The Design and Methodology of Clinical Studies of Neuroprotection in Cardiac Surgery

Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.14117 ◽

2019 ◽

Vol 30 (10) ◽

pp. 2150-2163

Author(s):

Giangiuseppe Cappabianca ◽

Sandro Ferrarese ◽

Cassandra Tutino ◽

Claudio Corazzari ◽

Matteo Matteucci ◽

...

Keyword(s):

Cardiac Surgery ◽

Clinical Studies ◽

Left Atrial ◽

Meta Analysis ◽

Pacemaker Implantation ◽

Surgical Ablation ◽

Safety And Efficacy

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Argatroban and Bivalirudin for Perioperative Anticoagulation in Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000001976 ◽

2018 ◽

Vol 128 (2) ◽

pp. 390-400 ◽

Cited By ~ 16

Author(s):

Andreas Koster ◽

David Faraoni ◽

Jerrold H. Levy

Keyword(s):

Cardiac Surgery ◽

Clinical Studies ◽

Surgical Patients ◽

Mechanical Support ◽

Perioperative Anticoagulation

Argatroban and bivalirudin are used as replacement anticoagulants for heparin. The authors review clinical studies for these drugs in the perioperative setting of cardiac surgical patients including extracorporeal management and mechanical support therapy.

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Pressure ulcers in cardiac surgery: Few clinical studies, difficult risk assessment, and profound clinical implications

International Wound Journal ◽

10.1111/iwj.12994 ◽

2018 ◽

Vol 16 (1) ◽

pp. 9-12 ◽

Cited By ~ 4

Author(s):

Camilla Chello ◽

Mario Lusini ◽

Davide Schilirò ◽

Salvatore Matteo Greco ◽

Raffaele Barbato ◽

...

Keyword(s):

Risk Assessment ◽

Cardiac Surgery ◽

Clinical Studies ◽

Pressure Ulcers ◽

Clinical Implications

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A prospective study of patients’ pain intensity after cardiac surgery and a qualitative review: effects of examiners’ gender on patient reporting

Scandinavian Journal of Pain ◽

10.1515/sjpain-2018-0111 ◽

2019 ◽

Vol 19 (1) ◽

pp. 39-51 ◽

Cited By ~ 1

Author(s):

Christine H. Meyer-Frießem ◽

Patrycja Szalaty ◽

Peter K. Zahn ◽

Esther M. Pogatzki-Zahn

Keyword(s):

Cardiac Surgery ◽

Pain Intensity ◽

Gender Bias ◽

Clinical Studies ◽

Rating Scale ◽

Experimental Studies ◽

Intense Pain ◽

Female Patients ◽

Lower Pain ◽

Male Patients

Abstract Background and aims As indicated by experimental studies, reports of pain intensity may depend on the examiner’s gender. Until now, it is unclear whether this is relevant in clinical routine. This study investigated prospectively whether the gender of assessor plays a role in patients’ pain reports and whether this role differs in male and female patients. Methods 165 patients (66.4 years±0.63; 118 males) scheduled for heart surgery were allocated consecutively to one examiner out of four students of both genders: two females and two males (aged 24.3 years±1.7). Therefore, the following study groups were defined: Group 1: female assessors-female patients, 2: female-male; 3: male-female, 4: male-male. Using a standardized analgesic scheme, patients were asked to rank their pain intensity on a numeric rating scale (NRS: 0–10), postoperatively. Statistics: Kruskal-Wallis, Mann-Whitney; p<0.05. Additionally, a qualitative literature review of the databases Medline and CENTRAL was performed focusing on experimental and clinical studies on experimenter gender bias. Due to the review, this prospective clinical study was designed to investigate whether patients after surgery report lower pain intensities when assessed by a female compared to a male assessor. Results Summarizing all patients, pain intensity on POD_1 was rated 4.0±2.4 on NRS and decreased on POD_2 to 3.0±2.1 [H(3)=37.941, p=0.000]. On average, pain intensity did not differ between males and females (NRS: 3.5 vs. 3.6). Only on the second postoperative day, more intense pain was reported in front of female assessors and less intense pain in front of male assessors (NRS: 3.4 vs. 2.4; p=0.000). A main effect for the four groups was seen (p=0.003): male patients reported higher pain scores to female assessors (NRS: 3.5 vs. 2.3; p=0.000). Conclusions Together, contrary to the expectations, patients after cardiac surgery reported a higher pain intensity in front of a female and a lower pain intensity in front of a male assessor. In particular, female caregivers may heighten the reported pain intensity up to 1.2 NRS-points; this bias seems to be more relevant for male patients. Implications Therefore, despite some methodological weakness, our data suggest that attention should be paid to a rather small, but somehow significant and consistent examiner gender bias after cardiac surgery especially in male patients. Further clinical studies are needed to show the true extent of clinical relevance and exact mechanisms underlying these gender reporting bias.

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Perioperative Cardioprotection by Remote Ischemic Conditioning

International Journal of Molecular Sciences ◽

10.3390/ijms20194839 ◽

2019 ◽

Vol 20 (19) ◽

pp. 4839 ◽

Cited By ~ 6

Author(s):

Youn Joung Cho ◽

Won Ho Kim

Keyword(s):

Cardiac Surgery ◽

Clinical Studies ◽

Current Knowledge ◽

Ischemia Reperfusion ◽

Confounding Factors ◽

Protective Effects ◽

Signal Transfer ◽

Humoral Factors ◽

Remote Ischemic Conditioning ◽

Ischemic Conditioning

Remote ischemic conditioning has been investigated for cardioprotection to attenuate myocardial ischemia/reperfusion injury. In this review, we provide a comprehensive overview of the current knowledge of the signal transduction pathways of remote ischemic conditioning according to three stages: Remote stimulus from source organ; protective signal transfer through neuronal and humoral factors; and target organ response, including myocardial response and coronary vascular response. The neuronal and humoral factors interact on three levels, including stimulus, systemic, and target levels. Subsequently, we reviewed the clinical studies evaluating the cardioprotective effect of remote ischemic conditioning. While clinical studies of percutaneous coronary intervention showed relatively consistent protective effects, the majority of multicenter studies of cardiac surgery reported neutral results although there have been several promising initial trials. Failure to translate the protective effects of remote ischemic conditioning into cardiac surgery may be due to the multifactorial etiology of myocardial injury, potential confounding factors of patient age, comorbidities including diabetes, concomitant medications, and the coadministered cardioprotective general anesthetic agents. Given the complexity of signal transfer pathways and confounding factors, further studies should evaluate the multitarget strategies with optimal measures of composite outcomes.

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The use of leucocyte-depleting and conventional arterial line filters in cardiac surgery: a systematic review of clinical studies

Perfusion ◽

10.1177/026765910101600602 ◽

2001 ◽

Vol 16 (6) ◽

pp. 433-446 ◽

Cited By ~ 17

Author(s):

D C Whitaker ◽

J A Stygall ◽

S P Newman ◽

M JG Harrison

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Clinical Studies ◽

Literature Search ◽

Additional Benefit ◽

Controlled Trials ◽

Arterial Line ◽

Clear Cut ◽

Randomized Controlled ◽

Definite Effect

Although various forms of arterial line filter have been available for use during cardiopulmonary bypass (CPB) for 30 years, their use is not universal. The aim of this review was to seek evidence of the clinical benefit of using conventional or leucocyte-depleting arterial line filters during bypass. A literature search revealed 28 relevant clinical studies. Despite the wide variety of patient populations, types of filter and outcome measures utilized in studies, a few conclusions are possible. Whereas conventional filtration has the definite effect of reducing neuropsychological deficit post-CPB, the results of studies using the leucocyte-depleting filter are less clear cut. Leucocyte-depleting filters have potential for reducing inflammatory mediated heart and lung injury, however it is recommended that any additional benefit of leucocyte-depleting filters over conventional filters should be further tested by randomized controlled trials of sufficient size.

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