Total documents retrieved: 23
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<1>
Accession Number
2009623297
Authors
Soveri I. Abedini S. Holdaas H. Jardine A. Eriksson N. Fellstrom B.
Institution
(Soveri, Fellstrom) Department of Medical Sciences, Uppsala University,
Uppsala, Sweden.
(Soveri) Acute Internal Medicine, Uppsala University Hospital, Uppsala,
Sweden.
(Abedini, Holdaas) Rikshospitalet, Oslo, Norway.
(Jardine) Nephrology, General Infirmary, Glasgow, United Kingdom.
(Eriksson) Uppsala Clinical Research Center, Uppsala, Sweden.
Title
Metabolic syndrome and cardiovascular risk in renal transplant recipients:
Effects of statin treatment.
Source
Clinical Transplantation. 23(6)(pp 914-920), 2009. Date of Publication:
2009.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Renal transplant recipients (RTR) have high risk for
cardiovascular disease (CVD). They also have high prevalence of insulin
resistance and metabolic syndrome (MS). Statin treatment reduces CVD risk
in RTR. The aim was to study MS as CVD risk factor in RTR, and to
investigate the effect of statin treatment in RTR with MS. Methods: In
total, 1706 non-diabetic RTR from the Assessment of Lescol in Renal
Transplantation trial were followed for 7-8 yr. The captured endpoints
included major adverse cardiac events [MACE, defined as cardiac death
(CD), non-fatal myocardial infarction or coronary revascularization
procedure], and CD. MS was defined at baseline according to Adult
Treatment Panel III definition with waist girth replaced by body mass
index [greater-than or equal to]30 kg/m2. Results: MS was diagnosed in 32%
of the patients. During the follow-up, MACE incidence was 16% in those
with MS and 11% in those without MS (p < 0.001). Statin treatment reduced
MACE risk by 53% in the group with MS. CD risk was 74% higher in RTR with
MS (p = 0.012), and statin treatment reduced CD risk in those with MS (p =
0.03). Conclusions: RTR with MS have increased risk for CVD. RTR with MS
are an easily identifiable group of patients who benefit from statin
treatment. copyright 2009 John Wiley & Sons A/S.
<2>
Accession Number
2009623290
Authors
Stein E.M. Cohen A. Freeby M. Rogers H. Kokolus S. Scott V. Mancini D.
Restaino S. Brown R. McMahon D.J. Shane E.
Institution
(Stein, Cohen, Freeby, Rogers, Kokolus, Scott, Mancini, Restaino, Brown,
McMahon, Shane) Department of Medicine, College of Physicians and
Surgeons, Columbia University, New York, NY, United States.
Title
Severe vitamin D deficiency among heart and liver transplant recipients.
Source
Clinical Transplantation. 23(6)(pp 861-865), 2009. Date of Publication:
2009.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Although patients with end-stage organ failure are at high
risk for vitamin D deficiency because of limited sunlight exposure and
hepatic dysfunction, few studies have measured 25-hydroxy vitamin D
(25OHD) at the time of transplantation. Methods: We measured serum 25OHD
immediately after transplantation in 69 heart and liver transplant
recipients. Results: Forty-six heart and 23 liver transplant recipients
were evaluated (mean age 53 yr). Mean 25OHD was well below the lower limit
of the normal range (43.2 +/- 21.2 nmol/L). Ninety-one percent had levels
below 75 nmol/L, the threshold commonly used to denote sufficiency, and
71% had levels below 50 nmol/L. Severe deficiency (25OHD <25 nmol/L) was
found in 16%. Vitamin D levels did not differ by race, age, gender, or
season. Mean 25OHD was lower among liver than heart transplant recipients
(34.4 +/- 17.5 vs. 47.7 +/- 20.7 nmol/L; p < 0.03). Among liver transplant
recipients, 22% had undetectable levels (<17 nmol/L). Conclusions: Vitamin
D deficiency is highly prevalent among heart and liver transplant
recipients; those with liver failure are at greatest risk. As vitamin D
deficiency has many serious skeletal and extra-skeletal sequelae,
physicians who treat transplant patients should maintain a high degree of
vigilance for this problem. copyright 2009 John Wiley & Sons A/S.
<3>
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Accession Number
0019996947
Authors
Beaulieu Y. Denault A.Y. Couture P. Roy D. Talajic M. O'Meara E. Carrier
M. Page P. Levesque S. Lambert J. Tardif J.C.
Institution
(Beaulieu, Denault, Couture, Roy, Talajic, O'Meara, Carrier, Page,
Levesque, Lambert, Tardif) Department of Medicine, Montreal Heart
Institute, Universite de Montreal, Montreal, Quebec, Canada.
Title
Perioperative intravenous amiodarone does not reduce the burden of atrial
fibrillation in patients undergoing cardiac valvular surgery..
Source
Anesthesiology. 112(1)(pp 128-137), 2010. Date of Publication: Jan 2010.
Abstract
BACKGROUND: Atrial fibrillation is a common complication after cardiac
surgery. Postoperative atrial fibrillation is associated with increased
risks of morbidity and mortality, and, therefore, preventive strategies
using oral amiodarone have been developed but are often unpractical.
Intravenous amiodarone administered after the induction of anesthesia and
continued postoperatively for 48 h could represent an effective strategy
to prevent postoperative atrial fibrillation in patients undergoing
cardiac valvular surgery. METHODS: Single-center, double-blinded,
double-dummy, randomized controlled trial in patients undergoing valvular
surgery. Patients received either an intravenous loading dose of 300 mg of
amiodarone or placebo in the operating room, followed by a perfusion of 15
mg . kg(-1) . 24 h(-1) for 2 days. The primary endpoint was the
development of atrial fibrillation occurring at any time within the
postoperative period. RESULTS: One hundred twenty patients were randomly
assigned (mean age was 65 +/- 11 yr). Overall atrial fibrillation occurred
more frequently in the perioperative intravenous amiodarone group compared
with the placebo group (59.3 vs. 40.0%; P = 0.035). Four preoperative
factors were found to be independently associated with a higher risk of
developing postoperative atrial fibrillation: older age (P = 0.0003),
recent myocardial infarction (<6 months; P = 0.026), preoperative angina
(P = 0.0326), and use of a calcium channel blocker preoperatively (P =
0.0078) when controlling for groups. CONCLUSION: In patients undergoing
cardiac valvular surgery, a strategy using intravenous amiodarone for 48 h
is not efficacious in reducing the risk of atrial fibrillation during
cardiac valvular surgery.
<4>
Accession Number
0019635155
Authors
Qiu Z. Chen X. Xu M. Jiang Y. Xiao L. Liu L. Wang L.
Institution
(Qiu, Chen, Xu, Jiang, Xiao, Liu, Wang) Department of Thoracic and
Cardiothoracic Surgery, Nanjing First Hospital affiliated to Nanjing
Medical University, Nanjing Heart Institute, 210006 Nanjing, PR China.
Title
Evaluation of preoperative intra-aortic balloon pump in coronary patients
with severe left ventricular dysfunction undergoing OPCAB surgery: early
and mid-term outcomes..
Source
Journal of cardiothoracic surgery. 4(pp 39), 2009. Date of Publication:
2009.
Abstract
BACKGROUND: The purpose of the present study was to evaluate the safety
and the cost-effectiveness of using preoperative IABP as support compared
with postoperative IABP treatment in coronary patients with severe left
ventricular dysfunction (SLVD) who is undergoing off-pump coronary artery
bypass surgery (OPCAB), including early outcomes, hospital mortality and
morbidity, and mid-term follow-up outcomes. METHODS: Between March 2000
and December 2008, we prospectively and randomly studied the insertion of
preoperative IABP in 115 (7.4%) and postoperative IABP in 106 (6.8%) of
the 1560 consecutive patients. Group A is preoperative IABP therapy. Group
B is postoperative IABP therapy. RESULTS: There was no significant
difference in the number of grafts used between the two groups.
Completeness of revascularization did not differ between the two groups.
The statistically significant difference was hospital mortality (2.6% in
group A vs. 3.8% in group B) (p < 0.05). And there was significant
reduction in postoperative low cardiac output, malignant arrhythmia, acute
renal failure and length of stay in ICU in group A, compared with group B
(p < 0.05). In the two groups, six-, 12-, 24- and 48-month survival rates
were similar. In the study the degree of improvement in angina and quality
of life did not differ significantly between the two groups. CONCLUSION:
The use of preoperative IABP in SLVD patients undergoing OPCAB is of
safety and effectiveness. The combined use of preoperative IABP and OPCAB
allows complete revascularization in SLVD patients with an important
reduction in operative mortality and excellent mid-term results.
<5>
Accession Number
0019818194
Authors
Quenneville S.P. Xie X. Brophy J.M.
Institution
(Quenneville, Xie, Brophy) Department of Cardiology, Royal Victoria
Hospital, McGill University Health Centre, Quebec, Canada.
Title
The cost-effectiveness of Maze procedures using ablation techniques at the
time of mitral valve surgery..
Source
International journal of technology assessment in health care. 25(4)(pp
485-496), 2009. Date of Publication: Oct 2009.
Abstract
BACKGROUND: The classic cut and sew surgical Maze procedure has been shown
to reduce atrial fibrillation (AF), and recently newer surgical ablation
techniques with reduced technical complexity have been introduced. This
study sought to systematically review the efficacy and safety of these
newer techniques and to evaluate their long-term cost-effectiveness at the
time of scheduled mitral valve (MV) surgery. METHODS: A systematic
literature search and meta-analysis was performed to generate the most
reliable efficacy and safety parameter estimates for a Markov decision
analysis model comparing MV surgery alone to MV surgery plus an ablation
Maze procedure. Both basic and probabilistic sensitivity analyses were
conducted. RESULTS: Based on the six randomized controlled trials (RCTs)
identified, the pooled 1-year estimate of AF after surgery alone was 71
percent (95 percent confidence interval [CI], 64 percent to 78 percent).
The pooled risk ratio of AF after surgical ablation treatment at the time
of mitral valve surgery relative to valve surgery alone was 0.33 (95
percent CI, 0.19 to 0.55). The pooled analyses showed that no statistical
significant increases in operative mortality, permanent pacemaker
implantation, and postoperative bleeding with the ablative Maze
procedures. An ablation-based Maze procedure at the time of mitral valve
surgery had an incremental cost-effectiveness ratio (ICER) of $4,446CAD
($3,850US) per quality-adjusted life-year (QALY) compared with valve
surgery alone. Specifically costs were an extra $900CAD but with improved
clinical outcomes (0.20 QALYs), including a prolonged life expectancy of
0.10 life-years. In one-way sensitivity analyses, survival time after MV
surgery had the largest impact on ICER. Other variables influencing the
ICER included the risk ratio of AF, utility, and cost estimates.
Probabilistic sensitivity analysis suggests that 58.1 percent, 73.9
percent, and 89.3 percent of the simulations of the Maze strategy are
cost-effective at willingness to pay thresholds of $20,000, $50,000, and
$100,000CAD per QALY gained, respectively. CONCLUSIONS: Our meta-analysis
suggests that a Maze surgical ablation procedure at the time of MV surgery
is associated with a reduced postoperative AF risk. Our economic model
further suggests that the surgical ablation strategy at the time of mitral
valve surgery is likely a cost-effective intervention, provided patients
have a good long-term postsurgical prognosis.
<6>
Accession Number
2010008756
Authors
Hayward P.A.R. Gordon I.R. Hare D.L. Matalanis G. Horrigan M.L. Rosalion
A. Buxton B.F.
Institution
(Hayward, Matalanis, Rosalion, Buxton) Department of Cardiac Surgery,
Austin Hospital, University of Melbourne, Melbourne, Vic., Australia.
(Gordon) Statistical Consulting Centre, University of Melbourne,
Parkville, Vic., Australia.
(Hare, Horrigan) Department of Cardiology, Austin Hospital, University of
Melbourne, Melbourne, Vic., Australia.
Title
Comparable patencies of the radial artery and right internal thoracic
artery or saphenous vein beyond 5 years: Results from the Radial Artery
Patency and Clinical Outcomes trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 139(1)(pp 60-67), 2010.
Date of Publication: January 2010.
Publisher
Mosby Inc.
Abstract
Objective: To investigate the optimum conduit for coronary targets other
than the left anterior descending artery, we evaluated long-term patencies
and clinical outcomes of the radial artery, right internal thoracic
artery, and saphenous vein through the Radial Artery Patency and Clinical
Outcomes trial. Methods: As part of a 10-year prospective, randomized,
single-center trial, patients undergoing primary coronary surgery were
allocated to the radial artery (n = 198) or free right internal thoracic
artery (n = 196) if aged less than 70 years (group 1), or radial artery (n
= 113) or saphenous vein (n = 112) if aged at least 70 years (group 2).
All patients received a left internal thoracic artery to the left anterior
descending, and the randomized conduit was used to graft the second
largest target. Protocol-directed angiography has been performed at
randomly assigned intervals, weighted toward the end of the study period.
Grafts are defined as failed if there was occlusion, string sign, or
greater than 80% stenosis, independently reported by 3 assessors. Analysis
is by intention to treat. Results: At mean follow up of 5.5 years,
protocol angiography has been performed in groups 1 and 2 in 237 and 113
patients, respectively. There are no significant differences within each
group in preoperative comorbidity, age, or urgency. Patencies were similar
for either of the 2 conduits in each group (log rank analysis, P = .06 and
P = .54, respectively). The differences in estimated 5-year patencies were
6.6% (radial minus right internal thoracic artery) in group 1 and 2.9%
(radial minus saphenous vein graft) in group 2. Conclusion: At mean 5-year
angiography in largely asymptomatic patients, the selection of arterial or
venous conduit for the second graft has not significantly affected
patency. This finding offers surgeons, for now, enhanced flexibility in
planning revascularization. copyright 2010.
<7>
Accession Number
2010008726
Authors
Benedetto U. Angeloni E. Refice S. Sinatra R.
Institution
(Benedetto, Angeloni, Refice, Sinatra) Cardiac Surgery Department, II
School of Medicine, University of Rome La Sapienza, Rome, Italy.
Title
Radial artery versus saphenous vein graft patency: Meta-analysis of
randomized controlled trials.
Source
Journal of Thoracic and Cardiovascular Surgery. 139(1)(pp 229-231), 2010.
Date of Publication: January 2010.
Publisher
Mosby Inc.
<8>
Accession Number
2010008734
Authors
Manrique A.M. Arroyo M. Lin Y. El Khoudary S.R. Colvin E. Lichtenstein S.
Chrysostomou C. Orr R. Jooste E. Davis P. Wearden P. Morell V. Munoz R.
Institution
(Manrique, Arroyo, Colvin) Department of Pediatrics, Heart Center,
Children's Hospital of Pittsburgh, Pittsburgh, Pa, United States.
(Lin) Department of Medicine, Department of Biostatistics, University of
Pittsburgh, Pittsburgh, Pa, United States.
(El Khoudary) Department of Medicine, Department of Epidemiology,
University of Pittsburgh, Pittsburgh, Pa, United States.
(Lichtenstein, Jooste, Davis) Department of Anesthesiology, Children's
Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa, United
States.
(Wearden, Morell) Department of Cardiothoracic Surgery Children's Hospital
of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa, United States.
(Chrysostomou, Orr, Munoz) Department of Critical Care Medicine, Division
of Cardiac Intensive Care, Children's Hospital of Pittsburgh, Pittsburgh,
Pa, United States.
Title
Magnesium supplementation during cardiopulmonary bypass to prevent
junctional ectopic tachycardia after pediatric cardiac surgery: A
randomized controlled study.
Source
Journal of Thoracic and Cardiovascular Surgery. 139(1)(pp 162-169.e2),
2010. Date of Publication: January 2010.
Publisher
Mosby Inc.
Abstract
Objectives: We analyzed the role of magnesium sulfate (MgSO4)
supplementation during cardiopulmonary bypass in pediatric patients
undergoing cardiac surgery, assessing the incidence of hypomagnesemia and
the incidence of junctional ectopic tachycardia. Methods: We performed a
randomized, double-blind, controlled trial in 99 children. MgSO4 or
placebo was administered during the rewarming phase of cardiopulmonary
bypass: group 1, placebo group (29 patients); group 2, 25 mg/kg of MgSO4
(30 patients); and group 3, 50 mg/kg of MgSO4 (40 patients). Results: At
the time of admission to the cardiac intensive care unit, groups receiving
MgSO4 had significantly greater levels of ionized magnesium (group 1, 0.51
+/- 0.07; group 2, 0.57 +/- 0.09; group 3, 0.59 +/- 0.09). Hypomagnesemia
before bypass was common (75%-86.2%) and not significantly different among
the groups. The proportion of hypomagnesemia decreased significantly at
admission to the cardiac intensive care unit in groups receiving MgSO4
(group 1, 77.8%; group 2, 63%; group 3, 47.4%). Patients receiving placebo
(group 1) had a significantly greater occurrence of junctional ectopic
tachycardia than groups receiving MgSO4 (group 1, n = 5 [17.9%]; group 2,
n = 2 [6.7%]; group 3, n = 0 [0%]). Age (<1 month), Aristotle score (>4),
and history of cardiac failure were associated with junctional ectopic
tachycardia. None of the patients with those characteristics in group 3
had junctional ectopic tachycardia. No association was found between study
groups and the Pediatric Risk of Mortality score or length of stay in the
cardiac intensive care unit. Conclusions: Supplementation with MgSO4
during cardiopulmonary bypass seems to reduce the incidence of
hypomagnesemia and junctional ectopic tachycardia at admission to the
cardiac intensive care unit. This effect seems to be dose related.
copyright 2010 The American Association for Thoracic Surgery.
<9>
Accession Number
2009655320
Authors
Tebbe U. Hochadel M. Bramlage P. Kerber S. Hambrecht R. Grube E. Hauptmann
K.E. Gottwik M. Elsasser A. Glunz H.-G. Bonzel T. Carlsson J. Zeymer U.
Zahn R. Senges J.
Institution
(Tebbe) Klinikum Lippe GmbH, Fachbereich Herz-Kreislauf, Rontgenstrasse
18, 32756 Detmold, Germany.
(Hochadel, Zeymer, Senges) Stiftung Institut fur Herzinfarktforschung
Ludwigshafen An der Universitat Heidelberg, Ludwigshafen, Germany.
(Bramlage) Institut fur Kardiovaskulare Pharmakologie und Epidemiologie,
Mahlow, Germany.
(Kerber) Herz- und Gefaklinik GmbH, Bad Neustadt, Germany.
(Hambrecht) Krankenhaus Links der Weser, Bremen, Germany.
(Grube) Helios Klinikum Siegburg, Siegburg, Germany.
(Hauptmann) Krankenhaus der Barmherzigen Bruder, Trier, Germany.
(Gottwik) Klinikum Nurnberg Sud, Medizinische Klinik 8, Nurnberg, Germany.
(Elsasser) Stadt. Kliniken Oldenburg, Oldenburg, Germany.
(Glunz) Westpfalz-Klinikum GmbH, Standort i Kaiserlautern, Kaiserlautern,
Germany.
(Bonzel) Klinikum Fulda, Fulda, Germany.
(Carlsson) Lanssjukhuset i Kalmar, Lasarettsvagen, Kalmar, Sweden.
(Zahn) Herzzentrum Ludwigshafen, Klinikum der Stadt Ludwigshafen GGmbH,
Ludwigshafen, Germany.
Title
In-hospital outcomes after elective and non-elective percutaneous coronary
interventions in hospitals with and without on-site cardiac surgery
backup.
Source
Clinical Research in Cardiology. 98(11)(pp 701-707), 2009. Date of
Publication: November 2009.
Publisher
D. Steinkopff-Verlag
Abstract
Background: Guidelines recommend on-site surgery backup (SB) when elective
percutaneous coronary intervention (PCI) is performed. The evidence for
this recommendation is however weak. Objectives: The objective of the
present study was to compare clinical outcomes in patients undergoing PCI
in hospitals with SB or without surgery backup (non-SB). Methods:
Prospective German PCI registry in 36 hospitals throughout Germany.
Consecutive procedures were collected and analyzed centrally. Results: In
2006, a total of 23,148 patients were included; 12,465 patients (53.8%) in
11 hospitals with SB and 10,683 patients (46.2%) in 25 hospitals without
on-site cardiac SB. Both patient groups were well-balanced with regard to
age and gender. SB hospitals had more patients with ACS (OR 1.29; 95%CI
1.23-1.36) and less patients with stable angina (OR 0.78; 95%CI 0.74-0.82)
than non-SB hospitals. There was no indication of a clinically relevant
differential outcome for in-hospital death, MACE, non-fatal MI, non-fatal
stroke/TIA, or emergency CABG between SB and non-SB hospitals for neither
patients with ACS nor stable angina except for emergency CABG in ACS
patients (more frequent in SB hospitals, OR 2.29; 95%CI 1.02-5.13).
Conclusions: There was no evidence of an excess risk associated with
PCI-procedures performed in non-SB hospitals. copyright 2009
Springer-Verlag.
<10>
Accession Number
2010008715
Authors
Reesink H.J. Surie S. Kloek J.J. Tan H.L. Tepaske R. Fedullo P.F. Bresser
P.
Institution
(Reesink, Surie, Bresser) Department of Pulmonology, University of
Amsterdam, Amsterdam, Netherlands.
(Kloek) Department of Cardiothoracic Surgery, University of Amsterdam,
Amsterdam, Netherlands.
(Tan) Department of Cardiology, University of Amsterdam, Amsterdam,
Netherlands.
(Tepaske) Department of Intensive Care Medicine, the Academic Medical
Center, University of Amsterdam, Amsterdam, Netherlands.
(Fedullo) Division of Repiratory and Critical Care Medicine, University of
California San Diego, San Diego, CA, United States.
Title
Bosentan as a bridge to pulmonary endarterectomy for chronic
thromboembolic pulmonary hypertension.
Source
Journal of Thoracic and Cardiovascular Surgery. 139(1)(pp 85-91), 2010.
Date of Publication: January 2010.
Publisher
Mosby Inc.
Abstract
Objectives: In proximal chronic thromboembolic pulmonary hypertension,
pulmonary endarterectomy is the treatment of first choice. In general,
medical treatment before pulmonary endarterectomy is not indicated.
However, selected "high-risk" patients might benefit by optimization of
pulmonary hemodynamics. Moreover, in patients whose surgery is delayed
owing to limited medical resources, pretreatment may prevent clinical
deterioration. The primary objective of this study was to determine
whether the dual endothelin-1 antagonist bosentan improves pulmonary
hemodynamics and functional capacity in patients with proximal chronic
thromboembolic pulmonary hypertension waiting for pulmonary
endarterectomy. Methods: We used an investigator-initiated, randomized,
controlled single-blind study. Patients were randomized to receive
bosentan (n = 13) or no bosentan (n = 12) for 16 weeks, next to "best
standard of care." The primary end point was change in total pulmonary
resistance. Secondary end points included changes in 6-minute walk
distance, mean pulmonary artery pressure, and cardiac index. Results:
After 16 weeks, the mean differences in change from baseline between the
groups were as follows: total pulmonary resistance 299 dynes . s . cm-5 (P
= .004), 6-minute walk distance 33 m (P = .014), mean pulmonary artery
pressure 11 mm Hg (P = .005), and cardiac index 0.3 L . min-1 . m-2 (P =
.08). Treatment with bosentan was safe. After pulmonary endarterectomy, 4
patients died (no-bosentan group: n = 3); the short-term in-hospital
postoperative clinical course was similar in both groups of patients.
Conclusions: Patients with proximal chronic thromboembolic pulmonary
hypertension may benefit hemodynamically and clinically from treatment
with bosentan before pulmonary endarterectomy. Individual factors
predictive of a beneficial response and whether this influences either
morbidity or mortality associated with pulmonary endarterectomy remain to
be established. copyright 2010 The American Association for Thoracic
Surgery.
<11>
Accession Number
0019950738
Authors
Mahoori A. Heshmati F. Noroozinia H. Mehdizadeh H. Salehi S. Rohani M.
Institution
(Mahoori, Heshmati, Noroozinia, Rohani) Division of Cardiovascular
Anesthesia, Urmia University of Medical Sciences, Urmia, Iran, Islamic
Republic of.
(Mehdizadeh, Salehi) Division of Cardiac Surgery, Urmia University of
Medical Sciences, Urmia, Iran, Islamic Republic of.
Title
Intraoperative minimal acute normovolemic hemodilution in patients
undergoing coronary artery bypass surgery.
Source
Middle East Journal of Anesthesiology. 20(3)(pp 423-430), 2009. Date of
Publication: October 2009.
Publisher
American University of Beirut
Abstract
Background & Objective: Efficacy of minimal acute normovolemic
hemodilution (ANH) in avoiding homologous blood transfusion during
cardiovascular surgery remains controversial. Postoperative bleeding and
transfusion remain a source of morbidity and cost after open heart
operations. Our objective was to evaluate the impact of minimal ANH on
blood transfusion requirements during open cardiovascular surgery using
cardiopulmonary bypass (CPB). Methods: This study was a randomized
controlled trial. One hundred one patients scheduled for elective coronary
artery bypass graft (CABG) under cardiopulmonary bypass in October 2007
through March 2008 in Imam Khomeini hospital were randomly assigned to a
control group (standard care, no = 47) or an ANH or study group (no = 54).
We used minimal ANH (representing 10% of patients' blood volume). Mean
490+/-50 mL of fresh autologous blood was removed after induction of
anesthesia and reinfused at the end of CPB. The blood transfusion
guidelines were uniformly applied to all patients. Results: Significant
decrease in the number of red blood cell units (1.39 +/- 1.0 and
2.551.9+/- units; p < 0.0001) in the ANH group versus the control group
was observed. Conversely, chest tube output, postoperative hematocrits,
and platelet count did not differ between two groups. Percentage of
patients in whom allogeneic red blood cells were transfused was 44% in
study group versus 76% in control group; (p < 0.01). No patient was
transfused with platelet concentrates or fresh frozen plasma. Conclusions:
Minimal ANH is safe and cost effective and its routine use in eligible
patients is therefore justified. Intraoperative autologous blood donation
in CABG surgery decreased perioperative allogeneic blood requirement.
However, the removal and reinfusion of about one unit autologous blood had
no effect on postoperative bleeding or platelet count.
<12>
Accession Number
0019950733
Authors
Schwarzkopf K. Hueter L. Schreiber T. Preussler N.-P. Loeb V. Karzai W.
Institution
(Schwarzkopf, Loeb) Department of Anesthesiology, Intensive Care Medicine,
Klinikum Saarbruecken, Germany.
(Hueter, Preussler) Department of Anesthesiology, Intensive Care Medicine,
University of Jena, Germany.
(Schreiber, Karzai) Department of Anesthesiology, Intensive Care Medicine,
Zentralklinik Bad Berka, Germany.
Title
Oxygenation during one-lung ventilation with propofol or sevoflurane.
Source
Middle East Journal of Anesthesiology. 20(3)(pp 397-400), 2009. Date of
Publication: October 2009.
Publisher
American University of Beirut
Abstract
60 patients, ASA I-III, underwent one-lung ventilation for open or
video-assisted thoracic surgery randomized either with intravenous
anesthesia with propofol or with inhalational anesthesia with 1 MAC
sevoflurane. Propofol was titrated during one-lung ventilation to achieve
a mean arterial pressure of 75-80 mmHg. Blood gas analyses, hemodynamic
and respiratory parameters were measured during two-lung ventilation at
the beginning of the surgical procedure and 10 min, 20 min and 30 min
after start of one-lung ventilation. At all time points, hemodynamic and
respiratory parameters were comparable in both groups. Oxygenation did not
differ between groups at comparable mean arterial blood pressures.
<13>
Accession Number
0019899321
Authors
Fakhari S. Bilehjani E. Azarfarin R. Kianfar A.A. Mirinazhad M. Negargar
S.
Institution
(Fakhari) Madani Heart Hospital, Tabriz University of Medical Sciences,
Tabriz, Iran, Islamic Republic of.
(Bilehjani, Azarfarin, Kianfar, Mirinazhad, Negargar) Department of
Anesthesiology, Madani Heart Hospital, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of.
Title
Anesthesia in adult cardiac surgery without maintenance of muscle
relaxants: A randomized clinical trial.
Source
Pakistan Journal of Biological Sciences. 12(16)(pp 1111-1118), 2009. Date
of Publication: 2009.
Publisher
Asian Network for Scientific Information
Abstract
There may be no need for muscle paralysis during cardiac surgery when
adequate anesthesia is provided. We studied intra- and post-operative
conditions during cardiac surgery without maintenance muscle relaxant
therapy. Eighty adult patients who were candidates for elective coronary
artery bypass graft surgery were randomly allocated into two groups. In
the noMR or study group (noMR group; n = 40) only an intubation dose of
cisatracurium (0.15 mg kg-1) was administrated, as opposed to the control
group (MR group; n = 40), who had a continuous infusion added to the
intubation dose. The anesthesia level was maintained at a Bispectral score
of 40-50 using a propofol infusion. A remifentanil infusion was titrated
to control patient hemodynamic response. During surgery, any minor (fine
body or respiratory muscle movements) or major (coarse body movements or
bucking/caught) movements were recorded. Postoperatively, analgesia was
provided by remifentanil. The surgical condition was classified into three
states: good (no movement), acceptable (minor movements), or poor (major
movements). Anesthesia, surgery and postoperative characteristics were
compared between the two groups. Statistical analysis was performed in
only 78 patients (noMR= 38, MR = 40). The demographic and preoperative
characteristics of the two groups were comparable. Intra-operative
propofol consumption was the same, but significantly more remifentanil was
used in the noMR group (p = 0.001). Post-operative characteristics and
complication rates did not differ between the two groups. There were no
movements in the MR group patients, while in the noMR group one patient
had major movement and three had minor movements. We concluded that
omitting maintenance muscle relaxants in adult cardiac surgery or
eliminating residual muscle paralysis at the end of the surgery without
improving early outcome can increase patient intra-operative movement
risk. copyright 2009 Asian Network for Scientific Information.
<14>
Accession Number
0019770798
Authors
Booth J.H. Quinn T.A. Richmond M.E. Cabreriza S.E. Weinberg A.D. Johnston
T. Spotnitz H.M.
Institution
(Booth, Quinn, Richmond, Cabreriza, Weinberg, Johnston, Spotnitz)
Department of Surgery, Columbia University, New York, NY 10032, USA.
Title
Cardiac output measurement by arterial pressure waveform analysis during
optimization of biventricular pacing after cardiac surgery..
Source
ASAIO journal (American Society for Artificial Internal Organs : 1992).
55(6)(pp 587-591), 2009. Date of Publication: 2009 Nov-Dec.
Abstract
Biventricular pacing (BiVP) can optimize cardiac output (CO) in patients
after cardiac surgery, so devices that calculate continuous CO from
arterial pressure may be a useful tool. We investigated PulseCO for
measuring CO during optimization by comparison with aortic flow probe
measurement. Seven patients in the Biventricular Pacing After Cardiac
Surgery (BiPACS) trial were studied. Before weaning from cardiopulmonary
bypass, BiVP was initiated. After bypass, CO was optimized by varying
atrioventricular pacing delay, ventricular site, and interventricular
pacing delay with a randomized protocol. Continuous CO was measured by
PulseCO and aortic flow probe. Reliability was estimated by Fleiss method
and agreement assessed by Bland-Altman analysis. Compared with flow probe,
PulseCO reliably measured changes in CO (intraclass correlation
coefficient = 0.90) but underestimated the change (-4% + or - 17%). In
contrast, changes in mean arterial pressure did not reflect changes in CO
(intraclass correlation coefficient = 0.02). Thus, PulseCO can measure
continuous CO in open-chest patients after cardiac surgery, whereas
underestimating changes occurring across 10-second pacemaker changes.
Further studies in the closed chest are indicated.
<15>
[Use Link to view the full text]
Accession Number
0019920002
Authors
Hlatky M.A. Boothroyd D.B. Melsop K.A. Kennedy L. Rihal C. Rogers W.J.
Venkitachalam L. Brooks M.M.
Institution
(Hlatky, Boothroyd, Melsop, Kennedy, Rihal, Rogers, Venkitachalam, Brooks)
Stanford University School of Medicine, Stanford, CA 94305-5405, USA.
Title
Economic outcomes of treatment strategies for type 2 diabetes mellitus and
coronary artery disease in the Bypass Angioplasty Revascularization
Investigation 2 Diabetes trial..
Source
Circulation. 120(25)(pp 2550-2558), 2009. Date of Publication: 22 Dec
2009.
Abstract
BACKGROUND: The economic outcomes of clinical management strategies are
important in assessing their value to patients. METHODS AND RESULTS:
Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D)
randomized patients with type 2 diabetes mellitus and angiographically
documented, stable coronary disease to strategies of (1) prompt
revascularization versus medical therapy with delayed revascularization as
needed to relieve symptoms and (2) insulin sensitization versus insulin
provision. Before randomization, the physician declared whether coronary
artery bypass grafting or percutaneous coronary intervention would be used
if the patient were assigned to revascularization. We followed 2005
patients for medical utilization and costs and assessed the
cost-effectiveness of these management strategies. Medical costs were
higher for revascularization than medical therapy, with a significant
interaction with the intended method of revascularization (P<0.0001). In
the coronary artery bypass grafting stratum, 4-year costs were $80 900 for
revascularization versus $60 600 for medical therapy (P<0.0001). In the
percutaneous coronary intervention stratum, costs were $73 400 for
revascularization versus $67 800 for medical therapy (P<0.02). Costs also
were higher for insulin sensitization ($71 300) versus insulin provision
($70 200). Other factors that significantly (P<0.05) and independently
increased cost included insulin use and dose at baseline, female sex,
white race, body mass index > or =30, and albuminuria. Cost-effectiveness
based on 4-year data favored the strategy of medical therapy over prompt
revascularization and the strategy of insulin provision over insulin
sensitization. Lifetime projections of cost-effectiveness showed that
medical therapy was cost-effective compared with revascularization in the
percutaneous coronary intervention stratum ($600 per life-year added) with
high confidence. Lifetime projections suggest that revascularization may
be cost-effective in the coronary artery bypass grafting stratum ($47 000
per life-year added) but with lower confidence. CONCLUSIONS: Prompt
coronary revascularization significantly increases costs among patients
with type 2 diabetes mellitus and stable coronary disease. The strategy of
medical therapy (with delayed revascularization as needed) appears to be
cost-effective compared with the strategy of prompt coronary
revascularization among patients identified a priori as suitable for
percutaneous coronary intervention.
<16>
[Use Link to view the full text]
Accession Number
0019920001
Authors
Chaitman B.R. Hardison R.M. Adler D. Gebhart S. Grogan M. Ocampo S. Sopko
G. Ramires J.A. Schneider D. Frye R.L.
Institution
(Chaitman, Hardison, Adler, Gebhart, Grogan, Ocampo, Sopko, Ramires,
Schneider, Frye) St Louis University School of Medicine, 1034 S Brentwood
Blvd., St Louis, MO 63117, USA.
Title
The Bypass Angioplasty Revascularization Investigation 2 Diabetes
randomized trial of different treatment strategies in type 2 diabetes
mellitus with stable ischemic heart disease: impact of treatment strategy
on cardiac mortality and myocardial infarction..
Source
Circulation. 120(25)(pp 2529-2540), 2009. Date of Publication: 22 Dec
2009.
Abstract
BACKGROUND: The Bypass Angioplasty Revascularization Investigation 2
Diabetes (BARI 2D) trial in 2368 patients with stable ischemic heart
disease assigned before randomization to percutaneous coronary
intervention or coronary artery bypass grafting strata reported similar
5-year all-cause mortality rates with insulin sensitization versus insulin
provision therapy and with a strategy of prompt initial coronary
revascularization and intensive medical therapy or intensive medical
therapy alone with revascularization reserved for clinical indication(s).
In this report, we examine the predefined secondary end points of cardiac
death and myocardial infarction (MI). METHODS AND RESULTS: Outcome data
were analyzed by intention to treat; the Kaplan-Meier method was used to
assess 5-year event rates. Nominal P values are presented. During an
average 5.3-year follow-up, there were 316 deaths (43% were attributed to
cardiac causes) and 279 first MI events. Five-year cardiac mortality did
not differ between revascularization plus intensive medical therapy (5.9%)
and intensive medical therapy alone groups (5.7%; P=0.38) or between
insulin sensitization (5.7%) and insulin provision therapy (6%; P=0.76).
In the coronary artery bypass grafting stratum (n=763), MI events were
significantly less frequent in revascularization plus intensive medical
therapy versus intensive medical therapy alone groups (10.0% versus 17.6%;
P=0.003), and the composite end points of all-cause death or MI (21.1%
versus 29.2%; P=0.010) and cardiac death or MI (P=0.03) were also less
frequent. Reduction in MI (P=0.001) and cardiac death/MI (P=0.002) was
significant only in the insulin sensitization group. CONCLUSIONS: In many
patients with type 2 diabetes mellitus and stable ischemic coronary
disease in whom angina symptoms are controlled, similar to those enrolled
in the percutaneous coronary intervention stratum, intensive medical
therapy alone should be the first-line strategy. In patients with more
extensive coronary disease, similar to those enrolled in the coronary
artery bypass grafting stratum, prompt coronary artery bypass grafting, in
the absence of contraindications, intensive medical therapy, and an
insulin sensitization strategy appears to be a preferred therapeutic
strategy to reduce the incidence of MI.
<17>
[Use Link to view the full text]
Accession Number
0019948506
Authors
Kowey P.R. Dorian P. Mitchell L.B. Pratt C.M. Roy D. Schwartz P.J.
Sadowski J. Sobczyk D. Bochenek A. Toft E.
Institution
(Kowey, Dorian, Mitchell, Pratt, Roy, Schwartz, Sadowski, Sobczyk,
Bochenek, Toft) Division of Cardiovascular Disease, Lankenau Hospital and
Institute of Medical Research, Wynnewood, PA 19096, USA.
Title
Vernakalant hydrochloride for the rapid conversion of atrial fibrillation
after cardiac surgery: a randomized, double-blind, placebo-controlled
trial..
Source
Circulation. Arrhythmia and electrophysiology. 2(6)(pp 652-659), 2009.
Date of Publication: Dec 2009.
Abstract
BACKGROUND: Postoperative atrial arrhythmias are common and are associated
with considerable morbidity. This study was designed to evaluate the
efficacy and safety of vernakalant for the conversion of atrial
fibrillation (AF) or atrial flutter (AFL) after cardiac surgery. METHODS
AND RESULTS: This was a prospective, randomized, double-blind,
placebo-controlled trial of vernakalant for the conversion of AF or AFL
after coronary artery bypass graft, valvular surgery, or both. Patients
were randomly assigned 2:1 to receive a 10-minute infusion of 3 mg/kg
vernakalant or placebo. If AF or AFL was present after a 15-minute
observation period, then a second 10-minute infusion of 2 mg/kg
vernakalant or placebo was given. The primary end point was the conversion
of postcardiac surgery AF or AFL to sinus rhythm within 90 minutes of
dosing. In patients with AF, 47 of 100 (47%) who received vernakalant
converted to SR compared with 7 of 50 (14%) patients who received placebo
(P<0.001). The median time to conversion was 12 minutes. Vernakalant was
not effective in converting postoperative AFL to sinus rhythm. Two serious
adverse events occurred within 24 hours of vernakalant administration
(hypotension and complete atrioventricular block). There were no cases of
torsades de pointes, sustained ventricular tachycardia, or ventricular
fibrillation. There were no deaths. CONCLUSIONS: Vernakalant was safe and
effective in the rapid conversion of AF to sinus rhythm in patients who
had AF after cardiac surgery. CLINICAL TRIAL REGISTRATION:
clinicaltrials.gov. Identifier: NCT00125320.
<18>
Accession Number
0019930626
Authors
Urwyler N. Trelle S. Theiler L. Juni P. Staub L.P. Luyet C. Alberio L.
Stricker K. Greif R.
Institution
(Urwyler, Trelle, Theiler, Juni, Staub, Luyet, Alberio, Stricker, Greif)
University Department of Anesthesiology and Pain Therapy, University
Hospital of Bern, Inselspital, 3010 Bern, Switzerland.
Title
Does point of care prothrombin time measurement reduce the transfusion of
fresh frozen plasma in patients undergoing major surgery? The POC-OP
randomized-controlled trial..
Source
Trials. 10(pp 107), 2009. Date of Publication: 2009.
Abstract
BACKGROUND: Bleeding is a frequent complication during surgery. The
intraoperative administration of blood products, including packed red
blood cells, platelets and fresh frozen plasma (FFP), is often live
saving. Complications of blood transfusions contribute considerably to
perioperative costs and blood product resources are limited. Consequently,
strategies to optimize the decision to transfuse are needed. Bleeding
during surgery is a dynamic process and may result in major blood loss and
coagulopathy due to dilution and consumption. The indication for
transfusion should be based on reliable coagulation studies. While
hemoglobin levels and platelet counts are available within 15 minutes,
standard coagulation studies require one hour. Therefore, the decision to
administer FFP has to be made in the absence of any data. Point of care
testing of prothrombin time ensures that one major parameter of
coagulation is available in the operation theatre within minutes. It is
fast, easy to perform, inexpensive and may enable physicians to rationally
determine the need for FFP. METHODS/DESIGN: The objective of the POC-OP
trial is to determine the effectiveness of point of care prothrombin time
testing to reduce the administration of FFP. It is a patient and assessor
blind, single center randomized controlled parallel group trial in 220
patients aged between 18 and 90 years undergoing major surgery (any type,
except cardiac surgery and liver transplantation) with an estimated blood
loss during surgery exceeding 20% of the calculated total blood volume or
a requirement of FFP according to the judgment of the physicians in
charge. Patients are randomized to usual care plus point of care
prothrombin time testing or usual care alone without point of care
testing. The primary outcome is the relative risk to receive any FFP
perioperatively. The inclusion of 110 patients per group will yield more
than 80% power to detect a clinically relevant relative risk of 0.60 to
receive FFP of the experimental as compared with the control group.
DISCUSSION: Point of care prothrombin time testing in the operation
theatre may reduce the administration of FFP considerably, which in turn
may decrease costs and complications usually associated with the
administration of blood products. TRIAL REGISTRATION: NCT00656396.
<19>
Accession Number
0019742431
Authors
Wong C.K. White H.D.
Institution
(Wong, White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand.
Title
Cardiogenic shock from left ventricular dysfunction complicating an acute
ST-elevation myocardial infarction..
Source
The American heart hospital journal. 7(1)(pp 33-38), 2009. Date of
Publication: 2009 Summer.
Abstract
Cardiogenic shock from left ventricular dysfunction complicating an acute
ST-elevation myocardial infarction is associated with high mortality. Much
of the current understanding of the importance of emergency
revascularization comes from the SHOCK trial. Mortality benefits combined
with improved quality of life among the survivors justify the routine use
of emergency revascularization in patients <75 years of age and in
selected patients >or=75 years of age. This article discusses the SHOCK
trial and potential mechanisms of benefit from revascularization as well
as more recent information. Adjunctive therapies have been disappointing.
To further improve outcomes, earlier pre-emptive and preventive strategies
to ensure early revascularization should be pursued.
<20>
[Use Link to view the full text]
Accession Number
2009656224
Authors
St. John Sutton M. Ghio S. Plappert T. Tavazzi L. Scelsi L. Daubert C.
Abraham W.T. Gold M.R. Hassager C. Herre J.M. Linde C.
Institution
(St. John Sutton, Plappert) University of Pennsylvania Medical Center,
3400 Spruce St, 9018 Gates Pavilion, Philadelphia, PA 19104, United
States.
(Ghio, Scelsi) Policlinico San Matteo, Pavia, Italy.
(Tavazzi) GVM Hospitals of Care and Research, Cotignola, Italy.
(Daubert) Departement de Cardiologie, Centre Hospitalier Universitaire,
Rennes, France.
(Abraham) Division of Cardiovascular Medicine, Davis Heart and Lung
Research Institute, Ohio State University, Columbus, OH, United States.
(Gold) Division of Cardiology, Medical University of South Carolina,
Charleston, SC, United States.
(Hassager) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark.
(Herre) Sentara Norfolk General Hospital, Norfolk, VA, United States.
(Linde) Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden.
Title
Cardiac resynchronization induces major structural and functional reverse
remodeling in patients with New York heart association class I/II heart
failure.
Source
Circulation. 120(19)(pp 1858-1865), 2009. Date of Publication: November
2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-: Cardiac resynchronization therapy (CRT) improves LV
structure, function, and clinical outcomes in New York Heart Association
class III/IV heart failure with prolonged QRS. It is not known whether
patients with New York Heart Association class I/II systolic heart failure
exhibit left ventricular (LV) reverse remodeling with CRT or whether
reverse remodeling is modified by the cause of heart failure. Methods and
Results-: Six hundred ten patients with New York Heart Association class
I/II heart failure, QRS duration [greater-than or equal to]120 ms, LV
end-diastolic dimension [greater-than or equal to]55 mm, and LV ejection
fraction [less-than or equal to]40% were randomized to active therapy (CRT
on; n=419) or control (CRT off; n=191) for 12 months. Doppler
echocardiograms were recorded at baseline, before hospital discharge, and
at 6 and 12 months. When CRT was turned on initially, immediate changes
occurred in LV volumes and ejection fraction; however, these changes did
not correlate with the long-term changes (12 months) in LV end-systolic
(r=0.11, P=0.31) or end-diastolic (r=0.10, P=0.38) volume indexes or LV
ejection fraction (r=0.07, P=0.72). LV end-diastolic and end-systolic
volume indexes decreased in patients with CRT turned on (both P<0.001
compared with CRT off), whereas LV ejection fraction in CRT-on patients
increased (P<0.0001 compared with CRT off) from baseline through 12
months. LV mass, mitral regurgitation, and LV diastolic function did not
change in either group by 12 months; however, there was a 3-fold greater
reduction in LV end-diastolic and end-systolic volume indexes and a 3-fold
greater increase in LV ejection fraction in patients with nonischemic
causes of heart failure. Conclusions-: CRT in patients with New York Heart
Association I/II resulted in major structural and functional reverse
remodeling at 1 year, with the greatest changes occurring in patients with
a nonischemic cause of heart failure. CRT may interrupt the natural
disease progression in these patients. Clinical Trial Registration-:
Clinicaltrials.gov Identifier: NCT00271154. copyright 2009 American Heart
Association, Inc.
<21>
[Use Link to view the full text]
Accession Number
2009656218
Authors
Baker W.L. White C.M. Coleman C.I.
Institution
(Baker, White, Coleman) University of Connecticut Schools of Pharmacy,
Hartford Hospital Evidence-Based Practice Center, Hartford, CT, United
States.
Title
Letter by baker et al regarding article, benefits and risks of
corticosteroid prophylaxis in adult cardiac surgery: A dose-response
meta-analysis.
Source
Circulation. 120(20)(pp e163), 2009. Date of Publication: November 2009.
Publisher
Lippincott Williams and Wilkins
<22>
[Use Link to view the full text]
Accession Number
2009656211
Authors
Rodes-Cabau J. Bertrand O.F. Larose E. Dery J.-P. Rinfret S. Bagur R.
Proulx G. Nguyen C.M. Cote M. Landcop M.-C. Boudreault J.-R. Rouleau J.
Roy L. Gleeton O. Barbeau G. Noel B. Courtis J. Dagenais G.R. Despres
J.-P. Delarochelliere R.
Institution
(Rodes-Cabau, Bertrand, Larose, Dery, Rinfret, Bagur, Proulx, Nguyen,
Cote, Landcop, Boudreault, Rouleau, Roy, Gleeton, Barbeau, Noel, Courtis,
Dagenais, Despres, Delarochelliere) Institut Universitaire de Cardiologie
et de Pneumologie de Quebec, 2725, Chemin Sainte-Foy, QC G1V 4G5, Canada.
Title
Comparison of plaque sealing with paclitaxel-eluting stents versus medical
therapy for the treatment of moderate nonsignificant saphenous vein graft
lesions: The moderate vein graft lesion stenting with the taxus stent and
intravascular ultrasound (VELETI) pilot trial.
Source
Circulation. 120(20)(pp 1978-1986), 2009. Date of Publication: November
2009.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND-: The presence of moderate saphenous vein graft (SVG) lesions
is a major predictor of cardiac events late after coronary artery bypass
grafting. We determined the effects of sealing moderate nonsignificant SVG
lesions with paclitaxel-eluting stents (PES) on the prevention of SVG
atherosclerosis progression. METHODS AND RESULTS-: Patients with at least
1 moderate SVG lesion (30% to 60% diameter stenosis) were randomized
either to stenting the moderate SVG lesion with a PES (n=30, PES group) or
to medical treatment alone (n=27, medical treatment group). Patients had
an angiographic and intravascular ultrasound evaluation of the SVG at
baseline and at 12-month follow-up. The primary end points were (1) the
ultrasound SVG minimal lumen area at follow-up and (2) the changes in
ultrasound atheroma volume in an angiographically nondiseased SVG segment.
Mean time from coronary artery bypass grafting was 12+/-6 years, and mean
low-density lipoprotein cholesterol level was 73+/-31 mg/dL. A total of 70
moderate SVG lesions (39+/-7% diameter stenosis) were evaluated.
Significant disease progression occurred in the medical treatment group at
the level of the moderate SVG lesion (decrease in minimal lumen area from
6.3+/-3.0 to 5.6+/-3.1 mm; P<0.001), leading to a severe flow-limiting
lesion or SVG occlusion in 22% of the patients compared with none in the
PES group (P=0.014). In the PES group, mean minimal lumen area increased
(P<0.001) from 6.1+/-2.2 to 8.6+/-2.9 mm at follow-up (P=0.001 compared
with the medical treatment group at 12 months). There were no cases of
restenosis or stent thrombosis. No significant atherosclerosis progression
occurred at the nonstented SVG segments. At 12-month follow-up, the
cumulative incidence of major adverse cardiac events related to the target
SVG was 19% in the medical treatment group versus 3% in the PES group
(P=0.091). CONCLUSIONS-: Stenting moderate nonsignificant lesions in old
SVGs with PES was associated with a lower rate of SVG disease progression
and a trend toward a lower incidence of major adverse cardiac events at
1-year follow-up compared with medical treatment alone, despite very low
low-density lipoprotein cholesterol values. This pilot study supports
further investigation into the role of plaque sealing in SVGs. copyright
2009 American Heart Association, Inc.
<23>
Accession Number
0019534641
Authors
Elahi M.M. Worner M. Khan J.S. Matata B.M.
Institution
(Elahi, Worner, Khan, Matata) Department of Cardiothoracic Surgery, Punjab
Institute of Cardiology, Lahore, Pakistan.
Title
Inspired nitric oxide and modulation of oxidative stress during cardiac
surgery..
Source
Current drug safety. 4(3)(pp 188-198), 2009. Date of Publication: Sep
2009.
Abstract
Evidence in the literature is contradictory regarding the precise role of
nitric oxide (NO) in modulating systemic inflammatory response induced by
cardiopulmonary bypass (CPB). We studied the impact of inspired NO gas on
physiological function and markers of inflammation-oxidative stress for
subjects (n=15, age 62+/-4.5 and 12/3 M/F) scheduled for coronary artery
bypass graft (CABG) operation. Outcomes from subjects that received 5 ppm
and 20 ppm of inspired NO (n=5/group) were compared to those not given NO
gas. Breath-to-breath measurement commenced at the start of intubation and
continued up to 4h later. Indices of cardiovascular function,
alveolar-capillary gas exchange and haematological parameters were not
significantly different in outcomes for the inspired NO groups as compared
with control. We observed a reduction in mean systemic arterial in all
subjects at 30 min and 4h after bypass when compared with pre bypass
values. Markers of systemic inflammatory response and oxidative stress
increased during CPB particularly at 4h and 24h after the initiation of
bypass. In contrast, we observed a reduction in expired NO, at 24h after
surgery in the groups given inspired NO. In addition, there was also a
significant reduction in oxidative stress markers in blood at 24h after
surgery for the groups given inspired NO as compared with the control
group. In contrast, cytokines response remained similar in all the three
groups at all time points. The results suggested that inspired NO gas has
an antioxidant property that reduces the levels of cell death, and is not
associated with significantly worse-off physiological outcomes.
