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Eur J Cardiothorac Surg 1999;15:816-823
© 1999 Elsevier Science NL
Service de chirurgie cardiovasculaire, CHU de Fort de France, 97200Martinique, France
Received 22 September 1998; received in revised form 8 March 1999; accepted 11 March 1999.
Corresponding author. Tel.: +596-552271; fax: +596-758438; email: f.r.fwi@wanadoo.fr
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Abstract |
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 Top Abstract 1. Introduction
2. Methods
3. Results
4. Discussion
Appendices A - IAppendix J. Conference...References |
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Key Words: Risk factors • EuroSCORE database
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1. Introduction |
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TopAbstract1. Introduction
2. Methods
3. Results
4. Discussion
Appendices A - IAppendix J. Conference...References |
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2. Methods |
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TopAbstract1. Introduction
2. Methods
3. Results
4. Discussion
Appendices A - IAppendix J. Conference...References |
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2.2. Data collection
A simple data collection form was then designed so that information on these risk factors could be entered easily on one side of A4 size paper. Comprehensive information on data collection requirements and definitions of variables was provided to all participating institutions and summarized on detachable sections on every data collection form. Mortality was defined as death within 30 days of operation or within the same hospital admission (Appendix I). To preserve confidentiality, patient and centre identification was coded. Members of the steering committee acted as national organizers to supervise and coordinate centre recruitment and data collection in participating countries. Recruitment was on a voluntary basis. Data collection was carried out over three months (September–December 1995). All adult patients who underwent cardiac surgery under cardiopulmonary bypass during this period were included in the study.
2.3. Data entry
Data were gathered and entered onto a computer database at the biostatistical research centre of the University of Bordeaux, France. In order to ensure the highest possible quality of data entry, all data were entered twice independently by two operators and any discrepancies checked and corrected. The database was subjected to 16 out-of-range error checking operations and a further 16 separate operations were used to identify errors of logic. Incomplete forms were identified by the absence of information in any of 10 mandatory fields. Erroneous and incomplete data collection forms thus identified were returned to the participating centres for correction and completion. At the end of this procedure, centres whose data did not reach the preset target of >99% for accuracy and completeness of mandatory fields were removed from the study.
2.4. Analysis
The statistical model was multiple logistic regression. The variables entered in the model were selected using bivariate tests, chi square tests for categorical covariates and unpaired t-tests or Wilcoxon rank sum tests for continuous covariates. All variables significant at the P<0.2 level were entered into the model provided they were present in at least 2% of the sample. Non-significant variables were eliminated from the model one at a time, beginning with the variable having the highest P-value. Stability of the model was checked every time a variable was eliminated. In the case of continuous variables where the relationship with outcome was not linear, such as serum creatinine, we determined cut-off points using the fractional polynomials method. When all statistically non-significant variables had been eliminated from the model, goodness-of-fit testing was used to assess how well the model was calibrated and the area under the receiver operating characteristic (ROC) curve was used to assess how well the model could discriminate between patients who lived and patients who died.
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3. Results |
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TopAbstract1. Introduction
2. Methods
3. Results
4. Discussion
Appendices A - IAppendix J. Conference...References |
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3.2. Vascular disease
Evidence of extracardiac arteriopathy as defined in Appendix C was present in 11% of patients: 2.9% had already undergone vascular surgery and in 1.3% such surgery was planned for the future. Intermittent claudication affected 5.8% of patients. Carotid disease was present in 4.4% and was bilateral in one third. Abdominal aortic disease was present in 1.3%. There was some overlap between the above categories because of the presence of generalized arteriopathy in some patients.
3.3. Renal and respiratory function
Mean serum creatinine was 103 µmol/l with 5% of patients exceeding 150 µmol/l. A diagnosis of chronic renal insufficiency was established in 3.5% but only 0.5% were on long-term dialysis treatment. Chronic pulmonary disease, defined by the long-term use of bronchodilators and steroids, affected 3.9% of patients.
3.4. General cardiac status
Previous cardiac surgery had been carried out in 7.2% of patients of whom 85% had one previous operation, 10% had two and 5% had three or more. Chronic cardiac insufficiency was present in 13.7% of patients, with 5.8% in NYHA class IV. Atrial fibrillation was present in 9%. Left ventricular (LV) function was normal in 61% of patients with an ejection fraction (EF) of 50% or more, moderate in 32% (EF 30–50%) and poor in 7% (EF<30%).
3.5. Cardiac status of coronary patients
In patients undergoing isolated coronary surgery, 15% had a myocardial infarction within the preceding 3 months with a mean interval of 35 days. Rest pain was present in 21% of patients and 12% were unstable to the extent of needing intravenous nitrate therapy. Emergency surgery for catheter laboratory complications accounted for 1% of all procedures. Two thirds of coronary patients had triple vessel disease, a quarter had double vessel disease and only 8% single vessel disease. Left main stem stenosis (>50%) was present in 22% of patients and very tight (>90%) in 5.3%.
3.6. Cardiac status of valve patients
In mitral valve surgery, the valve lesion was regurgitation in 58%, stenosis in 26% and both in 16%. Pulmonary artery systolic pressure exceeded 60 mmHg in 16.5% of mitral patients. In aortic valve surgery, the proportions were reversed with stenosis being the predominant lesion (55%) over regurgitation (27%) and mixed lesions (18%). In aortic stenosis the systolic gradient across the valve exceeded 120 mmHg in 8% of patients. Active endocarditis was present in 202 (3.6%) of all valve patients.
3.7. Other variables
Critical preoperative conditions affected 774 (4%) of patients and are summarized in Table 2. Rare conditions which may contribute to risk were identified in 737 patients (3.9%) and are detailed in Table 3.
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3.9. Mortality
Overall cardiac surgical mortality for all procedures was 4.8%. Table 4 illustrates the overall procedural mortality as well as the baseline mortality for patients without any identifiable risk factors whether significant or not.
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4. Discussion |
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TopAbstract1. Introduction
2. Methods
3. Results
4. Discussion
Appendices A - IAppendix J. Conference...References |
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There have been many studies of risk-factors in cardiac surgery [2–14]. Most were derived from the North American patient population and may not necessarily apply to European practice. This study was undertaken to produce a reliable and contemporary European risk profile for cardiac surgery. Entry to the study was voluntary. This necessarily means that centres which agreed to participate were self selected. We accept that this inevitably leads to a degree of bias, but the alternative approach of random selection followed by compulsion would have been associated with two larger problems. The first is that of non-compliance leading to incomplete data collection. The second and worse problem is possible scepticism or malevolence towards the project leading to unreliable data, wrong results and erroneous conclusions. We believe that the excellent compliance and high degree of data accuracy that we obtained justifies the voluntary enrolment approach. Accuracy and completeness were further enhanced by three features of the study design: considerable time and effort were invested in the preparation of a brief, user-friendly and unambiguous data collection sheet with detailed explanation at the point of use; data collection was ‘short and sweet’ in order to avoid loss of momentum and enthusiasm for the project over time; finally, patient and centre confidentiality were guaranteed.
Many risk factors have been associated with cardiac surgical mortality. Some are preoperative patient characteristics, others are related to the type and severity of the cardiac disease itself and a third group are related to the type and extent of the surgical procedure. Although the risk factors selected for evaluation were largely similar to those in other studies, it will be noted that, whenever possible, objective and simple definitions were provided. Previous studies have stumbled in fields which are either naturally complex, poorly defined or both such as unstable angina, extracardiac arteriopathy and pulmonary disease. We provided simplified definitions and clear subclassifications in order to avoid ambiguity and the loss of potentially valuable information.
This large database has for the first time provided a unique opportunity to assess the true risk of cardiac surgery in the absence of any identifiable risk factors. For the purposes of this analysis, baseline mortality figures were calculated in patients in whom no pre-operative risk factors could be identified (including risk factors which were not found to have a significant impact in this study, such as diabetes and hypertension). When all such patients are excluded, it was gratifying to note the extremely low current mortality for cardiac surgery in Europe: nil for atrial septal defect repair, 0.4% for CABG and barely over 1% for single valve repair or replacement. Many of these ‘near-zero-risk’ patients with coronary disease are currently offered interventional cardiology on the alleged basis of appreciable cardiac surgical mortality. These patients and their physicians may be well advised to reconsider the option of coronary surgery in the light of these results.
Many of the risk factors identified as significant in the multivariate analysis, such as age, sex and left ventricular function have been identified elsewhere [2,4,13,18].The absence of diabetes, hypertension and smoking may surprise some clinicians but this too is supported by other studies [19–21]. Two relatively new risk factors figure prominently in our findings: extracardiac arteriopathy and severe neurological dysfunction. Many cardiac surgeons have learnt from experience that these are important determinants of outcome, and this is supported in recent work [2,22]. We believe that our ability convincingly to demonstrate their impact owes much to the simple and objective definitions provided at the data collection stage. The same applies to our definition of chronic airway disease, a condition judged to be too vague for inclusion by other workers [4].
The EuroSCORE database will be used to construct a risk stratification system for use in all European cardiac surgery. It is also a rich and highly accurate database, reflecting a snapshot of cardiac surgery in the 1990s, and will be subjected to further analysis in order to determine demographic, regional and procedural variations in European cardiac surgery.
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Acknowledgments |
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Footnotes |
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Appendices A - I |
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TopAbstract1. Introduction
2. Methods
3. Results
4. Discussion
Appendices A - IAppendix J. Conference...References |
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Appendix B. General patient information
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Appendix C. Preoperative general risk factors
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a Extracardiac arteriopathy was defined as the presence of one or more of these four risks.
Appendix D. Preoperative cardiac risk factors
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Appendix E. Critical preoperative situation
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Appendix F. Rare general conditions
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Appendix G. Indication for surgery
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Appendix H. Operative information
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Appendix I. Outcome
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Appendix J. Conference discussion |
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TopAbstract1. Introduction
2. Methods
3. Results
4. Discussion
Appendices A - IAppendix J. Conference...References |
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Dr F. Grover (Denver, CO): I chair the STS National Database Committee and want to congratulate you on your risk modelling, your statistical analysis and your effort. As you know, in the United States we found out the hard way, about 10 years ago, just as the previous discusser mentioned, what happens when other people analyse our data and do not risk stratify the data so that you have a level playing field. You have a problem when governmental and other organizations publish non-risk stratified data. I firmly believe in the importance of any effort that we can all make as an international community to risk stratify, and the importance of taking the risk of the patient into account ahead of time. It is also interesting how close your odds ratios are for the various preoperative risk factors to ours the STS Database.
Dr R. Dion (Brussels, Belgium): How did you select the centres and are you planning to include more centres in your study? We would be very keen in Belgium to participate in such a study.
Dr Roques: We chose the centres on a voluntary basis. We announced, in most countries by mailing, that we intended to do this study and lots of centres answered us. But of course yesterday Sam Nashef invited everybody who wants to use this score to go on and use it and to share the study with us. And I do agree with Mr Bachet saying that now national societies or even the European Society should help us in this work.
Dr B. Bridgewater (Manchester, UK): Two points first and then a question. We have looked at the predictive ability of some of the North American models to predict mortality following coronary artery surgery in the UK, and we found that the makeup of the population that we operate on is very different in terms of its preoperative characteristics to the USA population, and the North American risk models are not good when you subject them to statistical analysis. The second thing is, even within a small geographically defined region within the UK such as the northwest of England there are very big differences in patient characteristics between the different centres. So my question is, have you started to look in a structured way at the differences in preoperative characteristics across the large geographical area which is Europe and how do you think that might influence the ability of the model to predict mortality accurately in the different areas?
Dr Roques: Well, first of all, we had to analyse whether or not there were differences between North American results and European results. We have already worked on this subject in France four years ago and the study has been presented to you. Concerning regional particularity, of course we will not produce 10 or 12 or 100 scores all over Europe. We have to decide to use a score that will help every one of us to work, even if it does not take care of regional specificities. That is the reason why we have used an overall score concerning coronary surgery and valve surgery, because we know that in Europe some countries may still perform more valvular surgery than coronary surgery. That is the reason why we chose a global score.
Dr G. Rizzoli (Padua, Italy): The prevalence of the disease is changing quite rapidly. For instance, in Italy now, the mitral valve operation, which was more common among the valvular operations, has been superseded by the aortic valve, and the aortic is associated with coronary artery bypass. So I would like to know if you have special rules to take care of confounding from the prevalence of the different diseases when you prepare these studies?
Dr Roques: Well, we have tested every variable, we have tested 100 variables, and we decided to find a score, taking care of the major problems so as to create a global score. We considered any of the operative situations as valve surgery and coronary surgery, but we will not answer in detail to every specific problem. This is not the aim, this is not the purpose of our work. The purpose of the work is not to answer individual operative mortality assessment but rather to analyse quality of care for a centre, a country, in Europe.
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References |
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TopAbstract1. Introduction
2. Methods
3. Results
4. Discussion
Appendices A - IAppendix J. Conference...References |
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 N. Galiè and A. Manes CHAPTER 24 Pulmonary Hypertension ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
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S. Koster, F. G.J. Oosterveld, A. G. Hensens, A. Wijma, and J. van der Palen Delirium After Cardiac Surgery and Predictive Validity of a Risk Checklist Ann. Thorac. Surg., December 1, 2008; 86(6): 1883 - 1887. [Abstract] [Full Text] [PDF]
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M. Ranucci, G. Bozzetti, A. Ditta, M. Cotza, G. Carboni, and A. Ballotta Surgical Reexploration After Cardiac Operations: Why a Worse Outcome? Ann. Thorac. Surg., November 1, 2008; 86(5): 1557 - 1562. [Abstract] [Full Text] [PDF]
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W. Dietrich, M. Spannagl, J. Boehm, K. Hauner, S. Braun, T. Schuster, and R. Busley Tranexamic Acid and Aprotinin in Primary Cardiac Operations: An Analysis of 220 Cardiac Surgical Patients Treated with Tranexamic Acid or Aprotinin Anesth. Analg., November 1, 2008; 107(5): 1469 - 1478. [Abstract] [Full Text] [PDF]
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A. Zierer, G. Wimmer-Greinecker, S. Martens, A. Moritz, and M. Doss The transapical approach for aortic valve implantation. J. Thorac. Cardiovasc. Surg., October 1, 2008; 136(4): 948 - 953. [Abstract] [Full Text] [PDF]
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F. Biancari, M. A. A. Mahar, M. Mosorin, J. Heikkinen, M. Pokela, P. Taskinen, V. Anttila, J. Lahtinen, and M. Lepojarvi Immediate and Intermediate Outcome After Off-Pump and On-Pump Coronary Artery Bypass Surgery in Patients With Unstable Angina Pectoris Ann. Thorac. Surg., October 1, 2008; 86(4): 1147 - 1152. [Abstract] [Full Text] [PDF]
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M. Musci, A. Loforte, E. V. Potapov, T. Krabatsch, Y. Weng, M. Pasic, and R. Hetzer Body Mass Index and Outcome After Ventricular Assist Device Placement Ann. Thorac. Surg., October 1, 2008; 86(4): 1236 - 1242. [Abstract] [Full Text] [PDF]
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W. Rademacher, A. Knape, J. Schumm, M. Ferrari, A. Lauten, H. Mudra, and H. R. Figulla Acute and long-term outcome of unprotected left main coronary angioplasty compared to the anticipated surgical risk Interactive CardioVascular and Thoracic Surgery, October 1, 2008; 7(5): 871 - 877. [Abstract] [Full Text] [PDF]
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M. L. Brown, H. V. Schaff, M. E. Sarano, Z. Li, T. M. Sundt, J. A. Dearani, C. J. Mullany, and T. A. Orszulak Is the European System for Cardiac Operative Risk Evaluation model valid for estimating the operative risk of patients considered for percutaneous aortic valve replacement? J. Thorac. Cardiovasc. Surg., September 1, 2008; 136(3): 566 - 571. [Abstract] [Full Text] [PDF]
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N. Luciani, A. Anselmi, R. De Geest, L. Martinelli, M. Perisano, and G. Possati Extracorporeal circulation by peripheral cannulation before redo sternotomy: Indications and results J. Thorac. Cardiovasc. Surg., September 1, 2008; 136(3): 572 - 577. [Abstract] [Full Text] [PDF]
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 J. Granton and D. Cheng Risk Stratification Models for Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2008; 12(3): 167 - 174. [Abstract] [PDF]
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A. A. Klein and S. A. M. Nashef Perception and Reporting of Cardiac Surgical Performance Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2008; 12(3): 184 - 190. [Abstract] [PDF]
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 P. Massoudy, S. Wagner, M. Thielmann, U. Herold, E. Kottenberg-Assenmacher, G. Marggraf, A. Kribben, T. Philipp, H. Jakob, and S. Herget-Rosenthal Coronary artery bypass surgery and acute kidney injury--impact of the off-pump technique Nephrol. Dial. Transplant., September 1, 2008; 23(9): 2853 - 2860. [Abstract] [Full Text] [PDF]
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P. T.L. Chiam and C. E. Ruiz Percutaneous Transcatheter Aortic Valve Implantation: Assessing Results, Judging Outcomes, and Planning Trials: The Interventionalist Perspective J. Am. Coll. Cardiol. Intv., August 1, 2008; 1(4): 341 - 350. [Abstract] [Full Text] [PDF]
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S W Grant, A D Grayson, M Jackson, J Au, B M Fabri, G Grotte, M Jones, and B Bridgewater Does the choice of risk-adjustment model influence the outcome of surgeon-specific mortality analysis? A retrospective analysis of 14 637 patients under 31 surgeons Heart, August 1, 2008; 94(8): 1044 - 1049. [Abstract] [Full Text] [PDF]
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M. Di Mauro and A. M. Calafiore Reply Ann. Thorac. Surg., July 1, 2008; 86(1): 350 - 350. [Full Text] [PDF]
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C. A. den Uil, W. K. Lagrand, P. E. Spronk, R. T. van Domburg, J. Hofland, C. Luthen, J. J. Brugts, M. van der Ent, and M. L. Simoons Impaired sublingual microvascular perfusion during surgery with cardiopulmonary bypass: A pilot study J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 129 - 134. [Abstract] [Full Text] [PDF]
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B Bridgewater and B Keogh Surgical "league tables" Heart, July 1, 2008; 94(7): 936 - 942. [Full Text] [PDF]
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 P. Kojodjojo, N. Gohil, D. Barker, P. Youssefi, T.V. Salukhe, A. Choong, M. Koa-Wing, J. Bayliss, D.R. Hackett, and M.A. Khan Outcomes of elderly patients aged 80 and over with symptomatic, severe aortic stenosis: impact of patient's choice of refusing aortic valve replacement on survival QJM, July 1, 2008; 101(7): 567 - 573. [Abstract] [Full Text] [PDF]
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J. Dunning, J. R.L. Waller, B. Smith, S. Pitts, S. W.H. Kendall, and K. Khan Coronary Artery Bypass Grafting is Associated With Excellent Long-Term Survival and Quality of Life: A Prospective Cohort Study Ann. Thorac. Surg., June 1, 2008; 85(6): 1988 - 1993. [Abstract] [Full Text] [PDF]
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N. Piazza, Y. Onuma, E. Jesserun, P. P. Kint, A.-M. Maugenest, R. H. Anderson, P. P. T. de Jaegere, and P. W. Serruys Early and Persistent Intraventricular Conduction Abnormalities and Requirements for Pacemaking After Percutaneous Replacement of the Aortic Valve J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 310 - 316. [Abstract] [Full Text] [PDF]
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A. Sachithanandan, P. Nanjaiah, P. Nightingale, I. C. Wilson, T. R. Graham, S. J. Rooney, B. E. Keogh, and D. Pagano Deep sternal wound infection requiring revision surgery: impact on mid-term survival following cardiac surgery Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 673 - 678. [Abstract] [Full Text] [PDF]
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L. Merello, E. Riesle, J. Alburquerque, H. Torres, E. Aranguiz-Santander, O. Pedemonte, and B. Westerberg Risk Scores Do Not Predict High Mortality After Coronary Artery Bypass Surgery in the Presence of Diastolic Dysfunction Ann. Thorac. Surg., April 1, 2008; 85(4): 1247 - 1255. [Abstract] [Full Text] [PDF]
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M. van Gameren, A. P. Kappetein, E. W. Steyerberg, A. C. Venema, E. A.J. Berenschot, E. L. Hannan, A. J.J.C. Bogers, and J. J.M. Takkenberg Do We Need Separate Risk Stratification Models for Hospital Mortality After Heart Valve Surgery? Ann. Thorac. Surg., March 1, 2008; 85(3): 921 - 930. [Abstract] [Full Text] [PDF]
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L. A. Menicanti The surgeon, the statistics and the data Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 323 - 324. [Full Text] [PDF]
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P. D'Errigo, F. Seccareccia, S. Rosato, V. Manno, G. Badoni, D. Fusco, C. A. Perucci, and the Research Group of the Italian CABG Outcome Pro Comparison between an empirically derived model and the EuroSCORE system in the evaluation of hospital performance: the example of the Italian CABG Outcome Project Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 325 - 333. [Abstract] [Full Text] [PDF]
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G. Silvay, J. G. Castillo, J. Chikwe, B. Flynn, and F. Filsoufi Cardiac Anesthesia and Surgery in Geriatric Patients Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2008; 12(1): 18 - 28. [Abstract] [PDF]
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 S. Schneeweiss, J. D. Seeger, J. Landon, and A. M. Walker Aprotinin during Coronary-Artery Bypass Grafting and Risk of Death N. Engl. J. Med., February 21, 2008; 358(8): 771 - 783. [Abstract] [Full Text] [PDF]
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M. Ranucci, A. Pazzaglia, C. Bianchini, G. Bozzetti, and G. Isgro Body Size, Gender, and Transfusions as Determinants of Outcome After Coronary Operations Ann. Thorac. Surg., February 1, 2008; 85(2): 481 - 486. [Abstract] [Full Text] [PDF]
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Z. Colak, I. Segotic, S. Uzun, M. Mazar, V. Ivancan, and V. Majeric-Kogler Health related quality of life following cardiac surgery correlation with EuroSCORE Eur. J. Cardiothorac. Surg., January 1, 2008; 33(1): 72 - 76. [Abstract] [Full Text] [PDF]
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T. Deneke, K. Khargi, B. Lemke, T. Lawo, M. Lindstaedt, A. Germing, T. Brodherr, L. Bosche, A. Mugge, A. Laczkovics, et al. Intra-operative cooled-tip radiofrequency linear atrial ablation to treat permanent atrial fibrillation Eur. Heart J., December 1, 2007; 28(23): 2909 - 2914. [Abstract] [Full Text] [PDF]
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 S Green and E Aird Imaging in radiotherapy Br. J. Radiol., December 1, 2007; 80(960): 967 - 969. [Full Text] [PDF]
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F. Versaci, C. Del Giudice, A. Scafuri, J. Zeitani, R. Gandini, P. Nardi, A. Salvati, E. Pampana, F. Sebastiano, A. Romagnoli, et al. Sequential Hybrid Carotid and Coronary Artery Revascularization: Immediate and Mid-Term Results Ann. Thorac. Surg., November 1, 2007; 84(5): 1508 - 1514. [Abstract] [Full Text] [PDF]
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P. J. Van der Linden, J.-F. Hardy, A. Daper, A. Trenchant, and S. G. De Hert Cardiac surgery with cardiopulmonary bypass: does aprotinin affect outcome? Br. J. Anaesth., November 1, 2007; 99(5): 646 - 652. [Abstract] [Full Text] [PDF]
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 A. Szekely, P. Balog, E. Benko, T. Breuer, J. Szekely, M. D. Kertai, F. Horkay, M. S. Kopp, and J. F. Thayer Anxiety Predicts Mortality and Morbidity After Coronary Artery and Valve Surgery A 4-Year Follow-Up Study Psychosom Med, September 1, 2007; 69(7): 625 - 631. [Abstract] [Full Text] [PDF]
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C. A. Mestres, M. A. Castro, E. Bernabeu, M. Josa, R. Cartana, J. L. Pomar, J. M. Miro, J. Mulet, and the Hospital Clinico Endocarditis Study Group Preoperative risk stratification in infective endocarditis. Does the EuroSCORE model work? Preliminary results Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 281 - 285. [Abstract] [Full Text] [PDF]
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F. Bakhtiary, P. Therapidis, O. Dzemali, K. Ak, H. Ackermann, D. Meininger, P. Kessler, P. Kleine, A. Moritz, T. Aybek, et al. Impact of high thoracic epidural anesthesia on incidence of perioperative atrial fibrillation in off-pump coronary bypass grafting: A prospective randomized study J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 460 - 464. [Abstract] [Full Text] [PDF]
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M. Gaudino, F. Girola, M. Piscitelli, L. Martinelli, A. Anselmi, C. Della Vella, R. Schiavello, and G. Possati Long-term survival and quality of life of patients with prolonged postoperative intensive care unit stay: Unmasking an apparent success J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 465 - 469. [Abstract] [Full Text] [PDF]
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D. Ledoux, M. Monchi, J.-P. Chapelle, and P. Damas Cystatin C blood level as a risk factor for death after heart surgery Eur. Heart J., August 1, 2007; 28(15): 1848 - 1853. [Abstract] [Full Text] [PDF]
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E. Grube, L. Buellesfeld, U. Gerckens, R. Mueller, M. Menichelli, T. Schmidt, J. C. Laborde, T. Felderhoff, S. Iversen, B. Sauren, et al. Response to Letter Regarding Article, "Percutaneous Implantation of the CoreValve Self-Expanding Valve Prosthesis in High-Risk Patients With Aortic Valve Disease: The Siegburg First-in-Man Study" Circulation, June 5, 2007; 115(22): e613 - e613. [Full Text] [PDF]
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Y.-N. Youn, Y.-L. Kwak, and K.-J. Yoo Can the EuroSCORE Predict the Early and Mid-Term Mortality After Off-Pump Coronary Artery Bypass Grafting? Ann. Thorac. Surg., June 1, 2007; 83(6): 2111 - 2117. [Abstract] [Full Text] [PDF]
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Y. Lamarche, L. P. Perrault, S. Maltais, K. Tetreault, J. Lambert, and A. Y. Denault Preliminary experience with inhaled milrinone in cardiac surgery Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1081 - 1087. [Abstract] [Full Text] [PDF]
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M. Mirabel, B. Iung, G. Baron, D. Messika-Zeitoun, D. Detaint, J.-L. Vanoverschelde, E. G. Butchart, P. Ravaud, and A. Vahanian What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur. Heart J., June 1, 2007; 28(11): 1358 - 1365. [Abstract] [Full Text] [PDF]
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B. Bridgewater, A. D Grayson, N. Brooks, G. Grotte, B. M Fabri, J. Au, T. Hooper, M. Jones, B. Keogh, and on behalf of the North West Quality Improvement Pr Has the publication of cardiac surgery outcome data been associated with changes in practice in northwest England: an analysis of 25 730 patients undergoing CABG surgery under 30 surgeons over eight years Heart, June 1, 2007; 93(6): 744 - 748. [Abstract] [Full Text] [PDF]
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A. S. Adabag, T. Rector, S. Mithani, J. Harmala, H. B. Ward, R. F. Kelly, J. T. Nguyen, E. O. McFalls, and H. E. Bloomfield Prognostic Significance of Elevated Cardiac Troponin I After Heart Surgery Ann. Thorac. Surg., May 1, 2007; 83(5): 1744 - 1750. [Abstract] [Full Text] [PDF]
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M. Paul, A. Raz, L. Leibovici, H. Madar, R. Holinger, and B. Rubinovitch Sternal wound infection after coronary artery bypass graft surgery: Validation of existing risk scores J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 397 - 403. [Abstract] [Full Text] [PDF]
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Authors/Task Force Members, A. Vahanian, H. Baumgartner, J. Bax, E. Butchart, R. Dion, G. Filippatos, F. Flachskampf, R. Hall, B. Iung, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology Eur. Heart J., January 26, 2007; (2007) ehl428v1. [Full Text] [PDF]
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