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https://www.readbyqxmd.com/read/29666020/geographic-variation-in-the-treatment-of-u-s-adult-heart-transplant-candidates
#1
William F Parker, Allen S Anderson, Donald Hedeker, Elbert S Huang, Edward R Garrity, Mark Siegler, Matthew M Churpek
BACKGROUND: The current U.S. priority ranking for heart candidates is based on treatment intensity, not objective markers of severity of illness. This system may encourage centers to overtreat candidates. OBJECTIVES: This study sought to describe national variation in the intensity of treatment of adult heart transplantation candidates and identify center-level predictors of potential overtreatment. METHODS: The registrations of all U.S. adult heart transplantation candidates from 2010 to 2015 were collected from the SRTR (Scientific Registry of Transplant Recipients)...
March 20, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29658871/new-onset-ventricular-arrhythmias-in-patients-with-left-ventricular-dysfunction-after-coronary-surgery-incidence-risk-factors-and-prognosis
#2
Nan Cheng, Changqing Gao, Rong Wang, Ming Yang, Lin Zhang
BACKGROUND: The incidence, risk factors, and long-term prognosis of new-onset ventricular tachycardia (VT) and ventricular fibrillation (VF) after coronary artery bypass graft surgery (CABG) in patients with impaired left ventricular function have not been thoroughly examined. Methods: This study enrolled 612 consecutive patients with impaired left ventricular function (ejection fraction <50%) undergoing CABG at a single institution between March, 1996, and September, 2015. Outcomes were analyzed and compared, including in-hospital mortality and long-term survival...
March 26, 2018: Heart Surgery Forum
https://www.readbyqxmd.com/read/29656961/in-hospital-outcomes-of-percutaneous-ventricular-assist-devices-versus-intra-aortic-balloon-pumps-in-non-ischemia-related-cardiogenic-shock
#3
Gbolahan O Ogunbayo, Le Dung Ha, Qamar Ahmad, Naoki Misumida, Ayman Elbadawi, Odunayo Olorunfemi, Andrew Kolodziej, Adrian W Messerli, Ahmed Abdel-Latif, Claude S Elayi, Maya Guglin
INTRODUCTION: This study compared inpatient outcomes related to the use of these two devices among patients who developed cardiogenic shock not due to acute myocardial infarction or coronary revascularization. METHODS: We extracted admission-level records of patients with a diagnosis of cardiogenic shock who underwent either PVAD or IABP implantation from the National Inpatient Sample (NIS) database from 2010 to 2014. Our outcomes of interest were mortality and length of stay...
April 12, 2018: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/29652272/comparison-of-immediate-extubation-versus-ultrafast-tracking-strategy-in-the-management-of-off-pump-coronary-artery-bypass-surgery
#4
Amarja Sachin Nagre, Nagesh P Jambures
Introduction: Ultrafast tracking of anesthesia (UFTA) is practiced routinely, whereas immediate on-table extubation after off-pump coronary artery bypass (OPCAB) grafting surgery has many concerns. The purpose of our study was to evaluate the safety and feasibility of immediate extubation (IE) versus UFTA. Methods: Sixty patients were enrolled who underwent OPCAB surgery. The two groups IE and UFTA had thirty patients each. Inclusion criteria were patients for OPCAB surgery including left main stenosis...
April 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29652271/prophylactic-preoperative-levosimendan-for-off-pump-coronary-artery-bypass-grafting-in-patients-with-left-ventricular-dysfunction-single-centered-randomized-prospective-study
#5
Pushkar Mahendra Desai, Manjula S Sarkar, Sanjeeta R Umbarkar
Background: Off-pump coronary artery bypass surgery (OPCAB) is often complicated by hemodynamic instability, especially in patients with prior left ventricular (LV) dysfunction and appropriate choice of inotrope plays a vital role in perioperative management of these patients. Aim and Objective: To study hemodynamic effects and immediate outcome of prophylactic infusion of levosimendan in patients with the LV dysfunction undergoing OPCAB surgery and whether this strategy helps in successful conduct of OPCAB surgery...
April 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29644151/trans-cranial-doppler-as-an-ancillary-study-supporting-irreversible-brain-injury-in-a-post-cardiac-arrest-patient-on-extracorporeal-membrane-oxygenation
#6
Naresh Mullaguri, Aarti Sarwal, Nakul Katyal, Premkumar Nattanamai, Pravin George, Christopher R Newey
Obtaining neuroimaging in patients on cardiopulmonary support devices such as extracorporeal membrane oxygenation (ECMO) can be challenging, given the complexities in monitoring, instrumentation, and associated hemodynamic lability. Transcranial Doppler (TCD) is used as an ancillary test for the assessment of cerebral circulatory arrest, but its use in non-pulsatile blood flow in venoarterial (VA) ECMO is not well described. We report the use of TCD in a patient on VA ECMO post-cardiac arrest for evaluation of death by neurological criteria...
February 6, 2018: Curēus
https://www.readbyqxmd.com/read/29626516/national-trends-and-outcomes-of-endomyocardial-biopsy-for-patients-with-myocarditis-from-the-national-inpatient-sample-database
#7
Ayman Elbadawi, Islam Y Elgendy, Le Dung Ha, Amgad Mentias, Gbolahan O Ogunbayo, Waqas Tahir, Nishit Binwale, Odunayo Olorunfemi, Kirolos Barssoum, Maya Guglin
BACKGROUND: The utility of endomyocardial biopsy (EMB) in the management of myocarditis in the era of advanced cardiac imaging has been challenged. METHODS AND RESULTS: The Nationwide Inpatient Sample Database years (1998-2013) was queried to identify hospitalization records with a primary diagnosis of myocarditis, and underwent EMB procedure. We identified 22,299 hospitalization records with a diagnosis of myocarditis during the study period. Of those, 798 (3.6%) underwent EMB procedure...
April 4, 2018: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/29613887/clinical-outcomes-and-reduced-pulmonary-artery-pressure-with-intra-aortic-balloon-pump-during-central-extracorporeal-life-support
#8
Sarah Tepper, Moises Baltazar Garcia, Irene Fischer, Amena Ahmed, Anam Khan, Keki R Balsara, Muhammad Faraz Masood, Akinobu Itoh
Patients supported with extracorporeal life support (ECLS) can experience severe complications from increased left ventricular afterload. The intra-aortic balloon pump (IABP) is thought to unload the left ventricle (LV) and is routinely used with ECLS despite conflicting evidence of its clinical benefit. This retrospective, single-center study examined the effect of the simultaneous use of IABP and centrally cannulated ECLS on patient outcomes and provides new insights into IABP-mediated LV unloading. Thirty patients supported with central ECLS and IABP (ECLS-I) were compared with 30 patients with central ECLS alone (ECLS) for cardiogenic shock...
March 30, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29600725/overview-of-impella-and-mechanical-devices-in-cardiogenic-shock
#9
Hymie Habib Chera, Menachem Nagar, Nai-Lun Chang, Carlos Morales-Mangual, George Dous, Jonathan D Marmur, Muhammad Ihsan, Paul Madaj, Yitzhak Rosen
Cardiogenic shock (CS) is a life-threatening condition associated with significant morbidity and mortality. The Impella (Abiomed Inc.) is an axial flow pump on a pigtail catheter that is placed across the aortic valve to unload the left ventricle by delivering non-pulsatile blood flow to the ascending aorta. It is used for high-risk percutaneous coronary intervention and CS. Areas covered: Percutaneous mechanical support devices are placed in a minimally invasive manner and provide life-saving assistance. We review Impella and other percutaneous devices such as intra-aortic balloon pump, TandemHeart, and extracorporeal membrane oxygenation (ECMO) and the evidence supporting their use in the setting of CS...
March 30, 2018: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/29560351/cardiac-output-monitoring-by-pulse-contour-analysis-the-technical-basics-of-less-invasive-techniques
#10
REVIEW
Jörn Grensemann
Routine use of cardiac output (CO) monitoring became available with the introduction of the pulmonary artery catheter into clinical practice. Since then, several systems have been developed that allow for a less-invasive CO monitoring. The so-called "non-calibrated pulse contour systems" (PCS) estimate CO based on pulse contour analysis of the arterial waveform, as determined by means of an arterial catheter without additional calibration. The transformation of the arterial waveform signal as a pressure measurement to a CO as a volume per time parameter requires a concise knowledge of the dynamic characteristics of the arterial vasculature...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/29559842/advancis-score-predicts-acute-kidney-injury-after-percutaneous-coronary-intervention-for-acute-coronary-syndrome
#11
Pei-Chun Fan, Tien-Hsing Chen, Cheng-Chia Lee, Tsung-Yu Tsai, Yung-Chang Chen, Chih-Hsiang Chang
Acute kidney injury (AKI), a common and crucial complication of acute coronary syndrome (ACS) after receiving percutaneous coronary intervention (PCI), is associated with increased mortality and adverse outcomes. This study aimed to develop and validate a risk prediction model for incident AKI after PCI for ACS. We included 82,186 patients admitted for ACS and receiving PCI between 1997 and 2011 from the Taiwan National Health Insurance Research Database and randomly divided them into a training cohort (n = 57,630) and validation cohort (n = 24,656) for risk model development and validation, respectively...
2018: International Journal of Medical Sciences
https://www.readbyqxmd.com/read/29527864/left-ventricular-support-during-complex-transradial-percutaneous-coronary-intervention-for-complete-revascularization
#12
Annamaria Dachille, Amelia Focaccio, Lucio Selvetella, Giovanni Napolitano, Carlo Briguori
Although there is not uniform definition of high-risk percutaneous coronary intervention (PCI), patients with severe three-vessel disease, left main disease, single remaining patent vessel and/or depressed left ventricular ejection fraction are considered a high-risk population. In this setting, periprocedural hemodynamic instability represents a serious issue. Percutaneous mechanical circulatory support (MCS) devices may improve both safety and efficacy of high risk PCI. Indeed, MCS help to maintain coronary perfusion pressure and reduce myocardial workload, providing the operator sufficient time to reach the target of complete revascularization...
March 8, 2018: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/29517515/left-ventricular-unloading-during-veno-arterial-ecmo-a-simulation-study
#13
Dirk W Donker, Daniel Brodie, José P S Henriques, Michael Broomé
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is widely used in cardiogenic shock. It provides systemic perfusion, but left ventricular (LV) unloading is suboptimal. Using a closed-loop, real-time computer model of the human cardiovascular system, cardiogenic shock supported by peripheral VA ECMO was simulated and effects of various adjunct LV unloading interventions were quantified. After VA ECMO initiation (4 L/min) in cardiogenic shock (baseline), hemodynamics improved (mean arterial pressure (MAP) increased to 85 mmHg), while LV overload occurred (10% increase in end-diastolic volume (EDV), and 5 mmHg increase in pulmonary capillary wedge pressure (PCWP))...
March 6, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29516192/randomized-controlled-trial-of-remote-ischaemic-conditioning-in-st-elevation-myocardial-infarction-as-adjuvant-to-primary-angioplasty-ric-stemi
#14
António Gaspar, André P Lourenço, Miguel Álvares Pereira, Pedro Azevedo, Roberto Roncon-Albuquerque, Jorge Marques, Adelino F Leite-Moreira
To test whether remote ischaemic conditioning (RIC) as adjuvant to standard of care (SOC) would prevent progression towards heart failure (HF) after ST-elevation myocardial infarction (STEMI). Single-centre parallel 1:1 randomized trial (computerized block-randomization, concealed allocation) to assess superiority of RIC (3 cycles of intermittent 5 min lower limb ischaemia) over SOC in consecutive STEMI patients (NCT02313961, clinical trials.gov). From 258 patients randomized to RIC or SOC, 9 and 4% were excluded because of unconfirmed diagnosis and previously unrecognized exclusion criteria, respectively...
March 7, 2018: Basic Research in Cardiology
https://www.readbyqxmd.com/read/29514584/unstable-angina-in-the-era-of-high-sensitivity-troponin-testing-a-genuine-entity-and-a-cautionary-tale
#15
Thomas Krysztofiak, John Byrne
High-sensitivity cardiac troponin assays have emerged as a powerful tool in the management of patients presenting acutely to hospital with suspected cardiac chest pain. Recent guidelines emphasize the reassurance offered by low troponin concentrations early after admission. We describe a patient with known coronary artery disease, who presented with a classical history of recurrent myocardial ischaemia. High-sensitivity cardiac Troponin-I concentrations remained in the low-normal sex-specific reference range, despite serial testing on the day of admission, and despite recurrent pain with dynamic ECG changes...
January 1, 2018: Scottish Medical Journal
https://www.readbyqxmd.com/read/29513023/apical-takotsubo-syndrome-versus-anterior-acute-myocardial-infarction-findings-from-the-tokyo-cardiovascular-care-unit-network-registry
#16
Toshiaki Isogai, Tsutomu Yoshikawa, Tetsuro Ueda, Tetsuo Yamaguchi, Yoichi Imori, Yuichiro Maekawa, Konomi Sakata, Tsutomu Murakami, Hiroki Mochizuki, Kenshiro Arao, Akihisa Kimura, Ken Nagao, Takeshi Yamamoto, Morimasa Takayama
BACKGROUND: Although the typical apical form of Takotsubo syndrome and anterior acute myocardial infarction have similar electrocardiographic and echocardiographic presentations, data on the clinical differences between the two disorders are limited. METHODS: Using the Tokyo Cardiovascular Care Unit network registry, we identified patients hospitalised with apical Takotsubo syndrome ( n=540; 2010-2014) or anterior acute myocardial infarction ( n=2,806; 2013-2014) and created 522 age and sex-matched pairs (mean age 74...
March 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29510430/is-there-any-difference-in-risk-factors-between-male-and-female-patients-in-new-onset-atrial-fibrillation-after-coronary-artery-bypass-grafting
#17
Barış Akça, Nevzat Erdil, Mehmet Cengiz Colak, Olcay Murat Disli, Bektas Battaloglu, Cemil Colak
BACKGROUND:  We aimed to investigate the risk factors of post-coronary artery bypass grafting (CABG) atrial fibrillation (AF) in male and female patients without any history of AF, to identify the sex-specific risk factors, and to examine the effect of sex-specific risk factors on the overall population. METHODS:  This retrospective study was conducted using the hospital database with 4,758 patients who underwent CABG surgery. Among them, 2,836 patients with complete data participated in this study...
March 6, 2018: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/29506260/external-aortic-clamping-versus-endoaortic-balloon-occlusion-in-minimally-invasive-cardiac-surgery-a-systematic-review-and-meta-analysis
#18
Habib Khan, Christopher Hadjittofi, Mohsin Uzzaman, Kareem Salhiyyah, Sheena Garg, Salman Butt, Haleema Aya, Sanjay Chaubey
OBJECTIVES: Minimally invasive cardiac valve surgery is safe, effective and increasingly popular. It is performed worldwide with the use of either external aortic clamping or endoaortic balloon occlusion. METHODS: We conducted a literature search using MEDLINE, EMBASE, Scopus and Web of Science. Primary outcomes included aortic dissection, conversion to sternotomy, mortality, stroke and cross-clamp time. Secondary outcomes included atrial fibrillation, acute kidney injury, reoperation for bleeding, cardiopulmonary bypass times, myocardial infarction, use of intra-aortic balloon pump and length of hospital stay...
February 28, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29506135/-choosing-wisely-culture-among-brazilian-cardiologists
#19
Luis C L Correia, Guilherme B Barcellos, Vitor Calixto, André Volschan, José A S Barreto-Filho, Renato D Lopes, Anis Rassi, Wendy Levinson, Angelo A V de Paola
Objective: (i) To describe how aligned the 'Choosing Wisely' concept is with the medical culture among Brazilian cardiologists and (ii) to identify predictors for physicians' preference for avoiding wasteful care. Design: Cross-sectional study. Setting: Brazilian Society of Cardiology. Participants: Cardiologists who agree to fill a web questionary. Intervention: A task force of 12 Brazilian cardiologists prepared a list of 13 'do not do' recommendations, which were made available on the Brazilian Society of Cardiology website for affiliates to assign a supported score of 1 to 10 to each recommendation...
March 1, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29503828/using-intra-aortic-balloon-pump-for-management-of-cardiogenic-shock-following-aluminum-phosphide-poisoning-report-of-3-cases
#20
Ahmad Bagheri-Moghaddam, Hasan Abbaspour, Shahrad Tajoddini, Vahideh Mohammadzadeh, Ali Moinipour, Bita Dadpour
Introduction: Aluminium phosphide (Alp) poisoning mortality rate has been reported as high as 70-100%, and refractory hypotension and cardiogenic shock are the two most common presentations leading to death. Due to lack of specific antidote, all treatments are focused on supportive care and recently, intra-aortic balloon pump (IABP) has been suggested to treat cardiogenic shock resulting from toxic myocarditis. In the current paper, we introduce three Alp poisoned patients for whom IABP was applied to manage their refractory shock...
2018: Emergency (Tehran, Iran)
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