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<1>
Accession Number
0020393932
Authors
Carless P.A. Henry D.A. Moxey A.J. O'Connell D. Brown T. Fergusson D.A.
Institution
(Carless, Henry, Moxey, O'Connell, Brown, Fergusson) Discipline of
Clinical Pharmacology, Faculty of Health, University of Newcastle, Level
5, Clinical Sciences Building, Newcastle Mater Hospital, Edith Street,
Waratah, Newcastle, New South Wales, Australia, 2298.
Title
Cell salvage for minimising perioperative allogeneic blood transfusion..
Source
Cochrane database of systematic reviews (Online). 4(pp CD001888), 2010.
Date of Publication: 2010.
Abstract
BACKGROUND: Concerns regarding the safety of transfused blood have
prompted reconsideration of the use of allogeneic (from an unrelated
donor) red blood cell (RBC) transfusion, and a range of techniques to
minimise transfusion requirements. OBJECTIVES: To examine the evidence for
the efficacy of cell salvage in reducing allogeneic blood transfusion and
the evidence for any effect on clinical outcomes. SEARCH STRATEGY: We
identified studies by searching CENTRAL (The Cochrane Library 2009, Issue
2), MEDLINE (1950 to June 2009), EMBASE (1980 to June 2009), the internet
(to August 2009) and bibliographies of published articles. SELECTION
CRITERIA: Randomised controlled trials with a concurrent control group in
which adult patients, scheduled for non-urgent surgery, were randomised to
cell salvage (autotransfusion) or to a control group who did not receive
the intervention. DATA COLLECTION AND ANALYSIS: Data were independently
extracted and the risk of bias assessed. Relative risks (RR) and weighted
mean differences (WMD) with 95% confidence intervals (CIs) were
calculated. Data were pooled using a random-effects model. The primary
outcomes were the number of patients exposed to allogeneic red cell
transfusion and the amount of blood transfused. Other clinical outcomes
are detailed in the review. MAIN RESULTS: A total of 75 trials were
included. Overall, the use of cell salvage reduced the rate of exposure to
allogeneic RBC transfusion by a relative 38% (RR 0.62; 95% CI 0.55 to
0.70). The absolute reduction in risk (ARR) of receiving an allogeneic RBC
transfusion was 21% (95% CI 15% to 26%). In orthopaedic procedures the RR
of exposure to RBC transfusion was 0.46 (95% CI 0.37 to 0.57) compared to
0.77 (95% CI 0.69 to 0.86) for cardiac procedures. The use of cell salvage
resulted in an average saving of 0.68 units of allogeneic RBC per patient
(WMD -0.68; 95% CI -0.88 to -0.49). Cell salvage did not appear to impact
adversely on clinical outcomes. AUTHORS' CONCLUSIONS: The results suggest
cell salvage is efficacious in reducing the need for allogeneic red cell
transfusion in adult elective cardiac and orthopaedic surgery. The use of
cell salvage did not appear to impact adversely on clinical outcomes.
However, the methodological quality of trials was poor. As the trials were
unblinded and lacked adequate concealment of treatment allocation,
transfusion practices may have been influenced by knowledge of the
patients' treatment status potentially biasing the results in favour of
cell salvage.
<2>
Accession Number
0020100336
Authors
Chan C.W. Kwong Y.L. Kwong R.Y. Lau C.P. Tse H.F.
Institution
(Chan, Kwong, Kwong, Lau, Tse) Cardiology Division, Department of
Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Title
Improvement of myocardial perfusion reserve detected by cardiovascular
magnetic resonance after direct endomyocardial implantation of autologous
bone marrow cells in patients with severe coronary artery disease..
Source
Journal of cardiovascular magnetic resonance : official journal of the
Society for Cardiovascular Magnetic Resonance. 12(1)(pp 6), 2010. Date of
Publication: 2010.
Abstract
BACKGROUND: Recent studies suggested that bone marrow (BM) cell
implantation in patients with severe chronic coronary artery disease (CAD)
resulted in modest improvement in symptoms and cardiac function. This
study sought to investigate the functional changes that occur within the
chronic human ischaemic myocardium after direct endomyocardial BM cells
implantation by cardiovascular magnetic resonance (CMR). METHODS AND
RESULTS: We compared the interval changes of left ventricular ejection
fraction (LVEF), myocardial perfusion reserve and the extent of myocardial
scar by using late gadolinium enhancement CMR in 12 patients with severe
CAD. CMR was performed at baseline and at 6 months after catheter-based
direct endomyocardial autologous BM cell (n = 12) injection to viable
ischaemic myocardium as guided by electromechanical mapping. In patients
randomized to receive BM cell injection, there was significant decrease in
percentage area of peri-infarct regions (-23.6%, P = 0.04) and increase in
global LVEF (+9.0%, P = 0.02), the percentage of regional wall thickening
(+13.1%, P= 0.04) and MPR (+0.25%, P = 0.03) over the target area at
6-months compared with baseline. CONCLUSIONS: Direct endomyocardial
implantation of autologous BM cells significantly improved global LVEF,
regional wall thickening and myocardial perfusion reserve, and reduced
percentage area of peri-infarct regions in patients with severe CAD.
<3>
Accession Number
2010253694
Authors
Weissenbacher A. Bodner J.
Institution
(Weissenbacher, Bodner) Department of Visceral, Transplant and Thoracic
Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck,
Austria.
Title
Robotic Surgery of the Mediastinum.
Source
Thoracic Surgery Clinics. 20(2)(pp 331-339), 2010. Date of Publication:
May 2010.
Publisher
W.B. Saunders
Abstract
Several different mediastinal procedures for benign and malignant diseases
have been proved to be feasible and safe when performed by a robotic
minimally invasive approach. This article reviews the published data on
robotic mediastinal surgery, focusing on technical aspects and
perioperative outcomes. These are evaluated for differences and potential
benefits over open and conventional minimally invasive techniques. Is
there a need for the robot in the mediastinum? Is its application
justified? copyright 2010 Elsevier Inc. All rights reserved.
<4>
Accession Number
2010246187
Authors
Ciszewski A. Bilinska Z.T. Kepka C. Kruk M. Ksiezycka-Majczynska E.
Ruzyllo W.
Institution
(Ciszewski, Bilinska, Kepka, Kruk, Ksiezycka-Majczynska, Ruzyllo) Instytut
Kardiologii, ul. Alpejska 42, 04-628 Warszawa, Poland.
Title
The protective effect of influenza vaccination on the clinical course of
coronary disease in patients with acute coronary syndromes treated by
primary PCI - A report from FLUCAD study.
Source
Postepy w Kardiologii Interwencyjnej. 6(1)(pp 6-11), 2010. Date of
Publication: 2010.
Publisher
Termedia Publishing House Ltd.
Abstract
Background and aim: We compared the protective effect of influenza
vaccination on the clinical course of coronary artery disease (CAD) in
patients (pts) with acute coronary syndrome (ACS) treated by primary
angioplasty (PCI), and in stable angina pts. Methods: Prospective,
randomized 1 : 1, double-blind, placebo controlled study. We included 658
optimally treated CAD pts; 477 men, mean age 59.9 +/- 10.3 years. Median
follow-up was 298 (interquartile range 263-317) days. Results: There were
157 pts (83 - active vaccine, 74 - placebo) vaccinated after primary PCI
in ACS, and 501 pts (242 - vaccine, 259 - placebo) with stable angina. In
stable angina pts there were no significant differences in estimated
12-month cumulative event rates between vaccinated and placebo groups for
the: primary endpoint (cardiovascular death), secondary endpoints: major
adverse cardiac event (MACE) - (cardiovascular death or myocardial
infarction or coronary revascularization) and coronary ischemic event
(composite of MACE or hospitalization for angina). In ACS group, in
vaccinated pts we observed: (1) a significant reduction in the rate of
coronary ischemic event with HR 0.37 (95% CI 0.14-0.99, p = 0.047); (2) a
statistical trend for reduction of MACE with HR 0.36 (95% CI 0.09-1.39; p
= 0.139); (3) no effect on cardiovascular mortality. Conclusions: The
protective effect of influenza vaccination on CAD clinical course was
observed in pts with ACS but not in those with stable angina. Influenza
vaccination may be safely performed immediately after ACS and primary PCI.
<5>
Accession Number
2010260063
Authors
Tully P.J.
Institution
(Tully) Department of Cardiac and Thoracic Surgery, Flinders Medical
Centre, Adelaide, 5042, SA, Australia.
(Tully) School of Psychology, University of Adelaide, North Terrace,
Adelaide, 5005, Adelaide, SA, Australia.
Title
Telephone-delivered collaborative care for post-CABG depression is more
effective than usual care for improving mental-health-related quality of
life.
Source
Evidence-Based Medicine. 15(2)(pp 57-58), 2010. Date of Publication:
April 2010.
Publisher
BMJ Publishing Group
<6>
Accession Number
2010260370
Authors
Stone G.W. Rizvi A. Newman W. Mastali K. Wang J.C. Caputo R. Doostzadeh J.
Cao S. Simonton C.A. Sudhir K. Lansky A.J. Cutlip D.E. Kereiakes D.J.
Institution
(Stone, Lansky) Columbia University Medical Center, New York-Presbyterian
Hospital, Cardiovascular Research Foundation, New York, NY, United States.
(Rizvi) Heart Center of Indiana, Indianapolis, IN, United States.
(Newman) Wake Medical Center, Raleigh, NC, United States.
(Mastali) St. Joseph Medical Center, Towson, MD, United States.
(Wang) Union Memorial Hospital, Baltimore, MD, United States.
(Caputo) St. Joseph's Hospital Syracuse, Syracuse, NY, United States.
(Doostzadeh, Cao, Simonton, Sudhir) Abbott Vascular, Santa Clara, CA,
United States.
(Cutlip) Harvard Clinical Research Institute, Boston, United States.
(Kereiakes) Christ Hospital Heart and Vascular Center-Lindner Research
Center, Cincinnati, United States.
Title
Everolimus-Eluting versus Paclitaxel-Eluting Stents in Coronary Artery
Disease.
Source
New England Journal of Medicine. 362(18)(pp 1663-1674), 2010. Date of
Publication: 06 May 2010.
Publisher
Massachussetts Medical Society
Abstract
Background: Previous studies have established the superiority of coronary
everolimus-eluting stents over paclitaxel-eluting stents with respect to
angiographic findings. However, these trials were not powered for
superiority in clinical end points. Methods: We randomly assigned 3687
patients at 66 U.S. sites to receive everolimus-eluting stents or
paclitaxel-eluting stents without routine follow-up angiography. The
primary end point was the 1-year composite rate of target-lesion failure
(defined as cardiac death, target-vessel myocardial infarction, or
ischemia-driven target-lesion revascularization). Results:
Everolimus-eluting stents were superior to paclitaxel-eluting stents with
respect to the primary end point of target-lesion failure (4.2% vs. 6.8%;
relative risk, 0.62; 95% confidence interval, 0.46 to 0.82; P = 0.001).
Everolimus-eluting stents were also superior with respect to the major
secondary end point of the 1-year rate of ischemia-driven target-lesion
revascularization (P = 0.001) and were noninferior with respect to the
major secondary end point of the 1-year composite rate of cardiac death or
target-vessel myocardial infarction (P<0.001 for noninferiority; P = 0.09
for superiority). The 1-year rates of myocardial infarction and stent
thrombosis were also lower with everolimus-eluting stents than with
paclitaxel-eluting stents (1.9% vs. 3.1%, P = 0.02 for myocardial
infarction; 0.17% vs. 0.85%, P = 0.004 for stent thrombosis).
Target-lesion failure was consistently reduced with everolimus-eluting
stents as compared with paclitaxel-eluting stents in 12 prespecified
subgroups, except in the subgroup of patients with diabetes (6.4% vs.
6.9%, P = 0.80). Conclusions: Everolimus-eluting stents, as compared with
paclitaxel-eluting stents, resulted in reduced rates of target-lesion
failure at 1 year, results that were consistent in all patients except
those with diabetes, in whom the results were nonsignificantly different.
(ClinicalTrials.gov number, NCT00307047.) Copyright copyright 2010
Massachusetts Medical Society.
<7>
Accession Number
2010243502
Authors
Mishra P.K. Mathias H. Millar K. Nagrajan K. Murday A.
Institution
(Mishra, Mathias, Nagrajan, Murday) Department of Cardiothoracic Surgery,
Glasgow Royal Infirmary, Glasgow, United Kingdom.
(Millar) Department of Psychological Medicine, University of Glasgow,
Gartnavel Royal Hospital, Glasgow, United Kingdom.
Title
A randomized controlled trial to assess the effect of audiotaped
consultations on the quality of informed consent in cardiac surgery.
Source
Archives of Surgery. 145(4)(pp 383-388), 2010. Date of Publication: April
2010.
Publisher
American Medical Association
Abstract
Objective:Toevaluate the effect of audiotaping outpatient consultations on
informed consent for cardiac surgery. Design: Randomized controlled trial.
Setting: Tertiary health care center in Scotland. Participants:
Eighty-four patients who had first-time coronary artery surgery conducted
by 1 surgeon from February 10, 2005, through March 15, 2006, whose
consultations before surgery were audiotaped. Intervention: Randomization
to 3 trial arms. The control group (n=29) received no tape. The generic
group (n=25) received a tape about coronary artery surgery, which we
scripted to include information covering the domains described by the
General Medical Council. The consultation group (n=30) received a tape of
their consultation interview. On admission to the hospital, patients were
interviewed with the Knowledge Questionnaire, the Multidimensional Health
Locus of Control, and the Hospital Anxiety and Depression Scale. Main
Outcome Measures: The effect of audiotaping in improving the informed
consent process for cardiac surgery. Results: The mean knowledge score of
patients in the consultation group was much higher than that of the
control individuals (P<.001). Patients in the consultation group reported
a significantly greater sense of control with regard to their own health
(P<.001) and being less anxious and depressed overall. Conclusion:
Providing an audiotaped recording of the consultation before cardiac
surgery appears to improve patients' knowledge and perceptions of control
of their health status and to reduce anxiety and depression. Trial
Registration: isrctn.org Identifier: ISRCTN20081026 copyright2010 American
Medical Association. All rights reserved.
<8>
[Use Link to view the full text]
Accession Number
2010221195
Authors
Fox A.A. Muehlschlegel J.D. Body S.C. Shernan S.K. Liu K.-Y. Perry T.E.
Aranki S.F. Cook E.F. Marcantonio E.R. Collard C.D.
Institution
(Fox, Muehlschlegel, Body, Shernan, Liu, Perry) Department of
Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School,
Brigham and Womens Hospital, Boston, MA, United States.
(Aranki) Division of Cardiac Surgery, Brigham and Womens Hospital, Harvard
Medical School, Boston, MA, United States.
(Cook) Department of Epidemiology, Harvard School of Public Health,
Boston, MA, United States.
(Marcantonio) Department of Medicine, Beth Israel Deaconess Medical
Center, Harvard Medical School, Houston, TX, United States.
(Collard) Division of Cardiovascular Anesthesia, Baylor College of
Medicine, Saint Lukes Episcopal Hospital, Houston, TX, United States.
Title
Comparison of the utility of preoperative versus postoperative B-type
natriuretic peptide for predicting hospital length of stay and mortality
after primary coronary artery bypass grafting.
Source
Anesthesiology. 112(4)(pp 842-851), 2010. Date of Publication: April
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Preoperative B-type natriuretic peptide (BNP) is known to
predict adverse outcomes after cardiac surgery. The value of postoperative
BNP for predicting adverse outcomes is less well delineated. The authors
hypothesized that peak postoperative plasma BNP (measured postoperative
days 1-5) predicts hospital length of stay (HLOS) and mortality in
patients undergoing primary coronary artery bypass grafting, even after
adjusting for preoperative BNP and perioperative clinical risk factors.
METHODS:: This study is a prospective longitudinal study of 1,183 patients
undergoing primary coronary artery bypass grafting surgery. Mortality was
defined as all-cause death within 5 yr after surgery. Cox proportional
hazards analyses were conducted to separately evaluate the associations
between peak postoperative BNP and HLOS and mortality. Multivariable
adjustments were made for patient demographics, preoperative BNP
concentration, and clinical risk factors. BNP measurements were log10
transformed before analysis. Results:One hundred fifteen deaths (9.7%)
occurred in the cohort (mean follow-up = 4.3 yr, range = 2.38-5.0 yr).
After multivariable adjustment for preoperative BNP and clinical
covariates, peak postoperative BNP predicted HLOS (hazard ratio [HR] =
1.28, 95% CI = 1.002-1.64, P = 0.049) but not mortality (HR = 1.62, CI =
0.71-3.68, P = 0.25), whereas preoperative BNP independently predicted
HLOS (HR = 1.09, CI = 1.01-1.18, P = 0.03) and approached being an
independent predictor of mortality (HR = 1.36, CI = 0.96-1.94, P = 0.08).
When preoperative and peak postoperative BNP were separately adjusted for
within the clinical multivariable models, each independently predicted
HLOS (preoperative BNP HR = 1.13, CI = 1.05-1.21, P = 0.0007; peak
postoperative BNP HR = 1.44, CI = 1.15-1.81, P = 0.001) and mortality
(preoperative BNP HR = 1.50, CI = 1.09-2.07, P = 0.01; peak postoperative
BNP HR = 2.29, CI = 1.11-4.73, P = 0.02). Conclusions: Preoperative BNP
may be better than peak postoperative BNP for predicting HLOS and longer
term mortality after primary coronary artery bypass grafting surgery.
<9>
[Use Link to view the full text]
Accession Number
2010221215
Authors
Ray P. Manach Y.L. Riou B. Houle T.T.
Institution
(Ray) Department of Emergency Medicine and Surgery, Groupe Hospitalier
Pitie-Salpetriere, Paris, France.
(Ray) Universite Pierre et Marie Curie-Paris 6, Paris, France.
(Ray) Institut National de la Sante et de la Recherche Medicale (INSERM)
U956, Paris, France.
(Manach) Department of Anesthesiology and Critical Care, Groupe
Hospitalier Pitie-Salpetriere, France.
(Riou) Department of Emergency Medicine and Surgery, Universite Pierre et
Marie Curie-Paris 6, France.
(Riou) INSERM U956, Wake Forest University, School of Medicine,
Winston-Salem, NC, United States.
(Houle) Department of Anesthesiology, Wake Forest University, School of
Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, United
States.
Title
Statistical evaluation of a biomarker.
Source
Anesthesiology. 112(4)(pp 1023-1040), 2010. Date of Publication: April
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
A biomarker may provide a diagnosis, assess disease severity or risk, or
guide other clinical interventions such as the use of drugs. Although
considerable progress has been made in standardizing the methodology and
reporting of randomized trials, less has been accomplished concerning the
assessment of biomarkers. Biomarker studies are often presented with poor
biostatistics and methodologic flaws that precludes them from providing a
reliable and reproducible scientific message. A host of issues are
discussed that can improve the statistical evaluation and reporting of
biomarker studies. Investigators should be aware of these issues when
designing their studies, editors and reviewers when analyzing a
manuscript, and readers when interpreting results.
<10>
Accession Number
2010249760
Authors
Nguyen D.T. Delahaye F. Obadia J.-F. Duval X. Selton-Suty C. Carteaux
J.-P. Hoen B. Alla F.
Institution
(Nguyen) CHU de Nancy, 54000, France.
(Nguyen, Carteaux, Alla) Nancy-Universite, Faculte de medecine, EA4003,
Nancy, 54000, France.
(Nguyen, Alla) INSERM, CIC-EC, Nancy, 54000, France.
(Delahaye, Obadia) Universite de Claude Bernard Lyon 1, Lyon, 69500,
France.
(Delahaye) HCL, Hopital Cardiovasculaire et Pneumologique Louis Pradel,
Cardiologie, Lyon-Bron, 69500, France.
(Obadia) HCL, Hopital Cardiovasculaire et Pneumologique Louis Pradel,
Laboratoire de Physiologie Lyon Nord, Lyon, France.
(Duval) APHP, Hopital Bichat Claude Bernard, Centre d'Investigation
Clinique, Paris, 75018, France.
(Selton-Suty) CHU Nancy, Cardiologie, Nancy, 54000, France.
(Carteaux) CHU Nancy, clinique de chirurgie cardiaque et transplantations,
Nancy, 54500, France.
(Hoen) CHU Besancon, Maladies Infectieuses et Tropicales, 25000 Besancon,
France.
(Alla) CHU Nancy, Epidemiologie, Nancy, 54000, France.
Title
Aortic valve replacement for active infective endocarditis: 5-year
survival comparison of bioprostheses, homografts and mechanical
prostheses.
Source
European Journal of Cardio-thoracic Surgery. 37(5)(pp 1025-1032), 2010.
Date of Publication: May 2010.
Publisher
Elsevier
Abstract
Objective: In the surgical treatment of acute aortic valve infective
endocarditis (IE), the long-term outcome depending on the choice of valve
replacement remains uncertain. We aimed to compare the impact on 5-year
mortality of use of three types of implanted valves: bioprosthesis
(heterograft), mechanical prosthesis and homograft. Methods: A total of
167 patients with a definite aortic valve IE who underwent aortic
replacement were selected from a prospective observational
population-based study. Association between the type of implanted valve
and 5-year mortality was examined by the use of an adjusted Cox model.
Results: Bioprostheses were implanted in 31 patients (18.6%), homograft in
27 (16.2%) and mechanical valves in 109 (65.2%). Patients with
bioprothesis had a higher 5-year mortality risk than patients with
mechanical prosthesis (adjusted hazard ratio (HR) 2.39, 95% confidence
interval (95% CI), 1.09-5.21; p = 0.029), particularly in patients
[less-than or equal to]65 years old (adjusted HR 4.14 (1.27-13.45), p =
0.018) but not in patients >65 years old (adjusted HR: 1.45 (0.35-5.97), p
= 0.60). Five-year mortality risk did not differ between patients with
homografts and those with mechanical prostheses (HR 0.46, 95% CI
(0.15-1.42), p = 0.18). Conclusions: A bioprosthetic valve used for aortic
valve IE replacement may be associated with lower overall 5-year survival
than the use of a mechanical valve in patients up to 65 years old. Further
studies are needed to explain these results. copyright 2009 European
Association for Cardio-Thoracic Surgery.
<11>
Accession Number
2010274400
Authors
Saha S.A. Arora R.R.
Institution
(Saha) Sacred Heart Medical Center, Spokane, WA, United States.
(Saha) University of Washington School of Medicine, Seattle, WA, United
States.
(Arora) The Chicago Medical School, North Chicago, IL, United States.
Title
Fibrates in the prevention of cardiovascular disease in patients with type
2 diabetes mellitus - A pooled meta-analysis of randomized
placebo-controlled clinical trials.
Source
International Journal of Cardiology. 141(2)(pp 157-166), 2010. Date of
Publication: 28 May 2010.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Fibrates are thought to be useful anti-dyslipidemic agents
particularly in patients with diabetes mellitus and dyslipidemia
characterized by high triglyceride (TG) and low high-density lipoprotein
cholesterol (HDL-C) levels. We conducted a systematic review and
meta-analysis of long-term randomized controlled trials to evaluate the
role of fibrates in the prevention of cardiovascular events in patients
with type 2 diabetes mellitus. Data sources: English-language journals
indexed in Index Medicus/MEDLINE and the Cochrane Collaboration databases
(through December 2007), unpublished data from selected clinical trials.
Data extraction and analysis: A total of 11,590 patients from 6 published
randomized placebo-controlled trials were analyzed using pooled
meta-analysis techniques. Relative risks were computed for various
cardiovascular outcomes and mortality, and statistical significance was
tested using the z-test statistic (two-sided alpha error < 0.05). Results:
The use of fibrates did not significantly affect the risk of all-cause
mortality or cardiac mortality, and also did not affect the risk of
stroke, unstable angina, or invasive coronary revascularization. However,
the relative risk of non-fatal myocardial infarction was significantly
reduced by about 21% (pooled relative risk 0.79, p = 0.006) with the use
of fibrates. Conclusions: Long-term use of fibrates in patients with type
2 diabetes mellitus significantly reduces the risk of non-fatal myocardial
infarction, but has no significant effect on mortality or on other adverse
cardiovascular outcomes. copyright 2008 Elsevier Ireland Ltd. All rights
reserved.
<12>
Accession Number
0020346182
Authors
Papadopoulos G. Sintou E. Siminelakis S. Koletsis E. Baikoussis N.G.
Apostolakis E.
Institution
(Papadopoulos, Sintou, Siminelakis, Koletsis, Baikoussis, Apostolakis)
Department of Anesthesia, University Hospital of Ioannina, Ioannina,
Greece.
Title
Perioperative infusion of low- dose of vasopressin for prevention and
management of vasodilatory vasoplegic syndrome in patients undergoing
coronary artery bypass grafting-A double-blind randomized study..
Source
Journal of cardiothoracic surgery. 5(pp 17), 2010. Date of Publication:
2010.
Abstract
Preoperative medication by inhibitors of angiotensin-converting enzyme
(ACE) in coronary artery patients predisposes to vasoplegic shock early
after coronary artery bypass grafting. Although in the majority of the
cases this shock is mild, in some of them it appears as a situation,
"intractable" to high-catecholamine dose medication. In this study we
examined the possible role of prophylactic infusion of low-dose
vasopressin, during and for the four hours post-bypass after
cardiopulmonary bypass, in an effort to prevent this syndrome. In
addition, we studied the influence of infused vasopressin on the
hemodynamics of the patients, as well as on the postoperative urine-output
and blood-loss. In our study 50 patients undergoing coronary artery bypass
grafting were included in a blind-randomized basis. Two main criteria were
used for the eligibility of patients for coronary artery bypass grafting:
ejection fraction between 30-40%, and patients receiving ACE inhibitors,
at least for four weeks preoperatively. The patients were randomly divided
in two groups, the group A who were infused with 0.03 IU/min vasopressin
and the group B who were infused with normal saline intraoperativelly and
for the 4 postoperative hours. Measurements of mean artery pressure (MAP),
central venous pressure (CVP), systemic vascular resistance (SVR),
ejection fracture (EF), heart rate (HR), mean pulmonary artery pressure
(MPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were
performed before, during, and after the operation. The requirements of
catecholamine support, the urine-output, the blood-loss, and the
requirements in blood, plasma and platelets for the first 24 hours were
included in the data collected. The incidence of vasodilatory shock was
significantly lower (8% vs 20%) in group A and B respectively (p = 0,042).
Generally, the mortality was 12%, exclusively deriving from group B.
Postoperatively, significant higher values of MAP, CVP, SVR and EF were
recorded in the patients of group A, compared to those of group B. In
group A norepinephrine was necessary in fewer patients (p = 0.002) and
with a lower mean dose (p = 0.0001), additive infusion of epinephrine was
needed in fewer patients (p = 0.001), while both were infused for a
significant shorter infusion-period (p = 0.0001). Vasopressin
administration (for group A) was associated with a higher 24 hour
diuresis) (0.0001).In conclusion, low-dose of infused vasopressin during
cardiopulmonary bypass and for the next 4 hours is beneficial for its
postoperative hemodynamic profile, reduces the doses of requirements of
catecholamines and contributes to prevention of the postcardiotomy
vasoplegic shock in the patient with low ejection fraction who is
receiving ACE preoperatively.
<13>
Accession Number
0020181257
Authors
Vretzakis G. Kleitsaki A. Stamoulis K. Bareka M. Georgopoulou S.
Karanikolas M. Giannoukas A.
Institution
(Vretzakis, Kleitsaki, Stamoulis, Bareka, Georgopoulou, Karanikolas,
Giannoukas) Cardiac Anesthesia Unit, Department of Anesthesiology,
University Hospital of Larissa, Greece.
Title
Intra-operative intravenous fluid restriction reduces perioperative red
blood cell transfusion in elective cardiac surgery, especially in
transfusion-prone patients: a prospective, randomized controlled trial..
Source
Journal of cardiothoracic surgery. 5(pp 7), 2010. Date of Publication:
2010.
Abstract
BACKGROUND: Cardiac surgery is a major consumer of blood products, and
hemodilution increases transfusion requirements during cardiac surgery
under CPB. As intraoperative parenteral fluids contribute to hemodilution,
we evaluated the hypothesis that intraoperative fluid restriction reduces
packed red-cell (PRC) use, especially in transfusion-prone adults
undergoing elective cardiac surgery. METHODS: 192 patients were randomly
assigned to restrictive (group A, 100 pts), or liberal (group B, 92 pts)
intraoperative intravenous fluid administration. All operations were
conducted by the same team (same surgeon and perfusionist). After
anesthesia induction, intravenous fluids were turned off in Group A (fluid
restriction) patients, who only received fluids if directed by protocol.
In contrast, intravenous fluid administration was unrestricted in group B.
Transfusion decisions were made by the attending anesthesiologist, based
on identical transfusion guidelines for both groups. RESULTS: 137 of 192
patients received 289 PRC units in total. Age, sex, weight, height, BMI,
BSA, LVEF, CPB duration and surgery duration did not differ between
groups. Fluid balance was less positive in Group A. Fewer group A patients
(62/100) required transfusion compared to group B (75/92, p < 0.04). Group
A patients received fewer PRC units (113) compared to group B (176; p <
0.0001). Intraoperatively, the number of transfused units and transfused
patients was lower in group A (31 u in 19 pts vs. 111 u in 62 pts; p <
0.001). Transfusions in ICU did not differ significantly between groups.
Transfused patients had higher age, lower weight, height, BSA and
preoperative hematocrit, but no difference in BMI or discharge hematocrit.
Group B (p < 0.005) and female gender (p < 0.001) were associated with
higher transfusion probability. Logistic regression identified group and
preoperative hematocrit as significant predictors of transfusion.
CONCLUSIONS: Our data suggest that fluid restriction reduces
intraoperative PRC transfusions without significantly increasing
postoperative transfusions in cardiac surgery; this effect is more
pronounced in transfusion-prone patients. TRIAL REGISTRATION: NCT00600704,
at the United States National Institutes of Health.
<14>
Accession Number
0020430261
Authors
Gao R. Zhang J. Cheng L. Wu X. Dong W. Yang X. Li T. Liu X. Xu Y. Li X.
Zhou M.
Institution
(Gao, Zhang, Cheng, Wu, Dong, Yang, Li, Liu, Xu, Li, Zhou) Cardiovascular
Institute and Fuwai Hospital, Chinese Academy of Medical Sciences,
Beijing, China.
Title
A Phase II, randomized, double-blind, multicenter, based on standard
therapy, placebo-controlled study of the efficacy and safety of
recombinant human neuregulin-1 in patients with chronic heart failure..
Source
Journal of the American College of Cardiology. 55(18)(pp 1907-1914),
2010. Date of Publication: 4 May 2010.
Abstract
OBJECTIVES: The purpose of this study was to assess the safety and
efficacy of recombinant human neuregulin-1 (rhNRG-1) in chronic heart
failure (CHF) patients. BACKGROUND: Neuregulin-1 plays important roles in
maintaining cardiomyocyte structure and cardiac pumping functionality and
physiology. Previously, rhNRG-1 was proven to be effective in treating
heart failure in animals by reducing end-diastolic volume (EDV) and
end-systolic volume (ESV) and increasing left ventricular ejection
fraction (LVEF%). METHODS: A total of 44 CHF patients designated as New
York Heart Association functional class II or III were enrolled in a
double-blind, randomized manner and treated with a placebo or rhNRG-1
(0.3, 0.6, or 1.2 microg/kg/day) for 10 days, in addition to standard
therapies. The follow-up period was 90 days; left ventricular function and
structure measured by magnetic resonance imaging were the primary end
points. RESULTS: Although not statistically different from placebo, the
LVEF% was significantly increased by 27.11 +/- 31.12% (p = 0.009) at day
30 after rhNRG-1 treatment in the 0.6-microg/kg group, whereas it was only
increased 5.83 +/- 25.75% in the placebo group (p = 0.49). In addition,
there were decreases in ESV (-11.58 +/- 12.74%, p = 0.002) and EDV (-5.64
+/- 10.03%, p = 0.05) in the 0.6-microg/kg/day group at day 30; more
importantly, both ESV and EDV levels continued to decrease at day 90
(-20.79 +/- 17.03% and -14.03 +/- 13.17%, respectively), accompanied by a
sustained increase in LVEF%. This suggests that short-term treatment with
rhNRG-1 results in a long-term reversal of remodeling. The effective dose
was proven to be tolerable and safe for CHF patients. CONCLUSIONS: rhNRG-1
improved the cardiac function of CHF patients by increasing the LVEF% and
showed the capability of antiremodeling by decreasing ESV and EDV compared
with pre-treatment. (A Randomized, Double-Blind, Multi-Center, Placebo
Parallel controlled, Standard Therapy Based Phase II Clinical Trial to
Evaluate the Efficacy and Safety of Recombinant Human Neuregulin-1 for
Injection in Patients with Chronic Heart Failure; ChiCTR-TRC-00000414).
Copyright 2010 American College of Cardiology Foundation. Published by
Elsevier Inc. All rights reserved.
<15>
Accession Number
0020369508
Authors
Golczyk K. Kompis M. Englberger L. Carrel T.P. Stalder M.
Institution
(Golczyk, Kompis, Englberger, Carrel, Stalder) Department of
Cardiovascular Surgery, University Hospital Berne, Switzerland.
Title
Heart valve sound of various mechanical composite grafts, and the impact
on patients' quality of life..
Source
The Journal of heart valve disease. 19(2)(pp 228-232), 2010. Date of
Publication: Mar 2010.
Abstract
BACKGROUND AND AIM OF THE STUDY: The closing sounds of mechanical heart
valves can be disturbing for patients and their closest relatives.
Although some investigations into mechanical heart valve sounds have been
performed, the particularities of the valve sound when it is attached to a
vascular prosthesis to replace the aortic root and the ascending aorta has
not been studied to date. The study aim was to compare the closing sounds
of three various mechanical composite graft prostheses, and to analyze the
impact of such sounds on the patients' quality of life. METHODS: Thirty
patients who had undergone aortic root replacement were prospectively
randomized into three groups, receiving either a Sorin, St. Jude Medical
(SJM) or ATS mechanical composite graft. Valve sounds were recorded with
microphones, and sound pressures at peak measured at three months after
operation. Patients were interviewed at three and six months after surgery
to assess subjective disturbance, using both an analog scale from 1 to 10
and a more detailed questionnaire. RESULTS: Sound pressures at peak tended
to be lower for the ATS than for the SJM and Sorin composite grafts (44.4
+/- 3.1 dB versus 47.8 +/- 3.1 dB and 46.6 +/- 6.0 dB; p = NS). The
overall subjective disturbance with ATS valves scored significantly lower
than the SJM and Sorin composite grafts (2.5 +/- 1.6 versus 4.1 +/- 1.7
and 4.6 +/- 2.2; p<0.05 after three months; and 2.6 +/- 1.2 versus 4.4 +/-
2.3 and 4.4 +/- 3.3; p<0.05 after six months). Scores for disturbance
during daily activities, sleep disturbance and audibility to relatives
were lowest for the ATS composite grafts. CONCLUSION: The sound pressure
of ATS composite grafts was slightly (p = NS) lower than that of SJM and
Sorin composite grafts. Patients who received an ATS composite graft were
significantly less disturbed by the valve noise than those with SJM and
Sorin composite grafts.
<16>
Accession Number
0020369498
Authors
Cevik C. Izgi C. Dechyapirom W. Nugent K.
Institution
(Cevik, Izgi, Dechyapirom, Nugent) Texas Tech University Health Sciences
Center, Department of Internal Medicine, 3601 4th Street, Lubbock, TX
79430, USA.
Title
Treatment of prosthetic valve thrombosis: rationale for a prospective
randomized clinical trial..
Source
The Journal of heart valve disease. 19(2)(pp 161-170), 2010. Date of
Publication: Mar 2010.
Abstract
BACKGROUND AND AIM OF THE STUDY: Prosthetic valve thrombosis (PVT) is a
serious complication that may cause significant morbidity and mortality.
Despite advances in valve technology, patient education and adequate
anticoagulation, the risk of PVT persists indefinitely. Certain clinical
and prothrombotic states, including atrial fibrillation, insufficient
anticoagulation and pregnancy, predispose these patients to develop PVT.
The optimal treatment of the condition is controversial, and to date no
randomized clinical trials have been conducted to assist in decision
making. Consequently, the guidelines lack definitive Class I
recommendations, have significant disparities, and--in most cases--leave
the decision to the clinician's experience. METHODS: A review of the
studies, guidelines, and expert opinions on the treatment of PVT was
conducted, and treatment recommendations made for obstructive and
non-obstructive thrombotic cases, based on the results of the recent
reports. RESULTS: Although surgical therapy has been the traditional
therapeutic approach, studies with low-dose and slow-infusion rates of
thrombolytic agents have revealed excellent results in these patients.
Surgery should be considered first in patients with left atrial thrombus,
active bleeding, and within the first four days after valve replacement.
Patients with nonobstructive PVT can initially be managed with an
intensification of anticoagulation. CONCLUSION: The management of PVT
remains controversial. Clearly, a prospective randomized clinical trial is
required, and this could be achieved by developing an international
database for patient enrollment and randomization into available treatment
strategies.
<17>
Accession Number
2010240292
Authors
Gao P. Xiong H. Zheng Z. Li L. Gao R. Hu S.-S.
Institution
(Gao, Xiong, Zheng, Hu) Department of Surgery, Peking Union Medical
College, Chinese Academy of Medical Sciences, 167A Beilishilu, Beijing
100037, China.
(Gao, Zheng, Hu) Research Center for Cardiovascular Regenerative Medicine,
Ministry of Health, Beijing, China.
(Li) Department of Anesthesiology, Peking Union Medical College, Chinese
Academy of Medical Sciences, Beijing, China.
(Gao) Department of Cardiology, Peking Union Medical College, Fu Wai
Hospital, Beijing, China.
Title
Evaluation of antiplatelet effects of a modified protocol by platelet
aggregation in patients undergoing "one-stop" hybrid coronary
revascularization.
Source
Platelets. 21(3)(pp 183-190), 2010. Date of Publication: 2010.
Publisher
Informa Healthcare
Abstract
"One-stop" hybrid coronary revascularization has emerged to be a reliable
and attractive alternative for selected patients with multivessel coronary
artery disease. However, the optimal antiplatelet regimen of the one-stop
hybrid procedure still remains controversial. We modified the antiplatelet
protocol in order to reduce the risk of perioperative bleeding and
maximally inhibit platelet activity. This study sought to investigate
whether the inhibition of platelet activity by this modified antiplatelet
protocol is comparable with the conventional protocol widely used and
recommended in percutaneous coronary interventions (PCI). Twenty three
patients undergoing one-stop hybrid procedure and 20 patients undergoing
conventional PCI were enrolled in this prospective study. The modified
antiplatelet protocol included perioperative use of aspirin; clopidogrel
was administered immediately before PCI with a 300 mg loading dose,
followed by a maintenance dose of 75 mg/day for 12 months. Blood samples
were obtained before the operation and 2 hours, day 1 and day 3 after
operation. Platelet aggregation was induced with: 1) arachidonic acid (AA)
(final concentration 0.5 mmol/L) to assess the efficacy of aspirin; 2)
adenosine diphosphate (ADP) (final concentration 10 mol/L) to assess the
specific efficacy of clopidogrel. Platelet counts were statistically lower
in the hybrid group than in the PCI control group (p=0.0018) on day 1
after operation. AA-induced platelet aggregation increased significantly
in comparison with the preoperative baseline values (p=0.0079) and the PCI
control group (p=0.0023) on day 1 after operation. ADP-induced platelet
aggregation gradually decreased in the hybrid group, and achieved similar
platelet inhibition with the PCI group on 2 hours and day 1 after
operation. No major adverse clinical events such as death, perioperative
myocardial infarction, stent thrombosis or reoperation for bleeding
occurred in both groups within 30 days after procedure. These results
demonstrate that our modified antiplatelet therapy can sufficiently
inhibit platelet activity similarly as the conventional protocol for PCI
early after operation. Thus, this modified protocol, with continuous use
of aspirin and intraoperative administration of loading dose clopidogrel,
might be a safe and effective antiplatelet strategy for the one-stop
hybrid coronary revascularization. copyright 2010 Informa Healthcare Ltd.
<18>
Accession Number
0020415152
Authors
Safaei N. Gaem H.M. Alikhah H.
Institution
(Safaei, Gaem) Department of Cardiothoracic Surgery, Shahid Madani
Hospital, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of.
(Alikhah) Continuing Medical Education Center, Tabriz University of
Medical Sciences, Tabriz, Iran, Islamic Republic of.
Title
Intracoronary shunt in off-pump coronary artery bypass graft.
Source
Pakistan Journal of Biological Sciences. 13(1)(pp 40-45), 2010. Date of
Publication: 2010.
Publisher
Asian Network for Scientific Information
Abstract
This study was performed to compare the early postoperative results of off
Pump Coronary Artery Bypass Graft (OPCABG) with or without using Intra
Coronary Shunt (ICS). We randomized 208 patients scheduled for OPCABG into
shunt group (group 1, n = 104) and no-shunt group (group 2, n = 104). The
two groups were well matched according to the age, gender, angina class,
New York Heart Association (NYHA) functional class, or operative priority
and disease severity. Peri- and post-operative changes in
electrocardiography, wall motion abnormality in echocardiography, rate of
myocardial infarction, mortality, morbidity, cardiac enzymes and ICU stay
were recorded. There was no significant difference between two groups in
changes of electrocardiography, myocardial infarction, left ventricular
ejection fraction (LVEF), in hospital mortality and ICU stay but Creatine
Kinase Myocardial Band (CK-MB) enzyme was higher in no shunt group, while
troponin-I was increased in shunt group. Preoperative LVEF was higher in
no-shunt group, but postoperative LVEF was higher in shunt group (p>0.05).
Also, the change of LVEF before and after operation in each group was not
significant. Using intracoronary shunt in off pump coronary artery bypass
graft leads to less change in cardiac enzymes but had no effect on
perioperative and postoperative myocardial infarction, LVEF, mortality and
morbidity. copyright 2010 Asian Network for Scientific Information.
