Results Generated From:
Embase <1980 to 2015 Week 37>
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Embase <1980 to 2015 Week 37>
Embase (updates since 2015-09-03)
<1>
Accession Number
2014968024
Authors
Iannaccone A. Marwick T.H.
Institution
(Iannaccone, Marwick) Menzies Research Institute Tasmania, 17 Liverpool
St, Hobart, TAS 7000, Australia
Title
Cost Effectiveness of Transcatheter Aortic Valve Replacement Compared with
Medical Management or Surgery for Patients with Aortic Stenosis.
Source
Applied Health Economics and Health Policy. 13 (1) (pp 29-45), 2015. Date
of Publication: 2015.
Publisher
Springer International Publishing
Abstract
Background: In the symptomatic patient, severe aortic stenosis (AS) has an
extremely adverse prognosis in the absence of valve replacement,
inevitably leading to deterioration of heart function, heart failure, and
death. However, many patients with severe AS, advanced age, and comorbid
disease may die with AS rather than from AS. While the results of surgical
aortic valve replacement (SAVR) are extremely favorable, this technique is
not always possible because of either local- or patient-level
contraindications. Over the last decade, transcatheter aortic valve
replacement (TAVR) has emerged as a new treatment strategy for selected
patients with AS. It has now become the standard of care for extremely
high-risk (inoperable) patients with AS, and is an appropriate alternative
to surgery in high-risk but operable patients. However, whether this
intervention is a cost-effective use of resources is open to question.
Aim: The aim of this review was to assess the results and quality of the
economic evaluations in the current literature and to identify the drivers
of cost effectiveness.
Methods: We performed an electronic data search using four different
electronic databases, selecting all studies that included
cost-effectiveness data for TAVR compared with either medical management
or surgery. Sixteen studies were evaluated for a qualitative and
quantitative assessment.
Results: The quality of the cost-effectiveness analyses (CEAs) were
generally sufficient. In contrast, we found an extreme heterogeneity of
input assumptions with consequent difficulties to generalize the
conclusions. However, in the population of patients with severe
symptomatic AS and a prohibitive surgical risk, TAVR generally represents
a good choice, with incremental costs that are well balanced by the great
benefit in terms of quality of life and survival. Nevertheless, the cost
effectiveness of this procedure in the real world, particularly in
patients with high healthcare costs from other comorbid conditions, may be
less favorable. In AS patients with high (but not prohibitive) surgical
risk, the choice between TAVR and SAVR is still debatable. Both procedures
are comparable in terms of efficacy and safety but the evidence is
inconclusive from an economic point of view.
Conclusions: On the basis of this review, it was ascertained that the
details of risk evaluation and patient selection will be critical in
understanding how improvements in survival can be used to target the use
of TAVR to ensure the cost-effective and sustainable use of resources.
<2>
Accession Number
2014935565
Authors
Alexander S. Doukky R.
Institution
(Alexander, Doukky) Division of Cardiology, Rush University Medical
Center, Chicago, IL, United States
(Doukky) Division of Cardiology, John H. Stroger, Jr. Hospital of Cook
County, 1901 W. Harrison St., Chicago, IL 60612, United States
Title
Effective Risk Stratification of Patients on the Basis of Myocardial
Perfusion SPECT Is Dependent on Appropriate Patient Selection.
Source
Current Cardiology Reports. 17 (1) , 2015. Date of Publication: 2015.
Publisher
Current Medicine Group LLC 1
Abstract
Myocardial perfusion imaging (MPI) with single-photon emission computed
tomography (SPECT) is commonly used in risk assessment, as an abnormal
scan predicts a multifold increase in cardiac risk. Recent studies have
showed that application of the appropriate use criteria (AUC) sharpens the
prognostic value of SPECT-MPI, while inappropriate use is clinically
ineffective and may lead to unnecessary downstream invasive testing and
revascularization procedures. In this review, we will discuss recent
literature examining the impact of appropriate use on the prognostic value
of SPECT-MPI and downstream decision-making. We will also discuss the
implications of appropriate use on cost-effectiveness of MPI.
<3>
Accession Number
2015343052
Authors
Han Y. Zhen D. Liu Z. Xu S. Liu S. Qin M. Zhou S. Yu D. Song X. Li Y. Xiao
N. Su C. Shi K.
Institution
(Han, Zhen, Liu, Xu, Liu, Qin, Zhou, Yu, Song, Li, Xiao, Su, Shi)
Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical
University, Beijing Tuberculosis and Thoracic Tumor Research Institute,
Machang 97, Tongzhou District, Beijing 101149, China
Title
Surgical treatment for pulmonary tuberculosis: Is video-assisted thoracic
surgery "better" than thoracotomy?.
Source
Journal of Thoracic Disease. 7 (8) (pp 1452-1458), 2015. Date of
Publication: 2015.
Publisher
Pioneer Bioscience Publishing
Abstract
Objective: To compare video-assisted thoracoscopic surgery (VATS)
lobectomy and conventional open lobectomy in patients with pulmonary
tuberculosis (TB) who require surgery. Methods: Forty patients with
pulmonary TB who required lobectomy were randomized to receive either VATS
or open lobectomy. Patient demographic, pulmonary function, operative, and
postoperative data were compared between the groups. Results: There were
20 patients who received VATS lobectomy (median age 31.5 years, range
19-67 years) and 20 that received open lobectomy (median age 33.5 years,
range 16-60 years). The two groups were similar with respect to gender,
age and pulmonary function (all, P > 0.05). Lobectomy was completed by
VATS in 19 of 20 patients (95%), and by thoracoscope-assisted
mini-incision lobectomy in 1 patient. The median intraoperative blood loss
was 345 mL (range, 100-800 mL), and the median duration of pleural cavity
closed drainage was 5 days (range, 3-7 days). All open lobectomies were
completed successfully, and the median intraoperative blood loss was 445
mL (range, 150-950 mL) and the median duration of pleural cavity closed
drainage was 5 days (range, 3-9 days). No statistically significant
differences were found between the groups with respect to operation
completion rates, type of lung resection, intraoperative blood loss,
closed pleural drainage duration and volume of postoperative chest
drainage. The operation time, number of postoperative complications,
postoperative pain index at 24 hours after surgery and postoperative
hospital stay were all significantly less in the VATS group. With a median
follow-up duration of 14 months (range, 8-18 months) no positive sputum
examination results were found in either group. Conclusions: VATS
lobectomy is an effective and minimally invasive method for treating
patients with pulmonary TB.
<4>
Accession Number
2015346885
Authors
Li L. Ai Q. Lin L. Ge P. Yang C. Zhang L.
Institution
(Li, Lin, Ge, Zhang) Departments of Pathophysiology, Chongqing Medical
University, Chongqing, China
(Ai) Departments of Physiology, Chongqing Medical University, Chongqing,
China
(Yang) Department of Anesthesiology, The First People's Hospital of
Jingmen, Jingmen, Hubei Province, China
Title
Efficacy and safety of landiolol for prevention of atrial fibrillation
after cardiac surgery: A meta-analysis of randomized controlled trials.
Source
International Journal of Clinical and Experimental Medicine. 8 (7) (pp
10265-10273), 2015. Date of Publication: 30 Jul 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Atrial fibrillation (AF) is a quite common complication during the
postoperative period after cardiac surgery. Increasing studies have
reported that landiolol may be effective in prevention of AF after cardiac
surgery. Its efficacy and safety are seldom explored, hence we conducted a
meta-analysis of randomized controlled trials (RCTs) to evaluate the
efficacy and safety of landiolol in prevention of AF after cardiac
surgery. Databases of PubMed, Embase and Cochrane Central Register of
Controlled Trials were searched from inception through to December 2014
for RCTs that explored the efficacy and safety of landiolol on the
prevention of AF after cardiac surgery. Pooled results were expressed as
risk ratios (RRs) with 95% confidence intervals (CIs). Nine eligible RCTs
involving 807 patients were included in this meta-analysis. Compared with
the control group, landiolol was associated with a significant reduction
of AF after cardiac surgery (RR=0.41, 95% CI 0.32-0.52, P<0.001), and the
administration of landiolol seems more effective in patients who underwent
coronary artery bypass grafting (CABG) (RR=0.36, 95% CI 0.25-0.52,
P<0.001). Compared with placebo, no difference was detected in the
incidence of major complications (RR=0.77, 95% CI 0.34-1.72, P=0.52).
Landiolol is effective in prevention of AF after cardiac surgery and
without increasing the risk of major complications.
<5>
Accession Number
2015929990
Authors
Nam M.J. Lim C.H. Kim H.-J. Kim Y.H. Choi H. Son H.S. Lim H.J. Sun K.
Institution
(Nam) School of Medicine, Korea University, Seoul, South Korea
(Lim, Kim, Lim) Anesthesiology and Pain Medicine, College of Medicine,
Korea University, Seoul, South Korea
(Kim) Department of Preventive Medicine, College of Medicine, Korea
University, Seoul, South Korea
(Choi) Department of Medical Science, Graduate School of Medicine, Korea
University, Seoul, South Korea
(Son, Sun) Thoracic and Cardiovascular Surgery, Korea University, Seoul,
South Korea
Title
A Meta-Analysis of Renal Function After Adult Cardiac Surgery With
Pulsatile Perfusion.
Source
Artificial Organs. 39 (9) (pp 788-794), 2015. Date of Publication: 01 Sep
2015.
Publisher
Blackwell Publishing Inc.
Abstract
The aim of this meta-analysis was to determine whether pulsatile perfusion
during cardiac surgery has a lesser effect on renal dysfunction than
nonpulsatile perfusion after cardiac surgery in randomized controlled
trials. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled
Trials were used to identify available articles published before April 25,
2014. Meta-analysis was conducted to determine the effects of pulsatile
perfusion on postoperative renal functions, as determined by creatinine
clearance (CrCl), serum creatinine (Cr), urinary neutrophil
gelatinase-associated lipocalin (NGAL), and the incidences of acute renal
insufficiency (ARI) and acute renal failure (ARF). Nine studies involving
674 patients that received pulsatile perfusion and 698 patients that
received nonpulsatile perfusion during cardiopulmonary bypass (CPB) were
considered in the meta-analysis. Stratified analysis was performed
according to effective pulsatility or unclear pulsatility of the pulsatile
perfusion method in the presence of heterogeneity. NGAL levels were not
significantly different between the pulsatile and nonpulsatile groups.
However, patients in the pulsatile group had a significantly higher CrCl
and lower Cr levels when the analysis was restricted to studies on
effective pulsatile flow (P<0.00001, respectively). The incidence of ARI
was significantly lower in the pulsatile group (P<0.00001), but incidences
of ARF were similar. In conclusion, the meta-analysis suggests that the
use of pulsatile flow during CPB results in better postoperative renal
function.
<6>
Accession Number
2015341420
Authors
Meurin P. Lelay-Kubas S. Pierre B. Pereira H. Pavy B. Iliou M.C. Bussiere
J.L. Weber H. Beugin J.P. Farrokhi T. Bellemain-Appaix A. Briota L. Tabet
J.-Y.
Institution
(Meurin) Les Grands Pres, 27 rue Sainte Christine, Villeneuve Saint Denis
77174, France
Title
Colchicine for Post-Operative Pericardial Effusion Preliminary Results of
the POPE-2 Study.
Source
Journal of the American College of Cardiology. 66 (10) (pp 1198-1199),
2015. Date of Publication: 08 Sep 2015.
Publisher
Elsevier USA
<7>
Accession Number
2015229729
Authors
Arabkhani B. Mookhoek A. Di Centa I. Lansac E. Bekkers J.A. De Lind Van
Wijngaarden R. Bogers A.J.J.C. Takkenberg J.J.M.
Institution
(Arabkhani, Mookhoek, Bekkers, De Lind Van Wijngaarden, Bogers,
Takkenberg) Erasmus University Medical Center, Rotterdam, Netherlands
(Di Centa) Hopital Foch, Suresnes, France
(Lansac) Institut Mutualiste Montsouris, Paris, France
Title
Reported outcome after valve-sparing aortic root replacement for aortic
root aneurysm: A systematic review and meta-analysis.
Source
Annals of Thoracic Surgery. 100 (3) (pp 1126-1131), 2015. Date of
Publication: 01 Sep 2015.
Publisher
Elsevier USA
Abstract
Valve-sparing aortic root techniques have progressively gained ground in
the treatment of aortic root aneurysm and aortic insufficiency. By
avoiding anticoagulation therapy they offer a good alternative to
composite graft replacement. This systematic review describes the reported
outcome of valve-sparing aortic root replacement, focusing on the
remodeling and reimplantation technique. A systematic literature search on
the characteristics of and outcomes after valve-sparing aortic root
replacement revealed 1,659 articles. The inclusion criteria were a focus
on valve-sparing aortic root replacement in adults with aortic root
aneurysm, presentation of survival data, and inclusion of at least 30
patients. Data were pooled by inverse variance weighting and analyzed by
linear regression. Of 1,659 articles published between January 1, 2000,
and January 1, 2014, 31 were included (n = 4,777 patients). The mean age
at operation was 51 +/- 14.7 years, and 14% of patients had a bicuspid
aortic valve. The reimplantation technique was used in 72% and remodeling
in 27% (1% other). No clinical advantage in terms of survival and
reoperation of one technique over the other was found. Cusp repair was
performed in 33%. Pooled early mortality was 2% (n = 103). During
follow-up (21,716 patient-years), 262 patients died (survival 92%), and
228 (5%) underwent reoperation, mainly valve replacement. Major adverse
valve-related events were low (1.66% patient-years). Preoperative severe
aortic valve regurgitation showed a trend toward higher reoperation rate.
Remodeling and reimplantation techniques show comparable survival and
valve durability results, providing a valid alternative to composite valve
replacement. The heterogeneity in the data underlines the need for a
collaborative effort to standardize outcome reporting.
<8>
Accession Number
2015337109
Authors
Radulovic V. Laffin A. Hansson K.M. Backlund E. Baghaei F. Jeppsson A.
Institution
(Radulovic, Baghaei) Department of Medicine/Hematology and Coagulation
Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
(Laffin, Backlund, Jeppsson) Department of Cardiothoracic Surgery,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Hansson) AstraZeneca R AndD, Molndal, Sweden
(Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine, University of Gothenburg, Gothenburg, Sweden
Title
Heparin and protamine titration does not improve haemostasis after cardiac
surgery: A prospective randomized study.
Source
PLoS ONE. 10 (7) , 2015. Article Number: e0130271. Date of Publication: 02
Jul 2015.
Publisher
Public Library of Science
Abstract
Background: Bleeding complications are common in cardiac surgery.
Perioperative handling of heparin and protamine may influence the
haemostasis. We hypothesized that heparin and protamine dosing based on
individual titration curves would improve haemostasis in comparison to
standard dosing. Subjects and Methods: Sixty patients scheduled for first
time elective coronary artery bypass grafting or valve surgery were
included in a prospective randomized study. The patients were randomized
to heparin and protamine dosing with Hepcon HMS Plus device or to standard
weight and activated clotting time (ACT) based dosing. Blood samples were
collected before and 10 minutes, 2 hours and 4 hours after cardiopulmonary
bypass. Primary endpoint was endogenous thrombin potential in plasma 2
hours after surgery as assessed by calibrated automated thrombography.
Secondary endpoints included total heparin and protamine doses, whole
blood clot formation (thromboelastometry) and post-operative bleeding
volume and transfusions. Heparin effect was assessed by measuring anti-Xa
activity. Results: Endogenous thrombin potential and clot formation
deteriorated in both groups after surgery without statistically
significant intergroup difference. There were no significant differences
between the groups in total heparin and protamine doses, heparin effect,
or postoperative bleeding and transfusions at any time point. Significant
inverse correlations between anti- Xa activity and endogenous thrombin
potential were observed 10 min (r = -0.43, p = 0.001), 2 hours (r = -0.66,
p<0.001) and 4 hours after surgery (r = -0.58, p<0.001). Conclusion: In
conclusion, the results suggest that perioperative heparin and protamine
dosing based on individual titration curves does not improve haemostasis
after cardiac surgery. Postoperative thrombin generation capacity
correlates to residual heparin effect.
<9>
Accession Number
2015166668
Authors
Boreland L. Scott-Hudson M. Hetherington K. Frussinetty A. Slyer J.T.
Institution
(Boreland, Scott-Hudson, Hetherington, Frussinetty, Slyer) Pace
University, College of Health Professions, Lienhard School of Nursing, 163
William Street, 5th Floor, New York, NY 10038, United States
Title
The effectiveness of tight glycemic control on decreasing surgical site
infections and readmission rates in adult patients with diabetes
undergoing cardiac surgery: A systematic review.
Source
Heart and Lung: Journal of Acute and Critical Care. 44 (5) (pp 430-440),
2015. Date of Publication: 01 Sep 2015.
Publisher
Mosby Inc.
Abstract
Objective: A systematic review of the effects of tight glycemic control
with a continuous insulin infusion to achieve blood glucose levels < 200
mg/dL on surgical site infections and readmission rates in adult patients
with diabetes after cardiac surgery. Methods: A quantitative systematic
review of the literature. Databases, including PubMed, CINAHL, EMBASE, and
CENTRAL, were searched for relevant studies from database inception
through August 2014. Randomized and quasi-experimental studies were
included. Results: A meta-analysis of ten studies demonstrated that
glycemic control with a continuous insulin infusion to achieve blood
glucose levels < 200 mg/dL significantly reduced surgical site infection
rates (odds ratio 0.35, 95% confidence interval 0.25-0.49; Z = 6.0, P <
0.00001) compared with standard diabetes management. Conclusions:
Maintaining blood glucose levels < 200 mg/dL with a continuous insulin
infusion in all stages of the perioperative period in cardiac surgery
patients with diabetes can reduce the incidence of surgical site
infections.
<10>
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Accession Number
2015344655
Authors
Wrobel K. Stevens S.R. Jones R.H. Selzman C.H. Lamy A. Beaver T.M.
Djokovic L.T. Wang N. Velazquez E.J. Sopko G. Kron I.L. Dimaio J.M.
Michler R.E. Lee K.L. Yii M. Leng C.Y. Zembala M. Rouleau J.L. Daly R.C.
Al-Khalidi H.R.
Institution
(Wrobel) Allenort Hospital, Warsaw, Poland
(Wrobel) John Paul II Hospital, Krakow, Poland
(Stevens) Duke Clinical Research Institute, Durham, NC, United States
(Jones, Velazquez, Lee, Al-Khalidi) Duke University, School of Medicine,
Duke Clinical Research Institute, Durham, NC, United States
(Selzman) University of Utah, Salt Lake City, UT, United States
(Lamy) Hamilton General Hospital, McMaster University, Hamilton, ON,
Canada
(Beaver) Shands Hospital, University of Florida, Gainesville, FL, United
States
(Djokovic) Dedinje Cardiovascular Institute, Belgrade, Serbia
(Wang) Loma Linda University Medical Center, CA, United States
(Sopko) National Institutes of Health, National Heart, Blood, and Lung
Institute, Bethesda, MD, United States
(Kron) University of Virginia, Charlottesville, VA, United States
(Dimaio) Baylor University Medical Center, Dallas, TX, United States
(Michler) Montefiore Medical Center, Albert Einstein College of Medicine,
New York, NY, United States
(Yii) St. Vincent's Hospital Melbourne, University of Melbourne, Australia
(Leng) National Heart Centre Singapore, Singapore, Singapore
(Zembala) Silesian Center for Heart Diseases in Zabrze, Zabrze, Poland
(Rouleau) Montreal Heart Institute, University de Montreal, Canada
(Daly) Mayo Clinic, Rochester, MN, United States
Title
Influence of baseline characteristics, operative conduct, and
postoperative course on 30-day outcomes of coronary artery bypass grafting
among patients with left ventricular dysfunction: Results from the
Surgical Treatment for Ischemic Heart Failure (STICH) trial.
Source
Circulation. 132 (8) (pp 720-730), 2015. Date of Publication: 25 Aug 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Patients with severe left ventricular dysfunction, ischemic
heart failure, and coronary artery disease suitable for coronary artery
bypass grafting (CABG) are at higher risk for surgical morbidity and
mortality. Paradoxically, those patients with the most severe coronary
artery disease and ventricular dysfunction who derive the greatest
clinical benefit from CABG are also at the greatest operative risk, which
makes decision making regarding whether to proceed to surgery difficult in
such patients. To better inform such decision making, we analyzed the
Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for
detailed information on perioperative risk and outcomes. Methods and
Results - In both STICH trials (hypotheses), 2136 patients with a left
ventricular ejection fraction of <35% and coronary artery disease were
allocated to medical therapy, CABG plus medical therapy, or CABG with
surgical ventricular reconstruction. Relationships of baseline
characteristics and operative conduct with morbidity and mortality at 30
days were evaluated. There were a total of 1460 patients randomized to and
receiving surgery, and 346 (=25%) of these high-risk patients developed a
severe complication within 30 days. Worsening renal insufficiency, cardiac
arrest with cardiopulmonary resuscitation, and ventricular arrhythmias
were the most frequent complications and those most commonly associated
with death. Mortality at 30 days was 5.1% and was generally preceded by a
serious complication (65 of 74 deaths). Left ventricular size, renal
dysfunction, advanced age, and atrial fibrillation/flutter were
significant preoperative predictors of mortality within 30 days.
Cardiopulmonary bypass time was the only independent surgical variable
predictive of 30-day mortality. Conclusions - CABG can be performed with
relatively low 30-day mortality in patients with left ventricular
dysfunction. Serious postoperative complications occurred in nearly 1 in 4
patients and were associated with mortality.
<11>
Accession Number
2015344370
Authors
He L. Hu X. Tang Y. Li X. Zheng S. Ni J.
Institution
(He, Hu, Tang, Li, Zheng, Ni) Department of Pain Management, Xuanwu
Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng
Zone, Beijing, China
Title
Efficacy of coblation annuloplasty in discogenic low back pain.
Source
Medicine (United States). 94 (19) , 2015. Article Number: 846. Date of
Publication: 01 May 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
In degenerative disc, the innervated outer annulus is confirmed to the
major origin resulted in discogenic pain. To alleviate the discogenic
pain, annuloplasty with electrothermal technology was proved to be
effective, which mainly involves the thermal heating of the annulus to
denature collagen fibers and denervate posterior annular nerve fibers.
However, little is known that efficacy of annuloplasty with coblation
technology in treating discogenic pain through directly interrupting
nerves in outer annulus. The purpose of this study was to evaluate the
clinical outcomes of coblation annuloplasty for the treatment of
discogenic low back pain. In a clinical prospective observational study,
17 consecutive patients with discogenic low back pain underwent coblation
annuloplasty under local anesthesia. Pain visual analogue scale (VAS)
scores, patient responses stating significant (>50%) pain relief, and
modified MacNab criteria were adopted to evaluate the pain intensity,
degree of pain relief, and functional status after 6 months of follow-up.
The preoperative pain VAS score was 6.5+/-0.8(95% confidence interval [CI]
6.1-6.9) and the pain VAS score decreased to 2.9+/-1.6 (95% CI 2.1-3.8),
2.9+/-1.7 (95% CI 2.1-3.8), 3.2+/-1.6 (95% CI 2.4-4.1), 3.2+/-1.7 (95% CI
2.4-4.2) at 1 week and 1, 3 and 6 month postoperatively, respectively. 12
(70.6%), 11 (64.7%), 10 (58.8%) and 10 (58.8%) of patients reported
significant pain relief at 1 week and 1, 3 and 6 months postoperatively.
At 1, 3, and 6 months postoperatively, the numbers of patients with
"excellent" or "good" ratings were 13 (76.5%), 11 (64.7%), and 10 (58.8%)
according to the modified MacNab criteria. No serious complications were
observed. The finds show that coblation annuloplasty is an effective,
safe, and less uncomfortable procedure in managing discogenic low back
pain.
<12>
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Accession Number
2015344367
Authors
Su D. Yan B. Guo L. Peng L. Wang X. Zeng L. Ong H. Wang G.
Institution
(Su) Departments of Cardiology, Second Affiliated Hospital, Xi'an Jiaotong
University, Xi'an, China
(Yan, Peng, Wang) Departments of Emergency Medicine, Second Affiliated
Hospital, Xi'an Jiaotong University, Xi'an, China
(Guo, Wang) Intensive Care Unit, First Affiliated Hospital, Xi'an Jiaotong
University, Xi'an, China
(Zeng) Cardiovascular Division, King's College London, British Heart
Foundation Centre, London, United Kingdom
(Ong) Department of Cardiology, Khoo Teck Puat Hospital, Singapore,
Singapore
Title
Intra-aortic balloon pump may grant no benefit to improve the mortality of
patients with acute myocardial infarction in short and long term.
Source
Medicine (United States). 94 (19) , 2015. Article Number: 876. Date of
Publication: 01 May 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Intra-aortic balloon pump (IABP) has been extensively used in clinical
practice as a circulatory-assist device. However, current literature
demonstrated significantly varied indications for IABP application and
prognosis. The objective of the study was to assess the potential benefits
or risks of IABP treatment for acute myocardial infarction (AMI)
complicated with or without cardiogenic shock. MEDLINE and EMBASE database
were systematically searched until November 2014, using the terms as
follows: IABP, IABC (intra-aortic balloon counterpulsation), AMI, heart
infarction, coronary artery disease, ischemic heart disease, and acute
coronary syndrome. Only randomized controlled trials (RCTs) that compared
the use of IABP or non-IABP support in AMI with or without cardiogenic
shock were included. Two researchers performed data extraction
independently, and at the mean time, the risk of bias among those RCTs was
also assessed. Of 3026 citations, 17 studies (n=3226) met the inclusion
criteria. There is no significant difference between IABP group and
control group on the short-term mortality (relative risk [RR], 0.90; 95%
confidence interval [CI], 0.77-1.06; P=0.214) and long-term mortality (RR,
0.91; 95% CI, 0.79-1.04; P=0.155) in AMI patients with or without
cardiogenic shock. These results were consistent when the analysis was
performed on studies that only included patients with cardiogenic shock,
both on short-term mortality (RR, 0.91; 95% CI, 0.77-1.08; P=0.293) and
long-term mortality (RR, 0.95; 95% CI, 0.83-1.10; P=0.492). Similar result
was also observed in AMI patients without cardiogenic shock. Furthermore,
the risks of hemorrhage (RR, 1.49; 95% CI, 1.09-2.04; P=0.013) and
recurrent ischemia (RR 0.54, 95% CI 0.37 to 0.79; P=0.002) were
significantly higher in IABP group compared with control group. We did not
observe substantial benefit from IABP application in reducing the short-
and long-term mortality, while it might promote the risks of hemorrhage
and recurrent ischemia. Therefore, IABP may be not an optimal therapy in
AMI with or without cardiogenic shock until more elaborate classification
is used for selecting appropriate patients.
<13>
Accession Number
2015338820
Authors
Decelis D.A. Adami M.Z. Galea J. Attard-Pizzuto M. Inglott A.S. Azzopardi
L.M.
Institution
(Decelis, Adami, Attard-Pizzuto, Inglott, Azzopardi) Department of
Pharmacy, University of Malta, Msida, Malta
(Galea) Department of Surgery, University of Malta, Msida, Malta
Title
Pharmacist intervention in pain management following heart surgery.
Source
European Journal of Hospital Pharmacy: Science and Practice. 22 (5) (pp
306-308), 2015. Date of Publication: 01 Sep 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives Pain is a common symptom in cardiac surgery patients. This
study aimed to investigate the influence of pharmacist intervention to
ease postoperative pain in cardiac surgery patients. Methodology Patients
undergoing heart surgery were randomised to control or intervention. The
intervention group was given systematic verbal information and, at
discharge, a pharmaceutical care plan. Pain score and diary assessment
were compared up to 6 weeks after the surgery. Results 100 patients
participated. Mean Pain Score was lower in the intervention group from
week 1 to 6 (p<0.05). Compliance with analgesic was higher in the
intervention group. Conclusions The intervention improved compliance and
decreased pain score, illustrating the positive effect the pharmacist had
on these patients.
<14>
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Accession Number
2015339083
Authors
Perin E.C. Borow K.M. Silva G.V. DeMaria A.N. Marroquin O.C. Huang P.P.
Traverse J.H. Krum H. Skerrett D. Zheng Y. Willerson J.T. Itescu S. Henry
T.D.
Institution
(Perin, Silva, Zheng, Willerson) Stem Cell Center, Texas Heart Institute,
Houston, TX, United States
(Perin, Silva, Willerson) Adult Cardiology, Texas Heart Institute,
Houston, TX, United States
(Borow) Borow Consulting Group, LLC, Bryn Mawr, PA, United States
(DeMaria) Division of Cardiology, School of Medicine, University of
California San Diego, San Diego, CA, United States
(Marroquin) Heart and Vascular Institute, Center for Heart and Vascular
Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical
Center, United States
(Huang) Heart and Vascular Institute, Swedish Medical Center, Seattle, WA,
United States
(Traverse) Minneapolis Heart Institute Foundation, Abbott Northwestern
Hospital, MN, United States
(Krum) Monash University, Melbourne, Australia
(Skerrett) Mesoblast Inc, New York, NY, United States
(Itescu) Mesoblast Inc, Melbourne, VIC, Australia
(Henry) Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles,
CA, United States
Title
A Phase II dose-escalation study of allogeneic mesenchymal precursor cells
in patients with ischemic or nonischemic heart failure.
Source
Circulation Research. 117 (6) (pp 576-584), 2015. Date of Publication: 28
Aug 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Rationale: Allogeneic mesenchymal precursor cells (MPCs) have been
effective in large animal models of ischemic and nonischemic heart failure
(HF). Objective: To evaluate the feasibility and safety of 3 doses (25,
75, or 150 million cells) of immunoselected allogeneic MPCs in chronic HF
patients in a phase 2 trial. Methods and Results: We sequentially
allocated 60 patients to a dosing cohort (20 per dose group) and
randomized them to transendocardial MPC injections (n=15) or mock
procedures (n=5). The primary objective was safety, including antibody
testing. Secondary efficacy end points included major adverse cardiac
events (MACE; cardiac death, myocardial infarction, or revascularization),
left ventricular imaging, and other clinical-event surrogates. Safety and
MACE were evaluated for up to 3 years. MPC injections were feasible and
safe. Adverse events were similar across groups. No clinically symptomatic
immune responses were noted. MACE was seen in 15 patients: 10 of 45 (22%)
MPC-treated and 5 of 15 (33%) control patients. We found no differences
between MPC-treated and control patients in survival probability,
MACE-free probability, and all-cause mortality. We conducted a post hoc
analysis of HF-related MACE (HF hospitalization, successfully resuscitated
cardiac death, or cardiac death) and events were significantly reduced in
the 150 million MPC group (0/15) versus control (5/15; 33%), 25 million
MPC group (3/15; 20%), and 75 million MPC group (6/15; 40%); the 150
million MPC group differed significantly from all groups according to
Kaplan-Meier statistics >3 years (P=0.025 for 150 million MPC group versus
control). Conclusions: Transendocardial injections of allogeneic MPCs were
feasible and safe in chronic HF patients. High-dose allogeneic MPCs may
provide benefits in this population.
<15>
Accession Number
2015338010
Authors
Koukis I. Gkiozos I. Ntanos I. Kainis E. Syrigos K.N.
Institution
(Koukis) Department Cardiothoracic Surgery, 401 Army General Hospital,
Athens, Greece
(Gkiozos, Ntanos, Kainis, Syrigos) Oncology Unit, GPP, Sotiria General
Hospital, Athens Medical School, 152, Mesogeion Av., Athens, Greece
Title
Clinical and surgical-pathological staging in early non-small cell lung
cancer.
Source
Oncology Reviews. 7 (1) (pp 46-52), 2013. Date of Publication: 2013.
Publisher
Page Press Publications (via Giuseppe Belli, Pavia 7, 27100, Italy)
Abstract
Staging is of the utmost importance in the evaluation of a patient with
non-small cell lung cancer (NSCLC) because it defines the actual extent of
the disease. Accurate staging allows multidisciplinary oncology teams to
plan the best surgical or medical treatment and to predict patient
prognosis. Based on the recommendation of the International Association
for the Study of Lung Cancer (IASLC), a tumor, node, and metastases (TNM)
staging system is currently used for NSCLC. Clinical staging (c-TNM) is
achieved via non-invasive modalities such as examination of case history,
clinical assessment and radiological tests. Pathological staging (p-TNM)
is based on histological examination of tissue specimens obtained with the
aid of invasive techniques, either non-surgical or during the
intervention. This review is a critical evaluation of the roles of current
pre-operative staging modalities, both invasive and non-invasive. In
particular, it focuses on new techniques and their role in providing
accurate confirmation of patient TNM status. It also evaluates the
surgical-pathological staging modalities used to obtain the
true-pathological staging for NSCLC.
<16>
Accession Number
2015334335
Authors
Verma S. Eikelboom J.W. Nidorf S.M. Al-Omran M. Gupta N. Teoh H. Friedrich
J.O.
Institution
(Verma, Teoh) Division of Cardiac Surgery, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Al-Omran) Division of Vascular Surgery, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Teoh) Division of Endocrinology and Metabolism, Keenan Research Centre
for Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Verma, Al-Omran, Teoh) Department of Surgery, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Teoh, Friedrich) Department of Medicine, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Friedrich) Department of Critical Care, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Verma, Al-Omran) Department of Surgery, University of Toronto, Toronto,
ON, Canada
(Friedrich) Department of Medicine and Interdepartmental Division of
Critical Care, University of Toronto, Toronto, ON, Canada
(Eikelboom, Gupta) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Nidorf) Heart Research Institute, Perth, WA, Australia
Title
Colchicine in cardiac disease: A systematic review and meta-analysis of
randomized controlled trials.
Source
BMC Cardiovascular Disorders. 15 (1) , 2015. Article Number: 96. Date of
Publication: August 29, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Colchicine has unique anti-inflammatory properties that may be
beneficial in various cardiovascular conditions. This systematic review
and meta-analysis of randomized controlled trials (RCTs) examines this
issue. Methods: We searched MEDLINE, EMBASE, and the Cochrane Database
from inception to June 2014 for RCTs using colchicine in adult patients
with cardiac diseases. Results were pooled using random effects. Results:
15 RCTs (n = 3431 patients, median treatment 3 and follow-up 15 months)
were included. All but 2 used colchicine 1 mg/day. In 5 trials, n = 1301)
at risk for cardiovascular disease (coronary artery disease, acute
coronary syndrome or stroke, post-angioplasty [2 RCTs], or congestive
heart failure), colchicine reduced composite cardiovascular outcomes by
~60 % (risk ratio [RR] 0.44, 95 % confidence interval [CI] 0.28-0.69,
p=0.0004; I<sup>2</sup>=0 %) and showed a trend towards lower all-cause
mortality (RR 0.50, 95 % CI 0.23-1.08, p=0.08; I<sup>2</sup>=0 %). In
pericarditis or post-cardiotomy, colchicine decreased recurrent
pericarditis or post-pericardiotomy syndrome (RR 0.50, 95 % CI 0.41-0.60,
p<0.0001; I<sup>2</sup>=0 %; 8 RCTs, n=1635), and post-pericardiotomy or
ablation induced atrial fibrillation (RR 0.65, 95 % CI 0.51-0.82,
p=0.0003; I<sup>2</sup>=31 %; 4 RCTs, n=1118). The most common adverse
event was diarrhea. Treatment discontinuation overall and due to adverse
events (RR 4.34, 95 % CI 1.70-11.07, p=0.002; I<sup>2</sup>=29 %; 7 RCTs,
83/790 [10.5 %] vs. 11/697 [1.6 %]) was higher in colchicine-assigned
patients. Conclusions: Current RCT data suggests that colchicine may
reduce the composite rate of cardiovascular adverse outcomes in a range of
patients with established cardiovascular disease. Furthermore, colchicine
reduces rates of recurrent pericarditis, post-pericardiotomy syndrome, and
peri-procedural atrial fibrillation following cardiac surgery. Further
RCTs evaluating the potential of colchicine for secondary prevention of
cardiovascular events would be of interest.
<17>
Accession Number
2015336423
Authors
Bavishi C. Bangalore S. Patel D. Chatterjee S. Trivedi V. Tamis-Holland
J.E.
Institution
(Bavishi, Patel, Chatterjee, Trivedi, Tamis-Holland) Mount Sinai St.
Luke's Hospital, New York, NY, United States
(Bangalore) New York University, School of Medicine, New York, NY, United
States
Title
Short and long-term mortality in women and men undergoing primary
angioplasty: A comprehensive meta-analysis.
Source
International Journal of Cardiology. 198 (pp 123-130), 2015. Date of
Publication: 28 Aug 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction Women with acute myocardial infarction are treated less
aggressively than men and have a higher mortality. It is possible that
these sex-related differences in outcome are a result of differences in
baseline risk and management. Methods and results We undertook a
meta-analysis to study the differences in mortality among women and men
with ST-segment elevation myocardial infarction (STEMI) undergoing primary
percutaneous coronary intervention (P-PCI). Studies reporting sex-specific
crude mortality rates and/or adjusted effect estimates in STEMI patients
undergoing P-PCI were identified. Among 48 studies, involving 103,895
patients, (26,556 women and 77,337 men), the crude in-hospital [pooled
relative risk (RR): 1.94, 95% confidence interval (CI): 1.74-2.16, p <
0.001; 23 studies (n = 43,872)], 30-day [RR: 1.76, 95% CI: 1.50-2.07, p <
0.001; 20 studies (n = 43,279)], and long-term [RR: 1.60, 95% CI:
1.46-1.76, p < 0.001; 26 studies (n = 51,656)] mortality was significantly
higher in women compared to men. When meta-analysis using adjusted effect
estimates from individual studies was performed, in-hospital [RR: 1.31,
95% CI: 1.08-1.65, p = 0.007; 14 studies (n = 33,380)] and 30-day
mortality [RR: 1.19, 95% CI: 1.01-1.39, p = 0.03; 14 studies (n = 28,564)]
remained significant while long-term mortality [RR: 1.01, 95% CI:
0.93-1.11, p = 0.75; 20 studies (n = 52,492)] was no longer different
between women and men. Conclusions Sex-based differences exist in short
and long-term mortality among patients with STEMI undergoing P-PCI.
However, these differences were markedly attenuated following adjustment
for clinical differences and/or hospital course. Despite adjustment,
short-term mortality remains higher in women than men, while long-term
mortality was no longer significantly different.
<18>
Accession Number
2015336631
Authors
Chen S.-L. Xu B. Han Y.-L. Sheiban I. Zhang J.-J. Ye F. Kwan T.W. Paiboon
C. Zhou Y.-J. Lv S.-Z. Dangas G.D. Xu Y.-W. Wen S.-Y. Hong L. Zhang R.-Y.
Wang H.-C. Jiang T.-M. Wang Y. Sansoto T. Chen F. Yuan Z.-Y. Li W.-M. Leon
M.B.
Institution
(Chen, Zhang, Ye) Cardiological Department, Nanjing First Hospital,
Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
(Xu) Beijing Fuwai Cardiovascular Hospital, Beijing, China
(Han) Northen Hospital, Shenyang, China
(Sheiban) San Giovanni Battista Hospital, University of Turin, Turin,
Italy
(Kwan) Beth Israel Hospital, New York, NY, United States
(Paiboon) Bangkok General Hospital, Bangkok, Thailand
(Zhou, Lv, Chen) Beijing Anzhen Hospital, Capital Medical University,
Beijing, China
(Dangas) Mount Sinai Hospital, New York, NY, United States
(Xu) Shanghai 10th Hospital, Shanghai, China
(Wen) Daqing Oil General Hospital, Daqing, China
(Hong) Jiangxi Provincial People's Hospital, Nanchang, China
(Zhang) Shanghai Ruijin Hospital, Shanghai, China
(Wang) Xijing Hospital, Xi'an 4th Military Medical University, Xi'an,
China
(Jiang) Tianjing Policemen Medical College Hospital, Tianjing, China
(Wang) Xia'Men Zhongshan Hospital, Xia'Men, China
(Sansoto) Medistra Hospital, University of Indonesia Medical School,
Jakarta, Indonesia
(Yuan) Xi'an Communication University Hospital, Xi'an, China
(Li) Haarbin Medical University 1st Hospital, Haarbin, China
(Leon) Cardiovascular Research Foundation, New York, NY, United States
Title
Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left
Main Bifurcation Lesions: The 3-Year Follow-Up Results of the DKCRUSH-III
Study.
Source
JACC: Cardiovascular Interventions. 8 (10) (pp 1335-1342), 2015. Article
Number: 2070. Date of Publication: 24 Aug 2015.
Publisher
Elsevier Inc.
Abstract
Objectives The present study aimed to investigate the difference in major
adverse cardiac events (MACE) at 3 years after double-kissing (DK) crush
versus culotte stenting for unprotected left main distal bifurcation
lesions (LMDBLs). Background The multicenter and randomized DKCRUSH-III
(Comparison of double kissing crush versus culotte stenting for
unprotected distal left main bifurcation lesions: results from a
multicenter, randomized, prospective study) showed that DK crush stenting
was associated with fewer MACE at 1-year follow-up in patients with LMDBLs
compared with culotte stenting. Here, we report the 3-year clinical
outcome of the DKCRUSH-III study. Methods A total of 419 patients with
LMDBLs who were randomly assigned to either the DK crush or culotte group
in the DKCRUSH-III study were followed for 3 year. The primary endpoint
was the occurrence of a MACE at 3 years. Stent thrombosis (ST) was the
safety endpoint. Patients were classified by simple and complex LMDBLs
according to the DEFINITION (Definition and Impact of Complex Bifurcation
Lesions on Clinical Outcomes After Percutaneous Coronary Intervention
Using Drug-Eluting Stents) study criteria. Results At 3 years, MACE
occurred in 49 patients the culotte group and in 17 patients in the DK
crush group (cumulative event rates of 23.7% and 8.2%, respectively; p <
0.001), mainly driven by increased myocardial infarction (8.2% vs. 3.4%,
respectively; p = 0.037) and target-vessel revascularization (18.8% vs.
5.8%, respectively; p < 0.001) between groups. Definite ST rate was 3.4%
in the culotte group and 0% in the DK crush group (p = 0.007). Complex
LMDBLs were associated with a higher rate of MACE (35.3%) at 3 years
compared with a rate of 8.1% in patients with simple LMDBLs (p < 0.001),
with an extremely higher rate in the culotte group (51.5% vs. 15.1%, p <
0.001). Conclusions Culotte stenting for LMDBLs was associated with
significantly increased rates of MACE and ST. (Double Kissing [DK] Crush
Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main
Bifurcation Lesions: DKCRUSH-III, a Multicenter Randomized Study Comparing
Double-Stent Techniques; ChiCTR-TRC-11001877).
<19>
Accession Number
2015338066
Authors
Daniels P.R.
Institution
(Daniels) Mayo Clinic Thrombophilia Center and Division of General
Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
55905, United States
Title
Peri-procedural management of patients taking oral anticoagulants.
Source
BMJ (Online). 351 , 2015. Article Number: h2391. Date of Publication: 14
Jul 2015.
Publisher
BMJ Publishing Group
Abstract
The use of oral anticoagulants is becoming increasingly common. For many
years warfarin was the main oral anticoagulant available, but therapeutic
options have expanded with the introduction of oral direct thrombin
(dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and
edoxaban). Management of patients taking any oral anticoagulant in the
peri-procedural period poses a challenge to medical and surgical providers
because of the competing risks of thrombosis and hemorrhage. Bridging
therapy has been used to minimize time without anticoagulation when
warfarin is interrupted for invasive procedures, but validated strategies
based on high quality data are lacking. Existing data suggest that the use
of bridging therapy may increase the risk of bleeding for some patients
without reducing the risk of thrombosis. Clinical trials are currently
under way to answer these questions. Because the half lives and time to
anticoagulant activity of newer oral anticoagulants are shorter than for
warfarin, bridging therapy is not thought to be necessary with these
agents. Peri-procedural management of patients taking these agents is
complicated by the lack of demonstrated reversal agents in emergency
situations, although specific antidotes are being developed and tested.
Existing guidelines for peri-procedural management of patients on oral
anticoagulants highlight the importance of individualized patient decision
making and suggest strategies to minimize complications. From a patient's
perspective, given the uncertainties surrounding optimal management,
explicit discussions regarding risks and benefits of treatment options and
demonstration of effective communication among medical and surgical
providers are essential.
<20>
Accession Number
2015238798
Authors
Szeto W.Y. Svensson L.G. Rajeswaran J. Ehrlinger J. Suri R.M. Smith C.R.
Mack M. Miller D.C. McCarthy P.M. Bavaria J.E. Cohn L.H. Corso P.J. Guyton
R.A. Thourani V.H. Lytle B.W. Williams M.R. Webb J.G. Kapadia S. Tuzcu
E.M. Cohen D.J. Schaff H.V. Leon M.B. Blackstone E.H.
Institution
(Szeto) Division of Cardiovascular Surgery, University of Pennsylvania
Health System, Philadelphia, PA, United States
(Svensson, Rajeswaran, Leon, Blackstone) Placement of Aortic Transcatheter
Valves Publications Office, Cleveland, OH, United States
(Svensson, Suri, Lytle, Blackstone) Department of Quantitative Health
Sciences, Cleveland Clinic, Cleveland, OH, United States
(Rajeswaran, Ehrlinger, Blackstone) Department of Thoracic and
Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, United States
(Smith) Department of Surgery, Columbia University Medical Center, New
York Presbyterian Hospital, New York, NY, United States
(Mack) Cardiovascular Surgery, Baylor Scott White Health, Plano, TX,
United States
(Miller) Department of Cardiovascular Surgery, Falk Cardiovascular
Research Center, Stanford University School of Medicine, Stanford, CA,
United States
(McCarthy) Cardiac Surgery, Northwestern Memorial Hospital, Chicago, IL,
United States
(Bavaria) Division of Thoracic Surgery, University of Pennsylvania Health
System, Philadelphia, PA, United States
(Cohn) Department of Surgery, Brigham and Women's Hospital, Boston, MA,
United States
(Corso) Department of Cardiac Surgery, Medstar Washington Hospital Center,
Washington, DC, United States
(Guyton, Thourani) Department of Surgery, Division of Cardiothoracic
Surgery, Emory University Hospital, Atlanta, GA, United States
(Williams) Department of Cardiothoracic Surgery, New York University,
Langone Medical Center, New York, NY, United States
(Webb) Division of Cardiology, Department of Medicine, St Paul's Hospital,
University of British Columbia, Vancouver, BC, Canada
(Kapadia, Tuzcu) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Cohen) Division of Cardiology, St. Luke's Mid-America Heart Institute,
Kansas City, MO, United States
(Schaff) Cardiac Surgery, Mayo Clinic, Rochester, MN, United States
(Leon) Center for Interventional Vascular Therapy, Division of Cardiology,
Department of Medicine, Columbia University Medical Center, New York
Presbyterian Hospital, New York, NY, United States
Title
Appropriate patient selection or health care rationing? Lessons from
surgical aortic valve replacement in the Placement of Aortic Transcatheter
Valves i trial Read at the 95th Annual Meeting of the American Association
for Thoracic Surgery, Seattle, Washington, April 25-29.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (3) (pp 557-568e11),
2015. Date of Publication: 01 Sep 2015.
Publisher
Mosby Inc.
Abstract
Objectives The study objectives were to (1) compare the safety of
high-risk surgical aortic valve replacement in the Placement of Aortic
Transcatheter Valves (PARTNER) I trial with Society of Thoracic Surgeons
national benchmarks; (2) reference intermediate-term survival to that of
the US population; and (3) identify subsets of patients for whom aortic
valve replacement may be futile, with no survival benefit compared with
therapy without aortic valve replacement. Methods From May 2007 to October
2009, 699 patients with high surgical risk, aged 84 +/- 6.3 years, were
randomized in PARTNER-IA; 313 patients underwent surgical aortic valve
replacement. Median follow-up was 2.8 years. Survival for therapy without
aortic valve replacement used 181 PARTNER-IB patients. Results Operative
mortality was 10.5% (expected 9.3%), stroke 2.6% (expected 3.5%), renal
failure 5.8% (expected 12%), sternal wound infection 0.64% (expected
0.33%), and prolonged length of stay 26% (expected 18%). However,
calibration of observed events in this relatively small sample was poor.
Survival at 1, 2, 3, and 4 years was 75%, 68%, 57%, and 44%, respectively,
lower than 90%, 81%, 73%, and 65%, respectively, in the US population, but
higher than 53%, 32%, 21%, and 14%, respectively, in patients without
aortic valve replacement. Risk factors for death included smaller body
mass index, lower albumin, history of cancer, and prosthesis-patient
mismatch. Within this high-risk aortic valve replacement group, only the
8% of patients with the poorest risk profiles had estimated 1-year
survival less than that of similar patients treated without aortic valve
replacement. Conclusions PARTNER selection criteria for surgical aortic
valve replacement, with a few caveats, may be more appropriate, realistic
indications for surgery than those of the past, reflecting contemporary
surgical management of severe aortic stenosis in high-risk patients at
experienced sites.
<21>
Accession Number
71997305
Authors
Loganathan K. West D. Rahman I. McElnay P.
Institution
(Loganathan) School of Medicine, University of Bristol, Bristol, United
Kingdom
(West) Thoracic Surgery, University Hospital Bristol, NHS Foundation
Trust, Bristol, United Kingdom
(Rahman) University of Bristol, Bristol, United Kingdom
(McElnay) Cardiothoracic Surgery, Newcastle upon Tyne Hospitals NHS
Foundation Trust, Newcastle, United Kingdom
Title
3D printing a bony chest wall from computed tomography-scan data as an
adjunct to prosthetic reconstruction after chest wall resection.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 23rd European
Conference on General Thoracic Surgery Lisbon Portugal. Conference Start:
20150531 Conference End: 20150603. Conference Publication: (var.pagings).
21 , 2015. Date of Publication: August 2015.
Publisher
Oxford University Press
Abstract
Objectives: Resection of the bony chest wall is usually reconstructed with
a rigid prosthesis, often a nylon mesh and methylmethacrylate (MMA)
sandwich. Currently prostheses are fashioned intraoperatively by visual
estimation. 3D printing of a prosthetic mould may save operative time and
produce a more accurate reconstruction. We aimed to explore the
feasibility of 3D printing a human bony hemithorax to aid prosthesis
manufacture. Based on a recent systematic review, this would be the first
recorded use of 3D printing in thoracic surgery. Methods: The computed
tomography (CT) scan of a 67 year old male patient was used to test the
feasibility of creating a 3D model. CTscan bony reconstruction images were
converted to a 3D-print compatible format using the SPIERSTM software
package. The specific steps undertaken were recorded together with the
learning points, challenges, and advantages of this novel technique.
Results: A completed 3D rendering of the patient's left thoracic cagewas
generated in .stl format, compatible with most 3D printers, and a
graspable model was printed. Specific techniques to deal with technical
difficulties at the thoracic inlet and costal cartilages were developed. A
scaled down graspable model was printed using facilities available at the
university. Conclusions: This proof of concept exercise shows that 3D
printing of a human bony chest wall from CT scan images is possible with
existing software. Technical challenges encountered with rendering costal
cartilages and the thoracic inlet could be overcome. The potential
advantages include printing a hemithorax by mirroring the contralateral
side in cases of existing deformity or destruction, reduced theatre time,
improved aesthetics, better planning and patient education.
<22>
Accession Number
71997205
Authors
Fan J. Chen D. Du H. Shen C. Che G.
Institution
(Fan, Chen, Du, Shen, Che) Department of Thoracic Surgery, West China
Hospital, Chengdu, China
Title
Prognostic factors for resection of isolated pulmonary metastases in
breast cancer patients: A systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 23rd European
Conference on General Thoracic Surgery Lisbon Portugal. Conference Start:
20150531 Conference End: 20150603. Conference Publication: (var.pagings).
21 , 2015. Date of Publication: August 2015.
Publisher
Oxford University Press
Abstract
Objectives: The aim of this study was to conduct a systematic review and
meta-analysis of cohort studies to assess the 5-year overall survival rate
and the prognostic factors for pulmonary metastasectomy in breast cancer
patients. Methods: An electronic search in MEDLINE (via PubMed), EMBASE
(via OVID), CENTRAL (via Cochrane Library), and Chinese BioMedical
Literature Database (CBM) complemented by manual searches in article
references were conducted to identify eligible studies. All cohort studies
in which survival and/or prognostic factors for pulmonary metastasectomy
from breast cancer were reported were included in the analysis. We
calculated the pooled 5-year survival rates, identified the prognostic
factors for overall survival (OS) and combined the hazard ratios (HRs) for
the identified prognostic factors. Results: Sixteen studies with a total
of 1937 patients were included in this metaanalysis. The pooled 5-year
survival rates after pulmonary metastasectomy was 46% (95% confidence
interval [95% CI] 43%-49%). The poor prognostic factors were disease-free
interval (<3 years) with HR = 1.70 (95% CI 1.37-2.10), resection of
metastases (incomplete) with HR = 2.06 (95% CI 1.63-2.62), number of
pulmonary metastases (>1) with HR = 1.31 (95% CI 1.13-1.50) and the
hormone receptor status of metastases (negative) with HR = 2.30 (95% CI
1.43-3.70). Conclusions: Surgery with a relatively high 5-year overall
survival rate after pulmonary metastasectomy (46%), may be a promising
treatment for pulmonary metastases in breast cancer patients with a good
performance status and limited disease. The poor prognostic factors were
disease-free interval (<3 years), resection of metastases (incomplete),
number of pulmonary metastases (>1) and hormone receptor status of
metastases (negative).
<23>
Accession Number
71997181
Authors
Donahoe L. Deslauriers J. Waddell T.K. Darling G.E.
Institution
(Donahoe, Waddell, Darling) Thoracic Surgery, University of Toronto,
Toronto, Canada
(Deslauriers) Thoracic Surgery, University of Laval, Quebec, Canada
Title
Use of the delphi process to achieve consensus in developing a randomized
controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 23rd European
Conference on General Thoracic Surgery Lisbon Portugal. Conference Start:
20150531 Conference End: 20150603. Conference Publication: (var.pagings).
21 , 2015. Date of Publication: August 2015.
Publisher
Oxford University Press
Abstract
Objectives: Currently, there is no evidence to show that intensive
follow-up after resection of non-small cell lung cancer (NSCLC) improves
survival. An attempt to develop a protocol for a randomized trial of
standard follow-up for resected NSCLC failed to achieve consensus on the
two arms of the proposed trial at a face-to-face meeting of Canadian
Thoracic Surgeons. The purpose of this study was to use a Delphi method to
establish the standard arm for the study. Methods: All thoracic surgeons
in Canada were asked to complete three electronic surveys. The first round
(R1) involved questions about follow-up practices (i.e. time intervals,
imaging). Round two (R2) collated the responses from R1, which were used
to suggest standard and intensive follow-up protocols for R3. Round three
(R3) presented the final protocols to determine willingness of surgeons to
enroll patients in the RCTusing these study arms. Results: Fourty-eight
participants (64% of Canadian Thoracic Surgeons) responded in R1. All 48
followed patients after NSCLC resection, and felt establishing a protocol
through an RCT was worthwhile. A standard protocol was used by 40 surgeons
(83%) and 30 (62.5%) used the same protocol for all stages. Most
respondents used CT in follow-up, and only 1 used MRI/CT brain or PET
scan. No respondents used bone scans. Respondents felt it was important to
detect asymptomatic locoregional recurrence (44; 91.7%) and metastatic
disease (30; 62.5%). Only 29 participants (37%) responded in R2 and R3.
Using feedback from R2, the final protocols were presented in R3.
Conclusions: The modified Delphi method was successfully used to develop
standard and intensive follow-up arms for a RCT to develop a follow-up
protocol for NSCLC.
<24>
Accession Number
71997173
Authors
Al-Sahaf M. Perikleous P. Belcher E. Raubenheimer H. Asadi N. Cufari M.E.
Proli C. Jordan S. Dusmet M. Ladas G. Lim E.
Institution
(Al-Sahaf, Perikleous, Belcher, Raubenheimer, Asadi, Cufari, Proli,
Jordan, Dusmet, Ladas, Lim) Thoracic Surgery, Royal Brompton Hospital,
London, United Kingdom
Title
Efficacy of surgical sealants for persistent air leak after lung
resection: Individual patient data meta-analysis from two randomized
trials.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 23rd European
Conference on General Thoracic Surgery Lisbon Portugal. Conference Start:
20150531 Conference End: 20150603. Conference Publication: (var.pagings).
21 , 2015. Date of Publication: August 2015.
Publisher
Oxford University Press
Abstract
Objectives: Prolonged air leak is often associated with increased length
of hospital stay and recent Cochrane review failed to conclusively
identify the role of surgical sealants in the management of patients with
air leaks detected intraoperatively immediately after lung resection. We
sought to analyze individual patient data from two randomized trials at
our institution to determine the efficacy of surgical sealants on length
of hospital stay. Methods: We conducted two single blind randomized
controlled trials of surgical sealant (vs no sealant) after conventional
management (suturing) of air leaks detected intraoperatively. From 2002 to
2005 we evaluated Bioglue and from 2005 to 2007 we randomized patients to
either Bioglue or Vivostat. We compared results of sealants vs no sealants
indirectly, and the efficacy of BioGlue vs Vivostat on postoperative
length of stay using Kaplan-Meier time to event analyses. Results: Of 154
patients participating in both trials, 27 were randomized to no sealant,
75 to BioGlue and 52 to Vivostat. No differences in time to discharge were
noted as the median length of hospital stay was 7 days in each of the
three arms. There was no difference in pairwise comparisons for length of
stay for all 154 participants comparing sealant vs no sealant (P = 0.722),
102 participants comparing BioGlue vs no sealant (P = 0.691) and 79
participants comparing Vivostat vs no sealant (P = 0.801). Conclusions:
Our results indicate no benefit from the use of the two aforementioned
sealants in management of intraoperative air leak with respect to hospital
stay.
<25>
Accession Number
71997057
Authors
Boubia S. Idelhaj N. Cherkab R. Ridai M.
Institution
(Boubia, Idelhaj, Ridai) Department of Thoracic Surgery, University
Hospital Ibn Rochd, Casablanca, Morocco
(Cherkab) Department of Anaesthesia and Intensive Care, University
Hospital Ibn Rochd, Casablanca, Morocco
Title
Effect of tranexamic acid on surgical bleeding in pulmonary resection: A
randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 23rd European
Conference on General Thoracic Surgery Lisbon Portugal. Conference Start:
20150531 Conference End: 20150603. Conference Publication: (var.pagings).
21 , 2015. Date of Publication: August 2015.
Publisher
Oxford University Press
Abstract
Objectives: The effectiveness of tranexamic acid (TA) in reducing blood
loss and transfusion requirements has been amply demonstrated in many
types of surgeries, including traumatology and cardiovascular surgery.
However, to date, there are no studies evaluating the effect of TA in
pulmonary resection surgery. The aim of our study is to evaluate the
effect of TA on perioperative bleeding and transfusion requirements for
patients undergoing pulmonary resection surgery. Methods: We performed a
rospective randomized, double blinded, placebo-controlled, parallel-group
trial including patients aged over 18 years, scheduled for surgical
pulmonary resection. Biological, demographic, clinical, transfusion
requirements, blood loss and perioperative complications data were
recorded. There were 2 groups of patients: TA group; Placebo group (p).
Statistical analysis used the Student t-test with significance level P <
0.05. Results: Thirty-three patients comprised the study cohort. The mean
age was 46 +/- 15.46 years. The main comorbidities found were: COPD (8%)
and pulmonary tuberculosis (4%). 54.5% of patients belonged to the TA
group (n =18). There was no significant difference between the two groups
in terms of per-operative blood loss assessed by surgical aspiration (P =
0.48), gauze and surgical sites (P = 0.32). Postoperative blood loss
quantified by chest tubes were significantly lower in the TA group (P =
0.009). Perioperative transfusion requirements were similar in both groups
(P = 0.58 vs 0.49). Also, no significant difference was found in the
levels of hemoglobin, hematocrit, and prothrombin. The most important
per-operative and postoperative complications were bleeding (8%) and
sepsis (8%). No side-effects related to the TA (convulsion,
thromboembolism) were noted perioperatively. Conclusions: In pulmonary
resection surgery, TA seems to reduce postoperative bleeding without
having an impact on transfusion requirements. Other largescale studies are
needed to confirm these results and will thus establish a clear protocol
for the use of TA in this type of surgery.
