AIM To investigate the survival benefit of bilateral internal mammary artery(BIMA) grafts in patients with left ventricular dysfunction.METHODS Between 1996 and 2009,we performed elective,isolated,primary,multiple car...AIM To investigate the survival benefit of bilateral internal mammary artery(BIMA) grafts in patients with left ventricular dysfunction.METHODS Between 1996 and 2009,we performed elective,isolated,primary,multiple cardiac arterial bypass grafting in 430 consecutive patients with left ventricular ejection fraction ≤ 40%. The early and long-term results were compared between 167 patients undergoing BIMA grafting and 263 patients using left internal mammary artery(LIMA)-saphenous venous grafting(SVG).RESULTS The mean age of the overall population was 60.1 ± 15 years. In-hospital mortality was not different between the two groups(7.8% vs 10.3%,P = 0.49). Early postoperative morbidity included myocardial infarction(4.2% vs 3.8%,P = 0.80),stroke(1.2% vs 3.8%,P = 0.14),and mediastinitis(5.3% vs 2.3%,P = 0.11). At 8-year follow-up,Kaplan-Meier-estimated survival(74.2% vs 58.9%,P = 0.02) and Kaplan-Meier-estimated event-free survival(all cause deaths,myocardial infarction,stroke,target vessel revascularization,heart failure)(61.7% and 41.1%,P < 0.01) were significantly higher in the BIMA group compared with the LIMA-SVG group in univariate analysis. The propensity score matching analysis confirmed that BIMA grafting is a safe revascularization procedure but there was no long term survival(P = 0.40) and event-free survival(P = 0.13) in comparison with LIMA-SVG use.CONCLUSION Our longitudinal analysis suggests that BIMA grafting can be performed with acceptable perioperative mortality in patients with left ventricular dysfunction.展开更多
Tumour necrosis factor-α is a cytokine released during myocardial infarction. According to the literature, the effect of TNFα on myocardial infarction is controversial, especially when administered before the ischem...Tumour necrosis factor-α is a cytokine released during myocardial infarction. According to the literature, the effect of TNFα on myocardial infarction is controversial, especially when administered before the ischemic period. The deleterious effects of TNFα seem to be related to the triggering of apoptosis. This study has been designed to determine if different doses of TNFα, administered before the ischemic period, have the same effect on infarct size and on activation of caspase-3 and-8, two enzymes involved in apoptosis. Four groups, using a porcine model of myocardial infarction, have been used: placebo and TNFα (0.1 μg/kg;1 μg/kg and 3 μg/kg). All administered 15 minutes before a 50 minutes occlusion of the left anterior descending artery. Myocardial infarct size has been determined at 3 hours of reperfusion. In a subgroup of animals, reperfusion period has been limited to 15 min to determine the activity of caspase-3 and-8 by spectrofluorometry. Results indicated that infarct size is significantly smaller in groups 0.1 μg/kg and 1 μg/ kg as compared to the placebo group. In contrast, the 3 μg/kg group presented an infarct size similar to the placebo group. Activity of caspase-3 and-8 is reduced in the ischemic region in groups 0.1 and 1 μg/ kg as compared to the placebo group whereas activity in the 3 μg/kg group was similar to the placebo. The results obtained indicated that a low dose of TNFα administered before the ischemic period reduces infarct size, whereas the cardioprotection is lost with the high dose.展开更多
Objectives: To analyse clinical, echocardiographic, and prognostic characteristics of Staphylococcus aureus infective endocarditis(IE) compared with endocarditis caused by other pathogens. Design: Cohort study. Method...Objectives: To analyse clinical, echocardiographic, and prognostic characteristics of Staphylococcus aureus infective endocarditis(IE) compared with endocarditis caused by other pathogens. Design: Cohort study. Methods: 194 consecutive patients with definite IE according to the Duke criteria prospectively examined by transthoracic and transoesophageal echocardiography were enrolled. Patients without identified microorganisms were excluded. The S aureus IE group(n=61) was compared with the group with IE caused by other pathogens(n=133). Results: Compared with IE caused by other pathogens, S aureus IE was characterised by severe comorbidity, a shorter duration of symptoms before diagnosis, and a higher prevalence of right sided IE, cutaneous portal of entry, and history of renal failure. Severe sepsis, major neurological events, and multiple organ failure were more frequent during the acute phase in S aureus IE. In-hospital mortality(34%v 10%, p< 0.001) was higher in patients with S aureus IE and the 36 month actuarial survival rate was lower in S aureus IE than in IE caused by other pathogens(47%v 68%, p=0.002). Multivariate analyses identified S aureus infection as a predictive factor for in-hospital mortality and for overall mortality. Conclusions: S aureus IE compared with IE caused by other pathogens occurs in a more debilitated clinical setting and is characterised by a higher prevalence of severe sepsis, major neurological events, and multiple organ failure leading to higher mortality.展开更多
文摘AIM To investigate the survival benefit of bilateral internal mammary artery(BIMA) grafts in patients with left ventricular dysfunction.METHODS Between 1996 and 2009,we performed elective,isolated,primary,multiple cardiac arterial bypass grafting in 430 consecutive patients with left ventricular ejection fraction ≤ 40%. The early and long-term results were compared between 167 patients undergoing BIMA grafting and 263 patients using left internal mammary artery(LIMA)-saphenous venous grafting(SVG).RESULTS The mean age of the overall population was 60.1 ± 15 years. In-hospital mortality was not different between the two groups(7.8% vs 10.3%,P = 0.49). Early postoperative morbidity included myocardial infarction(4.2% vs 3.8%,P = 0.80),stroke(1.2% vs 3.8%,P = 0.14),and mediastinitis(5.3% vs 2.3%,P = 0.11). At 8-year follow-up,Kaplan-Meier-estimated survival(74.2% vs 58.9%,P = 0.02) and Kaplan-Meier-estimated event-free survival(all cause deaths,myocardial infarction,stroke,target vessel revascularization,heart failure)(61.7% and 41.1%,P < 0.01) were significantly higher in the BIMA group compared with the LIMA-SVG group in univariate analysis. The propensity score matching analysis confirmed that BIMA grafting is a safe revascularization procedure but there was no long term survival(P = 0.40) and event-free survival(P = 0.13) in comparison with LIMA-SVG use.CONCLUSION Our longitudinal analysis suggests that BIMA grafting can be performed with acceptable perioperative mortality in patients with left ventricular dysfunction.
文摘Tumour necrosis factor-α is a cytokine released during myocardial infarction. According to the literature, the effect of TNFα on myocardial infarction is controversial, especially when administered before the ischemic period. The deleterious effects of TNFα seem to be related to the triggering of apoptosis. This study has been designed to determine if different doses of TNFα, administered before the ischemic period, have the same effect on infarct size and on activation of caspase-3 and-8, two enzymes involved in apoptosis. Four groups, using a porcine model of myocardial infarction, have been used: placebo and TNFα (0.1 μg/kg;1 μg/kg and 3 μg/kg). All administered 15 minutes before a 50 minutes occlusion of the left anterior descending artery. Myocardial infarct size has been determined at 3 hours of reperfusion. In a subgroup of animals, reperfusion period has been limited to 15 min to determine the activity of caspase-3 and-8 by spectrofluorometry. Results indicated that infarct size is significantly smaller in groups 0.1 μg/kg and 1 μg/ kg as compared to the placebo group. In contrast, the 3 μg/kg group presented an infarct size similar to the placebo group. Activity of caspase-3 and-8 is reduced in the ischemic region in groups 0.1 and 1 μg/ kg as compared to the placebo group whereas activity in the 3 μg/kg group was similar to the placebo. The results obtained indicated that a low dose of TNFα administered before the ischemic period reduces infarct size, whereas the cardioprotection is lost with the high dose.
文摘Objectives: To analyse clinical, echocardiographic, and prognostic characteristics of Staphylococcus aureus infective endocarditis(IE) compared with endocarditis caused by other pathogens. Design: Cohort study. Methods: 194 consecutive patients with definite IE according to the Duke criteria prospectively examined by transthoracic and transoesophageal echocardiography were enrolled. Patients without identified microorganisms were excluded. The S aureus IE group(n=61) was compared with the group with IE caused by other pathogens(n=133). Results: Compared with IE caused by other pathogens, S aureus IE was characterised by severe comorbidity, a shorter duration of symptoms before diagnosis, and a higher prevalence of right sided IE, cutaneous portal of entry, and history of renal failure. Severe sepsis, major neurological events, and multiple organ failure were more frequent during the acute phase in S aureus IE. In-hospital mortality(34%v 10%, p< 0.001) was higher in patients with S aureus IE and the 36 month actuarial survival rate was lower in S aureus IE than in IE caused by other pathogens(47%v 68%, p=0.002). Multivariate analyses identified S aureus infection as a predictive factor for in-hospital mortality and for overall mortality. Conclusions: S aureus IE compared with IE caused by other pathogens occurs in a more debilitated clinical setting and is characterised by a higher prevalence of severe sepsis, major neurological events, and multiple organ failure leading to higher mortality.
