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EMBASE (updates since 2010-06-10)
<1>
Accession Number
2010317677
Authors
Holme I. Boman K. Brudi P. Egstrup K. Gohlke-Baerwolf C. Kesaniemi Y.A.
Malbecq W. Rossebo A.B. Wachtell K. Willenheimer R. Pedersen T.R.
Institution
(Holme, Pedersen) Centre of Preventive Medicine, Oslo University Hospital,
Ulleval, Oslo, Norway.
(Rossebo) Division of Cardiology, Oslo University Hospital, Aker, Oslo,
Norway.
(Boman) Department of Medicine, Institution of Public Health and Clinical
Medicine, Umea University, Skelleftea, Sweden.
(Willenheimer) Lund University, Heart Health Group, Malmo, Sweden.
(Brudi) Merck and Co, Inc., Whitehouse Station, NJ, United States.
(Egstrup) Department of Medicine, Svendborg Hospital, Denmark.
(Gohlke-Baerwolf) Herz-Zentrum, Bad Krozingen, Germany.
(Kesaniemi) Department of Internal Medicine and Biocenter Oulu, University
of Oulu, Oulu, Finland.
(Malbecq) MSD, Europe, Inc., Brussels, Belgium.
(Wachtell) Department of Cardiology B2142, The Heart Centre,
Rigshospitalet, Copenhagen, Denmark.
Title
Observed and Predicted Reduction of Ischemic Cardiovascular Events in the
Simvastatin and Ezetimibe in Aortic Stenosis Trial.
Source
American Journal of Cardiology. 105(12)(pp 1802-1808), 2010. Date of
Publication: 15 Jun 2010.
Publisher
Elsevier Inc.
Abstract
In the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial, combined
ezetimibe (10 mg) and simvastatin (40 mg) decreased low-density
lipoprotein cholesterol levels by 50% and ischemic cardiovascular event
(ICE) risk by 22% compared to placebo. A larger decrease in ICE risk might
have been expected for the degree of lipid-lowering observed. This
analysis investigated relations between changes in lipoprotein components
(LCs), and ICE risk decrease in the SEAS trial in all patients, by
severity of aortic stenosis (AS), and compared to results of other
clinical trials. A total of 1,570 patients with baseline aortic jet
velocity (JV) data, baseline and 1-year low-density lipoprotein
cholesterol, high-density lipoprotein cholesterol, and apolipoprotein B,
and no ICEs during the first year were included in the analysis. Relations
between on-treatment measurements of 1-year LCs and time-to-ICE occurrence
were assessed in all patients and in JV tertiles (<2.8, 2.8 to 3.3, and
>3.3 m/s). Observed and predicted ICE risk decreases were compared by Cox
model. Decreases in LCs after 1 year of ezetimibe plus simvastatin were
associated with decreased ICE risk in all patients and in the 2 lower JV
tertiles (p <0.05 to <0.001) but not in tertile 3. In JV tertiles 1 and 2,
ICE risk decreased by 47% and 36%, respectively, was reasonably well
predicted by all LCs, and was consistent with findings from
meta-regression analyses in other populations. In conclusion, the degree
of lipid lowering by ezetimibe plus simvastatin may predict the extent of
ICE risk decrease in patients with mild AS, but ICE risk prediction in
patients with more severe AS is confounded by AS-associated cardiovascular
events and a shorter interval of exposure to lipid lowering. copyright
2010.
<2>
Accession Number
2010310136
Authors
Rapchuk I.L. O'Connell L. Liessmann C.D. Cornelissen H.R. Fraser J.F.
Institution
(Rapchuk, O'Connell, Liessmann, Cornelissen, Fraser) Departments of
Anaesthesia, Critical Care Research Group, Prince Charles Hospital,
Chermside, QLD, Australia.
Title
Effect of gabapentin on pain after cardiac surgery: A randomised,
double-blind, placebo-controlled trial.
Source
Anaesthesia and Intensive Care. 38(3)(pp 445-451), 2010. Date of
Publication: May 2010.
Publisher
Australian Society of Anaesthetists
Abstract
This study evaluated whether perioperative administration of gabapentin in
cardiac surgery patients could reduce postoperative opioid consumption,
postoperative sleep or perceived quality of recovery. This randomised
controlled trial assigned 60 patients undergoing cardiac surgery to
receive 1200 mg of gabapentin or placebo two hours preoperatively, and
then 600 mg of gabapentin or placebo twice a day for the next two
postoperative days. Postoperative opioid use was measured by the amount of
fentanyl used in the first 48 hours postoperatively. Pain at rest and with
movement at 12, 24, 48 and 72 hours after surgery, sleep scores on
postoperative days two and three and patient-perceived quality of recovery
were also assessed. Fentanyl use, visual analog pain scores, sleep scores,
adjunctive pain medication use and number of anti-emetics given were not
significantly different between the gabapentin and placebo groups. The
incidence of side-effects was similar between the gabapentin and placebo
groups, and no difference was found between groups in relation to quality
of recovery. These findings indicate that preoperative use of gabapentin
followed by postoperative dosing for two days did not significantly affect
the postoperative pain, sleep, opioid consumption or patient-perceived
quality of recovery for patients undergoing cardiac surgery.
<3>
Accession Number
2010294390
Authors
Saia F. Marrozzini C. Guastaroba P. Ortolani P. Palmerini T. Pavesi P.C.
Gordini G. Pancaldi L.G. Taglieri N. Palma R.D. Pasquale G.D. Branzi A.
Marzocchi A.
Institution
(Saia, Marrozzini, Ortolani, Palmerini, Taglieri, Branzi, Marzocchi)
Istituto di Cardiologia, Universit di Bologna, Policlinico S.
Orsola-Malpighi, Italy.
(Guastaroba, Palma) Agenzia Sanitaria Regionale Regione Emilia-Romagna,
Bologna, Italy.
(Pavesi, Pasquale) Unit Operativa di Cardiologia, Ospedale Maggiore,
Bologna, Italy.
(Gordini) Servizio Emergenza Territoriale 118 di Bologna, Ospedale
Maggiore, Bologna, Italy.
(Pancaldi) Unit Operativa di Cardiologia, Ospedale di Bentivoglio,
Bologna, Italy.
Title
Lower long-term mortality within a regional system of care for
ST-elevation myocardial infarction.
Source
Acute Cardiac Care. 12(2)(pp 42-50), 2010. Date of Publication: 2010.
Publisher
Informa Healthcare
Abstract
Introduction: Organization of regional systems of care (RSC) with an
emphasis on pre-hospital triage and primary percutaneous coronary
intervention (PCI) has been recommended to implement guidelines and
improve clinical outcome in ST-segment elevation myocardial infarction
(STEMI). Patients and methods: All STEMI patients (n 1,823) admitted to
any of the 13 hospitals of the province of Bologna, Italy, before
(pre-RSC, n 858) and after (RSC, n 965) the implementation of a RSC were
enrolled in the study. Primary evaluation was mortality. Secondary
outcomes included death, myocardial infarction, stroke, and coronary
revascularization procedures up to three-year follow-up. Results: Among
patients admitted <12 h from symptom onset, reperfusion was performed in
68.7% pre-RSC versus 89.8% RSC, P <0.001. Within the RSC, primary PCI
became the main reperfusion treatment (34.5% pre-RSC versus 85.9% RSC; P
<0.001 for both), and one-year mortality was lower (23.9% pre-RSC versus
18.8% RSC; P 0.0015). At three-year, this advantage was maintained and
actually increased (31.7% pre-RSC versus 24.8% RSC; P 0.0031). Independent
predictors of mortality at three-years were RSC, age, heart failure,
cerebrovascular disease, renal disease, shock, peripheral vascular
disease, and malignancies. Conclusions: In this study, RSC for the
treatment of STEMI was associated with increased rates of reperfusion and
reduction of long-term mortality. copyright 2010 Informa UK Ltd.
<4>
Accession Number
0020458988
Authors
Chailler M. Ellis J. Stolarik A. Woodend K.
Institution
(Chailler) University of Ottawa, Ottawa, ON.
Title
Cold therapy for the management of pain associated with deep breathing and
coughing post-cardiac surgery..
Source
Canadian journal of cardiovascular nursing = Journal canadien en soins
infirmiers cardio-vasculaires. 20(2)(pp 18-24), 2010. Date of
Publication: 2010.
Abstract
BACKGROUND: Coughing has been identified as the most painful experience
post cardiac surgery. METHODS: Participants (n = 32), in a randomized
crossover trial, applied a frozen gel pack to their sternal incision
dressing before performing deep breathing and coughing (DB & C) exercises.
Pain scores from 0 to 10 at rest were compared with pain scores post DB &
C with and without the gel pack. Participants were also asked to describe
their sensations with the frozen gel pack, as well as their preferences
for gel pack application. RESULTS: The repeated measures analysis of
variance revealed a significant reduction in pain scores between pre- and
post-application of the gel pack (F = 28.69, p < .001). There were 22
(69%) participants who preferred the application of the gel pack compared
with no gel pack. All 32 (100%) participants would reapply the gel pack in
the future. CONCLUSION: This study demonstrates that cold therapy can be
used to manage sternal incisional pain when DB & C.
<5>
Accession Number
0020419963
Authors
Tanveer R. Khan A.U. Siddiqi T.A. Siddique S. Nasreen A. Salman-ur-Rehman
Badar S.
Institution
(Tanveer) National Institute of Cardiovascular Diseases, Karachi.
Title
Continuous versus interrupted technique of ventricular septal defect (VSD)
closure in total correction for tetrology of Fallot pertaining to residal
VSD..
Source
JPMA. The Journal of the Pakistan Medical Association. 60(4)(pp 253-256),
2010. Date of Publication: Apr 2010.
Abstract
OBJECTIVE: To analyze the outcome of continuous versus interrupted closure
technique of ventricular septal defect (VSD) closure in Tetrology of
Fallot with reference to postoperative residual VSD after total
correction. METHODS: A randomised control study was conducted between
January 2008 to December 2008 at The Department of Cardiac Surgery,
National Institute of Cardiovascular Diseases (NICVD), Karachi. The
results of total correction (T.C) of VSD in patients with Tetralogy of
Fallot, with emphasis on the suturing technique and eventually on the
occurrence of residual ventricular septal defect(VSD) were analyzed.
Transventricular as well as transatrial route was used to approach VSD. In
thirty patients VSD was closed with 5/0 proline continuous double ended
suture while in remaining 30 (50%) patients VSD was closed with
interrupted 5/0 prolene double ended sutures. Postoperative
echocardiography was done in all patients as a routine on second
postoperative day, to document residual VSD. RESULTS: The study included
60 (100%) patients with T.O.F. There were 20 (33.3%) females and 40
(66.6%) males with ages ranging between 04 to 18 years (mean 13.025 +/-
2.123 years). Postoperative echocardiography showed residual VSD in 05
(8.3%) patients at posteroinferior rim of VSD. Of these 05 cases, in four
VSD had been closed with continuous 5/0 proline double ended sutures, and
one had VSD closed with interrupted 5/0 double ended sutures. CONCLUSION:
Residual VSD is common with continuous suturing technique as compared to
interrupted suturing technique. This is perhaps because of poor myocardium
quality and higher RV pressures in our patients presenting at a late age.
Small (less than 05 milimeter) residual VSD can be treated conservatively
in haemodynamically stable patients.
<6>
Accession Number
0020051451
Authors
van de Gevel D.F. Hamad M.A. Elenbaas T.W. Ostertag J.U. Schonberger J.P.
Institution
(van de Gevel) Department of Cardio-thoracic Surgery, Catharina Hospital,
Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
Title
Is the use of Steri-StripTM S for wound closure after coronary artery
bypass grafting better than intracuticular suture?.
Source
Interactive cardiovascular and thoracic surgery. 10(4)(pp 561-564), 2010.
Date of Publication: Apr 2010.
Abstract
Several methods have been used in wound closure after coronary artery
bypass grafting (CABG). In this study, the safety and efficacy of one of
these methods, Steri-Strip S is compared with the traditional
intracuticular suture method. Eighty-one patients undergoing CABG were
prospectively randomized into two groups according to the method of skin
closure: Steri-Strip S group and traditional suture group. Comparison
between the two methods was done with regards to the length of the wound
and the time needed to close it. The median closure time with Steri-Strip
S was 5.45+/-3.35 min vs. 7.53+/-3.41 min in the suture group. A pain
score of >or=6 at the first postoperative day was found in 30% of the
patients in the suture group vs. 14% of the patients in the Steri-Strip S
group (P=0.07). Cosmetic evaluation showed a non-significant difference in
the linear visual analogue score in favor of Steri-Strip S group compared
to the intracuticular suture group (73.1 vs. 70.1) (P=0.07). Steri-Strip S
is a fast, safe alternative for wound closure of the sternotomy incision
and graft harvesting site. A larger study is needed to establish the
potential beneficial effect of Steri-Strip S on wound infection
prevention.
<7>
Accession Number
0020012609
Authors
Stassano P. Di Tommaso L. Monaco M. Mastrogiovanni G. Musumeci A. Contaldo
A. Pepino P.
Institution
(Stassano) Cardiac Surgery Unit, University Federico II, School of
Medicine, Naples, Italy.
Title
Left heart pump-assisted myocardial revascularization favorably affects
neutrophil apoptosis..
Source
World journal of surgery. 34(4)(pp 652-657), 2010. Date of Publication:
Apr 2010.
Abstract
OBJECTIVES: Granulocyte apoptosis is a key control process in the
clearance of neutrophils from inflammatory sites, and its rate is
modulated by a number of inflammatory mediators. In this study, we
investigated whether the use of left ventricular-assisted technique (LVA)
in beating heart myocardial revascularization would exert less impact on
neutrophil apoptosis compared with conventional cardiopulmonary bypass
(CPB). METHODS: Forty consecutive patients who underwent myocardial
revascularization were randomly assigned to LVA (group A, 21 patients) or
CPB (group B, 19 patients). Blood samples for detection of interleukin-6,
interleukin-8, and tumor necrosis factor-alpha were measured at baseline
and at various time points postoperatively. Neutrophil apoptosis was
detected by light microscopy as well as by the annexin-V assays together
with the activity of caspase 3 on postoperative samples. RESULTS:
Preoperative clinical and demographic data did not differ between the two
groups. The two groups also were similar with respect to mortality, number
of grafts performed, duration of extracorporeal circulation, and need for
inotropes. However postoperatively, spontaneous apoptosis was
significantly delayed in neutrophils from CPB patients compared with LVA
patients. Neutrophils were activated, as indicated by increased surface
expression of CD11b. Caspase 3 activity was found to be significantly
reduced in neutrophils from CPB patients after 18 and 24 hours of culture.
CONCLUSIONS: Patients who underwent beating heart myocardial
revascularization with LVA show a better preserved neutrophil apoptosis
than patients treated with the CPB.
<8>
Accession Number
0020230566
Authors
Mosing M. Reich H. Moens Y.
Institution
(Mosing, Reich, Moens) Clinic of Anaesthesia and Perioperative Intensive
Care, University of Veterinary Medicine, Vienna, Austria.
Title
Clinical evaluation of the anaesthetic sparing effect of brachial plexus
block in cats.
Source
Veterinary Anaesthesia and Analgesia. 37(2)(pp 154-161), 2010. Date of
Publication: March 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Objective: To evaluate the isoflurane sparing effect and the post-surgical
analgesia provided by a brachial plexus block (BPB) in cats undergoing
distal thoracic limb surgery. Study design: Prospective randomized blinded
clinical study. Animals: Twenty client-owned cats. Methods: Cats were
assigned to receive either no BPB (group NB) or a nerve stimulator guided
BPB (group BPB) using lidocaine (3.6 mg kg-1) and bupivacaine (1.2 mg
kg-1). Pre-medication consisted of midazolam and ketamine intravenously
(IV). Anaesthesia was induced with propofol IV to effect and maintained
with isoflurane delivered in oxygen and a continuous rate infusion of
fentanyl (2 mug kg-1 hour-1). End-tidal isoflurane concentration (Fe'ISO)
was adjusted every 3 minutes guided by changes in cardiorespiratory
parameters and reflexes present, to maintain a stable depth of
anaesthesia. Five time points were chosen to record all parameters and
compare values between groups. Recovery and post-operative pain assessment
were performed using a visual analogue scale (VAS) at 15 and 45 minutes
after extubation and thereafter at hourly intervals until 5 hours after
placement of the BPB. Results: No clinically significant differences were
seen for heart rate, respiratory rate and non-invasive blood pressure
between groups. Mean F. e'ISO was significantly lower in group BPB
compared with group NB at all time points. In group NB, all intraoperative
measurements of F. e'ISO were significantly higher compared with baseline
(3 minutes before start of surgery) measurements. During recovery, VAS
scores for group BPB were significantly lower than for group NB.
Additional analgesics were needed in all cats within the study period.
Conclusion and Clinical relevance: In cats undergoing orthopaedic surgery
of the thoracic limb, BPB reduced intra-operative isoflurane requirement
and pain during the early post-operative period when compared with
procedures without a BPB. BPB is a useful adjunct to anaesthesia in such
cases. copyright 2010 The Authors. Journal compilation copyright 2010
Association of Veterinary Anaesthetists.
<9>
Accession Number
2010302163
Authors
Kofoed K.F. Madsen J.K. Grande P. Saunamki K. Nielsen T.T. Kassis E.
Thayssen P. Rasmussen K.
Institution
(Kofoed, Grande, Saunamki) Department of Cardiology B, University of
Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100-Cph, Denmark.
(Madsen, Kassis) Department of Cardiology, Gentofte Hospital, Gentofte,
Denmark.
(Nielsen) Department of Cardiology, Skejby Hospital, Aarhus, Denmark.
(Thayssen) Department of Cardiology, Odense University Hospital, Odense,
Denmark.
(Rasmussen) Department of Cardiology, Aalborg Hospital South, Aalborg,
Denmark.
Title
Long-term effects of invasive treatment in patients with a
post-thrombolytic Q-wave myocardial infarction.
Source
Scandinavian Cardiovascular Journal. 44(3)(pp 146-152), 2010. Date of
Publication: 2010.
Publisher
Informa Healthcare
Abstract
Objectives. The aim of the present study was to assess the effect of a
deferred invasive treatment strategy on long-term outcome in patients with
a post-thrombolytic Q-wave myocardial infarction and inducible myocardial
ischemia. Design. Patients (N751) with post-thrombolytic Q-wave myocardial
infarction and inducible ischemia (angina pectoris or silent myocardial
ischemia) were randomized to a deferred invasive treatment (balloon
angioplasty or coronary bypass surgery) or medical treatment. Vital status
and non-fatal cardiac events defined as hospitalization caused by acute
cardiac events were recorded for a median of 11.4 years. Results. Survival
was significantly improved in patients receiving invasive treatment
compared to patients treated medically (hazard ratio 0.85 (95% confidence
limits 0.73-0.99), p=0.034). Subgroup analysis showed a reduction of
non-fatal cardiac events and improved survival among the patients with
post-infarction angina pectoris and not among the patients with silent
myocardial ischemia. Conclusions. A deferred invasive treatment strategy
improves survival compared to medical treatment in patients with inducible
myocardial ischemia after a post-thrombolytic Q-wave myocardial
infarction. copyright 2010 Informa UK Ltd.
<10>
Accession Number
2010302160
Authors
Moller C.H. Perko M.J. Lund J.T. Andersen L.W. Kelbaek H. Madsen J.K.
Gluud C. Steinbrchel D.A.
Institution
(Moller, Perko, Lund, Steinbrchel) Department of Cardio-Thoracic Surgery,
Rigshospitalet, Copenhagen University Hospital, Denmark.
(Andersen) Department of Cardio-Thoracic Anaesthesiology, Rigshospitalet,
Copenhagen University Hospital, Denmark.
(Kelbaek) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Denmark.
(Madsen) Department of Cardiology, Gentofte Hospital, Copenhagen
University Hospital, Denmark.
(Moller, Gluud) Copenhagen Trial Unit, Rigshospitalet, Copenhagen
University Hospital, Denmark.
Title
Graft patency after off-pump versus on-pump coronary artery surgery in
high-risk patients.
Source
Scandinavian Cardiovascular Journal. 44(3)(pp 161-167), 2010. Date of
Publication: 2010.
Publisher
Informa Healthcare
Abstract
Objective. To compare angiographic graft patency in high-risk patients
randomly allocated to off-pump vs. on-pump coronary artery bypass grafting
(CABG). Design. From a randomised, single-centre clinical trial including
patients undergoing isolated first-time coronary bypass surgery a subgroup
of patients were scheduled to 1-year coronary angiographic follow-up.
Patients had 3-vessel disease and a EuroSCORE [greater-than or equal to]5.
We evaluated graft patency using a patency index (percentage of patent
grafts out of the total number of grafts in each patient). Results.
One-year angiography was performed in 34 patients undergoing off-pump
surgery and 35 patients undergoing on-pump surgery. The mean number of
distal anastomoses was 3.38+/-0.65 in the off-pump group versus
3.46+/-0.61 in the on-pump group (NS). The number of patients without
graft failure was 22 in the off-pump group and 24 in the on-pump group
(NS). The overall patency index was 85% in the off-pump group versus 87%
in the on-pump group with a mean difference of 2.1%, 95% confidence
interval 12.9 to 8.7 (NS). Conclusions. In patients with 3-vessel disease
and a high-risk profile we found no statistically significant difference
in graft patency between off-pump and on-pump CABG at 1-year coronary
angiographic follow-up. copyright 2010 Informa UK Ltd.
<11>
Accession Number
2010298300
Authors
Ohye R.G. Sleeper L.A. Mahony L. Newburger J.W. Pearson G.D. Lu M.
Goldberg C.S. Tabbutt S. Frommelt P.C. Ghanayem N.S. Laussen P.C. Rhodes
J.F. Lewis A.B. Mital S. Ravishankar C. Williams I.A. Dunbar-Masterson C.
Atz A.M. Colan S. Minich L.L. Pizarro C. Kanter K.R. Jaggers J. Jacobs
J.P. Krawczeski C.D. Pike N. McCrindle B.W. Virzi L. Gaynor J.W.
Institution
(Ohye, Goldberg) University of Michigan Medical School, Ann Arbor, MI,
United States.
(Sleeper, Lu, Virzi) New England Research Institutes, Watertown, MA,
United States.
(Mahony) University of Texas Southwestern Medical Center, Dallas, TX,
United States.
(Newburger, Laussen, Dunbar-Masterson, Colan) Children's Hospital Boston,
Boston, United States.
(Pearson) National Heart, Lung, and Blood Institute, Bethesda, MD, United
States.
(Tabbutt, Ravishankar, Gaynor) Children's Hospital of Philadelphia,
Philadelphia, United States.
(Frommelt, Ghanayem) Children's Hospital of Wisconsin, Medical College of
Wisconsin, Milwaukee, WI, United States.
(Rhodes, Jaggers) North Carolina Consortium: Duke University, Durham, NC,
United States.
(Rhodes, Jaggers) East Carolina University, Greenville, United States.
(Rhodes, Jaggers) Wake Forest University, Winston-Salem, NC, United
States.
(Lewis, Pike) Children's Hospital Los Angeles, Los Angeles, CA, United
States.
(Mital, McCrindle) Hospital for Sick Children, Toronto, Canada.
(Williams) Children's Hospital of New York, New York, United States.
(Atz) Medical University of South Carolina, Charleston, SC, United States.
(Minich) Primary Children's Medical Center, University of Utah, Salt Lake
City, UT, United States.
(Pizarro) Nemours Cardiac Center, Wilmington, DE, United States.
(Kanter) Emory University, Atlanta, GA, United States.
(Jacobs) Congenital Heart Institute of Florida, St. Petersburg, FL, United
States.
(Krawczeski) Cincinnati Children's Medical Center, Cincinnati, United
States.
Title
Comparison of shunt types in the Norwood procedure for single-ventricle
lesions.
Source
New England Journal of Medicine. 362(21)(pp 1980-1992), 2010. Date of
Publication: 27 May 2010.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: The Norwood procedure with a modified Blalock-Taussig (MBT)
shunt, the first palliative stage for single-ventricle lesions with
systemic outflow obstruction, is associated with high mortality. The right
ventricle-pulmonary artery (RVPA) shunt may improve coronary flow but
requires a ventriculotomy. We compared the two shunts in infants with
hypoplastic heart syndrome or related anomalies. METHODS: Infants
undergoing the Norwood procedure were randomly assigned to the MBT shunt
(275 infants) or the RVPA shunt (274 infants) at 15 North American
centers. The primary outcome was death or cardiac transplantation 12
months after randomization. Secondary outcomes included unintended
cardiovascular interventions and right ventricular size and function at 14
months and transplantation-free survival until the last subject reached 14
months of age. RESULTS: Transplantation-free survival 12 months after
randomization was higher with the RVPA shunt than with the MBT shunt (74%
vs. 64%, P=0.01). However, the RVPA shunt group had more unintended
interventions (P=0.003) and complications (P=0.002). Right ventricular
size and function at the age of 14 months and the rate of nonfatal serious
adverse events at the age of 12 months were similar in the two groups.
Data collected over a mean (+/-SD) follow-up period of 32+/-11 months
showed a nonsignificant difference in transplantation-free survival
between the two groups (P=0.06). On nonproportional-hazards analysis, the
size of the treatment effect differed before and after 12 months (P=0.02).
CONCLUSIONS: In children undergoing the Norwood procedure,
transplantation-free survival at 12 months was better with the RVPA shunt
than with the MBT shunt. After 12 months, available data showed no
significant difference in transplantation-free survival between the two
groups. (ClinicalTrials.gov number, NCT00115934.) Copyright copyright 2010
Massachusetts Medical Society.
<12>
Accession Number
2010298148
Authors
Pancholy S. Sanghvi K. Thomas M. Patel T.
Institution
(Pancholy, Sanghvi) Commonwealth Medical College, Scranton, PA, United
States.
(Patel) Scranton-Temple Residency Program, Scranton, PA, United States.
(Thomas) Wilkes University, Wilkes Barre, PA, United States.
(Patel) Seth N.H.L. Municipal Medical College, Ahmedabad, India.
Title
Comparison of door-to-balloon times for primary PCI using transradial
versus transfemoral approach.
Source
Catheterization and Cardiovascular Interventions. 75(7)(pp 991-995),
2010. Date of Publication: 01 Jun 2010.
Publisher
Wiley-Liss Inc.
Abstract
Objectives: The objective of this study was to compare door-to-balloon
times and other variables in ST-segment elevation myocardial infarction
(STEMI) patients undergoing primary percutaneous coronary intervention
(PCI) using transfemoral or transradial approaches. Background:
Transradial PCI has been shown to lower the risk of access site
complications but the procedure is not applied to STEMI patients, due to
concerns of procedural complexity adversely affecting prompt reperfusion.
There is paucity of real-world data comparing TRI with TFI in patients
with STEMI. Methods: Three hundred sixteen consecutive patients with STEMI
undergoing primary PCI were studied. Patients were divided in two groups,
Group I (n = 204) undergoing PCI trans-femorally and Group II (n = 109)
patients transradially. Demographic data, door-to-balloon times,
procedural variables, predischarge adverse events, access site
complications, and 1 year follow-up major adverse cardiac events (MACE)
were recorded. Results: Door-to-balloon time was 72 +/- 14 min in Group I
compared with 70 +/- 17 min in Group II, the difference was not
statistically significant (t = 1.096, P > 0.27). Group II patients had
significantly fewer access site complications compared with Group I (20
vs. 1 patient, chi2 = 10.8, P < 0.05). Demographics, predischarge adverse
events, and MACE at 1 year follow-up were comparable between the two
groups. Conclusions: Transradial approach to primary PCI provides similar
door-to-balloon times to transfemoral approach, and significantly lowers
access site related complications, in patients presenting with STEMI.
copyright 2010 Wiley-Liss, Inc.
<13>
Accession Number
2010297167
Authors
Kilger E. Mohnle P. Nassau K. Beiras-Fernandez A. Lamm P. Frey L. Briegel
J. Zwissler B. Weis F.
Institution
(Kilger, Mohnle, Nassau, Frey, Briegel, Zwissler, Weis) Department of
Anesthesiology, Ludwig-Maximilians-Universitat Munchen, Marchioninistr.
15, 81377 Munich, Germany.
(Beiras-Fernandez, Lamm) Department of Cardiac Surgery,
Ludwig-Maximilians-Universitat Munchen, Munich, Germany.
Title
Noninvasive mechanical ventilation in patients with acute respiratory
failure after cardiac surgery.
Source
Heart Surgery Forum. 13(2)(pp E91-E95), 2010. Date of Publication: April
2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Objective: To evaluate the feasibility and outcomes of protocol-driven
noninvasive mechanical ventilation in patients with acute respiratory
failure (ARF) after cardiac surgery. Methods: From 2001 to 2004, a total
of 2428 cardiac surgery patients admitted to our intensive care unit were
observed. After exclusion of patients who received tracheostomy or were
discharged while still on mechanical ventilation, 2261 patients with
spontaneous breathing were further evaluated for ARF. Patients diagnosed
with ARF were treated with intermittent noninvasive mechanical ventilation
(NIV) if possible. Risk factors for the development of postoperative ARF
as well as outcomes in patients with and without ARF were analyzed.
Results: In 2261 spontaneously breathing postoperative cardiac surgical
patients after primarily successful extubation, 799 patients (35%) were
diagnosed with ARF. Fifty-six patients (7%) did not tolerate NIV
treatment. In 743 patients (33%) intermittent NIV was performed. In
patients with ARF, ejection fraction was lower, combined cardiac surgical
procedures were more frequent, postoperative mechanical ventilation time
was longer, and the severity of illness score (SAPS II) was higher (P <
.05). The duration of catecholamine support was longer, and the
transfusion rate was higher in the NIV group (P < .05); however, mortality
did not differ between patients with ARF treated by NIV and patients
without ARF. Conclusion: Our study demonstrates the feasibility of NIV in
patients after cardiac surgery. These results might suggest that NIV
should be considered as first-line ventilatory support in ARF after
cardiac surgery. A large randomized trial is warranted to confirm these
findings. copyright 2010 Forum Multimedia Publishing, LLC.
<14>
Accession Number
2010289931
Authors
Boldt J. Mayer J. Brosch C. Lehmann A. Mengistu A.
Institution
(Boldt, Mayer, Brosch, Lehmann, Mengistu) Department of Anesthesiology and
Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen,
Germany.
Title
Volume Replacement With a Balanced Hydroxyethyl Starch (HES) Preparation
in Cardiac Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(3)(pp 399-407),
2010. Date of Publication: 2010.
Publisher
W.B. Saunders
Abstract
Objective: Balanced fluids appear to be have advantages over unbalanced
fluids for correcting hypovolemia. The effects of a new balanced
hydroxyethyl starch (HES) were studied in cardiac surgery patients.
Design: Prospective, randomized, unblinded study. Setting: Clinical study
in a single cardiac surgery institution. Participants: Sixty patients
undergoing elective cardiac surgery with cardiopulmonary bypass.
Intervention: Patients received either a balanced 6% HES 130/0.4 plus a
balanced crystalloid (n = 30) or an unbalanced HES-in-saline plus saline
(n = 30) to keep cardiac index >2.5 L/min/m2. Measurements and Main
Results: Base excess (BE), kidney function, inflammatory response
(interleukins-6, -10), endothelial activation (intercellular adhesion
molecule-1 [ICAM]), and coagulation (thromboelastometry, whole blood
aggregation) were measured after induction of anesthesia, after surgery
and 5 hours later, and at the 1st and 2nd postoperative days; 2,950 +/-
530 mL of balanced and 3,050 +/- 560 mL of unbalanced HES were given. BE
was reduced significantly in the unbalanced group (from 1.11 +/- 0.71
mmol/L to -5.11 +/- 0.48 mmol/L after surgery) and remained unchanged in
the balanced group. Balanced volume replacement resulted in significantly
lower IL-6, IL-10, and ICAM plasma concentrations and lower urine
concentrations of kidney-specific proteins than in the unbalanced group.
After surgery, thromboelastometry data and platelet function were changed
significantly in both groups; 5 hours thereafter they were significantly
changed only in the unbalanced group. Conclusion: A plasma-adapted HES
preparation in addition to a balanced crystalloid resulted in
significantly less decline in BE, less increase in concentrations of
kidney-specific proteins, less inflammatory response and endothelial
damage, and fewer changes in hemostasis compared with an unbalanced fluid
strategy. copyright 2010 Elsevier Inc. All rights reserved.
<15>
Accession Number
2010287292
Authors
Kelly D. Khan S.Q. Dhillon O. Quinn P. Struck J. Squire I.B. Davies J.E.
Ng L.L.
Institution
(Kelly, Khan, Dhillon, Quinn, Squire, Davies, Ng) Department of
Cardiovascular Sciences, University of Leicester, Leicester Royal
Infirmary, Leicester LE2 7LX, United Kingdom.
(Struck) B.R.A.H.M.S. AG, Hennigsdorf, Berlin, Germany.
Title
Procalcitonin as a prognostic marker in patients with acute myocardial
infarction.
Source
Biomarkers. 15(4)(pp 325-331), 2010. Date of Publication: June 2010.
Publisher
Informa Healthcare
Abstract
Background: Procalcitonin is involved in the inflammatory response and is
associated with adverse prognosis in certain conditions. Aims: To
investigate the association between procalcitonin and major adverse
cardiac events (MACE), left ventricular (LV) function and remodelling
following acute myocardial infarction (AMI). Methods: Plasma procalcitonin
was measured in 977 patients with AMI. Subjects were followed for MACE
(median 671 days). A subgroup underwent echocardiography at discharge and
follow-up LV function and volume assessment. Results: Procalcitonin was
associated with MACE on uni- and multivariable analysis. KaplanMeier
assessment revealed an adverse outcome in subjects with procalcitonin
above the median. Procalcitonin was related to markers of LV dysfunction
and remodelling. Conclusion: Procalcitonin is associated with MACE, LV
dysfunction and remodelling post-AMI. copyright 2010 Informa UK Ltd.
<16>
Accession Number
2010193126
Authors
Baumeister H. Hutter N. Bengel J.
Institution
(Baumeister, Hutter, Bengel) Department of Rehabilitation Psychology and
Psychotherapy, Institute of Psychology, University of Freiburg,
Engelbergerstr. 41, Freiburg, 79085, Germany.
Title
Psychological and pharmacological interventions for depression in patients
with coronary artery disease.
Source
Cochrane Database of Systematic Reviews. (4), 2009. Article Number:
CD008012. Date of Publication: 2009.
Publisher
John Wiley and Sons Ltd
<17>
Accession Number
2010193111
Authors
Ford K. Simmonds J. Burch M. Clarke M.J.
Institution
(Ford) Pharmacy Department, Great Ormond Street Hospital for Children,
Great Ormond Street, London, WC1N 3JH, United Kingdom.
(Simmonds, Burch) Cardiology Department, Great Ormond Street Hospital for
Children, London, United Kingdom.
(Clarke) UK Cochrane Centre, Oxford, United Kingdom.
Title
Primary immunosuppression following heart transplantation.
Source
Cochrane Database of Systematic Reviews. (4), 2009. Article Number:
CD008135. Date of Publication: 2009.
Publisher
John Wiley and Sons Ltd
<18>
Accession Number
2010192825
Authors
Wijeysundera D.N. Bender J.S. Beattie W.S.
Institution
(Wijeysundera) Department of Anesthesia, University of Toronto, Toronto
General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
(Bender) Department of Anaesthesia, St Jospeh's Health Centre, Toronto,
ON, Canada.
(Beattie) Department of Anaesthesia, Toronto General Hospital, University
Health Network, Toronto, ON, Canada.
Title
Alpha-2 adrenergic agonists for the prevention of cardiac complications
among patients undergoing surgery.
Source
Cochrane Database of Systematic Reviews. (4), 2009. Article Number:
CD004126. Date of Publication: 2009.
Publisher
John Wiley and Sons Ltd
Abstract
Background: The surgical stress response plays an important role on the
pathogenesis of perioperative cardiac complications. Alpha-2 adrenergic
agonists attenuate this response and may thereby prevent cardiac
complications. Objectives: This review assessed the efficacy and safety of
preoperative (within 24 hours), intraoperative, and postoperative (first
48 hours) alpha-2 adrenergic agonists for preventing mortality and cardiac
complications after surgery performed under either general or neuraxial
anaesthesia, or both. Search strategy: We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue
3),MEDLINE (1950 to August week 4 2008), EMBASE (1980 to week 36 2008),
the Science Citation Index, and reference lists of articles. Selection
criteria: We included randomized controlled trials that compared alpha-2
adrenergic agonists (clonidine, dexmedetomidine, or mivazerol) against
placebo or non-alpha-2 adrenergic agonists. Included studies had to report
on mortality, myocardial infarction, myocardial ischaemia, or
supraventricular tachyarrhythmia. Data collection and analysis: Three
authors independently assessed trial quality and extracted data. Two
authors independently performed computer entry of abstracted data. We
contacted study authors for additional information. Adverse event data
were gathered from the trials. Main results: We included 31 studies (4578
participants). Study quality was generally inadequate, with only six
studies clearly reporting methods for blinding and allocation concealment.
Overall, alpha-2 adrenergic agonists reduced mortality (relative risk (RR)
0.66; 95% CI 0.44 to 0.98; P = 0.04) and myocardial ischaemia (RR 0.68;
95% CI 0.57 to 0.81; P < 0.0001). However, their effects appeared to vary
with the surgical procedure. The most encouraging data pertained to
vascular surgery, where they reduced mortality (RR 0.47; 95% CI 0.25 to
0.90; P = 0.02), cardiac mortality (RR 0.36; 95% CI 0.16 to 0.79; P =
0.01), and myocardial infarction (RR 0.66; 95% CI 0.46 to 0.94; P = 0.02).
With regard to adverse effects, alpha-2 adrenergic agonists significantly
increased perioperative hypotension (RR 1.32; 95% CI 1.07 to 1.62; P =
0.009) and bradycardia (RR 1.66; 95% CI 1.14 to 2.41; P = 0.008). Authors'
conclusions: Our study provides encouraging evidence that alpha-2
adrenergic agonists may reduce cardiac risk, especially during vascular
surgery. Nonetheless, these data remain insufficient to make firm
conclusions about their efficacy and safety. A large randomized trial of
alpha-2 adrenergic agonists is therefore warranted. Additionally, future
research must determine which specific alpha-2 adrenergic agonist should
be used, and whether it is safe to combine them with other perioperative
interventions (for example beta-adrenergic blockade). Copyright copyright
2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
<19>
Accession Number
2010289922
Authors
Boldt J. Mengistu A.
Institution
(Boldt, Mengistu) Department of Anesthesiology and Intensive Care
Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
Title
A New Plasma-Adapted Hydroxyethyl Starch Preparation: In Vitro Coagulation
Studies.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(3)(pp 394-398),
2010. Date of Publication: 2010.
Publisher
W.B. Saunders
Abstract
Objective: Preparing hydroxyethyl starch (HES) in a plasma-adapted
solution is supposed to improve safety with regard to coagulation. The
influence of a new plasma-adapted HES preparation on coagulation was
studied. Design: Operator-blinded, randomized study. Setting: Laboratory
in vitro study. Participants: Fifteen healthy young men scheduled for
blood donation. Interventions: Blood was diluted by 10%, 30%, and 50%
using either a plasma-adapted or nonplasma-adapted (prepared in saline
solution) potato-derived 6% HES 130/0.42. Only the composition of the
solvent of the 2 HES preparations was different. Measurements and Main
Results: Rotation thromboelastometry (ROTEM; Pentapharm, Munich, Germany)
was used to assess changes in coagulation; whole blood aggregometry with 3
inducers was used to assess effects of dilution with HES on platelet
function. Clotting time (CT) and clot formation time were significantly
prolonged by 30% and 50% dilution, showing significantly longer times in
the non-plasma-adapted than in the plasma-adapted HES group (eg, intrinsic
CT at the 30% dilution level: plasma-adapted HES 228 +/- 26 seconds
[within normal range] v 269 +/- 29 seconds in the nonplasma-adapted HES
group). Clot strengthening and clot firmness were significantly reduced by
the non-plasma-adapted HES at the 30% dilution level. Platelet aggregation
was significantly more reduced by the non-plasma-adapted HES at the 30%
and 50% dilution levels. Conclusions: Dilution with the nonplasma-adapted
HES 130/0.42 was associated with more negative effects on
thromboelastometry and platelet aggregation than the same HES 130/0.4
dissolved in a plasma-adapted solution. The benefits of using a
plasma-adapted modern HES preparation on blood loss and use of blood/blood
products in cardiac surgery need to be studied. copyright 2010 Elsevier
Inc. All rights reserved.
<20>
Accession Number
2010289921
Authors
Jung S.M. Cho C.K. Kim Y.J. Cho H.M. Kim C.-w. Kwon H.U. Kim E.K. Park
J.M.
Institution
(Jung, Cho, Kwon, Kim, Park) Department of Anesthesiology, Konyang
University Hospital, Daejeon, South Korea.
(Kim, Cho) Department of Thoracic and Cardiovascular Surgery, Konyang
University Hospital, Daejeon, South Korea.
(Kim) Department of Preventive Medicine, Chungnam National University
Hospital, Daejeon, South Korea.
Title
The Effect of Thoracic Epidural Anesthesia on Pulmonary Shunt Fraction and
Arterial Oxygenation During One-Lung Ventilation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(3)(pp 456-462),
2010. Date of Publication: 2010.
Publisher
W.B. Saunders
Abstract
Objective: To compare the effect of thoracic epidural local anesthetic,
epidural opioid, and intravenous opioid on pulmonary shunt fraction,
arterial oxygenation, and hemodynamic changes during one-lung ventilation
(OLV) in patients undergoing thoracic surgery. Design: A prospective,
randomized, double-blind study. Setting: A university hospital.
Participants: Thirty-nine patients undergoing OLV for pulmonary resection.
Interventions: Patients were randomized into 1 of 3 groups: epidural
bupivacaine (TEA-B group, n = 13), epidural sufentanil (TEA-S group, n =
13), or intravenous remifentanil (IV-R group, n = 13) during general
anesthesia with propofol. A double-lumen tube was inserted, and mechanical
ventilation with 100% oxygen was used in the lateral decubitus position.
Measurements and Main Results: Hemodynamic variables and arterial and
mixed venous blood gas analysis from the radial and pulmonary artery
catheter were measured and shunt fraction was calculated during two-lung
ventilation (TLV), 15, 30, and 60 minutes after the initiation of OLV, and
15 minutes after the reinstitution of TLV. Although mean arterial
pressures 15 and 30 minutes after OLV in the IV-R group were significantly
higher than the value in TEA-S group, cardiac output and pulmonary
vascular resistance were maintained. Decreases in PaO2, SaO2, PvO2, and
SvO2 and an increase in the shunt fraction after OLV were not different
among groups and returned to baseline value after the resumption of TLV.
Conclusions: Thoracic epidural bupivacaine, epidural sufentanil, and
intravenous remifentanil-combined general intravenous anesthesia have
comparable effects on shunt fraction and arterial oxygenation during OLV
in patients undergoing thoracic surgery. copyright 2010 Elsevier Inc. All
rights reserved.
<21>
Accession Number
2010278429
Authors
Takagi H. Matsui M. Umemoto T.
Institution
(Takagi, Matsui, Umemoto) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan.
Title
Off-Pump Coronary Artery Bypass May Increase Late Mortality: A
Meta-Analysis of Randomized Trials.
Source
Annals of Thoracic Surgery. 89(6)(pp 1881-1888), 2010. Date of
Publication: June 2010.
Publisher
Elsevier USA
Abstract
Background: Although a lot of randomized trials of off-pump coronary
artery bypass grafting (CABG) versus on-pump CABG were conducted, the
majority of them reported only early outcomes. Previous meta-analyses of a
few randomized trials found no differences for 1-year to 2-year mortality.
Methods: We focused late ([greater-than or equal to]1 year) all-cause
mortality and performed a meta-analysis of randomized controlled trials of
off-pump versus on-pump CABG. The MEDLINE, the EMBASE, and the Cochrane
Central Register of Controlled Trials were searched using PubMed and OVID.
For each study, data regarding all-cause mortality in both the off-pump
and on-pump groups were used to generate risk ratios (RRs) and 95%
confidence intervals. Study-specific estimates were combined using inverse
variance-weighted averages of logarithmic RRs in both fixed-effects and
random-effects models. Results: Our search identified 11 results of 12
randomized trials (4,326 patients) of off-pump versus on-pump CABG. Pooled
analysis demonstrated a statistically significant increase in midterm
all-cause mortality by a factor of 1.37 with off-pump relative to on-pump
CABG (RR, 1.373; 95% confidence interval, 1.043 to 1.808). Exclusion of
any single result, except for the largest (>2,000 patients) trial, from
the analysis did not substantively alter the overall result of our
analysis. Eliminating the largest trial demonstrated a statistically
nonsignificant benefit of on-pump over off-pump CABG for midterm all-cause
mortality (RR, 1.344; 95% confidence interval, 0.952 to 1.896).
Conclusions: The results of our analysis suggest that off-pump CABG may
increase late all-cause mortality by a factor of 1.37 over on-pump CABG.
Longer term mortality from randomized trials of off-pump versus on-pump
CABG is needed. copyright 2010 The Society of Thoracic Surgeons.
