Results Generated From:
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<1>
Accession Number
2013171254
Authors
Nouraei M. Gholipour Baradari A. Ghafari R. Habibi M.R. Emami Zeydi A.
Sharifi N.
Institution
(Nouraei, Ghafari) Department of Surgery, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Gholipour Baradari, Habibi, Sharifi) Department of Anesthesia and
Critical Care, Mazandaran University of Medical Sciences, Sari, Iran,
Islamic Republic of
(Emami Zeydi) Department of Nursing, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Title
Decreasing blood loss and the need for transfusion after CABG surgery: A
double-blind randomized clinical trial of topical tranexamic acid.
Source
Turkish Journal of Medical Sciences. 43 (2) (pp 273-278), 2013. Date of
Publication: 2013.
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Aim: Reopening sternotomy to control bleeding after coronary artery bypass
grafting surgery (CABG) has been reported in 2%-7% of cases. Platelet
dysfunction and activation of fibrinolytic cascade are the common causes
of bleeding after on-pump CABG. Different antifibrinolytic drugs have been
used to reduce bleeding. In this study, we aimed to investigate the
efficacy of topical tranexamic acid in reducing postoperative mediastinal
bleeding after CABG. Materials and methods: This was a double-blind
placebo-controlled randomized clinical trial on 40 patients as the control
and another 40 patients as the study group. On completion of CABG before
sternotomy wound closure, tranexamic acid (2 g/20 mL) or placebo (20 mL of
saline) was diluted in 500 mL of warm saline (37 degreeC), poured into the
pericardial cavity, and left for 5 min. Results: There was no significant
difference in baseline demographic data and laboratory results between the
2 groups (P > 0.05). Mediastinal bleeding and packed red cell transfusion
requirements were significantly lower in the study group (P <= 0.01).
There were no complications related to topical tranexamic such as
mortality, myocardial infarction, cerebrovascular accident, seizure, or
renal failure. Conclusion: Topical tranexamic acid can reduce mediastinal
bleeding and packed red cell transfusion requirements after CABG.
TUBITAK.
<2>
Accession Number
2013185580
Authors
Giakoumidakis K. Eltheni R. Patelarou E. Theologou S. Patris V. Michopanou
N. Mikropoulos T. Brokalaki H.
Institution
(Giakoumidakis, Eltheni, Theologou, Michopanou, Mikropoulos) Cardiac
Surgery ICU, Evangelismos General Hospital of Athens, 45-47 Ipsilantou
Street, 10646 Athens, Greece
(Patelarou) Department of Postgraduate Research, The Florence Nightingale
School of Nursing and Midwifery, King's College, 57 Waterloo Road, London
SE1 8WA, United Kingdom
(Patris) 2nd Cardio-thoracic Department, Evangelismos General Hospital of
Athens, 45-47 Ipsilantou Street, 106461 Athens, Greece
(Brokalaki) Faculty of Nursing, National and Kapodistrian, University of
Athens, 123 Papadiamantopoulou Street, 11527 Athens, Greece
Title
Effects of intensive glycemic control on outcomes of cardiac surgery.
Source
Heart and Lung: Journal of Acute and Critical Care. 42 (2) (pp 146-151),
2013. Date of Publication: March 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: To investigate the effects of postoperative intensive glycemic
control on patient outcomes. Background: Ineffective perioperative
glycemic control has been associated with high mortality and morbidity
rates among cardiac surgery patients. Methods: 212 cardiac surgery
patients were allocated by a quasi-experimental design to: a) a control
group (. n = 107) with targeted blood glucose levels 161-200 mg/dl or b) a
therapy group (. n = 105) with blood glucose target 120-160 mg/dl. We
compared the two groups on their mortality, length of stay, duration of
intubation, incidence of severe hypoglycemia and frequency of
postoperative infections. Results: The mean postoperative blood glucose
levels were significantly lower for the therapy group compared with the
control group (153.9 mg/dl vs. 173.9 md/dl, p < 0.001). The intensive
glycemic control was strongly associated with decreased in-hospital
mortality (7 deaths/105 patients for the control group vs. 1 death/105
patients for the therapy group; p = 0.033). We did not identify any
statistically significant associations regarding the other patient
outcomes. Conclusions: This randomized quasi-experimental trial found
lower in-hospital mortality with more intense blood glucose control.
Effective postoperative glycemic control did not affect the other studied
patient outcomes. 2013 Elsevier Inc.
<3>
Accession Number
2013181596
Authors
Mardani D. Bigdelian H.
Institution
(Mardani) Department of Nursing, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Bigdelian) Department of Cardiac Surgery, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
Title
Prophylaxis of dexamethasone protects patients from further post-operative
delirium after cardiac surgery: A randomized trial.
Source
Journal of Research in Medical Sciences. 18 (2) (pp 137-143), 2013. Date
of Publication: 2013.
Publisher
Isfahan University of Medical Sciences (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
Background: Coronary artery bypass graft is one of common cardiac
surgeries which unfortunately accompany with some adverse events such as
delirium. Proinflammatory processes play an important role in pathogenesis
of post-operative delirium. Therefore, the effect of dexamethasone (DEX)
on post-operative delirium after cardiac surgery was evaluated. Materials
and Methods: This randomized clinical trial study was conducted with
objective of evaluation of DEX effects on post-operative deliriums and
complications after cardiac surgery. Ninety three eligible patients who
undergone coronary arteries bypass graft was divided into two groups of
DEX with 43patients and placebo (PCB) with 50patients. DEX group taken 8mg
DEX intra-venous before induction of anesthesia followed by 8mg every 8h
for 3day and other group received PCB in same way. Results: All patients
assessed by Mini-mental status questionnaire and psychiatric interviewing
with aim of diagnosing delirium. Extubation time of DEX group was
significantly reduced. The first post-operative day deliriums, extubation
time, hospital, and intensive-care unit length of stay significantly
reduced in DEX group without increasing serious complications such as
infectious disease. After administration of DEX only hyperglycemia as an
adverse event was increased in DEX group. Other complications of renal,
cardiac, cerebrovascular and respiratory system did not show any
significant differences between groups. Conclusion: Pre-operative
administration of DEX might safely protect brain of the patients who
undergone cardiac surgery against post-operative delirium.
<4>
Accession Number
2013177817
Authors
Deo S.V. Dunlay S.M. Shah I.K. Altarabsheh S.E. Erwin P.J. Boilson B.A.
Park S.J. Joyce L.D.
Institution
(Deo, Shah, Altarabsheh, Park, Joyce) Division of Cardiovascular Surgery,
Mayo Clinic, 100 2nd Street SW, Rochester, MN, United States
(Deo) Department of Cardiovascular Surgery, Adventist Wockhardt Heart
Hospital, Surat, Gujarat, India
(Dunlay, Boilson) Division of Cardiovascular Diseases, Mayo Clinic,
Rochester, MN, United States
(Altarabsheh) Division of Cardiovascular Surgery, Princess Alia Heart
Institute, Amman, Jordan
(Erwin) Department of Medical Education, Mayo Clinic, Rochester, MN,
United States
Title
Dual anti-platelet therapy after coronary artery bypass grafting: Is there
any benefit? A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 28 (2) (pp 109-116), 2013. Date of
Publication: March 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background Anti-platelet therapy is an important component of medical
therapy post coronary artery bypass grafting (CABG). While aspirin
administration is a Class I indication after CABG, the benefit of
concomitant clopidogrel is a controversial issue. Methods We searched OVID
Medline, Cochrane, Scopus, and EMBASE for randomized control trials and
observational studies comparing aspirin A+/- placebo to aspirin +
clopidogrel after CABG. Results Eleven articles (five randomized control
trials and six observational studies) including 25,728 patients met
inclusion criteria. Early saphenous vein graft occlusion was reduced with
the use of dual anti-platelet therapy (risk ratio (RR) = 0.59, 95% CI
0.43-0.82, p = 0.02). In-hospital or 30-day mortality was lower with
aspirin + clopidogrel (0.8%) compared to aspirin alone (1.9%) (p <
0.0001), while risk of angina or perioperative myocardial infarction was
comparable (RR = 0.60, 95% CI 0.31-1.14, p = 0.12). Patients treated with
aspirin + clopidogrel demonstrated a trend towards a higher incidence of
major bleeding episodes as compared to patients treated with aspirin alone
(RR = 1.17, 95% CI 1.00-1.37, p = 0.05). In a pooled analysis of studies
involving off-pump CABG compared to aspirin alone, dual anti-platelet
therapy reduced the risk of perioperative myocardial infarction and
saphenous graft occlusion by 68% (47% to 71%) and 55% (2% to 79%)
respectively. Conclusion Dual anti-platelet therapy after CABG improved
early saphenous vein graft patency, but may increase the risk of bleeding.
The use of dual anti-platelet therapy appears to be most beneficial in
patients undergoing off-pump CABG. Prospective randomized studies are
necessary to determine whether this beneficial effect of dual therapy is
also achieved in patients undergoing on pump CABG. 2013 Wiley
Periodicals, Inc.
<5>
Accession Number
2013178151
Authors
Yaroustovsky M. Plyushch M. Popov D. Samsonova N. Abramyan M. Popok Z.
Krotenko N.
Institution
(Yaroustovsky, Plyushch, Popov, Samsonova, Abramyan, Popok, Krotenko)
Bourakovsky Institute of Cardiac Surgery, Bakoulev Scientific Centre for
Cardiovascular Surgery, Moscow, Russian Federation
Title
Prognostic value of endotoxin activity assay in patients with severe
sepsis after cardiac surgery.
Source
Journal of Inflammation (United Kingdom). 10 (1) , 2013. Article Number:
8. Date of Publication: 2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: To evaluate the prognostic value of endotoxin activity assay
(EAA) in adult patients with suspected or proven severe sepsis after
cardiac surgery. Methods. Blood samples taken from 81 patients immediately
after the diagnosis of severe sepsis were tested with the EAA. Patients
were divided into 3 groups: low (<0.4, n=20), moderate (0.4-0.59, n=35)
and high (0.6, n=26) EAA levels. Results: Gram-negative bacteraemia was
found in 19/55 (35%) of cases with <0.6 and in 11/26 (42%) of cases with
higher , p=0.67. Mortality at 28days in Groups 1, 2 and 3 was 20%, 43% and
54%, respectively. Patients with an EAA higher than 0.65 had a higher
28-day mortality than those with lower EAA values (18/26 - 69% vs. 19/55 -
34.5%; p=0.0072). ROC analysis for the prediction of 28-day mortality
revealed an AUC for APACHE II scores, EAA and PCT of 0.81, 0.73 and 0.66,
respectively. Conclusions: E might be useful for recognising patients who
have an increased risk of mortality due to severe sepsis. 2013
Yaroustovsky et al; licensee BioMed Central Ltd.
<6>
Accession Number
2013177803
Authors
Li Q. Qu H. Wang H. Wang D. Li P. Liu T.
Institution
(Li, Qu, Wang, Wang, Li, Liu) Department of Cardiovascular Surgery,
Shandong Provincial Qianfoshan Hospital, Shandong University, 16766
Jingshi Road, Jinan 250014, China
Title
Ventricular diverticulum: A review of the literature.
Source
Journal of Cardiac Surgery. 28 (2) (pp 133-138), 2013. Date of
Publication: March 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Ventricular diverticulum (VD) is a rare cardiac malformation.
The surgical indications for VD remain controversial. This review is
designed to determine the demographic characteristics, diagnosis, and
surgical indications of this disease. Methods: Using PubMed and the
Chinese electronic databases CNKI, WANFANG, and VIP, a computerized search
was performed of the literature from China published between March 1965
and July 2012. Major risk factors for developing VD complications were
confirmed by logistic regression analysis in case-control studies.
Results: Ninety-three articles and 127 VD patients were identified in this
literature review. VDs can lead to aortic insufficiency, thrombosis,
infective endocarditis, heart failure, diverticular rupture, ventricular
arrhythmia, and cerebral embolism. In patients with VD complications,
92.3% were men (OR = 6.43, 95% CI = 1.23-33.53), 84.6% of the patients had
a fibrous type VD (OR = 10.54, 95% CI = 2.86-38.85), and 48.0% of the
cases were subaortic diverticulum (SD) related (OR = 6.41, 95% CI =
1.17-35.19). Conclusions: VD can result in rupture, cerebral embolism,
heart failure, ventricular arrhythmia, infective endocarditis, thrombosis
and aortic insufficiency. Male gender, fibrous type, and SD are three
major independent risk factors for developing VD complications. Surgical
resection should be performed in those VD patients with risk factors for
major complications. 2013 Wiley Periodicals, Inc.
<7>
Accession Number
2013178730
Authors
Goodnough L.T. Smith P.K. Levy J.H. Poston R.S. Short M.A. Weerakkody G.J.
Lenarz L.A.
Institution
(Goodnough) Departments of Pathology and Medicine, Stanford University
School of Medicine, M/C 5626, 300 Pasteur Dr., Stanford, CA 94305-5626,
United States
(Smith) Division of Thoracic and Cardiovascular Surgery, Duke University
Medical Center, Durham, NC, United States
(Levy) Department of Anesthesiology, Emory University School of Medicine,
Atlanta, GA, United States
(Poston) Division of Cardiothoracic Surgery, Department of Surgery,
University of Arizona School of Medicine, Tucson, AZ, United States
(Short, Weerakkody, Lenarz) Lilly USA, LLC, Indianapolis, IN, United
States
Title
Transfusion outcomes in patients undergoing coronary artery bypass
grafting treated with prasugrel or clopidogrel: TRITON-TIMI 38
retrospective data analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (4) (pp 1077-1082.e4),
2013. Date of Publication: April 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Coronary artery bypass grafting-related bleeding and associated
transfusion is a concern with dual antiplatelet therapy in patients with
acute coronary syndromes. The objective of the present study was to
characterize a potential risk-adjusted difference in transfusion
requirements between prasugrel and clopidogrel cohorts. Methods: The data
from 422 patients undergoing isolated coronary artery bypass grafting from
the TRial to assess Improvement in Therapeutic Outcomes by optimizing
platelet InhibitioN with prasugrel Thrombolysis In Myocardial Infarction
38 were analyzed retrospectively. Results: We found no difference in
baseline transfusion risk scores between cohorts. As predicted, the number
of units of red blood cells transfused perioperatively correlated with the
transfusion risk score (P < .0001). Overall, the 12-hour chest tube
drainage volumes and platelet transfusion rates in the prasugrel cohort
were significantly greater. However, no statistically significant
differences were found in the number of red blood cell transfusions, total
hemostatic components transfused, or total blood donor exposure. A
significantly greater number of platelet units were transfused
postoperatively in the prasugrel patients who underwent surgery within 5
days or less after withdrawal of drug. In an analysis adjusted for the
predicted risk of mortality, total donor exposure was not associated with
increased mortality. Conclusions: The use of prasugrel compared with
clopidogrel was associated with greater 12-hour chest tube drainage
volumes and platelet transfusion rates but without any significant
differences in red blood cell transfusions, total hemostatic components
transfused, or total blood donor exposure. 2013 by The American
Association for Thoracic Surgery.
<8>
[Use Link to view the full text]
Accession Number
2013175423
Authors
Hu T. Ma H. Li H. Ren J.
Institution
(Hu, Ma, Li, Ren) Department of Cardiology, Second Affiliated Hospital of
Wuhan University, Wuhan, China
Title
Efficacy of cilostazol in patients with acute coronary syndrome after
percutaneous coronary intervention.
Source
American Journal of Therapeutics. 20 (2) (pp 151-153), 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
The objective of this study was to explore the long-term effect of
cilostazol-optimized antiplatelet therapy after percutaneous coronary
intervention (PCI) in patients with acute coronary syndrome (ACS). One
hundred forty-six patients with ACS who underwent PCI were enrolled.
Patients were randomly divided into 2 groups based on clot rate (CR), and
both groups received antiplatelet therapy: aspirin and clopidogrel plus
cilostazol (intensification group, n = 72) or aspirin and clopidogrel
(control group, n = 74). Clinical follow-up was up to 12 months after PCI.
During follow-up, CR was determined at day 1 and at 1, 3, 6, and 12 months
post-PCI. Efficacy endpoints included second acute myocardial infarction,
in-stent thrombosis, revascularization (second PCI), sudden death, and
hemorrhage. CR was significantly lower in the intensification group than
in the control group at 1, 3, and 6 months after PCI (P < 0.05). The
incidences of second acute myocardial infarction, in-stent thrombosis,
revascularization (second PCI), and sudden cardiac death were also lower
but insignificant; there were no hemorrhage events (P > 0.05).
Cilostazol-optimized antiplatelet therapy can significantly decrease CR
after PCI in patients with acute coronary syndrome. 2013 Lippincott
Williams & Wilkins.
<9>
Accession Number
2013176887
Authors
Zhou C. Liu Y. Yao Y. Zhou S. Fang N. Wang W. Li L.
Institution
(Zhou, Yao, Zhou, Fang, Wang, Li) State Key Laboratory of Cardiovascular
Medicine, Peking Union Medical College, Fuwai Hospital, Beijing, China
(Zhou, Yao, Zhou, Fang, Wang) Department of Anesthesiology, Peking Union
Medical College, Fuwai Hospital, Beijing, China
(Liu) Department of Intensive Care Unit, Beijing Chest Hospital, Capital
Medical University, Beijing, China
Title
beta-blockers and volatile anesthetics may attenuate cardioprotection by
remote preconditioning in adult cardiac surgery: A meta-analysis of 15
randomized trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (2) (pp 305-311),
2013. Date of Publication: April 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: Clinical trials on cardioprotection by remote ischemic
preconditioning (RIPC) for adult patients undergoing cardiac surgery
revealed mixed results. Previous meta-analyses have been conducted and
found marked heterogeneity among studies. The aim of this meta-analysis
was to evaluate the factors affecting cardioprotection by remote
preconditioning in adult cardiac surgery. Design: A meta-analysis of
randomized controlled trials. Setting: University hospitals. Participants:
Adult subjects undergoing cardiac surgery. Interventions: RIPC.
Measurements and Main Results: Fifteen trials with a total of 1,155 study
patients reporting postoperative myocardial biomarker (CK-MB or troponin)
levels were identified from PubMed, Embase, and the Cochrane Library (up
to July 2012). Compared with controls, RIPC significantly reduced
postoperative biomarkers of myocardial injury (standardized mean
difference = -0.31, p = 0.041; heterogeneity test: I<sup>2</sup> = 83.5%).
This effect seemed more significant in valve surgery (standardized mean
difference = -0.74, p = 0.002) than in coronary artery surgery
(standardized mean difference = -0.23; p = 0.17). Univariate
meta-regression analyses suggested that the major sources of significant
heterogeneity were beta-blockers (%) (coefficient = 0.0161, p = 0.022,
adjusted R<sup>2</sup> = 0.37) and volatile anesthetics (coefficient =
0.6617, p = 0.065, adjusted R<sup>2</sup> = 0.22). These results were
further confirmed in multivariate regression and subgroup analyses.
Conclusions: Available data from this meta-analysis further confirmed the
cardioprotection conferred by RIPC in adult cardiac surgery. Moreover, the
cardioprotective effect may be attenuated when combined with beta-blockers
or volatile anesthetics. 2013 Elsevier Inc. All rights reserved.
<10>
Accession Number
2013176877
Authors
Majure D.T. Greco T. Greco M. Ponschab M. Biondi-Zoccai G. Zangrillo A.
Landoni G.
Institution
(Majure) Department of Medicine, University of California, San Francisco,
CA, United States
(Greco, Greco, Zangrillo, Landoni) Anesthesia and Intensive Care
Department, Vita-Salute San Raffaele University, Milan, Italy
(Ponschab) Department of Anaesthesia and Intensive Care, Trauma Hospital
Linz, Linz, Austria
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
Title
Meta-analysis of randomized trials of effect of milrinone on mortality in
cardiac surgery: An update.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (2) (pp 220-229),
2013. Date of Publication: April 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The long-term use of milrinone is associated with increased
mortality in chronic heart failure. A recent meta-analysis suggested that
it might increase mortality in patients undergoing cardiac surgery. The
authors conducted an updated meta-analysis of randomized trials in
patients undergoing cardiac surgery to determine if milrinone impacted
survival. Design: A meta-analysis. Setting: Hospitals. Participants: One
thousand thirty-seven patients from 20 randomized trials. Interventions:
None. Measurements and Main Results: Biomed, Central, PubMed, EMBASE, the
Cochrane central register of clinical trials, and conference proceedings
were searched for randomized trials that compared milrinone versus placebo
or any other control in adult and pediatric patients undergoing cardiac
surgery. Authors of trials that did not include mortality data were
contacted. Only trials for which mortality data were available were
included. Overall analysis showed no difference in mortality between
patients receiving milrinone versus control (12/554 [2.2%] in the
milrinone group v 10/483 [2.1%] in the control arm; relative risk [RR] =
1.15; 95% confidence interval [CI], 0.55-2.43; p = 0.7) or in analysis
restricted to adults (11/364 [3%] in the milrinone group v 9/371 [2.4%] in
the control arm; RR = 1.17; 95% CI, 0.54-2.53; p = 0.7). Sensitivity
analyses in trials with a low risk of bias showed a trend toward an
increase in mortality with milrinone (8/153 [5.2%] in the milrinone arm v
2/152 [1.3%] in the control arm; RR = 2.71; 95% CI, 0.82-9; p for effect =
0.10). Conclusions: Despite theoretic concerns for increased mortality
with intravenous milrinone in patients undergoing cardiac surgery, the
authors were unable to confirm an adverse effect on survival. However,
sensitivity analysis of high-quality trials showed a trend toward
increased mortality with milrinone. 2013 Elsevier Inc. All rights
reserved.
<11>
Accession Number
2013176873
Authors
Lomivorotov V.V. Fominskiy E.V. Efremov S.M. Nepomniashchikh V.A.
Lomivorotov V.N. Chernyavskiy A.M. Shilova A.N. Karaskov A.M.
Institution
(Lomivorotov, Fominskiy, Efremov, Nepomniashchikh, Lomivorotov,
Chernyavskiy, Shilova, Karaskov) Department of Anesthesiology and
Intensive Care, Academician en Meshalkin Novosibirsk State Budget Research
Institute of Circulation Pathology, Rechkunovskaya Street 15, Novosibirsk
630055, Russian Federation
Title
Hypertonic solution decreases extravascular lung water in cardiac patients
undergoing cardiopulmonary bypass surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (2) (pp 273-282),
2013. Date of Publication: April 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To test the hypothesis that the infusion of hypertonic solution
would decrease extravascular lung water postoperatively and thus improve
pulmonary function. Design: Prospective, randomized, blinded trial.
Setting: Tertiary cardiothoracic referral center. Participants: Twenty-six
patients with coronary artery disease who underwent surgery with
cardiopulmonary bypass (CPB). Interventions: Patients were allocated
randomly to receive 4 mL/kg of 7.2% NaCl/hydroxyethyl starch, 200/0.5 (HSH
group) or an equal volume of 0.9% NaCl (control group) for 30 minutes
starting after anesthesia induction. The extravascular lung water index,
hemodynamic and biochemical data, and the rate of complications were
analyzed. Measurements and Main Results: The extravascular lung water
index was significantly lower (7 v 9.5 mL/kg) in the HSH group at the
first postoperative day (p < 0.01). The index of arterial oxygenation
efficiency was significantly higher at 5 minutes and 2 and 4 hours after
cardiopulmonary bypass (CPB) in the HSH group (p < 0.05). The
alveolar-arterial oxygen tension difference was significantly lower at 5
minutes and 2 and 4 hours after CPB in the HSH group (p < 0.01). The
cardiac index was significantly higher at 5 minutes after infusion in the
HSH group (p < 0.05). Conclusions: The infusion of HSH leads to
significant decreases in the extravascular lung water index during and
after cardiac surgery and is associated with better preservation of
pulmonary function and transient increases in the cardiac index. Further
trials are needed to clarify the clinical advantages of hypertonic
solution administration in patients undergoing surgery with CPB. 2013
Elsevier Inc. All rights reserved.
<12>
Accession Number
2013177058
Authors
Anastasiadis K. Antonitsis P. Haidich A.-B. Argiriadou H. Deliopoulos A.
Papakonstantinou C.
Institution
(Anastasiadis, Antonitsis, Argiriadou, Deliopoulos, Papakonstantinou)
Department of Cardiothoracic Surgery, Aristotle University of
Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
(Haidich) Department of Medical Statistics, Medical School, Aristotle
University of Thessaloniki, Greece
Title
Use of minimal extracorporeal circulation improves outcome after heart
surgery; A systematic review and meta-analysis of randomized controlled
trials.
Source
International Journal of Cardiology. 164 (2) (pp 158-169), 2013. Date of
Publication: 05 Apr 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: The question whether use of minimal extracorporeal circulation
(MECC) influences patients' outcome remains unanswered. We performed a
systemic review of the literature and a meta-analysis of randomized
controlled trials to evaluate the impact of MECC compared to conventional
extracorporeal circulation (CECC) on mortality and major adverse
cardiovascular events in patients undergoing heart surgery. Methods: We
independently conducted a systemic review of English and non-English
articles using Medline, Embase and Cochrane database. Random allocation to
treatment with a minimum of 40 patients in both groups was considered
mandatory for inclusion in the meta-analysis. Primary outcomes were
operative mortality and major adverse cardiac and cerebrovascular events
comprising death before discharge, myocardial infarction and neurologic
damage. Results: We included 24 studies comparing MECC vs. CECC with a
total of 2770 patients. Use of MECC was associated with a significant
decrease in mortality (0.5% vs. 1.7%, P = 0.02), in the risk of
postoperative myocardial infarction (1.0% vs. 3.8%, P = 0.03) and reduced
rate of neurologic events (2.3% vs. 4.0%, P = 0.08). Additionally, MECC
was associated with reduced systemic inflammatory response as measured by
polymorphonuclear elastase, hemodilution as calculated by hematocrit drop
after procedure, need for red blood cell transfusion, reduced levels of
peak troponin release, incidence of low cardiac output syndrome, need for
inotropic support, peak creatinine level, occurrence of postoperative
atrial fibrillation, duration of mechanical ventilation and intensive care
unit stay. Conclusions: Use of MECC in heart surgery resulted in improved
short-term outcome as reflected by reduced mortality and morbidity
compared with conventional extracorporeal circulation. 2011 Elsevier
Ireland Ltd.
<13>
Accession Number
2013165785
Authors
Ziabakhsh-Tabary S. Mokhtari-Esbuie F.
Institution
(Ziabakhsh-Tabary) Department of Cardiac Surgery, Mazandaran University of
Medical Sciences, Sari, Iran, Islamic Republic of
(Mokhtari-Esbuie) Mazandaran University of Medical Sciences, Sari, Iran,
Islamic Republic of
Title
Effects of single dose of erythropoietin on blood transfusion requirement
in patients undergoing coronary artery bypass graft surgery.
Source
Journal of Babol University of Medical Sciences. 15 (2) (pp 18-24), 2013.
Date of Publication: March 2013.
Publisher
Babol University of Medical Sciences (Journal office,Ganj Afrooz Avenue,
Babol 4717641367, Iran, Islamic Republic of)
Abstract
BACKGROUND AND OBJECTIVE: Recently, therapeutic strategies for reducing
hemoglobin decrease during and after coronary artery bypass graft surgery
was evaluated in a lot of clinic trial studies. In this paper we evaluate
effects of single dose of erythropoietin on blood transfusion requirement
after coronary artery bypass graft surgery. METHODS: In this clinic trial
study, 60 patients that were candidate for elective coronary artery bypass
graft surgery randomly divided into two groups, study and control group.
Patients in study group received intravenous infusion of erythropoietin
(700 IU/kg), during coronary artery bypass graft surgery. The number of
units of pack cell that was infused during surgery and postoperative
period was measured. Also hemoglobin concentration was measured and
compared before surgery and 5, 15 and 30 days after surgery. FINDINGS: The
mean number of units of pack cell transfused per patients during surgery
and postoperative days was significantly decreased in the study group, as
compared with control group (2.93+/- 1.11 vs. 3.7+/- 1.08, p=0.013). The
mean level of hemoglobin concentration on 15 days after surgery (11.03+/-
1.51 vs. 10.24+/- 1.14, p=0.018) and also 30 days after surgery (12.6+/-
1.45 vs. 11.84+/- 1.21, p=0.03) was significantly higher in study group.
CONCLUSION: The results showed that a single dose of erythropoietin during
surgery reduced a perioperative transfusion requirement in the patient
undergoing coronary artery bypass graft surgery. Erythropoietin injection
also raised a hemoglobin concentration on 15 and 30 days after coronary
artery bypass graft surgery in patients in erythropoietin group.
<14>
Accession Number
2013169277
Authors
Zhang R. Song Y. Zhou Y. Sun L.
Institution
(Zhang, Song, Zhou, Sun) Department of Ultrasound, The First Affiliated
Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Title
Comparison of Aortic Annulus Diameter Measurement between Multi-Detector
Computed Tomography and Echocardiography: A Meta-Analysis.
Source
PLoS ONE. 8 (3) , 2013. Article Number: e58729. Date of Publication: 14
Mar 2013.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background and Purpose: Accurate measurement of aortic annulus diameter is
crucial for choosing suitable prosthetic size for transcatheter aortic
valve implantation (TAVI). Several imaging methods are available for the
measurement, but significant variability between different modalities has
been observed. The purpose of this study was to systematically compare the
measurements of aortic annulus diameter between multi-detector computed
tomography (MDCT), transthoracic echocardiography (TTE), and
transesophegeal echocardiography (TEE). Methods: PubMed and EMBASE
databases between January 2000 and January 2012 were searched. We
extracted data from eligible studies evaluating the aortic annulus
diameter by MDCT and echocardiography (TTE, TEE, or both). We performed a
random-effects meta-analysis to calculate the weighted mean differences of
aortic annulus diameter measurement between MDCT, TTE, and TEE. Results: A
total of 10 eligible studies involving 581 subjects with aortic valve
stenosis were included. Aortic annulus diameter measured on coronal view
by MDCT (25.3+/-0.52 mm) was respectively larger than that measured on
sagittal view by MDCT (22.7+/-0.37 mm), TTE (22.6+/-0.28 mm), and TEE
(23.1+/-0.32 mm). The weighted mean difference of aortic annulus diameter
between coronal view by MDCT and TTE these two methods was 2.97 mm,
followed by the weighted mean difference of 2.53 mm between coronal view
and sagittal view by MDCT, and the mean difference of 1.74 mm between
coronal view on MDCT and TEE (P<0.0001 for all). The weighted mean
difference of aortic annulus diameter measurement between TEE and TTE was
significant but somewhat small (0.45 mm, P = 0.007). Conclusion: Aortic
annulus diameter measured on coronal view by MDCT was robustly and
significantly larger than that obtained on sagittal view by MDCT, TTE, or
TEE. Such variability of aortic annulus diameter measurement by different
imaging modalities cannot be ignored when developing optimal strategies
for selection of prosthetic valve size in TAVI. 2013 Zhang et al.
<15>
Accession Number
2013181368
Authors
Daley M.J. Lat I. Mieure K.D. Jennings H.R. Hall J.B. Kress J.P.
Institution
(Daley) Critical Care, Department of Pharmacy, Seton Healthcare Family,
Austin, TX, United States
(Lat) Critical Care, Department of Pharmaceutical Sciences, University of
Chicago Medicine, Chicago, IL, United States
(Mieure) University of Chicago Medicine, United States
(Jennings) Department of Pharmaceutical Services, Department of Pulmonary
and Critical Care Medicine, University of Chicago Medicine, United States
(Hall) Pulmonary and Critical Care Medicine, University of Chicago
Medicine, United States
(Kress) Medical Intensive Care Unit, Department of Pulmonary and Critical
Care Medicine, University of Chicago Medicine, United States
Title
A comparison of initial monotherapy with norepinephrine versus vasopressin
for resuscitation in septic shock.
Source
Annals of Pharmacotherapy. 47 (3) (pp 301-310), 2013. Date of Publication:
March 2013.
Publisher
Harvey Whitney Books Company (8044 Montgomery Road, Suite 415, Cincinnati
OH 45236, United States)
Abstract
BACKGROUND: Early goal-directed therapy is a time-sensitive therapeutic
algorithm with a tiered approach to target hypoperfusion and
cardiovascular collapse within the first 6 hours of septic shock. The
Surviving Sepsis Campaign guidelines recommend norepinephrine or dopamine
as the initial vasoactive agent for resuscitation in septic shock,
reserving the administration of vasopressin as adjunctive therapy.
OBJECTIVE: To determine whether vasopressin was noninferior to
norepinephrine as the initial vasopressor to achieve a mean arterial
pressure (MAP) goal in the first 6 hours of shock onset. METHODS: This
retrospective cohort study evaluated adults who received monotherapy with
either norepinephrine or vasopressin as initial vasoactive therapy for the
management of septic shock. Patients were excluded if the treatment arm
was not monotherapy, if they were admitted to a cardiology or
cardiothoracic surgery service, or if they lacked a comparator-based 1:1
frequency matching. RESULTS: A total of 130 patients were included, 65 in
each treatment arm. The proportion of patients who achieved a goal MAP in
the vasopressin group was 63% (95% CI 51%-75%) and was 67.7% (95% CI
56%-79%) in the norepinephrine group. This observed difference between
goal MAP attainment did not exceed the predefined noninferiority margin of
-25% (CI for 4.7% difference -21.2% to 12%), suggesting noninferiority of
vasopressin. No significant difference was identified between vasopressin
and norepinephrine for final mean (SD) MAP achieved (75 [9.6] and 76.0
[8.2] mm Hg, respectively; p = 0.06) or the mean total change from
baseline MAP to goal (14.1 [8.4] and 15.1 [9.1] mm Hg, respectively; p =
0.6). CONCLUSIONS: Vasopressin was noninferior to norepinephrine for the
achievement of a MAP goal in the first 6 hours from onset of septic shock.
Further prospective analysis is warranted; however, the results are useful
for consideration of alternative vasopressors in the setting of drug
shortages. 1967-2013 Harvey Whitney Books Co. All rights reserved.
<16>
Accession Number
2013176896
Authors
Kennedy E.D. Choy K.C.C. Alston R.P. Chen S. Farhan-Alanie M.M.H. Anderson
J. Ang Y.L. Moore D.E. MacKenzie S.A. Sykes R.A.
Institution
(Kennedy, Choy, Chen, Farhan-Alanie, Anderson, Ang, Moore, MacKenzie,
Sykes) University of Edinburgh, College of Medicine and Veterinary
Medicine, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16
4SB, United Kingdom
(Alston) Department of Anaesthesia, Critical Care and Pain Medicine, Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
Title
Cognitive outcome after on- and off-pump coronary artery bypass grafting
surgery: A systematic review and meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (2) (pp 253-265),
2013. Date of Publication: April 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The aim of this study was to compare cognition following
coronary artery bypass grafting (CABG) surgery with or without
cardiopulmonary bypass (CPB) (on- or off-pump). Design: Systematic review
and meta-analysis of randomized control trials comparing cognitive outcome
in patients undergoing CABG surgery on- or off-pump as assessed by
continuous measures from a battery of 7 psychometric tests. Setting:
Multi-institutional centers performing CABG surgery. Participants:
Patients with coronary artery disease requiring CABG surgery.
Interventions: CABG surgery with or without CPB. Measurements and main
results: A structured literature search identified 13 randomized control
trials that included a total of 2,405 patients. Results from 7
psychometric tests were grouped into early (<=3 months) and late (6-12
months) postoperative periods. No significant differences were found
between on- and off-pump groups in any of the 7 psychometric tests in
either the early (p range 0.21-0.78) or late (p range 0.09-0.93)
postoperative period. Conclusion: The results suggested that CPB may not
be associated with cognitive decline that is associated with CABG surgery.
2013 Elsevier Inc. All rights reserved.
<17>
Accession Number
2013176895
Authors
Biancari F. Schifano P. Pighi M. Vasques F. Juvonen T. Vinco G.
Institution
(Biancari, Schifano, Vasques, Juvonen, Vinco) Department of Surgery, Oulu
University Hospital, P.O. Box 21, 90029 Oulu, Finland
(Pighi) Department of Medicine, University of Verona, Ospedale Civile
Maggiore, Verona, Italy
Title
Pooled estimates of immediate and late outcome of mitral valve surgery in
octogenarians: A meta-analysis and meta-regression.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (2) (pp 213-219),
2013. Date of Publication: April 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The authors evaluated the outcome of patients>=80 years
undergoing mitral valve (MV) surgery. Design: Systematic review of the
literature and meta-analysis. Setting: None. Participants: None.
Interventions: None. Main Results: Twenty-four studies reporting on 5,572
patients >=80 years of age who underwent MV surgery were included in this
analysis. Pooled proportion of operative mortality was 15.0% (95%
confidence interval [CI] 11.9-18.1), stroke was 3.9% (95% CI 2.6-5.2), and
dialysis was 2.7% (95% CI 0.5-4.9). Early date of study (p = 0.014),
increased age (p = 0.006), MV replacement (p = 0.008), procedure other
than isolated MV surgery (p = 0.010), MV surgery associated with coronary
artery surgery (p = 0.029), aortic cross-clamping time (p<0.001), and
cardiopulmonary bypass time (p<0.001) were associated significantly with
increased operative mortality. MV repair had lower operative mortality
compared with MV replacement (7.3% v 14.2%, relative risk 0.573, 95% CI
0.342-0.962). Random-effects metaregression showed that prolonged aortic
cross-clamping time (p = 0.005) was the only determinant of increased
operative mortality, even when adjusted (p<0.001) for date of study (p =
0.004). Operative mortality was significantly higher in studies reporting
a mean cross-clamp time >90 minutes (17.0% v 7.4%, p<0.001). Survival
rates at 1, 3, and 5 years were 76.1%, 67.7%, and 56.5%, respectively.
Conclusions: MV surgery in patients >=80 years of age is associated with
operative mortality, which has decreased significantly during recent
years. Prolonged aortic cross-clamp time is a major determinant of
operative mortality. MV repair may achieve better results than MV
replacement in the very elderly. Five-year survival of these patients is
good and justifies surgical treatment of MV diseases in octogenarians.
2013 Elsevier Inc. All rights reserved.
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