Subject(s)
Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Disease Management , Pregnancy Complications, Cardiovascular/diagnostic imaging , Pregnancy Complications, Cardiovascular/surgery , Severity of Illness Index , Adult , Aortic Valve Stenosis/complications , Female , Humans , Infant, Newborn , Pregnancy , UltrasonographyABSTRACT
OBJECTIVE: The aim of the present study was to assess the influence of preoperative statin therapy on postoperative mortality in high-risk patients after isolated valve surgery. DESIGN: An observational cohort study. SETTING: A 1,200-bed university hospital. PARTICIPANTS: All consecutive patients undergoing isolated nonemergent valve surgery with cardiopulmonary bypass between November 2005 and December 2007 were included. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: During the period, 772 consecutive patients underwent nonemergent isolated valve surgery. Among them, 430 were high cardiovascular risk (defined by patients with 2 or more cardiovascular risk factors). In the high-risk cardiovascular patients, statin pretreatment was administered in 222 patients (52%). In multivariate analysis, after adjustment with a propensity score analysis, preoperative statin therapy was associated with a significant reduction of postoperative mortality in patients with high risk (odds ratio = 0.41; 95% confidence interval, 0.17-0.97; p = 0.04). Low left ventricular ejection fraction and elevated pulmonary artery pressure also were independently associated with increased postoperative mortality. By contrast, in the low-risk patient group, few patients received preoperative statin therapy (7%). CONCLUSIONS: This study suggests that preoperative statin therapy may have a potential beneficial effect on postoperative mortality after isolated cardiac valve surgery in high-risk cardiovascular patients.
Subject(s)
Cardiac Surgical Procedures/mortality , Heart Valves/surgery , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Postoperative Complications/mortality , Postoperative Complications/prevention & control , Preoperative Care , Adult , Aged , Anesthesia , Body Mass Index , Cardiac Surgical Procedures/adverse effects , Cardiopulmonary Bypass , Cardiovascular Diseases/complications , Cause of Death , Cohort Studies , Endpoint Determination , Female , Hemodynamics/physiology , Humans , Male , Middle Aged , Monitoring, Intraoperative , Multivariate Analysis , Postoperative Complications/epidemiology , Propensity Score , Risk , Risk FactorsABSTRACT
The objective of this study was to evaluate the effects of hydroxyethyl starch, (130/0.4) 6%, compared to Ringer's acetate and modified gelatin on hypoxemia, inflammatory response, and oxidative stress in an experimental model of acute lung injury (ALI). The ALI/Adult Respiratory Distress Syndrome (ARDS) experimental model was produced by a bronchoalveolar saline lavage. Mature New Zealand white rabbits were anesthetized, provided with a tracheostomy and vascular catheters, and randomized to receive 25 ml/kg/hr of Ringer's acetate (group R, n = 7), 25 ml/kg/hr of modified gelatin (group G, n = 7), or 25 ml/kg/hr of hydroxyethyl starch (group S, n = 7). All of the rabbits received mechanical ventilation to maintain the PaCO2 between 35 and 45 mm Hg. Blood gas levels and hemodynamic values were recorded before induction of lung injury (T0) and 10 (T10), 120 (T120) and 240 (T240) min following induction of lung injury. At the same time-points, blood samples were collected to measure the plasma levels of TNFalpha (tumor necrosis factor-alpha) and TBARS (thiobarbituric acid-reactive substances). The experiment yielded the following results: The blood PaO2/FiO2 ratio was higher in group S than in groups R and G at T10, T120, and T240 (p <0.05). In group S, the plasma TNFalpha and TBARS concentrations were lower than in groups R and G at T120 and T240 (p <0.05). In conclusion, rabbits treated with hydroxyethyl starch, (130/0.4) 6%, demonstrated reductions of hypoxemia, inflammatory response, and oxidative lung damage, compared to raabbits treated with Ringer's acetate or modified gelatin.
