European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jun 2007
Cost reduction of perioperative coagulation management in cardiac surgery: value of "bedside" thrombelastography (ROTEM).
Demographic changes and aggressive platelet inhibition have resulted in a marked increase in blood- and coagulation product expenditure and costs in cardiac surgery. We analyzed "bedside" coagulation test (ROTEM) in order to verify clot forming quality for the purpose of finding a cost-effective treatment path. ⋯ Cumulative costs for treatment of perioperative coagulation disorders can be reduced by "bedside" ROTEM analysis to achieve a selective substitution management. Saved costs for blood- and coagulation products clearly outweighed the expenses of ROTEM. Adequate differential coagulation management can therefore be cost-effective.
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Eur J Cardiothorac Surg · Jun 2007
Midterm follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure.
Extracardiac conduit Fontan procedure has some theoretical advantages over other types of Fontan procedures, such as optimized flow dynamics, a lower frequency of arrhythmias, and technical ease of procedure. However, lack of growth potential and thrombogenicity of the artificial conduit is the main concern and can possibly lead to reoperation for the conduit stenosis. In this study, we investigated the change and the status of the Gore-Tex graft used in extracardiac conduit Fontan procedure. ⋯ During midterm follow-up of about 3 years, the conduit cross-sectional area decreased by 14%, and this did not differ according to the conduit size used. The extent of decrease of the conduit cross-sectional area remained stable irrespective of the follow-up duration. Sixteen millimeters conduit showed no evidence of clinically significant stenosis, but careful follow-up is warranted because of the possible conduit stenosis relative to the patients' somatic growth.
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Eur J Cardiothorac Surg · Jun 2007
Review Meta AnalysisHeparin-bonded circuits versus nonheparin-bonded circuits: an evaluation of their effect on clinical outcomes.
Heparinization of the blood contact surface in cardiopulmonary bypass circuits has been promoted as an important step in the development of open heart surgery. As it decreases the inflammatory response resulting from the extracorporeal circulation, it may have a positive effect on clinical outcomes. This meta-analysis was carried out to examine if heparin-bonded circuits (HBCs) reduce the need for blood products and improve overall clinical outcome. ⋯ HBCs had no effect on other adverse events evaluated. Although HBCs showed a positive effect on some of the clinical outcomes, we identified only marginal differences for other outcomes. Further evaluation of the cost-effectiveness of this technology is required.
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Eur J Cardiothorac Surg · Jun 2007
Comparative StudyComparison of on pump and off pump coronary surgery: risk factors for neurological outcome.
Cerebrovascular accidents (CVA) are devastating complications after coronary artery bypass grafting (CABG). The reported incidence of neurological complications after conventional CABG (CCABG) is 3-6%. Off-pump coronary bypass grafting (OPCAB) has been associated in recent studies to a decreased morbidity and risk of perioperative stroke. Nevertheless, uncertainty still surrounds the relative benefits of OPCAB. We investigated whether, in our experience, OPCAB was associated with lower neurological morbidity than conventional CABG approach. ⋯ In our experience patients undergoing CCABG were not exposed to a greater risk of neurological adverse events when compared to OPCAB patients.
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Eur J Cardiothorac Surg · Jun 2007
Videothoracoscopic silver nitrate pleurodesis for primary spontaneous pneumothorax: an alternative to pleurectomy and pleural abrasion?
The optimal surgical management of primary spontaneous pneumothorax (PSP) is still controversial, especially in terms of the technique to be used. The aim of this paper was to report our experience of videothoracoscopic silver nitrate pleurodesis (VATSNP). ⋯ It is one of the first reports on the use of video-assisted thoracoscopic silver nitrate pleurodesis for PSP. We demonstrate safety and effectiveness of the procedure with long-term results comparable with standard open pleural abrasion or pleurectomy.