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 2006
Randomized Controlled TrialA randomized trial of automated versus conventional protocol-driven weaning from mechanical ventilation following coronary artery bypass surgery.
The Siemens servo 300 A ventilator has an automode function that allows automated weaning of patients from mechanical ventilation. Spontaneous breathing triggers the ventilator. After two spontaneously triggered breaths, the ventilator automatically changes from mandatory mechanical ventilation to spontaneous ventilation. If spontaneous breathing or triggering does not occur, the Siemens servo 300 A ventilator changes from spontaneous ventilation back to mandatory mechanical ventilation. We compared the effects of automated versus conventional protocol-driven weaning on the time until extubation in patients undergoing coronary artery bypass graft (CABG) surgery. In addition, we studied the effects of the mode of weaning on hemodynamic and physiologic parameters. ⋯ Automode ventilator weaning trended toward more rapid extubation than did conventional protocol-driven ventilation in conjunction with a standardized weaning protocol. Physiologic and hemodynamic factors were better in patients using automode ventilation compared to patients using conventional ventilation. Automode ventilation was well tolerated and did not induce significant adverse effects.
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Eur J Cardiothorac Surg · Jun 2006
Does the Aristotle Score predict outcome in congenital heart surgery?
The Aristotle Score has been proposed as a measure of 'complexity' in congenital heart surgery, and a tool for comparing performance amongst different centres. To date, however, it remains unvalidated. We examined whether the Basic Aristotle Score was a useful predictor of mortality following open-heart surgery, and compared it to the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system. We also examined the ability of the Aristotle Score to measure performance. ⋯ The Basic Aristotle Score was only weakly associated with postoperative mortality in this series. Operative performance appeared to be inflated by the fact that the overall complexity of cases was relatively high in this series. An alternative equation (performance = complexity/mortality) is proposed as a fairer and more logical method of risk-adjustment.
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Eur J Cardiothorac Surg · Jun 2006
Clinical TrialHeparin resistance and increased platelet activation in coronary surgery patients treated with enoxaparin preoperatively.
Patients with unstable coronary disease have changes in the hemostatic system. These patients are often treated with low molecular weight heparin. In patients who are accepted for coronary artery bypass grafting, treatment with low molecular weight heparin is frequently continued until surgery. We hypothesized that in coronary artery bypass grafting, the hypercoagulable state seen in unstable patients persists into the intra- and postoperative phase despite preoperative treatment with low molecular weight heparin. The aim of this study was to explore and describe the perioperative hemostatic process in patients with unstable coronary artery disease undergoing coronary artery bypass grafting. ⋯ Patients treated with enoxaparin before coronary artery bypass grafting showed signs of heparin resistance intraoperatively. Enoxaparin-treated patients also had increased perioperative platelet activation. Reasons for the observed difference in platelet activation remain unclear.
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Eur J Cardiothorac Surg · Jun 2006
Comparative StudySympathetic stimulation increases the blood flow through the in situ right gastroepiploic artery graft after off-pump coronary artery bypass graft surgery.
The right gastroepiploic artery is gaining popularity as an in situ arterial graft for coronary artery bypass surgery. Unlike the internal thoracic artery, the right gastroepiploic artery is a visceral artery and has a vasoconstrictive tendency in response to sympathetic stimulation. We hypothesized that blood flow through the in situ right gastroepiploic arterial graft might be compromised after sympathetic stimulation. ⋯ Sympathetic stimulation increases, rather than compromises, blood flow through the right gastroepiploic artery graft after coronary revascularization.
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Eur J Cardiothorac Surg · Jun 2006
Morbidity and mortality following acute conversion from off-pump to on-pump coronary surgery.
Many studies have described reduced morbidity in hospital and equivalent midterm outcomes with off-pump coronary artery bypass (OPCAB) surgery compared to conventional CABG (CABG-CPB). However, OPCAB is sometimes converted acutely to CABG-CPB. We describe the risk of acute conversion and compare patients' outcomes for acutely converted OPCAB with unconverted OPCAB and CABG-CPB. ⋯ Experienced OPCAB surgeons have a low risk of acute conversion. Acutely converted patients have a moderately increased risk of death and serious complications in hospital. These risks are difficult to quantify precisely because conversion is rare.