Clinical research in cardiology : official journal of the German Cardiac Society
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Comparative Study
Coronary reoperation with and without cardiopulmonary bypass.
Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality compared to primary operation. Myocardial protection is one of the key issues in redo on pump CABG and is still a matter of debate. Off pump redo CABG seems to be an attractive alternative as native coronary blood flow remains and cross clamping of the aorta is avoided. ⋯ Overall survival was 83.8% in the on pump group and 88.6% in the off pump group (p = 0.92). On pump redo CABG and off pump redo CABG can be safely performed with low mortality and morbidity. Off pump redo CABG might be limited due to incomplete revascularization.
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Controlled Clinical Trial
NT-pro-BNP in obstructive sleep apnea syndrome is decreased by nasal continuous positive airway pressure.
The aim of this study was to evaluate the impact of obstructive sleep apnea syndrome (OSAS) on B-type natriuretic peptide (BNP) and to determine the effect of nasal continuous positive airway pressure (nCPAP) treatment on BNP levels. ⋯ Normotensive and hypertensive OSAS was not associated with a significant elevation of NT-pro-BNP. Application of nCPAP decreased NT-pro-BNP levels significantly in normotensive and, in particular, hypertensive OSAS. These findings may provide further evidence of the potential for nCPAP to improve cardiovascular comorbidity and co-mortality in OSAS and sleep disordered breathing, in general.
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Dyspnea is a frequent reason for emergency consultations in hospitals or community medical facilities. Besides heart failure, a wide variety of other disorders may cause this symptom. Thus, early and accurate differential diagnosis is mandatory in order to facilitate rapid institution of appropriate therapy. ⋯ As also recognized by the European Guidelines for diagnosis and treatment of chronic heart failure, a BNP level of <100 pg/ml has proven particularly useful for excluding heart failure. Thus, a directed history, symptoms, physical findings, chest-X-ray and ECG remain the diagnostic mainstay. If the diagnosis cannot be established by these traditional tools, BNP or NT-proBNP testing may be very helpful, especially for ruling out heart failure.
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Diabetes has significant implications for cardiac surgery. It is not only a major risk factor for coronary heart disease but also increases the risk for cerebrovascular complications during heart surgery. Surgical technique is pivotal for the outcome. "Off-pump" surgery carries a lower risk for stroke than conventional heart surgery. ⋯ Initial blood glucose levels during a stroke and final outcome are highly correlated. Consequently, patients with ischemic stroke after cardiac surgery should be treated according to the current criteria for stroke treatment. This includes strict monitoring of blood glucose level and avoidance of hypo- as well as hyperglycemia.