Total documents retrieved: 45
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<1>
Accession Number
2013791146
Authors
Abizaid A. Ormiston J.A. Fajadet J. Mauri L. Schofer J. Verheye S. Dens J.
Thuesen L. Macours N. Qureshi A.C. Spaulding C.
Institution
(Abizaid) Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil
(Ormiston) North Shore Hospital, Auckland, New Zealand
(Fajadet) Clinique Pasteur, Toulouse, France
(Mauri) Harvard Clinical Research Institute, Boston, MA, United States
(Schofer) Herzkatheterlabor und Praxisklinik, Hamburg, Germany
(Verheye) Middelheim Hospital, Antwerp, Belgium
(Dens) Ziekenhuis Oost-Limburg, Genk, Belgium
(Thuesen) Skejby Sygehus, Aarhus, Denmark
(Macours, Qureshi) Clinical Research, Cordis Corporation, Waterloo,
Belgium
(Macours, Qureshi) Clinical Research, Cordis Corporation, Bridgewater, NJ,
United States
(Spaulding) Hopital Europeen Georges Pompidou, Assistance Publique
Hopitaux de Paris, Paris Descartes University, Paris, France
Title
Two-year follow-up of the NEVO ResElution-I(NEVO RES-I) trial: A
randomised, multicentre comparison of the NEVO sirolimus-eluting coronary
stent with the TAXUS Liberte paclitaxel-eluting stent in de novo native
coronary artery lesions.
Source
EuroIntervention. 9 (6) (pp 721-729), 2013. Date of Publication: October
2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To assess the two-year clinical follow-up of the NEVO RES-1 study, a
randomised comparison between the NEVO sirolimus-eluting coronary stent
system (NEVO SES) and the TAXUS Liberte paclitaxel-eluting stent (TAXUS
PES). Methods and results: NEVO RES-I randomised 394 patients with single
de novo lesions with a maximum length of 28 mm and diameter of 2.5-3.5 mm
to NEVO SES (n=202) versus TAXUS PES (n=192). Six-month angiographic
results demonstrated the superiority of the NEVO SES over the TAXUS PES
for the primary endpoint, in-stent late loss. At one year, MACE (death,
emergent CABG, TLR, and MI) in the NEVO SES group was 6.1% versus 10.6% in
the TAXUS PES group (p=0.139). After two years, MACE was 7.2% in the NEVO
SES group versus 13.0% in TAXUS PES group (p=0.086). Corresponding rates
of TLR were 3.6% versus 7.6% (p=0.116). No ARC-defined definite or
probable stent thromboses (ST) were reported with NEVO SES while two
occurred with TAXUS PES. Conclusions: While not designed or powered for
clinical endpoints, individual and composite clinical endpoints
numerically favoured the NEVO SES over the TAXUS PES, with continued
separation over time up to two years. No ARC-defined definite or probable
ST was reported in the NEVO SES group at two years. Clinical trial
identifier: NCT00606333 http://www.clinicaltrials.gov Europa Digital &
Publishing 2013. All rights reserved.
<2>
Accession Number
23731705
Authors
Costantino M.F. Galderisi M. Dores E. Innelli P. Tarsia G. Di Natale M.
Santoro C. De Stefano F. Esposito R. de Simone G.
Institution
(Costantino) Division of Cardiology, San Carlo Hospital, Potenza, Italy.
Title
Parallel improvement of left ventricular geometry and filling pressure
after transcatheter aortic valve implantation in high risk aortic
stenosis: comparison with major prosthetic surgery by standard echo
Doppler evaluation.
Source
Cardiovascular ultrasound. 11 , 2013. Article Number: 18. Date of
Publication: 2013.
Abstract
The effect of Transcatheter Aortic Valve Implantation (TAVI) on left
ventricular (LV) geometry and function was compared to traditional aortic
replacement (AVR) by major surgery. 45 patients with aortic stenosis (AS)
undergoing TAVI and 33 AVR were assessed by standard echo Doppler the day
before and 2 months after the implantation. 2D echocardiograms were
performed to measure left ventricular (LV) mass index (LVMi), relative
wall thickness (RWT), ejection fraction (EF) and the ratio between
transmitral E velocity and early diastolic velocity of mitral annulus
(E/e' ratio). Valvular-arterial impedance (Zva) was also calculated. At
baseline, the 2 groups were comparable for blood pressure, heart rate,
body mass index mean transvalvular gradient and aortic valve area. TAVI
patients were older (p<0.0001) and had greater LVMi (p<0.005) than AVR
group. After 2 months, both the procedures induced a significant reduction
of transvalvular gradient and Zva but the decrease of LVMi and RWT was
significant greater after TAVI (both p<0.0001). E/e' ratio and EF were
significantly improved after both the procedure but E/e' reduction was
greater after TAVI (p<0.0001). TAVI exhibited greater percent reduction in
mean transvalvular gradient (p<0.05), Zva (p<0.02), LVMi (p<0.0001), RWT
(p<0.0001) and E/e' ratio (p<0.0001) than AVR patients. Reduction of E/e'
ratio was positively related with reduction of RWT (r = 0.46, p<0.002)
only in TAVI group, even after adjusting for age and percent reduction of
Zva (r =0.43, p<0.005). TAVI induces a greater improvement of estimated LV
filling pressure in comparison with major prosthetic surgery, due to more
pronounced recovery of LV geometry, independent on age and changes of
hemodynamic load.
<3>
Accession Number
2014012846
Authors
Damiano Jr. R.J. Badhwar V. Acker M.A. Veeragandham R.S. Kress D.C.
Robertson J.O. Sundt T.M.
Institution
(Damiano Jr., Robertson) Division of Cardiothoracic Surgery, Washington
University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110,
United States
(Badhwar) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
(Acker) Division of Cardiovascular Surgery, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Veeragandham) Department of Cardiothoracic Surgery, John Muir Medical
Center, Concord, CA, United States
(Kress) Department of Cardiovascular and Thoracic Surgery, Aurora St.
Luke's Medical Center, Milwaukee, WI, United States
(Sundt) Division of Cardiac Surgery, Massachusetts General Hospital,
Boston, MA, United States
Title
The CURE-AF trial: A prospective, multicenter trial of irrigated
radiofrequency ablation for the treatment of persistent atrial
fibrillation during concomitant cardiac surgery.
Source
Heart Rhythm. 11 (1) (pp 39-45), 2014. Date of Publication: January 2014.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background Ablation technology has been introduced to replace the surgical
incisions of the Cox-Maze procedure in order to simplify the operation.
However, the efficacy of these ablation devices has not been prospectively
evaluated. Objective The purpose of this study was to examine the efficacy
and safety of irrigated unipolar and bipolar radiofrequency ablation for
the treatment of persistent and long-standing persistent atrial
fibrillation (AF) during concomitant cardiac surgical procedures. Methods
Between May 2007 and July 2011, 150 consecutive patients were enrolled at
15 U.S. centers. Patients were followed for 6 to 9 months, at which time a
24-hour Holter recording and echocardiogram were obtained. Recurrent AF
was defined as any atrial tachyarrhythmia (ATA) lasting over 30 seconds on
the Holter monitor. The safety end-point was the percent of patients who
suffered a major adverse event within 30 days of surgery. All patients
underwent a biatrial Cox-Maze lesion set. Results Operative mortality was
4%, and there were 4 (3%) 30-day major adverse events. Overall freedom
from ATAs was 66%, with 53% of patients free from ATAs and also off
antiarrhythmic drugs at 6 to 9 months. Increased left atrial diameter,
shorter total ablation time, and an increasing number of concomitant
procedures were associated with recurrent AF (P <.05). Conclusion
Irrigated radiofrequency ablation for treatment of AF during cardiac
surgery was associated with a low complication rate. No device-related
complications occurred. The Cox-Maze lesion set was effective at restoring
sinus rhythm and had higher success rates in patients with smaller left
atrial diameters and longer ablation times. 2014 Heart Rhythm Society.
All rights reserved.
<4>
Accession Number
2014009968
Authors
Mariscalco G. Musumeci F.
Institution
(Mariscalco) Department of Heart and Vessels, Cardiac Surgery Unit, Varese
University Hospital, Via Guicciardini 7, Varese 21100, Italy
(Musumeci) Department of Cardiac Surgery and Transplantation, S. Camillo
Hospital, Rome, Italy
Title
The minithoracotomy approach: A safe and effective alternative for heart
valve surgery.
Source
Annals of Thoracic Surgery. 97 (1) (pp 356-364), 2014. Date of
Publication: January 2014.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Despite criticisms over the last decade, heart valve surgery through right
anterior minithoracotomy (MT) proved excellent short-term and
long-term-term results, becoming a feasible and popular alternative to the
sternotomy approach. The rapid development and refinements of techniques
have led to MT valve surgery being considered safe, effective, and
durable. Minithoracotomy has been demonstrated to be a valid
cost-effective and cost-saving strategy for valve surgery, being
associated with reduced morbidity and mortality. Tangible benefits include
less pain, faster postoperative recovery, and better cosmetic results. As
a result, MT has been increasingly used as a routine approach in many
centers for both aortic and mitral valve surgery. 2014 by The Society of
Thoracic Surgeons.
<5>
Accession Number
2014009986
Authors
Ebrahimi R. Bakaeen F.G. Uberoi A. Ardehali A. Baltz J.H. Hattler B.
Almassi G.H. Wagner T.H. Collins J.F. Grover F.L. Shroyer A.L.
Institution
(Ebrahimi, Uberoi, Ardehali) Greater Los Angeles VA Medical Center,
Department of Medicine-Cardiology Section (111E), 11301 Wilshire Blvd.,
Los Angeles CA 90073, United States
(Bakaeen) Michael E. DeBakey VA Medical Center, Houston, TX, United States
(Bakaeen) Department of Cardiothoracic Surgery, Baylor College of
Medicine, Houston, TX, United States
(Shroyer) Northport VA Medical Center, Northport, NY, United States
(Baltz, Hattler, Grover) Eastern Colorado Health Care System, Department
of Veterans Affairs, Denver, CO, United States
(Grover) Department of Surgery, University of Colorado School of Medicine,
Anschutz Medical Campus, Aurora, CO, United States
(Hattler) Department of Medicine, University of Colorado School of
Medicine, Anschutz Medical Campus, Aurora, CO, United States
(Collins) Cooperative Studies Program Coordinating Center, VA Medical
Center, Perry Point, MD, United States
(Wagner) VA Palo Alto Health Economics Resource Center, Menlo Park, CA,
United States
(Almassi) Department of Health Research and Policy, Stanford University,
Stanford, CA, United States
(Almassi, Wagner) Zablocki VA Medical Center, Milwaukee, Medical College
of Wisconsin, Milwaukee, WI, United States
Title
Effect of clopidogrel use post coronary artery bypass surgery on graft
patency.
Source
Annals of Thoracic Surgery. 97 (1) (pp 15-21), 2014. Date of Publication:
January 2014.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background Clopidogrel use post coronary artery bypass grafting (CABG) has
become more popular under the assumption that it improves graft patency.
The purpose of this sub-analysis from the Randomized On and Off-Pump
Bypass (ROOBY) trial is to evaluate the role of clopidogrel use post CABG
to improve graft patency when added to standard aspirin therapy. Methods
The ROOBY trial was a multi-center, randomized, controlled clinical trial
that compared on-pump versus off-pump coronary artery bypass grafting
(CABG). Clopidogrel use post CABG was left at the discretion of the
operator. Detailed data regarding the use and timing of clopidogrel post
CABG were collected prospectively, along with 1-year angiograms to
evaluate graft status. Results Of the 2,203 subjects undergoing CABG, 953
patient records had complete clopidogrel use and 1-year angiographic data.
Of these, 345 (36.2%) received clopidogrel post CABG prior to discharge.
Compared with patients with no post-CABG clopidogrel use, baseline
characteristics were similar for the clopidogrel group except for the
following: lower preoperative aspirin use (80.2% vs 86.7%, p = 0.009);
higher preoperative clopidogrel use (23.5% vs 14.0%, p < 0.001), less
on-pump (35.9% vs 55.9%, p < 0.0001); and lower endoscopic vein harvesting
(30.8% vs 42.5%, p < 0.001) rates. Overall 1-year graft patency rates were
not different between the clopidogrel and no-clopidogrel groups (86.5% vs
85.3%, p = 0.43). Multivariable analyses did not alter these findings.
Conclusions This study suggests that routine post-CABG clopidogrel use may
not translate to improved 1-year graft patency. Future studies appear
warranted to better define the role of more aggressive antiplatelet
therapy post CABG on graft patency and clinical outcomes. 2014 by The
Society of Thoracic Surgeons.
<6>
Accession Number
2014015113
Authors
Sahebally S.M. Healy D. Coffey J.C. Walsh S.R.
Institution
(Sahebally, Healy, Coffey, Walsh) Department of Surgery, University
Hospital Limerick, Ireland
Title
Should patients taking aspirin for secondary prevention continue or
discontinue the medication prior to elective, abdominal surgery? Best
evidence topic (BET).
Source
International Journal of Surgery. 12 (1) (pp 16-21), 2014. Date of
Publication: 2014.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
This best evidence topic was investigated according to a described
protocol. The question asked was: should patients on acetylsalicylic acid
(ASA) for secondary prevention stop or continue the medication prior to
elective, abdominal surgery. Using the reported search 826 papers were
found of which five represented the best evidence to answer the clinical
question. The strongest evidence was from a randomized controlled trial
(RCT) specifically looking at elective abdominal surgery, which showed no
statistically significant difference between ASA continuation and
discontinuation in terms of haemorrhagic or thrombotic events. Two other
RCT's examined elective non-cardiac surgery but only a minor proportion
(20.6% and 23.6%) of patients underwent abdominal surgery and data were
unavailable regarding adverse events in these patients. However, one of
these trials did show a 7.2% absolute risk reduction in postoperative
cardiac adverse events when ASA was continued. One prospective cohort
study found no difference between ASA maintenance and cessation except for
longer duration of surgery in the ASA continuation group. Finally one
recent retrospective cohort study revealed similar bleeding rates between
ASA-treated and non-ASA-treated patients but increased cardiac
complication rates in the ASA group.Only two studies compared continuation
versus discontinuation of ASA, while the remaining three looked at
patients on ASA versus those not on ASA. This heterogeneity in methodology
makes it difficult to draw justifiable conclusions from the data. However,
it appears that continuing ASA isn't associated with excessive bleeding.
Further adequately powered trials with well-defined end points are needed
to answer this important clinical question. 2013 Surgical Associates Ltd.
<7>
Accession Number
2014009997
Authors
Vestergaard R.F. Nielsen P.H. Terp K.A. Soballe K. Andersen G. Hasenkam
J.M.
Institution
(Vestergaard, Hasenkam) Department of Cardiothoracic and Vascular Surgery,
Aarhus University Hospital, Aarhus, Denmark
(Vestergaard, Nielsen, Terp, Hasenkam) Department of Clinical Medicine,
Aarhus University Hospital, Aarhus, Denmark
(Vestergaard, Soballe) Department of Orthopedics, Aarhus University
Hospital, Aarhus, Denmark
(Andersen) Department of Radiology, Aarhus University Hospital, Aarhus,
Denmark
Title
Effect of hemostatic material on sternal healing after cardiac surgery.
Source
Annals of Thoracic Surgery. 97 (1) (pp 153-160), 2014. Date of
Publication: January 2014.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background Postoperative sternal infection and dehiscence cause increased
morbidity, mortality, and socioeconomic costs as well as patient
discomfort and pain. Some predisposing factors have been uncovered but
others remain uninvestigated. Among these are the influence of topical
hemostatic agents such as bone wax (BW) and Ostene (Ceremed Inc, Los
Angeles, CA) a new, water-soluble polymer wax (WSW). The object of this
study was to investigate the impact of topical hemostatic agents on
sternal healing in patients. Methods In total, 50 patients subjected to
elective cardiac surgery and requiring intraoperative hemostatic treatment
were randomized to 1 of 2 treatment groups: BW or WSW. Twenty-five
patients without need for sternal hemostasis constituted a control group.
The doctors analyzing the endpoints were blinded to the treatment.
Radiologic bone healing was assessed by a radiologist using computed
tomography at 3 and 6 months postoperatively. Quality of life and bodily
pain was assessed by questionnaires (Short Form-36 and Visual Analogue
Scale). Results No patients displayed complete radiologic healing at 3
months. Bone healing (evaluated semi-quantitatively at a score from 0 to
10) was significantly impaired in the BW group compared with both the
control and WSW groups at both 3 and 6 months postoperatively (p <
0.0001). Radiologic bone healing was positively correlated with physical
functioning score (Short Form-36) (p < 0.001). Pain scores were generally
low (<1) at both 3 and 6 months with no significant difference between
study groups. Conclusions The results from this study suggest that WSW
provides a useful alternative to BW when topic hemostasis on the sternum
is required. 2014 by The Society of Thoracic Surgeons.
<8>
Accession Number
2014010018
Authors
Sharma V. Deo S.V. Park S.J. Joyce L.D.
Institution
(Sharma, Park, Joyce) Division of Cardiovascular Surgery, Mayo Clinic
College of Medicine, 200 First St SW, Rochester, MN 55905, United States
(Deo) Department of Cardiovascular Surgery, Adventist Wockhardt Hospitals,
Surat, Gujrat, India
Title
Meta-analysis of staged versus combined carotid endarterectomy and
coronary artery bypass grafting.
Source
Annals of Thoracic Surgery. 97 (1) (pp 102-109), 2014. Date of
Publication: January 2014.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background The multiple options in the management of patients with
concomitant carotid and coronary artery disease (CAD) make it difficult to
find a clear consensus regarding the ideal surgical strategy. We performed
a meta-analysis of studies comparing early outcomes of synchronous and
staged approach of carotid endarterectomy and coronary artery bypass
grafting. Methods All English language publications were searched using
the terms "carotid artery disease," "coronary artery disease," "carotid
endarterectomy," and "coronary artery bypass grafting" alone or in
combination. The endpoints studied were early mortality, major stroke, and
major postoperative morbidity; myocardial infarction (MI) and stroke, and
combined early mortality or stroke. Early events were compared using
pooled estimates of risk ratios (RR) (random effects model) utilizing the
inverse-variance method. Results Twelve studies were identified with a
total of 17,469 and 7,552 patients in the combined and staged group,
respectively. The pooled analysis revealed no difference in the early
mortality (RR 1.36 [0.78, 2.36]; p = 0.27), post operative stroke (RR 1.14
[0.99, 1.31], p = 0.07), combined early mortality or stroke (RR 1.08
[0.98, 1.20], p = 0.11) and combined endpoint of MI or stroke (RR 0.75
[0.48, 1.17; I<sup>2</sup> = 11%], p = 0.2) between the 2 surgical
approaches. Conclusions Our meta-analysis of observational studies
suggests comparable outcomes in combined and staged approach for
synchronous carotid and coronary artery disease. Hence, the 2 strategies
can be used interchangeable in the clinical practice, with each having
specific applications linked to specific clinical conditions. A randomized
trial is warranted to answer this question definitively. 2014 by The
Society of Thoracic Surgeons.
<9>
Accession Number
24180712
Authors
Alvarez J. Baluja A. Selas S. Otero P. Rial M. Veiras S. Caruezo V.
Taboada M. Rodriguez I. Castroagudin J. Tome S. Rodriguez A. Rodriguez J.
Institution
(Alvarez) Department Anesthesia and Surgical ICU, University Hospital,
University of Santiago de Compostela, Spain.
Title
A comparison of dobutamine and levosimendan on hepatic blood flow in
patients with a low cardiac output state after cardiac surgery: a
randomised controlled study.
Source
Anaesthesia and intensive care. 41 (6) (pp 719-727), 2013. Date of
Publication: Nov 2013.
Abstract
Liver dysfunction due to a low cardiac output state after cardiac surgery
is associated with a poor prognosis, but whether one inotrope is superior
to another in improving hepatic perfusion remains uncertain. This study
compared the systemic and hepatic haemodynamic effects of levosimendan to
dobutamine in patients with a low cardiac output state (cardiac index <
2.2 l/min/m2) after on-pump cardiac surgery. A total of 25 patients were
randomised to receive either an intravenous bolus of levosimendan (12
mug/kg) over 15 minutes, followed by an infusion of 0.2 mug/kg/min for 24
hours, or an infusion of dobutamine 7.5 mug/kg/min for 24 hours and
completed the study. The systemic and hepatic haemodynamics at 24 and 48
hours were all better after levosimendan than dobutamine (dobutamine
group: cardiac index (l/min/m2)=2.51 [standard deviation +0.29],
2.40+0.23; portal vein flow (ml/min): 614.0+124.7, 585.9+144.8;
pulsatility index: 2.02+0,28, 2.98+0.27 versus the levosimendan group:
cardiac index: 3.02+ 0.27, 2.98+ 0.30; portal vein flow: 723.0+ 143.5,
702.9+117.8; pulsatility index: 1.71+0.26, 1.73+0.27). The improvement in
portal vein blood flow at 48 hours was significantly better after
levosimendan than dobutamine (41% vs. 11% increment from baseline,
P<0.05). In addition, there was a significant reduction in hepatic artery
resistance after levosimendan but not dobutamine (resistance index
reduction 6.5% vs. 0%, P<0.05). In summary, levosimendan can be considered
as a selective liver vasodilator and can improve hepatic blood flow
through both the hepatic artery and portal venous system, whereas
dobutamine can only improve the portal venous blood flow without
vasodilating the hepatic artery.
<10>
Accession Number
2013805916
Authors
Elmahdy M.F. Antoniucci D.
Institution
(Elmahdy) Aswan Heart Center, Aswan, Egypt
(Antoniucci) Careggi Hospital, Florence, Italy
Title
ARCTIC: Additional proof against antiplatelet adjusted therapy.
Source
Global Cardiology Science and Practice. (2) , 2013. Date of Publication:
2013.
Publisher
Bloomsbury Qatar Foundation Journals (Villa 3, Education City, PO Box
5825, Doha, Qatar)
<11>
Accession Number
2013801406
Authors
Van Den Branden B.J.L. Teeuwen K. Koolen J.J. Van Der Schaaf R.J.
Henriques J.P.S. Tijssen J.G.P. Kelder J.C. Vermeersch P.H.M.J. Rensing
B.J.W.M. Suttorp M.J.
Institution
(Van Den Branden, Teeuwen, Rensing, Suttorp) Department of Interventional
Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein,
Netherlands
(Koolen) Department of Interventional Cardiology, Catharina Hospital,
Eindhoven, Netherlands
(Van Der Schaaf) Department of Interventional Cardiology, Onze Lieve
Vrouwe Gasthuis, Amsterdam, Netherlands
(Henriques) Department of Interventional Cardiology, Academic Medical
Center, Amsterdam, Netherlands
(Tijssen) Research and Statistics, Academic Medical Center, Amsterdam,
Netherlands
(Kelder) Department of Research and Statistics, St. Antonius Hospital,
Nieuwegein, Netherlands
(Vermeersch) Department of Interventional Cardiology, Middelheim Hospital,
Antwerp, Belgium
Title
Primary Stenting of Totally Occluded Native Coronary Arteries III (PRISON
III): A randomised comparison of sirolimus-eluting stent implantation with
zotarolimus-eluting stent implantation for the treatment of total coronary
occlusions.
Source
EuroIntervention. 9 (7) (pp 841-853), 2013. Date of Publication: November
2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: We investigated whether sirolimus-eluting stents (SES) are superior
to next-generation zotarolimuseluting stents (ZES) in treating patients
with total coronary occlusions (TCO). Methods and results: In
a?prospective, randomised trial we compared the SES with the
zotarolimus-eluting stent (ZES; Endeavor or Resolute) after successful
recanalisation of TCO. During the first phase of the trial, 51 patients
were assigned to receive the SES and 46 patients to receive the Endeavor
ZES. In the second phase we randomised 103 patients to the SES group and
104 patients to the Resolute ZES group. The primary endpoint was
in-segment late lumen loss at eight-month follow-up. At eight months,
patients in the SES group had less in-segment and in-stent late loss as
compared to the Endeavor group: -0.13+0.3 mm vs. 0.27+0.6 mm (p=0.0002)
and -0.13+0.5 mm vs. 0.54+0.5 mm (p<0.0001), respectively. In contrast,
the SES and the Resolute ZES showed comparable amounts of in-segment
(-0.03+0.7 mm vs. -0.10+0.7 mm, p=0.6) and in-stent (0.03+0.8 mm vs.
0.05+0.8 mm, p=0.9) late loss. Conclusions: In the treatment of TCOs, the
SES was associated with superior angiographic outcomes compared to the
Endeavor ZES. On the other hand, the SES and the Resolute ZES showed
comparable angiographic outcomes. Europa Digital & Publishing 2013. All
rights reserved.
<12>
Accession Number
2013797253
Authors
Han Y.-S. Zhang J. Xia Q. Liu Z.-M. Zhang X.-Y. Wu X.-Y. Lun Y. Xin S.-J.
Duan Z.-Q. Xu K.
Institution
(Han, Zhang, Xia, Liu, Zhang, Wu, Lun, Xin, Duan) Department of Vascular
and Thyroid Surgery, First Hospital of China Medical University, Shenyang,
Liaoning 110001, China
(Xu) Department of Vascular Intervention, First Hospital of China Medical
University, Shenyang, Liaoning 110001, China
Title
A comparative study on the medium-long term results of endovascular repair
and open surgical repair in the management of ruptured abdominal aortic
aneurysms.
Source
Chinese Medical Journal. 126 (24) (pp 4771-4779), 2013. Date of
Publication: 2013.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Although it is generally acknowledged that patients with
ruptured abdominal aortic aneurysm (rAAA) obtain the greatest benefit from
endovascular repair (EVAR), convincing evidence on the medium-long term
effect is lacking. The aim of this study was to compare and summarize
published results of rAAA that underwent EVAR with open surgical repair
(OSR). Methods A search of publicly published literature was performed.
Based on an inclusion and exclusion criteria, a systematic meta-analysis
was undertaken to compare patient characteristics, complications, short
term mortality and medium-long term outcomes. A random-effects model was
used to pool the data and calculate pooled odds ratios and weighted mean
differences. A quantitative method was used to analyze the differences
between these two methods. Results A search of the published literature
showed that fourteen English language papers comprising totally 1213
patients with rAAA (435 EVAR and 778 OSR) would be suitable for this
study. Furthermore, 13 Chinese studies were included, including 267
patients with rAAA totally, among which 238 patients received operation.
The endovascular method was associated with more respiratory diseases
before treatment (OR=1.81, P=0.01), while there are more patients with
hemodynamic instability before treatment in OSR group (OR=1.53, P=0.031).
Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted
mean difference (WMD) 1500 ml, P=0.014). The endovascular method was
associated with a shorter stay in intensive care (WMD 2.34 days, P <0.001)
and a shorter total postoperative stay (WMD 6.27 days, P <0.001). The
pooled post-operative complication rate of respiratory system and visceral
ischemia seldom occurred in the EVAR group (OR=0.48, P <0.001 and OR=0.28,
P=0.043, respectively). The pooled 30-day mortality was 25.7% for EVAR and
39.6% for OSR, and the odds ratio was 0.53 (95% confidence interval (CI)
0.41-0.70, P <0.001). There was not, however, any significant reduction in
the medium-long all-cause mortality rate (HR=1.13, P=0.381) and
re-intervention rate (OR= 2.19, P=0.243) following EVAR. In EVAR group,
nevertheless, incidence of type I endoleak was significantly lower than
type II endoleak (OR=0.33, P=0.039) at late follow-up period. Conclusions
On the basis of this systematic review, rAAA EVAR results in less blood
use for transfusion, shorter operation time, shorter intensive care unit
and hospital stays, and lower 30-day mortality. However, in the
medium-long term, it is not associated with a reduction in all-cause
mortality.
<13>
Accession Number
23566712
Authors
Gurbuz H.A. Durukan A.B. Salman N. Tavlasoglu M. Durukan E. Ucar H.I.
Yorgancioglu C.
Institution
(Gurbuz) Department of Cardiovascular Surgery, Medicana International
Ankara Hospital, Ankara, Turkey.
Title
Hydroxyethyl starch 6%, 130/0.4 vs. a balanced crystalloid solution in
cardiopulmonary bypass priming: a randomized, prospective study.
Source
Journal of cardiothoracic surgery. 8 (pp 71), 2013. Date of Publication:
2013.
Abstract
Since the advent of cardiopulmonary bypass, many efforts have been made to
avoid the complications related with it. Any component of the pump
participates in occurrence of these adverse events, one of which is the
type of prime solution. In this study, we aimed to compare the effects of
6% hydroxyethyl starch 130/0.4 with a commonly used balanced electrolyte
solution on postoperative outcomes following coronary bypass surgery. Two
hundred patients undergoing elective coronary bypass surgery were
prospectively studied. The patients were randomized in to two groups.
First group received a balanced electrolyte solution and the second group
received 6% hydoxyethyl starch 130/0.4 as prime solution. The
postoperative outcomes of the patients were studied. The mean age of the
patients was 61.81 + 10.12 in the crystalloid group whereas 61.52 + 9.29
in the HES group. There were 77 male patients in crystalloid group and 74
in HES group. 6% hydroxyethyl starch 130/0.4 did not have any detrimental
effects on renal and pulmonary functions. The intensive care unit stay and
postoperative hospital length of stay were shorter in hydroxyethyl starch
group (p < 0.05 for each). Hydroxyethyl starch did not increase
postoperative blood loss, amount of blood and fresh frozen plasma used,
but it decreased platelet concentrate requirement. It did not have any
effect on occurrence of post-coronary bypass atrial fibrillation (p >
0.05). 6% hydroxyethyl starch 130/0.4 when used as a prime solution did
not adversely affect postoperative outcomes including renal functions and
postoperative blood transfusion following coronary bypass surgery.
<14>
Accession Number
2013820869
Authors
Kim J.-H. Shim J.-K. Song J.-W. Song Y. Kim H.-B. Kwak Y.-L.
Institution
(Kim) Department of Anesthesiology and Pain Medicine, National Health
Insurance Service Ilsan Hospital, Gyeonggi-do, South Korea
(Shim, Song, Song, Kim) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Yonsei University Health System,
Seoul, South Korea
(Kwak) Biomedical Science Institute, Department of Anesthesiology and Pain
Medicine, Anesthesia and Pain Research Institute, 250 Seongsanno,
Sedaemun-gu, Seoul 120-752, South Korea
Title
Effect of erythropoietin on the incidence of acute kidney injury following
complex valvular heart surgery: A double blind, randomized clinical trial
of efficacy and safety.
Source
Critical Care. 17 (5) , 2013. Article Number: R254. Date of Publication:
24 Oct 2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Introduction: Recombinant human erythropoietin (EPO) is known to provide
organ protection against ischemia-reperfusion injury through its
pleiotropic properties. The aim of this single-site, randomized,
case-controlled, and double-blind study was to investigate the effect of
pre-emptive EPO administration on the incidence of postoperative acute
kidney injury (AKI) in patients with risk factors for AKI undergoing
complex valvular heart surgery. Methods: We studied ninety-eight patients
with preoperative risk factors for AKI. The patients were randomly
allocated to either the EPO group (n = 49) or the control group (n = 49).
The EPO group received 300 IU/kg of EPO intravenously after anesthetic
induction. The control group received an equivalent volume of normal
saline. AKI was defined as an increase in serum creatinine >0.3 mg/dl or
>50% from baseline. Biomarkers of renal injury were serially measured
until five days postoperatively. Results: Patient characteristics and
operative data, including the duration of cardiopulmonary bypass, were
similar between the two groups. Incidence of postoperative AKI (32.7%
versus 34.7%, P = 0.831) and biomarkers of renal injury including cystatin
C and neutrophil gelatinase-associated lipocalin showed no significant
differences between the groups. The postoperative increase in
interleukin-6 and myeloperoxidase was similar between the groups. None of
the patients developed adverse complications related to EPO
administration, including thromboembolic events, throughout the study
period. Conclusions: Intravenous administration of 300 IU/kg of EPO did
not provide renal protection in patients who are at increased risk of
developing AKI after undergoing complex valvular heart surgery.Trial
registration: Clinical Trial.gov, NCT01758861. 2013 Kim et al.; licensee
BioMed Central Ltd.
<15>
[Use Link to view the full text]
Accession Number
2014009249
Authors
Gronkjaer M. Eliasen M. Skov-Ettrup L.S. Tolstrup J.S. Christiansen A.H.
Mikkelsen S.S. Becker U. Flensborg-Madsen T.
Institution
(Gronkjaer, Eliasen, Skov-Ettrup, Tolstrup, Christiansen, Mikkelsen,
Becker, Flensborg-Madsen) National Institute of Public Health, University
of Southern Denmark, Copenhagen, Denmark
(Becker) Department of Medical Gastroenterology, Hvidovre Hospital,
Copenhagen University Hospital, Copenhagen, Denmark
(Flensborg-Madsen) Unit of Medical Psychology, Department of Public
Health, University of Copenhagen, Oster Farimagsgade 5, 1353 Copenhagen K,
Denmark
Title
Preoperative smoking status and postoperative complications: A systematic
review and meta-analysis.
Source
Annals of Surgery. 259 (1) (pp 52-71), 2014. Date of Publication: January
2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVE: To systematically review and summarize the evidence of an
association between preoperative smoking status and postoperative
complications elaborated on complication type. BACKGROUND: The conclusions
of studies examining the association between preoperative smoking and
postoperative complications are inconsistent, thus there is a need for a
review and meta-analysis to summarize the existing evidence. METHODS: A
systematic review and meta-analysis based on a search in MEDLINE, EMBASE,
CINAHL, and PsycINFO. Included were original studies of the association
between smoking status and postoperative complications occurring within 30
days of operation. In total, 9354 studies were identified and reviewed for
eligibility and data were extracted. Forest plots and summarized relative
risks (RR) including 95% confidence intervals (CIs) were estimated for
various complication types. RESULTS: Of the 9354 identified studies, 107
studies were included in the meta-analyses and based on these, 157 data
sets were extracted. Preoperative smoking was associated with an increased
risk of various postoperative complications including general morbidity
(RR = 1.52, 95% CI: 1.33-1.74), wound complications (RR = 2.15, 95% CI:
1.87-2.49), general infections (RR = 1.54, 95% CI: 1.32-1.79), pulmonary
complications (RR = 1.73, 95% CI: 1.35-2.23), neurological complications
(RR = 1.38, 95% CI: 1.01-1.88), and admission to intensive care unit (RR =
1.60, 95% CI: 1.14-2.25). Preoperative smoking status was not observed to
be associated with postoperative mortality, cardiovascular complications,
bleedings, anastomotic leakage, or allograft rejection. CONCLUSIONS:
Preoperative smoking was found to be associated with an increased risk of
the following postoperative complications: general morbidity, wound
complications, general infections, pulmonary complications, neurological
complications, and admission to the intensive care unit. Copyright 2013
by Lippincott Williams & Wilkins.
<16>
Accession Number
2014009385
Authors
Cuspidi C. Rescaldani M. Tadic M. Sala C. Grassi G.
Institution
(Cuspidi, Grassi) Department of Health Science, University of
Milano-Bicocca, Milan, Italy
(Cuspidi) Istituto Auxologico Italiano, Milan, Italy
(Rescaldani, Sala) Department of Clinical Sciences and Community Health,
University of Milano, Milan, Italy
(Tadic) Fondazione Policlinico di Milano, University Clinical Hospital
Centre dragisa Misovic, Belgrade, Serbia
(Grassi) Istituto di Ricerche A Carattere Scientifico Multimedica, Sesto
San Giovanni, Milan, Italy
Title
Effects of bariatric surgery on cardiac structure and function: A
systematic review and meta-analysis.
Source
American Journal of Hypertension. 27 (2) (pp 146-156), 2014. Date of
Publication: February 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Background Morbid obesity, a condition increasingly treated with bariatric
procedures, is strongly associated with left ventricular (LV) hypertrophy
and impaired LV function. We analyzed the literature to provide
comprehensive information on cardiac structural and functional changes, as
assessed by imaging techniques, after bariatric surgery.METHODSThe studies
were identified by the following search terms: "bariatric surgery,"
"obesity," "left ventricle," "left ventricular hypertrophy," "cardiac
hypertrophy," "ventricular dysfunction," "left ventricular hypertrophy
regression," "echocardiography," "magnetic resonance imaging," and
"cardiac imaging techniques."RESULTS In a pooled population of 1,022 obese
subjects with preserved systolic function included in 23 studies,
bariatric procedures induced (i) a decrease in LV mass (standardized mean
difference (SMD) =-0.46; P < 0.001) and relative wall thickness (SMD
=-0.20; P < 0.001); (ii) an improvement of LV diastolic function, as
reflected by the increase in mitral flow E/A ratio (SMD = +0.39; P <
0.001); (iii) a decrease in left atrium diameter (SMD =-0.26; P < 0.001);
or (iv) no changes in LV ejection fraction (SMD = +0.03; P =
0.46).CONCLUSIONSThe present meta-analysis, the largest to date focusing
on cardiac structural and functional changes in morbidly obese subjects
after bariatric surgery, documents that this therapeutic approach exerts
important cardioprotective effects in terms of regression of LV
hypertrophy, improvement of LV geometry and diastolic function, and
reduction of left atrial size. 2013 American Journal of Hypertension,
Ltd.
<17>
Accession Number
24145742
Authors
Wu J.H. Marchioli R. Silletta M.G. Macchia A. Song X. Siscovick D.S.
Harris W.S. Masson S. Latini R. Albert C. Brown N.J. Lamarra M. Favaloro
R.R. Mozaffarian D.
Institution
(Wu) Department of Epidemiology, Harvard School of Public Health, Boston,
MA.
Title
Plasma phospholipid omega-3 fatty acids and incidence of postoperative
atrial fibrillation in the OPERA trial.
Source
Journal of the American Heart Association. 2 (5) (pp e000397), 2013. Date
of Publication: Oct 2013.
Abstract
Long-chain polyunsaturated omega-3 fatty acids (n-3 PUFA) demonstrated
antiarrhythmic potential in experimental studies. In a large multinational
randomized trial (OPERA), perioperative fish oil supplementation did not
reduce the risk of postoperative atrial fibrillation (PoAF) in cardiac
surgery patients. However, whether presupplementation habitual plasma
phospholipid n-3 PUFA, or achieved or change in n-3 PUFA level
postsupplementation are associated with lower risk of PoAF is unknown. In
564 subjects undergoing cardiac surgery between August 2010 and June 2012
in 28 centers across 3 countries, plasma phospholipid levels of
eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and
docosahexaenoic acid (DHA) were measured at enrollment and again on the
morning of cardiac surgery following fish oil or placebo supplementation
(10 g over 3 to 5 days, or 8 g over 2 days). The primary endpoint was
incident PoAF lasting > 30 seconds, centrally adjudicated, and confirmed
by rhythm strip or ECG. Secondary endpoints included sustained (> 1 hour),
symptomatic, or treated PoAF; the time to first PoAF; and the number of
PoAF episodes per patient. PoAF outcomes were assessed until hospital
discharge or postoperative day 10, whichever occurred first. Relative to
the baseline, fish oil supplementation increased phospholipid
concentrations of EPA (+142%), DPA (+13%), and DHA (+22%) (P < 0.001
each). Substantial interindividual variability was observed for change in
total n-3 PUFA (range = -0.7% to 7.5% after 5 days of supplementation).
Neither individual nor total circulating n-3 PUFA levels at enrollment,
morning of surgery, or change between these time points were associated
with risk of PoAF. The multivariable-adjusted OR (95% CI) across
increasing quartiles of total n-3 PUFA at enrollment were 1.0, 1.06 (0.60
to 1.90), 1.35 (0.76 to 2.38), and 1.19 (0.64 to 2.20); and for changes in
n-3 PUFA between enrollment and the morning of surgery were 1.0, 0.78
(0.44 to 1.39), 0.89 (0.51 to 1.55), and 1.01 (0.58 to 1.75). In
stratified analysis, demographic, medication, and cardiac parameters did
not significantly modify these associations. Findings were similar for
secondary PoAF endpoints. Among patients undergoing cardiac surgery,
neither higher habitual circulating n-3 PUFA levels, nor achieved levels
or changes following short-term fish oil supplementation are associated
with risk of PoAF.
<18>
Accession Number
24045120
Authors
Hsu J.C. Badhwar N. Gerstenfeld E.P. Lee R.J. Mandyam M.C. Dewland T.A.
Imburgia K.E. Hoffmayer K.S. Vedantham V. Lee B.K. Tseng Z.H. Scheinman
M.M. Olgin J.E. Marcus G.M.
Institution
(Hsu) Section of Cardiac Electrophysiology, Division of Cardiology,
Department of Medicine, University of California, San Francisco, San
Francisco, CA.
Title
Randomized trial of conventional transseptal needle versus radiofrequency
energy needle puncture for left atrial access (the TRAVERSE-LA study).
Source
Journal of the American Heart Association. 2 (5) (pp e000428), 2013. Date
of Publication: Oct 2013.
Abstract
Transseptal puncture is a critical step in achieving left atrial (LA)
access for a variety of cardiac procedures. Although the mechanical
Brockenbrough needle has historically been used for this procedure, a
needle employing radiofrequency (RF) energy has more recently been
approved for clinical use. We sought to investigate the comparative
effectiveness of an RF versus conventional needle for transseptal LA
access. In this prospective, single-blinded, controlled trial, 72 patients
were randomized in a 1:1 fashion to an RF versus conventional (BRK-1)
transseptal needle. In an intention-to-treat analysis, the primary outcome
was time required for transseptal LA access. Secondary outcomes included
failure of the assigned needle, visible plastic dilator shavings from
needle introduction, and any procedural complication. The median
transseptal puncture time was 68% shorter using the RF needle compared
with the conventional needle (2.3 minutes [interquartile range {IQR}, 1.7
to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P = 0.005).
Failure to achieve transseptal LA access with the assigned needle was less
common using the RF versus conventional needle (0/36 [0%] versus 10/36
[27.8%], P < 0.001). Plastic shavings were grossly visible after needle
advancement through the dilator and sheath in 0 (0%) RF needle cases and
12 (33.3%) conventional needle cases (P < 0.001). There were no
differences in procedural complications (1/36 [2.8%] versus 1/36 [2.8%]).
Use of an RF needle resulted in shorter time to transseptal LA access,
less failure in achieving transseptal LA access, and fewer visible plastic
shavings.
<19>
Accession Number
2013786121
Authors
Tully P.J. Baker R.A.
Institution
(Tully, Baker) Cardiac Surgery Research and Perfusion, Cardiac and
Thoracic Surgery Unit, Flinders Medical Centre and Flinders University,
Adelaide, SA, Australia
(Tully) Discipline of Medicine, School of Medicine, The University of
Adelaide, Adelaide, SA, Australia
Title
Current readings: Neurocognitive impairment and clinical implications
after cardiac surgery.
Source
Seminars in Thoracic and Cardiovascular Surgery. 25 (3) (pp 237-244),
2013. Date of Publication: 23 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
The earliest reports of cardiac surgery literatures reported evidence of
neurocognitive decline, highlighted in the 1995 statement of Consensus on
assessment of neurobehavioral outcomes after cardiac surgery. Until now,
the magnitude and clinical importance of neurocognitive outcomes continues
to fluctuate and lack clarity. The aim of this review is to evaluate the
contemporary status of neurocognitive outcomes in relation to pre-existing
impairment, revascularization strategy, broader cardiovascular
pathophysiological processes, and any longer-term clinical implications.
Five studies published between 2009 and 2013 were reviewed. A
meta-analysis did not find differences between on- and off-pump
procedures. In other studies, there was evidence for extensive
preoperative neurocognitive impairments. Additional 2 studies showed that
longer-term neurocognitive impairment, including dementia, was not
dissimilar to nonsurgical patients with cardiovascular disease. Currently,
there is no convincing evidence to suggest that cardiac surgery, and
cardiopulmonary bypass in particular, has a causal role in progression to
dementia, or long-term deficit, independent of pre-existing neurocognitive
impairments and cardiovascular disease. 2013.
<20>
Accession Number
2014001696
Authors
Biccard B.M. Rodseth R.N.
Institution
(Biccard, Rodseth) Perioperative Research Group, Department of
Anaesthetics, Nelson R. Mandela School of Medicine, University of
KwaZulu-Natal, Private Bag 7, Congella 4013, South Africa
(Biccard, Rodseth) Department of Anaesthetics, Inkosi Albert Luthuli
Central Hospital, Durban, South Africa
(Rodseth) Population Health Research Institute, Hamilton Health Sciences,
Hamilton, ON, Canada
Title
What evidence is there for intraoperative predictors of perioperative
cardiac outcomes? A systematic review.
Source
Perioperative Medicine. 2 (1) , 2013. Article Number: 14. Date of
Publication: 03 Jul 2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Patients undergo cardiac preoperative evaluation to identify
those at risk of adverse perioperative cardiac events. The Revised Cardiac
Risk index is commonly used for this task, although it is unable to
accurately risk stratify in all patients. This may be partly a result of
intraoperative events which significantly modify preoperative risk.
Methods: We conducted a systematic review to identify independent
intraoperative predictors of adverse cardiac events in patients undergoing
non-cardiac surgery. Four databases (Ovid Healthstar 1966 to Jan 2012,
Ovid Medline 1946 to 6 March 2012, EMBASE 1974 to March 05 2012 and The
Cochrane Library to March 06 2012) were searched. Results: Fourteen
eligible studies were identified. The need for intraoperative blood
transfusion (odds ratio (OR), 2.3; 95% confidence interval (CI), 1.4-3.3),
vascular surgery (OR, 2.3; 95% CI, 1.2-3.4) and emergent/urgent surgery
(OR, 2.3; 95% CI, 1.1-3.5) were the only independent intraoperative risk
predictors identified in more than study. Other independent intraoperative
factors identified included a >20 mmHg fall in mean arterial blood
pressure for > 60 min (OR, 3.0; 95% CI, 1.8-4.9), >30% increase in
baseline systolic pressure (OR, 8.0; 95% CI, 1.3-50), tachycardia in the
recovery room (>30 beats per min (bpm) from baseline for >5 min) (OR, 7;
95% CI, 1.9-26), new onset atrial fibrillation (OR, 6.6; 95% CI, 2.5-20),
hypothermia (OR, 2.2; 95% CI, 1.1-5) and remote ischemic preconditioning
(OR, 0.22; 95% CI, 0.07-0.67). Other markers of surgical complexity were
not independently associated with postoperative adverse cardiac outcomes.
None of these studies controlled for blood transfusion. Conclusions:
Intraoperative events significantly increase the risk for postoperative
cardiac complications, although only intraoperative blood transfusion has
strong evidence supporting this finding. It is possible that modification
of these intraoperative risk factors by anesthetists and surgeons may
reduce postoperative cardiac events and improve outcome. The Vascular
Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study
will add important information to understanding intraoperative risk
factors for adverse cardiac events. 2013 Biccard and Rodseth; licensee
BioMed Central Ltd.
<21>
Accession Number
2014001683
Authors
Hui M.L. Kumar A. Adams G.G.
Institution
(Hui) The Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
(Kumar) Faculty of Medicine and Health Science, University of Nottingham,
Clifton Boulevard, Nottingham, NG7 2RD, United Kingdom
(Adams) Insulin and Diabetes Experimental Research (IDER) Group, Faculty
of Medicine and Health Science, University of Nottingham, Clifton
Boulevard, Nottingham, NG7 2RD, United Kingdom
Title
Protocol-directed insulin infusion sliding scales improve perioperative
hyperglycaemia in critical care.
Source
Perioperative Medicine. 1 (1) , 2012. Article Number: 7. Date of
Publication: 06 Oct 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Perioperative hyperglycaemia is associated with poor outcomes in patients
undergoing cardiac surgery. Frequent postoperative hyperglycaemia in
cardiac surgery patients has led to the initiation of an insulin infusion
sliding scale for quality improvement. A systematic review was conducted
to determine whether a protocol-directed insulin infusion sliding scale is
as safe and effective as a conventional practitioner-directed insulin
infusion sliding scale, within target blood glucose ranges. A literature
survey was conducted to identify reports on the effectiveness and safety
of an insulin infusion protocol, using seven electronic databases from
2000 to 2012: MEDLINE, CINAHL, EMBASE, the Cochrane Library, the Joanna
Briggs Institute Library and SIGLE. Data were extracted using
pre-determined systematic review and meta-analysis criteria. Seven
research studies met the inclusion criteria. There was an improvement in
overall glycaemic control in five of these studies. The implementation of
protocols led to the achievement of blood glucose concentration targets
more rapidly and the maintenance of a specified target blood glucose range
for a longer time, without any increased frequency of hyperglycaemia. Of
the seven studies, four used controls and three had no controls. In terms
of the meta-analysis carried out, four studies revealed a failure of
patients reaching target blood glucose levels (P < 0.0005) in the control
group compared with patients in the protocol group. The risk of
hypoglycaemia was significantly reduced (P <0.00001) between studies. It
can be concluded that the protocol-directed insulin infusion sliding scale
is safe and improves blood glucose control when compared with the
conventional practitioner-directed insulin infusion sliding scale. This
study supports the adoption of a protocol-directed insulin infusion
sliding scale as a standard of care for post-cardiac surgery patients.
2012 Hui et al.; licensee BioMed Central Ltd.
<22>
Accession Number
23520132
Authors
Genuth S.M. Backlund J.Y. Bayless M. Bluemke D.A. Cleary P.A. Crandall J.
Lachin J.M. Lima J.A. Miao C. Turkbey E.B.
Institution
(Genuth) Case Western Reserve University, Cleveland, Ohio.
Title
Effects of prior intensive versus conventional therapy and history of
glycemia on cardiac function in type 1 diabetes in the DCCT/EDIC.
Source
Diabetes. 62 (10) (pp 3561-3569), 2013. Date of Publication: Oct 2013.
Abstract
Intensive diabetes therapy reduces the prevalence of coronary
calcification and progression of atherosclerosis and the risk of
cardiovascular disease (CVD) events in the Diabetes Control and
Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and
Complications (EDIC) study. The effects of intensive therapy on measures
of cardiac function and structure and their association with glycemia have
not been explored in type 1 diabetes (T1DM). We assess whether intensive
treatment compared with conventional treatment during the DCCT led to
differences in these parameters during EDIC. After 6.5 years of intensive
versus conventional therapy in the DCCT, and 15 years of additional
follow-up in EDIC, left ventricular (LV) indices were measured by cardiac
magnetic resonance (CMR) imaging in 1,017 of the 1,371 members of the DCCT
cohort. There were no differences between the DCCT intensive versus
conventional treatment in end diastolic volume (EDV), end systolic volume,
stroke volume (SV), cardiac output (CO), LV mass, ejection fraction, LV
mass/EDV, or aortic distensibility (AD). Mean DCCT/EDIC HbA1c over time
was associated with EDV, SV, CO, LV mass, LV mass/EDV, and AD. These
associations persisted after adjustment for CVD risk factors. Cardiac
function and remodeling in T1DM assessed by CMR in the EDIC cohort was
associated with prior glycemic exposure, but there was no effect of
intensive versus conventional treatment during the DCCT on cardiac
parameters.
<23>
Accession Number
24151759
Authors
Wang Z. Zhou C. Gu H. Zheng Z. Hu S.
Institution
(Wang) Department of Surgery, State Key Laboratory of Cardiovascular
Disease, Fu Wai Hospital, National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, People's Republic of China.
Title
Mitral valve repair versus replacement in patients with rheumatic heart
disease.
Source
The Journal of heart valve disease. 22 (3) (pp 333-339), 2013. Date of
Publication: May 2013.
Abstract
Rheumatic fever is still the main cause of valve disease in developing
countries. The study aim was to investigate the appropriateness of mitral
valve repair in adult patients with rheumatic heart disease (RHD). A
systematic literature retrieval was performed for all clinical trials
comparing the outcomes of mitral valve repair and replacement for RHD in
PubMed, EMBASE and the Cochrane Library. Studies were excluded if they
lacked a direct comparison of repair versus replacement. The primary
outcomes were 30-day and long-term (> 5 years) survival. Secondary
outcomes were postoperative complications and reoperation rates. Standard
meta-analysis techniques were used. A total of seven studies was included.
When comparing mitral valve repair (MVP) to mitral valve replacement
(MVR), the summary odds ratio for 30-day mortality was 0.54 (95%
confidence interval (CI) 0.34-0.86; p = 0.009), and the summary hazard
ratio (HR) for long-term mortality was 0.62 (95% CI 0.45-0.85; p = 0.003).
Other than the benefits of better survival rates, the risk of
postoperative complications (cardiac death, bleeding or thromboembolic
complications) was also lower in the repair group (HR 0.63; 95% CI
0.47-0.84; p = 0.002). A significantly higher reoperation rate was
observed among patients with mitral valve repair (HR 1.85; 95% CI
1.41-2.43; p < 0.01). Mitral valve repair provides better short-term and
long-term event-free survival for rheumatic patients. With an acceptable
reoperation rate, MVP is also more beneficial by avoiding troublesome
lifelong anticoagulation. Thus, whenever possible, MVP should be attempted
in patients with RHD.
<24>
Accession Number
23904176
Authors
Spencer S. Tang A. Khoshbin E.
Institution
(Spencer) Faculty of Health and Medicine, Lancaster University, Lancaster,
UK.
Title
Leukodepletion for patients undergoing heart valve surgery.
Source
The Cochrane database of systematic reviews. 7 (pp CD009507), 2013. Date
of Publication: 2013.
Abstract
There is some evidence for the benefits of leukodepletion in patients
undergoing coronary artery surgery. Its effectiveness in higher risk
patients, such as those undergoing heart valve surgery, particularly in
terms of overall clinical outcomes, is currently unclear. To assess the
beneficial and harmful effects of leukodepletion on clinical,
patient-reported and economic outcomes in patients undergoing heart valve
surgery. We searched the Cochrane Central Register of Controlled Trials
(CENTRAL) (2013, Issue 3 of 12) in The Cochrane Library, the NHS Economic
Evaluations Database (1960 to April 2013), MEDLINE Ovid (1946 to April
week 2 2013), EMBASE Ovid (1947 to Week 15 2013), CINAHL (1982 to April
2013) and Web of Science (1970 to 17 April 2013) on 19 April 2013. We also
searched the World Health Organization (WHO) International Clinical Trials
Registry Platform (ICTRP), the US National Institutes of Health (NIH)
clinical trials database and the International Standard Randomised
Controlled Trial Number Register (ISRCTN) in April 2013 for ongoing
studies. No language or time period restrictions were applied. We examined
the reference lists of all included randomised controlled trials and
contacted authors of identified trials. We searched the 'grey' literature
at OpenGrey and handsearched relevant conference proceedings. Randomised
controlled trials comparing a leukocyte-depleting arterial line filter
with a standard arterial line filter, on the arterial outflow of the
heart-lung bypass circuit, in elective patients undergoing heart valve
surgery. Data were collected on the study characteristics, three primary
outcomes (1. post-operative in-hospital all-cause mortality within three
months, 2. post-operative all-cause mortality excluding inpatient
mortality < 30 days, 3. length of stay in hospital, 4. adverse events and
serious adverse events) and seven secondary outcomes (1. tubular or
glomerular kidney injury, 2. validated health-related quality of life
scales, 3. validated renal injury scales, 4. use of continuous veno-venous
haemo-filtration, 5. length of stay in intensive care, 6. costs of care).
Data were extracted by one author and verified by a second author.
Insufficient data were available to perform a meta-analysis or sensitivity
analysis. Eight studies were eligible for inclusion in the review but data
on prespecified review outcomes were available from only one, modestly
powered (24 participants) study (Hurst 1997). There were no differences
between a leuko-depleting versus standard filter in length of stay in the
intensive care unit (ICU) (mean difference (MD) 0.80 days; 95% confidence
interval (CI) -0.24 to 1.84) or length of hospital stay (MD 0.20 days; 95%
CI -1.78 to 2.18). There are currently insufficient good quality trials
with valve surgery patients to inform recommendations for changes in
clinical practice. A future National Institute for Health Research
(NIHR)-funded feasibility study (recruiting mid-year 2013) comparing
leukodepletion with a standard arterial line filter in patients undergoing
elective heart valve surgery (the ROLO trial) will be the largest study to
date and will make a significant contribution to future updates of this
review.
<25>
Accession Number
23839768
Authors
Massel D.R. Little S.H.
Institution
(Massel) Cardiology, London Health Sciences Centre, London,
Title
Antiplatelet and anticoagulation for patients with prosthetic heart
valves.
Source
The Cochrane database of systematic reviews. 7 (pp CD003464), 2013. Date
of Publication: 2013.
Abstract
Patients with prosthetic heart valves are at increased risk for valve
thrombosis and arterial thromboembolism. Oral anticoagulation alone, or
the addition of antiplatelet drugs, has been used to minimise this risk.
An important issue is the effectiveness and safety of the latter strategy.
This is an update of our previous review; the goal was to create a valid
synthesis of all available, methodologically sound data to further assess
the safety and efficacy of combined oral anticoagulant and antiplatelet
therapy versus oral anticoagulant monotherapy in patients with prosthetic
heart valves. We updated the previous searches from 2003 and 2010 on 16
January 2013 and searched the Cochrane Central Register of Controlled
Trials (CENTRAL) on The Cochrane Library (2012, Issue 12), MEDLINE (OVID,
1946 to January Week 1 2013), and EMBASE (OVID, 1980 to 2013 Week 02). We
have also looked at reference lists of individual reports, review
articles, meta-analyses, and consensus statements. We included reports
published in any language or in abstract form. All reports of randomised
controlled trials comparing standard-dose oral anticoagulation to
standard-dose oral anticoagulation and antiplatelet therapy in patients
with one or more prosthetic heart valves. Two review authors independently
performed the search strategy, assessed trials for inclusion and study
quality, and extracted data. We collected adverse effects information from
the trials. One new study has been identified and included in this update.
In total, 13 studies involving 4122 participants were included in this
review update. Years of publication ranged from 1971 to 2011. Compared
with anticoagulation alone, the addition of an antiplatelet agent reduced
the risk of thromboembolic events (odds ratio (OR) 0.43, 95% confidence
interval (CI) 0.32 to 0.59; P < 0.00001) and total mortality (OR 0.57, 95%
CI 0.42 to 0.78; P = 0.0004). Aspirin and dipyridamole reduced these
events similarly. The risk of major bleeding was increased when
antiplatelet agents were added to oral anticoagulants (OR 1.58, 95% CI
1.14 to 2.18; P = 0.006).For major bleeding, there was no evidence of
heterogeneity between aspirin and dipyridamole and in the comparison of
trials performed before and after 1990, around the time when
anticoagulation standardisation with the international normalised ratio
was being implemented. A lower daily dose of aspirin (< 100 mg) may be
associated with a lower major bleeding risk than higher doses. Adding
antiplatelet therapy, either dipyridamole or low-dose aspirin, to oral
anticoagulation decreases the risk of systemic embolism or death among
patients with prosthetic heart valves. The risk of major bleeding is
increased with antiplatelet therapy. These results apply to patients with
mechanical prosthetic valves or those with biological valves and
indicators of high risk such as atrial fibrillation or prior
thromboembolic events. The effectiveness and safety of low-dose aspirin
(100 mg daily) appears to be similar to higher-dose aspirin and
dipyridamole. In general, the quality of the included trials tended to be
low, possibly reflecting the era when the majority of the trials were
conducted (1970s and 1980s when trial methodology was less advanced).
<26>
Accession Number
23740694
Authors
Svircevic V. Passier M.M. Nierich A.P. van Dijk D. Kalkman C.J. van der
Heijden G.J.
Institution
(Svircevic) Department of Perioperative Care and Emergency Medicine,
University Medical Center Utrecht, Utrecht, Netherlands.
Title
Epidural analgesia for cardiac surgery.
Source
The Cochrane database of systematic reviews. 6 (pp CD006715), 2013. Date
of Publication: 2013.
Abstract
A combination of general anaesthesia (GA) with thoracic epidural analgesia
(TEA) may have a beneficial effect on clinical outcomes by reducing the
risk of perioperative complications after cardiac surgery. The objective
of this review was to determine the impact of perioperative epidural
analgesia in cardiac surgery on perioperative mortality and cardiac,
pulmonary or neurological morbidity. We performed a meta-analysis to
compare the risk of adverse events and mortality in patients undergoing
cardiac surgery under general anaesthesia with and without epidural
analgesia. We searched the Cochrane Central Register of Controlled Trials
(CENTRAL) (2012, Issue 12) in The Cochrane Library; MEDLINE (PubMed) (1966
to November 2012); EMBASE (1989 to November 2012); CINHAL (1982 to
November 2012) and the Science Citation Index (1988 to November 2012). We
included randomized controlled trials comparing outcomes in adult patients
undergoing cardiac surgery with either GA alone or GA in combination with
TEA. All publications found during the search were manually and
independently reviewed by the two authors. We identified 5035 titles, of
which 4990 studies did not satisfy the selection criteria or were
duplicate publications, that were retrieved from the five different
databases. We performed a full review on 45 studies, of which 31
publications met all inclusion criteria. These 31 publications reported on
a total of 3047 patients, 1578 patients with GA and 1469 patients with GA
plus TEA. Through our search (November 2012) we have identified 5035
titles, of which 31 publications met our inclusion criteria and reported
on a total of 3047 patients. Compared with GA alone, the pooled risk ratio
(RR) for patients receiving GA with TEA showed an odds ratio (OR) of 0.84
(95% CI 0.33 to 2.13, 31 studies) for mortality; 0.76 (95% CI 0.49 to
1.19, 17 studies) for myocardial infarction; and 0.50 (95% CI 0.21 to
1.18, 10 studies) for stroke. The relative risks (RR) for respiratory
complications and supraventricular arrhythmias were 0.68 (95% CI 0.54 to
0.86, 14 studies) and 0.65 (95% CI 0.50 to 0.86, 15 studies) respectively.
This meta-analysis of studies, identified to 2010, showed that the use of
TEA in patients undergoing coronary artery bypass graft surgery may reduce
the risk of postoperative supraventricular arrhythmias and respiratory
complications. There were no effects of TEA with GA on the risk of
mortality, myocardial infarction or neurological complications compared
with GA alone.
<27>
Accession Number
23782856
Authors
Li Q. Zhang Z. Yin R.X.
Institution
(Li) Department of Cardiology, Institute of Cardiovascular Diseases, the
First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road,
Nanning 530021 Guangxi, People's Republic of China.
Title
Drug-eluting stents or coronary artery bypass grafting for unprotected
left main coronary artery disease: a meta-analysis of four randomized
trials and seventeen observational studies.
Source
Trials. 14 , 2013. Article Number: 133. Date of Publication: 2013.
Abstract
The clinical application of drug-eluting stents (DES) or coronary artery
bypass grafting (CABG) for unprotected left main coronary artery disease
(ULMCAD) is still controversial. The purpose of this meta-analysis was to
compare the safety and efficacy between DES and CABG for ULMCAD. Databases
of MEDLINE, EMBASE and the Cochrane Library were systematically searched.
Twenty-one studies with 8,413 patients were included in this
meta-analysis. The risk was lower in DES than in CABG groups at the early
outcomes of death (risk ratio (RR): 0.49, 95% confidence interval (CI):
0.30-0.78), cerebrovascular events (RR: 0.19, 95% CI: 0.08-0.45) and
composite endpoint (RR: 0.53, 95% CI: 0.40-0.70); death after 2 years (RR:
0.81, 95% CI: 0.66-0.99), 4 years (RR: 0.69, 95% CI: 0.53-0.90), 5 years
(OR: 0.76, 95% CI: 0.61-0.95) and their total effect (RR: 0.79, 95% CI:
0.71-0.87); composite endpoint 1 year (RR: 0.69, 95% CI: 0.58-0.83), 4
years (RR: 0.69, 95% CI: 0.53-0.88), 5 years (RR: 0.74, 95% CI: 0.59-0.92)
and their total effect (RR: 0.78, 95% CI: 0.71-0.85). There were no
significant differences in the risk for the early outcomes of myocardial
infarction (RR: 0.97, 95% CI: 0.68-1.38), death 1 year (OR: 0.81, 95% CI:
0.57-1.15) and 3 years (OR: 0.85, 95% CI: 0.69-1.04), composite endpoint
of 2 years (RR: 0.88, 95% CI: 0.72-1.09) and 3 years (RR: 0.87, 95% CI:
0.73-1.04). Nonetheless, there was a lower risk for revascularization
associated with CABG from 1 to 5 years and their total effect (RR: 3.77,
95% CI: 3.35-4.26). There was no difference in death, myocardial
infarction, cerebrovascular events or revascularization at 1 year between
RCT and observational groups. Our meta-analysis indicates that DES has
higher safety but higher revascularization than CABG in patients with
ULMCAD in the 5 years after intervention.
<28>
Accession Number
23782510
Authors
Sibilitz K.L. Berg S.K. Hansen T.B. Risom S.S. Rasmussen T.B. Hassager C.
Kober L. Steinbruchel D. Gluud C. Winkel P. Thygesen L.C. Hansen J.L.
Schmid J.P. Conraads V. Brocki B.C. Zwisler A.D.
Institution
(Sibilitz) The Heart Centre, Department of Cardiology, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark.
Title
Effect of comprehensive cardiac rehabilitation after heart valve surgery
(CopenHeartVR): study protocol for a randomised clinical trial.
Source
Trials. 14 , 2013. Article Number: 104. Date of Publication: 2013.
Abstract
Heart valve diseases are common with an estimated prevalence of 2.5% in
the Western world. The number is rising due to an ageing population. Once
symptomatic, heart valve diseases are potentially lethal, and heavily
influence daily living and quality of life. Surgical treatment, either
valve replacement or repair, remains the treatment of choice. However,
post surgery, the transition to daily living may become a physical, mental
and social challenge. We hypothesise that a comprehensive cardiac
rehabilitation programme can improve physical capacity and self-assessed
mental health and reduce hospitalisation and healthcare costs after heart
valve surgery. A randomised clinical trial, CopenHeartVR, aims to
investigate whether cardiac rehabilitation in addition to usual care is
superior to treatment as usual after heart valve surgery. The trial will
randomly allocate 210 patients, 1:1 intervention to control group, using
central randomisation, and blinded outcome assessment and statistical
analyses. The intervention consists of 12 weeks of physical exercise, and
a psycho-educational intervention comprising five consultations. Primary
outcome is peak oxygen uptake (VO2 peak) measured by cardiopulmonary
exercise testing with ventilatory gas analysis. Secondary outcome is
self-assessed mental health measured by the standardised questionnaire
Short Form 36. Also, long-term healthcare utilisation and mortality as
well as biochemistry, echocardiography and cost-benefit will be assessed.
A mixed-method design is used to evaluate qualitative and quantitative
findings encompassing a survey-based study before the trial and a
qualitative pre- and post-intervention study. The study is approved by the
local regional Research Ethics Committee (H-1-2011-157), and the Danish
Data Protection Agency (j.nr. 2007-58-0015). ClinicalTrials.gov
(http://NCT01558765).
<29>
Accession Number
23497625
Authors
Li L. Li G. Yu C. Li Y.
Institution
(Li) Department of Gastroenterology, The First Affiliated Hospital,
College of Medicine, Zhejiang University, Hangzhou 310003, PR China.
Title
The role of remote ischemic preconditioning on postoperative kidney injury
in patients undergoing cardiac and vascular interventions: a
meta-analysis.
Source
Journal of cardiothoracic surgery. 8 (pp 43), 2013. Date of Publication:
2013.
Abstract
The objective of this study was to perform a meta-analysis of randomized
controlled trials (RCTs) investigating whether a remote ischemic
preconditioning (RIPC) protocol provides renal protection to patients
undergoing cardiac and vascular interventions. Searches were conducted in
the databases PUBMED, EMBASE and Cochrane Library. RCTs that fulfilled the
inclusion criteria and addressed the clinical questions of this analysis
were further assessed. We identified ten studies with a total of 924
patients undergoing cardiac and vascular interventions with or without
RIPC. There was a significantly lower incidence of acute kidney injury in
the RIPC group compared with control group using the fixed effect model
(RR 0.69, 95% CI 0.53 to 0.90, P = 0.007), but not with the random effects
model (RR 0.73, 95% CI 0.50 to 1.06, P = 0.10). There was no difference in
the levels of renal biomarkers, incidence of renal replacement therapy,
mortality, hospital stay, and intensive care unit stay between two groups.
In conclusion, there is no enough evidence that RIPC provided renal
protection in patients undergoing cardiac and vascular interventions.
Large-scale RCTs are necessary to confirm the potential role of RIPC on
renal impairment.
<30>
Accession Number
23497457
Authors
Yimin H. Xiaoyu L. Yuping H. Weiyan L. Ning L.
Institution
(Yimin) Department of Anesthesiology, Jinling hospital, medical school of
Nanjing University, Nanjing, 210002, PR China.
Title
The effect of vasopressin on the hemodynamics in CABG patients.
Source
Journal of cardiothoracic surgery. 8 (pp 49), 2013. Date of Publication:
2013.
Abstract
Vasopressin is widely used to treat various type of hypotension, but the
effect of vasopressin on coronary artery bypass grafting surgery (CABG)
patients is not clear. This study was to investigate the effect of
vasopressin on the hemodynamics in CABG patients. Twenty coronary artery
disease (CAD) patients were randomly divided into two groups:
norepinephrine group and vasopressin group. During the anesthesia and the
operation, the central venous pressure (CVP) and pulmonary capillary wedge
pressure (PCWP) were maintained to 8-10cmH2O, and the hemocrit was
maintained above 30% through lactate ringer's mixture, artifact colloid
and red blood cells. The invasive artery blood pressure (IBP) was
maintained by appropriate anesthetic depth and norepinephrine or
vasopressin respectively. The target IBP was 70 mmHg, and heart rate (HR)
was 60 bpm. The MAP (mean artery pressure), HR, ST-T, CVP, PAP (pulmonary
artery pressure), PCWP, SVR (systemic vascular resistance), PVR (pulmonary
vascular resistance), CO (cardiac output), urine output, blood gas
analysis, surgery duration and blood loss were monitored. The MAP, HR, and
ST-T were stable in either group during the operation. CVP, PCWP and SVR
increased but CI deceased during the posterior descending artery (PDA) was
grafted in both groups and without any significant difference between
them. PAP increased during PDA was grafted in either group and there was
significant difference between the two groups. PVR increased during ADA
and PDA being grafted in norepinephrine group but not in vasopressin
group. Metoprolol usage was 11.2 mg and 5.9 mg in norepinephrine group and
vasopressin group respectively. Vasopressin was better than
norepinephrine.to keep the hemodynamics stability of patients undergoing
CABG surgery.
<31>
Accession Number
23666460
Authors
Pepe S. Liaw N.Y. Hepponstall M. Sheeran F.L. Yong M.S. d'Udekem Y. Cheung
M.M. Konstantinov I.E.
Institution
(Pepe) Heart Research Group, Murdoch Childrens Research Institute,
University of Melbourne, Melbourne, Australia.
Title
Effect of remote ischemic preconditioning on phosphorylated protein
signaling in children undergoing tetralogy of Fallot repair: a randomized
controlled trial.
Source
Journal of the American Heart Association. 2 (3) (pp e000095), 2013. Date
of Publication: Jun 2013.
Abstract
Our previous randomized controlled trial demonstrated cardiorespiratory
protection by remote ischemic preconditioning (RIPC) in children before
cardiac surgery. However, the impact of RIPC on myocardial prosurvival
intracellular signaling remains unknown in cyanosis. RIPC may augment
phosphorylated protein signaling in myocardium and circulating leukocytes
during tetralogy of Fallot (ToF) repair. Children (n=40) undergoing ToF
repair were double-blind randomized to RIPC (n=11 boys, 9 girls) or
control (sham RIPC: n=9 boys, 11 girls). Blood samples were taken before,
immediately after, and 24 hours after cardiopulmonary bypass. Resected
right ventricular outflow tract muscle and leukocytes were processed for
protein expression and mitochondrial respiration. There was no difference
in age (7.1 + 3.4 versus 7.1 + 3.4 months), weight (7.7 + 1.8 versus 7.5 +
1.9 kg), or bypass or aortic cross-clamp times between the groups (control
versus RIPC, mean+SD). No differences were seen between the groups for an
increase in the ratio of phosphorylated to total protein for protein
kinase B, p38 mitogen activated protein kinase, signal transducer and
activator of transcription 3, glycogen synthase kinase 3beta, heat shock
protein 27, Connexin43, or markers associated with promotion of necrosis
(serum cardiac troponin I), apoptosis (Bax, Bcl-2), and autophagy (Parkin,
Beclin-1, LC3B). A high proportion of total proteins were in
phosphorylated form in control and RIPC myocardium. In leukocytes,
mitochondrial respiration and assessed protein levels did not differ
between groups. In patients with cyanotic heart disease, a high proportion
of proteins are in phosphorylated form. RIPC does not further enhance
phosphorylated protein signaling in myocardium or circulating leukocytes
in children undergoing ToF repair. URL:
(http://www.anzctr.org.au/trial_view.aspx?id=335613. Unique identifier:
Australian New Zealand Clinical Trials Registry number
ACTRN12610000496011.
<32>
Accession Number
23461482
Authors
Hoseini S. Soltani F. Babaee Beygi M. Zarifsanaee N.
Institution
(Hoseini, Soltani) Fatemeh (P.B.U.H) School of Nursing and Midwifery,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Babaee Beygi) Department of Cardiac, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Zarifsanaee) Center of Excellence for Electronic Learning in Medical
Sciences, School of Medicine, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
Title
The effect of educational audiotape programme on anxiety and depression in
patients undergoing coronary artery bypass graft.
Source
Journal of Clinical Nursing. 22 (11-12) (pp 1613-1619), 2013. Date of
Publication: June 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Aims and objectives: To investigate use of educational audiotape programme
on anxiety and depression in patients undergoing coronary artery bypass
graft (CABG). Background: Anxiety and depression after CABG are the most
common complications, having a negative impact on the prognosis of heart
disease, leading to special needs according to their new physical and
mental conditions. Design: Randomised clinical trial. Methods: This study
conducted in Iran, 70 patients undergoing CABG were included and divided
into two equal groups, the control group and intervention group. They were
followed up for six weeks. An audiotape educational programme was given to
the intervention group after surgery in addition to the routine training.
But patients in the control group received only routine training. Anxiety
and depression were assessed by Hospital Anxiety and Depression Scale, a
standardised questionnaire for anxiety and depression. Data were collected
before and six weeks after the intervention. For the comparison of mean
scores between the groups, the data were analysed in spss, version 16,
using independent T-test and paired T-test. Results: The mean scores
obtained in both anxiety and depression dimensions were significantly
different between the intervention and control groups. Conclusions:
Audiotape educational programme used by patients undergoing CABG decreases
the level of their anxiety and depression after cardiac surgery. Relevance
to clinical practice: The most significant finding was the importance of
audiotape educational programme to meet the needs of the CABG patients,
which suggest that patient education through audiotape can be effective in
self-care after heart surgery and nurses can use an audiotape containing
preparatory information to improve outcomes and reduce anxiety and
depression in patients having CABG. 2013 Blackwell Publishing Ltd.
<33>
Accession Number
23364237
Authors
Ren S. Qian S. Wang W. Wang F. Liu J. Liu P.
Institution
(Ren, Qian, Wang, Liu, Liu) Cardiovascular Surgery, China-Japan Friendship
Hospital, Chinese Ministry of Health, Beijing, China
(Wang) Department of Anesthesiology, China-Japan Friendship Hospital,
Chinese Ministry of Health, Beijing, China
Title
Prospective study of sarpogrelate hydrochloride on patients with
arteriosclerosis obliterans.
Source
Annals of Thoracic and Cardiovascular Surgery. 19 (1) (pp 30-34), 2013.
Date of Publication: 2013.
Publisher
Japanese Association for Coronary Artery Surgery (2-1 Nibancho,
Chiyoda-ku, Tokyo 102-0084, Japan)
Abstract
Objective: To evaluate the effect of sarpogrelate for patients with
atherosclerotic obliterans (ASO). Patients and Methods: Patients with ASO
were randomly divided into sarpogrelate group (n = 92) and control group
(n = 84). The patients in sarpogrelate group received sarpogrelate (100
mg, tid), whereas in control group aspirin (100 mg, qd) was administered
orally. The patients were followed up monthly to observe any side effect
of medication. Clinical manifestation, painless walking distance,
Rutherford type and ankle brachial Index (ABI) were studied. Results: In
comparison with control group, the severity of pain, Rutherford type 0 and
1 were improved with statistic significance. Incidence of patients with
intermittent claudication decreased from 56.6% before treatment to 28.3%
after treatment; the painless walking distance was prolonged (116.3 +
72.3m vs. 243.5 + 175.3m, P <0.001); ABI values were increased (0.74 +
0.17 vs. 0.86 + 0.18; p <0.001). No side effect of medication was
observed. Conclusion: Sarpogrelate has a therapeutic effect on patients
with atherosclerotic obliterans. 2013 The Editorial Committee of Annals of
Thoracic and Cardiovascular Surgery. All rights reserved.
<34>
Accession Number
22785552
Authors
Darcin O.T. Zor M.H. Sahin V. Kara I. Bekmezci M. Sahsivar O.
Institution
(Darcin, Zor, Sahin, Kara, Bekmezci, Sahsivar) Konya Education and
Research Hospital, Clinic of Cardiovascular Surgery, Konya, Turkey
Title
Effect of iloprost on renal function in patients undergoing coronary
artery bypass grafting: A clinical study.
Source
Annals of Thoracic and Cardiovascular Surgery. 19 (1) (pp 12-17), 2013.
Date of Publication: 2013.
Publisher
Japanese Association for Coronary Artery Surgery (2-1 Nibancho,
Chiyoda-ku, Tokyo 102-0084, Japan)
Abstract
Purpose: Renal dysfunction remains a serious complication of coronary
artery bypass grafting (CABG) surgery and is associated with increased
mortality and morbidity. To date, a number of different strategies,
including new pharmacologic agents, off-pump and cardiopulmonary bypass
techniques have been used to avoid it, but none of them proves the
excellent result. Methods: Between April 2009 to September 2011, 185
consecutive patients with multivessel coronary artery disease undergoing
elective CABG were included the study. Iloprost was given with the onset
of rewarming period at a dose of 1.25-2.5 ng/kg/min and it was ended
together with the ending of CPB in 94 patients and remaining were in the
control group. Creatinine clearance (CCr) and GFR were measured at the
time of hospitalisation and on day first and fifth postoperatively. Serum
potassium level was determined every 6 hours, during the first 24 hours
postoperatively, and every 12 hours for the next 72 hours, and glomerular
filtration rate was estimated. Results: There was no statistically
significant difference in preoperative comorbidity. There were no
significant differences in postoperative morbidity or mortality between
either of the two groups that completed the study. However, urine output
during the operation was significantly higher in the study group. An
increase in creatine levels was more common in the control group.
Development of a new CCr less than 50 ml/min was also significantly higher
in the control group, postoperatively. Conclusion: Our study demonstrates
that prophylactic intravenous iloprost administration after initiation of
a rewarming period during CPB in patients undergoing CABG surgery is
associated with improved renal function, compared with conventional
treatment in wellhydrated patients. It also has a good safety profile and
is generally well tolerated. 2012 The Editorial Committee of Annals of
Thoracic and Cardiovascular Surgery. All rights reserved.
<35>
Accession Number
23195627
Authors
Crisafulli A. Tocco F. Milia R. Angius L. Pinna M. Olla S. Roberto S.
Marongiu E. Porcu M. Concu A.
Institution
(Crisafulli, Tocco, Milia, Angius, Pinna, Olla, Roberto, Marongiu, Concu)
Department of Medical Sciences, Sport Physiology Lab., University of
Cagliari, Via Porcell 4, 09124 Cagliari, Italy
(Porcu) Department of Cardiovascular and Thoracic Pathology, Brotzu
Hospital, Cagliari, Italy
Title
Progressive improvement in hemodynamic response to muscle metaboreflex in
heart transplant recipients.
Source
Journal of Applied Physiology. 114 (3) (pp 421-427), 2013. Date of
Publication: 01 Feb 2013.
Publisher
American Physiological Society (9650 Rockville Pike, Bethesda MD
20814-3991, United States)
Abstract
Exercise capacity remains lower in heart transplant recipients (HTRs)
following transplant compared with normal subjects, despite improved
cardiac function. Moreover, metaboreceptor activity in the muscle has been
reported to increase. The aim of the present investigation was to assess
exercise capacity together with metaboreflex activity in HTR patients for
1 yr following heart transplant, to test the hypothesis that recovery in
exercise capacity was paralleled by improvements in response to
metaboreflex. A cardiopulmonary test for exercise capacity and V ? O2max
and hemodynamic response to metaboreflex activation obtained by
postexercise ischemia were gathered in six HTRs and nine healthy controls
(CTL) four times: at the beginning of the study (T0, 42 + 6 days after
transplant), at the 3rd, 6th, and 12th month after TO (T1, T2, and T3).
The main results were: 1) exercise capacity and VO<sub>2max</sub> were
seen to progressively increase in HTRs; 2) at T0 and T1, HTRs achieved a
higher blood pressure response in response to metaboreflex compared with
CTL, and this difference disappeared at T2 and T3; and 3) this exaggerated
blood pressure response was the result of a systemic vascular resistance
increment. This study demonstrates that exercise capacity progressively
improves in HTRs after transplant and that this phenomenon is accompanied
by a progressive reduction of the metaboreflex-induced increase in blood
pressure and systemic vascular resistance. These facts indicate that,
despite improved cardiac function, resetting of cardiovascular regulation
in HTRs requires months. Copyright 2013 the American Physiological
Society.
<36>
Accession Number
23515737
Authors
Sa M.P.B.O. Ferraz P.E. Escobar R.R. Martins W.N. Lustosa P.C. Nunes E.O.
Vasconcelos F.P. Lima R.C.
Institution
(Sa, Ferraz, Escobar, Martins, Lustosa, Nunes, Vasconcelos, Lima) Division
of Cardiovascular Surgery, Pronto Socorro Cardiologico de Pernambuco
(PROCAPE), University of Pernambuco (UPE), Recife, PE, Brazil
Title
Off-pump versus on-pump coronary artery bypass surgery: Meta-analysis and
meta-regression of 13,524 patients from randomized trials.
Source
Brazilian Journal of Cardiovascular Surgery. 27 (4) (pp 631-641), 2012.
Date of Publication: October-December 2012.
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (Av. Juscelino Kubitschek
de Oliviera 1505, Sao Jose do Rio Preto 15091-450, Brazil)
Abstract
Background: Most recent published meta-analysis of randomized controlled
trials (RCTs) showed that off-pump coronary artery bypass graft surgery
(CABG) reduces incidence of stroke by 30% compared with on-pump CABG, but
showed no difference in other outcomes. New RCTs were published,
indicating need of new meta-analysis to investigate pooled results adding
these further studies. Methods: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO,
LILACS, Google Scholar and reference lists of relevant articles were
searched for RCTs that compared outcomes (30-day mortality for all-cause,
myocardial infarction or stroke) between off-pump versus on-pump CABG
until May 2012. The principal summary measures were relative risk (RR)
with 95% Confidence Interval (CI) and P values (considered statistically
significant when <0.05). The RR's were combined across studies using
DerSimonian-Laird random effects weighted model. Meta-analysis and
meta-regression were completed using the software Comprehensive
Meta-Analysis version 2 (Biostat Inc., Englewood, New Jersey, USA).
Results: Forty-seven RCTs were identified and included 13,524 patients
(6,758 for off-pump and 6,766 for on-pump CABG). There was no significant
difference between off- pump and on-pump CABG groups in RR for 30-day
mortality or myocardial infarction, but there was difference about stroke
in favor to off-pump CABG (RR 0.793, 95% CI 0.660-0.920, P=0.049). It was
observed no important heterogeneity of effects about any outcome, but it
was observed publication bias about outcome "stroke". Meta-regression did
not demonstrate influence of female gender, number of grafts or age in
outcomes. Conclusion: Off-pump CABG reduces the incidence of
post-operative stroke by 20.7% and has no substantial effect on mortality
or myocardial infarction in comparison to on-pump CABG. Patient gender,
number of grafts performed and age do not seem to explain the effect of
off-pump CABG on mortality, myocardial infarction or stroke, respectively.
<37>
Accession Number
2013798361
Authors
Barakat H.M. Shahin Y. Barnes R. Gohil R. Souroullas P. Khan J. McCollum
P.T. Chetter I.C.
Institution
(Barakat, Shahin, Barnes, Gohil, Souroullas, Khan, McCollum, Chetter)
Academic Vascular Surgical Unit, Vascular Laboratory, Hull Royal
Infirmary, Anlaby Road, Hull, HU3 2JZ, United Kingdom
Title
Supervised exercise program improves aerobic fitness in patients awaiting
abdominal aortic aneurysm repair.
Source
Annals of Vascular Surgery. 28 (1) (pp 74-79), 2014. Date of Publication:
January 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background Aerobic fitness is an important predictor of postoperative
outcome in major surgery. In this study, we assess the effects of a period
of preoperative exercise on aerobic fitness as measured by cardiopulmonary
exercise testing (CPET) in patients scheduled for abdominal aortic
aneurysm (AAA) repair. Methods As part of a randomized trial, the first
patients recruited in the intervention group were enrolled in a supervised
exercise program of six week duration. Treadmill CPET parameters were
measured before and after exercise preoperatively for these patients.
These parameters were as follows: peak oxygen uptake (VO<sub>2</sub>
peak), anaerobic threshold (AT), and ventilator equivalents for oxygen and
carbon dioxide (V<sub>E</sub>/VO<sub>2</sub> and
V<sub>E</sub>/VCO<sub>2</sub>, respectively). Total exercise time and the
time at which AT was achieved were also recorded. A comparison between
pre- and postexercise parameters was made to detect for a possible
improvement in aerobic fitness. Results Twenty patients with AAA (17 men;
mean age: 74.9 + 5.9 years) were included in this study. Thirty-five
percent of patients had a history of ischemic heart disease, 25% of
obstructive airway disease, and 15% of cerebral vascular events. Seventy
percent were previous smokers, and 15% were current smokers. Fifty-five
percent of patients were taking aspirin and 75% were undergoing statin
therapy. The median (interquartile range) VO<sub>2</sub> peak at baseline
was 18.2 (15.4-19.9) mL/kg/min, and after exercise was 19.9 (17.1-21.1; P
= 0.048). Median AT at baseline was 12.2 (10.5-14.9), and 14.4 (12.3-15.4)
after exercise (P = 0.023). Time of exercise tolerated also improved from
a median of 379 to 604 sec (P = 0.001). No significant changes were seen
in V<sub>E</sub>/VO<sub>2</sub>, V<sub>E</sub>/VCO<sub>2</sub>, or the
time at which AT was achieved. Conclusion This study shows that
cardiopulmonary aerobic fitness improves after a period of supervised
exercise in patients scheduled for AAA repair. This is justification for a
randomized trial to assess whether this affects morbidity and mortality
after AAA repair. 2014 by Elsevier Inc. All rights reserved.
<38>
Accession Number
2013788582
Authors
Kekecs Z. Jakubovits E. Varga K. Gombos K.
Institution
(Kekecs) Eotvos Lorand University, Faculty of Education and Psychology,
Affective Psychology Department, Budapest, Hungary
(Jakubovits) Semmelweis University, Faculty of Health Scienses, Hungary
(Varga) Eotvos Lorand University, Faculty of Education and Psychology,
Affective Psychology Department, Hungary
(Gombos) Szent Janos Korhaz es Eszak-budai Egyesitett Korhazak,
Ophthalmology, Hungary
Title
Effects of patient education and therapeutic suggestions on cataract
surgery patients: A randomized controlled clinical trial.
Source
Patient Education and Counseling. 94 (1) (pp 116-122), 2014. Date of
Publication: January 2014.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objective: This paper describes a randomized controlled single blind study
testing the effects of a patient education intervention combined with
positive therapeutic suggestions on anxiety for cataract surgery patients.
Methods: 84 patients participated in the study. Physiological and
behavioral indicators of anxiety were compared between a regularly treated
control and an intervention group receiving an audio CD containing
information, relaxation, and positive imagery. Results: We found that the
intervention group was calmer throughout the four measurement points of
the study (p = .004; d= 0.71) and they were more cooperative (p = .01; d=
0.60) during the operation. The groups did not differ in sleep quality
before the day of the operation, heart rate during the procedure, and
subjective Well-being. Conclusion: Findings indicate that preoperative
information combined with positive suggestions and anxiety management
techniques might reduce patient anxiety in the perioperative period of
cataract surgery, but further research is needed to investigate the
benefits of such interventions and to uncover the underlying mechanisms.
Practice implications: Patient education interventions providing
additional anxiety management techniques are recommended for use prior to
cataract surgery. 2013 Elsevier Ireland Ltd.
<39>
Accession Number
2013810071
Authors
Shahraki A.D. Feizi A. Jabalameli M. Nouri S.
Institution
(Shahraki) Department of Obstetrics and Gynecology, Isfahan University of
Medical Sciences, Isfahan, Iran, Islamic Republic of
(Feizi) Department of Epidemiology and Biostatistics, Isfahan University
of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Jabalameli) Department of Anesthesiology, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Nouri) School of Medicine, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
Title
The effect of intravenous Dexamethasone on post-cesarean section pain and
vital signs: A double-blind randomized clinical trial.
Source
Journal of Research in Pharmacy Practice. 2 (3) (pp 99-104), 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: Any operation leads to body stress and tissue injury that
causes pain and its complications. Glucocorticoids such as Dexamethasone
are strong anti-inflammatory agents, which can be used for a short time
post-operative pain control in various surgeries. Main purpose of this
study is to evaluate the effect of administration of intravenous (IV)
Dexamethasone on reducing the pain after cesarean. Methods: A double-blind
prospective randomized clinical trial was performed on 60 patients
candidate for elective caesarean section. Patients were randomly assigned
into two groups: A (treatment: 8 mg IV Dexamethasone) and B (control: 2 mL
normal saline). In both groups, variables such as mean arterial blood
pressure (MAP), heart rate (HR), respiratory rate (RR), pain and vomiting
severity (based on visual analog scale) were recorded in different time
points during first 24 h after operation. Statistical methods using
repeated measure analysis of variances and t-test, Mann-Whitney and
Chi-square tests were used for analyzing data. Findings: The results
indicated that within-group comparisons including severity of pain, MAP,
RR and HR have significant differences (P < 0.001 for all variables)
during the study period. Between group comparisons indicated significant
differences in terms of pain severity (P < 0.001), MAP (P = 0.048) and HR
(P = 0.078; marginally significant), which in case group were lower than
the control group. Conclusion: IV Dexamethasone could efficiently reduce
post-operative pain severity and the need for analgesic consumption and
improve vital signs after cesarean section. Shahraki Azar 1 Department of
Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan
Feizi Awat 2 Department of Epidemiology and Biostatistics, Isfahan
University of Medical Sciences, Isfahan Jabalameli Mitra 3 Department of
Anesthesiology, Isfahan University of Medical Sciences, Isfahan Nouri
Shadi 4 School of Medicine, Isfahan University of Medical Sciences,
Isfahan Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet
2011;377:2215-25. Liu K, Hsu CC, Chia YY. Effect of dexamethasone on
postoperative emesis and pain. Br J Anaesth 1998;80:85-6. Jokela RM,
Ahonen JV, Tallgren MK, Marjakangas PC, Korttila KT. The effective
analgesic dose of dexamethasone after laparoscopic hysterectomy. Anesth
Analg 2009;109:607-15. Kardash K, Sarrazin F, Tressler M, Velly A. Single
dose dexamethasone reduces dynamic pain after total hip artroplasty. Pain
Med 2008;4:1253-7. Wu JI, Lo Y, Chia YY, Liu K, Fong WP, Yang LC, et al.
Prevention of postoperative nausea and vomiting after intrathecal morphine
for cesarean section: A randomized comparison of dexamethasone,
droperidol, and a combination. Int J Obstet Anesth 2007;16:122-7. Movafegh
A, Soroush AR, Navi A, Sadeghi M, Esfehani F, Akbarian-Tefaghi N. The
effect of intravenous administration of dexamethasone on postoperative
pain, nausea, and vomiting after intrathecal injection of meperidine.
Anesth Analg 2007;104:987-9. Aminmansour B, Khalili HA, Ahmadi J, Nourian
M. Effect of high-dose intravenous dexamethasone on postlumbar discectomy
pain. Spine (Phila Pa 1976) 2006;31:2415-7. Kaan MN, Odabasi O, Gezer E,
Daldal A. The effect of preoperative dexamethasone on early oral intake,
vomiting and pain after tonsillectomy. Int J Pediatr Otorhinolaryngol
2006;70:73-9. El Azab SR, Rosseel PM, de Lange JJ, Groeneveld AB, van
Strik R, van Wijk EM, et al. Dexamethasone decreases the pro- to
anti-inflammatory cytokine ratio during cardiac surgery. Br J Anaesth
2002;88:496-501. Shahraki AD, Jabalameli M, Ghaedi S. Pain relief after
cesarean section: Oral methadone vs. intramuscular pethidine. J Res Med
Sci 2012;17:143-7. Jabalameli M, Saryazdi H, Massahipour O. The effect of
subcutaneous dexamethasone added to bupivacaine on postcesarean pain: A
randomized controlled trial. JIMS 2010;35:21-6. Jaafarpour M, Khani A,
Dyrekvandmoghadam A, Khajavikhan J, Saaidpour Kh. The effect of
dexamethasone on nausea, vomiting and pain in parturients undergoing
caesarean delivery. J Clin Diagn Res 2008;3:854-8. Nortcliffe SA, Shah J,
Buggy DJ. Prevention of postoperative nausea and vomiting after spinal
morphine for caesarean section: Comparison of cyclizine, dexamethasone and
placebo. Br J Anaesth 2003;90:665-70. Martin JA, Hamilton BE, Sutton PD,
Ventura SJ, Menacker F, Kirmeyer S. Births: Final data for 2004. Births:
Final data for 2009. Natl Vital Stat Rep 2011;60:1-72. Ahmad-Nia S,
Delavar B, Eini-Zinab H, Kazemipour S, Mehryar AH, Naghavi M. Caesarean
section in the Islamic Republic of Iran: Prevalence and some
sociodemographic correlates. East Mediterr Health J 2009;15:1389-98.
Skjelbred P, Lokken P. Post-operative pain and inflammatory reaction
reduced by injection of a corticosteroid. A controlled trial in bilateral
oral surgery. Eur J Clin Pharmacol 1982;21:391-6. Aasboe V, Raeder JC,
Groegaard B. Betamethasone reduces postoperative pain and nausea after
ambulatory surgery. Anesth Analg 1998;87:319-23. Coloma M, Duffy LL, White
PF, Kendall Tongier W, Huber PJ Jr. Dexamethasone facilitates discharge
after outpatient anorectal surgery. Anesth Analg 2001;92:85-8. Romundstad
L, Breivik H, Roald H, Skolleborg K, Haugen T, Narum J, et al.
Methylprednisolone reduces pain, emesis, and fatigue after breast
augmentation surgery: A single-dose, randomized, parallel-group study with
methylprednisolone 125 mg, parecoxib 40 mg, and placebo. Anesth Analg
2006;102:418-25. Romundstad L, Breivik H, Niemi G, Helle A, Stubhaug A.
Methylprednisolone intravenously 1 day after surgery has sustained
analgesic and opioid-sparing effects. Acta Anaesthesiol Scand
2004;48:1223-31. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J.
Preoperative dexamethasone improves surgical outcome after laparoscopic
cholecystectomy: A randomized double-blind placebo-controlled trial. Ann
Surg 2003;238:651-60. Afman CE, Welge JA, Steward DL. Steroids for
post-tonsillectomy pain reduction: Meta-analysis of randomized controlled
trials. Otolaryngol Head Neck Surg 2006;134:181-6. Bamgbose BO, Akinwande
JA, Adeyemo WL, Ladeinde AL, Arotiba GT, Ogunlewe MO. Effects of
co-administered dexamethasone and diclofenac potassium on pain, swelling
and trismus following third molar surgery. Head Face Med 2005;1:11. Lin
TC, Lui MT, Chang RC. Premedication with diclofenac and prednisolone to
prevent postoperative pain and swelling after third molar removal.
Zhonghua Yi Xue Za Zhi (Taipei) 1996;58:40-4. Holte K, Kehlet H.
Perioperative single-dose glucocorticoid administration: Pathophysiologic
effects and clinical implications. J Am Coll Surg 2002;195:694-712. White
PF. The role of non-opioid analgesic techniques in the management of pain
after ambulatory surgery. Anesth Analg 2002;94:577-85. Tzeng JI, Wang JJ,
Ho ST, Tang CS, Liu YC, Lee SC. Dexamethasone for prophylaxis of nausea
and vomiting after epidural morphine for post-caesarean section analgesia:
Comparison of droperidol and saline. Br J Anaesth 2000;85:865-8. Hval K,
Thagaard KS, Schlichting E, Raeder J. The prolonged postoperative
analgesic effect when dexamethasone is added to a nonsteroidal
antiinflammatory drug (rofecoxib) before breast surgery. Anesth Analg
2007;105:481-6. Song IH, Buttgereit F. Non-genomic glucocorticoid effects
to provide the basis for new drug developments. Mol Cell Endocrinol
2006;246:142-6. O'Sullivan BT, Cutler DJ, Hunt GE, Walters C, Johnson GF,
Caterson ID. Pharmacokinetics of dexamethasone and its relationship to
dexamethasone suppression test outcome in depressed patients and healthy
control subjects. Biol Psychiatry 1997;41:574-84. Hong JY, Han SW, Kim WO,
Kim EJ, Kil HK. Effect of dexamethasone in combination with caudal
analgesia on postoperative pain control in day-case paediatric orchiopexy.
Br J Anaesth 2010;105:506-10. Splinter W, Roberts DJ. Prophylaxis for
vomiting by children after tonsillectomy: Dexamethasone versus
perphenazine. Anesth Analg 1997;85:534-7. Cardoso MM, Leite AO, Santos EA,
Gozzani JL, Mathias LA. Effect of dexamethasone on prevention of
postoperative nausea, vomiting and pain after caesarean section: A
randomised, placebo-controlled, double-blind trial. Eur J Anaesthesiol
2013;30:102-5. Wang JJ, Ho ST, Lee SC, Liu YC, Ho CM. The use of
dexamethasone for preventing postoperative nausea and vomiting in females
undergoing thyroidectomy: A dose-ranging study. Anesth Analg
2000;91:1404-7. Lopez-Olaondo L, Carrascosa F, Pueyo FJ, Monedero P, Busto
N, Saez A. Combination of ondansetron and dexamethasone in the prophylaxis
of postoperative nausea and vomiting. Br J Anaesth 1996;76:835-40. Fujii
Y, Saitoh Y, Tanaka H, Toyooka H. Granisetron/dexamethasone combination
for reducing nausea and vomiting during and after spinal anesthesia for
cesarean section. 2013, Journal of Research in Pharmacy Practice.
<40>
Accession Number
2014004826
Authors
Kolias T.J.
Institution
(Kolias) University of Michigan, Ann Arbor, MI, United States
Title
Dabigatran increased bleeding and stroke compared with warfarin after
mechanical heart valve implantation.
Source
Annals of Internal Medicine. 159 (12) (pp JC6), 2013. Date of Publication:
17 Dec 2013.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
<41>
Accession Number
2014004823
Authors
Brown R. Lip G.Y.H.
Institution
(Brown, Lip) University of Birmingham Centre for Cardiovascular Sciences,
Birmingham, United Kingdom
Title
PCI in noninfarction arteries reduced cardiac events in acute STEMI with
multivessel coronary disease.
Source
Annals of Internal Medicine. 159 (12) (pp JC3), 2013. Date of Publication:
17 Dec 2013.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
<42>
Accession Number
2014004805
Authors
Lamas G.A. Boineau R. Goertz C. Mark D.B. Rosenberg Y. Stylianou M. Rozema
T. Nahin R.L. Lindblad L. Lewis E.F. Drisko J. Lee K.L.
Institution
(Lamas) Columbia University Division of Cardiology, Mount Sinai Medical
Center, 4300 Alton Road, Miami Beach, FL 33140, United States
(Boineau, Rosenberg, Stylianou) National Heart, Lung, and Blood Institute,
6701 Rockledge Drive, MSC 7956, Bethesda, MD 20892, United States
(Goertz) Palmer Center for Chiropractic Research, 741 Brady Street,
Davenport, IA 52804, United States
(Mark, Lindblad, Lee) Duke Clinical Research Institute, 2400 Pratt Street,
Durham, NC 27705, United States
(Rozema) Biogenesis Medical Center, 1000 East Rutherford Road, Landrum, SC
29356, United States
(Nahin) National Center for Complementary and Alternative Medicine, 31
Center Drive, Bethesda, MD 20892, United States
(Lewis) Brigham and Women's Hospital, Harvard Medical School, 75 Francis
Street, Boston, MA 02115, United States
(Drisko) Integrative Medicine, University of Kansas Medical Center, 3901
Rainbow Boulevard, MS 1017, Kansas City, KS 66160, United States
Title
Oral high-dose multivitamins and minerals after myocardial infarction: A
randomized trial.
Source
Annals of Internal Medicine. 159 (12) (pp 797-804), 2013. Date of
Publication: 17 Dec 2013.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Whether high-dose multivitamins are effective for secondary
prevention of atherosclerotic disease is unknown. Objective: To assess
whether oral multivitamins reduce cardiovascular events and are safe.
Design: Double-blind, placebo-controlled, 2 x 2 factorial, multicenter,
randomized trial. (ClinicalTrials.gov: NCT00044213) Setting: 134 U.S. and
Canadian academic and clinical sites. Patients: 1708 patients aged 50
years or older who had myocardial infarction (MI) at least 6 weeks earlier
and had serum creatinine levels of 176.8 mumol/L (2.0 mg/dL) or less.
Intervention: Patients were randomly assigned to an oral, 28- component,
high-dose multivitamin and multimineral mixture or placebo. Measurements:
The primary end point was time to total death, recurrent MI, stroke,
coronary revascularization, or hospitalization for angina. Results: The
median age was 65 years, and 18% of patients were women. The qualifying MI
occurred a median of 4.6 years (interquartile range [IQR], 1.6 to 9.2
years) before enrollment. Median follow-up was 55 months (IQR, 26 to 60
months). Patients received vitamins for a median of 31 months (IQR, 13 to
59 months) in the vitamin group and 35 months (IQR, 13 to 60 months) in
the placebo group (P = 0.65). Totals of 645 (76%) and 646 (76%) patients
in the vitamin and placebo groups, respectively, completed at least 1 year
of oral therapy (P = 0.98), and 400 (47%) and 426 (50%) patients,
respectively, completed at least 3 years (P = 0.23). Totals of 394 (46%)
and 390 (46%) patients in the vitamin and placebo groups, respectively,
discontinued the vitamin regimen (P = 0.67), and 17% of patients withdrew
from the study. The primary end point occurred in 230 (27%) patients in
the vitamin group and 253 (30%) in the placebo group (hazard ratio, 0.89
[95% CI, 0.75 to 1.07]; P = 0.21). No evidence suggested harm from vitamin
therapy in any category of adverse events. Limitation: There was
considerable nonadherence and withdrawal, limiting the ability to draw
firm conclusions (particularly about safety). Conclusion: High-dose oral
multivitamins and multiminerals did not statistically significantly reduce
cardiovascular events in patients after MI who received standard
medications. However, this conclusion is tempered by the nonadherence
rate. Copyright 2013 American College of Physicians. All Rights Reserved.
<43>
Accession Number
2014001372
Authors
Ghavidel A.A. Nabavi S. Haghjoo M. Toutonchi Z. Mirmesdagh Y.
Javadikasgari H.
Institution
(Ghavidel, Nabavi, Mirmesdagh, Javadikasgari) Heart Valve Disease Research
Center AND Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Haghjoo) Cardiac Electrophysiology Research Center AND Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Toutonchi) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Amiodarone versus lidocaine for the prevention of reperfusion ventricular
fibrillation: A randomized clinical trial.
Source
ARYA Atherosclerosis. 9 (6) (pp 343-349), 2013. Date of Publication: 2013.
Publisher
Isfahan University of Medical Sciences (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Reperfusion ventricular fibrillation after aortic cross clamp
is one of the important complications of open cardiac surgery and its
prevention could reduce myocardial injuries. This study aimed to evaluate
the efficacy of single dose of amiodarone or lidocaine by the way of pump
circuit three minutes before aortic cross clamp release and compare the
results with normal saline as placebo in a randomized double blinded
controlled trial. METHODS: One hundred fifty patients scheduled for first
time elective coronary artery bypass graft surgery were randomly assigned
to receive either single dose of amiodarone (150 mg), lidocaine (100 mg),
or normal saline (5 ml) three minutes before aortic cross clamp release.
The incidence of ventricular fibrillation and the need for reuse of drug
were compared between these groups by chi-square, Student's t-test,
Mann-Whitney test, and One-way ANOVA. SPSS software was used for
statistical analysis. RESULTS: The incidence of ventricular fibrillation
is higher in the placebo group (15.9%) compare to lidocaine (11.8%) and
amiodarone (8.9%) groups; however, there was no statistical difference
among the three groups (P = 0.41). Moreover, the reuse of amiodarone
(22.7%) was statistically higher (P < 0.05) than lidocaine (5.9%).
CONCLUSION: This study showed no difference among lidocaine, amiodarone,
and placebo in preventing ventricular fibrillation after aortic cross
clamp release.
<44>
Accession Number
71283560
Authors
Kapusta P. Natorska J. Wypasek E. Undas A.
Institution
(Kapusta, Natorska, Wypasek, Undas) John Paul II Hospital, Pradnicka 80,
Krakow, Poland
Title
Effect of statins on tissue factor expression and calcification in human
aortic valve interstitial cells.
Source
Kardiologia Polska. Conference: 17th International Congress of the Polish
Cardiac Society Wroclaw Poland. Conference Start: 20130926 Conference End:
20130928. Conference Publication: (var.pagings). 71 (pp 305), 2013. Date
of Publication: September 2013.
Publisher
Via Medica
Abstract
BACKGROUND: Aortic valve stenosis (AS) that shares pathogenetic mechanisms
with atherosclerosis is common valvular heart disease in older adults.
There is evidence of tissue factor (TF) expression in calcified aortic
valve leaflets and it has been suggested that TF is involved in
calcification through enhanced generation of thrombin and the modulation
of osteopontin function. Statins known to reduce TF expression in
atherosclerotic lesions and cardiovascular events failed to reduce AS
progression. OBJECTIVE: The aim of the study was to investigate the effect
of statins on the TF expression in the human aortic valve interstitial
cells (AVICs). METHODS: AVICs obtained from human calcified aortic valves
during surgical valve replacement were cultured either under control
conditions or after stimulating with TNF-alpha (50ng/ml), peptidoglycan
(10mug/ml), lipopolysaccha-rides 200ng/ml or bone morphogenetic protein 2
(BMP-2) 100ng/ml and with various final concentration of atorvastatin
(0.01-10muM) or rosuvastatin (0.001-1muM). TF, interleukin-6, osteopontin
and Runt-related transcription factor 2 (Runx2) transcripts were
quantified by Taqman real-time PCR. Alkaline phosphatase activity was
measured in cell lysates using chromogenic assay. Calcification was
measured using Alizarin red S staining. RESULTS: The TNF-alpha,
peptidoglycan, lipopolysaccharides and BMP-2 stimulation increase TF mRNA
expression (7.4+1.3; 8.4+1.5; 9.3+1.7 and 10.8+1.8-fold respectively, all
p<0.001). All the proinfiammatory agents induced expression of
interleukin-6, osteopontin, Runx2, alkaline phosphatase activity and
calcification (p<0.01). Both atorvastatin and rosuvastatin reduced T F,
interleukin-6, osteopontin and Runx2 expression (all p<0.01), alkaline
phosphatase activity and calcification (p<0.05) with in a dose-dependent
manner. CONCLUSION: Atorvastatin and rosuvastatin decrease TF expression
and calcification in stimulated AVICs. Recent randomized controlled
studies show that statins do not delay progression of aortic valve
stenosis. It remains to be established why statins are ineffective in
slowing down the progression of AS in contrast to their beneficial effects
in atherosclerotic vascular disease.
<45>
Accession Number
71282380
Authors
Baricevic Z. Lovric D. Cikes M. Skoric B. Ljubas Macek J. Reskovic Luksic
V. Separovic Hanzevacki J. Milicic D.
Institution
(Baricevic, Lovric, Cikes, Skoric, Ljubas Macek, Reskovic Luksic,
Separovic Hanzevacki, Milicic) University Hospital Centre Zagreb,
Department of Cardiovascular Diseases, Zagreb, Croatia
Title
Speckle tracking echocardiography in heart transplant recipients: Global
radial strain is reduced in healthy hearts early after transplantation.
Source
European Heart Journal Cardiovascular Imaging. Conference: 17th Annual
Meeting of the European Association of Echocardiography, EUROECHO 2013
Istanbul Turkey. Conference Start: 20131211 Conference End: 20131214.
Conference Publication: (var.pagings). 14 (pp ii14), 2013. Date of
Publication: December 2013.
Publisher
Oxford University Press
Abstract
Purpose: Allograft rejection and vasculopathy in heart transplant (HTx)
patients require timely recognition, with coronary angiography and
endomyocardial biopsy being the diagnostic gold standards. Finding a
non-invasive alternative remains the major objective. Speckle tracking
echocardiography (STE) permits early recognition of myocardial
dysfunction. The reduction in strain has been shown to denote both
rejection and vasculopathy. However, deformation indices are also reduced
in healthy HTx recipients > l year after transplantation when compared
with control subjects. Whether the reduction in strain is a chronic
progressive process or the immediate result of transplantation (due to
allograft ischaemia, denervation, cardioplegia etc.) has not yet been
established. Hence, the lack of STE reference values in HTx population,
especially during early posttransplant period, is one of the reasons that
strain has not been used to follow-up these patients. The aim of the study
was to evaluate whether radial deformation parameters are reduced in
healthy HTx recipients during the first post-transplant year. Methods:
Two-dimensionalSTEwasused to evaluate radial strain in 15 healthy patients
up to 6 months following heart transplantation. Patients were excluded if
they had histologic evidence of acute rejection (>1A ISHLT), reduced LVEF
(<55%), significant coronary vasculopathy (epicardial coronary narrowing
>50% assessed by coronary angiography at the end of 1st post-transplant
year), wide QRS-complex (>120 ms), significant valvular disease or major
cardiac events. Frame rates of 50 to 70 s-1 to avoid speckle
decorrelationandgoodimagequality for accurate tracking were mandatory.
Segmental radial strain analysis was performed at the LV basal,middle and
apical levels, and values were averaged to determine global radial strain.
The results were then compared with the healthy normal subjects' values,
using recent meta-analysis data. Student's t-test was applied to evaluate
findings. Results: Global radial strain was significantly lower in
transplant patients when compared with control subjects - mean 39.2% (95%
CI 33.5 to 44.9%) vs. 47.3% (95% CI 43.6 to 51.0%), p 0.008. Conclusions:
The reduction of global radial strain in healthy HTx subjects during early
post-transplant period may be an immediate consequence of the transplant
procedure. Thebaseline strain values shouldbeobtained in all transplant
patientssoonafter the transplantation so that these values can later be
used as a reference for early detection of myocardial abnormalities.
