EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015296631
Authors
Beckmann S. Ivanovic N. Drent G. Ruppar T. Geest S.D.
Institution
(Beckmann, Ivanovic, Geest) University of Basel, Institute of Nursing
Science, Bernoullistrasse 28, Basel CH-4056, Switzerland
(Drent) University of Groningen, Department of Gastroenterology and
Hepatology, University Medical Center Groningen, PO box 30.001, Groningen,
RB 9700, Netherlands
(Ruppar) University of Missouri, Sinclair School of Nursing, S423,
Columbia, MO 65211, United States
(Geest) Health Services and Nursing Research, KU Leuven, Kapucijnenvoer
35, Leuven B-3000, Belgium
Title
Weight gain, overweight and obesity in solid organ transplantation-a study
protocol for a systematic literature review.
Source
Systematic Reviews. 4 (1) , 2015. Article Number: 2. Date of Publication:
January 06, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Overweight and obesity, which have a substantial impact on
health in the general population, have similar prevalence in solid organ
transplant recipients but carry even more serious ramifications. As this
group's use of immunosuppressive medication increases the risk for
comorbidities, e.g. metabolic syndrome and cardiovascular disease, the
prevention of additional risk factors is vital. This systematic review
will be the first to summarize the issue of weight gain, overweight and
obesity concurrently within and across solid organ transplantation. The
three research questions relating to solid organ transplantation are the
following: (1) What are the prevalence and evolution of overweight and
obesity from pre- to post-transplant?; (2) Which pre- and post-transplant
risk factors are associated with post-transplant weight gain, overweight
or obesity? and (3) Which post-transplant patient outcomes and
comorbidities are associated with pre- and post-transplant weight gain,
overweight and obesity? Methods/Design: MEDLINE via PubMed, The Cochrane
Library, Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO
and Excerpta Medica DataBase (EMBASE) will be searched for original
quantitative studies in adult liver, heart, lung or kidney transplant
patients. Topics of interest will be the prevalence and evolution of
overweight and obesity over time, risk factors associated with changes in
weight or body mass index (BMI), overweight and obesity, and the
relationship of weight or BMI with post-transplant outcomes and
comorbidities. Screening of titles and abstracts, full-text reading and
data extraction will be divided between three researchers. Researchers
will cross-check one another's screening decisions for random samples of
studies to adhere as closely as possible to the recommendations of The
Cochrane Collaboration. For quality assessment, a purpose-adapted 19-item
instrument will be used. Effect sizes will be calculated for relationships
investigated in a minimum of five studies. Random effects meta-analysis
with moderator analyses will be conducted if applicable. Discussion: This
systematic review will comprehensively synthesize the existing evidence
concerning weight gain, overweight and obesity in solid organ
transplantation in view of magnitude, influencing factors and associations
with patient outcomes and comorbidities. The results can fuel the
development of interventions to prevent weight gain in the solid organ
transplant population. Systematic review registration: PROSPERO
CRD42014009151

<2>
[Use Link to view the full text]
Accession Number
2015293580
Authors
Barry A.E. Chaney M.A. London M.J.
Institution
(Barry, Chaney) Department of Anesthesia and Critical Care, University of
Chicago, 5841 S. Maryland Ave., MC 4028, Chicago, IL 60637, United States
(London) Department of Anesthesiology Service, University of California,
San Francisco, San Francisco, CA, United States
Title
Anesthetic Management during Cardiopulmonary Bypass: A Systematic Review.
Source
Anesthesia and Analgesia. 120 (4) (pp 749-769), 2015. Date of Publication:
25 Apr 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Cardiopulmonary bypass (CPB) required for cardiac surgery presents unique
challenges to the cardiac anesthesiologist responsible for providing the 3
most basic facets of any anesthetic: amnesia, analgesia, and muscle
relaxation. Unique pathophysiologic changes during CPB result in
pharmacokinetic alterations that impact the serum and tissue
concentrations of IV and volatile anesthetics. Similarly, CPB causes
pharmacodynamic alterations that impact anesthetic efficacy. The clinical
significance of these alterations represents a "moving target" as practice
evolves and the technology of CPB circuitry advances. In addition,
perfusionists choose, modify, and maintain the CPB circuitry and membrane
oxygenator. Thus, their significance may not be fully appreciated by the
anesthesiologist. These issues have a profound impact on the anesthetic
state of the patient. The delivery and maintenance of anesthesia during
CPB present unique challenges. The perfusionist may be directly
responsible for the delivery of anesthetic during CPB, a situation unique
to the cardiac suite. In addition, monitors of anesthetic depth -
assessment of clinical signs, hemodynamic indicators, the bispectral index
monitor, end-tidal anesthetic concentration, or twitch monitoring - are
often absent, unreliable, or directly impacted by the unique
pathophysiology associated with CPB. The magnitude of these challenges is
reflected in the higher incidence of intraoperative awareness during
cardiac surgery. Further complicating matters are the lack of specific
clinical guidelines and varying international policies regarding medical
device specifications that add further layers of complexity and introduce
practice variability both within institutions and among nations. We
performed a systematic survey of the literature to identify where
anesthetic practice during CPB is evidence based (or not), identify gaps
in the literature to guide future investigations, and explore the
implications of evolving surgical practice, perfusion techniques, and
national policies that impact amnesia, analgesia, and muscle relaxation
during CPB.

<3>
[Use Link to view the full text]
Accession Number
2015292750
Authors
Hu F.-B. Cui L.-Q.
Institution
(Hu, Cui) Department of Cardiology, Provincial Hospital Affiliated,
Shandong University, Jinan, Shandong Province, China
(Hu) Department of Cardiology, Jingjiang People's Hospital, No. 28
Zhongzhou Road, Jingjiang, Jiangsu Province 214500, China
Title
Short-term clinical outcomes after hybrid coronary revascularization
versus off-pump coronary artery bypass for the treatment of multivessel or
left main coronary artery disease: A meta-analysis.
Source
Coronary Artery Disease. 26 (6) (pp 526-534), 2015. Date of Publication:
08 Aug 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background Hybrid coronary revascularization (HCR) and off-pump coronary
artery bypass grafting (OPCABG) are both feasible, less invasive
techniques for coronary revascularization. Although both techniques
utilize the left internal mammary artery to left anterior descending
artery graft, HCR uses drug-eluting stents instead of saphenous vein
bypass. It remains unclear whether HCR is equal to, better or worse than
OPCABG. Methods and results A meta-analysis was carried out using a
random-effects model. Seven observational studies were included. There was
no significant difference either in in-hospital mortality [relative risk
(RR) 0.57, 95% confidence interval (CI) 0.13-2.59, P=0.47] or in the MACCE
rate (RR 0.63, 95% CI 0.24-1.64, P=0.34) between the HCR group and the
OPCABG group. A significant difference was observed between the two groups
in the length of hospitalization (RR 0.55, 95% CI 0.13-0.97, P=0.01),
length of ICU stay (RR 0.45, 95% CI 0.10-0.80, P<0.05), intubation time
(RR 0.48, 95% CI 0.13-0.84, P<0.01), need for red blood transfusion (RR
0.67, 95% CI 0.56-0.82, P<0.001), and total in-hospital costs (RR 0.90,
95% CI 0.39-1.42, P<0.01). Conclusion Compared with OPCABG, HCR did not
improve early survival but decreased the length of hospitalization, length
of ICU stay, intubation time, and need for red blood transfusion, and
increased total in-hospitalcosts.

<4>
Accession Number
2015290088
Authors
Hooper C.E. Edey A.J. Wallis A. Clive A.O. Morley A. White P. Medford
A.R.L. Harvey J.E. Darby M. Zahan-Evans N. Maskell N.A.
Institution
(Hooper, Clive, Maskell) Academic Respiratory Unit, School of Clinical
Sciences, University of Bristol, Bristol BS10 5NB, United Kingdom
(Hooper, Clive, Morley, Medford, Harvey, Zahan-Evans, Maskell) Pleural
Clinical Trials Unit, North Bristol Lung Centre, Southmead Hospital,
Bristol, United Kingdom
(Edey, Wallis, Darby) Department of Radiology, Southmead Hospital, North
Bristol NHS Trust, Bristol, United Kingdom
(White) Statistical Department, University of West of England, Bristol,
United Kingdom
Title
Pleural irrigation trial (PIT): A randomised controlled trial of pleural
irrigation with normal saline versus standard care in patients with
pleural infection.
Source
European Respiratory Journal. 46 (2) (pp 456-463), 2015. Date of
Publication: 01 Aug 2015.
Publisher
European Respiratory Society
Abstract
Pleural infection is increasing in incidence. Despite optimal medical
management, up to 30% of patients will die or require surgery. Case
reports suggest that irrigation of the pleural space with saline may be
beneficial. A randomised controlled pilot study in which saline pleural
irrigation (three times per day for 3 days) plus best-practice management
was compared with best-practice management alone was performed in patients
with pleural infection requiring chest-tube drainage. The primary outcome
was percentage change in computed tomography pleural fluid volume from day
0 to day 3. Secondary outcomes included surgical referral rate, hospital
stay and adverse events. 35 patients were randomised. Patients receiving
saline irrigation had a significantly greater reduction in pleural
collection volume on computed tomography compared to those receiving
standard care (median (interquartile range) 32.3% (19.6-43.7%) reduction
versus 15.3% (-5.5-28%) reduction) ( p<0.04). Significantly fewer patients
in the irrigation group were referred for surgery (OR 7.1, 95% CI
1.23-41.0; p=0.03). There was no difference in length of hospital stay,
fall in C-reactive protein, white cell count or procalcitonin or adverse
events between the treatment groups, and no serious complications were
documented. Saline irrigation improves pleural fluid drainage and reduces
referrals for surgery in pleural infection. A large multicentre randomised
controlled trial is now warranted to evaluate its effects further.

<5>
Accession Number
2015290675
Authors
Katzenellenbogen J.M. Woods J.A. Teng T.-H.K. Thompson S.C.
Institution
(Katzenellenbogen, Woods, Teng, Thompson) The University of Western
Australia (M706), Western Australian Centre for Rural Health, 35 Stirling
Highway, Crawley, WA 6009, Australia
(Katzenellenbogen) The University of Western Australia (M431), School of
Population Health, 35 Stirling Highway, Crawley, WA 6009, Australia
Title
Atrial fibrillation in the Indigenous populations of Australia, Canada,
New Zealand, and the United States: A systematic scoping review.
Source
BMC Cardiovascular Disorders. 15 (1) , 2015. Article Number: 87. Date of
Publication: August 13, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: The epidemiology of atrial fibrillation (AF) among Indigenous
minorities in affluent countries is poorly delineated, despite the high
cardiovascular disease burden in these populations. We undertook a
systematic scoping review examining the epidemiology of AF in the
Indigenous populations of Australia, Canada, New Zealand (NZ) and the
United States (US). Methods: PubMed, Scopus, EMBASE and CINAHL-Plus
databases were systematically searched in May 2014. Supplementary
full-text searches of Google Scholar and government website searches were
also undertaken. Results: Key findings from 27 publications with diverse
aims and methods were included. Small studies from Canada and NZ suggest
higher AF prevalence in Indigenous than other populations. However, this
was not reflected in a large sample of US male military veterans. No data
were identified on community-based incidence rates of AF in Indigenous
populations. Australian and Canadian studies indicate higher first-ever
and overall AF hospitalisation rates among Indigenous than other
populations, at younger ages and with more comorbidity. Studies in stroke,
heart failure and other clinical groups demonstrate AF as a common
comorbidity, with AF possibly more prevalent at younger ages in Indigenous
people. Indigenous patients have similar early post-hospitalisation
adjusted mortality but higher 1-year risk-adjusted mortality than
non-Indigenous patients. Conclusions: No clear epidemiological pattern of
AF frequency across the considered Indigenous populations emerges from the
limited available evidence. AF should be included in key conditions
reported in national surveillance reports, although Indigenous identifiers
are required in administrative data from Canada and the US. Sufficiently
powered, community-based studies of AF epidemiology in diverse Indigenous
populations are needed.

<6>
Accession Number
2015286361
Authors
Erdas E. Medas F. Podda F. Furcas S. Pisano G. Nicolosi A. Calo P.G.
Institution
(Erdas, Medas, Podda, Furcas, Pisano, Nicolosi, Calo) Chirurgia Generale
A, Policlinico Universitario di Monserrato, AOU di Cagliari, Italy
Title
The use of a biologic topical haemostatic agent (TachoSil) for
the prevention of postoperative bleeding in patients on antithrombotic
therapy undergoing thyroid surgery: A randomised controlled pilot trial.
Source
International Journal of Surgery. 20 (pp 95-100), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Anticoagulants and antiplatelet agents are well-known risk
factors for post-operative bleeding. The aim of this prospective,
randomized pilot study was to evaluate the effectiveness of a topical
haemostatic agent, namely TachoSil, for the prevention of postoperative
bleeding in patients on antithrombotic therapy undergoing thyroidectomy.
Perioperative management and some distinctive aspects of cervical
haematomas were also discussed. Methods: Between January 2012 and May
2014, all patients taking vitamin K antagonists (VKAs) or acetyl salicylic
acid (ASA) scheduled for total thyroidectomy were enrolled and randomly
allocated to group 1 (standard haemostasis) and group 2 (standard
haemostasis + TachoSil). Antithrombotic drugs were always suspended prior
to surgery and, when indicated, replaced by bridging anticoagulation with
low-molecular-weight heparin. The primary endpoint was the incidence of
postoperative cervical haematomas. Results: A total of 70 patients were
included in the study, representing 8.5% (70/820) of all patients who
underwent thyroidectomies in the same period. The overall rate of
post-operative cervical haematoma was 7.1% (5/70) and reached 14.8% (4/27)
in patients on VKA therapy. All but one occurred more than 24 h after
surgery (32nd hour, 8th, 10th, and 13th days). Group 1 (37 patients) and
group 2 (33 patients) were well-matched according to clinical and
demographic features. Postoperative haematoma was observed in 2/37
patients (5.4%) recruited in the Group 1 and 3/33 patients (9.1%)
recruited in the Group 2 (P = 0.661). Conclusions: Patients taking
antithrombotic drugs represent a major problem in thyroid surgery. The
incidence of bleeding after thyroidectomy is significantly high and the
use of TachoSil do not seem effective in preventing its occurrence.
However, larger multicenter study is needed to confirm these results.

<7>
Accession Number
2015285583
Authors
Levsky J.M. Spevack D.M. Travin M.I. Menegus M.A. Huang P.W. Clark E.T.
Kim C.-W. Hirschhorn E. Freeman K.D. Tobin J.N. Haramati L.B.
Institution
(Levsky, Haramati) Division of Cardiothoracic Imaging, Department of
Radiology, Montefiore Medical Center, Albert Einstein College of Medicine,
111 East 210th Street, Bronx, NY 10467-2490, United States
(Spevack, Menegus) Division of Cardiology, Department of Medicine,
Montefiore Medical Center, Albert Einstein College of Medicine, 111 East
210th Street, Bronx, NY 10467-2490, United States
(Travin) Division of Nuclear Medicine, Department of Radiology, Montefiore
Medical Center, Albert Einstein College of Medicine, 111 East 210th
Street, Bronx, NY 10467-2490, United States
(Huang) Division of Hospital Medicine, Department of Medicine, Montefiore
Medical Center, Albert Einstein College of Medicine, 111 East 210th
Street, Bronx, NY 10467-2490, United States
(Clark) Cohen Children's Medical Center, 269-01 76th Avenue, New Hyde
Park, NY 11040, United States
(Kim) Department of Radiology, Stony Brook School of Medicine, 100 Nicolls
Road, Stony Brook, NY 11794-8460, United States
(Hirschhorn) 1925 Eastchester Road, Bronx, NY 10461, United States
(Freeman) Extrapolate Statistics, 1145 Harbor Drive, Delray Beach, FL
33483, United States
(Tobin) 5 West 37th Street, New York, NY 10018, United States
Title
Coronary computed tomography angiography versus radionuclide myocardial
perfusion imaging in patients with chest pain admitted to telemetry: A
randomized trial.
Source
Annals of Internal Medicine. 163 (3) (pp 174-183), 2015. Date of
Publication: 04 Aug 2015.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: The role of coronary computed tomography angiography (CCTA) in
the management of symptomatic patients suspected of having coronary artery
disease is expanding. However, prospective intermediate-term outcomes are
lacking. Objective: To compare CCTA with conventional noninvasive testing.
Design: Randomized, controlled comparative effectiveness trial.
(ClinicalTrials.gov: NCT00705458) Setting: Telemetry-monitored wards of an
inner-city medical center. Patients: 400 patients with acute chest pain
(mean age, 57 years); 63% women; 54% Hispanic and 37% African-American;
and low socioeconomic status. Intervention: CCTA or radionuclide stress
myocardial perfusion imaging (MPI). Measurements: The primary outcome was
cardiac catheterization not leading to revascularization within 1 year.
Secondary outcomes included length of stay, resource utilization, and
patient experience. Safety outcomes included death, major cardiovascular
events, and radiation exposure. Results: Thirty (15%) patients who had
CCTA and 32 (16%) who had MPI underwent cardiac catheterization within 1
year. Fifteen (7.5%) and 20 (10%) of these patients, respectively, did not
undergo revascularization (difference, -2.5 percentage points [95% CI,
-8.6 to 3.5 percentage points]; hazard ratio, 0.77 [CI, 0.40 to 1.49]; P =
0.44). Median length of stay was 28.9 hours for the CCTA group and 30.4
hours for the MPI group (P = 0.057). Median follow-up was 40.4 months. For
the CCTA and MPI groups, the incidence of death (0.5% versus 3%; P =
0.12), nonfatal cardiovascular events (4.5% versus 4.5%),
rehospitalization (43% versus 49%), emergency department visit (63% versus
58%), and outpatient cardiology visit (23% versus 21%) did not differ.
Long-term, all-cause radiation exposure was lower for the CCTA group (24
versus 29 mSv; P < 0.001). More patients in the CCTA group graded their
experience favorably (P = 0.001) and would undergo the examination again
(P = 0.003). Limitation: This was a single-site study, and the primary
outcome depended on clinical management decisions. Conclusion: The CCTA
and MPI groups did not significantly differ in outcomes or resource
utilization over 40 months. Compared with MPI, CCTA was associated with
less radiation exposure and with a more positive patient experience.

<8>
Accession Number
2015255890
Authors
Wendt D. Kleinbongard P. Knipp S. Al-Rashid F. Gedik N. El Chilali K.
Schweter S. Schlamann M. Kahlert P. Neuhauser M. Forsting M. Erbel R.
Heusch G. Jakob H. Thielmann M.
Institution
(Wendt, Knipp, Schweter, Jakob, Thielmann) Department of Thoracic and
Cardiovascular Surgery, West-German Heart and Vascular Center Essen,
University Hospital Essen, Essen, Germany
(Kleinbongard, Gedik, Heusch) Institute for Pathophysiology, West-German
Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
(Al-Rashid, El Chilali, Kahlert, Erbel) Department of Cardiology,
West-German Heart and Vascular Center Essen, University Hospital Essen,
Essen, Germany
(Schlamann, Forsting) Institute of Diagnostic and Interventional Radiology
and Neuroradiology, University Hospital Essen, Essen, Germany
(Neuhauser) Department of Mathematics and Technology, Koblenz University
of Applied Science, Remagen, Germany
Title
Intraaortic Protection From Embolization in Patients Undergoing
Transaortic Transcatheter Aortic Valve Implantation.
Source
Annals of Thoracic Surgery. 100 (2) (pp 686-691), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Elsevier USA
Abstract
Purpose. Transcatheter aortic valve implantation (TAVI) results in the
dislodgement of debris with risk of cerebral lesions or stroke. The
EMBOL-X protection device (Edwards Lifesciences, Irvine, CA) is positioned
within the ascending aorta to capture such debris. Description. Between
July 2012 and April 2014 we randomly assigned 30 high-risk patients to
undergo transaortic TAVI with the SAPIEN XT prosthesis (Edwards
Lifesciences) combined with either the EMBOL-X device (group-1, n = 14) or
without (group-2, n = 16). Periprocedural cerebral lesions were assessed
by diffusion-weighted magnetic resonance imaging (DW-MRI) at baseline and
within 7 days post-procedurally. Evaluation. New foci of restricted
diffusion on cerebral DW-MRI were found in 69% in group-2 and 50% in
group-1. Lesion size was smaller in patients treated with the EMBOL-X
device than in those without (88 +/- 60 vs 168 +/- 217 mm³, p =
0.27, t = 1.2, degrees of freedom = 10). Transaortic TAVI patients treated
with the EMBOL-X device had significantly smaller lesion volumes in the
supply region of the middle cerebral artery (33 +/- 29 vs 76 +/- 67
mm³, p = 0.04). There were no neurologic events after
transaortic TAVI. Conclusions. The intraaortic protection device seems to
reduce both the incidence and the volume of new cerebral lesions
(ClinicalTrials.gov number, NCT01735513).

<9>
Accession Number
2015194112
Authors
Mishra P. Thekkudan J. Sahajanandan R. Gravenor M. Lakshmanan S. Fayaz K.
Luckraz H.
Institution
(Mishra, Thekkudan, Luckraz) Department of Cardiothoracic Surgery, Heart
and Lung Centre, Wolverhampton WV10 0QP, United Kingdom
(Sahajanandan, Lakshmanan, Fayaz) Department of Cardiothoracic
Anaesthesiology, Heart and Lung Centre, Wolverhampton WV10 0QP, United
Kingdom
(Gravenor) Institute of Life Science, College of Medicine, Swansea SA2
8PP, United Kingdom
Title
The role of point-of-care assessment of platelet function in predicting
postoperative bleeding and transfusion requirements after coronary artery
bypass grafting.
Source
Annals of Cardiac Anaesthesia. 18 (1) (pp 45-51), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: Objective platelet function assessment after cardiac surgery
can predict postoperative blood loss, guide transfusion requirements and
discriminate the need for surgical re-exploration. We conducted this study
to assess the predictive value of point-of-care testing platelet function
using the Multiplate device. Methods: Patients undergoing
isolated coronary artery bypass grafting were prospectively recruited ( n
= 84). Group A ( n = 42) patients were on anti-platelet therapy until
surgery; patients in Group B ( n = 42) stopped anti-platelet treatment at
least 5 days preoperatively. Multiplate and thromboelastography
(TEG) tests were performed in the perioperative period. Primary end-point
was excessive bleeding (>2.5 ml/kg/h) within first 3 h postoperative.
Secondary end-points included transfusion requirements, re-exploration
rates, intensive care unit and in-hospital stays. Results: Patients in
Group A had excessive bleeding (59% vs. 33%, P = 0.02), higher
re-exploration rates (14% vs. 0%, P < 0.01) and higher rate of blood (41%
vs. 14%, P < 0.01) and platelet (14% vs. 2%, P = 0.05) transfusions. On
multivariate analysis, preoperative platelet function testing was the most
significant predictor of excessive bleeding (odds ratio [OR]: 2.3, P =
0.08), need for blood (OR: 5.5, P < 0.01) and platelet transfusion (OR:
15.1, P < 0.01). Postoperative "ASPI test" best predicted the need for
transfusion (sensitivity - 0.86) and excessive blood loss (sensitivity -
0.81). TEG results did not correlate well with any of these outcome
measures. Conclusions: Peri-operative platelet functional assessment with
Multiplate was the strongest predictor for bleeding and
transfusion requirements in patients on anti-platelet therapy until the
time of surgery. Study registration: ISRCTN43298975
(http://www.controlled-trials.com/ISRCTN43298975/).

<10>
Accession Number
2015194107
Authors
Muthialu N. Balakrishnan S. Sundar R. Muralidharan S.
Institution
(Muthialu, Muralidharan) Departments of Cardiothoracic Surgery, G
Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
(Balakrishnan, Sundar) Anaesthesiology and Critical Care, G Kuppuswamy
Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
Title
Efficacy of tranexamic acid as compared to aprotinin in open heart surgery
in children.
Source
Annals of Cardiac Anaesthesia. 18 (1) (pp 23-26), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Coagulopathy is a major issue in children undergoing high?risk
pediatric cardiac surgery. Use of anti?fibrinolytics is well documented in
adults, but recently there are questions raised about safety and
effectiveness of their use on routine use. Tranexamic acid is a potent
anti?fibrinolytic, but its role is not fully understood in children. This
study aims to study the benefits tranexamic acid in controlling
postoperative bleeding in pediatric cardiac surgical patients. Methods and
Results: Fifty consecutive children who underwent cardiac surgery were
randomized prospectively to receive either aprotinin (Group A; n = 24) or
tranexamic acid (Group B; n = 26) from September 2009 to February 2010
were studied. Primary end points were early mortality, postoperative
drainage, reoperation for bleeding and complications. Mean age and body
weight was smaller in Group A (Age: 48.55 vs. 64.73 months; weight 10.75
vs. 14.80 kg) respectively. Group A had more cyanotic heart disease than
Group B (87.5% vs. 76.92%). Mean cardiopulmonary bypass time (144.33 vs.
84.34 min) and aortic cross?clamp time (78.5 vs. 41.46 min) were
significantly higher in group A. While the blood and products usage was
significantly higher in Group A, there was no difference in indexed
postoperative drainage in first 4, 8 and 12 h and postoperative
coagulation parameters. Mean C?reactive protein was less in Group A than B
and renal dysfunction was seen more in Group A (25% vs. 7.6%). Mortality
in Group A was 16.66% and 7.6% in Group B. Conclusion: Anti?fibrinolytics
have a definitive role in high?risk children who undergo open?heart
surgery. Tranexamic acid is as equally effective as aprotinin with no
additional increase in morbidity or mortality. Ultramini Abstract:
Coagulopathy has been a major issue in pediatric cardiac surgery, and
anti?fibrinolytics have been used fairly regularly in various settings.
This study aims to evaluate the efficacy of tranexamic acid as compared
against that of aprotinin in a randomized model. Tranexamic acid proves to
be equally effective with less toxicity with no added mortality.

<11>
Accession Number
2015194105
Authors
Nasr D. Abdelhamid H. Mohsen M. Aly A.
Institution
(Nasr, Abdelhamid, Mohsen) Department of Anesthesia and Intensive Care
Medicine, Ain Shams University Hospitals, 6, Tawfikia Zone, Mostafa
El-Nahas Street, 8th, District, Nasr City, Cairo, Egypt
(Aly) Department of Cardiothoracic Surgery, Ain Shams University
Hospitals, Cairo, Egypt
Title
The analgesic efficacy of continuous presternal bupivacaine infusion
through a single catheter after cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 18 (1) (pp 15-20), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Median sternotomy, sternal spreading, and sternal wiring are
the main causes of pain during the early recovery phase following cardiac
surgery. Aim: This study was designed to evaluate the analgesic efficacy
of continuous presternal bupivacaine infusion through a single catheter
after parasternal block following cardiac surgery. Materials and Methods:
The total of 40 patients (American Society of Anesthesiologist status II,
III), 45-60 years old, undergoing coronary - artery bypass grafting were
enrolled in this prospective, randomized, double?blind study. A presternal
catheter was inserted with continuous infusion of 5 mL/h bupivacaine 0.25%
(Group B) or normal saline (Group C) during the first 48 postoperative
hrs. Primary outcomes were postoperative morphine requirements and pain
scores, secondary outcomes were extubation time, postoperative respiratory
parameters, incidence of wound infection, Intensive Care Unit (ICU) and
hospital stay duration, and bupivacaine level in blood. Statistical
Methods: Student's t?test was used to analyze the parametric data and
Chi?square test for categorical variables. Results: During the
postoperative 48 h, there was marked reduction in morphine requirements in
Group B compared to Group C, (8.6 +/- 0.94 mg vs. 18.83 +/- 3.4 mg
respectively, P = 0.2), lower postoperative pain scores, shorter
extubation time (117 +/- 10 min vs. 195 +/- 19 min, respectively, P =
0.03), better respiratory parameters (PaO<inf>2</inf>/ FiO<inf>2</inf>,
PaCO<inf>2</inf> and pH), with no incidence of wound infection, no
differences in ICU or hospital stay duration. The plasma concentration of
bupivacaine remained below the toxic threshold (at T24, 1.2 ug/ml +/- 0.3
and T48 h 1.7 +/- 0.3 ug/ml). Conclusion: Continuous presternal
bupivacaine infusion has resulted in better postoperative analgesia,
reduction in morphine requirements, shorter time to extubation, and better
postoperative respiratory parameters than the control group.

<12>
Accession Number
2015253343
Authors
Gong X. Zhu T. Zhang Q. Zhang Y. Wang X. Yang Z. Li C.
Institution
(Wang, Gong, Zhu, Zhang, Yang, Li) Department of Cardiology, The First
Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029,
China
(Wang) Department of Cardiology, Maanshan people's Hospital, Maanshan,
Anhui 243000, China
(Zhu) Department of Cardiology, Jiangning People's Hospital, Nanjing,
Jiangsu, China
(Zhang) Department of Cardiology, The Second People's Hospital of
Changzhou City, Changzhou, Jiangsu, China
(Zhang, Wang) Department of Cardiac-thoracic Surgery, The First Affiliated
Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
Title
Clopidogrel improves aspirin response after off-pump coronary artery
bypass surgery.
Source
Journal of Biomedical Research. 28 (2) (pp 108-113), 2014. Date of
Publication: 2014.
Publisher
Nanjing Medical University
Abstract
We sought to assess the incidence of aspirin resistance after off-pump
coronary artery bypass (OPCAB) surgery, and investigate whether
clopidogrel can improve aspirin response and be safely applied early after
OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were
randomized into two groups. One group (30 patients) received
mono-antiplatelet treatment (MAPT) with aspirin 100 mg daily and the other
group received dual antiplatelet treatment (DAPT) with aspirin 100 mg
daily plus clopidogrel 75 mg daily. Platelet aggregations in response to
arachidonic acid (PLAA) and adenosine diphosphate (ADP) (PLADP) were
measured preoperatively and on days 1 to 6, 8 and 10 after the
antiplatelet agents were administered. A PLAA level above 20% was defined
as aspirin resistance. Postoperative bleeding and other perioperative
variables were also recorded. There were no significant differences
between the two groups in baseline characteristics, average number of
distal anastomosis, operation time, postoperative bleeding, ventilation
time and postoperative hospital stay. However, the incidence of aspirin
resistance was significantly lower in the DAPT group than that in the MAPT
group on the first and second day after antiplatelet agents were given
(62.1% vs. 32.1%, 34.5% vs. 10.7%, respectively, both P < 0.05). There was
no significant difference in postoperative complication between the two
groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB
patients early after the procedure. Moreover, clopidogrel reduces the
incidence of OPCAB-related aspirin resistance.

<13>
Accession Number
2015254792
Authors
Tzimas P. Petrou A. Laou E. Milionis H. Mikhailidis D.P. Papadopoulos G.
Institution
(Tzimas, Petrou, Laou, Papadopoulos) Department of Anaesthesia and
Postoperative Intensive Care, School of Medicine, University of Ioannina,
Ioannina University Campus, Stavros Niarchos Ave., Ioannina 45110, Greece
(Milionis) Department of Internal Medicine, School of Medicine, University
of Ioannina, Ioannina University Campus, Stavros Niarchos Ave., Ioannina
45110, Greece
(Mikhailidis) Department of Clinical Biochemistry (Vascular Disease
Prevention Clinics), Royal Free Hospital Campus, University College London
Medical School, University College London (UCL), Pond Street, London NW3
2QG, United Kingdom
Title
Impact of metabolic syndrome in surgical patients: Should we bother?.
Source
British Journal of Anaesthesia. 115 (2) (pp 194-202), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Clinicians inevitably encounter patients who meet the diagnostic criteria
for the metabolic syndrome (MetS); these criteria include central obesity,
hypertension, atherogenic dyslipidaemia, and hyperglycaemia. Regardless of
the variations in its definition, MetS may be associated with adverse
outcomes in patients undergoing both cardiac and non-cardiac surgery.
There is a paucity of data concerning the anaesthetic management of
patients with MetS, and only a few observational (mainly retrospective)
studies have investigated the association of MetS with perioperative
outcomes. In this narrative review, we consider the impact of MetS on the
occurrence of perioperative adverse events after cardiac and non-cardiac
surgery. Metabolic syndrome has been associated with higher rates of
cardiovascular, pulmonary, and renal perioperative events and wound
infections compared with patients with a non-MetS profile. Metabolic
syndrome has also been related to increased health service costs,
prolonged hospital stay, and a greater need for posthospitalization care.
Therefore, physicians should be able to recognize the MetS in the
perioperative period in order to formulate management strategies that may
modify any perianaesthetic and surgical risk. However, further research is
needed in this field.

<14>
Accession Number
2015252472
Authors
Whiting P. Al M. Westwood M. Ramos I.C. Ryder S. Armstrong N. Misso K.
Ross J. Severens J. Kleijnen J.
Institution
(Whiting, Westwood, Ryder, Armstrong, Misso, Ross) Kleijnen Systematic
Reviews Ltd, York, United Kingdom
(Al, Ramos, Severens) Institute of Health Policy and Management, Erasmus
University Rotterdam, Rotterdam, Netherlands
(Kleijnen) School for Public Health and Primary Care (CAPHRI), Maastricht
University, Maastricht, Netherlands
Title
Viscoelastic point-of-care testing to assist with the diagnosis,
management and monitoring of haemostasis: A systematic review and
cost-effectiveness analysis.
Source
Health Technology Assessment. 19 (58) (pp 1-228), 2015. Date of
Publication: 01 Jul 2015.
Publisher
NIHR Journals Library
Abstract
Background: Patients with substantive bleeding usually require transfusion
and/or (re-)operation. Red blood cell (RBC) transfusion is independently
associated with a greater risk of infection, morbidity, increased hospital
stay and mortality. ROTEM (ROTEM Delta, TEM International GmbH, Munich,
Germany; www.rotem.de), TEG (TEG 5000 analyser, Haemonetics Corporation,
Niles, IL, USA; www.haemonetics.com) and Sonoclot (Sonoclot coagulation
and platelet function analyser, Sienco Inc., Arvada, CO) are point-of-care
viscoelastic (VE) devices that use thromboelastometry to test for
haemostasis in whole blood. They have a number of proposed advantages over
standard laboratory tests (SLTs): they provide a result much quicker, are
able to identify what part of the clotting process is disrupted, and
provide information on clot formation over time and fibrinolysis.
Objectives: This assessment aimed to assess the clinical effectiveness and
cost-effectiveness of VE devices to assist with the diagnosis, management
and monitoring of haemostasis disorders during and after cardiac surgery,
trauma-induced coagulopathy and post-partum haemorrhage (PPH). Methods:
Sixteen databases were searched to December 2013: MEDLINE (OvidSP),
MEDLINE In-Process and Other Non-Indexed Citations and Daily Update
(OvidSP), EMBASE (OvidSP), BIOSIS Previews (Web of Knowledge), Science
Citation Index (SCI) (Web of Science), Conference Proceedings Citation
Index (CPCI-S) (Web of Science), Cochrane Database of Systematic Reviews
(CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database
of Abstracts of Reviews of Effects (DARE), Health Technology Assessment
(HTA) database, Latin American and Caribbean Health Sciences Literature
(LILACS), International Network of Agencies for Health Technology
Assessment (INAHTA), National Institute for Health Research (NIHR) HTA
programme, Aggressive Research Intelligence Facility (ARIF), Medion, and
the International Prospective Register of Systematic Reviews (PROSPERO).
Randomised controlled trials (RCTs) were assessed for quality using the
Cochrane Risk of Bias tool. Prediction studies were assessed using
QUADAS-2. For RCTs, summary relative risks (RRs) were estimated using
random-effects models. Continuous data were summarised narratively. For
prediction studies, the odds ratio (OR) was selected as the primary effect
estimate. The health-economic analysis considered the costs and
quality-adjusted life-years of ROTEM, TEG and Sonoclot compared with SLTs
in cardiac surgery and trauma patients. A decision tree was used to take
into account short-term complications and longer-term side effects from
transfusion. The model assumed a 1-year time horizon. Results: Thirty-one
studies (39 publications) were included in the clinical effectiveness
review. Eleven RCTs (n = 1089) assessed VE devices in patients undergoing
cardiac surgery; six assessed thromboelastography (TEG) and five assessed
ROTEM. There was a significant reduction in RBC transfusion [RR 0.88, 95%
confidence interval (CI) 0.80 to 0.96; six studies], platelet transfusion
(RR 0.72, 95% CI 0.58 to 0.89; six studies) and fresh frozen plasma to
transfusion (RR 0.47, 95% CI 0.35 to 0.65; five studies) in VE testing
groups compared with control. There were no significant differences
between groups in terms of other blood products transfused. Continuous
data on blood product use supported these findings. Clinical outcomes did
not differ significantly between groups. There were no apparent
differences between ROTEM or TEG; none of the RCTs evaluated Sonoclot.
There were no data on the clinical effectiveness of VE devices in trauma
patients or women with PPH. VE testing was cost-saving and more effective
than SLTs. For the cardiac surgery model, the cost-saving was 43 for
ROTEM, 79 for TEG and 132 for Sonoclot. For the trauma population, the
cost-savings owing to VE testing were more substantial, amounting to
per-patient savings of 688 for ROTEM compared with SLTs, 721 for TEG, and
818 for Sonoclot. This finding was entirely dependent on material costs,
which are slightly higher for ROTEM. VE testing remained cost-saving
following various scenario analyses. Conclusions: VE testing is
cost-saving and more effective than SLTs, in both patients undergoing
cardiac surgery and trauma patients. However, there were no data on the
clinical effectiveness of Sonoclot or of VE devices in trauma patients.
Study registration: This study is registered as PROSPERO CRD42013005623.
Funding: The NIHR Health Technology Assessment programme.

<15>
Accession Number
2015250340
Authors
Koch K.T. Grundeken M.J. Vos N.S. IJsselmuiden A.J.J. Van Geuns R.-J.
Wessely R. Dengler T. La Manna A. Silvain J. Montalescot G. Spaargaren R.
Tijssen J.G.P. Amoroso G.
Institution
(Koch, Grundeken, Tijssen) Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Vos, Amoroso) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(IJsselmuiden) Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands
(Van Geuns) Erasmus Medical Center, Rotterdam, Netherlands
(Wessely) Cologne Cardiovascular and Chest Center, Cologne, Germany
(Dengler) SLK Kliniken, Heilbronn, Germany
(La Manna) Ospedale Ferrarotto, Catania, Italy
(Silvain, Montalescot) CHU la Pitie-Salpetriere (AP-HP), ACTION Study
Group, Univ Paris 06, Paris, France
(Spaargaren) STENTYS S.A, Paris, France
Title
One-year clinical outcomes of the STENTYS Self-Apposing coronary stent in
patients presenting with ST-segment elevation myocardial infarction:
Results from the APPOSITION III registry.
Source
EuroIntervention. 11 (3) (pp 264-271), 2015. Date of Publication: 01 Jul
2015.
Publisher
EuroPCR
Abstract
Aims: The aim of APPOSITION III was to evaluate the feasibility and
performance of the STENTYS Self-Apposing stent (STENTYS S.A., Paris,
France) in the setting of primary percutaneous coronary intervention
(PCI). Methods and results: APPOSITION III was an international,
prospective, multicentre registry. The study population consisted of 965
patients. The rate of the primary endpoint major adverse cardiac events
(MACE), defined as the composite of cardiac death, recurrent target vessel
myocardial infarction (TV-MI), and clinically driven target lesion
revascularisation (CD-TLR), at one year was 9.3%. One-year cardiac death
rate was 2.0%, TV-MI rate was 1.3%, CD-TLR rate was 7.4% and
definite/probable stent thrombosis (ST) rate was 3.5% (definite ST 2.8%).
An interim safety analysis of in-hospital outcomes in the first 400
patients showed higher event rates if post-dilation was not performed, and
post-dilations became highly recommended in the remaining cohort. Patients
undergoing post-dilation eventually showed a numerically lower one-year
MACE rate (8.4% vs. 11.3%, p=0.137). One-year TV-MI (0.8% vs. 2.5%,
p=0.027) and definite ST (1.9% vs. 5.0%, p=0.010) rates were significantly
lower if post-dilation was performed, with the divergence occurring at <30
days. Conclusions: The use of the STENTYS Self-Apposing stent in the
setting of primary PCI was feasible and associated with acceptable
cardiovascular event rates which improved when post-dilation was
performed.