| 1. |
- Ahlgren, Ewa, 1959-, et al.
(författare)
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Neurocognitive impairment and driving performance after coronary artery bypass surgery
- 2003
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940 .- 1873-734X. ; 23:3, s. 334-340
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Neurocognitive impairment is common after cardiac surgery but few studies have examined the relationship between postoperative neuropsychological test performance and everyday behavior. The influence of postoperative cognitive impairment on car driving has previously not been investigated. The purpose of this study was to evaluate neurocognitive function and driving performance after coronary artery bypass grafting (CABG).Methods: Twenty-seven patients who underwent coronary artery bypass grafting with standard cardiopulmonary bypass technique and 20 patients scheduled for percutaneous coronary intervention (PCI) under local anesthesia (control group) were enrolled in this prospective study conducted from April 1999 to September 2000. Complete data were obtained in 23 and 19 patients, respectively. The patients underwent neuropsychological examination with a test battery including 12 tests, a standardized on-road driving test and a test in an advanced driving simulator before and 4–6 weeks after intervention.Results: More patients in the coronary artery bypass grafting group (n=11, 48%) than in the percutaneous coronary intervention group (n=2, 10%) showed a cognitive decline after intervention (P=0.01). In the on-road driving test, patients who underwent coronary artery bypass grafting deteriorated after surgery in the cognitive demanding parts like traffic behavior (P=0.01) and attention (P=0.04). Patients who underwent percutaneous intervention deteriorated in maneuvering of the vehicle (P=0.04). No deterioration was detected in the simulator in any of the groups after intervention. Patients with a cognitive decline after intervention also tended to drop in the on-road driving scores to a larger extent than did patients without a cognitive decline.Conclusion: This study indicates that cognitive functions important for safe driving may be influenced after cardiac surgery.
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| 5. |
- Dellgren, G., et al.
(författare)
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Eleven years' experience with the Biocor stentless aortic bioprosthesis : clinical and hemodynamic follow-up with long-term relative survival rate
- 2002
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Ingår i: European Journal of Cardio-Thoracic Surgery. - 1010-7940 .- 1873-734X. ; 22:6, s. 912-921
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The long-term durability and hemodynamics of stentless valves are largely unknown. Our aim was to prospectively investigate long-term hemodynamic function and clinical outcome after aortic valve replacement with the Biocor stentless aortic bioprosthesis. Patients and methods. Between October 1990 and November 2000 we inserted the Biocor stentless aortic valve in 112 patients (male/female: 38:74) with a mean age of 78.5 years (median 79.3, range 60-88). The predominant diagnosis was aortic stenosis in 86% of the patients. Concomitant coronary artery bypass surgery was performed in 31% of the patients. Average prosthetic valve size was 23.3 +/- 1.6 mm. All patients were followed in a prospective study with a mean follow-up of 66 +/- 33 months. The follow-up was 100% complete with a closing interval from October I to December 31, 2001. The observed actuarial survival of patients was compared to expected survival for an age- and gender-matched comparison population as calculated from Swedish life tables by Statistics Sweden. Relative survival rates were calculated annually for the patient population. Results. Early mortality was 7% (8/112). Late mortality was 38% (43/112). Actuarial survival at 5 and 9 years was 74 +/- 5% and 38 +/- 7%, respectively. Observed survival among patients was not different from the expected survival for the comparison population and calculation of relative survival rates indicates a 'normalized' survival pattern for the patient population. At 5 and 9 years the actuarial freedom from valve-related death was 94 +/- 3% and 86 +/- 6%; from cardiac death, 82 +/- 4% and 57 +/- 8%; from valve reoperation, 96 +/- 2% and 87 6%; from structural valve degeneration, 96 +/- 2% and 87 +/- 6%; from thromboembolism, 89 +/- 4% and 71 +/- 9%; and from endocarditis, 96 +/- 2% and 90 +/- 5%. At 9 years the transvalvular mean pressure difference for all valves was 7.3 +/- 1.3 mmHg (range 6-10 mmHg) measured with Doppler echocardiography. Aortic regurgitation progressed slowly over time in a few patients and necessitated reoperation in two patients. Conclusion. The Biocor stentless bioprosthesis has an excellent hemodynamic function and confers a good long-term outcome. This patient population could be regarded as 'cured' from valve disease since the observed survival did not differ from the expected survival for an age- and gender-matched Swedish comparison population, a conclusion that is also supported by a constant relative survival after the first postoperative year. However, despite excellent long-term hemodynamics, patients with stentless bioprostheses need to be evaluated with echocardiography at regular intervals to discover the rare cases of progressive aortic regurgitation.
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| 12. |
- Ridderstolpe, Lisa, et al.
(författare)
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Superficial and deep sternal wound complications : Incidence, risk factors and mortality
- 2001
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford Academic. - 1010-7940 .- 1873-734X. ; 20:6, s. 1168-1175
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Sternal wound complications often have a late onset and are detected after patients are discharged from the hospital. In an effort to catch all sternal wound complications, different postdischarge surveillance methods have to be used. Together with this long-term follow-up an analysis of risk factors may help to identify patients at risk and can lead to more effective preventive and control measures.Methods: This retrospective study of 3008 adult patients who underwent consecutive cardiac surgery from January 1996 through September 1999 at Link÷ping University Hospital, Sweden, evaluated 42 potential risk factors by univariate analysis followed by backward stepwise multivariate logistic regression analysis.Results: Two-thirds of the 291 (9.7%) sternal wound complications that occurred were identified after discharge. Of the 291 patients, 47 (1.6%) had deep sternal infections, 50 (1.7%) had postoperative mediastinitis, and 194 (6.4%) had superficial sternal wound complications. Twenty-three variables were selected by univariate analysis (P<0.15) and included in a multivariate analysis where eight variables emerged as significant (P<0.05). Preoperative risk factors for deep sternal infections/mediastinitis were obesity, insulin-dependent diabetes, smoking, peripheral vascular disease, and high New York Heart Association score. An intraoperative risk factor was bilateral use of internal mammary arteries, and a postoperative risk factor was prolonged ventilator support. Risk factors for superficial sternal wound complications were obesity, and an age of
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- Svedjeholm, Rolf, et al.
(författare)
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Neurological injury after surgery for ischemic heart disease: risk factors, outcome and role of metabolic interventions
- 2001
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Ingår i: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - 1010-7940. ; 19:5, s. 611-618
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Neurological complication remains a feared and increasing problem in association with cardiac surgery. The aim of this study was to analyze risk factors for neurological complications in a cohort of patients in whom inotropes for weaning from cardiopulmonary bypass was gradually replaced by metabolic treatment. Methods: The records of 775 consecutive patients undergoing coronary artery bypass grafting (CABG) or combined CABG+valve procedures were examined. Forward stepwise multiple logistic regression analysis was used for statistical evaluation of independent risk factors. Results: The incidence of neurological injury was 1.8% in patients undergoing isolated CABG and 5.4% after combined CABG+valve procedures. After cross-validation multivariate analysis identified history of cerebrovascular disease, advanced age and aortic cross-clamp time as independent risk factors for postoperative cerebral complications. Chronic obstructive pulmonary disease and number of bypasses also emerged as risk factors in the primary analysis. Conclusions: In general, markers for advanced atherosclerosis, with history of cerebrovascular disease as the most important, emerged as predictors for neurological injury. Although it did not enter the final risk model, the results also suggest that postoperative heart failure deserves further surveillance as a potential risk factor for neurological complications. However, no evidence for untoward neurological effects associated with glutamate or glucose–insulin–potassium treatment was found.
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| 15. |
- Svedjeholm, Rolf, 1952-, et al.
(författare)
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Reply to H.S. Bedi and M.S. Kalkat
- 2000
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Elsevier. - 1010-7940 .- 1873-734X. ; 17:2, s. 195-195
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- We would like to thank Dr Bedi and Dr Kalkat for drawing attention to another potential application of retrograde perfusion of the coronary sinus with oxygenated blood. The connection of the aortic and retrograde cannula to allow retrograde perfusion is beautiful in its simplicity. In contrast to our report on retrograde perfusion to treat severe myocardial ischemia during early stages of surgery, they seem to have employed retrograde perfusion in off pump surgery to avoid ischemia. However, in some cases they observed regression of ECG changes as retrograde perfusion was commenced. Although these type of clinical reports (like our own report) almost inevitably are anecdotal they do have a scientific basis (references given in the respective reports). According to current knowledge of coronary sinus anatomy and interventions, retrograde coronary sinus perfusion has the potential to alleviate myocardial ischemia caused by obstruction of antegrade flow to myocardium drained by the coronary sinus. This is in agreement with the reported experience by Drs Bedi and Kalkat, who found signs of ischemia only while performing anastomoses to the right coronary artery.Certainly, the method described deserves further evaluation in off pump surgery as it potentially allows unhurried anastomosis, and it could contribute to a reduced need for conversion to on-pump procedures and an increasing proportion of off-pump procedures in multi-vessel coronary disease. If the latter, on the other hand, is a desirable evolution for the majority of patients remains to be established.
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| 16. |
- Svenmarker, S., et al.
(författare)
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Neurological and general outcome in low-risk coronary artery bypass patients using heparin coated circuits
- 2001
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Ingår i: European Journal of Cardio-Thoracic Surgery. - Oxford : Oxford University Press. - 1010-7940 .- 1873-734X. ; 19:1, s. 47-53
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The clinical significance of heparin coating in cardiopulmonary bypass has previously been investigated. However, few studies have addressed the possible influence on brain function and memory disturbances. Methods: Three hundred low-risk patients exposed to coronary bypass surgery were randomised into three groups according to type of heparin coating: Carmeda Bioactive Surface, Baxter Duraflo II and a control group. Outcome was determined from a number of clinically oriented parameters, including a detailed registry of postoperative deviations from the normal postoperative course. Brain damage was assessed through S100 release and memory tests, including a questionnaire follow-up. Results: Clinical outcome was similar for all groups. Blood loss (Duraflo only), transfusion requirements and postoperative creatinine elevation were reduced in the heparin-coated groups. A lower incidence of atrial fibrillation was noted in the Duraflo group. Heparin coating did not uniformly attenuate the release of S100 or the degree of memory impairment. Conclusions: Cardiopulmonary bypass (CPB) with heparin coating and a reduced dose of heparin seems to be safe. Clinical outcome and neurological injury seem not to be associated with type of heparin coating used for CPB. However, blood loss and transfusion requirements may be reduced.
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| 20. |
- Belboul, Ali, et al.
(författare)
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The effect of autologous fibrin sealant (Vivostat) on morbidity after pulmonary lobectomy: a prospective randomised, blinded study.
- 2004
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Ingår i: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940. ; 26:6, s. 1187-91
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Postoperative air leakage is the most frequent complication after pulmonary surgery. The development of modern surgical techniques has been influenced strongly by the need to manage air leakage effectively during pulmonary resection. This study evaluated the effect of using an autologous fibrin sealant (Vivostat) during lobectomy on morbidity following surgery. METHODS: This was a prospective, blinded, randomised clinical study. Patients undergoing lobectomy were enrolled into two groups (Vivostat or non-treatment control, 20 per group). Air leakage was measured over a 1-h period (using a mechanical suction pump) on the day of operation, and both air leakage and bleeding/exudation (drainage volume) were recorded every morning postoperatively until the chest tubes were removed. Personnel recording these parameters were blinded to the intervention received. Results: Compared with the control group, mean bleeding/exudate volumes were significantly reduced in the Vivostat group (day 1,370 vs. 525 ml; total, 424 vs. 782 ml; both P<0.001), and drains were inserted for a shorter time (medians, 1 vs. 2 days, P=0.07). Significantly fewer patients had air leakage at any time in the Vivostat group (40 vs. 80%, P=0.02), and air leakage volumes were significantly lower compared with the control group (median differences: day of surgery: 0.6l/min, P=0.01; total 0.8l/min, P=0.03). Postoperative hospitalisation time was shorter in the Vivostat group than in the control group but the difference was not significant (0.5 days, P=0.12). CONCLUSIONS: Vivostat fibrin sealant significantly reduces post-surgical air leakage and drainage volumes following lobectomy in pulmonary surgery and is suitable for routine use in this procedure.
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| 23. |
- Grattan, MT, et al.
(författare)
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Leaflet arrest in St Jude Medical and CarboMedics valves: an experimental study
- 2004
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940. ; 25:6, s. 953-957
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Two patients who suffered acute failure of their St Jude Medical Masters aortic valve prostheses due to leaflet arrest that were unrelated to suture material are presented. It was hypothesized that the valves failed because force applied to bear upon the valve annulus caused the hinge mechanism to become restricted or to arrest. Methods: A study was designed to measure the force that would cause leaflet arrest in three sizes of St Jude Medical Masters valves and CarboMedics mechanical valves. A specially manufactured pushrod device was used to apply a variable force to the sewing cuff, low annulus level, or to the pivot guards of all the valves. Results: For every valve size tested, the St Jude Medical Masters valves required significantly less force applied than did the CarboMedics valves to cause one or both leaflets to arrest (P < 0.0004). Conclusions: A force applied on the valve ring of mechanical valves can cause leaflet arrest. The force required to arrest the leaflets is within an order of magnitude of that measured in other in vivo animal studies. We conclude that force on the valve rings in patients after aortic valve surgery could cause leaflet malfunction and even arrest in some patients. (C) 2004 Elsevier B.V. All rights reserved.
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| 26. |
- Rexius, Helena, 1967, et al.
(författare)
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Gender and mortality risk on the waiting list for coronary artery bypass grafting
- 2004
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Ingår i: Eur J Cardiothorac Surg. - : Oxford University Press (OUP). - 1010-7940. ; 26:3, s. 521-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: There are gender differences in clinical presentation, treatment and outcome of patients with coronary artery disease. We investigated whether there is also a gender difference in terms of mortality risk on the waiting list in patients accepted for coronary artery bypass grafting (CABG). METHODS: All our patients accepted for elective CABG 1995-1999 (1303 women and 4561 men) were included. Prospectively registered preoperative characteristics and mortality were compared between men and women. Hazard functions for death on the waiting list were calculated using Poisson regression. RESULTS: At acceptance, women were older (68+/-9 vs 65+/-9 years, P<0.001), had a higher Cleveland risk score (2.4+/-1.8 vs 1.8+/-1.8, P<0.001) and a better left ventricular ejection fraction (60+/-14 vs 57+/-14%, P<0.001). More women had unstable angina pectoris (33 vs 20%, P<0.001), diabetes mellitus (23 vs 17%, P<0.001), chronic obstructive pulmonary disease (8 vs 5%, P<0.001), hypertension (47 vs 37%, P<0.001) and planned concomitant aortic valve surgery (13 vs 4%, P<0.001) while more men had three vessel disease (70 vs 66%, P=0.001). Median waiting time (55 vs 54 days, P=0.19) and unadjusted mortality (1.4 vs 1.0%, P=0.25) on the waiting list did not differ significantly between men and women but in a multivariate hazard analysis, female gender was associated with a lower risk than men of death on the waiting list (risk ratio 0.42, 95% confidence interval 0.19-0.93, P=0.032). CONCLUSIONS: Women have a lower risk of death on the waiting list for CABG, in spite of more advanced age, more co-morbidity, and a higher percentage of unstable angina pectoris.
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| 29. |
- Wehlin, L, et al.
(författare)
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Reply to Raja
- 2004
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Ingår i: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. - : Oxford University Press (OUP). - 1010-7940. ; 25:5, s. 907-907
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 30. |
- Åberg, Torkel
(författare)
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Defence, counterattack, retreat?
- 2004
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press. - 1010-7940 .- 1873-734X .- 1567-4258. ; 26:Suppl 1, s. S32-S35
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Tidskriftsartikel (refereegranskat)abstract
- Cardio-thoracic surgery is facing changes which are imposed upon us from two sources, medical development within cardiology and the general demographic and economic development of the western world. These two developments have to be faced. This treaty describes one way of thinking in our response to the changes. Using old strategic principles our options are attack, defence and retreat. The three options are described in some detail. In order to be well prepared, knowledge and preparation for all three options is necessary in meeting the challenges of the future.
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