Results Generated From:
Embase <1980 to 2012 Week 09>
Embase (updates since 2012-02-24)
<1>
Accession Number
2012104020
Authors
Mutwalli H.A. Fallows S.J. Arnous A.A. Zamzami M.S.
Institution
(Mutwalli) Department of Clinical Sciences, University of Chester,
Chester, United Kingdom
(Fallows) Department of Clinical Sciences, University of Chester, Chester
CH1 4BJ, United Kingdom
(Arnous) Cardiac Surgery Department, King Fahd Armed Forces Hospital,
Jeddah, Saudi Arabia
(Zamzami) Department of Physical Education, Umm Al-Qura University, Makkah
Al-Mukarramah, Saudi Arabia
Title
Randomized controlled evaluation shows the effectiveness of a home-based
cardiac rehabilitation program.
Source
Saudi Medical Journal. 33 (2) (pp 152-159), 2012. Date of Publication:
2012.
Publisher
Saudi Arabian Armed Forces Hospital (P.O. Box 7897, Riyadh 11159, Saudi
Arabia)
Abstract
Objectives: To evaluate the effectiveness of a home-based cardiac
rehabilitation (CR) program on post-coronary arteries bypass graft
patients. Methods: This is a randomized study conducted in King Fahd Armed
Forces Hospital, Jeddah, Kingdom of Saudi Arabia between June 2008 and
January 2010. Forty-nine participants were randomized to either a control
group (standard hospital treatment, n=21) or an intervention group
(home-based CR, n=28). Data were collected before hospital discharge
(baseline test) and repeated 6 months after hospital discharge (follow-up
test). Results: There were no significant differences between the groups
in the body mass index, hemodynamics, serum fasting lipid profile, and
Quality of Life questionnaire (QoL) (p>0.05), with differences in physical
function and Hospital Anxiety and Depression Scales (HADS) (p<0.05) at the
baseline test. At the follow-up test, the intervention group showed
greater improvement in health-related QoL and risk factors compared to the
control group, with significant differences in fasting blood glucose,
triglycerides, high density lipoprotein cholesterol, physical function,
and both QoL and HADS questionnaires (p<0.05). The intervention group also
demonstrated significant improvements in QoL, HADS, body mass index, heart
rate, high density lipoprotein cholesterol and physical function (p<0.05),
while significant differences were observed in the control group in heart
rate, QoL and physical function (p<0.05). Conclusion: The home-based CR
program improves health-related QoL and risk factor profiles for patients
following coronary arteries bypass graft to greater extent than the
standard hospital care.
<2>
Accession Number
2012103839
Authors
Godinho A.S. Alves A.S. Pereira A.J. Pereira T.S.
Institution
(Godinho, Alves, Pereira) Escola Superior de Saude Dr. Lopes Dias Coimbra,
Castelo Branco, Portugal
(Pereira) Escola Superior de Tecnologia da Saude de Coimbra, Coimbra,
Portugal
Title
On-pump versus off-pump coronary-artery bypass surgery: A meta-analysis.
Source
Arquivos Brasileiros de Cardiologia. 98 (1) (pp 87-93), 2012. Date of
Publication: January 2012.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
There are controversies about the possible benefits of offpump coronary
artery bypass grafting (OPCABG) compared to on-pump coronary artery bypass
grafting (ONCABG). For a better perspective on this important issue, we
performed a meta-analysis of randomized controlled trials, comparing the
two techniques. The objective of this study was to verify which technique
applied in Coronary Artery Bypass Surgery, OPCABG or ONCABG, provides
better results through a meta-analysis of published randomized trials
comparing the two techniques. We carried out a computer-based literature
search in PubMed, Embase, B-on and Science Direct from March 2009 to
January 2010. The studies covered were recovered according to
predetermined criteria. A systematic review of randomized clinical trials
was performed in order to evaluate the differences between the two
revascularization techniques (OPCABG versus ONCABG) regarding mortality
and morbidity. Selected studies did not include patients at high risk and
long-term longitudinal evaluations. The meta-analysis focused on nine
randomized clinical trials, corresponding to a total of 75,086 patients,
and compared OPCABG to ONCABG. Regarding mortality, a reduction of 18% in
the risk of cardiovascular mortality (OR: 0.82, 95%CI: 0.70 to 0.98, p =
0.03) and 27% in the risk of stroke postoperatively (OR: 0.73, 95%CI: 0.63
to 0.85, p = 0.0001) were observed, both in favor of OPCABG. Concerning
the occurrence of complications associated with the procedure, no
significant differences were found between the two surgical techniques,
particularly with regard to the occurrence of kidney complications (OR:
0.97, 95%CI: 0.84-1.14, p = 0, 74) and sepsis (OR 0.98, 95%CI: 0.64-1.51,
p = 0.93, respectively). Off-pump CABG significantly reduces the
occurrence of major cardiovascular events (mortality and CVA) compared to
on-pump CABG surgery.
<3>
Accession Number
2012103832
Authors
Sbruzzi G. de Quadros A.S. Ribeiro R.A. Abelin A.P. Berwanger O. Plentz
R.D.M. Schaan B.D.
Institution
(Sbruzzi, de Quadros, Ribeiro, Abelin, Plentz, Schaan) Instituto de
Cardiologia do Rio Grande do Sul, Fundacao Universitaria de Cardiologia1,
Porto Alegre, RS, Brazil
(Plentz) Universidade Federal de Ciencias da Saude de Porto Alegre, Porto
Alegre, RS, Brazil
(Schaan) Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio
Grande do Sul, Porto Alegre, RS, Brazil
(Berwanger) Instituto de Ensino e Pesquisa do HCor (Hospital do Coracao),
Sao Paulo, SP, Brazil
Title
Intracoronary ultrasound-guided stenting improves outcomes: A metaanalysis
of randomized trials.
Source
Arquivos Brasileiros de Cardiologia. 98 (1) (pp 35-44), 2012. Date of
Publication: January 2012.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
Background: Intracoronary ultrasound (IVUS) has been used as an adjunctive
method in order to optimize implantation of stents. However, the impact of
this method in some outcomes is controversial. Objective: To
systematically review the impact of routine IVUS-guided coronary stent as
compared to angiographic-guided, on clinical and angiographic outcomes.
Methods: A search of databases (MEDLINE, Cochrane CENTRAL, EMBASE) and
references of published studies, from 1982 to 2010, was conducted.
Randomized clinical trials (RCTs) that compared angiography plus
IVUS-guided (IVUS) vs. angiography alone guided (ANGIO) coronary stent
implantation were included. Minimum follow-up was 6 months and the
outcomes assessed were major adverse cardiac events (MACE), target lesion
revascularization (TLR) and angiographic restenosis. Two reviewers
independently extracted the data. Summary risk ratio and 95% confidence
intervals (CI) were calculated with random-effects models. The GRADE
approach was used to determine the overall quality of evidence for each
outcome. Results: Out of 3,631 articles identified, 8 RCTs evaluating a
total of 2,341 patients were included. There was a 27% reduction in
angiographic restenosis (95%CI: 3%-46%) and a 38% reduction in TLR (95%CI:
17%-53%) in favor of IVUS vs. ANGIO. However, MACE were not reduced by
IVUS (RR: 0.79; 95%CI: 0.61-1.03). The MACE data represent only 47% of the
optimal information size required to reliably detect a plausible treatment
effect. Conclusions: We observed that IVUS-guided coronary stenting
provides significant reductions in TLR and angiographic restenosis
compared to angiographically-guided stenting, but it does not reduce MACE.
<4>
Accession Number
2012093373
Authors
Sulaiman S. Karthekeyan R.B. Vakamudi M. Sundar A.S. Ravullapalli H.
Gandham R.
Institution
(Sulaiman, Karthekeyan, Sundar, Ravullapalli, Gandham) Department of
Cardiac Anaesthesiology, Sri Ramachandra Medical College and Research
Institute, No 1, Ramachandra Nagar, Porur, Chennai-600116, India
(Vakamudi) Department of Anaesthesiology and Critical Care, Sri
Ramachandra Medical College and Research Institute, Porur, Chennai, India
Title
The effects of dexmedetomidine on attenuation of stress response to
endotracheal intubation in patients undergoing elective off-pump coronary
artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 15 (1) (pp 39-43), 2012. Date of
Publication: January-March 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
This study was designed to study the efficacy of intravenous
dexmedetomidine for attenuation of cardiovascular responses to
laryngoscopy and endotracheal intubation in patients with coronary artery
disease. Sixty adult patients scheduled for elective off-pump coronary
artery bypass surgery were randomly allocated to receive dexmedetomidine
(0.5 mcg/kg) or normal saline 15 min before intubation. Patients were
compared for hemodynamic changes (heart rate, arterial blood pressure and
pulmonary artery pressure) at baseline, 5 min after drug infusion, before
intubation and 1, 3 and 5 min after intubation. The dexmedetomidine group
had a better control of hemodynamics during laryngoscopy and endotracheal
intubation. Dexmedetomidine at a dose of 0.5 mcg/kg as 10-min infusion was
administered prior to induction of general anesthesia attenuates the
sympathetic response to laryngoscopy and intubation in patients undergoing
myocardial revascularization. The authors suggest its administration even
in patients receiving beta blockers.
<5>
Accession Number
2012091878
Authors
Chen Y.-H. Feng B. Chen Z.-W.
Institution
(Chen, Feng) Department of Endocrinology, East Hospital, Tongji
University, 150 Jimo Road, Shanghai 200120, China
(Chen) Department of Cardiology, Zhongshan Hospital, Fudan University,
Shanghai, China
Title
Statins for primary prevention of cardiovascular and cerebrovascular
events in diabetic patients without established cardiovascular diseases: A
meta-analysis.
Source
Experimental and Clinical Endocrinology and Diabetes. 120 (2) (pp
116-120), 2012. Date of Publication: 2012.
Publisher
Georg Thieme Verlag (Rudigerstrasse 14, Stuttgart D-70469, Germany)
Abstract
Aims: Lipid-lowering medications could lead to a significant reduction in
major cardiovascular events in patients with diabetes. However, there was
still controversy regarding the use of statins in patients with diabetes
for primary prevention. The meta-analysis was performed to evaluate the
outcomes of statin-therapy in diabetic patients without established
cardiovascular diseases. Methods: 7 randomized controlled trials of
statin- vs. control-therapy in patients with diabetes were included. A
total number of 12711 patients were involved. The outcomes of interest
were major adverse cardiovascular and cerebrovascular events (MACCE),
including myocardial infarction, stroke, all-cause mortality and coronary
revascularization. Results: A total of 1376 MACCE occurred during
follow-up, with 9.54% (605 patients) in the statin therapy group and
12.10% (771 patients) in control group. Statin therapy was associated with
a significant reduction in the incidence of MACCE (0.79, 95%CI 0.66-0.95;
P=0.01). Meanwhile, the risk of stroke and coronary revascularization were
reduced 29 and 26% in statin therapy group. However, there was no
statistical difference of all-cause mortality between statin- and
control-therapy group (3.73 vs. 4.65%, P=0.13). Conclusions: For primary
prevention in patients with diabetes without established cardiovascular
disease, statin therapy could reduce the cardiovascular and
cerebrovascular events, but not all-cause mortality. J. A. Barth Verlag
in Georg Thieme Verlag KG Stuttgart New York.
<6>
Accession Number
2012082649
Authors
Whitlock R.P. Sun J.C. Fremes S.E. Rubens F.D. Teoh K.H.
Institution
(Whitlock, Teoh) Population Health Research Institute, McMaster
University, David Braley Cardiac, Vascular, and Stroke Research Institute,
237 Barton St East, Hamilton, ON L8L 2X2, Canada
(Sun) University of Washington School of Medicine, Seattle, WA, United
States
(Fremes) Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada
(Rubens) Ottawa Heart Institute, Ottawa, ON, Canada
Title
Antithrombotic and thrombolytic therapy for valvular disease:
Antithrombotic therapy and prevention of thrombosis, 9th ed: American
college of chest physicians evidence-based clinical practice guidelines.
Source
Chest. 141 (2 SUPPL.) (pp e576S-e600S), 2012. Date of Publication:
February 2012.
Publisher
American College of Chest Physicians (3300 Dundee Road, Northbrook IL
60062-2348, United States)
Abstract
Background: Antithrombotic therapy in valvular disease is important to
mitigate thromboembolism, but the hemorrhagic risk imposed must be
considered. Methods: The methods of this guideline follow those described
in Methodology for the Development of Antithrombotic Therapy and
Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention
of Thrombosis, 9th ed: American College of Chest Physicians Evidence-
Based Clinical Practice Guidelines in this supplement. Results: In
rheumatic mitral disease, we recommend vitamin K antagonist (VKA) therapy
when the left atrial diameter is > 55 mm (Grade 2C) or when complicated by
left atrial thrombus (Grade 1A). In candidates for percutaneous mitral
valvotomy with left atrial thrombus, we recommend VKA therapy until
thrombus resolution, and we recommend abandoning valvotomy if the thrombus
fails to resolve (Grade 1A). In patients with patent foramen ovale (PFO)
and stroke or transient ischemic attack, we recommend initial aspirin
therapy (Grade 1B) and suggest substitution of VKA if recurrence (Grade
2C). In patients with cryptogenic stroke and DVT and a PFO, we recommend
VKA therapy for 3 months (Grade 1B) and consideration of PFO closure
(Grade 2C). We recommend against the use of anticoagulant (Grade 1C) and
antiplatelet therapy (Grade 1B) for native valve endocarditis. We suggest
holding VKA therapy until the patient is stabilized without neurologic
complications for infective endocarditis of a prosthetic valve (Grade 2C).
In the first 3 months after bioprosthetic valve implantation, we recommend
aspirin for aortic valves (Grade 2C), the addition of clopidogrel to
aspirin if the aortic valve is transcatheter (Grade 2C), and VKA therapy
with a target international normalized ratio (INR) of 2.5 for mitral
valves (Grade 2C). After 3 months, we suggest aspirin therapy (Grade 2C).
We recommend early bridging of mechanical valve patients to VKA therapy
with unfractionated heparin (DVT dosing) or lowmolecular- weight heparin
(Grade 2C). We recommend long-term VKA therapy for all mechanical valves
(Grade 1B): target INR 2.5 for aortic (Grade 1B) and 3.0 for mitral or
double valve (Grade 2C). In patients with mechanical valves at low
bleeding risk, we suggest the addition of low-dose aspirin (50-100 mg/d )
(Grade 1B). In valve repair patients, we suggest aspirin therapy (Grade
2C). In patients with thrombosed prosthetic valve, we recommend
fibrinolysis for right-sided valves and left-sided valves with thrombus
area < 0.8 cm<sup>2</sup> (Grade 2C). For patients with left-sided
prosthetic valve thrombosis and thrombus area >= 0.8 cm<sup>2</sup>, we
recommend early surgery (Grade 2C). Conclusions: These antithrombotic
guidelines provide recommendations based on the optimal balance of
thrombotic and hemorrhagic risk. 2012 American College of Chest
Physicians.
<7>
Accession Number
2012082645
Authors
Douketis J.D. Spyropoulos A.C. Spencer F.A. Mayr M. Jaffer A.K. Eckman
M.H. Dunn A.S. Kunz R.
Institution
(Douketis, Spencer) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Spyropoulos) Department of Medicine, University of Rochester, Rochester,
NY, United States
(Mayr) Medical Outpatient Department, University Hospital Basel, Basel,
Switzerland
(Jaffer) Division of Hospital Medicine, Department of Medicine, University
of Miami Miller School of Medicine, Miami, FL, United States
(Eckman) Division of General Internal Medicine, Center for Clinical
Effectiveness, University of Cincinnati Medical Center, Cincinnati, OH,
United States
(Dunn) Department of Medicine, Mount Sinai School of Medicine, New York,
NY, United States
(Kunz) Academy of Swiss Insurance Medicine, Department of Medicine,
University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
Title
Perioperative management of antithrombotic therapy. Antithrombotic therapy
and prevention of thrombosis, 9th ed: American College of Chest Physicians
evidence-based clinical practice guidelines.
Source
Chest. 141 (2 SUPPL.) (pp e326S-e350S), 2012. Date of Publication:
February 2012.
Publisher
American College of Chest Physicians (3300 Dundee Road, Northbrook IL
60062-2348, United States)
Abstract
Background: This guideline addresses the management of patients who are
receiving anticoagulant or antiplatelet therapy and require an elective
surgery or procedure. Methods: The methods herein follow those discussed
in the Methodology for the Development of Antithrombotic Therapy and
Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention
of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based
Clinical Practice Guidelines article of this supplement. Results: In
patients requiring vitamin K antagonist (VKA) interruption before surgery,
we recommend stopping VKAs 5 days before surgery instead of a shorter time
before surgery(Grade 1B). In patients with a mechanical heart valve,
atrial fibrillation, or VTE at high risk for thromboembolism, we suggest
bridging anticoagulation instead of no bridging during VKA interruption
(Grade 2C); in patients at low risk, we suggest no bridging instead of
bridging(Grade 2C). In patients who require a dental procedure, we suggest
continuing VKAs with an oral prohemostatic agent or stopping VKAs 2 to 3
days before the procedure instead of alternative strategies(Grade 2C). In
moderate-to high-risk patients who are receiving acetylsalicylic acid(ASA)
and require noncardiac surgery, we suggest continuing ASA around the time
of surgery instead of stopping ASA 7 to 10 days before surgery(Grade 2C).
In patients with a coronary stent who require surgery, we recommend
deferring surgery >6 weeks after bare-metal stent placement and >6 months
after drug-eluting stent placement instead of undertaking surgery within
these time periods(Grade 1C); in patients requiring surgery within 6 weeks
of bare-metal stent placement or within 6 months of drug-eluting stent
placement, we suggest continuing antiplatelet therapy perioperatively
instead of stopping therapy 7 to 10 days before surgery(Grade 2C).
Conclusions: Perioperative antithrombotic management is based on risk
assessment for thromboembolism and bleeding, and recommended approaches
aim to simplify patient management and minimize adverse clinical outcomes.
2012 American College of Chest Physicians.
<8>
Accession Number
2012090257
Authors
Winchester D.E. Brearley W.D. Wen X. Park K.E. Bavry A.A.
Institution
(Winchester, Brearley, Park, Bavry) Department of Medicine, Division of
Cardiovascular Medicine, University of Florida, 1600 SW Archer Rd,
Gainesville, FL 32610, United States
(Wen) Department of Epidemiology and Health Policy Research, University of
Florida, Gainesville, FL, United States
Title
Efficacy and safety of unfractionated heparin plus glycoprotein IIb/IIIa
inhibitors during revascularization for an acute coronary syndrome: A
meta-analysis of randomized trials performed with stents and
thienopyridines.
Source
Clinical Cardiology. 35 (2) (pp 93-100), 2012. Date of Publication:
February 2012.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Background: Early studies of glycoprotein IIb/IIIa inhibitors (GPIs)
demonstrated benefit during percutaneous coronary intervention for acute
coronary syndromes (ACS). Since their introduction, the magnitude of
benefit of GPIs has become unclear. Hypothesis: We hypothesized that
adding a GPI to unfractionated heparin in ACS patients treated with stents
and thienopyridines is beneficial. Methods: We searched the MEDLINE,
Cochrane, and clinicaltrials.gov databases for randomized clinical trials
that studied the use of GPIs during ACS. We required that patients be
randomly assigned to unfractionated heparin plus a GPI versus
unfractionated heparin plus placebo (or control). Additional inclusion
criteria included the use of coronary stents and periprocedural
thienopyridines. Outcomes were assessed at 30 days. Random effects
DerSimonian-Laird summary risk ratios (RR) and 95% confidence intervals
(CIs) were constructed. Results: Sixteen studies with 7611 patients were
included. Myocardial infarction was 3.1% with GPI versus 4.4% with control
(RR = 0.74; 95% CI, 0.59-0.94, P = 0.014); revascularization, 1.7% versus
2.7% (RR = 0.64; 95% CI, 0.46-0.89, P = 0.008); major bleeding, 2.5%
versus 2.1% (RR = 1.21; 95% CI, 0.89-1.63, P = 0.22); minor bleeding, 5.5%
versus 4.1% (RR = 1.37; 95% CI, 1.06-1.78, P = 0.016); and mortality, 2.2%
versus 2.9% (RR = 0.79; 95% CI, 0.59-1.06, P = 0.12), respectively.
Conclusions: Among ACS patients treated with stents and thienopyridines,
GPIs were associated with reduced myocardial infarction and
revascularization. Minor, but not major bleeding was increased with GPIs.
Mortality was similar between the groups. 2011 Wiley Periodicals, Inc.
<9>
Accession Number
2012080744
Authors
Baaj A.A. Smith D.A. Vale F.L. Uribe J.S.
Institution
(Baaj) Department of Neurosurgery, Johns Hopkins School of Medicine, 4940
Eastern Avenue, Baltimore, MD 21224, United States
(Smith, Vale, Uribe) Department of Neurosurgery, University of South
Florida, 2A Columbia Drive, Tampa, FL 33616, United States
Title
Surgical approaches to thoracic ossification of the posterior longitudinal
ligament.
Source
Journal of Clinical Neuroscience. 19 (3) (pp 349-351), 2012. Date of
Publication: March 2012.
Publisher
Churchill Livingstone (1-3 Baxter's Place, Leith Walk, Edinburgh EH1 3AF,
United Kingdom)
Abstract
Thoracic ossification of the posterior longitudinal ligament is a rare but
debilitating condition. It is most commonly diagnosed in the Japanese
population. If left untreated, significant myelopathy and weakness can
ensue. Anterior decompression and stabilization is effective but
technically demanding and is associated with high rate of complications.
Posterior laminectomy appears to be an acceptable approach with lower
risks. This work reviews the published literature on this topic and
highlights the salient points. 2011 Elsevier Ltd. All rights reserved.
<10>
Accession Number
2012107740
Authors
Unzueta C. Tusman G. Suarez-Sipmann F. Bhm S. Moral V.
Institution
(Unzueta, Moral) Department of Anesthesiology, Hospital de Sant Pau,
Barcelona, Spain
(Tusman) Department of Anesthesiology, Hospital Privado de Comunidad, Mar
del Plata, Argentina
(Suarez-Sipmann) Department of Critical Care Medicine, Fundacin Jimenez
Diaz-UTE, IIS-FJD, Madrid, Spain
(Bhm) Swisstom AG, Landquart, Switzerland
Title
Alveolar recruitment improves ventilation during thoracic surgery: A
randomized controlled trial.
Source
British Journal of Anaesthesia. 108 (3) (pp 517-524), 2012. Date of
Publication: March 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Background. This study was conducted to determine whether an alveolar
recruitment strategy (ARS) applied during two-lung ventilation (TLV) just
before starting one-lung ventilation (OLV) improves ventilatory
efficiency. Methods. Subjects were randomly allocated to two groups: (i)
control group: ventilation with tidal volume (VT) of 8 or 6 ml
kg<sup>-1</sup> for TLV and OLV, respectively, and (ii) ARS group: same
ventilatory pattern with ARS consisting of 10 consecutive breaths at a
plateau pressure of 40 and 20 cm H2O PEEP applied immediately before and
after OLV. Volumetric capnography and arterial blood samples were recorded
5 min (baseline) and 20 min into TLV, at 20 and 40 min during OLV, and
finally 10 min after re-establishing TLV. Results. Twenty subjects were
included in each group. In all subjects, the airway component of dead
space remained constant during the study. Compared with baseline, the
alveolar dead space ratio (VDalv/VTalv) increased throughout the protocol
in the control but decreased in the ARS group. Differences in VDalv/VTalv
between groups were significant (P<0.001). Except for baseline, all values
in kPa (sd) were higher in the ARS than in the control group (P<0.001),
respectively [70 (7) and 55 (9); 33 (9) and 24 (10); 33 (8) and 22 (10);
70 (7) and 55 (10)]. Conclusions. Recruitment of both lungs before
instituting OLV not only decreased alveolar dead space but also improved
arterial oxygenation and the efficiency of ventilation. The Author
[2011].
<11>
Accession Number
2012095071
Authors
Ganesan A.N. Brooks A.G. Roberts-Thomson K.C. Lau D.H. Kalman J.M. Sanders
P.
Institution
(Ganesan, Brooks, Roberts-Thomson, Lau, Sanders) Centre for Heart Rhythm
Disorders (CHRD), Department of Cardiology, Royal Adelaide Hospital,
Adelaide, SA 5000, Australia
(Kalman) Department of Cardiology, University of Melbourne, Royal
Melbourne Hospital, Melbourne, Australia
Title
Role of AV nodal ablation in cardiac resynchronization in patients with
coexistent atrial fibrillation and heart failure: A systematic review.
Source
Journal of the American College of Cardiology. 59 (8) (pp 719-726), 2012.
Date of Publication: 21 Feb 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The aim of this study was to systematically review the medical
literature to evaluate the impact of AV nodal ablation in patients with
heart failure and coexistent atrial fibrillation (AF) receiving cardiac
resynchronization therapy (CRT). Background: CRT has a substantial
evidence base in patients in sinus rhythm with significant systolic
dysfunction, symptomatic heart failure, and prolonged QRS duration. The
role of CRT is less well established in AF patients with coexistent heart
failure. AV nodal ablation has recently been suggested to improve outcomes
in this group. Methods: Electronic databases and reference lists through
September 15, 2010, were searched. Two reviewers independently evaluated
citation titles, abstracts, and articles. Studies reporting the outcomes
after AV nodal ablation in patients with AF undergoing CRT for symptomatic
heart failure and left ventricular dyssynchrony were selected. Data were
extracted from 6 studies, including 768 CRT-AF patients, composed of 339
patients who underwent AV nodal ablation and 429 treated with medical
therapy aimed at rate control alone. Results: AV nodal ablation in CRT-AF
patients was associated with significant reductions in all-cause mortality
(risk ratio: 0.42 [95% confidence interval: 0.26 to 0.68]), cardiovascular
mortality (risk ratio: 0.44 [95% confidence interval: 0.24 to 0.81]), and
improvement in mean New York Heart Association functional class (risk
ratio: 0.52 [95% confidence interval: 0.87 to 0.17]). Conclusions: AV
nodal ablation was associated with a substantial reduction in all-cause
mortality and cardiovascular mortality and with improvements in New York
Heart Association functional class compared with medical therapy in CRT-AF
patients. Randomized controlled trials are warranted to confirm the
efficacy and safety of AV nodal ablation in this patient population. 2012
American College of Cardiology Foundation.
<12>
Accession Number
2012092417
Authors
Yang C. Deng Z. Jiang X. Han K. Zhang T. Zhu W. Geng T. Chen X. Ma A.
Institution
(Yang, Han, Zhang, Zhu, Ma) Department of Cardiology, First Hospital of
xi'An Jiaotong University, No. 1 Jiankang Road, Xi'an, Shaanxi 710061,
China
(Deng, Jiang, Chen) Department of Cardiology, Shaanxi Provincial People's
Hospital (The Third Hospital of xi'An Jiaotong University), Xi'an, Shaanxi
710068, China
(Geng) Key Laboratory of Environment and Genes Related to Diseases, First
Hospital of xi'An Jiaotong University, Ministry of Education, Xi'an,
Shaanxi 710061, China
Title
Long-term effects of primary early granulo-monocyte colony-stimulating
factor treatment on the left ventricular function and remodeling in
patients with acute myocardial infarction with five-year follow-up.
Source
International Journal of Cardiology. 155 (2) (pp 287-290), 2012. Date of
Publication: 08 Mar 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
<13>
Accession Number
2012092399
Authors
Sciahbasi A. Biondi-Zoccai G. Romagnoli E. Valgimigli M. Rasoul S. Van'T
Hof A. Lioy E. Stone G.W.
Institution
(Sciahbasi, Romagnoli, Lioy) UOC Cardiologia, Policlinico Casilino-ASL
RMB, Via Casilina 1049, Rome, Italy
(Biondi-Zoccai) S. Giovanni Battista Molinette Hospital, University of
Turin, Italy
(Valgimigli) Cardiovascular Institute, Azienda Opedaliera Universitaria di
Ferrara, Italy
(Rasoul, Van'T Hof) Isala Clinics, Zwolle, Netherlands
(Stone) Columbia University Medical Center, New York-Presbyterian
Hospital, Cardiovascular Research Foundation, NY, United States
Title
Routine upstream versus selective downstream administration of
glycoprotein IIb/IIIa inhibitors in patients with non-ST-elevation acute
coronary syndromes: A meta-analysis of randomized trials.
Source
International Journal of Cardiology. 155 (2) (pp 243-248), 2012. Date of
Publication: 08 Mar 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Glycoprotein (GP) IIb/IIIa inhibitors reduce ischemic
complications in patients with non-ST-elevation acute coronary syndromes
(NSTEACS) who undergo invasive procedures. However the optimal timing of
therapy (upstream - at hospital admission in all patients prior to
coronary catheterization, or downstream - after coronary angiography
selectively in patients prior to percutaneous coronary intervention) is
still debated. The aim of this meta-analysis was to compare the outcome of
NSTEACS patients randomized to routine upstream versus deferred selective
downstream GP IIb/IIIa inhibitors. Methods: We scanned the literature from
January 1990 to May 2009 to identify all randomized trials comparing
upstream administration of GP IIb/IIIa inhibitors versus its downstream
use in invasively managed NSTEACS. Results: In 5 randomized trials a total
of 9753 patients were randomized to upstream GP IIb/IIIa inhibitors
therapy versus 9716 patients randomized to deferred selective downstream
therapy. Upstream therapy was associated with reduced in-hospital or
30-day major adverse ischemic cardiac events (odds ratio = 0.90 [95%
confidence interval 0.82-0.98], p = 0.02). However the risk of major
bleeding was significantly higher with upstream therapy (odds ratio = 1.35
[1.11-1.63], p = 0.002). Combining ischemic and hemorrhagic events in a
net clinical end-point showed no significant differences between the two
approaches (odds ratio = 1.01 [0.92-1.10], p = 0.88). Conclusions: In
conclusion early administration of GP IIb/IIIa inhibitors in NSTEACS is
associated with significant reduction in ischemic events compared to a
selective deferred therapy after coronary angiography. However upstream
therapy is also associated with increased bleeding complications. This
approach should therefore be reserved for patients at high ischemic and/or
low hemorrhagic risk. 2010 Elsevier Ireland Ltd. All rights reserved.
<14>
Accession Number
2012091601
Authors
Kosaka T. Hosokawa K. Shime N. Taniguchi F. Kokufu T. Hashimoto S.
Fujiwara H. Yaku H. Sugioka N. Okada K. Fujita N.
Institution
(Kosaka, Kokufu, Okada) Department of Pharmacy, Kyoto Prefectural
University, School of Medicine, Kyoto, Japan
(Hosokawa, Shime, Taniguchi, Hashimoto) Department of Anesthesiology and
Intensive Care, Kyoto Prefectural University, School of Medicine, 465
Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
(Fujiwara) Department of Surgery, Kyoto Prefectural University, School of
Medicine, Kyoto, Japan
(Yaku) Division of Cardiovascular Surgery, Kyoto Prefectural University,
School of Medicine, Kyoto, Japan
(Fujita) Department of Clinical Laboratory Medicine, Kyoto Prefectural
University, School of Medicine, Kyoto, Japan
(Kosaka, Shime, Fujita) Department of Infection Control and Prevention,
Kyoto Prefectural University, School of Medicine, Kyoto, Japan
(Sugioka) Department of Clinical Pharmacokinetics, Kobe Gakuin University,
Faculty of Pharmaceutical Sciences, Kobe, Japan
Title
Effects of renal function on the pharmacokinetics and pharmacodynamics of
prophylactic cefazolin in cardiothoracic surgery.
Source
European Journal of Clinical Microbiology and Infectious Diseases. 31 (2)
(pp 193-199), 2012. Date of Publication: February 2012.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
The purpose of this investigation was to study the effects of renal
function on the pharmacokinetics and pharmacodynamics (PK-PD) of free
cefazolin administered prophylactically in cardiothoracic surgery.
Patients received an initial 2-g dose of cefazolin, followed by 1-g doses
6, 12, 18 and 24 h after the first dose. In patients who underwent
cardiopulmonary bypass, 1 g was added to the priming solution. In 35
patients with a normal estimated creatinine clearance (CLcr) >=50 ml/min,
a free cefazolin concentration <4 mug/ml was observed in 11.4, 5.7 and
54.3% of patients before the second dose, at the end and 24 h after
operation, respectively. In contrast, only 7.4% of 27 patients with CLcr
<49 ml/min had a free cefazolin concentration <4 mug/ml 24 h after the
operation. There was a high negative correlation between CLcr and time
above the target minimal inhibitory concentration (MIC) when the CLcr was
<50 ml/min (r <sup>2</sup> = 0.807), and no correlation when the CLcr was
>=50 ml/min. Renal function has a significant impact on the PK-PD of
prophylactic cefazolin in cardiothoracic surgery. The postoperative drug
dosing intervals should be <6 h in order to achieve a 100% time above the
MIC in patients with CLcr >= 50 ml/min. 2011 Springer-Verlag.
<15>
Accession Number
2012096084
Authors
Zhou Y.-H. Wei X. Lu J. Ye X.-F. Wu M.-J. Xu J.-F. Qin Y.-Y. He J.
Institution
(Zhou, Lu, Ye, Wu, Xu, Qin, He) Department of Health Statistics, Second
Military Medical University, Shanghai, China
(Wei) School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Title
Effects of combined aspirin and clopidogrel therapy on cardiovascular
outcomes: A systematic review and meta-analysis.
Source
PLoS ONE. 7 (2) , 2012. Article Number: e31642. Date of Publication: 13
Feb 2012.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background: Aspirin and clopidogrel monotherapies are effective treatments
for preventing vascular disease. However, new evidence has emerged
regarding the use of combined aspirin and clopidogrel therapy to prevent
cardiovascular events. We therefore performed a comprehensive systematic
review and meta-analysis to evaluate the benefits and harms of combined
aspirin and clopidogrel therapy on major cardiovascular outcomes.
Methodology/Principal Findings: We systematically searched Medline,
Embase, the Cochrane Central Register of Controlled Trials, reference
lists of articles, and proceedings of major meetings to identify studies
to fit our analysis. Eligible studies were randomized controlled trials
assessing the effect of combined aspirin and clopidogrel therapy compared
with aspirin or clopidogrel monotherapy. We identified 7 trials providing
data with a total of 48248 patients. These studies reported 5134 major
cardiovascular events, 1626 myocardial infarctions, 1927 strokes, and 1147
major bleeding events. Overall, the addition of aspirin to clopidogrel
therapy as compared to single drug therapy resulted in a 9% RR reduction
(95%CI, 2 to 17) in major cardiovascular events, 14% RR reduction (95%CI,
3 to 24) in myocardial infarction, 16% RR reduction (95%CI, 1 to 28) in
stroke, and 62% RR increase (95%CI, 26 to 108) in major bleeding events.
We also present the data as ARR to explore net value as the reduction in
cardiovascular events. Overall, we observed that combined therapy yielded
1.06% decrease (95%CI, 0.23% to 1.99%) in major cardiovascular events and
1.23% increase (95%CI, 0.52% to 2.14%) in major bleeding events.
Conclusion/Significance: Although the addition of aspirin to clopidogrel
resulted in small relative reductions in major cardiovascular events,
myocardial infarction, and stroke, it also resulted in a relative increase
in major bleeding events. In absolute terms the benefits of combined
therapy, a 1.06% reduction in major cardiovascular events, does not
outweigh the harms, a 1.23% increase in major bleeding events. 2012 Zhou
et al.
<16>
Accession Number
2012091825
Authors
Hisatomi K. Eishi K.
Institution
(Hisatomi, Eishi) Department of Cardiovascular Surgery, Nagasaki
University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
Title
Multicenter trial of carperitide in patients with renal dysfunction
undergoing cardiovascular surgery.
Source
General Thoracic and Cardiovascular Surgery. 60 (1) (pp 21-30), 2012.
Date of Publication: January 2012.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose: The aim of this study was to evaluate the efficacy of carperitide
in maintaining renal function during intraoperative and postoperative
management of patients with renal dysfunction undergoing elective
cardiovascular surgery. Methods: The subjects were 88 patients with a
preoperative serum creatinine level >=1.2 mg/dl who underwent elective
cardiovascular surgery using cardiopulmonary bypass. They were
prospectively divided into a group that received carperitide from the
start of surgery (carperitide group, n = 44) and a group that was not
given carperitide (control group, n = 44). Carperitide infusion was
initiated at the beginning of surgery and was continued for >=5 days, with
the central dose being 0.02 g/kg/min. The primary endpoint was the serum
creatinine level on postoperative day (POD) 3. Results: The serum
creatinine levels on PODs 3, 4, and 7 were significantly lower, and
creatinine clearance on PODs 2 and 3 was significantly higher in the
carperitide group than in the controls. One patient in the control group
and no patient in the carperitide group required continuous
hemodiafiltration, but the difference was not statistically significant.
Conclusion: Continuous low-dose infusion of carperitide from the start of
cardiovascular surgery maintained renal function in patients with
preoperative renal dysfunction. 2012 The Japanese Association for
Thoracic Surgery.
<17>
Accession Number
2012105689
Authors
Pedersen K.R. Ravn H.B. Povlsen J.V. Schmidt M.R. Erlandsen E.J. Hjortdal
V.E.
Institution
(Pedersen, Hjortdal) Department of Cardiothoracic and Vascular Surgery,
Arhus University Hospital, Skejby, 8200 Arhus N, Denmark
(Ravn) Department of Anesthesia and Intensive Care, Arhus University
Hospital, Skejby, Arhus, Denmark
(Povlsen) Department of Renal Medicine C, Arhus University Hospital,
Skejby, Arhus, Denmark
(Schmidt) Department of Cardiology, Arhus University Hospital, Skejby,
Arhus, Denmark
(Erlandsen) Department of Clinical Biochemistry, Viborg Regional Hospital,
Viborg, Denmark
Title
Failure of remote ischemic preconditioning to reduce the risk of
postoperative acute kidney injury in children undergoing operation for
complex congenital heart disease: A randomized single-center study.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (3) (pp 576-583),
2012. Date of Publication: March 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The objective of this study was to evaluate whether remote
ischemic preconditioning can protect kidney function in children
undergoing operation for complex congenital heart disease. Methods:
Children (n = 113) aged 0 to 15 years admitted for complex congenital
heart disease were randomly allocated according to age to remote ischemic
preconditioning and control groups. After exclusion of 8 patients, we
conducted the analysis on 105 patients (remote ischemic preconditioning
group, n = 54; control group, n = 51). Before surgery, remote ischemic
preconditioning was performed as 4 cycles of 5 minutes of ischemia by
inflating a cuff around a leg to 40 mm Hg above the systolic pressure. End
points were development of acute kidney injury, initiation of dialysis,
plasma creatinine, estimated glomerular filtration rate, plasma cystatin
C, plasma and urinary neutrophil gelatinase-associated lipocalin, and
urinary output. Secondary end points included postoperative blood
pressure, inotropic score, and mortality, as well as morbidity reflected
by reoperation and stays in the intensive care unit and hospital. Results:
Overall, 57 of the children (54%) had acute kidney injury develop, with 27
(50%) in the remote ischemic preconditioning group and 30 (59%) in the
control group (P >.2). Remote ischemic preconditioning was not associated
with improvement in either any of the renal biomarkers or any of the
secondary end points. Conclusions: We found no evidence that remote
ischemic preconditioning provided protection of kidney function in
children undergoing operation for complex congenital heart disease.
Copyright 2012 by The American Association for Thoracic Surgery.
<18>
Accession Number
2012105706
Authors
Lemma M.G. Coscioni E. Tritto F.P. Centofanti P. Fondacone C. Salica A.
Rossi A. De Santo T. Di Benedetto G. Piazza L. Rinaldi M. De Luca Tupputi
Schinosa A.L. De Paulis R. Contino M. Genoni M.
Institution
(Lemma, Contino) Department of Cardiovascular Surgery, Luigi Sacco
University General Hospital, Via GB Grassi 74, Milan 20157, Italy
(Coscioni, Di Benedetto) Cardiac Surgery Department, S. Giovanni di Dio e
Ruggi d'Aragona Hospital, Salerno, Italy
(Tritto, Piazza) Division of Cardiac Surgery, San Sebastiano Hospital,
Caserta, Italy
(Centofanti, Rinaldi) Department of Cardiac Surgery, University of
Medicine, S. Giovanni Battista Hospital, Turin, Italy
(Fondacone, De Luca Tupputi Schinosa) Department of Cardiac Surgery,
Policlinico Hospital, University of Bari, Bari, Italy
(Salica, De Paulis) Division of Cardiac Surgery, European Hospital, Rome,
Italy
(Genoni) Cardiac Surgery Division, City Hospital Triemli Zurich, Zurich,
Switzerland
(Rossi, De Santo) Clinical Department, Medtronic Italy, Sesto San
Giovanni, Italy
Title
On-pump versus off-pump coronary artery bypass surgery in high-risk
patients: Operative results of a prospective randomized trial (on-off
study).
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (3) (pp 625-631),
2012. Date of Publication: March 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: To analyze the risk reduction of cardiopulmonary bypass
complications between on-pump and off-pump coronary artery bypass grafting
in high-risk patients. Methods: This multicenter, prospective, randomized,
parallel trial enrolled patients for elective or urgent isolated coronary
artery bypass grafting with an additive European System for Cardiac
Operative Risk Evaluation of 6 or more. The patients in cardiogenic shock
were excluded. The composite primary end point included operative
mortality, myocardial infarction, stroke, renal failure, reoperation for
bleeding and adult respiratory distress syndrome within 30 days after
surgery. The total sample size was 693 patients, according to a scheduled
interim analysis at 400 patients enrolled (alpha-spending = 0.029, Pocock
method). Results: A total of 411 patients were included in the interim
analysis. Randomization assigned 203 patients to on-pump and 208 patients
to off-pump treatment. Of the 411 patients, 24 crossed over; thus, 195
patients were actually treated on-pump and 216 off-pump. According to the
intention to treat analysis, the rate of the composite primary end point
was significantly lower (unadjusted P = .009, adjusted P = .010) in the
off-pump group (5.8% vs 13.3%). The risk of experiencing the primary end
point was significantly greater for the on-pump group (unadjusted odds
ratio, 2.51; 95% confidence interval, 1.23-5.10; P = .011; adjusted odds
ratio, 3.07; 95% confidence interval, 1.32-7.14; P = .009). Conclusions:
Off-pump coronary artery bypass grafting reduces early mortality and
morbidity in high-risk patients. Copyright 2012 by The American
Association for Thoracic Surgery.
<19>
Accession Number
2012094526
Authors
Arora S. Gude E. Sigurdardottir V. Mortensen S.A. Eiskjaer H. Riise G.
Mared L. Bjortuft O. Ekmehag B. Jansson K. Simonsen S. Aukrust P. Solbu D.
Iversen M. Gullestad L.
Institution
(Arora, Gude, Bjortuft, Simonsen, Aukrust, Gullestad) Department of
Cardiology, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway
(Sigurdardottir, Riise) Sahlgrenska University Hospital, Gothenburg,
Sweden
(Mortensen, Eiskjaer, Iversen) Skeiby University Hospital, Aarhus, Denmark
(Mared, Ekmehag) Lund Hospital, Lund, Sweden
(Jansson) Heart Center University Hospital, Linkoping, Sweden
(Solbu) Novartis Norge, Oslo, Norway
(Aukrust, Gullestad) University of Oslo, Oslo, Norway
Title
Improvement in renal function after everolimus introduction and
calcineurin inhibitor reduction in maintenance thoracic transplant
recipients: The significance of baseline glomerular filtration rate.
Source
Journal of Heart and Lung Transplantation. 31 (3) (pp 259-265), 2012.
Date of Publication: March 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: The NOCTET (NOrdic Certican Trial in HEart and lung
Transplantation) trial demonstrated that everolimus improves renal
function in maintenance thoracic transplant (TTx) recipients.
Nevertheless, introduction of everolimus is not recommended for patients
with advanced renal failure. We evaluated NOCTET data to assess everolimus
introduction amongst TTx recipients with advanced renal failure. Methods:
This 12-month multicenter Scandinavian study randomized 282 maintenance
TTx recipients to everolimus introduction with calcineurin inhibitor (CNI)
reduction or standard CNI therapy. The measured glomerular filtration rate
(mGFR) was noted at baseline and after 1-year using
Cr-ethylenediaminetetraacetic acid clearance. Results: In 21 patients with
a baseline mGFR of 20 to 29 ml/min/1.73 m<sup>2</sup>, renal function
improved in the everolimus group compared with the control group ((mGFR
6.7 +/- 9.0 vs -1.6 +/- 5.1 ml/min/1.73 m<sup>2</sup>; p = 0.03). Amongst
173 patients with moderate renal impairment (mGFR 3059 ml/min/1.73
m<sup>2</sup>), renal function improvement was also greater amongst
everolimus patients than in controls (mGFR 5.1 +/- 11.1 vs -0.5 +/- 8.7
ml/min/1.73 m <sup>2</sup>; p < 0.01). In 55 patients with mGFR 60 to 89
ml/min/1.73 m <sup>2</sup>, mGFR did not change significantly in either
group. Improvement in mGFR was limited to patients with a median time
since TTx of less than 4.6 years and was also influenced by CNI reduction
during the study period. Conclusions: Everolimus introduction and reduced
CNI significantly improved renal function amongst maintenance TTx patients
with pre-existing advanced renal failure. This beneficial effect was
limited to patients undergoing conversion in less than 5 years after TTx,
indicating a window of opportunity that is appropriate for pharmacologic
intervention with everolimus. 2012 International Society for Heart and
Lung Transplantation. All rights reserved.
<20>
Accession Number
22231536
Authors
Fakin R. Zimpfer D. Sodeck G.H. Rajek A. Mora B. Dumfarth J. Grimm M.
Czerny M.
Institution
(Fakin) Division of General Thoracic Surgery, University Hospital Bern,
University of Bern, Bern, Switzerland.
Title
Influence of temperature management on neurocognitive function in
biological aortic valve replacement. A prospective randomized trial.
Source
The Journal of cardiovascular surgery. 53 (1) (pp 107-112), 2012. Date
of Publication: Feb 2012.
Abstract
Aim of this study was to elucidate if postoperative neurocognitive
function after biological aortic valve replacement (AVR) can be influenced
by temperature management during cardiopulmonary bypass (CPB). In this
prospective randomized study, we measured the effect of mild hypothermic
(32 degreeC, N.=30) vs. normothermic (37 degreeC, N.=30) CPB on
neurocognitive function. All patients underwent elective isolated
biological AVR (mean age 67 +/- 8 years, mean additional EuroSCORE 5.6 +/-
2.4). Neurocognitive function was objectively measured by means of
objective P300 auditory-evoked potentials before surgery, one week and
four months after surgery. Clinical data and outcome were monitored. P300
evoked potentials were comparable between patients operated with mild
hypothermic (370 +/- 30 ms) and normothermic CPB (373 +/- 32 ms) before
surgery (P=0.85). P300 peak latencies were prolonged (=impaired) in
patients operated with normothermic (402 +/- 29, P<0.0001) as well as with
mild hypothermic CPB (405 +/- 30 ms, P<0.0001) one week after surgery.
Even four months after surgery, still impairment of P300 peak latencies
could be documented in either patients operated with normothermic (394 +/-
28 ms) and mild hypothermic CPB (400 +/- 33 ms,) in repeated measures
analysis of variance (P=0.042). Group comparison revealed no difference
between patients operated with normothermic and mild hypothermic CPB at
one week (P=0.54) and four months (P=0.67) after surgery. Clinical data as
well as postoperative adverse events were comparable between the two
groups. Normothermic temperature management during CPB is non-inferior to
hypothermic in means of neuroprotection. Since patients after biological
aortic valve replacement show a subclinical but measurable cognitive
deficit up to four months after surgery, other factors have to be
addressed to add further benefit to the extremely good results of open
biological AVR.
<21>
Accession Number
22186117
Authors
Narbute I. Jegere S. Kumsars I. Mintale I. Zakke I. Bumeistere K. Sondore
D. Grave A. Erglis A.
Institution
(Narbute, Jegere, Kumsars, Mintale, Zakke, Bumeistere, Sondore, Grave,
Erglis) Latvian Centre of Cardiology, Pauls Stradins Clinical University
Hospital, Riga, Latvia
Title
Are paclitaxel-eluting stents better in unprotected left main coronary
artery disease? Three-year clinical and intravascular imaging results from
a randomized study.
Source
Medicina. 47 (10) (pp 536-543), 2011. Date of Publication: 2011.
Publisher
Kauno Medicinos Universitetas (A. Mickeviciaus g. 9, Kaunas 44307,
Lithuania)
Abstract
Background and Objective. Recent publications have demonstrated superior
outcomes in unprotected left main patients after paclitaxel-eluting stent
(PES) implantation. Long-term data in these patients are limited. The aim
of this study was to evaluate if intravascular ultrasound (IVUS)-guided
PES implantation is superior to bare metal stent (BMS) implantation in
unprotected left main disease after lesion pretreatment with cutting
balloon during long-term follow-up. Material and Methods. Unprotected left
main patients were randomized to BMS (n=50) or PES implantation (n=53).
All interventions were IVUS-guided and cutting balloon pretreatment before
stenting was performed in all patients. All patients were scheduled for
6-month and 3-year follow-up. Subgroups of patients who underwend IVUS and
OCT imaging at 3-year follow-up were analyzed. The primary endpoint was
the major adverse cardiac events (MACEs) defined as death, Q-wave
myocardial infarction, or target lesion revascularization. Results.
Baseline characteristics were similar in both the groups with a mean
SYNTAX score of 31.4+/-14.5 in BMS and 32.6+/-11.7 in PES patients
(P=0.718). At 3 years, MACEs occurred in 18 patients (36.0%) in the BMS
and 7 patients (13.2%) in the PES group (P=0.011). By IVUS, percent
neointimal volume obstruction at 3 years was reduced from 18.1%+/-8.7%
with BMSs to 10.0%+/-5.4% with PESs (P<0.001). The total number of
uncovered stent struts per OCT image and IVUS image was 0.4+/-0.8 and
1.2+/-1.5, respectively (P<0.001). Conclusions. The current study
demonstrated that IVUS-guided PES implantation was superior to BMS
implantation after cutting balloon pretreatment in unprotected left main
disease at 3 years. If compared with IVUS, OCT was more precise in the
assessment of stent endothelization.
