RESUMO
<p><b>BACKGROUND</b>Myocardial protection during off-pump coronary artery bypass grafting (OPCABG) is a multifactorial problem in which maintaining stable systemic hemodynamics is very important. In this study passive graft perfusion (PGP) was applied to investigate the effect during and after OPCABG as evaluated by cardiac troponin I (CTnI) and hemodynamic indexes.</p><p><b>METHODS</b>Thirty first-time patients underwent OPCABG under one surgeon. They were randomly divided into two groups: The passive graft perfusion group (PGP, n = 15) received distal coronary perfusion during the anastomosis and immediate graft perfusion after the distal anastomosis. The control group, no graft perfusion group, (NGP, n = 15) received no graft perfusion after the distal anastomosis. The results of the two protocols were evaluated by concentration of CTnI and hemodynamic indexes before induction and after operation.</p><p><b>RESULTS</b>There were no statistically significant differences between these two groups in their perioperation parameters. The level of CTnI increased postoperatively, reached its peak at 6 hours (P < 0.05) and recovered by the 6 days postoperative. Compared with the control group the concentration of CTnI in the PGP group was significantly lower at 6 and 24 hours (P < 0.01). Compared with the NGP group, cardiac index (CI) in the PGP group was higher at 12 and 24 hours after operation (P < 0.05). The period of mechanical ventilation was significantly shorter in the PGP group than in the NGP group (P < 0.05).</p><p><b>CONCLUSION</b>PGP can increase the flow to the myocardium and shorten the heart ischemia time, thus maintain stable systemic hemodynamics, supply a satisfactory CI after surgery and improve surgery outcome.</p>
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão Sanguínea , Ponte de Artéria Coronária sem Circulação Extracorpórea , Métodos , Circulação Coronária , Frequência Cardíaca , Perfusão , Troponina I , SangueRESUMO
<p><b>OBJECTIVE</b>To investigate the safety and efficacy of basiliximab as induction agent in preventing early acute rejection post heart transplantation.</p><p><b>METHODS</b>Basiliximab (20 mg, iv) was administered one hour before and 4 days post operation to patients (n = 47) underwent heart transplantation between June 2004 and Feb 2005 in our department. Intravenous methylprednisolone (500 mg at operation beginning and repeated immediately post operation, followed by 125 mg every 8 hours for the first day). Prednisone was then initiated at 1 mg.kg(-1).d(-1) tapered 10 mg every 3 days to 10 mg/d. Mycophenolate mofetil (MMF, 0.5 - 1.0 g twice daily) was also administered post intubation, oral Cyclosporine A (CsA, 3 to 6 mg.kg(-1).d(-1)) was prescribed after transplantation if serum creatinine was < 150 micromol/L. The dose of CsA was individually adjusted to achieve a target serum concentration of 180 - 300 ng/ml. Endomyocardial biopsies were performed 3 weeks (19.7 +/- 9.6) d post heart transplantation. Biopsy specimens were graded according to the standardized criteria of the International Society for Heart and Lung Transplantation (ISHLT). Echocardiograms were routinely performed weekly within the first 3 weeks post-operation.</p><p><b>RESULTS</b>All 47 consecutive patients [mean age (44.9 +/- 13.4) years, range 13 - 63 years, 38 men] survived the operation and the underlying diseases was idiopathic cardiomyopathy (42.5%), ischemic heart disease (25.5%), arrhythmogenic right ventricular cardiomyopathy (17.0%), hypertrophic cardiomyopathy (4.2%), heart tumor (4.25%), valve heart disease (2.1%), hypertensive cardiomyopathy (2.1%) and giant cell myocarditis (2.1%). There were 4 patients with pre-operation PRA > 10% and CDC was less than 5% in all patients. The grades of the acute rejection in biopsy specimens were as follow: Grade (G) 0 in 30 (63.8%), G IA in 11 (23.4%), G IB in 3 (6.3%) and GII in 3 (6.3%) patients. The average dose of MMF was (1.2 +/- 0.3) g/d. The initial time of receiving CsA was (3.4 +/- 2.1) day post operation. The average cumulative dose of CsA was (4.1 +/- 1.2) mg.kg(-1).d(-1) before endomyocardial biopsy. The average serum concentration of CsA was (237.0 +/- 76.2) ng/ml. Left ventricular ejection fraction assessed by echocardiogram was normal in all patients within the first 3 weeks. Five patients suffered from respiratory infections and recovered post antibiotic and symptomatic therapies.</p><p><b>CONCLUSION</b>Basiliximab as induction agent in combination with conventional triple immunosuppressive therapy is safe and effective in preventing acute rejection in Chinese cardiac transplantation receipts.</p>