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 2010
Ross and Yasui operations for complex biventricular repair in infants with critical left ventricular outflow tract obstruction.
To define the outcomes following Ross and Yasui procedures for complex biventricular repair of critical left ventricular outflow tract obstruction (LVOTO). ⋯ Case selection is key for complex biventricular repair and the importance of appropriate case selection is exaggerated at young ages. All available options should be considered before pursuing the Ross operation in the presence of co-existing functional morphological abnormalities or emergent iatrogenic aortic regurgitation. However, both the Ross and Yasui operations in children (including neonates and young infants) with favourable functional morphology offer good survival, at least matching that of other biventricular repair strategies.
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Eur J Cardiothorac Surg · Feb 2010
Absolute and relative risk prediction in patients candidate to isolated aortic valve replacement: should we change our mind?
The European System for Cardiac Operative Risk Evaluation (EuroSCORE) calculator performance in 30-day outcome prediction after isolated aortic valve replacement (AVR) was evaluated to assess its absolute reliability and usefulness as selection criteria to percutaneous aortic valve implantation (PAVI). ⋯ EuroSCORE appears to be an invalid model in absolute and relative risk prediction for isolated AVR. On this basis, its use in selecting candidates to PAVI should be carefully weighted. Correct stratification and sufficient calibration of absolute risk estimate of high-risk patients are, therefore, mandatory in the aim of assigning those patients who show risk factors really responsible for the worst surgical outcome to new techniques. The goal should be reached by exploring the weight of each independent predictor of death in each single institution involved in PAVI procedures, evaluating local surgical results in terms of absolute risk and analysing those variables significantly affecting relative risk.
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Eur J Cardiothorac Surg · Feb 2010
Review Meta AnalysisThe prognostic value of troponin release after adult cardiac surgery - a meta-analysis.
To assess the accuracy of increased troponin (Tn) concentrations for the prediction of mid-term (> or = 12 months) mortality after coronary artery bypass graft (CABG) and valve surgery, we performed a systematic review identifying all studies reporting on the association between postoperative troponin release and mortality after cardiac surgery. Studies were identified through 30 April 2008 by electronic searches of the MEDLINE, EMBASE and BIOSIS databases. Two reviewers independently selected studies, assessed methodological quality and extracted the data. ⋯ Between-study variability was high. In conclusion, this meta-analysis provides evidence for an association between postoperative Tn release with mid- and short-term all-cause mortality after adult cardiac surgery. However, differences in populations, timing of Tn testing, Tn subunit and Tn assays make definitive conclusions about effect size and cut-off values difficult.
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Eur J Cardiothorac Surg · Feb 2010
Randomized Controlled Trial Comparative StudyA comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management.
Thoracotomy is a surgical procedure associated with severe pain. Operative morbidity rates reduce by effective postoperative pain control. The aim of this study is to compare the effectiveness of the thoracic epidural blockade (TEB) and the paravertebral blockade (PVB) methods in relieving the pain caused by a thoracotomy incision. ⋯ PVB catheterisation can be easily performed and placed in a short span perioperatively. Therefore, it might be the preferred method over TEB which has a high incidence of adverse effects and complication rates.
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Eur J Cardiothorac Surg · Feb 2010
Case ReportsTranscatheter aortic valve prosthesis surgically replaced 4 months after implantation.
Transcatheter aortic valve implantation is a new and rapidly evolving treatment option for high-risk surgical patients with degenerative aortic valve stenosis. Long-term results with these new valve prostheses are lacking, and potential valve dysfunction and failure would require valve replacement. We report the first case of surgical valve replacement in a patient with a dysfunctional transcatheter-implanted aortic valve prosthesis 4 months after implantation.