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Improved outcome of coronary arterial bypass surgery in a small center after identification and modification of peroperative risk factors.

https://arctichealth.org/en/permalink/ahliterature12240
Source
Int J Cardiol. 1990 Jan;26(1):15-24
Publication Type
Article
Date
Jan-1990
Author
A. Thomassen
O. Lund
L. Nielsen
P T Mortensen
L. Borg
Author Affiliation
Department of Cardiology, Skejby Sygehus, Aarhus, Denmark.
Source
Int J Cardiol. 1990 Jan;26(1):15-24
Date
Jan-1990
Language
English
Publication Type
Article
Keywords
Angina Pectoris - etiology
Cardioplegic Solutions
Coronary Artery Bypass - adverse effects - mortality
Denmark
Hospitals, Municipal
Humans
Hypothermia, Induced
Male
Middle Aged
Propranolol - therapeutic use
Research Support, Non-U.S. Gov't
Retrospective Studies
Risk factors
Abstract
By uni- and multivariate analysis, predictors of surgical mortality and postoperative angina were identified retrospectively in 189 patients having had coronary arterial bypass surgery over the period 1978-1984. After modification of these risk factors, surgical outcome was followed up in another 178 patients undergoing operation from 1985 to 1987. The surgical mortality of 7% in the first series was closely associated with postoperative signs of acute myocardial injury. All deaths occurred in patients having at least 3 out of 5 pre- and peroperative risk factors: triple vessel/left main coronary arterial disease, incomplete revascularization, no propranolol treatment, Bretschneider cardioplegia other than "HTP"-solution with blood preperfusion and perioperative vasopressor support. The procedures of cardiac protection were modified. St Thomas multidose potassium cardioplegia and general hypothermia were introduced, perioperative propranolol treatment increased and bypass time decreased. Improved cardiac protection with this regime was seen in the patients operated in 1985-1987 when compared with the first series with regard to perioperative vasopressor support (8 vs 33%, P less than 0.001), spontaneous operative defibrillation (72 vs 52%, P less than 0.001), postoperative arrhythmias (20 vs 43%, P less than 0.001), peak levels of serum enzymes (P less than 0.001), myocardial infarction (7 vs 19%, P less than 0.001) and hospital mortality (2 vs 7%, P less than 0.05). The incidence of freedom from symptoms at 3 months was also increased in the patients undergoing operation from 1985 to 1987 (72 vs 61%, P less than 0.05). Even small centers can improve their surgical outcome by carefully analysing their own results and modifying the identified risk factors.
PubMed ID
2298514 View in PubMed
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Long-term follow-up of patients treated with implantable cardioverter defibrillators in a Danish centre. Accurrence ICD therpay and patient survivors.

https://arctichealth.org/en/permalink/ahliterature54577
Source
Scand Cardiovasc J. 1997;31(3):151-6
Publication Type
Article
Date
1997
Author
J C Nielsen
P T Mortensen
A K Pedersen
Author Affiliation
Department of Cardiology, Skejby University Hospital, Aarhus, Denmark.
Source
Scand Cardiovasc J. 1997;31(3):151-6
Date
1997
Language
English
Publication Type
Article
Keywords
Adult
Aged
Confidence Intervals
Coronary Disease - complications - mortality - therapy
Death
Defibrillators, Implantable
Denmark - epidemiology
Electric Countershock
Female
Follow-Up Studies
Humans
Male
Middle Aged
Multivariate Analysis
Prognosis
Proportional Hazards Models
Prospective Studies
Risk factors
Survival Rate
Tachycardia, Ventricular - complications - mortality - therapy
Treatment Outcome
Abstract
The aim of the this prospective follow-up study was to evaluate long-term survival and implantable cardioverter-defibrillator (ICD) therapy for ventricular tachyarrhythmias in patients treated with an ICD in a Danish centre. A total of 140 consecutive patients (112 men), of which 70.7% had coronary artery disease, received an ICD at Skejby University Hospital between March 1989 and October 1996. Mean age was 55.6 +/- 14.6 years (range 14-78 years). After implantation, 136 of the patients were followed for a median (range) of 17.7 (0.4-74.1) months. Survival, mode of death and incidence of appropriate ICD therapy and therapy due to potential life-threatening ventricular tachyarrhythmia were the main outcome measures. Kaplan-Meier plots representing total survival, cardiac death, sudden cardiac death and first episode of ICD therapy are presented. After 1, 2, 3 and 4 years, respectively, the cumulative incidences of death were 9, 18, 20 and 24%, of cardiac death 4, 11, 14 and 18%, and of sudden cardiac death 2, 3, 6 and 6%. The cumulative incidences of appropriate therapy after 1, 2, 3 and 4 years were 47, 56, 66 and 80%, respectively. The cumulative incidences of cardiac death after the first episode of appropriate therapy were 9, 11, 15 and 20% after 1, 2, 3 and 4 years, respectively. The occurrence of ICD therapy and patient survival in the present study population treated with ICD at a Danish centre was comparable to results published previously from other larger centres. The rate of sudden cardiac death was low and most of our patients received appropriate ICD therapy during follow-up, indicating correct patient selection and probable benefit of the ICD device.
PubMed ID
9264163 View in PubMed
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Quality assessment of pacemaker implantations in Denmark.

https://arctichealth.org/en/permalink/ahliterature31455
Source
Europace. 2002 Apr;4(2):107-12
Publication Type
Article
Date
Apr-2002
Author
M. Møller
P. Arnsbo
M. Asklund
P D Christensen
N. Gadsbøll
J H Svendsen
E. Klarholt
K E Kleist
P T Mortensen
A. Pietersen
E H Simonsen
P E B Thomsen
T. Vesterlund
R. Wiggers
Author Affiliation
The Danish Pacemaker Register, Odense Universitetshospital. moller@pacemaker.dk
Source
Europace. 2002 Apr;4(2):107-12
Date
Apr-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Denmark
Female
Humans
Infant
Infant, Newborn
Male
Middle Aged
Pacemaker, Artificial
Prospective Studies
Registries
Reoperation
Abstract
AIMS: Quality assessment of therapeutic procedures is essential to insure a cost-effective health care system. Pacemaker implantation is a common procedure with more than 500,000 implantations world-wide per year, but the general complication rate is not well described. We studied procedure related complications for all implantations performed in an entire nation over a 3-year period. METHODS AND RESULTS: A prospective study of complications related to 99% of the 5648 primary pacemaker implantations performed in the 12 Danish pacemaker centres in 1997-1999 was carried out. Overall 76% of the patients received a physiological pacemaker system and 91% received the optimal pacing mode according to international guidelines. Perioperative complications requiring reoperation were: haematoma 0.3%, atrial lead related 1.9%, ventricular lead related 1.7%. Late complications requiring reoperation were: infection 02%, atrial lead related 13%, ventricular lead related 1.2%. The complication rate decreased over the study period, but overall the complication rate was higher than expected and showed considerable variation between centres. CONCLUSIONS: Our results demonstrate that sensitive data such as complications related to pacemaker implantations can be collected on a national basis. We suggest that a reoperation rate higher than 3% for atrial as well as ventricular pacing electrodes in the individual implanting centre should cause the centre to evaluate carefully the procedure as well as the performance of the individual implanter.
PubMed ID
12135240 View in PubMed
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[Treatment with implantable cardioverter-defibrillators. Experiences from Skejby hospital during the period 1989-1994]

https://arctichealth.org/en/permalink/ahliterature54685
Source
Ugeskr Laeger. 1996 Feb 19;158(8):1068-72
Publication Type
Article
Date
Feb-19-1996
Author
J C Nielsen
E H Christiansen
P T Mortensen
A K Pedersen
Author Affiliation
Hjertemedicinsk afdeling B, Skejby Sygehus, Arhus.
Source
Ugeskr Laeger. 1996 Feb 19;158(8):1068-72
Date
Feb-19-1996
Language
Danish
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Defibrillators, Implantable
Denmark - epidemiology
English Abstract
Female
Follow-Up Studies
Humans
Male
Middle Aged
Tachycardia, Ventricular - mortality - physiopathology - therapy
Abstract
The aim of the present study was to evaluate survival and therapy for ventricular tachyarrhythmia in patients treated with implantable cardioverter-defibrillator (ICD)-implantation at Skejby Hospital. Seventy-two patients, of which 54 were male, have received an ICD since 1989. Mean (range) age was 54 (16-74) years. Forty-nine (68%) had ischaemic heart disease. The patients were followed for a median (range) of 14 (1/2-50) months. Kaplan-Meyer plots are presented for total mortality, cardiac mortality, sudden cardiac mortality, appropriate therapy, and therapy for life-threatening tachyarrhythmia. After one, two and three years respectively, mortality was respectively 13, 27, and 32%, cardiac mortality was 5, 19, and 24%, sudden cardiac mortality was 3, 6, and 12%, cumulative incidence of appropriate therapy was 56, 66, and 90%, and cumulative incidence of therapy for life-threatening tachyarrhythmia was 19, 29 and 52%. It is concluded, that the majority of patients treated with an ICD developed ventricular tachyarrhythmia and had appropriate or lifesaving ICD-therapy during follow-up.
PubMed ID
8638339 View in PubMed
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