Results Generated From:
Embase <1980 to 2012 Week 28>
Embase (updates since 2012-07-05)
<1>
Accession Number
2010217102
Authors
Crowe E. Lovibond K. Gray H. Henderson R. Krause T. Camm J.
Institution
(Crowe, Lovibond, Krause) National Clinical Guideline Centre, Royal
College of Physicians of London, London NW1 4LE, United Kingdom
(Gray) Southampton University Hospital, Southampton SO16 6YD, United
Kingdom
(Henderson) Nottingham University Hospitals, Nottingham NG5 1PB, United
Kingdom
(Camm) St. George's, University of London, London SW17 0RE, United Kingdom
Title
Early management of unstable angina and non-ST segment elevation
myocardial infarction: Summary of NICE guidance.
Source
BMJ (Online). 340 (7750) (pp 805-807), 2010. Article Number: c1134. Date
of Publication: 10 Apr 2010.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
<2>
Accession Number
2012365581
Authors
Kang D.-H. Kim Y.-J. Kim S.-H. Sun B.J. Kim D.-H. Yun S.-C. Song J.-M.
Choo S.J. Chung C.-H. Song J.-K. Lee J.-W. Sohn D.-W.
Institution
(Kang, Sun, Kim, Song, Song) Division of Cardiology, Asan Medical Center,
University of Ulsan, 388-1, Poongnap-dong, Songpa-ku, Seoul, South Korea
(Choo, Chung, Lee) Division of Cardiac Surgery, Asan Medical Center,
University of Ulsan, Seoul, South Korea
(Kim) Division of Infectious Disease, Asan Medical Center, University of
Ulsan, Seoul, South Korea
(Yun) Division of Biostatistics, Asan Medical Center, University of Ulsan,
Seoul, South Korea
(Kim, Sohn) Cardiovascular Center, Seoul National University Hospital,
Seoul National University College of Medicine, Seoul, South Korea
Title
Early surgery versus conventional treatment for infective endocarditis.
Source
New England Journal of Medicine. 366 (26) (pp 2466-2473), 2012. Date of
Publication: 28 Jun 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: The timing and indications for surgical intervention to
prevent systemic embolism in infective endocarditis remain controversial.
We conducted a trial to compare clinical outcomes of early surgery and
conventional treatment in patients with infective endocarditis. METHODS:
We randomly assigned patients with left-sided infective endocarditis,
severe valve disease, and large vegetations to early surgery (37 patients)
or conventional treatment (39). The primary end point was a composite of
in-hospital death and embolic events that occurred within 6 weeks after
randomization. RESULTS: All the patients assigned to the early-surgery
group underwent valve surgery within 48 hours after randomization, whereas
30 patients (77%) in the conventional-treatment group underwent surgery
during the initial hospitalization (27 patients) or during follow-up (3).
The primary end point occurred in 1 patient (3%) in the early-surgery
group as compared with 9 (23%) in the conventional-treatment group (hazard
ratio, 0.10; 95% confidence interval [CI], 0.01 to 0.82; P = 0.03). There
was no significant difference in all-cause mortality at 6 months in the
early-surgery and conventional-treatment groups (3% and 5%, respectively;
hazard ratio, 0.51; 95% CI, 0.05 to 5.66; P = 0.59). The rate of the
composite end point of death from any cause, embolic events, or recurrence
of infective endocarditis at 6 months was 3% in the early-surgery group
and 28% in the conventional-treatment group (hazard ratio, 0.08; 95% CI,
0.01 to 0.65; P = 0.02). CONCLUSIONS: As compared with conventional
treatment, early surgery in patients with infective endocarditis and large
vegetations significantly reduced the composite end point of death from
any cause and embolic events by effectively decreasing the risk of
systemic embolism. (EASE ClinicalTrials.gov number, NCT00750373.)
Copyright 2012 Massachusetts Medical Society. All rights reserved.
<3>
Accession Number
2012367401
Authors
Pawlaczyk R. Swietlik D. Lango R. Rogowski J.
Institution
(Pawlaczyk, Rogowski) Department of Cardiovascular Surgery, Medical
University of Gdansk, Debinki 7, Gdansk, 80-952, Poland
(Swietlik) Department of Biostatistic, Medical University of Gdansk,
Gdansk, Poland
(Lango) Department of Cardioanesthesiology, Medical University of Gdansk,
Gdansk, Poland
Title
Off-pump coronary surgery may reduce stroke, respiratory failure, and
mortality in octogenarians.
Source
Annals of Thoracic Surgery. 94 (1) (pp 29-37), 2012. Date of Publication:
July 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Octogenarians are a challenging group of patients referred for
cardiac surgery. The aim of this study is to assess early outcomes of
coronary artery bypass grafting (CABG) performed in the elderly
population. Methods: We performed a meta-analysis of all published
observational studies comparing early results of conventional CABG surgery
and off-pump CABG surgery in patients aged 80 years or older. The outcomes
of interest were mortality, stroke, respiratory failure, renal failure,
incidence of support with intraaortic balloon pump, and incidence of
postoperative atrial fibrillation. The random effects model was used.
Results: Fourteen studies were analyzed. The total number of included
subjects was 4,991, of whom 3,113 underwent conventional CABG surgery
(62.4%), and 1,878 (37.6%) underwent off-pump CABG surgery. The rates of
mortality, stroke, and respiratory failure were significantly higher in
the conventional CABG surgery group. Conclusions: These results confirm
that off-pump CABG surgery remains a valuable option of surgical
myocardial revascularization, and may optimize the outcome in senior
patients. 2012 The Society of Thoracic Surgeons.
<4>
Accession Number
2012367399
Authors
Schier R. Hinkelbein J. Marcus H. Mehran R. El-Zein R. Hofstetter W.
Swafford J. Riedel B.
Institution
(Schier, Hinkelbein, Marcus) Department of Anaesthesiology and Intensive
Care Medicine, University Hospital of Cologne, Kerpener Strasse 62, 50937
Cologne, Germany
(Mehran, Hofstetter) Department of Thoracic Surgery, University of Texas,
M. D. Anderson Cancer Center, Houston, TX, United States
(El-Zein) Department of Epidemiology, University of Texas, M. D. Anderson
Cancer Center, Houston, TX, United States
(Swafford) Department of Cardiology, University of Texas, M. D. Anderson
Cancer Center, Houston, TX, United States
(Riedel) Department of Anaesthesia and Pain Medicine, Peter MacCallum
Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
Title
Preoperative microvascular dysfunction: A prospective, observational study
expanding risk assessment strategies in major thoracic surgery.
Source
Annals of Thoracic Surgery. 94 (1) (pp 226-233), 2012. Date of
Publication: July 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Brachial artery reactivity testing (BART) - a surrogate test
of microvascular function - predicts cardiac risk in the nonsurgical
population and associates it with adverse outcome after vascular surgery.
This pilot study investigated BART-derived variables, including
flow-mediated dilation (FMD), in preoperative risk stratification for
major thoracic surgery. Methods: After institutional review board
approval, BART was performed in 63 patients before major thoracic surgery.
Ultrasonography recorded two-dimensional images and Doppler flow signals
of the brachial artery preoperatively at baseline and after induced
reactive hyperemia. Variables derived using BART were correlated with
preoperative risk factors, established risk scores, and postoperative
complications. Results: The median preoperative FMD value in patients
without postoperative complications was 11.5%. This value was used to
delineate all patients into two groups: low (FMD < 11.5%) and high (FMD <
11.5%) FMD cohorts. Patients in the low FMD group experienced more
postoperative complications: 54% versus 30% had one or more adverse
postoperative event, and 11% versus 0% had three or more adverse
postoperative events (p < 0.001), respectively. The low FMD group required
longer intensive care unit (3.9 +/- 2.0 days versus 0.9 +/- 0.3 days; p =
0.015) and hospital (14.0 +/- 3.3 days versus 6.8 +/- 0.6 days; p = 0.007)
stays. This cutoff point for FMD accurately predicted 71% of the patients
with adverse postoperative events, achieving 71.4% (95% confidence
interval, 54.7 to 88.2) sensitivity and 48.6% (95% confidence interval,
32.0 to 65.1) specificity. Conclusions: Using BART, preoperative
microvascular dysfunction can be identified in patients at increased risk
for postoperative complications. These data suggest that larger
observational studies and studies exploring preoperative optimization
strategies aimed at improving microvascular function are warranted. 2012
The Society of Thoracic Surgeons.
<5>
Accession Number
2012365195
Authors
Serruys P.W. Farooq V. Vranckx P. Girasis C. Brugaletta S. Garcia-Garcia
H.M. Holmes Jr. D.R. Kappetein A.-P. Mack M.J. Feldman T. Morice M.-C.
Stahle E. James S. Colombo A. Pereda P. Huang J. Morel M.-A. Van Es G.-A.
Dawkins K.D. Mohr F.W. Steyerberg E.W.
Institution
(Serruys, Farooq, Vranckx, Girasis, Brugaletta, Garcia-Garcia, Holmes Jr.)
Erasmus University, Medical Centre, Thoraxcenter, Rotterdam, Netherlands
(Kappetein) Mayo Clinic, Rochester, MN, United States
(Mack) Medical City Dallas Hospital, Dallas, TX, United States
(Feldman) Evanston Hospital, Evanston, IL, United States
(Morice) Institut Jacques Cartier, Massy, France
(Stahle, James) University Hospital Uppsala, Uppsala, Sweden
(Colombo) San Raffaele Scientific Institute, Milan, Italy
(Pereda, Huang, Dawkins) Boston Scientific Corporation, Natick, MA, United
States
(Morel, Van Es) Cardialysis BV, Rotterdam, Netherlands
(Mohr) Herzzentrum, Leipzig, Germany
(Steyerberg) Department of Public Health, Erasmus University Medical
Center, Rotterdam, Netherlands
Title
A global risk approach to identify patients with left main or 3-vessel
disease who could safely and efficaciously be treated with percutaneous
coronary intervention: The SYNTAX trial at 3 years.
Source
JACC: Cardiovascular Interventions. 5 (6) (pp 606-617), 2012. Date of
Publication: June 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: The aim of this study was to assess the additional value of
the Global Risk - a combination of the SYNTAX Score (SXscore) and additive
EuroSCORE - in the identification of a low-risk population, who could
safely and efficaciously be treated with coronary artery bypass graft
surgery (CABG) or percutaneous coronary intervention (PCI). Background:
PCI is increasingly acceptable in appropriately selected patients with
left main stem or 3-vessel coronary artery disease. Methods: Within the
SYNTAX Trial (Synergy between PCI with TAXUS and Cardiac Surgery Trial),
all-cause death and major adverse cardiac and cerebrovascular events
(MACCE) were analyzed at 36 months in low (GRC <sub>LOW</sub>) to high
Global Risk groups, with Kaplan-Meier, log-rank, and Cox regression
analyses. Results: Within the randomized left main stem population (n =
701), comparisons between GRC<sub>LOW</sub> groups demonstrated a
significantly lower mortality with PCI compared with CABG (CABG: 7.5%,
PCI: 1.2%, hazard ratio [HR]: 0.16, 95% confidence interval [CI]: 0.03 to
0.70, p = 0.0054) and a trend toward reduced MACCE (CABG: 23.1%, PCI:
15.8%, HR: 0.64, 95% CI: 0.39 to 1.07, p = 0.088). Similar analyses within
the randomized 3-vessel disease population (n = 1,088) demonstrated no
statistically significant differences in mortality (CABG: 5.2%, PCI: 5.8%,
HR: 1.14, 95% CI: 0.57 to 2.30, p = 0.71) or MACCE (CABG: 19.0%, PCI:
24.7%, HR: 1.35, 95% CI: 0.95 to 1.92, p = 0.10). Risk-model performance
and reclassification analyses demonstrated that the EuroSCORE--with the
added incremental benefit of the SXscore to form the Global Risk--enhanced
the risk stratification of all PCI patients. Conclusions: In comparison
with the SXscore, the Global Risk, with a simple treatment algorithm,
substantially enhances the identification of low-risk patients who could
safely and efficaciously be treated with CABG or PCI. 2012 American
College of Cardiology Foundation.
<6>
Accession Number
2012363464
Authors
Min J.K. Koduru S. Dunning A.M. Cole J.H. Hines J.L. Greenwell D. Biga C.
Fanning G. LaBounty T.M. Gomez M. Horowitz J.M. Hadimitzsky M. Hausleiter
J. Callister T.Q. Rosanski A.R. Shaw L.J. Berman D.S. Lin F.Y.
Institution
(Min, LaBounty, Gomez, Berman) Heart Institute, Division of Cardiology,
Cedars Sinai Medical Center, Los Angeles, CA, United States
(Koduru, Horowitz, Lin) Department of Medicine, Division of Cardiology,
Weill Cornell Medical College, New York Presbyterian Hospital, 520 E 70th
Street, Starr Pavilion, K415, New York, NY 10021, United States
(Dunning) Department of Radiology, Weill Cornell Medical College, New York
Presbyterian Hospital, New York, NY, United States
(Dunning) Department of Public Health, Weill Cornell Medical College, New
York Presbyterian Hospital, New York, NY, United States
(Cole, Greenwell) Cardiology Associates, Mobile, AL, United States
(Hines, Biga, Fanning) Illinois Heart and Vascular Institute, Chicago, IL,
United States
(Hadimitzsky, Hausleiter) Department of Cardiology, Deutsches Herzzentrum
Munchen, Klinik an der Technischen Universitat Munchen, Munich, Germany
(Callister) Tennessee Heart and Vascular Institute, Nashville, TN, United
States
(Rosanski) St. Luke's Roosevelt Hospital, New York, NY, United States
(Shaw) Emory University School of Medicine, Atlanta, GA, United States
Title
Coronary CT angiography versus myocardial perfusion imaging for near-term
quality of life, cost and radiation exposure: A prospective multicenter
randomized pilot trial.
Source
Journal of Cardiovascular Computed Tomography. 6 (4) (pp 274-283), 2012.
Date of Publication: July 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background: Clinical outcomes and resource utilization after coronary
computed tomography angiography (CTA) versus myocardial perfusion
single-photon emission CT (MPS) in patients with stable angina and
suspected coronary artery disease (CAD) has not been examined. Objective:
We determined the near-term clinical effect and resource utilization after
cardiac CTA compared with MPS. Methods: We randomly assigned 180 patients
(age, 57.3 +/- 9.8 years; 50.6% men) presenting with stable chest pain and
suspected CAD at 2 sites to initial diagnostic evaluation by coronary CTA
(n = 91) or MPS (n = 89). The primary outcome was near-term
angina-specific health status; the secondary outcomes were incident
medical and invasive treatments for CAD, CAD health care costs, and
estimated radiation dose. Results: No patients experienced myocardial
infarction or death with 98.3% follow-up at 55 +/- 34 days. Both arms
experienced comparable improvements in angina-specific health status.
Patients who received coronary CTA had increased incident aspirin (22% vs
8%; P = 0.04) and statin (7% vs -3.5%; P = 0.03) use, similar rates of
CAD-related hospitalization, invasive coronary angiography, noninvasive
cardiac imaging tests, and increased revascularization (8% vs 1%; P =
0.03). Coronary CTA had significantly lower total costs ($781.08
[interquartile range (IQR), $367.80-$4349.48] vs $1214.58 [IQR,
$978.02-$1569.40]; P < 0.001) with no difference in induced costs.
Coronary CTA had a significantly lower total estimated effective radiation
dose (7.4 mSv [IQR, 5.0-14.0 mSv] vs 13.3 mSv [IQR, 13.1-38.0 mSv]; P <
0.0001) with no difference in induced radiation. Conclusion: In a pilot
randomized controlled trial, patients with stable CAD undergoing coronary
CTA and MPS experience comparable improvements in near-term angina-related
quality of life. Compared with MPS, coronary CTA evaluation is associated
with more aggressive medical therapy, increased coronary
revascularization, lower total costs, and lower effective radiation dose.
2012 .
<7>
Accession Number
2012366275
Authors
Ghafari R. Baradari A.G. Firouzian A. Nouraei M. Aarabi M. Zamani A. Zeydi
A.E.
Institution
(Ghafari, Nouraei) Department of Cardiac Surgery, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Baradari, Firouzian, Zamani) Department of Anesthesiology, Faculty of
Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Aarabi) Department of Epidemiology, Cardiovascular Research Center,
Golestan University of Medical Sciences, Gorgan, Iran, Islamic Republic of
(Zeydi) Department of Medical Surgical Nursing, Faculty of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
Title
Cognitive deficit in first-time coronary artery bypass graft patients: A
randomized clinical trial of lidocaine versus procaine hydrochloride.
Source
Perfusion (United Kingdom). 27 (4) (pp 320-325), 2012. Date of
Publication: July 2012.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Introduction: Cognitive dysfunction increasingly has been recognized as a
complication after cardiac surgery. Different methods have been considered
for the reduction of cognitive dysfunction after cardiac surgery. One of
these methods is by using lidocaine during surgery. The aim of this study
was to determine the effects of adding lidocaine to the cardioplegia
solution on cognitive impairment after coronary artery surgery. Design and
methods: In a prospective, randomized, double-blind trial, 110 patients
aged between 20-70 years, scheduled for elective CABG surgery using
cardiopulmonary bypass, were recruited into the study. They were
randomized into two groups who received either cardioplegia solution
containing lidocaine 2 mg/kg or procaine hydrochloride 5 mg/kg. The
neurocognitive test used in this study was the Mini Mental State
Examination (MMSE) or Folstein test. The test was done on the day before
and 10 days and 2 months after the operation. Results: In the procaine
group, the total score after 10 days decreased significantly compared to
the preoperative score (mean difference 0.68; 95% CI: 0.20 to 1.17,
p=0.006). Comparison between mean differences after 10 and 60 days of
operation between the lidocaine and procaine groups were statistically
significant, p-value 0.017 and 0.013, respectively. There was no cognitive
impairment in the lidocaine group, but, in the procaine group, four
patients (7.7%) after 10 days and one patient (1.9%) after both 10 and 60
days had cognitive impairment, p=0.051. Conclusions: Administration of
lidocaine compared to that of procaine through the cardioplegia solution
had a better effect on cognitive function after coronary artery bypass
graft surgery. The Author(s) 2012.
<8>
Accession Number
2012366268
Authors
Scrascia G. Rotunno C. Nanna D. Rociola R. Guida P. Rubino G. De Luca
Tupputi Schinosa L. Paparella D.
Institution
(Scrascia, Rotunno, Nanna, Rociola, Guida, De Luca Tupputi Schinosa,
Paparella) Division of Cardiac Surgery, Department of Emergency and Organ
Transplant, University of Bari Aldo Moro, Piazza Giulio Cesare, 1170100
Bari, Italy
(Rubino) Division of Anesthesia, Policlinico Hospital of Bari, Bari, Italy
Title
Pump blood processing, salvage and re-transfusion improves hemoglobin
levels after coronary artery bypass grafting, but affects coagulative and
fibrinolytic systems.
Source
Perfusion (United Kingdom). 27 (4) (pp 270-277), 2012. Date of
Publication: July 2012.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Cell saving systems are commonly used during cardiac operations to improve
hemoglobin levels and to reduce blood product requirements. We analyzed
the effects of residual pump blood salvage through a cell saver on
coagulation and fibrinolysis activation and on postoperative hemoglobin
levels. Thirty-four elective coronary artery bypass graft (CABG) patients
were randomized. In 17 patients, residual cardiopulmonary bypass (CPB)
circuit blood was transfused after the cell saving procedure (cell salvage
group). In the other 17 patients, residual CPB circuit blood was discarded
(control group). Activation of the coagulative, fibrinolytic and
inflammatory systems was evaluated pre-operatively (Pre), 2 hours after
the termination of CPB (T0) and 24 hours postoperatively (T1), measuring
prothrombin fragment 1.2 (PF 1.2), plasmin-anti-plasmin (PAP), plasminogen
activator inhibitor-1 (PAI-1) and interleukin-6 (IL-6). The cell salvage
group of patients had a significant improvement in hemoglobin levels after
processed blood infusion (2.7 +/- 1.7 g/dL vs 1.2 +/- 1.1 g/dL; p=0.003).
PF1.2 levels were significantly higher after infusion (T0: 1175 +/- 770
pmol/L vs 730 +/- 237 pmol/L; p=0.037; T1: 331 +/- 235 pmol/L vs 174 +/-
134 pmol/L; p=0.026). Also, PAP levels were higher in the cell salvage
group, although not significantly (T0: 253 +/- 251 ng/mL vs 168 +/- 96
ng/mL; p: NS; T1: 95 +/- 60 ng/mL vs 53 +/- 32 ng/mL; p: NS). No
differences were found for PAI-1, IL-6, heparin levels or for red blood
cell (RBC) transfusions. The cell salvage group of patients had increased
chest tube drainage (749 +/- 320 vs 592 +/- 264; p: NS) and fresh frozen
plasma transfusion rate (5 (29%) pts vs 0 pts; p<0.04). Pump blood salvage
with a cell saving system improved postoperative hemoglobin levels, but
induced a strong thrombin generation, fibrinolysis activation and lower
fibrinolysis inhibition. These conditions could generate a consumption
coagulopathy. The Author(s) 2012.
<9>
Accession Number
2012353193
Authors
Tabarsi P. Soraghi A. Marjani M. Zandian P. Baghaei P. Najafizadeh K.
Droudinia A. Sarrafzadeh S.A. Javanmard P. Mansouri D.
Institution
(Tabarsi, Soraghi, Marjani, Zandian, Baghaei, Najafizadeh, Droudinia,
Javanmard, Mansouri) Transplantation Research Center, National Research
Institute for Tuberculosis and Lung Disease, Massih Daneshvari Hospital,
Shaheed Beheshti University of Medical Science, Iran, Islamic Republic of
(Sarrafzadeh) Immunology, Asthma and Allergy Research Institute, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Comparison of serum and bronchoalveolar lavage galactomannan in diagnosing
invasive aspergillosis in solid-organ transplant recipients.
Source
Experimental and Clinical Transplantation. 10 (3) (pp 278-281), 2012. Date
of Publication: 20120601.
Publisher
Baskent University (26 Austin Avenue,Baglica Kampusu, P.O. Box 337,Ankara
06530, Turkey)
Abstract
Objectives: This study sought to compare the sensitivities of serum
galactomannan and bronchoalveolar lavage galactomannan in diagnosing
invasive aspergillosis in solid-organ transplant recipients (lung and
heart). Materials and Methods: This study took place in the lung
transplant center of the National Research Institute for Tuberculosis and
Lung Disease. All patients with clinical and radiologic manifestations
suggestive of pulmonary infection were included. Serum and bronchoalveolar
lavage galactomannan were measured. Results: Seventeen patients were
included (lung, 15; heart, 1; heart-lung, 1). Probable or definite
invasive aspergillosis was diagnosed in 9 patients. With a cutoff >= 0.5,
serum galactomannan sensitivity and specificity for diagnosing invasive
aspergillosis were 77.18% and 100%. Negative predictive value and positive
predictive value were 80% and 100%. The sensitivity and specificity of
bronchoalveolar lavage galactomannan for diagnosing invasive aspergillosis
with cutoff of >= 0.5 was 100%. Conclusions: Regarding the high levels of
mortality and problems in diagnosing this disease, using bronchoalveolar
lavage galactomannan could be a suitable option. Baskent University 2012
Printed in Turkey. All Rights Reserved.
<10>
Accession Number
2012360140
Authors
Goksedef D. Omeroglu S.N. Balkanay O.O. Yalvac E.S.D. Talas Z. Albayrak A.
Ipek G.
Institution
(Goksedef, Omeroglu, Balkanay, Yalvac, Talas, Albayrak, Ipek) Department
of Cardiovascular Surgery, Istanbul University, Cerrahpasa Medical Faculty
PK 21, 34098 Istanbul, Turkey
Title
Hemolysis at different vacuum levels during vacuum-assisted venous
drainage: A prospective randomized clinical trial.
Source
Thoracic and Cardiovascular Surgeon. 60 (4) (pp 262-268), 2012. Date of
Publication: 2012.
Publisher
Georg Thieme Verlag (Rudigerstrasse 14, Stuttgart D-70469, Germany)
Abstract
Background: There are several reports on the application of variable
degrees of vacuum pressure to hardshell venous reservoirs. The aim of the
current study was to compare the hemolytic effects of vacuum-assisted
venous drainage (VAVD) at two different vacuum levels with the classical
gravity siphon method. Methods: A prospective, equally randomized (1: 1:
1), parallel group study was performed in elective coronary artery bypass
grafting (CABG) operations. Patients (n = 162) were divided into three
groups: gravity siphon (group 1, n = 55), VAVD at 40 mmHg (group 2, n =
55) and VAVD at 80 mmHg (group 3, n = 52). Hemolysis tests were performed
at 2, 24 and 48 h following the operations. Results: There were no deaths
in this study. Plasma-free hemoglobin (PfHb) levels showed a difference at
2 h (p < 0.001) compared to 24 h (p = 0.02) between the groups.
Haptoglobin (Hp) levels also revealed hemolysis in groups 2 and 3 at all
sampling times. Conclusions: Constant negative suction at 80 mmHg during
elective coronary bypass operations caused more hemolysis. We do not
recommend a constant suction of 80 mmHg for VAVD. Copyright 2012 by
Thieme Medical Publishers, Inc.
<11>
Accession Number
2012369052
Authors
Jilaihawi H. Chakravarty T. Weiss R.E. Fontana G.P. Forrester J. Makkar
R.R.
Institution
(Jilaihawi, Chakravarty, Forrester, Makkar) Heart Institute, Cedars-Sinai
Medical Center, Los Angeles, CA, United States
(Weiss) Department of Biostatistics, UCLA School of Public Health, Los
Angeles, CA, United States
(Fontana) Lenox Hill Hospital Heart, Vascular Institute of New York, New
York, United States
Title
Meta-analysis of complications in aortic valve replacement: Comparison of
Medtronic-Corevalve, Edwards-Sapien and surgical aortic valve replacement
in 8,536 patients.
Source
Catheterization and Cardiovascular Interventions. 80 (1) (pp 128-138),
2012. Date of Publication: 01 Jul 2012.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background: We sought to establish the complication rates following
transcatheter aortic valve replacement (TAVR) in the context of high risk
and octogenarian surgical aortic valve replacement (SAVR) in the
contemporary literature, and to critically analyze population
characteristics and outcomes. Methods: TAVR studies were selected from
nonoverlapping series and SAVR studies for comparison if they met similar
entry criteria. Bayesian meta-analytic methods were employed. Results: For
the 5024 TAVR and 3512 SAVR patients included in the study, TAVR subjects
had greater baseline renal impairment (P < 0.001), a higher incidence of
prior myocardial infarction (P = 0.032) and respiratory disease (P =
0.005) and a higher logistic EuroSCORE (P = 0.039). There were no
significant differences observed in complications studied in SAVR and
TAVR: 30 day mortality (9% vs 8.5%, P = 0.31), 1 year mortality (18.4% vs
22.8%, P = 0.65), 30 day stroke (2.4% vs 2.6%, P = 0.72), new permanent
pacemaker (5.9% vs 12.1%, P = 0.055) and dialysis inception (2.4% vs 4.1%,
P = 0.70). We also compared demographics and outcomes between the two
types of transcatheter valves. Apart from some variation in functional
status, there were no significant differences at baseline with different
TAVR designs. The only difference in complications was the need for
pacemaker insertion, higher with the Medtronic-Corevalve than with the
Edwards-Sapien design (24.5% vs 5.9% P < 0.0001). Conclusions:
Complications for elderly and high risk aortic stenosis patients being
treated by TAVR appear comparable to those selected for SAVR in the
real-world. Copyright 2012 Wiley Periodicals, Inc.
<12>
Accession Number
2012364366
Authors
Navarese E.P. Kozinski M. Obonska K. Margheri M. Gurbel P.A. Kubica J. De
Luca G.
Institution
(Navarese, Kozinski, Obonska, Kubica) Department of Cardiology and
Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 9
Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland
(Navarese, Margheri) Interventional Cardio-Angiology Unit, GVM, Care and
Research, Cotignola (RA), Italy
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital of
Baltimore, Baltimore, MD, United States
(De Luca) Division of Cardiology, Maggiore Della Carita Hospital,
Universita del Piemonte Orientale, Novara, Italy
Title
Clinical efficacy and safety of intracoronary vs. intravenous abciximab
administration in STEMI patients undergoing primary percutaneous coronary
intervention: A meta-analysis of randomized trials.
Source
Platelets. 23 (4) (pp 274-281), 2012. Date of Publication: June 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Adjunctive therapy with abciximab has been proven to reduce mortality and
reinfarction in patients with ST-elevation myocardial infarction (STEMI)
referred to invasive management. Standard abciximab regimen consists of an
intravenous (IV) bolus followed by a 12-h IV infusion. Experimental
studies and small clinical trials suggest the superiority of intracoronary
(IC) injection of abciximab over the IV route. We aimed to perform a
meta-analysis of randomized controlled trials to assess the clinical
efficacy and safety of IC vs. IV abciximab administration in STEMI
patients undergoing primary percutaneous coronary intervention (PPCI). The
primary endpoint was mortality, while recurrent myocardial infarction and
target vessel revascularization (TVR) were selected as secondary
endpoints. The safety endpoint was the risk of major bleeding
complications. A total of six randomized trials were finally included in
the meta-analysis, enrolling a total of 1246 patients. Compared to IV
route, IC abciximab was associated with a significant reduction in
mortality (odds ratio, OR [95% confidence interval (CI)]=0.43 [0.20-0.94],
p=0.03), and TVR (OR [95% CI]=0.53 [0.29-0.99], p=0.05). No differences in
terms of recurrent myocardial infarction (OR [95% CI]=0.54 [0.23-1.28],
p=0.17) or major bleeding complications (OR [95% CI]=0.91 [0.46-1.79],
p=0.79) were observed between the two strategies. The present
meta-analysis showed that IC administration of abciximab is associated
with significant benefits in mortality at short-term follow-up compared to
IV abciximab administration, without any excess of major bleeding in STEMI
patients undergoing PPCI. However, further trials are warranted to
establish the optimal strategy of abciximab treatment in this setting.
Copyright 2012 Informa UK Ltd.
<13>
Accession Number
2012365147
Authors
Ramadeen A. Connelly K.A. Leong-Poi H. Hu X. Fujii H. Van Krieken R.
Laurent G. Holub B.J. Bazinet R.P. Dorian P.
Institution
(Ramadeen, Connelly, Leong-Poi, Hu, Fujii, Van Krieken, Dorian) Keenan
Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital,
Toronto, ON, Canada
(Ramadeen, Van Krieken, Dorian) Department of Pharmacology and Toxicology,
University of Toronto, Toronto, ON, Canada
(Ramadeen, Dorian) Cardiovascular Sciences Collaborative Program,
University of Toronto, Toronto, ON, Canada
(Connelly, Leong-Poi, Dorian) Division of Cardiology, St. Michael's
Hospital, 30 Bond St, 6-050Q, Toronto, ON M5B 1W8, Canada
(Connelly, Leong-Poi) Department of Medicine, University of Toronto,
Toronto, ON, Canada
(Laurent) Department of Cardiology, University Hospital BOCAGE, Dijon,
France
(Holub) Department of Human Biology and Nutritional Sciences, University
of Guelph, Guelph, ON, Canada
(Bazinet) Department of Nutritional Sciences, University of Toronto,
Toronto, ON, Canada
Title
N-3 polyunsaturated fatty acid supplementation does not reduce
vulnerability to atrial fibrillation in remodeling atria.
Source
Heart Rhythm. 9 (7) (pp 1115-1122), 2012. Date of Publication: July 2012.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
BACKGROUND: Prophylactic supplementation with omega-3 polyunsaturated
fatty acids (PUFAs) reduce vulnerability to atrial fibrillation (AF). The
effect of PUFAs given after cardiac injury has occurred is unknown.
OBJECTIVE: To investigate using a model of pacing-induced cardiac injury,
the time course of development of injury and whether it was altered by
postinjury PUFAs. METHODS: Sixty-five dogs were randomized to undergo
simultaneous atrial and ventricular pacing (SAVP, 220 beats/min) for 0, 2,
7, or 14 days. Twenty-two dogs received PUFAs (850 mg/d) either
prophylactically or after some pacing had occurred (postinjury).
Electrophysiologic and echocardiographic measurements were taken at
baseline and sacrifice. Atrial tissue samples were collected at sacrifice
for histologic and molecular analyses. RESULTS: With no PUFAs, the
inducibility of AF increased with pacing duration (P < .001). Postinjury
PUFAs (started after 7 days of pacing) did not reduce the inducibility of
AF after 14 days of pacing (9.3% +/- 8.8% no PUFAs vs 9.7% +/- 9.9%
postinjury PUFAs; P = .91). Atrial myocyte size and fibrosis increased
with pacing duration (P < .05). Postinjury PUFAs did not significantly
attenuate the cell size increase after 14 days of pacing (no PUFAs 38% +/-
30% vs postinjury PUFAs 19% +/- 28%; P = .11). Similarly, postinjury PUFAs
did not attenuate the increase in fibrosis after 14 days of pacing (no
PUFAs 66% +/- 51% vs postinjury PUFAs 63% +/- 76%; P = .90). CONCLUSION:
PUFA supplementation begun after cardiac injury has already occurred does
not reduce atrial structural remodeling or vulnerability to AF. 2012
Heart Rhythm Society. All rights reserved.
<14>
Accession Number
2012361979
Authors
Fertin M. Dubois E. Belliard A. Amouyel P. Pinet F. Bauters C.
Institution
(Fertin, Amouyel, Pinet, Bauters) Centre Hospitalier Regional,
Universitaire de Lille, Lille, France
(Fertin, Amouyel, Bauters) Faculte de Medecine de Lille, Lille, France
(Fertin, Dubois, Belliard, Amouyel, Pinet, Bauters) Institut National de
la Sante et de la Recherche Medicale U744, Lille, France
(Fertin, Dubois, Belliard, Amouyel, Pinet, Bauters) Institut Pasteur de
Lille, Lille, France
(Fertin, Dubois, Belliard, Amouyel, Pinet, Bauters) Universite Lille Nord
de France, Lille, France
Title
Usefulness of circulating biomarkers for the prediction of left
ventricular remodeling after myocardial infarction.
Source
American Journal of Cardiology. 110 (2) (pp 277-283), 2012. Date of
Publication: 15 Jul 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Left ventricular (LV) remodeling after myocardial infarction (MI)
indicates a high risk of heart failure and death, but LV remodeling
remains difficult to predict. Biomarkers may help to refine risk
stratification for a more personalized medical approach. They may also
shed light on the pathophysiologic processes involved. We performed a
systematic review of the published evidence about the association of
circulating biomarkers with LV remodeling after MI. We selected 59
publications. Overall, these studies examined 112 relations between 52
different biomarkers and LV remodeling. The biomarkers most consistently
associated with LV remodeling were involved in extracellular matrix
turnover or neurohormonal activation: matrix metalloproteinase-9, collagen
peptides, and B-type natriuretic peptide. This review underscores the
vitality of the research on LV remodeling but concludes that the ideal
biomarker has not yet been identified. To reach this goal, future studies
will have to be larger, have standardized imaging end points, and include
replication populations to define optimal cutoffs for LV remodeling
prediction. Cardiovascular magnetic resonance appears to be the best
technique for LV remodeling assessment but its current availability may be
a concern for recruitment for multicenter studies. Recent technologic
advances will probably yield new candidate biomarkers of LV remodeling.
Tests are necessary to determine whether a multimarker approach would
significantly improve risk prediction. 2012 Elsevier Inc. All rights
reserved.
<15>
Accession Number
2012361588
Authors
Seo J.-H. Hong D.M. Lee J.-M. Chung E.-J. Bahk J.-H.
Institution
(Seo, Hong, Lee, Chung, Bahk) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul National University
College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea
Title
Double-lumen tube placement with the patient in the supine position
without a headrest minimizes displacement during lateral positioning.
Source
Canadian Journal of Anesthesia. 59 (5) (pp 437-441), 2012. Date of
Publication: May 2012.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Purpose The correct position of double-lumen tubes (DLTs) is customarily
confirmed after tracheal intubation by bronchoscopy with the patient
supine on a headrest. However, displacement of DLTs usually occurs during
lateral positioning because of neck extension. This study was undertaken
to determine whether displacement of DLTs could be minimized during
lateral positioning if DLTs were positioned without a headrest. Methods
One hundred patients scheduled for thoracic surgery were randomized into
two groups (n = 50 each). After tracheal intubation using a headrest,
adjustment of DLT position was performed according to group assignment,
i.e., either with the headrest in place or without the headrest. Using a
bronchoscope, distances from the tracheal opening to the main carina and
from the bronchial opening to the left bronchial carina were measured in
both the supine and lateral positions. Results Displacement of DLTs [mean
(standard deviation)] during lateral positioning was greater in the
headrest group than in the no-headrest group [12.3 (6.5) mm vs 6.8 (5.5)
mm, respectively, in the trachea; 11.6 (6.7) mm vs 6.0 (4.6) mm,
respectively, in the bronchus; P<0.001]. The incidence of significant
displacement, defined as<10 mm from initial correct position, was greater
in the headrest group than in the no-headrest group (64% vs 28%,
respectively, in the trachea; 58% vs 20%, respectively, in the bronchus;
P<0.001). Conclusion Displacement of DLTs during lateral positioning
appears to be caused primarily by extension of the neck. Correct
adjustment of DLT position without a headrest in the supine position is an
easy and effective method to minimize DLT displacement during lateral
positioning (ClinicalTrials.gov number, NCT01413347). 2012 Canadian
Anesthesiologists' Society.
<16>
Accession Number
2012361590
Authors
Djaiani G. Katznelson R. Fedorko L. Rao V. Green R. Carroll J. Karski J.
Institution
(Djaiani, Katznelson, Fedorko, Carroll, Karski) Department of Anesthesia
and Pain Management, Toronto General Hospital, University of Toronto, 200
Elizabeth Street, Toronto, ON M5G 2C4, Canada
(Rao) Division of Cardiovascular Surgery, Toronto General Hospital,
University of Toronto, Toronto, ON, Canada
(Green) Toronto Rehabilitation Institute, Toronto General Hospital,
University of Toronto, Toronto, ON, Canada
Title
Early benefit of preserved cognitive function is not sustained at one-year
after cardiac surgery: A longitudinal follow-up of the randomized
controlled trial.
Source
Canadian Journal of Anesthesia. 59 (5) (pp 449-455), 2012. Date of
Publication: May 2012.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Purpose Recently, we showed that processing of shed blood with a
continuous-flow cell saver during cardiopulmonary bypass resulted in a
clinically significant reduction in postoperative cognitive decline (POCD)
six weeks after coronary artery bypass graft (CABG) surgery. The current
study examined if the early benefit of reduced POCD was sustained in the
same patient population at one-year follow- up. Methods One hundred
seventy patients (cell saver group, n = 84; controls, n = 86) underwent
neuropsychological testing at baseline and one year after surgery. The raw
scores for each test were converted to Z-scores, and at combined Z-score
of ten main variables was then calculated for each study group. Results
Postoperative cognitive decline was present in 16 of 84 (19%) patients in
the cell saver group (95% confidence interval [CI], 10.8 to 27.2) vs 15 of
86 (17.4%) patients in the control group (95% CI, 9.6 to 25.2) (P =
0.786). Six of the 15 patients in the control group with POCD at six weeks
had the impairment at one year and five did not; four were lost to
follow-up. Three of the six cell saver patients with POCD at six weeks
still had impairment at one year, two did not, and one was not tested.
Thirteen (15.4%) and nine (10.5%) patients in the cell saver and control
groups, respectively, developed new POCD which was not evident at the
six-week follow-up. Conclusions The short-term preservation of cognitive
function in elderly patients using the cell saver management strategy did
not translate into a long-term benefit one year after CABG surgery. The
presence of progressing cerebrovascular disease may be responsible for the
long-term cognitive decline. (ClinicalTrials.gov number, NCT00193999).
2012 Canadian Anesthesiologists' Society.
<17>
Accession Number
70799482
Authors
Emery R. Klima U. Villafana M.
Institution
(Emery) St. Joseph's Hospital, St. Paul, MN, United States
(Klima) American Hospital Dubai, Dubai, United Arab Emirates
(Villafana) Kips Bay Medical, Minneapolis, MN, United States
Title
Long-term angiographic follow-up of the nitinol eSVS mesh.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 15th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2012 Los Angeles, CA
United States. Conference Start: 20120530 Conference End: 20120602.
Conference Publication: (var.pagings). 7 (2) (pp 143), 2012. Date of
Publication: March-April 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The eSVS Mesh is a knitted nitinol wire external support
intended for use to improve patency of saphenous vein grafts (SVGs) in
CABG surgery. It is designed to provide radial support to prevent SVG
dilatation, to reduce graft diameter to more closely match target coronary
artery diameter and to provide a uniform graft lumen to help improve blood
flow characteristics and mitigate the development of stenosing neointimal
hyperplasia (NIH), a primary cause of mid-term graft failure. The object
of the study was to assess comparative graft patency at 9-12 month and
safety of the e-SVS Mesh support device for major adverse clinical events
(MACE: death, stroke, MI, target lesion revascularization) at 30 days.
Methods: From August 2008 through July 2009, 90 patients were enrolled in
a prospective, global multi center, randomized, controlled clinical trial
and received both an eSVS Mesh and Control SVG. Each patient was implanted
with one eSVS Mesh graft and one control graft and randomized to site,
thus the patients served as their own control. The eSVS Mesh diameters
were 3.0, 3.5, 4.0 and 4.5 mm. Results: Overall MACE rate was 4.4%
comparable to the Objective Performance Criteria (OPC) for CABG of 9.4%.
There were no deaths, two strokes (2.2%), and two MI events (2.2%). 73
patients (81%) presented for angiography during the 9-12 month interval.
The 3.0 Mesh proved to be too aggressive in downsizing and has been
eliminated. One site experienced technical difficulties with the device
and had substantially lower eSVS patency. Excluding this site and 3.0 mm
data, the angiographic patency of eSVS Mesh and Control SVG's is
statistically equivalent. * 3.5/4.0/4.5 mm Mesh: Patency of 73% (24/33),
95% CI of 54%-87% * Controls: Patency of 76% (25/33), 95% CI of 58%-89% To
date, 20 subjects, who had angiographically patent eSVS Mesh SVG's during
the 9-12 month period, have presented for the 24-36 month imaging and all
grafts remain patent. Conclusions: Angiographic imaging studies indicate
that when the eSVS Mesh is patent at 9-12 months post implant, patency is
maintained a 24-36 months post implant. CE Mark approval granted. Post
market studies continue.
<18>
Accession Number
70799468
Authors
Milanez A.M. Dallan L.A. Viana C.B. Dallan L.R. Platania F. Moreira L.F.
Stolf N.G.
Institution
(Milanez, Dallan, Viana, Dallan, Platania, Moreira, Stolf) Heart
Institute, Sao Paulo, Brazil
Title
Minimally invasive single-vessel coronary bypass: A randomized controlled
trial.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 15th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2012 Los Angeles, CA
United States. Conference Start: 20120530 Conference End: 20120602.
Conference Publication: (var.pagings). 7 (2) (pp 138-139), 2012. Date of
Publication: March-April 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: There are several cohort studies and cases reports concerning
minimally invasive coronary surgery, but just a few are randomized
controlled trials. The aim of this trial is to compare minimally invasive
LIMA to LAD coronary surgery (MICS) bypass with conventional LIMA to LAD
coronary surgery (CCS) off-pump bypass. Methods: From 2007 to 2010, 36
patients were randomized to either LIMA robotically harvested to LAD
artery minimally invasive bypass or conventional LIMA to LAD off-pump
bypass. Patients assigned to MICS group underwent robotic endoscopic
harvesting of LIMA with the AESOP system followed by a small left
thoracotomy in the 4th intercostal space for off-pump LAD bypass. Patients
assigned to CCS group underwent full median sternotomy, open LIMA
harvesting followed by off-pump LAD bypass. Transit time flow measurement
(Medi-Stim Butterfly, Medtronic Inc., Minneapolis, MN USA) was used for
intraoperative evaluation of LIMA to LAD patency. After a mean 24-month
follow-up, Multislice Computed Tomography (Aquilion ONE 320, Toshiba
America Medical Systems, Inc., Tustin, CA USA) was used to evaluate LIMA
to LAD midterm patency. Results: The mean LIMA harvesting time in robotic
group was 50.8 +/- 11.2 min vs. 22.7 +/- 3.4 min in conventional group.
There was no significant difference in intraoperative LIMA to LAD flow
between MICS and CCS groups (46.18 +/- 20.73 mL/min vs. 48.65 +/- 24.15
mL/min, p=0.84). There were no significant differences in incidence of
wound infection (0 vs. 2, p=0.484) and reoperation for bleeding (0 vs. 1,
p=1.00) between MICS and CCS groups respectively. In MICS group,
Multislice CT revealed patent LIMA graft in 18 (100%) patients vs. 17
(94.4%) patients in CCS group (p=1.00). There was no mortality in the
study group. Conclusions: Minimally invasive LAD bypass using LIMA graft
robotically harvested was safe and feasible. Early and mid-term LIMA
patency was similar between both techniques.
<19>
Accession Number
70799460
Authors
Borgermann J. Gummert J.F. Kuss O.
Institution
(Borgermann, Gummert) Heart and Diabetes Center North-Rhine Westphalia,
Bad Oeynhausen, Germany
(Kuss) Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
Title
Do patients with lower ejection fraction benefit from off-pump surgery?
analysis of 9,906 patients from randomized trials.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 15th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2012 Los Angeles, CA
United States. Conference Start: 20120530 Conference End: 20120602.
Conference Publication: (var.pagings). 7 (2) (pp 136), 2012. Date of
Publication: March-April 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: It is commonly believed that especially higher-risk patients
benefit from off-pump coronary artery bypass grafting. However, analyses
from several registries give different results. A common shortcoming of
all those analyses is the fact that they concentrate on evidence from
nonrandomized trials. Methods: In an ecologic analysis, we included all
randomized trials comparing the on- and off-pump techniques until January
2011. By logistic regression, we investigated whether the effect of
off-pump surgery on mortality, myocardial infarction, stroke, and atrial
fibrillation is modified across the range of the 3 risk factors: age,
proportion of women, and ejection fraction. Results: Eighty-six studies
with a total population of 9,906 patients reported on at least 1 risk
factor and 1 outcome. We found a superiority of the off-pump technique in
patients with lower ejection fraction values for the outcomes mortality
and atrial fibrillation. No effect modification was seen for the risk
factors age and proportion of women. Conclusions: Our ecologic analysis
found a superiority of the off-pump technique in patients with lower
ejection fraction values, especially for the most valid outcome of
mortality. As every ecologic analysis is prone to ecologic bias, a
definite answer on the benefit of the off-pump technique in higher-risk
patients can only be given by meta-analyses using individual patient data.
<20>
Accession Number
70800096
Authors
Saczkowski R. Mesana T. Dacey C. Ruel M.
Institution
(Saczkowski, Mesana, Ruel) Department of Cardiac Surgery, University of
Ottawa Heart Institute, Ottawa, ON, Canada
(Dacey) Department of Cardiovascular Surgery, Tufts University, Medical
Center, Boston, MA, United States
Title
Centrifugal pump and roller pump in adult cardiac surgery: A meta-analysis
of randomized controlled trials.
Source
Artificial Organs. Conference: 19th Congress of the International Society
for Rotary Blood Pumps, ISRBP 2011 Louisville, KY United States.
Conference Start: 20110908 Conference End: 20110910. Conference
Publication: (var.pagings). 36 (5) (pp A45), 2012. Date of Publication:
June 2012.
Publisher
Blackwell Publishing Inc.
Abstract
Objective: Centrifugal pump (CP) and roller pump (RP) designs are the
dominant main arterial pumps used in cardiopulmonary bypass (CPB). Trials
reporting clinical outcome measures comparing CP and RP are controversial.
Therefore, a meta-analysis was undertaken to evaluate clinical variables
from randomized controlled trials (RCT). Methods: Keyword searches were
performed on Medline (1966-2011), EmBase (1980-2011), and CINAHL
(1981-2011) for studies comparing RP and CP as the main arterial pump in
adult CPB. Pooled fixed-effects estimates for dichotomous and continuous
data were calculated as an odds ratio and weighted mean difference,
respectively. The P value was utilized to assess statistical significance
(P < 0.05) between CP and RP groups. Results: Fifteen RCTs met inclusion
criteria, which represented 1868 patients (CP = 961, RP = 907). The two
groups were similar with respect to age (CP = 62 years, RP = 61 years, P =
0.46), male sex (CP = 79%, RP = 88%, P = 0.08), CPB time (CP = 98 min, RP
= 99 min, P = 0.84), and cross-clamp time (CP = 55 min, RP = 55 min, P =
0.85). The prevailing operation was isolated coronary artery bypass graft
surgery (CP = 88%, RP = 87%). Fixed-effects pooled estimates were
performed for end-of-CPB (ECB) and postoperative day 1 (PDO) for platelet
count (ECB: P = 0.30, PDO: P = 0.10), plasma-free hemoglobin (ECB: P =
0.36, PDO: P = 0.24), white blood cell count (ECB: P = 0.21, PDO: P =
0.66), and hematocrit (ECB: P = 0.05, PDO: P = 0.54). No difference was
demonstrated for postoperative blood loss (P = 0.65), and red blood cell
(P = 0.71) and fresh frozen plasma (P = 0.40) transfusions. The trials
reported similar rates for stroke, coma, neurological dysfunction, and
mortality. Conclusion: The meta-analysis of RCT comparing CP and RP in
adult cardiac surgery demonstrated no significant difference for
hematological variables, postoperative blood loss, transfusions,
neurological outcomes, and mortality.
No comments:
Post a Comment