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 2010
Comparative Study Controlled Clinical TrialUnilateral cerebral perfusion: right versus left.
Unilateral cerebral perfusion for brain protection is gaining increasing interest, although the pathways of collateral flow as well as many aspects of the surgical strategy regarding optimal perfusion pressure, flow and temperature remain unclear. This study evaluates the differences between right- and left-sided unilateral cerebral perfusion, if any, especially with regard to neurovascular monitoring findings and clinical outcome. ⋯ Unilateral cerebral perfusion under mild hypothermia is an efficient method of cerebral protection. The advantage of the right-sided perfusion in which two brain-supplying arteries are perfused could not be verified.
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Eur J Cardiothorac Surg · Jun 2010
The fate of the aortic root after early repair of tetralogy of Fallot.
Late aortic root dilatation is a growing concern in patients operated on for tetralogy of Fallot (ToF). This longitudinal follow-up study sought to evaluate the changes in the aortic root dimensions in relation to body growth, assuming that early repair of tetralogy of Fallot might prevent late aortic dilatation. ⋯ The initially dilated aortic root in tetralogy of Fallot normalises in size at the level of the annulus and sinotubular junction within 7 years after early repair. This process seems delayed at the level of the aortic sinuses, although the indexed root diameter shows significant regression over time. These results suggest that early repair of ToF abrogates the enlargement of the aortic root, validating one aspect of the need for tetralogy correction at a young age.
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Eur J Cardiothorac Surg · Jun 2010
Cerebral functions and metabolism after antegrade selective cerebral perfusion in aortic arch surgery.
Antegrade selective cerebral perfusion (ASCP) represents the best method of cerebral protection during surgery of the thoracic aorta. However, brain integrity and metabolism after antegrade cerebral perfusion have not yet been investigated. We assessed cerebral positron emission tomography (PET), diffusion-weighted imaging, proton magnetic resonance spectroscopy and cognitive functions in patients undergoing either ASCP or coronary artery bypass grafting (CABG) to elucidate whether cerebral perfusion was associated with postoperative neuronal alterations, metabolic deficit or cognitive decline. ⋯ There was no evidence of ischaemic brain injury after ASCP even if some degree of reversible brain oedema secondary to cardiopulmonary bypass (CPB) was present. The cognitive outcomes in patients undergoing ASCP were comparable to patients undergoing coronary artery bypass. The lack of left subclavian artery perfusion during cerebral perfusion leads to temporary glucose hypometabolism in the occipital lobes without neuronal injury.
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Eur J Cardiothorac Surg · Jun 2010
Correction of leaflet prolapse extends the spectrum of patients suitable for valve-sparing aortic root replacement.
Preservation of the native aortic valve in patients requiring aortic root replacement avoids the need for lifelong anticoagulation and potentially offers greater durability than a bio-prosthetic valve. Such techniques have generally been applied to patients with early grades of aortic regurgitation (AR) and less severe aortic root dilatation where leaflets have been minimally stretched. We reviewed our experience with these techniques and in particular the durability of the addition of leaflet prolapse correction in patients with more advanced aortic root pathology compared to those with non-prolapsing leaflets. ⋯ Patients with large aortic root aneurysms and advanced AR often have stretched leaflets that will prolapse and lead to early failure if only root geometry is corrected. With the addition of leaflet prolapse correction, we have shown equivalent durability to those without stretched leaflets. This has allowed valve preservation in a sizable subgroup who would otherwise have received prosthetic valves. Greater patient numbers and longer follow-up are needed to fully validate this approach.
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Eur J Cardiothorac Surg · Jun 2010
Congenital heart disease: interrelation between German diagnosis-related groups system and Aristotle complexity score.
The Disease-Related Groups (DRGs) system postulates that inpatient stays with similar levels of clinical complexity are expected to consume similar amounts of resources. This, applied to surgery of congenital heart disease, suggests that the higher the complexity of procedures as estimated by the Aristotle complexity score, the higher hospital reimbursement should be. This study analyses how much case-mix index (CMI) generated by German DRG 2009 version correlates with Aristotle score. ⋯ ACC score correlates almost perfectly with corresponding cost-weights (CMI) generated by the German DRG 2009. It could therefore be used as the basis for hospital reimbursement to compensate in conformity with procedures' complexity. Extrapolated CMI in this series would be 9.264. Modulation of reimbursement according to surgical performance could be established and thus 'reward' quality in congenital heart surgery.