E. Fosse - Academia.edu (original) (raw)
Papers by E. Fosse
The Journal of Thoracic and Cardiovascular Surgery, 1999
longed recovery, or death. Heparin coating of the blood-contact surfaces of cardiopulmonary bypas... more longed recovery, or death. Heparin coating of the blood-contact surfaces of cardiopulmonary bypass (CPB) equipment may reduce this inflammatory reac-C ontact between blood and the foreign surfaces of a heart-lung machine evokes a systemic inflammatory reaction that may result in organ dysfunction, pro-Objectives: 1. To study possible clinical benefits of heparin-coated cardiopulmonary bypass in patients with a broad range of preoperative risk factors. 2. To evaluate the correlation between the terminal complement complex and clinical outcome. 3. To identify clinical predictors of complement activation and correlates of granulocyte activation during cardiac surgery. Methods: Blood samples from adults undergoing elective cardiac surgery with Duraflo II heparin-coated (n = 81) or uncoated (n = 75) cardiopulmonary bypass sets (Duraflo coating surface; Baxter International, Inc, Deerfield, Ill) were analyzed for activation of complement (C3 activation products, terminal complement complex), granulocytes (myeloperoxidase, lactoferrin), and platelets (β-thromboglobulin) by enzyme immunoassays. Preoperative risk was assessed by means of the "Higgins' score." Complications (cardiac, renal, pulmonary, gastrointestinal, and central nervous system dysfunction, infections, death) were registered prospectively. Data were analyzed by analysis of variance, logistic regression, and linear regression. Results and conclusions: Sixty-seven percent of the patients had predefined risk factors. Complications developed in 53 patients (34%), equivalently with and without heparin-coated bypass sets (P = .44-.82), despite a significant reduction in complement and granulocyte activation by heparin coating. No clear-cut relationship between the terminal complement complex and outcome was found, even if it was significant in the models for renal and central nervous system dysfunction and infections (P = .006). The Higgins' score was significantly related to complement activation (P < .05). Approximately 50% of the variation in granulocyte activation was explained by complement (P ≤ .01) and platelet activation (P < .05), heparin/protamine dose ratio (P = .02), duration of cardiopulmonary bypass (P < .01), and gender (P < .05). Therefore measures reducing complement activation alone will not necessarily reduce granulocyte activation sufficiently for clinical significance.
European Journal of Cardio-Thoracic Surgery, 1997
Objecti6e: This study was carried out to: (a) compare complement and granulocyte activation durin... more Objecti6e: This study was carried out to: (a) compare complement and granulocyte activation during cardiac operations in patients operated with cardiopulmonary bypass coated with heparin by the Duraflo II method, with activation in patients operated with uncoated circuits; and (b) relate complement, and granulocyte activation to selected adverse effects. Methods: In a multicentre study among Rikshospitalet, Ullevaal Hospital in Norway and Uppsala University Hospital in Sweden, plasma concentrations of the complement activation products C4b/iC4b/C4c (C4bc), C3b/iC3b/C3c (C3bc), the terminal SC5b-9 complement complex (TCC), and the granulocyte proteins myeloperoxidase and lactoferrin were assessed in two groups of patients undergoing aortocoronary bypass. Seventy-six patients underwent surgery operated with circuits coated by the Duraflo II heparin coating and 75 with uncoated circuits. The same amount of systemic heparin was administered to all patients. Results: In both groups a significant increase in C4bc was first seen by the end of operation, from 86.79 12.5 to 273.09277.4 nM in controls and from 86.9 918.5 to 320.29190.5 nM in the control group, confirming previous documentation that the classical pathway is not activated during CPB, but as a consequence of protamin administration. The formation of C4bc did not differ significantly between the two groups. In the uncoated group the C3bc concentration increased from 124.09 15.3 to a maximum of 1176.1 9 64.7 nM (PB0.01) and in the coated group it increased from 129.8 9 16.1 to a maximum of 1019.4 954.9 nM (PB0.01) during CPB. Summary values but not peak values differed significantly between the groups. In the uncoated group the TCC concentration increased from 0.529 0.03 to a maximum value of 8.09 9 0.57 AU/ml (P B0.01) while in the coated group the TCC concentration increased from a baseline of 0.53 90.03 to a peak value of 5.2 9 0.24. AU/ml (PB 0.01). The difference between the peak values was statistically significant (P = 0.00002). In both groups a significant increase in myeloperoxidase and lactoferrin release was observed by the end of operation. There was no difference in myeloperoxidase or lactoferrin release between the two groups. TCC levels were compared to the occurrence of perioperative infarction, development of lung or renal failure, postoperative bleeding, time on ventilator and days in hospital. Three patients developed perioperative infarction; the peak levels of TCC were significantly higher in these patients than in the 148 patients that did not develop infarction. The reduction in TCC formation in the heparin-coated group was not associated with differences in any of the other clinical parameters. Few adverse effects occurred in the study. The peak values of C3bc were higher in the patients needing inotropic support than in those
The Annals of Thoracic Surgery
The American Journal of Cardiology, 2002
ABSTRACT We evaluated the in-hospital and 1-year outcomes in 119 consecutive patients who underwe... more ABSTRACT We evaluated the in-hospital and 1-year outcomes in 119 consecutive patients who underwent minimally invasive direct coronary artery bypass grafting (MID-CAB) with 441 consecutive patients undergoing coronary stenting in isolated proximal or mid-left anterior descending lesions. MIDCAB and coronary artery stenting have very similar in-hospital and 1-year mortality and myocardial infarction rates; MIDCAB requires longer hospitalization, but the current stent designs have higher 1-year target vessel revascularization and major adverse cardiac event, rates than MIDCAB.
The Journal of Thoracic and Cardiovascular Surgery, 2010
Objective: Although health status after coronary artery bypass grafting improves at the group lev... more Objective: Although health status after coronary artery bypass grafting improves at the group level, individual outcomes demonstrate variation. We aimed to evaluate relative importances of changes in cardiac and cognitive function and symptom status regarding physical and mental health at 1 year after coronary artery bypass grafting. Methods: Outcomes in multivariable regression analysis (n ¼ 86) were self-reported physical and mental health (Medical Outcomes Study 36-Item Short Form) at 12 months' follow-up, adjusting for baseline. Independent variables were change in exercise capacity (staged ergometer protocol), cognitive function (neurocognitive test battery), and self-reported improvement of angina. Graft patency was evaluated by angiography (82/86 patients). Results: After surgery, health status was comparable to the age-and sex-matched population norm. Improvement of angina was associated with gain in physical health in the range of 0.5 SD (b ¼ 0.23, P ¼ .012). Change in observed physical exercise capacity (mean AE SD 199 AE 426 W $ min) accounted for 9% of variance in physical health (b ¼ 0.42, P ¼ .001). Positive change in cognitive function was significantly related to mental (b ¼ 0.52, P ¼ .007) but not physical health. Graft occlusion (22/82 patients) was not significantly related to health status. Conclusions: Individual variation in objective functional performance and symptom relief is significant for selfreported health status, beyond the predictive ability of preoperative health status, sex, and graft patency. Awareness of the extent and impact of outcome variation is important when counseling patients before and after coronary artery bypass grafting.
European Journal of Cardio-Thoracic Surgery, 2014
OBJECTIVES: Preservation of left ventricular (LV) function is crucial for a beneficial outcome in... more OBJECTIVES: Preservation of left ventricular (LV) function is crucial for a beneficial outcome in high-risk patients undergoing cardiac surgery. The present study evaluated a motion sensor (accelerometer) for continuous monitoring of LV performance during changes in global and regional LV function. METHODS: In 11 pigs, an accelerometer was sutured to the epicardium on the anterior apical LV region. Global LV function was modulated by esmolol, epinephrine and fluid loading, whereas regional LV dysfunction was induced by a 3-min occlusion of left anterior descending (LAD) coronary artery. Epicardial acceleration in the circumferential direction was obtained by the accelerometer, and from this signal, epicardial velocity was calculated. Peak systolic velocity was measured and used as an index of LV performance. The accelerometer was compared with left ventricular stroke work (LVSW), ejection fraction and myocardial strain by echocardiography. RESULTS: Accelerometer peak systolic velocity and LVSW changed significantly during all interventions, affecting global LV function. Systolic velocity by the accelerometer increased during epinephrine and fluid loading from 14.1 [10.2; 17.3] to 25.4 [16.7; 28.5] (P < 0.05) and 14.8 [12.5; 18.5] cm/s (P < 0.05), respectively. Esmolol infusion significantly decreased accelerometer peak systolic velocity to 9.4 [7.3; 10.7] cm/s (P < 0.05). Minor changes were seen in the echocardiographic measurements, with significant changes only observed in myocardial strain during the interventions with esmolol and epinephrine. Regional LV dysfunction was clearly detected by the accelerometer during LAD occlusion, and peak systolic velocity was reduced from 14.1 [10.2; 17.3] to 5.7 [5.0; 6.8] cm/s (P < 0.05). The accelerometer demonstrated higher sensitivity and specificity for the detection of myocardial ischaemia than LVSW and ejection fraction. For all interventions, accelerometer peak systolic velocity correlated strongly with LVSW (r = 0.81, P < 0.01) and myocardial strain (r = 0.80; P < 0.01). CONCLUSIONS: It was possible to obtain accurate information on LV performance by the use of an epicardially attached accelerometer. The method allows continuous monitoring of LV function and may therefore improve perioperative monitoring of cardiac surgery patients.
The Journal of Thoracic and Cardiovascular Surgery, 2010
Objective: Although health status after coronary artery bypass grafting improves at the group lev... more Objective: Although health status after coronary artery bypass grafting improves at the group level, individual outcomes demonstrate variation. We aimed to evaluate relative importances of changes in cardiac and cognitive function and symptom status regarding physical and mental health at 1 year after coronary artery bypass grafting.
The Journal of Thoracic and Cardiovascular Surgery, 1999
longed recovery, or death. Heparin coating of the blood-contact surfaces of cardiopulmonary bypas... more longed recovery, or death. Heparin coating of the blood-contact surfaces of cardiopulmonary bypass (CPB) equipment may reduce this inflammatory reac-C ontact between blood and the foreign surfaces of a heart-lung machine evokes a systemic inflammatory reaction that may result in organ dysfunction, pro-Objectives: 1. To study possible clinical benefits of heparin-coated cardiopulmonary bypass in patients with a broad range of preoperative risk factors. 2. To evaluate the correlation between the terminal complement complex and clinical outcome. 3. To identify clinical predictors of complement activation and correlates of granulocyte activation during cardiac surgery. Methods: Blood samples from adults undergoing elective cardiac surgery with Duraflo II heparin-coated (n = 81) or uncoated (n = 75) cardiopulmonary bypass sets (Duraflo coating surface; Baxter International, Inc, Deerfield, Ill) were analyzed for activation of complement (C3 activation products, terminal complement complex), granulocytes (myeloperoxidase, lactoferrin), and platelets (β-thromboglobulin) by enzyme immunoassays. Preoperative risk was assessed by means of the "Higgins' score." Complications (cardiac, renal, pulmonary, gastrointestinal, and central nervous system dysfunction, infections, death) were registered prospectively. Data were analyzed by analysis of variance, logistic regression, and linear regression. Results and conclusions: Sixty-seven percent of the patients had predefined risk factors. Complications developed in 53 patients (34%), equivalently with and without heparin-coated bypass sets (P = .44-.82), despite a significant reduction in complement and granulocyte activation by heparin coating. No clear-cut relationship between the terminal complement complex and outcome was found, even if it was significant in the models for renal and central nervous system dysfunction and infections (P = .006). The Higgins' score was significantly related to complement activation (P < .05). Approximately 50% of the variation in granulocyte activation was explained by complement (P ≤ .01) and platelet activation (P < .05), heparin/protamine dose ratio (P = .02), duration of cardiopulmonary bypass (P < .01), and gender (P < .05). Therefore measures reducing complement activation alone will not necessarily reduce granulocyte activation sufficiently for clinical significance.
European Journal of Cardio-Thoracic Surgery, 1997
Objecti6e: This study was carried out to: (a) compare complement and granulocyte activation durin... more Objecti6e: This study was carried out to: (a) compare complement and granulocyte activation during cardiac operations in patients operated with cardiopulmonary bypass coated with heparin by the Duraflo II method, with activation in patients operated with uncoated circuits; and (b) relate complement, and granulocyte activation to selected adverse effects. Methods: In a multicentre study among Rikshospitalet, Ullevaal Hospital in Norway and Uppsala University Hospital in Sweden, plasma concentrations of the complement activation products C4b/iC4b/C4c (C4bc), C3b/iC3b/C3c (C3bc), the terminal SC5b-9 complement complex (TCC), and the granulocyte proteins myeloperoxidase and lactoferrin were assessed in two groups of patients undergoing aortocoronary bypass. Seventy-six patients underwent surgery operated with circuits coated by the Duraflo II heparin coating and 75 with uncoated circuits. The same amount of systemic heparin was administered to all patients. Results: In both groups a significant increase in C4bc was first seen by the end of operation, from 86.79 12.5 to 273.09277.4 nM in controls and from 86.9 918.5 to 320.29190.5 nM in the control group, confirming previous documentation that the classical pathway is not activated during CPB, but as a consequence of protamin administration. The formation of C4bc did not differ significantly between the two groups. In the uncoated group the C3bc concentration increased from 124.09 15.3 to a maximum of 1176.1 9 64.7 nM (PB0.01) and in the coated group it increased from 129.8 9 16.1 to a maximum of 1019.4 954.9 nM (PB0.01) during CPB. Summary values but not peak values differed significantly between the groups. In the uncoated group the TCC concentration increased from 0.529 0.03 to a maximum value of 8.09 9 0.57 AU/ml (P B0.01) while in the coated group the TCC concentration increased from a baseline of 0.53 90.03 to a peak value of 5.2 9 0.24. AU/ml (PB 0.01). The difference between the peak values was statistically significant (P = 0.00002). In both groups a significant increase in myeloperoxidase and lactoferrin release was observed by the end of operation. There was no difference in myeloperoxidase or lactoferrin release between the two groups. TCC levels were compared to the occurrence of perioperative infarction, development of lung or renal failure, postoperative bleeding, time on ventilator and days in hospital. Three patients developed perioperative infarction; the peak levels of TCC were significantly higher in these patients than in the 148 patients that did not develop infarction. The reduction in TCC formation in the heparin-coated group was not associated with differences in any of the other clinical parameters. Few adverse effects occurred in the study. The peak values of C3bc were higher in the patients needing inotropic support than in those
The Annals of Thoracic Surgery
The American Journal of Cardiology, 2002
ABSTRACT We evaluated the in-hospital and 1-year outcomes in 119 consecutive patients who underwe... more ABSTRACT We evaluated the in-hospital and 1-year outcomes in 119 consecutive patients who underwent minimally invasive direct coronary artery bypass grafting (MID-CAB) with 441 consecutive patients undergoing coronary stenting in isolated proximal or mid-left anterior descending lesions. MIDCAB and coronary artery stenting have very similar in-hospital and 1-year mortality and myocardial infarction rates; MIDCAB requires longer hospitalization, but the current stent designs have higher 1-year target vessel revascularization and major adverse cardiac event, rates than MIDCAB.
The Journal of Thoracic and Cardiovascular Surgery, 2010
Objective: Although health status after coronary artery bypass grafting improves at the group lev... more Objective: Although health status after coronary artery bypass grafting improves at the group level, individual outcomes demonstrate variation. We aimed to evaluate relative importances of changes in cardiac and cognitive function and symptom status regarding physical and mental health at 1 year after coronary artery bypass grafting. Methods: Outcomes in multivariable regression analysis (n ¼ 86) were self-reported physical and mental health (Medical Outcomes Study 36-Item Short Form) at 12 months' follow-up, adjusting for baseline. Independent variables were change in exercise capacity (staged ergometer protocol), cognitive function (neurocognitive test battery), and self-reported improvement of angina. Graft patency was evaluated by angiography (82/86 patients). Results: After surgery, health status was comparable to the age-and sex-matched population norm. Improvement of angina was associated with gain in physical health in the range of 0.5 SD (b ¼ 0.23, P ¼ .012). Change in observed physical exercise capacity (mean AE SD 199 AE 426 W $ min) accounted for 9% of variance in physical health (b ¼ 0.42, P ¼ .001). Positive change in cognitive function was significantly related to mental (b ¼ 0.52, P ¼ .007) but not physical health. Graft occlusion (22/82 patients) was not significantly related to health status. Conclusions: Individual variation in objective functional performance and symptom relief is significant for selfreported health status, beyond the predictive ability of preoperative health status, sex, and graft patency. Awareness of the extent and impact of outcome variation is important when counseling patients before and after coronary artery bypass grafting.
European Journal of Cardio-Thoracic Surgery, 2014
OBJECTIVES: Preservation of left ventricular (LV) function is crucial for a beneficial outcome in... more OBJECTIVES: Preservation of left ventricular (LV) function is crucial for a beneficial outcome in high-risk patients undergoing cardiac surgery. The present study evaluated a motion sensor (accelerometer) for continuous monitoring of LV performance during changes in global and regional LV function. METHODS: In 11 pigs, an accelerometer was sutured to the epicardium on the anterior apical LV region. Global LV function was modulated by esmolol, epinephrine and fluid loading, whereas regional LV dysfunction was induced by a 3-min occlusion of left anterior descending (LAD) coronary artery. Epicardial acceleration in the circumferential direction was obtained by the accelerometer, and from this signal, epicardial velocity was calculated. Peak systolic velocity was measured and used as an index of LV performance. The accelerometer was compared with left ventricular stroke work (LVSW), ejection fraction and myocardial strain by echocardiography. RESULTS: Accelerometer peak systolic velocity and LVSW changed significantly during all interventions, affecting global LV function. Systolic velocity by the accelerometer increased during epinephrine and fluid loading from 14.1 [10.2; 17.3] to 25.4 [16.7; 28.5] (P < 0.05) and 14.8 [12.5; 18.5] cm/s (P < 0.05), respectively. Esmolol infusion significantly decreased accelerometer peak systolic velocity to 9.4 [7.3; 10.7] cm/s (P < 0.05). Minor changes were seen in the echocardiographic measurements, with significant changes only observed in myocardial strain during the interventions with esmolol and epinephrine. Regional LV dysfunction was clearly detected by the accelerometer during LAD occlusion, and peak systolic velocity was reduced from 14.1 [10.2; 17.3] to 5.7 [5.0; 6.8] cm/s (P < 0.05). The accelerometer demonstrated higher sensitivity and specificity for the detection of myocardial ischaemia than LVSW and ejection fraction. For all interventions, accelerometer peak systolic velocity correlated strongly with LVSW (r = 0.81, P < 0.01) and myocardial strain (r = 0.80; P < 0.01). CONCLUSIONS: It was possible to obtain accurate information on LV performance by the use of an epicardially attached accelerometer. The method allows continuous monitoring of LV function and may therefore improve perioperative monitoring of cardiac surgery patients.
The Journal of Thoracic and Cardiovascular Surgery, 2010
Objective: Although health status after coronary artery bypass grafting improves at the group lev... more Objective: Although health status after coronary artery bypass grafting improves at the group level, individual outcomes demonstrate variation. We aimed to evaluate relative importances of changes in cardiac and cognitive function and symptom status regarding physical and mental health at 1 year after coronary artery bypass grafting.