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Dive into the research topics where Mario J. Perko is active.

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Featured researches published by Mario J. Perko.


Heart | 2011

Three-year follow-up in a subset of high-risk patients randomly assigned to off-pump versus on-pump coronary artery bypass surgery: the Best Bypass Surgery Trial

Christian H. Møller; Mario J. Perko; Jens T. Lund; Lars Willy Andersen; Henning Kelbæk; Jan Kyst Madsen; Per Winkel; Christian Gluud; Daniel A. Steinbrüchel

Objective To evaluate off-pump versus on-pump coronary artery bypass grafting (CABG) in patients with three-vessel disease and a high-risk operative profile. Design A randomised clinical trial. Setting Rigshospitalet, University Hospital, Copenhagen, Denmark. Participants 341 patients with three-vessel disease and a EuroSCORE of 5 or greater. Main exclusion criteria were previous heart surgery, poor left ventricular function (ejection fraction <30%), or unstable preoperative condition. Intervention CABG performed with versus without cardiopulmonary bypass. Main outcome measure The primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE) including all-cause mortality, acute myocardial infarction, cardiac arrest with successful resuscitation, low cardiac output syndrome/cardiogenic shock, stroke and coronary reintervention. Results MACCE occurred in 69 (40%) patients allocated to off-pump versus 54 (33%) patients allocated to on-pump CABG during the median 3.7u2005years of follow-up (HR 1.22; 95% CI 0.86 to 1.75; p=0.26). All-cause mortality was significantly increased in the off-pump group (24% vs 15%; HR 1.66, 95% CI 1.02 to 2.73; p=0.04), but cardiac-related death was not significantly different (10% vs 7%; HR 1.30, 95% CI 0.64 to 2.66; p=0.47). An insignificant trend towards a reduction in myocardial infarction after off-pump CABG was observed (7% vs 14%; HR 0.53, 95% CI: 0.27 to 1.04; p=0.06). Conclusions No significant difference in the primary outcome of MACCE was found between off-pump and on-pump CABG. However, mortality seemed higher after off-pump CABG. Trial registration http://clinicaltrials.gov/ number, NCT00120991.


Scandinavian Cardiovascular Journal | 2010

Graft patency after off-pump versus on-pump coronary artery surgery in high-risk patients

Christian H. Møller; Mario J. Perko; Jens T. Lund; Lars Willy Andersen; Henning Kelbæk; Jan Kyst Madsen; Christian Gluud; Daniel A. Steinbrüchel

Abstract Objective. To compare angiographic graft patency in high-risk patients randomly allocated to off-pump vs. on-pump coronary artery bypass grafting (CABG). Design. From a randomised, single-centre clinical trial including patients undergoing isolated first-time coronary bypass surgery a subgroup of patients were scheduled to 1-year coronary angiographic follow-up. Patients had 3-vessel disease and a EuroSCORE ≥5. We evaluated graft patency using a patency index (percentage of patent grafts out of the total number of grafts in each patient). Results. One-year angiography was performed in 34 patients undergoing off-pump surgery and 35 patients undergoing on-pump surgery. The mean number of distal anastomoses was 3.38±0.65 in the off-pump group versus 3.46±0.61 in the on-pump group (NS). The number of patients without graft failure was 22 in the off-pump group and 24 in the on-pump group (NS). The overall patency index was 85% in the off-pump group versus 87% in the on-pump group with a mean difference of –2.1%, 95% confidence interval –12.9 to 8.7 (NS). Conclusions. In patients with 3-vessel disease and a high-risk profile we found no statistically significant difference in graft patency between off-pump and on-pump CABG at 1-year coronary angiographic follow-up. Trial registration: ClinicalTrials.gov identifier: NCT00120991.


European Heart Journal | 2008

One-year results of total arterial revascularization vs. conventional coronary surgery: CARRPO trial

Sune Damgaard; Jørn Wetterslev; Jens T. Lund; Nikolaj B. Lilleør; Mario J. Perko; Henning Kelbæk; Jan Kyst Madsen; Daniel A. Steinbrüchel

AIMSnTo investigate clinical and angiographic outcomes after coronary surgery using total arterial revascularization (TAR).nnnMETHODS AND RESULTSnWe randomized 331 patients with multivessel or isolated left main disease to TAR [internal thoracic (ITA) and radial arteries] vs. conventional revascularization (CR) using left ITA and vein grafts. The primary angiographic outcome was the patency index: number of patent grafts (<50% stenosed) divided by number of constructed grafts. One-year angiography was complete for 83% of patients. Mean patency index (+/-SD) was 87 +/- 22% in the TAR group and 88 +/- 18% in the conventional group (P = 0.52). In 72% of TAR patients and 67% of the conventional group, all grafts were patent (P = 0.45). Multiple imputation of missing angiographic data did not influence on results. Within 1 year, 37 (23%) TAR patients and 43 (25%) conventional group patients suffered cardiac events (HR 1.09, 95% CI 0.70-1.69, P = 0.70). One patient (0.6%) in the TAR group and two (1.2%) in the conventional group died (P = 1.00).nnnCONCLUSIONnWithin 1 year post-operatively, TAR seems at least as safe and effective as CR. Prolonged follow-up will reveal whether this is sustained or superior results of TAR can justify a more general use.


Scandinavian Cardiovascular Journal | 2014

Conditioning techniques and ischemic reperfusion injury in relation to on-pump cardiac surgery.

Fredrik Eric Olof Holmberg; Konstantin Alex Ottas; Charlotte Andreasen; Mario J. Perko; Christian H. Møller; Thomas Engstrøm; Daniel A. Steinbrüchel

Abstract Objectives. The objective was to investigate the potential protective effects of two conditioning methods, on myocardial ischemic and reperfusion injury in relation to cardiac surgery. Design. Totally 68 patients were randomly assigned to either a control group (n = 23), a remote ischemic preconditioning (RIPC) group (n = 23) or a glucagon-like peptide-1 (GLP-1) analogue group (n = 22). The RIPC protocol consisted of three cycles of upper limb ischemia. The GLP-1 analogue protocol consisted of intravenous infusion with exenatide. The primary endpoint was postoperative cardiac enzyme release. The other secondary endpoints were metabolic parameters related to myocardial ischemia, measured using microdialysis technique, as well as other operative- and postoperative data. Results. Postoperative cardiac enzyme release indicated a possible beneficial effect of the interventions, but the difference did not reach statistical significance. RIPC showed a trend toward lower levels (p = 0.07). We managed to establish a functional myocardial microdialysis model, but we were unable to demonstrate clear protective effects. Conclusions. We were in this prospective randomized proof-of-concept trial, unable to show distinct protective effects of the studied conditioning methods. However, this trial can hopefully contribute to generate a productive discussion concerning limitations and future use of cardiac conditioning as well as microdialysis technique.


The Journal of Thoracic and Cardiovascular Surgery | 2008

Comparable three months' outcome of total arterial revascularization versus conventional coronary surgery : Copenhagen Arterial Revascularization Randomized Patency and Outcome trial

Sune Damgaard; Jens T. Lund; Nikolaj B. Lilleør; Mario J. Perko; Kåre Sander; Blagoja Dimo; Maiken Brit Jensen; Jan Kyst Madsen; Henning Kelbæk; Daniel A. Steinbrüchel

OBJECTIVEnThe in-hospital safety of total arterial revascularization for coronary artery bypass surgery seems to be comparable to conventional revascularization, but randomized trials evaluating this are few and data on complications in the postoperative months are sparse.nnnMETHODSnIn a randomized single-center trial, 331 patients underwent total arterial revascularization using single or bilateral internal thoracic and radial arteries versus conventional revascularization using the left internal thoracic artery and saphenous vein grafts. We report the results from 3 months follow-up.nnnRESULTSnThe mean age of patients was 59 +/- 8 years, and 39 were women (12%). The median EuroSCORE was 2 (interquartile range 1-4). The arterial group comprised 161 patients, and the conventional group comprised 170 patients. The mean number of bypasses in the arterial group was 2.9 +/- 0.9 versus 3.2 +/- 0.9 in the conventional group (P = .004). Three months follow-up for the arterial versus conventional groups showed the following: deaths: 1 (0.6%) versus 0; stroke: 3 (1.9%) versus 3 (1.8%); myocardial infarction: 6 (3.7%) versus 4 (2.4%); sternal wound reoperation: 4 (2.5%) versus 0 (P = .054); arm and leg wound complications requiring hospitalization: 3 (1.9%) versus 6 (3.5%) (P = .50), respectively.nnnCONCLUSIONnThese results confirm previous reports that total arterial revascularization can be performed with low in-hospital morbidity and mortality. Further, in the 3 postoperative months, total arterial revascularization did not lead to more complications or admissions than conventional surgery. Arterial grafting was performed with significantly fewer bypasses, but no differences in anginal status were seen after 3 months. A tendency toward more sternal complications after arterial grafting was observed, but clinical outcomes were comparable to conventional grafting.


European Journal of Cardio-Thoracic Surgery | 2004

Long-term outcome of lung transplantation for cystic fibrosis — Danish results

Bo Bech; T. Pressler; Martin Iversen; Jørn Carlsen; Nils Milman; Kirsten Eliasen; Mario J. Perko; Henrik Arendrup


Journal of Cardiothoracic and Vascular Anesthesia | 2001

Electric impedance for evaluation of body fluid balance in cardiac surgical patients

Mario J. Perko; Inge-Lise Jarnvig; Niels Højgaard-Rasmussen; Kirsten Eliasen; Henrik Arendrup


Contemporary Clinical Trials | 2007

The Best Bypass Surgery Trial: Rationale and design of a randomized clinical trial with blinded outcome assessment of conventional versus off-pump coronary artery bypass grafting☆

Christian H. Møller; Birte Østergaard Jensen; Christian Gluud; Mario J. Perko; Jens T. Lund; Lars Willy Andersen; Jan Kyst Madsen; Pia Hughes; Daniel A. Steinbrüchel


European Journal of Cardio-Thoracic Surgery | 2006

Myocardial oxygen tension during surgical revascularization. A clinical comparison between blood cardioplegia and crystalloid cardioplegia.

Jacob Tveiten Bjerrum; Mario J. Perko; Bo Beck


European Journal of Cardio-Thoracic Surgery | 2006

Myocardial oxygen tension during surgical revascularization.

Jacob Tveiten Bjerrum; Mario J. Perko; Bo Beck

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Daniel A. Steinbrüchel

Copenhagen University Hospital

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Jens T. Lund

Copenhagen University Hospital

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Christian H. Møller

Copenhagen University Hospital

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Jan Kyst Madsen

Loyola University Medical Center

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Lars Willy Andersen

Copenhagen University Hospital

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Henrik Arendrup

Copenhagen University Hospital

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Kirsten Eliasen

Copenhagen University Hospital

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Nikolaj B. Lilleør

Copenhagen University Hospital

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