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 2012
Comparative StudyDoes the outcome improve after radiofrequency ablation for atrial fibrillation in patients undergoing cardiac surgery? A propensity-matched comparison.
Preoperative atrial fibrillation (AF) significantly reduces the survival rate post cardiac surgery. It has been shown that patients in persistent or paroxysmal AF have higher mid- and long-term mortality post cardiac surgery compared with those in sinus rhythm. In this study we aimed to assess whether radiofrequency (RF) ablation during cardiac surgery in these patients improves the survival. ⋯ Despite, the similar postoperative outcome with or without ablation in persistent/paroxysmal AF, 5-year survival was found to be significantly higher with the ablation during cardiac surgery. This improvement can be due to the fall in the incidence of cerebro-vascular events or bleeding with AF or warfarin. Ablation during cardiac surgery is a simple and quick procedure and should be considered if indicated.
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To update the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk model. ⋯ Cardiac surgical mortality has significantly reduced in the last 15 years despite older and sicker patients. EuroSCORE II is better calibrated than the original model yet preserves powerful discrimination. It is proposed for the future assessment of cardiac surgical risk.
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Eur J Cardiothorac Surg · Apr 2012
Subtle changes in renal function are associated with differences in late survival following adult cardiac surgery.
To determine the predictors of post-operative renal function following adult cardiac surgery, and to assess the influence of this on late survival. ⋯ Subtle early changes in renal function at the time of surgery are powerful predictors of adverse late outcome and can be predicted by pre-operative renal function.
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Eur J Cardiothorac Surg · Apr 2012
Feasibility of hybrid thoracoscopic lobectomy and en-bloc chest wall resection.
Lobectomy with an en-bloc chest wall resection is an effective but potentially morbid treatment of lung cancer invading the chest wall. Minimally invasive approaches to lobectomy have reduced morbidity compared with thoracotomy for early stage lung cancer, but there is insufficient evidence regarding the feasibility of hybrid thoracoscopic lobectomy chest wall resection. We reviewed our experience with an en-bloc chest wall resection and lobectomy to evaluate the outcomes of a hybrid approach using thoracoscopic lobectomy combined with the chest wall resection where rib spreading is avoided. ⋯ A hybrid approach that combines thoracoscopic lobectomy and chest wall resection is feasible and effective in selected patients. The use of a limited counter incision without rib spreading does not compromise oncologic efficacy. Further experience is needed to determine if this approach provides any advantage in outcomes, including post-operative morbidity.
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Eur J Cardiothorac Surg · Apr 2012
Comparative StudyPropensity matched analysis of bilateral internal mammary artery versus single left internal mammary artery grafting at 17-year follow-up: validation of a contemporary surgical experience.
Bilateral internal mammary arteries (BIMA) remains widely underutilized in coronary artery bypass grafting (CABG). Although prior research has demonstrated a long-term benefit of the use of BIMA over left internal mammary artery (LIMA)-only, validation of these results is lacking in a contemporary surgical experience. We compared complications and survival at 17-year follow-up in a large series of consecutive CABG patients from a single institution that underwent BIMA grafting with a propensity-matched group where LIMA only was used. ⋯ Perioperative complications do not increase with the use of BIMAs. Long-term survival is optimized with off-pump CABG and BIMA grafting. The low morbidity and mortality rates in this series are likely due to the continuous evolution of technology and the adoption of less invasive options for CABG patients. A more widespread use of BIMAs in CABG patients would continue to improve the overall excellent short- and long-term results of this operation.