Bcl-2 expression enhances myoblast sheet transplantation therapy for acute myocardial infarction.

Myoblast sheet transplantation is a promising novel treatment modality for heart failure after an ischemic insult. However, low supply of blood and nutrients may compromise sheet survival. The aim of this study was to investigate the effect of mitochondria-protective Bcl-2-modified myoblasts in cell sheet transplantation therapy. In the Bcl-2-expressing rat L6 myoblast sheets (L6-Bcl2), increased expression of myocyte markers and angiogenic mediators was evident compared to wild-type (L6-WT) sheets. The L6-Bcl2 sheets demonstrated significant resistance to apoptotic stimuli, and their differentiation capacity in vitro was increased. We evaluated the therapeutic effect of Bcl-2-modified myoblast sheets in a rat model of acute myocardial infarction (AMI). Sixty-four Wistar rats were divided into four groups. One group underwent AMI (n = 22), another AMI and L6-WT sheet transplantation (n = 17), and a third AMI and L6-Bcl2 sheet transplantation (n = 20). Five rats underwent a sham operation. Echocardiography was performed after 3, 10, and 28 days. Samples for histological analysis were collected at the end of the study. After AMI, the Bcl-2-expressing sheets survived longer on the infarcted myocardium, and significantly improved cardiac function. L6-Bcl2 sheet transplantation reduced myocardial fibrosis and increased vascular density in infarct and border areas. Moreover, the number of c-kit-positive and proliferating cells in the myocardium was increased in the L6-Bcl2 group. In conclusion, Bcl-2 prolongs survival of myoblast sheets, increases production of proangiogenic paracrine mediators, and enhances the therapeutic efficacy of cell sheet transplantation.

Meta-analysis of randomized trials on the efficacy of posterior pericardiotomy in preventing atrial fibrillation after coronary artery bypass surgery.

OBJECTIVE: Posterior pericardiotomy is considered a method to reduce the incidence of atrial fibrillation after cardiac surgery. Its efficacy in preventing atrial fibrillation and supraventricular arrhythmias after coronary artery bypass surgery has been evaluated in the present meta-analysis. METHODS: This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews. RESULTS: The search yielded 6 prospective, randomized studies reporting on postoperative atrial fibrillation in 763 patients after coronary artery bypass grafting. The cumulative incidence of atrial fibrillation was 10.8% in the posterior pericardiotomy group (PP group) and 28.1% in the control group (I(2) 68%, random effect: P = .003; odds ratio [OR], 0.33; 95% confidence interval [CI], 0.16-0.69). Supraventricular arrhythmias occurred in 13.8% of patients in the PP group and 35.4% in the control group (I(2) 70%, random effect: P = .002; OR, 0.31; 95% CI, 0.15-0.65). Early pericardial effusion (6.9% vs 46.2%; I(2) 67%; random effect: P < .0001; OR, 0.10; 95% CI, 0.04-0.28) and late pericardial effusion (0% vs 11.3%; I(2) 0%; fixed effect: P = .0001; OR, 0.04; 95% CI, 0.01-0.21) were significantly less frequent in the PP group. Pleural effusion (5 studies included: 22.2% vs 17.1%; I(2) 0%; fixed effect: P = .10; OR, 1.40; 95% CI, 0.94-2.08) and pulmonary complications were only slightly more frequent in the PP group (4 studies included: 3.6% vs 2.5%; I(2) 0%; fixed effect: P = .46; OR, 1.45; 95% CI, 0.54-3.86). CONCLUSIONS: Posterior pericardiotomy seems to significantly reduce the incidence of postoperative atrial fibrillation and supraventricular arrhythmias after coronary artery bypass grafting. The marked reduction of postoperative pericardial effusion after posterior pericardiotomy suggests that pericardial effusion is one of the main triggers involved in the development of atrial fibrillation after cardiac surgery.

Immediate and intermediate outcome after off-pump and on-pump coronary artery bypass surgery in patients with unstable angina pectoris.

BACKGROUND: We have evaluated the immediate and intermediate outcome after off-pump (OPCAB) and conventional on-pump coronary artery bypass surgery (CCAB) in patients with unstable angina pectoris requiring nitrates infusion until arrival in the operating room. METHODS: A consecutive series of 153 and 161 patients with unrelenting angina pectoris underwent CCAB and OPCAB, respectively. Conversion from OPCAB to beating heart surgery with perfusion occurred in 4 patients. RESULTS: The OPCAB patients had a significantly higher operative risk than CCAB patients (logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE]: 13.8 +/- 12.8% vs 10.5 +/- 10.0%, p = 0.005). In the overall series, a lower 30-day postoperative mortality was observed among OPCAB patients (1.9% vs 3.9%, p = 0.33), the difference increased along the logistic EuroSCORE tertiles (upper tertile: 3.2% vs 9.5%, p = 0.14), but failed to reach statistical significance. Similar results have been observed among one-to-one propensity score matched pairs. The results of three surgeons who treated most of their patients (96.9%) with OPCAB were compared with those of three surgeons who used, in most of cases (97.1%), the CCAB technique. When adjusted for logistic EuroSCORE, patients operated on by CCAB surgeons had a significantly higher 30-day postoperative mortality (7.1% vs 2.1%, p = 0.04; odds ratio [OR] 10.143; 95% confidence interval [CI] 1.084 to 94.945) as well as a higher risk of combined adverse events (47.1% vs. 35.1%, p = 0.009; OR 2.586; 95% CI 1.274 to 5.250). CONCLUSIONS: This study provided further evidence on the safety and efficacy of OPCAB in the treatment of high-risk patients. A dedicated approach to OPCAB seems to provide particularly good results. Such findings further support a more confident approach with OPCAB in these patients.

Validation of the Finnvasc score in infrainguinal percutaneous transluminal angioplasty for critical lower limb ischemia.

The aim of the present study was to validate the Finnvasc score for prediction of immediate outcome after infrainguinal percutaneous transluminal angioplasty (PTA) for critical lower limb ischemia (CLI). Our registry included prospective data on 512 patients who underwent isolated infrainguinal PTA revascularization procedures for CLI. The Finnvasc score herein evaluated was calculated by assigning one point each to diabetes, coronary artery disease, foot gangrene, and urgent operation. Early mortality and major limb amputation rates after PTA revascularization were 2.5% and 12.3%, respectively. Seventy-two patients (14.1%) died and/or had lower limb amputation. Diabetes (p = 0.001), foot gangrene (p = 0.047), urgent operation (p < 0.0001), and preoperative renal failure (p = 0.001) were independent predictors of postoperative mortality and/or major limb amputation. Finnvasc score was predictive of major lower limb amputation (p = 0.003), mortality (p < 0.0001), and mortality and/or major amputation (p < 0.0001) after PTA. Mortality, major lower limb amputation, and combined end point rates in patients with a Finnvasc score of 3-4 were 12.8%, 25.6%, and 35.9%, respectively. The Finnvasc score is a simple risk scoring method which can be useful to estimate the risk of immediate postprocedural mortality and/or major lower limb amputation also in patients undergoing infrainguinal PTA for CLI.

Impact of estimated glomerular filtration rate on the 15-year outcome after coronary artery bypass surgery.

OBJECTIVE: The aim of the present study was to evaluate the impact of estimated glomerular filtration rate (eGFR) on the 15-year outcome after coronary artery bypass surgery (CABG) in a community-wide population study. METHODS: Eight hundred and eighty-two patients who underwent CABG were included in this study. eGFR was estimated by the modified Modification of Diet in Renal Disease study equation. RESULTS: Among 30-day operative survivors, patients with eGFR<60 ml/min/1.73 m(2) had significantly poorer overall survival (at 5, 10 and 15 year, 84.7%, 63.5% and 43.8% vs 92.8%, 77.6% and 58.3%, respectively, p<0.0001). eGFR (HR 0.989, 95% CI 0.981-0.997, as well as eGFR<60 ml/min/1.73 m(2): HR 1.470, 95% CI 1.092-1.979) was an independent predictor of late all-cause mortality only when patients' age was excluded from the regression model. This was probably due to strong impact of age on eGFR. eGFR (HR 0.987, 95% CI 0.975-0.998, as well as eGFR<60 ml/min/1.73 m(2); HR 1.612, 95% CI 1.086-2.395) was an independent predictor of cardiovascular mortality secondary to ischemic heart disease or ischemic stroke. eGFR (HR 0.991, 95% CI 0.983-0.999, as well as eGFR<60 ml/min/1.73 m(2): HR 1.396 95% CI 1.031-1.891) was an independent predictor of cardiovascular mortality and morbidity (myocardial infarction, stroke, need for redo CABG or PCI). When both preoperative serum creatinine and eGFR were included in the regression model, only eGFR was predictive of all-cause mortality, cardiovascular mortality and combined cardiovascular mortality and morbidity. CONCLUSIONS: This study showed that an eGFR<60 ml/min/1.73 m(2) is an important determinant of long-term outcome after isolated CABG. Since its predictive value seems to be superior to serum creatinine, eGFR may be useful to identify those patients undergoing CABG with subclinical chronic kidney disease.