Journal of cardiac surgery
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Randomized Controlled Trial Comparative Study
Avecor Trillium oxygenator versus noncoated Monolyth oxygenator: a prospective randomized controlled study.
The surface coating of a synthetic surface is currently investigated to decrease the harmful effects of cardiopulmonary bypass (CPB). This study was designed to study the effects of the surface coating of a hollow fiber membrane oxygenator on coagulation, inflammation markers, and clinical outcomes. The biomaterials used to coat the membrane include heparin, polyethylene oxide chains (PEO), and sulfate/sulfonate groups. The coated membrane was compared to an uncoated oxygenator made of polypropylene. ⋯ The oxygenator Avecor offers similar results in terms of inflammation and coagulation profiles and blood loss during valvular surgery compared to a standard uncoated control oxygenator. The rate of neurological events was unusually elevated in the former group of patients, with only speculative explanation at this point. Further studies are warranted to clarify this aspect.
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Randomized Controlled Trial
Plasma nitrate/nitrite (NOx) is not a useful biomarker to predict inherent cardiopulmonary bypass inflammatory response.
There were strong evidences that nitric oxide has capital importance in the progressive vasodilatation associated with varied circulatory shock forms, including systemic inflammatory response syndrome (SIRS), in patients undergoing cardiac surgeries for cardiopulmonary bypass (CPB). If CPB procedures, per se, are the inciting stimulus for inflammation, plasma nitrate/nitrite (NOx) excretion would be expected to be higher in these patients rather than in patients operated without CPB. In consequence, we hypothesized that increased levels of NOx would be predictive for vasoplegic syndrome. ⋯ Considering the inflammatory process intrinsic to CPB, this study reinforces the idea that plasma NOx is not useful as a biomarker of inflammatory response onset, which may or may not lead to SIRS and/or vasoplegic syndrome.
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Randomized Controlled Trial
Temporary biventricular pacing postcardiopulmonary bypass in patients with reduced ejection fraction.
Patients with low ejection fraction (EF) undergoing myocardial revascularization frequently require ventricular pacing following cardiopulmonary bypass (CPB). While the benefits of chronic biventricular (BiV) pacing in patients with low EF are well established, there are little data on acute effects during heart surgery. This study analyzed the response of BiV versus single ventricle lead pacing on hemodynamics and left ventricular (LV) function immediately following CPB. ⋯ In patients with low EF, BiV pacing immediately after CPB significantly improves LV systolic function and cardiac output, and suggests significantly improved diastolic function.
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Atorvastatin has previously been shown to reduce the endogenous angiogenic response to chronic ischemia in a porcine model. One possible mechanism for this effect is reduced bioavailability of nitric oxide, a key mediator of angiogenesis, secondary to increased oxygen free radicals. We sought to determine if atorvastatin modulates oxidative stress in myocardial tissue. ⋯ Treatment with atorvastatin was associated with increased levels of myocardial tissue protein and lipid oxidative stress biomarkers and a reduced functional endogenous angiogenic response, but improved coronary microvascular reactivity. Increased oxidative stress in tissues may play a role in the reduced angiogenic response seen with atorvastatin treatment in other studies.
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Multicenter Study
Use of perioperative cardiac medical therapy among patients undergoing coronary artery bypass graft surgery.
Previous studies have demonstrated that cardiac medical therapy is associated with improved clinical outcomes in noncardiac surgery. However, the use of these agents among patients undergoing coronary artery bypass graft (CABG) remains poorly understood. ⋯ In-hospital cardiac medical therapies are underused among patients undergoing CABG. This is particularly true at discharge, where the benefits of these agents for secondary prevention are well established.