The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Oct 2009
Comparative StudyA comparison before and after aprotinin was suspended in cardiac surgery: different results in the real world from a single cardiac center in China.
Use of aprotinin has been suspended in cardiac surgery since recent studies reported its risks associated with mortality and other adverse events. This study was to investigate the safety and efficacy of aprotinin through a comparison before and after aprotinin was suspended in cardiac surgery. ⋯ Use of aprotinin in cardiac surgery could reduce blood loss and transfusion requirement significantly and showed a protective effect on the lungs, but it did not increase the risk of mortality or major complications.
-
J. Thorac. Cardiovasc. Surg. · Oct 2009
Bone morphogenic protein 2 induces Runx2 and osteopontin expression in human aortic valve interstitial cells: role of Smad1 and extracellular signal-regulated kinase 1/2.
Bone morphogenic protein 2 is found in calcified areas of stenotic aortic valves, and prolonged stimulation of aortic valve interstitial cells with bone morphogenic protein 2 results in increased expression of alkaline phosphatase, indicating a mechanistic role for bone morphogenic protein 2 in aortic valve calcification. The purposes of this study were to assess the effect of bone morphogenic protein 2 on the expression of the osteogenic factors Runx2 and osteopontin in human aortic valve interstitial cells and to determine the signaling mechanisms that mediate the expression of these early osteogenic factors. ⋯ Interstitial cells of stenotic human aortic valves are characterized by increased bone morphogenic protein 2 levels. A short period of exposure of human aortic valve interstitial cells to bone morphogenic protein 2 induces the expression of Runx2 and osteopontin. The extracellular signal-regulated kinase 1/2 pathway modulates bone morphogenic protein 2-induced osteopontin expression, and the Smad1 pathway plays a role in regulating the expression of both Runx2 and osteopontin induced by bone morphogenic protein 2.
-
J. Thorac. Cardiovasc. Surg. · Oct 2009
Randomized Controlled TrialProphylactic nesiritide does not prevent dialysis or all-cause mortality in patients undergoing high-risk cardiac surgery.
Natriuretic peptides have been shown to improve renal blood flow and stimulate natriuresis. In a recent retrospective trial, we documented that prophylactic use of nesiritide was associated with a 66% reduction in the odds for dialysis or in-hospital mortality at 21 days in patients undergoing high-risk cardiac surgery; therefore, we designed a prospective trial. ⋯ These results do not demonstrate a benefit for prophylactic use of nesiritide on the incidence of dialysis and/or death in patients undergoing high-risk cardiac surgery. Although nesiritide may provide some renal protection in the immediate postoperative period, no effect on length of stay was observed.
-
J. Thorac. Cardiovasc. Surg. · Oct 2009
Results of mitral valve annuloplasty with a standard-sized posterior band: is measuring important?
This study was undertaken to determine hemodynamic and clinical outcomes of annuloplasty with a standard-sized (63 mm) posterior band in adult patients undergoing mitral valve repair for degenerative valve disease. ⋯ A standard-sized (unmeasured) posterior annuloplasty band provided excellent intermediate results with good durability. There were neither excess gradients in larger patients nor excess regurgitation in smaller patients. Measured annuloplasty is unnecessary for most adults undergoing mitral valve repair.
-
J. Thorac. Cardiovasc. Surg. · Oct 2009
Obesity is associated with increased morbidity after coronary artery bypass graft surgery in patients with renal insufficiency.
Although obesity is a major risk factor for cardiovascular disease, it is not clear whether obesity increases the risk of postoperative morbidity and mortality in patients undergoing coronary artery bypass grafting surgery. Increasing evidence suggests that both obesity and renal insufficiency are associated with increased systemic inflammation, thrombogenicity, and endothelial dysfunction. Cardiac surgical patients with comorbid obesity and renal insufficiency might thus be at greater risk for systemic proinflammatory and thrombotic states, which in turn might increase the risk of adverse perioperative outcomes. We investigated the influence of obesity on adverse postoperative outcomes after coronary artery bypass grafting surgery in patients with and without renal insufficiency. ⋯ Obesity is an independent risk factor for increased cardiovascular morbidity and prolonged hospital stay in patients with preoperative renal insufficiency undergoing primary coronary artery bypass grafting surgery.