1,720,978 research outputs found
Single-pill combination therapy in the initial treatment of marked hypertension: a propensity-matched analysis.
No full textEffects of statin therapy on ascending aorta aneurysms growth: A propensity-matched analysis.
No full textRadial artery versus saphenous vein graft patency: Meta-analysis of randomized controlled trials
No full text[No abstract available
Coronary artery bypass grafting versus drug-eluting stents in multivessel coronary disease. A meta-analysis on 23,842 patients
No full textPreoperative Right ventricular dysfunction detected by Tissue Doppler Imaging predicts late tricuspid regurgitation following mitral valve surgery
No full textPerioperative administration of enoximone and renal function after cardiac surgery: A propensity-matched analysis
No full textBackground: Perioperative administration of enoximone has been shown to improve hemodynamics, organ function, and inflammatory response. Aim of the present study is to evaluate the impact of enoximone on postoperative renal function after on-pump cardiac surgery. Methods: A total of 3727 patients undergoing cardiac surgery at one Institution between May 2004 and November 2010 were reviewed. A propensity score was built and a 1: 1 perfect matching was performed, providing two fairly comparable cohorts of 712 patients each, receiving or not enoximone after surgery. Renal function was evaluated by lower glomerular filtration rate (GFR) value reached postoperatively. Results: Overall 30-day mortality rate was 4.3% (62/1424). Cumulative incidence of postoperative renal failure (RF) was 157/1424(11%), of which 99/1424(7%) needed renal replacement therapy. Mean lower postoperative GFR in patients who received or not enoximone was 63 +/- 30.1 and 53.5 +/- 26.1 ml/min/1.73 m(2) (p<0.0001), respectively. At multivariable analysis age (OR2.75, p=0.0004), diabetes (OR1.82, p=0.006), preoperative GFR (OR3.81, p<0.0001), preoperative cardiogenic shock (OR1.65, p=0.004), previous cardiac surgery (OR2.12, p=0.0002), type of intervention (OR1.96, p=0.005), and enoximone (OR0.38, p=0.001) were found to be independently associated with postoperative RF. Logistic regression analysis showed that the administration of enoximone (OR0.41, p=0.0001), and of no inotropes (OR0.27, p<0.0001) were protective vs. the occurrence of postoperative RF. Conclusion: Patients perioperatively receiving enoximone showed a statistically significant better renal function after cardiac surgery. (C) 2012 Elsevier Ireland Ltd. All rights reserved
Miniaturized cardiopulmonary bypass and acute kidney injury in coronary artery bypass graft surgery.
No full textBackground. Acute kidney injury (AKI) is one of the most important complications after on-pump coronary artery bypass graft surgery (CABG). Miniaturized cardiopulmonary bypass (mini-CPB) systems have been developed to allow the ease of on-pump surgery but tempering the disadvantages. Whether mini-CPB reduces the incidence of AKI remains to be determined. Methods. Using a propensity score matched analysis, we investigated the occurrence of AKI among patients undergoing CABG on mini-CPB (n 104) versus conventional CPB (n 601). Acute kidney injury was defined according to the recent Acute Kidney Injury Network classification. Results. Overall, acute kidney injury developed in 274 of 705 patients (38.8%). A total of 27 of 705 patients (3.8%) required renal replacement therapy. The median postoperative length of intensive care unit stay in survivors with AKI was 5.4 (3.9 to 6.8) days compared with 2.0 (1.0 to 3.0) days for patients without AKI (p 0.0002). The overall incidence of AKI for patients undergoing mini- CPB was 30 of 104 (28.8%) compared with 244 of 601 (40.5%) for patients undergoing conventional CPB (p 0.03). In the propensity score matched-pair statistical analysis, mini-CPB was independently associated with a decreased incidence of AKI (adjusted odds ratio [OR] 0.61; 95% confidence interval [CI]: 0.38 to 0.97). Other variables independently associated with AKI were preoperative glomerular filtration rate (OR 0.988 for 1 mL · min1 · 1.73 m2 increase; 95% CI: 0.98 to 0.99), postoperative red blood cell transfusion (OR 1.58; 95% CI: 1.12 to 2.23); CPB time (OR 1.005 for 1-minute increase; 95% CI: 1.0 to 1.009), and postoperative low output syndrome (OR 1.72; 95% CI: 1.23 to 2.41). Conclusions. The present study showed that mini-CPB is associated with a lower incidence of AKI when compared with conventional CPB among patients undergoing CABG
Unilateral versus bilateral antegrade cerebral protection during aortic surgery. an updated meta-analysis
No full textBACKGROUND:
In the context of complex aortic surgery, despite the wide consensus about the use of moderate hypothermia in association with antegrade selective cerebral perfusion (ASCP), its bilateral administration is not always warranted. The aim of the present meta-analysis was to investigate outcomes of unilateral versus bilateral ASCP.
METHODS:
Outcomes investigated were postoperative mortality and neurologic permanent and temporary disease (PND and TND); separate analysis of heterogeneity using the Cochrane Q statistic was used to perform comparisons. Circulatory arrest (CA) time and temperature, and sample size were explored as potential causes for heterogeneity with meta-regression analysis.
RESULTS:
The study population consisted of 3,723 patients receiving bilateral ASCP and 3,065 patients receiving unilateral ASC. Pooled analysis showed similar rates of postoperative mortality: 9.8% (95% confidence interval [CI], 7.8% to 12.3%) for bilateral ASCP versus 7.6% (95% CI, 5.7% to 10.2%) for unilateral ASCP; p = 0.19. Postoperative PND rates as well did not differ significantly: 6.9% (95% CI, 5.0% to 9.4%) for bilateral ASCP versus 5.8% (95% CI, 3.8% to 8.7%) for unilateral ASCP; p = 0.53. Similar results yielded from TND analysis: 9.3 % (95% CI, 7.0% to 12.2%) versus 6.5% (95% CI, 4.5% to 9.5%), respectively, p = 0.14. Meta-regression analysis showed that longer CA times were associated with significantly increased mortality only among patients administered with unilateral ASCP (model Q 65.8, p < 0.0001). Furthermore, higher CA temperatures were associated with significantly reduced rates of mortality (Q 64.1, p = 0.001), PND (Q 52.3, p = 0.01), and TND (Q 62.2, p = 0.002) in both groups.
CONCLUSIONS:
Unilateral versus bilateral ASCP administration did not result in different mortality and neurologic morbidity rates. Nevertheless, among prolonged CA times unilateral ASCP resulted in poorer outcomes with respect to bilateral ASCP. Furthermore, moderate hypothermia was associated with best outcomes in both groups
Metabolic Syndrome Affects Midterm Outcome After Coronary Artery Bypass Grafting
No full textBackground. Metabolic syndrome (MetS) is frequently associated with coronary artery disease, but data on the impact of MetS on long-term outcome of patients undergoing coronary artery bypass grafting are still lacking. The aim of the present study was to assess the effect of MetS on mortality and morbidity late after coronary artery bypass grafting. Methods. A total of 1,726 consecutive patients who had elective coronary artery bypass grafting were retrospectively reviewed and clinical follow-up was completed (mean follow-up time, 34.4 months; range, 6 to 79 months). The MetS was diagnosed using the modified Adult Treatment Panel III criteria, and to eliminate covariate differences, a propensity score adjustment was used. Major adverse cerebral and cardiovascular events were investigated, and C-reactive protein levels were assessed both preoperatively, postoperatively, and at follow-up. Results. A total of 798 of 1,726 patients (46.2%) met the diagnostic criteria for MetS. At follow-up, all-cause mortality (7% versus 4.6%; p = 0.04), cardiac arrhythmias (35.3% versus 25.2%; p < 0.0001), renal failure (12% versus 8.7%; p = 0.03), and major adverse cerebral and cardiovascular events (52.4% versus 39.5%; p < 0.0001) showed a significantly higher incidence in MetS patients. Variables correlated with late mortality at propensityadjusted Cox proportional-hazards regression were age (p = 0.0008), preoperative left ventricular ejection fraction (p = 0.001), preoperative renal failure (p = 0.001), and MetS (p = 0.006). Higher C-reactive protein levels were found preoperatively (8.6 +/- 2.3 versus 5.14 +/- 3.1 mg/L; p < 0.0001) and both early (71.2 +/- 9 versus 49.6 +/- 8.7 mg/L; p < 0.0001) and late (7.4 +/- 2.7 versus 4.8 +/- 2.5mg/L; p < 0.0001) after surgery. Conclusions. The main finding of our study was the association between MetS and mortality both early and late after coronary artery bypass grafting. Thus, MetS should be recognized as an independent preoperative variable that can lead to the identification of high-risk patients and as a risk factor to correct with lifestyle modifications and pharmacologic therapy. (Ann Thorac Surg 2012;93:537-44) (C) 2012 by The Society of Thoracic Surgeon
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