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Biomedical subjects

Jari Laurikka

Publications and source records attributed to Jari Laurikka.

29 records · Page 2Linked to original sources
PubMed2003

Arrhythmias in off-pump coronary artery bypass grafting and the antiarrhythmic effect of regional ischemic preconditioning.

OBJECTIVE: The authors sought to establish whether regional ischemic preconditioning (IP) reduces ischemic reperfusion arrhythmias in patients who undergo off-pump coronary artery bypass grafting (OPCAB). DESIGN: A controlled, randomized, prospective study. SETTING: A university hospital. PARTICIPANTS: Thirty-two patients with left anterior descending coronary artery (LAD) or 2-vessel heart disease (including LAD) who were to undergo OPCAB were randomized into an IP and a control group. INTERVENTIONS: IP was induced by occluding the LAD twice for a 2-minute period followed by 3-minute LAD reperfusion before bypass grafting of the first coronary vessel. MEASUREMENTS AND MAIN RESULTS: Twenty-four-hour electrocardiography was recorded from the preoperative day to the second postoperative day. The heart rate (HR) was significantly elevated after surgery. Supraventricular extrasystole (SVES) events were similar before and after surgery. The incidence of patients with ventricular extrasystole (VES), supraventricular tachycardia (SVT), atrial fibrillation (AF), and ventricular tachycardia (VT) was significantly increased after the operation. Ventricular arrhythmias occurred mostly during anastomosis and the early reperfusion period and recovered 2 hours after reperfusion. Supraventricular tachyarrhythmias were mostly encountered 24 hours after reperfusion. IP significantly suppressed HR elevation, SVT, and VT after surgery. SVES, VES, and AF episodes were similar between the groups. CONCLUSIONS: Arrhythmia was a common phenomenon during and after an OPCAB procedure. The present IP protocol significantly suppressed HR elevation, the episodes of SVT, and the incidence of VT after surgery.

Adult↗
PubMed2003

Recent unstable angina and off-pump coronary artery bypass grafting is not related to postoperative atrial fibrillation.

OBJECTIVE: Atrial fibrillation (AF) is the most frequently encountered postoperative arrhythmic complication after coronary artery bypass grafting (CABG). The purpose of the present study was to investigate the incidence and predictors of postoperative AF in patients with stable and unstable angina pectoris undergoing on-pump and off-pump CABG procedures. DESIGN: One hundred and seventeen stable, unstable on-pump and off-pump CABG patients were included in the present study. Holter data were collected 1 day before the operation to the 2nd postoperative day. AF was registered as positive if any AF event occurred. RESULTS: The overall incidence of postoperative AF and sustained AF was 31.6 and 25.6%, respectively. Postoperative AF incidences in stable on-pump, unstable on-pump and stable off-pump patients were 29.5, 39.0 and 25%, respectively (p = 0.412). Patients with AF had compromised postoperative haemodynamic function, greater need of inotropic support and antiarrhythmic medication, and longer intensive care unit (ICU) stays. CONCLUSION: Post-CABG AF is associated with more complicated postoperative outcome. Recent unstable angina and off-pump procedure is not related to the occurrence of post-CABG AF.

Aged↗
PubMed2003

Soluble adhesion molecules in coronary artery bypass surgery.

Plasma levels of sE-selectin, sP-selectin, and sICAM-1 were measured before anesthesia and at 0.5, 4, and 20 hours after cardiopulmonary bypass in 37 men undergoing coronary artery bypass surgery. Plasma sE-selectin remained close to the preoperative levels. The levels of sP-selectin increased significantly from 46.5 +/- 15.3 ng x mL(-1) to 69.3 +/- 39.6 ng x mL(-1) at 0.5 hours, 84.1 +/- 45.5 ng x mL(-1) at 4 hours, and 79.6 +/- 35.5 ng x mL(-1) at 20 hours. Plasma sICAM-1 levels decreased 0.5 hours after cardiopulmonary bypass, recovered at 4 hours, and showed a significant increase at 20 hours. The changes in plasma levels of adhesion molecules did not correlate with the duration of bypass or aortic crossclamping, hemodynamics, or creatine kinase-MB levels. However, sE-selectin and sICAM-1 levels increased considerably more in patients who needed norepinephrine in the intensive care unit. These results indicate that the transient changes in plasma levels of soluble adhesion molecules are not associated with postoperative myocardial injury in low-risk coronary grafting, although they correlate with the need for a vasopressor.

Aged↗
PubMed2002

Ischemic preconditioning suppresses ventricular tachyarrhythmias after myocardial revascularization.

BACKGROUND: Ventricular fibrillation (VF) and tachycardia (VT) are the common and potential life-threatening complications after CABG. Ischemic preconditioning (IP) has been proved effective in reducing ischemia reperfusion arrhythmia in animals and humans. Whether IP is effective in suppressing postoperative VF/VT in patients with CABG has not been studied. METHODS AND RESULTS: Eighty-six patients with CABG with stable and unstable 3-vessel disease were equally randomly assigned into an IP and a control group. The patients who received IP received 2 periods of 2-minute ischemia followed by 3-minute reperfusion. Twenty-four-hour electrocardiographic data were collected. IP resulted in fewer cases of VF after declamping (48.8% versus 79.1% in IP and control, P=0.004) and a shorter VF period (2.28+/-0.44 versus 4.41+/-0.51 minutes, P=0.002). The episodes of VT were significantly reduced in patients in the IP group during early reperfusion and 24 hours after reperfusion (0.65+/-0.16 versus 3.71+/-0.46, P=0.000 and 0.07+/-0.04 versus 2.12+/-1.41, P=0.002, respectively). De novo sustained VT occurred in 3 control patients as against none in the IP group after surgery. As a result, IP significantly curtailed the mechanical ventilation period and reduced the need for inotropes. CONCLUSIONS: IP significantly reduced postoperative VF/VT in patients with CABG with 3-vessel disease. Suppression of VT during early reperfusion and 24 hours after reperfusion suggests early and delayed IP phenomena in patients undergoing CABG surgery.

Aged↗
PubMed2002

Performance of three preoperative risk indices; CABDEAL, EuroSCORE and Cleveland models in a prospective coronary bypass database.

OBJECTIVES: The aim of the present study was to evaluate the performance of three different preoperative risk models in the prediction of postoperative morbidity and mortality in coronary artery bypass (CAB) surgery. METHODS: Data on 1132 consecutive CAB patients were prospectively collected, including preoperative risk factors and postoperative morbidity and in-hospital mortality. The preoperative risk models CABDEAL, EuroSCORE and Cleveland model were used to predict morbidity and mortality. A C statistic (receiver operating characteristic (ROC) curve) was used to test the discrimination of these models. RESULTS: The area under the ROC curve for morbidity was 0.772 for the CABDEAL, 0.694 for the EuroSCORE and 0.686 for the Cleveland model. Major morbidity due to postoperative complications occurred in 268 patients (23.6%). The mortality rate was 3.4% (n=38 patients). The ROC curve areas for prediction of mortality were 0.711 for the CABDEAL, 0.826 for the EuroSCORE and 0.858 for the Cleveland model. CONCLUSIONS: The CABDEAL model was initially developed for the prediction of major morbidity. Thus, it is not surprising that this model evinced the highest predictive value for increased morbidity in this database. Both the Cleveland and the EuroSCORE models were better predictive of mortality. These results have implications for the selection of risk indices for different purposes. The simple additive CABDEAL model can be used as a hand-held model for preoperative estimation of patients' risk of postoperative morbidity, while the EuroSCORE and Cleveland models are to be preferred for the prediction of mortality in a large patient sample.

Aged↗
PubMed2002

Cardioprotective effect of pump prime aprotinin in coronary artery bypass grafting.

BACKGROUND: Several studies have reported that high-dose aprotinin is cardioprotective in coronary surgery. The cardioprotective efficacy of low-dose aprotinin is less well defined. The present randomised study evaluated the cardioprotective and anti-inflammatory effects of pump prime aprotinin in patients undergoing coronary bypass surgery. METHODS: Sixty-four male patients admitted for first-time elective coronary artery bypass surgery were randomised into control or aprotinin groups. Patients in the aprotinin group received 280 mg of aprotinin in the pump prime. Postoperative CK-MB release, leukocyte counts and hemodynamics were recorded. Perioperative myeloperoxidase, IL-6, IL-8 and IL-10 levels were measured in a subgroup of patients (15 patients in each group). RESULTS: There were no significant differences between the groups in mechanical ventilation time and ICU and hospital stay. Postoperative bleeding was less serious in the aprotinin group than in the controls (742.0 +/- 361.1 versus 885.2 +/- 335.1 ml, p = 0.12) and CK-MB values were significantly lower (6 hrs, 35.5 +/- 11.8 versus 4.5 +/- 24.0 U/L; 24 hrs, 32.3 +/- 25.0 versus 40.2 +/- 26.8 U/L; 48 hrs, 15.9 +/- 7.0 versus 24.7 +/- 21.1 U/L; p=0.041). Perioperative hemodynamics was similar in both groups. There was a tendency towards less vasopressor and inotropes use in the pump prime aprotinin group. There was no significant difference between groups in terms of perioperative myeloperoxidase, IL-6, IL-8 and IL-10 levels. CONCLUSIONS: Pump prime aprotinin marginally limits myocardial enzyme release, but fails to limit inflammatory responses after elective coronary surgery.

Aged↗
PubMed2002

Soluble adhesion molecules in coronary surgery and cardiopulmonary bypass with pump prime aprotinin.

OBJECTIVE: The purpose of the present study was to establish whether pump prime aprotinin could influence soluble adhesion molecules in patients undergoing elective coronary artery bypass surgery. DESIGN: Thirty patients admitted for first-time elective coronary artery bypass surgery were randomized into control or aprotinin groups. Patients in the aprotinin group received 280 mg of aprotinin in the pump prime. Plasma levels of soluble adhesion molecules were analyzed perioperatively. RESULTS: There were no significant changes in plasma sE-selectin after the operation in either group. Plasma sP-selectin increased significantly up to 20 h after reperfusion to the myocardium. Plasma sICAM-1 decreased in the early stage after cardiopulmonary bypass (CPB), then recovered at 4 h after reperfusion and a significant increase in sICAM-1 was observed 20 h later. There were no significant differences between the groups in postoperative changes in sP-selectin (p = 0.21) and sICAM-1 (p = 0.91). CONCLUSION: Pump prime aprotinin did not influence plasma levels of E-selectin, P-selectin and ICAM-1 in the present patients. The present results do not support the concept of an anti-inflammatory effect of pump prime aprotinin.

Aged↗
PubMed2002

Regional ischemic preconditioning enhances myocardial performance in off-pump coronary artery bypass grafting.

OBJECTIVES: We intended to investigate whether ischemic preconditioning (IP) enhances myocardial performance in patients who undergo off-pump coronary artery bypass grafting (CABG). DESIGN: A controlled, randomized, prospective study. SETTING: A university hospital. PATIENTS: Thirty-two patients with left anterior descending coronary artery (LAD) or two-vessel heart disease (including LAD) who were to undergo off-pump CABG were randomized into an IP group and a control group. INTERVENTIONS: IP was induced by occluding the LAD twice for a 2-min period followed by 3-min LAD reperfusion before bypass grafting of the first coronary vessel. MEASUREMENTS AND RESULTS: Registration included hemodynamic data from the peripheral artery and the pulmonary artery, and the measurement of cardiac troponin I (CTnI) and creatine kinase isoenzyme MB (CK-MB) values. IP resulted in a complete recovery of the mean stroke volume index (SVI) after the operation. In the control subjects, the mean SVI showed a significant reduction postoperatively (p = 0.039). On the first postoperative day, the increase in the mean heart rate (HR) was also significantly lower in the IP patients. The CTnI level was statistically significantly lower in the IP group (p = 0.043), and IP patients tended to have a smaller CK-MB release after surgery (not significant). The duration of mechanical ventilation, the length of stay in the ICU, and the use of inotropic medication did not increase after the IP protocol. CONCLUSIONS: Two cycles of regional 2-min IP in the LAD, followed by 3 min of reperfusion, proved to be applicable and safe in patients undergoing off-pump myocardial revascularization, it tended to decrease the immediate myocardial enzyme release, it prohibited the postoperative increase in HR, and it enhanced the recovery of SVI.

Adult↗
PubMed2002

Regional differences in the use of a vascular surgical service and incidence of amputations in a well-defined geographical area.

OBJECTIVE: To evaluate regional differences in the use of a vascular surgical service in the treatment of critical lower limb ischaemia and incidence of amputation in the 1990s in a well-defined geographical area. DESIGN: Retrospective study. SETTING: One university and five county hospitals, Finland. SUBJECTS: All referrals to the university hospital vascular surgical unit for chronic critical lower limb ischaemia and the number of major amputations in the region. MAIN OUTCOME MEASURES: Numbers of new vascular surgical consultations and amputations in 11 municipalities. Correlation between numbers of consultations and amputations. RESULTS: Between the subregions the age-standardised incidence of new vascular surgical consultations in the 15-85 year old population varied from 52.4 to 104.7/10(5) and the incidence of amputation from 10.2 to 24.8/10(5). There was an inverse correlation between the numbers of consultations and amputations. The most significant inverse correlation was between consultations and below knee amputations in diabetic patients (r = -0.70). For above knee amputations there was no correlation (r = -0.21). CONCLUSION: An active referral policy leads to reduced amputation rates.

Ambulatory Care↗
PubMed2001

Cytokine Responses in Low-Risk Coronary Artery Bypass Surgery.

Inflammatory cytokines have been implicated in myocardial function, severe congestive heart failure and sepsis. The present study tested the hypothesis that cytokine levels are elevated after low-risk coronary artery bypass surgery (CABG), and that they may be associated with postoperative cardiac dysfunction. Twenty male patients undergoing elective CABG in cardiopulmonary bypass (CPB) were studied. Plasma levels of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, IL-8, and IL-10 were measured before anesthesia induction, 5 minutes after, and 1, 4, and 20 hours after reperfusion to the myocardium. Levels of the MB isoenzyme of creatine kinase (CK-MB) were measured postoperatively. Hemodynamic data were also recorded. Myocardial ischemia was followed by an increase in the plasma levels of IL-6, IL-8, and IL-10. The duration of IL-6 response lasted throughout the postoperative period studied. Plasma cytokine levels at 1 hour after reperfusion correlated with the maximum CK-MB value (IL-6, r = 0.587, p < 0.01; IL-8, r = 0.460, p < 0.05; IL-10, r = 0.570, p < 0.05). Higher plasma IL-6 and IL-8 levels after reperfusion tended to be linked with lower cardiac index. The present results confirm that the levels of inflammatory cytokines IL-6, IL-8, and IL-10 are elevated after CABG. Increased systemic pro-inflammatory cytokine levels were partially associated with postoperative myocardial dysfunction. </hea

Journal Article↗