Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Apr 2012
Randomized Controlled Trial Comparative StudyAn increase in endogenous erythropoietin concentrations has no cardioprotective effects in patients undergoing coronary artery bypass graft surgery.
Preliminary data showed an increase in endogenous erythropoietin (EPO) concentrations after acute normovolemic hemodilution (ANH) in patients undergoing coronary artery bypass graft (CABG) surgery. Numerous studies have shown the organ protective properties of EPO. The aim of this study was to investigate the cardioprotective effects of these increased EPO concentrations that resulted from ANH during cardiac surgery. ⋯ In patients undergoing CABG surgery on CPB, an increase in endogenous EPO concentrations in the physiologic range has no cardioprotective effects.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2012
ReviewAdvances in acute kidney injury associated with cardiac surgery: the unfolding revolution in early detection.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is important because it remains common and serious. A major limitation in the management of CSA-AKI has been ongoing delayed diagnosis by standard clinical approaches, including serum creatinine and calculated glomerular filtration rate. Recent advances in the understanding of CSA-AKI have highlighted the utility of novel biomarkers that diagnose CSA-AKI within the first 24 hours. ⋯ Future clinical trials likely will focus on whether these biomarkers predict adverse outcomes independent of serum creatinine fluctuations and whether therapies guided by biomarker profiles improve renal salvage and overall clinical outcomes. Given their clinical utility, these novel biomarkers have been evaluated beyond cardiac surgery for AKI in multiple clinical environments, including the emergency department, the operating room, the cardiac catheterization laboratory, and the intensive care unit. Their integration into clinical practice seems likely in the near future.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2012
Comparative StudyTiming of preoperative aspirin discontinuation and outcome after elective coronary artery bypass graft surgery.
Whether aspirin should be discontinued before coronary artery bypass grafting is controversial. The potential benefits and harms associated with late use of aspirin (no discontinuation or discontinuation <3 days before surgery) were investigated in this retrospective, multicenter study. ⋯ Late or no discontinuation of low-dose aspirin before coronary artery bypass grafting may decrease the risk of postoperative stroke without increased postoperative bleeding and need for blood transfusion. These findings and the risk of cardiovascular events possibly occurring at the time of its discontinuation suggest that the use of aspirin until the day of elective coronary surgery may be beneficial.
-
J. Cardiothorac. Vasc. Anesth. · Apr 2012
Comparative StudyMitral annular nonplanarity: correlation between annular height/commissural width ratio and the nonplanarity angle.
To compare two methods of mitral annular nonplanarity: the mathematically calculated annular height-to-commissural width ratio (AHCWR) and the echocardiographically derived nonplanarity angle. ⋯ A favorable correlation was found between the nonplanarity angle and the AHCWR. This suggests that the nonplanarity angle can be used to assess mitral annular nonplanarity in a clinically feasible fashion.