Results Generated From:
Embase <1980 to 2016 Week 23>
Embase (updates since 2016-05-26)
<1>
Accession Number
2015693093
Author
Masson S.; Wu J.H.Y.; Simon C.; Barlera S.; Marchioli R.; Mariani J.;
Macchia A.; Lombardi F.; Vago T.; Aleksova A.; Dreas L.; Favaloro R.R.;
Hershson A.R.; Puskas J.D.; Dozza L.; Silletta M.G.; Tognoni G.;
Mozaffarian D.; Latini R.
Institution
(Masson, Barlera, Latini) Department of Cardiovascular Research,
IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
(Wu) The George Institute for Global Health, Sydney Medical School, The
University of Sydney, Sydney, NSW, Australia
(Simon) Cardiovascular Department, Cardiac Surgery, Ospedali Riuniti di
Bergamo, Bergamo, Italy
(Marchioli) Hematology-Oncology Therapeutic Delivery Unit, Quintiles,
Milan, Italy
(Mariani, Macchia) GESICA Foundation, Buenos Aires, Argentina
(Lombardi) U.O.C. Malattie Cardiovascolari, Fondazione IRCCS Ospedale
Maggiore Policlinico, Department of Clinical and Community Sciences,
University of Milan, Milan, Italy
(Vago) Laboratory of Endocrinology, Ospedale Luigi Sacco, Milan, Italy
(Aleksova, Dreas) Cardiovascular Department, 'Ospedali Riuniti' and
University of Trieste, Trieste, Italy
(Favaloro, Hershson) AR Fundacion Favaloro, Buenos Aires, Argentina
(Puskas) Emory Health Care, Atlanta, GA, United States
(Dozza) E.S. Research Foundation, GVM Care and Research, Maria Cecilia
Hospital, Cotignola, Italy
(Silletta, Tognoni) Laboratory of Clinical Epidemiology of Cardiovascular
Disease, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
(Mozaffarian) Departments of Epidemiology and Nutrition, Harvard School of
Public Health, Boston, MA, United States
(Mozaffarian) Division of Cardiovascular Medicine and Channing Division of
Network Medicine, Department of Medicine, Brigham and Women's Hospital and
Harvard Medical School, Boston, MA, United States
Title
Circulating cardiac biomarkers and postoperative atrial fibrillation in
the OPERA trial.
Source
European Journal of Clinical Investigation. 45 (2) (pp 170-178), 2015.
Date of Publication: 01 Feb 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Postoperative atrial fibrillation (POAF) is a common
complication after cardiac surgery and predicts increased morbidity and
mortality. Identification of patients at high risk of POAF with the help
of circulating biomarkers may enable early preventive treatment but data
are limited, especially in contemporary surgical patients. Methods: Plasma
concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP)
and high-sensitivity cardiac troponin T (hs-cTnT) were measured at
enrolment, on the morning of cardiac surgery, at end surgery, and 2 days
postsurgery in 562 patients undergoing cardiac surgery, randomized to
perioperative supplementation with oral fish oil or placebo in the Omega-3
Fatty Acids for Prevention of Post-Operative Atrial Fibrillation trial
(OPERA). The primary endpoint was incident POAF lasting > 30 s, centrally
adjudicated and confirmed electrocardiographically. Results: Higher levels
of NT-proBNP and hs-cTnT before surgery were associated with older age,
renal or cardiac dysfunction and EuroSCORE. NT-proBNP peaked on
postoperative day 2 (2172 [1238-3758] ng/L, median [Q1-Q3]), while hs-cTnT
peaked at the end of surgery (373 [188-660] ng/L). Fish oil
supplementation did not alter the time course of the cardiac biomarkers (P
> 0.05). Concentrations of NT-proBNP or hs-cTnT, on the morning of
surgery, or changes in their level between morning of surgery and
postsurgery, were not significantly associated with POAF after adjustment
for clinical and surgical characteristics. Conclusion: Among patients
undergoing cardiac surgery, NT-proBNP and hs-cTnT are related to clinical
and surgical characteristics, have different perioperative time courses
but are not independently associated with risk of POAF.
<2>
Accession Number
2014620708
Author
Costa R.A.; Abizaid A.; Lotan C.; Dudek D.; Silber S.; Dizon J.M.; Maehara
A.; Dressler O.; Brener S.J.; Stone G.W.
Institution
(Costa, Abizaid) Department of Invasive Cardiology, Institute Dante
Pazzanese of Cardiology, Sao Paulo, Brazil
(Costa, Abizaid) Cardiovascular Research Center, Sao Paulo, Brazil
(Lotan) Hadassah Medical Center, Jerusalem, Israel
(Dudek) Department of Interventional Cardiology, Jagiellonian University
Medical College, Krakow, Poland
(Silber) Heart Center at the Isar, Munich, Germany
(Dizon, Maehara, Dressler, Brener, Stone) Cardiovascular Research
Foundation, New York, NY, United States
(Brener) New York Methodist Hospital, Brooklyn, NY, United States
(Stone) New York Presbyterian Hospital, Columbia University Medical
Center, New York, United States
Title
Impact of thrombus burden on outcomes after standard versus mesh-covered
stents in acute myocardial infarction (from the MGuard for Acute ST
Elevation Reperfusion Trial).
Source
American Journal of Cardiology. 115 (2) (pp 161-166), 2015. Date of
Publication: 15 Jan 2015.
Publisher
Elsevier Inc.
Abstract
Large thrombus burden negatively affects the results of percutaneous
coronary intervention (PCI) for acute ST-segment elevation myocardial
infarction (STEMI). We investigated the impact of thrombus burden in
patients with STEMI undergoing primary PCI with the mesh-covered MGuard
stent (InspireMD Ltd., Tel Aviv, Israel) versus a control bare-metal or
drug-eluting stent. In 433 patients with STEMI randomized to the MGuard
stent versus a control stent, angiographically visible thrombus was
identified in 383 patients (88.5%), with median thrombus area 30.15 mm2
(22.70, 41.93). Lesions with large thrombus (area > median) were treated
with more frequent use of manual aspiration (80.8% vs 65.8%, p = 0.0009)
and longer (22.1 +/- 5.9 vs 19.4 +/- 5.4 mm, p <0.0001) and larger (3.46
+/- 0.40 vs 3.29 +/- 0.36 mm, p <0.0001) stents. PCI of lesions with large
thrombus burden had more thrombotic complications (30.6% vs 15.9%, p =
0.0007) and reduced angiographic success (80.3% vs 91.1%, p = 0.003). In
large thrombus lesions, the MGuard stent was more effective than control
stents in achieving Thrombolysis In Myocardial Infarction-3 flow (87.9% vs
74.5%, p = 0.02) and tended to result in less slow flow or no reflow (8.8%
vs 17.6%, p = 0.07). ST-segment resolution was improved with the MGuard,
and clinical outcomes were favorable in both stent groups, regardless of
thrombus burden. In conclusion, reperfusion success is reduced after
primary PCI in lesions with large thrombus burden, an outcome that may be
modified by the MGuard stent.
<3>
Accession Number
2014966873
Author
Cho S.; Shin D.-H.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi D.; Jang Y.; Hong
M.-K.
Institution
(Cho, Shin, Kim, Kim, Ko, Choi, Jang, Hong) Severance Cardiovascular
Hospital, Yonsei University Health System, Seoul, South Korea
(Shin, Kim, Kim, Ko, Choi, Jang, Hong) Cardiovascular Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Jang, Hong) Severance Biomedical Science Institute, Yonsei University
College of Medicine, Seoul, South Korea
Title
Rationale and design: Impact of intravascular ultrasound guidance on
long-term clinical outcomes of everolimus-eluting stents in long coronary
lesions.
Source
Contemporary Clinical Trials. 40 (pp 90-94), 2015. Date of Publication:
January 01, 2015.
Publisher
Elsevier Inc.
Abstract
Background: Although the use of drug-eluting stents (DESs) in patients
with coronary artery disease has contributed to a significant reduction in
in-stent restenosis and repeat revascularization, treating diffuse long
lesions using DESs remains challenging due to the high rates of in-stent
restenosis and stent thrombosis. Intravascular ultrasound (IVUS) provides
tomographic images of coronary vascular structure and is useful for
evaluating lesion morphology and stent optimization during percutaneous
coronary intervention. However, it remains controversial whether IVUS
guidance in DES implantation for long coronary lesions could reduce
adverse clinical outcomes. Hypothesis: We hypothesize that the long-term
clinical outcomes of IVUS-guided DES implantation would be superior to
those of angiography-guided DES implantation in a subset of patients with
long coronary lesions. Study design: This study is a randomized,
prospective, multi-center trial comparing the long-term clinical outcomes
of IVUS-guided and angiography-guided everolimus-eluting stent
implantation in patients with long coronary lesions (implanted stent >.
28. mm in length). The primary end point is a composite of major adverse
cardiac events, including cardiac death, target lesion-related myocardial
infarction, or target lesion revascularization at 1. year following
intervention. A total of 1,400 patients will be required to be enrolled
according to sample size calculations. Conclusion: This study will test
the hypothesis that IVUS guidance improves long-term clinical outcomes in
patients treated with everolimus-eluting stents for long coronary lesions
compared with angiographic guidance.
<4>
Accession Number
2014877497
Author
Gu C.-Y.; Zhang J.; Qian Y.-N.; Tang Q.-F.
Institution
(Gu) Department of Anesthesiology, Affiliated Suzhou Hospital of Nanjing
Medical University, Suzhou, Jiangsu 215008, China
(Zhang, Qian) Department of Anesthesiology, First Affiliated Hospital of
Nanjing Medical University, Nanjing, Jiangsu 210029, China
(Tang) Department of Anesthesiology, Suzhou BenQ Medical Center, Nanjing
Medical University, Suzhou, Jiangsu 215009, China
Title
Effects of epidural anesthesia and postoperative epidural analgesia on
immune function in esophageal carcinoma patients undergoing thoracic
surgery.
Source
Molecular and Clinical Oncology. 3 (1) (pp 190-196), 2015. Date of
Publication: 2015.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece)
Abstract
Thoracic epidural anesthesia (TEA) has been demonstrated to significantly
reduce stress and immune dysfunction in trauma patients. In esophageal
carcinoma patients undergoing thoracic surgery, TEA combined with general
anesthesia during surgery and subsequent postoperative patient-controlled
epidural analgesia (PCEA) may improve plasma cortisol (Cor), interleukin
(IL)-6 and IL-17 levels and helper T-cell differentiation. A total of 60
esophageal carcinoma patients undergoing thoracic surgery were randomly
allocated into groups I, II, III and I (n=15 per group). During surgery,
groups I and II received total intravenous general anesthesia (TIVA),
whereas groups III and IV received combined TEA and TIVA. Postoperatively,
groups I and III received postoperative patient-controlled intravenous
analgesia (PCIA), while groups II and IV received PCEA. The Cor, IL-6,
IFN-gamma, IL-4 and IL-17 levels were measured in peripheral blood samples
collected prior to anesthesia (T0), at 2 h after incision (T1), at 4 h
postoperatively (T2), at 24 h postoperatively (T3) and at 48 h
postoperatively (T4). The plasma Cor, IL-17 and IL-6 levels increased
significantly at the beginning of the operation in groups I, II and III,
while in group IV there were no significant differences during the entire
period, concurrent with enhanced Th0 to Th2 shift, contributing to a
Th2-dominant Th1/Th2 ratio. General anesthesia with TEA more efficiently
inhibited the onset of the Th2-dominant status and decreased the plasma
levels of Cor and IL-6 compared to general anesthesia alone and PCEA
inhibited the Th2-dominant status more efficiently compared to PCIA.
Therefore, general anesthesia combined with TEA and sole administration of
PCEA were demonstrated to inhibit the stress response and minimize immune
dysfunction, generating most pronounced results upon combination TEA/PCEA
treatment.
<5>
Accession Number
2014451992
Author
Xiang K.; Cai H.; Song Z.
Institution
(Xiang) Department of Anesthesiology, Xiangtan Central Hospital, Xiangtan,
Hunan, China
(Cai, Song) Department of Anesthesiology, Xiangya Hospital, Central South
University, No. 87 Xiangya Road, Changsha, Hunan, China
Title
Comparison of analgesic effects of remifentanil and fentanyl NCA after
pediatric cardiac surgery.
Source
Journal of Investigative Surgery. 27 (4) (pp 214-218), 2014. Date of
Publication: August 2014.
Publisher
Informa Healthcare
Abstract
The purpose of this study was to compare the analgesic effects of
remifentanil with fentanyl following pediatric cardiac surgery. Fifty
patients were included in the study and were randomized into two groups.
Patients in group R were given remifentanil (50 mug/ml) at an infusion
rate of 0.07 mug/kg/min and with bolus doses of 0.25 mug/kg with a 5-min
lockout time; group F patients received fentanyl (50 mug/ml) at an
infusion rate of 0.1mug/kg/min and with bolus doses of 1 mug/kg with a
5-min lockout time. Pain was assessed using the Face, Legs, Activity, Cry,
Consolability scale (FLACC scale), and sedation was assessed using the
Ramsay sedation score. The number of boluses and demands, time to
extubation, and side effects were analyzed. The FLACC scale, Ramsay
sedation score, and mean extubation times were similar in the two groups.
The total number of boluses and demands were significantly greater for
group R than for group F. Itching as a side-effect was more severe in
group F (p < .05). NCA remifentanil and fentanyl offer similarly effective
pain control after pediatric cardiac surgery, but remifentanil has fewer
side effects than fentanyl, indicating the suitability of remifentanil for
use in NCA systems. © 2014 Informa Healthcare USA, Inc.
<6>
Accession Number
2014429982
Author
Kotekar N.; Kuruvilla C.S.; Murthy V.
Institution
(Kotekar, Kuruvilla) Department of Anaesthesiology, JSS Medical College,
Mysore, Karnataka, India
(Murthy) Department of Molecular Pharmacology and Experimental
Therapeutics, Mayo Clinic, Rochester, MN 55905, United States
Title
Post-operative cognitive dysfunction in the elderly: A prospective
clinical study.
Source
Indian Journal of Anaesthesia. 58 (3) (pp 263-268), 2014. Date of
Publication: May-June 2014.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background and Aims: Aging population is a major demographic trend
worldwide. Globally, 50% of all the elderly individuals are estimated to
undergo atleast one surgical procedure and post-operative cognitive
dysfunction (POCD) is one of the most common and often poorly understood
post-operative complications in this section of the population. This
randomised prospective study was conducted to assess the post-operative
cognitive status in the elderly undergoing non-cardiac surgery, evaluate
the cognitive parameters affected, evaluate the potential risk factors and
thereby analyse the potential for implementation of preventive strategies.
Methods: This study was conducted on 200 patients aged 60 years or older
scheduled for elective non-cardiac surgeries. The baseline cognitive
status of the patients was assessed 2 days prior to the date of the
surgery. The post-operative cognitive status was assessed on the 3rd day,
7th day and after 1 month. Statistical analysis was performed using SAS
and SPSS. Results: The incidence of POCD showed a gradual decline from
postoperative day 3 to 30. Females were found to be at significant risk in
developing POCD. Advancing age and level of education emerged as dominant
factors, while type of anaesthesia, duration of surgery, and presence of
coexisting comorbidities had no influence on the incidence of cognitive
dysfunction. Conclusion: POCD is a definite complication after surgery and
anaesthesia in the elderly population. Gender emerged as a significant
risk factor with increasing age as a dominating factor contributing to
POCD.
<7>
Accession Number
2014398893
Author
Lateef Wani M.; Gani Ahangar A.; Singh S.; Irshad I.; ul-Hassan N.; Nabi
Wani S.; Ahmad Ganie F.; Akbar Bhat M.
Institution
(Lateef Wani, Gani Ahangar, Singh, ul-Hassan, Nabi Wani, Ahmad Ganie,
Akbar Bhat) Department of Cardiovascular and Thoracic Surgery,
Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
(Irshad) Lal Ded Hospital, Srinagar, Kashmir, India
Title
Efficacy and safety of beating heart mitral valve replacement.
Source
International Cardiovascular Research Journal. 8 (2) (pp 61-65), 2014.
Date of Publication: 2014.
Publisher
Iranian Cardiovascular Research Journal
Abstract
Background: The interest in beating heart surgery is growing since better
results can be obtained with this procedure compared to conventional
myocardial protection techniques using cardioplegic solutions. This led us
to consider mitral valve replacement with beating heart. Objectives: This
study aimed to determine the safety and efficacy of beating heart mitral
valve replacement without cross clamp. Methods: This prospective study was
conducted on the patients with isolated mitral valve disease requiring
mitral valve replacement according to ACC / AHA guidelines. In this study,
15 patients underwent mitral valve replacement using beating heart
technique (Group A) and 15 ones underwent mitral valve replacement using
arrested heart technique (Group B). The patients were randomized using
block randomization. The data were analyzed using the SPSS statistical
software. Results: Preoperative parameters were comparable in the two
groups. Most of the patients in both study groups were in NYHA class III
or IV. Postoperatively, however, most of the patients in the two groups
were either in NYHA class I or II. No mortality occurred in the beating
heart group, while one mortality occurred in the arrested heart group. The
results showed a significant difference between the two groups regarding
the mean bypass time, mean operating time, mean ICU stay, and mean length
of hospital stay. Conclusions: Beating heart mitral valve replacement is
equally safe as the arrested heart technique. Thus, it is recommended as
an appropriate alternative to the arrested heart technique for mitral
valve replacement.
<8>
Accession Number
2014389455
Author
Bligaard N.; Thuesen L.; Saunamaki K.; Thayssen P.; Aaroe J.; Hansen P.R.;
Lassen J.F.; Stephansen G.; Jeppesen J.L.; Galloe A.M.
Institution
(Bligaard, Hansen, Stephansen) Department of Cardiology, Gentofte
University Hospital, Hellerup, Denmark
(Thuesen, Lassen) Department of Cardiology, Aarhus University Hospital
Skejby, Aarhus, Denmark
(Saunamaki) Department of Cardiology, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark
(Thayssen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Aaroe) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(Jeppesen) Department of Medicine, Glostrup University Hospital, Glostrup,
Denmark
(Galloe) Department of Cardiology, Roskilde University Hospital, K gevej
7-13, DK-4000 Roskilde, Denmark
Title
Similar five-year outcome with paclitaxel-And sirolimus-eluting coronary
stents.
Source
Scandinavian Cardiovascular Journal. 48 (3) (pp 148-155), 2014. Date of
Publication: June 2014.
Publisher
Informa Healthcare
Abstract
Objective. Millions of patients were treated with the sirolimus-eluting
CypherTM and the paclitaxel-eluting TaxusTM coronary stents with potential
late-occurring increase in event rates. Therefore, the long-term outcome
follow-up is of major clinical interest. Design. In total, 2.098
unselected patients with ST-segment elevation myocardial infarction
(STEMI), non-STEMI, stable or unstable angina pectoris were randomized to
receive CypherTM (n = 1.065) or TaxusTM (n = 1.033) stents and were
followed for 5 years. Results. The primary end-point; the composite of
cardiac death, myocardial infarction and target vessel revascularization
(major adverse cardiac event, MACE), occurred in 467 patients (22.3%);
CypherTM n = 222 (20.8%), TaxusTM n = 245 (23.7%), ns. Definite and
probable stent thrombosis occurred in 107 patients (5.1%); CypherTM n = 51
(4.8%), TaxusTM n = 56 (5.4%), ns. No statistically significant
differences were found in the elements of the primary end-point or in
other secondary end-points between the two stent groups. After one year,
the annual rates of stent thrombosis and MACE remained constant.
Conclusions. During 5-year follow-up, the CypherTM and the TaxusTM
coronary stents had similar clinical outcome with no signs of increasing
rates of adverse events over time. © 2014 Informa Healthcare.
<9>
Accession Number
2014379418
Author
Zirak N.; Esfahanizadeh J.; Tashnizi M.A.; Shamloo A.S.; Motahedi B.;
Soltani G.
Institution
(Zirak) Department of Anesthesiology, Imam Reza Hospital, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Esfahanizadeh, Tashnizi, Soltani) Department of Cardiac Surgery, Imam
Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran,
Islamic Republic of
(Shamloo) School of Medicine, Mashhad University of Medical Sciences,
Mashhad, Iran, Islamic Republic of
(Motahedi) Department of Cardiac Surgery, Ghaem Hospital, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Title
Renal function following on-pump versus off-pump CABG.
Source
Iranian Heart Journal. 14 (4) (pp 43-46), 2014. Date of Publication: 2014.
Publisher
Iranian Heart Association
Abstract
Introduction- Despite the success of on-pump coronary artery bypass
grafting (CABG) in the treatment of coronary artery disease, morbidity and
mortality due to renal failure is a wellknown complication of this method.
Currently, it is believed that off-pump CABG can be done with the same
result and fewer adverse renal effects due to a lack of the use of the
cardiopulmonary bypass machine. The aim of this study was to compare
postoperative renal function between off-pump CABG and on-pump CABG.
Method- Sixty-seven consecutive candidates for elective isolated CABG were
enrolled in this study and randomized into two groups. The on-pump group
consisted of 34 patients and the off-pump group included 33 patients. All
the patients were operated on via the same technique and surgeon. Blood
samples were obtained before surgery and 6, 24, and 48 hours after surgery
to measure the serum creatinine and assess creatinine clearance. Either
20% increase in the serum creatinine level or 20% decrease in creatinine
clearance was considered as renal dysfunction. Results- In the off-pump
group, 5, 9, and 4 patients developed renal dysfunction 6, 24, and 48
hours postoperatively, respectively in comparison with 13, 22, and 11
patients of the on-pump group at the same time. There was a significant
difference between the two groups regarding renal dysfunction 6 and 24
hours postoperatively (p value=0.038 and 0.003, respectively), but no
significant difference was observed at 48 hours after surgery. We found no
relationship between age and weight and postoperative renal dysfunction in
either of the groups. Preoperative hypertension and diabetes had no effect
on postoperative renal dysfunction. Conclusions- Renal function was better
preserved in the patients undergoing off-pump CABG than on-pump CABG. Old
age was not a risk factor for renal function but it could be a matter of
debate and must be studied in future experiments.
<10>
Accession Number
2014343417
Author
Kadan M.; Erol G.; Oz B.S.; Arslan M.
Institution
(Kadan, Erol, Oz, Arslan) Department of Cardiovascular Surgery, Gulhane
Military Academy of Medicine, Etlik, Ankara, Turkey
Title
Effects of topical hypothermia on postoperative inflammatory markers in
patients undergoing coronary artery bypass surgery.
Source
Cardiovascular Journal of Africa. 25 (2) (pp 67-72), 2014. Date of
Publication: March-April 2014.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Background: We aimed to examine the effects of topical hypothermia on
inflammatory markers in patients undergoing coronary artery bypass
surgery. Methods: Fifty patients undergoing isolated coronary artery
bypass surgery were included the study. They were randomised to two
groups. Mild hypothermic cardiopulmonary bypass (28-32degreeC) was
performed on both groups using standardised anaesthesiology and surgical
techniques. Furthermore, topical cooling with 4degreeC saline was
performed on patients in group I. We recorded peri-operative and
infra-operative results of blood samples, pre-operative and postoperative
outcomes of electrocardiography and echocardiography, diaphragm levels on
X-ray, and the necessity of positive inotropic medication and intra-aortic
balloon pump (IABP). Results: Time-dependent changes in blood samples were
compared between the two groups. The changes on complement 3 (C3) and
TNF-alpha levels were more significant in group I than group II (p < 0.05
and p < 0.001, respectively). Spontaneous restoration rate of sinus rhythm
was higher in group II than group I (80 vs 32%, p < 0.01). Atrial
fibrillation was seen in six patients in group I and one patient in group
II (p < 0.05). IABP was performed on four patients (16%) in group I (p <
0.05). Diaphragmatic paralysis was seen in seven patients in group I but
not in group II (p < 0.01). Partial pericardiotomy rates were compared
within the groups but there was no statistically significant difference (p
> 0.05). One patient in group I died on the 18th postoperative day, but
operative mortality rate was not statistically significant between the two
groups (p > 0.05). Conclusions: Topical hypothermia had a negative impact
on inflammatory markers and postoperative morbidities.
<11>
Accession Number
2014264627
Author
Williams M.; Kodali S.K.; Hahn R.T.; Humphries K.H.; Nkomo V.T.; Cohen
D.J.; Douglas P.S.; Mack M.; McAndrew T.C.; Svensson L.; Thourani V.H.;
Tuzcu E.M.; Weissman N.J.; Kirtane A.J.; Leon M.B.
Institution
(Williams, Kodali, Hahn, Kirtane, Leon) Herbert and Sandi Feinberg
Interventional Cardiology and Heart Valve Center, Columbia University
Medical Center, New York Presbyterian Hospital, 177 Fort Washington
Avenue, New York, NY 10032, United States
(Humphries) Division of Cardiology, University of British Columbia,
Vancouver, BC, Canada
(Nkomo) Mayo Clinic, Rochester, MN, United States
(Cohen) Saint Luke's Mid-America Heart Institute, Kansas City, MO, United
States
(Douglas) Duke Clinical Research Institute, Durham, NC, United States
(Mack) Baylor Healthcare System, Dallas, TX, United States
(McAndrew) Cardiovascular Research Foundation, New York, NY, United States
(Svensson, Tuzcu) Cleveland Clinic Foundation, Cleveland, OH, United
States
(Thourani) Emory University, School of Medicine, Atlanta, GA, United
States
(Weissman) Medstar Research Institute, Washington, DC, United States
Title
Sex-related differences in outcomes after transcatheter or surgical aortic
valve replacement in patients with severe aortic stenosis: Insights from
the partner trial (placement of aortic transcatheter valve).
Source
Journal of the American College of Cardiology. 63 (15) (pp 1522-1528),
2014. Date of Publication: 22 Apr 2014.
Publisher
Elsevier USA
Abstract
Objectives: This study sought to examine sex-specific differences in
outcomes after surgical aortic valve replacement (SAVR) or transcatheter
aortic valve replacement (TAVR) in high-risk patients with severe aortic
stenosis. Background: The PARTNER (Placement of Aortic Transcatheter
Valve) trial demonstrated similar 2-year survival with SAVR or TAVR for
high-risk patients, but sex-specific outcomes are unknown. Methods: In
all, 699 patients (300 female) were randomly assigned 1:1 to either SAVR
or TAVR with a balloon expandable pericardial tissue valve. Baseline
characteristics and 2-year outcomes of TAVR versus SAVR were compared
among males and females. Results: Baseline characteristics differed
between the sexes. Despite higher Society of Thoracic Surgeons mortality
risk scores (11.9 vs. 11.6; p = 0.05), female patients had lower
prevalence of coronary artery disease (64.4% vs. 83.7%), prior coronary
artery bypass graft surgery (19.8% vs. 61.2%), peripheral vascular disease
(36.4% vs. 46.9%), diabetes mellitus (35.6% vs. 45.6%), and elevated
creatinine (11.7% vs. 23.9%). Among female patients, procedural mortality
trended lower with TAVR versus SAVR (6.8% vs. 13.1%; p = 0.07) and was
maintained throughout follow-up (hazard ratio [HR]: 0.67; 95% confidence
interval [CI]: 0.44 to 1.00; p = 0.049), driven by the transfemoral arm
(HR: 0.55; 95% CI: 0.32 to 0.93; p = 0.02). Among male patients, although
procedural mortality was lower with TAVR (6% vs. 12.1%; p = 0.03), there
was no overall survival benefit (HR: 1.15; 95% CI: 0.82 to 1.61; p =
0.42). Conclusions: In this retrospective subanalysis of high-risk,
symptomatic aortic stenosis patients in the PARTNER trial, female subjects
had lower late mortality with TAVR versus SAVR. This was especially true
among patients suitable for transfemoral access and suggests that TAVR may
be preferred over surgery for high-risk female patients. A randomized,
controlled trial conducted specifically in female patients is necessary to
properly study differences in mortality between treatment modalities.
© 2014 by the American College of Cardiology Foundation.
<12>
Accession Number
2014235466
Author
Erturk E.; Aydogdu Kaya F.; Kutanis D.; Besir A.; Akdogan A.; Geze S.;
Tugcugil E.
Institution
(Erturk, Aydogdu Kaya, Kutanis, Besir, Akdogan, Geze) Department of
Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz
Technical University, 61080 Trabzon, Turkey
(Tugcugil) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey
Title
The effectiveness of preemptive thoracic epidural analgesia in thoracic
surgery.
Source
BioMed Research International. 2014 (no pagination), 2014. Article Number:
673682. Date of Publication: 2014.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. The aim of this study is to investigate the effectiveness of
preemptive thoracic epidural analgesia (TEA) comparing conventional
postoperative epidural analgesia on thoracotomy. Material and Methods.
Forty-four patients were randomized in to two groups (preemptive: Group P,
control: Group C). Epidural catheter was inserted in all patients
preoperatively. In Group P, epidural analgesic solution was administered
as a bolus before the surgical incision and was continued until the end of
the surgery. Postoperative patient controlled epidural analgesia infusion
pumps were prepared for all patients. Respiratory rates (RR) were
recorded. Patient's analgesia was evaluated with visual analog scale at
rest (VASr) and coughing (VASc). Number of patient's demands from the
pump, pump's delivery, and additional analgesic requirement were also
recorded. Results. RR in Group C was higher than in Group P at
postoperative 1st and 2nd hours. Both VASr and VASc scores in Group P were
lower than in Group C at postoperative 1st, 2nd, and 4th hours. Patient's
demand and pump's delivery count for bolus dose in Group P were lower than
in Group C in all measurement times. Total analgesic requirements on
postoperative 1st and 24th hours in Group P were lower than in Group C.
Conclusion. We consider that preemptive TEA may offer better analgesia
after thoracotomy. © 2014 Engin Erturk et al.
<13>
Accession Number
2014203369
Author
Verma S.; Lovren F.; Pan Y.; Yanagawa B.; Deb S.; Karkhanis R.; Quan A.;
Teoh H.; Feder-elituv R.; Moussa F.; Souza D.S.R.; Fremes S.E.
Institution
(Verma, Lovren, Pan, Yanagawa, Quan, Teoh, Feder-elituv) Division of
Cardiac Surgery, Keenan Research Centre in the Li Ka Shing Knowledge
Institute at St. Michael's Hospital, Toronto, ON, Canada
(Verma, Yanagawa, Deb, Moussa, Fremes) Department of Surgery, University
of Toronto, Toronto, ON, Canada
(Deb, Karkhanis, Moussa, Fremes) Division of Cardiac Surgery, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Teoh) Division of Endocrinology and Metabolism, Keenan Research Centre in
the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto,
ON, Canada
(Souza) Department of Cardiovascular and Thoracic Surgery,, Orebro
University Hospital, Orebro, Sweden
Title
Pedicled no-touch saphenous vein graft harvest limits vascular smooth
muscle cell activation: The PATENT saphenous vein graft study.
Source
European Journal of Cardio-thoracic Surgery. 45 (4) (pp 717-725), 2014.
Article Number: ezt560. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVE: Neointimal hyperplasia secondary to vascular smooth muscle cell
(VSMC) activation limits the long-term patency of saphenous vein grafts
(SVGs). We compared markers of vascular injury and VSMC activation in SVGs
harvested using the pedicled 'no-touch' (NT) vs the conventional (CON)
technique. METHODS: Patients undergoing coronary artery bypass surgery
were enrolled in the PATENT SVG trial (clinicaltrials.gov NCT01488084).
Patients were randomly allocated to have SVGs harvested with the NT
technique from one leg and the CON method from the other. SVG segments
underwent morphometry, histological and electron microscopy assessments
and transcript measurements of VSMC activation and differentiation
markers. Leg wound functional recovery and harvest site complications were
assessed using a quality-of-life questionnaire. RESULTS: A total of 17
patients (65.3 +/- 7.3 years) were enrolled. SVGs harvested using the NT
vs CON technique exhibited preserved intimal, medial and adventitial
architecture. CON harvest was associated with greater medial Kruppel-like
factor 4 transcript levels (0.26 +/- 0.05 vs 0.11 +/- 0.02, P < 0.05). CON
samples had significantly lower medial serum response factor (0.53 +/-
0.11 vs 1.44 +/- 0.50, P < 0.05) and myocardin (0.59 +/- 0.08 vs 1.33 +/-
0.33, P < 0.05) transcript levels. MicroRNA-145, an inhibitor of VSMC
activation and differentiation, was higher in the NT vs CON samples (1.84
+/- 1.03 vs 0.50 +/- 0.19, P < 0.05). Leg assessment scores were worse in
the NT legs at 3 months, but similar to CON scores at 12 months.
CONCLUSIONS: SVGs harvested using the 'NT' technique exhibit an early
molecular and morphological pattern consistent with decreased VSMC
activation compared with CON harvesting. Functional leg recovery was
similar in both groups at 12 months. Larger studies are required to
corroborate these findings. © The Author 2013. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.
<14>
Accession Number
2014894278
Author
Sagiroglu G.; Baysal A.; Copuroglu E.; Gul Y.G.; Karamustafaoglu Y.A.;
Dogukan M.
Institution
(Sagiroglu, Copuroglu) Department of Anesthesiology and Reanimation,
Trakya University, Edirne, Turkey
(Baysal) Anesthesiology and Reanimation Clinic, Kartal Kosuyolu High
Speciality Research and Training Hospital, Istanbul, Turkey
(Karamustafaoglu) Anesthesiology and Reanimation Clinic, Arnavutkoy State
Hospital, Istanbul, Turkey
(Gul) Department of Thoracic Surgery, Trakya University, Edirne, Turkey
(Dogukan) Department of Anesthesiology and Reanimation, Adiyaman
University, Adiyaman, Turkey
Title
Does early use of bilevel positive airway pressure (bipap) in
cardiothoracic intensive care unit prevent reintubation?.
Source
International Journal of Clinical and Experimental Medicine. 7 (10) (pp
3439-3446), 2014. Date of Publication: 30 Oct 2014.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Introduction: Non-invasive ventilation (NIV) is a preferred treatment in
acute respiratory failure after operations. Our aim is to investigate the
success of early use of bilevel positive airway pressure (BIPAP) after
cardiac or thoracic surgeries to prevent reintubation.
Methods: In a prospective randomized study, 254 patients were divided into
two groups depending on the time period between extubation and the
application of BIPAP. In Group 1 BIPAP was applied after extubation within
48 hours after surgery following fulfilling of acute respiratory failure
criterias whereas, in Group 2, BIPAP was applied one hour after extubation
for two episodes of 20 minute duration and 3 hours apart. Arterial blood
gas values (pH, PaO2, PaCO2) at first and fourth hour after BIPAP were
collected.
Results: In comparison between groups, no significant differences were
observed for arterial blood gas values of pH and PaCO2 at baseline, one
and four hours after BIPAP (p > 0.05) however, the PaO2 values at one and
four hours after BIPAP were significantly better in Group 1 in comparison
to Group 2 (p < 0.001, p < 0.001; respectively). Reintubation rate was 14
patients (11%) in Group 1 and 7 patients (5.5%) in Group 2 (p = 0.103).
Conclusions: The early and prophylactic use of BIPAP after cardiac or
thoracic operations did not provide diminished rates in the postoperative
complications such as reintubation.
<15>
Accession Number
2014881436
Author
Cavalcante E.S.; Magario R.; Conforti C.A.; Junior G.C.; Arena R.;
Carvalho A.C.C.; Buffolo E.; Filho B.L.
Institution
(Cavalcante, Carvalho, Buffolo, Filho) UNIFESP-Universidade Federal de Sao
Paulo, SP, Brazil
(Magario) USP-Universidade de Sao Paulo, SP, Brazil
(Conforti) Santa Casa de Misericordia de Santos, Santos, SP, Brazil
(Junior) UNB-Universidade de Brasilia, DF, Brazil
(Arena) Virginia Commonwealth University, Richmond, VA, United States
Title
Impact of intensive physiotherapy on cognitive function after coronary
artery bypass graft surgery.
Source
Arquivos Brasileiros de Cardiologia. 103 (5) (pp 391-397), 2014. Date of
Publication: 01 Nov 2014.
Publisher
Arquivos Brasileiros de Cardiologia
Abstract
Background: Coronary artery bypass graft (CABG) is a standard surgical
option for patients with diffuse and significant arterial plaque. This
procedure, however, is not free of postoperative complications, especially
pulmonary and cognitive disorders.
Objective: This study aimed at comparing the impact of two different
physiotherapy treatment approaches on pulmonary and cognitive function of
patients undergoing CABG.
Methods: Neuropsychological and pulmonary function tests were applied,
prior to and following CABG, to 39 patients randomized into two groups as
follows: Group 1 (control)-20 patients underwent one physiotherapy session
daily; and Group 2 (intensive physiotherapy)-19 patients underwent three
physiotherapy sessions daily during the recovery phase at the hospital.
Non-paired and paired Student t tests were used to compare continuous
variables. Variables without normal distribution were compared between
groups by using Mann-Whitney test, and, within the same group at different
times, by using Wilcoxon test. The chi-square test assessed differences of
categorical variables. Statistical tests with a p value < 0.05 were
considered significant.
Results: Changes in pulmonary function were not significantly different
between the groups. However, while Group 2 patients showed no decline in
their neurocognitive function, Group 1 patients showed a decline in their
cognitive functions (P < 0.01).
Conclusion: Those results highlight the importance of physiotherapy after
CABG and support the implementation of multiple sessions per day,
providing patients with better psychosocial conditions and less morbidity.
<16>
Accession Number
2014856664
Author
van Loon R.B.; Veen G.; Kamp O.; Baur L.H.B.; van Rossum A.C.
Institution
(van Loon, Veen, Kamp, van Rossum) Department of Cardiology, 5F003, VU
University Medical Center, De Boelelaan 1117, HV Amsterdam 1081,
Netherlands
(Baur) Department of Cardiology, Atrium Medical Center Parkstad, 6419 PC
Heerlen and Faculty of Health, Medicine and Life Sciences, University
Maastricht, MD, Maastricht 6200, Netherlands
Title
Left ventricular remodeling after acute myocardial infarction: The
influence of viability and revascularization - an echocardiographic
substudy of the VIAMI-trial.
Source
Trials. 15 (1) (pp 1-11), 2014. Article Number: 329. Date of Publication:
August 18, 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Viability seems to be important in preventing ventricular
remodeling after acute myocardial infarction (AMI). We investigated the
influence of viability, as demonstrated with low-dose dobutamine
echocardiography, and the role of early revascularization on the process
of left ventricular (LV) remodeling after AMI.Methods: We retrospectively
investigated 224 patients who were initially included in the
viability-guided angioplasty after acute myocardial infarction-trial
(VIAMI-trial). Patients in the VIAMI-trial did not undergo a primary or
rescue percutaneous coronary intervention and were stable in the early
in-hospital phase. Patients underwent viability testing within 72 hours
after AMI. Patients with viability were randomized to an invasive strategy
or an ischemia-guided strategy. Follow-up echocardiography was performed
at a mean of 205 days. In this echocardiographic substudy, patients were
divided into three new groups: group 1, viable and revascularized before
follow-up echocardiogram; group 2, viable, but medically treated; and
group 3, non-viable patients.Results: Group 1 showed preservation of LV
volume indices. The ejection fraction (EF) increased significantly from
54.0% to 57.5% (P = 0.047). Group 2 showed a significant increase in LV
volume indices with no improvement in EF (53.3% versus 53.0%, P = 0.86).
Group 3 showed a significant increase in LV volume indices, with a
decrease in EF from 53.5% to 49.1% (P = 0.043). Multivariate logistic
regression analysis indicated the number of viable segments and
revascularization during follow-up as independent predictors for EF
improvement, especially in patients with lower EF at baseline.Conclusion:
Viability early after AMI is associated with improvement in LV function
after revascularization. When viable myocardium is not revascularized, the
LV tends to remodel with increased LV volumes, without improvement of EF.
Absence of viability results in ventricular dilatation and deterioration
of EF, irrespective of revascularization status.Trial registration:
NCT00149591 (assigned: 6 September 2005).
<17>
Accession Number
2014856830
Author
Rudd N.; Subiakto I.; Asrar ul Haq M.; Mutha V.; van Gaal W.J.
Institution
(Rudd, Subiakto, Asrar ul Haq, Mutha, van Gaal) Department of Cardiology,
The Northern Hospital, 185 Cooper Street, Epping, VIC 3076, Australia
(Rudd, Subiakto, Asrar ul Haq, Mutha, van Gaal) Department of Medicine,
University of Melbourne, Grattan St, Melbourne, VIC 2010, Australia
Title
Use of ivabradine and atorvastatin in emergent orthopedic lower limb
surgery and computed tomography coronary plaque imaging and novel
biomarkers of cardiovascular stress and lipid metabolism for the study and
prevention of perioperative myocardial infarction: Study protocol for a
randomized controlled trial.
Source
Trials. 15 (1) (no pagination), 2014. Article Number: Article 352. Date of
Publication: 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: The incidence of perioperative myocardial infarction (PMI)
globally is known to be around 2 to 3% and can prolong hospitalization,
increased morbidity and mortality. Little is known about the
pathophysiology and risk factors for PMI. We investigate the presence of
elevated novel cardiac markers and preoperative coronary artery plaque
through contemporary laboratory techniques to determine the correlation
with PMI, as well as studying ivabradine and atorvastatin as protective
pharmacotherapies against PMI in the context of orthopedic surgery.
Methods/Design: We aim to enroll 200 patients aged above 60 years who
suffer from neck of femur fracture requiring surgery. Patients will be
randomized to four arms (no study drugs, atorvastatin only, ivabradine
only and ivabradine and atorvastatin). Our primary outcome is incidence of
PMI. All patients will receive an electrocardiogram, cardiac
echocardiography, measurement of novel cardiac biomarkers and computed
tomography (CT) coronary angiography. A telephone interview post discharge
will be conducted at 30 days, 60 days and 1 year. Discussion: We postulate
that ivabradine and atorvastatin will reduce the rate and magnitude of PMI
following surgery by reducing heart rate and attenuating
catecholamine-induced tachycardia postoperatively. Secondly, we postulate
that postoperative reduction in heart rate and catecholamine-induced
tachycardia with ivabradine will correlate with a reduction in
cardiovascular novel biomarkers which will reduce atrial stretch and
postoperative incidence of arrhythmia. We aim to demonstrate that
treatment with ivabradine and atorvastatin will cause a reduction in the
incidence and magnitude of PMI, the benefit of which is derived primarily
in patients with greater atherosclerotic burden as measured by higher CT
coronary calcium scores.
<18>
Accession Number
2014820456
Author
Ahmad A.M.Z.; Ali G.S.R.; Tariq W.
Institution
(Ahmad, Ali, Tariq) Department of Cardiac Surgery, Ch. Pervaiz Elahi
Institute of Cardiology, Abdali Road, Multan, Punjab, Pakistan
Title
Remote ischemic preconditioning is a safe adjuvant technique to myocardial
protection but adds no clinical benefit afer on-pump coronary artery
bypass grafting.
Source
Heart Surgery Forum. 17 (4) (pp E220-E223), 2014. Date of Publication: 01
Aug 2014.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: To evaluate the impact of remote ischemic preconditioning
(RIPC) on clinical outcome, biological markers of myocardial injury, and
its safety in patients undergoing on-pump coronary artery bypass grafting
(CABG).
Material and Methods: This study was conducted at Ch. Pervaiz Elahi
Institute of Cardiology (CPEIC) in Multan. The study took place from March
2012 to June 2013.Patients were randomly placed into two groups. Group A
(N = 32) did not undergo RIPC; Group B (N = 35) received RIPC after
induction of anesthesia. Similar standard general anesthesia,
cardiopulmonary technique, myocardial protection strategies, and surgical
techniques were used in both groups except the protocol for RIPC.
Following postoperative outcome, i.e. cardiac defibrillation after removal
of aortic cross clamp during the period of rewarming, demand for
intra-aortic balloon pump (IABP), demand for antiarrhythmic before leaving
the operation room, postoperative creatine kinase-myocardial band (CK-MB)
level (at 1h, 12h, 24h, and 48h after surgery), postoperative serum
creatinine level on first postoperative day, postoperative ejection
fraction (EF) on third postoperative day, in-hospital mortality, and
one-year mortality were noted, prospectively. Safety of protocol of RIPC
was estimated by limb ischemia monitored by pulse oximetry during and
after procedure of RIPC and postoperative neurapraxia by nerve examination
of right upper limb.
Results: Post aortic cross clamp release cardiac defibrillation, demand
for IABP, demand for high inotropes, and use of antiarrhythmic in the
operation room were statistically insignificant in the non-RIPC and RIPC
group with P values of.54,.78,.16, and.16, respectively. Mean
postoperative CK-MB level (IU/L) showed the following results: At 1h
(Group A 20.94 + 1.66, Group B 20.57 + 1.54, P =.35), at 12h (Group A
27.13 + 1.85, Group B 28.05 + 3.04, P =.135), at 24h (Group A 27.63 + 1.7,
Group B 27.85 + 2.2, P =.63), and at 48h (Group A 22.95 + 2.76, Group B
23.27 + 3.6, P =.69). First postoperative day serum creatinine (Group A
1.29 + 0.395, Group B 1.33 + 0.57, P =.77) and postoperative ejection
fraction percentage on the third postoperative.
<19>
Accession Number
2014701139
Author
Mullen J.C.; Kuurstra E.J.; Oreopoulos A.; Bentley M.J.; Wang S.
Institution
(Mullen, Kuurstra, Oreopoulos, Bentley, Wang) Division of Cardiac Surgery,
University of Alberta Hospital, Edmonton, AB, Canada
(Mullen) Division of Cardiac Surgery, University of Alberta Hospital,
2D2.18 WMC, 8440 112 Street, Edmonton, AB T6G 2B7, Canada
Title
A randomized controlled trial of daclizumab versus anti-thymocyte globulin
induction for heart transplantation.
Source
Transplantation Research. 3 (1) (no pagination), 2014. Article Number: 14.
Date of Publication: July 30, 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: The purpose of this study was to test the efficacy and safety
of daclizumab (DZM) versus anti-thymocyte globulin (ATG) as a component of
induction therapy in heart transplant recipients.Methods: Thirty heart
transplant patients were randomized to receive either ATG or DZM during
induction therapy. Patients in the DZM group received an initial dose of 2
mg/kg intravenous (IV) at the time of transplant and 1 mg/kg IV on
postoperative day 4.Discussion: Recipient, donor, and intraoperative
variables did not differ significantly between groups. The cost of
induction therapy, total drug cost, and hospital ward costs were
significantly less for the DZM group. Average absolute lymphocyte and
platelet counts were significantly higher in the DZM group. There were no
significant differences in the incidence of rejection, infection,
malignancy, or steroid-induced diabetes. One year survival was excellent
in both groups (87%, P = 0.1). Daclizumab is a safe component of induction
therapy in heart transplantation.
<20>
Accession Number
2014588128
Author
Mohamed A.A.; Attia A.R.; Abdelfattah M.M.
Institution
(Attia, Abdelfattah) Mansoura University, Egypt
Title
Hemodynamic effects of sevoflurane versus dexmedetomidine.
Source
Bahrain Medical Bulletin. 36 (3) (no pagination), 2014. Date of
Publication: 2014.
Publisher
Bahrain Medical Bulletin
Abstract
Background: Cardiac catheterization procedures produce challenges for the
anesthetist because of the increased need to provide support in sedating
and/or anesthetizing patients. Objective: To compare pulmonary and
systemic hemodynamics of two anesthetic regimens: sevoflurane as volatile
induction maintenance anesthesia and dexmedetomidine as total intravenous
anesthesia in pediatric patients suffering from congenital heart disease
with left-to-right intracardiac shunt. Design: A Prospective Randomized
Study. Setting: Mansoura University Children Hospital (MUCH), Egypt.
Method: Sixty pediatric patients of both sexes were referred for elective
cardiac catheterization. Patients were randomly allocated into two equal
groups, consisted of 30 patients. In the first group, the patients
received volatile induction maintenance anesthesia (VIMA) with sevoflurane
(GS group) while in the second, the patients received total intravenous
anesthesia (TIVA) with dexmedetomidine (1 mug/kg) intravenous bolus dose
over 10 minutes, anesthesia was maintained by intravenous infusion of
dexmedetomidine at a rate of 1-2 mug/kg/hour (GD group). Result: The
present study showed that the heart rate (HR), Pulmonary blood flow index
(QpI), Systemic blood flow index (QsI) and Qp/Qs ratio were comparable in
both groups. Pulmonary vascular resistance index (PVRI) and Systemic
vascular resistance index (SVRI) were significantly lower in GS group
after induction of general anesthesia (GA) if compared with the basal
value maintaining PVR/SVR at baseline value. However, PVRI and SVRI were
insignificantly higher in GD group after induction of GA if compared with
the basal value; thus, maintaining PVR/SVR. The Systemic Mean arterial
blood pressure (MAP) decreased in both groups. Conclusion: Total
intravenous anesthesia with dexmedetomidine provided hemodynamic
stability. It is comparable to volatile induction and maintenance of
anesthesia with sevoflurane when administered to pediatric patients
suffering from congenital heart disease with left-to-right intracardiac
shunt during cardiac catheterization.
<21>
Accession Number
2014538277
Author
Peng J.-J.; Wang Z.-Y.; Lei L.-C.; Ren L.-H.; Ye H.-M.
Institution
(Peng, Wang, Lei, Ren, Ye) Department of Cardiology, Affiliated Beijing
Shijitan Hospital, Capital Medical University, Beijing 100038, China
Title
Evaluation on the safety and efficacy of high-loading-dose tirofiban in
patients with acute ST-segment elevation myocardial infarction undergoing
primary percutaneous coronary intervention.
Source
Experimental and Clinical Cardiology. 20 (7) (pp 1987-1997), 2014. Date of
Publication: 2014.
Abstract
Objective: To investigate the effectiveness and safety of a
high-loading-dose of tirofiban in STEMI patients undergoing Ppci. Methods:
The study was conducted on 134 patients with STsegment elevation
myocardial infarction (STEMI) undergoing PPCI. Patients were randomized
1:1 into the standard-dose group (a bolus dose of 10mug/kg within 3 min
and followed by continuous intravenous infusion of 0.15mug/kg * min, SD
group) or the high-dose group (the bolus dose was 20mug/kg and the
maintenance dose was 0.225mug/kg * min, HD group), The primary end points
were TIMI flow immediately after angioplasty, sum of ST-segment elevation
resolution (STR) at 90 minutes after angioplasty, the left ventricular
ejection fraction (LVEF) in the hospital and at 90 days follow-up. cardiac
death, target vessel revascularization (TVR), re-infarction and the
combination of these three as major adverse cardiac events (MACE) within
90 days and any bleeding events. Results: Baseline characteristics of the
two groups were well-balanced. the proportions of TIMI grade 3 seemed
higher in high-dose group during and after PCI, but not statistically
different. Patients who were in HD group showed higher LVEF in 90 days
compared with that of the SD group[ (60.07+/-1.08)% vs (55.96+/-1.26)%,
p=0.0047]. At 90d , the incidences of MACEs were not statistically
different in SD and HD group. There was no major bleeding or
thrombocytopenia in both two groups.However, minor bleeding was
significantly higher in HD group. Conclusion: To the STEMI patients
undergoing primary PCI, the use of high-dose tirofiban may be related with
improved short-term clinical outcomes and with no increased risk of major
bleeding.
<22>
[Use Link to view the full text]
Accession Number
2014537416
Author
Raber L.; Kelbaek H.; Taniwaki M.; Ostojic M.; Heg D.; Baumbach A.; Von
Birgelen C.; Roff M.; Tuller D.; Engstrom T.; Moschovitis A.; Pedrazzini
G.; Wenaweser P.; Kornowski R.; Weber K.; Luscher T.F.; Matter C.M.; Meier
B.; Juni P.; Windecker S.
Institution
(Raber, Taniwaki, Moschovitis, Wenaweser, Meier, Windecker) Department of
Cardiology, Bern University Hospital, 3010 Bern, Switzerland
(Kelbaek, Engstrom) Cardiac Catheterization Laboratory, Rigshospitalet,
Copenhagen, Denmark
(Ostojic) Department of Cardiology, Clinical Center of Serbia, Belgrade,
Serbia
(Heg, Juni) Institute of Social and Preventive Medicine, University of
Bern, Bern, Switzerland
(Baumbach) Bristol Heart Institute, Bristol, United Kingdom
(Von Birgelen) Thoraxcenter Twente and Twente University, Enschede,
Netherlands
(Von Birgelen) Division of Cardiology, University Hospital, Geneva,
Switzerland
(Roff) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Tuller, Pedrazzini) Cardiocentro, Lugano, Switzerland
(Kornowski) Rabin Medical Center, Petach Tikva, Israel
(Kornowski) Tel Aviv University, Tel Aviv, Israel
(Weber) Kantonsspital Winterthur, Winterthur, Switzerland
(Luscher, Matter) Department of Cardiology, University Hospital Zurich,
Zurich, Switzerland
(Juni, Windecker) Clinical Trials Unit, Department of Clinical Research,
University of Bern, Bern, Switzerland
Title
Biolimus-eluting stents with biodegradable polymer versus bare-metal
stents in acute Myocardial infarction two-year clinical results of the
COMFORTABLE AMI trial.
Source
Circulation: Cardiovascular Interventions. 7 (3) (pp 355-364), 2014. Date
of Publication: June 2014.
Abstract
Background-This study sought to determine whether the 1-year differences
in major adverse cardiac event between a stent eluting biolimus from a
biodegradable polymer and bare-metal stents (BMSs) in the COMFORTABLE
trial (Comparison of Biolimus Eluted From an Erodible Stent Coating With
Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) were
sustained during long-term follow-up. Methods and Results-A total of 1161
patients were randomly assigned to biolimus-eluting stent (BES) and BMS at
11 centers, and follow-up rates at 2 years were 96.3%. A subgroup of 103
patients underwent angiography at 13 months. At 2 years, differences in
the primary end point of cardiac death, target-vessel myocardial
infarction, and target lesion revascularization continued to diverge in
favor of BES-treated patients (5.8%) compared with BMS-treated patients
(11.9%; hazard ratio=0.48; 95% confdence interval, 0.31-0.72; P<0.001)
with a signifcant risk reduction during the second year of follow-up
(hazard ratio 1-2 years=0.45; 95% confdence interval, 0.20-1.00; P=0.049).
Differences in the primary end point were driven by a reduction in target
lesion revascularization (3.1% versus 8.2%; P<0.001) and target-vessel
reinfarction (1.3% versus 3.4%; P=0.023). The composite of death, any
reinfarction and revascularization (14.5% versus 19.3%; P=0.03), and
cardiac death or target-vessel myocardial infarction (4.2% versus 7.2%;
P=0.036) were less frequent among BES-treated patients compared with
BMS-treated patients. The 13-month angiographic in-stent percent diameter
stenosis amounted to 12.0+/-7.2 in BES- and 39.6+/-25.2 in BMS-treated
lesions (P<0.001). Conclusions-Among patients with ST-segment-elevation
myocardial infarction undergoing primary percutaneous coronary
intervention, BES continued to improve cardiovascular events compared with
BMS beyond 1 year. © 2014 American Heart Association, Inc.
<23>
Accession Number
2014510576
Author
White M.; Boucher A.; Dandavino R.; Fortier A.; Pelletier G.B.; Racine N.;
Ducharme A.; de Denus S.; Carrier M.; Collette S.
Institution
(White, Pelletier, Racine, Ducharme, de Denus, Carrier) Montreal Heart
Institute, Universite de Montreal, Montreal, Canada
(Boucher, Dandavino, Collette) Hopital Maisonneuve-Rosemont, Universite de
Montreal, Montreal, Canada
(Fortier) Montreal Heart Institute Coordinating Center, Montreal, Canada
Title
Sirolimus Immunoprophylaxis and Renal Histological Changes in Long-Term
Cardiac Transplant Recipients: A Pilot Study.
Source
Annals of Pharmacotherapy. 48 (7) (pp 837-846), 2014. Date of Publication:
2014.
Publisher
SAGE Publications Inc.
Abstract
Background: The effects of sirolimus (SIR), as a substitution for
calcineurin inhibitor (CNI) immunoprophylaxis, on renal function in
very-long-term cardiac transplant recipients have been a matter of
controversy. Objective: To assess the impacts of SIR as a substitution for
CNI on renal function up to 24 months in long-term cardiac recipients as
well as the renal histological changes in patients with suspected
CNI-induced nephrotoxicity. Methods: A total of 23 cardiac transplant
recipients aged 57.7 +/- 11.2 years, 91 months post-cardiac
transplantation were recruited; 15 patients were randomized to CNI-free
immune suppression with SIR, and 8 patients were allocated to continue
their CNI regimens. Serum creatinine and calculated serum creatinine
clearance were measured at prespecified time points up to 24 months. Renal
structure and function were assessed by renal biopsies, renal ultrasound,
and magnetic resonance imaging at baseline. Results: There were no
significant changes in creatinine clearance during the course of the study
in patients treated with SIR. However, SIR-treated patients exhibited a
significant decrease in 24-hours and nighttime systolic and diastolic
blood pressures. Typical findings of significant hypertensive renal
disease were detected in 9 of the 11 (82%) patients. Features of chronic
CNI toxicity were detected in 6 (55%) patients. Conclusions: There is a
very high rate of hypertensive renal disease concomitantly with some
degree of CNI toxicity in long-term cardiac transplant recipients with
renal dysfunction. This very high rate of hypertension-related disease may
limit the impact of SIR on improving renal function long term following
cardiac transplantation. © The Author(s) 2014.
<24>
Accession Number
2014471080
Author
Uchiyama K.; Ishikawa T.; Sakamoto N.; Kajikawa H.; Takagi T.; Handa O.;
Tatsumi Y.; Yagi N.; Naito Y.; Itoh Y.; Takemura S.
Institution
(Uchiyama, Ishikawa, Sakamoto, Takagi, Handa, Yagi, Naito, Itoh) Molecular
Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine,
465 Kajiicho Hirokoji Kawaramachi, Kamigyo-ku, Kyoto, 602-8566, Japan
(Kajikawa, Takemura) New Ooe Hospital, Kyoto, Japan
(Tatsumi) Department of Gastrointestinal Diseases, Panasonic Health Care
Center, Osaka, Japan
Title
Analysis of cardiopulmonary stress during endoscopy: Is unsedated
transnasal esophagogastroduodenoscopy appropriate for elderly patients?.
Source
Canadian Journal of Gastroenterology and Hepatology. 28 (1) (pp 31-34),
2014. Date of Publication: January 2014.
Publisher
Pulsus Group Inc. (410 Park Avenue, 15th Floor, 287 pmb, New York NY
10022, United States)
Abstract
BACKGROUND: Transnasal esophagogastroduodenoscopy (EGD) without sedation
has been reported to be safe and tolerable. It has recently been used
widely in Japan for the detection of upper gastrointestinal disease.
Alternatively, transoral examination using a thin endoscope has also been
reported to be highly tolerable. OBJECTIVE: To examine the
cardiocirculatory effects of transoral versus transnasal EGD in an attempt
to determine the most suitable endoscopic methods for patients >75 years
of age. Methods: Subjects who underwent monitoring of respiratory and
circulatory dynamics without sedation during endoscopic screening
examinations were enrolled at the New Ooe Hospital (Kyoto, Japan) between
April 2008 and March 2009. A total of 165 patients (age >75 years)
provided written informed consent and were investigated in the present
study. Patients were randomly divided into three subgroups: UO group -
thin endoscope; SO group - standard endoscope; and UT group - transnasal
EGD. Percutaneous arterial blood oxygen saturation, heart rate and blood
pressure were evaluated just before EGD and at five time points during
EGD. After transnasal EGD, patients who had previously been examined using
transoral EGD with a standard endoscope were asked about preferences for
their next examination. RESULTS: There were no statistical differences in
the characteristics among the groups. Percutaneous oxygen saturation in
the UT group showed a transient drop compared with the SO and UO groups at
the beginning of the endoscopic procedure. Heart rate showed no
significant differences among the SO, UO and UT groups; Systolic blood
pressure in the UO group was lower immediately after insertion compared
with the SO and UT groups. The rate pressure product in the UO group was
comparable with that in the UT group during endoscopy, and the SO group
showed a continuously higher level than the UO and UT groups. More than
one-half (54.4%) of patients were 'willing to choose transnasal EGD for
next examination'. CONCLUSIONS: For elderly patients, unsedated transnasal
EGD failed to show an advantage over unsedated standard endoscopy.
Transoral thin EGD was estimated to be safe and tolerable. ©2014
Pulsus Group Inc. All rights reserved.
<25>
Accession Number
2014462626
Author
Yang H.S.; Kim T.-Y.; Bang S.; Yu G.-Y.; Oh C.; Kim S.-N.; Yang J.-H.
Institution
(Yang) Departments of Cardiovascular Medicine, Konkuk University Medical
Center, Konkuk University School of Medicine, Seoul, South Korea
(Kim, Yu, Oh) Departments of Anesthesiology, Konkuk University Medical
Center, Konkuk University School of Medicine, Seoul, South Korea
(Bang) Departments of Cardiovascular Surgery, Konkuk University Medical
Center, Konkuk University School of Medicine, Seoul, South Korea
(Kim) Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk
University School of Medicine, Seoul, South Korea
(Yang) General Surgery, Konkuk University Medical Center, Konkuk
University School of Medicine, Seoul, South Korea
Title
Comparison of the impact of the anesthesia induction using thiopental and
propofol on cardiac function for non-cardiac surgery.
Source
Journal of Cardiovascular Ultrasound. 22 (2) (pp 58-64), 2014. Date of
Publication: 2014.
Publisher
Korean Society of Echocardiography
Abstract
Background: Thiopental and propofol have been widely used for general
anesthesia induction, but their impacts on cardiac function have not been
well described. A recent study speculated that anesthesia induction using
propofol 2 mg/kg transiently reduced left ventricular (LV) contraction by
analyzing tissue Doppler-derived imaging (TDI) during induction phase. The
purpose of this study was to analyze and to compare the impacts of
propofol- and thiopental-induction on LV function. Methods: Twenty-four
female patients with normal LV function undergoing non-cardiac surgery
were randomly administered intravenous bolus thiopental (5 mg/kg,
Thiopental-group, n = 12) or propofol (2 mg/kg, Propofol-group, n = 12)
for anesthesia-induction. TDI of septal mitral annular velocity during
systole (S'), early diastole (e') and atrial contraction (a') were
determined by transthoracic echocardiography before and 1, 3, and 5
minutes after thiopental/propofol administration (T0, T1, T2, and T3,
respectively). Results: The bispectral index and systolic blood pressure
declined significantly during anesthesia induction in both groups,
however, more depressed in Thiopental-group compared with those in
Propofol-group at T2 and T3 (all, p < 0.05). Among TDI two parameters
demonstrated a significant inter-group difference: the S' in propofol was
lower than that in Thiopental-group at T3 (p = 0.002), and a' velocities
were persistently lower in Propofol-group, compared with same time values
in Thiopental-group (T1, T2, and T3: p = 0.025, 0.007, and 0.009,
respectively). Conclusion: Anesthesia induction using propofol revealed a
more persistent and profound decline of LV and atrial contraction than
that using thiopental. Further studies are needed to understand the
clinical implication. © 2014 Korean Society of Echocardiography.
<26>
Accession Number
2014737596
Author
Pezzella A.T.; Holmes S.D.; Pritchard G.; Speir A.M.; Ad N.
Institution
(Pezzella, Holmes, Pritchard, Speir, Ad) Cardiac Surgery, Inova Heart and
Vascular Institute, 3300 Gallows Rd, Ste 3100, Falls Church, VA
22042-3307, United States
Title
Impact of perioperative glycemic control strategy on patient survival
after coronary bypass surgery.
Source
Annals of Thoracic Surgery. 98 (4) (pp 1281-1285), 2014. Date of
Publication: 01 Oct 2014.
Publisher
Elsevier USA
Abstract
Background. Glycemic control in the perioperative period decreases
mortality and morbidity, but data arescarce with regard to the effects of
glucose control approacheson survival. We assessed long-term survival
inpatients treated with 2 strategies of glucose control afterfirst-time
isolated coronary artery bypass graft.
Methods. In a previously published trial, patientswere prospectively
randomized to strict (90120 mg/dL) or liberal (121180 mg/dL) glucose
control protocols.The aim of this study was to assess long-termdata on
survival and health-related quality of lifebased on the original
prospective randomized studypopulation.
Results. No differences were found in cumulativesurvival between the
strict (95.5%) and liberal (93.5%)target range groups (log-rank [ 0.32, p
[ 0.57) over amean follow-up of 40.0 +/- 4.4 months. Physical
healthrelatedquality of life significantly improved in all patientsfrom
baseline to 6 months after surgery (F [ 17.73,p < 0.001), and there were
no differences in improvementof health-related quality of life between the
2 target rangegroups (F [ 0.15, p [ 0.70).
Conclusions. These results support our previous findingsand indicate that
a liberal glycemic control strategyafter coronary artery bypass leads to
survival rates andimprovements in health-related quality of life that
aresimilar to those achieved with a strict target range. Inaddition, the
liberal strategy is superior in glucose controland target range
management.
<27>
Accession Number
2014463016
Author
Arbel Y.; Ben-Assa E.; Halkin A.; Keren G.; Schwartz A.L.; Havakuk O.;
Leshem-Rubinow E.; Konigstein M.; Steinvil A.; Abramowitz Y.; Finkelstein
A.; Banai S.
Institution
(Arbel, Ben-Assa, Halkin, Keren, Schwartz, Havakuk, Leshem-Rubinow,
Konigstein, Steinvil, Abramowitz, Finkelstein, Banai) Department of
Cardiology, Tel-Aviv Medical Center affiliated to the Sackler Faculty of
Medicine, Tel-Aviv University, 6 Weizman Street, Tel Aviv, Israel
Title
Forced diuresis with matched hydration in reducing acute kidney injury
during transcatheter aortic valve implantation (Reduce-AKI): Study
protocol for a randomized sham-controlled trial.
Source
Trials. 15 (1) (no pagination), 2014. Article Number: 262. Date of
Publication: 02 Jul 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Acute kidney injury (AKI) is observed in up to 41% of patients
undergoing transcatheter aortic valve implantation (TAVI) and is
associated with increased risk for mortality. The aim of the present study
is to evaluate whether furosemide-induced diuresis with matched isotonic
intravenous hydration using the RenalGuard system reduces AKI in patients
undergoing TAVI.Methods/Design: Reduce-AKI is a randomized sham-controlled
study designed to examine the effect of an automated matched hydration
system in the prevention of AKI in patients undergoing TAVI. Patients will
be randomized in a 1:1 fashion to the RenalGuard system (active group)
versus non-matched saline infusion (sham-controlled group). Both arms
receive standard overnight saline infusion and N-acetyl cysteine before
the procedure.Discussion: The Reduce-AKI trial will investigate whether
the use of automated forced diuresis with matched saline infusion is an
effective therapeutic tool to reduce the occurrence of AKI in patients
undergoing TAVI.Trial registration: Clinicaltrials.gov: NCT01866800, 30
April 30 2013. © 2014 Arbel et al.; licensee BioMed Central Ltd.
<28>
Accession Number
2014371334
Author
Yasuuji M.; Kusunoki S.; Hamada H.; Kawamoto M.
Institution
(Yasuuji, Kusunoki) Department of Anesthesiology and Critical Care,
Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
(Hamada, Kawamoto) Department of Anesthesiology and Critical Care,
Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima
734-8551, Japan
Title
Intermittent reinflation is safe to maintain oxygenation without
alteration of extravascular lung water during one-lung ventilation.
Source
Journal of Clinical Anesthesia. 26 (3) (pp 177-183), 2014. Date of
Publication: May 2014.
Publisher
Elsevier Inc.
Abstract
Study Objective To investigate whether a maneuver for repeated cycles of
collapse and reexpansion of the operative lung, termed "intermittent
reinflation" (IR), to counter hypoxemia during one-lung ventilation (OLV),
results in a time-dependent alteration of extravascular lung water. Design
Prospective, randomized clinical study. Setting Operating room and
postsurgical intensive care unit of a university hospital. Patients 36 ASA
physical status 1 and 2 patients undergoing elective, video-assisted
thoracic surgery for lung tumors. Interventions Patients were randomly
assigned to two groups. Group C consisted of 18 patients whose
nondependent lung was kept collapsed during OLV, while Group IR included
18 patients with IR that consisted of 4 separate, 10-second manual
inflations and 5-second openings within one minute at intervals of 20
minutes during OLV. Measurements Perioperative parameters included
transcutaneous oxygen saturation (SpO2), hemodynamic data, extravascular
lung water index (EVLWI), pulmonary vascular permeability index (PVPI) as
determined by the single-indicator transpulmonary thermodilution
technique, and partial pressure of arterial oxygen/inspired oxygen
fraction (PaO2/FIO2) ratio. Main Results Group IR had significantly higher
SpO2 at 20 minutes after commencement of OLV (98.9% vs 96.3%, P = 0.029)
and average SpO2 throughout OLV (98.7% vs 97.0%, P = 0.020). Hemodynamic
data, EVLWI, PVPI, and PaO2/FIO2 ratio did not differ between the groups,
and there were no differences between groups in postoperative morbidity or
hospital stay. Conclusions Intermittent reinflation had a beneficial
effect on oxygenation during OLV, without any significant effects on EVLW
or postoperative outcomes. © 2014 Elsevier Inc.
<29>
Accession Number
2014361410
Author
Carranza C.L.; Ballegaard M.; Werner M.U.; Hasbak P.; Kjaer A.; Kofoed
K.F.; Lindschou J.; Jakobsen J.C.; Gluud C.; Olsen P.S.; Steinbruchel D.A.
Institution
(Carranza, Olsen, Steinbruchel) Department of Cardio-thoracic Surgery, The
Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Ballegaard) Department of Clinical Neurophysiology, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
(Werner) Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
(Hasbak, Kjaer) Department of Clinical Physiology, Nuclear Medicine and
PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Kofoed) Department of Cardiology and Radiology, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
(Lindschou, Jakobsen, Gluud) Copenhagen Trial Unit, Centre for Clinical
Intervention Research, Rigshospitalet, Copenhagen University Hospital,
Blegdamsvej 9, 2100 Copenhagen, Denmark
Title
Endoscopic versus open radial artery harvest and mammario-radial versus
aorto-radial grafting in patients undergoing coronary artery bypass
surgery: Protocol for the 2 x 2 factorial designed randomised NEO trial.
Source
Trials. 15 (1) (no pagination), 2014. Article Number: 135. Date of
Publication: 23 Apr 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Coronary artery bypass grafting using the radial artery has,
since the 1990s, gone through a revival. Observational studies have
indicated better long-term patency when using radial arteries. Therefore,
radial artery might be preferred especially in younger patients where long
time patency is important. During the last 10 years different endoscopic
techniques to harvest the radial artery have evolved. Endoscopic radial
artery harvest only requires a small incision near the wrist in contrast
to open harvest, which requires an incision from the elbow to the wrist.
However, it is unknown whether the endoscopic technique results in fewer
complications or a graft patency comparable to open harvest. When the
radial artery has been harvested, there are two ways to use the radial
artery as a graft. One way is sewing it onto the aorta and another is
sewing it onto the mammary artery. It is unknown which technique is the
superior revascularisation technique. Methods/Design: The NEO Trial is a
randomised clinical trial with a 2 x 2 factorial design. We plan to
randomise 300 participants into four intervention groups: (1)
mammario-radial endoscopic group; (2) aorto-radial endoscopic group; (3)
mammario-radial open surgery group; and (4) aorto-radial open surgery
group. The hand function will be assessed by a questionnaire, a clinical
examination, the change in cutaneous sensibility, and the measurement of
both sensory and motor nerve conduction velocity at 3 months
postoperatively. All the postoperative complications will be registered,
and we will evaluate muscular function, scar appearance, vascular supply
to the hand, and the graft patency including the patency of the central
radial artery anastomosis. A patency evaluation by multi-slice computer
tomography will be done at one year postoperatively.We expect the nerve
conduction studies and the standardised neurological examinations to be
able to discriminate differences in hand function comparing endoscopic to
open harvest of the radial artery. The trial also aims to show if there is
any patency difference between mammario-radial compared to aorto-radial
revascularisation techniques but this objective is exploratory.Trial
registration: ClinicalTrials.gov identifier: NCT01848886.Danish Ethics
committee number: H-3-2012-116.Danish Data Protection Agency:
2007-58-0015/jr.n:30-0838. © 2014 Carranza et al.; licensee BioMed
Central Ltd.
<30>
[Use Link to view the full text]
Accession Number
2014466523
Author
Simpson S.A.; Zaccagni H.; Bichell D.P.; Christian K.G.; Mettler B.A.;
Donahue B.S.; Roberts L.J.; Pretorius M.
Institution
(Simpson, Zaccagni) Department of Pediatrics, Vanderbilt University
Medical School, Nashville, TN, United States
(Bichell, Christian, Mettler) Department of Cardiac Surgery, Vanderbilt
University Medical School, Nashville, TN, United States
(Donahue, Pretorius) Department of Anesthesiology, Vanderbilt University
Medical School, Nashville, TN, United States
(Roberts) Department of Pharmacology, Vanderbilt University Medical
School, Nashville, TN, United States
(Pretorius) Division of Clinical Pharmacology, Department of Medicine,
Vanderbilt University Medical School, Nashville, TN, United States
Title
Acetaminophen attenuates lipid peroxidation in children undergoing
cardiopulmonary bypass.
Source
Pediatric Critical Care Medicine. 15 (6) (pp 503-510), 2014. Date of
Publication: July 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVE: Hemolysis, occurring during cardiopulmonary bypass, is
associated with lipid peroxidation and postoperative acute kidney injury.
Acetaminophen inhibits lipid peroxidation catalyzed by hemeproteins and in
an animal model attenuated rhabdomyolysis-induced acute kidney injury.
This pilot study tests the hypothesis that acetaminophen attenuates lipid
peroxidation in children undergoing cardiopulmonary bypass. DESIGN:
Single-center prospective randomized double-blinded study. SETTING:
University-affiliated pediatric hospital. PATIENTS: Thirty children
undergoing elective surgical correction of a congenital heart defect.
INTERVENTIONS: Patients were randomized to acetaminophen (OFIRMEV
[acetaminophen] injection; Cadence Pharmaceuticals, San Diego, CA) or
placebo every 6 hours for four doses starting before the onset of
cardiopulmonary bypass. MEASUREMENT AND MAIN RESULTS: Markers of
hemolysis, lipid peroxidation (isofurans and F2-isoprostanes), and acute
kidney injury were measured throughout the perioperative period.
Cardiopulmonary bypass was associated with a significant increase in free
hemoglobin (from a prebypass level of 9.8 +/- 6.2 mg/dL to a peak of 201.5
+/- 42.6 mg/dL postbypass). Plasma and urine isofuran and F2-isoprostane
concentrations increased significantly during surgery. The magnitude of
increase in plasma isofurans was greater than the magnitude in increase in
plasma F2-isoprostanes. Acetaminophen attenuated the increase in plasma
isofurans compared with placebo (p = 0.02 for effect of study drug). There
was no significant effect of acetaminophen on plasma F2-isoprostanes or
urinary makers of lipid peroxidation. Acetaminophen did not affect
postoperative creatinine, urinary neutrophil gelatinase-associated
lipocalin, or prevalence of acute kidney injury. CONCLUSION:
Cardiopulmonary bypass in children is associated with hemolysis and lipid
peroxidation. Acetaminophen attenuated the increase in plasma isofuran
concentrations. Future studies are needed to establish whether other
therapies that attenuate or prevent the effects of free hemoglobin result
in more effective inhibition of lipid peroxidation in patients undergoing
cardiopulmonary bypass. Copyright © 2014 by the Society of Critical
Care Medicine and the World.
<31>
Accession Number
2014344490
Author
Hafermann M.J.; Kiser T.H.; Lyda C.; Fish D.N.; Barber G.R.; Wempe M.F.;
Cleveland J.C.
Institution
(Hafermann) University of Washington Medical Center, Seattle, WA, United
States
(Kiser, Lyda, Fish, Barber) University of Colorado Hospital, Aurora, CO,
United States
(Kiser, Fish) Department of Clinical Pharmacy, University of Colorado,
Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, United
States
(Wempe) Department of Pharmaceutical Sciences, University of Colorado,
Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, United
States
(Cleveland) Division of Cardiothoracic Surgery, Department of Surgery,
University of Colorado Anschutz Medical Center, Aurora, CO, United States
Title
Weight-based versus set dosing of vancomycin for coronary artery bypass
grafting or aortic valve surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (6) (pp 1925-1930),
2014. Date of Publication: June 2014.
Publisher
Mosby Inc.
Abstract
Objectives This study was undertaken to identify a preferred dosing
strategy for patients undergoing coronary artery bypass grafting or valve
replacement procedures with cardiopulmonary bypass. Methods Patients
undergoing coronary artery bypass grafting, valve replacement surgery, or
both were randomly assigned to receive either standard 1-g dosing with
vancomycin before and after cardiopulmonary bypass or a single
weight-based 20-mg/kg dose before surgery. The primary outcome was the
percentage of time plasma concentrations were greater than 15 mug/mL
during cardiopulmonary bypass and at surgical closure. Secondary outcomes
included concentration of vancomycin in endothoracic tissue after
vancomycin infusion, average time patients had vancomycin concentrations
greater than 15 mug/mL, and vancomycin plasma and tissue pharmacokinetic
parameters. Results Baseline characteristics were similar between the
study dosing group (n = 10) and the standard dosing group (n = 10). From
postinfusion to end of bypass, the median percentage of time vancomycin
concentrations remained greater than 15 mug/mL was 100% (interquartile
range [IQR], 72.6%-100%) for weight-based dosing versus 43.7% (IQR,
28.7%-53.4%) for standard dosing (P =.0005). From postinfusion to surgical
closure, the percentage of time vancomycin concentrations remained greater
than 15 mug/mL was significantly higher in the weight-based group (100%
[IQR, 58.3%-100%] vs 34.6% [IQR, 25.3%-41.6%]; P =.0005). Weight-based
dosing increased calculated time with vancomycin concentrations greater
than 15 mug/mL and resulted in higher endothoracic tissue vancomycin
concentrations. Conclusions Weight-based vancomycin dosing before coronary
artery bypass grafting or valve replacement results in vancomycin
concentrations greater than 15 mug/mL consistently more than does standard
1-g dosing. © 2014 by The American Association for Thoracic Surgery.
<32>
Accession Number
2014234656
Author
Nishimura M.; Okamoto Y.; Tokoro T.; Sato N.; Nishida M.; Hashimoto T.;
Kobayashi H.; Yamazaki S.; Okino K.; Iwamoto N.; Takahashi H.; Ono T.
Institution
(Nishimura) Cardiovascular Division, Toujinkai Hospital, 83-1, Iga,
Momoyama-cho Fushimi-ku, Kyoto 612-8026, Japan
(Okamoto) Division of Anesthesiology, Toujinkai Hospital, Kyoto, Japan
(Tokoro) Division of Nephrology, Toujinkai Hospital, Kyoto, Japan
(Sato, Nishida, Hashimoto, Kobayashi, Iwamoto, Ono) Division of Urology,
Toujinkai Hospital, Kyoto, Japan
(Yamazaki) Toujinkai Clinic, Kyoto, Japan
(Okino) Toujinkai Satellite Clinic, Kyoto, Japan
(Takahashi) Department of Clinical Sciences and Laboratory Medicine,
Kansai Medical University, Osaka, Japan
Title
Clinical potential of oral nicorandil to improve myocardial fatty acid
metabolism after percutaneous coronary intervention in hemodialysis
patients.
Source
Nephron - Clinical Practice. 126 (1) (pp 24-32), 2014. Date of
Publication: April 2014.
Publisher
S. Karger AG
Abstract
Background/Aims: The assessment of myocardial fatty acid metabolism
impairment by single-photon emission computed tomography (SPECT) using
123I-beta-methyliodophenyl-pentadecanoic acid (BMIPP) might predict the
risk of cardiac death in hemodialysis patients. We investigated the
potential of oral nicorandil to improve myocardial fatty acid metabolism
after percutaneous coronary intervention (PCI) in this population.
Methods: We evaluated 128 hemodialysis patients who had obtained coronary
revascularization by PCI (90 men and 38 women, 66 +/- 9 years).
Participants for the analysis were randomly assigned to either the
nicorandil (n = 63) or control group (n = 65). BMIPP SPECT was performed
every year after coronary revascularization by PCI. Uptake on SPECT was
graded in 17 segments on a 5-point scale (0, normal; 4, absent) and
assessed as BMIPP summed scores (SS). Results: The incidence of cardiac
death was lower (p = 0.004) in the nicorandil group (7/63, 11.1%) than in
the control group (21/65, 32.3%) during a mean follow-up of 2.7 +/- 1.4
years. BMIPP SS reduction rates improved in the nicorandil group compared
with the control group from 3 years of administration. In Kaplan-Meier
analyses, free survival rate of cardiac death was higher in patients with
a >20% BMIPP SS reduction rate as compared with those with a <20% BMIPP SS
reduction rate (p = 0.0001). In multiple logistic analysis, oral
administration of nicorandil was associated with >20% reduction rates of
BMIPP SS (odds ratio 2.823, p = 0.011). Conclusion: Long-term oral
administration of nicorandil may improve impaired myocardial fatty acid
metabolism after coronary revascularization by PCI in hemodialysis
patients. © 2014 S. Karger AG, Basel.
<33>
Accession Number
2014066732
Author
Sabate M.; Brugaletta S.; Cequier A.; Iniguez A.; Serra A.;
Hernadez-Antolin R.; Mainar V.; Valgimigli M.; Tespili M.; Den Heijer P.;
Bethencourt A.; Vazquez N.; Backx B.; Serruys P.W.
Institution
(Sabate, Brugaletta) University Hospital Clinic, IDIBAPS, Cardiology
Department, Barcelona, Spain
(Cequier) University Hospital of Bellvitge, Interventional Cardiology
Unit, Barcelona, Spain
(Iniguez) Hospital Do Meixoeiro, Interventional Cardiology Unit, Vigo,
Spain
(Serra) University Hospital of Sant Pau, Interventional Cardiology Unit,
Barcelona, Spain
(Hernadez-Antolin) University Hospital San Carlos, Interventional
Cardiology Unit, Madrid, Spain
(Mainar) Hospital General of Alicante, Interventional Cardiology Unit,
Alicante, Spain
(Valgimigli) University Hospital Ferrara, Interventional Cardiology Unit,
Ferrara, Italy
(Tespili) University Hospital Bolognini Seriate, Interventional Cardiology
Unit, Bergamo, Italy
(Den Heijer) Amphia Ziekenhuis, Interventional Cardiology Unit, Breda,
Netherlands
(Bethencourt) Hospital Son Espases, Interventional Cardiology Unit, Palma
de Mallorca, Spain
(Vazquez) Hospital Juan Canalejo, Interventional Cardiology Unit, A
Coruna, Spain
(Backx) Erasmus Medical Center, Interventional Cardiology Unit, Rotterdam,
Netherlands
(Serruys) Cardialysis, Rotterdam, Netherlands
Title
The EXAMINATION trial (everolimus-eluting stents versus bare-metal stents
in st-segment elevation myocardial infarction): 2-year results from a
multicenter randomized controlled trial.
Source
JACC: Cardiovascular Interventions. 7 (1) (pp 64-71), 2014. Date of
Publication: January 2014.
Abstract
Objectives This study sought to assess the 2-year outcomes of the
population included in the EXAMINATION (Everolimus-Eluting Stents Versus
Bare-Metal Stents in ST-Segment Elevation Myocardial Infarction) trial
beyond the 1-year prescription period of dual antiplatelet therapy.
Background The EXAMINATION trial compared the performance of
everolimus-eluting stents (EES) versus bare-metal stents (BMS) in an
all-comer ST-segment elevation myocardial infarction (STEMI) population.
Methods This was a multicenter, multinational, prospective, randomized,
single-blind, controlled trial in patients with STEMI. The primary
endpoint, which was the combined endpoint of all-cause death, any
recurrent myocardial infarction, and any revascularization, and the
endpoints target lesion revascularization and stent thrombosis were
assessed at 2 years. Results Between December 31, 2008, and May 15, 2010,
1,498 patients were randomized to receive EES (n = 751) or BMS (n = 747).
Compliance with dual antiplatelet regimen was reduced at 2 years to a
similar degree (17.3% vs. 17.2%, p = 0.91). At 2 years, the primary
endpoint occurred in 108 (14.4%) patients of the EES group and in 129
(17.3%) patients of the BMS group (p = 0.11). Rate of target lesion
revascularization was significantly lower in the EES group than in the BMS
group (2.9% vs. 5.6%; p = 0.009). Rates of definite and definite or
probable stent thrombosis were also significantly reduced in the EES group
(0.8% vs. 2.1%; p = 0.03, and 1.3% vs. 2.8%; p = 0.04, respectively).
Conclusions The 2-year follow-up of the EXAMINATION trial confirms the
safety and efficacy of the EES compared with BMS in the setting of STEMI.
Specifically, both rates of target lesion revascularization and stent
thrombosis were reduced in recipients of EES without any signs of late
attrition for either of these endpoints. (A Clinical Evaluation of
Everolimus Eluting Coronary Stents in the Treatment of Patients With
ST-Segment Elevation Myocardial Infarction: EXAMINATION Study;
NCT00828087). © 2014 by the American College of Cardiology
Foundation.
<34>
Accession Number
2014152757
Author
Watanabe G.; Yamaguchi S.; Takagi T.; Tomita S.; Tuan P.M.
Institution
(Watanabe, Yamaguchi, Takagi, Tomita, Tuan) Department of General and
Cardiothoracic Surgery, Kanazawa University Graduate School of Medical
Science, Kanazawa, 13-1 Takara-machi, Kanazawa 920-8640, Japan
Title
Potent vasodilatory effect of fasudil on radial artery graft in coronary
artery bypass operations.
Source
Annals of Thoracic Surgery. 97 (3) (pp 845-850), 2014. Date of
Publication: March 2014.
Publisher
Elsevier USA
Abstract
Background The radial artery (RA) is a useful conduit for coronary artery
bypass grafting (CABG) but is susceptible to vasospasm during harvesting.
We evaluated the usefulness of fasudil, a Rho kinase inhibitor, in
dilating the RA graft and increasing graft free flow (GFF) compared with
the conventional graft-dilating agents papaverine and
verapamil-nitroglycerin (VG). Methods Between June 2012 and January 2013,
45 patients with ischemic heart disease who underwent isolated CABG using
the RA were enrolled and randomly assigned to fasudil (n = 15), papaverine
(n = 15), or VG (n = 15). Fasudil (2.67 mmol/L), papaverine (1.0 mmol/L)
mixed with heparinized blood, or VG (30 mumol/L each of verapamil and
nitroglycerin) was injected intraluminally into the RA graft after
harvesting. Main outcome measures were RA GFF, hemodynamic changes, and
histopathologic examination of the RA. Results In the fasudil group, GFF
increased significantly (p < 0.001) from 36.8 +/- 20.4 at baseline to
148.0 +/- 88.3 mL/min after injection. GFF increased significantly (p <
0.001) from 36.0 +/- 19.0 to 72.3 +/- 36.7 mL/min in the papaverine group
and increased significantly (p < 0.001) from 39.5 +/- 23.3 to 64.3 +/-
29.9 mL/min in the VG group. The GFF was significantly higher (p = 0.001)
in fasudil-treated RA than in papaverine- or VG-treated RA.
Histopathologically, RA graft diameter was markedly increased after
fasudil injection, and the structure of the multiple elastic lamellae was
intact. Blood pressure did not change significantly after drug injection
in all groups. Conclusions Fasudil exhibited a very potent vasodilatory
effect on the RA compared with conventional papaverine or VG, resulting in
increased GFF. This agent is useful for dilating RA grafts in CABG. ©
2014 by The Society of Thoracic Surgeons.
<35>
Accession Number
2014954271
Author
Muhlestein J.B.; Lappe D.L.; Lima J.A.C.; Rosen B.D.; May H.T.; Knight S.;
Bluemke D.A.; Towner S.R.; Le V.; Bair T.L.; Vavere A.L.; Anderson J.L.
Institution
(Muhlestein, Lappe, May, Knight, Towner, Le, Bair, Anderson) Intermountain
Medical Center Heart Institute, 5121 S Cottonwood St, Murray, UT 84107,
United States
(Muhlestein, Lappe, Knight, Anderson) University of Utah School of
Medicine, Salt Lake City, UT, United States
(Lima, Rosen, Vavere) Cardiology Division, Department of Medicine, Johns
Hopkins University, Baltimore, MD, United States
(Bluemke) Department of Radiology and Imaging Sciences, National
Institutes of Health Clinical Center, Bethesda, MD, United States
Title
Effect of screening for coronary artery disease using CT angiography on
mortality and cardiac events in high-risk patients with diabetes: The
FACTOR-64 randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 312 (21) (pp
2234-2243), 2014. Date of Publication: 03 Dec 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE: Coronary artery disease (CAD) is a major cause of
cardiovascular morbidity and mortality in patients with diabetes mellitus,
yet CAD often is asymptomatic prior to myocardial infarction (MI) and
coronary death. OBJECTIVE: To assess whether routine screening for CAD by
coronary computed tomography angiography (CCTA) in patients with type 1 or
type 2 diabetes deemed to be at high cardiac risk followed by
CCTA-directed therapy would reduce the risk of death and nonfatal coronary
outcomes. DESIGN, SETTING, AND PARTICIPANTS: The FACTOR-64 studywas a
randomized clinical trial in which 900 patients with type 1 or type 2
diabetes of at least 3 to 5 years' duration and without symptoms of
CADwere recruited from 45 clinics and practices of a single health system
(Intermountain Healthcare, Utah), enrolled at a single-site coordinating
center, and randomly assigned to CAD screening with CCTA (n = 452) or to
standard national guidelines-based optimal diabetes care (n = 448)
(targets: glycated hemoglobin level <7.0%, low-density lipoprotein
cholesterol level <100 mg/dL, systolic blood pressure <130 mm Hg). All
CCTA imaging was performed at the coordinating center. Standard therapy or
aggressive therapy (targets: glycated hemoglobin level <6.0%, low-density
lipoprotein cholesterol level <70 mg/dL, high-density lipoprotein
cholesterol level >50 mg/dL [women] or >40 mg/dL [men], triglycerides
level <150 mg/dL, systolic blood pressure <120 mm Hg), or aggressive
therapy with invasive coronary angiography, was recommended based on CCTA
findings. Enrollment occurred between July 2007 and May 2013, and
follow-up extended to August 2014. MAIN OUTCOMES AND MEASURES: The primary
outcomewas a composite of all-cause mortality, nonfatal MI, or unstable
angina requiring hospitalization; the secondary outcome was ischemic major
adverse cardiovascular events (composite of CAD death, nonfatal MI, or
unstable angina). RESULTS: At a mean follow-up time of 4.0 (SD, 1.7)
years, the primary outcome event rates were not significantly different
between the CCTA and the control groups (6.2% [28 events] vs 7.6% [34
events]; hazard ratio, 0.80 [95% CI, 0.49-1.32]; P = .38). The incidence
of the composite secondary end point of ischemic major adverse
cardiovascular events also did not differ between groups (4.4% [20 events]
vs 3.8% [17 events]; hazard ratio, 1.15 [95% CI, 0.60-2.19]; P = .68).
CONCLUSIONS AND RELEVANCE: Among asymptomatic patients with type 1 or type
2 diabetes, use of CCTA to screen for CAD did not reduce the composite
rate of all-cause mortality, nonfatal MI, or unstable angina requiring
hospitalization at 4 years. These findings do not support CCTA screening
in this population. TRIAL REGISTRATION: clinicaltrials.gov Identifier:
NCT00488033.
<36>
Accession Number
2014946513
Author
Frommelt P.C.; Gerstenberger E.; Cnota J.F.; Cohen M.S.; Gorentz J.; Hill
K.D.; John J.B.; Levine J.C.; Lu J.; Mahle W.T.; Mccandless R.T.; Mertens
L.; Pearson G.D.; Spencer C.; Thacker D.; Williams I.A.; Wong P.C.;
Newburger J.W.
Institution
(Frommelt, Gorentz) Medical College of Wisconsin, Milwaukee, WI, United
States
(Gerstenberger) New England Research Institute, Watertown, MA, United
States
(Cnota) Cincinnati Children's Hospital, Cincinnati, OH, United States
(Cohen) Children's Hospital of Philadelphia, Philadelphia, PA, United
States
(Hill) Duke University, Durham, NC, United States
(John) Congenital Heart Institute of Florida/Pediatrix, Tampa, FL, United
States
(Levine, Newburger) Boston Children's Hospital, Boston, MA, United States
(Lu) University of Michigan, Ann Arbor, MI, United States
(Mahle) Emory University School of Medicine, Atlanta, GA, United States
(Mccandless) Primary Children's Hospital, Salt Lake City, UT, United
States
(Mertens) Hospital for Sick Children, Toronto, ON, Canada
(Pearson) National Heart, Lung and Blood Institute, National Institutes of
Health, Bethesda, MD, United States
(Spencer) Medical University of South Carolina, Charleston, SC, United
States
(Thacker) Alfred I. DuPont Hospital for Children, Wilmington, DE, United
States
(Williams) Columbia University Medical Center, New York, NY, United States
(Wong) Children's Hospital of Los Angeles, Los Angeles, CA, United States
Title
Impact of initial shunt type on cardiac size and function in children with
single right ventricle anomalies before the fontan procedure: The single
ventricle reconstruction extension trial.
Source
Journal of the American College of Cardiology. 64 (19) (pp 2026-2035),
2014. Date of Publication: 11 Nov 2014.
Publisher
Elsevier USA
Abstract
Background In children with single right ventricular (RV) anomalies,
changes in RV size and function may be influenced by shunt type chosen at
the time of the Norwood procedure.
Objectives The study sought to identify shunt-related differences in
echocardiographic findings at 14 months and > 6 months pre-Fontan in
survivors of the Norwood procedure.
Methods We compared 2-dimensional and Doppler echocardiographic indices of
RV size and function, neo-aortic and tricuspid valve annulus dimensions
and function, and aortic size and patency at 14.1 1.2 months and 33.6 9.6
months in subjects randomized to a Norwood procedure using either the
modified Blalock-Taussig shunt (MBTS) or right ventricle to pulmonary
artery shunt (RVPAS).
Results Acceptable echocardiograms were available at both time points in
240 subjects (114 MBTS, 126 RVPAS). At 14 months, all indices were similar
between shunt groups. From the 14-month to pre-Fontan echocardiogram, the
MBTS group had stable indexed RV volumes and ejection fraction, while the
RVPAS group had increased RV end-systolic volume (p = 0.004) and decreased
right ventricular ejection fraction (RVEF) (p = 0.004). From 14 months to
pre-Fontan, the treatment groups were similar with respect to decline in
indexed neo-aortic valve area, ;neo-aortic valve regurgitation (5% at each
time), indexed tricuspid valve area, and moderate tricuspid valve
regurgitation (20% at each time).
Conclusions Initial Norwood shunt type influences pre-Fontan RV remodeling
during the second and third years of life in survivors with single RV
anomalies, with greater RVEF deterioration after RVPAS. Encouragingly,
other indices of RV function remain stable before Fontan regardless of
shunt type. (Comparison of Two Types of Shunts in Infants with Single
Ventricle Defect Undergoing Staged Reconstruction - Pediatric Heart
Network; NCT00115934)
<37>
Accession Number
2013812381
Author
Rodes-Cabau J.; Bertrand O.F.; Larose E.; Dery J.-P.; Rinfret S.; Urena
M.; Jerez M.; Nombela-Franco L.; Ribeiro H.B.; Allende R.; Proulx G.;
Nguyen C.M.; Boudreault J.-R.; Rouleau J.; Roy L.; Gleeton O.; Barbeau G.;
Noel B.; COte M.; Despres J.-P.; Dagenais G.R.; DeLarochelliere R.
Institution
(Rodes-Cabau, Bertrand, Larose, Dery, Rinfret, Urena, Jerez,
Nombela-Franco, Ribeiro, Allende, Proulx, Nguyen, Boudreault, Rouleau,
Roy, Gleeton, Barbeau, Noel, COte, Despres, Dagenais, DeLarochelliere)
Quebec Heart and Lung Institute, Quebec City, QC, Canada
Title
Five-Year Follow-up of the Plaque Sealing With Paclitaxel-Eluting Stents
vs Medical Therapy for the Treatment of Intermediate Nonobstructive
Saphenous Vein Graft Lesions (VELETI) Trial.
Source
Canadian Journal of Cardiology. 30 (1) (pp 138-145), 2014. Date of
Publication: January 2014.
Publisher
Pulsus Group Inc.
Abstract
Background: Very few data exist on the long-term follow-up of patients
with intermediate nonobstructive saphenous vein graft (SVG) lesions. The
purpose of this study was to evaluate the 5-year clinical outcomes of the
patients enrolled in the Moderate Vein Graft Lesion Stenting With the
Taxus Stent and Intravascular Ultrasound (VELETI) and the factors
associated with SVG disease progression and outcomes. Methods: Patients
with > 1 intermediate SVG lesion (30%-60% diameter stenosis) were
randomized to either stenting the SVG lesion with a paclitaxel-eluting
stent (PES group, n= 30) or to medical treatment alone (MT group, n= 27).
All patients were followed yearly up to 5 years. Results: Major adverse
cardiac events (MACEs) (cardiac death, myocardial infarction [MI],
revascularization) related to the target SVG lesion tended to be lower in
the PES group (17% vs 33%; P= 0.146) due to a lower lesion
revascularization rate (13% vs 33%; P= 0.072), with no difference in
cardiac death or MI between groups. MACEs related to the target SVG and
global MACEs were similar between groups (P > 0.20 for both). A higher
cholesterol level at baseline was the only independent predictive factor
of MACEs related to the target SVG (P= 0.016). Conclusions: Over a 5-year
period, one third of intermediate lesions in old SVGs progressed, leading
to a cardiac event. Stenting these lesions with PESs tended to improve
clinical outcomes by reducing lesion progression but not SVG failure.
Higher cholesterol levels were associated with SVG disease progression and
clinical events. This pilot study provides the basis for a larger trial to
determine the efficacy of intermediate SVG lesion plaque sealing. ©
2014 Canadian Cardiovascular Society.
<38>
Accession Number
2014393070
Author
Kohl B.A.; Hammond M.S.; Cucchiara A.J.; Ochroch E.A.
Institution
(Kohl, Hammond, Cucchiara, Ochroch) Department of Anesthesiology and
Critical Care, Perelman School of Medicine, University of Pennsylvania,
3400 Spruce Street, Founders 5, Philadelphia, PA 19104, United States
Title
Intravenous GLP-1 (7-36) amide for prevention of hyperglycemia during
cardiac surgery: A randomized, double-blind, placebo-controlled study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (3) (pp 618-625),
2014. Date of Publication: June 2014.
Publisher
W.B. Saunders
Abstract
Objective The authors sought to evaluate the efficacy of an intravenous
glucagon-like peptide-1 (GLP-1) infusion, compared with placebo, to
mitigate intraoperative hyperglycemia. Design Prospective, double-blinded,
randomized, placebo-controlled. Setting University hospital. Participants
Diabetic (non-insulin dependent) and non-diabetic patients undergoing
elective cardiac surgery with cardiopulmonary bypass. Interventions
Patients were randomized in a 1:1 fashion to GLP-1 (7-36) amide infusion
(1.5 pmol/kg/min) or placebo. Insulin was administered intraoperatively to
both groups per a standardized protocol. Measurements and Main Results A
total of 77 patients were included for analysis (GLP-1, n = 37; placebo, n
= 40). Mean blood glucose during cardiopulmonary bypass was 127.5 mg/dL
and 142.5 mg/dL (p = 0.002) in the GLP-1 and placebo groups, respectively.
Mean blood glucose values during the entire intraoperative course were
12.2 mg/dL lower for subjects given GLP-1 (95% CI 2.3, 22, p = 0.015),
independent of time. During the period of cardiopulmonary bypass, mean
blood glucose values in subjects given GLP-1 were 14.1 mg/dL lower than
those who received placebo (95% CI 3.5, 24.8, p = 0.009), independent of
time. The incidence of hypoglycemia did not differ significantly between
the 2 groups. Conclusions Administration of intravenous GLP-1 (7-36) amide
to patients undergoing cardiac surgery significantly reduced their plasma
glucose levels intraoperatively and may represent a novel therapeutic
strategy to prevent perioperative hyperglycemia. © 2014 Elsevier Inc.
<39>
[Use Link to view the full text]
Accession Number
2014149389
Author
Macken L.C.; Yates B.C.; Meza J.; Norman J.; Barnason S.; Pozehl B.
Institution
(Macken, Yates, Meza, Norman) University of Nebraska Medical Center,
Omaha, NE, United States
(Barnason, Pozehl) University of Nebraska at Lincoln, Lincoln, NE, United
States
Title
Health-related quality-of-life outcomes in coronary artery bypass surgery
patients and partners.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 34 (2) (pp
130-137), 2014. Date of Publication: March-April 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
PURPOSE: The purpose of this study was to examine health-related
quality-of-life (HRQOL) outcomes in coronary artery bypass surgery (CABS)
patients and partners enrolled together in cardiac rehabilitation versus a
usual care group. METHODS: After CABS, couples were randomly assigned to
the Partners Together in Health (PaTH) intervention (n = 17) or usual care
(n = 17) groups. Health-related quality-of-life was operationalized as
physical function (SF-36 Physical Functioning subscale), depression
(Patient Health Questionnaire), and marital adjustment (Dyadic Adjustment
Scale). Data were measured in patients and partners at the start (T1) and
end of cardiac rehabilitation (T2), and 3 months after cardiac
rehabilitation (T3). Nonparametric statistics were used to examine changes
over time and differences between groups. RESULTS: Patients in both
groups, and partners in the PaTH group, significantly improved physical
function between T1 and T2. At T1, 18% of patients and 6% of partners were
depressed. At T2 and T3, only 3% of patients and no partners were
depressed. Almost 12% of patients and partners were maritally distressed
at T1. At T2 and T3, patients' marital distress was unchanged, but more
partners reported marital distress (15%). CONCLUSIONS: This study adds to
our understanding of the trajectory of HRQOL outcomes after CABS for
patients and partners. These findings demonstrated promise for the PaTH
intervention. Future testing of the intervention is warranted in a larger
sample. Because patients and partners are impacted by CABS as a shared
life experience, couple-centered interventions may improve HRQOL outcomes
more than individually focused interventions. Copyright © 2014
Wolters Kluwer Health
Lippincott Williams & Wilkins.
<40>
Accession Number
2014253393
Author
Geller B.J.; Mega J.L.; Morrow D.A.; Guo J.; Hoffman E.B.; Gibson C.M.;
Ruff C.T.
Institution
(Geller, Mega, Morrow, Guo, Hoffman, Ruff) Department of Medicine, Brigham
and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, Boston,
MA, United States
(Gibson) Department of Medicine, Beth Israel Hospital, Harvard Medical
School, Boston, MA, United States
Title
Autoantibodies to phosphorylcholine and cardiovascular outcomes in
patients with acute coronary syndromes in the ATLAS ACS-TIMI 46 trial.
Source
Journal of Thrombosis and Thrombolysis. 37 (3) (pp 310-316), 2014. Date of
Publication: April 2014.
Publisher
Kluwer Academic Publishers
Abstract
Atherogenesis is a complex inflammatory process stemming from the
accumulation and oxidation of low density lipoproteins (LDL). IgM
autoantibodies against phosphorylcholine (anti-PC) bind to the PC epitope
on oxidized LDL (OxLDL), inhibiting the uptake of oxLDL by macrophages in
atherosclerotic lesions. Anti-PC autoantibodies have been reported to be
protective against atherothrombosis. We investigated the relationship of
anti-PC concentrations with cardiovascular outcomes in patients with acute
coronary syndromes (ACS). We measured anti-PC levels within 7 days of an
ACS in 3,356 patients enrolled in the ATLAS ACS-TIMI 46 trial, a
randomized dose ranging study of rivaroxaban versus placebo. The primary
endpoint was death, myocardial infarction (MI), stroke, or severe
recurrent ischemia (SRI) requiring revascularization during 6 months. The
median baseline anti-PC concentration was 40.9 U/mL (25th, 75th
percentiles: 25.4, 67.4). There was no significant association between
anti-PC levels and the primary endpoint (Q1: 6.8 %, Q2: 4.2 %, Q3: 7.8 %,
Q4: 5.4 %, p-trend = 0.87), all-cause mortality (Q1: 1.4 %, Q2: 0.7 %, Q3:
2.4 %, Q4: 0.9 %, p-trend = 0. 96), or any of the other individual
endpoint components (MI: p-trend = 0.87, Stroke: p-trend = 0.43, SRI:
p-trend = 0.66). Using the previously reported anti-PC cutpoint of 17 U/mL
did not reveal a significant relationship between anti-PC concentrations
and cardiovascular outcomes (<17 U/mL: 8.1 % vs. >17 U/mL: 5.8 %; p =
0.11). Similarly, evaluation of anti-PC as a continuous variable did not
reveal a significant association (p = 0.30). In this study of patients
early after ACS undergoing intensive secondary preventive therapy, IgM
anti-PC titers did not exhibit a significant relationship with
cardiovascular outcomes. © 2013 Springer Science+Business Media.
<41>
Accession Number
2014309920
Author
Bouchard D.; Jensen H.; Carrier M.; Demers P.; Pellerin M.; Perrault L.P.;
Lambert J.
Institution
(Bouchard, Jensen, Carrier, Demers, Pellerin, Perrault) Department of
Cardiac Surgery, Montreal Heart Institute, Universite de Montreal, 5000
Belanger St, Montreal, QC H1T 1C8, Canada
(Lambert) Department of Social and Preventive Medicine, Universite de
Montreal, Montreal, QC, Canada
Title
Effect of systematic downsizing rigid ring annuloplasty in patients with
moderate ischemic mitral regurgitation.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (5) (pp 1471-1477),
2014. Date of Publication: May 2014.
Publisher
Mosby Inc.
Abstract
Objective: Functional ischemic mitral regurgitation (FIMR) increases
mortality independently of the baseline characteristics and ventricular
function. The effect of treating FIMR with annuloplasty is unclear when
mitral regurgitation is moderate. Myocardial revascularization alone has
been shown to improve mitral valve function. Methods: We randomized 31
patients with moderate (grade 2-4) FIMR to receive either coronary artery
bypass grafting (CABG) alone or CABG plus downsizing mitral ring
annuloplasty. The patients were followed up for clinical outcomes and
echocardiographic assessment of mitral valve function and left ventricular
dimensions at 3 and 12 months. Clinical improvement was assessed using the
Minnesota quality-of-life questionnaire, 6-minute walk test, and brain
natriuretic peptide levels. Results: The clinical course was similar in
the 2 groups of patients during the study period. FIMR was perfectly
corrected intraoperatively in the ring group. Echocardiographic follow-up
at 3 months showed no difference in the FIMR grade between the 2 groups
(66% less than grade 2 in the CABG alone and 86% in the CABG plus ring
group; P =.316). The improvement in the CABG alone group was even more
marked at 12 months (85% less than grade 2 in the CABG group and 85% in
the CABG plus ring group). The left ventricular ejection fraction was
significantly better at 3 months in the CABG alone group, although at 12
months, the left ventricular ejection fraction in the 2 groups had
improved similarly. Conclusions: Although initially effective at reducing
moderate FIMR, the addition of a ring did not change the clinical course
after CABG surgery. At 12 months, no echocardiographic difference was
found in terms of residual mitral regurgitation, left ventricular
dimensions and function, or clinical outcomes. Copyright © 2014 by
The American Association for Thoracic Surgery.
<42>
Accession Number
2014082332
Author
Aser R.; Orhan C.; Niemann B.; Roth P.; Perepelitsa A.; Attmann T.; Boning
A.
Institution
(Aser, Orhan, Niemann, Roth, Perepelitsa, Attmann, Boning) Department of
Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
Title
Temporary epicardial pacemaker wires: Significance of position and
electrode type.
Source
Thoracic and Cardiovascular Surgeon. 62 (1) (pp 66-69), 2014. Date of
Publication: February 2014.
Abstract
Objective To determine the pacing and sensing properties of different
temporary epicardial pacemaker electrodes after cardiac surgery depending
on position at the heart and time after surgery. Methods From September
2009 to October 2010, 60 patients undergoing cardiac surgery were
prospectively randomized into two groups: group O: Osypka-electrodes (n =
30), group M: Medtronic-electrodes (n = 30). In position 1, the bipolar
electrodes were inserted onto the anterior wall of the right ventricle and
at the right atrial auricle, in position 2, onto the diaphragmal wall of
the right ventricle and at the aortic aspect of the superior vena cava
medial close to the atrium. Sensing values and pacing thresholds were
measured for all electrodes during surgery, on day 1 and every second day
up to day 10 after surgery. Results In both groups, pacing thresholds
(both positions) were higher during surgery (ventricle 3.1 +/- 0.6 V,
atrium 3.1 +/- 0.3 V) than at day 1 (ventricle 2.4 +/- 0.7 V, atrium 2.4
+/- 0.3 V) and increased during the perioperative course until day 10
(ventricle 4.7 +/- 1.0 V, atrium 4.9 +/- 1.1 V, p = 0.04, p = 0.02). P and
R wave amplitudes did not change over time (atrium 5.1 +/- 0.1 mV
initially, 4.2 +/- 0.1 mV at removal (p = ns); ventricle 10.4 +/- 0.2 mV
vs. 10.1 +/- 0.25 mV). Group M had better median pacing thresholds
compared with group O (atrium: 2.9 +/- 0.6 V vs. 3.9 +/- 0.7 V, p = 0.04
and ventricle: 2.6 +/- 0.6 V vs. 3.9 +/- 0.6 V, p = 0.045). Atrial
position 1 was superior to position 2 concerning pacing thresholds of
Medtronic electrodes (2.1 +/- 0.3 mV vs. 3.4 +/- 0.4 mV, p = 0.02).
Osypka-electrodes were easier to handle due to their more pliable texture.
Conclusions 1. Up to postoperative day 10, adequate pacing and sensing
performance was achieved by both electrode types in each position. 2.
Medtronic electrodes had better pacing thresholds in atrium and ventricle
after day 5. 3. Positioning of pacemaker electrodes does not alter
functionality. 4. Handling of Osypka electrodes was easier than that of
Medtronic electrodes. © 2014 Georg Thieme Verlag KG Stuttgart New
York.
<43>
Accession Number
2014095935
Author
Rustad L.A.; Nytroen K.; Amundsen B.H.; Gullestad L.; Aakhus S.
Institution
(Rustad, Nytroen, Gullestad, Aakhus) Department of Cardiology, Oslo
University Hospital HF, Rikshospitalet, Postbox 4950, Nydalen, 0424 Oslo,
Norway
(Rustad, Amundsen, Aakhus) Department of Circulation and Medical Imaging,
Norwegian University of Science and Technology, Trondheim, Norway
(Amundsen) Department of Cardiology, St Olavs University Hospital,
Trondheim, Norway
(Gullestad) Faculty of Medicine, University of Oslo, Norway
Title
One year of high-intensity interval training improves exercise capacity,
but not left ventricular function in stable heart transplant recipients: A
randomised controlled trial.
Source
European Journal of Preventive Cardiology. 21 (2) (pp 181-191), 2014. Date
of Publication: February 2014.
Abstract
Background: Heart transplant recipients have lower exercise capacity and
impaired cardiac function compared with the normal population.
High-intensity interval training (HIIT) improves exercise capacity and
cardiac function in patients with heart failure and hypertension, but the
effect on cardiac function in stable heart transplant recipients is not
known. Thus, we investigated whether HIIT improved cardiac function and
exercise capacity in stable heart transplant recipients by use of
comprehensive rest- and exercise- echocardiography and cardiopulmonary
exercise testing. Design and methods: Fifty-two clinically stable heart
transplant recipients were randomised either to HIIT (4-4 minutes at
85-95% of peak heart rate three times per week for eight weeks) or to
control. Three such eight-week periods were distributed throughout one
year. Echocardiography (rest and submaximal exercise) and cardiopulmonary
exercise testing were performed at baseline and follow-up. Results: One
year of HIIT increased VO2peak from 27.7+/-5.5 at baseline to 30.9+/-5.0
ml/kg/min at follow-up, while the control group remained unchanged
(28.5+/-7.0 vs. 28.0+/-6.7 ml/kg per min, p<0.001 for difference between
the groups). Systolic and diastolic left ventricular functions at rest and
during exercise were generally unchanged by HIIT. Conclusions: Whereas
HIIT is feasible in heart transplant recipients and effectively improves
exercise capacity, it does not alter cardiac systolic and diastolic
function significantly. Thus, the observed augmentation in exercise
capacity is best explained by extra-cardiac adaptive mechanisms. ©
The European Society of Cardiology 2012.
<44>
Accession Number
2014094929
Author
Riley A.A.; Jefferies J.L.; Nelson D.P.; Bennett M.R.; Blinder J.J.; Ma
Q.; Devarajan P.; Goldstein S.L.
Institution
(Riley) Pediatric Renal Section, Baylor College of Medicine, Houston, TX,
United States
(Jefferies, Nelson, Bennett, Ma, Devarajan, Goldstein) Center for Acute
Care Nephrology, Cincinnati Children's Medical Center, Cincinnati, OH,
United States
(Blinder) Department of Cardiology, Boston Children's Hospital, Boston,
MA, United States
(Jefferies, Nelson, Goldstein) The Heart Institute, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States
Title
Peritoneal dialysis does not adversely affect kidney function recovery
after congenital heart surgery.
Source
International Journal of Artificial Organs. 37 (1) (pp 39-47), 2014. Date
of Publication: January 2014.
Publisher
Wichtig Publishing Srl
Abstract
Purpose: Acute kidney injury (AKI) after cardiopulmonary bypass surgery to
correct congenital heart disease is common. We prevent fluid overload and
further cardiac compromise in oliguric infants with continuous peritoneal
dialysis (CPD). The effect of CPD on kidney recovery is unknown, thus
indications to discontinue CPD are unclear. We aimed to determine if CPD
affects kidney recovery, measured by urine output and novel urinary AKI
biomarker concentrations. Methods: Twenty infants <90 days old with
congenital heart disease who underwent bypass surgery and were
post-operatively treated with CPD were randomized at the time of clinical
readiness for CPD discontinuation to 1) discontinue CPD (control) or 2)
continue 24 h more CPD (experimental). Urine output (ml/kg per h), total
output (ml/kg per h) and urinary neutrophil gelatinase-associated
lipocalin, interleukin-18, liver-type fatty acid binding protein, and
kidney injury molecule-1 were assessed postsurgery until CPD catheter
removal. Results: 24 hours preceding randomization, there were no
differences in mean urine output or total output; 24 hours
post-randomization, the control group had higher mean urine output (4.2
+/- 2.6 ml/kg per h vs. 2.8 +/- 2.0 ml/kg per h, p = 0.02) but lower total
output (6.3 +/- 2.1 ml/kg per h vs. 4.7 +/- 2.7 ml/kg per h, p = 0.01).
Median biomarker concentrations did not differ significantly between
groups at any time point. Conclusions: Our results suggest renal
replacement therapy does not change the time course of kidney function
recovery. © 2014 Wichtig Editore.
<45>
Accession Number
2014064741
Author
Muhammad M.I.A.
Institution
(Muhammad) Department of Cardio-Thoracic Surgery, Faculty of Medicine,
Suez Canal University, Egypt
(Muhammad) Department of Thoracic Surgery, King Fahad Hospital, Al-Madina
Al-Munawara, Saudi Arabia
Title
Thoracoscopic repair of pectus excavatum using different bar stabilizers
versus open repair.
Source
Asian Cardiovascular and Thoracic Annals. 22 (2) (pp 187-192), 2014. Date
of Publication: February 2014.
Publisher
SAGE Publications Inc.
Abstract
Objectives: To identify the preoperative characteristics and compare
operative variables and postoperative outcomes in adult patients with
pectus excavatum undergoing thoracoscopic repair using different bar
stabilizers or open surgical repair. Methods: 31 patients were randomly
divided into 3 groups: group A was 9 patients who underwent a modified
Ravitch repair, group B was 11 patients who underwent video-assisted
thoracoscopic repair using metal stabilizers, and group C was 11 patients
who underwent video-assisted thoracoscopic repair using absorbable
stabilizers. Preoperative, intraoperative, and postoperative variables and
mortality were compared among groups. Results: In all groups, preoperative
variables were well-matched for age, sex, and Haller index. Operative time
was significantly longer in group A. The postoperative length of hospital
stay was significantly shorter in group A. Postoperative complications
occurred in 7 (22.6%) patients, mostly in groups B and C. All patients
were satisfied with the cosmetic result. Conclusions: Repair of pectus
excavatum in adult patients can be performed effectively either through an
open surgical technique or thoracoscopy, with no intraoperative
complications and excellent immediate results, but video-assisted
thoracoscopic repair using metallic or absorbable bar stabilizers gives a
better cosmetic result; however, absorbable bar stabilizers are more
vulnerable and break more easily than metal stabilizers. © The
Author(s) 2013.
<46>
Accession Number
2014030989
Author
Toikkanen V.; Rinne T.; Huhtala H.; Laurikka J.; Porkkala H.; Tarkka M.;
Mennander A.
Institution
(Toikkanen, Laurikka, Tarkka, Mennander) Heart Center, Tampere University
Hospital and University of Tampere, Tampere, Finland
(Rinne, Porkkala) Division of Cardiac Anesthesia, Heart Center, Tampere
University Hospital, Tampere, Finland
(Huhtala) School of Health Sciences, University of Tampere, Tampere,
Finland
(Mennander) Department of Cardiothoracic Surgery, Heart Center, Tampere
University Hospital, Teiskontie 35, Box 2000, 33521 Tampere, Finland
Title
Cardiopulmonary bypass decreases pulmonary vascular resistance index after
coronary artery bypass surgery.
Source
Scandinavian Journal of Clinical and Laboratory Investigation. 74 (1) (pp
37-43), 2014. Date of Publication: January 2014.
Abstract
Background. Decreased pulmonary vascular resistance index (PVRI) reflects
favorable postoperative pulmonary circulation after coronary artery bypass
grafting. This randomized study investigated whether cardiopulmonary
bypass (CPB) impacts PVRI after coronary artery bypass grafting. Material
and methods. A total of 47 patients undergoing coronary artery bypass
grafting were randomized into four groups according to the ventilation and
surgical technique: (1) No ventilation group, with intubation tube
detached from the ventilator, (2) low tidal volume group, with continuous
low tidal volume ventilation, (3) continuous 10 cm H2O positive airway
pressure (CPAP) group, and (4) randomly selected patients undergoing
surgery without CPB. Oxygenation index, pulmonary shunt, alveolar-arterial
oxygen gradient and PVRI were determined. PVRI was calculated as the
transpulmonary pressure gradient divided by cardiac index multiplied by
80. Results. During the first postoperative morning there were no
statistical differences in oxygenation index, pulmonary shunt or
alveolar-arterial oxygen gradient between the groups, while PVRI remained
elevated in patients without CPB as compared with patients with CPB (263
+/- 98 vs. 122 +/- 84, dyne-s-cm-5, respectively, p < 0.001). PVRI
decreased in all patients with CPB regardless of ventilation technique. In
contrast, elevated postoperative PVRI values were predictive for patients
without CPB (AUC 0.786; SE 0.043; p < 0.001; 95% CI. 0.701-0.870).
Conclusions. Modified ventilation does not affect PVRI in elective
patients with healthy lungs during CPB. Instead, CPB per se may have an
important role on diminished PVRI. We suggest that CPB preserves pulmonary
arterial endothelial integrity. © 2014 Informa Healthcare.
<47>
Accession Number
2014631040
Author
Elbarouni B.; Cantor W.J.; Ducas J.; Borgundvaag B.; Dzavik V.; Heffernan
M.; Buller C.E.; Langer A.; Goodman S.G.; Yan A.T.
Institution
(Elbarouni, Buller, Langer, Goodman, Yan) Terrence Donnelly Heart Centre,
St Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Elbarouni, Ducas) St Boniface General Hospital, University of Manitoba,
Winnipeg, MB, Canada
(Cantor) Southlake Regional Health Centre, Newmarket, University of
Toronto, Toronto, ON, Canada
(Borgundvaag) Mount Sinai Hospital, Toronto, ON, Canada
(Dzavik) Peter Munk Cardiac Centre, University Health Network, University
of Toronto, Toronto, ON, Canada
(Heffernan) Oakville Hospital, Oakville, ON, Canada
(Langer, Goodman) Canadian Heart Research Centre, Toronto, ON, Canada
Title
Efficacy of an Early Invasive Strategy After Fibrinolysis in ST-Elevation
Myocardial Infarction Relative to the Extent of Coronary Artery Disease.
Source
Canadian Journal of Cardiology. 30 (12) (pp 1555-1561), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Pulsus Group Inc.
Abstract
Background: A strategy of early transfer for coronary angiography and
intervention is superior to a standard approach of delayed coronary
angiography after fibrinolysis for ST-elevation myocardial infarction
(STEMI). STEMI patients with lesions in noninfarct-related arteries have a
worse prognosis compared with patients with single vessel disease. This
study aimed to assess whether the benefits of an early invasive strategy
differ in patients with single vessel and multivessel disease. Methods:
The Trial of Routine ANgioplasty and Stenting after Fibrinolysis to
Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI)
randomized STEMI patients receiving fibrinolysis to a strategy of early
transfer and coronary angiography vs a standard approach. In this post hoc
analysis, we stratified 992 patients into 2 groups according to the
presence or absence of multivessel disease. We compared the 2 groups in
terms of baseline characteristics, in-hospital management, and patient
outcomes, and tested for treatment heterogeneity. Results: Multivessel
disease was present in 369 (37%) patients. Patients with multivessel
disease had a greater rate of the primary composite end point of
in-hospital death, recurrence of infarction, recurrent ischemia, shock, or
heart failure at 30 days (18.2% vs 10.8%; P < 0.001). An early invasive
strategy was efficacious in both groups for the primary outcome. In
multivariable analysis adjusting for Global Registry of Acute Coronary
Events (GRACE) risk score, there was no significant treatment
heterogeneity (all P interaction > 0.40) for the primary end point, or
death/recurrence of infarction at 6 months and 1 year. Conclusions:
Multivessel disease is present in a significant proportion of STEMI
patients treated with fibrinolysis and is associated with worse outcomes.
A strategy of early transfer and coronary intervention after fibrinolysis
was beneficial regardless of the presence or absence of multivessel
disease.
<48>
Accession Number
2014627834
Author
Wang K.; Kong X.; Zhu Y.; Wang J.
Institution
(Wang, Kong, Zhu, Wang) Department of Cardiovascular Surgery, Tianjin
First Center Hospital, Tianjin 300192, China
Title
Use of an intra-aortic balloon pump with chronic renal cardiac surgery.
Source
Clinica Terapeutica. 165 (5) (pp e353-e356), 2014. Date of Publication:
2014.
Publisher
Societa Editrice Universo
Abstract
Objective. To investigate the protective effect of an intra-aortic balloon
pump (IABP) on renal function during open-heart surgery in patients with
chronic renal insufficiency. Materials and Methods. Seventeen patients
with moderate renal insufficiency who underwent cardiac pulmonary bypass
surgery were randomly assigned to receive either IABP or usual care
(control group). In the IABP group, the IABP was inserted immediately
after anesthesia, and built-in counterpulsation was continued during
aortic blockade. The IABP was gradually removed when postoperative
hemodynamics and renal function was recovered. Clinical parameters related
to renal function, including urine output and serum creatinine levels,
were recorded perioperatively. Results. Urine volume during surgery,
postoperative usage of diuretics, and mechanical ventilation time were
better in the IABP group than in the control group. Serum creatinine
increased after surgery in both groups, but the increase was significantly
smaller in the IABP group. Conclusion. Preoperative use of IABP in
patients with moderate renal insufficiency undergoing cardiac surgery can
help protect renal function and may improve prognosis.
<49>
Accession Number
2014053015
Author
Khanykin B.; Siddiqi R.; Jensen P.F.; Bigler D.R.; Atroshchenko G.V.
Institution
(Khanykin, Siddiqi, Jensen, Bigler) Department of Thoracic Anesthesiology,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Atroshchenko) Department of Cardiothoracic Surgery, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
Title
Comparison of remifentanil and low-dose fentanyl for fast-track cardiac
anesthesia: A prospective randomized study.
Source
Heart Surgery Forum. 16 (6) (pp E324-E328), 2013. Date of Publication:
December 2013.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Different anesthetic techniques have been used for fast
tracking in cardiac anesthesia. Remifentanil, with its unique
pharmacokinetic profile, could be an ideal drug for fast tracking.
Possible limitations of remifentanil are rapid onset of postoperative pain
after discontinuation of the drug infusion, which may increase the risk of
an ischemic event. We conducted this randomized study to compare the
efficacy of remifentanil versus low doses of fentanyl in fast-track
cardiac anesthesia. It has been hypothesized that remifentanil would
provide a safe anesthesia with no impact on myocardial function and with
positive effects on extubation time and mobilization. Methods: We compared
the postoperative course of patients, the remifentanil group (RG) and the
low-dose fentanyl group (LDFG), in whom remifentanil and low-dose
fentanyl, respectively, were used for fast-track cardiac anesthesia. The
study was designed as a prospective randomized study. The primary outcomes
were changes in the cardiac index and creatine kinase MB fraction (CKMB),
extubation times, mobilization times, and lengths of stay in the intensive
care unit (ICU) and the hospital. Frequency of myocardial infarction (MI),
reoperations due to excessive bleeding, renal impairment, and cerebral
complications were registered as well. Results: Seventy-one patients were
enrolled in the study, and 7 were excluded due to difficult airway,
bleeding, and technical difficulties. The RG comprised 33 patients and the
LDFG comprised of 31 patients. There were no differences between the
groups in terms of age, Euroscore, types of surgery, extracorporeal
circulation, and aortic cross-clamp time. We did not find significant
difference in cardiac index, CKMB, extubation times, mobilization times,
length of stay in the ICU and in the hospital between the groups.
Postoperative complications such as MI, rates of reoperations, renal and
cerebral complications and incidence of atrial fibrillation did not show
any significant differences. Conclusions: Remifentanil fast-track
anesthesia for cardiac patients has no negative impact on myocardial
function. Both remifentanil and low-dose fentanyl are equally effective
and safe for fast-track cardiac anesthesia. The study did not highlight
any statistical superiority of remifentanil anesthesia over low-dose
fentanyl anesthesia. © 2013 Forum Multimedia Publishing, LLC.
<50>
Accession Number
2013817456
Author
Boom C.E.; Herdono P.; Koto C.G.; Hadi S.; Permana I.M.A.
Institution
(Boom, Herdono, Koto, Hadi, Permana) Department of Anaesthesia and
Intensive Care, National Cardiovascular Center, Harapan Kita Hospital,
Jakarta, Indonesia
Title
Effect of hyperosmolar sodium lactate infusion on haemodynamic status and
fluid balance compared with hydroxyethyl starch 6% during the cardiac
surgery.
Source
Indian Journal of Anaesthesia. 57 (6) (pp 576-582), 2013. Date of
Publication: November/December 2013.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background and Aim: No solution has been determined ideal for fluid
therapy during cardiac surgery. Previous studies have shown that
hyperosmolar sodium lactate (HSL) infusion has improved cardiac
performance with smaller volume infusion, which resulted in negative fluid
balance. This study compared the effects between a patent-protected HSL
infusion and hydroxyethyl starch (HES) 6% on haemodynamic status of the
patients undergoing cardiac surgery. Methods: In this open-label
prospective controlled randomized study, patients were randomly assigned
to receive loading dose of either HSL or HES 6%, at 3 mL/kgBW within 15
min, at the beginning of surgery. Haemodynamic parameters and fluid
balance were evaluated, while biochemical parameters and any adverse
effect were also recorded. Haemodynamic and laboratory parameters were
analyzed through repeated measures analysis of variance. Statistical
assessment of fluid management was carried out through Student t-test. All
statistical analyses were performed using the statistical package for the
social sciences version 15, 2006 (SPSS Inc., Chicago, IL). Results: Out of
100 enrolled patients in this study (50 patients in each arm), 98 patients
were included in analysis (50 in HSL group; 48 in HES group). Cardiac
index increased higher in HSL group (P = 0.01), whereas systemic vascular
resistance index decreased more in HSL than HES group (P = 0.002). Other
haemodynamic parameters were comparable between HSL and HES group. Fluid
balance was negative in HSL group, but it was positive in HES group
(-445.94 +/- 815.30 mL vs. +108.479 +/- 1219.91 mL, P < 0.009).
Conclusion: Administration of HSL solution during the cardiac surgery
improved cardiac performance and haemodynamic status better than HES did.
<51>
Accession Number
2013804321
Author
Joung K.-W.; Rhim J.-H.; Chin J.-H.; Kim W.-J.; Choi D.-K.; Lee E.-H.;
Hahm K.-D.; Sim J.-Y.; Choi I.-C.
Institution
(Joung, Rhim, Chin, Kim, Choi, Lee, Hahm, Sim, Choi) Department of
Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
Title
Effect of remote ischemic preconditioning on cognitive function after
off-pump coronary artery bypass graft: A pilot study.
Source
Korean Journal of Anesthesiology. 65 (5) (pp 418-424), 2013. Date of
Publication: November 2013.
Publisher
Korean Society of Anesthesiologists
Abstract
Background: Several studies have shown in animal models that remote
ischemic preconditioning (rIPC) has a neuro-protective effect. However, a
randomized controlled trial in human subjects to investigate the
neuroprotective effect of rIPC after cardiac surgery has not yet been
reported. Therefore, we performed this pilot study to determine whether
rIPC reduced the occurrence of postoperative cognitive dysfunction in
patients who underwent of-pump coronary artery bypass graft (OPCAB)
surgery. Methods: Seventy patients who underwent OPCAB surgery were
assigned to either the control or the rIPC group using a
computer-generated randomization table. Te application of rIPC consisted
of four cycles of 5 min ischemia and 5 min reperfusion on an upper limb
using a blood pressure cufinfating 200 mmHg before coronary artery
anastomosis. Te cognitive function tests were performed one day before
surgery and again on postoperative day 7. We defined postoperative
cognitive dysfunction as decreased postoperative test values more than 20%
of the baseline values in more than two of the six cognitive function
tests that were performed. Results: In the cognitive function tests, there
were no signifcant differences in the results obtained during the
preoperative and postoperative periods for all tests and there were no
mean differences observed in the preoperative and postoperative scores. Te
incidences of postoperative cognitive dysfunction in the control and rIPC
groups were 28.6% (10 patients) and 31.4% (11 patients), respectively.
Conclusions: rIPC did not reduce the incidence of postoperative cognitive
dysfunction after OPCAB surgery during the immediate postoperative period.
© the Korean Society of Anesthesiologists, 2013.
<52>
Accession Number
2013639069
Author
Pellicori P.; Torromeo C.; Barilla F.; Mangieri E.; Evangelista A.;
Truscelli G.; Costanzo P.; Hoye A.; Wong K.
Institution
(Pellicori, Costanzo, Hoye, Wong) Department of Cardiology, Hull and East
Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building,
Castle Hill Hospital, Cottingham, United Kingdom
(Pellicori, Torromeo, Barilla, Mangieri, Evangelista, Truscelli) Heart and
Great Vessel Department, Policlinico Umberto I, Sapienza University, Rome,
Italy
Title
Intravenous versus intracoronary bolus of glycoprotein IIb/IIIa inhibitor
administration during primary percutaneous coronary intervention on
long-term left ventricular systolic and diastolic function.
Source
Cardiology Journal. 20 (3) (pp 310-317), 2013. Date of Publication: 2013.
Abstract
Background: In primary percutaneous coronary intervention (PCI),
glycoprotein (GP) IIb/IIIa inhibitors are often given in order to attain
and maintain better myocardial perfusion. We tested the hypothesis that
intracoronary (IC) bolus of GP IIb/IIIa inhibitors might produce a greater
improvement in left ventricular (LV) systolic and diastolic function than
an intravenous (IV) bolus. Methods and results: Seventy seven patients
undergoing primary PCI for their first STelevation myocardial infarction
(STEMI) were randomly assigned to either an IC or IV bolus of GP IIb/IIIa
inhibitor, followed by IV infusion. Compared with the echocardiographic
findings within 3 days after PCI, LV ejection fraction was higher at 1
year, with no significant differences between the IV and IC groups (IV:
44% vs. 49%, p = 0.001; IC: 43% vs. 48%, p<0.001). LV diastolic function
(E/E') did not significantly change at 1 year by either approach.
Conclusions: LV systolic function improved by a similar magnitude
following primary PCI, with either IC or IV bolus administration of GP
IIb/IIIa inhibitor therapy. However, no significant changes were observed
in LV diastolic function. © 2013 Via Medica.
<53>
Accession Number
2013078675
Author
Tashnizi M.A.; Soltani G.; Moeinipour A.A.; Ayatollahi H.; Tanha A.S.;
Jarahi L.; Shamloo A.S.; Zirak N.
Institution
(Tashnizi, Moeinipour, Shamloo) Department of Cardiac Surgery, Imam Reza
Hospital, Mashhad University of Medical, Iran, Islamic Republic of
(Soltani, Tanha, Zirak) Departments of Anesthesiology, Imam Reza Hospital,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Ayatollahi) Department of Anatomical and Clinical Pathology, Imam Reza
Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Jarahi) Departments of Community Medicine, Mashad University of Medical
Sciences, Mashad, Iran, Islamic Republic of
Title
Comparison between preoperative administration of methylprednisolone with
its administration before and during congenital heart surgery on serum
levels of IL-6 and IL-10.
Source
Iranian Red Crescent Medical Journal. 15 (2) (no pagination), 2013. Date
of Publication: 2013.
Publisher
Iranian Red Crescent Society
Abstract
Background: Steroid administration during cardiopulmonary bypass is
considered to improve cardiopulmonary function by modulating inflammations
caused by bypass. Objectives: This study was performed to compare
effectiveness of preoperative and intraoperative methylprednisolone (MP)
to preoperative methylprednisolone alone in post bypass inflammatory
(IL-6) and anti-inflammatory (IL-10) factors. Patients and Methods: Fifty
pediatric patients undergoing cardiopulmonary bypass surgery from August
2011 to 2012 in the cardiac surgery department of Imam Reza Hospital, the
major center for CPB, in Mashhad, Iran were randomly assigned to receive
preoperative and intraoperative MP (30 mg/kg, 4 hours before bypass and in
bypass prime, number 25) or preoperative MP only (30 mg/kg, number 25).
Before and after bypass, four and 24 hours after bypass, serum IL-6 and
IL-10 were measured by ELISA. Results: In both groups, no significant
different with variation of expression for IL-6 (inflammatory factor) and
IL-10 (anti-inflammatory factor) in different times after bypass, was
observed. Conclusions: No significant different in reducing post bypass
inflammation between preoperative steroid treatment and combined
preoperative and intraoperative steroid administration reported and they
have the same effects.
<54>
Accession Number
2014146803
Author
Sanal Bas S.; Erdemli M.O.
Institution
(Sanal Bas, Erdemli) Turkiye Yuksek Ihtisas Egitim ve Arastirma Hastanesi,
Turkey
Title
Effects of thiopental, propofol, etomidate, midazolam on hemodynamic state
in anesthesia induction and intubation of hypertensive patients in the
coronary artery bypass grafting surgery.
Source
Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi. 19 (4) (pp
161-167), 2013. Date of Publication: December 2013.
Publisher
Turkish Anaesthesiology and Intensive Care Society (Yildiz Posta Caddesi,
Sinan Apt. No; 36 D: 66/67, Gayrettepe-Istanbul 34349, Turkey)
Abstract
Objective: The purpose of this study is to compare the hemodynamic effects
of thiopental, propofol, etomidate, midazolam on induction of anesthesia,
laryngoscopy, and endotracheal intubation of hypertensive patients who
will undergo coronary artery bypass grafting (CABG) surgery. Material and
Methods: A total of 80 patients with chronic hypertension, aged between 40
and 75 who are to undergo CABG surgery were included in a prospective,
single-blind, and randomized study. Group T received thiopental sodium
(5-7 mg kg-1), Group E etomidate (0.2-0.5 mg kg-1), Group P propofol
(1-2.5 mg kg-1), and Group M midazolam (0.1-0.4 mg kg-1) anesthetic
agents. The induction was achieved by using fentanyl and rocuronium in all
groups. Heart rate (HR), systolic arterial pressure (SAP),diastolic
arterial pressure (DAP), mean arterial pressure (MAP) were recorded for
the first 15 minutes. Also arterial blood gases (ABG) were sampled, and
partial arterial carbon dioxide (aC02) values were recorded. Results: SAP
values decreased prior to laryngoscopy in Group T, E, and P. Only in Group
E, increase in SAP during laryngoscopy and tracheal intubation was
statistically significant. The decrease in MAP was significant in only
Group T. At 15 minutes of intubation increases in MAP and HR in Group P
was also statistically significant. Conclusion: We think that the safest
induction of anesthesia during laryngoscopy, and endotracheal intubation
in hypertensive patients who will undergo CABG surgery will be acvhieved
with midazolam (Group M).
<55>
Accession Number
2011537798
Author
Sun Y.; Zhu M.; Zhang J.-W.; Xu W.-Y.; Bai J.; Zhang M.-Z.
Institution
(Sun, Zhu, Zhang, Xu, Bai, Zhang) Department of Anesthesiology, Shanghai
Children Medical Center, Shanghai Jiaotong University School of Medicine,
Shanghai 200127, China
Title
Effects of sevoflurane preconditioning and postconditioning on myocardial
reperfusion injury under cardiopulmonary bypass in infants.
Source
Journal of Shanghai Jiaotong University (Medical Science). 31 (9) (pp
1316-1319), 2011. Date of Publication: 2011.
Publisher
Editorial Department of Journal of Shanghai Second Medical University
Abstract
Objective To investigate the effects of sevoflurane preconditioning and
postconditioning on myocardial reperfusion injury under cardiopulmonary
bypass in infants undergoing surgery for congenital heart disease. Methods
Sixty children undergoing surgery for ventricular septal defect were
randomly divided into control group (no inhalation anesthetics during the
surgery), preconditioning group (inhalation of 1.5 MAC sevoflurane for 20
min before aortic cross clamping), postconditioning group (inhalation of
1.5 MAC sevoflurane for 20 min after aortic cross unclamping) and
preconditioning + postconditioning group (inhalation of 1.5 MAC
sevoflurane for 20 min before and after aortic cross clamping
respectively), with 15 patients in each group. The time of aortic cross
clamping, time of cardiopulmonary bypass, time of operation, time of
mechanical ventilation, duration of stay in cardiac intensive care unit
(CICU) and duration of hospital stay were recorded and compared. The mass
concentrations of myocardial injury markers of troponin I (cTn-I),
myoglobin (Mb) and creatine kinase isoenzyme (CK-MB) were determined after
anesthesia induction (T0), before cardiopulmonary bypass (T1), at the end
of cardiopulmonary bypass (T2), and 1 h, 6 h, 12 h and 24 h after
cardiopulmonary bypass (T3, T4, T5 and T6 respectively). Results There was
no significant difference in time of aortic cross clamping, time of
cardiopulmonary bypass, time of operation, time of mechanical ventilation,
duration of stay in CICU and duration of hospital stay among groups (P >
0.05). The plasma mass concentrations of cTn I, Mb and CK-MB at the time
points of T2 to T6 were significantly higher than those at the time point
of T0 in each group. The plasma mass concentrations of cTn I, Mb) and
CK-MB at the time points of T3 to T5 in preconditioning group,
postconditioning group and preconditioning + postconditioning group were
significantly lower than those in control group (P < 0.05). There was no
significant difference in the plasma mass concentrations of cTn I, Ml) and
CK-MB at each time point among preconditioning group, postconditioning
group and preconditioning + postconditioning group (P > 0.05). Conclusion
Both sevoflurane preconditioning and postconditioning can relieve
myocardial reperfusion injury under cardiopulmonary bypass in infants
undergoing surgery for congenital heart disease, while the combination of
them may not bring additional benefit.
<56>
Accession Number
25967124
Author
Mittnacht J.; Choukair D.; Kneppo C.; Brunner R.; Parzer P.; Gorenflo M.;
Bettendorf M.
Institution
(Mittnacht, Choukair, Kneppo, Brunner, Parzer, Gorenflo, Bettendorf)
Division of Paediatric Endocrinology and Diabetes, Department of
Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
Title
Long-Term Neurodevelopmental Outcome of Children Treated with
Tri-Iodothyronine after Cardiac Surgery: Follow-Up of a Double-Blind,
Randomized, Placebo-Controlled Study.
Source
Hormone research in paediatrics. 84 (2) (pp 130-136), 2015. Date of
Publication: 2015.
Abstract
BACKGROUND: Transient thyroid dysfunction occurs in children after
cardiopulmonary bypass (CPB). We demonstrated significant benefits of
acute postoperative tri-iodothyronine (T3) treatment for recovery and
myocardial function. Now we report the long-term neurodevelopment of these
children.
METHODS: Twenty-eight children (70% of the original study population)
could be recruited for a follow-up examination (median age 10.7 years,
range 10-19.6 years) retaining the double-blind, randomized,
placebo-controlled protocol. Cognitive function and motor development were
tested, as were growth and thyroid and cardiac functions.
RESULTS: The median full-scale intelligence quotient of all children was
within the reference range and similar in the placebo and T3 groups. Tests
for motor and cognitive functions, growth, and thyroid and cardiac
functions revealed concurrent results.
CONCLUSIONS: Overall intellectual development is preserved in adolescents
treated with CPB in infancy irrespectively of low postoperative thyroid
hormone concentrations. While acute postoperative T3 treatment in children
after CPB improves recovery, no significant long-term effects on
neurodevelopment could be detected. We therefore speculate that transient
postoperative thyroid dysfunction by means of nonthyroidal illness
syndrome is predominantly mediated by extranuclear, nongenomic mechanisms
and thus acutely affects the cardiovascular system but not the development
of the central nervous system mediated by genomic mechanisms.
<57>
Accession Number
20160364016
Author
Rofe M.-T.; Shacham Y.; Steinvi A.; Barak L.; Hareuveni M.; Banai S.;
Keren G.; Finkelstein A.; Shmilovich H.
Institution
(Rofe, Shacham, Steinvi, Barak, Banai, Keren, Finkelstein, Shmilovich)
Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated to
the Sackler Faculty of Medicine, Tel Aviv, Israel
(Hareuveni) Department of Haematology, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel
Title
Prevalence of blood type A and risk of vascular complications following
transcatheter aortic valve implantation.
Source
Netherlands Heart Journal. 24 (5) (pp 350-354), 2016. Date of Publication:
May 2016.
Publisher
Bohn Stafleu van Loghum
Abstract
Objectives To assess the prevalence of blood type A among patients
referred for transcatheter aortic valve implantation (TAVI) and whether it
is related to vascular complications. Backgrounds Vascular complications
following TAVI are associated with adverse outcomes. Various blood types,
particularly type A, have been shown to be more prevalent in
cardiovascular diseases and to be related to prognosis. Methods The
prevalence of various blood types in a cohort of 491 consecutive patients
who underwent TAVI was compared with a control group of 6500 consecutive
hospitalised patients. The prevalence and predictors of vascular
complications and bleeding events were evaluated in the blood type A group
and were compared with non-type A patients. Results The mean age of TAVI
patients was 83 +/- 6 years, and 40 % were males. Patients were divided
into two groups: blood type A (n = 220) and non-type A (n = 271). Type A
was significantly more prevalent in the TAVI group than in the control
group (45 vs. 38 %, p = 0.023). Compared with the non-type A group,
patients with blood type A had more major and fatal bleeding (14.5 vs. 8.1
%, p = 0.027) and more vascular complications (any vascular complication:
24.5 vs. 15.9 % p = 0.016; major vascular complications: 12.3 vs. 7 % p =
0.047). In a multivariable analysis, blood type A emerged as a significant
and independent predictor for vascular complications and bleeding events.
Conclusions Blood type A is significantly more prevalent in TAVI patients
than in the general population and is related to higher rates of vascular
and bleeding complications.
<58>
Accession Number
20160230248
Author
Chu E.W.; Chernoguz A.; Divino C.M.
Institution
(Chu, Chernoguz, Divino) Division of Genery Surgery, Department of
Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place,
Box 1259, New York, NY 10029, United States
Title
The evaluation of clopidogrel use in perioperative general surgery
patients: A prospective randomized controlled trial.
Source
American Journal of Surgery. 211 (6) (pp 1019-1025), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Elsevier Inc.
Abstract
Background The perioperative safety profile of clopidogrel, a potent
antiplatelet agent used in the management of cardiovascular disease, is
unknown, and there are no evidence-based guidelines recommending for
either its interruption or continuation at this time. The aim of this
study was to determine whether patients who are maintained on clopidogrel
before general surgical procedures are at increased risk of perioperative
bleeding complications. Methods Patients receiving clopidogrel at the time
of elective general surgery were randomized to either discontinue
clopidogrel 1 week before surgery (group A) or continue clopidogrel into
surgery (group B). All other antiplatelet and anticoagulant agents were
discontinued before surgery. The primary end points were perioperative
bleeding requiring intraoperative or postoperative transfusion of blood or
blood components and bleeding-related readmission, reoperation, or
mortality within 90 days of surgery. The secondary end points were
perioperative myocardial infarction or cerebrovascular accidents within 90
days of surgery. Results Thirty-nine patients were enrolled and underwent
43 general surgical operations. Twenty-one procedures were randomized to
group A and 22 to group B. The most commonly performed individual
procedures were open inguinal hernia repair (23%), laparoscopic
cholecystectomy (21%), open ventral hernia repair (15%), laparoscopic
ventral hernia repair (11%), and laparoscopic inguinal hernia repair (9%).
No perioperative mortalities, bleeding events requiring blood transfusion,
or reoperations occurred. One readmission for intra-abdominal hematoma
requiring percutaneous drainage occurred in each group (group A: 4.8% vs
group B: 4.5%; P = 1.0). No myocardial infarctions or cerebrovascular
accidents were observed or reported. Conclusions The outcomes from this
prospective study suggest that, patients undergoing commonly performed
elective general surgical procedures can be safely maintained on
clopidogrel without increased perioperative bleeding risk.
<59>
Accession Number
20160377015
Author
Wood C.; Phillips C.
Institution
(Wood) University of York, Department of Health Sciences, Seebohm Rowntree
Building, York YO10 5DD, United Kingdom
(Phillips) Department of Care Sciences, University of Glamorgan, Faculty
of Health, Sport and Science, Glyn Taff Campus, Pontypridd, Rhondda Cynon
Taff CF37 1DL, United Kingdom
Title
Cyanoacrylate microbial sealants for skin preparation prior to surgery.
Source
Cochrane Database of Systematic Reviews. 2016 (5) (no pagination), 2016.
Article Number: CD008062. Date of Publication: 18 May 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Surgical site infections (i.e. incisions that become infected)
are a continuing concern in health care. Microbial sealant is a liquid
that can be applied to the skin immediately before surgery and is thought
to help reduce the incidence of surgical site infections (SSIs) by sealing
in the skin flora, thus preventing contamination and infection of the
surgical site. Objectives: To assess the effects of the preoperative
application of microbial sealants (compared with no microbial sealant) on
rates of SSI in people undergoing clean surgery. Search methods: For this
second update we searched the following electronic databases in May 2015:
the Cochrane Wounds Specialised Register; the Cochrane Central Register of
Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid
MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO
CINAHL. There were no restrictions based on language or date of
publication or study setting. Selection criteria: Randomised controlled
trials (RCTs) were eligible for inclusion if they involved people
undergoing clean surgery (i.e. surgery that does not involve the breathing
system, gut, genital or urinary tract, or any part of the body with an
existing infection) in an operating theatre and compared the use of
preoperative microbial sealants with no microbial sealant. Data collection
and analysis: All review authors independently extracted data on the
characteristics, risk of bias and outcomes of the eligible trials. Main
results: Seven trials (859 participants undergoing clean surgery) met the
inclusion criteria. The trials all compared cyanoacrylate microbial
sealant with no sealant. We found there were fewer SSIs with the use of
microbial sealant (23/443 participants) than with the control comparison
(46/416 participants). There was no evidence of a difference between the
two groups in surgical site infection rates following the use of microbial
sealants when the results were pooled (risk ratio (RR) 0.53, 95% CI 0.24
to 1.18). There were adverse events in three studies, but these were not
judged to be a result of the use of microbial sealant. Authors'
conclusions: In this second update there is still insufficient evidence
available to determine whether the use of microbial sealants reduces the
risk of surgical site infection or not. Further rigorous,
adequately-powered RCTs are required to investigate this properly.
<60>
Accession Number
2015467325
Author
Amanda Dew M.; Rosenberger E.M.; Myaskovsky L.; DiMartini A.F.; DeVito
Dabbs A.J.; Posluszny D.M.; Steel J.; Switzer G.E.; Shellmer D.A.;
Greenhouse J.B.
Institution
(Amanda Dew, DiMartini) University of Pittsburgh School of Medicine and
Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
(Amanda Dew) Department of Psychology, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew) Department of Biostatistics, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew, Rosenberger) Clinical and Translational Science Institute,
University of Pittsburgh, Pittsburgh, PA, United States
(Rosenberger, Myaskovsky, Posluszny, Switzer) Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
(Myaskovsky, Switzer) Center for Health Equity Research and Promotion,
Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA,
United States
(DiMartini, Steel, Shellmer) Department of Surgery, University of
Pittsburgh, Pittsburgh, PA, United States
(DeVito Dabbs) Department of Acute and Tertiary Care, University of
Pittsburgh School of Nursing, Pittsburgh, PA, United States
(Greenhouse) Department of Statistics, Carnegie Mellon University,
Pittsburgh, PA, United States
Title
Depression and anxiety as risk factors for morbidity and mortality after
organ transplantation: A systematic review and meta-analysis.
Source
Transplantation. 100 (5) (pp 988-1003), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background. Depression and anxiety are common mental health problems in
transplant populations. There is mixed evidence concerning whether they
increase morbidity and mortality risks after transplantation. If such
associations exist, additional risk reduction strategiesmay be
needed.Methods. Four bibliographic databases were searched from1981
through September 2014 for studies prospectively examining whether
depression or anxiety (determined with diagnostic evaluations or
standardized symptomscales) affected risk for posttransplant mortality,
graft loss, acute graft rejection, chronic rejection, cancer, infection,
and rehospitalization. Results. Twenty-seven studies (10 heart, total n =
1738; 6 liver, n = 1063; 5 kidney, n = 49515; 4 lung, n = 584; 1 pancreas,
n = 80; 1 mixed recipient sample, n = 205) were identified. In each,
depression and/or anxiety were typically measured before or early after
transplantation. Follow-up for outcomes was a median of 5.8 years (range,
0.50-18.0). Depression increased the relative risk (RR) of mortality by
65% (RR, 1.65; 95% confidence interval [95% CI], 1.34-2.05; 20 studies).
Meta-regression indicated that risk was stronger in studies that did (vs
did not) control for potential confounders (P = .032). Risk was unaffected
by type of transplant or other study characteristics. Depression increased
death-censored graft loss risk (RR, 1.65; 95% CI, 1.21- 2.26, 3 studies).
Depression was not associated with other morbidities (each morbidity was
assessed in 1-4 studies). Anxiety did not significantly increase mortality
risk (RR, 1.39; 95% CI, 0.85-2.27, 6 studies) or morbidity risks (assessed
in single studies). Conclusions. Depression increases risk for
posttransplant mortality. Few studies considered morbidities; the
depression-graft loss association suggests that linkages with morbidities
deserve greater attention. Depression screening and treatment may be
warranted, although whether these activities would reduce posttransplant
mortality requires study.
<61>
Accession Number
20160372892
Author
Baker W.L.; Jennings D.L.
Institution
(Baker) University of Connecticut, Storrs, CT, United States
(Jennings) New York-Presbyterian Hospital Columbia University Medical
Center, New York, NY, United States
Title
Pre-Cardiac Transplant Amiodarone Use Increases Postoperative Mortality: A
Meta-analysis.
Source
Annals of Pharmacotherapy. 50 (6) (pp 514-515), 2016. Date of Publication:
2016.
Publisher
SAGE Publications Inc.
<62>
[Use Link to view the full text]
Accession Number
20160382029
Author
Riaz H.; Alansari S.A.R.; Khan M.S.; Riaz T.; Raza S.; Luni F.K.; Khan
A.R.; Riaz I.B.; Krasuski R.A.
Institution
(Riaz, Alansari) Department of Internal Medicine, Cleveland Clinic, 9500
Euclid Ave, Cleveland, OH 44195, United States
(Alansari, Raza) Department of Cardiothoracic Surgery, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Khan) Department of Internal Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Riaz) Department of Internal Medicine, Bronx Lebanon Hospital, New York,
NY, United States
(Luni) Department of Cardiovascular Medicine, Mercy Saint Vincent Medical
Center, Toledo, OH, United States
(Khan) Department of Cardiovascular Medicine, University of Louisville,
Louisville, KY, United States
(Riaz) Department of Internal Medicine, University of Arizona, Tucson, AZ,
United States
(Krasuski) Department of Cardiovascular Medicine, Duke University, Durham,
NC, United States
Title
Safety and use of anticoagulation after aortic valve replacement with
bioprostheses.
Source
Circulation: Cardiovascular Quality and Outcomes. 9 (3) (pp 294-302),
2016. Date of Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - The American College of Cardiology guidelines recommend 3
months of anticoagulation after replacement of the aortic valve with a
bioprosthesis. However, there remains great variability in the current
clinical practice and conflicting results from clinical studies. To assist
clinical decision making, we pooled the existing evidence to assess
whether anticoagulation in the setting of a new bioprosthesis was
associated with improved outcomes or greater risk of bleeding. Methods and
Results - We searched the PubMed database from the inception of these
databases until April 2015 to identify original studies (observational
studies or clinical trials) that assessed anticoagulation with warfarin in
comparison with either aspirin or no antiplatelet or anticoagulant
therapy. We included the studies if their outcomes included
thromboembolism or stroke/transient ischemic attacks and bleeding events.
Quality assessment was performed in accordance with the Newland Ottawa
Scale, and random effects analysis was used to pool the data from the
available studies. I 2 testing was done to assess the heterogeneity of the
included studies. After screening through 170 articles, a total of 13
studies (cases=6431; controls=18210) were included in the final analyses.
The use of warfarin was associated with a significantly increased risk of
overall bleeding (odds ratio, 1.96; 95% confidence interval, 1.25-3.08;
P<0.0001) or bleeding risk at 3 months (odds ratio, 1.92; 95% confidence
interval, 1.10-3.34; P<0.0001) compared with aspirin or placebo. With
regard to composite primary outcome variables (risk of venous
thromboembolism, stroke, or transient ischemic attack) at 3 months, no
significant difference was seen with warfarin (odds ratio, 1.13; 95%
confidence interval, 0.82-1.56; P=0.67). Moreover, anticoagulation was
also not shown to improve outcomes at time interval >3 months (odds ratio,
1.12; 95% confidence interval, 0.80-1.58; P=0.79). Conclusions - Contrary
to the current guidelines, a meta-analysis of previous studies suggests
that anticoagulation in the setting of an aortic bioprosthesis
significantly increases bleeding risk without a favorable effect on
thromboembolic events. Larger, randomized controlled studies should be
performed to further guide this clinical practice.
<63>
Accession Number
20160386611
Author
Florian S.; De Waha S.; Eitel I.; Desch S.; Fuernau G.; Thiele H.
Institution
(Florian) University of Leipzig, Heart Center, Leipzig, Germany
(De Waha, Eitel, Desch, Fuernau, Thiele) Medical Clinic II -
Cardiology/Angiology/Intensive Care Medicine, University Heart Center
Lubeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160,
Lubeck 23538, Germany
Title
Interventional post-myocardial infarction ventricular septal defect
closure: A systematic review of current evidence.
Source
EuroIntervention. 12 (1) (pp 94-102), 2016. Date of Publication: May 2016.
Publisher
EuroPCR
Abstract
Aims: Interventional closure of post-myocardial infarction ventricular
septal defects (VSD) is an alternative treatment option to surgical
repair. However, only limited evidence exists concerning the
interventional closure of a VSD. This review seeks to establish an
overview of the existing literature and to carry out a systematic analysis
of the success rate and clinical outcome of this procedure. Methods and
results: We conducted a comprehensive systematic literature search to
evaluate the existing evidence of percutaneous device closure of
post-infarction VSD. Patient series with fewer than five reported cases
were excluded. In total, 13 series were identified, with an overall
inclusion of 273 patients. Mean patient age was 70 years. Cardiogenic
shock was present in 48% of cases at the time of intervention. Device
closure within the first 14 days (acute phase) after VSD detection was
performed in 42% of cases. Technical success rate was high (>75%).
Successful device implantation rate was 89%. Overall inhospital/30-day
mortality was 32%. Major complications included device embolisation,
ventricular perforation and arrhythmias. Conclusions: Percutaneous device
closure of post-myocardial infarction VSD is a valuable alternative to
surgical repair, with the advantage of immediate shunt reduction to
prevent haemodynamic deterioration. A high rate of technically successful
percutaneous procedures can be achieved; however, the mortality rate
remains high, especially in cardiogenic shock patients.
<64>
Accession Number
20160386606
Author
Schmitt B.; Spriestersbach H.; O H-Ici D.; Radtke T.; Bartosch M.; Peters
H.; Sigler M.; Frese L.; Dijkman P.E.; Baaijens F.P.T.; Hoerstrup S.P.;
Berger F.
Institution
(Schmitt, Spriestersbach, O H-Ici, Radtke, Bartosch, Peters, Berger)
Department of Congenital Heart Disease and Paediatric Cardiology,
Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353,
Germany
(Sigler) Department of Paediatric Cardiology and Paediatric Intensive Care
Medicine, Georg-August University, Gottingen, Germany
(Frese, Dijkman, Hoerstrup) Division of Surgical Research, University and
University Hospital Zurich, Zurich, Switzerland
(Baaijens) Department of Biomedical Engineering, Eindhoven University of
Technology, Eindhoven, Netherlands
Title
Percutaneous pulmonary valve replacement using completely
tissue-engineered off-the-shelf heart valves: Six-month in vivo
functionality and matrix remodelling in sheep.
Source
EuroIntervention. 12 (1) (pp 62-70), 2016. Date of Publication: May 2016.
Publisher
EuroPCR
Abstract
Aims: The objective was to implant a stented decellularised
tissue-engineered heart valve (sdTEHV) percutaneously in an animal model,
to assess its in vivo functionality and to examine the repopulation and
remodelling of the valvular matrix by the recipient's autologous cells.
Methods and results: Prototypes of sdTEHV were cultured in vitro,
decellularised and percutaneously implanted into the pulmonary position in
15 sheep. Functionality was assessed monthly by intracardiac
echocardiography (ICE). Valves were explanted after eight, 16 or 24 weeks
and analysed macroscopically, histologically and by electron microscopy.
Implantation was successful in all animals. Valves showed normal pressure
gradients throughout the study. Due to a suboptimal design with small
coaptation area, stent ovality led to immediate regurgitation which
continuously increased during follow-up. Analyses revealed complete
endothelialisation and rapid cellular repopulation and remodelling of the
entire matrix. Valves were free from endocarditis, calcification and graft
rejection. Conclusions: sdTEHV can be safely implanted percutaneously. The
fast autologous recellularisation and the extensive matrix remodelling
demonstrate the valve's potential as a next-generation percutaneous
prosthesis with the capacity for tissue self-maintenance and longevity.
Regurgitation may be prevented by valve design optimisation.
<65>
Accession Number
20160386602
Author
Chieffo A.; Hildick-Smith D.
Institution
(Chieffo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Via Olgettina 60, Milan 20132, Italy
(Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex University,
Hospitals NHS Trust, Brighton, United Kingdom
Title
The European Bifurcation Club Left Main Study (EBC MAIN): Rationale and
design of an international, multicentre, randomised comparison of two
stent strategies for the treatment of left main coronary bifurcation
disease.
Source
EuroIntervention. 12 (1) (pp 47-52), 2016. Date of Publication: May 2016.
Publisher
EuroPCR
Abstract
Aims: Our aim is to investigate clinical outcomes following single versus
dual stenting strategies for the treatment of true bifurcation distal left
main coronary artery lesions. Methods and results: The EBC MAIN study is a
prospective, multinational, randomised clinical study of left main stem
true bifurcation lesions (type 1,1,1 or 0,1,1: both left anterior
descending and circumflex artery >2.75 mm diameter). The study hypothesis
is that left main coronary bifurcation lesions are best treated with a
planned single-stent strategy rather than a planned dual-stent strategy,
with respect to death, target lesion revascularisation and myocardial
infarction at one year. A total of 450 patients will be enrolled and
treated either with a planned single or a planned dual zotarolimus-eluting
stent strategy according to randomisation. The primary study endpoint is a
composite of death, myocardial infarction and target lesion
revascularisation at 12 months. Secondary endpoints are: death, myocardial
infarctions, and target lesion revascularisation, each at 12 months;
angina status, stent thrombosis, death, myocardial infarction, target
lesion revascularisation at three- and five-year clinical follow-up.
Conclusions: EBC MAIN will be the first randomised clinical trial to
compare single versus dual stenting strategies for the treatment of true
bifurcation distal left main coronary artery lesions.
<66>
Accession Number
20160366618
Author
Zangrillo A.; Alvaro G.; Pisano A.; Guarracino F.; Lobreglio R.; Bradic
N.; Lembo R.; Gianni S.; Calabro M.G.; Likhvantsev V.; Grigoryev E.;
Buscaglia G.; Pala G.; Auci E.; Amantea B.; Monaco F.; De Vuono G.;
Corcione A.; Galdieri N.; Cariello C.; Bove T.; Fominskiy E.; Auriemma S.;
Baiocchi M.; Bianchi A.; Frontini M.; Paternoster G.; Sangalli F.; Wang
C.-Y.; Zucchetti M.C.; Biondi-Zoccai G.; Gemma M.; Lipinski M.J.;
Lomivorotov V.V.; Landoni G.
Institution
(Zangrillo, Lembo, Gianni, Calabro, Monaco, Bove, Fominskiy, Gemma,
Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
(Zangrillo) Anesthesia and Intensive Care, Policlinico Universitario Magna
Grecia, Catanzaro, Italy
(Alvaro, Amantea, De Vuono) Cardiac Anesthesia and Intensive Care Unit,
Monaldi Hospital A.O.R.N. Dei Colli, Naples, Italy
(Pisano, Galdieri) Department of Anaesthesia and Critical Care Medicine,
Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
(Guarracino, Cariello) Department of Anaesthesia and Critical Care
Medicine, Citta della Salute e della Scienza, Torino, Italy
(Lobreglio) Clinic of Anesthesiology and Intensive Care Medicine,
University Hospital, Dubrava, Zagreb, Croatia
(Bradic) Anesthesiology and Intensive Care Department Moscow Regional
Clinical, Research Institute, Moscow, Russian Federation
(Likhvantsev) Department of Intensive Care, Research Institute for Complex
Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
(Grigoryev) Anesthesia and Intensive Care, A.O.U. IRCSS IST San Martino,
Genova, Italy
(Buscaglia) Cardiac Anesthesia and Intensive Care, Ospedale Civile SS.
Annunziata, Sassari, Italy
(Pala) Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria
Santa Maria della Misericordia, Udine, Italy
(Corcione) Department of Anesthesia and Critical Care, AORN Dei Colli,
Naples, Italy
(Auci, Auriemma) Department of Cardiac Surgery, Ospedale S.Bortolo, Viale
Rodolfi 37, Vicenza, Italy
(Baiocchi) Anesthesia and Intensive Care, S.Orsola-Malpighi University
Hospital, Bologna, Italy
(Bianchi) Anesthesia and Intensive Care, Azienda Ospedaliera Ordine
Mauriziano, Torino, Italy
(Frontini) Anesthesia and Intensive Care, Azienda Ospedaliera Spedali
Civili, Brescia, Italy
(Paternoster) Departement of Cardiovascular Anaesthesia and Intensive Care
Azienda Ospedaliera S. Carlo, Potenza, Italy
(Sangalli) Anesthesia and Intensive Care, Ospedale S. Gerardo, Monza,
Italy
(Wang) Department of Anaesthesiology, Faculty of Medicine, University of
Malaya, Kuala Lumpur, Malaysia
(Zucchetti) Anesthesia and Intensive Care Azienda Ospedaliera
Papardo-Piemonte, Messina, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences, Biotechnologies
Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS, Neuromed,
Pozzilli, Italy
(Lipinski) Division of Cardiology, Medstar Washington Hospital Center,
Washington, DC, United States
(Lomivorotov) Department of Anesthesiology and Intensive Care, State
Research Institute of Circulation Pathology, Novosibirsk, Russian
Federation
Title
A randomized controlled trial of levosimendan to reduce mortality in
high-risk cardiac surgery patients (CHEETAH): Rationale and design.
Source
American Heart Journal. 177 (pp 66-73), 2016. Date of Publication: 01 Jul
2016.
Publisher
Mosby Inc.
Abstract
Objective Patients undergoing cardiac surgery are at risk of perioperative
low cardiac output syndrome due to postoperative myocardial dysfunction.
Myocardial dysfunction in patients undergoing cardiac surgery is a
potential indication for the use of levosimendan, a calcium sensitizer
with 3 beneficial cardiovascular effects (inotropic, vasodilatory, and
anti-inflammatory), which appears effective in improving clinically
relevant outcomes. Design Double-blind, placebo-controlled, multicenter
randomized trial. Setting Tertiary care hospitals. Interventions Cardiac
surgery patients (n = 1,000) with postoperative myocardial dysfunction
(defined as patients with intraaortic balloon pump and/or high-dose
standard inotropic support) will be randomized to receive a continuous
infusion of either levosimendan (0.05-0.2 mug/[kg min]) or placebo for
24-48 hours. Measurements and main results The primary end point will be
30-day mortality. Secondary end points will be mortality at 1 year, time
on mechanical ventilation, acute kidney injury, decision to stop the study
drug due to adverse events or to start open-label levosimendan, and length
of intensive care unit and hospital stay. We will test the hypothesis that
levosimendan reduces 30-day mortality in cardiac surgery patients with
postoperative myocardial dysfunction. Conclusions This trial is planned to
determine whether levosimendan could improve survival in patients with
postoperative low cardiac output syndrome. The results of this
double-blind, placebo-controlled randomized trial may provide important
insights into the management of low cardiac output in cardiac surgery.
<67>
Accession Number
20160310621
Author
Ji T.; Feng C.; Sun L.; Ye X.; Bai Y.; Chen Q.; Qin Y.; Zhu J.; Zhao X.
Institution
(Ji) Department of Geriatrics, Shanghai First People's Hospital Affiliated
with Shanghai Jiaotong University, Shanghai, China
(Feng, Bai, Chen, Qin, Zhu, Zhao) Department of Cardiology, Changhai
Hospital, Second Military Medical University, Shanghai, China
(Sun) Department of Nephrology, Shanghai Changzheng Hospital, Second
Military Medical University, Shanghai, China
(Ye) Department of Health Statistics, Second Military Medical University,
Shanghai, China
Title
Are beta-blockers effective for preventing post-coronary artery bypass
grafting atrial fibrillation? Direct and network meta-analyses.
Source
Irish Journal of Medical Science. 185 (2) (pp 503-511), 2016. Date of
Publication: 01 May 2016.
Publisher
Springer-Verlag London Ltd
Abstract
Background: Atrial fibrillation is the most common arrhythmia in clinical
practice and is a major contributor to mortality. Recently, several
studies have reported different results for treatments aimed at reducing
the risk of postoperative AF. Aims: The aim of this study was to evaluate
the efficacy of beta-blockers (BBs) in preventing post-coronary artery
bypass grafting (CABG) AF and to compare the efficacies of different BB
treatments using a network meta-analytical approach. Methods: The PubMed,
EMBASE and Cochrane Library databases were searched (Jan 1995 to May 2014)
to identify randomized controlled trials. Two independent investigators
separately extracted the data using a seven-point scoring system to assess
randomization, allocation concealment, blinding, withdrawals and dropouts.
A direct meta-analysis of these randomized controlled trials was
conducted. Then, six trials comparing different BB treatments for the
prevention of postoperative AF were added to perform a Bayesian network
meta-analysis with mixed treatment comparisons. Results: Treatment with
BBs was associated with a significant reduction in the postoperative
incidence of AF compared with placebo/control [22.37 % compared with 34.45
%, relative risk (RR) = 0.53, 95 % confidence interval (CI): 0.37-0.75, p
< 0.00001]. Conclusions: The network meta-analysis revealed no significant
differences among eight types of BB treatments but did provide a ranking.
BB treatments could significantly reduce the occurrence of post-CABG AF.
Insufficient evidence was available to show that one BB treatment was more
effective than the others were. According to our network meta-analysis,
bisoprolol and landiolol+bisoprolol are better alternatives compared with
the other treatments.
<68>
[Use Link to view the full text]
Accession Number
20160242082
Author
Meredith I.T.; Tanguay J.-F.; Kereiakes D.J.; Cutlip D.E.; Yeh R.W.;
Garratt K.N.; Lee D.P.; Steg P.G.; Weaver W.D.; Holmes D.R.; Brindis R.G.;
Trebacz J.; Massaro J.M.; Hsieh W.-H.; Mauri L.
Institution
(Meredith, Hsieh) Monash Heart and Monash University, Melbourne, Australia
(Tanguay) Montreal Heart Institute, Universite de Montreal, QC, Canada
(Kereiakes) Christ Hospital Heart, Vascular Center, Lindner Center for
Research and Education, Cincinnati, OH, United States
(Cutlip) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Cutlip, Yeh, Massaro, Mauri) Harvard Clinical Research Institute, Boston,
MA, United States
(Cutlip, Yeh, Mauri) Harvard Medical School, Boston, MA, United States
(Yeh) Smith Center for Outcomes Research in Cardiology, Beth Israel
Deaconess Medical Center, Boston, MA, United States
(Garratt) Lenox Hill Hospital, New York, NY, United States
(Lee) Stanford University, Stanford, CA, United States
(Steg) Universite Paris-Diderot, INSERM U-1148, Hopital Bichat,
Departement Hospitalo-Universitaire Fibrosis, Inflammation, and
Remodeling, Assistance Publique-Hopitaux de Paris, Paris, France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Weaver) Henry Ford Medical Group, Detroit, MI, United States
(Holmes) Mayo Clinic, Rochester, MN, United States
(Brindis) Institute for Health Policy Studies, University of California,
San Francisco, United States
(Trebacz) Jan Pawel II Hospital Krakow, Poland
(Massaro) Boston University, School of Public Health, Boston, MA, United
States
(Mauri) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, 75 Francis -St, Boston, MA 02115, United
States
Title
Diabetes mellitus and prevention of late myocardial infarction after
coronary Stenting in the randomized dual Antiplatelet therapy study.
Source
Circulation. 133 (18) (pp 1772-1782), 2016. Date of Publication: 03 May
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Patients with diabetes mellitus (DM) are at high risk for
recurrent ischemic events after coronary stenting. We assessed the effects
of continued thienopyridine among patients with DM participating in the
Dual Antiplatelet Therapy (DAPT) Study as a prespecified analysis. Methods
and Results - After coronary stent placement and 12 months treatment with
open-label thienopyridine plus aspirin, 11 648 patients free of ischemic
or bleeding events and who were medication compliant were randomly
assigned to continued thienopyridine or placebo, in addition to aspirin,
for 18 more months. After randomization, patients with DM (n=3391), in
comparison with patients without DM (n=8257), had increased composite
outcome of death, myocardial infarction (MI), or stroke (6.8% versus 4.3%,
P<0.001), increased death (2.5% versus 1.4%, P<0.001), and MI (4.2% versus
2.6%, P<0.001). Among patients with DM, in a comparison of continued
thienopyridine versus placebo, rates of stent thrombosis were 0.5% versus
1.1%, P=0.06, and rates of MI were 3.5% versus 4.8%, P=0.058; and among
patients without DM the rates were 0.4% versus 1.4%, P<0.001 (stent
thrombosis, P interaction=0.21) and 1.6% versus 3.6%, P<0.001 (MI, P
interaction=0.02). Bleeding risk with continued thienopyridine was similar
among patients with or without DM (interaction P=0.61). Conclusions - In
patients with DM, continued thienopyridine beyond 1 year after coronary
stenting is associated with reduced risk of MI, although this benefit is
attenuated in comparison with patients without DM. Clinical Trial
Registration - URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00977938.
<69>
[Use Link to view the full text]
Accession Number
20160022288
Author
Phan K.; Huo Y.R.; Zhao D.F.; Yan T.D.; Tchantchaleishvili V.
Institution
(Phan, Huo, Zhao, Yan, Tchantchaleishvili) Collaborative Research (CORE)
Group, Macquarie University, Sydney, Australia
(Phan, Zhao, Yan) Faculty of Medicine, University of Sydney, Sydney,
Australia
(Phan, Huo) Faculty of Medicine, University of New South Wales (UNSW),
Sydney, Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
Sydney, Australia
(Tchantchaleishvili) Division of Cardiac Surgery, University of Rochester,
Rochester, NY, United States
Title
Ventricular recovery and pump explantation in patients supported by left
ventricular assist devices: A systematic review.
Source
ASAIO Journal. 62 (3) (pp 219-231), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Several studies have reported that a portion of patients who exhibit
cardiac recovery during left ventricular assist device (LVAD) support can
have their device explanted with reasonable long-term survival. The aim of
this systematic review is to assess the survival and cardiac function in
patients with explanted LVADs from the current literature. Electronic
search was performed to identify all studies in English literature
assessing LVAD explantation. All identified articles were systematically
assessed using the inclusion and exclusion criteria. Selected studies were
subjected to quantitative assessment. From 5 electronic databases, 11
studies (213 patients) were included. Pooled mean perioperative mortality
rate of those explanted was 9.2% (95% CI, 5.0-14.5%; I<sup>2</sup> = 0).
Pooled mean late mortality rate was 15% (95% CI, 9.0-22.1%; I<sup>2</sup>
= 31%). The pooled 1, 5, and 10 year survival postexplant was 91, 76, and
65.7%, respectively. Pooled postweaning freedom from heart failure (HF)
recurrence reached 81.3%. Subset analysis demonstrated that patients
explanted from a continuous-flow LVAD versus pulsatile LVAD had a lower
rate of HF recurrence (6.6 vs. 28.3%, p = 0.03) and LVAD reimplantation
(7.5 vs. 37%, p = 0.001). Before LVAD explantation, overall mean left
ventricular ejection fraction (LVEF) was 49%. Weighted pooled early and
late postexplantation mean LVEF was 47.3 and 41.2%, respectively. Late
postexplantation LVEF was significantly higher in the continuous-flow
versus pulsatile LVAD subgroup (41.5 vs. 24%, p = 0.001). This review
shows encouraging safety and 10 year survival outcomes after explantation
of LVADs in carefully selected patients, with rates better than expected
after a heart transplant. Recovery of the native heart is the most
desirable clinical outcome in patients supported with LVADs and should be
actively sought.
<70>
Accession Number
20160381028
Author
Abbas S.; Yunus A.; Riaz W.; Iqbal M.; Tufail Z.; Khan J.F.
Institution
(Abbas) Department of Cardio-Thoracic Surgery, LUMHS, Jamshoro, Pakistan
(Yunus) Cardiac Surgery Department, KEMU, Lahore, Pakistan
(Riaz, Tufail) PIC, Lahore, Pakistan
(Iqbal, Khan) CME Department, Punjab Institute of Cardiology, Lahore,
Pakistan
Title
Complete chordae preservation during mitral valve replacement in patients
with rheumatic mitral regurgitation with LVESD>50mm. A single center
prospective randomized study.
Source
Pakistan Journal of Medical and Health Sciences. 10 (1) (pp 265-269),
2016. Date of Publication: January-March 2016.
Publisher
Lahore Medical And Dental College (Tulspura, North Canal Bank, Lahore,
Pakistan)
Abstract
Aim: To compare the echocardiographic results of complete sparing of
mitral valve apparatus vs only posterior leaflet sparing in Mechanical
Bi-leaflet Mitral valve Prosthesis replacement, in patients with Rheumatic
Mitral Regurgitation with LVESD > 50 mm Methods: This prospective
randomized controlled trial was performed at Department of Cardiovascular
Surgery, Punjab Institute of Cardiology, Lahore, Pakistan, from January
2010 to March 2015, by a single Surgeon. Forty patients between 26-50
years of age, with LVESD > 50mm and LVEDD > 65mm, were included. Two
groups made; Group A (Mitral apparatus sparing) Group B (Posterior Mitral
sparing). The results of final TTE at the end of First year postop were
compared for Left Ventricular Ejection Fraction (EF), Left Ventricular End
Diastolic Dimension (LVEDD), Left Ventricular End Systolic Dimension, Left
Atrial Diameter (LAD), Interventricular Septum Thickness (IVS-T),
Pulmonary Artery Pressure Severity (PAP). Statistical analyses were
performed using IBM SPSS Version 21.0. Chi-square test and Fisher Exact
test was applied to observe the association of qualitative variables with
both groups, while quantitative variables with respect to both groups were
compared using independent samples t-test. A value of P<0.05 was
considered statistically significant. Results: Among 40 patients of
Rheumatic Mitral Valve, 13 patient were male (32.5%) whereas 27 were
females (67.5%). The mean age was 38.3+/-9.85 years (41.35+/-9.21 years in
Group A, 34.70+/-9.34 years in Group B). In Group A, EF improved
significantly from 48.00+/-3.23% to 56.75+/-4.38% (p=0.001), LVESD from
54.45+/-2.44mm to 49.80+/-3.61mm (p=0.001), LVEDD dropped from
67.80+/-2.14mm to 65.30+/-1.87mm (p=0.001), LA Diameter improved from
59.75+/-5.47mm to 56.40+/-4.71mm (p=0.001) and IVS-T got better from
11.25+/-0.79mm to 10.15+/-0.37mm (p=0.001). Conclusion: The bileaflet
preservation technique for MVR in patients with rheumatic mitral
regurgitation and LVESD > 50mm is superior to posterior leaflet only
preservation technique.
<71>
Accession Number
20160377633
Author
Zheng Z.; Jayaram R.; Jiang L.; Emberson J.; Zhao Y.; Li Q.; Du J.;
Guarguagli S.; Hill M.; Chen Z.; Collins R.; Casadei B.
Institution
(Zheng, Jiang, Zhao, Li, Du, Chen) Department of Cardiovascular Surgery,
State Key Laboratory of Cardiovascular Disease, National Clinical Research
Center of Cardiovascular Diseases, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, 167 Beilishi Rd., Xicheng District, Beijing 100037, China
(Jayaram, Guarguagli, Casadei) Division of Cardiovascular Medicine,
Radcliffe Department of Medicine, University of Oxford, John Radcliffe
Hospital, L6, West Wing, Oxford OX3 9DU, United Kingdom
(Emberson, Hill, Chen, Collins) Clinical Trial Service Unit,
Epidemiological Studies Unit, Nuffield Department of Population Health,
University of Oxford, Oxford, United Kingdom
Title
Perioperative rosuvastatin in cardiac surgery.
Source
New England Journal of Medicine. 374 (18) (pp 1744-1753), 2016. Date of
Publication: 05 May 2016.
Publisher
Massachussetts Medical Society
Abstract
Background: Complications after cardiac surgery are common and lead to
substantial increases in morbidity and mortality. Meta-analyses of small
randomized trials have suggested that perioperative statin therapy can
prevent some of these complications. Methods: We randomly assigned 1922
patients in sinus rhythm who were scheduled for elective cardiac surgery
to receive perioperative rosuvastatin (at a dose of 20 mg daily) or
placebo. The primary outcomes were postoperative atrial fibrillation
within 5 days after surgery, as assessed by Holter electrocardiographic
monitoring, and myocardial injury within 120 hours after surgery, as
assessed by serial measurements of the cardiac troponin I concentration.
Secondary outcomes included major in-hospital adverse events, duration of
stay in the hospital and intensive care unit, left ventricular and renal
function, and blood biomarkers. Results: The concentrations of low-density
lipoprotein cholesterol and C-reactive protein after surgery were lower in
patients assigned to rosuvastatin than in those assigned to placebo
(P<0.001). However, the rate of postoperative atrial fibrillation did not
differ significantly between the rosuvastatin group and the placebo group
(21.1% and 20.5%, respectively; odds ratio 1.04; 95% confidence interval
[CI], 0.84 to 1.30; P = 0.72), nor did the area under the troponin
I-release curve (102 ng x hour per milliliter and 100 ng x hour per
milliliter, respectively; between-group difference, 1%; 95% CI, -9 to 13;
P = 0.80). Subgroup analyses did not indicate benefit in any category of
patient. Rosuvastatin therapy did not result in beneficial effects on any
of the secondary outcomes but was associated with a significant absolute
(+/-SE) excess of 5.4+/-1.9 percentage points in the rate of postoperative
acute kidney injury (P = 0.005). Conclusions: In this trial, perioperative
statin therapy did not prevent postoperative atrial fibrillation or
perioperative myocardial damage in patients undergoing elective cardiac
surgery. Acute kidney injury was more common with rosuvastatin.
<72>
Accession Number
20160363076
Author
Gutierrez J.A.; Harrington R.A.; Blankenship J.C.; Stone G.W.; Steg P.G.;
Gibson C.M.; Hamm C.W.; Price M.J.; Genereux P.; Prats J.; Deliargyris
E.N.; Mahaffey K.W.; White H.D.; Bhatt D.L.
Institution
(Gutierrez, Bhatt) Brigham and Women's Hospital Heart, Vascular Center,
Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States
(Harrington, Mahaffey) Stanford University Medical School, Stanford, CA,
United States
(Blankenship) Geisinger Medical Center, Danville, PA, United States
(Stone, Genereux) Columbia University Medical Center, Cardiovascular
Research Foundation, New York, NY, United States
(Steg) INSERM Unite 1148, Universite Paris-Diderot,
Assistance-Publique-Hopitaux de Paris, Paris, France
(Steg) NHLI, Imperial College, Royal Brompton Hospital, London, United
Kingdom
(Gibson) Beth Israel Deaconess Medical Center, Division of Cardiology,
Boston, MA, United States
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Price) Scripps Clinic and Scripps Translational Science Institute, San
Diego, CA, United States
(Prats, Deliargyris) Medicines Company, Parsippany, NJ, United States
(White) Green Lane Cardiovascular Service, Auckland, New Zealand
Title
The effect of cangrelor and access site on ischaemic and bleeding events:
Insights from CHAMPION PHOENIX.
Source
European Heart Journal. 37 (14) (pp 1122-1130), 2016. Date of Publication:
07 Apr 2016.
Publisher
Oxford University Press
Abstract
Aims To assess whether the use of the femoral or radial approach for
percutaneous coronary intervention (PCI) interacted with the efficacy and
safety of cangrelor, an intravenous P2Y<inf>12</inf> inhibitor, in
CHAMPION PHOENIX. Methods and results A total of 11 145 patients were
randomly assigned in a double-dummy, double-blind manner either to a
cangrelor bolus and 2-h infusion or to clopidogrel at the time of PCI. The
primary endpoint, a composite of death, myocardial infarction,
ischaemia-driven revascularization, or stent thrombosis, and the primary
safety endpoint, Global Use of Strategies to Open Occluded Coronary
Arteries (GUSTO) defined severe bleeding, were evaluated at 48 h. Of the
patients undergoing PCI and receiving study drug treatment, a total of
8064 (74%) and 2855 (26%) patients underwent femoral or radial PCI,
respectively. Among the femoral cohort, the primary endpoint rate was 4.8%
with cangrelor vs. 6.0% with clopidogrel (odds ratio, OR [95% confidence
interval, CI] = 0.79 [0.65-0.96]); among the radial cohort, the primary
endpoint was 4.4% with cangrelor vs. 5.7% with clopidogrel (OR [95% CI] =
0.76 [0.54-1.06]), P-interaction 0.83. The rate of GUSTO severe bleeding
in the femoral cohort was 0.2% with cangrelor vs. 0.1% with clopidogrel
(OR [95% CI] = 1.73 [0.51-5.93]). Among the radial cohort, the rate of
GUSTO severe bleeding was 0.1% with cangrelor vs. 0.1% with clopidogrel
(OR [95% CI] = 1.02 [0.14-7.28]), P-interaction 0.65. The evaluation of
safety endpoints with the more sensitive ACUITY-defined bleeding found
major bleeding in the femoral cohort to be 5.2% with cangrelor vs. 3.1%
with clopidogrel (OR [95% CI] = 1.69 [1.35-2.12]); among the radial cohort
the rate of ACUITY major bleeding was 1.5% with cangrelor vs. 0.7% with
clopidogrel (OR [95% CI] = 2.17 [1.02-4.62], P-interaction 0.54).
Conclusion In CHAMPION PHOENIX, cangrelor reduced ischaemic events with no
significant increase in GUSTO-defined severe bleeding. The absolute rates
of bleeding, regardless of the definition, tended to be lower when PCI was
performed via the radial artery.
<73>
Accession Number
20160261115
Author
Weng W.; Zhang F.; Lineaweaver W.C.; Gao W.; Yan H.
Institution
(Weng, Gao, Yan) Division of Plastic and Hand Surgery, Department of
Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University,
109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
(Zhang, Lineaweaver) Joseph M. Still Burn and Reconstructive Center,
Jackson, MS, United States
Title
The Value of Postconditioning in Plastic and Reconstructive Surgery: A
Systematic Review.
Source
Journal of Reconstructive Microsurgery. 32 (4) (pp 285-293), 2016. Date of
Publication: 28 Mar 2016.
Publisher
Thieme Medical Publishers, Inc.
Abstract
Background Ischemia-reperfusion (I/R) injury by abrupt restoration of
circulation after prolonged ischemia has still been an unsolved problem in
plastic and reconstructive surgery. The concept of postconditioning
(post-con), which has been well described in cardiovascular surgery, has
been recently introduced in plastic and reconstructive surgery. As an
"after-injury strategy," post-con may be a promising approach to reduce
I/R injury and improve flap survival after ischemia. Methods A systematic
review was performed by searching electronic databases of PubMed and web
of science to identify all the studies regarding the application of the
post-con technique in plastic and reconstructive surgery between 1950 and
2015. Inclusion criteria were English articles with clear reporting the
post-con techniques and detailed outcomes. Results In total, 476 articles
were identified and 18 studies reporting post-con in plastic and
reconstructive surgery met the inclusion criteria in this review,
including 11 studies of mechanical post-con, 3 studies of pharmacological
post-con, 1 study of both mechanical and pharmacological post-con, and 3
studies of remote post-con. All these studies reported protective effects
of any kind of post-con techniques in I/R injuries and could improve flap
survivals. Conclusion In general, the strategy of post-con may effectively
reduce I/R injury and improve the survival of flaps after ischemia in
animal studies, yet no consensus regarding the exact technical details
(intervention timing, cycles, intermittent duration, etc.) has been
reached. Further studies aiming to explore its mechanisms as well as
specific methodology are required before clinical application in plastic
and reconstructive surgery.
<74>
Accession Number
20160197354
Author
Saw J.; Wong G.C.; Mayo J.; Bernstein V.; Mancini G.B.J.; Ye J.; Skarsgard
P.; Starovoytov A.; Cairns J.
Institution
(Saw, Wong, Bernstein, Mancini, Starovoytov, Cairns) Divisions of
Cardiology, University of British Columbia, Vancouver General Hospital,
2775 Laurel Street, Level 9, Vancouver, BC V5Z1M9, Canada
(Mayo) Divisions of Radiology, Vancouver General Hospital, St Paul's
Hospital, University of British Columbia, Vancouver, BC, Canada
(Ye, Skarsgard) Divisions of Cardiovascular Surgery, Vancouver General
Hospital, St Paul's Hospital, University of British Columbia, Vancouver,
BC, Canada
Title
Ticagrelor and aspirin for the prevention of cardiovascular events after
coronary artery bypass graft surgery.
Source
Heart. 102 (10) (pp 763-769), 2016. Date of Publication: 01 May 2016.
Publisher
BMJ Publishing Group
Abstract
Background: Ticagrelor was shown to reduce mortality in patients who
underwent coronary artery bypass grafting (CABG), but its effect on graft
patency is unknown. Methods: We performed a prospective, randomised,
double-blind, placebo-controlled trial, comparing ticagrelor 90 mg twice
daily versus placebo for 3 months added to aspirin 81 mg/day, following
isolated CABG. Aspirin was started within 12 h, and study medication
within 72 h after CABG. Primary outcome was graft occlusion on CT
angiography (CTA) performed 3 months post CABG. Patients were followed to
12 months for death, myocardial infarction, stroke, repeat
revascularisation and bleeding. Results: The study was terminated
prematurely after randomising 70 patients between September 2011 and
August 2014 because of slow recruitment. CTA was performed in 56 patients
who completed >1 month of study drug. Graft occlusion occurred in 7/25
(28.0%) patients on ticagrelor and 17/31 (48.3%) on placebo, p=0.044. Of
207 analysable grafts, graft occlusion occurred in 9/87 (10.3%) with
ticagrelor and 22/120 (18.3%) with placebo, p=0.112. Graft occlusion or
stenosis >50% occurred in 10/87 (11.5%) ticagrelor vs 32/120 (26.7%)
placebo, p=0.007. There was no major bleeding, but minor bleeding was
higher with ticagrelor (31.4% vs 2.9%, p=0.003). In univariate analysis,
ticagrelor use reduced graft occlusion (OR 0.32, 95% CI 0.10 to 0.97,
p=0.047), which remained significant on multivariable analysis (OR 0.25,
95% CI 0.073 to 0.873, p=0.03). Conclusions: Ticagrelor added to aspirin
after CABG reduced the proportion of patients with graft occlusion, and
was a significant univariate and multivariable predictor of graft
occlusion. These results are hypothesis-generating and should be confirmed
in larger studies. Trial registration number: NCT01373411: Results.
<75>
Accession Number
2015365809
Author
Iliopoulos I.; Branco R.G.; Brinkhuis N.; Furck A.; Larovere J.; Cooper
D.S.; Pathan N.
Institution
(Iliopoulos, Branco, Brinkhuis, Furck, Larovere, Pathan) Paediatric
Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
(Iliopoulos, Cooper) Cardiac Intensive Care Unit, Cincinnati Children's
Hospital Medical Center, MLC 2003, 3333 Burnet Avenue, Cincinnati, OH
45229-3026, United States
(Branco, Pathan) Paediatric Intensive Care Unit, Cambridge University
Hospitals NHS Trust, Cambridge, United Kingdom
(Larovere) Division of Cardiovascular Critical Care, Children's Hospital
Boston, United States
(Pathan) Department of Paediatrics, University of Cambridge, United
Kingdom
Title
Mesenteric near-infrared spectroscopy and risk of gastrointestinal
complications in infants undergoing surgery for congenital heart disease.
Source
Cardiology in the Young. 26 (4) (pp 772-780), 2016. Date of Publication:
01 Apr 2016.
Publisher
Cambridge University Press
Abstract
We hypothesised that lower mesenteric near-infrared spectroscopy values
would be associated with a greater incidence of gastrointestinal
complications in children weighing <10 kg who were recovering from cardiac
surgery. We evaluated mesenteric near-infrared spectroscopy, central
venous oxygen saturation, and arterial blood gases for 48 hours
post-operatively. Enteral feeding intake, gastrointestinal complications,
and markers of organ dysfunction were monitored for 7 days. A total of 50
children, with median age of 16.7 (3.2-31.6) weeks, were studied. On
admission, the average mesenteric near-infrared spectroscopy value was
71+/-18%, and the systemic oxygen saturation was 93+/-7.5%. Lower
admission mesenteric near-infrared spectroscopy correlated with longer
time to establish enteral feeds (r=-0.58, p<0.01) and shorter duration of
feeds at 7 days (r=0.48, p<0.01). Children with gastrointestinal
complications had significantly lower admission mesenteric near-infrared
spectroscopy (58+/-18% versus 73+/-17%, p=0.01) and higher mesenteric
arteriovenous difference of oxygen at admission [39 (23-47) % versus 19
(4-27) %, p=0.02]. Based on multiple logistic regression, admission
mesenteric near-infrared spectroscopy was independently associated with
gastrointestinal complications (Odds ratio, 0.95; 95% confidence interval,
0.93-0.97; p=0.03). Admission mesenteric near-infrared spectroscopy showed
an area under the receiver operating characteristic curve of 0.76 to
identify children who developed gastrointestinal complications, with a
suggested cut-off value of 72% (78% sensitivity, 68% specificity). In this
pilot study, we conclude that admission mesenteric near-infrared
spectroscopy is associated with gastrointestinal complications and enteral
feeding tolerance in children after cardiac surgery.
<76>
Accession Number
20160360868
Author
Huseyin S.; Yuksel V.; Guclu O.; Turan F.N.; Canbaz S.; Ege T.; Sunar H.
Institution
(Huseyin, Yuksel, Guclu, Canbaz, Ege) Departments of Cardiovascular
Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey
(Turan) Departments of Biostatistics, Faculty of Medicine, Trakya
University, Edirne, Turkey
(Sunar) Kartal Kosuyolu Research Hospital, Istanbul, Turkey
Title
Comparison of early period results of blood use in open heart surgery.
Source
Journal of Research in Medical Sciences. 21 (2) (no pagination), 2016.
Date of Publication: 2016.
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
Background: Various adverse effects of homologous blood transfusion
detected particularly in open heart surgery, in which it is frequently
used, lead researchers to study on autologous blood use and to evaluate
the patient's blood better. Due to the complications of homologous blood
transfusion, development of techniques that utilize less transfusion has
become inevitable. We aimed to evaluate the effects of acute normovolemic
hemodilution (ANH) in patients undergoing open heart surgery. Materials
and Methods: In this study, 120 patients who underwent open heart surgery
were included. Patients were grouped into three: Autologous transfusion
group (Group 1), homologous transfusion group (Group 2), and those
received autologous blood and homologous blood products (Group 3). Patient
data regarding preoperative characteristics, biochemical parameters,
drainage, extubation time, duration of stay at intensive care, atrial
fibrillation (AF) development, and hospital stay were recorded. Results: A
statistically significant difference (P < 0.005) was found in favor of
autologous group (Group 1) with respect to gender, body surface area,
European System for Cardiac Operative Risk Evaluation, smoking, hematocrit
levels, platelet counts, urea, C-reactive protein levels, protamine use,
postoperative drainage, frequency of AF development, intubation period,
stay at intensive care and hospital stay, and amount of used blood
products. Conclusion: The use of autologous blood rather than homologous
transfusion is not only attenuates side effects and complications of
transfusion but also positively affects postoperative recovery process.
Therefore, ANH can be considered as an easy, effective, and cheap
technique during open heart surgery.
<77>
Accession Number
20160358657
Author
Li H.; Lin Y.-L.; Diao S.-L.; Ma B.-X.; Liu X.-L.
Institution
(Li, Lin, Diao, Ma) Department of Cardiology, Affiliated Hospital of
Binzhou Medical University, Binzhou, China
(Liu) Department of Cardiology, Qilu Hospital of Shandong University,
Jinan, Shandong Province, China
Title
Does short preoperative statin therapy prevent infectious complications in
adults undergoing cardiac or non-cardiac surgery?: A meta-analysis of 5
randomized placebo-controlled trials.
Source
Saudi Medical Journal. 37 (5) (pp 492-497), 2016. Date of Publication: May
2016.
Publisher
Saudi Arabian Armed Forces Hospital
Abstract
Objectives: To evaluate the effect of preoperative statin therapy on the
incidence of postoperative infection. Methods: This systematic review of
the literature was carried out in August 2015. Studies were retrieved via
PubMed, Embase, and the Cochrane Library (1980 to 2015), and the reference
files were limited to Englishlanguage articles. We used a standardized
protocol, and a meta-analysis was performed for data abstraction.
Systematic Review Results: Five studies comprising 1,362 patients
qualified for the analysis. The incidence of postoperative infections in
the statin group (1.1%) was not significantly lower than that in the
placebo group (2.4%), with a risk ratio (RR) of 0.56 (95% confidence
interval [CI] 0.24-1.33, p=0.19). Patients of 3 studies underwent cardiac
surgery. The aggregated results of these studies failed to show
significant differences in postoperative infection when a fixed effects
model was used (RR: 0.39; 95% CI: 0.08-1.97, p=0.26]. Conclusions: We
failed to find sufficient evidence to support the association between
statin use and postoperative infectious complications. The absence of any
evidence for a beneficial effect in available randomized trials reduces
the likelihood of a causal effect as reported in observational studies.
