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  • 1.
    Appel, Carl-Fredrik
    et al.
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland. Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Hultkvist, Henrik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Ahn, Henrik Casimir
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Freter, Wolfgang
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland. Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Transcatheter versus surgical treatment for aortic stenosis: Patient selection and early outcome2012In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, no 5, p. 301-307Article in journal (Refereed)
    Abstract [en]

    Objectives. To describe short-term clinical and echocardiography outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). To explore patient selection criteria for treatment with TAVI. Design. TAVI patients (n = 45) were matched to SAVR patients (n = 45) with respect to age within +/- 10 years, sex and systolic left ventricular function. Results. TAVI patients were older, 82 +/- 8 versus 78 +/- 5 years (p = 0.005) and they had higher logEuroSCORE, 16 +/- 11% versus 8 +/- 4% (p andlt; 0.001). There were no significant differences in 30 days mortality, stroke and myocardial infarction. TAVI patients received less erythrocyte (53% vs. 78%, p = 0.03) and thrombocyte (7% vs. 27%, p = 0.02) transfusions. Postoperative atrial fibrillation was less common (18% vs. 60%, p andlt; 0.001) in the TAVI group. Paravalvular regurgitation was more common in TAVI patients (87% vs. 0%, p andlt; 0.001) and 27% had access site complications. Aortic transvalvular velocity was 2.3 +/- 0.4 m/s versus 2.6 +/- 0.5 m/s (p = 0.002) and mean valve pressure gradient was 12 +/- 4 mmHg versus 15 +/- 5 mmHg (p = 0.01) in the TAVI and SAVR groups, respectively. Twenty-nine (64%) of the TAVI patients had logEuroSCORE andlt; 15%. Conclusions. Both TAVI and SAVR have good short term clinical outcome with excellent hemodynamic result. In clinical practice, factors other than high logEuroSCORE play an important role in patient selection for TAVI.

  • 2.
    Baranowski, Jacek
    et al.
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Wallby, Lars
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Boano, Gabriella
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Löfström, Lars
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Johansson, Mats
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Nielsen, Nils-Erik
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    MitraClip efter hjärtinfarkt med akut papillarmuskelruptur och som behandling vid SAM efter mitralisplastik - 2 fallbeskrivningar2013Conference paper (Refereed)
  • 3. Baranowski, Jacek
    et al.
    Wallby, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Boano, Gabriella
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Löfstöm, Lars
    Johansson, Mats
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Nielsen, Niels-Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    MitraClip after myocardial infarction with papillary muscle rupture and as treatment of systolic anterior motion of the mitral valve.2014Conference paper (Refereed)
  • 4.
    Forsberg, Lena M
    et al.
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Tamas, Eva
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL. Linköping University, Center for Medical Image Science and Visualization, CMIV.
    Left and right ventricular function in aortic stenosis patients 8 weeks post-transcatheter aortic valve implantation or surgical aortic valve replacement2011In: European Journal of Echocardiography, ISSN 1525-2167, E-ISSN 1532-2114, Vol. 12, no 8, p. 603-611Article in journal (Refereed)
    Abstract [en]

    Aims Knowledge of longitudinal left and right ventricular (LV and RV) function after transcatheter aortic valve implantation (TAVI) is scarce. We hypothesized that the longitudinal systolic biventricular function in aortic stenosis (AS) patients is affected differently by TAVI and surgical aortic valve replacement (SAVR). less thanbrgreater than less thanbrgreater thanMethods and results Thirty-three AS patients (all-TAVI group, age 81 +/- 9 years, 18 female), with EuroSCORE 18 +/- 9%, were accepted for TAVI. Seventeen of these patients were matched (by gender, age, and LV function) to 17 patients undergoing SAVR. Conventional echocardiographic parameters, systolic atrioventricular plane displacement (AVPD) at standard sites and peak systolic velocity (PSV) by pulsed tissue Doppler at basal RV free wall, LV lateral wall, and septum were studied before and 8 weeks after the procedure. Procedural success was 100%, and 30-day mortality 9%. In all TAVI patients, AVPD(lateral), PSV(lateral), AVPD(septal), and PSV(septal) increased (P andlt; 0.001, 0.003, 0.006 and 0.002). When studying the matched patients postoperatively, both the SAVR and TAVI patients had increased PSV(lateral) and AVPD(lateral) (SAVR: P = 0.03 and P = 0.04, TAVI: P = 0.04 and P = 0.01). The PSV(RV) increased in the all-TAVI group (P = 0.007), while the AVPD(RV) was unchanged. SAVR patients had decreased AVPD(RV) (P = 0.001) and PSV(RV) (P = 0.004), while the matched TAVI patients had unchanged RV function parameters. less thanbrgreater than less thanbrgreater thanConclusion An improvement in regional longitudinal LV function in the septal and lateral wall could be seen after TAVI. Among the matched patients, both the TAVI and SAVR patients seemed to improve LV function in the lateral wall. RV systolic function increased in TAVI patients, but was impaired in the matched SAVR group at the 8-week follow-up.

  • 5.
    Forsberg, Lena M
    et al.
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Tamás, Eva
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Differences in recovery of left and right ventricular function following aortic valve interventions: a longitudinal echocardiographic study in patients undergoing surgical, transapical or transfemoral aortic valve implantation2013In: Catheterization and cardiovascular interventions, ISSN 1522-1946, E-ISSN 1522-726X, Vol. 82, no 6, p. 1004-1014Article in journal (Refereed)
    Abstract [en]

    Objectives

    To evaluate longitudinal left and right ventricular function (LVF and RVF) after transcatheter aortic valve implantation (TAVI) as compared to surgical aortic valve replacement (SAVR) and LVF and RVF after TAVI by the transfemoral (TF) or transapical (TA) approach.

    Background

    Knowledge about differences in recovery of LVF and RVF after TAVI and SAVR is scarce.

    Methods

    Sixty patients (age 81 ± 7 years, logistic EuroSCORE 16 ± 10%), undergoing TAVI (TF: n = 35 and TA: n  = 25), were examined by echocardiography including atrioventricular plane displacement (AVPD) and peak systolic velocities (PSV) by tissue Doppler at basal RV free wall, LV lateral wall and septum preprocedurally, 7 weeks and 6 months postprocedurally. Twenty-seven SAVR patients were matched to 27 TAVI patients by age, gender and LVF.

    Results

    Early postintervention, TAVI patients had improved longitudinal LVF. However, when analyzed separately, only TF, but not TA patients, had improved LV lateral and septal AVPD and PSV (all P ≤ 0.01). All TAVI patients, as well as the TF and TA group had unchanged longitudinal LVF between the early and late follow-ups (all P > 0.05). The SAVR group had higher septal LVF than the matched TAVI group preprocedurally, while postoperatively this difference was diminished. Longitudinal RVF was better in the TF group than in the TA group pre- and postprocedurally. Although the SAVR group had superior longitudinal RVF preoperatively, this was inferior to TAVI postoperatively.

    Conclusions

    Postprocedural longitudinal LVF and RVF in patients undergoing TF-TAVI, TA-TAVI, or SAVR differ considerably. Preservation of longitudinal RVF after TAVI might influence the selection of aortic valve intervention in the future.

  • 6.
    Holm, Jonas
    et al.
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland. Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Håkanson, Erik
    Linköping University, Department of Medical and Health Sciences, Cardiothoracic Anaesthesia and Intensive care. Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Mixed venous oxygen saturation predicts short- and long-term outcome after coronary artery bypass grafting surgery: a retrospective cohort analysis2011In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 107, no 3, p. 344-350Article in journal (Refereed)
    Abstract [en]

    Background. Complications of an inadequate haemodynamic state are a leading cause of morbidity and mortality after cardiac surgery. Unfortunately, commonly used methods to assess haemodynamic status are not well documented with respect to outcome. The aim of this study was to investigate SV(O2) as a prognostic marker for short-and long-term outcome in a large unselected coronary artery bypass grafting (CABG) cohort and in subgroups with or without treatment for intraoperative heart failure. less thanbrgreater than less thanbrgreater thanMethods. Two thousand seven hundred and fifty-five consecutive CABG patients and subgroups comprising 344 patients with and 2411 patients without intraoperative heart failure, respectively, were investigated. SV(O2) was routinely measured on admission to the intensive care unit (ICU). The mean (SD) follow-up was 10.2 (1.5) yr. less thanbrgreater than less thanbrgreater thanResults. The best cut-off for 30 day mortality related to heart failure based on receiver-operating characteristic analysis was SV(O2) 60.1%. Patients with SV(O2) andlt;60% had higher 30 day mortality (5.4% vs 1.0%; P andlt; 0.0001) and lower 5 yr survival (81.4% vs 90.5%; P andlt; 0.0001). The incidences of perioperative myocardial infarction, renal failure, and stroke were also significantly higher, leading to a longer ICU stay. Similar prognostic information was obtained in the subgroups that were admitted to ICU with or without treatment for intraoperative heart failure. In patients admitted to ICU without treatment for intraoperative heart failure and SV(O2) andgt;= 60%, 30 day mortality was 0.5% and 5 yr survival 92.1%. less thanbrgreater than less thanbrgreater thanConclusions. SV(O2) andlt;60% on admission to ICU was related to worse short- and long-term outcome after CABG, regardless of whether the patients were admitted to ICU with or without treatment for intraoperative heart failure.

  • 7.
    Holm, Jonas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Håkanson, R Erik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Mixed venous oxygen saturation is a prognostic marker after surgery for aortic stenosis2010In: ACTA ANAESTHESIOLOGICA SCANDINAVICA, ISSN 0001-5172, Vol. 54, no 5, p. 589-595Article in journal (Refereed)
    Abstract [en]

    Background Adequate monitoring of the hemodynamic state is essential after cardiac surgery and is vital for medical decision making, particularly concerning hemodynamic management. Unfortunately, commonly used methods to assess the hemodynamic state are not well documented with regard to outcome. Mixed venous oxygen saturation (SvO(2)) was therefore investigated after cardiac surgery. Methods Detailed data regarding mortality were available on all patients undergoing aortic valve replacement for isolated aortic stenosis during a 5-year period in the southeast region of Sweden (n=396). SvO(2) was routinely measured on admission to the intensive care unit (ICU) and registered in a database. A receiver operating characteristics (ROC) analysis of SvO(2) in relation to post-operative mortality related to cardiac failure and all-cause mortality within 30 days was performed. Results The area under the curve (AUC) was 0.97 (95% CI 0.96-1.00) for mortality related to cardiac failure (P=0.001) and 0.76 (95% CI 0.53-0.99) for all-cause mortality (P=0.011). The best cutoff for mortality related to cardiac failure was SvO(2) 53.7%, with a sensitivity of 1.00 and a specificity of 0.94. The negative predictive value was 100%. The best cutoff for all-cause mortality was SvO(2) 58.1%, with a sensitivity of 0.75 and a specificity of 0.84. The negative predictive value was 99.4%. Post-operative morbidity was also markedly increased in patients with a low SvO(2). Conclusion SvO(2), on admission to the ICU after surgery for aortic stenosis, demonstrated excellent sensitivity and specificity for post-operative mortality related to cardiac failure and a fairly good AUC for all-cause mortality, with an excellent negative predictive value.

  • 8.
    Holm, Jonas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vidlund, M.
    Örebro University Hospital, Sweden .
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Friberg, O.
    Örebro University Hospital, Sweden .
    Håkanson, E.
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery2014In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 113, no 1, p. 75-82Article in journal (Refereed)
    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.

  • 9.
    Holm, Jonas
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vidlund, Marten
    University of Örebro, Sweden .
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Friberg, Orjan
    University of Örebro, Sweden .
    Hakanson, Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Preoperative NT-proBNP independently predicts outcome in patients with acute coronary syndrome undergoing CABG2013In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 47, no 1, p. 28-35Article in journal (Refereed)
    Abstract [en]

    Objectives. The predictive value of preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) was evaluated in patients with acute coronary syndrome undergoing coronary artery bypass grafting (CABG). Design. As a substudy to a clinical trial 383 patients with acute coronary syndrome undergoing CABG were studied. 17 patients had a concomitant procedure. NT-proBNP was measured immediately preoperatively and evaluated with regard to in-hospital mortality, and severe circulatory failure postoperatively according to prespecified criteria. Follow-up was 3.2 +/- 0.9 years. Results. In patients with isolated CABG, receiver operating characteristics (ROC) analysis showed an area under the curve (AUC) of 0.82 for in-hospital mortality and 0.87 for severe circulatory failure respectively with a best cut-off for preoperative NT-proBNP of 1028 ng/L. This cut-off level independently predicted severe circulatory failure. Patients with NT-proBNP andlt; 1028 ng/L had significantly better long-term survival (p = 0.004). Preoperative NT-proBNP was higher in patients with concomitant procedure than isolated CABG (2146 +/- 1858 v 887 +/- 1635 ng/L; p = 0.0005). In patients with concomitant procedure ROC analysis showed an AUC of 0.93 for severe circulatory failure with a best cut-off for preoperative NT-proBNP of 3145 ng/L. Conclusions. Preoperative NT-proBNP predicted in-hospital mortality, severe circulatory failure postoperatively and long-term survival in patients undergoing surgery for acute coronary syndrome but a higher threshold was found in patients having concomitant procedures.

  • 10.
    Holm, Jonas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vidlund, Mårten
    University of Örebro, Sweden .
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Friberg, Örjan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Håkanson, Erik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Does preoperative NT-proBNP provide additional prognostic information to EuroSCORE II in patients undfergoing CABG?2013Conference paper (Other academic)
  • 11.
    Holm, Jonas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vidlund, Mårten
    Departments of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital.
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Friberg, Örjan
    Departments of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital.
    Håkanson, Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    EuroSCORE II and NT-proBNP for risk evaluation: an observational longitudinal study in patients undergoing CABGManuscript (preprint) (Other academic)
    Abstract [en]

    BACKGROUND: Postoperative heart failure remains the major cause of death after cardiac surgery. As 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: 365 patients with acute coronary syndrome (ACS) undergoing isolated CABG were studied prospectively. Preoperative NT-proBNP and EuroSCORE II were evaluated with regard to severe circulatory failure postoperatively 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 Reciever Operating Chracateristics (ROC) analysis these cohorts were assessed with regard to preoperative NT-proBNP below or above 1028 ng/L. Follow-up time averaged 4.4 ± 0.7 years.

    RESULTS: Preoperative NT-proBNP ≥ 1028 ng/L (OR 9.9, 95%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 postoperatively. In intermediate risk patients (EuroSCORE II 2.0 – 10.0) NT-proBNP ≥ 1028 ng/L 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 ICU stay (37±35 vs 27±38 hours; 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. NTproBNP may be particularly useful in patients at intermediate risk according to EuroSCORE II.

  • 12.
    Holm, Jonas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vidlund, Mårten
    Örebro University, Sweden.
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Friberg, Örjan
    Örebro University Hospital, Sweden.
    Håkansson, Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    NT-proBNP provides additional prognostic information to Euroscoe II in patients undergoing CABG2013Conference paper (Other academic)
  • 13.
    Hultkvist, Henrik
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vánky, Farkas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Betydelsen av Euroscore and postoperative hjärtsvikt för prognosen efter operation an aortastenos2008Conference paper (Other academic)
  • 14.
    Hultkvist, Henrik
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vánky, Farkas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Euroscore and postoperative heart failure predicts long-term mortality after aortic valve replacement for aortic stenosis.2008In: European Workgroup of Cardiothoracic Intensivists EWCI,2008, ICS , 2008Conference paper (Refereed)
  • 15.
    Hultkvist, Henrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    The combined impact of postoperative heart failure and euroScore on long-term outcome after surgery for aortic stenosis2011In: Journal of Heart Valve Disease, ISSN 0966-8519, E-ISSN 2053-2644, Vol. 20, no 6, p. 633-638Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM OF THE STUDY:

    Although the EuroSCORE was developed for predicting operative mortality after cardiac surgery, it has also been shown to predict long-term mortality. It has been reported that postoperative heart failure (PHF) in association with surgery, albeit comparatively benign in the short term, has a profound impact on five-year survival after surgery for aortic stenosis (AS). The study aim was to determine the combined impact of EuroSCORE and PHF on long-term survival after isolated aortic valve replacement (AVR) for AS.

    METHODS:

    A total of 397 patients (48% females; average age 70 +/- 10 years) who underwent AVR for AS at the authors' institution between 1995 and 2000 was studied. The cohort was subdivided according to the additive EuroSCORE into a high-risk group (EuroSCORE >7) and a low-risk group (EuroSCORE < or = 7), and further analyzed in relation to PHF.

    RESULTS:

    The average follow up was 8.1 years (range: 5.2-11.2 years). Forty-five patients (11%) were treated for procedure-associated PHF. Patients with or without PHF and a high-risk EuroSCORE had crude five-year survivals of 57% and 64%, respectively (p = 0.6), whereas those with or without PHF but with a low-risk EuroSCORE had crude five-year survivals of 58% and 89%, respectively (p = 0.0003).

    CONCLUSION:

    Both PHF and a high EuroSCORE were associated with poor long-term survival. The role of PHF per se for the long-term prognosis was illustrated by the fact that the negative impact on long-term survival was almost as profound in patients of the low-risk group as of the high-risk group.

  • 16.
    Lima, LE
    et al.
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Jatene, F
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Buffolo, E
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Vánky, Farkas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Casimir-Ahn, E
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Lohn, U
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Leprince, P
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Pavie, A
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Laczkovics, AMM
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Reichenspurner, H
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Calafiore, A
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Nataf, P
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    Mack, M
    Sta Lucia Hosp, CARDIOCTR, BR-70390905 Brasilia, DF, Brazil Anchieta Hosp, Incor, Brasilia, DF, Brazil Inst Heart, Sao Paulo, Brazil Univ Sao Paulo, Sao Paulo, Brazil Linkoping Heart Ctr, Linkoping, Sweden Hop La Pitie Salpetriere, Paris, France Cardiovasc Surg Ctr, Bochum, Germany Univ Hosp Grosshadern, Munich, Germany Univ G DAnnunzio, Chieti, Italy Ctr Cardiol Nord, St Denis, France Columbia Hosp, Dallas, TX USA.
    A multicenter initial clinical experience with right heart support and beating heart coronary surgery2001In: Heart Surgery Forum, ISSN 1098-3511, E-ISSN 1522-6662, Vol. 4, no 1, p. 61-64Article in journal (Refereed)
    Abstract [en]

    Background: During coronary surgery without CPB, exposure of posterior vessel via sternotomy can cause deterioration of cardiac hemodynamics requiring inotrope drugs support. Recent animal experiments demonstrate hemodynamic benefit of right heart support (RHS) with the AMED system. The purpose of this study was to evaluate the hemodynamic effects during cardiac manipulation to expose the posterior coronary arteries, and determine the effect of RHS in restoring hemodynamics, increasing anastomotic exposure and reducing inotropic requirements. Material and Methods: From July 28 to December 29, 32 patients (25 men/ 7 women), mean age of 63.4 (+/- 6.2 years, ages: 49 - 78) received coronary revascularization with the A-Med RHS device. They were divided into two groups of 16 patients, A and B. Group A patients had at least one circumflex branch bypassed. The anterior wall was systematically bypassed off-pump without RHS. The right coronary artery (RCA) and the obtuse coronary artery (OM) were completed utilizing RHS. In group B patients, all vessels including anterior vessels were bypassed with the RHS. Mean arterial pressure (MAP), mean pulmonary arterial pressure (PAP), cardiac output (CO) and the average pump flow (APF) were recorded during the OM and RCA bypass for group A, and for group B LAD data was also recorded. Results: Elective beating heart coronary artery bypass graft (CABG) was successfully accomplished in 32 patients with RHS. Data measurements recorded in Group A showed the improved hemodynamic recovery for OM and RCA bypass with RHS. The MAP increased from 44 to 68mmHg (OM) and from 63 to 81mmHg (RCA), the CO from 2.1 to 4.4 L/min (OM) and from 3.3 to 4.7 L/min (RCA). In group B, the data recorded showed the stability of the MAP in all vessels bypassed (LAD, OM and RCA). No device-related patient incidents ocurred. All 32 patients were discharged to their homes. Conclusons: The AMED system, as RHS support, facilitated coronary bypass without CPB to posterior vessels, restoring hemodynamics, providing better exposure to anastomotic sites and apparently reducing inotropes need. Prospective randomize trials are necessary to confirm this initial experience.

  • 17.
    Nilsson, Lennart
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Appel, Carl-Fredrik
    Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Hultkvist, Henrik
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Medicine and Health Sciences.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Medicine and Health Sciences.
    Evaluation of the Valve Academic Research Consortium-2 Criteria for Myocardial Infarction in Transcatheter Aortic Valve Implantation: A Prospective Observational Study2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 6, p. e0130423-Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the relevance of the individual components of the Valve Academic Research Consortium (VARC)-2 criteria for periprocedural myocardial infarction (MI) in transcatheter aortic valve implantation (TAVI). The association between biomarkers and adverse procedural outcome has been established. However, the additive prognostic importance of signs and symptoms are more uncertain. 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) greater than 600 ng/L, and presence of signs or symptoms correlated with 6 months mortality, prolonged ICU stay, elevation of N-terminal prohormone brain natriuretic peptide, and renal impairment. No signs or symptoms were found in 7 (44%) of the patients who fulfilled the criterion of elevated TnT greater than 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] mu g/L versus 29 [25-39] mu g/L, p = 0.32). In the multivariate Cox regression analysis, TnT greater than 600 ng/L was the only significant independent variable associated with 6-months postprocedural mortality. Conclusions Myocardial injury in TAVI, measured with biomarkers, correlates well with adverse procedural outcome. In this study it is also the strongest predictor for early postprocedural mortality. The additional requirement of signs or symptoms for the diagnosis of MI results in omission of a considerable number of clinically significant MI.

  • 18.
    Svedjeholm, Rolf
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Holm, Jonas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vánky, Farkas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Sv02 predicts short-term morbidity and mortality after CABG.2008In: 57th Annaul meeting of the Scandinavian Association for Thoracic Surgery,2008, 2008Conference paper (Refereed)
  • 19.
    Svedjeholm, Rolf
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Szabó, Zoltán
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vánky, Farkas
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Neurological injury after surgery for ischemic heart disease: risk factors, outcome and role of metabolic interventions2001In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, ISSN 1010-7940, Vol. 19, no 5, p. 611-618Article in journal (Refereed)
    Abstract [en]

    Objectives: Neurological complication remains a feared and increasing problem in association with cardiac surgery. The aim of this study was to analyze risk factors for neurological complications in a cohort of patients in whom inotropes for weaning from cardiopulmonary bypass was gradually replaced by metabolic treatment.

    Methods: The records of 775 consecutive patients undergoing coronary artery bypass grafting (CABG) or combined CABG+valve procedures were examined. Forward stepwise multiple logistic regression analysis was used for statistical evaluation of independent risk factors.

    Results: The incidence of neurological injury was 1.8% in patients undergoing isolated CABG and 5.4% after combined CABG+valve procedures. After cross-validation multivariate analysis identified history of cerebrovascular disease, advanced age and aortic cross-clamp time as independent risk factors for postoperative cerebral complications. Chronic obstructive pulmonary disease and number of bypasses also emerged as risk factors in the primary analysis.

    Conclusions: In general, markers for advanced atherosclerosis, with history of cerebrovascular disease as the most important, emerged as predictors for neurological injury. Although it did not enter the final risk model, the results also suggest that postoperative heart failure deserves further surveillance as a potential risk factor for neurological complications. However, no evidence for untoward neurological effects associated with glutamate or glucose–insulin–potassium treatment was found.

  • 20.
    Svedjeholm, Rolf
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Tajik, B
    Vidlund, M
    Friberg, Örjan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Holm, Jonas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?2014Conference paper (Other academic)
  • 21.
    Svedjeholm, Rolf
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vanhanen, Ingemar
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Håkanson, Erik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Metabolic Intervention for weaning problems in patients with preoperative left ventricular dysfunction2013Conference paper (Other academic)
  • 22.
    Svedjeholm, Rolf
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vanhanen, Ingemar
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Håkanson, Erik
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Metabolic intervention for weaning problems in patients with preoperative left ventricular dysfunction.2013Conference paper (Refereed)
  • 23.
    Svedjeholm, Rolf
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vanhanen, Ingemar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vánky, Farkas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Weaning problems and preoperative left ventricular dysfunction.2008In: 57th Annual meeting of the Scandinavian Association for Thoracic Surgery,2008, 2008Conference paper (Refereed)
    Abstract [en]

      

  • 24.
    Svedjeholm, Rolf
    et al.
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Vidlund, Mårten
    Östergötlands Läns Landsting.
    Håkanson, Erik
    Östergötlands Läns Landsting.
    Friberg, Örjan
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Juhl-Andersen, Sören
    Östergötlands Läns Landsting.
    Holm, Jonas
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Sunnermalm, Lena
    Östergötlands Läns Landsting.
    Borg, Jan-Olov
    Örebro University Hospital, Örebro.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Sharma, Rajiv
    Örebro University Hospital, Örebro.
    GLUTAMICS: A RANDOMIZED CLINICAL TRIAL ON GLUTAMATE INFUSION IN PATIENTS OPERATED FOR ACUTE CORONARY SYNDROME in JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, vol 57, issue 14, pp E938-E9382011In: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Elsevier Science , 2011, Vol. 57, no 14, p. E938-E938Conference paper (Refereed)
    Abstract [en]

    n/a

  • 25.
    Svedjeholm, Rolf
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vánky, Farkas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Influence of early postoperative heart failure on 5-year survival after surgery for aortic stenosis compared with CABG2006In: 55th Annual meeting of the Scandinavian Association for Thoracic Surgery,2006, 2006, p. 106-106Conference paper (Other academic)
  • 26.
    Svedjeholm, Rolf
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vánky, Farkas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Jorfeldt, Lennart
    KS, Stockholm.
    Does glutamate influence myocardial and peripheral tissue metabolism after surgery for aortic stenosis?2006In: 55th Annual meeting of the Scandinavian Association for Thoracic Surgery,2006, 2006, p. 111-111Conference paper (Refereed)
    Abstract [en]

      

  • 27.
    Svedjeholm, Rolf
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Westberg, K
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Long-term outcome of a simplified technique to improve revascularization of diffusely diseased LAD2013Conference paper (Other academic)
  • 28. Tajik, B
    et al.
    Vidlund, M
    Sundbom, Per
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Friberg, Örjan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Holm, Jonas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?2014Conference paper (Other academic)
  • 29.
    Vanhanen, Ingemar
    et al.
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Joachimsson, P.O.
    Department of Anesthesiology, Akademiska Hospital, Uppsala.
    Jorfeldt, Lennart
    Department of Thoracic Physiology, Karolinska Hospital, Stockholm, Sweden.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Assessment of myocardial glutamate requirements early after coronary artery bypass surgery1998In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 32, no 3, p. 145-152Article in journal (Refereed)
    Abstract [en]

    Glutamate is an important substrate for the intermediary metabolism of the heart, particularly in association with ischemia. Early after coronary artery bypass surgery (CABG) myocardial uptake of glutamate seems to be limited by substrate availability (arterial levels). However, glutamate is not an innocuous substrate. As arterial levels of glutamate are important both for myocardial uptake and adverse effects, an attempt was made to determine a minimum dose of glutamate sufficient to supply the needs of the heart after CABG. Ten patients received and infusion of 220-240 ml of 0.1 M L-glutamic acid solution at varying rates during two 30-min periods, starting 2 h after uncomplicated elective CABG. Intravenous glutamate infusion caused a dose-dependent linear increase in arterial glutamate and an increased myocardial uptake of glutamate. However, myocardial uptake of glutamate correlated with arterial levels only at lower infusion rates. Although maximal peak uptake in individual patients (6.6 ± 1.1 μmol/min) occurred at an average increase of arterial whole blood glutamate of 172 ± 34 μmol/L, the greatest impact on myocardial glutamate uptake was achieved by increasing arterial whole blood glutamate by less than 100 μmol/L. This implies that an infusion rate of 30-40 mg glutamate/kg BW/h could suffice to achieve a maximal or near maximal myocardial glutamate uptake in most patients after CABG. The adequacy of this dosage remains to be confirmed in high-risk patients.

  • 30.
    Vanky, Farkas B
    et al.
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkanson, Erik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Long-Term Consequences of Postoperative Heart Failure After Surgery for Aortic Stenosis Compared With Coronary Surgery2007In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 83, no 6, p. 2036-2043Article in journal (Refereed)
    Abstract [en]

    Background: Although postoperative heart failure is a major determinant of operative mortality in cardiac surgery it has received little attention in the literature, and long-term consequences remain to be addressed. Therefore, the impact of postoperative heart failure on long-term survival in relation to other risk factors was studied. Methods: All patients undergoing aortic valve replacement (AVR) for aortic stenosis from 1995 through 2000 in the southeast region of Sweden (n = 398) were compared with a cohort, matched for age and sex, undergoing coronary artery bypass grafting (CABG [n = 398]). Risk factors for 5-year mortality were analyzed. Results: Forty-five AVR and 47 CABG patients required treatment for postoperative heart failure. Thirty-day, 1-year, and 5-year mortality in patients with and without postoperative heart failure after AVR were 6.7% versus 1.4% (p = 0.05), 8.9% versus 4.0% (p = 0.13), and 42.2% versus 14.2% (p < 0.0001) respectively. Corresponding results in the CABG group were 21.3% versus 1.1% (p < 0.0001), 25.5% versus 3.1% (p < 0.0001), and 36.2% versus 11.1% (p = 0.0015). Postoperative heart failure, preoperative renal dysfunction, procedure-associated stroke, body mass index less than 19 kg/m2, older age, preoperative atrial fibrillation, and preoperative anemia turned out as independent risk factors for 5-year mortality after AVR. In the CABG group, postoperative heart failure, diabetes mellitus, older age, and procedure-associated stroke emerged as independent risk factor for 5-year mortality. Conclusions: Postoperative heart failure was associated with high early mortality after CABG whereas the grave consequences of postoperative heart failure after AVR for aortic stenosis became evident only with time. © 2007 The Society of Thoracic Surgeons.

  • 31. Vestberg, Katarina
    et al.
    Vánky, Farkas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Long-term results of a simplified technique to improve revascularization of diffusely diseased lad2006In: 55th Annual meeting of the Scandinavian Association for Thoracic Surgery,2006, 2006, p. 153-153Conference paper (Refereed)
    Abstract [en]

      

  • 32. Vidlund, M
    et al.
    Holm, Jonas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Friberg, Örjan
    Linköping University, Faculty of Health Sciences.
    Sunnermalm, L
    Vánky, Farkas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    The S100-B substudy of the Glutamics-trial: Elevation of S-100B is linked to aortic calcification and postoperative confusion.2008In: 57th Annual meeting of the Scandinavian Association for Thoracic Surgery,2008, 2008Conference paper (Refereed)
  • 33.
    Vidlund, M
    et al.
    University Hospital, Örebro.
    Håkanson, Erik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Friberg, Ö
    University Hospital, Örebro.
    Holm, Jonas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Sunnermalm, L
    University Hospital, Örebro.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    The influence of inotropic drugs on the outcome of the GLUTAMICS trial2013Conference paper (Other academic)
  • 34.
    Vidlund, Marten
    et al.
    University of Örebro, Sweden .
    Håkansson, Erik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Friberg, Orjan
    University of Örebro, Sweden .
    Juhl-Andersen, Soren
    Cardiothorac Anesthesia Blekinge Hospital, Sweden .
    Holm, Jonas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Sunnermalm, Lena
    University of Örebro, Sweden .
    Borg, Jan-Olov
    Cardiothorac Anesthesia Blekinge Hospital, Sweden .
    Sharma, Rajiv
    Cardiothorac Anesthesia Blekinge Hospital, Sweden .
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    GLUTAMICS-a randomized clinical trial on glutamate infusion in 861 patients undergoing surgery for acute coronary syndrome2012In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 144, no 4, p. 922-Article in journal (Refereed)
    Abstract [en]

    Objective: Glutamate has been claimed to protect the heart from ischemia and to facilitate metabolic and hemodynamic recovery after ischemia. The GLUTAmate for Metabolic Intervention in Coronary Surgery trial investigated whether an intravenous glutamate infusion given in association with surgery for acute coronary syndrome could reduce mortality and prevent or mitigate myocardial injury and postoperative heart failure. less thanbrgreater than less thanbrgreater thanMethods: In the present prospective, triple-center, double-blind study, 861 patients undergoing surgery for acute coronary syndrome were randomly assigned to an intravenous infusion of glutamate (n=428) or saline (n=433) perioperatively. less thanbrgreater than less thanbrgreater thanResults: The incidence of the primary endpoint-a composite of 30-day mortality, perioperative myocardial infarction, and left ventricular heart failure at weaning from cardiopulmonary bypass-was 7.3% versus 5.8% (P=.41) in the glutamate and control groups, respectively. Patients with left ventricular failure at weaning from cardiopulmonary bypass had a shorter median intensive care unit stay (25 vs 92 hours; P=.02) if they were treated with glutamate. In patients with unstable angina (Canadian Cardiovascular Society class IV) undergoing isolated coronary artery bypass grafting (n=458), the incidence of severe circulatory failure according to the prespecified criteria was significantly lower in the glutamate group (1.3% vs 6.9%; P=.004). On multivariate analysis, glutamate infusion was associated with a reduced risk of developing severe circulatory failure (odds ratio, 0.17; 95% confidence interval, 0.04-0.72; P=.02). A relative risk reduction exceeding 50% for developing severe circulatory failure was seen in most risk groups undergoing isolated coronary artery bypass grafting, with those with diabetes a notable exception. less thanbrgreater than less thanbrgreater thanConclusions: The primary endpoint did not differ significantly between the groups. The secondary outcomes and post hoc analyses warrant additional studies with regard to the potential beneficial effect of glutamate on postischemic myocardial recovery.

  • 35.
    Vidlund, Mårten
    et al.
    Department of Cardiothoracic Surgery and Anesthesia, University Hospital Örebro, Sweden.
    Holm, Jonas
    Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkanson, Erik
    Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Friberg, Örjan
    Department of Cardiothoracic Surgery and Anesthesia, University Hospital Örebro, Sweden.
    Sunnermalm, Lena
    Department of Cardiothoracic Surgery and Anesthesia, University Hospital Örebro, Sweden.
    Vánky, Farkas
    Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Svedjeholm, Rolf
    Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    The S-100B substudy of the GLUTAMICS trial: Glutamate infusion not associated with sustained elevation of plasma S-100B after coronary surgery2010In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 29, no 3, p. 358-364Article in journal (Refereed)
    Abstract [en]

    Background and aims: Concerns have been raised about potential neurological injury related to exogenous glutamate. In cardiac surgery glutamate has been administered as a putative cardioprotective agent by cardioplegia or intravenous infusion. In the GLUTAMICS trial, in addition to surveillance of clinical neurological injuries, a prespecified subgroup was analyzed with regard to postoperative S-100B levels to detect potential subclinical neurological injury related to glutamate infusion. Methods: Sixty-nine patients operated on for unstable coronary syndrome were randomized to intravenous infusion of glutamate (n = 35) or saline (n = 34) perioperatively. Plasma levels of S-100B were obtained on the third postoperative day. Results: S-100B in the glutamate group and the control group were 0.079 +/- 0.034 mu g/L and 0.090 +/- 0.042 mu g/L respectively (p = 0.245). There were no patients with stroke or mortality. Three patients in the control group and two in the glutamate group had postoperative confusion. These patients had significantly elevated S-100B compared with those without confusion (0.132 +/- 0.047 vs 0.081 +/- 0.036 mu g/L; p = 0.003). Overall, 21 patients had S-100B above reference level (greater than= 0.10 mu g/L) and these patients had significantly more calcifications in the ascending aorta on epiaortic scanning. Conclusions: Intravenous glutamate infusion during surgery for unstable coronary artery disease did not initiate a sustained elevation of plasma S-100B. Thus, no evidence for subclinical neurological injury related to glutamate infusion was found. In contrast, postoperative elevation of plasma S-100B was linked to calcification of the ascending aorta and postoperative confusion.

  • 36.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Surgery for aortic stenosis: with special reference to myocardial metabolism, postoperative heart failure and long-term outcome2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Postoperative heart failure (PHF) remains a major determinant of the outcome after cardiac surgery. However, characteristics of and risk factors for PHF after valve surgery have received little attention.

    Post-ischaemic disturbances of myocardial metabolism that may contribute to PHF and are amenable to metabolic treatment have been identified early after coronary surgery (CABG). Knowledge derived from these studies may not be applicable to other patient groups. We therefore studied myocardial energy metabolism in 20 elective patients undergoing aortic valve replacement (AVR) for isolated aortic stenosis (AS). The metabolic studies indicated that myocardial oxidative metabolism had not fully recovered when the procedure was completed. Free fatty acids were the only major substrates taken up by the heart. Signs of preoperative and postoperative metabolic adaptation with substantial uptake of glutamate, previously demonstrated in patients with coronary artery disease, were found. Postoperative infusion of glutamate, (2 mL/kg body weight and hour of 0.125 M solution) based on assessment of myocardial glutamate requirements in CABG patients, resulted in a two-fold increase in myocardial glutamate uptake and a seven-fold increase in AV differences across the leg. This was associated with a significant myocardial uptake of lactate and metabolic changes in the leg suggesting mitigation of net amino acid loss and peripheral tissue lipolysis.

    Characteristics of and risk factors for PHF were evaluated in 398 patients undergoing isolated AVR for AS from 1 January 1995 to 31 December 2000. These were compared with 398 patients, matched for age and sex, undergoing on-pump isolated CABG. Forty-five AVR and 47 CABG patients fulfilled criteria for PHF and these were studied in detail. PHF usually presented at weaning from cardiopulmonary bypass. After CABG it was closely associated with preoperative ischaemic events and intraoperatively acquired myocardial infarction. Potential causes and eliciting events of PHF after AVR for AS were obvious only in one-third of the patients. Risk factors for PHF after AVR for AS indicated either pre-existing myocardial dysfunction, increased right or left ventricular after-load, or intraoperatively acquired myocardial injury. PHF was associated with high early mortality after CABG, whereas the consequences of PHF after AVR for AS became evident only with time, resulting in a 42% five-year mortality. Although PHF had a different temporal impact on late mortality after CABG and AVR for AS, it emerged as the statistically most significant risk factor for mortality occurring within 5 years from surgery both after AVR for AS and after CABG. Potential implications of our findings include needs for greater focus on preoperative surveillance of patients with AS for optimal timing of surgery, mitigation of intraoperatively acquired myocardial injury and tailoring of treatment for PHF. Furthermore, the findings have implications for long-term follow up of AS patients after surgery.

    List of papers
    1. Different characteristics of postoperative heart failure after surgery for aortic stenosis and coronary disease
    Open this publication in new window or tab >>Different characteristics of postoperative heart failure after surgery for aortic stenosis and coronary disease
    2004 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 38, no 3, p. 152-158Article in journal (Refereed) Published
    Abstract [en]

    Objective: Postoperative heart failure (PHF) remains a major determinant of outcome after cardiac surgery. However, possible differences in characteristics of PHF after valve surgery and coronary surgery (CABG) have received little attention. Therefore, this issue was studied in patients undergoing aortic valve replacement (AVR) and CABG, respectively.

    Design: Three hundred and ninety-eight patients undergoing isolated AVR for aortic stenosis were compared with 398 patients, matched for age and sex, undergoing on-pump isolated CABG. Forty-five AVR and 47 CABG patients required treatment for PHF and these were studied in detail.

    Results: The AVR group had longer aortic cross-clamp time and higher rate of isolated right ventricular heart failure postoperatively. Myocardial ischemia during induction and perioperative myocardial infarction were more common in the CABG group. One-year mortality was 8.9% in the AVR group vs 25.5% in the CABG group (p = 0.05).

    Conclusions: The incidence of PHF was similar in both groups but different characteristics were found. Isolated right ventricular failure and PHF precipitated by septicemia were more common in AVR patients. PHF was more clearly associated with myocardial ischemia and infarction in CABG patients, which could explain their less favorable survival.

    Keyword
    aortic valve surgery, complications of surgery, coronary artery bypass surgery, heart failure, prognosis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14018 (URN)10.1080/14017430410029734 (DOI)
    Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2009-08-21
    2. Risk factors for postoperative heart failure in patients operated on for aortic stenosis
    Open this publication in new window or tab >>Risk factors for postoperative heart failure in patients operated on for aortic stenosis
    2006 (English)In: The Annals of Thoracic Surgery, ISSN 0003-4975, Vol. 81, no 4, p. 1297-1304Article in journal (Refereed) Published
    Abstract [en]

    Background

    Risk factors for postoperative heart failure (PHF) have not been specifically studied in valve surgery although it has been acknowledged that patient variables may have a more profound influence on postoperative outcome than valve-related factors.

    Methods

    All patients undergoing isolated aortic valve replacement for aortic stenosis from January 1995 to December 2000 in the southeast region of Sweden were studied (n = 398). Forty-five patients with aortic valve replacement required treatment for PHF. Univariate and multivariate logistic regression analysis was carried out to identify risk factors for PHF.

    Results

    Thirty-day mortality was 6.7% versus 1.4% for patients with and without PHF, respectively (p = 0.05). With regard to clinical presentation of aortic stenosis, angina was associated with reduced risk, whereas history of congestive heart failure increased the risk for PHF. Five preoperative (hypertension, history of congestive heart failure, severe systolic left ventricular dysfunction, pulmonary hypertension, preoperative hemodynamic instability) and two intraoperative (aortic cross-clamp time, intraoperative myocardial infarction) variables were identified as independent risk factors for PHF. Patient–prosthesis mismatch did not influence the risk of PHF significantly.

    Conclusions

    Postoperative heart failure was associated with a marked increase in postoperative mortality and morbidity. Risk factors for PHF were variables indicating preexisting myocardial dysfunction, increased right or left ventricular afterload, and intraoperative myocardial injury. Our results highlight issues concerning cross-clamp time and myocardial protection, particularly for patients with preoperatively compromised myocardial function. Asymptomatic patients with significant aortic stenosis should be considered for surgery before substantial echocardiographic evidence of left ventricular dysfunction or increased pulmonary artery pressure develops.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14019 (URN)10.1016/j.athoracsur.2005.11.036 (DOI)
    Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2009-06-08
    3. Influence of early postoperative heart failure on five-year survival after surgery for aortic stenosis compared with CABG
    Open this publication in new window or tab >>Influence of early postoperative heart failure on five-year survival after surgery for aortic stenosis compared with CABG
    Manuscript (Other academic)
    Identifiers
    urn:nbn:se:liu:diva-14020 (URN)
    Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2010-01-13
    4. Myocardial metabolism before and after valve replacement for aortic stenosis
    Open this publication in new window or tab >>Myocardial metabolism before and after valve replacement for aortic stenosis
    Show others...
    2006 (English)In: Journal of Cardiovascular Surgery, ISSN 0021-9509, E-ISSN 1827-191X, Vol. 47, no 3, p. 305-313Article in journal (Refereed) Published
    Abstract [en]

    AIM: Post ischemic disturbances of myocardial metabolism that may contribute to postoperative heart failure and are accessible to metabolic treatment have been identified early after coronary surgery. Knowledge derived from these studies may not be applicable to other patient groups. Therefore we studied myocardial energy metabolism in patients operated for isolated aortic stenosis.

    METHODS: Twenty patients undergoing isolated aortic valve replacement (AVR) because of aortic stenosis without significant regurgitation were studied before and immediately after surgery. Myocardial uptake of oxygen and energy substrates was assessed with coronary sinus catheter technique.

    RESULTS: Free fatty acids (FFA) were the main source of myocardial energy before and after AVR. A significant uptake of lactate was only recorded preoperatively. A significant uptake of glutamate of the same magnitude as previously described in coronary patients was found pre- and postoperatively. Postoperatively a relative decrease of myocardial oxygen extraction ratio (P<0.001) and oxygen consumption (P=0.14) by approximately 20% was observed.

    CONCLUSION: Preoperative and postoperative metabolic adaptation with substantial uptake of glutamate, previously claimed to be due to chronic or repetitive ischemia, was demonstrated. The results indicate that oxidative metabolism had not fully recovered when the procedure was completed. However, the potentially unfavorable postoperative metabolic state with predominant reliance on FFA as energy source was out-balanced by the unloading effect of AVR with a reduction in myocardial oxygen extraction.

    Keyword
    Aged, Amino Acids, Aortic Valve Stenosis, Biological Markers, Blood Glucose, Energy Metabolism, Fatty Acids, Female, Glycerol, Heart Valve Prosthesis Implantation, Hemodynamics, Humans, Lactic Acid, Male, Middle Aged, Myocardium, Oxygen, Oxygen Consumption, Postoperative Care, Preoperative Care, Treatment Outcome
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14021 (URN)
    Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2017-12-13
    5. Does glutamate influence myocardial and peripheral tissue metabolism after aortic valve replacement for aortic stenosis?
    Open this publication in new window or tab >>Does glutamate influence myocardial and peripheral tissue metabolism after aortic valve replacement for aortic stenosis?
    2006 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 25, no 6, p. 913-922Article in journal (Refereed) Published
    Abstract [en]

    Background & aims

    Glutamate plays an important role for myocardial metabolism in association with ischaemia. Patients with coronary artery disease characteristically demonstrate increased uptake of glutamate. Improved recovery of myocardial metabolism and haemodynamic state after coronary surgery has been reported in patients treated with glutamate infusion. However, the effect of glutamate has not been studied after other cardiac surgical procedures. In addition, the effects of glutamate on peripheral tissue metabolism remain to be described.

    Methods

    Twenty patients undergoing surgery for aortic stenosis were studied after randomisation to blinded infusion of glutamate or saline during 1 h immediately after skin closure. Myocardial and leg tissue metabolism were assessed with organ balance techniques.

    Results

    Postoperative glutamate infusion induced a marked increase in myocardial and leg tissue uptake of glutamate. This was associated with a significant uptake of lactate in the heart. The negative arterial–venous differences of amino acids and free fatty acids across the leg were significantly smaller in the glutamate group. Haemodynamic state remained stable and did not differ between groups.

    Conclusion

    The heart and peripheral tissues consumed the exogenously administered glutamate after surgery for aortic stenosis. Potentially favourable effects of glutamate on myocardial and peripheral tissue metabolism are suggested.

    Keyword
    Glutamate; Myocardial metabolism; Humans; Aortic stenosis; Surgery
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14022 (URN)10.1016/j.clnu.2006.04.002 (DOI)
    Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2017-12-13
    6. Assessment of myocardial glutamate requirements early after coronary artery bypass surgery
    Open this publication in new window or tab >>Assessment of myocardial glutamate requirements early after coronary artery bypass surgery
    Show others...
    1998 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 32, no 3, p. 145-152Article in journal (Refereed) Published
    Abstract [en]

    Glutamate is an important substrate for the intermediary metabolism of the heart, particularly in association with ischemia. Early after coronary artery bypass surgery (CABG) myocardial uptake of glutamate seems to be limited by substrate availability (arterial levels). However, glutamate is not an innocuous substrate. As arterial levels of glutamate are important both for myocardial uptake and adverse effects, an attempt was made to determine a minimum dose of glutamate sufficient to supply the needs of the heart after CABG. Ten patients received and infusion of 220-240 ml of 0.1 M L-glutamic acid solution at varying rates during two 30-min periods, starting 2 h after uncomplicated elective CABG. Intravenous glutamate infusion caused a dose-dependent linear increase in arterial glutamate and an increased myocardial uptake of glutamate. However, myocardial uptake of glutamate correlated with arterial levels only at lower infusion rates. Although maximal peak uptake in individual patients (6.6 ± 1.1 μmol/min) occurred at an average increase of arterial whole blood glutamate of 172 ± 34 μmol/L, the greatest impact on myocardial glutamate uptake was achieved by increasing arterial whole blood glutamate by less than 100 μmol/L. This implies that an infusion rate of 30-40 mg glutamate/kg BW/h could suffice to achieve a maximal or near maximal myocardial glutamate uptake in most patients after CABG. The adequacy of this dosage remains to be confirmed in high-risk patients.

    Keyword
    adverse effects, biological transport, cardiac surgery, coronary artery disease, dose-response, human glutamate, metabolism, myocardium
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14023 (URN)10.1080/14017439850140102 (DOI)
    Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2017-12-13Bibliographically approved
  • 37.
    Vánky, Farkas B.
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Håkansson, Erik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Jorfeldt, Lennart
    Division of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Does glutamate influence myocardial and peripheral tissue metabolism after aortic valve replacement for aortic stenosis?2006In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 25, no 6, p. 913-922Article in journal (Refereed)
    Abstract [en]

    Background & aims

    Glutamate plays an important role for myocardial metabolism in association with ischaemia. Patients with coronary artery disease characteristically demonstrate increased uptake of glutamate. Improved recovery of myocardial metabolism and haemodynamic state after coronary surgery has been reported in patients treated with glutamate infusion. However, the effect of glutamate has not been studied after other cardiac surgical procedures. In addition, the effects of glutamate on peripheral tissue metabolism remain to be described.

    Methods

    Twenty patients undergoing surgery for aortic stenosis were studied after randomisation to blinded infusion of glutamate or saline during 1 h immediately after skin closure. Myocardial and leg tissue metabolism were assessed with organ balance techniques.

    Results

    Postoperative glutamate infusion induced a marked increase in myocardial and leg tissue uptake of glutamate. This was associated with a significant uptake of lactate in the heart. The negative arterial–venous differences of amino acids and free fatty acids across the leg were significantly smaller in the glutamate group. Haemodynamic state remained stable and did not differ between groups.

    Conclusion

    The heart and peripheral tissues consumed the exogenously administered glutamate after surgery for aortic stenosis. Potentially favourable effects of glutamate on myocardial and peripheral tissue metabolism are suggested.

  • 38.
    Vánky, Farkas B.
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Maros, Tamás
    Linköping University, Faculty of Health Sciences.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Health Sciences.
    Different characteristics of postoperative heart failure after surgery for aortic stenosis and coronary disease2004In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 38, no 3, p. 152-158Article in journal (Refereed)
    Abstract [en]

    Objective: Postoperative heart failure (PHF) remains a major determinant of outcome after cardiac surgery. However, possible differences in characteristics of PHF after valve surgery and coronary surgery (CABG) have received little attention. Therefore, this issue was studied in patients undergoing aortic valve replacement (AVR) and CABG, respectively.

    Design: Three hundred and ninety-eight patients undergoing isolated AVR for aortic stenosis were compared with 398 patients, matched for age and sex, undergoing on-pump isolated CABG. Forty-five AVR and 47 CABG patients required treatment for PHF and these were studied in detail.

    Results: The AVR group had longer aortic cross-clamp time and higher rate of isolated right ventricular heart failure postoperatively. Myocardial ischemia during induction and perioperative myocardial infarction were more common in the CABG group. One-year mortality was 8.9% in the AVR group vs 25.5% in the CABG group (p = 0.05).

    Conclusions: The incidence of PHF was similar in both groups but different characteristics were found. Isolated right ventricular failure and PHF precipitated by septicemia were more common in AVR patients. PHF was more clearly associated with myocardial ischemia and infarction in CABG patients, which could explain their less favorable survival.

  • 39.
    Vánky, Farkas B.
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Håkansson, Erik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Tamás, Eva
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Risk factors for postoperative heart failure in patients operated on for aortic stenosis2006In: The Annals of Thoracic Surgery, ISSN 0003-4975, Vol. 81, no 4, p. 1297-1304Article in journal (Refereed)
    Abstract [en]

    Background

    Risk factors for postoperative heart failure (PHF) have not been specifically studied in valve surgery although it has been acknowledged that patient variables may have a more profound influence on postoperative outcome than valve-related factors.

    Methods

    All patients undergoing isolated aortic valve replacement for aortic stenosis from January 1995 to December 2000 in the southeast region of Sweden were studied (n = 398). Forty-five patients with aortic valve replacement required treatment for PHF. Univariate and multivariate logistic regression analysis was carried out to identify risk factors for PHF.

    Results

    Thirty-day mortality was 6.7% versus 1.4% for patients with and without PHF, respectively (p = 0.05). With regard to clinical presentation of aortic stenosis, angina was associated with reduced risk, whereas history of congestive heart failure increased the risk for PHF. Five preoperative (hypertension, history of congestive heart failure, severe systolic left ventricular dysfunction, pulmonary hypertension, preoperative hemodynamic instability) and two intraoperative (aortic cross-clamp time, intraoperative myocardial infarction) variables were identified as independent risk factors for PHF. Patient–prosthesis mismatch did not influence the risk of PHF significantly.

    Conclusions

    Postoperative heart failure was associated with a marked increase in postoperative mortality and morbidity. Risk factors for PHF were variables indicating preexisting myocardial dysfunction, increased right or left ventricular afterload, and intraoperative myocardial injury. Our results highlight issues concerning cross-clamp time and myocardial protection, particularly for patients with preoperatively compromised myocardial function. Asymptomatic patients with significant aortic stenosis should be considered for surgery before substantial echocardiographic evidence of left ventricular dysfunction or increased pulmonary artery pressure develops.

  • 40.
    Vánky, Farkas B.
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Szabó, Zoltán
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Jorfeldt, L.
    Department of Cardiothoracic Surgery, Linköping Heart Center, University Hospital, Linköping, Sweden..
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Håkansson, Erik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Myocardial metabolism before and after valve replacement for aortic stenosis2006In: Journal of Cardiovascular Surgery, ISSN 0021-9509, E-ISSN 1827-191X, Vol. 47, no 3, p. 305-313Article in journal (Refereed)
    Abstract [en]

    AIM: Post ischemic disturbances of myocardial metabolism that may contribute to postoperative heart failure and are accessible to metabolic treatment have been identified early after coronary surgery. Knowledge derived from these studies may not be applicable to other patient groups. Therefore we studied myocardial energy metabolism in patients operated for isolated aortic stenosis.

    METHODS: Twenty patients undergoing isolated aortic valve replacement (AVR) because of aortic stenosis without significant regurgitation were studied before and immediately after surgery. Myocardial uptake of oxygen and energy substrates was assessed with coronary sinus catheter technique.

    RESULTS: Free fatty acids (FFA) were the main source of myocardial energy before and after AVR. A significant uptake of lactate was only recorded preoperatively. A significant uptake of glutamate of the same magnitude as previously described in coronary patients was found pre- and postoperatively. Postoperatively a relative decrease of myocardial oxygen extraction ratio (P<0.001) and oxygen consumption (P=0.14) by approximately 20% was observed.

    CONCLUSION: Preoperative and postoperative metabolic adaptation with substantial uptake of glutamate, previously claimed to be due to chronic or repetitive ischemia, was demonstrated. The results indicate that oxidative metabolism had not fully recovered when the procedure was completed. However, the potentially unfavorable postoperative metabolic state with predominant reliance on FFA as energy source was out-balanced by the unloading effect of AVR with a reduction in myocardial oxygen extraction.

  • 41.
    Vánky, Farkas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Hultkvist, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Is the present definition of mycardial infarction in transcatheter aortic valve implantation relevant for the postprocedulal outcome?2015Conference paper (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.

  • 42.
    Vánky, Farkas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Maros, T
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Implications of Postoperative Heart Failure after surgery for Aortic Stenosis and Coronary Disease2003In: European Association of Cardiovascular Surgery,2003, 2003Conference paper (Other academic)
  • 43.
    Vánky, Farkas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Marós, T
    Tamas, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Different characteristics of postoperative heart failure after surgery for aortic stenosis and coronary disease: implications for short-term and long-term outcome2005In: EWCI European Workgruoup for Cardiothoracic Intensivists,2005, 2005Conference paper (Other academic)
  • 44.
    Vánky, Farkas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Szabó, Zoltán
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Nylander, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Jorfeldt, Lennart
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Myocardial metabolism and energetics before and after valve replacement for aortic stenosis2005In: Scandinavian Association for Thoracic Surgery,2005, 2005Conference paper (Other academic)
  • 45.
    Vánky, Farkas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Tamas, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Risk factors for postoperative heart failure in patients operated for aortic stenosis2005In: Scandinavian Association for Thoracic Surgery,2005, 2005Conference paper (Other academic)
1 - 45 of 45
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