EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 12

Results Generated From:
Embase <1980 to 2013 Week 27>
Embase (updates since 2013-06-27)

<1>
Accession Number
2013396363
Authors
Niccoli G. Rigattieri S. De Vita M.R. Valgimigli M. Corvo P. Fabbiocchi F.
Romagnoli E. De Caterina A.R. La Torre G. Lo Schiavo P. Tarantino F.
Ferrari R. Tomai F. Olivares P. Cosentino N. D'Amario D. Leone A.M. Porto
I. Burzotta F. Trani C. Crea F.
Institution
(Niccoli, Cosentino, D'Amario, Leone, Porto, Burzotta, Trani, Crea)
Institute of Cardiology, Catholic University of the Sacred Heart, Largo F.
Vito 1, 00168 Rome, Italy
(Rigattieri, Lo Schiavo) U.O. Dipartimentale di Emodinamica e Cardiologia
Interventistica, S. Pertini Hospital, Rome, Italy
(De Vita, Tarantino) U.O. Cardiologia, G. B. Morgagni-L. Pierantoni
Hospital, Forli, Italy
(Valgimigli, Ferrari) Department of Cardiology, Arcispedale S. Anna,
Ferrara, Italy
(Corvo, Tomai) Department of Cardiovascular Sciences, European Hospital,
Rome, Italy
(Fabbiocchi, Olivares) U.O. Cardiologia Interventistica, Cardiologic
Center Monzino, Milan, Italy
(Romagnoli) Policlinico Casilino, Rome, Italy
(De Caterina) Istituto Scienze della Vita, Scuola Superiore sant'Anna,
Pisa, Italy
(La Torre) Department of Public Health and Infectious Diseases, Sapienza
University of Rome, Rome, Italy
Title
Open-label, randomized, placebo-controlled evaluation of intracoronary
adenosine or nitroprusside after thrombus aspiration during primary
percutaneous coronary intervention for the prevention of microvascular
obstruction in acute myocardial infarction: The REOPEN-AMI study
(intracoronary nitroprusside versus adenosine in acute myocardial
infarction).
Source
JACC: Cardiovascular Interventions. 6 (6) (pp 580-589), 2013. Date of
Publication: June 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives This study sought to assess whether intracoronary adenosine or
nitroprusside following thrombus aspiration (TA) is superior to TA alone
for the prevention of microvascular obstruction (MVO) in ST-segment
elevation myocardial infarction (STEMI) patients undergoing percutaneous
coronary intervention (PCI). Background MVO, due to its multifactorial
pathogenesis, still occurs after TA in a sizeable portion of patients.
Methods We performed a placebo-controlled, randomized, open-label,
blind-examination, multicenter trial. A total of 240 STEMI patients with
Thrombolysis In Myocardial Infarction (TIMI) flow grade 0/1 were randomly
allocated 1:1:1 to receive adenosine (n = 80), nitroprusside (n = 80), or
saline (n = 80) given distal to the occluded site after TA. The primary
endpoint was the incidence of ST-segment resolution (STR) >70% on surface
electrocardiogram at 90 min after PCI. Secondary endpoints were
angiographic MVO incidence (TIMI flow grade <=2 or 3 with a myocardial
blush grade <2) and major adverse cardiac event (MACE) rate at 30 days as
a composite of cardiac death, myocardial infarction, target lesion
revascularization, and heart failure requiring hospitalization. Results
STR >70% occurred in in 71% of adenosine-treated patients, in 54% of
nitroprusside-treated patients, and in 51% of saline-treated patients (p =
0.009 and p = 0.75, respectively, vs. saline). Angiographic MVO occurred
in 18% of adenosine-treated patients, in 24% of nitroprusside-treated
patients, and in 30% of saline-treated patients (p = 0.06 and p = 0.37,
respectively, vs. saline). MACE occurred in 10%, 14%, and 20% of patients,
respectively (p = 0.08 and p = 0.29 vs. saline). Conclusions In STEMI
patients treated by PCI and TA, the additional intracoronary
administration of adenosine, but not that of nitroprusside, results in a
significant improvement of MVO, as assessed by STR. 2013 American College
of Cardiology Foundation.

<2>
[Use Link to view the full text]
Accession Number
2013395716
Authors
Maurer M.S. Teruya S. Chakraborty B. Helmke S. Mancini D.
Institution
(Maurer, Teruya, Chakraborty, Helmke, Mancini) Clinical Cardiovascular
Research Laboratory for the Elderly, Allen Hospital of NewYork
Presbyterian, 5141 Broadway, New York, NY 10034, United States
Title
Treating anemia in older adults with heart failure with a preserved
ejection fraction with epoetin alfa single-blind randomized clinical trial
of safety and efficacy.
Source
Circulation: Heart Failure. 6 (2) (pp 254-263), 2013. Date of Publication:
March 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Anemia is a common comorbidity in older adults with heart
failure and a preserved ejection fraction and is associated with worse
outcomes. We hypothesized that treating anemia with subcutaneous epoetin
alfa would be associated with reverse ventricular remodeling and improved
exercise capacity and health status compared with placebo. Methods and
Results-Prospective, randomized, single-blind, 24-week study with blinded
end point assessment among anemic (average hemoglobin of 10.4+/-1 g/dL)
older adult patients (n=56; 77+/-11 years; 68% women) with heart failure
and a preserved ejection fraction (ejection fraction=63+/-15%; B-type
natriuretic peptide=431+/-366 pg/mL) was conducted. Treatment with epoetin
alfa resulted in significant increases in hemoglobin (P<0.0001). Changes
in end-diastolic volume (-6+/-14 versus -4+/-16 mL; P=0.67) at 6 months
did not differ between epoetin alfa and placebo, but declines in stroke
volume (-5+/-8 versus 2+/-10 mL; P=0.09) without significant changes in
left ventricular mass were observed. Changes in 6-minute walk distance
(16+/-11 versus 5+/-12 m; P=0.52) did not differ. Although quality of life
improved by the Kansas City Cardiomyopathy Questionnaire and the Minnesota
Living with Heart Failure Questionnaire in both cohorts, there were no
significant differences between groups. Conclusions-Administration of
epoetin alfa to older adult patients with heart failure and a preserved
ejection fraction compared with placebo did not change left ventricular
end-diastolic volume and left ventricular mass nor did it improve
submaximal exercise capacity or quality of life. 2013 American Heart
Association, Inc.

<3>
Accession Number
2013393264
Authors
Alba A.C. Alba L.F. Delgado D.H. Rao V. Ross H.J. Goeree R.
Institution
(Alba, Delgado, Ross) Heart Failure/Transplantation, Toronto General
Hospital, University Health Network, Toronto, Canada
(Alba, Rao) Cardiovascular Surgery, Toronto General Hospital, University
Health Network, 585 University Ave, 11c-1207, Toronto, ON M5G2N2, Canada
(Alba) Economic Sciences, National University of Cuyo, Mendoza, Argentina
(Goeree) Clinical Epidemiology and Biostatistics, McMaster University,
PATH Research Institute, Hamilton, Canada
Title
Cost-effectiveness of ventricular assist device therapy as a bridge to
transplantation compared with nonbridged cardiac recipients.
Source
Circulation. 127 (24) (pp 2424-2435), 2013. Date of Publication: 18 Jun
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Current available treatment options for advanced heart failure
include heart transplantation and ventricular assist device (VAD) therapy.
This project aimed to evaluate the cost-effectiveness of a
bridge-to-transplantation (BTT)-VA D approach relative to direct heart
transplantation in transplant-eligible patients. Methods and Results: A
Markov model was used to evaluate survival benefits and costs for BTT-VAD
versus nonbridged heart transplant recipients. Three different scenarios
were considered according to severity of patients' baseline hemodynamic
status (high, medium, and low risk). Results are presented in terms of
survival, costs, and cost-effectiveness ratio. Sensitivity analyses were
used to analyze uncertainty in model estimates. Over a 20-year time
horizon, BTT-VA D therapy increased survival at an increased cost relative
to nonbridged heart transplant recipients: $100841 more in costs and 1.19
increased life years (LYs) in high-risk patients ($84 964/LY), $112 779
more in costs and 1.14 more LYs ($99 039/LY) in medium-risk patients, and
an additional cost of $144 334 and incremental clinical benefit of 1.21
more LYs ($119 574/LY) in low-risk patients. The sensitivity analysis
estimated a 59%, 54%, and 43% chance of BTT-VAD therapy being
cost-effective for high-, medium-, and low-risk patients at a
willingness-to-pay level of $100 000/LY. Subgroup analyses indicated that
risk of post-VAD and transplantation complications, waiting time, renal
dysfunction, and patient age substantially affected the cost-effectiveness
ratio. Conclusions: BTT-VAD therapy is associated with improved survival
and increased costs. On the basis of commonly accepted willingness-to-pay
thresholds, BTT-VAD therapy is likely to be cost-effective relative to
nonbridged heart transplantation in specific circumstances. 2013 American
Heart Association, Inc.

<4>
Accession Number
2013390770
Authors
Alsabbagh M.M. Asmar A. Ejaz N.I. Aiyer R.K. Kambhampati G. Ejaz A.A.
Institution
(Alsabbagh, Aiyer, Kambhampati, Ejaz) Division of Nephrology, Hypertension
and Renal Transplantation, University of Florida, P.O. Box 100224,
Gainesville, FL 32610-0224, United States
(Asmar) Department of Clinical Sciences, University of Central Florida,
Orlando, FL, United States
(Ejaz) College at the University of Chicago, Chicago IL, United States
Title
Update on clinical trials for the prevention of acute kidney injury in
patients undergoing cardiac surgery.
Source
American Journal of Surgery. 206 (1) (pp 86-95), 2013. Date of
Publication: July 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background: Effective therapeutic agents for the prevention and treatment
of acute kidney injury (AKI) after cardiac surgery remain elusive despite
the tremendous advances in surgical techniques, technology, and
understanding of disease processes. Recent developments and their effect
on the incidence of AKI after cardiac surgery are discussed. Data Sources:
Published clinical trials in PubMed, strength of evidence assessed by the
guidelines of the American Family Physicians. Conclusions: The definition
of AKI has changed, and the focus of interventions has shifted from
treatment to prevention to recovery from AKI. Antioxidants and biological
agents have been added to classic armaments of hydration and diuretics in
addition to tighter metabolic control to prevent AKI. Although the
treatment options remain unsatisfactory, a lot of progress nevertheless
continues to be made in the prevention and treatment of AKI. 2013
Elsevier Inc.

<5>
Accession Number
23369948
Authors
Cakir H. Gur O. Ege T. Kunduracilar H. Ketenciler S. Duran E.
Institution
(Cakir) Cardiovascular Surgery, Adana Numune Hospital, Adana, Turkey.
Title
Comparison of the efficacy of the cardiac hypothermia and normothermia to
myocardial damage in coronary artery bypass graft surgery with systemic
normothermic cardiopulmonary bypass.
Source
The Journal of cardiovascular surgery. 54 (3) (pp 397-401), 2013. Date of
Publication: Jun 2013.
Abstract
The aim of our research is to investigate the cardiac damage formed by
either local cardiac hypothermia or cardiac normothermia technique in
patients who undergone isolated coronary artery bypass graft (CABG)
surgery. The total of 40 patients who underwent isolated CABG operation
under normothermic cardiopulmonary bypass (CPB) were studied. Patients
were randomly divided into two groups as cardiac hypothermia and cardiac
normothermia. Myocardial temperature was measured from the
interventricular septum before aortic cross-clamp (ACC) (baseline), the
ACC 20th minutes (ischemia) and after 20 minutes removal of the ACC
(reperfusion). The coronary sinus blood samples were simultaneously
obtained from the retrograde cardioplegia cannula while myocardial
temperature was being measured. Complement component 3 (C3), complement
component 4 (C4), troponin I and tumor necrosis factor-alpha (TNF-alpha)
was measured from the coronary sinus blood samples. Myocardial temperature
was between 18-28 degreeC (deep hypothermia) during ACC in group 1.
Myocardial temperature was over 34 degreeC (normothermia) during ACC in
group 2. TNF-alpha values of group 1 for ischemia and reperfusion were
higher than group 2, and it was found statistically significant (P<0.05).
Myocardial damage was less than in normothermia group according to
hypothermia group. The results show that ice-cold blood cardioplegia and
local ice treatment of the heart during CPB seems to harm the heart more
than warm blood cardioplegia.

<6>
Accession Number
23138609
Authors
Van Der Heyden J. Van Werkum J. Hackeng C.M. Kelder J.C. Breet N.J. Deneer
V.H. Ackerstaff R.G. Tromp S.C. De Vries J.P. Vos J.A. Suttorp M.J.
Elsenberg E.H. Van Neerven D. Schonewille W.J. Wolters F. Ten Berg J.M.
Institution
(Van Der Heyden) Department of Interventional Cardiology, St Antonius
Hospital, Nieuwegein, The Netherlands.
Title
High versus standard clopidogrel loading in patients undergoing carotid
artery stenting prior to cardiac surgery to assess the number of
microemboli detected with transcranial Doppler: results of the randomized
IMPACT trial.
Source
The Journal of cardiovascular surgery. 54 (3) (pp 337-347), 2013. Date of
Publication: Jun 2013.
Abstract
The aim of this study was to compare the effects of 300 mg or 600 mg
clopidogrel loading dose, prior to carotid artery stenting (CAS) on the
number of transcranial Doppler (TCD)-detected microembolic signals (MES)
and to investigate the relationship between the magnitude of platelet
reactivity and MES. In this prospective randomized, double-blind study, 35
consecutive asymptomatic patients (17.1% females), scheduled for CAS and
cardiac surgery were included. The primary endpoint was the number of
TCD-detected MES. The secondary endpoints were the absolute magnitude of
on-treatment platelet reactivity and the adverse cerebral events. Negative
binomial regression to find predictors for sum of single emboli, the
student's t-test to assess the association between platelet function tests
and randomized dose of 300 mg or 600 mg clopidogrel, and the R2
calculation for the assessment of the association between platelet
function tests and embolic load, were used. No statistically significant
difference in the number of TCD-detected MES, in the sum of all the single
emboli or showers and platelet aggregation measurements between the two
groups was observed (aggregometry: 21.7+/-18.3 versus 23+/-18%, P=0.8499
and 45.8+/-17.5 versus 46.5+/-14.5%, P=0.9003) (verifyNow P2Y12 assay:
231+/-93 PRU versus 222+/-86 PRU, P=0.7704). In one patient a transient
ischemic attack occurred. A loading dose of 300 mg of clopidogrel in
combination with aspirin is as effective as 600 mg of clopidogrel in
achieving adequate platelet inhibition and preventing periprocedural
events in asymptomatic patients undergoing CAS prior to cardiac surgery.

<7>
[Use Link to view the full text]
Accession Number
2013383226
Authors
Sun J. Young N. Liu H. Yao L. Silvestry S. Sun W. Zhao N. Diehl J.
Institution
(Sun, Yao) Department of Anesthesiology, Thomas Jefferson University,
Philadelphia, PA, United States
(Young) Division of Cardiothoracic Surgery, University of California
Davis, Medical Center, Sacramento, CA, United States
(Liu) Department of Anesthesiology and Pain Medicine, University of
California Davis, Medical Center, Sacramento, CA, United States
(Yao) Department of Anesthesiology, Tangdu Hospital, Fourth Military
Medical University, Xian, China
(Silvestry, Diehl) Division of Cardiothoracic Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
(Sun) Jefferson Medical College, Thomas Jefferson University,
Philadelphia, PA, United States
(Zhao) Department of Psychiatry, University of Pennsylvania Health System,
Philadelphia, PA, United States
Title
Reply to letters: "Preoperative aspirin use and outcomes in cardiac
surgery patients: A role of platelet function assessment" and
"preoperative aspirin use in cardiac surgery".
Source
Annals of Surgery. 258 (1) (pp e8-e9), 2013. Date of Publication: July
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)

<8>
Accession Number
2013385081
Authors
Sun Y.-J. Song D.-D. Diao Y.-G. Zhou J. Zhang T.-Z.
Institution
(Sun, Song, Diao, Zhou, Zhang) Department of Anesthesiology, General
Hospital of Shenyang Commend, PLA, Shenyang 110016, China
Title
Penehyclidine hydrochloride preserves the intestinal barrier function in
patients undergoing cardiopulmonary bypass.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (1) (pp 179-185),
2013. Date of Publication: July 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The study objective was to investigate the protective effect of
penehyclidine hydrochloride on intestinal barrier function integrity and
its therapeutic potential on endotoxemia and systemic inflammatory
response in patients undergoing cardiopulmonary bypass. Methods: Forty
patients undergoing cardiac valve replacement with cardiopulmonary bypass
were enrolled in the study. All patients were randomly divided into the
penehyclidine hydrochloride or control group (20 patients in each group).
Patients in the penehyclidine hydrochloride group received an intravenous
injection of 0.05 mg/kg penehyclidine hydrochloride 10 minutes before
cardiopulmonary bypass, and those in the control group were given the same
volume of saline. Blood samples for blood glucose, lactic acid, intestinal
fatty acid binding protein, D-lactate, serum endotoxin
(lipopolysaccharide), interleukin-6, and interleukin-10 measurements were
collected during the following time points: immediately after anesthesia
induction (T₀), 10 minutes after the release of aortic-clamping
(T₁), immediately after weaning from cardiopulmonary bypass
(T₂), 2 hours postoperatively (T₃), 6 hours
postoperatively (T₄), and 18 hours postoperatively
(T₅). Results: Blood glucose, lactic acid, intestinal fatty
acid binding protein, D-lactate, lipopolysaccharide, interleukin-6, and
interleukin-10 were significantly increased at all postoperative time
points. At specific postoperative time points, blood glucose, lactic acid,
intestinal fatty acid binding protein, D-lactate, lipopolysaccharide, and
interleukin-6 were statistically lower in the penehyclidine hydrochloride
group than in the control group. Postoperatively, interleukin-10 did not
differ between the penehyclidine hydrochloride and control groups.
Conclusions: Penehyclidine hydrochloride preserves intestinal barrier
function integrity, attenuates endotoxemia, and inhibits systemic
inflammatory response in patients undergoing cardiopulmonary bypass,
possibly by improving intestinal microcirculation and depressing stress
response. 2013 by The American Association for Thoracic Surgery.

<9>
Accession Number
2013385085
Authors
Maslow A.D. Stafford T.S. Davignon K.R. Ng T.
Institution
(Maslow, Davignon) Department of Anesthesiology, Warren Alpert Medical
School, Brown University, Providence, RI, United States
(Stafford, Ng) Department of Surgery, Warren Alpert Medical School, Brown
University, Providence, RI, United States
Title
A randomized comparison of different ventilator strategies during
thoracotomy for pulmonary resection.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (1) (pp 38-44), 2013.
Date of Publication: July 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Protective lung ventilation is reported to benefit patients
with acute respiratory distress syndrome. It is not known whether
protective lung ventilation is also beneficial to patients undergoing
single-lung ventilation for elective pulmonary resection. Methods: In an
institutional review board-approved prospective randomized trial, 34
patients undergoing elective pulmonary resection requiring single-lung
ventilation were enrolled. Informed consent was obtained. Patients were
randomized to 1 of 2 groups: (1) high tidal volume (Hi-TV) of 10 mL/kg,
rate of 7 breaths/min, and zero positive end-expiratory pressure or (2)
low tidal volume (Lo-TV) of 5 mL/kg, rate of 14 breaths/min, and 5
cmH₂O positive end-expiratory pressure. Ventilator settings
were continued during both double- and single-lung ventilation. Pulmonary
functions, hemodynamics, and postoperative outcomes were recorded.
Results: Patient demographics, operative characteristics, intraoperative
hemodynamics, and postoperative pain and sedation scores were similar
between the 2 groups. During most time periods, airway pressures (peak and
plateau) were significantly higher in the Hi-TV group; however, plateau
pressures remained less than 30 cmH₂O at all times for all
patients. The Hi-TV group had significantly lower arterial carbon dioxide
tension, less arterial carbon dioxide tension-end-tidal carbon dioxide
gradient, lower alveolar dead space ratio, and higher dynamic pulmonary
compliance. There were no differences in postoperative morbidity and
hospital days between the 2 groups, but atelectasis scores on
postoperative days 1 and 2 were lower in the Hi-TV group. Conclusions: The
use of Hi-TV during single-lung ventilation for pulmonary resection
resulted in no increase in morbidity and was associated with less
hypercarbia, less dead space ventilation, better dynamic compliance, and
less postoperative atelectasis. 2013 by The American Association for
Thoracic Surgery.

<10>
Accession Number
2013389656
Authors
Ebade A.A. Khalil M.A. Mohamed A.K.
Institution
(Ebade, Khalil, Mohamed) Department of Anesthesia, Faculty of Medicine,
Cairo University, Cairo, Egypt
(Khalil) Department of Anesthesia, Saad Specialist Hospital, Prince Faisal
Bin Fahad Street, Al-Khobar 31952, Saudi Arabia
Title
Levosimendan is superior to dobutamine as an inodilator in the treatment
of pulmonary hypertension for children undergoing cardiac surgery.
Source
Journal of Anesthesia. 27 (3) (pp 334-339), 2013. Date of Publication:
June 2013.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose: To compare the effectiveness of levosimendan and dobutamine in
reducing pulmonary artery pressure (PAP) and increasing cardiac output for
children undergoing cardiac surgery. Patients and methods: The study
included 50 patients with high systolic pulmonary artery pressure (PAP)
undergoing surgical repair of cardiac septal defects. Patients were
randomly allocated to two equal groups: group L received levosimendan and
group D received dobutamine. PAP was measured preoperatively, by use of
transthoracic echocardiography (baseline), intraoperatively, directly, by
use of a 22-gauge catheter inserted in the pulmonary artery, and
postoperatively, by use of transesophageal echocardiography (TEE). Cardiac
index (CI) was recorded by use of a transesophageal 4-MHz Doppler probe.
Results: Both drugs significantly reduced PAP compared with the level at
the time of induction of anesthesia. Mean PAP measurement before chest
closure, 1 and 20 h after ICU admission were significantly lower for
patients who received levosimendan (32.7 +/- 4.1, 25.8 +/- 2.8, 19.8 +/- 2
mmHg, respectively) than for those who received dobutamine (37.6 +/- 2.75,
32.8 +/- 2.36, 26.5 +/- 2.2 mmHg, respectively). Both drugs significantly
improved CI compared with its level at the time of induction of
anesthesia. Mean CI measurements 5 min after weaning from cardiopulmonary
bypass (CPB) until 20 h after ICU admission were significantly higher for
patients who received levosimendan than for those who received dobutamine
(3.55 +/- 0.35, 3.8 +/- 0.36, 3.81 +/- 0.34, respectively, in group L vs.
3.4 +/- 0.36, 3.6 +/- 0.33, 3.66 +/- 0.29, respectively, in group D).
Conclusion: Levosimendan is better than dobutamine for treatment of
pulmonary hypertension of children undergoing cardiac surgery. 2012
Japanese Society of Anesthesiologists.

<11>
Accession Number
2013385093
Authors
Andropoulos D.B. Brady K. Easley R.B. Dickerson H.A. Voigt R.G.
Shekerdemian L.S. Meador M.R. Eisenman C.A. Hunter J.V. Turcich M. Rivera
C. McKenzie E.D. Heinle J.S. Fraser Jr. C.D.
Institution
(Andropoulos, Brady, Easley, Meador) Department of Anesthesiology, Baylor
College of Medicine, Houston, TX, United States
(Andropoulos, Brady, Easley, Dickerson, Voigt, Shekerdemian, Meador,
Eisenman, Turcich, Rivera, Fraser Jr.) Department of Pediatrics, Baylor
College of Medicine, Houston, TX, United States
(McKenzie, Heinle, Fraser Jr.) Department of Surgery, Baylor College of
Medicine, Houston, TX, United States
(Hunter) Department of Radiology, Baylor College of Medicine, Houston, TX,
United States
(Andropoulos, Brady, Easley, Meador, Eisenman) Division of Pediatric
Cardiovascular Anesthesiology, Texas Children's Hospital, Houston, TX,
United States
(McKenzie, Heinle, Fraser Jr.) Division of Congenital Heart Surgery, Texas
Children's Hospital, Houston, TX, United States
(Dickerson) Division of Pediatric Cardiology, Texas Children's Hospital,
Houston, TX, United States
(Shekerdemian) Division of Pediatric Intensive Care, Texas Children's
Hospital, Houston, TX, United States
(Hunter) Division of Pediatric Neuroradiology, Texas Children's Hospital,
Houston, TX, United States
(Rivera) Division of Pediatric Neurology, Texas Children's Hospital,
Houston, TX, United States
(Voigt, Turcich) Division of Developmental Pediatrics, Texas Children's
Hospital, Houston, TX, United States
Title
Erythropoietin neuroprotection in neonatal cardiac surgery: A phase I/II
safety and efficacy trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (1) (pp 124-131),
2013. Date of Publication: July 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Neonates undergoing complex congenital heart surgery have a
significant incidence of neurologic problems. Erythropoietin has
antiapoptotic, antiexcitatory, and anti-inflammatory properties to prevent
neuronal cell death in animal models, and improves neurodevelopmental
outcomes in full-term neonates with hypoxic ischemic encephalopathy. We
designed a prospective phase I/II trial of erythropoietin neuroprotection
in neonatal cardiac surgery to assess safety and indicate efficacy.
Methods: Neonates undergoing surgery for D-transposition of the great
vessels, hypoplastic left heart syndrome, or aortic arch reconstruction
were randomized to 3 perioperative doses of erythropoietin or placebo.
Neurodevelopmental testing using the Bayley Scales of Infant and Toddler
Development III was performed at age 12 months. Results: Fifty-nine
patients received the study drug. Safety profile, including magnetic
resonance imaging brain injury, clinical events, and death, was not
different between groups. Three patients in each group died. Forty-two
patients (22 in the erythropoietin group and 20 in the placebo group; 79%
of survivors) returned for 12-month follow-up. In the group receiving
erythropoietin, mean Cognitive Scale scores were 101.1 +/- 13.6, Language
Scale scores were 88.5 +/- 12.8, and Motor Scale scores were 89.9 +/-
12.3. In the group receiving placebo, Cognitive Scale scores were 106.3
+/- 10.8 (P =.19), Language Scores were 92.4 +/- 12.4 (P =.33), and Motor
Scale scores were 92.6 +/- 14.1 (P =.51). Conclusions: Safety profile for
erythropoietin administration was not different than placebo.
Neurodevelopmental outcomes were not different between groups; however,
this pilot study was not powered to definitively address this outcome.
Lessons learned suggest optimized study design features for a larger
prospective trial to definitively address the utility of erythropoietin
for neuroprotection in this population. 2013 by The American Association
for Thoracic Surgery.

<12>
Accession Number
2013390328
Authors
Ding X.L. Xie C. Jiang B. Gao J. Zhang L.L. Zhang H. Zhang J.J. Miao L.Y.
Institution
(Ding, Xie, Gao, Zhang, Zhang, Miao) Clinical Pharmacology Research
Laboratory, First Affiliated of Soochow University, Shi-Zi Street, Suzhou
215006, China
(Jiang) Department of Cardiology, First Affiliated of Soochow University,
Suzhou, China
(Zhang) Department of Pharmacy, West China Second University Hospital,
Sichuan University, Chengdu, China
Title
Efficacy and safety of adjunctive cilostazol to dual antiplatelet therapy
after stent implantation: An updated meta-analysis of randomized
controlled trials.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 18 (3) (pp
222-228), 2013. Date of Publication: May 2013.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Background: Aspirin and clopidogrel dual antiplatelet therapy (DAT) reduce
ischemic events in patients with cardiovascular disease. However,
recurrent ischemic event occurrence during DAT remains a major concern.
This systematic review assesses the efficacy and safety of adjunctive
cilostazol to DAT in combination with DAT on reducing clinical adverse
events. Methods: We searched randomized controlled trials (RCTs) in
PubMed, Embase, Cochrane library, clinicaltrial.gov, and Chinese
Biomedical Database through July 2011. Pooled risk ratio (RR) with 95%
confidence intervals (CIs) was calculated. Two independent reviewers
evaluated the included studies. The extracted data were analyzed by Review
Manager 5.1.2 (The Cochrane Collaboration, Oxford, UK) and GRADEprofiler
3.6 (GRADE Working Group). Results: A total of 7 RCTs (4351 patients) were
included in the analysis, with a follow-up period of 6 to 12 months.
Pooled analysis showed that cilostazol was associated with a significant
reduction in major adverse cardiac events (MACEs; pooled RR 0.69, 95% CI
0.52-0.91; P = .008) and repeat revascularization (RR 0.74, 95% CI
0.61-0.89; P = .002); however, cilostazol was not associated with a
reduction in the risk of stent thrombosis (RR 1.00, 95% CI 0.41-2.45; P =
1.00). Cilostazol seems to be safe, with no significant increase in the
risk of bleeding (RR 1.06, 95% CI 0.72-1.56; P = .77). The 4 outcomes were
low-quality evidence for MACE, moderate-quality evidence for repeat
revascularization, and high-quality evidence for bleeding and stent
thrombosis. Conclusions: When compared to the currently recommended DAT,
triple antiplatelet therapy with cilostazol can reduce repeat
revascularization with no increase in the risk of bleeding. 2013 The
Author(s).