Results Generated From:
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<1>
Accession Number
2013283385
Authors
Ozaydin M. Erdogan D. Yucel H. Peker O. Icli A. Akcay S. Etli M. Ceyhan
B.M. Sutcu R. Varol E. Dogan A. Yavuz T.
Institution
(Ozaydin, Erdogan, Yucel, Icli, Akcay, Varol, Dogan) Department of
Cardiology, Suleyman Demirel University, Isparta, Turkey
(Peker, Etli, Yavuz) Department of Cardiovascular Surgery, Suleyman
Demirel University, Isparta, Turkey
(Ceyhan, Sutcu) Department of Biochemistry, Suleyman Demirel University,
Isparta, Turkey
Title
N-acetyl cysteine for the conversion of atrial fibrillation into sinus
rhythm after cardiac surgery: A prospective, randomized, double-blind,
placebo-controlled pilot study.
Source
International Journal of Cardiology. 165 (3) (pp 580-583), 2013. Date of
Publication: 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
<2>
Accession Number
2013298983
Authors
Sadaka M. Loutfy M. Sobhy M.
Institution
(Sadaka, Loutfy, Sobhy) Cardiovascular Department, Faculty of Medicine,
Alexandria University, Egypt
Title
Partial revascularization plus medical treatment versus medical treatment
alone in patients with multivessel coronary artery disease not eligible
for CABG.
Source
Egyptian Heart Journal. 65 (2) (pp 57-64), 2013. Date of Publication: June
2013.
Publisher
Egyptian Society of Cardiology (Egypt)
Abstract
Aim: The purpose of this study was to compare the impact of incomplete
revascularization (IR) plus optimal medical therapy (OMT) to OMT alone on
1. year clinical outcomes in patients with multivessel coronary artery
disease (MVD) who were not eligible for coronary bypass graft surgery
(CABG). Methods: This is a prospective randomized study conducted on 50
selected patients with chronic stable angina with documented MVD and CABG
was refused by the surgeon due to poor distal vessel quality. Patients
were randomized 1:1 into two groups, group (I): 25 patients were subjected
to OMT alone and group (II): 25 patients were subjected to IR plus OMT.
All patients were subjected to 1. year follow up. Results: The baseline
patients' details were matched. At 1. year; death occurred slightly more
in group II (16% versus 12%; p=. 1.000), ACS occurred more in the group I
(32% versus 16%; p=. 0.321) while freedom from angina occurred more in
group II (20% versus 4%; p=. 0.189). The OMT alone did not affect neither
the level of angina class nor EI while the IR plus OMT markedly improved
the decline in the level of angina class (p=. 0.011), but it did not
improve EF significantly (p=. 0.326). Conclusion: In patients with MVD who
were not eligible for CABG; IR plus OMT was not superior to OMT alone in
improving the 1year clinical outcomes except the improvement in the level
of angina class, which could be the adopted strategy to improve the
quality of life in such patients 2012 .
<3>
Accession Number
2013291280
Authors
Haghjooy Javanmard S. Ziaei A. Ziaei S. Ziaei E. Mirmohammad-Sadeghi M.
Institution
(Haghjooy Javanmard, Ziaei) Department of Physiology, Physiology Research
Centre, Isfahan University of Medical Sciences, Hezar Jerib Avenue,
Isfahan 73461-8174, Iran, Islamic Republic of
(Ziaei) Medical Research Center, Medical School, Isfahan University of
Medical Sciences, Isfahan 73461-8174, Iran, Islamic Republic of
(Ziaei) Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Ziaei) Medical Research Center, Medical School, Shahrekord University of
Medical Sciences, Shahrekord, Iran, Islamic Republic of
(Mirmohammad-Sadeghi) Department of Cardiac Surgery, Isfahan Medical
School, Isfahan University of Medical Sciences, Isfahan 73461-8174, Iran,
Islamic Republic of
Title
The effect of preoperative melatonin on nuclear erythroid 2-related factor
2 activation in patients undergoing coronary artery bypass grafting
surgery.
Source
Oxidative Medicine and Cellular Longevity. , 2013. Article Number:
676829. Date of Publication: 2013.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
During and after coronary artery bypass grafting (CABG), oxidative stress
occurs. Finding an effective way to improveantioxidant response is
important in CABG surgery. It has been shown that patients with coronary
heart disease have a low Melatonin production rate. The present study
aimed to investigate the effects ofMelatoninon nuclear erythroid 2-related
factor 2(Nrf2) activity in patients undergoing CABG surgery. Thirty
volunteers undergoing CABG were randomized to receive 10 mg oral Melatonin
(Melatonin group, n=15) or placebo (placebo group, n=15) before sleeping
for 1 month before surgery. The activatedNrf2 was measured twice by
DNA-based ELISA method in the nuclear extract of peripheral blood
mononuclear cells of patients before aortic clumps and 45 minutes after
CABG operation. Melatonin administration was associated with a
significantincrease in both plasma levels of Melatonin and Nrf2
concentration in Melatonin group compared to placebo group, respectively
(15.2+/-4.6 pmol/L, 0.28+/-0.01 versus 1.1+/-0.59 pmol/L, 0.20+/-0.07,
P<0.05). The findings of the present study provide preliminary data
suggesting that Melatoninmay play a significant role in the potentiation
of the antioxidant defense and attenuate cellular damages resulting from
CABG surgery via theNrf2 pathway. 2013 Shaghayegh Haghjooy Javanmard et
al.
<4>
Accession Number
2013289153
Authors
Imantalab V. Seddighinejad A. Mir Mansouri A. Sadeghi Meibodi A. Dadkhah
H. Farzam S. Forghan-Parast K.
Institution
(Imantalab, Seddighinejad, Mir Mansouri) Guilan University of Medical
Sciences, Department of Cardiac Anesthesia, Rasht University of Medical
Sciences, Heshmat Hospital, Iran, Islamic Republic of
(Sadeghi Meibodi, Dadkhah, Farzam, Forghan-Parast) Guilan University of
Medical Sciences, Iran, Islamic Republic of
Title
Effect of calcium gluconate on mean arterial pressure (MAP) after
induction of anesthesia with propofol in patients undergoing coronary
artery bypass graft surgery.
Source
Iranian Heart Journal. 13 (4) (pp 49-56), 2013. Date of Publication: 2013.
Publisher
Iranian Heart Association (P.O. Box 15745-1341, Tehran, Iran, Islamic
Republic of)
Abstract
Introduction: A combination of Propofol and Fentanyl is used as a method
to induce general anesthesia. Although Propofol is widely used for the
induction and maintenance of anesthesia, it has a significant effect on
reducing the arterial blood pressure.It has been suggested that calcium
gluconate, when administered simultaneously with Propofol, may reduce the
inotrope negative effect of Propofolon the heart function. Objective: We
sought to determine the efficacy of calcium gluconate in decreasing the
negative effect of Propofol. Materials and Methods: This randomized,
controlled, double-blind clinical trial, divided 70 patients undergoing
elective coronary artery bypass graft surgery (CABG) into two groups:
Group A (calcium gluconate) and Group B (placebo group).Each patient was
injected with Fentanyl (4 mug/kg) andPancuronium (0.1 mg/kg),followed by
Propofol(1.5mg/kg) during 60 secondsviaa CVline. Calcium gluconate (30
mg/kg) was administered to Group A and saline (placebo) was given to Group
B as well. Homodynamic data were obtained at baseline (T0), 4 minutes
after anesthesia induction (T1), and 2 minutes after tracheal intubation
(T2).The data were analyzed using descriptive statistics and repeated
measurement as well as t tests. A p value <0.05 was considered
statistically significant. Results: The mean and standard deviation (SD)
of the mean arterial pressure(MAP) at T0 was 101.11+/- 13.63 for Group A
and 107.142+/-14.59 for Group B (non-significant). These data for T1 (4
minutes after anesthesia induction) and T2 (2 minutes after tracheal
intubation) were 70.14+/-14.67 and 80.22+/- 23.29 for Group A and
72.05+/-15.45 and 82.42+/-14.86 for Group B, respectively
(non-significant). Conclusion: The findings of this research indicated no
differences between the two groups. Moreover, calcium gluconate appeared
to have no efficacy in reducing the negative effect of Propofol. (Iranian
Heart Journal 2013; 13(4):49-56).
<5>
Accession Number
2013261151
Authors
Dearden A.S. Sammon P.M. Matthew E.F.
Institution
(Dearden, Sammon, Matthew) Department of Cardiothoracic surgery, Royal
Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom
Title
In patients undergoing video-assisted thoracic surgery for pleurodesis in
primary spontaneous pneumothorax, how long should chest drains remain in
place prior to safe removal and subsequent discharge from hospital?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (5) (pp 686-691),
2013. Date of Publication: May 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was how long chest drains
should be left in place following video-assisted thoracic surgery (VATS)
pleurodesis for primary spontaneous pneumothorax. Altogether, a total of
730 papers were found using the reported search, of which eight
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
We report that the main determining factor for the length of hospital stay
following VATS pleurodesis is chest-drain duration. Providing no
postoperative complications occur, and chest X-ray appearances of lung
inflation are satisfactory, there is no documented contraindication to
removing chest drains as early as 2 days postoperatively, with discharge
the following day. Furthermore, leaving chest drains on water seal after a
brief period of suction has been shown to benefit in reducing
postoperative chest-drain duration and subsequent hospital stay. There is
a paucity of literature directly addressing early vs late chest-drain
removal protocols in this patient group. Hence, we conclude that, in
clinical practice, the decision of when to remove chest drains
postoperatively should remain guided empirically towards the individual
patient. 2013 The Author 2013.
<6>
Accession Number
2013261146
Authors
Wang W. Buehler D. Wang X. Yuan X.
Institution
(Wang, Buehler) Department of Cardiac Surgery, Scripps Memorial Hospital,
9850 Genesee Ave. Suite 560, San Diego, CA 92037, United States
(Wang, Wang, Yuan) Department of Cardiac Surgery, Shanxi Cardiovascular
Hospital, Taiyuan, Shanxi, China
Title
Effectiveness of biatrial pacing in reducing early postoperative atrial
fibrillation after the maze procedure.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (5) (pp 589-594),
2013. Date of Publication: May 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESInteratrial conduction abnormalities have an important role in
the initiation of recurrent atrial fibrillation (AF) after the maze
procedure. Biatrial pacing or single atrial pacing alters the site and
timing of atrial depolarization and may improve restoration of sinus
rhythm after the maze procedure. To further evaluate whether biatrial
pacing is superior to single atrial or no pacing, we performed a
randomized prospective study on 240 patients with a full maze procedure to
compare the effectiveness with different pacing approaches in the
postoperative period.METHODSBetween 2002 and 2010, 240 patients undergoing
mitral +/- tricuspid valve surgery concomitant with the maze procedure
were randomized into three equal groups: Group I using overdrive biatrial
pacing, Group II utilizing single atrial pacing and Group III without
pacing. The atria were paced continuously in Atrium paced, Atrium sensed,
and pacemaker Inhibited in response to sensed beat (AAI) mode at a rate of
80 pulses per minute or 10 pulses above the underlying rate for 5 days.
The endpoints were the onset of AF or discharge.RESULTSThe incidence of
recurrent postoperative atrial fibrillation was significantly less in
Group I with 9 of 80 patients (11%) incurring atrial fibrillation compared
with 23 of 80 patients (28%) in Group II (P < 0.01) and 29 of 80 patients
in Group III (P < 0.01). The length of hospital stay and the mean costs of
hospital stay were significantly lower in the biatrial pacing group (P <
0.05). CONCLUSIONSBiatrial overdrive pacing is well tolerated and more
effective in preventing the early recurrence of atrial fibrillation after
the maze procedure. The impacts of the long-term results with the maze
procedure require further study. 2013 The Author 2013.
<7>
Accession Number
2013261144
Authors
Lenkin A.I. Zaharov V.I. Lenkin P.I. Smetkin A.A. Bjertnaes L.J. Kirov
M.Y.
Institution
(Lenkin) Department of Anesthesiology and Intensive Care Medicine, City
Hospital 1 of Arkhangelsk, Arkhangelsk, Russian Federation
(Zaharov, Lenkin, Smetkin, Kirov) Department of Anesthesiology and
Intensive Care Medicine, Northern State Medical University, Troitsky
Avenue 51, Arkhangelsk 163000, Russian Federation
(Bjertnaes) Department of Clinical Medicine (Anesthesiology), Faculty of
Medicine, University of Tromsoe, Tromsoe, Norway
Title
Normothermic cardiopulmonary bypass increases cerebral tissue oxygenation
during combined valve surgery: A single-centre, randomized trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (5) (pp 595-601),
2013. Date of Publication: May 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESIn cardiac surgery, the choice of temperature regimen during
cardiopulmonary bypass (CPB) remains a subject of debate. Hypothermia
reduces tissue metabolic demands, but may impair the autoregulation of
cerebral blood flow and contribute to neurological morbidity. The aim of
this study was to evaluate the effect of two different temperature
regimens during CPB on the systemic oxygen transport and the cerebral
oxygenation during surgical correction of acquired heart
diseases.METHODSIn a prospective study, we randomized 40 adult patients
with combined valvular disorders requiring surgical correction of two or
more valves into two groups: (i) a normothermic (NMTH) group (n = 20), in
which the body core temperature was maintained at 36.6degreeC during CPB
and (ii) a hypothermic (HPTH) group (n = 20), in which the body was cooled
to a core temperature of 32degreeC maintained throughout the period of
CPB. The systemic oxygen transport and the cerebral oxygen saturation
(SctO <sub>2</sub>) were assessed by means of a PiCCO<sub>2</sub>
haemodynamic monitor and a cerebral oximeter, respectively. All the
patients received standard perioperative monitoring. We assessed
haemodynamic and oxygen transport parameters, the duration of mechanical
ventilation and the length of the ICU and the hospital stays.RESULTSDuring
CPB, central venous oxygen saturation was significantly higher in the HPTH
group but SctO<sub>2</sub> was increased in the NMTH group (P < 0.05).
Cardiac index, systemic oxygen delivery and consumption increased
postoperatively in both groups. However, oxygen delivery and consumption
were significantly higher in the NMTH group (P < 0.05). The duration of
respiratory support and the length of ICU and hospital stays did not
differ between the groups.CONCLUSIONSDuring combined valve surgery,
normothermic CPB provides lower central venous oxygen saturation, but
increases cerebral tissue oxygenation when compared with the hypothermic
regimen.TRIAL REGISTRATION NUMBERNCT01685554. 2013 The Author 2013.
<8>
Accession Number
2013261138
Authors
Llewellyn-Bennett R. Wotton R. West D.
Institution
(Llewellyn-Bennett, Wotton, West) Department of Thoracic Surgery, Bristol
Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, United Kingdom
Title
Prophylactic flap coverage and the incidence of bronchopleural fistulae
after pneumonectomy.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (5) (pp 681-685),
2013. Date of Publication: May 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'In pneumonectomy
patients, is buttressing the bronchial stump associated with a reduced
incidence of bronchopleural fistula?'. Fifty-seven papers were found using
the reported search, of which 12 represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. One prospective randomized
controlled trial was identified, which found significantly lower rates of
bronchopleural fistula and empyema after pneumonectomy with the use of
pedicled intercostal flap buttressing. Intercostal muscle flaps and
pericardial flaps have been used in case series of high-risk patients,
e.g. those with neoadjuvant therapy or extended resections, with low rates
of subsequent bronchopleural fistulae. There is the least-reported
evidence for thoracodorsal artery perforator and omental flaps. There is
relatively little published evidence beyond the single randomized trial
identified, with only a few comparison studies to guide clinicians. We
conclude that there is evidence for flap buttressing in reducing the risk
of bronchopleural fistulae after pneumonectomy in diabetic patients. Flap
coverage in other high-risk situations, such as extrapleural or completion
pneumonectomy, has been reported in case series with good results. Of the
reported techniques, the evidence is strongest for the pedicled
inter-costal flap. 2013 The Author 2013.
<9>
Accession Number
2013261137
Authors
Rajakaruna C. Rogers C. Pike K. Alwair H. Cohen A. Tomkins S. Angelini
G.D. Caputo M.
Institution
(Rajakaruna) Section of Cardiac Surgery, Yale School of Medicine, New
Haven, CT, United States
(Rogers, Pike, Alwair, Cohen, Tomkins, Angelini, Caputo) Bristol Heart
Institute, University of Bristol, Bristol BS2 8HW, United Kingdom
Title
Superior haemodynamic stability during off-pump coronary surgery with
thoracic epidural anaesthesia: Results from a prospective randomized
controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (5) (pp 602-607),
2013. Date of Publication: May 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESOff-pump coronary artery bypass (OPCAB) surgery is a technically
more demanding strategy of myocardial revascularization compared with the
standard on-pump technique. Thoracic epidural anaesthesia, by reducing
sympathetic stress, may ameliorate the haemodynamic changes occurring
during OPCAB surgery. The aim of this randomized controlled trial was to
evaluate the impact of thoracic epidural anaesthesia on intraoperative
haemodynamics in patients undergoing OPCAB surgery.METHODSTwo hundred and
twenty-six patients were randomized to either general anaesthesia plus
epidural (GAE) (n = 109) or general anaesthesia (GA) only (n = 117). Mean
arterial blood pressure (MAP), heart rate (HR) and central venous pressure
(CVP) were measured before sternotomy and subsequently after positioning
the heart for each distal anastomosis.RESULTSBoth groups were well
balanced with respect to baseline characteristics and received a
standardized anaesthesia. The MAP decreased in both groups with no
significant difference (mean difference (GAE minus GA) -1.11, 95% CI -3.06
to 0.84, P = 0.26). The HR increased in both groups after sternotomy but
was significantly less in the GAE group (mean difference (GAE minus GA)
-4.29, 95% CI -7.10 to -1.48, P = 0.003). The CVP also increased in both
groups after sternotomy, but the difference between the groups varied over
time (P = 0.05). A difference was observed at the third anastomosis when
the heart was in position for the revascularization of the circumflex
artery (mean difference (GAE minus GA) +2.09, 95% CI 0.21-3.96, P = 0.03),
but not at other time points. The incidence of new arrhythmias was also
significantly lower in the GAE compared with the GA group (OR = 0.41, 95%
CI 0.22-0.78, P = 0.01).CONCLUSIONThoracic epidural with general
anaesthesia minimizes the intraoperative haemodynamic changes that occur
during heart positioning and stabilization for distal coronary anastomosis
in OPCAB surgery. 2013 The Author 2013.
<10>
Accession Number
2013261135
Authors
Filosso P.L. Ruffini E. Sandri A. Lausi P.O. Giobbe R. Oliaro A.
Institution
(Filosso, Ruffini, Sandri, Lausi, Giobbe, Oliaro) Department of Thoracic
Surgery, University of Torino, San Giovanni Battista Hospital, Via Genova
3, 10126 Turin, Italy
Title
Efficacy and safety of human fibrinogen-thrombin patch (TachoSil) in the
treatment of postoperative air leakage in patients submitted to redo
surgery for lung malignancies: A randomized trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (5) (pp 661-666),
2013. Date of Publication: May 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESPrevious studies of the human fibrinogen-thrombin patch TachoSil
for air leak management in thoracic surgery have excluded patients
undergoing redo surgery, a group at high risk of persistent air leaks.
This is the first study to assess TachoSil in patients undergoing redo
surgery.METHODSPatients who had undergone pulmonary resection for primary
lung cancer or lung metastasis and were scheduled for completion lobectomy
plus lymphadenectomy due to tumour recurrence were eligible. After
complete lobectomy, patients with intraoperative Macchiarini grade 3 air
leaks (or >30% of the tidal volume at plethysmographic assessment) were
randomized to receive either TachoSil or further lung parenchymal
stapling/suturing procedures according to standard surgical
practice.RESULTSA total of 24 patients were randomized to TachoSil (n =
13) or standard treatment (n = 11). Mean duration of surgery was
significantly shorter in the TachoSil group than in the standard group
(3.6 vs 4.0 h; P = 0.023). The mean duration of air leaks was also
significantly reduced in the TachoSil group (4.7 vs 10.0 days; P < 0.001),
and the removal of both the first and the second chest tubes occurred
earlier (mean 3.8 vs 5.5 days; P = 0.005; and 6.1 vs 10.8 days; P < 0.001,
respectively). TachoSil was also effective in reducing persistent (>=9
days) air leaks (1 vs 7 patients; P = 0.008). There were no significant
differences between groups in other postoperative complications. Mean
length of hospital stay was significantly shorter in TachoSil-treated
patients (6.9 vs 9.5 days; P < 0.001).CONCLUSIONSTachoSil was superior to
standard stapling and suturing aerostatic techniques in reducing
postoperative air leaks in patients undergoing redo thoracic surgery.
2013 The Author 2013.
<11>
Accession Number
2013301637
Authors
McAteer J.P. LaRiviere C.A. Drugas G.T. Abdullah F. Oldham K.T. Goldin
A.B.
Institution
(McAteer, Drugas, Goldin) Division of Pediatric General and Thoracic
Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA
98105, United States
(McAteer, Drugas, Goldin) Department of Surgery, University of Washington
School of Medicine, Seattle, United States
(LaRiviere) Department of Surgery, Louisiana State University, New
Orleans, United States
(Abdullah) Department of Surgery, Johns Hopkins University, Baltimore, MD,
United States
(Oldham) Division of Pediatric Surgery, Children's Hospital of Wisconsin,
Milwaukee, United States
Title
Influence of surgeon experience, hospital volume, and specialty
designation on outcomes in pediatric surgery.
Source
JAMA Pediatrics. 167 (5) (pp 468-475), 2013. Date of Publication: May
2013.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Importance: Analyses of volume-outcome relationships in adult surgery have
found that hospital and physician characteristics affect patient outcomes,
such as length of stay, hospital charges, complications, and mortality.
Similar investigations in children's surgical specialties are fewer in
number, and their conclusions are less clear. Objective: To review the
evidence regarding surgeon or hospital experience and their influence on
outcomes in children's surgery. Evidence Review: A MEDLINE and EMBASE
search was conducted for English-language studies published from January
1, 1980, through April 13, 2012. Titles and abstracts were screened in a
standardized manner by 2 reviewers. Studies selected for inclusion had to
use ameasure of hospital or surgeon experience as a predictor variable and
had to report postoperative outcomes as dependent response variables.
Included studies were reviewed with regard to methodologic quality, and
study results were extracted. Findings: Sixty-three studies were reviewed.
Significant heterogeneity was detected in exposure definitions, outcome
measures, and risk adjustment, with the greatest heterogeneity seen in
appendectomy studies. Various ex- exposure levels were examined: hospital
level in 48 (68%) studies, surgeon level in 11 (17%), and both in 9 (14%).
Nineteen percent of studies did not adjust for confounding, and 57% did
not adjust for sample clustering. The most consistent methods and
reproducible results were seen in the pediatric cardiac surgical
literature. Forty-nine studies (78%) showed positive correlation between
experience and most primary outcomes, but differences in outcomes and
exposure definitions made comparisons between studies difficult. In
general, hospital-level factors tended to correlate with outcomes for
high-complexity procedures, whereas surgeon-level factors tended to
correlate with outcomes for more common procedures. Conclusions and
Relevance: Data on experiencerelated outcomes in children's surgery are
limited in number and vary widely in methodologic quality. Future studies
should seek both to standardize definitions, making results more
applicable, and to differentiate procedures affected by surgeon experience
from those more affected by hospital resources and system-level variables.
2013 American Medical Association. All rights reserved.
<12>
Accession Number
2013286699
Authors
Song J. Park J. Kim J.-Y. Kim J.-D. Kang W.-S. Muhammad H.B. Kwon M.-Y.
Kim S.-H. Yoon T.G. Kim T.-Y. Chung J.W.
Institution
(Song) Department of Anesthesiology, CHA Bundang Medical Center, CHA
University, Seongnam, South Korea
(Park, Kim, Kim, Kang, Muhammad, Kim, Yoon, Kim) Department of
Anesthesiology, Konkuk University Medical Center, Research Institute of
Biomedical Science, Konkuk University School of Medicine, Seoul, South
Korea
(Kwon) Department of Anesthesiology, National Medical Center, Seoul, South
Korea
(Chung) Department of Thoracic Surgery, Konkuk University Medical Center,
Konkuk University School of Medicine, Seoul, South Korea
Title
Effect of ulinastatin on perioperative organ function and systemic
inflammatory reaction during cardiac surgery: A randomized double-blinded
study.
Source
Korean Journal of Anesthesiology. 64 (4) (pp 334-340), 2013. Date of
Publication: April 2013.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: This study evaluated the efficacy of ulinastatin for
attenuating organ injury and the release of proinflammatory cytokines due
to cardiopulmonary bypass (CPB) during cardiac surgery. Methods: Patients
undergoing valvular heart surgery employing CPB were assigned to receive
either ulinastatin (group U, n = 13) or a placebo (group C, n = 11) before
the commencement of CPB. Hemodynamic data, parameters of major organ
injury and function, and proinflammatory cytokines were measured after the
induction of anesthesia (T1), after CPB (T2), at the end of anesthesia
(T3), and at 24 hours after surgery (POD). Results: The demographic data,
CPB duration, and perioperative transfusions were not different between
the groups. PaO2/FiO2 in group U was significantly higher than that in
group C at T3 (3.8 +/- 0.8 vs. 2.8 +/- 0.7, P = 0.005) and at POD (4.0 +/-
0.7 vs. 2.8 +/- 0.7, P < 0.001). Creatine kinase-MB at POD in group U was
significantly lower than that in group C (17.7 +/- 8.3 vs. 33.7 +/- 22.1,
P = 0.03), whereas troponin I at POD was not different between the groups.
Creatinine clearance and the extubation time were not different between
the groups at POD. The dopamine infusion rate during the post-CPB period
in group U was significantly lower than that in group C (1.6 +/- 1.6 vs.
5.5 +/- 3.3 mug/kg/min, P = 0.003). The interleukin-6 and tumor necrosis
factor-alpha concentrations at T1, T2, and T3 as well as the incidences of
postoperative cardiac, pulmonary and kidney injuries were not different
between the groups. Conclusions: Ulinastatin pretreatment resulted in an
improved oxygenation profile and reduced inotropic support, probably by
attenuating the degree of cardiopulmonary injury; however, it did not
reduce the levels of proinflammatory cytokines. the Korean Society of
Anesthesiologists, 2013.
<13>
Accession Number
2013275425
Authors
Westwood M.E. Raatz H.D.I. Misso K. Burgers L. Redekop K. Lhachimi S.K.
Armstrong N. Kleijnen J.
Institution
(Westwood, Misso, Armstrong) Kleijnen Systematic Reviews Ltd, Escrick
Business Park, Escrick, York YO19 6FD, United Kingdom
(Raatz) Basel Institute of Clinical Epidemiology and Biostatistics,
University Hospital Basel, Basel, Switzerland
(Burgers, Redekop, Lhachimi) Institute of Health Policy and Management,
Erasmus University Rotterdam, Rotterdam, Netherlands
(Kleijnen) School for Public Health and Primary Care, Maastricht
University, Maastricht, Netherlands
Title
Systematic review of the accuracy of dual-source cardiacct for detection
of arterial stenosis in difficult to image patient groups.
Source
Radiology. 267 (2) (pp 387-395), 2013. Date of Publication: May 2013.
Publisher
Radiological Society of North America Inc. (820 Jorie Boulevard, Oak Brook
IL 60523-2251, United States)
Abstract
Purpose: To assess the diagnostic performance of dual-source cardiac (DSC)
computed tomography (CT) newer-generation CT instruments for identifying
anatomically significant coronary artery disease (CAD) in patients who are
difficult to image by using 64-section CT. Materials and Methods: A
literature search comprised bibliographic databases (January 1, 2000, to
March 22, 2011, with a pragmatic update on September 6, 2012), trial
registries, and conference proceedings. Only studies using invasive
coronary angiography as reference standard were included. Risk of bias was
assessed (QUADAS-2). Results were stratified according to patient group on
the basis of clinical characteristics. Summary estimates of sensitivity
and specificity of DSC CT for detecting 50% or greater arterial stenosis
were calculated by using a bivariate summary receiver operating
characteristic or random-effects model. Results: Twenty-five studies
reported accuracy of DSC CT for diagnosing CAD in difficult to image
patients; in 22 studies, one of two CT units of the same manufacturer
(Somatom Definition or Somatom Definition Flash) was used, and in the
remaining three, a different CT unit of another manufacturer (Aquilion
One) was used. The pooled, per-patient estimates of sensitivity were 97.7%
(95% confidence interval [CI]: 88.0%, 99.9%) and 97.7% (95% CI: 93.2%,
99.3%) for patients with arrhythmias and high heart rates, respectively.
The corresponding pooled estimates of specificity were 81.7% (95% CI:
71.6%, 89.4%) and 86.3% (95% CI: 80.2%, 90.7%), respectively. All data
were acquired by using Somatom Definition. In two studies with Somatom and
one study with Aquilion One, sensitivity estimates of 90% or greater were
reported in patients with previous stent implantations; specificities were
81.7% and 89.5% for Somatom and 81.0% for Aquilion One. In patients with
high coronary calcium scores, previous bypass grafts, or obesity, only
per-segment or per-artery data were available. Sensitivity estimates
remained high (.90% in all but one study), and specificities ranged from
79.1% to 100%. All data were acquired by using Somatom Definition.
Conclusion: DSC CT may be sufficiently accurate to diagnose clinically
significant CAD in some or all difficult to image patients. RSNA, 2013.
<14>
Accession Number
2013282338
Authors
Kikkert W.J. Claessen B.E. Stone G.W. Mehran R. Witzenbichler B. Brodie
B.R. Wohrle J. Witkowski A. Guagliumi G. Zmudka K. Henriques J.P.S.
Tijssen J.G.P. Sanidas E.A. Chantziara V. Xu K. Dangas G.D.
Institution
(Claessen, Stone, Mehran, Sanidas, Chantziara, Xu, Dangas) Cardiovascular
Research Foundation, New York, NY, United States
(Stone, Sanidas, Chantziara) Columbia University Medical Center, New York,
NY, United States
(Mehran, Dangas) Mount Sinai Medical Center, New York, NY, United States
(Kikkert, Claessen, Henriques, Tijssen) Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Guagliumi) Ospedali Reuniti di Bergamo, Bergamo, Italy
(Witzenbichler) Charite Universitatsmedizin Campus Benjamin Franklin,
Berlin, Germany
(Wohrle) University of Ulm, Ulm, Germany
(Brodie) LeBauer CV Research Foundation, Greensboro, NC, United States
(Witkowski) National Institute of Cardiology, Warsaw, Poland
(Zmudka) Szpital Jana Pawla II, Krakow, Poland
(Dangas) Mount Sinai Medical Center, Cardiovascular Institute, One Gustave
L. Levy Place, New York, NY 10029, United States
Title
Relationship between biomarkers and subsequent bleeding risk in ST-segment
elevation myocardial infarction patients treated with paclitaxel-eluting
stents: A HORIZONS-AMI substudy.
Source
Journal of Thrombosis and Thrombolysis. 35 (2) (pp 200-208), 2013. Date of
Publication: February 2013.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Major bleeding complications in STEMI patients result in significant
mortality, morbidity and healthcare cost. Identification of patients at
increased risk of bleeding is therefore essential. New biomarkers might be
of incremental value to identify patients at risk for bleeding after
primary PCI. A total of 26 biomarkers were measured at enrolment and
analyzed at a central core laboratory in 464 STEMI patients in the
HORIZONS-AMI trial. We investigated the relationship between tertiles of
biomarker and in hospital non-CABG major bleeding. In hospital non-CABG
major bleeding occurred in 3.7 % of patients (n = 17). Increasing levels
of cystatin C and D-dimer at admission were associated with higher rates
of in hospital major bleeding. After adjustment for a risk score for
bleeding, the odds ratio for in hospital major bleeding was 3.13 for
cystatin C > 2.04 mg/L (p = 0.046) and 3.28 for ESAM > 34 ng/mL (p =
0.037). In this exploratory analysis of the HORIZONS-AMI biomarker
substudy, high cystatin C and ESAM levels were associated with a higher
risk of major bleeding. Larger studies are warranted to confirm the
prognostic value of cystatin C and ESAM for major bleeding in STEMI
patients. 2012 Springer Science+Business Media New York.
<15>
Accession Number
2013283349
Authors
Henrard V. Ducharme A. Khairy P. Gisbert A. Roy D. Levesque S. Talajic M.
Thibault B. Racine N. White M. Guerra P.G. Tardif J.-C.
Institution
(Henrard, Ducharme, Khairy, Gisbert, Roy, Talajic, Thibault, Racine,
White, Guerra, Tardif) Montreal Heart Institute, Universite de Montreal,
Research Center, 5000 Belanger East, Montreal, QC H1T-1C8, Canada
(Ducharme, Khairy, Roy, Levesque, Talajic, Thibault, White, Tardif)
Montreal Heart Institute Coordinating Center (MHICC), Montreal, QC, Canada
Title
Cardiac remodeling with rhythm versus rate control strategies for atrial
fibrillation in patients with heart failure: Insights from the AF-CHF
echocardiographic sub-study.
Source
International Journal of Cardiology. 165 (3) (pp 430-436), 2013. Date of
Publication: 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: In patients with heart failure and atrial fibrillation, the
AF-CHF (Atrial Fibrillation and Congestive Heart Failure) trial did not
demonstrate the superiority of rhythm control (RhyC) over a rate control
(RaC) strategy on cardiovascular mortality. Nevertheless, deleterious
hemodynamic effects of atrial fibrillation can lead to further decrease in
left ventricular (LV) function and progression of symptoms. This
echocardiographic sub-study was designed to compare the effects of the two
treatment strategies on LV ejection fraction (LVEF), chamber volumes and
dimensions, valvular regurgitation and functional status. Methods and
results: A total of 59 patients (29 RhyC, 30 RaC) aged 67 +/- 8 years (14%
women), enrolled in the AF-CHF trial at the Montreal Heart Institute
underwent standardized echocardiograms at baseline and at 12 months. Mean
LVEF at baseline was severely depressed (RhyC: 27.0 +/- 4.9% and RaC: 27.6
+/- 7.4%, p = 0.73), and improved to a similar degree in both groups
(RhyC: + 8.0 +/- 10.4% and RaC: + 4.5 +/- 10.6, both p < 0.05; p = 0.19
for RhyC versus RaC). Other echocardiographic parameters, such as LV
end-systolic volume index and degree of mitral and tricuspid
regurgitation, remained unchanged. New York Heart Association functional
class and distance walked in 6 min improved significantly in both groups
(RhyC: + 48.9 +/- 78.7 m and RaC: + 47.2 +/- 96.7 m, both p <= 0.01), with
no difference between RhyC and RaC strategies. Conclusions: Improvements
in LVEF and functional status are observed after 12 months in patients
with heart failure and atrial fibrillation, regardless of whether rate or
rhythm control strategies are used. 2011 Elsevier Ireland Ltd.
<16>
Accession Number
2013296397
Authors
Casida J.M. Yaremchuk K.L. Shpakoff L. Marrocco A. Babicz G. Yarandi H.
Institution
(Casida) University of Michigan School of Nursing, 400 North Ingalls, Ann
Arbor, MI 48109, United States
(Yaremchuk) Head and Neck Surgery/Otolaryngology, Henry Ford Hospital, Ann
Arbor, MI, United States
(Shpakoff, Yarandi) Wayne State University College of Nursing, Detroit,
MI, United States
(Marrocco, Babicz) Cardiothoracic Surgery Department, Detroit, MI, United
States
Title
The effects of guided imagery on sleep and inflammatory response in
cardiac surgery: A pilot randomized controlled trial.
Source
Journal of Cardiovascular Surgery. 54 (2) (pp 269-279), 2013. Date of
Publication: April 2013.
Publisher
Edizioni Minerva Medica (Corso Bramante 83-85, Torino 10126, Italy)
<17>
Accession Number
2013289008
Authors
Veljovic M. Popadic A. Vukic Z. Ilic R. Trifunovic Z. Antunovic M.
Mandaric V. Tisma S. Markovic Z.
Institution
(Veljovic, Popadic, Vukic) Clinic of Anesthesiology and Intensive Care,
Belgrade, Serbia
(Ilic, Trifunovic, Mandaric, Tisma, Markovic) Clinic of Cardiac Surgery,
Military Medical Academy, Belgrade, Serbia
(Antunovic) Sector of Pharmacy, Military Medical Academy, Belgrade, Serbia
(Veljovic, Ilic, Antunovic) University of Defence, Belgrade, Serbia
Title
Myocardial protection during elective coronary artery bypasses grafting by
pretreatment with omega-3 polyunsaturated fatty acids.
Source
Vojnosanitetski Pregled. 70 (5) (pp 484-492), 2013. Date of Publication:
May 2013.
Publisher
Vojnomedicinske akademija (Crnotravska 17, Belgrade 11040, Serbia)
Abstract
Background/Aim. Despite recent advances in coronary artery bypass grafting
(CABG), cardioplegic cardiac arrest and cardiopulmonary bypass (CPB) are
still associated with myo-cardial injury. Accordingly, the efforts have
been made lately to improve the outcome of CPB by
glucose-insulin-potassium, adenosine, Ca<sup>2+</sup>-channel antagonists,
L-arginine, N-acetylcysteine, coenzyme Q10, diazoxide,
Na<sup>+</sup>/H<sup>+</sup> exchange inhibitors, but with an unequal
results. Since omega-3 polyunsatutated fatty acids (PUFAs) have shown
remarkable cardioprotection in preclinical researches, the aim of our
study was to check their effects in prevention of ischemia re-perfusion
injury in patients with CPB. Methods. This prospective, randomized,
placebo-controlled study was performed with parallel groups. The patients
undergoing elective CABG were randomized to receive preoperative
intravenous omega-3 PUFAs infusion (n = 20) or the same volume of 0.9%
saline solution infusion (n = 20). Blood samples were collected
simultaneously from the radial artery and the coronary sinus before
starting CPB and at 10, 20 and 30 min after the release of the aortic
cross clamp. Lactate extraction/excretion and myo-cardial oxygen
extraction were calculated and compared between the two groups. The levels
of troponin I (TnT) and cre-atine kinase-myocardial band (CK-MB) were
determined before starting CPB and 4 and 24 h postoperatively. Results.
Demographic and operative characteristics, including CPB and aortic
cross-clamp time, were similar between the two groups of patients. The
level of lactate extraction 10 and 20 min after aortic cross-clamp time
has shown negative values in the control group, but positive values in the
PUFAs group with statistically significant differences (-19.6% vs 7.9%; p
< 0.0001 and -19.9% vs 8.2%; p < 0.0008, respectively). The level of
lactate extraction 30 minutes after reperfusion was not statistically
different between the two groups (6.9% vs 4.2%; p < 0.54). Oxygen
extraction in the PUFAs group was statistically significantly higher
compared to the control group after 10, 20 and 30 min of reperfusion
(35.5% vs 50.4%, p < 0.0004; 25.8% vs 48.7%, p 0.0001 and 25.8% vs 45.6%,
p < 0.0002, respectively). The level of TnT, 4 and 24 h after CPB, was
significantly higher in the control group compared to PUFAs group, with
statistically significant differences (11.4 vs 6.6, p < 0.009 and 12.7 vs
5.9, p < 0.008, respectively). The level of CK-MB, 4 h after CPB, was
significantly higher in the control group compared to PUFAs group (61.9 vs
37.7, p < 0.008), but its level, 24 h after CPB, was not statistically
different between the two groups (58.9 vs 40.6, p 0.051). Conclusion.
Treatment with omega-3 PUFAs administered preoperatively promoted early
metabolic recovery of the heart after elective CABG and improved
myocardial protection. This study showed that omega-3 emulsion should not
be considered only as a nutritional supplement but also as a clinically
safe and potent cardioprotective adjunct during CPB.
<18>
Accession Number
2013264980
Authors
Rathnayake N. Akerman S. Klinge B. Lundegren N. Jansson H. Tryselius Y.
Sorsa T. Gustafsson A.
Institution
(Rathnayake, Klinge, Tryselius, Gustafsson) Karolinska Institutet,
Department of Dental Medicine, Division of Periodontology, Stockholm,
Sweden
(Akerman, Lundegren) Malmo University, Faculty of Odontology, Department
of Oral Diagnostics, Malmo, Sweden
(Klinge, Jansson) Malmo University, Faculty of Odontology, Department of
Periodontology, Malmo, Sweden
(Sorsa) University of Helsinki, Helsinki University Central Hospital,
Department of Oral and Maxillofacial Diseases, Helsinki, Finland
Title
Salivary Biomarkers for Detection of Systemic Diseases.
Source
PLoS ONE. 8 (4) , 2013. Article Number: e61356. Date of Publication: 24
Apr 2013.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background and Objective:Analysis of inflammatory biomarkers in saliva
could offer an attractive opportunity for the diagnosis of different
systemic conditions specifically in epidemiological surveys. The aim of
this study was to investigate if certain salivary biomarkers could be used
for detection of common systemic diseases.Materials and Methods:A randomly
selected sample of 1000 adults living in Skane, a county in the southern
part of Sweden, was invited to participate in a clinical study of oral
health. 451 individuals were enrolled in this investigation, 51% women.
All participants were asked to fill out a questionnaire, history was
taken, a clinical examination was made and stimulated saliva samples were
collected. Salivary concentrations of IL-1beta, -6, -8, TNF-alpha,
lysozyme, MMP-8 and TIMP-1 were determined using ELISA, IFMA or Luminex
assays.Results:Salivary IL-8 concentration was found to be twice as high
in subjects who had experience of tumour diseases. In addition, IL-8
levels were also elevated in patients with bowel disease. MMP-8 levels
were elevated in saliva from patients after cardiac surgery or suffering
from diabetes, and muscle and joint diseases. The levels of IL-1beta, IL-8
and MMP-8, as well as the MMP-8/TIMP-1 ratio were higher in subjects with
muscle and joint diseases.Conclusion:Biomarkers in saliva have the
potential to be used for screening purposes in epidemiological studies.
The relatively unspecific inflammatory markers used in this study can not
be used for diagnosis of specific diseases but can be seen as markers for
increased systemic inflammation. 2013 Rathnayake et al.
<19>
Accession Number
2013279671
Authors
Panza J.A. Holly T.A. Asch F.M. She L. Pellikka P.A. Velazquez E.J. Lee
K.L. Borges-Neto S. Farsky P.S. Jones R.H. Berman D.S. Bonow R.O.
Institution
(Panza, Asch) Division of Cardiology, MedStar Washington Hospital Center,
110 Irving Street, NW, Washington, DC 20010, United States
(Holly, Bonow) Northwestern University Feinberg School of Medicine,
Chicago, IL, United States
(She, Velazquez, Lee, Borges-Neto, Jones) Duke Clinical Research
Institute, Duke University Medical Center, Durham, NC, United States
(Pellikka) Mayo Clinic College of Medicine, Rochester, MN, United States
(Farsky) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Berman) Cedars-Sinai Medical Center, Los Angeles, CA, United States
Title
Inducible myocardial ischemia and outcomes in patients with coronary
artery disease and left ventricular dysfunction.
Source
Journal of the American College of Cardiology. 61 (18) (pp 1860-1870),
2013. Date of Publication: 07 May 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The study objectives were to test the hypotheses that ischemia
during stress testing has prognostic value and identifies those patients
with coronary artery disease (CAD) with left ventricular (LV) dysfunction
who derive the greatest benefit from coronary artery bypass grafting
(CABG) compared with medical therapy. Background: The clinical
significance of stress-induced ischemia in patients with CAD and
moderately to severely reduced LV ejection fraction (EF) is largely
unknown. Methods: The STICH (Surgical Treatment for IsChemic Heart
Failure) trial randomized patients with CAD and EF <=35% to CABG or
medical therapy. In the current study, we assessed the outcomes of those
STICH patients who underwent a radionuclide (RN) stress test or a
dobutamine stress echocardiogram (DSE). A test was considered positive for
ischemia by RN testing if the summed difference score (difference in
tracer activity between stress and rest) was >=4 or if >=2 of 16 segments
were ischemic during DSE. Clinical endpoints were assessed by intention to
treat during a median follow-up of 56 months. Results: Of the 399 study
patients (51 women, mean EF 26 +/- 8%), 197 were randomized to CABG and
202 were randomized to medical therapy. Myocardial ischemia was induced
during stress testing in 256 patients (64% of the study population).
Patients with and without ischemia were similar in age, multivessel CAD,
previous myocardial infarction, LV EF, LV volumes, and treatment
allocation (all p = NS). There was no difference between patients with and
without ischemia in all-cause mortality (hazard ratio: 1.08; 95%
confidence interval: 0.77 to 1.50; p = 0.66), cardiovascular mortality, or
all-cause mortality plus cardiovascular hospitalization. There was no
interaction between ischemia and treatment for any clinical endpoint.
Conclusions: In CAD with severe LV dysfunction, inducible myocardial
ischemia does not identify patients with worse prognosis or those with
greater benefit from CABG over optimal medical therapy. (Comparison of
Surgical and Medical Treatment for Congestive Heart Failure and Coronary
Artery Disease [STICH]; NCT00023595) 2013 American College of Cardiology
Foundation.
<20>
Accession Number
2013279132
Authors
Vohra H.A. Whistance R.N. De kerchove L. Punjabi P. El khoury G.
Institution
(Vohra, De kerchove, El khoury) Divisions of Cardiothoracic and Vascular
Surgery, Universite Catholique de Louvain, Cliniques Universitaires
Saint-Luc, Brussels, Belgium
(Whistance) Academic Unit of Surgical Research, School of Social and
Community Medicine, University of Bristol, Bristol, United Kingdom
(Punjabi) Imperial College Heathcare NHS Trust, Imperial College School of
Medicine, London, United Kingdom
Title
Valve-preserving surgery on the bicuspid aortic valve.
Source
European Journal of Cardio-thoracic Surgery. 43 (5) (pp 888-898), 2013.
Article Number: ezs664. Date of Publication: May 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Valve repair has emerged as an important intervention for the management
of bicuspid aortic valve disease. This systematic review aims to assess
the safety, efficacy and durability of bicuspid aortic valve repair.
Initial searches yielded 682 abstracts, reduced by de-duplication to 370,
of which 56 full papers were accessed and 30 met the inclusion criteria.
Overall, 163 unique outcomes for bicuspid aortic valve-preserving surgery
were reported on 280 occasions. Bicuspid aortic valve-preserving surgery
exhibited low operative mortality (0.0-5.2%), excellent 5-year survival
(82-100%) and 43-100% 5-year freedom from reoperation. Bicuspid aortic
valve repair is safe and efficacious, but concerns regarding its
durability necessitate further standardized outcome assessments. The
Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.
<21>
Accession Number
2013279077
Authors
Haase M. Haase-Fielitz A. Plass M. Kuppe H. Hetzer R. Hannon C. Murray
P.T. Bailey M.J. Bellomo R. Bagshaw S.M.
Institution
(Haase, Haase-Fielitz) Department of Nephrology and Hypertension,
Diabetes, and Endocrinology, Otto-von-Guericke-University Magdeburg,
Germany
(Plass, Kuppe) Department of Anesthesiology, The German Heart Center,
Berlin, Germany
(Hetzer) Department of Cardiothoracic Surgery, The German Heart Center,
Berlin, Germany
(Hannon, Murray) Nephrology and Clinical Pharmacology, University College
Dublin School of Medicine and Medical Science, Dublin, Ireland
(Bailey) The Australian and New Zealand Intensive Care Research Centre,
Department of Epidemiology and Preventive Medicine, Monash University,
Melbourne, Australia
(Bellomo) Department of Intensive Care, The Austin Hospital, Melbourne,
Australia
(Bagshaw) Division of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Alberta, Canada
Title
Prophylactic Perioperative Sodium Bicarbonate to Prevent Acute Kidney
Injury Following Open Heart Surgery: A Multicenter Double-Blinded
Randomized Controlled Trial.
Source
PLoS Medicine. 10 (4) , 2013. Article Number: e1001426. Date of
Publication: April 2013.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background: Preliminary evidence suggests a nephroprotective effect of
urinary alkalinization in patients at risk of acute kidney injury. In this
study, we tested whether prophylactic bicarbonate-based infusion reduces
the incidence of acute kidney injury and tubular damage in patients
undergoing open heart surgery. Methods and Findings: In a multicenter,
double-blinded (patients, clinical and research personnel), randomized
controlled trial we enrolled 350 adult patients undergoing open heart
surgery with the use of cardiopulmonary bypass. At induction of
anesthesia, patients received either 24 hours of intravenous infusion of
sodium bicarbonate (5.1 mmol/kg) or sodium chloride (5.1 mmol/kg). The
primary endpoint was the proportion of patients developing acute kidney
injury. Secondary endpoints included the magnitude of acute tubular damage
as measured by urinary neutrophil gelatinase-associated lipocalin (NGAL),
initiation of acute renal replacement therapy, and mortality. The study
was stopped early under recommendation of the Data Safety and Monitoring
Committee because interim analysis suggested likely lack of efficacy and
possible harm. Groups were non-significantly different at baseline except
that a greater proportion of patients in the sodium bicarbonate group
(66/174 [38%]) presented with preoperative chronic kidney disease compared
to control (44/176 [25%]; p = 0.009). Sodium bicarbonate increased urinary
pH (from 6.0 to 7.5, p<0.001). More patients receiving bicarbonate (83/174
[47.7%]) developed acute kidney injury compared with control patients
(64/176 [36.4%], odds ratio [OR] 1.60 [95% CI 1.04-2.45]; unadjusted p =
0.032). After multivariable adjustment, a non-significant unfavorable
group difference affecting patients receiving sodium bicarbonate was found
for the primary endpoint (OR 1.45 [0.90-2.33], p = 0.120]). A greater
postoperative increase in urinary NGAL in patients receiving bicarbonate
infusion was observed compared to control patients (p = 0.011). The
incidence of postoperative renal replacement therapy was similar but
hospital mortality was increased in patients receiving sodium bicarbonate
compared with control (11/174 [6.3%] versus 3/176 [1.7%], OR 3.89
[1.07-14.2], p = 0.031). Conclusions: Urinary alkalinization using sodium
bicarbonate infusion was not found to reduce the incidence of acute kidney
injury or attenuate tubular damage following open heart surgery; however,
it was associated with a possible increase in mortality. On the basis of
these findings we do not recommend the prophylactic use of sodium
bicarbonate infusion to reduce the risk of acute kidney injury.
Discontinuation of growing implementation of this therapy in this setting
seems to be justified. Trial registration: ClinicalTrials.gov NCT00672334
Please see later in the article for the Editors' Summary. 2013 Haase et
al.
<22>
Accession Number
2013278968
Authors
Li X.-D. Yang Y.-J. Hao Y.-C. Yang Y. Zhao J.-L. Dou K.-F. Gu D.-F.
Institution
(Li, Yang, Hao, Yang) Department of Evidence Based Medicine, Fuwai
Hospital and Cardiovascular Institute, Peking Union Medical College and
Chinese Academy of Medical Sciences, Beijing 100037, China
(Zhao, Dou, Gu) Department of and Cardiology, Fuwai Hospital and
Cardiovascular Institute, Peking Union Medical College and Chinese Academy
of Medical Sciences, Beijing 100037, China
Title
Effect of pre-procedural statin therapy on myocardial no-reflow following
percutaneous coronary intervention: A meta analysis.
Source
Chinese Medical Journal. 126 (9) (pp 1755-1760), 2013. Date of
Publication: 05 May 2013.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Successful revascularization of coronary artery disease,
especially ST-elevation myocardial infarction (STEMI), does not always
mean optimal myocardial reperfusion in a portion of patients because of
no-reflow phenomenon. We hypothesized that statins might attenuate the
incidence of myocardial no-reflow when used before percutaneous coronary
intervention (PCI). The purpose of this study was to summarize the
evidence of pre-procedural statin therapy to reduce myocardial no-reflow
after PCI. Methods We searched the MEDLINE, Cochrane, and
clinicaltrials.gov databases from inception to October 2012 for clinical
trials that examined statin therapy before PCI. We required that studies
initiated statins before PCI and reported myocardial no-reflow. A
DerSimonian-Laird model was used to construct random-effects summary risk
ratios. Results In all, 7 studies with 3086 patients met our selection
criteria. The use of pre-procedural statins significantly reduced
post-procedural no-reflow by 4.2% in all PCI patients (risk ratio (RR)
0.56, 95% confidence interval (CI) 0.35 to 0.90, P=0.016), and attenuated
by 5.0% in non-STEMI patients (RR 0.41, 95% CI 0.18 to 0.94, P=0.035).
This benefit was mainly observed in the early or acute intensive statin
therapy populations (RR 0.43, 95% CI 0.26 to 0.71, P=0.001). Conclusions
Acute intensive statin therapy before PCI significantly reduces the hazard
of post-procedural no-reflow phenomenon. The routine use of statins before
PCI should be considered.
<23>
Accession Number
2013277256
Authors
Harskamp R.E. Park D.-W.
Institution
(Harskamp) Academic Medical Center, University of Amsterdam, Netherlands
(Park) Department of Cardiology, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Harskamp, Park) Duke Clinical Research Institute, Duke University,
Durham, NC, United States
Title
Percutaneous coronary intervention in diabetic patients: Should choice of
stents be influenced?.
Source
Expert Review of Cardiovascular Therapy. 11 (5) (pp 541-553), 2013. Date
of Publication: May 2013.
Publisher
Expert Reviews Ltd. (2 Albert Place, London N3 1QB, United Kingdom)
Abstract
Patients with diabetes mellitus are prone to a diffuse and rapidly
progressive form of coronary artery disease. As a result, diabetic
patients undergoing coronary revascularization are at higher risk of
cardiovascular events compared with nondiabetic patients. Due to marked
advances of stent device technology and adjunctive pharmacology,
percutaneous coronary intervention has been regarded as an efficient
revascularization strategy in diabetic patients. Numerous randomized
trials and large observational registries have compared the efficacy and
safety of bare-metal stents and drug-eluting stents, as well as several DE
platforms. This article systematically reviews the cumulative evidence
from key clinical studies and tries to help guide the physician in making
informed decisions on the optimal stent type for patients with diabetes
mellitus. 2013 2013 Expert Reviews Ltd.
<24>
Accession Number
2013258027
Authors
Curtis A.B. Worley S.J. Adamson P.B. Chung E.S. Niazi I. Sherfesee L.
Shinn T. Sutton M.St.J.
Institution
(Curtis) Department of Medicine, University at Buffalo, Buffalo General
Medical Center, 100 High St., D2-76, Buffalo, NY 14203, United States
(Worley) Lancaster General Hospital, Lancaster, PA, United States
(Adamson) Oklahoma Foundation for Cardiovascular Research, Oklahoma City,
OK, United States
(Chung) Heart and Vascular Center at Christ Hospital, Cincinnati, United
States
(Niazi) St. Luke's Medical Center, Milwaukee, United States
(Sherfesee) Medtronic, Minneapolis, United States
(Shinn) St. Joseph Mercy, Ann Arbor, MI, United States
(Sutton) University of Pennsylvania Medical Center, Philadelphia, PA,
United States
Title
Biventricular pacing for atrioventricular block and systolic dysfunction.
Source
New England Journal of Medicine. 368 (17) (pp 1585-1593), 2013. Date of
Publication: 25 Apr 2013.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Right ventricular pacing restores an adequate heart rate in
patients with atrioventricular block, but high percentages of right
ventricular apical pacing may promote left ventricular systolic
dysfunction. We evaluated whether biventricular pacing might reduce
mortality, morbidity, and adverse left ventricular remodeling in such
patients. METHODS: We enrolled patients who had indications for pacing
with atrioventricular block; New York Heart Association (NYHA) class I,
II, or III heart failure; and a left ventricular ejection fraction of 50%
or less. Patients received a cardiac-resynchronization pacemaker or
implantable cardioverter-defibrillator (ICD) (the latter if the patient
had an indication for defibrillation therapy) and were randomly assigned
to standard right ventricular pacing or biventricular pacing. The primary
outcome was the time to death from any cause, an urgent care visit for
heart failure that required intravenous therapy, or a 15% or more increase
in the left ventricular end-systolic volume index. RESULTS: Of 918
patients enrolled, 691 underwent randomization and were followed for an
average of 37 months. The primary outcome occurred in 190 of 342 patients
(55.6%) in the right-ventricular-pacing group, as compared with 160 of 349
(45.8%) in the biventricular-pacing group. Patients randomly assigned to
biventricular pacing had a significantly lower incidence of the primary
outcome over time than did those assigned to right ventricular pacing
(hazard ratio, 0.74; 95% credible interval, 0.60 to 0.90); results were
similar in the pacemaker and ICD groups. Left ventricular lead-related
complications occurred in 6.4% of patients. CONCLUSIONS: Biventricular
pacing was superior to conventional right ventricular pacing in patients
with atrioventricular block and left ventricular systolic dysfunction with
NYHA class I, II, or III heart failure. (Funded by Medtronic; BLOCK HF
ClinicalTrials.gov number, NCT00267098.) Copyright 2013 Massachusetts
Medical Society.
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Accession Number
2013280136
Authors
Rosa R.F.M. Rosa R.C.M. Zen P.R.G. Graziadio C. Paskulin G.A.
Institution
(Rosa) UFCSPA, Geneticista Clinico, Hospital Materno Infantil Presidente
Vargas (HMIPV), Porto Alegre, RS, Brazil
(Rosa) UFCSPA, Porto Alegre, RS, Brazil
(Zen, Graziadio) UFCSPA, Disciplina de Genetica Clinica da UFCSPA, Porto
Alegre, RS, Brazil
(Paskulin) Universidade Federal do Rio Grande do Sul (UFRGS), Disciplina
de Genetica Clinica da UFCSPA, Porto Alegre, RS, Brazil
Title
Trisomy 18: Review of the clinical, etiologic, prognostic, and ethical
aspects.
Source
Revista Paulista de Pediatria. 31 (1) (pp 111-120), 2013. Date of
Publication: January-March 2013.
Publisher
Sao Paulo Pediatric Society (Alameda Santos 211, Cerq cesar, Sao Paulo
01419-000, Brazil)
Abstract
Objective: To review the clinical, etiological, diagnostic, and prognostic
characteristics of trisomy 18 (Edwards syndrome). Data sources: Scientific
articles in the MedLine, Lilacs, and SciELO databases were searched using
the descriptors 'trisomy 18' and 'Edwards syndrome'. The research was not
limited to a specific time period and included all articles in such
databases. Data synthesis: Edwards syndrome is a disease characterized by
a broad clinical picture and a very reserved prognosis. There are
descriptions of more than 130 different anomalies, which can involve
virtually all organs and systems. Its findings are the result of the
presence of three copies of chromosome 18. The main chromosomal
constitution observed among these patients is a free trisomy of chromosome
18, which is associated with the phenomenon of nondisjunction, especially
in maternal gametogenesis. Most fetuses with Edwards syndrome die during
the embryonic and fetal life. The median of survival among live births has
usually varied between 2.5 and 14.5 days. Conclusions: Knowledge on the
clinical picture and on the prognosis of Edwards syndrome patients is of
great importance regarding the neonatal care and the decisions about
invasive treatments. The speed to have a confirmed diagnosis is important
for making decisions about medical procedures. Often, interventions are
performed under emergency conditions, without many opportunities for
discussion, and they involve difficult medical and ethical issues.
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Accession Number
71061360
Authors
Meads D.M. Fairbairn T.A. Hulme C.T. Mather A.N. Plein S. Blackman D.J.
Greenwood J.P.
Institution
(Meads, Fairbairn, Hulme, Mather, Plein, Greenwood) University of Leeds,
Leeds, United Kingdom
(Blackman) Leeds General Infirmary, Leeds, United Kingdom
Title
The cost-effectiveness of transcatheter aortic valve implantation versus
surgical aortic valve replacement in patients with severe aortic stenosis
at high operative risk.
Source
Value in Health. Conference: ISPOR 18th Annual International Meeting New
Orleans, LA United States. Conference Start: 20130518 Conference End:
20130522. Conference Publication: (var.pagings). 16 (3) (pp A294), 2013.
Date of Publication: May 2013.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: To determine the cost-effectiveness of Transcatheter aortic
valve implantation (TAVI) compared to surgical aortic valve replacement
(SAVR) in a high-risk aortic stenosis (AS) population from the perspective
of the UK health and personal social services. METHODS: A Markov model was
developed to enable a cost-utility analysis employing NICE reference case
methods. A systematic review was conducted to identify model parameter
values. Mean utility values per NYHA category were derived from a UK
high-risk AS population. Two-year TAVI and SAVR effectiveness was taken
from the PARTNER A trial. Costs and effects were modelled from two years
over a 10 year horizon via NYHA health state transitions. Incremental
cost-effectiveness ratios (ICER) and cost effectiveness acceptability
curves (CEAC) were calculated and deterministic and probabilistic
sensitivity analyses conducted. RESULTS: Despite greater procedural costs
(16,500 vs. 9,256), TAVI was cost-effective compared to SAVR over 10 years
(costs 52,593 vs. 53,943 and QALYs 2.81 vs 2.75), indicating TAVI
dominated SAVR. This appeared to be due to greater SAVR post-surgical
costs and attendant length and cost of hospital stay. The results appeared
robust to a number of deterministic sensitivity (including high stroke
rates, worst case scenario complication rates, alternative utility values
and higher costs) and probabilistic analyses. Given modest cost savings
and QALY benefits conferred by TAVI, results were sensitive to some
parameter changes when incurred by one arm in isolation. The CEAC
indicated that at a 20,000 incremental QALY willingness to pay threshold,
TAVI had a 64.6% likelihood of being cost-effective. CONCLUSIONS: This
economic evaluation is the first to incorporate two year data comparing
TAVI and SAVR in elderly high risk AS patients. TAVI is likely to be a
cost-effective option compared to SAVR. However, uncertainty surrounding
the long-term outcomes for TAVI patients remains; this could have a
substantive impact on estimates of cost-effectiveness.
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Accession Number
71058379
Authors
Cholette J. Powers K. Alfieris G. Angona R. Henrichs K. Blumberg N.
Institution
(Cholette, Powers) Golisano Children's Hospital, University of Rochester,
United States
(Alfieris, Angona, Henrichs, Blumberg) University of Rochester, United
States
Title
Cell saver for volume replacement in children following cardiopulmonary
bypass reduces the number of RBC and blood product transfusions and donor
exposures.
Source
Critical Care Medicine. Conference: Critical Care Congress 2012 Houston,
TX United States. Conference Start: 20120204 Conference End: 20120208.
Conference Publication: (var.pagings). 39 (pp 7), 2011. Date of
Publication: December 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Children typically require large numbers of red blood cell
(RBC) and blood component therapy following repair or palliation of
cardiac defects with cardiopulmonary bypass (CPB). Cell savers remove
heparin and cytokines from CPB salvage, and are now available for
pediatrics. The impact of cell saver infusion on RBC and component therapy
in pediatric cardiac surgery has not been explored. Hypothesis:
Utilization of cell saver for volume replacement in children undergoing
cardiac surgery for congenital heart defects with CPB reduces
post-operative allogeneic RBC and blood component transfusions, and donor
exposures. Methods: A prospective, randomized controlled trial of cell
saver v. allogeneic RBC and crystalloid/colloid for post-operative volume
replacement in children undergoing cardiac surgery with CPB.Subjects:
Children 20 kg undergoing CPB, stratified by weight and surgical
severity.Study Group: Residual CPB volume was processed by the Fresinius
Continuous Auto Transfusion System and collected as cell saver. Cell saver
was infused for anemia, or for volume replacement if hemoglobin (Hb) < 13
g/dL. Albumin or crystalloid was given for volume replacement if Hb >/= 13
g/dL.Control Group: Allogeneic RBC, albumin, or crystalloid was given for
anemia or volume replacement per the current standard of care. Blood
component therapy was transfused in each group per the standard of care.
Results: 34 cell saver and 31 control subjects were studied.
Post-operatively until hospital discharge, the cell saver group received a
mean of 1.9 +/<sup>-</sup> 1.5 allogeneic RBC transfusions v. 3.6
+/<sup>-</sup> 2.5 in the control group (p<0.001). The cell saver group
received 2.1 +/- 1.6 total post-operative transfusions (FFP, cryo, plts)
v. 4.3 +/<sup>-</sup> 3.2 in the control group (p<0.001). Mean
post-operative donor exposures were 1.6 +/- 1.6 for the cell saver group
and 3.2 +/- 2.8 for the control group (p<0.001). There was no significant
difference in RBC storage age or clinical outcomes. Conclusions: Infusion
of cell saver for volume replacement in children following CPB reduces the
number of allogeneic RBC and blood product transfusions and donor
exposures, and may reduce complications from blood product transfusions.
