Results Generated From:
EMBASE <1980 to 2009 Week 49>
EMBASE (updates since 2009-11-25)
<1>
Accession Number
2009580340
Authors
Shroyer A.L. Grover F.L. Hattler B. Collins J.F. McDonald G.O. Kozora E.
Lucke J.C. Baltz J.H. Novitzky D.
Institution
(Shroyer) Northport Veterans Affairs (VA) Medical Center, Northport, NY,
United States.
(Shroyer, Grover, Hattler, Baltz) Eastern Colorado Health Care System,
Department of Veterans Affairs, Denver, CO, United States.
(Kozora) National Jewish Health, Denver, CO, United States.
(Grover, Baltz) Department of Surgery, School of Medicine, University of
Colorado Denver, Aurora, CO, United States.
(Hattler, Kozora) Department of Medicine, School of Medicine, University
of Colorado Denver, Aurora, CO, United States.
(Collins) Cooperative Studies Program Coordinating Center, VA Medical
Center, Perry Point, MD, United States.
(McDonald) Department of Veterans Affairs, Office of Patient Care
Services, Washington, DC, United States.
(Lucke) Charles George VA Medical Center, Asheville, NC, United States.
(Novitzky) James A. Haley Veterans Hospital, Department of Surgery,
University of South Florida, Tampa, FL, United States.
Title
On-pump versus off-pump coronary-artery bypass surgery.
Source
New England Journal of Medicine. 361(19)(pp 1827-1837), 2009. Date of
Publication: 05 Nov 2009.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Coronary-artery bypass grafting (CABG) has traditionally been
performed with the use of cardiopulmonary bypass (on-pump CABG). CABG
without cardiopulmonary bypass (off-pump CABG) might reduce the number of
complications related to the heart-lung machine. METHODS: We randomly
assigned 2203 patients scheduled for urgent or elective CABG to either
on-pump or off-pump procedures. The primary short-term end point was a
composite of death or complications (reoperation, new mechanical support,
cardiac arrest, coma, stroke, or renal failure) before discharge or within
30 days after surgery. The primary long-term end point was a composite of
death from any cause, a repeat revascularization procedure, or a nonfatal
myocardial infarction within 1 year after surgery. Secondary end points
included the completeness of revascularization, graft. RESULTS: There was
no significant difference between off-pump and on-pump CABG in the rate of
the 30-day composite outcome (7.0% and 5.6%, respectively; P=0.19). The
rate of the 1-year composite outcome was higher for off-pump than for
on-pump CABG (9.9% vs. 7.4%, P=0.04). The proportion of patients with
fewer grafts completed than originally planned was higher with off-pump
CABG than with on-pump CABG (17.8% vs. 11.1%, P<0.001). Follow-up
angiograms in 1371 patients who underwent 4093 grafts revealed that the
overall rate of graft patency was lower in the off-pump group than in the
on-pump group (82.6% vs. 87.8%, P<0.01). There were no treatment-based
differences in neuropsychological outcomes or short-term use of major
resources. CONCLUSIONS: At 1 year of follow-up, patients in the off-pump
group had worse composite outcomes and poorer graft patency than did
patients in the on-pump group. No significant differences between the
techniques were found in neuropsychological outcomes or use of major
resources. (ClinicalTrials.gov number, NCT00032630.) Copyright copyright
2009 Massachusetts Medical Society. All rights reserved.
<2>
Accession Number
2009556750
Authors
Bitton A.
Title
Intensive smoking cessation programs for hospitalized coronary patients: A
proven intervention in need of implementation.
Source
Journal of Clinical Outcomes Management. 16(9)(pp 398-399), 2009. Date of
Publication: September 2009.
Publisher
Turner White Communications Inc.
<3>
Accession Number
2009485687
Authors
Frobel A.-K. Hulpke-Wette M. Schmidt K.G. Laer S.
Institution
(Frobel, Laer) Clinical Pharmacy and Pharmacotherapy,
Heinrich-Heine-University, 26.22.02.21, Universitaetsstr. 1, Duesseldorf,
40225, Germany.
(Hulpke-Wette) Outpatient Clinic for Paediatrics, Goettingen, Germany.
(Schmidt) Paediatric Cardiology and Pneumology, University Hospital,
Duesseldorf, Germany.
Title
Beta-blockers for congestive heart failure in children.
Source
Cochrane Database of Systematic Reviews. (1), 2009. Article Number:
CD007037. Date of Publication: 2009.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Beta-blockers are an essential part of standard therapy in
adult congestive heart failure and are therefore also expected to be
beneficial in children. However, congestive heart failure in children
differs strongly from that in adults in terms of characteristics and
aetiology; also, an increased drug clearance has been reported. Paediatric
needs have therefore to be specifically investigated. Objectives: To
assess the effect of beta-adrenoceptor-blockers in children with
congestive heart failure. Search strategy: We searched the Cochrane
Central Register of Controlled Trials (CENTRAL) on The Cochrane Library
(Issue 4 2007), MEDLINE (1966 to January 2008), EMBASE (1980 to January
2008), and LILACS (1980 to January 2008). Bibliographies of identified
studies were checked. No language restrictions were applied. Selection
criteria: Randomised, controlled clinical trials investigating the effect
of beta-blocker therapy on paediatric congestive heart failure. Data
collection and analysis: Two authors independently extracted and assessed
data from the included trials. Main results: Three studies with an overall
number of 203 participants were identified. Two small studies, with 20 and
22 children respectively, showed an improvement of congestive heart
failure, while a larger study with 161 participants showed no evidence of
benefit over placebo in the composite measure of heart failure outcomes
which was the main outcome measure of the trial (56% improvement in both
the placebo and the treatment group, p=0.74). However, study populations
showed vast differences with regard to treatment (choice of beta-blocker,
dosing, duration of treatment), age and age range of the participants and
in particular with regard to condition (aetiology and severity of heart
failure; homogeneity of condition in the study population). In addition
methods and outcome measures differed strongly and were not standardised.
The results can therefore not be compared against each other. Authors'
conclusions: There are not enough data to recommend or discourage the use
of beta-blockers in children with congestive heart failure. Further
investigations in clearly defined populations with standardised
methodology are required to establish guidelines for therapy.
Pharmacokinetic investigations of beta-blockers in children are required
to provide effective dosing in future trials. Copyright copyright 2009 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
<4>
Accession Number
2009599554
Authors
Haase M. Bellomo R. Devarajan P. Schlattmann P. Haase-Fielitz A.
Institution
(Haase, Haase-Fielitz) Department of Nephrology and Intensive Care
Medicine, Charite University Medicine, Berlin, Germany.
(Bellomo) Department of Intensive Care, Austin Health, Melbourne,
Australia.
(Devarajan) Department of Pediatrics and Developmental Biology, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH, United States.
(Schlattmann) Department of Biometry and Clinical Epidemiology, Charite
University Medicine, Campus Mitte, Berlin, Germany.
Title
Accuracy of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Diagnosis
and Prognosis in Acute Kidney Injury: A Systematic Review and
Meta-analysis.
Source
American Journal of Kidney Diseases. 54(6)(pp 1012-1024), 2009. Date of
Publication: December 2009.
Publisher
W.B. Saunders
Abstract
Background: Neutrophil gelatinase-associated lipocalin (NGAL) appears to
be a promising biomarker for the early diagnosis of acute kidney injury
(AKI); however, a wide range in its predictive value has been reported.
Study Design: Meta-analysis of diagnostic test studies using custom-made
standardized data sheets sent to each author. Setting & Population:
Different clinical settings of AKI. Selection Criteria for Studies:
MEDLINE, EMBASE, and CENTRAL databases and congress abstracts were
searched for studies reporting the value of NGAL to predict AKI. Index
Tests: Plasma/serum and urine NGAL within 6 hours from the time of insult
(if known) or 24-48 hours before the diagnosis of AKI if the time of
insult was not known. Reference Tests: The primary outcome was AKI,
defined as an increase in serum creatinine level > 50% from baseline
within 7 days or contrast-induced nephropathy (creatinine increase > 25%
or concentration > 0.5 mg/dL in adults or > 50% increase in children
within 48 hours). Other outcomes predicted using NGAL were renal
replacement therapy initiation and in-hospital mortality. Results: Using a
hierarchical bivariate generalized linear model to calculate the
diagnostic odds ratio (DOR) and sample size-weighted area under the curve
for the receiver-operating characteristic (AUC-ROC), we analyzed data from
19 studies and 8 countries involving 2,538 patients, of whom 487 (19.2%)
developed AKI. Overall, the DOR/AUC-ROC of NGAL to predict AKI was 18.6
(95% CI, 9.0-38.1)/0.815 (95% CI, 0.732-0.892). The DOR/AUC-ROC when
standardized platforms were used was 25.5 (95% CI, 8.9-72.8)/0.830 (95%
CI, 0.741-0.918) with a cutoff value > 150 ng/mL for AKI compared with
16.7 (95% CI, 7.1-39.7)/0.732 (95% CI, 0.656-0.830) for "research-based"
NGAL assays. In cardiac surgery patients, the DOR/AUC-ROC of NGAL was 13.1
(95% CI, 5.7-34.8)/0.775 (95% CI, 0.669-0.867); in critically ill
patients, 10.0 (95% CI, 3.0-33.1)/0.728 (95% CI, 0.615-0.834); and after
contrast infusion, 92.0 (95% CI, 10.7-794.1)/0.894 (95% CI, 0.826-0.950).
The diagnostic accuracy of plasma/serum NGAL (17.9 [95% CI,
6.0-53.7]/0.775 [95% CI, 0.679-0.869]) was similar to that of urine NGAL
(18.6 [95% CI, 7.2-48.4]/0.837 [95% CI, 0.762-0.906]). We identified age
to be an effective modifier of NGAL value with better predictive ability
in children (25.4 [95% CI, 8.9-72.2]/0.930 [95% CI, 0.883-0.968]) compared
with adults (10.6 [95% CI, 4.8-23.4]/0.782 [95% CI, 0.689-0.872]). NGAL
level was a useful prognostic tool with regard to the prediction of renal
replacement therapy initiation (12.9 [95% CI, 4.9-33.9]/0.782 [95% CI,
0.648-0.917]) and in-hospital mortality (8.8 [95% CI, 1.9-40.8]/0.706 [95%
CI, 0.530-0.747]). Limitations: Serum creatinine level was used for AKI
definition. Conclusions: NGAL level appears to be of diagnostic and
prognostic value for AKI. copyright 2009 National Kidney Foundation, Inc.
<5>
Accession Number
2009593736
Authors
White H.D.
Institution
(White) Department of Cardiology, Green Lane Cardiovascular Service,
Auckland City Hospital, Private Bag 92 189, Auckland 1030, New Zealand.
Title
Is there an acceptable ceiling for bleeding for an antithrombotic drug
dose to be tested in a phase 3 trial?.
Source
European Heart Journal. 30(21)(pp 2556-2557), 2009. Date of Publication:
November 2009.
Publisher
Oxford University Press
<6>
Accession Number
2009593734
Authors
Breithardt G.
Institution
(Breithardt) Medizinische Klinik und Poliklinik C
(Kardiologie/Angiologie), Universitatsklinikum Munster, D-48129 Munster,
Germany.
Title
MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac
Resynchronization Therapy): Cardiac resynchronization therapy towards
early management of heart failure.
Source
European Heart Journal. 30(21)(pp 2551-2553), 2009. Date of Publication:
November 2009.
Publisher
Oxford University Press
<7>
Accession Number
2009507353
Authors
Ulrich C. Jurgensen J.S. Degen A. Hackethal M. Ulrich M. Patel M.J. Eberle
J. Terhorst D. Sterry W. Stockfleth E.
Institution
(Ulrich, Degen, Hackethal, Ulrich, Eberle, Terhorst, Sterry, Stockfleth)
Department of Dermatology, Skin Cancer Center, Charite University
Hospital, 10117 Berlin, Germany.
(Jurgensen) Department of Nephrology and Intensive Care Medicine, Charite
Universitatsmedizin Berlin, 10117 Berlin, Germany.
(Patel) Department of Dermatology, Johns Hopkins University, Baltimore, MD
21287-0900, United States.
Title
Prevention of non-melanoma skin cancer in organ transplant patients by
regular use of a sunscreen: A 24 months, prospective, case-control study.
Source
British Journal of Dermatology. 161(SUPPL. 3)(pp 78-84), 2009. Date of
Publication: November 2009.
Publisher
Blackwell Publishing Ltd
Abstract
Background Skin cancers represent a major challenge within the ever
growing group of long time surviving organ transplant recipients (OTR)
world wide. Especially UV-induced non-melanoma skin cancers (NMSC) like
invasive squamous cell carcinomas (SCC) and actinic keratoses (AK), and
basal cell carcinoma (BCC), outnumber every other form of cancer in organ
transplant recipients. Despite encouraging reports of protective effects
of broad-spectrum sunscreens in immunocompetent patients, evidence for the
prevention of NMSC in immunocompromised patients is still missing.
Objectives To assess preventive effects of regular sun-screen use on AK,
SCC and BCC in chronically immunocompromised organ transplant recipients.
Methods Hundred and twenty matched (age, sex, skin type, graft, transplant
duration, previous post-transplant skin malignancies) organ transplant
recipients (40 heart, 40 kidney, 40 liver grafted) were recruited for this
prospective, single-center study. Both groups received equally written and
oral information on sun protection measures. Sixty patients were provided
with a free broad spectrum study-sunscreen (SPF > 50, high-UVA absorption)
for daily application of 2 mg cm-2 to the head, neck, forearms, and hands.
Results All 120 patients completed the 24 months study. Within this 24
month study interval 42 of the 120 patients developed 82 new AK (-102 sun
screen group vs. + 82 control; P < 0.01), 8 new invasive SCC (0 vs. 8; P <
0.01) and 11 BCC (2 vs. 9; ns). In spite of equal numbers of AK at
baseline, a marked difference in favor of the intent-to-treat sunscreen
group was recorded after 24 months (89 vs. 273; P < 0.01, mean difference
3.07 [1.76-4.36]) and the lesion count was significantly lower as compared
to the initial visit (89 vs. 191; P < 0.01, mean difference 1.7
[0.68-2.72]). With an average of 5.6 applications per week throughout the
24 months the study sunscreen was generally well tolerated. Serum
25-hydroxy vitamin D levels as marker for vitamin D status were decreased
in all patients without adequate substitution and 25(OH)D was found to be
lower in the sunscreen-group as compared to the control group (mean value
53 ng mL-1 vs. 60 ng mL-1). Interpretation Regular use of sunscreens, as
part of a consequent UV-protection strategy, may prevent the development
of further AK and invasive SCC and, to a lesser degree, BCC in
immune-compromised organ transplant recipients. copyright 2009 British
Association of Dermatologists.
<8>
Accession Number
2009485906
Authors
Briones E. Lacalle J.R. Marin I.
Institution
(Briones) Quality and Health Information, Valme University Hospital, Avda
Bellavista s.n., Sevilla, 41014, Spain.
(Lacalle) Preventive Medicine and Public Health, Universidad de Sevilla,
Sevilla, Spain.
(Marin) Internal Medicine, Valme University Hospital, Sevilla, Spain.
Title
Transmyocardial laser revascularization versus medical therapy for
refractory angina.
Source
Cochrane Database of Systematic Reviews. (1), 2009. Article Number:
CD003712. Date of Publication: 2009.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Chronic angina and advanced forms of coronary disease are
increasingly more frequent. Although the improved efficacy of available
revascularization treatments, a subgroup of patients present with
refractory angina. Transmyocardial laser revascularization (TMLR) has been
proposed to improve the clinical situation of these patients. Objectives:
To assess the efficacy and safety of TMLR versus optimal medical treatment
in patients with refractory angina in alleviating the severity of angina
and improving survivorship and heart function. Search strategy: We
searched the Cochrane Central Register of Controlled Trials on The
Cochrane Library (Issue 2 2007), MEDLINE (January 2006 to June 2007),
EMBASE ( 2004 to June 2007) and ongoing studies were sought using the meta
Register of Controlled Trials database (mRCT) and Clinical Trials. gov
databases. No languages restrictions were applied. Reference lists of
relevant papers were also checked. Selection criteria: Studies were
selected if they fulfilled the following criteria: randomized controlled
trials of TMLR, by thoracotomy, in patients with angina grade III-IV who
were excluded fromother revascularization procedures. From a total of 181
references, 20 papers were selected, reporting data from seven studies.
Data collection and analysis: Two reviewers abstracted data from selected
papers; . The reviewers performed independently both quality assessment
and data extraction. Selected studies present methodological weaknesses.
None of them fulfilled all the quality criteria. Main results: Seven
studies (1137 participants of which 559 randomized to TMLR) were included.
Overall, 43.8 % of patients in the treatment group decreased two angina
classes as compared with 14.8 % in the control group, odds ratio (OR) of
4.63 (95% confidence interval (CI) 3.43 to 6.25), and heterogeneity was
statistically significant. Mortality by intention-to-treat analysis at
both 30 days (4.0 % in the TMLR group and 3.5 % in the control group) and
1 year (12.2 % in the TMLR group and 11.9 % in the control group) was
similar in both groups. The 30-days mortality as treated was 6.8% in TMLR
group and 0.8% in the control group, showing a statistically significant
difference. The pooled OR was 3.76 (95% CI 1.63 to 8.66), because of the
higher mortality in patients crossing from standard treatment to TMLR.
Authors' conclusions: There is insufficient evidence to conclude that the
clinical benefits of TMLR outweigh the potential risks. The procedure is
associated with a significant early mortality. copyright 2009 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.
<9>
[Use Link to view the full text]
Accession Number
2009582152
Authors
Cook R.C. Humphries K.H. Gin K. Janusz M.T. Slavik R.S. Bernstein V.
Tholin M. Lee M.K.
Institution
(Cook, Janusz) Division of Cardiovascular Surgery, Vancouver, BC, Canada.
(Humphries, Gin, Bernstein) Division of Cardiology, Department of
Anaesthesiology, Pharmacology and Therapeutics, Vancouver, BC, Canada.
(Tholin) University of British Columbia, Vancouver, BC, Canada.
(Humphries, Lee) Provincial Health Services Authority of British Columbia,
Vancouver, BC, Canada.
(Slavik) Pharmacy Department, Interior Health Authority of British
Columbia, Vancouver, BC, Canada.
(Cook) St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6,
Canada.
Title
Prophylactic intravenous magnesium sulphate in addition to oral
beta-blockade does not prevent atrial arrhythmias after coronary artery or
valvular heart surgery a randomized, Controlled Trial.
Source
Circulation. 120(SUPPL. 1)(pp S163-S169), 2009. Date of Publication:
2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Atrial arrhythmias (AA) are an important cause of morbidity
after cardiac surgery. Efforts at prevention of postoperative AA have been
suboptimal. Perioperative beta-blocker administration is the standard of
care at many centers. Although prophylactic administration of magnesium
sulfate (MgSO4) has been recommended, review of all previously published
trials of MgSO4 reveals conflicting results. This study was designed to
address methodological shortcomings from previous studies and is the
largest randomized, placebo-controlled trial of intravenous (IV) MgSO4 for
the prevention of AA after coronary artery bypass grafting or cardiac
valvular surgery. Methods and Results - A total of 927 nonemergent cardiac
surgery patients were stratified into 2 groups: isolated coronary artery
bypass grafting (n=694), or valve surgery with or without coronary artery
bypass grafting (n=233), and randomized to receive either 5g IV MgSO4 or
placebo on removal of the cross-clamp, followed by daily 4-hour infusions,
from postoperative day 1 until postoperative day 4. All patients were
treated according to an established oral beta-blocker protocol.
Postoperative serum Mg levels were checked and standard of care was to
administer IV MgSO4 for low serum levels. The primary end point was AA
lasting [greater-than or equal to]30 minutes or requiring treatment for
hemodynamic compromise. There were no differences in the incidence of AA
between patients who received IV MgSO4 or placebo (26.4% versus 24.3%,
respectively). The results were similar when broken down according to
stratified groups. Conclusions - In patients treated with a protocol for
postoperative oral beta-blocker after nonemergent cardiac surgery, the
addition of prophylactic IV MgSO4 did not reduce the incidence of AA.
copyright 2009 American Heart Association, inc.
<10>
Accession Number
2009580620
Authors
Exner D.V.
Institution
(Exner) Libin Cardiovascular Institute of Alberta, University of Calgary,
Calgary, Alta., Canada.
Title
Is it Time to Expand the Use of Cardiac Resynchronization Therapy to
Patients With Mildly Symptomatic Heart Failure?.
Source
Journal of the American College of Cardiology. 54(20)(pp 1847-1849),
2009. Date of Publication: 10 Nov 2009.
Publisher
Elsevier USA
<11>
Accession Number
2009580619
Authors
Daubert C. Gold M.R. Abraham W.T. Ghio S. Hassager C. Goode G. Szili-Torok
T. Linde C.
Institution
(Daubert) Departement de Cardiologie et maladies vasculaires, CHU, Rennes,
France.
(Gold) Division of Cardiology, Medical University of South Carolina,
Charleston, SC, United States.
(Abraham) Division of Cardiovascular Medicine and the Davis Heart, Lung
Research Institute, The Ohio State University, Columbus, OH, United
States.
(Ghio) Division of Cardiology, Fondazione IRCCS Policlinico San Matteo,
Pavia, Italy.
(Hassager) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark.
(Goode) Cardiology Research, Lancashire Cardiac Centre, Blackpool Victoria
Hospital NHS Trust, Blackpool, United Kingdom.
(Szili-Torok) Hungarian Institute of Cardiology, Budapest, Hungary.
(Linde) Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden.
Title
Prevention of Disease Progression by Cardiac Resynchronization Therapy in
Patients With Asymptomatic or Mildly Symptomatic Left Ventricular
Dysfunction. Insights From the European Cohort of the REVERSE
(Resynchronization Reverses Remodeling in Systolic Left Ventricular
Dysfunction) Trial.
Source
Journal of the American College of Cardiology. 54(20)(pp 1837-1846),
2009. Date of Publication: 10 Nov 2009.
Publisher
Elsevier USA
Abstract
Objectives: The aim of this study was to determine the long-term effects
of cardiac resynchronization therapy (CRT) in the European cohort of
patients enrolled in the REVERSE (Resynchronization Reverses Remodeling in
Systolic Left Ventricular Dysfunction) trial. Background: Previous data
suggest that CRT slows disease progression and improves the outcomes of
asymptomatic or mildly symptomatic patients with left ventricular (LV)
dysfunction and a wide QRS complex. Methods: We randomly assigned 262
recipients of CRT pacemakers or defibrillators, with QRS [greater-than or
equal to]120 ms and LV ejection fraction [less-than or equal to]40% to
active (CRT ON; n = 180) versus control (CRT OFF; n = 82) treatment, for
24 months. Mean baseline LV ejection fraction was 28.0%. All patients were
in sinus rhythm and receiving optimal medical therapy. The primary study
end point was the proportion worsened by the heart failure (HF) clinical
composite response. The main secondary study end point was left
ventricular end-systolic volume index (LVESVi). Results: In the CRT ON
group, 19% of patients were worsened versus 34% in the CRT OFF group (p =
0.01). The LVESVi decreased by a mean of 27.5 +/- 31.8 ml/m2 in the CRT ON
group versus 2.7 +/- 25.8 ml/m2 in the CRT OFF group (p < 0.0001). Time to
first HF hospital stay or death (hazard ratio: 0.38; p = 0.003) was
significantly delayed by CRT. Conclusions: After 24 months of CRT, and
compared with those of control subjects, clinical outcomes and LV function
were improved and LV dimensions were decreased in this patient population
in New York Heart Association functional classes I or II. These
observations suggest that CRT prevents the progression of disease in
patients with asymptomatic or mildly symptomatic LV dysfunction.
(REsynchronization reVErses Remodeling in Systolic Left vEntricular
Dysfunction [REVERSE]; NCT00271154). copyright 2009 American College of
Cardiology Foundation.
<12>
Accession Number
2009578823
Authors
Stassano P. Di Tommaso L. Monaco M. Iorio F. Pepino P. Spampinato N. Vosa
C.
Institution
(Stassano, Di Tommaso, Iorio, Spampinato, Vosa) Cardiac Surgery Unit,
University Federico II, School of Medicine, Naples, Italy.
(Monaco, Pepino) Cardiac Surgery Unit, Istituto Clinico Pineta Grande,
Castelvolturno, Italy.
Title
Aortic Valve Replacement. A Prospective Randomized Evaluation of
Mechanical Versus Biological Valves in Patients Ages 55 to 70 Years.
Source
Journal of the American College of Cardiology. 54(20)(pp 1862-1868),
2009. Date of Publication: 10 Nov 2009.
Publisher
Elsevier USA
Abstract
Objectives: The aim of this study was to determine long-term results
between bioprosthetic (BP) and mechanical (MP) aortic valves in
middle-aged patients. Background: It has not been established which is the
best aortic valve substitute in patients ages 55 to 70 years. We conducted
a randomized study to compare long-term outcomes between BP and MP aortic
valves. Methods: Between January 1995 and June 2003, 310 patients were
randomized to receive a BP or an MP aortic valve. Primary end points of
the study were survival, valve failure, and reoperation. Results: One
hundred fifty-five patients received a BP valve, and 155 patients received
an MP valve. Four patients died, perioperatively, in the MP group (2.6%),
and 6 patients died in the BP group (3.9%, p = 0.4). At late follow-up
(mean 106 +/- 28 months) 41 patients died in the MP group and 45 patients
died in the BP group (p = 0.6). There was no difference in the survival
rate at 13 years between the MP and BP groups. Valve failures and
reoperations were more frequent in the BP group compared with the MP group
(p = 0.0001 and p = 0.0003, respectively). There were no differences in
the linearized rate of thromboembolism, bleeding, endocarditis, and major
adverse prosthesis-related events (MAPE) between the MP and BP valve
groups. Conclusions: At 13 years, patients undergoing aortic valve
replacement either with MP or BP valves had a similar survival rate as
well the same rate of occurrence of thromboembolism, bleeding,
endocarditis, and MAPE, but patients who had undergone aortic valve
replacement with BP valves faced a significantly higher risk of valve
failure and reoperation. copyright 2009 American College of Cardiology
Foundation.
<13>
[Use Link to view the full text]
Accession Number
2009565267
Authors
Shehabi Y. Grant P. Wolfenden H. Hammond N. Bass F. Campbell M. Chen J.
Institution
(Shehabi) University of New South Wales Clinical School, Acute Care
Program, Prince of Wales Hospital, Sydney, Australia.
(Grant, Wolfenden) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, University of New South Wales Clinical School, Sydney,
Australia.
(Hammond) George Institute, Sydney, Australia.
(Bass, Campbell) Department of Intensive Care Services, Prince of Wales
Hospital, Sydney, Australia.
(Chen) Simpson Centre for Health Services Research, University of New
South Wales, Sydney, Australia.
Title
Prevalence of delirium with dexmedetomidine compared with morphine based
therapy after cardiac surgery: A randomized controlled trial
(DEXmedetomidine compared to morphine-DEXCOM study).
Source
Anesthesiology. 111(5)(pp 1075-1084), 2009. Date of Publication: November
2009.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND:: Commonly used sedatives/analgesics can increase the risk of
postoperative complications, including delirium. This double-blinded study
assessed the neurobehavioral, hemodynamic, and sedative characteristics of
dexmedetomidine compared with morphine-based regimen after cardiac surgery
at equivalent levels of sedation and analgesia. METHODS:: A total of 306
patients at least 60 yr old were randomized to receive dexmedetomidine
(0.1-0.7 mug * kg * h) or morphine (10-70 mug * kg * h) with open-label
propofol titrated to a target Motor Activity Assessment Scale of 2-4.
Primary outcome was the prevalence of delirium measured daily via
Confusion Assessment Method for intensive care. Secondary outcomes
included ventilation time, additional sedation/analgesia, and hemodynamic
and adverse effects. RESULTS:: Of all sedation assessments, 75.2% of
dexmedetomidine and 79.6% (P = 0.516) of morphine treatment were in the
target range. Delirium incidence was comparable between dexmedetomidine 13
(8.6%) and morphine 22 (15.0%) (relative risk 0.571, 95% confidence
interval [CI] 0.256-1.099, P = 0.088), however, dexmedetomidine-managed
patients spent 3 fewer days (2 [1-7] versus 5 [2-12]) in delirium (95% CI
1.09-6.67, P = 0.0317). The incidence of delirium was significantly less
in a small subgroup requiring intraaortic balloon pump and treated with
dexmedetomidine (3 of 20 [15%] versus 9 of 25 [36%]) (relative risk 0.416,
95% CI 0.152-0.637, P = 0.001). Dexmedetomidine-treated patients were more
likely to be extubated earlier (relative risk 1.27, 95% CI 1.01-1.60, P =
0.040, log-rank P = 0.036), experienced less systolic hypotension (23%
versus 38.1%, P = 0.006), required less norepinephrine (P < 0.001), but
had more bradycardia (16.45% versus 6.12%, P = 0.006) than morphine
treatment. CONCLUSION:: Dexmedetomidine reduced the duration but not the
incidence of delirium after cardiac surgery with effective
analgesia/sedation, less hypotension, less vasopressor requirement, and
more bradycardia versus morphine regimen. copyright 2009 the American
Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc.
<14>
Accession Number
2009555850
Authors
Yao Y.-T. Li L.-H.
Institution
(Yao, Li) Department of Anesthesiology, Fuwai Cardiovascular Hospital,
Peking Union Medical College, Beijing 100037, China.
Title
Sevoflurane versus propofol for myocardial protection in patients
undergoing coronary artery bypass grafting surgery: A meta-analysis of
randomized controlled trials.
Source
Chinese Medical Sciences Journal. 24(3)(pp 133-141), 2009. Date of
Publication: September 2009.
Publisher
Taylor and Francis Ltd.
Abstract
Objective: To systematically review randomized controlled trials to
compare myocardial protection profiles of sevoflurane with propofol in
patients undergoing coronary artery bypass grafting (CABG) surgery.
Methods: Electronic databases were searched to identify all randomized
controlled trials comparing sevoflurane with propofol for protecting
myocardium in adult patients undergoing CABG surgery. Two authors
independently extracted patients' perioperative data, including patients'
baseline characteristics, surgical variables, and outcome data. For
continuous variables, treatment effects were calculated as weighted mean
difference (WMD) and 95% confidential interval (CI). For dichotomous data,
treatment effects were calculated as odds ratio (OR) and 95% CI. Each
outcome was tested for heterogeneity, and randomized-effects or
fixed-effects model was used in the presence or absence of significant
heterogeneity (Q test P<0.05). Sensitivity analyses were done by examining
the influence of statistical model on estimated treatment effects.
Publication bias was explored through visual inspection of funnel plots of
the outcomes. Statistical significance was defined as P<0.05. Results: Our
search yielded 13 studies including 696 patients, and 402 patients were
allocated into sevoflurane group and 294 into propofol group. There was no
significant difference in postoperative mechanical ventilation time,
inotropic support, mortality, myocardial infarction, and atrial
fibrillation between the two groups (all P>0.05). Patients randomized into
sevoflurane group had higher post-bypass cardiac index (WMD=0.39, 95% CI:
0.18 to 0.60, P=0.0003), lower troponin I level (WMD=-0.82, 95% CI: -0.87
to -0.85, P=0.0002), lower incidence of myocardial ischemia (OR=0.37, 95%
CI: 0.16 to 0.83, P=0.02), shorter ICU and hospital stay length
(WMD=-10.99, 95% CI: -12.97 to -9.01, P<0.00001; WWD=-0.78, 95% CI: -1.00
to -0.56, P<0.00001, respectively). Conclusion: This meta-analysis has
found some evidence showing that sevoflurane has better myocardial
protection than propofol in CABG surgery.
<15>
Accession Number
2009577738
Authors
Stroobant N. Vingerhoets G.
Institution
(Stroobant, Vingerhoets) Laboratory for Neuropsychology, Department of
Internal Medicine-Section Neurology, Ghent University Hospital, 4K3, De
Pintelaan 185, B-9000 Ghent, Belgium.
Title
Pre-existing cognitive impairment in candidates for cardiac surgery: An
overview.
Source
Heart. 95(22)(pp 1820-1825), 2009. Date of Publication: November 2009.
Publisher
BMJ Publishing Group
Abstract
Until now, little attention has been paid to the preoperative status of
the patient awaiting cardiac surgery when investigating the effects of
cardiac surgery on cognition. However, there is growing evidence that
pre-bypass patients show poorer cognitive function than healthy subjects.
This article reviews existing published evidence of poor cognitive
function in pre-bypass patients by describing patient characteristics,
providing an inventory of affected neurocognitive domains, discussing
adequate control groups and proposing potential aetiological mechanisms of
neuropsychological dysfunctioning. It is concluded that there is a growing
need for future research into this important topic on cognitive
dysfunctioning in candidates for coronary artery bypass grafting surgery.
<16>
Accession Number
2009575696
Authors
Adamopoulos C. Ahmed A. Fay R. Angioi M. Filippatos G. Vincent J. Pitt B.
Zannad F.
Institution
(Adamopoulos, Fay, Angioi, Zannad) Inserm, Centre d'Investigations
Cliniques CIC Inserm, Hopital Jeanne D Arc, Toul 54200, France.
(Ahmed) University of Alabama at Birmingham, VA Medical Center,
Birmingham, AL, United States.
(Angioi, Zannad) Hypertension and Heart Failure Division, Department of
Cardiovascular Disease, Hopital Jeanne D Arc, Nancy, France.
(Filippatos) Department of Cardiology, Athens University Hospital Attikon,
Athens, Greece.
(Vincent) Pfizer Inc., New York, NY, United States.
(Pitt) University of Michigan, Ann Arbor, MI, United States.
Title
Timing of eplerenone initiation and outcomes in patients with heart
failure after acute myocardial infarction complicated by left ventricular
systolic dysfunction: Insights from the EPHESUS trial.
Source
European Journal of Heart Failure. 11(11)(pp 1099-1105), 2009. Date of
Publication: November 2009.
Publisher
Oxford University Press
Abstract
Aims To test the hypothesis that an earlier post-acute myocardial
infarction (AMI) eplerenone initiation in patients with left ventricular
systolic dysfunction (LVSD) and heart failure (HF) is associated with
better long-term outcomes.Methods and resultsThe 6632 patients of the
EPHESUS study were randomized from day 3 to 14 after the index AMI (median
= 7 days), of these 3319 were assigned to eplerenone. We analysed the
differential effects of time-to-eplerenone initiation vs. placebo, based
on the median time to initiation of treatment (<7 days-'earlier',
[greater-than or equal to]7days-'later'). Effects on outcomes were
evaluated over a mean 16-month follow-up, using Cox proportional hazards
regression analysis. The earlier eplerenone initiation (<7 days) reduced
the risk of all-cause mortality by 31 (P = 0.001) when compared with the
'earlier' placebo' and also reduced the risks of cardiovascular (CV)
hospitalization/CV mortality by 24 (P < 0.0001) and sudden cardiac death
(SCD) by 34 (P < 0.0001). In contrast, later eplerenone initiation
([greater-than or equal to]7 days) had no significant effect on outcomes.
Interactions between time-to-randomization and treatment were significant.
These associations remained substantially unchanged after risk adjustment
in multivariable models.ConclusionAn earlier eplerenone administration
(3-7days) post-AMI improved outcomes in patients with LVSD and HF. This
benefit was not observed when eplerenone was initiated later
([greater-than or equal to]7days).
<17>
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Accession Number
2009524388
Authors
Mujanovic E. Nurkic M. Caluk J. Terzic I. Kabil E. Bergsland J.
Institution
(Mujanovic, Nurkic, Caluk, Terzic, Kabil, Bergsland) Cardiovascular
Clinic, University Clinical Medical Center, Tuzla,
(Mujanovic, Caluk, Terzic, Kabil, Bergsland) BH Heart Center Tuzla, Tuzla,
(Mujanovic, Nurkic, Caluk, Terzic, Kabil) Tuzla University, Tuzla,
(Bergsland) Interventional Centre, Rikshospitalet, Oslo, 0027, Norway.
Title
The effect of combined clopidogrel and aspirin therapy after off-pump
coronary surgery: A pilot study.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 4(5)(pp 265-268), 2009. Date of Publication: September-October
2009.
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVE: The purpose of this randomized study was to evaluate the effect
on graft patency by adding clopidogrel to aspirin in off-pump coronary
artery bypass (OPCAB) grafting and the possible side effects of such
therapy. METHODS: Twenty patients who underwent standard OPCAB through
median sternotomy were randomized immediately after surgery in two groups.
Patients in group A (n = 10) received 100 mg of aspirin starting
preoperatively, continuing indefinitely. Patients in group B received 100
mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately
after the operation and for 3 months. Postoperative bleeding and other
perioperative parameters were compared. Angiography was repeated 3 months
after surgery to determine the patency and quality of grafts. RESULTS:
Preoperative risk factors were similar in the two groups. There was no
significant difference in average number of distal anastomosis (P =
0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256),
ventilation time (P = 0.635), and intensive care unit stay (P = 0.065).
Length of stay was shorter in group B (P = 0.024). There was no
postoperative complication in either groups. Eight of 27 grafts in group A
and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of
control angiography. CONCLUSIONS: Early administration of a combined
regimen of clopidogrel and aspirin after OPCAB grafting is not associated
with increased postoperative bleeding or other major complications.
Despite the small number of patients in this study and small number of
examined grafts, the results suggest that the addition of clopidogrel may
increase graft patency after OPCAB grafting. Copyright copyright 2009 by
the International Society for Minimally Invasive Cardiothoracic Surgery.
<18>
Accession Number
2009560499
Authors
Gula L.J. Redfearn D.P. Veenhuyzen G.D. Krahn A.D. Yee R. Klein G.J.
Skanes A.C.
Institution
(Gula, Krahn, Yee, Klein, Skanes) Division of Cardiology, Department of
Medicine, University of Western Ontario, London, ON, Canada.
(Redfearn) Division of Cardiology, Queen's University, Kingston, ON,
Canada.
(Veenhuyzen) Division of Cardiology, University of Calgary, Calgary, AB,
Canada.
(Skanes) London Health Sciences Center, University Campus, 339 Windermere
Road, London, ON N6A 5A5, Canada.
Title
Reduction in atrial flutter ablation time by targeting maximum voltage:
Results of a prospective randomized clinical trial.
Source
Journal of Cardiovascular Electrophysiology. 20(10)(pp 1108-1112), 2009.
Date of Publication: 2009.
Publisher
Blackwell Publishing Inc.
Abstract
Reduction in Atrial Flutter Ablation Time by Targeting Maximum Voltage.
Background: Radiofrequency ablation (RFA) of the cavotricuspid isthmus
(CTI) is an established therapy for typical atrial flutter. Previous
studies have demonstrated that the CTI is often composed of discrete
muscle bundles, and evidence has suggested that these bundles correlate
with high-voltage local electrograms in the tricuspid isthmus. This
randomized, multicenter clinical trial was designed to prospectively
compare the hypothesis that a maximum voltage-guided (MVG) technique
targets critical conducting bundles in the isthmus, as reflected by a
reduction in ablation requirements compared to the anatomical approach to
atrial flutter ablation. Methods: Bidirectional block was achieved in
patients undergoing ablation for typical atrial flutter using 1 of 2
randomly assigned methods. The anatomical approach produced a contiguous
line of ablation lesions from the inferior aspect of the tricuspid annulus
to the inferior vena cava using a standard method. The MVG technique
sequentially targeted the maximum voltage local electrograms in the CTI
along a similar line. Results: Sixty-nine patients were randomized, with
mean age 63 +/- 10 and 58 (84%) male. Among patients in the anatomic group
(n = 34), mean ablation time was 11.2 +/- 7.5 minutes compared to 5.9 +/-
3.3 in the MVG group (n = 35) (P = 0.0026). A mean of 14.2 +/- 9.7
ablation lesions were created in the anatomic group, and 7.9 +/- 4.8 in
the MVG group (P = 0.0042). Conclusions: Ablation for atrial flutter using
an MVG technique results in significantly less ablation requirements than
the traditional approach, potentially by concentrating ablation lesions on
the muscle bundles responsible for transisthmus conduction. (J Cardiovasc
Electrophysiol, Vol. pp. 1108-1112) copyright 2009 Wiley Periodicals, Inc.
<19>
Accession Number
2009559971
Authors
Walter T. Szabo S. Kazmaier S. Suselbeck T. Borggrefe M. Hoffmeister H.M.
Institution
(Walter, Suselbeck, Borggrefe) First Department of Medicine, University
Hospital Mannheim, Mannheim, Germany.
(Szabo, Kazmaier, Hoffmeister) Department of Internal Medicine II,
Staedtisches Klinikum Solingen, Solingen, Germany.
(Walter) First Department of Medicine - Cardiology, University Hospital
Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Title
Effect of ACE inhibition on the fibrinolytic system in patients requiring
coronary artery bypass grafting.
Source
Thoracic and Cardiovascular Surgeon. 57(6)(pp 368-369), 2009. Date of
Publication: 2009.
Publisher
Georg Thieme Verlag
Abstract
Background: Regulation of the fibrinolytic balance between plasminogen
activators and inhibitors is modulated by the renin-angiotensin system,
Thus, alterations in the renin-angiotensin system by ACE inhibitors
probably result in modification of the fibrinolytic system. We examined
the effect of a short-term treatment with the ACE inhibitor enalapril in
47 patients with severe coronary artery disease requiring coronary artery
bypass grafting (CABG). Methods: Patients received either 20 mg/d
enalapril or placebo for 6 days. Tissue-type plasminogen activator (TPA),
plasminogen activator inhibitor-1 (PAI-1), plasmin-a2-antiplasmin-complex
(PAP) and D-dimers were measured initially and after treatment, Results:
In the enalapril group PAI-1 levels were significantly reduced after
treatment (11,9 +/- 2,3 U/ml vs. 17.1 +/- 3.0 U/1; p < 0.05). In the
placebo group PAP levels were significantly higher (p<0.05) after
treatment compared to initial values. No differences could be detected
between the study groups with regard to TPA and D-dimers. Conclusion:
Although PAI-1 activity levels are reduced after short-term treatment with
ACE inhibitors in patients with stable angina pectoris while TPA antigen
is unaffected, treatment with ACE inhibitors does not lead to a marked
change in plasmin activation.copyright Georg Thieme Verlag KG Stuttgart
New York.
<20>
Accession Number
2009557630
Authors
Bertrand O.F. Poirier P. Rodes-Cabau J. Rinfret S. Title L. Dzavik V.
Natarajan M. Angel J. Batalla N. Almeras N. Costerousse O. De
Larochelliere R. Roy L. Despres J.-P.
Institution
(Bertrand, Poirier, Rodes-Cabau, Almeras, Costerousse, De Larochelliere,
Roy, Despres) Hopital Laval, Quebec Heart and Lung Institute, 2725 Chemin
Sainte-Foy, Quebec, QC, Canada.
(Rinfret) Hopital Notre-Dame, Centre Hospitalier, Universite de Montreal,
Montreal, QC, Canada.
(Title) Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
(Dzavik) Toronto General Hospital, Toronto, ON, Canada.
(Natarajan) Hamilton Civic Hospital, McMaster University, Hamilton, ON,
Canada.
(Angel, Batalla) Hospital Vall d'Hebron, Barcelona, Spain.
Title
A multicentre, randomized, double-blind placebo-controlled trial
evaluating rosiglitazone for the prevention of atherosclerosis progression
after coronarya artery bypass graft surgery in patients with type 2
diabetes. Design and rationale of the Veln-Coronary aTherOsclerosis and
Rosiglitazone after bypass surgerY (VICTORY) trial.
Source
Canadian Journal of Cardiology. 25(9)(pp 509-515), 2009. Date of
Publication: 2009.
Publisher
Pulsus Group Inc.
Abstract
Background: The number of patients with coronary artery disease and type 2
diabetes will increase dramatically over the next decade. Diabetes has
been related to accelerated atherosclerosis and many patients with
diabetes will require coronary artery bypass graft (CABG) surgery
utilizing saphenous vein grafts. After CABG, accelerated atherosclerosis
in saphenous vein grafts leads to graft failure in approximately 50% of
cases over a 10-year period. Rosightazone, a peroxisome
proliferator-activated receptor-gamma agonist, has been shown to improve
multiple metabolic parameters in patients with type 2 diabetes. However,
its role in the prevention of atherosclerosis progression is uncertain.
Study Design: Veln-Coronary aTherOsclerosis and Rosiglitazorle after
bypass surgerY (VICTORY) is a cardiometabolic trial in which patients with
type 2 diabetes, one to 10 years after CABG, will be randomly assigned to
receive rosiglitazone (up to 8 mg/day) or a placebo after qualifying
angiography and intravascular ultrasound of a segment of one vein graft
with or without a native anastomosed coronary artery. A comprehensive set
of athero-thrombo-inflammatory markers will be serially assessed during
the 12-month follow-up period. Body fat distribution and body composition
will be assessed by computed tomography and dual energy x-ray
absorptiometry, respectively, at baseline, six months and 12 months
follow-up. For atherosclerosis progression evaluation, repeat angiography
and intravascular ultrasound will be performed after 12 months follow-up.
The primary end point of the study will be the change in atherosclerotic
plaque volume in a 40 mm or longer segment of one vein graft. Conclusions:
The VICTORY trial is the first cardiometabolic study to evaluate the
antiatherosclerotic and metabolic effects of rosiglitazone in post-CABG
patients with type 2 diabetes. copyright 2009 Pulsus Group Inc. All rights
reserved.
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