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
Extracorporeal membrane oxygenation support for complex tracheo-bronchial procedures†.
The published experience with advanced broncho-plastic procedures performed with extracorporeal membrane oxygenation (ECMO) support is very limited. We examined our results to assess the risks and benefits of this approach. ⋯ Based on this experience, we consider veno-arterial ECMO support as a safe and valuable approach for complex airway surgery.
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Eur J Cardiothorac Surg · Feb 2015
Longer hospital stay after Fontan completion in the November to March period.
Initial evidence suggests that total cavopulmonary connection (TCPC) completion during winter is associated with prolonged pleural effusion and hospitalization. This study was carried out to review the impact of season of operation on short-term outcome after TCPC procedure. ⋯ TCPC surgery performed in the period between November and March is associated with increased morbidity, especially longer hospitalization. Given the elective nature of TCPC operation, this operation should be scheduled outside of the NM period if possible.
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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.