Results Generated From:
Embase <1980 to 2011 Week 42>
Embase (updates since 2011-10-13)
<1>
Accession Number
2011558524
Authors
Kelly D.J. Gershlick T. Witzenbichler B. Guagliumi G. Fahy M. Dangas G.
Mehran R. Stone G.W.
Institution
(Kelly, Gershlick) Department of Academic Cardiology, Glenfield Hospital,
Groby Road, Leicester, United Kingdom
(Witzenbichler) Charite Campus Benjamin Franklin, Berlin, Germany
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Fahy, Stone) Columbia University, Medical Center and Cardiovascular
Research Foundation, New York, NY, United States
(Dangas, Mehran) Mt. Sinai Medical Center and Cardiovascular Research
Foundation, New York, NY, United States
Title
Incidence and predictors of heart failure following percutaneous coronary
intervention in ST-segment elevation myocardial infarction: The
HORIZONS-AMI trial.
Source
American Heart Journal. 162 (4) (pp 663-670), 2011. Date of Publication:
October 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Congestive heart failure (CHF) is a major source of morbidity,
mortality, and health-care resource consumption. However, the incidence of
symptomatic CHF after primary percutaneous coronary intervention (PCI) for
ST-segment elevation myocardial infarction (STEMI) has rarely been fully
reported. We therefore examined the early and late incidence, predictors,
and implications of CHF in the large-scale, prospective, randomized
HORIZONS-AMI trial. Methods and Results: New York Heart Association (NYHA)
functional classification was prospectively collected from patient-level
data at baseline, 30 days, 6 months, and at 1 and 2 years from 3,343
patients with STEMI undergoing PCI at 123 centers in 11 countries. The
baseline incidence of CHF (before the index STEMI) was 2.6%, increasing to
4.6% 1 month after primary PCI (P <.0001), 4.7% at 1 year, and 5.1% at 2
years. The incidence of NYHA class III/IV symptoms was 0.4% at baseline
and 0.8% at 2 years (P =.03). CHF at 1 year was associated with diabetes
(P <.0001), dyslipidemia (P =.009), previous MI (P <.0001), previous
revascularization (P =.01), anterior STEMI (P =.02), and baseline TIMI
grade 0 flow (P =.01) but not procedural anticoagulation with bivalirudin
versus heparin + GPIIb/IIIa inhibitors (P =.93) or use of drug-eluting
versus bare metal stents (P =.66). Among patients in whom CHF was not
present at baseline but developed after PCI, the rate of all-cause
mortality was significantly higher during 2-year follow-up (7.3% vs 2.0%,
P <.0001), as was cardiac mortality (2.4% vs 0.8%, P =.004), reinfarction
(9.4% vs 5.2%, P =.0009), stent thrombosis (7.0% vs 3.8%, P =.007), and
ischemic target vessel revascularization (19.4% vs 11.8%, P <.0001).
Conclusion: In the HORIZONS-AMI trial, the development of new-onset CHF
within 2 years after contemporary PCI, although infrequent, was associated
with significantly increased rates of mortality and major adverse ischemic
events. 2011 Mosby, Inc. All rights reserved.
<2>
Accession Number
2011558521
Authors
Alexopoulos D. Xanthopoulou I. Davlouros P. Plakomyti T.-E. Panagiotou A.
Mavronasiou E. Hahalis G.
Institution
(Alexopoulos, Xanthopoulou, Davlouros, Plakomyti, Panagiotou, Mavronasiou,
Hahalis) Department of Cardiology, Patras University, Hospital Rio,
Patras, Greece
Title
Prasugrel overcomes high on-clopidogrel platelet reactivity in chronic
coronary artery disease patients more effectively than high dose (150 mg)
clopidogrel.
Source
American Heart Journal. 162 (4) (pp 733-739), 2011. Date of Publication:
October 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: High on-treatment platelet reactivity (HTPR) is present in a
substantial percentage of patients on chronic clopidogrel treatment and
may have prognostic implications. Strategies to optimize platelet
inhibition in such patients are not clear. Methods: We performed a
prospective, single-center, single-blinded, investigator-initiated
randomized, crossover study of platelet inhibition by prasugrel 10 mg/day
versus high-dose 150 mg/day clopidogrel, with a 14 day treatment period,
in 31 patients with HTPR (out of 99 screened, 31.3%) while on chronic (>=
12 months) treatment with clopidogrel. All patients had stable coronary
artery disease and 87.1% of them had a prior percutaneous coronary
intervention. Platelet reactivity (PR) was assessed by the VerifyNow assay
measured in platelet reactivity units (PRU). Results: The primary end
point of PR at the end of the two treatment periods was lower in patients
receiving prasugrel compared with high dose clopidogrel (least squares
estimate 148.1, 95% CI 127.1-169.2 and 219.8, 95% CI 198.6-240.9
respectively, P <.001). The secondary end point of HTPR rate was lower for
prasugrel compared with clopidogrel, 11.5% vs 46.3%, P =.003. Conclusions:
Prasugrel appears more effective than double clopidogrel in inhibiting PR
in patients with HTPR following chronic clopidogrel treatment. 2011
Mosby, Inc. All rights reserved.
<3>
Accession Number
2011559058
Authors
Kadakia M.B. Fox C.S. Scirica B.M. Murphy S.A. Bonaca M.P. Morrow D.A.
Institution
(Kadakia, Scirica, Murphy, Bonaca, Morrow) Department of Medicine,
Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical
School, Boston, MA, United States
(Kadakia) Division of Cardiovascular Medicine, Hospital of the University
of Pennsylvania, Philadelphia, PA, United States
(Fox) NHBLI's Framingham Heart Study, National Heart, Lung, and Blood
Institute, Framingham, MA, United States
(Fox) Division of Endocrinology, Brigham and Women's Hospital and Harvard
Medical School, Boston, MA, United States
Title
Central obesity and cardiovascular outcomes in patients with acute
coronary syndrome: Observations from the MERLIN-TIMI 36 trial.
Source
Heart. 97 (21) (pp 1782-1787), 2011. Date of Publication: November 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: Despite the association of obesity with incident cardiovascular
disease, obese patients with acute coronary syndrome (ACS) appear to have
more favourable short-term outcomes. A study was undertaken to determine
whether this 'obesity paradox' persists in the long term and to examine
the specific relationship of central obesity with outcomes after ACS.
Methods: The relationship was investigated between two measures of obesity
- body mass index (BMI) and waist circumference (WC) - and 30-day and
1-year outcomes after ACS. 6560 patients with non-ST elevation ACS in the
MERLIN-TIMI 36 trial were followed for 1 year. Patients were stratified
into three BMI groups (<25, 25-30, >=30 kg/m<sup>2</sup>) and
gender-specific tertiles of WC. The primary endpoint was cardiovascular
death, myocardial infarction or recurrent ischaemia. Results: Patients
with BMI >=30 kg/m<sup>2</sup> had a significantly lower risk of the
primary endpoint than those with BMI <25 kg/m<sup>2</sup> (HR 0.64; 95% CI
0.51 to 0.81, p<0.0001) at 30 days. However, after the 30-day acute phase,
landmark analysis from 30 days to 1 year showed no difference in risk
between BMI groups (HR 1.09; 95% CI 0.92 to 1.29, p=0.34). WC tertiles
demonstrated a similar relationship. When BMI groups were stratified by WC
there was a trend towards more adverse outcomes in higher WC groups among
those in lower BMI groups. The group with the lowest BMI and highest WC
had the highest risk (HR 2.8; 95% CI 0.93 to 8.3; p=0.067). Conclusions:
Obesity is associated with more favourable short-term outcomes after ACS.
However, in the longer term the obesity paradox is no longer present and
may reverse. Those with WC out of proportion to BMI suggestive of
significant central adiposity may be at highest risk following ACS.
<4>
Accession Number
2011557691
Authors
Illuminati G. Ricco J.-B. Cali F. Pacil M.A. Miraldi F. Frati G. MacRina
F. Toscano M.
Institution
(Illuminati, Cali, Pacil) 'Francesco Durante' Department of Surgery,
University of Rome 'La Sapienza', Rome, Italy
(Ricco) Department of Vascular Surgery, University of Poitiers, Poitiers,
France
(Miraldi, Frati, MacRina, Toscano) Department of Cardiovascular Surgery,
University of Rome 'La Sapienza', Rome, Italy
Title
Short-term results of a randomized trial examining timing of carotid
endarterectomy in patients with severe asymptomatic unilateral carotid
stenosis undergoing coronary artery bypass grafting.
Source
Journal of Vascular Surgery. 54 (4) (pp 993-999), 2011. Date of
Publication: October 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: This study evaluated the timing of carotid endarterectomy (CEA)
in the prevention of stroke in patients with asymptomatic carotid stenosis
>70% receiving a coronary artery bypass graft (CABG). Methods: From
January 2004 to December 2009, 185 patients with unilateral asymptomatic
carotid artery stenosis >70%, candidates for CABG, were randomized into
two groups. In group A, 94 patients received a CABG with previous or
simultaneous CEA. In group B, 91 patients underwent CABG, followed by CEA.
All patients underwent preoperative helical computed tomography scans,
excluding significant atheroma of the ascending aorta or aortic arch.
Baseline characteristics of the patients, type of coronary artery lesion,
and preoperative myocardial function were comparable in the two groups. In
group A, all patients underwent CEA under general anesthesia with the
systematic use of a carotid shunt, and 79 patients had a combined
procedure and 15 underwent CEA a few days before CABG. In group B, all
patients underwent CEA, 1 to 3 months after CABG, also under general
anesthesia and with systematic carotid shunting. Results: Two patients
(one in each group) died of cardiac failure in the postoperative period.
Operative mortality was 1.0% in group A and 1.1% in group B (P =.98). No
strokes occurred in group A vs seven ipsilateral ischemic strokes in group
B, including three immediate postoperative strokes and four late strokes,
at 39, 50, 58, and 66 days, after CABG. These late strokes occurred in
patients for whom CEA was further delayed due to an incomplete sternal
wound healing or because of completion of a cardiac rehabilitation
program. The 90-day stroke and death rate was 1.0% (one of 94) in group A
and 8.8% (eight of 91) in group B (odds ratio [OR], 0.11; 95% confidence
interval [CI], 0.01-0.91; P =.02). Logistic regression analysis showed
that only delayed CEA (OR, 14.2; 95% CI, 1.32-152.0; P =.03) and duration
of cardiopulmonary bypass (OR, 1.06; 95% CI, 1.02-1.11; P =.004) reliably
predicted stroke or death at 90 days. Conclusions: This study suggests
that previous or simultaneous CEA in patients with unilateral severe
asymptomatic carotid stenosis undergoing CABG could prevent stroke better
than delayed CEA, without increasing the overall surgical risk. 2011
Society for Vascular Surgery.
<5>
Accession Number
2011566385
Authors
Biancari F. Vasques F. Benenati V. Juvonen T.
Institution
(Biancari, Vasques, Benenati, Juvonen) Division of Cardio-thoracic and
Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu,
Finland
Title
Contemporary results after surgical repair of type A aortic dissection in
patients aged 80 years and older: A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 40 (5) (pp 1058-1063), 2011.
Date of Publication: November 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: The benefits of surgical treatment of type A aortic dissection
(AAD) in patients aged 80 years and older are questioned by the perceived
high operative risk of these patients. This issue has been investigated in
the present meta-analysis of observational studies. Methods: Studies on
surgical repair of AAD in patients aged 80 years and older were identified
up to January 2011. The results were expressed as pooled proportions with
95% confidence interval (95% CI). Results: Pooled analysis showed that
patients aged 80 years and older included in six studies had a
significantly higher risk of immediate postoperative mortality compared
with younger patients (risk ratio 2.32, 95% CI 1.47-3.66, p<. 0.0001,
pooled estimates 45.7% vs 19.5%). Analysis of data retrieved from nine
studies reporting on the results of surgical treatment of AAD in a total
of 308 patients aged 80 years and older showed a pooled mortality rate of
36.7% (95% CI 23.8-51.8%, 111/308 patients). The pooled stroke rate was
11.9% (95% CI 7.3-18.7%, 37/347 patients). Pooled analysis of data from
two studies evaluating patients surgically or medically treated showed a
non-significant reduced risk of immediate postoperative death after
surgery (risk ratio 0.42, 95% CI 0.14-1.29, pooled estimates: 25.2% vs
59.0%). Conclusions: Immediate postoperative survival rates after surgery
for AAD in patients aged 80 years and older are satisfactory. These
findings suggest a confident approach toward emergency repair of AAD in
this fragile patient population. More data on the intermediate survival
and quality of life of these patients are, however, needed to better
establish the role of emergency surgery for AAD in octogenarians and
nonagenarians. 2011 European Association for Cardio-Thoracic Surgery.
<6>
Accession Number
2011551661
Authors
Kirakli C. Ozdemir I. Ucar Z.Z. Cimen P. Kepil S. Ozkan S.A.
Institution
(Kirakli, Ucar, Cimen) Intensive Care Unit, Izmir Dr Suat Seren Chest
Diseases and Thoracic Surgery Education and Research Hospital, 1671 sok.
No 159 D, 5 35530 Karsiyaka Izmir, Turkey
(Ozdemir, Kepil, Ozkan) Pulmonary Division, Izmir Dr Suat Seren Chest
Diseases and Thoracic Surgery Education and Research Hospital, Izmir,
Turkey
Title
Adaptive support ventilation for faster weaning in COPD: A randomised
controlled trial.
Source
European Respiratory Journal. 38 (4) (pp 774-780), 2011. Date of
Publication: 01 Oct 2011.
Publisher
European Respiratory Society (4 Ave Sainte-Luce, Lausanne CH-1003,
Switzerland)
Abstract
Adaptive support ventilation (ASV) is a closed-loop ventilation mode that
can act both as pressure support ventilation (PSV) and pressure-controlled
ventilation. Weaning with ASV shows promising results, mainly in
post-cardiac surgery patients. The aim of the present randomised
controlled study was to test the hypothesis that weaning with ASV could
reduce the weaning duration in patients with chronic obstructive pulmonary
disease (COPD) when compared with PSV. From among 435 COPD patients
admitted to the intensive care unit (ICU) during a 20-month period, 97
were enrolled. Patients were assigned at random to either ASV or PSV as a
weaning mode. Compared with PSV, ASV provided shorter weaning times
(median 24 (interquartile range 20-62) h versus 72 (24-144) h, p=0.041)
with similar weaning success rates (35 out of 49 for ASV and 33 out of 48
for PSV). Length of stay in the ICU was also shorter with ASV but the
difference was not statistically significant. This study suggests that ASV
may be used in the weaning of COPD patients with the advantage of shorter
weaning times. Further studies are needed to investigate the role and
potential advantages of ASV in the weaning period of different patient
groups. CopyrightERS 2011.
<7>
Accession Number
2011401802
Authors
Cohen D.J.
Institution
(Cohen) St. Luke's Mid America Heart Institute, Kansas City, MO, United
States
Title
CABG and PCI did not differ clinically for angina relief in severe CAD.
Source
Annals of Internal Medicine. 155 (2) (pp JC1-10), 2011. Date of
Publication: July 19, 2011.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
<8>
Accession Number
2011549144
Authors
Zimmerman R.F. Ezeanuna P.U. Kane J.C. Cleland C.D. Kempananjappa T.J.
Lucas F.L. Kramer R.S.
Institution
(Zimmerman, Ezeanuna, Kempananjappa) Division of Nephrology, Maine Medical
Center, 22 Bramhall Street, Portland, ME 04102-3175, United States
(Kane, Kramer) Division of Cardiothoracic Surgery, Maine Medical Center,
Portland, ME, United States
(Cleland) Department of Anesthesiology, Maine Medical Center, Portland,
ME, United States
(Lucas) Center for Outcomes Research, Maine Medical Center, Portland, ME,
United States
Title
Ischemic preconditioning at a remote site prevents acute kidney injury in
patients following cardiac surgery.
Source
Kidney International. 80 (8) (pp 861-867), 2011. Date of Publication: 02
Oct 2011.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Acute kidney injury, a common complication of cardiac surgery with
cardiopulmonary bypass, is associated with increased morbidity and
mortality. Ischemic preconditioning at a remote site mitigates
ischemia-reperfusion injury and may prevent acute kidney injury after
cardiac surgery, thus providing clinical benefit. To further study this,
we enrolled 120 adult patients undergoing elective cardiac surgery for
whom cardiopulmonary bypass was anticipated in a randomized, single-blind,
and controlled pilot trial. Patients were stratified for the type of
surgery and equally assigned to a control group or to receive remote
ischemic preconditioning by an automated thigh tourniquet consisting of
three 5-min intervals of lower extremity ischemia separated by 5-min
intervals of reperfusion. The primary end point was acute kidney injury
defined as an elevation of serum creatinine of 0.3 mg/dl or 50% within 48
h after surgery. Fifty-nine patients in each group were analyzed on an
intention-to-treat basis. Acute kidney injury occurred in 12 remote
ischemic preconditioned and 28 control patients, reflecting an absolute
risk reduction of 0.27 and a significantly reduced relative risk due to
preconditioning of 0.43. Hence, remote ischemic preconditioning prevents
acute kidney injury in patients undergoing cardiopulmonary bypass-assisted
cardiac surgery. 2011 International Society of Nephrology.
<9>
[Use Link to view the full text]
Accession Number
2011555420
Authors
Martin D.T. McNitt S. Nesto R.W. Rutter M.K. Moss A.J.
Institution
(Martin, Nesto) Department of Cardiovascular Medicine, Lahey Clinic
Medical Center, 41 Mall Rd., Burlington, MA 01805, United States
(McNitt, Moss) Department of Medicine, University of Rochester Medical
Center, Rochester, NY, United States
(Rutter) Cardiovascular Research Group, School of Biomedicine, University
of Manchester, United Kingdom
(Rutter) Manchester Diabetes Centre, NIHR Manchester Biomedical Research
Centre, Hospitals NHS Foundation TruSt., Manchester, United Kingdom
Title
Cardiac resynchronization therapy reduces the risk of cardiac events in
patients with diabetes enrolled in the multicenter automatic defibrillator
implantation trial with cardiac resynchronization therapy (MADIT-CRT).
Source
Circulation: Heart Failure. 4 (3) (pp 332-338), 2011. Date of
Publication: May 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Data are limited regarding whether the presence of diabetes
mellitus (DM) influences the benefit of cardiac resynchronization with
defibrillator therapy (CRT-D) in heart failure (HF) patients. Methods and
Results-The effect of CRT-D was evaluated in 1817 patients who were
enrolled in the Multicenter Automatic Defibrillator Implantation Trial
with Cardiac Resynchronization Therapy (MADIT-CRT). Patients were
minimally symptomatic (New York Heart Association class I or II), with
ejection fraction <=0.30 and QRS >=130 ms. We used Cox regression to
determine hazard ratio (HR) of CRT-D versus implantable
cardioverter-defibrillator (ICD) therapy for the risk of HF event or
death, whichever came first (MADIT-CRT primary end point), in DM (n=552)
and non-DM (n=1265) patients. Compared with the non-DM patients, those
with DM had more coronary risk factors. During an average follow-up of 2.4
years, DM patients had significantly more primary end point events than
non-DM patients (26.6% versus 18%, P<0.001). CRT-D was associated with a
significant reduction in risk of primary end point in both DM (HR=0.56,
P<0.001) and non-DM patients (HR=0.67, P=0.003). Compared with non-DM
patients, CRT-D:ICD HRs in DM patients were lower in the total population,
and in subgroups with ischemic cardiomyopathy (0.63 versus 0.64),
nonischemic cardiomyopathy (0.39 versus 0.73), and left bundle-branch
block (0.36 versus 0.50). There were no significant differences in
ventricular remodeling, arrhythmia events, or device-related complications
between DM and non-DM patients. Conclusions-Patients with diabetes, left
ventricular dysfunction, mildly symptomatic HF, and wide QRS complex
derive similar benefit from CRT-D compared with patients without diabetes.
2011 American Heart Association, Inc.
<10>
Accession Number
2011555198
Authors
Dumaresq D.M.H. de Vasconcelos R.C. Guimaraes S.B. Cavalcante S.L. Garcia
J.H.P. de Vasconcelos P.R.L.
Institution
(Dumaresq, Cavalcante, Garcia, de Vasconcelos) Department of Surgery, UFC,
Ceara, Brazil
(de Vasconcelos) UFC, Ceara, Brazil
(Guimaraes) Department of Surgery, LABCEX, UFC, Ceara, Brazil
Title
Metabolic and oxidative effects of sevoflurane and propofol in children
undergoing surgery for congenital heart disease.
Source
Acta Cirurgica Brasileira. 26 (SUPPL. 1) (pp 66-71), 2011. Date of
Publication: 2011.
Publisher
Sociedade Brasileira para o Desenvolvimente da (Al.Rio Claro 179, 14 and.,
Sao Paulo 01332-010, Brazil)
Abstract
PURPOSE: To evaluate the metabolic and oxidative effects of sevoflurane
and propofol in children undergoing surgery for correction of congenital
heart disease. METHODS: Twenty children with acyanotic congenital heart
disease, scheduled for elective cardiac surgery with cardiopulmonary
bypass, age range 1 day to 14 years were randomly assigned to 2 groups:
Group GP, programmed to receive total intravenous anesthesia with propofol
and group GS scheduled to use balanced anesthesia with sevoflurane.
Exclusion criteria were cyanotic heart disease or complex, association
with other malformations, severe systemic diseases, infection or children
undergoing treatment and palliative or emergency surgery. Blood samples
were collected at three different time-points: T0, after radial artery
cannulation, T1, 30 minutes after cardiopulmonary bypass (CPB) launch and
T2, at the end of procedure. Parameters analyzed included thiobarbituric
acid-reactive substance (TBARS), glutathione (GLN), lactate and pyruvate
plasmatic concentrations. RESULTS: TBARS, GSH, lactate and pyruvate
concentrations did not change significantly by Friedman's test.
Lactate/pyruvate ratio (L/P) was >10 in both groups. There was a moderate
Pearson correlation for TBARS, in T1 (r=0.50; p=0.13) e T2 (r=0.51;
p=0.12). Pearson correlation was high between groups during CPB (T1) for
lactate (r=0.68; p=0.02), pyruvate (r=0.75; p=0.01) and L/P ratio (r=0.83;
p=0.003). CONCLUSION: Anesthetic techniques investigated in this study
showed a similar pattern, with no increase in metabolic substrates and
oxidative stress during surgical correction of congenital heart defects in
non-cyanotic children.
<11>
Accession Number
2011553526
Authors
Hissa M.N. de Vasconcelos R.C. Guimaraes S.B. Silva R.P. Garcia J.H.P. de
Vasconcelos P.R.L.
Institution
(Hissa, Silva, de Vasconcelos) Department of Surgery, UFC, Ceara, Brazil
(de Vasconcelos) UFC, Ceara, Brazil
(Guimaraes) Department of Surgery, LABCEX, UFC, Ceara, Brazil
(Garcia) Department of Clinical Medicine, UFC, Ceara, Brazil
Title
Preoperative glutamine infusion improves glycemia in heart surgery
patients.
Source
Acta Cirurgica Brasileira. 26 (SUPPL. 1) (pp 77-81), 2011. Date of
Publication: 2011.
Publisher
Sociedade Brasileira para o Desenvolvimente da (Al.Rio Claro 179, 14 and.,
Sao Paulo 01332-010, Brazil)
Abstract
PURPOSE: To evaluate the effects of pre-operative L-alanyl-glutamine
(L-Ala-Gln) on blood glucose control in patients with coronary
obstruction, selected for myocardial revascularization. METHODS:
Twenty-two patients (63+/-8 years) were randomly assigned to receive 250ml
of L-Ala-Gln 20% plus saline 750 ml (Group L- Ala-Gln, n=11) or saline
1000 ml (Group Saline, n=11) over 3 hours before operation. Pre-operative
blood samples were collected 3h before (T-1) and at the beginning of the
surgical procedure (T-2). Intra-operative samples were collected
immediately before the start (T-3) and the end of extra-corporeal
perfusion (T- 4). Post-operative samples were collected 12h (T-12) and 24h
later (T-24). RESULTS: Glycemia decreased significantly in L-Ala-Gln
treated patients during the intraoperative period. The same effect did not
occur in saline patients. As the rate of insulin infusion, administered
routinely to patients undergoing surgery with extracorporeal circulation
was constant in both groups during surgery, the reduction of blood glucose
in group L-Ala-Gln does not seem to be related to exogenous insulin.
CONCLUSION: Pre-operative use of L-Ala-Gln improves glycemic control in
patients with coronary artery occlusion, submitted to myocardial
revascularization.
<12>
Accession Number
2011550428
Authors
Dinardo J.A.
Institution
(Dinardo) Division of Cardiac Anesthesia, Children's Hospital Boston,
Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United
States
Title
Con: Extubation in the operating room following pediatric cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (5) (pp 877-879),
2011. Date of Publication: October 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
<13>
Accession Number
2011556072
Authors
Jagannath A.D. Johri A.M. Liberthson R. Larobina M. Passeri J. Tighe D.
Agnihotri A.K.
Institution
(Jagannath, Larobina, Agnihotri) Department of Surgery, Division of
Cardiology, Massachusetts General Hospital, Boston, MA, United States
(Johri, Passeri) Cardiac Ultrasound Laboratory, Division of Cardiology,
Massachusetts General Hospital, Boston, MA, United States
(Liberthson) Congenital Heart Disease Program, Division of Cardiology,
Massachusetts General Hospital, Boston, MA, United States
(Tighe) Department of Cardiology, University of Massachusetts, Memorial
Hospital, Worcester, MA, United States
Title
Quadricuspid aortic valve: A report of 12 cases and a review of the
literature.
Source
Echocardiography. 28 (9) (pp 1035-1040), 2011. Date of Publication:
October 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Quadricuspid aortic valve (QAV) is rare and its diagnosis, clinical
course, and management are less well defined relative to other aortic
valve abnormalities. Advances in diagnostic imaging, notably in
ultrasound, have increased clinical awareness of this anomaly and prompted
this review of our experience with 12 new patients and a compilation of
previously reported patients to further characterize this condition.
2011, Wiley Periodicals, Inc.
<14>
Accession Number
2011556069
Authors
Chen X. Sun D. Yang J. Feng W. Gu T. Zhang Z. Xiu Z. Tang L. Ma C. Wang X.
Cheng Y. Li N. Liu S.
Institution
(Chen, Sun, Yang, Feng, Tang, Ma, Wang, Cheng, Li, Liu) Echo Lab, First
Affiliated Hospital, China Medical University, 155 Nanjing North Street,
Heping District, Shenyang 110001, China
(Gu, Zhang, Xiu) Department of Cardiac Surgery, First Affiliated Hospital,
China Medical University, Shenyang, China
Title
Preoperative assessment of mitral valve prolapse and chordae rupture using
real time three-dimensional transesophageal echocardiography.
Source
Echocardiography. 28 (9) (pp 1003-1010), 2011. Date of Publication:
October 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Mitral valve (MV) repair provides a better outcome in patients
with significant mitral regurgitation than MV replacement. Valve repair
requires a thorough understanding of MV morphology. Recently developed
real time three-dimensional transesophageal echocardiography (RT3D TEE)
can provide online acquisition and accurate information of cardiac
structures. The study aim was to evaluate the feasibility and accuracy of
using RT3D TEE to assess mitral valve prolapse (MVP) and chordae rupture
for surgical planning purposes. Methods: Fifty-six consecutive patients
with moderate to severe mitral regurgitation due to MVP received
two-dimensional (2D) TEE and RT3D TEE the day before operation. The
accuracy of the assessment of MVP and chordae rupture by RT3D TEE was
determined and compared with assessment by 2D TEE using surgical
inspection as the gold standard. Results: The overall sensitivity,
specificity, accuracy, positive predictive value, and negative predictive
value of 2D TEE in detection of MVP were 87%, 96%, 93%, 88%, and 95%,
respectively, whereas those of RT3D TEE were 100%, 99%, 99%, 98%, and
100%, respectively (P < 0.05 for all comparisons). The receiver operating
characteristic (ROC) curve areas for assessment of anterior leaflet and
posterior leaflet segment involvement using RT3D TEE (ROC areas 0.96 and
0.99) were higher than for those using 2D TEE (ROC areas 0.86 and 0.94).
Interobserver agreement for RT3D TEE (K = 0.97, 95% confidence interval
[CI] 0.92-1.00) was significantly greater than for 2D TEE (K = 0.89, 95%
CI 0.81-0.93) (P < 0.05). Conclusion: RT3D TEE is a feasible, accurate and
reproducible method for evaluating MVP and chordae rupture in the clinical
setting. 2011, Wiley Periodicals, Inc.
<15>
Accession Number
2011550407
Authors
Ponschab M. Landoni G. Biondi-Zoccai G. Bignami E. Frati E. Nicolotti D.
Monaco F. Pappalardo F. Zangrillo A.
Institution
(Ponschab, Landoni, Bignami, Frati, Nicolotti, Monaco, Pappalardo,
Zangrillo) Department of Anesthesia and Intensive Care, Universit
Vita-Salute San Raffaele, Milan, Italy
(Biondi-Zoccai) Division of Cardiology, University of Modena and Reggio
Emilia, Modena, Italy
Title
Recombinant activated factor VII increases stroke in cardiac surgery: A
meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (5) (pp 804-810),
2011. Date of Publication: October 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: Recombinant activated factor VII (rFVIIa) is used in various
surgical procedures to reduce the incidence of major blood loss and the
need for re-exploration. Few clinical trials have investigated rFVIIa in
cardiac surgery. The authors performed a meta-analysis focusing on the
rate of stroke and surgical re-exploration. Design: Meta-analysis.
Setting: Hospitals. Participants: A total of 470 patients. Interventions:
None. Measurements and Main Results: Four investigators independently
searched PubMed and conference proceedings including backward snowballing
(ie, scanning of reference of retrieved articles and pertinent reviews)
and contacted international experts. A total of 470 patients (254
receiving rFVIIa and 216 controls) from 6 clinical trials (2 randomized, 3
propensity matched, and 1 case matched) were included in the analysis. The
use of rFVIIa was associated with an increased rate of stroke (12/254
[4.7%] in the rFVIIa group v 2/216 [0.9%] in the control arm, odds ratio
[OR] = 3.69 [1.1-12.38], p = 0.03) with a nonsignificant reduction in rate
of surgical re-exploration (13% v 42% [OR = 0.27 (0.04-1.9), p = 0.19]).
The authors observed a trend toward an increase of overall perioperative
thromboembolic events (19/254 [7.5%] in the rFVIIa group v 10/216 [5.6%]
in the control arm [OR = 1.84 (0.82-4.09), p = 0.14]). No difference in
the rate of death was observed. Conclusions: The administration of rFVIIa
in cardiac surgery patients could result in a significant increase of
stroke with a trend toward a reduction of the need for surgical
re-exploration. The authors do not recommend routine use in cardiac
surgery patients. rFVIIa may be considered with caution in patients with
refractory life-threatening bleeding. 2011 Elsevier Inc.
<16>
Accession Number
2011550404
Authors
Ucak A. Onan B. Sen H. Selcuk I. Turan A. Yilmaz A.T.
Institution
(Ucak, Onan, Selcuk, Yilmaz) Department of Cardiovascular Surgery, GATA
Haydarpasa Education Hospital, Tibbiye Caddesi, Uskudar, 34668-Istanbul,
Turkey
(Sen) Department of Anesthesiology and Reanimation, GATA Haydarpasa
Education Hospital, Istanbul, Turkey
(Turan) Department of Outcomes Research, Cleveland Clinic, Cleveland, OH,
United States
Title
The effects of gabapentin on acute and chronic postoperative pain after
coronary artery bypass graft surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (5) (pp 824-829),
2011. Date of Publication: October 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives The purpose of this study was to evaluate the analgesic effects
of perioperative gabapentin on postoperative acute and chronic pain after
coronary artery bypass graft (CABG) surgery with median sternotomy and
internal mammary artery harvesting. Design A double-blind randomized
clinical study. Setting A single-academic hospital. Participants Patients
with ischemic heart disease who were scheduled to undergo CABG surgery.
Interventions Forty patients were allocated randomly into 2 groups; the
gabapentin group (n = 20) received 1.2 g/d of oral gabapentin before and
for 2 days after surgery, and the placebo group (n = 20) received a
placebo capsule instead. The primary outcome was to evaluate the effects
of gabapentin on acute and chronic pain after surgery. The postoperative
evaluation included the assessment of pain at rest and when coughing,
intravenous tramadol usage, postoperative morbidities, and side effects of
gabapentin. Postoperative analgesia at 6, 12, 18, 24, 48, and 72 hours
after extubation and at discharge was evaluated with the visual analog
scale. The assessment of postoperative pain at the 1- and 3-month
follow-ups was performed using a numeric rating scale. Main Results
Postoperative pain scores at 1, 2, and 3 days were significantly lower in
the gabapentin group when compared with the placebo group (p < 0.05). Pain
scores at 1 and 3 months postoperatively were lower in the gabapentin
group than in the placebo group (p > 0.05). Consumption of intravenous
tramadol given as rescue analgesic within 24 hours after extubation in the
gabapentin group was 99.0 +/- 53.8 mg versus 149.4 +/- 72.5 mg in the
placebo group (p < 0.05). There were no differences in the incidence of
side effects and time to extubation between the groups. Conclusions
Gabapentin significantly reduced the intensity of pain and tramadol
consumption in the early postoperative period after CABG surgery. Pain
scores at 1 and 3 months after surgery were low in both groups, with no
significant difference between the groups. 2011 Elsevier Inc.
<17>
Accession Number
2011550400
Authors
Simeoforidou M. Vretzakis G. Bareka M. Chantzi E. Flossos A. Giannoukas A.
Tsilimingas N.
Institution
(Simeoforidou, Vretzakis, Bareka, Chantzi, Flossos) Anesthesiology Clinic,
University of Thessaly, Larissa University Hospital, Mezourlo, Larissa
41110, Greece
(Giannoukas) Vascular Surgery Clinic, University of Thessaly, Larissa,
Greece
(Tsilimingas) Cardiothoracic Surgery Clinic, University of Thessaly,
Larissa, Greece
Title
Thoracic epidural analgesia with levobupivacaine for 6 postoperative days
attenuates sympathetic activation after thoracic surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (5) (pp 817-823),
2011. Date of Publication: October 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective To investigate the impact of 2 postoperative analgesic regimens
on heart rate variability in patients who underwent thoracotomy. Design A
prospective, randomized trial. Setting A single-institutional study in a
university hospital. Participants Fifty patients who underwent thoracotomy
under combined general anesthesia and thoracic epidural analgesia divided
by a number generator into 2 equal groups (A and B). Interventions In
group A, postoperative analgesia consisted of thoracic epidural analgesia
with levobupivacaine for 6 postoperative days. In group B, on the 3rd
postoperative day this regimen was changed to patient-controlled
intravenous morphine. Heart rate variability recordings were performed on
the day before surgery, after the epidural, after operation, and on every
postoperative day. Statistical analysis used chi-square and Student t
tests (Bonferroni correction). Measurements and Main Results In both
groups, the low-frequency component of the analyzed recordings declined
after epidural and after surgery. In group A, the low-frequency component
was significantly lower compared with baseline from the 2nd postoperative
day onward, whereas in group B it was significantly higher compared with A
on the 4th and 6th postoperative days. In both groups, the changes in high
frequency were statistically insignificant. Intergroup comparisons of the
low-/high-frequency ratio showed statistical difference on the last day of
observation. There was no difference between the groups in hemodynamic
variables and visual analog scale/10 scores. Conclusions Postoperatively
decreased cardiac sympathetic outflow continues with epidural analgesia,
whereas it is abolished by the change to intravenous patient-controlled
morphine. 2011 Elsevier Inc.
<18>
Accession Number
2011542248
Authors
Kulik A. Voisine P. Mathieu P. Masters R.G. Mesana T.G. Le May M.R. Ruel
M.
Institution
(Kulik) Lynn Heart and Vascular Institute, Boca Raton Regional Hospital,
Florida Atlantic University, Boca Raton, FL, United States
(Voisine, Mathieu) Department of Cardiac Surgery, Hpital Laval, Quebec
City, QC, Canada
(Masters, Mesana, Le May, Ruel) Divisions of Cardiac Surgery and
Cardiology, University of Ottawa, Heart Institute, Ottawa, ON, Canada
Title
Statin therapy and saphenous vein graft disease after coronary bypass
surgery: Analysis from the CASCADE randomized trial.
Source
Annals of Thoracic Surgery. 92 (4) (pp 1284-1291), 2011. Date of
Publication: October 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Current guidelines recommend statin therapy after coronary
artery bypass grafting (CABG) to attain low-density lipoprotein (LDL)
levels less than 100 mg/dL. Whether achieving LDL levels less than 70
mg/dL improves postoperative graft patency remains unknown. Methods: The
CASCADE (Clopidogrel after Surgery for Coronary Artery Disease) trial was
a randomized study that evaluated the addition of clopidogrel to aspirin
on the development of saphenous vein graft disease after CABG. Patients
received the standard of care regarding postoperative statin therapy with
targeted LDL levels less than 100 mg/dL. Twelve months postoperatively,
patients returned for a coronary angiogram and saphenous vein graft (SVG)
intravascular ultrasonogram. In this post hoc analysis, the impact of
statin therapy on graft patency and vein graft intimal hyperplasia was
assessed. Results: LDL levels significantly declined over the period of
the trial (p = 0.002). Twelve months postoperatively, 58.4% patients
achieved LDL levels less than 70 mg/dL. Twelve-month graft patency was
higher for patients with LDL levels less than 100 mg/dL (96.5%) compared
with patients with LDL levels >100 mg/dL (83.3%, p = 0.03), even after
adjustment in multivariate analysis (odds ratio [OR], 5.2; 95% confidence
interval [CI], 1.321.6; p = 0.02). However, no improvement in graft
patency was noted with further LDL reduction to less than 70 mg/dL (p =
1.00). Consistent statin use throughout the trial period was independently
associated with less vein graft intimal hyperplasia documented by
intravascular ultrasound at 12 months (p = 0.04). Conclusions: Statin
therapy to achieve LDL levels less than 100 mg/dL was independently
associated with improved graft patency in the CASCADE trial. Randomized
clinical trials are warranted to prospectively evaluate postoperative LDL
reduction to less than 70 mg/dL and its impact on graft patency after
CABG. 2011 The Society of Thoracic Surgeons.
<19>
Accession Number
2011498681
Authors
Yank V. Logan A.C. Stafford R.S.
Institution
(Yank) Stanford University, Stanford, CA 94304-5411, United States
(Logan) Stanford University School of Medicine, Stanford, CA 94305, United
States
(Stafford) Stanford University, Stanford, CA 94304-5411, United States
Title
Re: Off-label use of recombinant factor VIIa.
Source
Annals of Internal Medicine. 155 (5) (pp 338-339), 2011. Date of
Publication: September 6, 2011.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
<20>
Accession Number
2011448495
Authors
Velazquez E.J.
Institution
(Velazquez) Duke Clinical Research Institute, Durham, NC, United States
Title
CABG added no benefit to medical therapy for preventing death in coronary
artery disease with heart failure.
Source
Annals of Internal Medicine. 155 (4) (pp JC2-JC9), 2011. Date of
Publication: August 16, 2011.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
<21>
Accession Number
2011551224
Authors
Zhang B.-C. Che W.-L. Li W.-M. Xu Y.-W.
Institution
(Zhang, Che, Li, Xu) Department of Cardiology, Shanghai Tenth People's
Hospital, Tongji University School of Medicine, 301 Yanchang Road,
Shanghai 200072, China
Title
Meta-analysis of P wave character as predictor of atrial fibrillation
after coronary artery bypass grafting.
Source
International Journal of Cardiology. 152 (2) (pp 260-262), 2011. Date of
Publication: 20 Oct 2011.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
No comments:
Post a Comment