Circulation
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Randomized Controlled Trial Comparative Study Clinical Trial
Cyclosporine-induced hypertension. Efficacy of omega-3 fatty acids in patients after cardiac transplantation.
Cyclosporine-induced hypertension may be related to vasoconstriction of the afferent arterioles in the glomeruli caused by changes in the prostaglandin profile. omega-3 Fatty acids have demonstrated vasodilatory properties related to a favorable effect in the prostaglandin profile. The purpose of this study was to evaluate the antihypertensive effects of oral supplementation with omega-3 fatty acids in cyclosporine-treated cardiac transplant recipients. ⋯ omega-3 Fatty acids (3 g/d) reduce blood pressure by decreasing systemic vascular resistance and, therefore, can be used as an adjuvant for the treatment of hypertension in cyclosporine-treated cardiac transplant recipients. Their vasodilatory effect may be related to a beneficial change in the prostaglandin profile.
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Randomized Controlled Trial Comparative Study Clinical Trial
Nafamostat mesilate reduces blood loss during open heart surgery.
Nafamostat mesilate (FUT-175) is a protease inhibitor inactivating coagulation, fibrinolysis, and platelet aggregation. A prospective, randomized trial was performed to assess the efficacy of FUT-175 in the reduction of postoperative bleeding tendency. ⋯ FUT-175 inhibits fibrinolysis and preserves platelet counts and function during CPB and reduces blood loss during open heart surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of cold versus warm cardioplegia. Crystalloid antegrade or retrograde blood?
To evaluate the efficacy of warm versus cold and antegrade versus retrograde cardioplegia, 163 patients were randomized in sequence in three groups and underwent isolated coronary artery bypasses (mean, 4 grafts/patients) alternating in sequence. ⋯ Continuous warm cardioplegia (group 2) did not provide better myocardial protection despite that no CK-MB isoenzyme leak was demonstrated intraoperatively. Intermittent cold crystalloid cardioplegia and cold retrograde provided a clearer operative field and motionless heart. As long as O2 was adequately supplied, under 90 minutes' cross-clamp time, cold crystalloid cardioplegia and cold retrograde blood cardioplegia is safe under hypothermic conditions, whereas warm cardioplegia requires continuous uninterrupted technique with oxygen delivery.
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Coronary bypass surgery in women is associated with lower survival than in men. We need to know whether this is because of patient-related factors and whether the lower survival is present in all subgroups of patients and for all time periods during which the surgery was performed. ⋯ Women have a higher operative mortality and lower long-term survival than men after coronary bypass surgery for angina. However, the differences are small, even if statistically significant. Importantly, patient-related factors and not sex are independent predictors of poorer survival. Therefore, coronary bypass surgery should not be delayed or denied to women who have the usual indications for surgery.