Results Generated From:
Embase <1980 to 2013 Week 35>
Embase (updates since 2013-08-23)
<1>
Accession Number
2013519346
Authors
Bara C. Dengler T. Hack M.A. Ladenburger S. Lehmkuhl H.B.
Institution
(Bara) Medizinische Hochschule Hannover, Klinik fur Herz-, Thorax-,
Transplantations- und Gefas chirurgie, Carl-Neuberg-Strase 1, Hannover
30625, Germany
(Dengler) Department of Cardiology, University of Heidelberg, Heidelberg,
Germany
(Hack, Ladenburger) Novartis Pharma GmbH, Nuernberg, Germany
(Lehmkuhl) Deutsches Herzzentrum, Berlin, Germany
Title
A 1-year randomized controlled study of everolimus versus mycophenolate
mofetil with reduced-dose cyclosporine in maintenance heart transplant
recipients.
Source
Transplantation Proceedings. 45 (6) (pp 2387-2392), 2013. Date of
Publication: July-August 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background The aim of this study was to demonstrate noninferiority of
everolimus with reduced cyclosporine (CsA) vs mycophenolate mofetil (MMF)
with reduced CsA in improving renal function. Methods In this 1-year
randomized, open-label, noninferiority study in maintenance heart
transplant recipients with impaired renal function 70 patients received
everolimus (n = 36) or MMF (n = 34) in combination with reduced CsA. The
planned sample size was not reached as the study was prematurely
discontinued due to slow recruitment. Results Noninferiority of the
everolimus regimen could not be shown: In the total population MMF seemed
to be favorable on renal function assessed by serum creatinine and
filtration rates, but not in the subset of patients who reached the
intended reduced CsA level. Incidence rates of rejection episodes were
significantly higher under MMF at month 6 (P =.0332). Conclusions Overall,
the results of this trial using reduced CsA in combination with either
everolimus or MMF show that there is evidence to reduce the CsA level when
everolimus is given concomitantly and that the benefit of MMF with reduced
CsA levels is limited due to insufficient immunosuppression. 2013
Elsevier Inc.
<2>
Accession Number
2013517888
Authors
Curzen N. Gurbel P.A. Myat A. Bhatt D.L. Redwood S.R.
Institution
(Curzen) Wessex Cardiothoracic Unit, University Hospital Southampton, NHS
Foundation Trust, Southampton SO16 6YD, United Kingdom
(Gurbel) Sinai Center for Thrombosis Research, Cardiac Catheterisation
Laboratory, Sinai Hospital of Baltimore, Baltimore, MD, United States
(Myat, Redwood) King's College London, BHF Centre of Research Excellence,
St Thomas' Hospital, London, United Kingdom
(Bhatt) VA Boston Healthcare System, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
Title
What is the optimum adjunctive reperfusion strategy for primary
percutaneous coronary intervention?.
Source
The Lancet. 382 (9892) (pp 633-641), 2013. Date of Publication: 2013.
Publisher
Lancet Publishing Group (Langford Lane, Kidlington, Oxford OX5 1GB, United
Kingdom)
Abstract
Acute ST-segment elevation myocardial infarction (STEMI) is a dynamic,
thrombus-driven event. As understanding of its pathophysiology has
improved, the central role of platelets in initiation and orchestration of
this process has become clear. Key components of STEMI include formation
of occlusive thrombus, mediation and ultimately amplification of the local
vascular inflammatory response resulting in increased vasoreactivity,
oedema formation, and microvascular obstruction. Activation,
degranulation, and aggregation of platelets are the platforms from which
these components develop. Therefore, prompt, potent, and predictable
antithrombotic therapy is needed to optimise clinical outcomes after
primary percutaneous coronary intervention. We review present
pharmacological and mechanical adjunctive therapies for reperfusion and
ask what is the optimum combination when primary percutaneous coronary
intervention is used as the mode of revascularisation in patients with
STEMI.
<3>
Accession Number
2013517886
Authors
Thielmann M. Kottenberg E. Kleinbongard P. Wendt D. Gedik N. Pasa S. Price
V. Tsagakis K. Neuhauser M. Peters J. Jakob H. Heusch G.
Institution
(Thielmann, Wendt, Pasa, Price, Tsagakis, Jakob) Department of Thoracic
and Cardiovascular Surgery, Universitatsklinikum Essen, Essen, Germany
(Kottenberg, Peters) Klinik Fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Essen, Germany
(Kleinbongard, Gedik, Heusch) Institut Fur Pathophysiologie,
Universitatsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany
(Neuhauser) Department of Mathematics and Technology, Koblenz University
of Applied Science, Remagen, Germany
Title
Cardioprotective and prognostic effects of remote ischaemic
preconditioning in patients undergoing coronary artery bypass surgery: A
single-centre randomised, double-blind, controlled trial.
Source
The Lancet. 382 (9892) (pp 597-604), 2013. Date of Publication: 2013.
Publisher
Lancet Publishing Group (Langford Lane, Kidlington, Oxford OX5 1GB, United
Kingdom)
Abstract
Background Remote ischaemic preconditioning has been associated with
reduced risk of myocardial injury after coronary artery bypass graft
(CABG) surgery. We investigated the safety and efficacy of this procedure.
Methods Eligible patients were those scheduled to undergo elective
isolated first-time CABG surgery under cold crystalloid cardioplegia and
cardiopulmonary bypass at the West-German Heart Centre, Essen, Germany,
between April, 2008, and October, 2012. Patients were prospectively
randomised to receive remote ischaemic preconditioning (three cycles of 5
min ischaemia and 5 min reperfusion in the left upper arm after induction
of anaesthesia) or no ischaemic preconditioning (control). The primary
endpoint was myocardial injury, as reflected by the geometric mean area
under the curve (AUC) for perioperative concentrations of cardiac troponin
I (cTnI) in serum in the first 72 h after CABG. Mortality was the main
safety endpoint. Analysis was done in intention-to-treat and per-protocol
populations. This trial is registered with ClinicalTrials.gov, number
NCT01406678. Findings 329 patients were enrolled. Baseline characteristics
and perioperative data did not differ between groups. cTnI AUC was 266
ng/mL over 72 h (95% CI 237-298) in the remote ischaemic preconditioning
group and 321 ng/mL (287-360) in the control group. In the
intention-to-treat population, the ratio of remote ischaemic
preconditioning to control for cTnI AUC was 083 (95% CI 070-097, p=0022).
cTnI release remained lower in the per-protocol analysis (079, 066-094,
p=0001). All-cause mortality was assessed over 154 (SD 122) years and was
lower with remote ischaemic preconditioning than without (ratio 027, 95%
CI 008-098, p=0046). Interpretation Remote ischaemic preconditioning
provided perioperative myocardial protection and improved the prognosis of
patients undergoing elective CABG surgery.
<4>
Accession Number
2013499753
Authors
Sakr S.A. Ramadan M.M. Osama M.
Institution
(Sakr, Ramadan) Department of Cardiology, Mansoura University, Mansoura
City, Egypt
(Osama) National Heart Institute, Ministry of Health, Cairo, Egypt
Title
A novel technique for multi-track percutaneous balloon mitral valvoplasty.
Source
International Heart Journal. 54 (4) (pp 196-201), 2013. Date of
Publication: 2013.
Publisher
International Heart Journal Association (7-3-1 Hongo, Bunkyo-ku, Tokyo
113-8655, Japan)
Abstract
Percutaneous balloon mitral valvoplasty (PBMV) has become the treatment of
choice for severe pliable rheumatic mitral stenosis. The multi-track
system is a recent variation of the double-balloon technique and is easier
owing to the use of a monorail balloon and a simple, single-guidewire
approach. In the present study, we used the double-coil Inoue metal wire
with a multi-track balloon instead of the conventional multi-track wire.
We studied 62 consecutive patients (55 females) with signifcant
symptomatic rheumatic mitral valve stenosis who underwent multi-track
PBMV. Patients were randomized into 2 groups: the frst group included 32
patients treated with the novel multi-track technique using the
double-coil Inoue metal wire, and the second group included 30 patients
treated with the conventional multi-track technique using a balloon
endhole catheter and multi-track 0.035 inch stiff wire. None of the
patients had cardiac tam-ponade, systemic thromboembolism, or any groin
complications. No statistically signifcant differences were found between
the 2 groups regarding any of the studied variables. There were no
in-hospital deaths or complications necessitating emergent cardiac surgery
in either group. In conclusion, this new technique with the double-coil
Inoue metal wire achieves the double beneft of being as safe as (and
indeed easier than) the conventional technique, and it utilizes fewer
materials, making the multi-track system more cost-effective.
<5>
Accession Number
2013517885
Authors
Stone G.W. Witzenbichler B. Weisz G. Rinaldi M.J. Neumann F.-J. Metzger
D.C. Henry T.D. Cox D.A. Duffy P.L. Mazzaferri E. Gurbel P.A. Xu K. Parise
H. Kirtane A.J. Brodie B.R. Mehran R. Stuckey T.D.
Institution
(Stone, Weisz, Xu, Parise, Kirtane) Columbia University Medical Center,
New York-Presbyterian Hospital, Cardiovascular Research Foundation, 111 E
59th Street, New York, NY 10022, United States
(Witzenbichler) Charite Campus Benjamin Franklin, Berlin, Germany
(Rinaldi) Sanger Heart and Vascular Institute, Charlotte, NC, United
States
(Neumann) Universitats-Herzzentrum Freibrug Bad Krozingen, Bad Krozingen,
Germany
(Metzger) Wellmont CVA Heart Institute, Kingsport, TN, United States
(Henry) Minneapolis Heart Institute, Minneapolis, MN, United States
(Cox) Lehigh Valley Health Network, Allentown, PA, United States
(Duffy) FirstHealth Moore Regional Hospital, Pinehurst, NC, United States
(Mazzaferri) Ohio State University, Columbus, OH, United States
(Gurbel) Sinai Hospital of Baltimore, Baltimore, MD, United States
(Brodie, Stuckey) Moses Cone Heart and Vascular Center, Greensboro, NC,
United States
(Mehran) Mount Sinai Medical Center, Cardiovascular Research Foundation,
New York, NY, United States
Title
Platelet reactivity and clinical outcomes after coronary artery
implantation of drug-eluting stents (ADAPT-DES): A prospective multicentre
registry study.
Source
The Lancet. 382 (9892) (pp 614-623), 2013. Date of Publication: 2013.
Publisher
Lancet Publishing Group (Langford Lane, Kidlington, Oxford OX5 1GB, United
Kingdom)
Abstract
Background The relation between platelet reactivity and stent thrombosis,
major bleeding, and other adverse events after coronary artery
implantation of drug-eluting stents has been incompletely characterised.
We aimed to determine the relation between platelet reactivity during dual
therapy with aspirin and clopidogrel and clinical outcomes after
successful coronary drug-eluting stent implantation. Methods ADAPT-DES was
a prospective, multicentre registry of patients successfully treated with
one or more drugeluting stents and given aspirin and clopidogrel at 10-15
US and European hospitals. We assessed platelet reactivity in those
patients after successful percutaneous coronary intervention using
VerifyNow point-of-care assays, and assigned different cutoffs to define
high platelet reactivity. The primary endpoint was definite or probable
stent thrombosis; other endpoints were all-cause mortality, myocardial
infarction, and clinically relevant bleeding. We did a propensity-adjusted
multivariable analysis to determine the relation between platelet
reactivity and subsequent adverse events. This study is registered with
ClinicalTrials.gov, number NCT00638794. Findings Between Jan 7, 2008, and
Sept 16, 2010, 8665 patients were prospectively enrolled at 11 sites, of
which 8583 were eligible. At 1-year follow-up, stent thrombosis had
occurred in 70 (08%) patients, myocardial infarction in 269 (31%),
clinically relevant bleeding in 531 (62%), and death in 161 (19%)
patients. High platelet reactivity on clopidogrel was strongly related to
stent thrombosis (adjusted HR 249 [95% CI 143-431], p=0001) and myocardial
infarction (adjusted HR 142 [109-186], p=001), was inversely related to
bleeding (adjusted HR 073 [061- 089], p=0002), but was not related to
mortality (adjusted HR 120 [085-170], p=030). High platelet reactivity on
aspirin was not significantly associated with stent thrombosis (adjusted
HR 146 [058-364], p=042), myocardial infarction, or death, but was
inversely related to bleeding (adjusted HR 065 [043-099], p=004).
Interpretation The findings from this study emphasise the
counter-balancing effects of haemorrhagic and ischaemic complications
after stent implantation, and suggest that safer drugs or tailored
strategies for the use of more potent agents must be developed if the
benefits of greater platelet inhibition in patients with cardiovascular
disease are to be realised.
<6>
Accession Number
2013505339
Authors
Suezawa T. Aoki A. Kotani M. Tago M. Kobayashi O. Hirasaki A. Sano M.
Kameda N. Mitsunaka H.
Institution
(Suezawa, Aoki, Kotani, Tago) Department of Cardiovascular Surgery, Kagawa
Prefectural Central Hospital, 5-4-16 Ban-cho, Takamatsu, Kagawa 760-8557,
Japan
(Kobayashi, Hirasaki, Sano, Kameda) Department of Anesthesiology, Kagawa
Prefectural Central Hospital, Takamatsu, Kagawa, Japan
(Mitsunaka) Department of Rheumatology, Kagawa Prefectural Central
Hospital, Takamatsu, Kagawa, Japan
Title
Clinical benefits of methylprednisolone in off-pump coronary artery bypass
surgery.
Source
General Thoracic and Cardiovascular Surgery. 61 (8) (pp 455-459), 2013.
Date of Publication: August 2013.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Background: It has not been established whether off-pump coronary artery
bypass grafting (OPCABG) is less invasive than conventional CABG. In our
experience, OPCABG has several advantages such as shorter operative
duration, decreased requirement of blood transfusion and myocardial
protection compared with conventional CABG. However, frequency of
postoperative paroxysmal atrial fibrillation (PAF) is similar between
these techniques and early postoperative C-reactive protein (CRP) levels
have been shown to be significantly higher in OPCABG. We hypothesized that
preoperative steroid administration, routinely used only in conventional
CABG, may alleviate high postoperative PAF and CRP levels. Therefore, a
prospective, double-blind, clinical trial was conducted in OPCABG patients
to investigate the clinical effects of preoperative steroid
administration. Methods: Thirty OPCABG patients were randomly divided into
2 groups: control (Group C: n = 15) and methylprednisolone (Group M: n =
15) groups. Group M patients were intravenously administered 1000 mg
methylprednisolone during anesthesia induction. Results: Hospital death
and infectious complication such as mediastinitis were not observed in
either group. Postoperative PAF occurred in 47 % (7/15) of patients in
group C but in only 1 patient in group M (7 %, P = 0.013). Early
postoperative CRP levels were significantly lower in group M than in group
C (peak values on postoperative day 2: group M 15 +/- 6 mg/dL vs. group C
23 +/- 4 mg/dL; P = 0.0002). Conclusions: Preoperative steroid
administration in OPCABG patients significantly suppresses CRP elevation
and prevents postoperative PAF without increasing in-hospital mortality or
infectious complications. 2013 The Japanese Association for Thoracic
Surgery.
<7>
Accession Number
2013518584
Authors
Gruber-Baldini A.L. Marcantonio E. Orwig D. Magaziner J. Terrin M. Barr E.
Brown J.P. Paris B. Zagorin A. Roffey D.M. Zakriya K. Blute M.-R. Hebel
J.R. Carson J.L.
Institution
(Gruber-Baldini, Orwig, Magaziner, Terrin, Barr, Brown, Hebel) Division of
Gerontology, Department of Epidemiology and Public Health, University of
Maryland School of Medicine, 660 W. Redwood St., Baltimore, MD 21201,
United States
(Marcantonio) Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA, United States
(Paris, Zagorin) Maimonides Medical Center, Brooklyn, NY, United States
(Roffey) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Zakriya) Total Health Care, Baltimore, MD, United States
(Blute) Johns Hopkins Bayview, Baltimore, MD, United States
(Carson) Robert Wood Johnson Medical School, University of Medicine and
Dentistry of New Jersey, New Brunswick, NJ, United States
Title
Delirium outcomes in a randomized trial of blood transfusion thresholds in
hospitalized older adults with hip fracture.
Source
Journal of the American Geriatrics Society. 61 (8) (pp 1286-1295), 2013.
Date of Publication: August 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Objectives To determine whether a higher blood transfusion threshold would
prevent new or worsening delirium symptoms in the hospital after hip
fracture surgery. Design Ancillary study to a randomized clinical trial.
Setting Thirteen hospitals in the United States and Canada. Participants
One hundred thirty-nine individuals hospitalized with hip fracture aged 50
and older (mean age 81.5 +/- 9.1) with cardiovascular disease or risk
factors and hemoglobin concentrations of less than 10 g/dL within 3 days
of surgery recruited in an ancillary study of the Transfusion Trigger
Trial for Functional Outcomes in Cardiovascular Patients Undergoing
Surgical Hip Fracture Repair. Intervention Individuals in the liberal
treatment group received one unit of packed red blood cells and as much
blood as needed to maintain hemoglobin concentrations at greater than 10
g/dL; those in the restrictive treatment group received transfusions if
they developed symptoms of anemia or their hemoglobin fell below 8 g/dL.
Measurements Delirium assessments were performed before randomization and
up to three times after randomization. The primary outcome was severity of
delirium according to the Memorial Delirium Assessment Scale (MDAS). The
secondary outcome was the presence or absence of delirium defined
according to the Confusion Assessment Method (CAM). Results The liberal
group received a median two units of blood and the restrictive group zero
units of blood. Hemoglobin concentration on Day 1 after randomization was
1.4 g/dL higher in the liberal group. Treatment groups did not differ
significantly at any time point or over time on MDAS delirium severity (P
=.28) or CAM delirium presence (P =.83). Conclusion Blood transfusion to
maintain hemoglobin concentrations greater than 10 g/dL alone is unlikely
to influence delirium severity or rate in individuals with hip fracture
after surgery with a hemoglobin concentration less than 10 g/dL. 2013,
The American Geriatrics Society.
<8>
Accession Number
2013518117
Authors
Chacko J. Harling L. Ashrafian H. Athanasiou T.
Institution
(Chacko, Harling, Ashrafian, Athanasiou) Department of Surgery and Cancer,
Imperial College London, St. Mary's Hospital, South Wharf Road, London W2
1NY, United Kingdom
Title
Can statins improve outcomes after isolated cardiac valve surgery? A
systematic literature review.
Source
Clinical Cardiology. 36 (8) (pp 448-455), 2013. Date of Publication:
August 2013.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Background HMG CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase
inhibitors, or statins, have been associated with an improvement in
outcomes after coronary artery surgery for some time; however, their role
in isolated valve surgery (IVS) remains undetermined. Hypothesis The
pleiotropic effects of statins may produce similar beneficial effects on
outcomes after IVS. Methods A systematic review of the literature was
performed investigating the role of statins in bioprosthetic valve
replacement. Results Nine observational studies (7 retrospective, 2
prospective) incorporating a total of 18 154 patients were found
investigating the role of statin therapy in bioprosthetic valve
replacement. Conclusions There is presently insufficient evidence to
recommend routine statin therapy in IVS, unless concomitant
hypercholesterolemia or coronary artery disease is present. A prospective
study clearly defining the dose, type, and duration of therapy is now
required to finally clarify whether statins alone confer a postoperative
benefit in these patients. 2013 Wiley Periodicals, Inc.
<9>
Accession Number
2013514044
Authors
Inoue S. Mori A. Shimizu H. Yoshitake A. Tashiro R. Kabei N. Yozu R.
Institution
(Inoue, Shimizu, Yoshitake, Yozu) Department of Cardiovascular Surgery,
Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo,
1608582, Japan
(Mori, Tashiro, Kabei) Department of Cardiovascular Surgery, Saitama
Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan
Title
Combined use of an epidural cooling catheter and systemic moderate
hypothermia enhances spinal cord protection against ischemic injury in
rabbits.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (3) (pp 696-701),
2013. Date of Publication: September 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Epidural placement of a cooling catheter can protect against
ischemic spinal cord injury. With the use of rabbits, we investigated
whether this epidural cooling technique, when combined with systemic
moderate hypothermia, can protect the spinal cord against ischemic
metabolic stress. Methods: New Zealand white rabbits (n = 28) were
assigned to 1 of 4 different groups. Animals underwent abdominal aortic
occlusion for 30 minutes using a 3F balloon catheter. Group 1 (n = 7)
underwent epidural cooling by the catheter and systemic moderate
hypothermia (35 C) induced with a cooling blanket. Group 2 (n = 7)
underwent epidural cooling under systemic normothermia (38.5 C). Group 3
(n = 7) underwent systemic moderate hypothermia (35 C) without epidural
cooling. Group 4 (n = 7) underwent neither epidural nor blanket cooling as
a negative control. Neurologic status of their hind limbs was graded
according to the modified Tarlov scale at 1, 2, and 7 days after surgery.
Results: During infrarenal aortic ischemia, epidural temperature was
significantly lower in group 1 (18.5 C +/- 0.8 C) than in group 2 (28.6 C
+/- 1.0 C; P =.0001), group 3 (34.2 C +/- 0.06 C; P =.0001), or group 4
(38.5 C +/- 0.2 C; P =.0001). Hind limb function recovery was greater in
group 1 (mean Tarlov score, 4.9 +/- 0.057) than in group 2 (2.6 +/- 0.3; P
=.0028), group 3 (2.1 +/- 0.34; P =.0088), or group 4 (0.0 +/- 0.0; P
=.0003). Conclusions: Epidural cooling catheter combined with systemic
moderate hypothermia produced additive cooling ability and protected the
spinal cord against ischemia in rabbits more effectively than either
intervention alone. 2013 by The American Association for Thoracic
Surgery.
<10>
Accession Number
2013514045
Authors
Song W. Sun J. Su B. Yang R. Dong H. Xiong L.
Institution
(Song, Sun, Su, Dong, Xiong) Department of Anesthesiology, Xijing
Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province,
China
(Song, Yang) Department of Anesthesiology, Shaanxi Province People's
Hospital, Xi'an, Shaanxi Province, China
Title
Ischemic postconditioning protects the spinal cord from
ischemia-reperfusion injury via modulation of redox signaling.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (3) (pp 688-695),
2013. Date of Publication: September 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: It is well known that ischemic postconditioning reduces
ischemic-reperfusion injury, but the underlying mechanism is not fully
understood. The current study investigated the role of reactive oxygen
species-mediated upregulation of endogenous antioxidant enzymes in the
generation of a protective effect induced by ischemic postconditioning
against spinal cord reperfusion injury in the rabbit. Methods: New Zealand
White rabbits were randomly allocated to sham, ischemia-reperfusion, and
postconditioning groups (3 cycles of 30 seconds of reperfusion and 30
seconds of occlusion during the onset of reperfusion). Spinal cord
ischemia was induced by clamping the infrarenal abdominal aorta for 20
minutes in the ischemia-reperfusion and postconditioning groups.
Forty-eight hours after reperfusion, the neurologic status of the lower
limbs was assessed. Blood samples were collected for analysis of serum
neuron-specific enolase levels, and the lumbar spinal cord segments (L5-7)
were harvested for histopathologic and antioxidant enzyme activities and
mRNA analysis with or without administration of
N-2-mercaptopropionylglycine (an effective oxygen free radical scavenger)
given at different reperfusion times. Results: Continuous administration
of N-2-mercaptopropionylglycine for 13 minutes, starting at 10 minutes
before (but not 10 minutes after) the beginning of reperfusion, attenuated
the neuroprotective effect of postconditioning against spinal cord
ischemia and reversed the increase in activity of the antioxidant enzymes
superoxide dismutase and catalase in spinal cord tissue subjected to
ischemic postconditioning. Conclusions: The results indicate that reactive
oxygen species-triggered upregulation of endogenous antioxidant enzyme
activities may be involved in the mechanism of neuroprotection of ischemic
postconditioning. 2013 by The American Association for Thoracic Surgery.
<11>
Accession Number
2013514047
Authors
Checchia P.A. Bronicki R.A. Muenzer J.T. Dixon D. Raithel S. Gandhi S.K.
Huddleston C.B.
Institution
(Checchia) Department of Pediatrics, Texas Children's Hospital, Baylor
College of Medicine, 6621 Fannin, WT6-006, Houston, TX 77030, United
States
(Bronicki, Muenzer, Dixon, Raithel, Gandhi, Huddleston) Departments of
Surgery and Pediatrics, Washington University School of Medicine, St
Louis, MO, United States
Title
Nitric oxide delivery during cardiopulmonary bypass reduces postoperative
morbidity in children - A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (3) (pp 530-536),
2013. Date of Publication: September 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Cardiac surgery requiring cardiopulmonary bypass and
cardioplegic arrest leads to myocardial ischemic and reperfusion injury.
Gaseous nitric oxide has been demonstrated to have a myocardial protective
effect following ischemia-reperfusion. We hypothesized that gaseous nitric
oxide administered during cardiopulmonary bypass would have similar
beneficial effects. Methods: In a prospective, randomized, blinded,
placebo-controlled study, children undergoing repair of tetralogy of
Fallot received either 20 ppm of gaseous nitric oxide or placebo delivered
to the membrane oxygenator during cardiopulmonary bypass. Results: A total
of 16 children were randomized into 2 equal groups once their parents or
guardians had given written informed consent. No differences were found in
age, crossclamp time, cardiopulmonary bypass time, or methemoglobin
between the 2 groups. The group receiving gaseous nitric oxide had a
significantly shortened duration of mechanical ventilation (8.4 +/- 7.6 vs
16.3 +/- 6.5 hours; P <.05) and intensive care unit length of stay (53.8
+/- 19.7 vs 79.4 +/- 37.7 hours; P <.05) compared with the placebo group.
The patients had significantly lower troponin levels at 12, 24, and 48
hours (P <.05) and lower B-type natriuretic peptide levels at 12 and 24
hours (P <.05). A trend was found toward a less positive fluid balance,
with significantly less diuretic usage. The study patients had a greater
mean hemoglobin at 48 hours, despite the absence of differences in chest
tube output, packed red blood cell transfusion, platelet counts or
transfusion requirements, fresh frozen plasma transfusion, or prothrombin
time/partial thromboplastin time in the first 48 hours. Conclusions: The
delivery of gaseous nitric oxide to the cardiopulmonary bypass circuit for
children undergoing cardiac surgery results in myocardial protection,
improved fluid balance, and an improved postoperative intensive care unit
course. 2013 by The American Association for Thoracic Surgery.
<12>
Accession Number
2013513991
Authors
Green P. Cohen D.J. Genereux P. McAndrew T. Arnold S.V. Alu M. Beohar N.
Rihal C.S. Mack M.J. Kapadia S. Dvir D. Maurer M.S. Williams M.R. Kodali
S. Leon M.B. Kirtane A.J.
Institution
(Green, Genereux, McAndrew, Alu, Maurer, Williams, Kodali, Leon, Kirtane)
Department of Medicine, Columbia University Medical Center, NY
Presbyterian Hospital and Cardiovascular Research Foundation, New York,
NY, United States
(Cohen, Arnold) Department of Medicine, Kansas City School of Medicine,
University of Missouri, Kansas City, MO, United States
(Beohar) Department of Medicine, Columbia University Division of
Cardiology at Mount Sinai Medical Center, Miami Beach, FL, United States
(Rihal) Department of Medicine, Mayo Clinic, Rochester, MN, United States
(Mack) Department of Surgery, Medical City Dallas Hospital, Dallas, TX,
United States
(Kapadia) Department of Medicine, Cleveland Clinic Foundation, Cleveland,
OH, United States
(Dvir) Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada
Title
Relation between six-minute walk test performance and outcomes after
transcatheter aortic valve implantation (from the PARTNER Trial).
Source
American Journal of Cardiology. 112 (5) (pp 700-706), 2013. Date of
Publication: 01 Sep 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Functional capacity as assessed by 6-minute walk test distance (6MWTD) has
been shown to predict outcomes in selected cohorts with cardiovascular
disease. To evaluate the association between 6MWTD and outcomes after
transcatheter aortic valve implantation (TAVI) among participants in the
Placement of AoRTic TraNscathetER valve (PARTNER) trial, TAVI recipients
(n = 484) were stratified into 3 groups according to baseline 6MWTD:
unable to walk (n = 218), slow walkers (n = 133), in whom 6MWTD was below
the median (128.5 meters), and fast walkers (n = 133) with 6MWTD >128.5
meters. After TAVI, among fast walkers, follow-up 6MWTD decreased by 44
+/- 148 meters at 12 months (p <0.02 compared with baseline). In contrast,
among slow walkers, 6MWTD improved after TAVI by 58 +/- 126 meters (p
<0.001 compared with baseline). Similarly, among those unable to walk,
6MWTD distance increased by 66 +/- 109 meters (p <0.001 compared with
baseline). There were no differences in 30-day outcomes among 6MWTD
groups. At 2 years, the rate of death from any cause was 42.5% in those
unable to walk, 31.2% in slow walkers, and 28.8% in fast walkers (p =
0.02), driven primarily by differences in noncardiac death. In conclusion,
among high-risk older adults undergoing TAVI, baseline 6MWTD does not
predict procedural outcomes but does predict long-term mortality.
Nonetheless, patients with poor baseline functional status exhibit the
greatest improvement in 6MWTD. Additional work is required to identify
those with poor functional status who stand to benefit the most from TAVI.
2013 Elsevier Inc. All rights reserved.
<13>
Accession Number
2013514003
Authors
Alam M. Virani S.S. Shahzad S.A. Siddiqui S. Siddiqui K.H. Mumtaz S.A.
Kleiman N.S. Coselli J.S. Lakkis N.M. Jneid H.
Institution
(Alam, Virani, Coselli, Lakkis, Jneid) Baylor College of Medicine,
Houston, TX, United States
(Virani, Jneid) Michael E. DeBakey Veterans Affairs Medical Center,
Houston, TX, United States
(Shahzad, Mumtaz) Al-Noor Specialist Hospital, Makkah, Saudi Arabia
(Siddiqui) Michigan State University, East Lansing, MI, United States
(Siddiqui) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
(Kleiman) Methodist DeBakey Heart and Vascular Center, Houston, TX, United
States
(Kleiman) Weill-Cornell Medical College, New York, NY, United States
Title
Comparison by meta-analysis of percutaneous coronary intervention versus
coronary artery bypass grafting in patients with a mean age of >=70 years.
Source
American Journal of Cardiology. 112 (5) (pp 615-622), 2013. Date of
Publication: 01 Sep 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
A paucity of published data evaluating the outcomes of older patients (age
>=70 years) undergoing revascularization for unprotected left main
coronary artery disease is available. We performed aggregate data
meta-analyses of the clinical outcomes (all-cause mortality, nonfatal
myocardial infarction, stroke, repeat revascularization, and major adverse
cardiac and cerebrovascular events at 30 days and 12 and 22 months) in
studies comparing percutaneous coronary intervention (PCI) and coronary
artery bypass grafting (CABG) in patients with a mean age of >=70 years
and unprotected left main coronary artery disease. A comprehensive,
time-unlimited literature search to January 31, 2013 identified 10 studies
with a total of 2,386 patients (PCI, n = 909; CABG, n = 1,477). Summary
odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using
the random-effects model. The patients in the PCI group were more likely
than those in the CABG group to present with acute coronary syndrome
(59.6% vs 44.8%, p <0.001). PCI was associated with a shorter hospital
stay (4.2 +/- 0.8 vs 8.3 +/- 0.01 days, p <0.001). No significant
differences were found between PCI and CABG for all cause-mortality,
nonfatal myocardial infarction, and major adverse cardiac and
cerebrovascular events at 30 days and 12 and 22 months. However, PCI was
associated with lower rates of stroke at 30 days (OR 0.14, 95% CI 0.02 to
0.76) and 12 months (OR 0.14, 95% CI 0.03 to 0.60) and higher rates of
repeat revascularization at 22 months (OR 4.34, 95% CI 2.69 to 7.01).
These findings were consistent with the findings from a subgroup analysis
of patients aged >=75 years. In conclusion, older patients (age >=70
years) with unprotected left main coronary artery disease had comparable
rates of all-cause mortality, nonfatal myocardial infarction, and major
adverse cardiac and cerebrovascular events after PCI or CABG. The patients
undergoing PCI had a shorter hospital stay and lower rates of early
stroke; however, they experienced higher repeat revascularization rates at
longer term follow-up. 2013 Elsevier Inc. All rights reserved.
<14>
Accession Number
2013506449
Authors
Zielinska D. Bellwon J. Rynkiewicz A. Elkady M.A.
Institution
(Zielinska) Clinic of Rehabilitation, Medical University of Gdansk, ul.
Debinki 7, 80-952 Gdansk, Poland
(Bellwon, Rynkiewicz) Department of Cardiology, Medical University of
Gdansk, Poland
(Elkady) Department of Physical Medicine and Rehabilitation, Ain Shams
University, Cairo, Egypt
Title
Prognostic value of the six-minute walk test in heart failure patients
undergoing cardiac surgery: A literature review.
Source
Rehabilitation Research and Practice. 2013 , 2013. Article Number:
965494. Date of Publication: 2013.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. The prognostic value of cardiopulmonary exercise testing
(CPET) is known, but the predictive value of 6MWT in patients with heart
failure (HF) and patients undergoing coronary artery bypass grafting
(CABG) is not established yet. Objective. We conducted a systematic review
exploring the prognostic value of 6MWT in HF patients undergoing cardiac
surgery. The aim was to find out whether the change in the distance walked
during follow-up visits was associated with prognosis. Data Source. We
searched "PubMed" from January 1990 to December 2012 for any review
articles or experimental studies investigating the prognostic value of
6MWT in HF patients and patients undergoing cardiac surgery. Results. 53
studies were included in the review, and they explored the role of 6MWT in
cardiology, cardiac surgery, and rehabilitation. The results did not show
the relation between the six-minute walk distance and adverse events after
CABG. The predictive power of the distance walked for death in HF patients
undergoing cardiac surgery was not found. It is not yet proved if the
change in the six-minute walk distance is associated with prognosis. The
predictive power of the six-minute walk distance for death in HF patients
undergoing cardiac surgery remains unclear. 2013 Dominika Zielinska et
al.
<15>
Accession Number
2013507347
Authors
Indes J.E. Pfaff M.J. Farrokhyar F. Brown H. Hashim P. Cheung K. Sosa J.A.
Institution
(Indes, Pfaff, Brown, Hashim, Sosa) Department of Surgery, Yale University
School of Medicine, 333 Cedar St, BB-204, New Haven, CT 06510, United
States
(Farrokhyar, Cheung) Department of Surgery, Canada
(Farrokhyar) Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, ON, Canada
Title
Clinical outcomes of 5358 patients undergoing direct open bypass or
endovascular treatment for aortoiliac occlusive disease: A systematic
review and meta-analysis.
Source
Journal of Endovascular Therapy. 20 (4) (pp 443-455), 2013. Date of
Publication: August 2013.
Publisher
Allen Press Publishing Services (810 E, 10th Street, Lawrence KS 66044,
United States)
Abstract
Purpose: To examine clinical outcomes of endovascular and open bypass
treatment for aortoiliac occlusive disease (AIOD). Methods: Multiple
databases were systematically searched to identify studies on open and
endovascular treatment for AIOD published from 1989 to 2010. Studies were
independently reviewed for eligibility criteria. Study selection and
assessment of methodological quality were performed by two independent
reviewers. Assuming between-study heterogeneity due to biases inherent to
observational studies, a random effects model (DerSimonian-Laird method)
was used for calculation of weighted proportions. Pooled weighted
proportions or weighted means are reported. Twenty-nine open bypass
studies (3733 patients) and 28 endovascular treatment studies (1625
patients) were analyzed. Results: Weighted mean patient age was 60.4 years
for open bypass and 60.8 years for endovascular treatment. Poor
preoperative runoff was greater in the open bypass group (50.0% vs. 24.6%,
p<0.001). Mean length of hospital stay (LOS) was 13 days for open bypass
vs. 4 days for endovascular treatment procedures (p<0.001). The open
bypass group experienced more complications (18.0% vs. 13.4%, p<0.001) and
greater 30-day mortality (2.6% vs. 0.7%, p<0.001). At 1, 3, and 5 years,
pooled primary patency rates were greater in the open bypass group vs. the
endovascular cohort (94.8% vs. 86.0%, 86.0% vs. 80.0%, 82.7% vs. 71.4%,
respectively; all p<0.001); the same was true for secondary patency [95.7%
vs. 90.0% (p=0.002), 91.5 vs. 86.5% (p<0.001), and 91.0% vs. 82.5%
(p<0.001), respectively]. Conclusion: Although this study was limited by a
paucity of randomized control trials, these results demonstrate superior
durability for open bypass, although with longer LOS and increased risk
for complications and mortality, when compared to the endovascular
approach. 2013 by the International Society of Endovascular Specialists.
<16>
Accession Number
2013489056
Authors
Palmerini T. Biondi-Zoccai G. Della Riva D. Mariani A. Sabate M.
Valgimigli M. Frati G. Kedhi E. Smits P.C. Kaiser C. Genereux P. Galatius
S. Kirtane A.J. Stone G.W.
Institution
(Palmerini, Della Riva, Mariani) Dipartimento Cardiovascolare, Policlinico
Sant' Orsola, Bologna, Italy
(Biondi-Zoccai, Frati) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Sabate) Hospital Clinic, Barcelona, Spain
(Valgimigli) Institute of Cardiology, University of Ferrara, Ferrara,
Italy
(Kedhi, Smits) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Kaiser) University Hospital Basel, Basel, Switzerland
(Genereux, Kirtane, Stone) Columbia University Medical Center, New
York-Presbyterian Hospital, Cardiovascular Research Foundation, 111 East
59th Street, New York, NY 10022, United States
(Galatius) Department of Cardiology, Gentofte University Hospital,
Copenhagen, Denmark
Title
Clinical outcomes with drug-eluting and bare-metal stents in patients with
ST-segment elevation myocardial infarction: Evidence from a comprehensive
network meta-analysis.
Source
Journal of the American College of Cardiology. 62 (6) (pp 496-504), 2013.
Date of Publication: 06 Aug 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives The authors investigated the relative safety and efficacy of
different drug-eluting stents (DES) and bare metal stents (BMS) in
patients with ST-segment elevation myocardial infarction (STEMI) using a
network meta-analysis. Background The relative safety of DES and BMS in
patients with STEMI continues to be debated, and whether advances have
been made in this regard with second-generation DES is unknown. Methods
Randomized controlled trials comparing currently U.S. approved DES or DES
with BMS in patients with STEMI were searched using MEDLINE, EMBASE, and
Cochrane databases. Information on study design, inclusion and exclusion
criteria, sample characteristics, and clinical outcomes was extracted.
Results Twenty-two trials including 12,453 randomized patients were
analyzed. At 1-year follow-up, cobalt-chromium everolimus eluting stents
(CoCr-EES) were associated with significantly lower rates of cardiac death
or myocardial infarction (MI) and stent thrombosis (ST) than BMS.
Differences in ST were apparent as early as 30 days and were maintained
for 2 years. CoCr-EES were also associated with significantly lower rates
of 1-year ST than paclitaxel-eluting stents (PES). Sirolimus-eluting
stents (SES) were also associated with significantly lower rates of 1-year
cardiac death/myocardial infarction than BMS. CoCr-EES, PES, and SES, but
not zotarolimus-eluting stents, had significantly lower rates of 1-year
target vessel revascularization (TVR) than BMS, with SES also showing
lower rates of TVR than PES. Conclusions In patients with STEMI, steady
improvements in outcomes have been realized with the evolution from BMS to
first-generation and now second-generation DES, with the most favorable
safety and efficacy profile thus far demonstrated with CoCr-EES. 2013 by
the American College of Cardiology Foundation.
<17>
Accession Number
71144934
Authors
Rolig J. Bauer A. Schubel J. Ulrich C. Hausmann H.
Institution
(Rolig, Schubel, Hausmann) Herzzentrum Coswig, Herzchirurgie, Coswig,
Germany
(Bauer, Ulrich) Herzzentrum Coswig, Kardiotechnik, Coswig, Germany
Title
Minimal extracorporeal circulation improves outcome in diabetic patients
undergoing elective coronary bypass grafting-a prospective randomized
study.
Source
Thoracic and Cardiovascular Surgeon. Conference: 42nd Annual Meeting of
the German Society for Cardiovascular and Thoracic Surgery Freiburg
Germany. Conference Start: 20130217 Conference End: 20130220. Conference
Publication: (var.pagings). 61 , 2013. Date of Publication: January 2013.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Cardiopulmonary bypass (CPB) is known to cause part of the
systemic inflammatory reaction after cardiac surgery that can be
responsible for acute kidney injury (AKI). Miniaturized extracorporeal
circulation (MECC) attempts to reduce the adverse effects of conventional
extracorporeal circulation bypass. Finally, AKI after CPB is a significant
clinical problem that increasingly complicates the course of
hospitalization and clinical outcome. Methods: We performed a prospective
randomized controlled trial to evaluate the influence of the kidney
function during and after coronary bypass grafting. All patients
undergoing elective isolated CPB between February 2010 and April 2012 (104
patients) were prospectively enrolled and divided into two groups. The
blood samples were collected at baseline and at frequent intervals after
CPB (on arrival at ICU and in the end 1h, 4h, 24h, 48h and 72h after
operation). The early diagnosis of acute kidney injury (AKI) currently
depends on detection of reduced kidney function by the rise in serum
creatinine concentration, also Urea and cystatin C, NGAL levels in plasma
and finally in urine Albumin and alpha1-Microglobulin. Results: Use of
MECC was associated with a significant decrease in AKI measured with NGAL
levels in plasma at time on arrival at ICU, 1h and 4h after CPB (p =
0.0001). Miniaturized extracorporeal circulation also significantly reduce
levels of cystatin C on arrival at ICU (p = 0.004) and in serum creatinine
to the same time. No significant difference in hospital stay or time on
ICU was identified, as well complications after surgery. One death
occurred during this time (0.96%). Three patients received dialysis
support prior to CABG (2.88%). Conclusion: Miniaturized extracorporeal
circulation is not associated with increased complications after cardiac
surgery. Use of MECC in surgery resulted in improved renal function as
reflected by reduced NGAL levels compared with conventional extracorporeal
circulation. The profit for the kidney function seems to exist in patients
with diabetes in heart surgery.
<18>
Accession Number
71145484
Authors
Borgermann J. Gummert J.F. Kuss O.
Institution
(Borgermann, Gummert) Herz- und Diabeteszentrum NRW, Universitatsklinikum
der Ruhr-Universitat Bochum, Klinik fur Thorax- und
Kardiovaskularchirurgie, Bad Oeynhausen, Germany
(Kuss) Martin-Luther Universitat Halle-Wittenberg, Institute of Medical
Epidemiology, Biostatistics and Informatics, Faculty, Halle (Saale),
Germany
Title
Patients with lower ejection fraction benefit from off-pump coronary
artery bypass grafting: Evidence from an ecologic analysis of 9,906
patients from randomized trials.
Source
Thoracic and Cardiovascular Surgeon. Conference: 41st Annual Meeting of
the German Society for Cardiovascular and Thoracic Surgery: One Heart -
One Team Freiburg Germany. Conference Start: 20120212 Conference End:
20120215. Conference Publication: (var.pagings). 60 , 2012. Date of
Publication: February 2012.
Publisher
Georg Thieme Verlag
Abstract
Objective: It is commonly believed that especially higher-risk patients
benefit from off-pump coronary artery bypass grafting. However, analyses
from several registries give different results. A common shortcoming of
all those analyses is the fact that they concentrate on evidence from
nonrandomized trials. Methods: In an ecologic analysis, we included all
randomized trials comparing the on- and off-pump techniques until January
2011. By logistic regression, we investigated whether the effect of
off-pump surgery on mortality, myocardial infarction, stroke, and atrial
fibrillation is modified across the range of the 3 risk factors: age,
proportion of women, and ejection fraction. Results: Eighty-six studies
with a total population of 9,906 patients reported on at least 1 risk
factor and 1 outcome. We found a superiority of the off-pump technique in
patients with lower ejection fraction values for the outcomes mortality
and atrial fibrillation. No effect modification was seen for the risk
factors age and proportion of women. Conclusions: Our ecologic analysis
found a superiority of the off-pump technique in patients with lower
ejection fraction values, especially for the most valid outcome of
mortality. As every ecologic analysis is prone to ecologic bias, a
definite answer on the benefit of the off-pump technique in higher-risk
patients can only be given by meta-analyses using individual patient data.
<19>
Accession Number
71145410
Authors
Kaczmarek I. Zaruba M.M. Bigdeli A.K. Sadoni S. Schramm R. Uberfuhr P.
Reichart B. Meiser B.
Institution
(Kaczmarek, Bigdeli, Sadoni, Schramm, Uberfuhr, Reichart) Klinikum
Grosshadern, LMU Munchen, Herzchirurgische Klinik, Munchen, Germany
(Zaruba) Klinikum Grosshadern, LMU Munchen, Medizinische Klinik 1,
Munchen, Germany
(Meiser) Klinikum Grosshadern, LMU Munchen, Transplantationszentrum,
Munchen, Germany
Title
Prospective randomized 3-arm trial comparing tacrolimus with mycophenolate
mofetil (MMF) or sirolimus with calcineurininhibitor-free
immunosuppression (Sirolimus/MMF) after heart transplantation: 5-year
results.
Source
Thoracic and Cardiovascular Surgeon. Conference: 41st Annual Meeting of
the German Society for Cardiovascular and Thoracic Surgery: One Heart -
One Team Freiburg Germany. Conference Start: 20120212 Conference End:
20120215. Conference Publication: (var.pagings). 60 , 2012. Date of
Publication: February 2012.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Despite improvements in immunosuppressive therapy the most
advantageous combination for cardiac transplant recipients has not yet
been established. Therefore, we performed a randomized controlled trial to
evaluate the efficacy and safety of three immunosuppressive protocols.
Methods: Between April 2003 and October 2005, 78 de novo cardiac
transplant recipients were randomized on a 2:2:1 basis to receive steroids
and either tacrolimus (TAC) with mycophenolate mofetil (MMF) (n=32), TAC
with sirolimus (SRL) (n=31), or SRL with MMF (n=15). Antilymphocyte
induction therapy was only given in the SRL/MMF group. Steroids were
withdrawn after 6 months. All patients received statins. Results: We
performed an intention to treat analysis. Cumulative survival at 5 years
was: 86.1% (TAC/MMF), 93.1% (TAC/SRL) and 86.7% (SRL/MMF) (p=ns). Freedom
from biopsy proven rejection or hemodynamic compromise rejection requiring
treatment at 5 years was 82.4% (TAC/MMF), 85.2% (TAC/SRL) and 73.3%
(SRL/MMF) (p=ns). Freedom from cardiac allograft vasculopathy (CAV) was:
TAC/MMF 72.2%, TAC/SRL 80.8%, and SRL/MMF 93.3%, revealing superior
CAV-prevention for SRL/MMF (p=0.01) and TAC/SRL (p=0.02) when compared to
TAC/MMF treatment. Freedom from CMV-infection was: TAC/MMF 72.2%, TAC/SRL
89.7%, and SRL/MMF 86.7%. There was a superiority for freedom from
CMV-infection for SRL/MMF (p=0.01) and TAC/SRL (p=0.01) when compared to
TAC/MMF. Mean serum creatinine at 5 years was TAC/MMF 1.44+/-0.5mg/dL,
TAC/SRL 1.65+/-0.9mg/dL and SRL/MMF 1.25+/-0.3mg/dL, revealing a trend
towards superior renal function for SRL/MMF. Total cholesterol at 5 years
was TAC/MMF 167+/-42mg/dL, TAC/SRL 179+/-34mg/dL, and SRL/MMF
183+/-33mg/dL, triglyceride levels at 5 years were TAC/MMF 160+/-112mg/dL,
TAC/SRL 146+/-98mg/dL, and SRL/MMF 161+/-90mg/dL (p=ns). In the SRL/MMF
group 10 patients temporarily discontinued SRL treatment because of
adverse events (gastrointestinal, pericardial effusions, wound healing) or
rejection episodes. Conclusions: Both tacrolimus groups proved to be
efficacious for the prevention of acute rejection. The side effect profile
for the SRL/MMF group is inferior to the TAC groups resulting in a high
discontinuation rate. Both sirolimus groups revealed a lower incidence of
CMV infections and cardiac allograft vasculopathy in the long-term
analysis.
<20>
Accession Number
71145382
Authors
Stange S. Liakopoulos O.J. Kuhn E.W. Deppe A.C. Choi Y.H. Slottosch I.
Wahlers T.
Institution
(Stange, Liakopoulos, Kuhn, Deppe, Choi, Slottosch, Wahlers) Universitat
zu Koln, Koln, Germany
Title
Statin use and clinical outcomes after cardiac surgery: A meta-analysis of
over 90.000 patients.
Source
Thoracic and Cardiovascular Surgeon. Conference: 41st Annual Meeting of
the German Society for Cardiovascular and Thoracic Surgery: One Heart -
One Team Freiburg Germany. Conference Start: 20120212 Conference End:
20120215. Conference Publication: (var.pagings). 60 , 2012. Date of
Publication: February 2012.
Publisher
Georg Thieme Verlag
Abstract
Objective: Preoperative statin therapy reduces adverse postoperative
outcomes in patients undergoing non-cardiac surgery through
lipid-independent actions, but data from large RCT cardiac surgery trials
is lacking. We sought to determine the strength of evidence for
preoperative statin use on adverse postoperative outcomes in cardiac
surgery patients. Methods: A meta-analysis of randomized (RCT) and
observational trials reporting the effects of preoperative statin therapy
on major clinical outcomes after cardiac surgery was performed. Analyzed
outcomes included early all-cause mortality, myocardial infarction, atrial
fibrillation, stroke and renal failure. Odds ratio (OR) with 95%
confidence intervals (95% CI) were reported using fixed or random effect
models and publication bias was assessed. Results: After literature search
in major databases, 2371 studies were retrieved and screened, and 54
studies identified (12 RCT, 42 observational) that reported outcomes of
91.491 cardiac surgery patients with (n=46614; 51%) or without (n=44877;
49%) preoperative statin therapy. Statin use resulted in a 0.9% absolute
risk (2.6% vs. 3.5%) and odds reduction for early all-cause mortality (OR
0.69; 95% CI 0.59-0.81; p<0.0001). A significant reduction (p<0.01) in
statin pretreated patients was also observed for atrial fibrillation (OR
0.69; 95% CI 0.59-0.80), new onset atrial fibrillation (OR 0.68; 95% CI
0.54-0.85), stroke (OR 0.83; 95% CI 0.74-093), but not for myocardial
infarction (OR 1.05; 95% CI 0.91-1.21) or renal failure (OR 1.03; 95% CI
0.89-1.19). Conclusion: Our meta-analysis provides evidence that
preoperative statin therapy exerts substantial clinical benefit on early
postoperative adverse outcomes in cardiac surgery patients and underlines
the need for large RCT trials.
<21>
Accession Number
71145381
Authors
Deppe A.C. Liakopoulos O.J. Slottosch I. Kuhn E.W. Stange S. Choi Y.H.
Wahlers T.
Institution
(Deppe, Liakopoulos, Slottosch, Kuhn, Stange, Choi, Wahlers) University
Hospital of Cologne, Department of Cardiotoracic Surgery, Cologne, Germany
Title
Endoscopic vein harvesting improves leg wound related morbidity and might
impair graft patency: A systematic literature review with meta-analysis.
Source
Thoracic and Cardiovascular Surgeon. Conference: 41st Annual Meeting of
the German Society for Cardiovascular and Thoracic Surgery: One Heart -
One Team Freiburg Germany. Conference Start: 20120212 Conference End:
20120215. Conference Publication: (var.pagings). 60 , 2012. Date of
Publication: February 2012.
Publisher
Georg Thieme Verlag
Abstract
Objective: Recent reports seriously question the value of endoscopic vein
harvesting techniques for coronary bypass grafts. Therefore, we determined
the current strength of evidence for or against (EVH) in patients
undergoing coronary artery bypass grafting (CABG). Methods: A
meta-analysis of randomized (RCT) and observational trials was performed
that reported the impact of EVH on adverse clinical outcomes after CABG.
Analyzed postoperative outcomes included wound infection, postoperative
pain, myocardial infarction, graft failure, length of hospital stay and
mortality. Pooled treatment effects (odds ratio (OR) or weighted mean
difference (WMD), 95% confidence intervals (95% CI)) were assessed using a
fixed or random effects model. Results: A total of 27.789 patients from 44
studies (17 RCT, 27 observational) were identified that underwent
saphenectomy via endoscopic (46%; n=12.822) or conventional technique
(54%; n=14.967). Pooled effect estimates revealed a reduced incidence
(p<0.01) for wound infections (OR 0.27, 95% CI 0.22 to 0.32), pain (WMD
-1.26, 95% CI -2.07 to -0.44) and length of hospital stay (WMD -0.6 days,
95% CI -1.08 to -0.12). Bypass graft failure was reported in 27.1% with
EVH and 20.4% after conventional vein harvesting, resulting in a 6.7%
absolute risk reduction for graft failure (OR 1.41, 95% CI 1.05 to 1.90,
p=0.02). In contrast, clinical endpoints including mortality, myocardial
infarction or repeat revascularization were not different between analyzed
harvesting techniques. Conclusion: The present meta-analysis provides
evidence that compared to conventional harvesting techniques, EVH reduces
leg wound infection, pain and results in reduced length of hospital stay,
but increases early graft failure after CABG.
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