Results Generated From:
EMBASE <1980 to 2010 Week 16>
EMBASE (updates since 2010-04-15)
<1>
Accession Number
0020237039
Authors
Abraham A. Nichol G. Williams K.A. Guo A. deKemp R.A. Garrard L. Davies
R.A. Duchesne L. Haddad H. Chow B. DaSilva J. Beanlands R.S.
Institution
(Abraham, Nichol, Williams, Guo, deKemp, Garrard, Davies, Duchesne,
Haddad, Chow, DaSilva, Beanlands) National Cardiac PET Centre and Division
of Cardiology, Cardiovascular Research Methods Centre, University of
Ottawa Heart Institute, Ottawa, Ontario, Canada.
Title
18F-FDG PET imaging of myocardial viability in an experienced center with
access to 18F-FDG and integration with clinical management teams: the
Ottawa-FIVE substudy of the PARR 2 trial..
Source
Journal of nuclear medicine : official publication, Society of Nuclear
Medicine. 51(4)(pp 567-574), 2010. Date of Publication: Apr 2010.
Abstract
(18)F-FDG PET may assist decision making in ischemic cardiomyopathy. The
PET and Recovery Following Revascularization (PARR 2) trial demonstrated a
trend toward beneficial outcomes with PET-assisted management. The
substudy of PARR 2 that we call Ottawa-FIVE, described here, was a post
hoc analysis to determine the benefit of PET in a center with experience,
ready access to (18)F-FDG, and integration with clinical teams. METHODS:
Included were patients with left ventricular dysfunction and suspected
coronary artery disease being considered for revascularization. The
patients had been randomized in PARR 2 to PET-assisted management (group
1) or standard care (group 2) and had been enrolled in Ottawa after August
1, 2002 (the date that on-site (18)F-FDG was initiated) (n = 111). The
primary outcome was the composite endpoint of cardiac death, myocardial
infarction, or cardiac rehospitalization within 1 y. Data were compared
with the rest of PARR 2 (PET-assisted management [group 3] or standard
care [group 4]). RESULTS: In the Ottawa-FIVE subgroup of PARR 2, the
cumulative proportion of patients experiencing the composite event was 19%
(group 1), versus 41% (group 2). Multivariable Cox proportional hazards
regression showed a benefit for the PET-assisted strategy (hazard ratio,
0.34; 95% confidence interval, 0.16-0.72; P = 0.005). Compared with other
patients in PARR 2, Ottawa-FIVE patients had a lower ejection fraction
(25% +/- 7% vs. 27% +/- 8%, P = 0.04), were more often female (24% vs.
13%, P = 0.006), tended to be older (64 +/- 10 y vs. 62 +/- 10 y, P =
0.07), and had less previous coronary artery bypass grafting (13% vs. 21%,
P = 0.07). For patients in the rest of PARR 2, there was no significant
difference in events between groups 3 and 4. The observed effect of
(18)F-FDG PET-assisted management in the 4 groups in the context of
adjusted survival curves demonstrated a significant interaction (P =
0.016). Comparisons of the 2 arms in Ottawa-FIVE to the 2 arms in the rest
of PARR 2 demonstrated a trend toward significance (standard care, P =
0.145; PET-assisted management, P = 0.057). CONCLUSION: In this post hoc
group analysis, a significant reduction in cardiac events was observed in
patients with (18)F-FDG PET-assisted management, compared with patients
who received standard care. The results suggest that outcome may be
benefited using (18)F-FDG PET in an experienced center with ready access
to (18)F-FDG and integration with imaging, heart failure, and
revascularization teams.
<2>
Accession Number
2010217625
Authors
Hemingway H. Henriksson M. Chen R. Damant J. Fitzpatrick N. Abrams K.
Hingorani A. Janzon M. Shipley M. Feder G. Keogh B. Stenestrand U.
McAllister K. Kaski J.-C. Timmis A. Palmer S. Sculpher M.
Institution
(Hemingway, Chen, Damant, Fitzpatrick, Hingorani, Shipley, McAllister)
Department of Epidemiology and Public Health, University College London,
United Kingdom.
(Henriksson) Centre for Medical Technology Assessment, Linkoping
University, Sweden.
(Henriksson, Palmer, Sculpher) Centre for Health Economics, University of
York, United Kingdom.
(Abrams) Department of Health Sciences, University of Leicester, United
Kingdom.
(Janzon, Stenestrand) Department of Cardiology, Linkoping University,
Sweden.
(Feder) Department of Primary Health Care, University of Bristol, United
Kingdom.
(Keogh) Department of Health, London, United Kingdom.
(Kaski) Cardiovascular Biology Research Centre, St George's, University of
London, United Kingdom.
(Timmis) Barts and the London NHS Trust, London, United Kingdom.
Title
The effectiveness and costeffectiveness of biomarkers for the
prioritisation of patients awaiting coronary revascularisation: A
systematic review and decision model.
Source
Health Technology Assessment. 14(9)(pp 1-178), 2010. Date of Publication:
2010.
Publisher
National Co-ordinating Centre for HTA
Abstract
Objective: To determine the effectiveness and cost-effectiveness of a
range of strategies based on conventional clinical information and novel
circulating biomarkers for prioritising patients with stable angina
awaiting coronary artery bypass grafting (CABG). Data sources: MEDLINE and
EMBASE were searched from 1966 until 30 November 2008. Review methods: We
carried out systematic reviews and meta-analyses of literature-based
estimates of the prognostic effects of circulating biomarkers in stable
coronary disease. We assessed five routinely measured biomarkers and the
eight emerging (i.e. not currently routinely measured) biomarkers
recommended by the European Society of Cardiology Angina guidelines. The
cost-effectiveness of prioritising patients on the waiting list for CABG
using circulating biomarkers was compared against a range of alternative
formal approaches to prioritisation as well as no formal prioritisation. A
decision-analytic model was developed to synthesise data on a range of
effectiveness, resource use and value parameters necessary to determine
costeffectiveness. A total of seven strategies was evaluated in the final
model. Results: We included 390 reports of biomarker effects in our
review. The quality of individual study reports was variable, with
evidence of small study (publication) bias and incomplete adjustment for
simple clinical information such as age, sex, smoking, diabetes and
obesity. The risk of cardiovascular events while on the waiting list for
CABG was 3 per 10,000 patients per day within the first 90 days (184
events in 9935 patients with a mean of 59 days at risk). Risk factors
associated with an increased risk, and included in the basic risk
equation, were age, diabetes, heart failure, previous myocardial
infarction and involvement of the left main coronary artery or
three-vessel disease. The optimal strategy in terms of cost-effectiveness
considerations was a prioritisation strategy employing biomarker
information. Evaluating shorter maximum waiting times did not alter the
conclusion that a prioritisation strategy with a risk score using
estimated glomerular filtration rate (eGFR) was cost-effective. These
results were robust to most alternative scenarios investigating other
sources of uncertainty. However, the cost-effectiveness of the strategy
using a risk score with both eGFR and Creactive protein (CRP) was
potentially sensitive to the cost of the CRP test itself (assumed to be
[pounds]6 in the base-case scenario). Conclusions: Formally employing more
information in the prioritisation of patients awaiting CABG appears to be
a cost-effective approach and may result in improved health outcomes. The
most robust results relate to a strategy employing a risk score using
conventional clinical information together with a single biomarker (eGFR).
The additional prognostic information conferred by collecting the more
costly novel circulating biomarker CRP, singly or in combination with
other biomarkers, in terms of waiting list prioritisation is unlikely to
be cost-effective. copyright 2010 Queen's Printer and Controller of HMSO.
<3>
Accession Number
0020091633
Authors
Hollands G.J. Hankins M. Marteau T.M.
Institution
(Hollands, Hankins, Marteau) Health Psychology Section, King's College
London, 5th Floor, Bermondsey Wing, Guy's Campus, London, UK, SE1 9RT.
Title
Visual feedback of individuals' medical imaging results for changing
health behaviour..
Source
Cochrane database of systematic reviews (Online). (1)(pp CD007434), 2010.
Date of Publication: 2010.
Abstract
BACKGROUND: Feedback of medical imaging results can reveal visual evidence
of actual bodily harm attributable to a given behaviour. This may offer a
particularly promising approach to motivating changes in health behaviour
to decrease risk. Applicable behaviours include smoking cessation, skin
self-examination, sun protection behaviour, dietary intake, physical
activity and medication usage. The current review assembles and evaluates
the evidence concerning the behavioural impact of showing and explaining
images, in order to determine whether their communication is an effective
intervention approach. OBJECTIVES: To assess the extent to which feedback
to individuals of images of their own bodies created during medical
imaging procedures increases or decreases a range of health behaviours.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL, The Cochrane Library, Issue 3 2009), MEDLINE (1950 to 14
September 2009), EMBASE (1980 to 14 September 2009), CINAHL (1982 to 9
October 2009), PsycINFO (1806 to 14 September 2009) and reference lists of
articles. We also contacted authors of selected papers, and searched the
ProQuest Dissertations and Theses database on 1 October 2009 for grey
literature. SELECTION CRITERIA: Randomised or quasi-randomised controlled
trials involving adult (18 years and over) non-pregnant individuals
undergoing medical imaging procedures assessing risk of disease or of an
existing condition, for which personal risk may be reduced by modification
of behaviour. The sole or principal component of included interventions is
visual feedback of individuals' medical imaging results, defined as
individuals being shown, and having explained, source images (still or
moving images) of their bodies generated by the procedure. DATA COLLECTION
AND ANALYSIS: Two authors searched for studies and independently extracted
data from included studies, with disagreements resolved by consensus and a
third author acting as arbiter. The risk of bias of included studies was
assessed and reported in accordance with the guidelines in the Cochrane
Handbook for Systematic Reviews of Interventions. We conducted a narrative
synthesis of the included studies, dividing them into clinical and
non-clinical population groups and presenting major characteristics and
results. Where the studies were sufficiently similar in terms of
population, inclusion criteria, interventions and/or outcomes, we pooled
the data statistically. MAIN RESULTS: We included nine trials involving
1371 participants. Overall, results were mixed. Regarding five trials in
clinical populations, three assessed smoking cessation behaviours, all
featuring arterial scanning procedures to assess cardiovascular risk, and
reported a statistically significant effect favouring the intervention,
producing a pooled odds ratio (OR) of 2.81 (95% confidence interval (CI)
1.23 to 6.41, P = 0.01). One of these trials also measured physical
activity and reported no statistically significant difference between the
groups. A further trial measured skin examination behaviour following a
skin photography procedure for assessing moles, and reported a
statistically significant increase in favour of the intervention, with an
OR of 4.86 (95% CI 1.95 to 12.10, P = 0.0007). The final clinical
population trial measured a range of dietary intake and medication usage
behaviours and featured an arterial scanning procedure assessing
cardiovascular risk, and reported no statistically significant
effects.Among the four trials in non-clinical populations, all featuring
ultraviolet (UV) photography to highlight UV-related skin damage, a
statistically significant result favouring the intervention was found in
one trial for reducing tanning booth use, producing a mean difference (MD)
of -1.10 (95% CI -1.90 to -0.30, P = .007) and one trial reported an
outcome on which the control condition was favoured, with an MD of 0.45
(95% CI 0.04 to 0.86, P = 0.03) on intentional hours spent in the sun. In
two further trials, no statistically significant behavioral effects were
reported regarding time spent in the sun or sun protection
behaviours.There was no evidence of significant adverse effects in the
included trials, although this was not well reported. AUTHORS'
CONCLUSIONS: Due to the limited nature of the available evidence and the
mixed results that were found, no strong statements can be made about the
effectiveness of communicating medical imaging results to change health
behaviour. Only three trials in clinical populations were similar enough
in term of setting, intervention and outcome to allow meta-analysis. We
suggest, however, that targeted interventions using medical imaging
technologies may be effective in certain contexts, or as applied to
certain behaviours, but that this should be considered on an intervention
by intervention basis, and not assumed as a general principle.
<4>
Accession Number
0020091618
Authors
Taylor R.S. Dalal H. Jolly K. Moxham T. Zawada A.
Institution
(Taylor, Dalal, Jolly, Moxham, Zawada) PenTAG, Peninsula Medical School,
University of Exeter, Noy Scott House, Barrack Road, Exeter, UK, EX2 5DW.
Title
Home-based versus centre-based cardiac rehabilitation..
Source
Cochrane database of systematic reviews (Online). (1)(pp CD007130), 2010.
Date of Publication: 2010.
Abstract
BACKGROUND: The burden of cardiovascular disease world-wide is one of
great concern to patients and health care agencies alike. Traditionally
centre-based cardiac rehabilitation (CR) programmes are offered to
individuals after cardiac events to aid recovery and prevent further
cardiac illness. Home-based cardiac rehabilitation programmes have been
introduced in an attempt to widen access and participation. OBJECTIVES: To
determine the effectiveness of home-based cardiac rehabilitation
programmes compared with supervised centre-based cardiac rehabilitation on
mortality and morbidity, health-related quality of life and modifiable
cardiac risk factors in patients with coronary heart disease. SEARCH
STRATEGY: We updated the search of a previous review by searching the
Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane
Library (2007, Issue 4), MEDLINE, EMBASE and CINAHL from 2001 to January
2008. We checked reference lists and sought advice from experts. No
language restrictions were applied. SELECTION CRITERIA: Randomised
controlled trials (RCTs) that compared centre-based cardiac rehabilitation
(e.g. hospital, gymnasium, sports centre) with home-based programmes, in
adults with myocardial infarction, angina, heart failure or who had
undergone revascularisation. DATA COLLECTION AND ANALYSIS: Studies were
selected independently by two reviewers, and data extracted by a single
reviewer and checked by a second one. Authors were contacted where
possible to obtain missing information. MAIN RESULTS: Twelve studies
(1,938 participants) met the inclusion criteria. The majority of studies
recruited a lower risk patient following an acute myocardial infarction
(MI) and revascularisation. There was no difference in outcomes of home-
versus centre-based cardiac rehabilitation in mortality risk ratio (RR)
was1.31 (95% confidence interval (C) 0.65 to 2.66), cardiac events,
exercise capacity standardised mean difference (SMD) -0.11 (95% CI -0.35
to 0.13), as well as in modifiable risk factors (systolic blood pressure;
diastolic blood pressure; total cholesterol; HDL-cholesterol;
LDL-cholesterol) or proportion of smokers at follow up or health-related
quality of life. There was no consistent difference in the healthcare
costs of the two forms of cardiac rehabilitation. AUTHORS' CONCLUSIONS:
Home- and centre-based cardiac rehabilitation appear to be equally
effective in improving the clinical and health-related quality of life
outcomes in acute MI and revascularisation patients. This finding,
together with an absence of evidence of difference in healthcare costs
between the two approaches, would support the extension of home-based
cardiac rehabilitation programmes such as the Heart Manual to give
patients a choice in line with their preferences, which may have an impact
on uptake of cardiac rehabilitation in the individual case.
<5>
Accession Number
0020091510
Authors
Toomtong P. Suksompong S.
Institution
(Toomtong, Suksompong) Department of Anesthesiology, Faculty of Medicine,
Siriraj Hospital, Mahidol University, 2 Prannok Road, Siriraj,
Bangkok-noi, Bangkok, Thailand, 10700.
Title
Intravenous fluids for abdominal aortic surgery..
Source
Cochrane database of systematic reviews (Online). (1)(pp CD000991), 2010.
Date of Publication: 2010.
Abstract
BACKGROUND: Surgery on the abdominal aorta to treat aneurysms or occlusive
disease is a major undertaking which requires intensive physiological
support and fluid management. Blood products are often used but the main
fluid replacement is with crystalloids or colloids. For years there has
been controversy over which fluid is optimal and a number of studies have
examined the subject. This is an update of a Cochrane review first
published in 2000 and previously updated in 2002. OBJECTIVES: To determine
the effectiveness of different non-blood replacement fluids used in
abdominal aorta procedures with a view to identifying the optimal fluid
for use. SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases Group
searched their Specialised Register (August 2009) and the Cochrane Central
Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue
3) for publications describing randomised controlled trials of non-blood
replacement fluids in abdominal aortic surgery. In addition, the reference
lists from retrieved trials were screened for further information about
trials. SELECTION CRITERIA: Randomised controlled trials assessing the
effects of at least one specific non-blood fluid used for replacement
therapy in operations on, and confined to, the abdominal aorta. DATA
COLLECTION AND ANALYSIS: Data were extracted and then entered into the
Review Manager software where statistical analyses were performed. MAIN
RESULTS: Thirty-eight trials involving 1589 patients were included.
Patients undergoing aortic surgery had various physiological parameters
measured before and after their operation (these were cardiac,
respiratory, haematological, and biochemical). Patients were randomised to
a fluid type. This review demonstrated that no single fluid affects any
outcome measure significantly more than another fluid across a range of
outcomes. The death rate in these studies was 2.45% (39 patients).
AUTHORS' CONCLUSIONS: Despite the confirmed beneficial effects of colloids
in this review, further studies are still required. There are no studies
examining the effects of combination fluid therapy. The primary research
outcome was death, for which results were limited; therefore, future
studies should pay more attention to short-term outcomes such as
minimising the need for allogenic blood transfusion, complications (organ
failure), and length of stay in both the intensive care unit and hospital.
<6>
Accession Number
2010174269
Authors
Ma Y. Liu Y. Zuo J.
Institution
(Ma, Liu) Department of Thoracic Surgery, General Hospital of the People's
Liberation Army, Beijing 100853, China.
(Zuo) Department of Thoracic Surgery, Military General Hospital of Beijing
PLA, Beijing 100700, China.
Title
Cryoanalgesia of intercostal nerves following thoracotomy: Clinical trial
based on animal experiment.
Source
Neural Regeneration Research. 4(12)(pp 1083-1087), 2009. Date of
Publication: December 2009.
Publisher
Editorial Board of Neural Regeneration Research
Abstract
BACKGROUND: Cryoanalgesia at -50 degreesC for 90 seconds yields effective
pain relief following thoracotomy. In China, -50 degreesC is a common
temperature for intercostal cryoanalgesia following thoracotomy. However,
experimental results vary. OBJECTIVE: To explore intercostal nerve
pathological changes at -70 degreesC for various freezing times by
studying canines, and to evaluate long-term clinical efficacy of
intercostal nerve cryoanalgesia for postoperative pain relief based on the
animal experiments. DESIGN, TIME AND SETTING: A comparative animal study
was performed at the Animal Experimental Center of the General Hospital of
the People's Liberation Army. Based on results from the animal study, a
randomized, controlled, clinical trial was performed at the Department of
Thoracic Surgery of the General Hospital of the People's Liberation Army
between October 2006 and October 2008. PARTICIPANTS: A total of 120
patients undergoing posterolateral single incision lobectomy at the
Department of Thoracic Surgery of PLA General Hospital between October
2006 and October 2008 were selected. Nervous system diseases were
excluded. METHODS: Animal experiment: 8 anaesthetized, mixed-breed dogs
were used. The intercostal nerves (costal bone 6-10) were frozen at -70
degreesC for varying times (30, 60, 90, 120, and 180 seconds). Clinical
study: 120 patients were randomly assigned to 2 groups (n = 60). In the
cryoanalgesia group, the intercostal nerves were frozen prior to chest
closure, and 4 costal nerves (1 at incision level, 2 above and below
incision, and 1 at drainage tube level) were frozen for 90 seconds at -70
degreesC, respectively. Intercostal nerves were not frozen in the control
group patients. Dolantin was used to relieve postoperative pain in
patients from both groups. MAIN OUTCOME MEASURES: Pathological changes in
frozen intercostal nerves were examined at days 1, 10, 30, and 60
following freezing. Following surgery, the degree of postoperative pain in
all patients was evaluated by visual analogue scale at days 1, 3, 5, 9,
30, 60, 90, and 180. Dolantin doses at days 1, 3, 5, 9 post-surgery and
postoperative complications were noted. RESULTS: Nerve damage
progressively increased with length of freezing time at -70 degreesC, and
recovery time from damage was gradually increased. After freezing for 90
seconds, the nerves exhibited obvious histopathological damage, and then
completely recovered. In addition, after freezing for 180 seconds, the
histopathological changes in nerves were reversible. In the clinical
study, visual analogue scale scores were significantly less in the
cryoanalgesia group compared with the control group (P < 0.01), which was
maintained over 30 days. In the cryoanalgesia group, the mean dolantin
dose administered and postoperative complications were significantly
reduced compared with the control group (P < 0.01). CONCLUSION: Freezing
of the intercostal nerve at -70 degreesC for 90 seconds is a safe and
long-term effective method for relieving post-thoracotomy pain.
<7>
Accession Number
2010155544
Authors
Alghamdi A.A. Elmistekawy E.M. Singh S.K. Latter D.A.
Institution
(Alghamdi, Elmistekawy, Singh, Latter) Division of Cardiac Surgery, St.
Michael's Hospital, University of Toronto, Toronto, Canada.
Title
Is concomitant surgery for moderate functional Mitral regurgitation
indicated during aortic valve replacement for aortic stenosis? a
systematic review and evidence-based recommendations.
Source
Journal of Cardiac Surgery. 25(2)(pp 182-187), 2010. Date of Publication:
March 2010.
Publisher
Blackwell Publishing Inc.
Abstract
Background: Mitral regurgitation (MR) is associated with poor clinical
outcomes. Functional MR is often associated with aortic stenosis (AS) and
may resolve after aortic valve replacement (AVR). The objective of this
study was to derive evidence-based recommendations regarding surgical
intervention for moderate functional MR at the time of AVR for AS.
Methods: An exhaustive literature search strategy including Medline,
Embase, the Cochrane library, and meeting abstracts was performed. Studies
meeting inclusion criteria were critically appraised and data pooled
according to accepted meta-analysis techniques. The primary outcome was
change in moderate MR after isolated AVR. Secondary outcomes were the
impact of functional MR on survival and identifying factors that predict
progression of MR, in patients undergoing isolated AVR for AS. Results:
Thirteen nonrandomized studies including 2113 patients were reviewed. A
total of 268 patients had preoperative moderate functional MR and AS. All
studies were appraised as poor methodological quality. After isolated AVR
a trend toward improvement in MR was observed. Left ventricular
dysfunction, left atrial enlargement, and atrial fibrillation were
associated with progression of MR after AVR. However, the impact of
residual MR on late survival was not consistent. Conclusion: Pooling
current evidence provided inconclusive evidence to make clinical practice
recommendations for or against routine surgical intervention of moderate
MR at the time of AVR for AS. The incidence of this pathology makes
further clinical trial studies warranted. copyright 2009 Wiley
Periodicals, Inc.
<8>
Accession Number
2010152641
Authors
Ramadan A.S.E. Stefanidis C. N'Gatchou W. El Oumeiri B. Jansens J.-L. De
Smet J.-M. Antoine M. De Canniere D.
Institution
(Ramadan, Stefanidis, N'Gatchou, El Oumeiri, Jansens, De Smet, Antoine, De
Canniere) Department of Cardiac Surgery, Erasme Hospital, University of
Brussels (ULB), 808, Route de Lennik, 1070 Brussels, Belgium.
Title
Five years follow-up after Y-graft arterial revascularization: On pump
versus off pump; prospective clinical trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(3)(pp 423-427), 2010.
Date of Publication: March 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
Objectives: We report our comparative experience of on-pump and off-pump
full arterial coronary artery bypass grafting (CABG) using both internal
mammary arteries (IMAs) anastomosed as a Y-graft. Methods: A single-center
clinical study was conducted prospectively between January 2003 and May
2008. It compared the short- and mid-term clinical outcomes of on- and
off-pump arterial revascularization where the left internal mammary artery
(LIMA) was anastomosed to the left anterior descending (LAD) artery while
the free right internal mammary artery (RIMA) graft taking off from the
LIMA was used to bypass different coronary targets. Results: One hundred
and ninety-two patients were divided into 77 on-pump and 115 off-pump
procedures based on the intention to treat. The mean age in both groups
was 60.2+/-11.7 and 68.1+/-10.6 years, respectively (P<0.05). Mean
predictive logistic EuroSCORE was 3.5+/-6.7% for the on-pump group and
7.3+/-8.6% for the off-pump group (P<0.0001). Mean number of distal
anastomoses were 2.7+/-0.6 (group ON) and 2.5+/-0.6 (group OFF) (P=NS).
Postoperative mortality was two patients (2.6%) in the on-pump group and
four patients (3.4%) in the off-pump group (P=0.63). No major adverse
cardiac event, no stroke and no late death were reported during the
follow-up that averaged 36.5+/-18.6 months. Angina recurrence was three
patients (2.6%) in off-pump and two patients (3.5%) in on-pump group
(P=NS). Conclusions: The use of a free RIMA as Y-graft from the LIMA
performed off pump eradicates aortic manipulations and provides complete
revascularization to high-risk patients with mortality similar to the one
of a lower risk population operated on pump. The morbidity and cost was
lower in the off-pump group. This advocates for the widespread usage of
the technique in high-risk patients.
<9>
Accession Number
2010152626
Authors
Gunaydin S. McCusker K. Sari T. Onur M.A. Zorlutuna Y.
Institution
(Gunaydin) University of Kirikkale, Angora Evleri G-8 Bl. No: 1, Ankara
06800, Turkey.
(McCusker) New York Medical College, NY, United States.
(Sari, Zorlutuna) Bayindir Hospital, Ankara, Turkey.
(Onur) Hacettepe University, Ankara, Turkey.
Title
Clinical performance and biocompatibility of hyaluronan-based
heparin-bonded extracorporeal circuits in different risk cohorts.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(3)(pp 371-376), 2010.
Date of Publication: March 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
This prospective randomized study compares novel hyaluronan-based
heparin-bonded circuits vs. uncoated controls across EuroSCORE patient
risk strata including biomaterial evaluation. Over a two-year period, 90
patients undergoing coronary artery bypass grafting were prospectively
randomized to one of the two perfusion protocols: Group 1 was treated with
hyaluronan-based heparin-bonded preconnected circuits (Vision
HFO-GBS[trademark], Gish, CA, USA) and Group 2 with identical uncoated
controls. Each group was composed of three subgroups (n=15) with respect
to preoperative evaluation of low (EuroSCORE 0-2), medium (3-5) and high
(6+) risk patients. Blood samples were collected after induction (T1) and
heparinization (T2), 15 min after cardiopulmonary bypass start (T3),
before cessation of CPB (T4), 15 min after reversal (T5), and the first
postoperative day (T6). In high-risk patients, platelet counts
demonstrated significant preservation at T4, T5 and leukocyte counts were
lower at T5 in hyaluronan group (P[less-than or equal to]0.05 vs.
control). C3a (ng.ml -1) levels were significantly lower at T3 (0.2+/-0.04
vs. 0.31+/-0.05), T4 (0.25+/-0.04 vs. 0.51+/-0.05), T5 (0.38+/-0.04 vs.
0.56+/-0.05) and interleukin-6 (pg.ml -1 ) at T4 (91+/-18 vs. 124+/-20),
T5 (110+/-20 vs. 220+/-25) in coated group vs. control (P[less-than or
equal to]0.05). Protein desorption (microalbumin) on fibers (mg.mm-3) was
less in hyaluronan vs. control groups (P[less-than or equal to]0.05).
Hyaluronan coating reduced platelet adhesion and cell adsorption, and
modulated inflammatory response in high-risk patients.
<10>
[Use Link to view the full text]
Accession Number
2010102114
Authors
Bolognese L. Falsini G. Grotti S. Limbruno U. Liistro F. Carrera A.
Angioli P. Picchi A. Ducci K. Pierli C.
Institution
(Bolognese, Falsini, Grotti, Liistro, Angioli, Ducci) Cardiovascular
Department, San Donato Hospital, Arezzo, Italy.
(Limbruno, Picchi) Department of Cardiology, Misericordia Hospital,
Grosseto, Italy.
(Carrera, Pierli) Cardiovascular Department, University Hospital of Siena,
Siena, Italy.
Title
The contrast media and nephrotoxicity following coronary revascularization
by primary angioplasty for acute myocardial infarction study: Design and
rationale of the CONTRAST-AMI study.
Source
Journal of Cardiovascular Medicine. 11(3)(pp 199-206), 2010. Date of
Publication: March 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Contrast-induced acute kidney injury (CI-AKI) is a complex
syndrome of acute renal failure occurring after the administration of
contrast media and contributing to prolonged hospital stay and mortality.
The risk of CI-AKI is higher among patients undergoing primary
percutaneous coronary interventions for acute myocardial infarction (AMI),
but its clinical relevance in such setting has only been evaluated by
small sample size single-center studies and retrospective or observational
analyses. Furthermore, whereas high-osmolar contrast media was shown to
have direct nephrotoxicity, the role of low-osmolar and iso-osmolar agents
is still debated. Study design: The CONTRAST-AMI study is a prospective,
multicenter, controlled, randomized, single-blind, parallel-group trial,
designed to show the noninferiority of the effects of iopromide
(low-osmolar) compared with iodixanol (iso-osmolar) contrast media on the
incidence of CI-AKI and tissue-level perfusion in patients with AMI. All
consecutive patients admitted to participating centers for ST-segment
elevation AMI undergoing primary percutaneous coronary intervention will
be enrolled. All patients will be treated with high-dose N-acetylcysteine
(1200 mg intravenously during the procedure and 1200 mg orally two times
daily for the next 48 h after percutaneous coronary intervention) and
hydration according to a standardized protocol. The primary endpoint is
the proportion of patients with a relative increase in serum creatinine
(sCr) of at least 25% from baseline to 72 h after agent administration.
The secondary endpoints are absolute and relative increases in sCr of at
least 50%, thrombolysis in myocardial infarction (TIMI) perfusion grade,
and major adverse cardiac events at 1, 6, and 12 months. Conclusion: The
CONTRAST-AMI study will provide information on the effects of iodixanol
and iopromide on the incidence of CI-AKI and tissue-level perfusion in
patients with AMI. copyright 2010 Italian Federation of Cardiology.
<11>
Accession Number
2010205250
Authors
Tanveer R. Khan A.-R. Siddiqi T.A. Siddique S. Nasreen A. Salman-ur-Rehman
Badar S.
Institution
(Tanveer, Khan, Siddiqi, Siddique, Nasreen, Salman-ur-Rehman, Badar)
National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
Title
Continuous versus interrupted technique of ventricular septal defect (VSD)
closure in total correction for tetrology of fallot pertaining to residal
VSD.
Source
Journal of the Pakistan Medical Association. 64(4)(pp 253-256), 2010.
Date of Publication: April, 2010.
Publisher
Pakistan Medical Association
Abstract
Objective: To analyze the outcome of continuous versus interrupted closure
technique of ventricular septal defect (VSD) closure in Tetrology of
Fallot with reference to postoperative residual VSD after total
correction. Methods: A randomised control study was conducted between
January 2008 to December 2008 at The Department of Cardiac Surgery,
National Institute of Cardiovascular Diseases (NICVD), Karachi. The
results of total correction (T.C) of VSD in patients with Tetralogy of
Fallot, with emphasis on the suturing technique and eventually on the
occurrence of residual ventricular septal defect(VSD) were analyzed.
Transventricular as well as transatrial route was used to approach VSD. In
thirty patients VSD was closed with 5/0 proline continuous double ended
suture while in remaining 30(50%) patients VSD was closed with interrupted
5/0 prolene double ended sutures. Postoperative echocardiography was done
in all patients as a routine on second postoperative day, to document
residual VSD. Results: The study included 60 (100%) patients with T.O.F.
There were 20 (33.3%) females and 40 (66.6%) males with ages ranging
between 04 to 18 years (mean 13.025 +/- 2.123 years). Postoperative
echocardiography showed residual VSD in 05 (8.3%) patients at
posteroinferior rim of VSD. Of these 05 cases, in four VSD had been closed
with continuous 5/0 proline double ended sutures, and one had VSD closed
with interrupted 5/0 double ended sutures. Conclusion: Residual VSD is
common with continuous suturing technique as compared to interrupted
suturing technique. This is perhaps because of poor myocardium quality and
higher RV pressures in our patients presenting at a late age. Small (less
than 05 milimeter) residual VSD can be treated conservatively in
haemodynamically stable patients.
<12>
Accession Number
2010171374
Authors
Neumann F.-J.
Institution
(Neumann) Herz-Zentrum, Bad Krozingen, Germany.
Title
Balancing efficacy and safety in the TRITON-TIMI 38 trial.
Source
European Heart Journal, Supplement. 11(G)(pp G14-G17), 2009. Date of
Publication: 2009.
Publisher
Oxford University Press
Abstract
The TRITON-TIMI 38 study tested the hypothesis that prasugrel compared
with clopidogrel is more efficacious in prevention of ischaemic events in
patients undergoing percutaneous coronary intervention (PCI) for either
ST-elevation myocardial infarction or for non-ST-elevation acute coronary
syndromes. In a double-blind design, 13 608 patients were randomly
assigned to receive prasugrel or clopidogrel. During 15-month follow-up,
prasugrel compared with clopidogrel significantly reduced the incidence of
the primary endpoint, the composite of the rate of cardiovascular death,
myocardial infarction, or stroke from 12.1 to 9.9% (hazard ratio: 0.81; P
< 0.001). Significant benefit of prasugrel was found during the first 3
days (hazard ratio: 0.82; P = 0.01) and from day 4 to the end of the study
(hazard ratio: 0.8; P = 0.003). Of the patients treated with prasugrel,
2.4% experienced at least one TIMI major haemorrhage unrelated to coronary
artery bypass graft, compared with 1.8% treated with clopidogrel (hazard
ratio: 1.32; P = 0.03). Thus, in the entire study group, the balance of
efficacy and safety was in favour of prasugrel with an absolute 2.2%
reduction in the primary efficacy endpoint by prasugrel when compared with
clopidogrel that was opposed by an only 0.6% increase in major
haemorrhage. In conclusion, in patients with acute coronary syndromes
undergoing PCI prasugrel significantly reduced the incidence of ischaemic
events, both in the acute and long term. Prasugrel was associated with an
increased risk of bleeding. In the entire cohort, the superior efficacy of
prasugrel outweighed the increased risk of bleeding. copyright The Author
2009.
<13>
Accession Number
2010115239
Authors
Alavi S.M. Kish R.F. Farsad F. Imani F. Sheikhvatan M.
Institution
(Alavi, Kish, Farsad, Imani, Sheikhvatan) Iran University of Medical
Sciences, P.O.Box: 13185-1678, Tehran, Iran, Islamic Republic of.
Title
Intravenous sufentanil and morphine for post-cardiac surgery pain relief
using patient-controlled analgesia (PCA) device: A randomized double-blind
clinical trial.
Source
Pakistan Journal of Medical Sciences. 26(1)(pp 137-141), 2010. Date of
Publication: January-March 2010.
Publisher
Professional Medical Publications
Abstract
Background: Selection of the best analgesic technique in patients
undergoing major surgeries can result in lower morbidity and satisfactory
postoperative pain relief. In the present study, we tried to compare the
effect of morphine and sufentanil on postoperative pain severity and
hemodynamic changes by using patient-controlled analgesia (PCA) device in
patients who were candidate for coronary artery bypass surgery (CABG).
Methodology: It was a randomized double-blinded clinical trial in which
120 patients aged 30-65 years, ASA physical status I-III, candidate for
CABG in Shahid Rajaee hospital in Tehran were included. Before anesthesia,
patients were randomly assigned to one of three groups to receive
sufentanil (n=40), morphine (n=40) or normal saline (n=40). After tracheal
extubation at intensive care unit, PCA was started by, sufentanil 4mg for
the first group, morphine 2mg for the second group and normal saline, at
same volume for the third group, intravenously with 10 minute lockout
interval. Postoperative pain was evaluated by VAS scale, 1, 6, 12, 18 and
24 hours after extubation and systolic blood pressure, arterial oxygen
saturation, PCO2 and PO2 were recorded 24 hours after extubation. Results:
VAS scores at rest revealed significantly less pain for patients in
sufentanil and morphine groups than normal saline group, throughout the
twenty-four hours after operation (P<0.001). However, there were no
significant differences in the means of VAS scores between sufentanil and
morphine groups. Among studied hemodynamic parameters, only systolic blood
pressure was reduced more in morphine than sufentanil group (P<0.001).
Conclusion: After CABG surgery, administration of intravenous sufentanil
and morphine using PCA can lead to similar reduction of postoperative pain
severity.
<14>
Accession Number
2010205284
Authors
Landoni G. Mizzi A. Biondi-Zoccai G. Bignami E. Prati P. Ajello V. Marino
G. Guarracino F. Zangrillo A.
Institution
(Landoni, Mizzi, Bignami, Prati, Ajello, Marino, Zangrillo) Department of
Anesthesiology and Intensive Care, Vita-Salute San Raffaele University,
via Olgettina 60, Milan, 20132, Italy.
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
University of Turin, Turin, Italy.
(Guarracino) Department of Cardiothoracic Surgery, University Hospital of
Pisa, Pisa, Italy.
Title
Levosimendan reduces mortality in critically ill patients. A meta-analysis
of randomized controlled studies.
Source
Minerva Anestesiologica. 76(4)(pp 276-286), 2010. Date of Publication:
April, 2010.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Aim. Critically ill patients often need catecholamines, but these agents
could be associated with an increased risk of death and other adverse
cardiac events. Levosimendan is a calcium sensitizer that is able to
enhance myocardial contractility without increasing myocardial oxygen use.
We conducted a meta-analysis to determine the impact of levosimendan on
mortality in critically ill patients. Methods. Four investigators
independently searched BioMedCentral and PubMed to identify all randomized
trials that compared levosimendan vs. control with no restriction in dose
or time of administration. Exclusion criteria were duplicate publications,
non-human experimental studies, and no information on the primary outcome
(mortality). Results. Data from a total of 3,350 patients from 27
randomized controlled studies were included in the analysis. Levosimendan
was associated with a significant reduction in mortality (333/1893 [17.6%]
in the levosimendan group vs. 326/1457 [22.4%] in the control arm, OR=0.74
[0.62-0.89], P for effect=0.001) and in the rate of myocardial infarction
(3/493 [0.6%] in the levosimendan group vs. 14/356 [3.9%] in the control
arm P=0.007), with a significant increase in the rate of hypotension
(164/1484 [11.1%] in the levosimendan group vs. 106/1093 [9.7%] in the
control arm P=0.02). Conclusion. Levosimendan has cardioprotective effects
that could result in a reduced mortality in critically ill patients. A
large randomized controlled study is warranted in this setting.
<15>
Accession Number
2010205281
Authors
Ranucci M. de Benedetti D. Bianchini C. Castelvecchio S. Ballotta A.
Frigiola A. Menicanti L.
Institution
(Ranucci, de Benedetti, Bianchini, Castelvecchio, Ballotta) Department of
Cardiothoracic-Vascular Anesthesia and Intensive Care, IRCCS S. Donato
Policlinic, Milan, Italy.
(Frigiola, Menicanti) Department of Cardiac Surgery, IRCCS S. Donato
Policlinic, Milan, Italy.
Title
Effects of fenoldopam infusion in complex cardiac surgical operations: A
prospective, randomized, double-blind, placebo-controlled study.
Source
Minerva Anestesiologica. 76(4)(pp 249-259), 2010. Date of Publication:
April, 2010.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Aim. Fenoldopam mesylate is a short-acting dopamine-1 agonist that has
been suggested to be a possible reno-protective agent in patients
undergoing cardiac surgery. The present study is a prospective,
randomized, double-blind placebo controlled trial conducted to determine
the effects of fenoldopam in a population of patients undergoing complex
cardiac operations. Methods. Eighty subjects undergoing complex cardiac
operations with cardiopulmonary bypass (CPB) were enrolled in the study.
Patients were randomly assigned either to the fenoldopam (0.1 mug. kg-1.
min-1) or the placebo group. Fenoldopam infusion started at the onset of
CPB and was maintained for the first twelve postoperative hours. CPB
parameters and renal outcome data were collected. Results. Patients in the
fenoldopam group had higher oxygen delivery during CPB and a significantly
lower perfusion pressure, although this parameter was still within the
normal range. Blood lactate concentrations during CPB were similar in the
two groups. Urine output during and after CPB did not differ between
groups, nor did the renal function parameters. There was a significantly
higher rate of acute kidney injury (AKI) in the placebo group (10% vs 0%).
In the subgroup of patients requiring inotropic support for more than 48
hours, renal function parameters were significantly better, the peak
arterial blood lactate was significantly lower, and the major morbidity
rate was significantly lower (36% vs100%) for patients who received
fenoldopam. Conclusion. Fenoldopam improves the quality of perfusion
during CPB. In patients receiving catecholamines to treat a postoperative
low cardiac output state, fenoldopam significantly improves renal function
and prevents AKI and major morbidity.
<16>
Accession Number
2010190100
Authors
Sanz J. Moreno P.R. Fuster V.
Institution
(Sanz, Moreno, Fuster) The Zena and Michael A. Wiener Cardiovascular
Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular
Health, Mount Sinai School of Medicine, New York, NY, United States.
(Fuster) Centro Nacional de Investigaciones Cardiovasculares, Madrid,
Spain.
Title
The Year in Atherothrombosis.
Source
Journal of the American College of Cardiology. 55(14)(pp 1487-1498),
2010. Date of Publication: 06 Apr 2010.
Publisher
Elsevier USA
<17>
Accession Number
2010190093
Authors
Sorajja P. Gersh B.J. Cox D.A. McLaughlin M.G. Zimetbaum P. Costantini C.
Stuckey T. Tcheng J.E. Mehran R. Lansky A.J. Grines C.L. Stone G.W.
Institution
(Sorajja, Gersh) Division of Cardiovascular Diseases and Internal
Medicine, Mayo Clinic, Mayo Foundation, Rochester, MN, United States.
(McLaughlin, Zimetbaum) Beth Israel Deaconess Medical Center, Boston, MA,
United States.
(Cox) Mid Carolina Cardiology, Charlotte, NC, United States.
(Stuckey) Moses Cone Health System, Greensboro, NC, United States.
(Tcheng) Duke University Medical Center, Durham, NC, United States.
(Grines) William Beaumont Hospital, Royal Oak, MI, United States.
(Costantini, Mehran, Lansky, Stone) College of Physicians and Surgeons,
Columbia University Medical Center, New York, NY, United States.
(Costantini, Mehran, Lansky, Stone) Cardiovascular Research Foundation,
New York, NY, United States.
Title
Impact of Delay to Angioplasty in Patients With Acute Coronary Syndromes
Undergoing Invasive Management. Analysis From the ACUITY (Acute
Catheterization and Urgent Intervention Triage strategY) Trial.
Source
Journal of the American College of Cardiology. 55(14)(pp 1416-1424),
2010. Date of Publication: 06 Apr 2010.
Publisher
Elsevier USA
Abstract
Objectives: The aim of this study was to determine the impact of delay to
angioplasty in patients with acute coronary syndromes (ACS). Background:
There is a paucity of data on the impact of delays to percutaneous
coronary intervention (PCI) in patients with non-ST-segment elevation
acute coronary syndromes (NSTE-ACS) undergoing an invasive management
strategy. Methods: Patients undergoing PCI in the ACUITY (Acute
Catheterization and Urgent Intervention Triage strategY) trial were
stratified according to timing of PCI after clinical presentation for
outcome analysis. Results: Percutaneous coronary intervention was
performed in 7,749 patients (median age 63 years; 73% male) with NSTE-ACS
at a median of 19.5 h after presentation (<8 h [n = 2,197], 8 to 24 h [n =
2,740], and >24 h [n = 2,812]). Delay to PCI >24 h after clinical
presentation was significantly associated with increased 30-day mortality,
myocardial infarction (MI), and composite ischemia (death, MI, and
unplanned revascularization). By multivariable analysis, delay to PCI of
>24 h was a significant independent predictor of 30-day and 1-year
mortality. The incremental risk of death attributable to PCI delay >24 h
was greatest in those patients presenting with high-risk features.
Conclusions: In this large-scale study, delaying revascularization with
PCI >24 h in patients with NSTE-ACS was an independent predictor of early
and late mortality and adverse ischemic outcomes. These findings suggest
that urgent angiography and triage to revascularization should be a
priority in NSTE-ACS patients. copyright 2010 American College of
Cardiology Foundation.
<18>
Accession Number
2010181877
Authors
Taleska G. Trajkovska T. Kokareva A. Popovska A. Naumoska M. Gavrilovska
A. Dzhambazovska-Trajkovska V. Toleska M. Dimov A.
Institution
(Taleska, Trajkovska, Kokareva, Popovska, Naumoska, Gavrilovska,
Dzhambazovska-Trajkovska, Toleska, Dimov) Clinic of Anesthesiology,
Reanimation and Intensive Care, Faculty of Medicine, University Ss Kiril
and Metodij, Skopje, Macedonia.
Title
Preemptive epidural analgesia with bupivacaine and sufentanyl and the
effects of epiduraly added epinephrine for thoracic surgery.
Source
Macedonian Journal of Medical Sciences. 3(1)(pp 46-53), 2010. Date of
Publication: 15 Mar 2010.
Publisher
Institute of Immunobiology and Human Genetics
Abstract
Aim. The aim of the study was to determine if preemptive epidural
analgesia in thoracic surgery reduces postoperative pain, and to compare
these effects in relation to the usage of epinephrine. Material and
Methods. Sixty patients admitted for thoracic surgery were randomly
allocated into three groups (n = 20 each). Group A received bupivacaine
and sufentanyl epiduraly prior to skin incision, followed by infusion of
bupivacaine and sufentanyl. Group B (control) received saline in the
epidural. In both groups patients received bupivacaine and sufentanyl
epiduraly at the time of the chest closure. In Group C the same doses of
bupivacaine and sufentanyl as in Group A were given to the patients
including epinephrine in the epidural mixture. The level of statistical
significance was pointed at p < 0.05. Results. The patients in Group A had
lower intraoperative isofluran requirements, lower postoperative epidural
infusion rates and lower pain scores in first eight postoperative hours,
compared with the control. In the epinephrine group patients had lower
pain intensity and smaller needs for postoperative epidural infusion rate
than those in Group A. Conclusion. The usage of epinephrine has caused
less nausea and easier mobilization. While there was a beneficial effect
of the reduced intraoperative anesthetic requirements, any lasting effect
of preemptive analgesia did not extend beyond eight hours after the
operation. copyright 2010 Taleska G.
