EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2014249477
Authors
Giglioli C. Cecchi E. Vladi L. Stolcova M. Valente S. Meucci F.
Baldereschi G.J. Chiostri M. Romano S.M. Gensini G.F. Barchielli A. Balzi
D.
Institution
(Giglioli, Cecchi, Vladi, Stolcova, Valente, Meucci, Baldereschi,
Chiostri, Romano, Gensini) Dipartimento del Cuore e dei Vasi, Azienda
Ospedaliero-Universitaria Careggi, Firenze, Italy
(Barchielli, Balzi) Epidemiology Unit, Local Health 10, Florence, Italy
Title
Comparison between drug-eluting and bare metal stent on ST-elevation
myocardial infarction outcome: Should second-generation drug-eluting stent
be preferred?.
Source
Journal of Cardiology. 63 (4) (pp 296-301), 2014. Date of Publication:
April 2014.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background and purpose: Although several studies reported that
drug-eluting stents (DES) are able to reduce restenosis incidence without
increasing mortality, concerns still exist about their safety in
ST-segment elevation myocardial infarction (STEMI) patients mainly for a
possible higher rate of in-stent thrombosis. Recent evidence suggests a
better safety profile of second-generation DES, but data on their outcome
in STEMI are still poor. In this study we evaluated the impact on
mortality and target lesion revascularization (TLR) of DES or bare metal
stent (BMS) implantation in STEMI patients submitted to primary
angioplasty. Methods and subjects: We analyzed mortality and TLR in 1150
STEMI patients during a mean 43-month follow-up after DES (44.6%) or BMS
(55.4%) implantation. A propensity score method was used to minimize bias.
During follow-up, 223 deaths occurred. Essential results: Unadjusted for
potential confounders, DES implantation was associated with a significant
reduction in all-cause mortality [hazard ratio (HR) 0.40; 95%CI 0.30-0.54]
and TLR (HR 0.55; 95%CI 0.36-0.86); this latter was confirmed after
propensity score analysis (HR 0.39; 95%CI 0.21-0.67). Second- ( n= 179)
vs. first- ( n= 337) generation DES showed a further reduction in TLR (HR
0.17; 95%CI 0.05-0.57). Adjusted analyses showed a significant reduction
in the combined end-point of all-cause mortality or TLR after both first-
and second-generation DES vs. BMS implantation with a trend to a lower
risk for second- vs. first-generation DES. Principal conclusions: DES
implantation in STEMI patients showed a significant reduction in TLR and
in the combined endpoint of TLR or mortality. Second-generation DES showed
a more protective effect on the combined endpoint, suggesting that they
would be preferred in this setting. 2013 Japanese College of Cardiology.

<2>
Accession Number
2014235460
Authors
He Q.-L. Zhong F. Ye F. Wei M. Liu W.-F. Li M.-N. Li Q.-B. Huang W.-Q. Sun
L.-B. Shu H.-H.
Institution
(He, Ye, Wei, Liu, Li, Li, Huang, Sun, Shu) Department of Anesthesiology,
First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd
Road, Guangzhou, Guangdong 510080, China
(Zhong) School of Public Health, Sun Yat-sen University, No. 74 Zhongshan
2nd Road, Guangzhou, Guangdong 510080, China
(Zhong) Guangzhou Municipal Center for Disease Control and Prevention,
Guangzhou 0086-510080, China
Title
Does intraoperative ulinastatin improve postoperative clinical outcomes in
patients undergoing cardiac surgery: A meta-analysis of randomized
controlled trials.
Source
BioMed Research International. 2014 , 2014. Article Number: 630835. Date
of Publication: 2014.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Introduction. The systematic meta-analysis of randomized controlled trials
(RCTs) evaluated the effects of intraoperative ulinastatin on
early-postoperative recovery in patients undergoing cardiac surgery.
Methods. RCTs comparing intraoperative ulinastatin with placebo in cardiac
surgery were searched through PubMed, Cochrane databases, Medline,
SinoMed, and the China National Knowledge Infrastructure (1966 to May
20th, 2013). The primary endpoints included hospital mortality,
postoperative complication rate, length of stay in intensive care unit,
and extubation time. The physiological and biochemical parameters
illustrating postoperative cardiac and pulmonary function as well as
inflammation response were considered as secondary endpoints. Results.
Fifteen RCTs (509 patients) met the inclusion criteria. Ulinastatin did
not affect hospital mortality, postoperative complication rate, or ICU
length of stay but reduced extubation time. Ulinastatin also increased the
oxygenation index on postoperative day 1 and reduced the plasma level of
cardiac troponin-I. Additionally, ulinastatin inhibited the increased
level of tumor necrosis factor-alpha, polymorphonuclear neutrophil
elastase, interleukin-6, and interleukin-8 associated with cardiac
surgery. Conclusion. Ulinastatin may be of value for the inhibition of
postoperative increased inflammatory agents and most likely provided
pulmonary protective effects in cardiac surgery. However, larger
adequately powered RCTs are required to define the clinical effect of
ulinastatin on postoperative outcomes in cardiac surgery. 2014 Qiu-Lan He
et al.

<3>
Accession Number
2014225779
Authors
Dong S. Zhang L. Li W. Du J. Liu X. Chen X.
Institution
(Dong, Zhang, Li, Du, Liu, Chen) Department of Thoracic Surgery, China
Medical University, Shenyang, Liaoning Province, China
Title
Evaluation of video-assisted thoracoscopic surgery for pulmonary
metastases: A meta-analysis.
Source
PLoS ONE. 9 (1) , 2014. Article Number: e85329. Date of Publication: 09
Jan 2014.
Publisher
Public Library of Science
Abstract
Background: To evaluate the evidence comparing video-assisted thoracic
surgery (VATS) and open thoracotomy in the treatment of metastatic lung
cancer using meta-analytical techniques. Methods: A literature search was
undertaken until July 2013 to identify the comparative studies evaluating
disease-free survival rates and survival rates. The pooled odds ratios
(OR) and the 95% confidence intervals (95% CI) were calculated with the
fixed or random effect models. Results: Six retrospective studies were
included in our meta-analysis. These studies included a total of 546
patients: 235 patients were treated with VATS, and 311 patients were
treated with open thoracotomy. The VATS and the thoracotomy did not
demonstrate a significant difference in the 1-,3-,5-year survival rates
and the 1-year disease-free survival rate. There were significant
statistical differences between the 3-year disease free survival rate (p =
0.04), which favored open thoracotomy. Conclusions: The VATS approach is a
safe and feasible treatment in terms of the survival rate for metastatic
lung cancer compared with the thoracotomy. The 3-year disease-free
survival rate in the VATS group is inferior to that of open thoracotomy.
The VATS approach could not completely replace open thoracotomy. 2014
Dong et al.

<4>
Accession Number
2014245320
Authors
Aryal M.R. Hakim F.A. Giri S. Ghimire S. Pandit A. Bhandari Y. Acharya
Y.P. Pradhan R.
Institution
(Aryal) Department of Internal Medicine, Reading Health System, West
Reading, PA, United States
(Hakim, Pandit) Division of Cardiovascular Diseases, Department of
Medicine, Mayo Clinic, Scottsdale, AZ, United States
(Giri) Division of Internal Medicine, University of Tennessee, Health
Science Center, Memphis, TN, United States
(Ghimire, Acharya) Division of Internal Medicine, Tribhuvan University
Teaching Hospital, Kathmandu, Nepal
(Bhandari) Department of Nursing, Alvernia University, Reading, PA, United
States
(Pradhan) Regional Heart Doctors, Rapid City Regional Hospital, Rapid
City, SD, United States
Title
Right atrial appendage aneurysm: A systematic review.
Source
Echocardiography. 31 (4) (pp 534-539), 2014. Date of Publication: April
2014.
Publisher
Blackwell Publishing Inc.
Abstract
Background Right atrial appendage aneurysm (RAAA) is rare with fewer than
20 cases reported in the literature. We sought to systematically review
the published cases of RAAA in terms of demographics, clinical
characteristics, treatment, complications, and outcome. Methodology
Electronic search for case reports, case series, and related articles
published until July 2013 was carried out and clinical data were extracted
and analyzed. Results Seventeen cases of RAAA were identified with equal
sex distribution and commonly presenting in the third decades of life.
Dyspnea and palpitation were the most common clinical presentations.
Echocardiography was the most common diagnostic modality. The mean size of
aneurysm was 8.83 + 4.84 x 6.05 + 2.99 cm. Most of the patients were
treated medically with close follow-up. The mean follow-up period was 10
months. Atrial tachyarrhythmias and heart failure were the most common
complications. Conclusion Right atrial appendage aneurysm although rare
may be associated with significant morbidity. Surgical resection is
indicated in symptomatic patients. 2014, Wiley Periodicals, Inc.

<5>
Accession Number
2014247051
Authors
Cho J.-E. Shim J.-K. Song J.-W. Lee H.-W. Kim D.-H. Kwak Y.-L.
Institution
(Cho, Lee, Kim) Department of Anesthesiology and Pain Medicine, Anam
Hospital, Korea University, Seoul, South Korea
(Shim, Song, Kwak) Department of Anesthesiology and Pain Medicine and
Anesthesia and Pain Research Institute, Severance Biomedical Science
Institute, Yonsei University College of Medicine, Seoul, South Korea
Title
Effect of 6% hydroxyethyl starch 130/0.4 as a priming solution on
coagulation and inflammation following complex heart surgery.
Source
Yonsei Medical Journal. 55 (3) (pp 625-634), 2014. Date of Publication:
May 2014.
Publisher
Yonsei University College of Medicine
Abstract
Purpose: Prolonged duration of cardiopulmonary bypass aggravates the
degree of inflammation and coagulopathy. We investigated the influence of
6% hydroxyethyl starch (HES) 130/0.4 on coagulation and inflammation
compared with albumin when used for both cardiopulmonary bypass priming
and perioperative fluid therapy in patients undergoing complex valvular
heart surgery. Materials and Methods: Fifty four patients were randomly
allocated into albumin-HES, albumin-nonHES, and HES-HES groups. The
cardiopulmonary bypass circuit was primed with 5% albumin in the
albumin-HES and albumin-nonHES group, and with HES in the HES-HES group.
As perioperative fluid, only plasmalyte was used in the albumin-nonHES
group whereas HES was used up to 20 mL/kg in the albumin-HES and
albumin-HES group. Serial assessments of coagulation profiles using the
rotational thromboelastometry and inflammatory markers (tissue necrosis
factor-alpha, interleukin-6, and interleukin-8) were performed. Results:
Patients' characteristics and the duration of cardiopulmonary bypass
(albumin-HES; 137+34 min, HES-HES; 136+47 min, albumin-nonHES; 132+39 min)
were all similar among the groups. Postoperative coagulation profiles
demonstrated sporadic increases in clot formation time and coagulation
time, without any differences in the actual amount of perioperative
bleeding and transfusion requirements among the groups. Also, inflammatory
markers showed significant activation after cardiopulmonary bypass without
any differences among the groups. Conclusion: Even in the presence of
prolonged duration of cardiopulmonary bypass, HES seemed to yield similar
influence on the ensuing coagulopathy and inflammatory response when used
for priming and perioperative fluid therapy following complex valvular
heart surgery compared with conventional fluid regimen including albumin
and plasmalyte. Yonsei University College of Medicine 2014.

<6>
Accession Number
2014247016
Authors
Corley A. Sharpe N. Caruana L.R. Spooner A.J. Fraser J.F.
Institution
(Corley, Sharpe, Caruana, Spooner, Fraser) Critical Care Research Group,
The Prince Charles Hospital, University of Queensland, Brisbane, QLD,
Australia
Title
Lung volume changes during cleaning of closed endotracheal suction
catheters: A randomized crossover study using electrical impedance
tomography.
Source
Respiratory Care. 59 (4) (pp 497-503), 2014. Date of Publication: April
2014.
Publisher
Daedalus Enterprises Inc.
Abstract
BACKGROUND: Airway suctioning in mechanically ventilated patients is
required to maintain airway patency. Closed suction catheters (CSCs)
minimize lung volume loss during suctioning but require cleaning
post-suction. Despite their widespread use, there is no published evidence
examining lung volumes during CSC cleaning. The study objectives were to
quantify lung volume changes during CSC cleaning and to determine whether
these changes were preventable using a CSC with a valve in situ between
the airway and catheter cleaning chamber. METHODS: This prospective
randomized crossover study was conducted in a metropolitan tertiary ICU.
Ten patients mechanically ventilated via volume-controlled synchronized
intermittent mandatory ventilation (SIMV-VC) and requiring manual
hyperinflation (MHI) were included in this study. CSC cleaning was
performed using 2 different brands of CSC (one with a valve [Ballard Trach
Care 72, Kimberly-Clark, Roswell, Georgia] and one without [Portex
Steri-Cath DL, Smiths Medical, Dublin, Ohio]). The maneuvers were
performed during both SIMV-VC and MHI. Lung volume change was measured via
impedance change using electrical impedance tomography. A mixed model was
used to compare the estimated means. RESULTS: During cleaning of the
valveless CSC, significant decreases in lung impedance occurred during MHI
(-2563 impedance units, 95% CI 2213-2913, P <.001), and significant
increases in lung impedance occurred during SIMV (762 impedance units, 95%
CI 452-1072, P <.001). In contrast, cleaning of the CSC with a valve in
situ resulted in non-significant lung volume changes and maintenance of
normal ventilation during MHI and SIMV-VC, respectively (188 impedance
units, 95% CI _136 to 511, P =.22; and 22 impedance units, 95% CI -342 to
299, P =.89). CONCLUSIONS: When there is no valve between the airway and
suction catheter, cleaning of the CSC results in significant derangements
in lung volume. Therefore, the presence of such a valve should be
considered essential in preserving lung volumes and uninterrupted
ventilation in mechanically ventilated patients. 2014 Daedalus
Enterprises.

<7>
Accession Number
2014242095
Authors
Wang X. Zhang G. Jiang X. Zhu H. Lu Z. Xu L.
Institution
(Wang, Jiang, Zhu, Lu, Xu) Department of Cardiology, Renmin Hospital of
Wuhan University, China
(Zhang) Department of Cardiology, Zhongnan Hospital of Wuhan University,
China
Title
Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality
and cardiovascular events among patients undergoing angiography or cardiac
revascularization: A meta-analysis of observational studies.
Source
Atherosclerosis. 234 (1) (pp 206-213), 2014. Date of Publication: May
2014.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: The aim of this study was to investigate whether neutrophil to
lymphocyte ratio (NLR) was an independent predictor for all-cause
mortality or cardiovascular events in patients undergoing angiography or
cardiac revascularization with observational studies by meta-analysis.
Methods: Pubmed and Embase were searched without language restrictions for
cohort studies published prior to November 2013. Citations were
independently screened by 2 authors, and those meeting the inclusion
criteria defined a priori were retained. Data on authors, year of
publication, location, target participant, comparison of NLR, outcome
assessment, number of event and sample size, duration and statistical
adjustments were abstracted. Results: Eight studies were identified that
reported on all-cause mortality and five studies were identified that
reported on cardiovascular events. The pooled relative risk (RR) of
all-cause mortality was 2.33 (95% CI 1.88-2.88) and the RR of
cardiovascular events was 1.89 (95% CI 1.42, 2.52) comparing the highest
with the lowest category of NLR. Conclusions: The meta-analysis indicates
that NLR is a predictor of all-cause mortality and cardiovascular events.
Further well-designed trials are warranted to confirm this association.
2014 Elsevier Ireland Ltd.

<8>
Accession Number
2014241783
Authors
Nielsen H.B.
Institution
(Nielsen) Department of Anesthesia, Rigshospitalet, University of
Copenhagen, Rigshospitalet 2041, Blegdamsvej 9, DK-2100 Copenhagen O,
Denmark
Title
Systematic review of near-infrared spectroscopy determined cerebral
oxygenation during non-cardiac surgery.
Source
Frontiers in Physiology. 5 MAR , 2014. Article Number: Article 93. Date
of Publication: 2014.
Publisher
Frontiers Media SA
Abstract
Near-infrared spectroscopy (NIRS) is used to monitor regional cerebral
oxygenation (rScO₂) during cardiac surgery but is less
established during non-cardiac surgery. This systematic review aimed (i)
to determine the non-cardiac surgical procedures that provoke a reduction
in rScO₂ and (ii) to evaluate whether an intraoperative
reduction in rScO₂ influences postoperative outcome. The PubMed
and Embase database were searched from inception until April 30, 2013 and
inclusion criteria were intraoperative NIRS determined rScO₂ in
adult patients undergoing non-cardiac surgery. The type of surgery and
number of patients included were recorded. There was included 113 articles
and evidence suggests that rScO₂ is reduced during thoracic
surgery involving single lung ventilation, major abdominal surgery, hip
surgery, and laparoscopic surgery with the patient placed in
anti-Tredelenburg's position. Shoulder arthroscopy in the beach chair and
carotid endarterectomy with clamped internal carotid artery (ICA) also
cause pronounced cerebral desaturation. A >20% reduction in
rScO₂ coincides with indices of regional and global cerebral
ischemia during carotid endarterectomy. Following thoracic surgery, major
orthopedic, and abdominal surgery the occurrence of postoperative
cognitive dysfunction (POCD) might be related to intraoperative cerebral
desaturation. In conclusion, certain non-cardiac surgical procedures is
associated with an increased risk for the occurrence of rScO₂.
Evidence for an association between cerebral desaturation and
postoperative outcome parameters other than cognitive dysfunction needs to
be established. 2014 Nielsen.

<9>
Accession Number
2014239124
Authors
Chai Q. Liu J.
Institution
(Chai, Liu) Department of Critical Medicine and Anesthesiology, West China
Hospital, Sichuan University, Sichuan Province, China
Title
Early stage effect of ischemic preconditioning for patients undergoing
on-pump coronary artery bypass grafts surgery: Systematic review and
meta-analysis.
Source
Pakistan Journal of Medical Sciences. 30 (3) , 2014. Date of Publication:
2014.
Publisher
Professional Medical Publications
Abstract
Background: During the on-pump coronary artery bypass grafts surgery,
ischemia/reperfusion injury would happen. Ischemia preconditioning could
increase the tolerance against subsequent ischemia and reduce the
ischemia/reperfusion injury. However the clinical outcomes of the
available trials were different. Methods: We searched the Cochrane Central
Register of Controlled Trials on The Cochrane Library (Issue 3, 2013), the
Medline/PubMed and CNKI in March 2013. RevMan 5.1.6 and GRADEprofiler 3.6
were used for statistical analysis and evidence quality assessment.
Heterogeneity was evaluated with significance set at P < 0.10. Results:
Eighteen randomized controlled trials were included. There were no
differences on in-hospital mortality, postoperative myocardial infarction
morbidity between ischemia preconditioning and control groups. The
heterogeneity of creatine kinase-MB level 24 hours after surgery was
obvious. The differences of 72 hours area under the curve of cardiac
troponin T (mean differences of -14.50, 95% confidence interval of -21.71
to -7.28) and troponin I (mean differences -181.79, 95% confidence
interval of -270.07 to -93.52) after surgery were observed. Conclusions:
All the 18 trails, the positive and the negative results were equal. The
meta-analysis results should be interpreted with caution due to limited
effective data. Because of high cost-effectiveness, ischemia
preconditioning could not be denied completely. Large-scale randomized
studies are needed, with the operation procedures and included criteria
being more specific.

<10>
Accession Number
2014243123
Authors
Jackson C.S. Gerson L.B.
Institution
(Jackson) Division of Gastroenterology, Loma Linda VA Medical Center, Loma
Linda, CA, United States
(Gerson) Division of Gastroenterology, California Pacific Medical Center,
San Francisco, CA, United States
Title
Management of gastrointestinal angiodysplastic lesions (GIADs): A
systematic review and meta-analysis.
Source
American Journal of Gastroenterology. 109 (4) (pp 474-483), 2014. Date of
Publication: April 2014.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
OBJECTIVES:Gastrointestinal angiodysplastic lesions (GIADs) are defined as
pathologically dilated communications between veins and capillaries. The
objective of this systematic review and meta-analysis was to determine the
efficacy of available treatment modalities for GIADs.METHODS:We identified
eligible studies by searching through PubMed, SCOPUS, and Cochrane central
register of controlled trials. We searched for clinical trials examining
the efficacy of endoscopic, pharmacologic, or surgical therapy for GIADs.
Data were pooled using a random-effects model, and the effect of response
to medical or surgical therapy was reported as odds ratios with 95%
confidence intervals (CIs). Data and quality indicators were extracted by
two authors from 22 studies, including 831 individuals with GIADs. The
analysis included 623 patients treated with endoscopic therapy, 63 with
hormonal therapy, 72 patients with octreotide, and 73 status post aortic
valve replacement surgery.RESULTS:Hormonal therapy, based on two
case-control studies, was not effective for bleeding cessation (odds
ratio: 1.0, 95% CI: 0.5-1.96). On the basis of 14 studies including
patients with gastric, colonic, and small-bowel GIADs, endoscopic therapy
was effective as initial therapy, but the pooled recurrence bleeding rate
was 36% (95% CI: 28-44%) over a mean (+s.d.) of 22+13 months. The event
rate for re-bleeding increased to 45% (95% CI: 37-52%) when studies
including only small-bowel GIADs were included (N=341). In four studies
assessing the efficacy of somatostatin analogs, the pooled odds ratio was
14.5 (95% CI: 5.9-36) for bleeding cessation. In two studies assessing the
role of aortic valve replacement (AVR) in 73 patients with Heyde's
syndrome, the event rate for re-bleeding was 0.19 (95% CI: 0.11-0.30) over
a mean follow-up period of 4 years postoperatively.CONCLUSIONS:Over
one-third of patients with GIADs experienced re-bleeding after endoscopic
therapy. Somatostatin analogs and AVR for Heyde's syndrome appeared to be
effective therapy for GIADs. 2014 by the American College of
Gastroenterology.