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Midterm follow-up after off-pump versus on-pump coronary artery bypass grafting. Results from a case-matched study
No full textObjective - Early survival in off-pump coronary artery bypass (OPCAB) patients is reported to be as good as that of conventional coronary artery bypass grafting (CABG). However, it remains unknown whether midterm cardiac outcome after off-pump surgery is similar to that for the on-pump procedure. Methods and results - One hundred OPCAB patients (67.8 (9.3) y) were compared to a case-matched contemporary group of CABG patients (69.4 (8.8) y). In-hospital and midterm outcome data are presented. Follow-up was 100% complete. The mean number of distal anastomoses per patient was 1.9 (0.8) and 2.4 (1.0) in the OPCAB and CABG group, respectively. Grafting according to treatment plan was 100% in both groups. Peak creatine kinase muscle-brain and cardiac troponin I (cTnl) release were similar in the overall groups, but the cTnl release in the 25 most recently operated patients was significantly lower in the OPCAB group (4.8 (9.1) ng/ml vs. 14.0 (20.5) ng/ml, p = 0.04). Duration of mechanical ventilation, ICU stay and hospital stay were shorter in the OPCAB group. The incidence of atrial fibrillation was similar. There were no differences in in-hospital complications. The actuarial survival at 1, 3 and 5 years was 88% (C.I. 81.6 to 94.3), 78% (C.I. 66.1 to 90.2) and 78% (C.1. 66.1 to 90.2) in the OPCAB and 90% (C.I. 84.0 to 95.9), 84% (C.I. 74.6 to 92.5) and 68% (C.I. 44.7 to 90.6) in the CABG group (log rank p-value = 0.96). Event-free survival at 1, 3, 5 years was 85% (C.I. 77.8 to 91.9), 71 % (C.I. 57.4 to 84.2) and 71 % (C.I. 57.4 to 84.2) in the OPCAB and 85% (C.I. 77.8 to 91.9),72% (C.I. 61.1 to 82.7) and 58% (C.I. 37.2 to 78.8) in the CABG group (log rank p-value = 0.63). Recurrence of angina (3%) and need for reintervention (2%) in the OPCAB group were low. Conclusions - OPCAB surgery is a safe and reproducible technique, yielding short-and midterm outcomes comparable to conventional CABG
Release of cardiac troponin I in antegrade crystalloid versus cold blood cardioplegia
No full textObjective: The purpose of this study was to assess the efficacy of myocardial protection, comparing antegrade crystalloid cardioplegia with cold blood cardioplegia, in patients with preserved left ventricular function who were undergoing elective first coronary artery bypass grafting, Release of cardiac troponin I was used as a marker for the effectiveness of myocardial protection, Methods: A consecutive series of 62 patients were randomly assigned to receive crystalloid or blood cardioplegia, Cardiac troponin I concentrations were determined in venous blood samples before the operation, immediately after unclamping, at 6, 9, 12, and 24 hours, and daily thereafter for 5 days, Results: Rising levels of troponin I were found in all patients. The time course and peak release were similar in the crystalloid cardioplegia and the blood cardioplegia groups. No patients in either group had electrocardiographic evidence of perioperative myocardial infarction, Cardiac troponin I was able to detect small areas of myocardial damage, not revealed by electrocardiography or creatine kinase MB release, Aprotinin administration was associated with lower cardiac troponin I release in both groups, Cardiac troponin I was lower in patients whose conditions did not require electrical defibrillation after aortic unclanlping, irrespective of cardioplegia type. The presence of a main stem lesion was associated with higher cardiac troponin I release only in the crystalloid cardioplegia group. Conclusions: Antegrade cold blood cardioplegia is equally effective as antegrade crystalloid cardioplegia in a randomized group of patients with preserved left ventricular function who were undergoing elective first coronary artery bypass grafting, Aprotinin administration resulted in lower cardiac troponin I release, whereas electrical defibrillation was related to a higher release irrespective of cardioplegia type, The presence of a main stem lesion resulted in higher cardiac troponin I release in the crystalloid cardioplegia group
Release of cardiac troponin I in antegrade crystalloid versus cold blood cardioplegia
No full textObjective: The purpose of this study was to assess the efficacy of myocardial protection, comparing antegrade crystalloid cardioplegia with cold blood cardioplegia, in patients with preserved left ventricular function who were undergoing elective first coronary artery bypass grafting, Release of cardiac troponin I was used as a marker for the effectiveness of myocardial protection, Methods: A consecutive series of 62 patients were randomly assigned to receive crystalloid or blood cardioplegia, Cardiac troponin I concentrations were determined in venous blood samples before the operation, immediately after unclamping, at 6, 9, 12, and 24 hours, and daily thereafter for 5 days, Results: Rising levels of troponin I were found in all patients. The time course and peak release were similar in the crystalloid cardioplegia and the blood cardioplegia groups. No patients in either group had electrocardiographic evidence of perioperative myocardial infarction, Cardiac troponin I was able to detect small areas of myocardial damage, not revealed by electrocardiography or creatine kinase MB release, Aprotinin administration was associated with lower cardiac troponin I release in both groups, Cardiac troponin I was lower in patients whose conditions did not require electrical defibrillation after aortic unclanlping, irrespective of cardioplegia type. The presence of a main stem lesion was associated with higher cardiac troponin I release only in the crystalloid cardioplegia group. Conclusions: Antegrade cold blood cardioplegia is equally effective as antegrade crystalloid cardioplegia in a randomized group of patients with preserved left ventricular function who were undergoing elective first coronary artery bypass grafting, Aprotinin administration resulted in lower cardiac troponin I release, whereas electrical defibrillation was related to a higher release irrespective of cardioplegia type, The presence of a main stem lesion resulted in higher cardiac troponin I release in the crystalloid cardioplegia group
No evidence of transdifferentiation of human mesenchymal or hematopoietic stem cells into cardiomyocytes following coculture with neonatal rat cardiomyocytes
No full textBackground: Several clinical trials have shown that stem cell based therapy may improve heart function. Both bone marrow derived mesenchymal (MSC) as well as hematopoietic stem cells (HSC) are reported to be multipotent. This study investigates whether neonatal rat cardiomyocytes (NRCM), when co-cultured, can induce transdifferentiation of either MSC or HSC into cardiomyocytes (CM). Methods and results: Ex vivo expanded human bone marrow derived MSC showed expression of CD49c, CD73, CD90, CD105 but not of CD34, CD45, CD106
and CD184. The expanded MSC kept their multipotent characteristics. In contrast, HSC were
freshly isolated by flow-sorting based on their expression of CD133 CD34 . Co-cultures,
using cell tracker green (5-chloromethylfluorescein diacetate) labelled MSC or HSC and cell
tracker red (5-(and6)-(((4-chloromethyl)benzoyl)amino)tetramethylrhodamin) labelled NRCM,
were performed at different ratios (1:6, 1:4, 1:3 and 1:1). Since several reports indicate that
dimethylsulfoxide (DMSO) and 5-azacytidin (5-aza) induce myocardial differentiation, 1% DMSO
for 48h or 3 M 5-aza for 24h was added to the co-cultures and compared to conditions
without additives. After three weeks green and red labelled cells were separated by
flow-sorting and cardiac gene expression was analyzed by RT-PCR. Co-culturing MSC induced
the expression of troponin T (TnT) and GATA-4. However, no expression of -actinin, myosin
heavy chain (MHC) or troponin I (TnI) could be detected. Furthermore, co-culturing HSC, could
only induce the expression of TnT, but no expression of -actinin, MHC, TnI or GATA-4 was
observed. Transmission electron microscopy confirmed the absence of sarcomeric organization
both in co-cultured MSC and HSC. Conclusions: This in vitro co-culture study obtained no convincing evidence of transdifferentiation of either MSC of HSC into CM. Despite the induction of Tnt and GATA-4, several cardiac specific genes are not expressed after 3 weeks of co-culture. No influence of DMSO or 5-aza on the transdifferentiation of MSC or HSC could be detected. Therefore, the reported functional improvement following cell based therapy for myocardial infarction may be due to other mechanisms than transdifferentiation of MSC or HSC
Duration of hospitalization for minimally invasive CABG versus CABG through sternotomy; a stepwise linear regression analysis.
No full textDuration of hospitalization for minimally invasive CABG versus CABG through sternotomy; a stepwise linear regression analysis.
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