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<1>
Accession Number
2009533861
Authors
Van Brabandt H. Neyt M.
Institution
(Van Brabandt, Neyt) Belgian Health Care Knowledge Centre, Administratief
Centrum Kruidtuin, Kruidtuinlaan 55, 1000 Brussels, Belgium.
Title
Safety of percutaneous aortic valve insertion. A systematic review.
Source
BMC Cardiovascular Disorders. 9(pp 45), 2009. Article Number: 1471. Date
of Publication: 01 Sep 2009.
Publisher
BioMed Central Ltd.
Abstract
Background: The technique of percutaneous aortic valve implantation (PAVI)
for the treatment of severe aortic stenosis (AS) has been introduced in
2002. Since then, many thousands such devices have worldwide been
implanted in patients at high risk for conventional surgery. The procedure
related mortality associated with PAVI as reported in published case
series is substantial, although the intervention has never been formally
compared with standard surgery. The objective of this study was to assess
the safety of PAVI, and to compare it with published data reporting the
risk associated with conventional aortic valve replacement in high-risk
subjects. Methods: Studies published in peer reviewed journals and
presented at international meetings were searched in major medical
databases. Further data were obtained from dedicated websites and through
contacts with manufacturers. The following data were extracted: patient
characteristics, success rate of valve insertion, operative risk status,
early and late all-cause mortality. Results: The first PAVI has been
performed in 2002. Because of procedural complexity, the original
transvenous approach from 2004 on has been replaced by the transarterial
and transapical routes. Data originating from nearly 2700 non-transvenous
PAVIs were identified. In order to reduce the impact of technical
refinements and the procedural learning curve, procedure related safety
data from series starting recruitment in April 2007 or later (n = 1975)
were focused on. One-month mortality rates range from 6.4 to 7.4% in
transfemoral (TF) and 11.6 to 18.6% in transapical (TA) series.
Observational data from surgical series in patients with a comparable
predicted operative risk, indicate mortality rates that are similar to
those in TF PAVI but substantially lower than in TA PAVI. From all
identified PAVI series, 6-month mortality rates, reflecting both
procedural risk and mortality related to underlying co-morbidities, range
from 10.0-25.0% in TF and 26.1-42.8% in TA series. It is not known what
the survival of these patients would have been, had they been treated
medically or by conventional surgery. Conclusion: Safety issues and
short-term survival represent a major drawback for the implementation of
PAVI, especially for the TA approach. Results from an ongoing randomised
controlled trial (RCT) should be awaited before further using this
technique in routine clinical practice. In the meantime, both for safety
concerns and for ethical reasons, patients should only be subjected to
PAVI within the boundaries of such an RCT. copyright 2009 Van Brabandt and
Neyt; licensee BioMed Central Ltd.
<2>
Accession Number
2009515416
Authors
Babiker A. Del Angel J.G. Perez-Vizcayno M.J. Rodriguez J.E. Macaya C.
Hernandez R. Escaned J.
Institution
(Babiker, Del Angel, Perez-Vizcayno, Rodriguez, Macaya, Hernandez,
Escaned) Cardiovascular Institute, Hospital Clinico San Carlos, 28040
Madrid, Spain.
Title
Rescue percutaneous intervention for acute complications of coronary
artery surgery.
Source
EuroIntervention. 5(SUPPL. D)(pp D64-D69), 2009. Date of Publication:
2009.
Publisher
EuroPCR
Abstract
Although percutaneous interventions in the context of perioperative
coronary artery surgery ischaemic complications are not unusual, this type
of secondary revascularisation is rarely addressed in the literature.
Information on aspects such as complications and clinical outcome is
limited, in spite of this being a high-risk population. To shed light on
the subject, the present article presents a systematic review of the
literature on this topic, along with the analysis of the institutional
experience at a centre with high surgical and percutaneous
revascularisation case volume. copyright Europa Edition. All rights
reserved.
<3>
Accession Number
2009513973
Authors
Balciunas M. Bagdonaite L. Samalavicius R. Griskevicius L. Vuysteke A.
Institution
(Balciunas) Department of Pathology, Forensic Medicine and Pharmacology,
Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
(Bagdonaite) Department of Physiology, Biochemistry and Laboratory
Medicine, Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
(Balciunas, Samalavicius) Centre of Anaesthesiology, Intensive Therapy and
Pain Management, Vilnius University Hospital, Santariskiu Clinics,
Santariskiu Street 35-19, LT-08439 Vilnius, Lithuania.
(Griskevicius) Centre of Hematology, Oncology and Transfusion Medicine,
Vilnius University Hospital, Santariskiu Clinics, Santariskiu Street
35-19, LT-08439 Vilnius, Lithuania.
(Vuysteke) Department of Anaesthesia and Intensive Care, Papworth Hospital
NHS Trust, Papworth Everard, Cambridge CB23 3RE, United Kingdom.
Title
Pre-operative high sensitive C-reactive protein predicts cardiovascular
events after coronary artery bypass grafting surgery: A prospective
observational study.
Source
Annals of Cardiac Anaesthesia. 12(2)(pp 127-132), 2009. Date of
Publication: 2009.
Publisher
Medknow Publications
Abstract
C-reactive protein is a powerful independent predictor of cardiovascular
events in patients with coronary artery disease. The relation between
C-reactive protein (CRP) concentration and in-hospital outcome, after
coronary artery bypass grafting (CABG), has not yet been established. The
study aims to evaluate the predictive value of pre-operative CRP for
in-hospital cardiovascular events after CABG surgery. High-sensitivity CRP
(hs-CRP) levels were measured pre-operatively on the day of surgery in 66
patients scheduled for elective on pump CABG surgery. Post-operative
cardiovascular events such as death from cardiovascular causes, ischemic
stroke, myocardial damage, myocardial infarction and low output heart
failure were recorded. During the first 30 days after surgery, 54 patients
were free from observed events and 14 developed the following
cardiovascular events: 10 (15%) had myocardial damage, four (6%) had low
output heart failure and two (3%) suffered stroke. No patients died during
the follow-up period. Serum concentration of hs-CRP [greater-than or equal
to] 3.3 mg/l (cut-off point obtained by ROC analysis) was related to
higher risk of post-operative cardiovascular events (36% vs 6%, P = 0.01),
myocardial damage (24% vs 6%, P = 0.04) and low output heart failure (12%
vs 0%, P = 0.04). Multivariate logistic regression analysis showed that
hs-CRP = 3.3 mg/l (P = 0.002, O.R.: 19.3 (95% confidence interval (CI)
2.9-128.0)), intra-operative transfusion of red blood cells (P = 0.04,
O.R.: 9.9 (95% C.I. 1.1-85.5)) and absence of diuretics in daily
antihypertensive treatment (P = 0.02, O.R.: 15.1 (95% C.I. 1.4- 160.6)
were independent predictors of combined cardiovascular event. Patients
having hs-CRP value greater or equal to 3.3 mg/l pre-operatively have an
increased risk of post-operative cardiovascular events after on pump
coronary artery bypass grafting surgery.
<4>
Accession Number
2009497237
Authors
Zhao S.-p. Peng D.-q. Yu B.-l. Huo Y.
Institution
(Zhao, Peng, Yu) Department of Cardiology, the Second Xiangya Hospital of
Central South, University, Changsha, Hunan, China.
(Huo) Department of Cardiology, Peking University First Hospital, Beijing,
China.
Title
Rationale and design of China intensive lipid lowering with statins in
acute coronary syndrome: The CHILLAS study.
Source
American Heart Journal. 158(4)(pp 509-512.e1), 2009. Date of Publication:
October 2009.
Publisher
Mosby Inc.
Abstract
Background: Current guidelines recommended intensive low-density
lipoprotein cholesterol lowering with statins, aiming at the target of 70
mg/dL (1.81 mmol/L) of low-density lipoprotein cholesterol for those with
very high risk of coronary artery events. However, there is no multicenter
study assessing the effect of intensive lipid lowering therapy with
statins on acute coronary syndrome (ACS) in Chinese population. Methods:
An open-label multicenter study is planned to evaluate whether intensive
treatment with statins for 2 to 5 years results in more reduction of
cardiovascular events in patients with ACS compared to the standard statin
therapy. A total of 1,600 patients will be randomly assigned to receive
intensive statin therapy (atorvastatin, 20 or 40 mg/d, or equivalent dose
of other statins) or standard statin therapy (atorvastatin, 10 mg/d, or
equivalent dose of other statins). Both groups will receive dietary
counseling. Over the follow-up period, the primary outcome measure is the
time to occurrence of cardiac death, nonfatal acute myocardial infarction,
revascularization with either percutaneous coronary intervention or
coronary-artery bypass grafting, documented unstable angina or severe
heart failure requiring emergency hospitalization, and stroke. The planned
duration for enrollment is between December 2006 and December 2009.
Conclusions: The CHILLAS study will be the first multicenter study in a
Chinese population using a patient-level analysis to compare the effects
and safety of intensive statin therapy with that of standard-dose statin
therapy, which may provide new evidence and therapeutic standards for the
treatment of ACS. copyright 2009 Mosby, Inc. All rights reserved.
<5>
Accession Number
2009514410
Authors
Griffin B.L. Burkiewicz J.S. Peppers L.R. Warholak T.L.
Institution
(Griffin, Burkiewicz) Pharmacy Practice, Chicago College of Pharmacy,
Midwestern University, 555 31st Street, Downers Grove, IL 60515, United
States.
(Peppers) Global Medical Information, Abbott Park, IL, United States.
(Warholak) Pharmacy Practice and Science, College of Pharmacy, University
of Arizona, Tucson, AZ, United States.
Title
International Normalized Ratio values in group versus individual
appointments in a pharmacist-managed anticoagulation clinic.
Source
American Journal of Health-System Pharmacy. 66(13)(pp 1218-1223), 2009.
Date of Publication: 01 Jul 2009.
Publisher
American Society of Health-Systems Pharmacy
Abstract
Purpose. The clinical effectiveness of a group-visit model versus
individual point-of-care visits is compared by International Normalized
Ratio (INR) monitoring in a pharmacist-managed anticoagulation clinic.
Methods. This study was a prospective, randomized, repeated-measures,
two-group, intention-to-treat comparison and survey at a
pharmacist-managed anticoagulation clinic in a managed-care ambulatory
care setting. Patients were eligible for this study if they were taking
warfarin therapy for at least 30 days, had a goal INR range, and provided
consent. At a routine point-of-care visit, eligible patients were randomly
invited to participate in group visits. The number of visits and INR
values were documented prospectively for both groups during the 16-week
study period. Results. Of the 45 patients who consented and enrolled in
group visits, 28 patients participated for the 16-week study period. The
control group included 108 patients seen by a pharmacist for individual
anticoagulation appointments. No significant difference in the percentage
of INR values within the therapeutic range was detected between patients
in the group-visit model versus patients receiving individual visits (59%
versus 56.6%, respectively; p = 0.536). Seventy-three percent of INR
values for patients who attended group visits were within +/-0.2 of the
desired INR range compared with 71.9% of those in the control group (p =
0.994). In addition, 79% of group-visit patients were within the
therapeutic range at their last clinic visit compared with 67% of patients
who attended individual appointments (p = 0.225). Group visits were
preferred by 51% (n = 38) of patients who completed the satisfaction
survey. Of the 92 patients who declined group-visit participation, 36%
indicated that the time of day that group visits were offered was
inconvenient. There were no thromboembolic or hemorrhagic events
documented in either group during the study period. Conclusion. Group
visits in a pharmacist-managed anticoagulation clinic may provide a safe
and effective alternative to individual appointments. Copyright copyright
2009, American Society of Health-System Pharmacists, Inc. All rights
reserved.
<6>
Accession Number
2009539736
Authors
Firanescu C.E. Martens E.J. Schonberger J.P.A.M. Soliman Hamad M.A. van
Straten A.H.M.
Institution
(Firanescu, Schonberger, Soliman Hamad, van Straten) Department of
Cardio-thoracic Surgery, Catharina Hospital, Eindhoven, Netherlands.
(Martens) Department of Education and Research, Catharina Hospital,
Eindhoven, Netherlands.
(Martens) Center of Research on Psychology in Somatic Diseases, Department
of Medical Psychology, Tilburg University, Netherlands.
Title
Postoperative blood loss in patients undergoing coronary artery bypass
surgery after preoperative treatment with clopidogrel. A prospective
randomised controlled study.
Source
European Journal of Cardio-thoracic Surgery. 36(5)(pp 856-862), 2009.
Date of Publication: November 2009.
Publisher
Elsevier
Abstract
Objective: The optimal timing for discontinuation of clopidogrel before
surgery remains under debate. The purpose of this study is to determine
the effect of preoperative clopidogrel administration on postoperative
blood loss and the total requirements of homologous blood products after
coronary artery bypass grafting (CABG). We also evaluated the
perioperative complications. Methods: Consecutive patients (n = 130)
undergoing elective CABG were recruited and randomised between 2006 and
2007. In 38 patients (group 1), treatment with clopidogrel was
discontinued 5 days prior to surgery, in 40 patients (group 2) 3 days
before surgery and in 40 other patients (group 3) clopidogrel was stopped
on the day of surgery. Results: Significantly more postoperative blood
loss was observed in group 3 compared to group 1 (929 +/- 472 ml vs 664
+/- 312 ml; p = 0.009). Other group comparisons were not significant.
Blood loss after 12 h and at drain removal was also significantly higher
in group 3. Patients in group 3 also had higher total requirements of
homologous blood products (p = 0.046) and a significantly higher need for
fresh frozen plasma (FFP) transfusion (p = 0.034). Univariable regression
analyses revealed that continuing clopidogrel till the day of surgery
(group 3) was predictive for postoperative blood loss (beta = 0.289; p =
0.007) and the total requirements of homologous blood products after
surgery (beta = 0.280; p = 0.008). These effects remained the same in
multivariable analyses. Conclusions: Continuation of clopidogrel until the
day of surgery induces significantly more postoperative blood loss and
increases significantly the total requirements of homologous blood
products and FFP transfusion after surgery. The blood loss and the use of
blood products in the group that stopped at 3 days preoperatively were
similar to that of the group that stopped at 5 days preoperatively.
copyright 2009 European Association for Cardio-Thoracic Surgery.
<7>
Accession Number
2009539739
Authors
Fibla J.J. Molins L. Mier J.M. Sierra A. Vidal G.
Institution
(Fibla, Molins, Mier, Vidal) Department of Thoracic Surgery, Hospital
Universitari Sagrat Cor., C/Viladomat 288, 08029 Barcelona, Spain.
(Sierra) Department of Anesthesia, Hospital Universitari Sagrat Cor.,
C/Viladomat 288, 08029 Barcelona, Spain.
Title
A prospective study of analgesic quality after a thoracotomy:
paravertebral block with ropivacaine before and after rib spreading.
Source
European Journal of Cardio-thoracic Surgery. 36(5)(pp 901-905), 2009.
Date of Publication: November 2009.
Publisher
Elsevier
Abstract
Objective: Paravertebral block (PVB) is an effective alternative to
epidural analgesia in the management of post-thoracotomy pain. Rib
spreading (RS) is an important noxious stimulus considered a major cause
of post-thoracotomy pain. Our hypothesis was that a bolus of ropivacaine
0.2% through a paravertebral catheter (PVC) inserted before RS could
decrease pain during the first 72 postoperative hours. Methods: The
methodology employed was to perform a prospective randomised study of 60
consecutive patients submitted to thoracotomy. Patients were divided in
two independent groups (anterior thoracotomy (AT) and posterolateral
thoracotomy (PT)). A catheter was inserted under direct vision in the
thoracic paravertebral space at the level of incision. In each group,
patients were randomised to receive a bolus of 20 ml of ropivacaine 0.2%
before rib spreading (pre-RS) or after (post-RS), just before closing the
thoracotomy. They postoperatively received 15 ml of ropivacaine 0.2% every
6 h combined with methamizol (every 6 h). Subcutaneous meperidine was
employed as a rescue drug. The level of pain was measured with the visual
analogue scale (VAS) at 1, 6, 24, 48 and 72 h after surgery. The need of
meperidine as a rescue drug and secondary effects were also recorded.
Results: We did not register secondary effects in relation to the PVC
(paravertebral or cutaneous bleeding or haematoma, respiratory depression,
cardiotoxicity, confusion, sedation, urinary retention, nausea, vomiting
or pruritus). Seven patients (11.6%) needed meperidine as rescue drug
(four pre-RS and three post-RS). The mean VAS values were the following:
all cases (n = 60): 4.7 +/- 2.0; AT (n = 32): 4.0 +/- 2.1; PT (n = 28):
5.6 +/- 1.8; pre-RS (n = 30): 4.8 +/- 1.9; post-RS (n = 30): 4.6 +/- 2.0;
AT-pre-RS (n = 16): 4.1 +/- 2.0; AT-post-RS (n = 16): 3.9 +/- 2.1;
PT-pre-RS (n = 14): 5.6 +/- 1.6; PT-post-RS (n = 14): 5.4 +/- 1.7.
Conclusions: Post-thoracotomy analgesia combining PVC and a non-steroidal
anti-inflammatory drug is a safe and effective practice. VAS values are
acceptable (only 11.6% of patients required meperidine). It prevents the
risk of side effects related to epidural analgesia. Patients submitted to
AT experienced less pain than those with PT (4.0 vs 5.6; p < 0.01). PVB
with ropivacaine before RS got similar VAS values than the block after RS
(4.8 vs 4.6; p > 0.05). The moment of the insertion of the PVC does not
seem to affect postoperative pain levels. copyright 2009 European
Association for Cardio-Thoracic Surgery.
<8>
Accession Number
2009518162
Authors
Teshima H. Kawano H. Kashikie H. Nakamura K. Imada T. Oda T. Aoyagi S.
Institution
(Teshima, Kawano, Kashikie, Nakamura, Imada) Department of Cardiovascular
Surgery, Omura Municipal Hospital, Cardiovascular Center, Nagasaki, Japan.
(Teshima, Oda, Aoyagi) Department of Surgery, Kurume University School of
Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
Title
A new hydrocolloid dressing prevents surgical site infection of median
sternotomy wounds.
Source
Surgery Today. 39(10)(pp 848-854), 2009. Date of Publication: October
2009.
Publisher
Springer Japan
Abstract
Purpose: This prospective and semi-randomized study was conducted to
clarify the effectiveness of a new hydrocolloid dressing placed over
median sternotomy wounds using an occlusive dressing technique. Methods:
The subjects were 253 patients undergoing coronary artery bypass grafting
(CABG), who were randomized to receive either the new hydrocolloid
dressing (Karayahesive, n = 117) or a polyurethane foam dressing (Tegaderm
plus Pad, n = 136) immediately after sternal wound closure. Karayahesive
was left in place for 7 days, whereas the Tegaderm plus Pad was removed on
postoperative day (POD) 2 and replaced with an adhesive wound dressing
until POD 7. Results: In the Karayahesive group, complete integrity of the
wound was achieved in 91% of the patients, with an infection developing in
3.4%: as a superficial surgical site infection (SSI) in three and as a
deep SSI in one. On the other hand, in the Tegaderm plus Pad group, an
infection developed in 10.3% (14 patients) of the patients: as a
superficial SSI in nine and as a deep SSI in five (P < 0.05). The total
treatment costs from the application of the dressing until completion of
treatment was 699 yen for the Karayahesive and 910 yen for the Tegaderm
plus Pad (P < 0.001). Conclusions: The new hydrocolloid dressing, applied
with an occlusive dressing technique to median sternotomy wounds,
prevented SSI and was cost effective. copyright 2009 Springer.
<9>
Accession Number
2009438338
Authors
Langford R.M. Joshi G.P. Gan T.J. Mattera M.S. Chen W.-H. Revicki D.A.
Chen C. Zlateva G.
Institution
(Langford) Pain and Anaesthesia Research Centre, St Bartholomew's
Hospital, West Smithfield, London, EC1A 7BE, United Kingdom.
(Joshi) Department of Anesthesiology and Pain Management, University of
Texas, Southwestern Medical Center, Dallas, TX, United States.
(Gan) Department of Anesthesiology, Duke University, Medical Center,
Durham, NC, United States.
(Mattera, Chen, Revicki) Center for Health Outcomes Research, United
BioSource Corporation, Bethesda, MD, United States.
(Chen, Zlateva) Pfizer Inc., New York, NY, United States.
Title
Reduction in opioid-related adverse events and improvement in function
with parecoxib followed by valdecoxib treatment after non-cardiac surgery:
A randomized, double-blind, placebo-controlled, parallel-group trial.
Source
Clinical Drug Investigation. 29(9)(pp 577-590), 2009. Date of
Publication: 2009.
Publisher
Adis International Ltd
Abstract
Background: Multimodal pain therapy including cyclo-oxygenase-2 inhibitors
can result in optimal pain management with decreased opioid use and fewer
opioid-related adverse events. Patient reported outcomes (PROs) help
identify benefits in reduced opioid use and increased pain control.
Methods: In this randomized, double-blind trial, patients (n = 1062)
undergoing major non-cardiac elective surgery received either parenteral
parecoxib for 3 days or placebo then oral valdecoxib or placebo for a
total of 10 days, with both arms being allowed additional opioid
analgesia. Clinically meaningful opioid-related adverse events were
assessed daily using the Opioid- Related Symptom Distress Scale (OR-SDS).
Pain severity and interference with function were evaluated daily using
the modified Brief Pain Inventory exploratory form (mBPI-e). Additional
validation work was undertaken to understand the psychometric properties
of the two PROs. Detailed clinical results were reported elsewhere.
Results: Patients receiving parecoxib/valdecoxib achieved significantly
better pain control and consumed 37% and 28% less opioid medication than
the placebo group on day 2 and day 3, respectively. Over the 10-day
treatment period, patients receiving parecoxib/valdecoxib consumed 31%
less opioid medication. This coincided with significantly fewer (p <
0.0001) OR-SDS clinically meaningful events (CMEs) and lower mBPI-e scores
from days 2-10 in the parecoxib/valdecoxib group compared with the placebo
group. On day 3, the percentage of patients reporting one, two or three
CMEs in the parecoxib/valdecoxib versus placebo group was 11.6% versus
13.0%, 2.3% versus 5.1%, and 0.8% versus 2.3%, respectively. The mean
(+/-standard error) mBPI-e pain severity scores over days 2-10 were
2.47+/-0.04 for the parecoxib/ valdecoxib group and 3.01+/-0.04 for the
placebo group, and the mean mBPI-e pain interference scores were 1.73 +/-
0.04 and 2.19+/-0.04, respectively. Conclusions: Patients receiving
parecoxib/valdecoxib had less pain interference on physical functioning,
required less opioid medication and experienced fewer clinically
meaningful opioid-related adverse events than patients receiving placebo.
copyright 2009 Adis Data Information BV. All rights reserved.
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