Results Generated From:
Embase <1980 to 2012 Week 39>
Embase (updates since 2012-09-21)
<1>
Accession Number
2012546388
Authors
Vasques F. Lucenteforte E. Paone R. Mugelli A. Biancari F.
Institution
(Vasques, Paone, Biancari) Deptment of Surgery, Oulu University Hospital,
PO Box 21, 90029 Oulu, Finland
(Lucenteforte, Mugelli) Deptment of Preclinical and Clinical Pharmacology,
M. Aiazzi Mancini, University of Florence, Florence, Italy
Title
Outcome of patients aged >=80 years undergoing combined aortic valve
replacement and coronary artery bypass grafting: A systematic review and
meta-analysis of 40 studies.
Source
American Heart Journal. 164 (3) (pp 410-418.e1), 2012. Date of
Publication: September 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Aim: This study was planned to evaluate the outcome of patients aged >=80
years undergoing combined conventional aortic valve replacement (AVR) and
coronary artery bypass grafting (CABG). Methods: This is a systematic
review of the literature and meta-analysis of data on patients aged >=80
years who underwent combined AVR and CABG. Results: The literature search
yielded 40 observational studies reporting on 8,975 patients aged >=80
years. Pooled proportion of immediate postoperative mortality was 9.7%
(95% CI 8.4-11.1, 40 studies, 8,975 patients). Immediate mortality was
8.2% (95% CI 6.5-10.0) in 15 studies with a mid-date from 2000 to 2007 and
10.8% (95% CI 9.1-12.7) in 25 studies with a mid-date from 1982 to 1999 (P
=.043). Postoperative stroke rate was 3.7% (95% CI 2.8-4.8, 12 studies,
2,770 patients), and postoperative implantation of pacemaker was 4.3% (95%
CI 2.6-6.5, 5 studies, 535 patients). The mean length of stay in intensive
care unit was 5.3 days (95% CI 3.3-7.3, 5 studies, 490 patients), and the
mean length of in-hospital stay was 16.9 days (95% CI 12.4-21.4, 5
studies, 424 patients). One-, 3-, 5- and 10-year pooled survival rates
after combined AVR and CABG were 83.2%, 72.9%, 60.8%, and 25.7%,
respectively. Conclusions: Conventional AVR and CABG in patients aged >=80
years are associated with significant operative mortality and morbidity as
well as prolonged in-hospital treatment. However, conventional surgery is
associated with remarkably good late survival. This suggests that any
alternative treatment modality must prove itself of being enough durable
also in the very elderly. 2012 Mosby, Inc. All rights reserved.
<2>
Accession Number
2012543435
Authors
Vermeltfoort I.A.C. Teule G.J.J. van Dijk A.B. Muntinga H.J. Raijmakers
P.G.H.M.
Institution
(Vermeltfoort, Teule, van Dijk) Department of Nuclear Medicine, Verbeeten
Institute, PO Box 90120, 5000 LA Tilburg, Netherlands
(Muntinga) Department of Cardiology, Tweesteden Hospital, Dr Deelenlaan 5,
5042 AD Tilburg, Netherlands
(Raijmakers) Department of Nuclear Medicine and PET Research, VU
University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands
Title
Long-term prognosis of patients with cardiac syndrome X: A review.
Source
Netherlands Heart Journal. 20 (9) (pp 365-371), 2012. Date of Publication:
September 2012.
Publisher
Bohn Stafleu van Loghum (P.O. Box 75971, Amsterdam 1070 A2, Netherlands)
Abstract
Aims Follow-up studies of patients with cardiac syndrome X (CSX) generally
report good prognosis. However, some recent studies report an adverse
outcome for women. Methods and results Structured literature search and
metaanalysis for studies regarding prognosis of cardiac syndrome X
patients. We identified 85 studies, ultimately selecting 16 for inclusion.
Meta-analysis yielded a pooled major cardiac event percentage of 1.5% per
5 years and a pooled vascular event percentage of 4.8% per 5 years (n=16
studies, n=1694 patients). Fourteen studies reported upon the recurrence
rate of angina pectoris: the pooled percentage of angina recurrence was
55% (n=1336 patients). Conclusion The present review of recent archival
literature demonstrates an overall major cardiac event rate of 1.5% per 5
years. Although this is an excellent prognosis for CSX patients, the
quality of life is impaired because of the high recurrence rate of angina
pectoris (55%). The Author(s) 2012.
<3>
Accession Number
2012543432
Authors
Ghani A. Dambrink J.-H.E. van't Hof A.W.J. Ottervanger J.P. Gosselink
A.T.M. Hoorntje J.C.A.
Institution
(Ghani, Dambrink, van't Hof, Ottervanger, Gosselink, Hoorntje) Department
of Cardiology, Isala klinieken, Groot Wezenland 20, 8011 JW, Zwolle,
Netherlands
Title
Treatment of non-culprit lesions detected during primary PCI: Long-term
follow-up of a randomised clinical trial.
Source
Netherlands Heart Journal. 20 (9) (pp 347-353), 2012. Date of Publication:
September 2012.
Publisher
Bohn Stafleu van Loghum (P.O. Box 75971, Amsterdam 1070 A2, Netherlands)
Abstract
Background There are conflicting data regarding optimal treatment of
non-culprit lesions detected during primary percutaneous coronary
intervention (PCI) in patients with ST-elevation myocardial infarction
(STEMI) and multi-vessel disease (MVD). We aimed to investigate whether
ischaemia-driven early invasive treatment improves the long-term outcome
and prevents major adverse cardiac events (MACE). Methods 121 patients
with at least one non-culprit lesion were randomised in a 2:1 manner, 80
were randomised to early fractional flow reserve (FFR)-guided PCI
(invasive group), and 41 to medical treatment (conservative group). The
primary endpoint was MACE at 3 years. Results Three-year follow-up was
available in 119 patients (98.3 %). There was no significant difference in
all-cause mortality between the invasive and conservative strategy, 4
patients (3.4 %) died, all in the invasive group (P=0.29). Re-infarction
occurred in 14 patients (11.8 %) in the invasive group versus none in the
conservative group (p=0.002). Re-PCI was performed in 7 patients (8.9 %)
in the invasive group and in 13 patients (32.5 %) in the conservative
group (P=0.001). There was no difference in MACE between these two
strategies (35.4 vs 35.0 %, p=0.96). Conclusions In STEMI patients with
MVD, early FFR-guided additional revascularisation of the non-culprit
lesion did not reduce MACE at three-year follow-up compared with a more
conservative strategy. The rate of MACE in the invasive group was
predominantly driven by death and re-infarction, whereas in the
conservative group the rate of MACE was only driven by repeat
interventions. Springer Media / Bohn Stafleu van Loghum 2012.
<4>
Accession Number
2012539842
Authors
Samantaray A. Rao M.H. Chandra A.
Institution
(Samantaray, Rao) Department of Anaesthesiology and Critical Care, Sri
Venkateswara Institute of Medical Sciences, SVIMS University, Tirupati,
Andhra Pradesh, Pin - 517 507, India
(Chandra) Departments of Cardiovascular and Thoracic Surgery, Sri
Venkateswara Institute of Medical Sciences, SVIMS University, Tirupati,
Andhra Pradesh, India
Title
The effect on post-operative pain of intravenous clonidine given before
induction of anaesthesia.
Source
Indian Journal of Anaesthesia. 56 (4) (pp 359-364), 2012. Date of
Publication: July/August 2012.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background: Treatment of acute post-thoracotomy pain is particularly
important not only to keep the patient comfortable but also to minimize
pulmonary complications. Aim: This study was designed to test the effect
of pre-induction administration of clonidine, given as a single
intravenous dose, on post-operative pain scores and fentanyl consumption
in patients after thoracic surgery. Setting and Design: Tertiary referral
centre. Prospective, randomised, double-blind, placebo-controlled trial.
Methods: Sixty patients were randomly allocated to receive clonidine (3
mcg/kg) or saline pre-operatively before induction of anaesthesia. The
primary endpoint was pain on coughing (visual analogue scale (VAS) 0-100
mm) 120 min after surgery, time to first analgesic injection in the
post-anaesthesia care unit (PACU) and 24-h fentanyl consumption.
Statistical Analysis: For between-group comparisons, t-test and U-test
were used as appropriate after checking normality of distribution. The
incidence of complications between the groups was compared by Fisher's
exact test. Results: The post-operative VAS for the first 120 min and the
fentanyl consumption at 24 h was significantly greater in the placebo
group compared with the clonidine group (P<0.05). The sedation score was
increased in the clonidine group during study drug infusion, but did not
differ significantly on admission to the PACU. Conclusions: A single
intravenous dose of clonidine (3 mcg/kg) given before induction of
anaesthesia significantly reduced the post-operative VAS score in the
initial period and fentanyl consumption during 24 h after thoracic
surgery.
<5>
Accession Number
2012533866
Authors
Abicht J.-M. Beiras-Fernandez A. Bengel D. Vicol C.
Institution
(Abicht) Department for Anaesthesiology, Ludwig-Maximilians-Universitat
Munchen, Marchioninistrase 15, 81377 Munich, Germany
(Bengel, Vicol) Department of Cardiac Surgery, Ludwig Maximilian
University of Munich, Munich, Germany
(Beiras-Fernandez) Department of Cardiothoracic and Vascular Surgery,
Goethe University Frankfurt, Frankfurt am Main, Germany
Title
Deep pericardial traction suture versus vacuum-assisted apical suction to
expose the posterior wall of the heart in off-pump coronary artery bypass:
A prospective, randomized study.
Source
Heart Surgery Forum. 15 (4) (pp E224-E231), 2012. Date of Publication:
August 2012.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Displacement of the heart to expose the posterior vessels
during off-pump coronary artery bypass (OPCAB) may cause hemodynamic
instability. Deep pericardial traction suture (DPTS) and vacuum-assisted
apical suction (VAS) with the Starfish positioning device help to provide
good exposure without relevant hemodynamic changes. Our aim was to compare
these two methods in patients undergoing multivessel OPCAB. Methods: We
prospectively randomized 20 patients undergoing multivessel OPCAB to the
use of VAS or DPTS. The Octopus device was used in both groups to
stabilize the target vessel. Hemodynamic parameters, including venous
oxygen content (SvO<sub>2</sub>), cardiac index (CI), central venous
pressure (CVP), mean arterial pressure (MAP), pulmonary artery pressure
(PAP), and pulmonary capillary wedge pressure (PCWP), were measured before
grafting (baseline), after heart positioning, and during performance of
peripheral anastomoses. Results: Perioperative data for the two groups
were similar. During exposure of the lateral wall, there were fewer
hemodynamic changes in the DPTS group (increase in CVP) than in the VAS
group (increases in CVP, PAP, and PCWP); the CVP was significantly higher
in the DPTS group (P < .05). During exposure of the posterior wall,
significant hemodynamic changes occurred only in the DPTS group (increase
in PCWP). Values for all other parameters were similar, including
anastomosis time, graft flow, postoperative myocardial enzymes, and
inotropic support. Conclusions: Heart positioning during OPCAB with either
VAS or DPTS is a safe and effective maneuver for exposure of coronary
arteries. In our study, the use of the VAS device produced less
hemodynamic impairment during exposure of the lateral and posterior walls.
2012 Forum Multimedia Publishing, LLC.
<6>
Accession Number
2012543531
Authors
Wang M.S. Lang X.L. Cui S.T. Fei K. Zou L.J. Cao J. Wang L.X. Zhang S.H.
Wu X.T. Wang Y.L. Ji Q.
Institution
(Wang) Department of Thoracic Cardiovascular Surgery, Xinhua Hospital of
Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
(Lang, Zou) Department of Cardiothoracic Surgery, Changhai Hospital,
Second Military Medical University, Shanghai 200433, China
(Cui) Department of Emergency Surgery, Ninth People's Hospital of Shanghai
Jiaotong University School of Medicine, Shanghai 200072, China
(Fei) Department of Thoracic Surgery, Pulmonary Hospital of Tongji
University, Shanghai 200433, China
(Cao, Wang, Zhang, Wu, Wang) Department of Thoracic Cardiovascular
Surgery, Tenth People's Hospital of Tongji University, Shanghai 200072,
China
(Ji) Department of Thoracic Cardiovascular Surgery, Tongji Hospital of
Tongji University, Shanghai 200065, China
Title
Clinical application of pharmacogenetic-based warfarin-dosing algorithm in
patients of han nationality after rheumatic valve replacement: A
ran-domized and controlled trial.
Source
International Journal of Medical Sciences. 9 (6) (pp 472-479), 2012. Date
of Publication: 2012.
Publisher
Ivyspring International Publisher (POBox 9338, Wyoming, New South Wales
2250, Australia)
Abstract
Background The polymorphisms of VKORC1 and CYP2C9 play increasingly
important roles in the inter-individual variability in warfarin dose. This
study aimed to evaluate the fea-sibility of clinical application of
pharmacogenetic-based warfarin-dosing algorithm in patients of Han
nationality with rheumatic heart disease after valve replacement in a
randomized and controlled trial. Methods One hundred and one consecutive
patients of Han nationality with rheumatic heart disease undergoing valve
surgery were enrolled and randomly assigned to an experimental group
(n=50, based on CYP2C9 and VKORC1 genotypes, pharmacogenet-ic-based
"predicted warfarin dose" for 3 days and then was adjusted to INR until
stable warfarin maintenance dose) or a control group (n=51, 2.5mg/d for 3
days and then was ad-justed to INR until stable warfarin maintenance
dose). All included patients were followed for 50 days after initiation of
warfarin therapy. The primary end-point was the time to reach a stable
warfarin maintenance dose. Results During the follow-up, 84.0% patients in
the ex-perimental group and 58.8% patients in the control group received
warfarin maintenance dose. Compared with control group, patients in the
experimental group had shorter mean time elapse from initiation of
warfarin therapy until warfarin maintenance dose (27.5+/-1.8 d versus
34.7+/-1.8 d, p<0.001). Cox regression revealed that group (HR for
experimental versus control group: 1.568, 95%CI 1.103-3.284) and age were
two significant variables related to the time elapse from initiation of
warfarin therapy until warfarin maintenance dose. The predicted warfarin
maintenance dose was prominently correlated with the actual warfarin
maintenance dose (r=0.684, p<0.001). Conclusion: Based on CYP2C9 and
VKORC1 genotypes, the pharmacogenetic-based warfarin-dosing algorithm may
shorten the time elapse from initiation of warfarin therapy until warfarin
maintenance dose. It is feasible for the clinical application of the
pharmacogenetic-based warfarin-dosing algorithm in patients of Han
nationality with rheumatic heart disease after valve replacement.
Ivyspring International Publisher.
<7>
Accession Number
2012540821
Authors
Emir M. Kunt A.G. Cicek M. Bozok S. Karakisi S.O. Uguz E. Hidiroglu M.
Cetin L. Sener E.
Institution
(Emir, Bozok, Karakisi, Sener) Department of Cardiovascular Surgery, Recep
Tayyip Erdogan University Faculty of Medicine, Training and Research
Hospital, Rize, Turkey
(Kunt, Cicek, Uguz, Hidiroglu, Cetin) Department of Cardiovascular
Surgery, Yildirim Beyazit Univ. Faculty of Medicine, Ankara Ataturk
Training and Research Hospital, Ankara, Turkey
Title
Sequential radial artery for coronary artery bypass grafting: Five-year
follow-up and evaluation with multi-detector row computed tomography.
Source
Cardiovascular Revascularization Medicine. 13 (5) (pp 272-276), 2012. Date
of Publication: September 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
This study was undertaken to compare early postoperative results,
programmed multi-detector row computed tomography coronary angiographic
patency and midterm results of revascularization by sequential radial
artery grafting with those of single radial artery grafting during a
five-year period. Patients were grouped as those with sequential radial
artery grafts (Group A, n = 27) and single radial artery grafts (Group B,
n = 26). Multi-detector row computed tomography coronary angiography was
scheduled at 1 and 5. years postoperatively. Each distal anastomosis was
accepted as nonfunctional if a radial artery graft was occluded proximally
or there was a critical stenosis. One sequential radial artery graft and
two single radial artery grafts failed in the 1-year period (p>. 0.05). In
the 5-year period, three radial artery grafts failed in each group (p>.
0.05). In Group A, there was no mortality in the five-year period, but in
Group B, one patient died four years after the operation due to cardiac
problems (p>. 0.05). In addition to one death in Group B, there were three
percutaneous interventions and two myocardial infarctions among the 26
patients during the five-year follow-up. In group A, among 27 patients,
there were 4 percutaneous interventions and one myocardial infarction (p>.
0.05). Although the sample size is relatively small to be conclusive,
these data suggest that sequential radial artery grafting may be
considered as a method of choice for maximizing arterial graft survival
and patency. Noninvasive control of sequential and single radial artery
grafts with multi-detector row computed tomography is feasible with no
discomfort for the patient and excellent visualization of grafts. 2012.
<8>
Accession Number
2012535877
Authors
Hellstrom J. Owall A. Sackey P.V.
Institution
(Hellstrom, Owall) Institution of Molecular Medicine and Surgery, Section
of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet,
Stockholm, Sweden
(Sackey) Institution of Physiology and Pharmacology, Section of
Anesthesiology and Intensive Care Medicine, Karolinska Institutet,
Stockholm, Sweden
Title
Wake-up times following sedation with sevoflurane versus propofol after
cardiac surgery.
Source
Scandinavian Cardiovascular Journal. 46 (5) (pp 262-268), 2012. Date of
Publication: October 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objectives. Intravenous sedation in the intensive care unit (ICU) may
contribute to altered consciousness and prolonged mechanical ventilation.
We tested the hypothesis that replacing intravenous propofol with inhaled
sevoflurane for sedation after cardiac surgery would lead to shorter
wake-up times, quicker patient cooperation, and less delusional memories.
Design. Following coronary artery bypass surgery with cardiopulmonary
bypass, 100 patients were randomized to sedation with sevoflurane via the
anesthetic conserving device or propofol. Study drugs were administered
for a minimum of 2 hours until criteria for extubation were met. Primary
endpoints were time from drug stop to extubation and to adequate verbal
response. Secondary endpoints were adverse recovery events, memories
reported in the ICU Memory Tool test, and ICU/hospital stay. Results.
Median time from drug stop to extubation (interquartile range/total range)
was shorter after sevoflurane compared to propofol sedation; 10 (10/100)
minutes versus 25 (21/240) minutes (p <0.001). Time from extubation to
adequate verbal response was shorter (p 0.036). No differences were found
in secondary endpoints. Conclusions. Sevoflurane sedation after cardiac
surgery leads to shorter wake-up times and quicker cooperation compared to
propofol. No differences were seen in ICU-stay, adverse memories or
recovery events in our short-term sedation. 2012 Informa Healthcare.
<9>
Accession Number
2012535876
Authors
Juhl A.A. Koudahl V. Damsgaard T.E.
Institution
(Juhl, Koudahl, Damsgaard) Department of Plastic Surgery, Aarhus
University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark
Title
Deep sternal wound infection after open heart surgery reconstructive
options.
Source
Scandinavian Cardiovascular Journal. 46 (5) (pp 254-261), 2012. Date of
Publication: October 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objectives. The management of sternal defects arisen after deep sternal
wound infection is challenging and often requires extensive
interdisciplinary teamwork between plastic and thoracic surgeons. In this
study, the published literature on methods used to reconstruct sternal
defects arisen as a result of deep sternal wound infection after
open-heart surgery will be reviewed. Design. The Cochrane, Embase, PubMed,
and SveMed databases were searched in December 2011. Only papers regarding
treatment of deep sternal wound infection after open-heart surgery in
adults were included. Results. The literature search identified 224
original papers that met the inclusion criteria. The majority dealt with
surgical techniques. None of the studies regarding reconstructive options
were designed as randomized controlled trials, and the levels of evidence
are generally low. Conclusion. The treatment of deep sternal wound
infection has evolved considerably, but there is still little consensus
regarding optimal surgical management and a general lack of a standard
treatment protocol. The use of muscle flap transposition is well
documented. Recent studies recommend the use of topical negative pressure
therapy as an adjunct to surgical reconstruction. 2012 Informa
Healthcare.
<10>
Accession Number
2012538110
Authors
Martins G.F. Filho A.G.S. Santos J.B.F. Assuncao C.R.C. Vieira F.B.
Valencia A. de Carvalho K.G. Jessen B.
Institution
(Martins, Filho, Santos, Assuncao, Vieira, Valencia, de Carvalho, Jessen)
Instituto de Cardiologia Aloysio de Castro, Rio de Janeiro, RJ, Brazil
(Martins, Filho, Santos, Assuncao, Vieira, Valencia, de Carvalho, Jessen)
Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
Title
Trimetazidine and inflammatory response in coronary artery bypass
grafting.
Source
Arquivos Brasileiros de Cardiologia. 99 (2) (pp 688-696), 2012. Date of
Publication: August 2012.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
Background: Organic inflammatory response is a pathophysiological
mechanism present at every coronary artery bypass grafting with
extracorporeal circulation (CABG ECC), the release of inflammatory
mediators being one of itsdefense mechanisms. Objective: To assess, in a
prospective double-blind randomized and placebo-controlled study, the
effects of trimetazidine (Tmz) on the inflammatory response, by using the
variation in interleukins 6 and 8, TNF-alpha, complements C3 and C5, and
highly sensitive C-reactive protein (HS-CRP) levels in the pre- and
post-operative periods. Methods: This study assessed 30 patients
undergoing CABG-ECC with intermittent hypothermic cardioplegia, and
having, at most, mild ventricular dysfunction. The patients were divided
into two groups (placebo and Tmz), stratified by echocardiography, and
received drug/placebo at the dose of 60 mg/day. Measurements were taken as
follows: in the pre-operative period with no drug; on the day of surgery,
corresponding to 12 to 15 days on drug/placebo; five minutes after aortic
unclamping; 12 and 24 hours after surgery, for interleukins and
complements; and 48 hours after surgery, for HS-CRP. Results: No
significant difference between the levels of interleukin 8, TNF-alpha, C3
and C5, and HS-CRP was observed. However, the interleukin 6 levels were
significantly lower in the group treated as compared with those in the
control group at all time points assessed. Conclusion: Trimetazidine
proved to be effective only for reducing interleukin 6 in patients
undergoing CABG.
<11>
Accession Number
2012537302
Authors
Li J. Zheng H.
Institution
(Li, Zheng) Department of Anesthesia, The First Hospital, Xinjiang Medical
University, Xin Jiang 830054, China
Title
Influence of myocardial injury markers on the mortality after coronary
artery bypass grafting: A meta-analysis.
Source
Chinese Journal of Evidence-Based Medicine. 12 (7) (pp 777-784), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To evaluate the influences of myocardial injury markers on the
short-term and long-term mortality after coronary artery bypass grafting
(CABG), so as to provide valuable references for clinical prognosis
assessment. Methods Literature was electronically searched in CBM, PubMed,
OVID, EMbase and CNKI from the date of their establishment to August 2011,
meanwhile the manual searches were also performed to systemize the papers.
According to the Cochrane Handbook for systematic reviews, the studies
were screened by two reviewers independently, the quality of the included
studies was evaluated, the data were extracted, and meta-analysis was
conducted using RevMan5.0 software. Results A total of 10 observational
studies including creatine kinase-myocardial band (CK-MB) and cardiac
troponin I (cTnI), and the patients involved were 10 793 totally. Results
of meta-analysis showed that the increasing release of CK-MB was
associated with an increasing short-term mortality risk of both on-pump
(RR=2.88, 95%CI 1.94 to 4.28, P<0.000 01) and off-pump group (RR=3.64,
95%CI 1.07 to 12.42), P=0.04). Also the increasing release of CK-MB was
associated with an increasing long-term mortality risk of both on-pump
(RR=2.55, 95%CI 1.91 to 3.40, P<0.000 01) and offpump group (RR=3.36,
95%CI1.46 to 7.72, P=0.004). The increasing release of cTnI was also
associated with an increasing risk of both short-term mortality (RR=6.45,
95%CI 2.50 to 16.66, P<0.1) and long-term mortality (RR=4.18, 95%CI 2.78
to 6.28, P<0.1). Conclusion The evidence shows that the increasing release
of both CK-MB and cTnI is associated with an increasing risk of the
short-term and long-term mortality. 2012 Editorial Board of Chin J
Evid-based Med.
<12>
Accession Number
2012536473
Authors
Ben-Dor I. Dvir D. Barbash I.M. Okubagzi P. Torguson R. Xue Z. Lindsay J.
Satler L.F. Pichard A.D. Waksman R.
Institution
(Ben-Dor, Dvir, Barbash, Okubagzi, Torguson, Xue, Lindsay, Satler,
Pichard, Waksman) Division of Cardiology, Washington Hospital Center,
Washington, DC, United States
Title
Outcomes of patients with severe aortic stenosis at high surgical risk
evaluated in a trial of transcatheter aortic valve implantation.
Source
American Journal of Cardiology. 110 (7) (pp 1008-1014), 2012. Date of
Publication: 01 Oct 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Recent randomized clinical trials have demonstrated that transcatheter
aortic valve implantation (TAVI) reduces mortality in high-risk patients
with aortic stenosis who are not candidates for aortic valve replacement
(AVR). In similar patients who are acceptable candidates for AVR, TAVI
provides equivalent outcomes to AVR. In this study, 900 patients with
severe aortic stenosis at high surgical risk were evaluated as possible
candidates for TAVI. Of these, 595 (66.1%) had neither TAVI nor AVR and
constituted the medical arm. In addition to the best available
conservative care, 345 patients (39.3%) in this group had balloon aortic
valvuloplasty. The AVR arm consisted of 146 patients (16.2%) and the TAVI
arm of 159 patients (17.6%). The AVR group had significantly lower
clinical risk compared to the medical and TAVI groups, with lower mean
age, Society of Thoracic Surgeons score, and logistic European System for
Cardiac Operative Risk Evaluation score. Patients in the medical and
balloon aortic valvuloplasty group had significantly higher B-type
natriuretic peptide levels compared to those in the AVR and TAVI groups
and had, on average, lower ejection fractions. The medical and balloon
aortic valvuloplasty group was followed for a median of 206 days; the
mortality rate was 46.6% (n = 277). The AVR group was followed for 628
days; 39 patients died (26.7%). In 399 days of follow-up, the mortality
rate in the TAVI group was 30.8% (n = 49). In conclusion, patients with
severe AS who did not undergo TAVI or AVR had high mortality. In properly
selected patients, TAVI and AVR improve outcomes. Renal failure is the
strongest correlate for adverse outcomes, irrespective of treatment group.
2012 Published by Elsevier Inc.
<13>
Accession Number
70878755
Authors
Huang A. Mallet L.
Institution
(Huang) Geriatric Medicine, McGill University Health Centre, Montreal, QC,
Canada
(Mallet) University of Montreal, Faculty of Pharmacy, Montreal, QC, Canada
Title
The medication reconciliation process: Keys to success.
Source
European Geriatric Medicine. Conference: 8th Congress of the European
Union Geriatric Medicine Society Brussels Belgium. Conference Start:
20120926 Conference End: 20120928. Conference Publication: (var.pagings).
3 (pp S113), 2012. Date of Publication: September 2012.
Publisher
Elsevier Masson SAS
Abstract
Introduction.- The medication reconciliation process is a required
organizational practice mandated by the hospital accreditation
organizations in both Canada and the United States. However, the evidence
of the effectiveness and efficiency of this intervention as a standard
operating procedure across a general hospital, for all patients is
questionable. Method.- Cluster randomized controlled trial in two adult
sites within an academic hospital. Five service pairs = Geriatrics,
General Internal Medicine, General Surgery, Cardiac/Thoracic Surgery and
Urology/ENT/Vascular Surgery. Cohort = 3714 adults who are covered by the
provincial drug insurance plan, admitted to the study sites. Study
initiated February 2012. Intervention = use of a customdeveloped web
application which electronically collects both the medications dispensed
in the community and the active hospital medications profile. The
application also includes a computerassisted tool to validate the
community medications, generate the best possible medication history,
perform a reconciliation against the in-hospital list and generate a
discharge prescription. On discharge, communication of stops, changes and
additions to the community medication list is sent to the dispensing
pharmacies and prescribing physicians. Outcome = decreased in adverse
events, return to Emergency Department and readmission to hospital 30-
days post discharge compared to controls. Results.- Preliminary data
showed that pharmacists spent 88+/-38 min completing the best possible
medication history and physicians spent 28+/-23 min doing medication
reconciliation and generating a final discharge prescription. Conclusion.-
Once full results are obtained and the analyses are completed better
targeting parameters (patient, service, area) will be clarified, to make
best use of this important intervention to improve patient safety.
<14>
Accession Number
70878424
Authors
Ettema R. Van Koeven H. Peelen L. Schuurmans M.
Institution
(Ettema) Healthcare, University of Applied Science Utrecht, Utrecht,
Netherlands
(Van Koeven) Division of Anesthesiology, Intensive Care and Emergency
Medicine, University Medical Center Utrecht, Utrecht, Netherlands
(Peelen) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
(Schuurmans) Nursing Research, University Medical Center Utrecht, Utrecht,
Netherlands
Title
Preadmission interventions preventing postoperative complications in older
cardiac surgery patients: A systematic review of the literature.
Source
European Geriatric Medicine. Conference: 8th Congress of the European
Union Geriatric Medicine Society Brussels Belgium. Conference Start:
20120926 Conference End: 20120928. Conference Publication: (var.pagings).
3 (pp S8-S9), 2012. Date of Publication: September 2012.
Publisher
Elsevier Masson SAS
Abstract
Objective(s).- The literature on postoperative complications in cardiac
surgery patients shows high incidences of delirium, depression, pressure
ulcers, hospital infections, postoperative pulmonary complications and
atrial fibrillation. These complications are associated with functional
and cognitive decline and a decrease in the quality of life and well-being
after discharge. It is unclear how older cardiac surgery patients can best
be prepared for their hospital admission with cardiac surgery. Therefore,
we aimed to provide an overview of preadmission interventions designed to
prevent postoperative complications or adverse events in older elective
cardiac surgery patients. Methods.- We systematically reviewed the
literature following the PRISMA statement guidelines. Results.- of 1,335
initial citations, 31 were subjected to critical appraisal. Finally, 23
studies were included, of which we derived a list of interventions that
were applied in the preadmission period. These interventions, some ofwhich
are have multiple components, have been shown to effectively reduce
postoperative depression, infection and postoperative pulmonary
complications in older elective cardiac surgery patients. No studies of
good quality were found that described effective interventions to prevent
postoperative delirium.We did not find any studies that targeted the
prevention of pressure ulcers in older cardiac surgery patients.
Conclusions.- There are interventions that prevent the occurrence of
postoperative depression (comprehensive approaches), postoperative
pulmonary complications (comprehensive approach) and infection (combined
disinfection with CHX and immuneenhancing nutritional supplement) in older
patients undergoing cardiac surgery. Unfortunately, there are no studies
of strong or moderate evidence that have demonstrated effective strategies
preventing delirium or pressure ulcers in these patients.
<15>
Accession Number
70877999
Authors
Cholette J.M. Powers K.S. Alfieris G.M. Angona R. Henrichs K.F. Masel D.S.
Swartz M. Daugherty L.E. Belmont K. Blumberg N.
Institution
(Henrichs, Masel, Blumberg) Transfusion Medicine, University of Rochester
Medical Center, Rochester, NY, United States
(Cholette, Powers, Daugherty) Pediatrics, University of Rochester Medical
Center, Rochester, NY, United States
(Alfieris, Angona, Swartz, Belmont) Surgery, University of Rochester
Medical Center, Rochester, NY, United States
Title
Transfusion of salvaged blood in pediatric heart surgery reduces
allogeneic transfusions: A prospective, randomized trial.
Source
Transfusion. Conference: AABB Annual Meeting and CTTXPO 2012 Boston, MA
United States. Conference Start: 20121006 Conference End: 20121009.
Conference Publication: (var.pagings). 52 (pp 121A), 2012. Date of
Publication: September 2012.
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: There are no randomized trials evaluating the
impact of blood conservation via intra-operative cell saver blood salvage
on post-operative allogeneic transfusion needs of newborns and infants. We
hypothesized that transfusion of salvaged blood from the bypass circuit,
washed and stored at the bedside in a simple temperature controlled cooler
for 24 hours post-operatively, would decrease the number of post-operative
allogeneic RBC transfusions and donor exposures without increasing the
risk of nosocomial infection. Study Design/Methods: A prospective,
randomized, controlled, clinical trial was conducted in the pediatric
cardiac intensive care unit of a teaching hospital. Neonates and infants
(n = 106) with congenital heart disease undergoing cardiac surgical repair
or palliation with cardiopulmonary bypass were randomized to a cell saver
transfusion group, where salvaged blood was available for re-infusion up
to 24 hours post-collection, or to a control group. Cell saver subjects
received salvaged blood for volume replacement and/or anemia therapy.
Control subjects received crystalloid or albumin for volume replacement
and RBCs for anemia with hemodynamic instability or impaired oxygen
utilization, per the current standard of care. Blood transfusions and
donor exposures, and clinical outcomes were compared between treatment
groups. Results/Findings: Children randomized to the cell saver group
received significantly fewer allogeneic RBC transfusions (cell saver: 0.19
+/- 0.44 [SD] vs. control: 0.75 +/- 1.2; p = 0.003) and
platelet/plasma/cryoprecipitate transfusions in the first 48 hours post-op
(cell saver: 0.09 +/- 0.45 vs. control: 0.62 +/- 1.4; p = 0.013). The
total number of allogeneic donor exposures over the entire hospitalization
was significantly less in the cell saver group when compared to controls
(cell saver: 0.83 +/- 1.7 v. control: 2.7 +/- 5.3; p = 0.018). There were
no significant clinical outcome differences. Conclusion: Cell saver
salvaged blood can be safely stored at the bedside and available for
re-infusion for up to 24 hours post-collection. Administration of cell
saver blood significantly reduces the number of allogeneic RBC and
hemostatic component transfusions in the immediate post-operative period
and reduces total donor exposures. Reduction of allogeneic blood
transfusions may also have the potential to reduce transfusion-associated
complications and improve clinical outcomes.
No comments:
Post a Comment