Clinical evaluation of minimized extracorporeal circulation in high-risk coronary revascularization: impact on air handling, inflammation, hemodilution and myocardial function

Perfusion ◽  
2009 ◽  
Vol 24 (3) ◽  
pp. 153-162 ◽  
Author(s):  
Serdar Gunaydin ◽  
Tamer Sari ◽  
Kevin McCusker ◽  
Uwe Schonrock ◽  
Yaman Zorlutuna
Keyword(s):  
High Risk ◽  
Inflammatory Response ◽  
Coronary Revascularization ◽  
Blood Protein ◽  
Safety Level ◽  
Handling Characteristics ◽  
Ann Arbor ◽  
Minimized Extracorporeal Circulation ◽  
Extracorporeal Circuits ◽  
Group 2

Objective: We examined intraoperative microembolic signals (GME), inflammatory response, hemolysis, perioperative regional cerebral oxygen saturation (rSO2), myocardial protection and desorbed protein amount on oxygenator fibers in high-risk patients undergoing coronary revascularization (CABG) with minimized and conventional cardiopulmonary bypass (CPB). Methods: Over a ten-month period, 40 Euroscore 6+ patients undergoing CABG were prospectively randomized to one of the two perfusion protocols (N=20): Group 1: minimized extracorporeal circuits (Mini-CPB) (ROCsafe MPC, Terumo, Ann Arbor, MI, USA) and Group 2: conventional extracorporeal circuits (CECC) (Capiox SX18, Terumo, USA). Serum creatinine kinase-MB (CKMB), free hemoglobin, interleukin-6 (IL-6) and C3a levels were measured. Blood samples were collected at T1: following induction of anesthesia; T2: thromboelastography control; T3:15 min after commencement of CPB; T4: before cessation of CPB; T5: 15 min after protamine reversal and T6: ICU. Results: Serum IL-6 levels were significantly lower in the Mini-CPB group at T4 and T5 and C3a levels were significantly less in the Mini-CPB group at T3, T4 and T5 vs. CECC (p<0.01). CKMB levels in coronary sinus blood demonstrated well preserved myocardium in the Mini-CPB group. Percentage expression of neutrophil CD11b/CD18 levels were significantly lower in the Mini-CPB group at T4 and T5 (p<0.05). There were no significant differences in air handling characteristics or free plasma hemoglobin levels in either circuit. rSO2 measurements were significantly better at T3 and T4 in the Mini-CPB vs. CECC (p<0.05) and always higher in the Mini-CPB during follow-up. Blood protein adsorption analysis of oxygenator membranes demonstrated a significantly increased amount of microalbumin on CECC fibers (p<0.05). Conclusion: Mini-CPB provided a comfort and safety level similar to conventional control via satisfactory air handling, attenuated inflammatory response and hemodilution, with a better clinical outcome in patients undergoing high-risk CABG.

Abstract 13343: Is the Early Invasive Strategy Really the Optimal Time for Patients at High-risk of Acute Coronary Syndromes Without ST-segment Elevation?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Isabel Campos ◽  
Cátia Oliveira ◽  
Carla Marques Pires ◽  
Paulo Medeiros ◽  
Rui Flores ◽  
...  
Keyword(s):  
High Risk ◽  
Coronary Revascularization ◽  
Optimal Time ◽  
Optimal Timing ◽  
Invasive Strategy ◽  
Multicenter Observational Study ◽  
St Segment Elevation ◽  
Group 2 ◽  
Early Invasive Strategy ◽  
Group 1

Introduction: An early invasive strategy has become the standard of care for pts at high-risk of NSTE-ACS in the latest guidelines, however the optimal timing of coronary intervention in this pts is still a matter of debate. Hypothesis: To compare the prognosis between pts at high-risk of NSTE-ACS submitted an early (<24h) versus a delayed invasive strategy (24-72h). Methods: A retrospective multicenter observational study including 6722 pts at high-risk NSTE-ACS (established diagnosis of NSTE-ACS based on cardiac troponins OR dynamic ST/T-changes OR GRACE score>140). Low, intermediate and very high-risk of NSTE-ACS pts were excluded, such as pts with an invasive strategy >72h. Pts were divided into two groups: group 1 - pts at high-risk of NSTE-ACS submitted an early invasive strategy (<24h) (n=3351,49.9%); group 2 - pts at high-risk of NSTE-ACS submitted a delayed invasive strategy (24-72h) (n=3371,50.1%). Primary endpoint was the occurrence of death at 1 year. Results: The sample was formed by 74.5% men and 25.5% women, with mean age of 65±12 years. Group 2 pts had a higher prevalence of hypertension (69.4% vs 73.0%,p=0.001), dyslipidaemia (63.1% vs 66.7%,p=0.002), CKD (3.2% vs 4.9%,p<0.001), previous MI (19.9% vs 24.3%, p<0.001) and HF (2.4% vs 3.4%, p=0.012). On admission, group 1 pts had more chest pain (96.9% vs 95.7%, p=0.010) compared to group 2 pts that had more dyspnea (1.1% vs 1.9%,p=0.007) and presented more to a non-PCI center (36.0% vs 46.3%,p<0.001). During hospitalization, group 2 had more often HF (3.3% vs 4.5%,p=0.013) and LVEF≤40% (5.9% vs 7.6%,p=0.042). Group 1 pts were more likely to have coronary revascularization (78.9% vs 74.6%,p<0.001), with the culprit artery being less identified in group 2 (20.8% vs 25.2%,p<0.001). In multivariate analysis and after adjusting for different baseline characteristics, pts at high-risk of NSTE-ACS submitted an early strategy had the same risk of 1-year mortality compared to those submitted a delayed invasive strategy [OR0.76,p=0.280]. Conclusion: In Portugal, only half of patients at high risk of NSTE-ACS undergo an early invasive strategy. However the early invasive coronary evaluation did not improve overall long-term clinical outcome compared with delayed invasive strategy.

Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Stepien ◽  
P Furczynska ◽  
M Zalewska ◽  
K Nowak ◽  
A Wlodarczyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Clinical Outcomes ◽  
Mmse Score ◽  
Coronary Revascularization ◽  
High Risk Population ◽  
Risk Population ◽  
History Of

Abstract Background Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown. Purpose We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. Methods 142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. Results SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of &lt;17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P&lt;0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007). Conclusions As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization. The survival free of rehospitalization Funding Acknowledgement Type of funding source: None

scholarly journals Inflammation as a determinant of healing response after coronary stent implantation

2021 ◽  
Author(s):  
Dorota Ochijewicz ◽  
Mariusz Tomaniak ◽  
Grzegorz Opolski ◽  
Janusz Kochman
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Inflammatory Response ◽  
Percutaneous Coronary Interventions ◽  
Coronary Stent Implantation ◽  
Percutaneous Coronary ◽  
Prevention And Treatment ◽  
Risk Patients ◽  
Excessive Inflammatory Response

AbstractCardiovascular disease remains the leading cause of death and morbidity worldwide. Inflammation plays an important role in the development of atherosclerosis and is associated with adverse clinical outcomes in patients after percutaneous coronary interventions. Data on stent elements that lead to excessive inflammatory response, proper identification of high–risk patients, prevention and treatment targeting residual inflammatory risk are limited. This review aims to present the role of inflammation in the context of evolving stent technologies and appraise the potential imaging modalities in detection of inflammatory response and anti-inflammatory therapies.

Coronary Revascularization Without Cardiopulmonary Bypass Versus the Conventional Approach in High-Risk Patients

2005 ◽  
Vol 79 (2) ◽  
pp. 552-557 ◽  
Author(s):  
Sotiris C. Stamou ◽  
Kathleen A. Jablonski ◽  
Peter C. Hill ◽  
Ammar S. Bafi ◽  
Steven W. Boyce ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Coronary Revascularization ◽  
Conventional Approach ◽  
High Risk Patients ◽  
Risk Patients

Abstract P711: Factors Affecting Intracranial Aneurysm Incidence and Phenotypes at Risk of Rupture in Autosomal Dominant Polycystic Kidney Disease

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Chan-Hyuk Lee ◽  
Hyunjin Ryu ◽  
Curie Ahn ◽  
Hyun-Seung Kang ◽  
Seul-Ki Jeong ◽  
...  
Keyword(s):  
High Risk ◽  
Intracranial Aneurysm ◽  
Autosomal Dominant ◽  
Polycystic Kidney ◽  
Mitral Inflow ◽  
Group 3 ◽  
Autosomal Dominant Polycystic Kidney ◽  
Group 2 ◽  
Group 1 ◽  
Deceleration Time

Background: Autosomal dominant polycystic kidney disease (ADPKD) is an autosomal dominant genetic disorder in which cysts of various sizes invade the renal parenchyma. Intracranial aneurysms occur in 8-12% of ADPKD patients, which is approximately 3-4 times the rate of the healthy population. However, research on factors related to aneurysm incidence and rupture in patients with ADPKD is insufficient. Objective: We analyzed the factors associated with risk of aneurysm incidence and phenotype in ADPKD patients. Methods: From the ADPKD registry in the tertiary hospital, we screened patients with cerebral angiography enrolled between January 2007 and May 2017. Then, 926 enrolled patients were classified into three groups according to the intracranial aneurysm incidence and phenotype (multiplicity, size, location): no intracranial aneurysm (Group 1); low-risk intracranial aneurysm (Group 2); high-risk intracranial aneurysm (Group 3). We analyzed the difference of patients’ demographic factors, cardiovascular risk factors, laboratory data, echocardiographic data, and imaging data between groups. Results: The prevalence [C1] of intracranial aneurysm in ADPKD patients was 16.0%. Aneury[C2] sm-positive group (Group 2 and 3, n=148) was significantly older (p<0.001) and had a greater proportion of females (p<0.001) than patients in the aneurysm-negative group (Group 1, n=778). Compared to Group 1, Group 3 was significantly associated with age (odds ratio (OR) 1.027, p=0.007), female sex (OR 3.184, p<0.001), dyslipidemia (OR 0.460, P=0.001), basilar artery dolichoectasia (OR 8.443, p=0.016), and mitral inflow deceleration time (OR 1.005, p=0.039). Conclusion: Factors associated with a high-risk aneurysms were age, sex, dolichoectasia, dyslipidemia, and mitral inflow deceleration time in ADPKD patients. Identification of these factors would help detect high risk aneurysms and manage the aneurysms in ADPKD patients.

Transaortic Transcatheter Aortic Valve Implantation and Concomitant off Pump Revascularization

2016 ◽  
Vol 11 (5) ◽  
pp. 363-366 ◽  
Author(s):  
Hardy Baumbach ◽  
Samir Ahad ◽  
Stephan Hill ◽  
Tim Schäufele ◽  
Sara Adili ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Coronary Revascularization ◽  
Off Pump ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Artery Disease ◽  
Valve Implantation

An increasing number of patients with severe aortic stenosis and concomitant critical coronary artery disease were referred to our hospital. Some of those patients were classified as high-risk patients qualifying for a transcatheter therapy with the additional need for coronary revascularization. As a consequence of their comorbidities, the established transapical as well as transfemoral approach were either not possible or not favored owing to the indispensable need for coronary revascularization. We present 4 successfully combined off-pump procedures consisting of a transcatheter aortic valve implantation (Edwards SAPIEN XT) via the transaortic approach and an off-pump coronary artery bypass grafting. All patients were discharged free from stroke, myocardial infarction, or access site complications either to rehabilitation facility or to the referring hospital with none or trace aortic regurgitation and patent grafts. These cases confirm the feasibility of those combined operations and should be considered as realistic alternative for surgical treatment in high-risk patients who are clearly identified to benefit from transcatheter approach to treat aortic stenosis and who have severe concomitant coronary artery disease.

scholarly journals Appropriate secondary prevention and clinical outcomes after acute myocardial infarction according to atherothrombotic risk stratification: The FAST-MI 2010 registry

2018 ◽  
Vol 26 (4) ◽  
pp. 411-419 ◽  
Author(s):  
Victoria Tea ◽  
Marc Bonaca ◽  
Chekrallah Chamandi ◽  
Marie-Christine Iliou ◽  
Thibaut Lhermusier ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Secondary Prevention ◽  
High Risk Patients ◽  
Risk Patients ◽  
St Elevation ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background Full secondary prevention medication regimen is often under-prescribed after acute myocardial infarction. Design The purpose of this study was to analyse the relationship between prescription of appropriate secondary prevention treatment at discharge and long-term clinical outcomes according to risk level defined by the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) after acute myocardial infarction. Methods We used data from the 2010 French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction (FAST-MI) registry, including 4169 consecutive acute myocardial infarction patients admitted to cardiac intensive care units in France. Level of risk was stratified in three groups using the TRS-2P score: group 1 (low-risk; TRS-2P=0/1); group 2 (intermediate-risk; TRS-2P=2); and group 3 (high-risk; TRS-2P≥3). Appropriate secondary prevention treatment was defined according to the latest guidelines (dual antiplatelet therapy and moderate/high dose statins for all; new-P2Y12 inhibitors, angiotensin-converting-enzyme inhibitor/angiotensin-receptor-blockers and beta-blockers as indicated). Results Prevalence of groups 1, 2 and 3 was 46%, 25% and 29% respectively. Appropriate secondary prevention treatment at discharge was used in 39.5%, 37% and 28% of each group, respectively. After multivariate adjustment, evidence-based treatments at discharge were associated with lower rates of major adverse cardiovascular events (death, re-myocardial infarction or stroke) at five years especially in high-risk patients: hazard ratio = 0.82 (95% confidence interval: 0.59–1.12, p = 0.21) in group 1, 0.74 (0.54–1.01; p = 0.06) in group 2, and 0.64 (0.52–0.79, p < 0.001) in group 3. Conclusions Use of appropriate secondary prevention treatment at discharge was inversely correlated with patient risk. The increased hazard related to lack of prescription of recommended medications was much larger in high-risk patients. Specific efforts should be directed at better prescription of recommended treatment, particularly in high-risk patients.

scholarly journals Does pre-emptive onlay mesh reinforcement of midline laparotomies reduce incidence of incisional hernia in high–risk patients?

2019 ◽  
Vol 6 (7) ◽  
pp. 2300
Author(s):  
Hosam F. Abdelhameed ◽  
Samir A. Abdelmageed
Keyword(s):  
High Risk ◽  
Incisional Hernia ◽  
Chronic Wound ◽  
Midline Laparotomy ◽  
High Risk Patients ◽  
Wound Pain ◽  
Risk Patients ◽  
Onlay Mesh ◽  
Group 2 ◽  
Group 1

Background: One of the major morbidity after abdominal surgery is incisional hernia. In high risk patients its incidence reaches 11-20% despite various optimal closure techniques for midline laparotomy. Our aim is to evaluate the efficacy of onlay mesh placement in reducing the incidence of incisional hernia in those high risk patients.Methods: A total of 65 high risk patients suspected to develop post-operative incisional hernia underwent midline abdominal laparotomies. Patients were divided into two groups; group1 (30 patients) for whom the incision was closed by conventional method and group2 (35 patients) for whom the incision was closed with reinforcement by onlay polypropylene mesh. The primary end point was the occurrence of incisional hernia while the secondary end point was post-operative complications including subcutaneous seroma, chronic wound pain, and surgical site infection (SSI). Patients were followed up for two years.Results: The base line characteristics of the two groups were similar. The incidence of incisional hernia is significantly reduced 1/35 (2.8%) in group 2 while it was 6/30 (20%) in group 1. As regard seroma and chronic wound pain they increased in (group2) 6/35 (17.14%) and 5/35(14.28%) respectively compared to (group 1) which was 4/30 (13.33%) and 2/30 (6.66%). SSI occurred in 1/35 (2.85%) in group 2 and in 1/30 (3.33%) in group 1.Conclusions: Prophylactic onlay mesh reinforcement of the midline laparotomy for high risk patients can be used safely and markedly reduces the incidence of incisional hernia with little morbidity.

Comparison of polymethoxyethylacrylate-coated circuits with leukocyte filtration and reduced heparinization protocol on heparin-bonded circuits in different risk cohorts

Perfusion ◽  
2006 ◽  
Vol 21 (6) ◽  
pp. 329-342 ◽  
Author(s):  
Serdar Gunaydin ◽  
Kevin McCusker ◽  
Venkataramana Vijay ◽  
Selim Isbir ◽  
Tamer Sari ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Control Cell ◽  
Postoperative Bleeding ◽  
Cell Counts ◽  
Heparin Administration ◽  
Control Serum ◽  
Group 2 ◽  
Filter Mesh ◽  
Group 1

Objectives: The relative benefits of strategic leukofiltration on polymer-coated and low-dose heparin protocol on heparin-coated circuits were studied across EuroSCORE patient risk strata for three different cohorts. Methods: In a prospective, randomized study, 270 patients undergoing coronary artery bypass grafting were allocated into three groups (n = 90): Group 1 -polymethoxyethylacrylate-coated circuits+leukocyte filters; Group 2 -polypeptide-based heparin-bonded circuits with reduced heparinization; and Group 3 -Control: uncoated circuits. Each group was further divided into three subgroups (n = 30), with respect to low- (EuroSCORE 0-2), medium- (3-5), and high- (6+) risk patients. Blood samples were collected at T1: following induction of anesthesia; T2: following heparin administration; T3: 15 min after CPB; T4: before cessation of CPB; T5: 15 min after protamine reversal; and T6: ICU. Results: In high-risk cohorts, leukocyte counts demonstrated significant differences at T4 and T5 in Group 1, and at T4 in Group 2. Platelet counts were preserved significantly better at T4 and T5 in both groups (p <0.05 versus control). Serum IL-2 and C3a levels were significantly lower at T3, T4 and T5 in Group 1, and T4 and T5 in Group 2 (p <0.05). Postoperative bleeding, respiratory support time and incidence of atrial fibrillation were lower in the study groups versus control. Cell counts on filter mesh and heparin-coated fibers/circuits were significantly higher in the high-risk cohorts versus uncoated fibers. Phagocytic capacity increased on filter mesh, especially in high-risk specimens. SEM evaluation demonstrated better preserved coated circuits. Conclusion: Leukofiltration and coating reduced platelet adhesion, protein adsorption, atrial fibrillation and reduced heparinization acted via modulation of systemic inflammatory response in high-risk groups.

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