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1.
Effect of preoperative oral pravastatin reload in systemic inflammatory response and myocardial damage after coronary artery bypass grafting. A pilot double-blind placebo-controlled study.
Castaño, M, González-Santos, JM, López, J, García, B, Centeno, JE, Aparicio, B, Bueno, MJ, Díez, R, Sagredo, V, Rodríguez, JM, et al
The Journal of cardiovascular surgery. 2015;(4):617-29
Abstract
AIM: Statins exert pleiotropic effects that result in cardioprotective and antiinflammatory properties. There is a lack of information about the effect of preoperative reloading statin administration in surgical coronary patients regarding myocardial protection, systemic inflammatory response (SIR) attenuation and nitric oxide (NO) metabolism. METHODS Thirty consecutive dyslipidemic patients under chronic treatment with statins were randomized to orally receive pravastatin 80 mg (N.=10), 40 mg (N.=10) or placebo (N.=10) two hours before anesthetic induction for non-emergent on-pump coronary artery bypass grafting (CABG) procedures. Perioperative peripheral venous and intraoperative CS blood samples were collected for determination of drug-related adverse effects, NO metabolism and both myocardial damage and SIR biomarkers. RESULTS Pravastatin reloading resulted in a significant and dose-related intense attenuation of SIR, but no differences in cardiac damage biomarker levels were demonstrated. NO release and inducible nitric oxide synthase expression was significantly reduced in both treatment groups. Highest pravastatin doses significantly increased systemic creatine phosphokinase (CPK) concentration compared with intermediate doses but no other adverse effects were observed. CONCLUSION Oral pravastatin reloading before non-emergent CABG significantly attenuates postoperative SIR and systemic NO/iNOS concentrations with no effect in perioperative myocardial damage. Highest pravastatin doses increase CPK levels and must be avoided in susceptible patients.
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2.
Volatile anesthetics reduce biochemical markers of brain injury and brain magnesium disorders in patients undergoing coronary artery bypass graft surgery.
Dabrowski, W, Rzecki, Z, Czajkowski, M, Pilat, J, Wacinski, P, Kotlinska, E, Sztanke, M, Sztanke, K, Stazka, K, Pasternak, K
Journal of cardiothoracic and vascular anesthesia. 2012;(3):395-402
Abstract
OBJECTIVES Neuropsychological disorders are some of the most common complications of coronary artery bypass graft (CABG) surgery. The early diagnosis of postoperative brain damage is difficult and mainly based on the observation of specific brain injury markers. The aim of this study was to analyze the effects of volatile anesthesia (VA) on plasma total and ionized arteriovenous magnesium concentrations in the brain circulation (a-vtMg and a-viMg), plasma matrix metalloproteinase-9 (MMP-9), and glial fibrillary acidic protein (GFAP) in adult patients undergoing CABG surgery. DESIGN An observational study. SETTING The Department of Cardiac Surgery in a Medical University Hospital. PATIENTS AND METHODS Studied parameters were measured during surgery and in the early postoperative period. Patients were assigned to 3 groups: group O, patients who did not receive VA; group ISO, patients who received isoflurane; and group SEV, patients who received sevoflurane. RESULTS Ninety-two patients were examined. CABG surgery increased MMP-9 and GFAP. The highest MMP-9, GFAP, and the most dramatic disorders in a-vtMg and a-viMg were noted in group O. CONCLUSIONS Cardiac surgery increased plasma MMP-9 and GFAP concentrations. Changes in MMP-9, GFAP, and arteriovenous tMg and iMg were significantly higher in group O. Volatile anesthetics, such as ISO or SEV, reduced plasma MMP-9, GFAP concentrations, and disturbances in a-vtMg and a-viMg.
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3.
Inspired nitric oxide and modulation of oxidative stress during cardiac surgery.
Elahi, MM, Worner, M, Khan, JS, Matata, BM
Current drug safety. 2009;(3):188-98
Abstract
Evidence in the literature is contradictory regarding the precise role of nitric oxide (NO) in modulating systemic inflammatory response induced by cardiopulmonary bypass (CPB). We studied the impact of inspired NO gas on physiological function and markers of inflammation-oxidative stress for subjects (n=15, age 62+/-4.5 and 12/3 M/F) scheduled for coronary artery bypass graft (CABG) operation. Outcomes from subjects that received 5 ppm and 20 ppm of inspired NO (n=5/group) were compared to those not given NO gas. Breath-to-breath measurement commenced at the start of intubation and continued up to 4h later. Indices of cardiovascular function, alveolar-capillary gas exchange and haematological parameters were not significantly different in outcomes for the inspired NO groups as compared with control. We observed a reduction in mean systemic arterial in all subjects at 30 min and 4h after bypass when compared with pre bypass values. Markers of systemic inflammatory response and oxidative stress increased during CPB particularly at 4h and 24h after the initiation of bypass. In contrast, we observed a reduction in expired NO, at 24h after surgery in the groups given inspired NO. In addition, there was also a significant reduction in oxidative stress markers in blood at 24h after surgery for the groups given inspired NO as compared with the control group. In contrast, cytokines response remained similar in all the three groups at all time points. The results suggested that inspired NO gas has an antioxidant property that reduces the levels of cell death, and is not associated with significantly worse-off physiological outcomes.
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4.
[The short- and long-term motivational effects of a patient education programme for patients with coronary artery bypass grafting].
Krannich, JH, Weyers, P, Lueger, S, Faller, H, Schimmer, C, Deeg, P, Elert, O, Leyh, R
Die Rehabilitation. 2008;(4):219-25
Abstract
PURPOSE An important rehabilitation aim following coronary artery bypass graft (CABG) surgery is to modify cardiovascular risk factors positively. Among the most potent possibilities for improvement of these factors is a lifestyle change in terms of increasing sports exercise, changing diet patterns, stress reduction, etc. An indispensable condition for these changes is the motivation to implement the necessary changes. In our working group a patient education programme was developed aimed at enhancing the motivation for lifestyle change, which was already applied in a cardiac surgery hospital. In evaluating the programme, we could observe that various cognitive factors of motivation for lifestyle change had dropped in untreated patients and risen in patients participating in the programme. Based on these preliminary findings we examined the motivation for lifestyle change one year after CABG surgery. METHOD Each patient was evaluated for his/her value in motivation for lifestyle change using a 30-item questionnaire which measures the six factors Vulnerability, Intention, Social Expectations, Outcome Expectation, Self-Efficacy Expectation, and Perceived Severity two days before CABG surgery as well as ten days and one year after CABG surgery. Between January and May 2002 patients in usual care were investigated as control group (n=70). From January to May 2003, n=70 patients had the opportunity to take part in a comprehensive patient education programme that was provided by a specifically trained psychologist. Data from 108 patients could be evaluated one year after CABG surgery (response rate=77.1%). The programme had comprised individualized units, as well as a group lecture. If partners were available they were included in the process. RESULTS One year after CABG surgery no significant differences between the control group and the intervention group could be found. CONCLUSION The positive effects of the patient education programme measured ten days after surgery were found to have vanished one year after the operation. A possible reason is the short duration of the programme. Long-term, structured aftercare programmes should help stabilize the positive effects obtained in the short term.
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5.
Preoperative statin therapy and troponin T predict early complications of coronary artery surgery.
Pascual, DA, Arribas, JM, Tornel, PL, Marín, F, Oliver, C, Ahumada, M, Gomez-Plana, J, Martínez, P, Arcas, R, Valdes, M
The Annals of thoracic surgery. 2006;(1):78-83
Abstract
BACKGROUND Pretreatment with statins reduces early ischemic events after percutaneous coronary interventions, primarily in patients with a high level of inflammation markers. We sought to examine the association between preoperative statin therapy, systemic inflammation, and myocardial ischemia with the occurrence of early cardiac complications after coronary artery bypass grafting surgery. METHODS One hundred forty-one consecutive patients who underwent coronary artery bypass grafting surgery from two university tertiary hospitals were stratified according to their preoperative status of statin therapy (87 treated and 54 nontreated). Preoperative blood samples were collected for measurement of lipid parameters, C-reactive protein, interleukin-6, and troponin T. The evaluated primary endpoint was a composite of death and myocardial infarction at 30 days. RESULTS Patients undergoing preoperative statin therapy showed a reduced incidence of death (2.3% versus 13.0%, p = 0.012), myocardial infarction (5.7% versus 18.5%, p = 0.017), and primary combined endpoint (8.0% versus 22.2%, p = 0.017). In the multivariate model, preoperative troponin T greater than 0.01 ng/mL (odds ratio 6.85, p = 0.001) and nonstatin therapy (odds ratio 4.2, p = 0.01) predicted a higher risk of primary endpoint. Statins showed a significant interaction with troponin T status and benefited primarily those patients with positive troponin T. Among 19 patients with troponin T greater than 0.01 ng/mL, the primary endpoint occurred in all 6 nonstatin-treated patients, but it occurred in only 1 of 13 statin-treated patients (p < 0.001). Neither C-reactive protein nor interleukin-6 predicted early complications, nor did they interact with statin therapy (p = not significant). CONCLUSIONS Preoperative statin therapy reduces early complications and offers additional protection in patients with positive troponin T status, regardless of inflammatory markers.
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6.
The effects of lipid-lowering therapy on graft patency in coronary bypass surgery patients.
Sungun, M, Us, MH, Ulusoy, RE, Keskin, O, Pocan, S, Inan, K, Yilmaz, AT
The heart surgery forum. 2006;(3):E626-9
Abstract
BACKGROUND Our aim was to investigate the effects of lipid-lowering treatment (LLT) on graft patency in coronary artery bypass grafting (CABG) patients. METHODS A total of 209 CABG patients (95 men, 45%) with a total cholesterol level above 200 mg/dL and a low-density lipoprotein level above 100 mg/dL were included. Patients were divided into 2 groups on the basis of administration of LLT after CABG group 1 received LLT after the operation (those patients undergoing operations after 1998, n = 102, 49% male) and group 2 did not receive LLT after the operation (those patients undergoing operations between 1992 and 1998, n = 107, 42% male). Median duration of follow-up was 5.2 years. Follow-up angiography could be obtained in 108 (52%) patients (56 in group 1, 52 in group 2). RESULTS There was a 42% reduction in ischemic events and deaths in group 1, and 60% of these patients had a symptom-free or event-free period for 6 years. The 5-year graft patency for left internal mammary artery-to-left anterior descending artery grafts in group 1 was 95%, and the corresponding figure was 90% in group 2. Right coronary artery-to-saphenous vein graft patency was 66% for group 1 and 30% for group 2. Circumflex artery-to-saphenous vein patency rate was 59% for group 1 and 53% for group 2. A higher graft patency was found in group 1 as a whole. CONCLUSION Results of this retrospective study support the fact that LLT provides a higher graft patency for CABG patients.
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7.
[Development of cardiovascular risk factors in patients after coronary artery bypass grafting with an in-hospital rehabilitation programme (WHO Stage I of Rehabilitation): 1-year follow-up].
Schimmer, C, Krannich, JH, Brauchle-Hopp, U, Elert, O
Die Rehabilitation. 2006;(2):95-101
Abstract
BACKGROUND The purpose of this study was to evaluate the influence of an in-hospital (stage I of rehabilitation) individualized motivation programme for life-style change on the cardiovascular risk factors of patients after coronary artery bypass grafting (CABG). METHODS 142 consecutive patients undergoing CABG because of coronary heart disease were divided into two groups. Group I received the usual care; Group II received the intervention (individual motivation programme). Medical variables concerning all cardiovascular risk factors and the current medication plan were evaluated on admission and one year after surgery. RESULTS After 12 months significant reductions in systolic blood pressure (p = 0.002), LDL-cholesterol (p = 0.023) and triglyceride (p = 0.046) were found in the intervention group on comparison of the two groups. The HDL cholesterol improved in the intervention group and decreased slightly in the control group. Both groups showed an improvement in diastolic blood pressure, Body Mass Index, blood cholesterol and blood glucose values. The intervention did not show a significant influence on smoking and medication habits. CONCLUSION An individualized motivation programme starting in the acute hospital may positively influence cardiovascular risk factors with ongoing success.
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8.
[The effect of glutamate and aspartate on myocardial protection at cardiopulmonary bypass].
Ozcan, V, Beşoğul, Y, Tünerir, B, Dernek, S, Erden, T, Ozdemir, C, Unal, O, Aslan, R, Kural, T
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology. 2004;(2):114-9
Abstract
OBJECTIVE To determine whether glutamat and aspartat enriched cold crystalloid cardioplegia which was given in antegrade way has any effect on the myocardial protection during cardiopulmonary bypass. METHODS Thirty-four patients who were electively undergone open heart surgery at Osmangazi University Faculty of Medicine, thoracic and cardiovascular surgery department, between March 2001 and May 2001 were included in this study. The patients were divided in two groups, each consisting of 17 patients. In group 1 coronary artery bypass surgery (CABG) was performed in 11 patients, mitral valve replacement (MVR) in 3 patients, aortic valve replacement (AVR) in 1 patient and AVR and MVR in 2 patients. While in group 2 CABG was performed in 13 patients and MVR was done in 4 patients. Group 1 patients received antegrade glutamat and aspartat (15 mmol/L) enriched cold crystalloid cardioplegia and group 2 patients were given cold crystalloid cardioplegia by antegrade route. Age, gender, diabetes mellitus, hypertension, preoperative myocardial infarction, smoking, ejection fraction, aortic cross-clamp time, need to defibrillation, inotropic support, and intraaortic balloon pump were recorded. The levels of cardiac troponin I (cTI) and creatine kinase myocardial band fraction (CK-MB) were measured in arterial blood samples at five different times. Statistical analysis was performed using Student's t-test and Chi-square test. RESULTS There were no statistically significant differences in cTI and CK-MB values in blood samples taken at 5 different times pre and postoperatively between group 1 and group 2. CONCLUSION It is concluded that glutamat and aspartat enriched cold crystalloid cardioplegia does not have any effect on myocardial protection.
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9.
Comparison of cardiac troponin I versus T and creatine kinase MB after coronary artery bypass grafting in patients with and without perioperative myocardial infarction.
Peivandi, AA, Dahm, M, Opfermann, UT, Peetz, D, Doerr, F, Loos, A, Oelert, H
Herz. 2004;(7):658-64
Abstract
BACKGROUND AND PURPOSE Cardiac troponins have shown to be specific markers of myocardial injury. The aim of this prospective study was to compare patterns and kinetics of troponin I and T after coronary artery bypass grafting (CABG) with or without perioperative myocardial infarction (PMI). PATIENTS AND METHODS 119 patients (male/female: 96/23, age 64 +/- 10 years) underwent first time elective CABG. Preoperative mean ejection fraction was 55.8% +/- 15.6%. The mean number of grafts was 3.1 +/- 1.1/patient, in 85.7% the internal mammary artery was used. Cardiac troponin I (cTnI) and T (cTnT) levels, total serum activities of creatine kinase (CK) and creatine kinase isoenzyme MB (CK-MB) were measured before operation, at arrival on the intensive care unit (ICU), and 6, 12, 24, 48, and 120 h after unclamping of the aorta. Twelve lead electrocardiograms (ECGs) were recorded preoperatively and at days 1, 2, and 5. Perioperative data and postoperative cTnI and cTnT levels were correlated statistically. RESULTS Two patients died due to refractory myocardial failure in the early postoperative period. For further evaluation, patients were divided in two groups according to postoperative ECG changes (group I: patients without PMI, n = 107; group II: patients with PMI, n = 10: six of them with Q-wave and four of them with non-Q-wave PMI). Calculated best cutoff values for cTnI and cTnT were 8.35 microg/l and 0.768 microg/l in ROC (receiver-operator characteristic) analysis. Serum concentrations of cTnI, and cTnT were in the normal range preoperatively and increased significantly after surgery in both groups. In both groups, cTnI reached its medium peak level after 24 h (group I: 2.7 microg/l, 95% confidence interval [CI]: [2.1,3.2]); group II: 70.5 microg/l). CTnT reached its medium peak level in group I without PMI after 48 h (0.298 microg/l, 95% CI: [0.254,0.354]), in group II with PMI not until 120 h (3.0 microg/l) postoperatively. In group II serum level of both troponins remained considerably high at 120 h (cTnI median = 10.75 microg/l, cTnT median = 3 microg/l). CONCLUSION Release patterns of cTnI and cTnT after CABG are different: cTnI reaches its postoperative peak value earlier and declines more quickly than cTnT. After uncomplicated CABG, serum levels of both cardiac troponins remain continuously low. Elevated concentrations reflect perioperative myocardial ischemia or infarction. CTnT shows a different release pattern in patients with or without myocardial infarction.
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10.
Nuclear imaging techniques in the assessment of myocardial perfusion and function after CABG: does it correlate with CK-MB elevation?
Kwinecki, P, Jemielity, M, Czepczyński, R, Baszko, A, Ruchała, M, Sowiński, J, Dyszkiewicz, W
Nuclear medicine review. Central & Eastern Europe. 2003;(1):5-9
Abstract
BACKGROUND An increase of the creatine kinase MB (CK-MB) isoenzyme after cardiac surgery suggests perioperative myocardial infarction. The interpretation is more difficult when increased enzymes are not accompanied by electrocardiographic markers of infarction. The aim of this study was to correlate the results of myocardial perfusion imaging (MPI) and radionuclide ventriculography (RNV) with CK-MB isoenzyme level in patients without ECG abnormalities after CABG. MATERIAL AND METHODS 36 patients (age: 52.5 +/- 8.5 years, 33M/3F) treated with CABG were prospectively studied. CK-MB level was assessed at 0, 4, 8, 12, 24, 36, 48 and 72 hours after surgery. MPI (SPECT using Tc-99m-MIBI) and RNV were performed 2 weeks before and 3-4 months after surgery. All patients had an uneventful hospitalisation. The subjects were divided into two groups: group 1 with CK-MB increase > 50 IU/ml (n = 9) and group 2 with CK-MB levels ≤ 50 IU/ml (n = 27). There was no difference between the groups regarding the number of diseased arteries, haemodynamic parameters, aortic clamping time or the number of grafts. RESULTS Perfusion improvement at stress and at rest was significantly lower in group 1 than in group 2. The ejection fraction did not change significantly in both groups (DeltaEF = 0.6 +/- 13.5 in group 1 v. 0.7 +/- 9.7 in group 2, p = NS), however, in 5 patients from group 1 (56%) and in 6 patients from group 2 (22%) the EF decreased significantly at follow-up RNV (p = 0.05). In 6 patients (5 in group 1 and 1 in group 2) a new defect of perfusion was found at follow-up MPI. The sensitivity and specificity of increased CK-MB level in predicting perfusion deterioration were 83% and 87%, respectively. CONCLUSIONS We conclude that patients with an increased level of CK-MB isoenzyme (> 50 IU/ml) after coronary artery surgery have a higher rate of perfusion and function deterioration. The increase of CK-MB level early after coronary bypass surgery in patients without ECG markers of perioperative infarction indicates a probable ischaemic insult during surgery.