ABSTRACT
Various techniques for administration of blood cardioplegia are used worldwide. In this study, the effect of warm blood cardioplegia administration with or without the use of a roller pump on perioperative myocardial injury was studied in patients undergoing coronary artery bypass grafting using minimal extra-corporeal circuits (MECCs). Sixty-eight patients undergoing elective coronary bypass surgery with an MECC system were consecutively enrolled and randomized into a pumpless group (PL group: blood cardioplegia administration without roller pump) or roller pump group (RP group: blood cardioplegia administration with roller pump). No statistically significant differences were found between the PL group and RP group regarding release of cardiac biomarkers. Maximum postoperative biomarker values reached at T1 (after arrival intensive care unit) for heart-type fatty acid binding protein (2.7 [1.5; 6.0] ng/mL PL group vs. 3.2 [1.6; 6.3] ng/mL RP group, p = .63) and at T3 (first postoperative day) for troponin T high-sensitive (22.0 [14.5; 29.3] ng/L PL group vs. 21.1 [15.3; 31.6] ng/L RP group, p = .91), N-terminal pro-brain natriuretic peptide (2.1 [1.7; 2.9] ng/mL PL group vs. 2.6 [1.6; 3.6] ng/mL RP group, p = .48), and C-reactive protein (138 [106; 175] µg/mL PL group vs. 129 [105; 161] µg/mL RP group, p = .65). Besides this, blood cardioplegia flow, blood cardioplegia line pressure, and aortic root pressure during blood cardioplegia administration were similar between the two groups. Administration of warm blood cardioplegia with or without the use of a roller pump results in similar clinically acceptable myocardial protection.
Subject(s)
Coronary Artery Bypass/methods , Heart Arrest, Induced/methods , Heart Arrest, Induced/statistics & numerical data , Aged , Biomarkers/blood , C-Reactive Protein/analysis , Fatty Acid Binding Protein 3 , Fatty Acid-Binding Proteins/blood , Female , Heart Arrest, Induced/adverse effects , Humans , Male , Middle Aged , Troponin T/bloodABSTRACT
OBJECTIVE: To evaluate the effect of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life (HRQoL) outcomes in breast cancer patients and survivors. METHODS: A meta-analysis was carried out to quantify the effects of behavioral and exercise interventions on fatigue, depression, anxiety, body-image, stress and HRQoL. Summary effect sizes and standard errors were calculated. The presence of publication bias was explored and sensitivity analyses were performed to identify possible sources of heterogeneity. RESULTS: In total, 56 studies were included. Statistically significant results were found for the effect of behavioral techniques on fatigue (ES -0.158; 95% CI -0.233 to -0.082, p<0.001), depression (ES -0.336; 95% CI -0.482 to -0.190, p<0.001), anxiety (ES -0.346; 95% CI -0.538 to -0.154, p<0.001) and stress (ES -0.159; 95% CI -0.310 to -0.009, p=0.038). For the effect of physical exercise interventions, statistically significant results were found on fatigue (ES -0.315; 95% CI -0.532 to -0.098, p=0.004), depression (ES -0.262; 95% CI -0.476 to -0.049, p=0.016), body-image (ES 0.280; 95% CI 0.077 to 0.482, p=0.007) and HRQoL (ES 0.298; 95% CI 0.117 to 0.479, p=0.001). CONCLUSIONS: The results indicate that behavioral techniques and physical exercise improve psychosocial functioning and HRQoL in breast cancer patients and survivors. Future research is needed on the effect of physical exercise on stress and the effect of the combined intervention in breast cancer patients.
