Results Generated From:
Embase <1980 to 2014 Week 14>
Embase (updates since 2014-03-28)
<1>
Accession Number
24193288
Authors
Lopez C. Facciolo F. Lequaglie C. Rendina E.A. Saita S. Dell'Amore D.
Sollitto F. Urciuoli G. Loizzi M. Cisternino M.L. Granone P. Angelelli A.
Cardillo F Mucilli G. Rienzo G.D.I.
Institution
(Lopez, Rienzo) Division of Thoracic Surgery, V. Fazzi Hospital, Piazza
Muratore, 73100 Lecce, Italy
(Facciolo) Division of Thoracic Surgery, Regina Elena National Cancer
Institute, Rome, Italy
(Lequaglie) Division of Thoracic Surgery, I.R.C.C.S. C.R.O.B. Cancer
Institute, Rionero in Vulture, Potenza, Italy
(Rendina) Division of Thoracic Surgery, University la Sapienza -
sant'Andrea Hospital, Rome, Italy
(Saita) Division of Thoracic Surgery, Vittorio Emanuele Hospital, Catania,
Italy
(Dell'Amore) Division of Thoracic Surgery, Morgagni Hospital, Forli, Italy
(Sollitto) Division of Thoracic Surgery, Ospedali Riuniti - University of
Foggia, Foggia, Italy
(Urciuoli) Division of Thoracic Surgery, S. Carlo Hospital, Potenza, Italy
(Loizzi) Division of Thoracic Surgery, Policlinico Hospital, University of
Bari, Bari, Italy
(Cisternino) Division of Thoracic Surgery, S. Paolo Hospital, Bari, Italy
(Granone) Division of Thoracic Surgery, Catholic University Policlinico A.
Gemelli, Rome, Italy
(Angelelli) Division of Thoracic Surgery, Card. G. Panico Hospital,
Tricase, Lecce, Italy
(Cardillo F Mucilli) Division of Thoracic Surgery, S. Camillo-Forlanini
Hospital, Rome, Italy
(Cardillo F Mucilli) Division of Thoracic Surgery, Ospedale Clinicizzato
SS. Annunziata, University of Chieti, Chieti, Italy
Title
Efficacy and safety of fibrin sealant patch in the treatment of air
leakage in thoracic surgery.
Source
Minerva Chirurgica. 68 (6) (pp 559-567), 2013. Date of Publication:
December 2013.
Abstract
Aim. Air leakage represents a major problem in lung surgery. Absorbable
fibrin sealant patch (AFSP), a collagen sponge coated with human
fibrinogen and thrombin, can be used as an adjunct to primary stapling or
suturing. This study compared the efficacy of AFSP with manual suturing
after primary stapling. Methods. This was a prospective, multicenter,
randomized study. Patients undergoing lobectomy, bilobectomy, anatomical
segmentectomy for lung cancer or wedge resection for pulmonary metastasis
with air leakage grade 1 or 2 according to Macchiarini scale after stapler
suture were randomized to receive AFSP or standard surgical treatment
(ST). The primary endpoint was the reduction of intraoperative air leakage
intensity. Duration of postoperative air leakage and number of days until
removal of last chest drain were secondary endpoints. Safety was recorded
for all patients. Results. A total of 346 patients were enrolled in 14
centres, 179 of whom received AFSP and 167 ST. Intraoperative air leak
intensity was reduced in 90.5% of AFSP patients and 82% of ST patients
(P=0.03). A significant reduction in postoperative air leakage duration
was observed in the AFSP group (P=0.0437). The median number of days until
removal of last drainage was 6 (3-37) in the AFSP group and 7 (2-27) in
the ST (P=0.38). Occurrence of adverse events was comparable in both
groups. Conclusion. AFSP was more efficacious than standard ST as an
adjunct to primary stapiing in reducing intraoperative air leakage
intensity and duration of postoperative air leakage in patients undergoing
pulmonary surgery. AFSP was well tolerated.
<2>
Accession Number
24434889
Authors
Packer A.C. Pires P.F. Dibai-Filho A.V. Rodrigues-Bigaton D.
Institution
(Packer) From the Laboratory of Therapeutic Resources, Postgraduate
Program in Physiotherapy, Universidade Metodista de Piracicaba,
Piracicaba, Sao Paulo, Brazil.
Title
Effects of upper thoracic manipulation on pressure pain sensitivity in
women with temporomandibular disorder: a randomized, double-blind,
clinical trial.
Source
American journal of physical medicine & rehabilitation / Association of
Academic Physiatrists. 93 (2) (pp 160-168), 2014. Date of Publication: Feb
2014.
Abstract
The aim of the present study was to evaluate the effects of upper thoracic
manipulation on pain in subjects with temporomandibular disorder.
Thirty-two women with a diagnosis of temporomandibular disorder were
randomly allocated to an experimental group (n = 16), submitted to upper
thoracic manipulation, and a placebo group (n = 16), submitted to a
procedure in the thoracic region with no therapeutic effect. All
volunteers underwent an evaluation of pain in the masticatory muscles and
the temporomandibular joint using an algometer and the visual analog scale
before and immediately after the procedure as well as after 48-72 hrs.
Two-way repeated-measures analysis of variance was used for the intragroup
and intergroup analyses, with the level of significance set to 5% (P <
0.05). Cohen d was calculated for the determination of the effect size. No
significant group-by-time interaction was found (P > 0.05) for algometry
in any analysis, and Cohen d revealed no significant effect of the
treatment. Moreover, no significant group-by-time interaction was found
for facial pain intensity determined using the visual analog scale (P >
0.05), and Cohen d also revealed no significant effect of the treatment
regarding this variable. On the basis of the present findings, upper
thoracic spinal manipulation does not lead to a reduction in pain in women
with temporomandibular disorder.
<3>
Accession Number
2014207641
Authors
Harskamp R.E. Bagai A. Halkos M.E. Rao S.V. Bachinsky W.B. Patel M.R. De
Winter R.J. Peterson E.D. Alexander J.H. Lopes R.D.
Institution
(Harskamp, Rao, Patel, Peterson, Alexander, Lopes) Duke Clinical Research
Institute, Duke University Medical Center, Durham, NC, United States
(Harskamp, De Winter) Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Bagai) St Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Halkos) Emory University, School of Medicine, Atlanta, GA, United States
(Bachinsky) Pinnacle Health Cardiovascular Institute, Harrisburg Hospital,
Harrisburg, PA, United States
Title
Clinical outcomes after hybrid coronary revascularization versus coronary
artery bypass surgery: A meta-analysis of 1,190 patients.
Source
American Heart Journal. 167 (4) (pp 585-592), 2014. Date of Publication:
April 2014.
Publisher
Mosby Inc.
Abstract
Background Hybrid coronary revascularization (HCR) represents a minimally
invasive revascularization strategy in which the durability of the
internal mammary artery to left anterior descending artery graft is
combined with percutaneous coronary intervention to treat remaining
lesions. We performed a systematic review and meta-analysis to compare
clinical outcomes after HCR with conventional coronary artery bypass graft
(CABG) surgery. Methods A comprehensive EMBASE and PUBMED search was
performed for comparative studies evaluating in-hospital and 1-year death,
myocardial infarction (MI), stroke, and repeat revascularization. Results
Six observational studies (1 case control, 5 propensity adjusted)
comprising 1,190 patients were included; 366 (30.8%) patients underwent
HCR (185 staged and 181 concurrent), and 824 (69.2%) were treated with
CABG (786 off-pump, 38 on-pump). Drug-eluting stents were used in 328
(89.6%) patients undergoing HCR. Hybrid coronary revascularization was
associated with lower in-hospital need for blood transfusions, shorter
length of stay, and faster return to work. No significant differences were
found for the composite of death, MI, stroke, or repeat revascularization
during hospitalization (odds ratio 0.63, 95% CI 0.25-1.58, P =.33) and at
1-year follow-up (odds ratio 0.49, 95% CI 0.20-1.24, P =.13). Comparisons
of individual components showed no difference in all-cause mortality, MI,
or stroke, but higher repeat revascularization among patients treated with
HCR. Conclusions Hybrid coronary revascularization is associated with
lower morbidity and similar in-hospital and 1-year major adverse
cerebrovascular or cardiac events rates, but greater requirement for
repeat revascularization compared with CABG. Further exploration of this
strategy with adequately powered randomized trials is warranted. 2014
Mosby, Inc.
<4>
Accession Number
2014207619
Authors
Jones W.S. Dolor R.J. Hasselblad V. Vemulapalli S. Subherwal S. Schmit K.
Heidenfelder B. Patel M.R.
Institution
(Jones, Dolor, Hasselblad, Vemulapalli, Subherwal, Schmit, Heidenfelder,
Patel) Duke Clinical Research Institute, Duke University Medical Center,
Durham, NC, United States
(Jones, Vemulapalli, Patel) Division of Cardiology, Duke University
Medical Center, Durham, NC, United States
(Dolor, Schmit, Heidenfelder) Duke Evidence-based Practice Center, Duke
Clinical Research Institute, Duke University, Durham, NC, United States
Title
Comparative effectiveness of endovascular and surgical revascularization
for patients with peripheral artery disease and critical limb ischemia:
Systematic review of revascularization in critical limb ischemia.
Source
American Heart Journal. 167 (4) (pp 489-498.e7), 2014. Date of
Publication: April 2014.
Publisher
Mosby Inc.
Abstract
Background For patients with critical limb ischemia (CLI), the optimal
treatment to enhance limb preservation, prevent death, and improve
functional status is unknown. We performed a systematic review and
meta-analysis to assess the comparative effectiveness of endovascular
revascularization and surgical revascularization in patients with CLI.
Methods We systematically searched PubMed, Embase, and the Cochrane
Database of Systematic Reviews for relevant English-language studies
published from January 1995 to August 2012. Two investigators screened
each abstract and full-text article for inclusion, abstracted the data,
and performed quality ratings and evidence grading. Random-effects models
were used to compute summary estimates of effects, with endovascular
treatment as the control group. Results We identified a total of 23
studies, including 1 randomized controlled trial, which reported no
difference in amputation-free survival at 3 years (odds ratio [OR] 1.22,
95% CI 0.84-1.77) and all-cause mortality (OR 1.07, 0.73-1.56) between the
2 treatments. Meta-analysis of the observational studies showed a
statistically nonsignificant reduction in all-cause mortality at 6 months
(11 studies, OR 0.85, 0.57-1.27) and amputation-free survival at 1 year (2
studies, OR 0.76, 0.48-1.21) in patients treated with endovascular
revascularization. There was no difference in overall death, amputation,
or amputation-free survival at >2 years. Conclusions The currently
available literature suggests that there is no difference in clinical
outcomes for patients with CLI treated with endovascular or surgical
revascularization. There is a paucity of high-quality data available to
guide clinical decision making, especially as it pertains to patient
subgroups or anatomical considerations. 2014 Mosby, Inc.
<5>
Accession Number
2014197943
Authors
Hausenloy D.J. Kunst G. Boston-Griffiths E. Kolvekar S. Chaubey S. John L.
Desai J. Yellon D.M.
Institution
(Hausenloy, Boston-Griffiths, Yellon) Hatter Cardiovascular Institute,
University College London, Hospital and Medical School, 67 Chenies Mews,
London WC1E 6HX, United Kingdom
(Kunst) Department of Anaesthetics, King's College Hospital NHS Foundation
Trust, London, United Kingdom
(Kolvekar) Department of Cardiothoracic Surgery, Heart Hospital, UCL,
London, United Kingdom
(Chaubey, John, Desai) Department of Cardiothoracic Surgery, King's
College Hospital NHS Foundation Trust, London, United Kingdom
Title
The effect of cyclosporin-A on peri-operative myocardial injury in adult
patients undergoing coronary artery bypass graft surgery: A randomised
controlled clinical trial.
Source
Heart. 100 (7) (pp 544-549), 2014. Date of Publication: April 2014.
Publisher
BMJ Publishing Group
Abstract
Objective: Cyclosporin-A (CsA) has been reported to reduce myocardial
infarct size in both the experimental and clinical settings. This
protective effect is dependent on its ability to prevent the opening of
the mitochondrial permeability transition pore, a critical determinant of
cell death in the setting of acute ischaemia-reperfusion injury. Whether
CsA can reduce the extent of perioperative myocardial injury (PMI) in
patients undergoing coronary artery bypass graft (CABG) surgery is
unknown, and is investigated in this randomised controlled clinical trial.
Methods: 78 adult patients undergoing elective CABG surgery were
randomised to receive either an intravenous bolus of CsA (2.5 mg/kg) or
placebo administered after induction of anaesthesia and prior to
sternotomy. PMI was assessed by measuring serum cardiac enzymes, troponin
T (cTnT) and CK-MB at 0, 6, 12, 24, 48 and 72 h after surgery. Results:
There was no significant difference in mean peak cTnT levels between
control (n=43) and CsA treatment (n=40) patients (0.56+0.06 ng/mL with
control vs 0.35+0.05 ng/mL with CsA; p=0.07). However, in higher-risk
patients with longer cardiopulmonary bypass times, there was a significant
reduction in PMI with CsA therapy (p=0.049), with a reduced postoperative
cTnT rise by 0.03 ng/mL for every 10 min, when compared with control.
Conclusions: In patients with longer cardiopulmonary bypass times, a
single intravenous bolus of CsA administered prior to CABG surgery reduced
the extent of PMI.
<6>
Accession Number
2014197948
Authors
Achilli F. Malafronte C. Maggiolini S. Lenatti L. Squadroni L. Gibelli G.
Capogrossi M.C. Dadone V. Gentile F. Bassetti B. Gennaro F.D. Camisasca P.
Calchera I. Valagussa L. Colombo G.I. Pompilio G.
Institution
(Achilli, Camisasca, Calchera, Valagussa) Department of Cardiology, San
Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
(Malafronte, Lenatti) Department of Cardiology, A. Manzoni Hospital,
Lecco, Italy
(Maggiolini) Department of Cardiology, San L. Mandic Hospital, Merate,
Lecco, Italy
(Squadroni) Department of Cardiology, San Carlo Hospital, Milan, Italy
(Gibelli) Cardiology Unit, Clinica San Carlo, Paderno Dugnano, Italy
(Capogrossi) Laboratory of Vascular Pathology, Istituto Dermopatico
dell'Immacolata IRCCS, Rome, Italy
(Dadone, Gentile) Department of Cardiology, Bassini Hospital, Cinisello
Balsamo, Milan, Italy
(Bassetti, Pompilio) Department of Clinical and Community Sciences,
University of Milan, Milan, Italy
(Gennaro) Department of Radiology, San Gerardo Hospital, Monza, Italy
(Colombo) Laboratory of Immunology and Functional Genomics, Centro
Cardiologico Monzino IRCCS, Milan, Italy
(Pompilio) Laboratory of Vascular Biology and Regenerative Medicine,
Centro Cardiologico Monzino IRCCS, Milan, Italy
(Pompilio) Department of Cardiovascular Surgery, Centro Cardiologico
Monzino IRCCS, Milan, Italy
Title
G-CSF treatment for STEMI: Final 3-year follow-up of the randomised
placebo-controlled STEM-AMI trial.
Source
Heart. 100 (7) (pp 574-581), 2014. Date of Publication: April 2014.
Publisher
BMJ Publishing Group
Abstract
Objective: To assess whether granulocyte colonystimulating factor (G-CSF)
treatment induces a sustained benefit on adverse remodelling in patients
with large anterior ST-elevation myocardial infarction (STEMI) and left
ventricular (LV) dysfunction after successful reperfusion. Methods: The
STEM-AMI Trial was a prospective, placebo-controlled, multicentre study.
Sixty consecutive patients with a first anterior STEMI, who underwent
primary percutaneous coronary intervention 2-12 h after symptom onset,
with LV ejection fraction (LVEF) <45% measured by echocardiography within
12 h after successful revascularisation (TIMI flow score >2), were
randomised 1:1 to G-CSF (5 mumg/Kg body weight b.i.d.) or placebo.
Clinical events and Major Adverse Cardiac and Cerebrovascular Event
(MACCE) were monitored, and LVEF, LV end-diastolic (LVEDV) and
end-systolic (LVESV) volumes, and infarct size were evaluated by MRI at
the final 3-year follow-up. Results: Fifty-four patients completed the
study, of whom 35 with MRI. No significant differences were found in
mortality and MACCE between G-CSF and placebo-treated groups. The 3-year
infarct size was not different between groups, whereas LVEDV was
significantly lower in G-CSF (n=20) than in placebo (n=15) patients
(170.1+8.1 vs 197.2+8.9 mL, respectively; p=0.033 at analysis of
covariance). A significant inverse correlation was detected in G-CSF
patients between the number of circulating CD34 cells at 30 days after
reperfusion and the 3-year absolute and indexed LVEDV (=-0.71, 95% CI
-0.90 to -0.30, and =-0.62, -0.86 to -0.14, respectively), or their change
over time (r=-0.59, -0.85 to -0.11, and r=-0.55, -0.83 to -0.06,
respectively). Conclusions: G-CSF therapy may be beneficial in attenuating
ventricular remodelling subsequent to a large anterior STEMI in the long
term. No differences have been detected in clinical outcome.
<7>
Accession Number
2014206726
Authors
Monk-Hansen T. Dall C.H. Christensen S.B. Snoer M. Gustafsson F. Rasmusen
H. Prescott E.
Institution
(Monk-Hansen, Dall, Snoer, Rasmusen, Prescott) Department of Cardiology,
Bispebjerg University Hospital, Bispebjerg Bakke 23, byg. 67, 2400
Kobenhavn NV, Denmark
(Christensen, Gustafsson) Department of Cardiology, Rigshospitalet
University Hospital, Copenhagen, Denmark
Title
Interval training does not modulate diastolic function in heart transplant
recipients.
Source
Scandinavian Cardiovascular Journal. 48 (2) (pp 91-98), 2014. Date of
Publication: April 2014.
Publisher
Informa Healthcare
Abstract
Objectives. This study investigates the effect of aerobic interval
training on diastolic function at rest and during exercise in stable heart
transplant (HTx) recipients. Design. Twenty-three stable HTx recipients
(74% males, mean age 50 + 14.9 years) were recruited to a training
programme. Intervention was 8 weeks intensive training or control in a
randomized controlled design. Results. At baseline, participants had
normal or mild diastolic dysfunction at rest. During exercise, mean E/e'
increased from 9.0 (+ 2.8) to 12.8 (+ 7.7) (p = 0.09), E/A increased from
2.1 (+ 0.6) to 2.6 (+ 0.7) (p = 0.02), and deceleration time decreased by
over 50 ms, all markers of increased filling pressure. There were no
correlations between diastolic function and VO2peak at baseline. After
intervention VO2peak increased from 23.9 (+ 4.5) to 28.3(+ 6) ml/kg/min in
the training group (difference between groups p = 0.0018). No consistent
pattern of improvement in diastolic function at rest or during exercise
was seen. Conclusion. The study does not support a role of diastolic
dysfunction in the limited exercise capacity of HTx recipients and
suggests that in these patients peripheral factors are of greater
importance. 2014 Informa Healthcare.
<8>
Accession Number
2014200206
Authors
Ge Y.-Z. Yu P. Jia R.-P. Wu R. Ding A.-X. Li L.-P. Zhao Y. Feng Y.-M. Gui
Z.-L. Liao S.
Institution
(Ge, Yu, Jia, Wu, Zhao, Feng, Gui, Liao) Department of Urology and Center
of Renal Transplantation, Nanjing First Hospital, Nanjing Medical
University, 68 Changle Road, Nanjing 210006, China
(Ding) Department of General Surgery, Nanjing First Hospital, Nanjing
Medical University, 68 Changle Road, Nanjing 210006, China
(Li) Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing
Medical University, 68 Changle Road, Nanjing 210006, China
Title
Association between transforming growth factor beta-1 +869T/C polymorphism
and acute rejection of solid organ allograft: A meta-analysis and
systematic review.
Source
Transplant Immunology. 30 (2-3) (pp 76-83), 2014. Date of Publication:
March 2014.
Publisher
Elsevier
Abstract
Background: Transforming growth factor beta-1(TGFB1) is involved in the
acute rejection (AR) episodes of solid organ transplant recipients.
However, results from published studies on the association between
donor/recipient TGFB1 + 869 T/C polymorphism and AR risk are conflicting
and inconclusive. Methods: PUBMED, EMBASE, CNKI and Wanfang Database were
searched to identify eligible studies investigating the association
between donor/recipient TGFB1 +. 869. T/C polymorphism and AR risk.
Statistical analysis was performed by using STATA 10.0. Results: A total
of 29 studies were included. Overall, the donor TGFB1 + 869 T/C
polymorphism was significantly associated with AR risk in heterozygote
comparison (CT vs. TT: OR = 1.67, 95%CI, 1.17-2.39; P heterogeneity =
0.285) and dominant model (CC vs. TC/TT: OR = 1.47, 95%CI, 1.05-2.06; P
heterogeneity = 0.445). In addition, subgroup analysis revealed that CT
variant (CT vs. TT: OR = 1.97, 95%CI, 1.20-3.25; P heterogeneity = 0.777)
and CC/CT genotype (CC/CT vs. TT: OR = 1.72, 95%CI, 1.07, 2.78; P
heterogeneity = 0.619) within donors contributed to higher risk of AR in
recipients administrated with CsA or FK506, compared with those applied
only CsA. On the other hand, no significant association between recipient
TGFB1 + 869 T/C polymorphism and AR was detected in all genetic models.
Conclusions: This meta-analysis and systematic review suggested that donor
TGFB1 + 869 T/C polymorphism was significantly associated with AR of solid
organ transplant recipients, and especially among patients in CsA/FK 506
group compared with those in CsA group. 2014 Elsevier B.V.
<9>
Accession Number
2014191805
Authors
Wang K. Pan X. Tang Q. Pang Y.
Institution
(Wang, Pan, Tang, Pang) Department of Pediatrics, First Affiliated
Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning
530021, Guangxi Autonomous Region, China
Title
Catheterization therapy vs surgical closure in pediatric patients with
patent ductus arteriosus: A meta-analysis.
Source
Clinical Cardiology. 37 (3) (pp 188-194), 2014. Date of Publication: March
2014.
Publisher
John Wiley and Sons Inc.
Abstract
Background Patent ductus arteriosus (PDA) remains a common congenital
heart disease in pediatric patients, and the new trend of catheterization
therapy is still associated with some potential risks and complications.
Hypothesis Compared with surgical closure, the clinical effect of
catheterization therapy in pediatric PDA patients requires meta-analysis.
Methods A systematic literature search of PubMed, Cochrane Library,
Embase, Science Citation Index, Web of Science, and the Chinese
Biomedicine literature database was conducted. Eligible studies included
controlled trials of pediatric PDA patients receiving catheterization
therapy vs surgical closure. Relative risks (RRs), standard mean
differences, and 95% confidence intervals (CIs) were calculated and
heterogeneity was assessed with the I<sup>2</sup> test. Results Seven
studies with a total of 810 patients met the inclusion criteria.
Catheterization therapy neither significantly increased the primary
success rate (RR: 0.92, 95% CI: 0.82-1.03, P = 0.16) nor reduced the total
postprocedure complications (RR: 0.74, 95% CI: 0.44-1.25, P = 0.26) and
blood transfusion (RR: 1.10, 95% CI: 0.16-7.67, P = 0.93). Catheterization
was associated with a statistically significant increase in residual
shunts (RR: 5.19, 95% CI: 1.41-19.20, P = 0.01) and reduction in length of
hospital stay (standard mean difference: -1.66, 95% CI: -2.65 to -0.67, P
= 0.001). Conclusions Catheterization therapy in pediatric PDA patients
did not show a significant advantage in primary success rate, total
complications, or blood transfusion, but it was associated with increase
in residual shunts and reduction in length of hospital stay. 2014 Wiley
Periodicals, Inc.
<10>
Accession Number
2014191610
Authors
Dicecco S.R. Francisco-Ziller N.
Institution
(Dicecco, Francisco-Ziller) Mayo Clinic Hospital, Rochester Methodist
Campus, 201 West Center Street, Rochester, MN 55902, United States
Title
Obesity and organ transplantation: Successes, failures, and opportunities.
Source
Nutrition in Clinical Practice. 29 (2) (pp 171-191), 2014. Date of
Publication: April 2014.
Publisher
SAGE Publications Ltd
Abstract
The increasing rate of societal obesity is also affecting the transplant
world through obesity in candidates and donors as well as its
posttransplant repercussions. Being overweight and obese has been shown to
have significant effects on both short- and long-term complications as
well as patient and graft survival. However, much of the comorbidity can
be controlled or prevented with careful patient selection and aggressive
management. A team approach to managing obesity and its comorbidities both
pre- and posttransplant is essential for successful transplant outcomes.
Complicating understanding the results of obesity research is the
inclusion different weight categories, use of listing vs transplant
weights, patient populations large enough for statistical power, and
changes in transplant management, especially immunosuppression protocols,
anti-infection protocols, and operative techniques. Much more research is
needed regarding many elements, including safe weight loss before
transplantation, prevention of weight gain after transplant, genomic
influences, and the role of bariatric surgery in the transplant process.
2014 American Society for Parenteral and Enteral Nutrition.
<11>
Accession Number
2014181284
Authors
Jolly S.S. Cairns J. Yusuf S. Niemela K. Steg P.G. Worthley M. Ferrari E.
Cantor W.J. Fung A. Valettas N. Rokoss M. Olivecrona G.K. Widimsky P.
Cheema A.N. Gao P. Mehta S.R.
Institution
(Jolly, Yusuf, Valettas, Rokoss, Gao, Mehta) McMaster University,
Population Health Research Institute, Hamilton Health Sciences, Hamilton,
ON, Canada
(Cairns, Fung) University of British Columbia, Vancouver, BC, Canada
(Niemela) Tampere University Hospital, Heart Center, Tampere, Finland
(Steg) Universite Paris-Diderot, Paris, France
(Worthley) University of Adelaide, Royal Adelaide Hospital, Adelaide,
Australia
(Ferrari) Hopital Pasteur, Nice, France
(Cantor) Southlake Regional Health Centre, University of Toronto, ON,
Canada
(Olivecrona) Skane University Hospital, Lund, Sweden
(Widimsky) Charles University, Hospital Kralovske Vinohrady, Prague, Czech
Republic
(Cheema) St. Michael's Hospital, University of Toronto, ON, Canada
Title
Procedural volume and outcomes with radial or femoral access for coronary
angiography and intervention.
Source
Journal of the American College of Cardiology. 63 (10) (pp 954-963), 2014.
Date of Publication: 18 Mar 2014.
Publisher
Elsevier USA
Abstract
Objectives The study sought to evaluate the relationship between
procedural volume and outcomes with radial and femoral approach.
Background RIVAL (RadIal Vs. femorAL) was a randomized trial of radial
versus femoral access for coronary angiography/intervention (N = 7,021),
which overall did not show a difference in primary outcome of death,
myocardial infarction, stroke, or non-coronary artery bypass graft major
bleeding. Methods In pre-specified subgroup analyses, the hazard ratios
for the primary outcome were compared among centers divided by tertiles
and among individual operators. A multivariable Cox proportional hazards
model was used to determine the independent effect of center and operator
volumes after adjusting for other variables. Results In high-volume radial
centers, the primary outcome was reduced with radial versus femoral access
(hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28 to 0.87) but
not in intermediate- (HR: 1.23; 95% CI: 0.88 to 1.72) or low-volume
centers (HR: 0.83; 95% CI: 0.52 to 1.31; interaction p = 0.021).
High-volume centers enrolled a higher proportion of ST-segment elevation
myocardial infarction (STEMI). After adjustment for STEMI, the benefit of
radial access persisted at high-volume radial centers. There was no
difference in the primary outcome between radial and femoral access by
operator volume: high-volume operators (HR: 0.79; 95% CI: 0.48 to 1.28),
intermediate (HR: 0.87; 95% CI: 0.60 to 1.27), and low (HR: 1.10; 95% CI:
0.74 to 1.65; interaction p = 0.536). However, in a multivariable model,
overall center volume and radial center volume were independently
associated with the primary outcome but not femoral center volume (overall
percutaneous coronary intervention volume HR: 0.92, 95% CI: 0.88 to 0.96;
radial volume HR: 0.88, 95% CI: 0.80 to 0.97; and femoral volume HR: 1.00,
95% CI: 0.94 to 1.07; p = 0.98). Conclusions Procedural volume and
expertise are important, particularly for radial percutaneous coronary
intervention. 2014 by the American College of Cardiology Foundation
Published by Elsevier Inc.
<12>
Accession Number
2014194161
Authors
Wang Y.F. Yao M. Liu H.B. Yang Y.J. Xie J.M. Jia X.W. Pan H.J. Wang C.Y.
Institution
(Wang, Xie, Jia, Pan, Wang) Department of Cardiovascular Disease,
Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China
(Yao, Liu, Yang) Department of Cardiovascular Disease, Cardiovascular
Institute and Fu Wai Hospital, Chinese Academy Medical Science and Peking
Union Medical College, Beijing 100037, China
Title
Correlation between balloon release pressure and no-reflow in patients
with acute myocardial infarction undergoing direct percutaneous coronary
intervention.
Source
Chinese Medical Journal. 127 (6) (pp 1008-1011), 2014. Date of
Publication: 2014.
Publisher
Chinese Medical Association
Abstract
Background Balloon release pressure may increase the incidence of no
reflow after direct percutaneous coronary intervention (PCI). This
randomized controlled study was designed to analyze the correlation
between balloon release pressure and no-reflow in patients with acute
myocardial infarction (AMI) undergoing direct PCI. Methods There were 156
AMI patients who underwent PCI from January 1, 2010 to December 31, 2012,
and were divided into two groups according to the stent inflation
pressure: a conventional pressure group and a high pressure group. After
PCI, angiography was conducted to assess the thrombolysis in myocardial
infarction (TIMI) grade with related artery. Examinations were undertaken
on all patients before and after the operation including cardiac enzymes,
total cholesterol, low-density lipoprotein, blood glucose, homocysteine,
beta-thromboglobulin (beta-TG), Hamilton depression scale (HAMD) and
self-rating anxiety scale (SAS). After interventional therapy, the
afore-mentioned parameters in both the conventional pressure group and
high pressure group were again analyzed. Results The results showed that
CK-MB, HAMD, SAS were significantly different (P <0.05) in all patients
after PCI, especially the CK-MB in the high pressure group ((25.7+7.6) U/L
vs. (76.7+11.8) U/L). CK-MB, HAMD, SAS, and beta-TG were comparative
before PCI but they were significantly changed (P <0.05) after
intervention. No-reflow phenomenon occurred in 13 patients in the high
pressure group, which was significantly higher than in the conventional
pressure group (17.11% vs. 6.25%, P <0.05). Conclusion In stent
implantation, using a pressure less than 1823.4 kPa balloon to release
pressure may be the better choice to reduce the occurrence of no-reflow
following direct PCI.
<13>
Accession Number
2014197225
Authors
Genereux P. Cohen D.J. Williams M.R. Mack M. Kodali S.K. Svensson L.G.
Kirtane A.J. Xu K. McAndrew T.C. Makkar R. Smith C.R. Leon M.B.
Institution
(Genereux, Williams, Kodali, Kirtane, Smith, Leon) Columbia University
Medical Center, New York Presbyterian Hospital, 161 Fort Washington
Avenue, New York, NY 10032, United States
(Genereux, Kodali, Kirtane, Xu, McAndrew, Leon) Cardiovascular Research
Foundation, New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Mack) Baylor Healthcare System, Plano, TX, United States
(Svensson) Cleveland Clinic Foundation, Cleveland, OH, United States
(Makkar) Cedars Sinai Medical Center, Los Angeles, CA, United States
Title
Bleeding complications after surgical aortic valve replacement compared
with transcatheter aortic valve replacement: Insights from the PARTNER i
trial (Placement of Aortic Transcatheter Valve).
Source
Journal of the American College of Cardiology. 63 (11) (pp 1100-1109),
2014. Date of Publication: 25 Mar 2014.
Publisher
Elsevier USA
Abstract
Objectives This study sought to identify the incidence, predictors, and
prognostic impact of bleeding complications (BC) after surgical aortic
valve replacement (SAVR) compared with transcatheter aortic valve
replacement (TAVR). Background Bleeding complications after SAVR and TAVR
are frequent and may be associated with an unfavorable prognosis. Methods
In the randomized controlled PARTNER (Placement of Aortic Transcatheter
Valve) I trial, 657 patients from cohort A (operable high risk) were
randomly assigned to SAVR or TAVR (transfemoral [TF] if iliofemoral access
was suitable or transapical [TA] if not) and received the designated
treatment. First-generation Edwards SAPIEN valves and delivery systems
(Edwards Lifesciences, Irvine, California) were used for TAVR, through a
22- or 24-F sheath. The 30-day rates of major BC (modified Valve Academic
Research Consortium definitions), predictors of BC, and their association
with 1-year mortality were assessed. Results A total of 71 (22.7%), 27
(11.3%), and 9 (8.8%) patients had major BC within 30 days of the
procedure after SAVR, TF-TAVR, and TA-TAVR, respectively (p < 0.0001).
SAVR was associated with a significantly higher 30-day rate of transfusion
(17.9%) than either TF-TAVR (7.1%) or TA-TAVR (4.8%; p < 0.0001).
Independent predictors of major BC were the occurrence of major vascular
complications and use of intraprocedural hemodynamic support among TF-TAVR
patients, severe procedural complications requiring conversion to open
surgery among TA-TAVR patients, and the presence of low hemoglobin at
baseline among SAVR patients. Major BC was identified as the strongest
independent predictor of 1-year mortality among the full cohort. However,
risk-adjusted analyses demonstrated a significant interaction between BC
and treatment strategy with respect to mortality, suggesting that BC after
SAVR have a greater impact on prognosis than after TAVR. Conclusions Among
high-risk aortic stenosis patients enrolled in the PARTNER I randomized
trial, BC were more common after SAVR than after TAVR and were also
associated with a worse long-term prognosis. (THE PARTNER TRIAL: Placement
of AoRTic TraNscathetER Valve Trial; NCT00530894) 2014 by the American
College of Cardiology Foundation.
<14>
Accession Number
2014197224
Authors
Lindman B.R. Pibarot P. Arnold S.V. Suri R.M. McAndrew T.C. Maniar H.S.
Zajarias A. Kodali S. Kirtane A.J. Thourani V.H. Tuzcu E.M. Svensson L.G.
Waksman R. Smith C.R. Leon M.B.
Institution
(Lindman, Maniar, Zajarias) Cardiovascular Division, Washington University
School of Medicine, Campus Box 8086, 660 South Euclid Avenue, St. Louis,
MO 63110, United States
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Arnold) Saint Luke's Mid-America Heart Institute, Kansas City MO, United
States
(Suri) Mayo Clinic, Rochester MN, United States
(McAndrew, Kodali, Kirtane, Leon) Cardiovascular Research Foundation, New
York NY, United States
(Kodali, Kirtane, Smith, Leon) Columbia University Medical Center, New
York Presbyterian Hospital, New York NY, United States
(Thourani) Emory University School of Medicine, Atlanta GA, United States
(Tuzcu, Svensson) Cleveland Clinic Foundation, Cleveland OH, United States
(Waksman) MedStar Washington Hospital Center, Washington DC, United States
Title
Transcatheter versus surgical aortic valve replacement in patients with
diabetes and severe aortic stenosis at high risk for surgery: An analysis
of the PARTNER trial (Placement of Aortic Transcatheter Valve).
Source
Journal of the American College of Cardiology. 63 (11) (pp 1090-1099),
2014. Date of Publication: 25 Mar 2014.
Publisher
Elsevier USA
Abstract
Objectives The goal of this study was to determine whether a less-invasive
approach to aortic valve replacement (AVR) improves clinical outcomes in
diabetic patients with aortic stenosis (AS). Background Diabetes is
associated with increased morbidity and mortality after surgical AVR for
AS. Methods Among treated patients with severe symptomatic AS at high risk
for surgery in the PARTNER (Placement of Aortic Transcatheter Valve)
trial, we examined outcomes stratified according to diabetes status of
patients randomly assigned to receive transcatheter or surgical AVR. The
primary outcome was all-cause mortality at 1 year. Results Among 657
patients enrolled in PARTNER who underwent treatment, there were 275
patients with diabetes (145 transcatheter, 130 surgical). There was a
significant interaction between diabetes and treatment group for 1-year
all-cause mortality (p = 0.048). Among diabetic patients, all-cause
mortality at 1 year was 18.0% in the transcatheter group and 27.4% in the
surgical group (hazard ratio: 0.60 [95% confidence interval: 0.36 to
0.99]; p = 0.04). Results were consistent among patients treated via
transfemoral or transapical routes. In contrast, among nondiabetic
patients, there was no significant difference in all-cause mortality at 1
year (p = 0.48). Among diabetic patients, the 1-year rates of stroke were
similar between treatment groups (3.5% transcatheter vs. 3.5% surgery; p =
0.88), but the rate of renal failure requiring dialysis >30 days was lower
in the transcatheter group (0% vs. 6.1%; p = 0.003). Conclusions Among
patients with diabetes and severe symptomatic AS at high risk for surgery,
this post-hoc stratified analysis of the PARTNER trial suggests there is a
survival benefit, no increase in stroke, and less renal failure from
treatment with transcatheter AVR compared with surgical AVR. (The PARTNER
Trial: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894) 2014
by the American College of Cardiology Foundation.
<15>
Accession Number
2014197285
Authors
Jang J.-S. Song Y.-J. Kang W. Jin H.-Y. Seo J.-S. Yang T.-H. Kim D.-K. Cho
K.-I. Kim B.-H. Park Y.H. Je H.-G. Kim D.-S.
Institution
(Jang, Song, Kang, Jin, Seo, Yang, Kim, Kim) Department of Cardiology,
Busan Paik Hospital, University of Inje College of Medicine, Busan, South
Korea
(Cho) Department of Cardiology, Kosin University Medical Center, Busan,
South Korea
(Kim) Department of Cardiology, Pusan National University Hospital, Busan,
South Korea
(Park, Je) Department of Cardiology and Cardiovascular Surgery, Pusan
National University Yangsan Hospital, Yangsan, South Korea
Title
Intravascular ultrasound-guided implantation of drug-eluting stents to
improve outcome: A meta-analysis.
Source
JACC: Cardiovascular Interventions. 7 (3) (pp 233-243), 2014. Date of
Publication: March 2014.
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to systematically review and perform
a meta-analysis of randomized trials and observational studies of
intravascular ultrasound (IVUS)-guided versus angiography-guided
implantation of drug-eluting stents (DES). Background: Although studies in
the bare-metal stents era suggested that there were clinical benefits to
IVUS guidance, it is still controversial whether percutaneous coronary
intervention (PCI) with DES guided by IVUS leads to better clinical
outcomes. Methods: Relevant studies published through March 31, 2013, were
searched for and identified in the electronic databases. Summary estimates
were obtained using a random-effects model. Results: From 138 initial
citations, 3 randomized trials and 12 observational studies with 24,849
patients (11,793 IVUS-guided and 13,056 angiography-guided) were included
in this study. Comparison of IVUS- versus angiography-guided PCI disclosed
odds ratios (ORs) for major adverse cardiac events of 0.79 (95% confidence
interval [CI]: 0.69 to 0.91; p = 0.001). IVUS-guided PCI was also
associated with significantly lower rates of all-cause mortality (OR:
0.64; 95% CI: 0.51 to 0.81; p < 0.001), myocardial infarction (OR: 0.57;
95% CI: 0.42 to 0.78; p < 0.001), target vessel revascularization (OR:
0.81; 95% CI: 0.68 to 0.95; p = 0.01), and stent thrombosis (OR: 0.59; 95%
CI: 0.42 to 0.82; p = 0.002). A meta-analysis of propensity-matched
studies demonstrated similar results in terms of clinical outcomes, but
not repeat revascularization. Conclusions: IVUS-guided DES implantation is
associated with significantly lower rates of adverse clinical events
compared with angiography guidance. Further study is needed to clarify
which subgroups of subjects with IVUS guidance will have greater benefit.
2014 by the American College of Cardiology Foundation.
<16>
Accession Number
2014196131
Authors
Puskas J. Gerdisch M. Nichols D. Quinn R. Anderson C. Rhenman B. Fermin L.
McGrath M. Kong B. Hughes C. Sethi G. Wait M. Martin T. Graeve A.
Institution
(Puskas) Department of Cardiothoracic Surgery, Emory University Hospital
Midtown, Medical Office Tower, 550 Peachtree St, NE, 6th Fl, Atlanta, GA
30308, United States
(Gerdisch) Department of Cardiothoracic Surgery, Franciscan St Francis
Health, Indianapolis, IN, United States
(Nichols, Anderson, Graeve) Department of Cardiothoracic Surgery,
Multicare Tacoma General, Tacoma, WA, United States
(Quinn) Department of Cardiothoracic Surgery, Maine Medical, Portland, MI,
United States
(Rhenman, Fermin) Department of Cardiothoracic Surgery, Southern Arizona
Veterans Affairs Hospital, Tucson, AZ, United States
(McGrath) Department of Cardiothoracic Surgery, Sentara Norfolk General
Hospital, Norfolk, VA, United States
(Kong) Department of Cardiothoracic Surgery, St Joseph Mercy Hospital,
Ypsilanti, MI, United States
(Hughes) Department of Cardiothoracic Surgery, Duke University, Durham,
NC, United States
(Sethi) Department of Cardiothoracic Surgery, University of Arizona,
Tucson, AZ, United States
(Wait) Department of Cardiothoracic Surgery, University of Texas, Dallas,
TX, United States
(Martin) Department of Cardiothoracic Surgery, University of Florida,
Gainesville, FL, United States
Title
Reduced anticoagulation after mechanical aortic valve replacement: Interim
results from the Prospective Randomized On-X Valve Anticoagulation
Clinical Trial randomized Food and Drug Administration investigational
device exemption trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (4) (pp 1202-1211.E2),
2014. Date of Publication: April 2014.
Publisher
Mosby Inc.
Abstract
Objective Under Food and Drug Administration investigational device
exemption, the Prospective Randomized On-X Anticoagulation Clinical Trial
(PROACT) has been testing the safety of less aggressive anticoagulation
than recommended by the American College of Cardiology/American Heart
Association guidelines after implantation of an approved bileaflet
mechanical valve. Methods In this first limb of the PROACT, patients with
elevated risk factors for thromboembolism were randomized at 33 US centers
to receive lower dose warfarin (test international normalized ratio [INR],
1.5-2.0) or continue standard warfarin (control INR, 2.0-3.0), 3 months
after mechanical aortic valve replacement. The INR was adjusted by home
monitoring; all patients received 81 mg aspirin daily. Adverse events were
independently adjudicated. Results A total of 375 aortic valve replacement
patients were randomized into control (n = 190) and test (n = 185) groups
from September 2006 to December 2009. The mean age + standard deviation
was 55.2 + 12.5 years; 79% were men; and 93% were in sinus rhythm
preoperatively. Calcific degeneration was present in 67%; active
endocarditis was excluded. Concomitant procedures included coronary artery
bypass grafting (27%), aortic aneurysm repair (14%), and other (25%). The
follow-up duration averaged 3.82 years (755.7 patient-years [pt-yrs] for
control; 675.2 pt-yrs for test). The mean INR was 2.50 + 0.63 for the
control and 1.89 + 0.49 for the test groups (P <.0001). The test group
experienced significantly lower major (1.48% vs 3.26%/pt-yr; P =.047) and
minor (1.32% vs 3.41%/pt-yr; P =.021) bleeding rates. The incidence of
stroke, transient ischemic attack, total neurologic events, and all-cause
mortality were similar between the 2 groups. Conclusions INR can be safely
maintained between 1.5 and 2.0 after aortic valve replacement with this
approved bileaflet mechanical prosthesis. With low-dose aspirin, this
resulted in a significantly lower risk of bleeding, without a significant
increase in thromboembolism.
<17>
Accession Number
2014193901
Authors
Vonk A.B.A. Veerhoek D. Van Den Brom C.E. Van Barneveld L.J.M. Boer C.
Institution
(Vonk, Veerhoek, Van Barneveld) Department of Cardio-thoracic Surgery,
Institute for Cardio-vascular Research, VU University Medical Center,
Amsterdam, Netherlands
(Van Den Brom, Boer) Department of Anesthesiology, VU University Medical
Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
Title
Individualized heparin and protamine management improves rotational
thromboelastometric parameters and postoperative hemostasis in valve
surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 235-241),
2014. Date of Publication: April 2014.
Publisher
W.B. Saunders
Abstract
Objectives This study investigated whether a tailored approach to heparin
and protamine management improved thromboelastometric parameters after
cardiopulmonary bypass and reduced postoperative blood loss compared with
activated coagulation time (ACT)-based fixed target heparin and protamine
management. Design Randomized controlled study. Setting Tertiary
university hospital. Participants Patients undergoing elective valve
surgery (n = 38). Interventions Heparin and protamine management were
based either on the ACT (n = 19) or hemostasis management system (HMS)
measurements (n = 19; HMS Plus; Medtronic, Minneapolis, MN). Measurements
and Main Results The target ACT for initiation of cardiopulmonary bypass
was 480 seconds. Study variables included rotational thromboelastometry
EXTEM (extrinsic coagulation), HEPTEM (intrinsic coagulation with
heparinase), and FIBTEM (fibrin part of clot formation) tests and 24-hour
blood loss. The use of HMS reduced the median protamine-to-heparin ratio
from 1.00 (1.00-1.00) to 0.62 (0.56-0.66; p<0.001). The ACT group showed a
prolonged postbypass clotting time for both EXTEM (86+13 seconds v 78+10
seconds; p = 0.05) and HEPTEM (217+58 seconds v 183+24 seconds; p = 0.03)
tests. There was a moderate correlation between protamine dosing with the
EXTEM and HEPTEM clotting time (r = 0.42; p = 0.009 and r = 0.38; p =
0.02, respectively). The number of patients with more than 450 mL/24 hours
was higher in the ACT than in the HMS group (42% v 12%; p = 0.04).
Conclusions Individualized heparin and protamine management decreased the
protamine-to-heparin ratio, improved postbypass thromboelastometric
hemostatic parameters, and reduced the incidence of severe blood loss
compared with an ACT-based strategy, supporting the added value of this
approach for hemostatic optimization during cardiac surgery. 2014
Elsevier Inc.
<18>
Accession Number
2014196086
Authors
Chen T. Jiang N. Wang L. Guo Z. Han J. Jing S. Liu J.
Institution
(Chen) Chest Clinical Research Center, Tianjin Medical University,
Tianjin, China
(Jiang, Wang, Guo, Han, Jing, Liu) Division of Cardiac Surgery, Tianjin
Chest Hospital, 93 Xi'an Road, Heping District, Tianjin 300000, China
Title
The significance of natriuretic peptide in treatment of pulmonary
hypertension after mitral valve replacement.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (4) (pp 1362-1367),
2014. Date of Publication: April 2014.
Publisher
Mosby Inc.
Abstract
Objectives To compare the therapeutic efficacy of recombinant human brain
natriuretic peptide and prostaglandin E1 in the treatment of pulmonary
hypertension after mitral valve replacement. Methods Sixty patients with
postoperative pulmonary hypertension were divided randomly into 3 groups
that received saline, prostaglandin E1, and natriuretic peptide infusions
for 12 hours each. The hemodynamics data were monitored consecutively, and
the levels of thromboxane A2 and cyclic guanosine monophosphate were
detected pretreatment, after treatment, and 1 week after surgery. Results
The arterial pressure, pulmonary arterial pressure, and pulmonary
capillary wedge pressure decreased 1 hour after prostaglandin E1 treatment
and rebounded after treatment discontinuation. The pulmonary arterial
pressure and pulmonary capillary wedge pressure in the natriuretic peptide
group decreased 3 hours after treatment; pulmonary arterial pressure
decreased less than that of the prostaglandin group, and there was no
evidence of hemodynamic rebound after treatment discontinuation. The
natriuretic peptide had no significant effects on arterial pressure. In
both the prostaglandin and natriuretic peptide groups, cyclic guanosine
monophosphate increased after the treatment, which was even higher in the
latter group. Prostaglandin E1 could lead to the decrease of thromboxane
A2, which was not seen in the natriuretic peptide group. Conclusions Both
brain natriuretic peptide and prostaglandin E1 can effectively reduce
pulmonary hypertension; however, natriuretic peptide has a slower and
milder efficacy. The effects of these 2 drugs in reducing the pulmonary
arterial pressure may be mediated through different pathways.
<19>
Accession Number
2014193892
Authors
Lenkin A.I. Zaharov V.I. Lenkin P.I. Smetkin A.A. Bjertnaes L.J. Kirov
M.Y.
Institution
(Lenkin) City Hospital 1 of Arkhangelsk, Department of Anesthesiology and
Intensive Care Medicine, Suvorov Street 1, Arkhangelsk, 163001, Russian
Federation
(Zaharov, Lenkin, Smetkin, Kirov) Department of Anesthesiology and
Intensive Care Medicine, Northern State Medical University, Arkhangelsk,
Russian Federation
(Bjertnaes, Kirov) Department of Clinical Medicine (Anesthesiology),
Faculty of Health Sciences, University of Tromsoe, Tromsoe, Norway
Title
Monitoring of anesthetic depth during surgical correction of acquired
valvular disorders: Single center, randomized trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 301-307),
2014. Date of Publication: April 2014.
Publisher
W.B. Saunders
Abstract
Objective The authors' primary objective was to test the hypothesis that
Cerebral State Index (CSI)-guided control of anesthetic depth might reduce
the consumption of anesthetics and shorten the duration of ICU and
hospital stays after surgical correction of combined valve disorders.
Design Single center, randomized trial. Setting City Hospital Number 1 of
Arkhangelsk, Russian Federation. Participants Fifty adult patients with
combined valve disorders requiring surgical correction. Interventions The
patients were randomized into 2 groups. In the CSI group, anesthetic depth
was monitored, and the rate of infusion of propofol was titrated to
maintain the depth of anesthesia corresponding to a CSI of 40-60. In the
control group, the depth of anesthesia was monitored clinically, and the
dosage of propofol was administered according to the recommendations of
the manufacturer. Measurements and Main Results All patients received
standard perioperative monitoring. Consumption of anesthetics and length
of ICU and hospital stays were recorded. Preoperative patient
characteristics did not differ significantly between the groups. In the
CSI group, average intraoperative doses of midazolam and propofol were
reduced by 41% and 19%, respectively (p<0.01). Maintenance of anesthesia
guided by CSI shortened the time until fit for ICU discharge by 50% and
reduced the lengths of ICU and postoperative hospital stays by 35% and
25%, respectively (p< 0.05). Conclusions Monitoring of anesthetic depth
reduces the requirements for midazolam and propofol, resulting in a faster
recovery and a shorter postoperative ICU and hospital stay after surgical
correction of combined valve disorders. 2014 Elsevier Inc.
<20>
Accession Number
2014193880
Authors
Guay J. Ochroch E.A.
Institution
(Guay) Department of Anesthesiology, University of Montreal, Montreal, QC,
Canada
(Ochroch) Department of Anesthesiology, University of Pennsylvania Health
System, Philadelphia, PA, United States
Title
Effects of adding statins before surgery on mortality and major morbidity:
A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 255-266),
2014. Date of Publication: April 2014.
Publisher
W.B. Saunders
Abstract
Objective To re-evaluate the effects of adding a statin before surgery on
mortality at 30 days and at 1 year and on major morbidity at 0-30 days.
Design A meta-analysis of parallel, randomized, controlled trials
published in English. Setting A university-based electronic search.
Participants Adult patients undergoing any type of procedure. Intervention
Adding a statin before a procedure compared to a placebo or no
intervention. Measurements and Main Results A search for all randomized
controlled trials (RCT) was done in PubMed, Embase, Ovid MEDLINE and the
Cochrane Central Register of Controlled Trials in November 2012. The
quality of each study was assessed with the Cochrane Collaboration Tools.
An I-square >25% was chosen as the cut-off point for heterogeneity
exploration. The search produced 29 trials. Statins reduced the 0-30 days'
risk of myocardial infarction: risk ratio (RR) 0.48 (95%CI 0.38, 0.61);
I-square 13.2%; p<0.001; number needed-to-treat 17 (14, 24). There were no
statistical differences at 0-30 days for stroke RR 0.70 (0.25, 1.95),
acute renal insufficiency RR 0.54 (0.26, 1.12) or reoperation RR 1.10
(0.51, 2.38). There was a trend for a reduced mortality at 1 year RR 0.26
(0.06, 1.02); I-square 0%; p = 0.053. The hospital length of stay was
slightly decreased with atorvastatin: standardized mean difference (SMD)
-0.27 (-0.39, -0.14), p<0.001; fluvastatin SMD -0.95 (-1.56, -0.34), p =
0.002; and rosuvastatin SMD -0.69 (-0.98, -0.40), p<0.001 but not with
simvastatin SMD -0.04 (-0.41, 0.48). Conclusions Adding a statin before a
high risk cardiac procedure reduces the 0-30 days' risk of myocardial
infarction. 2014 Elsevier Inc.
<21>
Accession Number
2014193881
Authors
Lomivorotov V.V. Shmirev V.A. Efremov S.M. Ponomarev D.N. Moroz G.B.
Shahin D.G. Kornilov I.A. Shilova A.N. Lomivorotov V.N. Karaskov A.M.
Institution
(Lomivorotov, Shmirev, Efremov, Ponomarev, Moroz, Shahin, Kornilov,
Shilova, Lomivorotov, Karaskov) Research Institute of Circulation
Pathology, Department of Anesthesiology and Intensive Care, Novosibirsk,
Russian Federation
Title
Hypothermic versus normothermic cardiopulmonary bypass in patients with
valvular heart disease.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 295-300),
2014. Date of Publication: April 2014.
Publisher
W.B. Saunders
Abstract
Objective The aim of this study was to test the hypothesis that
normothermic cardiopulmonary bypass (CPB) is as effective as hypothermic
CPB in terms of cardiac protection (cTnI level) and outcome in patients
with valvular heart disease. Design Prospective randomized study. Setting
A tertiary cardiothoracic referral center. Participants 140 patients who
had valvular heart disease, with/without coronary artery disease,
surgically treated under CPB. Interventions The patients were allocated
randomly to undergo either hypothermic (temperature [T], 31 C-32 C) or
normothermic CPB (T>36 C). Measurements and Main Results The primary
endpoint was the dynamics of troponin I. The secondary endpoints were
ventilation time, the need for inotropic support, intensive care unit
(ICU) and hospital stay durations, complications, and mortality. There
were no significant intergroup differences in dynamics of troponin I.
Ventilation time was significantly lower in the hypothermic group (6 (5-9)
and 8 (5-12); p = 0.01). Conclusions Normothermic CPB in patients with
valvular heart disease was as effective as hypothermic perfusion in terms
of myocardial protection after the surgery assessed by cTnI release. The
short ventilation duration in patients who underwent hypothermic CPB needs
to be confirmed in a future investigation. 2014 Elsevier Inc.
<22>
Accession Number
2014186545
Authors
Jellema L.-J.C. Backus B.E. Six A.J. Braam R. Groenemeijer B. Van Der
Zaag-Loonen H.J. Tio R. Van Suijlen J.D.E.
Institution
(Jellema, Backus, Six, Braam, Groenemeijer, Van Der Zaag-Loonen, Tio, Van
Suijlen) Gelre Ziekenhuizen Apeldoorn, Albert Schweitzerlaan 31, 7334 DZ
Apeldoorn, Netherlands
Title
The value of clinical and laboratory diagnostics for chest pain patients
at the emergency department.
Source
Clinical Chemistry and Laboratory Medicine. 52 (2) (pp 259-266), 2014.
Date of Publication: February 2014.
Publisher
Walter de Gruyter and Co.
Abstract
Background: The focus during the diagnostic process for patients with
acute chest pain is to discriminate patients who can be safely discharged
from those who are at risk for an acute coronary syndrome (ACS). In this
study the diagnostic value of the clinical examination is compared with
laboratory testing of troponin., Methods: This study included 710 chest
pain patients who presented at the ED of two hospitals in the Netherlands.
Clinical examination and laboratory testing were combined in the recently
developed HEART-score. The diagnostic values of clinical presentation,
troponin and the HEART-score for a major adverse coronary event (MACE) and
an ACS within 6 weeks were assessed. Furthermore, the improvement of HEART
with the second troponin measurement after 6 h was assessed using the net
reclassification improvement (NRI)., Results: The use of HEART (AUCMACE:
0.77; AUCACS: 0.82) obtains a higher diagnostic value than troponin
(AUCMACE: 0.72; AUCACS: 0.74) or clinical evaluation (AUCMACE: 0.69;
AUCACS: 0.74). Statistical significant different AUCs were obtained when
HEART is compared to troponin or clinical evaluation (p < 0.01). The use
of the second troponin test (after 6 h of admission) within HEART resulted
in an improvement of 8.0%., Conclusions: The HEART-score combines clinical
evaluation and results from laboratory testing, which should be used
together, to discriminate patients at risk of a cardiac event from
patients who can be safely discharged. In addition, it is shown that a
second troponin measurement slightly improves the discriminative ability
of the HEART-score.
<23>
Accession Number
2014197290
Authors
Abdel-Wahab M. Comberg T. Buttner H.J. El-Mawardy M. Chatani K. Gick M.
Geist V. Richardt G. Neumann F.-J.
Institution
(Abdel-Wahab, El-Mawardy, Chatani, Geist, Richardt) Cardiology Department,
Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Comberg, Buttner, Gick, Neumann) Cardiology Department, University Heart
Center Bad Krozingen, Bad Krozingen, Germany
Title
Aortic regurgitation after transcatheter aortic valve implantation with
balloon- and self-expandable prostheses: A pooled analysis from a 2-center
experience.
Source
JACC: Cardiovascular Interventions. 7 (3) (pp 284-292), 2014. Date of
Publication: March 2014.
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to assess aortic regurgitation (AR) after
transcatheter aortic valve implantation (TAVI) with the self-expandable
Medtronic CoreValve (MCV) (Medtronic Inc., Minneapolis, Minnesota) versus
balloon-expandable Edwards Sapien XT valve (ESV) (Edwards Lifesciences,
Irvine, California). Background: AR after TAVI has been associated with
poor survival, but limited data exist comparing MCV with ESV. Methods: We
pooled the prospective TAVI databases of 2 German centers. The primary
endpoint was more-than-mild post-TAVI AR assessed by echocardiography. We
also assessed device success and survival within 1 year. Endpoints were
adjudicated according to the Valve Academic Research Consortium criteria
and analyzed by unadjusted and propensity-score-adjusted models. Results:
A total of 394 patients were included, 276 treated with MCV and 118 with
ESV. More-than-mild AR was significantly higher with MCV than with ESV
(12.7% vs. 2.6%, p = 0.002). This difference remained significant after
propensity adjustment (adjusted odds ratio [OR]: 4.59, 95% confidence
interval [CI]: 1.03 to 20.44). The occurrence of any degree of AR was also
higher with MCV (71.6% vs. 56.9%, p = 0.004). Device success was mainly
influenced by the occurrence of AR and was consequently higher with ESV
(95.8% vs. 86.6%, p = 0.007), but this was not significant after
propensity adjustment (adjusted OR: 0.34, 95% CI: 0.11 to 1.03, p = 0.06).
At 1 year, survival was comparable between both valve types (83.8% MCV vs.
88.2% ESV, p = 0.42), but was significantly worse in patients with
more-than-mild AR (69.8% vs. 87.4%, p = 0.004) and in those with device
failure (65.6% vs. 87.4%, p < 0.001). Conclusions: More-than-mild AR after
TAVI was more frequent with MCV than with ESV. This finding deserves
consideration, as more-than-mild AR was associated with higher mortality
at 1 year. 2014 by the American College of Cardiology Foundation.
<24>
Accession Number
2014187821
Authors
Cuff D.J. Pupello D.R.
Institution
(Cuff, Pupello) Suncoast Orthopaedic Surgery and Sports Medicine,
Foundation for Orthopaedic Research and Education, Tampa, FL, United
States
(Cuff) Suncoast Orthopaedic Surgery and Sports Medicine, 836 Sunset Lake
Boulevard, Venice, FL 34292, United States
(Pupello) Foundation for Orthopaedic Research and Education, 13020 North
Telecom Parkway, Tampa, FL 33637, United States
Title
Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the
treatment of proximal humeral fractures in elderly patients.
Source
Journal of Bone and Joint Surgery - Series A. 95 (22) (pp 2050-2055),
2013. Date of Publication: 20 Nov 2013.
Publisher
Journal of Bone and Joint Surgery Inc.
Abstract
Background: Treatment of complex three and four-part proximal humeral
fractures with hemiarthroplasty in elderly patients has yielded mixed
clinical results. Reverse shoulder arthroplasty has emerged as a treatment
option for comminuted proximal humeral fractures for these patients. The
purpose of the study was to perform a prospective evaluation of patient
outcomes comparing hemiarthroplasty and reverse shoulder arthroplasty for
the treatment of comminuted proximal humeral fractures in elderly
patients. Methods: Fifty-three consecutive elderly patients (average age,
74.4 years) underwent an arthroplasty for a complex proximal humeral
fracture. Indications for arthroplasty were four-part fractures,
three-part fractures with severe comminution of the greater tuberosity,
and fractures that involved an articular split of the humeral head.
Twenty-six patients underwent hemiarthroplasty (the HA group), followed by
twenty-seven patients who underwent reverse shoulder arthroplasty (the RSA
group). A total of forty-seven patients (twenty-three in the HA group and
twenty-four in the RSA group) were available for follow-up at a minimum of
two years. Results: Final average outcome scores were lower in the HA
group than in the RSA group (American Shoulder and Elbow Surgeons [ASES]
score of 62 versus 77 [p = 0.0001] and Simple Shoulder Test [SST] of 5.8
versus 7.4 [p = 0.0062]), and patient-reported satisfaction was lower in
the HA group than in the RSA group (61% versus 91%; p = 0.038).
Radiographic healing of the tuberosities occurred in 61% of the patients
in the HA group compared with 83% of the patients in the RSA group (p =
0.17). Forward elevation of the arm was higher in the RSA group
(139degree) than in the HA group (100degree) (p = 0.0002), but no
significant differences were observed for shoulder external rotation or
internal rotation. Complication rates in both groups were similar. Three
patients (13%) in the HA group elected revision to reverse shoulder
arthroplasty because of failed tuberosity healing and resultant shoulder
pseudoparesis. Conclusions: In this series, reverse shoulder arthroplasty
resulted in better clinical outcomes and a similar complication rate
compared with hemiarthroplasty for the treatment of comminuted proximal
humeral fractures in the elderly. Level of Evidence: Therapeutic Level II.
See Instructions for Authors for a complete description of levels of
evidence.
