Sodium-hydrogen exchange inhibition by cariporide to reduce the risk of ischemic cardiac events in patients undergoing coronary artery bypass grafting: results of the EXPEDITION study.

Background: The EXPEDITION study addressed the efficacy and safety of inhibiting the sodium hydrogen exchanger isoform-1 (NHE-1) by cariporide in the prevention of death or myocardial infarction (MI) in patients undergoing coronary artery bypass graft surgery. The premise was that inhibition of NHE-1 limits intracellcular Na accumulation and thereby limits Na/Ca-exchanger-mediated calcium overload to reduce infarct size.

Methods: High-risk coronary artery bypass graft surgery patients (n = 5,761) were randomly allocated to receive either intravenous cariporide (180 mg in a 1-hour preoperative loading dose, then 40 mg per hour over 24 hours and 20 mg per hour over the subsequent 24 hours) or placebo.

Risk factor identification and mortality prediction in cardiac surgery using artificial neural networks.

Objective: The artificial neural network model is a nonlinear technology useful for complex pattern recognition problems. This study aimed to develop a method to select risk variables and predict mortality after cardiac surgery by using artificial neural networks.

Methods: Prospectively collected data from 18,362 patients undergoing cardiac surgery at 128 European institutions in 1995 (the European System for Cardiac Operative Risk Evaluation database) were used.

Long-term outcome of the MitroFlow pericardial bioprosthesis in the elderly after aortic valve replacement.

Background And Aim Of The Study: The current trend in Europe and the USA demonstrates an increased number of tissue valves being implanted. However, studies presenting long-term follow up of the Mitroflow pericardial bioprosthesis are relatively scarce. In the present study, the long-term outcome of the Mitroflow in the aortic position was analyzed in a geriatric population using actuarial statistics; risk factors for early and late mortality were also evaluated.

Quality of life in the very elderly after cardiac surgery: a comparison of SF-36 between long-term survivors and an age-matched population.

Background: Octogenarians are the fastest growing section of the population in Western countries. Since health care resources are limited, there is a need for critical evaluations of the long-term surgical outcome and quality of life in the elderly.

Objectives: Our aim was to assess the quality of life and long-term survival after cardiac surgery in the very elderly.

Leaflet arrest in St Jude Medical and CarboMedics valves: an experimental study.

Objective: Two patients who suffered acute failure of their St Jude Medical Masters aortic valve prostheses due to leaflet arrest that were unrelated to suture material are presented. It was hypothesized that the valves failed because force applied to bear upon the valve annulus caused the hinge mechanism to become restricted or to arrest.

Methods: A study was designed to measure the force that would cause leaflet arrest in three sizes of St Jude Medical Masters valves and CarboMedics mechanical valves.

Impact of sodium-hydrogen exchange inhibition by cariporide on death or myocardial infarction in high-risk CABG surgery patients: results of the CABG surgery cohort of the GUARDIAN study.

Objectives: To evaluate the effects of cariporide on all-cause mortality or myocardial infarction at 36 days in patients at risk of myocardial necrosis after coronary artery bypass graft surgery.

Methods: In the coronary artery bypass graft cohort of the GUARD During Ischemia Against Necrosis trial, patients > or =18 years who required urgent coronary artery bypass graft, repeat coronary artery bypass graft, or had a history of unstable angina and > or =2 risk factors (age >65 years, female gender, diabetes mellitus, ejection fraction <35%, or left main or 3-vessel disease) were randomized to placebo (n = 743) or cariporide 20 mg (n = 736), 80 mg (n = 705), or 120 mg (n = 734). A 1-hour intravenous infusion was initiated shortly before surgery and administered every 8 hours for 2 to 7 days.

Cause of late death after cardiac surgery in the very elderly: a single institution experience.

Objectives: The referrals of elderly for cardiac surgery are increasing. The aim of this retrospective study is to review the long-term survival and to identify causes of late death in elderly after cardiac surgery.

Design: Between 1990 and 1993, 130 octogenarians underwent cardiac surgery in our department.