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<1>
Accession Number
20151013538
Authors
Papachristofi O. Sharples L.D. Mackay J.H. Nashef S.A.M. Fletcher S.N.
Klein A.A.
Institution
(Papachristofi) MRC Biostatistics Unit, Institute of Public Health,
Cambridge, United Kingdom
(Sharples) Clinical Trials Research Unit, University of Leeds, Leeds,
United Kingdom
(Mackay, Klein) Department of Anaesthesia and Intensive Care, Papworth
Hospital, Cambridge, United Kingdom
(Nashef) Department of Cardiothoracic Surgery, Papworth Hospital,
Cambridge, United Kingdom
(Fletcher) Departments of Anaesthesia and Critical Care, St Georges
University Hospital, London, United Kingdom
(Klein) Association of Cardiothoracic Anaesthetists, Society of
Cardiothoracic Surg., Manchester, United Kingdom
Title
The contribution of the anaesthetist to risk-adjusted mortality after
cardiac surgery.
Source
Anaesthesia. 71 (2) (pp 138-146), 2016. Date of Publication: 01 Feb 2016.
Publisher
Blackwell Publishing Ltd
Abstract
It is widely accepted that the performance of the operating surgeon
affects outcomes, and this has led to the publication of surgical results
in the public domain. However, the effect of other members of the
multidisciplinary team is unknown. We studied the effect of the
anaesthetist on mortality after cardiac surgery by analysing data
collected prospectively over ten years of consecutive cardiac surgical
cases from ten UK centres. Casemix-adjusted outcomes were analysed in
models that included random-effects for centre, surgeon and anaesthetist.
All cardiac surgical operations for which the EuroSCORE model is
appropriate were included, and the primary outcome was in-hospital death
up to three months postoperatively. A total of 110 769 cardiac surgical
procedures conducted between April 2002 and March 2012 were studied, which
included 127 consultant surgeons and 190 consultant anaesthetists. The
overwhelming factor associated with outcome was patient risk, accounting
for 95.75% of the variation for in-hospital mortality. The impact of the
surgeon was moderate (intra-class correlation coefficient 4.00% for
mortality), and the impact of the anaesthetist was negligible (0.25%).
There was no significant effect of anaesthetist volume above ten cases per
year. We conclude that mortality after cardiac surgery is primarily
determined by the patient, with small but significant differences between
surgeons. Anaesthetists did not appear to affect mortality. These findings
do not support public disclosure of cardiac anaesthetists' results, but
substantially validate current UK cardiac anaesthetic training and
practice. Further research is required to establish the potential effects
of very low anaesthetic caseloads and the effect of cardiac anaesthetists
on patient morbidity.
<2>
Accession Number
25079771
Authors
Zhang Y. Ma L.
Institution
(Zhang) Department of Cardiothoracic Surgery, First Affiliated Hospital of
Zhejiang University, Hangzhou, China
(Ma) Department of Cardiothoracic Surgery, First Affiliated Hospital of
Zhejiang University, Hangzhou, China
Title
Effect of preoperative angiotensin-converting enzyme inhibitor on the
outcome of coronary artery bypass graft surgery.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 47 (5) (pp 788-795),
2015. Date of Publication: 01 May 2015.
Abstract
The safety of the preoperative administration of angiotensin-converting
enzyme inhibitors (ACEIs) in patients undergoing coronary artery bypass
grafting (CABG) surgery is still uncertain. This systematic review thus
evaluated the effect of preoperative ACEIs on the clinical outcomes in
patients undergoing CABG surgery. We searched PubMed, the Cochrane Library
and the Web of Science for randomized control trials or observational
studies that compared the use of ACEIs with that of placebos before
isolated CABG. Thirteen studies (3 randomized control trials and 10
observational studies) that included 31 390 patients met the eligibility
criteria. Preoperative ACEI treatment increased the risk of hypotension
[risk ratio (RR) = 2.36, 95% confidence interval (CI) 1.11-5.02, P =
0.03], postoperative myocardial infarction (RR = 1.14, 95% CI 1.02-1.27, P
= 0.02) and postoperative renal dysfunction (RR = 1.26, 95% CI 1.00-1.60,
P = 0.05) in patients undergoing on-pump CABG, but had no significant
impact on the risk of postoperative atrial fibrillation (RR = 0.79, 95% CI
0.37-1.71, P = 0.56) or postoperative stroke (RR = 1.17, 95% CI 0.74-1.85,
P = 0.50), and did not influence the early mortality (RR = 1.21, 95% CI
0.95-1.54, P = 0.12) in patients undergoing on-pump CABG. Preoperative use
of ACEIs increased the risk of several postoperative complications in
patients undergoing CABG. Further randomized studies are needed to more
clearly elucidate the risks and benefits of ACEI therapy before CABG.
<3>
Accession Number
25064051
Authors
Tsai Y.-C. Phan K. Munkholm-Larsen S. Tian D.H. La Meir M. Yan T.D.
Institution
(Tsai) Department of Cardiothoracic Surgery, The Prince Charles Hospital,
Chermside, Australia
(Phan) The Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia Sydney Medical School, University of Sydney, Sydney,
Australia
(Munkholm-Larsen) Sydney Medical School, University of Sydney, Sydney,
Australia Department of Cardiology, Hvidovre University Hospital,
Copenhagen, Denmark
(Tian) The Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia
(La Meir) Department of Cardiothoracic Surgery and Cardiology, Academic
Hospital Maastricht and Cardiovascular Research Institute Maastricht,
Maastricht, Netherlands University Hospital Brussels, Brussels, Belgium
(Yan) The Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia Department of Cardiothoracic Surgery, Royal Prince
Alfred Hospital, University of Sydney, Sydney, Australia
tristanyan@annalscts.com
Title
Surgical left atrial appendage occlusion during cardiac surgery for
patients with atrial fibrillation: a meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 47 (5) (pp 847-854),
2015. Date of Publication: 01 May 2015.
Abstract
OBJECTIVES: Concomitant left atrial appendage occlusion (LAAO) during
surgical ablation has emerged as a potential treatment strategy to reduce
stroke and perioperative mortality in patients with atrial fibrillation
(AF). The present meta-analysis aims to assess current evidence on the
efficacy and safety between LAAO and LAA preservation cohorts for patients
undergoing cardiac surgery.
METHODS: Electronic searches were performed using six electronic databases
from their inception to November 2013, identifying all relevant
comparative randomized and observational studies comparing LAAO with
non-LAAO in AF patients undergoing cardiac surgery. Data were extracted
and analysed according to predefined endpoints including mortality,
stroke, postoperative AF and reoperation for bleeding.
RESULTS: Seven relevant studies identified for qualitative and
quantitative analyses, including 3653 patients undergoing LAAO (n = 1716)
versus non-LAAO (n = 1937). Stroke incidence was significantly reduced in
the LAAO occlusion group at the 30-day follow-up [0.95 vs 1.9%; odds ratio
(OR) 0.46; P = 0.005] and the latest follow-up (1.4 vs 4.1%; OR 0.48; P =
0.01), compared with the non-LAAO group. Incidence of all-cause mortality
was significantly decreased with LAAO (1.9 vs 5%; OR 0.38; P = 0.0003),
while postoperative AF and reoperation for bleeding was comparable.
CONCLUSIONS: While acknowledging the limitations and inadequate
statistical power of the available evidence, this study suggests LAAO as a
promising strategy for stroke reduction perioperatively and at the
short-term follow-up without a significant increase in complications.
Larger randomized studies in the future are required, with clearer
surgical and anticoagulation protocols and adequate long-term follow-up,
to validate the clinical efficacy of LAAO versus non-LAAO groups.
<4>
[Use Link to view the full text]
Accession Number
2015467305
Authors
Elhoff J.J. Chowdhury S.M. Zyblewski S.C. Atz A.M. Bradley S.M. Graham
E.M.
Institution
(Elhoff, Chowdhury, Zyblewski, Atz, Graham) Division of Pediatric
Cardiology, Department of Pediatrics, Medical University of South
Carolina, Charleston, SC, United States
(Bradley) Division of Pediatric Cardiothoracic Surgery, Department of
Surgery, Medical University of South Carolina, Charleston, SC, United
States
Title
Intraoperative Steroid Use and Outcomes Following the Norwood Procedure:
An Analysis of the Pediatric Heart Network's Public Database.
Source
Pediatric Critical Care Medicine. 17 (1) (pp 30-35), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Data supporting the use of perioperative steroids during
cardiac surgery are conflicting, and most pediatric studies have been
limited by small sample sizes and/or diverse cardiac diagnoses. The
objective of this study was to determine if intraoperative steroid
administration improved outcomes following the Norwood procedure. Design:
A retrospective analysis was performed on the 549 neonates who underwent a
Norwood procedure in the publicly available datasets from the Pediatric
Heart Network's Single Ventricle Reconstruction trial. Groups were
compared to determine if outcomes differed between intraoperative steroid
recipients (n = 498, 91%) and nonrecipients (n = 51, 9%). Setting: Fifteen
North American centers. Subjects: Infants enrolled in the Single Ventricle
Reconstruction trial. Interventions: None. Measurements and Main Results:
Baseline characteristics and intraoperative variables were similar between
groups with the exception of a shorter duration of cross clamp and
cardiopulmonary bypass time in the group that received steroids. Subjects
who did not receive intraoperative steroids had improved hospital survival
(94% vs 83%, p = 0.03) but longer ICU stays (16 d; interquartile range,
12-33 vs 14 d; interquartile range, 9-28; p = 0.04) and hospital stays (29
d; interquartile range, 21-50 vs 23 d; interquartile range, 15-40; p =
0.01) than steroid recipients. In multivariate analysis, lengths of stay
associations were no longer significant, but hospital survival trended
toward favoring the nonsteroid group with an odds ratio of 3.52 (95% CI,
0.98-12.64; p = 0.054). Conclusions: In the large multicentered Single
Ventricle Reconstruction trial, there was widespread use of intraoperative
steroids. Intraoperative steroid administration was not associated with an
improvement in outcomes and may be associated with a reduction in hospital
survival in neonates undergoing the Norwood procedure. This study
highlights the need for a randomized control trial.
<5>
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Accession Number
2015513938
Authors
Alexander K.P. Weisz G. Prather K. James S. Mark D.B. Anstrom K.J.
Davidson-Ray L. Witkowski A. Mulkay A.J. Osmukhina A. Farzaneh-Far R.
Ben-Yehuda O. Stone G.W. Ohman E.M.
Institution
(Alexander, Prather, Mark, Anstrom, Davidson-Ray, Ohman) Duke Clinical
Research Institute, Duke University, Durham, NC, United States
(Weisz) Shaare Zedek Medical Center, Jerusalem, Israel
(Weisz, Ben-Yehuda) Cardiovascular Research Foundation, New York, NY,
United States
(James) Department of Medical Sciences, Cardiology, Uppsala University,
Uppsala, Sweden
(Witkowski) Department of Interventional Cardiology and Angiology,
Institute of Cardiology, Warsaw, Poland
(Mulkay) Holy Name Medical Center, Hackensack, NJ, United States
(Osmukhina, Farzaneh-Far) Gilead Sciences Inc, Foster City, CA, United
States
(Ben-Yehuda, Stone) New York Presbyterian Hospital, Columbia University
Medical Center, United States
Title
Effects of ranolazine on angina and quality of life after percutaneous
coronary intervention with incomplete revascularization: Results from the
ranolazine for incomplete vessel revascularization (RIVER-PCI) trial.
Source
Circulation. 133 (1) (pp 39-47), 2016. Date of Publication: 05 Jan 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Angina often persists or returns in populations following
percutaneous coronary intervention (PCI). We hypothesized that ranolazine
would be effective in reducing angina and improving quality of life (QOL)
in incomplete revascularization (ICR) post-PCI patients. Methods and
Results - In RIVER-PCI, 2604 patients with a history of chronic angina who
had ICR post-PCI were randomized 1:1 to oral ranolazine versus placebo;
QOL analyses included 2389 randomized subjects. Angina and QOL
questionnaires were collected at baseline and months 1, 6, and 12.
Ranolazine patients were more likely than placebo to discontinue study
drug by month 6 (20.4% versus 14.1%, P<0.001) and 12 (27.2% versus 21.3%,
P<0.001). Following qualifying index PCI, the primary QOL outcome (Seattle
Angina Questionnaire [SAQ] angina frequency score) improved markedly, but
similarly, in the ranolazine and placebo groups, respectively, from
baseline (67.3+/-24.5 versus 69.7+/-24.0, P=0.01) to month 1 (86.6+/-18.1
versus 85.8+/-18.5, P=0.27) and month 12 (88.4+/-17.8 versus 88.5+/-17.8,
P=0.94). SAQ angina frequency repeated measures did not differ in adjusted
analysis between groups post baseline (mean difference 1.0; 95% CI -0.2,
2.2; P=0.11). Improvement in SAQ angina frequency was observed with
ranolazine at month 6 among diabetics (mean difference 3.3; 95% CI 0.6,
6.1; P=0.02) and those with more angina (baseline SAQ angina frequency
<60; mean difference 3.4; 95% CI 0.6, 6.2; P=0.02), but was not maintained
at month 12. Conclusions - Despite ICR following PCI, there was no
incremental benefit in angina or QOL measures by adding ranolazine in this
angiographically-identified population. These measures markedly improved
within 1 month of PCI and persisted up to 1 year in both treatment arms.
<6>
Accession Number
20160038895
Authors
Gargiulo G. Capodanno D. Sannino A. Barbanti M. Perrino C. Capranzano P.
Stabile E. Indolfi C. Trimarco B. Tamburino C. Esposito G.
Institution
(Gargiulo, Sannino, Perrino, Stabile, Trimarco, Esposito) Division of
Cardiology, Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy
(Capodanno, Barbanti, Capranzano, Tamburino) Cardio-toracic-vascular
Department, Ferrarotto Hospital, University of Catania, Via Citelli, 6,
Catania 95124, Italy
(Indolfi) Laboratory of Molecular and Cellular Cardiology, Cardiovascular
Institute, Magna Graecia University, Italy
(Indolfi) URT-CNR, Magna Graecia University, Catanzaro, Italy
Title
New-onset atrial fibrillation and increased mortality after transcatheter
aortic valve implantation: A causal or spurious association?.
Source
International Journal of Cardiology. 203 (pp 264-266), 2016. Date of
Publication: 2016.
Publisher
Elsevier Ireland Ltd
<7>
Accession Number
20160032646
Authors
Tarigopula M. Genereux P. Madhavan M.V. Parvataneni R. Weisz G. Mehran R.
Stone G.W.
Institution
(Tarigopula, Genereux, Parvataneni, Weisz, Mehran, Stone) Cardiovascular
Research Foundation, Columbia University Medical Center, 111 E. 59th St.,
New York, NY 10022, United States
(Tarigopula) University of Illinois at Chicago, Chicago, IL, United States
(Genereux, Madhavan, Weisz, Stone) NewYork-Presbyterian Hospital, Columbia
University Medical Center, New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, Canada
(Weisz) Shaare Zedek Medical Center, Jerusalem, Israel
(Mehran) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
Title
Revascularization Strategies for Calcified Lesions in Patients Presenting
with Acute Coronary Syndromes (From the Acute Catheterization and Urgent
Intervention Triage StrategY [ACUITY] Trial).
Source
Journal of Invasive Cardiology. 28 (1) (pp 10-16), 2016. Date of
Publication: January 2016.
Publisher
HMP Communications
Abstract
BACKGROUND: Revascularization of calcified coronary lesions has been shown
to be associated with suboptimal outcomes. The optimal revascularization
strategy for calcified lesions in patients presenting with non-ST segment
elevation acute coronary syndromes (NSTEACS) has yet to be defined.
METHODS: Outcomes in patients presenting with NSTEACS and moderately or
severely calcified target lesions in native coronary vessels, as assessed
by an independent angiographic core lab, were examined according to
revascularization strategy (percutaneous coronary intervention [PCI] vs
coronary artery bypass graft [CABG] surgery) from the large-scale,
prospective ACUITY trial. Propensity-adjusted multivariable analysis was
used to identify the independent predictors of events at 30 days. RESULTS:
Of 1315 NSTEACS patients with moderately and severely calcified lesions in
whom revascularization was performed, a total of 334 (25%) and 981 (75%)
underwent CABG and PCI, respectively. CABG patients had more severe
baseline comorbidities and coronary artery disease. By propensity-adjusted
multivariable analysis, the CABG group had higher 30-day rates of
reinfarction, composite death or reinfarction, major bleeding, and
thrombocytopenia. CONCLUSIONS: In this large-scale study of patients
presenting for NSTEACS, 30-day adverse events were more frequent after
revascularization of calcified coronary lesions with CABG rather than PCI.
Further studies are warranted to evaluate means of improving early safety
outcomes in this high-risk patient group with complex coronary disease.
<8>
Accession Number
20160028121
Authors
Chaudhary R.K. Nepal C. Khanal N. Pathak R. Giri S. Bhatt V.R.
Institution
(Chaudhary) Department of Medicine, Institute of Medicine, Tribhuvan
University, Kathmandu, Nepal
(Nepal) Department of Medicine, Woodhull Medical and Mental Health Center,
New York City, NY, United States
(Khanal) Department of Internal Medicine, Creighton University Medical
Center, Omaha, NE, United States
(Pathak) Department of Medicine, Reading Health System, Reading, PA,
United States
(Giri) Department of Medicine, University of Tennessee Health Science
Center, Memphis, TN, United States
(Bhatt) Department of Internal Medicine, Division of Hematology and
Oncology, University of Nebraska Medical Center, Omaha, NE, United States
Title
Management and outcome of heparin-induced thrombocytopenia in pregnancy: A
systematic review.
Source
Cardiovascular and Hematological Agents in Medicinal Chemistry. 13 (2) (pp
92-97), 2015. Date of Publication: 01 Dec 2015.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Objective: Safety and efficacy of therapeutic agents used for
heparin-induced thrombocytopenia are not established in pregnancy.
Methods: MEDLINE database was searched in November 2014 to identify all
patients who received therapy for HIT during pregnancy. Results: A total
of 12 patients with the median age of 28 years (range 21-39) were
diagnosed with HIT at the median gestational age of 20 weeks (range 5-34).
Clinical probability (4T) score for HIT was high (50%) or intermediate
(50%) and associated with thrombosis in 50%. Patients were initially
managed with lepirudin (33%), argatroban (25%), danaparoid (25%) or
fondaparinux (17%) and ultimately bridged to vitamin K antagonist or
maintained on lepirudin. All patients had resolution of HIT. Complications
included therapeutic abortion prior to valve replacement for valve
thrombosis (8%), preterm delivery (18%) and preeclampsia (8%). Except for
one instance of hypoplastic lung related to preterm delivery, none of the
other newborns had any complications during delivery. Conclusion:
Confirmed cases of HIT in pregnant patients appear to be rare. Within the
limits of retrospective analysis, the use of argatroban, danaparoid,
fondaparinux and lepirudin may be effective in preventing the thrombotic
complications of HIT in pregnancy. The effect of HIT or its therapy on
obstetrical complications cannot be determined based on this study since
many of the obstetrical complications are common in otherwise healthy
pregnancies. Although this study did not identify any fetal teratogenicity
except hypoplastic lung related to preterm delivery, small number of cases
treated with various therapies precludes any definite conclusion
<9>
Accession Number
20160028119
Authors
Bhatt V.R. Dahal S. Verma V. Shukla P. Khanal N. Pathak R. Giri S.
Institution
(Bhatt) University of Nebraska Medical Center, Department of Internal
Medicine, Division of Hematology- Oncology, Omaha, NE, United States
(Dahal) Department of Internal Medicine, Interfaith Medical Center, NY,
United States
(Verma) Department of Radiation Oncology, University of Nebraska Medical
Center, Omaha, NE, United States
(Shukla) Department of Medicine, Institute of Medicine, Tribhuvan
University, Kathmandu, Nepal
(Khanal) Department of Internal Medicine, Creighton University Medical
Center, Omaha, NE, United States
(Pathak) Department of Medicine, Reading Health System, Reading, PA,
United States
(Giri) Department of Medicine, University of Tennessee Health Science
Center, Memphis, TN, United States
Title
Fondaparinux for Management of Heparin-induced Thrombocytopenia after
Cardiovascular Intervention: A systematic review.
Source
Cardiovascular and Hematological Agents in Medicinal Chemistry. 13 (2) (pp
82-86), 2015. Date of Publication: 01 Dec 2015.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Objectives: The efficacy and safety of fondaparinux, an emerging
therapeutic option for heparin-induced thrombocytopenia (HIT), remain
unclear in cardiac surgery patients with HIT. Methods: Using several
search criteria, we reviewed all cases of fondaparinux use in patients who
developed HIT after any cardiovascular intervention and were indexed in
MEDLINE by August 2014. Based on pre-specified criteria, cases were
divided into confirmed HIT, probable HIT and possible HIT. The outcome of
fondaparinux use in each group was compared using Chi-square test.
Results: Of 43 total cases, 22 had confirmed HIT and 21 had possible HIT.
Valve replacement or repair (39%) and heart transplant or ventricular
assist device placement (21%) were the most common preceding
cardiovascular interventions. Creatinine clearance <30 ml was present in
27% and 52% of confirmed and possible HIT respectively. Overall the risk
of new thrombosis and bleeding with fondaparinux were 4.6% and 7%
respectively, without any differences in the two subgroups. The majority
(86%) of cases improved clinically; of the remainder patients, similar
percentage of cases with possible HIT and confirmed HIT died (24% vs. 5%;
p= 0.102). None of the deaths were attributed to HIT or complications of
bleeding. Conclusion: Within the limitations of this study, the risk of
thrombosis and bleeding with fondaparinux use in cardiac surgery patients
with HIT are low and largely comparable to outcomes reported in literature
with other agents.
<10>
Accession Number
20160007661
Authors
Smelt J. Corredor C. Edsell M. Fletcher N. Jahangiri M. Sharma V.
Institution
(Smelt, Jahangiri) Department of Cardiothoracic Surgery, St George's
Hospital, Blackshaw Rd, London SW17 0QT, United Kingdom
(Corredor, Edsell, Fletcher, Sharma) Cardiothoracic Anesthesia, St
George's Hospital, London, United Kingdom
Title
Simulation-based learning of transesophageal echocardiography in
cardiothoracic surgical trainees: A prospective, randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (1) (pp 22-25), 2015.
Date of Publication: 2015.
Publisher
Mosby Inc.
Abstract
Objectives The Intercollegiate Surgical Curriculum now recommends that
cardiac surgical trainees should be able to understand and interpret
transesophageal echocardiography images. However, cardiac surgical
trainees receive limited formal transesophageal echocardiography training.
The objective of this study was to assess the impact of simulation-based
teaching versus more traditional operating room teaching on
transesophageal echocardiography knowledge in cardiac surgical trainees.
Methods A total of 25 cardiac surgical trainees with no formal
transesophageal echocardiography learning experience were randomly
assigned by computer to a study group receiving simulation-based
transesophageal echocardiography teaching via the Heartworks (Inventive
Medical, London, UK) simulator (n = 12) or a control group receiving
transesophageal echocardiography teaching during elective cardiac surgery
(n = 13). Each subject undertook a video-based test composed of 20
multiple choice questions on standard transesophageal echocardiography
views before and after teaching. Results There was no significant
difference in the pretest scores between the 2 groups (P =.89). After
transesophageal echocardiography teaching, subjects within each group
demonstrated a statistically significant improvement in transesophageal
echocardiography knowledge. Although the subjects within the simulation
group outperformed their counterparts in the operating room teaching group
in the post-test scores, this difference was not significant (P =.14).
Conclusions Despite the familiarity with transesophageal echocardiography
images during surgery, subjects in the simulation group performed at least
as well as those in the operating room group. Surgical trainees will
benefit from formal transesophageal echocardiography teaching incorporated
into their training via either learning method.
<11>
Accession Number
20160028699
Authors
Mihos C.G. Larrauri-Reyes M. Santana O.
Institution
(Mihos) Cardiac Ultrasound Laboratory, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, United States
(Larrauri-Reyes, Santana) Columbia University Division of Cardiology,
Mount Sinai Heart Institute, Miami Beach, FL, United States
Title
A Meta-Analysis of Ring Annuloplasty Versus Combined Ring Annuloplasty and
Subvalvular Repair for Moderate-to-Severe Functional Mitral Regurgitation.
Source
Journal of Cardiac Surgery. 31 (1) (pp 31-37), 2016. Date of Publication:
01 Jan 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Background A ring annuloplasty (Ring) for moderate-to-severe functional
mitral regurgitation (MR) is associated with suboptimal outcomes, and
adjunctive subvalvular repair techniques (Ring + Subvalvular) have been
advocated to improve repair durability. However, the outcomes of this
strategy are not clearly defined. Methods A systematic review was
performed to identify studies that compared a Ring versus Ring +
Subvalvular repair for the treatment of moderate-to-severe functional MR.
A meta-analysis was conducted on clinical outcomes and echocardiographic
measures of follow-up MR and left ventricular reverse remodeling. Risk
ratio (RR) and mean difference (MD) were calculated by the Mantel-Haenszel
and Inverse Variance methods under a fixed or random effects model, as
appropriate. Results Seven non-randomized studies were identified, with a
total of 531 patients (Ring = 301, Ring + Subvalvular = 230). At follow-up
(range 30-47 months), a Ring + Subvalvular repair was associated with a
lower mortality (RR = 0.59, 95%confidence interval [CI] 0.37-0.94, p =
0.03), greater freedom from moderate or greater MR (RR = 0.44, 95%CI
0.27-0.72, p = 0.001), and improved left ventricular end-diastolic
diameter (MD = -3.49 mm, 95%CI -5.45 to -1.53, p = 0.0005) and New York
Heart Association functional class (MD = -0.25, 95%CI -0.42 to -0.08, p =
0.004). A trend toward a reduced risk of reoperation for recurrent MR was
noted with a combined Ring + Subvalvular repair (RR = 0.28, 95%CI
0.06-1.22, p = 0.09). Finally, a Ring + Subvalvular repair did not impact
operative mortality or follow-up left ventricular ejection fraction.
Conclusion A combined Ring + Subvalvular repair for moderate-to-severe
functional MR can be safely performed, and may improve mid-term outcomes,
as compared with Ring alone. doi: 10.1111/jocs.12662 (J Card Surg
2016;31:31-37)
<12>
Accession Number
20160021850
Authors
Weinberg L. Miles L.F. Allaf M. Pillai P. Peyton P. Doolan L.
Institution
(Weinberg) Department of Anesthesia, Centre for Anesthesia, Perioperative
and Pain Medicine, University of Melbourne, VIC, Australia
(Miles, Allaf, Pillai, Peyton) Department of Anesthesia, Intensive Care,
Austin Hospital, Heidelberg, VIC, Australia
(Doolan) Department of Intensive Care, Austin Hospital, Heidelberg, VIC,
Australia
Title
Video Fluoroscopy for Positioning of Pulmonary Artery Catheters in
Patients Undergoing Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (6) (pp 1511-1516),
2015. Date of Publication: 01 Dec 2015.
Publisher
W.B. Saunders
Abstract
Objectives To determine whether video fluoroscopy combined with
traditional pressure waveform analyses facilitates optimal pulmonary
artery catheter (PAC) flotation and final positioning compared with the
traditional pressure waveform flotation technique alone. Design
Prospective, single-center, randomized, controlled trial. Setting
Single-center university teaching hospital. Participants The study
included 50 cardiac surgery patients at higher risk for PAC complications.
Interventions Use of video fluoroscopy to facilitate optimal PAC flotation
and positioning. Measurements and Main Results The primary outcome was the
time taken to float and position the PAC balloon in the pulmonary artery
as confirmed by transesophageal echocardiography. Secondary outcomes
included number of attempts at flotation, ventricular rhythm disturbances,
and catheter malposition. Patients were evenly matched in baseline
demographics, New York Heart Association symptoms of heart failure,
severity of left and right ventricular dysfunction, end-diastolic
pressures and dimensions, severity of tricuspid valvular disease, and
atrial and pulmonary artery pressures. Mean (SD) time to float the PAC was
significantly shorter in the video fluoroscopy group than in the usual
care group: 73 seconds (SD, 65.1) versus 176 seconds (SD, 180.6),
respectively; p = 0.014. The median (interquartile range [IQR]) number of
attempts to successful flotation was fewer in the video fluoroscopy group
than in the usual care group: 1 (IQR 1:2) attempt versus 2 (IQR 1:4)
attempts, respectively; p = 0.007. The composite complication rate
(malposition and arrhythmias) was lower in the video fluoroscopy group
than in the usual care group (16% v 52%, respectively; p = 0.01).
Conclusions In cardiac surgery patients at higher risk for PAC
complications, video fluoroscopy facilitated faster and safer catheter
flotation and positioning compared with the traditional pressure waveform
flotation technique.
<13>
Accession Number
20160029049
Authors
Keerthy P.H. Balakrishna R. Srungeri K.M. Singhvi N. John J. Islam M.
Institution
(Keerthy, Balakrishna, Srungeri, Islam) Department of Oral and
Maxillofacial Surgery, Oxford Dental College Hospital, Begur Road,
Bangalore, Bomannahalli, India
(Singhvi) Department of Oral and Maxillofacial Surgery, Navodaya Dental
College Hospital, #12-10-97/40, Indralok, Raichur, Karnataka, Paras Garden
584101, India
(John) Department of Oral and Maxillofacial Surgery, Malabar Dental
College, Manoor, Kerala, India
Title
Comparitive evaluation of propofol and midazolam as conscious sedatives in
minor oral surgery.
Source
Journal of Oral and Maxillofacial Surgery. 14 (3) (pp 773-783), 2014. Date
of Publication: September 2014.
Publisher
W.B. Saunders
Abstract
Objective: The objective of the study was to assess the efficacy of
propofol and midazolam as an intravenous sedative agent in minor oral
surgical procedures in terms of: (a) the onset of action, (b) heart rate,
(c) oxygen saturation, (d) systolic and diastolic blood pressure, (e)
respiratory rate, (f) pain during the injection of sedative agent, (g)
recovery period, (h) side effects, (i) patient's cooperation during the
surgery. Methodology: This was a double blind randomized study in which
one group of 20 patients received propofol with the induction dose of 0.5
mg/kg and 50 mug/kg/min which was administered by syringe infusion pump as
a maintenance dose and the other group received midazolam in a single dose
of 75 mug/kg and no maintenance dose was given, instead 5 % dextrose was
administered by syringe infusion pump at the rate of 50 mug/kg/min. Since
propofol was milky white in colour, a green cloth was covered over the
infusion pump in all cases. The surgeon, assistants and observers were
blind about the medications which would be given to the patient for
sedation. After the administration of the sedative, local anesthesia was
achieved with 2 % lignocaine hydrochloride. Results: The onset of action
in propofol group was significant as onset of action was faster. The
maximum increase in heart rate in propofol group was at 10 min
intraoperatively (Mean +/- 80.40 +/- 12.73) and that in midazolam group
was at 15 min intraoperatively (Mean 79.25 +/- 13.44). Post operatively
the heart rate decreased near to the baseline value in both the groups.
The average oxygen saturation before induction in propofol group was 99.7
+/- 0.73 % and that of midazolam group was 99.15 +/- 01.31 P = 0.314. None
of the patients in this study developed apnea. The systolic blood pressure
(Mean +/- SD) before induction in both the groups decreased from the
baseline value after the administration of sedatives. The diastolic blood
pressure (Mean +/- SD) before induction in both the groups decreased from
the baseline value after the administration of sedatives and the decreased
diastolic blood pressure was maintained throughout the procedure. The
respiratory rate (Mean +/- SD) before induction in both the groups
decreased from the baseline value after the administration of sedatives.
The decreased respiratory rate remained throughout the surgical procedure.
Pain during the injection of the sedatives was reported by nine patients
(45 %) in the propofol group whereas none of the patients in midazolam
group complained of pain during the injection. This is statistically
significant (P = 0.001). The recovery time (Mean +/- SD) in propofol group
was 22.50 +/- 3.04 (range 15-25 min) and that in midazolam group was 33.75
+/- 3.93 (range 30-40 min), which was statistically significant (P <
0.001). Patients in the propofol group were significantly less
co-operative than midazolam group at both 10 and 25 min intra operatively.
Conclusion: The design of the present study permitted qualitative
assessment of propofol and midazolam as sedative agents in minor oral
surgical procedures. The ideal anesthetic agent should provide rapid onset
of action, profound intra operative amnesia while ensuring rapid recovery
without much complications. There were no significant differences in
either patient demographics or surgical characteristics between the two
groups. The propofol group was less co-operative than midazolam group.
Pain during the injection of sedative was a significant adverse effect in
the propofol group. Cardiovascular parameters remained stable throughout
the procedure in both study groups and no intervention was required.
However recovery and onset of action was faster in the propofol group as
compared with the midazolam group.
<14>
Accession Number
20160013715
Authors
Bundhun P.K. Wu Z.J. Chen M.-H.
Institution
(Bundhun, Wu, Chen) Institute of Cardiovascular Diseases, The First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
530027, China
Title
Coronary artery bypass surgery compared with percutaneous coronary
interventions in patients with insulin-treated type 2 diabetes mellitus: A
systematic review and meta-analysis of 6 randomized controlled trials.
Source
Cardiovascular Diabetology. 15 (1) (no pagination), 2016. Article Number:
2. Date of Publication: January 06, 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: Data regarding the long-term clinical outcomes in patients
with insulin-treated type 2 diabetes mellitus (ITDM) revascularized by
either coronary artery bypass surgery (CABG) or percutaneous coronary
intervention (PCI) are still controversial. We sought to compare the
long-term (>1year) adverse clinical outcomes in patients with ITDM who
underwent revascularization by either CABG or PCI. Methods: Randomized
Controlled Trials (RCTs) comparing the long-term clinical outcomes in
patients with ITDM and non-ITDM revascularized by either CABG or PCI were
searched from electronic databases. Data for patients with ITDM were
carefully retrieved. Odd Ratio (OR) with 95% confidence interval (CI) was
used to express the pooled effect on discontinuous variables and the
pooled analyses were performed with RevMan 5.3. Results: Six RCTs
involving 10 studies, with a total of 1297 patients with ITDM were
analyzed (639 patients from the CABG group and 658 patients from the PCI
group). CABG was associated with a significantly lower mortality rate
compared to PCI with OR: 0.59, 95% CI 0.42-0.85; P=0.004. Major adverse
cardiovascular and cerebrovascular events as well as repeated
revascularization were also significantly lower in the CABG group with OR:
0.51, 95% CI 0.27-0.99; P=0.03 and OR 0.34, 95% CI 0.24-0.49; P<0.00001
respectively. However, compared to PCI, the rate of stroke was higher in
the CABG group with OR: 1.41, 95% CI 0.64-3.09; P=0.40, but this result
was not statistically significant. Conclusion: CABG was associated with
significantly lower long-term adverse clinical outcomes compared to PCI in
patients with ITDM. However, due to an insignificantly higher rate of
stroke in the CABG group, further researches with a larger number of
randomized patients are required to completely solve this issue.
<15>
[Use Link to view the full text]
Accession Number
20160018307
Authors
Hurley E.T. O'Sullivan K.E. Segurado R. Hurley J.P.
Institution
(Hurley, O'Sullivan, Hurley) Heart Team, Mater Private Hospital, Eccles
St., Dublin 7, Ireland
(Segurado) CSTAR Centre for Statistical Training and Research, University
College, Dublin, Ireland
Title
A meta-analysis examining differences in short-term outcomes between
sutureless and conventional aortic valve prostheses.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 10 (6) (pp 375-382), 2015. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Sutureless aortic valve prostheses are anchored by radial force
in a mechanism similar to that of transcatheter aortic valve implantation.
Transcatheter aortic valve implantation is associated with an increased
permanent pacemaker (PPM) requirement in a significant proportion of
patients. We undertook a meta-analysis to examine the incidence of PPM
insertion associated with sutureless compared with conventional surgical
aortic valve replacement. Methods: A systematic review was conducted in
accordance with the Prisma guidelines.<sup>1</sup> All searches were
performed on August 10, 2014. Studies between 2007 and 2014 were included
in the search. Results: A total of 832 patients were included in the
sutureless group and 3,740 in the conventional group. Aortic cross-clamp
(39.8 vs 62.4 minutes; P < 0.001) and cardiopulmonary bypass (64.9 vs 86.7
minutes; P = 0.002) times were shorter in the sutureless group. Permanent
pacemaker implantation rate was higher in the sutureless cohort (9.1% vs
2.4%; P = 0.025). Conclusions: Sutureless aortic valve prostheses are
associated with significantly shorter cardiopulmonary bypass and aortic
cross-clamp times and a higher incidence of PPM insertion than
conventional. Further investigation of the prognostic significance is
required.
<16>
Accession Number
20160018250
Authors
Hanke J.S. Rojas S.V. Avsar M. Bara C. Ismail I. Haverich A. Schmitto J.D.
Institution
(Hanke, Rojas, Avsar, Bara, Ismail, Haverich, Schmitto) Department of
Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical
School, Hannover, Germany
Title
HeartWare left ventricular assist device for the treatment of advanced
heart failure.
Source
Future Cardiology. 12 (1) (pp 17-26), 2016. Date of Publication: January
2016.
Publisher
Future Medicine Ltd.
Abstract
The importance of mechanical circulatory support in the therapy of
advanced heart failure is steadily growing. The rapid developments in the
field of mechanical support are characterized by continuous
miniaturization and enhanced performance of the assist devices, providing
increased pump durability and prolonged patient survival. The HeartWare
left ventricular assist device system (HeartWare Inc., Framingham, MA,
USA) is a mechanical ventricular assist device with over 8000
implantations worldwide. Compared with other available assist devices it
is smaller in size and used in a broad range of patients. The possibility
of minimally invasive procedures is one of the major benefits of the
device - allowing implants and explants, as well as exchanges of the
device with reduced surgical impact. We present here a review of the
existing literature on the treatment of advanced heart failure using the
HeartWare left ventricular assist device system.
<17>
[Use Link to view the full text]
Accession Number
20151042502
Authors
Valdis M. Chu M.W.A. Schlachta C.M. Kiaii B.
Institution
(Valdis, Chu, Kiaii) Division of Cardiac Surgery, Department of Surgery,
Western University, London Health Sciences Centre, 339 Windermere Rd.,
London, ON N6A 5A5, Canada
(Schlachta) Division of General Surgery, Department of Surgery, Western
University, London Health Sciences Centre, London, ON, Canada
Title
Validation of a novel virtual reality training curriculum for robotic
cardiac surgery a randomized trial.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 10 (6) (pp 383-388), 2015. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Robotic cardiac surgery training has relied entirely on
classical methods of surgical teaching. We sought to evaluate the impact
of a virtual reality (VR) simulation curriculum to improve skill
acquisition in robotic cardiac surgery. Methods: We randomly assigned 20
surgical trainees to undergo a 9-exercise VR curriculum on a robotic
surgical simulator or a control group that received no additional
training. The trainees were then evaluated in a blinded fashion by
assessing their de-identified video recordings of the following: (1)
standardized robotic internal thoracic artery harvest and (2) mitral valve
annuloplasty performed in porcine models, using a validated time-based
scoring system and an objective intraoperative scoring tool.
Postintervention assessments were compared to baseline. Results: Trainees
randomized to the VR group were faster than the control group for both the
internal thoracic artery harvest (957.3 T 98.9 vs. 749.1 T 171.9; P =
0.004) and mitral annuloplasty (580.4 T 14.4 vs. 463.8 T 86.4; P G 0.001)
and scored significantly higher with the intraoperative scoring tool (22.8
T 2.7 vs. 11.0 T 4.5; P G 0.001). Additionally, the VR group achieved a
proficiency level similar to our experts for both time-based scores (P =
0.624 and P = 0.967), and the intraoperative assessment (P = 0.110),
whereas the control group was not able to meet this level of proficiency
for any of the primary outcomes. The average duration of training to
successfully complete all required tasks was 9.3 hours. Conclusions: We
have demonstrated that a VR simulation curriculum can significantly
improve the efficiency and quality of learning in robotic cardiac surgery.
Further evaluation of this curriculum is required for its widespread
implementation in surgical training (ClinicalTrials.gov, NCT#02357056).
<18>
Accession Number
2015028323
Authors
Kirkeby-Garstad I. Tronnes H. Stenseth R. Sellevold O.F.M. Aadahl P.
Skogvoll E.
Institution
(Kirkeby-Garstad, Tronnes, Stenseth, Sellevold, Aadahl, Skogvoll)
Department of Anesthesiology and Intensive Care, St. Olav University
Hospital, Prinsesse Kristinas gate 3, Trondheim N-7006, Norway
(Stenseth, Sellevold, Aadahl, Skogvoll) Department of Circulation and
Medical Imaging, Norwegian University of Science and Technology,
Trondheim, Norway
Title
The Precision of Pulmonary Artery Catheter Bolus Thermodilution Cardiac
Output Measurements Varies with the Clinical Situation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (4) (pp 881-888),
2015. Date of Publication: 2015.
Publisher
W.B. Saunders
Abstract
Objective To investigate the effects of ventilatory mode, injectate
temperature, and clinical situation on the precision of cardiac output
measurements. Design Randomized, prospective observational study. Setting
Single university hospital. Participants Forty patients undergoing planned
cardiac surgery, receiving a pulmonary artery catheter according to
institutional routine. Interventions Cardiac output was measured at 4
predefined time points during the perioperative patient course, twice
during controlled and twice during spontaneous ventilation, using 2 blocks
of 8 measurement replications with cold and tepid injectate in random
order. Measurements and Main Results The data were analyzed using a
hierarchical linear mixed model. Clinical precision was determined as half
the width of the 95% confidence interval for the underlying true value.
The single-measurement precision measured in 2 different clinical
situations for each temperature/ventilation combination was 8% to 10%, 11%
to 13%, 13% to 15%, and 23% to 24% in controlled ventilation with cold
injectate, controlled ventilation with tepid injectate, spontaneous
breathing with cold injectate, and spontaneous breathing with tepid
injectate, respectively. Tables are provided for the number of
replications needed to achieve a certain precision and for how to identify
significant changes in cardiac output. Conclusions Clinical precision of
cardiac output measurements is reduced significantly during spontaneous
relative to controlled ventilation. The differences in precision between
repeated measurement series within the temperature/ventilation
combinations indicate influence of other situation-specific factors not
related to ventilatory mode. Compared with tepid injectate in patients
breathing spontaneously, the precision is 3-fold better with cold
injectate and controlled ventilation.
<19>
Accession Number
2015806084
Authors
Clayton-Smith A. Bennett K. Alston R.P. Adams G. Brown G. Hawthorne T. Hu
M. Sinclair A. Tan J.
Institution
(Clayton-Smith, Bennett, Alston, Adams, Brown, Hawthorne, Hu, Sinclair,
Tan) College of Medicine and Veterinary Medicine, Academic Administration,
University of Edinburgh, Chancellors Building, 49 Little France Crescent,
Edinburgh L1116 45B, United Kingdom
Title
A Comparison of the Efficacy and Adverse Effects of Double-Lumen
Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A
Systematic Review and Meta-analysis of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (4) (pp 955-966),
2015. Date of Publication: 2015.
Publisher
W.B. Saunders
Abstract
Objective To compare the efficacy and adverse effects of using bronchial
blockers (BBs) and double-lumen endobronchial tubes (DLTs). Design
Systematic review and meta-analysis of randomized controlled trials (RCTs)
comparing BBs and DLTs. Setting Hospital units undertaking thoracic
surgery Participants Patients undergoing thoracic surgery requiring lung
isolation. Interventions BBs and DLTs. Measurements and Main Results A
systematic literature search was conducted for RCTs comparing BBs and DLTs
using Google Scholar, Ovid Medline, and Cochrane library databases up to
October 2013. Inclusion criteria were RCTs comparing BBs and DLTs,
intubation carried out by qualified anesthesiologists or trainee
specialists, outcome measures relating to either efficacy or adverse
effects. Studies that were inaccessible in English were excluded.
Mantel-Haenszel fixed-effect meta-analysis of recurring outcome measures
was performed using RevMan 5 software. The search produced 39 RCTs
published between 1996 and 2013. DLTs were quicker to place (mean
difference: 51 seconds, 95% confidence intervals [CI] 8-94 seconds; p =
0.02) and less likely to be incorrectly positioned (odds ratio [OR] 2.70;
95% CI 1.18-6.18, p = 0.02) than BBs. BBs were associated with fewer
patients having a postoperative sore throat (OR 0.39, 95% CI: 0.23-0.68, p
= 0.0009), less hoarseness (OR: 0.43,95%, CI 0.24-0.75, p = 0.003), and
fewer airway injuries (OR 0.40, 95% CI 0.21-0.75, p = 0.005) than DLTs.
Conclusion While BBs are associated with a lower incidence of airway
injury and a lower severity of injury, DLTs can be placed quicker and more
reliably.
<20>
Accession Number
2015748633
Authors
Neuburger P.J. Ngai J.Y. Chacon M.M. Luria B. Manrique-Espinel A.M. Kline
R.P. Grossi E.A. Loulmet D.F.
Institution
(Neuburger, Ngai, Chacon, Luria, Manrique-Espinel, Kline) NYU Langone
Medical Center, Department of Anesthesiology, 550 First Avenue, New York,
NY 10282, United States
(Grossi, Loulmet) Department of Cardiothoracic Surgery, NYU Langone
Medical Center, New York, United States
Title
A Prospective Randomized Study of Paravertebral Blockade in Patients
Undergoing Robotic Mitral Valve Repair.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (4) (pp 930-936),
2015. Date of Publication: 2015.
Publisher
W.B. Saunders
Abstract
Objective The aim of this study was to evaluate the addition of
paravertebral blockade to general anesthesia in patients undergoing
robotic mitral valve repair. Design A randomized, prospective trial.
Setting A single tertiary referral academic medical center. Participants
60 patients undergoing robotic mitral valve surgery. Interventions
Patients were randomized to receive 4-level paravertebral blockade with
0.5% bupivicaine before induction of general anesthesia. All patients were
given a fentanyl patient-controlled analgesia upon arrival to the
intensive care unit, and visual analog scale pain scores were queried for
24 hours. On postoperative day 2, patients were given an anesthesia
satisfaction survey. Measurements and Main Results After obtaining
institutional review board approval, surgical and anesthetic data were
recorded perioperatively and compared between groups. Compared to general
anesthesia alone, patients receiving paravertebral blockade and general
anesthesia reported significantly less postoperative pain and required
fewer narcotics intraoperatively and postoperatively. Patients receiving
paravertebral blockade also reported significantly higher satisfaction
with anesthesia. Successful extubation in the operating room at the
conclusion of surgery was 90% and similar in both groups. Hospital length
of stay also was similar. No adverse reactions were reported. Conclusions
The addition of paravertebral blockade to general anesthesia appears safe
and can reduce postoperative pain and narcotic usage in patients
undergoing minimally invasive cardiac surgery. These findings were similar
to previous studies of patients undergoing thoracic procedures.
Paravertebral blockade alone likely does not reduce hospital length of
stay. This may be more closely related to early extubation, which is
possible with or without paravertebral blockade.
<21>
Accession Number
20160013118
Authors
You Z. Huang L. Cheng X. Wu Q. Jiang X. Wu Y.
Institution
(You, Huang, Cheng, Wu, Jiang, Wu) Department of Cardiology, The Second
Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
Title
Effect of milrinone on cardiac functions in patients undergoing coronary
artery bypass graft: A meta-analysis of randomized clinical trials.
Source
Drug Design, Development and Therapy. 10 (pp 53-58), 2015. Date of
Publication: 24 Dec 2015.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background and aim: Inotropes are commonly used to treat myocardial
dysfunction, which is the major complication after coronary artery bypass
graft (CABG). Milrinone, a phosphodiesterase 3 inhibitor, is one of these
inotropes. Recently, a number of clinical studies have been carried out to
evaluate the effects of milrinone on cardiac function in patients with low
ventricular ejection fraction undergoing CABG. However, it has been
inconclusive because of the inconsistent results. In addition, some
studies found that milrinone increased the incidence of postoperative
atrial arrhythmias and did not show any long-term beneficial effects on
survival. Therefore, it is very important to perform a meta-analysis to
summarize the results so as to determine the clinical efficacy and safety
of milrinone. Method: Several databases and websites for clinical trials
were searched until October 2015 for prospective clinical studies
comparing milrinone versus placebo on cardiac functions in patients
undergoing CAGB. Results: Four articles were identified by our search
strategy. 1) Milrinone decreased incidence of myocardial ischemia and
myocardial infarction (15.6% versus 44.4%; 4.7% versus 18% in milrinone
and control group respectively). 2) Milrinone decreased duration of
inotropic support (95% confidence interval [CI]: -6.52 to -1.68; P=0.0009)
and mechanical ventilation (h) support (95% CI -5.00 to -0.69; P=0.010),
but did not decrease the requirement for intra-aortic balloon pump or
inotropic support (P>0.05). 3) Milrinone did not decrease the overall
mortality or morbidity, intensive care unit stay (P>0.05). Conclusion:
Perioperative continuous infusion of milrinone is effective to lower
incidence of myocardial ischemia and myocardial infarction in patients
post-CABG, but it was unable to improve the overall morbidity and
mortality or decreased duration of intensive care unit stay. The available
sample size is small; therefore, future studies should be directed toward
a better understanding of the benefit of milrinone to CABG patients.
<22>
Accession Number
72156779
Authors
Bazzi A. Hoseini S.T.M.
Institution
(Bazzi) Atherosclerosis Prevention Research Center, Imam Reza Hospital,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Hoseini) Department of Medical Surgical, School of Nursing and Midwifery,
Sabzevar University of Medical Sciences, Sabzevar, Iran, Islamic Republic
of
Title
Olfactory stimulation with fresh rose flowers: A systematic review of
aromatherapy.
Source
Avicenna Journal of Phytomedicine. Conference: International Congress on
Complementary and Alternative Medicine 2015 Mashhad Iran, Islamic Republic
of. Conference Start: 20151007 Conference End: 20151009. Conference
Publication: (var.pagings). 5 (pp 82), 2015. Date of Publication: October
2015.
Publisher
Mashhad University of Medical Sciences
Abstract
Objectives: Aromatherapy is inhaling concentrated essence from various
types of plants such as rose flowers to promote physical and psychological
well-being. In this review, all the quantitative studies on the effect of
rose essential oil inhalation, which were conducted during 1990-2014, were
investigated. Materials and Methods: Ovid Medline, Google scholar, CINAHL,
Science Direct and PubMed databases were searched to obtain articles
evaluating the effect of rose essential oil inhalation on human health.
Results: The search yielded nine quantitative studies, including six
randomized controlled trials examining aromatherapy. The majority of the
findings suggested positive psychological effects such as anxiety,
depression and sleep quality improvement. In a clinical trial, fresh rose
flowers induced a significant increase in parasympathetic nervous
activities, improved the vital signs of patients after coronary artery
bypass surgery and increased comfortable feelings in irritable bowel
syndrome disorder. In addition, a study demonstrated that it can
effectively reduce renal colic. In other studies, it was more effective
than massage therapy in menopausal and postpartum depression. One study
reported that olfactory stimulation with fresh rose flowers did not cause
any significant changes to patients' perception of self-esteem. No adverse
effects were reported. Conclusion: Aromatherapy, having no significant
side effects, could be applied as a complementary therapy for patients
with psychological disorders and in postoperative pain management,
together with other common treatments.
<23>
Accession Number
72159263
Authors
Corre J. Leroux L. Casassus F.
Institution
(Corre) CHU Bordeaux, Hopital Cardiologique du Haut-Leveque, Rythmologie,
Pessac, France
(Leroux, Casassus) CHU Bordeaux, Hopital Cardiologique du Haut-Leveque,
Soins Intensifs Cardiologiques, Pessac, France
Title
Impella 2.5 in acute myocardial infarction complicated by cardiogenic
shock: Experience from Bordeaux.
Source
Archives of Cardiovascular Diseases Supplements. Conference: 25es Journees
Europeennes de la Societe Francaise de Cardiologie Paris France.
Conference Start: 20150114 Conference End: 20150117. Conference
Publication: (var.pagings). 7 (1) (pp 107-108), 2015. Date of Publication:
January 2015.
Publisher
Elsevier Masson SAS
Abstract
Background: Cardiogenic shock, mainly due to an acute coronary syndrome
(ACS), is still subject to a high mortality despite early coronary
revascularization. Nowadays, transient percutaneous left ventricular
assist device, like Impella 2.5 (Abiomed), would improve the hemodynamic
situation and the survival. Methods: In our institution, all the patients
treated with Impella 2.5 as first line therapy for a cardiogenic shock
consecutive to ACS were retrospectively included. The mortality at day 30,
the hemodynamic efficacy and complications have been analyzed. Results:
From July 2008 to December 2012, 22 patients (13 men, 58+/-11 years) with
cardiogenic shock (LV Ejection Fraction 26+/-8%; SOFA 9.2+/-4; cardiac
index (CI) 2.1+/-0.4L/min/m2) were included (12 cardiac arrest, 59%
STEMI).The Impella 2.5 device provided effective hemodynamic support (CI
increased by 16%, lung and capillary pressures respectively reduced by 36%
and 28%). Survival at day 30 was 59%, and it has been maintained up to 6
months. Factors associated with mortality were incomplete
revascularization (p<0.01), age >70 years (p=0.07), a SOFA score >9 (p
=0.02) and blood lactate >6.3 mmol/L (p=0.07) at implantation. Conclusion:
This couraging results in our single-center experience should be confirmed
by a randomized controlled trial.
<24>
Accession Number
72155713
Authors
Krpan M. Samardzic J. Skoric B. Cikes M. Petricevic M. Milicic D.
Institution
(Krpan) University Hospital Centre Zagreb, Department of Cardiovascular
Diseases, Zagreb, Croatia
(Samardzic, Skoric, Cikes, Milicic) University of Zagreb, School of
Medicine, Department of Cardiovascular Diseases, Zagreb, Croatia
(Petricevic) University of Zagreb, School of Medicine, Department of
Cardiac Surgery, Zagreb, Croatia
Title
Additional loading and high clopidogrel maintenance dosing regimen in
acute coronary syndrome with persistent platelet hyperreactivity after
stenting-a twelve month follow-up safety substudy.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2015 Vienna Austria. Conference Start: 20151017
Conference End: 20151019. Conference Publication: (var.pagings). 4 (pp
277), 2015. Date of Publication: October 2015.
Publisher
SAGE Publications Inc.
Abstract
Introduction: Clopidogrel is still widely used in treating acute coronary
syndrome (ACS) despite it's limitations and development of new P2Y12
inhibitors like prasugrel and ticagrelor. High on-treatment platelet
reactivity (HTPR) on clopidogrel is associated with increased risk for new
ischemic events. We sought to investigate whether repeated clopidogrel
loading regimen and long term high maintenance dose MD (300 mg/day) is
safe in persistent HTPR on clopidogrel after successful coronary stenting
in ACS during 12 months. Methods: Interventional group from the randomized
controlled trial (RCT) NCT02096419 was analyzed in this substudy. Cut-off
value for high on-treatment platelet reactivity on clopidogrel was set at
46U as recommended by consensus statement of experts. Patients received
additional loading dose of clopidogrel on day 2 and underwent platelet
function testing (PFT) again the following day. Remaining low responders
received another 600 mg loading dose followed by a MD of 150 mg/day. On
day 7, we repeated PFT and patients who still had HTPR on clopidogrel were
assigned to 300 mg/day MD. Patients older than 70 remained on 150 mg/day.
One, two, three, six and twelve months after PCI control PFT and interview
was perfomed. We assesed platelet reactivity, compliance to treatment and
major bleeding events according to BARC classification. Results:
Fourty-three patients were enrolled in the original interventional group.
Persistent HTPR was present in 8 patients after one week (18.6%). After 1,
2, 3, 6 and 12 months HTPR on clopidogrel was found in 5, 3, 2, 1 and 1
patient, respectively. No patient had a major bleeding event. One patient
died before first month visit (ischemic CVI). Conclusions: The results
imply that repeated clopidogrel loading doses and high clopidogrel MD
might be safe in persistent low responders on clopidogrel. Maintaining
high doses of clopidogrel in late post PCI period might prevail HTPR
phenotype in certain number of patients. New P2Y12 blockers such as
ticagrelor and prasugrel should be used in patients with persistent HTPR
on clopidogrel if available. Due to limited power of this analysis, these
results warrant confirmation in large RCTs.
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