Results Generated From:
Embase <1980 to 2013 Week 43>
Embase (updates since 2013-10-17)
<1>
Accession Number
2013642667
Authors
Kraal J.J. Peek N. van den Akker-Van Marle M.E. Kemps H.M.C.
Institution
(Kraal, Peek, Kemps) Department of Medical Informatics, Academic Medical
Center, University of Amsterdam, Amsterdam, Netherlands
(van den Akker-Van Marle) Department of Medical Decision Making, Leiden
University Medical Center, Leiden, Netherlands
(Kemps) Department of Cardiology, Maxima Medical Center, Veldhoven,
Netherlands
Title
Effects and costs of home-based training with telemonitoring guidance in
low to moderate risk patients entering cardiac rehabilitation: The
FIT@Home study.
Source
BMC Cardiovascular Disorders. 13 , 2013. Article Number: 82. Date of
Publication: 08 Oct 2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Physical training has beneficial effects on exercise capacity,
quality of life and mortality in patients after a cardiac event or
intervention and is therefore a core component of cardiac rehabilitation.
However, cardiac rehabilitation uptake is low and effects tend to decrease
after the initial rehabilitation period. Home-based training has the
potential to increase cardiac rehabilitation uptake, and was shown to be
safe and effective in improving short-term exercise capacity. Long-term
effects on physical fitness and activity, however, are disappointing.
Therefore, we propose a novel strategy using telemonitoring guidance based
on objective training data acquired during exercise at home. In this way,
we aim to improve self-management skills like self-efficacy and action
planning for independent exercise and, consequently, improve long-term
effectiveness with respect to physical fitness and physical activity. In
addition, we aim to compare costs of this strategy with centre-based
cardiac rehabilitation.Methods/design: This randomized controlled trial
compares a 12-week telemonitoring guided home-based training program with
a regular, 12-week centre-based training program of equal duration and
training intensity in low to moderate risk patients entering cardiac
rehabilitation after an acute coronary syndrome or cardiac intervention.
The home-based group receives three supervised training sessions before
they commence training with a heart rate monitor in their home
environment. Participants are instructed to train at 70-85% of their
maximal heart rate for 45-60 minutes, twice a week. Patients receive
individual coaching by telephone once a week, based on measured heart rate
data that are shared through the internet. Primary endpoints are physical
fitness and physical activity, assessed at baseline, after 12 weeks and
after one year. Physical fitness is expressed as peak oxygen uptake,
assessed by symptom limited exercise testing with gas exchange analysis;
physical activity is expressed as physical activity energy expenditure,
assessed by tri-axial accelerometry and heart rate measurements. Secondary
endpoints are training adherence, quality of life, patient satisfaction
and cost-effectiveness.Discussion: This study will increase insight in
long-term effectiveness and costs of home-based cardiac rehabilitation
with telemonitoring guidance. This strategy is in line with the trend to
shift non-complex healthcare services towards patients' home environments.
Trial registration: Dutch Trial Register: NTR3780. Clinicaltrials.gov
register: NCT01732419. 2013 Kraal et al.; licensee BioMed Central Ltd.
<2>
[Use Link to view the full text]
Accession Number
2013644177
Authors
Munoz P. Valerio M. Palomo J. Giannella M. Yanez J.F. Desco M. Bouza E.
Institution
(Munoz, Valerio, Giannella, Bouza) Department of Clinical Microbiology and
Infectious Diseases, Hospital General Universitario Gregorio Maranon,
Madrid, Spain
(Palomo, Yanez) Department of Cardiology, Hospital General Universitario
Gregorio Maranon, Madrid, Spain
(Desco) Department of Experimental Medicine, Hospital General
Universitario Gregorio Maranon, Madrid, Spain
(Munoz, Bouza) Department of Medicine, Universidad Complutense de Madrid,
Madrid, Spain
(Munoz, Bouza) Red Espanola de Investigacion en Patologia Infecciosa
(REIPI), Madrid, Spain
(Munoz, Bouza) CIBER de Enfermedades Respiratorias (CIBER RES), Palma
deMallorca, Spain
(Munoz, Bouza) Spanish Study Group of Infections in Transplant Recipients
(GESITRA), Madrid, Spain
(Desco) Department of Bioengineering and Aerospace Engineering,
Universidad Carlos III de Madrid, Spain
Title
Targeted antifungal prophylaxis in heart transplant recipients.
Source
Transplantation. 96 (7) (pp 664-669), 2013. Date of Publication: 15 Oct
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND: Antifungal prophylaxis after heart transplantation is usually
targeted to high-risk recipients, but the duration is normally fixed and
empirical. Our purpose was to assess the efficacy of a personalized
prophylactic approach based on the duration of the risk factors. METHODS:
In a prospective cohort, from 2003 to 2010, prophylaxis was only
administered to patients with risk factors (13 of 133) and duration was
personalized, starting with the risk factor and continued a median of 20
days after its resolution. RESULTS: Antifungal prophylaxis was prescribed
only in 9.8% of the recipients and was effective in all but one patient
who should have received a higher dose of caspofungin due to his obesity.
Despite suffering an outbreak of invasive aspergillosis (IA) in the
intensive care unit due to extremely high concentration of spores in the
air (three cases with no personal risk factors), there was a reduction in
the incidence of IA (8.6% vs. 2.2%; P=0.01) and Aspergillus-related
mortality (5.75% vs. 1.5%; P=0.06). CONCLUSIONS: Targeted prophylaxis for
IA in heart recipients provided only to patients with risk factors and
maintained for a median of 20 days after their disappearance is effective
and safe. A high environmental load of Aspergillus spores in the intensive
care unit would also indicate the need for antifungal prophylaxis in all
exposed patients. Copyright 2013 by Lippincott Williams & Wilkins.
<3>
Accession Number
2013612654
Authors
Chatterjee S. Ghose A. Sharma A. Guha G. Mukherjee D. Frankel R.
Institution
(Chatterjee, Sharma, Frankel) Maimonides Medical Center, 864 49th Street
Apt C11, Brooklyn NY 11220, United States
(Ghose) University of Toledo, Toledo OH, United States
(Guha) Oregon State University, Corvallis OR, United States
(Mukherjee) Texas Tech University Health Sciences Center, El Paso TX,
United States
Title
Comparing newer oral anti-platelets prasugrel and ticagrelor in reduction
of ischemic events-evidence from a network meta-analysis.
Source
Journal of Thrombosis and Thrombolysis. 36 (3) (pp 223-232), 2013. Date of
Publication: October 2013.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
The two newer antiplatelet drugs, prasugrel and ticagrelor have both been
incorporated in various national guidelines and are both under
consideration for approval or have already been approved by various drug
regulatory authorities. Mortality benefits with clopidogrel were
comparable to newer anti-platelets, and prasugrel had great anti-ischemic
potency than ticagrelor. We searched PubMed, EMBASE and Cochrane Central
Register of Controlled Trials' databases for randomized controlled trials
conducted between 1990 and 2012 that assessed clinical outcomes with
prasugrel or ticagrelor. The comparator was standard dosage of
clopidogrel. Outcomes assessed were the risk of all causes mortality, TIMI
non-CABG major bleeding, and a composite of stent thrombosis, recurrent
ischemia and serious recurrent ischemia in the intervention groups versus
the comparator groups. Event rates were compared using a forest plot of
relative risk using a random effects model (Mantel-Haenszel); and Odd's
ratio was calculated in the absence of significant heterogeneity.
Prasugrel was indirectly compared with ticagrelor using network
meta-analysis. Four studies (total N = 34,126) met the inclusion/exclusion
criteria. Both drugs had improved mortality and greater risk of bleeding
compared to clopidogrel; but outcomes were comparable for both (p = NS).
However a composite of recurrent ischemic events, including rates of stent
thrombosis (p = 0.045) was reduced to a modest degree with prasugrel
compared with ticagrelor. This systematic review suggests greater clinical
efficacy of both prasugrel and ticagrelor compared with clopidogrel and an
indirect comparison indicates prasugrel may be more effective than
ticagrelor for preventing stent thrombosis and recurrent ischemic events.
2012 Springer Science+Business Media New York.
<4>
Accession Number
2013639236
Authors
Laiq N. Khan R.A. Malik A.
Institution
(Laiq) Department of Anaesthesia, Lady Reading Hospital Peshawar, Pakistan
(Khan, Malik) Department of Cardiovascular Surgery, Lady Reading Hospital
Peshawar, Pakistan
Title
Non-invasive positive pressure ventilation facilitates early extubation in
post operative cardiac patients.
Source
Journal of Postgraduate Medical Institute. 27 (4) (pp 361-365), 2013. Date
of Publication: 2013.
Publisher
Postgraduate Medical Institute (Lady Reading Hospital, Peshawar, Pakistan)
Abstract
Objectives: To assess the use of NIPPV (non-invasive positive pressure
ventilation) during weaning from mechanical ventilation in post-op
patients in an ICU and compared this procedure with intermittent mandatory
ventilation (IMV) by analyzing cardiac and respiratory parameters and
complications. Methodology: A randomized clinical trial was conducted from
June 2009 to July 2010 on Post-operative surgical patients that were on
IMV for more than 48 hours, who failed at 30 minutes of spontaneous
breathing T-piece trial (SBT). If failure occurred before the 30th minute,
he/she was included in the group previously defined by random assignment.
Patients in the experimental group were extubated and placed on NIPPV,
whereas other patients (the control group) returned to IMV. Daily SBT was
carried out thereafter in order to evaluate the possibility of extubation
in control group. Results: Of 60 patients who failed T-piece trials, 30
patients were placed on NIPPV & 30 on (IMV). The ages of patients in the
NIPPV and IMV groups were 45.7+/- 18.11 and 47.10 +/- 18.45 years
respectively. In both groups, ventilation time before T-piece trial was
2-3 days. Patients of the NIPPV group had a shorter stay in the ICU and in
the hospital i.e., 2.93 +/-0.785 days versus 7.4+1.11 days for IMV group.
No serious complications were observed in both groups. Conclusion: The
results of this study suggest that the combination of early extubation and
NIPPV is a good alternative.
<5>
Accession Number
2013644910
Authors
De Gast-Bakker D.H. De Wilde R.B.P. Hazekamp M.G. Sojak V. Zwaginga J.J.
Wolterbeek R. De Jonge E. Gesink-Van Der Veer B.J.
Institution
(De Gast-Bakker, De Wilde, De Jonge, Gesink-Van Der Veer) Pediatric
Intensive Care Unit, Leiden University Medical Center, Leiden, Netherlands
(Hazekamp, Sojak) Department of Cardiothoracic Surgery, Leiden University
Medical Center, Leiden, Netherlands
(Zwaginga) Center for Clinical Transfusion Research, Sanquin Research,
Leiden, Netherlands
(Zwaginga) Department of Immuno-hematology and Blood Transfusion, Leiden
University Medical Center, Leiden, Netherlands
(Wolterbeek) Department of Medical Statistics and Bioinformatics, Leiden
University Medical Center, Leiden, Netherlands
(De Wilde) Albinusdreef 2, 2300 RC Leiden, Netherlands
Title
Safety and effects of two red blood cell transfusion strategies in
pediatric cardiac surgery patients: A randomized controlled trial.
Source
Intensive Care Medicine. 39 (11) (pp 2011-2019), 2013. Date of
Publication: 2013.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Objective: To investigate the safety and effects of a restrictive red
blood cell (RBC) transfusion strategy in pediatric cardiac surgery
patients. Design: Randomized controlled trial. Setting: Pediatric ICU in
an academic tertiary care center, Leiden University Medical Center,
Leiden, The Netherlands. Patients: One hundred seven patients with
non-cyanotic congenital heart defects between 6 weeks and 6 years of age.
One hundred three patients underwent corrective surgery on cardiopulmonary
bypass. Interventions: Prior to surgery patients were randomly assigned to
one of two groups with specific RBC transfusion thresholds: Hb 10.8 g/dl
(6.8 mmol/l) and Hb 8.0 g/dl (5.0 mmol/l). Measurements: Length of stay in
hospital (primary outcome), length of stay in PICU, duration of
ventilation (secondary outcome), incidence of adverse events and
complications related to randomization (intention to treat analysis).
Results: In the restrictive transfusion group, mean volume of transfused
RBC was 186 (+/-70) ml per patient and in the liberal transfusion group
258 (+/-87) ml per patient, (95 % CI 40.6-104.6), p < 0.001. Length of
hospital stay was shorter in patients with a restrictive RBC transfusion
strategy: Median 8 (IQR 7-11) vs. 9 (IQR 7-14) days, p = 0.047. All other
outcome measures and incidence of adverse effects were equal in both RBC
transfusion groups. Cost of blood products for the liberal transfusion
group was 438.35 (+/-203.39) vs. 316.27 (+/-189.96) euros (95 % CI
46.61-197.51) per patient in the restrictive transfusion group, p = 0.002.
Conclusions: For patients with a non-cyanotic congenital heart defect
undergoing elective cardiac surgery, a restrictive RBC transfusion policy
(threshold of Hb 8.0 g/dl) during the entire perioperative period is safe,
leads to a shorter hospital stay and is less expensive. 2013
Springer-Verlag Berlin Heidelberg and ESICM.
<6>
Accession Number
2013644886
Authors
Mesgarpour B. Heidinger B.H. Schwameis M. Kienbacher C. Walsh C. Schmitz
S. Herkner H.
Institution
(Mesgarpour, Heidinger, Schwameis, Kienbacher, Herkner) Department of
Emergency Medicine, General Hospital, Medical University of Vienna,
Wahringer Gurtel 18-20, 1090 Vienna, Austria
(Mesgarpour, Schwameis) Department of Clinical Pharmacology, Medical
University of Vienna, Vienna, Austria
(Walsh) Department of Statistics, Trinity College Dublin, Dublin, Ireland
(Schmitz) Department of Pharmacology and Therapeutics, Trinity College
Dublin, Dublin, Ireland
Title
Safety of off-label erythropoiesis stimulating agents in critically ill
patients: A meta-analysis.
Source
Intensive Care Medicine. 39 (11) (pp 1896-1908), 2013. Date of
Publication: 2013.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: Erythropoiesis stimulating agents (ESAs) are used to treat anemia
in critically ill patients. This indication is off-label, because it is
not licensed by regulatory authorities. Recently ESAs were suspected to
harm critically ill patients. Our objective was to assess the safety of
ESAs in off-label indications in critically ill patients. Methods: Eleven
databases were searched up to April 2012. We considered randomized
controlled trials (RCTs) and controlled observational studies in any
language that compared off-label ESAs treatment with other effective
interventions, placebo or no treatment in critically ill patients. Two
authors independently screened and evaluated retrieved records, extracted
data and assessed risk of bias and quality of reporting. Results: We used
frequentist and Bayesian models to combine studies, and performed
sensitivity and subgroup analyses. From 12,888 citations, we included 48
studies (34 RCTs; 14 observational), involving 944,856 participants. Harm
reporting was of medium to low quality. There was no statistically
significant increased risk of adverse events in general, serious adverse
events, the most frequently reported adverse events, and death in
critically ill patients treated with ESAs. These results were robust
against risk of bias and analysis methods. There is evidence that ESAs
increase the risk of clinically relevant thrombotic vascular events, and
there is some less certain evidence that ESAs might increase the risk for
venous thromboembolism. Conclusions: In critically ill patients,
administration of ESAs is associated with a significant increase in
clinically relevant thrombotic vascular events but not with other
frequently reported adverse events and death. 2013 Springer-Verlag Berlin
Heidelberg and ESICM.
<7>
[Use Link to view the full text]
Accession Number
2013640357
Authors
Presutti D.G. D'Ascenzo F. Omede P. Biondi-Zoccai G. Moretti C. Bollati M.
Sciuto F. Lee M.S. Moreno R. Bikkina M. Di Cuia M. Resmini C. Gaita F.
Sheiban I.
Institution
(Presutti, D'Ascenzo, Omede, Moretti, Sciuto, Di Cuia, Resmini, Gaita,
Sheiban) Division of Cardiology, Department of Internal Medicine,
University of Turin, Turin, Italy
(Bikkina) Department of Cardiology, St.Joseph's Regional Medical Center,
Paterson, NJ, United States
(Lee) Division of Cardiology, David Geffen School of Medicine, University
of California, Los Angeles, CA, United States
(Moreno) Division of Interventional Cardiology, Instituto Cardiovascular,
Hospital la Paz, Paseo La Castellana, Madrid, Spain
(Biondi-Zoccai) Department of Medico-Surgical Sciences, Biotechnologies
Sapienza University of Rome, Italy
(Bollati) Invasive Cardiology, Campus Middelheim, Antwerpen, Belgium
(D'Ascenzo, Biondi-Zoccai, Moretti) Meta-analysis and Evidence Based
Medicine Training in Cardiology, Italy
Title
Percutaneous coronary intervention in nonagenarian: A meta-analysis of
observational studies.
Source
Journal of Cardiovascular Medicine. 14 (11) (pp 773-779), 2013. Date of
Publication: November 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND: Developed countries are facing a sustained increase in life
expectancy. Along with all social and cultural implications of increase
lifespan, very elderly patients are undergoing percutaneous coronary
intervention (PCI) with increasing frequency. However, there is limited
evidence to guide clinicians in evaluating pros and cons of PCI in this
very frail patient population. We, thus, aimed to perform a systematic
review and meta-analysis of clinical studies reporting on PCI with
stenting in nonagenarians. METHODS: Studies reporting on five or more
nonagenarians undergoing PCI were systematically searched in PubMed (last
updated on November 2011). Baseline and clinical characteristics,
in-hospital and long-term outcomes were systematically appraised. End
points of interest were in-hospital and long-term follow-up incidence of
death and Major Adverse Cardiac Events (MACE; i.e. the composite of death
from all causes, myocardial infarction or repeat revascularization).
Events were pooled with a random-effect model, generating summary
estimates of incidence rates [95% confidence intervals (CI)]. RESULTS: A
total of 10 studies were included, reporting on a total of 575
nonagenarians undergoing PCI with stenting who represented 1.99%
(1.34-2.5) of those undergoing revascularization in the cath lab in a mean
period of 5 (3-7) years. Twenty-three percent (13-45) of patients
presented with STEMI (ST Segment Elevation Myocardial Infarction), 10%
(7-12) with cardiogenic shock and in 78% (64-88) of cases a multivessel
disease was diagnosed. Meta-analytic pooling of event rates showed an
in-hospital death risk of 12.61% (9.71-15.50) with MACE in 16.41%
(13.36-19.47). After a follow-up ranging from 6 to 29 months (median 12),
the risk of long-term death was 31.00% (17.10-45.52), with MACE in 37.00%
(19.56-55.95; all CI 95%). CONCLUSION: Our meta-analysis, pooling the
largest cohort ever of nonagenarians undergoing PCI with stents, confirms
the feasibility of percutaneous coronary stenting even in this very frail
patient subset, despite the expected severe event attrition during
follow-up. Thus, nonagenarians with an acceptable risk profile, recent
clinical instability and/or disabling symptoms should not be denied the
possibility of percutaneous coronary revascularization. 2013 Italian
Federation of Cardiology.
<8>
Accession Number
2013615216
Authors
Mier J.M. Chavarin A. Izquierdo-Vidal C. Fibla J.J. Molins L.
Institution
(Mier, Chavarin, Izquierdo-Vidal, Fibla, Molins) Hospital Universitari
Sagrat Cor, c/Viladomat 288, 08029 Barcelona, Spain
Title
A prospective study comparing three-port video-assisted thoracoscopy with
the single-incision laparoscopic surgery (SILS) port and instruments for
the video thoracoscopic approach: A pilot study.
Source
Surgical Endoscopy and Other Interventional Techniques. 27 (7) (pp
2557-2560), 2013. Date of Publication: July 2013.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
Background: Single-incision laparoscopic surgery (SILS) has proved its
advantages in several procedures, mainly a shorter hospital stay, improved
aesthetic results, and less postoperative pain. The authors have used this
approach for several thoracic surgical procedures. Methods: This
prospective study compared 20 cases between standard three-port
video-assisted thoracic surgery (VATS) and the single-incision approach
using a standard abdominal SILS system. In both groups, postsurgical
analgesia was provided with 15 ml of bupivacaine 0.5% at 3 h intervals via
a paravertebral catheter. The hospital length of stay and chest drain
duration (in hours) were recorded as well as postoperative pain using an
analogic visual pain scale (AVPS). A telephone survey was conducted for
all the outpatients. The Mann-Whitney U test was used for statistical
analysis. Results: This study of 20 procedures included 11 lung biopsies,
6 pneumothorax procedures, 2 mediastinic cystectomies, and 1 catamenial
pneumothorax procedure. No statistically significant difference was
reported in hospital length of stay or chest drain duration between the
two groups. However, postoperative pain at 24 h was significantly less in
the SILS group (AVPS, 4.40) than in the VATS group (AVPS, 6.20) (p =
0.035). The SILS group reported two minor surgical wound complications and
one catamenial pneumothorax recurrence that did not require drainage. The
VATS group reported one case of skin rash with no identifiable cause.
Conclusions: The use of the SILS port in thoracic surgery results in less
postoperative pain. This is related to the port's protective effect over
the periostium and the intercostal nerve, relieving them of direct contact
with surgical instruments. However, the findings showed a higher incidence
of surgical wound complications with the SILS port, which can be
attributed to increased pressure on the skin and soft tissues surrounding
the port and to the fact that this same incision was used for chest drain
placement, thus increasing the risk for complications. 2013 Springer
Science+Business Media New York.
<9>
Accession Number
2013644738
Authors
Dwyer N.B. Mikami Y. Hilland D. Aljizeeri A. Friedrich M.G. Traboulsi M.
Anderson T.J.
Institution
(Dwyer, Mikami, Hilland, Friedrich, Traboulsi, Anderson) Department of
Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of
Calgary, Calgary, AB, Canada
(Aljizeeri) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, ON, Canada
Title
No cardioprotective benefit of ischemic postconditioning in patients with
ST-segment elevation myocardial infarction.
Source
Journal of Interventional Cardiology. 26 (5) (pp 482-490), 2013. Date of
Publication: October 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background Postconditioning is a potential cardioprotective strategy that
has demonstrated conflicting and variable reductions in infarct size in
human trials. Objectives To determine whether postconditioning could
increase the extent of myocardial salvage in patients with acute
ST-segment elevation myocardial infarction undergoing primary percutaneous
coronary intervention (PPCI). Methods One hundred two patients (aged 57
+/- 11 years; 88% male) were randomly assigned to a postconditioning or
standard protocol. Cardiovascular magnetic resonance imaging was performed
3 days after PPCI to measure the volumetric extent of myocardial necrosis
and the area at risk. Results With similar time-to-reperfusion (170 +/- 84
minutes in the postconditioning group vs. 150 +/- 70 minutes in the
standard group, P = 0.22), the myocardial salvage index was not
significantly different between the postconditioned group and the control
group, averaging 42 +/- 22% vs. 33 +/- 21%, respectively (P = 0.08).
Furthermore, postconditioning was not associated with a smaller infarct
size compared to controls (13 +/- 7 g/m<sup>2</sup> vs. 15 +/- 8
g/m<sup>2</sup>, respectively, P = 0.18). Conclusions Postconditioning
does not significantly increase myocardial salvage or reduce infarct size
in patients with STEMI undergoing PPCI. However, the possibility of a more
modest impact of postconditioning cannot be excluded with our sample size.
2013, Wiley Periodicals, Inc.
<10>
[Use Link to view the full text]
Accession Number
2013640366
Authors
Lee T.H. Ouellet J.-F. Cook M. Schreiber M.A. Kortbeek J.B.
Institution
(Lee, Cook, Schreiber) Section of Trauma/Critical Care, Oregon Health,
Science University, Canada
(Kortbeek) Department of Surgery and Critical Care, University of Calagry,
Foothills Medical Centre, 1403-29st NW, Calgary, AB T3C1J5, Canada
(Ouellet) Department of Surgery, Universite Laval, Canada
Title
Pericardiocentesis in trauma: A systematic review.
Source
Journal of Trauma and Acute Care Surgery. 75 (4) (pp 543-549), 2013. Date
of Publication: October 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND: Pericardiocentesis (PCC) had been taught as a mandatory skill
in the Advanced Trauma Life Support (ATLS) course as a bridge to
definitive surgical therapy for traumatic pericardial tamponade since its
inception in 1978. Immediate thoracotomy for penetrating trauma to the
heart and chest has resulted in the decreased use of PCC in trauma. PCC is
now offered as an optional skill in the ninth edition of the ATLS. A
review of the literature regarding the use and effectiveness of PCC in
traumatic pericardial tamponade in the modern era is necessary to better
define its current role in trauma care. METHODS: Scientific publications
from 1970 to 2010 involving PCC after trauma were identified. The
Preferred Reporting Items for Systematic reviews and Meta-Analyses was
used. Human studies describing acute traumatic tamponade were included.
Publications involving nontraumatic or chronic pericardial tamponade from
effusions caused by inflammatory, infectious, or neoplastic etiology were
excluded. Publications were categorized by level of evidence. RESULTS: Of
the 135 publications identified, 27 were included, composing of 2,094
trauma patients with suspected cardiac tamponade. The reported use of PCC
decreased from 45.9% of patients in the period 1970 to 1979 down to 6.4%
of patients in the period between 2000 and 2010 (p < 0.05). Reported rates
describing the use of PCC as the sole intervention decreased from 13.7% in
the period 1970 to 1979 to 2.1% in the period 2000 to 2010 (p < 0.05).
Survival analysis after PCC was possible for 380 patients. Overall
survival following PCC was 83.4% (n = 317) and 91.8% (n = 145) when used
as the sole intervention. In patients who received PCC then thoracotomy,
survival rate was 79.5% (n = 178). CONCLUSION: Studies on the use of PCC
for trauma are limited and biased toward survivors. The reported survival
rate is high. There remains a limited role for PCC in nontrauma centers
where definitive surgical management is not immediately available and
transport time to a higher level of care facility supports the use of
temporary decompression by PCC. 2013 Lippincott Williams and Wilkins.
<11>
Accession Number
2013637275
Authors
Kuhn E.W. Liakopoulos O.J. Stange S. Deppe A.-C. Slottosch I. Scherner M.
Choi Y.-H. Wahlers T.
Institution
(Kuhn, Liakopoulos, Stange, Deppe, Slottosch, Scherner, Choi, Wahlers)
Department of Cardiothoracic Surgery, Heart Center, University of Cologne,
Kerpener Strasse 62, Cologne 50924, Germany
Title
Meta-Analysis of patients taking statins before revascularization and
aortic valve surgery.
Source
Annals of Thoracic Surgery. 96 (4) (pp 1508-1516), 2013. Date of
Publication: October 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Statin intake before cardiac surgery is associated with favorable
outcomes. We sought to analyze the evidence for statin pretreatment before
isolated coronary artery bypass graft surgery and aortic valve replacement
surgery. In this meta-analysis, we demonstrate beneficial results for the
endpoints mortality, stroke, atrial fibrillation, and length of stay in
hospital in 36,053 statin-pretreated coronary artery bypass graft surgery
patients compared with control subjects retrieved from 32 studies, but
fail to detect relevant advantages through preoperative statin therapy for
3,091 patients undergoing aortic valve replacement from four trials.
Strict adherence to guidelines recommending statin treatment before CABG
surgery is therefore mandatory. 2013 The Society of Thoracic Surgeons.
<12>
Accession Number
2013637249
Authors
Onorati F. D'Errigo P. Barbanti M. Rosato S. Covello D.R. Maraschini A.
Ranucci M. Grossi C. Santoro G. Tamburino C. Santini F. Seccareccia F.
Institution
(Onorati) Division of Cardiac Surgery, University of Verona Medical
School, P.le Scuro, 10, Verona, Italy
(D'Errigo, Barbanti, Rosato, Covello, Maraschini, Ranucci, Grossi,
Santoro, Tamburino, Santini, Seccareccia) National Centre for
Epidemiology, Surveillance and Health Promotion, Istituto Superiore di
Sanita, Rome Italy; Division of Cardiology, Ferrarotto Hospital,
University of Catania, ETNA Foundation, Catania Italy; Department of
Cardiovascular Surgery, S. Croce e Carle Hospital, Cuneo Italy; Division
of Cardiology, Careggi Hospital, Florence Italy; and Division of Cardiac
Surgery, Ospedale San Martino University of Genoa Medical School, Genoa,
Italy
Title
Results differ between transaortic and open surgical aortic valve
replacement in women.
Source
Annals of Thoracic Surgery. 96 (4) (pp 1336-1342), 2013. Date of
Publication: October 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background Despite the well-known impact of female sex on outcome after
surgical aortic valve replacement (sAVR), few studies investigated its
role after transcatheter aortic valve replacement (TAVR). Methods After
propensity-matching for age, baseline comorbidities, previous
interventions, priority, frailty score, New York Heart Association class,
left ventricular function and associated cardiac diseases, hospital
mortality, and procedure-related morbidities of 388 women (194 TAVR versus
194 sAVR) - of 5,231 patients enrolled in 70 centers participating in this
prospective multicenter national registry - were analyzed at a central
management unit of the Italian National Institute of Health. Results
Although hospital mortality was comparable (4.1% TAVR versus 3.1% sAVR; p
= 0.177), women undergoing sAVR showed a higher rate of transfusion (63.9%
versus 37.1% TAVR; p = 0.0001); higher number of transfusions per patient
(3.6 +/- 0.4 versus 2.3 +/- 0.3 TAVR; p = 0.049); a higher incidence of
low cardiac output state (5.7% versus 3.6% TAVR; p = 0.017) and acute
renal failure (8.8% versus 4.1% TAVR; p = 0.01); and higher mean
transprosthetic gradients (15.7 +/- 12.6 mm Hg versus 11.9 +/- 10.7 mm Hg
TAVR; p = 0.004). In contrast, women undergoing TAVR experienced
significant postprocedural aortic regurgitation (mild, 37.6% versus 7.7%
sAVR; moderate-to-severe, 7.1% versus 1.5% sAVR; p = 0.0001) and a higher
rate of stroke (7.7% versus 2.5% sAVR; p = 0.037), major vascular
complications (9.3% versus 0.5% sAVR; p = 0.0001), pacemaker implantation
(12.4% versus 6.2% sAVR; p = 0.004), need for emergent percutaneous
coronary intervention (1.0% versus 0% sAVR; p = 0.007), and longer
intermediate care unit length of stay (2.5 +/- 4.4 days versus 1.4 +/- 2.6
days sAVR; p = 0.008). Perioperative myocardial infarction and lengths of
intensive care unit stay and hospitalization were comparable (not
significant). Conclusions Women undergoing sAVR and TAVR experienced
different periprocedural morbidities. These data strongly suggest the need
to strictly individualize the indications. 2013 The Society of Thoracic
Surgeons.
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Accession Number
2013637273
Authors
Sauer A.-M.C. Nathoe H.M. Hendrikse J. Peelen L.M. Regieli J. Veldhuijzen
D.S. Kalkman C.J. Grobbee D.E. Doevendans P.A. Van Dijk D.
Institution
(Sauer, Peelen, Veldhuijzen, Kalkman, Van Dijk) Department of
Anesthesiology, University Medical Center Utrecht, PO Box 85500, 3508 GA
Utrecht, Netherlands
(Nathoe, Regieli, Doevendans) Department of Cardiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Hendrikse) Department of Radiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Peelen, Grobbee) Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht, Netherlands
Title
Cognitive outcomes 7.5 years after angioplasty compared with off-pump
coronary bypass surgery.
Source
Annals of Thoracic Surgery. 96 (4) (pp 1294-1300), 2013. Date of
Publication: October 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Off-pump coronary artery bypass grafting and percutaneous
coronary intervention are both associated with cognitive decline, but
limited data are available on long-term outcomes. This study compared
long-term cognitive outcomes between patients managed with percutaneous
coronary intervention and off-pump coronary artery bypass grafting.
Methods: A multicenter trial in the Netherlands randomized 280 patients to
percutaneous coronary intervention or off-pump coronary artery bypass
grafting. Cognitive performance 7.5 years after randomization was assessed
through a battery of 9 neuropsychologic tests and summarized into a
combined Z-score. Results: After 7.5 years, cognitive assessment could be
performed in 81% of the 249 surviving patients. Better cognitive
performance was observed in the off-pump coronary artery bypass grafting
group (combined Z-score 0.11 for off-pump coronary artery bypass grafting
versus -0.17 for percutaneous coronary intervention; difference 0.28, 95%
confidence interval 0.08 to 0.47, p < 0.01). However, this difference
became nonsignificant (Z-score difference 0.14, 95% confidence interval
-0.01 to 0.29, p = 0.08) after multivariable adjustment for potential
confounders. Conclusions: At 7.5 years follow-up, off-pump coronary artery
bypass grafting patients had a similar or perhaps even better cognitive
performance compared with percutaneous coronary intervention patients.
2013 The Society of Thoracic Surgeons.
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