Concomitant Archives - World Asthma Foundation

Concomitant MAZE procedure during cardiac surgical procedures, is there any survival advantage in conversion to sinus rhythm?

Minerva Cardioangiol. 2014 Oct 30;

Authors: Neragi-Miandoab S, Skripochnik E, Michler RE, Friedman P, D’alessandro DA

Abstract
BACKGROUND: The MAZE procedure, or concomitant intraoperative ablation, is an effective technique to restore long–term sinus rhythm (SR). The survival benefit of conversion to SR has been questioned recently.
METHODS AND RESULTS: We retrospectively evaluated the conversion rate to SR and its correlation with long–term survival in 209 patients with chronic AF, who had a MAZE procedure during cardiac surgical procedures between the years 2006 and 2011 at our institution. The mean age was 67.2 ± 12.0 years and 52.2% were female (n=109). Perioperative mortality was 5.74% (n=12). In univariate analysis, significant risk factors for perioperative mortality were age (p=0.0033), duration of perfusion time (p=0.0093), elevated creatinine (?1.6 mg/dL, p=.02), and cross clamp time (p=0.016). In multivariate analysis age (HR 2.97) and duration of perfusion time (HR 1.48) were the only independent predictors of perioperative mortality. The overall one and five–year survival rates were 88%±2.2%, and 76%±3.3%, respectively. The one and five–year survival rates for patients who converted and were in sinus rhythm (SR) upon discharge (n=154) were 88%±2.6% and 80%±3.5%, respectively. While the one and five–year survival rates for patients who were still in AF upon discharge (n=55) were 94%±3% and 82%±6.6%, respectively, this survival difference was not statistically significant (p=0.24). Significant risk factors for long–term mortality included DM (p=0.023), preoperative MI (p=0.043), preoperative renal insufficiency (creatinine, ?1.6 mg/dL, p=0.02) and asthma/COPD (p=0.040). In multivariate analysis, age (HR 1.048) and preoperative MI (HR 1.948) were the only independent predictors of long–term mortality.
CONCLUSION: The surgical MAZE procedure has a high conversion rate, however, our data did not show improved survival in patients who converted to SR prior to discharge.

PMID: 25358018 [PubMed – as supplied by publisher]

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Concomitant inhibition of primary equine bronchial fibroblast proliferation and differentiation by selective ?2-adrenoceptor agonists and dexamethasone.

Eur J Pharmacol. 2014 Aug 13;

Authors: Franke J, Abraham G

Abstract
Altered airway cell proliferation plays an important role in the pathogenesis of human bronchial asthma and chronic obstructive pulmonary disease (COPD) as well as the equine recurrent airway obstruction (RAO) with consistent changes, i.e. narrowing the airway wall, explained by proliferation and differentiation of fibroblasts. In permanent cell lines, it has been suggested that ?2-adrenoceptor agonists and glucocorticoids regulate cell proliferation via the ?2-adrenoceptor pathway; indeed, no study was carried out in fresh isolated primary equine bronchial fibroblasts (EBF). We characterized the ?-adrenoceptors in EBF, and compared effects of long-acting (clenbuterol) and short-acting (salbutamol, isoproterenol) ?2-agonists and dexamethasone on proliferation, differentiation and collagen synthesis. High density (Bmax; 5037±494 sites/cell) of ?2-adrenoceptor subtype was expressed in EBF. ?2-agonists inhibited concentration-dependently EBF proliferation with potency of clenbuterol>salbutamol l» isoproterenol which was inhibited by ICI 118.551 and propranolol but not by CGP 20712A. In contrast, dexamethasone alone inhibited less EBF proliferation, but the effect was high when dexamethasone was combined with ?2-agonists. Transforming growth factor-?1 (TGF-?1) increased transformation of fibroblasts into myofibroblasts, and which was inhibited by clenbuterol and dexamethasone alone and drug combination resulted in high inhibition rate. Collagen synthesis in EBF was rather hampered by dexamethasone than by ?-agonists. Collectively, the expression of ?2-adrenoceptor subtype in EBF and the anti-proliferative effect of clenbuterol suggest that ?2-adrenoceptors are growth inhibitory and anti-fibrotic in EBF. These ?2-agonist effects in EBF were synergistically enhanced by dexamethasone, providing the additive effects of glucocorticoids to counteract airway remodelling and morbidity of asthma and RAO.

PMID: 25128704 [PubMed – as supplied by publisher]

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