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Embase (updates since 2014-06-20)
<1>
Accession Number
24794475
Authors
Turan A. Egan C. You J. Sessler D. Abdelmalak B.
Institution
(Turan) Department of Outcomes Research, Cleveland Clinic, Cleveland,
Ohio, USA.
Title
Effect of statins on insulin requirements during non-cardiac surgery.
Source
Anaesthesia and intensive care. 42 (3) (pp 350-355), 2014. Date of
Publication: May 2014.
Abstract
Statins are thought to potentially impair glucose metabolism, increasing
plasma glucose concentration. The effect of prolonged statin use on
glucose metabolism among outpatients is thus well established. However,
the impact of statin use on glucose concentrations and insulin
requirements during surgery remains poorly characterised and may very well
differ considering the substantial hyperglycaemic stress response to
surgery. We conducted a study to test the hypothesis that patients taking
statins preoperatively require more intraoperative insulin than non-users.
We analysed 173 adults having major non-cardiac surgery who participated
in the Dexamethasone, Light Anaesthesia and Tight Glucose Control Trial
between 2007 and 2010. We compared statin and non-statin users on total
amount of intraoperative insulin to maintain plasma glucose concentration
within 4.4 to 6.1 mmol/l using the inverse propensity score weighting
method. Sixty-seven patients were statin users and 106 were non-statin
users. The estimated ratio of geometric means between the statin users and
the non-users was 1.45 (95% confidence interval: 0.93, 2.26, statin versus
non-statin, P=0.11). The total amount of intraoperative insulin usage did
not differ significantly among patients taking different types of statins
(P=0.50). While the total amount of intraoperative insulin used was not
statistically different between the statin users and non-users, we
observed a potentially important trend toward insulin resistance
intraoperatively among statin users during major non-cardiac surgery. This
result is consistent with non-operative settings and cardiac surgery.
Further investigation is essential to determine whether this effect is
real and, if so, determine which specific statins are more associated with
insulin resistance.
<2>
Accession Number
24794469
Authors
Cowie D.A. Nazareth J. Story D.A.
Institution
(Cowie) Department of Anaesthesia, Austin Health, Heidelberg, Victoria,
Australia.
Title
Cerebral oximetry to reduce perioperative morbidity.
Source
Anaesthesia and intensive care. 42 (3) (pp 310-314), 2014. Date of
Publication: May 2014.
Abstract
The use of cerebral oximetry to guide intraoperative management has been
shown to improve patient outcomes in cardiac surgery. This pilot trial
assessed the feasibility of performing a similar study of outcome in
patients over the age of 70 years undergoing non-cardiac surgery. Patients
over the age of 70 years undergoing total knee or hip arthroplasty or
bowel resection surgery were randomly assigned to have cerebral oximetry
values monitored (intervention group) or not monitored (control) while
under general anaesthesia. Indicators of proof of concept were: rate of
complications, rate of cerebral desaturation, relationship between
cerebral desaturation and complications, and anaesthetist response to
cerebral desaturation. Forty patients were recruited and randomised to a
control group (n=20) or an intervention group (n=20). The proportion of
the study population who had a complication was 40% (95% confidence
interval [CI] 26% to 55%). Cerebral desaturation (<75% of baseline)
occurred in only two patients (5.0% (CI 1.4% to 16%)), one in each group,
and neither of those patients recorded a complication. Changes to
anaesthetic management on the basis of cerebral oximetry values occurred
in only two patients in the intervention group (10% (CI 2.8% to 30%)).
Maintenance of cerebral oximetry values appeared to be closer to baseline
in the intervention group than in the control group but this difference
was not significant (P=0.15). Our results indicated that complications
occurred frequently in the study population but did not appear to be
associated with cerebral desaturation events. These findings do not
support a larger intervention study using the current study population.
<3>
Accession Number
2014406898
Authors
Velicki L. Cemerlic-Adjic N. Pavlovic K. Mihajlovic B.B. Bankovic D.
Mihajlovic B. Fabri M.
Institution
(Velicki, Cemerlic-Adjic, Pavlovic, Mihajlovic) Department of Surgery,
Medical Faculty, University of Novi Sad, Novi Sad, Serbia
(Velicki, Cemerlic-Adjic, Pavlovic, Mihajlovic, Mihajlovic, Fabri)
Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases
Vojvodina, Clinic of Cardiovascular Surgery, Put Doktora Goldmana 4, 21204
Sremska Kamenica, Serbia
(Bankovic) Department of Mathematics, State University of Novi Pazar, Novi
Pazar, Serbia
Title
Clinical performance of the EuroSCORE II compared with the previous
EuroSCORE Iterations.
Source
Thoracic and Cardiovascular Surgeon. 62 (4) (pp 288-297), 2014. Date of
Publication: June 2014.
Publisher
Georg Thieme Verlag
Abstract
Background The European System for Cardiac Operative Risk Evaluation
(EuroSCORE) II has been recently introduced as an update to the previous
versions. We sought to evaluate the predictive performance of the
EuroSCORE II model against the original additive and logistic EuroSCORE
models. Patients and Methods The study included 1,247 consecutive patients
who underwent cardiac surgery procedures during a 14-month period starting
from the beginning of 2012. The original additive and logistic EuroSCORE
models were compared with the EuroSCORE II focusing on the accuracy of
predicting hospital mortality. Results The overall hospital mortality rate
was 3.45%. The discriminative power of the EuroSCORE II was modest and
similar to other algorithms (C-statistics 0.754 for additive EuroSCORE;
0.759 for logistic EuroSCORE; and 0.743 for EuroSCORE II). The EuroSCORE
II significantly underestimated the all-patient hospital mortality (3.45%
observed vs. 2.12% predicted), as well as in the valvular (3.74% observed
vs. 2% predicted), and combined surgery cohorts (6.87% observed vs. 3.64%
predicted). The predicted EuroSCORE mortality significantly differed from
the observed mortality in the third and the fourth quartile of patients
stratified according to the EuroSCORE II mortality risk (p<0.05). The
calibration of the EuroSCORE II was generally good for the entire patient
population (Hosmer-Lemeshow [HL] p=0.139), for the valvular surgery subset
(HL p=0.485), and for the combined surgery subset (HL p=0.639). Conclusion
The EuroSCORE II might be considered a solid predictive tool for hospital
mortality. Although, the EuroSCORE II employs more sophisticated
calculation methods regarding the number and definition of risk factors
included, it does not seem to significantly improve the performance of
previous iterations. 2014 Georg Thieme Verlag KG Stuttgart. New York.
<4>
[Use Link to view the full text]
Accession Number
2014394072
Authors
Scrascia G. Rotunno C. Guida P. Amorese L. Polieri D. Codazzi D. Paparella
D.
Institution
(Scrascia, Rotunno, Guida, Amorese, Paparella) Division of Cardiac
Surgery, Department of Emergency and Organ Transplant, University of Bari
Aldo Moro, Bari, Italy
(Polieri) Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of
Medical and Surgical Pediatric Cardiology, Bambino Gesu Children's
Hospital, Rome, Italy
(Codazzi) Department of Anesthesia, Intensive and Palliative Care,
Foundation-I.R.C.C.S., National Institute of Cancer, Milan, Italy
Title
Perioperative steroids administration in pediatric cardiac surgery: A
meta-analysis of randomized controlled trials.
Source
Pediatric Critical Care Medicine. 15 (5) (pp 435-442), 2014. Date of
Publication: June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVE:: To evaluate the effects of prophylactic perioperative
corticosteroid administration, compared with placebo, on postoperative
mortality and clinical outcomes (renal dysfunction, duration of mechanical
ventilation, and ICU length of stay) in pediatric patients undergoing
cardiac surgery with cardiopulmonary bypass. DATA SOURCES:: MEDLINE and
Cochrane Library were screened through August 2013 for randomized
controlled trials in which perioperative steroid treatment was adopted.
STUDY SELECTION:: Included were randomized controlled trials conducted on
pediatric population that reported clinical outcomes about mortality and
morbidity. DATA EXTRACTION:: Eighty citations (PubMed, 48 citations;
Cochrane, 32 citations) were identified, of which 14 articles were
analyzed in depth and six articles fulfilled eligibility criteria and
reported mortality data (232 patients), two studies reported ICU length of
stay and mechanical ventilation duration (60 patients), and two studies
reported renal dysfunction (49 patients). DATA SYNTHESIS:: A
nonsignificant trend of reduced mortality was observed in steroid-treated
patients (11 [4.7%] vs 4 [1.7%] patients; odds ratio, 0.41; 95% CI,
0.14-1.15; p = 0.089). Steroids had no effects on mechanical ventilation
time (117.4 + 95.9 hr vs 137.3 + 102.4 hr; p = 0.43) and ICU length of
stay (9.6 + 4.6 d vs 9.9 + 5.9 d; p = 0.8). Perioperative steroid
administration reduced the prevalence of renal dysfunction (13 [54.2%] vs
2 [8%] patients; odds ratio, 0.07; 95% CI, 0.01-0.38; p = 0.002).
CONCLUSION:: Despite a demonstrated attenuation of cardiopulmonary
bypass-induced inflammatory response by steroid administration, a
systematic review of randomized controlled trials performed so far reveals
that steroid administration has potential clinical advantages (lower
mortality and significant reduction of renal function deterioration). A
larger prospective randomized study is needed to verify clearly the
effects of steroid prophylaxis in pediatric patients. Copyright 2014 by
the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies.
<5>
Accession Number
2014399923
Authors
Maeng M. Tilsted H.H. Jensen L.O. Krusell L.R. Kaltoft A. Kelbaek H.
Villadsen A.B. Ravkilde J. Hansen K.N. Christiansen E.H. Aaroe J. Jensen
J.S. Kristensen S.D. Botker H.E. Thuesen L. Madsen M. Thayssen P. Sorensen
H.T. Lassen J.F.
Institution
(Maeng, Jensen, Krusell, Kaltoft, Christiansen, Kristensen, Botker,
Thuesen, Lassen) Department of Cardiology, Aarhus University Hospital,
Brendstrupgaardsvej 100, 8200 Skejby, Aarhus, Denmark
(Tilsted, Villadsen, Ravkilde, Aaroe) Department of Cardiology, Aarhus
University Hospital, Aalborg Hospital, Aalborg, Denmark
(Hansen, Jensen, Thayssen) Department of Cardiology, Odense University
Hospital, Odense, Denmark
(Kelbaek) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark
(Jensen) Department of Cardiology, Gentofte University Hospital, Hellerup,
Denmark
(Madsen, Sorensen) Department of Clinical Epidemiology, Aarhus University
Hospital, Aarhus, Denmark
Title
Differential clinical outcomes after 1 year versus 5 years in a randomised
comparison of zotarolimus-eluting and sirolimus-eluting coronary stents
(the SORT OUT III study): A multicentre, open-label, randomised
superiority trial.
Source
The Lancet. 383 (9934) (pp 2047-2056), 2014. Date of Publication: 2014.
Publisher
Lancet Publishing Group
Abstract
Background: In head-to-head comparisons of coronary drug-eluting stents,
the primary endpoint is traditionally assessed after 9-12 months. However,
the optimum timepoint for this assessment remains unclear. In this study,
we assessed clinical outcomes at up to 5 years' follow-up in patients who
received two different types of drug-eluting stents. Methods: We undertook
this multicentre, open-label, randomised superiority trial at five
percutaneous coronary intervention centres in Denmark. We randomly
allocated 2332 eligible adult patients (>18 years of age) with an
indication for drug-eluting stent implantation to the zotarolimus-eluting
Endeavor Sprint stent (Medtronic, Santa Rosa, CA, USA) or the
sirolimus-eluting Cypher Select Plus stent (Cordis, Johnson & Johnson,
Warren, NJ, USA). Randomisation of participants was achieved by
computer-generated block randomisation and a telephone allocation service.
The primary endpoint of the SORT OUT III study was a composite of major
adverse cardiac events-cardiac death, myocardial infarction, and target
vessel revascularisation-at 9 months' follow-up. In this study, endpoints
included the occurrence of major adverse cardiac events and definite stent
thrombosis at follow-up times of up to 5 years. Analysis was by intention
to treat. The trial is registered with ClinicalTrials.gov, number
NCT00660478. Findings: We randomly allocated 1162 patients to receive the
zotarolimus-eluting stent and 1170 to the sirolimus-eluting stent. At
5-year follow-up, rates of major adverse cardiac events were similar in
patients treated with both types of stents (zotarolimus-eluting stents
197/1162 [170%] vs sirolimus-eluting stents 182/1170 [156%]; odds ratio
[OR] 110, 95% CI 088-137; p=040). This finding was indicative of the
directly contrasting results for rates of major adverse cardiac events at
1-year follow up (zotarolimus 93/1162 [80%] vs sirolimus 46/1170 [39%]; OR
213, 95% CI 148-307; p<00001) compared with those at follow-up between 1
and 5 years (104 [90%] vs 136 [116%]; OR 078, 95% CI 059- 102; p=0071). At
1-year follow-up, definite stent thrombosis was more frequent after
implantation of the zotarolimus-eluting stent (13/1162 [11%]) than the
sirolimus-eluting stent (4/1170 [03%]; OR 334, 95% CI 108-103; p=0036),
whereas the opposite finding was recorded for between 1 and 5 years'
follow-up (zotarolimus-eluting stent 1/1162 [01%] vs sirolimus-eluting
stent 21/1170 [18%], OR 005, 95% CI 001-036; p=0003). 26 of 88 (30%)
target lesion revascularisations in the zotarolimus-eluting stent group
occurred between 1 and 5 years' follow-up, whereas 54 of 70 (77%) of those
in the sirolimus-eluting stent group occurred during this follow-up
period. Interpretation: The superiority of sirolimus-eluting stents
compared with zotarolimus-eluting stents at 1-year follow-up was lost
after 5 years. The traditional 1-year primary endpoint assessment
therefore might be insufficient to predict 5-year clinical outcomes in
patients treated with coronary drug-eluting stent implantation. Funding:
Cordis and Medtronic.
<6>
Accession Number
2014405435
Authors
Qin X. Fan F. Cui Y. Chen F. Chen Y. Cheng X. Li Y. Wang B. Xu X. Huo Y.
Wang X.
Institution
(Qin, Wang) Division of Nephrology, Nanfang Hospital, Southern Medical
University, Guangzhou, China
(Qin) Institute of Biomedicine, Anhui Medical University, Hefei, China
(Fan, Huo) Department of Cardiology, Peking University First Hospital,
Beijing, China
(Cui) Department of Pharmacy, Peking University First Hospital, Beijing,
China
(Chen) Department of Cardiology, Capital Medical University Affiliated
with Beijing Anzhen Hospital, Beijing, China
(Chen) Department of Cardiology, People's Liberation Army General
Hospital, Beijing, China
(Cheng) Department of Cardiology, Second Affiliated Hospital, Nanchang
University, Nanchang, China
(Li) Institute of Cardiovascular Disease and Heart Center, Pinjing
Hospital Logistics University of the Chinese People's Armed Police Forces,
Tianjin, China
(Xu, Xu) Guangdong Institute of Nephrology, Southern Medical University,
Guangzhou, China
(Wang) Center on the Early Life Origins of Disease, Department of
Population, Family and Reproductive Health, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, MD, United States
Title
Folic acid supplementation with and without vitamin B6 and
revascularization risk: A meta-analysis of randomized controlled trials.
Source
Clinical Nutrition. 33 (4) (pp 603-612), 2014. Date of Publication: August
2014.
Publisher
Churchill Livingstone
Abstract
Background & aims: There is a growing amount of data and a continuing
controversy over the effect of folic acid supplementation with and without
vitamin B6 on revascularization risk. Methods: We conducted a
meta-analysis based on up-to-date published relevant randomized trials to
further examine this issue. Relative risk (RR) was used to measure the
effect of folic acid supplementation on risk of revascularization using a
random-effects model. Total revascularization was defined as any arterial
revascularization. Restenosis was defined as stenosis of more than 50
percent of the luminal diameter. Results: Overall, folic acid
supplementation had no significant effect on coronary revascularization (9
trials, n=27,418, RR=0.99; 95%CI:0.88-1.11, P=0.88), coronary artery
bypass grafting (CABG) (5 trials, n=10,703, 0.90; 0.79-1.03, P=0.11),
percutaneous coronary intervention (PCI) (5 trials, n=10,703, 1.05;
0.89-1.23, P=0.59), coronary restenosis (3 trials, n=926, 1.05; 0.89-1.23,
P=0.59) or total revascularization (7 trials, n=29,314, 1.06; 95%CI:
0.99-1.13, P=0.10). However, a greater beneficial effect was observed for
coronary revascularization among those trials with a moderate dose of
vitamin B6 (5-10mg/d; RR: 0.47; 95%CI: 0.28-0.80, P=0.005), but not in
trials without vitamin B6 or with a high dose of vitamin B6. And a
non-significant greater total revascularization risk was observed in
trials with a higher folic acid dose (>2mg/d, RR=1.11; 95%CI: 0.98-1.25,
P=0.09; >5mg/d, RR=1.98; 95%CI: 0.93-4.20, P=0.08). Conclusions: Our
analyses indicate that folic acid supplementation has no significant
effect on coronary revascularization, CABG, PCI, coronary restenosis or
total revascularization. However, a combination of folic acid and moderate
vitamin B6 may be beneficial in reducing coronary revascularization risk.
2014 Elsevier Ltd and European Society for Clinical Nutrition and
Metabolism.
<7>
Accession Number
2014403367
Authors
Pedersen S.H. Pfisterer M. Kaiser C. Jensen J.S. Alber H. Rickenbacher P.
SOrensen R. Iversen A. Jensen M.T. Wadt K. Galatius S.
Institution
(Pedersen, Jensen, SOrensen, Iversen, Jensen, Wadt, Galatius) Department
of Cardiology P, Gentofte University Hospital, Niels Andersens Vej 65,
DK-2900 Hellerup, Denmark
(Pfisterer, Kaiser) Department of Cardiology, University Hospital, Basel,
Switzerland
(Alber) Department of Cardiology, University Hospital, Innsbruck, Austria
(Rickenbacher) Department of Cardiology, University Hospital Bruderholz,
Bruderholz, Switzerland
Title
Drug-eluting stents and bare metal stents in patients with nste-acs:
2-year outcome from the randomised basketprove trial.
Source
EuroIntervention. 10 (1) (pp 58-64), 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: The use of drug-eluting stents (DES) in patients with non-ST-segment
elevation acute coronary syndrome (NSTE-ACS) is controversial and not yet
endorsed in clinical guidelines. Methods and results: This was an a priori
planned post hoc analysis involving 754 NSTE-ACS patients from the
randomised BASKET-PROVE trial (sirolimus-eluting stent vs.
everolimus-eluting stent vs. bare metal stent in large-vessel stenting).
The primary endpoint was the combined two-year rate of cardiovascular
death or non-fatal myocardial infarction (MI). Secondary endpoints were
each component of the primary endpoint, and clinically indicated target
vessel revascularisation (TVR) and stent thrombosis. Compared to patients
with BMS, those treated with SES and EES had a strong trend towards lower
two-year rates of the primary endpoint (HR: 0.31 [CI: 0.11-0.90], p=0.03,
and HR: 0.74 [CI: 0.44-1.24], p=0.25), and of TVR (HR: 0.58 [CI:
0.29-1.15], p=0.12) and (HR: 0.52 [CI: 0.34-0.78], p=0.002). When the SES
and EES groups were combined and compared to BMS, significant reductions
in both cardiovascular death/MI and TVR were found. Conclusions: Compared
with BMS, use of DES in NSTE-ACS patients undergoing stent implantation in
large vessels was associated with a reduction in both TVR and the combined
endpoint consisting of cardiovascular death/MI. Thus, DES use improves
both efficacy and safety. These findings support the use of DES in
NSTE-ACS patients. Europa Digital & Publishing 2014.
<8>
Accession Number
2014403366
Authors
Minguez J.R.L. Asensio J.M.N. Vecino L.J.D. Sandoval J. Romany S. Romero
P.M. Diaz J.A.F. Portales J.F. Fernandez R.G. Caceres G.M. Herrera A.M.
Manterola F.A.
Institution
(Minguez, Asensio, Vecino, Fernandez, Caceres, Herrera) Hospital
Universitario Infanta Cristina, Adelardo Covarsi n1, 6.D., 06005 Badajoz,
Spain
(Sandoval, Manterola) Hospital Universitario Clinico de San Carlos,
Madrid, Spain
(Romany, Portales) Hospital San Pedro de Alcantara, Caceres, Spain
(Romero) Hospital Puerto Real, Cadiz, Spain
(Diaz) Hospital Universitario Clinica Puerta de Hierro, Madrid, Spain
Title
A prospective randomised study of the paclitaxel-coated balloon catheter
in bifurcated coronary lesions (babilon trial): 24-month clinical and
angiographic results.
Source
EuroIntervention. 10 (1) (pp 50-57), 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: Paclitaxel drug-eluting balloons (pDEB) could be an attractive
option to minimise side branch (SB) restenosis in bifurcated coronary
lesions. We compared angiographic and clinical outcomes with pDEB plus
bare metal stent (BMS) versus drug-eluting stents (DES) in de novo
bifurcated lesions. Methods and results: This multicentre randomised trial
included 108 patients. Sequential main branch (MB)/SB dilatation with
pDEB, with provisional T-stenting with BMS in the MB was performed in the
pDEB group, and with everolimus DES in the DES group. The primary endpoint
was late lumen loss (LLL) at nine months. The secondary endpoint was the
incidence of major adverse cardiac events (MACE: death, myocardial
infarction, or target lesion revascularisation). In-segment MB LLL was
0.31+0.48 mm in the pDEB group, and 0.16+0.38 mm in the DES group
(p=0.15); mean difference was 0.15 mm (upper limit one-sided 95% CI: 0.27
mm; p=0.001; non-inferiority test). LLL in SB was -0.04+0.76 mm in the
pDEB group and -0.03+0.51 mm in the DES group (p=0.983). MACE and TLR were
higher in the pDEB group (17.3% vs. 7.1%; p=0.105, and 15.4% vs. 3.6%;
p=0.045), due to higher MB restenosis (13.5% vs. 1.8%; p=0.027).
Conclusions: pDEB bifurcation pretreatment with BMS implantation in MB
showed greater LLL (ns) and increased incidence of MACE compared to
everolimus DES. Both strategies showed similar results in the SB. Europa
Digital & Publishing 2014.
<9>
Accession Number
2014403223
Authors
Sardar P. Nairooz R. Chatterjee S. Mushiyev S. Pekler G. Visco F.
Institution
(Sardar, Nairooz, Mushiyev, Pekler, Visco) Department of Medicine, New
York Medical College-Metropolitan Hospital Center, 1901 First Avenue, New
York, NY, United States
(Chatterjee) Department of Cardiology, St. Luke's Roosevelt Hospital
Center, Columbia University College of Physicians and Surgeons, New York,
NY, United States
Title
Cangrelor for patients undergoing percutaneous coronary intervention:
Evidence from a meta-analysis of randomized trials.
Source
Journal of Thrombosis and Thrombolysis. 38 (1) (pp 1-10), 2014. Date of
Publication: July 2014.
Publisher
Kluwer Academic Publishers
Abstract
Cangrelor is a new parenteral adenosine diphosphate P2Y12 receptor
inhibitor with rapid, profound and reversible inhibition of platelet
activity. The aim of this meta-analysis was to evaluate efficacy and
safety of this new agent in patients undergoing percutaneous coronary
intervention (PCI). We searched PubMed, Cochrane Library, EMBASE, Web of
Science and CINAHL databases from the inception through April 2013.
Randomized controlled trials (RCTs) comparing cangrelor with control
(clopidogrel/placebo) were selected. We used the random-effects models to
calculate the risk ratio. The primary efficacy outcome was risk of
myocardial infarction, and the primary safety outcome was TIMI major
bleeding at 48 h. Three RCTs included a total of 25,107 participants.
Effects of Cangrelor were not different against comparators for myocardial
infarction (MI) (Risk ratio [RR] 0.94, 95 % confidence interval [CI]
0.78-1.13) and all-cause mortality (RR 0.72, 95 % CI 0.36-1.43). However,
cangrelor significantly reduced the risk of ischemia-driven
revascularization (RR 0.72, 95 % CI 0.52-0.98), stent thrombosis (RR 0.60,
95 % CI 0.44-0.82) and Q wave MI (RR 0.53, 95 % CI 0.30-0.92) without
causing extra major bleeding (Thrombolysis in Myocardial infarction
criteria) and severe or life-threatening bleeding (Global utilization of
streptokinase and tissue plasminogen activator for occluded coronary
arteries criteria). Separate analysis against only clopidogrel also showed
similar findings except Q wave MI outcome. Use of cangrelor during PCI
might reduce the risk of ischemia-driven revascularization and stent
thrombosis, without causing extra major bleeding. 2013 Springer
Science+Business Media.
<10>
Accession Number
2014389786
Authors
Wang S. Zhou J. Cai J.-F.
Institution
(Wang, Zhou) Department of Cardiac Surgery, Shanghai 10th People's
Hospital, Tongji University School of Medicine, Shanghai, China
(Cai) Department of Cardiac Surgery, Ruijin Hospital, Jiaotong University
School of Medicine, Shanghai, China
Title
Traditional coronary artery bypass graft versus totally endoscopic
coronary artery bypass graft or robot-assisted coronary artery bypass
graft - Meta-analysis of 16 studies.
Source
European Review for Medical and Pharmacological Sciences. 18 (6) (pp
790-797), 2014. Date of Publication: 2014.
Publisher
Verduci Editore
Abstract
BACKGROUND: Robot-assisted coronary artery bypass graft (RACAB) or totally
endoscopic coronary artery bypass graft (TECAB) utilizing the da Vinci
surgical system is increasingly used to treat coronary heart disease
(CHD), although traditional coronary artery bypass graft (CABG) remains a
classic treatment. The aim of the present study was to establish the
advantages and disadvantages of TECAB (or RACAB) compared with traditional
CABG. METHODS: PubMed and EBSCO databases were searched for studies of
TECAB (or RACAB) using the da Vinci surgical system and CABG for CHD. The
meta-analysis included 16 studies (2290 patients). RESULTS: Compared with
traditional CABG, TECAB (or RACAB) had lower rates of major adverse
cardiac or cerebrovascular events (MACCE) 12 months postprocedure (7.0%
vs. 12.4%; odds ratio [OR], 0.53; confidence interval [CI], 0.38-0.74; p <
0.05). Subgroup analysis highlighted the differences between TECAB and
RACAB as follows: TECAB decreased the rate of renal failure requiring
hemofiltration (OR, 0.25; CI, 0.07-0.88), wound infection (OR, 0.11; CI,
0.11- 1.99), and stroke (OR, 0.14; CI, 0.02-0.77) during follow-up, but
increased the need for re-exploration for bleeding and MACCE (OR, 2.18;
CI, 1.14-4.16; p < 0.05). CONCLUSIONS: TECAB and RACAB are safe and
feasible therapies for CHD. This meta-analysis supports TECAB(or
RACAB)using the da Vinci surgical system to treat CHD with reduced MACCE
after 12 months. In addition, TECAB and RACAB do not increase the rates of
MACCE in hospital, graft stenosis (or occlusion), and the need for
reintervention compared with CABG.
<11>
Accession Number
2014395455
Authors
Pu L. Li Y.-X. Jiang L.-H.
Institution
(Pu, Li, Jiang) Department of Cardiovascular Surgery, Yan'an Affiliated
Hospital of Kunming Medical University, Kunming 650051, Yunnan Province,
China
Title
Seed cells for tissue-engineered heart valves: Source and application.
Source
Chinese Journal of Tissue Engineering Research. 18 (2) (pp 277-282), 2014.
Date of Publication: 2014.
Publisher
Journal of Clinical Rehabilitative Tissue Engineering Research
Abstract
Background: Application of mechanical valve and bioprosthetic valve
replacement is an effective means for the treatment of end-stage valve
disease. However, their clinical application is constrained by multiple
factors. Tissue-engineered heart valves with biological activity hold the
potential to overcome the defect of the mechanical valves and
bioprosthetic valves. Choosing appropriate cells for cell seeding is a
significant aspect for the research of tissue-engineered heart valves. A
growing number of somatic cells and stem cells have been used for
construction of tissue-engineered heart valves, however, not yet achieve
the desired result. Objective: To review the studies on seed cells for
tissue-engineered heart valves and the cell seeding methods in vitro on
the basis of the cellular components of heart valves. Methods: First
author searched PubMed and Wanfang database with computer for related
articles published from January 2000 to December 2012. The keywords were
"tissue engineering, heart valves, cell". Preferred articles concerned
seed cells of tissue-engineered heart valves with the relevance and
authority. A total of 39 articles published in the prestigious journals
were reviewed. Results And Conclusion: Endothelial cells and interstitial
cells were mainly valvular cellular components. In the early stage,
endothelial cells and fibroblasts were used to construct tissue-engineered
heart valves. With deep stem cell research, the application of pulsatile
bioreactor cultivation mesenchymal stem cells holds a great potential to
produce tissue-engineered heart valves.
<12>
Accession Number
2014394879
Authors
Herrmann J. Gersh B.J. Goldfinger J.Z. Witzenbichler B. Guagliumi G. Dudek
D. Kornowski R. Brener S.J. Parise H. Fahy M. McAndrew T.C. Stone G.W.
Mehran R.
Institution
(Herrmann, Gersh) Division of Cardiovascular Diseases, Department of
Medicine, Mayo Clinic, Rochester, MN, United States
(Goldfinger, Mehran) Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Witzenbichler) Amper Kliniken AG, Dachau, Germany
(Guagliumi) Interventional Cardiology Unit, Ospedale Papa Giovanni XXIII,
Bergamo, Italy
(Dudek) Institute of Cardiology, Jagiellonian University, Krakow, Poland
(Kornowski) Division of Cardiology, Rabin Medical Center, Petach-Tikva,
Israel
(Brener) Institute for Cardiology and Cardiac Surgery, New York Methodist
Hospital, Brooklyn, NY, United States
(Brener, Parise, Fahy, McAndrew, Stone, Mehran) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Stone) Division of Cardiology, Columbia University Medical Center, New
York, NY, United States
Title
Body mass index and acute and long-term outcomes after acute myocardial
infarction (from the Harmonizing Outcomes with Revascularization and
Stents in Acute Myocardial Infarction Trial).
Source
American Journal of Cardiology. 114 (1) (pp 9-16), 2014. Date of
Publication: 01 Jul 2014.
Publisher
Elsevier Inc.
Abstract
The clinical outcome of acute cardiovascular events may be more favorable
in patients with a high body mass index (BMI), although obesity increases
the risk for cardiovascular diseases. The authors sought to define the
association between BMI and acute and long-term outcome of patients
presenting within 12 hours of ST-segment myocardial infarction (STEMI) in
a large multinational cohort. A total of 3,579 patients enrolled in the
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction trial were stratified according to BMI quartiles: <24.5, 24.5
to <27.1, 27.1 to 30.1, and >30.1 kg/m<sup>2</sup> (quartiles 1, 2, 3, and
4, respectively). Death, myocardial reinfarction, ischemia-driven target
vessel revascularization, stroke, and noncoronary artery bypass
grafting-related major bleeding events were centrally adjudicated for the
acute, 30 days, and yearly follow-up. Patients with a BMI in the highest
quartile were younger than patients in the lower BMI quartiles and more
frequently had hypertension, hyperlipidemia, and diabetes mellitus.
Complete occlusions and noncalcified lesions were more common in patients
with a high BMI. In-hospital mortality decreased with increasing BMI due
to lower cardiac mortality (2.9%, 2.3%, 1.2%, and 1.0% for quartiles 1, 2,
3, and 4, respectively, p <0.05). Out-of-hospital 3-year mortality was
also lower in higher-weight patients due to lower noncardiac mortality
(4.2%, 2.6%, 2.3%, and 1.7% for quartiles 1 to 4, respectively, p = 0.01).
After adjustment for covariates, BMI was no longer predictive of acute or
long-term mortality after STEMI. In conclusion, as BMI increases, patients
have a more extensive adjusted cardiovascular risk profile and disease
burden and premature STEMI onset but similar adjusted acute and long-term
outcomes. 2014 Elsevier Inc. All rights reserved.
<13>
Accession Number
2014392464
Authors
Xu R. Lu R. Jiang H. Li Q.-F. Sun Y. Xu H. Huang Y.
Institution
(Lu, Jiang, Li, Sun, Xu, Huang) Department of Anesthesiology, Ninth
People's Hospital, School of Medicine, Shanghai, China
(Xu) Department of Anesthesiology, Fengcheng Hospital, Fengxian District,
Shanghai, China
Title
Meta-analysis of protective effect of sevoflurane on myocardium during
cardiac surgery.
Source
European Review for Medical and Pharmacological Sciences. 18 (7) (pp
1058-1066), 2014. Date of Publication: 2014.
Publisher
Verduci Editore
Abstract
BACKGROUND: This study aims to evaluate the effect of sevoflurane
anesthesia on myocardium in cardiac surgery and provide evidence for
clinical anesthesia practice. MATERIALS AND METHODS: Literature about the
protective effect of sevoflurane anesthesia on myocardium in cardiac
surgery published before March, 2012 was retrieved from the database of
PubMed and EMBASE. The quality of inclusive randomized controlled trials
was evaluated and screened according to the Jadad scale. Finally,
meta-analysis was performed by using the RevMan5.0 software. RESULTS: In
this research, there were totally 17 articles in accordance with the
inclusive criteria and all of them were in English with the study sites
being abroad. Each article was more than 3 points in Jadad scale. Compared
with total intravenous anesthesia group, postoperative 12h CO and CI of
patients have been significantly improved in the sevoflurane anesthesia
group; and concentration of postoperative 24 h cTnI in the sevoflurane
anesthesia group has been reduced, as well as assisted respiratory time
and ICU stay after operation. There is no significant difference in
hospitalization stay between both groups; postoperative usage of
vasoactive drugs in sevoflurane anesthesia group is less than in total
intravenous anesthesia group. There is no significant difference in
postoperative appearance of atrial fibrillation, recurrence rate of angina
pectoris and mortality of patients after operation between both groups.
CONCLUSIONS: Sevoflurane can better protect myocardium in the cardiac
surgery.
<14>
Accession Number
2014391706
Authors
Cao L. Wang K. Gu T. Du B. Song J.
Institution
(Cao) Department of Intensive Care Unit, Second Affiliated Hospital of
Nantong University, Nantong, China
(Wang) Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical
College, Xuzhou, China
(Gu, Du, Song) Department of Anesthesiology, Second Affiliated Hospital of
Nantong University, Nantong, China
Title
Association between APOE epsilon 4 allele and postoperative cognitive
dysfunction: A meta-analysis.
Source
International Journal of Neuroscience. 124 (7) (pp 478-485), 2014. Date of
Publication: July 2014.
Publisher
Informa Healthcare
Abstract
Background: Carriers of the apolipoprotein E epsilon 4 allele (APOE4) may
be at increased risk of postoperative cognitive dysfunction (POCD), but
this association has not been reported consistently. We conducted a
meta-analysis to derive a more precise conclusion. Methods: The PubMed,
EBSCO and EMBASE databases were searched for eligible studies published in
English before March 2013. The association between APOE4 and POCD was
expressed by the odds ratio (OR) with 95% confidence interval (CI). Funnel
plots were constructed and publication bias assessed by Egger's test.
Results: Nine studies encompassing 1063 APOE4 carriers and 2983
noncarriers were included. At about 1-week postsurgery, a significant
association between APOE4 and POCD was found (OR 1.83, 95% CI: 1.18-2.85),
but the association was no longer significant after removing one large
study (OR 1.35, 95% CI: 0.92-1.97). Stratified analysis of
cardiac/vascular surgery patients also yielded no significant correlation
(OR 1.62, 95% CI: 0.80-3.28). One to three months postsurgery, neither the
overall analysis (OR 1.56, 95% CI: 0.87-2.81) nor the stratified analysis
of cardiac/vascular surgery patients (OR 3.33, 95% CI: 0.55-20.22)
indicated a significant correlation. APOE4 was also not correlated with
POCD at 1-year postsurgery (OR 1.15, 95% CI: 0.71-1.86). No evidence of
publication bias was revealed by Egger's test. Conclusions: The APOE4
allele was associated with a significantly increased POCD risk about
1-week postsurgery, but the association depended on one large study. No
association was found 1-3 months and 1-year postsurgery. 2014 Informa
Healthcare USA, Inc.
<15>
Accession Number
2014388337
Authors
Parolini F. Morandi A. Macchini F. Gentilino V. Zanini A. Leva E.
Institution
(Parolini, Morandi, Macchini, Gentilino, Zanini, Leva) Department of
Paediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore
Policlinico, Milano, Italy
(Parolini) Department of Paediatric Surgery, Azienda Ospedaliera Spedali
Civili Brescia, Italy
Title
Cervical/thoracotomic/thoracoscopic approaches for H-type congenital
tracheo-esophageal fistula: A systematic review.
Source
International Journal of Pediatric Otorhinolaryngology. 78 (7) (pp
985-989), 2014. Date of Publication: July 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Purpose: Aim of this systematic review is to investigate the thoracic and
cervical surgical approaches of H-type tracheo-esophageal fistula (TEF)
according to the position of the fistula. Methods: The PubMed database was
searched for original studies on H-type TEF treatment published between
1977 and 2012. Manuscripts finally included were divided into open and
thoracoscopic surgery groups. Results: Seventeen studies were selected for
open surgery group, and most of them agree on the importance of
pre-operative diagnosis of the fistula by preliminary tracheoscopy. Right
cervicotomy was used in 70 cases (76.9%), left cervicotomy in 12 (13.2%),
and thoracotomy only in 9 (9.9%). Five studies were included in
thoracoscopic group (6 patients). Indications for the surgical approach
(cervical vs thoracic) according to the position of the TEF were clearly
described in 10 manuscripts, and all stated differences in surgical
technique details. Complications and mortality rates were not
statistically correlated to the different surgical approaches.
Conclusions: The evidence base in regard to the treatment of H-type
fistula in children is poor and the skills and preferences of the surgeons
guide the choice of the procedure. Surgical division of the fistula is
curative, and the key to a successful repair is the pre-operatively
identification of the level of the fistula with tracheoscopy. Right
cervicotomy seems to be the approach of choice in the majority of case,
with the thoracic approach appropriate only for fistulae opening below T2.
Further well-designed prospective studies which take into account of
selection and performance bias are strongly required. 2014 Elsevier
Ireland Ltd.
<16>
Accession Number
2014399440
Authors
Young Y.R. Sheu B.F. Li W.C. Hsieh T.M. Hung C.W. Chang S.S. Lee C.C.
Institution
(Young) Department of Emergency Medicine, Chang Gung Memorial Hospital,
Chiayi Branch, Puzih City, Chiayi County, 613, Taiwan (Republic of China)
(Young, Sheu, Li, Hsieh, Hung, Chang) Chang Gung University College of
Medicine, Gueishan Township, Taoyuan County, 333, Taiwan (Republic of
China)
(Sheu) Department of Emergency Medicine, Chang Gung Memorial Hospital,
Linkou Branch, Gueishan Township, Taoyuan County, 333, Taiwan (Republic of
China)
(Li) Department of Occupation Medicine, Chang-Gung Memorial Hospital,
Chiayi Branch, Puzih City, Chiayi County, 613, Taiwan (Republic of China)
(Hsieh) Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung
Branch, Kaohsiung County, 833, Taiwan (Republic of China)
(Hung) Department of Emergency Medicine, Kaohsiung Chang Gung Memorial
Hospital, Kaohsiung County, 833, Taiwan (Republic of China)
(Chang) Department of Family Medicine, Chang Gung Memorial Hospital,
Taoyuan, Taiwan (Republic of China)
(Chang) Graduate Institute of Clinical Medical Sciences, College of
Medicine, Chang Gung University, Taoyuan, Taiwan (Republic of China)
(Lee) Department of Epidemiology, Harvard School of Public Health, Boston,
MA, United States
(Lee) Department of Emergency Medicine, National TWN University Hospital,
Douliou, Yunlin Branch, TWN and Department of Emergency Medicine, Taipei,
Taiwan (Republic of China)
Title
Predictive value of plasma brain natriuretic peptide for postoperative
cardiac complications-A systemic review and meta-analysis.
Source
Journal of Critical Care. 29 (4) (pp 696.e1-696.e10), 2014. Date of
Publication: August 2014.
Publisher
W.B. Saunders
Abstract
Background: We aimed to undertake a systematic review and meta-analysis of
studies addressing perioperative natriuretic peptide (NP) levels to
predict postoperative major adverse cardiac events (MACE) after major
surgery. Methods: We searched MEDLINE and Embase with no language
restrictions up to May 2013. The end points were major cardiac
complications. We summarized test performance characteristics with the use
of forest plots, hierarchical summary receiver operating characteristic
curves, and bivariate random effects models. Results: Of the 662 retrieved
articles, 24 studies satisfied the predefined eligibility criteria,
including 5438 patients along with 712 (13.1%) events. After major
surgery, the diagnostic odds ratio (DOR) of NP in predicting postoperative
MACE was 14.3 (95% confidence interval [CI], 9.87-20.7) for overall
population, 13.9 (8.43-22.8) for patients undergoing cardiac surgery, and
15.0 (8.84-25.5) for patients undergoing noncardiac surgery. The pooled
sensitivity was 0.84 (95% CI, 0.79-0.88) and specificity was 0.76 (95% CI,
0.71-0.81). Postoperative measurement (DOR, 18.9; 7.68-46.3) was
associated with higher predictive value than preoperative measurement
(DOR, 13.6; 7.68-46.3). Results were similar for a subgroup with the
composite outcome including mortality (DOR, 16.4; 10.6-25.5). B-type
natriuretic peptide was associated with higher predictive accuracy (area
under the summary receiver operating characteristic, 0.84; 0.81-0.87) than
N-terminal pro-b-type natriuretic peptide (area under the summary receiver
operating characteristic, 0.90; 0.87-0.92). Conclusions: The existing
literature suggests that perioperative NP testing have reasonable accuracy
and can be useful in perioperative risk stratification. Natriuretic
peptide testing has high rule-out value and low rule-in value for
predicting postoperative MACE. Medical decisions should be made in the
context of these characteristics. 2014 Elsevier Inc.
<17>
Accession Number
2014386573
Authors
Witkowski A. Jastrzebski J. Dabrowski M. Chmielak Z.
Institution
(Witkowski, Jastrzebski, Dabrowski, Chmielak) Interventional Cardiology
and Angiology Department, Institute of Cardiology, Warsaw, Poland
Title
Second transcatheter aortic valve implantation for treatment of suboptimal
function of previously implanted prosthesis: Review of the literature.
Source
Journal of Interventional Cardiology. 27 (3) (pp 300-307), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives To systematically review reported cases of second transcatheter
aortic valve deployment within a previously implanted prosthesis
(TAV-in-TAV). Background TAV-in-TAV deployment is one of the rescue
strategies undertaken due to an unsuccessful or suboptimal transcatheter
aortic valve implantation (TAVI) result. Currently, there are no clear
indications for second valve implantation and outcomes of patients with 2
prostheses deployed remain poorly known. Methods The MEDLINE and PubMed
databases were searched for cases of TAV-in-TAV implantations of aortic
valve. Results Forty-three articles reporting on TAV-in-TAV deployment
were included in the review. The most frequently observed indication for
second valve implantation was aortic regurgitation (AR) occurring shortly
after TAVI. There was a strong dominance of paravalvular over
intravalvular AR, with prosthesis malposition being the main underlying
cause of TAVI failure (81% of all identified cases). Perioperative
echocardiographic images are crucial in identifying causes of failure and
helpful in optimal rescue strategy selection. Success rate of TAV-in-TAV
implantation varies from 90% to 100% with mortality rate of 0-14.3% at 30
days. Despite similar aortic valve function in follow-up, TAV-in-TAV may
be an independent predictor of increased cardiovascular mortality.
Conclusions TAV-in-TAV implantation is feasible and results in favorable
short- and mid-term outcomes in patients with acute failure of TAVI
without recourse to open-heart surgery. Further studies are needed to
establish algorithm of the management of unsuccessful or suboptimal
implantation results. (J Interven Cardiol 2014;27:300-307) 2014, Wiley
Periodicals, Inc.
<18>
Accession Number
2014393102
Authors
Liu Y. Davari-Farid S. Arora P. Porhomayon J. Nader N.D.
Institution
(Liu, Davari-Farid, Arora, Porhomayon, Nader) SUNY at Buffalo, VA Western
NY Healthcare System, 3495 Bailey Avenue, Buffalo, NY 14215, United States
Title
Early versus late initiation of renal replacement therapy in critically
ill patients with acute kidney injury after cardiac surgery: A systematic
review and meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 557-563),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective To investigate the impact of early versus late renal replacement
therapy (RRT) on mortality in patients with acute kidney injury (AKI)
after cardiac surgery. Design Meta-analysis of 9 retrospective cohort
studies and 2 randomized clinical trials extracted from the Medline engine
from 1950 to 2013. Setting University medical school. Participants 841
Patients. Interventions None. Measurements and Main Results A total of 841
patients were studied. Pooled estimates of the odds ratio with 95%
confidence interval using a random-effect model were conducted as well as
the heterogeneity, publication bias, and sensitivity analysis. Primary
outcome was 28-day mortality, and secondary outcome was the intensive care
unit (ICU) length of stay. The 28-days mortality rate was lower in the
early RRT group (OR = 0.29, 95% CI, 0.16-0.52, p<0.0001, NNT = 5).
Heterogeneity was high (I2 = 56%), and publication bias was low. Secondary
outcome suggested 3.9 (1.5-6.3) days shorter ICU stay in the early RRT
group, p<0.0001, with extremely high heterogeneity (I<sup>2</sup> = 99%),
and low publication bias. Specifically, studies before 2000 and studies
with mortality less than 50% in the late RRT group reported significantly
higher odds ratio and mean difference than overall value favoring early
RRT. Conclusion Early initiation of RRT for patients with AKI after
cardiac surgery revealed lower 28-days mortality and shorter ICU length of
stay. However, this was based on 11 studies of various qualities with very
high heterogeneity of results. Defining treatment guidelines needs further
research with a larger and better database. 2014 Elsevier Inc. All rights
reserved.
<19>
Accession Number
2014393106
Authors
Aronson S. Levy J.H. Lumb P.D. Fontes M. Wang Y. Crothers T.A. Sulham K.A.
Navetta M.S.
Institution
(Aronson, Levy, Fontes) Department of Anesthesiology, Duke University
Medical Center, 3094, 101 Baker House, Duke South, Durham, NC 27710,
United States
(Lumb) Department of Anesthesiology, Keck School of Medicine, University
of Southern California, Los Angeles, CA, United States
(Wang, Crothers, Sulham, Navetta) Medicines Company, Parsippany, NJ,
United States
Title
Impact of perioperative blood pressure variability on health resource
utilization after cardiac surgery: An analysis of the ECLIPSE trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 579-585),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective To examine the impact of blood pressure control on hospital
health resource utilization using data from the ECLIPSE trials. Design
Post-hoc analysis of data from 3 prospective, open-label, randomized
clinical trials (ECLIPSE trials). Setting Sixty-one medical centers in the
United States. Participants Patients 18 years or older undergoing cardiac
surgery. Interventions Clevidipine was compared with nitroglycerin, sodium
nitroprusside, and nicardipine. Measurements and Main Results The ECLIPSE
trials included 3 individual randomized open-label studies comparing
clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine. Blood
pressure control was assessed as the integral of the cumulative area under
the curve (AUC) outside specified systolic blood pressure ranges, such
that lower AUC represents less variability. This analysis examined surgery
duration, time to extubation, as well as intensive care unit (ICU) and
hospital length of stay (LOS) in patients with AUC<10 mmHgxmin/h compared
to patients with AUC>10 mmHgxmin/h. One thousand four hundred ten patients
were included for analysis; 736 patients (52%) had an AUC<10 mmHgxmin/h,
and 674 (48%) had an AUC>10 mmHgxmin/h. The duration of surgery and ICU
LOS were similar between groups. Time to extubation and postoperative LOS
were both significantly shorter (p = 0.05 and p<0.0001, respectively) in
patients with AUC<10. Multivariate analysis demonstrates AUC<10 was
significantly and independently associated with decreased time to
extubation (hazard ratio 1.132, p = 0.0261) and postoperative LOS (hazard
ratio 1.221, p = 0.0006). Conclusions Based on data derived from the
ECLIPSE studies, increased perioperative BP variability is associated with
delayed time to extubation and increased postoperative LOS. 2014 Elsevier
Inc.
<20>
Accession Number
2014393066
Authors
Zeng J. He W. Qu Z. Tang Y. Zhou Q. Zhang B.
Institution
(Zeng, Zhang) Department of Anesthesia of Cardiovascular Institute, First
Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
(He) Department of Cardiothoracic Surgery, Nanchong Central Hospital,
Second Clinical College of North Sichuan Medical College, Nanchong,
Sichuan, China
(Qu, Tang) Department of Neurology, First Affiliated Hospital, Guangxi
Medical University, Nanning, Guangxi, China
(Zhou) Department of Cardiology, First Affiliated Hospital, Guangxi
Medical University, Nanning, Guangxi, China
Title
Cold blood versus crystalloid cardioplegia for myocardial protection in
adult cardiac surgery: A meta-analysis of randomized controlled studies.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 674-681),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective The purpose of this article was to systematically review
randomized controlled trials in which cold blood cardioplegia was compared
with cold crystalloid cardioplegia for cardiac surgery. Design Correlation
studies were searched independently in the EMBASE, MEDLINE and Cochrane
library databases. The primary endpoints of interest were spontaneous
sinus rhythm (SSR) after declamping, perioperative myocardial infarction
(MI) and mortality (within 30 days). Setting A hospital. Participants
Randomized controlled trials. Intervention A meta-analysis of 12 studies.
Measurements and Main Results The 12 included trials recruited a total of
2866 participants; 1357 patients received cold crystalloid cardioplegia,
and 1509 patients received cold blood cardioplegia. The pooled analysis
showed no significant difference favoring either cold crystalloid
cardioplegia or cold blood cardioplegia in terms of spontaneous sinus
rhythm (SSR) after declamping (789/1028 [76.75%] v 773/1025 [75.41%],
relative risk (RR) = 0.92 [0.76, 1.13], p = 0.43 with 6 studies included),
mortality (within 30 days) (20/1335 [1.50%] v 24/1469 [1.63%], relative
risk (RR) = 1.09 [0.62, 1.91], p = 0.77 with 11 studies included), atrial
fibrillation (AF) (329/1043 [31.54%] v 365/1040 [35.10%], RR =0.90 [0.80,
1.01], p = 0.08 with 6 studies included) or stroke (45/1114 [4.04%] v
20/1240 [1.61%], RR = 2.18 [0.69, 6.93], p = 0.19 with 4 studies
included). The aggregate data showed that the incidence of perioperative
myocardial infarction was lower in patients who received cold blood
cardioplegia (CB) (32/1310 [2.44%] v 17/1434 [1.19%], RR = 2.30 [1.33,
3.98], p = 0.003 with 11 studies included). Conclusions Cold blood
cardioplegia reduced perioperative myocardial infarction when compared
with cold crystalloid cardioplegia. No differences in the overall
incidence rates of spontaneous sinus rhythm, mortality (within 30 days),
atrial fibrillation or stroke were observed. 2014 Published by Elsevier
Inc.
<21>
Accession Number
2014393077
Authors
Baysal A. Yanartas M. Dogukan M. Gundogus N. Kocak T. Koksal C.
Institution
(Baysal, Kocak) Anesthesiology and Reanimation Clinic, Kartal Kosuyolu
High Speciality Training and Research Hospital, Istanbul, Turkey
(Yanartas, Koksal) Cardiovascular Surgery Clinic, Kartal Kosuyolu High
Speciality Training and Research Hospital, Istanbul, Turkey
(Dogukan) Anesthesiology and Reanimation Clinic, Adiyaman University
Training and Research Hospital, Adiyaman, Turkey
(Gundogus) Clinic of Anesthesiology and Reanimation, Sanliurfa Training
and Research Hospital, Sanliurfa, Turkey
Title
Levosimendan improves renal outcome in cardiac surgery: A randomized
trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 586-594),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective The effect of levosimendan on renal function in patients with
low ejection fraction undergoing mitral valve surgery was investigated.
Design A prospective, double-blinded, randomized clinical trial. Setting
Tertiary teaching and research hospital. Participants Of a total of 147
patients, 128 patients completed the study. In the levosimendan group (n =
64), levosimendan was administered in addition to standard inotropic
support; whereas, in the control group (n = 64), only standard inotropic
support was given. Interventions In the levosimendan group, a loading dose
of levosimendan (6 mug/kg) was administered after removal of the aortic
cross-clamp, followed by an infusion (0.1 mug/kg/min) in addition to
standard inotropic therapy for 24 hours. In the control group, only
standard inotropic therapy was administered. Preoperative characteristics,
serum creatinine (sCr) levels, and estimated glomerular filtration rate
(eGFR) were determined preoperatively, on postoperative days 1, 3, and 10.
Independent risk factors for renal replacement therapy (RRT) requirement
were investigated with stepwise multivariate logistic regression analysis.
Measurements and Main Results The primary endpoint was the effect of
levosimendan on postoperative renal clearance (sCr and eGFR). The
secondary endpoint was the effect of levosimendan on clinical outcomes
(length of intensive care unit and hospital stays, need for RRT).
Preoperative characteristics and eGFR were similar between the groups
(p>0.05). On postoperative days 1 and 3, sCr values were lower and eGFR
values were higher in the levosimendan group in comparison with the
control group (p = 0.0001, p = 0.009, respectively). Six patients (9.4%)
in the levosimendan group and 10 patients (15.6%) in the control group
required RRT therapy (p = 0.284). Independent risk factors for need of RRT
include preoperative sCr value between 1.2 to 2.09 mg/dL and>2.1 mg/dL (p<
0.05). Conclusions Perioperative treatment with levosimendan in addition
to standard inotropic therapy in patients with a low ejection fraction
undergoing mitral valve surgery improved immediate postoperative renal
function and reduced need for RRT. 2014 Elsevier Inc.
<22>
Accession Number
2014393072
Authors
Desebbe O. Faulcon C. Henaine R. Tran L. Koffel C. Delannoy B. Lehot J.-J.
Bastien O. Maucort-Boulch D.
Institution
(Desebbe, Faulcon, Koffel, Delannoy, Bastien) Department of Anesthesiology
and Intensive Care, Louis Pradel Hospital, Claude Bernard Lyon 1
University, Lyon, France
(Desebbe, Bastien) Laboratory EA4169, Louis Pradel Hospital, Claude
Bernard Lyon 1 University, Lyon, France
(Henaine) Department of Anesthesiology and Perioperative Care, University
of California, Irvine, CA, United States
(Tran) Department of Surgery, Louis Pradel Hospital, Claude Bernard Lyon 1
University, Lyon, France
(Lehot) Department of Anesthesiology and Intensive Care, Wertheimer Pierre
Hospital, Claude Bernard Lyon 1 University, Lyon, France
(Maucort-Boulch) Hospices Civils de Lyon, Universite Lyon i, Laboratoire
Biostatistique Sante, Pierre-Benite, France
Title
Tissue hemoglobin monitoring is unable to follow variations of arterial
hemoglobin during transitions from pulsatile to constant flow in cardiac
surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 668-673),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective To test whether the variations of tissue hemoglobin
concentration (<sub>T</sub>Hb) measured by the FORE-SIGHT cerebral
oximeter can accurately detect changes in arterial hemoglobin
concentration (<sub>A</sub>Hb) before, during, and after cardiopulmonary
bypass. Design A prospective clinical study. Setting Cardiac surgery
operating room. Participants Thirty patients scheduled for cardiac
surgery. Interventions Tissue hemoglobin concentration (<sub>T</sub>Hb)
was recorded continuously via 2 sensors applied on the forehead and
connected to the cerebral oximeter. Arterial hemoglobin concentration
(<sub>A</sub>Hb) was measured in a hematology analyzer laboratory.
Hemodynamic and respiratory parameters as well as epidemiologic data also
were noted. Data were collected at 3 perioperative times: After induction
of anesthesia, 10 minutes after cardioplegia, and at the end of the
surgery. Measurements and Main Results Ninety pairs of data were
collected. The coefficient of linear regression between <sub>T</sub>Hb and
<sub>A</sub>Hb was 0.4 (p<0.001). After exclusion of Hb variations<5%, the
trending ability of <sub>T</sub>Hb to predict <sub>A</sub>Hb was 87%.
However, the Bland and Altman plot graph for <sub>T</sub>Hb and
<sub>A</sub>Hb showed major limits of agreement (2.4 times the standard
deviation). Central venous pressure and carbon dioxide tension were linked
independently and positively with <sub>T</sub>Hb (p = 0.03). Conclusions
Continuous monitoring of <sub>T</sub>Hb cannot accurately track variations
of <sub>A</sub>Hb during the transition from pulsatile to continuous flow
and vice versa in cardiac surgery. Local hemodynamic factors such as
PaCO<sub>2</sub> and vasodilation significantly impact <sub>T</sub>Hb. In
this setting, <sub>T</sub>Hb monitoring should not be used to guide
eventual blood transfusion management. 2014 Elsevier Inc.
<23>
Accession Number
2014393069
Authors
Sethi B.S. Chauhan S. Bisoi A.K. Kapoor P.M. Kiran U. Rajput R.S.
Institution
(Sethi, Chauhan, Kapoor, Kiran, Rajput) Department of Cardiac Anaesthesia,
All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029,
India
(Bisoi) Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi, India
Title
Comparison of a waxy maize and a potato starch-based balanced hydroxyethyl
starch for priming in patients undergoing coronary artery bypass grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 690-697),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective Concerns have been raised about differences in the safety
profile of potato- versus waxy maize-derived hydroxyethyl starch (HES).
The objective of this study was to compare 2 HES solutions derived from 2
different source materials (potato versus waxy maize) for their
dose-related effects on hemostasis and organ function when used to prime
the cardiopulmonary bypass circuit (CPB). Design A prospective,
randomized, controlled study. Setting Tertiary care center. Participants
Eighty patients undergoing coronary artery bypass grafting (CABG) on CPB.
Interventions For priming the CPB circuit, the HES<sub>P</sub>RL group
received 1000 mL of potato-derived balanced 6% HES 130/0.42 along with 500
mL of Ringer's lactate; the HES<sub>P</sub> group received 1,500 mL of
potato-derived balanced 6% HES 130/0.42; the HES <sub>M</sub>RL group
received 1000 mL of waxy maize-derived balanced 6% HES 130/0.4 along with
500 mL of Ringer's lactate, and the HES<sub>M</sub> group received 1500 mL
of waxy maize-derived balanced 6% HES 130/0.4. Measurements and Main
Results There were no significant differences in 24-hour mediastinal
drainage, rate of re-exploration, blood product usage, coagulation
parameters, and measures of pulmonary, renal, and hepatic function with
respect to plant source of HES, when equivalent doses were used. Sonoclot
activated clotting time (SonACT) was significantly higher and clot rate
(CR) significantly lower at end of surgery (T<sub>1</sub>) and 24 hours
after surgery (T<sub>2</sub>) in the HES<sub>P</sub> and HES<sub>M</sub>
groups compared with the HES<sub>P</sub>RL and HES<sub>M</sub>RL groups.
Compared with baseline, CR and platelet function were significantly lower
at T<sub>1</sub>, PaO<sub>2</sub>/F<sub>I</sub>O <sub>2</sub> ratio
decreased significantly at T<sub>1</sub> and T<sub>2,</sub> and serum
bilirubin and transaminases increased significantly at T<sub>2</sub> in
all 4 groups. Conclusions There was no significant difference in
cumulative 24-hour mediastinal drainage when potato-derived balanced 6%
HES 130/0.42 or waxy maize-derived balanced 6% HES 130/0.4 was used to
prime the CPB circuit in patients undergoing CABG. In equal doses, both
starches exerted the same effect on blood coagulation and pulmonary,
renal, and hepatic function. 2014 Elsevier Inc.
<24>
Accession Number
2014393062
Authors
Yang L. Wang G. Du Y. Ji B. Zheng Z.
Institution
(Yang, Wang, Du) Department of Anesthesiology, Fuwai Hospital, Chinese
Academy of Medical Sciences, Beijing, China
(Ji) Department of Cardiopulmonary Bypass, Fuwai Hospital, Chinese Academy
of Medical Sciences, Beijing, China
(Zheng) Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of
Medical Sciences, Beijing, China
Title
Remote ischemic preconditioning reduces cardiac troponin i release in
cardiac surgery: A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 682-689),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objectives To determine whether remote ischemic preconditioning (RIPC)
reduces myocardial injury, mortality, morbidity, and resource utilization
in cardiac surgery. Design Meta-analysis of controlled clinical trials.
The primary outcome was cardiac troponin I (cTnI) concentrations.
Secondary outcomes included cardiac troponin T (cTnT) concentrations,
myocardial infarction, stroke, renal failure requiring hemodialysis,
atrial fibrillation, inotropic score, mechanical ventilation time, length
of intensive care unit stay, length of hospital stay, and death. Setting
University hospitals. Patients Adult and pediatric patients undergoing
cardiac surgery, including coronary artery bypass grafting, valve
procedures, and correction of congenital cardiac anomalies. Interventions
Remote ischemic preconditioning through limb ischemia. Measurements and
Main Results Nineteen randomized trials involving 1,235 patients were
included in the meta-analysis. The cTnI concentrations at 6 (or 4-8) hours
postoperatively and the total cTnI released after surgery showed a
statistically significant reduction in the RIPC group compared with a
control group (weighted mean difference [WMD] -2.03 ug/L, 95% confidence
interval [CI] -3.25 to -0.82 ug/L, p = 0.001; WMD -65.74 ug/L*h, 95% CI
-107.88 to -23.61 ug/L*h, p = 0.002, respectively). There were no
differences in mortality, morbidity, and resource utilization between
groups. Conclusions Current evidence suggests that RIPC reduces cardiac
troponin I release in patients undergoing cardiac surgery. The clinical
significance of these observations merits further investigation. 2014
Elsevier Inc.
<25>
Accession Number
2014390050
Authors
Nishimura R.A. Otto C.M. Bonow R.O. Carabello B.A. Erwin III J.P. Guyton
R.A. O'Gara P.T. Ruiz C.E. Skubas N.J. Sorajja P. Sundt III T.M. Thomas
J.D.
Title
2014 AHA/ACC guideline for the management of patients with valvular heart
disease: Executive summary: A report of the American college of
cardiology/American heart association task force on practice guidelines.
Source
Journal of the American College of Cardiology. 63 (22) (pp 2438-2488),
2014. Date of Publication: 10 Jun 2014.
Publisher
Elsevier USA
<26>
Accession Number
2014390049
Authors
Nishimura R.A. Otto C.M. Bonow R.O. Carabello B.A. Erwin III J.P. Guyton
R.A. O'Gara P.T. Ruiz C.E. Skubas N.J. Sorajja P. Sundt III T.M. Thomas
J.D.
Title
2014 AHA/ACC guideline for the management of patients with valvular heart
disease: A report of the American college of cardiology/American heart
association task force on practice guidelines.
Source
Journal of the American College of Cardiology. 63 (22) (pp e57-e185),
2014. Date of Publication: 10 Jun 2014.
Publisher
Elsevier USA
<27>
Accession Number
2014386682
Authors
Uyei J. Braithwaite R.S.
Institution
(Uyei, Braithwaite) Division of Comparative Effectiveness and Decision
Sciences, Department of Population Health, New York University School of
Medicine, 227 East 30th Street, New York, NY 10016, United States
Title
Effectiveness of wearable defibrillators: Systematic review and quality of
evidence.
Source
International Journal of Technology Assessment in Health Care. 30 (2) (pp
194-202), 2014. Date of Publication: April 2014.
Publisher
Cambridge University Press
Abstract
Objectives: The objectives of this systematic literature review were to
identify all published literature on wearable defibrillators, assess the
wearable defibrillator's efficacy and effectiveness in general and among
specific patient groups, including post-myocardial infarction, post
coronary artery bypass grafting or percutaneous coronary intervention,
non-ischemic cardiomyopathy, and ischemic cardiomyopathy, and to evaluate
the quality of evidence. Methods: The search and synthesis was informed by
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
statement, and the quality of evidence was evaluated using the Grading of
Recommendations Assessment, Development and Evaluation and the Newcastle
Ottawa Scale. Results: A total of thirty-six articles and conference
abstracts from thirty-three studies were included in the review. It
appears that wearable defibrillator use compared with no defibrillator use
reduces the chance of ventricular tachycardia and ventricular fibrillation
(VT/VF) associated deaths by an absolute risk reduction of approximately 1
percent, achieved by averting approximately 4/5th of all VT/VF associated
deaths. The quality of evidence was low to very low quality, such that our
confidence in the reported estimates is weak. Conclusions: To validate
beneficial results, further investigation using robust study designs
conducted by independent researchers is warranted. 2014 Cambridge
University Press.
<28>
Accession Number
2014377914
Authors
McCullough J.E.M. Liddle S.D. Sinclair M. Close C. Hughes C.M.
Institution
(McCullough, Liddle, Sinclair, Close, Hughes) Institute of Nursing and
Health Research, University of Ulster, Jordanstown Campus, Shore Road,
Newtownabbey, County Antrim BT37 0QB, United Kingdom
Title
The physiological and biochemical outcomes associated with a reflexology
treatment: A systematic review.
Source
Evidence-based Complementary and Alternative Medicine. 2014 , 2014.
Article Number: 502123. Date of Publication: 2014.
Publisher
Oxford University Press
Abstract
Background. Reflexology is one of the top forms of complementary and
alternative medicine in the UK and is used for healthcare by a diverse
range of people. However, it is offered by few healthcare providers as
little scientific evidence is available explaining how it works or any
health benefits it may confer. The aim of this review was to assess the
current evidence available from reflexology randomised controlled trials
(RCTs) that have investigated changes in physiological or biochemical
outcomes. Methods. Guidelines from the Cochrane Handbook of Systematic
Reviews of Interventions were followed: the following databases were
searched from inception to December 2013: AMED, CAM Quest, CINAHL Plus,
Cochrane Central Register of Controlled Trials, Embase, Medline Ovid,
Proquest, and Pubmed. Risk of bias was assessed independently by two
members of the review team and overall strength of the evidence was
assessed using the Grading of Recommendations, Assessment, Development,
and Evaluation guidelines. Results. Seventeen eligible RCTs met all
inclusion criteria. A total of 34 objective outcome measures were
analysed. Although twelve studies showed significant changes within the
reflexology group, only three studies investigating blood pressure,
cardiac index, and salivary amylase resulted in significant between group
changes in favour of reflexology. The overall quality of the studies was
low. 2014 J. E. M. McCullough et al.
<29>
Accession Number
71500954
Authors
Allard S.
Institution
(Allard) NHS Blood and Transplant, London, United Kingdom
Title
Making the right clinical decisions in component therapy.
Source
Vox Sanguinis. Conference: 33rd International Congress of the
International Society of Blood Transfusion, in Conjunction with the 33rd
Congress of the KSBT and the 2014 Congress of the Korean Hematology
Societies Seoul South Korea. Conference Start: 20140531 Conference End:
20140605. Conference Publication: (var.pagings). 107 (pp 4-5), 2014. Date
of Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Blood transfusion may be essential in the management of various diseases
where it can be lifesaving. However, donated blood is a limited resource
and clinical transfusion practice must focus on ensuring safe and
appropriate use underpinned by evidence based guidelines and supported by
education and training with regular audit of practice. The decision to
transfuse requires a careful assessment of the patient's clinical status
and is not just dependent on laboratory parameters such as the haemoglobin
level, platelet count or clotting screen. The risks and benefits of
component therapy must be assessed together with the availability of
transfusion alternatives. The patient should be informed with appropriate
documentation in the clinical records. Prospective randomised controlled
studies in key clinical areas such as intensive care, hip fracture
surgery, cardiac surgery and acute gastrointestinal haemorrhage have
demonstrated that a restrictive red cell transfusion strategy is
associated with at least equivalent or possibly better clinical outcomes
then more liberal transfusion. Accordingly a threshold for red cell
transfusion of 70-80 g/l haemoglobin is appropriate in the majority of
patients but pending further studies, a higher threshold of 80-90 g/l is
indicated in patients with acute coronary syndromes. Platelet transfusions
are indicated for the prevention and treatment of haemorrhage in patients
with thrombocytopenia or platelet function defects. The decision to
transfuse platelets should take into account clinical risk factors for
bleeding and the extent and site of bleeding together with the platelet
count. Fresh frozen plasma (FFP) is used to replace labile plasma
coagulation factors in the presence of bleeding and abnormal coagulation.
Wherever possible prothrombin complex concentrates rather than FFP should
be used in patients on oral anticoagulants where urgent reversal is
indicated. The management of major haemorrhage in any setting provides
particular challenges and requires a multidisciplinary approach. There
have been significant advances in techniques for resuscitation as well as
surgical, radiological and endoscopy interventions to control bleeding.
The timely provision of blood component therapy can improve outcomes but
requires good communication and effective team work between clinical
disciplines and the laboratory staff. The CRASH-2 study has demonstrated
the benefits of early use of antifibrinolytics. There is an emphasis on
early use of fresh frozen plasma and an increasing focus on prompt
correction of hypofibrinigenaemia but further prospective studies are
needed. The prompt availability of laboratory results or near patient
coagulation testing can help with appropriate clinical decision making
around component therapy but are often lacking in this setting. There
continues to be considerable inappropriate use of blood and components as
shown in various audits despite the increasing evidence base and the
development of numerous guidelines for transfusion. This warrants an
increased focus on strategies to improve practice including the use of
information technology to support the transfusion process. There is a
collective need to implement the principles of Patient Blood Management
(PBM) with an evidence based multidisciplinary approach to optimising the
care of all patients who might need transfusion with the timely use of
alternatives wherever available.
<30>
Accession Number
71500870
Authors
Giordana F. D'Ascenzo F. Omede P. Zoccai G.B. Benedetto S. Salizzoni S.
D'Amico M. Moretti C. Rinaldi M. Marra S. Gaita F.
Institution
(Giordana, D'Ascenzo, Omede, Benedetto, D'Amico, Moretti, Marra, Gaita)
Division of Cardiology, Citta Della Salute e della Scienza, University of
Turin, Turin, Italy
(Zoccai) Department of Medico-Surgical Sciences and Biotechnologies,
Sapienza University of Rome, Rome, Italy
(Salizzoni, Rinaldi) Division of Cardiac Surgery, Citta della Salute e
della Scienza, University of Turin, Turin, Italy
Title
Incidence and predictors of all-cause mortality after TAVI: A systematic
review and meta-analysis.
Source
Giornale Italiano di Cardiologia. Conference: 45 Congresso Nazionale di
Cardiologia dell'ANMCO Firenze Italy. Conference Start: 20140529
Conference End: 20140531. Conference Publication: (var.pagings). 15 (4
SUPPL. 2) (pp e123-e124), 2014. Date of Publication: 2014.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Aims. TAVI (transcatheter aortic valve implantation) was demonstrated to
be safe and efficacious in patients with severe aortic stenosis, although
with important rates of complications and of death at follow up, mainly
due to comorbidities of patients. An accurate estimation of risk of these
patients represents an actual challenge. Methods and Results. The PubMed
and Cochrane Collaboration databases were systematically searched for
articles reporting on the incidence and independent predictors of 30-day
and mid-term (>1 year) mortality. Adverse events were pooled with random
effect, while independent predictors were reported as odds ratios with 95%
confidence intervals. A total of 25 studies with 8874 patients were
included (median age 82.5+1.5, 54.6% females). At 30 days 7.5% (663) of
patients died. At mid-term follow-up (median 365 days [IQR 267-365]) the
cumulative mortality rate was 18.8% (1917). Acute kidney injury (AKI)
stage >2 (OR 18.0; CI 6.3-52), preprocedural hospitalization for heart
failure (OR 9.4; CI 2.6-35), peri-procedural myocardial injury (OR 8.5; CI
2.6- 33.5) and increased proBNP levels (OR 5.4; CI 1.7-16.5) were the most
important independent predictors of 30 days mortality. Increased proBNP
levels (OR 11; CI 1.5-81), AKI stage 3 (OR 6.8; CI 2.6-15.7), left
ventricle ejection fraction <30% (OR 6.7; CI 3.5-12.7) and peri-procedural
myocardial infarction (OR 6.5; CI 2.3-18.1) represented the predictors of
mid-term mortality. Conclusions. In this large meta-analysis of TAVI
patients we found that high proBNP levels and post-procedural AKI were the
strongest independent predictors of both 30-day and 1 year mortality.
These findings may contribute to a better understanding of the risk
assessment process of TAVI patients.
