European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 2010
Cardiopulmonary bypass with physiological flow and pressure curves: pulse is unnecessary!
Advocates of pulsatile flow postulate that the flow pattern during extracorporeal circulation (ECC) should be similar to the physiological one. However, the waveforms generated by clinically used pulsatile pumps are by far different from the physiological ones. Therefore, we constructed a new computer-controlled pulsator which can provide nearly physiological perfusion patterns during ECC. We compared its effect (group 1) with pulsatile (group 2) and non-pulsatile (group 3) perfusion generated by a conventional roller pump. ⋯ Even when using pulsatile flow patterns which mimic closely the physiological waveforms, there is no advantage concerning organ perfusion or inflammatory response. Moreover, the extent of haemolysis and capillary leak is higher compared to non-pulsatile perfusion. Efforts to optimise pulsatility are not justified.
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Eur J Cardiothorac Surg · Jan 2010
Comparative StudyPostoperative change in pulmonary function of the ipsilateral preserved lung after segmentectomy versus lobectomy.
Anatomical repositioning and expansion of the ipsilateral preserved lung after lung resection may influence postoperative pulmonary function. To study the postoperative changes in pulmonary function of the preserved lung after lobectomy compared with that after segmentectomy, the preoperative and postoperative forced expiratory volume in 1s (FEV(1)) of the ipsilateral non-operated lobe was measured using perfusion single-photon-emission computed tomography and computed tomography (SPECT/CT). ⋯ The FEV(1) of the ipsilateral non-operated lobes increased after surgery on left upper lobe, whereas it decreased after right upper lobectomy. The surgery on lower lobe did not affect the FEV(1) of the ipsilateral non-operated lobes. Our data may facilitate determining the indications for lung cancer surgery, especially in patients with tumours involving the upper lobes.
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Eur J Cardiothorac Surg · Jan 2010
Surgical management of congenital heart disease: evaluation according to the Aristotle score.
The Aristotle basic complexity (ABC) score (1.5-15 points) is the sum of potentials for early mortality, morbidity and anticipated surgical technique difficulty. The Aristotle comprehensive complexity (ACC) score (1.5-25 points) is the sum of ABC score and patient-adjusted complexity score; it comprises six complexity levels. We used the ACC score to evaluate quality in surgical management of congenital heart disease. ⋯ The Aristotle score is still under development. Morbidity evaluation should be ideally based on observed postoperative complications; estimation of surgical technical difficulty chosen in this study may not be generalised. Nevertheless, the actual Aristotle comprehensive complexity score, as evaluated in its three components, accurately determined the outcome of surgical management of congenital heart disease. It appears to be an adequate tool to evaluate quality in paediatric cardiac surgery, over time.
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Eur J Cardiothorac Surg · Jan 2010
Surgical treatment of prosthetic valve endocarditis in patients with double prostheses: is single-valve replacement safe?
Bias against operating on patients with prosthetic valve endocarditis (PVE) who have multiple prostheses may preclude the use of life-saving valve replacement. We investigated the accuracy of the preoperative diagnosis of PVE in patients with both mitral and aortic prosthesis and the safety of single-valve replacement when only one valve seemed infected. ⋯ TEE allowed a diagnosis of site involvement that did correlate with the anatomic diagnosis obtained during the operation. This fact contributed to the management of patients and was of great help in guiding the surgical intervention. Echo-oriented single-valve replacement may be a safe strategy for patients with PVE and double prostheses.