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Embase (updates since 2014-12-05)
<1>
Accession Number
2014250697
Authors
Cooper Jr. L.T. Keren A. Sliwa K. Matsumori A. Mensah G.A.
Institution
(Cooper Jr.) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Keren) Center for Heart Failure and Heart Muscle Diseases, Hadassah -
Hebrew University Hospital, Jerusalem, Israel
(Sliwa) Hatter Institute for Cardiovascular Research University of Cape
Town, Cape Town, South Africa
(Matsumori) Non-Profit Organization Asian Pacific Society of Cardiology,
Kyoto, Japan
(Mensah) Center for Translation Research and Implementation Science
(CTRIS), National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, MD, United States
Title
The global burden of myocarditis: Part 1: A systematic literature review
for the global burden of diseases, injuries, and risk factors 2010 study.
Source
Global Heart. 9 (1) (pp 121-129), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Myocarditis contributes to the global burden of cardiovascular disease
primarily through sudden death and dilated cardiomyopathy. A systematic
approach to identify the cardiovascular mortality and major morbidity
attributable to myocarditis has not been performed. A writing group
convened by the GBD 2010 (Global Burden of Diseases, Injuries and Risk
Factors) Study systematically reviewed the world's literature by a manual
review of all titles since 1966 on myocarditis identified using Ovid
Medline, development of a disease model, and provision of estimates when
possible of the incidence, prevalence, risk of death, and major morbidity
for the world regions. Accurate population-based estimates of myocarditis
incidence and prevalence are not directly available in any world region.
However, a model that quantitates the risk of acute death and chronic
heart failure following myocarditis was derived from the published data.
Using hospital dismissal data, the burden of myocarditis as a percentage
of prevalent heart failure varied by age and region from approximately
0.5% to 4.0%. The novel combination of multiple data sources may provide
an estimate of the years of life lost and years of life disabled from
myocarditis. Pending the integration of these data sources, the burden of
dilated cardiomyopathy and myocarditis were reported together in the 2010
GBD report. The 2013 GBD project may refine these estimates with the
inclusion of more comprehensive payor databases and more precise case
definitions. 2014 World Heart Federation (Geneva). Published by Elsevier
Ltd. All rights reserved.
<2>
Accession Number
2014250694
Authors
Bin Abdulhak A.A. Baddour L.M. Erwin P.J. Hoen B. Chu V.H. Mensah G.A.
Tleyjeh I.M.
Institution
(Bin Abdulhak) Department of Medicine, School of Medicine, University of
Missouri - Kansas City, Kansas City, MO, United States
(Baddour, Tleyjeh) Division of Infectious Diseases, Mayo Clinic,
Rochester, MN, United States
(Erwin) Mayo Medical Library, Mayo Clinic, Rochester, MN, United States
(Hoen) Department of Infectious Diseases, Dermatology and Internal
Medicine, University Medical Center of Guadeloupe, cedex, France
(Chu) Division of Infectious Diseases, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Mensah) Center for Translation Research and Implementation Science
(CTRIS), National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, MD, United States
(Tleyjeh) Division of Epidemiology, Mayo Clinic, Rochester, MN, United
States
(Tleyjeh) Department of Medicine, Infectious Diseases Section, King-Fahad
Medical City, Riyadh, Saudi Arabia
(Tleyjeh) College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
Title
Global and regional burden of infective endocarditis, 1990-2010: A
systematic review of the literature.
Source
Global Heart. 9 (1) (pp 131-143), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Infective endocarditis (IE) is a life-threatening disease associated with
serious complications. The GBD 2010 (Global Burden of Disease, Injuries,
and Risk Factors) study IE expert group conducted a systematic review of
IE epidemiology literature to inform estimates of the burden on IE in 21
world regions in 1990 and 2010. The disease model of IE for the GBD 2010
study included IE death and 2 sequelae: stroke and valve surgery. Several
medical and science databases were searched for IE epidemiology studies in
GBD high-, low-, and middle-income regions published between 1980 and
2008. The epidemiologic parameters of interest were IE incidence,
proportions of IE patients who developed stroke or underwent valve
surgery, and case fatality. Literature searches yielded 1,975 unique
papers, of which 115 published in 10 languages were included in the
systematic review. Eligible studies were population-based (17%),
multicenter hospital-based (11%), and single-center hospital-based studies
(71%). Population-based studies were reported from only 6 world regions.
Data were missing or sparse in many low- and middle-income regions. The
crude incidence of IE ranged between 1.5 and 11.6 cases per 100,000 people
and was reported from 10 countries. The overall mean proportion of IE
patients that developed stroke was 0.158 + 0.091, and the mean proportion
of patients that underwent valve surgery was 0.324 + 0.188. The mean case
fatality risk was 0.211 + 0.104. A systematic review for the GBD 2010
study provided IE epidemiology estimates for many world regions, but
highlighted the lack of information about IE in low- and middle-income
regions. More complete knowledge of the global burden of IE will require
improved IE surveillance in all world regions. 2014 World Heart
Federation (Geneva). Published by Elsevier Ltd. All rights reserved.
<3>
Accession Number
2012441583
Authors
Tung H.-H. Shen S.-F. Shih C.-C. Chiu K.-M. Lee J.-Y. Liu C.-Y.
Institution
(Tung) Tungs' Taichung MetroHabor Hospital, National Taipei University of
Nursing and Health Science, 365 Ming Te Road PeiTou, Taipei 112, Taiwan
(Republic of China)
(Shen) Buddish Tzu-Chi General Hospital, National Taipei University of
Nursing and Health Science, 365 Ming Te Road PeiTou, Taipei 112, Taiwan
(Republic of China)
(Shih) Cardiovascular Division, Taipei Veterans General Hospital, 201,
Sec. 2, Shih-Pai Road, PeiTou, Taipei 11217, Taiwan (Republic of China)
(Chiu) Cardiovascular Surgery Division, Far Eastern Memorial Hospital, No.
21, Sec. 2, Nanya S. Road, Banqiao Dist., New Taipei City 220, Taiwan
(Republic of China)
(Lee) Cardiovascular Department, Mackay Memorial Hospital, No. 92, Sec. 2,
Zhongshan N. Road, Zhongshan Dist., Taipei City 10449, Taiwan (Republic of
China)
(Liu) National Taipei University of Nursing and Health Science, 365 Ming
Te Road PeiTou, Taipei 112, Taiwan (Republic of China)
Title
Effects of a preoperative individualized exercise program on selected
recovery variables for cardiac surgery patients: A pilot study.
Source
Journal of the Saudi Heart Association. 24 (3) (pp 153-161), 2012. Date of
Publication: July 2012.
Publisher
Elsevier
Abstract
Objective: Research on preoperative individualized exercise prescription
(PIEP) for heart surgery patients in Taiwan is lacking. Thus, the purpose
of this study was to examine the feasibility of a PIEP in the Taiwanese
population. Method: A quasi-experimental design, using purposive sampling,
was conducted. Thirty-five patients were recruited, of whom 15 chose to
participate in the experimental (PIEP training plus usual care) group, and
20 chose to participate in the control (usual care) group. The effects of
the intervention were determined by pulmonary complication-related
parameters and quality of life. Results and conclusion: The development
and process of PIEPs suitable for cardiac patients was described in this
study. The results reveal that the two-week exercise-training program
contributed to a decreased peak respiratory exchange ratio (RER) after the
surgery and earlier ambulation. The effectiveness of PIEPs in improving
the quality of life in cardiac surgery patients was validated. This study
may also contribute as a reference of the PIEP effect on patients to the
healthcare providers. 2012 King Saud University.
<4>
Accession Number
2010677455
Authors
El-Sobkey S.B. Salem N.A.
Institution
(El-Sobkey) King Saud University, College of Applied Medical Sciences,
Rehabilitation Health Sciences Department, Riyadh, Saudi Arabia
(Salem) Faculty of Physical Therapy, Cairo University, Cairo, Egypt
Title
Can lung volumes and capacities be used as an outcome measure for phrenic
nerve recovery after cardiac surgeries?.
Source
Journal of the Saudi Heart Association. 23 (1) (pp 23-30), 2011. Date of
Publication: January 2011.
Publisher
Elsevier
Abstract
Phrenic nerve is the main nerve drive to the diaphragm and its injury is a
well-known complication following cardiac surgeries. It results in
diaphragmatic dysfunction with reduction in lung volumes and capacities.
This study aimed to evaluate the objectivity of lung volumes and
capacities as an outcome measure for the prognosis of phrenic nerve
recovery after cardiac surgeries. In this prospective experimental study,
patients were recruited from Cardio-Thoracic Surgery Department,
Educational-Hospital of College of Medicine, Cairo University. They were
11 patients with right phrenic nerve injury and 14 patients with left
injury. On the basis of receiving low-level laser irradiation, they were
divided into irradiated group and non-irradiated group. Measures of
phrenic nerve latency, lung volumes and capacities were taken pre and
post-operative and at 3-months follow up. After 3. months of low-level
laser therapy, the irradiated group showed marked improvement in the
phrenic nerve recovery. On the other hand, vital capacity and forced
expiratory volume in the first second were the only lung capacity and
volume that showed improvement consequent with the recovery of right
phrenic nerve (P value <0.001 for both). Furthermore, forced vital
capacity was the single lung capacity that showed significant statistical
improvement in patients with recovered left phrenic nerve injury (P value
<0.001). Study concluded that lung volumes and capacities cannot be used
as an objective outcome measure for recovery of phrenic nerve injury after
cardiac surgeries. 2010.
<5>
Accession Number
2011419774
Authors
Jacobson T.A.
Institution
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, GA, United
States
Title
Opening a new lipid "Apo-thecary": Incorporating apolipoproteins as
potential risk factors and treatment targets to reduce cardiovascular
risk.
Source
Mayo Clinic Proceedings. 86 (8) (pp 762-780), 2011. Date of Publication:
August 2011.
Publisher
Elsevier Ltd
Abstract
Statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors)
represent the cornerstone of drug therapy to reduce lowdensity lipoprotein
(LDL) cholesterol and cardiovascular risk. However, even optimal statin
management of LDL cholesterol leaves many patients with residual
cardiovascular risk, in part because statins are more effective in
reducing LDL cholesterol than apolipoprotein B (Apo B). Apo B may be a
better marker of atherogenic risk than LDL cholesterol because Apo B
measures the total number of all atherogenic particles (total
atherosclerotic burden), including LDL, very low-density lipoprotein,
intermediate-density lipoprotein, remnant lipoproteins, and
lipoprotein(a). To determine whether Apo B is a better indicator of
baseline cardiovascular risk and residual risk after lipid therapy
compared with LDL cholesterol, a MEDLINE search of the literature
published in English from January 1, 1975, through December 1, 2010, was
conducted. On the basis of data from most population studies, elevated Apo
B was more strongly associated with incident coronary heart disease than
similarly elevated LDL cholesterol. Apo B was also a superior benchmark
(vs LDL cholesterol) of statins' cardioprotective efficacy in both
primary-prevention and secondary-prevention trials. To minimize
cardiovascular risk among persons with hypercholesterolemia or
dyslipidemia, the best available evidence suggests that intensive therapy
with statins should be initiated to achieve the lowest possible Apo B
level (with adequate drug toleration) and then other therapies (eg,
niacin, bile acid resins, ezetimibe) added to potentiate these Apo B -
lowering effects. In future consensus lipid-lowering treatment guidelines,
Apo B should be considered as an index of residual risk, a potential
parameter of treatment efficacy, and a treatment target to minimize risk
of coronary heart disease. 2011 Mayo Foundation for Medical Education and
Research.
<6>
Accession Number
2010507613
Authors
Elmistekawy E. Lapierre H. Mesana T. Ruel M.
Institution
(Elmistekawy, Lapierre, Mesana, Ruel) University of Ottawa Heart
Institute, Division of Cardiac Surgery, 40 Ruskin Street, Suite 3403,
Ottawa, ON K1Y 4W7, Canada
Title
Apico-Aortic Conduit for severe aortic stenosis: Technique, applications,
and systematic review.
Source
Journal of the Saudi Heart Association. 22 (4) (pp 187-194), 2010. Date of
Publication: October 2010.
Publisher
Elsevier
Abstract
Patients referred for aortic valve replacement are often elderly and may
have increased surgical risk associated with ascending aortic
calcification, left ventricular dysfunction, presence of coronary artery
disease, previous surgery, and/or presence of several co-morbidities. Some
of these patients may not be considered candidates for conventional
surgery because of their high risk profile. While transcatheter aortic
valve replacement constitutes a widely accepted alternative, some patients
may not be eligible for this modality due to anatomic factors.
Apico-Aortic Conduit (AAC) insertion (aortic valve bypass surgery)
constitutes a possible option in those patients. Apico-Aortic Conduit is
not a new technique, as it has been used for decades in both pediatric and
adult populations. However, there is a resurging interest in this
technique due to the expanding scope of elderly patients being considered
for the treatment of aortic stenosis. Herein, we describe our surgical
technique and provide a systematic review of recent publications on AAC
insertion, reporting that there is continued use and several modifications
of this technique, such as performing it through a small thoracotomy
without the use of the cardiopulmonary bypass. 2010.
<7>
Accession Number
2014931504
Authors
Douds M.T. Straub E.J. Kent A.C. Bistrick C.H. Sistino J.J.
Institution
(Douds, Straub, Kent, Bistrick, Sistino) Division of Cardiovascular
Perfusion, College of Health Professions, Medical University of South
Carolina, 151B Rutledge Ave MSC 962, Charleston, SC 29425, United States
Title
A systematic review of cerebral oxygenation-monitoring devices in cardiac
surgery.
Source
Perfusion (United Kingdom). 29 (6) (pp 545-552), 2014. Date of
Publication: 27 Nov 2014.
Publisher
SAGE Publications Ltd
Abstract
Objective: Cerebral oxygenation monitoring via near-infrared spectroscopy
(NIRS) during cardiopulmonary bypass (CPB) is increasingly becoming an
accepted and valued component of intraoperative monitoring. In recent
years, new devices have become available which all make different claims.
The purpose of this study is to examine the research on these individual
devices to establish the levels of evidence for each and formulate a
research path for further evaluation of this technology in cardiac
surgery.
Methods: This study is a systematic review of published research on
cerebral oximetry. We searched PubMed, CINAHL and Scopus for full-length,
peer-reviewed articles containing original data resulting from the study
of patient neurologic outcomes based on the use of FDA-approved
near-infrared spectroscopy devices. The studies were then grouped and
classified based on the device used and the levels of evidence each study
provided.
Results: Only a very limited number of high-level clinical evidence
research papers are currently available, with nearly all of those papers
based on the INVOS system. This is likely due to the different lengths of
time each device has been on the market and its availability for use in
clinical trials. Challenges to testing include the expense of testing
various devices, the lack of a globally accepted gold standard for
cerebral oxygenation saturation, the limited availability of patient
frontal surface area and the gradual adoption of this technology. Despite
these limitations, significant results have been identified in relation to
patient outcomes.
Conclusion: At this time, there is limited high-level evidence available
for all of the NIRS devices on the market despite significant outcomes
found in these studies. Additional prospective randomized studies should
be conducted in order to establish the potential role NIRS may play in
patient monitoring as well as assessing the efficacy of the multiple
devices on the market.
<8>
Accession Number
2014931494
Authors
Azau A. Markowicz P. Corbeau J.J. Cottineau C. Moreau X. Baufreton C.
Beydon L.
Institution
(Azau, Markowicz, Corbeau, Cottineau, Moreau, Beydon) Department of
Anesthesia and Surgical Intensive Care, LUNAM Universite, Universite
d'Angers, 4 rue Larrey, Angers, Cedex 9 49933, France
(Baufreton) Department of Cardiac Surgery, LUNAM Universite, Universite
d'Angers, Angers, Larrey, France
Title
Increasing mean arterial pressure during cardiac surgery does not reduce
the rate of postoperative acute kidney injury.
Source
Perfusion (United Kingdom). 29 (6) (pp 496-504), 2014. Date of
Publication: 27 Nov 2014.
Publisher
SAGE Publications Ltd
Abstract
Introduction: We hypothesized that the optimization of renal haemodynamics
by maintaining a high level of mean arterial blood pressure (MAP) during
cardiopulmonary bypass (CPB) could reduce the rate of acute kidney injury
(AKI) in high-risk patients.
Methods: In this randomized, controlled study, we enrolled 300 patients
scheduled for elective cardiac surgery under cardiopulmonary bypass. All
had known risk factors of AKI: serum creatinine clearance between 30 and
60 ml/min for 1.73m or two factors among the following: age >60 years,
diabetes mellitus, diffuse atherosclerosis. After a standardized fluid
loading, the MAP was maintained between 75-85 mmHg during CPB with
norepinephrine (High Pressure, n=147) versus 50-60 mmHg in the Control
(n=145). AKI was defined by a 30% increased of serum creatinine (sCr). We
further tested others definitions for AKI: RIFLE classification, 50% rise
of sCr and the need for haemodialysis.
Results: The pressure endpoints were achieved in both the High Pressure
(79 + 6 mmHg) and the Control groups (60 + 6 mmHg; p<0.001). The rate of
AKI did not differ by group (17% vs. 17%; p=1), whatever the criteria used
for AKI. The length of stay in hospital (9.5 days [7.9-11.2] vs. 8.2
[7.1-9.4]) and the rate of death at day 28 (2.1% vs. 3.4%) and at six
months (3.4% vs. 4.8%) did not differ between the groups.
Conclusion: Maintaining a high level of MAP (on average) during
normothermic CPB does not reduce the risk of postoperative AKI. It does
not alter the length of hospital stay or the mortality rate.
<9>
[Use Link to view the full text]
Accession Number
2014723398
Authors
Van Hemelrijck J. Levien L.J. Veeckman L. Pitman A. Zafirelis Z. Standa T.
Institution
(Van Hemelrijck, Veeckman) Department of Anesthesiology, Clinical
Research, Universitaire Ziekenhuizen Leuven, Herestraat 49, Leuven B-3000,
Belgium
(Levien) Department of Vascular Surgery, Milpark Hospital, Parktown,
Johannesburg, South Africa
(Pitman) Independent Biostatistics Consultant, Peabody, MA, United States
(Zafirelis) Independent Consultant, Needham, MA, United States
(Standa) Department of Anesthesiology, University Hospital, Eppendorf,
Hamburg, Germany
Title
A safety and efficacy evaluation of hemoglobin-based oxygen carrier
HBOC-201 in a randomized, multicenter red blood cell controlled trial in
noncardiac surgery patients.
Source
Anesthesia and Analgesia. 119 (4) (pp 766-776), 2014. Date of Publication:
2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: We present the results of a previously unpublished
hemoglobin-based oxygen carrier (HBOC) study conducted in 1998-1999.
Methods: In a multicenter, randomized, single-blind, comparative study of
HBOC-201 versus allogeneic red blood cell (RBC) transfusions, no-cardiac
surgery patients received HBOC-201 to a maximum of 7 units (n = 83) or
RBCs (n = 77). Patients could be switched to RBCs for safety or any other
reason. The efficacy end points were elimination and/or reduction of
allogeneic RBC transfusions for 28 days.
Results: The proportion of patients in the HBOC-201 group that avoided RBC
transfusion was 0.427 (95% confidence interval, 0.321-0.533). Subjects in
the HBOC-201 group received on average 3.2 units of RBCs versus 4.4 units
in the control arm (P = 0.004). Seventy-nine (95.2%) subjects in the
HBOC-201 group and 72 (93.5%) in the RBC group experienced adverse events
(AEs), judged to be associated with study treatment in 59 (71.1%) and 18
(23.4%) subjects, respectively. Thirty-day mortality, 5 (6.0%) vs 4 (5.2%)
patients (P = 1.00), incidence of serious AEs, 24 (28.9%) vs 20 (26.0%) (P
= 0.73), or time to intensive care unit (log-rank P = 0.15) or hospital
discharge (log-rank P = 0.53) were similar for the HBOC-201 and RBC
groups, respectively.
Conclusions: Up to 7 units of HBOC-201 infused over the course of 6 days
resulted in RBC transfusion avoidance in 43% of patients. There were no
notable differences in mortality and serious AEs incidence. The use of
HBOC-201 was associated with a notable excess of nonserious AEs.
<10>
[Use Link to view the full text]
Accession Number
2014714062
Authors
Sauer A.-M.C. Slooter A.J.C. Veldhuijzen D.S. Van Eijk M.M.J. Devlin J.W.
Van Dijk D.
Institution
(Sauer, Veldhuijzen) Department of Anesthesiology, University Medical
Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, Netherlands
(Slooter, Van Eijk, Van Dijk) Departments of Intensive Care Medicine,
University Medical Center Utrecht, Utrecht, Netherlands
(Devlin) Department of Pharmacy Practice, Bouve College, Northeastern
University, Boston, MA, United States
(Van Eijk) Department of Anesthesiology, Leiden University Medical Center,
Leiden, Netherlands
Title
Cardiac surgery: A randomized clinical trial.
Source
Anesthesia and Analgesia. 119 (5) (pp 1046-1052), 2014. Date of
Publication: 04 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Delirium is common after cardiac surgery and may be partly
related to the systemic inflammatory response triggered by the surgery and
the use of cardiopulmonary bypass. We hypothesized that intraoperative
administration of high-dose dexamethasone, a drug with potent
anti-inflammatory effects, would reduce the incidence of delirium at any
time point during the first 4 postoperative days after cardiac surgery.
METHODS: This was a single-center substudy within a larger, multicenter
placebo-controlled randomized clinical trial, the Dexamethasone for
Cardiac Surgery (DECS) trial that randomized patients >18 years,
undergoing cardiac surgery with cardiopulmonary bypass, to receive, in a
double-blind fashion, either dexamethasone 1 mg/kg or placebo at the
induction of anesthesia. Over the first 4 postoperative days, we compared
between groups the incidence of delirium (based on the Confusion
Assessment Method adapted for the intensive care unit, or after intensive
care unit discharge, by the Confusion Assessment Method, accompanied by
chart review), restraint use, and administered haloperidol,
benzodiazepines, and opioids. Data were analyzed according to the
intention-to-treat principle. The proportion of patients with delirium in
the dexamethasone versus the placebo group was compared using the odds
ratio (OR) with a 95% confidence interval (CI). The proportion also was
compared using logistic regression to adjust for common baseline variables
that might confound the presence of delirium between the 2 groups.
RESULTS: Of 768 eligible patients, 737 subjects (96.0%) had complete data.
The incidence of delirium was similar between the dexamethasone (14.2%)
and placebo (14.9%) groups (crude OR = 0.95, 95% CI, 0.63-1.43; adjusted
OR = 0.85, 95% CI, 0.55-1.31). Among patients who developed delirium, the
median (interquartile range) duration of delirium was similar between the
dexamethasone and placebo groups (2 [1-3] vs 2 [1-2] days, respectively, P
= 0.45; WMWodds 0.98, 95% CI, 0.83-1.17). Restraint use and the
administration of haloperidol, benzodiazepines, and opioids were also
similar between the 2 groups. CONCLUSIONS: The intraoperative
administration of dexamethasone did not reduce the incidence or duration
of delirium in the first 4 days after cardiac surgery.
<11>
Accession Number
2014735506
Authors
Dai C. Zhang W. Lu Z. Zhu H. Xue S. Lian F.
Institution
(Dai, Zhang, Lu, Zhu, Xue, Lian) Department of Cardiovascular Surgery, Ren
Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai,
China
Title
Comparison of the safety of right internal mammary artery versus radial
artery for the second arterial conduit during coronary artery bypass
grafting.
Source
Heart Lung and Circulation. 23 (12) (pp 1179-1186), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Elsevier Ltd
Abstract
Objective: To compare the safety of procedure in patients receiving right
internal mammary artery (RIMA) versus radial artery (RA) as the second
arterial graft during left internal mammary artery bypass surgery.
Methods: A literature search was performed, and observational studies
comparing RA and RIMA as a second arterial conduit were included. The end
points included in-hospital mortality, sternal wound infection (SWI),
myocardial infarction (MI), reoperation for bleeding, stroke and low
cardiac output syndrome. Sensitivity analysis was performed, and
publication bias was assessed. Results: Analysis of nine studies
comprising 1,738 RIMA patients and 1,906 RA patients showed a similar risk
of in-hospital mortality (relative risk [RR] 1.13, 95% confidence interval
[CI] 0.64 to 1.98) between two groups. The risk of SWI in RIMA patients
was significantly higher than that in RA patients (RR 3.19, 95% CI 1.64 to
6.20). The risk of the rest end points did not differ. Conclusions: The
postoperative risk seems to be similar between RIMA group and RA group,
except the higher risk of SWI in RIMA patients. The surgeon relies on his
own experience with these two arterial grafts and assessment of the
patient profile to decide the choice of the second arterial conduit.
<12>
Accession Number
2014932907
Authors
Michael M. Abboudi H. Ker J. Khan M.S. Dasgupta P. Ahmed K.
Institution
(Michael, Khan, Dasgupta, Ahmed) MRC Centre for Transplantation, NIHR
Biomedical Research Centre, King's College London, London, United Kingdom
(Michael, Khan, Dasgupta, Ahmed) Department of Urology, Guy's Hospital,
London, United Kingdom
(Abboudi) Department of Urology, Royal Sussex County Hospital, Brighton,
United Kingdom
(Ker) Clinical Skills Centre, Ninewells Hospital and Medical School, Level
6, Dundee, United Kingdom
Title
Performance of technology-driven simulators for medical students - A
systematic review.
Source
Journal of Surgical Research. 192 (2) (pp 531-543), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Academic Press Inc.
Abstract
Background: Simulation-based education has evolved as a key training tool
in high-risk industries such as aviation and the military. In parallel
with these industries, the benefits of incorporating specialty-oriented
simulation training within medical schools are vast. Adoption of
simulators into medical school education programs has shown great promise
and has the potential to revolutionize modern undergraduate education.
Materials and methods: An English literature search was carried out using
MEDLINE, EMBASE, and psychINFO databases to identify all randomized
controlled studies pertaining to "technology-driven" simulators used in
undergraduate medical education. A validity framework incorporating the
"framework for technology enhanced learning" report by the Department of
Health, United Kingdom, was used to evaluate the capabilities of each
technology-driven simulator. Information was collected regarding the
simulator type, characteristics, and brand name. Where possible, we
extracted information from the studies on the simulators' performance with
respect to validity status, reliability, feasibility, education impact,
acceptability, and cost effectiveness. Results: We identified 19 studies,
analyzing simulators for medical students across a variety of
procedure-based specialities including; cardiovascular (n = 2), endoscopy
(n = 3), laparoscopic surgery ( n = 8), vascular access ( n = 2),
ophthalmology ( n = 1), obstetrics and gynecology (n = 1), anesthesia (n =
1), and pediatrics ( n = 1). Incorporation of simulators has so far been
on an institutional level; no national or international trends have yet
emerged. Conclusions: Simulators are capable of providing a highly
educational and realistic experience for the medical students within a
variety of speciality-oriented teaching sessions. Further research is
needed to establish how best to incorporate simulators into a more primary
stage of medical education; preclinical and clinical undergraduate
medicine.
<13>
Accession Number
2014944038
Authors
Sayed S.A. Katewa A. Srivastava V. Jana S. Patwardhan A.M.
Institution
(Sayed, Katewa, Srivastava, Jana, Patwardhan) King Edward Memorial
Hospital, Seth Gordhandas Sunderdas Medical College, Mumbai, India
(Sayed, Katewa, Srivastava) Sr. Registrar, Dept. of CVTS, J. N. Med.
College, Sawangi, Wardha (M), India
(Jana, Patwardhan) Dept. of CVTS, J. N. Med. College, Sawangi, Wardha (M),
India
(Patwardhan) CVTS, J. N. Med. College, Sawangi, Wardha (M), India
Title
Modified radial v/s biatrial maze for atrial fibrillation in rheumatic
valvular heart surgery.
Source
Indian Heart Journal. 66 (5) (pp 510-516), 2014. Date of Publication: 01
Sep 2014.
Publisher
Elsevier
Abstract
Background Atrial fibrillation (AF) is commonest sustained atrial
arrhythmia producing high morbidity. Although Cox's Maze III procedure
cures AF in majority, reduced atrial transport function (ATF) is a
concern. Radial approach with ablation lines radial from sinus node
towards atrioventricular annulii and parallel to atrial coronary arteries,
has shown better ATF.
Methods Single blind open randomized prospective study of 80 patients was
undertaken in two groups (40 each) of modified Cox's maze III and modified
radial approach, to evaluate conversion to normal sinus rhythm (NSR) and
ATF. Patients undergoing surgery for rheumatic valvular heart disease with
continuous AF were prospectively randomized. Ablation lines were created
with radiofrequency (RF) bipolar coagulation with cryoablation for the
isthmal lesions and coronary sinus.
Results were compared at 6 months and ATF was evaluated by atrial filling
fraction (AFF) and A/E ratio on echocardiography. Results The rate of
conversion to NSR in both groups was statistically insignificant by
Fisher's exact test (p > 0.05). ATF was better in modified radial approach
compared to modified Cox's Maze III (A/E compared by unpaired t test:0.52
+ 0.08 v/s 0.36 + 0.10; p < 0.05. AFF compared using Mann Whitney U test:
median AFF for radial group was 23 v/s 20 for biatrial group; p < 0.05).
Discussion In patients with AF undergoing rheumatic valvular surgery,
radiofrequency radial approach is as effective as modified Cox's maze III
for conversion to NSR with better atrial transport function.
<14>
Accession Number
2014944031
Authors
Raghuram N. Parachuri V.R. Swarnagowri M.V. Babu S. Chaku R. Kulkarni R.
Bhuyan B. Bhargav H. Nagendra H.R.
Institution
(Raghuram, Swarnagowri, Babu, Chaku, Bhargav, Nagendra) Division of Yoga
and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana
University, 19 Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar,
Bangalore, Karnataka, India
(Parachuri, Babu, Bhuyan) Department of Cardiology, Narayana Hrudayalaya
Institute of Cardiac Sciences, No. 258/A, Bommasandra Industrial Area,
Hosur Road, Anekal Taluk, Karnataka, India
(Kulkarni) Symbiosis International University, Pune, India
Title
Yoga based cardiac rehabilitation after coronary artery bypass surgery:
One-year results on LVEF, lipid profile and psychological states - A
randomized controlled study.
Source
Indian Heart Journal. 66 (5) (pp 490-502), 2014. Date of Publication: 01
Sep 2014.
Publisher
Elsevier
Abstract
Objective To compare the long term effects of yoga based cardiac
rehabilitation program with only physiotherapy based program as an add-on
to conventional rehabilitation after coronary artery bypass grafting
(CABG) on risk factors.
Methods In this single blind prospective randomized parallel two armed
active control study, 1026 patients posted for CABG at Narayana
Hrudayalaya Institute of Cardiac Sciences, Bengaluru (India) were
screened. Of these, 250 male participants (35-65 years) who satisfied the
selection criteria and consented were randomized into two groups. Within
and between group comparisons were done at three points of follow up (i.e.
6th week, 6th month, and 12th month) by using Wilcoxon's signed ranks test
and Mann Whitney U test respectively.
Results Yoga group had significantly (p = 0.001, Mann Whitney) better
improvement in LVEF than control group in those with abnormal baseline EF
(<53%) after 1 year. There was a better reduction in BMI in the yoga group
(p = 0.038, between groups) in those with high baseline BMI (>23) after 12
months. Yoga group showed significant (p = 0.008, Wilcoxon's) reduction in
blood glucose at one year in those with high baseline FBS >110 mg/dl.
There was significantly better improvement in yoga than the control group
in HDL (p = 0.003), LDL (p = 0.01) and VLDL (p = 0.03) in those with
abnormal baseline values. There was significantly better improvement (p =
0.02, between groups) in positive affect in yoga group. Within Yoga group,
there was significant decrease in perceived stress (p = 0.001), anxiety (p
= 0.001), depression (p = 0.001), and negative affect (p = 0.03) while in
the control group there was reduction (p = 0.003) only in scores on
anxiety.
Conclusion Addition of yoga based relaxation to conventional post-CABG
cardiac rehabilitation helps in better management of risk factors in those
with abnormal baseline values and may help in preventing recurrence.
<15>
Accession Number
2014934983
Authors
Frigiola A. Bull C. Wray J.
Institution
(Frigiola, Bull, Wray) Great Ormond Street Hospital for Children, NHS
Trust, Great Ormond Street, London WC1N 3JH, United Kingdom
(Frigiola) Institute of Child Health, University College of London,
London, United Kingdom
Title
Exercise capacity, quality of life, and resilience after repair of
tetralogy of Fallot: A cross-sectional study of patients operated between
1964 and 2009.
Source
Cardiology in the Young. 24 (1) (pp 79-86), 2014. Date of Publication:
2014.
Publisher
Cambridge University Press
Abstract
Introduction Patients with repaired tetralogy of Fallot have good
long-term survival but less is known about the subjectively assessed
quality of life or objectively measured functional status of those who
have not required subsequent pulmonary valve replacement. We assessed
these parameters in a group of children and adults free from pulmonary
valve replacement after tetralogy of Fallot repair. Methods and results A
random sample of 50 subjects - 16 children and 34 adults, aged 4.1-56.7
years - who had undergone tetralogy of Fallot repair and were free from
subsequent pulmonary valve replacement underwent cardiopulmonary exercise
testing and completed standardised questionnaires assessing health-related
quality of life and resilience. Patients were generally asymptomatic
(median New York Heart Association class = I). Exercise capacity was
within two standard deviations of normal for most children and adults
(mean z VO2max: 0.20 + 1.5; mean z VE/VCO2: -0.9 + 1.3). Children reported
a total health-related quality of life score similar to healthy norms (78
+ 10 versus 84 + 1, p = 0.73). Adult survivors also reported quality of
life scores comparable to healthy norms. Resilience was highly correlated
with all domains of health-related quality of life (r = 0.713, p <
0.0001). Conclusions Patients who have undergone tetralogy of Fallot
repair in childhood and have not required pulmonary valve replacement have
a good long-term health-related quality of life. The finding that patients
with greater resilience had better health-related quality of life suggests
that it may be beneficial to implement interventions to foster resilience.
<16>
Accession Number
2014935601
Authors
Sa M.P.B.D.O. Ferraz P.E. Escobar R.R. Nunes E.O. Lustosa P. Vasconcelos
F.P. Lima R.C.
Institution
(Sa, Ferraz, Escobar, Nunes, Lustosa, Vasconcelos, Lima) Division of
Cardiovascular Surgery of Pronto Socorro Cardiologico de Pernambuco -
PROCAPE, Recife, Brazil
(Sa, Ferraz, Escobar, Nunes, Lustosa, Vasconcelos, Lima) University of
Pernambuco - UPE, Recife, Brazil
(Sa, Ferraz, Escobar, Lima) Research in Health Sciences of Faculty of
Medical Sciences and Biological Sciences Inst. (FCM/ICB), Recife, Brazil
Title
Patency of skeletonized versus pedicled internal thoracic artery in
coronary bypass graft surgery: A systematic review, meta-analysis and
meta-regression.
Source
International Journal of Surgery. 12 (7) (pp 666-672), 2014. Date of
Publication: 2014.
Publisher
Elsevier Ltd
Abstract
Background: It is suggested that the skeletonization harvesting technique
influences the patency rates of internal thoracic artery (ITA) after
coronary artery bypass graft (CABG) surgery in comparison to conventional
(pedicled) harvesting. We conducted a meta-analysis to determine whether
there is any difference between skeletonized versus pedicled ITA in terms
of patency after CABG. Methods: We performed a systematic-review using
MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and
reference lists of relevant articles to search for studies that performed
angiographic evaluation within the first two years after CABG between
these two groups until December 2013. The principal summary measures were
odds ratio (OR) with 95% Confidence Interval (CI) and P values
(statistically significant when <0.05). The OR's were combined across
studies using weighted DerSimonian-Laird random effects model and weighted
Mantel-Haenszel fixed effects. Meta-analysis, sensitivity analysis and
meta-regression were completed using the software Comprehensive
Meta-Analysis version 2 (Biostat Inc., Englewood, New Jersey). Results:
Five studies involving 1764 evaluated conduits (1145 skeletonized; 619
pedicled) met the eligibility criteria. There was no evidence for
important heterogeneity of effects among the studies. The overall OR (95%
CI) for graft occlusion showed no statistical significant difference
between groups (fixed effect model: OR 1.351, 95% CI 0.408 to 4.471,
P=0.801; random effect model: OR 1.351, 95% CI 0.408 to 4.471, P=0.801).
In sensitivity analysis, no difference regarding to left or right ITA was
also observed. In meta-regression, we observed no statistically
significant coefficients for graft occlusion and proportion of female,
diabetics, renal failure, age, off-pump surgery or urgency, which means
that the effect is not modulated by these factors. Conclusion: In terms of
patency, skeletonized ITA appears to be non-inferior in comparison to
pedicled ITA after CABG.
<17>
Accession Number
2014931791
Authors
Bielefeld K. O'Connor M.J. Collins R.T.
Institution
(Bielefeld, O'Connor, Collins) Department of Pediatric Cardiology, UAMS,
Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR 72202,
United States
Title
Primary purulent pericarditis and secondary endocarditis: A case report.
Source
Cardiology in the Young. 24 (3) (pp 563-566), 2014. Date of Publication:
2014.
Publisher
Cambridge University Press
Abstract
Purulent pericarditis is a rare diagnosis to be made. It is exceedingly
rare as a primary infection. We describe the case of an 18-month-old boy
who presented with primary purulent pericarditis and developed a secondary
endocarditis. Current literature on the subject is reviewed and discussed.
<18>
Accession Number
2014931554
Authors
Campbell F. Thokala P. Uttley L.C. Sutton A. Sutton A.J. Al-Mohammad A.
Thomas S.M.
Institution
(Campbell, Thokala, Uttley, Sutton, Thomas) School of Health and Related
Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
(Sutton) Department of Health Sciences, University of Leicester,
Leicester, United Kingdom
(Al-Mohammad, Thomas) Sheffield Teaching Hospitals, Sheffield, United
Kingdom
Title
Systematic review and modelling of the cost-effectiveness of cardiac
magnetic resonance imaging compared with current existing testing pathways
in ischaemic cardiomyopathy.
Source
Health Technology Assessment. 18 (59) (pp i-xxii+1-120), 2014. Date of
Publication: 2014.
Publisher
NIHR Journals Library
Abstract
Conclusions: All the diagnostic pathways are a cost-effective use of NHS
resources. Given the uncertainty in the mortality rates, the
cost-effectiveness analysis was performed using a set of scenarios. The
cost-effectiveness analyses suggest that CE CMR and revascularising
everyone were the optimal strategies. Future research should look at
implementation costs for this type of imaging service, provide guidance on
consistent reporting of diagnostic testing data for viability assessment,
and focus on the impact of revascularisation or best medical therapy in
this group of high-risk patients.
Background: Cardiac magnetic resonance imaging (CMR) is increasingly used
to assess patients for myocardial viability prior to revascularisation.
This is important to ensure that only those likely to benefit are
subjected to the risk of revascularisation.
Objectives: To assess current evidence on the accuracy and
cost-effectiveness of CMR to test patients prior to revascularisation in
ischaemic cardiomyopathy; to develop an economic model to assess
cost-effectiveness for different imaging strategies; and to identify areas
for further primary research.
Data sources: Databases searched were: MEDLINE including MEDLINE
In-Process & Other Non-Indexed Citations Initial searches were conducted
in March 2011 in the following databases with dates: MEDLINE including
MEDLINE In-Process & Other Non-Indexed Citations via Ovid (1946 to March
2011); Bioscience Information Service (BIOSIS) Previews via Web of Science
(1969 to March 2011); EMBASE via Ovid (1974 to March 2011); Cochrane
Database of Systematic Reviews via The Cochrane Library (1996 to March
2011); Cochrane Central Register of Controlled Trials via The Cochrane
Library 1998 to March 2011; Database of Abstracts of Reviews of Effects
via The Cochrane Library (1994 to March 2011); NHS Economic Evaluation
Database via The Cochrane Library (1968 to March 2011); Health Technology
Assessment Database via The Cochrane Library (1989 to March 2011); and the
Science Citation Index via Web of Science (1900 to March 2011). Additional
searches were conducted from October to November 2011 in the following
databases with dates: MEDLINE including MEDLINE In-Process & Other
Non-Indexed Citations via Ovid (1946 to November 2011); BIOSIS Previews
via Web of Science (1969 to October 2011); EMBASE via Ovid (1974 to
November 2011); Cochrane Database of Systematic Reviews via The Cochrane
Library (1996 to November 2011); Cochrane Central Register of Controlled
Trials via The Cochrane Library (1998 to November 2011); Database of
Abstracts of Reviews of Effects via The Cochrane Library (1994 to November
2011); NHS Economic Evaluation Database via The Cochrane Library (1968 to
November 2011); Health Technology Assessment Database via The Cochrane
Library (1989 to November 2011); and the Science Citation Index via Web of
Science (1900 to October 2011). Electronic databases were searched
March-November 2011.
Review methods: The systematic review selected studies that assessed the
clinical effectiveness and cost-effectiveness of CMR to establish the role
of CMR in viability assessment compared with other imaging techniques:
stress echocardiography, single-photon emission computed tomography
(SPECT) and positron emission tomography (PET). Studies had to have an
appropriate reference standard and contain accuracy data or sufficient
details so that accuracy data could be calculated. Data were extracted by
two reviewers and discrepancies resolved by discussion. Quality of studies
was assessed using the QUADAS II tool (University of Bristol, Bristol,
UK). A rigorous diagnostic accuracy systematic review assessed clinical
and cost-effectiveness of CMR in viability assessment. A health economic
model estimated costs and quality-adjusted life-years (QALYs) accrued by
diagnostic pathways for identifying patients with viable myocardium in
ischaemic cardiomyopathy with a view to revascularisation. The pathways
involved CMR, stress echocardiography, SPECT, PET alone or in combination.
Strategies of no testing and revascularisation were included to determine
the most cost-effective strategy.
Results: Twenty-four studies met the inclusion criteria. All were
prospective. Participant numbers ranged from 8 to 52. The mean left
ventricular ejection fraction in studies reporting this outcome was
24-62%. CMR approaches included stress CMR and late gadolinium-enhanced
cardiovascular magnetic resonance imaging (CE CMR). Recovery following
revascularisation was the reference standard. Twelve studies assessed
diagnostic accuracy of stress CMR and 14 studies assessed CE CMR. A
bivariate regression model was used to calculate the sensitivity and
specificity of CMR. Summary sensitivity and specificity for stress CMR was
82.2% [95% confidence interval (CI) 73.2% to 88.7%] and 87.1% (95% CI
80.4% to 91.7%) and for CE CMR was 95.5% (95% CI 94.1% to 96.7%) and 53%
(95% CI 40.4% to 65.2%) respectively. The sensitivity and specificity of
PET, SPECT and stress echocardiography were calculated using data from 10
studies and systematic reviews. The sensitivity of PET was 94.7% (95% CI
90.3% to 97.2%), of SPECT was 85.1% (95% CI 78.1% to 90.2%) and of stress
echocardiography was 77.6% (95% CI 70.7% to 83.3%). The specificity of PET
was 68.8% (95% CI 50% to 82.9%), of SPECT was 62.1% (95% CI 52.7% to
70.7%) and of stress echocardiography was 69.6% (95% CI 62.4% to 75.9%).
All currently used diagnostic strategies were cost-effective compared with
no testing at current National Institute for Health and Care Excellence
thresholds. If the annual mortality rates for non-viable patients were
assumed to be higher for revascularised patients, then testing with CE CMR
was most cost-effective at a threshold of 20,000/QALY. The proportion of
model runs in which each strategy was most cost-effective, at a threshold
of 20,000/QALY, was 40% for CE CMR, 42% for PET and 16.5% for
revascularising everyone. The expected value of perfect information at
20,000/QALY was 620 per patient. If all patients (viable or not) gained
benefit from revascularisation, then it was most cost-effective to
revascularise all patients.
Limitations: Definitions and techniques assessing viability were highly
variable, making data extraction and comparisons difficult. Lack of
evidence meant assumptions were made in the model leading to uncertainty;
differing scenarios were generated around key assumptions.
<19>
Accession Number
2014935565
Authors
Alexander S. Doukky R.
Institution
(Alexander, Doukky) Division of Cardiology, Rush University Medical
Center, Chicago, IL, United States
(Doukky) Division of Cardiology, John H. Stroger, Jr. Hospital of Cook
County, 1901 W. Harrison St., Chicago, IL 60612, United States
Title
Effective Risk Stratification of Patients on the Basis of Myocardial
Perfusion SPECT Is Dependent on Appropriate Patient Selection.
Source
Current Cardiology Reports. 17 (1) , 2014. Date of Publication: 2014.
Publisher
Current Medicine Group LLC 1
Abstract
Myocardial perfusion imaging (MPI) with single-photon emission computed
tomography (SPECT) is commonly used in risk assessment, as an abnormal
scan predicts a multifold increase in cardiac risk. Recent studies have
showed that application of the appropriate use criteria (AUC) sharpens the
prognostic value of SPECT-MPI, while inappropriate use is clinically
ineffective and may lead to unnecessary downstream invasive testing and
revascularization procedures. In this review, we will discuss recent
literature examining the impact of appropriate use on the prognostic value
of SPECT-MPI and downstream decision-making. We will also discuss the
implications of appropriate use on cost-effectiveness of MPI.
<20>
[Use Link to view the full text]
Accession Number
71707642
Authors
Srivali N. Cheungpasitporn W. Thongprayoon C. Edmonds P. O'Corragain O.
Kittanamongkolchai W. Brabec B. Erickson S.
Institution
(Srivali) Division of Pulmonary and Critical Care Medicine, Mayo Clinic,
Rochester, MN, United States
(Cheungpasitporn, Thongprayoon, Kittanamongkolchai, Brabec, Erickson)
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN,
United States
(Edmonds) SUNY Upstate Medical University, Syracuse, NY, United States
(O'Corragain) University College Cork, Cork, Ireland
Title
Hydration for contrast-induced acute kidney injury prevention: A
meta-analysis.
Source
Critical Care Medicine. Conference: Critical Care Congress 2015 Phoenix,
AZ United States. Conference Start: 20150117 Conference End: 20150121.
Conference Publication: (var.pagings). 42 (12 SUPPL. 1) (pp A1585), 2014.
Date of Publication: December 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: The reports on efficacy of oral hydration compared to
intravenous hydration for the prevention of contrast-induced acute kidney
injury (CIAKI) in radiological procedures and cardiac catheterization
remains controversial. The objective of this meta-analysis was to assess
the efficacy of these hydration regimens for prevention of CIAKI. Methods:
Comprehensive literature searches for randomized controlled trials (RCTs)
of outpatient oral hydration treatment was performed using MEDLINE,
EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register
of Controlled Trials Systematic Reviews and clinicaltrials.gov from
inception until July 4th, 2014. Primary outcome was the incidence of
CIAKI. Results: Three prospective RCTs were included in our analysis. Of
242 patients undergoing procedures with contrast exposures, 22 patients
(9%) had CIAKI. These 3 RCTs, however, included only patients with
relatively normal kidney function to CKD stage 3 and excluded those who
had contrast exposure for urgent indications. There was no significant
increased risk of CIAKI in oral fluid regimen group compared to IV fluid
regimen group (RR = 1.83, 95% CI = 0.41-8.21). Conclusions: According to
our analysis, there is no evidence that oral fluid regimen is associated
with more risk of CIAKI in patients with contrast exposures compared to IV
fluid regimen. This finding suggests that the oral fluid regimen is a
possible treatment option for CIAKI prevention in non-urgent procedures in
patients with normal to moderately reduced kidney function.
<21>
[Use Link to view the full text]
Accession Number
71706902
Authors
Cholette J. Rubenstein J. Henrichs K. Powers K. Daugherty L. Swartz M.
Alfieris G. Blumberg N.
Institution
(Cholette, Rubenstein, Henrichs, Powers, Daugherty, Swartz, Alfieris,
Blumberg) University of Rochester, Rochester, NY, United States
Title
Results of a restrictive V. liberal transfusion strategy in neonatal and
infant cardiac surgery.
Source
Critical Care Medicine. Conference: Critical Care Congress 2015 Phoenix,
AZ United States. Conference Start: 20150117 Conference End: 20150121.
Conference Publication: (var.pagings). 42 (12 SUPPL. 1) (pp A1407), 2014.
Date of Publication: December 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: The purpose of this study is to determine if a
restrictive transfusion strategy is tolerated in neonates and infants
requiring surgical palliation or repair for congenital heart disease. We
hypothesized that a restrictive red cell transfusion strategy would
decrease red cell transfusions without affecting arterial lactate or
clinical outcomes. Methods: A prospective, randomized, non-inferiority
controlled clinical trial of infants'< 10kg with congenital heart disease
following surgery randomized to a restrictive v. liberal transfusion
strategy. Restrictive group: red cells were transfused for any hemoglobin
(Hb) < 7.0 g/dL for biventricular repair, or <9.0 g/dl for palliative
procedure. Liberal group: red cells were transfused for any Hb < 9.5 g/dL
for repair; or <12 g/dl for palliation. Primary endpoint was LacTime (%
time arterial lactate > 4.0 mmol/L). Secondary endpoints were Hb,
transfusion and clinical outcome data. Results: Of 162 infants studied; 72
(44%) were neonates. Mean age was 100 + 127 days; mean weight was 4.7 +
1.8 kg. Pre and intra-op characteristics were similar between groups. The
restrictive group received fewer RBC transfusions and exposures than the
liberal group (p < 0.001). 56 infants underwent palliative procedures (29
restrictive; 27 liberal) and 106 (52 restrictive; 54 liberal) underwent
biventricular repair. For palliated subjects the restricted group had
lower Hb levels [10.9 + 0.4 v. 13.7 + 0.3 g/dl (p < 0.001)] without a
significant difference in LacTime [4.0% v. 2.6% (p = 0.59)]. Similarly,
biventricular subjects in the restrictive group had lower Hb levels [9.4 +
0.9 v. 11.8 + 0.9 g/dl (p < 0.001)] with no significant difference in
LacTime [0.05% v. 0.8% (p=0.29)]. There were no clinical outcome
differences between groups. 5 subjects required ECMO (2 restrictive, 3
liberal). 30 day survival was 96%; 5 of 6 deaths (83%) (p = 0.21) occurred
in the liberal group. Conclusions: Despite their medical complexity,
neonates and infants undergoing cardiac surgical palliations and repairs
can be managed safely with a restrictive transfusion strategy.
<22>
Accession Number
71706091
Authors
Gianluigi Savarese G. Paolillo S. Costanzo P. Musella F. Marsico F.
Perrone-Filardi P.
Institution
(Gianluigi Savarese, Paolillo, Costanzo, Musella, Marsico,
Perrone-Filardi) University of Naples Federico II, Dpt of Clinical
Medicine, Cardiovascular and Immunological Science, Naples, Italy
Title
Does 6-minute walk test predict clinical events in pulmonary arterial
hypertension? A meta-analysis of 22 studies.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2013
Rome Italy. Conference Start: 20130418 Conference End: 20130420.
Conference Publication: (var.pagings). 20 (1 SUPPL. 1) (pp S106), 2013.
Date of Publication: April 2013.
Publisher
SAGE Publications Inc.
Abstract
Purpose: 6-minute walking distance (6MWD) is usually used as end-point in
clinical trials to assess the benefit of therapies in patients with
pulmonary arterial hypertension (PAH). The aim of this study was to verify
whether improvement in 6MWD is associated with reduced incidence of
clinical outcomes in PAH. Methods: MEDLINE, Cochrane databases, ISI Web of
Science and SCOPUS databases were searched for articles about PAH
treatment until August 2011. All randomized trials assessing functional
capacity by 6MWD at baseline and at end of follow-up and including
clinical endpoints (all-cause death, hospitalization for PAH and/or lung
or heart-lung transplantation, initiation of PAH rescue therapy) were
included in meta-analysis. Meta-analysis was performed to assess the
influence of treatments on outcomes. Meta-regression analysis was
performed to test the relationship between 6MWD changes and outcomes. The
influence of baseline patients' characteristics, 6MWD at baseline, Detsky
quality score, follow-up and study publication year were also explored.
Macaskill's modified test was used to assess the presence of publication
bias. Results: 22 trials enrolling 3,112 participants were included.
Active treatments led to significant reduction in the risk of all-cause
death (odds ratio [OR]:0.429; 95% confidence interval [CI]:0.277 to 0.664;
comparison (c) p<0.01; heterogeneity (h) p=0.796), hospitalization for PAH
and/or lung or heart-lung transplantation (OR:0.442; CI:0.309 to 0.632; c
p<0.01; h p=0.838), initiation of PAH rescue therapy (OR:0.555; CI:0.347
to 0.889; c p=0.01; h p=0.648) and composite outcome (OR:0.400; CI:0.313
to 0.510; c p<0.01; h p=0.345). In meta-regression analysis, no
relationship between 6MWD changes from baseline to end of follow-up and
outcomes was detected. No confounding variable influenced the relationship
between changes in 6MWD and outcomes. No publication bias was detected.
Conclusions: in patients with PAH, improvement in 6MWD, induced by
pharmacological treatment, does not reflect reduction in clinical
outcomes.
<23>
Accession Number
71706001
Authors
De Vecchis R. Cioppa C. Fusco A. Giasi A. Ariano C. Cantatrione S.
Institution
(De Vecchis, Cioppa, Fusco, Giasi, Ariano, Cantatrione) Cardiology Unit,
Presidio Sanitario Intermedio Elena d'Aosta, Naples, Italy
Title
The issue whether it is feasible that progression of non-rheumatic aortic
valve stenosis is retarded using statins: A meta-analysis.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2013
Rome Italy. Conference Start: 20130418 Conference End: 20130420.
Conference Publication: (var.pagings). 20 (1 SUPPL. 1) (pp S83), 2013.
Date of Publication: April 2013.
Publisher
SAGE Publications Inc.
Abstract
Purpose: To synthesize by metaanalysis the findings of recent experimental
studies focusing on possible therapeutic effectiveness of statins for
non-rheumatic calcific aortic stenosis (AS). Methods: Observational
studies and randomized controlled trials (RCTs) were selected from Pubmed
database to evaluate the hemodynamic progression of AS in statin treated
patients compared to controls (i.e. patients with AS taking placebo or no
treatment). The endpoints were the annualized changes in one or more of
the following ultrasonographic measures: peak aortic valve jet
velocity(PV), peak aortic valve pressure gradient(PG), mean aortic valve
pressure gradient(MG), aortic valve area (AVA). For estimating the overall
effect of statin therapy on each of the abovementioned continuous
variables across the considered studies, we used the weighted mean
difference (WMD) as effect size measure. In addition, we calculated the
Odds of aortic valve replacement surgery and cardiovascular death in both
patients statintreated and controls for subsequently estimating the
pertaining Odds ratios (ORs). Results: Nine studies were selected. Less
annualized increase in PV was found in statin-treated patients compared to
controls (overall WMD: -0.09 m/sec/year, 95%CI:-0.16, -0.01 p=0.018).
Similarly, smaller annualized increase in PG was found in the statin group
(overall WMD: - 2.04 mm Hg/year 95%CI: -3.56, -0.52 p=0.0085).However the
overall effects in statin -treated patients on both annualized increases
in MG and decreases in AVA were not significantly different from those
found in controls. Moreover, there was no significant difference in
cardiovascular outcomes in the statin groups compared to placebo groups in
each of the 3 analyzed RCTs and overall. Conclusions: Significant benefit
by statin therapy in retarding hemodynamic deterioration was identified by
favorable effects concerning annualized changes in PV and PG; on the
contrary, in statin- treated patients with AS no significant improvement
was found for annualized changes in MG and AVA and clinical outcomes.
<24>
Accession Number
71705847
Authors
Alban Dibra A. Pavli E. Dibra L. Xhepa S.
Institution
(Alban Dibra, Pavli, Dibra, Xhepa) University Hospital Center Nene Tereza,
Tirana, Albania
Title
Stenting versus coronary bapass artery grafting for proximal left anterior
descending artery disease: Meta-analysis of randomized trials in the
drug-eluting stent era.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2013
Rome Italy. Conference Start: 20130418 Conference End: 20130420.
Conference Publication: (var.pagings). 20 (1 SUPPL. 1) (pp S44), 2013.
Date of Publication: April 2013.
Publisher
SAGE Publications Inc.
Abstract
Purpose: The choice of revascularization strategy for proximal disease of
left anterior descending artery remains a matter of debate. There is
limited evidence on the relative performance of coronary artery bypass
surgery (CABG) versus stenting with bare metal or drug-eluting stents (BMS
or DES). Methods: We performed e meta-analysis of randomized trials
comparing coronary angioplasty with implantation of BMS or DES with CABG.
Seven trials reporting outcome data for a minimum of 6 months with a total
population of 1074 patients were selected for this analysis. DESs were
used in two of the trials with 319 patients. Patients were followed up
from a minimum of 6 months up to 5 years. The main outcome of interest was
the occurrence of major adverse cardiac events (MACE) defined as death,
myocardial infarction or repeat revascularization. Other outcomes of
interest were death, myocardial infarction and need for repeat
revascularization as individual endpoints. Results: The odds of incurring
a major adverse cardiac event were markedly higher with DES compared to
CAGB (OR 2.24, 95% CI: 1.59 to 3.15, p<0.001). This difference was
entirely explained by the superiority of CABG versus stenting regarding
the need for repeat revascularization procedures (OR 3.71, 95% CI: 2.31 to
5.97, p<0.001). However, the difference between stenting and CABG was no
longer observed when the analysis was confined to trials using DES (p=0.25
for MACE and p=0.63 for repeat revascularisation). On the other hand,
there were no differences between patients treated with DES versus CABG
regarding the odds of death (OR 0.70, 95% CI: 0.35 to 1.40, p=0.31) or
myocardial infarction (OR 0.76, 95% CI: 0.37 to 1.56, p=0.45).
Conclusions: Coronary artery bypass grafting is superior to stent
implantation for treatment of proximal disease of left anterior descending
artery. However, the superiority might be lost in patients undergoing DES
implantation.
<25>
Accession Number
71706458
Authors
Frederix I. Hansen D. Bonne K. Alders T. Van Driessche N. Berger J.
Dendale P.
Institution
(Frederix) Catholic University of Leuven, Leuven, Belgium
(Hansen, Bonne, Alders, Berger) Virga Jesse Hospital, Rehabilitation and
Health Centre, Hasselt, Belgium
(Van Driessche) Hasselt University, Hasselt, Belgium
(Dendale) Jessa Hospital, Hasselt, Belgium
Title
The value of telerehabilitation in encouraging coronary artery disease
patients to stay active after the acute rehabilitation phase.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2012
Dublin Ireland. Conference Start: 20120503 Conference End: 20120505.
Conference Publication: (var.pagings). 19 (1 SUPPL. 1) (pp S61), 2012.
Date of Publication: May 2012.
Publisher
SAGE Publications Inc.
Abstract
Purpose: The aim of this study was to evaluate whether the addition of a
motion sensor with automated feed-back by SMS to the conventional
rehabilitation program could result in an increase in daily activity among
coronary artery disease patients. Methods: 20 coronary artery disease
patients were included in this randomized, controlled trial after
admission for percutaneous coronary intervention or coronary artery bypass
grafting (target population of the study n=80). All patients were included
during phase II of the cardiac rehabilitation program. Patients with a
defibrillator, important arrhythmias or severe heart failure (NYHA class
III and IV) were excluded from the trial. The patients in the intervention
group (n=14) were asked to wear the motion sensor continuously during the
day for 6 weeks. Each week they uploaded their step data on the web and
received new step goals for the next week. The feed-back program was
designed to gradually increase the patients' activity level. In the
control group (n=6), the patients wore the motion sensor two times for one
week for measurement purposes only (week 1 and 6). All patients performed
a maximal cardiopulmonary exercise test at week 1 and 6 to determine their
peak oxygen uptake (VO2 peak). The primary hypothesis of the trial was
that the addition of a telerehabilitation program to the conventional
cardiac rehabilitation program results in a sustained, increased amount of
daily activity outside the rehabilitation centre. The secondary hypothesis
was that this also would translate into a greater increase in oxygen
uptake peak. The Wilcoxon and Mann-Whitney test were used to test these
hypotheses. Results: For the intervention patients, the Wilcoxon test
showed a significant increase in daily activity between week 1 and week 6
(P=0.0009) and a significant increase in oxygen uptake peak (P=0.0098). In
the control group, the respective P values were 0.219 and 0.375. The
Mann-Whitney test comparing the increase in walking steps from week 1 to
week 6 between the intervention and control group did also show a trend
toward larger increase in the intervention group (P=0.054). Conclusions:
The addition of an internet-based telerehabilitation program to
conventional cardiac rehabilitation resulted in a significant increase in
daily activity level and oxygen uptake peak after 6 weeks, as compared to
conventional rehabilitation alone. This observation was promising, because
it has proven difficult to encourage cardiac patients to stay active or to
increase their daily physical activity level. An internet-based
telerehabilitation intervention that uses motion sensors might be a
valuable instrument to overcome this difficulty.
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