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<1>
Accession Number
70383457
Authors
Arora S. Erikstad I. Wennerblom B. Sigurdardottir V. Eiskjaer H. Botker H.
Mortensen S.-A. Saunameki K. Ekmehag B. Jansson K. Simonsen S. Gude E.
Ragnarsson A. Solbu D. Gullestad L.
Institution
(Arora, Erikstad, Simonsen, Gude, Ragnarsson, Gullestad) Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Wennerblom, Sigurdardottir) Sahlgrenska University Hospital, Gothenburg,
Sweden
(Eiskjaer, Botker) Skeiby University Hospital, Aarhus, Denmark
(Mortensen, Saunameki) Rigshospitalet, Copenhagen, Denmark
(Ekmehag) Lund Hospital, Lund, Sweden
(Jansson) Heart Center University Hospital, Linkoping, Sweden
(Solbu) Novartis Norge, Oslo, Norway
Source
Journal of Heart and Lung Transplantation. Conference: 31st Annual
Meeting and Scientific Sessions of the International Society for Heart and
Lung Transplantation, ISHLT San Diego, CA United States. Conference Start:
20110413 Conference End: 20110416. Conference Publication: (var.pagings).
30 (4 SUPPL. 1) (pp S33-S34), 2011. Date of Publication: April 2011.
Publisher
Elsevier USA
Abstract
Purpose: Immunosuppressant regimes centered on everolimus have been
demonstrated to provide a quantitative reduction in cardiac allograft
vasculopathy (CAV) amongst de-novo heart transplant (HTx) recipients.
However, the effect of such therapy on CAV assessed by the qualitative
method of Virtual Histology (VH) is unknown and was investigated in this
prospective randomized-controlled trial. Methods and Materials: In this
12-month multicenter Scandinavian study 190 maintenance HTx recipients
were randomized to everolimus with reduced calcineurin inhibitor (CNI)
exposure or continue standard CNI-therapy. Both groups continued their
prior usage of azathioprine (AZA) or mycophenolate mofetil (MMF). 78
patients had evaluable VH examinations at baseline and 12 months and
matched analysis was performed to measure change in fibrotic, fibrofatty,
calcified and necrotic tissue component. Results: When considering all 78
patients, mean age 57.4+/- 10.3 years and mean time post-HTx 5.4+/-4.1
yrs, a similar rate of quantitative CAV progression was observed in the
everolimus (n=30) versus standard CNI therapy group (n=48) (plaque index
1.9+/-3.9% and 1.6+/-3.7%, respectively; p=0.65). Virtual Histology
analysis revealed a significant increase in calcified (2.4+/-4.0 versus
0.3+/-3.1%; p=0.02) and necrotic component (6.4+/-8.5 versus 1.0+/-8.6%;
p<0.01) amongst everolimus patients as compared to standard CNI therapy,
respectively. Increase in calcified and necrotic component was
significantly greater (p<0.05) in everolimus patients as compared to
controls irrespective of background immunosuppression (AZA or MMF). Change
in fibrotic and fibrofatty tissue was not significantly different in the
everolimus and control group (p>0.05). Conclusions: Conversion to
everolimus and reduced CNI does not significantly influence quantitative
progression of CAV but is associated with a significant increase in
calcified and necrotic tissue component. The prognostic implication of
these qualitative changes in HTx recipients is unclear and warrants
further investigation.
<2>
Accession Number
70383545
Authors
Wray J. Orrells C. Latch H. Burch M.
Institution
(Wray, Orrells, Latch, Burch) Cardiorespiratory, Great Ormond Street
Hospital for Children, NHS Trust, London, United Kingdom
Source
Journal of Heart and Lung Transplantation. Conference: 31st Annual
Meeting and Scientific Sessions of the International Society for Heart and
Lung Transplantation, ISHLT San Diego, CA United States. Conference Start:
20110413 Conference End: 20110416. Conference Publication: (var.pagings).
30 (4 SUPPL. 1) (pp S61), 2011. Date of Publication: April 2011.
Publisher
Elsevier USA
Abstract
Purpose: Despite improvements in survival, heart transplantation (HTx) is
still associated with significant morbidity, particularly coronary artery
vasculopathy (CAV). Diet, exercise and psychological factors are known to
influence the progression of CAV but no studies have been conducted to
determine whether an information based diet and exercise intervention has
an impact on physical and psychological well-being in paediatric heart
recipients. Methods and Materials: Seventy children (median age: 8.7
years) with no significant co-morbidities who had undergone HTx at least
12 months previously were randomized to either an intervention (IG) or
control (CG) group using minimization to stratify for age, gender,
pre-transplant diagnosis and body-mass index. Questionnaires assessing
quality of life (QoL), self-concept, knowledge about diet and exercise and
physical activity levels were completed by parents and older children at
baseline and 12 months later. Children in the IG and their parents
received individually tailored information about diet and exercise
delivered during 4 separate sessions over a 12 month period, using an
approach based on the Theory of Planned Behaviour. Those in the CG
received usual care. Results: The groups did not differ at baseline on any
medical or demographic parameters. All children in the IG completed the
intervention satisfactorily. At follow-up the change in each of the QoL
domains (physical, emotional, social and school) was more positive in the
IG compared to the CG and the difference was significant on the child
ratings of school QoL (t=2.177; p=.036). There were also improvements in
reported exercise and healthy eating behaviours in the IG relative to the
CG. Conclusions: The diet and exercise intervention had a positive impact
on QoL and on reported levels of physical activity and healthy eating
behaviours in the short term. Lack of knowledge of both parents and
children about the benefits and importance of a healthy life-style after
transplant needs to be addressed routinely.
<3>
Accession Number
70383738
Authors
Alba A.C. McDonald M. Rao V. Ross H.J. Delgado D.H.
Institution
(Alba, McDonald, Ross, Delgado) Division of Cardiology and Heart
Transplantation, Toronto General Hospital, Toronto, ON, Canada
(Rao) Division of Cardiovascular Surgery, Toronto General Hospital,
Toronto, ON, Canada
Source
Journal of Heart and Lung Transplantation. Conference: 31st Annual
Meeting and Scientific Sessions of the International Society for Heart and
Lung Transplantation, ISHLT San Diego, CA United States. Conference Start:
20110413 Conference End: 20110416. Conference Publication: (var.pagings).
30 (4 SUPPL. 1) (pp S124), 2011. Date of Publication: April 2011.
Publisher
Elsevier USA
Abstract
Purpose: VAD therapy is widely used as a bridge to cardiac transplant.
Studies addressing the effect of VADs on post-transplant outcomes showed
conflicting results. Our aim was to systematically evaluate the effect of
ventricular assist device (VAD) therapy on long-term post-transplant
outcomes in heart transplant recipients. Methods and Materials: We
searched online databases (Medline, Pubmed, Embase and CINAHL) and
unpublished data identified through reference of included articles.
Comparative studies evaluating the effect of VAD on post-transplant
outcomes in adults were included and study results were meta-analyzed
using random-effects models. We conducted sub-group analyses to assess the
effect estimate of extra-vs. intra-corporeal VADs and to evaluate the
impact of transplant era and listing status. Results: Overall, we
identified 31 observational studies. One-year posttransplant mortality in
recipients bridged with an extra-corporeal VAD was significantly higher
than in non-bridged recipients (RR 1.8, 95%CI 1.53-2.13,
I<sup>2</sup>=1%), while patients supported with an intra-corporeal VAD
had similar mortality to non-bridged recipients (RR 1.08, 95%CI 0.95-1.22,
I<sup>2</sup>=0%). (Table presented) The risks of rejection within the
first post-transplant year and coronary allograft vasculopathy were not
significantly different between patients with or without VAD support prior
to transplant. Publication bias was low; however, the risk of bias across
studies was moderate to high. Conclusions: Intra-corporeal VAD support
does not have a deleterious impact on post-transplant outcomes. However,
post-transplant survival may be poorer in the subgroup of patients
supported with extracorporeal devices. Studies with greater methodologic
rigour are warranted.
<4>
Accession Number
70383958
Authors
Nelson M.J. Liao K. John R. Shumway S. Tetteh H.A.
Institution
(Nelson, Liao, John, Shumway) Department of Cardiothoracic Surgery,
University of Minnesota, Minneapolis, MN, United States
(Tetteh) Department of Cardiothoracic Surgery, National Naval Medical
Center, Bethesda, MD, United States
Source
Journal of Heart and Lung Transplantation. Conference: 31st Annual
Meeting and Scientific Sessions of the International Society for Heart and
Lung Transplantation, ISHLT San Diego, CA United States. Conference Start:
20110413 Conference End: 20110416. Conference Publication: (var.pagings).
30 (4 SUPPL. 1) (pp S195-S196), 2011. Date of Publication: April 2011.
Publisher
Elsevier USA
Abstract
Purpose: Bi-atrial and bi-caval anastomotic techniques have been compared
in heart transplant populations and their respective rates of
postoperative permanent pacemaker (PPM) placement described. Previous
studies suggest that the rate of PPM placement is higher with the
bi-atrial technique because of postoperative atrial distortion. The aim of
this study is to confirm this finding among our patient population - now
just over 700 since the program's inception - and, further, to analyze the
cost impact of these two techniques in relation to their rates of PPM
placement. Methods and Materials: A prospective systematic review of 283
orthotopic heart transplants was performed at our institution from January
1, 2001 to December 31, 2009. 165 of these patients had bi-atrial
anastomoses (Group I), and 118 had bi-caval anastomoses (Group II). PPM
placement rates were compared and resultant excess cost was determined
using average Medicare reimbursement rates for DRG242 (PPM implant with
major complication and co-morbidities). Results: Group I had a PPM
placement rate of 11% (18/164) compared to Group II's 5.1% (6/118) (p =
0.057). Approximately 95% (23/24) of PPM's were placed within 30 days of
transplant. During the study period, Group I incurred an excess cost of
$336,162 attributable to PPM placement compared to Group II's excess cost
of $112,054. (Table presented) Conclusions: The higher rate of PPM
placement in Group I resulted in an initial cost difference from Group II
of $224,108. This difference warrants consideration, particularly at large
institutions where the marginal costs of PPM placement could have a
significant economic impact. Further analysis is also indicated to
determine the cost difference over the life expectancy of the transplant
recipient and the potential impact on patient survival.
<5>
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Accession Number
2011176042
Authors
Dadure C. Sauter M. Bringuier S. Bigorre M. Raux O. Rochette A. Canaud N.
Capdevila X.
Institution
(Dadure, Sauter, Raux, Rochette, Canaud) Department of Anesthesia and
Critical Care Medicine, Lapeyronie University Hospital, Montpellier,
France
(Bringuier) Departments of Anesthesia and Critical Care Medicine and
Biostatistics, Lapeyronie University Hospital, France
(Bigorre) Department of Pediatric Plastic Surgery, Lapeyronie University
Hospital, France
(Capdevila) Head of Department, Lapeyronie University Hospital, France
(Dadure) Departement d'Anesthesie Reanimation Lapeyronie, Hopital
Lapeyronie, 371 Ave du Doyen G. Giraud, 34295 Montpellier, France
Title
Intraoperative tranexamic acid reduces blood transfusion in children
undergoing craniosynostosis surgery: A randomized double-blind study.
Source
Anesthesiology. 114 (4) (pp 856-861), 2011. Date of Publication: April
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background: Surgical correction of craniosynostosis in children is
associated with substantial intraoperative bleeding. Tranexamic acid (TXA)
decreases intraoperative blood loss during cardiac or orthopedic surgery
in children. We hypothesized that intraoperative TXA would reduce blood
transfusion relative to placebo in patients pretreated with
erythropoietin. Methods: Forty consecutive children, American Society of
Anesthesiologists status 1 or 2, scheduled to undergo surgical correction
of craniosynostosis were randomly assigned to receive either intravenous
TXA or saline, 0.9%, intraoperatively. All children received preoperative
erythropoietin (600 U/kg once a week for 3 weeks before surgery).
Perioperative blood loss, number and volume of transfusions, percentage of
children who underwent transfusion, and side effects were noted after
surgery and at the end of the study. Surgeon satisfaction and cost of
treatment were also recorded. Results: There was no significant difference
between groups in demographic or surgical data. In the TXA group, the
volume of packed erythrocytes transfused was significantly reduced by 85%
(from 11 to 1.6 ml/kg) intraoperatively and by 57% (from 16.6 to 7.2
ml/kg) throughout the study period (P < 0.05). Compared with the placebo
group, the percentage of children requiring blood transfusion was lower in
the TXA group during surgery (9 [45%] of 20 vs. 2 [11%] of 19 children; P
< 0.05) and during the whole study period (14 [70%] of 20 vs. 7 [37%] of
19; P < 0.05). Preoperative and postoperative hematologic parameters were
comparable in both groups. There were no adverse events. Conclusion: In
children undergoing surgical correction of craniosynostosis and pretreated
with erythropoietin, intraoperative TXA reduces the transfusion
requirement. 2011, the American Society of Anesthesiologists, Inc.
Lippincott Williams & Wilkins.
<6>
Accession Number
2011178517
Authors
Rossig L. Genth-Zotz S. Rau M. Heyndrickx G.R. Schneider T. Gulba D.C.L.
Desaga M. Buerke M. Harder S. Zeiher A.M.
Institution
(Rossig, Zeiher) Department of Medicine III, J.W. Goethe University of
Frankfurt, Theodor Stern-Kai 7, 60590 Frankfurt, Germany
(Genth-Zotz) Johannes Gutenberg-University, Mainz, Germany
(Rau) Kerckhoff Klinik, Bad Nauheim, Germany
(Heyndrickx) Cardiovascular Center, Aalst, Belgium
(Schneider) Klinik III fur Innere Med, Universitat zu Koln, Germany
(Gulba) Abteilung Innere Med i, Krankenhaus Duren GmbH, Duren, Germany
(Desaga) AmperKliniken AG, Dachau, Germany
(Buerke) Klinik und Poliklinik fur Innere Med III,
Martin-Luther-University, Halle/Saale, Germany
(Harder) Clinical Pharmacology, University of Frankfurt, Germany
Title
Argatroban for elective percutaneous coronary intervention: The ARG-E04
multi-center study.
Source
International Journal of Cardiology. 148 (2) (pp 214-219), 2011. Date of
Publication: 14 Apr 2011.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
The synthetic arginine-derived direct thrombin inhibitor argatroban is an
attractive anticoagulant for percutaneous coronary intervention (PCI),
because of its rapid onset and offset, and its hepatic elimination.
Argatroban was approved for PCI in patients with heparin-induced
thrombocytopenia (HIT). However, there are limited data about argatroban
in non-HIT patients. The objective of this open-label, multiple-dose,
controlled study was to examine the safety and efficacy of argatroban in
patients undergoing elective PCI. Methods and results: Of 140 patients
randomized to three argatroban dose groups (ARG250, ARG300, and ARG350
with 250, 300, or 350 mug/kg bolus, followed by 15, 20, or 25 mug/kg/min
infusion) and one unfractionated heparin (UFH) group (70-100 IU/kg bolus),
138 patients were analyzed. Argatroban dose-dependently prolonged
activated clotting time (ACT) with more patients reaching the minimum
target ACT after the initial bolus injection (ARG250: 86.1%, ARG300:
89.5%, and ARG350: 96.8%) compared to 45.5% in UFH (p < 0.001). The
patient proportion who did not require additional bolus injections to
start PCI was significantly higher in argatroban than in UFH (p <= 0.002).
Consequently, the time to start of PCI was shortened in argatroban groups.
Composite incidences of death, myocardial infarction, and urgent
revascularization until day 30 were not significantly different between
the groups (ARG250: 2.8%, ARG300: 0.0%, ARG350: 3.2% vs. UFH: 3.0%). Major
bleeding was observed only in UFH (3.0%), while minor bleeding occurred in
ARG350 (3.2%) and UFH (6.1%, n.s.). Conclusion: Argatroban
dose-dependently increases coagulation parameters and, compared to UFH,
demonstrates a superior predictable anticoagulant effect in patients
undergoing elective PCI. 2009 Elsevier Ireland Ltd.
<7>
Accession Number
2011179238
Authors
Hempenius L. Van Leeuwen B.L. Van Asselt D.Z.B. Hoekstra H.J. Wiggers T.
Slaets J.P.J. De Bock G.H.
Institution
(Hempenius, Slaets) University Center for the Elderly, University Medical
Center Groningen, Groningen, Netherlands
(Van Leeuwen, Hoekstra, Wiggers) Department of Surgery, University Medical
Center Groningen, University of Groningen, Groningen, Netherlands
(Van Asselt) Department of Geriatric Medicine, Medical Center Leeuwarden,
Leeuwarden, Netherlands
(De Bock) Department of Epidemiology, University Medical Center Groningen,
University of Groningen, Groningen, Netherlands
Title
Structured analyses of interventions to prevent delirium.
Source
International Journal of Geriatric Psychiatry. 26 (5) (pp 441-450), 2011.
Date of Publication: May 2011.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Delirium is one of the most serious complications in
hospitalized elderly, with incidences ranging from 3-56%. The objective of
this meta-analysis was two-fold, first to investigate if interventions to
prevent delirium are effective and second to explore which factors
increase the effectiveness of these interventions. Methods: An electronic
search was carried out on articles published between January 1979 and July
2009. Abstracts were reviewed, data were extracted and methodologic
quality was assessed by two independent reviewers. Effect sizes of the
interventions were expressed as ORs (odds ratios) and 95%CIs (confidence
intervals). A random effect model was used to provide pooled ORs. To
explore which factors increase the effectiveness of the interventions, ORs
were stratified for several factors. Results: Sixteen relevant studies
were found. Overall the included studies showed a positive result of any
intervention to prevent delirium (pooled OR: 0.64; 95%CI: 0.46-0.88). The
largest effect was seen in studies on populations with an incidence of
delirium above 30% in the control group (pooled OR: 0.34; 95%CI: 0.16-0.71
versus 0.76; 95%CI: 0.60-0.97). Conclusions: Interventions to prevent
delirium are effective. Interventions seem to be more effective when the
incidence of delirium in the population under study is above 30%. To
maximize the options for a cost-effective strategy of delirium prevention
it might be useful to offer an intervention to a selected population.
Copyright 2010 John Wiley & Sons, Ltd.
<8>
Accession Number
2011161669
Authors
Wang D.Y. Richmond M.E. Quinn T.A. Mirani A.J. Rusanov A. Yalamanchi V.
Weinberg A.D. Cabreriza S.E. Spotnitz H.M.
Institution
(Wang) Department of Medicine, Columbia University, New York, NY, United
States
(Richmond, Mirani) Department of Pediatrics, Columbia University, New
York, NY, United States
(Rusanov, Yalamanchi, Cabreriza, Spotnitz) Department of Surgery, Columbia
University, New York, NY, United States
(Quinn) Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
(Weinberg) Department of Health Evidence and Policy, Mount Sinai School of
Medicine, New York, NY, United States
(Spotnitz) Department of Surgery, Columbia University Medical Center,
Vanderbilt Clinic, 622 West 168th St, New York, NY 10032, United States
Title
Optimized temporary biventricular pacing acutely improves intraoperative
cardiac output after weaning from cardiopulmonary bypass: A substudy of a
randomized clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (4) (pp
1002-1008.e1), 2011. Date of Publication: April 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Permanent biventricular pacing benefits patients with heart
failure and interventricular conduction delay, but the importance of
pacing with and without optimization in patients at risk of low cardiac
output after cardiac surgery is unknown. We hypothesized that pacing
parameters independently affect cardiac output. Accordingly, we analyzed
aortic flow measured with an electromagnetic flowmeter in patients at risk
of low cardiac output during an ongoing randomized clinical trial of
biventricular pacing (n = 11) versus standard of care (n = 9). Methods: A
substudy was conducted in all 20 patients in both groups with stable
pacing after coronary artery bypass grafting, valve surgery, or both.
Ejection fraction averaged 33% +/- 15%, and QRS duration was 116 +/- 19
ms. Effects were measured within 1 hour of the conclusion of
cardiopulmonary bypass. Atrioventricular delay (7 settings) and
interventricular delay (9 settings) were optimized in random sequence.
Results: Optimization of atrioventricular delay (171 +/- 8 ms) at an
interventricular delay of 0 ms increased flow by 14% versus the worst
setting (111 +/- 11 ms, P < .001) and 7% versus nominal atrioventricular
delay (120 ms, P < .001). Interventricular delay optimization increased
flow 10% versus the worst setting (P < .001) and 5% versus nominal
interventricular delay (0 ms, P < .001). Optimized pacing increased
cardiac output 13% versus atrial pacing at matched heart rate (5.5 +/- 0.5
vs 4.9 +/- 0.6 L/min, P = .003) and 10% versus sinus rhythm (5.0 +/- 0.6
L/min, P = .019). Conclusions: Temporary biventricular pacing increases
intraoperative cardiac output in patients with left ventricular
dysfunction undergoing cardiac surgery. Atrioventricular and
interventricular delay optimization maximizes this benefit. 2011 by The
American Association for Thoracic Surgery.
<9>
Accession Number
2011161670
Authors
Braathen B. Jeppsson A. Schersten H. Hagen O.M. Vengen O. Rexius H. Lepore
V. Tonnessen T.
Institution
(Braathen, Hagen, Vengen, Tonnessen) Department of Cardiothoracic Surgery,
Faculty of Hospital Medicine, Oslo University Hospital Ullevl, Oslo,
Norway
(Jeppsson, Schersten, Rexius, Lepore) Department of Cardiovascular Surgery
and Anesthesia, Sahlgrenska University Hospital, Gothenburg, Sweden
(Jeppsson, Schersten, Rexius, Lepore) Department of Molecular and Clinical
Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg,
Sweden
(Tonnessen) University of Oslo, Faculty of Hospital Medicine, Center for
Heart Failure Research, Oslo, Norway
Title
One single dose of histidine-tryptophan-ketoglutarate solution gives
equally good myocardial protection in elective mitral valve surgery as
repetitive cold blood cardioplegia: A prospective randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (4) (pp 995-1001),
2011. Date of Publication: April 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Histidine-tryptophan-ketoglutarate (HTK-Custodiol)
cardioplegic solution is administered as one single dose for more than 2
hours of ischemia. No prospective randomized clinical study has compared
the effects of HTK and cold blood cardioplegia on myocardial damage in
elective mitral valve surgery. Thus, the main aim of the present study was
to examine whether one single dose of cold antegrade HTK gives as good
myocardial protection as repetitive antegrade cold blood cardioplegia in
mitral valve surgery. Methods: Eighty consecutive patients undergoing
elective isolated mitral valve surgery for mitral regurgitation, with or
without ablation for atrial fibrillation, were included in the study and
randomized to HTK or blood cardioplegia. Markers of myocardial injury
(troponin-T and creatine kinase MB) were analyzed at baseline and 7 hours,
1 day, 2 days, and 3 days after surgery. Results: No significant
difference in creatine kinase MB and troponin-T between HTK and blood
cardioplegia groups was found at any time point. There was a significant
correlation between ischemic time and markers of myocardial injury in the
HTK group only and significantly more spontaneous ventricular fibrillation
after release of crossclamping in the HTK group. Conclusions: One single
dose of antegrade cold HTK cardioplegic solution in elective mitral valve
surgery protects the myocardium equally well as repetitive antegrade cold
blood cardioplegia. 2011 by The American Association for Thoracic
Surgery.
<10>
Accession Number
2011161675
Authors
Kukucka M. Potapov E. Stepanenko A. Weller K. Mladenow A. Kuppe H.
Habazettl H.
Institution
(Kukucka, Weller, Mladenow, Kuppe) Department of Anaesthesiology,
Deutsches Herzzentrum, Berlin, Germany
(Potapov, Stepanenko) Department of Cardiothoracic and Vascular Surgery,
Deutsches Herzzentrum, Berlin, Germany
(Habazettl) Institute of Physiology, Charite Campus Benjamin Franklin,
Berlin, Germany
(Kukucka) Deutsches Herzzentrum, Berlin, Department of Anesthesiology,
Augustenburger Platz 1, 13353 Berlin, Germany
Title
Acute impact of left ventricular unloading by left ventricular assist
device on the right ventricle geometry and function: Effect of nitric
oxide inhalation.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (4) (pp 1009-1014),
2011. Date of Publication: April 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Left ventricular assist device (LVAD) implantation is an
established option for treatment of patients with end-stage heart failure,
but outcome may be worsened by right ventricular failure. The aim of this
study was to evaluate the acute effect of LVAD on right ventricular
geometry and function and the pulmonary circulation. The effect of inhaled
nitric oxide (iNO) was assessed. Methods: We evaluated pre- and
postoperatively obtained transesophageal echocardiography images and
hemodynamics of patients participating in a randomized trial on the effect
of inhaled nitric oxide during LVAD implantation. Twenty-four patients
were randomized to the iNO group and 23 to the placebo group. Results:
After LVAD implantation marked decreases in pulmonary capillary wedge
pressure (P < .01) and mean pulmonary artery pressure (P < .01) were
observed in both groups. Pulmonary vascular resistance decreased only in
the iNO group (311 +/- 35 to 225 +/- 17, P < .01). Transesophageal
echocardiography measurements show significant improvement of right
ventricular geometry (right ventricular end-diastolic diameter: 50 +/- 2
to 45 +/- 2, P < .01 and 48 +/- 2 to 44 +/- 2 mm, P < .05 in iNO and
placebo groups) and function (right ventricular fractional area change:
24% +/- 2% to 31% +/- 2%, P < .05 and 23% +/- 2% to 29% +/- 2%, P < .05 in
iNO and placebo groups) without any difference between the iNO and placebo
groups. The overall incidence of postoperative right ventricular failure
was 4 of 47 (8.5%). Conclusions: LVAD implantation markedly improved right
ventricular geometry and function in most of the patients, probably by
resolving left ventricular congestion and thus reducing right ventricular
afterload. Beneficial effects of iNO may have been masked by more
pronounced consequences of left ventricular unloading on right ventricular
function. 2011 by The American Association for Thoracic Surgery.
<11>
Accession Number
2011168034
Authors
Sudhakaran N. Davenport M.
Institution
(Sudhakaran, Davenport) Department of Paediatric Surgery, King's College
Hospital, Denmark Hill, London SE5 9RS, United Kingdom
Title
Congenital parenchymal lesions of the lung.
Source
Current Respiratory Medicine Reviews. 7 (2) (pp 130-137), 2011. Date of
Publication: 2011.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Increasing use of ultrasonography during pregnancy has uncovered a range
of parenchymal lesions within the lung, some of which will, if left, be a
cause of morbidity and occasional mortality. These include congenital
cystic adenomatoid malformations (CCAM), bronchopulmonary sequestration
(BPS), congenital lobar & segmental emphysema and bronchogenic cysts.
Adverse antenatal features include mediastinal shift, caval obstruction,
and (rarely) hydrops. This review aims to define current thoughts on these
lesions and suggest appropriate management. 2011 Bentham Science
Publishers Ltd.
<12>
Accession Number
2011177100
Authors
Pellegrino V.A. Mudaliar Y. Gopalakrishnan M. Horton M.D. Killick C.J.
Parkin W.G. Playford H.R. Raper R.F.
Institution
(Pellegrino) Intensive Care Unit, Alfred Hospital, Commercial Rd,
Melbourne, VIC 3004, Australia
(Mudaliar, Playford) Intensive Care Unit, Westmead Hospital, Sydney, NSW,
Australia
(Gopalakrishnan) Intensive Care Unit, St. Vincent's Hospital, Sydney, NSW,
Australia
(Horton) Cardiothoracic Unit, St. George Hospital, Sydney, NSW, Australia
(Killick, Parkin) Intensive Care Unit, Monash Medical Centre, Melbourne,
VIC, Australia
(Raper) Intensive Care Unit, Royal North Shore Hospital, Sydney, NSW,
Australia
Title
Computer based haemodynamic guidance system is effective and safe in
management of postoperative cardiac surgery patients.
Source
Anaesthesia and Intensive Care. 39 (2) (pp 191-201), 2011. Date of
Publication: March 2011.
Publisher
Australian Society of Anaesthetists (P.O. Box 600, Edgecliff NSW 2027,
Australia)
Abstract
A circulatory guidance system, Navigator, was evaluated in a prospective,
randomised control trial at six Australian university teaching hospitals
involving 112 scheduled postoperative cardiac surgical patients with
pulmonary artery catheters placed and receiving 1:1 nursing care. The
guidance system was used to achieve and maintain physician-designated
cardiac output and mean arterial pressure targets and compared these with
standard post open-heart surgery care. The primary efficacy endpoint was
the standardised unsigned error between the targeted and the actual values
for cardiac output and mean arterial pressure, time averaged over the
duration of cardiac output monitoring - the average standardised distance.
This was 1.71 (SD=0.65) for the guidance group and 1.92 (SD=0.65) in the
control group (P=0.202). Rates of postoperative atrial fibrillation,
adverse events, intensive care unit and hospital length-of-stay were
similar in both groups. There were no device-related adverse events.
Guided haemodynamic therapy with the Navigator device was non-inferior to
standard intensive care unit therapy. The study was registered with
ClinicalTrials.gov Identifier NCT00468247.
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Accession Number
70379809
Authors
Podoll A. Kurian D. Finkel K.
Institution
(Podoll, Kurian, Finkel) University of Texas Health Science Center,
Houston, TX, United States
Source
American Journal of Kidney Diseases. Conference: National Kidney
Foundation 2011 Spring Clinical Meetings, SCM 11 Las Vegas, NV United
States. Conference Start: 20110426 Conference End: 20110430. Conference
Publication: (var.pagings). 57 (4) (pp A79), 2011. Date of Publication:
April 2011.
Publisher
W.B. Saunders
Abstract
Mortality after cardiac surgery is often due to complications such as
peri-operative myocardial infarction, impaired myocardial function,
arrhythmias, and acute renal failure. Based on the hypothesis that oxidant
injury is a consequence of cardiac surgery, the beneficial effects of
administration of xanthine oxidase inhibitors were studied in a series of
patients in the 1990's. Although the results of these studies were
variable, a 2003 review article recommended that allopurinol be considered
in all patients undergoing standard coronary artery bypass surgery unless
contraindicated. This study was not a systematic review and did not
include five studies available at the time. Adoption of the recommendation
was poor. With a recent renewed focus on the importance of oxidative
stress and the role of uric acid and its metabolites, we conducted a
systematic review of the use of xanthine oxidase inhibitors and the
complications of cardiac surgery. A systematic review and meta-analysis
was conducted on the use of allopurinol in cardiac surgery. A search
strategy using PubMed, Embase, and the Cochrane Library identified
randomized controlled and prospective cohort studies. Study quality was
assessed by the U.S. Preventive Task Force guidelines. A meta-analysis was
conducted on mortality and pooled cardiac complications of cardiac
function, arrhythmias and ischemic events. Two level I randomized
controlled trials with 219 patients demonstrated a decreased risk of
hospital mortality (RR 0.85, <0.001) and decreased cardiac complications
(RR 0.78, p<0.004). An additional 8 studies of Level II and III quality
(n=454) analyzed separately were associated with decreased cardiac
complications (RR 0.87, p<0.04), although mortality was not consistently
reported. In patients undergoing cardiac surgery, the use of allopurinol
may reduce mortality and cardiac complications but the evidence to support
its routine use is not robust. Our findings indicate that a large
randomized control trial using xanthine oxidase inhibitors to reduce the
post-operative complications of cardiac surgery is warranted.
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