Cardiac Surgery1 Research Articles

Evaluation of paediatric cardiosurgical model in Croatia by using the Aristotle basic complexity score and the risk adjustment for congenital cardiac surgery-1 method

The Aristotle basic complexity score and the risk adjustment in congenital cardiac surgery-1 method were developed and used to compare outcomes of congenital cardiac surgery. Both methods were used to compare results of procedures performed on our patients in Croatian cardiosurgical centres and results of procedures were taken abroad. The study population consisted of all patients with congenital cardiac disease born to Croatian residents between 1 October, 2002 and 1 October, 2007 undergoing a cardiovascular operation during this period. Of the 556 operations, the Aristotle basic complexity score could be assigned to 553 operations and the risk adjustment in congenital cardiac surgery-1 method to 536 operations. Procedures were performed in two institutions in Croatia and seven institutions abroad. The average complexity for cardiac procedures performed in Croatia was significantly lower. With both systems, along with the increase in complexity, there is also an increase in mortality before discharge and postoperative length of stay. Only after the adjustment for complexity there are marked differences in mortality and occurrence of postoperative complications. Both, the Aristotle basic complexity score and the risk adjustment in congenital cardiac surgery-1 method were predictive of in-hospital mortality as well as prolonged postoperative length to stay, and can be used as a tool in our country to evaluate a cardiosurgical model and recognise potential problems.

Clevidipine Effectively and Rapidly Controls Blood Pressure Preoperatively in Cardiac Surgery Patients: The Results of the Randomized, Placebo-Controlled Efficacy Study of Clevidipine Assessing Its Preoperative Antihypertensive Effect in Cardiac Surgery-1

Clevidipine Effectively and Rapidly Controls Blood Pressure Preoperatively in Cardiac Surgery Patients: The Results of the Randomized, Placebo-Controlled Efficacy Study of Clevidipine Assessing Its Preoperative Antihypertensive Effect in Cardiac Surgery-1

Clevidipine Effectively and Rapidly Controls Blood Pressure Preoperatively in Cardiac Surgery Patients: The Results of the Randomized, Placebo-Controlled Efficacy Study of Clevidipine Assessing Its Preoperative Antihypertensive Effect in Cardiac Surgery-1

Clevidipine is an ultrashort-acting, third-generation IV dihydropyridine calcium channel blocker that exerts rapid and titratable arterial blood pressure reduction, with fast termination of effect due to metabolism by blood and tissue esterases. As an arterial-selective vasodilator, clevidipine reduces peripheral vascular resistance directly, without dilating the venous capacitance bed. In this randomized, double-blind, placebo-controlled multicenter trial we evaluated the efficacy and tolerability of clevidipine in treating preoperative hypertension. One-hundred-fifty-two patients scheduled for cardiac surgery with current or recent hypertension were randomized to receive clevidipine or placebo preoperatively. One-hundred-five patients met postrandomization entrance criteria (systolic blood pressure [SBP] > or =160 mm Hg after inserting an arterial catheter) for reduction by > or =15% from baseline in SBP. The patients thus received infusions of clevidipine (0.4-8.0 microg x kg(-1) x min(-1)) or 20% lipid emulsion (placebo) for at least 30 min. Treatment failure was defined as failure to reduce SBP by > or =15% from baseline or discontinuance of drug for any reason. Patients treated with clevidipine demonstrated a 92.5% rate of treatment success and a significantly lower rate of treatment failure (7.5%, 4 of 53) than patients receiving placebo (82.7%, 43 of 52; P < 0.0001). Clevidipine achieved target blood pressures (SBP reduced by > or =15%) at a median of 6.0 min (95% confidence interval 6-8 min). A modest increase in heart rate from baseline occurred during clevidipine administration. Adverse events for each treatment group were similar. Clevidipine was effective in rapidly decreasing blood pressure preoperatively to targeted blood pressure levels and was well tolerated in patients scheduled for cardiac surgery.

AT1 Receptor Blockers for Cognition Decline After Cardiac Surgery?

To the Editor: We read with interest the review article on stroke and encephalopathy after cardiac surgery1 and the related editorial.2 We agree that assessing these complications provides a unique clinical opportunity for evaluating preventive strategies because patients at higher risk can be identified before surgery. We would like to add to the list of potential cerebroprotective agents proposed (gangliosides, glutamate receptor antagonists, antioxidants) the angiotensin AT1 receptor blockers (AT1RB). Both …

Risk stratification for training in cardiac surgery.

There is a potential conflict of interest in providing the best possible outcome for patients undergoing cardiac surgery and good training for junior cardiac surgeons. We analysed training with reference to volume of work, risk stratification and outcome for consultant and trainee procedures. The Parsonnet system was used for risk stratification. A retrospective audit was performed for a 6-year period. During the study period, 6037 operations were performed, of which 2166 were carried out by trainees. Direct consultant assistance in a trainee operation varied between 17% and 51% and increased towards the end of the study period. Of the operations performed by trainees, 88% were CABG. The median Parsonnet score for consultant operations was 9 compared with 4 for trainees. Actual mortality was below predicted for all surgeons. Morbidity was also lowest for trainees (10%). With appropriate case selection, trainees in cardiac surgery can achieve good results. As training changes in the UK, trainees should receive increased supervised exposure to a wider range of procedure to compensate for a lower volume of workload.

Target, application, and interpretation of scores and alternative methods for risk assessment in cardiac surgery.

The more popular the use of different methods for risk adjustment becomes, the more often data are applied without any regard about the primary target and/or about important assumptions. Furthermore, risk adjustment is no longer restricted for quality assurance purposes, but became a "tool" of health policy. Few working groups currently use risk adjustment for the development of new therapeutic concepts. The aim of our study is to clarify possibilities and limitations of popular risk adjustment methods. 4985 Patients underwent isolated CABG. Statistics was performed by calculating descriptive statistics, Parsonnet, and Higginsscores. Furthermore, the parametric, time-adjusted hazard function by Blackstone was used. Descriptive statistics allows intra-, and interinstitutional comparisons of single items to identify "outlying" results. Risk scores aim to predict preoperatively the risk category of the patient who undergoes cardiac surgery. However, since different scores are based on a score-specific combination of variables, and different definitions of the investigation interval, different results may occur, when different scores are calculated for a single patient. However, the use for example, of scores in patient groups allows description of changing risk structures. Most of the scores derive from univariate analyses and monophasic functions. However, survival curves are predominantly multiphasic and require a consideration of the time-dependency of "risk factors". An increasing number of patients with severe comorbidity undergoes cardiac surgery. To evaluate reliably present and futurous therapeutic options, risk adjustment is necessary. Since various tools for risk-adjustment are available, a serious discussion about reliability and application is necessary.

Absorption of gas bubbles in flowing blood.

ARTICLESAbsorption of gas bubbles in flowing bloodM. P. Hlastala, and L. E. FarhiM. P. Hlastala, and L. E. FarhiPublished Online:01 Sep 1973https://doi.org/10.1152/jappl.1973.35.3.311MoreSectionsPDF (1 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByDetection and differentiation of cerebral microemboli in patients undergoing major orthopaedic surgery using transcranial Doppler ultrasoundBritish Journal of Anaesthesia, Vol. 118, No. 3Effect of initial gas bubble composition on detection of inducible intrapulmonary arteriovenous shunt during exercise in normoxia, hypoxia, or hyperoxiaJonathan E. Elliott, Yujung Choi, Steven S. Laurie, Ximeng Yang, Igor M. Gladstone, and Andrew T. Lovering1 January 2011 | Journal of Applied Physiology, Vol. 110, No. 1Estimate of the maximum absorption rate of microscopic arterial air emboli after entry into the arterial circulation during cardiac surgery1 July 2016 | Perfusion, Vol. 11, No. 6Air embolism during cardiopulmonary bypass1 July 2016 | Perfusion, Vol. 10, No. 6Review article : Gaseous microemboli: a review30 June 2016 | Perfusion, Vol. 5, No. 2Gas exchange abnormalities produced by venous gas emboliRespiration Physiology, Vol. 36, No. 1Absorption of in vivo inert gas bubblesRespiration Physiology, Vol. 24, No. 2 More from this issue > Volume 35Issue 3September 1973Pages 311-316 Copyright & PermissionsCopyright © 1973 the American Physiological Societyhttps://doi.org/10.1152/jappl.1973.35.3.311PubMed4732323History Published online 1 September 1973 Published in print 1 September 1973 Metrics

Solubility of gases in human red blood cell ghosts.

ARTICLESSolubility of gases in human red blood cell ghostsG. G. Power, and H. StegallG. G. Power, and H. StegallPublished Online:01 Aug 1970https://doi.org/10.1152/jappl.1970.29.2.145MoreSectionsPDF (1 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByDiffusion of nitric oxide and oxygen in lipoproteins and membranes studied by pyrene fluorescence quenchingFree Radical Biology and Medicine, Vol. 128Impact of impurities on CO 2 storage in saline aquifers: Modelling of gases solubility in waterInternational Journal of Greenhouse Gas Control, Vol. 68Lens lipids and maximum lifespanExperimental Eye Research, Vol. 79, No. 6Estimate of the maximum absorption rate of microscopic arterial air emboli after entry into the arterial circulation during cardiac surgery1 July 2016 | Perfusion, Vol. 11, No. 6Dioxygen solubility in aqueous phosphatidylcholine dispersionsBiochimica et Biophysica Acta (BBA) - Biomembranes, Vol. 1061, No. 1Inorganic carbon transport in biological systemsComparative Biochemistry and Physiology Part B: Comparative Biochemistry, Vol. 90, No. 4Oxygen transfer conductance of human red blood cells at varied pH and temperatureRespiration Physiology, Vol. 67, No. 2Correlation of general anesthetic potency with solubility in membranesBiochimica et Biophysica Acta (BBA) - Biomembranes, Vol. 649, No. 1Solubility of carbon dioxide in lipid bilayer membranes and organic solventsBiochimica et Biophysica Acta (BBA) - Biomembranes, Vol. 596, No. 3 More from this issue > Volume 29Issue 2August 1970Pages 145-149 Copyright & PermissionsCopyright © 1970 the American Physiological Societyhttps://doi.org/10.1152/jappl.1970.29.2.145PubMed5428886History Published online 1 August 1970 Published in print 1 August 1970 Metrics

HYPERBARIC OXYGEN IN PATIENTS WITH VENOARTERIAL SHUNTS. THEORETICAL IMPLICATIONS.

OXYGEN under increased pressure has been used in cardiac surgery1 , 2 and in the treatment of a variety of conditions, including the respiratory-distress syndrome of the newborn infant,3 , 4 anaerobic infections5 and tissue ischemia6 and in the radiotherapy of tumors7 although the efficacy of hyperbaric oxygen in most of these diseases remains to be proved. The principle behind treatment with oxygen under pressure is to produce a high arterial oxygen tension (PaO2 ). The large increase in PaO2 that occurs in hyperbaric oxygen when the circulation is normal has been measured,8 but the influence of venoarterial shunts on . . .