Results Generated From:
Embase <1980 to 2012 Week 17>
Embase (updates since 2012-04-19)
<1>
Accession Number
2012215757
Authors
Bokesch P.M. Szabo G. Wojdyga R. Grocott H.P. Smith P.K. Mazer C.D.
Vetticaden S. Wheeler A. Levy J.H.
Institution
(Bokesch, Vetticaden, Wheeler) Cubist Pharmaceuticals, Inc., 65 Hayden
Avenue, Lexington, MA 02421, United States
(Bokesch) St. Elizabeth's Hospital, Tufts University School of Medicine,
Boston, MA, United States
(Szabo) University of Heidelberg, Heidelberg, Germany
(Wojdyga) Institute of Cardiology, Warsaw, Poland
(Grocott) University of Manitoba, Winnipeg, MB, Canada
(Smith) Duke University Medical Center, Durham, NC, United States
(Mazer) University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
(Levy) Emory University School of Medicine, Atlanta, GA, United States
Title
A phase 2 prospective, randomized, double-blind trial comparing the
effects of tranexamic acid with ecallantide on blood loss from high-risk
cardiac surgery with cardiopulmonary bypass (CONSERV-2 Trial).
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (5) (pp 1022-1029),
2012. Date of Publication: May 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Ecallantide is a recombinant peptide in the same class as
aprotinin that inhibits plasma kallikrein, a major component of the
contact coagulation and inflammatory cascades. Therefore, ecallantide was
expected to reduce blood loss associated with cardiac surgery requiring
cardiopulmonary bypass. Methods: This prospective multinational,
randomized, double-blind trial enrolled patients undergoing cardiac
surgery using cardiopulmonary bypass for procedures associated with a high
risk of bleeding. Patients were randomly assigned to ecallantide (n = 109)
or tranexamic acid (high dose, n = 24; low dose, n = 85). Efficacy was
assessed from the volume of packed red blood cells administered within the
first 12 hours after surgery. Results: The study was terminated early
after the independent data safety and monitoring board observed a
statistically significantly higher 30-day mortality in the ecallantide
group (12%) than in the tranexamic acid groups (4%, P = .041). Patients
receiving ecallantide received more packed red blood cells within 12 hours
of surgery than tranexamic acid-treated patients: median = 900 mL (95%
confidence interval, 600-1070) versus 300 mL (95% confidence interval,
0-523) (P < .001). Similar differences were seen at 24 hours and at
discharge. Patients treated with the higher tranexamic acid dose received
less packed red blood cells, 0 mL (95% confidence interval, 280-600), than
the group treated with the lower dose, 400 mL (95% confidence interval,
0-400) (P = .008). No deaths occurred in the higher dose tranexamic acid
group. Conclusions: Ecallantide was less effective at reducing
perioperative blood loss than tranexamic acid. High-dose tranexamic acid
was more effective than the low dose in reducing blood loss. Copyright
2012 by The American Association for Thoracic Surgery.
<2>
Accession Number
2012210564
Authors
Tietge W.J. de Heer L.M. van Hessen M.W.J. Jansen R. Bots M.L. van Gilst
W. Schalij M. Klautz R.J.M. van den Brink R.B.A. van Herwerden L.A.
Doevendans P.A. Chamuleau S.A.J. Kluin J.
Institution
(Tietge, Jansen, Doevendans, Chamuleau) Department of Cardiology, UMC
Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
(de Heer, van Herwerden, Kluin) Department of Cardiothoracic Surgery, UMC
Utrecht, Utrecht, Netherlands
(van Hessen) WCN, Utrecht, Netherlands
(Bots) Julius Center Utrecht, Utrecht, Netherlands
(van Gilst) ICIN, Utrecht, Netherlands
(Schalij) Department of Cardiology, LUMC, Leiden, Netherlands
(Klautz) Department of Cardiothoracic Surgery, LUMC, Leiden, Netherlands
(van den Brink) Department of Cardiology, AMC Amsterdam, Amsterdam,
Netherlands
Title
Early mitral valve repair versus watchful waiting in patients with severe
asymptomatic organic mitral regurgitation; rationale and design of the
Dutch AMR trial, a multicenter, randomised trial.
Source
Netherlands Heart Journal. 20 (3) (pp 94-101), 2012. Date of Publication:
2012.
Publisher
Bohn Stafleu van Loghum (P.O. Box 246, Houten 3990 GA, Netherlands)
Abstract
Background Asymptomatic severe mitral valve (MV) regurgitation with
preserved left ventricular function is a challenging clinical entity as
data on the recommended treatment strategy for these patients are scarce
and conflicting. For asymptomatic patients, no randomised trial has been
performed for objectivising the best treatment strategy. Methods The Dutch
AMR (Asymptomatic Mitral Regurgitation) trial is a multicenter,
prospective, randomised trial comparing early MV repair versus watchful
waiting in asymptomatic patients with severe organic MV regurgitation. A
total of 250 asymptomatic patients (18-70 years) with preserved left
ventricular function will be included. Intervention will be either
watchful waiting or MV surgery. Follow-up will be 5 years. Primary outcome
measures are all-cause mortality and a composite endpoint of
cardiovascular mortality, congestive heart failure, and hospitalization
for non-fatal cardiovascular and cerebrovascular events. Secondary outcome
measures are total costs, cost-effectiveness, quality of life,
echocardiographic and cardiac magnetic resonance parameters, exercise
tests, asymptomatic atrial fibrillation and brain natriuretic peptide
levels. Additionally, the complication rate in the surgery group and rate
of surgery in the watchful waiting group will be determined. Implications
The DutchAMR trial will be the first multicenter randomised trial on this
topic. We anticipate that the results of this study are highly needed to
elucidate the best treatment strategy and that this may prove to be an
international landmark study. Springer Media / Bohn Stafleu van Loghum
2012.
<3>
Accession Number
2012212254
Authors
Qiu Y. Xu H. Shi D.
Institution
(Qiu) Graduate School, Beijing University of Chinese Medicine, Beijing
100029, China
(Xu, Shi) Center for Cardiovascular Diseases, Xiyuan Hospital, China
Academy of Chinese Medical Sciences, Beijing 100091, China
Title
Traditional chinese herbal products for coronary heart disease: An
overview of cochrane reviews.
Source
Evidence-based Complementary and Alternative Medicine. 2012 , 2012.
Article Number: 417387. Date of Publication: 2012.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Objective. The aim of this overview was to evaluate and summarize Cochrane
reviews of traditional Chinese herbal products (TCHPs) as the treatment
for coronary heart disease (CHD). Methods. We searched the Cochrane
Database that was concerned with the effectiveness of TCHPs for CHD. We
also searched the Cochrane Central Register of Controlled Trials. Reviews
and primary studies of TCHP as the treatment of any type of CHD were
included. Data were extracted according to predefined inclusion criteria
by two independent reviewers. Results. Six Cochrane reviews were included.
They related to a wide range of TCHPs for different types of CHD. Four
reviews were concerned with angina pectoris (unstable or stable), one
review was concerned with heart failure, and for acute myocardial
infarction. No reviews concluded that TCHPs were definitely effective for
CHD because of the weak evidence. Eight primary studies were TCHPs from
CHD. These studies also maybe result in bias, but better than before.
Conclusion. Several Cochrane reviews of TCHPs for the treatment of
different types of CHD have recently been published. None of these reviews
got definite conclusion favoring the effectiveness of TCHPs due to the
weak evidence. With the improved quality of the new registered RCTs. The
potential role of TCHPs in treating CHD is anticipated to be detected.
Copyright 2012 Yu Qiu et al.
<4>
Accession Number
2012210997
Authors
Giugliano G.R. Falcone M.W. Mego D. Ebersole D. Jenkins S. Das T. Barker
E. Ruggio J.M. Maini B. Bailey S.R.
Institution
(Giugliano) Baystate Medical Center, Springfield, MA, United States
(Falcone) Providence Hospital, Waco, TX, United States
(Mego) Arkansas Heart Hospital, Little Rock, AR, United States
(Ebersole) Lakeland Regional Medial Center, Lakeland, FL, United States
(Jenkins) Ochsner Hospital, New Orleans, LA, United States
(Das) Presbyterian Hospital, Dallas, TX, United States
(Barker) Cardiovascular Institute of the South Lafayette, LA, United
States
(Ruggio) Irvine Regional Medical Center, Irvine, CA, United States
(Maini) Harrisburg Hospital, Harrisburg, PA, United States
(Bailey) University of Texas Health Sciences Center at San Antonio, TX,
United States
Title
A prospective multicenter registry of laser therapy for degenerated
saphenous vein graft stenosis: The COronary graft Results following
Atherectomy with Laser (CORAL) trial.
Source
Cardiovascular Revascularization Medicine. 13 (2) (pp 84-89), 2012. Date
of Publication: March 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Purpose: The primary aim of this study was to prospectively evaluate the
safety and efficacy of Excimer laser atherectomy as a primary treatment
strategy in consecutively eligible patients presenting for percutaneous
coronary intervention (PCI) of degenerated saphenous vein graft (SVG)
lesions using a multicenter registry. Prior single-center experience
suggested that laser atherectomy may decrease acute procedural
complications during treatment of degenerated SVGs, including lesions not
amenable to distal protection devices (DPDs). Methods and materials: The
COronary graft Results following Atherectomy with Laser investigators
enrolled 98 patients at 18 centers between June 23, 2003, and October 4,
2004, with greater than 50% stenosis of an SVG who presented for PCI due
to angina pectoris or objective evidence of myocardial ischemia in a
concordant myocardial distribution. Laser atherectomy was planned.
Patients were excluded if the operator planned to utilize a DPD. Inclusion
and exclusion criteria were aligned to those in the Saphenous vein graft
Angioplasty Free of Emboli Randomized (SAFER) trial. Results: The primary
end point [30-day major adverse cardiac events (MACE)] occurred in 18/98
(18.4%) patients driven primarily by non-q-wave myocardial infarction.
Major procedural complications included no reflow (. n=5) and major
dissection (. n=1). No perforations occurred. Univariate predictors of
30-day MACE included lesion length, vessel angulation, plaque burden, SVG
degeneracy score, number of laser pulses used, and larger-sized laser
catheters. Conclusions: This study demonstrated that Excimer laser
atherectomy of diseased SVGs is feasible with results comparable to the
30-day MACE in the control population from the SAFER trial. Whether the
addition of laser to embolic protection devices is of any clinical utility
remains to be tested in future studies. 2012 Elsevier Inc.
<5>
[Use Link to view the full text]
Accession Number
2012214221
Authors
Eljezi V. Duale C. Azarnoush K. Skrzypczak Y. Sautou V. Pereira B.
Tsokanis I. Schoeffler P.
Institution
(Eljezi, Skrzypczak, Tsokanis, Schoeffler) Pole Anesthesie-Reanimation,
Univ. Clermont1, Clermont-Ferrand, France
(Duale) Centre de Pharmacologie Clinique (INSERM CIC 501), CHU de
Clermont-Ferrand, Rue Montalembert, 63003, Clermont-Ferrand Cedex 1,
France
(Azarnoush) Pole Cardiologie (Chirurgie Cardio-Vasculaire), Univ.
Clermont1, Clermont-Ferrand, France
(Sautou) Pharmacie Centrale, Univ. Clermont1, Clermont-Ferrand, France
(Pereira) Direction de la Recherche Clinique et des Innovations CHU, Univ.
Clermont1, Clermont-Ferrand, France
(Sautou) C-Biosenss, Univ. Clermont1, Clermont-Ferrand, France
(Schoeffler) Fac. Medecine, Univ. Clermont1, Clermont-Ferrand, France
Title
The analgesic effects of a bilateral sternal infusion of ropivacaine after
cardiac surgery.
Source
Regional Anesthesia and Pain Medicine. 37 (2) (pp 166-174), 2012. Date of
Publication: March/April 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background and Objectives: The aim of this study was to assess the effects
of a continuous postoperative administration of local anesthetic through 2
catheters placed deeply under fascia at the lateral edges of the sternum,
close to the emergence of the intercostal nerves.We focused on pain during
mobilization, as this aspect is likely to interact with postoperative
morbidity. Methods: Forty adult patients scheduled for open heart surgery
with sternotomy were included in this randomized, placebo-controlled,
double-blind study. A continuous fixed-rate infusion of 4 mL/hr of 0.2%
ropivacaine or normal saline was administered during the first 48
postoperative hrs. All patients received acetaminophen and
self-administered morphine. The efficacy outcomes were as follows: pain
score during standardized mobilization and at rest; morphine consumption;
spirometry and arterial blood gases; postoperative rehabilitation
criteria, and patient satisfaction. Total ropivacaine plasma level was
monitored throughout the study. Results: Pain scores were lower in the
ropivacaine group during mobilization (P = 0.0004) and at rest (P =
0.0006), but the analgesic effects were mostly apparent during the second
day after surgery, with a 41% overall reduction in movement-evoked pain
levels. The bilateral sternal block also reduced morphine consumption. It
improved the patients' satisfaction and rehabilitation, but no effects
were noted on respiratory outcomes. No major adverse effect due to the
treatment occurred, but the ropivacaine plasma level was greater than 4
mg/L in 1 patient. Conclusions: This technique may find a role within the
framework of multimodal analgesia after sternotomy, although further
confirmatory studies are needed. Copyright 2012 by American Society of
Regional Anesthesia and Pain Medicine.
<6>
Accession Number
2012211057
Authors
Thim T. Maeng M. Lassen J.F. Kaltoft A. Jensen L.O. Ravkilde J. Thayssen
P. Galatius S. Christiansen E.H. Engstrom T. Madsen M. Thuesen L. Tilsted
H.H.
Institution
(Thim, Maeng, Lassen, Kaltoft, Christiansen, Thuesen) Department of
Cardiology, Aarhus University Hospital, Aarhus, Denmark
(Jensen, Thayssen) Department of Cardiology, Odense University Hospital,
Odense, Denmark
(Ravkilde, Tilsted) Department of Cardiology, Aarhus University Hospital
Aalborg, Aalborg, Denmark
(Galatius) Department of Cardiology, Gentofte University Hospital,
Copenhagen, Denmark
(Engstrom) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark
(Madsen) Department of Clinical Epidemiology, Aarhus University Hospital,
Aarhus, Denmark
(Thim) Department of Cardiology, Aarhus University Hospital,
Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark
Title
Clinical outcomes after treatment of multiple lesions with
zotarolimus-eluting versus sirolimus-eluting coronary stents (a SORT OUT
III substudy).
Source
BMC Cardiovascular Disorders. 12 , 2012. Article Number: 18. Date of
Publication: 19 Mar 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Data on clinical outcomes among patients treated with the
zotarolimus-eluting Endeavor stent versus the sirolimus-eluting Cypher
stent favor the sirolimus-eluting stent. However, a separate comparison of
clinical outcome among patients treated for multiple lesions with these
stents is lacking. We performed this comparison within the SORT OUT III
trial data set.Methods: Among 2332 patients randomized in SORT OUT III,
695 were treated for multiple lesions with zotarolimus-eluting (n = 350)
or sirolimus-eluting (n = 345) stents and followed for 18 months. Major
adverse cardiac events (MACE); composite of cardiac death, myocardial
infarction, or target vessel revascularization (TVR); was the primary
endpoint.Results: Zotarolimus-eluting compared to sirolimus-eluting stent
treatment was associated with increased MACE rate (13.2% vs. 2.6%; hazard
ratio 5.29 with 95% confidence interval: 2.59-10.8). All secondary
endpoints; all cause death, cardiac death, myocardial infarction, TVR,
target lesion revascularization, in-stent restenosis, and definite stent
thrombosis; were observed more frequently among zotarolimus-eluting stent
treated patients. For all endpoints, hazard ratios were 1.6 to 4.6 times
higher than in the overall results of the SORT OUT III trial.Conclusions:
We observed better clinical outcomes among patients treated for multiple
lesions with the sirolimus-eluting stent compared to those treated with
the zotarolimus-eluting stent. 2012 Thim et al; licensee BioMed Central
Ltd.
<7>
Accession Number
2012214783
Authors
Mahfoud F. Bohm M. Baumhakel M.
Institution
(Mahfoud, Bohm) University Hospital of the Saarland, Homburg, Germany
(Baumhakel) Medizinische Klinik fur Interventionelle Kardiologie und
Angiologie, CaritasKlinikum Saarbrucken St. Theresia, Rheinstr. 2, 66113
Saarbrucken, Germany
Title
Inadequate reporting of concomitant drug treatment in cardiovascular
interventional head-to-head trials.
Source
Clinical Cardiology. 35 (4) (pp 255-256), 2012. Date of Publication: April
2012.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Background: Optimal revascularization strategy is still under debate in
patients with coronary artery disease, particularly due to the results of
the Synergy Between Percutaneous Coronary Intervention With TAXUS and
Cardiac Surgery (SYNTAX) trial. Although medical prevention has been
clearly shown to be beneficial in coronary artery disease, it has been
suggested that patients were significantly undertreated with
evidence-based medications for cardiovascular protection. Hypothesis: The
purpose of the study was to evaluate concomitant medical treatment in
cardiovascular interventional head-to-head trials comparing coronary
artery bypass grafting (CABG) and percutaneous coronary intervention
(PCI). Methods: A systematic search of the literature regarding
documentation and reports of medical treatment in cardiovascular
interventional head-to-head trials with more than 500 patients comparing
CABG and PCI was performed. Results: Systematic research of the literature
identified 2106 articles of potential interest. After review and
selection, only 3 trials reported on medical treatment. Baseline
medication was reported in the RITA (Randomized Intervention Treatment of
Angina), CABRI (Coronary Angioplasty versus Bypass Revascularisation
Investigation), and SYNTAX trials, and follow-up data were provided by the
CABRI and SYNTAX 3-year trials only. Conclusions: Poor reporting of
medical treatment at discharge might reflect an underestimation of
secondary prevention in patients undergoing cardiac surgery or
interventional procedures in head-to-head interventional trials. Thus,
discussion of optimal revascularization procedure has to remain open, even
in terms of concomitant medical treatment of patients. Additional
Supporting Information may be found in the online version of this article.
The authors have no funding, financial relationships, or conflicts of
interest to disclose. 2012 Wiley Periodicals, Inc.
<8>
Accession Number
2012214712
Authors
Warmuth M. Mad P. Wild C.
Institution
(Warmuth, Mad, Wild) Ludwig Boltzmann Institute for Health Technology
Assessment, Garnisongasse 7/20, 1090 Vienna, Austria
Title
Systematic review of the efficacy and safety of fibrinogen concentrate
substitution in adults.
Source
Acta Anaesthesiologica Scandinavica. 56 (5) (pp 539-548), 2012. Date of
Publication: May 2012.
Publisher
Blackwell Munksgaard (1 Rosenorns Alle, P.O. Box 227, Copenhagen V
DK-1502, Denmark)
Abstract
Background A sufficient plasma level of fibrinogen is critical for the
formation of a fibrin clot and haemostasis in both the perioperative
setting and in massive haemorrhage. We assessed the efficacy and safety of
fibrinogen concentrate substitution in the perioperative setting and in
massive haemorrhage. Methods We conducted a systematic literature search
for studies conducted on humans and published in either English or German
in several databases from 1985 to 2010. In addition, we screened several
web sites for assessments on fibrinogen concentrate substitution and
conducted a hand search using Scopus. In terms of efficacy, we included
all prospective, controlled studies. Concerning safety, we included all
prospective studies. Results We identified two randomised controlled
trials and two non-randomised controlled studies, which included a total
of 74 patients. The studies indicate that the administration of fibrinogen
concentrate is associated with improved clot firmness and reduction in the
substitution of other blood products such as red blood cells, fresh frozen
plasma and platelet concentrates, as well as decreased post-operative
bleeding and drainage volume. In addition, fibrinogen concentrate
administration has been reported to be safe with regard to thrombosis and
thromboembolic complications, as well as mortality. However, the studies
identified were of poor quality. Conclusion In conclusion, the results of
the available controlled trials suggest that the administration of
fibrinogen concentrate was effective and safe. However, because all
studies identified were of inadequate quality, these findings need to be
confirmed by randomised controlled trials of sufficient size and long-term
follow-up. 2011 Ludwig Boltzmann Institute for Health Technology
Assessment Acta Anaesthesiologica Scandinavica.
<9>
Accession Number
2012215770
Authors
Sundareswaran K.S. Haggerty C.M. De Zelicourt D. Dasi L.P. Pekkan K.
Frakes D.H. Powell A.J. Kanter K.R. Fogel M.A. Yoganathan A.P.
Institution
(Sundareswaran, Haggerty, De Zelicourt, Yoganathan) Wallace H. Coulter
Department of Biomedical Engineering, Georgia Institute of Technology,
Emory University, 313 Ferst Dr, Atlanta, GA 30332, United States
(Dasi) Department of Mechanical Engineering, Colorado State University,
Fort Collins, CO, United States
(Pekkan) Department of Biomedical Engineering, Carnegie Mellon University,
Pittsburgh, PA, United States
(Frakes) School of Biological and Health Systems Engineering, Arizona
State University, Tempe, AZ, United States
(Frakes) Department of Cardiology, Children's Hospital Boston, Boston, MA,
United States
(Powell) Department of Pediatrics, Harvard Medical School, Boston, MA,
United States
(Kanter) Division of Pediatric Cardiothoracic Surgery, Emory University
School of Medicine, Atlanta, GA, United States
(Fogel) Division of Pediatric Cardiology, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
Title
Visualization of flow structures in Fontan patients using 3-dimensional
phase contrast magnetic resonance imaging.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (5) (pp 1108-1116),
2012. Date of Publication: May 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Our objective was to analyze 3-dimensional (3D) blood flow
patterns within the total cavopulmonary connection (TCPC) using in vivo
phase contrast magnetic resonance imaging (PC MRI). Methods: Sixteen
single-ventricle patients were prospectively recruited at 2 leading
pediatric institutions for PC MRI evaluation of their Fontan pathway.
Patients were divided into 2 groups. Group 1 comprised 8 patients with an
extracardiac (EC) TCPC, and group 2 comprised 8 patients with a lateral
tunnel (LT) TCPC. A coronal stack of 5 to 10 contiguous PC MRI slices with
3D velocity encoding (5-9 ms resolution) was acquired and a volumetric
flow field was reconstructed. Results: Analysis revealed large vortices in
LT TCPCs and helical flow structures in EC TCPCs. On average, there was no
difference between LT and EC TCPCs in the proportion of inferior vena cava
flow going to the left pulmonary artery (43% +/- 7% vs 46% +/- 5%; P =
.34). However, for EC TCPCs, the presence of a caval offset was a primary
determinant of inferior vena caval flow distribution to the pulmonary
arteries with a significant bias to the offset side. Conclusions: 3D flow
structures within LT and EC TCPCs were reconstructed and analyzed for the
first time using PC MRI. TCPC flow patterns were shown to be different,
not only on the basis of LT or EC considerations, but with significant
influence from the superior vena cava connection as well. This work adds
to the ongoing body of research demonstrating the impact of TCPC geometry
on the overall hemodynamic profile. Copyright 2012 by The American
Association for Thoracic Surgery.
<10>
Accession Number
2012215759
Authors
Mann D.L. Kubo S.H. Sabbah H.N. Starling R.C. Jessup M. Oh J.K. Acker M.A.
Institution
(Mann) Division of Cardiology, Washington University School of Medicine,
660 S. Euclid Ave, St Louis, MO 63110-1093, United States
(Kubo) Acorn Cardiovascular, St Paul, MN, United States
(Sabbah) Henry Ford Hospital, Detroit, MI, United States
(Starling) Cleveland Clinic Foundation, Cleveland, OH, United States
(Jessup, Acker) University of Pennsylvania, Philadelphia, PA, United
States
(Oh) Mayo Clinic, Rochester, MN, United States
Title
Beneficial effects of the CorCap cardiac support device: Five-year results
from the Acorn Trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (5) (pp 1036-1042),
2012. Date of Publication: May 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: The CorCap cardiac support device (Acorn Cardiovascular, Inc,
St Paul, Minn) is the first device that specifically addresses ventricular
remodeling in heart failure by reducing wall stress. We previously
reported outcomes from the Acorn randomized trial to a common closing date
(22.9 months of follow-up). This report summarizes results of extended
followup to 5 years. Methods: A total of 107 patients were enrolled in the
no-mitral valve repair/replacement stratum including 57 in the CorCap
treatment group and 50 in the control (optimal medical therapy alone)
group. Patients were assessed every year, until completing 5 years of
follow-up, for survival, adverse events, major cardiac procedures, New
York Heart Association (NYHA) functional status, and echocardiograms,
which were read at a core laboratory. Results: Overall survivals were
similar between the treatment and control groups, demonstrating no late
adverse effect on mortality. The treatment group had significant
reductions in left ventricular end-diastolic volume (P = .029) as well as
a small increase in sphericity index. More patients in the treatment group
improved by at least 1 NYHA functional class (P = .0005). There was no
difference in rates of adverse events. In a subgroup of patients with an
intermediate left ventricular end-diastolic dimension, there was a
significant reduction in the Kaplan-Meier estimate of the freedom from the
composite end point of death and major cardiac procedures (P = .04).
Conclusions: These cumulative data demonstrate the sustained reverse
remodeling of the left ventricle and the long-term safety and efficacy of
the CorCap cardiac support device as an adjunctive therapy for patients
with heart failure who remain symptomatic despite optimal medical therapy.
Copyright 2012 Published by Elsevier Inc. on behalf of The American
Association for Thoracic Surgery.
<11>
Accession Number
2012201124
Authors
Capranzano P. Dangas G.
Institution
(Capranzano) Cardiovascular Department, Ferrarotto Hospital, University of
Catania, Italy
(Dangas) Cardiovascular Institute, Box 1030, Mount Sinai Medical Center,
New York, NY 10029, United States
Title
Bivalirudin for primary percutaneous coronary intervention in acute
myocardial infarction: The HORIZONS-AMI trial.
Source
Expert Review of Cardiovascular Therapy. 10 (4) (pp 411-422), 2012. Date
of Publication: April 2012.
Publisher
Expert Reviews Ltd. (2 Albert Place, London N3 1QB, United Kingdom)
Abstract
The combination of unfractionated heparin (UFH) plus glycoprotein IIb/IIIa
inhibitors (GPIs) has been a frequently used anti-thrombotic treatment
strategy for acute coronary syndrome patients, including those with
ST-segment elevation myocardial infarction undergoing primary percutaneous
coronary intervention. However, the ischemic benefit of the UFH plus GPI
combination came at the expense of high rates of bleeding complications
and thrombocytopenia, both of which have been independently associated
with increased mortality. By contrast, bivalirudin monotherapy compared
with the combination of UFH plus GPI resulted in improved net clinical
outcomes, based on similar ischemic protection with significant reductions
in bleeding complications in randomized trials including patients with
stable angina, those with unstable angina and those with non-ST-segment
elevation myocardial infarction. More recently, the HORIZONS-AMI
randomized, open-label, multicenter trial has compared the efficacy and
safety of bivalirudin alone versus UFH plus a GPI in 3602 patients with
ST-segment elevation myocardial infarction undergoing primary percutaneous
coronary intervention. Clinical results derived from this large study,
including the final 3-year follow-up data, will be reviewed in the present
clinical trial report. 2012 Expert Reviews Ltd.
<12>
Accession Number
22098690
Authors
Campanella A. Bergamasco L. Macri L. Asioli S. Devotini R. Scipioni S.
Barbaro S. Rispoli P. Rinaldi M.
Institution
(Campanella) Thoracic and Cardiovascular Department, Division of Cardiac
Surgery, San Giovanni Battista of Turin Hospital, University of Turin,
Corso Bramante 84, 10126 Turin, Italy.
Title
Endoscopic Saphenous harvesting with an Open CO2 System (ESOS) trial for
coronary artery bypass grafting surgery: study protocol for a randomized
controlled trial.
Source
Trials. 12 (pp 243), 2011. Date of Publication: 2011.
Abstract
In coronary artery bypass grafting surgery, arterial conduits are
preferred because of more favourable long-term patency and outcome. Anyway
the greater saphenous vein continues to be the most commonly used bypass
conduit. Minimally invasive endoscopic saphenous vein harvesting is
increasingly being investigated in order to reduce the morbidity
associated with conventional open vein harvesting, includes postoperative
leg wound complications, pain and patient satisfaction. However, to date
the short and the long-term benefits of the endoscopic technique remain
controversial. This study provides an interesting opportunity to address
this gap in the literature. Endoscopic Saphenous harvesting with an Open
CO2 System trial includes two parallel vein harvesting arms in coronary
artery bypass grafting surgery. It is an interventional, single centre,
prospective, randomized, safety/efficacy, cost/effectiveness study, in
adult patients with elective planned and first isolated coronary artery
disease. A simple size of 100 patients for each arm will be required to
achieve 80% statistical power, with a significant level of 0.05, for
detecting most of the formulated hypotheses. A six-weeks leg wound
complications rate was assumed to be 20% in the conventional arm and less
of 4% in the endoscopic arm. Previously quoted studies suggest a
first-year vein-graft failure rate of about 20% with an annual occlusion
rate of 1% to 2% in the first six years, with practically no difference
between the endoscopic and conventional approaches. Similarly, the results
on event-free survival rates for the two arms have barely a 2-3% gap.
Assuming a 10% drop-out rate and a 5% cross-over rate, the goal is to
enrol 230 patients from a single Italian cardiac surgery centre. The goal
of this prospective randomized trial is to compare and to test improvement
in wound healing, quality of life, safety/efficacy, cost-effectiveness,
short and long-term outcomes and vein-graft patency after endoscopic open
CO2 harvesting system versus conventional vein harvesting.The expected
results are of high clinical relevance and will show the safety/efficacy
or non-inferiority of one treatment approach in terms of vein harvesting
for coronary artery bypass grafting surgery. www.clinicalTrials.gov
NCT01121341.
<13>
Accession Number
2012204773
Authors
Morrow D.A. Braunwald E. Bonaca M.P. Ameriso S.F. Dalby A.J. Fish M.P. Fox
K.A.A. Lipka L.J. Liu X. Nicolau J.C. Ophuis A.J.O. Paolasso E. Scirica
B.M. Spinar J. Theroux P. Wiviott S.D. Strony J. Murphy S.A.
Institution
(Morrow, Braunwald, Bonaca, Fish, Scirica, Wiviott, Murphy) TIMI Study
Group, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis
St., Boston, MA 02115, United States
(Ameriso) Institute for Neurological Research, FLENI, Buenos Aires,
Argentina
(Dalby) Milpark Hospital, Johannesburg, South Africa
(Fox) Division of Cardiovascular Research, University of Edinburgh,
Edinburgh, United Kingdom
(Lipka, Liu, Strony) Merck Research Laboratories, Rahway, NJ, United
States
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Ophuis) Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
(Paolasso) Instituto de Investigaciones Clinicas Rosario, Rosario,
Argentina
(Spinar) University Hospital Brno, Masaryk University, Brno, Czech
Republic
(Theroux) Montreal Heart Institute, University of Montreal, Montreal,
Canada
Title
Vorapaxar in the secondary prevention of atherothrombotic events.
Source
New England Journal of Medicine. 366 (15) (pp 1404-1413), 2012. Date of
Publication: 12 Apr 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Thrombin potently activates platelets through the
protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent
that selectively inhibits the cellular actions of thrombin through
antagonism of PAR-1. METHODS: We randomly assigned 26,449 patients who had
a history of myocardial infarction, ischemic stroke, or peripheral
arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo
and followed them for a median of 30 months. The primary efficacy end
point was the composite of death from cardiovascular causes, myocardial
infarction, or stroke. After 2 years, the data and safety monitoring board
recommended discontinuation of the study treatment in patients with a
history of stroke owing to the risk of intracranial hemorrhage. RESULTS:At
3 years, the primary end point had occurred in 1028 patients (9.3%) in the
vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard
ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to
0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or
recurrent ischemia leading to revascularization occurred in 1259 patients
(11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo
group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P = 0.001). Moderate or
severe bleeding occurred in 4.2% of patients who received vorapaxar and
2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to
1.93; P<0.001). There was an increase in the rate of intracranial
hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group;
P<0.001). CONCLUSIONS:Inhibition of PAR-1 with vorapaxar reduced the risk
of cardiovascular death or ischemic events in patients with stable
atherosclerosis who were receiving standard therapy. However, it increased
the risk of moderate or severe bleeding, including intracranial
hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number,
NCT00526474.) Copyright 2012 Massachusetts Medical Society.
<14>
Accession Number
2012208215
Authors
Clark A.L.
Institution
(Clark) Department of Clinical Cardiology, Castle Hill Hospital, United
Kingdom
Title
Heart failure.
Source
Archivos de Cardiologia de Mexico. 81 (4) (pp 383-390), 2011. Date of
Publication: 2011.
Publisher
Instituto Nacional de Cardiologia Ignazio Chavez (Juan Badiano 1, Col.
Seccion XVI, Deleg. Tlalpan, Mexico D.F. 14080, Mexico)
<15>
Accession Number
70719556
Authors
Valencia G. Canale G. Barolo R. Gorosito P. Picasso D.G.
Title
Usefulness of stress echocardiography in perioperative evaluation of
patients scheduled for non-cardiac surgery: A review.
Source
British Journal of Anaesthesia. Conference: 15th WFSA World Congress of
Anaesthesiologists Predio Ferial de Buenos Aires Argentina. Conference
Start: 20120325 Conference End: 20120330. Conference Publication:
(var.pagings). 108 (pp ii360), 2012. Date of Publication: March 2012.
Publisher
Oxford University Press
Abstract
Introduction: The need for assessment of the risk for developing
cardiovascular events in patients scheduled for noncardiac surgery
(PSFNCS) is undeniable. In many cases it is not enough to rely on the
patients clinical features, and stress tests must be used in order to
detect ischaemia. Stress Echocardiography (SE) rises as a useful tool,
joining exercise testing (ET) and single-photon emission computed
tomography (SPECT). Objectives: To assess the usefulness of SE in PSFNCS,
compared to that of ET and SPECT. Methods and Materials: We conducted a
throughout search in Medline and Ovid databases. Our keywords were "stress
echocardiography", "perioperative evaluation" and "noncardiac surgery". We
took into account reviews, meta-analysis, and RCTs published between 2000
and 2011. We included in our work 6 selected articles. Results and
Discussion: Exercise is the prototype of ischaemic stress. However, many
patients requiring a stress test can' t exercise, can exercise
submaximally, or have an uninterpretable ECG[1]. Besides, with
pharmacological stress testing factors such as hyperventilation, excessive
chest wall movement and myocardial hypercontraction (which make
echocardiographical assesment difficult and therefore reduce diagnostic
accuracy) are avoided.[2] SE with either dobutamine or dypiridamole shows
similar accuracy and sensibility. The choice of one test over the other
will depend on patient characteristics, availability and physician's
preferences.[3] Nevertheless, SE should be used as a first-line technique
only when ET is uninterpretable (like in left bundle-branch block, or
pacing).[4] The less informative and/or interpretable ET is, the higher is
the level of appropriateness to SE [5]. On the other hand, it must be
aknowledged that SE is recommended for high-risk patients with a previous
history of coronary artery disease (CAD) sheduled for high-risk surgical
procedures. The test is not recommended in low-to-medium-risk patients
[6]. One of the tests with which SE has been compared to, is SPECT.
According to many authors, SE should be chosen instead of SPECT, because
of its lower costs and lack of radiation (SPECT radiation burden equals
that of up to 1300 chest x-rays). [1] Conclusions: SE's diagnostic and
pronostic accuracy is similar to that of SPECT, at a lower cost, with no
enviromental impact and avoiding exposure to radiation. Stress testing
with SE is useful in patients for whom ET is not, and should only be used
in that setting. Finally, we remark that SE is useful for high surgical
risk patients, with known CAD.
<16>
Accession Number
70719048
Authors
Cheng D. Martin J. Bainbridge D.
Institution
(Cheng, Martin, Bainbridge) Department of Anesthesia and Perioperative
Medicine, EPiCOR Program, LHSC-University Hospital, University of Western
Ontario, Canada
Title
Opcab surgery in elderly patients: Evidence of benefits?.
Source
British Journal of Anaesthesia. Conference: 15th WFSA World Congress of
Anaesthesiologists Predio Ferial de Buenos Aires Argentina. Conference
Start: 20120325 Conference End: 20120330. Conference Publication:
(var.pagings). 108 (pp ii59-ii60), 2012. Date of Publication: March 2012.
Publisher
Oxford University Press
Abstract
Introduction: The majority of earlier trials comparing clinical outcomes
after off-pump bypass surgery (OPCAB) and conventional bypass surgery
(CCAB) were non-randomized comparisons of low-risk patients undergoing
single- or double-vessel bypass, with the potential risk of unbalanced
baseline patient characteristics leading to bias in favor of either OPCAB
or CCAB. There remains considerable uncertainty as to the role of OPCAB
for patients across the full spectrum of risk groups. Objectives: This
systematic review and meta-analysis sought to determine whether off-pump
bypass surgery (OPCAB) provides significant clinical advantages compared
to conventional coronary artery bypass surgery (CCAB) in elderly patients
(>60y, >70y, >80y, >90y), and whether the benefits of OPCAB over CCAB are
directly related to increasing age. Methods: Comprehensive searches of
MEDLINE, Cochrane CENTRAL, EMBASE, abstract databases up to January 2011.
Criteria for Included Trials: Randomized or non-randomized controlled
studies - Elderly patients (age>60) undergoing OPCAB compared directly
with elderly patients (age >60) undergoing CCAB, reporting a least one
relevant outcome in any language. Two reviewers independently identified
relevant trials and extracted outcomes data. Bias. Publication bias was
explored through visual inspection of funnel plots. Meta-Analysis: Odds
ratios [OR, 95% CI] were calculated for proportions, and weighted mean
differences [WMD, 95% CI] were calculated for continuous data. Results:
Eligible studies: 27 studies (26 nRCT and 1 RCT - 10,271 patients) were
included in the analysis. Regression did not show publication bias, but
significant heterogeneity was found for neurocognitive dysfunction, low
cardiac output syndrome, transfusions, ventilation time, and length of
stay. Significant clinical benefit of OPCAB over CCAB in elderly patients
was summarized in table 1. (Table presented) Conclusions: In elderly
patients, OPCAB is superior to CCAB for reducing risk of death, stroke,
AF, neurologic complications, low cardiac output syndrome, renal
insufficiency, transfusions, ventilation time, and hospital length of
stay, without increased risk for reoperation for bleeding, myocardial
infarction, angina recurrence, or need for reintervention. However, the
magnitude of benefit of OPCAB over CCAB did not rise further with
increasing age >70.
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