J Cardiovasc Surg
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Comparative Study Observational Study
Implementation of EuroSCORE II as an adjunct to APACHE II model and SOFA score, for refining the prognostic accuracy in cardiac surgical patients.
The aim of this paper was to assess the comparable applicability of European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure (SOFA) scores, in cardiac surgical population, on the basis of morbidity and mortality. ⋯ EuroSCORE II seems to confer noteworthy prognostic value, being almost equivalent to that of TMS, MeanSOFA and MaxSOFA scores, and superior than APACHE II in cardiac surgical population. Thus, EuroSCORE II emerges as an imperative adjunct to ICU-based APACHE II and SOFA algorithms as it enables risk stratification, morbidity and mortality prediction even from preoperative assessment.
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Spinal cord ischemia remains the most impressive and colliding complication following open surgical and endovascular aortic procedures. Paraparesis and paraplegia are devastating, having a major invalidating impact on the patient's life. Also for the surgeon and the entire team this dramatic adverse event causes a significant concussion. ⋯ Now, in 21st century, problem of spinal cord ischemia still exists. By understanding the reasons of its development we shall be able to find more useful methods for prevention as well as for the treatment. The aim of this article was to search what is behind this dreadful complication, explaining different mechanisms which take part in its development during endovascular and open surgical treatment.
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Blunt thoracic aortic injury (BTAI) remains a common cause of death following blunt mechanisms of trauma. Among patients who survive to reach hospital care, significant advances in diagnosis and treatment afford previously unattainable survival. ⋯ These include the refinement of selection criteria, timing for treatment and the need for long-term follow-up data. In addition, the advent of the Aortic Trauma Foundation (ATF) represents an important development in collaborative research in this field.
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Unresolved for over half a century now since the beginning of aortic surgery spinal cord injury (SCI) remains the most devastating complication after extensive open and endovascular thoracoabdominal aortic aneurysm (TAA/A) repair. Over the past decade extensive research on spinal cord perfusion lead to a better understanding of previously unknown physiologic mechanisms involved in the suspension of the cord's arterial supply and the consecutive development of SCI underscoring the need for new concepts in treatment strategy and monitoring methods during and after TAA/A repair. Based on this knowledge, new treatment strategies in particular the staged-repair were developed. ⋯ Another approach to overcome the most critical initial period after segmental artery occlusion due to stent graft deployment in the descending or thoracoabdominal aorta is temporary aneurysm sac perfusion, which also has recently been clinically trialed. Furthermore, the new non-invasive real-time monitoring method to record spinal cord viability by means of near-infrared spectroscopy of the paraspinal collateral network by means of near-infrared spectroscopy has also been suggested and successfully introduced in a pilot series to a clinical setting. This review addresses problems, unsolved questions and future perspectives regarding these three new concepts.