Biomedical subjects

U Tochtermann

Publications and source records attributed to U Tochtermann.

15 recordsLinked to original sources

PubMed2002

Minimal early mortality in CABG--simply a question of surgical quality?

BACKGROUND: The increasing number of risk scores and models for the evaluation of the early risk after cardiac surgery reflects the interest in 'calculating' the risk of adverse events. Different time intervals, but also different 'types' of death are generally accepted in the evaluation of early mortality. The aim of this study was to focus on the differences in the calculation of early mortality and to focus on their potentially misleading impact on risk stratification. METHODS: We investigated 7,436 patients who underwent coronary artery bypass grafting from June 30, 1988 through June 30, 2001. A follow-up was performed 180 days after operation (98.7 % complete). RESULTS: According to the definition of 30-day mortality to represent the total time interval between an intervention and the 30th postoperative day, the 30-day mortality was 5.92 % (n = 440 patients). Hospital mortality reflects the number of deaths from the day of intervention through the patient's individual discharge, independent of any fixed time interval. Hospital mortality was 5.86 % (n = 436 patients) in our patient group. 30-day hospital mortality requires the investigation of hospital mortality until the 30th postoperative day; in-hospital and general mortality after the 30th postoperative day remained excluded from the analysis; 30-day hospital mortality was 5.19 % (n = 386 patients). Assuming a maximum hospital stay of 5 days, hospital mortality would decrease to 2.64 % (n = 196 patients). CONCLUSIONS: 30-day mortality, hospital mortality and 30-day hospital mortality are used to determine early outcome. The present data indicate the vulnerability of non-standardized time intervals to discharge policy. However, both hospital mortality and 30-day hospital mortality are predominantly used in current risk scores and models. In view of the comparability and meaning of data, the methodology for the evaluation of early risk should be reconsidered.

Coronary Artery Bypass↗

PubMed2002

[Stability of the Euro-score as an identification tool for patient risk groups -- dependency of the applied documentation system].

From the different methods for risk adjustment, scores allow a rough classification of the patients. The Euroscore represents one of the most modern scores. The most recent version of the documentation system of the German Society for Thoracic and Cardiovascular Surgery may be used without extended extra-work to evaluate the Euroscore despite the presence of various limitations. The investigation of the scores with nearly complete adaptation of the variables of the quality assurance documentation to the original definition showed no substantial differences between the score groups. However, many methodological implications favor the development of self-evaluated models to obtain a most recent weight for each risk factor and to be able to take into account new therapeutical options. These models can be evaluated by the existing database and extended by the most recent data.

Cardiac Surgical Procedures↗

PubMed2001

Does the completeness of revascularization affect early survival after coronary artery bypass grafting in elderly patients?

OBJECTIVE: Usefulness and risks of incomplete versus complete revascularization are still matters of ongoing discussions. Because an increasing number of elderly patients are undergoing coronary artery bypass grafting (CABG), the question arises whether a less extensive surgical approach is more prudent than complete revascularization. METHODS: Of 6531 patients undergoing isolated CABG, 859 were 75 and older at the time of operation. Mean age of the 859 patients was 77+/-2.7 years (median: 76 years); 65% were men. Follow-up enquiry by questionnaire was performed at the 180th postoperative day with a completeness of 95.6%. Assessment of the impact of incomplete revascularization utilized both multivariable analysis and propensity score matching to account for selection factors. RESULTS: Incomplete revascularization was performed in 133 patients (16%). The most common reasons for incomplete revascularization were small vessels (55%) and massive calcification (32%). Mortality until 180 days after CABG was higher (n=32; 24%) after incomplete than after complete revascularization (n=105; 15%; P=0.005). By logistic multivariable regression, incomplete revascularization was identified as an independent risk factor for death (Odds ratio, 1.8; P=0.015). By time-related analysis, incomplete revascularization predominantly affected the early period after CABG (P=0.001). Aortic cross clamping time was only slightly shorter for the group with incomplete (59+/-27 min (median: 55 min) vs. 63+/-26 min (median: 58 min); P=0.1). CONCLUSIONS: Incomplete revascularization increases the early risk of death after CABG in patients aged 75 years and older. The potential compensating benefit of the shorter aortic cross clamping time does not outweigh the advantages of complete revascularization. Thus, in the era of high-volume interventional approaches and minimally invasive techniques, the advantages of complete revascularization need to be considered.

Aged↗

PubMed2001

Does the completeness of revascularization contribute to an improved early survival in patients up to 70 years of age?

OBJECTIVE: In the era of a renewal of incomplete revascularization approaches, the controversy reappears as to whether the approach for complete revascularization is of prognostic value. The clear advantage of complete revascularization in elderly patients has recently been published. However, for the younger patient group, there is no conclusive information available so far. The aim of our study was to investigate the effect of complete vs. incomplete revascularization in patients up to 70 years of age. PATIENTS AND METHODS: 6531 patients underwent isolated CABG. 5003 of these patients were aged up to 70 years at the time of operation. RESULTS: Incomplete revascularization was performed in 534 (10.7 %) patients. The most common reasons for incomplete revascularization were small vessels and massive calcification. The differences in mortality up to the 180(th) day after CABG are statistically significant. By Kaplan-Meier analysis, the time relationship between incomplete revascularization and death affects predominantly the very early period after CABG. By logistical regression, incomplete revascularization was found to be an independent risk factor for death after CABG. CONCLUSION: Incomplete revascularization affects the early outcome after CABG in patients up to 70 years of age as an independent risk factor for death. In view of recent approaches for primarily incomplete CABG, our results indicate the necessity to reconsider the advantages of complete revascularization.

Age Factors↗

PubMed2000

Vascular tracheobronchial compression syndromes-- experience in surgical treatment and literature review.

Between January 1988 and December 1997 a total of 22 patients (age: 8 days-46 years) were operated for vascular airway compression syndromes with respiratory insufficiency. Vascular anomalies in tracheal compression were double aortic arch in 7 patients, (2 previously operated elsewhere), right aortic arch + left ligamentum arteriosum in 1, and pulmonary artery sling in 3. Three of these patients had secondary long-segment tracheomalacia. Compression of trachea and a main bronchus existed in 2 patients with right aortic arch + left ligamentum. Isolated main bronchus obstruction was present in 9 patients (abnormal insertion of ligamentum arteriosum in 1, status post (s.p.) previous operation for PDA in 4, s. p. surgery for coarctation in 1, right aortic arch + left ligamentum arteriosum in 2, and right lung aplasia + left ligamentum in 1). 3 of these cases had secondary long-segment bronchomalacia. All patients had a complex respiratory anamnesis [long-term intubation in 7, s.p. tracheostomy in 2 (over 3 months - 3 years), and progressive respiratory insufficiency in 13). In tracheal compression, surgical correction included transsection of the underlying ring or sling components (with additional anterior aortic arch translocation in 5 patients resection-reimplantation of left pulmonary artery in 3, segmental tracheal resection in 1, and external tracheal suspension in 2). In the 2 cases with compression of the trachea and a main bronchus, aortic "extension" by a prosthetic tube was necessary. In isolated main bronchus obstruction, surgical decompression basically consisted of transsection of the ligamentum arteriosum or resection of its scarry remnant forming the "corner point" of a compression between aorta and pulmonary artery. In 3 patients with secondary long-segment malacia, additional external bronchus suspension was performed. Effective decompression and re-expansion of the airway segment concerned was achieved, and was demonstrated by intraoperative endoscopy in all patients. There were 3 postoperative deaths (sepsis 2; massive, irreversible edema of the tracheal mucosa 1). Of the 19 surviving patients 16 could be extubated between the 1st and 17th (mean = 7.5) postoperative day. In 1 case the preoperative long-term tracheostomy had to be left in place for inoperable additional laryngeal stricture. 2 patients had to be reoperated (segmental cervical tracheal resection after 5 months for primary long-term intubation-related subglottic stenosis in 1, esophageal decompression for residual dysphagia after 57 months related to a traction phenomenon at the right descending aorta in the other), both with gratifying results. In all other patients clinical, endoscopic, and radiographic examinations (follow-up = 2 months - 6 years) demonstrate good results.

Adolescent↗

PubMed2000

Target, application, and interpretation of scores and alternative methods for risk assessment in cardiac surgery.

BACKGROUND: The more popular the use of different methods for risk adjustment becomes, the more often data are applied without any regard about the primary target and/or about important assumptions. Furthermore, risk adjustment is no longer restricted for quality assurance purposes, but became a "tool" of health policy. Few working groups currently use risk adjustment for the development of new therapeutic concepts. The aim of our study is to clarify possibilities and limitations of popular risk adjustment methods. PATIENTS AND METHODS: 4985 Patients underwent isolated CABG. Statistics was performed by calculating descriptive statistics, Parsonnet, and Higginsscores. Furthermore, the parametric, time-adjusted hazard function by Blackstone was used. RESULTS: Descriptive statistics allows intra-, and interinstitutional comparisons of single items to identify "outlying" results. Risk scores aim to predict preoperatively the risk category of the patient who undergoes cardiac surgery. However, since different scores are based on a score-specific combination of variables, and different definitions of the investigation interval, different results may occur, when different scores are calculated for a single patient. However, the use for example, of scores in patient groups allows description of changing risk structures. Most of the scores derive from univariate analyses and monophasic functions. However, survival curves are predominantly multiphasic and require a consideration of the time-dependency of "risk factors". DISCUSSION: An increasing number of patients with severe comorbidity undergoes cardiac surgery. To evaluate reliably present and futurous therapeutic options, risk adjustment is necessary. Since various tools for risk-adjustment are available, a serious discussion about reliability and application is necessary.

Aged↗

PubMed1999

Influence of brain death and cardiac preservation on systolic and diastolic function and coronary circulation in the cross-circulated canine heart.

Previous studies have demonstrated hemodynamic instability and cardiac dysfunction in the brain-dead organ donor. It remains unclear if primary cardiac dysfunction is responsible for hemodynamic deterioration or decreased cardiac function is secondary to brain death-associated altered loading conditions. Therefore in the present study the effects of brain death on hemodynamics and cardiac function were analyzed in vivo in an open chest model and ex vivo in a cross-circulated heart preparation. In a second protocol, the impact of brain death-associated hemodynamic changes on postischemic graft function was investigated. Brain death was induced injecting saline in a subdural Foley catheter. Induction of brain death led to a hyperdynamic reaction followed by hemodynamic deterioration with a decrease of systemic vascular resistance and myocardial contractility. If the hearts were explanted and assessed ex vivo, no differences were found between control and brain-dead hearts. Furthermore, both control and brain-dead hearts showed full functional recovery after 4 hours of hypothermic ischemic storage. Despite hemodynamic deterioration in situ after brain death, there were no differences between the postischemic function of control and brain-dead hearts. These results indicate that myocardial dysfunction is not irreversible and may be secondary to altered loading conditions, and that the recovery of cardiac function after long-term hypothermic storage is not impaired by the hemodynamic changes observed in situ after brain death induction. These data may also indicate that potential donor hearts might not be excluded from transplantation on the basis of impaired hemodynamic characteristics, especially if they are evaluated by load-dependent parameters.

Analysis of Variance↗

PubMed1999

The meaning of early mortality after CABG.

OBJECTIVE: Investigations of early mortality after coronary artery bypass grafting (CABG) are predominantly based on 30-day mortality or hospital mortality. The advantages, disadvantages, and usefulness of hospital mortality and 30-day mortality analyses to investigate the early risk after CABG are evaluated. METHODS: A total of 4985 patients underwent isolated CABG from June 1988 to June 1997. A follow-up was performed 180 days after CABG (response rate: 98.6%). RESULTS: The mean hospital stay was 13.5+/-9.6 days, the range was 0 to 142 days (25% quartile, 9 days; median, 12 days; 75% quartile, 15 days). The hospital mortality was 5.3%. The 30-day mortality was 5.6%. The non-parametric Kaplan-Meier curve of the time interval 0-180 days postoperatively proves the persistence of the still decreasing behaviour of the survival curve beyond the 30th day until about the 60th postoperative day. Stratified by era of operation, the 'early phase' after CABG seems to be prolonged beyond 30 days at least for the more recent operation era since 1991. Risk stratification proves that the higher the risk group, the more the early phase tends towards a prolongation. CONCLUSIONS: The hospital mortality reflects institutional habits concerning postoperative patient care. Therefore, a systematic underestimation of early mortality is likely. In contrast to hospital stay, the evaluation of 30-day mortality requires a follow-up procedure but allows interinstitutional comparisons. Nevertheless, 30-day mortality systematically underestimates the early risk, at least in the more recent CABG period. So, a standardized evaluation of a longer time period (p.e. 180 days) is recommended.

Coronary Artery Bypass↗

PubMed1999

Influence of follow-up response on risk-factor analysis.

BACKGROUND: Long-term analyses after coronary artery bypass grafting (CABG) are used to investigate therapeutical options and factors influencing the natural course of ischemic heart disease. In general, long-term studies require a follow-up. Dependent on the interval between the intervention and the follow-up procedure a certain amount of patients is lost to follow-up. The aim of the present study was to examine the influence of incomplete follow-up on conclusions regarding the postoperative patient outcome. For the investigation, the same statistical methods were applied to the data accumulated by the 70% and by the 90% responses. METHODS: 2012 patients underwent isolated CABG between June 1988 and December 1992. For data acquisition, tools of the HVMD (Heidelberger Verein für multizentrische Datenanalyse e.V.) were used. Analyses were performed using tools of SAS (Statistical Analysis Systems, Inc.). The parametric, time-adjusted hazard function method was employed. A first follow-up questionnaire, was distributed six months after operation with a 97.8% response. In February 1997 the same questionnaire was sent to patients and their general practioners. The primary response to that was 68.9% (approximately 70%). Then another mailing of the same questionnaire and phone calls to patients and their home doctors raised the response to 93.7% (approximately 90%). RESULTS: The mean follow-up was 1378 days in the group with 70% response and 1682 days in the group with 90% response. The parametric, time-adjusted hazard function showed a very similar pattern of factors in the early phase of both groups. In the 90% response group, the intermediate phase reached a higher relative influence than in the 70% response group. The relative influence of the late phase showed an inverse pattern. In the multivariate analysis most of the variables which had been identified by the 70% response model reappeared in the 90% response model. However, there were some potentially important and interesting differences. CONCLUSIONS: The results indicate the necessity to carefully consider the acceptance of incomplete follow-up for differentiated risk adjustment.

Coronary Artery Bypass↗

PubMed1998

Interruption of bronchial circulation leads to a severe decrease in peribronchial oxygen tension in standard lung transplantation technique.

OBJECTIVE: In clinical practice lung transplantation is the only procedure where the transplanted organ is left without its own arterial perfusion. With the interruption of the bronchial arteries the nutritive support is dependent on collateral flow by the pulmonary artery and the oxygen tension of desaturated central venous blood, representing an abnormal physiology. METHODS: To analyze this problem systematically, we used a standard single left lung transplantation model in the pig (n = 12). In accordance with the clinical standard, lung preservation was performed with modified Euro-Collins solution with addition of prostacycline. The duration of ischemia was set to 4 h. Before and after single left lung transplantation tissue oxygen tension in the peribronchial tissue was measured with Licox tissue pO2 microprobes. For validation, the myocardial tissue oxygen tension was recorded simultaneously. The hemodynamic assessment included continuous flow measurement of the left and right pulmonary artery using Transsonic ultrasound flow probes. After transplantation the animals were observed for 4 h. For hypothetic augmentation of collateral blood flow to the peribronchial tissue we administered Nitric oxide (10 ppm) to the ventilation in six pigs (group B). Six pigs (group A) served as a control without the addition of nitric oxide (NO). All pigs were ventilated with a FiO2 of 0.5 resulting in paO2 values between 160 and 200 mmHg. RESULTS: In both groups single lung transplantation led to a significant decrease in peribronchial tissue oxygen tension throughout the observation period. Pre-Tx values of peribronchial tissue oxygen tension (38.31 +/- 6.56 mmHg) decreased to 9.72 +/- 2.55 mmHg in group A and 10.3 +/- 3.61 mmHg in group B after 4 h, which could not be altered by a FiO2 of 1.0 (P < 0.0001). The addition of NO in group B led to a significantly augmented flow in the left pulmonary artery (0.63 +/- 0.31 l/min in group B vs. 0.46 +/- 0.26 l/min group A, P < 0.001) representing 67 vs. 49% of the pre-Tx flow in groups B and A, respectively, but the peribronchial tissue oxygen tension was not influenced (P > 0.05). In both groups A and B, the central venous pO2 did not differ in the postoperative period (41.83 +/- 3.27 mmHg group A vs. 43.26 +/- 2.98 mmHg group B) and was kept in a comparable range to the pretransplantation values (45.23 +/- 3.41 mmHg pre-Tx). CONCLUSIONS: The persistence of a very low peribronchial tissue oxygen tension in the early phase after lung transplantation cannot be influenced by improved pulmonary artery flow and solely relates to the central venous pO2, which cannot be augmented by the addition of NO. This mechanism might be a trigger for anastomotic healing problems, infectious complications and later development of obliterative bronchiolitis (OB).

Animals↗

PubMed1998

Right ventricular function after brain death: response to an increased afterload.

OBJECTIVE: A major cause of early postoperative morbidity and mortality after cardiac transplantation is right ventricular (RV) failure which is attributed to the inability of the donor's RV to acutely compensate for the recipient's elevated pulmonary vascular resistance. This study was performed to determine: (1) the acute effects of brain death on the RV function; and (2) the adaptation potential of the RV to a progressive increase in RV afterload. METHODS: In 13 anesthetized, open-chest dogs (eight with brain death vs. five control with sham operation), brain death was induced by inflation of a subdural balloon catheter. Heart rate, RV systolic and end-diastolic pressure (RVSP, RVEDP), pulmonary arterial pressure (PAP), and cardiac output (CO), and pressure-length loops (sonomicrometry) were recorded. Afterload increase was induced 2 h after brain death induction by constriction of the pulmonary artery with an increase in RVP from 25 to 50 mmHg in 5 mmHg steps. RESULTS: Cushing phenomenon occurred within a few minutes after brain death induction, with a significant increase of HR (229 +/- 10 vs. 89 +/- 6 min(-1), P < 0.001), CO (3.2 +/- 0.2 vs. 1.7 +/- 0.1 l/min, P < 0.001), PAP (30.4 +/- 2.5 vs. 15.5 +/- 1.3 mmHg, P < 0.01) RVSP (55 +/- 5 vs. 23 +/- 2 mmHg, P < 0.001) and RVEDP (7.4 +/- 0.9 vs. 3.3 +/- 0.6 mmHg, P < 0.001). All these values were also significantly (P < 0.01) higher than the time corresponding values of the control group. The analysis of the pressure-length loops showed a hypercontractile state. Within 15-60 min, all parameters turned to baseline and remained stable for up to 2 h. When afterload was increased progressively, RVEDP increased markedly in the brain death and slightly in the control group (9.4 +/- 0.7 vs. 4.2 +/- 1.1 mmHg, P < 0.01, at RVSP = 50 mmHg). On the other hand, the increase of peak positive dP/dt was significantly higher in the control group (430 +/- 37 vs. 644 +/- 55 mmHg/s, P < 0.01, at RVP = 50 mmHg). However, global RV pump function characterized by CO and stroke work was similar in both groups. While regional RV contractility remained unchanged in the brain death group in terms of pressure-length relationships, RV contractility significantly increased in the control group. CONCLUSION: (1) Brain death per se does not result in an acute impairment of RV function. (2) While control animals adapt to an increased afterload by the homeometric, as well as the heterometric regulation, after brain death, an increase in RV preload follows elevations in RV afterload by the Frank-Starling mechanism subserving the increased stroke work required to ensure unchanged pump function.

Adaptation, Physiological↗

PubMed1998

Effects of brain death on myocardial function and ischemic tolerance of potential donor hearts.

BACKGROUND: An increasing number of experimental and clinical studies reports hemodynamic instability in the donor organism after brain death. However, the relative importance of brain death-related cardiac dysfunction on posttransplantation cardiac function and the reversibility of the observed changes remain controversial. In this study a load-independent analysis of cardiac function after brain death was performed. Special interest was focused on a possible interactive influence of brain death and cardiac preservation on postischemic cardiac function. METHODS: In 12 anesthetized dogs, brain death was induced by inflation of a subdural balloon; 12 sham-operated animals served as control subjects. After a 2-hour observation in situ, the hearts were explanted and perfused parabiotically either immediately or after hypothermic ischemic preservation (4 hours, 4 degrees C). Heart rate, cardiac output, left ventricular pressure, the maximum of left ventricular pressure development and aortic pressure were measured in situ. In addition, the slope of the end-systolic pressure-volume relationship, coronary blood flow, and myocardial oxygen consumption were estimated in the cross-circulated hearts. RESULTS: In spite of a brain death-associated hemodynamic deterioration in situ (expressed as low mean aortic pressure and significant decrease of maximal dP/dt), myocardial function was similar to control after explantation, if assessed ex vivo. Furthermore, after hypothermic ischemic preservation and reperfusion, complete functional recovery of control and brain-dead hearts could be observed. CONCLUSIONS: These data indicate that hemodynamic instability after brain death may rather reflect altered loading conditions than irreversible myocardial damage or primary cardiac dysfunction. Furthermore, there is no evidence for a brain death-related impairment of ischemic tolerance.

Animals↗

PubMed1997

Is the brain death related endocrine dysfunction an indication for hormonal substitution therapy in the early period ?

Experimental studies in animals have suggested that brain death (BD) -- related endocrinological dysregulations lead to a significant depression of cardiac pump and muscle function, however, the discussion about the relative extent of this influence remains controversal. The aim of the present study was to assess in an open chest animal model the short time course (5 hours) of hormonal (epinephrine, norepinephrine, T3, T4, ACTH, cortisol, insuline) and metabolic (glucose, lactate) changes in 10 brain dead dogs with special respect to the hemodynamic stability and myocardial pump function. After the onset of BD the concentrations of all hormonal parameters showed a significant decrease. Despite these changes, and in contrast to other studies, an adequate pump function (filling pressures, cardiac output) and muscle function (LVdp/dt) could be maintained by exclusive volume substitution without the use of hormonal or pressor agents. We conclude that in the present model a sufficient pump and muscle function can be maintained by adequate volume substitution, exclusively. The significant fall in adrenal and thyroid hormones had no direct effects on heart functional parameters in the first 5 hours after experimental BD induction.

Animals↗

PubMed1995

Cardiocirculatory effects of acutely increased intracranial pressure and subsequent brain death.

Hemodynamic instability and functional impairment of the donor heart are currently reported problems in organ transplantation. Actual shortage of potential donor hearts continues to raise controversial discussion about adequate donor management with regard to graft quality. In an experimental open chest model, physiopathologic effects of acutely induced, irreversible intracranial hypertension (AIIHT) were investigated in situ with respect to hemodynamics, cardiac pump and muscle function, and hormonal parameters. Acutely induced irreversible intracranial hypertension was induced by rapid inflation of a subdural balloon catheter in 10 anesthetized dogs, four animals serving as controls. The observation period in both groups was 300 min. Cardiocirculatory stability was maintained by continuous crystalloid volume substitution without the use of inotropic or pressor agents. After AIIHT, three characteristic hemodynamic response phases have been observed: 1) The "acute hyperdynamic phase" lasting up to 15 min with marked increases of heart rate (HR), left ventricular pressure (LVP), cardiac output (CO) and myocardial contractility indices, 2) At the end of the "early restabilization phase", (60 min), these parameters returned close to control levels, except HR (+50%) and systemic vascular resistance (SVR) (-40%), 3) During the "late restabilization phase", filling pressures, LVP and CO remained within control limits at low SVR, contractility indices showed a decreasing tendency. All assessed plasmatic hormones (Catecholamines, triiodothyronine (T3), thyroxine (T4), adrenocorticotropic hormone (ACTH), cortisol and anti-diuretic hormone (ADH) showed a continuous fall to levels significantly below control over the phases of restabilization. Acutely induced irreversible intracranial hypertension leads to multifactorial hemodynamic and hormonal changes. At low SVR, cardiac pump function was preserved exclusively by continuous volume substitution, while myocardial contractility indicated a slight decrease. From this observed hemodynamic and functional state within the donor organism, no reliable prediction on graft functional capacity can be made.

Animals↗

PubMed1990

Efficiency of a computer network in the administrative and medical field of cardiac surgery. Concept of and experience with a departmental system.

We report on a pilot project implementing electronic data processing (EDP) in the Department of Cardiac Surgery of the University of Heidelberg, based on a concept of complete integration of a medical database system into everyday clinical routine. A computer network was installed and has been in use since August 1988 as a department system supporting both the administrative and the medical side of the department (documentation, information, research, archives, organization, secretarial office, billing, statistics and communication). With a computer-assisted documentation system and standardized data acquisition, nearly 80% of letters and reports on operations are written automatically without any further need for dictation. Automatic computer controlled follow-up has been initiated to cover all patients operated on in our hospital. The complete integration of a new method of clinical documentation and EDP into everyday clinical routine and the extensive use of computer-derived information have proved to be significant advances. Our practice of computer-assisted information management and departmental organization serves the patient by; (1) providing up-to-date valid information for the clinical staff; (2) establishing and stabilizing contact and communication with physicians elsewhere, e.g. cardiologists; (3) facilitating pre- and postoperative contact with patients; (4) helping to optimize medical treatment by routine statistical data analysis (quality assurance); (5) creating a clear and logical computer-assisted departmental organizational structure; (6) permitting long-term evaluation of operative results based on a standardized computer-controlled follow-up procedure; (7) improving the quality of medical and administrative data.

Cardiac Surgical Procedures↗