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<1>
Accession Number
2013087899
Authors
Javadzadegan H. Toufan M. Sadighi A.R. Chang J.M. Nader N.D.
Institution
(Javadzadegan, Toufan) Department of Cardiology, Tabriz University of
Medical Sciences, Tabriz, Iran, Islamic Republic of
(Sadighi) Tuberculosis and Lung Disease Research Center, Tabriz University
of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Chang, Nader) Department of Anesthesiology, University at Buffalo School
of Medicine and Biomedical Sciences, VA Western New York Healthcare
System, 3495 Bailey Avenue, Buffalo, NY 14215, United States
Title
Comparative effects of surgical and percutaneous repair on P-wave and
atrioventricular conduction in patients with atrial septal defect - Ostium
secundum type.
Source
Cardiology in the Young. 23 (1) (pp 132-137), 2013. Date of Publication:
February 2013.
Publisher
Cambridge University Press (Shaftesbury Road, Cambridge CB2 2RU, United
Kingdom)
Abstract
Both surgical and percutaneous closures of atrial septal defects have been
successful in reversal of atrial dilatation. We compared the effects of
surgical and percutaneous transvenous device closure of atrial septal
defect on post-operative changes of P-wave duration, PR segment, and PR
interval. Electrocardiographic data were prospectively collected from 30
patients following either surgical (n equal to 16) or percutaneous (n
equal to 16) repair of atrial septal defects between 2004 and 2010. A
cardiologist blinded to the closure technique performed the
electrocardiographic analyses. P-wave duration (98.5 plus or minus 15.4 to
86.4 plus or minus 13.2 milliseconds, p-value less than 0.05) and PR
interval (162.9 plus or minus 18.5 to 140.6 plus or minus 15.2
milliseconds, p-value less than 0.05) were reduced after percutaneous
transvenous device closure. P-wave duration (104.5 plus or minus 24.7
versus 83.2 plus or minus 13.3 milliseconds, p-value less than 0.05) and
PR interval (173.2 plus or minus 38.7 versus 144.3 plus or minus 32.0
milliseconds, p-value less than 0.05) were also reduced after surgical
closure. PR segment in the percutaneous group was significantly reduced
(63.4 plus or minus 14.5 to 52.1 plus or minus 10.8 milliseconds, p-value
less than 0.05), but not in the surgical group (68.6 plus or minus 18.7
versus 61.1 plus or minus 24.7 milliseconds). However, the difference in
PR segment changes between the two groups was not significant (-11.3 plus
or minus 15.0 versus -7.6 plus or minus 20.5 milliseconds, p-value equal
to 0.18). Our analysis demonstrates that the changes between the two
groups were not different and that both closure techniques reduce P-wave
duration, PR segment, and PR interval within 6 months. Cambridge
University Press 2012.
<2>
Accession Number
2013079508
Authors
Fiorelli A. D'Aponte A. Canonico R. Palladino A. Vicidomini G. Limongelli
F. Santini M.
Institution
(Fiorelli, Vicidomini, Santini) Thoracic Surgery Unit, Second University
of Naples, Naples, Italy
(D'Aponte, Canonico, Limongelli) Department of Experimental Medicine,
Second University of Naples, Naples, Italy
(Palladino) Cardiomiology Unit, Second University of Naples, Naples, Italy
Title
T2-T3 sympathectomy versus sympathicotomy for essential palmar
hyperhidrosis: Comparison of effects on cardio-respiratory function.
Source
European Journal of Cardio-thoracic Surgery. 42 (3) (pp 454-461), 2012.
Article Number: ezs071. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: The aim of this study was to determine cardio-respiratory
changes after endothoracic sympathetic denervation and their correlation
with the extent of denervation. Methods: A total of 45 patients with
essential palmar hyperhidrosis were randomized into two groups: the
conventional group (CG; 23 patients) and the simplified group (SG; 22
patients). In the CG, excision of T2 and T3 ganglia was performed, whereas
in the SG only separation of the sympathetic chain was performed at the
same level. Patients underwent respiratory and cardiovascular exercise
tests before, at 2 weeks and again at 6 months after the procedure. The
postoperative values were then compared with the preoperative values to
assess the statistical difference. Results: Twenty-one patients in each
group completed the study. In the SG, forced expiratory volume in 1 s (FEV
1; P < 0.01) and forced vital capacity (FVC; P < 0.01) were significantly
reduced at 2 weeks, but returned to similar baseline values 6 months after
the procedure. No significant cardiac changes were observed. In the CG,
both FEV 1 and FVC were significantly reduced at 2 weeks (P < 0.01) and at
6 months after operation (P < 0.05). A significant reduction in forced
expiratory flow between 25 and 75% of vital capacity (P < 0.01) and a
relevant increase in airway resistance (P < 0.05) during the entire
postoperative course were also observed. Heart rates at rest and at peak
exercise were significantly reduced at 2 weeks (P < 0.01) and
significantly decreased 6 months after the procedure (P < 0.05). No other
changes were registered. The cardio-respiratory alterations remained at a
sub-clinical level; all patients completed the exercise test without
symptoms. Conclusion: Sympathectomy may result in a disturbance of
bronchomotor tone and cardiac function. Such changes remained at a
sub-clinical level and seemed directly correlated with the extension of
denervation. The Author 2012. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.
<3>
Accession Number
2013079504
Authors
Van't westeinde S.C. Horeweg N. De leyn P. Groen H.J.M. Lammers J.J.
Weenink C. Nackaerts K. Van klaveren R.J.
Institution
(Van't westeinde, Van klaveren) Department of Pulmonology, Erasmus MC
Rotterdam, Rotterdam, Netherlands
(Van't westeinde, Horeweg) Department of Public Health, Erasmus MC
Rotterdam, Rotterdam, Netherlands
(De leyn, Nackaerts) Department of Thoracic Surgery, UZ Gasthuisberg,
Leuven, Belgium
(Groen) Department of Pulmonology, UMC Groningen, Groningen, Netherlands
(Lammers) Department of Pulmonology, UMC Utrecht, Utrecht, Netherlands
(Weenink) Department of Pulmonology, Kennemer Gasthuis Haarlem, Haarlem,
Netherlands
Title
Complications following lung surgery in the dutch-belgian randomized lung
cancer screening trial.
Source
European Journal of Cardio-thoracic Surgery. 42 (3) (pp 420-429), 2012.
Article Number: ezs081. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVES: To assess the complication rate in participants of the screen
arm of the NELSON lung cancer screening trial who underwent surgical
resection and to investigate, based on a literature review, whether the
complication rate, length of hospital stay, re-thoracotomy and mortality
rates after a surgical procedure were different from those of the
non-screening series, taking co-morbidity into account. METHODS: Between
April 2004 and December 2008, 198 subjects underwent thoracic surgery.
Co-morbid conditions were retrieved from the medical records.
Postoperative complications were classified as minor and major. RESULTS:
In total, 182 thoracotomies, 5 thoracotomies after video-assisted
thoracoscopic surgery (VATS) and 11 VATS procedures were performed. In
these patients, 36% had chronic obstructive lung disease, 16% coronary
artery disease, 14% diabetes mellitus and 11% peripheral vascular disease.
Following thoracotomy, 47% (88/187) had >=1 minor (7-57% in literature)
and 10% (18/187) >=1 major complication (2-26% in literature); following
VATS, 38% (6/16) had >=1 minor complication, but no major complications.
Seventeen per cent (3/18) of major complications and 21% (20/96) of minor
complications were seen in subjects operated for benign disease. The
re-thoracotomy rate was 3% and there was no 30-day mortality after
thoracotomy or VATS (0-8.3% in literature). The mortality rate of 0% after
surgical procedures is low when compared with the non-screening series
(0-8.3%); the rate of complications (53%) is within range when compared
with the non-screening series (8.5-58%). CONCLUSIONS: In conclusion,
mortality rates after surgical procedures are lower in the NELSON lung
cancer screening trial than those in the non-screening series. The rate of
complications is within the same range as in the non-screening series.
Author 2012. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.
<4>
Accession Number
2013079491
Authors
Joseph C. Gaillat F. Duponq R. Lieven R. Baumstarck K. Thomas P.
Penot-ragon C. Kerbaul F.
Institution
(Joseph, Gaillat, Duponq, Lieven, Kerbaul) Intensive Care and
Anesthesiology Unit 2, Timone/Sainte-Marguerite Hospital, Assistance
Publique-Hopitaux de Marseille, Marseille, France
(Kerbaul) UMR MD2 P2COE, Aix-Marseille University, Marseille, France
(Baumstarck) Faculty of Medicine, Methodological Help to Clinical Research
Unit, Laboratory of Public Health, Marseille, France
(Thomas) Thoracic Surgery Unit, North Hospital, Assistance
Publique-Hopitaux de Marseille, Marseille, France
(Penot-ragon) Central Pharmacy Unit, Sainte-Marguerite Hospital,
Assistance Publique-Hopitaux de Marseille, Marseille, France
Title
Is there any benefit to adding intravenous ketamine to patient-controlled
epidural analgesia after thoracic surgery? A randomized double-blind
study.
Source
European Journal of Cardio-thoracic Surgery. 42 (4) (pp e58-e65), 2012.
Article Number: ezs398. Date of Publication: October 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: Thoracic surgery is associated with severe acute postoperative
pain, leading to pulmonary complications and hyperalgesia-induced chronic
pain. Thoracic patient-controlled epidural analgesia is also considered as
the gold-standard postoperative analgesia. As previously described in
major digestive surgery, combination with low-dose intravenous (i.v.)
ketamine could potentiate epidural analgesia and facilitate pulmonary
function recovery following thoracotomy. Methods: In a randomized,
double-blind trial, 60 patients scheduled to undergo thoracotomy were
included. All patients received a thoracic epidural catheter placed before
surgery, and standardized general anaesthesia. They were allocated to two
groups to receive either an i.v. bolus of ketamine at induction, followed
by a continuous infusion during surgery and the first 48 h
postoperatively, or an i.v. placebo (a saline solution under the same
infusion modalities). Cumulative epidural ropivacaine consumption,
postoperative pain scores (patient self-rated numeric pain intensity
scale), analgesic rescue consumption, residual pain, haemodynamics and
respiratory recovery function were recorded from 12 h to 3 months. Data
were expressed as mean +/- standard deviation or median +/- interquartile
range (25-75%). The comparisons between ketamine and placebo groups were
performed using chi<sup>2</sup> or Fisher's exact tests for frequencies,
and Mann-Whitney tests for quantitative variables. Results: Epidural
ropivacaine consumption was similar between groups during the first 48
postoperative hours. Postoperative pain scores and spirometric parameters
were not significantly different between groups. But the incidence of
postoperative nausea was significantly increased in patients owning to the
ketamine group. Finally, the incidence of residual pain was similar
between groups at 1 and 3 months following thoracotomy. Conclusions:
Adding i.v. ketamine did not potentiate epidural analgesia neither to
reduce acute and chronic postoperative pain nor to improve pulmonary
dysfunction following thoracic surgery. Pain scores were low in both
groups, mainly because of an optimized analgesia provided by the
patient-controlled epidural mode, and might explain this lack of benefit
in adding i.v. ketamine. The Author 2012. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.
<5>
Accession Number
2013088826
Authors
Heringlake M. Charitos E.I. Gatz N. Kabler J.-H. Beilharz A. Holz D. Schon
J. Paarmann H. Petersen M. Hanke T.
Institution
(Heringlake, Gatz, Kabler, Beilharz, Holz, Schon, Paarmann) Department of
Anesthesiology, University of Lubeck, Ratzeburger Allee 160, D-23538
Lubeck, Germany
(Charitos, Petersen, Hanke) Department of Cardiac and Thoracic Vascular
Surgery, University of Lubeck, Lubeck, Germany
Title
Growth differentiation factor 15: A novel risk marker adjunct to the
EuroSCORE for risk stratification in cardiac surgery patients.
Source
Journal of the American College of Cardiology. 61 (6) (pp 672-681), 2013.
Date of Publication: 12 Feb 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study sought to determine the usefulness of plasma growth
differentiation factor 15 (GDF-15) for risk stratification in patients
undergoing cardiac surgery in comparison with the additive European System
of Cardiac Operative Risk Evaluation (EuroSCORE), N-terminal pro-B-type
natriuretic peptide (NTproBNP), and high-sensitive troponin T (hsTNT).
Background: GDF-15 is emerging as a humoral marker for risk stratification
in cardiovascular disease. No data are available if this marker may also
be used for risk stratification in cardiac surgery. Methods: In total,
1,458 consecutive patients were prospectively studied. Pre-operative
plasma GDF-15, NTproBNP, hsTNT, clinical outcomes, and 30-day and 1-year
mortality were recorded. GDF-15 was determined with a pre-commercial
electrochemiluminescence immunoassay. Results: Median additive EuroSCORE
(addES) was 5 (interquartile range: 3 to 8); 30-day and 1-year mortality
were 3.4% and 7.6%, respectively. Median GDF-15 levels were 1.04 ng/ml
(95% confidence interval [CI]: 1.0 to 1.07 ng/ml) in 30-day survivors and
2.62 ng/ml (95% CI: 1.88 to 3.88) in 30-day nonsurvivors (p < 0.0001).
C-statistics showed that the area under the curve of a combined model of
GDF-15 and addES for 30-day mortality was significantly greater (0.85 vs.
0.81; p = 0.0091) than of the addES alone. For the EuroSCORE categories (0
to 2, 3 to 5, 6 to 10, >10) the presence of GDF-15 >=1.8 ng/ml resulted in
a significant 41.4% (95% CI: 19.2 to 63.7%; p < 0.001) net
reclassification improvement and an integrated discrimination improvement
of 0.038 (95% CI: 0.022 to 0.0547; p < 0.0001) compared to the model
including only the addES, whereas the presence of NTproBNP (cutoff >=2,000
pg/ml) or hsTNT (cutoff 14 pg/ml) did not result in significant
reclassification. Conclusions: The pre-operative plasma GDF-15 level is an
independent predictor of post-operative mortality and morbidity in cardiac
surgery patients, can further stratify beyond established risk scores and
cardiovascular markers, and thus adds important additional information for
risk stratification in these patients. (The Usefulness of Growth
Differentiation Factor 15 [GDF-15] for Risk Stratification in Cardiac
Surgery; NCT01166360). 2013 American College of Cardiology Foundation.
<6>
Accession Number
2013087468
Authors
Berger M.M. Delodder F. Liaudet L. Tozzi P. Schlaepfer J. Chiolero R.L.
Tappy L.
Institution
(Berger, Delodder, Liaudet, Chiolero) Service of Adult Intensive Care
Medicine and Burns, Lausanne University Hospital, CHUV BH-08.612, Rue du
Bugnon 46, CH-1011 Lausanne, Switzerland
(Tozzi) Service of Cardiovascular Surgery, University Hospital, Centre
Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
(Schlaepfer) Service of Cardiology, University Hospital, Centre
Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
(Tappy) University Physiology Institute, University of Lausanne, Lausanne,
Switzerland
Title
Three short perioperative infusions of n-3 PUFAs reduce systemic
inflammation induced by cardiopulmonary bypass surgery: A randomized
controlled trial.
Source
American Journal of Clinical Nutrition. 97 (2) (pp 246-254), 2013. Date of
Publication: 01 Feb 2013.
Publisher
American Society for Nutrition (9650 Rockville Pike, Bethesda MD
20814-3998, United States)
Abstract
Background: Fish oil (FO) has antiinflammatory effects, which might reduce
systemic inflammation induced by a cardiopulmonary bypass (CPB).
Objective: We tested whether perioperative infusions of FO modify the cell
membrane composition, inflammatory responses, and clinical course of
patients undergoing elective coronary artery bypass surgery. Design: A
prospective randomized controlled trial was conducted in cardiac surgery
patients who received 3 infusions of 0.2 g/kg FO emulsion or saline
(control) 12 and 2 h before and immediately after surgery. Blood samples
(7 time points) and an atrial biopsy (during surgery) were obtained to
assess the membrane incorporation of PUFAs. Hemodynamic data,
catecholamine requirements, and core temperatures were recorded at 10-min
intervals; blood triglycerides, nonesterified fatty acids, glucose,
lactate, inflammatory cytokines, and carboxyhemoglobin concentrations were
measured at selected time points. Results: Twenty-eight patients, with a
mean +/- SD age of 65.5 +/- 9.9 y, were enrolled with no baseline
differences between groups. Significant increases in platelet EPA (+0.86%;
P = 0.0001) and DHA (+0.87%; P = 0.019) were observed after FO consumption
compared with at baseline. Atrial tissue EPA concentrations were higher
after FO than after control treatments (+0.5%; P < 0.0001). FO did not
significantly alter core temperature but decreased the postoperative rise
in IL-6 (P = 0.018). Plasma triglycerides increased transiently after each
FO infusion. Plasma concentrations of glucose, lactate, and blood
carboxyhemoglobin were lower in the FO than in the control group on the
day after surgery. Arrhythmia incidence was low with no significant
difference between groups. No adverse effect of FO was detected.
Conclusions: Perioperative FO infusions significantly increased PUFA
concentrations in platelet and atrial tissue membranes within 12 h of the
first FO administration and decreased biological and clinical signs of
inflammation. These results suggest that perioperative FO may be
beneficial in elective cardiac surgery with CPB. 2013 American Society
for Nutrition.
<7>
Accession Number
2013080316
Authors
Later A.F.L. Bruggemans E.F. Romijn F.P.H.T.M. van Pelt J. Klautz R.J.M.
Institution
(Later, Bruggemans, Romijn, Klautz) Department of Cardiothoracic Surgery,
Leiden University Medical Centre, Albinusdreef 2, Postbus 9600, 2300 RC
Leiden, Netherlands
(van Pelt) Department of Clinical Chemistry, Leiden University Medical
Centre, Albinusdreef 2, Postbus 9600, 2300 RC Leiden, Netherlands
(van Pelt) Department of Clinical Chemistry, Medisch Centrum Alkmaar,
Wilhelminalaan 12, 1815 JD Alkmaar, Netherlands
Title
A comparative study of the immune modulating properties of
antifibrinolytics in cardiac surgery.
Source
Cytokine. 61 (2) (pp 438-444), 2013. Date of Publication: February 2013.
Publisher
Academic Press (24-28 Oval Road, London NW1 7DX, United Kingdom)
Abstract
Purpose: Antifibrinolytics, used in cardiac surgery to abate postoperative
blood loss, share anti-inflammatory properties by suppression of
pro-inflammatory D-dimer and plasmin levels. Additional drug specific
immune modulating qualities are often mentioned in the discussion on which
antifibrinolytic can best be used. To determine the extent and relevance
of these effects, we investigated cytokine and growth factor plasma levels
in cardiac surgery patients randomized to receive either tranexamic acid,
aprotinin, or placebo. Corticosteroid-treated patients served to put the
effects in perspective. Methods: Using a biochip immunoassay, plasma of 36
cardiac surgery patients was quantified for 12 cytokines and growth
factors, assessed preoperatively and 6, 12, 24, and 48. h after the start
of cardiopulmonary bypass. Eight patients were treated with tranexamic
acid, nine with aprotinin, and nine received placebo. Ten placebo-treated
patients received corticosteroids. Results: IL-1s, IL-6, IL-8, IL-10,
IFN-, TNF-alpha, VEGF, MCP-1, and EGF plasma concentrations significantly
changed over time across all patients. Aprotinin-treated patients showed
decreased pro-inflammatory TNF-alpha and peak MCP-1 plasma levels when
compared with placebo. However, corticosteroids attenuated the
inflammatory response to a much larger extent, lowering postoperative
IL-6, IL-10, IFN-, and VEGF concentrations also. Conclusions: Aprotinin
attenuates postoperative pro-inflammatory levels TNF-alpha and MCP-1
whereas tranexamic acid does not. The majority of plasma proteins studied,
however, were not affected by the use of antifibrinolytics when compared
with placebo. A clinically relevant common anti-inflammatory effect
through inhibition of fibrinolysis seems therefore unlikely. 2012
Elsevier Ltd.
<8>
Accession Number
2013082522
Authors
Pancholy S.B. Boruah P. Ahmed I. Kwan T. Patel T.M. Saito S.
Institution
(Pancholy) Cardiovascular Diseases, Wright Center for Graduate Medical
Education and Medicine, Commonwealth Medical College, Scranton, PA, United
States
(Boruah, Ahmed) Department of Cardiology, Wright Center for Graduate
Medical Education, Scranton, PA, United States
(Kwan) Department of Cardiology, Beth Israel Hospital, New York, NY,
United States
(Patel) Department of Cardiology, Seth N.H.L Municipal Medical College,
Ahmedabad, India
(Saito) Department of Cardiology, Shonan Kamakura Hospital, Kamakura,
Japan
Title
Meta-analysis of effect on mortality of percutaneous recanalization of
coronary chronic total occlusions using a stent-based strategy.
Source
American Journal of Cardiology. 111 (4) (pp 521-525), 2013. Date of
Publication: 15 Feb 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
We performed a systematic review and meta-analysis comparing the all-cause
mortality outcomes of successful percutaneous coronary intervention (PCI)
for chronic total occlusions (CTOs) with unsuccessful CTO-PCI, using a
stent-based strategy. Multiple studies comparing successful CTO-PCI with
unsuccessful CTO-PCI have reported variable outcomes. No systematic review
or meta-analysis has been performed after stenting became the default
strategy for CTO-PCI. Searching major electronic databases, 64 studies
were identified using the keywords "CTO," "PCI," and "mortality." Using
the Preferred Reporting Items for Systematic Reviews and Meta-analyses
method, 13 studies met the criteria for inclusion in the present
meta-analysis. The short-term (<=30 days) and long-term (>=1 year)
mortality outcomes were analyzed comparing successful CTO-PCI and
unsuccessful CTO-PCI. Coronary perforation and its association with
CTO-PCI success was analyzed. A significant reduction in short-term
mortality was noted with successful CTO-PCI compared to unsuccessful
CTO-PCI (odds ratio 0.218, 95% confidence interval 0.095 to 0.498, Z =
-3.61, p <0.001). A similar, significant reduction in long-term mortality
was noted with successful CTO-PCI compared to unsuccessful CTO-PCI (odds
ratio 0.391, 95% confidence interval 0.311 to 0.493, Z = -7.957, p
<0.001). A significant association was present between coronary
perforation and unsuccessful CTO-PCI (odds ratio 0.168, 95% confidence
interval 0.104 to 0.271, Z = -7.333, p <0.001). In conclusion, successful
CTO-PCI using a predominantly stent-based strategy is associated with a
significant reduction in short- and long-term mortality compared to
unsuccessful CTO-PCI. Coronary perforation was associated with CTO-PCI
failure. 2013 Published by Elsevier Inc. 2013 Elsevier Inc. All rights
reserved.
<9>
Accession Number
2013082878
Authors
Machtay M. Schipper M. Kong F.-M.
Institution
(Machtay, Schipper) Department of Radiation Oncology and Biostatistics,
University of Michigan, United States
Title
Shah et al. Induction chemoradiation is not superior to induction
chemotherapy alone in stage IIIA lung cancer. Annals of Thoracic Surgery
2012. (9).
Source
International Journal of Radiation Oncology Biology Physics. 85 (3) (pp
572-574), 2013. Date of Publication: 01 Mar 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
<10>
Accession Number
2013078291
Authors
Eggebrecht H. Schmermund A. Kahlert P. Erbel R. Voigtlander T. Mehta R.H.
Institution
(Eggebrecht, Schmermund, Voigtlander) Cardioangiological Center Bethanien
(CCB), Im Prufling 23, 60389 Frankfurt, Germany
(Kahlert, Erbel) Department of Cardiology, West German Heart Center Essen,
University Duisburg-Essen, Essen, Germany
(Mehta) Duke Clinical Research Institute, Duke University, Medical Center,
Durham, NC, United States
Title
Emergent cardiac surgery During Transcatheter aortic valve implantation
(TAVI): A weighted meta-analysis of 9,251 patients from 46 studies.
Source
EuroIntervention. 8 (9) (pp 1072-1080), 2013. Date of Publication: January
2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Transcatheter aortic valve implantation (TAVI) is a novel treatment
option for high surgical risk patients with severe symptomatic aortic
valve (AV) stenosis. During TAVI, some patients may require emergent
cardiac surgery (ECS). However, the incidence, reasons and outcomes of
those needing ECS remain unknown. Methods and results: We performed a
search of the English medical literature using MEDLINE to identify all
studies on TAVI and evaluate the incidence of ECS (i.e., within 24 hrs of
TAVI) and outcomes for these patients. Forty-six studies comprising 9,251
patients undergoing transfemoral, transapical or trans-subclavian TAVI for
native AV stenosis published between 01/2004 and 11/2011 were identified
and included in this weighted meta-analysis. Overall, TAVI patients were
old (mean=81.3+/-5.4 years) and had a high mean logistic EuroSCORE
(24.4+/-5.9%). Few patients required ECS (n=102; 1.1+/-1.1%) and this was
marginally higher among those undergoing transapical TAVI as compared to
those undergoing transarterial TAVI (1.9+/-1.7% vs. 0.6+/-0.9%). Data on
the reasons for ECS were available in 86% (88/102 patients) and 41% of
these (36/88) were performed for embolisation/dislocation of the AV
prosthesis, with aortic dissection (n=14), coronary obstruction (n=5),
severe AV regurgitation (n=10), annular rupture (n=6), aortic injury
(n=14), and myocardial injury including tamponade (n=12) constituting the
rest. Mortality at 30 days was about 9-fold higher in patients who did
need as compared with those patients who did not need ECS (67.1+/-37.9%
vs. 7.5+/-4.0%). Conclusions: Reported rates of ECS during TAVI were low
with embolisation or dislocation of the prosthesis being the most common
cause. ECS was associated with grave prognosis with two out of three
patients dying by 30 days. Thus, refinement in TAVI technology should not
only focus on miniaturisation and improving flexibility of the delivery
systems and/or devices-which may have the potential for decreasing aortic
dissection, annular rupture, and tamponade-but also incorporate
modifications to prevent embolisation/dislocation of the valve. Europa
Digital & Publishing 2013. All rights reserved.
<11>
Accession Number
2013079393
Authors
Faraoni D. Willems A. Melot C. De Hert S. Van der Linden P.
Institution
(Faraoni, Van der Linden) Department of Anaesthesiology, Centre
Hospitalier Universitaire (CHU) Brugmann - HUDERF, Brussels, Belgium
(Willems) Department of Paediatric Intensive Care, HUDERF, Brussels,
Belgium
(Melot) Department of Emergency, Erasme University Hospital, Brussels,
Belgium
(De Hert) Department of Anaesthesiology, Ghent University Hospital, Ghent,
Belgium
Title
Efficacy of tranexamic acid in paediatric cardiac surgery: A systematic
review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 42 (5) (pp 781-786), 2012.
Article Number: ezs127. Date of Publication: November 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
The benefit-to-risk ratio of using tranexamic acid (TXA) in paediatric
cardiac surgery has not yet been determined. This systematic review
evaluated studies that compared TXA to placebo in children undergoing
cardiac surgery. A systematic search was conducted in all relevant
randomized controlled trials. The following information was extracted from
the studies and analysed if relevant: demographic data, TXA dose and
regimen of administration, cardiopulmonary bypass time, blood loss and
blood product transfusion at 24 h. From the studies screened, only 8 (848
patients) were included in the analysis. Most data were heterogeneously
distributed and could not be analysed. Further, transfusion policies were
not well defined for each study. TXA reduced the need for red blood cell
transfusion by 6.4 ml kg<sup>-1</sup> day<sup>-1</sup> (I<sup>2</sup> =
0%, P = 0.45), platelet transfusion by 3.7 ml kg<sup>-1</sup>
day<sup>-1</sup> (I<sup>2</sup> = 0%, P = 0.46) and fresh frozen plasma
transfusion by 5.4 ml kg<sup>-1</sup> day<sup>-1</sup> (I<sup>2</sup> =
0%, P = 0.53). The number of children who avoided all blood product
transfusions was not reported in most of the studies. Evaluation of the
side effects associated with TXA use and the effects of the agent on
postoperative morbidity and mortality was not possible from the data.
There was marked variability in the dosage and infusion schemes used in
different studies. This systematic review showed that in paediatric
cardiac surgery, the benefit-to-risk ratio associated with the use of TXA
cannot be adequately defined. Evidence supporting the routine use of TXA
in paediatric cardiac surgery remains weak. The Author 2012. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<12>
Accession Number
2013075866
Authors
Tong A. Jan S. Wong G. Craig J.C. Irving M. Chadban S. Cass A. Howard K.
Institution
(Tong, Wong, Craig, Irving, Howard) Sydney School of Public, Health The
University of Sydney, Sydney, NSW, Australia
(Tong, Wong, Craig, Irving) Centre for Kidney Research, The Children's
Hospital at Westmead, Sydney, NSW, Australia
(Jan, Cass) Renal and Metabolic Division, The George Institute for Global
Health, Sydney, NSW, Australia
(Wong) Centre for Transplant and Renal Research, Westmead Hospital,
Sydney, Australia
(Chadban) Central Clinical School, Bosch Institute, The University of
Sydney, Sydney, NSW, Australia
Title
Rationing scarce organs for transplantation: Healthcare provider
perspectives on wait-listing and organ allocation.
Source
Clinical Transplantation. 27 (1) (pp 60-71), 2013. Date of Publication:
January/February 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Ongoing debate about how to maximize the benefit of scarce organs while
maintaining equity of access to transplantation exists. This study aims to
synthesize healthcare provider perspectives on wait-listing and organ
allocation. MEDLINE, Embase, and PsycINFO were searched till February 21,
2011. Quantitative data were extracted, and a qualitative synthesis of the
studies was conducted. Twenty studies involving 4254 respondents were
included. We identified two goals underpinning healthcare provider
preferences for organ allocation: (i) maximize clinical benefit (quality
of life gains, patient survival, treatment adherence, and graft survival)
and social outcomes (social support, productivity, and valuation); (ii)
achieve equity (waiting time, patient preferences, access to live
donation, and medical urgency). Maximizing clinical or social outcomes
meant organs would be preferentially given to patients expected to achieve
good transplant outcomes or wider social gain. Achieving equity meant all
patients should have an equal chance of transplant, or patients deemed
more urgent receive higher priority. A tension between equity and
efficiency is apparent. Balanced against dimensions of efficiency were
considerations to instill a degree of perceived fairness in organ
allocation. Ongoing engagement with stakeholders is needed to enhance
transparency, a reasonable balance between efficiency and equity, and
avoid discrimination against specific populations. 2012 John Wiley & Sons
A/S.
<13>
Accession Number
2013079385
Authors
Russell S.J. Tan C. O'Keefe P. Ashraf S. Zaidi A. Fraser A.G. Yousef Z.R.
Institution
(Russell, Fraser, Yousef) Wales Heart Research Institute, Cardiff
University, Cardiff, United Kingdom
(Tan, O'Keefe, Fraser, Yousef) University Hospital of Wales, Cardiff,
United Kingdom
(Ashraf, Zaidi) Morriston Hospital, Swansea, United Kingdom
Title
Optimized temporary bi-ventricular pacing improves haemodynamic function
after on-pump cardiac surgery in patients with severe left ventricular
systolic dysfunction: A two-centre randomized control trial.
Source
European Journal of Cardio-thoracic Surgery. 42 (6) (pp e146-e151), 2012.
Article Number: ezs492. Date of Publication: December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: Optimized temporary bi-ventricular (BiV) pacing may benefit
heart failure patients after on-pump cardiac surgery compared with
conventional dual-chamber right ventricular (RV) pacing. An improvement in
haemodynamic function with BiV pacing may reduce the duration of 'Level 3'
intensive care. Methods: Thirty-eight patients in sinus rhythm, ejection
fraction <=35%, undergoing on-pump surgical revascularization, valve
surgery or both were enrolled in this study. Before closing the sternum,
temporary epicardial pacing wires were attached to the right atrium, RV
outflow tract and basal posterolateral wall of the left ventricle.
Patients were randomly assigned to postoperative BiV pacing with the
optimization of the atrio- (AV) and inter-ventricular (VV) pacing
intervals (Group 1) or conventional dual-chamber right AV pacing (Group
2). The primary end-point was the duration of 'Level 3' intensive care.
Secondary end-points included cardiac output which was measured by
thermodiluation at admission to the intensive care unit and at 6 and 18 h
later, in five different pacing modes. Results: The duration of 'Level 3'
care was similar between groups (40 +/- 35 vs 54 +/- 63 h; Group 1 vs 2; P
= 0.43). Cardiac output was similar in all pacing modes at baseline. At 18
h, cardiac output with BiV pacing (5.8 l/min) was 7% higher than atrial
inhibited (5.4 l/min) and 9% higher than dual-chamber RV pacing (5.3
l/min; P = 0.02 and 0.001, respectively). Optimization of the VV interval
produced a further 4% increase in cardiac output compared with baseline
settings (P = 0.005). Conclusions: Postoperative haemodynamic function may
be enhanced by temporary BiV pacing of high-risk patients after on-pump
cardiac surgery. The Author 2012.
<14>
Accession Number
2013079351
Authors
Santini F. Onorati F. Telesca M. Menon T. Mazzi P. Berton G. Faggian G.
Mazzucco A.
Institution
(Santini, Onorati, Menon, Faggian, Mazzucco) Division of Cardiac Surgery,
University of Verona Medical School, Verona, Italy
(Telesca) Department of Cardiac Surgery, Ca' Foncello Hospital, Treviso,
Italy
(Mazzi, Berton) Department of Pathology, Section of General Pathology,
University of Verona, Verona, Italy
Title
Selective pulmonary pulsatile perfusion with oxygenated blood during
cardiopulmonary bypass attenuates lung tissue inflammation but does not
affect circulating cytokine levels.
Source
European Journal of Cardio-thoracic Surgery. 42 (6) (pp 942-950), 2012.
Article Number: ezs199. Date of Publication: December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objective: Improved respiratory outcome has been shown after selective
pulsatile pulmonary perfusion (sPPP) during cardiopulmonary bypass (CPB).
No contemporary study has analysed the impact of sPPP on alveolar and
systemic inflammatory response in humans. Methods: Sixty-four patients
undergoing a coronary artery bypass graft (CABG) were randomized to sPPP
or standard CPB (32 patients each). An alveolar-arterial oxygen gradient
(A-aDO. <sub>2</sub>) was measured preoperatively (T0), at ICU arrival
(T1), 3 h postoperatively (T2) and postextubation (T3). The
bronchoalveolar lavage (BAL) was collected at T0, T1 and T2. White blood
cells (WBCs), neutrophils, mononucleates and lymphocytes in BAL
infiltrates were compared between the two groups. A cytokine assay for
interleukin-1 (IL-1), IL-8, tumour necrosis factor alpha (TNF-alpha),
monocyte chemotactic protein-1 (MCP-1), growth regulated oncogene-alpha
(GRO-alpha) and interferon (IFN)- was collected from the BAL and
peripheral blood at the same time-points. Repeated-measure analysis of
variance and non-parametric statistics were used to assess the
between-group and during time differences. Results: The two groups proved
comparable for perioperative variables. A-aDO<sub>2</sub> proved better
after sPPP (group-P = 0.0001; group x time-P < 0.0001). BAL infiltrates
after sPPP showed lower WBCs, neutrophils and lymphocytes (group-P =
0.0001, group x time-P = 0.0001 for all) together with higher
mononucleates (group-P = 0.0001, group x time-P = 0.0001). Proinflammatory
cytokines and chemokine MCP-1 were lower in BAL after sPPP (group-P =
0.005, 0.034, 0.036 and 0.005, and group x time-P = 0.001, 0.009, 0.001
and 0.0001 for IL-1, IL-8, TNF-alpha and MCP-1, respectively), whereas the
immune modulator IFN- significantly augmented after sPPP (time-P = 0.0001)
but remained stable after the standard CPB (time-P = 0.101, group-P = 001,
group x time-P = 0.0001). Indeed, serum cytokines were not different in
the two groups during the study (P = NS at single time-points and as a
function of time). Conclusions: sPPP attenuates alveolar inflammation, as
demonstrated by the lower neutrophilic/lymphocytic alveolar infiltration,
and the secretion of anti-inflammatory rather than proinflammatory
mediators. The Author 2012. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.
<15>
Accession Number
70988542
Title
Abstracts from the 9th Annual Meeting of the Euro-Asian Bridge.
Source
Heart Surgery Forum. Conference: 9th Annual Meeting of the Euro-Asian
Bridge Pravets Bulgaria. Conference Start: 20120928 Conference End:
20120930. Conference Publication: (var.pagings). 15 (6) , 2012. Date of
Publication: December 2012.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
The proceedings contain 70 papers. The topics discussed include: surgical
treatment of massive pulmonary embolism; retrograde cerebral perfusion
with deep hypothermia - method of brain protection in surgery of ascending
aorta and arch aneurysms; surgery of the ascending aorta and aortic arch
in Albania; reconstructive surgery for aortic disease; experience of
aortic aneurysms surgical treatment in patient with marfane syndrome;
aortic valve sparing surgery in marfan syndrome patients; aortic root
reconstructive surgery-new created technique; full left side pericardial
agenesis preventing cardiac tamponade in case of type 1 aortic dissection;
coronary surgery in Albania; stenting versus coronary bapass artery
grafting for proximal left anterior descending artery disease:
meta-analysis of randomized trials in the drug-eluting stent era; and
surgery for patients with diffuse atherosclerotic disease.
<16>
Accession Number
70988493
Authors
Raanani E. Feinberg M. BenZikry S. Sternik L. Cohen H. Levin S. Shinfeld
A. Maor Y.
Institution
(Raanani, Sternik, Cohen, Levin, Shinfeld) Cardiac Surgery Department,
Sheba Medical Center, Ramat-Gan, Israel
(Feinberg) Cardiology Department, Sheba Medical Center, Ramat-Gan, Israel
(BenZikry) Heart Center, Sheba Medical Center, Ramat-Gan, Israel
(Maor) Infectious Disease Department, Sheba Medical Center, Ramat-Gan,
Israel
Title
Long-term echocardiographic results of mitral valve repair in
endocarditis.
Source
Heart Surgery Forum. Conference: 9th Annual Meeting of the Euro-Asian
Bridge Pravets Bulgaria. Conference Start: 20120928 Conference End:
20120930. Conference Publication: (var.pagings). 15 (6) (pp E336-E337),
2012. Date of Publication: December 2012.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Objective. While a systematic review of the literature shows that repair
of an infected mitral valve is associated with good clinical in-hospital
and long-term results, repair durability is still disputed. We compared
the long-term clinical and echocardiographic results of valve repair in
endocarditis and in degenerative heart disease. Methods. From 2004, 475
patients with degenerative mitral valve underwent repair in our Medical
Center. Of them, 42 (9 %) were operated on for acute or sub-acute mitral
endocarditis (group I), and were compared with 433 patients who had no
history of endocarditis (group II). All patients where followed
prospectively. Results. There was 1 (2%) in-hospital death in the
endocarditis group and 1 (0.2%) in the myxomatous group (p=0.17). Mean
late clinical and echocardiography followup was 28+/-22 months
(1-88months) and was 96% complete. Late all-cause mortality was 0% in
group I versus 1% (n=6) in group II (p=1.00). Freedom from reoperation on
the mitral valve was 95% (2 patients) and 99% (6 patients) in groups I and
II, respectively (p=0.15). Freedom from recurrent subacute bacterial
endocarditis (SBE) was 100% in group I. Late echocardiography revealed
that 85% and 90% of patients (groups I and II, respectively) were free
from moderate or severe mitral regurgitation (p=0.36). All other late
valverelated complications were similar between the groups. Conclusions.
Mid to long-term clinical and echocardiographic results, among patients
undergoing surgery for infective endocarditis, compare well with those of
repair in the non-SBE degenerative group. Freedom from recurrent
endocarditis was excellent.
<17>
Accession Number
70988482
Authors
Dibra A. Dibra L. Xhepa S. Likaj E. Dumani S. Kacani A. Refatllari A. Goda
A.
Institution
(Dibra, Dibra, Xhepa, Likaj, Dumani, Kacani, Refatllari, Goda) University
Hospital Center, Nene Tereza and German Hospital, Tirana, Albania
Title
Stenting versus coronary bapass artery grafting for proximal left anterior
descending artery disease: Meta-analysis of randomized trials in the
drug-eluting stent era.
Source
Heart Surgery Forum. Conference: 9th Annual Meeting of the Euro-Asian
Bridge Pravets Bulgaria. Conference Start: 20120928 Conference End:
20120930. Conference Publication: (var.pagings). 15 (6) (pp E331), 2012.
Date of Publication: December 2012.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Objective. The choice of revascularization strategy for proximal disease
of left anterior descending artery remains a matter of debate. There is
limited evidence on the relative performance of coronary artery bypass
surgery (CABG) versus stenting with bare metal or drug-eluting stents (BMS
or DES). Methods. We performed a meta-analysis of randomized trials
comparing coronary angioplasty with implantation of BMS or DES with CABG.
Seven trials reporting outcome data for a minimum of 6 months with a total
population of 1074 patients were selected for this analysis. DESs were
used in two of the trials with 319 patients. Patients were followed up
from a minimum of 6 months up to 5 years. The main outcome of interest was
the occurrence of major adverse cardiac events (MACE) defined as death,
myocardial infarction or repeat revascularization. Other outcomes of
interest were death, myocardial infarction and need for repeat
revascularization as individual endpoints. Results. The odds of incurring
a major adverse cardiac event were markedly higher with DES compared to
CAGB (OR 2.24, 95% CI: 1.59 to 3.15, p<0.001). This difference was
entirely explained by the superiority of CABG versus stenting regarding
the need for repeat revascularization procedures (OR 3.71, 95% CI: 2.31 to
5.97, p<0.001). However, the difference between stenting and CABG was no
longer observed when the analysis was confined to trials using DES (p=0.25
for MACE and p=0.63 for repeat revascularisation). On the other hand,
there were no differences between patients treated with DES versus CABG
regarding the odds of death (OR 0.70, 95% CI: 0.35 to 1.40, p=0.31) or
myocardial infarction (OR 0.76, 95% CI: 0.37 to 1.56, p=0.45). Conclusion.
Coronary artery bypass grafting is superior to stent implantation for
treatment of proximal disease of left anterior descending artery. However,
the superiority might be lost in patients undergoing DES implantation.
