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Shahriari M, Nikkhah H, Mahjoob MP, Behnaz N, Barkhordari S, Cheraqpour K. Impact of coronary artery bypass grafting surgery on the chorioretinal biomicroscopic characteristics. World J Clin Cases 2023; 11:6754-6762. [PMID: 37901009 PMCID: PMC10600861 DOI: 10.12998/wjcc.v11.i28.6754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Most patients with cardiovascular disorders suffer from coronary artery diseases, which can be treated successfully using coronary artery bypass grafting (CABG). One of the unpleasant events following CABG is postoperative vision loss (POVL). Vulnerability of retinal vessels to hemodynamic changes, an expectable event following CABG, may contribute to the development of POVL, which might be associated with the changes in the choroidal and retinal structures. AIM To investigate postoperative changes in chorioretinal and peripapillary nerve fiber layer (NFL) thickness, and progression of diabetic and hypertensive retinopathy after CABG. METHODS In this prospective, cross-sectional study, 49 eyes in 25 candidates for CABG underwent both ophthalmic and cardiovascular examinations within 6 mo prior to and 9 mo after surgery. RESULTS Among the study participants, 56% were male with a mean age of 62.84 years ± 10.49 years (range 33-80 years). Diabetes mellitus was observed in eight participants (32%). None of the patients suffered from postoperative anterior or posterior ischemic optic neuropathy, central retinal artery occlusion, and cortical blindness. The mean value of the preoperative best corrected visual acuity was 0.11 ± 0.10 logMAR (range, 0-0.4), which worsened to 0.15 ± 0.08 logMAR (range, 0-0.4) after CABG (P = 0.031). No significant difference was observed between the pre- and postsurgical choroidal (P = 0.853) and macular (P = 0.507) thickness, NFL thickness in the subfoveal (P > 0.999) and peripapillary areas (P = 0.659), as well as the severity of diabetic and hypertensive retinopathy. CONCLUSION CABG may reduce visual acuity without affecting ocular structures. Postoperative vision reduction might be attributable to molecular or cellular variations, changes in visual pathway function, or central nervous system.
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Affiliation(s)
- Mansoor Shahriari
- Department of Ophthalmology, Imam Hossein Educational Hospital, Tehran 1617763141, Iran
| | - Homayoun Nikkhah
- Department of Ophthalmology, Torfe Medical Center, Tehran 1149847514, Iran
| | | | - Nazanin Behnaz
- Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran 1617763141, Iran
| | - Shahriar Barkhordari
- Department of Ophthalmology, Imam Hossein Educational Hospital, Tehran 1617763141, Iran
| | - Kasra Cheraqpour
- Department of Ophthalmology, Farabi Eye Hospital, Tehran 1336616351, Iran
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Ibrahim RZ, Joyo EO. Intensive care unit length of stay and mortality comparison between on-pump and off-pump coronary artery bypass graft: a retrospective study. Egypt Heart J 2023; 75:48. [PMID: 37306794 DOI: 10.1186/s43044-023-00374-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Recently, coronary artery bypass graft (CABG) techniques, both on-pump (ONCABG) and off-pump (OPCABG), were compared to seek the most effective approach to reduce the cost of prolonged intensive care unit length of stay (ICU LOS) and mortality. This study aims to compare ICU LOS and mortality in ONCABG and OPCABG. RESULTS Demographic data of 1569 patients show the variance of characteristics. The analysis shows significant and longer ICU LOS in OPCABG than ONCABG (2.151 ± 0.100 vs. 1.573 ± 0.246 days; p = 0.028). Similar results were demonstrated after adjustment of covariates effects (3.146 ± 0.281 vs. 2.548 ± 0.245 days; p = 0,022). Logistic regression shows no significant difference in mortality in OPCABG and ONCABG, both in the unadjusted (OR [CI 95%] 1.133 [0.485-2.800]; p = 0.733) and the adjusted models (OR [CI 95%] 1.133 [0.482-2.817]; p = 0,735). CONCLUSION ICU LOS was significantly longer in OPCABG patients than in ONCABG patients in the author's centre. There was no significant difference in mortality between the two groups. This finding highlights a discrepancy between recently published theories and the practices observed in the author's centre.
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Affiliation(s)
- Rita Zahara Ibrahim
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Letjen S. Parman Kav 87 Slipi, West Jakarta, Jakarta, 11420, Indonesia
| | - Ericko Ongko Joyo
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Letjen S. Parman Kav 87 Slipi, West Jakarta, Jakarta, 11420, Indonesia.
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Knežević D, Ćurko-Cofek B, Batinac T, Laškarin G, Rakić M, Šoštarič M, Zdravković M, Šustić A, Sotošek V, Batičić L. Endothelial Dysfunction in Patients Undergoing Cardiac Surgery: A Narrative Review and Clinical Implications. J Cardiovasc Dev Dis 2023; 10:jcdd10050213. [PMID: 37233179 DOI: 10.3390/jcdd10050213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Cardiac surgery is one of the highest-risk procedures, usually involving cardiopulmonary bypass and commonly inducing endothelial injury that contributes to the development of perioperative and postoperative organ dysfunction. Substantial scientific efforts are being made to unravel the complex interaction of biomolecules involved in endothelial dysfunction to find new therapeutic targets and biomarkers and to develop therapeutic strategies to protect and restore the endothelium. This review highlights the current state-of-the-art knowledge on the structure and function of the endothelial glycocalyx and mechanisms of endothelial glycocalyx shedding in cardiac surgery. Particular emphasis is placed on potential strategies to protect and restore the endothelial glycocalyx in cardiac surgery. In addition, we have summarized and elaborated the latest evidence on conventional and potential biomarkers of endothelial dysfunction to provide a comprehensive synthesis of crucial mechanisms of endothelial dysfunction in patients undergoing cardiac surgery, and to highlight their clinical implications.
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Affiliation(s)
- Danijel Knežević
- Department of Anesthesiology, Reanimatology, Emergency and Intensive Care Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Božena Ćurko-Cofek
- Department of Physiology, Immunology and Pathophysiology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Tanja Batinac
- Department of Clinical Medical Sciences I, Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 2, 51000 Rijeka, Croatia
| | - Gordana Laškarin
- Department of Physiology, Immunology and Pathophysiology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
- Hospital for Medical Rehabilitation of Hearth and Lung Diseases and Rheumatism "Thalassotherapia-Opatija", M. Tita 188, 51410 Opatija, Croatia
| | - Marijana Rakić
- Hospital for Medical Rehabilitation of Hearth and Lung Diseases and Rheumatism "Thalassotherapia-Opatija", M. Tita 188, 51410 Opatija, Croatia
| | - Maja Šoštarič
- Clinical Department of Anesthesiology and Perioperative Intensive Therapy, Division of Cardiac Anesthesiology and Intensive Therapy, University Clinical Center Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia
- Department of Anesthesiology and Reanimatology, Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
| | - Marko Zdravković
- Department of Anaesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Alan Šustić
- Department of Anesthesiology, Reanimatology, Emergency and Intensive Care Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Vlatka Sotošek
- Department of Anesthesiology, Reanimatology, Emergency and Intensive Care Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Lara Batičić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
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Motion prediction for beating heart surgery with GRU. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Tıskaoğlu NS, Yazıcı A, Ercan A, Tınç K. The effect of off-pump coronary bypass graft surgery on subfoveal choroidal thickness, ganglion cell complex, and retinal nerve fiber layer thickness. Ther Adv Ophthalmol 2023; 15:25158414231204106. [PMID: 37841646 PMCID: PMC10571675 DOI: 10.1177/25158414231204106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background Cardiac surgery has been associated with adverse ocular events. Off-pump coronary artery bypass graft surgery evades the systemic inflammatory response seen in extracorporeal circulation and is superior to on-pump surgery with regard to end-organ dysfunction and neurological outcomes. Objectives To determine the effects of off-pump (without extracorporeal circulation) coronary artery bypass graft surgery on choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer. Design Prospective, longitudinal study. Methods Patients who underwent off-pump surgery were examined preoperatively and postoperatively at 1 week and 6 weeks after surgery. Choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer measurements were recorded, and the effects of off-pump coronary artery bypass on these parameters were assessed. Results A total of 44 eyes of 44 patients were included in the study. There was a statistically significant increase in subfoveal choroidal thickness from 252.84 ± 56.24 µm preoperatively to 273.82 ± 39.76 µm at 1 week and 301.97 ± 44.83 µm at 6 weeks after off-pump coronary artery bypass graft surgery (p = 0.044; p ⩽ 0.001). Ganglion cell complex and retinal nerve fiber measurements showed no significant difference compared to preoperative values. Conclusion Off-pump coronary artery bypass graft surgery showed no negative effects on ganglion cell complex and retinal nerve fiber measurements. A significant increase in subfoveal choroidal thickness was seen after off-pump surgery, which might be advantageous in patients who are at high risk or have preexisting ocular diseases that are affected by the choroid.
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Affiliation(s)
- Nesime Setge Tıskaoğlu
- Ophthalmology Department, Dr. Ersin Arslan Research and Education Hospital, Eyüpoğlu, Hürriyet Cd. No: 40, Şahinbey/Gaziantep 27010, Turkey
| | - Alper Yazıcı
- Ophthalmology Department, Batı Göz Hospital, Izmir, Turkey
| | - Abdulkadir Ercan
- Cardiovascular Surgery Department, Bursa Medical Park Hospital, Bursa, Turkey
| | - Kübra Tınç
- Ophthalmology Department, Erzurum research and education Hospital, Erzurum, Turkey
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Shetty RS, Kaul A, Goyal A, Konda GR, Srivastava S, Moharana AK, Deepak TS. Single-blind, randomized study comparing clinical equivalence of trulene and prolene polypropylene sutures in elective primary coronary artery bypass graft surgery. J Cardiothorac Surg 2022; 17:315. [PMID: 36527046 PMCID: PMC9757631 DOI: 10.1186/s13019-022-02095-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Coronary artery bypass graft surgery (CABG) is one of the principle therapies for coronary artery disease, as it improves survival rate and quality of life (QoL). Polypropylene suture is commonly used in vascular and cardiac surgeries for anastomosis due to its long-term tensile strength and minimal tissue trauma. This study compared the clinical equivalence of Trulene® (Healthium Medtech Limited) and Prolene® (Ethicon-Johnson & Johnson) polypropylene sutures regarding incidence of myocardial infarction, stroke, renal failure and cardiac death (MACCE) occurring up to 26 weeks' period post-CABG surgery. METHODS This multicenter, prospective, two-arm, parallel-group, randomized (1:1), single-blind study (n = 89) was conducted between August 2020 and September 2021. The primary endpoint, post-surgery cumulative incidence of MACCE was evaluated. In addition, anastomotic revision, surgical site infection (SSI), operative time, length of post-operative hospital stay, repeat revascularization, intraoperative suture handling characteristics, time taken to return to work and resume normal day to day activities, subject satisfaction score and QoL, and other adverse events were also recorded. RESULTS A total of 80 (89.89%) males and 9 (10.11%) females participated in the study. No incidence of MACCE was recorded in any of the study participants. Non-significant difference was observed in anastomotic revision, SSI, operative time, post-operative hospital stay, revascularization, return to work and normal day-to-day activities, subject satisfaction score and QoL, and intraoperative handling parameters (except ease of passage) between the treatment groups, Trulene® and Prolene®. Compared to screening visit, proportion of subjects with 'no problems' for each QoL dimension and the mean visual analogue scale increased with each subsequent follow-up visit. CONCLUSION Trulene® polypropylene suture is clinically equivalent to Prolene® polypropylene suture and is safe and effective for anastomosis construction in CABG surgery during a routine clinical procedure. Trial registration CTRI Registration No.: CTRI/2020/05/025157 (Registered on: 13/05/2020).
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Affiliation(s)
- Ravi Shankar Shetty
- Department of Cardio-Thoracic and Vascular Surgery, M S Ramaiah Medical College and Hospitals, Bangalore, Karnataka, 560054, India
| | - Ajay Kaul
- Department of Cardio-Thoracic and Vascular Surgery, BLK-Max Super Speciality Hospital, New Delhi, 110005, India
| | - Aayush Goyal
- Department of Cardio-Thoracic and Vascular Surgery, BLK-Max Super Speciality Hospital, New Delhi, 110005, India.
| | - Govardhan Reddy Konda
- Department of Cardio-Thoracic and Vascular Surgery, M S Ramaiah Medical College and Hospitals, Bangalore, Karnataka, 560054, India
| | - Sushant Srivastava
- Department of Cardio-Thoracic and Vascular Surgery, BLK-Max Super Speciality Hospital, New Delhi, 110005, India
| | - Ashok Kumar Moharana
- Clinical Affairs, Healthium Medtech Limited, Bangalore, Karnataka, 560064, India
| | - T S Deepak
- Clinical Affairs, Healthium Medtech Limited, Bangalore, Karnataka, 560064, India
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Jan A, Hayat MK, Khan MAA, Ullah R. Trends in per-operative parameters and postoperative complications associated with coronary artery bypass graft surgery (CABG); A four-year retrospective study. Pak J Med Sci 2021; 37:1734-1739. [PMID: 34912387 PMCID: PMC8613026 DOI: 10.12669/pjms.37.7.4315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the patterns of per-operative parameters and early outcomes of patients that underwent CABG surgery during a four-year period. Methods: This is a cross-sectional descriptive study conducted in a tertiary care of hospital from November 2020 to January 2021. All the patients that underwent the isolated coronary artery bypass grafting (CABG) procedure were included in the study from June 2017 till June 2020. Data was collected on a data extraction form and stored in SPSS format which was analyzed for qualitative statistics keeping p<0.05 as significant. All the results were represented in the form of tables. Results: A total of 1,613 patients were operated upon for Coronary Artery Bypass Grafting (CABG) procedure during the study period with 1,222 (75.8%) males and 391 (24.2%) females. Dyslipidemia (71.8%) was the most common risk factor. The average perfusion time decreased only slightly (~1 minute) from 96.01 minutes to 95.07 minutes (2017 to 2020). This change however was not significant (p=0.301). The rate of Left Internal Mammary Artery (LIMA) use stayed relatively stable over the 4-year period fluctuating between 88.7% and 92.9% (p=0.360). The average initial ICU stay (in hours), drain at 12 hours and 24 hours stays almost the same. The rate of mortality peaked in 2018 (4.76%) and subsequently fell to 3.57% by 2020. Conclusion: More males underwent CABG surgery at this tertiary care hospital and the overall complication rate and per-operative parameters improved over the years. The non-risk stratified mortality in this study was found to be higher than developed nations.
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Affiliation(s)
- Azam Jan
- Dr. Azam Jan, MD, Diplomate American Board of General Surgery (USA), Diplomate American Board of Thoracic (Cardiothoracic) Surgery (USA) Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Khizar Hayat
- Dr. Muhammad Khizar Hayat, MBBS Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Mohammad Ahmed Arsalan Khan
- Dr. Mohammad Ahmed Arsalan Khan, MBBS Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Rafi Ullah
- Dr. Rafi Ullah, MD. Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
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Oh TK, Song IA. Association between the weekday on which coronary artery bypass graft surgery is performed and the 30-day mortality: A nationwide cohort study in South Korea. J Card Surg 2021; 36:603-609. [PMID: 33386766 DOI: 10.1111/jocs.15274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative mortality associated with elective coronary artery bypass graft (CABG) surgery may reportedly increase as the weekday of surgery approaches the weekend. We aimed to investigate the potential effect of the weekday of CABG surgery on the 30-day mortality. METHODS This population-based cohort study analyzed data obtained from the South Korea national health insurance service database. The cohort included all adult patients diagnosed with ischemic heart disease (International Classification of Diseases-10 codes I20*-I25*) who underwent isolated and elective CABG surgery from January 2012 to December 2017. RESULTS Of the 13,556 patients included in the analysis, 595 (4.4%) died within 30 days after CABG surgery. In a multivariable Cox model, the 30-day mortality of patients who underwent CABG surgery later in the week (Wednesday-Friday) was not significantly associated with the weekday of surgery as similar to those who underwent surgery early in the week (Monday-Tuesday) (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 0.97-1.34; p = .109). Multivariable sensitivity analysis revealed that CABG surgery on Friday was associated with a 1.40-fold higher hazard of 30-day mortality (HR: 1.40; 95% CI: 1.09-1.80; p = .008) than CABG surgery on Monday. CONCLUSIONS This South Korean population-based cohort study revealed that relative to surgery early in the week (Monday-Tuesday), CABG surgery later in the week (Wednesday-Friday) was not associated with higher 30-day mortality. However, using surgery on Monday as a reference, CABG surgery on Friday was associated with higher 30-day mortality. Future studies must confirm these findings.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Kusu‐Orkar T, Kermali M, Oguamanam N, Bithas C, Harky A. Coronary artery bypass grafting: Factors affecting outcomes. J Card Surg 2020; 35:3503-3511. [DOI: 10.1111/jocs.15013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/29/2020] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Nina Oguamanam
- Department of Emergency Medicine East Sussex Healthcare NHS Trust Seaford UK
| | | | - Amer Harky
- Department of Cardiothoracic Surgery Liverpool Heart and Chest Hospital Liverpool UK
- Liverpool Center for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool UK
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Chan EG, Morrell MR, Chan PG, Sanchez PG. Bilateral sequential lung transplantation in Jehovah's Witnesses. Perfusion 2020; 36:672-676. [PMID: 32650703 DOI: 10.1177/0267659120939364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The ethical concerns of refusing lifesaving treatments after receiving an already limited resource such as a solid organ transplantation in a Jehovah's Witness patient have been discussed in the literature. Many of these studies have concluded that with a multidisciplinary approach, solid organ transplantation is possible in the setting of Jehovah's Witness patients. To date, there are no reported cases of bilateral sequential lung transplantation in the literature. We report two successful cases of bilateral sequential lung transplantation in Jehovah's Witness patients with excellent long-term follow-up.
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Affiliation(s)
- Ernest G Chan
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew R Morrell
- Department of Pulmonology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Patrick G Chan
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pablo G Sanchez
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Pulmonology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Seclì L, Sorge M, Morotti A, Brancaccio M. Blocking Extracellular Chaperones to Improve Cardiac Regeneration. Front Bioeng Biotechnol 2020; 8:411. [PMID: 32528937 PMCID: PMC7264090 DOI: 10.3389/fbioe.2020.00411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/14/2020] [Indexed: 12/24/2022] Open
Abstract
Chronic or acute insults to the myocardium are responsible for the onset of cardiomyopathy and heart failure. Due to the poor regenerative ability of the human adult heart, the survival of cardiomyocytes is a prerequisite to support heart function. Chaperone proteins, by regulating sarcomeric protein folding, function, and turnover in the challenging environment of the beating heart, play a fundamental role in myocardial physiology. Nevertheless, a number of evidences indicate that, under stress conditions or during cell damage, myocardial cells release chaperone proteins that, from the extracellular milieu, play a detrimental function, by perpetuating inflammation and inducing cardiomyocyte apoptosis. Blocking the activity of extracellular chaperones has been proven to have beneficial effects on heart function in preclinical models of myocardial infarction and cardiomyopathy. The application of this approach in combination with tissue engineering strategies may represent a future innovation in cardiac regenerative medicine.
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Affiliation(s)
- Laura Seclì
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Matteo Sorge
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Alessandro Morotti
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Mara Brancaccio
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
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12
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Bourazana A, Xanthopoulos A, Skoularigis J, Triposkiadis F. Preoperative Antiplatelet Therapy and Bleeding Risk in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: A Fine Balance. Angiology 2020; 71:701-703. [PMID: 32431160 DOI: 10.1177/0003319720925973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - John Skoularigis
- Department of Cardiology, Larissa University Hospital, Larissa, Greece
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13
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Miao N, Yang F, Du Z, Jiang C, Hao X, Wang J, Jiang Y, Yang X, Xie H, Hou X. Mortality risk factors from converting off-pump coronary artery bypass to on-pump coronary artery bypass. Perfusion 2017; 32:554-560. [PMID: 28425317 DOI: 10.1177/0267659117705193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: A number of large-scale retrospective studies revealed that off-pump coronary artery bypass (OPCAB) was superior to on-pump coronary artery bypass (ONCAB). The aim of the study was to investigate risk factors for mortality when OPCAB is converted to ONCAB. Methods: Patients who underwent OPCAB conversion to ONCAB at the Beijing Anzhen Hospital between January 2003 and January 2013 were assigned to the non-survivor and survivor groups. Background demographics, illness history and preoperative, intraoperative and postoperative variables were compared. Results: Of the 247 cases, 15.4% of the patients died. Patients in the non-survivor group were older and more frequently had diabetes mellitus (DM), arrhythmia, myocardial infarction (MI) in the past 30 days (all p<0.05) and MI combined with mitral regurgitation (p<0.0001); they more frequently had bigger left ventricular end-diastolic dimension (p=0.0019), greater fall in blood pressure, ventricular fibrillation for longer periods, longer conversion time and bypass graft occlusion. All patients in the non-survivor group received intra-aortic balloon pump compared to 89.5% in the survivor group and extracorporeal membrane oxygenation was more common. Left main coronary artery disease (OR=4.431, 95%CI: 2.440-8.048, p<0.0001), blood pressure decline ⩽40 mmHg (OR=0.509, 95%CI: 0.447-0.580, p<0.0001) and time for conversion to ONCAB ⩾20 min were independently associated with mortality. Rates of postoperative complications, such as renal failure, cerebral infarction or hemorrhage, MI and redo sternotomy, were higher in the non-survivor group. Conclusions: Conversion from OPCAB to ONCAB is associated with high mortality. Risk factors include left main artery disease and duration of blood pressure decline >40 min.
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Affiliation(s)
- Na Miao
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road, Chaoyang District, Beijing 100029, China
| | - Feng Yang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road, Chaoyang District, Beijing 100029, China
| | - Zhongtao Du
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road, Chaoyang District, Beijing 100029, China
| | - Chunjing Jiang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road, Chaoyang District, Beijing 100029, China
| | - Xing Hao
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road, Chaoyang District, Beijing 100029, China
| | - Jinhong Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road, Chaoyang District, Beijing 100029, China
| | - Yu Jiang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road, Chaoyang District, Beijing 100029, China
| | - Xiaofang Yang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road, Chaoyang District, Beijing 100029, China
| | - Haixiu Xie
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road, Chaoyang District, Beijing 100029, China
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road, Chaoyang District, Beijing 100029, China
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14
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Liu X, Yang Y, Meng Q, Sun J, Luo F, Cui Y, Zhang H, Zhang D, Tang Y. A Secure and High-Fidelity Live Animal Model for Off-Pump Coronary Bypass Surgery Training. JOURNAL OF SURGICAL EDUCATION 2016; 73:583-588. [PMID: 27168385 DOI: 10.1016/j.jsurg.2016.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 01/16/2016] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Existing simulators for off-pump coronary artery (CA) bypass grafting training are unable to provide cardiac surgery residents all necessary skills they need entering the operation room. In this study, we introduced a secure and high-fidelity live animal model to supplement the in vitro simulators for off-pump CA bypass grafting training. DESIGN The left internal thoracic artery (ITA) of 3 Chinese miniature pigs was grafted to the left anterior descending CA using an end-to-side anastomosis. The free segment of the ITA was fixed on the ventricle surface, making it a simulative CA beating in synchrony with the heart. A total of 6 to 8 training anastomoses were made on each ITA. SETTING Animal Experiment Center in Fuwai Hospital. PARTICIPANTS In total, 19 resident surgeons with at least 3 years of cardiac surgery work experience were trained using the new model. Their performances were recorded and reviewed. RESULTS Simulative coronary arteries were successfully constructed in all 3 animals with no adverse event observed. A total of 19 anastomoses were then completed, 1 pig of 7 anastomoses and the other 2 animals of 6 anastomoses. Time consumption for the anastomosis was 782 ± 107 seconds. Anastomotic leakage was observed in 10/19 procedures. The most frequency site (7/10) was at the toe of the anastomosis. Further, the most common cause was uneven spacing or small margin of the stitches or both. Emergencies occurred during the training process included hypotension (7 procedures), tachyarrhythmia (4 procedures), and low blood oxygen saturation (1 procedure). CONCLUSIONS This study demonstrated the safety and feasibility of our new live pig model in training resident surgeons. The simulative arteries can be easily accomplished and were long enough to place at least 6 anastomoses. Both on lumen diameter and motion status, they were proven to be a good substitution of the CA.
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Affiliation(s)
- Xiaopeng Liu
- Animal Experimental Center and Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Center of Cardiac Surgery for Adults, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yan Yang
- Center of Cardiac Surgery for Adults, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qiang Meng
- Center of Cardiac Surgery for Adults, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jiakang Sun
- Animal Experimental Center and Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Fuliang Luo
- Animal Experimental Center and Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yongchun Cui
- Animal Experimental Center and Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hong Zhang
- Animal Experimental Center and Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Center of Cardiac Surgery for Adults, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dong Zhang
- Animal Experimental Center and Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Center of Cardiac Surgery for Adults, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yue Tang
- Animal Experimental Center and Beijing Key Laboratory of Pre-Clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Center of Cardiac Surgery for Adults, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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15
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Mizuno T, Kamiyama H, Mizuno M, Mizukoshi T, Shinoda A, Harada K, Uchida S, Lee JS, Kasuya A, Sawada T, Uechi M. Plasma cytokine levels in dogs undergoing cardiopulmonary bypass. Res Vet Sci 2015; 101:99-105. [PMID: 26267098 DOI: 10.1016/j.rvsc.2015.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Currently, there are no reports of inflammatory responses to CPB in dogs. We investigated the time course of pro- and anti-inflammatory cytokine levels during and after CPB. ANIMALS The study group included 11 dogs that underwent mitral valve repair with CPB, and the control group included 7 healthy dogs that underwent ovariohysterectomy. METHODS Blood samples from the study group dogs were collected before, during and after surgery and analyzed for plasma levels of interleukin-6 (IL-6), tissue necrosis factor-α (TNF-α), interleukin-10 (IL-10), white blood cells (WBC), and C-reactive protein (CRP). Each inflammatory parameter was also compared with that of the control group dogs. RESULTS After CPB, plasma levels of IL-6, WBC counts, and CRP levels were significantly higher than preoperative levels, and IL-6 levels in the study group were significantly higher than those in the control group. CONCLUSIONS CPB induces a systemic inflammatory response in dogs.
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Affiliation(s)
- Takeshi Mizuno
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Hiroshi Kamiyama
- Veterinary Cardiovascular Medicine and Surgery Unit, Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-8510, Japan
| | - Masashi Mizuno
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Takahiro Mizukoshi
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Asako Shinoda
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Kayoko Harada
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Shuhei Uchida
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Joon-seok Lee
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Arane Kasuya
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Tamotsu Sawada
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Masami Uechi
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan.
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