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Diabetes and cardiac surgery

J Slieker, P Frauche, J Jurt, V Addor, C Blanc, Nicolas Demartines, M Hübner
BACKGROUND: Enhanced recovery after surgery (ERAS) pathway includes recovery goals requiring active participation of the patients; this may be perceived as "aggressive" care in older patients. The aim of the present study was to assess whether ERAS was feasible and beneficial in older patients. METHODS: Since June 2011, all consecutive colorectal patients were included in an ERAS pathway and documented in a dedicated prospective database. This retrospective analysis included 513 patients, 311 younger patients (<70 years) and 202 older patients (≥70 years)...
October 21, 2016: International Journal of Colorectal Disease
J R Martinez-Parachini, A Karatasakis, D Karmpaliotis, K Alaswad, F A Jaffer, R W Yeh, M Patel, J Bahadorani, A Doing, P-K Nguyen-Trong, B A Danek, J Karacsonyi, A Alame, B V Rangan, C A Thompson, Subhash Banerjee, E S Brilakis
AIM: To examine the impact of diabetes mellitus on procedural outcomes of patients who underwent percutaneous coronary intervention for chronic total occlusion. METHODS: We assessed the impact of diabetes mellitus on the outcomes of percutaneous coronary intervention for chronic total occlusion among 1308 people who underwent such procedures at 11 US centres between 2012 and 2015. RESULTS: The participants' mean ± sd age was 66±10 years, 84% of the participants were men and 44...
October 15, 2016: Diabetic Medicine: a Journal of the British Diabetic Association
Matthias Heringlake, Efstratios I Charitos, Kira Erber, Astrid Ellen Berggreen, Hermann Heinze, Hauke Paarmann
BACKGROUND: Growth-differentiation factor-15 (GDF-15) is an emerging humoral marker for risk stratification in cardiovascular disease. Cardiac-surgery-associated acute kidney injury (CSA-AKI), an important complication in patients undergoing cardiac surgery, is associated with poor prognosis. The present secondary analysis of an observational cohort study aimed to determine the role of GDF-15 in predicting CSA-AKI compared with the Cleveland-Clinic Acute Renal Failure (CC-ARF) score and a logistic regression model including variables associated with renal dysfunction...
October 8, 2016: Critical Care: the Official Journal of the Critical Care Forum
W Amara, S Naccache, C Akret, S Cheggour, S M'Zoughi, G Galuscan, A Dompnier
INTRODUCTION: Management of antiplatelet therapy at the time of device implantation remains controversial. This study aimed to assess the risk of bleeding complications in patients receiving ticagrelor at the time of cardiac device surgery. METHODS: We performed a multicentre (n=4), retrospective study from January 2015 to January 2016. The survey included all patients (pts) treated with ticagrelor before undergoing pacemaker, implantable cardioverter-defibrillator (ICD) implantation or generator replacement...
September 29, 2016: Annales de Cardiologie et D'angéiologie
Zekun Cai, Jianwei Dai, Dan Wu, Jian Qiu, Jun Ma, Guoying Li, Wei Zhu, Hongqiang Lei, Wenhua Huang, Heye Zhang, Lin Xu
The aim of this study is to investigate the value of 3-dimensional global peak longitudinal strain (GPLS) derived from the 3-dimensional speckle-tracking echocardiography (3D-STE) in the diagnosis of the complex non-ST-segment elevation acute coronary syndromes (NSTE-ACS) by comparing GPLS to the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score.A total of 59 inpatients with NSTE-ACS in our hospital between October 2014 and January 2015 were enrolled into our study...
September 2016: Medicine (Baltimore)
Zhongjian Cheng, Venkata Garikipati, Emily Nickoloff, Chunlin Wang, David J Polhemus, Jibin Zhou, Cynthia Benedict, Mohsin Khan, Suresh K Verma, Joseph E Rabinowitz, David Lefer, Raj Kishore
BACKGROUND: -Bone marrow cell-based treatment for critical limb ischemia (CLI) in diabetic patients yielded a modest therapeutic effect due to cell dysfunction. Therefore, approaches that improve diabetic stem/progenitor cell functions may provide therapeutic benefits. Here, we tested the hypotheses that restoration of hydrogen sulfide (H2S) production in diabetic bone marrow cells (BMCs) improves their reparative capacities. METHODS: -Mouse BMCs were isolated by density-gradient centrifugation...
September 22, 2016: Circulation
Deepashree Gupta, Meredith Kirn, Zafar A Jamkhana, Richard Lee, Stewart G Albert, Kimberly M Rollins
BACKGROUND: To assess the efficacy of a unified hyperglycemia and diabetic ketoacidosis (DKA) insulin infusion protocol (IIP), based on an Excel algorithm and implemented as an electronic order set, in achieving glycemic targets and minimizing hypoglycemia. METHODS: An IIP was instituted in medical and surgical intensive care units for post-cardiac surgery (PCS) and other stress hyperglycemia (SH), diabetes hyperglycemia (DH), and DKA. The IIP initiated therapeutic insulin rates at elevated blood glucose (BG), and decreased insulin when target range was achieved...
September 15, 2016: Diabetes & Metabolic Syndrome
Chantal A Boly, Etto C Eringa, R Arthur Bouwman, Rob F P van den Akker, Frances S de Man, Ingrid Schalij, Stephan A Loer, Christa Boer, Charissa E van den Brom
BACKGROUND: While most studies focus on cardiovascular morbidity following anesthesia and surgery in excessive obesity, it is unknown whether these intraoperative cardiovascular alterations also occur in milder forms of adiposity without type 2 diabetes and if insulin is a possible treatment to improve intraoperative myocardial performance. In this experimental study we investigated whether mild adiposity without metabolic alterations is already associated with cardiometabolic dysfunction during anesthesia, mechanical ventilation and surgery and whether these myocardial alterations can be neutralized by intraoperative insulin treatment...
2016: Cardiovascular Diabetology
Martin Ritt, Karl-Günter Gaßmann, Cornel Christian Sieber
Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls. Of further clinical interest, frailty might be at least in part reversible in some patients and subject to preventive strategies. In daily clinical practice older patients with a complex health status, who are mostly frail or at least at risk of developing frailty, are frequently cared for by geriatricians...
October 2016: Zeitschrift Für Gerontologie und Geriatrie
Pil Sang Song, Young Bin Song, Joo Myung Lee, Joo-Yong Hahn, Seung-Hyuk Choi, Jin-Ho Choi, Sang Hoon Lee, Kyung Woo Park, Hyo-Soo Kim, Yangsoo Jang, Ki Bae Seung, Ju Hyeon Oh, Hyeon-Cheol Gwon
OBJECTIVES: This study investigated the long-term outcomes and predictors of target vessel failure (a composite of cardiac death, myocardial infarction, stent thrombosis, or target vessel revascularization) in patients with bifurcation lesion treated by percutaneous coronary intervention (PCI) utilizing the 2-stent strategy with a drug-eluting stent (DES). BACKGROUND: There are limited data on outcomes of the 2-stent strategy in bifurcation PCI. METHODS: Patient-level pooled analysis was performed with patients undergoing PCI with 2-stent strategy from the Korean Bifurcation Pooled Cohorts...
September 26, 2016: JACC. Cardiovascular Interventions
Giuseppe Gatti, Luca Maschietto, Marco Morosin, Marco Russo, Bernardo Benussi, Gabriella Forti, Lorella Dreas, Gianfranco Sinagra, Aniello Pappalardo
BACKGROUND: Concerns about increased risk of postoperative complications, primarily deep sternal wound infection (DSWI), prevent liberal use of bilateral internal thoracic artery (BITA) grafting in women. Consequently, outcomes after routine BITA grafting remain largely unexplored in female gender. METHODS: Of 786 consecutive women with multivessel coronary disease who underwent isolated coronary bypass surgery at the authors' institution from 1999 throughout 2014, 477 (60...
August 14, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Davide Lazzeroni, Nicola Gaibazzi, Matteo Bini, Giacomo Bussolati, Umberto Camaiora, Roberto Cassi, Simone Geroldi, Pietro Tito Ugolotti, Lorenzo Brambilla, Valerio Brambilla, Paolo Castiglioni, Paolo Coruzzi
BACKGROUND: Previous studies showed that left atrial enlargement is an independent marker of adverse outcomes in both primary and secondary cardiovascular prevention. However, no data are available on long-term outcomes in patients undergoing valve surgery and/or coronary artery by-pass graft (CABG) surgery. Aim of the study was to evaluate long-term prognostic role of left atrial volume index (LAVi) after cardiac surgery, using the cutoff values recently proposed by the European Association of Cardiovascular Imaging and American Society of Echocardiography...
2016: Cardiovascular Ultrasound
Rubén Barba-Navarro, Mirell Tapia-Silva, Carlos Garza-Garcia, Salvador López-Giacoman, Ipsae Melgoza-Toral, Armando Vázquez-Rangel, Silvana Bazúa-Valenti, Norma Bobadilla, Michael Wasung de Lay, Francisco Baranda, Lakhmir S Chawla, Gerardo Gamba, Magdalena Madero
BACKGROUND: Cardiac surgery-related acute kidney injury (AKI) is a common postoperative complication that greatly increases morbidity and mortality. There are currently no effective interventions to prevent AKI associated with cardiac surgery. Experimental data have shown that administration of the mineralocorticoid receptor blocker spironolactone prevents renal injury induced by ischemia-reperfusion in rats. The objective of this study was to test whether short-term perioperative administration of oral spironolactone could reduce the incidence of AKI in cardiac surgical patients...
August 10, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Suzanne V Arnold, Philip G Jones, Larry A Allen, David J Cohen, Timothy J Fendler, Jonathan E Holtz, Sanjeev Aggarwal, John A Spertus
BACKGROUND: A left ventricular assist device (LVAD) improves survival and quality of life for many, but not all, patients with end-stage heart failure who are ineligible for transplantation. We sought to evaluate the frequency of poor outcomes using a novel composite measure that integrates quality of life with mortality. METHODS AND RESULTS: Within the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) national registry, poor outcome was defined as death or an average Kansas City Cardiomyopathy Questionnaire <45 during the year after LVAD (persistently limiting heart failure symptoms and poor quality of life)...
August 2016: Circulation. Heart Failure
Ragesh Panikkath, Deepa Panikkath, S Sanchez-Iglesias, D Araujo-Vilar, Joaquin Lado-Abeal
A 46-year-old African American woman presented with severe respiratory distress requiring intubation and was diagnosed with nonischemic cardiomyopathy. She had the typical phenotype of familial partial lipodystrophy 2 (FPLD2). Sequence analysis of LMNA gene showed a heterozygous missense mutation at exon 8 (c.1444C>T) causing amino acid change, p.R482W. She later developed severe coronary artery disease requiring multiple percutaneous coronary interventions and coronary artery bypass surgery. She was later diagnosed with diabetes, primary hyperparathyroidism, and euthyroid multinodular goiter...
July 2016: Journal of Investigative Medicine High Impact Case Reports
K C Hiew, A Sachithanandan, M Arif, B Badmanaban, A Muiz, I Faisal, L Hamdan, O Evi Diana
BACKGROUND: Acute kidney injury (AKI) following cardiac surgery is well established but the reported incidence is variable due to varying definitions and criteria. Furthermore there is a paucity of such data from Southeast Asia. OBJECTIVES: To determine the incidence of AKI, the associated risk factors, and its impact on early mortality and intensive care unit/hospital stay. METHOD: This is a single centre retrospective observational study to evaluate outcomes on 1260 consecutive patients from a multi-ethnic Southeast Asian population who underwent a primary isolated coronary artery bypass graft (CABG) operation...
June 2016: Medical Journal of Malaysia
Harish Mithiran, Glenn Kunnath Bonney, Saideep Bose, Srinivas Subramanian, Zan Ng Zhe Yan, Seth Yeak Zong En, Evangelos Papadimas, Ishaan Chauhan, Graeme MacLaren, Theodoros Kofidis
OBJECTIVE: To develop a scoring system to predict acute kidney injury in Asian patients after coronary artery bypass grafting. DESIGN: A retrospective analysis of data collected in an institutional cardiac database. SETTING: A tertiary academic hospital in a large metropolitan city. PARTICIPANTS: The study comprised 954 patients with coronary artery disease. INTERVENTIONS: All patients underwent coronary artery bypass surgery with cardiopulmonary bypass but did not undergo any other concomitant procedures...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Mei Gao, Jianzhong Sun, Nilas Young, Douglas Boyd, Zane Atkins, Zhongmin Li, Qian Ding, James Diehl, Hong Liu
OBJECTIVES: Body mass index (BMI) commonly is used in obesity classification as a surrogate measure, and obesity is associated with a cluster of risk factors for cardiovascular disease. The aim of this study was to investigate the impact of BMI on short-term outcomes after cardiac surgery. DESIGN: A retrospective cohort study. SETTING: University teaching hospital, 2 centers. PARTICIPANTS: The study comprised 4,740 patients who underwent cardiac surgery at 2 hospitals-from July 1, 2001, to June 30, 2013, in 1 hospital and from September 1, 2003, to August 31, 2014, in a second hospital...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Saswata Deb, Jack V Tu, Peter C Austin, Dennis T Ko, Rodolfo Rocha, C David Mazer, Alex Kiss, Stephen E Fremes
BACKGROUND: Ethnicity is an important predictor of coronary artery bypass graft surgery (CABG) outcomes. South Asians (SA), one of the largest ethnic groups with a high burden of cardiovascular disease, are hypothesized to have inferior outcomes after CABG compared to other ethnic groups. Given the paucity and controversy of literature in this area, the objective of this study was to examine the impact of SA versus the general population (GP) on long-term outcomes following CABG. METHOD AND RESULTS: Using administrative databases and a surname algorithm, 83 850 patients (SA: 2653, GP: 81 197) who underwent isolated CABG in Ontario, Canada from 1996 to 2007 were identified; mean follow-up was 9...
2016: Journal of the American Heart Association
Daniel J Bertges, Dan Neal, Andres Schanzer, Salvatore T Scali, Philip P Goodney, Jens Eldrup-Jorgensen, Jack L Cronenwett
OBJECTIVE: The objective of this study was to develop and to validate the Vascular Quality Initiative (VQI) Cardiac Risk Index (CRI) for prediction of postoperative myocardial infarction (POMI) after vascular surgery. METHODS: We developed risk models for in-hospital POMI after 88,791 nonemergent operations from the VQI registry, including carotid endarterectomy (CEA; n = 45,340), infrainguinal bypass (INFRA; n = 18,054), suprainguinal bypass (SUPRA; n = 2678), endovascular aneurysm repair (EVAR; n = 18,539), and open abdominal aortic aneurysm repair (OAAA repair; n = 4180)...
July 19, 2016: Journal of Vascular Surgery
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