run-in phase.
Percutaneous coronary intervention with drug-eluting stents is challenging coronary artery bypass grafting (CABG) as the gold standard for treatment of three-vessel and left main coronary disease. We evaluated the current practice pattern in hospitals throughout Europe and USA. ⋯ In patients with multivessel or left main disease, still coronary artery bypass grafting remains the dominant revascularization strategy. Percutaneous coronary intervention is performed frequently without supporting data from the literature. Percutaneous coronary intervention for this indication is performed more often in Europe than in USA. Only a minority of the patients receives total arterial grafting in case of coronary artery bypass grafting. The SYNTAX trial with randomized and registry cohorts should provide guidance for selecting the preferred form of treatment.
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Eur J Cardiothorac Surg · Feb 2006
Multicenter StudyAprotinin decreases reperfusion injury and allograft dysfunction in clinical lung transplantation.
Primary graft dysfunction caused by ischemia-reperfusion injury is one of the most frequent causes of early morbidity and death after lung transplantation. We hypothesized that the perioperative management with aprotinin decreases the incidence of allograft reperfusion injury and dysfunction after clinical lung transplantation. ⋯ Severe PTRI increased short-term morbidity and mortality. The incidence of reperfusion injury was not dependent upon the duration of donor organ ischemia. The use of aprotinin in the perioperative patient management in lung transplantation had strong beneficial effects on the patient outcomes and decreased the incidence of post-transplant ischemia-reperfusion injury significantly.
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Eur J Cardiothorac Surg · Dec 2005
Multicenter StudyThe RACHS-1 risk categories reflect mortality and length of stay in a Danish population of children operated for congenital heart disease.
The Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) was created in order to compare in-hospital mortality for groups of children undergoing surgery for congenital heart disease. The method was evaluated with two large multi-institutional data sets-the Paediatric Cardiac Care Consortium (PCCC) and Hospital Discharge (HD) data from three states in the USA. The RACHS-1 classification was later applied to a large German paediatric cardiac surgery population in Bad Oeynhausen (BO), where it was found that the RACHS-1 categories were also associated with length of stay. We applied the RACHS-1 classification to the 957 operations performed during January 1996 to December 2002 at Skejby Sygehus, Denmark and we examined the association between the RACHS-1 categories, in-hospital mortality and length of stay in the Intensive Care Unit. ⋯ The RACHS-1 classification can also be used to predict in-hospital mortality and length of stay in the Intensive Care Unit in a small volume centre.
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To evaluate the outcomes of mitral valve surgery in octogenarians. ⋯ Octogenarians undergoing mitral valve surgery have significantly greater incidence of urgent surgery, ischemic disease requiring combined revascularization surgery, and have decreased rates of survival. While caution is required when operating on these higher risk elderly patients, overall 52.3% of the octogenarians are alive at 7-years following surgery, which is greater than the survival of octogenarians in the community. The greatest survival benefit within octogenarians occurred when mitral valve repair was possible over replacement. Further study will more clearly define subgroups of octogenarians with potentially greater benefit from mitral valve surgery.
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Eur J Cardiothorac Surg · Jul 2005
Multicenter StudyDoes size matter? Larger Blalock-Taussig shunt in the modified Norwood operation correlates with better hemodynamics.
Excess pulmonary to systemic blood flow ratio (Qp/Qs) correlates with hemodynamic instability and mortality after modified Norwood operation. Studies suggest that maximal oxygen delivery occurs at a Qp/Qs of around 1. The use of a rather small modified Blalock-Taussig shunt (MBTS) is believed to achieve this goal. However, optimal MBTS size with respect to postoperative hemodynamics remains unclear. ⋯ Monitoring of the central venous oxygen saturations and application of afterload reduction in cases of high Qp/Qs allows the insertion of a larger MBTS without association with lower oxygen delivery. In fact, better hemodynamic status with less inotropic support was noted with a larger MBTS early after Norwood operation.