Current status of bosentan for treatment of pulmonary hypertension.

Pulmonary arterial hypertension (PAH) is a debilitating disease associated with significant morbidity and a high mortality if left untreated. Over the past 5 years, there have been significant advances with regard to the understanding of the pathogenesis, diagnosis and classification of PAH. The availability of newer drugs has resulted in a radical change in the management of this disease with significant improvement in both the quality of life and mortality. One of the recent drugs is an orally active dual endothelin receptor antagonist, bosentan; this drug has shown to improve the exercise capacity and survival in patients with PAH. This review article discusses the pharmacology of bosentan and summarises the current available evidence for the safety and efficacy of bosentan for the treatment of PAH.

Outcomes of off-pump coronary artery bypass surgery: current best available evidence.

In the last decade, there has been an upsurge of interest in less invasive alternatives to standard coronary artery bypass grafting performed with cardiopulmonary bypass. Off-pump coronary artery bypass grafting is one such less invasive alternative that has seen a resurgence in the last 10 years. The development and application of the technology required has largely been driven by the hope of decreasing the incidence and/or severity of the adverse outcomes associated with cardiopulmonary bypass, the idea being to perform coronary artery bypass grafting without cardiopulmonary bypass. A number of studies that have reported the safety and efficacy of off-pump coronary artery bypass surgery have provided the impetus for the development of this technology over the last decade. Despite tremendous enthusiasm on the part of cardiac surgeons, patients, industry and the media, skepticism still exists about the actual impact of off-pump coronary artery bypass grafting on the outcomes after coronary artery bypass grafting. The only means of countering this skepticism is to validate the safety and efficacy of off-pump coronary artery bypass surgery through the explicit and conscientious assessment of current best evidence. This review article attempts to evaluate the current best evidence available from randomized, controlled trials in order to compare the outcomes of off-pump coronary artery bypass surgery and conventional coronary artery bypass grafting.

Desmopressin for haemostasis in cardiac surgery: when to use?

Bleeding after cardiac surgery increases morbidity and exposes patients to the risks associated with blood transfusion. Desmopressin acetate, a synthetic vasopressin analogue, has been used in patients undergoing cardiac operations to reduce postoperative blood loss and transfusion requirements, although a benefit has not been demonstrated in large randomized controlled trials. Therefore, the routine use of desmopressin in uncomplicated cardiac operations is not recommended. This review article discusses the pharmacology of desmopressin as a haemostatic agent and evaluates available clinical evidence to determine current indications for desmopressin as a haemostatic agent in cardiac surgery.

Impact of off-pump coronary artery bypass surgery on post-operative pulmonary dysfunction: current best available evidence.

Pulmonary dysfunction is a well-recognized complication associated with cardiopulmonary bypass (CPB) and a major cause of morbidity and mortality in cardiac surgery. Off-pump coronary artery bypass (OPCAB) surgery has been gaining in popularity in the last few years. Resurgence of interest in OPCAB is associated with the expectation that avoiding deleterious effects of the CPB pump leads to better outcomes and possibly decreased costs and resource utilization. This review article attempts to evaluate the current best available evidence from randomized controlled trials on the impact of OPCAB on postoperative pulmonary dysfunction.