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 2004
Multicenter StudyThe Aristotle score: a complexity-adjusted method to evaluate surgical results.
Quality control is difficult to achieve in Congenital Heart Surgery (CHS) because of the diversity of the procedures. It is particularly needed, considering the potential adverse outcomes associated with complex cases. The aim of this project was to develop a new method based on the complexity of the procedures. ⋯ A complexity-adjusted method named the Aristotle Score, based on the complexity of the surgical procedures has been developed by an international group of experts. The Aristotle score, electronically available, was introduced in the EACTS and STS databases. A validation process evaluating its predictive value is being developed.
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Eur J Cardiothorac Surg · May 2004
Multicenter StudyRoss and Ross-Konno procedure in children and adolescents: mid-term results.
The aim of the study was to analyze mid-term results of aortic root replacement with pulmonary autograft in children and adolescents in two centers. ⋯ Our 7 years experience with the Ross and Ross-Konno operation has shown excellent mid-term results, with mortality rate approaching zero in both simple and complex left heart lesions, even in the neonates and infants. It is a procedure of choice in children with severe anomaly of the aortic valve and/or left ventricular outflow tract obstruction. The main concern is dilatation of the neo-aortic root leading to progression of AR, especially in the settings of geometric mismatch of aortic and pulmonary roots and bicuspid, regurgitant aortic valve. The risk of autograft failure in these specific subsets of patients remains to be determined.
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Eur J Cardiothorac Surg · Dec 2003
Multicenter StudySafe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve.
Off-pump coronary artery bypass (OPCAB) hopes to avoid morbidity associated with cardiopulmonary bypass, improving clinical outcomes. Yet its technical difficulty and unfamiliarity raise concern that adoption of OPCAB might be associated with poorer outcomes during each surgeon's 'learning curve'. We examined trends in patient selection over time as a single surgeon's practice evolved to routine OPCAB. ⋯ Despite a significant learning curve, evolution to routine OPCAB can be achieved while maintaining good patient outcomes. The development of specialized techniques, coronary stabilizers, and apical suction devices allows the application of OPCAB to virtually all coronary bypass patients, as surgeon experience matures.
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Eur J Cardiothorac Surg · Nov 2002
Multicenter StudyIndications and results of sleeve carinal resection.
Carinal resection is the most complicated procedure in tracheobronchial surgery. The main aspects of the technique are still debated at the present time. We present our experience of 231 carinal resections with analysis of operative techniques, complications and long-term survival. ⋯ The feasibility of carinal resection is limited by the patient's functional status and extension of tumor growth. Thorough selection of patients may improve immediate and long-term results.
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Eur J Cardiothorac Surg · Aug 2000
Multicenter Study Comparative StudyThe long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions.
Over the last 15 years we have managed patients with malignant pleural effusion, using a single procedure with thoracoscopy and talc pleurodesis or shunt as appropriate. Talc pleurodesis remains our primary treatment option but in those patient shown to have the 'trapped lung syndrome', in whom pleurodesis would fail, we have been using a pleuroperitoneal shunt. ⋯ Pleuroperitoneal shunt insertion provides effective and safe palliation for malignant pleural effusion when associated with the 'trapped lung syndrome'. There are however complications which require revision or shunt removal. There is no evidence that peritoneal deposits result from pleuroperitoneal shunting.