bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retransfusion of filtered shed blood in primary total hip and knee arthroplasty: a prospective randomized clinical trial
Authors: Moonen Adrianus F.C.M. , Knoors Nico T. , Van Os Johannes J. , Verburg Aart D. , Pilot Peter 
Published: January 2007

BACKGROUND: Allogeneic blood transfusions are associated with a number of well‐recognized risks and complications. Postoperative retransfusion of filtered shed blood is an alternative to (reduce) allogeneic blood transfusion. The objectives of this study were to evaluate the clinical efficacy of retransfusion of filtered shed blood and to evaluate the complications, in particular febrile reactions.STUDY DESIGN AND METHODS: In this clinical trial 160 patients undergoing primary total hip or knee replacement were randomly assigned to receive either a retransfusion system (Bellovac, AstraTech AB) or a regular drain (Abdovac, AstraTech AB). Patients with a preoperative hemoglobin (Hb) level of between 13.0 and 14.6 g per dL were included. The shed blood was returned 6 hours after operation. After surgery the anesthesiologist determined the transfusion trigger. When Hb level dropped below this trigger, an allogeneic blood transfusion was given. The following data were obtained: number of allogeneic blood transfusions, total volume of blood collected in the bag used for retransfusion, perioperative Hb levels, febrile reaction, and other complications.RESULTS: In the control group 19 percent of the patients received at least one allogeneic blood transfusion. In the study group this percentage was 6 percent of the patients (p = 0.015). Comparing total knee and total hip arthroplasty (control vs. study) the percentages were, respectively, 16 percent versus 2 percent (p = 0.040) and 21 percent versus 11 percent (NS). On average 308 mL of filtered shed blood was retransfused in the study group. In the study group 18 percent of patients had febrile reactions compared to 20 percent in the control group.CONCLUSION: Postoperative retransfusion of filtered shed blood is effective for decreasing allogeneic blood transfusions after total hip and knee arthroplasty. There was no relationship between retransfusions and postoperative febrile reactions.
Blood collection and transfusion in the United States in 2001
Authors: Sullivan Marian T. , Cotten Russell , Read Elizabeth J. , Wallace Edward L. 
Published: January 2007

BACKGROUND: Collection, processing, and transfusion of blood and blood components in the United States in 2001 were measured and compared with prior years.STUDY DESIGN AND METHODS: The survey was completed by 1443 blood centers and hospitals. Statistical procedures were used to verify the representativeness of the sample and to estimate national totals.RESULTS: The total US blood supply in 2001 was 15,320,000 units (before testing), 10.4 percent greater than in 1999. It included 14,259,000 allogeneic units, 619,000 autologous units, and 273,000 red cell (RBC) units collected by apheresis. Transfusion of whole blood (WB) and RBCs increased by 12.2 percent to 13,898,000 units. Platelet (PLT) transfusions totaled 10,196,000 units, an increase of 12.6 percent in comparison with 1999. The use of single‐donor apheresis PLTs increased by 26.0 percent to 7,582,000 PLT concentrate equivalent units. The use of PLTs from WB (PLT concentrates) continued a downtrend, declining 13.9 percent to 2,614,000.CONCLUSIONS: The margin between transfusion demand and the total allogeneic supply in 2001 was 1,162,000 units, 7.9 percent of supply. By comparison, the 1999 margin was 9.1 percent. The rate of blood collection per 1,000 donor‐eligible population in 2001 was 8.9 percent higher than in 1999, due largely to additional donations following the September terrorist attacks. During the same period, however, the rate of transfusion per 1,000 total US population increased by 9.9 percent to 50.0 units, the highest in 15 years of measurement. The steady increase in demand continues to challenge the US blood community.
Impact of demographic changes on the blood supply: Mecklenburg‐West Pomerania as a model region for Europe
Authors: Greinacher Andreus , Fendrich Konstanze , Alpen Ulf , Hoffmann Wolfgang 
Published: January 2007

BACKGROUND: The population structure in most European countries is currently changing with a shift from younger to older age groups. This study analyzed how demography will determine future blood demand and supply in a well‐characterized region.STUDY DESIGN AND METHODS: The population of the main catchment area of the University Hospital Greifswald (415,000 inhabitants) was projected to the year 2015 based on 1‐year age groups provided by the population registry, based on 2002 rates assuming stable death rates and migration patterns. Data on donors and recipients for the years 1996 through 2004 were extracted from the database of the Department of Transfusion Medicine.RESULTS: Until 2015, the increase in the older population will result in an 11.8 to 13.9 percent increase of blood transfusions. Assuming constant motivation to donate blood as in 2004, the decrease in the younger population will cause a 27.5 to 32.6 percent decrease of blood donations until 2015.CONCLUSION: The increased demand for blood coincides with a significant reduction in blood donations. From 2008 the shortfalls will grow to 32 to 35 percent of the total demand in 2015 in the area studied. The demographic trends will affect many regions in Europe similarly. Coordinated efforts will be required to prevent blood shortages based on these demographic trends in western societies.
A model to predict the improvement of automated blood culture bacterial detection by doubling platelet sample volume
Authors: Wagner Stephen J. , Eder Anne F. 
Published: January 2007

BACKGROUND: Some transmissions of bacterial infection from platelet (PLT) transfusion have occurred since introduction of automated blood culturing of apheresis PLTs. The majority of these cases involved false‐negative culture results in which slow‐growing Staphylococcus organisms were implicated. This study analyses the projected benefit in detecting slow growing organisms by increasing sample volume from 4 to 8 mL.STUDY DESIGN AND METHODS: Bacterial growth was modeled by varying the initial inoculum, doubling time, and lag time. The numbers of organisms present at a 24‐hour sampling time were calculated. Poisson analysis was used to determine the fraction of 4‐ or 8‐mL samples that could be detected because they contained organisms. For each inoculum, the percentage of improved detection by doubling sample volume was defined as delta, the difference between the percentage of detection of 8‐ and 4‐mL samples.RESULTS: The maximum improvement in detection by doubling sample volume was 25 percent and did not depend on bacterial growth rate or lag time. As inocula increased toward 40 colony‐forming units per unit, delta decreased. As lag and doubling times increased, inocula corresponding to maximum delta increased and the width of the distribution curve broadened.CONCLUSION: Doubling sample volume will not double the chance of detecting slow growing organisms, but instead is predicted to improve detection by 25 percent or less.
Autonomic Control in Patients Experiencing Atrial Fibrillation After Cardiac Surgery
Authors: BAUERNSCHMITT ROBERT , MALBERG HAGEN , WESSEL NIELS , BROCKMANN GERNOT , WILDHIRT STEPHEN M. , KOPP BURKHARD , KURTHS JÜRGEN , BRETTHAUER GEORG , LANGE RÜDIGER 
Published: January 2007

Background: Atrial fibrillation (AF) occurs in 20–40% of patients after open heart surgery and leads to an increased morbidity and prolonged hospital stay. Earlier studies have demonstrated that depressed baroreflex function predicts mortality and major arrhythmic events in patients surviving myocardial infarction. Cardiac surgery per se leads to decreased baroreflex sensitivity (BRS) and heart rate variability (HRV). Hence, the present study was aimed at analyzing the impact of the cardiovascular autonomous system on the development of postsurgical AF.
Methods and Results: The study covered 51 patients who consecutively underwent aortic valve replacement, coronary artery bypass surgery, or combined procedures. Noninvasive blood pressure and ECG were recorded the day before and 24 hour after surgery. BRS, linear as well as nonlinear HRV parameters were calculated using established methods. Eighteen patients developed AF during the first postoperative week, while 33 remained in sinus rhythm (SR) throughout the observation period. Patients with postoperative (PostOp) AF exhibited a significantly reduced preoperative (PreOp) BRS in terms of bradycardic and tachycardic regulation (average delayed slope [ms/mmHg]: SR: PreOp: 9.83 ± 3.26, PostOp: 6.02 ± 2.29, Pre‐Post: P < 0.001; AF: PreOp: 7.59 ± 1.99, PostOp: 6.39 ± 3.67, Pre‐Post: P < 0.044; AF vs SR: PreOp: P < 0.01, PostOp: ns). In both groups, surgery caused a decrease of BRS and HRV. Analysis of nonlinear dynamics revealed a tendency toward decreased system complexity caused by the operation; this trend was significant in patients remaining in sinus rhythm.
Conclusions: Patients experiencing postoperative AF obviously suffer from an impaired BRS before surgery already. These findings may be used to guide prophylactic antiarrhythmic therapy.
Staged Circumferential and Ostial Pulmonary Vein Ablation for the Treatment of Paroxysmal Atrial Fibrillation
Authors: KATRITSIS DEMOSTHENES , GIAZITZOGLOU ELEFTHERIOS , KOROVESIS SOCRATES , KOURLABA GEORGIA , VORIDIS EUTYCHIOS , CAMM A. JOHN 
Published: January 2007

Background: Comparisons between segmental ostial disconnection of the pulmonary veins (PV) and circumferential ablation have produced conflicting results in patients with paroxysmal atrial fibrillation (AF). The aim of this study was to evaluate a staged ablation procedure, every step of which was assessed by means of AF inducibility.
Methods: Twenty‐two patients with paroxysmal AF were subjected to three ablation stages during one session: (1) circumferential ablation around the PV ostia, (2) segmental ostial PV isolation, and (3) ablation of areas within the circumferential lines with fractionated electrograms or voltage >0.2 mV as well as linear ablation at the mitral isthmus and the left atrial roof. Endpoint of the procedure was noninducibility of AF at any stage.
Results: Average radiofrequency energy delivery, fluoroscopy, and procedure times were 43 ± 11 minutes, 40 ± 11 minutes, and 3.8 ± 0.5 hours, respectively. At 6‐months follow‐up, four patients experienced recurrence of AF (18%), whereas two additional patients (9%) had left atrial arrhythmias not registered before the procedure. Ninety‐five percent of the patients who did not have inducible AF (regardless of the stage of ablation at which noninducibility was achieved) were free of recurrent AF, as opposed to none of the patients in whom AF was inducible at the end of the procedure (log‐rank test, P < 0.001).
Conclusions: A staged ablation procedure combing circumferential and ostial PV ablation with AF noninducibilty as endpoint may result in high success rates without the need of prolonged ablation sessions in certain patients with paroxysmal atrial fibrillation.
Closed Loop Stimulation Improves Ejection Fraction in Pediatric Patients with Pacemaker and Ventricular Dysfunction
Authors: DRAGO FABRIZIO , SILVETTI MASSIMO S. , DE SANTIS ANTONELLA , FAZIO GIOVANNI , BIANCALANA GIANLUCA , GRUTTER GIORGIA , RINELLI GABRIELE 
Published: January 2007

Background: The aim of this prospective study was to evaluate the effect of the closed loop stimulation (CLS) on the ejection fraction in pediatric patients, affected by complete atrioventricular block (CAVB) or CAVB and sinus node dysfunction (SND), with a previously implanted pacemaker (PM) and ventricular dysfunction. The role of electrical therapy in the treatment of pediatric patients with congenital atrioventricular (AV) blocks has been shown. Conventional right ventricular pacing seems to affect ventricular function. Up to now, the feasibility and the long‐term results of biventricular pacing in pediatric patients were not entirely clear.
Methods: In eight pediatric patients with a previously implanted single or dual chamber PM, ventricular dysfunction, and CAVB or SND and CAVB, a dual chamber PM INOS2+‐CLS (Biotronik GmbH, Berlin, Germany) was implanted. The effect of the physiological modulation of CLS pacing mode on the ejection fraction was evaluated by Echo‐Doppler examination. Measurements were performed before the substitution of the old PM and for up to 2 years of follow‐up.
Results: All patients showed correct electrical parameters at implantation and during follow‐up. The mean value of the ejection fraction measured before the replacement of the old PM was 36 ± 7%, while after 2 years it was 47 ± 1% (P < 0.003). No patient showed any worsening of the ejection fraction, while only one showed no improvement.
Conclusions: DDD‐CLS pacing seems to improve ventricular function in pediatric patients with CAVB and/SND in spite of the use of the apical right conventional stimulation.
Importance of Anterograde Visualization of the Coronary Venous Network by Selective Left Coronary Angiography Prior To Resynchronization
Authors: DELARCHE NICOLAS , BADER HUGUES , LASSERRE RAPHAEL , DERVAL NICOLAS , DEBEUGNY STEPHAN , DENARD MAIALIZ , ESTRADE GÉRARD 
Published: January 2007

Background: Understanding of coronary anatomy is essential to the advancement of cardiac resynchronization therapy (CRT) techniques. We determined whether the difficulties associated with catheterization of the coronary sinus (CS) and its lateral branches could be overcome by a preliminary angiographical study of the coronary venous system carried out during a pre‐operative coronary angiography with examination of venous return.
Methods and Results: All patients were scheduled for an exploratory angiography procedure and indicated for CRT. Group A patients were implanted with a CRT device after a right arterial angiographical procedure while group B patients had a selective left angiogram including examination of venous return. Data analyzed in group B were: position of CS ostium, number and distribution of lateral branches, and ability to preselect a marginal vein suitable for catheterization. Subsequent device implantation was guided by these parameters. A total of 96 and 89 patients were included in groups A and B, respectively. Implantation success rates were not different (98% and 100%, respectively), but CS catheterization time was reduced in group B (6 minutes vs 4 minutes; P < 10−6) as well as total time required to position the left ventricular lead (25 minutes vs 15 minutes; P < 10−6), fluoroscopy exposure (7 minutes vs 5 minutes; P < 10−6), and volume of contrast medium required (45 mL vs 15 mL; P < 10−6).
Conclusion: A coronary angiographical study, including examination of the coronary venous return prior to implantation of a CRT device, can simplify the device implant and allows patient‐specific preselection of appropriate tools for the procedure.
Maximum Ventricular Dyssynchrony Predicts Clinical Improvement and Reverse Remodeling during Cardiac Resynchronization Therapy
Authors: TADA HIROSHI , TOIDE HIROYUKI , OKANIWA HIROKI , HIGUCHI RUMI , NAKAJIMA TSUTOMU , UTSUGI RIKA , HASHIMOTO TOHRU , MIYAJI KOHEI , KASENO KENICHI , TADOKORO KAZUYOSHI , NAITO SHIGETO , NOGAMI AKIHIKO , OSHIMA SHIGERU , TANIGUCHI KOICHI 
Published: January 2007

Background: Tissue synchronization imaging (TSI) and tissue tracking imaging (TTI) might facilitate the evaluation of ventricular dyssynchrony.
Methods: In 22 patients, TSI and TTI were performed before and <1 month after onset of cardiac resynchronization therapy (CRT). With TSI guidance, maximum left ventricular (LV) intraventricular conduction delay (IVCDmax) was the greatest difference in time‐to‐peak velocity between septum and lateral wall. IVCD between the basal septum and lateral wall (IVCDbase) was also measured. Using TTI, the mean peak myocardial displacement of the basal septal and lateral walls (PMDbase), and the temporal coefficient of variation of the PMD in six LV regions (CV‐PMDLV) were measured. The patients were divided into responders (whose LV end‐systolic volume decreased by ≥15% during a 27 ± 9 months follow‐up) and nonresponders.
Results: Before CRT, IVCDbase was similar in both groups, and remained unchanged within the 1st month of CRT in both groups. However, before CRT, IVCDmax was greater in responders than in nonresponders (P < 0.05), and decreased only in the responders during CRT (P < 0.05). No significant difference was observed in PMDbase or CV‐PMDLV between the two groups, before or during CRT.
Conclusions: TSI was useful to measure IVCDmax. A greater IVCDmax before CRT that decreased shortly after onset of CRT may predict long‐term clinical improvement in CRT recipients.
Effects of Stimulation Site on Diastolic Function in Cardiac Resynchronization Therapy
Authors: DE COCK CAREL C. , VOS DICK H. S. , JESSURUN EMILE , ALLAART COR P. , VISSER CEES A. 
Published: January 2007

Background: Cardiac resynchronization therapy (CRT) improves left ventricular (LV) systolic function and clinical status, and prolongs survival of patients suffering from heart failure. An optimal LV site selection is key with respect to improvements in systolic function, though whether a site‐specific effect on diastolic function exists is unclear. This study compared the effects of CRT on changes in systolic and diastolic function from 2 LV stimulation sites.
Methods: We studied 21 patients in New York Heart Association functional classes ≥III, and a LV ejection fraction <0.30 and QRS duration > 130 ms. CRT leads were placed in the right ventricle, right atrium, and coronary sinus tributaries. LV stimulation was applied from the postero‐lateral and antero‐lateral wall. A LV conductance catheter was used to measure LV systolic and diastolic function. Systolic responders had >10% changes in dP/dtmax, and diastolic responders <10% changes in τ during CRT versus baseline. Response was highly dependent on LV lead position for both diastolic and systolic function. Diastolic responders decreased from 29% to 10% of patients, and systolic responders from 76% to 48%, in the best versus the worst lead position, respectively. Improvements in diastolic function were less pronounced than in systolic function (relative change −14% vs +28%, P < 0.05). Overall, 45% were both systolic and diastolic responders, 17% were both systolic and diastolic nonresponders, and 38% had opposite responses.
Conclusions: Changes in systolic and diastolic function were both highly dependent on the LV stimulation site. Diastolic function was less influenced by CRT and a high proportion of patients had discordant results.
Feasibility Of Temporary Biventricular Pacing In Patients With Reduced Left Ventricular Function After Coronary Artery Bypass Grafting
Authors: EBERHARDT FRANK , HANKE THORSTEN , HERINGLAKE MATHIAS , MASSALME MAXIMILIAN S. , BECHTEL MATTHIAS , MISFELD MARTIN , WIEGAND UWE K. H. 
Published: January 2007

Background and Methods: Biventricular pacing improves hemodynamics after weaning from cardiopulmonary bypass in patients with severely reduced left ventricular (LV) function undergoing coronary artery bypass grafting (CABG). We examined the feasibility of temporary biventricular pacing for 96 hours postoperatively. Unipolar epicardial wires were placed on the roof of the right atrium (RA), the right ventricular (RV) outflow tract, and the LV free lateral wall and connected to an external pacing device in 51 patients (mean LV ejection fraction 35 ± 4%). Pacing and sensing thresholds, lead survival and incidence of pacemaker dysfunction were determined.
Results: Atrial and RV pacing thresholds increased significantly by the 4th postoperative day, from 1.6 ± 0.2 to 2.5 ± 0.3 V at 0.5 ms (P = 0.03) at the RA, 1.4 ± 0.3 V to 2.7 ± 0.4 mV (P = 0.01) at the RV, and 1.9 ± 0.6 V to 2.9 ± 0.7 mV (P = 0.3) at the LV, while sensing thresholds decreased from 2.0 ± 0.2 to 1.7 ± 0.2 mV (P = 0.18) at the RA, 7.2 ± 0.8 to 5.1 ± 0.7 mV (P = 0.05) at the RV, and 9.4 ± 1.3 to 5.5 ± 1.1 mV (P = 0.02) at the LV. The cumulative overall incidence of lead failure was 24% by the 4th postoperative day, and was similar at the RV and LV. We observed no ventricular proarrhythmia due to pacing or temporary pacemaker malfunction.
Conclusions: Biventricular pacing after CABG using a standard external pacing system was feasible and safe.
Relationship Between Global Myocardial Index and Automatic Left Ventricular Border Detection Pattern to Identify Biventricular Pacing Candidates
Authors: COZMA DRAGOS , POPESCU BOGDAN A. , LIGHEZAN DANIEL , LUCIAN PETRESCU , MORNOS CRISTIAN , LUCA CONSTANTIN T. , GINGHINĂ CARMEN , DRAGULESCU STEFAN‐IOSIF 
Published: January 2007

Objective of the Study:
to evaluate the relation between global myocardial index (GMI) and the pattern of left ventricular (LV) volume curves variation, using automatic border detection (ABD), and their role in assessing LV asynchrony.
Methods:
We studied 52 patients (mean age = 55 ± 17 years) with dilated cardiomyopathy. QRS duration (QRSd) and GMI were measured. Currently accepted TDI and M‐mode parameters were used to indicate LV dyssynchrony. On‐line continuous LV volume changes were recorded using ABD. Ejection time (ET ABD) was measured from the ABD wave‐forms as time interval between maximal and minimal volume variation during LV electromechanical systole. We derived the ejection time index (ETiABD) as the ratio between ET ABD and RR interval (ETiABD = ET/RR).
Results:
31 patients had a QRSd >120 ms and 21 patients had a QRSd <120 ms. Ventricular dyssynchrony was observed in 39 patients (29 patients had a QRSd > 120 ms). GMI was significantly higher in patients with, than in patients without ventricular dyssynchrony (1.06 ± 0.18 vs 0.73 ± 0.13, P = 0.0001), while ETABD was significantly smaller (233 ± 39 ms vs 321 ± 28 ms, P = 0.0001). The corresponding difference for ETiABD was 26.9 ± 6.8% vs 6.3 ± 4%, P < 0.0001. By simple regression analysis an inverse linear correlation was observed between GMI and ETiABD (r2=–0.51, P < 0.0001). The pattern of ABD waveforms showed increased isovolumic contraction and relaxation times in patients with LV asynchrony, similar to the GMI pattern.
Conclusions:
Regional delays in ventricular activation cause uncoordinated and prolonged ventricular contractions, with lengthening of the isovolumic contraction and relaxation times and shortening of the time available for filling and ejection. GMI explores these parameters and together with ABD might be useful to identify patients with ventricular asynchrony.