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<1>
Accession Number
2011039151
Authors
Ensor C.R. Paciullo C.A. Cahoon W.D. Nolan P.E.
Institution
(Ensor) School of Pharmacy, University of Maryland, United States
(Ensor) Department of Pharmac, Comprehensive Transplant Center, Johns
Hopkins Hospital, Baltimore, MD, United States
(Paciullo) Department of Pharmacy, Emory University Hospital, Atlanta, GA,
United States
(Cahoon) School of Pharmacy, Virginia Commonwealth University Health
System, Richmond, VA, United States
(Nolan) University Medical Center, University of Arizona, Tucson, AZ,
United States
Title
Pharmacotherapy for mechanical circulatory support: A comprehensive
review.
Source
Annals of Pharmacotherapy. 45 (1) (pp 60-77), 2011. Date of Publication:
January 2011.
Publisher
Harvey Whitney Books Company (8044 Montgomery Road, Suite 415, Cincinnati
OH 45236, United States)
Abstract
OBJECTIVE: To provide a comprehensive review of the pharmacotherapy
associated with the provision of mechanical circulatory support (MCS) to
patients with end-stage heart failure and guidance regarding the
selection, assessment, and optimization of drug therapy for this
population. DATA SOURCES: The MEDLINE/PubMed, EMBASE, and Cochrane
databases were searched from 1960 to July 2010 for articles published in
English using the search terms mechanical circulatory support, ventricular
assist system, ventricular assist device, left ventricular assist device,
right ventricular assist device, biventricular assist device, total
artificial heart, pulsatile, positive displacement, axial, centrifugal,
hemostasis, bleeding, hemodynamic, blood pressure, thrombosis,
antithrombotic therapy, anticoagulant, antiplatelet, right ventricular
failure, ventricular arrhythmia, anemia, arteriovenous malformation,
stroke, infection, and clinical pharmacist. STUDY SELECTION AND DATA
EXTRACTION: All relevant original studies, metaanalyses, systematic
reviews, guidelines, and reviews were assessed for inclusion. References
from pertinent articles were examined for content not found during the
initial search. DATA SYNTHESIS: MCS has advanced significantly since the
first left ventricular assist device was implanted in 1966. Further
advancements in MCS technology that occurred in the latter decade are
changing the overall management of endstage heart failure care and cardiac
transplantation. These pumps allow for improved bridge-to-transplant
rates, enhanced survival, and quality of life. Pharmacotherapy associated
with MCS devices may optimize the performance of the pumps and improve
patient outcomes, as well as minimize morbidity related to their adverse
effects. This review highlights the knowledge needed to provide
appropriate clinical pharmacy services for patients supported by MCS
devices. CONCLUSIONS: The HeartMate II clinical investigators called for
the involvement of pharmacists in MCS patient assessment and optimization.
Pharmacotherapeutic management of patients supported with MCS devices
requires individualized care, with pharmacists as part of the team, based
on the characteristics of each pump and recipient.
<2>
Accession Number
2011051692
Authors
Kralev S. Hennig O. Lang S. Kalsch T. Borggrefe M. Dempfle C.-E. Suselbeck
T.
Institution
(Kralev, Hennig, Lang, Kalsch, Borggrefe, Dempfle, Suselbeck) Department
of Medicine, Faculty of Medicine Mannheim, University of Heidelberg,
Mannheim, Germany
Title
Sex-based differences in clinical and angiographic outcomes in patients
with st-elevation myocardial infarction treated with concomitant use of
glycoprotein iib/iiia inhibitors.
Source
Cardiology Journal. 17 (6) (pp 580-586), 2010. Date of Publication:
2010.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: The widespread use of primary coronary intervention (PCI) has
significantly improved the prognosis of men presenting with acute coronary
syndromes, but the cardiovascular event rate among women has either
levelled off or increased. The purpose of the present prospective study
was to compare the clinical outcome of women and men presenting with
ST-elevation myocardial infarction (STEMI) undergoing primary PCI with
concomitant usage of GP IIb/IIIa inhibitors. Methods: Between January 2006
and December 2007, 297 consecutive patients presenting with STEMI were
prospectively included in this single center investigation. Overall, 82
(27.6%) women and 215 (72.4%) men were treated by PCI with additional bare
metal stent implantation and a GP IIb/IIIa inhibitor. Results: Women were
significantly older (65 +/- 10 vs 60 +/- 12 years, p = 0.04), presented
with a smaller reference luminal diameter (2.83 +/- 0.51 vs 2.94 +/- 0.43,
p = 0.03) and had a higher prevalence of hypertension (68% vs 53%, p =
0.025) and obesity (30% vs 18%, p = 0.03). The incidence of major adverse
cardiac events (MACE, defined as death, re-myocardial infarction, target
lesion revascularization and coronary artery bypass graft) during
long-term follow-up was similar in women and men (20% vs 26%, p = 0.29).
Age, C-reactive protein, platelet count and cardiogenic shock were
identified as independent predictors for MACE, whereas gender was not
predictive. Conclusions: In this study, female gender did not emerge as an
independent predictor for MACE, but women presenting with STEMI had a
higher cardiovascular risk profile; this emphasizes the need for a more
extensive therapeutic strategy. Combination therapy with primary PCI and
GP IIb/IIIa inhibitors might mitigate gender-related differences in
clinical outcomes. 2010 Via Medica.
<3>
Accession Number
70333535
Authors
Athappan G. Khan F. Popma J.
Source
Catheterization and Cardiovascular Interventions. Conference: 32nd Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI Las Vegas, NV United States. Conference Start:
20090506 Conference End: 20090509. Conference Publication: (var.pagings).
73 (pp S6), 2009. Date of Publication: 01 Jun 2009.
Publisher
Wiley-Liss Inc.
Abstract
Background: Coronary artery bypass surgery (CABG) is the recommended
standard of therapy for unprotected left main coronary artery stenosis
(UPLMS). Advances in percutaneous coronary intervention with stenting
(PCI) led to a reassessment of these options, but conclusive assessments
cannot be drawn from recent studies because of a lack of consistent
conclusions and limited sample sizes. We undertook a systematic review to
overcome these limitations and compare the outcomes of CABG vs. PCI for
UPLMS.(Table presented). Methods: We reviewed studies between January 2000
and December 2008 comparing PCI and CABG for UPLMS using meta-analytical
methods. Studies with majority of patients undergoing emergent
revascularization or with severely reduced LVEF were excluded. The results
were reviewed using a random effects model. The primary endpoints were
all-cause mortality and target vessel revascularization (TVR) at longest
follow-up. The secondary endpoints were long-term MACCE and MACCE after
the index procedure. Heterogeneity was assessed by Q-statistic and
sensitivity analyses were performed. Results: Eleven studies comprising
3781 patients met the inclusion criteria (Fig 1). 1287 patients underwent
PCI. There was no significant difference in the incidence of all-cause
mortality between the two groups (OR:1.008, 95%CI:0.668 to1.521; Fig 1).
TVR at longest follow up occurred more frequently in patients undergoing
PCI (OR:4.625, 95%CI:2.904 to7.365). MACCE at 30 days was significantly
reduced in patients undergoing PCI (OR:0.276, 95%CI: 0.151 to0.502)
whereas long-term MACCE was similar in the two groups. There was no change
in the results on sensitivity analyses. Conclusions: We conclude that PCI
is a safe and durable alternative to CABG for the revascularization of
UPLMS. These findings also suggest that updates in practice guidelines
should be considered and that the revascularization of choice for UPLMS
ought to be individualized.
<4>
Accession Number
70333695
Authors
Aslam A. Chaudhry M. Fox J. Gadhavi P. Wanahita N.
Institution
(Aslam, Fox, Gadhavi) Beth Israel Medical Center, Heart Institute, New
York, NY, United States
(Chaudhry) Long Island College Hospital, Brooklyn, NY, United States
Source
Catheterization and Cardiovascular Interventions. Conference: 32nd Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI Las Vegas, NV United States. Conference Start:
20090506 Conference End: 20090509. Conference Publication: (var.pagings).
73 (pp S68), 2009. Date of Publication: 01 Jun 2009.
Publisher
Wiley-Liss Inc.
Abstract
Background: Saphenous vein graft aneurysms (SVGA) are a complication of
coronary artery bypass graft (CABG) surgery. Studies of pathology
specimens have reported an incidence of 14% which is similar to
intravascular ultrasound studies. This literature review will define the
most common modes of presentation, diagnostic modalities and treatment
options employed in reported cases. Methods: Medline and PubMed databases
were searched by 2 independent reviewers for any SVGA cases published.
Univariate analysis was performed between different variables and clinical
outcome. Results: A total of 147 SVGA cases (1982-2008) were included in
the analysis. Subjects were 89% males. Mean age was 64 yrs. Mean follow up
was 4 months. Mean duration since the CABG was 14.3 yrs. True SVGAs were
reported from 3.9 yrs to 31 yrs after CABG whereas pseudoaneurysms were
reported from 29 days to 24 yrs after CABG. The frequency of single,
multiple and diffuse SVGA was 75%,16% and 3% respectively. True and
pseudoaneurysms were reported with similar frequency regardless of the
segment of graft involved. SVG to Circumflex artery more often develop
true aneurysms. The most common symptoms were chest pain (53%), dyspnea
(14%), and hemoptysis (8%). Most common clinical findings were mediastinal
mass (28%), vascular aneurysm (16 %), fistula (5%) shock (3.4%) and
tamponade (2.7 %). Diagnostic catheterization was performed in 63%
followed by CT scan in 15% and MRI (8 %). Aneurysms with greatest
dimension of 1 to 5 cm were most commonly reported followed by 5 to 10 cm.
Treatment was surgery in 64% cases (true 48%; pseudo 52%), PCI in 22%
(true 57%; pseudo 43%), PCI followed by surgery 1% and conservative
strategy 13% (true 67%; pseudo 33%). Death was reported in 14% of cases
(true 38%; pseudo 62%) at mean follow-up of 4 months. Our univariate
analysis showed that higher mortality rate is observed among patients
presenting with dyspnea (p=0.04), shock (p=0.001), and those who did not
undergo catheterization (p=0.01). There was a trend toward higher
mortality among patients who had PCI or conservative management.
Conclusions: Our data showed that presenting symptom of shortness of
breath, shock, and not having cardiac catheterization as a diagnostic
modality is associated with higher mortality. Pseudoaneurysms are
associated with a higher mortality than true SVGA. Surgery is more often
selected as therapy in cases with pseudoaneurysms. PCI and conservative
management trend towards higher mortality as compared to surgery.
<5>
Accession Number
70333756
Source
Catheterization and Cardiovascular Interventions. Conference: 32nd Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI Las Vegas, NV United States. Conference Start:
20090506 Conference End: 20090509. Conference Publication: (var.pagings).
73 , 2009. Date of Publication: 01 Jun 2009.
Publisher
Wiley-Liss Inc.
Abstract
The proceedings contain 230 papers. The topics discussed include: arstasis
approach for arterial access and sealing: first-in-man clinical
experience; when does door-to-balloon time matter? analysis from the
HORIZONS-AMI and CADILLAC trials; visualization of the left atrial
appendage to plan percutaneous appendage closure; safety, feasibility and
cost-effectiveness of bivalirudin bolus without infusion during
percutaneous coronary intervention; evidence of mobilization of
pluripotent and very small embryonic-like (VSEL) stem cells in patients
with myocardial ischemia: a potential therapeutic target; six-year
outcomes after sirolimus-eluting stent implantation (SIRIUS study); a
novel and versatile percutaneous life support system with LVAD and ECMO
capability in high-risk PCI and refractory shock; and left main coronary
artery stenosis: a meta analysis of stents versus coronary artery bypass
grafting.
<6>
Accession Number
2011023069
Authors
Rivas-Plata A. Castillo J. Pariona M. Chunga A.
Institution
(Rivas-Plata) Department of Thoracic and Cardiovascular Surgery, Edgardo
Rebagliati Martins National Hospital, Lima, Peru
(Castillo) Service of Hematology, Edgardo Rebagliati Martins National
Hospital, Lima, Peru
(Pariona) Service of Cardiology, Edgardo Rebagliati Martins National
Hospital, Lima, Peru
(Chunga) Tissue Bank Unit, Edgardo Rebagliati Martins National Hospital,
Lima, Peru
(Castillo) Av. La Floresta 395, Apt. 101, Santiago de Surco, Lima 33, Peru
Title
Bypass grafts and cell transplant in heart failure with low ejection
fraction.
Source
Asian Cardiovascular and Thoracic Annals. 18 (5) (pp 425-429), 2010.
Date of Publication: October 2010.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
From June 2004 to October 2007, 34 patients with chronic heart failure and
low ejection fraction underwent surgical revascularization; 23 received
bypass grafting plus transplantation of bone marrow-derived stem cells
(study group) and 11 had revascularization only (control group). The stem
cells were implanted into nonviable myocardial areas, bypass grafting was
performed in viable myocardial areas. In the study group, the ejection
fraction increased from the baseline 26.4% +/- 4% to 37.3% +/- 11.5% after
26 months. In the control group, ejection fraction increased from 29% +/-
2% to 31.5% +/- 4.3% after 27 months. The improvement in the study group
was significantly greater than that in the control group. Functional class
improved significantly from 3.2 to 1.2 in the study group vs. 3.0 to 2.3
in the control group. Stem cell transplantation associated with bypass
grafting is feasible and safe in patients with chronic heart failure with
low ejection fractions, and it improves ventricular systolic function and
functional class. SAGE Publications 2010.
<7>
Accession Number
2011028103
Authors
Parodi G. Antoniucci D. Nikolsky E. Witzenbichler B. Guagliumi G. Peruga
J.Z. Stuckey T. Dudek D. Kornowski R. Hartmann F. Lansky A.J. Mehran R.
Stone G.W.
Institution
(Parodi, Antoniucci) Division of Cardiology, Careggi Hospital, Viale
Pieraccini 17, Florence I-50134, Italy
(Nikolsky, Lansky, Mehran, Stone) Columbia University Medical Center,
Cardiovascular Research Foundation, New York, NY, United States
(Witzenbichler) Charite-Campus Benjamin Franklin, University Medicine
Berlin, Berlin, Germany
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Peruga) Institute of Internal Medicine, Medical University of Lodz, Lodz,
Poland
(Stuckey) Moses Cone Heart and Vascular Center, Greensboro, NC, United
States
(Dudek) Jagellonian University, Krakow, Poland
(Kornowski) Rabin Medical Center, Petach-Tikva, Israel
(Hartmann) Universitatsklinikum Schleswig-Holstein, Lubeck, Germany
Title
Impact of bivalirudin therapy in high-risk patients with acute myocardial
infarction: 1-year results from the HORIZONS-AMI (Harmonizing Outcomes
with RevasculariZatiON and Stents in Acute Myocardial Infarction) trial.
Source
JACC: Cardiovascular Interventions. 3 (8) (pp 796-802), 2010. Date of
Publication: August 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives This study sought to assess the relationship between 1-year
mortality and baseline patient risk in the HORIZONS-AMI (Harmonizing
Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction)
trial. Background The HORIZONS-AMI trial showed that bivalirudin compared
with unfractionated heparin (UFH) plus glycoprotein IIb/IIIa inhibitors
(GPI) decreased major bleeding and 30-day and 1-year mortality in patients
undergoing primary percutaneous intervention for acute myocardial
infarction. Methods Patients in the HORIZONS-AMI trial were classified as
low, intermediate, and high risk according to the CADILLAC (Controlled
Abciximab and Device Investigation to Lower Late Angioplasty
Complications) risk score based on 7 clinical variables. Results Among
2,530 CADILLAC-score evaluable HORIZONS-AMI trial patients, 1,522 (60%)
were classified as low risk, 531 (21%) as intermediate risk, and 477 (19%)
as high risk. The mortality rates in the bivalirudin and UFH plus GPI
arms, respectively, were 0.4% and 1.2% (p = 0.09) in the lowrisk group,
4.2% and 4.1% (p = 0.99) in the intermediate-risk group, and 8.4% and
15.9% (p = 0.01) in the high-risk group. Among high-risk patients, there
was also a decreased rate of recurrent myocardial infarction in patients
randomized to bivalirudin as compared to UFH plus GPI (3.6% vs. 7.9%, p =
0.04). Conclusions In high-risk patients undergoing primary percutaneous
coronary intervention for acute myocardial infarction, bivalirudin
compared with UFH plus GPI reduces 1-year mortality and recurrent
myocardial infarction. 2010 BY THE AMERICAN COLLEGE OF CARDIOLOGY
FOUNDATION.
<8>
Accession Number
2011031604
Authors
Konstam M.A. Kramer D.G. Patel A.R. Maron M.S. Udelson J.E.
Institution
(Konstam, Kramer, Patel, Maron, Udelson) Cardiovascular Center, Tufts
Medical Center, Tufts University School of Medicine, Boston, MA, United
States
Title
Left ventricular remodeling in heart failure: Current concepts in clinical
significance and assessment.
Source
JACC: Cardiovascular Imaging. 4 (1) (pp 98-108), 2011. Date of
Publication: January 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Ventricular remodeling, first described in animal models of left
ventricular (LV) stress and injury, occurs progressively in untreated
patients after large myocardial infarction and in those with dilated forms
of cardiomyopathy. The gross pathologic changes of increased LV volume and
perturbation in the normal elliptical LV chamber configuration is driven,
on a histologic level, by myocyte hypertrophy and apoptosis and by
increased interstitial collagen. Each of the techniques used for tracking
this processechocardiography, radionuclide ventriculography, and cardiac
magnetic resonancecarries advantages and disadvantages. Numerous
investigations have demonstrated the value of LV volume measurement at a
single time-point and over time in predicting clinical outcomes in
patients with heart failure and in those after myocardial infarction. The
structural pattern of LV remodeling and evidence of scarring on cardiac
magnetic resonance have additional prognostic value. Beyond the impact of
abnormal cardiac structure on cardiovascular events, the relationship
between LV remodeling and clinical outcomes is likely linked through
common local and systemic factors driving vascular as well as myocardial
pathology. As demonstrated by a recent meta-analysis of heart failure
trials, LV volume stands out among surrogate markers as strongly
correlating with the impact of a particular drug or device therapy on
patient survival. These findings substantiate the importance of
ventricular remodeling as central in the pathophysiology of advancing
heart failure and support the role of measures of LV remodeling in the
clinical investigation of novel heart failure treatments. 2011 American
College of Cardiology Foundation.
<9>
Accession Number
2010400555
Authors
Flier S. Post J. Concepcion A.N. Kappen T.H. Kalkman C.J. Buhre W.F.
Institution
(Flier, Post, Concepcion, Kappen, Kalkman, Buhre) Division of
Perioperative Care and Emergency Medicine, Department of Anaesthesiology,
University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht,
Netherlands
Title
Influence of propofol-opioid vs isoflurane-opioid anaesthesia on
postoperative troponin release in patients undergoing coronary artery
bypass grafting.
Source
British Journal of Anaesthesia. 105 (2) (pp 122-130), 2010. Date of
Publication: August 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Background. In experimental and clinical studies, volatile anaesthesia has
proven to possess cardioprotective properties. However, no randomized
controlled trials on the use of isoflurane during the entire cardiac
surgical procedure are available. We therefore compared
isoflurane-sufentanil vs propofol-sufentanil anaesthesia in patients
undergoing coronary artery bypass grafting. Methods. One hundred patients
were randomly assigned to receive isoflurane-sufentanil (I) (n = 51) or
propofol-sufentanil (P) (n = 49) anaesthesia, aimed at the same hypnotic
depth. Postoperative concentrations of cardiac troponin I (cTnI) were
followed for 72 h. Secondary outcome variables were length of stay (LOS)
in the intensive care unit (ICU) and in hospital, and 30 day and 1 yr
mortality and morbidity, defined as acute myocardial infarction,
arrhythmias, and cardiac dysfunction. Groups were compared by an
on-treatment analysis, using linear mixed models for repeated measures.
Results. Eighty-four patients completed the protocol (I: 41 vs P: 43).
Postoperative cTnI concentrations increased to a maximum of I: 2.72 ng
ml<sup>-1</sup> (1.78-5.85) and P: 2.64 ng ml<sup>-1</sup> (1.67-4.83),
but did not differ between groups (P=0.11). LOS in the ICU and in hospital
was similar [ICU I: 18 (17.0-21.5) vs P: 19 (17.0-22.0) h; hospital I: 9
(6.5-8.0) vs P: 8 (6.0-9.0) days]. Cardiac morbidity and mortality in
hospital and 30 days after surgery did not differ between groups. One year
after surgery, two patients had died of non-cardiac causes. No
between-group differences in cardiac morbidity were found. Conclusions. In
this study, the use of isoflurane-sufentanil in comparison with
propofol-sufentanil anaesthesia does not afford additional reduction of
postoperative cTnI levels. The Author [2010]. Published by Oxford
University Press on behalf of the British Journal of Anaesthesia. All
rights reserved.
<10>
Accession Number
2011040164
Authors
Michaux I. Filipovic M. Skarvan K. Bolliger D. Schumann R. Bernet F.
Seeberger M.D.
Institution
(Michaux, Filipovic, Skarvan, Bolliger, Schumann, Seeberger) Department of
Anesthesia, University Hospital Basel, Basel, Switzerland
(Bernet) Department of Surgery, Division of Cardiothoracic Surgery,
University Hospital Basel, Basel, Switzerland
(Michaux) Department of Intensive Care Medicine, Mont-Godinne University
Hospital, Universite Catholique de Louvain, B-5530 Yvoir, Belgium
Title
A randomized comparison of right ventricular function after on-pump versus
off-pump coronary artery bypass graft surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (2) (pp 361-367),
2011. Date of Publication: February 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Right ventricular dysfunction occurs very soon after
conventional coronary bypass surgery with cardiopulmonary bypass and might
not recover within 1 year after the operation. It has been postulated that
performing coronary surgery without cardiopulmonary bypass might preserve
right ventricular function. We hypothesized that right ventricular global
and overall systolic functions are better preserved 3 months after
off-pump surgery than after conventional coronary bypass surgery. Methods:
Fifty patients scheduled for elective coronary bypass surgery were
randomly assigned to conventional or off-pump surgery. Right ventricular
function was assessed by means of transthoracic echocardiographic analysis
the day before the operation and 3 months later. Right ventricular
myocardial performance index was used as a marker of global right
ventricular function, and right ventricular fractional area change was
used as a marker of overall right ventricular systolic function. Peak
systolic velocities of the lateral tricuspid annulus were studied to
assess regional systolic function of the right ventricular free wall.
Results: Surgical intervention was completed according to randomization in
48 of 50 patients. Demographic and perioperative characteristics were
similar in the 2 groups. Over the study period, right ventricular
myocardial performance index and right ventricular fractional area change
did not change in comparison with the baseline values in both groups. Peak
systolic velocity of the lateral tricuspid annulus was decreased
significantly in both groups 3 months after the operation. There were no
significant intergroup differences in any echocardiographic marker of
right ventricular function. Conclusions: Global right ventricular function
was not better preserved 3 months after off-pump surgery than after
conventional coronary bypass surgery. Copyright 2011 by The American
Association for Thoracic Surgery.
<11>
Accession Number
2011040169
Authors
Inan M.B. Yazcoglu L. Erylmaz S. Srlak M. Cetntas D. Kaya B. Ozyurda U.
Institution
(Inan, Yazcoglu, Erylmaz, Srlak, Cetntas, Kaya, Ozyurda) Department of
Cardiovascular Surgery, Ankara University, School of Medicine, Ankara,
Turkey
Title
Effects of prophylactic indomethacin treatment on postoperative
pericardial effusion after aortic surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (2) (pp 578-582),
2011. Date of Publication: February 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: This prospective, randomized study assessed the prophylactic
effects of indomethacin treatment on pericardial effusion after aortic
surgery. Methods: Eighty-five patients were found eligible to participate
in this double-blind study. Patients were assigned to a control group
receiving oral placebo or to an indomethacin group receiving 25 mg oral
indomethacin 3 times daily for 7 days preoperatively. After aortic
surgery, patients were followed up clinically and evaluated for
pericardial effusion with transthoracic echocardiography on the first and
seventh postoperative days during hospitalization and at the second and
sixth weeks after discharge. Results: The demographic and the operative
data were similar between groups. The surgical interventions included
Bentall procedure in 63 patients, valve-sparing procedures in 7 patients,
and supracoronary ascending aorta replacement in 15 patients. Hemiarch
replacement was performed in 16 patients. No patient in either group had
pericardial effusion after the first postoperative day. At the end of the
first week, however, 2 patients had pericardial effusion, at the end of
the second week after discharge, 3 patients had pericardial effusion, and
at the end of the sixth week after discharge, 4 patients had PEs. One of
the patients who had PE at the end of the sixth week received
indomethacin; the others were all in the control group, a significant
difference (P = .019). Five patients underwent transthoracic
echocardiographically guided pericardiocentesis; 4 underwent surgical
pericardiocentesis. Conclusions: Indomethacin may have beneficial effects
on the outcomes and incidence of postoperative pericardial effusion after
aortic surgery. Copyright 2011 by The American Association for Thoracic
Surgery.
<12>
Accession Number
2011040195
Authors
Zenati M.A. Shroyer A.L. Collins J.F. Hattler B. Ota T. Almassi G.H. Amidi
M. Novitzky D. Grover F.L. Sonel A.F.
Institution
(Zenati) Veterans Affairs Boston Healthcare System, West Roxbury, MA,
United States
(Zenati) Division of Cardiac Surgery, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Shroyer, Hattler, Grover) Eastern Colorado Healthcare System, Department
of Veterans Affairs, Denver, CO, United States
(Shroyer) Northport Veterans Affairs Medical Center, Northport, NY, United
States
(Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Perry Point, MD, United States
(Ota, Amidi, Sonel) Veterans Affairs Pittsburgh Healthcare System,
Pittsburgh, PA, United States
(Ota) Heart, Lung and Esophageal Surgery Institute, University of
Pittsburgh Medical Center, Pittsburgh, PA, United States
(Almassi) Medical College of Wisconsin, Zablocki Veterans Affairs Medical
Center, Milwaukee, WI, United States
(Novitzky) Department of Surgery, University of South Florida, Tampa, FL,
United States
Title
Impact of endoscopic versus open saphenous vein harvest technique on late
coronary artery bypass grafting patient outcomes in the ROOBY (Randomized
On/Off Bypass) Trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (2) (pp 338-344),
2011. Date of Publication: February 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: In the Randomized On/Off Bypass (ROOBY) Trial, the efficacy of
on-pump versus off-pump coronary artery bypass grafting was evaluated.
This ROOBY Trial planned subanalysis compared the effects on postbypass
patient clinical outcomes and graft patency of endoscopic vein harvesting
and open vein harvesting. Methods: From April 2003 to April 2007, the
technique used for saphenous vein graft harvesting was recorded in 1471
cases. Of these, 894 patients (341 endoscopic harvest and 553 open
harvest) also underwent coronary angiography 1 year after coronary artery
bypass grafting. Univariate and multivariable analyses were used to
compare patient outcomes in the endoscopic and open groups. Results:
Preoperative patient characteristics were statistically similar between
the endoscopic and open groups. Endoscopic vein harvest was used in 38% of
the cases. There were no significant differences in both short-term and
1-year composite outcomes between the endoscopic and open groups. For
patients with 1-year catheterization follow-up (n = 894), the saphenous
vein graft patency rate for the endoscopic group was lower than that in
the open harvest group (74.5% vs 85.2%, P < .0001), and the repeat
revascularization rate was significantly higher (6.7% vs 3.4%, P < .05).
Multivariable regression documented no interaction effect between
endoscopic approach and off-pump treatment. Conclusions: In the ROOBY
Trial, endoscopic vein harvest was associated with lower 1-year saphenous
vein graft patency and higher 1-year revascularization rates, independent
of the use of off-pump or on-pump cardiac surgical approach. Copyright
2011 by The American Association for Thoracic Surgery.
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Accession Number
2011022596
Authors
Sander M. Spies C.D. Berger K. Schroder T. Grubitzsch H. Wernecke K.D. von
Heymann C.
Institution
(Sander, Spies, Berger, Schroder, von Heymann) Department of
Anaesthesiology and Intensive Care Medicine, Charite Universitatsmedizin -
Berlin, Campus Virchow Klinikum and Campus Charite Mitte, Chariteplatz 1,
10117 Berlin, Germany
(Grubitzsch) Department of Cardiovascular Surgery, Charite
Universitatsmedizin - Berlin, Campus Charite Mitte, Chariteplatz 1, 10117
Berlin, Germany
(Wernecke) SOSTANA GmbH, Wildensteiner Str. 27, 10318 Berlin, Germany
Title
Perioperative indocyanine green clearance is predictive for prolonged
intensive care unit stay after coronary artery bypass grafting - an
observational study.
Source
Critical Care. 13 (5) , 2009. Article Number: R149. Date of
Publication: 14 Sep 2009.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Introduction: During cardiac surgery with cardiopulmonary bypass (CPB)
haemodilution occurs. Hepatic dysfunction after CPB is a rare, but
serious, complication. Clinical data have validated the
plasma-disappearance rate of indocyanine green (PDR ICG) as a marker of
hepatic function and perfusion. Primary objective of this analysis was to
investigate the impact of haemodilutional anaemia on hepatic function and
perfusion by the time course of PDR ICG and liver enzymes in elective CABG
surgery. Secondary objective was to define predictors of prolonged ICU
treatment like decreased PDR ICG after surgery.Methods: 60 Patients were
subjected to normothermic CPB with predefined levels of haemodilution
anaemia (haemotacrit (Hct) of 25% versus 20% during CPB). Hepatic function
and perfusion was assessed by PDR ICG, plasma levels of aspartate
aminotransferase (ASAT) and alpha-GST. Prolonged ICU treatment was defined
as treatment >= 48 hours.Results: Logistic regression analysis showed that
all postoperative measurements of PDR ICG (P < 0.01), and the late
postoperative ASAT (P < 0.01) measurement were independent risk factors
for prolonged ICU treatment. The predictive capacity for prolonged ICU
treatment was best of the PDR ICG one hour after admission to the ICU.
Furthermore, the time course of PDR ICG as well as ASAT and alpha-GST did
not differ between groups of haemodilutional anaemia.Conclusions: Our
study provides evidence that impaired PDR ICG as a marker of hepatic
dysfunction and hypoperfusion may be a valid marker of prolonged ICU
treatment. Additionally this study provides evidence that haemodilutional
anaemia to a Hct of 20% does not impair hepatic function and
perfusion.Trial registration: [ISRCTN35655335]. 2009 Sander et al.;
licensee BioMed Central Ltd.
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