Results Generated From:
Embase <1980 to 2013 Week 37>
Embase (updates since 2013-09-06)
<1>
Accession Number
2013553977
Authors
Sen O. Gonca S. Solakoglu S. Dalcik H. Dalcik C. Ozkara A.
Institution
(Sen, Ozkara) Departments of Cardiovascular Surgery, Istanbul Bilim
University School of Medicine, Istanbul, Turkey
(Solakoglu) Departments of Histology and Embryology, Istanbul Bilim
University School of Medicine, Istanbul, Turkey
(Gonca, Dalcik) Departments of Histology and Embryology, Kocaeli
University School of Medicine, Kocaeli, Turkey
(Dalcik) Departments of Anatomy, Kocaeli University School of Medicine,
Kocaeli, Turkey
Title
Comparison of conventional and no-touch techniques in harvesting saphenous
vein for coronary artery bypass grafting in view of endothelial damage.
Source
Heart Surgery Forum. 16 (4) (pp E177-E183), 2013. Date of Publication:
August 2013.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Optimization of saphenous vein patency for myocardial
revascularization. Objective: The goal of this study was to present the
no-touch technique of saphenous vein preparation. This technique consists
of harvesting the vein with a pedicle of surrounding tissue, which
protects the vein from distension pressure. Methods: We performed a
prospective, randomized study that compared 2 techniques for harvesting
saphenous veinconventional and no-touchin 40 patients undergoing coronary
artery bypass grafting. We carried out a morphologic study of the
endothelium with the aid of light and transmission electron microscopy and
an immunohistochemical assessment to identify adenosine, inducible nitric
oxide synthase (iNOS), and vascular endothelial growth factor (VEGF) in
the vein wall. Results: The integrity of endothelial cell and all vascular
layers was maintained better with the no-touch technique than with the
conventional procedure. The immunohistochemical assessment revealed that
adenosine receptor, iNOS, and VEGF immunoexpression levels were normal or
lower in the no-touch group than in the conventionalharvest group, as
shown by the staining densities in all layers of the vein wall.
Conclusion: Endothelial integrity and adenosine, iNOS, and VEGF
immunoreactivities were better preserved when the no-touch technique was
used for vein graft harvesting. The mechanical protection provided by the
cushion of surrounding tissue in the no-touch group and the vasorelaxation
and thromboresistant activities of nitric oxide may be responsible for the
reduction in vasospasms and the improved patency rate. 2013 Forum
Multimedia Publishing, LLC.
<2>
Accession Number
2013518418
Authors
Abdel-Meguid M.E. Essam M.
Institution
(Abdel-Meguid, Essam) Consultant Anesthesiologist, King Fahad Specialist
Hospital, Anesthesia Ain Shams University, Dammam, Egypt
Title
Prophylactic administration of recombinant activated factor VII in
coronary revascularization surgery.
Source
Saudi Journal of Anaesthesia. 7 (3) (pp 301-304), 2013. Date of
Publication: July-September 2013.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The objective of this clinical trial is to study the
effectiveness of administering recombinant activated factor VII (rFVIIa)
in reducing the amount of bleeding and the need for homologous blood and
products transfusion in cardiac surgical coronary revascularization
procedures done under cardiopulmonary bypass (CPB). Methods: In a
randomized controlled prospective observational study, 30 patients were
scheduled for elective cardiac revascularization under CPB. Patients were
randomly allocated into two groups. In Group I (Control group), no rFVIIa
was administered following CPB. In Group II (Study group), a dose of 90
ug/Kg of rFVIIa was administered following weaning off CPB. The total
amount of chest tube drain during the 1 <sup>st</sup> 24 h following
surgery was recorded as well as the qualitative and quantitative
assessments of homologous blood and products transfusion. Serial analysis
of hematological parameters including hemoglobin level and coagulation
test in a definite data points was done. T0=baseline readings prior to
CPB, T1=off CPB after protamine administration and before administration
of the study drug, T2=on Cardiac Intensive Care Unit (CICU) admission,
T3=12 h post-CICU admission, and T4=24 h post-CICU admission. Results:
Considering the total chest tube drainage, mean values showed
statistically significant results with a P value of 0.001. Homologous
blood and products transfusion were statistically lower in the study
group. Regarding the mean values for hematological assessment, results
showed statistically lower International Normalized Ratio values at CICU
admission and 12 h post-CICU admission with a P value of 0.018 and 0.004,
respectively. Also, the Partial Thromboplastin Time mean values were
statistically lower at same timings with estimated P values of 0.04 and
0.001, respectively. Conclusion: It is concluded that the prophylactic use
of rFVIIa in patients undergoing coronary revascularization surgery under
the management of CPB had a remarkable significant results on both the
amount of post-operative bleeding and the amount of blood and products
transfusion.
<3>
Accession Number
2012275369
Authors
Lenz A.M. Vassallo J.C. Moreno G.E. Althabe M. Gomez S. Magliola R.
Casimir L. Bologna R. Barretta J. Ruffa P.
Institution
(Lenz, Vassallo, Moreno, Althabe, Gomez, Magliola) UCI 35, Hospital
Nacional de Pediatria 'Prof. Dr. Juan P. Garrahan', Buenos Aires,
Argentina
(Casimir) Microbiologia, Hospital Nacional de Pediatria 'Prof. Dr. Juan P.
Garrahan', Buenos Aires, Argentina
(Bologna) Infectologia, Hospital Nacional de Pediatria 'Prof. Dr. Juan P.
Garrahan', Buenos Aires, Argentina
(Barretta, Ruffa) Cirugia cardiovascular, Hospital Nacional de Pediatria
'Prof. Dr. Juan P. Garrahan', Buenos Aires, Argentina
Title
Prevention of catheter-related infection; usefulness and
cost-effectiveness of antiseptic catheters in children.
Source
Revista Chilena de Pediatria. 83 (1) (pp 84-85), 2012. Date of
Publication: February 2012.
Publisher
Sociedad Chilena de Pediatria (Alcalde Eduardo Castillo Velasco 1838,
Nunoa, Santiago, Chile)
Abstract
Objective: To evaluate the cost-effectiveness of the
antiseptic-impregnated catheter compared with conventional catheters in
preventing catheter-related blood stream infections (CR-BSI). Design:
Cost-effectiveness analysis; clinical trial, experimental, randomized,
controlled, prospective, open label. Patients and Methods: A 172 patient
cohort, under 1-year-old or less than 10 kg, postoperative cardiovascular
children with central venous catheters (CVC) admitted to Cardiac Intensive
Care Unit (UCI 35) at Hospital Nacional de Pediatria "Prof. Dr. Juan P.
Garrahan", since September 2005 to December 2007. Demographic and CVC data
were retrieved to compare: age, gender, weight, diagnosis, surgery, CVC
days, costs and complications. Intervention: CVC Arrow, double-lumen, > 48
h of duration; intervention group: antiseptic-impregnated CVC vs control
group: CVC without antiseptics (conventional). Results: The incidence of
CR-IE (CR-Infected Events: colonization, local infection and/or CRBSI;
combined end point) was 27% for antiseptic-impregnated CVC vs. 31% for
conventional catheters (p = 0.6) with similar accumulated incidence of CR-
BSI: 2.8 vs. 3.3 per 1000 days catheter. We found no differences between
groups, except in weight: median 4.0 kg (r 2-17) vs 4.7 kg (r 2-9) p =
0.0002 and age, median 2 months (r 1- 48) vs 5 months (r 1- 24) p= 0.0019
in antiseptic-impregnated CVC group. These differences, though
statistically significant were clinically non relevant. Median cost per
patient during intensive care stay in the conventional CVC group was
$3.417 (359-9.453) and in the antisepticimpregnated- CVC group was $4.962
(239-24.532), p = 0.10. Conclusions: The use of antiseptic-impregnated CVC
compared with conventional CVC did not decrease CR-BSI in this population.
The cost per patients was higher in the antiseptic impregnated CVC group.
These results do not support the routine use of this type of CVC in our
population.
<4>
Accession Number
2012261652
Authors
Biccard D.L.
Institution
(Biccard) Perioperative Research Unit, Department of Anaesthetics,
University of Kwa-Zulu Natal, Durban, South Africa
Title
Statins in cardiac surgery.
Source
Southern African Journal of Anaesthesia and Analgesia. 18 (1) (pp 56),
2012. Date of Publication: 2012.
Publisher
Medpharm Publications (Pty) Ltd (PO Box 14804, Lyttelton, Gauteng 0157,
South Africa)
Abstract
Background: Recent studies on the utility of statins in cardiac surgery
appear to show conflicting results. Most studies are either retrospective
or prospective observational, with small sample sizes. In order to address
these limitations, we systematically reviewed studies from 2008 to the
present, in order to determine the clinical utility of perioperative
statin use in cardiac surgery. Method: We searched PubMed for studies
reporting the use of statin therapy in cardiac surgery. The outcomes of
interest were postoperative mortality, non-fatal myocardial infarction,
acute renal injury, erebrovascular events, and atrial fibrillation. An a
priori decision was taken to conduct a subgroup analysis of coronary
artery bypass surgery (CABG) and valve replacement surgery. Results:
Statins were associated with a reduction in all-cause mortality at 30 days
in cardiac surgical patients (odds ratio (OR) 0.65, [95% confidence
interval (CI) 0.60-0.71]), and this was consistent in both subgroups.
Statins were associated with a reduction in myocardial infarction in the
CABG group [OR 0.73, (95% CI 0.48-1.13)], but not in the valve group [OR
1.14, (95% CI 0.80-1.63)]. Statins were not associated with protection
from acute renal injury post-cardiac surgery [OR 1.20, (95% CI
1.10-1.31)]. Statins were associated with significantly less postoperative
cerebrovascular events [OR 0.83, (95% CI 0.71-0.97)], and this was
consistent for both CABG and valve surgery. Statins were associated with
significantly less postoperative atrial fibrillation [OR 0.78, (95% CI
0.70-0.98)], which was evident following CABG. However, there were
insufficient data to determine its efficacy in valve surgery. Conclusion:
Statins were associated with improved outcomes for mortality, myocardial
infarction, cerebrovascular accident, and atrial fibrillation, following
CABG. In valve surgery, statins were only associated with improved
outcomes for mortality and cerebrovascular accident. The associated
increase in acute renal injury needs further investigation. SASA.
<5>
Accession Number
2013529160
Authors
Gorlitzer M. Wagner F. Pfeiffer S. Folkmann S. Meinhart J. Fischlein T.
Reichenspurner H. Grabenwoeger M.
Institution
(Gorlitzer, Folkmann, Grabenwoeger) Hietzing Hospital, Wolkersbergenstr.
1, 1130 Vienna, Austria
(Wagner, Reichenspurner) University Heart Center, Hamburg, Germany
(Pfeiffer, Fischlein) Heart Center, Nuremberg, Germany
(Meinhart) Karl Landsteiner Institute for Cardiovascular Surgery Research,
Hospital Hietzing, Vienna, Austria
Title
Prevention of sternal wound complications after sternotomy: Results of a
large prospective randomized multicentre trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (3) (pp 515-522),
2013. Date of Publication: September 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESA prospective randomized multicentre trial was performed to
analyse the efficacy of a vest (Posthorax support vest) to prevent sternal
wound infection after cardiac surgery, and to identify risk
factors.METHODSFrom September 2007 to March 2010, 2539 patients undergoing
cardiac surgery via median sternotomy were prospectively randomized into
those who received a Posthorax vest and those who did not. Patients were
instructed to wear the vest postoperatively for 24 h a day for at least 6
weeks; the duration of follow-up was 90 days. Patients who did not use the
vest within a period of 72 h postoperatively were regarded as study
dropouts. Statistical calculations were based on an intention-to-treat
(ITT) analysis. Further evaluations comprised all subgroups of
patients.RESULTSComplete data were available for 2539 patients (age 67 +/-
11years, 45% female). Of these, 1351 were randomized to receive a vest,
while 1188 received no vest. No significant differences were observed
between groups regarding age, gender, diabetes, body mass index, chronic
obstructive pulmonary disease (COPD), renal failure, the logistic
EuroSCORE and the indication for surgery. The frequency of deep wound
complications (dWC: mediastinitis and sternal dehiscence) was
significantly lower in vest (n = 14; 1.04%) vs non-vest (n = 27; 2.27%)
patients (ITT, P < 0.01), but superficial complications did not differ
between groups. Subanalysis of vest patients revealed that only 933 (Group
A) wore the vest according to the protocol, while 202 (Group BR) refused
to wear the vest (non-compliance) and 216 (Group BN) did not use the vest
for other reasons. All dWC occurred in Groups BR (n = 7) and BN (n = 7),
although these groups had the same preoperative risk profile as Group A.
Postoperatively, Group BN had a prolonged intubation time, a longer stay
in the intensive care unit, greater use of intra-aortic balloon pump,
higher frequency of COPD and a larger percentage of patients who required
prolonged surgery.CONCLUSIONSConsistent use of the Posthorax vest
prevented deep sternal wounds. The anticipated risk factors for wound
complications did not prove to be relevant, whereas intra- and
postoperative complications appear to be very significant. The Author
2013. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.
<6>
Accession Number
2013529154
Authors
Dubois C. Coosemans M. Rega F. Poortmans G. Belmans A. Adriaenssens T.
Herregods M.-C. Goetschalckx K. Desmet W. Janssens S. Meyns B. Herijgers
P.
Institution
(Dubois, Coosemans, Adriaenssens, Herregods, Goetschalckx, Desmet,
Janssens) Department of Cardiovascular Diseases, University Hospitals
Leuven, Herestraat 49, 3000 Leuven, Belgium
(Dubois, Coosemans, Rega, Poortmans, Adriaenssens, Herregods,
Goetschalckx, Desmet, Janssens, Meyns, Herijgers) Department of
Cardiovascular Sciences, KU Leuven, Leuven, Belgium
(Rega, Meyns, Herijgers) Department of Cardiac Surgery, University
Hospitals Leuven, Leuven, Belgium
(Poortmans) Department of Anesthesiology, University Hospitals Leuven,
Leuven, Belgium
(Belmans) Interuniversity Institute for Biostatistics and Statistical
Bioinformatics, Katholieke Universiteit Leuven, Leuven, Belgium
(Belmans) Universiteit Hasselt, Hasselt, Belgium
Title
Prospective evaluation of clinical outcomes in all-comer high-risk
patients with aortic valve stenosis undergoing medical treatment,
transcatheter or surgical aortic valve implantation following heart team
assessment.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (3) (pp 492-500),
2013. Date of Publication: September 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESTranscatheter aortic valve implantation (TAVI) has been proposed
as a treatment alternative for patients with aortic valve stenosis (AS) at
high or prohibitive risk for surgical aortic valve replacement (AVR). We
aimed to assess real-world outcomes after treatment according to the
decisions of the multidisciplinary heart team.METHODSAt a tertiary centre,
all high-risk patients referred between 1 March 2008 and 31 October 2011
for symptomatic AS were screened and planned to undergo AVR, TAVI or
medical treatment. We report clinical outcomes as defined by the Valve
Academic Research Consortium.RESULTSOf 163 high-risk patients, those
selected for AVR had lower logistic EuroSCORE and STS scores when compared
with TAVI or medical treatment (median [interquartile range] 18 [12-26];
26 [17-36]; 21 [14-32]% (P = 0.015) and 6.5 [5.1-10.7]; 7.6 [5.8-10.5];
7.6 [6.1-15.7]% (P = 0.056)). All-cause mortalities at 1 year in 35, 73
and 55 patients effectively undergoing AVR, TAVI and medical treatment
were 20, 21 and 38%, respectively (P = 0.051). Cardiovascular death and
major stroke occurred in 9, 8 and 33% (P < 0.001) and 6, 4 and 2% (P =
0.62), respectively. For patients undergoing valve implantation, device
success was 91 and 92% for AVR and TAVI, respectively. The combined safety
endpoint at 30 days was in favour of TAVI (29%) vs AVR (63%) (P = 0.001).
In contrast, the combined efficacy endpoint at 1 year tended to be more
favourable for AVR (10 vs 24% for TAVI, P = 0.12).CONCLUSIONSPatients who
are less suitable for AVR can be treated safely and effectively with TAVI
with similar outcomes when compared with patients with a lower-risk
profile undergoing AVR. Patients with TAVI or AVR have better survival
than those undergoing medical treatment only. The Author 2013. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<7>
Accession Number
2013529149
Authors
Baig K. Harling L. Papanikitas J. Attaran S. Ashrafian H. Casula R.
Athanasiou T.
Institution
(Baig, Harling, Papanikitas, Attaran, Ashrafian, Casula, Athanasiou)
Department of Surgery and Cancer, Imperial College London, St. Mary's
Hospital, Praed Street, London W2 1NY, United Kingdom
Title
Does coronary artery bypass grafting improve quality of life in elderly
patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (3) (pp 542-553),
2013. Date of Publication: September 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Traditional outcome measures such as long-term mortality may be of less
value than symptomatic improvement in elderly patients undergoing coronary
artery bypass grafting (CABG). In this systematic review, we analyse
health-related quality of life (HRQOL) as a marker of outcome after CABG.
We aimed to assess the role of HRQOL tools in making recommendations for
elderly patients undergoing surgery, where symptomatic and quality-of-life
improvement may often be the key indications for intervention.
Twenty-three studies, encompassing 4793 patients were included. Overall,
elderly patients underwent CABG at reasonably low risk. Our findings,
therefore, support the conclusion that performing CABG in the elderly may
be associated with significant improvements in HRQOL. In order to overcome
previous methodological limitations, future work must clearly define and
stringently follow-up this elderly population, to develop a more robust,
sensitive and specialty-specific HRQOL tool. The Author 2013. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<8>
Accession Number
2013529144
Authors
Abdulkareem N. Smelt J. Jahangiri M.
Institution
(Abdulkareem, Smelt, Jahangiri) Department of Cardiothoracic Surgery, St.
George's University Hospital, Blackshaw Road, London SW17 0QT, United
Kingdom
Title
Bicuspid aortic valve aortopathy: Genetics, pathophysiology and medical
therapy.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (3) (pp 554-559),
2013. Date of Publication: September 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
The association between ascending aortic aneurysm (AA) and bicuspid aortic
valve (BAV) has been well established. Different genetic, haemodynamic and
cardiovascular risk factors have been implicated in the development and
progression of AA. However, to date, definite conclusions cannot be drawn
regarding the exact molecular, cellular and haemodynamic mechanisms
causing BAV-associated aortopathy. For this study, we performed a thorough
electronic systematic review of the literature using MEDLINE (1960-2012)
and EMBASE databases. MeSH terms included: 'bicuspid aortic valve and
ascending aorta', 'bicommissural aortic valve and aneurysm', 'bicuspid
aortopathy', 'bicuspid aortic valve pathophysiology', 'bicuspid aortic
valve and genetics' and 'bicuspid aortic valve and treatment'. We aim in
this review to discuss the mechanisms, pathophysiology, genetics and
modern drug therapy in the context of BAV-associated aortopathy. The
Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.
<9>
Accession Number
2013508836
Authors
Pandor A.
Institution
(Pandor) School of Health and Related Research (ScHARR) Technology
Assessment Group, University of Sheffield, Regent Court, 30 Regent Street,
Sheffield S1 4DA, United Kingdom
Title
Home telemonitoring or structured telephone support programmes for
patients with heart failure.
Source
Health Technology Assessment. 17 (32) , 2013. Date of Publication: 2013.
Publisher
NIHR Journals Library (Alpha House, Enterprise Road, Southampto SO16 7NS,
United Kingdom)
<10>
Accession Number
2013545294
Authors
Hernandez A.V. Kaw R. Pasupuleti V. Bina P. Ioannidis J.P.A. Bueno H.
Boersma E. Gillinov M.
Institution
(Hernandez) Postgraduate School, Universidad Peruana de Ciencias Aplicadas
(UPC), Av Salaverry 2255, San Isidro, Lima 27, Peru
(Hernandez) Health Outcomes and Clinical Epidemiology Section, Department
of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH,
United States
(Kaw, Pasupuleti, Bina) Department of Hospital Medicine and Outcomes
Research (Anesthesiology), Cleveland Clinic, Cleveland, OH, United States
(Ioannidis) Stanford Prevention Research Center, Department of Medicine,
Stanford University School of Medicine, Stanford, CA, United States
(Bueno) Department of Cardiology, Hospital Universitario Gregorio Maranon,
Madrid, Spain
(Boersma) Clinical Epidemiology Unit, Department of Cardiology, Erasmus
Medical Center, Rotterdam, Netherlands
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
Title
Association between obesity and postoperative atrial fibrillation in
patients undergoing cardiac operations: A systematic review and
meta-analysis.
Source
Annals of Thoracic Surgery. 96 (3) (pp 1104-1116), 2013. Date of
Publication: September 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
In a systematic review and random-effects meta-analysis, we evaluated
whether obesity is associated with postoperative atrial fibrillation
(POAF) in patients undergoing cardiac operations. We selected 18
observational studies until December 2011 that excluded patients with
preoperative AF (n = 36,147). Obese patients had a modest higher risk of
POAF compared with nonobese (odds ratio, 1.12; 95% confidence interval,
1.04 to 1.21; p = 0.002). The association between obesity and POAF did not
vary substantially by type of cardiac operation, study design, or year of
publication. POAF was significantly associated with a higher risk of
stroke, respiratory failure, and operative death. 2013 by The Society of
Thoracic Surgeons.
<11>
Accession Number
2013545277
Authors
Wagner T.H. Hattler B. Bishawi M. Baltz J.H. Collins J.F. Quin J.A. Grover
F.L. Shroyer A.L.W.
Institution
(Wagner) VA Palo Alto Health Economics Resource Center (HERC), Department
of Health Research and Policy, Stanford University, 795 Willow Rd,
152-MPD, Menlo Park, CA 94025, United States
(Wagner) Department of Health Research and Policy, Stanford University,
Stanford, CA, United States
(Hattler, Baltz, Grover, Shroyer) Eastern Colorado Health Care System,
Department of Veterans Affairs, Denver, CO, United States
(Hattler, Grover) University of Colorado, School of Medicine, Anschutz
Medical Campus, Aurora, CO, United States
(Bishawi, Shroyer) Northport VA Medical Center, Northport, NY, United
States
(Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Perry Point, MD, United States
(Quin) VA Boston Healthcare System, West Roxbury, MA, United States
Title
On-pump versus off-pump coronary artery bypass surgery: Cost-effectiveness
analysis alongside a multisite trial.
Source
Annals of Thoracic Surgery. 96 (3) (pp 770-777), 2013. Date of
Publication: September 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Questions have been raised about the costs and outcomes for
patients receiving on-pump and off-pump coronary artery bypass graft
surgery. As part of the Department of Veterans Affairs Randomized On/Off
Bypass (ROOBY) multisite trial, a cost-effectiveness analysis was
performed to compare on-pump versus off-pump patients' quality-adjusted
life-years and costs at 1 year. Methods: One-year outcomes and costs
(standardized to 2010 dollars) were estimated in multivariate regression
models, controlling for site and baseline patient factors. The 1-year
incremental cost-effectiveness analysis ratio with 95% confidence
intervals was calculated using bootstrapping. Results: Eighteen centers
randomly assigned 2,203 participants to on-pump (n = 1,099) versus
off-pump (n = 1,104) coronary artery bypass graft surgery. Both groups'
quality of life improved significantly after surgery (p < 0.01) compared
with baseline, but no differences were found between treatment groups.
Adjusted cost of the index coronary artery bypass graft surgery
hospitalization was $36,046 on-pump and $36,536 off-pump (p = 0.16). At 1
year, on-pump adjusted cost was $56,023 versus $59,623 off-pump (p =
0.046). Off-pump-to-on-pump conversions after first distal anastomosis
(4.8%) had significantly higher 1-year costs. Excluding conversions, there
were no significant differences between treatments for index
hospitalization or 1-year total costs. Conclusions: At 1 year, off-pump
coronary artery bypass graft surgery was more expensive than on-pump when
late off-pump-to-on-pump conversions were included. Excluding late
conversions, there was no difference in quality-adjusted life-years or
costs. 2013 by The Society of Thoracic Surgeons.
<12>
Accession Number
2013545252
Authors
Matsuhisa H. Yoshimura N. Higuma T. Misaki T. Onuma Y. Ichida F. Oshima Y.
Okita Y.
Institution
(Matsuhisa, Yoshimura, Higuma, Misaki) First Department of Surgery,
University of Toyama, Graduate School of Medicine, Toyama, Japan
(Onuma, Ichida) Department of Pediatrics, University of Toyama, Graduate
School of Medicine, Toyama, Japan
(Oshima) Department of Cardiovascular Surgery, Kobe Children's Hospital,
Kobe, Japan
(Okita) Division of Cardiovascular Surgery, Department of Surgery, Kobe
University Graduate School of Medicine, Kobe, Japan
Title
Ventricular septal dysfunction after surgical closure of multiple
ventricular septal defects.
Source
Annals of Thoracic Surgery. 96 (3) (pp 891-897), 2013. Date of
Publication: September 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: We assessed the global and regional ventricular septal
functions using conventional echocardiography and two-dimensional speckle
tracking imaging in children with postoperative multiple ventricular
septal defects. Methods: Thirty-six children were studied: 16 with
postoperative multiple ventricular septal defects and 20 normal control
subjects. In children with multiple ventricular septal defects, 60
ventricular septal defects were closed using one of three different
techniques (patch closure, the sandwich technique, direct closure).
Speckle tracking imaging was applied to three short-axis echocardiographic
images. Results: The total patch area used in the multiple ventricular
septal defects group was correlated with the postoperative ejection
fraction (r = 0.703) and Tei index (r = 0.778). The global septal peak
systolic radial displacement and global septal peak systolic radial strain
in the multiple ventricular septal defects group were significantly lower
than those observed in the control subjects. The peak systolic radial
strain in the segments closed with patches and the peak systolic radial
displacement in the segments closed with the felt sandwich technique were
significantly lower than those observed in the intact septal segments. No
significant regional functional depressions were identified in the
segments that were closed directly. Conclusions: The postoperative
ventricular global and septal functions were significantly reduced in
children with multiple ventricular septal defects, especially in the cases
with complex congenital heart disease and that were closed with large
prosthetic materials. These results suggest that an effort to minimize the
use of patch materials may lead to preserved postoperative ventricular
function. 2013 by The Society of Thoracic Surgeons.
<13>
[Use Link to view the full text]
Accession Number
2013547589
Authors
Woo J.S. Kim W. Ha S.J. Kim J.B. Kim S.-J. Kim W.-S. Seon H.J. Kim K.S.
Institution
(Woo, Kim, Ha, Kim, Kim, Kim, Kim) Division of Cardiology, Department of
Internal Medicine, Kyung Hee University Hospital, #1 Hoeki-Dong,
Dongdaemoon-Gu, Seoul 130-702, South Korea
(Seon) Department of Radiology, Chonnam National University Hospital,
Gwangju, South Korea
Title
Cardioprotective effects of exenatide in patients with
ST-segment-elevation myocardial infarction undergoing primary percutaneous
coronary intervention: Results of exenatide myocardial protection in
revascularization study.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. 33 (9) (pp 2252-2260),
2013. Date of Publication: September 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Objective-Experimental evidence suggests that exenatide, a glucagon-like
peptide 1 receptor analogue, has significant cardiovascular protective
effects in various conditions. We examined whether routine use of
exenatide at the time of primary percutaneous coronary intervention would
reduce infarct size in patients with ST-segment-elevation myocardial
infarction. Approach and Results-Fifty-eight patients with
ST-segment-elevation myocardial infarction and thrombolysis in myocardial
infarction flow 0 were enrolled in the study and randomly assigned to
receive either exenatide or placebo (saline) subcutaneously. Infarct size
was assessed by measuring the release of creatine kinase-MB and troponin I
during 72 hours and by performing cardiac magnetic resonance imaging at 1
month after infarction. Routine and speckle tracking echocardiography was
performed at initial presentation and at 3 days and 6 months after primary
percutaneous coronary intervention. The exenatide and control groups had
similar results with respect to ischemia time, demographic
characteristics, and ejection fraction before primary percutaneous
coronary intervention. The releases of creatine kinase-MB and troponin I
were significantly reduced in the exenatide group. In 58 patients
evaluated with cardiac magnetic resonance, the absolute mass of delayed
hyperenhancement was significantly reduced in the exenatide group as
compared with the control group (12.8+/-11.7 versus 26.4+/-11.6 g;
P<0.01). At 6 months, the exenatide group showed a significantly lower
value of E/E' with improved strain parameters. No significant adverse
effects of exenatide administration were detected. Conclusions-In patients
with ST-segment-elevation myocardial infarction, adjunctive exenatide
therapy with primary percutaneous coronary intervention was associated
with reduction of infarct size and improvement of subclinical left
ventricular function. 2013 American Heart Association, Inc.
<14>
Accession Number
2013540728
Authors
Crisafulli E. Venturelli E. Siscaro G. Florini F. Papetti A. Lugli D.
Cerulli M. Clini E.
Institution
(Crisafulli, Venturelli, Siscaro, Clini) University of Modena, DU of
Medical and Surgical Sciences, Via del Pozzo 171, 41121 Modena, Italy
(Siscaro, Florini, Papetti, Lugli, Cerulli, Clini) Villa Pineta Hospital,
Lung Unit and Pulmonary Rehabilitation, Via Gaiato 127, 41020 Pavullo nel
Frignano, Modena, Italy
Title
Respiratory muscle training in patients recovering recent open
cardiothoracic surgery: A randomized-controlled trial.
Source
BioMed Research International. 2013 , 2013. Article Number: 354276. Date
of Publication: 2013.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Objectives. To evaluate the clinical efficacy and feasibility of an
expiratory muscle training (EMT) device (Respilift) applied to patients
recovering from recent open cardiothoracic surgery (CTS). Design.
Prospective, double-blind, 14-day randomised-controlled trial.
Participants and Setting. A total of 60 inpatients recovering from recent
CTS and early admitted to a pulmonary rehabilitation program.
Interventions. Chest physiotherapy plus EMT with a resistive load of 30 cm
H<sub>2</sub>O for active group and chest physiotherapy plus EMT with a
sham load for control group. Measures. Changes in maximal expiratory
pressure (MEP) were considered as primary outcome, while maximal
inspiratory pressures (MIP), dynamic and static lung volumes, oxygenation,
perceived symptoms of dyspnoea, thoracic pain, and well being (evaluated
by visual analogic scale - VAS) and general health status were considered
secondary outcomes. Results. All outcomes recorded showed significant
improvements in both groups; however, the change of MEP (+34.2 mmHg, P <
0.001 and +26.1%, P < 0.001 for absolute and % of predicted, resp.) was
significantly higher in active group. Also VAS dyspnoea improved faster
and more significantly (P < 0.05) at day 12, and 14 in active group when
compared with control. The drop-out rate was 6%, without differences
between groups. Conclusions. In patients recovering from recent CTS,
specific EMT by Respilift is feasible and effective. This trial is
registered with ClinicalTrials.gov NCT01510275. 2013 Ernesto Crisafulli
et al.
<15>
Accession Number
2013531253
Authors
Peco-Antic A. Ivanisevic I. Vulicevic I. Kotur-Stevuljevic J. Ilic S.
Ivanisevic J. Miljkovic M. Kocev N.
Institution
(Peco-Antic, Kocev) School of Medicine, University of Belgrade, Belgrade,
Serbia
(Peco-Antic, Ivanisevic) Department of Nephrology, University Children's
Hospital, Belgrade, Serbia
(Vulicevic, Ilic) Department of Cardio-surgery, University Children's
Hospital, Belgrade, Serbia
(Kotur-Stevuljevic, Ivanisevic, Miljkovic) Faculty of Pharmacy, University
of Belgrade, Belgrade, Serbia
Title
Biomarkers of acute kidney injury in pediatric cardiac surgery.
Source
Clinical Biochemistry. 46 (13-14) (pp 1244-1251), 2013. Date of
Publication: 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: Acute kidney injury (AKI) is a significant problem in children
undergoing cardiopulmonary bypass (CPB). The aims of this study were to
assess the diagnostic validity of serum CysC (sCysC), serum neutrophil
gelatinase lipocalin (sNGAL), urine neutrophil gelatinase lipocalin
(uNGAL), urine kidney injury molecule (uKIM)-1, and urine liver fatty
acid-binding protein (uL-FABP) to predict AKI presence and severity in
children undergoing CPB. Design and methods: We performed a prospective
single-center evaluation of sCysC, sNGAL, uNGAL, uKIM-1 and uL-FABP at 0,
2, 6, 24 and 48. h postoperatively in children undergoing CPB during
cardiac surgery. AKI was defined as >=. 25% decrease in the estimated
creatinine clearance (eCCl) from pre-operative baseline at 48. h after
surgery. Results: Of the 112 patients, 18 patients (16.1%) developed AKI;
four of them needed acute dialysis treatment and three AKI patients died.
In the AKI compared to the non-AKI group, sCysC at 2. h, and uNGAL and
uL-FABP at 2-48. h were significantly increased, as well as CPB, aortic
cross clamp time and length of hospital stay. Biomarkers increased with
worsening AKI severity. At 2. h after CPB the best accuracy for diagnosis
of AKI had uL-FABP and sCysC with area under the receiver operator curve
(AUC) of 0.89 and 0.73, respectively. At 6 and 24. h after CPB the best
AUC was found for uL-FABP (0.75 and 0.87 respectively) and for uNGAL (0.70
and 0.93, respectively). Conclusions: sCysC, uNGAL and uL-FABP are
reliable early predictors for AKI after CPB. By allowing earlier timing of
injury and earlier intervention, they could improve AKI outcome. 2013 The
Canadian Society of Clinical Chemists.
<16>
Accession Number
71160620
Authors
Staveski S. Abrajano C. Casazza M. Dong E. Petty A. Felix K. Quan H. Bair
E. Roth S.J.
Institution
(Staveski, Abrajano, Casazza, Dong, Petty, Felix, Quan, Bair, Roth) Lucile
Packard Children's Hospital at Stanford, Palo Alto, CA, United States
(Staveski) University of California at San Francisco, School of Nursing,
Palo Alto, CA, United States
(Roth) Stanford University, School of Medicine, Palo Alto, CA, United
States
Title
Silver dressings for sternotomy incision care in pediatric cardiac
patients to decrease surgical site infections.
Source
Pediatric Critical Care Medicine. Conference: 9th International Conference
of the Pediatric Cardiac Intensive Care Society Miami Beach, FL United
States. Conference Start: 20121209 Conference End: 20121212. Conference
Publication: (var.pagings). 14 (5 SUPPL. 1) (pp S97), 2013. Date of
Publication: June 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Bacground and aims/Introduction: The consequences of surgical site
infections (SSIs) can be significant and range from discharge delays to
mediastinitis. The increased costs associated with each SSI are
significiant. The purpose of our study was to assess the infection
prevention effects of silver-impregnated dressings on post-operative
pediatric cardiac surgery patients. Our aim was to reduce the incidence of
SSIs. Methods: Our population included infants to adolescents < 19 years
of age and cardiac diagnoses ranging from RACHS-1 score 1 to 6. The final
sample was 122 children (silver = 62; standard = 60). The sample size was
chosen for a clinically-important effect size of 0.5 in the detection of
differences in SSI rates with > 75% power at a level of 0.05. Appropriate
dressings were applied in the operating room, and children were followed
for five days post-operatively or until discharge. The ASEPSIS wound score
is a validated wound assessment tool; it was utilized to assess for wound
infections. The study team supervised all dressing changes during the
study period. Thirty-day follow up for SSIs was performed. This randomized
controlled trial evaluated silver-impregnated dressing versus our standard
dressings on SSI rates. Results: There were no SSIs in either study group.
We found that there were no difference in type of dressing utilized on SSI
rates. Conclusions: Our study does not support the use of
silver-impregnated dressings in children after congenital heart surgery as
a SSI prevention method.
No comments:
Post a Comment