Matti Tarkka - Academia.edu (original) (raw)
Papers by Matti Tarkka
Interactive cardiovascular and thoracic surgery, 2002
Osteogenesis imperfecta is an inherited connective tissue disorder. Aortic root dilation, aortic ... more Osteogenesis imperfecta is an inherited connective tissue disorder. Aortic root dilation, aortic insufficiency and mitral valve prolapse are uncommon cardiovascular manifestations of osteogenesis imperfecta. Cardiac surgery in patients with osteogenesis imperfecta involves a high risk of complication rate. We report a case of coronary artery dissection induced by coronary angiogram in a patient with osteogenesis imperfecta and severe aortic regurgitation. In this case, the dissection of a coronary artery was not completely sealed by coronary stenting, and followed by successful combined aortic valve replacement and coronary artery bypass grafting on an emergency basis.
Journal of Perinatal Medicine, 1981
Circulation: Cardiovascular Genetics, 2013
Jula, MD MD MD, Ph hD D 8 8 8 ; ; ; Ni Nina H Hut t ut i i ri-Kähö hönen, MD M MD, Ph Ph hD D 9 9... more Jula, MD MD MD, Ph hD D 8 8 8 ; ; ; Ni Nina H Hut t ut i i ri-Kähö hönen, MD M MD, Ph Ph hD D 9 9 9 ; ; Ma k rkus J Juo u u nal la, MD MD, Ph PhD D 10 1 1 Laitinen, MD, Ph Ph PhD D D 11 11 11 ; ; Re Re Reij ij i o o o La La Laak ak akso so sone ne nen, n n M
Journal of Cardiac Surgery, 2009
Six patients operated on for renal cell carcinoma with vena caval involvement were prospectively ... more Six patients operated on for renal cell carcinoma with vena caval involvement were prospectively studied. The mean age of the four men and two women was 58 (range 51-77) years. In four of them the tumour was excised during cardiopulmonary bypass and deep hypothermic circulatory arrest. The operation was radical in three of these patients and palliative in one. There were no major complications or deaths during hospitalisation averaging 9 (7-17) days. The mean follow-up was 9 (4-14) months, during which two patients had died of metastatic disease. The surgical approach with cardiopulmonary bypass and deep hypothermic circulatory arrest is well tolerated and can be used to facilitate complete tumour thrombectomy, with low operative risk. Need for caval tumour thrombectomy was found in 5% of all patients with renal cell carcinoma during the study period.
Cardiovascular Diabetology, 2014
Background: The associations of metabolic syndrome (MetS) or diabetes mellitus (DM) on long-term ... more Background: The associations of metabolic syndrome (MetS) or diabetes mellitus (DM) on long-term survival after coronary artery bypass grafting (CABG) have not been extensively evaluated. The aim of the present study was to assess the impact of MetS and DM on the 16-year survival after CABG. Methods: Diabetic and metabolic status together with relevant cardiovascular data was established in 910 CABG patients operated in 1993-94. They were divided in three groups as follows: neither DM nor MetS (375 patients), MetS alone (279 patients) and DM with or without MetS (256 patients). The 16-year follow-up of patient survival was carried out using national health databases. The relative survival rates were analyzed using the Life comparing the observed survival rates of three patient groups to the rates based on age-, sex-and time-specific life tables for the whole population in Finland. To study the independent significance of MetS and DM for clinical outcome, multivariate analysis was made using an optimizing stepwise procedure based on the Bayesian approach.
Scandinavian Cardiovascular Journal, 2009
To establish which factors influence patients&amp... more To establish which factors influence patients' return to work and how well they remain at work after coronary artery bypass grafting (CABG). Five hundred and sixty nine consecutive CABG patients aged less than 65 years were followed for 10 years. Data were collected from patient records and by questionnaires supplemented with information from Finnish national archives. Multivariate analysis showed the best predictors for return to work to be younger age, preoperative working, as well as absence of diabetes or perioperative cardiac damage. Almost half of the patients aged less than 60 and preoperatively not retired were working one year after CABG. Five years postoperatively, 85% of patients younger than 60 years and once returned to work were still working. Correspondingly, of subjects remaining under 60 years during a 10-year follow-up, 75% continued working. Younger age and preoperative employment were the most important predictors of successful return to work. Once returned after CABG, patients' staying at work was comparable with that in the general population.
Duodecim; lääketieteellinen aikakauskirja, 2001
The Thoracic and cardiovascular surgeon, Jan 24, 2015
Objectives A cohort of patients having symptoms of sternal nonunion late after sternotomy was stu... more Objectives A cohort of patients having symptoms of sternal nonunion late after sternotomy was studied to find out whether the complaints were related to true sternal nonunion or decreased bone density. Methods A survey was mailed to 2,053 cardiac surgical patients operated in our institution between July 2007 and June 2010. The patients were requested about symptoms referring to sternal instability. A group of symptomatic individuals as well as 1:1 age- and time-matched asymptomatic controls were examined with sternal palpation, ultrasound during standardized sternal pressure provocation, and computed tomography (CT). Results The number of patients replied in the survey was 1,918 (93.4%); 2.3% (44 patients) reported sensation of movement or clicking in sternum during body movements and during coughing. Symptomatic patients living within 200 km to the hospital (21) and their asymptomatic controls (21) were selected for further clinical and imaging studies. Mean period between the ini...
International journal of nursing studies, 2002
The purpose of this study was to examine fear and anxiety of coronary artery bypass patients at d... more The purpose of this study was to examine fear and anxiety of coronary artery bypass patients at different time-points in the coronary artery bypass process and changes between different time-points. Patients (n = 171) from one university hospital completed questionnaires while awaiting surgery at home, in hospital the evening before surgery and 3 months later. The Bypass Grafting Fear scale was developed to measure fear. Anxiety was measured using state-trait-anxiety inventory and HAD. The highest levels of fear and anxiety were measured in the waiting period to coronary artery bypass grafting (CABG). Compared with the waiting period, fear and anxiety levels dropped in hospital and 3 months later. Female gender was related to change in fear and HAD anxiety. Marital status and vocational education were related to changes in STATE-A. Age under 55 years was related to higher TRAIT-A especially in the recovery period. These findings warrant concern for fear and anxiety in patients await...
Scandinavian Cardiovascular Journal, 2013
Resuscitation after cardiac arrest may lead to ischemia-reperfusion injury and infarction. We eva... more Resuscitation after cardiac arrest may lead to ischemia-reperfusion injury and infarction. We evaluated whether sildenafil, a phosphodiesterase-5 inhibitor, has an impact on recovery after cardiac arrest in a rat cardiac transplantation model. Sixty-one Fischer344 rats underwent syngeneic heterotopic cardiac transplantation after ischemia and ligation of the left anterior coronary artery of the heart to yield myocardial infarction (IRI + MI). Of these, 22 rats received subcutaneously injected sildenafil (1 mg/kg/day) (IRI +MI + S). Twenty-three additional grafted animals with transplantation only served as controls with ischemia reperfusion injury (IRI). After 2 days, immunohistochemistry for eNOS, and RT-PCR for iNOS and Aquaporin-7 were performed after graft harvesting and histology. Two days after transplantation, remote intramyocardial arteries were more preserved in IRI + MI + S as compared with IRI +MI and IRI (0.74 ± 0.14, 0.56 ± 0.23 and 0.55 ± 0.22, PSU, p < 0.05, respectively). Decreased eNOS staining confirmed the presence of developing infarction in IRI + MI and IRI + MI + S. The expression of iNOS was significantly lower during IRI + MI +S as compared with IRI + MI (0.02 ± 0.01 and 1.02 ± 0.02, FC, p < 0.05). Administered at the onset of reperfusion and developing infarction, sildenafil has an impact on myocardial recovery after cardiac arrest and ischemia.
Scandinavian Cardiovascular Journal, 1997
The mechanism of postoperative hyperamylasaemia was studied in 48 patients undergoing coronary ar... more The mechanism of postoperative hyperamylasaemia was studied in 48 patients undergoing coronary artery bypass grafting (CABG). Mild hyperamylasaemia developed in 87% of the patients, and in 10% the serum amylase activity was > 1000 U/l. Serial measurements of serum salivary (S-) and pancreatic (P-) isoamylases indicated that hyperamylasaemia was highest 24 hours after CABG and consisted mainly of P-amylase component. Serum creatinine, creatinine clearance and urinary albumin concentration remained normal after CABG, excluding severe renal damage. The fractional clearance (i.e. relative to creatinine clearance) of P-amylase decreased more than of S-amylase (from 3.6 to 0.9% vs 1.3 to 0.8%). Decreased rate of excretion into urine, rather than pancreatic cellular damage, is the main source of hyperamylasaemia after CABG.
Scandinavian Cardiovascular Journal, 2006
To evaluate whether off-pump surgery attenuates microalbuminuria and other markers of systemic in... more To evaluate whether off-pump surgery attenuates microalbuminuria and other markers of systemic inflammatory response to coronary artery bypass surgery as compared to surgery performed using cardiopulmonary bypass. Forty-three adult patients undergoing elective coronary artery bypass grafting surgery were operated on with or without cardiopulmonary bypass (CPB). Microalbuminuria, serum C-reactive protein, and oxygenation and lung function parameters were measured at several time points until the first postoperative morning. The urinary albumin/creatinine ratio was low in both groups before surgery, but reached a maximum level at the end of CPB or just after opening the last coronary artery clamp in the off-pump group (p<0.05). The urinary albumin/creatinine ratio remained slightly elevated in both groups until the morning after the operation (p<0.05). There were no statistical differences between groups. Serum C-reactive protein remained at the initial level the evening after the operation, but increased by the first postoperative morning in both groups (p<0.001). The alveolar-arterial gradient for oxygen partial pressure rose significantly after the operation in the intensive care unit in both groups (p<0.0001). The shunt fraction of the pulmonary circulation did not change in either group. Off-pump coronary artery surgery did not prevent the acute phase inflammatory response measured in the present study. The acute phase inflammatory response after coronary artery bypass surgery is more likely a response to the surgical trauma itself rather than to CPB.
Scandinavian Cardiovascular Journal, 1991
Scandinavian Cardiovascular Journal, 2009
Atherosclerosis is a systemic disease affecting several vessels of the body. Coronary artery pati... more Atherosclerosis is a systemic disease affecting several vessels of the body. Coronary artery patients requiring bypass surgery have increased prevalence of carotid artery atherosclerosis which is known to increase operative risk in coronary artery bypass surgery (CABG). Radial artery is often screened for grafting purposes preoperatively. Our aim was to find out whether atherosclerotic changes in forearm vessels are correlated and could reveal risk to carotid artery disease. Eighty-five patients planned for elective CABG were examined with ultrasonography preoperatively. Biplane ultrasonographic scanning was performed on forearm arteries and both carotid arteries. Eleven patients had pathologic changes in the wall of forearm vessels. Carotid artery disease was found on 19 patients. Forearm vessel pathology was found to have correlation to carotid artery disease. When forearm arteries show atherosclerotic pathology the risk of having carotid disease is at least five-fold, in subgroups even higher. Forearm arterial pathology is correlated to carotid artery disease. When forearm vessel pathology is evident in preoperative examination, scanning of the carotid vessels should be considered.
The Journal of Thoracic and Cardiovascular Surgery, 2013
Immunoglobulin (Ig) G4-positive aortitis may determine outcome after surgery for ascending aorta.... more Immunoglobulin (Ig) G4-positive aortitis may determine outcome after surgery for ascending aorta. We evaluated IgG4 expression of dilated ascending aortic wall. The study consisted of 91 patients who underwent ascending aortic surgery. For histology, hematoxylin-eosin, elastase-van Gieson, and periodic acid-Schiff stainings were performed. The amount of T and B lymphocytes, plasma cells, macrophages, cell proliferation, and IgG4 positivity were determined by immunohistochemistry. The aortic wall in 12 patients had IgG4 positivity that was always confined to the adventitia. Adventitial plasma cells were numerous in all but 2 of these patients (P < .0001). Aortitis was revealed in 2 patients (17%) with IgG4-positive staining of the aorta and in 6 patients (8%) with IgG4 negativity. IgG4 staining was significantly associated with total aortic wall inflammation (area under the curve, 0.865; standard error, 0.043; P = .000; 95% confidence interval, 0.779-0.950). The mean diameter of the ascending aorta was 69 ± 4.7 mm and 56 ± 1.1 mm in patients with IgG4 positivity and negativity, respectively (P < .004). Approximately half of the patients with IgG4 positivity had dissection (42%), compared with only 15 of 79 (19%) of the remaining patients (P = not significant). Two patients with IgG4 positivity had to undergo reoperation because of immediate postoperative dissection. Seven patients died, including 4 patients (33%) with IgG4 positivity; the remaining 3 patients (4%) were IgG4 negative (P < .005). IgG4-positive ascending aortic wall was frequent in our study cohort (13%) and revealed aortic inflammation associated with dilatation.
Journal of Clinical Nursing, 2001
The study aimed at ascertaining the gender differences and fears among patients awaiting coronary... more The study aimed at ascertaining the gender differences and fears among patients awaiting coronary artery bypass grafting. Data were collected using a mailed questionnaire from patients (n=207) scheduled for coronary artery bypass grafting at one hospital. Intensity of fear was measured on a 10-point scale including 12 objects of fear. The results showed that demographic data, lifestyle and functional capacity differed between the sexes. Patients' fears differed with respect to their objects and intensity, with women reporting more intense fears. Men also had fears, but the objects of fear differed from those in women. Apart from gender, the intensity of fear was associated with physical exercise, emotional problems and depression. Nursing interventions could be developed to meet the different needs for information and support, especially among women but also among men, to relieve their fears during the wait for coronary artery bypass grafting.
Journal of Clinical Nursing, 2002
The purpose of this study was to ascertain social support resources available for patients awaiti... more The purpose of this study was to ascertain social support resources available for patients awaiting coronary artery bypass grafting (CABG) and the effect of social support on their fear and anxiety. A postal questionnaire was sent to 270 patients awaiting CABG in one hospital, 207 of whom responded. Norbeck's Social Support Questionnaire (NSSQ) was used. The quality of basic cardiac information (QBCI) and the social support wanted (WSS) by patients were measured with an instrument developed for this study. Fear was measured with the Bypass Grafting Fear Scale (BGFS) developed for this study. Anxiety was measured with Spielberger's State-Trait Anxiety Inventory (STAI). The results were analysed using frequency and percentage distributions, cross-tabulation, non-parametric tests and logistic regression. Heart patients' spouses provided the most emotional and tangible aid. Low emotional support from the social network was associated with high anxiety. Half the patients rated the quality of basic information as good or excellent. Those who perceived the quality of information to be excellent experienced mild fear. Those who displayed high fear wanted informational support from nurses more often than patients with lower fear. We conclude that the fear and anxiety of patients awaiting CABG are connected with their social support resources.
Journal of Cardiothoracic and Vascular Anesthesia, 2004
Heart & Lung: The Journal of Acute and Critical Care, 2001
The purpose of this study was to identify the prevalence of fear and anxiety in patients awaiting... more The purpose of this study was to identify the prevalence of fear and anxiety in patients awaiting coronary artery bypass grafting and the factors associated with high fear and high anxiety.
The Annals of Thoracic Surgery, 1995
Oxygen-derived free radicals constitute one part of the etiologic factors for cardiac onset harmf... more Oxygen-derived free radicals constitute one part of the etiologic factors for cardiac onset harmful events. Allopurinol is able to reduce the generation of free radicals. Vitamins E and C scavenge radicals after their formation. Eighty-one patients with coronary artery disease were randomized into four study groups: Group 1 (n = 20) patients had stable disease and received oral vitamin E for 4 weeks, and vitamin C and allopurinol 2 days before and 1 day after coronary artery bypass grafting. Group 2 (n = 25) consisted of their controls. Group 3 patients (n = 17) had more unstable disease and received the same medications as group 1, except that vitamin E was given only 2 days before the operation. Group 4 (n = 19) was their controls. Groups 1 and 3 had fewer ischemic electrocardiographic events and required less dopamine perioperatively than corresponding control groups 2 and 4. Group 3 had fewer perioperative infarctions and less creatine kinase-MB release than the respective controls (group 4). Plasma levels of vitamins E and C, urate, and total free radical trapping ability were considered to support the theory about the role of free radicals in reperfusion injury. Especially the unstable patients, but also patients with stable coronary artery disease requiring coronary artery bypass grafting benefit from perioperative allopurinol and vitamin E and C treatment.
Interactive cardiovascular and thoracic surgery, 2002
Osteogenesis imperfecta is an inherited connective tissue disorder. Aortic root dilation, aortic ... more Osteogenesis imperfecta is an inherited connective tissue disorder. Aortic root dilation, aortic insufficiency and mitral valve prolapse are uncommon cardiovascular manifestations of osteogenesis imperfecta. Cardiac surgery in patients with osteogenesis imperfecta involves a high risk of complication rate. We report a case of coronary artery dissection induced by coronary angiogram in a patient with osteogenesis imperfecta and severe aortic regurgitation. In this case, the dissection of a coronary artery was not completely sealed by coronary stenting, and followed by successful combined aortic valve replacement and coronary artery bypass grafting on an emergency basis.
Journal of Perinatal Medicine, 1981
Circulation: Cardiovascular Genetics, 2013
Jula, MD MD MD, Ph hD D 8 8 8 ; ; ; Ni Nina H Hut t ut i i ri-Kähö hönen, MD M MD, Ph Ph hD D 9 9... more Jula, MD MD MD, Ph hD D 8 8 8 ; ; ; Ni Nina H Hut t ut i i ri-Kähö hönen, MD M MD, Ph Ph hD D 9 9 9 ; ; Ma k rkus J Juo u u nal la, MD MD, Ph PhD D 10 1 1 Laitinen, MD, Ph Ph PhD D D 11 11 11 ; ; Re Re Reij ij i o o o La La Laak ak akso so sone ne nen, n n M
Journal of Cardiac Surgery, 2009
Six patients operated on for renal cell carcinoma with vena caval involvement were prospectively ... more Six patients operated on for renal cell carcinoma with vena caval involvement were prospectively studied. The mean age of the four men and two women was 58 (range 51-77) years. In four of them the tumour was excised during cardiopulmonary bypass and deep hypothermic circulatory arrest. The operation was radical in three of these patients and palliative in one. There were no major complications or deaths during hospitalisation averaging 9 (7-17) days. The mean follow-up was 9 (4-14) months, during which two patients had died of metastatic disease. The surgical approach with cardiopulmonary bypass and deep hypothermic circulatory arrest is well tolerated and can be used to facilitate complete tumour thrombectomy, with low operative risk. Need for caval tumour thrombectomy was found in 5% of all patients with renal cell carcinoma during the study period.
Cardiovascular Diabetology, 2014
Background: The associations of metabolic syndrome (MetS) or diabetes mellitus (DM) on long-term ... more Background: The associations of metabolic syndrome (MetS) or diabetes mellitus (DM) on long-term survival after coronary artery bypass grafting (CABG) have not been extensively evaluated. The aim of the present study was to assess the impact of MetS and DM on the 16-year survival after CABG. Methods: Diabetic and metabolic status together with relevant cardiovascular data was established in 910 CABG patients operated in 1993-94. They were divided in three groups as follows: neither DM nor MetS (375 patients), MetS alone (279 patients) and DM with or without MetS (256 patients). The 16-year follow-up of patient survival was carried out using national health databases. The relative survival rates were analyzed using the Life comparing the observed survival rates of three patient groups to the rates based on age-, sex-and time-specific life tables for the whole population in Finland. To study the independent significance of MetS and DM for clinical outcome, multivariate analysis was made using an optimizing stepwise procedure based on the Bayesian approach.
Scandinavian Cardiovascular Journal, 2009
To establish which factors influence patients&amp... more To establish which factors influence patients' return to work and how well they remain at work after coronary artery bypass grafting (CABG). Five hundred and sixty nine consecutive CABG patients aged less than 65 years were followed for 10 years. Data were collected from patient records and by questionnaires supplemented with information from Finnish national archives. Multivariate analysis showed the best predictors for return to work to be younger age, preoperative working, as well as absence of diabetes or perioperative cardiac damage. Almost half of the patients aged less than 60 and preoperatively not retired were working one year after CABG. Five years postoperatively, 85% of patients younger than 60 years and once returned to work were still working. Correspondingly, of subjects remaining under 60 years during a 10-year follow-up, 75% continued working. Younger age and preoperative employment were the most important predictors of successful return to work. Once returned after CABG, patients' staying at work was comparable with that in the general population.
Duodecim; lääketieteellinen aikakauskirja, 2001
The Thoracic and cardiovascular surgeon, Jan 24, 2015
Objectives A cohort of patients having symptoms of sternal nonunion late after sternotomy was stu... more Objectives A cohort of patients having symptoms of sternal nonunion late after sternotomy was studied to find out whether the complaints were related to true sternal nonunion or decreased bone density. Methods A survey was mailed to 2,053 cardiac surgical patients operated in our institution between July 2007 and June 2010. The patients were requested about symptoms referring to sternal instability. A group of symptomatic individuals as well as 1:1 age- and time-matched asymptomatic controls were examined with sternal palpation, ultrasound during standardized sternal pressure provocation, and computed tomography (CT). Results The number of patients replied in the survey was 1,918 (93.4%); 2.3% (44 patients) reported sensation of movement or clicking in sternum during body movements and during coughing. Symptomatic patients living within 200 km to the hospital (21) and their asymptomatic controls (21) were selected for further clinical and imaging studies. Mean period between the ini...
International journal of nursing studies, 2002
The purpose of this study was to examine fear and anxiety of coronary artery bypass patients at d... more The purpose of this study was to examine fear and anxiety of coronary artery bypass patients at different time-points in the coronary artery bypass process and changes between different time-points. Patients (n = 171) from one university hospital completed questionnaires while awaiting surgery at home, in hospital the evening before surgery and 3 months later. The Bypass Grafting Fear scale was developed to measure fear. Anxiety was measured using state-trait-anxiety inventory and HAD. The highest levels of fear and anxiety were measured in the waiting period to coronary artery bypass grafting (CABG). Compared with the waiting period, fear and anxiety levels dropped in hospital and 3 months later. Female gender was related to change in fear and HAD anxiety. Marital status and vocational education were related to changes in STATE-A. Age under 55 years was related to higher TRAIT-A especially in the recovery period. These findings warrant concern for fear and anxiety in patients await...
Scandinavian Cardiovascular Journal, 2013
Resuscitation after cardiac arrest may lead to ischemia-reperfusion injury and infarction. We eva... more Resuscitation after cardiac arrest may lead to ischemia-reperfusion injury and infarction. We evaluated whether sildenafil, a phosphodiesterase-5 inhibitor, has an impact on recovery after cardiac arrest in a rat cardiac transplantation model. Sixty-one Fischer344 rats underwent syngeneic heterotopic cardiac transplantation after ischemia and ligation of the left anterior coronary artery of the heart to yield myocardial infarction (IRI + MI). Of these, 22 rats received subcutaneously injected sildenafil (1 mg/kg/day) (IRI +MI + S). Twenty-three additional grafted animals with transplantation only served as controls with ischemia reperfusion injury (IRI). After 2 days, immunohistochemistry for eNOS, and RT-PCR for iNOS and Aquaporin-7 were performed after graft harvesting and histology. Two days after transplantation, remote intramyocardial arteries were more preserved in IRI + MI + S as compared with IRI +MI and IRI (0.74 ± 0.14, 0.56 ± 0.23 and 0.55 ± 0.22, PSU, p < 0.05, respectively). Decreased eNOS staining confirmed the presence of developing infarction in IRI + MI and IRI + MI + S. The expression of iNOS was significantly lower during IRI + MI +S as compared with IRI + MI (0.02 ± 0.01 and 1.02 ± 0.02, FC, p < 0.05). Administered at the onset of reperfusion and developing infarction, sildenafil has an impact on myocardial recovery after cardiac arrest and ischemia.
Scandinavian Cardiovascular Journal, 1997
The mechanism of postoperative hyperamylasaemia was studied in 48 patients undergoing coronary ar... more The mechanism of postoperative hyperamylasaemia was studied in 48 patients undergoing coronary artery bypass grafting (CABG). Mild hyperamylasaemia developed in 87% of the patients, and in 10% the serum amylase activity was > 1000 U/l. Serial measurements of serum salivary (S-) and pancreatic (P-) isoamylases indicated that hyperamylasaemia was highest 24 hours after CABG and consisted mainly of P-amylase component. Serum creatinine, creatinine clearance and urinary albumin concentration remained normal after CABG, excluding severe renal damage. The fractional clearance (i.e. relative to creatinine clearance) of P-amylase decreased more than of S-amylase (from 3.6 to 0.9% vs 1.3 to 0.8%). Decreased rate of excretion into urine, rather than pancreatic cellular damage, is the main source of hyperamylasaemia after CABG.
Scandinavian Cardiovascular Journal, 2006
To evaluate whether off-pump surgery attenuates microalbuminuria and other markers of systemic in... more To evaluate whether off-pump surgery attenuates microalbuminuria and other markers of systemic inflammatory response to coronary artery bypass surgery as compared to surgery performed using cardiopulmonary bypass. Forty-three adult patients undergoing elective coronary artery bypass grafting surgery were operated on with or without cardiopulmonary bypass (CPB). Microalbuminuria, serum C-reactive protein, and oxygenation and lung function parameters were measured at several time points until the first postoperative morning. The urinary albumin/creatinine ratio was low in both groups before surgery, but reached a maximum level at the end of CPB or just after opening the last coronary artery clamp in the off-pump group (p<0.05). The urinary albumin/creatinine ratio remained slightly elevated in both groups until the morning after the operation (p<0.05). There were no statistical differences between groups. Serum C-reactive protein remained at the initial level the evening after the operation, but increased by the first postoperative morning in both groups (p<0.001). The alveolar-arterial gradient for oxygen partial pressure rose significantly after the operation in the intensive care unit in both groups (p<0.0001). The shunt fraction of the pulmonary circulation did not change in either group. Off-pump coronary artery surgery did not prevent the acute phase inflammatory response measured in the present study. The acute phase inflammatory response after coronary artery bypass surgery is more likely a response to the surgical trauma itself rather than to CPB.
Scandinavian Cardiovascular Journal, 1991
Scandinavian Cardiovascular Journal, 2009
Atherosclerosis is a systemic disease affecting several vessels of the body. Coronary artery pati... more Atherosclerosis is a systemic disease affecting several vessels of the body. Coronary artery patients requiring bypass surgery have increased prevalence of carotid artery atherosclerosis which is known to increase operative risk in coronary artery bypass surgery (CABG). Radial artery is often screened for grafting purposes preoperatively. Our aim was to find out whether atherosclerotic changes in forearm vessels are correlated and could reveal risk to carotid artery disease. Eighty-five patients planned for elective CABG were examined with ultrasonography preoperatively. Biplane ultrasonographic scanning was performed on forearm arteries and both carotid arteries. Eleven patients had pathologic changes in the wall of forearm vessels. Carotid artery disease was found on 19 patients. Forearm vessel pathology was found to have correlation to carotid artery disease. When forearm arteries show atherosclerotic pathology the risk of having carotid disease is at least five-fold, in subgroups even higher. Forearm arterial pathology is correlated to carotid artery disease. When forearm vessel pathology is evident in preoperative examination, scanning of the carotid vessels should be considered.
The Journal of Thoracic and Cardiovascular Surgery, 2013
Immunoglobulin (Ig) G4-positive aortitis may determine outcome after surgery for ascending aorta.... more Immunoglobulin (Ig) G4-positive aortitis may determine outcome after surgery for ascending aorta. We evaluated IgG4 expression of dilated ascending aortic wall. The study consisted of 91 patients who underwent ascending aortic surgery. For histology, hematoxylin-eosin, elastase-van Gieson, and periodic acid-Schiff stainings were performed. The amount of T and B lymphocytes, plasma cells, macrophages, cell proliferation, and IgG4 positivity were determined by immunohistochemistry. The aortic wall in 12 patients had IgG4 positivity that was always confined to the adventitia. Adventitial plasma cells were numerous in all but 2 of these patients (P < .0001). Aortitis was revealed in 2 patients (17%) with IgG4-positive staining of the aorta and in 6 patients (8%) with IgG4 negativity. IgG4 staining was significantly associated with total aortic wall inflammation (area under the curve, 0.865; standard error, 0.043; P = .000; 95% confidence interval, 0.779-0.950). The mean diameter of the ascending aorta was 69 ± 4.7 mm and 56 ± 1.1 mm in patients with IgG4 positivity and negativity, respectively (P < .004). Approximately half of the patients with IgG4 positivity had dissection (42%), compared with only 15 of 79 (19%) of the remaining patients (P = not significant). Two patients with IgG4 positivity had to undergo reoperation because of immediate postoperative dissection. Seven patients died, including 4 patients (33%) with IgG4 positivity; the remaining 3 patients (4%) were IgG4 negative (P < .005). IgG4-positive ascending aortic wall was frequent in our study cohort (13%) and revealed aortic inflammation associated with dilatation.
Journal of Clinical Nursing, 2001
The study aimed at ascertaining the gender differences and fears among patients awaiting coronary... more The study aimed at ascertaining the gender differences and fears among patients awaiting coronary artery bypass grafting. Data were collected using a mailed questionnaire from patients (n=207) scheduled for coronary artery bypass grafting at one hospital. Intensity of fear was measured on a 10-point scale including 12 objects of fear. The results showed that demographic data, lifestyle and functional capacity differed between the sexes. Patients' fears differed with respect to their objects and intensity, with women reporting more intense fears. Men also had fears, but the objects of fear differed from those in women. Apart from gender, the intensity of fear was associated with physical exercise, emotional problems and depression. Nursing interventions could be developed to meet the different needs for information and support, especially among women but also among men, to relieve their fears during the wait for coronary artery bypass grafting.
Journal of Clinical Nursing, 2002
The purpose of this study was to ascertain social support resources available for patients awaiti... more The purpose of this study was to ascertain social support resources available for patients awaiting coronary artery bypass grafting (CABG) and the effect of social support on their fear and anxiety. A postal questionnaire was sent to 270 patients awaiting CABG in one hospital, 207 of whom responded. Norbeck's Social Support Questionnaire (NSSQ) was used. The quality of basic cardiac information (QBCI) and the social support wanted (WSS) by patients were measured with an instrument developed for this study. Fear was measured with the Bypass Grafting Fear Scale (BGFS) developed for this study. Anxiety was measured with Spielberger's State-Trait Anxiety Inventory (STAI). The results were analysed using frequency and percentage distributions, cross-tabulation, non-parametric tests and logistic regression. Heart patients' spouses provided the most emotional and tangible aid. Low emotional support from the social network was associated with high anxiety. Half the patients rated the quality of basic information as good or excellent. Those who perceived the quality of information to be excellent experienced mild fear. Those who displayed high fear wanted informational support from nurses more often than patients with lower fear. We conclude that the fear and anxiety of patients awaiting CABG are connected with their social support resources.
Journal of Cardiothoracic and Vascular Anesthesia, 2004
Heart & Lung: The Journal of Acute and Critical Care, 2001
The purpose of this study was to identify the prevalence of fear and anxiety in patients awaiting... more The purpose of this study was to identify the prevalence of fear and anxiety in patients awaiting coronary artery bypass grafting and the factors associated with high fear and high anxiety.
The Annals of Thoracic Surgery, 1995
Oxygen-derived free radicals constitute one part of the etiologic factors for cardiac onset harmf... more Oxygen-derived free radicals constitute one part of the etiologic factors for cardiac onset harmful events. Allopurinol is able to reduce the generation of free radicals. Vitamins E and C scavenge radicals after their formation. Eighty-one patients with coronary artery disease were randomized into four study groups: Group 1 (n = 20) patients had stable disease and received oral vitamin E for 4 weeks, and vitamin C and allopurinol 2 days before and 1 day after coronary artery bypass grafting. Group 2 (n = 25) consisted of their controls. Group 3 patients (n = 17) had more unstable disease and received the same medications as group 1, except that vitamin E was given only 2 days before the operation. Group 4 (n = 19) was their controls. Groups 1 and 3 had fewer ischemic electrocardiographic events and required less dopamine perioperatively than corresponding control groups 2 and 4. Group 3 had fewer perioperative infarctions and less creatine kinase-MB release than the respective controls (group 4). Plasma levels of vitamins E and C, urate, and total free radical trapping ability were considered to support the theory about the role of free radicals in reperfusion injury. Especially the unstable patients, but also patients with stable coronary artery disease requiring coronary artery bypass grafting benefit from perioperative allopurinol and vitamin E and C treatment.