Research Grants 2010
Jan Marinus Dieleman, MD for his project "Postoperative new-onset atrial fibrillation in cardiac surgery: An explanatory study of the prophylactic effect of corticosteroids"|
Jan Marinus Dieleman, MD |
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Project Summary
Postoperative new-onset atrial fibrillation (PNAF) is a common complication after cardiac surgery, affecting up to 60% of patients. PNAF has been associated with a higher incidence of adverse postoperative outcomes including long-term mortality, and leads to an increased use of resources and higher social costs.
Many studies have investigated potential determinants of PNAF. Established determinants can grossly be divided into inflammatory factors, cardiac functional (echographic) parameters, cardiac electrophysiologic properties and other (demographic) risk factors. Also, a substantial number of studies have investigated pharmacological prophylactic strategies. In these studies, the highest effectiveness has been shown for strategies involving either betablockers, statins and, more recently, corticosteroids.
The DExamethasone for Cardiac Surgery - Postoperative New-onset Atrial Fibrillation (DECS-PNAF) project aims to elucidate how corticosteroids protect cardiac surgical patients from PNAF. The modulating effect of intraoperative prophylactic high-dose dexamethasone administration on the categories of perioperative determinants of PNAF mentioned above will be studied in 164 coronary artery bypass grafting surgery patients. For this, multiple perioperative assessments will be performed using, for example, repeated biochemical assessment of inflammation, genomic analysis of (mainly inflammatory) single nucleotide polymorphisms, continuous electrocardiographic (Holter) monitoring and transesophageal echocardiography. This project forms part of the DExamethasone for Cardiac Surgery (DECS) trial, a double blind, randomized, placebocontrolled study of dexamethasone in patients undergoing cardiac surgery with cardiopulmonary bypass (NCT00293592).
The DECS-PNAF project is one of the first prospective studies to combine a detailed assessment of multiple categories of PNAF determinants. Moreover, it is unique in studying the effect of prophylactic corticosteroid administration on every one of these determinants.
Dr. Fabio Guarracino and Dr. Giovanni Landoni for their project "Levosimendan to reduce mortality in high risk cardiac surgery patients. A randomized controlled trial".
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Dr. Fabio Guarracino |
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Dr. Giovanni Landoni |
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Project Summary
OBJECTIVE: Patients undergoing cardiac surgery are at risk of perioperative low cardiac output syndrome. The occurrence of myocardial dysfunction in patients undergoing cardiac surgery is a potential indication for the use of levosimendan, a calcium sensitizer with a double mechanism of action (inotropic and vasodilatory) which seems to be effective in improving clinical relevant outcomes.
DESIGN: Double blind, placebo-controlled, multicentre randomized trial.
SETTING: Hospitals with a cardiac surgery programme
INTERVENTIONS: Cardiac surgery patients with perioperative myocardial dysfunction will be randomized to receive a continuous infusion of either levosimendan or placebo for 24-48 hours or till discharge from the Intensive Care Unit.
MEASUREMENTS AND MAIN RESULTS: The primary endpoint will be 30 days mortality. Secondary endpoints will be mortality at 1 year, time on mechanical ventilation, acute renal failure, length of Intensive Care Unit and hospital stay. During the present study we will test the hypothesis that levosimendan would reduce 30 days mortality in patients undergoing cardiac surgery who have a perioperative myocardial dysfunction.
CONCLUSIONS: This trial is planned to assess if levosimendan could improve survival in patients with perioperative low cardiac output syndrome. Results of this double blind randomized trial could provide important insights to improve the management of critically ill patients undergoing cardiac surgery.