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<1>
Accession Number
2010600112
Authors
Zheng R. Gu C. Yang Z. Dou K. Wang J. Yu S. Wang H. Xie J. Wang Y. Yi D.
Pei J.
Institution
(Zheng, Gu, Yu, Wang, Xie, Yi, Pei) Department of Cardiovascular Surgery,
Xijing Hospital, Fourth Military Medical University, 15# Changle West Rd,
Xi'an 710032, China
(Wang, Wang) Department of Nuclear Medicine, Xijing Hospital, Fourth
Military Medical University, Xi'an, China
(Dou, Wang) Department of Hepato-Biliary Surgery, Xijing Hospital, Fourth
Military Medical University, Xi'an, China
(Yang, Pei) Department of Physiology, State Key Discipline of Cell
Biology, Fourth Military Medical University, Xi'an, China
Title
Impacts of intensive insulin therapy in patients undergoing heart valve
replacement.
Source
Heart Surgery Forum. 13 (5) (pp E292-E298), 2010. Date of Publication:
October 2010.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background and Aims: Cardiac surgery with cardioplegic cardiac arrest and
cardiopulmonary bypass (CPB) is associated with severe stress response,
systemic inflammatory response, and injury. This study was designed to
investigate the effects of intensive insulin therapy on patients
undergoing valve replacement with CPB. Methods: One hundred nondiabetic
inpatients undergoing valve replacement were randomly assigned to a
control group or an intensive insulin therapy (IT) group. Plasma cytokine
and cardiac troponin I (cTnI) levels were monitored perioperatively.
Results: Compared with the control group, the IT group had smaller
increases in plasma concentrations of tumor necrosis factor alpha,
interleukin 1beta (IL-1beta), IL-6, and cTnI, and had a more pronounced
increase in IL-10 levels after the initiation of CPB. After surgery, the
required inotropes were reduced in the IT group. In the IT group, the time
of artificial ventilation and the postoperative length of stay in the
hospital were markedly shortened; however, there were no significant
differences between the IT and control groups in mortality and the rate of
nosocomial infections of deep sternal wounds. Conclusions: IT can
significantly attenuate the systemic inflammatory response and improve a
damaged cardiac function, but it does not reduce the in-hospital mortality
rate. 2010 Forum Multimedia Publishing, LLC.
<2>
Accession Number
70297891
Authors
Souza G.E.C.S. Pego-Fernandes P.M. Moreira L.F.P. Vieira M.L.C. Guimaraes
G.V. Bacal F. Chizzola P.R. Bocchi E.A.
Institution
(Souza, Pego-Fernandes, Moreira, Vieira, Guimaraes, Bacal, Chizzola,
Bocchi) Heart Institute -InCor, Sao Paulo, Brazil
Source
European Journal of Heart Failure, Supplement. Conference: Heart Failure
2009 Nice France. Conference Start: 20090530 Conference End: 20090602.
Conference Publication: (var.pagings). 8 (pp ii116-ii117), 2009. Date
of Publication: May 2009.
Publisher
Oxford University Press
Abstract
Purpose: To investigate feasibility and safety of endoscopic clipping
video-assisted thoracoscopy sympathetic blockade (ECVTSB) in symptomatic
systolic heart failure (SHF) patients either refractory or intolerant to
beta-blockers (BB), Secondly, we sought to evaluate its cardiovascular
effects per-operatively and after a one month follow-up. Methods:
Randomized controlled trial with concealed allocation. Patients with
dilated cardiomyopathy and severe heart failure (LVEF<40%), NYHA
functional class II or III, sinus rythm and HR > 64 bpm despite either
adequate BB use or intolerant to it were included. Patients with Chagas
cardiomyopathy, atrial fibrilation, NYHA functional class I or IV, bearing
conditions which could limit short term survival or with pacemakers were
excluded. Every three patients included were randomized to either
treatment group (G1) or control group (G2) in a 2:1 basis. All of them
underwent clinical and echocardiographic evaluation before and two months
after procedure or randomization. G1 patients were placed in a
semi-sitting position, under one-lumen intubation under general anesthesia
and invasive hemodynamic monitoring. The procedure consisted of lower left
stellar ganglion plus left T1-T4 interspinal space clipping through
videothoracoscopy. All patients were closely monitored in ICU for 24h and
then in ward for more 24h. Study interruption and surgery reversal (clip
removal) criteria was death or severe worsening of SHF symptoms in the
per-operative period. Results: From January 2007 to december 2008, twelve
consecutive patients had been included (average age 49,8 years). Eight
patients underwent ECVTSB. Maximum procedure duration was 33 minutes. None
had any procedure-related adverse cardiovascular event in the
per-operative period or in the one month follow-up. Only one patient in G1
did not improve NYHA functional class (maintained functional class III)
while patients in G2 either maintained or worsened NYHA functional class.
There was a trend in improving LV ejection fraction in G1 in comparison to
G2. Conclusions: ECVTSB is feasible and appears to be safe in severe SHF
patients refractory or intolerant to BB. Exploratory data from this sample
suggest that this might be an effective alternative approach to
sympathetic blockade in SHF in this particular setting.
<3>
Accession Number
70298790
Authors
Ang K.L. Lai V.K. Rathbone W.E. Harvey N.J. Gaiinanes M.
Institution
(Ang, Lai, Rathbone, Gaiinanes) University of Leicester, Leicester, United
Kingdom
(Harvey) Glenfield Hospital, Leicester, United Kingdom
Source
European Journal of Heart Failure, Supplement. Conference: Heart Failure
2009 Nice France. Conference Start: 20090530 Conference End: 20090602.
Conference Publication: (var.pagings). 8 (pp ii707), 2009. Date of
Publication: May 2009.
Publisher
Oxford University Press
Abstract
Purpose: This study investigates whether autologous bone marrow cells
(BMCs) reduce myocardial ischemic injury during cardiac surgery.Methods:
44 elective CABG patients were randomized to control or BMCs group BMCs
were obtained during CABG. In the BMCs group, BMCs were then diluted in
blood cardioplegia and administered 10ml/injection) into the coronary
circulation antegradely at the end of each cardioplegia dose
(49.6+/-28.7x10<sup>6</sup>> cells/injection). Plasma cardiac enzymes
(troponin I, CK-MB) were measured during the first 48 hours after surgery
To study the cardioprotective effects of BMCs in-vitro and compare this
with ischemic pre-conditioning, the right atrial appendage from 12
controls were collected either before or 10min after the initiation of
cardiopulmonary bypass (CPB) and subjected to 90min ischemia.Results: In
the clinical study, the cardiac enzymes did not differ significantly after
surgery between control and BMCs group (Table A). However, in the in-vitro
study, BMCs and IP significantly reduced the CK release of muscles
obtained prior to CPB (Table B); although their combination did not afford
additional benefit When muscles were harvested after the initiation of
CPB, CK release in the ischemic group alone was less. This suggests they
were already protected; and BMCs and IP did not exert further CK
reduction.(Table presented) Conclusions: BMCs offer cardioprotection as
potent as IP, but benefit is only seen when the heart is not subjected to
stress, such as CPB, that per se, can precondition the myocardium.
<4>
Accession Number
2010591339
Authors
Sanchez-Lazaro I.J. Almenar-Bonet L. Martinez-Dolz L. Buendia-Fuentes F.
Navarro-Manchon J. Raso-Raso R. Aguero J. Salvador-Sanz A.
Institution
(Sanchez-Lazaro, Almenar-Bonet, Martinez-Dolz, Buendia-Fuentes,
Navarro-Manchon, Raso-Raso, Aguero, Salvador-Sanz) Heart Failure and
Transplant Unit, Cardiology Department, Hospital Universitario la Fe,
Valencia, Spain
Title
Preliminary results of a prospective randomized study of cyclosporine
versus tacrolimus in the development of cardiac allograft vasculopathy at
1 year after heart transplantation.
Source
Transplantation Proceedings. 42 (8) (pp 3199-3200), 2010. Date of
Publication: 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Introduction and aims: Cardiac allograft vasculopathy (CAV) is the leading
cause of death after the first year postheart transplantation (HT).
Numerous factors have been implicated in the development of CAV. The aim
of this prospective randomized study was to assess the impact of
cyclosporine (CsA) and tacrolimus (Tac) on the development of CAV.
Materials and methods: From November 2006 to October 2008, 49 HT patients
in our center were randomized to receive CsA or Tac. The additional
treatment for all patients consisted of daclizumab induction and
maintenance treatment with mycophenolate mofetil (1 g/12 hours) and
steroids (withdrawal was not attempted). Thirteen patients died before
coronary arteriography plus intravascular ultrasound of the left anterior
descending artery was performed at 1 year after HT. Hence, the final
number of patients included was 36 (18 per group). We considered
significant CAV to be the presence of intimal proliferation >1 mm and/or
>0.5 mm in 180degree. The statistical methods were Student t and
chi-square tests. Results: There were no differences in baseline
characteristics between the two groups. Nor were there significant
differences in maximum intimal proliferation between the groups (CsA 0.65
+/- 0.29 vs Tac 0.82 +/- 0.51 mm; P = .292) or in the development of
significant CAV when both criteria were combined (CsA 31.6% vs Tac 38.9%;
P = .642). Conclusions: One year after HT, no differences were detected in
the development of significant CAV according to the type of calcineurin
inhibitor used when combined with daclizumab induction and maintenance
treatment with mycophenolate mofetil and steroids. 2010 Elsevier Inc.
<5>
Accession Number
2010591453
Authors
Paniagua Martin M.J. Marzoa Rivas R. Barge Caballero E. Grille Cancela Z.
Fernandez C.J. Solla M. Pedrosa V. Rodriguez Fernandez J.A. Herrera J.M.
Castro-Beiras A. Crespo-Leiro M.G.
Institution
(Paniagua Martin, Marzoa Rivas, Barge Caballero, Grille Cancela,
Fernandez, Solla, Pedrosa, Rodriguez Fernandez, Herrera, Castro-Beiras,
Crespo-Leiro) Department of Cardiology, Hospital Universitario A Corua,
Xubias 84, 15006 La Corua, Spain
Title
Efficacy and tolerance of different types of prophylaxis for prevention of
early aspergillosis after heart transplantation.
Source
Transplantation Proceedings. 42 (8) (pp 3014-3016), 2010. Date of
Publication: 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background The incidence of aspergillosis (ASP) after heart
transplantation (HTx) is low (<4%5%), but the mortality is high (>78%).
Aim To determine the incidence of ASP in the first 3 months post-HTx
according to the type of prophylaxis and assess the tolerance to these
regimens. Methods This retrospective study of 571 adult HTx patients
engrafted from 1991 to December 2009 included 83% males with an overall
group age of 54.9 +/- 11 years. Three types of prophylaxis were compared:
group A was no prophylaxis (n = 99; 19911994); group B, itraconazole for 3
months (n = 352; 1995November 2004); and group C, inhaled amphotericin for
3 months (n = 120; December 20042009). The dependent variables were the
presence and severity or tracheobronchitis and invasive/disseminated
disease as well as, prognosis of Aspergillus infection and tolerance to
the regimen. Results The incidences of aspergillosis were 5% in group A (n
= 5); 1.4% in group B (n = 5); and 0% in group C. Significant differences
were observed between groups A versus B (P = .030) and between groups A
versus C (P = .013), but there were no differences between groups B versus
C. In terms of severity, there were no significant differences among the
five cases of tracheobronchitis (20% group A/80% group B), five of
invasive/disseminated disease (80% group A /20% group B). There were two
deaths (20%) from invasive/disseminated ASP at 0.67 months after
diagnosis. The mean time from HTx to ASP was 0.98 +/- 0.40 months. There
were no adverse effects associated with itraconazole, but they occurred in
3/120 patients (2.5%) treated with inhaled amphotericin, all of whom were
on mechanical ventilation, developing respiratory failure requiring
amphotericin withdrawal. Conclusions Prophylaxis with itraconazole or
inhaled amphotericin was effective for the prevention and severity of
pulmonary ASP in the first 3 months post-HTx. Although the incidence of
early ASP was low in our series, the 20% mortality rate justified the use
of preventive measures. Tolerance to both prophylactic treatments was
good. 2010 Elsevier Inc.
<6>
Accession Number
2010599541
Authors
Stone G.W. Parise H. Witzenbichler B. Kirtane A. Guagliumi G. Peruga J.Z.
Brodie B.R. Dudek D. McKel M. Lansky A.J. Mehran R.
Institution
(Stone, Parise, Kirtane, Lansky, Mehran) Columbia University Medical
Center, New York-Presbyterian Hospital, Cardiovascular Research
Foundation, 111 East 59th Street, 11th Floor, New York, NY 10022, United
States
(Witzenbichler) Charit Campus Benjamin Franklin, Berlin, Germany
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Peruga) Medical University, Lodz, Poland
(Brodie) LeBauer Cardiovascular Research Foundation and Moses Cone
Hospital, Greensboro, NC, United States
(Dudek) Jagiellonian University, Krakow, Poland
(McKel) Charit Campus Virchow-Klinikum, Berlin, Germany
Title
Selection criteria for drug-eluting versus bare-metal stents and the
impact of routine angiographic follow-up: 2-Year insights from the
horizons-ami (harmonizing outcomes with revascularization and stents in
acute myocardial infarction) trial.
Source
Journal of the American College of Cardiology. 56 (19) (pp 1597-1604),
2010. Date of Publication: 02 Nov 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives We sought to identify patients with ST-segment elevation
myocardial infarction most likely to benefit from drug-eluting stents
(DES), and to evaluate the impact of routine angiographic follow-up on the
apparent differences between stent types. Background DES might have
greatest utility in patients who would benefit most from their
antirestenotic properties. Methods We randomly assigned 3,006 patients
with ST-segment elevation myocardial infarction to paclitaxel-eluting
stents (PES) or to bare-metal stents (BMS). Events were assessed at 12
months and 24 months, with a subset undergoing routine angiographic
follow-up at 13 months. Using well-known risk factors for restenosis and
target lesion revascularization (TLR), risk groups were formed to examine
the absolute differences between PES and BMS. Results Compared with BMS,
PES reduced TLR at 12 months from 7.4% to 4.5% (p = 0.003).
Insulin-treated diabetes mellitus (hazard ratio: 3.12), reference vessel
diameter <=3.0 mm (hazard ratio: 2.89), and lesion length <30 mm (hazard
ratio: 2.49) were independent predictors of 12-month TLR after BMS. In
patients with 2 or 3 of these baseline risk factors, PES compared with BMS
markedly reduced 12-month TLR (19.8% vs. 8.1%, p = 0.003). In patients
with 1 of these risk factors, the 12-month rates of TLR were modestly
reduced by PES (7.3% vs. 4.3%, p = 0.02). The 12-month TLR rates were low
and similar for both stents in patients with 0 risk factors (3.3% vs.
3.2%, p = 0.93). Routine 13-month angiographic follow-up resulted in a
marked increase in TLR procedures (more so with BMS) so that the absolute
incremental benefit of PES compared with BMS doubled from 2.9% at 12
months to 6.0% at 24 months, a difference evident in all risk strata.
Conclusions Patients at high risk for TLR after BMS in ST-segment
elevation myocardial infarction for whom DES are of greatest benefit may
be identified. Conversely, DES may be of less clinical benefit for
patients at lower risk for TLR after BMS. Routine angiographic follow-up
increases the perceived clinical benefits of DES, and must be avoided to
accurately estimate absolute treatment effects. (Harmonizing Outcomes With
Revascularization and Stents in Acute Myocardial Infarction
[HORIZONS-AMI]; NCT00433966) 2010 American College of Cardiology
Foundation.
<7>
[Use Link to view the full text]
Accession Number
2010599835
Authors
Peyton P.J. Chong S.W.
Institution
(Peyton, Chong) Department of Anaesthesia, Austin Hospital, Melbourne,
Australia
(Peyton) Department of Surgery, Austin Hospital, University of Melbourne,
Melbourne, Australia
Title
Minimally invasive measurement of cardiac output during surgery and
critical care: A meta-analysis of accuracy and precision.
Source
Anesthesiology. 113 (5) (pp 1220-1235), 2010. Date of Publication:
November 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
When assessing the accuracy and precision of a new technique for cardiac
output measurement, the commonly quoted criterion for acceptability of
agreement with a reference standard is that the percentage error (95%
limits of agreement/mean cardiac output) should be 30% or less. We
reviewed published data on four different minimally invasive methods
adapted for use during surgery and critical care: pulse contour
techniques, esophageal Doppler, partial carbon dioxide rebreathing, and
transthoracic bioimpedance, to assess their bias, precision, and
percentage error in agreement with thermodilution. An English language
literature search identified published papers since 2000 which examined
the agreement in adult patients between bolus thermodilution and each
method. For each method a meta-analysis was done using studies in which
the first measurement point for each patient could be identified, to
obtain a pooled mean bias, precision, and percentage error weighted
according to the number of measurements in each study. Forty-seven studies
were identified as suitable for inclusion: N studies, n measurements: mean
weighted bias [precision, percentage error] were: pulse contour N = 24, n
= 714: -0.00 l/min [1.22 l/min, 41.3%]; esophageal Doppler N = 2, n = 57:
-0.77 l/min [1.07 l/min, 42.1%]; partial carbon dioxide rebreathing N = 8,
n = 167: -0.05 l/min [1.12 l/min, 44.5%]; transthoracic bioimpedance N =
13, n = 435: -0.10 l/min [1.14 l/min, 42.9%]. None of the four methods has
achieved agreement with bolus thermodilution which meets the expected 30%
limits. The relevance in clinical practice of these arbitrary limits
should be reassessed. 2010, the American Society of Anesthesiologists,
Inc. Lippincott Williams & Wilkins.
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