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 2005
Surgical outcomes in congenital heart disease: expectations and realities.
The past 50 years of congenital heart surgery has produced enormous progress. Current results surpass expectations. Yet there are important residual problems in patients growing up after heart surgery for congenital heart disease. ⋯ Both Registry and Academic databases have much to offer in improving care for future patients. Yet overzealous privacy laws threaten the knowledge base provided by computerized databases. We need to guide our legislators in ensuring that the valuable resource provided by database technology is not lost.
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Eur J Cardiothorac Surg · May 2005
Comparative StudyArch-first technique performed under hypothermic circulatory arrest with retrograde cerebral perfusion improves neurological outcomes for total arch replacement.
From 1998, we have adopted the arch first technique (reconstruction of arch vessels first and distal anastomosis second) instead of the distal anastomosis first technique for total arch replacement. The aim is to reduce the period of deep hypothermic circulatory arrest and the retrograde cerebral perfusion time. We evaluate the surgical results of the arch first technique. ⋯ The arch first technique is clearly superior to the conventional distal first technique in surgical mortality and morbidity regarding neurological outcome, and provides a higher survival rate and better quality of life. The arch first technique is an excellent method for total arch replacement.
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Eur J Cardiothorac Surg · May 2005
Evaluation of Cystatin C as a marker of renal injury following on-pump and off-pump coronary surgery.
Cardiopulmonary bypass is regarded as an important contributor to renal injury, whereas off-pump surgery is considered less damaging. Cystatin C, a cystine protease inhibitor, is more sensitive and specific than creatinine in the assessment of renal function. We assessed the value of Cystatin C in quantifying clinical and subclinical renal injury following on-pump and off-pump cardiac surgery. ⋯ Avoidance of cardiopulmonary bypass may reduce renal injury particularly in higher risk patients. Cystatin C proved to be a simple and sensitive measure of overall renal function and can be used in the routine assessment of renoprotective strategies.
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The relationship between the timing of intra-aortic balloon pump (IABP) support and surgical outcome remains a subject of debate. Peri-operative mechanical circulatory support is commenced either prophylactically or after increasing inotropic support has proved inadequate. This study evaluates the effect timing of IABP support on the 1-year survival of patients undergoing cardiac surgery. ⋯ Patients who warrant IABP support in the post-operative setting have a significantly increased mortality at 1-year when compared to any other group. Therefore, earlier IABP support as part of surgical strategy may help to improve the outcome.
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Eur J Cardiothorac Surg · May 2005
Assessment of node dissection for clinical stage I primary lung cancer by VATS.
The feasibility of systematic node dissection (SND) for stage I primary lung cancer by video-assisted thoracic surgery (VATS) remains controversial. The aim of this study was to assess the feasibility of SND by VATS. ⋯ The SND by VATS was as technically feasible as SND through OT regarding number of dissected nodes and morbidity. It seems acceptable as an oncological treatment for clinical stage I lung cancer.