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1.
PLoS One ; 17(8): e0273370, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36007072

RESUMO

Data substantiating the optimal patient body temperature during cooling procedures in cardiac operations are currently unavailable. To explore the optimal temperature strategy, we examined the association between temperature management and survival among patients during cardiopulmonary bypass assisted coronary artery bypass grafting (CABG) procedures on 30-days and 5-year postoperative survival. Adult patients (n = 5,672, 23.6% female and mean (SD) age of 66 (10) years) operated between 1997 and 2015 were included, with continuous measured intraoperative nasopharyngeal temperatures. The association between mortality and patient characteristics, laboratory parameters, the lowest intraoperative plateau temperature and intraoperative cooling/rewarming rates were examined by multivariate Cox regression analysis. Machine learning-based cluster analysis was used to identify patient subgroups based on pre-cooling parameters and explore whether specific subgroups benefitted from a particular temperature management. Mild hypothermia (32-35°C) was independently associated with improved 30-days and 5-year survival compared to patients in other temperature categories regardless of operation year. 30 days and 5-year survival were 98% and 88% in the mild hypothermia group, whereas it amounted 93% and 80% in the severe hypothermia (<30°C). Normothermia (35-37°C) showed the lowest survival after 30 days and 5 years amounting 93% and 72%, respectively. Cluster analysis identified 8 distinct patient subgroups principally defined by gender, age, kidney function and weight. The full cohort and all patient subgroups displayed the highest survival at a temperature of 32°C. Given these associations, further prospective randomized controlled trials are needed to ascertain optimal patient temperatures during CPB.


Assuntos
Hipotermia Induzida , Hipotermia , Adulto , Idoso , Temperatura Corporal , Ponte Cardiopulmonar/métodos , Estudos de Coortes , Ponte de Artéria Coronária/efeitos adversos , Feminino , Humanos , Hipotermia/etiologia , Hipotermia Induzida/métodos , Masculino
2.
Neth Heart J ; 18(5): 236-42, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20505796

RESUMO

Objectives. We aimed to compare the rate of apoptosis after cardiopulmonary bypass (CPB) and cardioplegic arrest during coronary artery bypass grafting (CABG) surgery between atrial and ventricular tissue.Methods. During CABG surgery with CPB and cardioplegic arrest, sequential biopsies were taken from the right atrial appendage and left ventricular anterior wall before CPB and after aortic cross clamp release. Change in number of apoptotic cells and biochemical markers of myocardial ischaemia and renal dysfunction were assessed.Results. CPB was associated with a transient small, but significant increase in CK (1091+/-374%), CK-MB (128+/-38%), troponin-T (102+/-13%) and NT-proBNP (1308+/-372%) levels (all: p<0.05). A higher number of apoptotic cells as assessed by caspase-3 staining was found in the ventricular biopsies taken after aortic cross clamp release compared with the biopsies taken before CPB (5.3+/-0.6 vs. 14.0+/-1.5 cells/microscopic field, p<0.01). The number of apoptotic cells in the atrial appendage was not altered during CPB. Correlation between the duration of aortic cross clamp time and the change in caspase-3 positive cells in the left ventricular wall was of borderline significance (r of 0.58, p=0.08). Similar results were obtained from TUNEL staining for apoptosis.Conclusion. CABG surgery with CPB and cardioplegic arrest is associated with an elevated rate of apoptosis in ventricular but not in atrial myocardial tissue. Ventricular tissue may be more sensitive to detect changes than atrial tissue, and may be more useful to investigate the protective effects of therapeutic intervention. (Neth Heart J 2010;18:236-42.).

4.
Ned Tijdschr Geneeskd ; 143(46): 2319-24, 1999 Nov 13.
Artigo em Holandês | MEDLINE | ID: mdl-10589221

RESUMO

A woman aged 64 was severely handicapped by dyspnoea due to 'terminal heart failure' resulting from idiopathic dilated cardiomyopathy. The mitral valve was seriously insufficient; the coronary vessels were normal. The patient was not eligible for heart transplantation. Partial left ventriculectomy by Batista's method was performed and the mitral valve replaced by an artificial one. The left ventricular ejection fraction increased from 0.12 before the operation to 0.35 postoperatively and to 0.43 two years later. Patient was then capable of normal exercise (New York Heart Association (NYHA): class I-II). In the Netherlands partial left ventriculectomy is the last surgical option for patients rejected for heart transplantation.


Assuntos
Bioprótese , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Dilatada/cirurgia , Insuficiência Cardíaca/etiologia , Transplante de Coração , Próteses Valvulares Cardíacas , Procedimentos Cirúrgicos Cardíacos/tendências , Cardiomiopatia Dilatada/complicações , Contraindicações , Feminino , Insuficiência Cardíaca/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Pessoa de Meia-Idade , Valva Mitral , Países Baixos , Resultado do Tratamento
5.
Anaesthesia ; 54(9): 879-82, 1999 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10460561

RESUMO

Dynamic cardiomyoplasty is a surgical treatment to improve cardiac performance in patients with end-stage heart failure by wrapping the latissimus dorsi muscle around the heart. The use of skeletal muscle raises concerns about the safety of neuromuscular blocking agents used during general anaesthesia in noncardiac surgery in patients after cardiomyoplasty. We describe the administration of rocuronium to a patient undergoing carotid endarterectomy 18 months after cardiomyoplasty. No clinically relevant effects on haemodynamics were observed. We conclude that the use of nondepolarising neuromuscular blocking agents for noncardiac surgery in patients after cardiomyoplasty does not compromise cardiac performance in a clinically relevant way, although the time between the cardiomyoplasty procedure and the use of nondepolarising neuromuscular blocking agents remains a concern.


Assuntos
Androstanóis/farmacologia , Cardiomioplastia , Hemodinâmica/efeitos dos fármacos , Fármacos Neuromusculares não Despolarizantes/farmacologia , Contraindicações , Endarterectomia das Carótidas , Humanos , Masculino , Pessoa de Meia-Idade , Rocurônio
6.
J Cardiothorac Anesth ; 3(4): 441-3, 1989 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-2577703

RESUMO

Dopexamine is a new dopamine analogue, with combined agonist properties on dopamine receptors and the beta 2-adrenoceptor. The aim of this study was to evaluate the short-term hemodynamic effects of dopexamine at different dosage rates in postoperative coronary artery bypass (CABG) patients, especially with respect to the right ventricle, using a right ventricular ejection fraction pulmonary artery catheter. With a dose of 2 micrograms/kg/min of dopexamine, significant increases in heart rate (25%), cardiac index (33%), and right ventricular ejection fraction (20%) were observed. Pulmonary vascular resistance decreased with a dose over 1 microgram/kg/min (15%). Mean arterial blood pressure and pulmonary artery pressures were not affected. At 4 micrograms/kg/min, cardiac index was further increased. In conclusion, dopexamine could be beneficial to patients with a compromised right ventricle by lowering afterload and improving ventricular performance after CABG.


Assuntos
Agonistas Adrenérgicos/uso terapêutico , Débito Cardíaco/efeitos dos fármacos , Ponte de Artéria Coronária , Dopamina/análogos & derivados , Artéria Pulmonar/fisiologia , Resistência Vascular/efeitos dos fármacos , Função Ventricular Direita/efeitos dos fármacos , Agonistas Adrenérgicos/administração & dosagem , Idoso , Pressão Sanguínea/efeitos dos fármacos , Dopamina/administração & dosagem , Dopamina/uso terapêutico , Feminino , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico/efeitos dos fármacos
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