European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Dec 2005
Multicenter StudyThe RACHS-1 risk categories reflect mortality and length of stay in a Danish population of children operated for congenital heart disease.
The Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) was created in order to compare in-hospital mortality for groups of children undergoing surgery for congenital heart disease. The method was evaluated with two large multi-institutional data sets-the Paediatric Cardiac Care Consortium (PCCC) and Hospital Discharge (HD) data from three states in the USA. The RACHS-1 classification was later applied to a large German paediatric cardiac surgery population in Bad Oeynhausen (BO), where it was found that the RACHS-1 categories were also associated with length of stay. We applied the RACHS-1 classification to the 957 operations performed during January 1996 to December 2002 at Skejby Sygehus, Denmark and we examined the association between the RACHS-1 categories, in-hospital mortality and length of stay in the Intensive Care Unit. ⋯ The RACHS-1 classification can also be used to predict in-hospital mortality and length of stay in the Intensive Care Unit in a small volume centre.
-
Eur J Cardiothorac Surg · Dec 2005
Randomized Controlled TrialInhaled iloprost to control residual pulmonary hypertension following pulmonary endarterectomy.
Pulmonary endarterectomy (PEA) is the standard therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH). In the immediate postoperative period, persistent pulmonary hypertension increases the risk of acute respiratory or right heart failure. In pulmonary arterial hypertension, prostanoid inhalation has been found to improve pulmonary hemodynamics, right ventricular function, gas exchange, and clinical outcome. We report the results of a double-blinded randomized trial with the aerosolized prostacyclin analogue iloprost in patients with residual pulmonary hypertension after PEA. ⋯ In addition to the effect of PEA, iloprost reduces residual postoperative pulmonary hypertension, decreases right ventricular afterload and may facilitate the early postoperative management after PEA.
-
Eur J Cardiothorac Surg · Dec 2005
Randomized Controlled TrialVentilation according to the open lung concept attenuates pulmonary inflammatory response in cardiac surgery.
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response, which is correlated with outcome. We hypothesized that ventilation according to the open lung concept (OLC) attenuates cytokine release. ⋯ OLC ventilation leads to an attenuated inflammatory response, presumably by reducing additional lung injury after cardiac surgery. Studies on cytokines after cardiac surgery should take these findings into account.
-
Eur J Cardiothorac Surg · Dec 2005
Perioperative diagnosis of mesenteric ischemia in acute aortic dissection by transesophageal echocardiography.
Although computed tomography, angiography, or magnetic resonance imaging is most commonly used for diagnosing mesenteric ischemia caused by acute aortic dissection, use of these modalities is often limited in the perioperative period. Thus, we have introduced transesophageal echocardiography to cover this deficit. Purpose of this study is to report the feasibility and accuracy of transesophageal echocardiographic diagnosis on mesenteric ischemia. ⋯ The transesophageal echocardiographic assessment is feasible in nearly all patients and potentially provides correct diagnosis on intestinal ischemia in the perioperative period of acute aortic dissection. Types C and D indicate significant mesenteric malperfusion.
-
Eur J Cardiothorac Surg · Dec 2005
Case ReportsDelayed visceral malperfusion in aortic dissection-successful surgical revascularization using a saphenous vein graft.
Obstruction of the thoracoabdominal aorta and/or its branches with subsequent organ ischemia is a frequent complication of aortic dissection. Surgical and percutaneous fenestrations have been used and endovascular stenting has emerged as an additional less invasive approach. In some cases, surgical revascularization may be the most successful procedure. We report two patients who underwent surgical revascularization of the celiac trunk and superior mesenteric artery for delayed abdominal malperfusion due to aortic dissection.