Biomedical subjects

Yusheng Bao

Publications and source records attributed to Yusheng Bao.

8 recordsLinked to original sources

PubMed2004

Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events.

BACKGROUND: This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium (GIK) solution in diabetic coronary artery bypass graft (CABG) patients would improve perioperative outcomes. METHODS AND RESULTS: One hundred forty-one diabetic patients undergoing CABG were prospectively randomized to tight glycemic control (serum glucose, 125 to 200 mg/dL) with GIK or standard therapy (serum glucose <250 mg/dL) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery. GIK patients had lower serum glucose levels (138+/-4 versus 260+/-6 mg/dL; P<0.0001), a lower incidence of atrial fibrillation (16.6% versus 42%; P=0.0017), and a shorter postoperative length of stay (6.5+/-0.1 versus 9.2+/-0.3 days; P=0.003). GIK patients also showed a survival advantage over the initial 2 years after surgery (P=0.04) and decreased episodes of recurrent ischemia (5% versus 19%; P=0.01) and developed fewer recurrent wound infections (1% versus 10%, P=0.03). CONCLUSIONS: Tight glycemic control with GIK in diabetic CABG patients improves perioperative outcomes, enhances survival, and decreases the incidence of ischemic events and wound complications.

Atrial Fibrillation↗

PubMed2004

Endoscopic radial artery harvest for coronary artery bypass grafting: initial clinical experience.

BACKGROUND: Recently, an endoscopic technique was developed to harvest the radial artery (RA) via a 3-cm wrist incision in patients undergoing coronary artery bypass graft (CABG). The aim of this study was to evaluate our initial clinical experience with this technology. METHODS: Data were prospectively collected on 75 consecutive patients undergoing CABG with endoscopic RA harvest using the Ultra-Retractor (CardioVations, Somerville, NJ, USA) and the harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA). RESULTS: There were 66 men (88%) and 9 women (12%) with a mean age of 60 years (range, 31-77 years). Forty-eight (64%) of cases had non-elective surgery. Thirty-one (41%) of patients had diabetes. Sixty seven percent of the operations were performed on pump and 33% off pump. Average RA harvest time was 66 minutes (range, 25-120 minutes) with a significant learning curve (75 minutes for the first 20 cases and 63 minutes for the last 50 cases). Two (2.6 %) radial arteries were discarded, one because of extensive calcifications and the other because of damage to the conduit. No patients suffered death, perioperative myocardial infarction, or stroke. There was one reexploration of the forearm for a tunnel hematoma. Follow-up was achieved in 100% of patients and averaged 3.6 months (range, 0.5-13 months). Two patients died during the follow-up. There were no myocardial infarctions or reinterventions, with 96% of patients in functional class I /II. There were no motor deficits. There were no sensory deficits in the distribution of the lateral antebrachial cutaneous nerve, but transient mild dorsal thenar numbness or paresthesias were observed in 86% of patients. Cosmetic results were defined as good to excellent in 82% of patients. CONCLUSIONS: Short-term results of endoscopic RA harvest are excellent. There is a significant learning curve. Longterm follow-up as well as structural and functional assessments of the conduit are indicated.

Adult↗

PubMed2003

Pretreatment with statins enhances myocardial protection during coronary revascularization.

OBJECTIVE: This experimental study was undertaken to determine whether pretreatment with statins would enhance myocardial protection and minimize ischemic injury during revascularization of acutely ischemic myocardium. METHODS: In 20 pigs the second and third diagonal arteries were occluded for 90 minutes, followed by 45 minutes of blood cardioplegic arrest and 180 minutes of reperfusion. Ten pigs received atorvastatin (40 mg orally every day) for 21 days before surgical intervention; 10 others received no statins. Ischemic damage was assessed on the basis of the need for cardioversions for ventricular arrhythmias, regional wall-motion scores (4 = normal to -1 = dyskinesia) were determined by means of 2-dimensional echocardiography, endothelial function was assessed on the basis of bradykinin-induced coronary artery relaxation, and infarct size was calculated by determining the area of necrosis to the area of risk by means of histochemical staining. Results are given as means +/- SE. RESULTS: Statin-treated animals required fewer cardioversions (0.11 +/- 0.01 vs 2.87 +/- 0.20, P =.0001), had improved wall-motion scores (2.81 +/- 0.10 vs 1.52 +/- 0.08, P =.01), had lower infarct size (21% +/- 2% vs 41% +/- 2%, P =.0001), and had more complete coronary artery relaxation (34% +/- 5% vs 8% +/- 4%, P =.01). Total serum cholesterol levels were similar between the groups (62 +/- 5 mg/dL for statin-treated animals vs 68 +/- 5 mg/dL for non-statin-treated animals, P =.30). CONCLUSIONS: Pretreatment with statins enhances myocardial protection during revascularization by means of mechanisms that are independent of their cholesterol-lowering properties.

Animals↗

PubMed2002

Pretreatment with angiotensin-converting enzyme inhibitors attenuates ischemia-reperfusion injury.

BACKGROUND: The Heart Outcomes Prevention Evaluation (HOPE) trial demonstrated that ischemic events are decreased in patients receiving angiotensin-converting enzyme (ACE) inhibitors. This study sought to determine whether pretreatment with ACE inhibitors would attentuate ischemic injury during surgical revascularization of ischemic myocardium. METHODS: In a porcine model, the second and third diagonal vessels were occluded for 90 minutes, followed by 45 minutes of cardioplegic arrest, and 180 minutes of reperfusion. Ten pigs received quinapril (20 mg p.o. q.d.) for 7 days prior to surgery; 10 others received no-ACE inhibitors. RESULTS: Quinapril-treated animals required less cardioversions for ventricular arrhythmias (1.58 +/- 0.40 vs 2.77 +/- 0.22; p < 0.05), had higher wall motion scores assessed by two-dimensional echocardiography (4 = normal to -1 = dyskinesia; 2.11 +/- 0.10 vs 1.50 +/- 0.07; p < 0.05), more complete coronary artery endothelial relaxation to bradykinin (45% +/- 3% vs 7% +/- 4%; p < 0.005), and lower infarct size (24.0% +/- 3.0% vs 40.0% +/- 1.7%; p < 0.0001). CONCLUSIONS: ACE inhibition prior to coronary revascularization enhances myocardial protection by decreasing ventricular irritability, improving regional wall motion, lowering infarct size, and preserving endothelial function.

Angiotensin-Converting Enzyme Inhibitors↗

PubMedDate not supplied

Does off-pump revascularization reduce coronary endothelial dysfunction?

BACKGROUND: Off-pump coronary revascularization (OPCAB) has been shown to reduce markers of acute inflammation but its effect on coronary endothelial function is unknown. This experimental study sought to determine whether OPCAB reduces endothelial dysfunction, compared to standard cardiopulmonary bypass (CPB) with and without the anticomplement agent soluble complement receptor-1 (sCR(1)). METHODS: In 10 pigs, OPCAB was simulated by snaring the left anterior descending (LAD) artery for 15 minutes followed by 3 hours of reperfusion. On-pump revascularization was simulated in 20 pigs by 15 minutes of LAD occlusion on CPB with cold blood cardioplegic arrest followed by 3 hours of reperfusion. Ten of these animals received sCR(1) (10 mg/kg) prior to CPB. Inflammatory response was monitored by percent (%) lung water increase, wall motion scores (WMS) with transthoracic echocardiography where 4 = normal to -1 = dyskinesia, and endothelial function in the distal LAD with bradykinin-induced coronary artery relaxation using organ chamber methodology. RESULTS: OPCAB had no effect on lung edema (% increase = 1.7 +/- 1.4 OPCAB vs. 3.4 +/- 0.5 CPB vs. 2.3 +/- 0.9 CPB + sCR(1)) and failed to prevent wall motion changes (WMS = 2.65 +/- 0.08 OPCAB vs. 2.70 +/- 0.04 CPB vs. 3.10 +/- 0.07* CPB + sCR(1), *p < 0.01) and coronary endothelial dysfunction (% relaxation = 41 +/- 9 OPCAB vs. 40 +/- 9 CPB vs. 78 +/- 8** CPB + sCR(1), **p < 0.001), which was best preserved with sCR(1). CONCLUSIONS: This study suggests that agents which directly inhibit complement activation such as sCR(1) are more important in preventing endothelial dysfunction during coronary revascularization than merely avoiding CPB.

Animals↗

PubMedDate not supplied

Aprotinin decreases ischemic damage during coronary revascularization.

BACKGROUND AND AIM: This study sought to determine whether the favorable anti-inflammatory effects of aprotinin might limit ischemic damage during the revascularization of ischemic myocardium. METHODS: Twenty pigs underwent 90 minutes of coronary occlusion followed by 45 minutes of blood cardioplegic arrest and 180 minutes of reperfusion. Ten animals received a loading dose of aprotinin (40,000 kallikrein inhibiting units/kg) during the start of coronary occlusion followed by an infusion of 20,000 kallikrein inhibiting units/kg/hour. Ten other animals received no aprotinin. Summary statistics are expressed as the mean +/- standard error. RESULTS: The aprotinin-treated animals required less cardioversions for ventricular arrhythmias (1.0 +/- 0.7 vs. 3.6 +/- 0.6; p < 0.001), accumulated less lung water (1.0 +/- 0.2% change vs. 6.2 +/- 0.9% change; p = 0.038), had more complete coronary relaxation to bradykinin (34.1 +/- 5.9% change vs. 9.2 +/- 3.5% change; p = 0.01), and had reduced infarct size (area necrosis/area risk = 20 +/- 1.1% vs. 39 +/- 1.2%; p = 0.003). CONCLUSIONS: Aprotinin limits ischemic injury during acute coronary revascularization by decreasing ventricular arrhythmias and lung edema, preserving endothelial function, and minimizing myocardial necrosis.

Animals↗

PubMedDate not supplied

Coronary artery bypass grafting in patients with severe left ventricular dysfunction--early and mid-term outcomes.

BACKGROUND: The prevalence of patients with severe left ventricular dysfunction (LVD) referred for coronary artery bypass grafting (CABG) is increasing. The aim of the present study was to assess the outcomes of patients with severe LVD undergoing CABG. METHODS: Outcomes of 115 consecutive patients with severe LVD (left ventricular ejection fraction [LVEF]</= 30%, mean 22 +/- 6%) undergoing isolated CABG between 1995 and 2000 were compared to 2335 patients with LVEF >30% (HEF). To further evaluate the LVD patients, they were divided into three subgroups base on LVEF: 0% to 10%, 11% to 20%, and 21% to 30%. Data were collected prospectively and entered into the departmental database of the Society of Thoracic Surgeons. RESULTS: Patients in the LVD group had increased incidence of diabetes, chronic obstructive pulmonary disease (COPD), peripheral vascular disease, prior myocardial infarction (MI), congestive heart failure, and less elective procedures compared to the HEF group. Despite this greater risk profile, operative mortality (LVD 2.6% vs. HEF 1.2%, p = 0.19), the incidence of stroke (2.6% vs. 1.0%, p = 0.13), and perioperative MI (0.9% vs. 0.7%) were not statistically different between the groups. The incidence of respiratory (14.8% vs. 1.9%, p < 0.001), renal (5.2% vs. 1.0%, p < 0.001), and vascular (5.2% vs. 0.5%, p < 0.001) complications was significantly higher in the LVD group, resulting in a longer hospital length of stay (8 +/- 8 vs. 6 +/- 4 days, p < 0.0001). In a multivariate analysis, advanced age was as an independent predictor of hospital mortality. Average follow-up in 108 (94%) LVD patients was 36 +/- 22 months (range 2 to 78 months). Twenty-one patients expired during the follow-up, for nine the causes were cardiac-related. Three- and 5-year survival rates were 91 +/- 3% and 76 +/- 6%, respectively. Independent predictors of mid-term mortality in the LVD group by a multivariate analysis included female gender, renal failure, respiratory complications, and grade I/II mitral regurgitation (MR). At the time of follow-up, 72% of LVD patients were in functional class I/II. There were no statistically significant differences in short- and mid-term outcomes among the LVD subgroups. CONCLUSION: CABG in patients with severe LVD can be performed with a low mortality, albeit with higher morbidity and longer length of hospital stay, than patients with LVEF >30%. Low ejection fraction per se was not a predictor of hospital mortality. CABG should be considered a safe and effective therapy for low ejection fraction patients with ischemic heart disease. Mitral valve repair/replacement in the presence of moderate degree of MR should be considered at the time of the initial operation.

Aged↗

PubMedDate not supplied

Endoscopic versus conventional radial artery harvest--is smaller better?

BACKGROUND: We sought to assess our initial experience with the recently introduced technique of endoscopic radial artery harvest (ERH) for coronary artery bypass grafting (CABG). METHODS: Data were prospectively collected on 108 consecutive patients undergoing isolated CABG with ERH, and compared to 120 patients having conventional harvest (CH). Follow-up was achieved in 227 patients (99%). At the time of follow-up the severity of motor and sensory symptoms, as well as cosmetic result in the harvest forearm, were subjectively graded using a 5-point scale. Grade 1-- high intensity deficits, poor cosmetic result. Grade 5 -- no deficits, excellent cosmetic result. RESULTS: Hospital mortality, myocardial infarction, and stroke rates were similar between the groups. Follow-up mortality, reintervention rate, and average angina class were also similar. Harvest time was longer in the ERH group (61 +/- 24 min vs. 45 +/- 11 min, p < 0.001). Three patients in the ERH group were converted to CH and one radial artery was discarded. There were no vascular complications of the hand in either group. Average score of motor (ERH 4.4 +/- 0.9, CH 4.2 +/- 1.0) or sensory symptoms (ERH 3.7 +/- 1.1, CH 3.8 +/- 1.2) were similar. In the CH group sensory deficits were observed in the distribution of both the lateral antebrachial cutaneous and the superficial radial nerves (SRN). In contrast, sensory deficits in the ERH group were limited to the distribution of the SRN. Cosmetic result score was higher in the ERH group (ERH 4.2 +/- 1.0, CH 3.1 +/- 1.4, p < 0.0001). CONCLUSIONS: ERH is safe. It is technically demanding with a significant learning curve. Motor and sensory symptoms are not completely eliminated by using a smaller incision, but cosmetic results are clearly superior.

Adult↗