European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Jan 2010
Surgical treatment of prosthetic valve endocarditis in patients with double prostheses: is single-valve replacement safe?
Bias against operating on patients with prosthetic valve endocarditis (PVE) who have multiple prostheses may preclude the use of life-saving valve replacement. We investigated the accuracy of the preoperative diagnosis of PVE in patients with both mitral and aortic prosthesis and the safety of single-valve replacement when only one valve seemed infected. ⋯ TEE allowed a diagnosis of site involvement that did correlate with the anatomic diagnosis obtained during the operation. This fact contributed to the management of patients and was of great help in guiding the surgical intervention. Echo-oriented single-valve replacement may be a safe strategy for patients with PVE and double prostheses.
-
Eur J Cardiothorac Surg · Jan 2010
Surgical management of congenital heart disease: evaluation according to the Aristotle score.
The Aristotle basic complexity (ABC) score (1.5-15 points) is the sum of potentials for early mortality, morbidity and anticipated surgical technique difficulty. The Aristotle comprehensive complexity (ACC) score (1.5-25 points) is the sum of ABC score and patient-adjusted complexity score; it comprises six complexity levels. We used the ACC score to evaluate quality in surgical management of congenital heart disease. ⋯ The Aristotle score is still under development. Morbidity evaluation should be ideally based on observed postoperative complications; estimation of surgical technical difficulty chosen in this study may not be generalised. Nevertheless, the actual Aristotle comprehensive complexity score, as evaluated in its three components, accurately determined the outcome of surgical management of congenital heart disease. It appears to be an adequate tool to evaluate quality in paediatric cardiac surgery, over time.
-
Eur J Cardiothorac Surg · Jan 2010
Cardiopulmonary bypass with physiological flow and pressure curves: pulse is unnecessary!
Advocates of pulsatile flow postulate that the flow pattern during extracorporeal circulation (ECC) should be similar to the physiological one. However, the waveforms generated by clinically used pulsatile pumps are by far different from the physiological ones. Therefore, we constructed a new computer-controlled pulsator which can provide nearly physiological perfusion patterns during ECC. We compared its effect (group 1) with pulsatile (group 2) and non-pulsatile (group 3) perfusion generated by a conventional roller pump. ⋯ Even when using pulsatile flow patterns which mimic closely the physiological waveforms, there is no advantage concerning organ perfusion or inflammatory response. Moreover, the extent of haemolysis and capillary leak is higher compared to non-pulsatile perfusion. Efforts to optimise pulsatility are not justified.
-
Eur J Cardiothorac Surg · Dec 2009
Open-heart surgery in premature and low-birth-weight infants--a single-centre experience.
Because of their poor clinical status, infants may require surgery for congenital heart disease regardless of weight or prematurity. This retrospective review describes a single-centre experience with open-heart surgery in low-weight infants. ⋯ In our patient population, early mortality was higher for infants weighing less than 2.5 kg. However, within the low-weight group, lower weight at surgery or history of prematurity was not associated with a higher mortality or bad neurological outcome.
-
Eur J Cardiothorac Surg · Dec 2009
Clinical TrialPreoperative statin treatment reduces systemic inflammatory response and myocardial damage in cardiac surgery.
To determine if preoperative statin treatment is associated with a reduction in systemic inflammatory response (SIR) and myocardial damage markers following cardiac surgery with cardiopulmonary bypass (CPB). ⋯ Preoperative treatment with statins is associated with a lower biochemical parameters of SIR and myocardial damage following cardiac surgery with CPB, regardless of it being coronary bypass grafting (CABG) or valvular surgery.