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Vasanthan V, Hassanabad AF, Kang S, Dundas J, Ramadan D, Holloway D, Adams C, Ahsan M, Fedak PWM. Novel hardening bone putty enhances sternal closure and accelerates postoperative recovery. J Thorac Cardiovasc Surg 2023; 166:e430-e443. [PMID: 36272766 DOI: 10.1016/j.jtcvs.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Regaining and maintaining sternal stability are key to recovery after cardiac surgery and resuming baseline quality of life. Montage (ABYRX) is a moldable, calcium phosphate-based putty that adheres to bleeding bone, hardens after application, and is resorbed and replaced with bone during the remodeling process. We evaluate the feasibility, safety, and efficacy of enhanced sternal closure with this novel putty to accelerate recovery in patients after sternotomy. METHODS A single-center, single-blinded, randomized controlled trial was performed (NCT03365843). Patients undergoing elective cardiac surgery via sternotomy received sternal closure with either Montage bone putty and wire cerclage (enhanced sternal closure; n = 33) or wire cerclage alone (control; n = 27). Standardized patient-reported outcomes assessed health-related quality of life (EQ-5D Index) and physical disability (Health Assessment Questionnaire). A Likert-type 11-point scale quantified pain. Spirometry assessed respiratory function. Patients reached 6-week follow-up, with 1-year follow-up for safety end points. RESULTS There were no device-related adverse events. Enhanced sternal closure improved physical functional recovery (reduced Healthcare Index and Quality) and quality of life (increased EQ-5D Index) at day 5/discharge, week 2, and week 4. Enhanced sternal closure reduced incisional pain while resting, breathing, sleeping, and walking at day 5/discharge. Enhanced sternal closure reduced chest wall and back pain at day 3 and day 5 discharge. A higher proportion of patients with enhanced sternal closure recovered to 60% of their baseline forced vital capacity by day 5/discharge. Enhanced sternal closure shortened hospital stay. CONCLUSIONS Enhanced sternal closure improves and accelerates postoperative recovery compared with conventional wire closure. Earlier discharge may provide substantial cost benefits for the healthcare system.
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Affiliation(s)
- Vishnu Vasanthan
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean Kang
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jameson Dundas
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Darlene Ramadan
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Holloway
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Corey Adams
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Muhammad Ahsan
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul W M Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Vasanthan V, Fatehi Hassanabad A, Kang S, Ramadan D, Holloway D, Adams C, Ahsan M, Fedak P. ENHANCEMENT OF STERNAL CLOSURE WITH NOVEL HARDENING BONE PUTTY ACCELERATES POST-OPERATIVE RECOVERY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Hall A, Kissel C, Fung M, Pajevic M, Ramadan D, Jackson-Carter L, Haykowski M, Howlett J, Dyck J, Anderson T. IMPAIRED MICROVASCULAR FUNCTION IN SUBJECTS WITH HEART FAILURE: RESULTS FROM THE ALBERTA HEART FAILURE ETIOLOGY AND ANALYSIS RESEARCH TEAM (HEART) STUDY. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Slawnych MP, Nieminen T, Kähönen M, Kavanagh KM, Lehtimäki T, Ramadan D, Viik J, Aggarwal SG, Lehtinen R, Ellis L, Nikus K, Exner DV. Post-Exercise Assessment of Cardiac Repolarization Alternans in Patients With Coronary Artery Disease Using the Modified Moving Average Method. J Am Coll Cardiol 2009; 53:1130-7. [DOI: 10.1016/j.jacc.2008.12.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 12/01/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
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Exner DV, Kavanagh KM, Slawnych MP, Mitchell LB, Ramadan D, Aggarwal SG, Noullett C, Van Schaik A, Mitchell RT, Shibata MA, Gulamhussein S, McMeekin J, Tymchak W, Schnell G, Gillis AM, Sheldon RS, Fick GH, Duff HJ. Noninvasive risk assessment early after a myocardial infarction the REFINE study. J Am Coll Cardiol 2007; 50:2275-84. [PMID: 18068035 DOI: 10.1016/j.jacc.2007.08.042] [Citation(s) in RCA: 275] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 08/03/2007] [Accepted: 08/13/2007] [Indexed: 12/27/2022]
Abstract
OBJECTIVES This study sought to determine whether combined assessment of autonomic tone plus cardiac electrical substrate identifies most patients at risk of serious events after myocardial infarction (MI) and to compare assessment at 2 to 4 weeks versus 10 to 14 weeks after MI. BACKGROUND Methods to identify most patients at risk of serious events after MI are required. METHODS Patients (n = 322) with an ejection fraction (EF) <0.50 in the initial week after MI were followed up for a median of 47 months. Serial assessment of autonomic tone, including heart rate turbulence (HRT), electrical substrate, including T-wave alternans (TWA), and EF was performed, interpreted blinded, and categorized using pre-specified cut-points where available. The primary outcome was cardiac death or resuscitated cardiac arrest. All-cause mortality and fatal or nonfatal cardiac arrest were secondary outcomes. RESULTS Mean EF significantly increased over the initial 8 weeks after MI. Testing 2 to 4 weeks after MI did not reliably identify patients at risk, whereas testing at 10 to 14 weeks did. The 20% of patients with impaired HRT, abnormal exercise TWA, and an EF <0.50 beyond 8 weeks post-MI had a 5.2 (95% confidence interval [CI] 2.4 to 11.3, p < 0.001) higher adjusted risk of the primary outcome. This combination identified 52% of those at risk, with good positive (23%; 95% CI 17% to 26%) and negative (95%; 95% CI 93% to 97%) accuracy. Similar results were observed for the secondary outcomes. CONCLUSIONS Impaired HRT, abnormal TWA, and an EF <0.50 beyond 8 weeks after MI reliably identify patients at risk of serious events. (Assessment of Noninvasive Methods to Identify Patients at Risk of Serious Arrhythmias After a Heart Attack; http://www.clinicaltrials.gov/ct/show/NCT00399503?order=1; NCT00399503).
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Affiliation(s)
- Derek V Exner
- Libin Cardiovascular Institute of Alberta, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Exner DV, Kavanagh K, Mitchell R, Aggarwal S, Shibata M, Ramadan D, Duff HJ. Increased repolarization alternans following myocardial infarction is related to adverse left ventricular remodeling: Implications for risk assessment & use of defibrillator therapy. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mitchell LB, Sheldon RS, Gillis AM, Connolly SJ, Duff HJ, Gardner MJ, Hui WK, Ramadan D, Wyse DG. Definition of predicted effective antiarrhythmic drug therapy for ventricular tachyarrhythmias by the electrophysiologic study approach: randomized comparison of patient response criteria. J Am Coll Cardiol 1997; 30:1346-53. [PMID: 9350938 DOI: 10.1016/s0735-1097(97)00294-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We sought to compare efficacies of therapy for ventricular tachyarrhythmias selected by programmed stimulation using two different patient response efficacy criteria: <5 versus <16 repetitive ventricular responses. BACKGROUND Therapy selection for ventricular tachyarrhythmias by programmed stimulation requires definition of a patient response that predicts long-term efficacy. Such definitions have not been previously compared prospectively. METHODS Patients with sustained ventricular tachyarrhythmias were randomized to therapy selection using either the <5 or <16 repetitive response criterion of predicted effective therapy. The primary end point was sudden death or recurrence of ventricular tachyarrhythmia requiring intervention. RESULTS Predicted effective drug therapy was found for 23 (34%) of 68 patients randomized to the <5 criterion and 29 (36%) of 81 patients randomized to the <16 criterion (p = NS). Definition of therapy required 3.0 +/- 1.6 drug trials (mean +/- SD) in patients randomized to the <5 criterion and 2.9 +/- 1.8 trials in patients randomized to the <16 criterion (p = NS). Patients randomized to the <5 criterion had a lower 2-year probability of the primary end point (0.20 +/- 0.05) than did patients randomized to the <16 criterion (0.33 +/- 0.05, one-tailed p = 0.004). The advantage of the <5 criterion was also seen in subgroup analyses involving patients with and without an initial drug efficacy prediction. CONCLUSIONS The programmed stimulation approach to the selection of antiarrhythmic therapy for ventricular tachyarrhythmias using a patient response criterion of <5 repetitive ventricular responses results in a lower probability of recurrence of ventricular tachyarrhythmia than does use of a <16 repetitive response criterion.
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Affiliation(s)
- L B Mitchell
- Department of Medicine, Foothills Hospital and University of Calgary, Alberta, Canada
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Mitchell LB, Duff HJ, Gillis AM, Ramadan D, Wyse DG. A randomized clinical trial of the noninvasive and invasive approaches to drug therapy for ventricular tachycardia: long-term follow-up of the Calgary trial. Prog Cardiovasc Dis 1996; 38:377-84. [PMID: 8604442 DOI: 10.1016/s0033-0620(96)80031-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Individualized antiarrhythmic drug therapy for patients with ventricular tachyarrhythmias may be selected by the noninvasive approach (suppression of spontaneous ventricular premature beats) or the invasive approach (suppression of ventricular tachyarrhythmias induced at an electrophysiologic study). There is controversy over which approach is superior. From a screened population of 124 patients with symptomatic ventricular tachycardia or ventricular fibrillation, 57 patients with both frequent ventricular premature beats and inducible ventricular tachycardia at baseline were randomized to have chronic therapy selected by either the noninvasive or invasive approach. These patients have now been followed up for a minimum event-free period of 6.5 years. By intention-to-treat, therapy selected by the invasive approach prevented subsequent ventricular tachyarrhythmias better than that selected by the noninvasive approach (6-year probabilities of freedom from symptomatic sustained ventricular tachyarrhythmia recurrence; noninvasive approach, 0.45 +/- 0.10; invasive approach, 0.73 +/- 0.09; p=.02). This advantage of the invasive approach was also evident for the outcome of any ventricular tachyarrhythmia recurrence and for efficacy analyses involving only those patients with a drug-efficacy prediction. We hypothesize that the difference between these results and those of the ESVEM trial are caused, in part, by differences in the characteristics of the enrolled patients and differences in criteria used to define a predicted-effective therapy.
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Affiliation(s)
- L B Mitchell
- Division of Cardiology, Foothills Medical Center, Calgary, Alberta, Canada
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Kellen JC, Ramadan D. The patient with recurrent atrioventricular nodal reentrant tachycardia or chronic atrial fibrillation or atrial flutter. Crit Care Nurs Clin North Am 1994; 6:41-53. [PMID: 8192883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Atrioventricular nodal reentry tachycardias, atrial fibrillation, and atrial flutter are common symptomatic arrhythmias encountered in clinical practice. The reentry mechanisms and pathophysiology of atrioventricular nodal reentrant tachycardias, atrial fibrillation, and atrial flutter are described. This article outlines the therapeutic approaches used in the acute phases of presentation. Nursing implications for patients admitted to intensive care/telemetry units are discussed.
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