Measuring follow-up completeness.

Completeness of follow-up is often used as a measure of the quality of follow-up, but the method used to compute it is often not declared. An ideal measure should be based on follow-up years instead of patients. Clark, Altman, and De Stavola proposed such a measure, called "C", which is the percentage of the maximum possible follow-up years, as of a given date, that has actually been accounted for or observed.

Do we need separate risk stratification models for hospital mortality after heart valve surgery?

Background: The EuroSCORE (European System for Cardiac Operative Risk Evaluation) is often used to benchmark and predict hospital mortality after cardiac surgery. Based mainly upon coronary surgery patients, EuroSCORE may not be optimal for valve surgery patients. We evaluated the New York (NY) State dedicated valve surgery models and compared their performance to the EuroSCORE model.

Blood dendritic cell levels and phenotypic characteristics in relation to etiology of end-stage heart failure: implications for dilated cardiomyopathy.

Background: Dysregulation of dendritic cell (DC) mediated immune responses towards auto-antigens, is considered an important feature in the maintenance of experimentally induced heart failure (HF). In order to evaluate the role of blood DCs in cardiomyopathies of different origins, we examined myeloid (mDC) and plasmacytoid (pDC) subset levels and maturation characteristics, according to HF severity and etiology in humans.

Methods: Absolute numbers of mDCs and pDCs in 12 New York Heart Association (NYHA) class-II, 28 NYHA class III-IV HF patients and 18 healthy controls, were studied by 4-colour whole blood flow cytometry.

Autograft or allograft aortic valve replacement in young adult patients with congenital aortic valve disease.

Aims: We analysed the outcome of young adults with congenital aortic valve disease who underwent allograft or autograft aortic valve or root replacement in our institution and evaluated whether there is a preference for either valve substitute.

Methods And Results: Between 1987 and 2007, 169 consecutive patients with congenital aortic valve disease aged 16-55, participating in our ongoing prospective follow-up study, underwent 63 autograft and 106 allograft aortic valve replacements (AVRs). Mean age was 35 years (SD 10.

Usefulness of microsimulation to translate valve performance into patient outcome: patient prognosis after aortic valve replacement with the Carpentier-Edwards supra-annular valve.

Objective: Numerous reports have been published documenting the results of aortic valve replacement. It is often not easy to translate these outcomes involving the condition of the valve into the actual consequences for the patient. We previously developed an alternative method to study outcome after aortic valve replacement that allows direct estimation of patient outcome after aortic valve replacement: microsimulation modeling.

Predicted patient outcome after aortic valve replacement with Medtronic Stentless Freestyle bioprostheses.

Background And Aim Of The Study: Knowledge on long-term patient outcome after implantation with the Medtronic Stentless Freestyle bioprosthesis is incomplete due to a limited follow up. In the present study, microsimulation was used to extrapolate the available primary data and to calculate the life expectancy and lifetime risks of valve-related events after aortic valve replacement (AVR) with the Freestyle bioprosthesis.

Methods: Eleven-year follow up data from 725 patients (mean age 72 +/- 8 years; range: 36-92 years) who underwent AVR with a Medtronic Freestyle bio-prosthesis were used to calculate the hazards of structural valvular deterioration (SVD) and of other valve-related events.

Does the type of biological valve affect patient outcome?

Patient background mortality and excess mortality related to aortic valve disease may play a greater role than implanted valve type in explaining the observed survival differences after aortic valve replacement. This study attempts to identify the differences between the performance of selected biological valves, given similar patient characteristics and excess mortality. Four biological valve types, the Carpentier-Edwards pericardial and supra-annular valve, Medtronic Freestyle valve and allografts were used for this analysis.

Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogeneic transfusion requirements in infants undergoing cardiac surgery.

Cardiopulmonary bypass in children may cause severe hemodilution and can lead to excessive perioperative blood loss and high transfusion requirements. Minimization of cardiopulmonary bypass circuit and salvage of red blood cells from the residual volume after the procedure are widely utilized to reduce allogeneic transfusion. We evaluated the effectiveness of those measures introduced in infant cardiac surgery in our institution.

Actual and actuarial probabilities of competing risks: apples and lemons.

The probability of a type of failure that is not inevitable, but can be precluded by other events such as death, is given by the cumulative incidence function. In cardiac research articles, it has become known as the actual probability, in contrast to the actuarial methods of estimation, usually implemented by the Kaplan-Meier (KM) estimate. Unlike cumulative incidence, KM attempts to predict what the latent failure probability would be if death were eliminated.

Allografts for aortic valve or root replacement: insights from an 18-year single-center prospective follow-up study.

Objective: Whether allografts are the biological valve of choice for AVR in non-elderly patients remains a topic of debate. In this light we analyzed our ongoing prospective allograft AVR cohort and compared allograft durability with other biological aortic valve substitutes.

Methods: Between April 1987 and October 2005, 336 patients underwent 346 allograft AVRs (95 subcoronary, 251 root replacement).

The Ross operation: a Trojan horse?

Aims: The Ross operation is the operation of choice for children who require aortic valve replacement (AVR) and may also provide a good option in selected adult patients. Although the autograft does not require anticoagulation and has a superior haemodynamic profile, concern regarding autograft and allograft longevity has risen. In this light, we report the 13-year results of our prospective autograft cohort study.

Congenital aortic stenosis in adults: rate of progression and predictors of clinical outcome.

Background: Little data are available on the natural history of young adults with congenital valvular aortic stenosis (AS). The aim of the present study was to determine the progression rate of AS in young adults, and to identify predictors of stenosis progression and outcome.

Methods: Retrospective study of all patients seen at a single centre diagnosed with congenital AS (> or = 2.

Degeneration of the pulmonary autograft: an explant study.

Objective: We sought to determine the histologic features of pulmonary autografts explanted after the Ross operation.

Methods: Histologic sections of 30 explanted autografts and 8 normal heart valves were compared and semiquantitatively scored by a blinded cardiovascular pathologist.

Results: Pulmonary autografts (n = 30) were explanted on average 6.

Early complications of stenting in patients with congenital heart disease: a multicentre study.

Aims: Stenting has become an established interventional cardiology procedure for congenital heart disease. Although most stent procedures are completed successfully, complications may occur. This multicentre study evaluated early complications after stenting in patients with congenital heart disease, including potential risk factors.

An evaluation of the Ross operation in adults.

Background And Aim Of The Study: Pulmonary autograft replacement of the aortic valve (the Ross operation) is the operation of choice in infants and children. Although this procedure can offer theoretical advantages at any age, its use in adults remains controversial.

Methods: A total of 264 consecutive patients (203 males, 61 females; mean age 35.

Outcome after aortic valve replacement in young adults: is patient profile more important than prosthesis type?

Background And Aim Of The Study: The optimal prosthesis choice in young adults requiring aortic valve replacement (AVR) remains controversial. The study aim was to determine whether implanted prosthesis type is an important determinant of outcome after AVR in young adults.

Methods: Between 1991 and 2001, 414 young adults (mean age 40 +/- 11 years; range: 16-55 years) underwent a total of 438 consecutive AVRs using 204 mechanical prostheses (MP), three bioprostheses (BP), 150 allografts (AL), and 81 autografts (AU).

The effect of open lung ventilation on right ventricular and left ventricular function in lung-lavaged pigs.

Introduction: Ventilation according to the open lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and high positive end-expiratory pressure, aiming at minimizing atelectasis. The minimization of atelectasis reduces the right ventricular (RV) afterload, but the increased intrathoracic pressures used by OLC ventilation could increase the RV afterload. We hypothesize that when atelectasis is minimized by OLC ventilation, cardiac function is not affected despite the higher mean airway pressure.

Serial echocardiographic assessment of neo-aortic regurgitation and root dimensions after the modified Ross procedure.

Background And Aim Of The Study: Concern exists regarding progressive root dilatation after the modified Ross procedure. The present prospective echocardiographic study aimed to provide further insight into neo-aortic regurgitation (nAR) and neoaortic root dimensions over time in adult Rotterdam Ross root patients, and to study potential risk factors for nAR and dilatation.

Methods: All Rotterdam Ross patients aged > or = 16 years at surgery were subjected to a prospective biennial standardized echocardiographic protocol.

Comparison of Carpentier-Edwards pericardial and supraannular bioprostheses in aortic valve replacement.

Objective: This study aimed at calculating and comparing the long-term outcomes of patients after aortic valve replacement with the Carpentier-Edwards bovine pericardial and porcine supraannular bioprostheses using microsimulation.

Methods: We conducted a meta-analysis of eight studies on the Carpentier-Edwards pericardial valves (2,685 patients, 12,250 patient-years) and five studies on the supraannular valves (3,796 patients, 20,127 patient-years) to estimate the occurrence rates of valve-related events. Eighteen-year follow-up data sets were used to construct age-dependent Weibull curves that described their structural valvular deterioration.