The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Mar 2014
MicroRNA-30b is a multifunctional regulator of aortic valve interstitial cells.
Calcific aortic valve disease is an active process involving a wide range of pathologic changes. Valve interstitial cells are the most prevalent cells in the heart valve and maintain normal valve structure and function. MicroRNAs (miRNAs) are essential posttranscriptional modulators of gene expression, and miRNA-30b is a known repressor of bone morphogenetic protein 2-mediated osteogenesis. We hypothesized that miRNA-30b is a multifunctional regulator of aortic valve interstitial cells during calcification. ⋯ We demonstrated a remarkable role of miRNA-30b in calcific aortic valve disease as a regulator of human aortic valvular calcification and apoptosis through direct targeting of Runx2, Smad1, and caspase-3. Targeting of miRNA-30b could serve as a novel therapeutic strategy to limit progressive calcification in aortic stenosis.
-
J. Thorac. Cardiovasc. Surg. · Mar 2014
Autophagy gene fingerprint in human ischemia and reperfusion.
Autophagy is an evolutionary conserved adaptive response that is believed to promote cell survival in response to stressful stimuli via recycling of precursors derived from the degradation of endogenous cellular components. The autophagic molecular machinery is controlled by a large family of autophagy-related genes (ATGs) and downstream regulators. We sought to define the autophagy gene fingerprint associated with human ischemia and reperfusion (IR) injury using an intraoperative model developed by Sellke and colleagues. ⋯ We provide the first human cardiac fingerprint of autophagy gene expression in response to IR. These findings may inform on appropriate cell- and gene-based therapeutic approaches to limit aberrant cardiac injury.
-
J. Thorac. Cardiovasc. Surg. · Mar 2014
Denervation of gastroepiploic artery graft can reduce vasospasm.
The right gastroepiploic artery is useful as an in situ arterial graft for coronary artery bypass grafting. However, the gastroepiploic artery is more likely to cause vasospasms compared with the internal thoracic artery. We hypothesized that the cause of the spasms is the stimulation of the periarterial sympathetic nerve, because the gastroepiploic artery is classified as a muscular artery. In this study, we examined whether the spasm is reduced by removing the periarterial sympathetic nerve. ⋯ The removal of the periarterial sympathetic nerve from the human gastroepiploic artery reduced vascular contraction, elicited by peripheral nerve stimulation, without disturbing endothelial and smooth muscle contractile functions. This reduction may contribute to the prevention of vasospasms.
-
J. Thorac. Cardiovasc. Surg. · Mar 2014
Safety and efficacy of prothrombin complex concentrates for the treatment of coagulopathy after cardiac surgery.
Coagulopathy is an important cause of bleeding after complex cardiac surgery. The conventional treatment for coagulopathy is transfusion, which is associated with adverse outcomes. We report our initial experience with the prothrombin complex concentrate FEIBA (factor VIII inhibitor bypassing activity) for the rescue treatment of coagulopathy and life-threatening bleeding after cardiac surgery. ⋯ Our initial experience with FEIBA administration for the rescue treatment of postoperative coagulopathy and life-threatening bleeding has been favorable. Further studies are indicated to confirm its efficacy and safety and determine specific clinical indications for its use in patients undergoing cardiac surgery.
-
J. Thorac. Cardiovasc. Surg. · Mar 2014
Relative amplitude index: a new tool for hemodynamic evaluation of periprosthetic regurgitation after transcatheter valve implantation.
The impact of paravalvular aortic regurgitation (PAR) on hemodynamic performance after transcatheter aortic valve implantation (TAVI) remains disputable. Common parameters such as the diastolic blood pressure or the blood pressure amplitude do not provide reproducible results. The aim of our study was to evaluate the impact of PAR on hemodynamics and outcome using the relative amplitude index (RAI). ⋯ The RAI is a useful tool to predict perioperative and 1-year outcome in patients with PAR after TAVI.