Results Generated From:
Embase <1980 to 2016 Week 27>
Embase (updates since 2016-06-23)
<1>
Accession Number
20160273027
Author
Gupta P.; Robertson M.J.; Rettiganti M.; Seib P.M.; Wernovsky G.;
Markovitz B.P.; Simsic J.; Tobias J.D.
Institution
(Gupta) Division of Pediatric Critical Care, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Gupta, Robertson, Seib) Division of Pediatric Cardiology, Arkansas
Children's Hospital, University of Arkansas for Medical Sciences, 1
Children's Way, Slot 512-3, Little Rock, AR, United States
(Rettiganti) Biostatistics Section, Department of Pediatrics, University
of Arkansas for Medical Sciences, Little Rock, AR, United States
(Wernovsky) Department of Pediatric Cardiology, Miami Children's Hospital,
Miami, FL, United States
(Markovitz) Department of Anesthesiology and Critical Care Medicine,
Children's Hospital Los Angeles, Los Angeles, CA, United States
(Simsic) Division of Pediatric Cardiology, Department of Pediatrics,
Nationwide Children's Hospital, The Ohio State University, Columbus, OH,
United States
(Tobias) Department of Anesthesiology and Pain Medicine, Nationwide
Children's Hospital, The Ohio State University, Columbus, OH, United
States
Title
Impact of Timing of ECMO Initiation on Outcomes After Pediatric Heart
Surgery: A Multi-Institutional Analysis.
Source
Pediatric Cardiology. 37 (5) (pp 971-978), 2016. Date of Publication: 01
Jun 2016.
Publisher
Springer New York LLC
Abstract
Little is known about the relationship of timing of extracorporeal
membrane oxygenation (ECMO) initiation on patient outcomes after pediatric
heart surgery. We hypothesized that increasing timing of ECMO initiation
after heart surgery will be associated with worsening study outcomes.
Patients aged <18 years receiving ECMO after pediatric cardiac surgery at
a Pediatric Health Information System-participating hospital (2004-2013)
were included. Outcomes evaluated included in-hospital mortality,
composite poor outcome, prolonged length of ECMO, prolonged length of
mechanical ventilation, prolonged length of ICU stay, and prolonged length
of hospital stay. Multivariable logistic regression models were fitted to
study the probability of study outcomes as a function of timing from
cardiac surgery to ECMO initiation. A total of 2908 patients from 42
hospitals qualified for inclusion. The median timing of ECMO initiation
after cardiac surgery was 0 days (IQR 0-1 day; range 0-294 days). After
adjusting for patient and center characteristics, increasing duration of
time from surgery to ECMO initiation was not associated with higher
mortality or worsening composite poor outcome. However, increasing
duration of time from surgery to ECMO initiation was associated with
prolonged length of ECMO, prolonged length of ventilation, prolonged
length of ICU stay, and prolonged length of hospital stay. Although this
relationship was statistically significant, the odds for prolonged length
of ECMO, prolonged length of ventilation, prolonged length of ICU stay,
and prolonged length of hospital stay increased by only 1-3 % for every
1-day increase in ECMO that may be clinically insignificant. We did not
demonstrate any relationship between timing of ECMO initiation and
mortality among the patients of varying age groups, and patients
undergoing cardiac surgery of varying complexity. We concluded that
increasing duration of time from surgery to ECMO initiation is not
associated with worsening mortality. Our results suggest that ECMO is
initiated at the appropriate time when dictated by clinical situation
among patients of all age groups, and among patients undergoing heart
operations of varying complexity.
<2>
Accession Number
26762727
Author
Barbanti M.; Schiltgen M.; Verdoliva S.; Bosmans J.; Bleiziffer S.;
Gerckens U.; Wenaweser P.; Brecker S.; Gulino S.; Tamburino C.; Linke A.
Institution
(Barbanti) Department of Cardiology, Ferrarotto Hospital, University of
Catania, Italy. Electronic address: mbarbanti83@gmail.com
(Schiltgen) Department of Structural Heart Clinical Operations, Medtronic,
Mounds View, Minnesota
(Verdoliva) Department of Biostatistics, North American Sciences
Associates, Inc., Minneapolis
(Bosmans) Department of Cardiology, University Hospital Antwerp, Antwerp,
Belgium
(Bleiziffer) Department of Cardiovascular Surgery, German Heart Center,
Technical University Munich, Germany
(Gerckens) Department of Cardiology, Gemeinschaftskrankenhaus, Bonn,
Germany
(Wenaweser) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Brecker) Department of Cardiology, St. George's Hospital, London, United
Kingdom
(Gulino) Department of Cardiology, Ferrarotto Hospital, University of
Catania, Italy
(Tamburino) Department of Cardiology, Ferrarotto Hospital, University of
Catania, Italy
(Linke) Department of Internal Medicine/Cardiology, Heart Center,
University of Leipzig, Leipzig, Germany
Title
Three-Year Outcomes of Transcatheter Aortic Valve Implantation in Patients
With Varying Levels of Surgical Risk (from the CoreValve ADVANCE Study).
Source
The American journal of cardiology. 117 (5) (pp 820-827), 2016. Date of
Publication: 01 Mar 2016.
Abstract
This study compared 3-year clinical outcomes of patients who underwent
transcatheter aortic valve implantation with the Society of Thoracic
Surgeons (STS) score <7% to those of patients with a score >7%. Data were
drawn from the ADVANCE study, a multinational post-market clinical trial
that enrolled real-world patients with severe aortic stenosis treated with
the CoreValve bioprosthesis. Events were independently adjudicated using
Valve Academic Research Consortium-1 definitions. A total of 996 patients
were implanted: STS <7% (n = 697, median STS 4.3%, interquartile range
3.1% to 5.4%) and STS >7% (n = 298, median STS 9.7%, interquartile range
8.0% to 12.4%). At 3 years, the STS <7% group had lower rates of all-cause
mortality (28.6 vs 45.9, p <0.01) and cardiovascular mortality (19.0 vs
30.2, p <0.01) than the STS >7% group. No differences were observed in
cerebrovascular accidents, vascular complications, bleeding, or myocardial
infarction. In patients with STS <7%, mortality at 3 years was higher in
those with moderate or severe aortic regurgitation (AR) at discharge than
in those with mild or less AR (39.9% vs 22.9%; hazard ratio 1.98; 95%
confidence interval 1.37 to 2.86; p <0.01). Conversely, the severity of AR
at discharge did not affect 3-year mortality in patients with STS >7%
(42.9% vs 44.6%, moderate/severe vs mild/less; hazard ratio 1.04; 95%
confidence interval, 0.62 to 1.75; p = 0.861; p for interaction = 0.047).
In conclusion, patients with STS <7% had lower rates of all-cause and
cardiovascular mortality at 3 years after transcatheter aortic valve
implantation. Complication rates were low and stable in both groups,
demonstrating the safety of this procedure for patients at various levels
of surgical risk.
<3>
Accession Number
26897642
Author
Yeung J.H.; Gates S.; Naidu B.V.; Wilson M.J.; Gao Smith F.
Institution
(Yeung, Gates, Naidu, Wilson, Gao Smith) Academic Department of
Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS
Foundation Trust, Birmingham Heartlands Hospital, 1/F MIDRU Building,
Birmingham Heartlands Hospital, Bordersley Green East, Birmingham, UK, B9
5SS
Title
Paravertebral block versus thoracic epidural for patients undergoing
thoracotomy.
Source
The Cochrane database of systematic reviews. 2 (pp CD009121), 2016. Date
of Publication: 2016.
Abstract
AUTHORS' CONCLUSIONS: Paravertebral blockade reduced the risks of
developing minor complications compared to thoracic epidural blockade.
Paravertebral blockade was as effective as thoracic epidural blockade in
controlling acute pain. There was a lack of evidence in other outcomes.
There was no difference in 30-day mortality, major complications, or
length of hospital stay. There was insufficient data on chronic pain and
costs. Results from this review should be interpreted with caution due to
the heterogeneity of the included studies and the lack of reliable
evidence. Future studies in this area need well-conducted,
adequately-powered RCTs that focus not only on acute pain but also on
major complications, chronic pain, length of stay and costs.
BACKGROUND: Operations on structures in the chest (usually the lungs)
involve cutting between the ribs (thoracotomy). Severe post-thoracotomy
pain can result from pleural (lung lining) and muscular damage,
costovertebral joint (ribcage) disruption and intercostal nerve (nerves
that run along the ribs) damage during surgery. Poor pain relief after
surgery can impede recovery and increase the risks of developing
complications such as lung collapse, chest infections and blood clots due
to ineffective breathing and clearing of secretions. Effective management
of acute pain following thoracotomy may prevent these complications and
reduce the likelihood of developing chronic pain. A multi-modal approach
to analgesia is widely employed by thoracic anaesthetists using a
combination of regional anaesthetic blockade and systemic analgesia, with
both non-opioid and opioid medications and local anaesthesia
blockade.There is some evidence that blocking the nerves as they emerge
from the spinal column (paravertebral block, PVB) may be associated with a
lower risk of major complications in thoracic surgery but the majority of
thoracic anaesthetists still prefer to use a thoracic epidural blockade
(TEB) as analgesia for their patients undergoing thoracotomy. In order to
bring about a change in practice, anaesthetists need a review that
evaluates the risk of all major complications associated with thoracic
epidural and paravertebral block in thoracotomy.
OBJECTIVES: To compare the two regional techniques of TEB and PVB in
adults undergoing elective thoracotomy with respect to:1. analgesic
efficacy;2. the incidence of major complications (including mortality);3.
the incidence of minor complications;4. length of hospital stay;5. cost
effectiveness.
SEARCH METHODS: We searched for studies in the Cochrane Central Register
of Controlled Trials (CENTRAL 2013, Issue 9); MEDLINE via Ovid (1966 to 16
October 2013); EMBASE via Ovid (1980 to 16 October 2013); CINAHL via EBSCO
host (1982 to 16 October 2013); and reference lists of retrieved studies.
We handsearched the Journal of Cardiothoracic Surgery and Journal of
Cardiothoracic and Vascular Anesthesia (16 October 2013). We reran the
search on 31st January 2015. We found one additional study which is
awaiting classification and will be addressed when we update the review.
SELECTION CRITERIA: We included all randomized controlled trials (RCTs)
comparing PVB with TEB in thoracotomy, including upper gastrointestinal
surgery.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures
expected by Cochrane. Two review authors (JY and SG) independently
assessed the studies for inclusion and then extracted data as eligible for
inclusion in qualitative and quantitative synthesis (meta-analysis).
MAIN RESULTS: We included 14 studies with a total of 698 participants
undergoing thoracotomy. There are two studies awaiting classification. The
studies demonstrated high heterogeneity in insertion and use of both
regional techniques, reflecting real-world differences in the anaesthesia
techniques. Overall, the included studies have a moderate to high
potential for bias, lacking details of randomization, group allocation
concealment or arrangements to blind participants or outcome assessors.
There was low to very low-quality evidence that showed no significant
difference in 30-day mortality (2 studies, 125 participants. risk ratio
(RR) 1.28, 95% confidence interval (CI) 0.39 to 4.23, P value = 0.68) and
major complications (cardiovascular: 2 studies, 114 participants.
Hypotension RR 0.30, 95% CI 0.01 to 6.62, P value = 0.45; arrhythmias RR
0.36, 95% CI 0.04 to 3.29, P value = 0.36, myocardial infarction RR 3.19,
95% CI 0.13, 76.42, P value = 0.47); respiratory: 5 studies, 280
participants. RR 0.62, 95% CI 0.26 to 1.52, P value = 0.30). There was
moderate-quality evidence that showed comparable analgesic efficacy across
all time points both at rest and after coughing or physiotherapy (14
studies, 698 participants). There was moderate-quality evidence that
showed PVB had a better minor complication profile than TEB including
hypotension (8 studies, 445 participants. RR 0.16, 95% CI 0.07 to 0.38, P
value < 0.0001), nausea and vomiting (6 studies, 345 participants. RR
0.48, 95% CI 0.30 to 0.75, P value = 0.001), pruritis (5 studies, 249
participants. RR 0.29, 95% CI 0.14 to 0.59, P value = 0.0005) and urinary
retention (5 studies, 258 participants. RR 0.22, 95% CI 0.11 to 0.46, P
value < 0.0001). There was insufficient data in chronic pain (six or 12
months). There was no difference found in and length of hospital stay (3
studies, 124 participants). We found no studies that reported costs.
<4>
Accession Number
25909892
Author
Heinelt M.; Drennan I.R.; Kim J.; Lucas S.; Grant K.; Spearen C.; Tavares
W.; Al-Imari L.; Philpott J.; Hoogeveen P.; Morrison L.J.
Title
Prehospital Identification of Underlying Coronary Artery Disease by
Community Paramedics.
Source
Prehospital emergency care : official journal of the National Association
of EMS Physicians and the National Association of State EMS Directors. 19
(4) (pp 548-553), 2015. Date of Publication: 2015.
Abstract
There is a lack of definitive evidence that preventative, in-home medical
care provided by highly trained community paramedics reduces acute health
care utilization and improves the overall well-being of patients suffering
from chronic diseases. The Expanding Paramedicine in the Community (EPIC)
trial is a randomized controlled trial designed to investigate the use of
community paramedics in chronic disease management (ClinicalTrials.gov ID:
NCT02034045). This case of a patient randomized to the intervention arm of
the EPIC study demonstrates how the added layer of frequent patient
contact by community paramedics and real-time electronic medical record
(EMR) correspondence between the paramedics, physicians and other involved
practitioners prevented possible life-threatening complications. The
visiting community paramedic deduced the need for an electrocardiogram,
which prompted the primary care physician to order a stress test revealing
abnormalities and thus a coronary artery bypass graft was performed
without emergency procedures, unnecessary financial expenditure or further
health degradation such as a myocardial infarction.
<5>
Accession Number
26151717
Author
Kowalewski M.; Pawliszak W.; Kolodziejczak M.; Navarese E.P.; Anisimowicz
L.
Institution
(Kowalewski) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital in Bydgoszcz, Poland; Faculty of Health Sciences,
Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland;
Systematic Investigation and Research on Interventions and Outcomes
(SIRIO) MEDICINE Research Network, Germany. Electronic address:
(Pawliszak) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital in Bydgoszcz, Poland
(Kolodziejczak) Department of Cardiology and Internal Medicine, Nicolaus
Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Bydgoszcz,
Poland; Systematic Investigation and Research on Interventions and
Outcomes (SIRIO) MEDICINE Research Network, Germany
(Navarese) Department of Internal Medicine, Division of Cardiology,
Pulmonology and Vascular Medicine, Heinrich-Heine-University, Dusseldorf,
Germany; Systematic Investigation and Research on Interventions and
Outcomes (SIRIO) MEDICINE Research Network, Germany
(Anisimowicz) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital in Bydgoszcz, Poland
Title
30-day mortality reduction with miniaturized extracorporeal circulation as
compared to conventional cardiopulmonary bypass for coronary
revascularization. Meta-analysis of randomized controlled trials.
Source
International journal of cardiology. 198 (pp 63-65), 2015. Date of
Publication: 01 Nov 2015.
<6>
Accession Number
2015479544
Author
Tang L.H.; Zwisler A.-D.; Taylor R.S.; Doherty P.; Zangger G.; Berg S.K.;
Langberg H.
Institution
(Tang, Zwisler, Zangger, Berg) Department of Cardiology, The Heart Centre,
Rigshospitalet - Copenhagen University Hospital, Denmark
(Tang, Langberg) CopenRehab, Section of Social Medicine, Department of
Public Health, University of Copenhagen, Denmark
(Tang) Department of Rehabilitation and Nutrition, Faculty of Health and
Technology, Metropolitan University College, Denmark
(Tang) The Centre for Physical Activity Research, Rigshospitalet,
University of Copenhagen, Denmark
(Zwisler) National Centre for Rehabilitation and Palliative Care,
University of Southern Denmark, Odense University Hospital, Denmark
(Taylor) Institute of Health Research, University of Exeter Medical
School, United Kingdom
(Taylor) National Institute of Public Health, University of Southern
Denmark, Denmark
(Doherty) Department of Health Sciences, University of York, United
Kingdom
Title
Self-rating level of perceived exertion for guiding exercise intensity
during a 12-week cardiac rehabilitation programme and the influence of
heart rate reducing medication.
Source
Journal of Science and Medicine in Sport. 19 (8) (pp 611-615), 2016. Date
of Publication: 01 Aug 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: To investigate whether self-rating level of perceived exertion
can adequately guide exercise intensity during a 12-week cardiac
rehabilitation programme. Design: Linear regression analysis using
rehabilitation data from two randomised controlled trials. Methods:
Patients undergoing radiofrequency ablation for atrial fibrillation or
following heart valve surgery and participating in exercise-based
rehabilitation were included. The 12-week rehabilitation outpatient
programme comprised three weekly training sessions, each consisting of 20
min aerobic exercise divided into three steps. Patients were asked to base
their exercise intensity for each step on a predefined rating of perceived
exertion specified in a training diary. Exercise intensity was objectively
measured by heart rate during the last 2 min for each exercise step.
Comparative analysis and linear regression of the rating of perceived
exertion and heart rate were performed. Results: A total of 2622 ratings
of perceived exertion were collected from 874 training sessions in 97
patients. Heart rate and rating of perceived exertion were associated both
across all three exercise steps and individually for each step, with a
mean of 6 to7 bpm per 1-point difference in the rating of perceived
exertion (p < 0.001). Adjusting for rate-reducing medication slightly
improved the strength of the association. Conclusions: The association
between change in the rating of perceived exertion and change in heart
rate indicates that a diary-led and self-regulated model using rating of
perceived exertion can help guide exercise intensity in everyday clinical
practice among patients with heart disease, irrespective if they are
taking heart rate-reducing medication.
<7>
Accession Number
20160463213
Author
Blyme A.; Asferg C.; Nielsen O.W.; Boman K.; Gohlke-Barwolf C.; Wachtell
K.; Olsen M.H.
Institution
(Blyme, Asferg) Department of Cardiology, Glostrup Hospital, University of
Copenhagen, Glostrup, Denmark
(Nielsen) Department of Cardiology, Bispebjerg Hospital, University of
Copenhagen, Copenhagen, Denmark
(Boman) Research Unit, Skelelftea, Institution of Public Health and
Clinical Medicine, Umea University, Umea, Sweden
(Gohlke-Barwolf) Heart Center Bad Krozingen, Bad Krozingen, Germany
(Wachtell) Oslo University Hospital, Division of Cardiovascular and
Pulmonary Diseases, Department of Cardiology, Section Cardiology
Intervention, Unit Ulleval, Oslo, Norway
(Olsen) Centre for Individualized Medicine in Arterial Diseases (CIMA),
Odense University Hospital, University of Southern Denmark, Denmark
(Olsen) Medical Research Council Unit on Hypertension and Cardiovascular
Disease, Hypertension in Africa Research Team (HART), North-West
University, Potchefstroom, South Africa
Title
Increased hsCRP is associated with higher risk of aortic valve replacement
in patients with aortic stenosis.
Source
Scandinavian Cardiovascular Journal. 50 (3) (pp 138-145), 2016. Date of
Publication: 03 May 2016.
Publisher
Taylor and Francis Ltd
Abstract
Objective To investigate relations between inflammation and aortic valve
stenosis (AS) by measuring high-sensitivity C-reactive protein, at
baseline (hsCRP<inf>0</inf>) and after 1 year (hsCRP<inf>1</inf>) and
exploring associations with aortic valve replacement (AVR). Design We
examined 1423 patients from the Simvastatin and Ezetimibe in Aortic
Stenosis study. Results During first year of treatment, hsCRP was reduced
both in patients later receiving AVR (2.3 [0.9-4.9] to 1.8 [0.8-5.4] mg/l,
p < 0.001) and not receiving AVR (1.90 [0.90-4.10] to 1.3 [0.6-2.9] mg/l,
p <0.001). In Cox-regression analyses, hsCRP<inf>1</inf> predicted later
AVR (HR = 1.17, p < 0.001) independently of hsCRP<inf>0</inf> (HR = 0.96,
p = 0.33), aortic valve area (AVA) and other risk factors. A higher rate
of AVR was observed in the group with high hsCRP<inf>0</inf> and an
increase during the first year (AVR<inf>highCRP0CRP1inc</inf>=47.3% versus
AVR<inf>highCRP0CRP1dec</inf>=27.5%, p < 0.01). The prognostic benefit of
a 1-year reduction in hsCRP was larger in patients with high versus low
hsCRP<inf>0</inf> eliminating the difference in incidence of AVR between
high versus low hsCRP<inf>0</inf> (AVR<inf>highCRP0CRP1dec</inf>=27.5%
versus AVR<inf>lowCRP0CRP1dec</inf>=25.8%, p = 0.66) in patients with
reduced hsCRP during the first year. Conclusions High hsCRP<inf>1</inf> or
an increase in hsCRP during the first year of follow-up predicted later
AVR independently of AVA, age, gender and other risk factors, although no
significant improvement in C-statistics was observed.
<8>
Accession Number
20160459279
Author
Poggio P.; Cavallotti L.; Songia P.; Di Minno A.; Ambrosino P.; Mammana
L.; Parolari A.; Alamanni F.; Tremoli E.; Di Minno M.N.D.
Institution
(Poggio, Cavallotti, Songia, Di Minno, Mammana, Alamanni, Tremoli, Di
Minno) Centro Cardiologico Monzino IRCCS, Milan, Italy
(Cavallotti, Mammana, Alamanni) Dipartimento di Medicina e Chirurgia,
University of Milan, Italy
(Songia, Tremoli) Department of Pharmacological and Biomolecular Sciences,
University of Milan, Italy
(Parolari) Department of Biomedical Sciences for Health, University of
Milan, Italy
(Ambrosino, Di Minno) Division of Cardiology, Department of Advanced
Biomedical Sciences, Federico II University, Naples, Italy
(Parolari) Unita Operativa di Cardiochirurgia e Ricerca Traslazionale, San
Donato IRCCS, San Donato Milanese, Italy
Title
Impact of valve morphology on the prevalence of coronary artery disease: A
systematic review and meta-analysis.
Source
Journal of the American Heart Association. 5 (5) (no pagination), 2016.
Article Number: e003200. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Literature studies suggested a lower prevalence of coronary
artery disease (CAD) in bicuspid aortic valve (BAV) than in tricuspid
aortic valve (TAV) patients. However, this finding has been challenged. We
performed a meta-analysis to assess whether aortic valve morphology has a
different association with CAD, concomitant coronary artery bypass
grafting (CABG), and postoperative mortality. Methods and Results-Detailed
search was conducted according to the PRISMA (Preferred Reporting Items
for Systematic reviews and Meta-Analyses) guideline to identify all
patients with BAV or TAV and presence of CAD, concomitant myocardial
surgical revascularization, and the postoperative mortality. Thirty-one
studies on 3017 BAV and 4586 TAV patients undergoing aortic valve surgery
were included. BAV patients showed a lower prevalence of CAD (odds ratio
[OR]: 0.33; 95% CI: 0.17, 0.65), concomitant CABG (OR, 0.45; 95% CI: 0.35,
0.59), and postoperative mortality (OR, 0.62; 95% CI: 0.40, 0.97) than
TAV. However, BAV subjects were significantly younger than TAV (mean
difference: -7.29; 95% CI: -11.17, -3.41) were more frequently males (OR,
1.61; 95% CI: 1.33, 1.94) and exhibited a lower prevalence of hypertension
(OR, 0.58; 95% CI: 0.39, 0.87) and diabetes (OR, 0.71; 95% CI: 0.54,
0.93). Interestingly, a metaregression analysis showed that younger age
and lower prevalence of diabetes were associated with lower prevalence of
CAD (Z value: -3.03; P=0.002 and Z value: -3.10; P=0.002, respectively)
and CABG (Z value: -2.69; P=0.007 and Z value: -3.36; P=0.001,
respectively) documented in BAV patients. Conclusions-Analysis of raw data
suggested an association of aortic valve morphology with prevalence of
CAD, concomitant CABG, and postoperative mortality. Interestingly, the
differences in age and diabetes have a profound impact on prevalence of
CAD between BAV and TAV. In conclusion, our meta-analysis suggests that
the presence of CAD is independent of aortic valve morphology.
<9>
Accession Number
20160449361
Author
Tabbalat R.A.; Hamad N.M.; Alhaddad I.A.; Hammoudeh A.; Akasheh B.F.;
Khader Y.
Institution
(Tabbalat, Hamad, Akasheh) Khalidi Hospital and Medical Centre, Ibn
Khaldoun St, Amman 11183, Jordan
(Alhaddad) Jordan Hospital, Amman, Jordan
(Hammoudeh) Istishari Hospital, Amman, Jordan
(Khader) Jordan University of Science and Technology, Irbid, Jordan
Title
Effect of ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart
Surgery Patients: END-AF Trial.
Source
American Heart Journal. 178 (pp 102-107), 2016. Date of Publication: 01
Aug 2016.
Publisher
Mosby Inc.
Abstract
Background Atrial fibrillation (AF) is a common arrhythmia in patients
undergoing cardiac surgery and may result in significant morbidity and
increased hospital stay. This study was conducted to determine if
colchicine administered preoperatively to patients undergoing cardiac
surgery and continued during hospitalization is effective in reducing the
incidence of postoperative AF. Methods In this multicenter prospective
randomized open-label study, consecutive patients with no history of AF
and scheduled to undergo elective cardiac surgery (n = 360) were
randomized to colchicine (n = 179) or no-colchicine (n = 181). Main
exclusion criteria were history of AF or supraventricular arrhythmias or
absence of sinus rhythm at enrolment, and contraindications to colchicine.
Colchicine was orally administered 12 to 24 hours preoperatively and
continued until hospital discharge. The primary efficacy end point was
documented AF lasting more than 5 minutes. Safety end point was colchicine
adverse effects. Results In-hospital mortality was 3.3%. The primary end
point of AF occurred in 63 patients (17.5%): 26 (14.5%) in the colchicine
group and 37 (20.5%) in the no-colchicine group (relative risk reduction
29.3% [P =.14]). Diarrhea occurred in 54 patients, 44 (24.6%) on
colchicine and 10 (5.5%) on no-colchicine (P <.001). Diarrhea led to
discontinuation of colchicine in 23 (52%) of the 44 patients. Conclusion
Colchicine administered preoperatively to patients undergoing cardiac
surgery and continued until hospital discharge failed to significantly
reduce the incidence of early postoperative AF. Diarrhea was the most
common adverse effect of colchicine leading to its discontinuation in more
than half of the patients with this adverse effect.
<10>
Accession Number
20160449962
Author
Vandenberghe W.; Gevaert S.; Kellum J.A.; Bagshaw S.M.; Peperstraete H.;
Herck I.; Decruyenaere J.; Hoste E.A.J.
Institution
(Vandenberghe, Peperstraete, Herck, Decruyenaere, Hoste) Departments of
Intensive Care Medicine, ICU, University Hospital Ghent, Ghent University,
Ghent BE 9000, Belgium
(Gevaert) Cardiology, Ghent University Hospital, Ghent University, Ghent,
Belgium
(Hoste) Research Foundation-Flanders (FWO), Brussels, Belgium
(Kellum) Centre for Critical Care Nephrology, University of Pittsburgh,
United States
(Kellum, Hoste) Clinical Research, Investigation, and Systems Modelling of
Acute Illness (CRISMA) Centre, Department of Critical Care Medicine,
University of Pittsburgh, School of Medicine, Pittsburgh, PA, United
States
(Bagshaw) Division of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, AL, Canada
Title
Acute kidney injury in cardiorenal syndrome type 1 patients: A systematic
review and meta-analysis.
Source
CardioRenal Medicine. 6 (2) (pp 116-128), 2015. Date of Publication: 2015.
Publisher
S. Karger AG
Abstract
Background: We evaluated the epidemiology and outcome of acute kidney
injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its
subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and
after cardiac surgery (CS). Summary: We performed a systematic review and
meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO),
worsening renal failure (WRF) and renal replacement therapy (RRT). We
investigated the three most common clinical causes of CRS-1: AHF, ACS and
CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41
studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by
AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had
a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI:
47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types
of acute cardiac disease. AKI was associated with an increased mortality
rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227
patients), a longer length of stay in the intensive care unit
[LOS<inf>ICU</inf>] (median duration = 1.37 days, 95% CI 0.41-2.33; 9
studies and 10,758 patients) and a longer LOS in hospital
[LOS<inf>hosp</inf>] (median duration = 3.94 days, 95% CI 1.74-6.15; 8
studies and 35,227 patients). Increasing AKI severity was associated with
worse outcomes. The impact of CRS-1 defined by AKI on mortality was
greatest in CS patients. RRT had an even greater impact compared to AKI
(mortality risk ratio = 9.2, median duration of LOS<inf>ICU</inf> = 10.6
days and that of LOS<inf>hosp</inf> = 20.2 days). Key Messages: Of all
included patients, almost one quarter developed AKI and approximately 3%
needed RRT. AHF patients experienced the highest occurrence rate of AKI,
but the impact on mortality was greatest in CS patients.
<11>
Accession Number
20160451977
Author
Mosala Nezhad Z.; Poncelet A.; De Kerchove L.; Gianello P.; Fervaille C.;
El Khoury G.
Institution
(Mosala Nezhad, Poncelet, De Kerchove, El Khoury) Institute of
Experimental and Clinical Research (IREC), Division of Cardiovascular
Research (CARD), Universite catholique de Louvain, Department of
Cardiovascular and Thoracic Surgery, Saint-Luc University Hospital UCL,
Avenue Hippocrate 10, Brussels 1200, Belgium
(Mosala Nezhad, Poncelet, De Kerchove, El Khoury) Department of
Cardiovascular and Thoracic Surgery, Universite Catholique de Louvain,
Saint-Luc University Hospital, Brussels, Belgium
(Gianello) Institute of Experimental and Clinical Research (IREC),
Division of Experimental Surgery and Transplantation (CHEX), Universite
catholique de Louvain, Brussels, Belgium
(Fervaille) Laboratory of Anatomy Pathology, Universite catholique de
Louvain, Godinne University Hospital-CHU, Yvoir, Belgium
Title
Small intestinal submucosa extracellular matrix (CorMatrix) in
cardiovascular surgery: A systematic review.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (6) (pp 839-850),
2016. Date of Publication: 25 Jun 2016.
Publisher
Oxford University Press
Abstract
Extracellular matrix (ECM) derived from small intestinal submucosa (SIS)
is widely used in clinical applications as a scaffold for tissue repair.
Recently, CorMatrix porcine SIS-ECM (CorMatrix Cardiovascular, Inc.,
Roswell, GA, USA) has gained popularity for 'next-generation'
cardiovascular tissue engineering due to its ease of use, remodelling
properties, lack of immunogenicity, absorbability and potential to promote
native tissue growth. Here, we provide an overview of the biology of
porcine SIS-ECM and systematically review the preclinical and clinical
literature on its use in cardiovascular surgery. CorMatrix has been used
in a variety of cardiovascular surgical applications, and since it is the
most widely used SIS-ECM, this material is the focus of this review. Since
CorMatrix is a relatively new product for cardiovascular surgery, some
clinical and preclinical studies published lack systematic reporting of
functional and pathological findings in sufficient numbers of subjects.
There are also emerging reports to suggest that, contrary to expectations,
an undesirable inflammatory response may occur in CorMatrix implants in
humans and longer-term outcomes at particular sites, such as the heart
valves, may be suboptimal. Large-scale clinical studies are needed driven
by robust protocols that aim to quantify the pathological process of
tissue repair.
<12>
Accession Number
20160447644
Author
Levin D.N.; Taras J.; Taylor K.; Thomas M.
Institution
(Levin) London School of Hygiene and Tropical Medicine and London School
of Economics, London, United Kingdom
(Levin) Department of Anesthesia, University of Toronto, Toronto, ON,
Canada
(Taras) Faculty of Medicine, University of Toronto, Toronto, ON, Canada
(Taylor) Department of Anesthesia, Hospital for Sick Children, Toronto,
ON, Canada
Title
The cost effectiveness of transesophageal echocardiography for pediatric
cardiac surgery: a systematic review.
Source
Paediatric Anaesthesia. 26 (7) (pp 682-693), 2016. Date of Publication: 01
Jul 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Intraoperative transesophageal echocardiography (ITEE) for
pediatric cardiac surgery has been described as clinically efficacious and
cost-effective. There are a small number of publications supporting these
claims. Aims: The objectives were to assess the quality of the research,
the variability of results across studies and, if possible, to make a
consensus statement based on the results. Methods: In March 2015, a
systematic search of MEDLINE and MEDLINE In-Process, EMBASE, and the
National Health Service Economic Evaluation Database was performed. The
search was supplemented with a review of Health Technology Assessment
reports through the Centre for Reviews and Dissemination database. English
language articles including any quantitative economic evaluation were
included. The quality of each study was assessed using the British Medical
Journal economic evaluation quality checklist. Data extracted included the
main outcomes from each study, study methodologies, itemized costs,
sensitivity ranges, biases, and delayed reoperation prevented with ITEE.
When possible, a cost-savings per ITEE was calculated to facilitate
comparison across studies and used to create a synthesis of the results.
Results: Seven studies met the inclusion criteria; of these, five were
included in the synthesis of results. The cost-savings per ITEE ranged
from $194 to $4910 with a mean of $1930 (95%CI: $845 to $3015) (2015 USD).
Prevented delayed reoperation rates using ITEE ranged from 2.8% to 10%.
Earlier studies were of poorer quality (scores 8-17) and more recent
studies were of higher quality (scores 22-25). Methodologies used were
either retrospective chart reviews (57%) or prospective observational
studies (43%) with a range of approaches to estimate costs. Conclusion:
ITEE for pediatric cardiac surgery is effective and cost-saving. This is a
validation of the current practice patterns. These finding may influence
the expansion of the use of this technology.
<13>
Accession Number
20160447643
Author
Mattila I.; Patila T.; Rautiainen P.; Korpela R.; Nikander S.; Puntila J.;
Salminen J.; Suominen P.K.; Tynkkynen P.; Hiller A.; Lonnqvist P.-A.
Institution
(Mattila, Patila, Puntila, Salminen) Division of Pediatric Surgery,
Hospital for Children and Adolescents, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
(Rautiainen, Korpela, Nikander, Suominen, Tynkkynen, Hiller) Division of
Anesthesiology, Hospital for Children and Adolescents, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
Title
The effect of continuous wound infusion of ropivacaine on postoperative
pain after median sternotomy and mediastinal drain in children.
Source
Paediatric Anaesthesia. 26 (7) (pp 727-733), 2016. Date of Publication: 01
Jul 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Postoperative pain after median sternotomy is usually treated
with i.v. opioids. We hypothesized that continuous wound infusion of
ropivacaine decreases postoperative morphine consumption and improves
analgesia in children who undergo cardiac surgery. Methods: This
randomized, double-blind study comprised 49 children aged 1-9 years who
underwent atrial septal defect (ASD) closure. Patients received continuous
local anesthetic wound infiltration either with 0.2% ropivacaine, 0.3-0.4
mg.kg<sup>-1</sup>.h<sup>-1</sup> (Group R) or with saline (Group C).
Rescue morphine consumption, Objective Pain Scale (OPS), time to
mobilization, time to enteral food intake, and time to discharge were
recorded. Results: There were no statistically significant differences in
morphine consumption at 24, 48, and 72 h postsurgery between R and C
groups. There was a weak evidence for a difference in the time to the
first morphine administration after tracheal extubation to be longer for
Group R than Group C (186.2 vs 81.0 min; 95% CI (-236.5, 26.2), P =
0.114). The incidence of nausea and vomiting were comparable between the
groups. No signs or symptoms of local anesthetic toxicity were registered.
Conclusions: Contrary to our hypothesis, continuous ropivacaine wound
infusion did not reduce morphine consumption, pain score values, or nausea
and vomiting in children who underwent ASD closure with median sternotomy
and mediastinal drain.
<14>
Accession Number
2015679042
Author
Simonen P.; Lommi J.; Hallikainen M.; Helske-Suihko S.; Werkkala K.;
Kupari M.; Kovanen P.T.; Gylling H.
Institution
(Simonen, Werkkala, Kupari) Heart and Lung Center, Helsinki University
Central Hospital, Helsinki, Finland
(Lommi, Helske-Suihko, Kovanen) Wihuri Research Institute, Helsinki,
Finland
(Hallikainen, Gylling) Institute of Public Health and Clinical Nutrition,
University of Eastern Finland, Kuopio, Finland
(Gylling) Department of Medicine, Division of Internal Medicine,
University of Helsinki, Helsinki, Finland
Title
Dietary plant stanols or sterols neither accumulate in stenotic aortic
valves nor influence their structure or inflammatory status.
Source
Clinical Nutrition. 34 (6) (pp 1251-1257), 2015. Date of Publication: 01
Dec 2015.
Publisher
Churchill Livingstone
Abstract
Background & aims: Consumption of plant stanols and plant sterols
decreases LDL cholesterol level and increases serum concentrations of
plant stanols/sterols, but it is practically unexplored whether also their
tissue concentrations increase. Thus, the aim of this study was to assess
whether consuming plant stanols/sterols increases their concentrations in
stenotic aortic valves and affect the valvular structure (collagen and
elastin) or inflammation (macrophages and mast cells). Methods: In a
randomized, double-blind controlled intervention patients with severe
aortic stenosis consumed margarine without (n = 11) or with 2 g of plant
stanols (n = 12) or sterols (n = 13) until valve replacement surgery (2.6
months, on average). The effects of sitostanol and sitosterol on the
expression and secretion of proinflammatory cytokines by cultured aortic
valve myofibroblasts were also assessed. Results: Control-related
LDL-cholesterol was diminished by 16% (p < 0.05) by plant stanol and by
11% (NS) by plant sterol consumption, respectively. In the resected
valves, cholesterol, plant stanol and sterol levels were similar in all
groups. Consumed plant stanols or sterols had no effect on valvular
structure or mast cell or macrophage numbers in valves. Incubation of
cultured myofibroblasts derived from stenotic valves with sitostanol or
sitosterol decreased mRNA expression of the monocyte chemotactic protein-1
(p < 0.05) and interleukin-1 beta (p < 0.05). Conclusions: In this study,
plant stanol/sterol consumption did not affect cholesterol, plant stanol
or sterol levels in stenotic aortic valves; neither did they influence the
structure or the inflammatory status of the valves. However, these
findings need to be confirmed in a larger-scale intervention.
ClinicalTrials.govRegister. NCT00738933.
<15>
Accession Number
20160232167
Author
Yi Q.; Li K.; Jian Z.; Xiao Y.-B.; Chen L.; Zhang Y.; Ma R.-Y.
Institution
(Yi, Jian, Xiao, Chen, Ma) Department of Cardiovascular Surgery, Xinqiao
Hospital, Third Military Medical University, 183 Xinqiao Street, Chongqing
400037, China
(Li) Department of Urologic Surgery, Daping Hospital, Third Military
Medical University, Chongqing, China
(Zhang) Department of Epidemiology, Third Military Medical University,
Chongqing, China
(Zhang) Evidence-Based Medicine and Clinical Epidemiology Center, Third
Military Medical University, Chongqing, China
Title
Risk factors for acute kidney injury after cardiovascular surgery:
Evidence from 2,157 cases and 49,777 controls - A meta-analysis.
Source
CardioRenal Medicine. 6 (3) (pp 237-250), 2016. Date of Publication: 01
May 2016.
Publisher
S. Karger AG
Abstract
Purpose: Cardiovascular surgery-associated acute kidney injury (AKI-CS)
contributes to mortality and morbidity. However, risk factors accelerating
its development are unclear. We identified risk factors for AKI-CS in
patients with cardiopulmonary bypass in the hospital surgical intensive
care unit to predict and minimize renal complication in future cardiac
surgery. Methods: We analyzed data from 14 case-control studies published
prior to June 2014 and indexed in Science Citation Index, PubMed, and
other databases to determine the major risk factors for AKI-CS. Results:
Analyzed risk factors were divided into three groups: preoperative,
intraoperative and postoperative. Preoperative factors included: age (OR,
4.87; 95% CI, 3.50-6.24), NYHA class III/IV (OR, 2.53; 95% CI, 1.32-4.86),
hypertension (OR, 1.68; 95% CI, 1.44-1.97), preoperative creatinine (OR,
0.66; 95% CI, 0.18-1.14), peripheral vascular disease (OR, 1.31 95% CI,
1.09-1.57), respiratory system disease (OR, 1.29; 95% CI, 1.10-1.50),
diabetes mellitus (OR, 1.52; 95% CI, 1.07-2.16), and cerebrovascular
disease (OR, 2.13; 95% CI, 1.11-4.09). Intraoperative factors were:
cardiopulmonary bypass time (OR, 33.78; 95% CI, 23.15-44.41), aortic
clamping time (OR, 13.24; 95% CI, 7.78-18.69), use of intra-aortic balloon
pump (OR, 4.44; 95% CI, 2.37-8.30), and type of surgery (OR, 1.01; 95% CI,
0.43-2.39). Postoperative factors were: infection (OR, 3.58; 95% CI,
1.43-8.97), redo operation (OR, 2.57; 95% CI, 1.75-3.78), emergency
surgery (OR, 4.76; 95% CI, 3.05-7.43), and low cardiac output (OR, 2.30;
95% CI, 1.05-5.04). Conclusions: Our results support that preoperative,
intraoperative, and postoperative factors are associated with AKI-CS.
Ejection fraction, BMI, acute myocardial infarction, type of surgery, and
congestive heart failure were not absolutely associated with AKI.
<16>
Accession Number
2015993891
Author
Amanullah M.M.; Hamid M.; Hanif H.M.; Muzaffar M.; Siddiqui M.T.; Adhi F.;
Ahmad K.; Khan S.; Hasan Z.
Institution
(Amanullah, Hanif, Muzaffar, Siddiqui, Adhi, Ahmad) Department of Surgery,
Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan
(Hamid) Department of Cardiac Anaesthesia, AKUH, Karachi, Pakistan
(Khan) Medical College, Agha Khan University, AKUH, Karachi, Pakistan
(Hasan) Department of Pathology and Microbiology, AKUH, Karachi, Pakistan
Title
Effect of steroids on inflammatory markers and clinical parameters in
congenital open heart surgery: A randomised controlled trial.
Source
Cardiology in the Young. 26 (3) (pp 506-515), 2016. Date of Publication:
01 Mar 2016.
Publisher
Cambridge University Press
Abstract
Background Cardiopulmonary bypass is associated with systemic inflammatory
response. Steroids suppress this response, although the therapeutic
evidence remains controversial. We hypothesised that intravenous steroids
in children undergoing open-heart surgery would decrease inflammation
leading to better early post-operative outcomes. We conducted a randomised
controlled trial to evaluate the trends in the levels of immunomodulators
and their effects on clinical parameters. Objective To assess the effects
of intravenous steroids on early post-operative inflammatory markers and
clinical parameters in children undergoing open-heart surgery. Materials
and methods A randomised controlled trial involving 152 patients, from one
month up to 18 years of age, who underwent open-heart surgery for
congenital heart disease from April 2010-2012 was carried out. Patients
were randomised and administered either three scheduled intravenous pulse
doses of dexamethasone (1 mg/kg) or placebo. Blood samples were drawn at
four time intervals and serum levels of inflammatory cytokines -
Interleukin-6, 8, 10, 18, and tumour necrosis factor-alpha - were
measured. Clinical parameters were also assessed. Results Blood cytokine
levels were compared between the dexamethasone (n=65) and placebo (n=64)
groups. Interleukin-6 levels were lower at 6 and 24 hours post-operatively
(p<0.001), and Interleukin-10 levels were higher 6 hours post-operatively
(p<0.001) in the steroid group. Interleukin-8, 18, and tumour necrosis
factor-alpha levels did not differ between the groups at any time
intervals. The clinical parameters were similar in both the groups.
Conclusion Dexamethasone caused quantitative suppression of Interleukin-6
and increased Interleukin-10 activation, contributing to reduced
immunopathology, but it did not translate into clinical benefit in the
short term.
<17>
Accession Number
20160438271
Author
Ke J.-D.; Hou H.-J.; Wang M.; Zhang Y.-J.
Institution
(Ke, Hou, Wang, Zhang) Department of Anesthesiology, Friendship Hospital,
Capital Medical University, Beijing 100050, China
Title
The comparison of anesthesia effect of lung surgery through video-assisted
thoracic surgery: A meta-analysis.
Source
Journal of Cancer Research and Therapeutics. 11 (8) (pp C265-C270), 2015.
Date of Publication: 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The epidural anesthesia and general anesthesia are the most
commonly used in lung surgery through video-assisted thoracic surgery
(VATS). Each of these methods has their advantages and disadvantages, so
the aim of this meta-analysis is to identify which anesthesia is more
conducive to lung surgery under VATS and rehabilitation of patients.
Materials and Methods: The Cochrane Library Database (Issue 12, 2013),
PubMed (1966-2015), and China National Knowledge Infrastructure
(1950-2015) were searched without language restrictions. Meta-analyses
were conducted using Review Manager 5.2 software (The Cochrane
Collaboration, Software Update, Oxford). We calculated odds ratio (OR) and
its confidence interval (95% CI) to estimate the difference between
epidural anesthesia and general anesthesia through finishing of the
collected data. Results: Due to our search results, 7 studies were
included in our study. Studies among them show that different contents of
these articles are not all the same about research direction. Our findings
suggested that epidural anesthesia had more advantages than general
anesthesia for operative time (mean difference = - 23.85, 95% CI: - 29.67
- 18.03, P = 0.0001). More than that, epidural anesthesia showed a good
surgical outcome on postoperative hospital stay (mean difference = - 0.43,
95% CI: - 0.85 - 0.01, P = 0.04) than general anesthesia. But we found
that there were no different on numbers of people with complications (OR =
0.45, 95% CI: 0.23-0.89, P = 0.97) and headache occurrence (OR = 2.69, 95%
CI: 0.62-11.70, P = 0.91) between epidural anesthesia and general
anesthesia. Conclusion: These results indicated that epidural anesthesia
can save operating time and postoperative hospital stay time. But epidural
anesthesia and general anesthesia have the same effect on complications.
<18>
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Accession Number
20160438671
Author
Skoloudik D.; Hurtikova E.; Brat R.; Herzig R.
Institution
(Skoloudik, Hurtikova, Brat) Department of Neurology, Comprehensive Stroke
Center, University Hospital Ostrava, Ostrava-Poruba CZ-708 52, Czech
Republic
(Skoloudik) Faculty of Health Sciences, Palacky University, Olomouc, Czech
Republic
(Herzig) Department of Cardiac Surgery, University Hospital Ostrava,
Ostrava, Czech Republic
(Brat) Department of Neurosurgery and Neurooncology, Comprehensive Stroke
Center, Military University Hospital, Prague, Czech Republic
Title
Sonolysis in Prevention of Brain Infarction during Cardiac Surgery
(SONORESCUE).
Source
Medicine (United States). 95 (20) (no pagination), 2016. Article Number:
e3615. Date of Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Here, we examined whether intraoperative sonolysis can alter the risk of
new ischemic lesions in the insonated brain artery territory during
coronary artery bypass grafting (CABG) or valve surgery. Silent brain
ischemic lesions could be detected in as many as two-Thirds of patients
after CABG or valve surgery. Patients indicated for CABG or valve surgery
were allocated randomly to sonolysis (60 patients, 37 males; mean age,
65.3 years) of the right middle cerebral artery (MCA) during cardiac
surgery and control group (60 patients, 37 males; mean age, 65.3 years).
Neurologic examination, cognitive function tests, and brain magnetic
resonance imaging (MRI) were conducted before intervention as well as 24
to 72hours and 30 days after surgery. New ischemic lesions on control
diffusion-weighted MRI in the insonated MCA territory >0.5mL were
significantly less frequent in the sonolysis group than in the control
group (13.3% vs 26.7%, P=0.109). The sonolysis group exhibited
significantly reduced median volume of new brain ischemic lesions
(P=0.026). Stenosis of the internal carotid artery >50% and smoking were
independent predictors of new brain ischemic lesions >0.5mL (odds
ratio=5.685 [1.272-25.409], P=0.023 and 4.698 [1.092-20.208], P=0.038,
respectively). Stroke or transient ischemic attack occurred only in 2
control patients (P=0.496). No significant differences were found in
scores for postintervention cognitive tests (P>0.05). This study provides
class-II evidence that sonolysis during CABG or valve surgery reduces the
risk of larger, new ischemic lesions in the brain. www.clinicaltrials.gov
(NCT01591018).
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