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Iwasaki Y, Ohbe H, Nakajima M, Sasabuchi Y, Ikumi S, Kaiho Y, Yamauchi M, Fushimi K, Yasunaga H. Association Between Intraoperative Landiolol Use and In-Hospital Mortality After Coronary Artery Bypass Grafting: A Nationwide Observational Study in Japan. Anesth Analg 2023; 137:1208-1215. [PMID: 38051291 DOI: 10.1213/ane.0000000000006741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Ischemic heart disease is a leading cause of death worldwide, and coronary artery bypass grafting (CABG) is a major treatment. Landiolol is an ultra-short-acting beta-antagonist known to prevent postoperative atrial fibrillation. However, the effectiveness of intraoperative landiolol on mortality remains unknown. This study aimed to evaluate the association between intraoperative landiolol use and the in-hospital mortality in patients undergoing CABG. METHODS To conduct this retrospective cohort study, we used data from the Japanese Diagnosis Procedure Combination inpatient database. All patients who underwent CABG during hospitalization between July 1, 2010, and March 31, 2020, were included. Patients who received intraoperative landiolol were defined as the landiolol group, whereas the other patients were defined as the control group. The primary outcome was in-hospital mortality. Propensity score matching was used to compare the landiolol and control groups. RESULTS In total, 118,506 patients were eligible for this study, including 25,219 (21%) in the landiolol group and 93,287 (79%) in the control group. One-to-one propensity score matching created 24,893 pairs. After propensity score matching, the in-hospital mortality was significantly lower in the landiolol group than that in the control group (3.7% vs 4.3%; odds ratio 0.85; 95% confidence interval 0.78 to 0.94; P = .010). CONCLUSIONS Intraoperative landiolol use was associated with decreased in-hospital mortality in patients undergoing CABG. Further randomized controlled trials are required to confirm these findings.
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Affiliation(s)
- Yudai Iwasaki
- From the Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Mikio Nakajima
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Emergency Life-Saving Technique Academy of Tokyo, Foundation for Ambulance Service Development, Tokyo, Japan
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | | | - Saori Ikumi
- From the Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yu Kaiho
- From the Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Masanori Yamauchi
- From the Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Caspersen E, Guinot PG, Rozec B, Oilleau JF, Fellahi JL, Gaudard P, Lorne E, Mahjoub Y, Besnier E, Moussa MD, Mongardon N, Hanouz JL, Briant AR, Paul LPS, Tomadesso C, Parienti JJ, Descamps R, Denisenko A, Fischer MO. Comparison of landiolol and amiodarone for the treatment of new-onset atrial fibrillation after cardiac surgery (FAAC) trial: study protocol for a randomized controlled trial. Trials 2023; 24:353. [PMID: 37226174 DOI: 10.1186/s13063-023-07353-6] [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: 10/03/2022] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Postoperative atrial fibrillation (PoAF) after cardiac surgery has a high incidence of 30%, but its management is controversial. Two strategies are recommended without evidence of a superiority of one against the other: rate control with beta-blocker or rhythm control with amiodarone. Landiolol is a new-generation beta-blocker with fast onset and short half-life. One retrospective, single-center study compared landiolol to amiodarone for PoAF after cardiac surgery with a better hemodynamic stability and a higher rate of reduction to sinus rhythm with landiolol, justifying the need for a multicenter randomized controlled trial. Our aim is to compare landiolol to amiodarone in the setting of PoAF after cardiac surgery with the hypothesis of a higher rate of reduction to sinus rhythm with landiolol during the 48 h after the first episode of POAF. METHODS The FAAC trial is a multicenter single-blind two parallel-arm randomized study, which planned to include 350 patients with a first episode of PoAF following cardiac surgery. The duration of the study is 2 years. The patients are randomized in two arms: a landiolol group and an amiodarone group. Randomization (Ennov Clinical®) is performed by the anesthesiologist in charge of the patient if PoAF is persistent for at least 30 min after correction of hypovolemia, dyskalemia, and absence of pericardial effusion on a transthoracic echocardiography done at bedside. Our hypothesis is an increase of the percentage of patients in sinus rhythm from 70 to 85% with landiolol in less than 48 h after onset of PoAF (alpha risk = 5%, power = 90%, bilateral test). DISCUSSION The FAAC trial was approved by the Ethics Committee of EST III with approval number 19.05.08. The FAAC trial is the first randomized controlled trial comparing landiolol to amiodarone for PoAF after cardiac surgery. In case of higher rate of reduction with landiolol, this beta-blocker could be the drug of choice used in this context as to reduce the need for anticoagulant therapy and reduce the risk of complications of anticoagulant therapy for patients with a first episode of postoperative atrial fibrillation after cardiac surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT04223739. Registered on January 10, 2020.
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Affiliation(s)
- Edouard Caspersen
- Department of Anaesthesiology-Resuscitation and Perioperative Medicine, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
- University of Bourgogne and Franche-Comté, LNC UMR1231, Dijon, France
- INSERM, LNC UMR1231, Dijon, France
- LipSTIC LabEx, FCS Bourgogne-Franche Comté, Dijon, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laennec, CHU Nantes, Nantes, France
- Institut du Thorax, Université de Nantes, CHU Nantes, CNRS, INSERM, Nantes, France
| | - Jean-Ferréol Oilleau
- Department of Anesthesiology and Surgical Intensive Care Unit, Brest University Hospital, 29200, Brest, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude-Bernard, Lyon 1, Lyon, France
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine Arnaud de Villeneuve, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Emmanuel Lorne
- Department of Anaesthesia and Critical Care Medicine, Clinique du Millénaire, Cedex 2, 34960, Montpellier, France
| | - Yazine Mahjoub
- Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
| | - Emmanuel Besnier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Mouhamed Djahoum Moussa
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000, Lille, France
| | | | - Jean-Luc Hanouz
- Department of Anaesthesiology-Resuscitation and Perioperative Medicine, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Anaïs R Briant
- Department of Biostatistics, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Laure Peyro Saint Paul
- Department of Clinical Research and Innovation, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Clémence Tomadesso
- Department of Clinical Research and Innovation, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Jean-Jacques Parienti
- Department of Biostatistics, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Richard Descamps
- Department of Anaesthesiology-Resuscitation and Perioperative Medicine, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Alina Denisenko
- Department of Anaesthesiology-Resuscitation and Perioperative Medicine, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Marc-Olivier Fischer
- Institut Aquitain du Coeur, Clinique Saint Augustin, Elsan, 114 Avenue d'Arès, 33074, Bordeaux Cedex, France.
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Hao J, Zhou J, Xu W, Chen C, Zhang J, Peng H, Liu L. Beta-Blocker Landiolol Hydrochloride in Preventing Atrial Fibrillation Following Cardiothoracic Surgery: A Systematic Review and Meta-Analysis. Ann Thorac Cardiovasc Surg 2021; 28:18-31. [PMID: 34421096 PMCID: PMC8915935 DOI: 10.5761/atcs.ra.21-00126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The purpose of this article was to assess the benefit of perioperative administration of the intravenous beta-blocker landiolol hydrochloride in preventing atrial fibrillation (AF) after cardiothoracic surgery. METHODS We performed a systematic search in PubMed, Web of Science, CNKI, and OVID to identify randomized controlled trials (RCTs) and cohorts up to January 2021. Data regarding postoperative atrial fibrillation (POAF) and safety outcomes were extracted. Odds ratios (ORs) with 95% confidence intervals (CIs) were determined using the Mantel-Haenszel method. Meanwhile, subgroup analyses were conducted according to surgery type including lung cancer surgery, esophageal cancer surgery, and cardiac surgery. RESULTS Seventeen eligible articles involving 1349 patients within 13 RCTs and four cohorts were included in our meta-analysis. Compared with control group, landiolol administration was associated with a significant reduction of the occurrence of AF after cardiothoracic surgery (OR = 0.32, 95% CI 0.23-0.43, P <0.00001). In addition, the results demonstrated that perioperative administration of landiolol hydrochloride minimized the occurrence of postoperative complications (OR = 0.48, 95% CI 0.33-0.70, P = 0.0002). Funnel plots indicated no obvious publication bias. CONCLUSIONS Considering this analysis, landiolol was effective in the prevention of AF after cardiothoracic surgery and did not increase the risk of major postoperative complications.
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Affiliation(s)
- Jianqi Hao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Wenying Xu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Cong Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jian Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Department of Thoracic Surgery, Chest Oncology Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Haoning Peng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Sezai A, Taoka M, Osaka S, Kitazumi Y, Suzuki K, Kamata K, Tanaka M. A Comparative Prospective Observational Study on the Use of Direct Oral Anticoagulants after Cardiac Surgery for the Management of Atrial Fibrillation. Ann Thorac Cardiovasc Surg 2021; 27:191-199. [PMID: 33208579 PMCID: PMC8343030 DOI: 10.5761/atcs.oa.20-00213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/26/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Recently, guidelines recommended the use of direct oral anticoagulants (DOACs) for the management of non-valvular atrial fibrillation (NVAF). Postoperative atrial fibrillation (POAF) is the most common post-surgical complication of cardiac surgery, but the efficacy and safety of DOAC for POAF have rarely been investigated. We conducted a prospective observational study to investigate the efficacy and safety of DOAC administered immediately after POAF. MATERIALS AND METHODS In all, 135 patients that experienced POAF after cardiac surgery were treated with a DOAC. Primary endpoints were either bleeding or thromboembolic events. Secondary endpoints included changes in hemoglobin (Hb), prothrombin time (PT), activated partial thromboplastin time (APTT), serum creatinine (sCr), estimated glomerular filtration rate (eGFR), and pleural/pericardial effusion. RESULTS Patients were treated with apixaban (n = 31), edoxaban (n = 87), and rivaroxaban (n = 17). Major bleeding (p = 0.011) and gastrointestinal (GI) bleeding (p = 0.047) were significantly more frequent in the rivaroxaban group. Stroke was observed in one rivaroxaban group patient and none in the other two groups. CONCLUSION DOAC as anticoagulation therapy for the early intervention of POAF following cardiac surgery is associated with a low incidence of major bleeding; a favorable safety profile and excellent efficacy were demonstrated for DOAC. Furthermore, our results indicate that the safety and efficacy of apixaban and edoxaban are better than rivaroxaban.
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Affiliation(s)
- Akira Sezai
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Taoka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shunji Osaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Kitazumi
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Keito Suzuki
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Keita Kamata
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masashi Tanaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
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Kogo H, Sezai A, Osaka S, Shiono M, Tanaka M. Does Epicardial Adipose Tissue Influence Postoperative Atrial Fibrillation? Ann Thorac Cardiovasc Surg 2019; 25:149-157. [PMID: 30568066 PMCID: PMC6587128 DOI: 10.5761/atcs.oa.18-00212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose: Epicardial adipose tissue (EAT) is associated with atrial fibrillation. We investigated the effect of EAT on postoperative atrial fibrillation (POAF) after cardiac surgery. Methods: In all, 77 patients underwent scheduled cardiac surgery. Before the operation, we measured total epicardial adipose tissue (Total EAT) and left atrial (LA) EAT by three-dimensional computed tomography (CT). During surgery, we obtained samples of the right atrial appendage, aortic fat, and epicardial fat. The primary endpoint was occurrence of POAF within 1 week after surgery. Results: POAF occurred in 21 patients (27%). Assessment of preoperative characteristics revealed significant differences of age and the use of aldosterone blockers and loop diuretics between the patients with and without POAF. In univariate analysis, the LA EAT/Total EAT ratio, age, use of aldosterone blockers and loop diuretics, P wave duration, cardioplegia volume, and central venous pressure (CVP) were all higher in POAF group. However, logistic regression analysis with propensity score matching found no significant differences of these factors although the LA EAT/Total EAT ratio was higher in POAF group. Conclusion: The use of loop diuretics showed the strongest association with POAF. Logistic regression analysis suggested that a high LA EAT/Total EAT ratio had the second strongest association with POAF.
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Affiliation(s)
- Hiroko Kogo
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Akira Sezai
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shunji Osaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Motomi Shiono
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masashi Tanaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
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6
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Sato H, Hosojima M, Ishikawa T, Aoki K, Okamoto T, Saito A, Tsuchida M. Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery. Ann Thorac Cardiovasc Surg 2017; 23:239-247. [PMID: 28717057 DOI: 10.5761/atcs.oa.17-00045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This purpose of this prospective study was to use a continuous glucose monitoring (CGM) system to evaluate the suitability of our institution's glucose management protocol after cardiovascular surgery and to clarify the impact of glycemic variability on postoperative complications. METHODS In all, 76 patients who underwent elective cardiovascular surgery and were monitored perioperatively using a CGM system were evaluated. Postoperative glucose management consisted of continuous intravenous insulin infusion (CIII) in the intensive care unit, and subcutaneous insulin injections (SQII) after oral food intake started. CIII and subcutaneous injections were initiated when blood glucose level exceeded 150 mg/dL. CGM data were used to analyze perioperative glycemic variability and association with postoperative complications. RESULTS Target glucose levels (71-180 mg/dL) were achieved during 97.1 ± 5.5% and 86.4 ± 19.0% of the continuous insulin infusion and subcutaneous injection periods, respectively. Major postoperative complications were surgical site infections, found in 6.6% of total patients, and atrial fibrillation, found in 44% of patients with off-pump coronary artery bypass grafting. High glycemic variability during SQII was associated with increased risk for both complications. CONCLUSION Data analysis revealed that our glucose management protocol during CIII was adequate. However, the management protocol during SQII required improvement.
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Affiliation(s)
- Hiroki Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Michihiro Hosojima
- Department of Clinical Nutrition Science, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Tomomi Ishikawa
- Division of Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Kenji Aoki
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Takeshi Okamoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Akihiko Saito
- Department of Applied Molecular Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
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Gür Ö, Gurkan S, Yumun G, Turker P. The Comparison of the Effects of Nebivolol and Metoprolol on Erectile Dysfunction in the Cases with Coronary Artery Bypass Surgery. Ann Thorac Cardiovasc Surg 2017; 23:91-95. [PMID: 28302931 PMCID: PMC5422634 DOI: 10.5761/atcs.oa.16-00242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/29/2016] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Beta-blocker use is common in the cases with coronary artery bypass surgery. According to the literature, beta-blockers have positive effects but may cause erectile dysfunction (ED). The most commonly used beta-blockers in ischemic cardiac disease are nebivolol and metoprolol. In our clinic, we aimed to compare the effects of nebivolol and metoprolol succinate on ED in the sexually active cases with coronary artery bypass surgery. METHODS In our clinic, a total of 119 patients with coronary artery bypass surgery were included in the study. International Index of Erectile Function (IIEF-5) Test was used to evaluate whether the patients had ED and to grade the cases. RESULTS No significant difference was found in terms of anti-ischemic efficacy between metoprolol succinate and nebivolol in the postoperative period; however, the incidence of any grade ED was %85.96 in Group 1, %83.87 in Group 2. This difference was considered as statistically significant (p = 0.036). CONCLUSION Beta-blocker use increases the risk of ED in cases with ischemic cardiac disease. We suggest that the complaints of ED could be less frequent with nebivolol use in sexually active cases with ischemic cardiac disease.
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Affiliation(s)
- Özcan Gür
- Department of Cardiovascular Surgery, Namik Kemal University, Tekirdag, Turkey
| | - Selami Gurkan
- Department of Cardiovascular Surgery, Namik Kemal University, Tekirdag, Turkey
| | - Gunduz Yumun
- Department of Cardiovascular Surgery, Namik Kemal University, Tekirdag, Turkey
| | - Polat Turker
- Department of Urology, Namik Kemal University, Tekirdag, Turkey
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Sezai A, Akahoshi T, Osaka S, Yaoita H, Arimoto M, Hata H, Tanaka M, Sekino H, Akashiba T. Sleep disordered breathing in cardiac surgery patients: The NU-SLEEP trial. Int J Cardiol 2017; 227:342-346. [DOI: 10.1016/j.ijcard.2016.11.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
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Sezai A, Osaka S, Yaoita H, Arimoto M, Hata H, Shiono M. Safety of The Direct Oral Anticoagulant Edoxaban for Atrial Fibrillation After Cardiac Surgery: Pilot Study. J Atr Fibrillation 2016; 9:1456. [PMID: 28496931 DOI: 10.4022/jafib.1456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 01/17/2023]
Abstract
Direct oral anticoagulants have recently been recommended for non-valvular atrial fibrillation, but have rarely been studied in the field of cardiac surgery. We prospectively investigated the safety of edoxaban, a novel oral anticoagulant, for use in cardiac surgery patients with postoperative atrial fibrillation (POAF), which is the most common complication of cardiac surgery and can lead to stroke. The subjects were adult cardiac surgery patients with POAF who received oral edoxaban for 2 months in an open-label pilot study. The primary endpoint was cerebrovascular/bleeding events up to 2 months, while the secondary endpoints were hemoglobin, prothrombin time, and activated partial thromboplastin time. There were no cerebrovascular or bleeding events during edoxaban treatment and the test drug was not discontinued by any patient. There was no macroscopic hematuria and hemoglobin did not decrease, being significantly higher than the baseline level after 2 months. The prothrombin time was significantly prolonged from 1 week to 2 months and the activated partial thromboplastin time was significantly prolonged from 1 day to 2 months. Echocardiography detected pericardial effusion in 1 patient, but hemoglobin did not decrease and the effusion improved with diuretic therapy. In conclusion, despite the limited sample size of this pilot study, it was demonstrated that edoxaban does not induce bleeding in patients with POAF after cardiac surgery, suggesting that it is safe to perform a large-scale efficacy study of edoxaban as anticoagulant therapy for POAF.
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Affiliation(s)
- Akira Sezai
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Itabashi, Tokyo, Japan
| | - Shunji Osaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Itabashi, Tokyo, Japan
| | - Hiroko Yaoita
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Itabashi, Tokyo, Japan
| | - Munehito Arimoto
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Itabashi, Tokyo, Japan
| | - Hiroaki Hata
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Itabashi, Tokyo, Japan
| | - Motomi Shiono
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Itabashi, Tokyo, Japan
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10
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Natriuretic peptides for perioperative management of cardiac surgery. J Cardiol 2016; 67:15-21. [DOI: 10.1016/j.jjcc.2015.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/25/2015] [Accepted: 09/14/2015] [Indexed: 11/20/2022]
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11
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Safety and efficacy of landiolol hydrochloride for prevention of atrial fibrillation after cardiac surgery in patients with left ventricular dysfunction: Prevention of Atrial Fibrillation After Cardiac Surgery With Landiolol Hydrochloride for Left Ventricular Dysfunction (PLATON) trial. J Thorac Cardiovasc Surg 2015; 150:957-64. [PMID: 26254752 DOI: 10.1016/j.jtcvs.2015.07.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 06/29/2015] [Accepted: 07/04/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We previously conducted a prospective study of landiolol hydrochloride (INN landiolol), an ultrashort-acting β-blocker, and reported that it could prevent atrial fibrillation after cardiac surgery. This trial was performed to investigate the safety and efficacy of landiolol hydrochloride in patients with left ventricular dysfunction undergoing cardiac surgery. METHODS Sixty patients with a preoperative left ventricular ejection fraction of less than 35% were randomly assigned to 2 groups before cardiac surgery and then received intravenous infusion with landiolol hydrochloride (landiolol group) or without landiolol (control group). The primary end point was occurrence of atrial fibrillation as much as 1 week postoperatively. The secondary end points were blood pressure, heart rate, intensive care unit and hospital stays, ventilation time, ejection fraction, biomarkers of ischemia, and brain natriuretic peptide. RESULTS Atrial fibrillation occurred in 3 patients (10%) in the landiolol group versus 12 (40%) in the control group, and its frequency was significantly lower in the landiolol group (P = .002). During the early postoperative period, levels of brain natriuretic peptide and ischemic biomarkers were significantly lower in the landiolol group than the control group. The landiolol group also had a significantly shorter hospital stay (P = .019). Intravenous infusion was not discontinued for hypotension or bradycardia in either group. CONCLUSIONS Low-dose infusion of landiolol hydrochloride prevented atrial fibrillation after cardiac surgery in patients with cardiac dysfunction and was safe, with no effect on blood pressure. This intravenous β-blocker seems useful for perioperative management of cardiac surgical patients with left ventricular dysfunction.
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Sezai A, Osaka S, Yaoita H, Ishii Y, Arimoto M, Hata H, Shiono M. Early and Long-Term Outcomes in Japanese Patients Aged 80 Years or Older Undergoing Conventional Aortic Valve Replacement. Ann Thorac Cardiovasc Surg 2015; 21:247-53. [PMID: 26004118 DOI: 10.5761/atcs.oa.15-00067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED In this study, we investigated the early and long-term results of conventional aortic valve replacement (AVR) in very old patients. METHODS Seventy-five patients with aortic stenosis underwent conventional AVR for patients aged 80 years.We examined early death and major adverse cardiovascular and cerebrovascular event (MACCE). RESULTS The operative mortality was 0% for isolated AVR and 19.2% for concomitant surgery. The postoperative survival rate and MACCE free-rate were no significant differences between the isolated AVR and the concomitant surgery. Univariate analysis confirmed that cardiac dysfunction, severe chronic kidney disease (CKD), hemodialysis, + coronary artery bypass grafting, and norepinephrine use were risk factor of early death. Univariate analysis confirmed that severe CKD, BNP >1000 pg/ml, aortic cross clamping time (ACCT) >180 min, and non-use carperitide and multivariate analysis confirmed that ACCT >180 min, and non-use carperitide were risk factor of MACCE. CONCLUSIONS This study showed that the results of conventional AVR in very old patients were not satisfactory. However, the results obtained with isolated AVR were favorable with no operative deaths. The present study demonstrated that preoperative cardiac function, preoperative renal function, and operative factors have an important impact on early mortality and MACCE.
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Affiliation(s)
- Akira Sezai
- The Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
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