European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Apr 2006
ReviewIs extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI > or = 40.
The increasing prevalence of obesity is a public health concern and perceived as a potential risk factor in open heart surgery. We critically appraised the literature available regarding postoperative complications in obese patients. ⋯ Cardiac surgery can be performed without significant increase in perioperative and 30-day mortality in obese and extremely obese patients. Overall complication rates and LOS in patients with BMI> or =40 is increased and demands attention. We provide evidence that rates of few specific complications increase with extreme obesity. For risk stratification in the setting of an obesity epidemic, we advocate an interdisciplinary approach in obese patients undergoing elective cardiac surgery.
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Eur J Cardiothorac Surg · Apr 2006
Randomized Controlled Trial Comparative StudyEndothelial apoptosis and circulating endothelial cells after bypass grafting with and without cardiopulmonary bypass.
We compared profiles of the numbers of circulating endothelial cells (CEC) and the apoptosis-inducing capacity of serum samples on human endothelial cells (hEC) in on-pump and off-pump coronary artery bypass grafting (CABG) patients. ⋯ The number of circulating endothelial cells and apoptotic endothelial cell death are markers of endothelial activation and damage during CABG. This study provides evidence that CABG with the use of CPB in comparison to OPCAB surgery is associated with a significantly more pronounced endothelial response in the immediate postoperative period.
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Eur J Cardiothorac Surg · Apr 2006
Frequency, characteristics, and predictors of microbiologically documented nosocomial infections after cardiac surgery.
Nosocomial infections still remain a serious problem in patients undergoing open heart surgery. The objective of this study was to evaluate frequency, characteristics, and predictors of nosocomial infections after cardiac surgery. ⋯ Postoperative nosocomial infections are a considerable problem in cardiac surgery patients. The identified independent predictors of nosocomial infection may be useful in identifying those at high risk for development of such infection in cardiac surgery patients.
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Eur J Cardiothorac Surg · Apr 2006
Optimal pulmonary to systemic blood flow ratio for best hemodynamic status and outcome early after Norwood operation.
Imbalances of pulmonary to systemic blood flow ratio (Q(p)/Q(s)) compounded with inadequate systemic oxygen delivery correlate with mortality after first-stage Norwood palliation of hypoplastic left heart syndrome. Mathematical models suggest that maximal systemic oxygen delivery occurs with Q(p)/Q(s) of less than 1. Whether this applies to clinical practice is unclear. This study evaluates the level of Q(p)/Q(s) that correlates with best hemodynamic status in the first 48 postoperative hours. ⋯ Maximum oxygen delivery after Norwood operation occurs at Q(p)/Q(s) of less than 1. However, optimal hemodynamic status and end-organ function and higher survival correlates with Q(p)/Q(s) between 1 and 2. Thus, Q(p)/Q(s) should be targeted at 1.5 for improved course early after first-stage Norwood palliation.
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Eur J Cardiothorac Surg · Apr 2006
Are there accurate predictors of long-term vital and functional outcomes in cardiac surgical patients requiring prolonged intensive care?
The decision to maintain intensive treatment in cardiac surgical patients with poor initial outcome is mostly based on individual experience. The risk scoring systems used in cardiac surgery have no prognostic value for individuals. This study aims to assess (a) factors possibly related to poor survival and functional outcomes in cardiac surgery patients requiring prolonged (> or = 5 days) intensive care unit (ICU) treatment, (b) conditions in which treatment withdrawal might be justified, and (c) the patient's perception of the benefits and drawbacks of long intensive treatments. ⋯ This study of cardiac surgical patients requiring > or =5 days of intensive treatment did not identify factors unequivocally justifying early treatment limitation in individuals. It found that 1-year mortality and disability rates can be maintained at a low level in this subset of patients, and that severe suffering in the ICU is infrequent.