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Simon W MacGowan

Publications and source records attributed to Simon W MacGowan.

6 recordsLinked to original sources
PubMed2005

A clinical, renal and immunological assessment of surface modifying additive treated (SMART) cardiopulmonary bypass circuits.

Biocompatible cardiopulmonary bypass (CPB) circuits aim to reduce contact activation and its physiological consequences. We investigated the hypothesis that use of Surface Modifying Additive (SMA)-treated circuits (Sorin Group Ltd) compared with non-SMA circuits would be associated with preservation of blood pressure during CPB and modulation of perioperative subclinical renal function (urinary alpha-1-microglobulin (alpha-1-m)) and plasma and urinary cytokine changes. In a study of low-risk CABG patients (n=40), randomized to SMA (n=20) versus non-SMA circuits (n=20), we found better preserved blood pressure at CPB initiation in SMA patients (p <0.05), particularly in ACE-inhibited SMA patients (n =11) versus ACE-inhibited non-SMA patients (n =10) (p <0.05). Plasma anti-inflammatory IL-10, as well as urinary alpha-1-m, were elevated 48 hours postoperatively (p <0.05). SMA patients also had lower blood loss (p <0.05). SMA circuits have some clinical benefit, especially in ACE-inhibited patients.

Aged↗
PubMed2004

Endoscopic vein harvest: advantages and limitations.

BACKGROUND: Although long saphenous vein remains the most commonly used conduit in coronary revascularization, traditional open vein harvest (OVH) may lead to significantly impaired wound healing and postoperative pain. Endoscopic vein harvest (EVH) attempts to reduce this morbidity and improve patient satisfaction with no compromise in outcome. METHODS: From September 2000 to November 2001, 108 saphenous vein harvests were prospectively randomly assigned to EVH (n = 52) or OVH (n = 56); EVH was performed with the Clearglide endoscopic vein harvest system (Cardiovations) by a single surgeon. Endpoints included impaired wound healing (ASEPSIS score), operative and harvest time, vein quality (including histology), outcome and postoperative pain (Visual Analog Scale). Follow-up was as long as 3 years. RESULTS: The groups were well matched demographically. Endoscopic vein harvest was quicker to perform if sufficient vein for two grafts was needed (p < 0.01). Wound healing was significantly impaired (ASEPSIS score) in the OVH group compared with the EVH group (p < 0.01). The new procedure did not prolong the overall operative time (p = 0.77). Postoperative pain was less (p < 0.01) in the EVH group. Stepwise multiple regression showed age, diabetes, peripheral vascular disease, total operative time, type of procedure, length of incision, and number of vein grafts to be predictive of impaired wound healing. More late interventions were needed in the OVH group for wound-related morbidity. CONCLUSIONS: These data demonstrate that endoscopic vein harvest results in fewer cases of impaired wound healing and reduced postoperative pain, and it does not prolong the operative time significantly nor compromise the vein quality. Furthermore, it is quicker to perform if two grafts are needed, and it reduces late interventions.

Coronary Artery Bypass↗
PubMedDate not supplied

Methylprednisolone favourably alters plasma and urinary cytokine homeostasis and subclinical renal injury at cardiac surgery.

UNLABELLED: Whilst elevated urinary transforming growth factor beta-1 (TGFbeta) is associated with chronic renal dysfunction its role in acute peri-operative renal dysfunction is unknown. In contrast, peri-operative increases in urinary IL-1 receptor antagonist (IL-1ra) and TNF soluble receptor-2 (TNFsr-2) mirror pro-inflammatory activity in the nephron and correlate with renal complications. Steroids modulate some plasma cytokines (decreasing TNFalpha, IL-8, IL-6 and increasing IL-10), whereas ability to reduce plasma and urinary TNFsr-2 and IL-1ra and peri-operative renal injury is unknown. Patients undergoing coronary artery bypass grafting with cardiopulmonary bypass (CPB) were randomised to receive methylprednisolone (n = 18) or placebo (n = 17) before induction of anaesthesia. Plasma and urinary pro- and anti-inflammatory cytokine balance was determined along with subclinical proximal tubular injury and dysfunction, measured by urinary N-acetyl-beta-d-glucosaminidase (NAG)/creatinine and alpha-1-microglobulin/creatinine ratios, respectively. In the control group compared with baseline, plasma IL-8, TNFalpha, IL-10, IL-1ra and TNFsr-2 were significantly elevated along with urinary IL-1ra, TNFsr-2 and TGFbeta1. Urinary NAG/creatinine and alpha-1-microglobulin/creatinine ratios rose from completion of revascularisation until 6 h with recovery at 24 h with a further rise in NAG/creatinine ratio at 48 h. Compared to placebo, the methylprednisolone group showed significantly reduced plasma IL-8, TNFalpha, IL-1ra and TNFsr-2 whereas plasma IL-10 increased. Compared to placebo, the methylprednisolone group demonstrated significantly reduced urinary NAG/creatinine ratio, TNFsr-2 and TGFbeta1 at 24 h whereas urinary alpha-1-microglobulin/creatinine ratios increased. CONCLUSIONS: Methylprednisolone administration during cardiac surgery significantly reduces plasma and urinary TNFsr-2 and IL-1ra, urinary TGFbeta1 and subclinical renal injury but not dysfunction.

Aged↗
PubMedDate not supplied

Aortic valve replacement in osteogenesis imperfecta--technical and practical considerations for a successful outcome.

Osteogenesis imperfecta is a connective tissue disorder that is rarely associated with isolated aortic insufficiency. Surgery on such patients carries high morbidity and mortality, which are mostly associated with bleeding tendencies secondary to increased tissue and capillary fragility. We report a 42-year-old male with isolated aortic incompetence, who underwent aortic valve replacement (AVR) with a mechanical prosthesis. The postoperative course was uneventful, and the patient was discharged home on the seventh postoperative day (POD 7). He remains well on follow-up 6 months later. We highlight the importance of a meticulous surgical technique, together with a strategy for management of anticipated perioperative complications to ensure a successful outcome.

Adult↗