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<1>
Accession Number
0020204984
Authors
Shelley M. Pakenham K.I. Frazer I.
Institution
(Shelley, Pakenham, Frazer) Department of Psychology, The University of
Queensland, St Lucia, Brisbane, Australia.
Title
Cortisol changes interact with the effects of a cognitive behavioural
psychological preparation for surgery on 12-month outcomes for surgical
heart patients..
Source
Psychology & health. 24(10)(pp 1139-1152), 2009. Date of Publication: Dec
2009.
Abstract
Previous studies offer contradictory evidence regarding the effects of
cortisol changes on health outcomes for surgical heart patients. Increased
cortisol and inflammation have been related to psychological stress while
separate studies have found an inverse relation between cortisol and
inflammation. Psychological preparations for surgery can reduce stress and
improve outcomes and may interact with cortisol changes. Following from
these relationships, we hypothesised that a preparation for surgery will
interact with changes in cortisol to affect outcomes. Measures were the SF
36 General Health and Activities, medical visits and satisfaction.
Eighty-five patients were randomly assigned to standard care plus a
psychological preparation or standard care alone using a single-blind
methodology. Data on psychological and biological functioning were
collected at admission, 1 day prior and 5 days post-surgery, and 12-months
after hospital discharge. General health and activities, and medical
visits were related to the interaction of cortisol change and
psychological preparation in support of the hypothesis. Patients were more
satisfied in the preparation group than controls. Based on these findings,
some outcomes from psychological preparations may be affected by changes
in levels of cortisol. These results caution against a one-size-fits-all
approach to psychological preparations.
<2>
[Use Link to view the full text]
Accession Number
2010281542
Authors
Hicks J.M. Singla A. Shen F.H. Arlet V.
Institution
(Hicks, Shen, Arlet) Department of Orthopaedic Surgery, University of
Virginia, Box 800159, Charlottesville, VA 22908, United States.
(Singla) Department of Neurological Surgery, State University of New York,
Syracuse, NY, United States.
Title
Complications of pedicle screw fixation in scoliosis surgery: A systematic
review.
Source
Spine. 35(11)(pp E465-E470), 2010. Date of Publication: 15 May 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
STUDY DESIGN.: Systematic review. OBJECTIVE.: To review the published
literature on the use of pedicle screws in pediatric spinal deformity to
quantify the risks and complications associated with pedicle screw
instrumentation, particularly in the thoracic spine. SUMMARY OF BACKGROUND
DATA.: The use of pedicle screws in adolescent scoliosis surgery is
common. Although many reports have been published regarding the use of
pedicle screws in pediatric patients, there has been no systematic review
on the risks of complications. METHODS.: PubMed, Ovid Medline, and
Cochrane databases were searched for studies reporting the use of thoracic
pedicle screws in pediatric deformity. We excluded articles dealing with
neuromuscular scoliosis or bone dysplasia to focus mostly on adolescent
thoracic idiopathic scoliosis and the likes. We then searched for cases
reports dealing with thoracic pedicle screws complications. RESULTS.: This
systematic review retrieved 21 studies with a total of 4570 pedicle screws
in 1666 patients. The mean age of the patients was 17.6 years; 812
patients were women and 252 were men, and 5 studies did not identify sex.
Overall, 518 (4.2%) screws were reported as malpositioned. However, in
studies in which postoperative computed tomography scans were done
systematically, the rate of screw malpositioning was as high as 15.7%. The
reported percentage of patients with screw malpositioned is around 11%.
Eleven patients underwent revision surgery for instrumentation
malposition. Other complications reported include loss of curve
correction, intraoperative pedicle fracture or loosening, dural
laceration, deep infection, pseudarthrosis, and transient neurologic
injury. There were no major vascular complications reported in these 21
studies. We could identify 9 case report articles dealing with
complications of pedicle screws. Such complications were mostly either
vascular (10 cases) or neurologic (4 cases), without any irreversible
complications. CONCLUSION.: Malposition is the most commonly reported
complication of thoracic pedicle screw placement, at a rate of 15.7% per
screw inserted with postoperative computed tomography scans. The use of
pedicle screws in the thoracic spine for the treatment of pediatric
deformity has been reported to be safe despite the high rate of patients
with malpositioned screws (11%). Major compli cations, such as neurologic
or vascular injury, were almost never reported in this literature review
of case series. Cases reports on the other hand have started to identify
such complications. copyright 2010, Lippincott Williams & Wilkins.
<3>
Accession Number
0020190704
Authors
Miyamoto H. Sakao Y. Sakuraba M. Oh S. Takahashi N. Miyasaka Y. Akaboshi
T. Inagaki T.
Institution
(Miyamoto, Sakao, Sakuraba, Oh, Takahashi, Miyasaka, Akaboshi, Inagaki)
Department of General Thoracic Surgery, Juntendo University, Tokyo, Japan.
Title
The effects of sheet-type absorbable topical collagen hemostat used to
prevent pulmonary fistula after lung surgery.
Source
Annals of Thoracic and Cardiovascular Surgery. 16(1)(pp 16-20), 2010.
Date of Publication: February, 2010.
Publisher
Japanese Association for Coronary Artery Surgery
Abstract
Background: Numerous reports have been published on the application of
fibrin glues, biological adhesives used as sealants for air leaks after
pulmonary resection; however, the use of blood products has been
questioned from both safety and economic perspectives. Therefore we were
prompted to attempt the use of Integran (method C), a sheet-type
absorbable topical collagen hemostat that is neither expensive nor derived
from blood. Objective: To compare the efficacy of method C with that of
method G, a combined approach in which TachoComb or a polyglycolic acid
(PGA) sheet was fixed with a fibrin glue in a randomized controlled trial
to prevent pulmonary fistula formation after lung surgery. Materials and
Methods: Of the patients who were scheduled to undergo pulmonary resection
in 2006 at the Department of General Thoracic Surgery, Juntendo
University, and who provided informed consent for the study before
surgery, those who developed visible air leaks during lobectomy,
segmentectomy, partial resection for lung tumor or pulmonary cyst, or
intractable pneumothorax were included as the subjects of this study. The
subjects were randomized for treatment with either of 2 procedures,
namely, method C or method G. Pulmonary fistula was defined as an obvious
air leak persisting until day 3 after surgery. Results: A total of 38
patients were assigned to method C and 34 to method G. Three patients
(7.9%) assigned to method C (including 1 who underwent lobectomy and 2 who
underwent partial resection), and 6 (17.6%) patients assigned to method G,
including 3 who each underwent a lobectomy and partial resection,
developed postoperative pulmonary fistula. The incidence of pulmonary
fistula was significantly lower in the group assigned to method C, with a
statistically significant difference of p = 0.044. Conclusions: In a
Randomized Controlled Trial of Sealing with a Sheet-type Collagen vs. a
Combined Approach of Fixing a Collagen Sponge, Using Fibrin Glue for
Closure of Air Leaks, the use of Integran, a sheet-type absorbable topical
collagen hemostat, is feasible to prevent pulmonary fistula after lung
surgery. It is also affordable and safe because it is not a blood product.
copyright 2010 The Editorial Committee of Annals of Thoracic and
Cardiovascular Surgery.
<4>
Accession Number
2010276035
Authors
Park M. Coca S.G. Nigwekar S.U. Garg A.X. Garwood S. Parikh C.R.
Institution
(Park, Coca, Parikh) Clinical Epidemiology Research Center, Veterans
Affairs Medical Center, West Haven, CT, United States.
(Park, Coca, Parikh) Department of Medicine, Yale University School of
Medicine, New Haven, CT, United States.
(Nigwekar) Department of Medicine, University of Rochester School of
Medicine, Rochester, NY, United States.
(Garg) Division of Nephrology, University of Western Ontario, London, ON,
Canada.
(Garg) Department of Epidemiology and Biostatistics, University of Western
Ontario, London, ON, Canada.
(Garg) Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
(Garwood) Department of Anesthesiology, Yale University School of
Medicine, New Haven, CT, United States.
(Parikh) Section of Nephrology, Yale University, VAMC, 950 Campbell Ave,
West Haven, CT 06516, United States.
Title
Prevention and treatment of acute kidney injury in patients undergoing
cardiac surgery: A systematic review.
Source
American Journal of Nephrology. 31(5)(pp 408-418), 2010. Date of
Publication: May 2010.
Publisher
S. Karger AG
Abstract
Background: Acute kidney injury (AKI) is common in patients undergoing
cardiac surgery and is associated with a high rate of death, long-term
sequelae and healthcare costs. We conducted a systematic review of
randomized controlled trials for strategies to prevent or treat AKI in
cardiac surgery. Methods: We screened Medline, Scopus, Cochrane Renal
Library, and Google Scholar for randomized controlled trails in cardiac
surgery for prevention or treatment of AKI in adults. Results: We
identified 70 studies that contained a total of 5,554 participants
published until November 2008. Most studies were small in sample size,
were single-center, focused on preventive strategies, and displayed wide
variation in AKI definitions. Only 26% were assessed to be of high quality
according to the Jadad criteria. The types of strategies with possible
protective efficacy were dopaminergic agents, vasodilators,
anti-inflammatory agents, and pump/perfusion strategies. When analyzed
separately, dopamine and N-acetylcysteine did not reduce the risk for AKI.
Conclusions: This summary of all the literature on prevention and
treatment strategies for AKI in cardiac surgery highlights the need for
better information. The results advocate large, good-quality, multicenter
studies to determine whether promising interventions reliably reduce rates
of acute renal replacement therapy and mortality in the cardiac surgery
setting. Copyright copyright 2010 S. Karger AG, Basel.
<5>
Accession Number
2010052862
Authors
Landoni G. Mizzi A. Biondi-Zoccai G. Bruno G. Bignami E. Corno L. Zambon
M. Gerli C. Zangrillo A.
Institution
(Landoni, Mizzi, Bruno, Bignami, Corno, Zambon, Gerli, Zangrillo)
Department of Cardiothoracic Anesthesia and Intensive Care, Universita
Vita-Salute San Raffaele, Milan, Italy.
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
University of Turin, Turin, Italy.
Title
Reducing Mortality in Cardiac Surgery With Levosimendan: A Meta-analysis
of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(1)(pp 51-57), 2010.
Date of Publication: February 2010.
Publisher
W.B. Saunders
Abstract
Objectives: The authors performed a meta-analysis to evaluate whether
levosimendan is associated with improved survival in patients undergoing
cardiac surgery. Design: A meta-analysis. Setting: Hospitals.
Participants: A total of 440 patients from 10 randomized controlled
studies were included in the analysis. Interventions: None. Measurments
and Main Results: Four investigators independently searched BioMedCentral
and PubMed. Inclusion criteria were random allocation to treatment,
comparison of levosimendan versus control, and cardiac surgery patients.
Exclusion criteria were duplicate publications, nonhuman experimental
studies, and no mortality data. The primary endpoint was postoperative
mortality. Levosimendan was associated with a significant reduction in
postoperative mortality (11/235 [4.7%] in the levosimendan group v 26/205
[12.7%] in the control arm, odds ratio = 0.35 [0.18-0.71], p for effect =
0.003, p for heterogeneity = 0.22, I2 = 27.4% with 440 patients included),
cardiac troponin release, and atrial fibrillation. No difference was found
in terms of myocardial infarction, acute renal failure, time on mechanical
ventilation, intensive care unit, and hospital stay. Conclusions:
Levosimendan has cardioprotective effects that could result in a reduced
postoperative mortality. A large randomized controlled study is warranted
in this setting. copyright 2010 Elsevier Inc. All rights reserved.
<6>
Accession Number
2010278187
Authors
Yin L. Wang Z. Wang Y. Ji G. Xu Z.
Institution
(Yin, Wang, Wang, Ji, Xu) Cardiothoracic Surgery Department, Changhai
Hospital, Second Military Medical University of PLA, Shanghai 200433,
China.
Title
Effect of statins in preventing postoperative atrial fibrillation
following cardiac surgery.
Source
Journal of Atrial Fibrillation. 1(11)(pp 609-615), 2010. Date of
Publication: March 2010.
Publisher
CardioFront LLC
Abstract
Background : Postoperative occurrence of AF has been associated with less
favorable outcomes in patients undergoing cardiac surgery and may result
in increased postoperative morbidity and mortality. Objectives : A focused
clinical question was designed and a Meta-analysis of published studies
was performed to identify the effect of preoperative use of statins on the
occurrence of AF after cardiac surgery. Methods : Using the Medline
database, the Cochrane clinical trials database and online clinical trial
databases, we reviewed all RCTs and observational studies examining the
effect of statins on AF occurrence following cardiac surgery. We searched
for literature published before April 2009 and earlier. Results : This
analysis identified 6 studies (observational studies) which examined the
effect of preoperative use of statins on AF occurrence following cardiac
surgery, involving 10165 patients. Contradictory to most of previous
studies, the overall outcomes suggested that the statins group did not
have a significant decrease in AF occurrence following cardiac surgery
comparing to control group (P = 0.19). Conclusions : The preoperative
medication of statins showed no significant decrease in AF occurrence
following cardiac surgery in this Meta-analysis result. More prospective
studies and researches are needed to explore and demonstrate the accurate
mechanism and effect of statins on postoperative AF.
<7>
Accession Number
2010246575
Authors
Chrysant S.G. Chrysant G.S. Chrysant C. Shiraz M.
Institution
(Chrysant, Chrysant, Chrysant, Shiraz) Oklahoma Cardiovascular and
Hypertension Center, Oklahoma City, OK 73132-4904, United States.
(Chrysant, Chrysant) University of Oklahoma, Oklahoma City, OK 73132-4904,
United States.
Title
The treatment of cardiovascular disease continuum: Focus on pharmacologic
management and RAS blockade.
Source
Current Clinical Pharmacology. 5(2)(pp 89-95), 2010. Date of Publication:
May 2010.
Publisher
Bentham Science Publishers B.V.
Abstract
The cardiovascular disease continuum is a sequence of events, which begins
with a host of risk factors consisting of diabetes mellitus, dyslipidemia,
hypertension, smoking and visceral obesity. If left untreated, it will
inexorably progress to atherosclerosis, CAD, myocardial infarction, left
ventricular remodeling, LVH, left ventricular enlargement, and eventually
end-stage heart failure and death. Treatment intervention at any stage of
its course will prevent or delay its further progression. However, the
best results are expected to be achieved when treatment is initiated at
the beginning, or at an early stage of its course. A Pub-Med/MEDLINE
search was conducted for relevant English language, randomized clinical
trials and epidemiologic studies for the years 1995-2009 using the terms,
cardiovascular continuum, obesity, hyperlipidemia, diabetes mellitus,
hypertension, metabolic syndrome, renal disease, stroke, and blockers of
the renin angiotensin system (RAS). A total of 34 pertinent studies were
selected for review. This concise review will focus on prevention and the
aggressive treatment of the existing cardiovascular risk factors with
emphasis on the blockers of RAS, and demonstrate that RAS blockers are the
best drugs for its treatment. copyright 2010 Bentham Science Publishers
Ltd.
<8>
Accession Number
2010053040
Authors
El-Tahan M.R. Hamad R.A. Ghoneimy Y.F. El Shehawi M.I. Shafi M.A.
Institution
(El-Tahan, Shafi) Department of Anesthesia and Surgical ICU, King Faisal
University, Dammam, Saudi Arabia.
(Ghoneimy) Department of Cardiothoracic Surgery, King Faisal University,
Dammam, Saudi Arabia.
(Hamad) Cardiac Surgery, Prince Sultan Cardiac Centre, Riyadh, Saudi
Arabia.
(El Shehawi) Cardiothoracic Anesthesia, Faculty of Medicine, Mansoura
University, Mansoura City, Egypt.
Title
A Prospective, Randomized Study of the Effects of Continuous
Ultrafiltration in Hepatic Patients After Cardiac Valve Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(1)(pp 63-68), 2010.
Date of Publication: February 2010.
Publisher
W.B. Saunders
Abstract
Objectives: The use of continuous ultrafiltration may be effective in
preventing the hepatic decompensation in cirrhotic patients after valvular
heart surgery with cardiopulmonary bypass (CPB). The authors aimed to
evaluate the effects of continuous ultrafiltration on the need for blood
transfusion, liver function tests, duration of postoperative ventilatory
support, and the length of the intensive care unit (ICU) stay in cirrhotic
patients undergoing valvular heart surgery. Design: A prospective,
randomized double-blinded placebo study. Setting: A single university
hospital. Participants: Sixty cirrhotic patients scheduled for valvular
surgery. Interventions: After local ethics committee approval and informed
consent, participants were divided into 2 groups. In the conventional
ultrafiltration (CUF) group (n = 30), CPB was used with conventional
ultrafiltration. In the continuous ultrafiltration group (n = 30), in
addition to the same CUF procedure, modified ultrafiltration was used
after CPB. Measurements and Main Results: Perioperative liver function
tests, hematocrit, platelet count, the postoperative ventilation time, ICU
and hospital length of stay, complications, and mortality were recorded.
After CPB, patients receiving continuous ultrafiltration had a shorter
time to extubation, postoperative ventilation time and ICU and hospital
length of stay (p < 0.01), lower bleeding (p < 0.01), greater rise in
hematocrit (11.3% +/- 2.39% v 4.7% +/- 1.22%, p = 0.001) and platelet
count (7.0 +/- 3.0 v 0.8 +/- 0.21 104/mumL, p = 0.001), higher albumin
levels (p < 0.001), and lower plasma levels of bilirubin,
aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase
(p < 0.02). There was no significant difference between the 2 groups in
the dosage of nitroglycerin or epinephrine, morbidity, or mortality.
Conclusions: The authors concluded that continuous ultrafiltration reduced
postoperative bleeding and blood transfusions, improved liver function,
and shortened the hospital stay in cirrhotic patients after valvular heart
surgery. copyright 2010.
<9>
[Use Link to view the full text]
Accession Number
2010240783
Authors
Melberg T. Nordrehaug J.E. Nilsen D.W.T.
Institution
(Melberg, Nilsen) Department of Cardiology, Stavanger University Hospital,
Box 8100, 4068 Stavanger, Norway.
(Melberg, Nordrehaug, Nilsen) Section for Cardiology, Institute of
Medicine, University of Bergen, Norway.
(Nordrehaug) Department of Heart Disease, Haukeland University Hospital,
Norway.
Title
A comparison of the health status after percutaneous coronary intervention
at a hospital with and without on-site cardiac surgical backup: A
randomized trial in nonemergent patients.
Source
European Journal of Cardiovascular Prevention and Rehabilitation.
17(2)(pp 235-243), 2010. Date of Publication: April 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Prospective randomized trials comparing the coronary artery
disease-related health status outcomes (changes in symptom grade, physical
functional capacity and health-related quality of life) after percutaneous
coronary intervention at hospitals with and without on-site cardiac
surgical backup have not been reported earlier. METHODS: We randomly
assigned 609 consecutive patients fulfilling pre-specified procedural
low-risk criteria to undergo percutaneous coronary intervention at either
a community hospital without or a regional hospital with on-site surgical
backup. Five hundred and seventy-six patients completed the health status
evaluation at baseline and at 6 months follow-up. RESULTS: At baseline,
91.4% had symptoms, and the mean (standard deviation) Canadian
Cardiovascular Society's classification was 2.5 (0.9). The procedural
success rates and the changes in health status measures were similar at
the two hospitals. Overall there was a substantial relief of symptoms with
a reduction in Canadian Cardiovascular Society's classification of 1.9
(1.2), increase in exercise time [1.4 (1.9)min] and reduction in use of
antianginal drugs [0.6 (0.9) less drugs] at follow-up compared with
baseline (all P<0.001). Health-related quality of life was evaluated with
the Short-Form 36 health survey. There were significant and similar
improvements in nearly all multi-item and summary scores from baseline to
follow-up at the two hospitals. The largest improvements were seen in
items related to physical functioning [overall change in Physical
Component Score from baseline to follow-up 6.9 (9.1) points, P<0.001] and
lowest in the mental health domains [change in Mental Component Score 3.3
(10.7) points, P<0.001]. INTERPRETATION: This study shows that a
substantial and comparable gain in coronary artery disease-related health
status can be achieved at hospitals both with and without surgical backup.
copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
<10>
Accession Number
2010278514
Title
Impact of positive pleural lavage cytology on survival in patients having
lung resection for non-small-cell lung cancer: An international individual
patient data meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 139(6)(pp 1441-1446),
2010. Date of Publication: June 2010.
Publisher
Mosby Inc.
Abstract
Objectives: Pleural lavage cytology is the microscopic study of cells
obtained from saline instilled into and retrieved from the chest during
surgery for non-small-cell lung cancer. The aims of this study were to
collate multi-institutional individual patient data for meta-analysis to
determine independence as a prognostic marker and to characterize the
impact of positive results on stage-adjusted survival. Methods: We
identified 31 publications from 22 centers/research groups that performed
pleural lavage cytology during surgery for non-small-cell lung cancer and
invited submission of individual patient data. Actuarial survival was
calculated using Kaplan-Meier methods, and comparisons were performed
using the log-rank test. Cox proportional hazards regression was used to
ascertain the covariates associated with survival. Results: By January 1,
2008, submissions were received internationally from 11 centers with
individual data from 8763 patients. In total, 511 (5.8%) patients had a
positive pleural lavage cytology result, and this was shown to be an
independent predictor of adverse survival associated with a hazard ratio
of 1.465 (1.290-1.665; P < .001) compared with a reference hazard ratio of
1 for a negative result. On statistical modeling, the best adjustment for
patients with a positive pleural lavage cytology result was a single
increase in the T category assigned to the case, up to a maximum of T4.
Correction for differences in survival were obtained in stages IB (P =
.315) and IIB (P = .453), with a degree of correction in stage IIIA (P =
.07). Conclusions: Pleural lavage cytology should be considered in all
patients with non-small-cell lung cancer suitable for resection. A
positive result is an independent predictor of adverse survival, and the
impact on survival suggests that it may be appropriate to upstage patients
by 1 T category. copyright 2010 The American Association for Thoracic
Surgery.
<11>
Accession Number
2010278512
Authors
Yan T.D. Cao C. Martens-Nielsen J. Padang R. Ng M. Vallely M.P. Bannon
P.G.
Institution
(Yan, Cao, Martens-Nielsen, Vallely, Bannon) Department of Cardiothoracic
Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney,
Australia.
(Yan, Vallely, Bannon) The Baird Institute for Applied Heart and Lung
Surgical, Sydney, Australia.
(Padang, Ng) Department of Cardiology, The University of Sydney, Royal
Prince Alfred Hospital, Sydney, Australia.
Title
Transcatheter aortic valve implantation for high-risk patients with severe
aortic stenosis: A systematic review.
Source
Journal of Thoracic and Cardiovascular Surgery. 139(6)(pp 1519-1528),
2010. Date of Publication: June 2010.
Publisher
Mosby Inc.
Abstract
Objectives: The present systematic review objectively assessed the safety
and clinical effectiveness of transcatheter aortic valve implantation for
patients at high surgical risk with severe aortic stenosis. Methods:
Electronic searches were performed in 6 databases from January 2000 to
March 2009. The end points included feasibility, safety, efficacy, and
durability. Clinical effectiveness was synthesized through a narrative
review with full tabulation of results of all included studies. Results:
The current evidence on transcatheter aortic valve implantation for aortic
stenosis is limited to short-term observational studies. The overall
procedural success rates ranged from 74% to 100%. The incidence of major
adverse events included 30-day mortality (0%-25%), major ventricular
tachyarrhythmia (0%-4%), myocardial infarction (0%-15%), cardiac tamponade
(2%-10%), stroke (0%-10%), conversion to surgery (0%-8%), moderate to
major paravalvular leak (4%-35%), vascular complication (8%-17%),
valve-in-valve procedure (2%-12%), and aortic dissection/perforation
(0%-4%). The overall 30-day major adverse cardiovascular and cerebral
events ranged from 3% to 35%. The mean aortic valve area ranged from 0.5
to 0.8 cm2 before and 1.3 to 2.0 cm2 after transcatheter aortic valve
implantation. The mean pressure gradient ranged from 34 to 58 mm Hg before
and 3 to 12 mm Hg after transcatheter aortic valve implantation. There was
no significant deterioration in echocardiography measurements during the
assessment period. Death rate at 6 months postprocedure ranged from 18% to
48%. No studies had adequate follow-up to reliably evaluate long-term
outcomes. Conclusions: The procedure has a potential for serious
complications. Although short-term efficacy based on echocardiography
measurements is good, there is little evidence on long-term outcomes. The
use of transcatheter aortic valve implantation should be considered only
within the boundaries of clinical trials. copyright 2010 The American
Association for Thoracic Surgery.
<12>
Accession Number
2010239555
Authors
Aronow W.S. Banach M.
Institution
(Aronow) Cardiology Division, Department of Medicine, New York Medical
College, Valhalla, NY, United States.
(Banach) Department of Molecular Cardionephrology and Hypertension,
Medical University of Lodz, Lodz, Poland.
Title
Atrial fibrillation: The new epidemic of the ageing world.
Source
Journal of Atrial Fibrillation. 1(6)(pp 337-361), 2009. Date of
Publication: April 2009.
Publisher
CardioFront LLC
Abstract
The prevalence of atrial fibrillation (AF) increases with age. As the
population ages, the burden of AF increases. AF is associated with an
increased incidence of mortality, stroke, and coronary events compared to
sinus rhythm. AF with a rapid ventricular rate may cause a
tachycardia-related cardiomyopathy. Immediate direct-current (DC)
cardioversion should be performed in patients with AF and acute myocardial
infarction, chest pain due to myocardial ischemia, hypotension, severe
heart failure, or syncope. Intravenous beta blockers, diltiazem, or
verapamil may be administered to reduce immediately a very rapid
ventricular rate in AF. An oral beta blocker, verapamil, or diltiazem
should be used in persons with AF if a fast ventricular rate occurs at
rest or during exercise despite digoxin. Amiodarone may be used in
selected patients with symptomatic life-threatening AF refractory to other
drugs. Digoxin should not be used to treat patients with paroxysmal AF.
Nondrug therapies should be performed in patients with symptomatic AF in
whom a rapid ventricular rate cannot be slowed by drugs. Paroxysmal AF
associated with the tachycardia-bradycardia syndrome should be treated
with a permanent pacemaker in combination with drugs. A permanent
pacemaker should be implanted in patients with AF and symptoms such as
dizziness or syncope associated with ventricular pauses greater than 3
seconds which are not drug-induced. Elective DC cardioversion has a higher
success rate and a lower incidence of cardiac adverse effects than does
medical cardioversion in converting AF to sinus rhythm. Unless
transesophageal echocardiography has shown no thrombus in the left atrial
appendage before cardioversion, oral warfarin should be given for 3 weeks
before elective DC or drug cardioversion of AF and continued for at least
4 weeks after maintenance of sinus rhythm. Many cardiologists prefer,
especially in elderly patients , ventricular rate control plus warfarin
rather than maintaining sinus rhythm with antiarrhythmic drugs. Patients
with chronic or paroxysmal AF at high risk for stroke should be treated
with long-term warfarin to achieve an International Normalized Ratio of
2.0 to 3.0. Patients with AF at low risk for stroke or with
contraindications to warfarin should be treated with aspirin 325 mg daily.
<13>
[Use Link to view the full text]
Accession Number
2010224015
Authors
Kang D.-H. Park S.-J. Rim J.H. Yun S.-C. Kim D.-H. Song J.-M. Choo S.J.
Park S.W. Song J.-K. Lee J.-W. Park P.-W.
Institution
(Kang, Rim, Yun, Kim, Song, Choo, Park, Song, Lee) Division of Cardiac
Surgery, Asan Medical Center, University of Ulsan, Seoul, South Korea.
(Park, Park, Park) Samsung Medical Center, Sungkyunkwan University School
of Medicine, Seoul, South Korea.
Title
Early surgery versus conventional treatment in asymptomatic very severe
aortic stenosis.
Source
Circulation. 121(13)(pp 1502-1509), 2010. Date of Publication: April
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
The optimal timing of surgical intervention remains controversial in
asymptomatic patients with very severe aortic stenosis. We therefore
compared the long-term results of early surgery and a conventional
treatment strategy. METHODS AND RESULTS: From 1996 to 2006, we
prospectively included a total of 197 consecutive asymptomatic patients
(99 men; age, 63+/-12 years) with very severe aortic stenosis. Patients
were excluded if they had angina, syncope, exertional dyspnea, ejection
fraction <0.50, significant mitral valve disease, or age >85 years. Very
severe aortic stenosis was defined as a critical stenosis in the aortic
valve area [less-than or equal to]0.75 cm accompanied by a peak aortic jet
velocity [greater-than or equal to]4.5 m/s or a mean transaortic pressure
gradient [greater-than or equal to]50 mm Hg on Doppler echocardiography.
The primary end point was defined as the composite of operative mortality
and cardiac death during follow-up. Early surgery was performed on 102
patients, and a conventional treatment strategy was used for 95 patients.
There were no significant differences between the 2 groups in terms of
age, gender, European System for Cardiac Operative Risk Evaluation score,
or ejection fraction. During a median follow-up of 1501 days, the operated
group had no operative mortalities, no cardiac deaths, and 3 noncardiac
deaths; the conventional treatment group had 18 cardiac and 10 noncardiac
deaths. The estimated actuarial 6-year cardiac and all-cause mortality
rates were 0% and 2+/-1% in the operated group and 24+/-5% and 32+/-6% in
the conventional treatment group, respectively (P<0.001), and for 57
propensity score-matched pairs, the risk of all-cause mortality was
significantly lower in the operated group than in the conventional
treatment group (hazard ratio, 0.135; 95% confidence interval, 0.030 to
0.597; P=0.008). CONCLUSIONS: Compared with the conventional treatment
strategy, early surgery in patients with very severe aortic stenosis is
associated with an improved long-term survival by decreasing cardiac
mortality. Early surgery is therefore a therapeutic option to further
improve clinical outcomes in asymptomatic patients with very severe aortic
stenosis and low operative risk. copyright 2010 American Heart
Association, Inc.
<14>
Accession Number
2010218400
Authors
Reiner J.S.
Institution
(Reiner) Cardiac Catheterization Lab., George Washington University
Medical Center, 2150 Pennsylvania Ave. N.W, Washington, DC 20037, United
States.
Title
Contrast-induced acute kidney injury prevention targets: What works and
what doesn't.
Source
Journal of Invasive Cardiology. 21(SUPPL.B)(pp 20B-22B), 2009. Date of
Publication: December 2009.
Publisher
HMP Communications
Abstract
Contrast-induced acute kidney injury is an ominous event following
diagnostic or interventional cardiac catheterization procedures, and its
occurrence is a potent predictor of mortality. In this report, we review
the various pharmacologic and procedural strategies proposed for
prevention of contrast-induced acute kidney injury.
<15>
[Use Link to view the full text]
Accession Number
2010255112
Authors
Dekutoski M.B. Norvell D.C. Dettori J.R. Fehlings M.G. Chapman J.R.
Institution
(Dekutoski) Department of Orthopaedic Surgery, Mayo Clinic College of
Medicine, 200 First Street SW, Rochester, MN 55905, United States.
(Norvell, Dettori) Spectrum Research, Tacoma, WA, United States.
(Fehlings) University of Toronto, Toronto, ON, Canada.
(Chapman) Department of Orthopaedic Surgery, Harborview Medical Center,
Seattle, WA, United States.
Title
Surgeon perceptions and reported complications in spine surgery.
Source
Spine. 35(SUPPL. 9S)(pp S9-S21), 2010. Date of Publication: April 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Study Design. Systematic review. Objective. To define the term
"complications" from the spine surgery literature and contrast this with
definitions from other federal institutions, to summarize the incidence of
adverse events in cervical, thoracic, and lumbar spine surgery, to include
the factors that contribute to these events, and to determine the
relationship between complications and patient centered outcomes. Summary
of Background Data. Efforts to understand and reduce complications in
medicine, and spine surgery in particular have been hampered as a result
of the lack of a meaningful and universally acceptable definition. The
complex field of spine surgery has been a particularly challenging area
for the development of a consensus to constructively describe these
"undesirable/unanticipated developments arising during or out of the
delivery of health care." Furthermore, an overall understanding of
expected complication rates after major spine surgery is lacking. Methods.
A systematic review of the English literature was undertaken for articles
published between 1990 and December 2008. Electronic and federal databases
and reference lists of key articles were searched to identify articles
defining complications and reporting rates of spine surgical
complications. Two independent reviewers assessed the level of evidence
quality using the Grading of Recommendations Assessment, Development, and
Evaluation (GRADE) criteria and disagreements were resolved by consensus.
Results. The definitions for complications in the spine literature and
federal agencies are inconsistent and at times conflicting. Mortality
rates for cervical spine and lumbar spine surgery are <1%. For thoracic
spine surgery, rates range from 0.3% to 7%. Complication rates range from
5% to 19%, 7% to 18%, and 4% to 14% after cervical, thoracic, and lumbar
spine surgery, respectively. Findings from a single study indicate that
major complications may have an impact on 1-year self-perceived general
health. However, minor complications may not. Conclusion. We define a
complication as an unintended and undesirable diagnostic or therapeutic
event that may impact the patient's care. Complications should be recorded
and analyzed relative to disease severity, patient comorbidities, and
ultimately their effect on patient outcomes. Further work needs to be done
to develop a complication risk impact index that has the ability to help
us assess and communicate the interaction of patient cormobidities and
complication severity on patient centered outcomes. copyright 2010,
Lippincott Williams & Wilkins.
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