John R. Pepper

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BACKGROUND Whether remote ischemic preconditioning (transient ischemia and reperfusion of the arm) can improve clinical outcomes in patients undergoing coronary-artery bypass graft (CABG) surgery is not known. We investigated this question in a randomized trial. METHODS We conducted a multicenter, sham-controlled trial involving adults at increased(More)
We would like to thank Dr Veselka for his interest in our work and appreciate the opportunity to respond to his letter. Our article illustrated that successful alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) led to significant and sustained improvement (up to 2-year follow-up) in echocardiographic measures of diastolic(More)
Controversy surrounds the use of minimal access aortic valve replacement (AVR). This meta-analytical study quantified the effects of minimal access AVR on morbidity and mortality compared with conventional AVR and evaluated study heterogeneity and robustness of the findings using sensitivity analysis. Overall, meta-analysis suggested marginal benefits in(More)
Extracorporeal life support (ECLS) is one of the recent fields in cardiac surgery which has improved significantly the quality of patient care in acute or chronic end-stage heart disease. The safe use of this new technology requires many different prerequisites which are summarized in this position article. It includes the necessary personnel and their(More)
BACKGROUND The regional wall motion impairment and predisposition to arrhythmias in human ventricular hibernation may plausibly result from abnormal intercellular propagation of the depolarizing wave front. This study investigated the hypothesis that altered patterns of expression of connexin43, the principal gap junctional protein responsible for passive(More)
BACKGROUND The effect of the use of coronary-artery bypass surgery without cardiopulmonary bypass and cardiac arrest ("off pump") on graft patency remains uncertain. We undertook a prospective, randomized, controlled study to compare graft-patency rates and clinical outcomes in off-pump surgery with conventional, "on-pump" surgery. METHODS We randomly(More)
Objective: To compare the effects of dopexamine and dopamine on the mucosal permeability of the gastrointestinal tract (GIT). Design: Prospective, randomised clinical trial. Setting: Intensive care unit of a postgraduate teaching hospital, London, England. Patients: Thirty patients undergoing elective surgery involving cardiopulmonary bypass, performed by a(More)
BACKGROUND The Stent or Surgery Trial is a randomized, controlled trial comparing percutaneous coronary intervention with coronary artery bypass grafting (CABG) for patients with multivessel disease. Initial results at a median follow-up of 2 years showed a survival advantage for patients randomized to CABG. This article reports survival outcome at a median(More)
STUDY OBJECTIVE To quantify simultaneously the pulmonary and gastrointestinal (GI) damage that occurs during uncomplicated surgery requiring cardiopulmonary bypass (CPB), and to examine the relationships between markers of such damage. DESIGN Prospective, open. SETTING Adult ICU of a national referral hospital. PATIENTS Twenty patients undergoing(More)
Recent data have suggested that regular consumption of nonsteroid anti-inflammatory drugs (NSAIDs), particularly selective inhibitors of cyclo-oxygenase-2 (COX-2), is associated with an increased risk of thrombotic events. It has been suggested that this is due to NSAIDs reducing the release from the endothelium of the antithrombotic mediator prostaglandin(More)