European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Feb 2012
Myocardial metabolism and diastolic function after aortic valve replacement for aortic stenosis: influence of patient-prosthesis mismatch.
This study evaluated the impact of patient-prosthesis mismatch on myocardial function and high-energy phosphate metabolism after aortic valve replacement for pure aortic stenosis. Patients with and without patient-prosthesis mismatch were compared using magnetic resonance techniques. ⋯ Aortic valve replacement leads to early improvement of left ventricle function and myocardial metabolism in all patients regardless of the occurrence of patient-prosthesis mismatch.
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Eur J Cardiothorac Surg · Feb 2012
Meta AnalysisIntra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis.
Coronary artery bypass surgery can offer excellent results when performed with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). The debate as to which technique is superior remains unanswered. Intra-operative conversion from off- to on-pump coronary surgery is a relatively unexplored phenomenon, which cannot be assessed within randomised controlled trial design. ⋯ Overall, conversion increased mortality by an odds ratio of 6.18 (95% confidence interval 4.65-8.20), whereas emergency conversion further raised the odds ratio of mortality to 6.99 (95% confidence interval 5.18-9.45). The conversion from off- to on-pump cardiac surgery may significantly increase the chance of an adverse outcome, whereas emergency conversion confers a significant rise in mortality. The risk of conversion should be discussed when obtaining the patient's informed consent and its prevention warrants serious consideration by cardiac surgeons and cardiac surgical training programmes.
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Eur J Cardiothorac Surg · Feb 2012
Washing of irradiated red blood cells in paediatric cardiopulmonary bypass: is it clinically useful? A retrospective audit.
Despite the introduction of smaller cardiopulmonary bypass (CPB) circuits for paediatrics, it is frequently necessary to add irradiated red blood cell concentrate (IRBC) to maintain adequate haemoglobin levels and the oxygen carrying capacity. Irradiation of blood weakens the cell membranes and results in an increase of lactate and potassium concentration. In addition, prolonged shelf time of IRBC may enhance its lactate level. To avoid the adverse effects of increased lactate and potassium concentration during paediatric bypass, prewashing of homologous blood in a cell-saving device was implemented at our institution. A retrospective audit of clinical data was performed to assess the relevance of this method. ⋯ Our retrospective audit shows that pre-washing of IRBCs is not associated with decreased lactate levels at the end of CPB compared with standard use of IRBCs, suggesting that the added value of pre-washing of IRBCs on minimisation of lactate levels during CPB remains doubtful.
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Eur J Cardiothorac Surg · Feb 2012
Comparative StudyComparison of the EuroSCORE and Cardiac Anesthesia Risk Evaluation (CARE) score for risk-adjusted mortality analysis in cardiac surgery.
The European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Cardiac Anesthesia Risk Evaluation (CARE) score are risk indices designed in the mid-1990 s to predict mortality after cardiac surgery. This study assesses their ability to provide risk-adjusted mortality in a contemporary cardiac surgical population. ⋯ The original additive and logistic EuroSCORE models significantly overestimate the risk of mortality after cardiac surgery. However, after recalibration both models provide reliable risk-adjusted mortality results. Despite its lower discrimination as compared with the logistic EuroSCORE, the CARE score remains calibrated a decade after its development. It is as robust as the recalibrated additive and logistic EuroSCORE to perform risk-adjusted mortality analysis.