المؤلفون: Anagnostopoulos CE; Department of Cardiac Surgery, University of Ioannina, Greece., Siminelakis S, Ananiadou O, Katsaraki A, Drossos G, Katritsis D, Panagiotopoulos J, Papadopoulos G

المصدر: The Journal of cardiovascular surgery [J Cardiovasc Surg (Torino)] 2003 Oct; Vol. 44 (5), pp. 591-6.

نوع المنشور: Comparative Study; Journal Article; Multicenter Study

بيانات الدورية: Publisher: Edizioni Minerva Medica Country of Publication: Italy NLM ID: 0066127 Publication Model: Print Cited Medium: Print ISSN: 0021-9509 (Print) Linking ISSN: 00219509 NLM ISO Abbreviation: J Cardiovasc Surg (Torino) Subsets: MEDLINE

مواضيع طبية MeSH: Clinical Competence*, Cardiac Surgical Procedures/*education , Cardiology/*education , Hospitals, Private/*statistics & numerical data , Hospitals, University/*statistics & numerical data, Analysis of Variance ; Cardiac Surgical Procedures/mortality ; Humans ; Intensive Care Units/statistics & numerical data ; Length of Stay ; Preoperative Care/methods ; Prospective Studies ; Risk Factors ; Severity of Illness Index

مستخلص: Aim: The purpose of this study was to determine any significant differences in "learning curves" between private and public hospitals when the same senior surgeon was responsible during the initial phases of open-heart surgery programs development, in relation to risk stratification and hospital location.
Methods: A prospective review of 610 patients records was performed at a newly-opened cardiothoracic program in a public University Hospital (PUH) in the periphery of Greece, and a private institution (PI) with an experienced intensive care unit (ICU) in the capital city of Athens. Preoperative risk stratification, mortality and postoperative length of stay (LOS) were analysed between 1999 to 2001.
Results: At PUH 298 patients were operated and 312 patients at PI. There were 136 low risk (EuroSCORE 0-2) and 474 medium and high-risk patients (EuroSCORE > or =3). There was no significantly elevated mortality or learning curve in low risk surgery either at PUH (57 patients with 1 death) or PI (79 patients and 1 death). In medium and high-risk surgery at PI there was no mortality in 68 patients operated by the senior surgeon and no learning curve in all 233 such patients. In 240 medium and high-risk patients at PUH there was a learning curve despite the involvement of the same senior surgeon. In 1999 and 2000 the observed mortality (OM) in 150 patients was 15.33%, EuroSCORE 5.98, and in 2001 in 91 patients OM 3.29%, EuroSCORE 5.95 with p=0.00.8 when "experienced" ICU staff was employed. LOS was significantly reduced in 97 patients in 2001 at PUH (8.7 d +/- 2.81 vs 11.07 days +/- 7.9 in 1999 and 2000, p=0.046) confirming the existence of a learning curve at the PUH. No such change was observed at PI (8.2 days vs 7.8, p=0.45).
Conclusion: No mortality differences or learning curve characteristics were detected for low risk operations either at PUH or PI. For medium and high risk surgery there appears to be a learning curve in PUH but not in PI despite senior surgeon involvement in both. The presence of an experienced ICU appears to play a critical role in the outcome of operations in newly opened cardiothoracic programs.

المؤلفون: Yosuke Hari, Kouki Nakashima, Toshiki Kuno, Tomo Ando, Hisato Takagi

المصدر: The Journal of Cardiovascular Surgery. 60

مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Transcatheter aortic, Arterial disease, 030204 cardiovascular system & hematology, Risk Assessment, Severity of Illness Index, Transcatheter Aortic Valve Replacement, Peripheral Arterial Disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Severity of illness, medicine, Humans, Aged, Aged, 80 and over, business.industry, Hazard ratio, Aortic Valve Stenosis, General Medicine, Peripheral, Treatment Outcome, 030228 respiratory system, Aortic Valve, Meta-analysis, Cardiology, Female, Surgery, Cardiology and Cardiovascular Medicine, business, Risk assessment, Cohort study

الوصف: INTRODUCTION The aim of this study was to determine whether peripheral arterial disease (PAD) is an independent predictor of mortality in patients who undergo transcatheter aortic valve implantation (TAVI) and we performed meta-analysis of currently available studies. EVIDENCE ACQUISITION MEDLINE and EMBASE were searched through June 2018 using Web-based search engines (PubMed and OVID). We included comparative studies of patients with PAD versus those without PAD and cohort studies which investigated PAD as one of prognostic factors of mortality, which used the multivariable analysis and reported an adjusted odds and hazard ratio (OR/HR) for early (30-day or in-hospital) and late (including early) mortality after TAVI. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model. EVIDENCE SYNTHESIS The primary meta-analysis which pooled all the ORs/HRs demonstrated that PAD was associated with a statistically significant increase in both early (OR, 1.21; P=0.02) and midterm (1-year to 7-year) mortality (HR, 1.31; P

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https://doi.org/10.23736/s0021-9509.19.10863-4

المؤلفون: Răzvan Constantin Șerban, Oana Țepeș, Zoltan Demjen, István Adorján, Laszlo Hadadi, Silvia Lupu, Tamás Juhász, Cristina Somkereki

المصدر: Minerva Cardioangiologica. 68

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Renal function, Coronary Artery Disease, Fractional flow reserve, 030204 cardiovascular system & hematology, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, In patient, Renal Insufficiency, 030212 general & internal medicine, Antihypertensive Agents, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Incidence, Incidence (epidemiology), Middle Aged, Fractional Flow Reserve, Myocardial, Lower incidence, Clinical trial, medicine.anatomical_structure, Hypertension, Cardiology, Population study, Female, Cardiology and Cardiovascular Medicine, business, Artery

الوصف: BACKGROUND Renal dysfunction, an important predictor of cardiovascular mortality, is paradoxically associated with a lower incidence of positive coronary fractional flow reserve (FFR) values, possibly due to renal disease-associated myocardial microvascular dysfunction. It is unknown if this relationship is influenced by arterial hypertension, a condition strongly associated with renal- and microvascular dysfunction. METHODS The incidence of positive (

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https://doi.org/10.23736/s0026-4725.20.05103-8

المؤلفون: Antonio Valvano, Federica Cammarota, Valentina Apuzzi, Mariarosaria De Luca, Giorgio Bosso, Claudio Tomas, Valentina Mercurio, Valeria Di Simone, Antonio Cittadini, Veronica Panicara, Ugo Oliviero

المساهمون: Valvano, A., Bosso, G., Apuzzi, V., Mercurio, V., Di Simone, V., Panicara, V., De Luca, M., Tomas, C., Cammarota, F., Cittadini, A., Oliviero, U.

المصدر: International Angiology. 39

مصطلحات موضوعية: Carotid Artery Diseases, Male, Carotid ultrasound, medicine.medical_specialty, Long term follow up, Population, 030204 cardiovascular system & hematology, 030230 surgery, Carotid Intima-Media Thickness, Risk Assessment, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Retrospective analysis, Humans, cardiovascular diseases, education, Stroke, Aged, Retrospective Studies, education.field_of_study, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Carotid Arteries, Italy, Ischemic Attack, Transient, Hypertension, Angiography, Cardiology, Population study, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies

الوصف: BACKGROUND: Carotid dolicoarteriopathies (CDA) are a common finding during the carotid ultrasound or angiography, but their potential role in the development of cerebrovascular diseases is still unclear. Aim of this study is to clarify the possible relationship between CDA and the occurrence of cerebral events. METHODS: We performed a retrospective analysis on 2124 hypertensive patients with high cardiovascular risk that underwent carotid ultrasound from January 2000 to December 2008. Follow-up data on cerebrovascular events (transient ischemic attack and/or stroke occurrence) at 10 years were collected. RESULTS: The global prevalence of CDA in the study population was 12.9% (274/2124), and carotid kinking was more frequent in females and in the left carotid axis. The percentage of cerebrovascular events among hypertensive patients with CDA was similar to those occurred in the group of patients without CDA (10.94% vs. 10.97%, P=NS), with no differences in the number of strokes (8.39% vs. 8.38% P=NS) and TIA (2.55% vs. 2.59% P=NS). CONCLUSIONS: CDA are not associated with a major occurrence of cerebrovascular events in a high-risk population of hypertensives.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b669a9d1ae8736ae04f15255c87fcf01
https://doi.org/10.23736/s0392-9590.19.04229-9

المؤلفون: Tiange Luo, Han Zhang, Yan Li, Zhihui Zhu, Jiangang Wang, Haibo Zhang, Jie Han, Xu Meng, Yuehuan Li

المصدر: The Journal of Cardiovascular Surgery. 60

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Mitral Valve Annuloplasty, Clinical Decision-Making, Echocardiography, Three-Dimensional, Hemodynamics, Regurgitation (circulation), 030204 cardiovascular system & hematology, Prosthesis Design, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, Mitral valve, medicine, Humans, Mitral Valve Stenosis, Mitral valve prolapse, Prospective Studies, cardiovascular diseases, Aged, Heart Valve Prosthesis Implantation, Annulus (mycology), Mitral regurgitation, business.industry, Patient Selection, Rheumatic Heart Disease, Mitral Valve Insufficiency, Recovery of Function, General Medicine, Middle Aged, medicine.disease, Stenosis, Treatment Outcome, medicine.anatomical_structure, 030228 respiratory system, Heart Valve Prosthesis, Predictive value of tests, cardiovascular system, Cardiology, Mitral Valve, Female, Surgery, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal

الوصف: Background Mitral valve (MV) repair has been recommended for MV diseases. Good repair requires a full understanding of the three-dimensional (3D) structure of the MV, however, currently little is known about the 3D structure of the rheumatic MV. Methods A total of 82 cases underwent 3DTEE. Of these, 41 patients with rheumatic valvular disease (RVD) were studied intraoperatively (17 had severe mitral stenosis, 8 had severe mitral regurgitation, 16 had severe mitral stenosis coupled with regurgitation). There were 19 patients with degenerative MV disease (mitral valve prolapse [MVP] with severe regurgitation) and 22 cases with normal MV served as control subjects (CS). Results Compared with CS, the anteroposterior diameter, anterolateral posteromedial, annulus circumference, and annulus area of both pathological groups, i.e., the RVD and MVP groups, were understandably greater. Though the sphericity index was greater in the RVD group vis-a-vis CS, the MVP group had nearly the same sphericity index as CS. The mitral annulus of patients with RVD tended to be round. Annular unsaddling, defined as annular height to commissural width ratio (an indicator of saddle degree) less than 15%, was significantly more prevalent in the group with degenerative MV disease. Automatic dynamic analysis revealed that the parameters of annular maximum displacement and annulus area fraction (two-dimensional) were considerably decreased in the RVD group. Conclusions Annular unsaddling was significantly more prevalent in the degenerative MV disease group. The mitral annulus of patients with RVD tended to be round and stiff.

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https://doi.org/10.23736/s0021-9509.19.10814-2

المؤلفون: Yichao Pan, Lushan Chen, Jialin He, Shaonan Li, Shenshen Fu, Yishan Luo, Pingan Chen

المصدر: International Angiology. 37

مصطلحات موضوعية: Male, China, medicine.medical_specialty, Blood lipids, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Logistic regression, Carotid Intima-Media Thickness, Severity of Illness Index, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Severity of illness, Humans, Medicine, Carotid Stenosis, cardiovascular diseases, Coronary atherosclerosis, Aged, business.industry, Middle Aged, medicine.disease, Collateral circulation, Plaque, Atherosclerotic, Carotid Arteries, Logistic Models, Intima-media thickness, Multivariate Analysis, Plaque area, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery

الوصف: BACKGROUND Carotid artery plaque is associated with coronary artery disease (CAD). Besides the presence of plaque, plaque characteristics is also related to the severity of CAD. So the characteristic difference of carotid plaque may affect this assessment role. However, it is unclear whether the maximum carotid plaque area can reflect the extents and severity of CAD. METHODS We enrolled 388 consecutive CAD patients and 45 controls, and 204 patients were studied after excluding 184 patients without carotid plaque or coronary angiogram. Carotid intima media thickness and carotid plaque were measured by carotid ultrasound. Coronary angiography was applied and Gensini score was calculated. Blood lipid and other parameters were also detected. RESULTS The total and right maximum carotid plaque area were greater in high Gensini Score group than those in low and moderate score groups (both P

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https://doi.org/10.23736/s0392-9590.18.03967-6

المؤلفون: Jean-François Brichant, Pascal Legros, Jean Joris, Eric Deflandre, Robert Poirrier, Damien Kempeneers, Stéphanie Degey

المصدر: Minerva Anestesiologica. 83

مصطلحات موضوعية: Male, medicine.medical_specialty, Population, Severity of Illness Index, Hypoxemia, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Severity of illness, medicine, Humans, 030212 general & internal medicine, Hypoxia, education, Retrospective Studies, Sleep Apnea, Obstructive, education.field_of_study, business.industry, Sleep apnea, Retrospective cohort study, Middle Aged, medicine.disease, Obesity, Obstructive sleep apnea, Anesthesiology and Pain Medicine, Cardiology, Female, medicine.symptom, business, Body mass index, 030217 neurology & neurosurgery

الوصف: Severe obstructive sleep apnea (sOSA) and oxygen desaturations are both risk factors for postoperative complications. In some but not all patients, sOSA is associated with frequent oxygen desaturation episodes during sleep. The aim of this retrospective study was to identify the risk factors for exhibiting oxygen desaturation in patients with sOSA.Records of 786 patients, mainly obese (Body Mass Index [mean+SD]=30.2+6.0 kg/m2), were analyzed. Univariate and multivariate analyzes were applied to identify predictive risk factors for oxygen desaturation. Prediction probability was used to test the association between potential risk factors (obesity, age, gender, smoking, alcohol consumption, and benzodiazepines use) and the combination of sOSA and oxygen desaturation. A P value0.05 was considered as statistically significant.Univariate and multivariate analyses identified five risk factors for oxygen desaturation in the whole population: age (P0.001), obesity (P0.001), benzodiazepine use (P0.001), smoking (P=0.016), and male gender (P=0.029). The same analyses applied to patients with sOSA identified two independent risk factors for oxygen desaturation: obesity (P0.001), and benzodiazepine use (P=0.017). Obesity obtains the best prediction probability [95% CI] for the combination of sOSA and oxygen desaturation: 0.74 [0.69-0.79]. A BMI49 kg/m2 was associated with a 50% probability of combining severe OSA and nocturnal oxygen desaturation.Less than 50% of patients with sOSA experience nocturnal oxygen desaturation. Obesity and daily benzodiazepine intake are independent risk factors for these patients to exhibit nocturnal oxygen desaturation. Benzodiazepine in obese patients with sOSA should, therefore, be used cautiously.

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https://doi.org/10.23736/s0375-9393.16.11491-9

المؤلفون: Nayera E. Hassan, Omar Hosni Dwidar, Wael Attia, Hala S. Hamza, Moenes M Abu Shady

المصدر: Minerva Pediatrics. 70

مصطلحات موضوعية: Male, medicine.medical_specialty, Pediatrics, Heart disease, Disease, Severity of Illness Index, Lesion, Thinness, Health hazard, Internal medicine, medicine, Humans, Child, Growth Disorders, Growth retardation, business.industry, Rheumatic Heart Disease, Anthropometry, medicine.disease, Cross-Sectional Studies, Echocardiography, Case-Control Studies, Child, Preschool, Mitral incompetence, Pediatrics, Perinatology and Child Health, Cardiology, Egypt, Female, medicine.symptom, Underweight, business

الوصف: BACKGROUND Advances in echocardiographic studies have identified a massive burden of rheumatic heart disease (RHD) which continues to be a major health hazard in most developing countries. The aim of this study was to investigate the correlation between cardiac affection as regards the presence of single or multiple valvular lesions, and their severity and the growth parameters in a group of Egyptian children with RHD. METHODS This study is a cross-sectional study, that was conducted on 200 children with RHD and 400 age-matched healthy. All subjects were subjected to anthropometric measurement and echocardiographic evaluation of the different cardiac parameters. RESULTS Isolated mitral incompetence (MI) was the most frequent type of valvular lesion in RHD (54.0%), followed by mixed MI and aortic incompetence (AI) (26.5%). Patients with RHD were more liable to be underweight and stunted compared to controls (P

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https://doi.org/10.23736/s0026-4946.16.04300-0

المؤلفون: Gerd Hasenfuß, M. Grossmann, Terézia B. Andrási, Bernhard C. Danner, Claudius Jacobshagen, Friedrich A. Schöndube

المصدر: The Journal of Cardiovascular Surgery. 59

مصطلحات موضوعية: Aortic valve, Heart transplantation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Treatment outcome, General Medicine, Femoral artery, 030204 cardiovascular system & hematology, medicine.disease, Transplantation, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030228 respiratory system, Aortic valve stenosis, Internal medicine, medicine.artery, Severity of illness, Aortic valve surgery, medicine, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, business

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https://doi.org/10.23736/s0021-9509.17.09788-9

المؤلفون: Dallit Mannheim, Ron Karmeli

المصدر: The Journal of Cardiovascular Surgery. 58

مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Kaplan-Meier Estimate, Carotid endarterectomy, 030204 cardiovascular system & hematology, Severity of Illness Index, Asymptomatic, Disease-Free Survival, 03 medical and health sciences, 0302 clinical medicine, Restenosis, Recurrence, Risk Factors, Internal medicine, medicine, Humans, Carotid Stenosis, Prospective Studies, cardiovascular diseases, Israel, Stroke, Aged, Proportional Hazards Models, Endarterectomy, Endarterectomy, Carotid, business.industry, Endovascular Procedures, General Medicine, Perioperative, Middle Aged, medicine.disease, Surgery, Stenosis, Treatment Outcome, Ischemic Attack, Transient, Asymptomatic Diseases, Cardiology, Female, Stents, Carotid stenting, medicine.symptom, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery

الوصف: Background For an asymptomatic patient with severe carotid stenosis the most important question is how to prevent an ischemic stroke. Carotid artery stenosis is the estimated cause of stroke in 8-20% of the cases. Today more than 50% of procedures for carotid stenosis are done on asymptomatic patients, but few of the randomized controlled trials comparing carotid endarterectomy and stenting examined specifically these patients. Methods All patients with severe (>70%) asymptomatic carotid artery stenosis seen in the Carmel medical center vascular clinic were prospectively screened and randomized 1:1 for carotid endarterectomy (CEA) or carotid stenting (CAS). Patients eligible for both procedures were enrolled. The primary objectives of the study were: 1) periprocedural complications - stroke (CVA), transient ischemic attack (TIA), myocardial infarction (MI), and death; 2) long-term results: mortality, prevention of ipsilateral stroke or TIA, and freedom from restenosis. Results One-hundred and thirty-six patients were treated with mean follow-up of 26 months. There was no difference in short and long term results between the two groups. Thirty day morbidity included: 1 CVA in each group with no MI. Long-term results included 4 deaths in each group; none from CVA. One TIA was noted after CAS, and 3 cases of restenosis were found in CEA and one in CAS. Conclusions CAS is a maturing procedure and has improved significantly over the past several years. Future developments of stents and protection devices will achieve better perioperative results. This along with our excellent long term results will promote the use of stenting for suitable patients.

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https://doi.org/10.23736/s0021-9509.16.09513-6