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Hultkvist, H., Holm, J., Svedjeholm, R. & Vánky, F. (2018). Rise and fall of NT-proBNP in aortic valve intervention.. Open heart, 5(1), Article ID e000739.
Open this publication in new window or tab >>Rise and fall of NT-proBNP in aortic valve intervention.
2018 (English)In: Open heart, ISSN 2053-3624, Vol. 5, no 1, article id e000739Article in journal (Refereed) Published
Abstract [en]

Objectives: To describe the dynamics of N-terminal pro-B-type natriuretic peptide (NT-proBNP) from preoperative evaluation to 6-month follow-up in patients undergoing aortic valve intervention, and to evaluate NT-proBNP with regard to 1-year mortality.

Methods: At preoperative evaluation, we prospectively included 462 patients accepted for aortic valve intervention. The median time to surgical aortic valve replacement (SAVR; n=336) or transcatheter aortic valve implantation (TAVI; n=126) was 4 months. NT-proBNP was measured at enrolment for preoperative evaluation, on the day of surgery, postoperatively on day 1, day 3 and at the 6-month follow-up. Subgroups of patients undergoing SAVR with aortic regurgitation and aortic stenosis with and without coronary artery bypass were also analysed.

Results: NT-proBNP remained stable in all subgroups during the preoperative waiting period, but displayed a substantial transient early postoperative increase with a peak on day 3 except in the TAVI group, which peaked on day 1. At the 6-month follow-up, NT-proBNP had decreased to or below the preoperative level in all groups. In the SAVR group, NT-proBNP preoperatively and on postoperative days 1 and 3 revealed significant discriminatory power with regard to 1-year mortality (area under the curve (AUC)=0.79, P=0.0001; AUC=0.71, P=0.03; and AUC=0.79, P=0.002, respectively). This was not found in the TAVI group, which had higher levels of NT-proBNP both preoperatively and at the 6-month follow-up compared with the SAVR group.

Conclusions: The dynamic profile of NT-proBNP differed between patients undergoing TAVI and SAVR. NT-proBNP in the perioperative course was associated with increased risk of 1-year mortality in SAVR but not in TAVI.

Keywords
aortic valve disease, heart failure, surgery-valve
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-149013 (URN)10.1136/openhrt-2017-000739 (DOI)29632678 (PubMedID)
Available from: 2018-06-25 Created: 2018-06-25 Last updated: 2018-07-26
Hansson, E. C., Jidéus, L., Åberg, B., Bjursten, H., Dreifaldt, M., Holmgren, A., . . . Jeppsson, A. (2016). Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study. European Heart Journal, 37(2), 189-197
Open this publication in new window or tab >>Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study
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2016 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, no 2, p. 189-197Article in journal (Refereed) Published
Abstract [en]

AIMS: Excessive bleeding impairs outcome after coronary artery bypass grafting (CABG). Current guidelines recommend withdrawal of clopidogrel and ticagrelor 5 days (120 h) before elective surgery. Shorter discontinuation would reduce the risk of thrombotic events and save hospital resources, but may increase the risk of bleeding. We investigated whether a shorter discontinuation time before surgery increased the incidence of CABG-related major bleeding complications and compared ticagrelor- and clopidogrel-treated patients.

METHODS AND RESULTS: All acute coronary syndrome patients in Sweden on dual antiplatelet therapy with aspirin and ticagrelor (n = 1266) or clopidogrel (n = 978) who underwent CABG during 2012-13 were included in a retrospective observational study. The incidence of major bleeding complications according to the Bleeding Academic Research Consortium-CABG definition was 38 and 31%, respectively, when ticagrelor/clopidogrel was discontinued <24 h before surgery. Within the ticagrelor group, there was no significant difference between discontinuation 72-120 or >120 h before surgery [odds ratio (OR) 0.93 (95% confidence interval, CI, 0.53-1.64), P = 0.80]. In contrast, clopidogrel-treated patients had a higher incidence when discontinued 72-120 vs. >120 h before surgery (OR 1.71 (95% CI 1.04-2.79), P = 0.033). The overall incidence of major bleeding complications was lower with ticagrelor [12.9 vs. 17.6%, adjusted OR 0.72 (95% CI 0.56-0.92), P = 0.012].

CONCLUSION: The incidence of CABG-related major bleeding was high when ticagrelor/clopidogrel was discontinued <24 h before surgery. Discontinuation 3 days before surgery, as opposed to 5 days, did not increase the incidence of major bleeding complications with ticagrelor, but increased the risk with clopidogrel. The overall risk of major CABG-related bleeding complications was lower with ticagrelor than with clopidogrel.

Place, publisher, year, edition, pages
Oxford University Press, 2016
Keywords
Acute coronary syndrome; Bleeding complications; Cardiac surgery; Dual antiplatelet therapy
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124323 (URN)10.1093/eurheartj/ehv381 (DOI)000370974300019 ()26330426 (PubMedID)
Note

Funding agencies:  AstraZeneca; Swedish Heart and Lung Foundation [20120372, 2014021]

Available from: 2016-01-26 Created: 2016-01-26 Last updated: 2017-05-03
Olsson, A., Alfredsson, J., Håkansson, E., Svedjeholm, R., Berglund, J. & Berg, S. (2016). Protamine reduces whole blood platelet aggregation after cardiopulmonary bypass. Scandinavian Cardiovascular Journal, 50(1), 58-63
Open this publication in new window or tab >>Protamine reduces whole blood platelet aggregation after cardiopulmonary bypass
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2016 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 1, p. 58-63Article in journal (Refereed) Published
Abstract [en]

Platelet dysfunction is an important cause of postoperative bleeding after cardiac surgery. Protamine is routinely used for reversal of heparin after cardiopulmonary bypass (CBP), but may affect platelet aggregation. We assessed changes in platelet function in relation to protamine administration. Design: Platelet aggregation was analyzed by impedance aggregometry before and after protamine administration in 25 adult cardiac surgery patients. Aggregation was also studied after in vitro addition of heparin and protamine. The activators adenosine diphosphate (ADP), thrombin receptor activating peptide-6 (TRAP), arachidonic acid (AA) and collagen (COL) were used.Results: Platelet aggregation was reduced by approximately 50% after in vivo protamine administration; ADP 640 +/- 230 (AU*min, mean +/- SD) to 250 +/- 160, TRAP 939 +/- 293 to 472 +/- 260, AA 307 +/- 238 to 159 +/- 143 and COL 1022 +/- 350 to 506 +/- 238 (all p&lt;0.001). Aggregation was also reduced after in vitro addition of protamine alone with activators ADP from 518 +/- 173 to 384 +/- 157 AU*min p&lt;0.001, and AA 449 +/- 311 to 340 +/- 285 (p&lt;0.01) and protamine combined with heparin (1:1 ratio) with activators ADP to 349 +/- 160 and AA to 308 +/- 260 (both p&lt;0.001); and COL from 586 +/- 180 to 455 +/- 172 (p&lt;0.05). Conclusions: Protamine given after CPB markedly reduces platelet aggregation. Protamine added in vitro also reduces platelet aggregation, by itself or in combination with heparin.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2016
Keywords
Cardiopulmonary bypass; platelet aggregation; platelet function tests; protamine
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-124094 (URN)10.3109/14017431.2015.1099720 (DOI)000365693900009 ()26402229 (PubMedID)
Note

Funding Agencies|Blekinge Institute of Technology, Karlskrona; Department of Cardiothoracic Anaesthesiology and Intensive Care, County Council of Ostergotland [LIO-284621]

Available from: 2016-01-25 Created: 2016-01-19 Last updated: 2018-04-03
Vánky, F., Hultkvist, H., Svedjeholm, R. & Nilsson, L. (2015). Is the present definition of mycardial infarction in transcatheter aortic valve implantation relevant for the postprocedulal outcome?. In: : . Paper presented at 7th joint Scandinavian Conference in Cardiothoracic Surgery,Bergen, Norway, 3-5 September 2015 (pp. 30-30).
Open this publication in new window or tab >>Is the present definition of mycardial infarction in transcatheter aortic valve implantation relevant for the postprocedulal outcome?
2015 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Background: The association between biomarkers and adverse procedural outcome has been established. However, the additive prognostic importance of signs and symptoms according to the Valve Academic Research Consortium (VARC)-2 criteria for periprocedural myocardial infarction (MI) are more uncertain.

Aim: To evaluate the relevance of the individual components of the VARC-2 criteria for periprocedural myocardial infarction (MI) in transcatheter aortic valve implantation (TAVI).Methods: A total of 125 consecutive TAVI patients were prospectively included in this study. Biomarkers for MI were analyzed and signs and symptoms according to VARC-2 criteria were collected from clinical records.

Results: The criteria of elevated biomarkers and of signs or symptoms were found in 27 ( 22%) and 32 ( 26%) of the patients, respectively. According to VARC-2 definition, 12 (10%) had MI. VARC-2 definition of MI, Troponin T (TnT) >600 ng/L, and presence of signs or symptoms correlated with 6 month mortality, prolonged ICU stay, elevation of N-terminal prohormone brain natriuretic peptide, and renal impairment. No signs or symptoms were found in 7 (4 4%) of the patients who fulfilled the criterion of elevated TnT>600 ng/L. In the group with positive TnT criterion, there were no significant differences between those with and without signs or symptoms in respect to levels of TnT (1014 [585-1720] ng/L versus 704 [515-905] ng/L, p=0.17) or creatine kinase-MB ( 36 [25-52] μg/L versus 29 [25-39] μg/L, p=0.32). In the multiple logistic regression model, TnT>600 ng/L turned out as the only independent variable associated with 6-month mortality, OR 7.89 (95% CI 2.21-28.1, p = 0.001).

Conclusion: Myocardial injury in TAVI, measured with TnT, correlates well with adverse procedural outcome. The additional requirement of signs or symptoms for the diagnosis of MI results in omission of a considerable number of clinically significant MI.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124325 (URN)
Conference
7th joint Scandinavian Conference in Cardiothoracic Surgery,Bergen, Norway, 3-5 September 2015
Available from: 2016-01-26 Created: 2016-01-26 Last updated: 2016-02-08Bibliographically approved
Jiang, H., Zhang, L., Hu, H., Hua, P., Zeng, K., Wang, M., . . . Yang, Y. (2015). Mixed venous oxygen saturation as an index of goal-directed therapy in postoperative care after cardiac surgery.. In: 23rd annual meeting of the Asian Society for Cardiovascular and Thoracic Surgery, 11-14 May 2015: . Paper presented at 23rd annual meeting of the Asian Society for Cardiovascular and Thoracic Surgery, Hong Kong, 11-14 May 2015.
Open this publication in new window or tab >>Mixed venous oxygen saturation as an index of goal-directed therapy in postoperative care after cardiac surgery.
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2015 (English)In: 23rd annual meeting of the Asian Society for Cardiovascular and Thoracic Surgery, 11-14 May 2015, 2015Conference paper, Published paper (Other academic)
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124324 (URN)
Conference
23rd annual meeting of the Asian Society for Cardiovascular and Thoracic Surgery, Hong Kong, 11-14 May 2015
Available from: 2016-01-26 Created: 2016-01-26 Last updated: 2016-02-08
Jiang, H., Zhang, L., Svedjeholm, R. & Yang, Y. (2015). Mixed venous oxygen saturation as an index of goal-directed therapy in postoperative care after cardiac surgery.. In: : . Paper presented at 7th joint Scandinavian Conference in Cardiothoracic Surgery,Bergen, Norway, 3-5 September 2015 (pp. 79-79).
Open this publication in new window or tab >>Mixed venous oxygen saturation as an index of goal-directed therapy in postoperative care after cardiac surgery.
2015 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background: Adequate mixed venous oxygen saturation (SvO2) indicates sufficient oxygen supply and better prognosis after cardiac surgery.

Aim: In this study, clinical significance of SvO2 as an index of goal-directed therapy in postope-rative care after cardiac surgery was retrospectively assessed.

Methods: SvO2 was collected postoperatively from 741 consecutive adult patients under-going different types of cardiac surgery. SvO2 on admission to ICU was defined as base point (SvO2base). SvO2 was followed every 6 hours or whenever necessary to evaluate efficacy of postoperative therapy in the first 24 hours. Receiver operating characteristic (ROC) analysis was used to analyze changes of SvO2 (△SvO2) in relation to hospital mortality.

Results: SvO2base demonstrated significant discriminatory power with regard to hospital mortality ( AUC 0.70; 95% CI 0.57-0.81; P=0.000). The best cutoff for SvO2base was 56.8%. Average △SvO2A for patients with SvO2base ≤56.8% (Group A ) was 10.6%. The best cutoff for △SvO2A with regard to hospital mortality was 6.6%, with a sensitivity of 0.68 and speci-ficity of 0.72. The negative predictive value was 91.2%. Average △SvO2B for patients with SvO2base>56.8% (Group B) was -2.4%. The best cutoff for △SvO2B with regard to hospital mortality was -4.5%, with a sensitivity of 0.61 and specificity of 0.79.The negative predictive value was 99.5%.

Conclusion: An increase of SvO2 by more than 6.6% in patients with SvO2base≤56.8% may improve prognosis significantly. Goal of ICU therapy for patients with SvO2base> 56.8% should be to avoid a drop of SvO2 by more than 4.5%, in order to prevent from worsened prognosis.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124326 (URN)
Conference
7th joint Scandinavian Conference in Cardiothoracic Surgery,Bergen, Norway, 3-5 September 2015
Available from: 2016-01-26 Created: 2016-01-26 Last updated: 2016-02-08Bibliographically approved
Svedjeholm, R. & Maathz, A. (2015). Preoperative discountinuation of warfarin and postoperative bleeding after cardiac surgery.. In: : . Paper presented at 7th Joint Scandinavian Conference in Cardiothoracic Surgery, 3-5 September 2015 Bergen,Norway.
Open this publication in new window or tab >>Preoperative discountinuation of warfarin and postoperative bleeding after cardiac surgery.
2015 (English)Conference paper, Published paper (Refereed)
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124327 (URN)
Conference
7th Joint Scandinavian Conference in Cardiothoracic Surgery, 3-5 September 2015 Bergen,Norway
Available from: 2016-01-26 Created: 2016-01-26 Last updated: 2016-01-26
Ågren, S., Berg, S., Svedjeholm, R. & Strömberg, A. (2015). Psychoeducational support to post cardiac surgery heart failure patients and their partners: A randomised pilot study. Intensive & Critical Care Nursing, 31(1), 10-18
Open this publication in new window or tab >>Psychoeducational support to post cardiac surgery heart failure patients and their partners: A randomised pilot study
2015 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 1, p. 10-18Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Postoperative heart failure is a serious complication that changes the lives of both the person who is critically ill and family in many ways. The purpose of this study was to evaluate the effects of an intervention in postoperative heart failure patient-partner dyads regarding health, symptoms of depression and perceived control.

RESEARCH METHODOLOGY/DESIGN: Pilot study with a randomised controlled design evaluating psychosocial support and education from an interdisciplinary team.

SETTING: Patients with postoperative heart failure and their partners.

MAIN OUTCOME MEASURES: SF-36, Beck Depression Inventory, Perceived Control at baseline, 3 and 12 months.

RESULTS: A total of 42 patient-partner completed baseline assessment. Partners in the intervention group increased health in the role emotional and mental health dimensions and patients increased health in vitality, social function and mental health dimensions compared with the control group. Patients' perceived control improved significantly in the intervention group over time.

CONCLUSION: Psychoeducational support to post cardiac surgery heart failure dyads improved health in both patients and partners at short term follow-up and improved patients' perceived control at both short and long-term follow-up. Psychoeducational support appears to be a promising intervention but the results need to be confirmed in larger studies.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Education; Family; Heart failure; Intervention; Postoperative complications; Psychosocial support; Quality of life
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-109501 (URN)10.1016/j.iccn.2014.04.005 (DOI)000349930300002 ()24969363 (PubMedID)
Available from: 2014-08-20 Created: 2014-08-20 Last updated: 2017-12-05Bibliographically approved
Holm, J., Vidlund, M., Vánky, F., Friberg, O., Håkanson, E., Walther, S. & Svedjeholm, R. (2014). EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery. British Journal of Anaesthesia, 113(1), 75-82
Open this publication in new window or tab >>EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery
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2014 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 113, no 1, p. 75-82Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Postoperative heart failure remains the major cause of death after cardiac surgery. As N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor for postoperative heart failure, the aim was to evaluate if preoperative NT-proBNP could provide additional prognostic information to the recently launched EuroSCORE II.

METHODS:

A total of 365 patients with acute coronary syndrome (ACS) undergoing isolated coronary artery bypass graft (CABG) surgery were studied prospectively. Preoperative NT-proBNP and EuroSCORE II were evaluated with regard to severe circulatory failure after operation according to prespecified criteria. To assess what clinical outcomes are indicated by NT-proBNP levels in different risk categories, the patients were stratified according to EuroSCORE II. Based on receiver operating characteristics analysis, these cohorts were assessed with regard to preoperative NT-proBNP below or above 1028 ng litre(-1). The follow-up time averaged 4.4 (0.7) yr.

RESULTS:

Preoperative NT-proBNP≥1028 ng litre(-1) [odds ratio (OR) 9.9, 95% confidence interval (CI) 1.01-98.9; P=0.049] and EuroSCORE II (OR 1.24, 95% CI 1.06-1.46; P=0.008) independently predicted severe circulatory failure after operation. In intermediate-risk patients (EuroSCORE II 2.0-10.0), NT-proBNP≥1028 ng litre(-1) was associated with a higher incidence of severe circulatory failure (6.6% vs 0%; P=0.007), renal failure (14.8% vs 5.4%; P=0.03), stroke (6.6% vs 0.7%; P=0.03), longer intensive care unit stay [37 (35) vs 27 (38) h; P=0.002], and worse long-term survival.

CONCLUSIONS:

Combining EuroSCORE II and preoperative NT-proBNP appears to improve risk prediction with regard to severe circulatory failure after isolated CABG for ACS. NT-proBNP may be particularly useful in patients at intermediate risk according to EuroSCORE II.

Place, publisher, year, edition, pages
Oxford University Press, 2014
Keywords
acute coronary syndrome; coronary artery bypass surgery; natriuretic peptides; risk assessment
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-109246 (URN)10.1093/bja/aeu088 (DOI)000338598700011 ()24727704 (PubMedID)
Available from: 2014-08-12 Created: 2014-08-11 Last updated: 2017-12-05Bibliographically approved
Tajik, B., Vidlund, M., Sundbom, P., Friberg, Ö., Holm, J., Vanky, F. & Svedjeholm, R. (2014). Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?. In: : . Paper presented at 29th Annual meeting of the European Association of Cardiothoracic Anesthesiologists, Florence, Italy.
Open this publication in new window or tab >>Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?
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2014 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114367 (URN)
Conference
29th Annual meeting of the European Association of Cardiothoracic Anesthesiologists, Florence, Italy
Available from: 2015-02-19 Created: 2015-02-19 Last updated: 2015-11-09
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9945-7486

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