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<1>
[Use Link to view the full text]
Accession Number
2013140847
Authors
Agarwal S. Nuttall G.A. Johnson M.E. Hanson A.C. Oliver W.C.
Institution
(Agarwal) Department of Anesthesiology, Detroit Medical Center, Detroit,
MI, United States
(Nuttall, Johnson, Oliver) Department of Anesthesiology, College of
Medicine, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, United
States
(Hanson) Department of Biostatistics, College of Medicine, Mayo Clinic,
Rochester, MN, United States
Title
A prospective, randomized, blinded study of continuous ropivacaine
infusion in the median sternotomy incision following cardiac surgery.
Source
Regional Anesthesia and Pain Medicine. 38 (2) (pp 145-150), 2013. Date of
Publication: March-April 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Objective: The aim of this prospective, randomized, double-blind, placebo
controlled trial was to evaluate the safety and efficacy of continuous
ropivacaine infusion of into the sternal wound. Methods: We planned to
enroll 200 patients scheduled for various cardiac surgical procedures into
the study. Patients, in a double-blind randomized fashion, were given
either normal saline or 0.3% ropivacaine through 2 subcutaneous multiport
catheters placed on either side of the sternal split at an infusion rate
of 4 mL/h for 64 hours. The efficacy outcomes measured were time to
extubation of the trachea, intensive care unit and hospital stay duration,
pain scores, and narcotic usage. The safety outcomes measured were
systemic local anesthetic toxicity, major cardiac complications, and wound
infection. MEASUREMENTS AND MAIN Results: The data safety monitoring board
stopped the study after enrolling 85 patients because of excessive sternal
wound infections (9%, n = 44) in the ropivacaine group. This rate of
infection was not statistically different from the control group (0%, n =
41, P = 0.12), but it was statistically different from our historical
incidence of sternal wound infection (1.9%, no = 6381, P = 0.002). There
was also a lack of evidence of efficacy for time to extubation of the
trachea, narcotic usage, and pain control. Conclusions: The phase III
trial did not show improvement in time to extubation of the trachea or
pain control in the 0.3% ropivacaine group, but it was stopped early by
the data safety monitoring board. 2013 by American Society of Regional
Anesthesia and Pain Medicine.
<2>
Accession Number
2013119642
Authors
Batchelor W.B. Ellis S.G. Ormiston J.A. Stone G.W. Joshi A.A. Wang H.
Underwood P.L.
Institution
(Batchelor) Florida State University, College of Medicine, Tallahassee,
FL, United States
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Ormiston) Mercy Angiography Unit, Mercy Hospital, Auckland, New Zealand
(Stone) Cardiovascular Research Foundation, New York. NY, United States
(Joshi, Wang, Underwood) Boston Scientific Corporation, Natick, MA, United
States
(Underwood) Boston Scientific Corporation, 100 Boston Scientific Way,
Marlborough, MA 01752, United States
(Underwood) Southern Medical Group, P.A., 1300 Medical Dr., Tallahassee,
FL 32308, United States
Title
Racial differences in long-term outcomes after percutaneous coronary
intervention with paclitaxel-eluting coronary stents.
Source
Journal of Interventional Cardiology. 26 (1) (pp 49-57), 2013. Date of
Publication: February 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Objectives To assess the influence of race on long-term outcomes following
percutaneous coronary intervention (PCI) with paclitaxel-eluting stents
(PES). Background Data on the influence of race on long-term outcomes
following PCI with drug-eluting stents are limited because of severe
underrepresentation of minority populations in randomized trials. Methods
We compared 5-year outcomes of 2,301 Whites, 127 Blacks, and 169 Asians
treated with PES in the TAXUS IV, V, and ATLAS trials. Outcomes were
adjusted using a propensity score logistic regression model with 1:4
matching. Results Blacks were more likely than Whites to be female, have a
history of hypertension, diabetes mellitus, congestive heart failure, and
stroke, but were less likely to have prior coronary artery disease.
Compared with Whites, Asians were younger, more likely to be male, have
stable angina, and left anterior descending disease, and less likely to
have silent ischemia, previous coronary artery bypass surgery, prior
coronary artery disease, diabetes mellitus, peripheral vascular disease,
and to receive glycoprotein IIb/IIIa inhibitors. Despite higher
antiplatelet compliance, the adjusted 5-year rates of myocardial
infarction (15.4% vs. 5.4%, P < 0.001) and stent thrombosis (5.6% vs.
1.1%, P = 0.002) were higher in Blacks than Whites. Despite lower
antiplatelet compliance, Asians had no differences in myocardial
infarction and stent thrombosis compared with Whites. Mortality and
revascularization rates were similar between the three groups. Conclusions
The long-term risk of major thrombotic events after PCI with PES was
higher in Blacks, but not Asians, compared with Whites. The mechanisms
underlying these racial differences warrant further investigation. (J
Interven Cardiol 2013;26:49-57) 2012, Wiley Periodicals, Inc.
<3>
Accession Number
2013131603
Authors
Roe Y.L. Zeitz C.J. Mittinty M.N. McDermott R.A. Chew D.P.
Institution
(Roe) School of Health Sciences, University of South Australia, Australia
(Zeitz) Division of Medicine, The Queen Elizabeth Hospital, Australia
(Mittinty) School of Population Health and Clinical Practice, University
of Adelaide, Australia
(McDermott) Public Health Group, Sansom Institute, University of South
Australia, Australia
(Chew) Department of Cardiology, Flinders University, Flinders Medical
Centre, Adelaide, SA, Australia
Title
Impact of age, gender and indigenous status on access to diagnostic
coronary angiography for patients presenting with non-ST segment elevation
acute coronary syndromes in Australia.
Source
Internal Medicine Journal. 43 (3) (pp 317-322), 2013. Date of Publication:
March 2013.
Publisher
Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053,
Australia)
Abstract
Using Australian guidelines for management of acute coronary syndromes, we
investigated the proportion of high-risk patients enrolled in the Acute
Coronary Syndromes Prospective Audit registry who received a coronary
angiogram. A prospective nationwide multicentre registry involving 39
Australian hospitals was used. The study cohort were patients with
high-risk clinical features without ST segment elevation (n = 1948)
admitted from emergency departments between 1 November 2005 and 31 July
2007. Eighty nine per cent of patients with ST segment elevation
myocardial infarction and only 53% of eligible patients with high-risk
acute coronary syndromes with no ST elevation received a diagnostic
angiogram. Increasing age was associated with lower rates of angiography;
a high-risk patient at the age of >=70 years was 19% less likely to
receive an angiogram than one at the age of <70 years (risk ratio (RR) =
0.81 95% confidence interval (CI) 0.76, 0.76). Women were 26% less likely
than men to receive an angiogram (RR = 0.74; 95% CI = 0.65, 0.83). The
adjusted RR from the multivariate analysis suggests that a patient at the
age of >=70 years was 35% less likely to receive an angiogram than one at
the age of <70 years (RR = 0.65, 95% CI = 0.60, 0.73), and that women were
13% less likely than men to receive an angiogram (RR = 0.87, 95% CI =
0.80, 0.96). Indigenous patients were as likely to access angiography as
eligible non-indigenous patients (RR = 1.03, 95% CI 0.85, 1.25). There is
underinvestigation of high-risk patients without ST segment elevation in
Australian hospitals, particularly for women and older patients.
Indigenous patients are younger and have poorer risk profiles, and
represent a group that would benefit from greater investment in prevention
strategies. 2013 Royal Australasian College of Physicians.
<4>
Accession Number
2013145371
Authors
Kim N.-Y. Shim J.-K. Bang S.-O. Sim J.-S. Song J.-W. Kwak Y.-L.
Institution
(Kim, Shim, Bang, Sim, Song, Kwak) Department of Anesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul, South Korea
(Shim, Bang, Song, Kwak) Anesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
Title
Effects of ulinastatin on coagulation in high-risk patients undergoing
off-pump coronary artery bypass graft surgery.
Source
Korean Journal of Anesthesiology. 64 (2) (pp 105-111), 2013. Date of
Publication: February 2013.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: Both systemic inflammatory reaction and regional myocardial
ischemia/reperfusion injury may elicit hypercoagulability after off-pump
coronary artery bypass grafting (OPCAB). We investigated the influence of
ulinastatin, which suppresses the activity of polymorphonuclear leukocyte
elastase and production of pro-inflammatory cytokines, on coagulation in
patients with elevated high-sensitivity C-reactive protein (hsCRP)
undergoing OPCAB. Methods: Fifty patients whose preoperative hsCRP > 3.0
mg/L were randomly allocated into the ulinastatin (600,000 U) or control
group. Serum concentrations of thrombin-antithrombin complex (TAT) and
prothrombin fragment 1+2 (F1+2) were measured preoperatively, immediately
after surgery, and at 24 h after surgery, respectively. Secondary
endpoints included platelet factor (PF)-4, amount of blood loss, and
transfusion requirement. Results: All baseline values of TAT, F1+2, and
PF-4 were higher than the normal range in both groups. F1+2 was elevated
in both groups at immediate, and at 24 h after surgery as compared to
baseline value, without any significant intergroup differences. Remaining
coagulation parameters, transfusion requirement and blood loss during
operation and postoperative 24 h were not different between the two
groups. Conclusions: Intraoperative administration of ulinastatin did not
convey beneficial influence in terms of coagulation and blood loss in
high-risk patients with elevated hsCRP undergoing multivessel OPCAB, who
already exhibited hypercoagulability before surgery. the Korean Society
of Anesthesiologists, 2013.
<5>
Accession Number
2013141258
Authors
Shi J. Wang G. Lv H. Yuan S. Wang Y. Ji H. Li L.
Institution
(Shi, Wang, Lv, Yuan, Ji, Li) Department of Anesthesiology and Critical
Care, Fuwai Hospital, Chinese Academy of Medical Sciences, 167 Bei Lishi
Rd, Beijing, 100037, China
(Wang) Department of Biostatistics, Peking Union Medical College, Chinese
Academy of Medical Sciences, Beijing, China
Title
Tranexamic acid in on-pump coronary artery bypass grafting without
clopidogrel and aspirin cessation: Randomized trial and 1-year follow-up.
Source
Annals of Thoracic Surgery. 95 (3) (pp 795-802), 2013. Date of
Publication: March 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Dual antiplatelet therapy is widely used in patients with
coronary artery disease and increases the risk of excessive bleeding and
transfusion in those undergoing coronary artery bypass grafting (CABG).
Methods: The study was a prospective, randomized, double-blinded and
placebo-controlled trial. Patients undergoing primary and isolated on-pump
CABG with their last dose of clopidogrel and aspirin less than 7 days
preoperatively were randomly assigned to receive tranexamic acid (15 mg/kg
before surgical incision and 15 mg/kg after protamine neutralization) or a
corresponding volume of saline solution. The primary outcome was
allogeneic erythrocyte transfusion. Results: Randomly assigned
participants were 120 adults among whom 117 were analyzed, 58 in the
tranexamic acid group and 59 in the placebo group. As compared with
placebo, tranexamic acid reduced allogeneic erythrocyte requirement - both
the volume transfused (4.84 +/- 5.85 versus 9.36 +/- 11.41 units; mean
difference -4.52 units; 95% interval confidence [CI], -7.85 to -1.19
units; p < 0.001) and the ratio exposed (72.4% versus 91.5%; risk
difference in percentage point, -19.1; 95% CI, -32.6 to -5.59; relative
risk, 0.79; 95% CI, 0.66 to 0.94; p = 0.007) - blood loss (1069.1 +/-
565.5 mL versus 1449.8 +/- 899.8 mL; mean difference, -380.7 mL; 95% CI,
-656.4 to -104.9 mL; p = 0.005), major bleeding (50.0% versus 78.0%; risk
difference, -28.0; 95% CI, -44.6 to -11.3; relative risk, 0.64; 95% CI,
0.48 to 0.86; p = 0.002), and reoperation (0.0% versus 10.2%; risk
difference, -10.2; 95% CI, -17.9 to -2.46; relative risk, 0.08; 95% CI,
0.00 to 1.36; p = 0.01). Conclusions: Tranexamic acid significantly
reduced blood loss, major bleeding, reoperation, and allogeneic
transfusion in patients undergoing primary and isolated on-pump CABG
without clopidogrel and aspirin cessation. 2013 The Society of Thoracic
Surgeons.
<6>
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Accession Number
2013140790
Authors
Guethoff S. Meiser B.M. Groetzner J. Eifert S. Grinninger C. Ueberfuhr P.
Reichart B. Hagl C. Kaczmarek I.
Institution
(Guethoff, Groetzner, Eifert, Ueberfuhr, Reichart, Hagl, Kaczmarek)
Department of Cardiac Surgery, University of Munich (LMU), Marchioninistr.
15, 81377 Munchen, Germany
(Meiser, Grinninger, Kaczmarek) Transplantation Center Munich, University
of Munich (LMU), Munich, Germany
Title
Ten-year results of a randomized trial comparing tacrolimus versus
cyclosporine a in combination with mycophenolate mofetil after heart
transplantation.
Source
Transplantation. 95 (4) (pp 629-634), 2013. Date of Publication: 27 Feb
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Long-term results of prospective randomized trials comparing
triple immunosuppressive strategies combining tacrolimus (TAC) or
cyclosporine A (CsA) with mycophenolate mofetil (MMF) and steroids after
heart transplantation (HTX) are rarely published. Therefore, we collected
long-term follow-up data of an intervention cohort 10 years after
randomization. Methods: Ten-year follow-up data of 60 patients included in
a prospective, randomized trial between 1998 and 2000 were analyzed as
intention-to-treat (TAC-MMF n=30; CsA-MMF n=30). Baseline characteristics
were well balanced. Cardiac allograft vasculopathy (CAV) was graduated in
accordance with the new ISHLT classification. Results: Survival at 1, 5,
and 10 years was 96.7%, 80.0%, and 66.7% for TAC-MMF and 90.0%, 83.3%, and
80.0% for CsA-MMF (P=ns). Freedom from acute rejection (AR) was
significantly higher in TAC-MMF versus CsA-MMF (65.5% vs. 21.7%, log-rank
8.3, P=0.004). Freedom from ISHLT>=CAV1 after 5 and 10 years was in
TAC-MMF 64.0% and 45.8%, and in CsA-MMF 36.0% (log-rank 3.0, P=0.085) and
8.0% (log-rank 9.0, P=0.003). No difference in long-term results for
freedom from coronary angioplasty or stenting, renal dysfunction, diabetes
mellitus, CMV infection, or malignancy was detected. Conclusion:
Cross-over effects because of treatment switch may result in impairment of
significance between the groups. The long-term analysis resulted in a
significant difference in manifestation of CAV between the groups after 10
years. Less rejection in the TAC-group might have contributed to the lower
incidence of CAV. Superior freedom from AR and CAV in the TAC-MMF group
did not result in better long-term survival. 2013 by Lippincott Williams
& Wilkins.
<7>
Accession Number
2013146803
Authors
Shang Q.-H. Xu H. Lu X.-Y. Wen C. Shi D.-Z. Chen K.-J.
Institution
(Shang) Beijing University of Chinese Medicine, Beijing (100029), China
(Xu, Lu, Wen) National Integrative Medicine Center for Cardiovascular
Diseases, China-Japan Friendship Hospital, Beijing (100029), China
(Shi, Chen) Xiyuan Hospital, China Academy of Chinese Medical Sciences,
Beijing (100091), China
Title
A multi-center randomized double-blind placebo-controlled trial of
Xiongshao Capsule in preventing restenosis after percutaneous coronary
intervention: A subgroup analysis of senile patients.
Source
Chinese Journal of Integrative Medicine. 17 (9) (pp 669-674), 2011. Date
of Publication: 2011.
Publisher
Chinese Journal of Integrated Traditional and (1 Caochang, Xiyuan, Beijing
100091, China)
Abstract
Objective: To evaluate the safety and efficacy of Xiongshao Capsule (XS),
consisting of Chuangxiongol and paeoniflorin, in preventing restenosis
after percutaneous coronary intervention (PCI) in senile coronary heart
disease (CHD) patients. Methods: A multi-center, randomized, double-blind,
placebo-controlled trial was conducted. A total of 335 CHD patients were
randomly assigned to treatment with oral administration of XS, or a
placebo for 6 months after successful PCI. A clinical follow-up was
performed at 1, 3 and 6 months after PCI and an angiographic follow-up was
scheduled at 6 months. The primary endpoint was angiographic restenosis
defined as a luminal stenosis 50% in follow-up. The secondary endpoints
were combined incidence of death, target lesion nonfatal myocardial
infarction, repeat target-vessel angioplasty, and coronary artery bypass
graft surgery (CABG). The follow-up for the above clinical endpoint events
was continued to 1 year after PCI. Results: The subgroup analysis of 152
senile patients (68 cases angiographic follow-up) showed that the
restenosis rates tended to reduce in the XS group as compared with that in
the placebo group (24.32% vs. 38.71%, P > 0.05), and the minimum lumen
diameter (MLD) significantly increased in the follow-up (2.15 +/- 0.84 for
XS vs. 1.73 +/- 0.91 for placebo, P < 0.05). The incidence of recurrent
angina at 3 and 6 months after PCI was also significantly reduced in the
XS group (4.11% and 12.33%) as compared with those in the placebo group
(17.72% and 43.04%), but there was no significant difference in the
combined incidence of clinical outcomes (6.85% in the XS group vs. 11.39%
in the placebo group, P > 0.05). No significant adverse reactions occurred
within the 6-month follow-up period in the XS group. Conclusion:
Administration of XS in addition to standardized Western medication for 6
months is demonstrated to be safe and effective in reducing post-PCI
recurrent angina and inhibiting luminal restenosis after PCI in senile CHD
patients. 2011 The Chinese Journal of Integrated Traditional and Western
Medicine Press and Springer-Verlag Berlin Heidelberg.
<8>
Accession Number
2013144911
Authors
Karlilar B. Tunc M. Gunal Sazak H. Telatar A. Savkilioglu E. Karabulut E.
Institution
(Karlilar) Clinic of Anesthesiology and Reanimation, Umut Surgical Medical
Center, Mersin, Turkey
(Tunc, Gunal Sazak, Savkilioglu) Anesthesiology and Reanimation, Ataturk
Pulmonary Diseases and Surgery Training and Research Hospital, Ankara,
Turkey
(Telatar) Anesthesiology and Reanimation, Sinop State Hospital, Sinop,
Turkey
(Karabulut) Department of biostatistics, Hacettepe University, Faculty of
Medicine, Ankara, Turkey
Title
Effects of epidural bupivacaine on the doses of propofol, alfentanil,
vecuronium, and neuromuscular block: A prospective randomized,
single-blind clinical study.
Source
Turkiye Klinikleri Journal of Medical Sciences. 33 (2) (pp 306-313), 2013.
Date of Publication: 2013.
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Objective: This study was planned to ascertain the effects of epidural
bupivacaine on the doses of propofol, alfentanil and vecuronium used for
the maintenance for general anesthesia in patients receiving thoracic
epidural anesthesia (TEA) combined with total intravenous anesthesia
(TIVA) in thoracic surgery. In addition, the impacts of TEA on duration,
intensity, reversal and the characteristics of residual block related to
vecuronium-induced neuromuscular blockade was investigated. Material and
Methods: Thirty patients scheduled for thoracic surgery were randomly
assigned into two groups. Group 1 received TIVA combined with TEA, whereas
Group 2 obtained TIVA solely. Epidural bupivacaine (0.375%) was given 6
mL/h following 1.5 mL/segment bupivacaine (0.5%) bolus in Group 1. General
anesthesia was provided with propofol, alfentanil and vecuronium in both
groups. Propofol dose was adjusted to maintain bispectral index (BIS)
value between 45 and 60, whereas alfentanil dose was titrated according to
the hemodynamic parameters. Following neuromuscular monitoring and
stabilization of response to the neuromuscular stimulus, 0.1 mg/kg
vecuronium was injected intravenously in 5 seconds. The responses to train
of four (TOF) stimulation (TOF1 and TOF2), posttetanic count (PTC), and
TOF rate (TOFR) values were recorded. The neuromuscular blockade was
reversed after closure of surgical incision and the fourth response to TOF
during recovery. The residual block was assessed in surgical intensive
care unit for 30 minutes. Results: Alfentanil amount used in the
maintenance was significantly less in Group 1 compared to Group 2
(p<0.05), whereas there was no difference between the groups for propofol
and vecuronium doses (p>0.05). There was no statistically significant
difference between the groups with respect to the onset time of
vecuronium, TOF1 time following induction, and duration of the clinical
effects of vecuronium used for induction and maintenance (p>0.05).
Conclusion: It was demonstrated that epidural bupivacaine decreased the
requirement of alfentanil without alterations in propofol and vecuronium
doses in patients undergoing thoracic surgery in our study. We also
suggest that in the present dose, epidural bupivacaine has no effect on
duration, intensity, reversal or the characteristics of residual block
related to vecuronium-induced neuromuscular blockade. 2013 by Turkiye
Klinikleri.
<9>
Accession Number
2013136857
Authors
Kamalesh M. Sharp T.G. Tang X.C. Shunk K. Ward H.B. Walsh J. King III S.
Colling C. Moritz T. Stroupe K. Reda D.
Institution
(Kamalesh, Sharp, Walsh) Roudebush VA Medical Center, School of Medicine,
Indiana University, 1481 West 10th Street, Indianapolis, IN 46202, United
States
(Tang, Moritz, Stroupe, Reda) Hines VA Cooperative Studies Program
Coordinating Center, Hines, IL, United States
(Shunk) University of California, San Francisco, VA Medical Center, San
Francisco, CA, United States
(Ward) University of Minnesota Medical Center, Minneapolis, MN, United
States
(King III) Saint Joseph's Heart and Vascular Institute, Atlanta, GA,
United States
(Colling) Cooperative Studies Program Clinical Research Pharmacy
Coordinating Center, Albuquerque, NM, United States
Title
Percutaneous coronary intervention versus coronary bypass surgery in
United States veterans with diabetes.
Source
Journal of the American College of Cardiology. 61 (8) (pp 808-816), 2013.
Date of Publication: 26 Feb 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study sought to determine the optimal coronary
revascularization strategy in patients with diabetes with severe coronary
disease. Background: Although subgroup analyses from large trials,
databases, and meta-analyses have found better survival for patients with
diabetes with complex coronary artery disease when treated with surgery, a
randomized trial comparing interventions exclusively with drug-eluting
stents and surgery in patients with diabetes with high-risk coronary
artery disease has not yet been reported. Methods: In a prospective,
multicenter study, 198 eligible patients with diabetes with severe
coronary artery disease were randomly assigned to either coronary artery
bypass grafting (CABG) (n = 97) or percutaneous coronary intervention
(PCI) with drug-eluting stents (n = 101) and followed for at least 2
years. The primary outcome measure was a composite of nonfatal myocardial
infarction or death. Secondary outcome measures included all-cause
mortality, cardiac mortality, nonfatal myocardial infarction, and stroke.
Results: The study was stopped because of slow recruitment after enrolling
only 25% of the intended sample size, leaving it severely underpowered for
the primary composite endpoint of death plus nonfatal myocardial
infarction (hazard ratio: 0.89; 95% confidence interval: 0.47 to 1.71).
However, after a mean follow-up period of 2 years, all-cause mortality was
5.0% for CABG and 21% for PCI (hazard ratio: 0.30; 95% confidence
interval: 0.11 to 0.80), while the risk for nonfatal myocardial infarction
was 15% for CABG and 6.2% for PCI (hazard ratio: 3.32; 95% confidence
interval: 1.07 to 10.30). Conclusions: This study was severely
underpowered for its primary endpoint, and therefore no firm conclusions
about the comparative effectiveness of CABG and PCI are possible. There
were interesting differences in the components of the primary endpoint.
However, the confidence intervals are very large, and the findings must be
viewed as hypothesis generating only. (Coronary Artery Revascularization
in Diabetes; NCT00326196) 2013 American College of Cardiology Foundation.
<10>
Accession Number
2013147529
Authors
Hakim F.A. Krishnaswamy C. Mookadam F.
Institution
(Hakim, Krishnaswamy, Mookadam) Department of Cardiovascular Diseases,
Mayo Clinic Arizona, College of Medicine, 13400 E Shea Blvd, Scottsdale,
AZ 85255, United States
Title
Mitral arcade in adults - A systematic overview.
Source
Echocardiography. 30 (3) (pp 354-359), 2013. Date of Publication: March
2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Mitral arcade (MA) is a rare congenital anomaly of the mitral valve and
its tensor apparatus. This condition has been reported primarily in
children younger than 3 years of age. MA is characterized by elongated
papillary muscles connected to each other and to the tip of anterior
mitral leaflet by a bridge of fibrous tissue. Because of progressive
mitral regurgitation and/or mitral stenosis, survival into adulthood is
rare. Not much is known about MA in the adult population. In this review
we address the demographic features, clinical presentation, diagnosis,
treatment, and outcome of this congenital anomaly in adult patients.
2013, Wiley Periodicals, Inc.
<11>
Accession Number
2013136870
Authors
Hulten E. Pickett C. Bittencourt M.S. Villines T.C. Petrillo S. Di Carli
M.F. Blankstein R.
Institution
(Hulten, Bittencourt, Di Carli, Blankstein) Noninvasive Cardiovascular
Imaging Program, Departments of Medicine (Cardiovascular Division) and
Radiology, Brigham and Women's Hospital and Harvard Medical School, 75
Francis Street, Boston, MA 02115, United States
(Pickett, Villines) Department of Medicine (Cardiology Service), Walter
Reed National Military Medical Center, Bethesda, MD, United States
(Petrillo) Department of Radiology, Mid-Atlantic Permanente Medical Group,
Rockville, MD, United States
Title
Outcomes after coronary computed tomography angiography in the emergency
department: A systematic review and meta-analysis of randomized,
controlled trials.
Source
Journal of the American College of Cardiology. 61 (8) (pp 880-892), 2013.
Date of Publication: 26 Feb 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The aim of the study was to systematically review and perform
a meta-analysis of randomized, controlled trials of coronary computed
tomography angiography (CCTA) versus usual care (UC) triage of acute chest
pain in the emergency department (ED). Background: CCTA allows rapid
evaluation of patients presenting to the ED with acute chest pain
syndromes; however, the impact of such testing on patient management and
downstream testing has emerged as a concern. Methods: We systematically
searched for randomized, controlled trials of CCTA in the ED and performed
a meta-analysis of clinical outcomes. Results: Four randomized, controlled
trials were included, with 1,869 patients undergoing CCTA and 1,397
undergoing UC. There were no deaths and no difference in the incidence of
myocardial infarction, post-discharge ED visits, or rehospitalizations.
Four studies reported decreased length of stay with CCTA and 3 reported
cost savings; 8.4% of patients undergoing CCTA versus 6.3% of those
receiving UC underwent invasive coronary angiography (ICA), whereas 4.6%
of patients undergoing CCTA versus 2.6% of those receiving UC underwent
coronary revascularization. The odds ratio of ICA for CCTA patients versus
UC patients was 1.36 (95% confidence interval [CI]: 1.03 to 1.80, p =
0.030), and for revascularization, it was 1.81 (95% CI: 1.20 to 2.72, p =
0.004). The absolute increase in ICA after CCTA was 21 per 1,000 CCTA
patients (95% CI: 1.8 to 44.9), and the number needed to scan was 48. The
absolute increase in revascularization after CCTA was 20 per 1,000
patients (95% CI: 5.0 to 41.4); the number needed to scan was 50. Both
percutaneous coronary intervention and coronary artery bypass graft
surgery independently contributed to the significant increase in
revascularization. Conclusions: Compared with UC, the use of CCTA in the
ED is associated with decreased ED cost and length of stay but increased
ICA and revascularization. 2013 American College of Cardiology
Foundation.
<12>
Accession Number
2013147512
Authors
Eroglu E. Cakal S.D. Cakal B. Dundar C. Alici G. Ozkan B. Yazicioglu M.V.
Tigen K. Esen A.M.
Institution
(Eroglu) Department of Cardiology, Yeditepe University Hospital, Devlet
Yolu, Ankara Cad No: 102/104, 34752 Kozyatagi, Istanbul, Turkey
(Cakal, Cakal, Dundar, Alici, Ozkan, Yazicioglu, Tigen, Esen) Department
of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital,
Istanbul, Turkey
Title
Time course of right ventricular remodeling after percutaneous atrial
septal defect closure: Assessment of regional deformation properties with
two-dimensional strain and strain rate imaging.
Source
Echocardiography. 30 (3) (pp 324-330), 2013. Date of Publication: March
2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Quantitative assessment of the right ventricular (RV) function
in atrial septal defect (ASD) patients before and after closure remains
difficult. The aim of this study was to assess the regional RV function in
ASD patients, to evaluate the extent and time course of RV remodeling
following ASD closure, and to investigate whether any regional difference
exists in RV remodeling. Methods: Twenty patients with ASD and 20
age-matched controls were included. All underwent standard
echocardiography and two-dimensional strain (S) and strain rate (SR)
imaging by speckle tracking before, and 24 hours and 1 month after the
defect closure. Results: Right ventricular S was higher in ASD patients
except apical lateral segment S, which was lower when compared with
controls. There was no difference in RV SR between ASD patients and
controls. RV septal S and SR, and lateral SR decreased in 24 hours after
the procedure and remained the same at 1 month. RV lateral basal and mid S
decreased and apical S increased in 24 hours after the closure. All 3
segments showed some more increase at 1 month. RV apical S showed strong
correlations with systolic pulmonary artery pressure and global RV
systolic function indices. Conclusions: Chronic volume overload in ASD
patients causes alterations in RV deformation. Percutaneous closure
results in rapid remodeling and normalization of RV deformation. The major
geometrical and deformational changes are completed in 24 hours. Lateral
wall S seems to reflect the RV deformational changes due to volume loading
and unloading better than SR in ASD patients. 2012, Wiley Periodicals,
Inc.
<13>
Accession Number
2013118719
Authors
Khalil M.A. Al-Agaty A.E. Ali W.G. Abdel Azeem M.S.
Institution
(Khalil, Al-Agaty, Ali) Department of Anesthesia, Faculty of Medicine,
Cairo University, Giza, Egypt
(Khalil) Department of Anesthesia, Saad Specialist Hospital, Prince Faisal
Bin Fahad Street, Al-Khobar 30353, Saudi Arabia
(Abdel Azeem) Department of Critical Care, Faculty of Medicine, Cairo
University, Giza, Egypt
Title
A comparative study between amiodarone and magnesium sulfate as
antiarrhythmic agents for prophylaxis against atrial fibrillation
following lobectomy.
Source
Journal of Anesthesia. 27 (1) (pp 56-61), 2013. Date of Publication:
February 2013.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose: Atrial fibrillations are common after thoracic surgery.
Amiodarone and magnesium sulfate have been used for the management of
atrial fibrillation following cardiac and non-cardiac surgery. However, to
our knowledge, comparisons of both drugs with each other and with a
control group in relation to the prevention of AF following lung surgery
have not been performed. Our primary aim in this study was to
prospectively evaluate the prophylactic effects of magnesium sulfate and
amiodarone used separately and compare them with a control group analyzed
retrospectively during and following lobectomy surgeries. Patients and
methods: The prophylactic value of amiodarone (group A; 219 patients)
administered as an intravenous infusion (15 mg/kg for 48 h
postoperatively) after a loading dose (5 mg/kg) was compared with
magnesium sulfate (group M; 219 patients) administered intravenously as a
loading dose (80 mg/kg magnesium sulfate over 30 min preoperatively) and
then as an intravenous infusion (8 mg/kg/h for 48 h) in 438 patients
undergoing lobectomy. These two groups were compared with a control group
of 219 patients who were analyzed retrospectively. Results: The results
showed significantly lower incidences of AF in groups A and M when
compared with group C (P < 0.05). There was no significant difference
between the amiodarone and magnesium sulfate groups. However, the
incidence of postoperative AF was lower in the amiodarone group, where
only 21 (10 %) patients developed AF in comparison to 27 (12.5 %) patients
in the magnesium sulfate group. Group C showed a higher incidence, 44
(20.5 %) patients, when compared with both groups. In addition, there were
significant differences between the three groups concerning intensive care
unit (ICU) and total hospital stays (P < 0.05). Conclusion: Our study
showed that during the intra- and postoperative periods, both amiodarone
and magnesium sulfate are effective at preventing the incidence of atrial
fibrillation following lung resection surgery in comparison to the control
group. 2012 Japanese Society of Anesthesiologists.
<14>
Accession Number
23440795
Authors
Taylor F. Huffman M.D. Macedo A.F. Moore T.H. Burke M. Davey Smith G. Ward
K. Ebrahim S.
Institution
(Taylor) Department of Non-communicable Disease Epidemiology, London
School of Hygiene and Tropical Medicine, London, UK.
Title
Statins for the primary prevention of cardiovascular disease.
Source
Cochrane database of systematic reviews (Online). 1 (pp CD004816), 2013.
Date of Publication: 2013.
Abstract
Reducing high blood cholesterol, a risk factor for cardiovascular disease
(CVD) events in people with and without a past history of CVD is an
important goal of pharmacotherapy. Statins are the first-choice agents.
Previous reviews of the effects of statins have highlighted their benefits
in people with CVD. The case for primary prevention was uncertain when the
last version of this review was published (2011) and in light of new data
an update of this review is required. To assess the effects, both harms
and benefits, of statins in people with no history of CVD. To avoid
duplication of effort, we checked reference lists of previous systematic
reviews. The searches conducted in 2007 were updated in January 2012. We
searched the Cochrane Central Register of Controlled Trials (CENTRAL) in
The Cochrane Library (2022, Issue 4), MEDLINE OVID (1950 to December Week
4 2011) and EMBASE OVID (1980 to 2012 Week 1).There were no language
restrictions. We included randomised controlled trials of statins versus
placebo or usual care control with minimum treatment duration of one year
and follow-up of six months, in adults with no restrictions on total, low
density lipoprotein (LDL) or high density lipoprotein (HDL) cholesterol
levels, and where 10% or less had a history of CVD. Two review authors
independently selected studies for inclusion and extracted data. Outcomes
included all-cause mortality, fatal and non-fatal CHD, CVD and stroke
events, combined endpoints (fatal and non-fatal CHD, CVD and stroke
events), revascularisation, change in total and LDL cholesterol
concentrations, adverse events, quality of life and costs. Odds ratios
(OR) and risk ratios (RR) were calculated for dichotomous data, and for
continuous data, pooled mean differences (MD) (with 95% confidence
intervals (CI)) were calculated. We contacted trial authors to obtain
missing data. The latest search found four new trials and updated
follow-up data on three trials included in the original review. Eighteen
randomised control trials (19 trial arms; 56,934 participants) were
included. Fourteen trials recruited patients with specific conditions
(raised lipids, diabetes, hypertension, microalbuminuria). All-cause
mortality was reduced by statins (OR 0.86, 95% CI 0.79 to 0.94); as was
combined fatal and non-fatal CVD RR 0.75 (95% CI 0.70 to 0.81), combined
fatal and non-fatal CHD events RR 0.73 (95% CI 0.67 to 0.80) and combined
fatal and non-fatal stroke (RR 0.78, 95% CI 0.68 to 0.89). Reduction of
revascularisation rates (RR 0.62, 95% CI 0.54 to 0.72) was also seen.
Total cholesterol and LDL cholesterol were reduced in all trials but there
was evidence of heterogeneity of effects. There was no evidence of any
serious harm caused by statin prescription. Evidence available to date
showed that primary prevention with statins is likely to be cost-effective
and may improve patient quality of life. Recent findings from the
Cholesterol Treatment Trialists study using individual patient data
meta-analysis indicate that these benefits are similar in people at lower
(< 1% per year) risk of a major cardiovascular event. Reductions in
all-cause mortality, major vascular events and revascularisations were
found with no excess of adverse events among people without evidence of
CVD treated with statins.
<15>
Accession Number
23440790
Authors
Arsenault K.A. Yusuf A.M. Crystal E. Healey J.S. Morillo C.A. Nair G.M.
Whitlock R.P.
Institution
(Arsenault) Department of Surgery, McMaster University, Hamilton, Canada.
Title
Interventions for preventing post-operative atrial fibrillation in
patients undergoing heart surgery.
Source
Cochrane database of systematic reviews (Online). 1 (pp CD003611), 2013.
Date of Publication: 2013.
Abstract
Atrial fibrillation is a common post-operative complication of cardiac
surgery and is associated with an increased risk of post-operative stroke,
increased length of intensive care unit and hospital stays, healthcare
costs and mortality. Numerous trials have evaluated various
pharmacological and non-pharmacological prophylactic interventions for
their efficacy in preventing post-operative atrial fibrillation. We
conducted an update to a 2004 Cochrane systematic review and meta-analysis
of the literature to gain a better understanding of the effectiveness of
these interventions. The primary objective was to assess the effects of
pharmacological and non-pharmacological interventions for preventing
post-operative atrial fibrillation or supraventricular tachycardia after
cardiac surgery. Secondary objectives were to determine the effects on
post-operative stroke or cerebrovascular accident, mortality,
cardiovascular mortality, length of hospital stay and cost of treatment
during the hospital stay. We searched the Cochrane Central Register of
ControlLed Trials (CENTRAL) (Issue 8, 2011), MEDLINE (from 1946 to July
2011), EMBASE (from 1974 to July 2011) and CINAHL (from 1981 to July
2011). We selected randomized controlled trials (RCTs) that included adult
patients undergoing cardiac surgery who were allocated to pharmacological
or non-pharmacological interventions for the prevention of post-operative
atrial fibrillation or supraventricular tachycardia, except digoxin,
potassium (K(+)), or steroids. Two review authors independently abstracted
study data and assessed trial quality. One hundred and eighteen studies
with 138 treatment groups and 17,364 participants were included in this
review. Fifty-seven of these studies were included in the original version
of this review while 61 were added, including 27 on interventions that
were not considered in the original version. Interventions included
amiodarone, beta-blockers, sotalol, magnesium, atrial pacing and posterior
pericardiotomy. Each of the studied interventions significantly reduced
the rate of post-operative atrial fibrillation after cardiac surgery
compared with a control. Beta-blockers (odds ratio (OR) 0.33; 95%
confidence interval) CI 0.26 to 0.43; I(2) = 55%) and sotalol (OR 0.34;
95% CI 0.26 to 0.43; I(2) = 3%) appear to have similar efficacy while
magnesium's efficacy (OR 0.55; 95% CI 0.41 to 0.73; I(2) = 51%) may be
slightly less. Amiodarone (OR 0.43; 95% CI 0.34 to 0.54; I(2) = 63%),
atrial pacing (OR 0.47; 95% CI 0.36 to 0.61; I(2) = 50%) and posterior
pericardiotomy (OR 0.35; 95% CI 0.18 to 0.67; I(2) = 66%) were all found
to be effective. Prophylactic intervention decreased the hospital length
of stay by approximately two-thirds of a day and decreased the cost of
hospital treatment by roughly $1250 US. Intervention was also found to
reduce the odds of post-operative stroke, though this reduction did not
reach statistical significance (OR 0.69; 95% CI 0.47 to 1.01; I(2) = 0%).
No significant effect on all-cause or cardiovascular mortality was
demonstrated. Prophylaxis to prevent atrial fibrillation after cardiac
surgery with any of the studied pharmacological or non-pharmacological
interventions may be favored because of its reduction in the rate of
atrial fibrillation, decrease in the length of stay and cost of hospital
treatment and a possible decrease in the rate of stroke. However, this
review is limited by the quality of the available data and heterogeneity
between the included studies. Selection of appropriate interventions may
depend on the individual patient situation and should take into
consideration adverse effects and the cost associated with each approach.
<16>
Accession Number
71013827
Authors
Kaya S. Coskun R. Gundogan K. Guven M. Sungur M.
Institution
(Kaya, Coskun, Gundogan, Guven, Sungur) Erciyes University Medical School,
Internal Medicine, Kayseri, Turkey
Title
Postoperative high frequency chest wall oscillation therapy in critically
ILL abdominal surgery patients: Randomized controlled study.
Source
Intensive Care Medicine. Conference: 25th Annual Congress of the European
Society of Intensive Care Medicine, ESICM 2012 Lisbon Portugal. Conference
Start: 20121013 Conference End: 20121017. Conference Publication:
(var.pagings). 38 (pp S167-S168), 2012. Date of Publication: October
2012.
Publisher
Springer Verlag
Abstract
INTRODUCTION. High frequency chest wall oscillation therapy (HFCWO) is
used for improvement in airway clearance. Postoperative patients requiring
intensive care at risk to develop pneumonia and clearance of secretions
may be difficult due to type of surgery and pain. Enhanced mucociliary
clearance with HFCWO devices previously used in cystic fibrosis COPD and
thoracic surgery patients. OBJECTIVES. We studied short term effects of
HFCWO on postoperative abdominal surgery patients. METHODS. Nonintubated
postoperative abdominal surgery patients requiring intensive care included
into the study. Patients were randomized either to standard chest
physiotherapy group (early mobilization, incentive spirometry, postural
drainage) or standard chest physiotherapy plus HFCWO group. HFCWO was
applied for 10 min at 12 Hz with. Laboratory data were collected for 3
days and the patients were followed until discharge from the hospital.
RESULTS. We included 30 patients to each group. Mean age was 61 +/- 13
years and 33 was male 27 was female. Mean body mass index was 26 +/- 5
kg/m<sup>2</sup>. APACHE II scores were 12 +/- 3 and 10 +/- 3 in control
and therapy groups. Statistically significant difference occurred only in
second day PaO<sub>2</sub>, SaO2 and third day arterial pH values which
were clinically insignificant. Mean ICU and hospital stay was 5.2 +/- 2.8,
4.5 +/- 2.6 and 17.9 +/- 14.7, 17.5 +/- 11.0 days in control and therapy
groups respectively (p>0.05). Intubation and mechanical ventilation were
required for 2 patients in control and for 1 patient in therapy groups.
Noninvasive mechanical ventilation was performed in 2 control patients
while it is required for therapy group. Three patients in control group
and 2 patients in therapy group died. Nosocomial pneumonia were developed
in 5 (16.6 %) control group patients and in 2 (6.6 %) therapy group
patients (p>0.05). There were no complications related to HFCWO therapy.
CONCLUSIONS. HCFWO therapy did not help to improve physiological
parameters and has no effect on duration of ICU and hospital stay,
mortality. Number of nosocomial pneumonia attacks were lower with HFCWO
but did not reach to statistical difference. HFCWO is a safe technique
which we did not observe any complications.
<17>
Accession Number
71013650
Authors
Abuella G. Corredor C. Arulkumaran N. Hamilton M. Rhodes A. Cecconi M.
Institution
(Abuella, Corredor, Arulkumaran, Hamilton, Rhodes, Cecconi) St George's
Hospital, Intensive Care Unit, London, United Kingdom
Title
Meta-analysis of goal directed therapy in high-risk patients undergoing
major non-cardiac surgery.
Source
Intensive Care Medicine. Conference: 25th Annual Congress of the European
Society of Intensive Care Medicine, ESICM 2012 Lisbon Portugal. Conference
Start: 20121013 Conference End: 20121017. Conference Publication:
(var.pagings). 38 (pp S120), 2012. Date of Publication: October 2012.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Patients with a limited cardiac reserve are less likely to
survive and suffer from more complications after major surgery [1]. By
augmenting DO2I with a combination of intravenous fluids and inotropes
(goal directed therapy; GDT), the postoperative mortality and morbidity of
high-risk patients is reduced. However, not all clinical trails are
consistent with these findings and GDT is not widely practiced.
OBJECTIVES. We hypothesized that GDT results in greatest benefit in terms
of mortality and morbidity in patients with the highest risk of mortality.
METHODS. We performed a systematic search of Medline, Embase and CENTRAL
databases for randomized controlled trials (RCTs) and reviews of GDT in
high-risk surgical patients. To minimize heterogeneity we excluded studies
involving cardiac surgery. Extremely high risk, high risk and intermediate
risk of mortality were defined as>20 %, 5-20 % and<5 % mortality rate in
the control arm of the trials respectively [2]. Metaanalyses were
performed and forest plots drawn using RevMan software. Data are presented
as odd ratios (OR), [95 % confidence intervals (CI)], and p values.
RESULTS. A total of 30 RCTs including 4557 patients were reviewed. All
studies reported mortality. 4 studies (n = 2221) were excluded from
assessment of complication rates as the number of patients with
complications was not reported. The mortality benefit of GDT was confined
to the subgroup of patients at extremely high-risk of death (OR = 0.71,
[0.56-0.90], p<0.00001). Complication rates were reduced in all subgroups
of patients (OR = 0.47, [0.39-0.56], p<0.00001). The benefit was greatest
among patients in the intermediate risk subgroup (OR = 0.41, [0.31-0.54],
p<0.00001), followed by the high risk subgroup (OR = 0.49, [0.36-0.66],
p<0.00001), and the extremely high risk subgroup (Table presented)
CONCLUSIONS. GDT is beneficial in all high-risk patients undergoing major
surgery. The mortality benefit of GDT was confined to the subgroup of
patients at extremely high risk of death. However, the reduction of
complication rates was seen across all subgroups of GDT patients but was
greatest in the intermediate mortality risk group.
<18>
Accession Number
71013501
Authors
Aya H.D. Geisen M. Ebm C. Hamilton M. Rhodes A. Cecconi M.
Institution
(Aya, Geisen, Ebm, Hamilton, Rhodes, Cecconi) St George's Healthcare NHS
Trust, Intensive Care, London, United Kingdom
Title
Goal-directed haemodynamic therapy in cardiac surgical patients:
Systematic review and meta-analysis of randomized controlled trials.
Source
Intensive Care Medicine. Conference: 25th Annual Congress of the European
Society of Intensive Care Medicine, ESICM 2012 Lisbon Portugal. Conference
Start: 20121013 Conference End: 20121017. Conference Publication:
(var.pagings). 38 (pp S80), 2012. Date of Publication: October 2012.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Operative and postoperative mortality after cardiac surgery
have decreased throughout the last decades although postoperative
morbidity has been increasing mainly because sicker, older and higher-risk
patients have been treated. Up to 10 %of cardiac surgical patients
experience a complicated postoperative period, with prolonged ICU stay and
poor long-term outcome [1]. Complications after major surgery are
undesirable and potentially avoidable. However, although some evidence
suggest that perioperative monitoring and pre-emptively manipulation of
haemodynamics reduces surgical mortality and morbidity [2], no clear data
are available in cardiac surgical patients, and no systematic
review-meta-analysis to study the effect on mortality, morbidity and
length of stay has been published. OBJECTIVES. The objective of this
review is to perform a meta-analysis on the effects of perioperative
goal-directed hemodynamic therapy (GDT) on mortality, morbidity and length
of hospital stay in cardiac surgical patients. METHODS. A systematic
literature review using MEDLINE, EMBASE and the Cochrane Controlled
Clinical Trial register was conducted. Additional sources were sought from
experts and industry representatives. Inclusion criteria include:
randomized controlled trials, mortality reported as an outcome,
pre-emptive haemodynamic intervention and cardiac surgical population.
Identified studies that fulfilled the entry criteria were examined in full
and subjected to quantifiable analysis, subgroup analysis and sensitivity
analysis where possible. Data synthesis was obtained by using odds ratio
(OR) with 95 % confidence interval (CI) by random-effects model. RESULTS.
From 4980 potential studies, only four studies met all the inclusion
criteria (659 patients). The quantitative analysis showed that the use of
GDT reduced surgical complications rate in 55.5 % (OR 0.36 [0.15, 0.84]; p
= 0,02) and hospital length of stay in 2.45 days, which is the 24 % of
average length of stay [OR -2.21 (-3.84, ,0.57); p = 0.008] when compared
with control group. There was no significant reduction of mortality.
CONCLUSIONS. The use of pre-emptive GDT in cardiac surgical patients
reduces morbidity and hospital length of stay.
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