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Leukocyte telomere shortening reflects stress burdens and has been associated with cardiac events. However, the patient-specific clinical value of telomere assessment remains unknown. Moreover, telomere shortening cannot be inferred from a single telomere length assessment. The authors investigated and developed a novel strategy for gauging leukocyte telomere shortening using autologous cardiac atrial referencing. Using multitissue assessments from 163 patients who underwent cardiovascular surgery, we determined that the cardiac atrium-leukocyte telomere length difference predicted post-operative complexity. This constituted the first evidence that a single-time assessment of telomere dynamics might be salient to acute cardiac care.

Survival after cardiac transplantation has improved substantially over recent decades with improved organ preservation, development of better tolerated immunosuppressive medications and careful patient selection. Multidisciplinary transplantation programs have become better [...], Background: Cardiac retransplantation remains the most viable option for patients with allograft heart failure; however, careful patient selection is paramount considering limited allograft resources. We analyzed clinical outcomes following retransplantation in an academic, tertiary care institution. Methods: Between 1981 and 2011, 593 heart transplantations, including 22 retransplantations were performed at our institution. We analyzed the preoperative demographic characteristics, cause of allograft loss, short- and long-term surgical outcomes and cause of death among patients who had cardiac retransplantations. Results: Twenty-two patients underwent retransplantation: 10 for graft vascular disease, 7 for acute rejection and 5 for primary graft failure. Mean age at retransplantation was 43 (standard deviation [SD] 15) years; 6 patients were women. Thirteen patients were critically ill preoperatively, requiring inotropes and/or mechanical support. The median interval between primary and retransplantation was 2.2 (range 0-16) years. Thirty-day mortality was 31.8%, and conditional (> 30 d) 1-, 5- and 10-year survival after retransplantation were 93%, 79% and 59%, respectively. A diagnosis of allograft vasculopathy (p = 0.008) and an interval between primary and retransplantation greater than 1 year (p = 0.016) had a significantly favourable impact on 30-day mortality. The median and mean survival after retransplantation were 3.3 and 5 (SD 6, range 0-18) years, respectively; graft vascular disease and multiorgan failure were the most common causes of death. Conclusion: Long-term outcomes for primary and retransplantation are similar if patients survive the 30-day postoperative period. Retransplantation within 1 year of the primary transplantation resulted in a high perioperative mortality and thus may be a contraindication to retransplantation. Contexte: Une nouvelle transplantation cardiaque demeure l'option la plus viable pour les patients qui presentent une insuffisance de leur caeur transplants. Il est toutefois crucial de bien selectionner les patients, compte tenu du nombre limite d'organes disponibles. Nous avons analyse les resultats cliniques des secondes transplantations cardiaques dans un etablissement universitaire de soins tertiaires. Methodes: Entre 1981 et 2011, on a procede dans notre etablissement a 593 transplantations cardiaques, dont 22 secondes transplantations. Nous avons analyse les caracteristiques demographiques preoperatoires, la cause de la perte du caur transplante, les resultats chirurgicaux a court et a long terme et la cause de mortalite chez les patients soumis a une seconde transplantation. Resultats: Vingt-deux patients ont subi une seconde greffe : 10 pour une maladie vasculaire affectant le caeur transplante, 7 pour un rejet aigu et 5 pour une insuffisance primaire du greffon. L'age moyen au moment de la seconde intervention etait de 43 ans (ecart-type [ET] 15 ans); 6 patients etaient des femmes. Treize patients etaient gravement malades avant l'intervention et avaient besoin d'inotropes et(ou) d'un soutien mecanique. L'intervalle median entre les 2 interventions a ete de 2,2 (etendue 016) ans. La mortalite a 30 jours s'est elevee a 31,8 % et la survie conditionnelle (> 30 jours) 1, 5 et 10 ans apres la seconde transplantation a ete de 93 %, 79 % et 59 %, respectivement. Un diagnostic de vasculopathie du caur transplante (p= 0,008) et un intervalle de plus d'un an separant les 2 transplantations (p= 0,016) ont exerce un impact significativement favorable sur la mortalite a 30 jours. La survie mediane et la survie moyenne apres la seconde transplantation ont ete de 3,3 ans et de 5 ans (ET 6 ans, etendue 0-18 ans), respectivement; la maladie vasculaire du greffon et l'insuffisance pluriorganique ont ete les plus frequentes causes de mortalite. Conclusion: Les resultats a long terme des premieres et secondes transplantations sont similaires si les patients survivent au-dela de la periode postoperatoire de 30 jours. La seconde transplantation effectuee dans l'annee suivant la premiere a donne lieu a une mortalite perioperatoire elevee et pourrait etre une contre-indication a une seconde transplantation.

Gastrointestinal complications following coronary artery bypass grafting (CABG), although infrequent, are associated with significant morbidity and mortality. Previous studies have suggested that cardiopulmonary bypass (CPB) could contribute to these complications. [...], Background: Gastrointestinal (GI) complications following coronary artery bypass grafting (CABG), although infrequent, are associated with significant morbidity and mortality. It has been suggested that systemic inflammatory response plays an important role in these complications. Cardiopulmonary bypass (CPB) is well known to cause increased systemic inflammation, and therefore it has been proposed that performing CABG using an off-pump technique could substantially minimize the risk of GI complications. Prolonged CPB duration has been shown to be an independent predictor of GI complications; however, the effect of avoiding CPB altogether through off-pump procedures has not been thoroughly examined. We sought to compare the incidence of GI complications in patients undergoing on-pump and off-pump CABG. Methods: We analyzed prospectively entered data on 2451 patients who Underwent isolated CABG between January 2000 and October 2004. We compared GI complication rates in 5 predetermined areas (GI bleed, ileus, pancreatitis, ischemic bowel and cholecystitis) among patients who had on-pump CABG with those of patients who had off-pump CABG. We also compared in-hospital mortality due to these complications between the 2 groups. Results: We compared data for a total of 2010 patients in the on-pump group and 441 in the off-pump group. In the on-pump group, 30 (1.49%) patients experienced GI complications compared with 4 (0.91%) in the off-pump group (p = 0.34). Gastrointestinal bleed was the most common complication in the off-pump group. Eight patients in the on-pump group experienced ischemic bowels compared with no patients in the off-pump group. Six patients (0.3%) in the on-pump group died from GI complications, whereas no patients in the off-pump group died from such complications (p = 0.25). Conclusion: We found no significant difference in the total number of GI complications between the off-pump and on-pump groups; however, trends could be seen in the types of GI complications that occurred in the 2 groups. Owing to the relatively infrequent occurrence of GI complications, a larger scale study would be beneficial to determine whether the differences observed would be significant. Contexte: Les complications gastro-intestinales (GI) apres une chirurgie de pontage coronarien sont rares, mais elles sont associees a une morbidite et une mortalite importantes. Certains ont evoque le role contributif de la reponse inflammatoire systemique dans ce type de complication. On sait en effet que la circulation extracorporelle cause une inflammation systemique, d'ou l'hypothese selon laquelle la realisation des pontages coronariens au moyen d'une technique ne faisant pas appel a la circulation extracorporelle reduirait substantiellement le risque de complications GI. La duree prolongee des interventions de pontage est un facteur predicteur independant des complications GI. Toutefois, les autres techniques permettant d'eviter completement la circulation extracorporelle n'ont pas fait l'objet d'etudes approfondies. Nous avons voulu comparer l'incidence des complications GI chez des patients ayant subi un pontage coronarien selon qu'ils etaient ou non sous circulation extracorporelle. Methodes: Apres saisie prospective des donnees de 2451 patients ayant subi un pontage coronarien simple entre janvier 2000 et octobre 2004, nous avons procede a une analyse. Nous avons compare les taux de 5 types de complications GI predetermines (saignements GI, ileus, pancreatite, ischemie intestinale et cholecystite) chez des patients soumis a un pontage coronarien avec ou sans circulation extracorporelle. Nous avons aussi compare la mortalite perhospitaliere resultant de ces complications entre les 2 groupes. Resultats: En tout, nous avons compare les donnees de 2010 patients du groupe avec circulation extracorporelle et de 441 patients du groupe sans circulation extracorporelle. Dans le groupe avec circulation extracorporelle, 30 patients (1,49%) ont eu des complications GI, contre 4 (0,91%) dans le groupe sans circulation extracorporelle (p = 0,34). Les saignements gastro-intestinaux ont ete la complication la plus frequente dans le groupe sans circulation extracorporelle. Dans le groupe avec circulation extracorporelle, 8 patients ont presente une ischemie intestinale, comparativement a aucun patient dans le groupe sans circulation extracorporelle. Enfin, dans le groupe avec circulation extracorporelle, 6 patients (0,3%) sont decedes des suites de complications GI, tandis qu'aucun patient du groupe sans circulation extracorporelle n'est decede de telles complications (p = 0,25). Conclusion: Nous n'avons observe aucune difference significative quant au nombre total des complications GI entre les groupes avec ou sans circulation extracorporelle. Il a toutefois ete possible de degager certaines tendances relativement au type de complications GI observees dans les 2 groupes. Etant donne la relative rarete des Complications GI, une etude a plus grande echelle serait indiquee pour determiner si les differences observees sont veritablement significatives.

Background: Studies conducted before 1999 of patients who had coronary artery bypass graft surgery (CABG) have shown a tendency toward increasing preoperative risk factors. This study examines whether this trend [...]

Introduction: Steroids In caRdiac Surgery trial (SIRS) is a large international randomised controlled trial of methylprednisolone or placebo in patients undergoing cardiac surgery with the use of a cardiopulmonary bypass pump. At the time of surgery, compared with placebo, methylprednisolone divided into two intravenous doses of 250 mg each may reduce the risk of postoperative acute kidney injury (AKI). Methods and analysis: With respect to the study schedule, over 7000 substudy eligible patients from 81 centres in 18 countries were randomised in December 2013. The authors will use a logistic regression to estimate the adjusted OR of methylprednisolone versus placebo on the primary outcome of AKI in the 14 days following surgery (a postoperative increase in serum creatinine of ≥50%, or ≥26.5 µmol/L, from the preoperative value). The stage of AKI will also be considered, as will the outcome of AKI in those with and without preoperative chronic kidney disease. After receipt of grant funding, the authors began to record additional perioperative serum creatinine measurements in consecutive patients enrolled at substudy participating centres, and patients were invited to enroll in a 6-month serum creatinine collection. In these trial subpopulations, the authors will consider the outcome of AKI defined in alternate ways, and the outcome of a 6-month change in kidney function from the preoperative value. Ethics and dissemination: The authors were competitively awarded a grant from the Canadian Institutes of Health Research for this SIRS AKI substudy. Ethics approval was obtained for additional serum creatinine recordings in consecutive patients enrolled at participating centres. The additional kidney data collection first began for patients enrolled after 1 March 2012. In patients who provided consent, the last 6-month kidney outcome data will be collected in 2014. The results will be reported no later than 2015. Clinical Trial Registration: Number NCT00427388. [ABSTRACT FROM AUTHOR]