The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Feb 2012
Implantation of left ventricular epicardial leads in cardiosurgical patients with impaired cardiac function--a worthwhile procedure in concomitant surgical interventions?
Cardiac resynchronization therapy (CRT) by means of multisite biventricular pacing is an effective therapeutic option for the treatment of severe heart failure. The present study estimates how many open heart-surgery patients could benefit from the implantation of permanent left ventricular (LV) pacing leads. After routine preoperative screening, epicardial electrodes were implanted in selected patients. Lead performance and outcomes were investigated. ⋯ A small group of cardiac surgery patients may benefit from LV-lead implantation during concomitant procedures. A protocol for responder identification is useful. Existing devices should be upgraded to CRT systems. As CRT-ICD implantation is frequent, the additional costs and time are justified.
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Thorac Cardiovasc Surg · Feb 2012
Comparative StudyComparison between Sequential Organ Failure Assessment score (SOFA) and Cardiac Surgery Score (CASUS) for mortality prediction after cardiac surgery.
Our purpose was to evaluate and compare the accuracy of the "Sequential Organ Failure Assessment" score (SOFA) and the "Cardiac Surgery Score" (CASUS) for the prediction of mortality after cardiac surgery. ⋯ Both CASUS and SOFA are reliable mortality prediction tools after cardiac surgery. However, CASUS was more accurate in predicting the individual patient's risk of mortality. Thus, use of the CASUS in cardiac surgery intensive care units is recommended.
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Thorac Cardiovasc Surg · Feb 2012
Comparative StudyAcute renal dysfunction does not develop more frequently among octogenarians compared to septuagenarians after cardiac surgery.
We tested the hypothesis that octogenarians develop more frequently renal dysfunction compared with septuagenarians after cardiac surgery. ⋯ Octogenarians do not develop acute kidney failure more frequently than their matched septuagenarian counterparts. They can be operated on at an acceptable risk for morbidity and mortality. Preoperative impaired renal function is associated with higher risk for mortality in septuagenarians.
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Thorac Cardiovasc Surg · Feb 2012
Daily-Mean-SOFA, a new derivative to increase accuracy of mortality prediction in cardiac surgical intensive care units.
Sequential organ failure assessment (SOFA) score is widely used in many cardiac surgical intensive care units (ICUs). Its derivatives (mean and maximum values) are known to be more accurate than the original daily values of SOFA itself. However, they were designed for research purposes and could be calculated only after ICU discharge. We aimed to develop a reliable derivative that can be easily calculated daily (Daily-Mean-SOFA) for aiding daily-decision-making and resource allocation. ⋯ The Daily-Mean-SOFA is a reliable derivative for daily risk stratification in cardiac ICUs. Due to its accuracy and daily availability, it may be used for risk-directed therapy in cardiac ICUs.
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Thorac Cardiovasc Surg · Feb 2012
Comparative StudyEndurance and performance of two different concepts for left ventricular stimulation with bipolar epicardial leads in long-term follow-up.
Epicardial left ventricular (LV) leads represent an alternative for CRT therapy if transvenous lead implantation fails. Data on endurance, performance, the impact of the surgical approach (lateral minithoracotomy vs. median sternotomy simultaneously with other cardiac surgery), and the optimal technical concept (screw-in vs. suture-on) is limited. ⋯ Our study showed that the implantation of epicardial leads was safe with very low complication rates. There was no superior technical epicardial lead concept (screw-in vs. suture-on leads) and all epicardial leads demonstrated an excellent long-term performance and durability. Therefore, it seems that epicardial leads represent a good alternative to transvenous leads and surgeons should be encouraged to implant epicardial leads during concomitant cardiac surgery when the indications for CRT are present.