European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Aug 2009
Preoperative atrial fibrillation decreases event-free survival following cardiac surgery.
To investigate the relationship between preoperative atrial fibrillation and early and late clinical outcomes following cardiac surgery. ⋯ Preoperative atrial fibrillation is associated with increased late mortality and recurrent cardiovascular events post-cardiac surgery. Effective management strategies for atrial fibrillation need to be explored and may provide an opportunity to improve the long-term outcomes of cardiac surgical patients.
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Eur J Cardiothorac Surg · Jul 2009
Case ReportsSeptal myectomy for hypertrophic obstructive cardiomyopathy: coil, boil and the role of rescue surgery.
Interventional treatment of hypertrophic obstructive cardiomyopathy has considerably developed and primary surgical approach is nowadays considered for a minority of patients with insufficient relief of obstruction following catheter intervention. We present the history of a patient who underwent alcohol ablation and developed a life-threatening ventricular septal defect consecutively to a large myocardial infarction because of alcohol injection into the LAD.
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Eur J Cardiothorac Surg · Jul 2009
Practice GuidelineGuideline for resuscitation in cardiac arrest after cardiac surgery.
The Clinical Guidelines Committee of the European Association for Cardio-Thoracic Surgery provides this professional view on resuscitation in cardiac arrest after cardiac surgery. This document was created using a multimodal methodology for evidence generation including the extrapolation of existing guidelines from the International Liaison Committee on Resuscitation where possible, our own structured literature reviews on issues particular to cardiac surgery, an international survey on resuscitation hosted by CTSNet and manikin simulations of potential protocols. This protocol differs from existing generic guidelines in a number of areas, the most import of which are the following: successful treatment of cardiac arrest after cardiac surgery is a multi-practitioner activity with six key roles that should be allocated and rehearsed on a regular basis; in ventricular fibrillation, three sequential attempts at defibrillation (where immediately available) should precede external cardiac massage; in asystole or extreme bradycardia, pacing (where immediately available) should precede external cardiac massage; where the above measures fail, and in pulseless electrical activity, early resternotomy is advocated; adrenaline should not be routinely given; protocols for excluding reversible airway and breathing complications and for safe emergency resternotomy are given. This guideline is subject to continuous informal review, and when new evidence becomes available.
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Eur J Cardiothorac Surg · Jul 2009
Is EuroSCORE useful in the prediction of extended intensive care unit stay after cardiac surgery?
Risk stratification allows preoperative assessment of cardiac surgical risk faced by individual patients and permits retrospective analysis of postoperative complications in the intensive care unit (ICU). The aim of this single-center study was to investigate the prediction of extended ICU stay after cardiac surgery using both the additive and logistic model of the European System for Cardiac Operative Risk Evaluation (EuroSCORE). ⋯ In our patient database, prolonged length of stay in the ICU correlated positively with EuroSCORE. The logistic model was more discriminatory than the additive in tracing extended ICU stay. The overall predictive performance of EuroSCORE is acceptable and most likely based on the presence of variables that are risk factors for both mortality and extended ICU stay. Hence, EuroSCORE is a useful predicting tool and provides both surgeons and intensivists with a good estimate of patient risk in terms of ICU stay.