Results Generated From:
Embase <1980 to 2016 Week 01>
Embase (updates since 2015-12-28)
<1>
Accession Number
2015338820
Authors
Decelis D.A. Adami M.Z. Galea J. Attard-Pizzuto M. Inglott A.S. Azzopardi
L.M.
Institution
(Decelis, Adami, Attard-Pizzuto, Inglott, Azzopardi) Department of
Pharmacy, University of Malta, Msida, Malta
(Galea) Department of Surgery, University of Malta, Msida, Malta
Title
Pharmacist intervention in pain management following heart surgery.
Source
European Journal of Hospital Pharmacy. 22 (5) (pp 306-308), 2015. Date of
Publication: 01 Sep 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives Pain is a common symptom in cardiac surgery patients. This
study aimed to investigate the influence of pharmacist intervention to
ease postoperative pain in cardiac surgery patients. Methodology Patients
undergoing heart surgery were randomised to control or intervention. The
intervention group was given systematic verbal information and, at
discharge, a pharmaceutical care plan. Pain score and diary assessment
were compared up to 6 weeks after the surgery. Results 100 patients
participated. Mean Pain Score was lower in the intervention group from
week 1 to 6 (p<0.05). Compliance with analgesic was higher in the
intervention group. Conclusions The intervention improved compliance and
decreased pain score, illustrating the positive effect the pharmacist had
on these patients.
<2>
Accession Number
20151029457
Authors
Zhang L. Gao S.
Institution
(Zhang, Gao) Department of Thoracic Surgery, Cancer Hospital, Chinese
Academy of Medical Sciences, Beijing 100021, China
Title
Robot-assisted thoracic surgery versus open thoracic surgery for lung
cancer: A system review and meta-analysis.
Source
International Journal of Clinical and Experimental Medicine. 8 (10) (pp
17804-17810), 2015. Date of Publication: 30 Oct 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
The aim of this meta-analysis is to compare the perioperative morbidity
and mortality outcomes of robotic-assisted thoracic surgery (RATS) with
open thoracic surgery (OTS) for patients with lung cancer. We searched
articles indexed in the Pubmed and Sciencedirect published as of July 2015
that met our predefined criteria. A meta-analysis was performed by
combining the results of reported incidences of perioperative morbidity
and mortality. The relative risk (RR) was used as a summary statistic.
Five eligible articles with 2433 subjects were considered in the analysis
(5 articles for morbidity, while 3 articles for mortality). Overall,
pooled analysis indicated that perioperative morbidity and mortality rate
was significantly lower among patients who underwent RATS than patients
who underwent OTS (for morbidity: RR, 0.83; 95% CI, 0.75 to 0.92; P<0.01;
for mortality: RR, 0.14; 95% CI, 0.03 to 0.59; P=0.007). No evidence of
publication bias was observed. In conclusion, this meta-analysis showed
that RATS resulted in significantly lower perioperative morbidity and
mortality rate compared with OTS cases. Thus, we suggest RATS be an
appropriate alternative to OTS for lung cancer resection. RATS should be
studied further in selected centers and compared with OTS in a randomized
fashion to better define its potential advantages and disadvantages.
<3>
Accession Number
2015531130
Authors
Lin H.M. Seldin D. Hui A.-M. Berg D. Dietrich C.N. Flood E.
Institution
(Lin, Hui, Berg) Millennium Pharmaceuticals, Inc., A Wholly Owned
Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United
States
(Seldin) Boston Medical Center, Boston, MA, United States
(Dietrich, Flood) ICON PRO, 820 W Diamond Ave, Gaithersburg, MD 20878,
United States
Title
The patients perspective on the symptom and everyday life impact of AL
amyloidosis.
Source
Amyloid. 22 (4) (pp 244-251), 2015. Date of Publication: 02 Oct 2015.
Publisher
Taylor and Francis Ltd
Abstract
Introduction: This study aimed to understand the symptomatic impact of
amyloid light-chain (AL) amyloidosis from the patients
perspective.Methods: Four data sources were included: a literature review,
review of online patient blogs, expert clinician interviews and patient
interviews. Patients were recruited through the Amyloidosis Foundation and
physician referral. Phone interviews were conducted and included
open-ended concept elicitation questions. Thematic analysis was performed
to identify symptoms and impacts. Descriptive statistics were used to
characterize the sample. A conceptual model was developed depicting the
impact of disease and treatment.Results: Two hundred seventy abstracts
were identified; 10 articles were deemed relevant. No qualitative studies
were identified, and only three studies included patient-reported
measures. Ten patients completed interviews (mean age 61 [+/-8]; 7 male).
Over 25 signs/symptoms were identified, including fatigue, weakness,
dyspnea, neuropathy, edema, dizziness/lightheadedness, anorexia, diarrhea
and constipation. Impacts included reduced physical and social
functioning, and emotional impacts, including frustration, anxiety and
depression. Findings from the blogs and expert interviews were consistent
with patient reports.Conclusion: Symptoms can vary widely, but a core set
of symptoms were common across patients. The conceptual model derived from
this study can be used to ensure a patient-centered approach to drug
development.
<4>
Accession Number
20151043880
Authors
Sher-i-Murtaza M. Rizvi H.M.F.A. Baig M.A.R. Hamid W. Zaman H.
Institution
(Sher-i-Murtaza, Rizvi, Baig, Hamid, Zaman) Department of Cardiac Surgery,
Chaudary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
Title
Myocardial protection with multiport antegrade cold blood cardioplegia and
continuous controlled warm shot through vein grafts during proximal ends
anastomosis in conventional coronary artery bypass graft.
Source
Journal of the Pakistan Medical Association. 66 (1) (pp 53-58), 2016. Date
of Publication: January 2016.
Publisher
Pakistan Medical Association
Abstract
Objective: To evaluate the benefits of simultaneous aortic root and vein
graft cold blood cardioplegia and continuous controlled warm blood
perfusion through vein grafts during proximal aortocoronary anastomosis in
conventional coronary artery bypass graft surgery in patients with
multi-vessel coronary artery disease. Methods: The prospective randomised
study was conducted at Chaudary Pervaiz Elahi Institute of Cardiology,
Multan, Pakistan, from April 2013 to June 2014, and comprised patients of
isolated conventional coronary artery bypass graft surgery. The patients
were randomised into 2 groups; Group I had patients in whom multiperfusion
set was used for cardioplegia and continuous warm blood perfusion through
vein grafts during proximal ends anastomosis, and Group II had patients in
whom routine aortic root antegrade cardioplegia was used with no warm
blood perfusion during proximal anastomosis of vein grafts. Data was
analysed using SPSS 20. Results: There were 434 patients in the study,
with Group 1 having 215(49.5%) being the study group, and Group II having
219(50.5%)being the Control group. The groups showed no significant
difference in the number of grafts, and aortic cross-clamp time (p>0.05
each). Total bypass time was significantly prolonged in the Control Group
(p=0.001). Incidence of intra-operative arrhythmias,
peri-operativemyocardial infarction, need for inotropic support and
intra-aortic balloon counter-pulsation and operative mortality were
significantly higher in the Control group (p<0.05 each). Conclusions:
Simultaneous aortic root and vein graft cold blood cardioplegia and
continuous controlled warm blood perfusion was beneficial for myocardial
protection and early patient outcome.
<5>
Accession Number
20151037357
Authors
Myers S.A. Huben N.B. Yentes J.M. McCamley J.D. Lyden E.R. Pipinos I.I.
Johanning J.M.
Institution
(Myers, Huben, Yentes, McCamley) Center for Research in Human Movement
Variability, School of Health, Physical Education and Recreation,
University of Nebraska Omaha, 6160 University Drive South, Omaha, NE
68182-0860, United States
(Lyden) College of Public Health, Department of Biostatistics, University
of Nebraska Medical Center, 984355 Nebraska Medical Center, Omaha, NE
68198, United States
(Pipinos, Johanning) Department of Surgery, Omaha Veterans Affairs Medical
Center, 4101 Woolworth Avenue (121), Omaha, NE 68105, United States
(Johanning) College of Medicine, Department of Surgery, University of
Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198,
United States
Title
Spatiotemporal Changes Posttreatment in Peripheral Arterial Disease.
Source
Rehabilitation Research and Practice. 2015 (no pagination), 2015. Article
Number: 124023. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Accumulating evidence suggests revascularization of peripheral arterial
disease (PAD) limbs results in limited improvement in functional gait
parameters, suggesting underlying locomotor system pathology. Spatial and
temporal (ST) gait parameters are well studied in patients with PAD at
baseline and are abnormal when compared to controls. The purpose of this
study was to systematically review and critically analyze the available
data on ST gait parameters before and after interventions. A full review
of literature was conducted and articles were included which examined ST
gait parameters before and after intervention (revascularization and
exercise). Thirty-three intervention articles were identified based on 154
articles that evaluated ST gait parameters in PAD. Four articles fully
assessed ST gait parameters before and after intervention and were
included in our analysis. The systematic review of the literature revealed
a limited number of studies assessing ST gait parameters. Of those found,
results demonstrated the absence of improvement in gait parameters due to
either exercise or surgical intervention. Our study demonstrates
significant lack of research examining the effectiveness of treatments on
ST gait parameters in patients with PAD. Based on the four published
articles, ST gait parameters failed to significantly improve in patients
with PAD following intervention.
<6>
Accession Number
20151044975
Authors
Brown C.H. Faigle R. Klinker L. Bahouth M. Max L. Laflam A. Neufeld K.J.
Mandal K. Gottesman R.F. Hogue C.W.
Institution
(Brown, Max, Laflam, Hogue) Department of Anesthesiology and Critical Care
Medicine, John Hopkins School of Medicine, Zayed 6208, Johns Hopkins, 1800
Orleans Street, Baltimore, MD 21287, United States
(Faigle, Bahouth, Gottesman) Department of Neurology, Johns Hopkins School
of Medicine, Baltimore, MD, United States
(Klinker) Johns Hopkins University, School of Medicine, Baltimore, MD,
United States
(Neufeld) Department of Psychiatry and Behavioral Sciences, Johns Hopkins
School of Medicine, Baltimore, MD, United States
(Mandal) Department of Surgery, Johns Hopkins School of Medicine,
Baltimore, MD, United States
Title
The Association of Brain MRI Characteristics and Postoperative Delirium in
Cardiac Surgery Patients.
Source
Clinical Therapeutics. 37 (12) (pp 2686-2699.e9), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Excerpta Medica Inc.
Abstract
Purpose Delirium is common after cardiac surgery and is associated with
adverse consequences, including cognitive decline. Identification of
vulnerable older adults might allow for early implementation of
delirium-prevention strategies. Brain MRI findings provide insight into
structural brain changes that may identify vulnerable patients. The
purpose of this study was to examine the association between brain MRI
characteristics potentially associated with delirium vulnerability and the
development of postoperative delirium in a nested cohort of patients
undergoing cardiac surgery. Methods We identified 79 cardiac surgery
patients who had brain MRI imaging after cardiac surgery, as part of an
ongoing randomized trial evaluating the efficacy of blood pressure
management based on cerebral autoregulation monitoring versus standard
management for improving neurological outcomes. Cerebral lateral
ventricular size, cortical sulcal width, and white matter hyperintensities
(WMH) on brain MRI scans were graded on a validated 0 to 9 scale, and
categorized into tertiles. New ischemic lesions were characterized as
present or absent. Delirium was assessed using a validated chart-review.
Neuropsychological testing performed before surgery was used to establish
preoperative cognitive baseline. Multivariable logistic regression was
used to assess the independent association between MRI characteristics and
postoperative delirium. Findings The average age of patients was 70.1 +/-
7.8 years old, and 72% were male. Twenty-eight of 79 (35.4%) patients
developed postoperative delirium. Patients with delirium had higher
unadjusted ventricular size (median 4 vs. 3, P = 0.003), and there was a
trend towards higher sulcal sizes and WMH grades. Increasing tertiles of
ventricular size (Odds Ratio [OR] 3.59; 95% Confidence Interval [CI]
1.59-8.12; P = 0.002) and sulcal size (OR 2.15; 95%CI 1.13-4.12; P = 0.02)
were associated with postoperative delirium, with a trend for tertiles of
WMH grade (OR 1.91; 95%CI 0.99-3.68; P = 0.05). In multivariable models
adjusted for logistic EuroSCORE, baseline cognitive status, bypass time,
and any postoperative complication, each tertile of ventricular size was
associated with increased odds of postoperative delirium (OR 3.23 per
tertile increase in ventricular size; 95%CI 1.21-8.60; P = 0.02). There
were no differences in odds of delirium by tertiles of sulcal grade,
tertiles of white matter grade, or presence of new ischemic lesions, in
adjusted models. Implications Increased brain ventricular size was
independently associated with delirium after cardiac surgery. These
results suggest that cerebral atrophy may contribute to increased
vulnerability for postoperative delirium. Baseline brain MRIs may be
useful in identifying cardiac surgery patients at high risk for
postoperative delirium, who might benefit from targeted perioperative
approaches to prevent delirium. ClinicalTrials.gov identifier:
NCT00981474.
<7>
Accession Number
20151034537
Authors
Zhang H. Liu Y. Qiu S. Liang W. Jiang L.
Institution
(Zhang, Liu) Southern Medical University, Guangzhou, Guangdong, China
(Qiu) Department of Medical Ultrasound, The Second Affiliated Hospital of
Guangzhou Medical University, Guangzhou, Guangdong, China
(Liang, Jiang) Department of Medical Ultrasound, The Third Affiliated
Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Title
Short-term and long-term survival after revascularization with or without
mitral valve surgery of patients with ischemic mitral valve regurgitation:
A meta-analysis.
Source
Medical Science Monitor. 21 (pp 3784-3791), 2015. Date of Publication: 04
Dec 2015.
Publisher
International Scientific Literature Inc.
Abstract
Background: There is no consensus on whether mitral valve repair or
replacement (MVRR) must be performed to treat ischemic mitral
regurgitation (MVR) after myocardial infarction. Our objective in this
study was to investigate the efficacy of coronary artery bypass grafting
(CABG) combined with or without MVRR for the ischemic MVR.
Material/Methods: An article search was performed in OvidSP, PubMed,
Cochrane Library, and Embase. In these articles, researchers compared the
efficacy of CABG with or without MVRR in treating patients with ischemic
MVR after acute coronary syndrome (ACS). We performed a meta-analysis to
compare the differences in the short-term and longterm survival rates of
patients treated with CABG only and those treated with both CABG and MVRR.
Secondary outcomes were compared with the preoperative and postoperative
degree of MVR, left ventricular end-systolic volume (LVESV), left
ventricular ejection fraction (LVEF), and New York Heart Association
(NYHA) class. Results: Out of the 1183 studies, we selected only 5
articles. A total of 3120 patients were enrolled; the CABG and MVRR group
included 575 patients, while the CABG only group included 2545 patients.
Long-term survival was higher in the CABG only group (hazard ratio [HR],
1.34; 95% confidence interval [CI] 1.15-1.58, P=0.003). Hospital mortality
was similar in both the groups (odds ratio [OR], 2.54; 95% CI, 0.65-9.95;
P=0.18). No differences were found in the degree of residual MVR, the mean
of LVESV, LVEF, or NYHA class. Conclusions: In patients with ischemic MVR,
the short-term survival rate was similar in both groups. Moreover, there
was no significant improvement in the long-term survival rates of patients
treated with both CAG and MVRR.
<8>
Accession Number
20151039754
Authors
Qazi S.M. Sindby E.J. Norgaard M.A.
Institution
(Qazi, Sindby, Norgaard) Department of Cardiothoracic Surgery, Aalborg
University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
Title
Ibuprofen - A safe analgesic during cardiac surgery recovery? A randomized
controlled trial.
Source
Journal of Cardiovascular and Thoracic Research. 7 (4) (pp 141-148), 2015.
Date of Publication: 2015.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Postoperative pain-management with non-steroid
anti-inflammatory drugs has been controversial, due to related
side-effects. We investigated whether there was a significant difference
between an oxycodone-based pain-management regimen versus a slow-release
ibuprofen based regimen, in a short term post-cardiac surgery setting.
Particular attention was given to the rate of myocardial infarction,
sternal healing, gastro-intestinal complications, renal failure and
all-cause mortality. Methods: This was a single-centre, open label
parallel design randomised controlled study. Patients, who were undergoing
cardiac surgery for the first time, were randomly allocated either to a
regimen of slow-release oxycodone (10 mg twice daily) or slow-release
ibuprofen (800 mg twice daily) combined with lansoprazole. Data relating
to blood-tests, angiographies, surgical details and administered medicine
were obtained from patient records. The follow-up period was to 37 months
(median 25 months). Results: One hundred eighty-two patients were included
in the trial and available for intention to treat analysis. There were no
significant difference between the groups (P>0.05) in the rates of sternal
healing, postoperative myocardial infarction or gastrointestinal bleeding.
The preoperative levels of creatinine were found to increase by 100% in
nine patients (9.6%) in the ibuprofen group, resulting in an acute renal
injury (in accordance with the RIFLE-criteria). Eight of these patients
returned to normal renal function within 14 days. The levels of creatinine
in patients in the oxycodone group were not found to increase to the same
magnitude. Conclusion: The results of this study suggest that patients
treated postoperatively, following cardiac surgery, are at no greater risk
of harm if short term slow release ibuprofen combined with lansoprazole
treatment is used when compared to an oxycodone based regimen. Renal
function should, however, be closely monitored and in the event of any
decrease in renal function ibuprofen must be discontinued.
<9>
Accession Number
20151038638
Authors
Yang H.C. Lee J. Ahn S. Cho S. Kim K. Jheon S. Kim J.S.
Institution
(Yang) Center for Lung Cancer, Research Institute and Hospital, National
Cancer Center, Goyang, South Korea
(Lee, Cho, Kim, Jheon, Kim) Department of Thoracic and Cardiovascular
Surgery, Seoul National University College of Medicine, Seoul, South Korea
(Ahn) Medical Research Collaborating Center, Seoul National University
Bundang Hospital, Seoul National University College of Medicine, Seoul,
South Korea
Title
Pain control of thoracoscopic major pulmonary resection: Is pre-emptive
local bupivacaine injection able to replace the intravenous patient
controlled analgesia?.
Source
Journal of Thoracic Disease. 7 (11) (pp 1960-1969), 2015. Date of
Publication: 2015.
Publisher
Pioneer Bioscience Publishing
Abstract
Background: The aim of this open-label, non-inferiority trial was to
evaluate whether pre-emptive local bupivacaine injection (PLBI) can
replace intravenous patient controlled analgesia (IV PCA) in
video-assisted thoracic surgery (VATS) major pulmonary resection. Methods:
A total of 86 patients scheduled for VATS segmentectomy/lobectomy were
randomly assigned into two groups. The PLBI group (n=42) received 0.5%
bupivacaine wound infiltration before skin incision, and the IV PCA group
(n=44) received a continuous infusion of fentanyl with a basal rate of 10
mug/mL/h. Visual analogue scale (VAS; range, 0-10) was measured as the
primary endpoint. The secondary endpoint was an additional use of
analgesics and drug induced side effects. Results: Both groups showed no
difference in terms of age, sex, disease entity, operation time, chest
tube indwelling time, and hospital stay. Serial pain scores between the
PLBI and IV PCA groups demonstrated no statistical differences
(non-inferiority margin; DELTAVAS =1.0) (Recovery room: 8.3+/-2.1 vs.
8.5+/-1.7; Day 0: 5.1+/-1.6 vs. 5.2+/-1.4; Day 1: 3.5+/-1.6 vs. 3.3+/-1.2;
Day 2: 2.7+/-1.3 vs. 2.5+/-1.2; Day 3: 2.3+/-1.3 vs. 2.1+/-1.5; 1 week
after discharge: 3.0+/-1.7 vs. 2.8+/-1.5; 1 month: 1.9+/-1.2 vs. 2.3+/-1.4
and 2 months: 1.5+/-1.2 vs. 1.3+/-1.2; 95% confidential interval (CI) of
DELTAVAS < 1.0; P > 0.05). The mean one-additional usage of IV analgesics
was needed in the PLBI group (3.3+/-2.1 vs. 2.3+/-1.3; P=0.03). The
occurrence of nausea/vomiting was higher in the IV PCA group (12.5% vs.
38.9%; P=0.026) and 41.7% of IV PCA patients experienced drug side effects
that required IV PCA removal within postoperative day (POD) 1.
Conclusions: PLBI is a simple, safe, effective, and economical method,
which is not inferior to IV PCA in VATS major pulmonary resection.
<10>
[Use Link to view the full text]
Accession Number
20151041050
Authors
Pokushalov E. Kozlov B. Romanov A. Strelnikov A. Bayramova S. Sergeevichev
D. Bogachev-Prokophiev A. Zheleznev S. Shipulin V. Lomivorotov V.V.
Karaskov A. Po S.S. Steinberg J.S.
Institution
(Pokushalov, Romanov, Strelnikov, Bayramova, Sergeevichev,
Bogachev-Prokophiev, Zheleznev, Lomivorotov, Karaskov) State Research
Institute of Circulation Pathology, Novosibirsk, Russian Federation
(Kozlov, Shipulin) Institute of Cardiology, Siberian Division, Russian
Academy of Medical Sciences, Tomsk, Russian Federation
(Po) Heart Rhythm Institute, University of Oklahoma, Health Sciences
Center, Oklahoma City, United States
(Steinberg) University of Rochester, School of Medicine and Dentistry,
Arrhythmia Institute, 200 West 57th St, New York, NY 10019, United States
(Steinberg) RidgewoodNJUnited States
Title
Long-Term Suppression of Atrial Fibrillation by Botulinum Toxin Injection
into Epicardial Fat Pads in Patients Undergoing Cardiac Surgery: One-Year
Follow-Up of a Randomized Pilot Study.
Source
Circulation: Arrhythmia and Electrophysiology. 8 (6) (pp 1334-1341), 2015.
Date of Publication: 01 Dec 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Animal models suggest that the neurotransmitter inhibitor, botulinum
toxin, when injected into the epicardial fat pads can suppress atrial
fibrillation inducibility. The aim of this prospective randomized
double-blind study was to compare the efficacy and safety of botulinum
toxin injection into epicardial fat pads for preventing atrial
tachyarrhythmias. Methods and Results-Patients with history of paroxysmal
atrial fibrillation and indication for coronary artery bypass graft
surgery were randomized to botulinum toxin (Xeomin, Merz, Germany; 50 U/1
mL at each fat pad; n=30) or placebo (0.9% normal saline, 1 mL at each fat
pad; n=30) injection into epicardial fat pads during surgery. Patients
were followed for 1 year to assess maintenance of sinus rhythm using an
implantable loop recorder. All patients in both groups had successful
epicardial fat pad injections without complications. The incidence of
early postoperative atrial fibrillation within 30 days after coronary
artery bypass graft was 2 of 30 patients (7%) in the botulinum toxin group
and 9 of 30 patients (30%) in the placebo group (P=0.024). Between 30 days
and up to the 12-month follow-up examination, 7 of the 30 patients in the
placebo group (27%) and none of the 30 patients in the botulinum toxin
group (0%) had recurrent atrial fibrillation (P=0.002). There were no
complications observed during the 1-year follow-up. Conclusions-Botulinum
toxin injection into epicardial fat pads during coronary artery bypass
graft provided substantial atrial tachyarrhythmia suppression both early
as well as during 1-year follow-up, without any serious adverse events.
<11>
Accession Number
20151034681
Authors
Avila-Alvarez A. Del Cerro Marin M.J. Bautista-Hernandez V.
Institution
(Avila-Alvarez) Department of Neonatology, Complexo Hospitalario
Universitario de A Coruna, A Coruna, (CHUAC), A Coruna, Spain
(Del Cerro Marin) Department of Pediatric Cardiology, Hospital
Universitario Ramon y Cajal, Madrid, Spain
(Bautista-Hernandez) Department of Cardiovascular Surgery, Complexo
Hospitalario Universitario A Coruna (CHUAC), Congenital and Structural
Heart Disease, Instituto de Investigacion Biomedica A Coruna (INIBIC), A
Coruna, Spain
Title
Pulmonary vasodilators in the management of low cardiac output syndrome
after pediatric cardiac surgery.
Source
Current Vascular Pharmacology. 14 (1) (pp 37-47), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Pulmonary hypertension is among the causes of low cardiac output syndrome
after neonatal and pediatric cardiac surgery. In the setting of transient
postoperative myocardial dysfunction, even a moderate elevation of
pulmonary pressure can result in heart dysfunction and circulatory
collapse. Although, specific pharmacological manipulation of pulmonary
vascular resistance is frequently required in the perioperative period,
there is no widely standardized management. In this review, a systematic
literature search of PubMed and MEDLINE databases using relevant terms was
performed. All clinical trials and relevant manuscripts, along with
important physiological, pharmacological, and evidence-based
considerations involving the use of pulmonary vasodilators in the
management of low cardiac output syndrome after cardiac surgery were
reviewed. This article addresses the fifth of eight topics comprising the
special issue entitled "Pharmacologic strategies with afterload reduction
in low cardiac output syndrome after pediatric cardiac surgery".
<12>
Accession Number
72123322
Authors
Gukop P. Gutman N. Bilkhu R. Shety A. Karapanagiotidis G.T. Momin A.
Institution
(Gukop, Gutman, Bilkhu, Shety, Karapanagiotidis, Momin) St George's
Hospital NHS Trust, Department of Cardio-Thoracic Surgery, London, United
Kingdom
Title
Who might benefit from early aspirin after coronary artery surgery?.
Source
Cardiology (Switzerland). Conference: 11th International Congress on
Coronary Artery Disease, ICCAD 2015 Florence Italy. Conference Start:
20151129 Conference End: 20151202. Conference Publication: (var.pagings).
132 (pp 126), 2015. Date of Publication: November 2015.
Publisher
S. Karger AG
Abstract
Aims: Early postoperative aspirin (300mg) administered within 6 hours
following CABG has been shown to be optimal for prevention of saphenous
vein graft (SVG) occlusion. Early aspirin has shown significant benefit in
reducing SVG occlusion, MI, stroke, renal failure and bowel infarction,
and subsequent mortality. The efficacy of early post-operative aspirin on
vein graft patency diminishes the later it is administered. It has optimal
benefit at 6 hours, significantly reduced benefit at 24 hours and no
benefit after 48hours post CABG. However the maximum benefit has been
demonstrated when administered at one hour post CABG. Method: ACC/AHA,
EACTS and ACCP have issued guidelines recommending administration of early
aspirin or an alternative (clopidogrel, ticlopidine and indobufen) at
6hours or soon after bleeding has settled as the standard of care for
optimisation of SVG patency. The ACCP guideline has also suggested that
optimal prevention of cardiovascular complication should merit higher
value than the small risk of post-operative bleeding. Several randomised
controlled studies (level 1 evidence) including a meta-analysis have shown
that administration of early aspirin following CABG is not associated with
increased blood loss or transfusion requirements. Post-operative bleeding
has been identified as a significant reason for non-administration of
early aspirin in a prospective study performed at our own institution.
Results: It is essential to define/quantify the postoperative blood loss
that precludes administration of early aspirin. Conclusion: This will
enhance prompt administration in some cases and guide judgement especially
in patients with high risk factors for vein graft
thrombosis.Administration at 6 hours is the optimal time to give aspirin
as long as bleeding has settled. Individualising the administration of
early aspirin based on clinical judgement on case to case basis would
maximise its benefit. We thus advocate a bespoke method of early aspirin
administration post CABG.
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