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https://www.readbyqxmd.com/read/29778671/international-study-of-comparative-health-effectiveness-with-medical-and-invasive-approaches-ischemia-trial-rationale-and-design
#1
David J Maron, Judith S Hochman, Sean M O'Brien, Harmony R Reynolds, William E Boden, Gregg W Stone, Sripal Bangalore, John A Spertus, Daniel B Mark, Karen P Alexander, Leslee Shaw, Jeffrey S Berger, T Bruce Ferguson, David O Williams, Robert A Harrington, Yves Rosenberg
BACKGROUND: Prior trials comparing a strategy of optimal medical therapy with or without revascularization have not shown that revascularization reduces cardiovascular events in patients with stable ischemic heart disease (SIHD). However, those trials only included participants in whom coronary anatomy was known prior to randomization and did not include sufficient numbers of participants with significant ischemia. It remains unknown whether a routine invasive approach offers incremental value over a conservative approach with catheterization reserved for failure of medical therapy in patients with moderate or severe ischemia...
April 21, 2018: American Heart Journal
https://www.readbyqxmd.com/read/29772591/-monitoring-and-modern-hemodynamic-concepts-in-cardiac-anesthesia
#2
Matthias Heringlake, Christian Schmidt, Sebastian Brandt
Patients undergoing cardiac surgery are growing older, present with more comorbidities, and are frequently scheduled for more complex and prolonged surgical procedures. Routine application of neurological as well as extended hemodynamic monitoring combined with goal-directed perioperative hemodynamic optimization, targeting optimization of systemic and cerebral oxygen balance, show promise to reduce postoperative complications and to improve mortality in this high risk population. Expert recommendations suggest to avoid synthetic colloids for fluid optimization...
May 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29770299/regenerative-medicine-therapy-for-single-ventricle-congenital-heart-disease
#3
REVIEW
Chetan Ambastha, Gregory J Bittle, David Morales, Nathaniel Parchment, Progyaparamita Saha, Rachana Mishra, Sudhish Sharma, Alexander Vasilenko, Muthukumar Gunasekaran, Manal T Al-Suqi, Deqiang Li, Peixin Yang, Sunjay Kaushal
One of the most complex forms of congenital heart disease (CHD) involving single ventricle physiology is hypoplastic left heart syndrome (HLHS), characterized by underdevelopment of the left ventricle (LV), mitral and aortic valves, and narrowing of the ascending aorta. The underdeveloped LV is incapable of providing long-term systemic flow, and if left untreated, the condition is fatal. Current treatment for this condition consists of three consecutive staged palliative operations: the first is conducted within the first few weeks of birth, the second between 4 to 6 months, and the third and final surgery within the first 4 years...
April 2018: Translational Pediatrics
https://www.readbyqxmd.com/read/29770244/predicting-length-of-stay-in-intensive-care-units-after-cardiac-surgery-comparison-of-artificial-neural-networks-and-adaptive-neuro-fuzzy-system
#4
Hamidreza Maharlou, Sharareh R Niakan Kalhori, Shahrbanoo Shahbazi, Ramin Ravangard
Objectives: Accurate prediction of patients' length of stay is highly important. This study compared the performance of artificial neural network and adaptive neuro-fuzzy system algorithms to predict patients' length of stay in intensive care units (ICU) after cardiac surgery. Methods: A cross-sectional, analytical, and applied study was conducted. The required data were collected from 311 cardiac patients admitted to intensive care units after surgery at three hospitals of Shiraz, Iran, through a non-random convenience sampling method during the second quarter of 2016...
April 2018: Healthcare Informatics Research
https://www.readbyqxmd.com/read/29769488/plasma-neutrophil-gelatinase-associated-lipocalin-pngal-level-to-identify-aki-early-in-patients-undergoing-cardiac-valve-surgery
#5
O F Miah, D K Roy, A A Chowdhury, K S Alam, M B Alam, M R Anwar, F A Dowel, A Latif, A N Hai, M A Mahmud, M A Razzak, T Ahammod, S U Ahammed, H Mahmud, R S Paul
Cardiac valve surgery is considered one of the most frequent surgical procedures in which AKI is a common & serious complication. Although serum creatinine is routinely used as a marker of renal function, it poorly reflects the immediate post operative period renal function. Within minutes to few hours after a renal insult, plasma neutrophil gelatinase associated lipocalin (pNGAL) is released. The aim of this study was to assess the superiority of pNGAL over serum creatinine in detecting AKI in early post operative period...
April 2018: Mymensingh Medical Journal: MMJ
https://www.readbyqxmd.com/read/29769130/diagnostic-accuracy-of-low-dose-dual-source-cardiac-computed-tomography-as-compared-to-surgery-in-univentricular-heart-patients
#6
Narumol Chaosuwannakit, Pattarapong Makarawate
BACKGROUND: To evaluate the ability of low radiation dose dual-source computed tomography (DSCT) to depict the features of morphological univentricular heart and to define accuracy by comparing findings with surgery. METHODS: Low radiation dose dual-source cardiac computed tomography (CCT) of 33 cases of functional univentricular heart preliminary diagnosis by echocardiography compared with the results of surgery were retrospectively analyzed (aged 1 day to 4 years, median 5 months)...
May 16, 2018: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29767239/time%C3%A2-dependent-and-independent-effects-of-thyroid-hormone-administration-following-myocardial-infarction-in-rats
#7
Ioanna Iliopoulou, Iordanis Mourouzis, George I Lambrou, Dimitra Iliopoulou, Dimitrios-Dionysios Koutsouris, Constantinos Pantos
Cardiac function is reduced following myocardial infarction (MI) due to myocardial injury and alterations in the viable non‑ischemic myocardium, a process known as cardiac remodeling. The current treatments available for patients with acute MI (AMI) reduce infarct size, preserve left ventricular (LV) function and improve survival; however, these treatments do not prevent remodeling, which can lead to heart failure. The aim of the present study was to investigate the effects of thyroid hormone (TH) treatment following MI in an in vivo rat model...
May 11, 2018: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29761891/processed-electroencephalogram-and-evoked-potential-techniques-for-amelioration-of-postoperative-delirium-and-cognitive-dysfunction-following-non-cardiac-and-non-neurosurgical-procedures-in-adults
#8
REVIEW
Yodying Punjasawadwong, Waraporn Chau-In, Malinee Laopaiboon, Sirivimol Punjasawadwong, Pathomporn Pin-On
BACKGROUND: Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) may complicate a patient's postoperative recovery in several ways. Monitoring of processed electroencephalogram (EEG) or evoked potential (EP) indices may prevent or minimize POD and POCD, probably through optimization of anaesthetic doses. OBJECTIVES: To assess whether the use of processed EEG or auditory evoked potential (AEP) indices (bispectral index (BIS), narcotrend index, cerebral state index, state entropy and response entropy, patient state index, index of consciousness, A-line autoregressive index, and auditory evoked potentials (AEP index)) as guides to anaesthetic delivery can reduce the risk of POD and POCD in non-cardiac surgical or non-neurosurgical adult patients undergoing general anaesthesia compared with standard practice where only clinical signs are used...
May 15, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29759300/decreased-contractile-response-of-peripheral-arterioles-to-serotonin-after-cpb-in-patients-with-diabetes
#9
Sharif A Sabe, Jun Feng, Yuhong Liu, Laura A Scrimgeour, Afshin Ehsan, Frank W Sellke
BACKGROUND: Regulation of coronary vasomotor tone by serotonin is significantly changed after cardioplegic arrest and reperfusion. The current study investigates whether cardiopulmonary bypass may also affect peripheral arteriolar response to serotonin in patients with or without diabetes. METHODS: Human peripheral microvessels (90-180 µm diameter) were dissected from harvested skeletal muscle tissues from diabetic and non-diabetic patients before and after cardiopulmonary bypass and cardiac surgery (n = 8/group)...
May 11, 2018: Surgery
https://www.readbyqxmd.com/read/29758209/bilateral-internal-mammary-artery-utilization-in-diabetics-friend-or-foe
#10
Todd C Crawford, Xun Zhou, Charles D Fraser, J Trent Magruder, Alejandro Suarez-Pierre, Diane Alejo, Jennifer Bobbitt, Clifford E Fonner, Kurt Wehberg, Brad Taylor, Christopher Kwon, Michael Fiocco, John V Conte, Rawn Salenger, Glenn J Whitman
BACKGROUND: Bilateral internal mammary artery (BIMA) grafting in diabetic patients undergoing coronary artery bypass grafting (CABG) remains controversial. Our study compared morbidity and mortality between 1)diabetic and non-diabetic BIMA patients and 2)diabetic BIMA versus diabetic patients who underwent left internal mammary artery (LIMA) grafting only. METHODS: Patients who underwent isolated CABG from July 2011 - June 2016 at any of the 10 centers in Maryland were propensity scored across 16 variables...
May 11, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29756691/cerebrovascular-autoregulation-impairments-during-cardiac-surgery-with-cardiopulmonary-bypass-are-related-to-postoperative-cognitive-deterioration-prospective-observational-study
#11
Birute Kumpaitiene, Milda Svagzdiene, Edmundas Sirvinskas, Virginija Adomaitiene, Vytautas Petkus, Rolandas Zakelis, Solventa Krakauskaite, Romanas Chomskis, Arminas Ragauskas, Teodoro F Dagi, Rimantas Benetis
BACKGROUND: Post-operative cognitive dysfunction (POCD) occurs in approximately 33-83% of patients after cardiac surgery with cardiopulmonary bypass (CPB). Recent clinical data suggest that real-time, intraoperative monitoring of patient- specific cerebrovascular autoregulation (CA) may help to prevent POCD by detecting individual critical limits for mean arterial pressure (MAP) outside which CA is impaired. Objectives of the study were to detect the episodes of impaired CA during cardiac surgery with CPB, and to investigate the association between CA impairment and POCD...
May 11, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29754693/preoperative-6-minute-walk-distance-is-associated-with-postoperative-cognitive-dysfunction
#12
Kazuhiro Hayashi, Hideki Oshima, Miho Shimizu, Kiyonori Kobayashi, Shigeyuki Matsui, Yoshihiro Nishida, Akihiko Usui
BACKGROUND: Postoperative cognitive dysfunction (POCD) is a neurologic dysfunction that occurs after surgery. POCD persists for a long period, ranging from weeks to months, and affects a patient's quality of life. A 6-minute walk distance (6MWD) has been used to predict postoperative complications after several operations. The present study investigated whether there was an independent association of a low preoperative 6MWD with POCD in patients who underwent cardiac operations. METHODS: The study included 181 patients who underwent a cardiac operation...
April 25, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29753653/cardiopulmonary-bypass-in-non-cardiac-surgery
#13
Timothy Luke Surman, Michael George Worthington, Jose Martinelli Nadal
BACKGROUND: Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) are used to facilitate circulatory support in standard cardiac surgery and emergency intervention, but CPB and ECMO are not used routinely in non-cardiac surgery involving the thorax and major vessels. The primary aim of this study was to identify the type of non-cardiac procedures and bypass used in our institution and review the patient outcomes including perioperative and bypass complications. METHODS: A retrospective study was performed within the Royal Adelaide Hospital Cardiothoracic Surgery Unit (CTSU) that examined all operations between 2006 and 2014...
April 19, 2018: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29750929/hyponatremia-predicts-poor-outcomes-in-patients-with-chronic-kidney-disease-undergoing-heart-surgery
#14
Linda Shavit, Ofer Merin, Tal Grenader, Ehud Jacobson, Chani Waldenberg, Daniel Bitran, Daniel Fink, Shuli Silberman
BACKGROUND: Preoperative hyponatremia adversely impacts outcomes of cardiothoracic surgery. However, in patients with chronic kidney disease, the association of sodium levels on postoperative events has never been evaluated. We investigated the impact of preoperative hyponatremia on outcomes after cardiac surgery in patients with non-dialysis-dependent chronic kidney disease. Primary endpoints were operative mortality and acute kidney injury requiring dialysis. Secondary endpoints were major infection and long-term survival...
May 8, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29749243/the-predictive-value-of-risk-indices-for-cardiac-complications-in-living-donor-liver-transplantation
#15
I P Canbolat, Y Erdogan, G Adali, O Kaplan, M Dayangac, Y Yuzer, Y Tokat
BACKGROUND AND AIMS: The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) risk tool and Revised Cardiac Risk Index (RCRI) are recommended tools for cardiovascular assessment before non-cardiac surgery to predict early postoperative cardiac morbidity and mortality. Their predictive value for postoperative cardiovascular morbidity and mortality after liver transplantation is unknown. We aimed to evaluate the validity of these two risk tools to predict early (30-day) cardiovascular complications and in-hospital all-cause mortality...
2018: Bratislavské Lekárske Listy
https://www.readbyqxmd.com/read/29748956/neurobehavioral-evaluation-of-neonates-with-congenital-heart-disease-a-cohort-study
#16
Whitnee J Hogan, Sarah Winter, Nelangi M Pinto, Cindy Weng, Xiaoming Sheng, Elisabeth Conradt, Janine Wood, Michael D Puchalski, Lloyd Y Tani, Thomas A Miller
AIM: To describe neurobehavioral patterns in neonates with congenital heart disease (CHD). METHOD: A cohort study describing neurobehavioral performance of neonates with CHD requiring cardiac surgery. The neonates were evaluated preoperatively and postoperatively with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) and scores were compared with published normative values. Clinical factors were obtained by chart review to assess their association with behavior...
May 10, 2018: Developmental Medicine and Child Neurology
https://www.readbyqxmd.com/read/29747289/-an-analysis-of-the-characteristics-of-perioperative-cardiac-troponin-elevation-in-orthopaedic-surgical-patients
#17
W L Hu, Y Z Chen, J H Wang, X L Hao, D X Zhai, H Y Sun, X S Zhao
Objective: Perioperative myocardial infarction remains a severe complication in non-cardiac surgery and is one of the major causes of death. Cardiac troponin (cTn) I elevation is associated with short-term and long-term mortality. The aim of the study was to assess the proportion rate of cTnI elevation and its clinical characteristics among patients admitted for orthopaedic surgery with or without cardiovascular events. Methods: This is a retrospective study including 27 744 patients aged 50 years or older who admitted for orthopaedic surgery from 2009-2015 in Beijing Jishuitan Hospital...
May 1, 2018: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29745623/the-role-of-intraoperative-stroke-volume-variation-on-bleeding-during-functional-endoscopic-sinus-surgery
#18
Roberta Di Mauro, Fabiana Lucci, Federica Martino, Maria B Silvi, Eleonora Gidaro, Santo Di Lorenzo, Nicola Toschi, Stefano Di Girolamo, Mario Dauri
BACKGROUNDː Functional Endoscopic Sinus Surgery (FESS) is a minimally-invasive surgical technique for patients with paranasal sinus pathology. Surgical bleeding reduces operative field visibility and increases the incidence of serious complications. Epinephrine injection into the nasal mucosa and controlled hypotension are used to minimise bleeding. Hypotension carries risks and sometimes does not reduce surgical bleeding. The goal of this study is to discover which haemodynamic parameter better correlates with surgical bleeding...
May 9, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29742783/-pro-epidural-analgesia-remains-the-gold-standard-for-abdominal-and-thoracic-surgery
#19
Hannah Listing, Daniel Pöpping
Pain relief with epidural analgesia is superior compared to systemic opioid analgesia after major abdominal and thoracic surgery. It remains a safe procedure, as long as it is embedded in a concept covering the whole perioperative period. This includes the knowledge of the anesthesiologist how to operate the process of catheter insertion as well as to treat complications like the hypotension, associated with the application of epidural local anesthetics. A close postoperative monitoring by an acute pain service team is a responsible task and should be available 24/7...
April 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29738755/durability-at-19-years-of-quadrangular-resection-with-annular-plication-for-mitral-regurgitation
#20
Elisabetta Lapenna, Benedetto Del Forno, Ludovica Amore, Stefania Ruggeri, Giuseppe Iaci, Davide Schiavi, Igor Belluschi, Marta Bargagna, Ottavio Alfieri, Michele De Bonis
BACKGROUND: To report the long-term (19 years) clinical and echocardiographic results of the quadrangular resection with annular plication and annuloplasty. METHODS: A hundred forty-five consecutive patients (mean age 58±11.1years, LVEF 59±9.5%) with severe degenerative mitral regurgitation due to posterior leaflet prolapse/flail, underwent quadrangular resection of the posterior leaflet combined with ring (127 patients,87.5%) or pericardium (18 patients,12.5%) annuloplasty...
May 5, 2018: Annals of Thoracic Surgery
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