Results Generated From:
Embase <1980 to 2015 Week 26>
Embase (updates since 2015-06-18)
Embase <1980 to 2015 Week 26>
Embase (updates since 2015-06-18)
<1>
Accession Number
2012688636
Authors
Romeo S. Maglio C. Burza M.A. Pirazzi C. Sjoholm K. Peltonen M. Svensson
P.-A. Sjostrom Lars Carlsson L.M.S.
Institution
(Romeo, Maglio, Burza, Pirazzi, Sjoholm, Jacobson, Svensson, Sjostrom,
Carlsson) Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
(Peltonen) Chronic Disease Epidemiology and Prevention Unit, Department of
Chronic Disease Prevention, National Institute for Health and Welfare,
Helsinki, Finland
Title
Cardiovascular events after bariatric surgery in obese subjects with type
2 diabetes.
Source
Diabetes Care. 35 (12) (pp 2613-2617), 2012. Date of Publication: 01 Dec
2012.
Publisher
American Diabetes Association Inc.
Abstract
OBJECTIVE - Obese individuals with type 2 diabetes have an increased risk
of cardiovascular disease. The effect of bariatric surgery on
cardiovascular events in obese individuals with type 2 diabetes remains to
be determined. The Swedish Obese Subjects (SOS) study is a prospective,
controlled intervention study that examines the effects of bariatric
surgery on hard end points. The aim of the present study was to examine
the effect of bariatric surgery on cardiovascular events in the SOS study
participants with type 2 diabetes. RESEARCH DESIGN AND METHODS - All SOS
study participants with type 2 diabetes at baseline were included in the
analyses (n = 345 in the surgery group and n = 262 in the control group).
Mean follow-up was 13.3 years (interquartile range 10.2-16.4) for all
cardiovascular events. RESULTS - Bariatric surgery was associated with a
reduced myocardial infarction incidence (38 events among the 345 subjects
in the surgery group vs. 43 events among the 262 subjects in the control
group; log-rank P = 0.017; adjusted hazard ratio [HR] 0.56 [95% CI
0.34-0.93]; P = 0.025). No effect of bariatric surgery was observed on
stroke incidence (34 events among the 345 subjects in the surgery group
vs. 24 events among the 262 subjects in the control group; log-rank P =
0.852; adjusted HR 0.73 [0.41-1.30]; P = 0.29). The effect of surgery in
reducing myocardial infarction incidence was stronger in individuals with
higher serum total cholesterol and triglycerides at baseline (interaction
P value = 0.02 for both traits). BMI (interaction P value = 0.12) was not
related to the surgery outcome. CONCLUSIONS - Bariatric surgery reduces
the incidence of myocardial infarction in obese individuals with type 2
diabetes. Preoperative BMI should be integrated with metabolic parameters
to maximize the benefits of bariatric surgery. © 2012 by the American
Diabetes Association.
<2>
Accession Number
2015130973
Authors
Lee S. Lee S.H. Chang B.-C. Shim J.-K.
Institution
(Lee, Lee, Chang) Department of Thoracic and Cardiovascular Surgery,
Cardiovascular Research Institute, Yonsei University College of Medicine,
Seoul, South Korea
(Shim) Department of Anesthesiology and Pain Medicine, Anesthesia and Pain
Research Institute, Yonsei University College of Medicine, Seoul, South
Korea
Title
Efficacy of goal-directed therapy using bioreactance cardiac output
monitoring after valvular heart surgery.
Source
Yonsei Medical Journal. 56 (4) (pp 913-920), 2015. Date of Publication: 01
Jul 2015.
Publisher
Yonsei University College of Medicine
Abstract
Purpose: We compared the efficacy of postoperative hemodynamic
goal-directed therapy (GDT) using a pulmonary artery catheter (PAC) and
bioreactance-based noninvasive cardiac output monitoring (NICOM) in
patients with atrial fibrillation undergoing valvular heart surgery.
Materials and Methods: Fifty eight patients were randomized into two
groups of GDT with common goals to maintain a mean arterial pressure of
60-80 mm Hg and cardiac index >2 L/min/m<sup>2</sup>: the PAC group
(n=29), based on pulmonary capillary wedge pressure, and the NICOM group
(n=29), based on changes in stroke volume index after passive leg raising.
The primary efficacy variable was length of hospital stay. Secondary
efficacy variables included resource utilization including vasopressor and
inotropic requirement, fluid balance, and major morbidity endpoints.
Results: Patient characteristics and operative data were similar between
the groups, except that significantly more patients underwent double valve
replacement in the NICOM group. The lengths of hospital stay were not
different between the two groups (12.2+/-4.8 days vs. 10.8+/-4.0 days,
p=0.239). Numbers of patients requiring epinephrine (5 vs. 0, p=0.019) and
ventilator care >24 h (6 vs. 1, p=0.044) were significantly higher in the
PAC group. The PAC group also required significantly larger amounts of
colloid (1652+/-519 mL vs. 11430+/-463 mL, p=0.004). Conclusion:
NICOM-based postoperative hemodynamic GDT showed promising results in
patients with atrial fibrillation undergoing valvular heart surgery in
terms of resource utilization.
<3>
Accession Number
2015125365
Authors
Aydin U. Yilmaz M. Duzyol C. Ata Y. Turk T. Orhan A.L. Kocogullari C.U.
Institution
(Aydin, Ata, Turk) Department of Cardiovascular Surgery, Bursa Yuksek
Ihtisas Education and Research Hospital, Bursa, Turkey
(Yilmaz, Orhan) Departments of Anesthesiology, Kocaeli Derince Education
and Research Hospital, Kocaeli, Turkey
(Duzyol, Kocogullari) Departments of Cardiovascular Surgery, Kocaeli
Derince Education and Research Hospital, Kocaeli, Turkey
Title
Efficiency of postoperative statin treatment for preventing new-onset
postoperative atrial fibrillation in patients undergoing isolated coronary
artery bypass grafting: A prospective randomized study.
Source
Anadolu Kardiyoloji Dergisi. 15 (6) (pp 491-495), 2015. Date of
Publication: 01 Jun 2015.
Publisher
AVES Ibrahim Kara (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey. E-mail: info@avesyayincilik.com)
Abstract
Objective: Recent studies have demonstrated that preoperative statin
therapy reduces the incidence of postoperative atrial fibrillation (AF).
The objective of this study was to assess the efficacy of statin therapy
started in the early postoperative period for the prevention from
new-onset AF after isolated coronary artery bypass grafting (CABG).
Methods: This prospective and randomized study consisted of 60 consecutive
patients who underwent elective isolated CABG. Patients were divided into
two groups to examine the influence of statins: those with postoperative
statin therapy (statin group, n=30) and those without it (non-statin
group, n=30). Patient data were collected and analyzed prospectively. In
the statin group, each extubated patient was given 40 mg of atorvastatin
per day, starting from an average of 6 hours after the operation. Results:
The overall incidence of postoperative AF was 30%. Postoperative AF
occurred in 5 patients (16.7%) in the statin group. This was significantly
lower compared with 13 patients (43.3%) in the non-statin group (p=0.049).
According to the multivariate analysis, postoperative atorvastatin reduced
the risk of postoperative AF by 49% [odds ratio (OR) 0.512, 95% confidence
interval (CI) 0.005 to 0.517, p=0.012]. Also, age was an independent
predictor of postoperative AF (OR 1.299, 95% CI 1.115 to 1.514, p=0.001).
Conclusion: Postoperative statin therapy seems to reduce new-onset AF
after isolated CABG in our study.
<4>
Accession Number
2015129773
Authors
Yanartas M. Baysal A. Aydin C. Ay Y. Kara I. Aydin E. Cevirme D. Koksal C.
Sunar H.
Institution
(Yanartas, Aydin, Cevirme, Koksal, Sunar) Cardiovascular Surgery Clinic,
Kartal Kosuyolu High, Speciality Training and Research Hospital, Istanbul,
Turkey
(Baysal) Anesthesiology and Reanimation Clinic, Kartal Kosuyolu High,
Speciality Training and Research Hospital, Istanbul, Turkey
(Aydin, Ay) Cardiovascular Surgery Clinic, Istanbul, Turkey
(Kara) Cardiovascular Surgery Clinic, Sakarya, Turkey
Title
The effects of tranexamic acid and 6% hydroxyethyl starch (HES) solution
(130/0.4) on postoperative bleeding in coronary artery bypass graft (CABG)
surgery.
Source
International Journal of Clinical and Experimental Medicine. 8 (4) (pp
5959-5971), 2015. Date of Publication: 30 Apr 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Background: The addition of 6% hydroxyethyl starch (HES) into Ringer
lactate priming solution may have adverse effects on hemostasis in
patients undergoing coronary artery bypass grafting (CABG) with
cardiopulmonary bypass (CPB) with or without the use of tranexamic acid.
Methods: In a prospective, randomized clinical trial, 132 patients were
assigned to receive 20 ml/kg of Ringer priming solution with or without
tranexamic acid (TA) (Group RS-TA, n=34 and Group RS-noTA, n=32) or 10
ml/kg of 6% HES plus 10 ml/kg of RS priming solution with or without
intravenous tranexamic acid (Group HES-TA, n=35 and Group HES-noTA, n=31).
Estimated blood loss, chest tube drainage, amount of blood products,
hemoglobin, hematocrit, platelet and coagulation parameters were examined
before and 24 hour after surgery. Results: For Group HES with tranexamic
acid, when compared to other groups, estimated blood loss, postoperative
24 hour drainage loss and blood product transfusions were less (P=0.023;
P=0.003; P=0.001; respectively) and hemoglobin, hematocrit values at 12
and 24 hours after surgery increased in comparison to other groups
(P=0.041, P=0.034, P=0.004, P=0.001; respectively). Platelet
concentrations were similar between groups (P>0.05). Conclusions: In CABG,
the administration of tranexamic acid in HES 130/0.4 prime solution study
group decreased estimated blood loss and chest tube drainage in comparison
to patients receving Ringer prime solution with or without tranexamic acid
postoperatively however, no effects on renal functions or postoperative
complications were shown.
<5>
Accession Number
2015920718
Authors
Taggart D.P. Ben Gal Y. Lees B. Patel N. Webb C. Rehman S.M. Desouza A.
Yadav R. De Robertis F. Dalby M. Banning A. Channon K.M. Di Mario C. Orion
E.
Institution
(Taggart, Rehman) Nuffield Department of Surgery, University of Oxford,
John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
(Ben Gal) Department of Cardiothoracic Surgery, Tal Aviv Sourasky Medical
Center, Tel Aviv University, Tel Aviv, Israel
(Lees) Clinical Trials and Evaluation Unit, Royal Brompton and Harefield
NHS Foundation Trust, London, United Kingdom
(Patel, Banning, Channon) Department of Cardiovascular Medicine,
University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
(Webb, Di Mario) Department of Cardiology, Royal Brompton Hospital,
London, United Kingdom
(Desouza, Yadav) Department of Cardiothoracic Surgery, Royal Brompton
Hospital, London, United Kingdom
(De Robertis) Department of Cardiothoracic Surgery, Harefield Hospital,
Middlesex, London, United Kingdom
(Dalby) Department of Cardiology, Harefield Hospital, Middlesex, London,
United Kingdom
(Orion) Vascular Graft Solutions Ltd, Tel Aviv, Israel
Title
A randomized trial of external stenting for saphenous vein grafts in
coronary artery bypass grafting.
Source
Annals of Thoracic Surgery. 99 (6) (pp 2039-2045), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Elsevier USA
Abstract
Background External stents inhibit saphenous vein graft (SVG) intimal
hyperplasia in animal studies. We investigated whether external stenting
inhibits SVG diffuse intimal hyperplasia 1 year after coronary artery
bypass graft surgery. Methods Thirty patients with multivessel disease
undergoing coronary artery bypass graft surgery were enrolled. In addition
to an internal mammary artery graft, each patient received one external
stent to a single SVG randomly allocated to either the right or left
coronary territories; and one or more nonstented SVG served as the
control. Graft patency was confirmed at the end of surgery in all
patients. The primary endpoint was SVG intimal hyperplasia (mean area)
assessed by intravascular ultrasonography at 1 year. Secondary endpoints
were SVG failure, ectasia (>50% initial diameter), and overall uniformity
as judged by Fitzgibbon classification. Results One-year follow-up
angiography was completed in 29 patients (96.6%). All internal mammary
artery grafts were patent. Overall SVG failure rates did not differ
significantly between the two groups (30% stented versus 28.2% nonstented
SVG, p = 0.55). The SVG mean intimal hyperplasia area, assessed in 43
SVGs, was significantly reduced in the stented group (4.37 +/- 1.40
mm<sup>2</sup>) versus nonstented group (5.12 +/- 1.35 mm<sup>2</sup>, p =
0.04). In addition, stented SVGs demonstrated marginally significant
improvement in lumen uniformity (p = 0.08) and less ectasia (6.7% versus
28.2%, p = 0.05). There was some evidence that ligation of side branches
with metallic clips increased SVG failure in the stented group.
Conclusions External stenting has the potential to improve SVG lumen
uniformity and reduce diffuse intimal hyperplasia 1 year after coronary
artery bypass graft surgery.
<6>
Accession Number
2015902000
Authors
Altarabsheh S.E. Deo S.V. Hang D. Haddad O.K. Cho Y.H. Markowitz A.H. Park
S.J.
Institution
(Altarabsheh, Deo, Haddad) Department of Cardiovascular Surgery, Queen
Alia Heart Institute, Amman, Jordan
(Markowitz, Park) Division of Cardiovascular Surgery, Case Western Reserve
University, Cleveland, OH, United States
(Hang) School of Medicine, Case Western Reserve University, Cleveland, OH,
United States
(Cho) Division of Cardiovascular Surgery, Samsung Hospital, Sungkyunkwang
School of Medicine, Seoul, South Korea
Title
Coronary artery bypass grafting after percutaneous intervention has higher
early mortality: A meta-analysis.
Source
Annals of Thoracic Surgery. 99 (6) (pp 2046-2052), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Elsevier USA
Abstract
Background We compared early adverse events and midterm survival between
primary coronary artery bypass grafting (pCABG) and CABG in patients with
percutaneous intervention (secondary CABG, sCABG) because data on this
topic are very limited. Methods A systematic review of published
literature was done to obtain original studies fulfilling the search
criteria. The end points studied were early mortality, stroke, renal
failure, myocardial infarction, and the need for an intra-aortic balloon
pump. A random-effect inverse variance weighted analysis was performed.
The results are presented as risk ratios (RR) (95% confidence interval); p
< 0.05 was considered statistically significant. Results Fourteen studies
(84,983 pCABG patients and 14,775 sCABG patients) were included in the
systematic review. Early mortality was lower with primary CABG (RR 1.54
[1.19-2]; p = 0.007). The incidence of myocardial infarction was also less
with pCABG than with sCABG. (RR 1.46 [1.04-2.06]; p = 0.06). Patients
undergoing pCABG were 14% (0% to 55%; p = 0.04). Less likely to need an
intra-aortic balloon pump. Although renal failure was lower with pCABG (RR
1.254 [1.047-1.502]; p = 0.014), the stroke rates were comparable in both
cohorts (p = 0.95). Renal failure was favorable in the primary CABG
cohort. Early stroke was comparable between the two cohorts (p = 0.95).
The pooled hazard ratios demonstrated comparable survival at the end of 3
years (p = 0.36). Conclusions Patients undergoing CABG after prior
percutaneous therapy have a higher incidence of myocardial infarction and
mortality in the postoperative period. However, midterm survival is
comparable in both cohorts.
<7>
Accession Number
2015726639
Authors
Fitzgerald D.C. Holmes S.D. St. Onge J.R. Ioanou C. Martin L.M. Ad N.
Institution
(Fitzgerald, Holmes, St. Onge, Ioanou, Martin, Ad) Division of
Cardiothoracic Surgery, Department of Cardiovascular Perfusion, Inova
Fairfax Hospital, 3300 Gallows Rd, Falls Church, VA 22042, United States
Title
Systemic inflammatory response during cardiac surgery: A pilot study.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 10 (2) (pp 125-132), 2015. Date of Publication: 04 Mar 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: There is a growing body of evidence indicating that
perioperative fluid management during cardiac surgery influences patient
care and outcome. The choice of fluid therapy and the degree of systemic
inflammatory response triggered during surgery control the effects of
tissue edema formation and end-organ function. As such, "goal-directed"
fluid resuscitation protocols that measure colloid osmotic pressure (COP)
may promote improvements in patient morbidity and mortality. Methods:
Thirty patients scheduled for primary coronary artery bypass grafting were
prospectively randomized for perioperative fluid treatment under COP
guidance [albumin (ALB), n = 17] or conventional fluid protocols without
COP support (control, n = 13). Wholeblood samples were drawn at four
different time intervals including (A) anesthesia induction, (B) 10
minutes after the initiation of cardiopulmonary bypass, (C) at the
completion of sternal skin approximation, and (D) 3 hours after admission
to the cardiac intensive care unit. Interleukin 6 (IL-6) and IL-8 were
measured by immunometric, enzyme-linked immunosorbent assays as well as
C-reactive protein. Colloid osmotic pressure values were measured using a
colloid osmometer. Results: As compared with conventional fluid protocols,
the patients treated in the intervention (ALB) group received
significantly less total perioperative fluid [7893.6 (1874.5) vs 10,754.8
(2403.9), P = 0.001], and this relationship remained after controlling for
age, sex, and The Society of Thoracic Surgeons risk score (beta = -0.5, t
= -3.1, P =0.005). Colloid osmotic pressure values were significantly
higher in the ALB group at time point D after surgery (P = 0.03). There
were no significant differences in IL-6, IL-8, and C-reactive protein
values between the groups at any of the time blood draw intervals.
Perioperative outcomes were evaluated by treatment group. For both groups,
the incidence of perioperative morbidity was low and did not differ by
treatment group. Conclusions: The use of COP-guided fluid resuscitation
was associated with a significant reduction in perioperative fluid demand.
However, patients prescribed toCOP-guided fluid therapy did not experience
a reduction in whole-body inflammation or improved surgical outcome as
compared with conventional fluid management techniques.
<8>
Accession Number
2015129792
Authors
Faritus S.Z. Khazaee-Koohpar M. Ziyaeifard M. Mehrabanian M.J.
Institution
(Faritus, Khazaee-Koohpar, Ziyaeifard, Mehrabanian) Rajaie Cardiovascular,
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Oral dexmedetomidine versus midazolam as anesthetic premedication in
children undergoing congenital heart surgery.
Source
Anesthesiology and Pain Medicine. 5 (3) , 2015. Article Number: e25032.
Date of Publication: 01 Jun 2015.
Publisher
Kowsar Medical Publishing Company
Abstract
Background: Premedication is required for reducing anxiety and child's
struggling against mask acceptance on anesthesia in pediatric surgery for
congenital heart disease. Midazolam has been widely used for this purpose,
but because of its side effects, finding an effective replacement with
less complication is necessary. Objectives: In the present study, we
compared the efficacy of oral midazolam versus dexmedetomidine in terms of
anxiolysis and mask acceptance behavior. Patients and Methods: Sixty
children aged between 2 and 12 years, and scheduled for on-pump surgery
due to a congenital heart disease were randomly assigned into two groups.
Oral midazolam (0.5 mg/kg up to 15 mg per patient) and dexmedetomidine (2
mug/kg) were administered 45 minutes pre-anesthesia. Children's anxiety,
mask acceptance behavior, hemodynamic measures, and cardiopulmonary
outcomes were recorded and compared. Results: The mean age of patients was
3.96 +/- 2.04 years. Twenty-eight (46.7%) patients were females. Two drugs
have similar effects on cardiopulmonary outcomes and hemodynamic measures
(P > 0.05). They equally relieved the children's anxiety (mean sedation
score 1.93 +/- 0.63 and 2.0 +/- 0.63 for midazolam and dexmedetomidine
groups, respectively; P > 0.05), while dexmedetomidine showed a better
effect on improving the mask acceptance behavior (mean mask acceptance
score 2.58 +/- 0.6 and 1.6 +/- 0.67 for midazolam and dexmedetomidine,
respectively; P < 0.05). Conclusions: It appears reasonable to apply oral
premedication with dexmedetomidine 45 minutes before transferring the
patient to the operating room when he or she is more prone to resist
inhalation anesthesia induction.
<9>
Accession Number
2015131144
Authors
Siegrist P.T. Sumitsuji S.
Institution
(Siegrist, Sumitsuji) Department of Advanced Cardiovascular Therapeutics,
Osaka University Graduate School of Medicine, Osaka, Japan
Title
Chronic total occlusion: Current methods of revascularisation.
Source
Kardiovaskulare Medizin. 17 (12) (pp 347-356), 2014. Date of Publication:
2014.
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Percutaneous coronary intervention (PCI) for chronic total occlusions
(CTO) has been referred to as the "last frontier" in interventional
cardiology. In recent years novel devices, refined imaging modalities and
innovative techniques have increased success rate and safety of PCI for
treatment of CTO remarkably. Favourable long-term outcome data and
excellent performance of drug-eluting stents further support the choice of
PCI for CTO recanalisation. As strategies for treating complex lesions are
continuously evolving, we provide here a systematic review of current
methods for CTO revascularisation. Detailed knowledge about the
histopathological characteristics of CTO is crucial to understand the
basic principles of advanced interventional techniques. The concept of
imaging-guid ed PCI further enhances efficacy and safety of this complex
intervention. Finally, understanding the principle of antegrade and
retrograde approaches are completing the armamentarium essential for
interventional cardiologists dealing with this challenging lesion subset.
<10>
Accession Number
2015115236
Authors
Scherr D. Derval N. Sohal M. Pascale P. Wright M. Jadidi A. Komatsu Y.
Roten L. Wilton S.B. Pedersen M. Ramoul K. Miyazaki S. Shah A. Linton N.
Manninger M. Denis A. Hocini M. Sacher F. Haissaguerre M. Jais P. Knecht
S.
Institution
(Scherr, Derval, Pascale, Wright, Jadidi, Komatsu, Roten, Wilton,
Pedersen, Ramoul, Miyazaki, Shah, Linton, Denis, Hocini, Sacher,
Haissaguerre, Jais, Knecht) Hopital Cardiologique du Haut Leveque,
Universite Victor-Segalen Bordeaux, Pessac, France
(Scherr, Manninger) Division of Cardiology, Department of Medicine,
Medical University of Graz, Austria
(Sohal, Wright) Kings College London BHF Centre, Cardiovascular Division,
. Thomas Hospital, Lambeth Wing, St, London SE1 7EH, United Kingdom
Title
Length of the mitral isthmus but not anatomical location of ablation line
predicts bidirectional mitral isthmus block in patients undergoing
catheter ablation of persistent atrial fibrillation: A randomized
controlled trial.
Source
Journal of Cardiovascular Electrophysiology. 26 (6) (pp 629-634), 2015.
Date of Publication: 01 Jun 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Importance of Line and Length for Mitral Isthmus Introduction Mitral
isthmus (MI) ablation is an effective option in patients undergoing
ablation for persistent atrial fibrillation (AF). Achieving bidirectional
conduction block across the MI is challenging, and predictors of MI
ablation success remain incompletely understood. We sought to determine
the impact of anatomical location of the ablation line on the efficacy of
MI ablation. Methods and Results A total of 40 consecutive patients (87%
male; 54 +/- 10 years) undergoing stepwise AF ablation were included. MI
ablation was performed in sinus rhythm. MI ablation was performed from the
left inferior PV to either the posterior (group 1) or the anterolateral
(group 2) mitral annulus depending on randomization. The length of the MI
line (measured with the 3D mapping system) and the amplitude of the EGMs
at 3 positions on the MI were measured in each patient. MI block was
achieved in 14/19 (74%) patients in group 1 and 15/21 (71%) patients in
group 2 (P = NS). Total MI radiofrequency time (18 +/- 7 min vs. 17 +/- 8
min; P = NS) was similar between groups. Patients with incomplete MI block
had a longer MI length (34 +/- 6 mm vs. 24 +/- 5 mm; P < 0.001), a higher
bipolar voltage along the MI (1.75 +/- 0.74 mV vs. 1.05 +/- 0.69 mV; P <
0.01), and a longer history of continuous AF (19 +/- 17 months vs. 10 +/-
10 months; P < 0.05). In multivariate analysis, decreased length of the MI
was an independent predictor of successful MI block (OR 1.5; 95% CI
1.1-2.1; P < 0.05). Conclusions Increased length but not anatomical
location of the MI predicts failure to achieve bidirectional MI block
during ablation of persistent AF.
<11>
Accession Number
2015118330
Authors
Yamaji K. Natsuaki M. Morimoto T. Ono K. Furukawa Y. Nakagawa Y. Kadota K.
Ando K. Shirai S. Watanabe H. Shiomi H. Kimura T.
Institution
(Yamaji, Ando, Shirai) Division of Cardiology, Kokura Memorial Hospital,
Kitakyushu, Japan
(Natsuaki) Division of Cardiology, Saiseikai Fukuoka General Hospital,
Fukuoka, Japan
(Morimoto) Division of General Medicine, Department of Internal Medicine,
Hyogo College of Medicine, Nishinomiya, Japan
(Ono, Watanabe, Shiomi, Kimura) Department of Cardiovascular Medicine,
Kyoto University, Graduate School of Medicine, Kyoto, Japan
(Furukawa) Department of Cardiovascular Medicine, Kobe City Medical
Center, General Hospital, Kobe, Japan
(Nakagawa) Division of Cardiology, Tenri Hospital, Tenri, Japan
(Kadota) Department of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
Title
Long-term outcomes after coronary stent implantation in patients
presenting with versus without acute myocardial infarction (an observation
from Coronary Revascularization Demonstrating Outcome Study-Kyoto Registry
Cohort-2).
Source
American Journal of Cardiology. 116 (1) (pp 15-23), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Inc.
Abstract
It has not been adequately addressed yet how long the excess
cardiovascular event risk persists after acute myocardial infarction (AMI)
compared with stable coronary artery disease. Of 10,470 consecutive
patients who underwent percutaneous coronary intervention either with
sirolimus-eluting stent (SES) only or with bare-metal stent (BMS) only in
the Coronary Revascularization Demonstrating Outcome Study-Kyoto Registry
Cohort-2, 3,710 (SES: n = 820 and BMS: n = 2,890) and 6,760 patients (SES:
n = 4,258 and BMS: n = 2,502) presented with AMI (AMI group) and without
AMI (non-AMI group), respectively. During the median 5-year follow-up, the
excess adjusted risk of the AMI group relative to the non-AMI group for
the primary outcome measure (cardiac death or myocardial infarction) was
significant (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.30 to
1.80, p <0.001). However, the excess event risk was limited to the early
period within 3 months. Late adjusted risk beyond 3 months was similar
between the AMI and non-AMI groups (HR 1.16, 95% CI 0.95 to 1.41, p =
0.15). The higher risk of the AMI group relative to the non-AMI group for
stent thrombosis (ST) was significant within 3 months (HR 3.38, 95% CI
2.04 to 5.60, p <0.001), whereas the risk for ST was not different between
the 2 groups beyond 3 months (HR 1.11, 95% CI 0.65 to 1.90, p = 0.70).
There were no interactions between the types of stents implanted and the
risk of the AMI group relative to the non-AMI groups for all the outcome
measures including ST. In conclusion, patients with AMI compared with
those without AMI were associated with similar late cardiovascular event
risk beyond 3 months after percutaneous coronary intervention despite
their higher early risk within 3 months.
<12>
Accession Number
2015072084
Authors
Agren S. Stromberg A. Jaarsma T. Luttik M.L.A.
Institution
(Agren) Department of Medical and Health Sciences, Linkoping University,
Department of Cardiothoracic Surgery, Linkoping, Sweden
(Agren, Stromberg, Luttik) Department of Medical and Health Sciences,
Linkoping University, Division of Nursing Sciences, Department of
Cardiology, Linkoping, Sweden
(Jaarsma) Department of Social and Welfare Studies, Linkoping University,
Linkoping, Sweden
(Luttik) Research Group Nursing Diagnostics, Hanze University of Applied
Sciences, Groningen, Netherlands
Title
Caregiving tasks and caregiver burden; effects of an psycho-educational
intervention in partners of patients withpost-operative heart failure.
Source
Heart and Lung: Journal of Acute and Critical Care. 44 (4) (pp 270-275),
2015. Date of Publication: 01 Jul 2015.
Publisher
Mosby Inc.
Abstract
Objective: To evaluate the effects of a psycho-educational intervention on
caregiver burden in partners of patients with postoperative heart failure.
Background: Since partners of cardiac surgery patients play a significant
role in the patient's recovery, it is important to address their needs
during hospitalization and after discharge. Methods: Forty-two patients
with postoperative heart failure and their partners participated in a
randomized controlled pilot study. Dyads in the intervention group
received psycho-educational support from a multidisciplinary team. Dyads
in the control group received usual care. Results: No significant
differences were found in the performance of caregiving tasks and
perceived caregiver burden in the control versus the intervention group.
Conclusion: A pilot study exploring the effects of a psycho-educational
intervention in patients and their partners did not reveal significant
effects with regard to reduced feelings of burden in partners. Alleviating
caregiver burden in partners may need a more intense or specific approach.
<13>
Accession Number
2015000375
Authors
Sucha D. Daans C.G. Symersky P. Planken R.N. Mali W.P.T.M. Van Herwerden
L.A. Budde R.P.J.
Institution
(Sucha, Daans, Mali, Budde) Department of Radiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Van Herwerden) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
(Symersky) Department of Cardiothoracic Surgery, VU University Medical
Center, Amsterdam, Netherlands
(Planken) Department of Radiology, Academic Medical Center, Amsterdam,
Netherlands
(Budde) Department of Radiology, Erasmus University Medical Center,
Rotterdam, Netherlands
Title
Reliability, agreement, and presentation of a reference standard for
assessing implanted heart valve sizes by multidetector-row computed
tomography.
Source
American Journal of Cardiology. 116 (1) (pp 112-120), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Inc.
Abstract
The implanted prosthetic heart valve (PHV) size is vital for the
evaluation of suspected PHV dysfunction and in case of reoperation or
valve-in-valve transcatheter approaches. The labeled size is not always
known, and discrepancies exist between manufacturers' labeled sizes and
true sizes. Reproducible methods for noninvasive PHV size assessment are
lacking. We determined the reliability and agreement of PHV size
measurements using multidetector-row computed tomography (MDCT) and
provide reference values of MDCT measurements compared with manufacturer
specifications. In vitro, 15 different PHV types in available sizes (total
n = 63) were imaged. In vivo, available MDCT acquisitions of patients with
PHVs were retrospectively gathered in 2 centers, and 230 patients with 249
PHVs were included. Inner valve area and area-derived diameter were
measured in all PHVs. For mechanical PHVs, the inner diameter was also
measured. Data were analyzed using the intraclass correlation coefficient
and Bland-Altman plots and related to manufacturer specifications.
Measurements could be obtained for all PHV types, except the Bjork-Shiley
(n = 7) because of severe valve-related artifacts hampering the image
quality. Intrarater and interrater reliability was excellent for
biological and mechanical PHVs (intraclass correlation coefficients
>0.903). Agreement was good for all measurements with an overall maximal
mean difference (95% confidence interval) of -2.61 mm<sup>2</sup> (-37.9
to 32.7), -0.1 mm (-1.1 to 1.0), and 0 mm (-0.4 to 0.3) for valve area,
area-derived diameter, and inner diameter, respectively. MDCT reliably
discriminated consecutive PHV sizes as labeled by the manufacturer because
the absolute ranges for the measurements never overlapped. In conclusion,
MDCT allows assessment of the implanted PHV size with excellent
reliability and agreement and can discriminate between PHV sizes for
contemporary prostheses. MDCT can be used to noninvasively identify the
manufacturer-labeled PHV size.
<14>
Accession Number
2015621109
Authors
Kidambi S. Mohamedali B. Bhat G.
Institution
(Kidambi, Bhat) Division of Advanced Heart Failure and Clinical
Transplantation, Advocate Christ Medical Center, Oak Lawn, IL, United
States
(Mohamedali) Rush University, Chicago, IL, United States
Title
Clinical outcomes in sensitized heart transplant patients bridged with
ventricular assist devices.
Source
Clinical Transplantation. 29 (6) (pp 499-505), 2015. Date of Publication:
01 Jun 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Left ventricular assist devices (LVADs) as a bridge to
transplant (BTT) have been known to cause allosensitization, as measured
by panel-reactive antibody (PRA) levels. The goal of this study was to
measure the impact of this allosensitization on outcomes. Methods:
Panel-reactive antibodies were analyzed in BTT patients, with
sensitization defined as peak PRAs > 10%. Baseline characteristics and
outcomes in the two patient groups were evaluated using descriptive
statistics, Kaplan-Meier, and regression analysis. Results: Thirty-eight
patients were included in the study (17 sensitized vs. 21 non-sensitized).
There were more women in the sensitized group (47% vs. 10%, p = 0.023).
There was no difference in mean times to high-grade acute cellular
rejection (ACR; 18.3 months in sensitized vs. 36.9 months in
non-sensitized). Five patients in the sensitized groups developed
antibody-mediated rejection (AMR) vs. 0 in the non-sensitized, and all
five patients died (Kaplan-Meier log-rank p = 0.024). There was also a
significant difference in the incidence of infection at the one- to
six-month stage (52.9% vs. 19.0%, p = 0.03). Conclusion: Sensitization
appears to have a negative effect on mortality. This mortality appears to
be concentrated in patients with AMR, and we postulate that the
development of AMR in a sensitized patient may be a predictor of
mortality.
<15>
Accession Number
2015887611
Authors
Luo T. Ni Y.
Institution
(Luo, Ni) Department of Cardiovascular Surgery, First Affiliated Hospital
College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou,
Zhejiang 310003, China
Title
Short-term and long-term postoperative safety of off-pump versus on-pump
coronary artery bypass grafting for coronary heart disease: A
meta-analysis for randomized controlled trials.
Source
Thoracic and Cardiovascular Surgeon. 63 (4) (pp 319-327), 2015. Date of
Publication: 24 Mar 2015.
Publisher
Georg Thieme Verlag
Abstract
Objective The aim was to compare the short-term (30 days after surgery)
and long-term (over 6 months' follow-up) postoperative safety of off-pump
and on-pump coronary artery bypass grafting (CABG) for patients with
coronary heart disease (CHD). Methods Relevant randomized controlled
trials (RCTs) were obtained from PubMed, Embase, Springer, Ovid, and
Cochrane library up to July 2013. Odds ratios (ORs) with their 95%
confidence intervals (CIs) were used to access effect sizes. Results Seven
RCTs involving 9,128 patients were included. Results suggested no
significant difference in all the short-term outcomes (mortality, OR =
0.90, 95% CI: 0.69 to 1.16, p = 0.41; myocardial infarction, OR = 0.95,
95% CI: 0.79 to 1.15, p = 0.61; stroke, OR = 0.78, 95% CI: 0.56 to 1.07, p
= 0.12; renal failure, OR = 0.84, 95% CI: 0.60 to 1.18, p = 0.43;
revascularization: OR = 1.95, 95% CI: 0.79 to 4.85, p = 0.15) and some
long-term outcomes (mortality, OR = 1.02, 95% CI: 0.86 to 1.22, p = 0.81;
myocardial infarction, OR = 0.86, 95% CI: 0.70 to 1.04, p = 0.12; stroke,
OR = 0.89, 95% CI: 0.67 to 1.19, p = 0.44) between off-pump and on-pump
CABG. However, off-pump CABG had a significantly higher revascularization
rate (OR = 1.45; 95% CI: 1.02 to 2.06; p = 0.04) than on-pump CABG in
long-term follow-up. Conclusion Short-term postoperative safety was
similar between off-pump and on-pump CABG. A high revascularization rate
was the drawback of off-pump CABG for CHD patients in long-term follow-up.
<16>
Accession Number
2015128641
Authors
Silvetti S. Silvani P. Azzolini M.L. Dossi R. Landoni G. Zangrillo A.
Institution
(Silvetti, Silvani, Azzolini, Dossi, Landoni, Zangrillo) Department of
Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan,
Italy
Title
A systematic review on levosimendan in paediatric patients.
Source
Current Vascular Pharmacology. 13 (1) (pp 128-133), 2015. Date of
Publication: 2015.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Levosimendan is a calcium-sensitizing agent that improves cardiac
function, hemodynamic performance, and survival in critically ill adult
patient. Few data exist on its off-label use in paediatric patients. We
therefore performed a systematic review updated in September 2013 of all
the published articles describing the use of levosimendan in paediatric
patients. We identified 24 studies published in the period 2004-2013 that
included a total of 623 patients, the largest one being a case series of
293 patients. Most of the patients underwent cardiac surgery, other
settings consisting of chronic heart failure, primary congenital heart
diseases and sepsis and cancer-associated cardiac dysfunction. Most
studies reported improvement in ventricular function, central venous
oxygen saturation, serum lactate levels or cardiac index. The 5 randomized
studies published so far have all been performed in cardiac surgery and
suggest a beneficial effect on hemodynamic data with no effect on
intensive care unit stay, hospital stay or survival. Side effects (e.g.
hypotension) were reported. This inodilator merits to be investigated with
further randomized trials focusing on clinically relevant outcomes.
<17>
Accession Number
2015070979
Authors
Ghatak A. Bavishi C. Cardoso R.N. MacOn C. Singh V. Badheka A.O. Padala S.
Cohen M.G. Mitrani R. O'Neill W. De Marchena E.
Institution
(Ghatak, Cardoso, MacOn, Singh, Cohen, Mitrani, De Marchena) University of
Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th
Street, Miami, FL 33136, United States
(Bavishi) Mount Sinai St. Luke's-Roosevelt Hospital, New York, NY, United
States
(Badheka) Wayne State University, Detroit, MI, United States
(Padala) Albany Medical Center, Albany, NY, United States
(O'Neill) Henry Ford Hospital, Detroit, MI, United States
Title
Complications and mortality in patients undergoing transcatheter aortic
valve replacement with edwards SAPIEN & SAPIEN XT valves: A meta-analysis
of world-wide studies and registries comparing the transapical and
transfemoral accesses.
Source
Journal of Interventional Cardiology. 28 (3) (pp 266-278), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction Both transfemoral (TF) and transapical (TA) routes are
utilized for Transcatheter Aortic Valve Replacement (TAVR) using Edwards
SAPIEN & SAPIEN XT valves. We intended to perform a meta-analysis
comparing the complication rates between these two approaches in studies
published before and after the standardized Valve Academic Research
Consortium (VARC) definitions. Methods We performed a comprehensive
electronic database search for studies published until January 2014
comparing TF and TA approaches using the Edwards SAPIEN/SAPIEN XT aortic
valve. Studies were analyzed based on the following endpoints: 1-year
mortality, 30-day mortality, stroke, new pacemaker implantation, bleeding,
and acute kidney injury. Results Seventeen studies were included in the
meta-analysis. Patients undergoing TA TAVR had a significantly higher
logistic EuroSCORE (24.6 +/- 12.9 vs. 21.3 +/- 12.0; P < 0.001). The
cumulative risks for 30-day mortality (RR 0.61; 95%CI 0.46-0.81; P =
0.001), 1-year mortality (RR 0.68; 95%CI 0.55-0.84; P < 0.001), and acute
kidney injury (RR 0.53; 95%CI 0.38-0.73; P < 0.001) were significantly
lower for patients undergoing TF as compared to TA approach. Both
approaches had a similar incidence of 30-day stroke, pacemaker
implantation, and major or life-threatening bleeding. Studies utilizing
the VARC definitions and those pre-dating VARC yielded similar results.
Conclusion This meta-analysis demonstrates a decreased 30-day and 1-year
mortality in TF TAVR as compared to TA TAVR. Post-procedure acute kidney
injury and the need for renal replacement therapy are also significantly
lower in the TF group. These differences hold true even after utilizing
the standardized Valve Academic Research Consortium criteria.
<18>
Accession Number
2015940819
Authors
Teismann I.K. Oelschlager C. Werstler N. Korsukewitz C. Minnerup J.
Ringelstein E.B. Dziewas R.
Institution
(Teismann) Department of Sleep Medicine and Neuromuscular Disorders,
Albert-Schweitzer-Campus 1, Building A1, Munster DE-48149, Germany
(Oelschlager) Department of Neurology, Evangelisches Krankenhaus
Bielefeld, Bielefeld, Germany
(Werstler, Korsukewitz, Minnerup, Ringelstein, Dziewas) Department of
Neurology, Munster, Germany
Title
Discontinuous versus continuous weaning in stroke patients.
Source
Cerebrovascular Diseases. 39 (5-6) (pp 269-277), 2015. Date of
Publication: 09 Jun 2015.
Publisher
S. Karger AG
Abstract
Background: An increasing number of stroke patients have to be supported
by mechanical ventilation in intensive care units (ICU), with a relevant
proportion of them requiring gradual withdrawal from a respirator. To
date, weaning studies have focused merely on mixed patient groups, COPD
patients or patients after cardiac surgery. Therefore, the best weaning
strategy for stroke patients remains to be determined. Methods: Here, we
designed a prospective randomized controlled study comparing adaptive
support ventilation (ASV), a continuous weaning strategy, with biphasic
positive airway pressure (BIPAP) in combination with spontaneous breathing
trials, a discontinuous technique, in the treatment of stroke patients.
The primary endpoint was the duration of the weaning process. Results:
Only the 40 (out of 54) patients failing in an initial spontaneous
breathing trial (T-piece test) were included into the study; the failure
proportion is considerably larger compared to previous studies. Eligible
patients were pseudo-randomly assigned to one of the two weaning groups.
Both groups did not differ regarding age, gender, and severity of stroke.
The results showed that the median weaning duration was 10.7 days (+/-SD
7.0) in the discontinuous weaning group, and 8 days (+/-SD 4.5) in the
continuous weaning group (p < 0.05). Conclusions: To the best of our
knowledge, this is the first clinical study to show that continuous
weaning is significantly more effective compared to discontinuous weaning
in mechanically ventilated stroke patients. We suppose that the reason for
the superiority of continuous weaning using ASV as well as the bad
performance of our patients in the 2 h T-piece test is caused by the
patients' compliance. Compared to patients on surgical and medical ICUs,
neurological patients more often suffer from reduced vigilance, lack of
adverse-effects reflexes, dysphagia, and cerebral dysfunction. Therefore,
stroke patients may profit from a more gradual withdrawal of weaning.
<19>
Accession Number
2015864562
Authors
Phan K. Wong S. Phan S. Ha H. Qian P. Yan T.D.
Institution
(Phan, Yan) The Collaborative Research (CORE) Group, Macquarie University
Hospital Clinic, Macquarie University, Suite 302, 2 Technology Place,
Sydney, NSW 2109, Australia
(Wong) Gosford Hospital, Gosford, Australia
(Phan, Phan) Sydney Medical School, University of Sydney, Sydney,
Australia
(Phan, Ha) St Vincent's Clinical School, University of New South Wales,
Sydney, Australia
(Phan, Qian) Department of Cardiology, Westmead Hospital, Sydney,
Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
Sydney, Australia
Title
Transcatheter Aortic Valve Implantation (TAVI) in Patients With Bicuspid
Aortic Valve Stenosis - Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 24 (7) (pp 649-659), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Ltd
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a feasible
interventional technique for severe aortic stenosis in patients who are
deemed inoperable or at high surgical risk. There is limited evidence for
the safety and efficacy of TAVI in patients with bicuspid aortic valves
(BAV), the most common congenital valve abnormality. In many TAVI trials,
patients with BAV have been contraindicated due to concerns surrounding
abnormal valve geometry, leading to malfunction or malpositioning. A
systematic review and meta-analysis was conducted in order to assess the
current evidence and relative merits of TAVI in aortic stenosis patients
with BAV. Method: From six electronic databases, seven articles including
149 BAV and 2096 non-BAV patients undergoing TAVI were analysed. Results:
Between the BAV and no-BAV cohorts, there was no difference in 30-day
mortality (8.3% vs 9.0%; P=0.68), post-TAVI mean peak gradients (weighted
mean difference, 0.36. mmHg; P=0.55), moderate or severe paravalvular leak
(25.7% vs 19.9%; P=0.29), pacemaker implantations (18.5% vs 27.9%;
P=0.52), life-threatening bleeding (8.2% vs 13.9%; P=0.33), major bleeding
(20% vs 16.8%; P=0.88), conversion to conventional surgery (1.9% vs 1.2%;
P=0.18) and vascular complications (8.6% vs 10.1%; P=0.32). Conclusions:
Preliminary short and mid-term pooled data from observation studies
suggest that TAVI is feasible and safe in older patients with BAV. While
future randomised trials are not likely, larger adequately-powered
multi-institutional studies are warranted to assess the long-term
durability and complications associated with TAVI in older BAV patients
with severe aortic stenosis.
<20>
Accession Number
2015696025
Authors
Wynne D.G. Rampat R. Trivedi U. De Belder A. Hill A. Hutchinson N.
Hildick-Smith D.
Institution
(Wynne, Rampat, Trivedi, De Belder, Hill, Hutchinson, Hildick-Smith)
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern
Road Brighton, East Sussex BN2 5BE, United Kingdom
Title
Transradial secondary arterial access for transcatheter aortic valve
implantation: Experience and limitations.
Source
Heart Lung and Circulation. 24 (7) (pp 682-685), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Ltd
Abstract
Objectives: The transradial approach limits vascular complications in
coronary interventions. The same may be true for transcatheter aortic
valve implantation (TAVI). We present our experience using secondary
transradial arterial access. Methods: Secondary transradial arterial
access has been our default strategy for TAVI since 2007. Procedural data
is collected prospectively. We assessed procedural success and
complications. Results: Data from 282 patients aged 81. +/-. 5.2yrs was
examined. Secondary arterial access was transradial (74%), femoral (24%)
and none (2%). Secondary femoral access was reserved for failed radial
access (3%), anatomical anomalies (4%), operator preference (7%), trial
requirements (6%) or proctor preference (4%). The principal pathology was
aortic stenosis (90.8%), aortic regurgitation (6.7%) or a combination
(2.5%). CoreValve (91.4%), Edwards (7%) or Lotus valves (1.7%) were
delivered via transfemoral (88.6%), direct aortic (5.3%), subclavian
(3.9%) or transapical approaches (1.8%). Significant vascular
complications occurred in 25 cases (9.4%), including surgical repair of a
failed percutaneous closure device (n=16), ilio-femoral dissection (n=3),
iliac perforations (n=3), plaque disruption (n=1) and false aneurysm
(n=2), one of which was from the secondary femoral access site. There was
no local vascular complication from the secondary radial site.
Conclusions: The transradial secondary access route for TAVI is safe and
effective. The transradial route may limit vascular access complications
from secondary transfemoral access.
<21>
Accession Number
2015123462
Authors
Safaie N. Montazerghaem H. Jodati A. Maghamipour N.
Institution
(Safaie, Jodati) Cardiovascular Research Center, Tabriz University of
Medical Sciences, Tabriz, Iran, Islamic Republic of
(Montazerghaem) Cardiovascular Research Center, Hormozgan University of
Medical Sciences, Bandar Abbas, Iran, Islamic Republic of
(Maghamipour) Department of Cardiac Surgery, Behsat Hospital, School of
Medical Science, Tehran, Iran, Islamic Republic of
Title
In-hospital complications of coronary artery bypass graft surgery in
patients older than 70 years.
Source
Journal of Cardiovascular and Thoracic Research. 7 (2) (pp 60-62), 2015.
Date of Publication: 2015.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Cardiovascular diseases contribute to mortality and
morbidity in aged individuals. It is crucial to have a clear perception of
coronary artery bypass graft (CABG) risks and benefits to make logical
decision in aged patients. Unfortunately, cardiovascular disease
researches have focused very little on the aged patients. The aim of the
present study is to evaluate in-hospital complications in patients older
than 70 years old following CABG operation to determine if CABG is
preferred or not considering present complications. Methods: In a cross
sectional study, 500 patients older than 70 years old were randomly
selected (70-75 patients for each year) from March 2004 to March 2011.
Descriptive statistical methods were used for evaluating the obtained
data. Results: Overall, 70.6% of patients (353 individuals) were male and
29.4% were female (147 individuals). Totally, 107 patients (21.4%) had
complications during hospitalization; these complications were
statistically significant in male individuals. Complications included
Stroke 1.6%, deep vein thrombosis 0.8%, MI 2.4%, repeat surgery 2.80%,
bleeding 2.40%, and more than 48 hours mechanical ventilation in 13.4%.
Conclusion: Need for more than 48 hours mechanical ventilation and
bleeding after surgery were the most occurred complications in these
patients.
<22>
Accession Number
2015123460
Authors
Sabzi F. Faraji R.
Institution
(Sabzi) Preventive Cardiovascular Research Center Kermanshah, Kermanshah
University of Medical Sciences, Kermanshah, Iran, Islamic Republic of
(Faraji) Yazd Cardiovascular Research Center, Shahid Sadoughi University
of Medical Sciences, Yazd, Iran, Islamic Republic of
Title
Liver function tests following open cardiac surgery.
Source
Journal of Cardiovascular and Thoracic Research. 7 (2) (pp 49-54), 2015.
Date of Publication: 2015.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: The cardiopulmonary bypass may have multiple systemic
effects on the body organs as liver. This prospective study was planned to
explore further the incidence and significance of this change. Methods:
Two hundred patients with coronary artery bypass grafting (CABG), were
randomly selected for the study. Total and indirect bilirubin, aspartate
aminotransferase, alanine aminotransferase, alkaline phosphatase were
measured preoperatively and at 24, 48 and 72 hours, following coronary
artery bypass grafting. Postoperative value of the liver function tests
with respect to hypothermia or hypotension were compared by one way
analysis of variance for repeated measure and compared with t test.
Patient's characteristics with bilirubin value (=1.5 mg or > 1.5 mg) were
compared with t test. Results: A significant increase of total bilirubin,
aspartate aminotransferase, and alkaline phosphatase were noted in the
third postoperative day. Significant relation was seen between hypotension
and alkaline phosphatase, and aspartate aminotransferase change but
hypothermia had not affected alanine aminotransferase, total bilirubin and
indirect bilirubin change. Pump time, alanine aminotransferase in third
postoperative day and direct bilirubin in first and second day of
postoperative period had significant relation with pre and post-operative
bilirubin change. Conclusion: Transient but not permanent alterations of
hepatic enzymes after coronary artery bypass grafting presumably
attributed to the decreased hepatic flow, hypoxia, or pump-induced
inflammation.
<23>
Accession Number
2015123459
Authors
Porhomayon J. Joude P. Adlparvar G. El-Solh A.A. Nader N.D.
Institution
(Porhomayon) VA Western New York Healthcare System, Division of Critical
Care Medicine, Department of Anesthesiology, State University of New York
at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United
States
(Joude, El-Solh) VA Western New York Healthcare System, Division of
Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine,
State University of New York at Buffalo School of Medicine and Biomedical
Sciences, Buffalo, NY, United States
(Adlparvar) Monroe College, State University of New York, Buffalo School
of Medicine and Biomedical Sciences, Rochester, NY, United States
(Nader) VA Western New York Healthcare System, Division of Cardiothoracic
Anesthesia and Pain Medicine, Department of Anesthesiology, State
University of New York at Buffalo School of Medicine and Biomedical
Sciences, Buffalo, NY, United States
Title
The impact of high versus low sedation dosing strategy on cognitive
dysfunction in survivors of intensive care units: A systematic review and
meta-analysis.
Source
Journal of Cardiovascular and Thoracic Research. 7 (2) (pp 43-48), 2015.
Date of Publication: 2015.
Publisher
Tabriz University of Medical Sciences
Abstract
Background: The practice of low vs. high sedation dosing strategy may
impact the cognitive and mental health function in the intensive care unit
(ICU). We aim to demonstrate that high sedation strategy will result in
change of mental health function in ICU patients. Methods: We performed a
systemic search and meta-analysis of medical databases in MEDLINE (from
1966 to March 2013) and EMBASE (from 1980 to March 2013), as well as the
Cochrane Library using the MESH terms "Intensive Care Unit," and "Mental
Health, for assessing the impact of sedation on posttraumatic stress
disorder (PTSD) or anxiety/depression and delirium in the mix ICU setting
including cardiac surgery patients. A total of 1216 patients were included
in the final analysis. Results: We included 11 studies in the final
analysis and concluded that high dose sedation strategy resulted in higher
incidence of cognitive dysfunction with P value of 0.009. The result for
subgroup of delirium showed P = 0.11 and PTSD/depression or anxiety of P =
0.001, Heterogeneity I<sup>2</sup> was 64%. Overall analysis was
statistically significant with a P value of 0.002. Conclusion: High
sedation dosing strategy will negatively affect cognitive function in
critically ill patients. Large randomized trials are needed to address
cognitive dysfunction in subgroup of patients with delirium.
<24>
Accession Number
2015120021
Authors
Alizadeh Ghavidel A. Totonchi Z. Chitsazan M. Dehaki M.G. Jalili F. Farsad
F. Hejrati M.
Institution
(Alizadeh Ghavidel, Chitsazan, Dehaki) Heart Valve Disease Research
Center, Rajaei Cardiovascular Medical and Research Center, Iran University
of Medical Science, Tehran, Iran, Islamic Republic of
(Totonchi, Jalili, Farsad) Rajaei Cardiovascular Medical and Research
Center, Iran University of Medical Science, Tehran, Iran, Islamic Republic
of
(Hejrati) Rasoul-e-Akram General Hospital, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Safety and efficacy of caproamin fides and tranexamic acid versus placebo
in patients undergoing coronary artery revascularization.
Source
Journal of Cardiovascular and Thoracic Research. 6 (3) (pp 197-202), 2014.
Date of Publication: 2014.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Excessive fibrinolysis contributes to post-cardiopulmonary
bypass bleeding. Tranexamic Acid (TXA) and Caproamin Fides are synthetic
lysine analogues that inhibit plasminogen-fibrin binding. The present
study aimed to compare TXA and Caproamin Fides versus placebo in patients
undergoing elective coronary artery revascularization. Methods: We
analyzed perioperative data of 300 adult patients undergoing coronary
artery revascularization. Patients were randomly allocated to receive TXA
(n=100), Caproamin Fides (n=100) or placebo (n=100) during perioperative
time. Mediastinal bleeding during the first 24 hours post-operation,
transfusion requirement and post-surgical complications were assessed.
Results: Most descriptive and intra-operative parameters were well
comparable between the 3 study groups. Except for mean number of packed
red blood cell (PRBC) units transfused during ICU stay (P=0.01), patients
in the Caproamin Fides and TXA groups did not show any statistically
significant differences regarding transfusion of blood products during
peri-operative period. There was no evidence of a significant difference
in mediastinal blood loss during the first 24 hours post-operation between
the patients receiving TXA or placebo, while patients in the Caproamin
Fides group had significantly lower mediastinal bleeding than the other 2
groups (Caproamin Fides vs. placebo, P=0.002, <0.001 and <0.001 at 6, 12
and 24 hours post-operation; Caproamin Fides vs. TXA, P=0.009, 0.003,
<0.001 at 6, 12 and 24 hours post-operation). The incidence of
postoperative complications were comparable between Caproamin Fides and
TXA groups (P>0.05). Conclusion: In conclusion, Caproamin Fides seems to
be superior to TXA regarding the blood saving effects in patients
undergoing coronary artery revascularization.
<25>
Accession Number
2015120013
Authors
Tarbiat M. Manafi B. Davoudi M. Totonchi Z.
Institution
(Tarbiat, Manafi, Davoudi) Ekbatan Cardiovascular Surgery Center,
Department of Anesthesiology, Hamedan University of Medical Sciences,
Hamedan, Iran, Islamic Republic of
(Totonchi) Department of Anesthesiology, Rajaei Heart Hospital, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Comparison of the complications between left side and right side
subclavian vein catheter placement in patients undergoing coronary artery
bypass graft surgery.
Source
Journal of Cardiovascular and Thoracic Research. 6 (3) (pp 147-151), 2014.
Date of Publication: 2014.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Percutaneous subclavian vein catheterization is one of the
most common invasive procedures performed in cardiac surgery. The aim of
this study was to compare left and right subclavian vein catheter
placement via the infraclavicular approach in patients who undergo
coronary artery bypass graft (CABG) surgery. Methods: This prospective,
randomized clinical trial was performed in193 patients. The technique
applied for cannulation was infraclavicular approach for both the right
and the left sides. Subclavian vein of other side was attempted only when
catheterization at initial side was unsuccessful at two attempts. The
success and complication rates were compared for the two sides. Results:
On193 patients, catheterization attempts were performed. Overall 177
catheterizations (91.7%) were successful during the first attempt, 105
(92.1%) on the right side and 72 (91.1%) on the left side. There was no
significant difference between success rate and side of catheterization.
Malposition of the catheter tip on the right side (9.6%) was significantly
more than the left side (0%) (P= 0.003). The differences in other
complications on two sides were statistically insignificant. Conclusion:
Compared with the right side, insertion of the cannula on the left side
resulted in fewer catheter tip misplacements. Incidence of cannulation
failure and other complications were similar on both sides.
<26>
Accession Number
2015913265
Authors
Naraghi L. Mejaddam A.Y. Birkhan O.A. Chang Y. Cropano C.M. Mesar T.
Larentzakis A. Peev M. Sideris A.C. Van der Wilden G.M. Imam A.M.
Hwabejire J.O. Velmahos G.C. Fagenholz P.J. Yeh D. de Moya M.A. King D.R.
Institution
(Naraghi, Mejaddam, Birkhan, Chang, Cropano, Mesar, Larentzakis, Peev,
Sideris, Van der Wilden, Imam, Hwabejire, Velmahos, Fagenholz, Yeh, de
Moya, King) Division of Trauma, Emergency Surgery and Surgical Critical
Care, Massachusetts General Hospital and Harvard Medical School, Boston,
MA, United States
Title
Sample entropy predicts lifesaving interventions in trauma patients with
normal vital signs.
Source
Journal of Critical Care. 30 (4) (pp 705-710), 2015. Date of Publication:
01 Aug 2015.
Publisher
W.B. Saunders
Abstract
Introduction: Heart rate complexity, commonly described as a "new vital
sign," has shown promise in predicting injury severity, but its use in
clinical practice is not yet widely adopted. We previously demonstrated
the ability of this noninvasive technology to predict lifesaving
interventions (LSIs) in trauma patients. This study was conducted to
prospectively evaluate the utility of real-time, automated, noninvasive,
instantaneous sample entropy (SampEn) analysis to predict the need for an
LSI in a trauma alert population presenting with normal vital signs.
Methods: Prospective enrollment of patients who met criteria for trauma
team activation and presented with normal vital signs was conducted at a
level I trauma center. High-fidelity electrocardiogram recording was used
to calculate SampEn and SD of the normal-to-normal R-R interval (SDNN)
continuously in real time for 2 hours with a portable, handheld device.
Patients who received an LSI were compared to patients without any
intervention (non-LSI). Multivariable analysis was performed to control
for differences between the groups. Treating clinicians were blinded to
results. Results: Of 129 patients enrolled, 38 (29%) received 136 LSIs
within 24 hours of hospital arrival. Initial systolic blood pressure was
similar in both groups. Lifesaving intervention patients had a lower
Glasgow Coma Scale. The mean SampEn on presentation was 0.7 (0.4-1.2) in
the LSI group compared to 1.5 (1.1-2.0) in the non-LSI group (. P <
.0001). The area under the curve with initial SampEn alone was 0.73 (95%
confidence interval [CI], 0.64-0.81) and increased to 0.93 (95% CI,
0.89-0.98) after adding sedation to the model. Sample entropy of less than
0.8 yields sensitivity, specificity, negative predictive value, and
positive predictive value of 58%, 86%, 82%, and 65%, respectively, with an
overall accuracy of 76% for predicting an LSI. SD of the normal-to-normal
R-R interval had no predictive value. Conclusions: In trauma patients with
normal presenting vital signs, decreased SampEn is an independent
predictor of the need for LSI. Real-time SampEn analysis may be a useful
adjunct to standard vital signs monitoring. Adoption of real-time,
instantaneous SampEn monitoring for trauma patients, especially in
resource-constrained environments, should be considered.
<27>
Accession Number
2015758653
Authors
Habets J. Tanis W. Reitsma J.B. van den Brink R.B.A. Mali W.P.T.M.
Chamuleau S.A.J. Budde R.P.J.
Institution
(Habets, Mali) Department of Radiology, University Medical Center Utrecht,
Heidelberglaan 100, Utrecht 3508 GA, Netherlands
(Tanis) Department of Cardiology, Haga Teaching Hospital, The Hague,
Netherlands
(Reitsma) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
(van den Brink) Department of Cardiology, Academic Medical Center,
Amsterdam, Netherlands
(Chamuleau) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Budde) Department of Radiology, Erasmus Medical Center, Rotterdam,
Netherlands
Title
Are novel non-invasive imaging techniques needed in patients with
suspected prosthetic heart valve endocarditis? A systematic review and
meta-analysis.
Source
European Radiology. 25 (7) (pp 2125-2133), 2015. Date of Publication: 14
Feb 2015.
Publisher
Springer Verlag
Abstract
Objectives: Multimodal non-invasive imaging plays a key role in
establishing a diagnosis of PHV endocarditis. The objective of this study
was to provide a systematic review of the literature and meta-analysis of
the diagnostic accuracy of TTE, TEE, and MDCT in patients with (suspected)
PHV endocarditis. Methods: Studies published between 1985 and 2013 were
identified via search and cross-reference of PubMed/Embase databases.
Studies were included if (1) they reported on the non-invasive index tests
TTE, TEE, or MDCT; (2) data was provided on PHV endocarditis as the
condition of interest; and (3) imaging results were verified against
either surgical inspection/autopsy or clinical follow-up reference
standards, thereby enabling the extraction of 2-by-2 tables. Results:
Twenty articles (including 496 patients) met the inclusion criteria for
PHV endocarditis. TTE, TEE, and MDCT + TEE had a pooled
sensitivity/specificity for vegetations of 29/100 %; 82/95 %, and 88/94 %,
respectively. The pooled sensitivity/specificity of TTE, TEE, and MDCT +
TEE for periannular complications was 36/93 %, 86/98 %, and 100/94 %,
respectively. Conclusions: TEE showed good sensitivity and specificity for
establishing a diagnosis of PHV endocarditis. Although MDCT data are
limited, this review showed that MDCT in addition to TEE may improve
sensitivity in detecting life-threatening periannular complications. Key
Points: * Multimodal imaging is an important ingredient of diagnostic
workup for PHV endocarditis. * Transthoracic and transesophageal
echography may miss life-threatening periannular complications. * MDCT can
improve sensitivity for the detection of life-threatening periannular
complications.
<28>
Accession Number
2015118917
Authors
Bagan P. De Dominicis F. Hernigou J. Dakhil B. Zaimi R. Pricopi C. Le
Pimpec Barthes F. Berna P.
Institution
(Bagan, Hernigou, Dakhil, Zaimi) Department of Thoracic and Vascular
Surgery, Victor Dupouy Hospital, rue du lieut, Prudhon, Argenteuil 95100,
France
(Bagan, De Dominicis, Berna) Department of Thoracic Surgery, Amiens
Picardie University Hospital, Amiens, France
(Bagan, Pricopi, Le Pimpec Barthes) Department of Thoracic Surgery and
Lung Transplantation, Pompidou European Hospital, Paris V University,
Paris, France
Title
Complete thoracoscopic lobectomy for cancer: Comparative study of
three-dimensional high-definition with two-dimensional high-definition
video systems.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (6) (pp 820-824),
2015. Date of Publication: 01 Jun 2015.
Publisher
Oxford University Press
Abstract
OBJECTIVES Common video systems for video-assisted thoracic surgery (VATS)
provide the surgeon a two-dimensional (2D) image. This study aimed to
evaluate performances of a new three-dimensional high definition (3D-HD)
system in comparison with a two-dimensional high definition (2D-HD) system
when conducting a complete thoracoscopic lobectomy (CTL). METHODS This
multi-institutional comparative study trialled two video systems: 2D-HD
and 3D-HD video systems used to conduct the same type of CTL. The
inclusion criteria were T1N0M0 non-small-cell lung carcinoma (NSCLC) in
the left lower lobe and suitable for thoracoscopic resection. The CTL was
performed by the same surgeon using either a 3D-HD or 2D-HD system.
Eighteen patients with NSCLC were included in the study between January
and December 2013: 14 males, 4 females, with a median age of 65.6 years
(range: 49-81). The patients were randomized before inclusion into two
groups: to undergo surgery with the use of a 2D-HD or 3D-HD system. We
compared operating time, the drainage duration, hospital stay and the N
upstaging rate from the definitive histology. RESULTS The use of the 3D-HD
system significantly reduced the surgical time (by 17%). However,
chest-tube drainage, hospital stay, the number of lymph-node stations and
upstaging were similar in both groups. CONCLUSIONS The main finding was
that 3D-HD system significantly reduced the surgical time needed to
complete the lobectomy. Thus, future integration of 3D-HD systems should
improve thoracoscopic surgery, and enable more complex resections to be
performed. It will also help advance the field of endoscopically assisted
surgery.
<29>
Accession Number
2015118915
Authors
Ali-Hassan-Sayegh S. Mirhosseini S.J. Haddad F. Karimi-Bondarabadi A.A.
Shahidzadeh A. Weymann A. Popov A.-F. Sabashnikov A.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Haddad, Karimi-Bondarabadi, Shahidzadeh)
Cardiovascular Research Center, Shahid Sadoughi University of Medical
Sciences, Arsalan Street, Yazd 8916936637, Iran, Islamic Republic of
(Mirhosseini) Department of Cardiovascular Surgery, Shahid Sadoughi
University of Medical Sciences, , Yazd, Iran, Islamic Republic of
(Weymann, Popov, Sabashnikov) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
Title
Protective effects of corticosteroids in coronary artery bypass graft
surgery alone or combined with valvular surgery: An updated and
comprehensive meta-analysis and systematic review.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (6) (pp 825-836),
2015. Date of Publication: 01 Jun 2015.
Publisher
Oxford University Press
Abstract
This systematic review with meta-analysis sought to determine the
protective effects of corticosteroids on clinical outcomes following
coronary artery bypass grafting (CABG). Medline, Embase, Elsevier and
Sciences online database as well as Google scholar literature were used
for selecting appropriate studies with randomized controlled design. The
effect sizes measured were odds ratio (OR) for categorical variables and
weighted mean difference with 95% confidence interval (CI) for calculating
differences between mean values of duration of hospitalization in
intervention and control groups. Values of P < 0.1 for Q-test or
I<sup>2</sup> > 50% indicated significant heterogeneity between the
studies. The literature search of all major databases retrieved 3735
studies. After screening, a total of 45 trials were identified that
reported outcomes. Pooled analysis was performed on incidence of atrial
fibrillation (OR of 0.71; 95% CI: 0.59-0.86; P = 0.000), stroke (OR of
1.61; 95% CI: 0.63-4.1; P = 0.3), infection (OR of 1.03; 95% CI: 0.68-1.5;
P = 0.8), re-infarction (OR of 0.88; 95% CI: 0.47-1.63; P = 0.6), length
of ventilation time [weighted mean difference (WMD) of 0.257; 95% CI:
0.10-0.41; P = 0.00], length of hospital stay (WMD of -0.48; 95% CI: -0.66
to -0.3; P = 0.000), amount of blood loss (WMD of -124.05; 95% CI: -147.72
to -100.38; P = 0.00), re-exploration (OR of 1.25; 95% CI: 0.66-2.35; P =
0.4) and mortality (OR of 0.87; 95% CI: 0.46-1.64; P = 0.6). Overall,
steroid prophylaxis in patients undergoing CABG could significantly reduce
complications such as atrial fibrillation and length of hospital stay, but
slightly increased the length of ventilation time. On the other hand, no
significant impact on the incidence of infection was observed compared
with the placebo.
<30>
Accession Number
2015123559
Authors
Ferguson Z.G. Yarborough D.E. Jarvis B.L. Sistino J.J.
Institution
(Ferguson, Yarborough, Jarvis, Sistino) Medical University of South
Carolina, Charleston, United States
Title
Evidence-based medicine and myocardial protection - where is the
evidence?.
Source
Perfusion (United Kingdom). 30 (5) (pp 415-422), 2015. Date of
Publication: 12 Jul 2015.
Publisher
SAGE Publications Ltd
Abstract
Objective: Myocardial protection with cardioplegia is an integral
component of most cardiac surgical procedures, providing protection of the
heart by limiting metabolic activity and increasing the myocardium's
capacity to withstand ischemia for prolonged periods of time. Cardioplegia
has greatly affected the landscape of cardiothoracic surgery since its
introduction in the 1960s, but, to this day, there continues to be a
debate over what the ideal cardioplegic solution should be. The goal of
this analysis is to describe current practices in cardioplegia and to
point out the lack of quality human research and subsequent publications
that prevent best practices from being utilized. Methods: This study is a
systematic review of journal publications pertaining to the composition of
commonly used cardioplegic solutions. Four main types of cardioplegia were
assessed to give a narrower field of examination; specifically,
microplegia, del Nido, Custodiol HTK, and 4:1 blood cardioplegia. Other
combinations of cardioplegia, including St. Thomas's Solution and the
University of Wisconsin (UW) Solution, were considered when applicable
according to the context of the publication being reviewed. Factors being
assessed consisted of scientific validity, nature of the test subject
(isolated organ vs. animal vs. human studies), experimental setup
(retrospective trials vs. randomized clinical trials) and patient
outcomes. Results: There are very few randomized clinical trials with
human subjects comparing commonly used cardioplegic solutions. Numerous
retrospective studies exist, but often show similar intraoperative and
postoperative outcomes between the solutions. Some solutions, del Nido
cardioplegia in particular, were found to have few or no significant human
trials to back the rigor required in such a highly specialized field as
cardiovascular surgery. A wide variation in the types of surgeries and
primary outcomes were included in the publications, so it is difficult to
perform an accurate systematic review of the topic. Conclusion: Uniform
variables among different studies would be preferable for analysis of this
topic; thus, it is the researchers' recommendation that the collection of
multicenter data be undertaken in order to more fully answer this research
question. Comparative effectiveness studies to associate commonly used
solutions are needed. Without this research, surgeon preference remains
the primary determining factor for deciding which cardioplegic solution to
use. Cardioplegia selection should rely more on higher scientific
research, using evidenced-based medicine and ranking of clinical studies.
<31>
Accession Number
2015123554
Authors
Chalegre S.T. Sa M.P.B.O. Goncalves De Rueda F. Salerno P.R. Vasconcelos
F.P. Lima R.C.
Institution
(Chalegre, Sa, Goncalves De Rueda, Salerno, Vasconcelos, Lima) Division of
Cardiovascular Surgery, Pronto Socorro Cardiologico de Pernambuco -
PROCAPE, Recife, Brazil
(Chalegre, Sa, Goncalves De Rueda, Salerno, Vasconcelos, Lima) University
of Pernambuco - UPE, Recife, Brazil
(Chalegre, Sa, Lima) Nucleus of Postgraduate and Research in Health
Sciences, Faculty of Medical Sciences FCM, Biological Sciences Institute
ICB, Recife, Brazil
(Chalegre) Universidade de Pernambuco, Faculdade de Ciencias Medicas,
Campus Universitario, Rua Arnobio Marques 310 Sto. Amaro, Recife, PE CEP
50.100-130, Brazil
Title
Central versus peripheral arterial cannulation and neurological outcomes
after thoracic aortic surgery: meta-analysis and meta-regression of 4459
patients.
Source
Perfusion (United Kingdom). 30 (5) (pp 383-388), 2015. Date of
Publication: 12 Jul 2015.
Publisher
SAGE Publications Ltd
Abstract
Background: Thoracic aortic surgeries remain with high mortality rates,
often associated with postoperative neurological complications. The choice
of the right cannulation site is extremely important for suitable blood
supply and maintenance of vital functions, especially of the central
nervous system. Objectives: To compare the influence of central versus
peripheral arterial cannulation on neurological outcomes in patients
undergoing thoracic aortic surgery through systematic review and
meta-analysis. Methods: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS and
reference lists of relevant articles were searched for clinical studies
that reported in-hospital neurological outcomes after central or
peripheral arterial cannulation during thoracic aortic surgery procedures
until December 2013. The principal summary measures were Odds Ratio (OR)
for central compared to peripheral arterial cannulation with 95%
confidence interval (CI) and p-values considered statistically significant
when <0.05. The ORs were combined across studies, using the
DerSimonian-Laird random effects model and fixed effects model using the
Mantel-Haenszel model - both models were weighted. The meta-analysis was
completed using the software Comprehensive Meta-Analysis version 2
(Biostat Inc., Englewood, NJ). Results: Six studies were identified and
included a total of 4459 patients (1180 for central and 3279 for
peripheral cannulation). There was no significant difference between the
central and peripheral groups regarding neurological outcomes. The
meta-regression evidenced no relationship between neurological outcomes
and the variables age, sex, previous coronary event, previous neurological
event, urgency surgery, cardiopulmonary bypass time, activated clotting
time and esophageal temperature with p>0,05. Conclusion: When it comes to
neurological outcomes in patients undergoing thoracic aortic surgery,
there was no evidence that argues in favor of any choice of arterial
cannulation site, which makes us reject any superiority of one approach
over the other in this regard.
<32>
Accession Number
2015123553
Authors
Gong B. Ji B. Sun Y. Wang G. Liu J. Zheng Z.
Institution
(Gong, Ji, Sun, Wang, Liu, Zheng) State Key Laboratory of Cardiovascular
Medicine, Fuwai Hospital, Chinese Academy of Medical Science, Beijing,
China
(Gong, Zheng) Department of Cardiovascular Surgery, Chinese Academy of
Medical Science, Peking Union Medical College, Beijing, China
(Ji, Sun, Liu) Department of Cardiopulmonary Bypass, Chinese Academy of
Medical Science, Peking Union Medical College, Beijing, China
(Wang) Department of Anesthesia, Chinese Academy of Medical Science,
Peking Union Medical College, Beijing, China
Title
Is microplegia really superior to standard blood cardioplegia? The results
from a meta-analysis.
Source
Perfusion (United Kingdom). 30 (5) (pp 375-382), 2015. Date of
Publication: 12 Jul 2015.
Publisher
SAGE Publications Ltd
Abstract
Background: Microplegia (whole blood cardioplegia with reduced volume)
retains all the advantages of blood cardioplegia (such as superior
oxygen-carrying capacity, better osmotic properties and antioxidant
capability, etc.) without the potential disadvantages of hemodilution
(such as myocardial edema). We sought to perform a systematic review and
meta-analysis to compare microplegia and standard blood cardioplegia on
the cardioprotective effects for patients undergoing coronary artery
bypass grafting (CABG). Methods: MEDLINE, EMBASE and the Cochrane Central
Register of Controlled Trials were searched for relevant controlled trials
published in English, from their inception up to May 15th, 2013. Data on
low output syndrome, spontaneous return to sinus rhythm, volume of
cardioplegia and perioperative myocardial infarction were analyzed.
Results: Five studies, totaling 296 patients, were included out of 77
retrieved citations. The microplegia group used less volume of
cardioplegia (WMD, -514.79 ml, 95%CI: -705.37 ml to -324.21 ml) when
compared with the standard blood cardioplegia group. There were no
statistical differences in the incidence of low output syndrome (RR, 0.95,
95%CI: 0.55 to 1.62), spontaneous return to sinus rhythm (RR, 1.64, 95%CI:
0.61 to 4.41) and perioperative myocardial infarction (RR, 0.62, 95%CI:
0.19 to 2.08). Conclusions: Microplegia was associated with less volume of
cardioplegia, whereas the incidence of spontaneous return to sinus rhythm
and perioperative myocardial infarction were similar, but large controlled
randomized trials are still needed to confirm this.
<33>
Accession Number
2015119559
Authors
Goel S. Sharma A.D. Goyal R. Srivastava M.
Institution
(Goel, Sharma, Goyal, Srivastava) Department of Anaesthesia, Sarswathi
institute of Medical Sciences Hapur, Ghaziabad, Uttar Pradesh, India
Title
A randomized double blind comparative study of intravenous diltiazem and
lignocaine in attenuating haemodynamic stress during laryngoscopy and
endotracheal intubation in western Uttar Pradesh.
Source
Indian Journal of Public Health Research and Development. 5 (4) (pp
309-312), 2014. Date of Publication: 2014.
Publisher
Indian Journal of Public Health Research and Development (Aster-06/603,
Supertech Emerald Court, Sector - 93 A, Expressway, NOIDA, UTTAR PRADESH
201 304, India. E-mail: editor.ijphrd@gmail.com )
Abstract
The procedure of laryngoscopy and endotracheal intubation frequently
induces a cardiovascular stress response characterized by hypertension,
tachycardia, arrhythmias and increased serum concentration of
catecholamines. Our study was undertaken to evaluate and compare the
influence of lignocaine and diltiazem on the cardiovascular responses to
laryngoscopy and intubation. A total of sixty patients of ASA grade I or
II patients, between 18-60 years of age, of either sex, scheduled for
non-cardiac surgery, were selected for the study. Baseline parameters i.e.
heart rate, systolic blood pressure, diastolic blood pressure and mean
arterial pressure were recorded and same parameters were recorded at one
minute interval till the completion of study period. The percentage change
(increase or decrease) was calculated and was analyzed statistically.
There was minimal change in heart rate, systolic blood pressure, diastolic
blood pressure and mean arterial pressure after intubation in patients who
were given diltiazem as compared to lignocaine and was more stable drug.
We concluded that Diltiazem 0.3 mg/kg is able to attenuate the
haemodynamic response better as compared to lignocaine.
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