| 1. |
- Silverborn, Martin, 1969, et al.
(författare)
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The performance of EuroSCORE II in CABG patients in relation to sex, age, and surgical risk: a nationwide study in 14,118 patients
- 2023
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Ingår i: Journal of Cardiothoracic Surgery. - : Springer Science and Business Media LLC. - 1749-8090. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundTo determine the discriminative accuracy and calibration of EuroSCORE II in relation to age, sex, and surgical risk in a large nationwide coronary artery bypass grafting (CABG) cohort.MethodsAll 14,118 patients undergoing isolated CABG in Sweden during 2012-2017 were included. Individual patient data were taken from the SWEDEHEART registry. Patients were divided by age (< 60, 60-69, 70-79, >= 80 years), sex, and surgical risk (low: EuroSCORE < 4%, intermediate: 4-8%, high: > 8%). Discriminative accuracy was determined by the area under the receiver operating characteristic curve (AUC) and calibration by the observed/estimated (O/E) mortality ratio at 30 days.ResultsAUC and O/E ratio were 0.82 (95% CI 0.79-0.85) and 0.58 (0.50-0.66) overall, 0.82 (0.79-0.86) and 0.57 (0.48-0.66) in men, and 0.79 (0.73-0.85) and 0.60 (0.47-0.75) in women. Regarding age, discriminative accuracy was highest in patients aged 60-69 years (AUC: 0.86 [0.80-0.93]) but was satisfactory in all groups (AUC: 0.74-0.80). O/E ratio varied from 0.26 for patients > 60 years to 0.90 for patients > 80 years. Regarding surgical risk, AUC and O/E ratio were 0.63 (0.44-0.83) and 0.18 (0.09-0.30) in low-risk patients, 0.60 (0.55-0.66) and 0.57 (0.46-0.68) in intermediate-risk patients, and 0.78 (0.73-0.83) and 0.78 (0.64-0.92) in high-risk patients.ConclusionsEuroSCORE II had good discriminative accuracy independently of sex and age, but markedly overestimated mortality risk, especially in younger patients. Accuracy and calibration were better in high-risk patients than in low-risk and intermediate-risk patients.
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| 2. |
- Lachonius, Maria, 1962, et al.
(författare)
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Socioeconomic factors and long-term mortality risk after surgical aortic valve replacement.
- 2023
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Ingår i: International journal of cardiology. Cardiovascular risk and prevention. - 2772-4875. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- There is scarce knowledge about the association between socioeconomic status and mortality in patients undergoing surgical aortic valve replacement. This study explores the associations between income, education and marital status, and long-term mortality risk.In this national registry-based observational cohort study we included all 14,537 patients aged >18 years who underwent isolated surgical aortic valve replacement for aortic stenosis in Sweden 1997-2020. Socioeconomic status and comorbidities were collected from three mandatory national registries. Cox regression models adjusted for patient characteristics and comorbidities were used to estimate the mortality risk.Mortality risk was higher for patients in the lowest versus the highest income quintile (adjusted hazard ratio [aHR] 1.36, 95% confidence interval [CI]: 1.11-1.65), for patients with <10 years education versus >12 years (aHR 1.20, 95% CI:1.08-1.33), and for patients who were not married/cohabiting versus those who were (aHR 1.24, 95% CI:1.04-1.48). Patients with the most unfavorable socioeconomic status (lowest income, shortest education, never married/cohabiting) had an adjusted median survival of 2.9 years less than patients with the most favorable socioeconomic status (14.6 years, 95% CI: 13.2-17.4 years vs. 11.7 years, 95% CI: 9.8-14.4).Low socioeconomic status in patients undergoing surgical aortic valve replacement is associated with shorter survival and an increased long-term adjusted mortality risk. These results emphasize the importance of identifying surgical aortic valve replacement patients with unfavorable socioeconomic situation and ensure sufficient post-discharge surveillance.
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| 3. |
- Dellgren, Göran, 1961, et al.
(författare)
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Extracorporeal membrane oxygenation as a bridge to lung transplantation: a long-term study
- 2015
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940 .- 1873-734X. ; 47:1
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Tidskriftsartikel (refereegranskat)abstract
- We investigated early outcomes in patients with end-stage pulmonary disease bridged with extracorporeal membrane oxygenation (ECMO) with the intention to perform lung transplantation (LTx).
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| 4. |
- Magnusson, Jesper, et al.
(författare)
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Long-term Extracorporeal Membrane Oxygenation Bridge to Lung Transplantation After COVID-19
- 2022
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 113:1
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Tidskriftsartikel (refereegranskat)abstract
- This report describes a patient with severe acute respiratory syndrome coronavirus 2 infection and irreversible lung destruction who underwent successful lung transplantation after 138 days of bridging with extracorporeal membrane oxygenation support. The case exemplifies that lung transplantation may be a possibility after very long-term coronavirus disease 2019 care, even if the patient is initially an unsuitable candidate. (C) 2022 by The Society of Thoracic Surgeons. Published by Elsevier Inc.
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| 5. |
- Nilsson, Tobias S, et al.
(författare)
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Hemofiltration in exvivo lung perfusion-a study in experimentally induced pulmonary edema.
- 2016
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Ingår i: The Journal of thoracic and cardiovascular surgery. - : Elsevier BV. - 1097-685X .- 0022-5223. ; 151:2, s. 570-75
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Tidskriftsartikel (refereegranskat)abstract
- Exvivo lung perfusion (EVLP) can potentially reduce pulmonary edema. In a pig model with induced pulmonary edema, we evaluated the effect of hemofiltration (HF) during EVLP on lung function, perfusate oncotic pressure, and lung weight.
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| 6. |
- Scherstén, Henrik, 1956, et al.
(författare)
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ECMO kan vara brygga till lungtransplantation : Ny metod räddar liv vid akut lungsvikt, visar retrospektiv studie.
- 2011
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Ingår i: Läkartidningen. - 0023-7205. ; 108:32-33, s. 1493-7
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Tidskriftsartikel (refereegranskat)abstract
- Lungtransplantation har utförts i Sverige sedan 20 år. Patienter som snabbt försämras i akut lungsvikt och inte återhämtar sig med konservativ behandling har tidigare bedömts som inte transplantabla och därför avlidit. Sedan några år använder vi i utvalda fall extrakorporeal membranoxygenering (ECMO) som brygga till lungtransplantation hos annars döende patienter. Överlevnaden för patienter som behandlats med ECMO syftande till lungtransplantation var 73 procent (8/11). Överlevnaden för dem som sedan genomgick lungtransplantation var 89 procent (8/9). Ingreppen genererade en hel del morbiditet, dock mest av övergående natur. Vi anser att ECMO-behandling i selekterade fall kan erbjudas yngre och medelålders patienter, trots att behandlingen i sig väcker frågor om morbiditet, kostnader och resursförbrukning. Det återstår att utvärdera långtidsresultaten hos patienter som genomgått ECMO-behandling som brygga till lungtransplantation.
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| 7. |
- Silverborn, Martin, 1969, et al.
(författare)
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Blunted vascular response to endothelin-a receptor blockade in cyclosporine-treated lung transplant recipients
- 2005
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Ingår i: J Heart Lung Transplant. - : Elsevier BV. - 1053-2498. ; 24:6, s. 665-70
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The majority of cyclosporine-treated transplant recipients develop hypertension. Endothelin-1 (ET-1) has been suggested to mediate cyclosporine-induced vasoconstriction when binding to ET-A receptors. We hypothesized that cyclosporine-treated lung transplant recipients have an increased basal vascular resistance and an augmented response to ET-A receptor blockade. METHODS: The selective ET-A receptor blocker BQ-123 (10 and 50 nmol/min) was infused into the brachial artery, alone or in combination with the nitric oxide synthase inhibitor NG-monomethyl-L-arginine acetate (L-NMMA) (2 and 4 micromol/min) in 10 lung transplant recipients without pharmacologically treated hypertension and 8 healthy controls. Forearm blood flow (FBF) was measured by venous occlusion plethysmography and plasma levels of ET-1 were analyzed. RESULTS: Baseline forearm vascular resistance did not differ between recipients and controls (32 +/- 4 vs 42 +/- 7 mmHg/ml/min, p = 0.32). BQ-123 increased FBF in controls but not in recipients (26% +/- 9% vs 5% +/- 11% at 10 nmol/min, p = 0.043 between groups). Coinfusion of BQ-123 and L-NMMA caused a comparable decrease in FBF in recipients and controls (-26% +/- 11%, vs -34% +/- 7%). Baseline ET-1 was higher in recipients (17.2 +/- 1.1 vs 14.7 +/- 0.8 pg/ml, p = 0.038). BQ-123 infusion increased plasma ET-1 in controls but not in recipients (+24% +/- 11% vs -0.4% +/- 6.2%, p = 0.029 between groups). CONCLUSIONS: The results demonstrate that cyclosporine-treated lung transplant recipients have increased plasma levels of ET-1 and a blunted response to ET-A receptor blockade compared with healthy subjects. In contrast, we found no evidence for an increased basal vascular resistance in transplant recipients. These alterations in endothelin handling may contribute to the development of transplant-associated hypertension.
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| 8. |
- Silverborn, Martin, 1969
(författare)
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Cardiovascular risk factors and peripheral vascular function in lung transplant recipients
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: Cardiovascular disease is a major contributor to morbidity and mortality after organ transplantation. Development of cardiovascular risk factors, like hypertension, is common after transplantation. The mechanism of post transplant hypertension is incompletely understood but vasoconstriction and endothelial dysfunction have been suggested to participate.Aims: To describe the prevalence of new-onset cardiovascular risk factors after lung transplantation, identify independent predictors and to investigate possible vascular mechanisms responsible for the development of hypertension after lung transplantation.Materials and methods: I: Lung transplant recipients (Ltx) without pre-transplant cardiovascular risk factors were included in a retrospective descriptive study. Cumulative prevalence of new-onset hypertension, hypercholesterolemia and diabetes were calculated, and independent preoperative predictors were identified. II-IV: Forearm vascular resistance (FVR) and effects on forearm blood flow of endothelial-dependent and independent vasodilators, inhibition of endothelial nitric oxide synthesis and endothelinA-receptor blockade were investigated in Ltx early (II-III) and late after transplantation (IV), and in healthy subjects by means of venous occlusion plethysmography. Plasma levels of endothelin-1 (ET-1) were determined and arterial compliance was measured by echo-tracking. Results: I: Three years after transplantation 90% of Ltx had developed at least one cardiovascular risk factor, and 40% two or more. Independent pre-transplant predictor for hypertension was; diastolic blood pressure, for hypercholesterolemia; serum-cholesterol level and for diabetes; cystic fibrosis and blood glucose level. II: Basal FVR, endothelial-independent vasodilatation and nitric oxide synthesis-inhibition induced vasoconstriction did not differ significantly between Ltx and controls. Ltx had an increased arterial stiffness. III: Ltx had an impaired vasodilatation to endothelinA-receptor blockade and increased plasma levels of ET-1. IV: Basal FVR was lower in Ltx late after transplantation while endothelial-dependent and -independent vasodilatation did not differ between the groups. There was a significant correlation between endothelin-1 levels and FVR in healthy subjects, but not in Ltx. Conclusions: Development of new-onset cardiovascular risk factors is common after lung transplantation and occurs early. No evidence of general vasoconstriction and endothelial dysfunction was detected after lung transplantation and accordingly, the results question this concept as being responsible for post-transplant hypertension. In contrast, alterations in endothelin-1 handling and endothelinA-receptor function were demonstrated in Ltx, which may have importance for the development of post-transplant hypertension.
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| 9. |
- Silverborn, Martin, 1969, et al.
(författare)
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Increased arterial stiffness in cyclosporine-treated lung transplant recipients early after transplantation
- 2004
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Ingår i: Clin Transplant. - : Wiley. - 0902-0063. ; 18:4, s. 473-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The majority of patients undergoing solid organ transplantation develop hypertension, to which cyclosporine (CsA)-induced peripheral vasoconstriction may contribute. We hypothesized that CsA-treated transplant recipients have an increased basal vascular tone and an altered response to nitric oxide. To test this hypothesis arterial resistance, non-endothelial dependent relaxation and arterial stiffness were investigated in CsA-treated lung transplant recipients within 18 months after transplantation. METHODS: In study 1, forearm blood flow (FBF) was measured by venous occlusion plethysmography at baseline and during glyceryl trinitrate (GTN) and N(G)-monomethyl-l-arginine acetate (l-NMMA) infusion in seven lung transplant recipients and nine healthy subjects. In study 2, arterial stiffness in carotid (CCA) and radial artery (RA) was measured by ultrasound (echo-tracking) in 10 lung transplant recipients, 12 healthy subjects and six patients waiting for lung transplantation. RESULTS: Basal FBF (3.1 +/- 0.2 vs. 3.0 +/- 0.3 mL/min, p = 0.79) and forearm arterial resistance (36 +/- 3 vs. 33 +/- 3 mmHg/mL/min, p = 0.60) did not differ between transplant recipients and controls. GTN infusion increased and l-NMMA decreased blood flow equally in both groups. Transplant recipients had increased arterial stiffness compared to both pre-transplant patients and healthy subjects (CCA stiffness index 11.7 +/- 1.1 vs. 8.5 +/- 0.2 and 8.6 +/- 0.6, p < 0.05 both; RA stiffness index 14.7 +/- 1.5 vs. 8.9 +/- 1.3 and 10.6 +/- 0.7, p < 0.05 both). CONCLUSIONS: Forearm blood flow and arterial resistance did not differ between healthy subjects and cyclosporine-treated lung transplant recipients early after transplantation. Increased arterial stiffness was demonstrated in transplant recipients, which may have implications for future development of transplant hypertension.
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| 10. |
- Silverborn, Martin, 1969, et al.
(författare)
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New-onset cardiovascular risk factors in lung transplant recipients
- 2005
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Ingår i: J Heart Lung Transplant. ; 24:10
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cardiovascular disease (CVD) is a common cause of morbidity and mortality after solid-organ transplantation. Both pre-existing cardiovascular risk factors in recipients and immunosuppressive drug toxicity may contribute to CVD. We sought to describe the prevalence of new-onset hypertension, hypercholesterolemia and diabetes mellitus in lung transplant recipients and to identify predisposing factors. METHODS: One hundred twenty-six patients without pre-transplant hypertension, hypercholesterolemia or diabetes were included in a retrospective descriptive study. All patients were initially on cyclosporine-based triple immunosuppression. Cumulative prevalence of new-onset hypertension, hypercholesterolemia and diabetes were calculated. A multivariate Cox regression model was used to identify independent pre-operative predictors. RESULTS: By 3 years after transplantation, 90% of patients had developed at least 1 cardiovascular risk factor and 40% developed > or = 2 risk factors. The cumulative prevalence of new-onset hypertension at 1, 3, 5 and 7 years was 45%, 65%, 67% and 72%, respectively. The corresponding prevalence for hypercholesterolemia was 16%, 33%, 48% and 58%, and for diabetes 6%, 7%, 7% and 10%, respectively. The independent pre-transplant predictors were: for hypertension, diastolic blood pressure (odds ratio: 2.1 per 10 mm Hg [95% confidence interval: 1.3 to 3.5], p = 0.005); for hypercholesterolemia, serum cholesterol level (OR: 1.8 per mmol/liter [95% CI: 1.3 to 2.5], p < 0.001); and, for diabetes, cystic fibrosis diagnosis (OR: 7.4 [95% CI: 1.6 to 35.6], p = 0.01) and blood glucose level (OR 2.2 per mmol/liter [95% CI 1.1 to 4.5], p = 0.02). CONCLUSIONS: The majority of cyclosporine-treated lung transplant recipients develop new-onset hypertension or hypercholesterolemia early after transplantation. Pre-transplant blood pressure, serum cholesterol levels and blood glucose levels are independent predictors of post-transplant hypertension, hypercholesterolemia and diabetes, respectively.
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