Renal Outcomes and Myocardial Performance after On-Pump Beating Heart versus Conventional On-Pump Surgery in Patients with Preoperative Low Glomerular Filtration Rate

Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-pump beating heart (OPBH) and conventional on-pump (COP), in patients who have preoperative low glomerular filtration rate (eGFR) as an indicator of creatinine clearance. Methods: From 2004 to 2015, 341 patients with preoperative creatinine clearance were lower than 90 ml/min/1.73m2 were selected for this study. On-Pump beating heart was performed in 111 patients (Group I). Conventional on-pump technique was used in 200 patients. In the remaining patients, we measured postoperative Tumor Necrosis Factor Alpha (TNF-alpha), cardiac troponin I (cTn-I), Brain natriuretic peptid (NT-Pro- BNP), creati-nine (Cr), blood urea nitrogen (BUN) and postoperative eGFR daily until day four after surgery. Results: There were no differences in baseline levels of TNF-alpha, NT-Pro-BNP, BUN, cTn-I, Cr levels between the groups. Cardiopulmonary bypass (CPB) time were much longer and cumulative inotrope use was significantly higher in patients underwent COP (P Conclusion: Our study showed that on-pump beating heart CABG technique provides a morbidity benefit and is associated with a lower risk of peroperative LOS in patients with mild renal disfunction. Our study results suggest that OPBH is superior to the COP in terms of postoperative renal injury and cardiac mediators.

Complete Coronary Revascularization with on Pump Beating Heart

Background Off-pump coronary artery bypass grafting (CABG) is becoming increasingly popular world - wide. But it is not always feasible. Current cardioplegic techniques do not consistently avoid myocardial ischemic damage. So we use on pump beating heart technique to supplement off-pump CABG. Methods Based on 860 off-pump CABG cases between Aug 1998 to Aug 2000. From Aug 1999 to Aug 2000, 46 CABG cases were performed with on pump beating heart technique at Mani-pal Hospital Heart Foundation, Bangalore, India. All surgeries were performed through a median sternotomy. Exposure techniques were tailored to individual vessels and cardiac regions and local immobilization was performed with octopus. Vascular control was achieved with occluders and shunts. Total cardiopulmonary bypass (CPB) was established before or during CABG and normolthemia was used. Results Among 46 on -pump beating heart CABG patients, 26 patients used CPB before or during OP - CABG because of unstable hemodynamics and electric instability , 7 had very deep intramyocardial left anterior descending arteries, 5 patients had poor LV function (LVEF < 30 % ), 8 patients had cardiomegaly. The average number of grafts was 3.5. No operative mortality. Three patients had postoperative myocardial infarction. Anesthetic time 4. 5±1. 2 hours, extubation time 10±2. 5 hours, blood lost 680±230 mL, blood requirement 540±150 mL, preoperative LVEF 50. 3±13 % , postoperative LVEF 64. 1±14 %, ICU stay 1. 5±0. 5 days, hospi- tal stay 9.2±1.8 days. Conclusion Complete coronary revascularization with on pump beating heart is a supplement for off - pump CABG when it is not feasible. It eliminates intraoperative globe myocardial ischemia and avoids transient myocardial injury during cardioplegic arrest and myocardial reperfusion.

Cynodon dactylon andSida acuta extracts impact on the function of the cardiovascular system in zebrafish embryos

The aim of the present study was to screen cardioactive herbs from Western Ghats of India. The heart beat rate （HBR） and blood flow during systole and diastole were tested in zebrafish embryos. We found that Cynodon dactylon （C. dactylon） induced increases in the HBR in zebrafish embryos with a HBR of （3.968±0.344） beats/ s, which was significantly higher than that caused by betamethosone [（3.770±0.344） beats/s]. The EC50 value of C. dactylon was 3.738 μg/mL. The methanolic extract of Sida acuta （S. acuta） led to decreases in the HBR in zebrafish embryos [（1.877 ±0.079） beats/s], which was greater than that caused by nebivolol （positive control）. The EC50 value of Sida acuta was 1.195 μg/mL. The untreated embryos had a HBR of （2.685±0.160） beats/s at 3 d post fertilization （dpf）. The velocities of blood flow during the cardiac cycle were （2,291.667 ±72.169） μm/s for the control, （4,250± 125.000） μm/s for C. dactylon and （1,083.333±72.169） μm/s for S. acuta. The LC50 values were 32.6 μg/mL for C. dactylon and 20.9 μg/mL for S. acuta. In addition, the extracts exhibited no chemical genetic effects in the drug dosage range tested. In conclusion, we developed an assay that can measure changes in cardiac function in response to herbal small molecules and determine the cardiogenic effects by microvideography.

Efficient Data Compression of ECG Signal Based on Modified Discrete Cosine Transform

This paper introduced an efficient compression technique that uses the compressive sensing(CS)method to obtain and recover sparse electrocardiography(ECG)signals.The recovery of the signal can be achieved by using sampling rates lower than the Nyquist frequency.A novel analysis was proposed in this paper.To apply CS on ECG signal,the first step is to generate a sparse signal,which can be obtained using Modified Discrete Cosine Transform(MDCT)on the given ECGsignal.This transformation is a promising key for other transformations used in this search domain and can be considered as the main contribution of this paper.A small number of wavelet components can describe the ECG signal as related work to obtain a sparse ECGsignal.Asensing technique for ECGsignal compression,which is a novel area of research,is proposed.ECG signals are introduced randomly between any successive beats of the heart.MIT-BIH database can be represented as the experimental database in this domain of research.TheMIT-BIH database consists of various ECG signals involving a patient and standard ECG signals.MATLAB can be considered as the simulation tool used in this work.The proposed method’s uniqueness was inspired by the compression ratio(CR)and achieved by MDCT.The performance measurement of the recovered signal was done by calculating the percentage root mean difference(PRD),mean square error(MSE),and peak signal to noise ratio(PSNR)besides the calculation of CR.Finally,the simulation results indicated that this work is one of the most important works in ECG signal compression.

Assessment of myocardial viability using a minimally invasive laser Doppler flowmetry on pig model

Background:The intra-operative real-time assessment of tissue viability can potentially improve therapy delivery and clinical outcome in cardiovascular therapies.Cardiac ablation therapy for the treatment of supraventricular or ventricular arrhythmia continues to be done without being able to assess if the intended lesion and lesion size have been achieved.Here,we report a method for continuous measurements of cardiac muscle microcirculation to provide an instrument for real-time ablation monitoring.Methods:We performed two acute open chest animal studies to assess the ability to perform real-time monitoring of creation and size of ablation lesion using a standard RF irrigated catheter.Radiofrequency ablation and laser Doppler were applied to different endocardial areas of alive open-chest pig.Results:We performed two experiments at three different RF ablation energy setting and different ablation times.Per-fusion signals before and after ablation were found extensively and distinctively different.By in-creasing the ablation energy and time,the perfusion signal was decreasing.Conclusion:In vivo assessing the local microcirculation during RF ablation by laser Doppler can potentially be useful to differentiate between viable and nonviable ablated beating heart in real time.

Conventional Coronary Artery Bypass Graft Surgery

Coronary artery bypass grafting (CABG) remains one of the most common procedures worldwide, and remains the gold standard therapy for symptomatic coronary artery disease (CAD) that involves the left main coronary artery, triple vessel CAD with or without left ventricular dysfunction, and other complex coronary CAD not amenable to percutaneous intervention, especially in diabetic patients or those with chronic total coronary occlusion. The majority of CABG operations are performed utilizing cardiopulmonary bypass, though beating heart or off-pump strategies have gained popularity by some surgeons. This review focuses on current technical strategies, and advances in conduit harvest and utility, and fundamental management components of cardiopulmonary bypass and beating heart principles.

Off-Pump Complete Coronary Revascularization with 860 cases andtwo year experience

Background Cardiopulmonary bypass (CPB) produces a well documented diffuse inflammatory response that affects multiple organ systems. To avoid the deleterious effects of cardiopulmonary bypass, off pump coronary artery bypass grafting is becoming increasingly popular world wide. We reviewed our experience of complete coronary artery revascularization on the beating heart without CPB. Methods From Aug 1998 to Aug 2000, 860 off pump revascularizations (99%since January 1999) were performed at Manipal Hospital Heart Foundation. The patients consist of males 757(88%), females 103(12%). Averaged age 64.2±15 years. All surgeries were performed through a median sternotomy. Exposure techniques are tailored to individual vessels and cardiac regions. Local immobilization is performed with octopus. Vascular control is achieved with occluders and shunts. Results Among 860 off pump CABG patients. Single graft 72 (8.3%), two grafts 208 (24.2%), three grafts 469 (54.5%), four grafts 101 (11.8%), five graft 10 (1.2%). The average number of grafts per patient was 2.72±0.32. Operative mortality was 0.69%(6 patients). Anesthetic time 3.9±1.2hours, extubation time 6±2.5 hours, Blood requirement 360±90 ml, Preoperative LVEF 60.2±8.5%, Post LVEF 64.1±14%Low cardiac output 48 patients (5.6%), IABP requirement: 25 patients(2.9%), 25 patients converted to CPB during OP CAB(2.9%)and 20 of them were done with on pump beating heart. 25 patients showed myocardial ischemic and 16 patients showed perioperative myocardial infarction. ICU stay 1.1±0.8 days, hospital stay 6.2±1.1 days. Conclusion Off-pump coronary artery bypass in complete revascularization is a safe, effective technique and suitable.

Aortic and mitral valve replacement with retrograde perfusion in the beating heart

Objective To estimate the value of aortic valves and combined mitral valve replacement with retrograde perfusion in beating hearts.Methods Continuous retrograde coronary sinus perfusion with beating hearts was used in 83 patients undergoing aortic valve or aortic valve combined with mitral valve replacement,without application of cardioplegia.After aortic valve replacement,the retrograde perfusion wes changed to antegrade perfusion for mitral valve replacement or correction of the other deformities(group A).Cold blood cardioplegia solution(15℃)was infused at intervals in 20 cases(group B).The following parameters were tested:lactate,ET,CTn-T and MDA in blood;myocardial ultra-structure;and cardiac rhythm and cardiac output (co).Results All biochemical values increased after cardiopulmonary bypass(P ＜ 0.05 - 0.01).Empty and beating heart sinus rhythm was maintained in group A.Myocardial ultrastructure did not change significantly.The pump was stopped smoothly as the surgical procedure finished.No postoperative low cardiac output syndrome or arrhythmia was observed.Eight-one patients recovered smoothly,two died from renal failure or infective shock.When the pump stopped,all patients in group B were supported by 5 - 10 μg· kg-1· min-1 dopamine.Transient pacing was used in 9 patients.One patient died from low cardiac output syndrome.Conclusion This method is a good myocardial protection which simulates physiologic status.It is applicable to aortic valve and combined mitral valve replacement of patients with large heart or heart failure and long time aortic cross-clamping.Ideal clinical effect can be achieved.

Testes extracts inhibit heart contractions in females of the blood-feeding insect, Rhodnius prolixus

Myogenic contractions of the heart of the female blood-feeding insect, Rhodnius prolixus （Stal）, are inhibited by crude extracts of testes applied directly to isolated dorsal vessels. Dorsal vessels were observed with a stereo microscope and heart beats timed with a stopwatch. In normal Rhodnius saline, hearts contract at 14.8 4- 7.1 beats per minute （n = 45）. Crude extracts of the testes and the two male reproductive accessory organs （the opaque and transparent accessory glands） were prepared from previously frozen tissue by homogenizing 5-20 glands in a small glass homogenizer containing Rhodnius saline, centrifuging for 5 rain at 2 000 g, and collecting the supernatant. Testes extract as low as 1.0 glands per mL inhibit contractions whereas crude extracts of the opaque or transparent accessory glands have no consistent effect. We refer to this cardiac inhibitor as rhodtestolin （Rhodnius testis inhibitory factor）, and discuss its possible effects on the female during copulation.

Optimists May Beat Heart Disease

心脏病是美国最大的杀手,每年三分之一的死亡归咎于心脏病。因此。美国人对心脏病所投入的研究也是最可观的。本文的主题句很有文采,sunny outlook取代了optimistic outlooko sunny outlook的反面,就应该是gloomy outlooko我在上小学时,老师用一简单例子向我们说明乐观和悲观。她说,两个酒鬼喝剩半瓶酒。醒来一看,甲说,唉,只有半瓶酒了,乙说,哦,还有半瓶子酒! 只有≠还有。前者悲观,后者乐观!本文郑重提醒:Maybe adding a little fun to people's lives can work like medicine to help prevent heart disease.以前对“心脏病”的一个委婉说法是heart condition,本文又亮出一个“心脏病”的新说法:heart event,值得注意。】

Optimists May Beat Heart Disease

心脏病是美国人的最大杀手,三分之一的美国人死于此疾。乐观对健康有益,本文对“乐观”的诠释却另辟蹊径:with a sunny(本义:阳光充足的) outlook(观点;简洁)on life/power of positive thinking。对生活抱“乐呵呵”的态度,同时又具有积极乐观思维者患心脏病或其他疾病的可能性大大降低！