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 1997
Comparison of two preoperative indices to predict perioperative mortality in non-cardiac thoracic surgery.
The preoperative classifications: physical status of the American Society of Anesthesiologists (ASA-PS) and/or cardiac risk index (CRI) of Goldman are widely used to estimate the perioperative risk in patients undergoing noncardiac throacic surgery. We tried to determine the validity of both methods in predicting the perioperative mortality in 845 consecutive patients scheduled for major elective noncardiac thoracic surgery. ⋯ The subjective assessment by an experienced anesthesiologist as expressed by the ASA-score is a valid method in the determination of the perioperative risk. CRI does not contribute additional information for the general perioperative risk.
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Eur J Cardiothorac Surg · Apr 1997
Long-term mechanical circulatory support as a bridge to transplantation, for recovery from cardiomyopathy, and for permanent replacement.
Since 1988, 295 patients have undergone MCS at the German Heart Institute Berlin; 246 received biventricular support with the extracorporeal pneumatically-driven Berlin Heart Assist Device, 49 received left ventricular support with implantable assist devices (33 Novacor, 16 TCI). Longer waiting periods for heart transplantation has caused the mean duration of MCS to increase from 12 days in 1988 to 76 days in 1994. Of the 24 patients who underwent MCS for more than 90 days, nine were implanted with a biventricular device, 12 with a Novacor device, and 15 with a TCI device. ⋯ Long-term mechanical support has become a reality. Heart transplantation after prolonged MCS yields results comparable to primary HTx. Some patients exhibit immunological changes and a dramatic improvement in ventricular function under long-term MCS and can be weaned with extremely satisfying results.
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Eur J Cardiothorac Surg · Apr 1997
Randomized Controlled Trial Comparative Study Clinical TrialHemostatic effects of three colloid plasma substitutes for priming solution in cardiopulmonary bypass.
To evaluate the effects on hemostasis of three different plasma substitutes with special reference to a newly developed hydroxyethyl starch used as priming solution in an extracorporeal circuit as well as peri- and postoperative infusion fluid, we studied 36 patients randomly assigned to one of three groups, undergoing coronary artery bypass grafting. ⋯ We conclude that, with human albumin the golden standard, 2.5% hydroxyethyl starch is a suitable colloid plasma substitute to be used as priming solution in an extracorporeal circuit as well as peri- and postoperative infusion fluid, reasonably well maintaining hemostasis.
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Eur J Cardiothorac Surg · Apr 1997
Letter Randomized Controlled Trial Comparative Study Clinical TrialThe use of low-dose aprotinin, epsilon-aminocaproic acid or tranexamic acid for prevention of mediastinal bleeding in patients receiving aspirin before coronary artery bypass operations.
Patients undergoing primary myocardial revascularization were randomized to one of three drug regimens (low-dose aprotinin, epsilon-aminocaproic Acid or tranexamic Acid) to determine which drug regimen would most effectively reduce post-operative bleeding and the need for blood products. All patients had received 325 mg of aspirin within 48 h before operation. All three drug regimens reduced the requirements for blood products and postoperative bleeding after coronary artery bypass operations. There was, however, no significant difference between drug regimens.
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Eur J Cardiothorac Surg · Apr 1997
A predictive parameter in patients with brain related complications after cardiac surgery?
The prognostic estimation of cerebral complications after cardiac surgery is a major problem in the early postoperative period. Neuron specific enolase (NSE) is an enzyme involved in glycolysis, which is localized in neurons and axonal processes. It escapes into the blood and cerebrospinal fluid at the time of neural injury. Therefore we focused the study on the question of how far serum levels of neuron specific enolase can predict the neurological and neuropsychological outcome after cardiac surgery. ⋯ The early serum levels of NSE after cardiopulmonary bypass, in those patients with severe neurological deficits, indicate that NSE is a suitable marker for the detection and quantification of cerebral injury after open heart surgery. Therefore, in addition NSE seems to be of predictive value for the clinical outcome and gives implications for the treatment and prognosis of patients with brain related complications in cardiac surgery.