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<1>
Accession Number
0019833593
Authors
Solak O. Emmiler M. Ela Y. Dundar U. Kocoiullari C.U. Eren N. Gokce I.Y.
Cekirdekci A. Kavuncu V.
Institution
(Solak, Emmiler, Ela, Dundar, Kocoiullari, Eren, Gokce, Cekirdekci,
Kavuncu) Department of Physical Medicine and Rehabilitation, Afyon
Kocatepe University, School of Medicine, Afyonkarahisar, Turkey.
Title
Comparison of continuous and intermittent transcutaneous electrical nerve
stimulation in postoperative pain management after coronary artery bypass
grafting: a randomized, placebo-controlled prospective study..
Source
The heart surgery forum. 12(5)(pp E266-271), 2009. Date of Publication:
Oct 2009.
Abstract
OBJECTIVE: We compared the effectiveness of continuous transcutaneous
electrical nerve stimulation (TENS) and intermittent TENS in the
management of pain after coronary artery bypass grafting (CABG). METHODS:
We randomized 100 patients who had undergone median sternotomy for CABG
into 4 groups with 25 patients each: (1) continuous TENS (CTENS) and
pharmacologic analgesia, (2) intermittent TENS (ITENS) and pharmacologic
analgesia, (3) placebo TENS (PTENS) and pharmacologic analgesia, and (4)
pharmacologic analgesia alone (control). We studied these groups with
regard to the relief of postoperative pain during the first 24 hours. For
each patient we recorded the following: demographic characteristics; vital
signs; intensity of pain with a visual analogue scale (VAS) before
treatment (VAS(0)), at the 12th hour (VAS(12)), and at the 24th hour
(VAS(24)); and analgesic intake. RESULTS: The groups were comparable with
respect to age, sex, and body mass index at baseline. Mean VAS scores
decreased within each group; however, the mean VAS(12) and VAS(24) scores
decreased significantly in the CTENS and ITENS groups, compared with PTENS
and control groups (P < .05). We found no significant difference between
the CTENS and ITENS groups with respect to decreasing VAS(12) and VAS(24)
scores (P > .05). Narcotic intake was significantly less in the CTENS and
ITENS groups than in the control and PTENS groups (P < .01). Furthermore,
narcotic requirements were significantly lower in the CTENS group than in
the ITENS group (P < .01). CONCLUSIONS: CTENS and ITENS after median
sternotomy for CABG decreased pain and reduced narcotic requirements more
than in the PTENS and control treatments during first postoperative 24
hours. Neither CTENS nor ITENS is superior to the other in decreasing
pain; however, CTENS leads to a greater reduction in the narcotic
requirement than ITENS.
<2>
Accession Number
0019833592
Authors
Ela Y. Emmiler M. Kocogullari C.U. Terzi Y. Sivaci R.G. Cekirdekci A.
Institution
(Ela, Emmiler, Kocogullari, Terzi, Sivaci, Cekirdekci) Department of
Anesthesiology, Kocatepe University, Afyonkarahisar, Turkey.
Title
Advantages of autologous blood transfusion in off-pump coronary artery
bypass..
Source
The heart surgery forum. 12(5)(pp E261-265), 2009. Date of Publication:
Oct 2009.
Abstract
BACKGROUND: In this randomized controlled study, we investigated the
effects of autologous Hemobag blood transfusion (AHBT) and allogenic blood
transfusion (ABT) in off-pump coronary artery bypass (OPCAB) surgery.
METHODS: Sixty patients who underwent surgery between February 2008 and
August 2008 were randomized into 2 groups. The AHBT group (n = 30)
consisted of patients who received autologous Hemobag blood transfusion,
and the ABT group (n = 30) consisted of patients who received allogenic
blood transfusion. All patients underwent OPCAB via sternotomy. The time
to extubation, chest tube drainage volume, postoperative white blood cell
counts, amount of blood transfusion, sedimentation rate, C-reactive
protein concentration, postoperative temperature, and the presence of
atelectasis were recorded in the intensive care unit. RESULTS:
Intraoperative bleeding and fluid resuscitation were similar in the 2
groups (P > .05); however, there were significant decreases in
postoperative blood loss, extubation period, postoperative white cell
counts, sedimentation rate, incidence of atelectasis, C-reactive protein,
and fever in the AHBT group compared with the ABT group (P < .05). The
rate of atrial fibrillation in the AHBT group tended to be lower than in
the ABT group. CONCLUSION: Autologous blood transfusion in OPCAB may be
beneficial in certain cardiac surgery patients; however, these beneficial
effects require further study to be proved.
<3>
Accession Number
0019833591
Authors
Yakut N. Tulukoglu E. Emrecan B. Bayrak S. Yilik L. Goktogan T. Gurbuz A.
Institution
(Yakut, Tulukoglu, Emrecan, Bayrak, Yilik, Goktogan, Gurbuz) Department of
Cardiovascular Surgery, Gazi Hospital, Izmir.
Title
Which is first: left anterior descending artery anastomosis or right
coronary artery anastomosis in off-pump coronary artery bypass grafting?.
Source
The heart surgery forum. 12(5)(pp E256-260), 2009. Date of Publication:
Oct 2009.
Abstract
OBJECTIVES: The sequence of the distal anastomosis for revascularization
in off-pump coronary artery bypass grafting (OPCABG) surgery is under
debate. The hypothesis in this study was that an analysis of cardiac
markers would reveal that anastomosing the left anterior descending
coronary artery (LAD) before the right coronary artery (RCA) would
decrease myocardial damage in OPCABG surgery for 2-vessel disease.
METHODS: Forty patients with stable angina who underwent OPCABG surgery
and who had LAD and RCA lesions were randomized into 2 groups of 20
patients each. The LAD was revascularized first in group 1, and the RCA
was revascularized first in group 2. Cardiac troponin I, creatine kinase
(CK), and CK myocardial band (CK-MB) were measured in the 2 groups before
surgery and at 8, 24, and 48 hours after surgery. RESULTS: No mortality
occurred in the 2 groups. The groups were similar with respect to sex,
age, durations of anastomosis of the left internal thoracic artery to the
LAD and of the saphenous vein graft to the RCA, and preoperative CK,
CK-MB, and troponin I levels. Postoperative CK-MB levels were
significantly higher in group 2 in the eighth and 24th postoperative hours
than in group 1 (P = .009 and .041, respectively). Similarly, troponin I
levels were significantly higher in group 2 in the eighth, 24th, and 48th
hours than in group 1 (P = .003, .003, and .006, respectively).
CONCLUSIONS: Anastomosis to the LAD first in OPCABG surgery led to a
slight reduction in myocardial enzyme release against the occlusion of the
target vessels during anastomoses in patients with RCA and LAD stenoses.
<4>
Accession Number
0019821351
Authors
Nigwekar S.U. Navaneethan S.D. Parikh C.R. Hix J.K.
Institution
(Nigwekar, Navaneethan, Parikh, Hix) Rochester General Hospital,
University of Rochester School of Medicine and Dentistry, 1425 Portland
Ave, Rochester, NY, USA, 14621.
Title
Atrial natriuretic peptide for preventing and treating acute kidney
injury..
Source
Cochrane database of systematic reviews (Online). (4)(pp CD006028), 2009.
Date of Publication: 2009.
Abstract
BACKGROUND: Acute kidney injury (AKI) is common in hospitalised patients
and is associated with significant morbidity and mortality. Despite recent
advances, outcomes have not substantially changed in the last four
decades. Atrial natriuretic peptide (ANP) has shown promise in animal
studies, however randomised controlled trials (RCTs) have shown
inconsistent clinical benefits. OBJECTIVES: To assess the benefits and
harms of ANP for preventing and treating AKI. SEARCH STRATEGY: We searched
CENTRAL, MEDLINE and EMBASE and reference lists of retrieved articles.
SELECTION CRITERIA: RCTs that investigated all forms of ANP versus any
other treatment in adult hospitalised patients with or "at risk" of AKI.
DATA COLLECTION AND ANALYSIS: Results were expressed as risk ratios (RR)
with 95% confidence intervals (CI) or mean difference (MD). Outcomes were
analysed separately for low and high dose ANP for preventing or treating
AKI. MAIN RESULTS: Nineteen studies (11 prevention, 8 treatment; 1,861
participants) were included. There was no difference in mortality between
ANP and control in either the low or high dose prevention studies. Low
(but not high) dose ANP was associated with a reduced need for RRT in the
prevention studies (RR 0.32, 95% CI 0.14 to 0.71). Length of hospital and
ICU stay were significantly shorter in the low dose ANP group. For
established AKI, there was no difference in mortality with either low or
high dose ANP. Low (but not high) dose ANP was associated with a reduction
in the need for RRT (RR 0.54, 95% CI 0.30 to 0.98). High dose ANP was
associated with more adverse events (hypotension, arrhythmias). After
major surgery there was a significant reduction in RRT requirement with
ANP in the prevention studies (RR 0.56, 95% CI 0.32 to 0.99), but not in
the treatment studies. There was no difference in mortality between ANP
and control in either the prevention or treatment studies. There was a
reduced need for RRT with low dose ANP in patients undergoing
cardiovascular surgery (RR 0.35, 95% CI 0.18 to 0.70). ANP was not
associated with outcome improvement in either radiocontrast nephropathy or
oliguric AKI. AUTHORS' CONCLUSIONS: ANP may be associated with improved
outcomes when used in low doses for preventing AKI and in managing
postsurgery AKI and should be further explored in these two settings.
There were no significant adverse events in the prevention studies,
however in the high dose ANP treatment studies there were significant
increases hypotension and arrhythmias.
<5>
Accession Number
0019821319
Authors
Wijeysundera D.N. Bender J.S. Beattie W.S.
Institution
(Wijeysundera, Bender, Beattie) Department of Anesthesia, Toronto General
Hospital and University of Toronto, EN 3-450, Toronto General Hospital,,
200 Elizabeth Street, Toronto, Ontario, Canada, M5G 2C4.
Title
Alpha-2 adrenergic agonists for the prevention of cardiac complications
among patients undergoing surgery..
Source
Cochrane database of systematic reviews (Online). (4)(pp CD004126), 2009.
Date of Publication: 2009.
Abstract
BACKGROUND: The surgical stress response plays an important role on the
pathogenesis of perioperative cardiac complications. Alpha-2 adrenergic
agonists attenuate this response and may thereby prevent cardiac
complications. OBJECTIVES: This review assessed the efficacy and safety of
preoperative (within 24 hours), intraoperative, and postoperative (first
48 hours) alpha-2 adrenergic agonists for preventing mortality and cardiac
complications after surgery performed under either general or neuraxial
anaesthesia, or both. SEARCH STRATEGY: We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue
3), MEDLINE (1950 to August week 4 2008), EMBASE (1980 to week 36 2008),
the Science Citation Index, and reference lists of articles. SELECTION
CRITERIA: We included randomized controlled trials that compared alpha-2
adrenergic agonists (clonidine, dexmedetomidine, or mivazerol) against
placebo or non-alpha-2 adrenergic agonists. Included studies had to report
on mortality, myocardial infarction, myocardial ischaemia, or
supraventricular tachyarrhythmia. DATA COLLECTION AND ANALYSIS: Three
authors independently assessed trial quality and extracted data. Two
authors independently performed computer entry of abstracted data. We
contacted study authors for additional information. Adverse event data
were gathered from the trials. MAIN RESULTS: We included 31 studies (4578
participants). Study quality was generally inadequate, with only six
studies clearly reporting methods for blinding and allocation concealment.
Overall, alpha-2 adrenergic agonists reduced mortality (relative risk (RR)
0.66; 95% CI 0.44 to 0.98; P = 0.04) and myocardial ischaemia (RR 0.68;
95% CI 0.57 to 0.81; P < 0.0001). However, their effects appeared to vary
with the surgical procedure. The most encouraging data pertained to
vascular surgery, where they reduced mortality (RR 0.47; 95% CI 0.25 to
0.90; P = 0.02), cardiac mortality (RR 0.36; 95% CI 0.16 to 0.79; P =
0.01), and myocardial infarction (RR 0.66; 95% CI 0.46 to 0.94; P = 0.02).
With regard to adverse effects, alpha-2 adrenergic agonists significantly
increased perioperative hypotension (RR 1.32; 95% CI 1.07 to 1.62; P =
0.009) and bradycardia (RR 1.66; 95% CI 1.14 to 2.41; P = 0.008). AUTHORS'
CONCLUSIONS: Our study provides encouraging evidence that alpha-2
adrenergic agonists may reduce cardiac risk, especially during vascular
surgery. Nonetheless, these data remain insufficient to make firm
conclusions about their efficacy and safety. A large randomized trial of
alpha-2 adrenergic agonists is therefore warranted. Additionally, future
research must determine which specific alpha-2 adrenergic agonist should
be used, and whether it is safe to combine them with other perioperative
interventions (for example beta-adrenergic blockade).
<6>
Accession Number
0019821289
Authors
Pedersen T. Moller A.M. Hovhannisyan K.
Institution
(Pedersen, Moller, Hovhannisyan) Head and Orthopaedic Center,
Rigshospitalet, HOC 2101, Rigshospitalet, University of
Copenhagen,Blegdamsvej 9, Copenhagen O, Denmark, DK-2100.
Title
Pulse oximetry for perioperative monitoring..
Source
Cochrane database of systematic reviews (Online). (4)(pp CD002013), 2009.
Date of Publication: 2009.
Abstract
BACKGROUND: Pulse oximetry is extensively used in the perioperative period
and might improve patient outcomes by enabling an early diagnosis and,
consequently, correction of perioperative events that might cause
postoperative complications or even death. Only a few randomized clinical
trials of pulse oximetry during anaesthesia and in the recovery room have
been performed that describe perioperative hypoxaemic events,
postoperative cardiopulmonary complications, and cognitive dysfunction.
OBJECTIVES: The objective of this review was to assess the effects of
perioperative monitoring with pulse oximetry and to clearly identify the
adverse outcomes that might be prevented or improved by the use of pulse
oximetry. SEARCH STRATEGY: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 2), MEDLINE
(1966 to May 2009), EMBASE (1980 to May 2009), CINAHL (1982 to May 2009),
ISI Web of Science (1956 to May 2009), LILACS (1982 to May 2009), and
databases of ongoing trials; and checked the reference lists of trials and
review articles. SELECTION CRITERIA: We included all controlled trials
that randomized patients to either pulse oximetry or no pulse oximetry
during the perioperative period. DATA COLLECTION AND ANALYSIS: Two authors
independently assessed data in relation to events detectable by pulse
oximetry, any serious complications that occurred during anaesthesia or in
the postoperative period, and intra- or postoperative mortality. MAIN
RESULTS: Searching identified five reports. We considered the studies with
data from a total of 22,992 patients that were eligible for analysis.
Results indicated that hypoxaemia was reduced in the pulse oximetry group,
both in the operating theatre and in the recovery room. During observation
in the recovery room, the incidence of hypoxaemia in the pulse oximetry
group was 1.5 to three times less. Postoperative cognitive function was
independent of perioperative monitoring with pulse oximetry. The one study
in general surgery showed that postoperative complications occurred in 10%
of the patients in the oximetry group and in 9.4% in the control group. No
statistically significant differences were detected in cardiovascular,
respiratory, neurologic, or infectious complications in the two groups.
The duration of hospital stay was a median of five days in both groups,
and an equal number of in-hospital deaths was registered in the two
groups. Continuous pulse oximetry has the potential to increase vigilance
and decrease pulmonary complications after cardiothoracic surgery, however
routine continuous monitoring did not reduce transfer to an intensive care
unit (ICU) or overall mortality. AUTHORS' CONCLUSIONS: The studies
confirmed that pulse oximetry can detect hypoxaemia and related events.
However, we have found no evidence that pulse oximetry affects the outcome
of anaesthesia for patients. The conflicting subjective and objective
results of the studies, despite an intense methodical collection of data
from a relatively large general surgery population, indicate that the
value of perioperative monitoring with pulse oximetry is questionable in
relation to improved reliable outcomes, effectiveness, and efficiency.
Routine continuous pulse oximetry monitoring did not reduce either
transfer to ICU or mortality, and it is unclear if there is any real
benefit from the application of this technology in patients who are
recovering from cardiothoracic surgery in a general care area.
<7>
Accession Number
0019794994
Authors
Kim J.A. Kim T.H. Yang M. Gwak M.S. Kim G.S. Kim M.J. Cho H.S. Sim W.S.
Institution
(Kim, Kim, Yang, Gwak, Kim, Kim, Cho, Sim) Department of Anesthesiology
and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School
of Medicine, Seoul, Korea.
Title
Is intravenous patient controlled analgesia enough for pain control in
patients who underwent thoracoscopy?.
Source
Journal of Korean medical science. 24(5)(pp 930-935), 2009. Date of
Publication: Oct 2009.
Abstract
This prospective randomized study was conducted to evaluate the efficacy
of two common analgesic techniques, thoracic epidural patient-controlled
analgesia (Epidural PCA), and intravenous patient-controlled analgesia (IV
PCA), in patients undergoing lobectomy by the video-assisted thoracic
surgical (VATS) approach. Fifty-two patients scheduled for VATS lobectomy
were randomly allocated into two groups: an Epidural PCA group receiving
an epidural infusion of ropivacaine 0.2%+fentanyl 5 microg/mL combination
at a rate of 4 mL/hr, and an IV PCA group receiving an intravenous
infusion of ketorolac 0.2 mg/kg+fentanyl 15 microg/mL combination at a
rate of 1 mL/hr. Pain scores were then recorded using the visual analogue
scale at rest and during motion (VAS-R and VAS-M, 0-10) for five days
following surgery. In addition, we measured the daily morphine
consumption, forced vital capacity (FVC), forced expiratory volume in 1
second (FEV(1)), satisfaction score, and the incidence of side effects.
Thirty-seven patients out of 52 completed the study (18 in the Epidural
PCA group, 19 in the IV PCA group). There were no differences in the pain
scores, analgesic requirements, pulmonary function, satisfaction score,
and the incidence of side effects between groups. This indicates that IV
PCA and Epidural PCA are equally effective to control the postoperative
pain after VATS lobectomy, which suggests that IV PCA may be used instead
of Epidural PCA.
<8>
Accession Number
0019917788
Authors
Bakhshandeh A.R. Salehi M. Radmehr H. Sattarzadeh R. Nasr A.R. Sadeghpour
A.H.
Institution
(Bakhshandeh, Salehi, Radmehr, Sattarzadeh, Nasr, Sadeghpour) Department
of Cardiovascular Surgery, Imam Tehran University Hospital, Tehran, Iran.
Title
Postoperative pericardial effusion and posterior pericardiotomy: related?.
Source
Asian cardiovascular & thoracic annals. 17(5)(pp 477-479), 2009. Date of
Publication: Oct 2009.
Abstract
Large pericardial effusions develop in 30% of patients after cardiac
surgery, and reach their maximum size after 10 days, with tamponade in 1%.
The aim of this prospective randomized case-controlled study was to assess
the effectiveness of a posterior pericardiotomy in preventing early and
late (>30 days) development of pericardial effusion. Between April 2005
and May 2006, 410 patients with a mean age of 68.4 +/- 9.2 years
undergoing coronary artery bypass grafting alone or combined with valve
surgery were divided into 2 groups of 205 each. In the pericardiotomy
group, a 4-cm longitudinal incision was made parallel and posterior to the
phrenic nerve. Echocardiography was performed at discharge and 15 and 30
days after the operation. At 15 and 30 days postoperatively, 90.2% and 97%
of patients in the pericardiotomy group were free of effusion; while none
in the control group were free of effusion. A posterior pericardiotomy is
easy to perform and seems to be a safe and effective means of preventing
postoperative effusion and its adverse consequences.
<9>
Accession Number
2010031600
Authors
Amr Y.M. Elmistekawy E. El-Serogy H.
Institution
(Amr, Elmistekawy, El-Serogy) Faculty of Medicine, Tanta University, Tanta
31111, Egypt.
Title
Effects of Dexamethasone on pulmonary and renal functions in patients
undergoing CABG with cardiopulmonary bypass.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 13(4)(pp 231-237),
2009. Date of Publication: December 2009.
Publisher
SAGE Publications Inc.
Abstract
This study evaluates whether dexamesathone in patients undergoing CABG
using CPB results in better renal and pulmonary outcome. Methods: 100
patients were randomized to receive either placebo or dexamethasone (1 mg/
kg, at induction of anesthesia and 0.5 mg/kg 8 h later). Results: The
differences regarding pulmonary parameters over times were significant in
relation to measurements taken 10 minutes after intubation within groups;
nevertheless, differences were significant between groups only at 12, 24
hours for A-a O 2 gradient, respiratory index, PaO2/FiO2 ratio.
Dexamethasone had no effect on extubation time. Creatinine clearance,
urinary micro albumin excretion and (NAG) levels were comparable in both
the groups. The dexamethasone treated patients were more likely to have
hyperglycemia. Conclusions: Dexamethasone offers no renal protective
effect and the drug is associated with significant improvement in A-a O2
gradient, respiratory index, PaO2/FiO2 at 12, 24 hours postoperatively and
had no effect on extubation time and lung compliance.
<10>
Accession Number
2010014908
Authors
Basel H. Kutlu H. Aydin U. Dostbil A. Kapan S. Akbayrak H.
Institution
(Basel, Kutlu, Aydin, Kapan) Cardio Vascular Surgery Clinic of Education,
Research Hospital of Van, Edremit/ VAN, Turkey.
(Dostbil) Anesthesia Clinic of Education, Research Hospital of Van,
Turkey.
(Akbayrak) Cardio Vascular Surgery Clinic of Sevgi Hospital, Malatya,
Turkey.
Title
Association between the left atrial diameter and radiofrequency ablation
procedure at restoring sinus rhythm (mid term and long term results).
Source
Pakistan Journal of Medical Sciences. 25(6)(pp 997-1002), 2009. Date of
Publication: October-December 2009.
Publisher
Professional Medical Publications
Abstract
Objective: Atrial fibrillation (AF) is the most common arhythmia type
among other arythmias. In this study, we aimed to search the effect of
left atrium diameter in AF treatment with radiofrequency ablation
procedure. Methodology: Preoperative left atrium diameter and
postoperative sinus rhythm restoration was prospectively studied in 84
patients who had undergone valve surgery and radiofrequency (RF) ablation
procedure in Department of Cardiovascular Surgery from January 2004 to
March 2009. The patients were classified in two groups. Group-I consisted
of the patients with left atrial diameter less than 5 cm, and Group II
consisted of the ones whose left atrial size was more than 5cm. Normal
sinus rhytm restoration was followed by electrocardiography (ECG). ECG
monitoring was done in early postoperative period, 12th, 24th and 36th
monthes following the operation. Results: In early post-operative period
normal sinus rhythm (NSR) was recorded in 34 patients (Group I: 20, Group
II: 14) in which unipolar RFA was performed. Supraventricular tachycardia
(SVT) was observed in 20 patients (Group I: 10, Group II: 10) and NSR was
restored with medical treatment in these patients. AF was permanent in 26
patients (Group I: 8, Group II: 18) and nodal rhythm was observed in 4
patients (Group I: 2, Group II: 2). The ECG monitoring was done in the
patients in early postoperative period at 12th, 24th and 36th monthes.
Datas were evaluated with statistical studies, too. Conclusion:
Radiofrequency (RF) ablation is a feasible, efficient and safe method for
the treatment for Atrial fibrillation (AF). In our study we found that
left atrial diameter is an important factor in restoring sinus rhythm.
However, AF treatment with extended left atrium is more difficult.
<11>
Accession Number
2009649133
Authors
Hosten Seyidov T. Elevli M.G. Gurkan Y. Kus A. Solak M. Toker K.
Institution
(Hosten Seyidov, Gurkan, Kus, Solak, Toker) Kocaeli Univ., Tip Fakultesi
Anesteziyoloji ve Reanimasyon,
(Elevli) Kocaeli Univ., Tip Fakultesi Kalp Damar Cerrahisi,
Title
Levobupivakaine and bupivacaine in parasternal block: Postoperative
analgesic efficacy.
Source
Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi. 15(1)(pp
13-19), 2009. Date of Publication: March 2009.
Publisher
Turkish Anaesthesiology and Intensive Care Society
Abstract
Objectives: Parasternal block to provide postoperative analgesia in open
heart surgery was first described by McDonald et al(1). They used
levobupivacaine as a local anesthetic in their placebo controlled study
and showed that parasternal block reduced postoperative opioid
consumption. The aim of our study was to compare the postoperative
analgesic effects of equal volumes and concentrations of levobupivacaine
with those of bupivacaine when used for parasternal block combined with
infiltration anesthesia in open heart surgery. Material and Methods: A
prospective, controlled, double-blind study was conducted on 40 ASA class
I-II patients undergoing elective open heart surgery under general
anesthesia. Patients were randomized to receive either 50 mL of 0.25 %
bupivacaine (Group B) or 0.25 % levobupivacaine (Group LB). Parasternal
block was performed by the surgeon before insertion of the sternal wires.
The measurements of relevant to efficacy included VAS scores (at rest and
cough), and additional bolus tramadol doses. Results: VASrest and VAS
rough scores were similar in both groups. In Group B, mean additional
tramadol doses in the first 8 hours and in the first 24 hours were
80.95+/-18.9 mg and 90.0+/-22.36 mg whereas in Group LB, these were
82:1+/-17.5 mg and 92.9+/-12.2 mg respectively and there were no
significant differences between the two groups (p: 0.39). Conclusions:
Levobupivacaine had an equivalent efficacy and safety profile compared
with bupivacaine with parasternal block. Therefore, levobupivacaine may be
an alternative to bupivueaine for parasternal block and infiltration
unesthesia.
<12>
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Accession Number
2010035870
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) Stanford University School of Medicine, HRP
Redwood Building, Stanford, CA 94305-5405, United States.
(Kennedy) Cleveland Clinic, Cleveland, OH, United States.
(Rihal) Mayo Clinic, Rochester, MI, United States.
(Rogers) University of Alabama at Birmingham, United States.
(Venkitachalam, Brooks) Graduate School of Public Health, University of
Pittsburgh, Pittsburgh, PA, United States.
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: December
2009.
Publisher
Lippincott Williams and Wilkins
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 [greater-than or equal to] 30, and lbuminuria.
Cost-effectiveness based on 4-year data favored the strategy of medical
therapy over prompt revascularization and the strateg of insulin provision
over insulin sensitization. Lifetime projections of cost-effectiveness
showed that medical theray 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. copyright 2009 American
Heart Association, Inc.
<13>
Accession Number
2010008928
Authors
Yogaratnam J.Z. Laden G. Guvendik L. Cowen M. Cale A. Griffin S.
Institution
(Yogaratnam, Guvendik, Cowen, Cale, Griffin) Department of Cardiothoracic
Surgery, Castle Hill Hospital, Castle Road, HU16 JQ Cottingham, United
Kingdom.
(Laden) North of England Hyperbaric, Medical Services, Classic Hospital,
Lowfield Road, Anlaby, East Yorkshire HU10 7AZ, United Kingdom.
Title
Hyperbaric oxygen preconditioning improves myocardial function, reduces
length of intensive care stay, and limits complications post coronary
artery bypass graft surgery.
Source
Cardiovascular Revascularization Medicine. 11(1)(pp 8-19), 2010. Date of
Publication: January 2010/March 2010.
Publisher
Elsevier Inc.
Abstract
Objective: The objective of this study was to determine whether
preconditioning coronary artery disease (CAD) patients with HBO2 prior to
first-time elective on-pump cardiopulmonary bypass (CPB) coronary artery
bypass graft surgery (CABG) leads to improved myocardial left ventricular
stroke work (LVSW) post CABG. The primary end point of this study was to
demonstrate that preconditioning CAD patients with HBO2 prior to on-pump
CPB CABG leads to a statistically significant (P<.05) improvement in
myocardial LVSW 24 h post CABG. Methods: This randomised control study
consisted of 81 (control group=40; HBO2 group=41) patients who had CABG
using CPB. Only the HBO2 group received HBO2 preconditioning for two
30-min intervals separated 5 min apart. HBO2 treatment consisted of 100%
oxygen at 2.4 ATA. Pulmonary artery catheters were used to obtain
perioperative hemodynamic measurements. All routine perioperative clinical
outcomes were recorded. Venous blood was taken pre HBO2, post HBO2 (HBO2
group only), and during the perioperative period for analysis of troponin
T. Results: Prior to CPB, the HBO2 group had significantly lower pulmonary
vascular resistance (P=.03). Post CPB, the HBO2 group had increased stroke
volume (P=.01) and LVSW (P=.005). Following CABG, there was a smaller rise
in troponin T in HBO2 group suggesting that HBO2 preconditioning prior to
CABG leads to less postoperative myocardial injury. Post CABG, patients in
the HBO2 group had an 18% (P=.05) reduction in length of stay in the
intensive care unit (ICU). Intraoperatively, the HBO2 group had a 57%
reduction in intraoperative blood loss (P=.02). Postoperatively, the HBO2
group had a reduction in blood loss (11.6%), blood transfusion (34%), low
cardiac output syndrome (10.4%), inotrope use (8%), atrial fibrillation
(11%), pulmonary complications (12.7%), and wound infections (7.6%).
Patients in the HBO2 group saved US$116.49 per ICU hour. Conclusion: This
study met its primary end point and demonstrated that preconditioning CAD
patients with HBO2 prior to on-pump CPB CABG was capable of improving
LVSW. Additionally, this study also showed that HBO2 preconditioning prior
to CABG reduced myocardial injury, intraoperative blood loss, ICU length
of stay, postoperative complications, and saved on cost, post CABG.
copyright 2010 Elsevier Inc. All rights reserved.
<14>
Accession Number
2010004284
Authors
Yan T.D. Black D. Bannon P.G. McCaughan B.C.
Institution
(Yan) University of Sydney, Department of Cardiothoracic Surgery, Royal
Prince Alfred Hospital, Sydney, NSW, Australia.
Title
Systematic review and meta-analysis of randomized and nonrandomized trials
on safety and efficacy of video-assisted thoracic surgery lobectomy for
early-stage non-small-cell lung cancer.
Source
Journal of Clinical Oncology. 27(15)(pp 2553-2562), 2009. Date of
Publication: 20 May 2009.
Publisher
American Society of Clinical Oncology
Abstract
Purpose: The current randomized trials comparing video-assisted thoracic
surgery (VATS) lobectomy with open lobectomy for patients with early-stage
non-small-cell lung cancer (NSCLC) have been of small size. We performed
the present meta-analysis of the randomized and nonrandomized comparative
studies in an attempt to assess the safety and efficacy of VATS lobectomy.
Methods: Electronic searches identified 21 eligible comparative studies
(two randomized and 19 nonrandomized) for inclusion. Two reviewers
independently appraised each study. Meta-analysis was performed by
combining the results of reported incidence of morbidity and mortality,
recurrence, and 5-year mortality rates. The relative risk (RR) was used as
a summary statistic. Results: There were no significant statistical
differences between VATS and open lobectomy in terms of postoperative
prolonged air leak (P = .71), arrhythmia (P = .86), pneumonia (P = .09),
and mortality (P = .49). VATS did not demonstrate any significant
difference in locoregional recurrence (P = .24), as compared with the open
lobectomy arm, but the data suggested a reduced systemic recurrence rate
(P = .03) and an improved 5-year mortality rate of VATS (P = .04). There
was no evidence to suggest heterogeneity of trial results. Fourteen
studies reported VATS to open lobectomy conversion rate ranging from 0% to
15.7% (median = 8.1%). Conclusion: Both randomized and nonrandomized
trials suggest that VATS lobectomy is an appropriate procedure for
selected patients with early-stage NSCLC when compared with open surgery.
copyright 2009 by American Society of Clinical Oncology.
<15>
Accession Number
2009648027
Authors
Eisenstein E.L. Wijns W. Fajadet J. Mauri L. Edwards R. Cowper P.A. Kong
D.F. Anstrom K.J.
Institution
(Eisenstein, Edwards, Cowper, Kong, Anstrom) Duke Clinical Research
Institute, Durham, NC, United States.
(Wijns) Cardiovascular Center, Aalst, Belgium.
(Fajadet) Clinique Pasteur, Toulouse, France.
(Mauri) Harvard Clinical Research Institute, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States.
Title
Long-Term Clinical and Economic Analysis of the Endeavor Drug-Eluting
Stent Versus the Driver Bare-Metal Stent. 4-Year Results From the ENDEAVOR
II Trial (Randomized Controlled Trial to Evaluate the Safety and Efficacy
of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo
Native Coronary Artery Lesions).
Source
JACC: Cardiovascular Interventions. 2(12)(pp 1178-1187), 2009. Date of
Publication: December 2009.
Publisher
Elsevier Inc.
Abstract
Objectives: This study was designed to evaluate long-term clinical and
economic outcomes for subjects receiving Endeavor drug-eluting versus
Driver bare-metal stents (both Medtronic CardioVascular, Santa Rosa,
California). Background: Early studies found that the drug-eluting stent
(DES) was a clinically and economically attractive alternative to the
bare-metal stent; however, associations between DES and very late stent
thrombosis suggest that longer follow-up is required. Methods: We used
clinical, resource use and follow-up data from 1,197 subjects randomized
to receive Endeavor (n = 598) versus Driver (n = 599) stents in ENDEAVOR
II (Randomized Controlled Trial to Evaluate the Safety and Efficacy of the
Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo Native
Coronary Artery Lesions) study with Medicare cost weights and quality of
life adjustments applied from secondary sources. We compared differences
through 4-year follow-up (1,440 days). Results: Patients in both treatment
groups had similar baseline characteristics. The use of Endeavor versus
Driver reduced 4-year target vessel revascularization rates per 100
subjects (10.4 vs. 21.5; difference: -11.1; 95% confidence interval [CI]:
-16.0 to -6.1; p < 0.001), with no difference in the rates per 100
subjects of death (5.0 vs. 5.2; difference: -0.2; 95% CI: -2.7 to 2.4; p =
0.90) or nonfatal myocardial infarction (3.2 vs. 4.4; difference: -1.2;
95% CI: -3.4 to 1.0; p = 0.29). After discounting at a 3% annual rate,
there were no differences in quality-adjusted survival days (1,093 vs.
1,090; difference: 3; 95% CI: -13 to 19; p = 0.69) and total medical costs
($21,483 vs. $21,680; difference: -$198; 95% CI: -$1,608 to $1,207; p =
0.78). Conclusions: The use of Endeavor versus Driver was associated with
a significant reduction in target vessel revascularization through 4-year
follow-up with no difference in death, nonfatal myocardial infarction,
quality-adjusted survival, or total medical costs. These results are
comparable to those for other studies evaluating drug-eluting versus
bare-metal stents. (Randomized Controlled Trial to Evaluate the Safety and
Efficacy of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De
Novo Native Coronary Artery Lesions [ENDEAVOR II]; NCT00614848). copyright
2009 American College of Cardiology Foundation.
<16>
Accession Number
2009648023
Authors
Ellis S.G. Stone G.W. Cox D.A. Hermiller J. O'Shaughnessy C. Mann T. Turco
M. Caputo R. Bergin P.J. Bowman T.S. Baim D.S.
Institution
(Ellis) Cleveland Clinic, Cleveland, OH, United States.
(Stone) Columbia University Medical Center, The Cardiovascular Research
Foundation, New York, NY, United States.
(Cox) Lehigh Valley Hospital, Allentown, PA, United States.
(Hermiller) The Care Group, LLC, Indianapolis, IN, United States.
(O'Shaughnessy) Elyria Memorial Hospital, Elyria, OH, United States.
(Mann) Wake Heart Associates, Raleigh, NC, United States.
(Turco) Washington Adventist Hospital, Takoma Park, MD, United States.
(Caputo) St. Joseph's Hospital Health Center, Syracuse, NY, United States.
(Bergin) Innovasa Corporation, Eugene, OR, United States.
(Bowman, Baim) Boston Scientific Corporation, Natick, MA, United States.
Title
Long-Term Safety and Efficacy With Paclitaxel-Eluting Stents. 5-Year Final
Results of the TAXUS IV Clinical Trial (TAXUS IV-SR: Treatment of De Novo
Coronary Disease Using a Single Paclitaxel-Eluting Stent).
Source
JACC: Cardiovascular Interventions. 2(12)(pp 1248-1259), 2009. Date of
Publication: December 2009.
Publisher
Elsevier Inc.
Abstract
Objectives: The pivotal TAXUS IV (TAXUS IV-SR: Treatment of De Novo
Coronary Disease Using a Single Paclitaxel-Eluting Stent) trial evaluated
the long-term safety and effectiveness of the paclitaxel-eluting stent
(PES) compared with an otherwise identical bare-metal stent (BMS) in a
relatively uncomplicated population of patients with a single de novo
lesion in a native coronary vessel, treated between March and July 2002.
Background: Long-term follow-up is required to determine whether the early
safety and efficacy of drug-eluting stents are maintained. Methods: The
primary end point of this prospective, randomized, double-blind trial was
9-month ischemia-driven target vessel revascularization (TVR) for PES
versus the BMS control. Follow-up was complete in 1,230 (95.1%) of 1,294
randomized evaluable patients at 5 years. Results: Compared with BMS, PES
significantly reduced TVR at 9 months (12.1% vs. 4.7%; p < 0.0001); this
benefit was maintained through 5 years (27.4% vs. 16.9%; p < 0.0001),
given comparable TVR rates for BMS and PES between years 1 and 5
(4.1%/year vs. 3.3%/year; respectively, p = 0.16). Similar patterns were
observed for composite major adverse cardiac events (MACE) (32.8% BMS vs.
24.0% PES, p = 0.0001 at 5 years). Stent thrombosis was comparable for PES
and BMS at 9 months (0.8% BMS vs. 0.8% PES; p = 0.98) and at 5 years (2.1%
BMS vs. 2.2% PES, p = 0.87). The overall revascularization benefits of PES
were consistent across multiple subgroups, including sex, diabetes, left
anterior descending artery lesion location, reference vessel diameter,
lesion length, and multiple stents. Conclusions: These 5-year results
demonstrate the long-term safety and sustained efficacy of PES compared
with BMS in patients with noncomplex lesions. (TAXUS IV-SR: Treatment of
De Novo Coronary Disease Using a Single Paclitaxel-Eluting Stent;
NCT00292474). copyright 2009 American College of Cardiology Foundation.
<17>
Accession Number
2009648021
Authors
Lotan C. Meredith I.T. Mauri L. Liu M. Rothman M.T.
Institution
(Lotan) Heart Institute, Hadassah-Hebrew University Medical Center,
Jerusalem, Israel.
(Meredith) Monash Heart Medical Centre, Melbourne, Australia.
(Mauri) Brigham and Women's Hospital, Harvard Clinical Research Institute,
Boston, MA, United States.
(Liu) Medtronic CardioVascular, Santa Rosa, CA, United States.
(Rothman) The London Chest Hospital, Barts, The London NHS Trust, London,
United Kingdom.
Title
Safety and Effectiveness of the Endeavor Zotarolimus-Eluting Stent in
Real-World Clinical Practice. 12-Month Data From the E-Five Registry.
Source
JACC: Cardiovascular Interventions. 2(12)(pp 1227-1235), 2009. Date of
Publication: December 2009.
Publisher
Elsevier Inc.
Abstract
Objectives: The E-Five registry was designed to evaluate the safety and
effectiveness of the Endeavor zotarolimus-eluting stent (ZES) (Medtronic
CardioVascular, Santa Rosa, California) for the treatment of coronary
artery stenosis across a wide range of patients treated in real-world
clinical practice settings. Background: Early clinical trials with the
Endeavor ZES have demonstrated low rates of target lesion
revascularization with a favorable safety profile including low late stent
thrombosis with up to 4 years of follow-up. A clinical registry was
designed to complement controlled trial data by examining a large patient
population, including high-risk patient subsets. Methods: The E-Five
registry is a prospective, nonrandomized, multicenter global registry
conducted at 188 centers worldwide. Adult patients (n = 8,314) with
coronary artery disease who underwent single-vessel or multivessel
percutaneous coronary intervention were enrolled. The primary end point
was the rate of major adverse cardiac events (MACE) at 12 months. A
secondary analysis stratified patients by standard versus extended-use
clinical and lesion characteristics. Results: Overall 12-month outcome
rates were MACE 7.5%; cardiac death 1.7%; myocardial infarction (all)
1.6%; target lesion revascularization 4.5%; and stent thrombosis (Academic
Research Consortium definite and probable) 1.1%. The 12-month MACE rates
were 4.3% and 8.6% for standard- and extended-use patients, respectively
(p < 0.001). Conclusions: This large, international multicenter registry
provides important information regarding the long-term safety and efficacy
of the Endeavor ZES across standard and extended-use patients in the
real-world setting. Rates of MACE and measures of safety including cardiac
death, myocardial infarction, and stent thrombosis were low and consistent
with pooled results of clinical trials. (E-Five Registry: A World-Wide
Registry With The Endeavor Zotarolimus Eluting Coronary Stent [eFive
Registry]; NCT00623441). copyright 2009 American College of Cardiology
Foundation.
<18>
Accession Number
2009633519
Authors
Barnason S. Zimmerman L. Schulz P. Tu C.
Institution
(Barnason, Zimmerman, Schulz, Tu) University of Nebraska Medical Center,
College of Nursing-Lincoln Division, Lincoln, NE, United States.
Title
Influence of an early recovery telehealth intervention on physical
activity and functioning after coronary artery bypass surgery among older
adults with high disease burden.
Source
Heart and Lung: Journal of Acute and Critical Care. 38(6)(pp 459-468),
2009. Date of Publication: November-December 2009.
Publisher
Mosby Inc.
Abstract
Objective: Older adults with poor functioning preoperatively are at risk
for delayed recovery and more impaired outcomes after coronary artery
bypass surgery (CABS). The study objective was to determine whether a
6-week early recovery telehealth intervention, designed to improve
self-efficacy and management related to symptoms after CABS, was effective
in improving outcomes (physical activity, physiologic, and psychologic
functioning) for older adults (aged > 65 years) with higher disease
burden. Methods: A descriptive, repeated-measures experimental design was
used. Follow-up data were collected at 3 and 6 weeks and 3 months after
CABS. Subjects were drawn from a larger randomized clinical trial. Parent
study subjects who had high disease burden preoperatively (physical
component score of < 50 on the Medical Outcome Study Short Form-36 and
RISKO score of > 6) were included (N = 55), with 23 subjects in the early
recovery intervention group and 31 subjects in the usual care group (n =
31). Subjects ranged in age from 65 to 85 years (M = 71.6 + 5.1 years).
Results: There was a significant main effect by group (F[1,209] = 4.66, P
< .05). The intervention group had a least square means of 27.9 kcal/kg/d
of energy expenditure compared with the usual care group of 26.6 kcal/kg/d
per the RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA). Both groups
had significantly improved physical (F[2,171] = 3.26, P < .05) and
role-physical (F[2,171] = 6.64, P < .005) functioning over time.
Conclusion: The subgroup of subjects undergoing CABS with high disease
burden were responsive to an early recovery telehealth intervention.
Improving patients' physical activity and functioning can reduce morbidity
and mortality associated with poor functioning after cardiac events.
copyright 2009 Mosby, Inc. All rights reserved.
<19>
Accession Number
2010014942
Authors
Chandrasena L.G. Peiris H. Waikar H.D.
Institution
(Chandrasena) Department of Biochemistry and Clinical Chemistry, Faculty
of Medicine, University of Kelaniya, Sri Lanka.
(Chandrasena, Peiris) Nawaloka Metropolis Clinical Laboratories, 23
Deshamanya H.K. Dharmadasa Mawatha, Colombo 02, Sri Lanka.
(Peiris) Department of Biochemistry, Faculty of Medical Sciences,
University of Sri Jayewardenepura, Sri Lanka.
(Waikar) Department of Cardiothoracic Anesthesia, Nawaloka Hospitals,
Colombo, Sri Lanka.
Title
Biochemical changes associated with reperfusion after off-pump and on-pump
coronary artery bypass graft surgery.
Source
Annals of Clinical and Laboratory Science. 39(4)(pp 372-377), 2009. Date
of Publication: Autumn 2009.
Publisher
Association of Clinical Scientists
Abstract
A prospective study was performed to monitor the postoperative changes in
biochemical markers associated with reperfusion injury following (i)
cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplagia
(CABG); (ii) CPB with a tissue stabilizing device (SUP.CPB); or (iii)
surgery on beating heart (off-pump CABG or OPCABG). Of the 48 patients, 16
were subjected to CABG, 16 to SUP.CPB, and 16 to OPCABG. Arterial and
venous blood samples drawn 10 min preoperatively and 0.2, 4, 24, and 48 hr
after surgery were assayed for plasma lactate, total calcium, and ionized
calcium and erythrocyte glutathione peroxidase (GPX) and superoxide
dismutase (SOD). Results revealed that ionized calcium, SOD, and GPX
levels of all patients increased at 4 hr following surgery but returned to
baseline levels at 24 or 48 hr after surgery. Increased postoperative GPX
levels reflect a cellular defense mechanism against oxidative damage
during reperfusion, while lactate levels during reperfusion reflect
delayed recovery of aerobic myocardial metabolism. The postoperative
release of lactate, GPX, and SOD in patients undergoing the CABG (on-pump)
technique was significantly higher compared to those subjected to OPCABG
or SUP.CPB. There were no significant differences in postoperative
patterns of release of biomarkers in patients with OPCABG vs SUP.CPB,
suggesting that these surgical techniques are equally acceptable.
copyright 2009 by the Association of Clinical Scientists, Inc.
<20>
Accession Number
2010045156
Authors
Lip G.Y.H. Huber K. Andreotti F. Arnesen H. Airaksinen K.J. Cuisset T.
Kirchhof P. Marin F.
Institution
(Lip) University of Birmingham, Centre for Cardiovascular Sciences, City
Hospital, Birmingham B18 7QH, United Kingdom.
(Huber) 3rd Department of Medicine, Cardiology and Emergency Medicine,
Wilhelminenhospital, Vienna, Austria.
(Andreotti) Department of Cardiovascular Medicine, A. Gemelli University
Hospital, Rome, Italy.
(Arnesen) Department of Cardiology, Oslo University Hospital, Ulleval,
Oslo, Norway.
(Airaksinen) Department of Medicine, Turku University Hospital, Turku,
Finland.
(Cuisset) Department of Cardiology, CHU Timone, Marseille, France.
(Kirchhof) Department of Cardiology and Angiology, Universitatsklinikum
Munster, Munster, Germany.
(Marin) Department of Cardiology, Hospital Universitario Virgen de la
Arrixaca, Ctra Madrid-Cartagena s/n, Murcia, Spain.
Title
Management of antithrombotic therapy in atrial fibrillation patients
presenting with acute coronary syndrome and/or undergoing percutaneous
coronary intervention/ stenting: A consensus document of the European
Society of Cardiology Working Group on thrombosis, endorsed by the
European Heart Rhythm Association [EHRA] and the European Association of
Percutaneous Cardiovascular Interventions [EAPCI].
Source
Thrombosis and Haemostasis. 103(1)(pp 13-28), 2010. Date of Publication:
January 2010.
Publisher
Schattauer GmbH
Abstract
There remains uncertainty over optimal antithrombotic management strategy
for patients with atrial fibrillation (AF) presenting with an acute
coronary syndrome and/or undergoing percutaneous coronary
intervention/stenting. Clinicians need to balance the risk of stroke and
thromboembolism against the risk of recurrent cardiac ischaemia and/ or
stent thrombosis, and the risk of bleeding. This consensus document
comprehensively reviews the published evidence and presents a consensus
statement on a 'best practice' antithrombotic therapy guideline for the
management of antithrombotic therapy in such AF patients. copyright
Schattauer 2010.
<21>
[Use Link to view the full text]
Accession Number
2010020855
Authors
Kushner F.G. Hand M. Smith S.C. King S.B. Anderson J.L. Antman E.M. Bailey
S.R. Bates E.R. Blankenship J.C. Casey D.E. Green L.A. Hochman J.S. Jacobs
A.K. Krumholz H.M. Morrison D.A. Ornato J.P. Pearle D.L. Peterson E.D.
Sloan M.A. Whitlow P.L. Williams D.O.
Title
2009 focused updates: ACC/AHA guidelines for the management of patients
with st-elevation myocardial infarction (Updating the 2004 guideline and
2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary
intervention (Updating the 2005 Guideline and 2007 Focused Update).
Source
Circulation. 120(22)(pp 2271-2306), 2009. Date of Publication: December
2009.
Publisher
Lippincott Williams and Wilkins
<22>
Accession Number
2009648654
Authors
Eisenstein E.L. Leon M.B. Kandzari D.E. Mauri L. Edwards R. Kong D.F.
Cowper P.A. Anstrom K.J.
Institution
(Eisenstein, Edwards, Kong, Cowper, Anstrom) Duke Clinical Research
Institute, Durham, NC, United States.
(Leon) Columbia University Medical Center, the Cardiovascular Research
Foundation, New York, NY, United States.
(Kandzari) Scripps Clinic, La Jolla, CA, United States.
(Mauri) Harvard Clinical Research Institute, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States.
Title
Long-Term Clinical and Economic Analysis of the Endeavor
Zotarolimus-Eluting Stent Versus the Cypher Sirolimus-Eluting Stent.
3-Year Results From the ENDEAVOR III Trial (Randomized Controlled Trial of
the Medtronic Endeavor Drug [ABT-578] Eluting Coronary Stent System Versus
the Cypher Sirolimus-Eluting Coronary Stent System in De Novo Native
Coronary Artery Lesions).
Source
JACC: Cardiovascular Interventions. 2(12)(pp 1199-1207), 2009. Date of
Publication: December 2009.
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to evaluate clinical and economic
outcomes for subjects receiving zotarolimus-eluting (ZES) (n = 323) versus
sirolimus-eluting stents (SES) (n = 113) in the ENDEAVOR III (Randomized
Controlled Trial of the Medtronic Endeavor Drug [ABT-578] Eluting Coronary
Stent System Versus the Cypher Sirolimus-Eluting Coronary Stent System in
De Novo Native Coronary Artery Lesions) clinical trial. Background:
Although previous clinical trials have evaluated long-term clinical
outcome for drug-eluting stents, none considered their economic
implications. Methods: We analyzed case report form information with
quality-of-life adjustment and Medicare cost weights applied from
secondary sources; compared differences in clinical outcomes,
quality-adjusted survival, medical resource use, and medical costs; and
evaluated cost-effectiveness through 3-year follow-up. Results: The use of
ZES versus SES reduced the 3-year rates/100 subjects of death or
myocardial infarction (3.9 vs. 10.8; difference, -6.9; 95% confidence
interval [CI]: -13.0 to 0.8; p = 0.028), with no difference in target
vessel revascularization rates (17.9 vs. 12.2; difference, 5.7; 95% CI:
-3.7 to 15.1; p = 0.23) but greater use of coronary artery bypass graft
(CABG) surgery (3.5 vs. 0.0; difference 3.5; 95% CI: 1.3 to 5.7; p =
0.002). After discounting at 3% per annum, total medical costs for ZES
versus SES were similar ($23,353 vs. $21,657; difference, $1,696; 95% CI:
-$1,089 to $4,482, p = 0.23), and the 3-year cost-effectiveness ratio was
$57,002/quality-adjusted life year. Conclusions: Despite a reduction in
death or myocardial infarction and no difference in total
revascularizations, medical costs were not decreased due to increased CABG
repeat revascularization procedures for subjects receiving ZES versus SES.
If future trials observe similar differences, improved safety with no
difference in medical costs, the use of ZES versus SES will be a
clinically and economically attractive treatment strategy. (The Medtronic
Endeavor III Drug Eluting Coronary Stent System Clinical Trial [ENDEAVOR
III]; NCT00217256). copyright 2009 American College of Cardiology
Foundation.
<23>
Accession Number
2009648653
Authors
Leon M.B. Kandzari D.E. Eisenstein E.L. Anstrom K.J. Mauri L. Cutlip D.E.
Nikolsky E. O'Shaughnessy C. Overlie P.A. Kirtane A.J. McLaurin B.T.
Solomon S.L. Douglas Jr. J.S. Popma J.J.
Institution
(Leon, Nikolsky, Kirtane) Columbia University Medical Center, the
Cardiovascular Research Foundation, New York, NY, United States.
(Kandzari) Scripps Clinic, La Jolla, CA, United States.
(Eisenstein, Anstrom) Duke Medical Center, Durham, NC, United States.
(Mauri) Harvard Clinical Research Institute, Brigham and Women's Hospital,
Boston, MA, United States.
(Cutlip, Popma) Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA, United States.
(O'Shaughnessy) Elyria Memorial Hospital, Elyria, OH, United States.
(Overlie) Lubbock Heart Hospital, Lubbock, TX, United States.
(McLaurin) Anderson Medical Center, Anderson, SC, United States.
(Solomon) Methodist Hospital, Houston, TX, United States.
(Douglas Jr.) Emory University, Atlanta, GA, United States.
Title
Late Safety, Efficacy, and Cost-Effectiveness of a Zotarolimus-Eluting
Stent Compared With a Paclitaxel-Eluting Stent in Patients With De Novo
Coronary Lesions. 2-Year Follow-Up From the ENDEAVOR IV Trial.
Source
JACC: Cardiovascular Interventions. 2(12)(pp 1208-1218), 2009. Date of
Publication: December 2009.
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to assess, after 2 years of
follow-up, the safety, efficacy, and cost-effectiveness of a
zotarolimus-eluting stent (ZES) compared with a paclitaxel-eluting stent
(PES) in patients with native coronary lesions. Background: Early
drug-eluting stents were associated with a small but significant incidence
of very late stent thrombosis (VLST), occurring >1 year after the index
procedure. The ZES has shown encouraging results in clinical trials.
Methods: The ENDEAVOR IV trial (Randomized, Controlled Trial of the
Medtronic Endeavor Drug [ABT-578] Eluting Coronary Stent System Versus the
Taxus Paclitaxel-Eluting Coronary Stent System in De Novo Native Coronary
Artery Lesions), a randomized (1:1), single-blind, controlled trial (n =
1,548) compared ZES versus PES in patients with single de novo coronary
lesions. Two-year follow-up was obtained in 96.0% of ZES and 95.4% of PES
patients. The primary end point was target vessel failure (TVF), and
safety end points included Academic Research Consortium-defined stent
thrombosis. Economic end points analyzed included quality-adjusted
survival, medical costs, and relative cost-effectiveness of ZES and PES.
Results: The TVF at 2 years was similar in ZES and PES patients (11.1% vs.
13.1%, p = 0.232). There were fewer myocardial infarctions (MIs) in ZES
patients (p = 0.022), due to fewer periprocedural non-Q-wave MIs and fewer
late MIs between 1 and 2 years. Late MIs were associated with increased
VLST (PES: 6 vs. ZES: 1; p = 0.069). Target lesion revascularization was
similar comparing ZES with PES (5.9% vs. 4.6%; p = 0.295), especially in
patients without planned angiographic follow-up (5.2% vs. 4.9%; p =
0.896). The cost-effectiveness of ZES and PES was similar. Conclusions:
After 2 years of follow-up, ZES demonstrated efficacy and
cost-effectiveness comparable to PES, with fewer MIs and a trend toward
less VLST. (The ENDEAVOR IV Clinical Trial: A Trial of a Coronary Stent
System in Coronary Artery Lesions; NCT00217269). copyright 2009 American
College of Cardiology Foundation.
<24>
Accession Number
2010040337
Authors
Lurati Buse G.A. Koller M.T. Grapow M. Bolliger D. Seeberger M. Filipovic
M.
Institution
(Lurati Buse, Bolliger, Seeberger, Filipovic) Department of Anaesthesia,
University Hospital Basel, CH-4031 Basel, Switzerland.
(Koller) Basel Institute of Clinical Epidemiology, University Hospital
Basel, Basel, Switzerland.
(Grapow) Division of Cardiothoracic Surgery, University Hospital Basel,
Basel, Switzerland.
Title
The prognostic value of troponin release after adult cardiac surgery - a
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 37(2)(pp 399-406), 2010.
Date of Publication: February 2010.
Publisher
Elsevier
Abstract
To assess the accuracy of increased troponin (Tn) concentrations for the
prediction of mid-term ([greater-than or equal to]12 months) mortality
after coronary artery bypass graft (CABG) and valve surgery, we performed
a systematic review identifying all studies reporting on the association
between postoperative troponin release and mortality after cardiac
surgery. Studies were identified through 30 April 2008 by electronic
searches of the MEDLINE, EMBASE and BIOSIS databases. Two reviewers
independently selected studies, assessed methodological quality and
extracted the data. We primarily considered mid-term ([greater-than or
equal to]12 months) and secondarily short-term ([less-than or equal to]30
days) all-cause mortality. A bivariate random-effects model was used to
study determinants and to pool measures of prognostic accuracy of Tn.
Seventeen studies fulfilled the inclusion criteria with a total of 237
mid-term deaths in 5189 patients and 296 short-term deaths in 9703
patients. The diagnostic odds ratio of increased Tn concentrations was
5.46 (95% confidence interval (CI) 2.0-14.6) for mid-term mortality and
6.57 (95% CI 4.3-10.1) for short-term mortality after adult cardiac
surgery. Alternatively expressed, for troponin elevation, the sensitivity
was 0.45 (0.26-0.67) and the specificity 0.87 (0.73-0.90) to predict
mid-term mortality. The sensitivity was 0.59 (0.48-0.69) and the
specificity 0.82 (0.72-0.89) for short-term mortality. Between-study
variability was high. In conclusion, this meta-analysis provides evidence
for an association between postoperative Tn release with mid- and
short-term all-cause mortality after adult cardiac surgery. However,
differences in populations, timing of Tn testing, Tn subunit and Tn assays
make definitive conclusions about effect size and cut-off values
difficult. copyright 2009 European Association for Cardio-Thoracic
Surgery.
<25>
Accession Number
2010027942
Authors
Parry M. Watt-Watson J. Hodnett E. Tranmer J. Dennis C.-L. Brooks D.
Institution
(Parry, Tranmer) Cardiac Surgery, Kingston General Hospital, Kingston, ON,
Canada.
(Parry, Watt-Watson, Hodnett, Dennis) Lawrence S Bloomberg Faculty of
Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8,
Canada.
(Brooks) Department of Physical Therapy, University of Toronto, Toronto,
ON, Canada.
Title
Cardiac Home Education and Support Trial (CHEST): A pilot study.
Source
Canadian Journal of Cardiology. 25(12)(pp e393-e398), 2009. Date of
Publication: December 2009.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Coronary artery bypass graft (CABG) surgery is performed more
frequently in individuals who are older and sicker than in previous years.
Increased patient acuity and reduced hospital length of stays leave
individuals ill prepared for their recovery. OBJECTIVES: To test the
feasibility of a peer support program and determine indicators of the
effects of peer support on recovery outcomes of individuals following CABG
surgery. METHODS AND RESULTS: A pre-post test pilot randomized clinical
trial design enrolled men and women undergoing first-time nonemergency
CABG surgery at a single site in Ontario. Patients were randomly assigned
to either usual care or peer support. Patients allocated to usual care
(n=50) received standard preoperative and postoperative education.
Patients in the peer support group (n=45) received individualized
education and support via telephone from trained cardiac surgery peer
volunteers for eight weeks following hospital discharge. Most (93%) peer
volunteers believed they were prepared for their role, with 98% of peer
volunteers initiating calls within 72 h of the patient's discharge. Peer
volunteers made an average of 12 calls, less than 30 min in duration over
the eight-week recovery period. Patients were satisfied with their peer
support (n=45, 98%). The intervention group reported statistical trends
toward improved physical function (physical component score) (t [89]=-1.6;
P=0.12) role function (t [93]=-1.9; P=0.06), less pain (t [93]=1.30;
P=0.20) and improved cardiac rehabilitation enrollment
(chi<sup>2</sup>=2.50, P=0.11). CONCLUSIONS: These preliminary results
suggest that peer support may improve recovery outcomes following CABG.
Data from the present pilot trial also indicate that a home-based peer
support intervention is feasible and an adequately powered trial should be
conducted. copyright2009 Pulsus Group Inc. All rights reserved.
<26>
Accession Number
2009661931
Authors
Dango S. Sienel W. Passlick B. Stremmel C.
Institution
(Dango, Sienel, Passlick, Stremmel) Department of Thoracic Surgery,
Albert-Ludwigs-University Freiburg, Freiburg, Germany.
Title
Impact of chest tube clearance on postoperative morbidity after
thoracotomy: results of a prospective, randomised trial.
Source
European Journal of Cardio-thoracic Surgery. 37(1)(pp 51-55), 2010. Date
of Publication: January 2010.
Publisher
Elsevier
Abstract
Objective: In many centres of thoracic surgery, milking of chest tubes is
performed to prevent them from blocking. The usefulness of chest tube
clearance is discussed controversially. Therefore, we investigated the
impact of postoperative chest tube milking on postoperative outcome in a
prospective, randomised trial. Methods: Within a period of 11 months, 145
patients undergoing pulmonary resection through thoracotomy were included
in the study. Two chest tubes each (silicone drainage, Redax, Mirandola,
Italy) were placed in all patients (ventral tube 21Ch and dorsal tube
24Ch). Milking was applied to both chest tubes for 1 min every 2 h within
the first 48 h postoperatively and continuous suction of -20 cm H2O was
maintained for 48 h. Duration of chest tube drainage, quantity and quality
of effusion or air leakage, co-morbidity, length of hospital stay and
30-day postoperative morbidity and mortality were analysed. Furthermore,
outcome was measured by assessment of chest radiographs at the time of
discharge from hospital. Results: Randomisation resulted in milking of
chest tubes of 73 patients and in observation of chest tubes without any
manipulation in 72 patients. Twenty-one patients had to be excluded from
further analysis due to violation from the study protocol (n = 9),
necessity of replacement of a chest tubes (n = 9) and re-operation for
bleeding (n = 3). The 30-day mortality rate was 1.4% in each group and the
30-day morbidity was 49.3% in the milking group and 52.8% in the
observation group. Milking of chest tubes was not associated with a lower
postoperative mortality or morbidity (p = 0.99 and p = 0.67, respectively;
chi-square test). We observed a significant increase of postoperative
pleural effusion drainage in the milking group 48 h after surgery (p =
0.004; unpaired t-test). No correlation was seen between milking of chest
tubes and the duration of chest tube drainage, quality of effusion, air
leakage or length of hospitalisation. Conclusions: We showed for the first
time that postoperative chest tube milking is associated with a
significant increase of pleural fluid drainage. Postoperative morbidity
and mortality was not improved and therefore chest tube milking cannot be
recommended as a routine postoperative procedure. copyright 2009 European
Association for Cardio-Thoracic Surgery.
<27>
Accession Number
2009661920
Authors
Brunelli A. Salati M. Refai M. Di Nunzio L. Xiume F. Sabbatini A.
Institution
(Brunelli, Salati, Refai, Di Nunzio, Xiume, Sabbatini) Unit of Thoracic
Surgery, Umberto I Regional Hospital, Ancona, Italy.
Title
Evaluation of a new chest tube removal protocol using digital air leak
monitoring after lobectomy: a prospective randomised trial.
Source
European Journal of Cardio-thoracic Surgery. 37(1)(pp 56-60), 2010. Date
of Publication: January 2010.
Publisher
Elsevier
Abstract
Background: The objective of this randomised trial was to assess the
effectiveness of a new fast-track chest tube removal protocol taking
advantage of digital monitoring of air leak compared to a traditional
protocol using visual and subjective assessment of air leak (bubbles).
Methods: One hundred and sixty-six patients submitted to pulmonary
lobectomy for lung cancer were randomised in two groups with different
chest tube removal protocols: (1) in the new protocol, chest tube was
removed based on digitally recorded measurements of air leak flow; (2) in
the traditional protocol, the chest tube removal was based on an
instantaneous assessment of air leak during daily rounds. The two groups
were compared in terms of chest tube duration, hospital stay and costs.
Results: The two groups were well matched for several preoperative and
operative variables. Compared to the traditional protocol, the new digital
recording protocol showed mean reductions in chest tube duration (p =
0.0007), hospital stay (p = 0.007) of 0.9 day, and a mean cost saving of
[euro]476 per patient (p = 0.008). In the new chest tube removal protocol,
51% of patients had their chest tube removed by the second postoperative
day versus only 12% of those in the traditional protocol. Conclusions: The
application of a chest tube removal protocol using a digital drainage unit
featuring a continuous recording of air leak was safe and cost effective.
Although future studies are warranted to confirm these results in other
settings, the use of this new protocol is now routinely applied in our
practice. copyright 2009 European Association for Cardio-Thoracic Surgery.
<28>
Accession Number
2009633523
Authors
Albert N.M. Gillinov A.M. Lytle B.W. Feng J. Cwynar R. Blackstone E.H.
Institution
(Albert) Nursing Institute, Cleveland Clinic, Cleveland, OH 44195, United
States.
(Gillinov, Lytle, Cwynar, Blackstone) Department of Thoracic and
Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic,
Cleveland, OH 44195, United States.
(Feng, Blackstone) Department of Quantitative Health Sciences, Cleveland
Clinic, Cleveland, OH 44195, United States.
Title
A randomized trial of massage therapy after heart surgery.
Source
Heart and Lung: Journal of Acute and Critical Care. 38(6)(pp 480-490),
2009. Date of Publication: November-December 2009.
Publisher
Mosby Inc.
Abstract
Objectives: To determine whether massage therapy improves postoperative
mood, pain, anxiety, and physiologic measurements; shortens hospital stay;
and decreases occurrence of atrial fibrillation. Methods: Two hundred
fifty-two adults undergoing cardiac surgery were randomized to usual
postoperative care (n = 126) or usual care plus two massages (n = 126).
Assessments of mood, depression, anxiety, pain, physiologic status,
cardiac rhythm, and hospital length of stay were completed. Logistic and
linear regressions were performed. Results: Preoperative pain, mood, and
affective state scores were positively associated with postoperative
scores; however, there were no postoperative differences between groups
for any measures (P = .11 to .93). There were no differences in
physiologic variables except lower postoperative blood pressure after
massage (P = .01). Postoperative atrial fibrillation occurrence (P = .6)
and median postoperative hospital length of stay (P = .4) were similar
between groups. Conclusion: Massage therapy is feasible in cardiac
surgical patients; however, it does not yield therapeutic benefit.
Nevertheless, it should be a patient-selected and -paid option. copyright
2009 Mosby, Inc. All rights reserved.
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