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 2006
Multicenter StudyValidation of the EuroSCORE model in Australia.
There is an important role for accurate risk prediction models in current cardiac surgical practice. Such models enable benchmarking and allow surgeons and institutions to compare outcomes in a meaningful way. They can also be useful in the areas of surgical decision-making, preoperative informed consent, quality assurance and healthcare management. The aim of this study was to assess the performance of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) model on the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) patient database. ⋯ The additive and logistic EuroSCORE does not accurately predict outcomes in this group of cardiac surgery patients from six Australian institutions. Hence, the use of the EuroSCORE models for risk prediction may not be appropriate in Australia. A model, which accurately predicts outcomes in Australian cardiac surgical patients, is required.
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Eur J Cardiothorac Surg · Apr 2006
Randomized Controlled Trial Comparative StudyEvaluation of respiratory muscle strength by randomized controlled trial comparing thoracoscopy, transaxillary thoracotomy, and posterolateral thoracotomy for lung biopsy.
The aim of this study was to demonstrate that the postoperative recovery of respiratory muscle strength is better in patients who undergo video-thoracoscopy than in patients who undergo transaxillary thoracotomy or posterolateral thoracotomy. ⋯ Video-thoracoscopy allows better recovery of respiratory muscle function after surgery than posterolateral thoracotomy. However, at 4 and 30 days after surgery, video-thoracoscopy and transaxillary thoracotomy gave similar results of impairment of respiratory muscle strength.
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Eur J Cardiothorac Surg · Apr 2006
Optimal pulmonary to systemic blood flow ratio for best hemodynamic status and outcome early after Norwood operation.
Imbalances of pulmonary to systemic blood flow ratio (Q(p)/Q(s)) compounded with inadequate systemic oxygen delivery correlate with mortality after first-stage Norwood palliation of hypoplastic left heart syndrome. Mathematical models suggest that maximal systemic oxygen delivery occurs with Q(p)/Q(s) of less than 1. Whether this applies to clinical practice is unclear. This study evaluates the level of Q(p)/Q(s) that correlates with best hemodynamic status in the first 48 postoperative hours. ⋯ Maximum oxygen delivery after Norwood operation occurs at Q(p)/Q(s) of less than 1. However, optimal hemodynamic status and end-organ function and higher survival correlates with Q(p)/Q(s) between 1 and 2. Thus, Q(p)/Q(s) should be targeted at 1.5 for improved course early after first-stage Norwood palliation.
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Eur J Cardiothorac Surg · Apr 2006
Relation of inflammatory cytokines to atrial fibrillation after off-pump coronary artery bypass grafting.
It has been observed that a systemic inflammatory response after on-pump coronary artery bypass grafting (CABG) participates in the pathogenesis of postoperative atrial fibrillation (AF). In patients undergoing off-pump CABG, it is plausible that inflammation is associated with the development of postoperative AF. The present study examined relation of proinflammatory cytokines, which play an important role in the upstream of inflammatory cascade, to the development of AF after off-pump CABG. ⋯ Advanced age was a major risk factor for postoperative AF. Furthermore, inflammatory response induced by surgical trauma was also associated with the development of AF after off-pump CABG.
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Eur J Cardiothorac Surg · Mar 2006
Platelet-monocyte pro-coagulant interactions in on-pump coronary surgery.
Platelets and monocytes possess haemostatic properties, but the clinical effect of platelet-monocyte interactions on haemostasis following coronary surgery is not known. The study characterises the platelet and monocyte responses in cardiac surgery and its impact on haemostasis. ⋯ A higher postoperative platelet count as well as monocyte% significantly and independently decreases postoperative blood loss following cardiac surgery.