TOP TEN SELECTED PAPERS
|
- |
May 2011 |
|
|
Pediatr Int. 2011 May 27. doi: 10.1111/j.1442-200X.2011.03407.x. [Epub ahead of
print]
Cognitive P300 Evoked Potentials in School-age Children after Surgical or
Trans-catheter Intervention for Ventricular Septal Defect.
Guan GT, Jin YP, Zheng RP, Liu FQ, Wang YL.
Division of Cardiology, Department of Pediatrics, Provincial Hospital affiliated
to Shandong University, Shandong University, No. 324, Jingwu Road, Jinan, 250021
P.R. China.
Back ground: Some studies suggested that neurological development may be
adversely affected in children with severe coronary heart disease who underwent
long periods of deep hypothermic cardiopulmonary bypass (CPB). Reports of
cognitive function in VSD patients in whom surgical repair required only a
relatively brief period of CPB are rare. As well, CPB is unnecessary for VSD
patients undergoing trans-catheter closure. Objective: To assess the cognitive
function in patients with ventricular septal defect. Methods: twenty nine
patients treated by surgery and 35 by trans-catheter closure and their age- and
sex-matched best friend completed the cognitive P300 auditory-evoked potentials
test and the intelligence test. Results: The patients and their best friends had
normal intelligence quotient. But the patients had longer P300 peak latencies in
cranial frontal lobe and cranial vertex leads (329.2 ± 24.8 and 335.1 ± 20.0ms)
than did healthy controls (319.1 ± 20.6 and 313 ± 18.2 ms) (p < 0.05). Patients
who underwent surgery had longer P300 peak latency in cranial frontal lobe and
cranial vertex leads than did those with trans-catheter closure and controls;
When cardiopulmonary bypass and aortic clamping was used, the duration was
associated with P300 peak latency for patients (p < 0.05). Conclusion:
Ventricular septal defect patients, especially those undergoing surgery, showed
poor cognitive function, which may be associated with duration of cardiopulmonary
bypass or aortic-clamping.
J Cardiopulm Rehabil Prev. 2011 May 26. [Epub ahead of print]
Patient Education and Quality of Home-Based Rehabilitation in Patients Older Than
60 Years After Acute Myocardial Infarction.
Wolkanin-Bartnik J, Pogorzelska H, Bartnik A.
Institute of Cardiology, Warsaw, Poland (Drs Wolkanin-Bartnik and Pogorzelska);
and University College London, United Kingdom (Ms Bartnik).
PURPOSE:: Because only one-third of eligible patients participate in formal
cardiac rehabilitation, home-based programs constitute a suitable alternative. We
examined effectiveness of a minimal educational intervention on patient fitness
and activity levels through the use of simple motivational tools including verbal
encouragement and the provision of a booklet containing exercise guidelines and
exercise diary. METHODS:: We enrolled 186 patients (age, 60-78 years; mean age,
69 years; 140 men) who were admitted to the outpatient clinic of Warsaw Institute
of Cardiology in 2007-2009 after acute myocardial infarction. Of these, 61.3% had
coronary angioplasty with stenting and 30.7% had coronary artery bypass. Patients
were randomly assigned into an intervention group receiving minimal educational
intervention or control. At baseline and 3 months, assessment was made of
cardiopulmonary fitness and autonomic tone with exercise testing. Leisure-time
physical activity and atherosclerosis risk factors were assessed at baseline and
after 3 and 12 months. RESULTS:: qAt baseline, exercise test results and
leisure-time activity levels were not significantly different between groups.
After 3 months, we noted statistically significant differences in exercise test
responses between the intervention group versus control: peak workload 57.3 ± 2.3
versus 47.2 ± 2.2 kJ (P < .04) and heart rate recovery 26.5 ± 3.3 versus 23.7 ±
4.2 bpm (P < .001). Leisure-time activity was greater in the intervention group
than in control, 3.9 versus 2.3 h/wk (P < .001). Improvement in atherosclerosis
risk factors during the course of the study was similar between groups.
CONCLUSION:: Minimal educational intervention is an effective and safe form of
promoting physical activity in older patients after myocardial infarction.
J Cardiothorac Vasc Anesth. 2011 May 24. [Epub ahead of print]
Population Pharmacokinetics of Lidocaine Administered During and After Cardiac
Surgery.
Hsu YW, Somma J, Newman MF, Mathew JP.
Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan.
OBJECTIVE: The objective of this study was to determine the pharmacokinetics of
lidocaine in a 48-hour infusion in patients undergoing cardiac surgery with
cardiopulmonary bypass (CPB). DESIGN: A retrospective substudy of a clinical
trial assessing the efficacy of intravenous lidocaine for postoperative cognitive
decline. SETTING: A university hospital. PARTICIPANTS: Ninety-nine patients
undergoing cardiac surgery with CPB. INTERVENTIONS: After the induction of
anesthesia, lidocaine was administered as a bolus of 1 mg/kg and followed by a
continuous infusion at 4 mg/min for the 1st hour, 2 mg/min for the 2nd hour, and
1 mg/min for the next 46 hours. MEASUREMENTS AND MAIN RESULTS: Blood samples were
taken at baseline, the end of CPB, and 24 and 48 hours after CPB for the
measurement of the plasma concentration of lidocaine. Lidocaine levels increased
significantly over time despite a constant rate of infusion (p < 0.05). The
pharmacokinetics of lidocaine was best described by a 2-compartment model, and
body weight was found to be a significant factor for the volume of the central
compartment and clearance. The final pharmacokinetic parameters were V(1)(L) =
0.0619*weight, V(2)(L) = 187, CL(1) (L/min) = 0.00419*weight, and CL(2) (L/min) =
8.92. CONCLUSIONS: A 2-compartment pharmacokinetic model best describes the
plasma concentrations of a 48-hour lidocaine infusion in patients undergoing
cardiac surgery with CPB. The inclusion of body weight as a covariate on
clearance and central compartment improves the model. Lidocaine infusions should
be dosed by body weight and decreased after 24 hours to avoid potential toxicity
in long-term infusions.
Scand Cardiovasc J. 2011 May 26. [Epub ahead of print]
Measurement of intraperitoneal metabolites during hypothermic cardiopulmonary
bypass using microdialysis.
Adluri RK, Singh AV, Skoyles J, Baker M, Mitchell IM.
Department of Cardiac Surgery, The Trent Cardiac Centre, Nottingham City Hospital
NHS Trust, Nottingham, UK.
Abstract Objective. Splanchnic hypoxia, with resultant mucosal acidosis during
cardiopulmonary bypass (CPB) has been demonstrated using tonometry. Microdialysis
is a minimally-invasive method of obtaining peritoneal fluid samples. We measured
the intraperitoneal metabolites during peri-operative period following
hypothermic CPB and studied the safety of intraperitoneal microdialysis. Design.
Eleven consecutive patients undergoing coronary artery bypass grafting (CABG)
were included after obtaining ethics committee approval and informed consent.
Microdialysis catheters were placed intraperitoneally after sternotomy.
Intraperitoneal samples and arterial blood samples were obtained peri-operatively
for first 24 hours. The samples were analysed for levels of glucose, lactate,
pyruvate and glycerol. Repeated measures ANOVA test was used to compare timed
serum and intraperitoneal samples. Results. The study population included nine
males and two females with a mean age of 63.7 ± 11 years. The mean CPB and X
clamp times were 50.9 ± 7.3 minutes and 27.3 ± 4.9 minutes, respectively. There
were no complications related to microdialysis. The intraperitoneal lactate (L),
pyruvate (P) and glycerol increased during CPB and four to six hours
postoperatively. The L:P ratio was >10:1 during CPB, but in the postoperative
period showed evidence of impaired oxygen utilisation. Conclusions. This
prospective study confirms incidence of intraperitoneal anaerobic metabolism of
glucose during CPB and impaired utilisation of glucose in the postoperative
period. Microdialysis provides a novel and minimally-invasive method to measure
real time intraperitoneal events.
Interact Cardiovasc Thorac Surg. 2011 May 22. [Epub ahead of print]
Plasma neutrophil gelatinase-associated lipocalin measured in consecutive
patients after congenital heart surgery using point-of-care technology.
Koch AM, Dittrich S, Cesnjevar R, Rüffer A, Breuer C, Glöckler M.
Department of Pediatric Cardiology, University of Erlangen-Nurnberg, Erlangen,
Germany.
Neutrophil gelatinase-associated lipocalin (NGAL) is an early predictive
biomarker of acute kidney injury. Plasma NGAL was measured in 218 consecutive
patients aged three days to 21.1 years after admission to the intensive care unit
after cardiopulmonary bypass surgery using a commercially available point-of-care
test to evaluate its diagnostic value in daily practice. Plasma NGAL was between
60 and 644 ng/ml in all patients [median 134 (interquartile range 94-194) ng/ml].
In 31% of patients, serum creatinine increased more than 50% within three days
after surgery, but no patient needed renal replacement therapy. In the early
neonatal period, NGAL was positively correlated to baseline serum creatinine
(r=0.47; P=0.02). In patients aged more than 10 days, plasma NGAL was correlated
to peak serum creatinine in the postoperative course (r=0.21; P=0.003), and to
the severity of acute kidney injury (r=0.15; P=0.032). However, NGAL values were
substantially scattered. Plasma NGAL levels early after congenital heart surgery
are correlated to acute kidney injury, but the severity of kidney injury cannot
be deduced from an individual NGAL value. Therefore, the value of one single
plasma NGAL measurement performed early after cardiac bypass surgery for
congenital heart disease is limited. Keywords: Acute kidney injury;
Cardiopulmonary bypass; Congenital cardiac surgery; Ischemia; Pediatric.
J Crit Care. 2011 May 17. [Epub ahead of print]
Ventilator-associated pneumonia is an important risk factor for mortality after
major cardiac surgery.
Tamayo E, Alvarez FJ, Martínez-Rafael B, Bustamante J, Bermejo-Martin JF, Fierro
I, Eiros JM, Castrodeza J, Heredia M, Gómez-Herreras JI; Valladolid Sepsis Study
Group.
Department of Anaesthesiology and Intensive Care, Hospital Clinico Universitario
de Valladolid, Valladolid, Spain 47005.
PURPOSE: Ventilator-associated pneumonia (VAP) is the main infectious
complication in cardiac surgery patients and is associated with an important
increase in morbidity and mortality. The aim of our study was to analyze the
impact of VAP on mortality excluding other comorbidities and to study its
etiology and the risk factors for its development. MATERIALS AND METHODS: This
prospective cohort study included 1610 postoperative cardiac surgery patients'
status post cardiopulmonary bypass (CPB) between July 2004 and January 2008. The
primary outcome measures were the development of VAP and in-hospital mortality.
RESULTS: Ventilator-associated pneumonia was observed in 124 patients (7.7%).
Patients with VAP had a longer length of hospitalization (40.7 ± 35.1 vs 16.1 ±
30.1 days, P < .0001) and greater in-hospital mortality (49.2% [61/124] vs 2.0%
[30/1486], P = .0001) in comparison with patients without VAP. After performing
the Cox multivariant analysis adjustment, VAP was identified as the most
important independent mortality risk factor (adjusted hazard ratio [HR], 8.53;
95% confidence interval, 4.21-17.30; P = .0001). Other independent risk factors
of in-hospital mortality were chronic renal failure (HR, 2.56), diabetes mellitus
(HR, 1.90), CPB time (HR, 1.51), respiratory failure (HR, 2.13), acute renal
failure (HR, 2.39), and mediastinal bleeding of at least 1000 mL (HR, 1.81).
CONCLUSIONS: The development of VAP after CPB is the most important independent
risk factor for in-hospital mortality. Identification of effective strategies for
the prevention of VAP is needed.
Perfusion. 2011 May 18. [Epub ahead of print]
2010 survey on cell phone use while performing cardiopulmonary bypass.
Smith T, Darling E, Searles B.
SUNY Upstate Medical University in Syracuse, NY, USA.
Cell phone use in the U.S. has increased dramatically over the past decade and
text messaging among adults is now mainstream. In professions such as perfusion,
where clinical vigilance is essential to patient care, the potential distraction
of cell phones may be especially problematic. However, the extent of this as an
issue is currently unknown. Therefore, the purpose of this study was to (1)
determine the frequency of cell phone use in the perfusion community, and (2) to
identify concerns and opinions among perfusionists regarding cell phone use. In
October 2010, a link to a 19-question survey (surveymonkey.com) was posted on the
AmSECT (PerfList) and Perfusion.com (PerfMail) forums. There were 439
respondents. Demographic distribution is as follows; Chief Perfusionist (30.5%),
Staff Perfusionist (62.0%), and Other (7.5%), with age ranges of 20-30 years
(14.2%), 30-40 years (26.5%), 40-50 years (26.7%), 50-60 years (26.7%), >60 years
(5.9%). The use of a cell phone during the performance of cardiopulmonary bypass
(CPB) was reported by 55.6% of perfusionists. Sending text messages while
performing CPB was acknowledged by 49.2%, with clear generational differences
detected when cross-referenced with age groups. For smart phone features,
perfusionists report having accessed e-mail (21%), used the internet (15.1%), or
have checked/posted on social networking sites (3.1%) while performing CPB.
Safety concerns were expressed by 78.3% who believe that cell phones can
introduce a potentially significant safety risk to patients. Speaking on a cell
phone and text messaging during CPB are regarded as "always an unsafe practice"
by 42.3% and 51.7% of respondents, respectively. Personal distraction by cell
phone use that negatively affected performance was admitted by 7.3%, whereas
witnessing another perfusionist distracted with phone/text while on CPB was
acknowledged by 33.7% of respondents. This survey suggests that the majority of
perfusionists believe cell phones raise significant safety issues while operating
the heart-lung machine. However, the majority also have used a cell phone while
performing this activity. There are clear generational differences in opinions on
the role and/or appropriateness of cell phones during bypass. There is a need to
further study this issue and, perhaps, to establish consensus on the use of
various communication modes within the perfusion community.
Eur J Cardiothorac Surg. 2011 May 16. [Epub ahead of print]
Safety and feasibility of intra-operative device closure of atrial septal defect
with transthoracic minimal invasion.
Chen Q, Cao H, Zhang GC, Chen LW, Chen DZ.
Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University,
Fuzhou, 350001, PR China.
Objective: The study aims to evaluate the safety and feasibility of
intra-operative device closure of atrial septal defect with transthoracic minimal
invasion. Methods: From May 2006 to June 2009, 252 patients with secundum-type
atrial septal defect closure were enrolled in our institution. The patients were
divided into two groups, with 182 patients in group I with intra-operative device
closure and 72 in group II with surgical closure. In group I, the patients' age
ranged from 3 months to 62 years (mean±standard deviation, 19.0±16.7 years). This
approach involved a transthoracic minimal invasion that was performed after full
evaluation of the atrial septal defect by transthoracic echocardiography,
deploying the device through the delivery sheath to occlude the atrial septal
defect. Results: In group I, 180 patients were occluded successfully under this
approach. The size of the occluder device implanted ranged from 6 to 48mm. Minor
complications occurred, which included transient arrhythmias (n=23) and pleural
effusion (n=15). Two patients with postoperative cardiac arrest were successfully
cardiopulmonary resuscitated. Another two patients with occluder dislodged back
into the right atrium were turned to surgical repair with cardiopulmonary bypass
on the postoperative day. In group II, all patients were occluded successfully,
and almost all patients needed blood transfusion and suffered from various minor
complications. All discharged patients were followed up for 1-5 years. During
this period, we found no recurrence, no thrombosis, even no device failure. In
our comparative studies, group II had significantly longer intensive care unit
(ICU) stay and hospital stay than group I (p<0.05). The cost for group I was less
than group II (p<0.05). Conclusions: Intra-operative device closure of atrial
septal defect with transthoracic minimal invasion is a safe and feasible
technique. It had the advantages of cost savings, yielding better cosmetic
results, and leaving less trauma than surgical closure.
J Thorac Cardiovasc Surg. 2011 May 16. [Epub ahead of print]
Atrioventricular valve repair in patients with functional single-ventricle
physiology: Impact of ventricular and valve function and morphology on survival
and reintervention.
Honjo O, Atlin CR, Mertens L, Al-Radi OO, Redington AN, Caldarone CA, Van Arsdell
GS.
The Labatt Family Heart Centre, The Hospital for Sick Children, and The
University of Toronto, Toronto, Ontario, Canada.
OBJECTIVE: This study was to determine whether atrioventricular valve repair
modifies natural history of single-ventricle patients with atrioventricular valve
insufficiency and to identify factors predicting survival and reintervention.
METHODS: Fifty-seven (13.5%) of 422 single-ventricle patients underwent
atrioventricular valve repair. Valve morphology, regurgitation mechanism, and
ventricular morphology and function were analyzed for effect on survival,
transplant, and reintervention with multivariate logistic and Cox regression
models. Comparative analysis used case-matched controls. RESULTS:
Atrioventricular valve was tricuspid in 67% and common in 28%. Ventricular
morphology was right in 83%. Regurgitation mechanisms were prolapse (n = 24,
46%), dysplasia (n = 18, 35%), annular dilatation (n = 8, 15%), and restriction
or cleft (n = 2, 4%). Postrepair insufficiency was none or trivial in 14 (26%),
mild in 33 (61%), and moderate in 7 (13%). Survival in repair group was lower
than in matched controls (78.9% vs 92.7% at 1 year, 68.7% vs 90.6% at 3 years,
P = .015). Patients with successful repair and normal ventricular function had
equivalent survival to matched controls (P = .36). Independent predictors for
death or transplant included increased indexed annular size (P = .05), increased
cardiopulmonary bypass time (P = .04), and decreased postrepair ventricular
function (P = .01). Ventricular dilation was a time-related factor for all
events, including failed repair. CONCLUSIONS: Survival was lower in
single-ventricle patients operated on for atrioventricular valve insufficiency
than in case-matched controls. Patients with little postoperative residual
regurgitation and preserved ventricular function had equivalent survival to
controls. Lower grade ventricular function and ventricular dilation correlated
with death and repair failure, suggesting that timing of intervention may affect
outcome.
Interact Cardiovasc Thorac Surg. 2011 May 13. [Epub ahead of print]
Aortic valve-sparing operations in aortic root aneurysms: remodeling or
reimplantation?
Rahnavardi M, Yan TD, Bannon PG, Wilson MK.
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW,
Australia.
A best evidence topic was written according to a structured protocol. The
question addressed was whether the reimplantation (David) technique or the
remodeling (Yacoub) technique provides the optimum event free survival in
patients with an aortic root aneurysm suitable for an aortic valve-sparing
operation. In total, 392 papers were found using the reported search criteria, of
which 14 papers provided the best evidence to answer the clinical question. A
total of 1338 patients (Yacoub technique in 606 and David technique in 732) from
13 centres were included. In most series, cardiopulmonary bypass time and aortic
cross-clamp time were longer for the David technique compared to the Yacoub
technique. Early mortality was comparable between the two techniques (0-6.9% for
the Yacoub technique and 0-6% for the David technique). There is a tendency for a
higher freedom from significant long-term aortic insufficiency in the David group
than the Yacoub group, which does not necessarily result in a higher reoperation
rate in the Yacoub group. In the largest series reported by David et al., freedom
from a moderate-to-severe aortic insufficiency at 12 years was 82.6±6.2% in the
Yacoub and 91.0±3.8% in the David group (P=0.035). Freedom from reoperation at
the same time point was 90.4±4.7% in the Yacoub group and 97.4±2.2% in the David
group (P=0.09). In another series reported by Erasmi et al., freedom from
reoperation at a follow-up time of about four years was 89±4% in the Yacoub group
and 98±2% in the David group. Although some authors merely preferred the Yacoub
technique for a bicuspid aortic valve, the accumulated evidence in the current
review indicates comparable results for both techniques in a bicuspid aortic
valve. Current evidence is in favour of the David rather than the Yacoub
technique in pathologies such as Marfan syndrome, acute type A aortic dissection,
and excessive annular dilatation that may impair aortic root integrity. Careful
selection of patients for each technique and successful restoration of normal
cusp geometry are the keys to success in aortic valve-sparing operations.
Keywords: Aortic valve-sparing operation; Remodeling; Reimplantation; Aortic root
aneurysm.
Back to Homepage
Back to Index
Footer
PERFUSION LINE - THE LARGEST COLLECTION OF PERFUSION RESOURCES
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Perfusion Line - Copyright © 1997-2012
International Page on Extracorporeal Technology
