The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Jul 2012
Randomized Controlled Trial Multicenter Study Comparative StudyThe German Aortic Valve Registry (GARY): a nationwide registry for patients undergoing invasive therapy for severe aortic valve stenosis.
Background The increasing prevalence of severe aortic valve defects correlates with the increase of life expectancy. For decades, surgical aortic valve replacement (AVR), under the use of extracorporeal circulation, has been the gold standard for treatment of severe aortic valve diseases. In Germany ~12,000 patients receive isolated aortic valve surgery per year. ⋯ Conclusion The implementation of new or innovative medical therapies needs supervision under the conditions of a well-structured scientific project. Up to now relevant data for implementation of TAVI and long-term results are missing. In contrast to randomized controlled trials, GARY is a prospective, controlled, 5-year observational multicenter registry, and a real world investigation with only one exclusion criterion, the absence of patients' written consent.
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Thorac Cardiovasc Surg · Jul 2012
Comparative StudyPrevention of alveolar air leakage after video-assisted thoracic surgery: comparison of the efficacy of methods involving the use of fibrin glue.
The aim of this study was to evaluate the appropriate condition of use of the fibrin glue plus polyglycolic acid (PGA) sheet combination to obtain the optimal sealing effect. ⋯ Method III was the most effective for preventing alveolar air leakage.
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Thorac Cardiovasc Surg · Jul 2012
Comparative StudyTransapical minimally invasive aortic valve implantation and conventional aortic valve replacement in octogenarians.
Transcatheter aortic valve implantation (TAVI) has been developed to minimize the operative trauma in high-risk patients. Patient selection for TAVI is still subject to debate and octogenarians are often regarded as high-risk patients. ⋯ AVR and TAVI in octogenarians show comparable results, but the analyzed cohorts differ significantly in their risk profile. The results indicate an overrated perioperative mortality using the EuroSCORE but on the other hand logistic EuroSCORE represents articulately the different risk profile of the two groups. For this reason, we consider the EuroSCORE still to be a useful tool for preoperative risk assessment. Moreover, octogenarians cannot per se be considered as "true high risk" patients. Differentiated clinical judgment is most important for reasonable decision making.