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<1>
Accession Number
2010257198
Authors
Kilian E.G. Sadoni S. Vicol C. Kelly R. van Hulst K. Schwaiger M. Kupatt
C. Boekstegers P. Pillai R. Channon K. Hetzer R. Reichart B.
Institution
(Kelly, van Hulst) Genzyme, Europe BV, Naarden, Netherlands.
(Kilian, Sadoni, Vicol, Reichart) Department of Cardiac Surgery,
University of Munich, Grosshadern, Marchioninistr 15, 81377 Munchen,
Germany.
(Schwaiger) Department of Nuclear Medicine, University of Munich, Germany.
(Kupatt, Boekstegers) Department of Cardiology, University of Munich,
Germany.
(Pillai) German Heart Centre Berlin, Department of Cardiothoracic and
Vascular Surgery, Germany.
(Hetzer) Department of Cardiothoracic Surgery, John Radcliffe Hospital,
Oxford, United Kingdom.
(Channon) Department of Cardiovascular Medicine, John Radcliffe Hospital,
Oxford, United Kingdom.
Title
Myocardial transfection of hypoxia inducible factor-1alpha via an
adenoviral vector during coronary artery bypass grafting - A multicenter
phase I and safety study.
Source
Circulation Journal. 74(5)(pp 916-924), 2010. Date of Publication: 2010.
Publisher
Japanese Circulation Society
Abstract
Background: Increasing numbers of patients with advanced coronary artery
disease have limited options for percutaneous and/or surgical
revascularization. A prospective, randomized, phase I clinical multicenter
trial was performed to assess the feasibility and safety of delivering a
pro-angiogenic transcription factor termed "hypoxia inducible
factor-1alpha", delivered to ischemic cardiac muscle via a type 2
adenoviral (Ad2HIF) vector. Methods and Results: The 13 patients were
included under the following criteria: 1 hypoperfused area of viable
ventricular muscle without options for revascularization and left
ventricular ejection fraction [greater-than or equal to]30%. After
coronary artery bypass grafting was completed, 10 injections of the study
drug (n=10), in 3 escalating doses up to 1x1011 viral particles or saline
(n=3) as a placebo control, were injected intramyocardially. After
completion of the 1-year follow-up, all patients had uncomplicated
postoperative courses, are alive and feeling well; 1 patient had a
self-limited run of tachycardia postoperatively and at 6 months, 1 patient
developed recurrent angina. Positron emission tomography perfusion
analysis revealed improvement in the Ad2HIF injected areas in selected
patients. Conclusions: These data support the feasibility and preliminary
safety of adenoviral transfection with Ad2HIF in regions of viable
myocardium. Additional studies will be required to determine the efficacy
and safety of Ad2HIF.
<2>
Accession Number
2010237745
Authors
Pardos-Gea J. Ordi-Ros J. Avegliano G. Cortes-Hernandez J. Balada E.
Evangelista A. Vilardell M.
Institution
(Pardos-Gea, Ordi-Ros, Cortes-Hernandez, Balada, Vilardell) Department of
Internal Medicine, Autoimmune Diseases Unit, Universitat Autonoma de
Barcelona, Pg. Vall dHebron 119-129, 08035 Barcelona, Spain.
(Avegliano, Evangelista) Department of Cardiology, Echocardiography Unit,
Universitat Autonoma de Barcelona, Barcelona, Spain.
Title
Echocardiography at diagnosis of antiphospholipid syndrome provides
prognostic information on valvular disease evolution and identifies two
subtypes of patients.
Source
Lupus. 19(5)(pp 575-582), 2010. Date of Publication: April 2010.
Publisher
SAGE Publications Ltd
Abstract
The evolution of valvular disease in antiphospholipid syndrome (APS) is
barely known. In order to evaluate whether the presence or absence of
valvular disease at the time of diagnosis of APS, assessed by an initial
echocardiogram, predicts its subsequent evolution, we performed a
prospective cohort study. We included 53 patients with APS. An initial
transthoracic echocardiogram was performed on patients at the time of
diagnosis of APS. Serial echocardiograms were conducted along a 12-year
follow-up. Final echocardiograms were used for comparative purposes. We
started with 29 patients (54%) with and 24 (45%) without valvulopathy at
initial echo. At the final echocardiogram, 27 of 29 patients with initial
valvulopathy continued to have valvular disease (a 93% observed
likelihood), and 22 of 24 patients without initial valvulopathy
demonstrated an absence of valvular disease (a 91% observed likelihood).
Patients with valvulopathy in comparison with those without presented more
arterial thrombotic events (69% vs. 20%, P < 0.001), atherosclerotic risk
factors (62% vs. 29%, P = 0.01), livedo (48% vs. 16%, P = 0.01) and
migraine (41% vs. 12%, P = 0.02). We have identified two subtypes of APS
patients with and without valvulopathy by defining differential clinical
features and with little crossover in valvular involvement over a long
follow-up period, giving a high prognostic value to the initial
echocardiographic assessment. copyright The Author(s), 2010.
<3>
Accession Number
2010244563
Authors
Reeve J.C. Nicol K. Stiller K. McPherson K.M. Birch P. Gordon I.R. Denehy
L.
Institution
(Reeve, McPherson) Division of Rehabilitation and Occupation Studies,
Faculty of Health and Environmental Studies, AUT University, Auckland, New
Zealand.
(Reeve, Denehy) School of Physiotherapy, Faculty of Medicine, Dentistry
and Health Sciences, Melbourne, Vic., Australia.
(Nicol, Birch) Allied Health, Auckland District Health Board, Auckland,
New Zealand.
(Stiller) Physiotherapy Department, Royal Adelaide Hospital, Adelaide, SA,
Australia.
(Gordon) Statistical Consulting Centre, The University of Melbourne, Vic.,
Australia.
Title
Does physiotherapy reduce the incidence of postoperative pulmonary
complications following pulmonary resection via open thoracotomy? A
preliminary randomised single-blind clinical trial.
Source
European Journal of Cardio-thoracic Surgery. 37(5)(pp 1158-1166), 2010.
Date of Publication: May 2010.
Publisher
Elsevier
Abstract
Objective: This study investigates whether targeted postoperative
respiratory physiotherapy decreased the incidence of postoperative
pulmonary complications and length of stay for patients undergoing
elective pulmonary resection via open thoracotomy. Methods: Seventy-six
patients participated in a prospective, single-blind, parallel-group,
randomised trial with concealed allocation, assessor blinding and
intention-to-treat analysis. Treatment group participants received daily
respiratory physiotherapy interventions until discharge. Control group
participants received standard medical/nursing care involving a clinical
pathway. The presence of postoperative pulmonary complications was
assessed on a daily basis during hospitalisation using a standardised
diagnostic tool. Length of stay was recorded. Results: Postoperative
pulmonary complications developed in two participants (4.8%) in the
treatment group and in one participant (2.9%) in the control group; the
difference (treatment minus control) was 1.8% (95% confidence interval
(CI) -10.6% to 13.1%) (p = 1.00). No significant difference was found
between groups for length of stay (treatment group, median 6.0 days;
control group 6.0 days) (p = 0.87). A preoperative forced expiratory
volume in 1 s of 1.5 l or less (p = 0.005) and a history of chronic
obstructive pulmonary disease (p = 0.008) were associated with a greater
number of criteria for a postoperative pulmonary complication being met.
Conclusions: In this patient population, given the low incidence of
postoperative pulmonary complications, targeted respiratory physiotherapy
may not be required in addition to standard care involving a clinical
pathway following pulmonary resection via open thoracotomy. These results
should be extrapolated with caution to those patients undergoing pulmonary
resection with poor preoperative lung function. copyright 2009 European
Association for Cardio-Thoracic Surgery.
<4>
Accession Number
2010244562
Authors
Aguinagalde B. Zabaleta J. Fuentes M. Bazterargui N. Hernandez C.
Izquierdo J.M. Pijuan J.I. Emparanza J.I.
Institution
(Aguinagalde, Zabaleta, Fuentes, Bazterargui, Hernandez, Izquierdo)
Thoracic Surgery Service, Hospital Donostia, Paseo Dr. Beguiristain 115,
Donostia-San Sebastian, 20014, Spain.
(Pijuan) Clinical Epidemiology Unit, CASPe, CIBER-ESP, Pza de Cruces 12,
Baracaldo 48902, Spain.
(Emparanza) Clinical Epidemiology Unit, CASPe, CIBER-ESP, Paseo Dr.
Beguriristain 115, Donostia-San Sebastian 20014, Spain.
Title
Percutaneous aspiration versus tube drainage for spontaneous pneumothorax:
systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 37(5)(pp 1129-1135), 2010.
Date of Publication: May 2010.
Publisher
Elsevier
Abstract
Spontaneous pneumothorax is an extremely frequent pathology. Despite this,
there is still no clear consensus on managing these patients. Therefore,
we perform a systematic review and meta-analysis of the effectiveness of
percutaneous aspiration compared with tube drainage for treating
idiopathic spontaneous pneumothorax. Controlled, randomised clinical
trials were selected, in which the effectiveness of percutaneous
aspiration is compared with that of chest tube drainage, in terms of
resolution of the pneumothorax and rates of relapse and hospital
admission. Relevant articles were identified by searching electronic
databases (e.g., Medline, EMBASE, CENTRAL, mRCT and Pascal), as well as
the references of the papers found in this manner, with a cut-off date of
April 2009. Quality was assessed by two independent evaluators, using the
CASPe appraisal tool. Effectiveness of percutaneous aspiration is compared
with that of chest tube drainage, in terms of resolution of the
pneumothorax and rates of relapse and hospital admission. copyright 2009
European Association for Cardio-Thoracic Surgery.
<5>
Accession Number
2010251243
Authors
Politi L. Sgura F. Rossi R. Monopoli D. Guerri E. Leuzzi C. Bursi F.
Sangiorgi G.M. Modena M.G.
Institution
(Politi, Sgura, Rossi, Monopoli, Guerri, Leuzzi, Bursi, Sangiorgi, Modena)
Institute of Cardiology, Policlinico University Hospital, Via del Pozzo
71, Modena 41100, Italy.
Title
A randomised trial of target-vessel versus multi-vessel revascularisation
in ST-elevation myocardial infarction: Major adverse cardiac events during
long-term follow-up.
Source
Heart. 96(9)(pp 662-667), 2010. Date of Publication: May 2010.
Publisher
BMJ Publishing Group
Abstract
Background: Few reports described outcomes of complete compared with
infarct-related artery (IRA)-only revascularisation in patients with
ST-elevation myocardial infarction (STEMI) and multivessel coronary artery
disease (CAD). Moreover, no studies have compared the simultaneous
treatment of non-IRA with the IRA treatment followed by an elective
procedure for the other lesions (staged revascularisation). Methods: The
outcomes of 214 consecutive patients with STEMI and multivessel CAD
undergoing primary angioplasty were studied. Before the first angioplasty
patients were randomly assigned to three different strategies: culprit
vessel angioplasty-only (COR group); staged revascularisation (SR group)
and simultaneous treatment of non-IRA (CR group). Results: During a mean
follow-up of 2.5 years, 42 (50.0%) patients in the COR group experienced
at least one major adverse cardiac event (MACE), 13 (20.0%) in the SR
group and 15 (23.1%) in the CR group, p<0.001. Inhospital death, repeat
revascularisation and rehospitalisation occurred more frequently in the
COR group (all p<0.05), whereas there was no significant difference in
re-infarction among the three groups. Survival free of MACE was
significantly reduced in the COR group but was similar in the CR and SR
groups. Conclusions: Culprit vessel-only angioplasty was associated with
the highest rate of long-term MACE compared with multivessel treatment.
Patients scheduled for staged revascularisation experienced a similar rate
of MACE to patients undergoing complete simultaneous treatment of non-IRA.
<6>
[Use Link to view the full text]
Accession Number
2010229298
Authors
Zisman E. Eden A. Shenderey A. Meyer G. Balagula M. Ammar R. Pizov R.
Institution
(Zisman, Eden, Shenderey, Balagula, Pizov) Departments of Anesthesiology
and Critical Care Medicine, Carmel Lady Davis Medical Center, Haifa,
Israel.
(Ammar) Cardiothoracic Surgery, Carmel Lady Davis Medical Center, Haifa,
Israel.
(Meyer, Pizov) Technion-Israel Institute of Technology, Haifa, Israel.
(Zisman) Department of Anesthesiology and Critical Care Medicine, Carmel
Medical Center, 7 Michal Street, Haifa 34362, Israel.
Title
The effect of acute autologous blood transfusion on coagulation
dysfunction after cardiopulmonary bypass.
Source
European Journal of Anaesthesiology. 26(10)(pp 868-873), 2009. Date of
Publication: October 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective To evaluate the influence of acute autologous blood transfusion
on postcardiopulmonary bypass coagulation disturbances evaluated by
thromboelastography (TEG) as a point-of-care test. Methods This
prospective randomized controlled study included consecutive patients who
underwent elective cardiac surgery with cardiopulmonary bypass. The
patients in group A underwent acute autologous blood transfusion with
acute normovolemic haemodilution and those in group H received homologous
blood, if needed, and served as controls. Results A total of 62 patients,
from 68 enrolled, completed the study: 27 in group A and 35 in group H.
Both groups had similar prolongation of prothrombin time and partial
thromboplastin time, decreased platelets count and changes in
postoperative thromboelastographic variables. There were no differences
between them for postoperative bleeding, blood transfusions or haemoglobin
values. There was significant prolongation of the R value of TEG (without
heparinase) in both groups at 4h after surgery compared with the immediate
postoperative values: from 11.3 +/- 4.2 to12.3 +/- 5.5 mm, P<0.05 for
group A and from 9.9 +/- 3.7 to 12.5 +/- 5.4 mm, P<0.01 for group H. The R
values of TEG with and without heparinase differed significantly (P<0.05)
at 4 h postoperatively. Conclusion Autologous blood transfusion of 15%
estimated blood volume did not affect postcardiopulmonary bypass
coagulopathy, nor did it decrease blood loss or homologous blood and its
products transfusion in the early postoperative period. TEG is a valuable
measure for detecting coagulation dysfunction with a potential role in the
postoperative management of cardiac patients. Eur J Anaesthesiol
26:868-873 copyright 2009 European Society of Anaesthesiology.
<7>
Accession Number
2010206626
Authors
Ahmad T. Ahmed S.W. Hussain N. Rais K.
Institution
(Ahmad, Ahmed, Hussain, Rais) Department of Thoracic Surgery, Jinnah
Postgraduate Medical Centre, Karachi, Pakistan.
Title
Clinical profile and postoperative outcome in patients with simple and
complex aspergilloma of lung.
Source
Journal of the College of Physicians and Surgeons Pakistan. 20(3)(pp
190-193), 2010. Date of Publication: March 2010.
Publisher
College of Physicians and Surgeons Pakistan
Abstract
Objective: To compare the clinical presentation and results of pulmonary
resection in simple and complex aspergilloma of the lung. Study Design:
Observational study. Place and Duration of Study: The Department of
Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, from
January 2003 to December 2008. Methodology: Fifty-one adult patients with
unilateral aspergilloma lung were included in this study. Patients were
divided into two groups: A (simple aspergilloma-SA, n=14) and B (complex
aspergilloma-CA, n=37), based on the radiological and operative
characteristics of the cavitatory lesion and the presence or absence of
extensive adhesions with the chest wall. Suitability for resection was
assessed with arterial gases, pulmonary function tests and echocardiogram.
Results were compared using Fishers exact test. Results: Recurrent
hemoptysis was the predominant symptom in both the groups. Exertional
dyspnea (A=21.4%; B=56.8%; p=0.03), chest pain (A=21.4%; B=59.5%;
p=0.027), cough (A=35.7%; B=70.3%; p < 0.05) and postoperative
complications like residual pleural space A=14.2%; B=54%; p=0.013) and
pleural collection (A=7.1%; B=37.8%; p=0.041) were predominant in group B.
Lobectomy was the most common procedure performed in group B (A=28.6%;
B=59.5%), while wedge excision was performed in the majority of patients
in group A (A=42.9%; B=29.7%). Recurrence of aspergilloma was seen in 3
patients (8.1%) in group B only. Total number of early and late
complications in SA and CA were 7, and 60, respectively. Early mortality
was 8.1% and 0.0% in group A and group B, respectively (p=0.552). The
overall mortality was 5.4%. Conclusion: Symptoms were more frequently
associated with CA as compared to SA. Surgery for CA was associated with
low mortality but significant morbidity, whereas SA had low postoperative
morbidity and no mortality.
<8>
Accession Number
2010068274
Authors
Cornu C. Joseph P. Gaillard S. Bauer C. Vedrinne C. Bissery A. Melot G.
Bossard N. Belon P. Lehot J.-J.
Institution
(Cornu, Gaillard, Melot) INSERM, CIC 201, Lyon, France.
(Cornu, Gaillard, Melot) Hospices Civils de Lyon, Service de Pharmacologie
Clinique, Lyon, France.
(Cornu, Gaillard, Bissery, Melot, Bossard) Universite de Lyon, Lyon,
France.
(Cornu, Gaillard, Melot, Belon) CNRS, UMR 5558, Lyon, France.
(Joseph, Bauer, Vedrinne, Lehot) Hospices Civils de Lyon, Hopital Louis
Pradel, Service dAnesthsie-Re7acute;animation, Bron,
(Joseph, Bauer, Vedrinne, Bissery, Lehot) Universite Lyon i, Villeurbanne,
France.
(Joseph, Bauer, Vedrinne, Lehot) INSERM, ERI 22, Lyon, France.
(Bissery) Hospices Civils de Lyon, Service de Biostatistique, Lyon,
France.
(Bissery) CNRS, UMR 5558, Laboratoire de Biometrie et Biologie Evolutive,
Equipe Biostatistique Sante, Pierre-Benite,
Title
No effect of a homoeopathic combination of Arnica montana and Bryonia alba
on bleeding, inflammation, and ischaemia after aortic valve surgery.
Source
British Journal of Clinical Pharmacology. 69(2)(pp 136-142), 2010. Date
of Publication: February 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Aims Arnica montana is a popular homoeopathic treatment with potential
haemostatic and anti-inflammatory properties. A homoeopathic combination
of A. montana and Bryonia alba was used in aortic valve surgery to
evaluate its effectiveness in reducing bleeding, inflammation, pain and
myocardial ischaemia. Methods One day before surgery, 92 adult patients
were randomly assigned to a double-blind parallel trial with either
homoeopathic granules or a matching placebo until 4 days after surgery.
The primary outcome was the volume of blood/liquid in the drains at their
removal. The secondary outcomes included postoperative blood/liquid losses
at 12 and 24 h as well as C-reactive protein (CRP), pain, temperature and
plasma troponin Ic. Results At 12 h and 24 h after surgery, then at drain
removal, blood losses in homoeopathy and placebo groups were not
statistically significant (362 +/- 218, 520 +/- 269 and 640 +/- 297 ml vs.
456 +/- 440, 620 +/- 477 and 796 +/- 717 ml; P = 0.19, 0.23 and 0.35,
respectively). The statistical modelling did not show significantly
different patterns of CRP, troponin and body temperature changes or of
pain perception. The number of transfused packed red cells was not
significantly different either (P = 0.58). Two patients from each group
died during the study period and the number of serious adverse events was
not statistically different (six in homoeopathy vs. 10 in placebo groups;
Fisher's exact test P = 0.41). Conclusions In the study setting, there was
no evidence of effects of A. montana and B. alba combination on bleeding,
inflammation, pain or myocardial ischaemia. copyright 2010 The British
Pharmacological Society.
<9>
Accession Number
2010253753
Authors
Abbate A. Kontos M.C. Grizzard J.D. Biondi-Zoccai G.G.L. Van Tassell B.W.
Robati R. Roach L.M. Arena R.A. Roberts C.S. Varma A. Gelwix C.C. Salloum
F.N. Hastillo A. Dinarello C.A. Vetrovec G.W.
Institution
(Abbate, Kontos, Grizzard, Van Tassell, Robati, Roach, Arena, Roberts,
Varma, Gelwix, Salloum, Hastillo, Vetrovec) Virginia Commonwealth
University, VCU Pauley Heart Center, Richmond, VA, United States.
(Biondi-Zoccai) Division of Cardiology, University of Turin, Turin, Italy.
(Dinarello) Department of Internal Medicine, University of Colorado,
Aurora, CO, United States.
Title
Interleukin-1 Blockade With Anakinra to Prevent Adverse Cardiac Remodeling
After Acute Myocardial Infarction (Virginia Commonwealth University
Anakinra Remodeling Trial [VCU-ART] Pilot Study).
Source
American Journal of Cardiology. 105(10)(pp 1371-1377.e1), 2010. Date of
Publication: 15 May 2010.
Publisher
Elsevier Inc.
Abstract
Acute myocardial infarction (AMI) initiates an intense inflammatory
response in which interleukin-1 (IL-1) plays a central role. The IL-1
receptor antagonist is a naturally occurring antagonist, and anakinra is
the recombinant form used to treat inflammatory diseases. The aim of the
present pilot study was to test the safety and effects of IL-1 blockade
with anakinra on left ventricular (LV) remodeling after AMI. Ten patients
with ST-segment elevation AMI were randomized to either anakinra 100
mg/day subcutaneously for 14 days or placebo in a double-blind fashion.
Two cardiac magnetic resonance (CMR) imaging and echocardiographic studies
were performed during a 10- to 14-week period. The primary end point was
the difference in the interval change in the LV end-systolic volume index
(LVESVi) between the 2 groups on CMR imaging. The secondary end points
included differences in the interval changes in the LV end-diastolic
volume index, and C-reactive protein levels. A +2.0 ml/m2 median increase
(interquartile range +1.0, +11.5) in the LVESVi on CMR imaging was seen in
the placebo group and a -3.2 ml/m2 median decrease (interquartile range
-4.5, -1.6) was seen in the anakinra group (p = 0.033). The median
difference was 5.2 ml/m2. On echocardiography, the median difference in
the LVESVi change was 13.4 ml/m2 (p = 0.006). Similar differences were
observed in the LV end-diastolic volume index on CMR imaging (7.6 ml/m2, p
= 0.033) and echocardiography (9.4 ml/m2, p = 0.008). The change in
C-reactive protein levels between admission and 72 hours after admission
correlated with the change in the LVESVi (R = +0.71, p = 0.022). In
conclusion, in the present pilot study of patients with ST-segment
elevation AMI, IL-1 blockade with anakinra was safe and favorably affected
by LV remodeling. If confirmed in larger trials, IL-1 blockade might
represent a novel therapeutic strategy to prevent heart failure after AMI.
copyright 2010 Elsevier Inc. All rights reserved.
<10>
Accession Number
2010218892
Authors
Zahn R. Hamm C.W. Zeymer U. Richardt G. Kelm M. Levenson B. Bonzel T.
Tebbe U. Sabin G. Nienaber C.A. Pfannebecker T. Senges J.
Institution
(Zahn, Zeymer, Senges) Einfach Weglassen der Med. Klinik B,
Kardiologie/Pneumologie/Angiologie/Internistische Intensivmedizin,
Herzzentrum Ludwigshafen, Bremserstrae 79, 67063 Ludwigshafen, Germany.
(Hamm) Kardiologie, Kerckhoff Klinik, Bad Nauheim, Germany.
(Richardt) Kardiologie, Segeberger Kliniken, Bad Segeberg, Germany.
(Kelm) Kardiologie, Universitatsklinikum, Dusseldorf, Germany.
(Levenson) Kardiologische Praxis, Berlin, Germany.
(Bonzel) Kardiologie, Klinikum Fulda, Fulda, Germany.
(Tebbe) Kardiologie, Klinikum Lippe-Detmold, Detmold, Germany.
(Sabin) Kardiologie, Elisabeth Krankenhaus, Essen, Germany.
(Nienaber) Kardiologie, Universitatsklinikum, Rostock, Germany.
(Pfannebecker) Cordis Corporation, Langenfeld, Germany.
Title
Coronary stenting with the sirolimus-eluting stent in patients with
restenosis after intracoronary brachytherapy: Results from the prospective
multicentre German Cypher Stent Registry.
Source
Clinical Research in Cardiology. 99(2)(pp 99-106), 2010. Date of
Publication: February 2010.
Publisher
D. Steinkopff-Verlag
Abstract
Background: Treatment of restenosis following intracoronary brachytherapy
(ICB) is still a challenging problem. Implantation of sirolimus-eluting
stents (SES) in this setting may be an option to be evaluated. Methods and
results: We analysed the prospective multicentre SES registry, the German
Cypher Stent Registry. 7,445 patients treated with an SES during
percutaneous coronary intervention (PCI) were registered. Out of these
patients, 61 (0.8%) were treated for restenosis after ICB: 56 patients
with completed follow-up could be evaluated. Median age was 65 years, with
80% male patients. 48% of patients had a prior myocardial infarction and
25% had already coronary bypass surgery (CABG). Type B2 lesion was present
in 40% and type C lesion in 22.4%. Event rates from SES implantation until
6.6 months follow-up were death 0%, myocardial infarction 3.6%, stroke
2.1%. Target vessel revascularization rate (TVR) was 16.4%, and major
adverse cardiovascular or cerebral events (MACCE) or TVR occurred in 17.9%
of patients. This TVR rate was higher compared with that of other patients
treated with an SES: 8.4% (P = 0.04). During 65 months follow-up MACCE or
TVR occurred in 44.6% of patients. Conclusions: The treatment of lesions
after ICB occurred in 0.8% out of all patients treated with an SES.
Clinical event rates during early follow-up were low. However, the TVR
rate was 16.4%, which was significantly higher when compared with other
SES-treated patients (8.4%, P = 0.04). The treatment of restenosis after
ICB with SES seems to be safe and reasonably effective; however, there
might be a late catch-up phenomenon. copyright 2009 Springer-Verlag.
<11>
Accession Number
2010232525
Authors
Ooi Su Min J. Ramzisham A.R.M. Zamrin M.D.
Institution
(Ooi Su Min) Division of Cardiothoracic Anaesthesia, Heart and Lung
Centre, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
(Ramzisham, Zamrin) Division of Cardiothoracic Surgery, Heart and Lung
Centre, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Title
Is 6% hydroxyethyl starch 130/0.4 safe in coronary artery bypass graft
surgery?.
Source
Asian Cardiovascular and Thoracic Annals. 17(4)(pp 368-372), 2009. Date
of Publication: 2009.
Publisher
SAGE Publications Inc.
Abstract
The aim of this study was to compare 6% hydroxyethyl starch 130/0.4 with
4% succinylated gelatin for priming the cardiopulmonary bypass circuit and
as volume replacement in patients undergoing coronary artery bypass, in
terms of postoperative bleeding, blood transfusion requirements, renal
function, and outcome after surgery. Forty-five patients received 6%
hydroxyethyl starch 130/0.4 (Voluven) and another 45 were given 4%
succinylated gelatin (Gelofusine) as the priming solution for the
cardiopulmonary bypass circuit as well as for volume replacement.
Postoperative bleeding was quantified from the hourly chest drainage in
the first 4 h and at 24 h postoperatively. The baseline characteristics of
both groups were similar. In the hydroxyethyl starch group, the total
amount of colloid used was 1.9+/-1.0 L, while the gelatin group had
2.0+/-0.7 L. There was no significant difference in hourly chest drainage
between groups. Blood transfusion requirements, estimated glomerular
filtration rate, extubation time, intensive care unit and hospital stay
were similar in both groups. It was concluded that 6% hydroxyethyl starch
130/0.4 is a safe alternative colloid for priming the cardiopulmonary
bypass circuit and volume replacement in patients undergoing coronary
artery bypass surgery. copyright SAGE Publications 2009.
<12>
Accession Number
2010227605
Authors
Orth-Gomer K. Schneiderman N. Wang H.-X. Walldin C. Blom M. Jernberg T.
Institution
(Orth-Gomer) Department of Public Health Sciences, Karolinska Institute,
Stockholm, Sweden.
(Schneiderman) Behavioral Medicine Program, Department of Psychology,
University of Miami, Miami, FL, United States.
(Wang) Department of Neurobiology, Care Sciences and Society, Aging
Research Center, University of Miami, Miami, FL, United States.
(Walldin, Blom, Jernberg) Department of Cardiology, Karolinska University
Clinics, Stockholm, Sweden.
(Orth-Gomer) Department of Psychosomatics, Campus Benjamin Franklin,
Charite Universitatsmedizin, Berlin, Germany.
Title
Stress reduction prolongs life in women with coronary disease: The
Stockholm women's intervention trial for coronary heart disease (SWITCHD).
Source
Circulation: Cardiovascular Quality and Outcomes. 2(1)(pp 25-32), 2009.
Date of Publication: January 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Psychosocial stress may increase risk and worsen prognosis of
coronary heart disease in women. Interventions that counteract women's
psychosocial stress have not previously been presented. This study
implemented a stress reduction program for women and investigated its
ability to improve survival in women coronary patients. Methods and
Results: Two hundred thirty-seven consecutive women patients, aged 75
years or younger, hospitalized for acute myocardial infarction, coronary
artery bypass grafting, or percutaneous coronary intervention were
randomized to a group-based psychosocial intervention program or usual
care. Initiated 4 months after hospitalization, intervention groups of 4
to 8 women met for a total of 20 sessions that were spread over a year. We
provided education about risk factors, relaxation training techniques,
methods for self-monitoring and cognitive restructuring, with an emphasis
on coping with stress exposure from family and work, and self-care and
compliance with clinical advice. From randomization until end of follow-up
(mean duration, 7.1 years), 25 women (20%) in the usual care and 8 women
(7%) in the stress reduction died, yielding an almost 3-fold protective
effect of the intervention (odds ratio, 0.33; 95% CI, 0.15 to 0.74;
P=0.007). Introducing baseline measures of clinical prognostic factors,
including use of aspirin, beta-blockers, angiotensin-converting enzyme
inhibitors, calcium-channel blockers, and statins into multivariate models
confirmed the unadjusted results (P=0.009). Conclusions: Although
mechanisms remain unclear, a group-based psychosocial intervention program
for women with coronary heart disease may prolong lives independent of
other prognostic factors. copyright 2009 American Heart Association, Inc.
<13>
Accession Number
2010221326
Authors
Bauer A. Diez C. Schubel J. El-Shouki N. Metz D. Eberle T. Hausmann H.
Institution
(Bauer) Department of Cardiovascular Technology, MediClin Heart Center
Coswig, Lerchenfeld 1, 06869 Coswig, Sachsen-Anhalt, Germany.
(Diez) Department of Cardiothoracic and Vascular Surgery, University
Hospital of Regensburg, Regensburg, Germany.
(Schubel, El-Shouki, Metz, Hausmann) Department of Cardiovascular Surgery,
MediClin Heart Centre Coswig, Sachsen Anhalt, Germany.
(Eberle) Department of Cardio - Anesthesiology, MediClin Heart Centre
Coswig, Sachsen Anhalt, Germany.
Title
Evaluation of hemodynamic and regional tissue perfusion effects of
minimized extracorporeal circulation (MECC).
Source
Journal of Extra-Corporeal Technology. 42(1)(pp 30-39), 2010. Date of
Publication: March 2010.
Publisher
American Society of Extra-Corporeal Technology
Abstract
Minimized extracorporeal circulation (MECC , Maquet, Cardiopulmonary AG,
Hirrlingen, Germany) is an established procedure to perform coronary
revascularization. Studies showed positive effects of MECC compared to
conventional cardiopulmonary bypass (CCPB) procedures in terms of
transfusion requirements, less inflammation reactions, and neurological
impairments. Recent retrospective studies showed higher mean arterial
pressure (MAP) and a lower frequency of vasoactive drug use. We addressed
this issue in this study. The hypothesis was to find a higher MAP during
coronary bypass grafting surgery in patients treated with MECC systems .
We performed a prospective, controlled, randomized trial with 40 patients
either assigned to MECC ( n = 18) or CCPB ( n = 22) undergoing coronary
bypass grafting. Primary endpoints were the perioperative course of mean
arterial pressure, and the consumption of norepinephrine. Secondary
endpoints were the regional cerebral and renal oxygen saturation (rSO2) as
an indicator of area perfusion and the course of hematocrit. Clinical and
demographic characteristics did not significantly differ between both
groups. Thirty-day mortality was 0%. At four of five time points during
extracorporeal circulation (ECC) MAP values were significantly higher in
the MECC group compared to CCPB patients (after starting the ECC 60 +/- 11
mmHg vs. 49 +/- 10 mmHg, p = .002). MECC patients received significantly
less norepinephrine (MECC 22.5 +/- 35 mug vs. CCPB 60.5 +/- 75 mug, p =
.045). The rSO2 measured at right and left forehead and the renal area was
similar for both groups during ECC and significantly higher at CCPB group
1 and 4 hours after termination of CPB. Minimized extracorporeal
circulation provides a higher mean arterial pressure during ECC and we
found a lower consumption of vasoactive drugs in the MECC group. There was
a decrease in regional tissue saturation at 1 and 4 hours post bypass in
the MECC group possibly due to increased systemic inflammation and
extravascular fluid shift in the CCPB group.
<14>
Accession Number
2010220893
Authors
Lingegowda V. Van Q.C. Shimada M. Beaver T.M. Dass B. Sood P. Ejaz A.A.
Institution
(Lingegowda, Van, Dass, Sood, Ejaz) Division of Nephrology, Hypertension
and Transplantation, University of Florida, P.O. Box 100224, Gainesville,
FL 32610-0224, United States.
(Beaver) Division of Thoracic and Cardiovascular Surgery, University of
Florida, Gainesville, Beaver, United States.
(Shimada) Division of Renal Diseases and Hypertension, University of
Colorado Health Sciences Center, Denver, CO, United States.
Title
Long-term outcome of patients treated with prophylactic nesiritide for the
prevention of acute kidney injury following cardiovascular surgery.
Source
Clinical Cardiology. 33(4)(pp 217-221), 2010. Date of Publication: April
2010.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Previously, we reported that the prophylactic use of
nesiritide did not reduce the incidence of dialysis or death following
cardiovascular (CV) surgery despite reducing the incidence of acute kidney
injury (AKI) in the immediate postoperative period. Therefore, we
investigatedwhether the observed renal benefits of nesiritide had any
long-termimpact on cumulative patient survival and renal outcomes.
Methods: Participants of the Nesiritide Study, a previously reported
prospective, double-blind, placebocontrolled, randomizedclinical trial
investigatingthe effect of nesiritide on the incidence of dialysis or
deathat 21 days in adult patientsundergoing high-risk CV surgery, were
included in the study. Data of the participants' most recent health and
renal function statuswere obtained using institutional review
board-approved patient questionnaires,medical records, and the database of
the Social Security Administration. Results: Data on all 94 patients from
the Nesiritide Study were obtained. The mean follow-up period was 20.8 +/-
10.4 months. No differences in cumulative survival between the groups were
noted at follow-up (nesiritide 77.7% vs placebo 81.6%, P = 0.798).
Patients with in-hospital incidence of AKI had a higher rate of mortality
than those with no AKI (AKI 41.4% vs no AKI 10.7%, P = 0.002). However,
differences in survival time were not significant between the groups when
the analysiswas restricted to patientswith AKI (nesiritide 16.8 +/-
4months vs placebo 18.5 +/- 2.3months, P = 0.729). Conclusions:
Renoprotectionprovided by nesiritide in the immediate postoperativeperiod
was not associated with improved long-termsurvival in patients undergoing
high-risk CV surgery. copyright 2010 Wiley Periodicals, Inc.
<15>
Accession Number
2010248809
Authors
Gotzmann M. Lindstaedt M. Bojara W. Mugge A. Germing A.
Institution
(Gotzmann, Lindstaedt, Bojara, Mugge, Germing) BG-Kliniken Bergmannsheil,
Medical Clinic II (Cardiology), Ruhr-University Bochum, Germany.
Title
Hemodynamic results and changes in myocardial function after transcatheter
aortic valve implantation.
Source
American Heart Journal. 159(5)(pp 926-932), 2010. Date of Publication:
May 2010.
Publisher
Mosby Inc.
Abstract
Background: This prospective study was designed to evaluate the
hemodynamic results of transcatheter aortic valve implantation (TAVI) with
the CoreValve prosthesis (Medtronic, Minneapolis, Minnesota) and the
effects on left ventricular function. Methods: From June 2008 to June
2009, consecutive patients with severe symptomatic aortic valve stenosis
(aortic valve area <1 cm2) and the indication for TAVI were included.
Aortic valve prosthesis was inserted retrograde. Examinations of study
patients were performed before, 30 days, and 6 months after TAVI and
comprised measurement of B-type natriuretic peptide and echocardiography.
Severe prosthesis-patient mismatch was defined as an indexed effective
aortic valve area [less-than or equal to]0.65 cm2/m2. Results: In 39
patients, follow-up examinations were performed after TAVI. Severe
prosthesis-patient mismatch seldom occurred (n = 1), but mild to moderate
aortic valve regurgitation due to paravalvular leaks was common (n = 24,
62%). After 6 months, left ventricular mass index declined (158 +/- 46 vs
138 +/- 45 g/m2, P = .001), and peak early diastolic mitral annular
velocity (E') and peak systolic mitral annular velocity (S') increased (P
= .004 and P < .001, respectively). B-type natriuretic peptide levels
decreased (744 +/- 708 at baseline vs 367 +/- 273 at 30 days, P = .003,
279 +/- 186 pg/mL at 6 months, P = .001). Left ventricular diameters and
ejection fraction remained unchanged. Conclusion: Despite the high
incidence of paravalvular regurgitation after TAVI, hemodynamic results
were favorable. Furthermore, TAVI had positive effects on left ventricular
remodeling and improved neurohormonal activity, myocardial hypertrophy,
and diastolic function. copyright 2010 Mosby, Inc. All rights reserved.
<16>
[Use Link to view the full text]
Accession Number
2010227791
Authors
Cheng D.C.H. Ad N. Martin J. Berglin E.E. Chang B.-C. Doukas G. Gammie
J.S. Nitta T. Wolf R.K. Puskas J.D.
Institution
(Cheng, Martin) Department of Anesthesia and Perioperative Medicine,
Evidence-Based Perioperative Clinical Outcomes Research Group (EPiCOR),
University of Western Ontario, London, ON, Canada.
(Ad) Department of Cardiac Surgery, Inova Heart and Vascular Institute,
Falls Church, VA, United States.
(Martin) High Impact Technology Evaluation Centre, London Health Sciences
Centre, London, ON, Canada.
(Berglin) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Goteborg, Sweden.
(Chang) Department of Cardiac Surgery, Yonsei University College of
Medicine, Seoul, South Korea.
(Doukas) Department of Cardiothoracic Surgery, Glenfield Hospital,
Leicester, United Kingdom.
(Gammie) Division of Cardiac Surgery, University of Maryland, School of
Medicine, Baltimore, MD, United States.
(Nitta) Department of Cardiac Surgery, Nippon Medical School Main
Hospital, Tokyo, Japan.
(Wolf) Deaconess Hospital, Cincinnati, OH, United States.
(Puskas) Division of Cardiothoracic Surgery, Emory University, Atlanta,
GA, United States.
Title
Surgical ablation for atrial fibrillation in cardiac surgery: A
meta-analysis and systematic review.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 5(2)(pp 84-96), 2010. Date of Publication: March-April 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVES:: This meta-analysis sought to determine whether surgical
ablation improves clinical outcomes and resource utilization compared with
no ablation in adult patients with persistent and permanent atrial
fibrillation (AF) undergoing cardiac surgery. METHODS:: A comprehensive
search was undertaken to identify all randomized (RCT) and nonrandomized
(non-RCT) controlled trials of surgical ablation versus no ablation in
patients with AF undergoing cardiac surgery up to April 2009. The primary
outcome was sinus rhythm. Secondary outcomes included survival and any
other reported clinically relevant outcome or indicator of resource
utilization. Odds ratios (OR) and weighted mean differences (WMD) and
their 95% confidence intervals (95% CI) were analyzed as appropriate using
the random effects model. Heterogeneity was measured using the I
statistic. Meta-regression was performed to explore the relationship
between the benefit from surgical AF and duration of follow-up. RESULTS::
Thirty-three studies met the inclusion criteria (10 RCTs and 23 non-RCTs)
for a total of 4647 patients. The number of patients in sinus rhythm was
significantly improved at discharge in the surgical AF ablation group
versus (68.6%) the surgery alone group (23.0%) in RCTs (OR 10.1, 95% CI
4.5-22.5) and non-RCTs (OR 7.15, 95% CI 3.42-14.95). This effect on sinus
rhythm (74.6% vs. 18.4%) remained at follow-up of 1 to 5 years (OR 6.7,
95% CI 2.8-15.7 for RCT, and OR 15.5, 95% CI 6.6-36.7 for non-RCT). The
risk of all-cause mortality at 30 days was not different between the
groups in RCT (OR 1.20, 95% CI 0.52-3.16) or non-RCT studies (OR 0.99, 95%
CI 0.52-1.87). In studies reporting all-cause mortality at 1 year or more
(up to 5 years), mortality did not differ in RCT studies (OR 1.21, 95% CI
0.59-2.51) but was significantly reduced in non-RCT studies (OR 0.54, 95%
CI 0.31-0.96). Stroke incidence was not reduced significantly; however, in
meta-regression, the risk of stroke decreased significantly with longer
follow-up. Other clinical outcomes were similar between groups. Operation
time was significantly increased with surgical AF ablation; however,
overall impact on length of stay was variable. CONCLUSIONS:: In patients
with persistent or permanent AF who present for cardiac surgery, the
addition of surgical AF ablation led to a significantly higher rate of
sinus rhythm in RCT and non-RCT studies compared with cardiac surgery
alone, and this effect remains robust over the longer term (1-5 years).
Although non-RCT studies suggest the possibility of reduced risk of stroke
and death, this remains to be proven in prospective RCTs with adequate
power and follow-up. Copyright copyright 2010 by the International Society
for Minimally Invasive Cardiothoracic Surgery.
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