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Berlin Brandenburg

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  • 1
    In: British Medical Journal, Feb 2, 2002, Vol.324(7332), p.280(3)
    Description: The authors discuss an investigation into how long patients stay in intensive care after cardiac surgery. They found that most patients leave intensive care within 48 hours, but those who do not, may stay in intensive care for a significantly longer time. They warn against rigid systems based on averages, since there is such variability in some patients' cases.
    Keywords: Critical Care Medicine -- Usage ; Coronary Care Units -- Services ; Heart Surgery ; Surgery
    ISSN: 1759-2151
    ISSN: 09598146
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  • 2
    Language: English
    In: The Annals of Thoracic Surgery, 2010, Vol.89(4), pp.1171-1179
    Description: The primary objective was to estimate the risk of paraprosthetic regurgitation (PPR) after aortic (AVR) and mitral valve replacement (MVR) using interrupted (IN) or semicontinuous (SC) sutures. The secondary objective was to estimate the risk of redo valve surgery and 10-year survival after valve replacement performed using either suture technique. Patients who underwent mechanical AVR or MVR using a St. Jude prosthesis between December 1991 and June 1997 were included. Eighteen patients had MVR and 43 had AVR using IN sutures; 49 and 83 patients received MVR and AVR, respectively, using SC sutures. The majority of these patients were part of a randomized controlled trial with different end points, presented elsewhere. Patients were followed for 10 years with annual transthoracic echocardiography, and clinical data were collected retrospectively. Kaplan-Meier survival analysis was performed. Cox's regression analysis was performed to identify factors predicting mortality as a function of time. Forward stepwise logistic regression was performed to analyze risk factors predicting PPR. Mann-Whitney test was used for continuous and nonparametric data, and χ test and Fisher's exact test were used for categorical data. A probability value less than 0.05 was considered significant. The overall risk of PPR after MVR and AVR was higher in the SC group than in the IN group. The need for redo AVR was significantly higher in the SC group. The suture technique did not affect the 10-year survival after either AVR or MVR. Use of SC technique increases the risk of significant PPR after AVR and MVR compared with IN technique independent of the size of prosthesis, degree of annular calcification, disease of the excised valve, or the implanting surgeon. Although 10-year survival is independent of suture technique, SC technique increases the risk of redo valve replacement after AVR.
    Keywords: 35;
    ISSN: 0003-4975
    E-ISSN: 1552-6259
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  • 3
    Language: English
    In: Journal of the American College of Cardiology, 27 March 2012, Vol.59(13), pp.E1574-E1574
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0735-1097(12)61575-7 Byline: Jason Dungu, Oswaldo Valencia, Aigul Baltabaeva, Tarek FT Antonios, Philip N. Hawkins, Lisa J. Anderson Author Affiliation: St George's University of London, London, United Kingdom, UK National Amyloidosis Centre, London, United Kingdom Article Note: (footnote) ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 11:00 a.m.-Noon Session Title: Pericardial/Myocardial Disease IV Abstract Category: 12. Pericardial/Myocardial Disease Presentation Number: 1126-119
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
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  • 4
    Language: English
    In: The Annals of Thoracic Surgery, July 2013, Vol.96(1), pp.43-49
    Description: The natural history and management of ascending aorta (AA) and arch dilatation in patients with bicuspid aortic valve (BAV) after aortic valve replacement (AVR) or aortic root replacement (ARR) remains controversial. Our aim is to identify dilatation of the remaining aorta after AVR or ARR in patients with BAV compared with patients with tricuspid aortic valve (TAV). Three hundred ninety-five patients who underwent AVR or ARR between 2002 and 2009 were studied. Preoperative computed tomography (CT) and echocardiography were performed in 192 patients with BAV, and the results were compared with those of 203 patients with TAV. An AA diameter 4.5 cm or greater was regarded as aneurysmal. Postoperative echocardiograms, computed tomographic scans, and magnetic resonance images were compared with subsequent imaging at a median follow-up of 4.6 years (2.2–9.8 years). Median ages of patients with BAV and patients with TAV were 57 ± 14 and 65 ± 16 years, respectively (  〈 0.05). Preoperative diameter of AA in the BAV group with no aneurysm (3.5 cm; range, 3.0–4.0 cm; n = 143) was significantly higher than in the TAV group (3.3 cm; range, 3.1–3.8 cm; n = 129) ( 〈 0.001). In both BAV and TAV groups with nonaneurysmal aortas who underwent AVR, there was no significant expansion of the AA and arch at 5 years' follow-up. In patients with aneurysmal aorta (BAV group, n = 49; TAV group, n = 74) who underwent ARR, there was also no significant difference in growth of the remaining aorta at 3 and 5 years' follow-up. No significant dilatation of the AA or arch was observed after AVR or ARR, respectively, in patients when a cut-off diameter of 4.5 cm or greater was considered for replacement in patients with BAV compared with patients with TAV up to 5 years after operation. The need for aortic replacement at smaller diameters was not found.
    Keywords: 35;
    ISSN: 0003-4975
    E-ISSN: 1552-6259
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  • 5
    Language: English
    In: The Annals of Thoracic Surgery, 2011, Vol.92(1), pp.104-110
    Description: Atrial fibrillation (AF) is an important cause of morbidity and mortality after cardiac surgery. The pathogenesis of AF appears to be multifactorial but little is known about the cause-effect relationship of substrate modifications with the onset of the arrhythmia. With the use of modern proteomics, this study aims to identify preexisting changes in the left atrium of patients susceptible to postoperative AF. We analyzed 20 matched patients undergoing elective, first-time coronary artery bypass grafting with no history of AF. They were divided into 2 equal groups according to the development of postoperative AF. Proteomic analysis was performed in left atrial tissue obtained during surgery using two-dimensional difference in gel electrophoresis techniques. Mass spectrometry identified proteins that were differentially expressed in patients who developed AF against those who remained in sinus rhythm. Proteomic analysis of left atrial tissue identified 19 differentially expressed protein spots between patients who developed postoperative AF and their sinus rhythm counterparts. In patients who developed AF, proteins associated with oxidative stress and apoptosis (peroxiredoxin 1, apoptosis-inducing factor, and 96S protease regulatory subunit 8) as well as acute phase response components (apolipoprotein A-I, fibrinogen) were found to be increased. Conversely, the expression of proteins responsible for glycolysis (enolase) and pyruvate metabolism (pyruvate dehydrogenase) was reduced. We describe protein changes that precede the development of postoperative AF and which might be suggestive of increased oxidative stress and glycolytic inhibition in the left atrium of patients predilected to AF.
    Keywords: 24;
    ISSN: 0003-4975
    E-ISSN: 1552-6259
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  • 6
    Language: English
    In: The Journal of Thoracic and Cardiovascular Surgery, February 2014, Vol.147(2), pp.606-610
    Description: Joint guidelines on myocardial revascularization were published by the European Society of Cardiology and European Association for Cardiothoracic Surgery: Patients with left main stem, proximal left anterior descending, or 3-vessel disease should be discussed with a surgeon before revascularization, and ad hoc percutaneous coronary intervention has no elective indication in these categories. We assess the impact of the guidelines on referral patterns to a cardiac surgery service at a large-volume cardiac center in the United Kingdom. Joint guidelines were published in August 2010. All patients with severe disease undergoing percutaneous coronary intervention at one institution were identified 6 months before (January to June 2010) and 6 months after (January to June 2011) their introduction. Decision-making and surgical referral were determined from minutes of multidisciplinary meeting. A total of 197 patients underwent elective percutaneous coronary intervention pre-guidelines, of whom 62 had severe disease. Only 6 patients (9%) were discussed at a multidisciplinary meeting before intervention. After introduction of the guidelines, elective percutaneous coronary interventions were performed in 164 patients, of whom 42 had surgical disease. Only 8 patients (17%) were discussed at a multidisciplinary meeting before intervention (  = not significant). Follow-up was a median of 480 (380-514) days for the pre-guideline group and 104 (31-183) days for the post-guideline group. Ad hoc percutaneous coronary intervention in surgical disease occurred in 8 patients (14%) pre-guidelines and was unchanged for 9 patients (26%) post-guidelines (  = not significant). Despite recommendation by both cardiology and cardiac surgical bodies and widespread publicity, a significant number of patients in this single-center study are not receiving optimal treatment recommended by these guidelines.
    Keywords: Cabg ; Eacts ; Esc ; Lad ; Lms ; PCI ; RCA ; 23;
    ISSN: 0022-5223
    E-ISSN: 1097-685X
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  • 7
    Language: Spanish
    In: Avances en Ciencias e Ingenierías, 01 December 2014, Vol.6(2)
    Description: Nowadays, most countries in the world suffer several traffic issues which generate public health problems such as deaths and injuries of drivers and pedestrians. In order to reduce these fatalities, a system for automatic detection of both distraction and drowsiness is presented in this research....
    Keywords: Distracción ; Adormecimiento ; Accidentes de Tráfico ; Tecnología Tof ; Vehículos Inteligentes
    ISSN: 1390-5384
    E-ISSN: 2528-7788
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  • 8
    Language: English
    In: Journal of Cardiothoracic and Vascular Anesthesia, December 2018, Vol.32(6), pp.2685-2691
    Description: To derive and validate a clinical risk index that can predict readmission to the intensive care unit (ICU) after cardiac surgery. Retrospective nonrandomized study to determine the perioperative variables associated with risk of readmission to the ICU after cardiac surgery. The study was carried out in a single university hospital. This was an analysis of 4,869 consecutive adult patients. All patients underwent cardiac surgery at a single center and were discharged to the ward from the ICU during the index surgical admission. A total of 156 patients (3.2%) were readmitted to the ICU during their index surgical admission. Risk factors associated with readmission were identified by performing univariate analysis followed by multivariate logistic regression. The final multivariable regression model was validated internally by bootstrap replications. Nine independent variables were associated with readmission: urgency of surgery, diabetes, chronic kidney disease stage 3 to 5, aortic valve surgery, European System for Cardiac Operative Risk Evaluation, postoperative anemia, hypertension, preoperative neurological disease, and the Intensive Care National Audit and Research Centre score. Our data also showed mortality (18% 3.2%, p 〈 0.0001) was significantly higher in readmitted patients. The median duration of ICU stay (7 [4-17] 1 [1-2] days, p 〈 0.0001) and hospital stay (20 [12-33] 7 [5-10] days, p 〈 0.0001) were significantly longer in patients who were readmitted to ICU compared to those who were not. From a comprehensive perioperative dataset, the authors have derived and internally validated a risk index incorporating 9 easily identifiable and routinely collected variables to predict readmission following cardiac surgery.
    Keywords: Logistic Regression ; Cardiac Surgery ; ICU Complications ; Readmissions ; Risk Index ; Medicine
    ISSN: 1053-0770
    E-ISSN: 1532-8422
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  • 9
    Language: English
    In: Journal of Critical Care, December 2014, Vol.29(6), pp.997-1000
    Description: The purpose of this study was to assess the effect of goal-directed therapy (GDT), after cardiac surgery, on the incidence of acute kidney injury (AKI). This is a prospective observational study designed to achieve and maintain maximum stroke volume for 8 hours, in patients after cardiac surgery. This is a single-center study in a 15-bedded cardiothoracic intensive care unit (ICU). Participants are patients after coronary artery bypass grafting and/or aortic valve surgery. Patients in the GDT group received cardiac output monitoring and fluid challenges targeting an increase in stroke volume by at least 10%. Stroke volume maximization was maintained for a period of 8 hours from admission to the ICU. All other aspects of care were dictated by the clinical team. Patients in the standard therapy (ST) group had intravenous fluids in accordance with the routine practice of the unit. Patients were divided into the GDT and ST group dependant on availability of cardiac output monitors and allocation of nursing staff with training in GDT. Patients’ data were collected prospectively in both groups. One hundred twenty-three patients received GDT compared with 141 patients in the ST group. Both groups received similar volumes of fluid (GDT, 2905 [1367] mL vs 2704 [1393] mL; = .09). Incidence of AKI was reduced in the GDT group (n = 8 [6.5%] vs n = 28 [19.9%]; = .002). The median duration of hospital stay was 6 (4) days in the GDT group vs 7 (8) days in the ST, = .004. Postoperative GDT in patients after cardiac surgery was associated with reduction in the incidence of AKI and a reduction in ICU and hospital duration of stay.
    Keywords: Goal-Directed Therapy ; Cardiac Surgery ; Acute Kidney Injury ; Medicine
    ISSN: 0883-9441
    E-ISSN: 1557-8615
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  • 10
    Language: English
    In: The Annals of Thoracic Surgery, March 2015, Vol.99(3), pp.802-808
    Description: The most likely mechanisms of neurologic injury after transcatheter aortic valve implantation (TAVI) and aortic valve replacement (AVR) are cerebral embolization and hypoperfusion. We set out to determine potential mechanisms of neurologic injury after TAVI compared with AVR. One hundred twenty-seven consecutive high-risk patients with severe aortic stenosis (AS) who underwent TAVI (n = 85) or AVR (n = 42) were studied. Transcranial Doppler ultrasound (TCD), cerebral oximetry, diffusion-weighted magnetic resonance imaging (DW-MRI) (before, 6 days, and 3 months after procedure), and neurocognitive assessment before and at 3 months were performed. Neurologic injury was not significantly different between TAVI and AVR at 1 (1.1% vs 2.2%,  = 0.25) and 3 months (4.7% vs 2.2%,  = 1). At 3 months, overall cognitive score was higher in AVR compared with TAVI when adjusted for baseline score; the estimated difference between groups was 0.63 (95% confidence interval 0.87% to 1.17%;  = 0.02). Cerebral embolic load was 212 (123 to 344) during AVR and 134 (76 to 244) during TAVI ( 0.07). Cerebral oxygen desaturation during AVR (7.56 ± 2.16) was higher compared with TAVI (5.93 ± 2.47) ( 〈 0.01). Ischemic lesions measured by DW-MRI occurred in 76% of TAVI and 71% of AVR patients at 6 days (  = 0.69) and 63% and 39% at 3 months (  = 0.11). No significant association was found between cerebral emboli, cerebral oxygen desaturation, brain ischemic lesions, and general cognitive score. At 3 months follow-up, overall cognitive score was higher in AVR compared with TAVI, adjusted for baseline score. However, there was no difference in cerebral embolic load, ischemic lesions, and oxygen desaturation.
    Keywords: 35;
    ISSN: 0003-4975
    E-ISSN: 1552-6259
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