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Article ; Online: Changes in the risk profile and outcomes of patients undergoing isolated coronary artery bypass grafting: A 23-year analysis of over 14000 patients.

Pattakos, Gregory / Siminelakis, Stavros / Apostolakis, Efstratios / Paskalis, Haralambos / Goudevenos, Ioannis

Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese

2022 Volume 69, Page(s) 64–66

MeSH term(s)	Humans ; Coronary Artery Bypass/adverse effects ; Coronary Artery Disease/surgery ; Treatment Outcome ; Retrospective Studies
Language	English
Publishing date	2022-09-29
Publishing country	Netherlands
Document type	Letter
ZDB-ID	2215027-4
ISSN	2241-5955 ; 1109-9666
ISSN (online)	2241-5955
ISSN	1109-9666
DOI	10.1016/j.hjc.2022.09.011
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Article: The Effect of Cell Salvage on Bleeding and Transfusion Needs in Cardiac Surgery.

Tachias, Frixos / Samara, Evangelia / Petrou, Anastasios / Karakosta, Agathi / Siminelakis, Stavros / Apostolakis, Efstratios / Tzimas, Petros

Anesthesiology research and practice

2022 Volume 2022, Page(s) 3993452

Abstract: Introduction: Cell salvaging is well established in the blood management of cardiac patients, but there remain some concerns about its effects on perioperative bleeding and transfusion variables. This randomized controlled study investigated the ... ...

Abstract	Introduction: Cell salvaging is well established in the blood management of cardiac patients, but there remain some concerns about its effects on perioperative bleeding and transfusion variables. This randomized controlled study investigated the potential effects of the centrifuged end-product on bleeding, transfusion rates, and other transfusion-related variables in adult cardiac surgery patients submitted to extracorporeal circulation. Materials and methods: Patients were randomly chosen to receive (cell-salvage group, 99 patients) or not to receive (control group, 110 patients) the centrifuged product of a cell salvage apparatus. Bleeding and transfusion rates according to the universal definition of perioperative bleeding (UDPB) classification, postoperative hemoglobin, coagulation, and oxygenation indices were recorded and compared between the groups. Results: Both groups had almost identical bleeding and transfusion rates (median value: 2 units of red blood cells (RBC) and no units of fresh frozen plasma (FFP) and platelets (PLT) for both groups, Conclusion: Within the study's constraints, the perioperative use of the cell salvage concentrate does not seem to affect bleeding or transfusion variables, although it could probably ameliorate postoperative oxygenation in adult cardiac surgery patients. A tendency to promote coagulation disturbances was detected.
Language	English
Publishing date	2022-09-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2397574-X
ISSN	1687-6970 ; 1687-6962
ISSN (online)	1687-6970
ISSN	1687-6962
DOI	10.1155/2022/3993452
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Article ; Online: Unraveling the role of resistin, retinol-binding protein 4 and adiponectin produced by epicardial adipose tissue in cardiac structure and function: evidence of a paracrine effect.

Christou, Georgios A / Andriopoulou, Christina E / Liakopoulou, Alexandra / Tsape, Eirini / Apostolakis, Efstratios / Tselepis, Alexandros D / Konstandi, Maria / Frühbeck, Gema / Kiortsis, Dimitrios N

Hormones (Athens, Greece)

2023 Volume 22, Issue 2, Page(s) 321–330

Abstract: Purpose: Adipokines produced by adipose tissue have been found to be involved in the pathophysiology of metabolic and cardiovascular diseases. We aimed to investigate the relationships of resistin, retinol-binding protein 4 (RBP4) and adiponectin ... ...

Abstract	Purpose: Adipokines produced by adipose tissue have been found to be involved in the pathophysiology of metabolic and cardiovascular diseases. We aimed to investigate the relationships of resistin, retinol-binding protein 4 (RBP4) and adiponectin produced by epicardial adipose tissue with coronary artery disease (CAD) and cardiac structure and function. Methods: Forty-one non-diabetic males scheduled for cardiothoracic surgery were examined. Anthropometric measurements, echocardiography, coronary angiography, and blood analysis were performed preoperatively. We measured the serum levels of resistin, RBP4, and adiponectin and their mRNA expression in thoracic subcutaneous adipose tissue and two epicardial adipose tissue samples, one close to left anterior descending artery (LAD) (resistin-LAD, RBP4-LAD, adiponectin-LAD), and another close to the right coronary artery (RCA) (resistin-RCA, RBP4-RCA, adiponectin-RCA). Results: Left ventricular (LV) ejection fraction correlated negatively with adiponectin-LAD (rho = - 0.390, p = 0.025). The ratio of early to late diastolic transmitral flow velocity, as an index of LV diastolic function, correlated negatively with resistin-LAD (rho = - 0.529, p = 0.024) and RBP4-LAD (rho = - 0.458, p = 0.049). There was no difference in epicardial adipose tissue mRNA expression of resistin, RBP4, and adiponectin between individuals with CAD and those without CAD. When we compared the individuals with CAD in the LAD with those without CAD in the LAD, there was no difference in resistin-LAD, RBP4-LAD, and adiponectin-LAD. There was no difference in resistin-RCA, RBP4-RCA, and adiponectin-RCA between the individuals with CAD in the RCA and those without CAD in the RCA. Conclusion: Elevation of epicardial adipose tissue mRNA expression of adiponectin was associated with LV systolic dysfunction, while that of both resistin and RBP4 was linked to LV diastolic dysfunction.
MeSH term(s)	Male ; Humans ; Adiponectin ; Resistin ; Adipose Tissue/metabolism ; Coronary Artery Disease ; RNA, Messenger/genetics ; Retinol-Binding Proteins/metabolism ; Retinol-Binding Proteins, Plasma/genetics ; Retinol-Binding Proteins, Plasma/metabolism
Chemical Substances	Adiponectin ; Resistin ; RNA, Messenger ; Retinol-Binding Proteins ; RBP4 protein, human ; Retinol-Binding Proteins, Plasma
Language	English
Publishing date	2023-03-24
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2075912-5
ISSN	2520-8721 ; 1109-3099
ISSN (online)	2520-8721
ISSN	1109-3099
DOI	10.1007/s42000-023-00447-5
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Article: External flail chest stabilization; The simple, low-cost way.

Apostolakis, Efstratios / Papakonstantinou, Nikolaos A / Liakopoulou, Alexandra / Chlapoutakis, Serafeim

Journal of cardiovascular and thoracic research

2020 Volume 13, Issue 2, Page(s) 174–175

Abstract: Flail chest is a life-threatening clinical entity which can be complicated by respiratory insufficiency. Paradoxical motion of a part of chest wall is the basic cause to put the blame on. Consequently, stabilization of the chest wall is occasionally of ... ...

Abstract	Flail chest is a life-threatening clinical entity which can be complicated by respiratory insufficiency. Paradoxical motion of a part of chest wall is the basic cause to put the blame on. Consequently, stabilization of the chest wall is occasionally of paramount importance to achieve early extubation in a patient with post-trauma respiratory insufficiency. Hereby, a simple, low cost, harmless and effective approach of external stabilization is presented.
Language	English
Publishing date	2020-11-28
Publishing country	Iran
Document type	Case Reports
ZDB-ID	2654729-6
ISSN	2008-6830 ; 2008-5117
ISSN (online)	2008-6830
ISSN	2008-5117
DOI	10.34172/jcvtr.2020.58
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Article ; Online: The Coadministration of Levosimendan and Exenatide Offers a Significant Cardioprotective Effect to Isolated Rat Hearts against Ischemia/Reperfusion Injury.

Leivaditis, Vasileios / Koletsis, Efstratios / Tsopanoglou, Nikolaos / Charokopos, Nikolaos / D'Alessandro, Cristian / Grapatsas, Konstantinos / Apostolakis, Efstratios / Choleva, Effrosyni / Plota, Maria / Emmanuil, Andreas / Dahm, Manfred / Dougenis, Dimitrios

Journal of cardiovascular development and disease

2022 Volume 9, Issue 8

Abstract: 1) Background: The present study aims to investigate the effect of administration of Levosimendan and Exenatide in various concentrations, as well as of the coadministration of those agents in an ischemia-reperfusion injury isolated heart model. (2) ... ...

Abstract	(1) Background: The present study aims to investigate the effect of administration of Levosimendan and Exenatide in various concentrations, as well as of the coadministration of those agents in an ischemia-reperfusion injury isolated heart model. (2) Methods: After 30 min of perfusion, the hearts underwent a 30 min period of regional ischemia followed by a 120 min period of reperfusion. All animals were randomly divided into 12 experimental groups of nine animals in each group: (1) Control, (2) Sham, (3) Digox (Negative control, Digoxin 1.67 μg/min), (4) Levo 1 (Levosimendan 0.01 μg/min), (5) Levo 2 (Levosimendan 0.03 μg/mL), (6) Levo 3 (Levosimendan 0.1 μg/min), (7) Levo 4 (Levosimendan 0.3 μg/min), (8) Levo 5 (Levosimendan 1 μg/min), (9) Exen 1 (Exenatide 0.001 μg/min), (10) Exen 2 (Exenatide 0.01 μg/min), (11) Exen 3 (Exenatide 0.1 μg/min) and (12) Combi (Levosimendan 0.1 µg/mL + Exenatide 0.001 μg/min). The hemodynamic parameters were recorded throughout the experiment. Arrhythmias and coronary flow were also evaluated. After every experiment the heart was suitably prepared and infarct size was measured. Markers of myocardial injury were also measured. Finally, oxidative stress was evaluated measuring reactive oxygen species. (3) Results: A dose-dependent improvement of the haemodynamic response was observed after the administration of both Levosimendan and Exenatide. The coadministration of both agents presented an even greater effect, improving the haemodynamic parameters further than the two agents separately. Levosimendan offered an increase of the coronary flow and both agents offered a reduction of arrhythmias. A dose-dependent reduction of the size of myocardial infarction and myocardial injury was observed after administration of Levosimendan and Exenatide. The coadministration of both agents offered a further improving the above parameters. Levosimendan also offered a significant reduction of oxidative stress. (4) Conclusions: The administration of Levosimendan and Exenatide offers a significant benefit by improving the haemodynamic response, increasing the coronary flow and reducing the occurrence of arrhythmias, the size of myocardial injury and myocardial oxidative stress in isolated rat hearts.
Language	English
Publishing date	2022-08-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2777082-5
ISSN	2308-3425 ; 2308-3425
ISSN (online)	2308-3425
ISSN	2308-3425
DOI	10.3390/jcdd9080263
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Article: Alexander the Great's Life-Threatening Thoracic Trauma.

Apostolakis, Efstratios / Papakonstantinou, Nikolaos A / Baikoussis, Nikolaos G / Apostolaki, Georgia

The Korean journal of thoracic and cardiovascular surgery

2018 Volume 51, Issue 4, Page(s) 241–246

Abstract: Alexander the Great was a world-class leader with tremendous courage. He paid no heed to the dangers of the battlefield, so he was always in the front lines. However, his excessive courage put his life in danger. Herein, we present an analysis of the ... ...

Abstract	Alexander the Great was a world-class leader with tremendous courage. He paid no heed to the dangers of the battlefield, so he was always in the front lines. However, his excessive courage put his life in danger. Herein, we present an analysis of the information contained in the chronicles about a very severe, life-threatening thoracic trauma that nearly killed the great
Language	English
Publishing date	2018-08-05
Publishing country	Korea (South)
Document type	Journal Article
ISSN	2233-601X
ISSN	2233-601X
DOI	10.5090/kjtcs.2018.51.4.241
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Article ; Online: Myocardial revascularization without extracorporeal circulation; Why hasn't it convinced yet?

Apostolakis, Efstratios / Papakonstantinou, Nikolaos A / Koniari, Ioanna

Annals of cardiac anaesthesia

2017 Volume 20, Issue 2, Page(s) 219–225

Abstract: Extracorporeal circulation has led to a great development in cardiovascular surgery during the last five decades. Its time-proven efficacy and safety have made on-pump coronary artery bypass grafting (CABG) the gold standard method of surgical ... ...

Abstract	Extracorporeal circulation has led to a great development in cardiovascular surgery during the last five decades. Its time-proven efficacy and safety have made on-pump coronary artery bypass grafting (CABG) the gold standard method of surgical revascularization. However, coronary revascularization on cardiopulmonary bypass and the accompanying aortic manipulation are related to plenty of deleterious complications. Therefore, off-pump CABG surgery was established to avoid complications. Nevertheless, despite the initial enthusiasm on this technique, only 20% of myocardial revascularization procedures worldwide are performed off-pump. Not only are off-pump cardiac procedures more technically difficult but also they do not provide better results in terms of graft patency, completeness of revascularization, repeat revascularization requirement, cost, and quality of life. Completeness of revascularization and anastomotic quality should not be compromised to avoid cardiopulmonary bypass.
MeSH term(s)	Coronary Artery Bypass, Off-Pump/methods ; Extracorporeal Circulation ; Humans ; Myocardial Revascularization/methods
Language	English
Publishing date	2017-04
Publishing country	India
Document type	Journal Article ; Review
ZDB-ID	2106866-5
ISSN	0974-5181 ; 0971-9784
ISSN (online)	0974-5181
ISSN	0971-9784
DOI	10.4103/aca.ACA_39_16
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Article ; Online: Cardioplegic storage solution: Is it the guardian of saphenous vein graft endothelium?

Papakonstantinou, Nikolaos A / Sykaras, Alexandros G / Vourlakou, Christina / Goudevenos, John / Papadopoulos, Georgios / Apostolakis, Efstratios

Journal of cardiac surgery

2020 Volume 35, Issue 5, Page(s) 996–1003

Abstract: Introduction: Despite their suboptimal long-term patency, saphenous vein grafts are the most widely used conduits to achieve complete revascularization during coronary artery bypass grafting (CABG). Although vein storage critically impairs endothelial ... ...

Abstract	Introduction: Despite their suboptimal long-term patency, saphenous vein grafts are the most widely used conduits to achieve complete revascularization during coronary artery bypass grafting (CABG). Although vein storage critically impairs endothelial integrity, contradictory data concerning optimal storage solutions exist. The aim of this study is to explore any in vitro impact of cardioplegic solutions and temperature on vein grafts endothelial integrity during their storage. Materials and methods: A single-center, prospective trial including 40 consecutive patients was conducted. Eligibility criteria included patients submitted to CABG receiving at least one vein graft. An excess segment of the graft was harvested and divided into four different parts. Each one of them was stored under different conditions; either in a conventional heparin-enriched blood solution or in a cardioplegic solution, at room temperature (20°C-22°C) and in the refrigerator (5°C). Endothelial integrity was evaluated via immunohistochemistry using an antibody against CD31. Results: Endothelial integrity (measured in a scale from 1-worst to 5-best) was significantly better after cardioplegic solution storage (2.83 ± 0.15 and 3.10 ± 0.13 in cold and room temperature, respectively) compared with storage in conventional solutions (2.23 ± 0.16 and 2.0 ± 0.15 in cold and room temperature, respectively). A significant effect of cardioplegic storage solution, as well as of cold temperature and cardioplegic solution interaction on endothelial preservation was reported, whereas storage temperature did not prove a significant factor by its own. Conclusions: Cardioplegic storage solutions result in significantly better endothelial preservation compared with conventional heparin-enriched blood solutions. The association with superior clinical outcomes remains to be proved.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Cardioplegic Solutions ; Coronary Artery Bypass ; Endothelium, Vascular ; Female ; Humans ; Male ; Middle Aged ; Organ Preservation/methods ; Organ Preservation Solutions ; Prospective Studies ; Saphenous Vein/transplantation ; Temperature
Chemical Substances	Cardioplegic Solutions ; Organ Preservation Solutions
Language	English
Publishing date	2020-03-24
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.14519
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Article ; Online: Reply to Myers et al.

Akinosoglou, Karolina / Apostolakis, Efstratios

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2013 Volume 43, Issue 4, Page(s) 874

MeSH term(s)	Endocarditis, Bacterial/surgery ; Female ; Heart Valve Diseases/surgery ; Heart Valve Prosthesis Implantation/methods ; Humans ; Male ; Tricuspid Valve/surgery
Language	English
Publishing date	2013-04
Publishing country	Germany
Document type	Comment ; Letter
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezs567
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Article ; Online: Myocardial revascularization without extracorporeal circulation; Why hasn't it convinced yet?

Efstratios Apostolakis / Nikolaos A Papakonstantinou / Ioanna Koniari

Annals of Cardiac Anaesthesia, Vol 20, Iss 2, Pp 219-

2017 Volume 225

Abstract	Extracorporeal circulation has led to a great development in cardiovascular surgery during the last five decades. Its time-proven efficacy and safety have made on-pump coronary artery bypass grafting (CABG) the gold standard method of surgical revascularization. However, coronary revascularization on cardiopulmonary bypass and the accompanying aortic manipulation are related to plenty of deleterious complications. Therefore, off-pump CABG surgery was established to avoid complications. Nevertheless, despite the initial enthusiasm on this technique, only 20% of myocardial revascularization procedures worldwide are performed off-pump. Not only are off-pump cardiac procedures more technically difficult but also they do not provide better results in terms of graft patency, completeness of revascularization, repeat revascularization requirement, cost, and quality of life. Completeness of revascularization and anastomotic quality should not be compromised to avoid cardiopulmonary bypass.
Keywords	Coronary artery bypass grafting ; off-pump ; on-pump ; myocardial revascularization ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; Anesthesiology ; RD78.3-87.3
Subject code	610
Language	English
Publishing date	2017-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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