Results Generated From:
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Embase (updates since 2017-12-01)
<1>
Accession Number
619449789
Author
Gopalasingam N.; Hansen M.A.; Thorn S.; Sloth E.; Juhl-Olsen P.
Institution
(Gopalasingam, Hansen, Thorn, Sloth, Juhl-Olsen) Department of
Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N,
Denmark
Title
Ultrasound-guided radial artery catheterisation increases the success rate
among anaesthesiology residents: A randomised study.
Source
Journal of Vascular Access. 18 (6) (pp 546-551), 2017. Date of
Publication: November-December 2017.
Publisher
Wichtig Publishing Srl (E-mail: jean.jones@wichtig.com)
Abstract
Introduction: The palpation technique is generally used for radial artery
catheterisation, but is associated with a high rate of failure and
complications. Dynamic needle tip positioning (DNTP) is a new
ultrasound-guided technique. We aimed to compare the traditional palpation
technique with DNTP performed by four anaesthesiology residents. Methods:
The study was a randomised, controlled, patient-blinded, crossover study.
Fourty patients underwent bilateral radial artery catheterisation using
both techniques. The primary endpoint was the first attempt success rate.
The secondary endpoints were: 1) number of skin perforations, 2) number of
needle retractions, 3) needle manipulation time, 4) total time, 5)
attempts lasting >180 seconds, 6) number of catheters used, 7) frequency
of aborted attempts or crossovers, and 8) pain scores (VAS). Results: The
first attempt success rate was significantly higher in the DNTP group
compared with the palpation group (36/40 vs. 28/40, p = 0.022). The
palpation technique group required a higher number of skin perforations
(44 vs. 60, p = 0.016), needle retractions (p = 0.001) and catheters (42
vs. 52, p = 0.011) compared with the DNTP group. Neither the total time
required for arterial catheterisation, the needle manipulation time nor
the VAS scores were significantly different between the groups (all
p>0.407). Aborted attempts were only seen in the palpation group (7/40, p
= 0.016). Conclusions: Ultrasound-guided arterial catheterisation using
the DNTP technique is superior to the standard palpation technique. This
study favours the ultrasound-guided DNTP technique as the first choice
rather than merely being viewed as a rescue procedure.<br/>Copyright
© 2017 Wichtig Publishing.
<2>
Accession Number
619397142
Author
Divchev D.; Stockl G.
Institution
(Divchev) Department of Cardiology and Angiology, University Hospital
Marburg, Baldingerstrasse, Marburg 35043, Germany
(Stockl) Department of Medical Affairs, Servier Deutschland GmbH, Munich,
Germany
Title
Treatment of Stable Angina with a New Fixed-Dose Combination of Ivabradine
and Metoprolol: Effectiveness and Tolerability in Routine Clinical
Practice.
Source
Cardiology and Therapy. 6 (2) (pp 239-249), 2017. Date of Publication: 01
Dec 2017.
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: In this prospective, multicenter, observational cohort
study, the effectiveness and tolerability of the first fixed-dose
combination (FDC) formulation of the selective heart rate reducing agent
ivabradine and the beta-blocker metoprolol was evaluated in stable angina
pectoris (AP) patients in a clinical practice setting. Methods: Stable AP
outpatients received a FDC of ivabradine and metoprolol (b.i.d.) for 4
months, in addition to cardiovascular standard therapy. Resting heart rate
(HR), number of angina attacks, short-acting nitrate consumption, severity
of symptoms (assessed by patient judgment and documented by CCS score) and
tolerability were documented. Medication adherence was assessed by a
modified four-item Morisky questionnaire. Descriptive statistics were
performed on all data. Results: A total of 747 stable AP patients (mean
age, 66.4 years, 62% male, 50% and 31% with previous PCI and myocardial
infarction, respectively) were included. Apart from ivabradine and
beta-blockers as free combination, most frequently used concomitant
standard medications at baseline were aspirin (68%), statins (71%),
ACEI/AT1-blockers (76%), diuretics (35%), and calcium antagonists (15%).
Highly prevalent comorbidities were hypertension (86%), hyperlipidemia
(65%), and diabetes (35%). After 4 months, switch to treatment with the
FDC was associated with a significant reduction in mean HR by 10 bpm.
Proportion of patients with >= 1 angina attacks/week decreased from 38 to
7%. Patients in CCS class 1 increased (25 to 63%), while they decreased in
CCS class 3 (19 to 5%). Medication adherence was also significantly
improved (p < 0.001 for all changes from baseline). Mostly mild adverse
events were documented in 5.4% of patients. Conclusions: In these stable
AP patients in a real-life setting, treatment with a FDC of ivabradine and
metoprolol was associated with reduced HR and angina symptoms, while
exercise capacity (CCS score) was improved. These effects may be mainly
mediated by the increased medication adherence of patients observed with
use of the FDC formulation. Funding: Servier Trial registration number:
ISRCTN51906157.<br/>Copyright © 2017, The Author(s).
<3>
Accession Number
619425428
Author
Li Y.; Zhang Z.; Xiong X.; Cho W.C.; Hu D.; Gao Y.; Shang H.; Xing Y.
Institution
(Li, Zhang, Xiong, Xing) Department of Cardiology, Guang'anmen Hospital,
Chinese Academy of Chinese Medical Sciences, Beijing, China
(Cho) Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon,
Hong Kong
(Hu) Masonic Medical Research Laboratory, Utica, NY, United States
(Gao, Shang) The Key Laboratory of Chinese Internal Medicine of the
Ministry of Education, Dongzhimen Hospital Affiliated to Beijing
University of Chinese Medicine, Beijing, China
Title
Immediate/Early vs. delayed invasive strategy for patients with
Non-ST-Segment elevation acute coronary syndromes: A systematic review and
meta-analysis.
Source
Frontiers in Physiology. 8 (NOV) (no pagination), 2017. Article Number:
952. Date of Publication: 27 Nov 2017.
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Invasive coronary revascularization has been shown to improve prognoses in
patients with non-ST-segment elevation acute coronary syndromes
(NSTE-ACS), but the optimal timing of intervention remains unclear. This
meta-analysis is to evaluate the outcomes in immediate (< 2 h), early (<
24 h), and delayed invasive group and find out which is the optimal timing
of intervention in NSTE-ACS patients. Studies were identified through
electronic literature search of Medline, PubMed Central, Embase, the
Cochrane Library, and CNKI. Data were extracted for populations,
interventions, outcomes, and risk of bias. All-cause mortality was the
pre-specified primary end point. The longest follow-up available in each
study was chosen. The odds ratio (OR) with 95% CI was the effect measure.
The fixed or random effect pooled measure was selected based on the
heterogeneity test among studies. In the comparison between early and
delayed intervention, we found that early intervention led to a
statistical significant decrease in mortality rate (n = 6,624; OR 0.78,
95% CI: 0.61-0.99) and refractory ischemia (n = 6,127; OR 0.50, 95% CI:
0.40-0.62) and a non-significant decrease in myocardial infarction (MI),
major bleeding and revascularization. In the analysis comparing immediate
and delayed invasive approach, we found that immediate intervention
significantly reduced major bleeding (n = 1,217; OR 0.46, 95% CI:
0.23-0.93) but led to a non-significant decrease in mortality rate,
refractory ischemia and revascularization and a non-significant increase
in MI. In conclusion, early invasive strategy may lead to a lower
mortality rate and reduce the risk of refractory ischemia, while immediate
invasive therapy shows a benefit in reducing the risk of major
bleeding.<br/>Copyright © 2017 Li, Zhang, Xiong, Cho, Hu, Gao, Shang
and Xing.
<4>
Accession Number
619147414
Author
Putzu A.; Clivio S.; Belletti A.; Cassina T.
Institution
(Putzu, Clivio, Cassina) Department of Cardiovascular Anesthesia and
Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
(Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
Title
Perioperative levosimendan in cardiac surgery: A systematic review with
meta-analysis and trial sequential analysis.
Source
International Journal of Cardiology. 251 (pp 22-31), 2018. Date of
Publication: 15 Jan 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background Several studies suggested beneficial effects of perioperative
levosimendan on postoperative outcome after cardiac surgery. However,
three large randomized controlled trials (RCTs) have been recently
published and presented neutral results. We performed a systematic review
with meta-analysis and trial sequential analysis (TSA) to assess benefits
and harms of perioperative levosimendan therapy in cardiac surgery.
Methods Electronic databases were searched up to September 2017 for RCTs
on preoperative levosimendan versus any type of control. The Cochrane
methodology was employed. We calculated odds ratio (OR) or Risk Ratio (OR)
and 95% confidence interval (CI) using fixed-effects meta-analyses and we
further performed TSA. Results We included data from 40 RCTs and 4246
patients. Pooled analysis of 5 low risk of bias trials (1910 patients)
showed no association between levosimendan and mortality (OR 0.86 [95% CI,
0.62, 1.18], p = 0.34, TSA inconclusive), acute kidney injury, need of
renal replacement therapy, myocardial infarction, ventricular arrhythmias,
and serious adverse events, but an association with higher incidence of
supraventricular arrhythmias (RR 1.11 [95% CI, 1.00, 1.24], p = 0.05, TSA
inconclusive) and hypotension (RR 1.15 [95% CI, 1.01, 1.30], p = 0.04, TSA
inconclusive). Analysis including all 40 trials found that levosimendan
was associated with lower postoperative mortality (OR 0.56 [95% CI, 0.44,
0.71], p < 0.00001, TSA conclusive), acute kidney injury, and renal
replacement therapy, and higher incidence of hypotension. Conclusions
There is not enough high-quality evidence to neither support nor
discourage the systematic use of levosimendan in cardiac
surgery.<br/>Copyright © 2017 Elsevier B.V.
<5>
Accession Number
617931165
Author
Villablanca P.A.; Al-Bawardy R.; Mohananey D.; Maraboto C.; Weinreich M.;
Gupta T.; Briceno D.F.; Ramakrishna H.
Institution
(Villablanca) New York University Langone Medical Center, New York, NY,
United States
(Al-Bawardy) Division of Cardiology, Massachusetts General
Hospital/Harvard Medical School, Boston, MA, United States
(Mohananey) Department of Internal Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Maraboto) Department of Medicine, Jacobi Medical Center/Albert Einstein
College of Medicine, New York, NY, United States
(Weinreich, Gupta, Briceno) Division of Cardiovascular Diseases,
Montefiore Medical Center/Albert Einstein College of Medicine, New York,
NY, United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic College of Medicine, Scottsdale, AZ, United States
Title
Bivalirudin versus heparin in patients undergoing percutaneous
transcatheter aortic valve interventions: A systematic review and
meta-analysis.
Source
Journal of Interventional Cardiology. 30 (6) (pp 586-594), 2017. Date of
Publication: December 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Bivalirudin may be an effective anticoagulation alternative to
heparin as anticoagulant agent in percutaneous transcatheter aortic valve
interventions (PAVI). We aimed to compare safety and efficacy of
bivalirudin versus heparin as the procedural anticoagulant agent in
patients undergoing PAVI. Methods: We conducted an electronic database
search of all published data. The primary efficacy endpoints were
all-cause mortality, cardiovascular mortality, myocardial infarction, and
stroke. Safety endpoints include major and life-threatening bleed
according to VARC and BARC bleeding, blood transfusion, vascular
complications, and acute kidney injury. Odds ratios (OR) and 95%
confidence intervals (CI) computed using the Mantel-Haenszel method.
Results: Three studies (n = 1690 patients) were included, one randomized
trial and two observational studies. There was a significant difference
favoring bivalirudin over heparin for myocardial infarction (OR 0.41,
95%CI 0.20-0.87). There was no significant difference in all-cause
mortality at 30 days (OR 0.97, 95%CI 0.62-1.52), cardiovascular mortality
(OR 1.03, 95%CI 0.52-2.05), stroke (OR 1.23, 95%CI 0.62-2.46), vascular
complications (OR 0.96, 95%CI 0.70-1.32), acute kidney injury (OR 1.03,
95%CI 0.53-2.00), blood transfusion (OR 0.67, 95% CI 0.45-1.01), major and
life-threatening bleed (OR 0.74, 95%CI 0.37-1.49), and BARC bleeding (OR
0.52, 95%CI 0.23-1.18). Conclusions: In patient undergoing aortic valve
interventions, no difference was seen between the use of bivalirudin and
heparin as the procedural anticoagulant agent, except for a significant
lower myocardial infarction events when bivalirudin was used. Further
large randomized trials are needed to confirm current
results.<br/>Copyright © 2017, Wiley Periodicals, Inc.
<6>
Accession Number
619471685
Author
Fitch Z.W.; Deng J.Z.; Yang C.-F.J.; D'Amico T.A.
Institution
(Fitch, Deng, Yang, D'Amico) Duke University Medical Center, Durham, NC,
United States
Title
Design of interventional studies in thoracic surgery.
Source
Journal of Thoracic Disease. 9 (10) (pp 4114-4116), 2017. Date of
Publication: 01 Oct 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Interventional studies differ from observational studies in that one or
more specific interventions are evaluated. Randomized controlled trials
remain the gold standard for interventional studies and can take different
forms. In surgical studies, the three types of randomized controlled
trials most commonly encountered are: (I) trials that compare two
different medical treatments for patients undergoing surgery; (II) trials
that evaluate two different surgical techniques and (III) studies that
compare surgery vs. non-operative management. When an intervention is to
be evaluated but a randomized controlled trial is not feasible,
alternative interventional study designs may be considered.<br/>Copyright
© Journal of Thoracic Disease.
<7>
Accession Number
619506089
Author
Buentzel J.; Heinz J.; Hinterthaner M.; Schondube F.A.; Straube C.; Roever
C.; Emmert A.
Institution
(Buentzel, Straube) Department of Haematology and Oncology, University
Medical Center, Georg-August University, Gottingen, Germany
(Heinz, Roever) Department of Medical Statistics, University Medical
Center, Georg-August University, Gottingen, Germany
(Hinterthaner, Schondube, Emmert) Department of Thoracic and
Cardiovascular Surgery, University Medical Center, Georg-August
University, Gottingen, Germany
Title
Robotic versus thoracoscopic thymectomy: The current evidence.
Source
International Journal of Medical Robotics and Computer Assisted Surgery.
13 (4) (no pagination), 2017. Article Number: e1847. Date of Publication:
December 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The purpose of this study was to analyze all relevant
comparative studies comparing robot-assisted minimally invasive thymectomy
(RATS) and video-assisted thoracic surgery thymectomy (VATS) in terms of
surgical and short-term outcomes. Methods: A systematic search for
articles describing robot-assisted and video-assisted thymectomy and
addressing surgical outcomes, operation time, length of hospitalization,
intra-operative blood loss, conversion to sternotomy and post-operative
complications was performed using the medical databases. Results: Of the
478 studies from preliminary screening, five articles were included. By
pooling these studies, we found no significant differences between the
RATS and VATS (odds ratio 1.24 (95% CI 0.51, 3.03; p = 0.63)).There were
no significant differences in comparison of conversion rates, operation
time (26.29 min (95% CI -2.57, 55.35; p = 0.07)) and length of
hospitalization (-1.58 days (95% CI -4.78, 1.62; p = 0.33)). There was a
slightly higher blood loss in the RATS group. Conclusion: Our
meta-analysis did not detect any statistically significant differences in
surgery outcomes between the two groups.<br/>Copyright © 2017 John
Wiley & Sons, Ltd.
<8>
Accession Number
619504183
Author
Coulson T.G.; Mullany D.V.; Reid C.M.; Bailey M.; Pilcher D.
Institution
(Reid, Bailey) School of Public Health and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(Mullany) Critical Care Research Group, Prince Charles Hospital,
University of Queensland, Brisbane, Australia
(Pilcher) Department of Intensive Care, Alfred Hospital, 55 Commercial Rd,
Melbourne, VIC 3004, Australia
(Pilcher) ANZICS Centre for Outcome and Resource Evaluation, Ievers
Terrace, Carlton, Melbourne, VIC, Australia
Title
Measuring the quality of perioperative care in cardiac surgery.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (1) (pp
11-19), 2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Quality of care is of increasing importance in health and surgical care.
In order to maintain and improve quality, we must be able to measure it
and identify variation. In this narrative review, we aim to identify
measures used in the assessment of quality of care in cardiac surgery and
to evaluate their utility. The electronic databases Pubmed/MEDLINE,
EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane
Database of Systematic Reviews, and CINAHL were searched for original
published studies using the terms 'cardiac surgery' and 'quality or
outcome or process or structure' as either keywords in the title or text
or MeSH terms. Secondary searches and identification of references from
original articles were carried out. We found a total of 54 original
articles evaluating measurements of quality. While structure, process, and
outcome indicators remain the mainstay of quality measurement, new and
innovative methods of risk assessment have improved reliability and
discrimination. Continuous assessment provides a promising method of both
maintaining and improving quality of care. Future studies should focus on
long-term and patient-centred outcomes, such as quality-of-life
measures.<br/>Copyright © The Author 2016.
<9>
Accession Number
619514336
Author
Miles L.F.; Kunz S.A.; Na L.H.; Braat S.; Burbury K.; Story D.A.
Institution
(Miles) Department of Anaesthesia and Anaesthetic Peri-operative and Pain
Medicine Unit Melbourne School of Population and Global Health and
Melbourne Clinical and Translational Science Platform (MCATS) University
of Melbourne Melbourne Australia
(Kunz) Department of Cardiac Surgery Austin Health Melbourne School of
Population and Global Health and Melbourne Clinical and Translational
Science Platform (MCATS) University of Melbourne Melbourne Australia
(Na, Braat) Melbourne School of Population and Global Health and Melbourne
Clinical and Translational Science Platform (MCATS) University of
Melbourne Melbourne Australia
(Burbury) Department of Haematology Victorian Comprehensive Cancer Centre
Melbourne School of Population and Melbourne Clinical and Translational
Science Platform (MCATS) University of Melbourne Melbourne Australia
(Story) Anaesthetic Peri-operative and Pain Medicine Unit and Melbourne
Clinical and Translational Science Platform (MCATS) University of
Melbourne Melbourne Australia
Title
Postoperative outcomes following cardiac surgery in non-anaemic
iron-replete and iron-deficient patients - an exploratory study.
Source
Anaesthesia. (no pagination), 2017. Date of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Iron deficiency anaemia is strongly associated with poor outcomes after
cardiac surgery. However, pre-operative non-anaemic iron deficiency (a
probable anaemia precursor) has not been comprehensively examined in
patients undergoing cardiac surgery, despite biological plausibility and
evidence from other patient populations of negative effect on outcome.
This exploratory retrospective cohort study aimed to compare an
iron-deficient group of patients undergoing cardiac surgery with an
iron-replete group. Consecutive non-anaemic patients undergoing elective
coronary artery bypass grafting or single valve replacement in our
institution between January 2013 and December 2015 were considered for
inclusion. Data from a total of 277 patients were analysed, and were
categorised by iron status and blood haemoglobin concentration into
iron-deficient (n = 109) and iron-replete (n = 168) groups. Compared with
the iron-replete group, patients in the iron-deficient group were more
likely to be female (43% vs. 12%, iron-replete, respectively); older, mean
(SD) age 64.4 (9.7) vs. 63.2 (10.3) years; and to have a higher
pre-operative EuroSCORE (median IQR [range]) 3 (2-5 [0-10]) vs. 3 (2-4
[0-9]), with a lower preoperative haemoglobin of 141.6 (11.6) vs. 148.3
(11.7) g.l<sup>-1</sup>. Univariate analysis suggested that iron-deficient
patients had a longer hospital length of stay (7 (6-9 [2-40]) vs. 7 (5-8
[4-23]) days; p = 0.013) and fewer days alive and out of hospital at
postoperative day 90 (83 (80-84 [0-87]) vs. 83 (81-85 [34-86]), p =
0.009). There was no evidence of an association between iron deficiency
and either lower nadir haemoglobin or higher requirement for blood
products during inpatient stay. After adjusting the model for
pre-operative age, sex, renal function, EuroSCORE and haemoglobin, the
mean increase in hospital length of stay in the iron-deficient group
relative to the iron-replete group was 0.86 days (bootstrapped 95%CI -0.37
to 2.22, p = 0.098). This exploratory study suggests there is weak
evidence of an association between non-anaemic iron deficiency and outcome
after cardiac surgery after controlling for potentially confounding
variables. 2017<br/>Copyright © The Association of Anaesthetists of
Great Britain and Ireland.
<10>
Accession Number
619507954
Author
Ma S.; Yan T.; Liu D.; Wang K.; Wang J.; Song J.; Wang T.; He W.; Bai J.;
Jin L.; Liang H.
Institution
(Ma, Yan, Liu, Wang, Wang, Song, Wang, He, Bai, Jin, Liang) Department of
Thoracic Surgery Peking University Third Hospital Beijing China
Title
Initial experience of sleeve lobectomy under complete video-assisted
thoracic surgery.
Source
Asia-Pacific Journal of Clinical Oncology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Purpose: Review the initial results of a single-center complete
video-assisted thoracoscopic surgery (VATS) sleeve lobectomy and discuss
the key procedure of this operation, in addition to its safety and
feasibility. Methods: Retrospectively analyze the perioperative data of 11
patients who accepted complete VATS sleeve lobectomy between May 2013 and
Jun 2017 in Peking University Third Hospital, try to evaluate the safety
of this procedure. All the patients were followed up and their oncological
recurrence and metastasis were observed, and feasibility of VATS sleeve
lobectomy for lung cancer was evaluated. Results: All of the 11 cases
underwent complete VATS sleeve lobectomy successfully and there is no
conversion to thoracotomy. The mean operative time was 338 min (range from
243 to 511 min), the mean time of bronchial anastomotic was 63 min (range
from 40 to 96 min), the mean blood loss was 205 mL (range from 50 to 400
mL), and the mean number of lymph nodes dissected is 22.1. There was no
other complication except one patient suffered from high-risk pulmonary
embolism, and no anastomotic leakage and stricture was found. The mean
hospital stay postoperation was 8.7 days. The time of follow-up was
between 2 and 38 months, only one out of the 11 cases died of bone
metastasis, and the other 10 survived till now. One of these 10 patients
had local recurrence 24 months after operation, and one suffered
adenocarcinoma of esophageal-gastric junction at 15 months postoperation.
The rest of eight patients all survived to June 2017 and no local
recurrence and metastasis was found. The mean survival time was 14.8
months. Conclusion: Complete VATS sleeve lobectomy is a safe and feasible
procedure, but the advantage of perioperative and long-term survival need
prospective randomized controlled large sample trial to be
confirmed.<br/>Copyright © 2017 John Wiley & Sons Australia, Ltd.
<11>
Accession Number
619359373
Author
Efremov S.; Lomivorotov V.; Stoppe C.; Shilova A.; Shmyrev V.; Deryagin
M.; Karaskov A.
Institution
(Efremov, Lomivorotov, Shmyrev, Deryagin, Karaskov) Department of
Anesthesiology and Intensive Care, E. Meshalkin National Medical Research
Center, Novosibirsk 630055, Russian Federation
(Stoppe) Department of Intensive Care Medicine, University Hospital, RWTH
Aachen University, Aachen 52074, Germany
(Shilova) Laboratory Diagnostics Department, E. Meshalkin National Medical
Research Center, Novosibirsk 630055, Russian Federation
Title
Standard vs. Calorie-dense immune nutrition in haemodynamically
compromised cardiac patients: A prospective randomized controlled pilot
study.
Source
Nutrients. 9 (11) (no pagination), 2017. Article Number: 1264. Date of
Publication: 20 Nov 2017.
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland)
Abstract
Background. The aim of study was to test the hypothesis that early enteral
nutrition (EN) with calorie-dense and protein rich enteral formula
improves enteral energy and protein delivery in critically ill cardiac
patients. Methods. Prospective randomized pilot study of 40 ventilated
adult patients undergoing elective cardiac surgery with use of
cardiopulmonary bypass receiving inotropic support postoperatively.
Patients were to receive either standard isocaloric (1000 Kcal/L and 38
g/L protein) early EN (n = 20) or calorie-dense and protein-rich (1300
Kcal/L and 66.7 g/L protein) early EN (n = 20). Results. The mean time to
EN initiation was 27 +/- 11 h. Early EN with the calorie-dense formula
provided significantly more energy and protein enteral delivery on the
2nd, (p < 0.0001), 5th (p = 0.036), and 7th days (p = 0.024), and was
associated with higher levels of prealbumin concentration on the 14th day
(0.13 +/- 0.01 g/L and 0.21 +/- 0.1 g/L; p = 0.04) and significantly
increased levels of transferrin on the 3rd, 5th, and 7th day (p < 0.05)
after surgery. Conclusion. Present findings support hypothesis that early
EN using a calorie-dense and protein rich formula leads to better enteral
energy and protein delivery and higher levels of short-lived serum
proteins.<br/>Copyright © 2017 by the authors. Licensee MDPI, Basel,
Switzerland.
<12>
Accession Number
619342216
Author
Kamali A.; Hosseini A.; Sharifi M.; Pazuki S.
Institution
(Kamali, Pazuki) Department of Anesthesiology, Arak University of Medical
Sciences, Arak, Iran, Islamic Republic of
(Hosseini, Sharifi) Department of Surgery, Arak University of Medical
Sciences, Arak, Iran, Islamic Republic of
Title
A comparative study of the effect of metoral and magnesium prophylactic in
controlling atrial fibrillation after coronary arteries bypass operation.
Source
Biomedical Research (India). 28 (19) (pp 8449-8453), 2017. Date of
Publication: 2017.
Publisher
Scientific Publishers of India (E-mail: qayyum@del3.vsnl.net.in)
Abstract
Objective: Arterial fibrillation is the most common type of arrhythmia
observed after coronary arteries bypass operation and culminates in
hemodynamic instability, higher morbidity and mortality rate, longer
period of hospitalization, and higher hospital expenditures. The present
research seeks to compare the effect of metoral, magnesium prophylactic,
and a mixture of both (magnesium and metoral) in reducing the occurrence
of CABG (coronary arteries bypass graft). Methods: This is a double blind
clinical trial where 195 patients candidated for CABG were selected based
upon exclusion and inclusion criteria and randomly divided into three
groups of metoral (receiving 5 mg metoral), magnesium (receiving 1.5 g
magnesium), and combined (2.5 mg metoral+1 g magnesium). The resulting
information was then analyzed using SPSS v.19 and ANOVA statistical tests.
Results: A significant difference was observed between the three groups in
terms of post-operation AF and other types of arrhythmia. Higher rates of
post-operation AF were observed in magnesium group than the two other
groups (P=0.001). On the other hand, higher rates of post-operation AF
were observed in the combined group than what was observed in metoral
group (0% vs. 4.5%). The occurrence of other types of post-operation
arrhythmia in the combined group was more than what was observed in the
other two groups (P=0.001). Conclusion: Both metoral and magnesium are
really useful in reducing post-operation AF among the patients with CABG,
while metoral was more effective than magnesium. On the other hand, adding
magnesium to metoral can clearly enhance its prophylactic
effects.<br/>Copyright © 2017, Scientific Publishers of India. All
rights reserved.
<13>
Accession Number
615407118
Author
Ray Mohapatra C.K.; Mishra P.; Saxena P.; Raut C.; Khandekar J.; Ammannaya
G.K.; Seth H.S.; Shah V.; Singh J.
Institution
(Ray Mohapatra, Mishra, Raut, Khandekar, Ammannaya, Seth, Shah, Singh)
Department of Cardiovascular & Thoracic Surgery, Lokmanya Tilak Municipal
Medical College & Sion Hospital, Mumbai, India
(Saxena) Department of Cardiothoracic Surgery, The Townsville Hospital,
James Cook University, Australia
Title
Use of nitroglycerin and verapamil solution by organ bath technique in
preparation of left internal thoracic artery for coronary artery bypass
surgery.
Source
Indian Heart Journal. 69 (6) (pp 772-776), 2017. Date of Publication:
November 2017.
Publisher
Elsevier B.V.
Abstract
Background The aim of this prospective study was to compare the effect of
application of nitroglycerin and verapamil solution (GV) by organ bath
technique with other methods of applications and solutions on the free
blood flow of LITA. The technique was not described for in situ graft
before. Method The patients were randomly assigned to four groups: group I
(n_32, GV solution by organ bath technique), group II (n_30, papaverine
solution by organ bath technique), group III (n_29, topical GV solution)
or group IV (n_29, topical papaverine solution). In each patient, pedicled
LITA was harvested; thereafter applied with the randomized different
methods and solutions. The free flow from the distal end of the divided
LITA was measured for 15 s under controlled hemodynamic conditions after
harvesting (Flow 1). The flow of LITA was measured again just prior to
anastomosing the conduit (Flow 2). Result The mean blood flow in LITA was
56.2 +/- 5.0 ml/min before application of solutions. After application,
the mean blood flow in group I:102.3 +/- 7.0 ml/min, in group II: 92.7 +/-
3.4 ml/min, and in group III: 88.6 +/- 2.2 ml/min and in group IV: 81.4
+/- 2.1. Proportional increases in blood flow observed in group I (82.6%)
> group II (65.1%)?> group III (57.6) > group IV (44.8%) (p < 0.05).
Conclusions GV solution by organ bath technique is effective and superior
in comparison to use of papaverine using organ bath technique or topical
spray of GV or papaverine solution.<br/>Copyright © 2017
Cardiological Society of India
<14>
Accession Number
618107545
Author
Solomon D.H.; Husni M.E.; Libby P.A.; Yeomans N.D.; Lincoff A.M.;
Lupsilonscher T.F.; Menon V.; Brennan D.M.; Wisniewski L.M.; Nissen S.E.;
Borer J.S.
Institution
(Solomon, Libby) Brigham and Women's Hospital, Boston, Mass, United States
(Husni, Lincoff, Menon, Brennan, Wisniewski, Nissen) Cleveland Clinic,
Cleveland, Ohio, United States
(Yeomans) Western Sydney University, Sydney, NSW, Australia
(Yeomans) University of Melbourne, Melbourne, Australia
(Luscher) University of Zurich, Zurich, Switzerland
(Borer) SUNY Downstate Medical Center, Brooklyn, NY, United States
Title
The Risk of Major NSAID Toxicity with Celecoxib, Ibuprofen, or Naproxen: A
Secondary Analysis of the PRECISION Trial.
Source
American Journal of Medicine. 130 (12) (pp 1415-1422.e4), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The relative safety of long-term use of nonsteroidal
anti-inflammatory drugs is unclear. Patients and providers are interested
in an integrated view of risk. We examined the risk of major nonsteroidal
anti-inflammatory drug toxicity in the PRECISION trial. Methods We
conducted a post hoc analysis of a double-blind, randomized, controlled,
multicenter trial enrolling 24,081 patients with osteoarthritis or
rheumatoid arthritis at moderate or high cardiovascular risk. Patients
were randomized to receive celecoxib 100 to 200 mg twice daily, ibuprofen
600 to 800 mg thrice daily, or naproxen 375 to 500 mg twice daily. All
patients were provided with a proton pump inhibitor. The outcome was major
nonsteroidal anti-inflammatory drug toxicity, including time to first
occurrence of major adverse cardiovascular events, important
gastrointestinal events, renal events, and all-cause mortality. Results
During follow-up, 4.1% of subjects sustained any major toxicity in the
celecoxib arm, 4.8% in the naproxen arm, and 5.3% in the ibuprofen arm.
Analyses adjusted for aspirin use and geographic region found that
subjects in the naproxen arm had a 20% (95% CI 4-39) higher risk of major
toxicity than celecoxib users and that 38% (95% CI 19-59) higher risk.
These risks translate into numbers needed to harm of 135 (95% CI, 72-971)
for naproxen and 82 (95% CI, 53-173) for ibuprofen, both compared with
celecoxib. Conclusions Among patients with symptomatic arthritis who had
moderate to high risk of cardiovascular events, approximately 1 in 20
experienced a major toxicity over 1 to 2 years. Patients using naproxen or
ibuprofen experienced significantly higher risk of major toxicity than
those using celecoxib.<br/>Copyright © 2017 Elsevier Inc.
<15>
Accession Number
618784261
Author
Papademetriou V.; Nylen E.S.; Doumas M.; Probstfield J.; Mann J.F.E.;
Gilbert R.E.; Gerstein H.C.
Institution
(Papademetriou, Nylen) Veterans Administration Medical Center, Washington,
DC, United States
(Papademetriou) Georgetown University Medical Center, Washington, DC,
United States
(Nylen, Doumas) George Washington University Medical Centers, Washington,
DC, United States
(Doumas) Aristotle University of Thessaloniki, Greece
(Probstfield) University of Washington, Seattle, United States
(Mann) KfH kidney Center, Munchen, Germany
(Gilbert) St. Michael's Hospital, University of Toronto, Ontario, Canada
(Gerstein) Department of Medicine and Population Health Research
Institute, McMaster University and Hamilton Health Sciences, Hamilton,
Ontario, Canada
Title
Chronic Kidney Disease, Basal Insulin Glargine, and Health Outcomes in
People with Dysglycemia: The ORIGIN Study.
Source
American Journal of Medicine. 130 (12) (pp 1465.e27-1465.e39), 2017. Date
of Publication: December 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Early stages of chronic kidney disease are associated with an
increased cardiovascular risk in patients with established type 2 diabetes
and macrovascular disease. The role of early stages of chronic kidney
disease on macrovascular outcomes in prediabetes and early type 2 diabetes
mellitus is not known. In the Outcome Reduction with an Initial Glargine
Intervention (ORIGIN) trial, the introduction of insulin had no effect on
cardiovascular outcomes compared with standard therapy. In this post hoc
analysis of ORIGIN, we compared cardiovascular outcomes in subjects
without to those with mild (Stages 1-2) or moderate chronic kidney disease
(Stage 3). Methods Two co-primary composite cardiovascular outcomes were
assessed. The first was the composite end point of nonfatal myocardial
infarction, nonfatal stroke, or death from cardiovascular causes; and the
second was a composite of any of these events plus a revascularization
procedure, or hospitalization for heart failure. Several secondary
outcomes were prespecified, including microvascular outcomes, incident
diabetes, hypoglycemia, weight, and cancers. Results Complete renal
function data were available in 12,174 of 12,537 ORIGIN participants. A
total of 8114 (67%) had no chronic kidney disease, while 4060 (33%) had
chronic kidney disease stage 1-3. When compared with nonchronic kidney
disease participants, the risk of developing the composite primary outcome
(nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death)
in those with mild to moderate chronic kidney disease was 87% higher;
hazard ratio (HR) 1.87; 95% confidence interval (CI), 1.71-2.04 (P
<.0001). The presence of chronic kidney disease 1-3 was also associated
with a greater than twofold higher risk for both all-cause mortality (HR
2.17; 95% CI, 1.98-2.38; P <.0001) and cardiovascular mortality (HR 2.39;
95% CI, 2.13-2.69; P <.0001). Moreover, patients with mild to moderate
chronic kidney disease had significantly higher risk for nonfatal
myocardial infarction (50%), nonfatal stroke (68%), any stroke (84%), the
above composite primary end point plus revascularization or heart failure
requiring hospitalization (59%), or a major coronary artery disease event
(56%). Furthermore, in patients with chronic kidney disease and early
diabetes mellitus type 2, the primary end point occurred 83% more
frequently as compared with nonchronic kidney disease participants (HR
1.83; 95% CI, 1.67-2.01; P <.001) and in patients with prediabetes and
chronic kidney disease 67% more frequently (HR 1.67; 95% CI,1.25-2.24; P
<.001). Conclusions In high-risk patients with dysglycemia (prediabetes
and early diabetes), mild and moderate chronic kidney disease
significantly increased cardiovascular events.<br/>Copyright © 2017
<16>
Accession Number
617056265
Author
Bai A.D.; Agarwal A.; Steinberg M.; Showler A.; Burry L.; Tomlinson G.A.;
Bell C.M.; Morris A.M.
Institution
(Bai) Department of Medicine, Queen's University, Kingston, Ontario,
Canada
(Agarwal) Faculty of Medicine, University of Toronto, Toronto, Ontario,
Canada
(Agarwal) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, Ontario, Canada
(Steinberg, Burry, Bell, Morris) Sinai Health System, Toronto, Ontario,
Canada
(Showler, Tomlinson, Bell, Morris) Department of Medicine, University of
Toronto, Toronto, Ontario, Canada
(Burry) Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto,
Ontario, Canada
(Tomlinson, Bell, Morris) University Health Network, Toronto, Ontario,
Canada
(Bell) Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
Title
Clinical predictors and clinical prediction rules to estimate initial
patient risk for infective endocarditis in Staphylococcus aureus
bacteraemia: a systematic review and meta-analysis.
Source
Clinical Microbiology and Infection. 23 (12) (pp 900-906), 2017. Date of
Publication: December 2017.
Publisher
Elsevier B.V. (E-mail: customerservices@oxonblackwellpublishing.com)
Abstract
Objectives We conducted a meta-analysis to summarize diagnostic properties
of risk factors and clinical prediction rules for diagnosing infective
endocarditis (IE) in Staphylococcus aureus bacteraemia (SAB). Methods We
searched MEDLINE, Embase, and the Cochrane Database from inception to 6
January 2016 to identify studies evaluating risk factors and clinical
prediction rules for IE in SAB patients. Pooled estimates of diagnostic
properties for main risk factors were calculated using a bivariate random
effects model. Results Of 962 articles identified, 30 studies were
included. These involved 16 538 SAB patients including 1572 IE cases. Risk
factors with positive likelihood ratio (PLR) greater than 5 included
embolic events (PLR 12.7, 95% CI 9.2-17.7), pacemakers (PLR 9.7, 95% CI
3.7-21.2), history of previous IE (PLR 8.2, 95% CI 3.1-22.0), prosthetic
valves (PLR 5.7, 95% CI 3.2-9.5), and intravenous drug use (PLR 5.2, 95%
CI 3.8-6.9). The only clinical factor with negative likelihood ratio (NLR)
less than 0.5 was documented clearance of bacteraemia within 72 hours (NLR
range 0.32-0.35). Of the nine published clinical prediction rules for
ruling out IE, five had an NLR below 0.1. Conclusions SAB patients with
high-risk features (embolic events, pacemakers, prosthetic valves,
previous IE, or intravenous drug use) should undergo a trans-esophageal
echocardiography (TEE) for IE. Clinical prediction rules show promise in
safely ruling out endocarditis, but require validation in future
studies.<br/>Copyright © 2017 European Society of Clinical
Microbiology and Infectious Diseases
<17>
Accession Number
617716751
Author
Iliadis C.; Lee S.; Kuhr K.; Metze C.; Matzik A.-S.; Michels G.; Rudolph
V.; Baldus S.; Pfister R.
Institution
(Iliadis, Lee, Metze, Matzik, Michels, Rudolph, Baldus, Pfister)
Department III of Internal Medicine, Heart Center, University of Cologne,
Kerpener Str. 62, Cologne 50937, Germany
(Kuhr) Institute of Medical Statistics, Informatics and Epidemiology,
University of Cologne, Cologne, Germany
Title
Functional status and quality of life after transcatheter mitral valve
repair: a prospective cohort study and systematic review.
Source
Clinical Research in Cardiology. 106 (12) (pp 1005-1017), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Estimating the quantitative effect of transcatheter mitral
valve repair on functional parameters and quality of life is important for
individual treatment decision-making. Methods: We combined data from a
prospective monocentric cohort study (N = 215) with data from a systematic
literature review (PubMed search term "mitraclip", till 30.04.2016) on
patients undergoing MitraClip with at least mortality after discharge
reported as an outcome. Effects on functional parameters were reported as
range of mean change. Results: 36 observational studies and 1 randomized
controlled trial were identified. Due to substantial heterogeneity of
effect estimates (I<sup>2</sup>-heterogeneity >75%) and inadequate quality
of studies with a lack of comparison group in 97.4% and lack of an
independent assessment of outcomes in 86.8%, no pooled estimates were
calculated. All studies reported improvements of mean New York Heart
Association (NYHA) class (0.5-1.9 classes), Short-Form (SF)-12/36 scores
(4.4-9.2 for physical component score, 2.6-8.9 for mental component
score), 6-min walk distance [(6MWD) 2-336 m] and Minnesota Living with
Heart failure questionnaire (MLWHFQ) score (-7 to -18 points), with
improvements regarded as clinically relevant in 20 of 29 studies for NYHA
class, in all of 7 studies for SF12/36, in 9 of 15 studies for 6MWD and in
all of 8 studies for MLWHFQ. Conclusion: MitraClip therapy provides
improvements in physical capacity, physical and mental functioning and
disease-specific quality of life in the majority of patients. However,
more comparative and high-quality studies are required for understanding
the heterogeneity of results, which is crucial for optimal patient
selection.<br/>Copyright © 2017, Springer-Verlag GmbH Germany.
<18>
Accession Number
619361548
Author
Reyes Valdivia A.A.; Duque Santos A.; Romero Lozano M.A.; Garnica Urena
M.; Ocana Guaita J.L.; Gandarias Zuniga C.
Institution
(Reyes Valdivia, Duque Santos, Romero Lozano, Garnica Urena, Ocana Guaita,
Gandarias Zuniga) Servicio de Angiologia y Cirugia Vascular, Hospital
Ramon y Cajal, Madrid, Spain
Title
Preliminary report on arterial stiffness changes after endovascular
aneurysm repair with a bifurcated, branched, and a sealed system
endoprosthesis.
Source
Angiologia. 69 (6) (pp 348-353), 2017. Date of Publication: November 2017.
Publisher
Viguera Editores S.L. (E-mail: cvig@vigueraeditores.com)
Abstract
Introduction Patients with diagnosis of abdominal aortic aneurysm (AAA)
are known to have an increased cardiovascular risk. Open surgery has been
the traditional approach however, endovascular repair has widely expanded
due to the lower peri-operative risk. Arterial stiffness has been
suggested to change and elevate after aortic stent-graft implantation.
Material and methods As part of a study registered in National Institutes
of Health website (ClinicalTrials.gov) with NCT02642952, a description is
presented of 3 groups with endovascular treatment of AAA with different
endografts and mechanisms. Group A with standard bifurcated endograft,
group B with a branched (4 branches) device, and group C with a sac
sealing device. Each group included 2 patients. A report is presented on
the individual changes of arterial stiffness measured by carotid-radial
pulse wave velocity (PWV) and Augmentation Index (AIx). Results All the
patients included were men, older than 70 years, with AAA greater than 55
mm, and high-risk (ASA III) patients. We observed a variable change in
carotid-radial PWV and IA@75 in the postoperative period in all patients
studied. Conclusions It seems that endovascular devices in the treatment
of AAAs are implicated in the change of arterial stiffness measurements.
More randomised studies, with larger samples comparing the different types
of endografts are required. The long-term impact on cardiovascular
outcomes needs further investigation.<br/>Copyright © 2017 SEACV
<19>
Accession Number
619487640
Author
Quisi A.; Kurt I.H.; Sahin D.Y.; KaypaklI O.; Soker G.; Kaya O.;
Allahverdiyev S.; Genc O.; Alici G.; Koc M.
Institution
(Quisi, Kurt, Sahin, KaypaklI, Allahverdiyev, Genc, Alici, Koc) Department
of Cardiology, Adana Numune Training and Research Hospital, Health
Sciences University, Adana 01170, Turkey
(Soker, Kaya) Department of Radiology, Adana Numune Training and Research
Hospital, Adana, Turkey
Title
Evaluation of the relationship between renal resistive index and extent
and complexity of coronary artery disease in patients with acute coronary
syndrome.
Source
Kardiologia Polska. 75 (11) (pp 1199-1207), 2017. Date of Publication: 22
Nov 2017.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Despite advances in cardiovascular medicine, acute coronary
syndrome (ACS) is still a major cause of morbidity and mortality
worldwide. Synergy between percutaneous coronary intervention with TAXUSTM
and Cardiac Surgery (SYNTAX) score is used to determine the extent and
complexity of coronary artery disease (CAD). Renal resistive index (RRI),
a renal Doppler ultrasound parameter, is used to detect renal
haemodynamics. Although some risk factors for CAD, including hypertension
and diabetes mellitus, were demonstrated to have an association with RRI;
a direct relationship between the presence, extent, and complexity of CAD
and RRI has not been investigated yet. Aim: In this study, we evaluated
the relationship between RRI and SYNTAX score in patients with ACS.
Methods: This cross-sectional study enrolled 235 patients who were
diagnosed with ACS and underwent coronary angiography at our tertiary
clinic between February 2016 and August 2016. Regarding clinical
presentation, 112 patients were diagnosed with non-ST-segment elevation
ACS (NSTE-ACS) and 123 patients were diagnosed with ST-segment elevation
ACS (STE-ACS). The patients' demographic, clinical, laboratory,
echocardiographic data, SYNTAX scores and measurements of renal Doppler
ultrasound parameters, including RRI, renal pulsatility index (RPI) and
acceleration time (AT) were recorded. Results: Among 235 patients, 112
(47.7%) were diagnosed with NSTE-ACS and 123 (52.3%) were diagnosed with
STE-ACS. Mean SYNTAX score and RRI of patients with NSTE-ACS and STE-ACS
were 15.4 and 0.69, 21.1 and 0.67, respectively. The SYNTAX score was
associated with gender, height, plasma uric acid level, left atrial
diameter, left ventricular (LV) end-systolic and end-diastolic diameter,
RPI, and RRI in patients with NSTE-ACS, as well as with low-density
lipoprotein-cholesterol, total cholesterol, ejection fraction, and LV
end-systolic diameter in patients with STE-ACS (p < 0.05 for each
variable). RRI was significantly associated with age, haemoglobin level,
left atrial diameter, SYNTAX score, AT, and RPI in patients with NSTE-ACS,
as well as with weight, body mass index, interventricular septum thickness
at diastole, LV posterior wall thickness at diastole, LV ejection
fraction, and RRI in patients with STE-ACS. Multivariate logistic
regression analysis demonstrated that LV end-systolic diameter (beta =
0.385, 95% CI 1.065-2.029, p = 0.019), RRI (beta = 32.230, 95% CI
5343.15-2.E+24, p = 0.008), and RPI (beta = -7.439, 95% CI 0.000-0.231, p
= 0.015) were independent predictors of moderate to high SYNTAX score in
patients with NSTE-ACS. Conclusions: Non-invasively detected RRI is
closely associated with the extent and complexity of CAD in patients with
NSTE-ACS. However, there is a need for randomised, controlled studies
involving wider populations.<br/>Copyright © Polskie Towarzystwo
Kardiologiczne 2017.
<20>
Accession Number
619496642
Author
Fu J.-T.; Popal M.S.; Zhang H.-B.; Han W.; Hu Q.-M.; Meng X.; Ma C.-Y.
Institution
(Fu, Popal, Zhang, Han, Hu, Meng) Department of Cardiac Surgery, Beijing
Anzhen Hospital, Capital Medical University, Beijing 100029, China
(Ma) Department of Cardiac Surgery, Baiqiuen No. 1 Hospital, Jilin
University, Changchun 130000, China
Title
A meta-analysis of late outcomes of mitral valve repair in patients with
rheumatic heart disease.
Source
Journal of Thoracic Disease. 9 (11) (pp 4366-4375), 2017. Date of
Publication: 01 Nov 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Rheumatic heart disease (RHD) is a predominant health concern
in developing countries. The aim of this meta-analysis was to evaluate the
outcomes of mitral valve (MV) repair in patients with RHD, and identify
predictors that may postoperatively affect treatment outcome. Methods: A
meta-analysis of eligible studies assessing patients undergoing MV repair
with RHD and reporting the outcomes of MV repair, including 30-day
mortality and long-term follow-up survival, MV reoperation rate and
postoperative adverse events. Relevant English articles were searched up
to 1 March, 2017 in Web of Science, PubMed, Google Scholar, Cochrane
Library, EmBase, Elsevier, and Science Direct. Selected studies should
meet all inclusion criteria, and underwent data extraction. Results: A
total of ten studies with 2,770 patients met all inclusion criteria, and
were selected for assessment. Pooled analysis showed that 30-day mortality
in patients with rheumatic MV disease after MV repair surgery was 1.9%,
95% confidence interval (CI) (0.8-2.9%); long-term survival was 97.3%, 95%
CI (95.9-98.6%), and a freedom from reoperation rate of 93.6%, 95% CI
(91.4-95.9%) was obtained; freedom from adverse events was 97.5%, 95% CI
(95.2-99.8%). Conclusions: The outcome of rheumatic MV repair is
outstanding in terms of low early mortality, high long-term survival and
freedom from valve-related complications, which may be very common in
patients after rheumatic MV replacement; meanwhile, MV reoperation rate
after initial surgery is acceptable. Surgeons may try to repair MV in RHD
when it is feasible.<br/>Copyright © Journal of Thoracic Disease.
<21>
Accession Number
619495358
Author
Zhou Z.; Wang Z.; Zheng Z.; Cao J.; Zhang C.; He Z.; Lv W.; Hu J.
Institution
(Zhou, Wang, Cao, Zhang, He, Lv, Hu) Department of Thoracic Surgery, The
First Affiliated Hospital, College of Medicine, Zhejiang University,
Hangzhou, China
(Zheng) Department of Ultrasound Imaging, The First Affiliated Hospital,
College of Medicine, Zhejiang University, Hangzhou, China
Title
An "alternative finger" in robotic-assisted thoracic surgery:
Intraoperative ultrasound localization of pulmonary nodules.
Source
Medical Ultrasonography. 19 (4) (pp 374-379), 2017. Date of Publication:
2017.
Publisher
Societatea Romana de Ultrasonografie in Medicina si Biologie (E-mail:
dfodor@ymail.com)
Abstract
Aim: Robotic-assisted thoracic surgery (RATS) has become a promising
treatment for pulmonary neoplasms. During RATS, intraoperative
ultrasonography can act as an "alternative finger" to "touch" and locate
lesions, especially pulmonary nodules. This study was aimed to investigate
the efficacy of intraoperative ultrasonographic localization during da
Vinci RATS procedures. Material and methods: Patients with pulmonary
nodules were randomly divided into an Experimental Group and Control Group
in which nodules were respectively located using intraoperative
ultrasonography or by the surgeon's anatomic knowledge. The success rates
and relevant localization factors were compared between the groups and
analyzed to conclude the efficacy of intraoperative ultrasonography.
Additionally, the intraoperative ultrasonography learning curve was
analyzed to evaluate each surgeon's ability to independently perform
intraoperative ultrasonography. Results: Thirty-four patients were
included in the study (n = 17/group). Respectively, the Experimental Group
and Control Group comprised 41.2% and 58.9% women (p= 0.937), and had
average ages of 55.5 and 55.8 years. In the Experimental group,
ultrasonographic localization for mixed ground-glass nodules with CT
values of -500 to -100 Hounsfield units had an efficacy of 87.5%. By
contrast, the localization efficacy in Control Group was 20.0% (p=0.032).
A single surgeon without prior experience performed intraoperative
ultrasonography in 20 cases, and the latter 10 procedures required
significantly less time relative to the former 10 procedures (p=0.000).
Conclusions: During RATS, the use of intraoperative ultrasonography as an
"alternative finger" to "touch" and find the accurate location of
pulmonary nodules, especially mixed ground-glass nodules, is warranted.
<22>
Accession Number
619499363
Author
Sharifi M.; Kamali A.; Ghandi Y.
Institution
(Sharifi) Department of Cardiovascular Surgery, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran
(Kamali) Department of Anesthesiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran
(Ghandi) Department of Pediatric Cardiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran
Title
Effect of Sustained Use of Aspirin until the Time of Surgery on Outcomes
following Coronary Artery Bypass Grafting: A Randomized Clinical Trial.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2017. Date of
Publication: 24 Nov 2017.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background The topic of aspirin (acetylsalicylic acid, ASA) use in
coronary artery disease patients planned for coronary artery bypass
grafting during perioperative period is among the most disputed issues in
cardiac surgery. We designed a study to weigh the risks and benefits of
continued ASA ingestion until the time of surgery. Methods In this
randomized double-blind clinical trial, 206 consecutive patients scheduled
for isolated coronary artery bypass surgery (CABG) were randomly
stratified into two groups. In group 1 (104 cases), patients were given 80
mg ASA per day until the day of surgery. In group 2 (102 patients), ASA
(80 mg per day) was stopped 4 days before the operation. Patients in these
two groups were similar in terms of preoperative patient and procedural
characteristics. ASA was resumed 24 hours after the surgery in all
patients. Results The rates of bleeding and reexploration within 24 hours
of surgery were significantly higher in group 1 (824.3 vs. 492.1 mL, p <
0.001 and 5.7% vs. 0, p = 0.0138, respectively). The amount of intra- and
postoperative packed red blood cell (PRBC) transfusion was considerably
greater in group 1 (mean: 1.83 vs. 0.71 units, p < 0.001). The rate of
hospital mortality was similar (1.9% in both the groups, p = 0.98).
Patients in group 1 had significantly longer mean hospital stay than
patients in group 2 (8 vs. 5.1 days, p < 0.001). Again the time interval
between weaning from heart-lung machine and closing the sternum was
strikingly longer in group 1 (mean: 32.1 vs. 14.5 minutes, p < 0.001). The
incidence of adverse postoperative outcomes such as myocardial infarction,
stroke, and renal failure was not statistically different between the two
groups. Conclusion Sustained ASA use until the day of surgery in patients
planned for elective isolated CABG can result in excessive bleeding,
increased rate of reexploration, and need for more PRBC transfusion
without any proven beneficial effect on reducing unfavorable postoperative
outcomes. Hence, we recommend discontinuing ASA between 3 and 5 days
before non-urgent CABG while keeping it on in nonelective circumstances.
<br/>Copyright © 2017, Georg Thieme Verlag KG. All rights reserved.
<23>
Accession Number
619492656
Author
Zochios V.; Klein A.A.; Gao F.
Institution
(Zochios) University Hospitals Birmingham NHS Foundation Trust, Department
of Critical Care Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston,
Birmingham, UK
(Zochios, Gao) Perioperative Critical Care and Trauma Trials Group,
Institute of Inflammation and Ageing, Centre of Translational Inflammation
Research, University of Birmingham, Birmingham, UK
(Klein) Department of Cardiothoracic Anesthesia and Critical Care
Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard,
Cambridge, UK
(Gao) The 2nd Affiliated Hospital and Yuying Children's Hospital, Wenzhou
Medical University, Wenzhou, China
Title
Protective Invasive Ventilation in Cardiac Surgery: A Systematic Review
With a Focus on Acute Lung Injury in Adult Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
<24>
Accession Number
619376948
Author
Rezaei-Nodehi M.; Shorofi S.A.; Bagheri-Nesami M.; Ghafari R.;
Yazdani-Charati J.; Darbeheshti M.
Institution
(Rezaei-Nodehi) Student Research Committee, School of Nursing and
Midwifery, Addiction Institute, Mazandaran University of Medical Sciences,
Sari, Iran, Islamic Republic of
(Shorofi) Traditional and Complementary Medicine Research Center,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Shorofi) Adjunct Research Fellow, Flinders University, Adelaide,
Australia
(Bagheri-Nesami) Traditional and Complementary Medicine Research Center,
Addiction Institute, Mazandaran University of Medical Sciences, Sari,
Iran, Islamic Republic of
(Ghafari) Department of Cardiac Surgery, School of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Yazdani-Charati) Health Sciences Research Center, Mazandaran University
of Medical Science, Sari, Iran, Islamic Republic of
(Darbeheshti) Department of Radiology, Mazandaran Cardiac Surgery Center,
Sari, Iran, Islamic Republic of
Title
The effect of pleasant olfactory mental imagery on the incidence and
extent of atelectasis in patients after open heart surgery.
Source
Complementary Therapies in Medicine. 36 (pp 33-37), 2018. Date of
Publication: February 2018.
Publisher
Churchill Livingstone
Abstract
Background and purpose Atelectasis is the most common pulmonary
complication after open heart surgery. This study was intended to examine
the effects of pleasant olfactory mental imagery on postoperative
atelectasis in patients undergoing open heart surgery. Materials and
methods This is a randomized controlled clinical trial. The sample
consisted of 80 patients who were randomly assigned to either practice
olfactory mental imagery (test group) or receive routine care (control
group). A card with the image of roses was given to patients and they were
asked to look at the image, visualize the scent of roses in the mind, and
then sniff as much as possible, hold their breath for 2 s and eventually
exhale slowly through the nose. This procedure was consecutively repeated
five times. After a fifteen-minute break, patients proceeded to practice
olfactory mental imagery with other fruit images (banana, apple, and
lemon). The test group executed the olfactory mental imagery for two hours
in the morning and two hours in the afternoon on postoperative days 1 and
2. The control group received the routine ICU care. A questionnaire
collected information on sociodemographic characteristics and clinical
parameters. Chest radiographs were used to diagnose atelectasis, which
were evaluated by the hospital radiologist. Results No statistically
significant differences were observed between the two groups regarding
sociodemographic, medical and surgical information. The incidence of
atelectasis in the test group (40%, n = 16) was significantly lower than
in the control group (67.5%, n = 27) on postoperative day 2 (p = 0.02).
Conclusion Our findings suggest that olfactory mental imagery can improve
respiratory function and reduce the risk of atelectasis in patients with
cardiac surgery.<br/>Copyright © 2017
<25>
Accession Number
619344110
Author
Masri A.; Gillinov A.M.; Johnston D.M.; Sabik J.F.; Svensson L.G.;
Rodriguez L.; Kapadia S.R.; Stewart W.J.; Grimm R.A.; Griffin B.P.; Desai
M.Y.
Institution
(Masri, Gillinov, Johnston, Sabik, Svensson, Rodriguez, Kapadia, Stewart,
Grimm, Griffin, Desai) Department of Cardiovascular Medicine, Heart and
Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5,
Cleveland, OH 44195, United States
Title
Anticoagulation versus antiplatelet or no therapy in patients undergoing
bioprosthetic valve implantation: A systematic review and meta-analysis.
Source
Heart. 103 (1) (pp 40-48), 2017. Date of Publication: 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Use of vitamin K antagonist (VKA) versus antiplatelet (AP)/no
therapy following bioprosthetic valve implantation remains controversial.
The aims of the current study were to (a) systematically review the
published literature comparing the use of VKA versus AP/no treatment in
such patients and (b) perform a meta-analysis of the risks and benefits of
using a VKA compared with AP/no therapy. Methods Five databases were
searched including PubMed, Medline, Embase, Ovid and Cochrane for
randomised clinical trials and observational studies comparing VKA (group
I) versus AP/no therapy (group II). Outcome was after surgical
intervention. Mantel-Haenszel odds ratio (OR) was calculated using
random-effects meta-analysis for the outcome. Heterogeneity was assessed
by I2 statistics. A total of 14 studies were included (two randomised
trials, 12 observational studies and one conference abstract, 31 740
patients). Results Between groups I (VKA) and II (AP/no therapy), there
were no differences in thromboembolic events (145 (1%) vs 262 (1.5%), OR
0.96 (95% CI 0.60 to 1.52)), all-cause mortality (351 (3.5%) vs 415
(2.9%), OR 1.48 (95% CI 0.87 to 2.50)) or need for redo surgery (47 (3.3%)
vs 55 (3.2%); OR 0.81 (95% CI 0.42 to 1.58)). However, there were more
bleeding events in group I versus group II (292 (2.6%) vs 189 (1.1%); OR
2.26 (95% CI 1.67 to 3.05)). Conclusions In a meta-analysis of randomised
and observational studies of VKA versus AP/no treatment in patients
undergoing bioprosthetic valve implantation, there was no benefit of
adding a VKA regarding thromboembolism or mortality. However, use of a VKA
was associated with increased risk of major bleeding.
<26>
Accession Number
613825884
Author
Song S.-T.; Bai C.-M.; Zhou J.-W.
Institution
(Song, Bai, Zhou) Department of Cardiothoracic Surgery, Cangzhou Central
Hospital, Cangzhou, China
Title
Serum TNF-alpha levels in children with congenital heart disease
undergoing cardiopulmonary bypass: A cohort study in China and a
meta-analysis of the published literature.
Source
Journal of Clinical Laboratory Analysis. 31 (6) (no pagination), 2017.
Article Number: e22112. Date of Publication: November 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To investigate the changes in tumor necrosis factor alpha
(TNF-alpha) serum levels after cardiopulmonary bypass (CPB) in children
with congenital heart disease (CHD), followed by a meta-analysis to
analyze the clinical value of TNF-alpha in CPB. Methods: Our cohort study
enrolled 67 CHD children, assigned into off-pump group (n=32) and CPB
group (n=35). The TNF-alpha serum levels in two groups were detected by
ELISA before the operation (T1), at the end of the operation (0 hour, T2),
and after 24 hours of the operation (T3). For meta-analysis, literature
search was conducted to identify published case-control articles about the
changes of TNF-alpha serum levels with CPB of CHD. Results: The TNF-alpha
levels in CPB group were lower than that in the off-pump group at T3
(P=.006). TNF-alpha level at T3 was significantly lower than that at T1
and T2 (all P<.05). Meta-analysis results further confirmed that the
TNF-alpha levels of CHD children were dramatically decreased at T3 as
compared to that at T1 and T2 (both P<.001). Conclusion: The TNF-alpha
serum levels showed a transient and dramatic decline after 24 hours of
CPB, and it may act as an important biological indicator for monitoring
the efficacy of CPB in CHD children.<br/>Copyright © 2016 Wiley
Periodicals, Inc.
<27>
Accession Number
618470395
Author
Mylonas K.S.; Tzani A.; Metaxas P.; Schizas D.; Boikou V.; Economopoulos
K.P.
Institution
(Mylonas) Division of Pediatric Surgery, Massachusetts General Hospital,
Harvard Medical School, Warren 11, 55 Fruit Street, Boston, MA 02114,
United States
(Mylonas, Tzani, Metaxas, Schizas, Economopoulos) Surgery Working Group,
Society of Junior Doctors, Athens, Greece
(Schizas) First Department of Surgery, Laiko General Hospital, National
and Kapodistrian University of Athens, Athens, Greece
(Boikou) Athens University of Economics and Business, Athens, Greece
(Economopoulos) Department of Surgery, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, United States
Title
Blood Versus Crystalloid Cardioplegia in Pediatric Cardiac Surgery: A
Systematic Review and Meta-analysis.
Source
Pediatric Cardiology. 38 (8) (pp 1527-1539), 2017. Date of Publication: 01
Dec 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The benefit of blood cardioplegia (BCP) compared to crystalloid
cardioplegia (CCP) is still debatable. Our aim was to systematically
review and synthesize all available evidence on the use of BCP and CCP to
assess if any modality provides superior outcomes in pediatric cardiac
surgery. A systematic literature search of the PubMed and Cochrane
databases was performed with respect to the PRISMA statement
(end-of-search date: January 30th, 2017). We extracted data on study
design, demographics, cardioplegia regimens, and perioperative outcomes as
well as relevant biochemical markers, namely cardiac troponin I (cTnI),
lactate, and ATP levels at baseline, after reperfusion and postoperatively
at 1, 4, 12, and 24 h as applicable. Data were appropriately pooled using
random and mixed effects models. Our systematic review includes 56 studies
reporting on a total of 7711 pediatric patients. A meta-analysis of the 10
eligible studies directly comparing BCP (n = 416) to CCP (n = 281) was
also performed. There was no significant difference between the two groups
with regard to cTnI and Lac at any measured time point, ATP levels after
reperfusion, length of intensive care unit stay (WMD: -0.08, 95% CI -1.52
to 1.36), length of hospital stay (WMD: 0.13, 95% CI -0.85 to 1.12), and
30-day mortality (OR 1.11, 95% CI 0.43-2.88). Only cTnI levels at 4 h
postoperatively were significantly lower with BCP (WMD: -1.62, 95% CI
-2.07 to -1.18). Based on the available data, neither cardioplegia
modality seems to be superior in terms of clinical outcomes, ischemia
severity, and overall functional recovery.<br/>Copyright © 2017,
Springer Science+Business Media, LLC.
<28>
Accession Number
618322323
Author
Sabatine M.S.; Leiter L.A.; Wiviott S.D.; Giugliano R.P.; Deedwania P.; De
Ferrari G.M.; Murphy S.A.; Kuder J.F.; Gouni-Berthold I.; Lewis B.S.;
Handelsman Y.; Pineda A.L.; Honarpour N.; Keech A.C.; Sever P.S.; Pedersen
T.R.
Institution
(Sabatine, Wiviott, Giugliano, Murphy, Kuder) TIMI Study Group, Division
of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard
Medical School, Boston, MA, United States
(Leiter) Li Ka Shing Knowledge Institute of St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Deedwania) UCSF Fresno, Fresno, CA, United States
(De Ferrari) Department of Molecular Medicine, University of Pavia, and
Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology,
IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes, and Preventive
Medicine, University of Cologne, Cologne, Germany
(Lewis) Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport
School of Medicine, Technion-IIT, Haifa, Israel
(Handelsman) Metabolic Institute of America, Tarzana, CA, United States
(Pineda, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, NHMRC Clinical Trials Centre, University of
Sydney, Sydney, NSW, Australia
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
Title
Cardiovascular safety and efficacy of the PCSK9 inhibitor evolocumab in
patients with and without diabetes and the effect of evolocumab on
glycaemia and risk of new-onset diabetes: a prespecified analysis of the
FOURIER randomised controlled trial.
Source
The Lancet Diabetes and Endocrinology. 5 (12) (pp 941-950), 2017. Date of
Publication: December 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The proprotein convertase subtilisin/kexin type 9 (PCSK9)
inhibitor evolocumab reduced LDL cholesterol and cardiovascular events in
the FOURIER trial. In this prespecified analysis of FOURIER, we
investigated the efficacy and safety of evolocumab by diabetes status and
the effect of evolocumab on glycaemia and risk of developing diabetes.
Methods FOURIER was a randomised trial of evolocumab (140 mg every 2 weeks
or 420 mg once per month) versus placebo in 27 564 patients with
atherosclerotic disease who were on statin therapy, followed up for a
median of 2.2 years. In this prespecified analysis, we investigated the
effect of evolocumab on cardiovascular events by diabetes status at
baseline, defined on the basis of patient history, clinical events
committee review of medical records, or baseline HbA<inf>1c</inf> of 6.5%
(48 mmol/mol) or greater or fasting plasma glucose (FPG) of 7.0 mmol/L or
greater. The primary endpoint was a composite of cardiovascular death,
myocardial infarction, stroke, hospital admission for unstable angina, or
coronary revascularisation. The key secondary endpoint was a composite of
cardiovascular death, myocardial infarction, or stroke. We also assessed
the effect of evolocumab on glycaemia, and on the risk of new-onset
diabetes among patients without diabetes at baseline. HbA<inf>1c</inf> was
measured at baseline then every 24 weeks and FPG was measured at baseline,
week 12, week 24, and every 24 weeks thereafter, and potential cases of
new-onset diabetes were adjudicated centrally. In a post-hoc analysis, we
also investigated the effects on glycaemia and diabetes risk in patients
with prediabetes (HbA<inf>1c</inf> 5.7-6.4% [39-46 mmol/mol] or FPG
5.6-6.9 mmol/L) at baseline. FOURIER is registered with
ClinicalTrials.gov, number NCT01764633. Findings At study baseline, 11 031
patients (40%) had diabetes and 16 533 (60%) did not have diabetes (of
whom 10 344 had prediabetes and 6189 had normoglycaemia). Evolocumab
significantly reduced cardiovascular outcomes consistently in patients
with and without diabetes at baseline. For the primary composite endpoint,
the hazard ratios (HRs) were 0.83 (95% CI 0.75-0.93; p=0.0008) for
patients with diabetes and 0.87 (0.79-0.96; p=0.0052) for patients without
diabetes (p<inf>interaction</inf>=0.60). For the key secondary endpoint,
the HRs were 0.82 (0.72-0.93; p=0.0021) for those with diabetes and 0.78
(0.69-0.89; p=0.0002) for those without diabetes
(p<inf>interaction</inf>=0.65). Evolocumab did not increase the risk of
new-onset diabetes in patients without diabetes at baseline (HR 1.05,
0.94-1.17), including in those with prediabetes (HR 1.00, 0.89-1.13).
Levels of HbA<inf>1c</inf> and FPG were similar between the evolocumab and
placebo groups over time in patients with diabetes, prediabetes, or
normoglycaemia. Among patients with diabetes at baseline, the proportions
of patients with adverse events were 78.5% (4327 of 5513 patients) in the
evolocumab group and 78.3% (4307 of 5502 patients) in the placebo group;
among patients without diabetes at baseline, the proportions with adverse
events were 76.8% (6337 of 8256 patients) in the evolocumab group and
76.8% (6337 of 8254 patients) in the placebo group. Interpretation PCSK9
inhibition with evolocumab significantly reduced cardiovascular risk in
patients with and without diabetes. Evolocumab did not increase the risk
of new-onset diabetes, nor did it worsen glycaemia. These data suggest
evolocumab use in patients with atherosclerotic disease is efficacious and
safe in patients with and without diabetes. Funding Amgen.<br/>Copyright
© 2017 Elsevier Ltd
<29>
Accession Number
619392902
Author
Kato E.T.; Cannon C.P.; Blazing M.A.; Bohula E.; Guneri S.; White J.A.;
Murphy S.A.; Park J.-G.; Braunwald E.; Giugliano R.P.
Institution
(Kato) Kyoto University Hospital, Kyoto, Japan
(Cannon, Bohula, Murphy, Park, Braunwald, Giugliano) TIMI (Thrombolysis in
Myocardial Infarction) Study Group, Cardiovascular Division, Brigham and
Women's Hospital and Harvard Medical School, Boston, MA, United States
(Blazing, White) Duke Clinical Research Institute, Durham, NC, United
States
(Guneri) Dokuz Eylul University, Izmir, Turkey
Title
Efficacy and safety of adding ezetimibe to statin therapy among women and
men: Insight from IMPROVE-IT (improved reduction of outcomes: Vytorin
efficacy international trial).
Source
Journal of the American Heart Association. 6 (11) (no pagination), 2017.
Article Number: e006901. Date of Publication: 01 Nov 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy
International Trial) showed that adding the nonstatin ezetimibe to statin
therapy further reduced cardiovascular events in patients after an acute
coronary syndrome. In a prespecified analysis, we explore results
stratified by sex. Methods and Results--In IMPROVE-IT, patients with acute
coronary syndrome and low-density lipoprotein cholesterol of 50 to 125
mg/dL were randomized to placebo/simvastatin 40 mg or
ezetimibe/simvastatin 10/40 mg. They were followed up for a median of 6
years for the primary composite of cardiovascular death, myocardial
infarction, hospitalization for unstable angina, coronary
revascularization >=30 days, and stroke. Among 18 144 patients in
IMPROVE-IT, 4416 (24%) were women. At 12 months, the addition of ezetimibe
to simvastatin significantly reduced low-density lipoprotein cholesterol
from baseline compared with simvastatin monotherapy in men and women
equally (absolute reduction, 16.7 mg/dL in men and 16.4 mg/dL in women).
Women receiving ezetimibe/simvastatin had a 12% risk reduction over those
receiving placebo/simvastatin for the primary composite end point (hazard
ratio, 0.88; 95% confidence interval, 0.79-0.99) compared with a 5%
reduction for men (hazard ratio, 0.95; 95% confidence interval, 0.90-1.01;
P=0.26 for interaction). When the total number of primary events was
considered, women had an 18% reduction with the addition of ezetimibe
(relative risk, 95% confidence interval, 0.81; 0.71-0.94) and men had a 6%
reduction (relative risk, 0.94; 95% confidence interval, 0.87-1.02; P=0.08
for interaction). The addition of ezetimibe did not increase the rates of
safety events in either women or men. Conclusions--IMPROVE-IT demonstrated
that the benefit of adding ezetimibe to statin is present in both women
and men, with a good safety profile supporting the use of intensive,
combination, lipid-lowering therapy to optimize cardiovascular
outcomes.<br/>Copyright © 2017 The Authors.
<30>
Accession Number
619321567
Author
Ghaffary S.; Ghaeli P.; Talasaz A.H.; Karimi A.; Noroozian M.; Salehiomran
A.; Jalali A.
Institution
(Ghaffary) Hematology and Oncology Research Center, Tabriz University of
Medical Sciences, Tabriz, Iran, Islamic Republic of
(Ghaeli, Talasaz) Departments of Pharmacotherapy, Faculty of Pharmacy,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Talasaz, Karimi, Salehiomran, Jalali) Tehran Heart Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Noroozian) Memory and Behavioral Neurology Department, Roozbeh Hospital,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Effect of memantine on post-operative cognitive dysfunction after cardiac
surgeries: A randomized clinical trial.
Source
DARU, Journal of Pharmaceutical Sciences. 25 (1) (no pagination), 2017.
Article Number: 24. Date of Publication: 21 Nov 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Post-operative cognitive dysfunction (POCD) is an important
complication of cardiac surgeries. Glutamate plays a critical role in
physiologic and pathologic conditions in the brain. Due to the role of
glutamate in ischemia, this study is designed to identify the effect of
memantine in prevention of POCD early and late after cardiac surgeries.
Methods: In this randomized clinical trial, 172 patients with ages 45-75
years old who underwent elective cardiac surgery were enrolled. For
patients in memantine group, 5 mg of memantine per day administered at
least 48 h before surgery and increased to 10 mg per day during the first
24 h after surgery and continued for 3 months. A brief Wechsler memory
test (WMT) was administered before, three to 5 days after, and 3 months
after surgery for both groups. Results: Both groups demonstrate standard
pattern of cognitive dysfunction after surgery and in follow up. Pre- and
post-operative WMT score showed significant improvement in memantine
compared to control group (P < 0.001) both in unadjusted and adjusted with
confounding factor analysis. Unadjusted pre-, post-operative, and follow
up WMT score improved significantly after 3 months in memantine group (P =
0.006). Conclusion: Pre-operative administration of memantine protects
patients from POCD following cardiac surgeries. In addition, it improves
cognitive function 3 months after surgery. Trial registration: The trial
was registered in the Iranian Registry of Clinical Trials (registration
number: IRCT201303168698N12). Graphical abstract: Memantin effect on
POCD.<br/>Copyright © 2017 The Author(s).
<31>
Accession Number
619197476
Author
Ueki K.; Sasako T.; Okazaki Y.; Kato M.; Okahata S.; Katsuyama H.;
Haraguchi M.; Morita A.; Ohashi K.; Hara K.; Morise A.; Izumi K.; Ishizuka
N.; Ohashi Y.; Noda M.; Kadowaki T.; Haneda M.; Iwashima Y.; Suda T.;
Tamasawa N.; Daimon M.; Satoh J.; Takebe N.; Ishigaki Y.; Watanabe T.;
Satoh H.; Kasai K.; Aso Y.; Ishibashi S.; Katayama S.; Ishikawa S.-E.;
Kakei M.; Namai K.; Hashimoto N.; Suzuki Y.; Onishi S.; Yokote K.; Matsuda
M.; Masuzawa M.; Hayashi Y.; Saito S.; Ogihara N.; Ishihara H.; Tajima N.;
Utsunomiya K.; Itoh H.; Kawamori R.; Watada H.; Mori Y.; Shiba T.; Isogawa
A.; Sakura H.; Odawara M.; Tobe K.; Tsukamoto K.; Yamauchi T.; Teramoto
T.; Hirata Y.; Uchimura I.; Ogawa Y.; Yoshino G.; Hirose T.; Kajio H.;
Atsumi Y.; Shimada A.; Oikawa Y.; Araki A.; Ueki A.; Ohno A.; Kitaoka M.;
Fujita Y.; Moriya T.; Tojo T.; Shichiri M.; Suzuki D.; Toyoda M.; Hamano
K.; Komi R.; Terauchi Y.; Kuzuya N.; Yamada M.; Takamura T.; Imura M.;
Tanaka H.; Hayashi M.; Kato Y.; Itoh M.; Suzuki A.; Nakayama M.; Sano T.;
Nakashima E.; Sumida Y.; Yano Y.; Tanaka T.; Murata K.; Kashiwagi A.;
Maegawa H.; Kono S.; Inagaki N.; Kosugi K.; Yasuda T.; Yoshimasa Y.;
Kishimoto I.; Sato T.; Hosoi M.; Yamasaki T.; Matsuhisa M.; Shimomura I.;
Taniguchi A.; Kuroe A.; Kurose T.; Ohara T.; Sakaguchi K.; Namba M.; Kaku
K.; Fujiwara M.; Shimizu I.; Ono K.; Ebisui O.; Tanizawa Y.; Okada Y.;
Kodera T.; Sato N.; Ide M.; Yamada K.; Umeda F.; Natori S.; Eto T.; Mimura
K.; Hiramatsu S.; Inoue T.; Takei R.; Ogo A.; Eguchi K.; Kawasaki E.;
Koide Y.; Araki E.; Jinnouchi H.; Yamamoto H.; Motoyoshi M.; Hiyoshi T.;
Tanaka Y.; Momoki T.; Sato K.; Yoneyama A.; Ito K.; Sobajima H.; Ikegami
H.; Ikeda M.; Ikeda H.; Takahashi K.; Makino H.; Ueda Y.; Nakazato M.
Institution
(Ueki) Department of Molecular Diabetic Medicine, Diabetes Research
Center, National Center for Global Health and Medicine, Tokyo, Japan
(Izumi) Department of Clinical Research Strategic Planning, Center for
Clinical Sciences, National Center for Global Health and Medicine, Tokyo,
Japan
(Ueki, Sasako, Okazaki, Haraguchi, Morita, Kadowaki) Department of
Diabetes and Metabolic Diseases, Graduate School of Medicine, The
University of Tokyo, Tokyo, Japan
(Sasako, Kadowaki) Translational Systems Biology and Medicine Initiative,
The University of Tokyo, Tokyo, Japan
(Kato) Health Management Center and Diagnostic Imaging Center, Toranomon
Hospital, Tokyo, Japan
(Okahata) Division of Diabetes and Metabolism, Toho University Ohashi
Medical Center, Tokyo, Japan
(Katsuyama) Department of Internal Medicine, National Center for Global
Health and Medicine, Kohnodai Hospital, Chiba, Japan
(Ohashi) Department of General Internal Medicine, National Cancer Center
Hospital, Tokyo, Japan
(Hara) Department of Endocrinology and Metabolism, Saitama Medical Center,
Jichi Medical University, Saitama, Japan
(Morise) Department of Internal Medicine, Tokyo Takanawa Hospital, Tokyo,
Japan
(Ishizuka) Clinical Research Center, The Cancer Institute Hospital,
Japanese Foundation for Cancer Research, Tokyo, Japan
(Ohashi) Department of Integrated Science and Engineering for Sustainable
Society, Chuo University, Tokyo, Japan
(Noda) Department of Endocrinology and Diabetes, Saitama Medical
University, Saitama, Japan
Title
Effect of an intensified multifactorial intervention on cardiovascular
outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label,
randomised controlled trial.
Source
The Lancet Diabetes and Endocrinology. 5 (12) (pp 951-964), 2017. Date of
Publication: December 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Limited evidence suggests that multifactorial interventions for
control of glucose, blood pressure, and lipids reduce macrovascular
complications and mortality in patients with type 2 diabetes. However,
safe and effective treatment targets for these risk factors have not been
determined for such interventions. Methods In this multicentre,
open-label, randomised, parallel-group trial, undertaken at 81 clinical
sites in Japan, we randomly assigned (1:1) patients with type 2 diabetes
aged 45-69 years with hypertension, dyslipidaemia, or both, and an
HbA<inf>1c</inf> of 6.9% (52.0 mmol/mol) or higher, to receive
conventional therapy for glucose, blood pressure, and lipid control
(targets: HbA<inf>1c</inf> <6.9% [52.0 mmol/mol], blood pressure <130/80
mm Hg, LDL cholesterol <120 mg/dL [or 100 mg/dL in patients with a history
of coronary artery disease]) or intensive therapy (HbA<inf>1c</inf> <6.2%
[44.3 mmol/mol], blood pressure <120/75 mm Hg, LDL cholesterol <80 mg/dL
[or 70 mg/dL in patients with a history of coronary artery disease]).
Randomisation was done using a computer-generated, dynamic balancing
method, stratified by sex, age, HbA<inf>1c</inf>, and history of
cardiovascular disease. Neither patients nor investigators were masked to
group assignment. The primary outcome was occurrence of any of a composite
of myocardial infarction, stroke, revascularisation (coronary artery
bypass surgery, percutaneous transluminal coronary angioplasty, carotid
endarterectomy, percutaneous transluminal cerebral angioplasty, and
carotid artery stenting), and all-cause mortality. The primary analysis
was done in the intention-to-treat population. This study is registered
with ClinicalTrials.gov, number NCT00300976. Findings Between June 16,
2006, and March 31, 2009, 2542 eligible patients were randomly assigned to
intensive therapy or conventional therapy (1271 in each group) and
followed up for a median of 8.5 years (IQR 7.3-9.0). Two patients in the
intensive therapy group were found to be ineligible after randomisation
and were excluded from the analyses. During the intervention period, mean
HbA<inf>1c</inf>, systolic blood pressure, diastolic blood pressure, and
LDL cholesterol concentrations were significantly lower in the intensive
therapy group than in the conventional therapy group (6.8% [51.0 mmol/mol]
vs 7.2% [55.2 mmol/mol]; 123 mm Hg vs 129 mm Hg; 71 mm Hg vs 74 mm Hg; and
85 mg/dL vs 104 mg/dL, respectively; all p<0.0001). The primary outcome
occurred in 109 patients in the intensive therapy group and in 133
patients in the conventional therapy group (hazard ratio [HR] 0.81, 95% CI
0.63-1.04; p=0.094). In a post-hoc breakdown of the composite outcome,
frequencies of all-cause mortality (HR 1.01, 95% CI 0.68-1.51; p=0.95) and
coronary events (myocardial infarction, coronary artery bypass surgery,
and percutaneous transluminal coronary angioplasty; HR 0.86, 0.58-1.27;
p=0.44) did not differ between groups, but cerebrovascular events (stroke,
carotid endarterectomy, percutaneous transluminal cerebral angioplasty,
and carotid artery stenting) were significantly less frequent in the
intensive therapy group (HR 0.42, 0.24-0.74; p=0.002). Apart from
non-severe hypoglycaemia (521 [41%] patients in the intensive therapy
group vs 283 [22%] in the conventional therapy group, p<0.0001) and oedema
(193 [15%] vs 129 [10%], p=0.0001), the frequencies of major adverse
events did not differ between groups. Interpretation Our results do not
fully support the efficacy of further intensified multifactorial
intervention compared with current standard care for the prevention of a
composite of coronary events, cerebrovascular events, and all-cause
mortality. Nevertheless, our findings suggest a potential benefit of an
intensified intervention for the prevention of cerebrovascular events in
patients with type 2 diabetes. Funding Ministry of Health, Labour and
Welfare of Japan, Asahi Kasei Pharma, Astellas Pharma, AstraZeneca, Bayer,
Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly,
GlaxoSmithKline, Kissei Pharmaceutical, Kowa Pharmaceutical, Mitsubishi
Tanabe Pharma, Mochida Pharmaceutical, MSD, Novartis Pharma, Novo Nordisk,
Ono Pharmaceutical, Pfizer, Sanwa Kagaku Kenkyusho, Shionogi, Sumitomo
Dainippon Pharma, Taisho Toyama Pharmaceutical, and Takeda.<br/>Copyright
© 2017 Elsevier Ltd
<32>
Accession Number
619329733
Author
Li S.; Zhou K.; Che G.; Yang M.; Su J.; Shen C.; Yu P.
Institution
(Li, Zhou, Che, Yang, Shen) Department of Thoracic Surgery, Rehabilitation
Medicine Center, West China Hospital, Sichuan University, Chengdu, China
(Su, Yu) Department of Rehabilitation, Rehabilitation Medicine Center,
West China Hospital, Sichuan University, Chengdu, China
Title
Enhanced recovery programs in lung cancer surgery: Systematic review and
meta-analysis of randomized controlled trials.
Source
Cancer Management and Research. 9 (pp 657-670), 2017. Date of Publication:
16 Nov 2017.
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Background: Enhanced recovery after surgery (ERAS) program is an effective
evidence-based multidisciplinary protocol of perioperative care, but its
roles in thoracic surgery remain unclear. This systematic review of
randomized controlled trials (RCTs) aims to investigate the efficacy and
safety of the ERAS programs for lung cancer surgery. Materials and
methods: We searched the PubMed and EMBASE databases to identify the RCTs
that implemented an ERAS program encompassing more than four care elements
within at least two phases of perioperative care in lung cancer surgery.
The heterogeneity levels between studies were estimated by the Cochrane
Collaborations. A qualitative review was performed if considerable
heterogeneity was revealed. Relative risk (RR) and weighted mean
difference served as the summarized statistics for the meta-analyses.
Additional analyses were also performed to perceive potential bias risks.
Results: A total of seven RCTs enrolling 486 patients were included. The
meta-analysis indicated that the ERAS group patients had significantly
lower morbidity rates (RR=0.64; p<0.001), especially the rates of
pulmonary (RR=0.43; p<0.001) and surgical complications (RR=0.46;
p=0.010), than those of control group patients. No significant reduction
was found in the inhospital mortality (RR=0.70; p=0.58) or cardiovascular
complications (RR=1.46; p=0.25). In the qualitative review, most of the
evidence reported significantly shortened length of hospital and intensive
care unit stay and decreased hospitalization costs in the ERAS-treated
patients. No significant publication bias was detected in the
meta-analyses. Conclusion: Our review demonstrates that the implementation
of an ERAS program for lung cancer surgery can effectively accelerate
postoperative recovery and save hospitalization costs without compromising
patients' safety. A worldwide consensus guideline is urgently required to
standardize the ERAS protocols for elective lung resections in the
future.<br/>Copyright © 2017 Li et al.
<33>
Accession Number
619475332
Author
Pai S.-L.; Wang R.D.; Aniskevich S.
Institution
(Pai, Wang, Aniskevich) Department of Anesthesiology and Perioperative
Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United
States
Title
Perioperative stroke: Incidence, etiologic factors, and prevention.
Source
Minerva Anestesiologica. 83 (11) (pp 1178-1189), 2017. Date of
Publication: November 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Stroke is a devastating complication that is difficult to diagnose in the
perioperative setting because of the effects of anesthetic and analgesic
agents. Lingering anesthesia effects hinder clinicians in identifying
stroke symptoms, frequently resulting in a delay in diagnosis and
treatment and in unfavorable outcomes. The authors performed a systematic
search in PubMed and the Cochrane Central Register. The search aimed to
identify studies published between January 1990 and December 2015 related
to the common etiologic factors, incidence, risk factors, risk modifiers,
and early management of perioperative stroke. Additional articles were
identified after review of the references of selected articles. Although
perioperative stroke is uncommon, the mortality rate is high. Patients
have higher risk of perioperative stroke when undergoing cardiac and
vascular operations than uncomplicated orthopedic and general procedures.
Preoperative optimization for preexisting risk factors may reduce the rate
of perioperative stroke. Prompt, early management can improve patient
outcomes. Recognition of the incidence, risk factors, and causes of
perioperative stroke may lead to prevention and proper management.
<34>
Accession Number
619467904
Author
Xu J.; Yang X.; Hu X.; Chen X.; Zhang J.; Wang Y.
Institution
(Xu, Yang, Hu, Zhang, Wang) Department of Anesthesiology, Huashan
Hospital, Fudan University, Shanghai, People's Republic of China
(Chen) Department of Cardiothorcic Surgery, Huashan Hospital, Fudan
University, Shanghai, People's Republic of China
Title
Multilevel Thoracic Paravertebral Block Using Ropivacaine With/Without
Dexmedetomidine in Video-Assisted Thoracoscopic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objectives: Thoracic paravertebral block (TPVB) is reported to have
advantages in postoperative pain management in unilateral thoracic
surgeries. Previous studies have demonstrated that dexmedetomidine could
be used as an adjuvant to local anesthetics, with the aim of prolonging
the duration of neural blockade. However, little is known about whether
such a combination could improve the quality of postoperative analgesia
compared with local anesthetic only when TPVB is used for patients
undergoing video-assisted thoracoscopic surgery (VATS). Design: A
prospective, randomized, controlled study. Setting: Single-center
university hospital. Participants: The study included 60 patients
undergoing VATS under general anesthesia. Interventions: The patients were
allocated randomly into the following 2 groups: 0.375% ropivacaine, 20 mL
only (group R, n = 30), and 0.375% ropivacaine, 20 mL plus 1 mug/kg of
dexmedetomidine (group RD, n = 30). At the end of surgery, TPVB guided
using ultrasound was performed at 4 points-T4-5, T5-6, T6-7, and T7-8-of
the surgical side; 5 mL of solution were injected at each point.
Postoperatively, the intravenous nonsteroidal anti-inflammatory drug
flurbiprofen was used as part of multimodal analgesia. Measurements and
Main Results: Pain scores at rest and during coughing were evaluated by a
blinded observer in the postanesthesia care unit postoperatively at 1, 2,
4, 8, 12, 24, 36, and 48 hours, and the dermatomal levels of sensory
blockade, postoperative requirements for rescue analgesia, adverse events,
and patient satisfaction also were recorded. There was a significant
reduction in postoperative pain scores at rest starting from the
postoperative 8th hour until the 48th hour and during coughing starting at
the postoperative 4th hour until the 48th hour in the group RD compared
with those in group R (p = 0.043). The dermatomal levels of sensory
blockade were comparable in the 2 groups. Patient satisfaction after
surgery was significantly higher in the group RD than in group R (p <
0.001). Total consumption of the intravenous rescue analgesic morphine and
adverse events were not significantly different between the 2 groups.
Conclusions: Compared with ropivacaine only, the addition of
dexmedetomidine, 1 mug/kg, to local anesthetic for multilevel TPVB in
patients undergoing VATS prolonged the duration of postoperative analgesia
and improved patient satisfaction without serious side effects when
combined with postoperative intravenous nonsteroidal anti-inflammatory
drug administration.<br/>Copyright © 2017 Elsevier Inc.
<35>
Accession Number
619465130
Author
Fricke T.A.; Lee M.G.Y.; Brink J.; d'Udekem Y.; Brizard C.P.; Konstantinov
I.E.
Institution
(Fricke, Lee, Brink, d'Udekem, Brizard, Konstantinov) Department of
Cardiothoracic Surgery, The Royal Children's Hospital, Melbourne,
Australia
(Fricke, Lee, Brink, d'Udekem, Brizard, Konstantinov) University of
Melbourne, Melbourne, Australia
(Fricke, Lee, Brink, d'Udekem, Brizard, Konstantinov) Murdoch Children's
Research Institute, Melbourne, Australia
Title
Early Mentoring of Medical Students and Junior Doctors on a Path to
Academic Cardiothoracic Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: In 2005 the Department of Cardiothoracic Surgery at The Royal
Children's Hospital started an early academic mentoring program for
medical students and junior doctors with the aim of fostering an interest
in academic surgery. Methods: Between 2005 and 2015, 37 medical students
and junior doctors participated in research in the Department of
Cardiothoracic Surgery at The Royal Children's Hospital. Each was given an
initial project on which to obtain ethics approval, perform a literature
review, data collection, statistical analysis, and prepare a manuscript
for publication. A search of the names of these former students and
doctors was conducted on PubMed to identify publications. Results: A total
of 113 journal articles were published in peer-reviewed journals with an
average impact factor of 4.1 (range, 1.1 to 19.9). Thirty (30 of 37, 81%)
published at least one article. A mean of 4.3 journal articles was
published per student or junior doctor (range, 0 to 29). Eleven (11 of 37,
30%) received scholarships for their research. Nine (9 of 37, 24%) have
completed or are enrolled in higher research degrees with a cardiothoracic
surgery focus. Of these 9, 2 have completed doctoral degrees while in
cardiothoracic surgery training. Five will complete their cardiothoracic
surgery training with a doctoral degree and the other 2 are pursuing
training in cardiology. Conclusions: A successful early academic mentoring
program in a busy cardiothoracic surgery unit is feasible. Mentoring of
motivated individuals in academic surgery benefits not only their medical
career, but also helps maintain high academic output of the
unit.<br/>Copyright © 2017 The Society of Thoracic Surgeons.
<36>
Accession Number
619299961
Author
Panoulas V.F.; Francis D.P.; Ruparelia N.; Malik I.S.; Chukwuemeka A.; Sen
S.; Anderson J.; Nihoyannopoulos P.; Sutaria N.; Hannan E.L.; Samadashvili
Z.; D'Errigo P.; Schymik G.; Mehran R.; Chieffo A.; Latib A.; Presbitero
P.; Mehilli J.; Petronio A.S.; Morice M.-C.; Tamburino C.; Thyregod
H.G.H.; Leon M.; Colombo A.; Mikhail G.W.
Institution
(Panoulas, Francis, Malik, Sen, Nihoyannopoulos, Sutaria, Mikhail)
Cardiovascular Sciences, National Heart and Lung Institute, Imperial
College London, London, United Kingdom
(Panoulas, Ruparelia, Malik, Sen, Nihoyannopoulos, Mikhail) Cardiology
Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust,
London, United Kingdom
(Chukwuemeka, Anderson) Cardiothoracic Department, Hammersmith Hospital,
Imperial College Healthcare NHS Trust, United States
(Hannan, Samadashvili) School of Public Health, University at Albany,
State University of New York, Albany, NY, United States
(D'Errigo) National Centre for Epidemiology, Surveillance and Health
Promotion, Istituto Superiore di Sanita, Rome, Italy
(Schymik) Medical Clinic IV, Department of Cardiology, Municipal Hospital
Karlsruhe, Academic Teaching Hospital of the University of Freiburg,
Freiburg, Germany
(Mehran) Interventional Cardiovascular Research and Clinical Trials, The
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Chieffo, Latib, Colombo) Cardiology department, San Raffaele Scientific
Institute, Milan, Italy
(Presbitero) Hemodynamic and Invasive Cardiology Unit, IRCCS Istituto
Clinico Humanitas, Milan, Italy
(Mehilli) Munich University Clinic, Ludwig-Maximilians University, Munich,
Germany
(Mehilli) Munich Heart Alliance at Deutsches Zentrum fur
Herz-Kreislauf-Forschung, Munich, Germany
(Petronio) Cardiothoracic and Vascular Department, University of Pisa,
Italy
(Morice) RAMSAY, Generale de Sante, ICPS, Institut Cardiovasculaire Paris
Sud, Massy, France
(Tamburino) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Italy
(Thyregod) Department of Cardiothoracic Surgery, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Leon) Columbia University Medical Center, New York, United States
(Tamburino) ETNA Foundation, Catania, Italy
Title
Female-specific survival advantage from transcatheter aortic valve
implantation over surgical aortic valve replacement: Meta-analysis of the
gender subgroups of randomised controlled trials including 3758 patients.
Source
International Journal of Cardiology. 250 (pp 66-72), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis
(AS) is the first area of interventional cardiology where women are
treated as often as men. In this analysis of the gender specific results
of randomised controlled trials (RCTs) comparing TAVI with surgical aortic
valve replacement (SAVR) we aimed to determine whether gender affects the
survival comparison between TAVI and SAVR. We identified all RCTs
comparing TAVI versus SAVR for severe AS and reporting 1 and/or 2 year
survival. Summary odds ratios (ORs) were obtained using a random-effects
model. Heterogeneity was assessed using the Q statistic and I<sup>2</sup>.
Four RCTs met the criteria, totalling 3758 patients, 1706 women and 2052
men. Amongst females, TAVI recipients had a significantly lower mortality
than SAVR recipients, at 1 year (OR 0.68; 95%CI 0.50 to 0.94) and at 2
years (OR 0.74; 95%CI 0.58 to 0.95). Amongst males there was no difference
in mortality between TAVI and SAVR, at 1 year (OR 1.09; 95%CI 0.86 to
1.39) or 2 years (OR 1.05; 95%CI 0.85 to 1.3). The difference in treatment
effect between genders was significant at both 1 year
(p<inf>interaction</inf> = 0.02) and 2 years (p<inf>interaction</inf> =
0.04). In women TAVI has a 26 to 31% lower mortality odds than SAVR. In
men, there is no difference in mortality between TAVI and
SAVR.<br/>Copyright © 2017 Elsevier B.V.
<37>
Accession Number
619398361
Author
Fiorentino M.; Castellano G.; Kellum J.A.
Institution
(Fiorentino, Kellum) Department of Critical Care Medicine, Center for
Critical Care Nephrology, CRISMA (Clinical Research, Investigation, and
Systems Modeling of Acute Illness) Center, University of Pittsburgh School
of Medicine, Pittsburgh, United States
(Fiorentino, Castellano) Department of Emergency and Organ
Transplantation, Nephrology, Dialysis and Transplantation Unit, University
of Bari, Bari, Italy
Title
Differences in acute kidney injury ascertainment for clinical and
preclinical studies.
Source
Nephrology Dialysis Transplantation. 32 (11) (pp 1789-1805), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Acute kidney injury (AKI) is a common clinical condition
directly associated with adverse outcomes. Several AKI biomarkers have
been discovered, but their use in clinical and preclinical studies has not
been well examined. This study aims to investigate the differences between
clinical and preclinical studies on AKI biomarkers. Methods We performed a
systematic review of clinical and preclinical interventional studies that
considered AKI biomarkers in enrollment criteria and/or outcome assessment
and described the main differences according to their setting, the
inclusion of biomarkers in the definition of AKI and the use of biomarkers
as primary or secondary end points. Results In the 151 included studies
(76 clinical, 75 preclinical), clinical studies have prevalently focused
on cardiac surgery (38.1%) and contrast-associated AKI (17.1%), while the
majority of preclinical studies have focused on ether ischemia-reperfusion
injury or drug-induced AKI (42.6% each). A total of 57.8% of clinical
studies defined AKI using the standard criteria and only 19.7% of these
studies used AKI biomarkers in the definition of renal injury. Conversely,
the majority of preclinical studies defined AKI according to the increase
in serum creatinine and blood urea nitrogen, and 32% included biomarkers
in that definition. The percentage of both clinical and preclinical
studies with biomarkers as a primary end point has not significantly
increased in the last 10 years; however, preclinical studies are more
likely to use AKI biomarkers as a primary end point compared with clinical
studies [odds ratio 2.31 (95% confidence interval 1.17-4.59); P=0.016].
Conclusion Differences between clinical and preclinical studies are
evident and may affect the translation of preclinical findings in the
clinical setting.<br/>Copyright © The Author 2017. Published by
Oxford University Press on behalf of ERA-EDTA. All rights reserved.
<38>
Accession Number
619384508
Author
Van Den Berg J.P.; Eleveld D.J.; De Smet T.; Van Den Heerik A.V.M.; Van
Amsterdam K.; Lichtenbelt B.J.; Scheeren T.W.L.; Absalom A.R.; Struys
M.M.R.F.
Institution
(Van Den Berg, Eleveld, Van Den Heerik, Van Amsterdam, Lichtenbelt,
Scheeren, Absalom, Struys) Department of Anesthesiology, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
(De Smet) Demed Medical, Temse, Belgium
(Struys) Department of Anaesthesia and Peri-Operative Medicine, Ghent
University, Ghent, Belgium
Title
Influence of Bayesian optimization on the performance of propofol
target-controlled infusion.
Source
British Journal of Anaesthesia. 119 (5) (pp 918-927), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Target controlled infusion (TCI) systems use population-based
pharmacokinetic (PK) models that do not take into account inter-individual
residual variation. This study compares the bias and inaccuracy of a
population-based vs a personalized TCI propofol titration using Bayesian
adaptation. Haemodynamic and hypnotic stability, and the prediction
probability of alternative PK models, was studied. Methods. A
double-blinded, prospective randomized controlled trial of 120 subjects
undergoing cardiac surgery was conducted. Blood samples were obtained at
10, 35, 50, 65, 75 and 120 min and analysed using a point-of-care propofol
blood analyser. Bayesian adaptation of the PK model was applied at 60 min
in the intervention group. Median (Absolute) Performance Error (Md(A)PE)
was used to evaluate the difference between bias and inaccuracy of the
models. Haemodynamic (mean arterial pressure [MAP], heart rate) and
hypnotic (bispectral index [BIS]) stability was studied. The predictive
performance of four alternative propofol PK models was studied. Results.
MdPE and MdAPE did not differ between groups during the pre-Adjustment
period (control group: 6.3% and 16%; intervention group: 5.4% and 18%).
MdPE differed in the post-Adjustment period (12% vs.-0.3%), but MdAPE did
not (18% vs. 15%). No difference in heart rate, MAP or BIS was found.
Compared with the other models, the Eleveld propofol PK model (patients)
showed the best prediction performance. Conclusions. When an accurate
population-based PK model was used for propofol TCI, Bayesian adaption of
the model improved bias but not precision. Clinical trial registration
Dutch Trial Registry NTR4518.<br/>Copyright © The Author 2017.
Published by Oxford University Press on behalf of the British Journal of
Anaesthesia.All rights reserved.
<39>
Accession Number
619344479
Author
Wang H.-B.; Ji P.; Zhao X.-S.; Xu H.; Yan X.-Y.; Yang Q.; Yao C.; Gao
R.-L.; Wu Y.-F.; Qiao S.-B.
Institution
(Wang, Yan, Yao, Wu) Peking University Clinical Research Institute,
Beijing, China
(Ji) Shenzhen-Peking University, Hongkong University of Science and
Technology Medical Center, Shenzhen, China
(Zhao) Department of Cardiology, Beijing Jishuitan Hospital, Fourth
Clinical Medical College of Peking University, Beijing, China
(Xu, Gao, Qiao) Department of Cardiology, Fuwai Hospital, National Center
for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking
Union Medical College, Beijing, China
(Yang) Guangzhou Recomgen Biotech Co. Ltd, Guangzhou, China
Title
Recombinant human TNK tissue-type plasminogen activator (rhTNK-tPA) versus
alteplase (rt-PA) as fibrinolytic therapy for acute ST-segment elevation
myocardial infarction (China TNK STEMI): Protocol for a randomised,
controlled, non-inferiority trial.
Source
BMJ Open. 7 (9) (no pagination), 2017. Article Number: e016838. Date of
Publication: 01 Sep 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Aim To evaluate the efficacy and safety of recombinant human TNK
tissue-type plasminogen activator (rhTNK-tPA) in lowering major adverse
cardiovascular and cerebrovascular events (MACCEs) in Chinese acute
ST-segment elevation myocardial infarction (STEMI) patients. Methods and
analysis The study is designed as a multicentre, randomised, controlled
non-inferiority phase IV trial with balanced randomisation (1:1) in
patients with STEMI. The planned sample size is 6200 participants (or 3100
per arm). Participants with STEMI will be randomised to receive either
rhTNK-tPA or alteplase (rt-PA), with stratification by research centre,
age and the time from symptom onset to randomisation. All patients will
receive concomitant antiplatelet and anticoagulant therapy before
fibrinolytic therapy. The participants assigned to the intervention group
will receive an intravenous bolus of 16 mg rhTNK-tPA, while those assigned
to the control group will receive an intravenous bolus of 8 mg rt-PA
followed by 42 mg infusion over 90 mins. Other medications can also be
administered at the discretion of the cardiologists in charge. All
participants will be followed up for the primary study endpoint, the
occurrence of MACCEs within 30 days after fibrinolytic therapy, which is
defined as all-cause mortality, non-fatal re-infarction, non-fatal stroke,
percutaneous coronary intervention (PCI) due to thrombolysis failure, and
PCI due to reocclusion. Both intention-to-treat and per-protocol analyses
will be done for the primary analyses. Ethics and dissemination The study
procedures and informed consent form were approved by all participating
hospitals. The results will be disseminated in peer review journals and
academic conferences. This multicentre randomised controlled trial will
provide high-quality data about the efficacy and safety of rhTNK-tPA and,
once approved, its easier use should help improve the application of
reperfusion therapy and hence the treatment outcomes of STEMI patients.
Trial registration number NCT02835534.<br/>Copyright © Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved.
<40>
Accession Number
619446154
Author
D'Souza R.; Ostro J.; Shah P.S.; Silversides C.K.; Malinowski A.; Murphy
K.E.; Sermer M.; Shehata N.
Institution
(D'Souza, Malinowski, Murphy, Sermer) Department of Obstetrics and
Gynaecology, Division of Maternal and Fetal Medicine, University of
Toronto, 700 University Avenue, Toronto, ON M5G 1Z5, Canada
(D'Souza, Shah, Murphy, Shehata) Institute of Health Policy, Management
and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T
3M6, Canada
(Ostro) Department of Medicine, Division of Hematology, University of
Toronto, Toronto, Canada
(Shah) Department of Paediatrics, Division of Neonatology, Mount Sinai
Hospital, 700 University Avenue, Toronto, ON M5G 1Z5, Canada
(Silversides) Department of Medicine, Division of Cardiology Obstetric
Medicine Program, University of Toronto, 700 University Avenue, Toronto,
ON M5G 1Z5, Canada
(Shehata) Departments of Medicine and Laboratory Medicine and
Pathobiology, Mount Sinai Hospital, Division of Hematology, 700 University
Avenue, Toronto, ON M5G 1Z5, Canada
Title
Anticoagulation for pregnant women with mechanical heart valves: A
systematic review andmeta-Analysis.
Source
European Heart Journal. 38 (19) (pp 1509-1516), 2017. Date of Publication:
May 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To review maternal and foetal outcomes in women with mechanical heart
valves (MHVs) treated with vitamin-K antagonists (VKAs), first-Trimester
heparin followed by VKAs (sequential treatment), low molecular weight
heparin (LMWH) and unfractionated heparin (UFH) during pregnancy, in order
to inform practice. Methods and results Medline, Embase and Central were
searched from inception until February 2016. Two reviewers independently
screened 1786 titles, reviewed 110 full-Texts and extracted data and
assessed risk-of-bias from 46 articles. Pooled incidence (95% confidence
intervals) was calculated for maternal and foetal outcomes. Included
studies had a moderate or high risk-ofbias. With VKAs, sequential
treatment and LMWH, maternal mortality occurred in 0.9% (0.4-1.4), 2.0%
(0.8-3.1) and 2.9% (0.2-5.7), thromboembolic complications in 2.7%
(1.4-4.0), 5.8% (3.8-7.7) and 8.7% (3.9-13.4), livebirths in 64.5%
(48.8-80.2), 79.9% (74.3-85.6) and 92.0% (86.1-98.0) and
anticoagulant-related foetal/neonatal adverse events (embryopathy or
foetopathy) in 2.0% (0.3-3.7), 1.4% (0.3-2.5) and 0%, respectively. When
UFH is used throughout pregnancy, 11.2% (2.8-19.6) suffered thromboembolic
complications. Foetal loss and adverse events occurred with
first-Trimester warfarin doses<= 5 mg/day, although there were more
livebirths [83.6% (75.8-91.4) vs. 43.9% (32.8-55.0)] and fewer foetal
anomalies [2.3% (0.7-4.0) vs. 12.4% (3.3-21.6)] with lower doses than with
warfarin> 5mg/day. Conclusions VKAs are associated with fewest maternal
complications but also with fewest livebirths. Sequential treatment does
not eliminate anticoagulant-related foetal/neonatal adverse events. LMWH
is associated with the highest number of livebirths. The safety of UFH
throughout pregnancy and first-Trimester warfarin <= 5 mg/day remains
unconfirmed.<br/>Copyright © The Author 2017.
<41>
Accession Number
619459883
Author
Hasaniya N.; Razzouk A.; Newcombe J.; Hassneiah D.; Heimes J.; Gysbers J.;
Martens T.; Bailey L.
Institution
(Hasaniya, Razzouk, Newcombe, Hassneiah, Heimes, Gysbers, Martens, Bailey)
Department of Cardiovascular and Thoracic Surgery, Loma Linda University
Children's Hospital, Loma Linda, California
Title
An Absorbable Hydrogel Spray Reduces Postoperative Mediastinal Adhesions
After Congenital Heart Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Adhesions encountered during reoperative cardiac surgery can
prolong operative time and increase operative risk. The purpose of this
clinical study was to investigate the antiadhesion property of a synthetic
bioabsorbable polymer spray after cardiac reoperations in infants.
Methods: A prospective randomized double-blinded study was designed. Forty
infants requiring staged cardiac operations were randomly allocated to a
study group (n = 20) or a control group (n = 20). The appropriate volume
of the polymer was sprayed onto the mediastinal surfaces before chest
closure after the first surgical procedure in the study group. At
reoperation, adhesions were evaluated by a blinded investigator following
a 5-grade scoring system. Five predetermined anatomic areas were scored.
Incision to extracorporeal circulation time was also analyzed. Results: In
all, 40 subjects were enrolled into the study. Four babies died before the
second operation. Three others were missed for reevaluation. The control
group (n = 16) had longer incision to extracorporeal circulation time (38
+/- 10 minutes) than the study group (n = 17; 23 +/- 6 minutes; p <
0.001). The control subjects had significantly more severe adhesions than
the study group at all five mediastinal areas: (1) retrosternal ( p <
0.001); (2) base of the heart (large vessels [. p < 0.05]); (3) right side
( p < 0.01); (4) left side ( p < 0.02); and (5) diaphragmatic side of the
mediastinum ( p < 0.001). Conclusions: The use of synthetic bioabsorbable
polymer sealant spray at the end of primary pediatric cardiac surgery
reduces the intensity of mediastinal adhesions and the reentry time in
infants undergoing repeat median sternotomy.<br/>Copyright © 2017 The
Society of Thoracic Surgeons.
<42>
Accession Number
619443956
Author
St-Onge S.; Perrault L.P.; Demers P.; Boyle E.M.; Gillinov A.M.; Cox J.;
Melby S.
Institution
(St-Onge, Perrault, Demers) Department of Cardiac Surgery, Montreal Heart
Institute, Universite de Montreal, Quebec, Canada
(Boyle) St. Charles Medical Center, Bend, Oregon
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio
(Cox, Melby) Department of Thoracic and Cardiovascular Surgery, Washington
University, St. Louis, Missouri
Title
Pericardial Blood as a Trigger for Postoperative Atrial Fibrillation After
Cardiac Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Prevention strategies have long been sought to reduce the
incidence and burden of postoperative atrial fibrillation (POAF) after
heart surgery. However, none has emerged as a dominant and widely
applicable prophylactic measure. The purpose of this review is to consider
the biological mechanisms by which shed mediastinal blood leads to
oxidation and inflammation within the postoperative pericardial
environment and how this might trigger POAF in susceptible persons, as
well as how it could represent a new target for prevention of POAF.
Methods: We conducted a structured research of literature using PubMed and
MEDLINE databases to May 2016. Biomolecular and clinical articles focused
on assessing the contribution of pericardial blood, or the resulting
inflammation within the pericardial space and its potential role in
triggering POAF, were included in this review. Results: Evidence suggests
that shed mediastinal blood through breakdown products, activation of
coagulation cascade, and oxidative burst contributes to a highly
pro-oxidant and proinflammatory milieu found within the pericardial space
that can trigger postoperative atrial fibrillation in susceptible persons.
The extent of this reaction could be blunted by reducing the exposition of
pericardium to blood either through posterior pericardiotomy or improved
chest drainage. Conclusions: Shed mediastinal blood undergoing
transformation within the pericardium appears to be an important
contributing factor to POAF. Strategies to prevent shed mediastinal blood
from pooling around the heart might be considered in developing future
paradigms for prevention of POAF.<br/>Copyright © 2017 The Society of
Thoracic Surgeons.
<43>
Accession Number
619378690
Author
Douglas P.S.; Leon M.B.; Mack M.J.; Svensson L.G.; Webb J.G.; Hahn R.T.;
Pibarot P.; Weissman N.J.; Miller D.C.; Kapadia S.; Herrmann H.C.; Kodali
S.K.; Makkar R.R.; Thourani V.H.; Lerakis S.; Lowry A.M.; Rajeswaran J.;
Finn M.T.; Alu M.C.; Smith C.R.; Blackstone E.H.
Institution
(Douglas, Leon, Hahn) Duke University Medical Center, Durham, NC, United
States
(Leon, Hahn, Kodali, Finn, Alu, Smith) New York Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Svensson, Kapadia, Lowry, Rajeswaran, Blackstone) Cleveland Clinic,
Cleveland, OH, United States
(Webb) St Paul's Hospital, University of British Columbia, Vancouver, BC,
Canada
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Weissman, Miller) MedStar Washington Hospital Center, Washington, DC,
United States
(Miller) Stanford University, Stanford, CA, United States
(Herrmann) University of Pennsylvania Health System, Philadelphia, PA,
United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Thourani, Lerakis) Emory University, Atlanta, GA, United States
Title
Longitudinal hemodynamics of transcatheter and surgical aortic valves in
the PARTNER Trial.
Source
JAMA Cardiology. 2 (11) (pp 1197-1206), 2017. Date of Publication:
November 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Use of transcatheter aortic valve replacement (TAVR) for
severe aortic stenosis is growing rapidly. However, to our knowledge, the
durability of these prostheses is incompletely defined. OBJECTIVE: To
determine the midterm hemodynamic performance of balloon-expandable
transcatheter heart valves. DESIGN, SETTING, AND PARTICIPANTS: In this
study, we analyzed core laboratory-generated data from echocardiograms of
all patients enrolled in the Placement of Aortic Transcatheter Valves
(PARTNER) 1 Trial with successful TAVR or surgical AVR (SAVR) obtained
preimplantation and at 7 days, 1 and 6 months, and 1, 2, 3, 4, and 5 years
postimplantation. Patients from continued access observational studies
were included for comparison. INTERVENTIONS: Successful implantation after
randomization to TAVR vs SAVR (PARTNER 1A; TAVR, n = 321; SAVR, n = 313),
TAVR vs medical treatment (PARTNER 1B; TAVR, n = 165), and continued
access (TAVR, n = 1996). Five-year echocardiogram data were available for
424 patients after TAVR and 49 after SAVR. MAIN OUTCOMES AND MEASURES:
Death or reintervention for aortic valve structural indications, measured
using aortic valve mean gradient, effective orifice area, Doppler velocity
index, and evidence of hemodynamic deterioration by reintervention,
adverse hemodynamics, or transvalvular regurgitation. RESULTS: Of 2795
included patients, the mean (SD) age was 84.5 (7.1) years, and 1313
(47.0%) were female. Population hemodynamic trends derived from nonlinear
mixed-effects models showed small early favorable changes in the first few
months post-TAVR, with a decrease of -2.9 mm Hg in aortic valve mean
gradient, an increase of 0.028 in Doppler velocity index, and an increase
of 0.09 cm<sup>2</sup> in effective orifice area. There was relative
stability at a median follow-up of 3.1 (maximum, 5) years. Moderate/severe
transvalvular regurgitation was noted in 89 patients (3.7%) after TAVR and
increased over time. Patients with SAVR showed no significant changes. In
TAVR, death/reintervention was associated with lower ejection fraction,
stroke volume index, and aortic valve mean gradient up to 3 years, with no
association with Doppler velocity index or valve area. Reintervention
occurred in 20 patients (0.8%) after TAVR and in 1 (0.3%) after SAVR and
became less frequent over time. Reintervention was caused by structural
deterioration of transcatheter heart valves in only 5 patients. Severely
abnormal hemodynamics on echocardiograms were also infrequent and not
associated with excess death or reintervention for either TAVR or SAVR.
CONCLUSIONS AND RELEVANCE: This large, core laboratory-based study of
transcatheter heart valves revealed excellent durability of the
transcatheter heart valves and SAVR. Abnormal findings in individual
patients, suggestive of valve thrombosis or structural deterioration, were
rare in this protocol-driven database and require further investigation.
TRIAL REGISTRATION: clinicaltrials.gov Identifier:
NCT00530894.<br/>Copyright © 2017 American Medical Association. All
rights reserved.
<44>
Accession Number
619375515
Author
Gao Z.-W.; Huang Y.-Z.; Zhao H.-M.; Sun Q.-S.; Luo M.; Pang L.-Q.; Sun H.
Institution
(Gao, Zhao, Sun, Luo, Sun) Department of Emergency, Huai'an First People's
Hospital, Nanjing Medical University, Huai'an 223300, China
(Huang) Department of Critical Care and Medicine, Zhongda Hospital,
Southeast University, Nanjing 210000, China
(Pang) Department of General Surgery, Huai'an First People's Hospital,
Nanjing Medical University, Huai'an, Jiangsu 223300, China
Title
Impact of intra-aortic balloon counterpulsation on prognosis of patients
with acute myocardial infarction: A meta-analysis.
Source
Acta Cardiologica Sinica. 33 (6) (pp 567-577), 2017. Date of Publication:
November 2017.
Publisher
Republic of China Society of Cardiology (E-mail: acs@tsoc.org.tw)
Abstract
Background: This study aimed to evaluate the impact of intra-aortic
balloon counterpulsation (IABP) on the prognosis of patients with acute
myocardial infarction (AMI). Methods:We identified and included in this
study AMI cases treated with IABP from January 1970 to May 2014. For
statistical analysis, we utilized RevMan 5.0 software. Results: Fourteen
RCTs with a total population of 2538 were included in this study. The
in-hospital and 30-day mortality rate in the IABP group was not
significantly lower than those in the non-IABP group. Subgroup analysis
according to the type of revascularization, OR values of TT subgroup, PCI
subgroup, and CABG subgroup were 0.64 (95% CI 0.25-1.61, p = 0.34), 0.85
(95% CI 0.65-1.11, p = 0.23) and 0.46 (95% CI 0.13-1.63, p = 0.23). And OR
values of AMI patients in the before and after PCI subgroup were 0.43 (95%
CI 0.21-0.91, p = 0.03) and 1.36 (95% CI 0.76-2.41, p = 0.30). The
6-monthmortality in the IABP group was not significantly lower than that
in the non-IABP group. And OR values of 6-month mortalities of the before
and after PCI subgroup were 0.47 (95% CI 0.26-0.86, p = 0.01) and 1.40
(95% CI 0.57-3.45, p = 0.47). Conclusions: IABP did not reduce the
in-hospital and 30-day mortality of AMI patients, and did not reduce the
6-month mortality. But IABP used in AMI patients before PCI was associated
not only with reduced in-hospital and 30-day mortality, but also reduced
6-month mortality.<br/>Copyright © 2017, Republic of China Society of
Cardiology. All rights reserved.
<45>
Accession Number
619329442
Author
Hu A.; Qiu Y.; Zhang P.; Hu B.; Yang Y.; Li S.; Zhao R.; Zhang Z.; Zhang
Y.; Zheng Z.; Qiu C.; Li F.; Gong X.
Institution
(Hu, Zhang, Zhang, Zheng) Shenzhen People's Hospital, Department of
Anesthesiology, Shenzhen 518001, China
(Hu, Zhang, Zhang, Zheng) Shenzhen Anesthesiology Engineering Center,
Shenzhen 518001, China
(Hu, Zhang, Zhang, Zheng) Jinan University, The Second Clinical Medical
College, Shenzhen 518001, China
(Qiu) West China Hospital, Sichuan University, Department of
Anesthesiology and Translational Neuroscience Center, Chengdu 610000,
China
(Zhang) Sichuan Academy of Medical Sciences and Sichuan Provincial
People's Hospital, Department of Anesthesiology, Chengdu 610072, China
(Hu) Affiliated Hospital of Guizhou Medical University, Department of
Anesthesiology, Guiyang 550004, China
(Yang) Henan Provincial People's Hospital of Zhengzhou University,
Department of Anesthesiology, Zhengzhou 450000, China
(Li) Taihe Hospital of Hubei University of Medicine, Department of
Anesthesiology, Shiyan, Hubei 442000, China
(Zhao) The Third Affiliated Hospital of Kunming Medical University,
Department of Anesthesiology, Kunming 650106, China
(Qiu, Li, Gong) The Second Clinical Medicine College, Jinan University,
Clinical Medical Research Center, Shenzhen 518001, China
Title
Comparison of the effect of high versus low mean arterial pressure levels
on clinical outcomes and complications in elderly patients during
non-cardiothoracic surgery under general anesthesia: Study protocol for a
randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 554. Date of
Publication: 21 Nov 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Intraoperative blood pressure (BP) is a concern in daily
clinic anesthesia and contributes to the differences in clinical outcome.
We conducted a randomized controlled trial (RCT) to compare the effect of
high vs. low mean arterial pressure (MAP) levels on clinical outcomes and
complications in elderly patients under general anesthesia (GA). Methods:
In this multicenter, randomized, parallel-controlled, open-label,
assessor-blinded clinical trial, 322 patients aged more than 65years will
be randomized for a low-level MAP (60-70mmHg) or high-level MAP
(90-100mmHg) during non-cardiothoracic surgery under GA. The primary
outcome will be the incidence of postoperative delirium. The secondary
outcomes will include the delirium duration days, intraoperative urine
volume, intraoperative blood loss, specific postoperative complications,
and all-cause 28-day mortality. Discussion: Results of this trial will
help clarify whether BP management is beneficial for elderly patients
under GA and will make clear whether the effect of high-level MAP can
reduce the postoperative complication compared to low-level MAP. Trial
registration: ClinicalTrials.gov, NCT02857153. Registered on 15 July
2016.<br/>Copyright © 2017 The Author(s).
<46>
Accession Number
619437583
Author
Saxena A.; Virk S.A.; Bowman S.R.A.; Jeremy R.; Bannon P.G.
Institution
(Saxena, Bannon) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, NSW, Australia
(Saxena, Bannon) Discipline of Surgery, Sydney Medical School, University
of Sydney, Sydney, NSW, Australia
(Virk) South Western Sydney Clinical School, University of New South
Wales, Sydney, NSW, Australia
(Bowman) Melbourne Medical School, University of Melbourne, Melbourne,
Vic, Australia
(Jeremy) Department of Cardiology, Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Title
Heart Valve Surgery Performed by Trainee Surgeons: Meta-Analysis of
Clinical Outcomes.
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier Ltd
Abstract
Background: Cardiac surgical units must balance trainee education with the
duty to provide optimal patient care. This is particularly challenging
with valvular surgery, given the lower volume and increased complexity of
these procedures. The present meta-analysis was conducted to assess the
impact of trainee operator status on clinical outcomes following valvular
surgery. Methods: Medline, Embase and CENTRAL databases were
systematically searched for studies reporting clinical outcomes according
to the training status of the primary operator (consultant or trainee).
Data were extracted and meta-analysed according to pre-defined endpoints.
Results: Eleven observational studies met the inclusion criteria,
reporting on five patient cohorts undergoing mitral valve surgery (n =
3975), six undergoing aortic valve replacement (AVR) (n = 6236) and three
undergoing combined AVR and coronary artery bypass grafting (CABG) (n =
3495). Perioperative mortality was not significantly different between
trainee and consultant cases for mitral valve surgery (odds ratio [OR]
0.92; 95% confidence interval [CI], 0.62-1.37), AVR (OR 0.67; 95% CI,
0.37-1.24), or combined AVR and CABG (OR 1.07; 95% CI, 0.40-2.85). The
incidences of perioperative stroke, myocardial infarction, arrhythmias,
acute renal failure, reoperation or wound infection were not significantly
different between trainee and consultant cases. There was a paucity of
mid-term survival data. Conclusions: Valvular surgery cases performed
primarily by trainees were not associated with adverse perioperative
outcomes. These findings suggest the rigorous design of cardiac surgical
trainee programs can sufficiently mitigate trainee deficiencies. However,
studies with longer follow-up duration and echocardiographic data are
required to assess long-term durability and safety.<br/>Copyright ©
2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
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