SummaryAimInsufficient oxygen supply to organs and tissues due to reduced arterial or venous blood flow results in ischaemia, during which, although ATP production stops, AMP and adenosine continue to be produced from ATP. The fate of irisin, which causes the production of heat instead of ATP during ischaemia, is unknown. Iloprost and sildenafil are two pharmaceutical agents that mediate the resumption of reperfusion (blood supply) via vasodilatation during ischaemic conditions. Our study aimed to explore the effects of iloprost and sildenafil on irisin levels in the heart, liver and kidney tissues and whether these pharmaceutical agents had any impact on serum irisin and nitric oxide levels in rats with induced experimental myocardial ischaemia.MethodsThe study included adult male Sprague-Dawley rats aged 10 months and weighing between 250 and 280 g. The animals were randomly allocated to eight groups, with five rats in each group. The groups were: sham (control), iloprost (ILO), sildenafil (SIL), ILO + SIL, myocardial ischaemia (MI), MI + ILO, MI + SIL and MI + ILO + SIL. The treatment protocols were implemented before inducing ischaemia, which was done by occluding the left coronary artery with a plastic ligature for 30 minutes. Following the reperfusion procedure, all rats were sacrificed after 24 hours, and their heart, liver and kidney tissues and blood samples were collected for analyses. An immunohistochemical method was used to measure the change in irisin levels, the ELISA method to quantify blood irisin levels, and Griess’ assay to determine nitric oxide (NO) levels in the serum and tissue. Myocardial ischaemia was confirmed based on the results of Masson’s trichrome staining, as well as levels of troponin and creatine kinase MB.ResultsIrisin levels in biological tissue and serum dropped statistically significantly in the ischaemic group (MI), but were restored with ILO and SIL administration. Individual SIL administration was more potently restorative than individual ILO administration or the combined administration of the two agents. NO level, on the other hand, showed the opposite tendency, reaching the highest level in the MI group, and falling with the use of pharmaceutical agents.ConclusionsIndividual or combined administration of ILO and SIL reduced myocardial ischaemia and NO levels, and increased irisin levels. Elevated levels of irisin obtained by drug administration could possibly contribute to accelerated wound recovery by local heat production. Sildenafil was more effective than iloprost in eliminating ischaemia and may be the first choice in offsetting the effects of ischaemia in the future.
No important adverse effect was detected during levosimendan infusion. Because levosimendan at a dose of 0.03-0.05 μg/kg/min increased myocardial performance significantly in the postoperative period, it can be used safely in end-stage renal disease patients undergoing isolated CABG. The requirement of vasopressors were lower in SG.
Using the off-pump technique is safe and improves postoperative early outcomes in high-risk patients with LMCA disease.
Objective: There is no common concencus the clinical results of coronary artery bypass grafting (CABG) surgery patients who underwent off-pump or conventional techniques. Our aim of this study was to compare the changes of myocardial functions, patients' clinical results, biochemical marker release during surgery and postoperatively in On-and Off-Pump CABG surgery. Method: A consecutive series of 50 coronary artery disease (CAD) patients who underwent elective CABG surgery included for this study. The patients were divided into two groups (Group 1, N = 25 and group 2, N = 25). Demographic data including the patients' age, gender, body mass index (BMI), diseased coronary artery numbers, LVEF were similar. Postoperative red package blood cell, fresh frozen plasma, and thrombocyte requirements were high in On-Pump group (p < 0.05). But there was not any significant difference when compared the number of unexpected surgery because of mediastinal bleeding after operations in both groups. Preoperative and postoperative N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), cardiac Troponin-I (cTnI) levels during and after surgery, and left ventricular ejection fractions (LVEF) prior to discharge from hospital were compared. Results: There were no statistical significancy when compared postoperative mortality and morbidity. The operations time was low in off-pump group (p < 0.05). The NT-proBNP levels were similar in both groups (p > 0.05). However, cTnI levels were significantly higher in the on-pump group (p = 0.0001). Postoperative LVEF decreased significantly in both groups when compared to preoperative echocardiography examinations (p = 0.001). But the changes of postoperative LVEFs in both groups were not statistical significant (p > 0.05). Conclusion: Our study results indicated that cardiac enzyme release was high after On-Pump CABG surgery. However, LVEF decreased in both techniques. There were some advantages of OPCAB operations such as decrease of inflammatory responses and angina pectoris incidence due to extracorporeal circulation; however, these techniques did not affect postoperative mortality and morbidity. Therefore, in selected cases to provide longer operation time, Off-Pump CABG could be used but it has no superiority over On-Pump CABG surgery.
A 52-year-old patient was admitted in our hospital for postinfarction ventricular septal defect (VSD), left ventricular aneurysm and coronary artery disease. He was investigated by echocardiography and coronary angiography and proposed for operation. In the light of the patient's stable hemodynamic condition, surgical intervention was delayed. 3 weeks following the acute myocardial infarction open heart surgery was performed and had been managed just pre-operatively with an intra-aortic balloon pumping. The patient underwent successful VSD closure with a patch. The repair involves VSD closure and infarct exclusion technique. The patient discharged 10 days postoperatively. We consider that this modification is a simple and effective way to decrease the surgical risk of postinfarction VSD.
Objective: Acute kidney disease develops 16%-30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-pump beating heart (OPBH) and conventional on-pump (COP), in patients who have preoperative low glomerular filtration rate (eGFR) as an indicator of creatinine clearance. Methods: From 2004 to 2015, 341 patients with preoperative creatinine clearance were lower than 90 ml/min/1.73m 2 were selected for this study. On-Pump beating heart was performed in 111 patients (Group I). Conventional on-pump technique was used in 200 patients. In the remaining patients, we measured postoperative Tumor Necrosis Factor Alpha (TNF-alpha), cardiac troponin I (cTn-I), Brain natriuretic peptid (NT-Pro-BNP), creatinine (Cr), blood urea nitrogen (BUN) and postoperative eGFR daily until day four after surgery. Results: There were no differences in baseline levels of TNF-alpha, NT-Pro-BNP, BUN, cTn-I, Cr levels between the groups. Cardiopulmonary bypass (CPB) time were much longer and cumulative inotrope use was significantly higher in patients underwent COP (P < 0.05). Postoperative TNF-alpha and c-TnI was significantly higher in group II (P < 0.001).
Background: The new onset of atrial fibrillation (NOAF) can be occurred after coronary artery bypass grafting (CABG) surgery. NOAF can be occurred because of postoperative severe hemodynamic instability, long duration of ICU and hospital staying time, morbidity and mortality. Our aim of this study was to investigate whether N-terminal pro-brain natriuretic peptide (NT-proBNP) is a cause of NOAF after CABG. Methods: Forty CABG patients were enrolled for this study. Twenty patients operated on cardiopulmonary bypass (Group I; n: 20). The remaining patients have operated using a beating heart technique (Group II; n: 20). The NT-proBNP levels were calculated preand postoperatively. Results: High rate of NOAF was detected in group I patients (P < 0.05). In both groups, the NT-proBNP levels were low with sinus rhythm. The NT-proBNP blood levels in different times (T1, T2, T3, T4) among Group I were found higher than Group II. Conclusions: Our research demonstrated that there was a strongly close relationship between blood NT-proBNP levels' and atrial fibrillation occurrence in CABG patients. According to our results to detect postoperative AF development in early time and its treatment, blood NT-proBNP levels can be calculated in those patients for reducing morbidity and mortality due to AF.
Background: The modified systemic to pulmonary artery shunt (mSPS) is an effective palliative procedure in children with cyanotic congenital heart disease (CCHD) who are not suited for total correction. Early graft failure related to hereditary thrombophilic disorder is one cause of mortality. The aim of this study is to compare the clinical outcomes and rate of graft failure after mSPS in cyanotic infants with hereditary thrombophilia using bovine mesenteric venous graft (BMVG) and polytetrafluoroethylene (PTFE). Methods: 60 cyanotic patients (28 neonates, mean age 19 ± 11.3 days; range 1 to 27) who had thrombophilic risk factors were divided into 2 groups: BMVG (n = 30) and PTFE (n = 30). Preoperative thrombophilic factors were measured for each patient. The most common thrombophilic factors were protein C and S deficiency and Factor V Leiden mutation. We also investigated D-dimer, positivity of prothrombin G20210A, factor XII and antithrombin III deficiency, and homocysteinemia in both groups. The mean age of patients was 4.6 ± 1.09 months (range 1 day to 6 months) in the BMVG group and 3.9 ± 1.02 months (range 2 days to 9 months) in the PTFE group (P = .67). mSPS procedures were performed via left thoracotomy (n = 19 in the BMVG group and n = 22 in the PTFE group) or right anterior thoracotomy (n = 3 in the BMVG group and n = 3 in the PTFE group). Median sternotomy was performed to create a central shunt in 8 neonates in the BMVG group. In the PTFE group, we performed a central shunt in 5 patients via median sternotomy. Low molecular weight heparin in combination with acetylsalicylic acid (aspirin) were administered after surgery in both groups. The patients received aspirin combined with warfarin (Coumadin) after being discharged from hospital. We performed revision surgery to observe whether any patient had a significant drop in saturation with inaudible mSPS murmur. Results: 7 patients died early after surgery (n = 2 in the BMVG group [6.6%] and n = 5 in the PTFE group [16.5%]; P = .022). 53 patients were discharged home in good clinical condition. Early graft thromboses were observed in 2 patients in the BMVG group (6.6%) and 8 patients in the PTFE group (26.6%) (P = .001). In a case from the BMVG group, the reason for graft thrombosis was entanglement of the graft. Revision surgery was performed successfully without any complication. Cil et collegues has been reported a successful percutaneous balloon angioplasty after an acute thrombosis of BMVG previously [Cil 2010]. In another patient who had acute BMVG thrombosis, we performed transluminal graft angioplasty using successful thrombolytic administration in the catheterization laboratory. There were no complications due to graft materials such as hematoma, seroma, or infection in the BMVG group. Bleeding from the needle hole was seen in 1 patient in the BMVG group. PTFE thrombosis developed in 3 patients within 24 hours (10%). We detected total or partial PTFE graft thrombosis in 5 patients during the follow-up period (20%). Revision surgeries in 3 patients were performed immediately after diagnosis. Transluminal balloon angioplasty combined with thrombolysis was performed in infants with partial or total PTFE occlusion in 5 patients. In the PTFE group, perigraft seroma (n = 5 [16.6%)] and hematoma (n = 2 [6.6%]) were detected. We performed revision surgery because of bleeding from the needle hole in 3 patients in the PTFE group (10%) in the early period after surgery. We detected a graft infection in 1 patient (3.3%) 6 months after surgery in the PTFE group. The rate of overall complications including pseudoaneurysm, seroma formation, graft infection, or partial or total graft occlusion in the early and follow-up periods was 6.6% in the BMVG group and 53.3% in the PTFE group (P = .0001). The rate of freedom from shunt failure was 92.6% ± 2.1% and 76.2% ± 4.8% during follow-up in BMVG and PTFE groups, respectively (P = .034). The rate of shunt-related mortality was 10.7% (n = 3) in the BMVG group and 20% in the PTFE group (P = .01). Regular physical examinations, transcutaneous oxygen saturation, and echocardiographic study were performed for shunt control during follow-up. Shunt occlusion or thrombosis was not seen in the BMVG group; 5 patients in the PTFE group (20%) had shunt occlusion during follow-up (P = .001). Conclusion: Our study shows that BMVG, as a biological material, may be used as an alternative material for creating mSPS. It decreases postoperative life-threatening complications after shunt procedures, including graft thrombosis, bleeding from the needle hole, perigraft hematoma, and seroma in patients with hereditary thrombophilia. To our knowledge, we report the first clinical comparison of the 2 grafts in our case series with thrombophilic risk factors.
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