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<1>
Accession Number
2013017094
Authors
Van Der Linden P. James M. Mythen M. Weiskopf R.B.
Institution
(Van Der Linden) Service D'Anesthesiologie-Reanimation, CHU Brugmann,
Bruxelles, Belgium
(James, Mythen) University College London, University College London and
Royal Free London NHS Foundation Trust, Research Support Centre, London,
United Kingdom
(Mythen) University College London Hospitals NHS Foundation Trust,
University College London and Royal Free London NHS Foundation Trust,
Research Support Centre, London, United Kingdom
(Mythen) Department of Health, Enhanced Recovery Partnership, London,
United Kingdom
(Weiskopf) Department of Anesthesia and Perioperative Care, University of
California, San Francisco, San Francisco, CA 94143, United States
Title
Safety of modern starches used during surgery.
Source
Anesthesia and Analgesia. 116 (1) (pp 35-48), 2013. Date of Publication:
January 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Various hydroxyethyl starch (HES) preparations have been used for decades
to augment blood volume. There has been concern recently regarding
possible adverse outcomes when using HES in the intensive care setting,
especially in patients with septic shock. However, the pharmacokinetic and
pharmacodynamic properties of HES preparations depend on their chemical
composition and source material. Thus, different clinical conditions could
result in differing effectiveness and safety for these preparations.
Consequently, we assessed the safety of tetrastarches when used during
surgery, using a formal search, that yielded 59 primary full publications
of studies that met a priori inclusion criteria and randomly allocated
4529 patients with 2139 patients treated with tetrastarch compared with
2390 patients treated with a comparator. There were no indications that
the use of tetrastarches during surgery induces adverse renal effects as
assessed by change or absolute concentrations of serum creatinine or need
for renal replacement therapy (39 trials, 3389 patients), increased blood
loss (38 trials, 3280 patients), allogeneic erythrocyte transfusion (20
trials, 2151 patients; odds ratio for HES transfusion 0.73 [95% confidence
interval = 0.61-0.87], P = 0.0005), or increased mortality (odds ratio for
HES mortality = 0.51 [0.24-1.05], P = 0.079). Copyright 2012
International Anesthesia Research Society.
<2>
[Use Link to view the full text]
Accession Number
2013022873
Authors
Andrassy J. Hoffmann V.S. Rentsch M. Stangl M. Habicht A. Meiser B.
Fischereder M. Jauch K.-W. Guba M.
Institution
(Andrassy, Rentsch, Stangl, Jauch, Guba) Department of Surgery, University
Hospital Grosshadern, Ludwig Maximilian's University, Munich, Germany
(Hoffmann) Institute of Medical Information Sciences, Biometry and
Epidemiology (IBE), Ludwig-Maximilian's-University, Munich, Germany
(Habicht, Meiser) Transplant Center Munich, University Hospital
Grosshadern, Ludwig Maximilian's University, Munich, Germany
(Fischereder) Medizinische Klinik und Poliklinik IV, University Hospital
Grosshadern, Ludwig Maximilian's University, Munich, Germany
Title
Is cytomegalovirus prophylaxis dispensable in patients receiving an mtor
inhibitor-based immunosuppression? a systematic review and meta-analysis.
Source
Transplantation. 94 (12) (pp 1208-1217), 2012. Date of Publication: 27 Dec
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Cytomegalovirus (CMV) is a common opportunistic infection
after solid organ transplantation. Cytomegalovirus causes increased
morbidity, mortality, and reduced allograft survival. Prophylaxis may help
control the virus but is associated with substantial side effects and does
not completely prevent virus reactivation; relapses after cessation of the
prophylaxis are frequent. Experimental and clinical data suggest that mTOR
inhibitors may have an anti-CMV effect. Here, we present a meta-analysis
of clinical trials after solid organ transplantation and describe
potential mechanisms involved in the anti-CMV effect of mTOR-inhibitors.
Methods: The current literature was reviewed for randomized controlled
trials in solid organ transplantation comparing an mTOR-I with a
non-mTOR-I (CNI based) treatment. The scientific quality of the trials was
assessed by the Jadad score, the use of an effective allocation
concealment (AC) and the existence of an intention-to-treat (ITT)
analysis. Cytomegalovirus incidence was assessed in studies comparing 1)
an mTOR-I-based with a CNI-based immunosuppression (10 trials, n=3,100
patients) and 2) an mTOR-I/CNI combination therapy with a CNI-based
immunosuppression (15 trials, n=7,100 patients). Results: In the first
meta-analysis, CMV events after solid organ transplantation occurred
significantly more often under CNIs (RR=2.27). The second meta-analysis
comparing the mTOR-I + CNI combination with a CNI treatment in 15 trials
of kidney, heart, and liver transplantation showed again a higher CMV
incidence when patients received an mTOR-I free immunosuppression
(RR=2.45). Conclusions: mTOR-inhibitor treatment either alone or in
combination with CNIs reduces significantly the CMV incidence after organ
transplantation. With the use of an mTOR-inhibitor, CMV prophylaxis may be
dispensible. 2012 Lippincott Williams & Wilkins.
<3>
Accession Number
2013025656
Authors
Sen H. Tandjung K. Basalus M.W.Z. Lowik M.M. Van Houwelingen G.K. Stoel
M.G. Louwerenburg H.W. De Man F.H.A.F. Linssen G.C.M. Nijhuis R. Nienhuis
M.B. Verhorst P.M.J. Van Der Palen J. Von Birgelen C.
Institution
(Sen, Tandjung, Basalus, Lowik, Van Houwelingen, Stoel, Louwerenburg, De
Man, Verhorst, Von Birgelen) Thoraxcentrum Twente, Department of
Cardiology, MST, Haaksbergerstraat 55, 7513ER Enschede, Netherlands
(Von Birgelen) MIRA, Institute for Biomedical Technology and Technical
Medicine, University of Twente, Enschede, Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Almelo,
Netherlands
(Nijhuis) Department of Cardiology, Ziekenhuisgroep Twente, Hengelo,
Netherlands
(Nienhuis) Department of Cardiology, Streekziekenhuis Koningin Beatrix,
Winterswijk, Netherlands
(Van Der Palen) Department of Epidemiology, Medisch Spectrum Twente,
Enschede, Netherlands
(Van Der Palen) Department of Research Methodology, Measurement and Data
Analysis, University of Twente, Enschede, Netherlands
Title
Comparison of eligible non-enrolled patients and the randomised TWENTE
trial population treated with Resolute and XIENCE v drug-eluting stentsz.
Source
EuroIntervention. 8 (6) (pp 664-671), 2012. Date of Publication: October
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The TWENTE trial recently enrolled more than 80% of all eligible
patients, who were randomised to zotarolimus-eluting Resolute or
everolimus-eluting XIENCE V stents. In the present study, we investigated
whether eligible, non-enrolled patients differed from the randomised
TWENTE trial population in baseline characteristics and one-year outcome.
Methods and results: Characteristics of 1,709 eligible patients were
analysed. Independent external adjudication of clinical events was
likewise performed for non-enrolled (n=318) and randomised patients
(n=1,391). Non-enrolled and randomised patients did not differ in gender
distribution, diabetes mellitus, and clinical presentation, but differed
significantly in age and cardiovascular history. Nevertheless, clinical
outcome after one year did not differ in the primary composite endpoint
target-vessel failure (TVF; 9.8% vs. 8.1%; p=0.34), and its components
cardiac death (1.6% vs. 1.2%; p=0.61), target vessel-related myocardial
infarction (4.7% vs. 4.6%; p=0.92), and target-vessel revascularisation
(3.8% vs. 3.0%; p=0.48). Previous bypass surgery predicted TVF in
non-enrolled patients (p=0.001); removal of these patients resulted in
identical TVF rates for non-enrolled and randomised patients (7.3% vs.
7.3%; p=0.99). Conclusions: Despite some differences in baseline
characteristics, non-enrolled and randomised patients did not differ in
one-year outcome, which was favourable for both populations and may be
related to the drug-eluting stents used. Europa Digital & Publishing
2012. All rights reserved.
<4>
Accession Number
2013025649
Authors
Zhang Y. Farooq V. Garcia-Garcia H.M. Bourantas C.V. Tian N. Dong S. Li M.
Yang S. Serruys P.W. Chen S.-L.
Institution
(Zhang, Tian, Li, Yang, Chen) Division of Cardiovascular Diseases, Nanjing
First Hospital, Nanjing Medical University, Nanjing, China
(Zhang, Farooq, Garcia-Garcia, Bourantas, Serruys) Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
(Dong) Soochow University, Suzhou, China
Title
Comparison of intravascular ultrasound versus angiography-guided
drug-eluting stent implantation: A meta-analysis of one randomised trial
and ten observational studies involving 19,619 patients.
Source
EuroIntervention. 8 (7) (pp 855-865), 2012. Date of Publication: November
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The impact of intravascular ultrasound (IVUS) guided coronary
drug-eluting stent (DES) implantation on clinical outcomes remains
controversial. A meta-analysis of the currently available clinical trials
investi-gating IVUS-guided DES implantation was undertaken. Methods and
results: We searched Medline, the Cochrane Library and other internet
sources, without language or date restrictions, for published articles
comparing clinical outcomes between IVUS-guided and angiography-guided DES
implantation. Clinical studies with both adjusted and unadjusted data were
included. Eleven studies were identified (one randomised controlled trial
and 10 registries) and included in the meta-analysis with a weighted
follow-up time of 20.7+/-11.5 months. Compared with angiography guid-ance,
IVUS-guided DES implantation was associated with a reduced incidence of
death (hazard ratio [HR]: 0.59, 95% confidence interval [CI]: 0.48-0.73,
p<0.001), major adverse cardiac events (HR: 0.87, 95% CI: 0.78-0.96,
p=0.008) and stent thrombosis (HR: 0.58, 95% CI: 0.44-0.77, p<0.001). The
incidence of myocar-dial infarction (HR: 0.82, 95% CI: 0.63-1.06,
p=0.126), target lesion (HR: 0.90, 95% CI: 0.73-1.11, p=0.316) and target
vessel (HR: 0.90, 95% CI: 0.77-1.05, p=0.195) revascularisation was
comparable between the angiography and IVUS-guided arms. A repeat
meta-analysis of propensity-matched studies only (six studies, n=5,300)
yielded broadly similar results in terms of clinical outcomes.
Conclusions: IVUS-guided coronary DES implantation is associated with a
significant reduction in death, MACE and stent thrombosis compared to
angiography guidance. Appropriately powered randomised trials are
necessary to confirm the findings from this meta-analysis. Europa Digital
& Publishing 2012. All rights reserved.
<5>
Accession Number
2013025642
Authors
Xu B. Dou K. Yang Y. Lv S. Wang H. Li Z. Wang L. Chen Y. Huo Y. Li W.
Kirtane A.J. Gao R.
Institution
(Xu, Dou, Yang, Li, Gao) Department of Cardiology, Fu Wai Hospital,
National Centre for Cardiovascular Diseases of China, No.167, Beilishi
Road, Xicheng District, Beijing, 100037, China
(Lv, Wang, Chen) Capital Medical University, Beijing, China
(Wang) 4th Military Medical University, Xi'an, China
(Li) Liaoning Provincial People's Hospital, Shenyang, China
(Wang) Chinese PLA Medical University, Beijing, China
(Huo) Peking University First Hospital, Beijing, China
(Kirtane) Columbia University Medical Center, New York, NY, United States
Title
Nine-month angiographic and 2-year clinical follow-up of the NOYA
biodegradable polymer sirolimus-eluting stent in the treatment of patients
with de novo native coronary artery lesions: The NOYA I trial.
Source
EuroIntervention. 8 (7) (pp 796-802), 2012. Date of Publication: November
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: This study sought to evaluate the safety and efficacy of the NOYA
stent which is a cobalt chromium-based sirolimus-eluting stent (SES) with
DL-polylactide biodegradable polymer (Medfavour Medical, Beijing, China)
in treating de novo coronary artery lesions. Methods and results: The NOYA
I trial was designed to compare the NOYA stent with the FIREBIRD2 stent, a
durable polymer SES widely used in China (MicroPort Medical, Shanghai,
China); the trial was a non-inferiority trial with a primary angiographic
endpoint of the in-stent late lumen loss (LLL) at nine-month follow-up.
The secondary endpoints were binary restenosis rates within nine months,
major adverse cardiac events (MACE) defined as the composite of cardiac
death, myocardial infarction (MI) or target lesion revascularisation
(TLR), and definite/probable stent thrombosis (ST) at 24-month follow-up.
A total of 300 patients (n=150 in each group) were enrolled in the study
from 16 Chinese centres. The LLL in the NOYA group at nine-month follow-up
was similar to the FIREBIRD2 group (0.11+/-0.18 mm vs. 0.14+/-0.23 mm,
p=0.16; non-inferiority p<0.001). The rates of MACE, death, MI and TLR at
24-month follow-up were comparable between these two devices (p>0.05,
respectively). Conclusions: The biodegradable polymer NOYA stent was
non-inferior to the FIREBIRD2 durable polymer stent with respect to the
primary non-inferiority endpoint of in-stent LLL at nine-month follow-up.
Clinical outcomes at 24-month follow-up were comparable between the two
stents. (ClinicalTrials.gov number, NCT01226355) Europa Digital &
Publishing 2012. All rights reserved.
<6>
Accession Number
2013008594
Authors
Diletti R. Farooq V. Girasis C. Bourantas C. Onuma Y. Heo J.H. Gogas B.D.
Van Geuns R.-J. Regar E. De Bruyne B. Dudek D. Thuesen L. Chevalier B.
McClean D. Windecker S. Whitbourn R.J. Smits P. Koolen J. Meredith I. Li
X. Miquel-Hebert K. Veldhof S. Garcia-Garcia H.M. Ormiston J.A. Serruys
P.W.
Institution
(Diletti, Farooq, Girasis, Bourantas, Onuma, Heo, Gogas, Van Geuns, Regar,
Serruys) Department of Interventional Cardiology, Thoraxcenter, Erasmus
MC, Rotterdam, Netherlands
(De Bruyne) Department of Interventional Cardiology, Cardiovascular Center
Aalst, Aalst, Belgium
(Dudek) Department of Cardiology, Jagiellonian University, Krakow, Poland
(Thuesen) Department of Cardiology, Skejby Sygehus, Aarhus University
Hospital, Skejby, Aarhus, Denmark
(Chevalier) Department of Cardiology, Institut Hospitalier Jacques
Cartier, Massy, France
(McClean) Department of Cardiology, Christchurch Hospital, Christchurch,
New Zealand
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Whitbourn) Department of Cardiology, St. Vincents Hospital, Fitzroy, VIC,
Australia
(Smits) Department of Interventional Cardiology, Maasstad Ziekenhuis
Rotterdam, Rotterdam, Netherlands
(Koolen) Department of Interventional Cardiology, Catharina Ziekenhuis,
Eindhoven, Netherlands
(Meredith) Department of Interventional Cardiology, Monash Medical Centre,
VIC, Australia
(Li) Abbott Vascular, Santa Clara, CA, United States
(Miquel-Hebert, Veldhof) Abbott Vascular, Diegem, Belgium
(Garcia-Garcia) Cardialysis B.V., Rotterdam, Netherlands
(Ormiston) Department of Cardiology, Auckland City Hospital, Auckland, New
Zealand
Title
Clinical and intravascular imaging outcomes at 1 and 2 years after
implantation of absorb everolimus eluting bioresorbable vascular scaffolds
in small vessels. Late lumen enlargement: Does bioresorption matter with
small vessel size? Insight from the ABSORB cohort B trial.
Source
Heart. 99 (2) (pp 98-105), 2013. Date of Publication: January 2013.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background: The long-term results after second generation everolimus
eluting bioresorbable vascular scaffold (Absorb BVS) placement in small
vessels are unknown. Therefore, we investigated the impact of vessel size
on long-term outcomes, after Absorb BVS implantation. Methods: In ABSORB
Cohort B Trial, out of the total study population (101 patients), 45
patients were assigned to undergo 6-month and 2-year angiographic
follow-up (Cohort B1) and 56 patients to have angiographic follow-up at
1-year (Cohort B2). The prereference vessel diameter (RVD) was <2.5 mm
(small-vessel group) in 41 patients (41 lesions) and >=2.5 mm
(large-vessel group) in 60 patients (61 lesions). Outcomes were compared
according to pre-RVD. Results: At 2-year angiographic follow-up no
differences in late lumen loss (0.29+/-0.16 mm vs 0.25+/-0.22 mm,
p=0.4391), and in-segment binary restenosis (5.3% vs 5.3% p=1.0000) were
demonstrated between groups. In the small-vessel group, intravascular
ultrasound analysis showed a significant increase in vessel area
(12.25+/-3.47 mm<sup>2</sup> vs 13.09+/-3.38 mm<sup>2</sup> p=0.0015),
scaffold area (5.76+/-0.96 mm<sup>2</sup> vs 6.41+/-1.30 mm<sup>2</sup>
p=0.0008) and lumen area (5.71+/-0.98 mm<sup>2</sup> vs 6.20+/-1.27 mm
<sup>2</sup> p=0.0155) between 6-months and 2-year follow-up. No
differences in plaque composition were reported between groups at either
time point. At 2-year clinical follow-up, no differences in
ischaemia-driven major adverse cardiac events (7.3% vs 10.2%, p=0.7335),
myocardial infarction (4.9% vs 1.7%, p=0.5662) or ischaemia-driven target
lesion revascularisation (2.4% vs 8.5%, p=0.3962) were reported between
small and large vessels. No deaths or scaffold thrombosis were observed.
Conclusions: Similar clinical and angiographic outcomes at 2-year
follow-up were reported in small and large vessel groups. A significant
late lumen enlargement and positive vessel remodelling were observed in
small vessels.
<7>
Accession Number
2013024807
Authors
Greisen J. Nielsen D.V. Sloth E. Jakobsen C.-J.
Institution
(Greisen, Nielsen, Sloth, Jakobsen) Department of Anaesthesiology and
Intensive Care, Aarhus University Hospital Skejby, DK-8200 Aarhus N,
Denmark
Title
High thoracic epidural analgesia decreases stress hyperglycemia and
insulin need in cardiac surgery patients.
Source
Acta Anaesthesiologica Scandinavica. 57 (2) (pp 171-177), 2013. Date of
Publication: February 2013.
Publisher
Blackwell Munksgaard (1 Rosenorns Alle, P.O. Box 227, Copenhagen V
DK-1502, Denmark)
Abstract
Objective Assuming that high thoracic epidural analgesia (HTEA) with the
sympathetic block might decrease postoperative blood glucose (BG) level
and reduce the need of insulin, the aim was to evaluate the effect of HTEA
on the BG level and insulin requirement in patients undergoing cardiac
surgery. Materials and methods Forty-two low-risk patients age 65-79 years
scheduled for elective coronary artery bypass grafting with or without
aortic valve replacement were randomised to receive HTEA as supplement for
general anaesthesia. BG and lactate were measured before and after
cardiopulmonary bypass and postoperatively at least every 3 h together
with administration of insulin. Postoperative pain was evaluated 30 min,
2, 4 and 6 h after extubation, and before discharge from the intensive
care unit. Results Overall BG levels showed great variation over time (P <
0.001). No statistically significant difference was found in perioperative
BG, but postoperative lower BG levels were found in HTEA patients (P =
0.042). The number of patients not receiving insulin in postoperative
period was significantly higher in HTEA group (9 vs. 2, P = 0.032). No
differences were seen in lactate levels. Patients in the HTEA group had
significant lower pain scores (P < 0.001). Conclusion HTEA preserves
glucose metabolism better and leads to a lesser degree of 'stress
hyperglycaemia' in cardiac surgery patients. 2012 The Authors. Acta
Anaesthesiologica Scandinavica 2012 The Acta Anaesthesiologica
Scandinavica Foundation.
<8>
Accession Number
2013025626
Authors
Wykrzykowska J.J. Diletti R. Gutierrez-Chico J.L. Van Geuns R.J. Van Der
Giessen W.J. Ramcharitar S. Duckers H.E. Schultz C. De Feyter P. Van Der
Ent M. Regar E. De Jaegere P. Garcia-Garcia H.M. Pawar R. Gonzalo N.
Ligthart J. De Schepper J. Van Den Berg N. Milewski K. Granada J.F.
Serruys P.W.
Institution
(Wykrzykowska, Diletti, Gutierrez-Chico, Van Geuns, Van Der Giessen,
Ramcharitar, Duckers, Schultz, De Feyter, Van Der Ent, Regar, De Jaegere,
Garcia-Garcia, Pawar, Gonzalo, Ligthart, Van Den Berg, Serruys) Department
of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam,
Netherlands
(Milewski, Granada) Skirball Center for Cardiovascular Research,
Cardiovascular Research Foundation, Columbia University Medical Center,
New York, NY, United States
(Wykrzykowska) Academic Medical Center, Amsterdam, Netherlands
(De Schepper) Svelte Medical Systems, New Providence, NJ, United States
Title
Plaque sealing and passivation with a mechanical self-expanding low
outward force nitinol vShield device for the treatment of IVUS and
OCT-derived thin cap fibroatheromas (TCFAs) in native coronary arteries:
Report of the pilot study vShield Evaluated at Cardiac hospital in
Rotterdam for Investigation and Treatment of TCFA (SECRITT).
Source
EuroIntervention. 8 (8) (pp 945-954), 2012. Date of Publication: December
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The aim of the pilot SECRITT trial was to evaluate the safety and
feasibility of sealing the high risk IVUS and optical coherence
tomography-derived thin cap fibroatheroma (TCFA), with a dedicated nitinol
self-expanding vShield device. Methods and results: After screening with
angiography, fractional flow reserve (FFR), intravascular ultrasound
virtual histology (IVUS-VH) and optical coherence tomography (OCT), 23
patients met enrolment criteria (presence of non-obstructive VH-derived
TCFA lesion with thin cap on OCT) and were randomised to vShield (n=13)
versus medical therapy (n=10). In the shielded group, baseline percent
diameter stenosis was 33.2+/-13.5%, FFR was 0.93+/-0.06. At six-month
follow-up in shielded patients percent diameter stenosis further decreased
to 18.7+/-16.9% and FFR remained the same 0.93+/-0.05. Average late loss
was 0.24+/-0.13 mm. Average baseline fibrous cap thickness was 48+/-12
mum. After shield placement at six-month follow-up neo-cap formation was
observed with average cap thickness of 201+/-168 mum. There were no
dissections after shield placement and no plaque ruptures. In addition,
mean stent area of 8.76+/-2.16 mm<sup>2</sup> increased to 9.45+/-2.30
mm<sup>2</sup>, that is by 9% at six-month follow-up. The number of
malapposed struts decreased from 10.7% to 7.6% and the number of uncovered
struts at six months was 8.1%. There were no device-related major adverse
cardiovascular events (MACE) events at six-month follow-up. Conclusions:
High risk plaque passivation and sealing with a vShield self-expanding
nitinol device appears feasible and safe. A long-term larger randomised
study with streamlined screening criteria is needed to evaluate the
efficacy of this approach over medical therapy. Europa Digital &
Publishing 2012. All rights reserved.
<9>
Accession Number
2013022246
Authors
Nielsen H.H.M. Klaaborg K.E. Nissen H. Terp K. Mortensen P.E. Kjeldsen
B.J. Jakobsen C.-J. Andersen H.R. Egeblad H. Krusell L.R. Thuesen L.
Hjortdal V.E.
Institution
(Nielsen, Klaaborg, Terp, Hjortdal) Department of Cardiothoracic Surgery,
Aarhus University Hospital, Skejby, Denmark
(Nissen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Mortensen, Kjeldsen) Department of Thoracic Surgery, Odense University
Hospital, Odense, Denmark
(Jakobsen) Department of Anesthesiology, Aarhus University Hospital,
Skejby, Denmark
(Andersen, Egeblad, Krusell, Thuesen) Department of Cardiology, Aarhus
University Hospital, Skejby, Denmark
Title
A prospective, randomised trial of transapical transcatheter aortic valve
implantation vs. surgical aortic valve replacement in operable elderly
patients with aortic stenosis: The STACCATO trial.
Source
EuroIntervention. 8 (3) (pp 383-389), 2012. Date of Publication: July
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: In a prospective randomised trial we aimed to compare transapical
transcatheter aortic valve implantation (a-TAVI) with surgical aortic
valve replacement (SAVR) in operable elderly patients. Methods and
results: The study was designed as a randomised controlled trial of a-TAVI
(Edwards SAPIEN heart valve system; Edwards Lifesciences, Irvine, CA, USA)
vs. SAVR. Operable patients with isolated aortic valve stenosis and an age
>=75 years were included. The primary endpoint was the composite of
all-cause mortality, cerebral stroke and/or renal failure requiring
haemodialysis at 30 days. After advice from the Data Safety Monitoring
Board, the study was prematurely terminated after the inclusion of 70
patients because of an excess of events in the a-TAVI group. The primary
endpoint was met in five a-TAVI patients (two deaths, two strokes, and one
case of renal failure requiring dialysis) vs. one stroke in the SAVR group
(p=0.07). In the a-TAVI group, one patient was converted to SAVR because
of an abnormally positioned heart, and four patients were re-operated with
open heart surgery because of annulus rupture (n=1), severe paravalvular
leakage (n=2), and blockage of the left coronary artery (n=1). In the SAVR
group, one patient was converted to TAVI because of a large intra-thoracic
goitre. Conclusions: Given the limitations of a small prematurely
terminated study, our results suggest that a-TAVI in its present form may
be associated with complications and device success rates in low-risk
patients similar or even inferior to those found in high-risk patients
with aortic valve stenosis. This will probably change in the near future
with improved catheter based devices and better pre-procedural assessment.
Europa Edition 2012. All rights reserved.
<10>
Accession Number
2013022177
Authors
Mookadam F. Raslan S.F. Jiamsripong P. Jalal U. Murad M.H.
Institution
(Mookadam, Raslan, Jiamsripong, Jalal) Division of Cardiovascular
Diseases, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ 85259,
United States
(Murad) Mayo Clinic, Rochester, MN, United States
Title
Percutaneous closure of mitral paravalvular leaks: A systematic review and
meta-analysis.
Source
Journal of Heart Valve Disease. 21 (2) (pp 208-217), 2012. Date of
Publication: March 2012.
Publisher
ICR Publishers Ltd (12/A South Approach, Moor Park, Northwood HA6 2ET,
United Kingdom)
Abstract
Background and aim of the study: The percutaneous closure of mitral
paravalvular leak (PVL) is emerging as an alternative treatment for
high-risk surgical candidates. Several cases have been reported, and a few
small studies have been conducted to investigate the outcome of the
technique. A meta-analysis of the combined data would be considered
helpful in deriving more powerful data; hence, the study aim was to
conduct a meta-analysis of the percutaneous closure of mitral PVLs, as
reported in the medical literature. Methods: Searches were conducted of
the PubMed, Embase, and CINAHL databases for reports of mitral PVL
percutaneous closure. The data were extracted by two reviewers, who
aggregated the information by using a random-effects model. Results: Eight
studies were included in the meta-analysis, with a total of 100 patients.
The percutaneous closure of mitral PVLs was associated with a 15%
cardiovascular mortality during the first year of follow up. Clinical
success was noted in 48% of patients, while 52% failed to show any
clinical improvement. Failures were mainly attributed either to deployment
failure (18%), to the presence of a persistent leak, to hemolysis, or both
(31%). Procedure-related complications (e.g., bleeding, stroke,
endocarditis) were observed in 16% of patients. Conclusion: The
percutaneous closure of mitral PVLs carries a 15% risk of cardiovascular
mortality. The reported mortality rates for surgically treated patients
ranged from 12% to 37%, but most patients who underwent percutaneous
closure were considered high-risk surgical candidates with multiple
comorbidities. While percutaneous closure appears promising, the
development of lesion-specific occluders, standardized imaging techniques
and parameters, and the design of randomized clinical trials to compare
the outcome of surgical versus percutaneous intervention, are required
before any final judgment may be made. Copyright by ICR Publishers 2012.
<11>
Accession Number
2013022098
Authors
Von Oppell U.O. Segadal L. Busund R. Johnston G.G. Dimitrakakis G. Masani
N. Lung T.-H.
Institution
(Von Oppell, Dimitrakakis, Masani) Department of Cardiothoracic Surgery,
University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United
Kingdom
(Segadal) Haukeland University Hospital, Bergen, Norway
(Busund) University Hospital of North Norway HF, Tromso, Norway
(Johnston) St. Joseph Hospital, Tacoma, WA, United States
(Lung) Medtronic, Inc., MN, United States
Title
Aortic annulus diameter and valve design each determine the valve size
implanted.
Source
Journal of Heart Valve Disease. 21 (5) (pp 591-598), 2012. Date of
Publication: September 2012.
Publisher
ICR Publishers Ltd (12/A South Approach, Moor Park, Northwood HA6 2ET,
United Kingdom)
Abstract
Background and aim of the study: The study aim was to compare the sizing
characteristics and hemodynamics of the Medtronic Mosaic Ultra porcine and
Carpentier-Edwards PERIMOUNT Magna bovine pericardial bioprosthetic
stented aortic valves in relation to the patient's true aortic annulus
size. Methods: In this prospective multicenter randomized study, data
acquired perioperatively and at six months postoperatively were collected.
Following aortic valve excision and debridement, the annulus was measured
by blinded sizers prior to the randomization of 141 patients (Ultra, n =
72; Magna, n = 69). Results: The median patient age was 75 years, and 89%
of the patients had aortic stenosis. A good left ventricular function was
present in 75% of patients, and the EuroSCORE-predicted mortality was 9%.
Concomitant procedures (coronary artery bypass grafting, mitral/tricuspid
repair, septal myectomy, modified Maze) were performed in 61% of patients.
The in-hospital mortality was 3%, and at six months postoperatively 96% of
the patients were NYHA class I or II, with no intergroup differences. The
mean 'true aortic annulus' size was 23.0 +/- 1.4 mm for the Ultra valve,
and 22.6 +/- 1.8 mm for the Magna valve (p = NS). The implanted labeled
valve size was >=23 mm for 83% of Ultra valves, and for 52% of Magna
valves (p <0.01), and smaller than the measured true aortic diameter (44%
Magna versus 33% Ultra). The mean echo gradients were lower with Magna
valves (11 +/- 6 mmHg) than with Ultra (17 +/- 6 mmHg; p <0.01), while the
effective orifice area (EOA) was higher with Magna than with Ultra (1.6
+/- 0.4 versus 1.4 +/- 0.4 cm<sup>2</sup>; p <0.01). Both groups showed a
similar left ventricular mass regression (Ultra -48 +/- 83 g; Magna - 42
+/- 70 g). Trivial to moderate regurgitation was noted in 24% of Ultra
valves compared to 48% of Magna valves (p <0.01). Conclusion: Selection of
the Ultra bioprosthetic valve allowed the implantation of larger valve
sizes. However, when compared to the 'true aortic annulus', the Magna was
associated with lower transprosthetic gradients and larger EOAs. The
longer term significance of these observations remains inconclusive in
terms of bioprosthesis selection, however. Copyright by ICR Publishers
2012.
<12>
Accession Number
2013021602
Authors
Mahesh B. Navaratnarajah M. Mensah K. Ilsley C. Amrani M.
Institution
(Mahesh, Navaratnarajah, Mensah, Ilsley, Amrani) Center for Cardiothoracic
Surgery and Transplantation, Harefield Hospital, Harefield, United Kingdom
Title
Mini-sternotomy aortic valve replacement: Is it safe and effective?
Comparison with standard techniques.
Source
Journal of Heart Valve Disease. 20 (6) (pp 650-656), 2011. Date of
Publication: November 2011.
Publisher
ICR Publishers Ltd (12/A South Approach, Moor Park, Northwood HA6 2ET,
United Kingdom)
Abstract
Background and aim of the study: Mini-sternotomy aortic valve replacement
(MSAVR) has been increasingly performed at the authors' institution since
October 2003. The study aim was to compare results obtained with MSAVR to
those following AVR with conventional sternotomy (SAVR). Methods: Between
1998 and 2008, a total of 143 consecutive patients (mean age: 67 +/- 12.5
years) underwent AVR at the authors' institution. Of these patients, 82
underwent SAVR, and 61 underwent MSAVR performed through a
reversed-L-shaped median sternotomy with a transverse limb at the right
fourth intercostal space. Ascending aortic and right atrial cannulation
through the mini-sternotomy were employed for cardiopulmonary bypass
(CPB). Results: Typically, the MSAVR patients were slightly younger than
SAVR patients (mean age: 67 +/- 16 years and 70 +/- 15 years,
respectively; p = 0.037), had a lower incidence of diabetes (3% versus
18%, p = 0.008), and a slightly higher left ventricular ejection fraction
(74.5 +/- 12% versus 71 +/- 12%, p = 0.019). There were no other
inter-group preoperative differences. As expected, MSAVR required a
slightly longer aortic cross-clamp time (49 +/- 19 min) compared to SAVR
(44.5 +/- 16 min; p = 0.019), and longer CPB times (77 +/- 31 min versus
60 +/- 26 min; p <0.0001), though the overall operating times were similar
(p = 0.38). Postoperatively, MSAVR patients were extubated at 3 +/- 5 h,
similar to SAVR patients (4 +/- 5 h) (p = 0.13). The median intensive
therapy unit stay was 1 +/- 1 days in both groups. The median hospital
stay was comparable between groups (MSAVR, 7 +/- 5 days; SAVR, 8 +/- 4
days; p = 0.48). The MSAVR patients had a higher incidence of delayed
pericardial effusions requiring pericardiocentesis (n = 4; p = 0.031), but
this did not affect survival. The 30-day mortality was similar in both
groups (MSAVR group, n = 1 (1.6%); SAVR group, n = 3 (3.7%); p = 0.64). At
five years after surgery, freedom from cardiac-related death was 96 +/-
2.6% in MSAVR patients, and 89 +/- 4.9% in SAVR patients (p = 0.32).
Conclusion: Mini-sternotomy AVR is technically challenging with longer CPB
and aortic cross-clamp times. However, with increasing surgical
experience, it offers results comparable to those achieved with
conventional AVR, and with acceptable cosmetic results. Copyright by ICR
Publishers 2011.
<13>
Accession Number
2013023362
Authors
Pellicer A. Riera J. Lopez-Ortego P. Bravo M.C. Madero R. Perez-Rodriguez
J. Labrandero C. Quero J. Buno A. Castro L. Lubomirov R. Cabanas F.
Institution
(Pellicer, Riera, Lopez-Ortego, Bravo, Perez-Rodriguez, Quero, Cabanas)
Department of Neonatology, La Paz University Hospital, Madrid, Spain
(Riera) Centre for Biomedical Technology, Technical University of Madrid,
Madrid, Spain
(Madero) Division of Biostatistics, La Paz University Hospital, Madrid,
Spain
(Labrandero) Department of Pediatric Cardiology, La Paz University
Hospital, Madrid, Spain
(Buno) Clinical Pathology Service, La Paz University Hospital, Madrid,
Spain
(Castro) Department of Pediatric Anaesthesiology, La Paz University
Hospital, Madrid, Spain
(Lubomirov) Clinical Pharmacology Centre, Pharmacology and Therapeutics
Department, School of Medicine, Madrid, Spain
Title
Phase 1 study of two inodilators in neonates undergoing cardiovascular
surgery.
Source
Pediatric Research. 73 (1) (pp 95-103), 2013. Date of Publication: January
2013.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Inodilators are routinely used in cardiovascular surgery with
cardiopulmonary bypass (CPB). Information regarding safety and
tolerability of the novel molecule, levosimendan (LEVO), in newborns is
anecdotal; no pharmacokinetic data in this population are
available.Methods:This was a phase I, randomized, and blinded study.
Neonates undergoing surgical repair for congenital heart defects received
stepwise dose increases of milrinone (MR; 0.5-1 mug/kg/min, n = 9) or LEVO
(0.1-0.2 mug/kg/min, n = 11) as an i.v. continuous infusion, starting
before CPB. Infants had continuous, time-locked, physiological, and
near-infrared spectroscopy (NIRS) (cerebral and peripheral) recordings
during the first 24 h, and at 48 and 96 h postsurgery. Serial biochemistry
and pharmacokinetic studies were performed.Results:During the first 24 h
postsurgery, patients showed time-related, group-independent increased
cerebral tissue oxygenation and decreased diastolic blood pressure; in
addition, group-dependent differences in heart rate and peripheral
perfusion were found. Early postsurgery, MR-treated infants showed lower
pH, higher glycemia, and higher inotrope score. The groups differed in
cerebral NIRS-derived variables from 24 to 96 h. Study drug withdrawal at
96 h was more frequent with LEVO. LEVO intermediate metabolites were
detected in plasma at day 14 after surgery.Conclusion:LEVO is well
tolerated in critically ill neonates. LEVO may have advantages over MR in
terms of the dosing regimen. 2013 International Pediatric Research
Foundation, Inc.
<14>
Accession Number
2013022257
Authors
Ceelie I. De Wildt S.N. Van Dijk M. Van Den Berg M.M.J. Van Den Bosch G.E.
Duivenvoorden H.J. De Leeuw T.G. Mathot R. Knibbe C.A.J. Tibboel D.
Institution
(Ceelie, De Wildt, Van Dijk, Van Den Berg, Van Den Bosch, Knibbe, Tibboel)
Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital,
Rotterdam, Netherlands
(De Leeuw) Department of Anesthesiology, Erasmus MC, Sophia Children's
Hospital, Rotterdam, Netherlands
(Duivenvoorden) Departments of Medical Psychology and Psychotherapy,
Erasmus MC, Rotterdam, Netherlands
(Mathot) Clinical Pharmacology Unit, Department Hospital Pharmacy,
Academic Medical Centre, Amsterdam, Netherlands
(Knibbe) Leiden/Amsterdam Center for Drug Research, Division of
Pharmacology, Leiden University, Leiden, Netherlands
(Knibbe) Department of Clinical Pharmacy, St. Antonius Hospital,
Nieuwegein, Netherlands
Title
Effect of intravenous paracetamol on postoperative morphine requirements
in neonates and infants undergoing major noncardiac surgery: A randomized
controlled trial.
Source
JAMA - Journal of the American Medical Association. 309 (2) (pp 149-154),
2013. Date of Publication: 09 Jan 2013.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Importance: Continuous morphine infusion as standard postoperative
analgesic therapy inyounginfants is associated withunwantedadverse effects
such as respiratory depression. Objective: To determine whether
intravenous paracetamol (acetaminophen) would significantly (>30%) reduce
morphine requirements in neonates and infants after major surgery. Design,
Setting, and Patients: Single-center, randomized, double-blind study
conducted in a level3 pediatric intensive care unit in Rotterdam, the
Netherlands. Patients were 71 neonates or infants younger than 1 year
undergoing major thoracic (noncardiac) or abdominal surgery between March
2008 and July 2010, with follow-up of 48 hours. Interventions: All
patients received a loading dose of morphine 30 minutes before the end of
surgery, followed by continuous morphine or intermittent intravenous
paracetamol up to 48 hours postsurgery. Infants in both study groups
received morphine (boluses and/or continuous infusion) as rescue
medication on the guidance of the validated pain assessment instruments.
Main Outcome Measures: Primary outcome was cumulative morphine dose (study
and rescue dose). Secondary outcomes were pain scores and morphine-related
adverse effects. Results: The cumulative median morphine dose in the first
48 hours postoperatively was 121 (interquartile range, 99-264) mug/kg in
the paracetamol group (n=33) and 357 (interquartile range, 220-605)
mug/kgin the morphine group (n=38), P<.001, with a between group
difference that was 66% (95% CI, 34%-109%) lower in the paracetamol group.
Pain scores and adverse effects were not significantly different between
groups. Conclusion and Relevance: Among infants undergoing major surgery,
postoperative use of intermittent intravenous paracetamol compared with
continuous morphine resulted in a lower cumulative morphine dose over 48
hours. Trial Registration: trialregister.nl Identifier: NTR1438. 2013
American Medical Association. All rights reserved.
<15>
Accession Number
2013027260
Authors
Sameenakousar Mahesh Srinivasan K.V.
Institution
(Sameenakousar, Mahesh) Department of Anaesthesia, P.E.S.I.M.S.R Kuppam,
AP, India
(Srinivasan) Department of Anaesthesia, P.E.S Medical College Kuppam,
Andhra Pradesh, India
Title
Comparison of fentanyl and clonidine for attenuation of the haemodynamic
response to laryngocopy and endotracheal intubation.
Source
Journal of Clinical and Diagnostic Research. 7 (1) (pp 106-111), 2013.
Date of Publication: 01 Jan 2013.
Publisher
Journal of Clinical and Diagnostic Research (71 Veer Nagar,G.T. Road,
Delhi 110007, India)
Abstract
Introduction: Laryngoscopy and tracheal intubation after the induction of
anaesthesia, are nearly always associated with a sympathetic
hyperactivity. To 'blunt' this pressor response, various methods have been
tried, but very few studies have been done to assess the effects of
fentanyl orI.V. clonidine on the haemodynamic response during laryngoscopy
and tracheal intubation. The purpose of this study was to compare these
agents, to find the drug which was best suited for this purpose and the
most favourable time for its administration. Methods: This was a
prospective study which involved 3 groups of patients. The patients in
group-1 (control) were given normal saline and the groups 2 and 3 were
given i.v. fentanyl and clonidine respectively. Each group had 50 patients
who presented for elective, non-cardiovascular surgeries. All the patients
were ASA-1 or ASA-II and were operated in PESIMSR, Kuppam. Results: The
heart rate rise was 48.07% in the control group, whereas it was
significantly lower in the fentanyl (II) 27.75% and the clonidine groups
(III) 12.57% (p<0.001). In the control group, the systolic blood pressure
increased maximally after 5 minutes (42.62%) i.e., immediately after the
laryngoscopy and the intubation. It decreased gradually over 10 minutes
(17.39%). With the administration of fentanyl, the maximum increase as
compared to the preinduction value was 9.91%, but it was only 7.38% in the
clonidine group. Both, when they were compared with the control, showed a
significant suppression (P<.001), with clonidine showing better results.
The maximum increase in the diastolic blood pressure was 30.12% in the
control group (P<.001) at 5 min and it was 18.22%, and 6.15% in the
fentanyl and the clonidine groups respectively, with clonidine faring
better again (P<.001). Interpretation and Conclusion: Clonidine showed
better attenuation of the sympathetic response, which is statistically
highly significant and it remained so till the end of 10 minutes.
Intravenous clonidine 2mug/kg which is administered 5 minutes before the
laryngoscopy can be recommended to attenuate the sympathetic response to
the laryngoscopy and the intubation.
<16>
Accession Number
2013018344
Authors
Scheeren T.W.L. van Harten A.E. Kok W.F. Absalom A.R.
Institution
(Scheeren, van Harten, Kok, Absalom) Universitair Medisch Centrum
Groningen, Rijksuniversiteit Groningen, Netherlands
Title
Intraoperative cerebral tissue oxygenation and postoperative cognitive
dysfunction after onand off-pump coronary artery bypass surgery - a
randomized study.
Source
Applied Cardiopulmonary Pathophysiology. 16 (4) (pp 347-349), 2012. Date
of Publication: 2012.
Publisher
Pabst Science Publishers (Eichengrund 28, Lengerich D-49525, Croatia)
<17>
Accession Number
2013018334
Authors
Habicher M. Treskatsch S. Spies C. von Heymann C. Sander M.
Institution
(Habicher, Treskatsch, Spies, von Heymann, Sander) Klinik fur
Anasthesiologie mit S. op. Intensivmedizin, Charite Universitatsmedizin
Berlin, CVK/CCM, Germany
Title
Active patient warming can reduce postoperative complications after
interventional aortic valve replacement.
Source
Applied Cardiopulmonary Pathophysiology. 16 (4) (pp 329-332), 2012. Date
of Publication: 2012.
Publisher
Pabst Science Publishers (Eichengrund 28, Lengerich D-49525, Croatia)
<18>
Accession Number
2013022825
Authors
Patel R.D. Saver J.L.
Institution
(Patel, Saver) David Geffen School of Medicine, University of California,
UCLA Stroke Center, 710 Westwood Plaza, Los Angeles, CA 90095, United
States
Title
Evolution of reperfusion therapies for acute brain and acute myocardial
ischemia: A systematic, comparative analysis.
Source
Stroke. 44 (1) (pp 94-98), 2013. Date of Publication: January 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background and Purpose-: Early reperfusion is the most effective therapy
for both acute brain and cardiac ischemia. However, the cervicocephalic
circulatory bed offers more challenges to recanalization interventions.
The historical development of reperfusion interventions has not previously
been systematically compared. Methods-: Medline search identified all
multi-arm, controlled trials of coronary revascularization for acute
myocardial infarction and multicenter trials of cerebral revascularization
for acute ischemic stroke reporting angiographic reperfusion rates.
Results-: Thirty-seven trials of coronary reperfusion enrolled 10 908
patients from 1983 to 2009, and 10 trials of cerebral reperfusion enrolled
1064 patients from 1992 to 2009. Coronary reperfusion trials included 10
of intravenous fibrinolysis alone, 8 combined intravenous fibrinolysis and
percutaneous transluminal coronary angioplasty with or without stenting, 3
intra-arterial fibrinolysis, and 16 percutaneous transluminal coronary
angioplasty with or without stenting. Cerebral reperfusion trials included
1 of intravenous fibrinolysis alone, 3 intra-arterial fibrinolysis, 3
endovascular device alone, and 3 of endovascular treatment +/- intravenous
fibrinolysis. In both circulatory beds, endovascular treatments were more
efficacious at achieving reperfusion than peripherally administered
fibrinolytics. In the coronary bed, rates of achieved reperfusion began at
high levels in the 1980s and improved modestly over the subsequent 3
decades. In the cerebral bed, reperfusion rates began at modest levels in
the early 1990s and increased more slowly. Most recently, in 2005 to 2009,
cardiac reperfusion rates substantially exceeded cerebral, partial
reperfusion 86.1% versus 61.1%, complete reperfusion 78.6% versus 23.4%.
Conclusions-: Reperfusion therapies developed more slowly and remain less
effective for cerebral than cardiac ischemia. Further, cerebral
circulation-specific technical advances are required for physicians to
become as capable at safely restoring blood flow to the ischemic brain as
the ischemic heart. 2012 American Heart Association, Inc.
<19>
Accession Number
2013006508
Authors
Pugliese M. Minardi G. Vitali A. Natale E. de Girolamo P. Zampi G. Leggio
M. Chiarelli A. Pappalardo A. Avella A. Laurenzi F. Fera M.S.
Institution
(Pugliese, Minardi, Vitali, Natale, Zampi, Chiarelli, Fera) Cardiovascular
Department, Intensive Cardiac Unit, San Camillo Hospital, Circ.ne
Gianicolense 87, 00152 Rome, Italy
(de Girolamo, Pappalardo, Avella, Laurenzi) Cardiovascular Arrhythmology
Unit, San Camillo Hospital, Rome, Italy
(Leggio) Cardiovascular Department, Cardiac Rehabilitation Unit, San
Filippo Neri Hospital, Rome, Italy
Title
Influence of myocardial viability on responsiveness to cardiac
resynchronization in ischemic dilated cardiomyopathy: A prospective
observational cohort study.
Source
Anadolu Kardiyoloji Dergisi. 12 (2) (pp 132-141), 2012. Date of
Publication: March 2012.
Publisher
AVES Publishing Co. (Kizilelma CAD. 5/3, Findikzade- Istanbul 34096,
Turkey)
Abstract
Objective: To understand whether patients with post-ischemic dilated
cardiomyopathy and myocardial viability (MV) could benefit from cardiac
resynchronization therapy (CRT) in terms of clinical, echocardiographic
and neuro- hormonal parameters compared to patients without MV. Methods:
One hundred and four consecutive patients were enrolled in a prospective
observational cohort study. Using dobutamine stress echocardiography, 2
groups were identified: group A of 51 patients with MV and group B of 53
patients without MV. All patients were implanted with biventricular pacing
devices combined with an internal cardioverter-defibrillator. Clinical,
echocardiographic and neuro-hormonal parameters were evaluated at baseline
and at six month follow-up. Analysis of variance for repeated measures on
each variable suggestive of remodeling was performed. We considered
responder every patient with: decrease of > 15% in left ventricular
volumes and/or improvement in left ventricular ejection fraction of > 5%
in addition to NYHA class improvement. Results: All the variables improved
in both groups (time effect). Comparing the two groups (group effect), the
following variables were significantly better in group A: N-terminal
pro-B-type natriuretic peptide (p=0.02), NYHA class (p=0.003), reverse
remodeling (RR) (p=0.007), dP/dt (p=0.005), left ventricular ejection
fraction (p=0.009), 3rd sound (p=0.01), and left ventricular end-systolic
volume after the first week (p=0.035). RR occurred at the first week after
CRT only in Group A and was maintained for all the time of this study. The
maximum difference of the decrease of left ventricular volumes between the
two groups occurred after the first week (p<0.001). Conclusion: Patients
with MV responded better than patients without MV with a significant
improvement after the first week from CRT. 2012 by AVES
Yayi{dotless}nci{dotless}li{dotless}k Ltd.
<20>
Accession Number
2013007429
Authors
Broughton J.D. Asopa S. Goodwin A.T. Gildersleeve S.
Institution
(Broughton, Asopa, Goodwin) Department of Cardiothoracic Surgery, James
Cook University Hospital, Middlesbrough, United Kingdom
(Gildersleeve) School of Health and Social Care, Teesside University,
Middlesbrough, United Kingdom
Title
Could routine saphenous vein ultrasound mapping reduce leg wound
complications in patients undergoing coronary artery bypass grafting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (1) (pp 75-78), 2013.
Date of Publication: January 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written in cardiothoracic surgery based on a
structured protocol. The question addressed was whether ultrasound mapping
of the long saphenous vein (LSV) might reduce leg wound complications by
reducing unnecessary leg incisions due to poor quality veins. Altogether,
32 abstracts were identified from the search, from which 5 represented the
best evidence to answer the clinical question. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Surgical site
infections can be extremely distressing for patients, and it is estimated
that treating a surgical wound can cost up to 1554 each. Ultrasound
mapping of the LSV has been reported to be an accurate way of assessing
vein quality preoperatively, reducing unnecessary surgical dissection,
theatre time and cost to both the patient and the health service. We
identified four studies that showed that ultrasound scanning
preoperatively could accurately predict the anatomy and quality of the LSV
(correlation coefficient 0.87). One paper showed that ultrasound scanning
reduced length of incision (P = 0.005), harvest time (P = 0.04) and
hospital stay and reduced morbidity (although not statistically
significant). However, one study found that it could not accurately
predict vein wall changes. Evidence from the papers supports the use of
preoperative ultrasound assessment of the saphenous vein. Benefits to the
patient include a smaller scar, reduced harvest time and minimizing
unnecessary incisions. 2012 The Author.
<21>
Accession Number
2013020079
Authors
Fiocca L. Guagliumi G. Rossini R. Parise H. Musumeci G. Sirbu V.
Lortkipanidze N. Yu J. Mihalcsik L. Vassileva A. Valsecchi O. Gavazzi A.
Mehran R. Stone G.W.
Institution
(Fiocca, Guagliumi, Rossini, Musumeci, Sirbu, Lortkipanidze, Mihalcsik,
Vassileva, Valsecchi, Gavazzi) Cardiovascular Department, Ospedali Riuniti
di Bergamo, Bergamo, Italy
(Parise, Mehran, Stone) Columbia University Medical Center, Cardiovascular
Research Foundation, New York, NY, United States
(Yu, Mehran) Mount Sinai Medical Center, New York, NY, United States
Title
Characteristics and outcomes of patients with ST-segment elevation
myocardial infarction excluded from the harmonizing outcomes with
revascularization and stents in acute myocardial infarction (horizons-ami)
trial.
Source
American Journal of Cardiology. 111 (2) (pp 196-201), 2013. Date of
Publication: 15 Jan 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Randomized controlled trials assessing new drugs and devices tend to
exclude subjects who are at greatest risk. The Harmonizing Outcomes With
Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)
trial incorporated broader inclusion criteria in an attempt to include a
more representative spectrum of patients presenting with ST-segment
elevation myocardial infarction (STEMI). To identify the differences
between this modern trial and the real world, we analyzed the
characteristics and outcomes of patients with STEMI who were screened but
not enrolled at a high-volume recruiting center. Of 318 consecutive
patients with STEMI who were screened, 200 (62.9%) were randomized, and
118 (37.1%) were excluded. The baseline characteristics and 30-day and
1-year clinical outcomes were compared in the 2 groups. The excluded
patients had numerous high-risk features compared to those randomized,
including being older (67.0 +/- 12.8 vs 63.0 +/- 11.4 years, p = 0.004),
more often had had a previous MI (34.7% vs 8.0%, p <0.001), Killip class
III-IV (27.4% vs 4.0%, p <0.001), and lower hemoglobin (13.4 +/- 2.3 vs
14.8 +/- 1.5 g/dl, p <0.001). The excluded patients had markedly greater
30-day and 1-year rates of all-cause mortality (17.4% vs 2.0%, p <0.001,
and 27.6% vs 2.5%, p <0.001, respectively), major adverse cardiovascular
events (death, MI, ischemia-driven target vessel revascularization, and
stroke), major bleeding, and net adverse clinical events (major adverse
cardiovascular events or major bleeding). On multivariate analysis, Killip
class III-IV at presentation, age, left ventricular ejection fraction, and
final Thrombolysis In Myocardial Infarction flow grade 3 were independent
predictors of outcome. In conclusion, despite the broadened entry criteria
of the HORIZONS-AMI trial, 37.1% of all patients presenting with STEMI at
a center with a high rate of enrollment were judged to be ineligible and
were excluded. The excluded patients had a significantly greater risk
profile and markedly increased mortality and adverse events compared to
the trial-eligible group. 2013 Elsevier Inc. All rights reserved.
<22>
Accession Number
2013011300
Authors
Boissonnat P. Gaillard S. Mercier C. Redonnet M. Lelong B. Mattei M.-F.
Mouly-Bandini A. Pattier S. Sirinelli A. Epailly E. Varnous S. Billes
M.-A. Sebbag L. Ecochard R. Cornu C. Gueyffier F.
Institution
(Boissonnat, Sebbag) Hospices Civils de Lyon, Hopital Louis Pradel, Pole
Medico-Chirurgical de Transplantation Cardiaque Adulte, 28, avenue du
Doyen Lepine, F-69677, Bron Cedex, France
(Gaillard, Cornu, Gueyffier) INSERM, CIC 201, Lyon, Hospices Civils de
Lyon, Service de Pharmacologie Clinique et Essais Therapeutiques,
Universite Lyon 1, 7 Rue Guillaume Paradin, F-69000, Lyon, France
(Mercier, Ecochard) Hospices Civils de Lyon, Service de Biostatistique,
162, avenue Lacassagne, F-69003, Lyon, France
(Redonnet) Departement de Chirurgie Cardiaque, Hopital Charles Nicolle,
Universite de Rouen, 1, rue de Germont, F-76000, Rouen, France
(Lelong) Service de Cardiologie, Centre Hospitalier et Universitaire de
Rennes, 2 rue Henri le Guilloux, F-35033, Rennes, France
(Mattei) Departement de Cardiologie et Transplantation, Hopital Brabois,
rue du Morvan, F-54511, Nancy, France
(Mouly-Bandini) Service de Chirurgie Cardiaque Adultes, Hopital Timone,
264 rue Saint-Pierre, F-13385, Marseille, France
(Pattier) Departement de Cardiologie et Transplantation, Hopital Guillaume
et Rene Laennec, boulevard Jacques Monod, F-44093, Nantes, France
(Sirinelli) Service de Chirurgie Cardiaque, Centre Hospitalier
Universitaire de Tours, 41, boulevard Beranger, F-37044, Tours, France
(Epailly) Service de Chirurgie Cardiaque, Les Hopitaux Universitaires de
Strasbourg, 3, rue Koeberle, F-67000, Strasbourg, France
(Varnous) Departement de Chirurgie Thoracique et Cardiovasculaire, Groupe
Hospitalier la Pitie-Salpetriere, 47-83 boulevard de l'hopital, F-75013,
Paris, France
(Billes) Departement de Cardiologie et Transplantation, Centre Hospitalier
du Haut Leveque, avenue de Magellan, 33604, Pessac, France
(Mercier, Ecochard) CNRS and Universite Lyon 1, UMR5558, Laboratoire de
Biometrie et Biologie Evolutive, Equipe Biotatistique-Sante, 162, avenue
Lacassagne, F-69003, Lyon, France
(Cornu, Gueyffier) CNRS and Universite Lyon 1, UMR5558, Laboratoire de
Biometrie et Biologie Evolutive, Equipe Modelisation et Evaluation des
Therapeutiques, 7 Rue Guillaume Paradin, F-69000, Lyon, France
Title
Impact of the early reduction of cyclosporine on renal function in heart
transplant patients: A French randomised controlled trial.
Source
Trials. 13 , 2012. Article Number: 231. Date of Publication: 03 Dec 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Using reduced doses of Cyclosporine A immediately after heart
transplantation in clinical trials may suggest benefits for renal function
by reducing serum creatinine levels without a significant change in
clinical endpoints. However, these trials were not sufficiently powered to
prove clinical outcomes.Methods: In a prospective, multicentre,
open-label, parallel-group controlled trial, 95 patients aged 18 to 65
years old, undergoing de novo heart transplantation were centrally
randomised to receive either a low (130 < trough CsA concentrations <200
mug/L, n = 47) or a standard dose of Cyclosporine A (200 < trough CsA
concentrations <300 mug/L, n = 48) for the three first post-transplant
months along with mycophenolate mofetil and corticosteroids. Participants
had a stable haemodynamic status, a serum creatinine level <250 mumol/L
and the donors' cold ischemia time was under six hours; multiorgan
transplants were excluded. The change in serum creatinine level over 12
months was used as the main criterion for renal function.
Intention-to-treat analysis was performed on the 95 randomised patients
and a mixed generalised linear model of covariance was applied.Results: At
12 months, the mean (+/- SD) creatinine value was 120.7 mumol/L (+/- 35.8)
in the low-dose group and 132.3 mumol/L (+/- 49.1) in the standard-dose
group (P = 0.162). Post hoc analyses suggested that patients with higher
creatinine levels at baseline benefited significantly from the lower
Cyclosporine A target. The number of patients with at least one rejection
episode was not significantly different but one patient in the low-dose
group and six in the standard-dose group required dialysis.Conclusions: In
patients with de novo cardiac transplantation, early Cyclosporine A dose
reduction was not associated with renal benefit at 12 months. However, the
strategy may benefit patients with high creatinine levels before
transplantation.Trial registration: ClinicalTrials.gov NCT00159159. 2012
Boissonnat et al.; licensee BioMed Central Ltd.
<23>
Accession Number
2013013989
Authors
Al-Mutairi F.H. Fallows S.J. Abukhudair W.A. Islam B.B. Morris M.M.
Institution
(Al-Mutairi, Fallows, Morris) Department of Clinical Sciences, University
of Chester, Chester, United Kingdom
(Abukhudair) Department of Cardiac Surgery, King Fahd Armed Forces
Hospital, Jeddah, Saudi Arabia
(Islam) Department of Pulmonary Care, King Fahd Armed Forces Hospital,
Jeddah, Saudi Arabia
Title
Difference between continuous positive airway pressure via mask therapy
and incentive spirometry to treat or prevent post-surgical atelectasis.
Source
Saudi Medical Journal. 33 (11) (pp 1190-1195), 2012. Date of Publication:
2012.
Publisher
Saudi Arabian Armed Forces Hospital (P.O. Box 7897, Riyadh 11159, Saudi
Arabia)
Abstract
Objectives: To assess the effect of early use of continuous positive
airway pressure (CPAP) therapy to treat or prevent acute atelectasis in
post-operative cardiac patients particularly smokers and elderly patients.
Methods: A pilot study suggested enrolling at least 32 participants in
each group to be significant. One hundred and eight patients from King
Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia who met the
inclusion criteria participated in this study conducted between March 2010
and March 2011. The participants were divided randomly into 3 groups,
incentive spirometry (IS) therapy, and CPAP therapy every 2 (CPAP2hrs), or
4 hours (CPAP4hrs). Inspiratory capacity (IC) was used to compare the 3
therapy regimes. Simultaneously, respiratory rate (RR), heart rate (HR)
and oxygen saturation (SpO<sub>2</sub>) were measured for all groups.
Failure was defined as requiring intubation, bi-level positive airway
pressure, or added chest physiotherapy. Results: Thirty-six patients
participated in each group (98 male and 10 female, with a mean age of
62+/-9.3 years). The IC increased significantly in the CPAP2hrs group when
compared with the control group or the CPAP4hrs group. The SpO<sub>2</sub>
decreased significantly in the control group and the CPAP4hrs groups when
compared with the CPAP2hrs group. Also, there were no significant
differences in RR and HR between all groups. Conclusion: Early use of CPAP
via mask therapy for half an hour every 2 hours had better outcomes to
reopen collapsed alveoli after cardiac surgery.
<24>
Accession Number
70969997
Authors
Shihong W.
Institution
(Shihong) PLA, Military General Hospital of Beijing, China
Title
Intracoronary autologous CD34+ stem cell therapy for intractable angina.
Source
Heart. Conference: 23rd Great Wall International Congress of Cardiology,
Asia Pacific Heart Congress 2012 Beijing China. Conference Start: 20121011
Conference End: 20121014. Conference Publication: (var.pagings). 98 (pp
E42-E43), 2012. Date of Publication: October 2012.
Publisher
BMJ Publishing Group
Abstract
Objectives: A large number of patients with coronary artery disease
experience angina that is not suitable for revascularisation and is
refractory to conventional medical therapy. Laboratory and preclinical
studies have provided evidence for the safety and potential efficacy of
autologous CD34+ stem cell therapies as treatment for angina. Clinical
studies investigating intramyocardial transplantation of autologous CD34+
stem cells by catheter injection for patients with refractory angina show
that this is safe and feasible. It remains unclear whether intracoronary
infusion of CD34+ stem cells exerts beneficial effects in patients with
angina as well. We addressed this question with a controlled clinical
trial by enrolling 112 patients with refractory angina. Previous trials
have investigated the safety and beneficial effects of CD34+ cells
isolated from granulocyte colony-stimulating factor-mobilised peripheral
blood; in our trial, we isolated CD34+ cells directly from the patient's
bone marrow. Methods: One hundred and twelve patients with diffuse
triple-vessel disease and Canadian Cardiovascular Society class III or IV
angina were enrolled in a double-blind, randomised (1: 1),
placebo-controlled study. Patients received optimal medical treatment but
were not candidates for mechanical revascularisation (percutaneous
coronary intervention or coronary artery bypass grafting). Fifty-six
patients (27 women and 29 men aged 42-80 years) were enrolled in the
treatment group, and 56 patients (28 women and 28 men aged 43-80 years)
who received optimal medical treatment and intracoronary saline injections
were enrolled in the placebo control group. Bone marrow was collected from
all enrolled patients at a volume of 120-150 ml each in both groups.
Selections of CD34+ cells were performed by a CE-marked device approved by
the Security, Food and Drug Administration of China. Coronary angiography
had been performed before enrolment in this study. Results: No myocardial
infarction was observed during intracoronary infusion. The intracoronary
infusion of cells or saline did not result in cardiac enzyme elevation,
cardiac perforation or pericardial effusion. No arrhythmia, such as
ventricular tachycardia or ventricular fibrillation, was induced by
intracoronary infusion. No serious adverse events occurred in either
group. The reduction in the frequency of angina episodes per week 3 and 6
months after infusion was significantly higher in the treatment group
(-14.6 8 4.8 at 3 months and -15.6 8 4.0 at 6 months) than in the control
group (-4.5 8 0.3 and -3.0 8 1.2, respectively; p ! 0.01). Other efficacy
parameters such as nitroglycerine usage, exercise time and the Canadian
Cardiovascular Society class also showed an improvement in the treatment
group compared to the control group. A significant improvement in
myocardial perfusion was noted in the treatment group compared to the
control group, as measured by single-photon emission CT. Conclusions: This
randomised trial investigating intracoronary infusion of autologous CD34+
cells in patients with intractable angina shows the safety and feasibility
of this therapy and provides evidence for efficacy.
<25>
Accession Number
70967984
Authors
Prokopchuk-Gauk O. Rosin M. Mycyk T. Lim H. Brose K.
Institution
(Prokopchuk-Gauk) Hematology and Hematologic Malignancy, University of
Calgary, Calgary, AB, Canada
(Rosin) Clinical Perfusion, Royal University Hospital, Saskatoon, SK,
Canada
(Mycyk) Cardiac Surgery, University of Saskatchewan, Saskatoon, SK, Canada
(Lim) Community Health and Epidemiology, University of Saskatchewan,
Saskatoon, SK, Canada
(Brose) Hematology, University of Saskatchewan, Saskatoon, SK, Canada
Title
Topical application of tranexamic acid to reduce post-operative bleeding
in coronary artery bypass surgery.
Source
Blood. Conference: 54th Annual Meeting of the American Society of
Hematology, ASH 2012 Atlanta, GA United States. Conference Start: 20121208
Conference End: 20121211. Conference Publication: (var.pagings). 120 (21)
, 2012. Date of Publication: 16 Nov 2012.
Publisher
American Society of Hematology
Abstract
Patients who undergo on-pump coronary artery bypass graft surgery (CABG)
are at an increased risk of bleeding due physiologic, mechanical and
pharmacologic disruption of hemostasis. The use of topically applied
antifibrinolytic agents has been explored as a blood-conservation adjunct
to reduce post-operative bleeding in cardiac surgery. Analysis of pooled
results in a meta-analysis published by Abrishami et al. in 2009 showed
that a significant reduction in blood loss could be achieved utilizing
topical tranexamic acid in the absence of concurrent intravenous
antifibrinolytic agents. However, current blood conservation clinical
practice guidelines recommend the use of intravenous lysine analogues to
limit peri-operative blood loss. Presently, there is no published
prospective data evaluating blood loss in CABG patients who have received
intravenous tranexamic acid, plus topical tranexamic acid versus placebo.
Our study was designed to determine whether combined intravenous and
topical application of tranexamic acid would reduce post-CABG blood loss
in low-risk bypass surgery candidates. A sample calculation based on pilot
study data analysis concluded that a minimum total of 74 patients was
required, allowing 80% power to detect a 200mL difference in total blood
loss (Type I error = 0.05) between groups. In our prospective,
double-blind, randomized controlled trial, patients enrolled were randomly
assigned to receive an intra-operative cardiac bath of either normal
saline or tranexamic acid solution prior to sternotomy closure. All
participants received intravenous tranexamic acid prior to the initiation
of circulatory bypass. Research subject participation ended upon transfer
out of the intensive care unit. Primary outcomes included the total volume
of chest tube blood loss and number of transfusions administered following
CABG. Secondary outcomes included chest tube loss volumes at 6 hours and
12 hours. Between December 1, 2011 and April 30, 2012, a total of 41
patients who underwent randomization were included in final data analysis.
Baseline characteristics of patients enrolled in both groups were similar.
Post-CABG losses at chest tube removal were found to be significantly
reduced in the patients who received topical tranexamic acid. Mean chest
tube loss in the placebo group (n=18) was 789mL versus 632mL in the
topical tranexamic acid group (n=23), with a difference of 157mL (Figure
1, p value of student t-test 0.0493). A significantly greater proportion
of patients in the placebo group were found to bleed more than 700mL at
chest tube removal, in comparison with the topical tranexamic acid group
(72.2% versus 30.4%, p value of chi-squared test 0.0079). Chest tubes
remained in situ for a mean duration of 20 hours and 19 hours,
respectively. None of the patients received post-operative red cell
transfusions. One patient, randomized to the topical tranexamic acid
group, received a single dose each of platelets and cryoprecipitate
post-operatively. The application of topical tranexamic acid did not
significantly reduce blood loss at 6 hours and 12 hours, with a difference
of 76mL (p=0.1876) and 106mL (p=0.0930) respectively. The application of
topical tranexamic acid reduces post-operative blood loss in patients
undergoing on-pump CABG who have received intravenous tranexamic acid.
There was no difference in blood product use between groups. Further
studies must be carried out to investigate long-term outcomes of this
practice and its applicability in high-risk cardiac surgery patients.
