ABSTRACT
BACKGROUND: A new concern in acute kidney injury (AKI) following coronary artery bypass grafting (CABG) is the elapsed time from coronary angiography (CAG) until subsequent surgery. This study aimed to retrospectively evaluate renal function following elective off-pump CABG (OPCAB). METHODS AND RESULTS: Three hundred and seven patients were divided either into group A (elapsed time between CAG and surgery ≤5 days, n=138) or B (elapsed time >5 days, n=169). The estimated glomerular filtration rate (eGFR) was obtained on the 1st, 3rd and 7th day following CABG. The pre-, intra-and postoperative relevant data were analyzed. 51 patients (16.6%) developed postoperative AKI. Patients with shorter elapsed time were more likely to present postoperative AKI than those with a longer elapsed time (23.9% vs. 10.7%, P=0.003). Multivariate logistic regression analysis showed that elapsed time had an independent influence on the development of postoperative AKI (odds ratio 2.35, 95% confidence interval 1.45-5.26, P=0.009). The eGFR reduced gradually after surgery, dropped to a minimum within 3 days, and then increased slowly in both groups. Minimum eGFR following surgery in group B was significantly higher than that in group A (64.3±6.5ml/min vs. 59.2±9.3ml/min, P<0.0001). CONCLUSIONS: Beginning OPCAB early after CAG did affect postoperative renal function and increased the incidence of AKI.
Subject(s)
Acute Kidney Injury , Coronary Angiography , Coronary Artery Bypass, Off-Pump/adverse effects , Glomerular Filtration Rate , Kidney/physiopathology , Postoperative Complications , Acute Kidney Injury/diagnostic imaging , Acute Kidney Injury/physiopathology , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Postoperative Complications/physiopathology , Postoperative Period , Retrospective Studies , Time FactorsABSTRACT
Inappropriate myocardial protection is considered one of the main causes of mortality and morbidity in the correction of tetralogy of Fallot (TOF). Results of previous reports about the effects of ischemic postconditioning on myocardial protection in animals and humans are very encouraging. This randomized and controlled trial aimed to assess the effect of ischemic postconditioning on protection against myocardial ischemia reperfusion injury in TOF patients receiving cardioplegia. From January 2008 to June 2010, 80 consecutive children undergoing correction of TOF were enrolled and randomly assigned to either a postconditioning group (three cycles of 30 seconds of ischemia and 30 seconds of reperfusion using re-clamping and de-clamping starting 30 seconds after the initial de-clamping of the aorta, n = 41) or a control group (n = 39). Cardiac troponin I (cTnI) was assayed preoperatively, and then 4 hours, 8 hours, 12 hours, 20 hours, and 48 hours after persistent reperfusion. The pre-, intra- and postoperative relevant data of all selected patients were analyzed. As a result, ischemic postconditioning reduced postoperative peak release by 45% for cTnI compared with the control group (0.43 ± 0.18 ng/mL versus 0.78 ± 0.15 ng/mL, P < 0.0001). Ischemic postconditioned patients had a lower peak inotropic score during the first postoperative 24 hours (5.6 ± 2.2 µg/kg/minute versus 8.6 ± 3.6 µg/kg/minute, P < 0.0001), extubation time (21.5 ± 7.3 hours versus 30.2 ± 12.4 hours, P = 0.0002) and length of ICU stay (43.4 ± 12.6 hours versus 56.3 ± 17.8 hours, P = 0.0003), while they had a higher cardiac output on the first postoperative day (1.41 ± 0.26 L/minute versus 1.28 ± 0.25 L/minute, P = 0.0255) as compared to the control group. In conclusion, ischemic postconditioning may to some extent provide myocardial protection in children undergoing correction of tetralogy of Fallot.
Subject(s)
Ischemic Postconditioning/methods , Myocardial Reperfusion Injury/prevention & control , Postoperative Complications/prevention & control , Tetralogy of Fallot/surgery , Cardiac Output/physiology , Cardiopulmonary Bypass , Child , Child, Preschool , China , Female , Humans , Infant , Male , Myocardial Reperfusion Injury/blood , Oxygen/blood , Postoperative Complications/blood , Prospective Studies , Stroke Volume/physiology , Tetralogy of Fallot/blood , Troponin I/blood , Ventricular Function, Left/physiologyABSTRACT
BACKGROUND: Atrial fibrillation (AF) after rheumatic valve replacement is the most common arrhythmic complication. Previous studies reported angiotensin-II receptor blocker can prevent AF. This study aimed to assess the effect of a combination of irbesartan and amiodarone on the maintenance of sinus rhythm after cardioversion of AF in patients with post-rheumatic valve replacement in a randomized, controlled trial. METHODS AND RESULTS: Eighty-five consecutive patients undergoing rheumatic valve surgery were enrolled and randomly assigned to an irbesartan plus amiodarone (irbesartan 150 mg/d, n=43) or an amiodarone group (n=42) starting 10 days before scheduled electrical cardioversion. The primary end-point was recurrence of AF. Pharmacological conversion was documented in 7 patients, and electrical conversion in 68 patients (87.2%). A higher rate of maintenance of sinus rhythm (69.8% vs 40.5%, P=0.01) and a better AF-free survival (chi(2)=7.466, P=0.006) were observed in the irbesartan plus amiodarone group compared to the amiodarone group during the 1-year follow-up period. Cox regression showed that use of irbesartan was an independent factor associated with the maintenance of sinus rhythm after cardioversion (OR=0.43, P=0.018), whereas increased left atrium diameter was associated with increased risk (OR=1.54, P=0.005). CONCLUSIONS: In patients with post-rheumatic valve replacement, the combination of amiodarone and irbesartan demonstrated a lower rate of AF recurrence after cardioversion than amiodarone alone, which might be due to preventing the atrial remodeling.
