Total documents retrieved: 47
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Embase <1980 to 2015 Week 46>
Embase (updates since 2015-11-05)
<1>
Accession Number
2015758761
Authors
Drakouli M. Petsios K. Giannakopoulou M. Patiraki E. Voutoufianaki I.
Matziou V.
Institution
(Drakouli, Giannakopoulou, Patiraki, Matziou) Faculty of Nursing, National
and Kapodistrian University of Athens, Athens, Greece
(Drakouli, Petsios, Voutoufianaki) Cardiac-Cardiosurgical PICU, Onassis
Cardiac Surgery Center (O.C.S.C.), 356 Sygrou Avenue, Athens, Greece
Title
Determinants of quality of life in children and adolescents with CHD: A
systematic review.
Source
Cardiology in the Young. 25 (6) (pp 1027-1036), 2015. Date of Publication:
24 Jul 2014.
Publisher
Cambridge University Press
Abstract
Purpose This review aims to outline a systematic approach for the
assessment of quality of life in children and adolescents with CHD and to
cite its main determinants. Methods A systematic critical literature
search in PubMed, Scopus, and Cinahl databases resulted in 954 papers
published after 2000. After the quality assessment, 32 original articles
met the inclusion criteria. Results Methodological quality of the included
studies varied greatly, showing a moderate quality. Impaired quality of
life was associated with more severe cardiac lesions. Children with CHD,
after cardiac surgery, reported diminished quality of life concerning
physical, psycho-social, emotional, and school functioning. The majority
of clinical studies showed significant differences among children and
their parents' responses regarding their quality of life, with a tendency
of children to report greater quality of life scores than their parents.
According to our analysis, concerning children with CHD, the most cited
determinants of their quality of life were as follows: (a) parental
support; (b) lower socio-economic status; (c) limitations due to physical
impairment; (d) sense of coherence; as well as (e) the level of child's
everyday anxiety and depression. These findings suggest that differences
in quality of life issues may exist across lesion severities. Conclusion
Quality of life in children with CHD should be assessed according to age;
severity; therapeutic approach; acceptance of the disease; and personality
features. Effective management and early recognition of significant
impairments in quality of life could impact clinical outcomes in children
with CHD.
<2>
Accession Number
2015839199
Authors
Schramko A. Suojaranta-Ylinen R. Niemi T. Pesonen E. Kuitunen A. Raivio P.
Salmenpera M.
Institution
(Schramko, Suojaranta-Ylinen, Niemi, Pesonen, Salmenpera) Department of
Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital,
Melahti Hospital, PO Box 340, Helsinki FI-00029 HUS, Finland
(Kuitunen) Department of Intensive Care, Tampere University Hospital,
Tampere, Finland
(Raivio) Department of Cardiothoracic Surgery, Helsinki University
Hospital, Meilahti Hospital, Helsinki, Finland
Title
The use of balanced HES 130/0.42 during complex cardiac surgery; Effect on
blood coagulation and fluid balance: A randomized controlled trial.
Source
Perfusion (United Kingdom). 30 (3) (pp 224-232), 2015. Date of
Publication: 19 Apr 2015.
Publisher
SAGE Publications Ltd
Abstract
Introduction: Colloids and crystalloid are used during cardiac surgery for
priming of the cardiopulmonary bypass (CPB) circuit. Colloids may decrease
postoperative fluid balance because of their high oncotic pressure and low
risk of fluid extravasation. On the other hand, colloids have been shown
to impair blood coagulation. Materials and methods: In a prospective,
randomized, double-blinded study, 50 patients scheduled for coronary
artery bypass grafting or a valve procedure were planned to be randomized
to receive either balanced 6% HES130/0.42 or Ringer-acetate solution for
CPB priming. Randomization was stopped prematurely after 35 randomized
patients (19 in the HES and 16 in the Ringer groups) because of the
published report where HES130/0.42 was associated with impaired renal
function. Effects on haemostasis and fluid balance were investigated.
Results: The rotational thromboelastometry (ROTEM) parameters and chest
tube drainage on the first postoperative morning (1POM) were comparable
between the groups (p>0.05). However, patients in the HES group needed
more blood and blood product transfusions. The total volume administered
into the CPB circuit was lower in the HES than in the Ringer (RIN) group,
2905+/-1049 mL versus 3973+/-1207 mL (p=0.011), but there was no
statistically significant difference in total fluid balance on the 1POM
(5086+/-1660 mL in the HES group versus 5850+/-1514 mL in the RIN group,
respectively). Conclusions: After complex cardiac surgery, the use of
balanced 6% HES130/0.42 solution for CPB circuit priming did not impair
haemostasis measured by ROTEM, but it increased the need for transfusions.
Fluid balance after CPB was less positive in the HES group, but, on the
1POM, it was comparable between the groups.
<3>
Accession Number
2015808751
Authors
Ozcan O.U. Tutar E. Candemir B. Ustun E.E. Erol C.
Institution
(Ozcan, Tutar, Candemir, Ustun, Erol) Department of Cardiology, Ankara
University, School of Medicine, Ankara 06230, Turkey
Title
Overcoming aspirin resistance with loading clopidogrel earlier in elective
percutaneous coronary intervention.
Source
International Journal of Angiology. 24 (1) (pp 19-24), 2015. Date of
Publication: 17 Feb 2015.
Publisher
Thieme Medical Publishers, Inc.
Abstract
We aimed to analyze the clinical effect of clopidogrel loading time on
adverse cardiovascular events among patients with aspirin resistance.
Recurrent adverse events may still occur despite dual antiplatelet therapy
after coronary stenting. Aspirin resistance is one of the possible reasons
of this trouble. Optimal antiplatelet strategy for coronary stenting is
unknown among patients with aspirin resistance. A total of 980 patients
scheduled for elective coronary stenting were enrolled and allocated into
two groups according to the loading time of clopidogrel more or less than
6 hours before coronary intervention (early- or late-loaded groups,
respectively). Aspirin resistance was determined according to the urinary
levels of 11-dehydrothromboxane B2. Overall 240 patients who were
allocated to early- and late-loaded groups were identified as aspirin
resistant according to the urinary levels of 11-dehydrothromboxane B2.
After a follow-up period of 12 months major adverse cardiac events were
observed among 16 patients (13.9%) in the early-loaded group and 30
patients (25.8%) in the late-loaded group (p = 0.02). Early loading of
clopidogrel was an independent predictor of lower rate of cardiac events
(hazard ratio = 0.46 [0.32-0.76, 95% confidence interval], p = 0.001). The
rates of bleeding events and periprocedural myocardial infarction were
similar in early- and late-loaded groups. The current study demonstrated
that loading of clopidogrel earlier than 6 hours before elective coronary
stenting among aspirin-resistant patients was associated with increased
benefits for ischemic events with similar bleeding rates.
<4>
Accession Number
2015644357
Authors
Tregay J. Wray J. Bull C. Franklin R.C. Daubeney P. Barron D.J. Brown K.
Knowles R.L.
Institution
(Tregay, Wray, Bull, Brown) Cardiorespiratory Unit, Great Ormond Street
Hospital NHS Foundation Trust, London, United Kingdom
(Franklin, Daubeney) Department of Paediatric Cardiology, Royal Brompton
and Harefield NHS Trust, London, United Kingdom
(Barron) Cardiac Unit, Birmingham Children's Hospital NHS Foundation
Trust, Birmingham, United Kingdom
(Knowles) Population, Policy and Practice Programme, Institute of Child
Health, University College London, 30 Guilford St, London WC1N 1EH, United
Kingdom
Title
Unexpected deaths and unplanned re-admissions in infants discharged home
after cardiac surgery: A systematic review of potential risk factors.
Source
Cardiology in the Young. 25 (5) (pp 839-852), 2015. Date of Publication:
10 Jun 2015.
Publisher
Cambridge University Press
Abstract
Background Babies with CHDs are a particularly vulnerable population with
significant mortality in their 1st year. Although most deaths occur in the
hospital within the early postoperative period, around one-fifth of
postoperative deaths in the 1st year of life may occur after hospital
discharge in infants who have undergone apparently successful cardiac
surgery. Aim To systematically review the published literature and
identify risk factors for adverse outcomes, specifically deaths and
unplanned re-admissions, following hospital discharge after infant surgery
for life-threatening CHDs. Methods A systematic search was conducted in
MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and PsycINFO
electronic databases, supplemented by manual searching of conference
abstracts. Results A total of 15 studies were eligible for inclusion.
Almost exclusively, studies were conducted in single US centres and
focussed on children with complex single ventricle diagnoses. A wide range
of risk factors were evaluated, and those more frequently identified as
having a significant association with higher mortality or unplanned
re-admission risk were non-Caucasian ethnicity, lower socio-economic
status, co-morbid conditions, age at surgery, operative complexity and
procedure type, and post-operative feeding difficulties. Conclusions
Studies investigating risk factors for adverse outcomes post-discharge
following diverse congenital heart operations in infants are lacking.
Further research is needed to systematically identify higher risk groups,
and to develop interventions targeted at supporting the most vulnerable
infants within an integrated primary and secondary care pathway.
<5>
Accession Number
2015102629
Authors
Turrini F. Scarlini S. Mannucci C. Messora R. Giovanardi P. Magnavacchi P.
Cappelli C. Evandri V. Zanasi A. Romano S. Cavani R. Ghidoni I. Tondi S.
Bondi M.
Institution
(Turrini, Scarlini, Mannucci, Messora, Giovanardi, Bondi) Cardiovascular
Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile
sant'Agostino Estense, Via Giardini 1355, Modena 41125, Italy
(Magnavacchi, Cappelli, Tondi) Cardiology Clinic, Department of
Cardiovascular Disease, Nuovo Ospedale Civile sant'Agostino Estense, Via
Giardini 1355, Modena 41125, Italy
(Evandri, Zanasi) Geriatrics Clinic, Department of Internal Medicine,
Endocrinology, Metabolism and Geriatrics, University of Modena, Via
Giardini 1355, Modena 41125, Italy
(Romano, Cavani) Diabetology Service, AUSL Modena, Via del Pozzo 71,
Modena 41124, Italy
(Ghidoni) Department of Cardiovascular and Thoracic Surgery, Hesperia
Hospital, Modena, Via Arqua 80, Modena 41125, Italy
Title
Does coronary Atherosclerosis Deserve to be Diagnosed earlY in Diabetic
patients? the DADDY-D trial. Screening diabetic patients for unknown
coronary disease.
Source
European Journal of Internal Medicine. 26 (6) (pp 407-413), 2015. Article
Number: 2929. Date of Publication: 01 Jul 2015.
Publisher
Elsevier
Abstract
Abstract Objectives To evaluate if screening and treatment of asymptomatic
coronary artery disease (CAD) are effective in preventing first cardiac
event in diabetics. Methods Diabetic patients without known CAD were
randomly assigned to undergo a screening for silent myocardial ischemia
followed by revascularization or to continue follow-up. The reduction of
cardiac death (CD) or nonfatal myocardial infarction (MI) represented the
primary aim; secondary aim was the prevention of heart failure (HF).
Results From September 2007 to May 2012, 520 patients (62 years; 104
female) were enrolled. Silent CAD was found in 20 of 262 patients (7.6%),
revascularization was performed in 12 (4.6%). After a mean follow-up of
3.6 years 12 events (4.6%) occurred in the study group and 14 (5.4%) in
the follow-up (HR = 0.849, 95% CI: 0.393-1.827, P = 0.678). The occurrence
of first HF episode did not differ between groups: 2 (0.8%) in screened
and 7 (2.7%) in follow-up (HR = 0.273, 95% CI: 0.057-1.314, P = 0.083).
Subgroup analysis revealed a significantly lower HF episodes among
patients with intermediate cardiovascular risk (Log rank P = 0.022).
Additionally, when CD and MI were analysed within subgroups, a significant
lower number of CDs was observed among older than 60 years (P = 0.044).
Conclusion Screening and revascularization of silent CAD in diabetics,
failed to demonstrate a significant reduction in cardiac events and HF
episodes. However, our data indicate that further research is warranted in
patients older than 60 years and those with an intermediate cardiovascular
risk. ClinicalTrials.gov NCT00547872.
<6>
Accession Number
2015919533
Authors
Liang J. Wang Z. Shi D. Liu Y. Zhao Y. Han H. Li Y. Liu W. Zhang L. Yang
L. Zhou Y.
Institution
(Liang, Wang, Shi, Liu, Zhao, Han, Li, Liu, Zhang, Yang, Zhou) Department
of Cardiology, Anzhen Hospital, Capital Medical University, Anzhen Avenue
#2, Chaoyang District, Beijing 100029, China
Title
High clopidogrel dose in patients with chronic kidney disease having
clopidogrel resistance after percutaneous coronary intervention.
Source
Angiology. 66 (4) (pp 319-325), 2015. Date of Publication: 14 Apr 2015.
Publisher
SAGE Publications Inc.
Abstract
We evaluated the impact of clopidogrel 150 mg/d in patients with chronic
kidney disease (CKD) having clopidogrel resistance (CR) after percutaneous
coronary intervention (PCI); 1076 consecutive patients with coronary
artery disease (CAD) having CKD were enrolled. Maximal platelet
aggregation (MPA) was assessed before, 24 hours, and 30 days after a
300-mg loading dose of clopidogrel prior to PCI. After PCI, 370 patients
with CR were randomized to receive clopidogrel 75 mg/d (n = 184) or 150
mg/d (n = 186) for 30 days. Stent thrombosis (ST), major adverse cardiac
events (MACEs), and bleeding were analyzed after 1 month. Patients in the
150 mg group had significant lower rates of ST and MACE. There was no
significant difference in major or minor bleeding. Patients in the 150 mg
group had lower MPA and greater inhibition of platelet aggregation.
One-month administration of 150 mg/d of clopidogrel decreases the rate of
ST and MACE without increasing bleeding in patients with CKD having CR
after PCI.
<7>
Accession Number
2014820001
Authors
Gao X.-F. Zhang Y.-J. Tian N.-L. Wu W. Li M.-H. Bourantas C.V. Jiang X.-M.
Wang Z.-M. Li B. Mao W.-X. Zhang J.-J. Chen S.-L.
Institution
(Gao, Zhang, Tian, Wu, Li, Jiang, Wang, Li, Mao, Zhang, Chen) Department
of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68
Changle Road, Nanjing 210006, China
(Zhang, Bourantas) Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands
(Tian, Chen) Department of Cardiology, Nanjing Heart Center, Nanjing,
China
Title
Stenting strategy for coronary artery bifurcation with drug-eluting
stents: A meta-analysis of nine randomised trials and systematic review.
Source
EuroIntervention. 10 (5) (pp 561-569), 2014. Date of Publication: 01 Sep
2014.
Publisher
EuroPCR
Abstract
Aims: The present study sought to compare angiographic and clinical
outcomes of a simple strategy versus a complex strategy in patients with
coronary bifurcation lesions undergoing drug-eluting stent implantation.
Methods and results: Medline, the Cochrane Library, and other internet
sources were searched for randomised trials comparing simple strategy
versus complex strategy for treating patients with bifurcation lesions.
Nine eligible randomised trials including 2,569 patients were identified.
The meta-analysis showed that cardiac death (odds ratio [OR]: 0.99, 95%
confidence interval [CI]: 0.40-2.41, p=0.98) and stent thrombosis (OR:
0.64, 95% CI: 0.31-1.34, p=0.24) were similar in the simple and the
complex strategy. Compared with the complex strategy, the simple strategy
was associated with a reduced risk of either early or follow-up myocardial
infarction (OR: 0.53, 95% CI: 0.36-0.79, p=0.002; OR: 0.60, 95% CI:
0.43-0.86, p=0.01, respectively). The overall risks of side branch
restenosis (OR: 1.44, 95% CI: 0.73-2.87, p=0.30), target lesion (OR: 1.72,
95% CI: 0.95-3.12, p=0.07) and target vessel revascularisation (OR: 1.59,
95% CI: 0.94-2.69, p=0.09) were comparable between the two groups. In the
true bifurcation, with large side branches, and DK-crush subgroups, there
were higher rates of reintervention seen in the simple strategy than in
the complex strategy.
Conclusions: A complex strategy remains an optional treatment for patients
with coronary bifurcation lesions without severe safety concerns. A
complex strategy may be an optimal treatment for true bifurcation lesions
with large side branches. © Europa Digital & Publishing 2014. All
rights reserved.
<8>
Accession Number
2015496177
Authors
Skytte Larsson J. Bragadottir G. Krumbholz V. Redfors B. Sellgren J.
Ricksten S.-E. Asai T.
Institution
(Skytte Larsson, Bragadottir, Krumbholz, Redfors, Sellgren, Ricksten,
Asai) Department of Anaesthesiology and Intensive Care Medicine, Institute
of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
Title
Effects of acute plasma volume expansion on renal perfusion, filtration,
and oxygenation after cardiac surgery: A randomized study on crystalloid
vs colloid.
Source
British Journal of Anaesthesia. 115 (5) (pp 736-742), 2015. Date of
Publication: November 2015.
Publisher
Oxford University Press
Abstract
Background In the present randomized study, we evaluated the differential
effects of a colloid and a crystalloid fluid on renal oxygen delivery
(RDO2), glomerular filtration (GFR), renal oxygen consumption (RVO2), and
the renal oxygen supply-demand relationship (i.e. renal oxygenation) after
cardiac surgery with cardiopulmonary bypass. Methods Thirty patients with
normal preoperative renal function, undergoing uncomplicated cardiac
surgery, were studied in the intensive care unit in the early
postoperative period. Patients were randomized to receive a bolus dose of
either a crystalloid (Ringers-acetate 20 ml kg<sup>-1</sup>, n=15) or a
colloid solution (Venofundin 10 ml kg<sup>-1</sup>, n=15). Systemic
haemodynamics were measured via a pulmonary artery catheter. Renal blood
flow and GFR were measured by the renal vein retrograde thermodilution
technique and by renal extraction of <sup>51</sup>Cr-EDTA (=filtration
fraction). Arterial and renal vein blood samples were obtained for
measurements of renal oxygen delivery (RDO2) and RVO2. Renal oxygenation
was estimated from the renal oxygen extraction. Results Despite an
increase in cardiac index and renal blood flow with both fluids, neither
of the fluids improved RDO2, because they both induced haemodilution. The
GFR increased in the crystalloid (28%) but not in the colloid group. The
crystalloid increased the filtration fraction (24%) and renal oxygen
extraction (23%), indicating that the increase in GFR, the major
determinant of RVO2, was not matched by a proportional increase in RDO2.
Conclusions Neither the colloid nor the crystalloid improved RDO2 when
used for postoperative plasma volume expansion. The crystalloid-induced
increase in GFR was associated with impaired renal oxygenation, which was
not seen with the colloid.
<9>
Accession Number
2015496159
Authors
Belletti A. Castro M.L. Silvetti S. Greco T. Biondi-Zoccai G. Pasin L.
Zangrillo A. Landoni G.
Institution
(Belletti, Silvetti, Greco, Pasin, Zangrillo, Landoni) Department of
Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute,
via Olgettina 60, Milan 20132, Italy
(Castro) Anaesthesiology Department, Centro Hospitalar Lisboa Central, EPE
- Hospital de Santa Marta, Rua de Santa Marta 50, Lisbon 1169-024,
Portugal
(Greco) Laboratorio di Statistica Medica, Biometria ed Epidemiologia G. A.
Maccacaro, Dipartimento di Scienze Cliniche e di Comunita, University of
Milan, Via Festa del Perdono 7, Milan 20122, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79,
Latina 04100, Italy
(Zangrillo, Landoni) Vita-Salute San Raffaele University, via Olgettina
58, Milan 20132, Italy
Title
The Effect of inotropes and vasopressors on mortality: A meta-analysis of
randomized clinical trials.
Source
British Journal of Anaesthesia. 115 (5) (pp 656-675), 2015. Date of
Publication: November 2015.
Publisher
Oxford University Press
Abstract
Background Inotropes and vasopressors are frequently administered to
critically ill patients in order to improve haemodynamic function and
restore adequate organ perfusion. However, some studies have suggested a
possible association between inotrope administration and increased
mortality. We therefore performed a meta-analysis of randomized trials
published in the last 20 yr to investigate the effect of these drugs on
mortality. Methods BioMedCentral, PubMed, Embase and the Cochrane Central
Register were searched (all updated April 8th, 2015). Inclusion criteria
were: random allocation to treatment, at least one group receiving an
inotropic or vasopressor drug compared with at least one group receiving a
non-inotropic/vasopressor treatment, study published after 1st January
1994, and systemic drug administration. Exclusion criteria were
overlapping populations, studies published as abstract only, crossover
studies, paediatric studies and lack of data on mortality. Results A total
of 28 280 patients from 177 trials were included. Overall, pooled
estimates showed no difference in mortality between the group receiving
inotropes/vasopressors and the control group [4255/14 036 (31.7%) vs
4277/14 244 (31.8%), risk ratio=0.98 (0.96-1.01), P for effect=0.23, P for
heterogeneity=0.30, I<sup>2</sup>=6%]. A reduction in mortality was
associated with inotrope/vasopressor therapy use in settings of vasoplegic
syndromes, sepsis and cardiac surgery. Levosimendan was the only drug
associated with improvement in survival. Subgroup analysis did not
identify any groups with increased mortality associated with
inotrope/vasopressor therapy. Conclusions Our systematic review found that
inotrope/vasopressor therapy is not associated with differences in
mortality in the overall population and in the majority of subsettings.
<10>
Accession Number
2015486474
Authors
Liu X. Qu X. Zheng J. Zhang L.
Institution
(Liu, Zheng, Zhang) College of Stomatology, Shanghai Jiao Tong University,
School of Medicine, Shanghai, China
(Qu) Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth
People's Hospital, Shanghai Jiao Tong University, School of Medicine,
Shanghai, China
(Zheng) Department of Oral and Maxillofacial Surgery, Shanghai Ninth
People's Hospital, Shanghai Jiao Tong University, School of Medicine,
Shanghai, China
Title
Effectiveness and safety of oral propranolol versus other treatments for
infantile hemangiomas: A meta-analysis.
Source
PLoS ONE. 10 (9) , 2015. Article Number: e0138100. Date of Publication: 16
Sep 2015.
Publisher
Public Library of Science
Abstract
Background: Epidemiological studies evaluating treatments for infantile
hemangiomas have produced inconsistent results. A meta-analysis of
published data was conducted to investigate the effectiveness and safety
of oral propranolol versus other treatments for infantile hemangiomas.
Methods: A meta-analysis was conducted based on literature (published from
1960 to December 1, 2014) found on the PubMed, EMBASE, and OVID search
engines. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were
estimated for the outcome measures. Heterogeneity, publication bias and
subgroup analysis were performed. Results: A total of 61 studies involving
5,130 participants met the inclusion criteria. Propranolol was found to be
a more effective modality in treating IHs (ORs = 0.92; 95%CI, 0.89-0.95)
and had fewer complications compared to the other treatments including
systemic steroids (ORs = 0.68; 95% CI, 0.59-0.76); laser ablation (ORs =
0.55; 95% CI, 0.43-0.67); other beta-adrenergic blockers (ORs = 0.56; 95%
CI, 0.50-0.61) and surgery (ORs = 0.55; 95% CI, 0.28-0.81). A subgroup
analysis of propranolol showed that a dose of 2 mg/kg/day or more yielded
better outcomes (ORs = 0.92; 95% CI, 0.88-0.95; ORs = 0.95; 95% CI,
0.89-1.00), and IHs that had not been previously treated had better
responses to propranolol treatment (ORs = 0.95; 95% CI, 0.91-0.98).
Conclusions: The meta-analysis demonstrated that propranolol was more
effective and safer than other therapies in treating IHs. It provides
strong evidence for supporting the use of propranolol as a first-line
therapy for IHs.
<11>
Accession Number
2015489987
Authors
Guay J. Faraoni D. Bonhomme F. Borel Derlon A. Lasne D.
Institution
(Guay) Department of Anesthesiology, University of Sherbrooke, Sherbrooke,
QC, Canada
(Faraoni) Department of Anesthesiology, Peri-operative and Pain Medicine,
Boston Children's Hospital, Harvard Medical School, Boston, MA, United
States
(Bonhomme) Department of Anesthesiology, Pharmacology and Intensive Care,
Geneva University Hospitals, 4, Rue Gabrielle-Perret-Gentil, Geneva 14
CH-1211, Switzerland
(Borel Derlon) Reference Centre for Hemophilia and von Willebrand Disease,
University Hospital of Caen, Caen, France
(Lasne) Department of Biological Hematology, AP-HP Hopital Necker-Enfants
Malades, INSERM, UMR-S 765, Paris Descartes University Sorbonne Paris
Cite, Paris, France
Title
Ability of hemostatic assessment to detect bleeding disorders and to
predict abnormal surgical blood loss in children: A systematic review and
meta-analysis.
Source
Paediatric Anaesthesia. 25 (12) (pp 1216-1226), 2015. Date of Publication:
December 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background Systematic preoperative coagulation testing is still widely
used in children scheduled for surgery, although current guidelines
recommend that a bleeding history should be the first choice for
hemostatic assessment. We performed a systematic review with meta-analysis
to evaluate the pertinence of bleeding questionnaire and screening
laboratory testing to detect bleeding disorders (BDs) in children and to
predict abnormal surgical blood loss. Methods A search was conducted in
PubMed, EMBASE, MEDLINE(R), Cochrane Central Register of Controlled
Trials, Health technology Assessment, and all EBM Reviews (Cochrane DSR,
ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED and EBM Reviews) up to
October 22, 2013. Prospective trials containing 20 children or more and
any tests evaluating either the ability of the test to detect a congenital
BD or the ability of the test to predict increased surgical blood loss
were retained. The quality of the study was judged with the Cochrane
Collaboration Tool and two investigators extracted data independently.
Data were combined to calculate the pooled diagnostic odds ratio (DOR) and
their 95% confidence intervals (CI 95%). I<sup>2</sup> statistics were
used to assess statistics heterogeneity. Results Data could be extracted
from 16 studies. Best results for detecting a congenital abnormality at
potential risk for increased surgical blood loss were obtained with the
PFA-100 (DOR = 113.0; 95% CI, 22.6-566.2; I<sup>2</sup> = 0%) in two
studies, followed by the bleeding time in two other studies (DOR = 110.7;
95% CI, 24.4-502.3; I<sup>2</sup> = 0%). With a high amount of
heterogeneity, questionnaires showed disappointing performances (DOR =
7.9; 95% CI: 3.5-17.5; I<sup>2</sup> = 72.6%). Conclusion Current evidence
does not identify a tool that adequately predicts BDs and/or abnormal
surgical blood loss in children. Questionnaires currently available do not
perform well. In the setting of a pediatric coagulation clinic, the
PFA-100 has the highest chance of detecting a BD. This meta-analysis
highlights the weakness of the literature regarding the prediction of
perioperative bleeding due to congenital hemostatic disorders in children.
<12>
Accession Number
2015463222
Authors
dos Santos L. Barroso J.J. Macau E.E.N. de Godoy M.F.
Institution
(dos Santos) Universidade do Vale do Paraiba - UNIVAP, Sao Jose dos
Campos, Sao Paulo, Brazil
(Barroso, Macau) Instituto Nacional de Pesquisas Espacias - INPE, Sao Jose
dos Campos, Sao Paulo, Brazil
(de Godoy) Sao Jose do Rio PretoSao PauloBrazil
Title
Assessment of heart rate variability by application of central tendency
measure.
Source
Medical and Biological Engineering and Computing. 53 (11) (pp 1231-1237),
2015. Date of Publication: 22 Sep 2015.
Publisher
Springer Verlag
Abstract
The heart rate variability (HRV) is an indicator of the subject
homeostasis alterations. For a healthy individual, the HRV shows a
nonlinear behavior, thus requiring a nonlinear approach to provide
additional information about HRV dynamics. In this work, the nonlinear
techniques, central tendency measure (CTM) and second-order difference
plot, are applied to HRV analysis using the successive difference of RR
intervals in a time series. In total are analyzed 170 tachograms collected
by Polar monitor and then classified into three groups according to a
cardiologist: healthy young adults, adults in preoperative evaluation for
coronary artery bypass grafting for severe coronary disease and premature
newborns. This approach identified the tachograms with high and low
variability, which demonstrates the ability of CTM to classify and
quantitatively characterize cardiac RR intervals.
<13>
[Use Link to view the full text]
Accession Number
2015447765
Authors
Lutsep H.L. Lynn M.J. Cotsonis G.A. Derdeyn C.P. Turan T.N. Fiorella D.
Janis L.S. Lane B.F. Montgomery J. Chimowitz M.I.
Institution
(Lutsep) Department of Neurology, Oregon Health and Science University,
Oregon Stroke Center, 3181 SW Sam Jackson Park Rd, Portland, OR 97239,
United States
(Lynn, Cotsonis, Lane, Montgomery) Department of Biostatistics and
Bioinformatics, Rollins School of Public Health, Emory University,
Atlanta, GA, United States
(Derdeyn) Department of Radiology, Washington University School of
Medicine, St. Louis, MO, United States
(Turan, Chimowitz) Department of Neurology, Medical University of South
Carolina, Charleston, United States
(Fiorella) Department of Neurological Surgery, State University of New
York, Old Westbury, United States
(Janis) National Institutes of Health, Bethesda, MD, United States
Title
Does the Stenting Versus Aggressive Medical Therapy Trial Support Stenting
for Subgroups with Intracranial Stenosis?.
Source
Stroke. 46 (11) (pp 3282-3284), 2015. Date of Publication: 01 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Purpose-Although the Stenting Versus Aggressive Medical
Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial showed that
medical therapy alone was superior to stenting plus medical therapy for
preventing recurrent strokes in patients with symptomatic intracranial
stenosis, we determined whether SAMMPRIS supported the use of stenting in
any subpopulations of patients with symptomatic intracranial arterial
stenosis. Methods-The primary outcome, 30-day stroke and death and later
strokes in the territory of the qualifying artery, was compared in those
with and without baseline factors in the 2 treatment arms, percutaneous
transluminal angioplasty and stenting (PTAS) plus aggressive medical
therapy versus aggressive medical therapy alone. Baseline factors included
sex, age, race, diabetes mellitus, hypertension, lipid disorder, smoking
status, type of qualifying event, qualifying event hypoperfusion symptoms,
use of antithrombotic or proton pump inhibitor at baseline, days to
enrollment, old infarcts in the same territory, percent stenosis, other
artery stenosis, and location of the symptomatic artery. Results-A total
of 451 patients were enrolled, 227 randomized to aggressive medical
therapy and 224 to PTAS. Of all variables evaluated, the observed 2-year
event rates were higher with PTAS than with aggressive medical therapy in
the vast majority and the interaction with treatment was not statistically
significant for any of the factors. Conclusions-The SAMMPRIS results do
not provide evidence to support the use of PTAS using the Wingspan stent
system compared with medical treatment in any examined subpopulation of
patients with symptomatic intracranial stenosis, including those with
qualifying event hypoperfusion symptoms.
<14>
Accession Number
2015387300
Authors
Barbanti M. Gulino S. Capranzano P. Imme S. Sgroi C. Ohno Y. Attizzani
G.F. Patane M. Sicuso R. Pilato G. Di Landro A. Todaro D. Di Simone E.
Picci A. Giannetto G. Costa G. Deste W. Giannazzo D. Grasso C. Capodanno
D. Tamburino C.
Institution
(Barbanti, Gulino, Capranzano, Imme, Sgroi, Tamburino, Ohno, Attizzani,
Patane, Sicuso, Pilato, Di Landro, Todaro, Di Simone, Picci, Giannetto,
Costa, Deste, Giannazzo, Grasso, Capodanno, Tamburino) Division of
Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
(Ohno) Department of Cardiology, University of Tokai, School of Medicine,
Isehara, Japan
(Attizzani) Valve and Structural Heart Disease Intervention Center,
Harrington Heart and Vascular Institute, University Hospitals, Case
Medical Center, Cleveland, OH, United States
(Tamburino) ETNA Foundation, Catania, Italy
Title
Acute Kidney Injury With the RenalGuard System in Patients Undergoing
Transcatheter Aortic Valve Replacement: The PROTECT-TAVI Trial
(PROphylactic effecT of furosEmide-induCed diuresis with matched isotonic
intravenous hydraTion in Transcatheter Aortic Valve Implantation).
Source
JACC: Cardiovascular Interventions. 8 (12) (pp 1595-1604), 2015. Date of
Publication: October 2015.
Publisher
Elsevier Inc.
Abstract
Objectives The purpose of this study was to investigate the effect of the
RenalGuard System (PLC Medical Systems, Milford, Massachusetts) on
prevention of acute kidney injury (AKI) in patients undergoing
transcatheter aortic valve replacement (TAVR). Background TAVR is
associated with varying degrees of post-procedural AKI. The RenalGuard
System is a dedicated device designed for contrast-induced AKI prevention.
Whether this device is also effective in patients with severe aortic
stenosis undergoing TAVR is unexplored. Methods The present is an
investigator-driven, single-center, prospective, open-label,
registry-based randomized study that used the TAVR institutional registry
of the Ferrarotto Hospital in Catania, Italy, as the platform for
randomization, data collection, and follow-up assessment. A total of 112
consecutive patients undergoing TAVR were randomly assigned to hydration
with normal saline solution controlled by the RenalGuard system and
furosemide (RenalGuard group) or normal saline solution (control group).
The primary endpoint was the incidence of Valve Academic Research
Consortium-defined AKI in the first 72 h after the procedure. Results The
AKI rate was lower in the RenalGuard group than in the control group (n =
3 [5.4%] vs. n =14 [25.0%], respectively, p = 0.014). The majority of
patients (5.4% vs. 23.2%) developed a mild AKI (stage 1); severe damage
(stage 3) occurred only in 1 patient in the control group (0.0% vs. 1.8%).
No case of in-hospital renal failure requiring dialysis was reported. No
significant differences in terms of mortality, cerebrovascular events,
bleeding, and hospitalization for heart failure were noted in both groups
at 30 days. Conclusions Furosemide-induced diuresis with matched isotonic
intravenous hydration using the RenalGuard system is an effective
therapeutic tool to reduce the occurrence of AKI in patients undergoing
TAVR.
<15>
Accession Number
2015216505
Authors
Kopjar T. Petricevic M. Gasparovic H. Svetina L. Milicic D. Biocina B.
Institution
(Kopjar, Petricevic, Gasparovic, Svetina, Biocina) University of Zagreb
School of Medicine, Department of Cardiac Surgery, University Hospital
Center Zagreb, Kispaticeva 12, Zagreb 10000, Croatia
(Milicic) University of Zagreb School of Medicine, Department of
Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb,
Croatia
Title
Postoperative atrial fibrillation is associated with high on-aspirin
platelet reactivity.
Source
Annals of Thoracic Surgery. 100 (5) (pp 1704-1711), 2015. Date of
Publication: November 2015.
Publisher
Elsevier USA
Abstract
Background Atrial fibrillation (AF) contributes to a prothrombotic state
through platelet activation. It is unclear whether increased platelet
aggregability in patients with AF is caused by the underlying
cardiovascular condition rather than the arrhythmia per se. We
investigated the effect of postoperative atrial fibrillation (POAF) on
platelet reactivity after coronary artery bypass grafting (CABG). Methods
This study is a post hoc analysis from a randomized controlled trial
(ClinicalTrials.gov: NCT01159639) based on patients undergoing elective
primary CABG. Patients were dichotomized according to POAF. Postoperative
platelet function testing with arachidonic acid as the platelet agonist
(ASPI test) was used to define high on-aspirin platelet reactivity (HAPR).
DELTAASPI presented the difference between pre- and postoperative ASPI
test values. To account for the isolated effect of POAF on platelet
reactivity, a propensity score analysis was applied. Results Overall
incidence of POAF was 23% (92 of 398 patients). HAPR was detected in 54%
(214 of 398) of patients. HAPR was more prevalent among patients with POAF
when compared with patients without POAF (64.1% versus 50.7%; odds ratio
[OR], 1.74; 95% confidence interval [CI], 1.08-2.82; p = 0.023). The
propensity score model produced a subcohort of patients that was well
balanced for comorbidities. When compared with the matched group without
POAF, the POAF group maintained its prevalence for HAPR (64.1% versus
45.7%; OR, 2.13; 95% CI, 1.18-3.85; p = 0.012) and had greater DELTAASPI
values (15.0 [IQR, 0.0-36.0] vs 8.0 [IQR, -5.5-19.5]; p = 0.030).
Conclusions The main finding of our study indicates there is added
platelet activation in patients with POAF after CABG before and after
controlling for pathologic conditions through propensity matching. The
present study does not prove a causal association between POAF and HAPR.
<16>
Accession Number
2015489033
Authors
Omar A.S. Sudarsanan S. Hanoura S. Osman H. Sivadasan P.C. Shouman Y. Tuli
A.K. Singh R. Al Khulaifi A.
Institution
(Omar, Sudarsanan, Hanoura, Osman, Sivadasan, Shouman, Tuli, Al Khulaifi)
Department of Cardiothoracic Surgery, Cardiac Anaesthesia and ICU Section,
Heart Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
(Omar) Department of Critical Care Medicine, Beni Suef University,
Beni-Suef 62511, Egypt
(Hanoura, Osman) Department of Anesthesia, Al-Azhar University, Cairo
11651, Egypt
(Singh) Department of Medical Research, Hamad Medical Corporation, P.O.
Box 3050, Doha, Qatar
Title
Kinetics of Highly Sensitive Troponin T after Cardiac Surgery.
Source
BioMed Research International. 2015 , 2015. Article Number: 574546. Date
of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Perioperative myocardial infarction (PMI) confers a considerable risk in
cardiac surgery settings; finding the ideal biomarker seems to be an ideal
goal. Our aim was to assess the diagnostic accuracy of highly sensitive
troponin T (hsTnT) in cardiac surgery settings and to define a diagnostic
level for PMI diagnosis. This was a single-center prospective
observational study analyzing data from all patients who underwent cardiac
surgeries. The primary outcome was the diagnosis of PMI through a specific
level. The secondary outcome measures were the lengths of mechanical
ventilation (LOV), stay in the intensive care unit (LOSICU), and
hospitalization. Based on the third universal definition of PMI, patients
were divided into two groups: no PMI (Group I) and PMI (Group II). Data
from 413 patients were analyzed. Nine patients fulfilled the diagnostic
criteria of PMI, while 41 patients were identified with a 5-fold increase
in their CK-MB (>120 U/L). Using ROC analysis, a hsTnT level of 3,466 ng/L
or above showed 90% sensitivity and 90% specificity for the diagnosis of
PMI. Secondary outcome measures in patients with PMI were significantly
prolonged. In conclusion, the hsTnT levels detected here paralleled those
of CK-MB and a cut-off level of 3466 ng/L could be diagnostic of PMI.
<17>
Accession Number
2015489934
Authors
Liu X.-L. Tan J.-Y. Molassiotis A. Suen L.K.P. Shi Y.
Institution
(Liu, Shi) 10th People's Hospital of Tongji University, 301 Yanchang Road,
Shanghai 200072, China
(Liu) School of Nursing, Midwifery and Paramedicine, Australian Catholic
University, 1100 Nudgee Road, Banyo, Brisbane, QLD 4014, Australia
(Liu) School of Nursing, Jinggangshan University, 28 Xueyuan Road, Ji'an
343009, China
(Tan, Molassiotis, Suen) School of Nursing, Hong Kong Polytechnic
University, Hung Hom, Kowloon, Hong Kong
Title
Acupuncture-Point Stimulation for Postoperative Pain Control: A Systematic
Review and Meta-Analysis of Randomized Controlled Trials.
Source
Evidence-based Complementary and Alternative Medicine. 2015 , 2015.
Article Number: 657809. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
The purpose of this study was to evaluate the effectiveness of
Acupuncture-point stimulation (APS) in postoperative pain control compared
with sham/placebo acupuncture or standard treatments (usual care or no
treatment). Only randomized controlled trials (RCTs) were included.
Meta-analysis results indicated that APS interventions improved VAS scores
significantly and also reduced total morphine consumption. No serious
APS-related adverse effects (AEs) were reported. There is Level I evidence
for the effectiveness of body points plaster therapy and Level II evidence
for body points electroacupuncture (EA), body points acupressure, body
points APS for abdominal surgery patients, auricular points seed
embedding, manual auricular acupuncture, and auricular EA. We obtained
Level III evidence for body points APS in patients who underwent cardiac
surgery and cesarean section and for auricular-point stimulation in
patients who underwent abdominal surgery. There is insufficient evidence
to conclude that APS is an effective postoperative pain therapy in
surgical patients, although the evidence does support the conclusion that
APS can reduce analgesic requirements without AEs. The best level of
evidence was not adequate in most subgroups. Some limitations of this
study may have affected the results, possibly leading to an overestimation
of APS effects.
<18>
Accession Number
2015477539
Authors
Patel N. Minhas J.S. Chung E.M.L.
Institution
(Patel, Minhas, Chung) Department of Cardiovascular Sciences, University
of Leicester, RKCSB, Leicester Royal Infirmary LE1 5WW, United Kingdom
(Patel, Chung) Leicester Cardiovascular Biomedical Research Unit,
Glenfield Hospital, Leicester, United Kingdom
(Minhas) University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Chung) Department of Medical Physics, University Hospitals of Leicester
NHS Trust, Leicester, United Kingdom
Title
The presence of new MRI lesions and cognitive decline after cardiac
surgery: A systematic review.
Source
Journal of Cardiac Surgery. 30 (11) (pp 808-812), 2015. Date of
Publication: November 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Patients are commonly reported to experience postoperative cognitive
decline (POCD) and new ischemic lesions following surgery, which many
researchers have hypothesised to result from emboli entering the cerebral
circulation during surgery. Modern magnetic resonance imaging techniques
have enabled clear and accurate identification of ischemic lesions.
However, difficulties in assessing subtle changes in cognitive impairment
clinically remain. The purpose of this systematic review is to discuss the
literature that has investigated cognitive outcome in relation to new
ischaemic brain lesions after cardiac surgery.
<19>
[Use Link to view the full text]
Accession Number
2015489219
Authors
Abbott A.L. Paraskevas K.I. Kakkos S.K. Golledge J. Eckstein H.-H.
Diaz-Sandoval L.J. Cao L. Fu Q. Wijeratne T. Leung T.W. Montero-Baker M.
Lee B.-C. Pircher S. Bosch M. Dennekamp M. Ringleb P.
Institution
(Abbott, Dennekamp) Department of Epidemiology and Preventive Medicine,
School of Public Health and Preventive Medicine, Monash University, 99
Commercial Rd, Melbourne, VIC 3008, Australia
(Bosch) Department of Surgery, Central Clinical School, Monash University,
Melbourne, VIC, Australia
(Abbott) Neurology Department, Alfred Hospital, Prahran, VIC, Australia
(Paraskevas) Department of Cardiovascular Sciences, St. george'Svascular
Institute, St George's Hospital, London, United Kingdom
(Kakkos) Department of Vascular Surgery, University of Patras, Patras,
Greece
(Golledge) Queensland Research Centre for Peripheral Vascular Disease,
College of Medicine and Dentistry, James Cook University, Townsville, QLD,
Australia
(Golledge) Department of Vascular and Endovascular Surgery, Townsville
Hospital, Townsville, QLD, Australia
(Eckstein) Department for Vascular and Endovascular Surgery, Klinikum
Rechts der Isar, Technical University Munich, Munich, Germany
(Diaz-Sandoval) Department of Medicine, Michigan State University, Metro
Health Hospital, Grand Rapids, MI, United States
(Cao) Cardiology Department, Xiamen Cardiovascular Hospital, Xiamen,
Fujian, China
(Fu) Center for Cardiology Intervention Treatment, Department of
Cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou,
Guangdong, China
(Wijeratne) Stroke Unit, Department of Neurology, Western Hospital,
University of Melbourne, Melbourne, VIC, Australia
(Leung) Department of Medicine and Therapeutics, Chinese University of
Hong Kong, Hong Kong
(Montero-Baker) Department of Vascular Surgery, University of Arizona and
Pima Vascular Group, Tucson, United States
(Lee) Department of Neurology, Hallym Neurological Institute, Hallym
University, Sacred Heart Hospital, Seoul, South Korea
(Pircher) Centre for Health and Social Research, Faculty of Health
Sciences, Australian Catholic University, Melbourne, VIC, Australia
(Ringleb) Department of Neurology, University Hospital Heidelberg,
Heidelberg, Germany
Title
Systematic Review of Guidelines for the Management of Asymptomatic and
Symptomatic Carotid Stenosis.
Source
Stroke. 46 (11) (pp 3288-3301), 2015. Date of Publication: 01 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Purpose-We systematically compared and appraised
contemporary guidelines on management of asymptomatic and symptomatic
carotid artery stenosis. Methods-We systematically searched for guideline
recommendations on carotid endarterectomy (CEA) or carotid
angioplasty/stenting (CAS) published in any language between January 1,
2008, and January 28, 2015. Only the latest guideline per writing group
was selected. Each guideline was analyzed independently by 2 to 6 authors
to determine clinical scenarios covered, recommendations given, and
scientific evidence used. Results-Thirty-four eligible guidelines were
identified from 23 different regions/countries in 6 languages. Of 28
guidelines with asymptomatic carotid artery stenosis procedural
recommendations, 24 (86%) endorsed CEA (recommended it should or may be
provided) for =50% to 99% average-surgical-risk asymptomatic carotid
artery stenosis, 17 (61%) endorsed CAS, 8 (29%) opposed CAS, and 1 (4%)
endorsed medical treatment alone. For asymptomatic carotid artery stenosis
patients considered high-CEA-risk because of comorbidities, vascular
anatomy, or undefined reasons, CAS was endorsed in 13 guidelines (46%).
Thirty-one of 33 guidelines (94%) with symptomatic carotid artery stenosis
procedural recommendations endorsed CEA for patients with =50% to 99%
average-CEA-risk symptomatic carotid artery stenosis, 19 (58%) endorsed
CAS and 9 (27%) opposed CAS. For high-CEA-risk symptomatic carotid artery
stenosis because of comorbidities, vascular anatomy, or undefined reasons,
CAS was endorsed in 27 guidelines (82%). Guideline procedural
recommendations were based only on results of trials in which patients
were randomized 12 to 34 years ago, rarely reflected medical treatment
improvements and often understated potential CAS hazards. Qualifying
terminology summarizing recommendations or evidence lacked
standardization, impeding guideline interpretation, and comparison.
Conclusions-This systematic review has identified many opportunities to
modernize and otherwise improve carotid stenosis management guidelines.
<20>
Accession Number
2015487319
Authors
Lemos P.A. Abizaid A.A.C. Meireles G.C. Sarmento-Leite R. Prudente M.
Cantarelli M. Dourado A.D. Mariani J. Perin M.A. Costantini C. Costa R.A.
Costa J.R. Chamie D. Campos C.A. Ribeiro E.
Institution
(Lemos, Campos, Ribeiro) Heart Institute (InCor), University of Sao Paulo
Medical School, Sao Paulo SP, Brazil
(Abizaid, Costa, Costa, Chamie) Instituto Dante Pazzanese de Cardiologia,
Sao Paulo SP, Brazil
(Meireles) Hospital do Servidor Publico Estadual - IAMSPE, Sao Paulo SP,
Brazil
(Sarmento-Leite) Institute of Cardiology/Fundacao, Universitaria de
Cardiologia de Porto Alegre, Porto Alegre RS, Brazil
(Prudente) Hospital Encore, Aparecida de Goiania GO, Brazil
(Cantarelli) Hospital Bandeirantes, Sao Paulo SP, Brazil
(Dourado) Hospital Santa Izabel, Salvador BA, Brazil
(Mariani) Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Sao
Paulo SP, Brazil
(Perin) Hospital Santa Marcelina, Sao Paulo SP, Brazil
(Costantini) Hospital Cardiologico Costantini, Curitiba PR, Brazil
Title
Metallic Limus-Eluting Stents Abluminally Coated with Biodegradable
Polymers: Angiographic and Clinical Comparison of a Novel Ultra-Thin
Sirolimus Stent Versus Biolimus Stent in the DESTINY Randomized Trial.
Source
Cardiovascular Therapeutics. 33 (6) (pp 367-371), 2015. Date of
Publication: December 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Aims: To evaluate the outcomes of patients treated with a new drug-eluting
stent formulation with low doses of sirolimus, built in an
ultra-thin-strut platform coated with biodegradable abluminal coating.
Methods: This study is a randomized trial that tested the main hypothesis
that the angiographic late lumen loss of the novel sirolimus-eluting stent
is noninferior compared with commercially available biolimus-eluting
stent. A final study population comprising 170 patients with one or two de
novo lesions was randomized in the ratio 2:1 for sirolimus-eluting stent
or biolimus-eluting stent, respectively. The primary endpoint was 9-month
angiographic in-stent late lumen loss. Adverse clinical events were
prospectively collected for 1 year. Results: After 9 months, the novel
sirolimus-eluting stent was shown noninferior compared with the biolimus
stent for the primary endpoint (angiographic in-stent late lumen loss:
0.20 +/- 0.29 mm vs. 0.15 +/- 0.20 mm, respectively; P value for
noninferiority <0.001). The 1-year incidence of death, myocardial
infarction, repeat revascularization, and stent thrombosis remained low
and not significantly different between the groups. Conclusions: The
present randomized trial demonstrates that the tested novel
sirolimus-eluting stent was angiographically noninferior in comparison
with a last-generation biolimus-eluting stent.
<21>
Accession Number
2015487318
Authors
Alsidawi S. Effat M. Rahman S. Abdallah M. Leesar M.
Institution
(Alsidawi, Effat, Rahman, Abdallah) Division of Cardiovascular Health and
Diseases, University of Cincinnati College of Medicine, Cincinnati, OH,
United States
(Leesar) Division of Cardiovascular Diseases, University of Alabama,
Birmingham, AL, United States
Title
The Role of Vascular Imaging in Guiding Routine Percutaneous Coronary
Interventions: A Meta-Analysis of Bare Metal Stent and Drug-Eluting Stent
Trials.
Source
Cardiovascular Therapeutics. 33 (6) (pp 360-366), 2015. Date of
Publication: December 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background: The routine use of vascular imaging including intravascular
ultrasound (IVUS) and optical coherence tomography (OCT) in guiding
percutaneous coronary interventions (PCI) is still controversial
especially when using drug-eluting stents. A meta-analysis of trials using
bare metal stents was previously published. Methods: We conducted a
meta-analysis of available published trials that compared imaging-guided
PCI and angiography-guided PCI in patients undergoing routine PCI only.
Trials that enrolled patients with acute coronary syndrome were excluded
to decrease heterogeneity. We aimed to study both drug-eluting stents
(DES) as well as bare metal stents (BMS). We identified seven randomized
controlled trials on IVUS-guided bare metal stents. We also identified
three randomized controlled trials on IVUS-guided drug-eluting stents. To
improve the power of the drug-eluting stent data, we identified, and
included, nine registries that compared IVUS-guided PCI to
angiography-guided PCI in the drug-eluting stent era. Nonrandomized
registries that included BMS only were excluded as there are multiple
previous meta-analyses that studied these patients. Finally, we identified
one registry that compared OCT-guided PCI to angiography-guided PCI using
either a BMS or a DES. A total of 14,197 patients were studied overall.
The meta-analysis was conducted using a random effect model. Results:
Imaging guidance was associated with a significantly larger
postintervention minimal luminal diameter (SMD: 0.289. 95% CI:
0.213-0.365. P < 0.01). Imaging-guided stenting was associated with a
significant decrease in the major adverse cardiac events (MACE) in the DES
patients (odds ratio: 0.810. 95% CI: 0.719-0.912. P < 0.01) and combined
DES and BMS patients (odds ratio: 0.782. 95% CI: 0.686-0.890. P < 0.01).
Imaging guidance was associated with significantly lower events of death
from all causes in DES patients (odds ratio: 0.654. 95% CI: 0.468-0.916. P
< 0.01) and in the combined DES and BMS patients (odds ratio: 0.727. 95%
CI: 0.540-0.980. P < 0.01). The risk of myocardial infarction (MI) was
significantly lower with imaging guidance in both, DES patients (odds
ratio: 0.551. 95% CI: 0.363-0.837. P < 0.01) and combined DES and BMS
patients (odds ratio: 0.589. 95% CI: 0.425-0.816. P < 0.01). This may, in
part, be explained by the significantly lower risk of stent thrombosis in
imaging-guided DES patients (odds ratio: 0.651. 95% CI: 0.499-0.850. P <
0.01) and combined DES and BMS patients (odds ratio: 0.665. 95% CI:
0.513-0.862. P < 0.01). Patients who received a DES showed no difference
between imaging guidance and angiography guidance in repeated target
lesion revascularization, while the analysis of BMS alone and the DES and
BMS combined showed significant superiority of the imaging-guided PCI
group. Conclusion: Imaging-guided PCI significantly lowered the risk of
death, MI, stent thrombosis, and the combined MACE in DES-implanted
patients and all stented patients (DES or BMS). However, imaging guidance
had no significant effect on repeated target vessel or target lesion
revascularization in patients who received DES, likely due to the effect
of the drug in the stent.© 2015 John Wiley
<22>
Accession Number
2015492795
Authors
Biccard B.M. Rodseth R.N.
Institution
(Biccard, Rodseth) Department of Anaesthetics, Nelson R Mandela School of
Medicine, Private Bag 7, Congella 4013, South Africa
Title
A meta-analysis of the prospective randomised trials of coronary
revascularisation before noncardiac vascular surgery with attention to the
type of coronary revascularisation performed.
Source
Anaesthesia. 64 (10) (pp 1105-1113), 2009. Date of Publication: 2009.
Publisher
Blackwell Publishing Ltd
Abstract
Prospective randomised trials of coronary revascularisation prior to
noncardiac surgery have shown no survival benefit following noncardiac
surgery. However, these studies have not differentiated the outcomes
associated with coronary artery bypass grafting (CABG) and percutaneous
coronary interventions. We performed a meta-analysis of the randomised
controlled trials of pre-operative coronary revascularisation for
noncardiac surgery, extracting data for 30 day and long term all-cause
mortality and myocardial infarction (MI) following revascularisation,
according to the type of revascularisation performed. Pre-operative
percutaneous coronary intervention was associated with significantly
increased 30 day MI and composite death and MI. Pre-operative CABG was
associated with a significantly improved long term composite outcome of
death and MI compared to percutaneous coronary interventions. The adverse
effect of percutaneous coronary interventions on both short and long term
outcomes in vascular surgical patients should be taken into consideration
when interpreting these trials. CABG may improve long term outcomes in
vascular surgical patients. The indications for and timing of CABG in
vascular surgical patients needs further research.
<23>
Accession Number
2015485746
Authors
Natsuaki M. Kozuma K. Morimoto T. Kadota K. Muramatsu T. Nakagawa Y.
Akasaka T. Igarashi K. Tanabe K. Morino Y. Ishikawa T. Nishikawa H. Awata
M. Abe M. Okada H. Takatsu Y. Ogata N. Kimura K. Urasawa K. Tarutani Y.
Shiode N. Kimura T.
Institution
(Natsuaki) Division of Cardiology, Saiseikai Fukuoka General Hospital,
Fukuoka, Japan
(Kozuma) Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Nishinomiya, Japan
(Kadota) Department of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Muramatsu) Division of Cardiology, Saiseikai Yokohama-city Eastern
Hospital, Yokohama, Japan
(Nakagawa) Division of Cardiology, Tenri Hospital, Tenri, Japan
(Akasaka) Department of Cardiovascular Medicine, Wakayama Medical
University Hospital, Wakayama, Japan
(Igarashi) Division of Cardiology, Japan Community Health Care
Organization Hokkaido Social Hospital, Sapporo, Japan
(Tanabe) Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(Morino) Division of Cardiology, Iwate Medical University Hospital,
Morioka, Japan
(Ishikawa) Division of Cardiology, Saitama Cardiovascular and Respiratory
Center, Kumagaya, Japan
(Nishikawa) Division of Cardiology, Mie Heart Center, Mie, Japan
(Awata) Division of Cardiology, Kansai Rosai Hospital, Cardiovascular
Center, Amagasaki, Japan
(Abe) Division of Cardiology, National Hospital Organization, Kyoto
Medical Center, Kyoto, Japan
(Okada) Division of Cardiology, Seirei Hamamatsu General Hospital,
Hamamatsu, Japan
(Takatsu) Division of Cardiology, Hyogo Prefectural Amagasaki Hospital,
Amagasaki, Japan
(Ogata) Division of Cardiology, Jichi Medical University Hospital,
Shimotsuke, Japan
(Kimura) Division of Cardiology, Yokohama City University, Medical Center,
Yokohama, Japan
(Urasawa) Division of Cardiology, Caress Sapporo Tokeidai Memorial
Hospital, Sapporo, Japan
(Tarutani) Division of Cardiology, Okamura Memorial Hospital, Shizuoka,
Japan
(Shiode) Division of Cardiology, Tsuchiya General Hospital, Hiroshima,
Japan
(Kimura) Department of Cardiovascular Medicine, Kyoto University, Graduate
School of Medicine, Kyoto 606-8507, Japan
Title
Final 3-Year Outcome of a Randomized Trial Comparing Second-Generation
Drug-Eluting Stents Using Either Biodegradable Polymer or Durable Polymer:
NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent
Trial.
Source
Circulation: Cardiovascular Interventions. 8 (10) , 2015. Article Number:
e002817. Date of Publication: 01 Oct 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
There is a paucity of data reporting the clinical outcomes of
biodegradable polymer biolimus-eluting stent (BP-BES) compared with
durable polymer everolimus-eluting stent (DP-EES) beyond 1 year after
stent implantation when the polymer is fully degraded. Methods and
Results-The NOBORI Biolimus-Eluting Versus XIENCE/PROMUS
Everolimus-Eluting Stent Trial (NEXT) is a prospective, multicenter,
randomized, open-label, noninferiority trial comparing BP-BES with DP-EES
in patients scheduled for percutaneous coronary intervention using
drug-eluting stent (DES) without any exclusion criteria among 98
participating centers in Japan. The trial was designed to evaluate
noninferiority of BP-BES relative to DP-EES in terms of any target-lesion
revascularization at 1 year and death or myocardial infarction at 3 years.
Between May and October 2011, 3235 patients were randomly assigned to
receive either BP-BES (1617 patients) or DP-EES (1618 patients). Complete
3-year follow-up was achieved in 97.6% of patients. At 3 years, the
primary safety end point of death or myocardial infarction occurred in 159
patients (9.9%) in the BP-BES group and in 166 patients (10.3%) in the
DP-EES group, demonstrating noninferiority of BP-BES relative to DP-EES (P
noninferiority<0.0001 and P superiority=0.7). Cumulative incidence of
target-lesion revascularization was not significantly different between
the 2 groups (7.4% versus 7.1%; P=0.8). By a landmark analysis at 1 year,
the cumulative incidences of death or myocardial infarction and
target-lesion revascularization were also not significantly different
between the 2 groups (4.6% versus 5.2%; P=0.46 and 3.3% versus 2.7%;
P=0.39, respectively). Conclusions-Safety and efficacy outcomes of BP-BES
were non inferior to those of DP-EES 3 years after stent implantation.
<24>
Accession Number
2015460179
Authors
Ng M.S.Y. Ng A.S.Y. Chan J. Tung J.-P. Fraser J.F.
Institution
(Ng, Ng, Tung, Fraser) Critical Care Research Group, The Prince Charles
Hospital, Rode Road, Chermside, Brisbane, QLD, Australia
(Ng, Ng, Chan, Tung, Fraser) School of Medicine, The University of
Queensland, Herston, Brisbane, QLD, Australia
(Ng, Tung) Research and Development, Australian Red Cross Blood Service,
Kelvin Grove, Brisbane, QLD, Australia
Title
Effects of packed red blood cell storage duration on post-transfusion
clinical outcomes: a meta-analysis and systematic review.
Source
Intensive Care Medicine. 41 (12) (pp 2087-2097), 2015. Date of
Publication: 05 Oct 2015.
Publisher
Springer Verlag
Abstract
Purpose: There is substantial conjecture regarding the clinical
significance of packed red blood cell (PRBC) changes that occur during in
vitro storage. Here, we present a meta- and systematic analysis of adult
studies published between 1994 and 2015 with the aim of updating existing
quantitative reviews and providing a comprehensive cover of the six most
commonly studied outcomes-mortality, infection, renal dysfunction,
multiple organ dysfunction syndrome (MODS), thrombotic complications and
prolonged hospital length of stay. Methods: Computerised searches of
Pubmed and EMBASE identified publications that reported target outcomes
and PRBC storage duration prior to transfusion. Bibliographies of relevant
literature were manually searched to incorporate missed studies.
Randomised controlled trial (RCT) data was meta-analysed using a random
effects model with Cochrane Collaboration Review Manager (RevMan) version
5.1 software. Observational investigations were systematically reviewed.
Results: Sixty-four papers were selected covering 462,581 patients with
the majority of studies being observational in nature. Meta-analysis of
eight RCTs demonstrated a trend towards decreased mortality with stored
PRBC transfusion; albeit this effect was not statistically significant (OR
0.91, 95 % CI 0.78-1.05, p = 0.20). In a small subset of intensive care
unit (ICU), cardiac surgery and trauma patients; observational studies
suggested that prolonged storage may be correlated with increased
mortality. Trauma and cardiac surgery patients appeared to be most
susceptible to the potential infectious complications of stored PRBCs.
Stored PRBCs were unlikely to affect thrombotic complications or hospital
length of stay. There were inadequate data to determine whether stored
PRBCs had clinically relevant effects on renal dysfunction and MODS.
Conclusion: Although literature presents a concerning picture of potential
storage complications, current findings are too inconsistent to drive
changes in clinical practice. Results from current RCTs will likely play a
role in PRBC age guidelines for cardiac surgery and ICU patients. However,
these studies may be less efficacious at detecting small effects that are
limited to specific subpopulations.
<25>
Accession Number
2015474883
Authors
Hartland B.L. Newell T.J. Damico N.
Institution
(Hartland, Newell, Damico) Department of Nurse Anesthesia, Virginia
Commonwealth University, Richmond, VA, United States
Title
Alveolar recruitment maneuvers under general anesthesia: A systematic
review of the literature.
Source
Respiratory Care. 60 (4) (pp 609-620), 2015. Article Number: A609. Date of
Publication: 2015.
Publisher
American Association for Respiratory Care
Abstract
BACKGROUND: The sigh is a normal homeostatic reflex that maintains lung
compliance and decreases atelectasis. General anesthesia abolishes the
sigh reflex with rapid onset of atelectasis in 100% of patients. Studies
show a strong correlation between atelectasis and postoperative pulmonary
complications, raising health-care costs. Alveolar recruitment maneuvers
recruit collapsed alveoli, increase gas exchange, and improve arterial
oxygenation. There is no consensus in the literature about the benefits of
alveolar recruitment maneuvers. A systematic review is necessary to
delineate their usefulness. METHODS: The search strategy included
utilizing PubMed, CINAHL, the Cochrane Library, the National Guideline
Clearinghouse, and all subsequent research reference lists up to January
2014. Inclusion criteria involved studies that compared the use of an
alveolarrecruitment maneuver with a control group lacking an alveolar
recruitment maneuver in adult surgical subjects not suffering from ARDS or
undergoing cardiac or thoracic surgeries. RESULTS: Six randomized
controlled trials of the 439 studies initially identified achieved a score
of > 3 on the Jadad scale and were included in this review. Alveolar
recruitment maneuvers consisted of a stepwise increase in tidal volume to
a plateau pressure of 30 cm H<sub>2</sub>O, a stepwise increase in PEEP to
20 cm H<sub>2</sub>O, or sustained manual inflations of the anesthesia
reservoir bag to a peak inspiratory pressure of 40 cm H<sub>2</sub>O.
Subjects in the alveolar recruitment maneuver groups experienced a higher
intraoperative P<sub>aO2</sub> with improved lung compliance. Different
alveolar recruitment maneuvers were equally effective. There was a
significant advantage when alveolar recruitment maneuvers were followed by
PEEP application. CONCLUSIONS: Alveolar recruitment maneuvers followed by
PEEP should be instituted after induction of general anesthesia, routinely
during maintenance, and in the presence of a falling S<sub>pO2</sub>
whenever feasible. They allow the anesthesia provider to reduce the
F<sub>IO2</sub> while maintaining a higher S<sub>pO2</sub>, limiting the
masking of shunts. Utilization of alveolar recruitment maneuvers may
reduce postoperative pulmonary complications and improve patient outcomes.
<26>
Accession Number
2015327378
Authors
Diemberger I. Parisi Q. De Filippo P. Narducci M.L. Zanon F. Potenza D.R.
Ciaramitaro G. Malacrida M. Boriani G. Biffi M.
Institution
(Diemberger, Boriani, Biffi) Institute of Cardiology, Department of
Experimental, Diagnostic and Specialty Medicine, University of Bologna,
Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, Bologna 40138, Italy
(Parisi) Cardiovascular Department, Fondazione di Ricerca e Cura Giovanni
Paolo II, Catholic University of the Sacred Heart, Campobasso, Italy
(De Filippo) Cardiac Electrophysiology and Pacing Unit, Cardiovascular
Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
(Narducci) Cardiovascular Sciences Department, Catholic University of
Sacred Heart, Rome, Italy
(Zanon) Arrhythmia and Electrophysiology Unit, Division of Cardiology,
Santa Maria della Misericordia Hospital, Rovigo, Italy
(Potenza) Department of Cardiology, Casa Sollievo della Sofferenza, San
Giovanni Rotondo (FG), Italy
(Ciaramitaro) Department of Cardiology, A.O.U. Policlinico P. Giaccone,
University of Palermo, Palermo, Italy
(Malacrida) CRM Division, Boston Scientific Italia, Milan, Italy
Title
Detect Long-term Complications after ICD Replacement (DECODE): Rationale
and Study Design of a Multicenter Italian Registry.
Source
Clinical Cardiology. 38 (10) (pp 577-584), 2015. Date of Publication:
October 2015.
Publisher
John Wiley and Sons Inc.
Abstract
The replacement of implantable cardioverter-defibrillators (ICDs) may give
rise to considerable clinical consequences, the importance of which is
underrated by the medical community. Replacement-related adverse events
are difficult to identify and require monitoring of both short-term
complications and long-term patient outcome. The aim of this study is to
perform a structured evaluation of both short- and long-term adverse
events and a cost analysis of consecutive ICD replacement procedures.
Detect Long-term Complications After ICD Replacement (DECODE) is a
prospective, single-arm, multicenter cohort study designed to estimate
long-term complication rates (at 12 months and 5 years) in patients
undergoing ICD generator replacement. The study will also evaluate
predictors of complications, patient management before and during the
replacement procedure in clinical practice, and the costs related to use
of health care resources. About 800 consecutive patients with standard
indications for ICD generator replacement will be enrolled in this study.
The decision to undertake generator replacement/upgrade will be made
according to the investigators' own judgment (which will be recorded).
Patients will be followed for 60 months through periodic in-hospital
examinations or remote monitoring. Detailed data on complications related
to ICD replacement in current clinical practice are still lacking. The
analysis of adverse events will reveal the value of new preventive
strategies, thereby yielding both clinical and economic benefits.
Moreover, assessment of complication rates after ICD replacement in a
real-life setting will help estimate the actual long-term cost of ICD
therapy and assess the real impact of increasing ICD longevity on
cost-effectiveness.
<27>
Accession Number
2015247486
Authors
Turgeon R.D. Barry A.R.
Institution
(Turgeon) Faculty of Pharmaceutical Sciences, University of British
Columbia, Vancouver, BC, Canada
(Barry) Faculty of Pharmacy and Pharmaceutical Sciences, University of
Alberta, Edmonton, AB, Canada
(Barry) Mazankowski Alberta Heart Institute, Alberta Health Services,
Edmonton, AB, Canada
Title
Single vs Dual Antiplatelet Therapy Following Transcatheter Aortic Valve
Implantation: A Systematic Review.
Source
Clinical Cardiology. 38 (10) (pp 629-634), 2015. Date of Publication:
October 2015.
Publisher
John Wiley and Sons Inc.
Abstract
There is wide variability in prescribing of antiplatelet regimens
following transcatheter aortic valve implantation (TAVI). The objective of
this review was to evaluate published and unpublished reports regarding
the efficacy and safety of dual antiplatelet therapy (DAPT) compared with
a single antiplatelet agent in patients undergoing TAVI. We searched
MEDLINE, CENTRAL, Embase, and unpublished sources of literature from
inception to December 2014 using terms synonymous with TAVI and DAPT. We
included randomized controlled trials (RCTs) and cohort or case-control
studies that compared DAPT with a single antiplatelet agent post-TAVI.
Four articles met the inclusion criteria (2 RCTs, 2 cohort studies), of
which all were deemed to be at high risk of bias, for a total of 662
patients. Compared with a single antiplatelet agent, DAPT did not
significantly reduce all-cause mortality (risk ratio: 1.22, 95% confidence
interval: 0.72-2.09, I<sup>2</sup> = 0%). Due to selective outcome
reporting and variable follow-up, other outcomes of interest could not be
meta-analyzed; however, evaluation of individual studies demonstrated no
significant reduction in thrombotic events with DAPT and a similar or
higher risk of bleeding. Current evidence, though limited by low
methodological quality, suggests a lack of benefit and potential harm with
DAPT compared with a single antiplatelet agent in patients post-TAVI.
Therefore, clinicians should evaluate the use of DAPT in patients
post-TAVI on a case-by-case basis until more robust evidence is available
to guide practice.
<28>
Accession Number
2015094063
Authors
Chieffo A. Van Mieghem N.M. Tchetche D. Dumonteil N. Giustino G. Van Der
Boon R.M.A. Pierri A. Marcheix B. Misuraca L. Serruys P.W. Millischer D.
Carrie D. De Jaegere P.P.T. Colombo A.
Institution
(Chieffo, Giustino, Colombo) Department of Cardio Thoracic and Vascular
Diseases, San Raffaele Scientific Institute, Interventional Cardiology
Unit, Via Olgettina 60, Milan 20132, Italy
(Van Mieghem, Van Der Boon, Serruys, De Jaegere) Department of
Interventional Cardiology, Thorax Center, Erasmus Medical Center,
Rotterdam, Netherlands
(Tchetche, Pierri, Misuraca, Millischer) Department of Cardiology,
Clinique Pasteur, Toulouse, France
(Dumonteil, Marcheix, Carrie) Pole Cardiovasculaire et Metaboliquec,
Hopital Rangueil, Toulouse, France
Title
Impact of mixed aortic valve stenosis on VARC-2 outcomes and
postprocedural aortic regurgitation in patients undergoing transcatheter
aortic valve implantation: Results from the international multicentric
study PRAGMATIC (Pooled Rotterdam-Milan-Toulouse in Collaboration).
Source
Catheterization and Cardiovascular Interventions. 86 (5) (pp 875-885),
2015. Date of Publication: 01 Nov 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives We sought to evaluate the impact of mixed aortic stenosis (MAS)
on postprocedural aortic regurgitation (PPAR) and clinical outcomes after
transcatheter aortic valve implantation (TAVI). Background The impact of
MAS of TAVI outcomes is unknown. Methods and Results Data from a
multicenter registry were retrospectively analysed. Outcomes were compared
between patients with pure aortic stenosis (PAS; associated AR < 1+/3+)
and MAS (associated AR > 1+/3+). Study objectives were PPAR incidence and
short- and long-term mortality. Overall, 1,062 patients were included: 419
(39.4%) with MAS and 643 (60.5%) with PAS. At 30 days, there were no
differences in mortality, however, a higher incidence of major bleeding
(22.7% vs. 16.8%; P = 0.016), PPAR > 1+/3+ (42.6% vs. 26.5%; P < 0.001)
and lower device success (89.3% vs. 93.3%; P = 0.019) was observed in
patients with MAS. Of note, MAS was an independent predictor of PPAR >
1+/3+ at multivariable analysis (OR: 2.882; CI: 1.851-4.488; P < 0.001).
At 2 years of follow-up, no survival differences were present between MAS
and PAS groups. Similarly, following stratification for PPAR > 1+/3+, MAS
had no protective effect on survival as compared with PAS. Conclusions MAS
was associated with lower device success and higher PPAR incidence.
However, despite these findings, it had no influence on long-term
postoperative outcomes.
<29>
Accession Number
2015086759
Authors
Haghikia A. Podewski E. Berliner D. Sonnenschein K. Fischer D. Angermann
C.E. Bohm M. Rontgen P. Bauersachs J. Hilfiker-Kleiner D.
Institution
(Haghikia, Podewski, Berliner, Sonnenschein, Rontgen, Bauersachs,
Hilfiker-Kleiner) Department of Cardiology and Angiology, Hannover Medical
School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
(Fischer) Department of Cardiology and Angiology, University Hospital
Muenster, Muenster, Germany
(Angermann) Department of Internal Medicine I, Comprehensive Heart Failure
Center, University Hospital of Wuerzburg, Wurzburg, Germany
(Bohm) Department of Internal Medicine III, University Hospital of
Saarland, Homburg/Saar, Germany
Title
Rationale and design of a randomized, controlled multicentre clinical
trial to evaluate the effect of bromocriptine on left ventricular function
in women with peripartum cardiomyopathy.
Source
Clinical Research in Cardiology. 104 (11) (pp 911-917), 2015. Date of
Publication: 31 May 2015.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Peripartum cardiomyopathy (PPCM) is an idiopathic heart
disease that develops in the last month of pregnancy and/or the first
months following delivery in previously healthy women and may lead to
acute heart failure. A cleaved fragment of the nursing hormone prolactin
is considered essential in the pathophysiology of PPCM. To date, no
specific therapy has been tested for PPCM in a randomized controlled trial
of adequate size. Aims: The purpose of this trial is to investigate the
safety of the dopamin-D2-receptor agonist bromocriptine and its effects on
left ventricular (LV) function in women with PPCM. Methods: This is an 11
center German trial with a prospective randomized controlled open-label
design. The trial enrolls females with newly diagnosed PPCM according to
European Society of Cardiology criteria with a LV ejection fraction (LVEF)
<35 %. Patients are randomized 1:1 to either best supportive care (BSC)
including standard heart failure therapy plus 8 weeks of bromocriptine
therapy (2.5 mg b.i.d. for 14 days and 2.5 mg q.d. from day 15 to 56) or
to BSC plus 1 week of low-dose bromocriptine (2.5 mg q.d.) with
anticoagulant therapy at a prophylactic dose administered during the
period of bromocriptine treatment in both groups. The primary endpoint is
change in LVEF from baseline to 6 months follow-up as assessed by cardiac
magnetic resonance imaging (or echocardiography if CMR is not tolerated).
The secondary endpoints are hospitalization for worsening heart failure,
heart transplantation, and all-cause mortality during follow-up or a
combination of these endpoints. A total of 60 patients will be recruited
(including 6 potential dropouts) giving a power of 0.9 for an expected
LVEF change of 10.8 % between treatment groups at 6 months. Perspective:
This trial will provide important knowledge on potential benefits and
safety of prolonged inhibition of prolactin release with bromocriptine in
addition to standard heart failure therapy in newly diagnosed PPCM. Trial
registration: ClinicalTrials.gov Identifier: NCT00998556.
<30>
Accession Number
72065476
Authors
Ansari M.M. Cardoso R.N. Garcia D.C. Spaziano M. De Marchena E. Brinster
D. Scheinerman S.J. Martucci G. Piazza N.
Institution
(Ansari) University of Miami, Jackson Memorial Hospital, New York, NY,
United States
(Cardoso, Garcia) University of Miami, Jackson Memorial Hospital, Miami,
FL, United States
(Spaziano) McGill University, Health Centre, Montreal, QC, Canada
(De Marchena) University of Miami, Miller School of Medicine, Miami, FL,
United States
(Brinster) Lenox Hill Heart and Vascular Institute, New York, NY, United
States
(Scheinerman) Hofstra North-Shore LIJ School of Medicine, New Hyde Park,
NY, United States
(Martucci, Piazza) McGill University, Health Center, Royal Victoria
Hospital, Montreal, QC, Canada
Title
A meta-analysis of embolic protection devices in the prevention of
cerebrovascular events after transcatheter aortic valve replacement.
Source
Journal of the American College of Cardiology. Conference: 27th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2015 San
Francisco, CA United States. Conference Start: 20151011 Conference End:
20151015. Conference Publication: (var.pagings). 66 (15 SUPPL. 1) (pp
B309), 2015. Date of Publication: 13 Oct 2015.
Publisher
Elsevier USA
Abstract
BACKGROUND Cerebrovascular events can occur in up to 7% of patients
following transcatheter aortic valve replacement (TAVR), increasing
dementia and mortality. Neuro-embolic events on post- TAVR
diffusion-weighted (DW) MRI are nearly universal, and have been associated
with cognitive decline. Embolic protection devices (EPD) have not shown
clinical reduction in post-TAVR neuro-embolic events, but previous studies
may have been under-powered to detect significant differences in outcomes.
METHODS We aimed to perform a meta-analysis evaluating EPD in the
prevention of clinical and imaging neuro-embolic events following TAVR.
Databases and conference abstracts were searched for studies that compared
efficacy and safety outcomes of TAVR with and without EPD. Random-effects
model was used. Heterogeneity was examined with Cochran Q test and I2
statistics. RESULTS A total of 4 studies with 289 patients were included,
of whom 152 (52.5%) underwent TAVR with an EPD. The success rate of EPD
implantation ranged from 89% to 100% (Table 1). In a follow-up up to 30
days, the use of EPD in TAVR was associated with a decreased incidence of
new neurologic impairment identified by specialist application of the
National Institute of Health Stroke Scale (OR 0.40; p=0.04; Figure 1).
EPDs were found to significantly increase fluoroscopy time by a mean of
5.23 minutes (p<0.01). There were no differences between groups in
clinical strokes (p=0.99), disabling strokes (p=0.70), DW-MRI lesions
(p=0.37), major vascular complications (p=0.85), life-threatening bleeding
(p=0.81), renal insufficiency (p=0.44), or mortality (p=0.66). CONCLUSIONS
This meta-analysis suggests that EPDs increase fluoroscopy time in TAVR,
but are otherwise safe, with a high technical success rate. In addition,
these devices have the potential to reduce the incidence of TAVR-related
new neurologic impairment. Thus, a benefit in the incidence of
peri-procedural strokes may become evident in larger clinical trials.
Further studies are warranted to confirm these findings. (Table
Presented).
<31>
Accession Number
72065452
Authors
Cardoso R.N. Ansari M.M. Mendirichaga R. Garcia D.C. Brinster D. Patel
N.C. Scheinerman S.J. Martucci G. Piazza N.
Institution
(Cardoso) University of Miami, Jackson Memorial Hospital, Miami, FL,
United States
(Ansari) University of Miami, Jackson Memorial Hospital, New York, NY,
United States
(Mendirichaga) University of Miami, Miller School of Medicine, Miami, FL,
United States
(Garcia) Ochsner Clinic Foundation, New Orleans, LA, United States
(Brinster) Lenox Hill Heart and Vascular Institute, New York, NY, United
States
(Patel) Lenox Hill Heart and Vascular Institute-North Shore LIJ Health
System, New York, NY, United States
(Scheinerman) Hofstra North-Shore LIJ School of Medicine, New Hyde Park,
NY, United States
(Martucci, Piazza) McGill University, Health Center, Royal Victoria
Hospital, Montreal, QC, Canada
Title
Heart failure functional classification following transcatheter versus
surgical aortic valve replacement: A meta-analysis of three randomized
controlled trials.
Source
Journal of the American College of Cardiology. Conference: 27th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2015 San
Francisco, CA United States. Conference Start: 20151011 Conference End:
20151015. Conference Publication: (var.pagings). 66 (15 SUPPL. 1) (pp
B299), 2015. Date of Publication: 13 Oct 2015.
Publisher
Elsevier USA
Abstract
BACKGROUND The decision to intervene in severe aortic stenosis is highly
dependent on the patient's symptoms and functional capacity. Approximately
80% of patients with severe symptomatic aortic stenosis who are high-risk
operable candidates for surgical aortic valve replacement (SAVR) are in
functional class III or IV upon enrollment in clinical trials. Among
patients who are eligible for both procedures, a recently published
randomized controlled trial (RCT) found that transcatheter aortic valve
replacement (TAVR) is associated with a higher New York Heart Association
(NYHA) functional class at 1-year as compared to SAVR. This finding was
not observed in other RCTs. We aimed to perform a meta-analysis of RCTs
comparing heart failure functional classification following TAVR vs. SAVR.
METHODS Pubmed, EMBASE, Cochrane Central, and conference abstracts were
searched for RCTs that (1) directly compared TAVR to SAVR in patients with
severe symptomatic aortic valve stenosis and (2) reported NYHA functional
class outcomes in (3) a follow-up period greater than 1 year. In studies
with overlapping populations, only the one with the largest sample size
was included. Odds-ratios were computed using random or fixed-effects
models. Heterogeneity was examined with I2 statistics. Review Manager 5.1
was used for metaanalysis statistics. RESULTS Three RCTs with a total of
1,393 patients were included, of whom 732 (52.5%) underwent TAVR. In a
follow-up that ranged from 1 to 2 years, no significant difference was
observed between treatment groups with regards to NYHA functional class IV
(OR 0.55; 95% CI 0.23- 1.32; p=0.18), functional class III or IV (OR 1.01;
95% CI 0.72-1.42; p=0.95), and functional class I (OR 0.86; 95% CI
0.55-1.36; p=0.53). CONCLUSIONS Our meta-analysis suggests that in
patients with severe symptomatic aortic stenosis who are eligible for
surgery, TAVR is as effective as SAVR for improvement in heart failure
symptoms in a 1 to 2-year follow-up. Ongoing trials will provide insights
as to longterm results. (Figure Presented).
<32>
Accession Number
72065203
Authors
Saurav A. Kaja A.K. Kaushik M. Alla V.M. Satpathy R. Smer A. White M.D.
Woodruff M. Mooss A. Del Core M.
Institution
(Saurav, Alla) Creighton University, School of Medicine, Omaha, NE, United
States
(Kaja, Kaushik, Woodruff) Creighton University Medical Center, Omaha, NE,
United States
(Satpathy) Alegent Creighton Heart and Vascular Institute, Omaha, United
States
(Smer, White, Mooss, Del Core) Cardiac Center, Creighton University,
Omaha, NE, United States
Title
Comparison of five-year outcomes of percutaneous versus surgical coronary
revascularization: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 27th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2015 San
Francisco, CA United States. Conference Start: 20151011 Conference End:
20151015. Conference Publication: (var.pagings). 66 (15 SUPPL. 1) (pp
B195), 2015. Date of Publication: 13 Oct 2015.
Publisher
Elsevier USA
Abstract
BACKGROUND Recent data from five-year results of SYNTAX trial showed
superiority of Coronary Artery Bypass Graft (CABG) with regards to all
major outcomes (mortality, MI, MACCE, repeat revascularization) whereas
stroke rate was similar to Percutaneous Coronary Revascularization (PCI).
We sought to compare five-year outcomes of PCI Vs CABG. METHODS PubMed &
Web of Science were searched for English language studies up to 1st June
2015 comparing five-year outcomes of PCI Vs CABG. Study quality,
publication bias & heterogeneity were assessed. Meta-analysis was
performed using DerSimonian-Liard random effects method. Outcomes were
reported for following groups: PCI Vs CABG, PCI with drug eluting stents
(DES) Vs CABG, PCI Vs CABG in diabetes and PCI with DES Vs CABG in
diabetes. RESULTS 10 studies were identified (n: PCI 6157 CABG 6029). Age
(PCI 66 yrs CABG 64.9 yrs) and gender distribution (Males: PCI 73.4% CABG
77%) were similar. Overall, PCI was associated with worse MACCE( RR 1.53,
CI 1.40-1.68, p<0.001), MI(RR 1.48, CI 1.05-2.09, p=0.02) & repeat
revascularization rates(RR 2.70, CI 2.06-3.55, p<0.001) while all-cause
mortality(RR 1.05, CI 0.90-1.23, p=0.51), cardiac mortality( RR 1.20, CI
0.98-1.46, p=0.07) were similar. Stroke (RR 0.79, CI 0.66-0.95, p=0.01)
was lower with PCI. Use of DES for PCI did not alter these outcomes while
stroke (RR 0.64, CI 0.49-0.85, p=0.002) remained higher with CABG. In
diabetics, PCI was associated with worse outcomes [all-cause mortality (RR
1.35, CI 1.17-1.56, p<0.001), cardiac mortality (RR 1.36, CI 1.12-1.66,
p=0.002), MI(RR 2.31, CI 1.79- 2.97, p<0.001), MACCE(RR 1.74, CI
1.45-2.00, p<0.001), repeat revascularization(RR 3.37, CI 2.96-3.84,
p<0.001)] while stroke( RR 0.78, CI 0.53-1.14, p=0.20) was similar to CABG
. Use of DES in diabetics yielded similar results except for the stroke
(RR 0.59, CI 0.42-0.84, p=0.003) that was higher with CABG. CONCLUSIONS In
unselected patients PCI was associated with worse outcomes in terms of
higher MACCE, MI, revascularization though stroke favored PCI regardless
of the type of stent used. In diabetics our meta-analysis findings agreed
with SYNTAX trial results favoring CABG for all major outcomes with
similar stroke rate as PCI.
<33>
Accession Number
72065190
Authors
Theodoropoulos K. Mennuni M.G. Garg A. Sharma A. Stefanini G.G.
Institution
(Theodoropoulos) Icahn school of medicine at Mount Sinai (Bronx), James J.
Peters VA Medical Center, Bronx, NY, United States
(Mennuni, Stefanini) Humanitas Research Hospital, Rozzano, Milan, Italy
(Garg) James J Peters VA Hospital, Icahn School of Medicine at Mount
Sinai, Bronx, NY, United States
(Sharma) SUNY Downstate University, Brooklyn, NY, United States
Title
Long-term mortality of percutaneous coronary intervention with
drug-eluting stents compared to bypass surgery in patients with left main
disease stratified by the syntax score: Comprehensive systematic review
and meta-analysis of 3372 patients.
Source
Journal of the American College of Cardiology. Conference: 27th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2015 San
Francisco, CA United States. Conference Start: 20151011 Conference End:
20151015. Conference Publication: (var.pagings). 66 (15 SUPPL. 1) (pp
B190), 2015. Date of Publication: 13 Oct 2015.
Publisher
Elsevier USA
Abstract
BACKGROUND According to the most recent guidelines, percutaneous coronary
intervention (PCI) with drug eluting stents (DES) should be considered
safe and effective alternative to coronary artery bypass grafting (CABG)
for the treatment of left main (LM) disease in patients with favorable
anatomy (SYNTAX score <32). Conversely in those with more complex coronary
disease (SYNTAX>33) CABG is favored mainly due to lower rates of
revascularization and myocardial infarction. However, whether the latter
it is translated into long-term mortality benefit it is not clear and
merits further investigation. METHODS A systematic review of the MEDLINE,
EMBASE, EBSCO, CINAHL, Web of Science and COCHRANE databases was conducted
in May 2015. Studies reporting long-term outcomes (at least 4 years mean
follow up) of PCI with DES to CABG for LM disease stratified by SS were
identified. Patients were categorized to low/intermediate (SS<32) and high
score (SS>33) groups. Random-effects meta-analyses were performed using
risk ratios as the metric of choice. RESULTS Four studies comprising two
randomized control trials (SYNTAX and PRECOMBAT) and two observational
studies (Maincompare and CREDO-Kyoto), with a total of 3372 patients were
included. 1248 patients (37%) had complex coronary artery disease (SS>33).
Over a mean follow up of 4.9 years, no significant difference in all-cause
mortality was observed between PCI and CABG irrespective of SYNTAX score
strata (Figure 1). Similar findings were observed for cardiovascular
mortality (SS < 32 RR 0.85; 95% 0.41-1.77; I2 66% for PCI vs. CABG; SS >33
RR 1.25; 95% CI 0.92-1.69; I2 29% for PCI vs. CABG). CONCLUSIONS Patients
with LM disease appear to have similar risks of mortality after PCI with
DES or CABG regardless of coronary artery disease burden or complexity
during long term follow up. (Figure Presented).
<34>
Accession Number
72065189
Authors
Garg A. Mennuni M.G. Theodoropoulos K. Sharma A. Kostis J. Stefanini G.G.
Institution
(Garg) Saint Peter's University Hospital, Rutgers- RWJMS, New Brunswick,
NJ, United States
(Mennuni, Stefanini) Humanitas Research Hospital, Rozzano, Milan, Italy
(Theodoropoulos) James J Peters VA Hospital, Icahn School of Medicine at
Mount Sinai, Bronx, NY, United States
(Sharma) SUNY Downstate University, Brooklyn, NY, United States
(Kostis) CVI and RWJMS, UMDNJ, New Brunswick, NJ, United States
Title
Percutaneous coronary intervention versus coronary artery bypass grafting
in left main coronary artery disease: Long-term follow-up meta-analysis of
6156 patients.
Source
Journal of the American College of Cardiology. Conference: 27th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2015 San
Francisco, CA United States. Conference Start: 20151011 Conference End:
20151015. Conference Publication: (var.pagings). 66 (15 SUPPL. 1) (pp
B189-B190), 2015. Date of Publication: 13 Oct 2015.
Publisher
Elsevier USA
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) has long been the
preferred revascularization approach in patients with left main (LM)
disease. However, evolving percutaneous coronary intervention (PCI)
techniques with DES implantation have shown comparable short-term efficacy
and safety during the last decade. Concurrently, ACC/AHA guidelines have
made a Class IIa recommendation for PCI in patients with LM stenosis and
favorable anatomy. However, concerns persist regarding long-term prognosis
of PCI with DES in high risk LM disease. Therefore, we aimed to
investigate the cumulative evidence for long-term outcomes of PCI with DES
versus CABG in patients with LM stenosis METHODS A systematic review of
randomized control trials and observational studies in MEDLINE, EMBASE,
EBSCO, CINAHL, Web of Science and Cochrane databases comparing PCI with
DES to CABG for LM disease was performed. Only studies with a median
follow-up of at least 4 years were included. Pre-specified outcomes of
interest were all-cause mortality, cardiovascular mortality, myocardial
infarction (MI), stroke, and repeat revascularization. Random-effects
meta-analyses were performed, using risk ratios as the metric of choice.
RESULTS Nine studies comprising two RCTs and seven observational studies,
with a total of 6156 patients were included. Median duration of follow-up
was 56 months. Overall, there were no significant differences between PCI
with DES and CABG in terms of all-cause mortality [RR 0.81, 95% CI
0.63-1.04; I2=66.8%] and cardiovascular mortality [RR 0.92, 95% CI
0.54-1.58; I2=72.1%]. Compared with CABG, PCI was associated with a
significant increase in the risk of MI [RR 1.59, 95% CI 1.07-2.36;
I2=38.2%] and repeat revascularization [RR 2.68, 95% CI 1.98-3.62;
I2=70%]. Whereas, a numerically lower risk of stroke with PCI as compared
to CABG [RR 0.59, 95% CI 0.31-1.13; I2=51.3%] was observed. The results
were consistent between RCTs and observational studies for each outcome.
CONCLUSIONS The findings of this meta-analysis suggest that for the
treatment of LM disease, PCI with DES and CABG have comparable mortality
(all cause and cardiovascular) during long-term follow-up. PCI with DES
appears to be associated with increased risks of MI and repeat
revascularization. (Table Presented).
<35>
Accession Number
72065176
Authors
Lee J.M. Hwang D. Park J. Kim K.-J. Park K.W. Ahn C. Koo B.-K.
Institution
(Lee, Hwang, Park, Kim) Seoul National University Hospital, Seoul, South
Korea
(Park) Department of Internal Medicine and Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Ahn) Food and Drug Administration, Silver Spring, MD, United States
(Koo) Seoul National University, Seoul, South Korea
Title
Percutaneous coronary intervention at centers with and without on-site
surgical backup: An updated meta-analysis of 23 studies.
Source
Journal of the American College of Cardiology. Conference: 27th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2015 San
Francisco, CA United States. Conference Start: 20151011 Conference End:
20151015. Conference Publication: (var.pagings). 66 (15 SUPPL. 1) (pp
B184), 2015. Date of Publication: 13 Oct 2015.
Publisher
Elsevier USA
Abstract
BACKGROUND Emergency coronary artery bypass grafting (CABG) for
unsuccessful percutaneous coronary intervention (PCI) is now rare. We
aimed to evaluate the current safety and outcomes of primary PCI and
non-primary PCI at centers with and without on-site surgical backup.
METHODS We performed an updated systematic review and metaanalysis using
mixed-effects models. Randomized controlled trials (RCT) or prospective
observational studies with adjustment of baseline differences, which
compared all-cause mortality or emergency CABG rates of PCI performed at
centers with or without on-site surgical back-up, were identified. The
primary outcome was all-cause mortality after PCI. Secondary outcomes were
rates of emergency CABG and various complications during or after PCI.
Odds ratios (OR) with 95% confidence intervals (CI) between with and
without on-site surgical back-up were compared. RESULTS We included 23
high-quality studies that compared clinical outcomes and complication
rates of 1,101,123 patients after PCI at centers with or without on-site
surgery. For primary PCI for STsegment elevation myocardial infarction
(133,574 patients), all-cause mortality (without on-site surgery vs. with
on-site surgery: observed rates, 4.8% vs. 7.2%, pooled OR 0.99, 95% CI
0.91-1.07, p=0.729, I2=3.4%) or emergency CABG rates (observed rates, 1.5%
vs. 2.4%, pooled OR 0.76, 95% CI 0.56-1.01, p=0.062, I2=42.5%) did not
differ by presence of on-site surgery. For non-primary PCI (967,549
patients), all-cause mortality (observed rates, 1.6% vs. 2.1%, pooled OR
1.15, 95% CI 0.94-1.41, p=0.172, I2=67.5%) and emergency CABG rates
(observed rates, 0.5% vs. 0.8%, pooled OR 1.14, 95% CI 0.62-2.13, p=0.669,
I2=81.7%) were not significantly different. PCI complication rates
(cardiogenic shock, stroke, aortic dissection, tamponade, recurrent
infarction) also did not differ by on-site surgical capability. Cumulative
meta-analysis of non-primary PCI showed a temporal decrease of the effect
size (OR) for all-cause mortality after 2007. CONCLUSIONS Clinical
outcomes and complication rates of PCI at centers without on-site surgery
did not differ from those with on-site surgery, for both primary and
non-primary PCI. Temporal trends indicated improving clinical outcomes in
non-primary PCI at centers without on-site surgery. (Figure Presented).
<36>
Accession Number
72065156
Authors
Rigattieri S. Sciahbasi A. Brilakis E. Burzotta F. Rathore S. Pugliese
F.R. Ziakas A. Zhou Y.J. Guzman L. Anderson R.A.
Institution
(Rigattieri, Sciahbasi, Pugliese) Sandro Pertini Hospital, Rome, Italy
(Brilakis) VA North Texas Healthcare System, UT Southwestern Medical
Center, Dallas, TX, United States
(Burzotta) Catholic University of the Sacred Heart, Rome, Italy
(Rathore) Frimley Park Hospital NHS Foundation Trust, London, United
Kingdom
(Ziakas) AHEPA Hospital, Thesalloniki, Greece
(Zhou) An Zhen Hospital, Capital Medical University, Beijing, China
(Guzman) University of Florida, Jacksonville, United States
(Anderson) University Hospital of Wales, Cardiff, United Kingdom
Title
Radial versus femoral approach for coronary angiography and intervention
in patients with CABG: Systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 27th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2015 San
Francisco, CA United States. Conference Start: 20151011 Conference End:
20151015. Conference Publication: (var.pagings). 66 (15 SUPPL. 1) (pp
B175), 2015. Date of Publication: 13 Oct 2015.
Publisher
Elsevier USA
Abstract
BACKGROUND Cardiac catheterization through the radial approach has been
shown to significantly reduce vascular access complications and bleeding,
as compared with the femoral approach, in multiple clinical settings.
However, in the subset of patients with previous coronary artery bypass
graft (CABG) surgery, optimal vascular access site for coronary
angiography and intervention is still a matter of debate, since
conflicting results were reported. According to several observational
studies, indeed, radial approach was as effective and safer as compared to
femoral approach, but these findings were questioned by the only
randomized trial available. METHODS In order to systematically review
studies comparing radial approach with femoral approach in patients with
previous CABG, we conducted a search on major electronic databases
entering the following key words: "radial", "vascular access", "femoral",
"coronary artery bypass graft", "coronary angiography" and "percutaneous
coronary intervention". We included in the analysis studies reporting
outcomes on at least one of the following end-points: fluoroscopy time,
procedural time, contrast volume, procedural success rate and vascular
complications. Data were extracted by two independent reviewers; weighted
mean differences and 95% confidence interval (C.I.) were calculated for
continuous outcomes, whereas odds ratio (OR) and 95% (C.I.) were
calculated for dichotomous outcomes. Summary statistics were calculated by
randomeffects model using Review Manager 5.3 software. RESULTS We included
in the meta-analysis 1 randomized and 8 nonrandomized studies, amounting
to 2763 patients. Radial and femoral approaches were comparable for
fluoroscopy time (0.62 min [-0.83, 2.07]), procedural time (3.24 min
[-1.76, 8.25]), contrast volume (-2.58 ml [-18.36, 13.20]) and procedural
success rate (OR 1.42 [0.61, 3.31]); differently, radial approach was
associated with lower risk of vascular complications (OR 0.48 [0.28,
0.85]). CONCLUSIONS Our meta-analysis, although limited by the inclusion
of mainly nonrandomized studies, suggests that among prior CABG patients
use of the radial versus femoral approach for coronary angiography and
intervention is associated with similar fluoroscopy time, procedural time,
contrast volume and procedural success rate, but lower risk of vascular
complications. (Figure Presented).
<37>
Accession Number
72065145
Authors
Mohananey D. Iskander M. Sidhu G.S. Spinetto P.A.V. Yadav N.
Institution
(Mohananey, Iskander, Sidhu, Yadav) John H Stroger Hospital of Cook
County, Chicago, IL, United States
(Spinetto) Montefiore Med Cntr, Albert Einstein College of Medicine, New
York, NY, United States
Title
Comparative meta-analysis of transulnar and transradial cardiac
catheterization.
Source
Journal of the American College of Cardiology. Conference: 27th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2015 San
Francisco, CA United States. Conference Start: 20151011 Conference End:
20151015. Conference Publication: (var.pagings). 66 (15 SUPPL. 1) (pp
B170), 2015. Date of Publication: 13 Oct 2015.
Publisher
Elsevier USA
Abstract
BACKGROUND Transradial (TR) catheterization has become popular as a
first-line approach for coronary angiography due to less bleeding and
access site complications. Recently, the transulnar (TU) approach has been
getting attention as a possible substitute to TR access for repeat
angiographic procedures and in cases of radial artery occlusion. It also
preserves the radial artery for subsequent coronary artery bypass
grafting. In this meta-analysis we attempt to compare safety and efficacy
of TU and TR catheterization. METHODS Electronic databases were searched
for all studies comparing TU and TR catheterization. A total of 6 studies
with 13,285 patients were identified to be included in this analysis.
Outcomes of interest were major adverse cardiovascular events (MACE),
vascular complications, procedure time, procedure success, and crossover
rate. Odds ratio (OR) or standardized mean difference (SMD) along with 95%
confidence intervals (CI) were computed for each outcome. Fixed and random
effects models were used as found appropriate. Sensitivity analysis and
bias assessment was done for each outcome. RESULTS There was no
significant difference between TR and TU for MACE [OR 0.83 (CI 0.52 to
1.33), p = 0.43], vascular complications [OR 0.9 (CI 0.61 to 1.32), p =
0.58], crossover rate [OR 1.93 (CI 0.69 to 5.37), p = 0.21], procedure
success [OR 1.17 (CI 0.66 to 2.08), p = 0.61] and procedure time [SMD
-0.14 (CI -0.29 to 0.011), p = 0.07]. Sensitivity analysis revealed that
removal of one study (Geng et al) resulted in a significantly increased
summary procedure time in TU catheterization [SMD -0.21 (CI -0.29 to
-0.14), p <0.01]. This study (Geng et al) had shown a non-significant
trend towards increase in procedure time in TR catheterization, which was
incongruent with all other studies. CONCLUSIONS Transulnar catheterization
is a safe alternative to transradial approach and has many potential
benefits with similar rates of procedure success. However, this approach
may be associated with an increased procedure time. (Figure Presented).
<38>
Accession Number
72064995
Authors
Jo S.-H. Park W.-J.
Institution
(Jo) Hallym University, Sacred Heart Hospital, Anyang-si, Gyeonggi-do,
South Korea
(Park) Hallym Univ., Sacred Heart Hospital, Anyang-si, HI, South Korea
Title
A meta-analysis of 43,432 patients: Concomitant use of proton pump
inhibitor with clopidogrel is associated with increased death and
myocardial infarction in patients receiving percutaneous coronary
intervention.
Source
Journal of the American College of Cardiology. Conference: 27th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2015 San
Francisco, CA United States. Conference Start: 20151011 Conference End:
20151015. Conference Publication: (var.pagings). 66 (15 SUPPL. 1) (pp
B100-B101), 2015. Date of Publication: 13 Oct 2015.
Publisher
Elsevier USA
Abstract
BACKGROUND Concomitant use of proton pump-inhibitor (PPI) with clopidogrel
has been reported to be associated with increased risk of mortality and
myocardial infarction in patients receiving coronary intervention due to
drug interaction. There is little data in large populations. METHODS We
have conducted a meta-analysis of published and unpublished studies
including patients with acute coronary syndrome or stable angina receiving
coronary stenting discharged on clopidogrel, Data source was
MEDLINE(ovid), PubMed, Web of Science, Cochrane Central Register of
Controlled Trials and Science Direct from 1950 to November 2009 with
English language. Using standardized protocol, 2 reviewed serially
abstracted data from each study. RESULTS Four published and 3 unpublished
studies with information on 43432 patients and 7354 events were included.
Common primary outcomes were death including cardiovascular cause,
myocardial infarction, stroke. The pooled odd ratio (OR) was 1.56 (95% CI.
1.28- 1.89), with significant heterogeneity across studies (I2=86.3%,
p<0.001). This heterogeneity was due to the different estimation between
published and unpublished studies: OR, 1.39(CI, 1.04-1.87) and 2.19 (CI,
1.25-3.83), respectively. CONCLUSIONS PPI use concomitant with clopidogrel
is associated with increased risk of mortality and myocardial infarction
after coronary intervention. Beneficial effect of clopidogrel may be
attenuated by drug interaction with PPI. (Figure Presented).
<39>
Accession Number
72064860
Authors
Cardoso R.N. Ansari M.M. Garcia D.C. Alfonso C. De Marchena E. Brinster D.
Scheinerman S.J. Martucci G. Piazza N.
Institution
(Cardoso, Ansari, Garcia) University of Miami, Jackson Memorial Hospital,
Miami, FL, United States
(Alfonso, De Marchena) University of Miami, Miller School of Medicine,
Miami, FL, United States
(Brinster) Lenox Hill Heart and Vascular Institute, New York, NY, United
States
(Scheinerman) Hofstra North-Shore LIJ School of Medicine, New York, NY,
United States
(Martucci, Piazza) McGill University Health Center, Royal Victoria
Hospital, Montreal, QC, Canada
Title
Single versus dual anti-platelet therapy in transcatheter aortic valve
replacement: A meta-analysis of safety and efficacy outcomes.
Source
Journal of the American College of Cardiology. Conference: 27th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2015 San
Francisco, CA United States. Conference Start: 20151011 Conference End:
20151015. Conference Publication: (var.pagings). 66 (15 SUPPL. 1) (pp
B38), 2015. Date of Publication: 13 Oct 2015.
Publisher
Elsevier USA
Abstract
BACKGROUND Major bleeding episodes or strokes can occur in up to 25% of
transcatheter aortic valve replacement (TAVR). Although guidelines
recommend dual antiplatelet therapy (DAPT) up to 6 months, they also
recognize there is a lack of evidence comparing antiplatelet strategies in
TAVR. Previous studies were not powered for individual, but rather
composite end-points. We aimed to performa meta-analysis comparing single
antiplatelet therapy (SAT) to DAPT in TAVR. METHODS PubMed, EMBASE,
Cochrane, and conference abstracts were searched for observational and
randomized studies that directly compared SAT to DAPT in patients
undergoing TAVR. Odds-ratios of safety and efficacy outcomes were computed
using random or fixed-effects models. Heterogeneity was examined with
Cochran Q test and I2 statistics. Metaanalysis statistics were performed
with Review Manager 5.1. RESULTS Four studies and 640 patients were
included, of whom 354 (55%) received SAT. In the DAPT group, two
antiplatelet agents were given for up to 6 months (Table 1). In a 30-day
follow-up, SAT was associated with a decreased incidence of major vascular
complications (OR 0.53; p=0.07), any vascular complication (OR 0.42;
p<0.01), major bleeding (OR 0.27; p<0.01; Figure 1), lifethreatening
bleeding (OR 0.41; p=0.02), and any bleeding episode (OR 0.44; p=0.03).
There were no significant differences between SAT and DAPT in all-cause
mortality (p=0.57), cardiovascular mortality (p=0.99), major stroke
(p=0.42), or any stroke/TIA (p=0.64). Similar results were observed in the
6 month follow-up. (Table presented) CONCLUSIONS This meta-analysis
suggests that SAT is safer than DAPT in terms of vascular complications
and major or life-threatening bleeding episodes after TAVR. Further, our
results indicate that a single antiplatelet agent is as effective as DAPT
in the prevention of cerebrovascular events. Our study is
hypothesis-generating; larger randomized trials are warranted to confirm
these findings.
<40>
Accession Number
25455544
Authors
Douglas P.S. Hahn R.T. Pibarot P. Weissman N.J. Stewart W.J. Xu K. Wang Z.
Lerakis S. Siegel R. Thompson C. Gopal D. Keane M.G. Svensson L.G. Tuzcu
E.M. Smith C.R. Leon M.B.
Institution
(Douglas) Duke Clinical Research Institute and Duke University Medical
Center, Durham, North Carolina. Electronic address:
pamela.douglas@duke.edu
(Hahn) Columbia University Medical Center/New York Presbyterian Hospital,
New York, New York
(Pibarot) Department of Medicine, Laval University, Quebec, Quebec, Canada
(Weissman) Medstar Health Research Institute and Georgetown University
School of Medicine, Washington, District of Columbia
(Stewart) Cleveland Clinic Foundation, Cleveland, Ohio
(Xu) Cardiovascular Research Foundation, New York, New York
(Wang) Medstar Washington Hospital Center, Washington, District of
Columbia
(Lerakis) Emory University School of Medicine, Atlanta, Georgia
(Siegel) Cedars-Sinai Medical Center, Los Angeles, California
(Thompson) St Paul's Hospital, Vancouver, British Columbia, Canada
(Gopal) The Heart Hospital Baylor, Scott and White Health, Plano, Texas
(Keane) Temple Heart and Vascular Center, Philadelphia, Pennsylvania
(Svensson) Cleveland Clinic Foundation, Cleveland, Ohio
(Tuzcu) Cleveland Clinic Foundation, Cleveland, Ohio
(Smith) Columbia University Medical Center/New York Presbyterian Hospital,
New York, New York
(Leon) Columbia University Medical Center/New York Presbyterian Hospital,
New York, New York
Title
Hemodynamic outcomes of transcatheter aortic valve replacement and medical
management in severe, inoperable aortic stenosis: a longitudinal
echocardiographic study of cohort B of the PARTNER trial.
Source
Journal of the American Society of Echocardiography : official publication
of the American Society of Echocardiography. 28 (2) (pp 210-217), 2015.
Date of Publication: 01 Feb 2015.
Abstract
BACKGROUND: Inoperable aortic stenosis may be treated with either
transcatheter aortic valve replacement (TAVR) or medical management (MM)
with or without balloon aortic valvuloplasty (BAV). The aim of this study
was to compare the long-term echocardiographic findings among TAVR, MM,
and BAV in patients with severe, inoperable aortic stenosis.
METHODS: A total of 358 inoperable patients in the Placement of Aortic
Transcatheter Valves trial were randomized to MM or TAVR. Echocardiograms
obtained at baseline, 30 days, and 1, 2, and 3 years were analyzed by a
central core laboratory.
RESULTS: At baseline, TAVR and MM were similar, with more frequent Society
of Thoracic Surgeons score > 10 (51.7% vs 65.0%, P = .03) and larger
end-systolic volumes (54.5 +/- 29.3 vs 69.1 +/- 48.0 mL, P = .03) in MM.
By 30 days after TAVR, mean aortic valve gradient had decreased (from 43.8
+/- 14.7 to 10.0 +/- 4.3 mm Hg, P < .001), ejection fraction had increased
(from 53.2 +/- 12.4% to 56.7 +/- 10.0%, P < .001), and left ventricular
(LV) mass index had decreased (from 144.7 +/- 36.1 to 140.0 +/- 37.9
gm/m(2), P < .05). After 1 year, aortic valve gradients and area were
unchanged, while LV mass index had decreased by another 16 gm/m(2) (to 124
gm/m(2)). By 30 days after BAV, mean aortic valve gradient had decreased
from 43.4 +/- 15.0 to 31.9 +/- 11.1 mm Hg, while ejection fraction and LV
mass index were unchanged; gradient reverted to baseline at 1 year. No
changes in gradients or mass were seen in MM patients.
CONCLUSIONS: TAVR results in immediate and sustained relief in pressure
overload and improved LV systolic function, with continued regression of
hypertrophy over 3 years. Poor clinical results with BAV are explained by
the modest and transient reductions in pressure overload with BAV, which
were not accompanied by improved LV function or remodeling. TAVR is the
preferred treatment in eligible inoperable patients (ClinicalTrials.gov
identifier NCT00530894).
<41>
Accession Number
26156911
Authors
Hemmati N. Zokaei A.H.
Institution
(Zokaei) School of Medicine, Kermanshah University of Medical Sciences,
Kermanshah. Hamidzokaei@gmail.com
Title
Comparison of the Effect of Anesthesia With Midazolam-Fentanyl Versus
Propofol-Remifentanil on Bispectral Index in Patients Undergoing Coronary
Artery Bypass Graft.
Source
Global journal of health science. 7 (5) (pp 233-238), 2015. Date of
Publication: 2015.
Abstract
The aim of this study was to compare the effect of anesthesia with
midazolam-fentanyl versus propofol-remifentanil on the BIS (bispectral
index) in patients undergoing coronary artery bypass grafting (CABG).
Sixty-four patients undergoing CABG were randomly assigned to one of two
study groups: midazolam-fentanyl (MF, N=32) or propofol-remifentanil (PR,
N=32). The BIS was measured before induction of anesthesia, five minutes
after induction of anesthesia, at skin incision, sternotomy,
pericardiotomy, aorta cannulation, onset of cardiopulmonary bypass, during
rewarming, five minutes after separation from cardiopulmonary bypass, at
thorax closure, and at the end of the surgery. There were no significant
differences between the two groups with regard to age and gender. The
difference in mean BIS between the two groups was significant (P<0.05) at
all times, except before induction, five minutes after induction, at skin
incision and on rewarming. Changes in the BIS were lower in the PR group
than in the MF group. Both techniques can provide adequate anesthesia in
patients undergoing CABG. However, the probability of awareness during
anesthesia is lower with propofol-remifentanil than with
midazolam-fentanyl.
<42>
Accession Number
26156921
Authors
Aryaeefar M.R. Jafari H. Yazdani-Charati J. Soleimani A.
Institution
(Jafari, Yazdani-Charati, Soleimani) Department of Medical-Surgical
Nursing, School of Nursing and Midwifery, Mazandaran University of Medical
Sciences. jafarih2010@gmail.com
Title
Green Tea Gargling Effect on Cough & Hoarseness After Coronary Artery
Bypass Graft.
Source
Global journal of health science. 7 (5) (pp 266-271), 2015. Date of
Publication: 2015.
Abstract
INTRODUCTION: Endotracheal intubation is a method necessary for
controlling and maintaining airway during general anesthesia. Cough and
hoarseness are common complications after endotracheal intubation.
Inflammation has an important role in postoperative cough and hoarseness
outbreak. Also it has been stated that green tea has anti-inflammatory
properties. Therefore, the current study has been conducted to investigate
green tea gargling solution effect on cough and hoarseness after coronary
artery bypass graft (CABG) surgery.
METHODS: In this single-blind, randomized, & controlled clinical trial, we
enrolled 121 patients undergoing CABG admitted to the ICU. The
intervention group participants were asked to gargle 30 cc of green tea
solution. The control group patients gargled 30 cc of distilled water. An
hour after extubation, the intervention group patients were asked to
gargle 30 cc of green tea and the control group patients were required to
gargle 30 cc of distilled water every 6 hour up to 24 hour (each patient
for 4 times). Moreover, the cough and hoarseness questionnaire was also
filled in 6, 12, and 24 hours after endotracheal extubation.
RESULTS: The results showed no significant differences among the patients
in both groups regarding age, gender, body mass index, smoking history,
and anesthesia duration. There was a significant difference between the
two groups in terms of cough 12 hours after removing the endotracheal
tube. At other times, there was no significant difference between the two
groups considering cough and hoarseness.
CONCLUSION: The present study results showed that green tea gargling does
not decrease hoarseness. Though, cough occurrence was less in the
intervention group than the other group.
<43>
Accession Number
25618303
Authors
Sipahi I.
Institution
(Sipahi) Department of Cardiology, Acibadem University Medical School,
Acibadem Maslak Hospital, Buyukdere Cad 40, 34457, Istanbul, Turkey,
Title
Bypass grafting versus percutaneous intervention in multivessel coronary
disease: the current state.
Source
Current cardiology reports. 17 (2) (pp 7), 2015. Date of Publication: 01
Feb 2015.
Abstract
Whether stenting or coronary artery bypass grafting (CABG) is the best
revascularization strategy in patients with multivessel disease has been a
heavily debated controversy. The trials comparing the two methods were
unfortunately underpowered for mortality. Moreover, results of clinical
trials appeared to contradict with each other. Because CABG is
unequivocally a more cumbersome method, stenting became commonly preferred
in the absence of evidence for mortality difference. Meta-analysis is a
powerful tool, especially when several high-quality randomized trials are
available on the same issue. In these instances, meta-analyses can
overcome the power limitation of the individual trials. Our recent
meta-analysis reveals that, as compared to stenting, CABG leads to
unequivocal reductions in mortality and myocardial infarctions in patients
with multivessel disease. These benefits are seen regardless of whether
patients are diabetic or not and also do not depend on whether bare-metal
or drug-eluting stents are used.
<44>
Accession Number
24088915
Authors
Lago Borges D. Jose da Silva Nina V. Pereira Baldez T.E. de Albuquerque
Goncalves Costa M. Pereira dos Santos N. Mendes Lima I. Lima da Silva Lula
J.
Institution
(Lago Borges, Jose da Silva Nina, Pereira Baldez, de Albuquerque Goncalves
Costa, Pereira dos Santos, Mendes Lima, Lima da Silva Lula) Cardiovascular
Intensive Care Unit, Presidente Dutra University Hospital, Sao Luis
(Maranhao), Brazil
Title
Effects of positive end-expiratory pressure on mechanical ventilation
duration after coronary artery bypass grafting: a randomized clinical
trial.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 20 (pp
773-777), 2014. Date of Publication: 2014.
Abstract
Patients undergoing cardiac surgery remain on mechanical ventilation
postoperatively until they regain consciousness. Positive end-expiratory
pressure (PEEP) may influence the duration of mechanical ventilation after
coronary artery bypass grafting (CABG). The aim of this study was to
compare the effects of different levels of PEEP on the duration of
mechanical ventilation after coronary artery bypass grafting. This was a
randomized clinical trial with 136 patients undergoing CABG between
January 2011 and March 2012. We divided the patients into three groups
with different levels of PEEP at the onset of mechanical ventilation:
Group A, PEEP=5 cmH2O (n=44); Group B, PEEP=8 cmH2O (n=47) and Group C,
PEEP=10 cmH2O (n=45). Mechanical ventilation time was obtained from a
Physical Therapy Evaluation Form. We excluded patients with chronic
obstructive pulmonary disease and those requiring concomitant, emergency
or off-pump surgeries. For statistical analysis, we used the
Kruskal-Wallis, G and Chi-square tests, with p<0.05 considered
significant. From the point of weaning from mechanical ventilation until
12 hours after intensive care unit (ICU) admission, we saw a statistically
different duration of mechanical ventilation between groups (p=0.029). In
Group A, the average mechanical ventilation time was 6.7+/-3.2 hours; it
was 6.8+/-3.3 hours in Group B and 5.1+/-2.9 hours in Group C. The use of
higher levels of PEEP was associated with shorter duration of mechanical
ventilation in postoperative CABG patients.
<45>
Accession Number
25059340
Authors
Khawaja M.Z. Wang D. Pocock S. Redwood S.R. Thomas M.R.
Institution
(Khawaja, Wang, Pocock, Redwood, Thomas) The Rayne Institute,
Cardiovascular Division, King's College London, BHF Centre of Excellence,
St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
Dr.zeeshan.khawaja@gmail.com
Title
The percutaneous coronary intervention prior to transcatheter aortic valve
implantation (ACTIVATION) trial: study protocol for a randomized
controlled trial.
Source
Trials. 15 (pp 300), 2014. Date of Publication: 2014.
Abstract
BACKGROUND: Current guidelines recommend treatment of significant coronary
artery disease by concomitant coronary artery bypass grafting (CABG) in
patients undergoing surgical aortic valve replacement. However there is no
consensus as to how best to treat coronary disease in high-risk patients
requiring transcatheter aortic valve implantation (TAVI).
METHODS/DESIGN: The percutaneous coronary intervention prior to
transcatheter aortic valve implantation (ACTIVATION) trial is a
randomized, controlled open-label trial of 310 patients randomized to
treatment of significant coronary artery disease by percutaneous coronary
intervention (PCI - test arm) or no PCI (control arm). Significant
coronary disease is defined as >1 lesion of >70% severity in a major
epicardial vessel or 50% in a vein graft or protected left main stem
lesion. The trial tests the hypothesis that the strategy of performing
pre-TAVI PCI is non-inferior to not treating such coronary stenoses with
PCI prior to TAVI, with a composite primary outcome of 12-month mortality
and rehospitalization. Secondary outcomes include efficacy end-points such
as 30-day mortality, safety endpoints including bleeding, burden of
symptoms, and quality of life (assessed using the Seattle Angina
Questionnaire and the Kansas City Cardiomyopathy Questionnaire). In
conclusion, we hope that using a definition of coronary artery disease
severity closer to that used in everyday practice by interventional
cardiologists - rather than the 50% severity used in surgical guidelines -
will provide robust evidence to direct guidelines regarding TAVI therapy
and improve its safety and efficacy profile of this developing technique.
TRIAL REGISTRATION: ISRCTN75836930,
http://www.controlled-trials.com/ISRCTN75836930 (registered 19 November
2011).
<46>
Accession Number
24952833
Authors
Snowdon D. Haines T.P. Skinner E.H.
Institution
(Snowdon) Department of Physiotherapy, Monash Medical Centre
(Haines) Allied Health Research Unit, Monash Health
(Skinner) Department of Physiotherapy, Monash Medical Centre; Allied
Health Research Unit, Monash Health; Department of Physiotherapy, Monash
Health, Western Health, Melbourne, Australia
Title
Preoperative intervention reduces postoperative pulmonary complications
but not length of stay in cardiac surgical patients: a systematic review.
Source
Journal of physiotherapy. 60 (2) (pp 66-77), 2014. Date of Publication: 01
Jun 2014.
Abstract
QUESTION: Does preoperative intervention in people undergoing cardiac
surgery reduce pulmonary complications, shorten length of stay in the
intensive care unit (ICU) or hospital, or improve physical function?
DESIGN: Systematic review with meta-analysis of (quasi) randomised trials.
PARTICIPANTS: People undergoing coronary artery bypass grafts and/or
valvular surgery.
INTERVENTION: Any intervention, such as education, inspiratory muscle
training, exercise training or relaxation, delivered prior to surgery to
prevent/reduce postoperative pulmonary complications or to hasten recovery
of function.
OUTCOME MEASURES: Time to extubation, length of stay in ICU and hospital
(reported in days). Postoperative pulmonary complications and physical
function were measured as reported in the included trials.
RESULTS: The 17 eligible trials reported data on 2689 participants.
Preoperative intervention significantly reduced the time to extubation (MD
-0.14 days, 95% CI -0.26 to -0.01) and the relative risk of developing
postoperative pulmonary complications (RR 0.39, 95% CI 0.23 to 0.66).
However, it did not significantly affect the length of stay in ICU (MD
-0.15 days, 95% CI -0.37 to 0.08) or hospital (MD -0.55 days, 95% CI -1.32
to 0.23), except among older participants (MD -1.32 days, 95% CI -2.36 to
-0.28). When the preoperative interventions were separately analysed,
inspiratory muscle training significantly reduced postoperative pulmonary
complications and the length of stay in hospital. Trial quality ranged
from good to poor and considerable heterogeneity was present in the study
features. Other outcomes did not significantly differ.
CONCLUSION: For people undergoing cardiac surgery, preoperative
intervention reduces the incidence of postoperative pulmonary
complications and, in older patients, the length of stay in hospital.
<47>
Accession Number
25720104
Authors
Witt-Majchrzak A. Zelazny P. Snarska J.
Title
Preliminary outcome of treatment of postoperative primarily closed
sternotomy wounds treated using negative pressure wound therapy.
Source
Polski przeglad chirurgiczny. 86 (10) (pp 456-465), 2014. Date of
Publication: 01 Oct 2014.
Abstract
UNLABELLED: Hospital infections, and in particular infections of the
surgical site are a common problem of the procedural departments. Due to
continuous progress of surgical techniques and patient population getting
older with multiple co-morbidities, multidirectional actions need to be
taken to avoid these infections or, if they do occur, achieve optimal
treatment outcomes. Vacuum wound therapy is one of the directions that has
been developed over the recent years. The aim of the study evaluate wound
healing in patients after an off-pump coronary artery bypass grafting
procedure, using the internal mammary artery, treated with negative
pressure wound therapy system.
MATERIAL AND METHODS: This prospective, open label study evaluated healing
of postoperative sternotomy wounds after their primary closure with
negative pressure wound therapy, using continuous negative pressure of -80
mmHg in 40 patients and 40 patients in a control group in whom
conventional dressings were applied in the postoperative period.
RESULTS: The number of patients in whom primary wound healing occurred
without complications was significantly higher in the negative pressure
wound therapy group versus the control group (x2 test =4.50, p=0.0339) and
the number of total superficial infections was significantly smaller
versus the control group (x2 test =5; p=0.0254). Antibiotic therapy was
also initiated significantly less often as compared to the group treated
with conventional dressings (x2 test = 4.11; p=0.0425).
CONCLUSIONS: Negative pressure wound therapy after primary wound closure
reduces the risk of superficial infections in the population with multiple
risk factors of complications in the sternotomy wound healing.
