Results Generated From:
EMBASE <1980 to 2010 Week 09>
EMBASE (updates since 2010-02-25)
<1>
Accession Number
2010116037
Authors
Wiklund L. Setina M. Tsang K. Cusimano R. Yau T.
Institution
(Wiklund) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Goteborg, Sweden.
(Setina) Department of Cardiothoracic Surgery, Ceske Budejovice Hospital,
Ceske Budejovice, Czech Republic.
(Tsang, Cusimano, Yau) Division of Cardiovascular Surgery, Peter Munk
Cardiac Center, Toronto General Hospital, Toronto, Ont., Canada.
Title
A multicenter prospective randomized trial of a second-generation
anastomotic device in coronary artery bypass surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 139(3)(pp 741-747), 2010.
Date of Publication: March 2010.
Publisher
Mosby Inc.
Abstract
Objective: Our objective was to perform a prospective randomized trial to
evaluate the clinical and angiographic outcomes of a second-generation
anastomotic device used for saphenous vein grafts. Methods: Patients
undergoing nonemergency isolated coronary artery bypass grafting at 3
centers from August 2003 to December 2004 with at least 2 saphenous vein
grafts were included. The proximal anastomoses were randomized, within
each patient, to be constructed by the connector or by suture. One-year
graft patency was evaluated by coronary angiography, magnetic resonance
imaging, or computed tomography and analyzed on an intent-to-treat basis.
Results: A total of 151 patients (65 +/- 9 years, 87% male) who met
inclusion/exclusion criteria were enrolled in the study and were analyzed.
A total of 489 grafts were constructed (3.2 +/- 0.5 grafts per patient),
including 327 vein grafts randomized to the connector (n = 162) or suture
(n = 165). In 162 connector grafts, 151 devices were successfully
implanted. Technical issues required explantation of 11 devices
intraoperatively. Patency was evaluated in 120 (81%) patients with 260
study grafts. Seventy-four patients with 161 grafts were evaluated by
coronary angiography, 31 patients with 69 grafts by magnetic resonance
imaging, and 15 patients with 30 grafts by computed tomography. The 1-year
patency rate for study grafts constructed with the anastomotic connector
was 92.2% (118/128) and for hand-sutured grafts, 91.7% (121/132).
Conclusions: This prospective multicenter randomized controlled trial
demonstrated good in-hospital and late clinical outcomes and excellent
1-year patency for vein grafts anastomosed both by the St Jude Medical
second-generation aortic connector system and by hand. The patency of the
connector grafts did not differ from that of the hand-sutured grafts.
copyright 2010 The American Association for Thoracic Surgery.
<2>
Accession Number
2010116035
Authors
Boodhwani M. Hamilton A. de Varennes B. Mesana T. Williams K. Wells G.A.
Nathan H. Dupuis J.Y. Babaev A. Wells P. Rubens F.D.
Institution
(Boodhwani, Mesana, Rubens) Division of Cardiac Surgery, University of
Ottawa Heart Institute, Ottowa, Ont., Canada.
(Hamilton) Division of Cardiac Surgery, Queen's University, Kingston,
Kingston, Ont., Canada.
(de Varennes) Division of Cardiac Surgery, Royal Victoria Hospital,
Montreal, Que., Canada.
(Williams, Wells) Department of Epidemiology and Community Medicine,
University of Ottawa, Ottowa, Ont., Canada.
(Nathan, Dupuis) Division of Cardiac Anaesthesia, University of Ottawa
Heart Institute, Ottowa, Ont., Canada.
(Babaev) Division of Perfusion, University of Ottawa Heart Institute,
Ottowa, Ont., Canada.
(Wells) Department of Medicine, University of Ottawa, Ottowa, Ont.,
Canada.
Title
A multicenter randomized controlled trial to assess the feasibility of
testing modified ultrafiltration as a blood conservation technology in
cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 139(3)(pp 701-706), 2010.
Date of Publication: March 2010.
Publisher
Mosby Inc.
Abstract
Objectives: Modified ultrafiltration is a technique after cardiopulmonary
bypass whereby blood withdrawn from the aortic cannula is passed across a
semipermeable membrane to hemoconcentrate. Unblinded trials have suggested
that modified ultrafiltration is efficacious for blood conservation. The
objective of this trial was to assess the feasibility of a model testing
modified ultrafiltration in which all members of the surgical team were
blinded to the intervention. Methods: Patients (<65 kg) undergoing
procedures involving cardiopulmonary bypass were randomized to undergo
either modified ultrafiltration (n = 29) or sham (circulation without an
interposed filter, n = 36) for 15 minutes. The circuit was shielded from
all members of the team except the perfusionist. A questionnaire was
administered to determine the blinding success. Results: Modified
ultrafiltration resulted in a removal of 1000 +/- 251 mL of fluid and a
reduction in the pump balance (1025 +/- 807 vs 1804 +/- 838; P < .001)
with an increase in hemoglobin immediately after intervention (increase of
7.7 +/- 8.8 g/L in modified ultrafiltration vs 3.8 +/- 5.1 g/L in sham; P
= .04). Introduction or increase in dose of vasopressors was more frequent
in the modified ultrafiltration group (52% vs 28%; P = .048). Differences
in red cell transfusion rates between groups did not reach statistical
significance (P = .59). Blinding was successful for the anesthetist
(blinding index 0.13 [95% confidence interval, 0.11-0.38] and the
intensivist (blinding index, 0.09 [95% confidence interval, 0.14-0.31])
but not for the surgeon (blinding index, 0.24 [95% confidence interval,
0.05-0.42]). The compliance rate for the transfusion protocol was greater
than 90%. Conclusions: Modified ultrafiltration was effective for
hemoconcentration after cardiopulmonary bypass in patients of low body
weight, but it is associated with an increased need for vasopressor
support. The anesthetist and intensivist were successfully blinded to the
intervention. copyright 2010 The American Association for Thoracic
Surgery.
<3>
Accession Number
2010092971
Authors
Svitek V. Lonsky V. Mandak J. Krejsek J. Kolackova M. Brzek V. Kubicek J.
Volt M. Bartos M. Harrer J.
Institution
(Svitek, Lonsky, Mandak, Brzek, Kubicek, Volt, Harrer) Department of
Cardiac Surgery, Faculty of Medicine, University Hospital in Hradec
Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic.
(Lonsky, Volt) Department of Cardiac Surgery, Palacky University Faculty
of Medicine and Dentistry, University Hospital in Olomouc, Czech Republic.
(Krejsek, Kolackova) Department of Clinical Immunology and Allergology,
Charles University in Prague, University Hospital, Hradec Kralove, Czech
Republic.
(Bartos) Department of Anesthesiology, Resuscitation and Intensive Care,
Charles University in Prague, University Hospital, Hradec Kralove, Czech
Republic.
Title
No clear clinical benefit of using mini-invasive extracorporeal
circulation in coronary artery bypass grafting in low-risk patients.
Source
Perfusion. 24(6)(pp 389-395), 2009. Date of Publication: November 2009.
Publisher
SAGE Publications Ltd
Abstract
Background: Current research is engaged in innovative technologies of
extracorporeal circulation (ECC) systems in an effort to eliminate
negative effetcs. Some studies have shown that, due to the complexity of
technical settings of mini-ECC, they invoke a weaker immune response
compared to classic ECC. The clinical benefits of using these systems have
not been clearly proven yet. Methods: A group of 54 patients who were
indicated for elective coronary surgery were randomised into two groups -
Group A (patients operated on using classic ECC - open modification) and
Group B (patients operated on using mini-ECC). The concentrations of IL-6,
PMN elastase and MCP-1 in both groups were monitored per- and
postoperatively, along with the postoperative clinical course. Results:
The groups did not differ in the basic pre- and peroperative
characteristics. We recorded a lower priming for mini-ECC (p < 0.001) and
significantly reduced hemodilution during ECC. There were no differences
in the clinical outcome in either group. Serum concentrations of monitored
markers of immune reaction towards ECC showed higher activity during
standard ECC. Conclusion: New technologies used in mini-systems have
proven to lower activation of the immune system, which can be monitored
using kinetics of proinflammatory mediators. In spite of these comparable
laboratory results, we did not find differences in short-term clinical
results when comparing both these groups of low-risk patients.
<4>
Accession Number
2010092968
Authors
Litmathe J. Philipp C. Kurt M. Boeken U. Gams E. Feindt P.
Institution
(Litmathe, Philipp, Kurt, Boeken, Gams, Feindt) Department of Thoracic-
and Cardiovascular Surgery, Heinrich-Heine-University, Moorenstrasse 5,
D-40225 Duesseldorf, Germany.
Title
The use of autologous platelet gel (APG) for high-risk patients in cardiac
surgery - Is it beneficial?.
Source
Perfusion. 24(6)(pp 381-387), 2009. Date of Publication: November 2009.
Publisher
SAGE Publications Ltd
Abstract
Background: Wound healing in cardiac surgery has become a major problem
due to the impaired risk profile of many patients. The aim of this study
was to prove the influence of autologous platelet gel (APG) on wound
healing in a special group of high-risk patients undergoing coronary
surgery. Patients and Methods: We performed a prospective, double-blind
study in 44 patients with a special risk constellation relating to wound
complications (obesity, diabetes, smoker, New York Heart Association
(NYHA) III-IV and peripheral vascular disease). The study group was
treated with APG, prepared using the Magellan copyright platelet
separator, the control group underwent conventional wound treatment.
Results: The incidence of major and minor wound complications at the
thoracotomy, as well as in the area of saphenous vein harvesting, was not
pronounced in either of the groups. Blood loss and pain sensations did not
differ significantly either. Stay in the intensive care unit (ICU) and the
in-hospital mortality were also comparable. The duration of the entire
operation and the time until removing the chest-tubes were prolonged in
the study group. Conclusion: Despite promising results in other fields of
surgery, APG shows no beneficial effect in high-risk patients undergoing
cardiac surgery. Probably, it depends on different types of
microcirculation in atherosclerotic patients, which are quite different
from those of other surgical areas. This factor may offset the existing
beneficial platelet effects which could be observed, for example, in
maxillo-facial surgery.
<5>
Accession Number
2010092966
Authors
Rudolph J.L. Babikian V.L. Treanor P. Pochay V.E. Wigginton J.B.
Crittenden M.D. Marcantonio E.R.
Institution
(Rudolph) Geriatric Research, Education and Clinical Center, Boston VA
Healthcare System, GRECC (JP-182), 150 South Huntington Ave., Boston, MA
02130, United States.
(Babikian, Pochay) Department of Neurology, Boston VA Healthcare System,
Boston, MA, United States.
(Treanor, Crittenden) Division of Cardiac Surgery, Boston VA Healthcare
System, Boston, MA, United States.
(Wigginton) University of Mississippi Medical Center, Jackson, MS, United
States.
(Crittenden) Department of Surgery, St Louis VA Medical Center, St Louis,
MO, United States.
(Marcantonio) Divisions of Gerontology and General Medicine and Primary
Care, Beth Israel Deaconess Medical Center, Boston, MA, United States.
(Rudolph) Division of Aging, Brigham and Womens Hospital, Boston, MA,
United States.
(Babikian) Department of Neurology, Boston University, School of Medicine,
Boston, MA, United States.
Title
Microemboli are not associated with delirium after coronary artery bypass
graft surgery.
Source
Perfusion. 24(6)(pp 409-415), 2009. Date of Publication: November 2009.
Publisher
SAGE Publications Ltd
Abstract
Delirium is an acute change in cognition which occurs frequently after
coronary artery bypass graft (CABG) surgery. Cerebral microemboli, from
plaque, air, or thrombus, have been hypothesized to contribute to delirium
and cognitive decline after CABG. The purpose of this study was to
determine if there was an association between cerebral microemboli and
delirium after cardiac surgery. Non-delirious patients (n=68) were
prospectively enrolled and underwent intraoperative monitoring of the
middle cerebral arteries with transcranial Doppler (TCD). TCD signals were
saved and analyzed postoperatively for microemboli manually, according to
established criteria. Postoperatively, patients were assessed for delirium
with a standardized battery. Thirty-three patients (48.5%) developed
delirium after surgery. Microemboli counts (mean +/- SD) were not
significantly different in those with and without delirium (303 +/- 449
vs. 299 +/- 350; p=0.97). While intraoperative microemboli were not
associated with delirium after CABG, further investigation into the source
and composition of microemboli can further elucidate the long-term
clinical impact of microemboli.
<6>
Accession Number
2010092964
Authors
Senay S. Toraman F. Karabulut H. Alhan C.
Institution
(Senay, Toraman, Karabulut, Alhan) Acibadem University School of Medicine,
Department of Cardiovascular Surgery, Istanbul, Turkey.
(Senay) Acibadem Kadkoy Hastanesi, Kalp Ve Damar Cerrahisi Bolumu, Kadkoy,
Istanbul, Turkey.
Title
Is it the patient or the physician who cannot tolerate anemia? A
prospective analysis in 1854 non-transfused coronary artery surgery
patients.
Source
Perfusion. 24(6)(pp 373-380), 2009. Date of Publication: November 2009.
Publisher
SAGE Publications Ltd
Abstract
Background and objective: Low hematocrit level and transfusion may coexist
during cardiopulmonary bypass and the actual impact of one on the outcome
parameters may be counfounded or masked by the other. This study aims to
determine the impact of the lowest hematocrit level during cardiopulmonary
bypass on outcome parameters in non-transfused patients. Methods: Two
thousand six hundred and thirty-two consecutive patients who underwent
isolated coronary artery bypass graft (CABG) surgery with cardiopulmonary
bypass were evaluated prospectively:1854 (70.4%) patients who did not
receive any red blood cells during hospital stay were included in the
study. Perioperative data and outcome parameters were recorded. Outcomes
were evaluated in 2 groups according to the lowest level of hematocrit
(>21%: high hematocrit group, n= 1680, (91.6%) and [less-than or equal
to]%: low hematocrit group, n=174, (9.4%)) during cardiopulmonary bypass.
Results: Overall mean lowest hematocrit level of patients was 27.7+/-4.4%
(19.7+/-1.9% in the low hematocrit group, 28.5+/-4.1% in the high
hematocrit group). The comparison of outcome parameters regarding the time
on ventilator, duration of intensive care unit stay, intensive care unit
re-admission, hospital re-admission, reoperation for bleeding or
tamponade, low cardiac output, postoperative atrial fibrillation, stroke,
creatinine level at hospital discharge, new onset renal failure,
mediastinitis, pulmonary complication and mortality rates were similar in
both groups. Conclusions: Our findings suggest that a lowest hematocrit
level of [less-than or equal to]% during cardiopulmonary bypass has no
adverse impact on outcome after isolated coronary surgery in
non-transfused patients.
<7>
Accession Number
2010092963
Authors
Zhang T. Gao C.-Q. Li J.-C. Wang J.-L. Li L.-B. Xiao C.-S.
Institution
(Zhang, Gao, Li, Wang, Li, Xiao) Department of Cardiovascular Surgery,
Chinese PLA General Hospital, No. 28 Fu Xing Road, Beijing 100853, China.
Title
Effect of subzero-balanced ultrafiltration on postoperative outcome of
patients after cardiopulmonary bypass.
Source
Perfusion. 24(6)(pp 401-408), 2009. Date of Publication: November 2009.
Publisher
SAGE Publications Ltd
Abstract
Objective: To evaluate the effect of a new ultrafiltration technique -
subzero-balanced ultrafiltration technique - on early postoperative
outcomes of adult patients undergoing cardiac operations with
cardiopulmonary bypass. Methods: A total of 120 patients who required
cardiopulmonary bypass for cardiac surgery were randomized into two
groups, 60 in each group. Patients in the treatment group received
subzero-balanced ultrafiltration during cardiopulmonary bypass, while
patients in the control group received routine cardiopulmonary bypass.
Postoperative outcomes, including hospital mortality and morbidity of the
two groups, were analyzed. Results: Hospital mortality was 0% (0 of 60) in
the treatment group versus 1.8% (1 of 60) in the control group (P=1.000).
Total hospital complications was lower in the treated patients (11 of 60
[18.3%] versus 22 of 60 [36.7%], P=0.025). Duration of intubation time was
shorter and transfusion volume within 24 hours postoperatively was less in
patients having received subzero-balanced ultrafiltration during
cardiopulmonary bypass (14.35 +/- 1.66 versus 18.64 +/- 1.57 h, P=0.036
and 1.54 +/- 1.56 versus 3.64 +/- 2.67 U/patient, P=0.032). Length of stay
on the intensive care unit, duration of hospital stay, need for infusion
of inotropic agent and drainage volumes within 24 h postoperatively
between the two groups were comparable. Conclusions: Subzero-balanced
ultrafiltration during cardiopulmonary bypass can effectively decrease the
patients hospital morbidity and the volume of blood transfusion: it also
may promote early postoperative recovery of patients. Routine application
of subzero-balanced ultrafiltration during adult cardiac operations should
not be necessary, but the technique should be compared to other
techniques, e.g. MUF, in further studies.
<8>
Accession Number
2010116028
Authors
Toole J.M. Ikonomidis J.S. Szeto W.Y. Zellner J.L. Mulcahy J. Deardorff
R.L. Spinale F.G.
Institution
(Toole, Ikonomidis, Mulcahy, Deardorff, Spinale) Medical University of
South Carolina, Charleston, SC, United States.
(Toole, Ikonomidis, Mulcahy, Deardorff, Spinale) Ralph H. Johnson VA
Medical Center, Charleston, SC, United States.
(Szeto) University of Pennsylvania, Philadelphia, Pa, United States.
(Zellner) University of Tennessee at Chattanooga, Chattanooga, Tenn,
United States.
Title
Selective endothelin-1 receptor type A inhibition in subjects undergoing
cardiac surgery with preexisting left ventricular dysfunction: Influence
on early postoperative hemodynamics.
Source
Journal of Thoracic and Cardiovascular Surgery. 139(3)(pp 646-654), 2010.
Date of Publication: March 2010.
Publisher
Mosby Inc.
Abstract
Objective: A robust release of endothelin-1 with subsequent endothelin-A
subtype receptor activation occurs in patients after cardiac surgery
requiring cardiopulmonary bypass. Increased endothelin-A subtype receptor
activation has been identified in patients with poor left ventricular
function (reduced ejection fraction). Accordingly, this study tested the
hypothesis that a selective endothelin-A subtype receptor antagonist
administered perioperatively would favorably affect post-cardiopulmonary
bypass hemodynamic profiles in patients with a preexisting poor left
ventricular ejection fraction. Methods: Patients (n = 29; 66 +/- 2 years)
with a reduced left ventricular ejection fraction (37% +/- 2%) were
prospectively randomized in a blinded fashion, at the time of elective
coronary revascularization or valve replacement requiring cardiopulmonary
bypass, to infusion of the highly selective and potent endothelin-A
subtype receptor antagonist sitaxsentan at 1 or 2 mg/kg (intravenous
bolus; n = 9, 10 respectively) or vehicle (saline; n = 10). Infusion of
the endothelin-A subtype receptor antagonist/vehicle was performed
immediately before separation from cardiopulmonary bypass and again at 12
hours after cardiopulmonary bypass. Endothelin and hemodynamic
measurements were performed at baseline, at separation from
cardiopulmonary bypass (time 0), and at 0.5, 6, 12, and 24 hours after
cardiopulmonary bypass. Results: Baseline plasma endothelin (4.0 +/- 0.3
fmol/mL) was identical across all 3 groups, but when compared with
preoperative values, baseline values obtained from age-matched subjects
with a normal left ventricular ejection fraction (n = 37; left ventricular
ejection fraction > 50%) were significantly increased (2.9 +/- 0.2
fmol/mL, P < .05). Baseline systemic (1358 +/- 83 dynes/sec/cm-5) and
pulmonary (180 +/- 23 dynes/sec/cm-5) vascular resistance were equivalent
in all 3 groups. As a function of time 0, systemic vascular resistance
changed in an equivalent fashion in the post-cardiopulmonary bypass
period, but a significant endothelin-A subtype receptor antagonist effect
was observed for pulmonary vascular resistance (analysis of variance; P <
.05). For example, at 24 hours post-cardiopulmonary bypass, pulmonary
vascular resistance increased by 40 dynes/sec/cm-5 in the vehicle group
but directionally decreased by more than 40 dynes/sec/cm-5 in the 2 mg/kg
endothelin-A subtype receptor antagonist group (P < .05). Total adverse
events were equivalently distributed across the endothelin-A subtype
receptor antagonist/placebo groups. Conclusion: These unique findings
demonstrated that infusion of an endothelin-A subtype receptor antagonist
in high-risk patients undergoing cardiac surgery was not associated with
significant hemodynamic compromise. Moreover, the endothelin-A subtype
receptor antagonist favorably affected pulmonary vascular resistance in
the early postoperative period. Thus, the endothelin-A subtype receptor
serves as a potential pharmacologic target for improving outcomes after
cardiac surgery in patients with compromised left ventricular function.
copyright 2010 The American Association for Thoracic Surgery.
<9>
Accession Number
2010115993
Authors
Weltert L. D'Alessandro S. Nardella S. Girola F. Bellisario A. Maselli D.
De Paulis R.
Institution
(Weltert, D'Alessandro, Nardella, Girola, Bellisario, Maselli, De Paulis)
Cardiac Surgery Department, European Hospital, Rome, Italy.
Title
Preoperative very short-term, high-dose erythropoietin administration
diminishes blood transfusion rate in off-pump coronary artery bypass: A
randomized blind controlled study.
Source
Journal of Thoracic and Cardiovascular Surgery. 139(3)(pp 621-627), 2010.
Date of Publication: March 2010.
Publisher
Mosby Inc.
Abstract
Objective: Human recombinant erythropoietin has been used to obtain a
rapid increase in red blood cells before surgery. Previously, the shortest
preparatory interval has been 4 days, but at the European Hospital only
2.4 days on average separate hospitalization and surgery. We therefore
proposed a randomized blind trial to test the efficacy of high-dose
erythropoietin for very short-term administration. Methods: All patients
presenting with a diagnosis of isolated coronary vessel disease were
randomized to either erythropoietin therapy or a control group. Patients
with a creatinine level greater than 2 mg/dL or hemoglobin level greater
than 14.5 g/dL were excluded. Hemoglobin values were collected
preoperatively and on postoperative days 1 and 4. Blood loss and blood
transfusion rate were recorded at the time of discharge. Results: We
enrolled 320 consecutive patients in the study. No significant difference
was found in preoperative parameters, postoperative blood loss, or mean
preoperative hemoglobin levels. On postoperative day 4, mean hemoglobin
was 15.5% higher in the erythropoietin group (10.70 +/- 0.72 g/dL vs 9.26
+/- 0.71 g/dL; P < .05). This group required 0.33 units of blood per
patient, whereas the controls required 0.76 units per patient (risk ratio
0.43, P = .008). Conclusion: A significant reduction in transfusion rate
and a significant increase in hemoglobin values were observed in the
erythropoietin group. No adverse events related to erythropoietin
administration were recorded. A very short preoperative erythropoietin
administration seems to be a safe and easy method to reduce the need for
blood transfusions. copyright 2010 The American Association for Thoracic
Surgery.
<10>
Accession Number
2010115982
Authors
Markman P.L. Rowland M.A. Leong J.-Y. Van Der Merwe J. Storey E. Marasco
S. Negri J. Bailey M. Rosenfeldt F.L.
Institution
(Markman, Rowland, Leong, Van Der Merwe, Marasco, Negri, Rosenfeldt)
Cardiac Surgical Research Unit, Alfred Hospital, Australia.
(Storey) Department of Neurology, Alfred Hospital, Department of Medicine
(Neuroscience), Melbourne, Australia.
(Bailey) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia.
Title
Skeletonized internal thoracic artery harvesting reduces chest wall
dysesthesia after coronary bypass surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 139(3)(pp 674-679), 2010.
Date of Publication: March 2010.
Publisher
Mosby Inc.
Abstract
Objective: A pain syndrome related to intercostal nerve injury during
internal thoracic artery harvesting causes significant morbidity after
coronary bypass surgery. We hypothesized that its incidence and severity
might be reduced by using skeletonized internal thoracic artery harvesting
rather than pedicled harvesting. Methods: In a prospective double-blind
clinical trial, 41 patients undergoing coronary bypass were randomized to
receive either unilateral pedicled or skeletonized internal thoracic
artery harvesting. Patients were assessed 7 (early) and 21 (late) weeks
postoperatively with reproducible sensory stimuli used to detect chest
wall sensory deficits (dysesthesia) and with a pain questionnaire used to
assess neuropathic pain. Results: At 7 weeks postoperatively, the area of
harvest dysesthesia (percentage of the chest) in the skeletonized group (n
= 21) was less (median, 0%; interquartile range, 0-0) than in the pedicled
group (n = 20) (2.8% [0-13], P = .005). The incidence of harvest
dysesthesia at 7 weeks was 14% in the skeletonized group versus 50% in the
pedicled group (P = .02). These differences were not sustained at 21
weeks, as the median area of harvest dysesthesia in both groups was 0% (P
= .89) and the incidence was 24% and 25% in the skeletonized and pedicled
groups, respectively (P = 1.0). The incidence of neuropathic pain in the
skeletonized group compared with the pedicled group was 5% versus 10% (P =
.6) at 7 weeks and 0% versus 0% (P = 1.0) at 21 weeks. Conclusions:
Compared with pedicled harvesting, skeletonized harvesting of the internal
thoracic artery provides a short-term reduction in the extent and
incidence of chest wall dysesthesia after coronary bypass, consistent with
reduced intercostal nerve injury and therefore the reduced potential for
neuropathic chest pain. copyright 2010 The American Association for
Thoracic Surgery.
<11>
Accession Number
2010112490
Authors
Van Bommel R.J. Bax J.J. Abraham W.T. Chung E.S. Pires L.A. Tavazzi L.
Zimetbaum P.J. Gerritse B. Kristiansen N. Ghio S.
Institution
(Van Bommel, Bax) Leiden University Medical Center, Albinusdreef 2, 2333
ZA, Leiden, Netherlands.
(Abraham) Ohio State University Heart Center, Columbus, OH, United States.
(Chung) Lindner Clinical Trial Center, Christ Hospital, Cincinnati, OH,
United States.
(Pires) Division of Cardiology, Heart Rhythm Center, St John Hospital,
Detroit, MI, United States.
(Tavazzi) GVM Hospitals of Care and Research, Cotignola, Italy.
(Zimetbaum) Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, United States.
(Gerritse, Kristiansen) Medtronic Bakken Research Center, Maastricht,
Netherlands.
(Ghio) Divisione di Cardiologia, Fondazione IRCCS Policlinico S. Matteo,
Pavia, Italy.
Title
Characteristics of heart failure patients associated with good and poor
response to cardiac resynchronization therapy: A PROSPECT (Predictors of
Response to CRT) sub-analysis.
Source
European Heart Journal. 30(20)(pp 2470-2477), 2009. Date of Publication:
October 2009.
Publisher
Oxford University Press
Abstract
AimsPredictors of Response to Cardiac Resynchronization Therapy (CRT)
(PROSPECT) was the first large-scale, multicentre clinical trial that
evaluated the ability of several echocardiographic measures of mechanical
dyssynchrony to predict response to CRT. Since response to CRT may be
defined as a spectrum and likely influenced by many factors, this
sub-analysis aimed to investigate the relationship between baseline
characteristics and measures of response to CRT.Methods and resultsA total
of 286 patients were grouped according to relative reduction in left
ventricular end-systolic volume (LVESV) after 6 months of CRT:
super-responders (reduction in LVESV [greater-than or equal to]30),
responders (reduction in LVESV 15-29), non-responders (reduction in LVESV
0-14), and negative responders (increase in LVESV). In addition, three
subgroups were formed according to clinical and/or echocardiographic
response: +/+ responders (clinical improvement and a reduction in LVESV
[greater-than or equal to]15), +/-responders (clinical improvement or a
reduction in LVESV [greater-than or equal to]15), and-/-responders (no
clinical improvement and no reduction in LVESV [greater-than or equal
to]15). Differences in clinical and echocardiographic baseline
characteristics between these subgroups were analysed. Super-responders
were more frequently females, had non-ischaemic heart failure (HF), and
had a wider QRS complex and more extensive mechanical dyssynchrony at
baseline. Conversely, negative responders were more frequently in New York
Heart Association class IV and had a history of ventricular tachycardia
(VT). Combined positive responders after CRT (+/+ responders) had more
non-ischaemic aetiology, more extensive mechanical dyssynchrony at
baseline, and no history of VT.ConclusionSub-analysis of data from
PROSPECT showed that gender, aetiology of HF, QRS duration, severity of
HF, a history of VT, and the presence of baseline mechanical dyssynchrony
influence clinical and/or LV reverse remodelling after CRT. Although
integration of information about these characteristics would improve
patient selection and counselling for CRT, further randomized controlled
trials are necessary prior to changing the current guidelines regarding
patient selection for CRT.
<12>
Accession Number
2010104550
Authors
Torgersen C. Dunser M.W. Wenzel V. Jochberger S. Mayr V. Schmittinger C.A.
Lorenz I. Schmid S. Westphal M. Grander W. Luckner G.
Institution
(Torgersen, Wenzel, Jochberger, Mayr, Schmittinger, Lorenz, Schmid,
Luckner) Department of Anaesthesiology and Critical Care Medicine,
Innsbruck Medical University, Innsbruck, Austria.
(Dunser) Department of Intensive Care Medicine, Inselspital,
Freiburgerstrasse, Bern 3010, Switzerland.
(Westphal) Department of Anesthesiology and Intensive Care, University
Hospital of Muenster, Muenster, Germany.
(Grander) Department of Internal Medicine, Community Hospital Hall in
Tirol, Hall in Tirol, Austria.
Title
Comparing two different arginine vasopressin doses in advanced
vasodilatory shock: A randomized, controlled, open-label trial.
Source
Intensive Care Medicine. 36(1)(pp 57-65), 2010. Date of Publication:
January 2010.
Publisher
Springer Verlag
Abstract
Purpose: To compare the effects of two arginine vasopressin (AVP) dose
regimens on the hemodynamic response, catecholamine requirements, AVP
plasma concentrations, organ function and adverse events in advanced
vasodilatory shock. Methods: In this prospective, controlled, open-label
trial, patients with vasodilatory shock due to sepsis, systemic
inflammatory response syndrome or after cardiac surgery requiring
norepinephrine >0.6 mug/kg/min were randomized to receive a supplementary
AVP infusion either at 0.033 IU/min (n = 25) or 0.067 IU/min (n = 25). The
hemodynamic response, catecholamine doses, laboratory and organ function
variables as well as adverse events (decrease in cardiac index or platelet
count, increase in liver enzymes or bilirubin) were recorded before, 1,
12, 24 and 48 h after randomization. A linear mixed effects model was used
for statistical analysis in order to account for drop-outs during the
observation period. Results: Heart rate and norepinephrine requirements
decreased while MAP increased in both groups. Patients receiving AVP at
0.067 IU/min required less norepinephrine (P = 0.006) than those infused
with AVP at 0.033 IU/min. Arterial lactate and base deficit decreased
while arterial pH increased in both groups. During the observation period,
AVP plasma levels increased in both groups (both P < 0.001), but were
higher in the 0.067 IU/min group (P < 0.001) and in patients on
concomitant hydrocortisone. The rate of adverse events and intensive care
unit mortality was comparable between groups (0.033 IU/min, 52%; 0.067
IU/min, 52%; P = 1). Conclusions: A supplementary AVP infusion of 0.067
IU/min restores cardiovascular function in patients with advanced
vasodilatory shock more effectively than AVP at 0.033 IU/min. copyright
2009 Copyright jointly hold by Springer and ESICM.
<13>
[Use Link to view the full text]
Accession Number
2010100528
Authors
Moller C.H. Perko M.J. Lund J.T. Andersen L.W. Kelbaek H. Madsen J.K.
Winkel P. Gluud C. Steinbruchel D.A.
Institution
(Moller, Perko, Lund, Steinbruchel) Departments of Cardiothoracic Surgery,
Rigshospitalet, Copenhagen University Hospital, Denmark.
(Andersen) Departments of Cardiothoracic Anesthesiology, Rigshospitalet,
Copenhagen University Hospital, Denmark.
(Kelbaek) Departments of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Denmark.
(Madsen) Department of Cardiology, Gentofte Hospital, Copenhagen
University Hospital,
(Moller, Winkel, Gluud) Center for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Title
No major differences in 30-day outcomes in high-risk patients randomized
to off-pump versus on-pump coronary bypass surgery: The best bypass
surgery trial.
Source
Circulation. 121(4)(pp 498-504), 2010. Date of Publication: February
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-:Off-pump coronary artery bypass grafting compared with
coronary revascularization with cardiopulmonary bypass seems safe and
results in about the same outcome in low-risk patients. Observational
studies indicate that off-pump surgery may provide more benefit in
high-risk patients. Our objective was to compare 30-day outcomes in
high-risk patients randomized to coronary artery bypass grafting without
or with cardiopulmonary bypass. Methods and Results-: We randomly assigned
341 patients with a EuroSCORE [greater-than or equal to]5 and 3-vessel
coronary disease to undergo coronary artery bypass grafting without or
with cardiopulmonary bypass. Patients were followed through the Danish
National Patient Registry. The primary outcome was a composite of adverse
cardiac and cerebrovascular events (ie, all-cause mortality, acute
myocardial infarction, cardiac arrest with successful resuscitation, low
cardiac output syndrome/cardiogenic shock, stroke, and coronary
reintervention). An independent adjudication committee blinded to
treatment allocation assessed the outcomes. Baseline characteristics were
well balanced between groups. The mean number of grafts per patient did
not differ significantly between groups (3.22 in off-pump group and 3.34
in on-pump group; P=0.11). Fewer grafts were performed to the lateral part
of the left ventricle territory during off-pump surgery (0.97 versus 1.14
after on-pump surgery; P=0.01). No significant differences in the
composite primary outcome (15% versus 17%; P=0.48) or the individual
components were found at 30-day follow-up. Conclusions-: Both off-and
on-pump coronary artery bypass grafting can be performed in high-risk
patients with low short-term complications. copyright 2010 American Heart
Association, Inc.
<14>
Accession Number
2010074108
Authors
Freynet A. Falcoz P.-E.
Institution
(Freynet) Department of Thoracic and Cardiovascular Surgery, Jean-Minjoz
University Hospital, Besancon, France.
(Falcoz) Department of Thoracic Surgery, University Hospital, Strasbourg,
France.
Title
Is transcutaneous electrical nerve stimulation effective in relieving
postoperative pain after thoracotomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(2)(pp 283-288), 2010.
Date of Publication: 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was whether the use of transcutaneous electrical
nerve stimulation (TENS) is effective in reducing post-thoracotomy pain.
Of the 74 papers found with a report search, nine prospective randomized
controlled trials (RCT), among which three were double-blind, presented
the best evidence to answer the clinical question. All investigated the
effect of TENS as an adjunct therapy for relieving acute post-thoracotomy
pain in patients undergoing thoracic surgery. The authors, journal, date
and country of publication, study type, group studied, relevant outcomes
and results of these papers are given. We conclude that a vast majority -
seven of the nine retrieved studies - were in favor of TENS as an adjuvant
to narcotic analgesics for improving outcome after thoracic surgery.
Indeed, the interest and benefit has been shown not only in the treatment
of acute post-thoracotomy pain (pain scores and narcotic requirements were
consistently lower in the TENS group as opposed to the Placebo-TENS
group), but also when used together with narcotic analgesics to reduce the
duration of recovery room stay and to increase chest physical tolerance
(better coughing attempts during chest physiotherapy) with positive
effects on pulmonary ventilator function wforced expiratory volume in 1 s
(FEV1) andyor forced vital capacity (FVC)x. Specifically, the TENS
treatment was shown to be ineffective when used alone in severe
post-thoracotomy pain (i.e. posterolateral thoracotomy incision), but
useful as an adjunct to other medications in moderate post-thoracotomy
pain (i.e. muscle sparing thoracotomy incision) and very effective as the
sole pain-control treatment in patients experiencing mild post-thoracotomy
pain (i.e. video-assisted thoracoscopy incision). Hence, current evidence
shows TENS associated with postoperative medications to be safe and
effective in alleviating postoperative pain and in improving patient
recovery, thus enhancing the choice of available medical care and
bettering outcome after thoracic surgery.
<15>
Accession Number
2010074106
Authors
Markar S.R. Kutty R. Edmonds L. Sadat U. Nair S.
Institution
(Markar, Kutty, Edmonds, Sadat, Nair) Department of Cardiothoracic
Surgery, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom.
Title
A meta-analysis of minimally invasive versus traditional open vein harvest
technique for coronary artery bypass graft surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(2)(pp 266-270), 2010.
Date of Publication: 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
The long saphenous vein remains the most commonly used conduit in coronary
artery bypass surgery. Vein harvest is a critical component of this
operation with significant morbidity associated with large leg wounds from
open techniques. Here, we analyse the available literature comparing
minimally invasive techniques vs. the traditional open method for vein
harvest. A systematic literature search of Medline, Embase and Cochrane
databases was performed using the following terms; 'saphenous vein',
'coronary artery bypass', 'tissue and organ harvesting' and 'endoscopic'.
Relevant papers were then analysed using Statsdirect software. There was
significantly reduced leg wound infection, leg wound haematoma and
postoperative pain in the minimally invasive group. There was no
statistical difference between the groups for vein harvest time, length of
hospital stay and incidence of vein injury. There was a significantly
reduced long-term graft patency in veins harvested by a minimally invasive
technique. The results of this meta-analysis demonstrate the operative
advantages of minimally invasive techniques for the purposes of vein
harvest in coronary artery bypass surgery. However, further studies are
required to look at long-term graft patency following minimally invasive
vein harvest as this remains a major concern.
<16>
Accession Number
2009502300
Authors
Gray A.J. Goodacre S. Newby D.E. Masson M.A. Sampson F. Dixon S. Crane S.
Elliott M. Nicholl J.
Institution
(Gray, Masson) Department of Emergency Medicine, Royal Infirmary of
Edinburgh, Edinburgh, United Kingdom.
(Goodacre, Sampson, Dixon, Nicholl) Medical Care Research Unit, University
of Sheffield, Sheffield, United Kingdom.
(Newby) University of Edinburgh, Edinburgh, United Kingdom.
(Crane) Department of Emergency Medicine, Leeds Teaching Hospitals NHS
Trust, Leeds, United Kingdom.
(Elliott) Department of Respiratory Medicine, Leeds Teaching Hospitals NHS
Trust, Leeds, United Kingdom.
Title
A multicentre randomised controlled trial of the use of continuous
positive airway pressure and non-invasive positive pressure ventilation in
the early treatment of patients presenting to the emergency department
with severe acute cardiogenic pulmonary oedema: The 3CPO trial.
Source
Health Technology Assessment. 13(33)(pp i-82), 2009. Date of Publication:
2009.
Publisher
National Co-ordinating Centre for HTA
Abstract
Objectives: To determine whether non-invasive ventilation reduces
mortality and whether there are important differences in outcome by
treatment modality. Design: Multicentre open prospective randomised
controlled trial. Setting: Patients presenting with severe acute
cardiogenic pulmonary oedema in 26 emergency departments in the UK.
Participants: Inclusion criteria were age > 16 years, clinical diagnosis
of acute cardiogenic pulmonary oedema, pulmonary oedema on chest
radiograph, respiratory rate > 20 breaths per minute, and arterial
hydrogen ion concentration > 45 nmol/l (pH < 7.35). Interventions:
Patients were randomised to standard oxygen therapy, continuous positive
airway pressure (CPAP) (5-15 cmH2O) or non-invasive positive pressure
ventilation (NIPPV) (inspiratory pressure 8-20 cmH2O, expiratory pressure
4-10 cmH2O) on a 1:1:1 basis for a minimum of 2 hours. Main outcome
measures: The primary end point for the comparison between NIPPV or CPAP
and standard therapy was 7-day mortality. The composite primary end point
for the comparison of NIPPV and CPAP was 7-day mortality and tracheal
intubation rate. Secondary end points were breathlessness, physiological
variables, intubation rate, length of hospital stay and critical care
admission rate. Economic evaluation took the form of a cost-utility
analysis, taken from an NHS (and personal social services) perspective.
Results: In total, 1069 patients [mean age 78 (SD 10) years; 43% male]
were recruited to standard therapy (n = 367), CPAP [n = 346; mean 10 (SD
4) cmH2O] or NIPPV [n = 356; mean 14 (SD 5)/7 (SD 2) cmH2O]. There was no
difference in 7-day mortality for standard oxygen therapy (9.8%) and
non-invasive ventilation (9.5%; p = 0.87). The combined end point of 7-day
death and intubation rate was similar, irrespective of non-invasive
ventilation modality (CPAP 11.7% versus NIPPV 11.1%; p = 0.81). Compared
with standard therapy, non-invasive ventilation was associated with
greater reductions (treatment difference, 95% confidence intervals) in
breathlessness (visual analogue scale score 0.7, 0.2-1.3; p = 0.008) and
heart rate (4/min, 1-6; p = 0.004) and improvement in acidosis (pH 0.03,
0.02-0.04; p < 0.001) and hypercapnia (0.7 kPa, 0.4-0.9; p < 0.001) at 1
hour. There were no treatment-related adverse events or differences in
other secondary outcomes such as myocardial infarction rate, length of
hospital stay, critical care admission rate and requirement for
endotracheal intubation. Economic evaluation showed that mean costs and
QALYs up to 6 months were [pounds]3023 and 0.202 for standard therapy,
[pounds]3224 and 0.213 for CPAP and [pounds]3208 and 0.210 for NIPPV.
Modelling of lifetime costs and QALYs produced values of [pounds]15,764
and 1.597 for standard therapy, [pounds]17,525 and 1.841 for CPAP, and
[pounds]17,021 and 1.707 for NIPPV. These results suggest that both CPAP
and NIPPV accrue more QALYs but at higher cost than standard therapy.
However, these estimates are subject to substantial uncertainty.
Conclusions: Non-invasive ventilatory support delivered by either CPAP or
NIPPV safely provides earlier improvement and resolution of
breathlessness, respiratory distress and metabolic abnormality. However,
this does not translate into improved short-or longer-term survival. We
recommend that CPAP or NIPPV should be considered as adjunctive therapy in
patients with severe acute cardiogenic pulmonary oedema in the presence of
severe respiratory distress or when there is a failure to improve with
pharmacological therapy. Trial registration: Current Controlled Trials
ISRCTN07448447. copyright 2009 Queen's Printer and Controller of HMSO. All
rights reserved.
<17>
Accession Number
2010084204
Authors
Jebeli M. Ghazinoor M. Mandegar M.H. Rasouli M.R. Eghtesadi-Araghi P.
Goodarzynejad H. Mohammadzadeh R. Darehzereshki A. Dianat S.
Institution
(Jebeli, Mandegar) Cardiac Surgery Department, Tehran University of
Medical Sciences, Shariati Hospital, Tehran, Iran, Islamic Republic of.
(Ghazinoor) Cardiac Surgery Department, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of.
(Rasouli, Eghtesadi-Araghi, Mohammadzadeh, Darehzereshki, Dianat) Cardiac
Surgery and Transplantation Research Center (CTRC), Tehran University of
Medical Sciences, Shariati Hospital Complex, North Karegar St.,
1411713135, Tehran, Iran, Islamic Republic of.
(Goodarzynejad) Tehran Heart Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of.
Title
Effect of milrinone on short-term outcome of patients with myocardial
dysfunction undergoing coronary artery bypass graft: A randomized
controlled trial.
Source
Cardiology Journal. 17(1)(pp 73-78), 2010. Date of Publication: 2010.
Publisher
Via Medica
Abstract
Background: Myocardial dysfunction needing inotropic support is a typical
complication after on-pump cardiac surgery. In this study, we evaluate the
effect of milrinone on patients with ventricular dysfunction undergoing
coronary artery bypass graft (CABG). Methods: Seventy patients with
impaired left ventricular function [left ventricular ejection fraction
(LVEF) < 35%] undergoing on-pump CABG were enrolled. Patients were
randomized to receive either an intraoperative bolus of milrinone (50
mug/kg) or saline as placebo followed by a 24-hour infusion of each agent
(0.5 mug/kg/min). Hemodynamic parameters and transthoracic
echocardiographic measurement of systolic and diastolic functions were the
variables evaluated. Results: Serum levels of creatine phosphokinase
(CPK), the MB isoenzyme of creatine kinase (CK-MB), occurrence of
myocardial ischemia or infarction, and mean duration of using inotropic
agents were significantly lower in the milrinone group (p < 0.05). There
were no significant differences between the two groups regarding the
development of ventricular arrhythmia, duration of cardiopulmonary bypass,
intra-aortic balloon pump and inotropic support requirement, duration of
mechanical ventilation, duration of intensive care unit stay and mortality
rate. Although mean pre-operative LVEF was significantly lower in the
milrinone group, there was no significant difference between
post-operative LVEFs. Conclusions: We suggest that perioperative
administration of milrinone in patients undergoing on-pump CABG,
especially those with low LVEF, is beneficial. Copyright copyright 2010
Via Medica.
<18>
Accession Number
2010058572
Authors
Minardi G. Pino P.G. Manzara C.C. Pulignano G. Stefanini G.G. Viceconte
G.N. Leonetti S. Madeo A. Gaudio C. Musumeci F.
Institution
(Minardi, Pino, Manzara, Pulignano, Leonetti) Department of Cardiovascular
Science, S Camillo-Forlanini Hospital, Rome, Italy.
(Stefanini, Viceconte, Leonetti, Madeo, Gaudio, Musumeci) Heart and Great
Vessels Department Attilio Reale, Sapienza University of Rome, Italy.
Title
Preoperative scallop-by-scallop assessment of mitral prolapse using
2D-transthoracic echocardiography.
Source
Cardiovascular Ultrasound. 8(1), 2010. Article Number: 1. Date of
Publication: 2010.
Publisher
BioMed Central Ltd.
Abstract
Background. This study was conducted to assess the accuracy of harmonic
imaging 2D-transthoracic echocardiography (2D-TTE) segmental analysis
compared to surgical findings, in degenerative mitral regurgitation (MR).
Methods. Seventy-seven consecutive patients with severe degenerative MR
were prospectively enrolled. Preoperative 2D-TTE with precise localization
of prolapsing or flailing scallops/segments was performed. All patients
underwent mitral valve surgical repair. Surgical reports (SR), including
valve description, were used as references for comparisons. A
postoperative control 2D-TTE was performed. Results. Out of 462
scallops/segments studied, surgical inspection identified 102 prolapses or
flails (22%), 92 of which had previously been detected by 2D-TTE (90.2%
sensitivity, 100% specificity). Agreement between preoperative 2D-TTE
segmental analysis and SR was 97.8% (k = 0.93; p < 0.0001). Sixty-nine out
of 77 2D-TTE reports were completely concordant with SR (89.6% diagnostic
accuracy). None of the 8 non-concordant 2D-TTE reports were in complete
disagreement with SR. P2 scallop was always involved in posterior leaflet
prolapse or flail and was described correctly by 2D-TTE in 68 out of 69
patients (98,7% agreement, k = 0,93; 98.5% sensitivity). The anterior
leaflet was involved in 14 patients (18%); A2 segment was involved in all
of those cases and was correctly detected by 2D-TTE in 13 (98,7%
agreement, k = 0,95; 92,8% sensitivity). Antero-lateral and postero-medial
para-commissural prolapse or flail had a lower prevalence (14% and 10%
respectively), with 2D-TTE sensitivity respectively of 64% and 50%.
Conclusions. 2D-TTE, performed by an experienced echo-lab, has very good
diagnostic accuracy in localizing the scallops/segments involved in
degenerative MR, particularly for the middle ones (P2-A2), which represent
almost the totality of prolapses. More invasive, time consuming and
expensive exams should be reserved to selected cases. copyright 2010
Minardi et al; licensee BioMed Central Ltd.
<19>
Accession Number
2010058525
Authors
Virmani S. Tempe D.K. Pandey B.C. Cheema A.S. Datt V. Garg M. Banerjee A.
Wadhera A.
Institution
(Virmani, Tempe, Pandey, Cheema, Datt, Garg, Wadhera) Department of
Anaesthesiology and Intensive Care, G.B. Pant Hospital, New Delhi, India.
(Banerjee) Department of Cardiothoracic Surgery, G.B. Pant Hospital, New
Delhi, India.
Title
Acute normovolemic hemodilution is not beneficial in patients undergoing
primary elective valve surgery.
Source
Annals of Cardiac Anaesthesia. 13(1)(pp 34-38), 2010. Date of
Publication: January-April 2010.
Publisher
Medknow Publications and Media Pvt. Ltd
Abstract
The objective of this study was to evaluate the effectiveness of acute
normovolemic hemodilution (ANH) as a sole method of reducing allogenic
blood requirement in patients undergoing primary elective valve surgery.
One hundred eighty eight patients undergoing primary elective valve
surgery were prospectively randomized into two groups: Group I (n=100)
acted as control and in Group II (n=88) autologous blood was removed (10%
of estimated blood volume in patients with hemoglobin (Hb) >12g% and 7%
when the Hb was <12g%) in the pre-cardiopulmonary bypass (CPB) period for
subsequent re-transfusion after protamine administration. The autologous
blood withdrawn was replaced simultaneously with an equal volume of
hydroxyl-ethyl starch solution. Banked blood was transfused in both the
groups when Hb was [less-than or equal to]6g% on CPB and [less-than or
equal to]8g% after CPB. Platelets were transfused when the count fell to
<100x 109/L and fresh frozen plasma (FFP) was transfused whenever there
was diffuse bleeding with laboratory evidence of coagulopathy. The two
groups were comparable as regards demographic data, type of surgical
procedures performed, duration of CPB and ischemia, duration of elective
ventilation and re-exploration for excessive bleeding. The autologous
blood withdrawn in patients with Hb[greater-than or equal to]12g% was
288.3+/-69.4 mL and 244.4+/-41.3 mL with Hb<12g% (P=NS). The Hb
concentration (g%) was comparable pre-operatively (Group I=12.1+/-1.6,
Group II=12.4+/-1.4), on postoperative day 1 (Group I=10.3+/-1.1, Group
II=10.6+/-1.2) and day 7 (Group I=10.9+/-1.5, Group II=10.4+/-1.5).
However, the lowest Hb recorded on CPB was significantly lower in Group II
(Group I=7.7+/-1.2, Group II=6.7+/-0.9, P<0.05). There was no difference
in the chest tube drainage (Group I=747.2+/-276.5 mL, Group
II=527.6+/-399.5 mL), blood transfusion (Group I=1.1+/-1.0 units vs. Group
II=1.3+/-1.0 units intra-operatively and Group I=1.7+/-1.2 units vs. Group
II=1.7+/-1.4 units post-operatively) and FFP transfusion (Group
I=581.4+/-263.4 mL, Group II=546.5+/-267.8 mL) in the two groups. We
conclude that low volume autologous blood pre-donation does not seem to
provide any added advantage as a sole method of reducing allogenic blood
requirement in primary elective valve surgery.
<20>
Accession Number
2010058524
Authors
Sharma M. Mehta Y. Sawhney R. Vats M. Trehan N.
Institution
(Sharma, Mehta, Sawhney, Vats, Trehan) Department of Anesthesiology and
Critical Care and Cardiothoracic Surgery, Indraprastha Apollo Hospitals,
New Delhi, India.
Title
Thoracic epidural analgesia in obese patients with body mass index of more
than 30 kg/m2 for off pump coronary artery bypass surgery.
Source
Annals of Cardiac Anaesthesia. 13(1)(pp 28-33), 2010. Date of
Publication: January-April 2010.
Publisher
Medknow Publications and Media Pvt. Ltd
Abstract
Perioperative Thoracic epidural analgesia (TEA) is an important part of a
multimodal approach to improve analgesia and patient outcome after cardiac
and thoracic surgery. This is particularly important for obese patients
undergoing off pump coronary artery bypass surgery (OPCAB). We conducted a
randomized clinical trial at tertiary care cardiac institute to compare
the effect of TEA and conventional opioid based analgesia on perioperative
lung functions and pain scores in obese patients undergoing OPCAB. Sixty
obese patients with body mass index >30 kg/m2 for elective OPCAB were
randomized into two groups (n=30 each). Patients in both the groups
received general anesthesia but in group 1, TEA was also administered. We
performed spirometry as preoperative assessment and at six hours, 24
hours, second, third, fourth and fifth day after extubation, along with
arterial blood gases analysis. Visual analogue scale at rest and on
coughing was recorded to assess the degree of analgesia. The other
parameters observed were: time to endotracheal extubation, oxygen
withdrawal time and intensive care unit length of stay. On statistical
analysis there was a significant difference in Vital Capacity at six
hours, 24 hours, second and third day postextubation. Forced vital
capacity and forced expiratory volume in one second followed the same
pattern for first four postoperative days and peak expiratory flow rate
remained statistically high till second postoperative day. ABG values and
PaO2/FiO2 ratio were statistically higher in the study group up to five
days. Visual analogue scale at rest and on coughing was significantly
lower till fourth and third postoperative day respectively. Tracheal
extubation time, oxygen withdrawal time and ICU stay were significantly
less in group 1. The use of TEA resulted in better analgesia, early
tracheal extubation and shorter ICU stay and should be considered for
obese patients undergoing OPCAB.
<21>
Accession Number
2010058522
Authors
Menda F. Koner O. Sayin M. Ture H. Imer P. Aykac B.
Institution
(Menda, Koner, Sayin, Ture, Imer, Aykac) Department of Anesthesiology,
Yeditepe University, Kozyatagi, Istanbul, Turkey.
Title
Dexmedetomidine as an adjunct to anesthetic induction to attenuate
hemodynamic response to endotracheal intubation in patients undergoing
fast-track CABG.
Source
Annals of Cardiac Anaesthesia. 13(1)(pp 16-21), 2010. Date of
Publication: January-April 2010.
Publisher
Medknow Publications and Media Pvt. Ltd
Abstract
During induction of general anesthesia hypertension and tachycardia caused
by tracheal intubation may lead to cardiac ischemia and arrhythmias. In
this prospective, randomized study, dexmedetomidine has been used to
attenuate the hemodynamic response to endotracheal intubation with low
dose fentanyl and etomidate in patients undergoing myocardial
revascularization receiving beta blocker treatment. Thirty patients
undergoing myocardial revascularization received in a double blind manner,
either a saline placebo or a dexmedetomidine infusion (1 mug/kg) before
the anesthesia induction. Heart rate (HR) and blood pressure (BP) were
monitored at baseline, after placebo or dexmedetomidine infusion, after
induction of general anesthesia, one, three and five minutes after
endotracheal intubation. In the dexmedetomidine (DEX) group systolic
(SAP), diastolic (DAP) and mean arterial pressures (MAP) were lower at all
times in comparison to baseline values; in the placebo (PLA) group SAP,
DAP and MAP decreased after the induction of general anesthesia and five
minutes after the intubation compared to baseline values. This decrease
was not significantly different between the groups. After the induction of
general anesthesia, the drop in HR was higher in DEX group compared to PLA
group. One minute after endotracheal intubation, HR significantly
increased in PLA group while, it decreased in the DEX group. The incidence
of tachycardia, hypotension and bradycardia was not different between the
groups. The incidence of hypertension requiring treatment was
significantly greater in the PLA group. It is concluded that
dexmedetomidine can safely be used to attenuate the hemodynamic response
to endotracheal intubation in patients undergoing myocardial
revascularization receiving beta blockers.
<22>
Accession Number
2010027994
Authors
Solomon R.J. Mehran R. Natarajan M.K. Doucet S. Katholi R.E. Staniloae
C.S. Sharma S.K. Labinaz M. Gelormini J.L. Barrett B.J.
Institution
(Solomon) Department of Renal Services, Fletcher Allen Health Care,
Burlington, VT, United States.
(Mehran) Center for Interventional Vascular Therapy, New York-Presbyterian
Hospital, Columbia University Medical Center, New York, NY, United States.
(Natarajan) Division of Cardiology, Hamilton Health Sciences, Hamilton,
ON, Canada.
(Doucet) Montreal Heart Institute, University of Montreal, Montreal, QC,
Canada.
(Katholi) Department of Medicine, Prairie Educational and Research
Cooperative, St. John's Hospital, Springfield, IL, United States.
(Staniloae) Comprehensive Cardiovascular Center, St. Vincent's Hospital
Manhattan and Medical Center, New York, NY, United States.
(Sharma) Cardiovascular Institute, Mount Sinai Medical Center, New York,
NY, United States.
(Labinaz) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, ON, Canada.
(Gelormini) Interventional Cardiology, Buffalo Heart Group, Buffalo, NY,
United States.
(Barrett) Patient Research Centre, Health Science Center, Memorial
University of Newfoundland, St. John's, NL, Canada.
Title
Contrast-induced nephropathy and long-term adverse events: Cause and
effect?.
Source
Clinical Journal of the American Society of Nephrology. 4(7)(pp
1162-1169), 2009. Date of Publication: 2009.
Publisher
American Society of Nephrology
Abstract
Background and objectives: The relationship of contrast-induced
nephropathy (CIN) to long-term adverse events (AEs) is controversial.
Although an association with AEs has been previously reported, it is
unclear whether CIN is causally related to these AEs. Design, setting,
participants, & measurements: We obtained long-term ([greater-than or
equal to]1 yr) follow-up on 294 patients who participated in a randomized,
double-blind comparison of two prevention strategies for CIN (iopamidol
versus iodixanol). A difference in the incidence of AEs between patients
who had developed CIN and those who had not was performed using a chi2
test and Poisson regression analysis. A similar statistical approach was
used for the differences in AEs between those who received iopamidol or
iodixanol. Multiple definitions of CIN were used to strengthen and
validate the results and conclusions. Results: The rate of long-term AEs
was higher in individuals with CIN (all definitions of CIN). After
adjustment for baseline comorbidities and risk factors, the adjusted
incidence rate ratio for AEs was twice as high in those with CIN.
Randomization to iopamidol reduced both the incidence of CIN and AEs.
Conclusions: The parallel decrease in the incidence of CIN and AEs in one
arm of this randomized trial supports a causal role for CIN. Copyright
copyright 2009 by the American Society of Nephrology.
<23>
Accession Number
2010015032
Authors
Li R. O'Sullivan M.J. Robinson J. Safford M.M. Curb D. Johnson K.C.
Institution
(Li, Johnson) University of Tennessee Health Science Center, Department of
Preventive Medicine, Memphis, TN, United States.
(O'Sullivan) University of Miami, Miller School of Medicine, Department of
Obstetrics and Gynecology, Miami, FL, United States.
(Robinson) University of Iowa, College of Public Health, Department of
Epidemiology, Iowa City, IA, United States.
(Safford) Deep South Center on Effectiveness, Birmingham VA Medical
Center, University of Alabama, Birmingham, AL, United States.
(Curb) Pacific Health Research Institute, Honolulu, HI, United States.
(Li) Office of Population Genomics (OPG), National Human Genome Research
Institute (NHGRI), National Institutes of Health (NIH), 5635 Fishers Lane,
Bethesda, MD 20892-9305, United States.
(Li) Office of Population Genomics (OPG), National Human Genome Research
Institute (NHGRI), National Institutes of Health (NIH), Rockville, MD
20852, United States.
Title
Family history of myocardial infarction predicts incident coronary heart
disease in postmenopausal women with diabetes: The women's health
initiative observational study.
Source
Diabetes/Metabolism Research and Reviews. 25(8)(pp 725-732), 2009. Date
of Publication: November 2009.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Diabetes is a risk factor for coronary heart disease (CHD) but
CHD does not occur in all diabetic individuals. The goal of this study was
to assess the relationship between family history of myocardial infarction
(MI) and incident CHD in diabetic postmenopausal women. Methods: We
conducted a prospective cohort study among 2642 diabetic postmenopausal
women without CHD at baseline in the Women's Health Initiative
Observational Study. Family history was defined as a proband report of MI
in first-degree relatives. Incident CHD was defined as non-fatal MI,
coronary revascularization, or CHD death. Results: During 7.3 (+/-1.8)
years of follow-up, 14.3% of the participants had incident CHD. The risk
of incident CHD was 50% higher (HR = 1.50, 95% CI: 1.20-1.87, p = 0.0003)
in those with a family history of an MI in at least one first-degree
relative, and 79% higher (HR = 1.79, 95% CI: 1.36-2.35, P < 0.0001) if two
or more first-degree relatives had an MI, compared to participants without
a family history, after adjustment for covariates. The CHD risk increased
with elevated systolic blood pressure (SBP) (HR = 1.01, 95% CI:
1.003-1.02, p = 0.001) but decreased with elevated diastolic BP (HR =
0.98, 95% CI: 0.97-0.999, p = 0.005) and with two or more episodes per
week of physical activity (HR = 0.70, 95% CI: 0.52-0.93, p = 0.02).
Conclusions: The results suggest that a family history of MI predicts CHD
in diabetic postmenopausal women. Close attention should be paid to BP
control and physical activity in these women. Copyright copyright 2009
John Wiley & Sons, Ltd.
<24>
Accession Number
2010014882
Authors
Siegel G. Schmidt A. Schafer P. Malmsten M. Ringstad L. Winkler K. Just S.
Institution
(Siegel, Schafer, Malmsten) Charite-Universitatsmedizin Berlin, Campus
Benjamin Franklin, Institute of Physiology, Arnimallee 22, D-14195 Berlin,
Germany.
(Schmidt) Molecular Cardiology, Leibniz-Institute of Arteriosclerosis
Research, University of Munster, D-48149 Munster, Germany.
(Siegel, Malmsten, Ringstad) Department of Physical Chemistry, Institute
of Pharmacy, Uppsala University, S-75123 Uppsala, Sweden.
(Winkler) University Clinic Freiburg, Institute of Clinical Chemistry,
D-79106 Freiburg, Germany.
(Just) Heart Center Cottbus, Department of Cardiac Surgery, D-03048
Cottbus, Germany.
Title
The importance of scavenging reactive oxygen species in anti-aging
medicine.
Source
Engineering in Life Sciences. 9(5)(pp 363-375), 2009. Date of
Publication: October 2009.
Publisher
Wiley-VCH Verlag
Abstract
In a pilot study, we had reported on the beneficial effects of Ginkgo
biloba (EGb 761) on arteriosclerotic nanoplaque formation and size in
cardiovascular high-risk patients who had undergone an aortocoronary
bypass operation. Briefly, nanoplaque formation and size, the ratio
oxLDL/LDL, and the highly atherothrombotic lipoprotein(a) concentration
were substantially reduced, while superoxide dismutase activity and the
blood concentration of the vasodilating substances cAMP and cGMP were
upregulated. Since the arteriosclerosis prophylactic and well-aging
promotive impact of Ginkgo extract has been proven in this pilot study, we
wanted to confirm these beneficial effects through a second observational
clinical trial. The measurable variables formerly used were additionally
supplemented by a wide, novel biomarker spectrum, through which the latest
parameters and markers of plaque stability and progression, oxidative
stress, and inflammation were available. In eleven patients with metabolic
syndrome in the initial stage, the reduction of arteriosclerotic
nanoplaque formation amounted to 14.3+/-2.9% (p<0.0077) and of nanoplaque
size to 23.4+/-3.7% (p<0.0004), respectively, after 2-months of treatment
with Ginkgo biloba extract. Additionally, superoxide dismutase (SOD) and
glutathione peroxidase (GPx) activities were upregulated by 19.6+/-10.0%
(p<0.0785) and 11.6+/-2.3% (p<0.001), respectively, the quotient oxLDL/LDL
lowered by 21.0+/-4.3% (p<0.002), and lipoprotein(a) concentration
decreased by 26.3+/-4.8% (p<0.001) in the patients' blood. The
concentration of cAMP and cGMP was augmented by 43.5+/-12.0% (p<0.001) and
32.9+/-10.4% (p<0.001), respectively. Surprisingly, we found a lowering of
the serum Ca21 concentration by 5.4+/-1.6% (p<0.0076) from 2.37+/-0.03 to
2.24+/-0.04 mmol/L (p<0.0069). Apart from an additional vasodilatory
effect, the lowered extracellular Ca2+ concentration affects nanoplaque
formation restrictively, since this is a Ca2+ driven process. Furthermore,
we could show a favourable development of the biomarkers 8-iso-PGF 2alpha,
oxLDL/LDL, SOD, GPx (oxidative stress), hs-CRP, MPO, TNFalpha, TGFbeta1
(inflammatory status) and MMP-9 (plaque stability). The markers selected
here are suited to provide a comprehensive risk profile for the prevention
of arteriosclerosis. Finally, a multiple regression analysis reveals a
basis for a mechanistic explanation of nanoplaque reduction under Ginkgo
treatment. The arteriosclerosis inhibiting effect is due to an attenuation
of the risk factors oxLDL/LDL, Lp(a), and [Ca2+] o as well as to a
significant increase in the vasodilator cAMP and cGMP concentration. Thus,
Ginkgo with its pleiotropic effects should be assigned a fixed rank among
the anti-aging medical therapeutics as a prophylactic measure, especially
in patients with early-stage metabolic syndrome. copyright 2009 Wiley-VCH
Verlag GmbH & Co. KGaA.
<25>
Accession Number
2010057915
Authors
Eggum R. Ueland T. Mollnes T.E. Videm V. Fiane A.E. Aukrust P. Lindberg
H.L.
Institution
(Eggum, Fiane, Lindberg) Department of Thoracic and Cardiovascular
Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway.
(Eggum) Department of Vascular Surgery, Buskerud Hospital, N-3004 Drammen,
Norway.
(Ueland, Aukrust) Research Institute for Internal Medicine, Oslo
University Hospital, University of Oslo, Oslo, Norway.
(Ueland) Department of Endocrinology, Oslo University Hospital, University
of Oslo, Oslo, Norway.
(Mollnes) Institute of Immunology, Oslo University Hospital, University of
Oslo, Oslo, Norway.
(Videm) Institute of Laboratory Medicine, Children's and Women's Health,
Norwegian University of Science and Technology, Trondheim, Norway.
(Videm) Department of Immunology and Transfusion Medicine, St Olav
University Hospital, Trondheim, Norway.
(Aukrust) Section of Clinical Immunology and Infectious Diseases, Oslo
University Hospital, University of Oslo, Oslo, Norway.
Title
Perfusion temperature, thyroid hormones and inflammation during pediatric
cardiac surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(1)(pp 76-80), 2010.
Date of Publication: January 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
Objectives: During cardiopulmonary bypass (CPB) surgery there are several
alterations in concentrations of thyroid hormones. Although hypothermia
and inflammation have been implicated in the disturbed thyroid axis during
CPB, these issues are far from clear. Methods and results: We measured
serumyplasma concentrations of thyroid hormones and inflammatory mediators
in children with body weight <10 kg, undergoing open heart surgery,
randomized to mild (n=15, 32 degreesC) or moderate (n=15, 25 degreesC)
hypothermia. During CPB there was a marked decrease in triiodothyronine
(T3), free thyroxin (FT4) and thyroid-stimulating hormone (TSH), followed
by a slight increase after 24 h, but without normalization 48 h after CPB.
There was no difference in the thyroid response between the two
hypothermia groups. During CPB the maximal changes in plasma levels of
interleukin (IL)-6 and the chemokines, regulated on activation normal T
cell expressed and secreted (RANTES) and monocyte chemoattractant protein
(MCP)-1 were inversely correlated with the maximal changes in serum levels
of T3. Conclusion: Our findings in this randomized trial do not support a
role for hypothermia as a major cause of altered thyroxin responses in
children undergoing CPB. Our finding may also suggest that in addition to
IL-6, other inflammatory cytokines, such as chemokines, should be further
investigated for their possible influence on the thyroid axis during CPB.
copyright 2010 Published by European Association for Cardio-Thoracic
Surgery. All rights reserved.
<26>
Accession Number
2010057909
Authors
Rubino A.S. Onorati F. Caroleo S. Galato E. Nucera S. Amantea B. Santini
F. Renzulli A.
Institution
(Rubino, Onorati, Nucera, Renzulli) Cardiac Surgery Unit, Magna Graecia
University of Catanzaro, Viale Europa, Localita Germaneto, 88100
Catanzaro, Italy.
(Caroleo, Galato, Amantea) Anaesthesiology Unit, Magna Graecia University,
Catanzaro, Italy.
(Santini) Cardiac Surgery Unit, University of Verona, Verona, Italy.
Title
Impact of clonidine administration on delirium and related respiratory
weaning after surgical correction of acute type-A aortic dissection:
Results of a pilot study.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(1)(pp 58-62), 2010.
Date of Publication: January 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
Delirium and transient neurologic dysfunctions (TND) often complicate the
postoperative course after surgery for acute type-A aortic dissection
(AAD). We evaluated the role of clonidine on neurological outcome and
respiratory function in 30 consecutive patients undergoing surgery for
AAD. Patients were prospectively randomized to receive either clonidine
(0.5 mug/kg bolus, followed by continuous infusion at 1-2 mug/kg/h) or
placebo (NaCl 0.9%) in on starting and throughout the weaning period from
the mechanical ventilation. Incidence of delirium and TND, Delirium
Detection Score (DDS), weaning parameters [respiratory rate to tidal
volume ratio - f/VT; pressure-frequency product (PFP); partial pressure of
arterial oxygen to fractional inspired oxygen concentration (PaO2/FiO2);
partial pressure of carbon dioxide (PaCO2)], weaning duration and
intensive care unit (ICU) length of stay were recorded. The two groups
were similar for preoperative and operative variables and also for the
incidence of postoperative complications. DDS was lower in the clonidine
group (P<0.001). Patients weaned with clonidine showed lower f/VT and PFP,
higher PaO2/FiO2 and PaCO2, lower DDS, weaning period and the related ICU
length of stay (P<0.001). This was further confirmed in patients
developing deliriumyTND. Intravenous clonidine after surgery for AAD
reduces the severity of delirium, improves the respiratory function,
shortens the weaning duration and the ICU length of stay. copyright 2010
Published by European Association for Cardio-Thoracic Surgery. All rights
reserved.
<27>
[Use Link to view the full text]
Accession Number
2010045715
Authors
Desai P.H. Kurian D. Thirumavalavan N. Desai S.P. Ziu P. Grant M. White C.
Landis R.C. Poston R.S.
Institution
(Desai, Kurian, Thirumavalavan, Desai, Ziu, Poston) Department of
Cardiothoracic Surgery, Boston University School of Medicine, Boston, MA,
United States.
(Grant) Department of Surgery, University of Maryland, School of Medicine,
Baltimore, MD, United States.
(White) Department of Radiology, University of Maryland, School of
Medicine, Baltimore, MD, United States.
(Landis) Edmund Cohen Laboratory for Vascular Research, Chronic Disease
Research Center, University of the West Indies, Bridgetown, Barbados.
Title
A randomized clinical trial investigating the relationship between
aprotinin and hypercoagulabilityin off-pump coronary surgery.
Source
Anesthesia and Analgesia. 109(5)(pp 1387-1394), 2009. Date of
Publication: November 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND:: Off-pump coronary artery bypass (OPCAB) surgery is associated
with a hypercoagulable state in which the platelet thrombin receptor,
protease-activated receptor-1 (PAR-1), helps propagate a thrombin burst
within saphenous vein grafts. Aprotinin, used in cardiothoracic surgery
mainly for its antifibrinolytic properties, also spares platelet PAR-1
activation due to thrombin. We hypothesized that this PAR-1 antagonistic
property provides an antithrombotic benefit during OPCAB surgery.
METHODS:: Patients were randomly assigned to receive saline (n = 38) or a
modified full-dose regimen of aprotinin (n = 37) IV during OPCAB surgery.
Blood sampled perioperatively from the coronary sinus, skin wounds, and
systemic circulation was analyzed to test coagulation and platelet
function. Major adverse cardiovascular events were monitored by obtaining
troponin I at 24 h (myocardial infarction), predischarge computed
tomography angiography (vein graft thrombosis), and by clinical
examination for stroke. RESULTS:: Coronary sinus blood obtained
immediately after OPCAB surgery showed significantly less activation in
the aprotinin group, as judged by reduced formation of platelet-leukocyte
conjugates (P < 0.02) and platelet-derived microparticles (P < 0.05). The
aprotinin group showed inhibition of platelet aggregation induced by
thrombin (P = 0.007) but not adenosine diphosphate. Thrombin generation,
defined by F1.2 levels, was significantly reduced by aprotinin in the
coronary sinus but not in skin wound incisions. Major adverse
cardiovascular events were significantly reduced in aprotinin-treated
patients (5.4% vs 29.7%, P < 0.05). Aprotinin also demonstrated
antifibrinolytic properties through diminished red blood cell transfusion
(P < 0.04) and reduced blood loss postoperatively (603 +/- 330 vs 810 +/-
415 mL, P < 0.004). CONCLUSION:: This study demonstrates that aprotinin
protects patients undergoing OPCAB surgery from a hypercoagulable state by
diminishing thrombin-induced platelet activation and thrombin generation
within saphenous vein grafts, while maintaining systemic hemostatic and
antifibrinolytic benefits. These results support further investigation of
aprotinin and other PAR-1 antagonists in OPCAB surgery. Copyright
copyright 2009 International Anesthesia Research Society.
No comments:
Post a Comment