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Objective: Assessment of the effects of haemofiltration during cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CABG) on the renal function and correlation with interleukin 6 (IL6) and interleukin 10 (IL10) levels. Methods: Seventy-nine patients scheduled for elective CABGwereprospectivelyrandomisedintotwogroups.GroupAwitha haemofilterattachedtoarteriallineoftheCPBcircuitandgroupBwithouta haemofilter. The two groups were comparable in their symptoms, sex, and previous history of myocardial infarction, left ventricular function, cross-clamp time, bypass time and total grafting per patients. Blood urea and creatinine levels were measured the day before operation, 12 h after operation and on the 3rd postoperative day. IL6 and IL10 were measured in blood samples collected 1 h before surgery, on arrival to ITU and after 12 h. IL6 and IL10 levels were measured using ELISA test. Results: High levels of IL6 (>100 pg/ml) postoperatively were associated with increased incidence of renal dysfunction (p 30 pg/ml) levels postoperatively were associated with increased incidence of renal dysfunction (p < 0.014). There were no effects of the haemofilter on postoperative IL6 and IL10 levels. Use of haemofiltration during CPB was found not to be protective against renal dysfunction (p < 0.071). Conclusions: Haemofilter use during cardiopulmonary bypass does not have a protective effect on postoperative kidney function. Haemofilter has no effect on the level of IL6 and IL10. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Objective As a result of recent failures in clinical governance the government has made a commitment to bring individual surgeons9 mortality data into the public domain. We have analysed a database to compare crude mortality after coronary artery bypass surgery with outcomes that were stratified by risk. Design Retrospective analysis of prospectively collected data. Setting All NHS centres in the geographical north west of England that undertake cardiac surgery in adults. Participants All patients undergoing isolated bypass graft surgery for the first time between April 1999 and March 2002. Main outcome measures Surgeon specific postoperative mortality and predicted mortality by EuroSCORE. Results 8572 patients were operated on by 23 surgeons. Overall mortality was 1.7%. Observed mortality between surgeons ranged from 0% to 3.7%; predicted mortality ranged from 2% to 3.7%. Eighty five per cent (7286) of the patients had a EuroSCORE of 5 or less; 49% of the deaths were in this lower risk group. A large proportion of the variability in predicted mortality between surgeons was due to a small but differing number of high risk patients. Conclusions It is possible to collect risk stratified data on all patients undergoing coronary bypass surgery. For most the predicted mortality is low. The small proportion of high risk patients is responsible for most of the differences in predicted mortality between surgeons. Crude comparisons of death rates can be misleading and may encourage surgeons to practise risk averse behaviour. We recommend a comparison of death rates that is stratified by risk and based on low risk cases as the national benchmark for assessing consultant specific performance.

OBJECTIVE: To develop a multivariate prediction model for in-hospital mortality following aortic valve replacement. METHODS: Retrospective analysis of prospectively collected data on 4550 consecutive patients undergoing aortic valve replacement between 1 April 1997 and 31 March 2004 at four hospitals. A multivariate logistic regression analysis was undertaken, using the forward stepwise technique, to identify independent risk factors for in-hospital mortality. The area under the receiver operating characteristic (ROC) curve was calculated to assess the performance of the model. The statistical model was internally validated using the technique of bootstrap resampling, which involved creating 100 random samples, with replacement, of 70% of the entire dataset. The model was also validated on 816 consecutive patients undergoing aortic valve replacement between 1 April 2004 and 31 March 2005 from the same four hospitals. RESULTS: Two hundred and seven (4.6%) in-hospital deaths occurred. Independent variables identified with in-hospital mortality are shown with relevant co-efficient values and p-values as follows: (1) age 70-75 years: 0.7046, p 85 years: 2.0339, p

Objective: To present the 5-year experience of the northwest of England’s surgical repair of post myocardial infarction (MI) ventricular septal defects (VSD). Our primary aim was to evaluate the effect of concomitant coronary artery bypass grafting (CABG) on mid-term survival and also to identify prognostic indicators. Methods: A multi-centre regional observational study involving clinical data from 65 consecutive patients who underwent post MI VSD repair in the northwest of England between April 1997 and March 2002. Both prospective and retrospective collection of preoperative, operative and postoperative information was performed. Patient follow-up was performed by linking their records to the National Strategic Tracing Service database. Multivariate logistic regression and Cox proportional hazards analyses were used to identify independent risk factors for poor prognosis. Results: Of the 65 patients included in the study, 42 (64.6%) underwent concomitant CABG with a median of two grafts. The majority of patients who had their coronary arteries grafted had multivessel disease (92.9%). Overall 30-day mortality was 23.1%. Predictors of poor prognosis included preoperative inotropes (P , 0:001) and total occlusion of infarct related artery (P ¼ 0:03). The crude hazard ratio (HR) of mid-term mortality for concomitant CABG patients was 0.82 [95% confidence interval (CI) 0.38 – 1.78; P ¼ 0:62]. After adjustment for differences in patient and disease characteristics, the adjusted HR of mid-term mortality for concomitant CABG patients was 0.17 (95% CI 0.04– 0.74; P ¼ 0:019). The adjusted freedom from death in the concomitant CABG patients at 30 days, 1, 2, and 4 years was 96.2%, 91.6%, 88.8%, and 82.8%, respectively, compared with 79.1%, 58.8%, 49.1%, and 32.2% for the non-concomitant CABG patients. Conclusion: These data provide evidence that concomitant CABG is significantly beneficial to mid-term mortality rates. We recommend that patients who present with post MI VSD who have multivessel disease should be routinely revascularised. q 2003 Elsevier B.V. All rights reserved.

We report the interesting case of an elderly woman who presented with hypoglycaemic episodes and weight loss. She was found to have a solitary fibrous tumour weighing more than 1.7 kg arising from the diaphragmatic pleura, which had been producing insulin-like growth factor II. After surgical removal of this well-encapsulated, pedunculated tumour her hypoglycaemia resolved and she returned to normal both clinically and biochemically.