European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Sep 2014
The extracardiac conduit Fontan procedure in Australia and New Zealand: hypoplastic left heart syndrome predicts worse early and late outcomes.
To identify factors associated with hospital and long-term outcomes in a binational cohort of extracardiac conduit (ECC) Fontan recipients. ⋯ The extracardiac Fontan procedure provides excellent survival into the second decade of life, but half of patients will suffer a late adverse event by 14 years. Patients with HLHS are at higher risk of late adverse events than other morphological groups, but their survival is still excellent.
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Eur J Cardiothorac Surg · Sep 2014
Performance of EuroSCORE II in a large US database: implications for transcatheter aortic valve implantation.
Validation studies of European system for cardiac operative risk evaluation II (EuroSCORE II) have been limited to European datasets. Therefore, the aims of this study were to assess the performance of EuroSCORE II in a large multicentre US database, and compare it with the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM). In addition, implications for patient selection for transcatheter aortic valve implantation (TAVI) were explored. ⋯ In a large US multicentre database, the STS-PROM performs better than EuroSCORE II for CABG. However, EuroSCORE II is a reasonable alternative in low-risk CABG patients and in those undergoing other cardiac surgical procedures. Clinical trials and physicians that use these scores recruit and treat patients who are at a lower risk than anticipated. This potentially leads to overtreatment with an investigational device. Decision-making should not solely be based on risk scores, but should comprise multidisciplinary heart team discussions.
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Eur J Cardiothorac Surg · Sep 2014
Clinical TrialPreoperative patient optimization using extracorporeal life support improves outcomes of INTERMACS Level I patients receiving a permanent ventricular assist device.
Interagency Registry for Mechanical Assisted Circulatory Support (INTERMACS) Level I patients have the highest early mortality after ventricular assist device (VAD) implantation. This is determined by the exposure of patients in shock with acutely damaged end-organs and high catecholamine support to a significant surgical trauma. We report our experience with a bridge-to-bridge concept consisting of initial veno-arterial extracorporeal life support (ECLS) and deferral of VAD implantation to recovery of end-organ function in INTERMACS Level I patients. ⋯ Preoperative patient optimization using ECLS improves outcomes of INTERMACS Level I patients receiving a permanent VAD.
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Eur J Cardiothorac Surg · Sep 2014
Case ReportsSingle-port video-assisted thoracoscopic right upper lobectomy using a flexible videoscope.
Single-port video-assisted thoracoscopic surgery (VATS) has recently been proposed as an innovative minimally invasive alternative to the standard three-port VATS for lobectomies, most of which are performed using a conventional rigid thoracoscope. Here, we report a single-port VATS approach for right upper lobectomy and systematic lymph node dissection using a flexible endoscope. A 61-year-old male smoker presented with a pulmonary nodule. ⋯ The procedure was successful and the recovery uneventful. The patient's chest tube was removed on the third day, and he was discharged home on the fourth. The use of a flexible videoscope facilitated the single-port VATS procedure by avoiding interference between the videoscope and other operating instruments and providing ample space for the surgeon.
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Eur J Cardiothorac Surg · Sep 2014
Key success factors for thoracic endovascular aortic repair for non-acute Stanford type B aortic dissection.
We aimed to determine the key factors associated with successful early and late outcomes after thoracic endovascular aortic repair (TEVAR) for non-acute Stanford type B aortic dissection at our institution. ⋯ The early results of TEVAR for non-acute Stanford type B aortic dissection were favourable. However, for cases with patent false lumens, complete obliteration of the false lumen of the entire aorta was difficult to achieve. Absence of the primary entry at the outer curvature of the distal aortic arch, younger age, small aortic diameter and absence of the abdominal aortic branches arising from the false lumen were the key success factors.