The Thoracic and cardiovascular surgeon
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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.
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Thorac Cardiovasc Surg · Feb 2012
Case ReportsAortic leaflet replacement with fresh autologous pericardium: at 17-year follow-up.
Fresh autologous pericardium is an alternative aortic valve substitute for children; however, the data were scarce and mixing. We presented a case of a 2-year-old boy who underwent right coronary leaflet replacement with fresh autologous pericardium and ventricular septal defect correction. At 17-year follow-up, the valve was in good condition and the patient remained asymptomatic without any medication.
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Thorac Cardiovasc Surg · Dec 2011
Case ReportsEndobronchial valve for secondary pneumothorax in a severe emphysema patient.
Secondary pneumothorax represents a challenging problem in patients with chronic obstructive pulmonary disease, due to their compromised health status. In this case, an endobronchial one-way valve was inserted in the left lower lobe by flexible bronchoscopy, resulting in a complete resolution of air leak and lung reexpansion. Endobronchial valve could represent a new option for the management of persistent air leak in patients not suitable for surgical procedures.