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Embase (updates since 2017-10-20)
<1>
Accession Number
618000006
Author
Banerjee K.; Poddar K.; Mick S.; White J.; Krishnaswamy A.; Johnston D.;
Rodriguez L.; Tuzcu E.M.; Kapadia S.
Institution
(Banerjee, Poddar, Mick, White, Krishnaswamy, Johnston, Rodriguez, Tuzcu,
Kapadia) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, Ohio, United States
Title
Meta-Analysis of Usefulness of Anticoagulation After Transcatheter Aortic
Valve Implantation.
Source
American Journal of Cardiology. 120 (9) (pp 1612-1617), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Since the advent of bioprosthetic valves, the implications of long-term
anticoagulation after valve replacement are unclear. There are very little
data on outcomes of long-term anticoagulation after transcatheter aortic
valve implantation (TAVI). Our aim was to conduct a systematic review of
literature regarding anticoagulation after TAVI. The existing literature
on anticoagulation after bioprosthetic valve replacement was thoroughly
reviewed, including the most recent American College of
Cardiology/American Heart Association 2017 guidelines for management of
valvular disease, which is based on sparse, nonrandomized retrospective
data. A systematic review of MEDLINE, EMBASE, and Cochrane CENTRAL
databases was conducted to retrieve articles reporting outcomes on
anticoagulation after TAVI, and 5 articles were retrieved. Pooled analysis
revealed lower bleeding rates in the anticoagulated group (22% vs 35%, p =
0.006). Stroke and mortality were inconsistently reported by the studies.
The data regarding outcomes of patients on anticoagulation after TAVI are
sparse. Systematic collection of anticoagulation data in the existing
registries and future trials should be strongly considered in patients
undergoing TAVI.<br/>Copyright © 2017 Elsevier Inc.
<2>
Accession Number
618328586
Author
Song Y.; Soh S.; Shim J.-K.; Park K.-U.; Kwak Y.-L.
Institution
(Song, Soh, Shim, Park, Kwak) Department of Anesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul,
South Korea
(Song, Soh, Shim, Kwak) Anesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seodaemun-gu, Seoul, South Korea
(Song) Department of Anesthesiology and Pain Medicine, Yonsei University
College of Medicine, Gangnam Severance Hospital, Gangnam-gu, Seoul, South
Korea
Title
Skin perfusion pressure as an indicator of tissue perfusion in valvular
heart surgery: Preliminary results from a prospective, observational
study.
Source
PLoS ONE. 12 (9) (no pagination), 2017. Article Number: e0184555. Date of
Publication: September 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Hemodynamic management aims to provide adequate tissue perfusion, which is
often altered during cardiac surgery with cardiopulmonary bypass (CPB). We
evaluated whether skin perfusion pressure (SPP) can be used for monitoring
of adequacy of tissue perfusion in patients undergoing valvular heart
surgery. Seventy-two patients undergoing valve replacement were enrolled.
SPP and serum lactate level were assessed after anaesthesia induction
(baseline), during CPB, after CPB-off, end of surgery, arrival at
intensive care unit, and postoperative 6 h. Lactate was further measured
until postoperative 48 h. Association of SPP with lactate and 30-day
morbidity comprising myocardial infarction, acute kidney injury, stroke,
prolonged intubation, sternal infection, reoperation, and mortality was
assessed. Among the lactate levels, postoperative 6 h peak value was most
closely linked to composite of 30-day morbidity. The SPP value during CPB
and its % change from the baseline value were significantly associated
with the postoperative 6 h peak lactate (r = -0.26, P = 0.030 and r =
0.47, P = 0.001, respectively). Optimal cut-off of % decrease in SPP
during CPB from baseline value for the postoperative 6 h hyperlactatemia
was 48% (area under curve, 0.808; 95% confidence interval (CI),
0.652-0.963; P = 0.001). Decrease in SPP >48% during CPB from baseline
value was associated with a 12.8-fold increased risk of composite endpoint
of 30-day morbidity (95% CI, 1.48-111.42; P = 0.021) on multivariate
logistic regression. Large decrease in SPP during CPB predicts
postoperative 6 h hyperlactatemia and 30-day morbidity, which implicates a
promising role of SPP monitoring in the achievement of optimal perfusion
during CPB.<br/>Copyright © 2017 Song et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.
<3>
Accession Number
618162249
Author
Khan M.R.; Kayani W.T.; Ahmad W.; Hira R.S.; Virani S.S.; Hamzeh I.; Jneid
H.; Lakkis N.; Alam M.
Institution
(Khan) Resident Internal Medicine, McLaren Flint/Michigan State
University, Flint, Michigan, United States
(Kayani, Virani, Hamzeh, Jneid, Lakkis, Alam) Department of Medicine,
Section of Cardiology, Baylor College of Medicine, Houston, Texas, United
States
(Ahmad) Nishtar Medical College, Multan, Pakistan
(Hira) University of Washington, Seattle, Washington, United States
(Virani, Jneid) Section of Cardiology, Michael E. DeBakey Veterans Affairs
Medical Center, Houston, Texas, United States
Title
Meta-Analysis of Comparison of 5-Year Outcomes of Percutaneous Coronary
Intervention Versus Coronary Artery Bypass Grafting in Patients With
Unprotected Left Main Coronary Artery in the Era of Drug-eluting Stents.
Source
American Journal of Cardiology. 120 (9) (pp 1514-1520), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with unprotected left main coronary artery (ULMCA) disease are
increasingly being treated with percutaneous coronary intervention (PCI)
using drug-eluting stents (DES), but long-term outcomes comparing PCI with
coronary artery bypass grafting (CABG) remain limited. We performed
aggregate data meta-analyses of clinical outcomes (all-cause death,
nonfatal myocardial infarction, stroke, repeat revascularization, cardiac
death, and major adverse cardiac and cerebrovascular events) in studies
comparing 5-year outcomes of PCI with DES versus CABG in patients with
ULMCA disease. A comprehensive literature search (January 1, 2003 to
December 10, 2016) identified 9 studies (6,637 patients). Effect size for
individual clinical outcomes was estimated using odds ratio (OR) with 95%
confidence intervals (CI) using a random effects model. At 5 years, PCI
with DES was associated with equivalent cardiac (OR 0.95, 95% CI 0.62 to
1.46) and all-cause mortality (OR 0.98, 95% CI 0.72 to 1.33), lower rates
of stroke (OR 0.50, 95% CI 0.30 to 0.84), and higher rates of repeat
revascularization (OR 2.52, 95% CI 1.63 to 3.91); compared with CABG,
major adverse cardiac and cerebrovascular events showed a trend favoring
CABG but did not reach statistical significance (OR 1.19, 95% CI 0.93 to
1.54). In conclusion, for ULMCA disease, PCI can be considered as a
comparably effective and yet less invasive alternative to CABG given the
comparable long-term mortality and lower incidences of
stroke.<br/>Copyright © 2017 Elsevier Inc.
<4>
Accession Number
618155298
Author
Li J.; Chen Z.; Gao X.; Zhang H.; Xiong W.; Ju J.; Xu H.
Institution
(Li, Zhang, Ju) Graduate School, Beijing University of Chinese Medicine,
Beijing, China
(Chen, Xu) Cardiovascular Diseases Center, Xiyuan Hospital, China Academy
of Chinese Medical Sciences, Beijing, China
(Gao) Graduate School, China Academy of Chinese Medical Sciences, Beijing,
China
(Xiong) Center for Evidence-Based Chinese Medicine, Beijing University of
Chinese Medicine, Beijing, China
Title
Meta-Analysis Comparing Metoprolol and Carvedilol on Mortality Benefits in
Patients With Acute Myocardial Infarction.
Source
American Journal of Cardiology. 120 (9) (pp 1479-1486), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Although carvedilol, a nonselective beta-blocker with alpha-adrenergic
blocking and multiple ancillary activities, has been demonstrated to be
superior to metoprolol in chronic heart failure, it remains unclear
whether the superiority of carvedilol still exists in myocardial
infarction (MI). Therefore, we performed a network meta-analysis of
randomized controlled trials (RCTs) to compare the 2 drugs in patients
with MI. All RCTs that compared either 2 of the following interventions,
carvedilol, metoprolol, and placebo, for the treatment of MI were
included. The Cochrane Collaboration Central Register of Controlled
Trials, Embase, and PubMed were searched thoroughly for potential eligible
studies. Finally, 12 RCTs involving 61,081 patients were included. Pooled
results showed that compared with placebo, carvedilol and metoprolol
significantly reduced composite cardiovascular events (risk ratio [RR]
0.63; 95% credible interval [CrI] 0.41, 0.85 for carvedilol; RR 0.78; 95%
CrI 0.65, 0.93 for metoprolol) and re-infarction (RR 0.57; 95% CrI 0.37,
0.84 for carvedilol; RR 0.77; 95% CrI 0.62, 0.91 for metoprolol) in
patients with MI. However, neither carvedilol nor metoprolol showed
significant benefits on all-cause death, cardiovascular death,
revascularization, and rehospitalization. Also, no obvious difference was
found when comparing carvedilol and metoprolol on primary or secondary
outcomes. In conclusion, there is insufficient evidence supporting the
superiority of carvedilol over metoprolol for the treatment of MI. Further
studies are needed to confirm our findings.<br/>Copyright © 2017
Elsevier Inc.
<5>
Accession Number
618057288
Author
Casset C.; Jankowski A.; Bertrand B.; Saunier C.; Piliero N.; Rodiere M.;
Ferretti G.; Quesada J.-L.; Broisat A.; Riou L.; Fagret D.; Ghezzi C.;
Vanzetto G.; Barone-Rochette G.
Institution
(Casset, Bertrand, Saunier, Piliero, Vanzetto, Barone-Rochette) Department
of Cardiology, University Hospital, Grenoble Alpes, France
(Jankowski, Rodiere, Ferretti) Department of Radiology, University
Hospital, Grenoble Alpes, France
(Quesada) Clinical Investigation Center, Grenoble Alpes University
Hospital, France
(Broisat, Riou, Fagret, Ghezzi, Vanzetto, Barone-Rochette) INSERM, U1039,
Radiopharmaceutiques Biocliniques, Universite Grenoble Alpes, France
(Vanzetto, Barone-Rochette) French alliance clinical trial, French
Clinical Research Infrastructure Network, Paris, France
Title
Evaluation of Imaging Strategy to Optimize and Improve Outcome of
Transcatheter Aortic Valvular Implantation.
Source
American Journal of Cardiology. 120 (9) (pp 1633-1638), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cardiac computed tomography (CT) provides additional information with
ultrasound in the transcatheter heart valve (THV) size selection. However,
the influence of these incremental data on outcomes has not been evaluated
in a randomized study. A single-center prospective, randomized, and open
study was performed. Patients referred for transfemoral transcatheter
aortic valve implantation with a balloon-expandable endoprothesis were
included. THV size selection was performed using either transthoracic and
transesophageal echocardiography data (control group) or ultrasound and CT
results (CT group). The primary composite end point included the
occurrence of stroke, major vascular complications, and moderate or severe
paravalvular aortic regurgitation (PAR) at 1 year. Fifty patients (n = 25
in the control and CT groups) were enrolled. The primary composite end
point occurred in 40% and 8% of patients from the control and CT groups,
respectively (p = 0.008). The Kaplan-Meier analysis revealed a pejorative
association with not performing the CT (p = 0.007). A decrease in the
occurrence of PAR was observed in the CT group compared with the control
group (PAR 28% vs 4%, p = 0.04; major vascular complications 12% vs 4%, p
= 0.6; all-cause death 16% vs. 4%, p = 0.34; no stroke). In conclusion,
the use of cardiac CT in addition to ultrasound data in THV size selection
reduced the long-term occurrence of cardiovascular events.<br/>Copyright
© 2017 Elsevier Inc.
<6>
Accession Number
617594862
Author
Cavalca V.; Rocca B.; Veglia F.; Petrucci G.; Porro B.; Myasoedova V.; De
Cristofaro R.; Turnu L.; Bonomi A.; Songia P.; Cavallotti L.; Zanobini M.;
Camera M.; Alamanni F.; Parolari A.; Patrono C.; Tremoli E.
Institution
(Cavalca, Veglia, Porro, Myasoedova, Turnu, Bonomi, Songia, Cavallotti,
Zanobini, Camera, Alamanni, Tremoli) Monzino Cardiology Center, IRCCS,
Milan, Italy
(Cavalca, Turnu, Songia, Camera, Alamanni) University of Milan, Milan,
Italy
(Rocca, Petrucci, Patrono) Department of Pharmacology, Catholic
University, Rome, Italy
(De Cristofaro) Department of Hematology, Catholic University, Rome, Italy
(Parolari) Policlinico San Donato Hospital, IRCCS, San Donato Milanese,
Italy
Title
On-pump Cardiac Surgery Enhances Platelet Renewal and Impairs Aspirin
Pharmacodynamics: Effects of Improved Dosing Regimens.
Source
Clinical Pharmacology and Therapeutics. 102 (5) (pp 849-858), 2017. Date
of Publication: November 2017.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
On-pump cardiac surgery may trigger inflammation and accelerate platelet
cyclooxygenase-1 renewal, thereby modifying low-dose aspirin
pharmacodynamics. Thirty-seven patients on standard aspirin 100 mg
once-daily were studied before surgery and randomized within 36 hours
postsurgery to 100 mg once-daily, 100 mg twice-daily, or 200 mg once-daily
for 90 days. On day 7 postsurgery, immature and mature platelets, platelet
mass, thrombopoietin, glycocalicin, leukocytes, C-reactive protein, and
interleukin-6 significantly increased. Interleukin-6 significantly
correlated with immature platelets. At day 7, patients randomized to 100
mg once-daily showed a significant increase in serum thromboxane
(TX)B<inf>2</inf> within the 24-hour dosing interval and urinary
TXA<inf>2</inf> metabolite (TXM) excretion. Aspirin 100 mg twice-daily
lowered serum TXB<inf>2</inf> and prevented postsurgery TXM increase (P <
0.01), without affecting prostacyclin metabolite excretion. After cardiac
surgery, shortening the dosing interval, but not doubling the once-daily
dose, rescues the impaired antiplatelet effect of low-dose aspirin and
prevents platelet activation associated with acute inflammation and
enhanced platelet turnover.<br/>Copyright © 2017 American Society for
Clinical Pharmacology and Therapeutics
<7>
Accession Number
611407523
Author
Shen S.; Zhang J.; Wang W.; Zheng J.; Xie Y.
Institution
(Shen, Wang) Zhejiang Provincial People's Hospital, Department of
Anesthesiology, Hangzhou, Zhejiang, China
(Zhang) Zhejiang Provincial People's Hospital, Department of Orthopedics,
Hangzhou, Zhejiang, China
(Zheng) School of Mathematical Sciences, Beijing University, Department of
Probability and Statistics, Beijing, China
(Xie) Zhejiang Provincial People's Hospital, Department of Cardiothoracic
Surgery, Hangzhou, Zhejiang, China
Title
Impact of intra-operative cell salvage on blood coagulation in
high-bleeding-risk patients undergoing cardiac surgery with
cardiopulmonary bypass: A prospective randomized and controlled trial.
Source
Journal of Translational Medicine. 14 (1) (no pagination), 2016. Article
Number: 228. Date of Publication: 29 Jul 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Intra-operative cell salvage (CS) was reported to have no
impairment on blood coagulation in low-bleeding-risk cardiac surgery with
cardiopulmonary bypass (CPB), but studies in high-bleeding-risk cardiac
surgery are limited. The objective of this study is to evaluate the impact
of CS on blood coagulation in high-bleeding-risk cardiac surgery with CPB.
Methods: One hundred and ten patients were randomly assigned to either
with intra-operative CS group (Group CS) or without intra-operative CS
group (Group C). Study endpoints included the incidence of impairment of
blood coagulation during perioperative period (peri-op) and the incidence
of adverse events during postoperative period (post-op). Peri-op was
defined as the period from beginning of anesthesia (anesthesia induction)
to 24 h after end of surgery. Post-op was defined as the period from the
end of surgery to 24 h after end of surgery. The types of impairment of
blood coagulation included heparin residual, coagulopathy due to low PLT,
coagulopathy due to low FIB, coagulopathy due to low coagulation factors,
hyperfibrinolytic. The sum of above five types was total impairment of
blood coagulation. Adverse events included excessive bleeding,
resternotomy, etc. Results: The incidence of heparin residual measured
both at the end of surgery and during post-op were significantly higher in
Group CS than in Group C (15.09 vs 4.00, 13.21 vs 2.00 %; p = 0.024,
0.010, respectively). Similarly, the incidence of total impairment of
blood coagulation at the end of surgery and during post-op were
significantly higher in Group CS than in Group C (32.08 vs 18.00, 26.42 vs
12.00 %; p = 0.043, 0.040, respectively). The incidence of excessive
bleeding during post-op was 32.08 % in Group CS compared with 16.00 % in
Group C (p = 0.038). Intriguingly, CS was associated with a significantly
increase in the relative risk ratios for heparin residual and excessive
bleeding (p = 0.034, 0.049, respectively). Conclusions: Intra-operative CS
could impair blood coagulation in the scenario of high-risk-bleeding
cardiac surgery with CPB.<br/>Copyright © 2016 The Author(s).
<8>
Accession Number
618808940
Author
Baron S.J.; Arnold S.V.; Wang K.; Magnuson E.A.; Chinnakondepali K.;
Makkar R.; Herrmann H.C.; Kodali S.; Thourani V.H.; Kapadia S.; Svensson
L.; Brown D.L.; Mack M.J.; Smith C.R.; Leon M.B.; Cohen D.J.
Institution
(Baron, Arnold, Wang, Magnuson, Chinnakondepali, Smith, Cohen)
Saint-Luke's Mid America Heart Institute, School of Medicine, University
of Missouri, 4401Wornall Rd, Kansas City, MO 64111, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, California (Makkar),
United States
(Herrmann) Hospital of University of Pennsylvania, Philadelphia, United
States
(Kodali, Leon) Columbia University Medical Center, New York, New York,
United States
(Thourani) Emory University School of Medicine, Atlanta, Georgia, United
States
(Kapadia, Svensson) Cleveland Clinic, Cleveland, OH, United States
(Brown) Baylor Scott and White Healthcare, Plano, Texas, United States
(Mack) Baylor Health Care System, Plano, Texas, United States
Title
Health status benefits of transcatheter vs surgical aortic valve
replacement in patients with severe aortic stenosis at intermediate
surgical risk: Results from the PARTNER 2 randomized clinical trial.
Source
JAMA Cardiology. 2 (8) (pp 837-845), 2017. Date of Publication: August
2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE In patients with severe aortic stenosis (AS) at intermediate
surgical risk treatment with transcatheter aortic valve replacement (TAVR)
or surgical aortic valve replacement (SAVR) results in similar 2-year
survival. The effect of TAVR vs SAVR on health status in patients at
intermediate surgical risk is unknown. OBJECTIVE To compare health-related
quality of life among intermediate-risk patients with severe AS treated
with either TAVR or SAVR. DESIGN, SETTING, AND PARTICIPANTS Between
December 2011 and November 2013, 2032 intermediate-risk patients with
severe AS were randomized to TAVR with the Sapien XT valve or SAVR in the
Placement of Aortic Transcatheter Valve 2 Trial and were followed up for 2
years. Data analysis was conducted between March 1, 2016, to April 30,
2017. MAIN OUTCOMES AND MEASURES Health status was assessed at baseline, 1
month, 1 year, and 2 years using the Kansas City Cardiomyopathy Quest
ionnaire (KCCQ) (23 items covering physical function, social function,
symptoms, self-efficacy and knowledge, and quality of life on a 0- to
100-point scale; higher scores indicate better quality of life), Medical
Outcomes Study Short Form-36 (36 items covering 8 dimensions of health
status as well as physical and mental summary scores; higher scores
represent better health status), and EuroQOL-5D (assesses 5 dimensions of
general health on a 3-level scale, with utility scores ranging from 0
[death] to 1 [ideal health]). Analysis of covariance was used to examine
changes in health status over time, adjusting for baseline status. RESULTS
Of the 2032 randomized patients, baseline health status was available for
1833 individuals (950 TAVR, 883 SAVR) who formed the primary analytic
cohort. A total of 1006 (54.9%) of the population were men; mean (SD) age
was 81.4 (6.8) years. Over 2 years, both TAVR and SAVR were associated
with significant improvements in both disease specific (16-22 points on
the KCCQ-OS scale) and generic health status (3.9-5.1 points on the SF-36
physical summary scale). At 1 month, TAVR was associated with better
health status than SAVR, but this difference was restricted to patients
treated via transfemoral access (mean difference in the KCCQ overall
summary [KCCQ-OS] score, 14.1 points; 95%CI, 11.7 to 16.4; P < .01) and
was not seen in patients treated via transthoracic access (mean difference
in KCCQ-OS, 3.5 points; 95%CI, -1.4 to 8.4; P < .01 for interaction).
There were no significant differences between TAVR and SAVR in any health
status measures at 1 or 2 years. CONCLUSIONS AND RELEVANCE Among
intermediate-risk patients with severe AS, health status improved
significantly with both TAVR and SAVR through 2 years of follow up. Early
health status improvement was greater with TAVR, but only among patients
treated via transfemoral access. Longer term follow-up is needed to assess
the durability of quality-of-life improvement with TAVR vs SAVR in this
population.<br/>Copyright © 2017 American Medical Association. All
rights reserved.
<9>
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Accession Number
618768047
Author
Ye Y.; Yang M.; Zhang S.; Zeng Y.
Institution
(Ye, Yang, Zhang, Zeng) Department of Cardiology, Peking Union Medical
College Hospital, Peking Union Medical College, Chinese Academy of Medical
Sciences, Beijing 100730, China
Title
Percutaneous coronary intervention versus cardiac bypass surgery for left
main coronary artery disease.
Source
Medicine (United States). 96 (41) (no pagination), 2017. Article Number:
e8115. Date of Publication: 01 Oct 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Several updated meta-analyses comparing percutaneous coronary
intervention (PCI) with coronary artery bypass grafting (CABG) for left
main coronary artery disease (LM CAD) have been published recently.
However, the risk of false-positive results could be high in conventional
updated meta-analyses due to repetitive testing of accumulating data.
Therefore, we compared these treatment approaches via trial sequential
analysis (TSA). Methods: The MEDLINE, Embase, and Cochrane Central
Register of Controlled Trials databases were searched for published
randomized controlled trials (RCTs) or subgroups of RCTs comparing PCI and
CABG in patients with LM CAD. The primary outcome was major cardiac and
cerebrovascular adverse events (MACCE). TSA was used to confirm the
conclusions derived from conventional meta-analysis. Results: Six RCTs
with 4700 patients were included. PCI was associated with a greater risk
of MACCE compared with CABG (pooled relative risk [RR] 1.21, 95%
confidence interval [CI]: 1.05-1.40, P=.008). In addition, PCI resulted in
a significantly higher risk of revascularization than CABG (pooled RR
1.61, 95% CI: 1.33-1.95, P<.0001). TSA provided firm evidence for the
reduction of MACCE and revascularization with CABG compared with PCI
(cumulative z-curve crossed the monitoring boundary). In the subgroup
analysis, CABG was better than PCI in patients with SYNTAX score >32
(pooled RR 1.41, 95% CI: 1.12-1.76, P=.003), which was confirmed by the
TSA. There was no difference in patients with a SYNTAX score from 0 to 32.
Conclusions: In patients with LM CAD, CABG may be better than PCI for
reducing MACCE due to a reduced risk of revascularization. CABG remains
the first choice for LM CAD patients with high anatomic complexity, while
PCI could be an alternative for those with low-to-moderate anatomic
complexity.<br/>Copyright © 2017 the Author(s). Published by Wolters
Kluwer Health, Inc.
<10>
Accession Number
611171627
Author
Ardhanari S.; Yarlagadda B.; Parikh V.; Dellsperger K.C.; Chockalingam A.;
Balla S.; Kumar S.
Institution
(Ardhanari, Yarlagadda, Chockalingam, Balla, Kumar) Department of
Medicine, Division of Cardiology, University of Missouri School of
Medicine, Columbia, MO, United States
(Parikh) Department of Cardiology, University of South Florida, Tampa, FL,
United States
(Dellsperger) Department of Medicine, Augusta University Health, Augusta,
GA, United States
Title
Systematic review of non-invasive cardiovascular imaging in the diagnosis
of constrictive pericarditis.
Source
Indian Heart Journal. 69 (1) (pp 57-67), 2017. Date of Publication: 01 Jan
2017.
Publisher
Elsevier B.V.
Abstract
Background Diagnosis of constrictive pericarditis (CP) can be challenging.
It can be nearly impossible to distinguish CP from other causes of right
heart failure. Although various imaging modalities help in the diagnosis,
no test is definitive. Several reviews have addressed the role of various
imaging techniques in the diagnosis of CP but a systematic review has not
yet been published. Objective Our intention was to study the ability of
various non-invasive imaging modalities to diagnose CP in patients with
surgically confirmed disease and to apply our findings to develop a
clinically useful diagnostic algorithm. Methods A PubMed (NLM) search was
performed with MeSH term "constrictive pericarditis". Original articles
that investigated the ability of various cardiovascular imaging modalities
to noninvasively diagnose surgically confirmed CP were included in our
review. Investigations that included any cases without surgical
confirmation were excluded. Results The PubMed search yielded 3001 results
with MeSH term "constrictive pericarditis" (January 8, 2016). We
identified (40) studies on CP that matched our inclusion criteria. We
summarized our results sorted by individual non-invasive CV imaging
modalities - echocardiography, cardiac computed tomography (CT), and
magnetic resonance imaging (MRI). Under each imaging modality, we grouped
our discussion based on different parameters useful in CP diagnosis.
Conclusions In conclusion, contemporary diagnosis of CP is based on
clinical features and echocardiography. Cardiac MRI is recommended in
patients where echocardiography is not diagnostic. Both cardiac MRI and CT
can guide surgical planning but we prefer MRI as it provides both
structural and functional information.<br/>Copyright © 2016
<11>
Accession Number
616957959
Author
Poon S.S.; Field M.; Gupta D.; Cameron D.
Institution
(Poon, Field) Thoracic Aortic Aneurysm Service, Department of Cardiac
Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
(Gupta) Interventional Cardiology, Department of Cardiology, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Cameron) Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore,
MD, United States
Title
Surgical septal myectomy or alcohol septal ablation: which approach offers
better outcomes for patients with hypertrophic obstructive
cardiomyopathy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (6) (pp 951-961),
2017. Date of Publication: 01 Jun 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Summary A best evidence topic in cardiac surgery was written according to
a structured protocol. The question addressed was whether surgical septal
myectomy (SM) is more beneficial than alcohol septal ablation (ASA) in
patients with hypertrophic obstructive cardiomyopathy. Altogether 218
articles were found using the reported search, of which 15 studies
represented the best evidence to answer the clinical question. There were
14 observational studies and 1 meta-analysis study. The authors, journal,
date and country of publication, patient group studied, study type,
relevant outcomes and results of these articles are tabulated. Surgical SM
was generally performed in younger patients whereas percutaneous ASA was
favoured in patients with advanced age and significant co-morbidities. In
a large study comprising 716 patients, the reduction of median residual
left ventricular outflow tract (LVOT) gradient at 3 months was comparable
after ASA (102 +/- 52-10 mmHg) and SM (92 +/- 39-9 mmHg). The New York
Heart Association (NYHA) functional class and symptomatic improvement for
either approach was comparable. Findings from the meta-analysis study
showed that patients who underwent ASA had a higher incidence of
post-procedure device implantation (odds ratio 3.09; P < 0.00001), as
reported in 6 other studies. The risk of permanent pacemaker insertion
during follow-up (FU) varied between 2.4-12.5% in SM and 1.7-22.0% in ASA.
Isolated surgical myectomy and ASA are safe and effective in abolishing
outflow obstruction, although the resolution of LVOT pressure gradient is
more complete with surgery. The post-procedural and late mortality rates
between the 2 groups are consistently low and comparable in carefully
selected patients. Nonetheless, ASA is associated with the increased
likelihood of complications such as permanent pacemaker implantation,
early sustained-VT and VF, and re-intervention. Overall, when performed by
experienced cardiologists and surgeons, both techniques are safe and
effective in most cases and therefore treatment should be offered based on
patient choice.<br/>Copyright © The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.
<12>
Accession Number
618872391
Author
Singh K.; Bhalla A.S.; Qutub M.A.; Carson K.; Labinaz M.
Institution
(Singh) Department of Cardiology, Gold Coast University Hospital, 1
Hospital Blvd, Southport, QLD 4215, Australia
(Singh) Griffith University, 58 Parklands Drive, Gold Coast, QLD 4215,
Australia
(Singh, Carson) University of Adelaide, North Terrace, Adelaide, SA 5000,
Australia
(Bhalla) University of Sydney, Sydney, NSW 2006, Australia
(Qutub) Department of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
(Labinaz) University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON
K1Y 4W7, Canada
Title
Systematic review and meta-analysis to compare outcomes between
intermediate- and high-risk patients undergoing transcatheter aortic valve
implantation.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (4) (pp
289-295), 2017. Date of Publication: 01 Oct 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Recent studies have reported non-inferior outcomes for transcatheter
aortic valve implantation (TAVI) compared with surgical aortic valve
replacement (SAVR) in intermediate-risk patients. However, a comparison of
outcomes among TAVI patients depending upon the surgical risk score has
not been performed in a large study. Our aim was to compare the outcomes
of TAVI in low-, intermediate-, and high-risk patients, to ascertain if
the morbidity and mortality is related to the patient's risk profile or
the procedure itself. Methods and results A thorough computer-based search
was performed using Ovid MEDLINE, EMBASE, Google Scholar, and PubMed
databases. We included original research studies reporting data on TAVI in
the low-, intermediate-, and high-risk groups. Patients in
intermediate-risk group were compared to the high-risk cohort for device
success, mortality, and complications. A total of 2414 patients in the
intermediate-risk group were compared with 1597 high-risk patients. On
meta-analysis, intermediate-risk group demonstrated similar device success
[odds ratio (OR) 1.29, 95% confidence interval (CI) 0.87-1.90, I 2 = 0%, P
= 0.2) but a lower 30-day mortality OR 0.54, 95% CI 0.34-0.86, I 2 = 49%,
P = 0.009). There was no difference in the incidence of stroke (OR 1.17,
95% CI 0.80-1.71, I 2 = 36%, P = 0.42) or permanent pacemaker implantation
between the two groups (OR 1.04, 95% CI 0.82-1.32, I 2 = 41%, P = 0.74).
Conclusion Transcatheter aortic valve implantation in intermediate-risk
patients carries a low mortality and high success. Incidence of pacemaker
and stroke remains high in the lower risk group. Published on behalf of
the European Society of Cardiology. All rights reserved.<br/>Copyright
© The Author 2017.
<13>
Accession Number
618867758
Author
Enter D.H.; Zaki A.L.; Marsh M.; Cool N.; Kruse J.; Li Z.; Andrei A.-C.;
Iddriss A.; McCarthy P.M.; Malaisrie S.C.; Anderson A.; Rich J.D.; Pham
D.T.
Institution
(Enter, Zaki, Kruse, Li, Andrei, Iddriss, McCarthy, Malaisrie, Pham)
Cardiac Surgery, Northwestern University, Chicago, IL, United States
(Marsh, Cool) Pharmacy, Northwestern University, Chicago, IL, United
States
(Anderson, Rich) Cardiology, Northwestern University, Chicago, IL, United
States
Title
Prothrombin Complex Concentrate Reduces Blood Product Utilization in Heart
Transplantation.
Source
Pharmacotherapy. 37 (10) (pp 1215-1220), 2017. Date of Publication:
October 2017.
Publisher
Pharmacotherapy Publications Inc.
Abstract
Background: Current practices for the reversal of warfarin before cardiac
surgery include the use of vitamin K and fresh frozen plasma (FFP) to
reduce the risk of bleeding. Although the 2010 International Society of
Heart and Lung Transplantation guidelines acknowledge the use of
prothrombin complex concentrate (PCC), there is no clear consensus on its
efficacy. The objective of this study was to assess the efficacy of
four-factor (4-F) PCC administration in patients requiring warfarin
reversal before heart transplantation by determining blood product
utilization perioperatively. Methods: Twenty-one patients who received 4-F
PCC for warfarin reversal before heart transplantation were compared to a
similar cohort of 39 patients who did not receive 4-F PCC, from January
2011 to July 2015. Blood product utilization was collected retrospectively
for the 24-hour preoperative, intraoperative, and 48-hour postoperative
periods. Results: Patients receiving 4-F PCC required fewer blood products
in all three time periods. In the 24-hour preoperative period, 22 (56%)
patients in the control group and 2 (10%) patients in the 4-F PCC groups
received blood products (p<0.001). Intraoperatively, all patients received
blood products. The 4-F PCC group required fewer units of packed red blood
cells (median 3 vs 7 units, p<0.001) and FFP (median 4 vs 9 units,
p<0.001). In the 48-hour postoperative period, 20 (51%) patients in the
control group and 5 (24%) patients in the 4-F PCC group received blood
products (p=0.04). Conclusions: 4-F PCC is associated with reduced blood
product utilization 24 hours preoperatively and intraoperatively.
Historically, the majority of patients require FFP for warfarin reversal
preoperatively. In this single-center study, a significant reduction in
the need for FFP was demonstrated with the use of 4-F PCC.<br/>Copyright
© 2017 Pharmacotherapy Publications, Inc.
<14>
Accession Number
618802895
Author
Momeni M.; Nkoy Ena L.; Van Dyck M.; Matta A.; Kahn D.; Thiry D.; Gregoire
A.; Watremez C.
Institution
(Momeni, Nkoy Ena, Van Dyck, Matta, Kahn, Watremez) Department of
Anesthesiology, Universite Catholique de Louvain, Cliniques Universitaires
Saint Luc, Brussels, Belgium
(Thiry, Gregoire) Department of Perfusion Services, Universite Catholique
de Louvain, Cliniques universitaires Saint Luc, Brussels, Belgium
Title
The dose of hydroxyethyl starch 6% 130/0.4 for fluid therapy and the
incidence of acute kidney injury after cardiac surgery: A retrospective
matched study.
Source
PLoS ONE. 12 (10) (no pagination), 2017. Article Number: e0186403. Date of
Publication: October 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
The safety of hydroxyethyl starches (HES) is still under debate. No
studies have compared different dosing regimens of HES in cardiac surgery.
We analyzed whether the incidence of Acute Kidney Injury (AKI) differed
taking into account a weight-adjusted cumulative dose of HES 6% 130/0.4
for perioperative fluid therapy. This retrospective cohort study included
all adult patients undergoing elective or emergency cardiac surgery with
or without cardiopulmonary bypass. Exclusion criteria were patients on
renal replacement therapy (RRT), cardiac trauma surgery, heart
transplantation, patients with ventricular assist devices, subjects who
required a surgical revision for bleeding and those whose medical records
were incomplete. Primary endpoint was AKI following the creatinine based
RIFLE classification. Secondary endpoints were 30-day mortality and RRT.
Patients were divided into 2 groups whether they had received a cumulative
HES dose of < 30 mL/kg (Low HES) or 30 mL/kg (High HES) during the intra-
and postoperative period. A total of 1501 patients were analyzed with 983
patients in the Low HES and 518 subjects in the High HES group. 185
(18.8%) patients in the Low HES and 119 (23.0%) patients in the High HES
group developed AKI (P = 0.06). In multivariable regression analysis the
dose of HES administered per weight was not associated with AKI. After
case-control matching 217 patients were analyzed in each group. AKI
occurred in 39 (18.0%) patients in the Low HES and 50 (23.0%) patients in
the High HES group (P = 0.19). In conditional regression analysis
performed on the matched groups a lower weight-adjusted dose of HES was
significantly associated with a reduced incidence of AKI [(Odds Ratio (95%
CI) = 0.825 (0.727-0.936); P = 0.003]. In the absence of any safety study
the cumulative dose of modern HES in cardiac surgery should be kept less
than 30 mL/kg.<br/>Copyright © 2017 Momeni et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.
<15>
Accession Number
618784017
Author
Choi P.T.; Beattie W.S.; Bryson G.L.; Paul J.E.; Yang H.
Institution
(Choi) Department of Anesthesiology, Pharmacology and Therapeutics,
University of British Columbia, Vancouver, BC, Canada
(Beattie) Department of Anaesthesia, University Health Network, Toronto,
ON, Canada
(Bryson, Yang) Department of Anesthesiology, University of Ottawa, Ottawa,
ON, Canada
(Paul) Department of Anesthesia, McMaster University, Hamilton, ON, Canada
Title
Effects of Neuraxial Blockade May Be Difficult to Study Using Large
Randomized Controlled Trials: The PeriOperative Epidural Trial (POET)
Pilot Study.
Source
PLoS ONE. 4 (2) (no pagination), 2009. Article Number: e4644. Date of
Publication: 2009.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Early randomized controlled trials have suggested that
neuraxial blockade may reduce cardiorespiratory complications after
non-cardiothoracic surgery, but recent larger trials have been
inconclusive. We conducted a pilot study to assess the feasibility of
conducting a large multicentre randomized controlled trial in Canada.
Methodology/Principal Findings: After Research Ethics Board approvals from
the participating institutions, subjects were recruited if they were >=45
years old, had an expected hospital stay >=48 hours, were undergoing a
noncardiothoracic procedure amenable to epidural analgesia, met one of six
risk criteria, and did not have contraindications to neuraxial blockade.
After informed consent, subjects were randomly allocated to combined
epidural analgesia (epidural group) and neuraxial anesthesia, with or
without general anesthesia, or intravenous opioid analgesia (IV group) and
general anesthesia. The primary outcomes were the rate of recruitment and
the percents of eligible patients recruited, crossed over, and followed
completely. Feasibility targets were defined a priori. A blinded,
independent committee adjudicated the secondary clinical outcomes.
Subjects were followed daily while in hospital and then at 30 days after
surgery. Analysis was intentionto- treat. Over a 15-month period, the
recruitment rate was 0.5+/-0.3 (mean+/-SEM) subjects per week per centre;
112/494 (22.7%) eligible subjects were recruited at four tertiary-care
teaching hospitals in Canada. Thirteen (26.5%) of 49 subjects in the
epidural group crossed over to the IV group; seven (14.3%) were due to
failed or inadequate analgesia or complications from epidural analgesia.
Five (9.8%) of 51 subjects in the IV group crossed over to the epidural
group but none were due to inadequate analgesia or complications.
Ninety-eight (97.0%) of 101 subjects were successfully followed up until
30 days after their surgery. Conclusion/Significance: Of the criteria we
defined for the feasibility of a full-scale trial, only the follow-up
target was met. The other feasibility outcomes did not meet our preset
criteria for success. The results suggest that a large multicentre trial
may not be a feasible design to study the perioperative effects of
neuraxial blockade.<br/>Copyright © 2009 Choi et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.
<16>
Accession Number
618880613
Author
Supino P.G.; Hai O.Y.; Sharma A.; Lampert J.; Hochreiter C.; Herrold E.M.;
Borer J.S.
Institution
(Supino, Hai, Sharma, Lampert, Hochreiter, Herrold, Borer) aHoward Gilman
Institute for Valvular Heart Diseases, State University of New York (SUNY)
Downstate Medical Center, Brooklyn, NY, and bDepartment of Cardiothoracic
Surgery, Weill Medical College of Cornell University, and cColumbia
University Medical Center, New York, NY, USA
Title
Impact of Beta-Blockade on Cardiac Events in Patients with Chronic Severe
Nonischemic Mitral Regurgitation.
Source
Cardiology (Switzerland). (pp 1-6), 2017. Date of Publication: 18 Oct
2017.
Publisher
S. Karger AG
Abstract
Objectives: The aim of this study was to examine the impact of
beta-blockade on cardiac events among patients with initially asymptomatic
chronic severe nonischemic mitral valve regurgitation (MR). Methods: Data
from 52 consecutive patients in our prospective natural history study of
isolated chronic severe nonischemic MR were assessed post hoc over 19
years to examine the relation of chronic beta-blockade use to subsequent
cardiac events (death or indications for mitral valve surgery, MVS). At
entry, all patients were free of surgical indications; 9 received
beta-blockers. Cardiac event rate differences were analyzed by
Kaplan-Meier log rank comparison. Results: During follow-up, cardiac
events included sudden death (1), heart failure (8), atrial fibrillation
(6), left ventricular dimensions at systole >=4.5 cm (11), left
ventricular ejection fraction <60% (6), right ventricular ejection
fraction <35% (2), and a combination of cardiac events (7). The cardiac
event risk was 4-fold higher among patients receiving beta-blockers
(average annual risk = 60.6%) versus those not receiving beta-blockers
(average annual risk = 15.2%; p = 0.001). These effects remained
statistically significant (p = 0.005) when analysis was adjusted for other
baseline covariates. Conclusions: Beta-blockade appears to confer an
increased risk of sudden cardiac death or indications for MVS among
patients with chronic severe nonischemic MR. Randomized trials are needed
to confirm these findings.<br/>Copyright © 2017 S. Karger AG, Basel
<17>
Accession Number
618879798
Author
Velagapudi P.; Turagam M.; Kholte D.; Khera S.; Parikh P.; Hyder O.;
Aronow H.; Abbott D.
Institution
(Velagapudi, Kholte, Parikh, Hyder, Aronow, Abbott) Division of
Cardiovascular Medicine, Brown University Warren Alpert Medical School,
Providence, RI, USA
(Turagam) Division of Cardiovascular Medicine, University of Missouri
Health Care, Columbia, MO, USA
(Khera) Division of Cardiovascular Medicine, New York Medical College,
Valhalla, NY, USA
Title
Less than two versus greater than two hour invasive strategy in non-ST
elevation myocardial infarction: a meta-analysis of randomized controlled
trials.
Source
Expert Review of Cardiovascular Therapy. (pp 1-6), 2017. Date of
Publication: 19 Oct 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Background: Optimal timing for an invasive strategy in non-ST elevation
myocardial infarction (NSTEMI) is unclear. Whether clinical outcomes are
improved with a less than two (LT2) compared with greater than two hour
(GT2) invasive strategy remains to be determined. We performed a
meta-analysis of randomized controlled trials (RCTs) comparing LT2 vs GT2
for NSTEMI. Methods: A comprehensive literature search for RCTs comparing
LT2 vs. GT2 in NSTEMI patients was performed. Three eligible studies
consisting of 1,075 patients (LT2: 537, GT2: 538) with NSTEMI were
identified. Follow-up ranged from 1 to 12 months. Results: Time from
randomization to sheath insertion ranged from 0.5-2.2 and 14.0-85.0 hours
in the LT2 and GT2 groups. More percutaneous coronary interventions and
fewer coronary artery bypass grafting were performed in the LT2 vs. GT2
group. There was no significant difference in all-cause mortality,
myocardial infarction (MI), and major bleeding between the two groups. LT2
was numerically, but not statistically superior to GT2 at preventing
recurrent ischemia/urgent revascularization/refractory ischemia.
Conclusion: Our meta-analysis found no significant difference in outcomes
between less than two versus greater than two hours invasive strategy for
NSTEMI. The differences observed in the mode of revascularization
according to timing of catheterization deserve further
study.<br/>Copyright © 2017 Informa UK Limited, trading as Taylor &
Francis Group
<18>
Accession Number
618863087
Author
Saad M.; Nairooz R.; Pothineni N.V.K.; Almomani A.; Kovelamudi S.; Sardar
P.; Katz M.; Abdel-Wahab M.; Bangalore S.; Kleiman N.S.; Block P.C.;
Abbott J.D.
Institution
(Saad, Pothineni, Almomani, Kovelamudi) Division of Cardiovascular
Medicine, University of Arkansas for Medical Sciences, Little Rock,
Arkansas
(Nairooz) Division of Cardiology, University of Southern California, Los
Angeles, California
(Sardar) Division of Cardiovascular Medicine, University of Utah, Salt
Lake City, Utah
(Katz) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Abdel-Wahab) Heart Center, Segeberger Kliniken (Academic Teaching
Hospital of the Universities of Kiel, Lubeck, and Hamburg), Bad Segeberg,
Germany
(Bangalore) Division of Cardiovascular Medicine, New York University
School of Medicine, New York, New York
(Kleiman) Houston Methodist DeBakey Heart and Vascular Center, Houston
Methodist Hospital, Houston, Texas
(Block) Division of Cardiovascular Medicine, Emory University School of
Medicine, Atlanta, Georgia
(Abbott) Division of Cardiovascular Medicine, Warren Alpert School of
Medicine at Brown University, Providence, Rhode Island
Title
Long-Term Outcomes With Transcatheter Aortic Valve Replacement in Women
Compared With Men. Evidence From a Meta-Analysis.
Source
JACC: Cardiovascular Interventions. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to examine long-term outcomes with
transcatheter aortic valve replacement (TAVR) in women versus men.
Background: TAVR is commonly performed in women. Previous studies have
shown conflicting results with respect to sex differences in outcomes with
TAVR. In addition, short-term outcomes have primarily been reported.
Methods: Electronic search was performed until March 2017 for studies
reporting outcomes with TAVR in women versus men. Random effects
DerSimonian-Laird risk ratios were calculated. Outcomes included all-cause
mortality and major cardiovascular events at short- (30 days) and
long-term (>1 year) follow-up. Results: Seventeen studies (8 TAVR
registries; 47,188 patients; 49.4% women) were analyzed. Women were older
but exhibited fewer comorbidities. At 30 days, women had more bleeding (p
< 0.001), vascular complications (p < 0.001), and stroke/transient
ischemic attack (p = 0.02), without difference in all-cause (p = 0.19) or
cardiovascular mortality (p = 0.91) compared with men. However, female sex
was associated with lower all-cause mortality at 1 year (risk ratio: 0.85;
95% confidence interval: 0.79 to 0.91; p < 0.001), and longest available
follow-up (mean 3.28 +/- 1.04 years; risk ratio: 0.86; 95% confidence
interval: 0.81 to 0.92; p < 0.001), potentially caused by less
moderate/severe aortic insufficiency (p = 0.001), and lower cardiovascular
mortality (p = 0.009). The female survival advantage remained consistent
across multiple secondary analyses. The risk of stroke, moderate/severe
aortic insufficiency, and all-cause mortality seemed to vary based on the
type of valve used; however, without significant subgroup interactions.
Conclusions: Despite a higher upfront risk of complications, women derive
a better long-term survival after TAVR compared with men.<br/>Copyright
© 2017 American College of Cardiology Foundation.
<19>
Accession Number
618057916
Author
Faerber G.; Zacher M.; Reents W.; Boergermann J.; Kappert U.; Boening A.;
Diegeler A.; Doenst T.
Institution
(Faerber, Doenst) Department of Cardiothoracic Surgery, Jena University
Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
(Zacher, Reents, Diegeler) Cardiovascular Clinic Bad Neustadt, Bad
Neustadt, Germany
(Boergermann) Clinic for Heart, Thoracic and Cardiovascular Surgery, Heart
and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
(Kappert) Department of Cardiac Surgery, Cardiovascular Institute,
University of Dresden, Dresden, Germany
(Boening) Department of Cardiovascular Surgery, University of Giesen,
Giesen, Germany
Title
Female sex is not a risk factor for post procedural mortality in coronary
bypass surgery in the elderly: A secondary analysis of the GOPCABE trial.
Source
PLoS ONE. 12 (8) (no pagination), 2017. Article Number: e0184038. Date of
Publication: August 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Objective: Female sex is considered a significant risk in cardiac surgery
and is included in the majority of scores for risk assessment. However,
the evidence is controversial and older women undergoing cardiac surgery
have not specifically been investigated. We assessed the influence of
female sex on surgical risk (30-day mortality) in a secondary analysis of
the GOPCABE trial (German Off-Pump Coronary Artery Bypass grafting in the
Elderly (GOPCABE) trial, comparing on- to off-pump) and also evaluated its
impact on risk prediction from commonly used risk scores. Methods: We
performed logistic regression analyses on the GOPCABE trial population,
where patients were randomized to either on- or off-pump CABG. The study
was performed in 12 cardiac surgery centers in Germany and analyzed 2394
patients having undergone CABG at age >=75 years (1187 on-pump, 1207
off-pump). Of the 2394 patients, 755 (32%) were women. The logistic
EuroSCORE and the German KCH score were calculated as expected (E)
mortality and values were compared to observed (O) 30-day mortality (O/E
ratio). Results: There was no difference in mortality or major
cardiovascular adverse events after 30 days between men and women for both
on- and off-pump CABG (men: on- vs. off-pump OR = 0.90, 95%-CI:
[0.63;1.27]; women: on- vs. off-pump OR = 1.07, 95%-CI: [0.62;1.87]).
Therefore, groups were combined for further analyses. Both men and women
had considerable and similar comorbidities. Expected mortality was
significantly higher for women than for men (logistic EuroSCORE:
8.88+/-6.71% vs. 7.99+/-6.69%, p = 0.003; KCH score: 4.42 +/-3.97% vs.
3.57+/-3.65%, p = 0.001). However, observed mortality rates (O) tended to
be even lower in women (2.1% vs. 3.0%). The O/E ratio was closer to 1 in
men than in women (0.84 vs. 0.47). Excluding female sex from the risk
models increased O/E ratio to 0.69. Conclusions: Female sex is not a risk
factor in coronary bypass surgery in the GOPCABE population. The result is
the same for on- and off-pump surgery. Since female sex is a component of
most risk scores, the findings may identify a potential inaccuracy in
current surgical risk assessment, specifically for elderly women. Trial
registration: Clinicaltrials.gov GOPCABE trial No.
NCT00719667.<br/>Copyright © 2017 Faerber et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.
<20>
Accession Number
611662290
Author
Dieberg G.; Smart N.A.; King N.
Institution
(Dieberg, Smart) School of Science and Technology, University of New
England, Armidale, NSW 2350, Australia
(King) School of Biomedical and Healthcare Sciences, Plymouth University
Peninsula Schools of Medicine and Dentistry, University of Plymouth,
Plymouth PL4 8AA, United Kingdom
Title
On- vs. off-pump coronary artery bypass grafting: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 223 (pp 201-211), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background To reduce complications during coronary artery bypass grafting
(CABG) off-pump CABG was introduced; however, results have been mixed. The
aim of this work was to conduct a systematic review and meta-analysis of
off-pump vs. on-pump CABG. Methods To identify potential studies
systematic searches were carried out using various databases. The search
strategy included the key concepts of "cardiopulmonary bypass" AND
"coronary artery bypass grafting" AND "off pump". This was followed by a
meta-analysis investigating post-operative atrial fibrillation, myocardial
infarction, <= 30 day mortality, stroke, ventilation time, intensive care
unit (ICU) stay and hospital stay. Results Fifty four studies (59
intervention groups), totalling 16,261 participants were analysed. Off
pump CABG led to a significantly lower incidence of post-operative atrial
fibrillation odds ratio (OR) 0.87 (95% confidence interval [CI] 0.78 to
0.97, p = 0.01), but no differences in either myocardial infarction OR
0.98 (95% CI 0.82 to 1.15, p = 0.77) or <= 30 day mortality OR 0.85 (95%
CI 0.68 to 1.06, p = 0.16). There was a strong trend towards a reduced
incidence of stroke OR 0.77 (95% CI 0.59 to 1.00, p = 0.05); however this
did not quite reach significance. Ventilation time mean difference (MD) -
3.78 h (95% CI - 4.75 to - 2.82, p < 0.00001); ICU stay MD - 0.34 days
(95% CI - 0.50 to - 0.17, p < 0.0001); and hospital stay MD - 0.9 days
(95% CI - 1.25 to - 0.56, p < 0.00001) were all significantly shorter in
the off-pump group. Conclusions Off-pump CABG has some benefits over
on-pump CABG, particularly in relation to post-operative atrial
fibrillation.<br/>Copyright © 2016 Elsevier Ireland Ltd
<21>
Accession Number
609398389
Author
Weng W.; Zhang F.; Lineaweaver W.C.; Gao W.; Yan H.
Institution
(Weng, Gao, Yan) Division of Plastic and Hand Surgery, Department of
Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University,
109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
(Zhang, Lineaweaver) Joseph M. Still Burn and Reconstructive Center,
Jackson, MS, United States
Title
The Value of Postconditioning in Plastic and Reconstructive Surgery: A
Systematic Review.
Source
Journal of Reconstructive Microsurgery. 32 (4) (pp 285-293), 2016. Date of
Publication: 28 Mar 2016.
Publisher
Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com)
Abstract
Background Ischemia-reperfusion (I/R) injury by abrupt restoration of
circulation after prolonged ischemia has still been an unsolved problem in
plastic and reconstructive surgery. The concept of postconditioning
(post-con), which has been well described in cardiovascular surgery, has
been recently introduced in plastic and reconstructive surgery. As an
"after-injury strategy," post-con may be a promising approach to reduce
I/R injury and improve flap survival after ischemia. Methods A systematic
review was performed by searching electronic databases of PubMed and web
of science to identify all the studies regarding the application of the
post-con technique in plastic and reconstructive surgery between 1950 and
2015. Inclusion criteria were English articles with clear reporting the
post-con techniques and detailed outcomes. Results In total, 476 articles
were identified and 18 studies reporting post-con in plastic and
reconstructive surgery met the inclusion criteria in this review,
including 11 studies of mechanical post-con, 3 studies of pharmacological
post-con, 1 study of both mechanical and pharmacological post-con, and 3
studies of remote post-con. All these studies reported protective effects
of any kind of post-con techniques in I/R injuries and could improve flap
survivals. Conclusion In general, the strategy of post-con may effectively
reduce I/R injury and improve the survival of flaps after ischemia in
animal studies, yet no consensus regarding the exact technical details
(intervention timing, cycles, intermittent duration, etc.) has been
reached. Further studies aiming to explore its mechanisms as well as
specific methodology are required before clinical application in plastic
and reconstructive surgery.<br/>Copyright © 2016 by Thieme Medical
Publishers, Inc.
<22>
Accession Number
612834036
Author
Smit K.F.; Brevoord D.; Hert S.; Mol B.A.; Kerindongo R.P.; Dieren S.;
Schlack W.S.; Hollmann M.W.; Weber N.C.; Preckel B.
Institution
(Smit, Brevoord, Kerindongo, Dieren, Schlack, Hollmann, Weber, Preckel)
Academic Medical Centre (AMC), Laboratory of Experimental Intensive Care
and Anesthesiology (L.E.I.C.A.), Department of Anesthesiology,
Meibergdreef 9, Amsterdam 1100 DD, Netherlands
(Mol) Academic Medical Centre (AMC), Department of Cardiothoracic Surgery,
Amsterdam, Netherlands
(Hert) Ghent University, Department of Anesthesiology, Ghent, Belgium
Title
Effect of helium pre- or postconditioning on signal transduction kinases
in patients undergoing coronary artery bypass graft surgery.
Source
Journal of Translational Medicine. 14 (1) (no pagination), 2016. Article
Number: 294. Date of Publication: 14 Oct 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The noble gas helium induces pre- and postconditioning in
animals and humans. Volatile anesthetics induce cardioprotection in humans
undergoing coronary artery bypass graft (CABG) surgery. We hypothesized
that helium induces pre- and postconditioning in CABG-patients, affecting
signaling molecules protein kinase C-epsilon (PKC-epsilon), p38 mitogen
activated protein kinase (p38 MAPK), extracellular signal-regulated kinase
1/2 (ERK-1/2) and heat shock protein 27 (HSP-27) within cardiac tissue,
and reducing postoperative troponin levels. Methods: After ethical
approval and informed consent, 125 elective patients undergoing CABG
surgery were randomised into this prospective, placebo controlled,
investigator blinded, parallel arm single-centre study. Helium
preconditioning (3 x 5 min of 70 % helium and 30 % oxygen) was applied
before aortic cross clamping; postconditioning (15 min of helium) was
applied before release of the aortic cross clamp. Signaling molecules were
measured in right atrial appendix specimens. Troponin-T was measured at 4,
12, 24 and 48 h postoperatively. Results: Baseline characteristics of all
groups were similar. Helium preconditioning did not significantly alter
the primary outcome (molecular levels of kinases PKC-epsilon and HSP-27,
ratio of activated p38 MAPK or ERK 1/2). Postoperative troponin T was 11
arbitrary units [5, 31; area-under-the-curve (interquartile range)] for
controls, and no statistically significant changes were observed after
helium preconditioning [He-pre: 11 (6, 18)], helium postconditioning
[He-post: 11 (8, 15)], helium pre- and postconditioning [He-PP: 14 (6,
20)] and after sevoflurane preconditioning [APC: 12 (8, 24), p = 0.13]. No
adverse effects related to study treatment were observed in this study.
Conclusions: No effect was observed of helium preconditioning,
postconditioning or the combination thereof on activation of p38 MAPK, ERK
1/2 or levels of HSP27 and PKC-epsilon in the human heart. Helium pre- and
postconditioning did not affect postoperative troponin release in patients
undergoing CABG surgery. Clinical trial number Dutch trial register (
http://www.trialregister.nl/ ) number NTR1226<br/>Copyright © 2016
The Author(s).
<23>
[Use Link to view the full text]
Accession Number
618778259
Author
Thomas M.P.; Bates E.R.
Institution
(Thomas, Bates) CVC Cardiovascular Medicine, 1500 E. Medical Center Drive,
Ann Arbor, MI 48109-5869, United States
Title
Percutaneous coronary intervention strategies in patients with ST-segment
elevation myocardial infarction and multivessel coronary artery disease.
Source
Current Opinion in Cardiology. 32 (6) (pp 755-760), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of review This review aims to summarize recent reports on
percutaneous coronary intervention (PCI) strategies for patients with
ST-elevation myocardial infarction (STEMI) and multivessel coronary artery
disease (CAD). Recent findings Recent randomized clinical trials and
meta-analyses have suggested that patients with STEMI and multivessel CAD
may benefit more from multivessel PCI (either multivessel primary PCI or
staged PCI before hospital discharge) than culprit vessel-only primary
PCI. These reports have changed clinical practice guideline
recommendations that now conclude that multivessel PCI may be considered
in selected hemodynamically stable patients with significant noninfarct
artery stenoses based on anatomic criteria alone. Fractional flow reserve
measurement can document functional significance in nonculprit stenoses,
but fractional flow reserve-guided PCI has not been shown to impact
mortality or myocardial infarction rates. Additionally, nonculprit artery
chronic total occlusion PCI was not effective in improving left
ventricular function in one randomized trial. Summary Multivessel primary
PCI or staged PCI is effective and safe in selected patients with STEMI
and multivessel coronary disease. Future randomized controlled trials are
needed to define the optimal timing of multivessel PCI, as well as the
appropriate use of PCI in nonculprit stenoses.<br/>Copyright © 2017
Wolters Kluwer Health, Inc. All rights reserved.
<24>
Accession Number
618804123
Author
Arnold S.V.; Inzucchi S.E.; Tang F.; McGuire D.K.; Mehta S.N.; Maddox
T.M.; Goyal A.; Sperling L.S.; Einhorn D.; Wong N.D.; Khunti K.; Lam
C.S.P.; Kosiborod M.
Institution
(Arnold, Tang, Kosiborod) Saint Luke's Mid America Heart Institute,
University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO
64111, United States
(Inzucchi) Yale School of Medicine, New Haven, CT, United States
(McGuire) University of Texas, Southwestern Medical Center, Dallas, TX,
United States
(Mehta) Joslin Diabetes Center, Boston, MA, United States
(Maddox) Washington University, School of Medicine, Saint Louis, MO,
United States
(Goyal, Sperling) Emory University, School of Medicine, Atlanta, GA,
United States
(Einhorn) University of California, San Diego School of Medicine, San
Diego, CA, United States
(Wong) University of California, Irvine School of Medicine, Irvine, CA,
United States
(Khunti) University of Leicester, Leicester, United Kingdom
(Lam) Duke-National University of Singapore, National Heart Centre,
Singapore
Title
Real-world use and modeled impact of glucose-lowering therapies evaluated
in recent cardiovascular outcomes trials: An NCDR Research to Practice
project.
Source
European Journal of Preventive Cardiology. 24 (15) (pp 1637-1645), 2017.
Date of Publication: 01 Oct 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aims Recent trials (EMPA-REG OUTCOME and Liraglutide Effect and Action in
Diabetes: Evaluation of Cardiovascular Outcome Results [LEADER]) have
shown improved cardiovascular (CV) mortality with specific currently
available glucose-lowering medications (empagliflozin and liraglutide,
respectively), but were limited to selected patient populations. We sought
to evaluate the current use and potential real-world impact of
empagliflozin (and other sodium-glucose co-transporter 2 inhibitors
[SGLT2is]) and liraglutide (and other glucagonlike peptide-1 receptor
agonist [GLP-1 RAs]) among patients in the Diabetes Collaborative Registry
(DCR). Methods and results We evaluated 182,525 patients from the DCR - a
large, US-based outpatient registry of individuals with type 2 diabetes
from 313 sites that included cardiology, endocrinology and primary care
practices. Among these patients, 26.2% met major eligibility criteria for
EMPA-REG OUTCOME and 48.0% met major eligibility criteria for LEADER. Of
these potentially eligible patients, only a small minority were actually
prescribed these agents: 5.2% on an SGLT2i and 6.0% on a GLP-1 RA,
respectively. Patients receiving these studied medications or medication
classes, in general, had lower CV disease burden compared with those not
on these agents. Assuming similar risk reductions as in the clinical
trials, if all potentially trial-eligible patients in the DCR were treated
for 1 year with empagliflozin (or other SGLT2is, assuming a class effect)
or liraglutide (or other GLP-1 RAs, assuming a class effect), this may
have prevented 354 CV deaths, 231 heart failure hospitalizations, 329 CV
deaths and 247 myocardial infarctions, respectively. Conclusion In a
large, US-based outpatient registry, we found a significant number of
patients would have been potentially eligible for glucose-lowering agents
that demonstrated CV benefit in recent clinical trials. In view of these
findings, a broader and better-targeted use of these medications in
evidence-based patient populations should be considered.<br/>Copyright
© European Society of Cardiology.
<25>
Accession Number
618804044
Author
Poffley A.; Thomas E.; Grace S.L.; Neubeck L.; Gallagher R.; Niebauer J.;
O'Neil A.
Institution
(Poffley) UNC Gillings School of Global Public Health, University of North
Carolina, United States
(Thomas, O'Neil) Melbourne School of Population and Global Health,
University of Melbourne, VIC, Australia
(Grace) Faculty of Health, York University, University Health Network,
Canada
(Neubeck) School of Health and Social Care, Edinburgh Napier University,
United Kingdom
(Gallagher) Sydney Nursing School, University of Sydney, Australia
(Niebauer) Institute of Sports Medicine, Prevention, and Rehabilitation,
Paracelsus Medical University, Austria
Title
A systematic review of cardiac rehabilitation registries.
Source
European Journal of Preventive Cardiology. 24 (15) (pp 1596-1609), 2017.
Date of Publication: 01 Oct 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction Despite cardiac rehabilitation being recommended in clinical
practice guidelines internationally these services are underutilised,
programmes are not standardised and quality improvement methods and
outcomes are rarely published. National registries are an important
strategy to characterise service delivery, quality and outcomes, yet the
number, type and components of national cardiac rehabilitation registries
have not been reported. Aims To identify and describe national and
international cardiac rehabilitation registries, and summarise their key
features. Methods We systematically reviewed the literature reporting on
cardiac rehabilitation registries at a national and international level. A
search of four databases was conducted in July 2016, with two reviewers
independently screening titles/abstracts and full texts for inclusion.
Data were extracted from included studies, independently checked by a
second reviewer and synthesised qualitatively. Results Eleven articles
were included in the review comprising seven national registries and one
international registry (of 12 European countries) for a total sample of
265,608 patients. Data were most commonly provided to the registry by a
web-based application, and included individual-level data (i.e.
sociodemographic characteristics, medical history, and clinical
measurements). When reported, service-level data most commonly included
wait times, programme enrolment and completion. The overarching
governance, funding modes (e.g. industry (n = 2), government (n = 1)), and
incentives for registry participation (e.g. benchmarking, financial
reimbursement, or mandatory requirement) varied widely. Conclusion The use
of national and international registries for characterising cardiac
rehabilitation and providing a benchmark for quality improvement is in its
early stages but shows promise for national and global
benchmarking.<br/>Copyright © European Society of Cardiology.
<26>
Accession Number
613258788
Author
Gonska B.; Seeger J.; Baarts J.; Rodewald C.; Scharnbeck D.; Rottbauer W.;
Wohrle J.
Institution
(Gonska, Seeger, Baarts, Rodewald, Scharnbeck, Rottbauer, Wohrle)
Department of Internal Medicine II - Cardiology, University of Ulm, Ulm
89081, Germany
Title
The balloon-expandable Edwards Sapien 3 valve is superior to the
self-expanding Medtronic CoreValve in patients with severe aortic stenosis
undergoing transfemoral aortic valve implantation.
Source
Journal of Cardiology. 69 (6) (pp 877-882), 2017. Date of Publication:
June 2017.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Residual paravalvular moderate or severe aortic regurgitation
(AR) has been an independent risk factor for mortality after transcatheter
aortic valve implantation (TAVI). The design of the third generation
Edwards Sapien 3 (ES3; Edwards Lifesciences, Irvine, CA, USA) valve was
optimized with an outer skirt to address the issue of paravalvular AR.
Methods and results We compared 100 consecutive patients treated with the
ES3 for severe aortic stenosis with 100 patients treated with the
Medtronic CoreValve (CV; Medtronic, Minneapolis, MN, USA) (Clinical Trial
Registration: NCT02162069). We evaluated post-procedural AR, rate of
permanent pacemaker implantation, device success, and 30-day clinical
outcome according to the criteria of the Second Valve Academic Research
Consortium (VARC-2). Frequency of post-procedural moderate or severe AR
was significantly lower with ES3 compared to CV (0% vs. 20%, p < 0.01),
none or trace AR significantly higher with ES3 (69% vs. 38%, p < 0.01) as
well as device success (97% vs. 73%, p < 0.01). There was a significantly
lower need for permanent pacemaker implantation with ES3 compared with CV
(14% vs. 31%, p < 0.01). Cardiovascular mortality at 30 days was
significantly lower with ES3 (0% vs. 6%, p = 0.01), and the combined
endpoint "early safety" was met significantly less with ES3 (10% vs. 21%
with CV, p = 0.03). Conclusions Transfemoral TAVI with the ES3 compared
with the CV was associated with a significantly lower rate of moderate or
severe AR, significantly lower need for pacemaker implantation, and a
significantly higher rate of device success according to
VARC-2.<br/>Copyright © 2016 Japanese College of Cardiology
<27>
Accession Number
618839457
Author
Cozzi E.; Roussel J.-C.; Galinanes M.; Costa C.; Takeuchi Y.;
Padler-Karavani V.; Breimer M.E.; Galli C.; Pascual M.; Gerosa G.; Le
Tourneau T.; Bottio T.; Nonell-Canals A.; Chen X.; Ritzwan M.; Nassi A.;
Vadori M.; Manez R.; Soulillou J.-P.
Institution
(Cozzi, Nassi) Transplant Immunology Unit, Dept. of Cardiac, Thoracic and
Vascular Sciences, Padua University Hospital, Padua, Italy
(Roussel) Department of Thoracic and Cardiovascular Surgery, Nantes
University Hospital, Nantes, France
(Galinanes) Department of Cardiac Surgery,Reparative Therapy of the Heart,
Hospital Universitari Vall d'Hebron, Barcelona, Spain
(Costa) Infectious Diseases and Transplantation Division, Bellvitge
Biomedical Research Institute (IDIBELL), Barcelona, Spain
(Takeuchi) MRC/UCL Centre for Medical Molecular Virology and Wohl Virion
Centre, University College London, London, United Kingdom
(Padler-Karavani) Department of Cell Research and Immunology, Tel Aviv
University, Tel Aviv, Israel
(Breimer) Department of Surgery, Institute of Clinical Sciences,
University of Gothenburg, Gothenburg, Sweden
(Galli) Laboratory of Reproductive Technologies, Avantea, Cremona, Italy
(Pascual) Institut Univ. De Cienciai Tecnologia (IUCT), Barcelona, Spain
(Gerosa, Bottio) Department of Cardiac, Thoracic and Vascular Science,
University of Padua, Padua, Italy
(Le Tourneau) Department of Cardiology, Institut du Thorax, Nantes
University Hospital, Nantes, France
(Nonell-Canals) Mind the Byte,S.L., Barcelona, Spain
(Chen) Department of Chemistry, University of California-Davis, Davis, CA,
United States
(Ritzwan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Vadori) Immunology Laboratory, CORIS, Padua, Italy
(Manez) Intensive Care Unit, Bellvitge University Hospital, Barcelona,
Spain
(Soulillou) Institut De Transplantation-Urologie- Nephrologie, INSERM
Unite Mixte De Recherche 1064, Nantes University Hospital, Nantes, France
Title
Translink: A Eu project aimed at studying the immune response in patient
recipients of biological heart valves.
Source
Xenotransplantation. Conference: 14th Congress of the International
Xenotransplantation Association, IXA 2017. United States. 24 (5) (no
pagination), 2017. Date of Publication: September - October 2017.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: Cardiac valve replacement is the first line therapy for
degenerative heart-valve diseases. In such cases, mechanical and
bioprosthetic valves (BHV) of bovine, porcine and equine origin are used.
BHV show improved functionality and bio-compatibility compared to the
mechanical valves but have an average life of 12-15 years, limiting their
use to subjects who are at least 65 years old. The aim of the TransLink
project is to characterize the immune response in BHV recipients and to
provide efficient strategies to enable safe implantation of BHV valves in
currently unsuitable candidates. Methods: This multicenter clinical trial
involves five major cardiothoracic units in Europe and Canada. The
patients enrolled have been divided into 3 cohorts consisting of a group
of patients suffering from early signs of valve dysfunction (Group A), a
group of De novo recipients of BHV (Group B1) and a group of patients whom
underwent valve replacement at least 5 years prior to inclusion in the
study (Group B2). Mechanical valve recipients or patients undergone
coronary by-pass have been enrolled as controls (Groups B1C and B2C).
Results: A total of 1737 patients have been enrolled in this clinical
study (171 patients in Cohort A; 647 patients in Cohort B1 (BHV+ controls)
and 919 patients in Cohort B2 (BHV+ controls)). Clinical, immunological
and echocardiography follow-up of patients enrolled is currently underway.
In particular, the follow-up for the B1 Group consists of sera collection
before and up to 42 months following valve implantation, together with an
echocardiography at 6 and 24 months. For B2-patients, sample collection
and echocardiography are scheduled annually. In cohort A patients, serum
collection has been performed at the onset of premature valve
deterioration as diagnosed by echocardiography. Conclusions: By
correlating the characteristics of the immune response with clinical data
obtained in this unique cohort of patients, it is expected that the
TransLink project will demonstrate beyond any reasonable doubt the central
role of the anti-BHV immune response in the premature failure of BHV and
will pave the way for new BHV which can be safely applied in young
patients.
<28>
Accession Number
618853987
Author
Gomes Neto M.; Martinez B.P.; Reis H.F.; Carvalho V.O.
Institution
(Gomes Neto, Reis) 1 Departamento de Biofuncao, Universidade Federal da
Bahia, Salvador, Brazil
(Gomes Neto) 2 Programa de Pos-graduacao em Medicina e Saude da
Universidade Federal da Bahia, Salvador, Brazil
(Gomes Neto, Carvalho) 3 The GREAT Group (GRupo de Estudos em ATividade
fisica), Brazil
(Martinez) 4 Departamento de Fisioterapia da Universidade do Estado da
Bahia, Salvador, Brazil
(Carvalho) 5 Departamento de Fisioterapia da Universidade Federal de
Sergipe, Aracaju, Brazil
Title
Pre- and postoperative inspiratory muscle training in patients undergoing
cardiac surgery: systematic review and meta-analysis.
Source
Clinical rehabilitation. 31 (4) (pp 454-464), 2017. Date of Publication:
01 Apr 2017.
Abstract
OBJECTIVE: To determine the effects of pre- and postoperative inspiratory
muscle training on length of postoperative hospital stay and pulmonary
function in patients undergoing cardiac surgery.
DESIGN AND METHODS: We conducted a systematic search using databases
(MEDLINE, CINAHL, EMBASE, PEDro and the Cochrane) to find controlled
trials evaluating the effects of pre- and postoperative inspiratory muscle
training.
RESULTS: Eight studies fulfilled the inclusion criteria. Four were about
preoperative inspiratory muscle training (416 patients), three about
postoperative inspiratory muscle training (115 patients) and one study
about pre- and postoperative inspiratory muscle training (43 patients).
Preoperative inspiratory muscle training resulted in improvement in:
Reduction in length of postoperative hospital stay of -2days (95% CI -3.4,
-0.7, N=302), inspiratory pressure of 16.7cmH2O (95% CI 13.8, 19.5,
N=386), forced expiratory volume in one second of 3% predicted (95% CI
0.1, 6, N=140), forced vital capacity of 4.6% predicted (95% CI 1.9, 7.4,
N=140). Patients that received preoperative training had an inspiratory
muscle training reduced risk of postoperative pulmonary complications,
(RR=0.6; 95% CI 0.5 to 0.8; P=0.0004, N=386). Postoperative inspiratory
muscle training resulted in improvement in inspiratory pressure of
16.5cmH2O (95% CI 4.9, 27.8, N=115), and tidal volume of 185ml (95% CI
19.7, 349.8, N=85).
CONCLUSION: Pre- and postoperative inspiratory muscle training showed to
be a beneficial intervention in the treatment of patients undergoing
cardiac surgery.
<29>
[Use Link to view the full text]
Accession Number
618816933
Author
Boese C.K.; Centeno L.; Walters R.W.
Institution
(Boese) 1Miller Orthopedic Specialists, Council Bluffs, Iowa 2Department
of Medicine, Creighton University, Omaha, Nebraska
Title
Blood Conservation Using Tranexamic Acid Is Not Superior to
Epsilon-Aminocaproic Acid After Total Knee Arthroplasty.
Source
The Journal of bone and joint surgery. American volume. 99 (19) (pp
1621-1628), 2017. Date of Publication: 04 Oct 2017.
Abstract
BACKGROUND: Epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) are
synthetic amino acid derivatives that interfere with fibrinolysis,
promoting hemostasis by pharmacological means. Although both drugs have
been shown to decrease blood loss with a minimal risk of thromboembolic
adverse events following cardiac and vascular surgery, we are aware of
only 1 published trial that directly compared the antifibrinolytic effects
of EACA with those of TXA after total knee arthroplasty (TKA). The primary
aim of this prospective, randomized, controlled trial was to determine
whether TXA provides superior blood conservation following TKA compared
with that provided by EACA.
METHODS: A total of 194 patients scheduled to undergo a primary unilateral
TKA in the same community-based hospital were prospectively randomized to
receive intravenous EACA (n = 96) or TXA (n = 98). Both the patients and
the operating surgeons were blinded to the treatment assignments. Primary
outcome measures included transfusions, estimated blood loss, and the drop
in the hemoglobin (Hgb) level. Secondary outcomes measures included the
change in the serum creatinine level, postoperative complications, and
length of hospital stay.
RESULTS: Although the patients who received TXA averaged less estimated
blood loss than the patients who received EACA (t185 = 2.18, p = 0.031;
mean difference = 144.2 mL, 95% confidence interval = 13.62 to 274.78 mL),
no transfusions were required in either group. We observed no
statistically significant or clinically relevant between-group differences
in the change in Hgb or serum creatinine level, postoperative
complications, or length of hospital stay.
CONCLUSIONS: Although the estimated blood loss was significantly greater
in the EACA group, no transfusions were required and no significant
between-group differences were observed for any other outcomes measured.
We concluded that EACA may be an acceptable alternative to TXA for blood
conservation following TKA, although replication of our results in
noninferiority trials is necessary.
LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a
complete description of levels of evidence.
<30>
Accession Number
618837823
Author
Secemsky E.A.; Yeh R.W.; Kereiakes D.J.; Cutlip D.E.; Cohen D.J.; Steg
P.G.; Cannon C.P.; Apruzzese P.K.; D'Agostino R.B.; Massaro J.M.; Mauri
L.; Kaplan A.; Ahmed A.; Ahmed A.-H.; Albirini A.; Moreyra A.; Rabinowitz
A.; Shroff A.; Moak A.; Jacobs A.; Kabour A.; Gupta A.; Irimpen A.;
Rosenthal A.; Taussig A.; Ferraro A.; Chhabra A.; Pucillo A.; Spaedy A.;
White A.; Pratsos A.; Shakir A.; Ghitis A.; Agarwal A.; Chawla A.; Tang
A.; Barker B.; Bertolet B.; Uretsky B.; Erickson B.; Rama B.; McLaurin B.;
Dearing B.; Negus B.; Price B.; Brott B.; Bhambi B.; Bowers B.; Watt B.;
Donohue B.; Hassel C.D.; Croft C.; Lambert C.; O'Shaughnessy C.; Shoultz
C.; Kim C.; Caputo C.; Nielson C.; Scott C.; Wolfe C.; McKenzie C.;
Brachfeld C.; Thieling C.; Fisher D.; Simon D.; Churchill D.; Dobies D.;
Eich D.; Goldberg D.; Griffin D.; Henderson D.; Kandzari D.; Lee D.; Lewis
D.; Mego D.; Paniagua D.; Rizik D.; Roberts D.; Safley D.; Abbott D.; Shaw
D.; Temizer D.; Canaday D.; Myears D.; Westerhausen D.; Ebersole D.; Netz
D.; Baldwin D.; Letts D.; Harlamert E.; Kosinski E.; Portnay E.; Mahmud
E.; Korban E.; Hockstad E.; Rivera E.; Shawl F.; Shamoon F.; Kiernan F.;
Aycock G.R.; Schaer G.; Kunz G.; Kichura G.; Myers G.; Pilcher G.; Tadros
G.; Kaddissi G.I.; Ramadurai G.; Eaton G.; Elsner G.; Mishkel G.; Simonian
G.; Piegari G.; Chen H.; Liberman H.; Aronow H.; Tamboli H.P.; Dotani I.;
Marin J.; Fleischhauer J.F.; Hopkins J.; Leggett J.; Mills J.; Phillips
J.; Revenaugh J.; Mann J.T.; Wilson J.; Pattanayak J.; Aji J.; Strain J.;
Patel J.; Carr J.; Moses J.; Chen J.-C.; Williams J.; Greenberg J.; Cohn
J.; Douglas J.; Gordon J.; Griffin J.; Hawkins J.; Katopodis J.; Lopez J.;
Marshall J.; Wang J.; Waltman J.; Saucedo J.; Galichia J.; McClure M.;
Kozina J.; Stella J.; Tuma J.; Kieval J.; Giri K.; Ramanathan K.; Allen
K.; Atassi K.; Baran K.; Khaw K.; Clayton K.; Croce K.; Skelding K.; Patel
K.; Garratt K.; Harjai K.; Chandrasekhar K.; Kalapatapu K.; Lin L.; Dean
L.; Barr L.; MacDonald L.; Cannon L.; Satler L.; Gruberg L.; Tami L.;
Bikkina M.; Shah M.; Atieh M.; Chauhan M.; Litt M.; Unterman M.; Lechin
M.; Zughaib M.; Fisch M.; Grabarczyk M.; Greenberg M.; Lurie M.;
Rothenberg M.; Stewart M.; Purvis M.; Hook M.; Leesar M.; Buchbinder M.;
Weiss M.; Guerrero M.; Abu-Fadel M.; Ball M.; Chang M.; Cunningham M.; Del
Core M.; Jones M.; Kelberman M.; Lim M.; Ragosta M.; Rinaldi M.; Rosenberg
M.; Savage M.; Tamberella M.; Kellett M.; Vidovich M.; Effat M.; Mirza
M.A.; Khan M.; Dib N.; Laufer N.; Kleiman N.; Farhat N.; Amjadi N.;
Schechtmann N.; Bladuell N.; Quintana O.; Gigliotti O.; Best P.; Flaherty
P.; Hall P.; Gordon P.; Gurbel P.; Ho P.; Luetmer P.; Mahoney P.; Mullen
P.; Teirstein P.; Tolerico P.; Ramanathan P.; Kerwin P.; Lee P.V.; Kraft
P.; Wyman R.M.; Gonzalez R.; Kamineni R.; Dave R.; Sharma R.; Prashad R.;
Aycock R.; Quesada R.; Goodroe R.; Magorien R.; Randolph R.; Bach R.;
Kettelkamp R.; Paulus R.; Waters R.; Zelman R.; Ganim R.; Bashir R.;
Applegate R.; Feldman R.; Frankel R.; Hibbard R.; Jobe R.; Jumper R.;
Maholic R.; Siegel R.; Smith R.; Stoler R.; Watson R.; Wheatley R.; Gammon
R.; Hill R.; Sundrani R.; Caputo R.; Jenkins R.; Stella R.; Germanwala S.;
Hadeed S.; Ledford S.; Dube S.; Gupta S.; Davis S.; Martin S.; Waxman S.;
Dixon S.; Naidu S.; Potluri S.; Cook S.; Crowley S.; Kirkland S.; McIntyre
S.; Thew S.; Lin S.; Marshalko S.; Guidera S.; Hearne S.; Karas S.;
Manoukian S.; Rowe S.; Yakubov S.; Pollock S.; Banerjee S.; Allaqaband S.;
Choi S.; Mulukutla S.; Papadakos S.; Bajwa T.; Addo T.; Schreiber T.;
Haldis T.; Mathew T.; McGarry T.; Nygaard T.; Pow T.; Larkin T.; Caulfield
T.; Stys T.; Lee T.; Mansouri V.; Srinivas V.; Gupta V.; Marquardt W.;
Ballard W.; Bachinsky W.; Colyer W.; Dillon W.; Felten W.; French W.;
Kuehl W.; Nicholas W.; Nicholson W.; Phillips W.; Khatib Y.; Al-Saghir Y.;
Hawa Z.; Masud Z.; Jafar Z.; Muller D.; Meredith I.; Rankin J.; Worthley
M.; Jepson N.; Thompson P.; Hendriks R.; Whitbourn R.; Duffy S.; Stasek
J.; Novobilsky K.; Naplava R.; Coufal Z.; Vaquette B.; Bressollette E.;
Teiger E.; Coste P.; Rihani R.; Darius H.; Bergmann M.W.; Radke P.;
Sebastian P.; Strasser R.; Hoffmann S.; Behrens S.; Moebius-Winkler S.;
Rutsch W.; Lupkovics G.; Horvath I.; Kancz S.; Forster T.; Koszegi Z.;
Devlin G.; Hart H.; Elliott J.; Ormiston J.; Abernathy M.; Fisher N.; Kay
P.; Harding S.; Jaffe W.; Hoffmann A.; Sosnowski C.; Trebacz J.; Buszman
P.; Dobrzycki S.; Kornacewicz-Jach Z.; Iancu A.C.; Ginghina C.D.; Matei
C.; Dobreanu D.; Bolohan F.R.; Dorobantu M.; Jacques A.; Jain A.; Bakhai
A.; Gershlick A.; Adamson D.; Newby D.; Felmeden D.; Purcell I.; Edmond
J.; Irving J.; De Belder M.; Pitt M.; Kelly P.; O'Kane P.; Clifford P.;
Suresh V.
Institution
(Secemsky) Division of Cardiology, Massachusetts General Hospital, Boston,
MA, United States
(Secemsky, Yeh, Cutlip, Cannon, Mauri) Harvard Medical School, Boston, MA,
United States
(Secemsky, Mauri) Center for Clinical Biometrics, Department of Medicine,
Brigham and Women's Hospital, Boston, MA, United States
(Secemsky, Yeh) Smith Center for Outcomes Research in Cardiology, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Secemsky, Yeh, Cutlip, Cannon, Apruzzese, D'Agostino, Massaro, Mauri)
Baim Institute for Clinical Research, Boston, MA, United States
(Yeh, Cutlip) Division of Cardiology, Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Cincinnati, OH,
United States
(Kereiakes) Lindner Center for Research and Education, Cincinnati, OH,
United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Cohen) University of Missouri-Kansas City, School of Medicine, Kansas
City, MO, United States
(Steg) Universite Paris-Diderot, Institut National de la Sante et de la
Recherche Medicale U-1148, Hopital Bichat, Paris, France
(Steg) Departement Hospitalo-Universitaire Fibrosis, Inflammation, and
Remodeling, Assistance Publique, Hopitaux de Paris, Paris, France
(Steg) National Heart and Lung Institute, Institute of Cardiovascular
Medicine and Science, Royal Brompton Hospital, Imperial College, London,
United Kingdom
(Cannon, Mauri) Division of Cardiology, Brigham and Women's Hospital, 75
Francis St, Boston, MA 02115, United States
(D'Agostino, Massaro) Boston University School of Public Health, Boston,
MA, United States
(Kaplan) Dartmouth Hitchcock Medical Center, United States
(Ahmed, Ahmed) Altru Health System, United States
(Albirini) Genesis HealthCare System, United States
(Moreyra) University of Medicine and Dentistry of New Jersey, United
States
(Rabinowitz) South Texas Cardiovascular, United States
(Shroff) Jesse Brown VA Medical Center, United States
(Moak) Penn Presbyterian Medical Center, United States
(Jacobs) Boston Medical Center, United States
(Kabour) Mercy St Vincent's Medical Center, United States
(Gupta) North Mississippi Medical Center, United States
(Irimpen) Tulane Medical Center, United States
(Rosenthal) Bayfront Medical Center, United States
(Taussig, Kim) Florida Hospital, United States
(Ferraro) Sacred Heart Medical Center, United States
(Chhabra) Cardiovascular Research, United States
(Pucillo, Kalapatapu) Westchester Medical Center, United States
(Spaedy) Missouri Heart Center, United States
(White) NEA Baptist Clinic, United States
(Pratsos) Bryn Mawr Hospital, United States
(Shakir) Midwest Regional Medical Center, United States
(Ghitis) Diagnostic Cardiology Associates, United States
(Agarwal, Strain) Valley Hospital, United States
(Jain) California Cardiovascular Consultants Medical Associates, United
States
(Chawla) Iowa Heart Center, United States
(Tang) Chambersburg Hospital, United States
(Barker, Siegel) Arizona Regional Medical Center, United States
(Bertolet) Cardiology Associates Research, United States
(Uretsky) Arkansas VA Medical Center, United States
(Erickson) Central Minnesota Heart Center, St Cloud Hospital, United
States
(Rama) Frederick C. Smith Clinic, United States
(McLaurin) AnMed Health, United States
(Dearing) Thomas Hospital, United States
(Negus, Ledford) Chattanooga Heart Institute, United States
(Price, Paulus) King's Daughters Medical Center, United States
(Brott) University of Alabama at Birmingham, United States
(Bhambi) Bakersfield Heart, United States
(Bowers) Cardiopulmonary Research Science and Technology Institute, United
States
(Watt) North Central Heart Institute, United States
(Donohue) University of Pittsburgh Medical Center, Shadyside Hospital,
United States
(Hassel, Litt) Jacksonville Heart Center, United States
(Croft) Holmes Regional Medical Center, United States
(Lambert) Pepin Heart Hospital, United States
(O'Shaughnessy, Farhat) North Ohio Heart Center, United States
(Shoultz) Providence Health Center, United States
(Suresh) Derriford Hospital, United States
(Caputo) North Florida Regional Medical Center, United States
(Nielson) Medical University of South Carolina Hospital, United States
(Scott) University of Tennessee Medical Center, United States
(Wolfe) Providence St Peter Hospital, United States
(McKenzie) St John's Mercy Cardio Research, United States
(Brachfeld) Promise Regional Medical Center, United States
(Thieling) Hattiesburg Clinic PA, United States
(Fisher) UMASS Memorial Medical Center, United States
(Lee) Bay Regional Medical Center, United States
(Simon, Cunningham) University Hospitals Case Medical Center, United
States
(Churchill) Washington Regional Medical Center, United States
(Dobies) Genesys Regional Medical Center, United States
(Eich, Mahoney) Sentara Norfolk General Hospital, United States
(Goldberg) New England Heart Institute, United States
(Griffin, Temizer) Good Samaritan Hospital, United States
(Henderson) Cardiology Research Associates, United States
(Kandzari, Ballard) Piedmont Heart Institute, United States
(Lee) Bakersfield Memorial Hospital, United States
(Lewis) South Central Wisconsin Heart, United States
(Mego, Flaherty) Little Rock Cardiology Clinic, United States
(Paniagua) Michael E. DeBakey VA Medical Center, United States
(Rizik) Scottsdale Health Care, United States
(Roberts) Sacramento Heart and Vascular Institute, United States
(Safley) St Luke's Hospital, United States
(Abbott) Rhode Island Hospital, United States
(Shaw) Christus St Frances Cabrini Hospital, United States
(Clifford) Wycombe General Hospital, United States
(Canaday) Inland Cardiology Associates, United States
(Myears, Hawkins) St John's Medical Research Institute, United States
(Westerhausen) Midwest Cardiovascular Research and Education Foundation,
United States
(Ebersole) Watson Clinic Center for Research, United States
(Netz) Nebraska Heart Institute, United States
(Baldwin) Tulane University Medical School, United States
(Letts, Tamberella) Carolina Heart Specialists, United States
(Harlamert, Fisch) Clarian North Medical Center, United States
(Kosinski) Connecticut Clinical Research, United States
(Portnay, Jumper) Cardiology Associates of Fairfield County, United States
(Mahmud) UCSD Medical Center, United States
(Korban) Jackson-Madison County General Hospital, United States
(Hockstad) Kansas City Heart Foundation, United States
(Rivera) Amarillo Heart Group, United States
(Shawl) Washington Adventist Hospital, United States
(Shamoon) St Michael's Medical Center, United States
(Kiernan) Hartford Hospital, United States
(Aycock, Fleischhauer, Stewart, Aycock) Cardiology Consultants, United
States
(Schaer) Rush University Medical Center, United States
(Kunz) New Mexico Heart Institute PA, United States
(Kichura) St John's Mercy Cardiovascular Research, United States
(Myers) Redmond Regional Medical Center, United States
(Pilcher) St Vincent's Healthcare, United States
(Tadros) North Memorial Medical Center, United States
(Kaddissi, Khaw) Our Lady of Lourdes Medical Center, United States
(Ramadurai) Heartland Cardiovascular Center, United States
(Eaton) Medcentral Health System, United States
(Elsner, McClure, Ball) Care Group, United States
(Mishkel) St John's Hospital, United States
(Simonian) Hackensack University Medical Center, United States
(Piegari) Berks Cardiologists, United States
(Chen) Heart Center PC, United States
(Liberman) Emory University Hospital Midtown, United States
(Aronow) Michigan Heart and Vascular Institute, United States
(Tamboli) Bay Area Cardiology Associates, United States
(Dotani) McFarland Clinic PC, United States
(Marin) St Joseph's Hospital, United States
(O'Kane) Bournemouth Hospital, United States
(Hopkins) Christiana Hospital, United States
(Leggett) Over Lake Hospital Medical Center, United States
(Mills) Duke Raleigh Hospital, United States
(Phillips) Palmetto Richland Memorial Hospital, United States
(Revenaugh) J. L. Sorenson Heart and Lung, United States
(Mann, Hook, Jobe) Wake Heart Research Institute, United States
(Wilson) Texas Heart Institute, United States
(Pattanayak, Kuehl) Asheville Cardiology Associates, United States
(Aji) Cooper University Hospital, United States
(Kelly) Basildon University Hospital, United States
(Patel) Hamilton Cardiology Associates, United States
(Carr) East Texas Medical Center, United States
(Moses) Columbia Presbyterian Hospital, United States
(Chen) Straub Clinic and Hospital, United States
(Williams) Mid Carolina Cardiology, United States
(Greenberg, Crowley) Aurora Denver Cardiology Associates, United States
(Cohn) Ingham Regional Medical Center, United States
(Douglas) Emory University Hospital, United States
(Gordon) Sharp Memorial Hospital, United States
(Griffin) Alegent Health Research Center, United States
(Griffin) Cardiovascular Associates, United States
(Pitt) Heartland Hospital, United States
(Katopodis) Tallahassee Research Institute, United States
(Lopez) Loyola University Medical Center, United States
(Marshall) Northeast Georgia Medical Center, United States
(Wang) Union Memorial Hospital, United States
(Waltman, Caputo, Lin) St Joseph Hospital, United States
(Saucedo, Abu-Fadel) University of Oklahoma Health Science Center, United
States
(Galichia) Galichia Heart Hospital, United States
(McClure) Mid-Michigan Heart and Vascular Center, United States
(Kozina, Chang, Marquardt) Mercy General Hospital, United States
(Stella, Stella) Heart Care Research Foundation, United States
(Tuma) Black Hills Cardiovascular Research, United States
(Kieval, Rothenberg) Palm Beach Heart Research Institute, United States
(Giri) Cardiovascular Associates of Delaware Valley, United States
(Ramanathan, Ramanathan) Northwest Ohio Cardiology Consultants, United
States
(Allen) Presbyterian Heart Group, United States
(Atassi) Northwest Indiana Cardiovascular Physicians PC, United States
(Baran) St Paul Heart Clinic, United States
(De Belder) James Cook Hospital, United States
(Clayton) Munson Medical Center, United States
(Croce) Brigham and Women's Hospital, United States
(Skelding) Geisinger Medical Center, United States
(Patel) St Joseph Mercy Oakland, United States
(Garratt, Papadakos) Lenox Hill Hospital, United States
(Harjai) Donald Guthrie Foundation, United States
(Chandrasekhar) Winter Haven Hospital, United States
(Irving) Ninewells Hospital and MS, United States
(Lin) Morton Plant Hospital, United States
(Dean) University of Washington, United States
(Barr, Kerwin) Midwest Heart Foundation, United States
(MacDonald) Swedish Medical Center, United States
(Cannon) Cardiac and Vascular Research Center of North Michigan, United
States
(Satler) Washington Hospital Center, United States
(Gruberg) Stony Brook University Medical Center, United States
(Tami) Memorial Regional Hospital, United States
(Bikkina) St Joseph's Regional Medical Center, United States
(Shah) Shah Associates, United States
(Atieh) Pinehurst Medical Clinic, United States
(Chauhan) Cardiovascular Specialists of Texas, United States
(Edmond) Weston General Hospital, United States
(Unterman) St Joseph's Hospital Atlanta, United States
(Lechin) College Station Medical Center, United States
(Zughaib, Hall) Providence Hospital, United States
(Purcell) Freeman Hospital, United States
(Grabarczyk) Greenville Memorial Hospital, United States
(Greenberg) Moses Hospital, United States
(Lurie, Wyman) Torrance Memorial Medical Center, United States
(Felmeden) Torbay Hospital, United States
(Newby) Royal Infirmary of Edinburgh, United States
(Purvis) Medical Center of the Rockies, United States
(Adamson) Coventry and Warwickshire UH, United States
(Leesar, Effat) University of Cincinnati, United States
(Buchbinder) Foundation for Cardiovascular Medicine, United States
(Weiss) Jersey Shore University Medical Center, United States
(Guerrero) Henry Ford Hospital, United States
(Gershlick) Glenfield Hospital, United States
(Bakhai) Barnet Hospital, United States
(Jain) London Chest Hospital, United States
(Jacques) St Peter's Hospital, United Kingdom
(Del Core) Cardiac Center of Creighton University Medical Center, United
States
(Jones) Central Baptist Hospital, United States
(Kelberman) St Elizabeth Medical Center, United States
(Lim) St Louis University, United States
(Ragosta) University of Virginia, United States
(Rinaldi) Carolinas Medical Center, United States
(Rosenberg) Advocate Good Shepherd Hospital, United States
(Savage) Thomas Jefferson University Hospital, United States
(Dorobantu) Spitalul Clinic de Urgenta Bucuresti, Romania
(Bolohan) Centrul Clinic de Urgenta de Boli Cardi, Romania
(Kellett) Maine Medical Center, United States
(Vidovich) University of Illinois Hospital, United States
(Dobreanu) Institutul de Boli Cardiovasculare si, Romania
(Mirza) Carilion Medical Center, United States
(Khan) North Dallas Research Associates, United States
(Dib) Mercy Gilbert Medical Center, United States
(Laufer) Heart and Vascular Center of Arizona, United States
(Kleiman) Methodist Hospital, United States
(Matei) Institutul de Urgentapentru Boli Cardiovas, Romania
(Amjadi) Texas Heart and Vascular, United States
(Schechtmann, Karas) MIMA Century Research Associates, United States
(Bladuell) WellStar Kennestone Hospital, United States
(Quintana) Hospital at Renaissance, United States
(Gigliotti) Seton Heart Institute, United States
(Best) Mayo Clinic, United States
(Ginghina) Inst. Urgenta Boli Cardiovasculare, Romania
(Iancu) Institutul Inimii Niculae Stancioiu Cluj-Napoca, Romania
(Gordon) Miriam Hospital, United States
(Gurbel) Sinai Center for Thrombosis Research, United States
(Ho) Kaiser Foundation Hospitals, United States
(Luetmer) Aspirus Heart and Vascular Institute, United States
(Kornacewicz-Jach) SPSK nr 2 Pomor. AM Szczecin, Poland
(Mullen) Memorial Hospital at Gulfport, United States
(Teirstein) Scripps Green Hospital, United States
(Tolerico, Nicholson) York Hospital, United Kingdom
(Dobrzycki) Uniwer. Szpital Klin. Bialystok, Poland
(Buszman) Polsko-Amerykanskie Kliniki Serca, Poland
(Lee) Northeast Cardiology Associates, United States
(Kraft) Beaumont Hospital Troy, United States
(Trebacz) NZOZ Centr. Med. Beluga-Med, Poland
(Gonzalez) Scott and White Health Care Round Rock, United States
(Kamineni) Salem Hospital, United States
(Dave) Spirit Physician Services, United States
(Sharma) St Anthony Central Hospital, United States
(Prashad) Ocala Research Institute, United States
(Sosnowski) Instytut Kardiologii Kardynala Wyszynskiego, Poland
(Quesada) Baptist Hospital, India
(Goodroe) Grand Strand Regional Medical Center, United States
(Magorien) Ohio State University Medical Center, United States
(Randolph) Winchester Medical Center, United States
(Bach) Washington University School of Medicine, St Louis, MO, United
States
(Kettelkamp) Cardiologists LC, United States
(Hoffmann) Wielospecj. Szpital Miejskiim, Poland
(Waters) St Joseph's Medical Center, United States
(Zelman) Cape Cod Research Institute, United States
(Ganim) Kingwood Medical Center, United States
(Bashir) Temple University, United States
(Applegate) Wake Forest University, United States
(Feldman) MediQuest Munroe Regional Medical Center, United States
(Frankel) Maimonides Medical Center, United States
(Hibbard) Bryan LGH Medical Center, United States
(Jaffe) Ascot Integrated Hospital, United States
(Harding) Wellington Hospital, United Kingdom
(Maholic) Hamot Medical Center, United States
(Kay) Middlemore Hospital, United States
(Smith) Tyler Cardiovascular Consultants, United States
(Stoler) Baylor Heart and Vascular Hospital, United States
(Watson) Abington Medical Specialist, United States
(Wheatley) Centennial Heart, United States
(Gammon) Austin Heart Research, United States
(Hill) St Bernard's Medical Center, United States
(Sundrani) Cardiovascular Consultants, United States
(Fisher) Nelson Hospital, United States
(Jenkins) Kootenai Medical Center, United States
(Abernathy) Wakefield Hospital, United States
(Germanwala) Longview Regional Medical Center, United States
(Hadeed) Conemaugh Valley Memorial Hospital, United States
(Ormiston) Mercy Angiography, United States
(Dube) Indiana Heart Hospital, United States
(Gupta) Oregon Health and Science University, United States
(Davis) Baptist Health Medical Center, United States
(Martin) Covenant Medical Center, United States
(Waxman) Lahey Clinic Medical Center, United States
(Dixon) William Beaumont Hospital, United States
(Naidu) Winthrop University Hospital, United States
(Potluri) Heart Hospital Baylor Plano, United States
(Cook) Novant Clinical Research Institute, United States
(Cook) Sacred Heart General Hospital, United States
(Elliott) Christchurch Hospital, United States
(Kirkland) Forsyth Medical Center, United States
(McIntyre) Martin Memorial Health Systems, United States
(Thew) Heart Clinics Northwest PS, United States
(Hart) North Shore Hospital, United States
(Marshalko) Bridgeport Hospital, United States
(Guidera) Doylestown Hospital, United States
(Hearne) Delmarva Heart Research Foundation, United States
(Devlin) Waikato Hospital, New Zealand
(Manoukian) Sarah Cannon Research Institute, United States
(Rowe) Cox Medical Centers, United States
(Yakubov) Ohio Health Research Institute, United States
(Pollock) Rockingham Memorial Hospital, United States
(Banerjee) VA North Texas Health Care Center, United States
(Allaqaband, Bajwa) Sinai Medical Center, United States
(Choi) California Pacific Medical Center Research, United States
(Mulukutla) University of Pittsburgh Medical Center, United States
(Koszegi) Josa Andras Oktato Korhaz Nonprofit Kft, Hungary
(Forster) Szegedi Tudomanyegyetem SZ-GY, Hungary
(Addo) University of Texas Southwestern Medical Center, United States
(Schreiber) DMC Harper University Hospital, United States
(Haldis) MeritCare Hospital Pharmacy, United States
(Mathew) Slocum Dickson Medical Group, United States
(McGarry) Oklahoma Foundation for Cardiovascular Research, United States
(Nygaard) Cardiovascular Group, United States
(Pow) Great Lakes Heart and Vascular Institute, United States
(Larkin) Midwest Heart Specialists, United States
(Caulfield) Providence St Vincent Medical Center, United States
(Stys) Sanford Research, United States
(Lee) Stanford Medical Center, United States
(Mansouri) St Thomas Hospital, United States
(Srinivas) Weiler Hospital, United States
(Gupta) Borgess Research Institute, United States
(Kancz) Gottsegen Gyorgy Orszagos Kardiologiai Intezet, Hungary
(Horvath) Pecsi Tudomanyegyetem Klinikai Kozpont, Hungary
(Bachinsky) Pinnacle Health, United States
(Colyer) University of Toledo Medical Center, United States
(Dillon) Louisville Cardiology Medical, United States
(Felten) Mid-Michigan Medical Center, United States
(French) LA Biomed Research Institute, United States
(Lupkovics) Zala Megyei Korhaz, Hungary
(Nicholas) Freeman West Hospital, United States
(Rutsch) Helios Klinikum Emil von Behring, Germany
(Phillips) Central Maine Medical Center, United States
(Khatib, Al-Saghir) 1st Coast Cardiovascular Institute, United States
(Moebius-Winkler) Herzzentrum Leipzig GmbH, Germany
(Hawa) North Kansas City Hospital, United States
(Masud) Kaleida Health, United States
(Jafar) Hudson Valley Heart Center, United States
(Muller) St Vincent's Hospital Sydney, Australia
(Meredith) Monash Heart Southern Health, Australia
(Rankin) Royal Perth Hospital, Australia
(Worthley) Royal Adelaide Hospital, Australia
(Jepson) Prince of Wales Eastern Heart, Australia
(Thompson) Sir Charles Gardiner Hospital, Australia
(Hendriks) Fremantle Hospital, Australia
(Whitbourn) St Vincent's Hospital Melbourne, Australia
(Duffy) Alfred Hospital, Australia
(Stasek) FN Hradec Kralove, Czech Republic
(Novobilsky) Mestska nemocnice Ostrava, Czech Republic
(Naplava) Centrum pro choroby srdce, Czech Republic
(Coufal) KNTB a.s., Czech Republic
(Vaquette) Hopital Saint Louis, France
(Bressollette) Nouvelle Clinique Nantaise, France
(Teiger) CHU Henri Mondor, France
(Coste) Groupe Hospitalier Sud, France
(Rihani) Hopital Saint Philibert, France
(Darius) Vivantes-Klinikum Neukoelln, Germany
(Bergmann) Asklepios Klinik St Georg, Germany
(Radke) UK-SH, Germany
(Sebastian) Elbe-Kliniken Stade GmbH, Germany
(Strasser) Universitaetsklinikum Dresden, Germany
(Hoffmann) Vivantes Klin. Friedrichshain, Germany
(Behrens) VivantesHumboldt Klinikum, Germany
Title
Mortality following cardiovascular and bleeding events occurring beyond 1
year after coronary stenting: A secondary analysis of the Dual
Antiplatelet Therapy (DAPT) Study.
Source
JAMA Cardiology. 2 (5) (pp 478-487), 2017. Date of Publication: May 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Early cardiovascular and bleeding events after coronary
stenting are associated with high risk of morbidity and mortality.
Objective: To assess the prognosis of cardiovascular and bleeding events
occurring beyond 1 year after coronary stenting. Design, Setting, and
Participants: This secondary analysis is derived from data from the Dual
Antiplatelet Therapy (DAPT) Study, a multi center trial involving 220 US
and in ternational clinical sites from 11 countries. The study dateswere
August 2009 to May 2014. Individuals who underwent coronary stenting and
completed 12 months of thienopyridine plus aspirin therapy without
ischemic or bleeding events remained on an aspirin regimen and were
randomized to continued thienopyridine therapy vs placebo for 18
additional months. Individuals were then followed up for 3 additional
months while receiving aspirin therapy alone. The analysis began in August
2015. Exposures: Ischemic events (myocardial infarction not related to
stent thrombosis, stent thrombosis, and ischemic stroke) and bleeding
events (Global Utilization of Streptokinase and Tissue Plasminogen
Activator for Occluded Arteries [GUSTO] classification moderate or severe
bleeding). Main Outcomes and Measures: Ischemic events (myocardial
infarction not related to stent thrombosis, stent thrombosis, and ischemic
stroke) and bleeding events (GUSTO classification moderate or severe
bleeding). Death at 21 months after randomization (33 months after
coronary stenting). Results: Intotal, 25 682 individuals older than 18
years with an indication for coronarystentingwere enrolled, and 11
648(meanage,61.3 years; 25.1%female)were randomized. After randomization,
478 individuals (4.1%) had 502 ischemic events (306 with myocardial
infarction, 113 with stent thrombosis, and 83 with ischemic stroke), and
232 individuals (2.0%) had 235 bleeding events (155 with moderate and 80
with severe bleeding). Among individuals with ischemic events, 52(10.9%)
died. The annualized mortality rate after an ischemic event was 27.2
(95%CI, 20.3-35.7) per 100 person-years. The cumulative incidence of death
after an ischemic event among the total randomized study population was
0.5%(0.3% with myocardial infarction,0.1% with stent thrombosis, and 0.1%
with ischemic stroke). Among individuals with bleeding events, 41 (17.7%)
died. The annualized mortality rate after a bleeding event was 21.5
(95%CI, 15.4-29.1) per 100 person-years. The cumulative incidence of death
after a bleeding event among the total randomized study population was
0.3%(0.1% with moderate and 0.2% with severe bleeding). Conclusions and
Relevance: In patients treated with dual antiplatelet therapy for at least
1 year after coronary stenting, ischemic events were more frequent than
bleeding events, and both events were associated with high risk of
mortality.<br/>Copyright © 2017 American Medical Association. All
rights reserved.
<31>
Accession Number
618848092
Author
Pesonen E.; Keski-Nisula J.; Passov A.; Vahatalo R.; Puntila J.; Andersson
S.; Suominen P.K.
Institution
(Pesonen, Passov, Vahatalo, Andersson) Division of Anaesthesiology,
Department of Anaesthesiology, Intensive Care and Pain Medicine,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Keski-Nisula, Vahatalo, Suominen) Department of Anaesthesia and Intensive
Care, Children's Hospital, University of Helsinki and Helsinki University
Hospital
(Keski-Nisula, Suominen) Division of Anaesthesiology, Department of
Anaesthesiology, Intensive Care and Pain Medicine, Children's Hospital,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Puntila) Department of Paediatric Cardiac and Transplantation Surgery,
Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
Title
Heart-Type Fatty Acid Binding Protein and High-Dose Methylprednisolone in
Pediatric Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objectives: Corticosteroids possess cardioprotection in experimental
cardiac ischemia/reperfusion. The authors hypothesized that if
cardioprotection of corticosteroids occured during pediatric cardiac
surgery, then methylprednisolone used in cardiopulmonary bypass prime
would reduce postoperative concentrations of heart-type fatty-acid-binding
protein, a cardiac biomarker. Design: A double-blind, placebo-controlled,
randomized clinical trial. Setting: Operating room and pediatric intensive
care unit of a university hospital. Participants: Forty-five infants and
young children undergoing ventricular or atrioventricular septal defect
correction. Interventions: The patients received one of the following: 30
mg/kg of methylprednisolone intravenously after anesthesia induction (n =
15), 30 mg/kg of methylprednisolone in cardiopulmonary bypass prime
solution (n = 15), or placebo (n = 15). Measurements and Main Results:
Plasma heart-type fatty-acid-binding protein (hFABP) was measured.
Preoperatively, hFABP did not differ among the study groups.
Methylprednisolone administered preoperatively and in the cardiopulmonary
bypass prime solution reduced hFABP by 44% (p = 0.010) and 38% (p = 0.033)
6 hours postoperatively. hFABP significantly correlated with concomitant
troponin T after protamine administration (R = 0.811, p < 0.001) and 6
hours postoperatively (R = 0.806, p < 0.001). Conclusions:
Methylprednisolone in cardiopulmonary bypass prime solution administered
only a few minutes before cardiac ischemia confered cardioprotection of
the same magnitude as preoperative methylprednisolone as indicated by
hFABP concentrations. Rapid cardioprotective actions of corticosteroids in
pediatric heart surgery observed previously experimentally may have
occurred.<br/>Copyright © 2017.
<32>
Accession Number
618847531
Author
El-Tahan M.R.; Khidr A.M.; Gaarour I.S.; Alshadwi S.A.; Alghamdi T.M.;
Al'ghamdi A.
Institution
(El-Tahan, Khidr, Gaarour, Alshadwi, Alghamdi, Al'ghamdi) Anesthesiology
Department, King Fahd Hospital of Imam Abdulrahman Bin Faisal University
(formerly University of Dammam), Dammam, Saudi Arabia
Title
A Comparison of 3 Videolaryngoscopes for Double-Lumen Tube Intubation in
Humans by Users With Mixed Experience: A Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objectives: To test the hypothesis that laryngoscopy using the Airtraq
(Prodol Limited, Viscaya, Spain) or King Vision laryngoscope (KVL) (Ambu
A/S, Ballerup, Denmark) would result in a shorter time for successful
double-lumen endobronchial tube (DLT) intubation by users with mixed
experience than the time required using the Macintosh or GlideScope
(Verathon Inc., Bothell, WA) laryngoscopes. Design: A randomized,
prospective, blind study. Setting: A single university hospital.
Participants: The study comprised 133 patients undergoing elective
thoracic surgery. Interventions: Patients were randomly allocated into the
following 4 groups of DLTs: Macintosh (n = 32), GlideScope (n = 34),
Airtraq (n = 35), or KVL (n = 32). Measurements and Main Results: The
following data were recorded: time required for achieving successful DLT
intubation; glottis visualization; optimization maneuvers; first-pass
success rate; intubation difficulty; failure to intubate, defined as an
attempt taking >150 seconds to perform or if peripheral oxygen saturation
<92% was noted; and postoperative sore throat and hoarseness were
recorded. Compared with GlideScope, the Airtraq resulted in shorter times
for achieving successful DLT intubation (median times: 21 s [95%
confidence interval 23.9-70.8 s] v 57.5 s [95% confidence interval
46.2-89.1 s], respectively; p = 0.021); a lower score for difficult
intubations (p = 0.023); and fewer optimization maneuvers. The 4
laryngoscopes were associated with comparable glottis visualization;
first-pass success rate (100%, 100%, 94.4%, and 100%, respectively; p =
0.522); incidence of oropharyngeal trauma; postoperative sore throat; and
hoarseness of voice. There were 2 (5.7%) endobronchial intubation failures
using the Airtraq due to the inability to advance the DLT through the
glottis opening. The experience of the anesthesiologists in using the 4
devices had a statistically significant negative correlation with the time
to confirmation of endobronchial intubation (Spearman r -0.392; p <
0.001). Conclusion: When used by operators with mixed experience, the
channeled Airtraq required less time for DLT intubation and was easier to
use than the GlideScope, although failures did occur with the Airtraq,
whereas they did not occur with the other systems.<br/>Copyright ©
2017 Elsevier Inc.
<33>
Accession Number
618846988
Author
Turan A.; Karimi N.; Zimmerman N.M.; Mick S.L.; Sessler D.I.; Mamoun N.
Institution
(Turan, Karimi, Zimmerman, Sessler) Department of Outcomes Research,
Anaesthesiology Institute, Cleveland Clinic, Cleveland, OH
(Zimmerman) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH
(Mick) Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland,
OH
(Mamoun) Departments of Cardiothoracic Anaesthesiology and Outcomes
Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, OH
Title
Intravenous Acetaminophen Does Not Decrease Persistent Surgical Pain After
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: The authors investigated the hypothesis that perioperative
acetaminophen reduces incisional pain at 30 and 90 days. Design: This was
a prospective, randomized, double-blind trial. Setting: Tertiary-care
hospital (single center) cardiac surgery unit. Participants: Patients
undergoing cardiac surgery via median sternotomy. Interventions: Patients
were assigned randomly to intravenous (IV) acetaminophen or IV placebo.
Patients were given 4 doses of 1 g of IV acetaminophen or an equal volume
of saline placebo over 15 minutes every 6 hours for 24 hours starting in
the operating room after sternal closure. Measurements and Main Results:
Study participants were assessed by phone for incisional pain severity 30
and 90 days after surgery. Those reporting any incisional pain were asked
to complete the Neuropathic Pain Questionnaire-Short Form and the modified
Brief Pain Inventory. Patients were compared on 30- and 90-day incisional
pain severity using separate multivariable linear regression models. IV
acetaminophen had no effect on 30- and 90-day incisional pain, with an
estimated difference in means (confidence interval) of 0.06 (-0.87 to
0.99) at 30 days (p = 0.88) and 0.07 (-0.71 to 0.86) at 90 days (p =
0.83). Low pain severity, neuropathic pain, and interference at both 30
and 90 days after surgery, regardless of treatment group, were observed.
Conclusions: IV acetaminophen did not reduce the incidence or intensity of
incisional pain at 30 days and 90 days after surgery.<br/>Copyright ©
2017 Elsevier Inc.
<34>
Accession Number
616484508
Author
Janssen P.W.A.; Mol E.A.; Geene S.M.C.; Barbato E.; ten Berg J.M.
Institution
(Janssen, Mol, Geene, ten Berg) Department of Cardiology, St. Antonius
Hospital, Nieuwegein, Netherlands
(Janssen, Mol, Geene, ten Berg) St. Antonius Center for Platelet Function
Research, St. Antonius Hospital, Nieuwegein, Netherlands
(Mol) Department of Cardiology, Laboratory of Experimental Cardiology,
University Medical Center Utrecht, Netherlands
(Barbato) Cardiovascular Research Center Aalst OLV Hospital, Aalst,
Belgium
(Barbato) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Naples, Italy
Title
Does percutaneous coronary stent implantation increase platelet
reactivity?.
Source
Blood Reviews. 31 (5) (pp 271-275), 2017. Date of Publication: September
2017.
Publisher
Churchill Livingstone
Abstract
High platelet reactivity (PR) values on treatment with clopidogrel are
associated with an increased rate of thrombotic events after a
percutaneous coronary intervention (PCI). However, we do not know the
optimal timing of the performance of the PR measurements. Platelets might
be activated during a PCI, which means that the timing of PR measurements,
before or after PCI, could influence the outcome. In turn, this could lead
to misinterpretation of the patient's response to antiplatelet therapy and
a less accurate prediction of the patient's risk of thrombotic events
during follow-up. We aimed to evaluate the effect of stent implantation on
PR in patients with and without acute coronary syndromes who undergo PCI
to assess the optimal timing of PR measurements. A systematic literature
search was performed and the results are summarized in this
review.<br/>Copyright © 2017 Elsevier Ltd
<35>
Accession Number
618734014
Author
Gray A.M.; Murphy J.; Altman D.G.; Benedetto U.; Campbell H.; Flather M.;
Gerry S.; Lees B.; Taggart D.P.
Institution
(Gray, Murphy, Campbell) Nuffield Department of Population Health, Health
Economics Research Centre, University of Oxford, Old Road Campus,
Headington, Oxford OX3 7LF, United Kingdom
(Altman, Gerry) Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, Centre for Statistics in Medicine, Botnar
Research Centre, University of Oxford, Oxford, United Kingdom
(Benedetto) School of Clinical Sciences, University of Bristol and Bristol
Royal Infirmary, Bristol, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norfolk and
Norwich University Hospital, Norwich, United Kingdom
(Lees, Taggart) Nuffield Department of Surgical Sciences, University of
Oxford, John Radcliffe Hospital, Oxford, United Kingdom
Title
One-year costs of bilateral or single internal mammary grafts in the
Arterial Revascularisation Trial.
Source
Heart. 103 (21) (pp 1719-1726), 2017. Date of Publication: 01 Nov 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: Coronary artery bypass grafting (CABG) using bilateral internal
mammary arteries (BIMA) may improve survival over CABG using single
internal mammary arteries (SIMA), but may be surgically more complex (and
therefore costly) and associated with impaired sternal wound healing. We
report, for the first time, a detailed comparison of healthcare resource
use and costs over 12 months, as part of the Arterial Revascularisation
(ART) Trial. Methods: 3102 patients in 28 hospitals in seven countries
were randomised to CABG surgery using BIMA (n=1548) or SIMA (n=1554).
Detailed resource use data were collected covering surgery, the initial
hospital episode, and for 12 months post randomisation. Using UK unit
costs, total costs were calculated and compared between trial arms and for
subgroups. Results: Patients randomised to BIMA spent 20 min longer in
theatre (95% CI 15 to 25, p<0.001) and also required more treatment for
sternal wound problems. Mean (SD) total costs per patient at 12 months
were 13 839 (10 534) for BIMA and 12 717 (9719) for SIMA (mean cost
difference 1122, 95% CI 407 to 1838, p=0.002). No tests for interaction
between subgroups and treatment allocation were significant. Conclusions:
At 12 months from randomisation, mean costs were approximately 9% higher
in BIMA than SIMA patients, primarily due to longer time in theatre and
in-hospital stay, and slightly higher costs related to sternal wound
problems during follow-up. Follow-up to the primary trial endpoint of 10
years will reveal whether longer-term differences emerge in graft patency
or in overall survival.<br/>Copyright © 2017 Article author(s).
<36>
Accession Number
618728981
Author
Chen F.; Duan G.; Wu Z.; Zuo Z.; Li H.
Institution
(Chen, Duan, Wu, Li) Department of Anesthesiology, Xinqiao Hospital, Third
Military Medical University, Chongqing, China
(Zuo) Department of Anesthesiology, University of Virginia,
Charlottesville, VA, United States
Title
Comparison of the cerebroprotective effect of inhalation anaesthesia and
total intravenous anaesthesia in patients undergoing cardiac surgery with
cardiopulmonary bypass: A systematic review and meta-Analysis.
Source
BMJ Open. 7 (10) (no pagination), 2017. Article Number: e014629. Date of
Publication: 01 Oct 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Neurological dysfunction remains a devastating postoperative
complication in patients undergoing cardiac surgery with cardiopulmonary
bypass (CPB), and previous studies have shown that inhalation anaesthesia
and total intravenous anaesthesia (TIVA) may produce different degrees of
cerebral protection in these patients. Therefore, we conducted a
systematic literature review and meta-Analysis to compare the
neuroprotective effects of inhalation anaesthesia and TIVA. Design
Searching in PubMed, EMBASE, Science Direct/Elsevier, China National
Knowledge Infrastructure and Cochrane Library up to August 2016, we
selected related randomised controlled trials for this meta-Analysis.
Results A total of 1485 studies were identified. After eliminating
duplicate articles and screening titles and abstracts, 445 studies were
potentially eligible. After applying exclusion criteria (full texts
reported as abstracts, review article, no control case, lack of outcome
data and so on), 13 studies were selected for review. Our results
demonstrated that the primary outcome related to S100B level in the
inhalation anaesthesia group was significantly lower than in the TIVA
group after CPB and 24 hours postoperatively (weighted mean difference
(WMD); 95% CI (CI): a 0.41(-0.81 to-0.01), a 0.32 (a 0.59 to a 0.05),
respectively). Among secondary outcome variables, mini-mental state
examination scores of the inhalation anaesthesia group were significantly
higher than those of the TIVA group 24 hours after operation (WMD (95%
CI): 1.87 (0.82 to 2.92)), but no significant difference was found in
arteriovenous oxygen content difference, cerebral oxygen extraction ratio
and jugular bulb venous oxygen saturation, which were assessed at cooling
and rewarming during CPB. Conclusion This study demonstrates that
anaesthesia with volatile agents appears to provide better cerebral
protection than TIVA for patients undergoing cardiac surgery with CPB,
suggesting that inhalation anaesthesia may be more suitable for patients
undergoing cardiac surgery.<br/>Copyright © 2017 BMJ Publishing
Group. All rights reserved.
<37>
Accession Number
614636395
Author
Yang X.-L.; Wang D.; Zhang G.-Y.; Guo X.-L.
Institution
(Yang, Wang) Affiliated Hospital of North Sichuan Medical College,
Departments of Anaesthesiology, 63# Wenhua Road, Nanchong, Sichuan,
Shunqing District 637000, China
(Zhang, Guo) Affiliated Hospital of North Sichuan Medical College,
Laboratory Medicine, Nanchong, Sichuan 637000, China
Title
Comparison of the myocardial protective effect of sevoflurane versus
propofol in patients undergoing heart valve replacement surgery with
cardiopulmonary bypass.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 37. Date
of Publication: 04 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: This study aimed to compare myocardial protective effects of
anaesthesia with intravenous infusion of propofol versus inhalation of
sevoflurane in patients undergoing heart valve replacement surgery with
cardiopulmonary bypass. Methods: Seventy-six patients undergoing valve
replacement with cardiopulmonary bypass were randomly assigned to propofol
or sevoflurane anesthesia during the surgery, respectively. For assessing
myocardial injury, cardiac troponin I (cTnI) and creatine kinase isozyme
(CK-MB) were determined before induction (T<inf>0</inf>), 0.5 h
(T<inf>1</inf>) and 3 h (T<inf>2</inf>) after aortic unclamping, and 24 h
(T<inf>3</inf>) and 48 h (T<inf>4</inf>) after surgery. The concentrations
of interleukin (IL)-6 and IL-10 as the systemic inflammatory and
anti-inflammatory markers were also measured at above time points.
Results: In the sevoflurane group, the plasma concentrations of cTnI and
CK-MB from T<inf>l</inf> to T<inf>4</inf> and the levels of IL-6 and IL-10
from T<inf>1</inf> to T<inf>2</inf> were lower than those in the propofol
group. Moreover, a higher ratio of automatic heart beat recovery and a
shorter length of intensive care unit or hospital stay were found in the
sevoflurane group comparing with the propofol group. Conclusion:
Sevoflurane anaesthesia produced more prominent myocardial protection and
attenuated inflammatory response than propofol anaesthesia in patients
with valve replacement surgery under cardiopulmonary bypass, resulting in
shorter ICU and in-hospital stay. Retrospective clinical trial
registration: Identified as ChiCTR-IOR-16009979at
http://www.chictr.org.cn/.<br/>Copyright © 2017 The Author(s).
<38>
Accession Number
614093226
Author
Cho Y.J.; Kim T.K.; Hong D.M.; Seo J.-H.; Bahk J.-H.; Jeon Y.
Institution
(Cho, Kim, Hong, Seo, Bahk, Jeon) Seoul National University Hospital,
Department of Anesthesiology and Pain Medicine, 101 Daehak-ro, Jongno-gu,
Seoul 03068, South Korea
Title
Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on
arterial oxygenation during one-lung ventilation for thoracoscopic
surgery: A prospective randomized trial.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 9. Date
of Publication: 18 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: One-lung ventilation during thoracic surgery frequently
disturbs normal systemic oxygenation. However, the effect of anesthetics
on arterial oxygenation during one-lung ventilation has not been well
established in human study. In this clinical trial, we investigated
whether a difference between desflurane-remifentanil and
propofol-remifentanil anesthesia can be observed with regard to
oxygenation during one-lung ventilation for thoracoscopic surgery.
Methods: Adult patients with lung cancer, scheduled for video-assisted
thoracoscopic lobectomy without preoperative oxygen support, were screened
and randomized to receive desflurane or propofol, with remifentanil
continuous infusion in both groups. Mechanical ventilation was performed
with tidal volume of 8 ml/kg and F<inf>I</inf>O<inf>2</inf> 0.5 during
two-lung ventilation, and 6 ml/kg and 1.0 during one-lung ventilation,
both with positive end-expiratory pressure of 5 cmH<inf>2</inf>O. Arterial
blood gas analysis was performed preoperatively, during two-lung
ventilation, and after 15, 30, 45, and 60 min of one-lung ventilation. The
primary endpoint was PaO<inf>2</inf> at 30 min after initiating one-lung
ventilation. Statistical analyses included the independent t-test for the
primary endpoint and a mixed model with a post-hoc analysis to evaluate
the serial changes in values. Results: Patients were recruited between
July 9 and December 2, 2014. In total, 103 patients were analyzed (n = 52
in desflurane group and n = 51 in propofol group). The primary endpoint,
PaO<inf>2</inf> at 30 min of one-lung ventilation was lower in the
desflurane group than the propofol group (170 +/- 72 vs. 202 +/- 82 mmHg;
p = 0.039). Serial changes in PaO<inf>2</inf> during one-lung ventilation
showed lower levels during desflurane anesthesia compared with propofol
anesthesia (mean difference, 45 mmHg; 95% confidence interval, 16-75 mmHg;
p = 0.003). Conclusions: In conclusion, desflurane-remifentanil anesthesia
resulted in decreased arterial oxygenation compared with that of
propofol-remifentanil anesthesia during one-lung ventilation for
thoracoscopic surgery in patients with lung cancer. Trial registration:
ClinicalTrials.gov identifier: NCT02191371, registered on July 7,
2014<br/>Copyright © 2017 The Author(s).
<39>
Accession Number
615039650
Author
Nederlof R.; Weber N.C.; Juffermans N.P.; de Mol B.A.M.J.; Hollmann M.W.;
Preckel B.; Zuurbier C.J.
Institution
(Nederlof, Weber, Hollmann, Preckel, Zuurbier) Academic Medical Center,
Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.),
Department of Anesthesiology, Amsterdam, Netherlands
(Juffermans) Academic Medical Center, Laboratory of Experimental Intensive
Care and Anesthesiology (L.E.I.C.A.), Department of Intensive Care
Medicine, Amsterdam, Netherlands
(de Mol) Academic Medical Center, Department of Cardiothoracic Surgery,
Amsterdam, Netherlands
(Zuurbier) University of Amsterdam, Academic Medical Center, Meibergdreef
9, Amsterdam 1105 AZ, Netherlands
Title
A randomized trial of remote ischemic preconditioning and control
treatment for cardioprotection in sevoflurane-anesthetized CABG patients.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 51. Date
of Publication: 29 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Remote ischemic preconditioning (RIPC) efficacy is debated.
Possibly, because propofol, which has a RIPC-inhibiting action, is used in
most RIPC trials. It has been suggested that clinical efficacy is,
however, present with volatile anesthesia in the absence of propofol,
although this is based on one phase 1 trial only. Therefore, in the
present study we further explore the relation between RIPC and
cardioprotection with perioperative anesthesia restricted to sevoflurane
and fentanyl, in CABG patients without concomitant procedures. Methods: In
a single-center study, we aimed to randomize 46 patients to either RIPC
(3x5 min inflation of a blood pressure cuff around the arm) or control
treatment (deflated cuff around the arm). Blood samples were obtained
before and after RIPC to evaluate potential RIPC-induced mediators
(Interleukin (IL)-6, IL-10, Tumor Necrosis Factor-alpha, Macrophage
Inhibitory Factor). An atrial tissue sample was obtained at cannulation of
the appendix of the right atrium for determination of mitochondrial bound
hexokinase II (mtHKII) and other survival proteins (Akt and AMP-activated
protein kinase alpha). In blood samples taken before and 6, 12 and 24 h
after surgery cardiac troponin T (cTnT) and C-reactive protein (CRP) were
determined. Surgery was strictly performed under sevoflurane anesthesia
(no propofol). Results: We actually randomized 16 patients to control
treatment and 13 patients to RIPC. The mean 24 h area under the curve
(AUC) cTnT was 11.44 (standard deviation 4.66) in the control group and
10.90 (standard deviation 4.73) in the RIPC group (mean difference 0.54,
95% CI -3.06 to 4.13; p = 0.76). The mean 24 h AUC CRP was 1319 (standard
deviation 92) in the control group and 1273 (standard deviation 141) in
the RIPC group (mean difference 46.2, 95% CI -288 to 380; p = 0.78). RIPC
was without effect on survival proteins in atrial tissue samples obtained
before surgery (mitochondrial hexokinase, Akt and AMPK) and inflammatory
mediators obtained before and immediately after RIPC (IL-6, IL-10,
TNF-alpha, macrophage migration inhibitory factor). Conclusion: Many
factors can interfere with the outcome of RIPC. Trying to correct for this
led to strict inclusion criteria, which, in combination with a decreased
institutional frequency of CABG without concomitant procedures and a
change in institutional anesthetic regimen away from volatile anesthetics
towards total intravenous anesthesia, caused slow inclusion and halting of
this trial after 3 years, before target inclusion could be reached.
Therefore this study is underpowered to prove its primary goal that RIPC
reduced AUC cTnT by < 25%. Nevertheless, we have shown that the effect of
RIPC on 24 h AUC cTnT, in cardiac surgery with anesthesia during surgery
restricted to sevoflurane/fentanyl (no propofol), was between a decrease
of 27% and an increase of 36%. These findings are not in line with
previous studies in this field. Trial registration: The Netherlands Trial
Register: NTR2915 ; Registered 25 Mei 2011.<br/>Copyright © 2017 The
Author(s).
<40>
Accession Number
610472124
Author
Li Q.; He Y.; Chen L.; Chen M.
Institution
(Li, He, Chen) Sichuan University, Department of Cardiology, West China
Hospital, Chengdu, China
(Li) Sichuan Provincial People's Hospital and Sichuan Academy of Medical
Science, Department of Cardiology, Chengdu, China
(Chen) Sichuan University, Department of Physiology, West China School of
Preclinical and Forensic Medicine, Chengdu, China
Title
Intensive plaque modification with rotational atherectomy and cutting
balloon before drug-eluting stent implantation for patients with severely
calcified coronary lesions: A pilot clinical study.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 112. Date of Publication: 26 May 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: This study investigated whether, for patients with severely
calcified coronary lesions, use of a cutting balloon (CB) during
rotational atherectomy (RA) before placing a drug-eluting stent will
improve periprocedural outcomes, compared to RA with a conventional plain
balloon. Methods: In a randomized controlled trial, patients with severely
calcified lesions of calcium arc >=180degree were apportioned to receive
intensive plaque modification with RA and CB (RA + CB; n = 35) or RA with
conventional plain balloon (RA; n = 36). Intravascular ultrasound was
applied for quantitative or qualitative analyses of percutaneous coronary
intervention outcomes. The primary outcome was acute lumen gain after
drug-eluting stent. Results: The RA + CB and RA groups were similar in
baseline mean arcs of superficial calcium, and minimum lumen
cross-sectional areas (CSAs). The mean minimum stent CSA after
percutaneous coronary intervention (PCI) of the RA + CB group (5.9 +/- 1.7
mm<sup>2</sup>) was significantly larger than that of the RA group (5.0
+/- 1.4 mm<sup>2</sup>; P = 0.021). Patients in the RA + CB group achieved
significantly larger acute CSA gain after PCI (4.5 +/- 1.5 mm<sup>2</sup>)
relative to the RA group (3.8 +/- 1.5 mm<sup>2</sup>; P = 0.035). The
groups were similar in rates of periprocedural complications, but at the
1-year follow-up the RA + CB had a lower rate of revascularization for
restenosis of the target vessel and MACE (5.7 %) than did the RA group
(22.2 %, P = 0.046). Conclusion: Aggressive plaque preparation with RA and
CB seems to be safe and effective for patients with severely calcified
coronary lesions. Trial registration: Current Controlled Trials
ChiCTR-INR-16008274. Retrospectively registered 12 April
2016.<br/>Copyright © 2016 Li et al.
<41>
Accession Number
618818847
Author
Lima A.C.; Fernandes G.A.; de Barros Araujo R.; Gonzaga I.C.; de Oliveira
R.A.; Nicolau R.A.
Institution
(Lima, Fernandes, Gonzaga, Nicolau) 1 Lasertherapy and Photobiology
Center, Research and Development Institute, IP&D, Universidade do Vale do
Paraiba , UNIVAP, Sao Paulo, Brazil
(Lima) 2 University of Piaui State (UESPI) , Teresina, Brazil
(Fernandes, Gonzaga, de Oliveira) 3 Uninovafapi College , Teresina, Brazil
(de Barros Araujo) 4 Department of Cardiac Surgery, Santa Maria Hospital,
University of Piaui State (UESPI) , Teresina, Brazil
(de Oliveira) 5 Department of Health Sciences, University of Piaui State
(UESPI) , Teresina, Brazil
Title
Photobiomodulation (Laser and LED) on Sternotomy Healing in Hyperglycemic
and Normoglycemic Patients Who Underwent Coronary Bypass Surgery with
Internal Mammary Artery Grafts: A Randomized, Double-Blind Study with
Follow-Up.
Source
Photomedicine and laser surgery. 35 (1) (pp 24-31), 2017. Date of
Publication: 01 Jan 2017.
Abstract
BACKGROUND AND OBJECTIVE: This study aimed at analyzing the healing
effects of low-level laser therapy (LLLT) (lambda620nm, 6J/cm2) and
light-emitting diode (LED) therapy (lambda640nm, 6J/cm2) on the
longitudinal sternotomy incisions of hyperglycemic and normoglycemic
patients who underwent coronary artery bypass grafting (CABG).
MATERIALS AND METHODS: 120 volunteers were electively submitted to CABG
and were randomly allocated into four different groups of equal size
(n=30): control, placebo, laser (lambda of 640nm and spatial average
energy fluency [SAEF] of 1.06J/cm2), and LED (lambda of 660+/-20nm and
SAEF of 0.24J/cm2). Laser and LED groups were irradiated from the second
to eighth day postsurgery, and sternotomy incision was photographically
registered. Then, participants were also separated into hyperglycemic and
normoglycemic groups, according to their fasting blood glucose test before
surgery. Three researchers blindly analyzed the incision photographs to
determine hyperemia and wound closure at the first day of hospital
discharge (eighth postoperative day).
RESULTS: LLLT and LED groups had similarly less hyperemia and less
incision bleeding or dehiscence (p<=0.005) and the outcomes were also
analogous between hyperglycemic and normoglycemic patients, which
indicates no difference observed in an intragroup analysis (p>=0.05).
CONCLUSIONS: With the present therapy parameters, it may be assumed that
both coherent light (laser) and non-coherent light (LED) are effective in
promoting sternotomy and healing acceleration, which are evident on the
eighth day postsurgery.
<42>
Accession Number
618832317
Author
Moradian S.T.; Najafloo M.; Mahmoudi H.; Ghiasi M.S.
Institution
(Moradian, Najafloo, Mahmoudi) Nursing Faculty, Baqiyatallah University of
Medical Sciences, Tehran, Iran
(Ghiasi) Baqiyatallah University of Medical Sciences, Tehran, Iran.
Electronic address: t.moradyan@yahoo.com
Title
Early mobilization reduces the atelectasis and pleural effusion in
patients undergoing coronary artery bypass graft surgery: A randomized
clinical trial.
Source
Journal of vascular nursing : official publication of the Society for
Peripheral Vascular Nursing. 35 (3) (pp 141-145), 2017. Date of
Publication: 01 Sep 2017.
Abstract
Atelectasis and pleural effusion are common after coronary artery bypass
graft surgery (CABG). Longer stay in the bed is one of the most important
contributing factors in pulmonary complications. Some studies confirm the
benefits of early mobilization (EM) in critically ill patients, but the
efficacy of EM on pulmonary complications after CABG is not clear. This
study was designed to examine the effect of EM on the incidence of
atelectasis and pleural effusion in patients undergoing CABG. In a
single-blinded randomized clinical trial, 100 patients who were undergoing
coronary artery bypass graft surgery were randomly assigned into two
groups each consisted of 50 patients. Patients in the experimental group
were enrolled in a mobilization protocol consisting of the mobilization
from the bed in the first 3 days after surgery in the morning and evening.
Patients in the control group were mobilized from bed in third
postoperation day, according to the hospital routine. Arterial blood
gases, pleural effusion, and atelectasis were compared between groups.
Atelectasis and pleural effusion was reduced in experimental group. The
partial pressure of oxygen in arterial blood in third postoperative day
and the percentage of arterial oxygen saturation in the fourth
postoperative day were higher in the intervention group (P value < .05).
EM from bed could be an effective intervention in reducing atelectasis and
pleural effusion in patients undergoing CABG.<br/>Copyright © 2017
Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights
reserved.
<43>
Accession Number
618792253
Author
Sanfilippo F.; Knight J.B.; Scolletta S.; Santonocito C.; Pastore F.;
Lorini F.L.; Tritapepe L.; Morelli A.; Arcadipane A.
Institution
(Sanfilippo, Knight, Santonocito, Pastore, Arcadipane) Department of
Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e
Terapie ad alta specializzazione (IRCCS-ISMETT), Via Tricomi 5, Palermo
90127, Italy
(Knight) University of Pittsburgh Medical Center, Department of
Anesthesiology, Pittsburgh, PA, United States
(Scolletta) Azienda Ospedaliera Universitaria Senese, Unit of Anesthesia
and Critical Care Medicine, Department of Medical Biotechnologies, Siena,
Italy
(Lorini) Department of Anaesthesia and Intensive Care, Papa Giovanni XXIII
Hospital, Bergamo, Italy
(Tritapepe) Sapienza University of Rome, Department of Cardiovascular,
Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Rome,
Italy
(Morelli) Policlinico Umberto 1, Sapienza University of Rome, Department
of Anesthesiology and Intensive Care, Rome, Italy
Title
Levosimendan for patients with severely reduced left ventricular systolic
function and/or low cardiac output syndrome undergoing cardiac surgery: A
systematic review and meta-analysis.
Source
Critical Care. 21 (1) (no pagination), 2017. Date of Publication: 19 Oct
2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Previous studies have shown beneficial effects of levosimendan
in high-risk patients undergoing cardiac surgery. Two large randomized
controlled trials (RCTs), however, showed no advantages of levosimendan.
Methods: We performed a systematic review and meta-analysis (MEDLINE and
Embase from inception until March 30, 2017), investigating whether
levosimendan offers advantages compared with placebo in high-risk cardiac
surgery patients, as defined by preoperative left ventricular ejection
fraction (LVEF) <= 35% and/or low cardiac output syndrome (LCOS). The
primary outcomes were mortality at longest follow-up and need for
postoperative renal replacement therapy (RRT). Secondary postoperative
outcomes investigated included myocardial injury, supraventricular
arrhythmias, development of LCOS, acute kidney injury (AKI), duration of
mechanical ventilation, intensive care unit and hospital lengths of stay,
and incidence of hypotension during drug infusion. Results: Six RCTs were
included in the meta-analysis, five of which investigated only patients
with LVEF <= 35% and one of which included predominantly patients with
LCOS. Mortality was similar overall (OR 0.64 [0.37, 1.11], p = 0.11) but
lower in the subgroup with LVEF < 35% (OR 0.51 [0.32, 0.82], p = 0.005).
Need for RRT was reduced by levosimendan both overall (OR 0.63 [0.42,
0.94], p = 0.02) and in patients with LVEF < 35% (OR 0.55 [0.31, 0.97], p
= 0.04). Among secondary outcomes, we found lower postoperative LCOS in
patients with LVEF < 35% receiving levosimendan (OR 0.49 [0.27, 0.89], p =
0.02), lower overall AKI (OR 0.62 [0.42, 0.92], p = 0.02), and a trend
toward lower mechanical support, both overall (p = 0.07) and in patients
with LVEF < 35% (p = 0.05). Conclusions: Levosimendan reduces mortality in
patients with preoperative severely reduced LVEF but does not affect
overall mortality. Levosimendan reduces the need for RRT after high-risk
cardiac surgery.<br/>Copyright © 2017 The Author(s).
<44>
Accession Number
618780251
Author
Chen Q.-H.; Zheng R.-Q.; Lin H.; Shao J.; Yu J.-Q.; Wang H.-L.
Institution
(Chen, Zheng, Lin, Shao, Yu, Wang) Yangzhou University, Department of
Critical Care Medicine, Subei People's Hospital, School of Medicine, 98
Nantong West Road, Yangzhou, Jiangsu 225001, China
(Wang) Yangzhou University, Department of Cardiology, Subei People's
Hospital, School of Medicine, 98 Nantong West Road, Yangzhou 225001, China
Title
Effect of levosimendan on prognosis in adult patients undergoing cardiac
surgery: A meta-analysis of randomized controlled trials.
Source
Critical Care. 21 (1) (no pagination), 2017. Date of Publication: 17 Oct
2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Small trials suggest that levosimendan is associated with a
favorable outcome in patients undergoing cardiac surgery. However,
recently published larger-scale trials did not provide evidence for a
similar benefit from levosimendan. We performed a meta-analysis to assess
the survival benefits of levosimendan in patients undergoing cardiac
surgery and to investigate its effects in subgroups of patients with
preoperative low-ejection fraction (EF). Methods: We identified randomized
clinical trials through 20 April 2017 that investigated levosimendan
therapy versus control in patients undergoing cardiac surgery. Individual
patient data from each study were compiled. Meta-analyses were performed
for primary outcomes, secondary outcomes and serious adverse events, and
subgroup analyses according to the preoperative EF of enrolled patients
were also conducted. The risk of bias was assessed using the Cochrane
risk-of-bias tool. Results: Seventeen studies involving a total of 2756
patients were included. Levosimendan therapy was associated with a
significant reduction in 30-day mortality (RR 0.67; 95% CI, 0.49 to 0.93;
p = 0.02) and reduced the risk of death in single-center trials (RR 0.49;
95% CI, 0.30 to 0.79; p = 0.004) and in subgroup trials of inferior
quality (RR 0.39; 95% CI, 0.17 to 0.92; p = 0.02); however, in multicenter
and in high-quality subgroup-analysis trials, no significant difference in
mortality was observed between patients who received levosimendan therapy
and controls (p > 0.05). However, in high-quality subgroup trials,
levosimendan therapy was associated with reduced mortality in patients in
a preoperative low-EF subgroup (RR 0.58; 95% CI, 0.38 to 0.88; p = 0.01).
Similarly, only patients in the preoperative low-EF subgroup benefited in
terms of reduced risk of renal replacement therapy (RR 0.54; 95% CI, 0.34
to 0.85; p = 0.007). Furthermore, levosimendan therapy was associated with
a significant reduction in intensive care unit (ICU) length of stay (MDR
-17.19; 95% CI, -34.43 to -2.94; p = 0.02). Conclusions: In patients
undergoing cardiac surgery, the benefit of levosimendan in terms of
survival was not shown in multicenter or in high-quality trials; however,
levosimendan therapy was associated with reduced mortality in patients
with preoperative ventricular systolic dysfunction.<br/>Copyright ©
2017 The Author(s).
<45>
Accession Number
618813138
Author
Wang Y.; Wen M.; Zhou J.; Chen Y.; Zhang Q.
Institution
(Wang, Wen, Zhou, Chen, Zhang) Department of Cardiology, West China
Hospital Sichuan University Chengdu China
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
in patients with noninsulin treated type 2 diabetes mellitus: A
meta-analysis of randomized controlled trials.
Source
Diabetes/Metabolism Research and Reviews. (no pagination), 2017. Date of
Publication: 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The outcomes and prognosis of revascularization by either
coronary artery bypass grafting (CABG) surgery or percutaneous coronary
intervention (PCI) in patients with noninsulin-treated type 2 diabetes
mellitus (NITDM) have not yet been well established. Methods: Randomized
controlled trials (RCTs) were identified by searching Pubmed, EMBASE, and
Cochrane library from inception until May 2016. Heterogeneity was
evaluated, and the pooled hazard ratio (HR) was calculated by using a
fixed-effect model. A random-effect model was used when statistically
significant heterogeneity was observed (I<sup>2</sup> >= 50%). All data
analyses were carried out by using RevMan 5.3 and STATA software 12.0.
Results: A total of 4 RCTs involving 5 studies, consisting of 2270
patients with noninsulin-treated type 2 diabetes mellitus, were
identified. Compared with CABG-treated patients, PCI-treated patients had
significantly higher all-cause mortality (HR 1.39; 95% CI 1.01 to 1.91; P
= .04), myocardial infarction (HR 2.14; 95% CI 1.40 to 3.27; P = .0004),
repeated revascularization (HR 2.52; 95% CI 1.77 to 3.57; P < .00001), and
major adverse cardiovascular and cerebrovascular events (HR 1.50; 95% CI
1.20-1.87; P = .0004). However, PCI was associated with lower incidence of
stoke (HR 0.47; 95% CI 0.24 to 0.90; P = .02). Conclusions: In NITDM
patients, our study suggests that CABG surgery is associated with reduced
risk of mortality and morbidity, although with increased incidence of
stroke compared with percutaneous coronary intervention. The decision if
to have percutaneous coronary intervention or CABG surgery should factor
the risk for stroke of the patients when considering CABG over
percutaneous coronary intervention. Adequately powered RCTs are needed to
confirm the results of this meta-analysis.<br/>Copyright © 2017 John
Wiley & Sons, Ltd.
<46>
Accession Number
618808988
Author
Coverdale N.S.; Hamilton A.; Petsikas D.; McClure R.S.; Malik P.; Milne
B.; Saha T.; Zelt D.; Brown P.; Payne D.M.
Institution
(Coverdale, Hamilton, Petsikas, Zelt, Brown, Payne) Department of Surgery,
Queen's University and Kingston General Hospital, Kingston, Ontario,
Canada
(McClure) Department of Surgery, Libin Cardiovascular Institute of
Alberta, Foothills Medical Center, University of Calgary, Calgary,
Alberta, Canada
(Malik) Department of Medicine, Queen's University and Kingston General
Hospital, Kingston, Ontario, Canada
(Milne, Saha) Department of Anesthesiology and Perioperative Medicine,
Queen's University and Kingston General Hospital, Kingston, Ontario,
Canada
Title
Remote Ischemic Preconditioning in High-risk Cardiovascular Surgery
Patients: A Randomized-controlled Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Remote ischemic preconditioning (RIPC) may reduce biomarkers of ischemic
injury after cardiovascular surgery. However, it is unclear whether RIPC
has a positive impact on clinical outcomes. We performed a blinded,
randomized controlled trial to determine if RIPC resulted in fewer adverse
clinical outcomes after cardiac or vascular surgery. The intervention
consisted of 3 cycles of RIPC on the upper limb for 5 minutes alternated
with 5 minutes of rest. A sham intervention was performed on the control
group. Patients were recruited who were undergoing (1) high-risk cardiac
or vascular surgery or (2) cardiac or vascular surgery and were at high
risk of ischemic complications. The primary end point was a composite
outcome of mortality, myocardial infarction, stroke, renal failure,
respiratory failure, and low cardiac output syndrome, and the secondary
end points included the individual outcome parameters that made up this
score, as well as troponin-I values. A total of 436 patients were
randomized and analysis was performed on 215 patients in the control group
and on 213 patients in the RIPC group. There were no differences in the
composite outcome between the 2 groups (RIPC: 67 [32%] and control: 72
[34%], relative risk [0.94 (0.72-1.24)]) or in any of the individual
components that made up the composite outcome. Additionally, we did not
observe any differences between the groups in troponin-I values, the
length of intensive care unit stay, or the total hospital stay. RIPC did
not have a beneficial effect on clinical outcomes in patients who had
cardiovascular surgery.<br/>Copyright © 2017 Elsevier Inc.
<47>
Accession Number
618808249
Author
Talwar S.; Bhoje A.; Sreenivas V.; Makhija N.; Aarav S.; Choudhary S.K.;
Airan B.
Institution
(Talwar, Bhoje, Choudhary, Airan) Department of Cardiothoracic and
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
(Sreenivas) Department of Biostatistics, All India Institute of Medical
Sciences, New Delhi, India
(Makhija) Department of Cardiac Anesthesiology, All India Institute of
Medical Sciences, New Delhi, India
(Aarav) Department of Pathology, All India Institute of Medical Sciences,
New Delhi, India
Title
Comparison of del Nido and St Thomas Cardioplegia Solutions in Pediatric
Patients: A Prospective Randomized Clinical Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
We conducted a prospective randomized trial to compare del Nido (DN)
cardioplegia with conventional cold blood cardioplegia (St Thomas [STH])
in pediatric patients. We randomized 100 pediatric patients aged <=12
years undergoing elective repair of ventricular septal defects and
tetralogy of Fallot to the DN and the STH groups. In the DN group, a 20
mL/kg single dose was administered. In the STH group, a 30 mL/kg dose was
administered, followed by repeated doses at 25- to 30-minute intervals.
The primary outcome was cardiac index that was measured 4 times intra- and
postoperatively. Troponin-I, interleukin-6, and tissue necrosis
factor-alpha were measured. Myocardial biopsy was obtained to assess
electron-microscopic ultrastructural changes. Cardiac indices were
significantly higher in the DN group than in the STH group 2 hours after
termination of cardiopulmonary bypass (P = 0.0006), after 6 hours (P =
0.0006), and after 24 hours (P <= 0.0001). On repeated measure regression
analysis, the cardiac index was on an average 0.50 L/min/m<sup>2</sup>
higher in the DN group than in the STH group at any time point (P =
0.002). Duration of mechanical ventilation (P = 0.01), intensive care unit
stay (P = 0.01), and hospital stay (P = 0.0007) was significantly lower in
the DN group. Patients in the DN group exhibited lower troponin-I release
24 hours following cardiopulmonary bypass (P = 0.021). Electron
microscopic studies showed more myofibrillar disarray in the STH group (P
= 0.02). Use of long-acting DN cardioplegia solution was associated with
better preservation of cardiac index, lesser troponin-I release, and
decreased morbidity. Ultrastructural changes showed better preservation of
myofibrillar architecture.<br/>Copyright © 2017 Elsevier Inc.
<48>
Accession Number
618803469
Author
Hounsome J.; Greenhalgh J.; Schofield-Robinson O.J.; Lewis S.R.; Cook
T.M.; Smith A.F.
Institution
(Hounsome) Liverpool Reviews and Implementation Group University of
Liverpool Liverpool UK
(Greenhalgh) Liverpool Reviews and Implementation Group University of
Liverpool Liverpool UK
(Schofield-Robinson, Lewis) Patient Safety Research Unit Department of
Anaesthesia Royal Lancaster Infirmary Lancaster UK
(Cook) Royal United Hospital Bath NHS Foundation Trust Bath UK
(Cook) School of Clinical Sciences University of Bristol Bristol UK
(Smith) Department of Anaesthesia Royal Lancaster Infirmary Lancaster UK
Title
Nitrous oxide-based vs. nitrous oxide-free general anaesthesia and
accidental awareness in surgical patients: An abridged Cochrane systematic
review.
Source
Anaesthesia. (no pagination), 2017. Date of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Accidental awareness during general anaesthesia can arise from a failure
to deliver sufficient anaesthetic agent, or from a patient's resistance to
an expected sufficient dose of such an agent. Awareness is 'explicit' if
the patient is subsequently able to recall the event. We conducted a
systematic review into the effect of nitrous oxide used as part of a
general anaesthetic on the risk of accidental awareness in people over the
age of five years undergoing general anaesthesia for surgery. We included
15 randomised controlled trials, 14 of which, representing a total of 3439
participants, were included in our primary analysis of the frequency of
accidental awareness events. The awareness incidence rate was rare within
these studies, and all were considered underpowered with respect to this
outcome. The risk of bias across all studies was judged to be high, and
76% of studies failed adequately to conceal participant allocation. We
considered the available evidence to be of very poor quality. There were a
total of three accidental awareness events reported in two studies, one of
which reported that the awareness was the result of a kink in a propofol
intravenous line. There were insufficient data to conduct a meta- or
sub-group analysis and there was insufficient evidence to draw
outcome-related conclusions. We can, however, recommend that future
studies focus on potentially high-risk groups such as obstetric or cardiac
surgery patients, or those receiving neuromuscular blocking drugs or total
intravenous anaesthesia.<br/>Copyright © The Association of
Anaesthetists of Great Britain and Ireland.
<49>
Accession Number
618803310
Author
Lange U.; Classen K.; Muller-Ladner U.; Richter M.
Institution
(Lange, Muller-Ladner) Department of Rheumatology and Clinical Immunology
Kerckhoff Clinic Bad Nauheim Germany
(Classen, Richter) Department of Cardiac Surgery Kerckhoff-Clinic Bad
Nauheim Germany
(Muller-Ladner) Department of Internal Medicine and Rheumatology
Justus-Liebig University Giessen Giessen Germany
(Lange) Department of Internal Rheumatology Osteology and Physical
Medicine Justus-Liebig University Giessen Giessen Germany
Title
Weekly oral bisphosphonates over 2 years prevent bone loss in cardiac
transplant patients.
Source
Clinical Transplantation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Heart transplantation (HTX) is an established therapy for
end-stage heart disease. The aim of this study was to determine whether
application of oral bisphosphonates is effective in preventing osseous
complications after HTX. Methods: Thirty-three cardiac transplant
recipients were treated with alendronate 70 mg/wk or risedronate 35 mg/wk
in combination with 1000 mg calcium and 800 IU vitamin D. Markers of bone
metabolism and dual-energy X-ray absorptiometry (DXA) were determined
directly after HTX and 2 years later. Primary endpoints were changes in
bone mineral density (BMD), markers of bone metabolism (osteocalcin,
crosslaps), serum levels of the cytokines osteoprotegerin (OPG), receptor
activator of NF kappa-B ligand (RANKL), and incidence of fractures.
Results: Eight patients presented with osteoporosis, and 16 patients with
osteopenia by DXA without prevalent fractures. Over 2 years, the BMD
improved in 2 patients from osteoporosis to osteopenia, and overall BMD
remained stable, and fractures did not occur. In addition, the serum
levels of OPG increased (P < .0005), and the RANKL levels (P < .001) as
well as the RANKL/OPG-ratio decreased significantly (P < .0005). The serum
crosslaps showed no significant changes. The BMD showed a significant
association with the increased 25-vitamin D levels only in females (P <
.001). Conclusions: In heart transplanted patients, weekly oral
bisphosphonates in combination with calcium and vitamin D supplementation
preserved bone mass, prevented uncoupling of bone resorption/formation and
fractures. Bone density should be measured and adequately treated, that
is, with regular bisphosphonates.<br/>Copyright © 2017 John Wiley &
Sons A/S.
<50>
Accession Number
618803178
Author
Liu J.-Z.; Li X.-F.; Miao Q.; Zhang C.-J.
Institution
(Liu, Li, Miao, Zhang) Department of Cardiac Surgery, Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences, Beijing, China
Title
Surgical treatment of active native mitral infective endocarditis: A
meta-analysis of current evidence.
Source
Journal of the Chinese Medical Association. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: The native mitral lesion of active infective endocarditis
implies a poor prognosis and is associated with adverse short- or
long-term results without surgical treatment. Both mitral valvuloplasty
(MVP) and mitral valve replacement (MVR) have been performed in the
treatment of active native mitral infective endocarditis (ANMIE). However,
the outcomes of the two approaches remain unclear. The aim of this study
was to systematically review the two procedures with mortality and
survival as the primary endpoints. Methods: A systematic review of the
literature was conducted to identify all relevant studies with comparative
data on MVP versus MVR for the treatment of ANMIE. Information on baseline
characteristics of patients, operation method, quality of literature,
follow-up, and so forth was abstracted using standardized protocols.
Pooled odds ratio (OR) or hazard ratio (HR) was calculated and possible
publication bias was tested. Results: Nine comparative observational
studies with a total of 633 patients (MVP = 265, MVR = 368) were
identified for qualitative assessment, data extraction, and analysis. The
summary OR for operative mortality, comparing repair with replacement, was
0.37 (95% CI 0.0.18-0.80; p = 0.0005). Summary 1- and 5-year HRs for
event-free survival were 0.43 (95% CI 0.20-0.92; p = 0.03) and 0.44 (95%
CI 0.25-0.77, p = 0.004), respectively (repair vs. replacement). Summary
1- and 5-year survival HRs were 0.51 (95% CI 0.24-1.08; p = 0.08) and 0.55
(95% CI 0.32-0.96; p = 0.004), respectively (repair vs. replacement). No
heterogeneity was revealed between studies, and possible publication bias
was insignificant. Conclusions: This meta-analysis suggests that MVP may
be associated with superior postoperative survival outcomes compared with
MVR. MVP is desirable, if possible, as a durable alternative to
replacement. However, we must consider the influence of different patient
characteristics and surgeons' preferences on the choice of surgical
approach, and additional powered clinical trials will be required to
confirm these findings.<br/>Copyright © 2017.
<51>
Accession Number
618731093
Author
Lockwood G.G.; Cabreros L.; Banach D.; Punjabi P.P.
Institution
(Lockwood, Cabreros, Banach) Centre for Perioperative Medicine and
Critical Care Research, Imperial College Healthcare NHS Trust, Department
of Anaesthesia, Hammersmith Hospital, London W12 0HS, United Kingdom
(Punjabi) Department of Cardiothoracic Surgery, Imperial College
Healthcare NHS Trust, London, United Kingdom
Title
Continuous bilateral thoracic paravertebral blockade for analgesia after
cardiac surgery: A randomised, controlled trial.
Source
Perfusion (United Kingdom). 32 (7) (pp 591-597), 2017. Date of
Publication: 01 Oct 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Continuous bilateral thoracic paravertebral blockade has been
used for analgesia after cardiac surgery, but its efficacy has never been
formally tested. Method: Fifty adult patients were enrolled in a
double-blind, randomised, controlled study of continuous bilateral
thoracic paravertebral infusion of 0.5% lidocaine (1
mg.kg<sup>-1</sup>.hr<sup>-1</sup>) for analgesia after coronary surgery.
Control patients received a subcutaneous infusion of lidocaine at the same
rate through catheters inserted at the same locations as the study group.
The primary outcome was morphine consumption at 48 hours using
patient-controlled analgesia (PCA). Secondary outcomes included pain,
respiratory function, nausea and vomiting. Serum lidocaine concentrations
were measured on the first two post-operative days. Results: There was no
difference in morphine consumption or in any other outcome measure between
the groups. Serum lidocaine concentrations increased during the study,
with a maximum of 5.9 mg.l<sup>-1</sup>. There were no adverse events as a
consequence of the study. Conclusion: Bilateral paravertebral infusion of
lidocaine confers no advantage over systemic lidocaine infusion after
cardiac surgery. Clinical trial registration: ISRCTN13424423
(https://www.isrctn.com)<br/>Copyright © The Author(s) 2017.
<52>
Accession Number
618265750
Author
Simon G.I.; Craswell A.; Thom O.; Fung Y.L.
Institution
(Simon, Fung) School of Health and Sports Sciences, University of the
Sunshine Coast, Sunshine Coast, QLD, Australia
(Craswell) School of Nursing, Midwifery, and Paramedicine, University of
the Sunshine Coast, Sunshine Coast, QLD, Australia
(Thom) Department of Emergency Medicine, Sunshine Coast Hospital and
Health Service, Sunshine Coast, QLD, Australia
Title
Outcomes of restrictive versus liberal transfusion strategies in older
adults from nine randomised controlled trials: a systematic review and
meta-analysis.
Source
The Lancet Haematology. 4 (10) (pp e465-e474), 2017. Date of Publication:
October 2017.
Publisher
Elsevier Ltd
Abstract
Background Guidelines for patient blood management recommend restrictive
transfusion practice for most adult patients. These guidelines are
supported by evidence from randomised controlled trials (RCTs); however,
one of the patient groups not explicitly examined in these studies is the
geriatric population. We examined RCTs relevant to transfusion outcomes in
older patients. Our aim was to determine whether special guidelines are
warranted for geriatric patients, recognising the different
pathophysiological characteristics of this group. Methods For this
systematic review and meta-analysis, we searched PubMed, Scopus, and the
Cochrane Library databases from their inception to May 5, 2017, for
evidence relating to transfusion outcomes in adults aged 65 years and
older. This criterion was widened to include RCTs where a substantial
proportion of the study population was older than 65 years. We also
included study populations of all clinical settings, and did not limit the
search by date, language, or study type. For articles not in English, only
available translations of the abstracts were reviewed. Studies were
excluded if they did not specify age. Observational studies and duplicate
patient and outcome data from studies that generated multiple publications
were also excluded. We screened bibliographies of retrieved articles for
additional publications. We analysed data extracted from published RCTs
comparing restrictive and liberal transfusion strategies in older adults.
We generated fixed effects risk ratios (RR) for pooled study data using
the Mantel-Haenszel method. Primary outcomes were 30-day and 90-day
mortality events for patients enrolled in restrictive and liberal
transfusion study groups. We included intention-to-treat outcome data in
the meta-analysis when available, otherwise we used per-protocol outcome
data. Findings 686 articles were identified by the search, and a further
37 by the snowball approach. Of these articles, 13 eligible papers
described findings from nine RCTs (five trials investigating orthopaedic
surgery, three cardiac surgery, and one oncology surgery; including 5780
patients). The risk of 30-day mortality was higher in older patients who
followed a restrictive transfusion strategy than in those who followed a
liberal transfusion strategy (risk ratio [RR] 1.36, 95% CI 1.05-1.74;
p=0.017). The risk of 90-day mortality was also higher in those who
followed a restrictive transfusion strategy than in those who followed a
liberal transfusion strategy (RR 1.45, 95% CI 1.05-1.98; p=0.022).
Interpretation Liberal transfusion strategies might produce better
outcomes in geriatric patients than restrictive transfusion strategies.
This outcome contradicts current restrictive transfusion approaches.
Population ageing will challenge resources globally, and this finding has
implications for blood supply and demand, and optimal care of older
adults. Further research is needed to formulate evidence-based transfusion
practice across clinical specialties specific to the geriatric population,
and to examine resource effects. Funding Australia's National Blood
Authority.<br/>Copyright © 2017 Elsevier Ltd
<53>
Accession Number
618736209
Author
Kano S.; Yamamoto M.; Shimura T.; Kagase A.; Tsuzuki M.; Kodama A.; Koyama
Y.; Kobayashi T.; Shibata K.; Tada N.; Naganuma T.; Araki M.; Yamanaka F.;
Shirai S.; Mizutani K.; Tabata M.; Ueno H.; Takagi K.; Higashimori A.;
Otsuka T.; Watanabe Y.; Hayashida K.
Institution
(Kano, Yamamoto, Otsuka) Department of Cardiology, Toyohashi Heart Canter,
2 1-1 Gobudori, Oyamachyo, Toyohashi, Aichi 441-8530, Japan
(Shimura, Higashimori) Department of Cardiology, Toyohashi Heart Canter,
Japan
(Kagase) Department of Cardiology, Sendai Kosei Hospital, Japan
(Tsuzuki) Department of Cardiology, New Tokyo Hospital, Chiba, Japan
(Kodama, Takagi) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Japan
(Koyama, Watanabe) Department of Cardiology, Syonan Kamakura General
Hospital, Japan
(Kobayashi, Hayashida) Department of Cardiology, Kokura Memorial Hospital,
Japan
(Shibata) Department of Cardiology, Osaka City General Hospital, Japan
(Tada) Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa
Medical Center, Chiba, Japan
(Naganuma) Department of Cardiology, Toyama University Hospital, Japan
(Araki) Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
(Yamanaka) Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka,
Japan
(Shirai) Department of Hygiene and Public Health, Nippon Medical School,
Tokyo, Japan
(Mizutani) Center for Clinical Research, Nippon Medical School Hospital,
Tokyo, Japan
(Tabata) Department of Cardiology, Teikyo University School of Medicine,
Tokyo, Japan
(Ueno) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Title
Gait speed can predict advanced clinical outcomes in patients who undergo
transcatheter aortic valve replacement insights from a Japanese
multicenter registry.
Source
Circulation: Cardiovascular Interventions. 10 (9) (no pagination), 2017.
Article Number: e005088. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-Gait speed reflects an important factor of frailty and is
associated with an increased risk of late mortality in patients with
cardiac disease. This study sought to assess the prognostic value of gait
speed in elderly patients who underwent transcatheter aortic valve
replacement. Methods and Results-We investigated the 5-m or 15-feet gait
speed (m/sec) in 1256 patients who underwent transcatheter aortic valve
implantation using data from the OCEAN-TAVI Japanese multicenter registry
(Optimized Catheter Valvular Intervention-Transcatheter Aortic Valve
Implantation). Baseline characteristics, procedural outcomes, and
all-cause mortality were compared among groups defined by differential
gait speed classification: model 1, normal (0.83 m/sec; n=563; 44.8%),
slow (0.5-0.83 m/sec; n=429; 34.2%), slowest (0.83 m/sec; n=205; 16.3%),
unable to walk (n=48; 3.8%); and model 2, classification and regression
tree survival model indicating the threshold of gait speed as 0.385 m/sec
(0.385 m/sec; n=1080 versus =0.385 m/sec; n=117). The cumulative 1-year
mortality rate showed significant differences in the classical gait speed
groups in model 1 (7.6%, 6.6%, 18.2%, and 40.7%, respectively; P0.001) and
survival classification and regression tree group in model 2 (7.7% versus
21.9%; P0.001). The slowest walkers and those unable to walk demonstrated
independent associations with increased midterm mortality after adjustment
for several confounding factors (hazard ratio, 1.83, 4.28; 95% confidence
interval, 1.03-3.26, 2.22-8.72; P=0.039, 0.001, respectively). Gait speed
0.385 m/sec determined by classification and regression tree also
independently associated with worse prognosis (hazard ratio, 2.40; 95%
confidence interval, 1.75-5.88; P=0.001). Conclusions-Gait speed using
both traditional and specific classification is useful as a potential
marker for predicting vulnerable patients associated with adverse clinical
outcomes after transcatheter aortic valve replacement..<br/>Copyright
© 2017 American Heart Association, Inc.
<54>
Accession Number
618618189
Author
Shaybak E.; Abdollahimohammad A.; Rahnama M.; Masinaeinezhad N.;
Azadi-Ahmadabadi C.; Firouzkohi M.
Institution
(Shaybak) Nursing and Midwifery School, Zabol, Iran, Islamic Republic of
(Abdollahimohammad, Rahnama, Firouzkohi) Nusing and Midwifery School,
Zabol University of Medical Sciences, Zabol, Iran, Islamic Republic of
(Masinaeinezhad, Azadi-Ahmadabadi) Medical School, Zahedan University of
Medical Sciences, Zahedan, Iran, Islamic Republic of
Title
The effect of reiki energy healing on CABG postoperative chest pain caused
by coughing and deep breathing.
Source
Indian Journal of Public Health Research and Development. 8 (2) (pp
305-310), 2017. Date of Publication: April-June 2017.
Publisher
Indian Journal of Public Health Research and Development (Aster-06/603,
Supertech Emerald Court, Sector - 93 A, Expressway, NOIDA, UTTAR PRADESH
201 304, India)
Abstract
Introduction: Many heart patients need Coronary Artery Bypass Graft (CABG)
for their health and survival. CABG is known as the first and best choice
in the treatment of these patients.the aim m this study was to study the
effect of Reiki on chest pain of the patients undergoing CABG. Method and
materials: Forty patients after CABG were randomly assigned to Reiki and
Sham Reiki groups. CABG Postoperative Chest Pain Caused by Coughing and
Deep Breathing were measured before and after the interventions. The
patients underwent Reiki healing energy and sham Reiki for 9 minutes. The
short and modified version of the McGill pain questionnaire and the Visual
Analog Scale was used for pain measurement. Results: shows that 60% of the
patients were male in both groups. No significant difference was found
between two groups in terms of age, length of stay, and the outset of
energy healing (P>0.05). No significant difference was found in terms of
diabetes, high blood pressure, high cholesterol, and history of smoking
and drug addiction (P>0.05). Discussion: According to the findings, Reiki
energy healing is advised as a non-medical method, easy, inexpensive,
noninvasive, and effective method for pain relief of the CABG patients.
Conclusion: future studies recommended are recommended to study the
stability of Reiki on pain severity of patients at different times after
intervention and compare the Reiki with drug therapy and other methods of
complementary medicine for reducing the postoperative pain in order to
provide better services for patients.<br/>Copyright © 2017, Indian
Journal of Public Health Research and Development. All rights reserved.
<55>
Accession Number
618683581
Author
Greenberg J.W.; Lancaster T.S.; Schuessler R.B.; Melby S.J.
Institution
(Greenberg, Lancaster, Schuessler, Melby) Barnes-Jewish Hospital, Division
of Cardiothoracic Surgery, Washington University School of Medicine, St.
Louis, MO, United States
Title
Postoperative atrial fibrillation following cardiac surgery: A persistent
complication.
Source
European Journal of Cardio-thoracic Surgery. 52 (4) (pp 665-672), 2017.
Date of Publication: 01 Oct 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Postoperative atrial fibrillation (POAF) is a common, expensive and
potentially morbid complication following cardiac surgery. POAF occurs in
around 35% of cardiac surgery cases and has a peak incidence on
postoperative day 2. Patients who develop POAF incur on average $10
000-$20 000 in additional hospital treatment costs, 12-24 h of prolonged
ICU time, and an additional 2 to 5 days in the hospital. POAF has been
identified as an independent predictor of numerous adverse outcomes,
including a 2- to 4-fold increased risk of stroke, reoperation for
bleeding, infection, renal or respiratory failure, cardiac arrest,
cerebral complications, need for permanent pacemaker placement, and a
2-fold increase in all-cause 30-day and 6-month mortality. The
pathogenesis of POAF is incompletely understood but likely involves
interplay between pre-existing physiological components and local and
systemic inflammation. POAF is associated with numerous risk factors
including advanced age, pre-existing conditions that cause cardiac
remodelling and certain non-cardiovascular conditions. Clinical management
of POAF includes both prophylactic and therapeutic measures, although the
efficacy of many interventions remains in question. This review provides a
comprehensive and up-to-date summary of the pathogenesis of POAF, outlines
current clinical guidelines for POAF prophylaxis and management, and
discusses new avenues for further investigation.<br/>Copyright © 2017
The European Society of Cardiology.
<56>
Accession Number
617044344
Author
Kowalewski M.; Raffa G.M.; Szwed K.A.; Anisimowicz L.
Institution
(Kowalewski, Anisimowicz) Department of Cardiac Surgery, Dr Antoni Jurasz
Memorial University Hospital, Bydgoszcz, Poland
(Kowalewski) Department of Hygiene, Epidemiology and Ergonomics, Division
of Ergonomics and Physical Effort, Collegium Medicum UMK, Bydgoszcz,
Poland
(Szwed) Department of Clinical Neuropsychology, Collegium Medicum UMK,
Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
Title
Meta-analysis to assess the effectiveness of topically used vancomycin in
reducing sternal wound infections after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (4) (pp 1320-1323.e3),
2017. Date of Publication: October 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
<57>
Accession Number
614798887
Author
Vezzani A.; Manca T.; Brusasco C.; Santori G.; Cantadori L.; Ramelli A.;
Gonzi G.; Nicolini F.; Gherli T.; Corradi F.
Institution
(Vezzani, Manca, Ramelli, Nicolini, Gherli) Department of Surgery,
University Hospital of Parma, Parma, Italy
(Brusasco, Corradi) Anaesthesia and Intensive Care Unit, E.O. Ospedali
Galliera, Mura Della Cappuccine 14, Genoa 16128, Italy
(Santori) Department of Surgical Sciences and Integrated Diagnostics,
University of Genoa, Genoa, Italy
(Cantadori) Department of Emergency Medicine, Fidenza Hospital, AUSL of
Parma, Parma, Italy
(Gonzi) Department of Cardiology, University Hospital of Parma, Parma,
Italy
Title
A randomized clinical trial of ultrasound-guided infra-clavicular
cannulation of the subclavian vein in cardiac surgical patients:
short-axis versus long-axis approach.
Source
Intensive Care Medicine. 43 (11) (pp 1594-1601), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: The aim of this study was to compare the success rate and safety
of short-axis versus long-axis approaches to ultrasound-guided subclavian
vein cannulation. Methods: A total of 190 patients requiring central
venous cannulation following cardiac surgery were randomized to either
short-axis or long-axis ultrasound-guided cannulation of the subclavian
vein. Each cannulation was performed by anesthesiologists with at least 3
years' experience of ultrasound-guided central vein cannulation (>150
procedures/year, 50% short-axis and 50% long-axis). Success rate,
insertion time, number of needle redirections, number of separate skin or
vessel punctures, rate of mechanical complications, catheter
misplacements, and incidence of central line-associated bloodstream
infection were documented for each procedure. Results: The subclavian vein
was successfully cannulated in all 190 patients. The mean insertion time
was significantly shorter (p = 0.040) in the short-axis group (69 +/- 74
s) than in the long-axis group (98 +/- 103 s). The short-axis group was
also associated with a higher overall success rate (96 vs. 78%, p <
0.001), first-puncture success rate (86 vs. 67%, p = 0.003), and
first-puncture single-pass success rate (72 vs. 48%, p = 0.002), and with
fewer needle redirections (0.39 +/- 0.88 vs. 0.88 +/- 1.15, p = 0.001),
skin punctures (1.12 +/- 0.38 vs. 1.28 +/- 0.54, p = 0.019), and
complications (3 vs. 13%, p = 0.028). Conclusions: The short-axis
procedure for ultrasound-guided subclavian cannulation offers advantages
over the long-axis approach in cardiac surgery patients.<br/>Copyright
© 2017, Springer-Verlag Berlin Heidelberg and ESICM.
<58>
Accession Number
618659173
Author
Anetsberger A.; Blobner M.; Haller B.; Schmid S.; Umgelter K.; Hager T.;
Langgartner C.; Kochs E.F.; Laugwitz K.-L.; Jungwirth B.; Bernlochner I.
Institution
(Anetsberger, Blobner, Schmid, Umgelter, Hager, Langgartner, Kochs,
Jungwirth) Klinik fur Anasthesiologie, Klinikum rechts der Isar,
Technische Universitat Munchen, Munich, Germany
(Haller) Institut fur Medizinische Statistik und Epidemiologie, Klinikum
rechts der Isar, Technische Universitat Munchen, Munich, Germany
(Laugwitz, Bernlochner) I. Medizinische Klinik und Poliklinik, Klinikum
rechts der Isar, Technische Universitat Munchen, Munich, Germany
Title
Immature platelets as a novel biomarker for adverse cardiovascular events
in patients after non-cardiac surgery.
Source
Thrombosis and Haemostasis. 117 (10) (pp 1887-1895), 2017. Date of
Publication: 2017.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
This study evaluates whether immature platelets (IPF) determined in the
post anesthesia care unit (PACU) can predict major adverse cardiovascular
events (MACE) or other thromboembolic events after intermediate and
high-risk surgery. IPF are increased in patients with acute coronary
syndrome and recently gained interest as novel biomarker for risk
stratification. In this prospective observational trial 732 patients
undergoing intermediate or high-risk non-cardiac surgery were enrolled
(NCT02097602). IPF was measured preoperatively and postoperatively in the
PACU. Primary outcome was a composite endpoint defined as MACE, deep vein
thrombosis or pulmonary embolism during hospital stay (modMACE). A cut off
for IPF identifying a threshold between a low and high risk for modMACE
was calculated by logrank optimization. A multivariate Cox regression was
calculated in a forward stepwise manner to assess the relation between
this IPF cut off and modMACE as well as other established risk factors
(inclusion if p<0.05). Preoperatively, there were no differences in IPF
between patients with and without modMACE (3.1 % [2.2 % - 4.7 %](median
[interquartile range]) vs. 2.8 % [1.9 % - 4.3 %]. Patients with modMACE
(28 of 730 patients; 3.8 %) had higher IPF values in the PACU compared to
patients without modMACE (3.6 % [2.6-6 %] vs. 2.9 % [2-4.4 %]; p=0.011).
The optimal cut off of IPF > 5.4 % was associated with an increased risk
for modMACE after adjustment for covariates (hazard ratio: 2.528; 95 %
confidence interval: 1.156 to 5.528, p=0.02). In conclusion, IPF is an
independent predictor of modMACE after surgery and might improve risk
stratification of surgical patients.<br/>Copyright © Schattauer 2017.
<59>
Accession Number
618782328
Author
Hulst A.H.; Polderman J.A.W.; Ouweneel E.; Pijl A.J.; Hollmann M.W.;
Devries J.H.; Preckel B.; Hermanides J.
Institution
(Hulst, Polderman, Ouweneel, Hollmann, Preckel, Hermanides) Department of
Anaesthesiology Academic Medical Centre, University of Amsterdam Amsterdam
The Netherlands
(Pijl) Department of Anaesthesiology Medical Centre Slotervaart Amsterdam
The Netherlands
(Devries) Department of Internal Medicine Academic Medical Centre,
University of Amsterdam Amsterdam The Netherlands
Title
Peri-operative continuation of metformin does not improve glycaemic
control in patients with type 2 diabetes: A randomized controlled trial.
Source
Diabetes, Obesity and Metabolism. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Historically, metformin was withheld before surgery for fear of
metformin-associated lactic acidosis. Currently, however, this risk is
deemed to be low and guidelines have moved towards the continuation of
metformin. We hypothesized that continuing metformin peri-operatively
would lower postoperative serum glucose level without an effect on plasma
lactate levels. We performed a single-blind multicentre randomized
controlled trial in people with type 2 diabetes mellitus scheduled for
non-cardiac surgery and continued (MF+ group) or withheld (MF- group)
metformin before surgery. The main outcome measures were the differences
in peri-operative plasma glucose and lactate levels. We randomized 70
patients (37 MF+ group and 33 MF- group) with type 2 diabetes mellitus.
Postoperative glucose levels were similar in the MF+ and the MF- groups
(8.2+/-1.8 vs 8.3+/-2.3mmol/L P=.95) Although preoperative lactate levels
were slightly higher in the MF+ group compared with the MF- group (1.5 vs
1.2mmol/L; P=.02), the postoperative lactate levels were not significantly
different (1.2 vs 1.0mmol/L; P=.18). In conclusion, continuation of
metformin during elective non-cardiac surgery does not improve glucose
control or raise lactate levels to a clinically relevant
degree.<br/>Copyright © 2017 John Wiley & Sons Ltd.
<60>
Accession Number
618786431
Author
Tousek P.; Kocka V.; Petr R.; Ulman J.; Hlavicka J.; Kolesar M.
Institution
(Tousek, Kocka, Petr, Ulman, Hlavicka, Kolesar) Cardiocenter, University
Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles
University, Prague, Czech Republic
Title
Use of Amplatzer occluders for treatment of aorto-pulmonary fistulas -
case and review of the literature.
Source
Expert Review of Medical Devices. (pp 1-3), 2017. Date of Publication: 13
Oct 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: the use of amplatzer occluder family in daily clinical
practice has already overcome on-label indications, with growing clinical
experience and the technological evolution of devices. Areas covered: We
present the case of a patient with a very rare complication following
proximal aortic surgery treated using a unique strategy. A huge
pseudoaneurysm around an ascending aortic prosthesis ruptured into the
right pulmonary artery. A hybrid treatment strategy consisting of
percutaneous closure of the fistula followed by cardiosurgery was chosen
due to the patient's poor haemodynamic condition. We also review current
clinical experience of endovascular treatment of aortopulmonary fistulas
by searching case reports in PubMed. Expert commentary: Closure of the APF
using an Amplatzer occluder via the antegrade venous approach is feasible,
and may improve the haemodynamic conditions and decrease the risk of
subsequent cardiac surgery.<br/>Copyright © 2017 Informa UK Limited,
trading as Taylor & Francis Group
<61>
Accession Number
618785012
Author
de Barros Araujo Junior R.; Gonzaga I.C.A.; Fernandes G.A.; Lima A.C.G.;
Cortelazzi P.S.T.; de Oliveira R.A.; Nicolau R.A.
Institution
(de Barros Araujo Junior) Department of Cardiac Surgery, Santa Maria
Hospital, University of Piaui State (UESPI), Rua Olavo Bilac 2335,
Teresina, Piaui 64001-280, Brazil
(Gonzaga, Fernandes, Lima, Nicolau) Lasertherapy and Photobiology Center,
Research and Development Institute, IP&D, Universidade do Vale do Paraiba,
UNIVAP, Avenida Shishima Hifumi, 2911, Sao Jose dos Campos, Sao Paulo
12244-000, Brazil
(Gonzaga, Fernandes, de Oliveira) Uninovafapi College, Rua Vitorino
Orthigues Fernandes 6123, Teresina, Piaui 64003-505, Brazil
(Lima) University of Piaui State (UESPI), Rua Olavo Bilac 2335, Teresina,
Piaui 64001-280, Brazil
(Cortelazzi) Department of Cardiac Surgery, Sao Paulo Hospital, Rua
Lindolfo Monteiro, 1551, Bairro de Fatima, Teresina, PI 64049-440, Brazil
(de Oliveira) Department of Health Sciences, University of Piaui State
(UESPI), Rua Olavo Bilac 2335, Teresina, Piaui 64001-280, Brazil
Title
Low-intensity LED therapy (lambda 640 +/- 20 nm) on saphenectomy healing
in patients who underwent coronary artery bypass graft: a randomized,
double-blind study.
Source
Lasers in Medical Science. (pp 1-7), 2017. Date of Publication: 13 Oct
2017.
Publisher
Springer London
Abstract
Myocardial revascularization surgery (CABG) is the most appropriate
treatment for coronary artery disease. Currently, the great challenge is
to reduce postoperative complications, such as wound infections,
dehiscence, pain, and patients' quality of life. The saphenectomy is the
target of complications in 10% of cases, which can cause greater
morbidity, time, and cost of hospitalization. Studies show that
low-intensity laser or light-emitted diode (LED) therapy promotes positive
biomodulation of the tissue repair process, culminating in a lower
incidence of dehiscence, pain reduction, and improvement in quality of
life. The objective of the present study was to evaluate clinically the
saphenous tissue repair after LED therapy. Forty subjects of both genders
who underwent CABG with extracorporeal circulation were randomly divided
into two groups: the placebo (PG) and experimental (EG). The experimental
group underwent low-intensity LED therapy (lambda 640 +/- 20 nm, 6
J/cm<sup>2</sup>) on saphenectomy. The tissue repair was analyzed by
digital photogrammetry on the first and fifth postoperative day. The
border closure was blindly evaluated by three researchers. The hematoma
and hyperemia area was quantitatively analyzed using ImageJ©
software. The results showed that in the experimental group, there were
less bleeding points and no dehiscence in saphenectomy, as compared to the
placebo group. There was also a smaller area of hematoma and hyperemia in
the experimental group (p < 0.0009). These data lead to the conclusion
that the type of phototherapy protocol employed can assist in tissue
repair.<br/>Copyright © 2017 Springer-Verlag London Ltd.
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