Results Generated From:
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Embase (updates since 2013-08-29)
<1>
Accession Number
2013533816
Authors
Kang S. Liu Y. Liu X.-B.
Institution
(Kang, Liu) Department of Cardiology, Shanghai East hospital, Tongji
University, Shanghai, China
(Liu) Department of Cardiac Surgery, Shanghai East hospital, Tongji
University, Shanghai, China
Title
Effects of aggressive statin therapy on patients with coronary saphenous
vein bypass grafts: A systematic review and meta-analysis of randomized,
controlled trials.
Source
Clinical Therapeutics. 35 (8) (pp 1125-1136), 2013. Date of Publication:
August 2013.
Publisher
Excerpta Medica Inc. (105 Raider Blvd, Suite 101, Hillsborough NJ 08844,
United States)
Abstract
The aim of this study was to investigate the effectiveness and safety of
aggressive statin versus moderate statin therapy on patients with
saphenous vein grafts (SVGs) in randomized, controlled trials (RCTs).
Methods: We searched MEDLINE (1980-June 2012), the Cochrane Controlled
Trials Register, EMBASE, Science Citation Index, and PubMed (to June
2012), and found 10 relevant RCTs, including 7 substudy analyses from a
Post-CABG trial, and 1 pooled analysis of the PROVE-IT TIMI 22 trial
(Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis
in Myocardial Infarction 22 Investigators) and A to Z trial. Early
intensive vs a delayed conservative simvastatin strategy in patients with
acute coronary syndromes; phase Z of the A to Z trial. Results: A total of
6645 of participants, ages ranging from 21 to 75 years old, were treated
with coronary artery bypass graft (CABG) and were followed for 2 to 5
years. Eight studies showed that aggressive statin therapy had lower LDL-C
levels and a decrease of 39% in graft atherosclerotic progression, 12% in
new occlusions, and 19% in new lesions more than moderate statin therapy.
Three reports indicated that aggressive statin therapy lowered the risk of
repeated myocardial infarction more than moderate statin therapy for
coronary revascularization (95% CI, 0.66-0.95; risk ratio [RR] = 0.80; and
95% CI, 0.66-0.85; RR = 0.75) and lowered the risk of cardiac death as
well (95% CI, 0.64-1.08; RR = 0.83). Aggressive statin therapy had safety
similar to that of moderate statin therapy except for a slight increase in
myopathic events and aminotransferase levels. Seventy percent to 90% of
patients took statin treatment as prescribed in long-term. Conclusions:
Compared with moderate statin therapy, long-term aggressive statin lowered
the LDL-C level significantly, further decreased the atherosclerotic
progression of SVG, reduced the risks of repeated myocardial infarction
and coronary revascularization after CABG, and revealed similar patient
compliance and statin-related adverse effects but slightly increased
myopathy events and aminotransferase levels. 2013.
<2>
Accession Number
2013533815
Authors
Athanasakis K. Petrakis I. Vitsou E. Pimenidou A. Kyriopoulos J.
Institution
(Athanasakis, Petrakis, Kyriopoulos) Department of Health Economics,
National School of Public Health, Athens, Greece
(Vitsou, Pimenidou) Pfizer Hellas, Athens, Greece
Title
A Cost-Effectiveness Analysis of Parecoxib in the Management of
Postoperative Pain in the Greek Health Care Setting.
Source
Clinical Therapeutics. 35 (8) (pp 1118-1124), 2013. Date of Publication:
August 2013.
Publisher
Excerpta Medica Inc. (105 Raider Blvd, Suite 101, Hillsborough NJ 08844,
United States)
Abstract
Postoperative pain management represents a significant factor of morbidity
and reduced quality of life for patients, as well as a situation that
substantially increases perioperative costs. Available analgesia
treatments improve patient outcomes and reduce resource use associated
with pain management, although with varying costs and adverse effects.
Objectives: The aim of this analysis was to assess the costs and patient
outcomes of parecoxib used in combination with opioids versus use of
opioids alone (monotherapy) in the postoperative treatment of surgical
patients in Greece. Methods: A model comparing parecoxib plus opioid
treatment versus opioids alone was developed that simulated the first 3
days postsurgery. Clinical efficacy was based on a Phase III, randomized,
double-blind, clinical trial that also provided the frequencies of the
occurrence of clinically meaningful events (CMEs) related to opioid use
for both treatment arms. Resource use associated with each CME was
elicited via strictly structured questionnaire-based interviews conducted
by a panel of experts (surgeons and anesthesiologists), and costs were
determined from the perspective of Social Insurance in Greece (2012
euros). Treatment effectiveness was calculated in summed pain intensity
scores. A series of 1-way sensitivity analyses were conducted to check the
robustness of the outcomes. Results: Patients treated with parecoxib plus
opioids had lower summed pain intensity scores (59.20 vs 80.80) and fewer
CMEs (0.62 vs 1.04 per patient) compared with opioids alone for a 3-day
period. This outcome led to a full offset of the excess cost of the
addition of parecoxib and led to potential savings of 858 per patient
compared with opioid use alone. Savings were mainly attributable to
decreased CMEs due to reduced intensive care unit and general ward
bed-days as well as to reduced physician and nurse time. Results were
sensitive with regard to probabilities of occurrence or co-occurrence of
CMEs (>=2 CMEs occurring simultaneously), although only to a small extent.
Medication costs had a minimal impact on the results of the sensitivity
analysis. Conclusions: Parecoxib may be a useful addition to opioid
treatment by improving postoperative analgesic management, reducing
opioid-related adverse events, and lowering per-patient treatment costs.
2013 Elsevier HS Journals, Inc.
<3>
Accession Number
2013533076
Authors
Silvestri L. Van Saene H.K.F. Parodi P.C.
Institution
(Silvestri) Department of Emergency, Unit of Anesthesia and Intensive
Care, Via Fatebenefratelli 34, 34170 Gorizia, Italy
(Van Saene) Institute of Ageing and Chronic Disease, University of
Liverpool, United Kingdom
(Parodi) Plastic and Reconstructive Surgery, University of Udine, Gemona
del Friuli, Italy
Title
Decolonization strategies to control aerobic gram-negative bacillary
infections in breast implant surgery.
Source
Surgical Infections. 14 (4) (pp 424-425), 2013. Date of Publication: 01
Aug 2013.
Publisher
Mary Ann Liebert Inc. (140 Huguenot Street, New Rochelle NY 10801-5215,
United States)
<4>
Accession Number
2013532879
Authors
Hofmann B. Bushnaq H. Kraus F.B. Raspe C. Simm A. Silber R.E. Ludwig-Kraus
B.
Institution
(Hofmann, Bushnaq, Simm, Silber) Department of Cardiothoracic Surgery,
Martin-Luther-University, University Hospital Halle, Ernst-Grube-Strase
40, 06120 Halle (Saale), Germany
(Kraus) Department of Biology, Martin-Luther-University, Halle, Germany
(Raspe) Department of Anesthesiology and Operative Intensive Care
Medicine, Martin-Luther-University, Halle, Germany
(Ludwig-Kraus) Department of Laboratory Medicine,
Martin-Luther-University, Halle, Germany
Title
Immediate effects of individualized heparin and protamine management on
hemostatic activation and platelet function in adult patients undergoing
cardiac surgery with tranexamic acid antifibrinolytic therapy.
Source
Perfusion (United Kingdom). 28 (5) (pp 412-418), 2013. Date of
Publication: September 2013.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Objective: This randomized prospective study was initiated to clarify
whether individualized heparin and protamine dosing has immediate effects
on hemostatic activation and platelet function in adult cardiac surgery.
Methods: Sixty adults undergoing elective coronary artery bypass grafting
(CABG) were assigned to receive individualized heparin and protamine (HMS
group, n= 29) or a standard dose (ACT group, n=24). Measures of thrombin
generation and Multiplate (Verum Diagnostica, Munich, Germany) platelet
function tests were performed before and after cardiopulmonary bypass
(CPB). Results: HMS patients received higher heparin (p = 0.006) and lower
protamine (p<0.001) doses. Post-CPB, HMS managed patients showed
significantly lower thrombin generation (thrombin-antithrombin (TAT)
p<0.02) than the ACT group. Moreover, HMS managed patients had a better
preservation of platelet function (COL p = 0.013; ADP p = 0.04; TRAP p =
0.04). Conclusion: An individualized and stable heparin concentration and
appropriate dosing of protamine can reduce thrombin generation and
preserve platelet function, even in short-time CPB. 2013 The Author(s).
<5>
Accession Number
2013532045
Authors
Kefer J. Gapira J.-M. Pierard S. De Meester C. Gurne O. Chenu P. Renkin J.
Institution
(Kefer, Gapira, Pierard, De Meester, Gurne, Chenu, Renkin) Cliniques
Universitaires Saint-Luc, Universite Catholique de Louvain, Division of
Cardiology, Avenue Hippocrate 10, 1200 Brussels, Belgium
Title
Recovery after balloon aortic valvuloplasty in patients with aortic
stenosis and impaired left ventricular function: Predictors and prognostic
implications.
Source
Journal of Invasive Cardiology. 25 (5) (pp 235-241), 2013. Date of
Publication: May 2013.
Publisher
HMP Communications (83 General Warren Blvd. Suite 100, Malven PA 19355,
United States)
Abstract
AIMS: The aim of this study was to evaluate predictors of recovery after
balloon aortic valvuloplasty (BAV) among patients with aortic stenosis and
depressed left ventricular ejection fraction (LVEF). Predictors for
recovery after BAV are not clearly defined. B-type natriuretic peptide
(BNP) predicts outcome after surgical and transcatheter aortic valve
replacement. Methods AND Results: Among 151 consecutive patients treated
in our institution by BAV, a total of 59 with poor LVEF underwent an
echocardiography at 1 month. In these 59 patients, LVEF significantly
improved in 22 patients (group 1) from 27 +/- 5% to 45 +/- 6% (P<.0001)
and remained unchanged in 37 patients (group 2) from 29 +/- 8% to 30 +/-
11% (P<=NS). BNP plasma levels at 24 hours only decreased in group 1 from
2170 +/- 967 pg/mL to 1208 +/- 662 pg/mL (P<=.001). By multivariate
analysis, BNP reduction >300 pg/mL was the strongest independent predictor
of LVEF improvement at 30 days (hazard ratio, 5.459; 95% confidence
interval, 1.580-18.860; P<=.007). Kaplan-Meier analysis showed that 1-year
survival after BAV was significantly higher in patients of group 1 than in
group 2 (95 +/- 4% vs 51 +/- 8%, respectively; P<=.02). Conclusions: BAV
in patients with poor left ventricular function resulted in LVEF
improvement at 30 days in 37% of cases, which was detected by a reduction
of BNP levels already seen at 24 hours. Survival at 1 year was
significantly higher in patients with such an improved LVEF after BAV.
<6>
Accession Number
2013528942
Authors
Leslie K. Myles P. Devereaux P. Williamson E. Rao-Melancini P. Forbes A.
Xu S. Foex P. Pogue J. Arrieta M. Bryson G. Paul J. Paech M. Merchant R.
Choi P. Badner N. Peyton P. Sear J. Yang H.
Institution
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Australia
(Leslie) Department of Pharmacology, University of Melbourne, Melbourne,
Australia
(Williamson) School of Population Health, University of Melbourne,
Melbourne, Australia
(Myles) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, Australia
(Myles) Academic Board of Anaesthesia and Perioperative Medicine, Monash
University, Melbourne, Australia
(Williamson, Forbes) Department of Epidemiology and Preventive Medicine,
Monash University, Melbourne, Australia
(Myles) National Health and Medical Research Council Practitioner Fellow,
Canberra, Australia
(Devereaux) Department of Medicine, McMaster University, Hamilton, Canada
(Devereaux) Department of Clinical Epidemiology, McMaster University,
Hamilton, Canada
(Devereaux) Department of Biostatistics, McMaster University, Hamilton,
Canada
(Rao-Melancini, Pogue) Population Health Research Institute, McMaster
University, Hamilton, Canada
(Xu) Fu Wai Cardiovascular Hospital, CAMS, Beijing, China
(Foex, Sear) Nuffield Department of Anaesthetics, Oxford University,
Oxford, United Kingdom
(Arrieta) Nueva Granada Military University, Bogota, Colombia
(Arrieta) Department of Anaesthesia, Resuscitation and Pain Management,
Central Military Hospital, Bogota, Colombia
(Bryson) Department of Anesthesiology, Ottawa Hospital, Ottawa, Canada
(Paul) Department of Anaesthesia, McMaster University, Hamilton Health
Sciences, Hamilton, Canada
(Paech) School of Medicine and Pharmacology, University of Western
Australia, Perth, Australia
(Paech) Department of Anaesthesia and Pain Medicine, King Edward Memorial
Hospital for Women, Perth, Australia
(Merchant) Department of Anaesthesia and Perioperative Medicine, Royal
Columbian Hospital, New Westminster, Canada
(Choi) Department of Anesthesiology, Pharmacology and Therapeutics,
University of British Columbia, Vancouver, Canada
(Choi) School of Population and Public Health, University of British
Columbia, Vancouver, Canada
(Badner) Department of Anaesthesia and Perioperative Medicine, University
of British Columbia, Kelowna, Canada
(Peyton) Department of Anaesthesia, Austin Hospital, Melbourne, Australia
(Peyton) Department of Surgery, Austin Hospital, University of Melbourne,
Melbourne, Australia
(Yang) Department of Anaesthesia, University of Ottawa, Ottawa, Canada
Title
Neuraxial block, death and serious cardiovascular morbidity in the POISE
trial.
Source
British Journal of Anaesthesia. 111 (3) (pp 382-390), 2013. Date of
Publication: September 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundThis post hoc analysis aimed to determine whether neuraxial
block was associated with a composite of cardiovascular death, non-fatal
myocardial infarction (MI) and non-fatal cardiac arrest within 30 days of
randomization in POISE trial patients.MethodsA total of 8351 non-cardiac
surgical patients at high risk of cardiovascular complications were
randomized to beta-blocker or placebo. Neuraxial block was defined as
spinal, lumbar or thoracic epidural anaesthesia. Logistic regression, with
weighting using estimated propensity scores, was used to determine the
association between neuraxial block and primary and secondary
outcomes.ResultsNeuraxial block was associated with an increased risk of
the primary outcome [287 (7.3%) vs 229 (5.7%); odds ratio (OR), 1.24; 95%
confidence interval (CI), 1.02-1.49; P=0.03] and MI [230 (5.9%) vs 177
(4.4%); OR, 1.32; 95% CI, 1.07-1.64; P=0.009] but not stroke [23 (0.6%) vs
32 (0.8%); OR, 0.76; 95% CI, 0.44-1.33; P=0.34], death [96 (2.5%) vs 111
(2.8%); OR, 0.87; 95% CI, 0.65-1.17; P=0.37] or clinically significant
hypotension [522 (13.4%) vs 484 (12.1%); OR, 1.13; 95% CI, 0.99-1.30;
P=0.08]. Thoracic epidural with general anaesthesia was associated with a
worse primary outcome than general anaesthesia alone [86 (12.1%) vs 119
(5.4%); OR, 2.95; 95% CI, 2.00-4.35; P<0.001].ConclusionsIn patients at
high risk of cardiovascular morbidity, neuraxial block was associated with
an increased risk of adverse cardiovascular outcomes, which could be
causal or because of residual confounding. The Author [2013]. Published
by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved.
<7>
Accession Number
2013528932
Authors
Stoppe C. Fahlenkamp A.V. Rex S. Veeck N.C. Gozdowsky S.C. Schalte G.
Autschbach R. Rossaint R. Coburn M.
Institution
(Stoppe, Fahlenkamp, Rex, Veeck, Gozdowsky, Schalte, Rossaint, Coburn)
Department of Anesthesiology, RWTH University Hospital, Pauwelsstr. 30,
D-52074 Aachen, Germany
(Stoppe) Institute of Biochemistry and Molecular Cell Biology, RWTH
University Hospital, Pauwelsstr. 30, D-52074 Aachen, Germany
(Autschbach) Department of Thoracic, Cardiac and Vascular Surgery, RWTH
University Hospital, Pauwelsstr. 30, D-52074 Aachen, Germany
(Rossaint, Coburn) Department of Intensive Care, RWTH University Hospital,
Pauwelsstr. 30, D-52074 Aachen, Germany
(Rex) Department of Anesthesiology, University Hospital Leuven, Campus
Gasthuisberg, Leuven, Belgium
(Rex) Department of Cardiovascular Sciences, KU Leuven, Belgium
Title
Feasibility and safety of xenon compared with sevoflurane anaesthesia in
coronary surgical patients: A randomized controlled pilot study.
Source
British Journal of Anaesthesia. 111 (3) (pp 406-416), 2013. Date of
Publication: September 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundTo date, only limited data exist about the use of xenon as an
anaesthetic agent in patients undergoing cardiac surgery. The favourable
cardio- and neuroprotective properties of xenon might attenuate
postoperative complications, improve outcome, and reduce the incidence of
delirium. Thus, the aims of this study were to investigate the feasibility
and safety of balanced xenon anaesthesia in patients undergoing cardiac
surgery and to gather pilot data for a future randomized multicentre
study.MethodsThirty patients undergoing elective coronary artery bypass
grafting were enrolled in this randomized, single-blind controlled trial.
They were randomized to receive balanced general anaesthesia with either
xenon (45-50 vol%) or sevoflurane (1-1.4 vol%). The primary outcome was
the occurrence of adverse events (AEs). Secondary outcome parameters were
feasibility criteria (bispectral index, perioperative haemodynamic, and
respiratory profile) and safety parameters (dosage of study treatments,
renal function, intraoperative blood loss, need for inotropic support,
regional cerebral tissue oxygenation). Furthermore, at predefined time
points, systemic and pulmonary haemodynamics were assessed by the use of a
pulmonary artery catheter.ResultsThere were no patient characteristic
differences between the groups. Patients undergoing xenon anaesthesia did
not differ with respect to the incidence of AE (6 vs 8, P=0.464) compared
with the sevoflurane group. No differences were detected regarding
secondary feasibility and safety criteria. The haemodynamic and
respiratory profile was comparable between the treatment
groups.ConclusionsBalanced xenon anaesthesia is feasible and safe compared
with sevoflurane anaesthesia in patients undergoing coronary artery bypass
surgery.AcronymCARDIAX: A pre- and post-coronary artery bypass graft
implantation disposed application of xenon.Clinical trial
registrationClinicalTrials.gov: NCT01285271; EudraCT-number:
2010-023942-63. Approved by the ethics committee 'Ethik-Kommission an der
Medizinischen Fakultat der Rheinisch-Westfalischen Technischen Hochschule
Aachen (RWTH Aachen)': EK-218/10. The Author [2013]. Published by Oxford
University Press on behalf of the British Journal of Anaesthesia. All
rights reserved.
<8>
Accession Number
2013511421
Authors
Skiba M.A. Pick A.W. Chaudhuri K. Bailey M. Krum H. Kwa L.J. Rosenfeldt
F.L.
Institution
(Pick, Chaudhuri, Kwa, Rosenfeldt) Department of Cardiothoracic Surgery
and Cardiac Surgical Research Unit, Alfred Hospital, Australia
(Skiba, Bailey, Krum, Rosenfeldt) Department of Epidemiology and
Preventive Medicine, Monash University, Australia
(Skiba, Krum) Clinical Pharmacology Department, Alfred Hospital, Australia
Title
Prophylaxis against atrial fibrillation after cardiac surgery: Beneficial
effect of perioperative metoprolol.
Source
Heart Lung and Circulation. 22 (8) (pp 627-633), 2013. Date of
Publication: August 2013.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Introduction: Multiple agents have been investigated to prevent atrial
fibrillation (AF) after cardiac surgery. Several studies have investigated
the use of beta-blockers such as metoprolol or amiodarone with promising
results. We aimed to investigate perioperative pharmacologic prophylaxis
against AF using metoprolol, and amiodarone in combination with
metoprolol. Methods: We conducted a prospective, randomised, single-blind,
controlled pilot study in patients undergoing elective cardiac surgery.
Subjects were randomised pre-operatively to one of three treatment groups:
standard therapy (control) or metoprolol (5. mg IV over 5. min on
commencement of bypass then 5. mg IV qid for 24. h then 25-50. mg tds
orally until discharge) or amiodarone (300. mg over 1. h starting shortly
after the commencement of bypass, then 900. mg over 24. h then 400. mg
orally tds until discharge) plus metoprolol as above. Patients had ECG
monitoring for the occurrence of AF for six days or until discharge.
Results: Two hundred and fifteen patients were enrolled. Between-group
differences in AF in an intention-to-treat analysis were not significant:
control 34% (23-45%), metoprolol 35% (24-46%), combined 22% (12-33%) (p=
0.21). However 87 patients (40%) did not receive the assigned treatment
mainly due to side effects, especially bradycardia. The remaining 128
patients were analysed on a per-protocol basis with the overall difference
between the three groups bordering on significance: control 34% (23-45%),
metoprolol 26% (9-43%), combined 11% (0-23%) (p= 0.06). Logistic
regression analysis, correcting for age and gender, was used to separate
the individual effects of metoprolol and amiodarone in the presence of
metoprolol which showed that compared to control there was a significant
effect of metroprolol on AF incidence (O.R. 0.31 (0.10-0.99), p= 0.048)
but not of amiodarone (O.R. 0.97 (0.19-5.02), p= 0.97). Conclusions: (1)
Perioperative metoprolol but not amiodarone itself in combination with
metoprolol is associated with a significant reduction in postoperative
AF.(2) Perioperative administration of metoprolol and combination of
metoprolol with amiodarone is associated with a high incidence of side
effects, especially bradycardia.(3) Further studies are indicated to
confirm these preliminary findings but in the meantime it would not be
unreasonable to implement the use of perioperative metoprolol for routine
prophylaxis of AF. 2013 Australian and New Zealand Society of Cardiac and
Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New
Zealand (CSANZ).
<9>
Accession Number
2013534302
Authors
Luo S.J. Zhou Y.J. Shi D.M. Ge H.L. Wang J.L. Liu R.F.
Institution
(Luo, Zhou, Shi, Ge, Wang, Liu) Department of Cardiology, An Zhen
Hospital, Capital Medical University, Beijing, China
(Luo) Capital Medical University School of Rehabilitation Medicine (China
Rehabilitation Research Centre), Beijing, China
Title
Remote ischemic preconditioning reduces myocardial injury in patients
undergoing coronary stent implantation.
Source
Canadian Journal of Cardiology. 29 (9) (pp 1084-1089), 2013. Date of
Publication: September 2013.
Publisher
Pulsus Group Inc. (2902 South Sheridan Way, Oakville ONT L6J 7L6, Canada)
Abstract
Background: Myocardial necrosis occurs frequently in elective percutaneous
coronary intervention (PCI) and is associated with subsequent major
adverse cardiovascular events (MACEs). This study assessed the protective
effect of remote ischemic preconditioning (RIPC) in patients undergoing
successful drug-eluting stent implantation with normal baseline troponin
values. Methods: We analyzed 205 participants with normal baseline
troponin values undergoing successful coronary stent implantation.
Subjects were randomized to 2 groups: The RIPC group (n= 101), whose
members received RIPC (created by three 5-minute inflations of a pneumatic
medical tourniquet cuff to 200 mm Hg around the upper arm, interspersed
with 5-minute intervals of reperfusion) < 2 hours before the PCI
procedure, and the control group (n= 104). Results: The primary outcomes
were high sensitive cardiac troponin I(hscTnI) levels and incidence of
myocardial infarction (MI 4a, defined as hscTnI > 0.20 ng/mL) at 16 hours
after the PCI procedure. The median hscTnI at 16 hours after PCI was lower
in the RIPC group compared with the unpreconditioned, control group (0.11
vs 0.21ng/mL; P < 0.01). The incidence of MI 4a was lower in the RIPC
group compared with the control group (39% vs 54%, P < 0.05). Index of
renal function showed no difference between the 2 groups at 16 hours after
PCI (P > 0.05). Conclusion: RIPC reduced post-PCI TnI release and
incidence of MI 4a in patients undergoing elective coronary stent
implantation. 2013 Canadian Cardiovascular Society.
<10>
Accession Number
2013505407
Authors
Kollum M. Heitzer T. Schmoor C. Brunner M. Witzenbichler B. Wiemer M.
Hoffmann R. Gutleben K.J. Schultheiss H.P. Horstkotte D. Brachmann J.
Meinertz T. Bode C. Zehender M.
Institution
(Kollum, Heitzer, Schmoor, Brunner, Witzenbichler, Wiemer, Hoffmann,
Gutleben, Schultheiss, Horstkotte, Brachmann, Meinertz, Bode, Zehender)
University Hospital Freiburg, Dept. of Cardiology and Angiology,
Hugstetter Strase 55, 79106 Freiburg i. Br., Germany
Title
Intra-individual head-to-head comparison of Sirolimus- and
Paclitaxel-eluting stents for coronary revascularization. A randomized,
multi-center trial.
Source
International Journal of Cardiology. 167 (4) (pp 1552-1559), 2013. Date of
Publication: 20 Aug 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Despite the known effects of drug-eluting stents (DES), other
cofactors attributed to patient characteristics affect their success.
Interest focused on designing a study minimizing these factors to answer
continuing concerns on the heterogeneity of response to different DESs.
The study's aim was to investigate the feasibility and impact of an
intra-individual comparison design in patients (pts) with two coronary
artery stenosis treated with a Sirolimus- (SES) and a Paclitaxel- (PES)
eluting stent. Methods and results: The study was conducted as a
prospective, randomized, multi-center trial in 112 pts who consented to
treatment with a SES and a PES. Pts were eligible if they suffered from
the presence of two single primary target lesions in two different native
coronary arteries. Lesions were randomized to either SES or PES treatment.
The primary endpoint was in-stent luminal late loss (LLL), as determined
by quantitative angiography at 8 months; clinical follow up was obtained
at 1, 8, and 12 months additionally. The LLL (0.13 +/- 0.28 mm SES vs 0.26
+/- 0.35 mm PES, p = 0.011) showed less neointima in SES. With a
predefined cut-off criterion of 0.2 mm difference in LLL, 53/87 pts SES
and PES were similar effective. 34/87 pts had a divergent result, 26 pts
had greater benefit from SES while 8 pts had greater benefit from PES.
Overall, MACE (MI, TLR, and death) occurred in 19 (17%) pts. Based on
lesion analysis of 108 lesions treated with SES and 110 lesions treated
with PES, 5 (4.6%) lesions with SES and 3 (2.7%) lesions with PES required
repeated TLR. Conclusion: An intra-individual comparison design to assess
differences in efficacy of different DESs is feasible, safe and achieves
similar results to inter-individual studies. This study is among the first
to show that failure of one DES does not necessarily implicate failure of
another DES and vice versa. 2012 Elsevier Ireland Ltd.
<11>
[Use Link to view the full text]
Accession Number
2013529588
Authors
Roe M.T. Goodman S.G. Ohman E.M. Stevens S.R. Hochman J.S. Gottlieb S.
Martinez F. Dalby A.J. Boden W.E. White H.D. Prabhakaran D. Winters K.J.
Aylward P.E. Bassand J.-P. McGuire D.K. Ardissino D. Fox K.A.A. Armstrong
P.W.
Institution
(Roe, Ohman, Stevens) Duke Clinical Research Institute, Duke University
Medical Center, 2400 Pratt St, Durham, NC 27705, United States
(Roe, Ohman) Division of Cardiology, Department of Medicine, Duke
University School of Medicine, Durham, NC, United States
(Goodman) Division of Cardiology, Department of Medicine, St. Michael's
Hospital, Toronto, ON, Canada
(Hochman) Cardiovascular Clinical Research Center, Leon H. Charney
Division of Cardiology, New York University School of Medicine and NYU
Langone Medical Center, New York, United States
(Gottlieb) Cardiac Institute, Bikur Cholim Campus, Shaare Zedek Medical
Center, Jerusalem, Israel
(Martinez) Department of Cardiology, Cordoba National University, Cordoba,
Argentina
(Dalby) Milpark Hospital, Johannesburg, South Africa
(Boden) Department of Medicine, Stratton VA Medical Center, Albany Medical
College, Albany, NY, United States
(White) Auckland City Hospital, Green Lane Cardiovascular Service,
Auckland, New Zealand
(Prabhakaran) Centre for Chronic Disease Control, New Delhi, India
(Winters) Eli Lilly and Company, Indianapolis, IN, United States
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Adelaide, Australia
(Bassand) Department of Cardiology, University Hospital Jean Minjoz,
Besancon, France
(McGuire) University of Texas, Southwestern Medical Center, Dallas, United
States
(Ardissino) Division of Cardiology, Azienda Ospedaliero-Universitaria di
Parma, Parma, Italy
(Fox) British Heart Foundation Centre for Cardiovascular Sciences,
University of Edinburgh, Edinburgh, United Kingdom
(Armstrong) Division of Cardiology, University of Alberta, Edmonton AB,
Canada
Title
Elderly patients with acute coronary syndromes managed without
revascularization: Insights into the safety of long-term dual antiplatelet
therapy with reduced-dose prasugrel versus standard-dose clopidogrel.
Source
Circulation. 128 (8) (pp 823-833), 2013. Date of Publication: 20 Aug 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND - : Dual antiplatelet therapy in older versus younger patients
with acute coronary syndromes is understudied. Low-dose prasugrel (5 mg/d)
is recommended for younger, lower-body-weight patients and elderly
patients with acute coronary syndromes to mitigate the bleeding risk of
standard-dose prasugrel (10 mg/d). METHODS AND RESULTS - : A total of 9326
medically managed patients with acute coronary syndromes from the Targeted
Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage
Acute Coronary Syndromes (TRILOGY ACS) trial (<75 years of age, n=7243;
>=75 years of age, n=2083) were randomized to prasugrel (10 mg/d; 5 mg/d
for those >=75 or <75 years of age and <60 kg in weight) or clopidogrel
(75 mg/d) plus aspirin for <=30 months. A total of 515 participants >=75
years of age (25% of total elderly population) had serial platelet
reactivity unit measurements in a platelet-function substudy. Cumulative
risks of the primary end point (cardiovascular death/myocardial
infarction/stroke) and Thrombolysis in Myocardial Infarction (TIMI) major
bleeding increased progressively with age and were >=2-fold higher in
older participants. Among those >=75 years of age, TIMI major bleeding
(4.1% versus 3.4%; hazard ratio, 1.09; 95% confidence interval, 0.57-2.08)
and the primary end point rates were similar with reduced-dose prasugrel
and clopidogrel. Despite a correlation between lower 30-day on-treatment
platelet reactivity unit values and lower weight only in the prasugrel
group, there was a nonsignificant treatment-by-weight interaction for
platelet reactivity unit values among participants >=75 years of age in
the platelet-function substudy (P=0.06). No differences in weight were
seen in all participants >=75 years of age with versus without TIMI
major/minor bleeding in both treatment groups. CONCLUSIONS - : Older age
is associated with substantially increased long-term cardiovascular risk
and bleeding among patients with medically managed acute coronary
syndromes, with no differences in ischemic or bleeding outcomes with
reduced-dose prasugrel compared with clopidogrel in elderly patients. No
significant interactions among weight, pharmacodynamic response, and
bleeding risk were observed between reduced-dose prasugrel and clopidogrel
in elderly patients. 2013 American Heart Association, Inc.
<12>
Accession Number
23452523
Authors
Ozer N. Karaman Ozlu Z. Arslan S. Gunes N.
Institution
(Ozer, Karaman Ozlu) Department of Nursing, Health Sciences Faculty,
Ataturk University, University, Erzurum, Turkey
(Arslan) Department of Nursing, Adana Health School, Cukurova University,
Adana, Turkey
(Gunes) Cardiovascular Surgery Intensive Care Unit, Research Hospital,
Ataturk University, Erzurum, Turkey
Title
Effect of Music on Postoperative Pain and Physiologic Parameters of
Patients after Open Heart Surgery.
Source
Pain Management Nursing. 14 (1) (pp 20-28), 2013. Date of Publication:
March 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
The aim of this study was to investigate the effect of listening to
personal choice of music on self-report of pain intensity and the
physiologic parameters in patients who have undergone open heart surgery.
The study design was quasiexperimental. Patients were selected through
convenience sampling in the Cardiovascular Surgery Intensive Care Unit at
a university hospital. The study was conducted with a total of 87 patients
who underwent open heart surgery: 44 in the music group, 43 in the control
group, ages between 18 and 78 years. Through pretest-posttest design,
postoperative first-day data were collected. First, physiologic parameters
(blood pressure, heart rate, oxygen saturation, and respiratory rate) were
recorded and a unidimensional verbal pain intensity scale applied to all
participants. Later, the control group had a rest in their beds while the
music group listened to their choice of music for 30 minutes. Physiologic
data were then collected and the pain intensity scale applied once more.
In the music group, there was a statistically significant increase in
oxygen saturation (p = .001) and a lower pain score (p = .001) than in the
control group. There was no difference between the groups in the other
physiologic parameters. Results of this research provide evidence to
support the use of music. Music might be a simple, safe, and effective
method of reducing potentially harmful physiologic responses arising from
pain in patients after open heart surgery. 2013 American Society for Pain
Management Nursing.
<13>
Accession Number
2013529283
Authors
Fischer C.P. Bochicchio G. Shen J. Patel B. Batiller J. Hart J.C.
Institution
(Fischer) Methodist Hospital, Weill Medical College of Cornell University,
6550 Fannin St, SM 1661, Houston, TX 77030, United States
(Bochicchio) Department of Surgery, Washington University in St. Louis,
St. Louis, MO, United States
(Shen, Patel, Batiller, Hart) Ethicon, Inc., Somerville, NJ, United States
Title
A prospective, randomized, controlled trial of the efficacy and safety of
fibrin pad as an adjunct to control soft tissue bleeding during abdominal,
retroperitoneal, pelvic, and thoracic surgery.
Source
Journal of the American College of Surgeons. 217 (3) (pp 385-393), 2013.
Date of Publication: September 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background: This study evaluated the hemostatic effectiveness and safety
of Fibrin Pad (Omrix Biopharmaceuticals Ltd.) vs absorbable hemostat in
patients undergoing nonemergent surgery. Fibrin Pad is a topical
absorbable hemostat designed to be effective in a variety of soft tissues
and across multiple bleeding intensities. Study Design: Patients 18 years
and older, requiring abdominal, retroperitoneal, pelvic, or thoracic
(noncardiac) surgery and with an appropriate soft-tissue target bleeding
site (TBS), were randomized to receive Fibrin Pad or absorbable hemostat
(NCT00658723). Patients were stratified by bleeding severity at the TBS.
Assessments included percentage of patients achieving hemostasis at 4
minutes after randomization with no rebleeding requiring treatment during
the subsequent 6 minutes (primary endpoint), proportion of patients
achieving hemostasis at 10 minutes, and incidence of treatment failure.
Results: On the primary endpoint, 98.3% of patients with Fibrin Pad and
53.3% with absorbable hemostat achieved hemostasis at 4 minutes (p <
0.0001). The treatment differential was magnified (efficacy was maintained
with Fibrin Pad but decreased with absorbable hemostat) with increasing
bleeding intensity: in patients with mild bleeding, 100.0% vs 80.0%
achieved hemostasis with Fibrin Pad and absorbable hemostat (p = 0.03),
respectively; rates were 96.6% vs 26.7%, respectively (p < 0.0001) with
moderate bleeding. Percentages of patients who achieved hemostasis at 10
minutes were: Fibrin Pad, 98.3% and absorbable hemostat, 73.3% (p <
0.0001). Incidences of adverse events were comparable between groups.
Conclusions: Fibrin Pad is superior to absorbable hemostat (SURGICEL
Original Absorbable Hemostat [Ethicon]) in soft-tissue bleeding control
and is safe and effective as an adjunct for rapidly and reliably achieving
hemostasis for soft-tissue bleeding during surgery. 2013 by the American
College of Surgeons.
<14>
Accession Number
2013526747
Authors
Verberkmoes N.J. Wolters S.L. Post J.C. Soliman-Hamad M.A. ter Woorst J.F.
Berreklouw E.
Institution
(Verberkmoes, Soliman-Hamad, ter Woorst, Berreklouw) Department of
Cardio-Thoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
(Wolters) Department of Radiology, Catharina Hospital, Eindhoven,
Netherlands
(Post) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
Title
Distal anastomotic patency of the Cardica C-PORT xA system versus the
hand-sewn technique: A prospective randomized controlled study in patients
undergoing coronary artery bypass grafting.
Source
European Journal of Cardio-thoracic Surgery. 44 (3) (pp 512-519), 2013.
Article Number: ezt079. Date of Publication: September 2013.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objectives: The C-Port Distal Anastomosis Systems (Cardica, Inc., Redwood
City, CA, USA) demonstrated favourable results in feasibility trials.
However, distal vein anastomoses created with the C-Port or C-Port xA
system have never been compared with hand-sewn distal vein anastomoses.
The objective of this study was to compare distal end-to-side anastomoses
facilitated with the C-Port xA System with the traditional hand-sewn
method. Methods: This single-centre prospective randomized controlled
study comprised 71 patients (device group n = 35, control group n = 36)
who underwent primary elective coronary artery bypass grafting between
June 2008 and April 2011. The primary study endpoint was12-month distal
anastomotic patency, which was assessed with prospective ECG-gated
256-multislice computed tomographic coronary angiography using a
step-and-shoot scanning protocol. For the primary end-point, a
per-protocol analysis was used. Results: In the device group, four (11%)
anastomoses were converted to hand-sewn anastomoses, and additional
stitches to achieve haemostasis were necessary in 22(76%) patients. There
was no hospital mortality in either group. During the 12-month follow-up,
a single death occurred in the Device group and was unrelated to the
device. Twenty-nine patients in the device group and 32 in the control
group completed 12-month CT coronary angiography. The overall patency of
160 studied distal vein graft anastomoses was 93%. Comparison of the
end-to-side target anastomosis showed 12-month patencies of 86 and 88% in
the device group and the control group, respectively. Conclusions:
According to these preliminary results and despite the limited number of
patients, the use of the C-Port xA System is safe enough to perform distal
end-to-side vein graft anastomosis, withrespect to 12-month end-to-side
distal venous anastomotic patency. Although there are some technical
challenges with this device, the incidence of complications is comparable
to the traditional hand-sewn technique. The Author 2013. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<15>
Accession Number
2013526728
Authors
Zhang Z. Liu D. Feng H. Yao Z. Zhang Y. Wei D. Teng J.
Institution
(Zhang, Feng, Teng) Department of Thoracic Surgery, China-Japan Friendship
Hospital, Beijing, China
(Liu, Yao, Wei) Department of Infection Management and Disease Prevention,
China-Japan Friendship Hospital, Beijing, China
(Zhang) Library of China-Japan Friendship Hospital, Beijing, China
Title
Is video-assisted thoracic surgery lobectomy better than thoracotomy for
early-stage non-small-cell lung cancer? A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 44 (3) (pp 407-414), 2013.
Article Number: ezt015. Date of Publication: September 2013.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
The study aimed to compare the reported oncological outcomes based on
satisfactory lymph node dissection (LND) or lymph node sampling (LNS),
systemic and loco-regional recurrence rate and long-term survival rate of
patients with early-stage non-small-cell lung cancer (NSCLC) who underwent
video-assisted thoracic surgery (VATS) lobectomy or thoracotomy lobectomy.
A systematic review was conducted using PubMed, EMBASE and OVID-EBMR
databases ranging from 1990 to 2011. The studies compared VATS and
thoracotomy for patients with NSCLC, with results including LND or LNS
where recurrence as well as survival rates were identified. Data were
abstracted by two reviewers independently. Mean difference or risk ratio
(RR) were pooled using RevMan 5.0 statistical software. 5389 cases were
included, of which 2380 underwent VATS and 3009 underwent thoracotomy.
There was no significant difference in the number of total LND or LNS
procedures (MD: -0.63; 95% confidence intervals (95% CI): -1.47 to 0.21; P
= 0.14) or mediastinal LND or LNS (MD: -0.51; 95% CI: -1.58 to 0.56; P =
0.35) between the two groups. Systemic (RR: 0.61; 95% CI: 0.48 to 0.78; P
> 0.01) and loco-regional (RR: 0.66; 95% CI: 0.46 to 0.95; P = 0.03)
recurrence rates were significantly lower in the VATS group. Moreover, a
significantly higher survival rate (RR: 1.09; 95% CI: 1.03 to 1.15; P >
0.01) was also demonstrated by a Forest plot in the VATS group. These
results suggest that VATS lobectomy might be an eligible alternative in
place of thoracotomy in patients with early-stage NSCLC by reducing
recurrence and improving survival rates The Author 2013. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<16>
Accession Number
2013524870
Authors
Ofman P. Peralta A. Hoffmeister P. Gaziano J.M. Djousse L.
Institution
(Ofman, Peralta, Hoffmeister, Gaziano) Division of Cardiology, VA Boston
Healthcare System and Harvard Medical School, Boston, MA, United States
(Ofman, Gaziano, Djousse) Division of Aging, Department of Medicine,
Brigham and Women's Hospital and Harvard Medical School, Boston, MA,
United States
(Ofman, Gaziano, Djousse) Massachusetts Veterans Epidemiology and Research
Information Center (MAVERIC), Boston Veterans Affairs Healthcare System,
Boston, MA, United States
(Gaziano) Division of Preventive Medicine, Brigham and Women's Hospital
and Harvard Medical School, Boston, MA, United States
(Gaziano, Djousse) Geriatric Research, Education, and Clinical Center
(GRECC), Boston Veterans Affairs Healthcare System, Boston, MA, United
States
Title
Do omega-3 fatty acids decrease the incidence of atrial fibrillation?.
Source
Journal of Atrial Fibrillation. 6 (1) (pp 71-76), 2013. Date of
Publication: June-July 2013.
Publisher
CardioFront LLC (135th St, Ste 264, Overland Park KS 66223, United States)
Abstract
Although atrial fibrillation is a very common medical problem in general
population and has a high incidence in the setting of open heart surgery,
there are very few therapies to prevent occurrence or recurrence of atrial
fibrillation. N-3 polyunsaturated fatty acids have been shown to change
basic physiologic properties of the atrial tissue to make it less
susceptible to atrial fibrillation. In this review, we first describe
basic physiological mechanisms thought to be responsible for these changes
and then discuss observational and interventional studies evaluating the
use n-3 polyunsaturated fatty acids for primary and secondary prevention
of atrial fibrillation in the general population, in subjects undergoing
open heart surgery, and in special subgroups of patients.
<17>
Accession Number
2013518077
Authors
Lee S.M. Kim W.H. Ahn H.J. Kim J.A. Yang M.K. Lee C.H. Lee J.H. Kim Y.R.
Choi J.W.
Institution
(Lee, Kim, Ahn, Kim, Yang, Lee, Lee, Choi) Department of Anaesthesia and
Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, South Korea
(Kim) Department of Anaesthesia and Pain Medicine, Hallym University
College of Medicine, Suwon, South Korea
Title
The effects of prolonged inspiratory time during one-lung ventilation: A
randomised controlled trial.
Source
Anaesthesia. 68 (9) (pp 908-916), 2013. Date of Publication: September
2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
We evaluated the effects of a prolonged inspiratory time on gas exchange
in subjects undergoing one-lung ventilation for thoracic surgery. One
hundred patients were randomly assigned to Group I:E = 1:2 or Group I:E =
1:1. Trterial blood gas analysis and respiratory mechanics measurements
were performed 10 min after anaesthesia induction, 30 and 60 min after
initiation of one-lung ventilation, and 15 min after restoration of
conventional two-lung ventilation. The mean (SD) ratio of the partial
pressure of arterial oxygen to fraction of inspired oxygen after 60 min of
one-lung ventilation was significantly lower in Group I:E = 1:2 compared
with Group I:E = 1:1 (27.7 (13.2) kPa vs 35.2 (22.1) kPa, respectively, p
= 0.043). Mean (SD) physiological dead space-to-tidal volume ratio after
60 min of one-lung ventilation was significantly higher in Group I:E = 1:2
compared with Group I:E = 1:1 (0.46 (0.04) vs 0.43 (0.04), respectively, p
= 0.008). Median (IQR [range]) peak inspiratory pressure was higher in
Group I:E = 1:2 compared with Group I:E = 1:1 after 60 min of one-lung
ventilation (23 (22-25 [18-29]) cmH<sub>2</sub>O vs 20 (18-21 [16-27]) cmH
<sub>2</sub>O, respectively, p < 0.001) and median (IQR [range]) mean
airway pressure was lower in Group I:E = 1:2 compared with Group I:E = 1:1
(10 (8-11 [5-15]) cmH<sub>2</sub>O vs 11 (10-13 [5-16]) cmH<sub>2</sub>O,
respectively, p < 0.001). We conclude that, compared with an I:E ratio of
1:2, an I:E ratio of 1:1 resulted in a modest improvement in oxygenation
and decreased shunt fraction during one-lung ventilation. 2013 The
Association of Anaesthetists of Great Britain and Ireland.
<18>
Accession Number
71150538
Authors
Snosek M. Tubbs S. Loukas M.
Institution
(Snosek, Loukas) St. George's University, St. George's, Grenada
(Tubbs) University of Alabama, Birmingham, AL, United States
Title
The sternalis muscle and its clinical significance.
Source
FASEB Journal. Conference: Experimental Biology 2013, EB Boston, MA United
States. Conference Start: 20130420 Conference End: 20130424. Conference
Publication: (var.pagings). 27 , 2013. Date of Publication: April 2013.
Publisher
FASEB
Abstract
The sternalis muscle is a well documented but rare muscular variation of
the anterior chest wall. It lies between the superficial fascia and the
pectoral fascia, and is found in 3-6% of the population. It presents in
varied morphological variants both in unilateral and bilateral fashion and
has no apparent physiological function. Much disagreement still exists
about its nerve supply and embryological origin. With the advent of
medical imaging and thoracic surgery the clinical importance of this
muscle has been re-emphasized. The sternalis muscle has been implicated in
misdiagnosis of breast masses on routine mammograms due to its parasternal
location and relative unfamiliarity with radiologists. When undetected
prior to any thoracic surgery, it has the potential to interfere with and
prolong such procedures. When present and detected it can be used as a
muscular flap in reconstructive surgeries of the breast and neck. The aim
of this study was to conduct a meta-analysis on the sternalis muscle with
special emphasis on its anatomy, embryology, clinical implications and
potential iatrogenic complications.
<19>
Accession Number
71146589
Authors
Garcia D. Benjo A. Cardoso R. Macedo F.Y. Aziz E. Herzog E. De Marchena E.
Institution
(Garcia, Cardoso, Macedo, De Marchena) Department of Cardiology,
University of Miami, Jackson Memorial Hospital, Miami, FL, United States
(Benjo, Aziz, Herzog) Department of Cardiology, Columbia College of
Physicians and Surgeons, St. Luke's Hospital, New York, NY, United States
Title
Comorbidities among transfemoral and transapical access for transcatheter
aortic valve replacement: Meta-analysis.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
18th World Congress on Heart Disease Annual Scientific Sessions 2013
Vancouver, BC Canada. Conference Start: 20130726 Conference End: 20130729.
Conference Publication: (var.pagings). 125 (pp 495), 2013. Date of
Publication: July 2013.
Publisher
S. Karger AG
Abstract
Intro Transcatheter aortic valve implantation (TAVI) has become an
important alternative to traditional surgical aortic valve replacement,
particularly in high risk patients. It carries complications, mainly
related to the via of access for the valve deployment. Currently, femoral
access is the less invasive approach for the procedure, and transapical
access is a feasible alternative option. They carry different rates of
comorbidities such as AMI, pacemaker implatation, renal dialysis, and
vascular complication. Therefore we aimed to compare the literature
information in a meta-analysis. Methods We searched PubMed, EMBASE, and
Cochrane databases from 1966 through April 2013. The studied outcomes were
AMI, pacemaker implatation, renal dialysis, vascular complication. We
excluded studies that could have overlapped population from another one.
We used Fixed or Random Effect analysis using the Cochrane Handbook of
Systematic Reviews. Results Out of 856 articles, ten studies presented the
studied data and were included in the analysis. Pooled data provided a
total of 9631 patients, 7075 underwent transfemoral approach and 2556
underwent transapical. As demonstrated in Figure 1, there was a 0.3 fold
increase in odds for renal dialysis on transpical group (p<0.01) and a
tendency for increased odds for AMI as well (p:0.06). There was a 3
increased fold on the transfemoral groups for vascular complication. There
was no difference among groups for pacemaker implantation. Discussion
While transfemoral is a less invasive approach, it carries a higher risk
for vascular complication while transpical is more invasive and carries a
higher risk for end organ damage.
<20>
Accession Number
71146588
Authors
Garcia D. Benjo A. Cardoso R. Macedo F.Y. Aziz E. Herzog E. De Marchena E.
Institution
(Garcia, Cardoso, Macedo, De Marchena) Department of Cardiology,
University of Miami, Jackson Memorial Hospital, Miami, FL, United States
(Benjo, Aziz, Herzog) Department of Cardiology, Columbia College of
Physicians and Surgeons, St. Luke's Hospital, New York, NY, United States
Title
Device complication among transfemoral and transapical access for
transcatheter aortic valve replacement: A metaanalysis.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
18th World Congress on Heart Disease Annual Scientific Sessions 2013
Vancouver, BC Canada. Conference Start: 20130726 Conference End: 20130729.
Conference Publication: (var.pagings). 125 (pp 494), 2013. Date of
Publication: July 2013.
Publisher
S. Karger AG
Abstract
Intro Transcatheter aortic valve implantation (TAVI) has become an
important alternative to traditional surgical aortic valve replacement,
particularly in high risk patients. Currently, femoral access is the less
invasive approach for the procedure, and transapical access is a feasible
alternative option. Concerns regarding those access route include
complications such as device embolization, coronary obstruction, "valve in
valve", need for surgical intervention and procedural success. Large
studies and databases comparing directly the 2 access are currently
scarce. We aimed combine the available information in a meta-analysis.
Methods We searched PubMed, EMBASE, and Cochrane databases from 1966
through April 2013. The studied outcomes were device embolization,
coronary obstruction, "valve in valve", need for surgical intervention and
procedural success. We excluded studies that could have overlapped
population from another one. We used Fixed or Random Effect analysis using
the Cochrane Handbook of Systematic Reviews. Results Out of 856 articles,
seven studies presented the studied data and were included in the
analysis. The pooled data provided a total of 9408 patients, 6770
underwent transfemoral approach and 2638 underwent transapical access. As
demonstrated in Figure 1, device embolization, coronary obstruction, and
need for surgical intervention did not differ between routes. There was a
tendency of a second valve implantation on the transapical group (p:0.06).
Although, procedural success also did not differ among the two groups.
Discussion Although transpical approach for TAVI is more invasive than
percutaneous transfemoral access, there is no significant difference among
them regarding complications and procedural success.
<21>
Accession Number
71146050
Authors
Gupta P. Santo Pereira I. Lau K. Rathinam S.
Institution
(Gupta, Santo Pereira, Lau, Rathinam) Thoracic Surgery, Glenfield
Hospital, Leicester, United Kingdom
Title
Continuous infusion analgesia in thoracic surgery reduces morphine usage
in patients who have empyema and undergoing open decortication.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 21st European
Conference on General Thoracic Surgery Birmingham United Kingdom.
Conference Start: 20130526 Conference End: 20130529. Conference
Publication: (var.pagings). 17 , 2013. Date of Publication: July 2013.
Publisher
Oxford University Press
Abstract
Objectives: Thoracic epidural analgesia is considered the gold standard
for postoperative pain control, However, it is not always feasible for
patients undergoing decortications for empyema. We have utilised
continuous incisional analgesia in thoracic surgery (CIATS) for
post-thoracotomy pain control. CIATS consists of a catheter in the wound,
which is initially topped up with 10 ml of 0.25% chirocaine and then
connected to a continuous infusion of 0.1% chirocaine running at 5 ml/h.
We reviewed the impact of CIATS in thoracic surgery in decortication
patients. Methods: Fifteen cases who had undergone thoracotomy for
decortication were retrospectively analysed. Eight had CIATS concomitantly
with morphine PCA (Group 1) while 7 patients had only morphine PCA (Group
2). Postoperative pain scores, amount of morphine used and length of
hospital stay (LOS) were measured. Results: In group 1, (7F:1M) median age
was 51 years. In group 2, (3F:4M) median age was 48 years and 1 patient
underwent two procedures in the same admission. Mean morphine infused,
mean duration of PCA used, mean postoperative pain scores on day 1 and 2
and mean hospital stay are recorded in . There was a trend of better pain
scores and reduced morphine usage in CIATS but this did not achieve
significance; however, there was a statistical significance between the 2
groups in mean duration of PCA usage (P = 0.05). Conclusions: CIATS is
efficacious in the management of post-thoracotomy pain. We need to
validate this result with a prospective randomised controlled trial.
<22>
Accession Number
71146007
Authors
Sastry P. Tocock A. Coonar A.
Institution
(Sastry, Tocock, Coonar) Thoracic Surgery, Papworth Hospital, Cambridge,
United Kingdom
Title
Adrenalectomy for isolated metastasis from operable non-small cell lung
cancer.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 21st European
Conference on General Thoracic Surgery Birmingham United Kingdom.
Conference Start: 20130526 Conference End: 20130529. Conference
Publication: (var.pagings). 17 , 2013. Date of Publication: July 2013.
Publisher
Oxford University Press
Abstract
Objectives: In patients with non-small cell lung cancer (NSCLC), isolated
metastases in the adrenal gland may be identified either synchronously or
metachronously. This study aims to identify whether, after curative lung
resection, adrenal metastatectomy improves survival when compared against
medical therapy. Methods: A systematic review was performed. The results
were collated and are described below. Results: Three published series
were identified comparing adjuvant medical therapy against adrenalectomy
after R0 resection of NSCLC. Together 60 patients were assessed.
Management strategy was left to the discretion of the clinician. In all 3
series, survival was improved in the adrenalectomy group. DFI was longer
and patients were younger in the adrenalectomy groups. No differencewas
identified in histological subtypes or tumour size. Conclusions: Surgical
resection is associated with improved survival for selected patients with
isolated adrenal metastasis from NSCLC. Patient selection is critical.
Important factors are: otherwise early stage NSCLC at initial staging, R0
resection, long DFI, and no evidence of other metastasis. Ipsilateral
adrenal metastasis may represent early lymphatic spread and therefore
these patients may derive more benefit from adrenalectomy.
<23>
Accession Number
71145873
Authors
Oosterhuis J.W. Verstegen N. Van Der Elst A. Mollema R. Van Tets W.
Joosten J. Amir A. Senan S.
Institution
(Oosterhuis) Surgery 7f35, VU University Medical Centre, Amsterdam,
Netherlands
(Verstegen, Senan) Radiation Oncology, VU University Medical Centre,
Amsterdam, Netherlands
(Van Der Elst) Surgery, Spaarne Ziekenhuis, Hoofddorp, Netherlands
(Mollema) Surgery, Medical Centre Alkmaar, Alkmaar, Netherlands
(Van Tets) Surgery, St Lucas Andreas Ziekenhuis, Amsterdam, Netherlands
(Joosten) Surgery, Westfries Gasthuis, Hoorn, Netherlands
(Amir) Surgery, Waterlandziekenhuis, Purmerend, Netherlands
Title
Propensity score-matched analysis of stage I-II non-small cell lung cancer
treated by video-assisted thoracoscopic lobectomy or stereotactic ablative
radiotherapy.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 21st European
Conference on General Thoracic Surgery Birmingham United Kingdom.
Conference Start: 20130526 Conference End: 20130529. Conference
Publication: (var.pagings). 17 , 2013. Date of Publication: July 2013.
Publisher
Oxford University Press
Abstract
Objectives: Video-assisted thoracoscopic surgery (VATS) lobectomy is often
used to treat operable patients with stage 1-2 non-small cell lung cancer
(NSCLC), but stereotactic ablative radiotherapy is not infrequently
employed. We performed a propensity score-matched analysis to compare
treatmentrelated complications VATS lobectomy data from 6 hospitals was
retrospectively accessed; stereotactic ablative radiotherapy data was
obtained from a single institution database. Patients were matched using
propensity scores based on cTNM-stage, age, gender, Charlson comorbidity
score, pulmonary function tests and performance score. Clinical staging
was done according to national guidelines and included 18FDG-PET and
surgical and/or endoscopic mediastinal staging. Eighty-six VATS and 527
stereotactic ablative radiotherapy patients were matched blinded to
outcome (1:1 ratio, caliper distance 0.025). Treatment-related
complications were scored according to Common Terminology Criteria for
Adverse Events. Locoregional failure was defined as recurrence in/adjacent
to the planning target volume/surgical margins, ipsilateral hilum or
mediastinum. Recurrences were either biopsy-confirmed or had to be
PET-positive and reviewed by a tumour board. Results: The matched cohort
consisted of 64 patients treated by stereotactic ablative radiotherapy and
64 patients treated by VATS lobectomy, with median follow-up of 30 and 16
months, respectively. Unforeseen N1 and/or N2 disease was detected in 12
operated patients (19%), 8 of these received adjuvant treatment.
Treatment-related complications >=grade 3 developed in 23% of VATS
patients and 6% of stereotactic ablative radiotherapy patients.
Locoregional control rates with stereotactic ablative radiotherapy were
superior compared to VATS lobectomy at 1 and 3 years (96.8% and 93.3% vs
86.9% and 82.6%, respectively, P = 0.04). Distant recurrences and overall
survival were not significantly different. Conclusions: This retrospective
analysis found a superior locoregional control after stereotactic ablative
radiotherapy compared to VATS lobectomy, but overall survival did not
differ. Our findings support the need to compare both treatments in a
randomized controlled trial.
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