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<1>
Accession Number
2012052617
Authors
Suleiman M. Koestler C. Lerman A. Lopez-Jimenez F. Herges R. Hodge D.
Bradley D. Cha Y.-M. Brady P.A. Munger T.M. Asirvatham S.J. Packer D.L.
Friedman P.A.
Institution
(Suleiman) Rambam Medical Center, Haifa, Israel
(Koestler, Lerman, Lopez-Jimenez, Herges, Hodge, Bradley, Cha, Brady,
Munger, Asirvatham, Packer, Friedman) Division of Cardiovascular Medicine,
Mayo Clinic, Rochester, MN 55905, United States
Title
Atorvastatin for prevention of atrial fibrillation recurrence following
pulmonary vein isolation: A double-blind, placebo-controlled, randomized
trial.
Source
Heart Rhythm. 9 (2) (pp 172-178), 2012. Date of Publication: February
2012.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: It is known that statins are effective in preventing atrial
fibrillation (AF) in patients undergoing cardiac surgery. Objective: The
purpose of this study was to evaluate the efficacy of statins in
preventing AF recurrence following left atrial ablation. Methods: One
hundred twenty-five patients who had no statin indication undergoing
catheter ablation due to drug-refractory paroxysmal (n = 90) or persistent
(n = 35) AF were randomized in a prospective, double-blind,
placebo-controlled trial to receive 80 mg atorvastatin (n = 62) or placebo
(n = 63) for 3 months. The primary endpoint was freedom from symptomatic
AF at 3 months. Secondary endpoints included freedom from any atrial
arrhythmia recurrence irrespective of symptoms, quality of life (QoL), and
reduction in C-reactive protein (CRP). Results: At 3 months, 95% of
patients in the atorvastatin group were free of symptomatic AF compared
with 93.5% in the placebo group (P =.75). Similarly, 85% of patients
treated in the atorvastatin group remained free of any recurrent atrial
arrhythmia vs 88% of patients in the placebo group (P =.37). Mean CRP
levels decreased in the atorvastatin group (mean change -0.75 +/- 3, P
=.02) and increased in the placebo group (mean change 2.1 +/- 19.9, P
=.48). Mean QoL score improved significantly in both groups (mean change
13.14 +/- 18.2 in the atorvastatin group and 11.10 +/- 17.7 in the placebo
group, P =.53). Conclusion: In patients with no standard indication for
statin therapy, treatment with atorvastatin 80 mg/day following AF
ablation does not decrease the risk of AF recurrence in the first 3 months
and should not be routinely administered to prevent periprocedural
arrhythmias. 2012 Heart Rhythm Society.

<2>
Accession Number
2012059171
Authors
Boden H. Van Der Hoeven B.L. Liem S.-S. Atary J.Z. Cannegieter S.C. Atsma
D.E. Bootsma M. Jukema J.W. Zeppenfeld K. Oemrawsingh P.V. Van Der Wall
E.E. Schalij M.J.
Institution
(Boden, Van Der Hoeven, Liem, Atary, Atsma, Bootsma, Jukema, Zeppenfeld,
Van Der Wall, Schalij) Dept. of Cardiology, Leiden University Medical
Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
(Cannegieter) Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, Netherlands
(Oemrawsingh) Department of Cardiology, Medical Center Haaglanden, The
Hague, Netherlands
(Schalij) P.O. Box 9600, 2300 RC Leiden, Netherlands
Title
Five-year clinical follow-up from the MISSION! Intervention Study:
Sirolimus-eluting stent versus bare metal stent implantation in patients
with ST-segment elevation myocardial infarction, a randomised controlled
trial.
Source
EuroIntervention. 7 (9) (pp 1021-1029), 2012. Date of Publication:
January 2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To evaluate the clinical outcomes of sirolimus-eluting stent (SES)
versus bare metal stent (BMS) implantation in patients with ST-segment
elevation myocardial infarction (STEMI) at long-term follow-up. Methods
and results: After five years, 310 STEMI patients randomly assigned to
implantation of either SES or BMS, were compared. Survival rates were
comparable between groups (SES 94.3% vs. BMS 92.8%, p=0.57), as were the
rates of reinfarction (10.6% vs. 13.7%, p=0.40), freedom of death/re-MI
(84.4% vs. 79.8%, p=0.29) and target vessel failure (14.9% vs. 21.7%,
p=0.11). Likewise, rates of overall stent thrombosis (ST) (5.4% vs. 2.7%,
p=0.28) and very late ST (4.1% vs. 0.7%, p=0.07) did not significantly
differ between the SES- and BMSgroup. In 184 patients with IVUS data,
definite and definite/probable VLST was more common in those with late
stent malapposition versus those without late stent malapposition (4.3%
and 6.6% vs. no events [p=0.018 and p=0.004], respectively). The
cumulative incidences of target vessel and target lesion revascularisation
(TVR and TLR) were not significantly lower in the SES-group (11.2% vs.
17.9%, p=0.09 and 7.2% vs. 12.9%, p=0.08), as was the rate of clinically
driven TLR (6.6% vs. 9.5%, p=0.30). Conclusions: SES implantation was
neither associated with increased rates of major adverse cardiac events,
nor with a reduction in re-intervention, compared to implantation of a BMS
in patients with STEMI after five years. However, a trend of more very
late stent thrombosis was observed after SES implantation
(ISRCTN62825862). Europa Edition 2012. All rights reserved.

<3>
Accession Number
2012057982
Authors
Cohen D.J. Lavelle T.A. Van Hout B. Li H. Lei Y. Robertus K. Pinto D.
Magnuson E.A. McGarry T.F. Lucas S.K. Horwitz P.A. Henry C.A. Serruys P.W.
Mohr F.W. Kappetein A.P.
Institution
(Cohen, Li, Lei, Robertus, Magnuson) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City, School of Medicine, 4401
Wornall Road, Kansas City, MO 64111, United States
(Lavelle) Harvard School of Public Health, Boston, MA, United States
(Van Hout) University of Sheffield, Sheffield, United Kingdom
(Pinto) Beth Israel Deaconess Medical Center, Boston, MA, United States
(McGarry) Oklahoma Foundation for Cardiovascular Research, Oklahoma City,
OK, United States
(Lucas) St. Anthony Hospital, Oklahoma City, OK, United States
(Horwitz) University of Iowa Hospital and Clinics, Iowa City, IA, United
States
(Henry) Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Serruys, Kappetein) Erasmus University Medical Center Rotterdam,
Rotterdam, Netherlands
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
Title
Economic outcomes of percutaneous coronary intervention with drug-eluting
stents versus bypass surgery for patients with left main or three-vessel
coronary artery disease: One-year results from the SYNTAX trial.
Source
Catheterization and Cardiovascular Interventions. 79 (2) (pp 198-209),
2012. Date of Publication: 01 Feb 2012.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objectives: To evaluate the cost-effectiveness of alternative approaches
to revascularization for patients with three-vessel or left main coronary
artery disease (CAD). Background: Previous studies have demonstrated that,
despite higher initial costs, long-term costs with bypass surgery (CABG)
in multivessel CAD are similar to those for percutaneous coronary
intervention (PCI). The impact of drug-eluting stents (DES) on these
results is unknown. Methods: The SYNTAX trial randomized 1,800 patients
with left main or three-vessel CAD to either CABG (n = 897) or PCI using
paclitaxel-eluting stents (n = 903). Resource utilization data were
collected prospectively for all patients, and cumulative 1-year costs were
assessed from the perspective of the U.S. healthcare system. Results:
Total costs for the initial hospitalization were $5,693/patient higher
with CABG, whereas follow-up costs were $2,282/patient higher with PCI due
mainly to more frequent revascularization procedures and higher outpatient
medication costs. Total 1-year costs were thus $3,590/patient higher with
CABG, while quality-adjusted life expectancy was slightly higher with PCI.
Although PCI was an economically dominant strategy for the overall
population, cost-effectiveness varied considerably according to
angiographic complexity. For patients with high angiographic complexity
(SYNTAX score > 32), total 1-year costs were similar for CABG and PCI, and
the incremental cost-effectiveness ratio for CABG was $43,486 per
quality-adjusted life-year gained. Conclusions: Among patients with
three-vessel or left main CAD, PCI is an economically attractive strategy
over the first year for patients with low and moderate angiographic
complexity, while CABG is favored among patients with high angiographic
complexity. 2011 Wiley Periodicals, Inc.

<4>
Accession Number
2012067513
Authors
Stevenson W.G. Hernandez A.F. Carson P.E. Fang J.C. Katz S.D. Spertus J.A.
Sweitzer N.K. Tang W.H.W. Albert N.M. Butler J. Westlake Canary C.A.
Collins S.P. Colvin-Adams M. Ezekowitz J.A. Givertz M.M. Hershberger R.E.
Rogers J.G. Teerlink J.R. Walsh M.N. Stough W.G. Starling R.C.
Institution
(Stevenson, Givertz) Department of Medicine, Division of Cardiology
Brigham, Women's Hospital, Boston, MA, United States
(Hernandez, Rogers) Department of Medicine, Division of Cardiology, Duke
University Medical Center, Durham, NC, United States
(Carson) Georgetown University, Washington DC Veterans Affairs Medical
Center, Washington, DC, United States
(Fang) Harrington-McLaughlin Heart and Vascular Institute, School of
Medicine, Case Western Reserve University, Cleveland, OH, United States
(Katz) Leon H. Charney Division of Cardiology, New York University, School
of Medicine, New York, NY, United States
(Spertus) Mid-America Heart Institute, St Luke's Hospital, University of
Missouri-Kansas City, Kansas City, MI, United States
(Sweitzer) Department of Medicine, University of Wisconsin, Madison, WI,
United States
(Tang, Starling) Department of Cardiovascular Medicine, Cleveland Clinic,
9500 Euclid Avenue, Cleveland, OH 44195, United States
(Albert) Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH,
United States
(Butler) Department of Medicine, Division of Cardiology, Emory University,
Atlanta, GA, United States
(Westlake Canary) School of Nursing, Azusa Pacific University, Azusa, CA,
United States
(Collins) Department of Emergency Medicine, Vanderbilt University,
Nashville, TN, United States
(Colvin-Adams) Cardiovascular Division, University of Minnesota,
Minneapolis, MN, United States
(Ezekowitz) Division of Cardiology, University of Alberta, Edmonton, AB,
Canada
(Hershberger) Department of Medicine, Division of Cardiology, University
of Miami, Miami, FL, United States
(Teerlink) Department of Medicine, University of California, San
Francisco, CA, United States
(Walsh) Care Group, Indianapolis, IN, United States
(Stough) Department of Clinical Research, Campbell University College of
Pharmacy and Health Sciences, Buies Creek, NC, United States
Title
Indications for cardiac resynchronization therapy: 2011 update from the
Heart Failure Society of America guideline committee.
Source
Journal of Cardiac Failure. 18 (2) (pp 94-106), 2012. Date of
Publication: February 2012.
Publisher
Churchill Livingstone Inc. (650 Avenue of the Americas, New York NY 10011,
United States)
Abstract
Cardiac resynchronization therapy (CRT) improves survival, symptoms,
quality of life, exercise capacity, and cardiac structure and function in
patients with New York Heart Association (NYHA) functional class II or
ambulatory class IV heart failure (HF) with wide QRS complex. The totality
of evidence supports the use of CRT in patients with less severe HF
symptoms. CRT is recommended for patients in sinus rhythm with a widened
QRS interval (>=150 ms) not due to right bundle branch block (RBBB) who
have severe left ventricular (LV) systolic dysfunction and persistent NYHA
functional class II-III symptoms despite optimal medical therapy (strength
of evidence A). CRT may be considered for several other patient groups for
whom evidence of benefit is clinically significant but less substantial,
including patients with a QRS interval of >=120 to <150 ms and severe LV
systolic dysfunction who have persistent mild to severe HF despite optimal
medical therapy (strength of evidence B), some patients with atrial
fibrillation, and some with ambulatory class IV HF. Several evidence gaps
remain that need to be addressed, including the ideal threshold for QRS
duration, QRS morphology, lead placement, degree of myocardial scarring,
and the modality for evaluating dyssynchrony. Recommendations will evolve
over time as additional data emerge from completed and ongoing clinical
trials. 2012 Elsevier Inc. All rights reserved.

<5>
Accession Number
2012066336
Authors
Jukema J.W. Collet J.-P. De Luca L.
Institution
(Jukema) Department of Cardiology, Leiden University Medical Centre, PO
Box 9600, 2300 RC Leiden, Netherlands
(Collet) Groupe Hospitalier Pitie-Salpetriere, Institut de Cardiologie,
Paris, France
(De Luca) Department of Cardiovascular Sciences, Interventional Cardiology
Unit, European Hospital, Rome, Italy
Title
Antiplatelet therapy in patients with ST-elevation myocardial infarction
undergoing myocardial revascularisation: Beyond clopidogrel.
Source
Current Medical Research and Opinion. 28 (2) (pp 203-211), 2012. Date of
Publication: February 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Background: Despite revascularisation, outcomes among patients presenting
with ST-elevation myocardial infarction (STEMI) remain suboptimal. Scope:
This review compares clopidogrel, ticagrelor and prasugrel as antiplatelet
strategies with a particular focus on STEMI. Medline and Google Scholar
were searched for relevant terms and citations from these articles were
also assessed. Findings: While clopidogrel represented an important
therapeutic advance, variations in platelet response and a relatively slow
onset of action compromise outcomes in some patients. Ticagrelor and
prasugrel are more effective than clopidogrel, although essentially only
one large study supports each drug. Nevertheless, a detailed examination
of the evidence reveals several issues that may influence the decision to
prescribe ticagrelor instead of prasugrel and vice versa. Arguably,
prasugrel could be the preferred strategy in STEMI, reflecting the drugs'
efficacy in clopidogrel-nave patients, the most common group in clinical
practice. Conversely, ticagrelor may be a better option than clopidogrel
in clopidogrel-pretreated patients showing a mortality benefit
irrespective of clopidogrel pre-treatment. The clinical benefits offered
by prasugrel and ticagrelor need to be offset against the increased cost
and we suggest an algorithm for using these new compounds in the primary
percutaneous coronary intervention (PCI) setting. The risk of bleeding
associated with prasugrel is similar to that of clopidogrel and ticagrelor
following exclusion of at-risk patients. Nevertheless, prasugrel may be
especially appropriate for STEMI patients undergoing PCI who are
considered to be at high risk of ischaemia. Conversely, ticagrelor's short
half-life, while potentially a limitation during maintenance therapy, may
reduce bleeding risk if the patient undergoes CABG during the same
hospital admission, although confirmatory studies are needed. Conclusion:
Future studies also need to address several other outstanding issues, such
as the subsequent approach if patients do not undergo PCI, and to overcome
limitations in and differences between the primary studies. In particular,
head-to-head comparisons need to compare directly the risks and benefits
of ticagrelor and prasugrel in STEMI patients. These caveats
notwithstanding, ticagrelor and prasugrel markedly improve the prognosis
for patients with STEMI. 2012 Informa UK Ltd.

<6>
[Use Link to view the full text]
Accession Number
2012051045
Authors
Landoni G. Biondi-Zoccai G. Greco M. Greco T. Bignami E. Morelli A.
Guarracino F. Zangrillo A.
Institution
(Landoni, Greco, Greco, Bignami, Zangrillo) Department of Anesthesia and
Intensive Care, Universita Vita-Salute San Raffaele, Milano, Italy
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
University of Turin, Turin, Italy
(Morelli) Department of Anesthesiology and Intensive Care, University of
Rome, La Sapienza, Rome, Italy
(Guarracino) Cardiothoracic Department, Azienda Ospedaliera Universitaria
Pisana, Pisa, Italy
Title
Effects of levosimendan on mortality and hospitalization. A meta-analysis
of randomized controlled studies.
Source
Critical Care Medicine. 40 (2) (pp 634-646), 2012. Date of Publication:
February 2012.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Objective: Catecholaminergic inotropes have a place in the management of
low output syndrome and decompensated heart failure but their effect on
mortality is debated. Levosimendan is a calcium sensitizer that enhances
myocardial contractility without increasing myocardial oxygen use. A
meta-analysis was conducted to determine the impact of levosimendan on
mortality and hospital stay. Data Sources: BioMedCentral, PubMed, Embase,
and the Cochrane Central Register of clinical trials were searched for
pertinent studies. International experts and the manufacturer were
contacted. Study Selection: Articles were assessed by four trained
investigators, with divergences resolved by consensus. Inclusion criteria
were random allocation to treatment and comparison of levosimendan vs.
control. There were no restrictions on dose or time of levosimendan
administration or on language. Exclusion criteria were: duplicate
publications, nonadult studies, oral administration of levosimendan, and
no data on main outcomes. Data Extraction: Study end points, main
outcomes, study design, population, clinical setting, levosimendan dosage,
and treatment duration were extracted. Data Synthesis: Data from 5,480
patients in 45 randomized clinical trials were analyzed. The overall
mortality rate was 17.4% (507 of 2,915) among levosimendan-treated
patients and 23.3% (598 of 2,565) in the control group (risk ratio 0.80
[0.72; 0.89], p for effect <.001, number needed to treat = 17 with 45
studies included). Reduction in mortality was confirmed in studies with
placebo (risk ratio 0.82 [0.69; 0.97], p = .02) or dobutamine (risk ratio
0.68 [0.52-0.88]; p = .003) as comparator and in studies performed in
cardiac surgery (risk ratio 0.52 [0.35; 0.76] p = .001) or cardiology
(risk ratio 0.75 [0.63; 0.91], p = .003) settings. Length of hospital stay
was reduced in the levosimendan group (weighted mean difference = -1.31
[-1.95; -0.31], p for effect = .007, with 17 studies included). A trend
toward a higher percentage of patients experiencing hypotension was noted
in levosimendan vs. control (risk ratio 1.39 [0.97-1.94], p = .053).
Conclusions: Levosimendan might reduce mortality in cardiac surgery and
cardiology settings of adult patients. Copyright 2012 by the Society of
Critical Care Medicine and Lippincott Williams & Wilkins.

<7>
[Use Link to view the full text]
Accession Number
2012051026
Authors
Lim T. Ryu H.-G. Jung C.-W. Jeon Y. Bahk J.-H.
Institution
(Lim, Jung, Jeon, Bahk) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Ryu) Department of Anesthesiology and Pain Medicine, Boramae Medical
Center, Seoul National University, Seoul, South Korea
Title
Effect of the bevel direction of puncture needle on success rate and
complications during internal jugular vein catheterization.
Source
Critical Care Medicine. 40 (2) (pp 491-494), 2012. Date of Publication:
February 2012.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Objective: Artery puncture and hematoma formation are the most common
immediate complications during internal jugular vein catheterization. This
study was performed to assess whether the bevel-down approach of the
puncture needle decreases the incidence of posterior venous wall damage
and hematoma formation during internal jugular vein catheterization.
Design: Prospective, randomized, controlled study. Setting: A
university-affiliated hospital. Patients: Three hundred thirty-eight
patients for scheduled for thoracic surgery requiring central venous
catheterization in the right internal jugular vein. Interventions:
Patients requiring internal jugular vein catheterization were enrolled and
randomized to either the bevel-down group (n = 169) or the bevel-up group
(n = 169). All patients were placed in the Trendelenburg position with the
head turned to the left. After identifying the right internal jugular vein
with ultrasound imaging, a double-lumen central venous catheter was
inserted using the modified Seldinger technique. Venous entry of the
needle was recognized by return of venous blood during needle advance or
withdrawal. The internal jugular vein was assessed cross-sectionally and
longitudinally after catheterization to identify any complications. A p
value of <.05 was considered to be statistically significant. Measurements
and Main Results; There was no difference in the incidence of the
puncture-on-withdrawal between the two groups (37 of 169 in the bevel-down
group and 25 of 169 in the bevel-up group). However, the incidence of
posterior hematoma formation was lower in the bevel-down group (six of 169
vs. 17 of 169, p = .031). Additionally, there was less incidence of the
posterior hematoma formation associated with puncture-on-withdrawal in the
bevel-down group (six of 37 vs. 11 of 25, p = .034). Conclusions: The
bevel-down approach of the right internal jugular vein may decrease the
incidence of posterior venous wall damage and hematoma formation compared
with the bevel-up approach, which implicates a reduced probability of
carotid artery puncture with the bevel-down approach during internal
jugular vein catheterization. Copyright 2012 by the Society of Critical
Care Medicine and Lippincott Williams & Wilkins.

<8>
Accession Number
2012053813
Authors
Chen Y.-B. Shu J. Yang W.-T. Shi L. Guo X.-F. Wang F.-G. Qian Y.-Y.
Institution
(Chen, Shu, Yang, Shi, Guo, Wang, Qian) Department of Cardiothoracic
Surgery, Second Affiliated Hospital, Soochow University, Suzhou, Jiangsu
215004, China
Title
Meta-analysis of randomized trials comparing the effectiveness of on-pump
and off-pump coronary artery bypass.
Source
Chinese Medical Journal. 125 (2) (pp 338-344), 2012. Date of
Publication: January 2012.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background The growing enthusiasm for coronary artery bypass grafting
(CABG) without cardiopulmonary bypass (CPB) is emerging, but the role of
off-pump coronary artery bypass (OPCAB) in clinical practice remains
controversial. The purpose of this study was to assess differences in the
incidences of stroke, atrial fibrillation (AF), and myocardial infarction
(MI) between OPCAB and conventional coronary artery bypass grafting
(CCABG) by meta-analyses of randomized clinical trials. Methods A
literature search for the period before March 2010 supplemented with
manual bibliographic review was performed for all Chinese or English
publications in Medline, the Science Citation Index Expanded, the Cochrane
Central Register of Controlled Trials (CENTRAL) and CBMdisc. A systematic
overview (meta-analyses) of randomized clinical trials was conducted to
evaluate the differences between OPCAB and CCABG in the incidences of
stroke, AF, and MI. The meta-analysis was performed using RevMan 5
software. Results Forty-three randomized clinical trials were selected for
meta-analysis after screening a total of 356 references, with 8104
patients in the OPCAB group and 8724 cases in the CCABG group. The
meta-analyses of these trials showed no significant difference between
OPCAB and CCABG in the incidences of stroke (odds ratio (OR)=0.80, 95%
confidence interval (CI)=0.52-1.22, P=0.30) and MI (OR=0.73,
95%CI=0.52-1.02, P=0.06). However, we found a significantly reduced risk
of AF (OR=0.65, 95%CI = 0.52-0.82, P=0.0002) in off-pump patients.
Conclusions Our meta-analyses suggest that OPCAB reduces the risk of
postoperative AF compared with CCABG, but there is no significant
difference in the incidences of stroke and MI between OPCAB and CCABG.

<9>
Accession Number
2012050053
Authors
Boden W.E. Probstfield J.L. Anderson T. Chaitman B.R. Desvignes-Nickens P.
Koprowicz K. McBride R. Teo K. Weintraub W.
Institution
(Boden) University at Buffalo, Buffalo, NY, United States
(Probstfield) University of Washington, Seattle, WA, United States
(Anderson) University of Calgary, Libin Cardiovascular Institute, Calgary,
AB, Canada
(Chaitman) Saint Louis University, St. Louis, United States
(Desvignes-Nickens) National Institutes of Health, National Heart, Lung,
and Blood Institute, Bethesda, MD, United States
(Koprowicz, McBride) Axio Research, 2601 Fourth Ave., Seattle, WA 98121,
United States
(Teo) McMaster University, Hamilton, ON, Canada
(Weintraub) Christiana Care Health Services, Wilmington, DE, United States
Title
Niacin in patients with low HDL cholesterol levels receiving intensive
statin therapy.
Source
New England Journal of Medicine. 365 (24) (pp 2255-2267), 2011. Date of
Publication: 15 Dec 2011.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: In patients with established cardiovascular disease, residual
cardiovascular risk persists despite the achievement of target low-density
lipoprotein (LDL) cholesterol levels with statin therapy. It is unclear
whether extended-release niacin added to simvastatin to raise low levels
of high-density lipoprotein (HDL) cholesterol is superior to simvastatin
alone in reducing such residual risk. METHODS: We randomly assigned
eligible patients to receive extended-release niacin, 1500 to 2000 mg per
day, or matching placebo. All patients received simvastatin, 40 to 80 mg
per day, plus ezetimibe, 10 mg per day, if needed, to maintain an LDL
cholesterol level of 40 to 80 mg per deciliter (1.03 to 2.07 mmol per
liter). The primary end point was the first event of the composite of
death from coronary heart disease, nonfatal myocardial infarction,
ischemic stroke, hospitalization for an acute coronary syndrome, or
symptom-driven coronary or cerebral revascularization. RESULTS: A total of
3414 patients were randomly assigned to receive niacin (1718) or placebo
(1696). The trial was stopped after a mean follow-up period of 3 years
owing to a lack of efficacy. At 2 years, niacin therapy had significantly
increased the median HDL cholesterol level from 35 mg per deciliter (0.91
mmol per liter) to 42 mg per deciliter (1.08 mmol per liter), lowered the
triglyceride level from 164 mg per deciliter (1.85 mmol per liter) to 122
mg per deciliter (1.38 mmol per liter), and lowered the LDL cholesterol
level from 74 mg per deciliter (1.91 mmol per liter) to 62 mg per
deciliter (1.60 mmol per liter). The primary end point occurred in 282
patients in the niacin group (16.4%) and in 274 patients in the placebo
group (16.2%) (hazard ratio, 1.02; 95% confidence interval, 0.87 to 1.21;
P = 0.79 by the log-rank test). CONCLUSIONS: Among patients with
atherosclerotic cardiovascular disease and LDL cholesterol levels of less
than 70 mg per deciliter (1.81 mmol per liter), there was no incremental
clinical benefit from the addition of niacin to statin therapy during a
36-month follow-up period, despite significant improvements in HDL
cholesterol and triglyceride levels. (Funded by the National Heart, Lung,
and Blood Institute and Abbott Laboratories; AIM-HIGH ClinicalTrials.gov
number, NCT00120289.) Copyright 2011 Massachusetts Medical Society. All
rights reserved.

<10>
Accession Number
70655312
Authors
Rodseth R.N. Buse G.A.L. Bolliger D.
Title
The predictive ability of preoperative B-type natriuretic peptide in
vascular patients for major adverse cardiac events: An individual patient
data meta-analysis.
Source
Journal of Vascular Surgery. Conference: 40th Annual Symposium of the
Society for Clinical Vascular Surgery, SCVS 2012 Las Vegas, NV United
States. Conference Start: 20120314 Conference End: 20120317. Conference
Publication: (var.pagings). 55 (2) (pp 616), 2012. Date of Publication:
February 2012.
Publisher
Mosby Inc.
Abstract
Conclusion: Preoperative natriuretic peptide levels are independent
predictors of cardiovascular events in the first 30 days following
vascular surgery and improve predictive performance of the revised cardiac
risk index. Summary: A recent randomized international controlled study of
8351 patients from 23 countries found a 6.9 % incidence of cardiovascular
events in patients >45 years of age undergoing non cardiac surgery.
(Devereaux PG. Lancet 2008;371:1839-47). There have been even higher rates
of preoperative mortality, adverse cardiovascular events, and
rehospitalizations reported in vascular surgery patients. (Noordzij PJ.
Anesthesiology 2010; 112:1105-15, and Jencks SF. N Engl J Med
2009;360:418-28). Current guidelines for stratifying cardiac risk utilize
clinical risk factors, type of surgery and exercise tolerance to direct
preoperative investigation. (Fleisher LA et al. J Am Coll Cardiol
2007;50:1707-32). Clinical factors include a history of compensated or
prior heart failure, a history of ischemic heart disease, cerebral
vascular events, renal insufficiency, and diabetes mellitus. (Lee TH et
al. Circulation 1999;100:1043-9). However, use of the revised cardiac risk
index has not provided good discrimination when applied to patients
undergoing vascular surgery (Kertai MD et al. Heart 2003;89: 1327-34).
Preoperative elevations of B-type natriuretic peptide (BNP) or its
prohormone have consistently been associated with cardiovascular events
following major vascular surgery. (Feringa HH. Heart 2007;93:226-31). The
aim of this study was to determine optimal BNP cutoffs to predict
cardiovascular events after vascular surgery and to determine whether the
use of preoperative levels of BNP, or its prohormone, could improve
current risk stratification prior to vascular surgery. The authors used an
electronic database search to identify studies reporting association of
preoperative natriuretic protein concentrations with post operative major
adverse cardiovascular events (cardiovascular death, nonfatal MI) in
vascular surgery. Secondary endpoints included all cause mortality,
cardiac death and non fatal MI. There were six data sets obtained, five
were for BNP (n = 632) and for 1 N-terminal pro-BNP (n = 218). A BNP level
higher than the optimal cut point independently predicted the primary
composite end point (odds ratio, 7.9; 95% CI, 4.7 to 13.3). BNP cut points
were 30pg/mL for screening (95% sensitivity; 44% specificity), 116 pg/mL
for highest accuracy (66% sensitivity; 82% specificity). Reclassification
of risks following the revised cardiac risk index stratification using NP
levels improved risk prediction. (Net reclassification improvement, 58%; P
< .000001). This was particularly so in the intermediate risk group (net
reclassification improvement, 84%; P < .001). Comment: Cardiac risk
stratification in vascular surgery has only been, at best, modestly
successful in predicting preoperative events in the vascular surgical
patient. The results here, suggest that in patients risk stratified with
the revised cardiac risk index, a BNP cut off point can be used to
reclassify these patients and provide a more accurate risk assessment.
This may help better identify patients who would benefit from further
cardiac evaluation. Importantly, it is also crucial to recognize that this
meta analysis, and other studies in this area (Ford MK et al. Ann Intern
Med 2010;152:26-35), raise serious concerns regarding the use the revised
cardiac risk index as a "stand alone" tool in the preoperative cardiac
evaluation of the vascular surgical patient.

<11>
Accession Number
70653771
Authors
Singh S. Kong Loke Y. Spangler J. Furberg C.D.
Institution
(Singh) Johns Hopkins University, Baltimore, MD, United States
(Kong Loke) University of East Anglia, Norwich, United Kingdom
(Spangler, Furberg) Wake Forest University, School of Medicine,
Winston-Salem, NC, United States
Title
ODDS of major adverse cardiovascular events associated with varenicline: A
systematic review and metaanalysis of randomized controlled trials.
Source
Journal of General Internal Medicine. Conference: 34th Annual Meeting of
the Society of General Internal Medicine Phoenix, AZ United States.
Conference Start: 20110504 Conference End: 20110507. Conference
Publication: (var.pagings). 26 (pp S290), 2011. Date of Publication:
May 2011.
Publisher
Springer New York
Abstract
BACKGROUND: Varenicline is a partial agonist at the I 4-I2 2
nicotinic acetylcholine receptors and a full agonist at I-7 nicotinic
acetylcholine receptors. Varenicline is associated with myocardial
infarction and cardiac arrest in spontaneous reports. Its effect on
cardiovascular outcomes is unknown. Our objective was to ascertain the
risk of major adverse cardiovascular effects of varenicline compared to
placebo controls among tobacco users. METHODS: Systematic searches were
conducted in August 2010 of relevant articles in MEDLINE, EMBASE,
regulatory authorityWeb-sites in the United States and Europe and
manufacturers' trial registries with no date restrictions. Randomized
controlled trials of varenicline for treatment of nicotine addiction among
smokers or smokeless tobacco users, had at least 7 days of treatment, and
reported on any major adverse cardiovascular event (including zero events)
of myocardial infarction, unstable angina, coronary revascularization,
coronary artery disease, arrythmias, transient ischemic attacks, strokes
and sudden death or cardiovascular death and congestive heart failure were
included. RESULTS: The initial search yielded 347 citations. After a
detailed screening of 45 full text studies for cardiovascular events, 14
double blind placebo controlled randomized controlled trials enrolling
8216 tobacco users were included. Follow-up duration ranged from 7 weeks
to 1 year. Major adverse cardiovascular events occurred among 52 of 4908
participants receiving varenicline and 27 of 3308 patients receiving
placebo therapy (Peto Odds Ratio (OR), 1.72 [95% confidence interval {CI},
1.09-2.71]; P=.02 I2=0%). Sensitivity analysies using treatment arm
continuity correction to account for imbalance in zero events among the
included trials yielded similar results. These estimates were also robust
to the choice of comparators (placebo vs active controls). There was no
evidence of publication bias via funnel plot asymmetry. CONCLUSION: Among
tobacco users varenicline use is associated with significantly increased
odds of major adverse cardiovascular events. (Table presented).

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Total documents retrieved: 11

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<1>
Accession Number
2012042481
Authors
Angiolillo D.J. Firstenberg M.S. Price M.J. Tummala P.E. Hutyra M. Welsby
I.J. Voeltz M.D. Chandna H. Ramaiah C. Brtko M. Cannon L. Dyke C. Liu T.
Montalescot G. Manoukian S.V. Prats J. Topol E.J.
Institution
(Angiolillo) Department of Cardiology, University of Florida,
Jacksonville, FL, United States
(Firstenberg) Division of Cardiothoracic Surgery, Ohio State University
Medical Center, Columbus, OH, United States
(Price, Topol) Division of Cardiovascular Diseases, Scripps Clinic and
Scripps Translational Science Institute, San Diego, CA, United States
(Tummala) Department of Cardiology, Northeast Georgia Heart Center,
Gainesville, GA, United States
(Hutyra) First Internal Clinic, Faculty Hospital Olomouc, Olomouc, Czech
Republic
(Welsby) Department of Anesthesiology, Duke University Medical Center,
Durham, NC, United States
(Voeltz) Department of Cardiology, Henry Ford Hospital, Detroit, MI,
United States
(Chandna) Department of Cardiology, Detar Hospital, Victoria, TX, United
States
(Ramaiah) Deptartment of Surgery, University of Kentucky, Lexington, KY,
United States
(Brtko) Deptartment of Cardiac Surgery, University Hospital, Hradec
Kralove, Czech Republic
(Cannon) Cardiac and Vascular Research Center of Northern Michigan,
Northern Michigan Regional Hospital, Petoskey, MI, United States
(Dyke) SouthEast Texas Cardiovascular Surgery Associates, Humble, TX,
United States
(Liu, Prats) Medicines Company, Parsippany, NJ, United States
(Montalescot) Groupe Hospitalier Pitie-Salpetriere, Universite Paris 6,
INSERM CMR 937, Paris, France
(Manoukian) Sarah Cannon Research Institute, Hospital Corporation of
America, Nashville, TN, United States
Title
Bridging antiplatelet therapy with cangrelor in patients undergoing
cardiac surgery: A randomized controlled trial.
Source
JAMA - Journal of the American Medical Association. 307 (3) (pp 265-274),
2012. Date of Publication: 18 Jan 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Thienopyridines are among the most widely prescribed medications,
but their use can be complicated by the unanticipated need for surgery.
Despite increased risk of thrombosis, guidelines recommend discontinuing
thienopyridines 5 to 7 days prior to surgery to minimize bleeding.
Objective: To evaluate the use of cangrelor, an intravenous, reversible
P2Y12 platelet inhibitor for bridging thienopyridine-treated
patients to coronary artery bypass grafting (CABG) surgery. Design,
Setting, and Patients: Prospective, randomized, double-blind,
placebocontrolled, multicenter trial, involving 210 patients with an acute
coronary syndrome (ACS) or treated with a coronary stent and receiving a
thienopyridine awaiting CABG surgery to receive either cangrelor or
placebo after an initial open-label, dose-finding phase (n=11) conducted
between January 2009 and April 2011. Interventions Thienopyridines were
stopped and patients were administered cangrelor or placebo for at least
48 hours, which was discontinued 1 to 6 hours before CABG surgery. Main
Outcome Measures: The primary efficacy end point was platelet reactivity
(measured in P2Y12 reaction units [PRUs]), assessed daily. The
main safety end point was excessive CABG surgery-related bleeding. Results
The dose of cangrelor determined in 10 patients in the open-label stage
was 0.75 mug/kg per minute. In the randomized phase, a greater proportion
of patients treated with cangrelor had low levels of platelet reactivity
throughout the entire treatment period compared with placebo (primary end
point, PRU <240; 98.8% (83 of 84) vs 19.0% (16 of 84); relative risk [RR],
5.2 [95% CI, 3.3-8.1] P<.001). Excessive CABG surgery-related bleeding
occurred in 11.8% (12 of 102) vs 10.4% (10 of 96) in the cangrelor and
placebo groups, respectively (RR, 1.1 [95% CI, 0.5-2.5] P=.763). There
were no significant differences in major bleeding prior to CABG surgery,
although minor bleeding episodes were numerically higher with cangrelor.
Conclusions: Among patients who discontinue thienopyridine therapy prior
to cardiac surgery, the use of cangrelor compared with placebo resulted in
a higher rate of maintenance of platelet inhibition. Trial Registration:
clinicaltrials.gov Identifier: NCT00767507. 2012 American Medical
Association. All rights reserved.

<2>
Accession Number
2012048144
Authors
Bortolotti U. Milano A.D. Frater R.W.M.
Institution
(Bortolotti) Cardio Thoracic and Vascular Department, University of Pisa
Medical School, Pisa, Italy
(Milano) Division of Cardiac Surgery, University of Verona Medical School,
Verona, Italy
(Frater) Department of Cardiothoracic Surgery and Pediatrics, Albert
Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United
States
Title
Mitral valve repair with artificial chordae: A review of its history,
technical details, long-term results, and pathology.
Source
Annals of Thoracic Surgery. 93 (2) (pp 684-691), 2012. Date of
Publication: February 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Mitral valve repair is considered the procedure of choice for correcting
mitral regurgitation in myxomatous disease, providing long-term results
that are superior to those with valve replacement. The use of artificial
chordae to replace elongated or ruptured chordae responsible for mitral
valve prolapse and severe mitral regurgitation has been the subject of
extensive experimental work to define feasibility, reproducibility, and
effectiveness of this procedure. Artificial chordae made of autologous or
xenograft pericardium have been replaced by chordae made of expanded
polytetrafluoroethylene (PTFE), a material with the unique property of
becoming covered by host fibrosa and endothelium. The use of artificial
chordae made of PTFE has been validated clinically over the past 2 decades
and has been an increasing component of the surgical armamentarium for
mitral valve repair. This article reviews the history, details of the
relevant surgical techniques, long-term results, and fate of artificial
chordae in mitral reconstructive surgery. 2012 The Society of Thoracic
Surgeons.

<3>
Accession Number
2012048143
Authors
Yu L. Gu T. Song L. Shi E. Fang Q. Wang C. Zhao J.
Institution
(Yu, Gu, Shi, Fang, Wang) Department of Cardiac Surgery, First Affiliated
Hospital, China Medical University, Nanjingbei St 155, Shenyang 110001,
China
(Song) Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan,
China
(Zhao) Molecular Cardiology Research Institute, Tufts Medical Center,
Boston, MA, United States
Title
Fibrin sealant provides superior hemostasis for sternotomy compared with
bone wax.
Source
Annals of Thoracic Surgery. 93 (2) (pp 641-644), 2012. Date of
Publication: February 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Purpose: The purpose of this study was to evaluate the hemostatic efficacy
and feasibility of direct injection of fibrin sealant into the sternal
marrow cavity in senior patients undergoing on-pump coronary artery bypass
grafting (CABG). Description: A total of 82 senior patients undergoing
on-pump CABG were randomized to the bone wax group (n = 40) or the fibrin
sealant group (n = 42) for the period July 2010 to January 2011.
Evaluation: The fibrin sealanttreated group had less chest drainage in the
first 24 hours (186.67 +/- 49.53 versus 333.75 +/- 60.49 mL), less total
chest drainage (326.19 +/- 67.24 versus 516 +/- 88.46 mL), less packed red
blood cell (PRBC) administration (3.6 +/- 1.25 versus 7.4 +/- 2.13 U),
less fresh frozen plasma (FFP) administration (5.52 +/- 1.64 versus 8.95
+/- 1.77 U), shorter intubation time (40.36 +/- 8.62 versus 46.25 +/-
10.46 hours), and shorter hospital stay (10.45 +/- 1.17 versus 11.03 +/-
1.37 days) compared with the bone wax group. No significant difference in
the incidence of postoperative complications was found. Conclusions:
Direct injection of fibrin sealant into the sternal marrow cavity
significantly reduces the amount of postoperative blood loss and offers an
attractive new treatment alternative for senior patients undergoing
on-pump CABG. 2012 The Society of Thoracic Surgeons.

<4>
Accession Number
2011663572
Authors
Chan Y.-K. Stewart S. Calderone A. Scuffham P. Goldstein S. Carrington
M.J.
Institution
(Chan, Stewart, Calderone, Carrington) Preventative Health, Baker IDI
Heart and Diabetes Institute, St Kilda Rd Central, Melbourne, VIC 8008,
Australia
(Scuffham) School of Medicine, Griffith University, Brisbane, Australia
(Goldstein) School of Public Health and Community Medicine, University of
New South Wales, Sydney, Australia
Title
Exploring the potential to remain "young @ Heart": Initial findings of a
multi-centre, randomised study of nurse-led, home-based intervention in a
hybrid health care system.
Source
International Journal of Cardiology. 154 (1) (pp 52-58), 2012. Date of
Publication: 12 Jan 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Disease management programs have been shown to improve health
outcomes in high risk individuals in many but not all health care systems.
Methods: Young @ Heart is a multi-centre, randomised controlled study of a
nurse-led, home-based intervention (HBI) program vs. usual care (UC) in
privately insured patients in Australia aged >= 45 years following an
acute cardiac admission. Intensity of HBI is tailored to an individual's
clinical stability, management and risk profile. The primary endpoint is
the rate of all-cause stay during a mean of 2.5 years follow-up. Results:
A target of 602 adults (72% men) were randomised to HBI (n = 306) or UC (n
= 296); their initial profiles being well matched. At baseline, 71% were
overweight (body mass index 29.7 +/- 3.9 kg/m2) and 66% had an
elevated blood pressure (153 +/- 18/89 +/- 7 mm Hg). Over half had a
history of smoking and 39% had a sub-optimal total cholesterol level > 4
mmol/L. Overall, 62% (376 cases) were treated for coronary artery disease
(27% with multi-vessel disease and 39% underwent cardiac
revascularisation). A further 20% (120 cases) were treated for a cardiac
arrhythmia (predominantly atrial fibrillation) and 19% type 2 diabetes
mellitus. At 7-14 days post-discharge, 293 (96%) HBI patients received a
home visit triggering urgent clinical review and/or enhanced clinical
management in many patients. Conclusions: The Young @ Heart intervention
is a well accepted and potentially effective intervention to reduce
recurrent hospital stay in privately insured cardiac patients in
Australia.

<5>
Accession Number
2012011828
Authors
Yusuf A.M. Warkentin T.E. Arsenault K.A. Whitlock R. Eikelboom J.W.
Institution
(Yusuf, Arsenault, Whitlock, Eikelboom) Population Health Research
Institute, Hamilton, ON, Canada
(Warkentin, Eikelboom) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Warkentin) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Whitlock) Department of Surgery, McMaster University, Hamilton, ON,
Canada
Title
Prognostic importance of preoperative anti-PF4/heparin antibodies in
patients undergoing cardiac surgery: A systematic review.
Source
Thrombosis and Haemostasis. 107 (1) (pp 8-14), 2012. Date of
Publication: January 2012.
Publisher
Schattauer GmbH (Hoelderlinstr 3 Stuttgart D-70174, Germany)
Abstract
It was the objective of this study to obtain best estimates of the
prevalence of anti-PF4/heparin antibodies in patients not suspected to
have clinical heparin-induced thrombocytopenia (HIT) prior to undergoing
cardiac surgery and to determine whether preoperative antibody status and
antibody class is predictive of postoperative thromboembolic outcomes,
non-thromboembolic outcomes, length of stay, and mortality. PubMed and
EMBASE online databases were searched up to July 2011, and we included
studies involving adults undergoing cardiac surgery examining the
relationship between preoperative anti-PF4/heparin antibodies (ELISA) and
postoperative clinical outcomes. Five studies involving a combined total
of 2,332 patients met our inclusion criteria. Preoperative
anti-PF4/heparin antibodies were detected in 5-22% of patients. No study
demonstrated an association between preoperative anti-PF4/heparin
antibodies and postoperative thromboembolic outcomes or mortality. Three
studies demonstrated a statistically significant association between
preoperative anti-PF4/heparin antibodies and length of stay while two
showed an association with non-thromboembolic complications. In the one
study that examined outcomes by anti-PF4/heparin antibody class, IgM
antibodies predicted non-thromboembolic complications and length-of-stay.
None of the studies reported prior heparin exposure, and most studies did
not examine the relationship of the absolute value of antibody titres
(ELISA OD) and risk, nor the incidence of true/clinical HIT in
preoperative positive or negative patients. In conclusion, pre-formed
anti-PF4/heparin antibodies are common in patients undergoing cardiac
surgery, but the available literature does not support that they predict
postoperative thromboembolic complications or death. There does appear to
be an association between anti-PF4/heparin antibodies and
non-thromboembolic adverse events, but a causal relationship is unlikely.
Schattauer 2012.

<6>
Accession Number
2012052746
Authors
Mazza A. Rigatelli G. Piva M. Rampin L. Cardaioli P. Giordan M. Roncon L.
Zattoni L. Zuin M. Al-Nahhas A. Rubello D. Ramazzina E. Ravenni R.
Casiglia E.
Institution
(Mazza, Zuin, Ramazzina) Department of Internal Medicine, Santa Maria
Della Misericordia Hospital, Rovigo, Italy
(Rigatelli, Cardaioli, Giordan) Interventional Cardiology Unit, Division
of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
(Piva) Unit of Nephrology, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Rampin, Rubello) Service of Nuclear Medicine and PET/CT Centre,
Department of Imaging, Santa Maria Della Misericordia Hospital, Rovigo,
Italy
(Roncon) Division of Cardiology, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Zattoni) Department of Imaging, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Al-Nahhas) Department of Nuclear Medicine, Hammersmith Hospital, London,
United Kingdom
(Casiglia) Department of Clinical and Experimental Medicine, University of
Padua, Padua, Italy
(Ravenni) Department of Neuroscience, Santa Maria Della Misericordia
Hospital, Rovigo, Italy
Title
In high risk hypertensive subjects with incidental and unilateral renal
artery stenosis percutaneous revascularization with stent improves blood
pressure control but not glomerular filtration rate.
Source
Minerva Cardioangiologica. 59 (6) (pp 533-542), 2011. Date of
Publication: December 2011.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Aim. In high-risk hypertensive subjects (HTs) with incidental unilateral
renal artery stenosis (RAS), the effectiveness of percutaneous
revascularization with stent (PR-STENT) on blood pressure (BP) and
glomerular filtration rate (GFR) is not established. Methods. Eighteen HTs
aged 65.7+/-9.2 years with angiographically diagnosed unilateral RAS
(260%) were randomized to receive PR-STENT (N=9) or to NO-STENT (N=9). BP
(mercury sphygmomanometer) and GFR (99mTc-DTPA clearances
during renal scintigraphy) were evaluated yearly for three years.
Echo-Doppler of renal arteries was performed to verify the anatomic
patency and flow velocities of the reperfused artery. Analysis of variance
compared BP and GFR values changes from baseline to the follow-up;
differences for continuous variables were evaluated between groups with
the Tukey's post hoc test after adjustment for age, change of BP between
baseline and at the follow-up, GFR and body mass index (BMI). Results.
Baseline systolic BP and GFR values were not different between groups. The
significantly greater GFR increase observed in PR-STENT than in NO-STENT
at univariate analysis at the end of follow-up (62.5+/-19.2 vs.
42.24+/-17.6, P<0.02) disappeared after adjustment for confounding
factors. However, systolic BP remained significantly lower in PR-STENT
than in NO-STENT (140.1+/-4.6 vs. 170.0+/-8.3, P<0.0001) also after
adjustment for age, GFR and BMI. Conclusion. PR-STENT reduces systolic BP
without improving GFR. Due to the strong association between high BP and
renal dam-age, this study raises the question on whether PR-STENT should
be performed in all HTs with unilateral and incidental RAS.

<7>
[Use Link to view the full text]
Accession Number
2012050182
Authors
Voeks J.H. Howard G. Roubin G.S. Malas M.B. Cohen D.J. Sternbergh III W.C.
Aronow H.D. Eskandari M.K. Sheffet A.J. Lal B.K. Meschia J.F. Brott T.G.
Institution
(Voeks) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, United States
(Howard) Department of Biostatistics, University of Alabama at Birmingham,
Birmingham, AL, United States
(Roubin) Department of Cardiovascular Medicine, Lenox Hill Hospital, New
York, NY, United States
(Malas) Department of Vascular and Endovascular Surgery, Johns Hopkins
Bayview Medical Center, Johns Hopkins Hospital, Baltimore, MD, United
States
(Cohen) Saint Luke's Mid America Heart and Vascular Institute, Kansas
City, MO, United States
(Sternbergh III) Vascular and Endovascular Surgery, Ochsner Health
Systems, New Orleans, LA, United States
(Aronow) Michigan Heart and Vascular Institute, Ypsilanti, MI, United
States
(Eskandari) Division of Vascular Surgery, Northwestern Memorial Hospital,
Chicago, IL, United States
(Sheffet) Department of Surgery, UMDNJ-New Jersey, Medical School, Newark,
NJ, United States
(Lal) Vascular Surgery, University of Maryland, Medical Center, Baltimore,
MD, United States
(Meschia, Brott) Department of Neurology, Mayo Clinic, 4500 San Pablo Rd.,
Griffin Bldg., Jacksonville, FL 32224, United States
Title
Age and outcomes after carotid stenting and endarterectomy: The Carotid
Revascularization Endarterectomy Versus Stenting Trial.
Source
Stroke. 42 (12) (pp 3484-3490), 2011. Date of Publication: December
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background and Purpose: High stroke event rates among carotid artery
stenting (CAS)-treated patients in the Carotid Revascularization
Endarterectomy Versus Stenting Trial (CREST) lead-in registry generated an
a priori hypothesis that age may modify the relative efficacy of CAS
versus carotid endarterectomy (CEA). In the primary CREST report, we
previously noted significant effect modification by age. Here we extend
this investigation by examining the relative efficacy of the components of
the primary end point, the treatment-specific impact of age, and
contributors to the increasing risk in CAS-treated patients at older ages.
Methods: Among 2502 CREST patients with high-grade carotid stenosis,
proportional hazards models were used to examine the impact of age on the
CAS-to-CEA relative efficacy, and the impact of age on risk within
CAS-treated and CEA-treated patients. Results: Age acted as a treatment
effect modifier for the primary end point (P interaction=0.02), with the
efficacy of CAS and CEA approximately equal at age 70 years. For CAS, risk
for the primary end point increased with age (P<0.0001) by 1.77-times (95%
confidence interval, 1.38-2.28) per 10-year increment; however, there was
no evidence of increased risk for CEA-treated patients (P=0.27). Stroke
events were the primary contributor to the overall effect modification (P
interaction=0.033), with equal risk at 64 years. The treatment-by-age
interaction for CAS and CEA was not altered by symptomatic status (P=0.96)
or by sex (P=0.45). Conclusions:Outcomes after CAS versus CEA were related
to patient age, attributable to increasing risk for stroke after CAS at
older ages. Patient age should be an important consideration when choosing
between the 2 procedures for treating carotid stenosis. Clinical Trial
Registration: URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00004732. 2011 American Heart Association, Inc.

<8>
Accession Number
2012040438
Authors
Udelsmann A. Maciel F.G. Servian D.C.M. Reis E. de Azevedo T.M. Melo
M.D.S.
Institution
(Udelsmann) Anesthesiology Dept. of the Faculdade de Ciencias Medicas
(FCM) of Univ. de Campinas (Unicamp), Brazil
(Maciel) R3, Unicamp, Brazil
(Servian, Reis, de Azevedo) Anesthesiology Sector of the Hospital das
Clinicas da Unicamp, Brazil
(Melo) Student in Surgical Sciences at FCM/Unicamp, Physician of the
Anesthesiology Sector of Hospital das Clinicas da Unicamp, Brazil
Title
Methadone and Morphine during Anesthesia Induction for Cardiac Surgery.
Repercussion in Postoperative Analgesia and Prevalence of Nausea and
Vomiting.
Source
Revista Brasileira de Anestesiologia. 61 (6) (pp 695-701), 2011. Date of
Publication: November 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background and objectives: Pain is an aggravating factor in postoperative
morbidity and mortality especially in large size surgeries. Methods to
effectively fend pain collide with elevated costs and for this reason they
are not accessible in every service. The option would be the use of an
opioid with long half-life, such as methadone. The objective of the
present study was to compare the requirements of postoperative analgesia
in patients who received methadone, morphine, or placebo during anesthetic
induction, besides the prevalence of postoperative nausea and vomiting.
Methods: Fifty-five patients scheduled for cardiac surgery were divided
into three groups and they received during anesthetic induction 20. mg of
methadone, 20. mg of morphine, or placebo. At the end of surgery, patients
were transferred to the ICU where the following parameters were evaluated:
duration of anesthesia, time until extubation, time until the need of the
first analgesic, number of doses required in 24 hours, assessment of
analgesia by the patient, and prevalence of nausea/vomiting. Results:
Differences in the duration of anesthesia and time until extubation were
not observed. The first dose of analgesic in patients who received
methadone was administered later than in patients in the other two groups.
The need of analgesics in the methadone group was lower, quality of
analgesia was better, and prevalence of nausea and vomiting was also
lower. Conclusions: Methadone during anesthetic induction was effective
for analgesia in large size surgeries. Lower incidence of nausea and
vomiting was observed in the methadone group and therefore it is a low
cost option available among us that should be stimulated. 2011 Elsevier
Editora Ltda.

<9>
Accession Number
2012044343
Authors
Campanella A. Bergamasco L. Macri L. Asioli S. Devotini R. Scipioni S.
Barbaro S. Rispoli P. Rinaldi M.
Institution
(Campanella, Devotini, Rinaldi) Thoracic and Cardiovascular Department,
Division of Cardiac Surgery, San Giovanni Battista of Turin Hospital,
University of Turin, Corso Bramante 84, 10126 Turin, Italy
(Bergamasco) Physics Department, University of Turin, Corso Bramante 84,
10126 Turin, Italy
(Macri, Asioli) Biomedical Sciences and Human Oncology Department,
Division of Third Pathological Anatomy, San Giovanni Battista of Turin
Hospital, University of Turin, Corso Bramante 84, 10126 Turin, Italy
(Scipioni, Barbaro) Sanitary Direction Department, Division of Hospital
Hygiene and Management of Sanitary Technologies, San Giovanni Battista of
Turin, Corso Bramante 84, 10126 Turin, Italy
(Rispoli) Thoracic and Cardiovascular Department, Division of Vascular
Surgery, San Giovanni Battista of Turin Hospital, University of Turin,
Corso Bramante 84, 10126 Turin, Italy
Title
Endoscopic Saphenous harvesting with an Open CO2 System (ESOS) trial for
coronary artery bypass grafting surgery: study protocol for a randomized
controlled trial.
Source
Trials. 12 , 2011. Article Number: 243. Date of Publication: 18 Nov
2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: In coronary artery bypass grafting surgery, arterial conduits
are preferred because of more favourable long-term patency and outcome.
Anyway the greater saphenous vein continues to be the most commonly used
bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is
increasingly being investigated in order to reduce the morbidity
associated with conventional open vein harvesting, includes postoperative
leg wound complications, pain and patient satisfaction. However, to date
the short and the long-term benefits of the endoscopic technique remain
controversial. This study provides an interesting opportunity to address
this gap in the literature.Methods/Design: Endoscopic Saphenous harvesting
with an Open CO2 System trial includes two parallel vein
harvesting arms in coronary artery bypass grafting surgery. It is an
interventional, single centre, prospective, randomized, safety/efficacy,
cost/effectiveness study, in adult patients with elective planned and
first isolated coronary artery disease. A simple size of 100 patients for
each arm will be required to achieve 80% statistical power, with a
significant level of 0.05, for detecting most of the formulated
hypotheses. A six-weeks leg wound complications rate was assumed to be 20%
in the conventional arm and less of 4% in the endoscopic arm. Previously
quoted studies suggest a first-year vein-graft failure rate of about 20%
with an annual occlusion rate of 1% to 2% in the first six years, with
practically no difference between the endoscopic and conventional
approaches. Similarly, the results on event-free survival rates for the
two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5%
cross-over rate, the goal is to enrol 230 patients from a single Italian
cardiac surgery centre.Discussion: The goal of this prospective randomized
trial is to compare and to test improvement in wound healing, quality of
life, safety/efficacy, cost-effectiveness, short and long-term outcomes
and vein-graft patency after endoscopic open CO2 harvesting
system versus conventional vein harvesting.The expected results are of
high clinical relevance and will show the safety/efficacy or
non-inferiority of one treatment approach in terms of vein harvesting for
coronary artery bypass grafting surgery.Trial registration:
www.clinicalTrials.gov NCT01121341. 2011 Campanella et al; licensee
BioMed Central Ltd.

<10>
Accession Number
2012033331
Authors
Wang K.-Y. Wang H.-W. Xin L.-F. Wang Y.-W. Xue Y.-L.
Institution
(Wang, Wang, Xin, Wang, Xue) Department of Anesthesiology, TEDA
International Cardiovascular Hospital, Tianjin 300457, China
Title
Evaluation of high-concentration sevoflurane for induction and
nasotracheal intubation without muscle relaxant for infants with different
pulmonary blood flow undergoing surgery for congenital heart diseases.
Source
Chinese Medical Journal. 124 (24) (pp 4144-4148), 2011. Date of
Publication: 20111220.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Inhalational anesthesia with sevoflurane for endotracheal
intubation without muscle relaxant is now used widely for pediatric
patients. This study assessed the efficacy and safety of induction with
high concentration sevoflurane and of nasotracheal intubation without
muscle relaxant in infants with increased or decreased pulmonary blood
flow (PBF) and undergoing surgery for congenital heart diseases. Methods
Fifty-five infants aged 2-12 months, weighing 4.7-10.0 kg, and scheduled
for congenital cardiac surgery were enrolled. Subjects were divided into
those with increased (IPBF group, n=29) and decreased (DPBF group, n=26)
pulmonary blood flow. All infants received inhalational induction with 8%
sevoflurane in 100.0% oxygen at a gas flow rate of 6 L/min. Nasotracheal
intubation was performed 4 minutes after induction. Sevoflurane
vaporization was decreased to 4.0% for placement of a peripheral
intravenous line and invasive hemodynamic monitors. Five minutes later,
sedatives and muscle relaxant were administered and the vaporizer was
adjusted to 2% for maintenance of anesthesia. Bispectral index (BIS)
scores, circulatory parameters, satisfactory and successful intubation
ratios, adverse reactions, and complications of intubation were recorded.
Results Times to loss of lash and pain reflexes were longer for the DPBF
group (P <0.01). Satisfactory intubation ratios were 93.1% and 61.5% for
the IPBF and DPBF groups, respectively (P=0.008). Successful intubation
ratios were 96.6% and 76.9% for the IPBF and DPBF groups, respectively
(P=0.044). Following sevoflurane inhalation, blood pressures decreased
significantly in the IPBF group but remained stable in the DPBF group. BIS
scores declined to similar stable values, and a "nadir BIS" was recorded
for both groups. No obvious adverse reactions or complications of
intubation were noted perioperatively. Conclusions Induction with high
concentration sevoflurane, although faster for infants with IPBF, is safe
for infants with IPBF or DPBF. However, nasotracheal intubation without
muscle relaxant after induction with high concentration sevoflurane is
less successful and less satisfactory for infants with DPBF and should be
used with caution in this patient group.

<11>
Accession Number
70647913
Authors
Berger J.S. Sallum R.H. Katona B.G. Maya J. Ranganathan G. Mwamburi M.
Institution
(Berger) New York University Medical Center, New York, NY, United States
(Sallum, Ranganathan) United BioSource Corporation, Lexington, MA, United
States
(Katona, Maya) Astra Zeneca LP, Wilmington, DE, United States
(Mwamburi) Tufts University, School of Medicine, Boston, MA, United States
Title
Meta-analysis of the relationship between aspirin dosing and efficacy and
bleeding outcomes in medically managed patients with acute coronary
syndromes (ACS).
Source
Pharmacotherapy. Conference: 2011 Annual Meeting of the American College
of Clinical Pharmacy Pittsburgh, PA United States. Conference Start:
20111016 Conference End: 20111019. Conference Publication: (var.pagings).
31 (10) (pp 320e-321e), 2011. Date of Publication: October 2011.
Publisher
Pharmacotherapy Publications Inc.
Abstract
PURPOSE: Acetylsalicylic acid (ASA) dosing guidelines for ACS treatment
are inconsistent and lack supporting data. This analysis evaluated the
relationship between ASA maintenance dosing and clinical outcomes in
patients with ACS who did not undergo revascularization and are managed
medically. METHODS: A meta-analysis was conducted with random-effects
modeling to estimate the frequency of clinical outcomes for low (75-149
mg) and high (150-325 mg) doses of ASA, using data from worldwide clinical
and observational trials published from Jan 1995 to Feb 2010, available
from PubMed, EMBASE and Current Contents. Clinical outcomes measured were:
revascularization rate (overall rate, percutaneous coronary intervention
[PCI] or coronary artery bypass graft [CABG]), cardiovascular (CV) death,
all-cause death, myocardial infarction (MI), stroke, and bleeding at 1, 3,
6 and 12 months. RESULTS: Sixty-eight studies including 207,523 patients
were accepted and appraised for quality using Oxford Centre for Evidence-
Based Medicine scoring. Significant heterogeneity was seen in the results
(quantified using the Cochran's Q statistics and the I2
measures), due to differences in enrolment procedures, medical management
regimens and timing of administration, study designs and some
inconsistencies in the definitions of bleeding and MACE. At one month, the
incidence of clinical outcomes with high- and low-dose ASA groups were
4.9% and 5.0% for MI; 6.3% and 3.7% for revascularization; 1.4% and 1.3%
for stroke; 5.5% and 3.4% for CV death; 5.7% and 4.3% for all cause death;
and 4.0% and 1.7% for major bleeding, respectively. Meta regression
demonstrated a significant association between aspirin dose and major
bleeding (p=0.037). Further data will be presented at the meeting.
CONCLUSIONS: This analysis suggests that in patients receiving medical
management for ACS, major bleeding occurred more frequently in patients
who received higher doses of ASA. ASA dose does not have a statistically
significant impact on the other outcomes analyzed.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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Total documents retrieved: 9

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<1>
Accession Number
2012013528
Authors
Whitlow P.L. Feldman T. Pedersen W.R. Lim D.S. Kipperman R. Smalling R.
Bajwa T. Herrmann H.C. Lasala J. Maddux J.T. Tuzcu M. Kapadia S. Trento A.
Siegel R.J. Foster E. Glower D. Mauri L. Kar S.
Institution
(Whitlow, Tuzcu, Kapadia) Department of Cardiovascular Medicine, J2-3,
Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
(Feldman) Northshore University Health System, Chicago, IL, United States
(Pedersen) Minneapolis Heart Institute and Foundation, Minneapolis, MN,
United States
(Lim) University of Virginia, Charlottesville, VA, United States
(Kipperman) Oklahoma Heart Hospital, Oklahoma City, OK, United States
(Smalling) Memorial Hermann Heart and Vascular Institute, Houston, TX,
United States
(Bajwa) Aurora Health Center, West Bend, WI, United States
(Herrmann) University of Pennsylvania, Philadelphia, PA, United States
(Lasala) Washington University, St. Louis, MO, United States
(Maddux) International Heart Institute of Montana, Missoula, MT, United
States
(Trento, Siegel, Kar) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Foster) University of California, San Francisco, San Francisco, CA,
United States
(Glower) Duke University Medical Center, Durham, NC, United States
(Mauri) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
Title
Acute and 12-month results with catheter-based mitral valve leaflet
repair: The EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk
Study.
Source
Journal of the American College of Cardiology. 59 (2) (pp 130-139), 2012.
Date of Publication: 10 Jan 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The EVEREST II (Endovascular Valve Edge-to-Edge Repair) High
Risk Study (HRS) assessed the safety and effectiveness of the MitraClip
device (Abbott Vascular, Santa Clara, California) in patients with
significant mitral regurgitation (MR) at high risk of surgical mortality
rate. Background: Patients with severe MR (3 to 4+) at high risk of
surgery may benefit from percutaneous mitral leaflet repair, a potentially
safer approach to reduce MR. Methods: Patients with severe symptomatic MR
and an estimated surgical mortality rate of >=12% were enrolled. A
comparator group of patients screened concurrently but not enrolled were
identified retrospectively and consented to compare survival in patients
treated by standard care. Results: Seventy-eight patients underwent the
MitraClip procedure. Their mean age was 77 years, >50% had previous
cardiac surgery, and 46 had functional MR and 32 degenerative MR.
MitraClip devices were successfully placed in 96% of patients.
Protocol-predicted surgical mortality rate in the HRS and concurrent
comparator group was 18.2% and 17.4%, respectively, and Society of
Thoracic Surgeons calculator estimated mortality rate was 14.2% and 14.9%,
respectively. The 30-day procedure-related mortality rate was 7.7% in the
HRS and 8.3% in the comparator group (p = NS). The 12-month survival rate
was 76% in the HRS and 55% in the concurrent comparator group (p = 0.047).
In surviving patients with matched baseline and 12-month data, 78% had an
MR grade of <=2+. Left ventricular end-diastolic volume improved from 172
ml to 140 ml and end-systolic volume improved from 82 ml to 73 ml (both p
= 0.001). New York Heart Association functional class improved from III/IV
at baseline in 89% to class I/II in 74% (p < 0.0001). Quality of life was
improved (Short Form-36 physical component score increased from 32.1 to
36.1 [p = 0.014] and the mental component score from 45.5 to 48.7 [p =
0.065]) at 12 months. The annual rate of hospitalization for congestive
heart failure in surviving patients with matched data decreased from 0.59
to 0.32 (p = 0.034). Conclusions: The MitraClip device reduced MR in a
majority of patients deemed at high risk of surgery, resulting in
improvement in clinical symptoms and significant left ventricular reverse
remodeling over 12 months. (Pivotal Study of a Percutaneous Mitral Valve
Repair System [EVEREST II]; NCT00209274). 2012 by the American College of
Cardiology Foundation.

<2>
Accession Number
2012035869
Authors
Fernandez-Sabe N. Cervera C. Farinas M.C. Bodro M. Munoz P. Gurgui M.
Torre-Cisneros J. Martin-Davila P. Noblejas A. Len O. Garcia-Reyne A. Del
Pozo J.L. Carratala J.
Institution
(Fernandez-Sabe, Bodro, Carratala) Infectious Disease Service, Institut
d'Investigacio Biomedica de Bellvitge (IDIBELL), Hospital Universitari de
Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain
(Cervera) Infectious Disease Service, Hospital Clinic, University of
Barcelona, Spain
(Farinas) Infectious Disease Unit, Hospital Universitario Marques de
Valdecilla, University of Cantabria, Santander, Spain
(Munoz) Department of Clinical Microbiology and Infectious Diseases,
Hospital General Universitario Gregorio Maranon, Universidad Complutense
de Madrid, Spain
(Gurgui) Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau,
Universitat Autonoma de Barcelona, Spain
(Torre-Cisneros) Unidad Clinica de Enfermedades Infecciosas, Hospital
Universitario Reina Sofia-IMIBIC, Universidad de Cordoba, Spain
(Martin-Davila) Department of Infectious Diseases, Hospital Universitario
Ramon y Cajal, Spain
(Noblejas) Transplant Department, Hospital Universitario Puerta de Hierro,
Madrid, Spain
(Len) Infectious Disease Service, Hospital Universitari Vall d'Hebron,
Barcelona, Spain
(Garcia-Reyne) Infectious Disease Unit, Hospital Universitario 12 de
Octubre, Madrid, Spain
(Del Pozo) Infectious Diseases Division, Clinica Universidad de Navarra,
Spain
Title
Risk factors, clinical features, and outcomes of toxoplasmosis in
solid-organ transplant recipients: A matched case-control study.
Source
Clinical Infectious Diseases. 54 (3) (pp 355-361), 2012. Date of
Publication: 01 Feb 2012.
Publisher
Oxford University Press (2001 Evans Road, Cary NC 27513, United States)
Abstract
Background. Solid-organ transplant (SOT) recipients are considered to be
at increased risk for toxoplasmosis. However, risk factors for this
infection have not been assessed. The aim of this study was to determine
the risk factors, clinical features, and outcomes of toxoplasmosis in SOT
recipients. Methods. A multicenter, matched case-control study (1:2 ratio)
was conducted between 2000 and 2009. Control subjects were matched for
center, transplant type, and timing. Cases were identified from the
hospitals' microbiology and transplantation program databases. Logistic
regression was performed to identify independent risk factors. Results.
Twenty-two cases (0.14%) of toxoplasmosis were identified among 15 800
SOTs performed in 11 Spanish hospitals, including 12 heart, 6 kidney, and
4 liver recipients. Diagnosis was made by seroconversion (n = 17),
histopathologic examination (n = 5), polymerase chain reaction (n = 2),
and autopsy (n = 2). In a comparison of case patients with 44 matched
control subjects, a negative serostatus prior to transplantation was the
only independent risk factor for toxoplasmosis (odds ratio, 15.12 [95%
confidence interval, 2.37-96.31]; P =. 004). The median time to diagnosis
following transplantation was 92 days. Primary infection occurred in 18
(81.8%) cases. Manifestations included pneumonitis (n = 7), myocarditis (n
= 5), brain abscesses (n = 5), chorioretinitis (n = 3), lymph node
enlargement (n = 2), hepatosplenomegaly (n = 2), and meningitis (n =1).
Five patients (22.7%) had disseminated disease. Crude mortality rate was
13.6% (3 of 22 patients). Conclusions. Although uncommon, toxoplasmosis in
SOT patients causes substantial morbidity and mortality. Seronegative
recipients are at high risk for developing toxoplasmosis and should be
given prophylaxis and receive careful follow-up. The Author 2011.
Published by Oxford University Press on behalf of the Infectious.

<3>
Accession Number
2012033138
Authors
Nojiri T. Yamamoto K. Maeda H. Takeuchi Y. Funakoshi Y. Inoue M. Okumura
M.
Institution
(Nojiri, Maeda, Takeuchi, Funakoshi) Department of General Thoracic
Surgery, Toneyama National Hospital, Toneyama 5-1-1, Toyonaka City
560-8552, Osaka, Japan
(Nojiri, Inoue, Okumura) Department of General Thoracic Surgery, Osaka
University, Graduate School of Medicine, Suita-City, Japan
(Yamamoto) Department of Cardiology, Osaka University, Graduate School of
Medicine, Suita-City, Japan
Title
Effect of low-dose human atrial natriuretic peptide on postoperative
atrial fibrillation in patients undergoing pulmonary resection for lung
cancer: A double-blind, placebo-controlled study.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (2) (pp 488-494),
2012. Date of Publication: February 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: We previously reported that patients with preoperative B-type
natriuretic peptide levels of 30 pg/mL or more have increased risk of
postoperative atrial fibrillation after pulmonary resection. This study
evaluated the effects of human atrial natriuretic peptide on postoperative
atrial fibrillation in patients undergoing pulmonary resection for lung
cancer. Methods: A prospective, randomized study was conducted with 40
patients who had preoperative elevated B-type natriuretic peptide (>=30
pg/mL) and underwent a scheduled pulmonary resection for lung cancer.
Results were compared between patients who received low-dose human atrial
natriuretic peptide and those who received a placebo. The primary end
point was the incidence of postoperative atrial fibrillation during the
first 4 days after surgery. Results: The incidence of postoperative atrial
fibrillation was significantly lower in the human atrial natriuretic
peptide group than in the placebo group (10% vs 60%; P < .001). Patients
in the human atrial natriuretic peptide group also showed significantly
lower white blood cell counts and C-reactive protein levels after surgery.
Conclusions: Continuous infusion of low-dose human atrial natriuretic
peptide during lung cancer surgery had a prophylactic effect against
postoperative atrial fibrillation after pulmonary resection in patients
with preoperative elevation of B-type natriuretic peptide levels. A larger
sample size is needed to establish the safety and efficacy of this
intervention. 2012 by The American Association for Thoracic Surgery.

<4>
Accession Number
2012033160
Authors
Desai S.P. Henry L.L. Holmes S.D. Hunt S.L. Martin C.T. Hebsur S. Ad N.
Institution
(Desai, Henry, Holmes, Hunt, Martin, Hebsur, Ad) Inova Heart and Vascular
Institute, 3300 Gallows Road, Falls Church, VA 22042, United States
Title
Strict versus liberal target range for perioperative glucose in patients
undergoing coronary artery bypass grafting: A prospective randomized
controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (2) (pp 318-325),
2012. Date of Publication: February 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The purpose of this study was to test the hypothesis that a
liberal blood glucose strategy (121-180 mg/dL) is not inferior to a strict
blood glucose strategy (90-120 mg/dL) for outcomes in patients after
first-time isolated coronary artery bypass grafting and is superior for
glucose control and target blood glucose management. Methods: A total of
189 patients undergoing coronary artery bypass grafting were investigated
in this prospective randomized study to compare 2 glucose control
strategies on patient perioperative outcomes. Three methods of analyses
(intention to treat, completer, and per protocol) were conducted. Observed
power was robust (>80%) for significant results. Results: The groups were
similar on preoperative hemoglobin A 1c and number of diabetic
patients. The liberal group was found to be noninferior to the strict
group for perioperative complications and superior on glucose control and
target range management. The liberal group had significantly fewer
patients with hypoglycemic events (<60 mg/dL; P < .001), but severe
hypoglycemic events (<40 mg/dL) were rare and no group differences were
found (P = .23). These results were found with all 3 methods of analysis
except for blood glucose variability, maximum blood glucose, and
perioperative atrial fibrillation. Conclusions: This study demonstrated
that maintenance of blood glucose in a liberal range after coronary artery
bypass grafting led to similar outcomes compared with a strict target
range and was superior in glucose control and target range management. On
the basis of the results of this study, a target blood glucose range of
121 to 180 mg/dL is recommended for patients after coronary artery bypass
grafting as advocated by the Society of Thoracic Surgeons. 2012 by The
American Association for Thoracic Surgery.

<5>
Accession Number
2012033153
Authors
Lee H.J. Kim Y.T. Park P.J. Shin Y.S. Kang K.N. Kim Y. Kim C.W.
Institution
(Lee, Kim) Department of Molecular Oncology, Cancer Research Institute,
Seoul National University, Seoul, South Korea
(Lee) National Evidence-Based Healthcare Collaborating Agency, Seoul,
South Korea
(Kim) Department of Thoracic and Cardiovascular Surgery, Clinical Research
Institute, Seoul National University Hospital, Seoul, South Korea
(Park, Shin, Kang) Bioinfra Inc, Cancer Research Institute, Seoul National
University, Seoul, South Korea
(Kim) Department of Statistics, Seoul National University, Seoul, South
Korea
(Kim) Department of Pathology, Cancer Research Institute, Seoul National
University, Seoul, South Korea
Title
A novel detection method of non-small cell lung cancer using multiplexed
bead-based serum biomarker profiling.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (2) (pp 421-427),
2012. Date of Publication: February 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Non-small cell lung cancer (NSCLC) is the leading cause of
cancer-related mortality. Development of an early diagnosis method may
improve survivals. We aimed to develop a new diagnostic model for NSCLC
using serum biomarkers. Methods: We set up a patient group diagnosed with
NSCLC (n = 122) and a healthy control group (n = 225). Thirty serum
analytes were selected on the basis of previous studies and a literature
search. An antibody-bead array of 30 markers was constructed using the
Luminex bead array platform (Luminex Inc, Austin, Tex) and was analyzed.
Each marker was ranked by importance using the random forest method and
then selected. Using selected markers, multivariate classification
algorithms were constructed and were validated by application to
independent validation cohort of 21 NSCLC and 28 control subjects.
Results: There was no difference in demographics between patients and the
control population except for age (64.8 +/- 10.0 for patients vs 53.0 +/-
7.6 years for the control group). Among the 30 serum proteins, 23 showed a
difference between the 2 groups (12 increased and 11 decreased in the
patient group). We found the highest accuracy of multivariate
classification algorithms when using the 5 highest-ranked biomarkers
(A1AT, CYFRA 21-1, IGF-1, RANTES, AFP). When we applied the algorithms on
a validation cohort, each method recognized the patients from the controls
with high accuracy (89.8% with random forest, 91.8% with support vector
machine, 88.2% with linear discriminant analysis, and 90.5% with logistic
regression). Conclusions: We confirmed that a new diagnostic method using
5 serum biomarkers profiling constructed by multivariate classification
algorithms could distinguish NSCLC from healthy controls with high
accuracy. 2012 by The American Association for Thoracic Surgery.

<6>
Accession Number
2012041563
Authors
van Loon R.B. Veen G. Baur L.H.B. Kamp O. Bronzwaer J.G.F. Twisk J.W.R.
Verheugt F.W.A. van Rossum A.C.
Institution
(van Loon, Veen, Kamp, Bronzwaer, van Rossum) Department of Cardiology, VU
University Medical Center, Amsterdam, Netherlands
(Baur) Department of Cardiology, Atrium Medical Center Parkstad, Heerlen
and Faculty of Health, Medicine and Life Sciences, University Maastricht,
Netherlands
(Twisk) Department of Clinical Epidemiology and Biostatistics, VU
University Medical Center, Amsterdam, Netherlands
(Verheugt) Heartcenter, University Medical Center, St Radboud, Nijmegen,
Netherlands
Title
Improved clinical outcome after invasive management of patients with
recent myocardial infarction and proven myocardial viability: Primary
results of a randomized controlled trial (VIAMI-trial).
Source
Trials. 13 , 2012. Article Number: 1. Date of Publication: 03 Jan
2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Patients with ST-elevation myocardial infarction (STEMI) not
treated with primary or rescue percutaneous coronary intervention (PCI)
are at risk for recurrent ischemia, especially when viability in the
infarct-area is present. Therefore, an invasive strategy with PCI of the
infarct-related coronary artery in patients with viability would reduce
the occurrence of a composite end point of death, reinfarction, or
unstable angina (UA).Methods: Patients admitted with an (sub)acute
myocardial infarction, who were not treated by primary or rescue PCI, and
who were stable during the first 48 hours after the acute event, were
screened for the study. Eventually, we randomly assigned 216 patients with
viability (demonstrated with low-dose dobutamine echocardiography) to an
invasive or a conservative strategy. In the invasive strategy stenting of
the infarct-related coronary artery was intended with abciximab as adjunct
treatment. Seventy-five (75) patients without viability served as registry
group. The primary endpoint was the composite of death from any cause,
recurrent myocardial infarction (MI) and unstable angina at one year. As
secondary endpoint the need for (repeat) revascularization procedures and
anginal status were recorded.Results: The primary combined endpoint of
death, recurrent MI and unstable angina was 7.5% (8/106) in the invasive
group and 17.3% (19/110) in the conservative group (Hazard ratio 0.42; 95%
confidence interval [CI] 0.18-0.96; p = 0.032). During follow up
revascularization-procedures were performed in 6.6% (7/106) in the
invasive group and 31.8% (35/110) in the conservative group (Hazard ratio
0.18; 95% CI 0.13-0.43; p < 0.0001). A low rate of recurrent ischemia was
found in the non-viable group (5.4%) in comparison to the
viable-conservative group (14.5%). (Hazard-ratio 0.35; 95% CI 0.17-1.00; p
= 0.051).Conclusion: We demonstrated that after acute MI (treated with
thrombolysis or without reperfusion therapy) patients with viability in
the infarct-area benefit from a strategy of early in-hospital stenting of
the infarct-related coronary artery. This treatment results in a long-term
uneventful clinical course. The study confirmed the low risk of recurrent
ischemia in patients without viability. Trial registration:
ClinicalTrials.gov: NCT00149591. 2012 van Loon et al; licensee BioMed
Central Ltd.

<7>
Accession Number
22253393
Authors
Angiolillo D.J. Firstenberg M.S. Price M.J. Tummala P.E. Hutyra M. Welsby
I.J. Voeltz M.D. Chandna H. Ramaiah C. Brtko M. Cannon L. Dyke C. Liu T.
Montalescot G. Manoukian S.V. Prats J. Topol E.J. BRIDGE Investigators
Institution
(Angiolillo) Department of Cardiology, University of Florida,
Jacksonville, USA.
Title
Bridging antiplatelet therapy with cangrelor in patients undergoing
cardiac surgery: a randomized controlled trial.
Source
JAMA : the journal of the American Medical Association. 307 (3) (pp
265-274), 2012. Date of Publication: 18 Jan 2012.
Abstract
Thienopyridines are among the most widely prescribed medications, but
their use can be complicated by the unanticipated need for surgery.
Despite increased risk of thrombosis, guidelines recommend discontinuing
thienopyridines 5 to 7 days prior to surgery to minimize bleeding. To
evaluate the use of cangrelor, an intravenous, reversible P2Y(12) platelet
inhibitor for bridging thienopyridine-treated patients to coronary artery
bypass grafting (CABG) surgery. Prospective, randomized, double-blind,
placebo-controlled, multicenter trial, involving 210 patients with an
acute coronary syndrome (ACS) or treated with a coronary stent and
receiving a thienopyridine awaiting CABG surgery to receive either
cangrelor or placebo after an initial open-label, dose-finding phase (n =
11) conducted between January 2009 and April 2011. Interventions
Thienopyridines were stopped and patients were administered cangrelor or
placebo for at least 48 hours, which was discontinued 1 to 6 hours before
CABG surgery. The primary efficacy end point was platelet reactivity
(measured in P2Y(12) reaction units [PRUs]), assessed daily. The main
safety end point was excessive CABG surgery-related bleeding. The dose of
cangrelor determined in 10 patients in the open-label stage was 0.75
mug/kg per minute. In the randomized phase, a greater proportion of
patients treated with cangrelor had low levels of platelet reactivity
throughout the entire treatment period compared with placebo (primary end
point, PRU <240; 98.8% (83 of 84) vs 19.0% (16 of 84); relative risk [RR],
5.2 [95% CI, 3.3-8.1] P < .001). Excessive CABG surgery-related bleeding
occurred in 11.8% (12 of 102) vs 10.4% (10 of 96) in the cangrelor and
placebo groups, respectively (RR, 1.1 [95% CI, 0.5-2.5] P = .763). There
were no significant differences in major bleeding prior to CABG surgery,
although minor bleeding episodes were numerically higher with cangrelor.
Among patients who discontinue thienopyridine therapy prior to cardiac
surgery, the use of cangrelor compared with placebo resulted in a higher
rate of maintenance of platelet inhibition. clinicaltrials.gov Identifier:
NCT00767507.

<8>
Accession Number
2012028337
Authors
Yazici D. Tas S. Emir H. Sunar H.
Institution
(Yazici) Sub-department of Endocrinology and Metabolism, Department of
Internal Medicine, School of Medicine, Marmara University, Istanbul,
Turkey
(Tas, Sunar) Cardiac and Vascular Surgery Clinic, Kartal Kosuyolu
Education and Research Hospital, Istanbul, Turkey
(Emir) Diabetes Education Nurse, Kartal Education and Research Hospital,
Istanbul, Turkey
Title
A Comparison of preprandial mixed insulin given three times daily and
basal-bolus insulin therapy started postoperatively on patients having
coronary artery bypass graft surgery.
Source
Marmara Medical Journal. 25 (1) (pp 16-19), 2012. Date of Publication:
2012.
Publisher
Marmara University (Haydarpasa, Istanbul, Turkey)
Abstract
Objective: Insulin therapy initiated after coronary artery bypass graft
(CABG) surgery has decreased long-term mortality. The aim was to compare
the effectiveness of prandial premixed therapy (PPT) using insulin thrice
daily and basal-bolus therapy (BBT) on patients having CABG surgery.
Patients and Methods: Thirty-four patients having CABG surgery were
included. Fasting blood glucose (FBG), postprandial blood glucose (PPBG),
hemoglobin A1c (HbA1c) and hemoglobin levels were determined
preoperatively and at the first week postoperatively when the patients
were randomized to either PPT or BBT. Initial measurements were repeated
at the end of three months. Results: Seventeen patients (F/M:9/8;
61.5+/-8.5 years) were assigned on a random basis to the mixed insulin arm
and 17 patients (F/M:10/7; 57.4+/-9.2 years) to the basal-bolus arm. FBG,
PPBG and HbA1c levels of both groups (7.6+/-0.8 % vs 6.7+/-0.5 % in the
BBT and 7.3+/-0.7 % vs 7.3+/-1.0 % in the PPT group) at the end of the 3
months were not different than at the time of randomization. The
percentage of patients reaching HbA1c levels below 6.0%, 6.5% and 7.0%
were higher in the BBT group compared to the PPT group. Conclusion: For
patients who had undergone CABG surgery, BBT provided more patients with
HbA1c levels below the target than did PPT. Marmara Medical Journal,
Published by Galenos Publishing.

<9>
Accession Number
2012031984
Authors
De Luca G. Iorio S. Venegoni L. Marino P.
Institution
(De Luca, Iorio, Venegoni, Marino) Division of Cardiology, Azienda
Ospedaliera-Universitaria Maggiore della Carit, Eastern Piedmont
University, Novara, Italy
Title
Evaluation of intracoronary adenosine to prevent periprocedural
myonecrosis in elective percutaneous coronary intervention (from the
PREVENT-ICARUS trial).
Source
American Journal of Cardiology. 109 (2) (pp 202-207), 2012. Date of
Publication: 15 Jan 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Great interest has focused on pharmacotherapy to prevent periprocedural
myocardial injury during elective percutaneous coronary intervention
(PCI). The aim of the present trial was to investigate the benefits of
preprocedural intracoronary administration of high-dose adenosine during
elective PCI. This was a single-center, double-blind, randomized trial of
patients undergoing elective PCI. The patients were randomized (1:1) by
sealed envelops to intracoronary adenosine (120 mug for the right coronary
artery and 180 mug for the left coronary artery) or placebo. The primary
study end point was a periprocedural increase in troponin I >3 times the
upper limit of normal. The secondary study end points were (1) the
corrected Thrombolysis In Myocardial Infarction frame count; (2) troponin
I release >10 times the upper limit of normal; (3) creatine kinase-MB mass
release <3 times the upper limit of normal; and (4) the combined
cumulative incidence of in-hospital death, periprocedural myocardial
infarction, and in-hospital urgent target vessel revascularization. The
safety end point was the occurrence of bradycardia and ventricular
arrhythmias during study drug administration. From November 2009 to
September 2010, we randomized 260 patients who were undergoing elective
PCI to intracoronary adenosine (n = 130) or placebo (n = 130). A greater
prevalence of calcified lesions was observed in the adenosine group (p =
0.002). In contrast, a greater prevalence of type C lesions (p = 0.091),
chronic occlusions (p = 0.015), worse preprocedural Thrombolysis In
Myocardial Infarction flow (p = 0.038), and more severely stenotic lesions
(p = 0.005) were observed in the placebo group. No difference was found in
the primary (67.7% vs 70%, p = 0.69) or secondary end points. No serious
side effects were observed with adenosine. In conclusion, our randomized
trial showed that preprocedural intracoronary administration of a single
high-dose bolus of adenosine does not provide any benefit in terms of
periprocedural myonecrosis in patients undergoing elective PCI. 2012
Elsevier Inc.

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Total documents retrieved: 14

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<1>
[Use Link to view the full text]
Accession Number
2012014641
Authors
Heusch G. Musiolik J. Kottenberg E. Peters J. Jakob H. Thielmann M.
Institution
(Heusch, Musiolik) Institut fur Pathophysiologie, Universitatsklinikum
Essen, Hufelandstr 55, 45122 Essen, Germany
(Kottenberg, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Essen, Germany
(Jakob, Thielmann) Klinik fur Thorax- und Kardiovaskulare Chirurgie,
Universitatsklinikum Essen, Essen, Germany
Title
STAT5 activation and cardioprotection by remote ischemic preconditioning
in humans.
Source
Circulation Research. 110 (1) (pp 111-115), 2012. Date of Publication:
06 Jan 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Rationale: The heart can be protected from infarction by brief episodes of
ischemia/reperfusion of a remote organ. Remote ischemic preconditioning
(RIPC) by brief arm ischemia/reperfusion has been recruited in patients
undergoing coronary artery bypass surgery or percutaneous coronary
interventions and during transport to the hospital for acute myocardial
infarction. Cardioprotective signaling has been extensively characterized
in animal experiments. Objective: To identify cardioprotective signaling
by RIPC in humans. Methods and Results: RIPC was induced by 3 cycles of 5
minutes of arm ischemia/5 minutes of reperfusion in patients undergoing
coronary artery bypass surgery. Twelve patients each were randomly
assigned to undergo RIPC or a sham control procedure. Protection was
confirmed by reduced serum troponin I concentrations in patients with RIPC
versus control patients. In myocardial biopsies, an array of established
cardioprotective proteins was analyzed by Western immunoblotting. The
phosphorylation of signal transducer and activator of transcription 5
(STAT5) increased from baseline before ischemic cardioplegic arrest to 10
minutes of reperfusion with RIPC, and STAT5 phosphorylation during
reperfusion was greater in patients with RIPC than in control patients.
Conclusions: The identification of this unique signaling signature of RIPC
will facilitate the development of pharmacological cardioprotection. 2011
American Heart Association, Inc.

<2>
Accession Number
2012022454
Authors
Robinson J.L. Doucette K.
Institution
(Robinson) Department of Pediatrics, University of Alberta, Edmonton,
Canada
(Doucette) Department of Medicine, University of Alberta, Edmonton, Canada
Title
The natural history of hepatitis C virus infection acquired during
childhood.
Source
Liver International. 32 (2) (pp 258-270), 2012. Date of Publication:
February 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background: The outcome of patients with hepatitis C virus (HCV) infection
acquired during childhood in the absence of antiviral therapy is not
clear. Aims: The purpose of this study was to review the outcome of
untreated HCV acquired in childhood. Only population-based studies were
included, as referred cases would be predicted to have more severe
disease. Methods: A systematic review of the literature was completed up
to October 2010 to identify studies where a population was screened for
HCV infection that was presumably acquired during childhood. Demographical
and clinical data were collected on infected patients who had not been
treated with an antiviral. Primary outcome was development of a severe
adverse outcome (cirrhosis, hepatoma, need for a liver transplant or
liver-related death). Results: There were 25 studies reporting a total of
733 infected patients. Liver biopsy results were provided for 180 patients
(25%), revealing cirrhosis in eight (1.0% of the total and 4.0% of those
who had a biopsy). None of the other patients developed a severe adverse
outcome. As a result of the small number of patients with a severe adverse
outcome, risk factors for HCV progression could not be identified.
Conclusion: Although HCV can lead to liver transplantation and death
during childhood, the vast majority of patients with disease acquired
during childhood have slowly progressive disease. There is no clear
indication for antiviral therapy in the majority of children with HCV
infection. 2011 John Wiley & Sons A/S.

<3>
Accession Number
2012003354
Authors
Damman P. Clayton T. Wallentin L. Lagerqvist B. Fox K.A.A. Hirsch A.
Windhausen F. Swahn E. Pocock S.J. Tijssen J.G.P. De Winter R.J.
Institution
(Damman, Hirsch, Windhausen, Tijssen, De Winter) Department of Cardiology,
Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ
Amsterdam, Netherlands
(Clayton, Pocock) London School of Hygiene and Tropical Medicine, Keppel
Street, London, United Kingdom
(Wallentin, Lagerqvist) Department of Cardiology, Cardiothoracic Center,
University Hospital, Uppsala, Sweden
(Fox) Cardiovascular Research, Department of Medical and Radiological
Sciences, Royal Infirmary, Edinburgh, United Kingdom
(Swahn) Department of Cardiology, Heart Centre, University Hospital,
Linkoping, Sweden
Title
Effects of age on long-term outcomes after a routine invasive or selective
invasive strategy in patients presenting with non-ST segment elevation
acute coronary syndromes: A collaborative analysis of individual data from
the FRISC II - ICTUS - RITA-3 (FIR) trials.
Source
Heart. 98 (3) (pp 207-213), 2012. Date of Publication: February 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To perform a patient-pooled analysis of a routine invasive
versus a selective invasive strategy in elderly patients with non-ST
segment elevation acute coronary syndrome. Methods: A meta-analysis was
performed of patientpooled data from the FRISC IIeICTUSeRITA-3 (FIR)
studies. (Un)adjusted HRs were calculated by Cox regression, with
adjustments for variables associated with age and outcomes. The main
outcome was 5-year cardiovascular death or myocardial infarction (MI)
following routine invasive versus selective invasive management. Results:
Regarding the 5-year composite of cardiovascular death or MI, the routine
invasive strategy was associated with a lower hazard in patients aged
65-74 years (HR 0.72, 95% CI 0.58 to 0.90) and those aged >=75 years (HR
0.71, 95% CI 0.55 to 0.91), but not in those aged <65 years (HR 1.11, 95%
CI 0.90 to 1.38), p=0.001 for interaction between treatment strategy and
age. The interaction was driven by an excess of early MIs in patients <65
years of age; there was no heterogeneity between age groups concerning
cardiovascular death. The benefits were smaller for women than for men
(p=0.009 for interaction). After adjustment for other clinical risk
factors the HRs remained similar. Conclusion: The current analysis of the
FIR dataset shows that the long-term benefit of the routine invasive
strategy over the selective invasive strategy is attenuated in younger
patients aged <65 years and in women by the increased risk of early events
which seem to have no consequences for long-term cardiovascular mortality.
No other clinical risk factors were able to identify patients with
differential responses to a routine invasive strategy. Trial registration:
http://www.controlled-trials.com/ISRCTN82153174 (ICTUS),
http://www.controlled-trials.com/ISRCTN07752711 (RITA-3).

<4>
Accession Number
2012014182
Authors
Shehata N. Burns L.A. Nathan H. Hebert P. Hare G.M.T. Fergusson D. Mazer
C.D.
Institution
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Departments of
Medicine, Anesthesia and Physiology, University of Toronto, St. Michael's
Hospital, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Central Ontario
Region, Canadian Blood Services, Toronto, ON, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Anesthesia, St Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Anesthesia, University of Ottawa, Ottawa, ON, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Critical Care, General Campus, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Clinical Epidemiology, Ottawa Hospital Research Institute, CMAJ, Ottawa,
ON, Canada
Title
A randomized controlled pilot study of adherence to transfusion strategies
in cardiac surgery.
Source
Transfusion. 52 (1) (pp 91-99), 2012. Date of Publication: January 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
BACKGROUND: It is important to determine the optimal hemoglobin (Hb)
concentration for red blood cell (RBC) transfusion for patients undergoing
cardiac surgery because increased mortality has been associated with the
severity of anemia and exposure to RBCs. Because a definitive trial will
require thousands of patients, and because there is variability in
transfusion practices, a pilot study was undertaken to determine adherence
to proposed strategies. STUDY DESIGN AND METHODS: A single-center parallel
randomized controlled pilot trial was conducted in high-risk cardiac
patients to assess adherence to two transfusion strategies. Fifty patients
were randomly assigned either to a "restrictive" transfusion strategy
(RBCs if their Hb concentration was 70 g/L or less intraoperatively during
cardiopulmonary bypass [CPB] and 75 g/L or less postoperatively) or a
"liberal" transfusion strategy (RBCs if their Hb concentration was 95 g/L
or less during CPB and less than 100 g/L postoperatively). RESULTS: The
percentage of adherence overall was 84% in the restrictive arm and 41% in
the liberal arm. Twenty-two (88%) patients were transfused 99 units of
RBCs in the liberal group compared to 13 patients who were transfused 50
units in the restrictive group (p < 0.01). There were no significant
differences in individual adverse outcomes; however, more adverse events
occurred in the restrictive group (38 vs. 15, p < 0.01). CONCLUSION:
Adherence to the evaluated interventions is vital to all randomized
controlled trials as it has the potential to affect outcomes. Further
pilot studies are required to optimize enrollment and transfusion
adherence before a definitive study is conducted. 2011 American
Association of Blood Banks.

<5>
Accession Number
22077816
Authors
Tricoci P. Huang Z. Held C. Moliterno D.J. Armstrong P.W. Van de Werf F.
White H.D. Aylward P.E. Wallentin L. Chen E. Lokhnygina Y. Pei J. Leonardi
S. Rorick T.L. Kilian A.M. Jennings L.H. Ambrosio G. Bode C. Cequier A.
Cornel J.H. Diaz R. Erkan A. Huber K. Hudson M.P. Jiang L. Jukema J.W.
Lewis B.S. Lincoff A.M. Montalescot G. Nicolau J.C. Ogawa H. Pfisterer M.
Prieto J.C. Ruzyllo W. Sinnaeve P.R. Storey R.F. Valgimigli M. Whellan
D.J. Widimsky P. Strony J. Harrington R.A. Mahaffey K.W. TRACER
Investigators
Institution
(Tricoci) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC 27705, USA.
Title
Thrombin-receptor antagonist vorapaxar in acute coronary syndromes.
Source
The New England journal of medicine. 366 (1) (pp 20-33), 2012. Date of
Publication: 5 Jan 2012.
Abstract
Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1) antagonist
that inhibits thrombin-induced platelet activation. In this multinational,
double-blind, randomized trial, we compared vorapaxar with placebo in
12,944 patients who had acute coronary syndromes without ST-segment
elevation. The primary end point was a composite of death from
cardiovascular causes, myocardial infarction, stroke, recurrent ischemia
with rehospitalization, or urgent coronary revascularization. Follow-up in
the trial was terminated early after a safety review. After a median
follow-up of 502 days (interquartile range, 349 to 667), the primary end
point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of
6471 patients receiving placebo (Kaplan-Meier 2-year rate, 18.5% vs.
19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01;
P=0.07). A composite of death from cardiovascular causes, myocardial
infarction, or stroke occurred in 822 patients in the vorapaxar group
versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard
ratio, 0.89; 95% CI, 0.81 to 0.98; P=0.02). Rates of moderate and severe
bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group
(hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial
hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95%
CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were
similar in the two groups. In patients with acute coronary syndromes, the
addition of vorapaxar to standard therapy did not significantly reduce the
primary composite end point but significantly increased the risk of major
bleeding, including intracranial hemorrhage. (Funded by Merck; TRACER
ClinicalTrials.gov number, NCT00527943.).

<6>
Accession Number
2012019313
Authors
Hassan Murad M. Coburn J.A. Coto-Yglesias F. Dzyubak S. Hazem A. Lane M.A.
Prokop L.J. Montori V.M.
Institution
(Hassan Murad, Coburn, Coto-Yglesias, Dzyubak, Hazem, Lane, Prokop,
Montori) Mayo Clinic, Knowledge and Evaluation Research Unit, 200 First
Street SW, Rochester, MN 55905, United States
(Hassan Murad, Hazem) Division of Preventive Medicine, Mayo Clinic,
Rochester, MN 55905, United States
(Hazem) Department of Internal Medicine, University of North Dakota,
Fargo, ND 58103, United States
(Montori) Division of Endocrinology, Diabetes, Metabolism, and Nutrition,
Mayo Clinic, Rochester, MN 55905, United States
Title
Glycemic control in non-critically ill hospitalized patients: A systematic
review and meta-analysis.
Source
Journal of Clinical Endocrinology and Metabolism. 97 (1) (pp 49-58),
2012. Date of Publication: January 2012.
Publisher
Endocrine Society (8401 Connecticut Ave. Suite 900, Chevy Chase MD 20815,
United States)
Abstract
Background: The effect of intensive therapy to achieve tight glycemic
control in patients hospitalized in non-critical care settings is unclear.
Methods:Weconducted a systematic review and meta-analysis to determine the
effect of intensive glycemic control strategies on the outcomes of death,
stroke, myocardial infarction, incidence of infection, and hypoglycemia.
We included randomized and observational studies. Bibliographic databases
were searched through February 2010. Random effects model was used to pool
results across studies. Results: Nineteen studies (nine randomized and 10
observational studies) were included. The risk of bias across studies was
moderate. Meta-analysis demonstrates that intensive glycemic control was
not associated with significant effect on the risk of death, myocardial
infarction, or stroke. There was a trend for increased risk of
hypoglycemia (relative risk, 1.58; 95% confidence interval,0.97-2.57),
particularly in surgical studies and when the planned glycemic target was
achieved. Intensive glycemic control was associated with decreased risk of
infection (relative risk, 0.41; 95% confidence interval, 0.21-0.77) that
was mainly derived from studies in surgical settings. Conclusion:
Intensive control of hyperglycemia in patients hospitalized in
non-critical care settings may reduce the risk of infection. The quality
of evidence is low and mainly driven by studies in surgical settings.
Copyright 2012 by The Endocrine Society.

<7>
Accession Number
2012013932
Authors
Navarese E.P. Kubica J. Castriota F. Gibson C.M. De Luca G. Buffon A.
Bolognese L. Margheri M. Andreotti F. Di Mario C. De Servi S.
Institution
(Navarese, Kubica) Department of Cardiology and Internal Medicine, Ludwik
Rydygier Collegium Medicum, Nicolaus Copernicus University,
Sklodowskiej-Curie Street No 9, 85-094 Bydgoszcz, Poland
(Castriota) GVM Care and Research, Interventional Cardio-Angiology Unit,
Cotignola, Italy
(Gibson) Cardiovascular Division, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
(De Luca) Department of Cardiology, Maggiore Della Carita Hospital,
Novara, Italy
(Buffon, Andreotti) Department of Cardiovascular Medicine, Catholic
University of the Sacred Heart, Rome, Italy
(Bolognese) Cardiovascular Department, San Donato Hospital, Arezzo, Italy
(Margheri) Division of Cardiology, Azienda Ospedaliera, Ravenna, Italy
(Di Mario) Royal Brompton Hospital, Imperial College, London, United
Kingdom
(De Servi) Department of Cardiovascular Diseases, Civic Hospital, Legnano,
Italy
Title
Safety and efficacy of biodegradable vs. durable polymer drug-eluting
stents: Evidence from a meta-analysis of randomised trials.
Source
EuroIntervention. 7 (8) (pp 985-994), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Drug-eluting stents (DES) are a major advance in interventional
cardiology; however concerns have been raised regarding their long-term
safety due to the permanent nature of the polymer. New generation stents
with biodegradable polymers (BDS) have recently been developed. The aim of
this study was to perform a meta-analysis of randomised controlled trials
(RCTs) comparing the safety and efficacy profile of BDS vs. durable
polymer DES. Methods and results: The MEDLINE/CENTRAL and Google Scholar
databases were searched for RCTs comparing safety and efficacy of BDS vs.
DES. Safety endpoints were mortality, myocardial infarction (MI), and
stent thrombosis (ST). Efficacy endpoints were target vessel
revascularisation (TVR), target lesion revascularisation (TLR) and
six-month in-stent late loss (ISLL). The meta-analysis included eight RCTs
(n=7,481). At a median follow-up of nine months, as compared to DES, BDS
use did not increase mortality (OR [95% CI] = 0.91 [0.69-1.22], p=0.53) or
MI (OR [95% CI] = 1.14 [0.90-1.44], p=0.29). Rate of late/very late ST was
significantly reduced in BDS patients (OR [95% CI] = 0.60 [0.39-0.91],
p=0.02), as was six-month ISLL (mean difference [95% CI] = -0.07 [-0.12;
-0.02] mm, p=0.004) in comparison with DES patients. Rates of TVR and TLR
were comparable between BDS and DES. Conclusions: BDS are at least as safe
as standard DES with regard to survival and MI, and more effective in
reducing late ST, as well as six-month ISLL. Further large RCTs with
long-term follow-up are warranted to definitively confirm the potential
benefits of BDS. Europa Edition 2011. All rights reserved.

<8>
Accession Number
2012013931
Authors
Sabate M. Cequier A. Iniguez A. Serra A. Hernandez-Antolin R. Mainar V.
Valgimigli M. Tespili M. Den Heijer P. Bethencourt A. Vazquez N.
Brugaletta S. Backx B. Serruys P.W.
Institution
(Sabate, Brugaletta) University Hospital Clinic, Barcelona, Spain
(Cequier) University Hospital of Bellvitge, Barcelona, Spain
(Iniguez) Hospital do Meixoeiro, Vigo, Spain
(Serra) University Hospital of Sant Pau, Barcelona, Spain
(Hernandez-Antolin) University Hospital San Carlos, Madrid, Spain
(Mainar) Hospital General of Alicante, Alicante, Spain
(Valgimigli) University Hospital Ferrara, Ferrara, Italy
(Tespili) University Hospital Bolognini Seriate, Bergamo, Italy
(Den Heijer) Amphia Ziekenhuis, Breda, Netherlands
(Bethencourt) Hospital Son Dureta, Palma de Mallorca, Spain
(Vazquez) Hospital Juan Canalejo, A Coruna, Spain
(Backx) Cardialysis, Rotterdam, Netherlands
(Serruys) Erasmus Medical Center, Rotterdam, Netherlands
Title
Rationale and design of the EXAMINATION trial: A randomised comparison
between everolimus-eluting stents and cobalt-chromium bare-metal stents in
ST-elevation myocardial infarction.
Source
EuroIntervention. 7 (8) (pp 977-984), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To assess the performance of the everolimus-eluting stent (EES)
versus cobalt chromium bare-metal stent (BMS) in the setting of primary
percutaneous coronary intervention for treatment of patients presenting
with ST-segment elevation myocardial infarction (STEMI). The implantation
of a drug-eluting stent in the setting of an acute myocardial infarction
is still controversial. In several registries this clinical scenario has
been associated with the development of stent thrombosis. The EES has
demonstrated to reduce the stent thrombosis rate as compared to
paclitaxel-eluting stent in randomised controlled trials, mainly performed
in patients in stable clinical conditions. There are however few data
regarding the effectiveness of EES in the context of STEMI. Methods and
results: This is an investigator-driven, prospective, multicentre,
multinational, randomised, single blind, two-arm, controlled trial
(ClinicalTrials.gov number: NCT00828087). This trial, with an all comer
design, randomises approximately 1,500 patients 1:1 to EES or BMS.
Overall, any patient presenting with STEMI up to 48 hours who requires
emergent percutaneous coronary intervention can be included. The primary
endpoint is the patient-oriented combined endpoint of all-cause death, any
myocardial infarction and any revascularisation at 1-year according to the
Academic Research Consortium. Clinical follow-up will be scheduled at 30
days, six months, one year and yearly up to five years. No angiographic
follow-up is mandated per protocol. Conclusions: This trial with broad
inclusion and few exclusion criteria will shed light on the performance of
the second generation EES in the complex scenario of STEMI. Europa
Edition 2011. All rights reserved.

<9>
Accession Number
2012013925
Authors
Kang W.C. Ahn T. Lee K. Han S.H. Shin E.K. Jeong M.H. Yoon J.H. Park J.-S.
Bae J.H. Hur S.H. Rha S.W. Oh S.K. Kim D.I. Jang Y. Choi J.W. Kim B.O.
Institution
(Kang, Ahn, Lee, Han, Shin) Cardiology, Gil Hospital, Gachon University of
Medicine and Science, 1198 Kuwol-dong, Namdong-gu, Incheon, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Yoon) Wonju Christian Hospital, Wonju, South Korea
(Park) Yeungnam University Hospital, Daegu, South Korea
(Bae) Konyang University Hospital, Daejeon, South Korea
(Hur) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Rha) Korea University Guro Hospital, Seoul, South Korea
(Oh) Wonkwang University Hospital, Iksan, South Korea
(Kim) Inje University Busan Paik Hospital, Busan, South Korea
(Jang) Severance Hospital, Seoul, South Korea
(Choi) Eulji Hospital, Seoul, South Korea
(Kim) Inje University Sanggye Paik Hospital, Seoul, South Korea
Title
Comparison of zotarolimus-eluting stents versus sirolimus-eluting stents
versus paclitaxel-eluting stents for primary percutaneous coronary
intervention in patients with ST-elevation myocardial infarction: Results
from the Korean Multicentre Endeavor (KOMER) acute myocardial infarction
(AMI) trial.
Source
EuroIntervention. 7 (8) (pp 936-943), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The aim of this study was to compare the efficacy and safety of
zotarolimus-eluting stents (ZES), sirolimus-eluting stents (SES) and
paclitaxel-eluting stents (PES) in patients with ST-segment elevation
myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention (PCI).Methods and results: This study was a prospective,
single-blind, multicentre, randomised trial. The primary endpoint was
major adverse cardiac events (MACE) at 12 months post-procedure, defined
as cardiac death, recurrent myocardial infarction (MI), or
ischaemia-driven target lesion revascularisation (TLR). An angiographic
substudy was performed at nine months among 348 patients. From October
2006 to April 2008, 611 patients with STEMI undergoing primary PCI were
randomly assigned to treatment with ZES (n=205), SES (n=204), or PES
(n=202). The cumulative incidence of MACE was 5.9% in the ZES group, 3.4%
in the SES group and 5.7% in the PES group at 12-month follow-up
(p=0.457). There was a trend towards a lower rate of ischaemia-driven TLR
at 12- (p=0.092) and 18-month (p=0.080) follow-up in the SES group
compared to the ZES and PES groups. No difference was observed in rates of
cardiac death, recurrent MI and combined death and/or recurrent MI among
three groups at 12- and 18-month follow-up. The rate of stent thrombosis
was similar among the three groups (2.0% in each group,
p=1.000).Conclusions: As compared with SES and PES, the use of ZES in
patients with STEMI undergoing primary PCI, showed similar rates of MACE,
cardiac death and recurrent MI at 12 and 18 months. There was a trend
towards a higher rate of TLR with ZES or PES compared to SES. Europa
Edition 2011. All rights reserved.

<10>
Accession Number
2012013921
Authors
Genereux P. Mehran R. Palmerini T. Caixeta A. Kirtane A.J. Lansky A.J.
Brodie B.R. Witzenbichler B. Mockel M. Guagliumi G. Peruga J.Z. Dudek D.
Fahy M.P. Dangas G. Stone G.W.
Institution
(Genereux, Mehran, Palmerini, Caixeta, Kirtane, Lansky, Fahy, Dangas,
Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, 111 E. 59th St., New York, NY 10022, United States
(Brodie) LeBauer Cardiovascular Research Foundation, Moses Cone Hospital,
Greensboro, NC, United States
(Witzenbichler, Mockel) Charite-Universitatsmediz in Berlin, Campus
Benjamin Franklin, Campus Virchow-Klinikum, Berlin, Germany
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Peruga) Department of Cardiology Medical University, Lodz Bieganski
Hospital, Lodz, Poland
(Dudek) Jagiellonian University, Krakow, Poland
Title
Radial access in patients with ST-segment elevation myocardial infarction
undergoing primary angioplasty in acute myocardial infarction: The
HORIZONS-AMI trial.
Source
EuroIntervention. 7 (8) (pp 905-916), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: We sought to determine whether a transradial (TR) approach compared
with a transfemoral (TF) approach was associated with improved clinical
outcomes in patients with ST-segment elevation myocardial infarction
(STEMI) undergoing primary percutaneous coronary intervention (PCI) in a
post hoc analysis of the HORIZONS-AMI trial. There is a paucity of data
comparing the TR approach with the TF approach in patients with STEMI
treated with primary PCI and contemporary anticoagulant regimens. Methods
and results: In HORIZONS-AMI, primary PCI for STEMI was performed in 3,340
patients, either by the TR (n=200) or TF approach (n=3,134). Endpoints
included the 30-day and one-year rates of major adverse cardiovascular
events (MACE: death, reinfarction, stroke or target vessel
revascularisation), non CABG-related major bleeding, and net adverse
clinical events (NACE: MACE or major bleeding). TR compared to TF access
was associated with significantly lower 30-day rates of composite death or
reinfarction (1.0% vs. 4.3%, OR 0.23, 95% CI [0.06,0.94], p=0.02), non
CABG-related major bleeding (3.5% vs. 7.6%, OR 0.45, 95% CI [0.21,0.95],
p=0.03), MACE (2.0% vs. 5.6%, OR 0.35, 95% CI [0.13,0.95], p=0.02), and
NACE (5.0% vs. 11.6%,OR 0.42, 95% CI [0.22,0.78], p<0.01). At one year,
the TR group still had significantly reduced rates of death or
reinfarction (4.0% vs. 7.8%, OR 0.51, 95% CI [0.25,1.02], p=0.05), non
CABG-related major bleeding (3.5% vs. 8.1%, OR 0.42, 95% CI [0.20,0.89],
p=0.02), MACE (6.0% vs. 12.4%, OR 0.47, 95% CI [0.26,0.83], p<0.01) and
NACE (8.5% vs. 17.8%, OR 0.45, 95% CI [0.28,0.74], p<0.001). By
multivariable analysis, TR access was an independent predictor of freedom
from MACE and NACE at 30 days and one year. Conclusions: In patients with
STEMI undergoing primary PCI with contemporary anticoagulation regimens in
the HORIZONS-AMI trial, a TR compared with a TF approach was associated
with reduced major bleeding and improved event-free survival. Europa
Edition 2011. All rights reserved.

<11>
Accession Number
2012022817
Authors
Santangeli P. Di Biase L. Pelargonio G. Dello Russo A. Casella M.
Bartoletti S. David Burkhardt J. Mohanty P. Santarelli P. Natale A.
Institution
(Santangeli, Di Biase, David Burkhardt, Mohanty, Natale) Texas Cardiac
Arrhythmia Institute, St. David's Medical Center, 1015 East 32nd Street,
Austin, TX, United States
(Pelargonio, Santarelli) Institute of Cardiology, Catholic University of
the Sacred Heart, Rome, Italy
(Dello Russo, Casella, Bartoletti) Arrhythmia Department, Institute of
Cardiology, IRCCS-Centro Cardiologico Monzino, Milan, Italy
(Di Biase, Natale) Department of Biomedical Engineering, University of
Texas, Austin, TX, United States
(Di Biase) Department of Cardiology, University of Foggia, Foggia, Italy
Title
Cardiac resynchronization therapy in patients with mild heart failure: A
systematic review and meta-analysis.
Source
Journal of Interventional Cardiac Electrophysiology. 32 (2) (pp 125-135),
2011. Date of Publication: November 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Purpose: Cardiac resynchronization therapy (CRT) reduces symptoms and
improves survival in patients with advanced heart failure (New York Heart
Association (NYHA) functional class III-IV), reduced ejection fraction,
and wide QRS complex. Whether CRT has the same benefit also in
asymptomatic or mildly symptomatic heart failure patients is
controversial. Our objective is to summarize the available evidence on the
effects of CRT in asymptomatic or mildly symptomatic (NYHA I-II) heart
failure patients. Methods: We searched major web databases for randomized
controlled trials of CRT in patients with mild heart failure (NYHA
functional class I-II). Data regarding all-cause mortality, heart failure
events, left ventricular (LV) volumes and ejection fraction, and worsening
of NYHA functional class were extracted. Results: We identified five
trials (CONTAK-CD, MIRACLE ICD-II, REVERSE, MADIT-CRT, and RAFT) that
enrolled 4,213 patients (91% with NYHA II functional class). Primary
analysis excluded the CONTAK-CD, which was not specifically conducted on
patients with mild heart failure. At pooled analysis, CRT decreased
mortality (odds ratio (OR), 0.78 [95% confidence interval (CI)], 0.63 to
0.97; p=0.024) and heart failure events (OR, 0.63 [95% CI, 0.52 to 0.76],
p<0.001), induced a significant LV reverse remodeling (weighted mean
difference (WMD) of LV ejection fraction =+4.8%[95% CI, + 0.9 to+ 8.7%],
p=0.015 and WMD of LV end-systolic volume index =
-19.4mL/m2[95%CI, - 18.2 to - 20.7mL/m2], p<0.001)
and prevented the progression of heart failure symptoms (OR for worsening
of NYHA functional class= 0.54 [95% CI, 0.31 to 0.93], p=0.026). Inclusion
of the CONTAK-CD did not change the results. Conclusions: Among patients
with mild (NYHA II) heart failure, CRT reduces mortality and the risk of
heart failure events, induces a favorable LV reverse remodeling and slows
the progression of heart failure symptoms. Springer Science+Business
Media, LLC 2011.

<12>
Accession Number
70639618
Authors
Haase-Fielitz A. Mertens P.R. Plas M. Kuppe H. Hetzer R. Westerman M.
Ostland V. Prowle J.R. Bellomo R. Haase M.
Institution
(Haase-Fielitz, Mertens, Haase) Otto von Guericke University, Nephrology,
Magdeburg, Germany
(Plas, Kuppe) German Heart Center Berlin, Institute of Anesthesiology,
Berlin, Germany
(Hetzer) German Heart Center Berlin, Department of Cardiothoracic Surgery,
Berlin, Germany
(Westerman, Ostland) Intrinsic LifeSciences LLC, San Diego, United States
(Prowle, Bellomo) Austin Health, Melbourne, Australia
Title
Urine hepcidin is an early predictor of protection from cardiopulmonary
bypass-associated acute kidney injury-an observational cohort study.
Source
Intensive Care Medicine. Conference: 24th Annual Congress of the European
Society of Intensive Care Medicine, ESICM LIVES 2011 Berlin Germany.
Conference Start: 20111001 Conference End: 20111005. Conference
Publication: (var.pagings). 37 (pp S208), 2011. Date of Publication:
September 2011.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Conventional markers of acute kidney injury (AKI) lack
diagnosticaccuracy and are expressed only late after cardiac surgery with
cardiopulmonary bypass(CPB). Recently, interest has focused on hepcidin, a
regulator of iron homeostasis, as a uniquerenal biomarker.OBJECTIVES. We
aimed to (1) assess the predictive value of early postoperative
urinehepcidin and plasma hepcidin for protection from AKI (2) investigate
the role of chronickidney disease on the predictive value of hepcidin and
(3) explore whether changes in urinehepcidin reflect changes in plasma
hepcidin.METHODS. We studied 100 adult patients in the control arm of a
randomized controlled trial(clinicaltrials.gov NCT00672334) that were
identified to be at increased risk of AKI aftercardiac surgery with CPB.
AKI was defined according to the RIFLE classification. Samples ofplasma
and urine were obtained simultaneously (1) before CPB (2) 6 h after the
start of CPBand (3) at 24 h after CPB. Plasma and urine hepcidin
25-isoforms were quantified by competitiveenzyme-linked
immunoassay.RESULTS. At 6 and 24 h after CPB, AKI-free patients (N = 91)
had largely increased andwere 3-7 times higher urine hepcidin
concentrations compared to patients with subsequentAKI (N = 9) in whom
postoperative urine hepcidin remained at preoperative levels(P = 0.004, P
= 0.002). Furthermore, higher urine hepcidin and, even more so, urine
hepcidinadjusted to urine creatinine at 6 h after CPB discriminated
patients who did not developAKI [AUC-ROC 0.80 (95% CI 0.71-0.87); 0.88
(95% CI 0.78-0.97)] or did not need renalreplacement therapy initiation
[AUC 0.81 (95% CI 0.72-0.88); 0.88 (95% CI 0.70-0.99)] fromthose who did.
At 6 h, urine hepcidin adjusted to urine creatinine was an independent
predictorof protection from AKI (P = 0.011). Plasma hepcidin did not
predict protection from AKI.The study findings remained essentially
unchanged after excluding patients with preoperativechronic kidney
disease.CONCLUSIONS. Our findings suggest that urine hepcidin is an early
predictive biomarker ofprotection from AKI after CPB thereby contributing
to early patients risk stratification.

<13>
Accession Number
70639315
Authors
Goepfert M.S. Richter H.P. Kubitz J.C. Von Sandersleben A. Gruetzmacher J.
Rafflenbeul E. Roeher K. Zu Eulenburg C. Reichenspurner H. Goetz A.E.
Reuter D.A.
Institution
(Goepfert, Richter, Kubitz, Von Sandersleben, Gruetzmacher, Rafflenbeul,
Roeher, Goetz, Reuter) University Medical Center Hamburg-Eppendorf,
Anaesthesiolgy and Intensive Care Medicine, Hamburg, Germany
(Zu Eulenburg) University Medical Center Hamburg-Eppendorf, Department of
Medical Biometry and Epidemiology, Hamburg, Germany
(Reichenspurner) University Heart Center Hamburg, Department of
Cardiovascular Surgery, Hamburg, Germany
Title
Does early perioperative goal directed therapy using functional and
volumetric hemodynamic parameters improve therapy in cardiac surgery? A
prospective, Randomized controlled trial.
Source
Intensive Care Medicine. Conference: 24th Annual Congress of the European
Society of Intensive Care Medicine, ESICM LIVES 2011 Berlin Germany.
Conference Start: 20111001 Conference End: 20111005. Conference
Publication: (var.pagings). 37 (pp S132), 2011. Date of Publication:
September 2011.
Publisher
Springer Verlag
Abstract
INTRODUCTION. There is growing evidence that an early and algorithm guided
hemodynamic therapy primarily increasing cardiac output by preload
optimization improves outcome in high risk surgical patients. Preload
optimization was so far guided either by the filling pressures CVP or
PAOP, cardiac output (CO), or functional parameters based on heart lung
interactions, i.e. stroke volume variations (SVV). In particular the
latter one, having shown to be useful intraoperatively under
controlledmechanical ventilation, but becomes invalid in patients under
assisted mechanical ventilation or during spontaneous breathing.
Volumetric parameters of cardiac preload, such as global end-diastolic
volume index (GEDI) differ significantly inter-individually in critically
ill patients, but have been proven to be highly accurate to allow tracking
changes in cardiac preload in both, mechanically ventilated patients, and
during spontaneous breathing. OBJECTIVES. We implemented a hemodynamic
treatment algorithmbased on measurements of CO, SVV, and a
patient-individual GEDI for optimizing therapy during and after elective
cardiac surgery.We compared a study group (SG) guided by this
algorithmwith a control group (CG) guided by an algorithm based on CVP and
mean arterial blood pressure (MAP). METHODS.After approval of the ethic
committee and written informed consent one-hundred patients scheduled for
elective coronary artery bypass (CAB) surgery or CAB surgery in
combination with aortic valve replacement (AVR) were randomized either to
the SG (n = 50), or to the CG (n = 50). Algorithm driven hemodynamic
therapy started immediately after induction of anesthesia and was
commenced until discharge from the intensive care unit (ICU). RESULTS. 92
Patients could finally be analyzed. There was no difference in
perioperative mortality. All over complications were less in the SG (42
vs. 63). Time to reach ICU discharge criteria (SG: 15 +/- 6 h vs. CG: 24
+/- 29 (p<0.001), length of stay on the ICU (SG: 42 +/- 19 h vs.CG: 61 +/-
58 (p<0.05), and time to reach criteria for hospital discharge (SG: 5d +/-
3 vs.CG: 6 +/- 3 (p<0.001) were significantly shorter in the SG. The
cumulative use of catecholamines and vasopressors was significantly less
in the SG (1,196 +/- 1,002 mug) compared to the CG (2,523 +/- 2,205mulg;
p<0.001).Areas under the curve for postoperative (36 h) creatinine kinase,
AST, ALT, and gGT all were smaller in the study group, however without
reaching statistical significance. There were no differences in pulmonary
or renal function within the study period. CONCLUSIONS. Goal-directed
hemodynamic therapy based on an algorithm using measurements of CO, SVV
and a patient-individual GEDI minimizes organ damage and reduces length of
ICU stay after elective cardiac surgery. If long-term outcome can be
improved by these treatment strategies needs to be clarified in the
future.

<14>
Accession Number
70639219
Authors
Paulus F. Veelo D.P. De Nijs S.B. Beenen L.F. Bresser P. De Mol B.A.
Binnekade J.M. Schultz M.J.
Institution
(Paulus, Veelo, Binnekade, Schultz) Academic Medical Center, Department of
Intensive Care, Amsterdam, Netherlands
(De Nijs) Academic Medical Center, Department of Respiratory Medicine,
Amsterdam, Netherlands
(Beenen) Academic Medical Center, Department of Radiology, Amsterdam,
Netherlands
(Bresser) Academic Medical Center, Respiratory Medicine, Amsterdam,
Netherlands
(De Mol) Academic Medical Center, Department of Cardiothoracic Surgery,
Amsterdam, Netherlands
Title
Manual hyperinflation partly prevents reductions of functional residual
capacity in cardiac surgical patients: A randomized controlled trial.
Source
Intensive Care Medicine. Conference: 24th Annual Congress of the European
Society of Intensive Care Medicine, ESICM LIVES 2011 Berlin Germany.
Conference Start: 20111001 Conference End: 20111005. Conference
Publication: (var.pagings). 37 (pp S108), 2011. Date of Publication:
September 2011.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Cardiac surgical patients are kept in an iatrogenic state of
physical and pharmacologic immobilization for several hours after surgery,
to facilitate intubation and weaning from mechanically ventilation.
Immobilization reduces mucociliary transport, which can lead to retention
of sputum at atelectasis. Manual hyperinflation (MH) aims at preventing
airway plugging by mobilization of airway secretions in mechanical
ventilated patients, and as such could improve functional residual
capacity (FRC) and oxygenation after surgery. OBJECTIVES. We performed a
randomized controlled trial in patients after cardiac surgery with the aim
to compare a strategy using routineMHmaneuvers with a strategy only
usingMH if clinically indicated. METHODS. Patients after elective cardiac
surgery and admitted to the ICU of a university hospital were randomly
allocated to "routine" (MH within 1/2 h after arrival in the ICU and every
6 h until tracheal extubation) or "on demand" MH (MH only in case of
failed endotracheal suctioning while sputum is obviously present, or in
case of oxygen de-saturation not responding to 3 min hyper-oxygenation)
during mechanical ventilation. FRC was measured pre-operatively and 1, 3,
and 5 days after extubation. Chest radiographs were obtained, both
pre-operative and on the third post-operative day. Peripheral hemoglobin
saturation (Spo2) was measured at day 1, 3, and 5 after extubation while
the patient was breathing room air. RESULTS. Hundred patients were
enrolled. Patients in the "routine" group received median [IOR] 2
[2-3]MHprocedures compared to 0 [0-0]MHprocedures in the "on demand"
group. In the "routine" group FRC decreased to 72% of the pre-operative
measurement compared to 57% in the "on demand" (P = 0.002). Post-operative
chest radiographs showed more patients without signs of atelectasis in the
routineMHgroup (17%) compared to patients in the control group (0%) (P =
0.002). There were, however, no differences in oxygenation. CONCLUSIONS.
"Routine" MH attenuates reduction of FRC in the early post-operative days
after cardiac surgery. In accordance, occurrence of atelectasis on
post-operative chest radiographs was significant lower in patients who
received MH.

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<1>
Accession Number
2012011537
Authors
Zangrillo A. Biondi-Zoccai G. Ponschab M. Greco M. Corno L. Covello R.D.
Cabrini L. Bignami E. Melisurgo G. Landoni G.
Institution
(Zangrillo, Greco, Corno, Covello, Cabrini, Bignami, Melisurgo, Landoni)
Department of Anesthesia and Intensive Care, Universita Vita-Salute San
Raffaele, Milan, Italy
(Biondi-Zoccai) Division of Cardiology, University of Modena and Reggio
Emilia, Modena, Italy
(Ponschab) Department of Anaesthesia and Intensive Care, Trauma Hospital
Linz, Linz, Austria
Title
Milrinone and mortality in adult cardiac surgery: A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (1) (pp 70-77),
2012. Date of Publication: February 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The authors conducted a review of randomized studies to show
whether there are any increases or decreases in survival when using
milrinone in patients undergoing cardiac surgery. Design: A meta-analysis.
Setting: Hospitals. Participants: Five hundred eighteen patients from 13
randomized trials. Interventions: None. Measurements and Main Results:
BioMedCentral, PubMed EMBASE, the Cochrane central register of clinical
trials, and conference proceedings were searched for randomized trials
that compared milrinone versus placebo or any other control in the setting
of cardiac surgery that reported data on mortality. Overall analysis
showed that milrinone increased perioperative mortality (13/249 [5.2%] in
the milrinone group v 6/269 [2.2%] in the control arm, odds ratio [OR] =
2.67 [1.05-6.79], p for effect = 0.04, p for heterogeneity = 0.23,
I2 = 25% with 518 patients and 13 studies included).
Subanalyses confirmed increased mortality with milrinone (9/84 deaths
[10.7%] v 3/105 deaths [2.9%] with other drugs as control, OR = 4.19
[1.27-13.84], p = 0.02) with 189 patients and 5 studies included) but did
not confirm a difference in mortality (4/165 [2.4%] in the milrinone group
v 3/164 [1.8%] with placebo or nothing as control, OR = 1.27 [0.28-5.84],
p = 0.76 with 329 patients and 8 studies included). Conclusions: This
analysis suggests that milrinone might increase mortality in adult
patients undergoing cardiac surgery. The effect was seen only in patients
having an active inotropic drug for comparison and not in the placebo
subgroup. Therefore, the question remains whether milrinone increased
mortality or if the control inotropic drugs were more protective. 2012
Elsevier Inc. All rights reserved.

<2>
Accession Number
2012011543
Authors
Kumar A.B. Suneja M. Bayman E.O. Weide G.D. Tarasi M.
Institution
(Kumar, Bayman, Weide, Tarasi) Department of Anesthesia, University of
Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United
States
(Suneja) Department of Nephrology, University of Iowa Hospitals and
Clinics, Iowa City, IA, United States
(Bayman) Department of Biostatistics, College of Public Health, Iowa City,
IA, United States
Title
Association between postoperative acute kidney injury and duration of
cardiopulmonary bypass: A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (1) (pp 64-69),
2012. Date of Publication: February 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: This meta-analysis examined the association between
cardiopulmonary bypass (CPB) time and acute kidney injury (AKI). Design:
Meta-analysis of previously published studies. Setting: Each single-center
study was conducted in a surgical intensive care unit and/or academic or
university hospital. Participants: Adult patients undergoing heart surgery
with CPB. Interventions: A systematic literature review was conducted
using PubMed, EMBASE, and Cochrane Library databases and Google Scholar
from January 1980 through September 2009. Initial search results were
refined to include human subjects, age >18 years, randomized controlled
trials, and prospective and retrospective cohort studies, meet the Acute
Kidney Injury Network definition of renal failure, and report times on
CPB. Measurements and main results: The length of time on CPB has been
implicated as an independent risk factor for development of AKI after CPB
(AKI-CPB). The 9 independent studies included in the final meta-analysis
had 12,466 patients who underwent CPB. Out of these, 756 patients (6.06%)
developed AKI-CPB. In 7 of the 9 studies, the mean CPB times were
statistically longer in the AKI-CPB cohort compared with the control group
(cohort without AKI). The absolute mean differences in CPB time between
the 2 groups were 25.65 minutes with the fixed-effects model and 23.18
minutes with the random-effects model. Conclusions: Longer CPB times are
associated with a higher risk of developing AKI-CPB, which, in turn, has a
significant effect on overall mortality as reported by the individual
studies. 2012 Elsevier Inc. All rights reserved.

<3>
Accession Number
2012011542
Authors
Kumbharathi R.B. Taneja R. Mehra R. Quantz M.A. Guo L.R. Bainbridge D.T.
Institution
(Kumbharathi) Department of Anesthesia, Thompson General Hospital,
Burntwood Regional Health Authority, Thompson, MB, Canada
(Taneja, Bainbridge) Department of Anesthesia and Peri-Operative Medicine,
London Health Sciences Centre, University of Western Ontario, London, ON,
Canada
(Mehra) Department of Anesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, VIC, Australia
(Quantz, Guo) Department of Cardiovascular and Thoracic Surgery, London
Health Sciences Centre, University of Western Ontario, London, ON, Canada
Title
Evaluation of tricuspid and pulmonary valves using epicardial and
transesophageal echocardiography - A comparative study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (1) (pp 32-38),
2012. Date of Publication: February 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To compare measurements obtained by transesophageal
echocardiography (TEE) and epicardial echocardiography (EE) for evaluation
of the tricuspid valve (TV) and pulmonary valve (PV). Design: Prospective
observational. Setting: University hospital. Participants: Patients
undergoing elective coronary artery bypass grafting with or without aortic
valve replacement. Interventions: After routine intraoperative TEE, EE was
performed to compare measurements obtained by the 2 methods. Measurements
and main results: After institutional review board approval, 25 patients
>18 years old were recruited. Biases with EE versus TEE for E and A waves
were 11.9 cm/second (95% confidence interval [CI], 48.2 to -24.4) and 6.8
cm/second (95% CI, 28 to -15), respectively, and for E/A ratio was 0.08
(95% CI, 1.2 to -1). Pulmonary velocity bias was 57.94 cm/second (95% CI,
192.9 to -76.98), with higher values using EE. Bias for pulmonary trunk
diameter was -0.31 cm (95% CI, 1.5 to -2.1). For quality of images, means
were 2.4 (standard deviation [SD], 1.0) for EE and 2.3 (SD, 0.57) with TEE
for TV and 2.4 (SD, 1.0) with EE and 2.5 (SD, 1.0) with TEE for PV. For
the number of leaflets visualized, means were 2.2 (SD, 1.0) with EE and
2.5 (SD, 0.5) with TEE for TV and 2.5 (SD, 0.5) for EE and 1.3 (SD, 1.1)
with TEE for PV. Conclusions: There was good agreement for Doppler
measurements across TVs; however, measurements across PVs were
significantly higher with EE versus TEE. TV Doppler measurements were
difficult to acquire even for surgeons experienced in epiaortic scanning.
2012 Elsevier Inc. All rights reserved.

<4>
Accession Number
2012011532
Authors
Greco M. Landoni G. Biondi-Zoccai G. Cabrini L. Ruggeri L. Pasculli N.
Giacchi V. Sayeg J. Greco T. Zangrillo A.
Institution
(Greco, Landoni, Cabrini, Ruggeri, Pasculli, Giacchi, Sayeg, Greco,
Zangrillo) Department of Anesthesiology and Intensive Care, Vita-Salute
San Raffaele University, Milan, Italy
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
University of Turin, Turin, Italy
Title
Remifentanil in cardiac surgery: A meta-analysis of randomized controlled
trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (1) (pp 110-116),
2012. Date of Publication: February 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The authors conducted a review of randomized controlled trials
to identify advantages in clinically relevant outcomes in patients
undergoing cardiac surgery with remifentanil. Design: Meta-analysis.
Setting: Hospitals. Participants: A total of 1,473 patients from 16
randomized trials. Interventions: None. Measurements and Main Result:
PubMed, BioMedCentral, and conference proceedings were searched (updated
May 2010) for randomized trials that compared remifentanil with fentanyl
or sufentanil in cardiac anesthesia. Four independent reviewers performed
data extraction, with divergences resolved by consensus. Overall analysis
showed that the use of remifentanil was associated with a significant
reduction in postoperative mechanical ventilation (WMD = -139 min [-244,
-32], p for effect = 0.01, p for heterogeneity < 0.001, I2 =
89%); length of hospital stay (WMD = -1.08 days [-1.60, -0.57], p for
effect < 0.0001, p for heterogeneity = 0.004, I2 = 71%); and
cardiac troponin-I release (WMD = -2.08 ng/mL [-3.93, -0.24], p for effect
= 0.03, p for heterogeneity < 0.02, I2 = 74%). No difference
was noted in mortality (3/344 [0.87%] in the remifentanil group vs [1.06%]
the control group, OR 0.76 [0.17-3.38], p for effect = 0.72, p for
heterogeneity = 0.35, I2 = 5%). Conclusions: Remifentanil
reduces cardiac troponin release, time of mechanical ventilation, and
length of hospital stay in patients undergoing cardiac surgery.

<5>
Accession Number
2011707318
Authors
Ahn S.W. Shim J.K. Youn Y.N. Song J.W. Yang S.Y. Chung S.C. Kwak Y.L.
Institution
(Ahn) Department of Anesthesiology and Pain Medicine, Kwandong University
College of Medicine, Goyang, South Korea
(Shim, Youn, Song, Yang, Chung, Kwak) Department of Anesthesiology and
Pain Medicine, Seoul, South Korea
(Shim, Kwak) Anesthesia and Pain Research Institute, Seoul, South Korea
(Youn) Department of Cardiothoracic Surgery, Seoul, South Korea
(Kwak) Severance Biomedical Science Institute, Yonsei University College
of Medicine, Seoul, South Korea
Title
Effect of tranexamic acid on transfusion requirement in dual
antiplatelet-treated anemic patients undergoing off-pump coronary artery
bypass graft surgery-a randomized controlled study.
Source
Circulation Journal. 76 (1) (pp 96-101), 2012. Date of Publication:
January 2012.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Anemia is not rare in patients presenting for coronary artery
bypass graft surgery (CABG) and as these patients are frequently on dual
antiplatelet therapy (DAPT), the coexisting conditions could potentially
increase the risk of bleeding and transfusion. The aim of this study was
to evaluate the effect of tranexamic acid (TA) on blood loss and
transfusion in preoperatively anemic patients who continued DAPT until
within 5 days of off-pump CABG (OPCAB). Methods and Results: Seventy-six
anemic patients were randomized into 2 groups: TA group receiving TA (1 g
bolus followed by infusion at 200 mg/h) and a Control group receiving the
same volume of saline. The amount of blood loss and transfusion
requirement during, and at 4 and 24 h after the operation were assessed.
Patients' characteristics and operative data were similar between the
groups. During the perioperative period, which combined the intraoperative
and postoperative 24 h data, the TA group received significantly smaller
amounts of packed red blood cells and fresh frozen plasma. Total amount of
perioperative blood loss was similar between the groups, although the
blood loss during the postoperative 4 h was significantly less in the TA
group. Conclusions: TA infusion could reduce the amount of transfusion
during the perioperative period in patients with preoperative anemia who
continue DAPT until within 5 days of OPCAB.

<6>
Accession Number
2011662786
Authors
Lip G.Y.H. Andreotti F. Fauchier L. Huber K. Hylek E. Knight E. Lane D.
Levi M. Marin F. Palareti G. Kirchhof P.
Institution
(Lip, Lane, Kirchhof) University of Birmingham Centre for Cardiovascular
Sciences, City Hospital, Birmingham B18 7QH, United Kingdom
(Andreotti) Department of Cardiovascular Medicine, A. Gemelli University
Hospital, Rome, Italy
(Fauchier) Cardiologie B, Centre Hospitalier Universitaire Trousseau et
Universite Francois Rabelais, Tours, France
(Huber) 3rd Dept of Medicine, Cardiology and Emergency Medicine,
Wilhelminenhospital, Vienna, Austria
(Hylek) Department of Medicine, Research Unit-Section of General Internal
Medicine, Boston University Medical Center, Boston, MA, United States
(Knight) Patient Representative, AntiCoagulation Europe, Bromley, United
Kingdom
(Levi) Department of Medicine, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Marin) Department of Cardiology, Hospital Universitario Virgen de la
Arrixaca, Murcia, Spain
(Palareti) Department of Angiology and Blood Coagulation, University
Hospital S. Orsola-Malpighi, Bologna, Italy
(Kirchhof) Department of Cardiology and Angiology, Universitatsklinikum
Munster, Munster, Germany
Title
Bleeding risk assessment and management in atrial fibrillation patients:
Executive summary# of a position document from the european heart rhythm
association [EHRA], endorsed by the european society of cardiology [ESC]
working group on thrombosis.
Source
Thrombosis and Haemostasis. 106 (6) (pp 997-1011), 2011. Date of
Publication: 2011.
Publisher
Schattauer GmbH (Hoelderlinstr 3 Stuttgart D-70174, Germany)
Abstract
In this executive summary of a Consensus Document from the European Heart
Rhythm Association, endorsed by the European Society of Cardiology Working
Group on Thrombosis, we comprehensively review the published evidence and
propose a consensus on bleeding risk assessments in atrial fibrillation
(AF) patients. The main aim of the document was to summarise 'best
practice' in dealing with bleeding risk in AF patients when approaching
antithrombotic therapy, by addressing the epidemiology and size of the
problem, and review established bleeding risk factors. We also summarise
definitions of bleeding in the published literature. Patient values and
preferences balancing the risk of bleeding against thromboembolism as well
as the prognostic implications of bleeding are reviewed. We also provide
an overview of published bleeding risk stratification and bleeding risk
schema. Brief discussion of special situations (e.g. periablation,
peri-devices such as implantable cardioverter defibrillators [ICD] or
pacemakers, presentation with acute coronary syndromes and/or requiring
percutanous coronary interventions/stents and bridging therapy) is made,
as well as a discussion of the prevention of bleeds and managing bleeding
complications. Finally, this document puts forwards consensus statements
that may help to define evidence gaps and assist in everyday clinical
practice. Schattauer 2011.

<7>
Accession Number
21645199
Authors
Krohm P. Levionnois O. Ganster M. Zilberstein L. Spadavecchia C.
Institution
(Krohm, Levionnois, Spadavecchia) Anaesthesia Section, Department for
Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern,
Switzerland
(Ganster, Zilberstein) Allevia AG, The Bone CRO, Bern, Switzerland
Title
Antinociceptive activity of pre- versus post-operative intra-articular
bupivacaine in goats undergoing stifle arthrotomy.
Source
Veterinary Anaesthesia and Analgesia. 38 (4) (pp 363-373), 2011. Date of
Publication: July 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Objective To evaluate the peri-operative analgesic efficacy of
intra-articular bupivacaine administered before or after stifle
arthrotomy. Study design Prospective, randomized, blind,
placebo-controlled experimental trial. Animals Thirty-nine healthy goats.
Methods The goats were allocated randomly to one of three intra-articular
treatment groups: group PRE (bupivacaine before and saline after surgery),
group POST (saline before and bupivacaine after surgery) and group CON
(saline before and after surgery). Anaesthesia was maintained with a
constant end-tidal sevoflurane of 2.5%. Intra-operatively heart rate (HR),
respiratory rate and mean arterial blood pressure (MAP) after critical
surgical events (CSE) were recorded and compared with pre-incision values.
Propofol requirements to maintain surgical anaesthesia were recorded.
Flunixin was administered for 5days. Post-operative pain assessment at
20minutes, 2hours, 4hours after recovery and on day 2 and 3 included a
multidimensional pain score (MPS), a lameness score and mechanical
nociceptive threshold (MNT) testing. Rescue analgesia consisted of
systemic opioids. Data were analysed using Kruskal-Wallis, Mann-Whitney,
Friedman or chi-square tests as appropriate. Results Intra-operatively,
group PRE had lower HR and MAP at several CSEs than groups POST/CON and
required less propofol [0mgkg-1 (0-0mgkg-1)] than
group POST/CON [0.3mgkg-1 (0-0.6mgkg-1)].
Post-operatively, group POST had significantly higher peri-articular MNTs
than groups PRE and CON up to 4hours after recovery. No treatment effect
was detected for MPS, lameness scores and rescue analgesic consumption at
any time point. Conclusions and clinical relevance Pre-operative
intra-articular bupivacaine provided notable intra-operative analgesia in
goats undergoing stifle arthrotomy but did not reduce post-operative pain.
Post-operative intra-articular bupivacaine provided a short lasting
reduction of peri-articular hyperalgesia without affecting the
requirements for systemic analgesia. Multimodal perioperative pain therapy
is recommended to provide adequate analgesia for stifle arthrotomy in
goats. 2011 The Authors. Veterinary Anaesthesia and Analgesia. 2011
Association of Veterinary Anaesthetists and the American College of
Veterinary Anesthesiologists.

<8>
Accession Number
2012002986
Authors
Lawson E.H. Gibbons M.M. Ingraham A.M. Shekelle P.G. Ko C.Y.
Institution
(Lawson, Gibbons, Ingraham, Ko) Department of Surgery, David Geffen School
of Medicine, University of California, Los Angeles, CA 90095, United
States
(Lawson, Ingraham, Ko) Division of Research and Optimal Patient Care,
American College of Surgeons, Chicago, IL, United States
(Gibbons) Department of Surgery, Olive View-UCLA (University of
California, Los Angeles) Medical Center, Sylmar, CA, United States
(Ingraham) Department of Surgery, University of Cincinnati, College of
Medicine, Cincinnati, OH, United States
(Shekelle) RAND Health, Santa Monica, CA, United States
(Shekelle, Ko) VA Greater Los Angeles Healthcare System, Los Angeles, CA,
United States
Title
Appropriateness criteria to assess variations in surgical procedure use in
the United States.
Source
Archives of Surgery. 146 (12) (pp 1433-1440), 2011. Date of Publication:
December 2011.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Objectives: To systematically describe appropriateness criteria (AC)
developed in the United States for surgical procedures and to summarize
how these criteria have been applied to identify overuse and underuse of
procedures in US populations. Data Sources: MEDLINE literature search
performed in February 2010 and May 2011. Study Selection: Studies were
included if they addressed the appropriateness of a surgical procedure
using the RAND-UCLA Appropriateness Method. Non-US studies were excluded.
Data Extraction: Information was abstracted on study design, surgical
procedure, and reported rates of appropriate use, overuse, and underuse.
Identified AC were cross-referenced with lists of common procedures from
the Nationwide Inpatient Sample and the State Ambulatory Surgery
databases. Data Synthesis: A total of 1601 titles were identified; 39 met
the inclusion criteria. Of these, 17 developed AC and 27 applied AC to US
populations. Appropriateness criteria have been developed for 16 surgical
procedures. Underuse has only been studied for coronary artery bypass
graft surgery, and rates range from 24% to 57%. Overuse has been more
broadly studied, with rates ranging from 9% to 53% for carotid
endarterectomy, 0% to 14% for coronary artery bypass graft, 11% to 24% for
upper gastrointestinal tract endoscopy, and 16% to 70% for hysterectomy.
Appropriateness criteria exist for 10 of the 25 most common inpatient
procedures and 6 of the 15 top ambulatory procedures in the United States.
Most studies are more than 5 years old. Conclusions: Most existing AC are
outdated, and AC have never been developed for most common surgical
procedures. A broad and coordinated effort to develop and maintain AC
would be required to implement this tool to address variation in the use
of surgical procedures. 2011 American Medical Association. All rights
reserved.

<9>
Accession Number
2011710920
Authors
Plewka M. Krzeminska-Pakula M. Peruga J.Z. Lipiec P. Kurpesa M.
Wierzbowska-Drabik K. Korycka-Wolowiec A. Kasprzak J.D.
Institution
(Plewka, Krzeminska-Pakula, Peruga, Kurpesa, Wierzbowska-Drabik, Kasprzak)
Department of Cardiology, Medical University of Lodz, ul. Kniaziewicza
1/5, 91-347 Lodz, Poland
(Lipiec) Department of Rapid Cardiac Diagnostics, Medical University of
Lodz, Lodz, Poland
(Korycka-Wolowiec) Department of Haematology, Medical University of Lodz,
Lodz, Poland
Title
The effects of intracoronary delivery of mononuclear bone marrow cells in
patients with myocardial infarction: A two year follow-up results.
Source
Kardiologia Polska. 69 (12) (pp 1234-1240), 2011. Date of Publication:
2011.
Publisher
Klinika Kardiologii CMKP (ul. Grenadierow 51/59, Warsaw 04-073, Poland)
Abstract
Background: Transplantation of bone marrow stem cells (BMSC) is a new
method of prevention of left ventricular (LV) remodelling in
post-infarction patients. Studies published to date point to LV systolic
and diastolic function improvement following this therapy however only a
few studies assessed the long-term effects of BMSC. Aim: To assess the 2
year prognosis in patients with anterior myocardial infarction (MI)
treated with BMSC transplantation in the acute phase. Methods: The study
group consisted of 60 patients with first anterior ST-segment elevation MI
(STEMI), treated with primary percutaneous angioplasty, with baseline LV
ejection fraction (LVEF) < 40%, who were randomly assigned to undergo BMSC
transplantation on day 7 of the STEMI (40 patients, BMSC group) or to
receive standard treatment (20 patients, control group). In all the
patients echocardiography was performed at baseline and after 1, 3, 6, 12
and 24 months. The composite end-point (death, MI, admission for heart
failure or repeat revascularisation) was assessed after 2 years of
follow-up. Results: Absolute increase of LVEF compared to baseline values
was higher in the BMSC group than in the control group. The LVEF increase
in BMSC group at 1 month was 7.1% (95% CI 3.1-11.1%), at 6 months - 9.3%
(95% CI 5.3-13.3%), at 12 months - 11.0% (95% CI 6.2-13.3%) and at 24
months - 10% (95% CI 7.2-12.1%). In the control group, LVEF increase was
3.7% (95% CI 2.3-9.7%) at 1 month, 4.7% (95% CI 1.2-10.6%) at 6 months,
4.8% (95% CI 1.5-11.0%) at 12 months and 4.7% (95% CI 1.4-10.7%) at 24
months. The composite end-point occurred significantly more frequently in
the control group (55%) than in the BMSC group (23%): OR 2.72; 95% CI
1.06-7.02, p = 0.015. Conclusions: Treatment with mononuclear bone marrow
cells on day 7 of the first anterior MI in patients with significant
baseline systolic dysfunction improves 2-year outcome. Copyright Polskie
Towarzystwo Kardiologiczne.

<10>
Accession Number
2011696332
Authors
Mathur P.N.
Institution
(Mathur) Indiana University School of Medicine, Indianapolis, IN, United
States
Title
Intrapleural t-PA plus DNase improved clinical outcomes in patients with
pleural infection.
Source
Annals of Internal Medicine. 155 (12) (pp JC6-9), 2011. Date of
Publication: 20111220.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<11>
Accession Number
21526669
Authors
Aghdaii N. Azarfarin R. Yazdanian F. Faritus S.Z.
Institution
(Aghdaii) Department of Anesthesiology, Shahid Rajaii cardiovascular
Medical Center, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Azarfarin, Yazdanian, Faritus) Cardiovascular Research Center, Madani
Heart hospital, Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic of
Title
Cardiovascular responses to orotracheal intubation in patients undergoing
coronary artery bypass grafting surgery: Comparing fiberoptic bronchoscopy
with direct laryngoscopy.
Source
Middle East Journal of Anesthesiology. 20 (6) (pp 833-838), 2010. Date
of Publication: October 2010.
Publisher
American University of Beirut (P.O.Box 11-0236, Beirut 1107 2020, Lebanon)
Abstract
Background: The intubation by using fiberoptic brochoscop (FOB) can avoid
the mechanical stimulus to oropharyngolaryngeal structures thereby it is
likely to attenuate hemodynamic response during orotracheal intubation.
Based on this hypothesis, we compared the hemodynamic responses to
orotracheal intubation using an FOB and direct laryngoscope (DLS) in
patients undergoing general anesthesia for coronary artery bypass grafting
(CABG) surgery. Methods: Fifty patients with ASA physical status II and
Mallampati score I and II were scheduled for elective CABG surgery under
general anesthesia requiring orotracheal intubation were randomly
allocated to either DLS group (n = 25) or FOB group (n = 25). The same
protocol of anesthetic medications was used. Invasive systolic and
diastolic blood pressure (SBP & DBP) and heart rate (HR) were recorded
before and after anesthesia induction, during intubation and in the first
and second minutes after intubation. The differences among the hemodynamic
variables recorded over time and differences in the circulatory variables
between the two study groups were compared. Results: Duration of
intubation was shorter in DLS group (19.3 +/- 4.7 sec) compared with FOB
group (34.9 +/- 9.8 sec; p = 0.0001). In both study groups basic SBP and
DBP and HR were not significantly different (P >0.05). During the
observation, there were no significant differences between the two groups
in BP or HR at any time points or in their maximal values (all p values
>0.05). Conclusion: We conclude that the FOB had no advantage in
attenuating the hemodynamic responses to orotracheal intubation in
patients undergoing CABG surgery.

<12>
Accession Number
20557390
Authors
Utriyaprasit K. Moore S.M. Chaiseri P.
Institution
(Utriyaprasit) Mahidol University, Bankoknoi, Bangkok, Thailand
(Moore) School of Nursing, Case Western Reserve University, Cleveland, OH,
United States
(Chaiseri) Central Chest Institute Muang, Nonthaburi, Thailand
Title
Recovery after coronary artery bypass surgery: Effect of an audiotape
information programme.
Source
Journal of Advanced Nursing. 66 (8) (pp 1747-1759), 2010. Date of
Publication: August 2010.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Aim.: The aim of the study was to test the effect of an audiotape giving
concrete objective information and strategies to reduce symptoms,
psychological distress and enhance physical functioning in patients having
coronary artery bypass grafts. Background.: The period following hospital
discharge is stressful for patients having coronary artery bypass grafts.
Evident-based interventions are needed to improve outcomes in Thai
populations following coronary artery bypass graft surgery. Methods.: A
randomized controlled trial was conducted during 2004-2005. A sample of
120 Thai patients having coronary artery bypass grafts was randomly
assigned to an intervention group or a control group. The intervention
group was given an information audiotape the day prior to hospital
discharge, and encouraged to listen to it as many times as necessary.
Participants were interviewed using validated instruments predischarge and
at 2 weeks and 4 weeks after discharge. Findings.: Participants in the
intervention group had statistically significantly fewer symptoms of
shoulder, back or neck pain and lack of appetite, and increased physical
activity after discharge, compared to the control group. This effect
remained statistically significant after controlling for age, gender,
co-morbidity and presurgical cardiac functional status. However, no
statistically significant difference in psychological distress was
observed. Conclusion.: Nurses can use an audiotape containing preparatory
information to improve outcomes for patients having coronary artery bypass
grafts during the few weeks after discharge from hospital. Further studies
are recommended to improve its effect on psychological distress. 2010
Blackwell Publishing Ltd.

<13>
Accession Number
70628103
Authors
Preiss D. Seshasai S.R.K. Welsh P. Sattar N. Ray K.
Institution
(Preiss, Seshasai, Welsh, Sattar, Ray) GlasgowUnited Kingdom
(Preiss, Seshasai, Welsh, Sattar, Ray) CambridgeUnited Kingdom
(Preiss, Seshasai, Welsh, Sattar, Ray) LondonUnited Kingdom
Title
Risk of incident diabetes on intensive compared to moderate dose statin
therapy: A collaborative meta-analysis of randomized trials.
Source
Diabetes. Conference: 71st Scientific Sessions of the American Diabetes
Association San Diego, CA United States. Conference Start: 20110624
Conference End: 20110628. Conference Publication: (var.pagings). 60 (pp
A88), 2011. Date of Publication: July 2011.
Publisher
American Diabetes Association Inc.
Abstract
A recent meta-analysis demonstrated that statin therapy is associated with
an excess risk of developing diabetes. Whether any such relationship
exists between intensive statin therapy and new-onset diabetes compared to
moderate dose therapy is unclear. We searched Medline, Embase and the
Cochrane Central Register of Controlled Trials from 1996 to 2010 for
randomized controlled endpoint trials including more than 1000 patients
with identical follow-up in both arms and duration of more than 1 year.
Using published and unpublished data, we calculated trial-specific risk
estimates for patients developing diabetes and experiencing major
cardiovascular events (cardiovascular death, nonfatal myocardial
infarction or stroke, coronary revascularization), and combined these
using random-effects model meta-analysis. Between-study heterogeneity was
assessed using the I 2 statistic. We identified five statin
trials with 32,752 participants without diabetes, of whom 2,749 (1,449
assigned intensive therapy, 1,300 assigned standard therapy) developed
diabetes and 6,684 (3,134 and 3,550 respectively) experienced
cardiovascular events over an average follow-up of 4.9 years. Intensive
statin therapy was associated with a 12% higher risk for newonset diabetes
(odds ratio [OR] 1.12; 95% CI 1.04-1.22; I 2=0%) and 16%
reduction in cardiovascular events (OR 0.84; 95% CI 0.75-0.94; I
2=74%). For every three fewer patients experiencing major
cardiovascular events on intensive therapy, one additional case of
diabetes occurred. (Table presented).

<14>
Accession Number
70627056
Authors
Pike K. Brierley R. Rogers C.A. Murphy G.J. Reeves B.C.
Institution
(Pike, Brierley, Rogers, Murphy, Reeves) Bristol Heart Institute,
University of Bristol, Bristol BS2 8HW, United Kingdom
Title
Adherence in a randomised controlled trial comparing liberal and
restrictive red blood cell (RBC) transfusion protocols after cardiac
surgery (TITRe2).
Source
Trials. Conference: Clinical Trials Methodology Conference 2011 Bristol
United Kingdom. Conference Start: 20111004 Conference End: 20111005.
Conference Publication: (var.pagings). 12 , 2011. Date of Publication:
13 Dec 2011.
Publisher
BioMed Central Ltd.
Abstract
Objectives: The TITRe2 trial is comparing two haemoglobin (Hb) thresholds
for RBC transfusion after cardiac surgery, Hb<9.0g/dl (liberal) vs.
Hb<7.5g/dl (restrictive). Based on historic data, and with complete
adherence, transfusion rates should be 100% in the liberal and 30% in the
restrictive group. Convergence of these rates due to non-adherence
severely threatens the power of the trial; there is also concern about
differential nonadherence, with transfusion being delayed or withheld in
the liberal group when Hb remains close to the 9.0g/dl threshold. Methods:
In order to capture non-adherence, research staff collect data describing:
The lowest daily Hb; Date and time of each RBC transfusion and the
preceding Hb measurement; Number of breaches of the allocated threshold
before a transfusion is prescribed. These data allow non-adherence to the
randomisation and transfusion protocols to be detected: Failure to
randomise when the 9.0g/dl threshold is breached; Randomised >24 hours
after first breaching Hb 9.0g/dl threshold; Randomised without or before
breaching Hb 9.0g/dl threshold; After randomisation, transfusion given
when allocated threshold not breached ('extra'), or transfusion withheld
when allocated threshold breached ('withheld'); Instances of extra and
withheld transfusions are classified as mild, moderate or severe depending
on their likely influence on overall transfusion rates. Results: 56% of
participants are being randomised; about 8% of the remaining 44% consented
participants breach the 9.0g/dl threshold but are not randomised. 3% of
randomised participants are randomised >24 hours after first breaching,
but none has been randomised without or before breaching the 9.0g/dl
threshold. 32% of participants have had >=1 instance of non-adherence to
the transfusion protocol; in 6%, non-adherence was judged severe (extra -
transfused and patient did not breach at any point post-randomisation;
withheld - not transfused and patient had no postrandomisation
transfusions). Site-specific rates of non-adherence are being fedback to
try to improve adherence. Rates of transfusion in the liberal and
restrictive groups are confidential to the Data Monitoring and Ethics
Committee (DMEC). Conclusions: We believe that this is the first attempt
to measure withheld transfusions in trials of this kind. Data collection
to do this is burdensome but satisfactory. The current rates of
transfusion in the liberal and restrictive groups are, so far, judged by
the DMEC to be consistent with the sample size justification.

<15>
Accession Number
70626993
Authors
Rogers C.A. Pike K. Angelini G.D. Reeves B.C.
Institution
(Rogers, Pike, Angelini, Reeves) Bristol Heart Institute, University of
Bristol, Bristol BS2 8HW, United Kingdom
Title
Use of an objective measure of time to recovery after cardiac surgery -
The STET randomised controlled trial.
Source
Trials. Conference: Clinical Trials Methodology Conference 2011 Bristol
United Kingdom. Conference Start: 20111004 Conference End: 20111005.
Conference Publication: (var.pagings). 12 , 2011. Date of Publication:
13 Dec 2011.
Publisher
BioMed Central Ltd.
Abstract
Objective: The STET trial is a two-centre open RCT comparing morbidity and
healthcare resource use when off-pump coronary artery bypass surgery is
carried out via a left anterolateral thoracotomy incision (ThoraCAB) or
via a conventional median sternotomy incision (OPCAB). It was hypothesised
that post-operative recovery would be faster with ThoraCAB. Methods:
Post-operative hospital stay is a commonly used measure of recovery.
However, in an open surgical trial, where the decision to discharge the
patient from hospital lies with the surgeon, post operative hospital stay
is susceptible to bias. For the STET trial we developed an objective
measure of recovery. Recovery time was defined as the time from surgery
until the patient was considered fit for discharge. Patients were
classified fit (a) when the x-ray was clear (no evidence of pleural
effusion requiring drainage, lung collapse/consolidation, pneumothorax);
(b) there was no suspected systemic, lower respiratory tract or wound
infection; (c) routine blood results and temperature were normal and (d)
when physically mobile (walking 70m, bowels open and oxygen
saturation>95%). These recovery criteria were monitored daily until
discharge. Results: 184 patients were recruited (91 randomised to
ThoraCAB, 93 to OPCAB). In the OPCAB group 77% were classified fit at or
before discharge versus 68% in the ThoraCAB group. For the remainder, the
recovery time was censored because discharge occurred before all the
criteria were met. Insufficient mobility accounted for the majority of
censored observations. The median recovery time was 6 days, IQR [4,7] in
the ThoraCAB group versus 5 days, IQR [4,7] in the OPCAB group (Time ratio
(ThoraCAB/OPCAB) 1.03 (95%CI [0.94, 1.14], p=0.53). In contrast, the
median time to discharge was 5 days in the ThoraCAB group versus 6 days in
the OPCAB group. Conclusion: The anticipated faster recovery with ThoraCAB
was not found and a significant proportion of patients were discharged
before all the recovery criteria were met. The results from the STET trial
illustrate the bias associated with clinical decision making in an open
RCT. The measure of recovery time (with slightly modified criteria) is
being used in other cardiac surgery trials.

<16>
Accession Number
70626945
Authors
Stocken D.D. Billingham L.J. Johnson P.J. Freemantle N.
Institution
(Stocken, Billingham, Johnson) Cancer Research UK Clinical Trials Unit,
University of Birmingham, Birmingham, United Kingdom
(Freemantle) Primary Care and Population Health, University College
London, London, United Kingdom
Title
Choice of transformation for modelling non-linear continuous biomarkers.
Source
Trials. Conference: Clinical Trials Methodology Conference 2011 Bristol
United Kingdom. Conference Start: 20111004 Conference End: 20111005.
Conference Publication: (var.pagings). 12 , 2011. Date of Publication:
13 Dec 2011.
Publisher
BioMed Central Ltd.
Abstract
Identification of prognostic and predictive biomarkers is important for
targeting treatments to patients and for the design and analysis of
randomised controlled trials. Cox proportional hazards modelling is a
standard method for assessing prognostic value of clinical biomarkers
where time to occurrence of an event is the primary outcome of interest.
An important issue in the analysis of prognostic factors is the functional
form of the relationship between the factor and outcome specifically for
continuous covariates. Continuous covariates are often simplified assuming
a linear relationship with log-hazard or dichotomisation which may be
inappropriate leading to loss of efficiency in statistical tests, bias and
incorrect conclusions. The effects of important prognostic biomarkers may
go unrecognised due to simplistic assumptions made in statistical
modelling. Two polynomial based strategies, restricted cubic splines and
fractional polynomials, are compared directly for determining the
functional form of non-linear relationships between prognostic biomarkers
and survival using two real datasets from randomised controlled trials in
advanced pancreatic cancer and cardiac surgery. Fractional polynomials are
an extended family of curves including non-integer and negative power
terms. Spline functions are piecewise polynomials connected across
intervals of a variable constrained to meet at the 'knots'. Multivariable
models were constructed based on Cox proportional hazards regression using
backward elimination. Internal validation to directly compare the fit of
the restricted cubic spline and fractional polynomial strategies was
carried out by calculating the sampling distribution of the difference in
AIC between the models using nonparametric bootstrap analyses. Further
analysis recalculated the univariate fractional polynomial transformation
within each bootstrap resample to compare directly against a 5-knot
restricted cubic spline. The influence of the size of the bootstrap
samples was also investigated. The fitted functions generated by splines
and fractional polynomials were similar resulting in comparable models.
The methods are generally different in the extremities where there is
often a paucity of data. Larger differences were seen between the two
methods when sample sizes were reduced due to the reduced power to detect
small effects but also to detect nonlinearity. Multivariable fractional
polynomial transformations are an alternative approach to restricted cubic
spline transformations for multivariable model building of continuous
biomarkers with non-linear relationships with outcome.

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Total documents retrieved: 10

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<1>
Accession Number
2012001391
Authors
Zimmet H. Porapakkham P. Sata Y. Haas S.J. Itescu S. Forbes A. Krum H.
Institution
(Zimmet, Haas, Forbes, Krum) Department of Epidemiology and Preventive
Medicine, School of Public Health, Preventive Medicine Monash University,
99 Commercial Rd, Melbourne, VIC 3004, Australia
(Porapakkham) Department of Cardiothoracic Surgery, Chest Disease
Institute, Nonthaburi, Thailand
(Porapakkham) Department of Cardiology, Chest Disease Institute,
Nonthaburi, Thailand
(Sata) Department of Cardiovascular Dynamics, National Cerebral and
CardioVascular Center Research Institute, Osaka, Japan
(Itescu) Department of Medicine, University of Melbourne, St. Vincent's
Hospital, Melbourne, Australia
Title
Short-and long-term outcomes of intracoronary and endogenously mobilized
bone marrow stem cells in the treatment of ST-segment elevation myocardial
infarction: A meta-analysis of randomized control trials.
Source
European Journal of Heart Failure. 14 (1) (pp 91-105), 2012. Date of
Publication: January 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Bone marrow stem cell (BMSC) treatment of ST-segment elevation
myocardial infarction (STEMI) has been primarily via the intracoronary
route or via endogenous mobilization using granulocyte colony-stimulating
factor (G-CSF). Studies have provided conflicting results. We therefore
performed a meta-analysis of these treatments, examining short-and
long-term efficacy and safety. Methods and results Randomized controlled
trials (RCTs) of BMSC-based therapy for STEMI, delivered within 9 days of
reperfusion, were identified by systematic search. Random effects models
were used to calculate pooled effects of clinical outcomes, with
meta-regression to assess dependence of the magnitude of effect sizes on
study characteristics. Twenty-nine RCTs enrolling 1830 patients were
included. Intracoronary BMSC therapy resulted in an overall improvement in
left ventricular ejection fraction (LVEF) of 2.70% [95 confidence interval
(CI) 1.483.92; P < 0.001] in the short term and 3.31% (95% CI 1.874.75; P
< 0.001) longer term. Meta-regression suggested a doseresponse
relationship between quantity of CD34+ cells delivered and
increase in LVEF (P = 0.007). G-CSF treatment resulted in a trend towards
similar benefits (P = 0.20). No significant differences were observed in
pooled adverse outcome rates between intervention and control groups of
either treatment approach, except for lower revascularization rates with
intracoronary BMSC vs. control (odds ratio 0.68, 95% CI 0.470.97; P 0.03).
Conclusions Intracoronary BMSC therapy post-STEMI improves LVEF beyond
standard medical treatment, in both the short and longer term. G-CSF
treatment shows positive but non-significant trends. Both treatments
demonstrate safety comparable with conventional medical treatment. 2011
The Author.

<2>
Accession Number
2011702158
Authors
Garnock-Jones K.P.
Institution
(Garnock-Jones) Adis A Wolters Kluwer Business, 41 Centorian Drive,
Private Bag 65901, North Shore 0754, Auckland, New Zealand
Title
Esmolol: A Review of its Use in the Short-Term Treatment of
Tachyarrhythmias and the Short-Term Control of Tachycardia and
Hypertension.
Source
Drugs. 72 (1) (pp 109-132), 2012. Date of Publication: 2012.
Publisher
Adis International Ltd (41 Centorian Drive, Private Bag 65901, Mairangi
Bay, Auckland 10 1311, New Zealand)
Abstract
Supraventricular tachyarrhythmia (including atrial fibrillation),
hypertension and tachycardia in the perioperative setting, and acute
ischaemic heart disease are generally agreed to require rapid attention
and treatment. Prolonged tachyarrhythmia or hypertension can result in
significant morbidity, such as cerebrovascular events, myocardial
infarction and other end-organ damage. This article reviews the clinical
efficacy and tolerability of intravenous infusions of esmolol for the
short-term treatment of tachyarrhythmias and the short-term control of
tachycardia and hypertension, and provides an overview of the
pharmacological properties of the drug.Esmolol, a cardioselective
beta-blocker, has been proven effective in the control of elevated
haemodynamic parameters in patients with supraventricular tachyarrhythmia,
hypertension and tachycardia in the perioperative setting, and acute
ischaemic heart disease, as well as being associated with a reduced risk
of some clinical sequelae to increased haemodynamic parameters. Esmolol
is, moreover, generally well tolerated; while it is associated with an
increased risk of hypotension, this is rapidly reversible.Definitive
conclusions on the efficacy of esmolol are difficult to reach, as most
trials investigating esmolol have limitations such as small patient
populations, and few studies investigate the same parameters. Ideally,
several further studies would be beneficial; however, as esmolol is a well
established, older drug, these are less likely to occur.Despite this,
esmolol, as a fast-acting, rapidly reversible, easily titratable
beta-blocker, is an established option for the short-term treatment of
tachyarrhythmias and the short-term control of tachycardia and
hypertension. 2012 Adis Data Information BV. All rights reserved.

<3>
Accession Number
2011701726
Authors
Boning A. Bruck M.
Institution
(Boning) Department of Cardiovascular Surgery, University Hospital Giessen
and Marburg, Rudolf-Buchheim-Strasse7, 35385 Giessen, Germany
(Bruck) Department of Cardiology and Nephrology, Lahn-Dill-Kliniken,
Wetzlar, Germany
Title
Heart valve prosthesis selection in patients with end-stage renal disease
requiring dialysis: A systematic review and meta-analysis.
Source
Heart. 98 (2) (pp 99), 2012. Date of Publication: January 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)

<4>
Accession Number
2011700922
Authors
Huen S.C. Parikh C.R.
Institution
(Huen, Parikh) Department of Medicine, School of Medicine, Yale
University, New Haven, United States
(Huen, Parikh) Clinical Epidemiology Research Center, Veterans Affairs
Medical Center, West Haven, CT, United States
Title
Predicting acute kidney injury after cardiac surgery: A systematic review.
Source
Annals of Thoracic Surgery. 93 (1) (pp 337-347), 2012. Date of
Publication: January 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Acute kidney injury (AKI) after cardiac surgery confers a significant
increased risk of death. Several risk models have been developed to
predict postoperative kidney failure after cardiac surgery. This
systematic review evaluated the available risk models for AKI after
cardiac surgery. Literature searches were performed in the Web of
Science/Knowledge, Scopus, and MEDLINE databases for articles reporting
the primary development of a risk model and articles reporting validation
of existing risk models for AKI after cardiac surgery. Data on model
variables, internal or external validation (or both), measures of
discrimination, and measures of calibration were extracted. The systematic
review included 7 articles with a primary development of a prediction
score for AKI after cardiac surgery and 8 articles with external
validation of established models. The models for AKI requiring dialysis
are the most robust and externally validated. Among the prediction rules
for AKI requiring dialysis after cardiac surgery, the Cleveland Clinic
model has been the most widely tested thus far and has shown high
discrimination in most of the tested populations. A validated score to
predict AKI not requiring dialysis is lacking. Further studies are
required to develop risk models to predict milder AKI not requiring
dialysis after cardiac surgery. Standardizing risk factor and AKI
definitions will facilitate the development and validation of risk models
predicting AKI. 2012 The Society of Thoracic Surgeons.

<5>
Accession Number
2011709494
Authors
Au A.G. Majumdar S.R. McAlister F.A.
Institution
(Au, Majumdar, McAlister) Division of General Internal Medicine,
Department of Medicine, University of Alberta, Edmonton, Canada
(McAlister) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Canada
Title
Preoperative thienopyridine use and outcomes after Surgery: A systematic
review.
Source
American Journal of Medicine. 125 (1) (pp 87-99.e1), 2012. Date of
Publication: January 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Although studies have demonstrated excess risk of ischemic events if
aspirin is withheld preoperatively, it is unclear whether preoperative
thienopyridine use influences postoperative outcomes. We conducted a
systematic review of 37 studies (31 cardiac and 6 noncardiac surgery, 3
randomized, 34 observational) comparing postoperative outcomes in patients
who were versus were not exposed to thienopyridine in the 5 days before
surgery. Exposure to thienopyridine in the 5 days preceding surgery
(compared with no exposure) was not associated with any reduction in
postoperative myocardial infarction (23 studies, 12,872 patients, 3.4% vs
3.0%, odds ratio [OR] 0.98; 95% confidence interval [CI], 0.72-1.34), but
was associated with increased risks of stroke (16 studies, 10,265
patients, 1.9% vs 1.4%, OR 1.54; 95% CI, 1.08-2.20), reoperation for
bleeding (32 studies, 19,423 patients, 4.3% vs 1.8%, OR 2.62; 95% CI,
1.96-3.49), and all-cause mortality (28 studies, 22,990 patients, 3.7% vs
2.6%, OR 1.38; 95% CI, 1.13-1.69). Results were identical when analyses
were restricted to long-term users of thienopyridines who continued versus
held the medication in the 5 days before surgery. Although all
associations were similar in direction for the subset of patients
undergoing noncardiac surgery, 97% of the outcome data in this
meta-analysis came from cardiac surgery trials. These data support
withholding thienopyridines 5 days before cardiac surgery; there was
insufficient evidence to make definitive recommendations for elective
noncardiac surgery although the direction and magnitude of associations
were similar.

<6>
Accession Number
2011706651
Authors
Harston A. Roberts C.
Institution
(Harston, Roberts) Department of Orthopaedic Surgery, University of
Louisville School of Medicine, 210 E. Gray Street, Louisville, KY 40202,
United States
Title
Fixation of sternal fractures: A systematic review.
Source
Journal of Trauma - Injury, Infection and Critical Care. 71 (6) (pp
1875-1879), 2011. Date of Publication: December 2011.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background: Traumatic sternal fractures occur in approximately 3% to 8% of
all blunt trauma patients. Most of these fractures are treated
conservatively, but a small number require operative intervention. Only a
few studies have reported operative fixation of sternal fractures, and no
investigation to our knowledge has systematically reviewed the literature
on this intervention. Methods: We conducted a systematic review of the
literature published from 1990 through September 2010 regarding the
treatment of traumatic sternal fractures. We analyzed the available
evidence regarding the surgical fixation of these fractures, the type of
fixation used, the timing of the surgery, complications, and patient
outcomes. Results: Twelve articles with 76 cases of surgically repaired
sternal fractures met our study criteria. The indications for surgery,
timing, and methods used for fixation were diverse. For instance, plates
were used in 52 patients and wiring was selected in 24 patients for
fixation. General and cardiothoracic surgeons treated the majority of
sternal fractures requiring operative fixation. No serious postoperative
complications were found in our review. Conclusions: Although the outcomes
were generally positive, only one-half of the articles documented patient
follow-up. In future studies, focus needs to be placed on long-term
results and specific indications for surgery. The first step toward a
standardized sternal fracture operative trial must be a prospective study
of incidence and nonoperative long-term outcomes. It is likely that as the
interest and demand for plate fixation increases, the demand for
orthopedic involvement with sternal fractures will also increase. 2011
Lippincott Williams & Wilkins.

<7>
Accession Number
2012002610
Authors
Mahmoud K. Ammar A.
Institution
(Mahmoud, Ammar) Department of Anesthesiology, Faculty of Medicine,
Minoufiya University, 3 Yaseen Abdelghaffar Street, Shebin Elkoam,
Minoufiya 32511, Egypt
Title
Immunomodulatory effects of anesthetics during thoracic surgery.
Source
Anesthesiology Research and Practice. 2011 , 2011. Article Number:
317410. Date of Publication: 2011.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. One-lung ventilation (OLV) during thoracic surgery may induce
alveolar cell damage and release of proinflammatory mediators. The current
trial was planned to evaluate effect of propofol versus isoflurane
anesthesia on alveolar and systemic immune modulation during thoracic
surgery.Methods. Fifty adult patients undergoing open thoracic surgery
were randomly assigned to receive propofol (n = 25) or isoflurane (n = 25)
anesthesia. The primary outcome measures included alveolar and plasma
concentrations of interleukin-8(IL-8) and tumour necrosis factor- (TNF-),
whereas secondary outcome measures were alveolar and plasma concentrations
of malondialdehyde (MDA), superoxide dismutase (SOD), and changes in
alveolar albumin concentrations and cell numbers. Results. Alveolar and
plasma concentrations of IL-8 and TNF- were significantly lower in the
isoflurane group, whereas alveolar and plasma concentrations of MDA were
significantly lower in the propofol group. Alveolar and plasma SOD levels
increased significantly in the propofol group whereas they showed no
significant change in the isoflurane group. Furthermore, the isoflurane
group patients developed significantly lower alveolar albumin
concentrations and cell numbers.Conclusion. Isoflurane decreased the
inflammatory response associated with OLV during thoracic surgery and may
be preferable over propofol in patients with expected high levels of
proinflammatory cytokines like cancer patients. Copyright 2011 Khaled
Mahmoud and Amany Ammar.

<8>
Accession Number
2011705250
Authors
Kunisawa T. Ueno M. Kurosawa A. Nagashima M. Hayashi D. Sasakawa T. Suzuki
A. Takahata O. Iwasaki H.
Institution
(Kunisawa, Ueno, Kurosawa, Nagashima, Hayashi, Sasakawa, Suzuki, Takahata,
Iwasaki) Department of Anesthesiology and Critical Care Medicine,
Asahikawa Medical College, 2-1-1-1 Midorigaoka-higashi, Asahikawa,
Hokkaido 0788510, Japan
Title
Dexmedetomidine can stabilize hemodynamics and spare anesthetics before
cardiopulmonary bypass.
Source
Journal of Anesthesia. 25 (6) (pp 818-822), 2011. Date of Publication:
December 2011.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose: We previously confirmed the effectiveness of dexmedetomidine
(DEX) for stabilizing hemodynamics as well as sparing anesthetics during
anesthetic induction in patients undergoing cardiac surgery (Kunisawa et
al. in J Clin Anesth 21:194-199, 1). In this study, we investigated
whether these effects of DEX continue until the start of cardiopulmonary
bypass (CPB). Methods: Twenty-two patients with mild to moderate
cardiovascular disease were randomized into two groups [DF2 group: DEX
dose of 0.7 mug/kg/h after initial dose and effect-site concentration
(ESC) of fentanyl of 2 ng/ml; PF4 group: saline and ESC of fentanyl of 4
ng/ml]. Propofol was administered for anesthetic induction and
maintenance. Hemodynamics, cardiovascular drugs, ESC of propofol, and
cardiovascular responses to skin incision (SI) and sternotomy (St) were
measured or calculated. Results: Blood pressure (BP) at the pre-/post-SI
periods was higher in the DEX group (137 +/- 17/140 +/- 16 mmHg) than in
the placebo group (85 +/- 9/109 +/- 24 mmHg). Percent increases in
cardiovascular response to SI or St were lower in the DEX group than in
the placebo group (for example, 1.9 +/- 2.2 vs. 27.4 +/- 19.9% in systolic
BP due to SI). ESCs of propofol at SI and St in the DEX group were lower
than those in the placebo group. Conclusions: DEX combined with 2 ng/ml
fentanyl before CPB can suppress the decrease in blood pressure at the
pre- and post-SI periods, can blunt the cardiovascular responses to SI and
St, and can spare the required ESC of propofol despite fentanyl
concentration, which was half of that in the placebo group. 2011 Japanese
Society of Anesthesiologists.

<9>
Accession Number
2011705798
Authors
Lomivorotov V.V. Efremov S.M. Shmirev V.A. Ponomarev D.N. Lomivorotov V.N.
Karaskov A.M.
Institution
(Lomivorotov, Efremov, Shmirev, Ponomarev, Lomivorotov, Karaskov)
Department of Anaesthesiology and Intensive Care, Academician E. N.
Meshalkin Novosibirsk State Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
Title
Glutamine is cardioprotective in patients with ischemic heart disease
following cardiopulmonary bypass.
Source
Heart Surgery Forum. 14 (6) (pp E384-E388), 2011. Date of Publication:
December 2011.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: The aim of the present study was to investigate the
cardioprotective effects of the perioperative use of
N(2)-l-alanyl-l-glutamine (GLN) in patients with ischemic heart disease
(IHD) who undergo their operations under cardiopulmonary bypass (CPB).
Methods: This double-blind, placebo-controlled, randomized study included
50 patients who underwent cardiac surgery with CPB. Exclusion criteria
were a left ventricular ejection fraction <50%, diabetes mellitus, <3
months since the onset of myocardial infarction, and emergency surgery.
Patients in the study group (n = 25) received 0.4 g/kg GLN (Dipeptiven,
20% solution) per day. Patients in the control group (n = 25) were
administered a placebo (0.9% NaCl). The primary end point was the dynamics
of troponin I at the following stages: (1) prior to anesthesia, (2) 30
minutes after CPB, (3) 6 hours after CPB, (4) 24 hours after surgery, and
(5) 48 hours after surgery. Secondary end points included measurements of
hemodynamics with a Swan-Ganz catheter. Results: On the fi rst
postoperative day after the surgery, the median troponin I level was
signifi cantly lower in the study group than in the placebo group: 1.280
ng/mL (interquartile range [IQR], 0.840-2.230 ng/mL) versus 2.410 ng/mL
(IQR, 1.060-6.600 ng/mL) (P = .035). At 4 hours after cardiopulmonary
bypass (CPB), the median cardiac index was higher in the patients in the
study group: 2.58 L/min per m2 (IQR, 2.34- 2.91 L/min per
m2) versus 2.03 L/min per m2 (IQR, 1.76- 2.32 L/min
per m2) (P = .002). The median stroke index also was higher in
the patients who received GLN: 32.8 mL/m2(IQR, 27.8-36.0 mL/m
2) versus 26.1 mL/m2 (IQR, 22.6- 31.8
mL/m2) (P = .023). The median systemic vascular resistance
index was signifi cantly lower in the study group than in the placebo
group: 1942 dyns/cm5 per m2 (IQR, 1828-2209
dyns/cm5 per m2) versus 2456 dyn?s/cm5 per m2 (IQR,
2400- 3265 dyn?s/cm5 per m2) (P = .001). Conclusion: Perioperative
administration of GLN during the fi rst 24 hours has cardioprotective
effects in IHD patients following CPB. This technique enhances the
troponin concentration at 24 hours after surgery and is associated with
improved myocardial function. 2011 Forum Multimedia Publishing, LLC.

<10>
Accession Number
2011705269
Authors
Shimizu K. Toda Y. Iwasaki T. Takeuchi M. Morimatsu H. Egi M. Suemori T.
Suzuki S. Morita K. Sano S.
Institution
(Shimizu, Toda, Iwasaki, Morimatsu, Egi, Suemori, Suzuki, Morita)
Department of Anesthesiology and Resuscitology, Okayama University
Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama 700-8558, Japan
(Sano) Department of Cardiovascular Surgery, Okayama University Hospital,
2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama 700-8558, Japan
(Takeuchi) Pediatric Operating Suite and Intensive Care, Jichi Children's
Medical Center Tochigi, Jichi Medical University, 3311-1 Yakushiji,
Shimono, Tochigi 329-0498, Japan
Title
Effect of tranexamic acid on blood loss in pediatric cardiac surgery: A
randomized trial.
Source
Journal of Anesthesia. 25 (6) (pp 823-830), 2011. Date of Publication:
December 2011.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose: The benefit of tranexamic acid (TXA) in pediatric cardiac surgery
on postoperative bleeding has varied among studies. It is also unclear
whether the effects of TXA differ between cyanotic patients and acyanotic
patients. The aim of this study was to test the benefit of TXA in
pediatric cardiac surgery in a well-balanced study population of cyanotic
and acyanotic patients. Methods: A total of 160 pediatric patients
undergoing cardiac surgery with cardiopulmonary bypass (81 cyanotic, 79
acyanotic) were included in this single-blinded, randomized trial at a
tertiary care university-affiliated teaching hospital. Eighty-one children
(41 cyanotic, 40 acyanotic) were randomly assigned to a TXA group, in
which they received 50 mg/kg of TXA as a bolus followed by 15 mg/kg/h
infusion and another 50 mg/kg into the bypass circuit. The other 79
patients were randomly assigned to a placebo group. The primary end point
was the amount of 24-h blood loss. Results: The amount of 24-h blood loss
was significantly less in the TXA group than in the placebo group [mean
(95% confidence interval): 18.6 (15.8-21.4) vs. 23.5 (19.4-27.5) ml/kg,
respectively; mean difference -4.9 (-9.7 to -0.01) ml/kg; p = 0.049]. This
effect of TXA was already significant at 6 h [9.5 (7.5-11.5) vs. 13.2
(10.6-15.9) ml/kg, respectively; mean difference -3.47 (-7.0 to -0.4)
ml/kg; p = 0.027]. However, there was no significant difference in the
amount of blood transfusion between the groups. There was also no
statistical difference in the effect of TXA in each cyanotic and acyanotic
subgroup. Conclusion: TXA can reduce blood loss in pediatric cardiac
surgery but not the transfusion requirement ( http://ClinicalTrials.gov
number NCT00994994). 2011 Japanese Society of Anesthesiologists.

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Total documents retrieved: 36

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<1>
Accession Number
2010391264
Authors
Gorlitzer M. Wagner F. Pfeiffer S. Folkmann S. Meinhart J. Fischlein T.
Reichenspurner H. Grabenwoger M.
Institution
(Gorlitzer, Folkmann, Grabenwoger) Department of Cardiovascular Surgery,
Hospital Hietzing, Wolkersbergenstr. 1, A-1130 Vienna, Austria
(Wagner, Reichenspurner) Department of Cardiovascular Surgery, University
Hospital Hamburg-Eppendorf, Hamburg, Germany
(Pfeiffer, Fischlein) Department of Cardiac Surgery, Heart Center,
Nuernberg, Germany
(Meinhart) Karl Landsteiner Institute for Cardiovascular Surgery Research,
Hospital Hietzing, Vienna, Austria
Title
A prospective randomized multicenter trial shows improvement of sternum
related complications in cardiac surgery with the Posthorax support vest.
Source
Interactive Cardiovascular and Thoracic Surgery. 10 (5) (pp 714-718),
2010. Date of Publication: May 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Sternal instability, dehiscence and mediastinitis are major causes of
morbidity and mortality in cardiac surgery. The aim of this analysis is to
determine the effect of a Posthorax support vest (Epple Inc,
Vienna, Austria) after median sternotomy. One thousand five hundred and
sixty cases were included in a prospective randomized multicenter trial.
Patients were randomized as follows: 905 received a flexible dressing
postoperatively (group A) and 655 patients were given a
Posthorax support vest (group B). Patients in groups A and B
were well matched. Their mean age was 68 years (range: 34-87 years). The
patient characteristics and operative data were equally distributed in
both groups. The mean total hospital stay was significantly shorter in
group B than in group A (A: 17.33 +/- 17.5; B: 14.76 +/- 7.7; P=0.04).
Sternal wound complications necessitating reoperation during the 90 days
follow-up period were observed in 4.5%. Reoperation rates were as follows:
3.9% in group A and 0.6% in group B (P<0.05). The use of the
Posthorax sternum support vest is a valuable adjunct to prevent
sternum-related complications after cardiac surgery. In the 90 days
follow-up period, additional surgical procedures were significantly
reduced by the use of the support vest. 2010 Published by European
Association for Cardio-Thoracic Surgery.

<2>
Accession Number
2010389766
Authors
Bauer T. Mollmann H. Weidinger F. Zeymer U. Seabra-Gomes R. Eberli F.
Serruys P. Vahanian A. Silber S. Wijns W. Hochadel M. Nef H.M. Hamm C.W.
Marco J. Gitt A.K.
Institution
(Bauer, Mollmann, Nef, Hamm) Kerckhoff-Klinik, Kardiologie, Benekestr.
2-8, 61231 Bad Nauheim, Germany
(Weidinger) Krankenhaus Rudolfstiftung, Vienna, Austria
(Zeymer, Hochadel, Gitt) Herzzentrum Ludwigshafen, Institut fur
Herzinfarktforschung Ludwigshafen, Universitat Heidelberg, Ludwigshafen,
Germany
(Seabra-Gomes) Instituto do Coracao, Lisbon, Portugal
(Eberli) Stadtspital Triemli, Zurich, Switzerland
(Serruys) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Vahanian) Bichat Hospital, Paris, France
(Silber) Kardiologische Gemeinschaftspraxis und Praxisklinik, Munich,
Germany
(Wijns) Cardiovascular Center, Aalst, Belgium
(Marco) Centre Cardiothoracique de Monaco, Monaco Cedex, Monaco
Title
Use of platelet glycoprotein IIb/IIIa inhibitors in diabetics undergoing
PCI for non-ST-segment elevation acute coronary syndromes: Impact of
clinical status and procedural characteristics.
Source
Clinical Research in Cardiology. 99 (6) (pp 375-383), 2010. Date of
Publication: June 2010.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Abstract Background The most recent ESC guidelines for percutaneous
coronary intervention (PCI) recommend the use of glycoprotein IIb/IIIa
inhibitors (GPI) in high risk patients with non-ST-segment elevation acute
coronary syndromes (NSTE-ACS), particularly in diabetics. Little is known
about the adherence to these guidelines within Europe. Methods and results
Between May 2005 and April 2008 a total of 47,407 consecutive patients
undergoing PCI were prospectively enrolled into the PCI-Registry of the
Euro Heart Survey Programme. In the present analysis we examined the use
of GPI in 2,922 diabetics who underwent PCI for NSTE-ACS. In this high
risk population only 22.2% received a GPI; 8.9% upstream and 13.4% during
PCI. The strategy of the individual institution had a major impact on the
usage of GPI. In the multiple regression analysis clinical instability and
complex lesion characteristics were strong independent determinants for
the use of GPI, whereas renal insufficiency was negatively associated with
its use. After adjustment for confounding variables no significant
differences in hospital mortality could be observed between the cohorts,
but a significantly higher rate of non-fatal postprocedural myocardial
infarction was observed among patients receiving GPI upstream. Conclusions
Despite the recommendation for its use in the current ESC guidelines, only
a minority of the diabetics in Europe undergoing PCI for NSTE-ACS received
a GPI. The use of GPI was mainly triggered by high-risk interventional
scenarios. The Author(s) 2010.

<3>
Accession Number
2011688242
Authors
Bolognese L. Falsini G. Schwenke C. Grotti S. Limbruno U. Liistro F.
Carrera A. Angioli P. Picchi A. Ducci K. Pierli C.
Institution
(Bolognese, Falsini, Grotti, Liistro, Angioli, Ducci) Department of
Cardiovascular Diseases, San Donato Hospital, Arezzo, Italy
(Schwenke) Sco:ssis Statistical Consulting, Berlin, Germany
(Limbruno, Picchi) Department of Cardiology, Misericordia Hospital,
Grosseto, Italy
(Carrera, Pierli) Cardiovascular Department, University Hospital of Siena,
Siena, Italy
Title
Impact of iso-osmolar versus low-osmolar contrast agents on
contrast-induced nephropathy and tissue reperfusion in unselected patients
with ST-segment elevation myocardial infarction undergoing primary
percutaneous coronary intervention (from the Contrast Media and
Nephrotoxicity Following primary Angioplasty for Acute Myocardial
Infarction [CONTRAST-AMI] trial).
Source
American Journal of Cardiology. 109 (1) (pp 67-74), 2012. Date of
Publication: 01 Jan 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Conflicting data have been reported on the effects of low-osmolar and
iso-osmolar contrast media on contrast-induced acute kidney injury
(CI-AKI). In particular, no clinical trial has yet focused on the effect
of contemporary contrast media on CI-AKI, epicardial flow, and
microcirculatory function in patients with ST-segment elevation acute
myocardial infarction who undergo primary percutaneous coronary
intervention. The Contrast Media and Nephrotoxicity Following Coronary
Revascularization by Angioplasty for Acute Myocardial Infarction
(CONTRAST-AMI) trial is a prospective, randomized, single-blind,
parallel-group, noninferiority study aiming to evaluate the effects of the
low-osmolar contrast medium iopromide compared to the iso-osmolar agent
iodixanol on CI-AKI and tissue-level perfusion in patients with ST-segment
elevation acute myocardial infarction. Four hundred seventy-five
consecutive, unselected patients who underwent primary percutaneous
coronary intervention were randomized to iopromide (n = 239) or iodixanol
(n = 236). All patients received high-dose N-acetylcysteine and hydration.
The primary end point was the proportion of patients with serum creatinine
(sCr) increases <25% from baseline to 72 hours. Secondary end points were
Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade,
increase in sCr <50%, increase in sCr <0.5 or <1 mg/dl, and 1-month major
adverse cardiac events. The primary end point occurred in 10% of the
iopromide group and in 13% of the iodixanol group (95% confidence interval
-9% to 3%, p for noninferiority = 0.0002). A TIMI myocardial perfusion
grade of 0 or 1 was present in 14% of patients in the 2 groups. No
differences between the 2 groups were found in any of the secondary
analyses of sCr increase. No significant difference in 1-month major
adverse cardiac events was found (8% vs 6%, p = 0.37). In conclusion, in a
population of unselected patients with ST-segment elevation acute
myocardial infarction who underwent primary percutaneous coronary
intervention, iopromide was not inferior to iodixanol in the occurrence of
CI-AKI; no significant differences were found in terms of tissue-level
reperfusion and major adverse cardiac events between the 2 contrast
agents. 2012 Elsevier Inc. All rights reserved.

<4>
Accession Number
2011688311
Authors
Schimmer C. Ozkur M. Sinha B. Hain J. Gorski A. Hager B. Leyh R.
Institution
(Schimmer, Ozkur, Gorski, Hager, Leyh) Department for Thoracic, Cardiac
and Thoracic Vascular Surgery, University Hospital of Wurzburg,
Oberdurrbacherstrase 6, 97080 Wurzburg, Germany
(Sinha) Institute of Hygiene and Microbiology, University of Wurzburg,
Germany
(Hain) Department of Mathematics VIII (Statistics), Institute of Medicine,
University of Wurzburg, Germany
Title
Gentamicin-collagen sponge reduces sternal wound complications after heart
surgery: A controlled, prospectively randomized, double-blind study.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (1) (pp 194-200),
2012. Date of Publication: January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Prophylactic retrosternal placement of a gentamicin-collagen
sponge has been the subject of several recent clinical studies and is a
matter of controversy. The present study is the first controlled,
prospective, randomized, double-blind, single-center study to investigate
the efficacy of a retrosternal gentamicin-collagen sponge in reducing
sternal wound complications after heart surgery. Methods: From June 2009
to June 2010, 720 consecutive patients who underwent median sternotomy
were assigned to a control placebo group (collagen sponge) or an
intervention group (gentamicin-collagen sponge). All patients received
guideline-compliant perioperative antibiotic prophylaxis. The primary end
point was the occurrence of deep sternal wound infections within 30 days
of index surgery (follow-up period). Secondary end points were the
occurrence of superficial sternal wound infections requiring treatment, as
well as further clinical parameters, including revision, bleeding volume,
and need for transfusions during the follow-up period. Results: A total of
720 of 994 patients (72.4%) were enrolled (control group: n = 367 vs
intervention group: n = 353). Risk factors for sternal wound infection and
demographic variables were comparable in the 2 groups. The incidence of
deep sternal wound infections was 13 of 367 (3.52%) in the control group
versus 2 of 353 (0.56%) in the intervention group (P = .014; adjusted odds
ratio, 0.15; 95% confidence interval, 0.02-0.69). The numbers needed to
treat relation for all sternal wound infections and deep sternal wound
infections were 26 and 33, respectively. No statistically significant
differences were demonstrated concerning secondary end points, such as
postoperative bleeding and transfusion of red cell units, thrombocytes,
and fresh-frozen plasma. Conclusions: Routine prophylactic retrosternal
use of a gentamicin-collagen sponge in patients undergoing cardiac surgery
significantly reduces deep sternal wound infections. 2012 by The American
Association for Thoracic Surgery.

<5>
Accession Number
2011688337
Authors
Pompeo E. Rogliani P. Tacconi F. Dauri M. Saltini C. Novelli G. Mineo T.C.
Institution
(Pompeo, Tacconi, Mineo) Department of Thoracic Surgery, Policlinico Tor
Vergata University, Rome, Italy
(Rogliani, Saltini) Department of Pneumology, Policlinico Tor Vergata
University, Rome, Italy
(Dauri) Department of Anesthesiology and Intensive Care, Policlinico Tor
Vergata University, Rome, Italy
(Novelli) Department of Biopathology and Diagnostic Imaging, Policlinico
Tor Vergata University, Rome, Italy
Title
Randomized comparison of awake nonresectional versus nonawake resectional
lung volume reduction surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (1) (pp 47-54), 2012.
Date of Publication: January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The study objective was to assess in a randomized controlled
study (NCT00566839) the comparative results of awake nonresectional or
nonawake resectional lung volume reduction surgery. Method: Sixty-three
patients were randomly assigned by computer to receive unilateral
video-assisted thoracic surgery lung volume reduction surgery by a
nonresectional technique performed through epidural anesthesia in 32 awake
patients (awake group) or the standard resectional technique performed
through general anesthesia in 31 patients (control group). Primary
outcomes were hospital stay and changes in forced expiratory volume in 1
second. During follow-up, the need of contralateral treatment because of
loss of postoperative benefit was considered a failure event as death.
Results: Intergroup comparisons (awake vs control) showed no difference in
gender, age, and body mass index. Hospital stay was shorter in the awake
group (6 vs 7.5 days, P = .04) with 21 versus 10 patients discharged
within 6 days (P = .01). At 6 months, forced expiratory volume in 1 second
improved significantly in both study groups (0.28 vs 0.29 L) with no
intergroup difference (P = .79). In both groups, forced expiratory volume
in 1 second improvements lasted more than 24 months. At 36 months, freedom
from contralateral treatment was 55% versus 50% (P = .5) and survival was
81% versus 87% (P = .5). Conclusions: In this randomized study, awake
nonresectional lung volume reduction surgery resulted in significantly
shorter hospital stay than the nonawake procedure. There were no
differences between study groups in physiologic improvements, freedom from
contralateral treatment, and survival. We speculate that compared with the
nonawake procedure, awake lung volume reduction surgery can offer similar
clinical benefit but a faster postoperative recovery. 2012 by The
American Association for Thoracic Surgery.

<6>
Accession Number
2011688312
Authors
Kim A.W. Boffa D.J. Wang Z. Detterbeck F.C.
Institution
(Kim, Boffa, Detterbeck) Section of Thoracic Surgery, Yale University,
School of Medicine, 330 Cedar St, BB 205, New Haven, CT 06520, United
States
(Wang) Department of Epidemiology and Public Health, School of Public
Health, Yale University, New Haven, CT, United States
Title
An analysis, systematic review, and meta-analysis of the perioperative
mortality after neoadjuvant therapy and pneumonectomy for non-small cell
lung cancer.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (1) (pp 55-63), 2012.
Date of Publication: January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Pneumonectomy after neoadjuvant therapy remains controversial.
Methods: A systematic PubMed search was performed for original articles
from 1990 through 2010 describing pneumonectomy after neoadjuvant therapy.
Specific data on 30-day and 90-day perioperative mortalities were
abstracted from these articles. Meta-analysis compared 30-day mortality
between right and left pneumonectomy with a fixed-effects model.
Comparison between 30-day and 90-day mortalities was also performed.
Results: The search strategy yielded 27 studies. Overall, 30-day and
90-day perioperative mortalities were 7% and 12%, respectively. Among 15
studies providing side-specific 30-day mortality, cumulative mortalities
were 11% and 5% for right and left pneumonectomies, respectively. In the
meta-analysis that included 10 studies, 30-day mortality for right
pneumonectomy remained greater than for left pneumonectomy (odds ratio,
1.97; 95% confidence interval, 1.11-3.49; P = .02). Among 6 studies
providing side-specific 90-day mortality, cumulative mortalities were 20%
and 9% for right and left pneumonectomies, respectively. In the
meta-analysis that included 4 studies, 90-day mortality for right
pneumonectomy was greater than for left pneumonectomy (odds ratio, 2.01;
95% confidence interval, 1.09-3.72; P = .03). Among 11 studies providing
both 30-day and 90-day mortalities, mortality difference was 5% (95%
confidence interval, 4%-7%, P < .0001). Pulmonary complications were the
most common cause of 30-day and 90-day deaths. Conclusions: Right
pneumonectomy is associated with significantly higher 30-day and 90-day
mortalities after neoadjuvant therapy than left pneumonectomy. Also,
90-day mortality for all pneumonectomies appears to be greater than
expected, suggesting that the 30-day mortality figure may inadequately
assess the perioperative mortality. 2012 by The American Association for
Thoracic Surgery.

<7>
Accession Number
2011687376
Authors
Kottenberg E. Thielmann M. Bergmann L. Heine T. Jakob H. Heusch G. Peters
J.
Institution
(Kottenberg, Bergmann, Heine, Peters) Klinik fur Anasthesiologie und
Intensivmedizin, Universitat Duisburg-Essen, Universitatsklinikum Essen,
Hufelandstr. 55, D-4511 Essen, Germany
(Thielmann, Jakob) Klinik fur Thorax- und Kardiovaskulare Chirurgie,
Universitat Duisburg-Essen, Universitatsklinikum Essen, Essen, Germany
(Heusch) Institut fur Pathophysiologie, Universitat Duisburg-Essen,
Universitatsklinikum Essen, Essen, Germany
Title
Protection by remote ischemic preconditioning during coronary artery
bypass graft surgery with isoflurane but not propofol - A clinical trial.
Source
Acta Anaesthesiologica Scandinavica. 56 (1) (pp 30-38), 2012. Date of
Publication: January 2012.
Publisher
Blackwell Munksgaard (1 Rosenorns Alle, P.O. Box 227, Copenhagen V
DK-1502, Denmark)
Abstract
Background Remote ischemic preconditioning (RIPC) of the myocardium by
limb ischemia/reperfusion may mitigate cardiac damage, but its interaction
with the anesthetic regimen is unknown. We tested whether RIPC is
associated with differential effects depending on background anesthesia.
Specifically, we hypothesized that RIPC during isoflurane anesthesia
attenuates myocardial injury in patients undergoing coronary artery bypass
graft (CABG) surgery, and that effects may be different during propofol
anesthesia. Methods In a randomized, single-blinded, placebo-controlled
prospective study, serum troponin I concentration (cTnI) (baseline, and 1,
6, 12, 24, 48, and 72 h postoperatively) were measured during
isoflurane/sufentanil or propofol/sufentanil anesthesia with or without
RIPC (three 5-min periods of intermittent left upper arm ischemia with 5
min reperfusion each) in non-diabetic patients (n = 72) with three-vessel
coronary artery disease (NCT01406678). Results RIPC during isoflurane
anesthesia (n = 20) decreased the area under the cTnI time curve (cTnI
AUC) (-50%, 190 +/- 105 ng/ml x 72 h vs. 383 +/- 262 ng/ml x 72 h, P =
0.004), and the peak (7.3 +/- 3.6 ng/ml vs. 11.8 +/- 5.5, P = 0.004) and
serial (P < 0.041) postoperative cTnI when compared to isoflurane alone (n
= 19). In contrast, RIPC during propofol anesthesia (n = 14) did not alter
the cTnI AUC [263 +/- 157 ng/ml x 72 h vs. 372 +/- 376 ng/ml x 72 h (n =
19), P = 0.318] or peak postoperative cTnI (10.1 +/- 4.5 ng/ml vs. 12 +/-
8.2, P = 0.444). None of the patients experienced harm or side effects
from the intermittent left arm ischemia. Conclusion Thus, RIPC during
isoflurane but not during propofol anesthesia decreased myocardial damage
in patients undergoing CABG surgery. Accordingly, effects of RIPC evoked
by upper limb ischemia/reperfusion depend on background anesthesia, with
combined RIPC/isoflurane exerting greater beneficial effects under
conditions studied. 2011 The Authors Acta Anaesthesiologica Scandinavica.

<8>
Accession Number
2011687478
Authors
Diercks D.B. Peacock IV W.F. Hollander J.E. Singer A.J. Birkhahn R.
Shapiro N. Glynn T. Nowack R. Safdar B. Miller C.D. Lewandrowski E.
Nagurney J.T.
Institution
(Diercks) University of California, Davis, Sacramento, CA, United States
(Peacock IV) Cleveland Clinic, Cleveland, OH, United States
(Hollander) University of Pennsylvania, Philadelphia, PA, United States
(Singer) Stony Brook University and Medical Center, Stony Brook, NY,
United States
(Birkhahn) New York Methodist Hospital, Brooklyn, NY, United States
(Shapiro) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Glynn) Ingham Regional Medical Center, Lansing, MT, United States
(Diercks, Peacock IV, Hollander, Singer, Birkhahn, Shapiro, Glynn, Nowack,
Safdar, Miller, Lewandrowski, Nagurney) Henry Ford Medical Center,
Detroit, MI, United States
(Nowack, Safdar) Yale University, New Haven, CT, United States
(Miller) Wake Forest University Health Sciences, Winston-Salem, NC, United
States
(Lewandrowski, Nagurney) Massachusetts General Hospital, Boston, MA,
United States
Title
Diagnostic accuracy of a point-of-care troponin i assay for acute
myocardial infarction within 3 hours after presentation in early
presenters to the emergency department with chest pain.
Source
American Heart Journal. 163 (1) (pp 74-80.e4), 2012. Date of
Publication: January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Guidelines recommend that serial cardiac marker testing to
rule out acute myocardial infarction (AMI) be performed for 8 to 12 hours
after symptom onset. We aim to determine the diagnostic accuracy of a
contemporary point-of-care (POC) troponin I (TnI) assay within 3 hours for
patients presenting within 8 hours of symptom onset. Methods: The MIDAS
study collected blood from patients presenting with suspected acute
coronary syndrome at presentation and at 90 minutes, 3 hours, and 6 hours
in whom the emergency physician planned an objective cardiac ischemia
evaluation. Criterion standard diagnoses were adjudicated by experienced
clinicians using all available medical records per American Heart
Association/American College of Cardiology criteria. Reviewers were
blinded to the investigational marker, Cardio3 TnI POC. The Cardio3 TnI
reference value was defined as >0.05 ng/mL. Measures of diagnostic
accuracy are presented with 95% CI. Results: A total of 858 of 1107
patients met the inclusion criteria. The study cohort had 476 men (55.5%)
with median age of 57.0 years (interquartile range 48.0-67.0 years).
Median time from symptom onset to initial blood draw was 3.9 hours
(interquartile range 2.7-5.2 hours). Acute myocardial infarction was
diagnosed in 82 patients (9.6%). The sensitivity, specificity, positive
likelihood ratio, and negative likelihood ratio over 3 hours were 84.1,
93.4, 12.8, and 0.17, respectively. There was no significant improvement
in diagnostic accuracy associated with adding 6-hour serial testing to the
3-hour sample. Conclusion: In suspected patients with acute coronary
syndrome presenting to the emergency department within 8 hours of symptom
onset, 3 hours of serial testing with the Cardio3 TnI POC platform
provides similar diagnostic accuracy for AMI as longer periods. 2012
Mosby, Inc. All rights reserved.

<9>
Accession Number
2011687477
Authors
Lamy A. Devereaux P.J. Prabhakaran D. Hu S. Piegas L.S. Straka Z. Paolasso
E. Taggart D. Lanas F. Akar A.R. Jain A. Noiseux N. Ou Y. Chrolavicius S.
Ng J. Yusuf S.
Institution
(Lamy, Devereaux, Yusuf) Population Health Research Institute, Hamilton
Health Sciences, McMaster University, Hamilton, Canada
(Prabhakaran) National Coordination Office, Center for Chronic Disease
Control and COE CARRS, Public Health Foundation of India, New Delhi, India
(Hu) Fuwai Hospital, Beijing, China
(Piegas) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Straka) Third Faculty of Medicine, Charles University, Prague, Czech
Republic
(Paolasso) Instituto de Investigaciones Clinicas de Rosario (IICR),
Rosario, Argentina
(Taggart) University of Oxford, Oxford, United Kingdom
(Lanas) Universidad de la Frontera, Temuco, Chile
(Akar) Ankara University School of Medicine, Ankara University Stem Cell
Institute, Ankara, Turkey
(Jain) SAL Hospital and Medical Institute, Ahmedabad, India
(Noiseux) Centre Hospitalier Universitaire de Montreal (CHUM), Montreal,
Canada
(Ou, Chrolavicius, Ng) Population Health Research Institute, Hamilton,
Canada
Title
Rationale and design of the coronary artery bypass grafting surgery off or
on pump revascularization study: A large international randomized trial in
cardiac surgery.
Source
American Heart Journal. 163 (1) (pp 1-6), 2012. Date of Publication:
January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Uncertainty remains regarding the benefits and risks of the
technique of operating on a beating heart (off pump) for coronary artery
bypass grafting (CABG) surgery versus on-pump CABG. Prior trials had few
events and relatively short follow-up. There is a need for a large
randomized, controlled trial with long-term follow-up to inform both the
short- and long-term impact of the 2 approaches to CABG. Methods: We plan
to randomize 4,700 patients in whom CABG is planned to undergo the
procedure on pump or off pump. The coprimary outcomes are a composite of
total mortality, myocardial infarction (MI), stroke, and renal failure at
30 days and a composite of total mortality, MI, stroke, renal failure, and
repeat revascularization at 5 years. We will also undertake a
cost-effectiveness analysis at 30 days and 5 years after CABG surgery.
Other outcomes include neurocognitive dysfunction, recurrence of angina,
cardiovascular mortality, blood transfusions, and quality of life.
Results: As of May 3, 2011, CORONARY has recruited >3,884 patients from 79
centers in 19 countries. Currently, patient's mean age is 67.6 years,
80.7% are men, 47.0% have a history of diabetes, 51.4% have a history of
smoking, and 34.4% had a previous MI. In addition, 20.9% of patients have
a left main disease, and 96.6% have double or triple vessel disease.
Conclusions: CORONARY is the largest trial yet conducted comparing
off-pump CABG to on-pump CABG. Its results will lead to a better
understanding of the safety and efficacy of off-pump CABG. 2012 Mosby,
Inc. All rights reserved.

<10>
Accession Number
2011687473
Authors
Lamas G.A. Goertz C. Boineau R. Mark D.B. Rozema T. Nahin R.L. Drisko J.A.
Lee K.L.
Institution
(Lamas) Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL
33140, United States
(Goertz) Palmer Center for Chiropractic Research, Davenport, IA, United
States
(Boineau) National Heart, Lung, and Blood Institute, Bethesda, MD, United
States
(Mark, Lee) Duke Clinical Research Institute, Durham, NC, United States
(Rozema) Biogenesis Medical Center, Landrum, SC, United States
(Nahin) National Center for Complementary and Alternative Medicine,
Bethesda, MD, United States
(Drisko) Integrative Medicine, University of Kansas Medical Center, Kansas
City, KS, United States
Title
Design of the Trial to Assess Chelation Therapy (TACT).
Source
American Heart Journal. 163 (1) (pp 7-12), 2012. Date of Publication:
January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
TACT is an National Institutes of Health-sponsored, randomized,
double-blind, placebo-controlled, 2 x 2 factorial clinical trial testing
the benefits and risks of 40 infusions of a multicomponent disodium EDTA
chelation solution compared with placebo and of an oral, high-dose
multivitamin and mineral supplement. TACT has randomized and will follow
up 1,708 patients for an average of approximately 4 years. The primary end
point is a composite of all-cause mortality, myocardial infarction,
stroke, coronary revascularization, and hospitalization for angina. A
900-patient substudy will examine quality-of-life outcomes. The trial is
designed to have >85% power to detect a 25% relative reduction in the
primary end point for each treatment factor. Enrollment began in September
2003 and was completed in October 2010. 2012 Mosby, Inc. All rights
reserved.

<11>
Accession Number
2011687355
Authors
Carvalho A.R. Ichinose F. Schettino I.A. Hess D. Rojas J. Giannella-Neto
A. Agnihotri A. Walker J. MacGillivray T.E. Vidal Melo M.F.
Institution
(Carvalho) Laboratory of Respiration Physiology, Carlos Chagas Filho
Institute of Biophysics, Rio de Janeiro, Brazil
(Ichinose, Schettino, Hess, Rojas, Vidal Melo) Department of Anesthesia,
Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard
Medical School, 55 Fruit St, Boston, MA 02114, United States
(Agnihotri, Walker, MacGillivray) Department of Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
(Giannella-Neto) Biomedical Engineering Program, Federal University of Rio
de Janeiro, Rio de Janeiro, Brazil
Title
Tidal lung recruitment and exhaled nitric oxide during coronary artery
bypass grafting in patients with and without chronic obstructive pulmonary
disease.
Source
Lung. 189 (6) (pp 499-509), 2011. Date of Publication: December 2011.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Background: We studied the occurrence of intraoperative tidal alveolar
recruitment/derecruitment, exhaled nitric oxide (eNO), and lung
dysfunction in patients with and without chronic obstructive pulmonary
disease (COPD) undergoing coronary artery bypass grafting (CABG). Methods:
We performed a prospective observational physiological study at a
university hospital. Respiratory mechanics, shunt, and eNO were assessed
in moderate COPD patients undergoing on-pump (n = 12) and off-pump (n = 8)
CABG and on-pump controls (n = 8) before sternotomy (baseline), after
sternotomy and before cardiopulmonary bypass (CPB), and following CPB
before and after chest closure. Respiratory system resistance (R
rs), elastance (E rs), and stress index (to quantify
tidal recruitment) were estimated using regression analysis. eNO was
measured with chemiluminescence. Results: Mechanical evidence of tidal
recruitment/derecruitment (stress index <1.0) was observed in all
patients, with stress index <0.8 in 29% of measurements. Rrs in on-pump
COPD was larger than in controls (p < 0.05). Ers increased in controls
from baseline to end of surgery (19.4 +/- 5.5 to 27.0 +/- 8.5 ml cm
H2O -1, p < 0.01), associated with increased shunt
(p < 0.05). Neither Ers nor shunt increased significantly in the COPD
on-pump group. eNO was comparable in the control (11.7 +/- 7.0 ppb) and
COPD on-pump (9.9 +/- 6.8 ppb) groups at baseline, and decreased similarly
by 29% at end of surgery(p < 0.05). Changes in eNO were not correlated to
changes in lung function. Conclusions: Tidal recruitment/derecruitment
occurs frequently during CABG and represents a risk for
ventilator-associated lung injury. eNO changes are consistent with small
airway injury, including that from tidal recruitment injury. However,
those changes are not correlated with respiratory dysfunction. Controls
have higher susceptibility to develop complete lung derecruitment. 2011
Springer Science+Business Media, LLC.

<12>
Accession Number
2011692441
Authors
Cho Y.-R. Kim Y.-D. Park T.-H. Park K. Baek H. Choi S.-Y. Kim K.-S. Hong
T.-J. Yang T.-H. Hwang J.-Y. Park J.-S. Hur S.-H. Lee S.-G.
Institution
(Cho, Kim, Park, Park, Park, Baek) Department of Internal Medicine, Dong-A
University College of Medicine, Busan, South Korea
(Cho, Kim, Park, Park, Park, Baek, Choi) Department of Cardiovascular
Center, Dong-A University Hospital, Busan, South Korea
(Kim) Department of Internal Medicine, Daegu Catholic University College
of Medicine, Daegu, South Korea
(Hong) Department of Internal Medicine, Pusan National University College
of Medicine, Busan, South Korea
(Yang) Department of Internal Medicine, Inje University College of
Medicine, Pusan Paik Hospital, Busan, South Korea
(Hwang) Department of Internal Medicine, Gyeongsang National University
College of Medicine, Jinju, South Korea
(Park) Department of Internal Medicine, Yeungnam University College of
Medicine, Daegu, South Korea
(Hur) Department of Internal Medicine, Keimyung University College of
Medicine, Deagu, South Korea
(Lee) Department of Internal Medicine, Ulsan University College of
Medicine, Ulsan, South Korea
Title
The impact of dose of the angiotensin-receptor blocker valsartan on the
post-myocardial infarction ventricular remodeling: Study protocol for a
randomized controlled trial.
Source
Trials. 12 , 2011. Article Number: 247. Date of Publication: 22 Nov
2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Angiotensin-converting enzyme inhibitors and the
angiotensin-receptor blocker valsartan ameliorate ventricular remodeling
after myocardial infarction (MI). Based on previous clinical trials, a
maximum clinical dose is recommended in practical guidelines. Yet, has not
been clearly demonstrated whether the recommended dose is more efficacious
compared to the lower dose that is commonly used in clinical
practice.Method/Design: Valsartan in post-MI remodeling (VALID) is a
randomized, open-label, single-blinded multicenter study designed to
compare the efficacy of different clinical dose of valsartan on the
post-MI ventricular remodeling. This study also aims to assess
neurohormone change and clinical parameters of patients during the
post-infarct period. A total of 1116 patients with left ventricular
dysfunction following the first episode of acute ST-elevation MI are to be
enrolled and randomized to a maximal tolerable dose (up to 320 mg/day) or
usual dose (80 mg/day) of valsartan for 12 months in 2:1 ratio.
Echocardiographic analysis for quantifying post-MI ventricular remodeling
is to be conducted in central core laboratory. Clinical assessment and
laboratory test are performed at fixed times.Discussion: VALID is a
multicenter collaborative study to evaluate the impact of dose of
valsartan on the post-MI ventricular remodeling. The results of the study
provide information about optimal dosing of the drug in the management of
patients after MI. The results will be available by 2012.Trial
registration: NCT01340326. 2011 Cho et al; licensee BioMed Central Ltd.

<13>
Accession Number
2011697676
Authors
Girasis C. Garg S. Rber L. Sarno G. Morel M.-A. Garcia-Garcia H.M. Lscher
T.F. Serruys P.W. Windecker S.
Institution
(Girasis, Garg, Rber, Sarno, Serruys) Department of Interventional
Cardiology Thoraxcenter, Erasmus Medical Center, Ba-583, 's Gravendijkwal
230, 3015, Rotterdam, Netherlands
(Rber, Windecker) Department of Cardiology, Bern University Hospital,
Bern, Switzerland
(Morel, Garcia-Garcia) Cardialysis B.V., Rotterdam, Netherlands
(Lscher) Department of Cardiology, Zurich University Hospital, Zurich,
Switzerland
Title
SYNTAX score and Clinical SYNTAX score as predictors of very long-term
clinical outcomes in patients undergoing percutaneous coronary
interventions: A substudy of SIRolimus-eluting stent compared with
pacliTAXel-eluting stent for coronary revascularization (SIRTAX) trial.
Source
European Heart Journal. 32 (24) (pp 3115-3127), 2011. Date of
Publication: December 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims To investigate the ability of SYNTAX score and Clinical SYNTAX score
(CSS) to predict very long-term outcomes in an all-comers population
receiving drug-eluting stents. Methods and resultsThe SYNTAX score was
retrospectively calculated in 848 patients enrolled in the
SIRolimus-eluting stent compared with pacliTAXel-Eluting Stent for
coronary revascularization (SIRTAX) trial. The CSS was calculated using
age, and baseline left ventricular ejection fraction and creatinine
clearance. A stratified post hoc comparison was performed for all-cause
mortality, cardiac death, myocardial infarction (MI), ischaemia-driven
target lesion revascularization (TLR), definite stent thrombosis, and
major adverse cardiac events (MACE) at 1- and 5-year follow-up. Tertiles
for SYNTAX score and CSS were defined as SSLOW <=7, 7< SSMID <=14, SSHIGH
>14 and CSSLOW <=8.0, 8.0 <CSSMID <=17.0 and CSSHIGH >17.0, respectively.
Major adverse cardiac events rates were significantly higher in SSHIGH
compared with SSLOW at 1- and 5-year follow-up, which was also seen at 5
years for all-cause mortality, cardiac death, MI, and TLR. Stratifying
outcomes across CSS tertiles confirmed and augmented these results. Within
CSSHIGH, 5-year MACE increased with use of paclitaxel- compared with
sirolimus-eluting stents (34.7 vs. 21.3, P 0.008). SYNTAX score and CSS
were independent predictors of 5-year MACE; CSS was an independent
predictor for 5-year mortality. Areas-under-the-curve for SYNTAX score and
CSS for 5-year MACE were 0.61 (0.560.65) and 0.62 (0.570.67), for 5-year
all-cause mortality 0.58 (0.510.65) and 0.66 (0.590.73) and for 5-year
cardiac death 0.63 (0.540.72) and 0.72 (0.630.81),
respectively.ConclusionSYNTAX score and to a greater extent CSS were able
to stratify risk for very long-term adverse clinical outcomes in an
all-comers population receiving drug-eluting stents. Predictive accuracy
for 5-year all-cause mortality was improved using CSS.Trial Registration
Number: NCT00297661. Published on behalf of the European Society of
Cardiology. The Author 2011.

<14>
[Use Link to view the full text]
Accession Number
2011688137
Authors
Gersh B.J. Maron B.J. Bonow R.O. Dearani J.A. Fifer M.A. Link M.S. Naidu
S.S. Nishimura R.A. Ommen S.R. Rakowski H. Seidman C.E. Towbin J.A.
Udelson J.E. Yancy C.W.
Title
2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic
cardiomyopathy: Executive summary: A report of the American College of
cardiology foundation/American heart association task force on practice
guidelines.
Source
Circulation. 124 (24) (pp 2761-2796), 2011. Date of Publication: 13 Dec
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)

<15>
Accession Number
2011691094
Authors
Singh M. Holmes Jr. D.R. Dehmer G.J. Lennon R.J. Wharton T.P. Kutcher M.A.
Aversano T. Rihal C.S.
Institution
(Singh, Holmes Jr., Rihal) Division of Cardiovascular Diseases, Mayo
Clinic, 200 First St SW, Rochester, MN 55905, United States
(Lennon) Division of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MN, United States
(Dehmer) Division of Cardiology, Scott and White Healthcare, Temple, TX,
United States
(Wharton) Cardiovascular Medicine, Exeter Hospital, Exeter, NH, United
States
(Kutcher) Department of Cardiology, Wake Forest University Baptist Medical
Center, Winston-Salem, NC, United States
(Aversano) Department of Cardiology, Johns Hopkins Hospital, Baltimore,
MD, United States
Title
Percutaneous coronary intervention at centers with and without on-site
surgery: A meta-analysis.
Source
JAMA - Journal of the American Medical Association. 306 (22) (pp
2487-2494), 2011. Date of Publication: 14 Dec 2011.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Percutaneous coronary interventions are performed at centers
without onsite surgery, despite current guidelines discouraging this.
Objective: To assess literature comparing rates of in-hospital mortality
and emergency coronary artery bypass grafting surgery at centers with and
without on-site surgery. Data Sources: A systematic search of studies
published between January 1990 and May 2010 was conducted using MEDLINE,
EMBASE, and Cochrane Review databases. Study Selection: English-language
studies of percutaneous coronary intervention performed at centers with
and without on-site surgery providing data on in-hospital mortality and
emergency bypass were identified. Two study authors independently reviewed
the 1029 articles originally identified and selected 40 for analysis. Data
Extraction: Study title, time period, indication for angioplasty, and
outcomes were extracted manually from all selected studies, and quality of
each study was assessed using the strengthening the reporting of
observational studies in epidemiology (STROBE) checklist. Data Synthesis:
High-quality studies of percutaneous coronary interventions performed at
centers with and without on-site surgery were included. Pooled-effect
estimates were calculated with random-effects models. Analyses of primary
percutaneous coronary intervention for ST-segment elevation myocardial
infarction of 124 074 patients demonstrated no increase in in-hospital
mortality (no on-site surgery vs on-site surgery: observed risk, 4.6% vs
7.2%; odds ratio [OR], 0.96; 95% CI, 0.88-1.05; I2 = 0%) or
emergency bypass (observed risk, 0.22% vs 1.03%; OR, 0.53; 95% CI,
0.35-0.79; I2 = 20%) at centers without on-site surgery. For
nonprimary percutaneous coronary interventions (elective and urgent, n =
914 288), the rates of in-hospital mortality (observed risk, 1.4% vs 2.1%;
OR, 1.15; 95% CI, 0.93-1.41; I2 = 46%) and emergency bypass
(observed risk, 0.17% vs 0.29%; OR, 1.21; 95% CI, 0.52-2.85; I
2 = 5%) were not significantly different at centers without or
with on-site surgery. Conclusion: Percutaneous coronary interventions
performed at centers without onsite surgery, compared with centers with
on-site surgery, were not associated with a higher incidence of
in-hospital mortality or emergency bypass surgery. 2011 American Medical
Association. All rights reserved.

<16>
Accession Number
2011679035
Authors
Drover D.R. Schmiesing C. Buchin A.F. Ortega H.R. Tanner J.W. Atkins J.H.
MacArio A.
Institution
(Drover, Schmiesing, Buchin, MacArio) Department of Anesthesia, Stanford
University, 300 Pasteur Drive, Stanford, CA 94305-5640, United States
(Ortega) ICAD Inc., Nashua, NH, United States
(Tanner, Atkins) University of Pennsylvania School of Medicine,
Philadelphia, PA, United States
Title
Titration of sevoflurane in elderly patients: Blinded, randomized clinical
trial, in non-cardiac surgery after beta-adrenergic blockade.
Source
Journal of Clinical Monitoring and Computing. 25 (3) (pp 175-181), 2011.
Date of Publication: June 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Background. Monitoring depth of anesthesia via the processed
electroencephalogram (EEG) has been found useful in reducing the amount of
anesthetic drugs, optimizing wake-up times, and, in some studies, reducing
awareness. Our goal was to determine if titrating sevoflurane as the
maintenance anesthetic to a depth of anesthesia monitor (SEDLine, Masimo,
CA) would shorten time to extubation in elderly patients undergoing
noncardiac surgery while on beta-adrenergic blockade. This patient
population was selected because the usual cardiovascular signs of
inadequate general anesthesia may be masked by beta-blocker therapy.
Methods. Surgical patients older than 65 years of age receiving
beta-adrenergic blockers for a minimum of 24 h preoperatively were
randomized to two groups: a group whose titration of sevoflurane was based
on SEDLine data (SEDLine group) and a group whose titration was based on
usual clinical criteria (control group) where SEDLine data were concealed.
The primary endpoint was time from skin closure to time to extubation.
Aldrete score, White Fast Track score and QoR-40 were also assessed.
Results. There was no significant difference in time to extubation [12.5
(SD 7.4) min in the control group versus 13.0 (SD 5.9) min for the
treatment group]. The control group used more fentanyl [339 mcg (SD 205)]
than did the treatment group [238 mcg (SD 123)] (P<0.02). There was no
difference in sevoflurane utilization, Aldrete, White Fast Track scores,
time toPACUdischarge, or QoR-40 assessments between the groups.
Conclusion. Use of the SEDLine monitor's data to titrate sevoflurane did
not improve the time to extubation or change short-term outcome of
geriatric surgical patients receiving beta-adrenergic blockers.
(ClinicalTrials.gov number, NCT00938782). Springer 2011.

<17>
Accession Number
2011693890
Authors
Matsuo S. Yamane T. Date T. Hioki M. Narui R. Ito K. Tanigawa S.-I. Nakane
T. Yamashita S. Tokuda M. Inada K. Nojiri A. Kawai M. Sugimoto K.-I.
Yoshimura M.
Institution
(Matsuo, Yamane, Date, Hioki, Narui, Ito, Tanigawa, Nakane, Yamashita,
Tokuda, Inada, Nojiri, Kawai, Sugimoto, Yoshimura) Department of
Cardiology, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi,
Minato-ku, Tokyo 105-8461, Japan
Title
Completion of mitral isthmus ablation using a steerable sheath:
Prospective randomized comparison with a nonsteerable sheath.
Source
Journal of Cardiovascular Electrophysiology. 22 (12) (pp 1331-1338),
2011. Date of Publication: December 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Although mitral isthmus (MI) ablation in atrial fibrillation
(AF) patients has been shown to be an effective ablative strategy, the
establishment of the bidirectional conduction block of the MI is
technically challenging. We investigated the usefulness of a steerable
sheath for MI ablation in patients with persistent AF and its impact on
the clinical outcome of persistent AF ablation. Methods: A total of 80
consecutive patients undergoing MI ablation were randomized to 1 of the
following 2 groups: group S (using a steerable long sheath) or group NS
(using a nonsteerable long sheath). MI ablation was performed by using an
open-irrigated ablation catheter with the guidance of a 3-dimensional
mapping system. The endpoint of the MI ablation was the achievement of a
bidirectional block. Results: Bidirectional block through the MI was
achieved in 87.5% (70/80) of patients with 14.0 +/- 6.7 minutes of
radiofrequency application. The bidirectional block was more frequently
achieved in patients in group S compared to group NS (97.5% (39/40) vs
77.5% (31/40), P = 0.02). Additionally, epicardial ablation within the
coronary sinus was less frequently required in group S compared to group
NS (12.5% (5/40) vs 72.5% (29/40), P < 0.0001). Atrial tachycardia after
the procedure more frequently occurred in the patients in whom MI block
had not been achieved during the initial procedure (40.0% (4/10) vs 10.0%
(7/70), P = 0.04). Conclusions: The MI block could be achieved in the
majority of patients by using a steerable sheath. An incomplete MI block
increased the risk of AT following persistent AF ablation. 2011 Wiley
Periodicals, Inc.

<18>
Accession Number
2011682118
Authors
Gray R.M. Nagendran M. Maruthappu M.
Institution
(Gray) St. John's College, University of Oxford, St. Giles, Oxford, United
Kingdom
(Nagendran, Maruthappu) Green Templeton College, University of Oxford,
Oxford, United Kingdom
Title
Is it safe to stop anticoagulants after successful surgery for atrial
fibrillation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 642-649),
2011. Date of Publication: December 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was: is it safe to stop
anticoagulants after successful surgery for atrial fibrillation?
Altogether, 177 papers were found using the reported search, of which 14
were selected that represented the best evidence to answer the clinical
question. Selection criteria included study relevance, primary outcome,
size of study population and length of follow-up. The authors, journal,
date and country of publication, patient group studied, study type,
relevant outcomes and results of these papers are tabulated. The weight of
evidence, including over 10,000 patient-years of follow-up, supports the
discontinuation of warfarin following atrial fibrillation correction
procedures as being safe, with an associated annual thromboembolic stroke
rate of 0-3.8% off warfarin, in studies where warfarin was stopped at a
mean of 3.6 months (range 0-8 months) after the procedure. However, the
confidence of this conclusion suffers from a paucity of high-quality
randomized controlled trials in the field, with the main body of evidence
coming instead from observational non-randomized studies. The stroke rate
also varies with the exact procedure performed; pulmonary vein isolation
procedures are the most extensively evaluated and carry the lowest stroke
rate following warfarin discontinuation (0-0.4% per annum when performed
as an isolated procedure). By contrast, left atrial appendage occlusion by
insertion of a transcatheter device has an associated annual stroke rate
of 0-3.8% off warfarin. Thus, discontinuation of warfarin following such
transcatheter procedures cannot be recommended at this time. Concomitant
heart surgeries, such as mitral valve repair have been shown to increase
the thromboembolic rate both unpredictably and dramatically, and this
review thus identifies concomitant mitral valve surgery as a potentially
substantial risk factor for late thromboembolic stroke in patients
undergoing corrective surgeries for atrial fibrillation. This review finds
in favour of warfarin discontinuation in selected patients at three months
post-procedure, emphasizing consideration of the patient's individual
risk-factor profile as paramount. This recommendation is in line with the
2010 guidelines for the management of atrial fibrillation produced by the
European Society of Cardiology. 2011 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<19>
Accession Number
2011682117
Authors
Sunderland N. Nagendran M. Maruthappu M.
Institution
(Sunderland) St Hugh's College, University of Oxford, St Margaret's Road,
Oxford, OX2 6LE, United Kingdom
(Nagendran, Maruthappu) Green Templeton College, University of Oxford,
Oxford, OX2 6H6, United Kingdom
Title
In patients with an enlarged left atrium does left atrial size reduction
improve maze surgery success?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 635-641),
2011. Date of Publication: December 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was: In [adults undergoing a
maze procedure for Atrial Fibrillation (AF)], [does Left Atrial size
reduction] compared to [maze surgery alone] improve [maze surgery
success]? A total of 58 papers were found using the reported search, of
which eight represented the best evidence to answer the clinical question.
The authors, journal, date and country of publication, patient group
studied, study type, relevant outcomes and results of these papers are
tabulated. Four out of eight papers compared a volume reduction technique
as an adjunct to the maze procedure to a maze procedure alone - all four
papers reported that atrial volume reduction significantly increased
restoration of sinus rhythm: 89.3% vs. 67.2%, P<0.001; 85% vs. 68%,
P<0.05; 84% vs. 68%, P<0.05; 90% vs. 69%, P<0.05. Three out of eight
papers had no control group but reported good rates of sinus rhythm
restoration at last follow-up - 90%, 92% and 89%, respectively - despite
the study population including atrial enlargement, a risk factor for
failure of a maze procedure. One paper reported no benefit of an atrial
reduction plasty in patients with a left atrium (LA) >70mm. An enlarged LA
is a risk factor for failure of a maze procedure, and various models of AF
suggest that reducing atrial mass and/or diameter may help to abolish the
re-entry circuits underlying AF. Furthermore, AF is uncommon when left
atrial diameter is <40mm, so there is at least some physiological basis
for atrial reduction surgery in aiding the success of a maze procedure.
The evidence suggests that patients with an enlarged (>=55mm) or giant
(>=75mm) LA who are at risk of failing to obtain sinus conversion after a
standard maze procedure may derive benefit from concomitant atrial
reduction surgery using either a tissue excision or a tissue plication
technique. However, the evidence is not strong since the papers available
are not readily comparable owing to substantial variations in the
populations and procedures involved. We therefore, emphasise the need for
prospective randomised studies in this area. 2011 Published by European
Association for Cardio-Thoracic Surgery. All rights reserved.

<20>
Accession Number
2011682116
Authors
Olland A. Falcoz P.-E. Kessler R. Massard G.
Institution
(Olland, Falcoz, Kessler, Massard) Strasbourg Lung Transplantation Team,
University Hospital, Strasbourg, France
(Olland, Falcoz, Massard) Department of Thoracic Surgery, University
Hospital, Strasbourg, France
(Kessler) Department of Pneumology, University Hospital, Strasbourg,
France
Title
Should cystic fibrosis patients infected with Burkholderia cepacia complex
be listed for lung transplantation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 631-634),
2011. Date of Publication: December 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was whether lung transplantation remained a
beneficial treatment for cystic fibrosis (CF) patients infected or
colonized with Burkholderia cepacia complex (BCC) prior to lung
transplantation (LTx). Of the 25 papers found using a report search, five
presented the best evidence to answer the clinical question. The authors,
journal, date and country of publication, study type, group studied,
relevant outcomes and results of these papers are given. We conclude that,
on the whole, the five studies were clearly in favor of maintaining access
to LTx lists for BCC infected or colonized CF patients. In other words,
access to LTx should not be denied to BCC infected CF patients in that the
beneficial effects of LTx do not differ with respect to non-infected
patients: comparison showed neither a difference in survival nor a higher
mortality risk. However, results would differ for Burkholderia cenocepacia
infected CF patients prior to LTx: both short-and long-term survival are
significantly lower when B. cenocepacia infected patients are compared to
other BCC infected patients or non-infected patients. Hence, current
evidence shows that careful screening of all BCC suspected CF patients and
risk-aware multidisciplinary management should be achieved before listing
patients for LTx. This would allow identification of different bacterial
species (in particular, B. cenocepacia) present and optimize lung
transplantation survival outcomes. 2011 Published by European Association
for Cardio-Thoracic Surgery. All rights reserved.

<21>
Accession Number
2011682115
Authors
Sepehripour A.H. Jarral O.A. Shipolini A.R. McCormack D.J.
Institution
(Sepehripour) Department of Cardiothoracic Surgery, Wythenshawe Hospital,
Southmoor Road, Manchester M23 9LT, United Kingdom
(Jarral, Shipolini, McCormack) Department of Cardiothoracic Surgery, The
London Chest Hospital, Bonner Road, London E2 9JX, United Kingdom
Title
Does a 'no-touch' technique result in better vein patency?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 626-630),
2011. Date of Publication: December 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether harvesting the saphenous vein (SV) as a
conduit for coronary artery bypass grafting (CABG) using a no-touch
technique would result in better patency rates. This technique involves
the harvest of the SV with a pedicle of peri-vascular tissue left intact
and the avoidance of distension of the vein prior to anastomosis. A total
of 405 papers were found using the reported searches of which eight
represented the best evidence to answer the clinical question. The
authors, date, journal, study type, population, main outcome measures and
results are tabulated. The studies found analysed the ultrastructural and
mechanical properties of the endothelium and vessel walls of the two
harvesting techniques; the protein and enzymatic expression and activity
observed; the early atherosclerotic changes detected; and the overall
patency of the grafts during short-and long-term angiographical follow-up.
Three small prospectively randomised studies compared the patency of
grafts harvested using the two techniques and found significant
improvements in graft patency using the no-touch harvesting technique in
comparison to both the conventional technique and more importantly
comparable to the left internal thoracic artery (LITA) patency. The most
favourable difference was that of graft patency after 8.5 years of
follow-up [90% vs. 76% (P=0.01), LITA patency 90%], and incidence of graft
stenosis [11% vs. 25% (P=0.006)]. These findings were supported by the
demonstrated improvements in the cellular integrity of the vessels and the
reduction in the mechanisms leading to graft failure seen in the no-touch
harvested SV grafts. These morphological and cellular analyses were
carried by five small comparative studies, demonstrating improved
endothelial integrity and reduced injury, decelerated atherosclerotic
processes, intact adventitial collagen layers, increase in the total area
of vasa vasorum, elevated endothelial nitric oxide synthase expression and
activity, and increased peri-vascular leptin levels and activity. We
conclude that there are clear enhancements in vessel wall properties at a
cellular level and angiographical evidence of superior graft patency when
the no-touch SV harvesting technique is employed. 2011 Published by
European Association for Cardio-Thoracic Surgery. All rights reserved.

<22>
Accession Number
2011682109
Authors
Marcucci G. Siani A. Accrocca F. Gabrielli R. Giordano A. Antonelli R.
Sbroscia A. Mounayergi F.
Institution
(Marcucci, Siani, Accrocca, Gabrielli, Giordano, Antonelli) Unit of
Vascular and Endovascular Surgery, San Paolo Hospital, Civitavecchia,
Rome, Italy
(Sbroscia) Unit of Anesthesia and Intensive Care, San Paolo Hospital,
Civitavecchia, Rome, Italy
(Mounayergi) Unit of Anesthesia and Intensive Care, European Hospital,
Rome, Italy
Title
Preserved consciousness in general anesthesia during carotid
endarterectomy: A six-year experience.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 601-605),
2011. Date of Publication: December 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objectives: We prospectively evaluated safety and efficacy from our
six-year results of general anesthesia (GA) using remifentanil conscious
sedation in carotid endarterectomy (CEA). Methods: From January 2005 to
December 2010, 625 consecutive CEAs were performed on 545 patients
(male/female 336/209, age 75+/-7years). After a superficial plexus block
with ropavacaine, GA was induced with an intravenous infusion of propofol,
using local lidocaine during tracheal intubation and a high-dose of
remifentanil, in all cases reducing and then stopping the remifentanil
infusion at the clamping time so that the patient would be awake and
collaborating within a few minutes, as in local anesthesia. Data on
postoperative morbidity and mortality, neurological complications, shunt
insertions and the responses to one-day and three-month questionnaires on
satisfaction were collected for all patients. Results: The 30-day
mortality was 0.32% (two patients). Only one major stroke (0.16%) and two
minor strokes (0.32%) occurred. A shunt was deployed in 83 cases (13.3%).
Eight patients (1.28%) reported cranial nerve injuries, and surgical
drainage for postoperative hematoma was performed in 11 patients (1.8%).
Thirty-one patients (4.6%) suffered postoperative nausea/vomiting. Almost
all patients were satisfied at the 24-h (94.6%) and three-month (>98%)
follow-up questionnaire. Conclusions: The six-year results for GA using
remifentanil conscious sedation were very satisfactory and highlighted the
advantages of both GA (hemodynamic stability and excellent control of
ventilation) and local anesthesia (ease of evaluation of neurological
status) in a calm and relaxed environment for both patient and surgeon.
2011 Published by European Association for Cardio-Thoracic Surgery. All
rights reserved.

<23>
Accession Number
2011626757
Authors
Phrommintikul A. Kuanprasert S. Wongcharoen W.
Institution
(Phrommintikul) Chiang Mai University, Chiang Mai, Thailand
Title
Influenza vaccination reduced cardiovascular events in patients
hospitalized with an acute coronary syndrome.
Source
Annals of Internal Medicine. 155 (10) (pp JC5-5), 2011. Date of
Publication: 20111115.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<24>
Accession Number
2011626751
Authors
Baigent C. Landray M.J. Reith C.
Institution
(Baigent) Clinical Trial Service Unit, Epidemiological Studies Unit
(CTSU), Oxford, England, United Kingdom
Title
Simvastatin plus ezetimibe reduced major atherosclerotic events in
patients with chronic kidney disease.
Source
Annals of Internal Medicine. 155 (10) (pp JC5-2), 2011. Date of
Publication: 20111115.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<25>
Accession Number
2011680664
Authors
Duvall W.L. Croft L.B. Ginsberg E.S. Einstein A.J. Guma K.A. George T.
Henzlova M.J.
Institution
(Duvall, Croft, Guma, George, Henzlova) Mount Sinai Division of Cardiology
(Mount Sinai Heart), Columbia University Medical Center, Mount Sinai
Medical Center, Box 1030, One Gustave L Levy Place, New York, NY 10029,
United States
(Ginsberg) Mount Sinai Department of Medicine, Division of Cardiology,
Department of Medicine, United States
(Einstein) Mount Sinai Medical Center, Division of Cardiology, Department
of Medicine, New York, NY, United States
Title
Reduced isotope dose and imaging time with a high-efficiency CZT SPECT
camera.
Source
Journal of Nuclear Cardiology. 18 (5) (pp 847-857), 2011. Date of
Publication: October 2011.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Background. In light of recent focus on diagnostic imaging, cardiac SPECT
imaging needs to become a shorter test with lower radiation exposure to
patients. Recently introduced Cadmium Zinc Telluride (CZT) cameras have
the potential to achieve both goals. Methods. During a 2-month period
patients presenting for a Tc-99m sestamibi SPECT MPI study were imaged
using a CZT camera using a low-dose rest-stress protocol (5 mCi rest and
15 mCi stress doses). Patients >=250 lbs or a BMI >=35 kg/m2
were excluded. Rest images were processed at 5- and 8-minute acquisition
times and stress images at 3- and 5-minute acquisition times. A subset of
patients had stress imaging performed using both conventional and CZT
SPECT cameras. Image acquisition times and SPECT camera images were
compared based on total counts, count rate, image quality, and summed rest
and stress scores. Twelve month clinical follow-up was also obtained.
Results. 131 patients underwent the study protocol (age 64.9 +/- 9.8
years, 54.2% male). There was no significant difference in image quality
and mean summed scores between 5- and 8- minute rest images and between 3-
and 5-minute stress images. When compared to a conventional SPECT camera
in 27 patients, total rest and stress perfusion deficits and calculated
LVEF were similar (r 5 0.94 and 0.96, respectively). At 12 months there
was a benign prognosis in patients with normal perfusion. The effective
dose was 5.8 mSv for this protocol which is 49.2% less than conventional
Tc-99m studies and 75.7% less than conventional Tl-201/Tc- 99m dual
isotope studies. Conclusions. New SPECT camera technology with low isotope
dose significantly reduces ionizing radiation exposure and imaging times
compared to traditional protocols while maintaining image quality and
diagnostic accuracy. (J Nucl Cardiol 2011;18:847-57.) 2011 American
Society of Nuclear Cardiology.

<26>
Accession Number
70614333
Authors
Pham C. Monagle P. Cameron F. Kantor S. Newall F.
Institution
(Pham, Monagle) Department of Paediatrics, University of Melbourne,
Australia
(Cameron, Kantor) Department of Endocrinology, Australia
(Newall) Department of Clinical Haematology, Royal Children's Hospital
Melbourne, Australia
Title
Comparison of bone mineral density in post-fontan children: Aspirin vs.
warfarin.
Source
Journal of Thrombosis and Haemostasis. Conference: 23rd Congress of the
International Society on Thrombosis and Haemostasis 57th Annual SSC
Meeting Kyoto Japan. Conference Start: 20110723 Conference End: 20110728.
Conference Publication: (var.pagings). 9 (pp 642), 2011. Date of
Publication: July 2011.
Publisher
Blackwell Publishing Ltd
Abstract
Warfarin is a commonly used vitamin K antagonist anticoagulant.
Bone-forming proteins also require vitamin K as an essential cofactor for
carboxylation and biologic activity. Long-term warfarin therapy has been
associated with reduced bone mineral density (BMD) and increased fracture
risk. This is of particular significance in children where bone accrual is
vital to achieve adequate peak bone mass in adulthood and reduce the risk
of osteoporosis and fractures. This effect of warfarin on BMD remains
uncertain; warfarin subjects have historically been compared to healthy
controls, so possibly the underlying condition is providing a confounding
effect on BMD. This is the first study to investigate warfarin's unique
contribution to BMD in a cohort of children with the same underlying
disease. In this follow-up study of a previous randomised controlled trial
(RCT), the BMD of children managed on warfarin vs. aspirin following
Fon-tan surgery for congenital heart disease was compared. As some aspirin
cases have since changed onto warfarin, an 'Intention to Treat' and a
'True' analysis were performed.

<27>
Accession Number
70620818
Authors
Gada H. Kapadia S.R. Tuzcu E.M. Svensson L.G. Marwick T.H.
Institution
(Gada, Kapadia, Tuzcu, Svensson, Marwick) Cardiovascular Medicine,
Cleveland Clinic, Cleveland, OH, United States
Title
Transcatheter valve replacement is a cost-effective alternative to
conventional surgery in selected high-risk patients.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transfemoral transcatheter aortic valve replacement (TAVR) is
cost-effective for management of severe aortic stenosis (AS) in patients
with unacceptable risk for aortic valve replacement (AVR). However, the
relative cost-effectiveness of TAVR and tissue AVR is ill-defined in
high-risk patients where surgery is an option. We developed a Markov model
to inform the choice between transfemoral TAVR and AVR in high-risk
patients. Methods: A Markov model was developed to examine the progression
of patients between health states, defined as peri- and post-procedural,
post-complication, and death. The mean and variance of risks, transition
probabilities, utilities and cost of TAVR and AVR were derived from
meta-analysis of relevant registries, studies and trials. Outcome and cost
were derived from 10,000 simulations. Sensitivity analyses were based on
the likelihood of mortality, stroke, and other commonly observed outcomes.
Further analyses evaluated situations thought to favor tissue AVR or TAVR.
Results: In the reference case (age 80, peri-operative mortality of
transfemoral TAVR and AVR 5.8 vs 9.1%, annual mortality 22.2 vs 22.5%),
the utility of TAVR was greater than AVR (1.71 vs 1.64 QALY). As the cost
of TAVR was greater than AVR ($26,176 vs $19,361), the incremental
cost-effectiveness ratio (ICER) was $97,357/QALY. In sensitivity analyses,
variations in stroke, peri-operative and annual mortality are the main
drivers of variation in health outcomes. The current risk profile of
transfemoral TAVR offered net health benefits when peri-operative AVR
mortality was >5.2%, or stroke post-TAVR was <11.3% (Figure). In a
scenario analysis based only on operable PARTNER patients (Cohort A),
QALYs for TAVR and AVR were 1.69 and 1.63, with an ICER of $70,633/QALY.
Conclusion: TAVR may provide net health benefits at acceptable cost in
selected high-risk patients among whom AVR is the current procedure of
choice.

<28>
Accession Number
70620705
Authors
Samad F. Hakeem A. Kim J. Bhatti S. Mohamed A.W. Arif I. Leesar M. Helmy
T.
Institution
(Samad) Internal Medicine, Univ. of Medicine and Dentistry of New Jersey,
Newark, NJ, United States
(Hakeem, Kim, Bhatti, Mohamed, Arif, Leesar, Helmy) Cardiology, Univ. of
Cincinnati, Cincinnati, OH, United States
Title
Comparative effectiveness of PCI versus CABG for unprotected left main
stenosis-meta analysis of randomzed controlled trials.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background The established mode of revascularization for unprotected left
main disease is coronary artery bypass grafting (CABG). Percutaneous
coronary intervention (PCI) has been increasingly utilized as a viable
alternate. Objectives We sought to evaluate the comparative effectiveness
of PCI vs. CABG for left main disease by collating the evidence from four
published randomized controlled trials. Data Sources Pubmed, Cochrane
Register of Controlled Trials, conference proceedings, and internet-based
resources of clinical trials. Study Selection Randomized trials comparing
PCI vs. CABG for unprotected left main disease evaluating the outcomes of
interest [death, myocardial infarction (MI), stroke, revascularization and
their composite (MACE) were included. Results Four randomized trials
including 1611 participants (809 in PCI arm and 802 in CABG arm) formed
the data set. There was no significant difference in the two groups with
regards to baseline characteristics. The weighted mean age was 64 years
with 70% men and 32% diabetics. The mean SYNTAX score was 26 in both
groups. During a mean follow up of 15 months, the incidence of death was
3% in the PCI arm and 4.2% in the CABG arm [RR 0.75 (0.45, 1.25); p=0.27]
.Similarly, there was no difference in the incidence of MI [RR 1(0.57,
1.75); p=0.99] or MACE [RR 1.1 (0.8, 1.5); p=0.26]. PCI was associated
with a significant reduction in the risk of stroke [0.2% vs. 1.7%; RR
0.22(0.06, 0.76);p=0.02] but a higher risk of revascularization.[RR
2.09(1.49,2.92);p<0.001].There was no heterogeneity found amongst the
trials for these endpoints (I2=0%). Conclusion This meta analysis of
randomized studies demonstrates the safety and efficacy of PCI compared to
CABG for left main disease. While there was no difference in mortality, MI
or MACE, PCI confered an advantage of significant reduction in the risk of
stroke which was balanced by a higher rate of downstream
revascularization. PCI could hence be considered a viable option in
selected patients.

<29>
Accession Number
70620703
Authors
Alam M. Shahzad S.A. Huang H.D. Chiang I.-H. Paniagua D. Kar B. Ramanathan
K.B. Shah A.R. Kleiman N.S. Jneid H.M.
Institution
(Alam, Huang, Chiang) Medicine, Section of Cardiology, Baylor College of
Medicine, Houston, TX, United States
(Shahzad) Critical Care, Al-Noor Specialist Hosp., Makkah, Saudi Arabia
(Paniagua, Kar, Jneid) Medicine, Section of Cardiology, Baylor College of
Medicine, Michael E. DeBakey VA Med. Cntr., Houston, TX, United States
(Ramanathan) Medicine, Section of Cardiology, Univ. of Tennessee Health
Sciences Cntr., Memphis, TN, United States
(Shah) Medicine, Section of Cardiology, Methodist DeBakey Heart and
Vascular Cntr., Houston, TX, United States
(Kleiman) Medicine, Section of Cardiology, Weill Cornell Med. College,
Methodist DeBakey Heart and Vascular Cntr., Houston, TX, United States
Title
Percutaneous coronary intervention with drug-eluting stents versus
coronary artery bypass graft surgery for unprotected left main coronary
artery stenosis: A meta-analysis of randomized clinical trials.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients with unprotected left main coronary artery (ULMCA)
stenosis are increasingly treated with PCI using DES. However, there is
paucity of long-term data from randomized clinical trials comparing PCI
with DES vs. CABG for ULMCA stenosis. Methods: We performed aggregate data
meta-analyses of clinical outcomes from randomized studies comparing PCI
with DES vs. CABG for ULMCA stenosis & reporting at least 12 months of
follow-up. A search of Medline & conference proceedings between 01/2003
and 04/2011 identified 4 studies (1,611 patients; PCI = 809 & CABG = 802).
Death, non-fatal myocardial infarction (MI), stroke, repeat
revascularization, MACCE (death, MI, repeat revascularization or stroke)
and composite safety outcome of death, MI or stroke were extracted at
30-days, 12-months, 24-months & 36-months. Summary odds ratios & 95%
confidence intervals were calculated using random-effects model. Results:
No major inter-group differences in baseline socio-demographic, clinical &
angiographic characteristics were observed. Compared with their CABG
counterparts, patients in the PCI arm had shorter Hospital stay (11.5 vs.
4.7 days, P < 0.05), and experienced a lower incidence of stroke at
30-days (OR 0.2, 95% CI 0.04 - 0.8), 12-months (OR 0.2, 95% CI 0.04 - 0.6)
and 24-months (OR 0.3, 95% CI 0.1 - 0.8). PCI was associated with a higher
incidence of repeat revascularization at 12-months (OR 2.2, 95% CI 1.5 -
3.2), 24-months (OR 2.0, 95% CI 1.4 - 2.8) and 36-months (OR 2.0, 95% CI
1.3 - 2.9). Both groups had comparable death, MI, MACCE and the composite
safety outcomes at follow-up (Table I). Conclusions: In randomized
clinical trials, revascularization of ULMCA stenosis with PCI using DES is
associated with a shorter Hospital stay, reduced rate of stroke but an
increased rate of repeat revascularization compared to CABG. Both
revascularization strategies had comparable mortality, MI, and MACCE
outcomes at intered.iate term follow-up.

<30>
Accession Number
70620506
Authors
Gemignani A.S. Kapoor M. Cohen S. Sharma S.C. Choudhary G. Wu W.-C.
Institution
(Gemignani, Cohen, Sharma, Choudhary, Wu) Cardiology, Providence VA Med.
Cntr., Brown Univ., Providence, RI, United States
(Kapoor) Internal Medicine, Rhode Island Hosp., Brown Univ., Providence,
RI, United States
Title
Preoperative renin-angiotensin system inhibitor use is associated with
worse clinical outcomes following cardiovascular surgery: Results of a
meta-analysis.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Use of renin-angiotensin system (RAS) inhibitors (ACE
inhibitors and ARBs) prior to cardiovascular surgery is common yet
controversial. RAS inhibitor use has the potential risks of hypotension
and kidney injury and the potential benefits of reduced cardiac ischemia
and arrhythmia. There is no consensus in the published literature
regarding the perioperative risk/benefit of RAS inhibitor use. Hence we
sought to evaluate the association between preoperative RAS inhibitor use
and postoperative mortality, acute kidney injury (AKI) and atrial
fibrillation (AF) by performing a systematic meta-analysis. Methods: We
included all randomized-controlled and observational studies with at least
2 weeks of RAS inhibitor use prior to cardiovascular surgery, and presence
of a control group, that reported mortality, AKI or AF as outcomes.
Studies prior to February 2011 identified from MEDLINE, Cochrane and NIH
databases were included in the analysis. Sensitivity analysis was
conducted based on trial design and ventricular function. We used the
Mantel-Haenszel fixed effect model for pooling the study results, a random
effects model was used for heterogeneous samples/results. Results: Of 310
published studies, we identified 14 studies (n=37145, mean age 65, 75%
male, LVEF range 52-61%) that met criteria for analysis. RAS inhibitor use
prior to cardiac surgery was 42% in our study population. In the pooled
analysis, preoperative use of RAS inhibitors was found to be associated
with increased postoperative mortality and AKI, but not AF (table).
Sensitivity analysis was consistent with the overall findings. Conclusion:
Use of RAS inhibitors prior to cardiac surgery is associated with
increased likelihood of postoperative mortality and AKI and not protective
against AF. It remains to be determined if preoperative discontinuation of
RAS inhibitors results in improved clinical outcomes.

<31>
Accession Number
70620456
Authors
Goto S.-N. Takagi H.
Institution
(Goto, Takagi) Cardiovascular Surgery, Shizuoka Med. Cntr., Sunto-gun,
Japan
Title
Lower survival after drug-eluting stents than coronary artery bypass
grafting for unprotected left main and/or multivessel disease: A
meta-analysis of randomized trials and risk-adjusted observational
comparative studies.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Backgrounds: Previous meta-analyses of raw data from randomized trials and
observational comparative studies have demonstrated no significant
difference in survival between drug-eluting stents (DES) and coronary
artery bypass grafting (CABG) for patients with unprotected left main
(ULMD) and/or multivesssel disease (MVD) (double-vessel [2VD] and
triple-vessel disease [3VD]). Raw data from observational studies,
however, are unadjusted and susceptible to confounding. Methods: To
attempt to control for confounding in observational studies, we performed
a meta-analysis of randomized trials and risk-adjusted observational
comparative studies (providing adjusted hazard ratios [HRs] using
propensity score and/or multivariate Cox proportional hazards regression
analyses) of DES versus CABG for survival in patients with ULMD and/or
MVD. Study-specific estimates were combined in a random-effects model.
Results: Our comprehensive search identified 3 randomized trials and 21
risk-adjusted observational comparative studies. Pooled analysis of 32 HRs
for all-cause death from all studies (36,574 patients) demonstrated a
significantly higher mortality with DES than CABG (HR, 1.22; 95%
confidence interval [CI], 1.04-1.42; P=0.01). Exclusion of any single HR
from the analysis did not substantively alter the overall results of our
analysis. When data were pooled separately in MVD (both 2VD and
3VD)-studies (31,325 patients) and ULMD-studies (4,214 patients), DES were
associated with a significantly higher mortality than CABG for MVD (HR,
1.34; 95% CI, 1.11-1.61; P=0.002), not for ULMD (HR, 0.93; 95% CI,
0.69-1.25; P=0.74). Separately pooled analysis of 3VD-studies (14,196
patients) and 2VD-studies (15,137 patients) demonstrated a significantly
higher mortality with DES than CABG for 3VD (HR, 1.49; 95% CI, 1.17-1.89;
P=0.001), not for 2VD (HR, 1.25; 95% CI, 0.82-1.89; P=0.29). Conclusions:
The present meta-analysis of randomized trials and risk-adjusted
observational comparative studies suggests that DES are associated with
lower survival than CABG for high-risk (ULMD and/or MVD) patients, mainly
due to lower survival for patients with 3VD.

<32>
Accession Number
70620450
Authors
Jang J.-S. Chung S.-R. Jin H.-Y. Seo J.-S. Yang T.-H. Park B. Kim D.-K.
Kim K.-H. Seol S.-H. Kim D.-I. Kim D.-S.
Institution
(Jang, Chung, Jin, Seo, Yang, Kim, Kim) Cardiology, Inje Univ., Busan Paik
Hosp., Busan, South Korea
(Park, Kim, Kim, Seol, Kim) Cardiology, Inje Univ., Haeundae Paik Hosp.,
Busan, South Korea
Title
Comparison between drug-eluting stents and coronary artery bypass grafting
for unprotected left main coronary artery disease: A pooled analysis of
three randomized trials and six observational studies.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The clinical outcomes for unprotected left main coronary
artery (ULMCA) disease between coronary artery bypass grafting (CABG) and
drug-eluting stents (DES) remain controversial. The objective of this
study was to compare the safety and efficacy of percutaneous coronary
intervention (PCI) using DES with CABG in patients with ULMCA disease.
Methods: Databases were searched for clinical studies that reported
outcomes after PCI with DES and CABG for the treatment of ULMCA disease.
The end points of this meta-analysis were mortality; the composite of
death, myocardial infarction, or stroke; and target vessel
revascularization at 1-year follow-up. The pooled effects were calculated
using fixed-effects model (Mantel-Haenszel method) or random effects
models (Dersimonian and Laird method). Results: Nine clinical studies (3
randomized trials and 6 observational studies) with 4,989 patients were
involved in this study. At 1-year follow-up, there was no significant
difference between the DES and CABG groups in the risk for death (odds
ratio [OR] 0.78, 95% confidence interval [CI] 0.49 to 1.23, p=0.29) or the
composite end point of death, myocardial infarction, or stroke (OR 0.79,
95% CI 0.62 to 1.02, p=0.07). Target vessel revascularization was
significantly higher in the DES group compared to the CABG group (OR 3.01,
95% CI 2.33 to 3.88, p<0.001). Conclusions: Our meta-analysis indicates
that there are no significant differences in the safety between DES and
CABG for the treatment of ULMCA disease. In selected cases with ULMCA
disease, PCI with DES is emerging as a good alternative.

<33>
Accession Number
70618838
Authors
Pilbrow A.P. Pearson J.F. McNoe L. Ellis K.L. Black M.A. Sweet W.E. Wilson
Tang W.H. Troughton R.W. Richards A.M. Moravec C.S. Cameron V.A.
Institution
(Pilbrow, Ellis, Troughton, Richards, Cameron) Medicine, Univ. of Otago
Christchurch, Christchurch, New Zealand
(Pearson) Public Health and General Practice, Univ. of Otago Christchurch,
Christchurch, New Zealand
(McNoe, Black) Biochemistry, Univ. of Otago, Dunedin, New Zealand
(Sweet, Wilson Tang, Moravec) Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
Title
Chromosome 1Q41 and 3Q22.3 coronary artery disease risk loci are
associated with altered cardiac gene expression profiles in normal and
Diseased Heart.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Meta-analyses of genome-wide association studies have confirmed
association of chromosomal loci 1q41 and 3q22.3 with coronary artery
disease (CAD). Although these loci are located in close proximity to the
melanoma inhibitory activity family, member 3 gene (MIA3) for 1q41
(rs17465637) and muscle RAS gene (MRAS) for 3q22.3 (rs9818870), the
mechanisms underlying these associations are unclear. To understand
pathways by which these loci might influence CAD risk, we investigated
associations between genotype and global gene expression in heart tissue
from 110 heart-transplant patients and 108 donors (no diagnosed heart
disease). Genotyping was performed with Taqman assays and gene expression
profiles generated with Affymetrix microarrays. Associations were analyzed
with additive (1q41) or recessive (3q22.3) models and unadjusted p-values
have been reported. In patients, the 1q41 minor (protective) allele was
associated with less previous history of myocardial infarction (p=0.001)
and with altered expression of 781 genes (p<0.05), whilst 2971 genes were
altered in donors (p<0.05) including MIA3 (+1.07-fold, p=0.008).
Differentially expressed genes with 1q41 were enriched for immune response
pathways in patients (p=3.2x10-8) and donors (p=2.1x10-8) and for
cytoskeleton remodeling (p=3.5x10-13) and cell adhesion (p=5.0x10-8)
processes in donors only, consistent with a reported role of MIA3 in
reducing monocyte adhesion. Having two copies of the 3q22.3 minor (risk)
allele was associated in patients with lower cardiac output (p=0.037),
higher systemic vascular resistance (p=0.022) and with altered expression
of 622 genes, (p<0.05), with 622 genes also altered in donors (p<0.05)
including MRAS (+1.58-fold, p=0.0009). Genes differentially expressed
between 3q22.3 genotypes were enriched for cell adhesion and muscle
contraction processes in patients (p=1.3x10-4, p=1.1x10-2 respectively)
and donors (p=5.8x10-5, p=8.2x10-5 respectively), and formed regulatory
networks with MRAS. A subset of genes was altered in both patients and
donors (1q41, 159 genes; 3q22.3, 36 genes). These data suggest that
networks of genes may be altered in association with 1q41 and 3q22.3 in
heart, both before and after disease onset, and may influence risk of CAD.

<34>
Accession Number
70618604
Authors
Langkilde A.M. Sugg J. Johannson P. Ying L. List J. Parikh S.
Institution
(Langkilde) R and D, Astra Zeneca, Molndal, Sweden
(Sugg) Clinical Science, Astra Zeneca, Wilmington, DE, United States
(Johannson) R and D, Astra Zeneca, Sodertalje, Sweden
(Ying) Global Biometric Science, Bristol-Myers Squibb, Hopewell, NJ,
United States
(List) Rsch. and Development, Bristol-Myers Squibb, Princeton, NJ, United
States
(Parikh) Clinical Development, Cardiovascular, Astra Zeneca, Wilmington,
DE, United States
Title
A meta-analysis of cardiovascular outcomes in clinical trials of
dapagliflozin.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of
cardiovascular (CV) disease. Dapagliflozin (DAPA), a selective SGLT2
inhibitor, is currently under evaluation for the treatment of T2DM. DAPA
reduces hyperglycemia by promoting renal glucose excretion, independent of
insulin secretion or action, also reducing weight and blood pressure. In
response to FDA recommendations for new T2DM therapies, a pre-specified
meta-analysis was conducted of data from 14 phase 2/3 studies (n=6228) to
assess the CV safety of all DAPA doses (2.5 to >10mg/d) pooled (n=4287),
relative to all comparators (active or placebo) pooled (n=1941). CV events
were systematically identified from investigator reports of adverse events
and adjudicated by an independent committee. Adjudication was blinded to
treatment allocation and conducted prospectively for the majority of
trials. The primary end point was a composite of time to first event of CV
death, myocardial infarction (MI), stroke, or hospitalization for unstable
angina. The secondary end point included the primary end point, unplanned
coronary revascularization, and hospitalization for heart failure.
Baseline characteristics were balanced between groups: mean age=56 years,
body mass index=31.5 kg/m2, and T2DM duration=6 years.
Characteristics mirrored CV risk in the general T2DM population and
included hypertension (62%), dyslipidemia (49%), smoking history (40%),
and CV disease history (19%). A total of 78 primary end point events were
confirmed with a stratified event rate (subjects with events/1000 subject
years) of 11.3 for DAPA vs 16.6 for comparators. The estimated hazard
ratio (HR) using a Cox proportional hazards method was 0.674 (98% CI:
0.385, 1.178; 95% CI: 0.421, 1.078). Analyses of the secondary end point
(HR: 0.632; 95% CI: 0.416, 0.959) and of a composite CV death, MI, and
stroke end point (HR: 0.596; 95% CI: 0.357, 0.996) were consistent with
primary results. Analyses by dose (DAPA 2.5, 5 and 10 mg) were comparable
to overall results. Review of data from the 4-month safety update
confirmed the conclusions from the initial pre-specified analysis. The
results suggest that DAPA is not associated with an increase in CV risk,
and are consistent with a potential reduction in CV risk.

<35>
Accession Number
70618327
Authors
Magnus P.C. Chaisson K. Kramer R.S. Ross C.S. Boss R.A. Agha S.A. Helm
R.E. Horton S.R. Hofmaster P. Westbrook B.M. Duquette D. Quinn R.D. Russo
L. Jones C. Brown J.R. Malenka D.J.
Institution
(Magnus, Agha, Malenka) Cardiology, Dartmouth-Hitchcock Med. Cntr,
Lebanon, NH, United States
(Chaisson) Cardiovascular Services, Concord Hosp, Concord, NH, United
States
(Kramer, Quinn) Cardiothoracic Surgery, Maine Med. Cntr, Portland, ME,
United States
(Ross, Brown) Dartmouth Institute for Health Policy and Clinical Practice,
Dartmouth Med. Sch., Lebanon, NH, United States
(Boss) Cardiology, Concord Hosp, Concord, NH, United States
(Helm) Cardiothoracic Surgery, Portsmouth Regional Hosp, Portsmouth, NH,
United States
(Horton, Russo) Cardiovascular Services, Central Maine Med. Cntr,
Lewiston, ME, United States
(Hofmaster) Quality Improvement, Eastern Maine Med. Cntr, Bangor, ME,
United States
(Westbrook) Cardiac Services, Catholic Med. Cntr, Manchester, NH, United
States
(Duquette) Cardiovascular Services, Portsmouth Regional Hosp, Portsmouth,
NH, United States
(Jones) Cardiovascular Services, Maine Med. Cntr, Portland, ME, United
States
Title
Causes of 30-day readmission after cardiac surgery in Northern New
England.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background. There is a high rate of readmission within 30 days following
discharge from a hospitalization for cardiac surgery. This is associated
with increased morbidity, mortality, and cost of care. A systematic review
of the medical record could identify details of the process of care and
causes of readmission that are actionable and could lead to a decrease in
rates of readmission. Methods. From our regional registry of open heart
surgery, we identified 268 consecutive patients readmitted within 30 days
(mean=11 days) of their index procedure. Trained health professionals
systematically abstracted the records of their index and readmission
hospitalizations, information that was merged to existing registry data.
Results. Readmitted patients had more comorbid conditions at the time of
their index procedure and were more likely to have valve surgery (30.2% v
23.2%). Early follow-up appointments were recommended for all patients but
variably scheduled (CT surgery 54.1%; PCP 1.1%). A minority of patients
(23.1%) were seen as outpatients prior to their readmission. Infections
(24%), effusions (20%), and rhythm disturbances (16%) were the most common
primary causes of readmission (Figure). Common secondary causes of
readmission included CHF/SOB (28%) and effusions (18%). Conclusions. Root
cause analysis of causes of readmission following open heart surgery is
feasible. Our pilot study suggests that more attention to volume status
and management of effusions could substantially decrease rates of
readmission.

<36>
Accession Number
70618025
Authors
Romero J. Kahan J. Gonzalez W. Garcia M.J.
Institution
(Romero, Kahan, Gonzalez) College of Physicians and Surgeons, St. Luke's
Roosevelt Hosp., Columbia Univ., New York, NY, United States
(Garcia) Cardiology, Montefiore Med. Cntr., Albert Einstein College of
Medicine, New York, NY, United States
Title
Magnetic resonance imaging assessing viability in patients with chronic
ventricular dysfunction due to coronary artery disease undergoing
revascularization. A meta-analysis of prospective clinical trials.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The best test to evaluate myocardial viability in patients
being contemplated for revascularization has not been determined. Magnetic
resonance has emerged as a valuable tool for assessing it. Objectives: The
purpose of this study was to evaluate the sensitivity, specificity,
negative and positive predictive values (PPV/NPV) of cardiac magnetic
resonance imaging (CMR) assessing myocardial viability. Three different
techniques were evaluated: 1) End-diastolic wall thickness (EDWT), 2) Low
dose dobutamine (LDD), and 3) Contrast delayed-enhancement (DE). Methods:
A systematic review of Medline, Cochrane, and Embase for all the
prospective trials assessing myocardial viability in subjects with chronic
left ventricular dysfunction using CMR was perforMed. using a hierarchical
meta-analytical model. Results: A total of 23 studies of cardiac magnetic
resonance evaluating myocardial viability with 628 patients fulfilled the
inclusion criteria. Eleven studies used DE CMR, nine studies used LDD CMR
and three studies used EDWT. The DE CMR studies included a 50% of LV wall
hyper-enhancement as a cut-off to determine viability. The mean
sensitivity and specificity were 95% and 52%, whereas the PPV and NPV were
67% and 90%. LDD CMR used a two-millimeter change in LV wall motion during
low-dose dobutamine infusion (5-10 mcg/kg/min) as a cut-off. In these
studies the mean weighted sensitivity and specificity were 81% and 91%,
whereas the PPV and NPV were 93% and 72% respectively. The cut-off used
for EDWT was six millimeters. The mean weighted sensitivity and
specificity were 96% and 40%, and the PPV and NPV were 66% and 80%
respectively. Conclusion: DE CMR provides the highest sensitivity and NPV
of any diagnostic modality and LDD CMR provides the best specificity and
PPV of any other test. Combining these two modalities might be therefore
clinically meaningful to improve clinical outcomes and guiding management
in patients being contemplated for revascularization.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

2011-12-24T02:28:00.001-08:00

Total documents retrieved: 21

Results Generated From:
Embase <1980 to 2011 Week 51>
Embase (updates since 2011-12-15)

<1>
Accession Number
70460233
Authors
Theuns D.A.M.J. Smith T. Hunink M.G.M. Bardy G.H. Jordaens L.
Institution
(Theuns, Smith, Jordaens) Department of Cardiology, Erasmus MC, Rotterdam,
Netherlands
(Smith, Hunink) Department of Epidemiology, Erasmus MC, Rotterdam,
Netherlands
(Hunink) Department of Radiology, Erasmus MC, Rotterdam, Netherlands
(Hunink) Department of Health Policy and Management, Harvard School of
Public Health, Boston, United States
(Bardy) Seattle Institute for Cardiac Research, Seattle, WA, United States
Title
Effectiveness of prophylactic implantation of cardioverter-defibrillators
without additional function improving interventions in patients with
ischemic or nonischemic cardiomyopathy: A systematic review and
meta-analysis.
Source
Europace. Conference: 17th World Congress in Cardiac Electrophysiology
and Cardiac Techniques, Cardiostim 2010 Nice France. Conference Start:
20100616 Conference End: 20100619. Conference Publication: (var.pagings).
12 (pp i47), 2010. Date of Publication: June 2010.
Publisher
Oxford University Press
Abstract
Objective: The aim was to investigate the efficacy of ICD-only therapy in
primary prevention in patients with ischemic or nonischemic
cardiomyopathy. Background: Much controversy continues to exist concerning
the efficacy for primary prophylactic implantable defibrillators (ICDs) in
patients with low ejection fraction respectively due to coronary artery
disease or dilated cardiomyopathy. This is also related to the potential
bias created by function improving interventions added to ICD therapy.
Methods: Public domain databases, MEDLINE. EMBASE. and Cochrane Register
of Controlled Trials were searched from 1980 to 2009 for randomized
clinical trials of ICD vs. conventional therapy. Two investigators
abstracted data independently. Pooled estimates were calculated using both
fixed-effects and random-effects models. Results: Eight trials were
included in the final analysis (5343 patients). ICDs significantly reduced
arrhythmic mortality (relative risk [RR], 0.40; 95% CI, 0.27 - 0.67) and
all-cause mortality (RR 0.72; 95% CI, 0.64-0.82). Regardless of etiology
of cardiomyopathy, ICD benefit was similar for ischemic cardiomyopathy (RR
0.71; 95% CI, 0.61-0.83) vs. nonischemic cardiomyopathy (RR 0.74; 95% CI,
0.59 - 0.93). Conclusions: The results of this meta-analysis provide
strong evidence for the beneficial effect of ICD-only therapy on the
survival of patients with ischemic or nonischemic cardiomyopathy, with a
left ventricular ejection fraction 35%, if they are 40 days from
myocardial infarction and 3 3 months from a coronary
revascularization procedure.

<2>
Accession Number
2011670279
Authors
Gong M. Lin X.-Z. Lu G.-T. Zheng L.-J.
Institution
(Gong) Department of Anesthesiology, Second Affiliated Hospital, Zhejiang
University, Hangzhou, China
(Lin, Lu, Zheng) Department of Anesthesiology, Taizhou Central Hospital,
Taizhou, China
Title
Preoperative inhalation of milrinone attenuates inflammation in patients
undergoing cardiac surgery with cardiopulmonary bypass.
Source
Medical Principles and Practice. 21 (1) (pp 30-35), 2012. Date of
Publication: December 2011.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Objectives: The purpose of this study was to evaluate the effect of
preoperative inhalation of milrinone on cardiopulmonary bypass
(CPB)-related inflammation. Subjects and Methods: A total of 30 patients
undergoing cardiac surgery were recruited and randomized for preoperative
inhalation of milrinone (Mil group) or normal saline (NS group),
respectively. Each group had 15 patients. Their hemodynamic parameters
were measured and blood samples were obtained longitudinally. The levels
of serum interleukin (IL-6), tumor necrosis factor-alpha (TNF-alpha), and
matrix metalloproteinase (MMP)-9 were determined by ELISA. Results: The
levels of serum IL-6, TNF-alpha, and MMP-9 significantly increased at the
end of cardiac surgery and remained high for 24 h in both groups of
patients. However, the levels of proinflammatory cytokines at the end of
cardiac surgery in the Mil group of patients were significantly lower than
those of the NS group of patients. Conclusions: Our data indicated that
preoperative inhalation of milrinone significantly mitigated CPB-related
inflammation. Copyright 2011 S. Karger AG, Basel.

<3>
Accession Number
2011686481
Authors
Christensen S.B. Dall C.H. Prescott E. Pedersen S.S. Gustafsson F.
Institution
(Christensen, Gustafsson) Department of Cardiology, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark
(Dall, Prescott) Department of Cardiology, Copenhagen University Hospital,
Bispebjerg Hospital, Copenhagen, Denmark
(Pedersen) Center of Research on Psychology in Somatic Diseases, Tilburg
University, Tilburg, Netherlands
Title
A high-intensity exercise program improves exercise capacity,
self-perceived health, anxiety and depression in heart transplant
recipients: A randomized, controlled trial.
Source
Journal of Heart and Lung Transplantation. 31 (1) (pp 106-107), 2012.
Date of Publication: January 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)

<4>
Accession Number
2011676914
Authors
Garwood C.L. Hwang J.M. Moser L.R.
Institution
(Garwood, Moser) Department of Pharmacy Practice, Eugene Applebaum College
of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue,
Detroit, MI 48201, United States
(Garwood, Hwang, Moser) Pharmacy Department, Harper University Hospital,
Detroit Medical Center, Detroit, MI, United States
Title
Striking a balance between the risks and benefits of anticoagulation
bridge therapy in patients with atrial fibrillation: Clinical updates and
remaining controversies.
Source
Pharmacotherapy. 31 (12) (pp 1208-1220), 2011. Date of Publication:
December 2011.
Publisher
Pharmacotherapy Publications Inc. (750 Washington Street, Boston MA 02111,
United States)
Abstract
Long-term anticoagulation with a vitamin K antagonist (VKA) or the new
agent dabigatran is recommended to decrease stroke risk in patients with
atrial fibrillation. When patients with atrial fibrillation undergo
initiation or interruption of VKA therapy, or experience an isolated
subtherapeutic international normalized ratio (INR), bridge therapy with a
parenteral anticoagulant may be considered. To describe the literature for
anticoagulation bridge therapy in patients with atrial fibrillation, we
conducted a MEDLINE search (1966-February 2011) of the English-language
literature to identify related studies. Ongoing clinical trials were
identified through a search of the ClinicalTrials.gov registry. Major
national and international guidelines were gathered and evaluated.
Additional literature was obtained through review of relevant references
of the identified articles. Bridging is not supported by guidelines or
clinical trials for patients starting VKA therapy for atrial fibrillation.
A subtherapeutic INR value during long-term VKA therapy may be associated
with increased thromboembolic events, but the benefit of bridging has not
been demonstrated. When VKA therapy is interrupted for procedures,
retrospective and cohort data suggest that the decision to bridge should
be based on a patient's thromboembolic and bleeding risks associated with
the procedure. Typically, it is recommended to use bridge therapy in
patients with atrial fibrillation at high risk for thromboembolism, but
the benefit of bridging is less clear in patients at low risk. Not all
procedures necessitate anticoagulation interruption. Recent trials suggest
that VKAs can be continued when patients are undergoing cardiac device
procedures and some types of radiofrequency ablation. Several clinical
trials are ongoing that will provide more definitive guidance for
perioperative anticoagulation management of patients with atrial
fibrillation. Patients taking dabigatran are unlikely to require bridge
therapy because of a predictable anticoagulant effect and rapid onset of
action. However, evidence for optimal perioperative management of
dabigatran is needed.

<5>
[Use Link to view the full text]
Accession Number
2011679398
Authors
Levine G.N. Bates E.R. Blankenship J.C. Bailey S.R. Bittl J.A. Cercek B.
Chambers C.E. Ellis S.G. Guyton R.A. Hollenberg S.M. Khot U.N. Lange R.A.
Mauri L. Mehran R. Moussa I.D. Mukherjee D. Nallamothu B.K. Ting H.H.
Jacobs A.K. Albert N. Creager M.A. Ettinger S.M. Halperin J.L. Hochman
J.S. Kushner F.G. Magnus Ohman E. Stevenson W. Yancy C.W.
Title
2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention a
report of the American College of Cardiology Foundation/American Heart
Association Task Force on Practice Guidelines and the Society for
Cardiovascular Angiography and Interventions.
Source
Circulation. 124 (23) (pp e574-e651), 2011. Date of Publication: 06 Dec
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)

<6>
Accession Number
2011669416
Authors
Spegar J. Vanek T. Snircova J. Fajt R. Straka Z. Pazderkova P. Maly M.
Institution
(Spegar, Vanek, Snircova, Fajt, Straka, Pazderkova) Department of Cardiac
Surgery, Charles University Prague, University Hospital Kralovske,
Vinohrady, Srobarova 50, 100 34 Prague, Czech Republic
(Maly) Department of Scientific Information and Biostatistics, National
Institute of Public Health, Prague, Czech Republic
Title
Local and systemic application of tranexamic acid in heart valve surgery:
A prospective, randomized, double blind LOST study.
Source
Journal of Thrombosis and Thrombolysis. 32 (3) (pp 303-310), 2011. Date
of Publication: October 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
The study was performed to examine a possible augmentation of systemic
administration of tranexamic acid by the additional topical application
during heart valve surgery in the post-aprotinin era. One-hundred patients
were enrolled in the study and all the patients were given tranexamic acid
intravenously. The participants were randomized into two groups (A, n =49;
B, n =51), and before commencing the sternal suturing, the study solution
(group A: 250 ml of normal saline + tranexamic acid 2.5 g, placebo group
B: 250 ml of normal saline) was poured into the pericardial cavity. The
cumulative blood loss (geometric means [95%confidence intervals]) 4 h
after the surgery was 86.1 [56.1, 132.2] ml in group A, and 135.4 [94.3,
194.4] in group B, test for equality of geometric means P =0.107, test for
equality of variances P =0.059. Eight hours after the surgery, the blood
loss was 199.4 [153.4, 259.2] ml in group A, 261.7 [205.1, 334.0] ml in
group B, P =0.130 and P =0.050, respectively. Twentyfour hours
postoperatively the blood loss was 504.2 [436.0, 583.0] ml in group A,
569.7 [476.0, 681.7] ml in group B, P =0.293 and P =0.014, respectively.
The proportion of patients transfused postoperatively by fresh frozen
plasma differed significantly between the two study groups (group A: n
=21, group B: n =36, P =0.008). Our hypothesis is supported by a
significant difference in the inter-group variance of blood loss and the
proportion of patients requiring fresh frozen plasma; however evident
differences in mean postoperative blood loss were not statistically
significant. Springer Science+Business Media, LLC 2011.

<7>
Accession Number
2011686924
Authors
Hsieh P.-L. Wu Y.-T. Chao W.-J.
Institution
(Hsieh, Wu, Chao) School and Graduate Institute of Physical Therapy,
College of Medicine, National Taiwan University, No. 17, Xuzhou Road,
Zhongzheng District Taipei City 10055, Taiwan (Republic of China)
(Wu) Department of Physical Medicine and Rehabilitation, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
Title
Effects of exercise training in heart transplant recipients: A
meta-analysis.
Source
Cardiology. 120 (1) (pp 27-35), 2011. Date of Publication: December
2011.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Objectives: Muscle wasting and exercise intolerance are common in heart
transplant recipients. Most studies on the effects of exercise training
have used relatively small sample sizes and are heterogeneous in nature.
The purpose of this meta-analysis was to systematically review the
relevant studies and investigate the effects of exercise training on
exercise capacity and muscle strength in heart transplant recipients.
Methods: A systematic search was adopted from electronic databases and
relevant references, using medical subject heading key words related to
heart transplantation and exercise. Only randomized controlled trials with
exercise intervention versus usual care were included. The data were
expressed as the weighted mean differences with 95% confidence intervals
(CIs). Results: Altogether 6 studies were included. Peak oxygen
consumption (VO2) was reported in 4 trials (117 patients), and
muscle strength was reported in 3 trials (67 patients). Peak
VO2 was significantly increased by 2.34 ml/kg/min (95% CI
0.63-4.05). One-repetition maxima of the chest press (23.28 kg, 95% CI
0.64-45.91) and leg press (28.84 kg, 95% CI 5.70-51.98) were significantly
improved by exercise training. Conclusion: Exercise training is
recommended for heart transplant recipients to improve peak VO2
and muscle strength despite the small number of trials included in this
meta-analysis. 2011 S. Karger AG, Basel.

<8>
Accession Number
2011680541
Authors
Mitaka C. Kudo T. Haraguchi G. Tomita M.
Institution
(Mitaka) Department of Critical Care Medicine, Tokyo Medical and Dental
University Graduate School, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519,
Japan
(Kudo, Haraguchi) Intensive Care Unit, Tokyo Medical and Dental University
Hospital Faculty of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519,
Japan
(Tomita) Clinical Research Center, Tokyo Medical and Dental University
Hospital Faculty of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519,
Japan
Title
Cardiovascular and renal effects of carperitide and nesiritide in
cardiovascular surgery patients: A systematic review and meta-analysis.
Source
Critical Care. 15 (5) , 2011. Article Number: R258. Date of
Publication: 27 Oct 2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Introduction: Acute kidney injury (AKI) following cardiovascular surgery
is a common disease process and is associated with both morbidity and
mortality. The aim of our study was to evaluate the cardiovascular and
renal effects of an atrial natriuretic peptide (ANP, carperitide) and a
B-type (or brain) natriuretic peptide (BNP, nesiritide) for preventing and
treating AKI in cardiovascular surgery patients.Methods: Electronic
databases, including PubMed, EMBASE and references from identified
articles were used for a literature search.Results: Data on the infusion
of ANP or BNP in cardiovascular surgery patients was collected from
fifteen randomized controlled trials and combined. The infusion of ANP or
BNP increased the urine output and creatinine clearance or glomerular
filtration rate, and reduced the use of diuretics and the serum creatinine
levels. A meta-analysis showed that ANP infusion significantly decreased
peak serum creatinine levels, incidence of arrhythmia and renal
replacement therapy. The meta-analysis also showed that ANP or BNP
infusion significantly decreased the length of ICU stay and hospital stay
compared with controls. However, the combined data were insufficient to
determine how ANP or BNP infusion during the perioperative period
influences long-term outcome in cardiovascular surgery
patients.Conclusions: The infusion of ANP or BNP may preserve
postoperative renal function in cardiovascular surgery patients. A large,
multicenter, prospective, randomized controlled trial will have to be
performed to assess the therapeutic potential of ANP or BNP in preventing
and treating AKI in the cardiovascular surgical setting. 2011 Mitaka et
al.; licensee BioMed Central Ltd.

<9>
Accession Number
2011673292
Authors
Asaad O.M.
Institution
(Asaad) Department of Anesthesia, Faculty of Medicine, Cairo University,
Egypt
Title
Bilateral Bispectral Index (BIS)-VISTA monitoring of cerebral
hypoperfusion in patients with carotid artery stenosis undergoing coronary
artery bypass surgery.
Source
Egyptian Journal of Anaesthesia. 27 (4) (pp 233-240), 2011. Date of
Publication: October 2011.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Background: Carotid stenosis is a frequent coexisting condition in
patients undergoing Coronary Artery Bypass Graft (CABG) surgery. During
cardiac surgery, acute hemodynamic changes can cause cerebral ischemia.
When acute slowing of the Electroencephalography (EEG) develops because of
cerebral ischemia, a profound reduction in Bispectral Index (BIS) is seen,
although the depth of anesthesia does not change. We investigated the
diagnostic value of bilateral BIS as an indicator of cerebral
hypoperfusion during CABG surgery in patients with carotid artery stenosis
and the incidence of left-right BIS differences. Methods: Forty patients
scheduled for elective CABG surgery were randomized into two groups
according to preoperative Duplex carotid ultrasound; Group with Carotid
Artery stenosis (CA-stenosis) (n = 23) and Group without stenosis
(CA-normal) (n = 17). All patients underwent monitoring using bilateral
BIS system. We analyzed BIS data at eight stages of the CABG procedure.
Results: Mean BIS values recorded from left and right hemispheres declined
significantly in comparison to steady state of anesthesia in both groups
(T2), (p < 0.0001 for both). In CA-stenosis group only, there were
significant interhemispheric differences during AXC apply (p < 0.01).
Average BIS values of right and left hemispheres and parallel to it, SEF
data decreased significantly in both groups during initiation of CPB-T3,
during AXC application-T4 and during AXC removal-T6 (p < 0.001).
Intergroup comparison showed significant decrease in BIS values in
CA-stenosis group when compared to CA-normal group during induction of
anesthesia-T1 and during AXC apply-T4 (both p < 0.001) and during AXC
removal-T6 (p = 0.04). Conclusion: Our findings suggest that an acute
decrease in BIS which represent abrupt slowing of the EEG, reflects acute
cerebral hypoperfusion particularly when it accompanies acute hypotension,
as long as the changes in BIS is not drug induced. 2011 Egyptian Society
of Anesthesiologists. Production and hosting by Elsevier B.V. All rights
reserved.

<10>
Accession Number
2011663794
Authors
Wykrzykowska J. Serruys P. Buszman P. Linke A. Ischinger T. Klauss V.
Eberli F. Corti R. Wijns W. Morice M.-C. Di Mario C. Van Geuns R.-J. Van
Es G.-A. Juni P. Windecker S.
Institution
(Wykrzykowska) Academic Medical Center, Amsterdam, Netherlands
(Serruys, Van Geuns) Thoraxcenter, Ba583a, Erasmus MC, 's-Gravendijkwal
230, 3015 CE Rotterdam, Netherlands
(Buszman) Medical University of Silesia, Katowicze, Poland
(Linke) Herzzentrum Leipzig, Leipzig, Germany
(Ischinger) Department of Cardiology, Hospital Bogenhausen, Munich,
Germany
(Klauss) Department of Cardiology, University Hospital Munich, Munich,
Germany
(Eberli, Corti) Department of Cardiology, University Hospital, Zurich,
Switzerland
(Wijns) Department of Cardiology, OLVZ, Aalst, Belgium
(Morice) Institut Cardiovasculaire, Paris-Sud, Massy, France
(Di Mario) Department of Cardiology, Royal Brompton Hospital, London,
United Kingdom
(Van Es) Cardialysis BV, Rotterdam, Netherlands
(Juni) CTU Bern, Bern University Hospital, Bern, Switzerland
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
Title
The three year follow-up of the randomised "all-comers" trial of a
biodegradable polymer biolimus-eluting stent versus permanent polymer
sirolimus-eluting stent (LEADERS).
Source
EuroIntervention. 7 (7) (pp 789-795), 2011. Date of Publication:
November 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The current study reports clinical outcomes at three year follow-up
of the LEADERS clinical trial which was the first all-comers trial
comparing a new generation biodegradable polymer biolimus drug-eluting
stent (BES) with the first generation permanent polymer sirolimus-eluting
stent (SES). Methods and results: One thousand seven hundred and seven
patients were randomised to unrestricted use of BES (n=857) or SES (n=850)
in an all-comers population. Three year follow-up was available in 95% of
the patients, 812 treated with BES and 809 treated with SES. At three
years, BES remains non-inferior to SES for the primary endpoint of major
adverse cardiac events (composite of cardiac death, myocardial infarction
(MI), or clinically-indicated target vessel revascularisation (CI-TVR)
(BES 15.7% versus SES 19%; HR 0.82 CI 0.65-1.03; p=0.09). The MACE Kaplan
Meier event curves increasingly diverge with the difference in events
increasing from 1.4% to 2.4% and 3.3% at 1, 2 and 3 years, respectively in
favour of BES. The rate of cardiac death was non-significantly lower 4.2%
versus 5.2% (HR=0.81 CI 0.52-1.26; p=0.34) and the rate of myocardial
infarction was equivalent 7.2% versus 7.1% (HR 1.01 CI 0.70-1.44; p=0.97)
for BES versus SES, respectively. Thus BES was non-inferior to SES in all
the safety endpoints. Clinically-indicated TVR occurred in 9.4% of BES
treated patients versus 11.1% of SES treated patients (HR 0.84 CI
0.62-1.13; p=0.25). Rates of definite stent thrombosis were 2.2% for BES
and 2.9% for SES (HR 0.78 CI 0.43-1.43; p=0.43), with the event rate
increase of 0.2% from one to three years for BES and 0.9% for SES. For
patients presenting with ST-elevation myocardial infarction BES was
superior to SES in reducing MACE. Conclusions: The findings of the three
year follow-up support the claim that the biodegradable polymer
biolimus-eluting stent has equivalent safety and efficacy to permanent
polymer sirolimus-eluting stent in an all-comers patient population. Its
performance is superior in some subpopulations such as in ST-elevation MI
patients and event rates for BES are overall lower than for SES with a
trend toward increasing divergence of outcomes over three years. Europa
Edition 2011. All rights reserved.

<11>
Accession Number
2011681503
Authors
Bulbulia R. Bowman L. Wallendszus K. Collins R. Meade T. Sleight P.
Armitage J. Parish S. Peto R. Youngman L. Buxton M. De Bono D. George C.
Fuller J. Keech A. Mansfield A. Pentecost B. Simpson D. Warlow C. McNamara
J. O'Toole L. Doll R. Wilhelmsen L. Fox K.M. Hill C. Sandercock P.
Institution
(Bulbulia, Bowman, Wallendszus, Parish, Armitage, Peto, Collins, Collins,
Meade, Sleight, Armitage, Parish, Peto, Youngman, Buxton, De Bono, George,
Fuller, Keech, Mansfield, Pentecost, Simpson, Warlow, McNamara, O'Toole,
Doll, Wilhelmsen, Fox, Hill, Sandercock) Clinical Trial Service Unit,
Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF,
United Kingdom
Title
Effects on 11-year mortality and morbidity of lowering LDL cholesterol
with simvastatin for about 5 years in 20 536 high-risk individuals: A
randomised controlled trial.
Source
The Lancet. 378 (9808) (pp 2013-2020), 2011. Date of Publication:
December 10-16, 2011.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Findings of large randomised trials have shown that lowering LDL
cholesterol with statins reduces vascular morbidity and mortality rapidly,
but limited evidence exists about the long-term efficacy and safety of
statin treatment. The aim of the extended follow-up of the Heart
Protection Study (HPS) is to assess long-term efficacy and safety of
lowering LDL cholesterol with statins, and here we report cause-specific
mortality and major morbidity in the in-trial and post-trial periods. 20
536 patients at high risk of vascular and non-vascular outcomes were
allocated either 40 mg simvastatin daily or placebo, using minimised
randomisation. Mean in-trial follow-up was 53 years (SD 12), and
post-trial follow-up of surviving patients yielded a mean total duration
of 110 years (SD 06). The primary outcome of the long-term follow-up of
HPS was first post-randomisation major vascular event, and analysis was by
intention to treat. This trial is registered with ISRCTN, number 48489393.
During the in-trial period, allocation to simvastatin yielded an average
reduction in LDL cholesterol of 10 mmol/L and a proportional decrease in
major vascular events of 23 (95 CI 19-28; p<00001), with significant
divergence each year after the first. During the post-trial period (when
statin use and lipid concentrations were similar in both groups), no
further significant reductions were noted in either major vascular events
(risk ratio [RR] 095 [089-102]) or vascular mortality (098 [090-107]).
During the combined in-trial and post-trial periods, no significant
differences were recorded in cancer incidence at all sites (098 [092-105])
or any particular site, or in mortality attributed to cancer (101
[092-111]) or to non-vascular causes (096 [089-103]). More prolonged
LDL-lowering statin treatment produces larger absolute reductions in
vascular events. Moreover, even after study treatment stopped in HPS,
benefits persisted for at least 5 years without any evidence of emerging
hazards. These findings provide further support for the prompt initiation
and long-term continuation of statin treatment. UK Medical Research
Council, British Heart Foundation, Merck & Co, Roche Vitamins. 2011
Elsevier Ltd.

<12>
Accession Number
2011670868
Title
Effect of simvastatin plus ezetimibe on incidence of major atherosclerotic
events in patients with advanced chronic kidney disease.
Source
Australian Journal of Pharmacy. 92 (1098) (pp 92), 2011. Date of
Publication: November 2011.
Publisher
Australian Pharmaceutical Publishing Company Ltd (40 Burwood Road,
Hawthorn VIC 3122, Australia)

<13>
[Use Link to view the full text]
Accession Number
2011671818
Authors
Altinbas A. Van Zandvoort M.J.E. Van Den Berg E. Jongen L.M. Algra A. Moll
F.L. Nederkoorn P.J. Mali W.P.T.M. Bonati L.H. Brown M.M. Kappelle L.J.
Van Der Worp H.B.
Institution
(Altinbas, Van Zandvoort, Van Den Berg, Jongen, Algra, Moll, Nederkoorn,
Mali, Bonati, Brown, Kappelle, Van Der Worp) Department of Neurology,
Rudolf Magnus Institute of Neuroscience, University Medical Center
Utrecht, PO Box 85500, G03.228, 3508 GA Utrecht, Netherlands
Title
Cognition after carotid endarterectomy or stenting: A randomized
comparison.
Source
Neurology. 77 (11) (pp 1084-1090), 2011. Date of Publication: 13 Sep
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Objective: To compare the effect on cognition of carotid artery stenting
(CAS) and carotid endarterectomy (CEA) for symptomatic carotid artery
stenosis. Methods: Patients randomized to CAS or CEA in the International
Carotid Stenting Study (ICSS; ISRCTN25337470) at 2 participating centers
underwent detailed neuropsychological examinations (NPE) before and 6
months after revascularization. Ischemic brain lesions were assessed with
diffusion-weighted imaging before and within 3 days after
revascularization. Cognitive test results were standardized into z scores,
from which a cognitive sumscore was calculated. The primary outcome was
the change in cognitive sumscore between baseline and follow-up. Results:
Of the 1,713 patients included in ICSS, 177 were enrolled in the 2 centers
during the substudy period, of whom 140 had an NPE at baseline and 120 at
follow-up. One patient with an unreliable baseline NPE was excluded. CAS
was associated with a larger decrease in cognition than CEA, but the
between-group difference was not statistically significant: -0.17 (95% CI
-0.38 to 0.03; p = 0.092). Eighty-nine patients had a pretreatment MRI and
64 within 3 days after revascularization. New ischemic lesions were found
twice as often after CAS than after CEA (relative risk 2.1; 95% CI 1.0 to
4.4; p = 0.041). Conclusions: Differences between CAS and CEA in effect on
cognition were not statistically significant, despite a substantially
higher rate of new ischemic lesions after CAS than after CEA.
Classification of Evidence: This study provides Class III evidence that
any difference between the effects of CAS and CEA on cognition at 6 months
after revascularization is small. 2011 by AAN Enterprises, Inc.

<14>
Accession Number
2011665469
Authors
Mizrak A. Kocamer B. Deniz H. Yendi F. Oner U.
Institution
(Mizrak, Kocamer, Yendi, Oner) Department of Anaesthesiology and
Reanimation, Gaziantep University School of Medicine, Gaziantep University
Medical Faculty, 27310 Sahinbey, Gaziantep, Turkey
(Deniz) Department of Cardiovascular Surgery, Gaziantep University School
of Medicine, 27310 Sahinbey, Gaziantep, Turkey
Title
Cardiovasular changes after placement of a classic endotracheal tube,
double-lumen tube, and Laryngeal Mask Airway.
Source
Journal of Clinical Anesthesia. 23 (8) (pp 616-620), 2011. Date of
Publication: December 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Study Objective: To compare hemodynamic responses, P wave dispersion (Pd),
and QT dispersion (QTd) after placement of a classic endotracheal tube
(ETT), double-lumen tube (DLT), or Laryngeal Mask Airway (LMA). Design:
Prospective study. Setting: Outpatient surgery center. Patients: 75 adult,
ASA physical status 1 and 2 patients undergoing cystoscopy and
thoracoscopic surgery. Interventions: Patients were randomized to undergo
placement of an ETT (Group T; n = 25), DLT (Group D; n = 25), or LMA
(Group L; n = 25). Anesthesia was induced by etomidate 0.3 mg/kg and
fentanyl 1.0 mug/kg, and maintained with nitrous oxide, oxygen, 2% to 3%
sevoflurane, and rocuronium 0.5 mg/kg. Measurements: Mean arterial
pressure (MAP) and heart rate (HR) were recorded immediately before
intubation and after intubation at one, 3, 5, 10,15, 20, 25, and 30
minutes after intubation/airway insertion. Results: QT dispersion after
tube placement was significantly higher than before tube placement in
Group D (P = 0.0001) and Group L (P = 0.03). Mean arterial pressure and HR
in Group T were significantly higher than in Group L at the first minute
after tube placement (P = 0.02). Heart rate and MAP at baseline were
significantly higher than the other measurement times in Groups T and D (P
< 0.01). Conclusions: The LMA caused no change in Pd, HR, or MAP values
during or after airway placement, but caused QTd after airway insertion.
The ETT caused a sudden increase at the first minute after tube placement,
without any Pd or QTd. In addition, DLT caused QTd without any serious
change in hemodynamics. 2011 Elsevier Inc. All rights reserved.

<15>
Accession Number
2011669426
Authors
Sun J.C.J. Teoh K.H.T. Sheth T. Landry D. Jung H. Warkentin T.E. Yusuf S.
Lamy A. Eikelboom J.W.
Institution
(Teoh, Lamy) Division of Cardiac Surgery, McMaster University, Hamilton,
Canada
(Sheth, Yusuf) Division of Cardiology, McMaster University, Hamilton,
Canada
(Landry) Department of Radiology, McMaster University, Hamilton, Canada
(Jung, Yusuf, Lamy, Eikelboom) Population Health Research Institute,
McMaster University, Hamilton, Canada
(Warkentin) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, Canada
(Warkentin, Yusuf, Eikelboom) Department of Medicine, McMaster University,
Hamilton, Canada
Title
Randomized trial of fondaparinux versus heparin to prevent graft failure
after coronary artery bypass grafting: The Fonda CABG study.
Source
Journal of Thrombosis and Thrombolysis. 32 (3) (pp 378-385), 2011. Date
of Publication: October 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
We sought to assess the feasibility of comparing the efficacy and safety
of fondaparinux versus heparin for prevention of graft failure and major
CV events in patients undergoing coronary artery bypass grafting (CABG).
Patients undergoing CABG were randomized to receive postoperative
injections of fondaparinux or heparin in-hospital. After discharge, the
fondaparinux group received fondaparinux and the heparin group received
placebo injections for 30 days post surgery. Efficacy outcomes were graft
failure, death, MI, and stroke at 30 days. Safety outcomes were bleeding,
transfusion, and reoperation. 100 patients were recruited, 99 were
randomized, 49 received fondaparinux and 50 received heparin. CT
angiography was performed in 97%of patients. 188 grafts in the treatment
group and 189 grafts in the heparin group were imaged. A similar
proportion of patients treated with fondaparinux compared with heparin had
at least one occluded graft (18.8%fondaparinux vs. 14.9%heparin, P =0.62)
and a similar number of grafts were occluded in each treatment group (all
grafts: 4.8%vs. 4.8%, P =0.99; saphenous vein grafts 4.2%vs. 4.2%, P
=0.98). There was no difference between treatment groups in death, MI,
stroke, bleeding events, or reoperation. One in 10 patients undergoing
CABG had at least one occluded graft at 30 days and one in 20 grafts is
occluded by 30 days. Fondaparinux appears to be a safe alternative to
heparin after CABG and it is feasible to conduct a definitive RCT using CT
angiography to evaluate the effect of fondaparinux treatment on graft
patency. Springer Science+Business Media, LLC 2011.

<16>
Accession Number
70608625
Authors
Keeping-Burke L. Purden M. Frasure-Smith N. Cossette S. McCarthy F. Amsel
R.
Institution
(Keeping-Burke) University of New Brunswick, Saint John, NB, Canada
(Purden, Frasure-Smith, Amsel) McGill University, Saint John, NB, Canada
(Cossette) Universite de Montreal, Saint John, NB, Canada
(McCarthy) Dalhousie University, Saint John, NB, Canada
Title
Recovery outcomes in coronary artery bypass graft (CABG) surgery patients
following a randomized controlled trial of a telehealth nursing
intervention.
Source
Canadian Journal of Cardiology. Conference: 64th Annual Meeting of the
Canadian Cardiovascular Society, CCS 2011 Vancouver, BC Canada. Conference
Start: 20111022 Conference End: 20111026. Conference Publication:
(var.pagings). 27 (5 SUPPL. 1) (pp S343), 2011. Date of Publication:
September-October 2011.
Publisher
Pulsus Group Inc.
Abstract
Few randomized trials have evaluated clinical outcomes of patients who
receive telehealth. In this study, CABG surgery patients and their
caregivers (n=182) were randomized on the day prior to surgery to receive
either one week of daily home audio-video nursing visits post-discharge or
routine discharge education in hospital. The purpose was to determine
whether a nurse-led telehealth program post-discharge resulted in greater
decreases in anxiety (S-STAI), depression (CESD-10), uncertainty (MUIS),
conflict (IPRI), and health care use, and greater perceptions of personal
and treatment control (IPQ-r) and support (IPRI) for patients who received
the program compared to those who received usual care. Telephone
interviews were conducted the day before surgery and 3 weeks
post-discharge. The data were analyzed using 2x2 analyses of covariance
that assessed main effects of telehealth and patient sex and their
interaction on changes in the outcome variables including baseline scores
as covariates. The findings demonstrated no difference between changes in
anxiety for patients in telehealth versus usual care. However, patients
who received telehealth showed significantly greater reductions in
uncertainty (p=.03), marginally greater improvements in perceived
treatment control (p=.09), and were less likely to contact a physician
(p=.04) compared to the standard care group. This randomized control study
is one of few to assess the benefits of telehealth programs for CABG
surgery patients. Future evaluations of multi-component telehealth
interventions should consider component analyses in order to disentangle
the relationships between the different elements of an intervention and
the effects on patients' recovery outcomes.

<17>
Accession Number
70608382
Authors
Simard T. Hibbert B. Pourdjabbar A. Wilson K. Hawken S. O'Brien E.
Institution
(Simard, Hibbert, Pourdjabbar, Wilson, Hawken, O'Brien) OttawaONCanada
Title
Percutaneous coronary intervention with or without on-site coronary artery
bypass surgery: A meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 64th Annual Meeting of the
Canadian Cardiovascular Society, CCS 2011 Vancouver, BC Canada. Conference
Start: 20111022 Conference End: 20111026. Conference Publication:
(var.pagings). 27 (5 SUPPL. 1) (pp S222), 2011. Date of Publication:
September-October 2011.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Current ACC/AHA guidelines recommend against the performance
of elective or primary PCI without surgical backup (ie. a class III and
IIb recommendation respectively). However, advances in percutaneous
coronary intervention (PCI) have markedly reduced complication rates such
that the need for cardiac surgery on-site (SOS) is unclear. Numerous
centers have already implemented PCI programs with noonsite surgery backup
(NSOS). To evaluate the necessity for SOS, we performed a systematic
review and meta-analysis of studies to determine if SOS conferred clinical
benefit in patients undergoing PCI. METHODS/RESULTS: English-language
articles published from 1966 through December 2010 were retrieved using
keyword searches of Medline and Scopus supplemented by letters to authors
and reviews of all bibliographies. Article inclusion and data extraction
was performed by two independent reviewers. We identified 18 articles (3
case control, 13 cohort, and 2 randomized control studies) published
between 1992 and 2009 which contained reported events on 1,150,200
patients. The combined odds ratio calculated using a random effects model
for death with NSOS was 0.93 (95% CI, 0.80-1.09). In studies with data
reported for primary PCI and elective PCI the OR for death was 0.91 (95%
CI, 0.84-1.00) and 1.04 (95% CI, 0.67-1.63). A lack of significant effect
of SOS was maintained when analysis was performed by study type or when
adjusted for study quality. No differences in rates of emergency coronary
artery bypass grafting or post procedural myocardial infarction were
observed between SOS and NSOS centers. CONCLUSION: Surgical backup on-site
does not confer a mortality benefit in either elective or primary PCI.
Currently available evidence does not support the ACC/AHA recommendations.
Performance of PCI in a NSOS setting appears both feasible and safe.
(Table Presented).

<18>
Accession Number
70608366
Authors
Sawatzky J.V. Christie S. Singal R.K.
Institution
(Sawatzky, Christie, Singal) WinnipegMBCanada
Title
An np managed cardiac surgery follow-up clinic: A randomized controlled
trial demonstrating improved patient outcomes.
Source
Canadian Journal of Cardiology. Conference: 64th Annual Meeting of the
Canadian Cardiovascular Society, CCS 2011 Vancouver, BC Canada. Conference
Start: 20111022 Conference End: 20111026. Conference Publication:
(var.pagings). 27 (5 SUPPL. 1) (pp S213-S214), 2011. Date of
Publication: September-October 2011.
Publisher
Pulsus Group Inc.
Abstract
INTRODUCTION: Advances in technology and peri-operative care have led to
rapid recovery and earlier discharge following cardiac surgery. However,
the limited time for discharge teaching to patients who may not be
cognitively or emotionally able to comprehend and retain the information
can have negative consequences. Furthermore, cardiac surgery patients
experience a variety of health-related issues following discharge.
Nevertheless, the shortened length of stay has generally not been
accompanied by an increased focus on follow-up care. OBJECTIVE: The aim of
this study was to describe and compare the outcomes of a Nurse
Practitioner (NP) managed early post-operative cardiac surgery follow-up
clinic with the standard model of post-discharge follow-up. METHODS: Two
hundred post-operative coronary artery bypass graft (CABG) patients in a
large tertiary centre were randomized to either: 1: an NP initiated
telephone assessment 3 days post-discharge, with additional NP follow-up
clinic visits, teaching, care, and referrals as required; or 2: the
standard model of post-discharge follow-up. RESULTS: The findings, based
on data collected at baseline (prior to discharge) and at 2 additional
intervals post-discharge, revealed that at 2 weeks post-discharge the
intervention group had significantly higher SF-36 physical functioning
scores and lower symptom inventory scores than the control group (P >
0.05). Although baseline differences were non-significant, at 2 and 6
weeks post-discharge the intervention group was more satisfied with the
quality of service compared to the control group. CONCLUSIONS: Early
post-discharge NP managed follow-up care in patients undergoing CABG is
associated with improved physical functioning, decreased symptoms and
increased patient satisfaction. Further development of this concept is
warranted as a potentially significant tool in the ever streamlined
management of these patients. The ongoing development and refinement of
this clinic, including planned clinical and research strategies to improve
health services and quality of life for these patients will be highlighted
in this presentation.

<19>
Accession Number
70608335
Authors
Price J. Naik V. Boodhwani M. Brandys T. Hendry P. Lam B.
Institution
(Price, Naik, Boodhwani, Brandys, Hendry, Lam) BrusselsBelgium
Title
The impact of after-hours simulator practice on performance of vascular
anastomosis during surgical training: A randomized trial.
Source
Canadian Journal of Cardiology. Conference: 64th Annual Meeting of the
Canadian Cardiovascular Society, CCS 2011 Vancouver, BC Canada. Conference
Start: 20111022 Conference End: 20111026. Conference Publication:
(var.pagings). 27 (5 SUPPL. 1) (pp S197), 2011. Date of Publication:
September-October 2011.
Publisher
Pulsus Group Inc.
Abstract
OBJECTIVES: Evidence supporting the benefit of surgical skills practice in
a simulated environment is increasing. However, the use of simulation in
cardiac surgical training has been limited. The purpose of the current
trial was to examine the effect of independent and deliberate simulator
practice, during nonclinical time, on the performance of an end-to-side
microvascular anastomosis in an in-vivo model. METHODS: This
single-blinded, randomized controlled trial received IRB approval.
Thirty-nine first and second year surgical trainees were randomized to an
expert-guided tutorial on a procedural trainer, or the expert-guided
tutorial combined with selfdirected practice on the same procedural
trainer. Self-directed practice consisted of 10 anastomoses performed on
the procedural trainer: a low-fidelity, commercially available bench model
utilizing 4mm PTFE graft as simulated blood vessel. Two weeks after the
tutorial, subjects performed an end-to-side anastomosis in a live porcine
model, under realistic operating room conditions. Assessment of outcomes
was performed by two blinded, expert observers, utilizing validated
measurements of technical skill. The primary outcome was the score on the
Objective Structured Assessment of Technical Skill (OSATS) scale.
Secondary outcomes included an anastomosis-specific end-product evaluation
and time to completion. Statistical analysis was conducted using
non-parametric, univariate techniques. RESULTS: Compared to residents who
received expert-guided simulator training alone, those who in addition
practiced on a simulator independently scored significantly higher on the
OSATS scale (23.7 +/- 4.7 vs. 18.5 +/- 3.9, P = 0.003). Residents who
practiced independently also scored significantly higher on the
end-product evaluation (11.4 +/- 3.2 vs. 8.9 +/- 2.1, P = 0.02) and
performed the anastomosis significantly faster (777 seconds vs. 977
seconds, P = 0.04). These findings were consistent for both first and
second year trainees. Interrater reliability was high between the expert
observers (Intraclass correlation coefficient = 0.8). CONCLUSIONS:
Residents who had the opportunity for self-directed simulator practice
performed an end-to-side anastomosis more adeptly, more quickly and with a
higher quality endproduct. The results of this randomized trial suggest
that independent training on a procedural trainer did transfer to improved
performance in an operating room environment. In an era of increasing work
hour restrictions, simulation represents a valuable alternative
methodology for training surgical skills. Simulator training should be
incorporated into cardiovascular surgical curricula and residents should
have access to this modality after-hours for independent practice to
improve operating room performance.

<20>
Accession Number
70610731
Authors
Nikolaidou V. Petsios K. Matziou V.
Institution
(Nikolaidou, Petsios) Pediatric Cardiosurgical Intensive Care Unit,
Onassis Cardiac Center, Athens, Greece
(Petsios) Faculty of Nursing, National and Kapodistrian University of
Athens, Athens, Greece
(Matziou) Faculty of Nursing, University of Athens, Athens, Greece
Title
Nursing management of postoperative pain in children after cardiac
surgery.
Source
Acta Paediatrica, International Journal of Paediatrics. Conference: 3rd
Excellence in Paediatrics Conference and the 1st PNAE Congress on
Paediatric Nursing Istanbul Turkey. Conference Start: 20111130 Conference
End: 20111203. Conference Publication: (var.pagings). 100 (pp 128-129),
2011. Date of Publication: December 2011.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Postoperative pain management in children is a complex,
multidimensional and subjective phenomenon. During last decades, many
protocols and significant tools have been developed for the management of
pain and a significant number of studies have been published. However,
there are only a limited number of studies for the management of pain in
children after cardiac surgery. Purpose: A systematic review of the
literature concerning the postoperative pain assessment and nursing
management in children after cardiac surgery was performed.
Material-Methods: A systemic review was conducted in international
scientific databases (PUBMED, CINAHL, WEB OF SCIENCE), related to the
management of pain in children after cardiac surgery which were published
after 2000. One hundred and thirty-eight articles were primarily
identified and 38 matched the review criteria and were further analyzed
(19 reviews and 18 studies). Results: Intra and post-operative anaesthesia
and analgesia for children undergoing cardiac surgery are an important
determinant of postoperative recovery. However, limited studies were
focused on postoperative sedation and analgesia within the paediatric
intensive care unit. The postoperative pain management in paediatric
cardiac patients depends from various factors such as the type of surgery,
the incision, the duration of the surgery, the analgesic therapy (type,
dose and frequency) along with the nursing experience and skills. For
example, children with sternal incisions reported significantly more pain
than subjects with submammary incisions and greater amounts of analgesia
were used in children under 3 years of age. Many protocols have been
developed for the administration of systemic and continuous intravenous
analgesic therapy using appropriate pain assessment tools. Morphine and
ketamine are most used for effective and safe analgesia. Conclusions:
There is a clear need for the development of a nursing standard to assess
and manage pain and sedation in this population. The development of
appropriate pain tools can lead to a reliable assessment of postoperative
pain in sedated and intubated children after cardiac surgery.

<21>
Accession Number
70610467
Title
Abstracts from the 2012 Southern Association for Vascular Surgery Annual
Meeting.
Source
Journal of Vascular Surgery. Conference: 2012 Southern Association for
Vascular Surgery Annual Meeting Scottsdale, AZ United States. Conference
Start: 20120118 Conference End: 20120121. Conference Publication:
(var.pagings). 54 (6) , 2011. Date of Publication: December 2011.
Publisher
Mosby Inc.
Abstract
The proceedings contain 54 papers. The topics discussed include:
additional supervised exercise therapy after a percutaneous vascular
intervention for peripheral arterial disease: a randomized clinical trial;
clinical and technical outcomes from a randomized clinical trial of
endovenous laser ablation compared with conventional surgery for great
saphenous varicose veins; staged versus synchronous carotid endarterectomy
and coronary artery bypass grafting: analysis of 10-year nationwide
outcomes; comparative predictors of mortality for endovascular and open
repair of ruptured infrarenal abdominal aortic aneurysms; systematic
review and meta-analysis of growth rates of small abdominal aortic
aneurysms; the von willebrand inhibitor ARC1779 reduces cerebral
embolization after carotid endarterectomy a randomized trial; venous
lower-limb evaluation in patients with acute pulmonary embolism; and iliac
artery recanalization of chronic occlusions to facilitate EVAR - midterm
multicenter results.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

2011-12-17T03:24:00.001-08:00

Total documents retrieved: 11

Results Generated From:
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Embase (updates since 2011-12-08)

<1>
Accession Number
2011675380
Authors
Lehmann N. Paul A. Moebus S. Budde T. Dobos G.J. Michalsen A.
Institution
(Lehmann, Moebus) Institute of Medical Informatics, Biometry and
Epidemiology, University Hospital Essen, Germany
(Paul, Dobos) Department of Internal and Integrative Medicine, Kliniken
Essen-Mitte, Essen, Germany
(Budde) Department of Cardiology, Alfried Krupp Hospital, Essen, Germany
(Michalsen) Institute of Social Medicine, Epidemiology and Health
Economics, Charite-University Medical Centre, Berlin, Germany
(Michalsen) Department of Internal and Integrative Medicine, Immanuel
Hospital Berlin, Berlin, Germany
Title
Effects of lifestyle modification on coronary artery calcium progression
and prognostic factors in coronary patients-3-Year results of the
randomized SAFE-LIFE trial.
Source
Atherosclerosis. 219 (2) (pp 630-636), 2011. Date of Publication:
December 2011.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objective: Given the multimodal medical and interventional treatment
options in coronary artery disease (CAD), the current value of intensified
lifestyle modification remains unclear. No randomized studies have so far
assessed the impact of lifestyle modification on coronary artery calcium
(CAC). We examined the long-term effects of a one-year comprehensive
lifestyle modification on risk factors and CAC by means of a randomized
clinical trial. Methods: 96 participants (age range 35-75 years, 22 women)
of the SAFE-LIFE randomized trial in patients with established CAD
completed 3-year follow-up. The active treatment was a one-year lifestyle
modification and stress reduction intervention (LG), while the control
group received written advice only (AG). CAC (derived from electron beam
tomography), blood lipids, heart rate, blood pressure, anginal symptoms
and quality-of-life were assessed on entry and at 3-year follow-up.
Results: Lifestyle modification had no impact on change of CAC after three
years (median progression factor [25th,. 75th percentile] 1.46 [1.16,.
2.19] in LG and 1.41 [1.20,. 1.79] in AG; p= 0.68), but led to reductions
of blood pressure, heart rate and to dose-reductions in anti-ischemic
medications as compared to AG. Multiple regression analysis indicated that
in the pooled study population increase of CAC was related to psychosocial
factors and heart rate. Conclusion: In the presence of modern treatments,
complementary prescription of comprehensive lifestyle modification has no
impact on CAC progression but sustainable benefit for blood pressure,
heart rate and the need of anti-ischemic medication is demonstrated. A
possible influence of stress reduction measures on CAC progression should
be further evaluated. 2011 Elsevier Ireland Ltd.

<2>
Accession Number
2011664651
Title
Cardiovascular disorders associated with obstructive sleep apnea.
Source
Obstructive Sleep Apnea in Adults: Relationship with Cardiovascular and
Metabolic Disorders. Advances in Cardiology. 46 (pp 197-265), 2011.
Date of Publication: 2011.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Epidemiological, longitudinal and therapeutic studies have produced
convincing evidence that obstructive sleep apnea (OSA) is associated with
an increased risk of cardiovascular morbidity and mortality. The strongest
evidence supports an independent causal link between OSA and arterial
hypertension. OSA may be independently associated with an increased risk
for ischemic heart disease, stroke, arrhythmias and mortality. It remains
to be determined whether OSA is an independent cause of congestive heart
failure and pulmonary hypertension. Confounders and methodological biases
are the main reasons for the lack of definitive conclusions in causality
studies. Longitudinal studies, adequately powered randomized controlled
studies and therapeutic studies involving well-defined participants are
all needed to definitively answer the questions surrounding the
relationship between OSA and clinical cardiovascular outcomes,
comorbidities and intermediate pathogenic mechanisms. OSA is a modifiable
risk factor: continuous positive airway pressure administration, the gold
standard treatment of OSA, may reduce the early signs of endothelial
dysfunction and atherosclerosis, and improve cardiovascular outcomes, such
as the mortality related to cardiovascular events, blood pressure,
nonfatal coronary events and cardiac function in heart failure patients.
However, cardiac patients may not display the typical signs and symptoms
of OSA, such as an excessive body mass index and sleepiness. This fact,
and the cardiovascular risk associated with OSA, underlines the need for
collaborative guidelines to define a diagnostic strategy specifically
oriented toward the evaluation of OSA in cardiovascular patients.
Copyright 2011 S. Karger AG, Basel.

<3>
Accession Number
2011664507
Authors
Poncelet A.J. van Steenberghe M. Moniotte S. Detaille T. Beauloye C.
Bertrand L. Nassogne M.-C. Rubay J.E.
Institution
(Poncelet, van Steenberghe, Rubay) Cardiac Surgery Department, Universite
catholique de Louvain, Cliniques universitaires Saint-Luc, Avenue
Hippocrate 10, B-1200 Brussels, Belgium
(Moniotte) Pediatric Cardiology Department, Universite catholique de
Louvain, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, B-1200
Brussels, Belgium
(Detaille) Intensive Care Department, Universite catholique de Louvain,
Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, B-1200 Brussels,
Belgium
(Beauloye, Bertrand) Division of Cardiology, Universite catholique de
Louvain, Avenue Hippocrate 55, B-1200 Brussels, Belgium
(Nassogne) Pediatric Neurology Department, Universite catholique de
Louvain, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, B-1200
Brussels, Belgium
Title
Cardiac and neurological assessment of normothermia/warm blood
cardioplegia vs hypothermia/cold crystalloid cardioplegia in pediatric
cardiac surgery: Insight from a prospective randomized trial.
Source
European Journal of Cardio-thoracic Surgery. 40 (6) (pp 1384-1390), 2011.
Date of Publication: December 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Although normothermia and warm blood cardioplegia are widely
used in adults, cold crystalloids and hypothermia remain routinely used in
pediatric cardiac surgery. The superiority of either technique in both
brain and myocardial protection remains controversial. We designed a
prospective randomized study to compare both approaches in terms of early
myocardial protection and late neurodevelopmental status. Methods: From
2004 to 2005, 47 patients were randomly assigned to either mild
hypothermia associated to cold crystalloid cardioplegia (CCC, 22 patients)
or normothermia with intermittent warm blood cardioplegia (IWBC, 25
patients). Intramyocyte adenosine triphosphate (ATP) was measured before,
during and after cardioplegic arrest and results between groups were
compared. In addition to their cardiac status, early and late neurologic
assessment was performed by psychometric evaluation tests. Results:
Intracellular ATP levels were not significantly different between the two
groups. However, intragroup comparison revealed different profiles
according to myocardial protection: in the normothermia/warm blood
cardioplegia group, ATP concentration increased during cardioplegic arrest
and returned to initial values afterward (11nmolmg-1 vs
21nmolmg-1 vs 10nmolmg-1, p<0.001), such changes did
not occur in the cold protocol (17nmolmg-1 vs
19nmolmg-1 vs 14nmolmg-1, p=NS). Early neurological
outcome was similar in both groups. At late follow-up (mean=4 years), no
significant difference was observed between the two groups. Conclusions:
This study demonstrates that normothermia/IWBC protocols are not
deleterious when compared with more conventional approaches. A more
physiologic ATP steady state, reflecting the absence of cellular ischemic
insult was observed in the IWBC group. Importantly, no significant
difference was found between IWBC and CCC groups in terms of early and
late neurodevelopmental status. 2011 European Association for
Cardio-Thoracic Surgery.

<4>
Accession Number
2011667115
Authors
Mahmoudi M. Delhaye C. Waksman R.
Institution
(Mahmoudi, Delhaye, Waksman) Division of Cardiology, Department of
Internal Medicine, Washington Hospital Center, Washington, DC 20010,
United States
Title
Safety and efficacy of drug-eluting stents and bare metal stents in acute
coronary syndrome.
Source
Cardiovascular Revascularization Medicine. 12 (6) (pp 385-390), 2011.
Date of Publication: November 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Compared with medical therapy, percutaneous coronary intervention has been
shown to reduce the rates of death and recurrent ischemia in patients
presenting with acute coronary syndromes (ACS). In the current
interventional era, both drug-eluting stents (DES) and bare-metal stents
(BMS) have been widely used, despite the fact that the use of DES in the
context of ACS was initially an "off-label" indication and that ACS has
been associated with stent thrombosis (ST). In contrast to the wealth of
data available for the use of DES in patients with ST-elevation myocardial
infarction, data regarding the performance of DES in non-ST-elevation ACS
is restricted to a handful of registries with conflicting data. The aim of
this review was to summarize the safety and efficacy of DES in the entire
spectrum of ACS. 2011.

<5>
Accession Number
2011666593
Authors
DeRossi R. Frazilio F.O. Jardim P.H.A. Martins A.R.C. Schmidt R.
Negrini-Neto J.M.
Institution
(DeRossi) Departments of Veterinary Medicine, Surgery and Anesthesiology,
Faculty of Veterinary Medicine and Animal Science, Federal University of
Mato Grosso do Sul, Campo Grande, MS, Brazil
(Jardim, Schmidt, Negrini-Neto) Veterinary Medicine, Faculty of Veterinary
Medicine and Animal Science, Federal University of Mato Grosso do Sul,
Campo Grande, MS, Brazil
(Frazilio, Martins) Department of Anesthesiology, School of Medicine, Sao
Paulo University, Sao Paulo, Brazil
Title
Evaluation of thoracic epidural analgesia induced by lidocaine, ketamine,
or both administered via a lumbosacral approach in dogs.
Source
American Journal of Veterinary Research. 72 (12) (pp 1580-1585), 2011.
Date of Publication: December 2011.
Publisher
American Veterinary Medical Association (1931 N. Meacham Road, Suite 100,
Schaumburg IL 60173-4360, United States)
Abstract
Objective-To determine the analgesic and systemic effects of thoracic
epidural administration of ketamine, lidocaine, or both in conscious dogs.
Animals-6 adult mixed-breed dogs. Procedures-Each dog received 2%
lidocaine hydrochloride without epinephrine (3.8 mg/ kg), 5% ketamine
hydrochloride (3.0 mg/kg), or both in randomized order with >= 1 week
between treatments. Drugs were administered in a total volume of 0.25
mL/kg through a thoracic epidural catheter implanted via the lumbosacral
approach. Heart rate, blood pressure, respiratory rate, rectal
temperature, analgesia, sedation, and ataxia were determined before
treatment (baseline [time 0]) and at 5, 10, 15, 20, 30, 40, 50, 60, 90,
120, 150, and 180 minutes after administration. Results-The main areas of
analgesia for the 3 treatments were the thorax and forelimbs bilaterally.
Median duration of analgesia was shorter after administration of ketamine
(30 minutes) than after administration of lidocaine (40 minutes) and
lidocaine plus ketamine (90 minutes). All treatments caused moderate motor
blockade, and only the ketamine and lidocaine plus ketamine treatments
caused mild sedation. Significant decreases in systolic and mean arterial
blood pressure were observed only with the lidocaine plus ketamine
treatment. Conclusions and Clinical Relevance-Thoracic epidural
administration of lidocaine plus ketamine resulted in longer duration of
analgesia of the thorax and forelimbs bilaterally in conscious dogs,
compared with administration of ketamine or lidocaine alone. Additional
studies are needed to determine whether this technique adequately relieves
postoperative pain after thoracic surgical procedures and whether it
causes respiratory depression in dogs.

<6>
Accession Number
2011652360
Authors
Du J. Huang Y.-G. Yu X.-R. Zhao N.
Institution
(Du) Department of Anaesthesiology, Subei People's Hospital, Yangzhou
University, Yangzhou, Jiangsu 225001, China
(Huang, Yu) Department of Anaesthesiology, Peking Union Medical College
Hospital, Beijing 100730, China
(Zhao) Department of Anaesthesiology, First Hospital, Qinghua University,
Beijing 100016, China
Title
Effects of preoperative ketamine on the endocrine-metabolic and
inflammatory response to laparoscopic surgery.
Source
Chinese Medical Journal. 124 (22) (pp 3721-3725), 2011. Date of
Publication: 20111120.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Ketamine is hypothesized to reduce perioperative
endocrine-metabolic and inflammatory responses in cardiac surgery
patients. This randomized, placebo-controlled, double-blind study was
performed to determine whether perioperative endocrine-metabolic and
inflammatory responses are attenuated by preoperative administration of
ketamine to healthy females receiving elective laparoscopic surgery.
Methods Forty female patients with American Society of Anesthesiologist
classification I or II who elected to receive gynecological laparoscopic
surgery were randomly assigned to the ketamine-treated (group K; n = 20)
or control (group C; n = 20) group. At 2 minutes prior to induction
patients in group K received ketamine (0.25 mg/kg) whereas those in group
C received normal saline. All patients received standardized general
anesthesia. Serum glucose and cortisol values were measured before
ketamine administration (T0), 2 minutes after tracheal intubation (T1), 30
minutes after skin incision (T2), 2 minutes after tracheal extubation (T3)
and 1 hour postoperatively (T4). Serum interleukin-6 and tumor necrosis
factor-alpha values were determined at T0 and T4. Postoperative analgesic
efficacy, side effects of administered drugs, and time to discharge were
recorded. Results Compared with subjects in group C, those in group K had
lower serum glucose values at T1, T2, T3 and T4 and lower serum cortisol
values at T4 (P <0.05). Postoperative interleukin-6 and tumor necrosis
factor-alpha concentrations for group K were lower than those for group C
(P <0.05). Postoperative visual analog scale scores at rest, cumulative
fentanyl consumption, and time to discharge were lower in group K as
compared to group C (P <0.05). No significant differences in drug side
effects were observed postoperatively between the two groups. Conclusion
Endocrine-metabolic and inflammatory responses to laparoscopic surgery are
attenuated in part by pre-incisional administration of ketamine.

<7>
Accession Number
2011671288
Authors
Nijjer S.S. Watson G. Athanasiou T. Malik I.S.
Institution
(Nijjer, Watson, Malik) Cardiology Department, Cardiovascular Sciences and
the Renal Institute, Hammersmith Hospital Campus, Du Cane Road, London W12
0HS, United Kingdom
(Athanasiou) Department of Surgery and Cancer, St Mary's Hospital Campus,
Imperial College London, United Kingdom
Title
Safety of clopidogrel being continued until the time of coronary artery
bypass grafting in patients with acute coronary syndrome: A meta-analysis
of 34 studies.
Source
European Heart Journal. 32 (23) (pp 2970-2988), 2011. Date of
Publication: December 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Guidelines suggest that patients should discontinue clopidogrel for 5
days prior to coronary artery bypass grafting (CABG) where possible. Those
with acute coronary syndrome (ACS) are at elevated risk of further
myocardial infarction (MI) and death without clopidogrel. This
meta-analysis Aims to determine the risk of CABG in ACS patients while
continuing clopidogrel. Method and results Thirty-four studies with 22 584
patients undergoing CABG were assessed. Patients with recent clopidogrel
exposure (CL) were compared with those without recent clopidogrel (NC).
Although mortality is increased in CL vs. NC [odds ratio (OR) 1.6, 95 CI
1.301.96, P < 0.00001], it is influenced by the ACS status and case
urgency in these mainly non-randomized studies. In ACS patients, there is
no significant difference in mortality (OR 1.44, 95 CI 0.972.1, P = 0.07)
or in postoperative MI (OR 0.57, 95 CI 0.311.07, P = 0.08) and stroke
rates (OR 1.23, 95 CI 0.662.29, P = 0.52). Combined major adverse
cardiovascular event (stroke, MI, and death) was not different in the two
groups (OR 1.10, 95 CI 0.871.41, P = 0.43). Reoperation rates are elevated
on clopidogrel but have reduced over time, and were specifically not
different in ACS patients (OR 1.5, 95 CI 0.882.54, P = 0.13). Conclusion
Previous studies focused on surrogate endpoints and compared higher risk
ACS patients with elective cases. However, many patients have safely
undergone CABG on clopidogrel and surgical expertise is growing.
Multinational trials are required to fully determine the balance of
ischaemia and bleeding. While results are awaited we suggest ACS patients
requiring urgent CABG proceed with surgery without delay for a
clopidogrel-free period. 2011 The Author.

<8>
Accession Number
2011658166
Authors
Restrepo R.D. Wettstein R. Wittnebel L. Tracy M.
Institution
(Restrepo, Wettstein, Wittnebel) Department of Respiratory Care, The
University of Texas Health Sciences Center at San Antonio, San Antonio,
TX, United States
(Tracy) Department of Respiratory Therapy, Rainbow Babies and Children's
Hospital, Cleveland, OH, United States
Title
Incentive Spirometry: 2011.
Source
Respiratory Care. 56 (10) (pp 1600-1604), 2011. Date of Publication:
October 2011.
Publisher
Daedalus Enterprises Inc. (9425 North MacArthur Blvd, Suite 100, Irving TX
75063, United States)
Abstract
We searched the MEDLINE, CINAHL, and Cochrane Library databases for
articles published between January 1995 and April 2011. The update of this
clinical practice guideline is the result of reviewing a total of 54
clinical trials and systematic reviews on incentive spirometry. The
following recommendations are made following the Grading of
Recommendations Assessment, Development, and Evaluation (GRADE) scoring
system. 1: Incentive spirometry alone is not recommended for routine use
in the preoperative and postoperative setting to prevent postoperative
pulmonary complications. 2: It is recommended that incentive spirometry be
used with deep breathing techniques, directed coughing, early
mobilization, and optimal analgesia to prevent postoperative pulmonary
complications. 3: It is suggested that deep breathing exercises provide
the same benefit as incentive spirometry in the preoperative and
postoperative setting to prevent postoperative pulmonary complications. 4:
Routine use of incentive spirometry to prevent atelectasis in patients
after upper-abdominal surgery is not recommended. 5: Routine use of
incentive spirometry to prevent atelectasis after coronary artery bypass
graft surgery is not recommended. 6: It is suggested that a
volume-oriented device be selected as an incentive spirometry device.
2011 Daedalus Enterprises.

<9>
Accession Number
70604268
Authors
Guay J.Y.
Institution
(Guay) Maisonneuve-Rosemont Hospital, University of Montreal, Montreal,
QC, Canada
Title
General anesthesia does not contribute to long term postoperative
cognitive dysfunction in adults: A meta-analysis.
Source
Anesthesia and Analgesia. Conference: 2011 Annual Meeting of the
International Anesthesia Research Society, IARS 2011 Vancouver, BC Canada.
Conference Start: 20110521 Conference End: 20110524. Conference
Publication: (var.pagings). 112 (5 SUPPL. 1) , 2011. Date of
Publication: May 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction : This is a meta-analysis evaluating the effects of the
anesthetic technique (regional vs. general anesthesia) on postoperative
cognitive dysfunction of patients undergoing noncardiac surgery. Methods :
A search for randomized controlled trials (RCT) comparing regional
anesthesia to general anesthesia for surgery was done in the American
National Library of Medicine's PUBMED in August 2009, in MEDLINE 1950 to
July 2009, 31; EMBASE 1980 to 2009 Week 32; EBM Reviews-Cochrane Central
Register of Controlled Trials 3rd Quarter 2009; PsychINFO 1806 to August
Week 1, 2009; Current Contents/All Editions 1993 Week 27 to 2009 Week 33.
Results : Twenty-six RCTs including 2365 patients: 1169 for regional
anesthesia and 1196 for general anesthesia were retained. The standardized
difference1 in means for the tests included in the 26 RCTs was
-0.08 (95% Confidence Interval: -0.17 to 0.01; P value 0.094; I-squared =
0.00%). The assessor was blinded to the anesthetic technique for 12 of the
RCTs only including 798 patients: 393 for regional anesthesia and 405 for
general anesthesia. The standardized difference in means for these 12
studies is 0.05 (-0.10 to 0.20; P = 0.51; I-squared = 0.00%). Discussion :
The present meta-analysis does not support the concerns that a single
exposure to general anesthesia in an adult would significantly contribute
to permanent postoperative cognitive dysfunction after non-cardiac
surgery. (Table presented) .

<10>
Accession Number
70603954
Authors
Gatling J. Horricks J.E. Lauer R. Jamison R. Kim U. Applegate R.L.
Institution
(Gatling, Horricks, Lauer, Jamison, Applegate) Department of
Anesthesiology, Loma Linda University, School of Medicine, Loma Linda, CA,
United States
(Kim) Loma Linda University, School of Medicine, Loma Linda, CA, United
States
Title
Impact of tranexamic acid or epsilon aminocaproic acid on blood loss in
cardiac surgery: A randomized controlled trial.
Source
Anesthesia and Analgesia. Conference: 2011 Annual Meeting of the
International Anesthesia Research Society, IARS 2011 Vancouver, BC Canada.
Conference Start: 20110521 Conference End: 20110524. Conference
Publication: (var.pagings). 112 (5 SUPPL. 1) , 2011. Date of
Publication: May 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction : Antifibrinolytics are routinely used for surgery with
cardiopulmonary bypass (CPB). Epsilon aminocaproic acid (E) and tranexamic
acid (T) have been shown to reduce bleeding and blood transfusion in this
population. While both have shown benefit compared to placebo, few studies
have directly compared them. Methods : IRB approved, double blind,
randomized trial (NCT01248104) comparing impact of E or T on blood loss
following CPB, in consenting adults undergoing primary cardiac surgery.
Exclusions included multiple valve, ascending aorta reconstruction or
repeat sternotomy procedures. After induction of anesthesia: E received
100 mg/kg given over 15 minutes, followed by infusion of 10 mg/kg/hr; T
received 10 mg/kg over 15 min, followed by infusion of 1 mg/kg/hr. This
dosing reflects the relative potency of T to E. Infusions were continued
throughout surgery until 4 hours after separation from CPB. Drugs were
delivered in a blinded fashion in identical volumes and infusion rates
based on patient weight. All other care decisions such as invasive
monitoring, anesthetic technique, transfusion decisions, and postoperative
care were at the discretion of the attending physicians. Data collection
included demographics, type of surgery, duration of CPB/surgery and
outcomes including ventilator hours and length of stay. Impact on blood
loss was determined by POD2 change in Hb and RBC volume (estimated blood
volume*hematocrit change + PRBC*0.55; includes impact of blood loss and
transfusion following CPB). Statistical analysis with p<0.05 considered
significant was performed using JMP 8.0.2. Continuous data were compared
using the t-test. Ordinal and nominal data were compared using Chi-Square.
Results : Data from 51 patients (E=26; T=25) have been analyzed to date.
There were no intergroup differences in age, gender, BMI, baseline lab
values or surgery duration. Perioperative risk assessed by P-POSSUM was
numerically higher in E. Outcome measures were numerically worse in T
(Table 1) but did not reach statistical significance. Discussion : These
results suggest E and T may have different impacts on outcome after CPB.
While only 27% of subjects were transfused, lower than reported in a
recent comparison, T had a larger decrease in Hb with a larger decrease in
PRBC volume by POD2 despite more frequent and larger average volume PRBC
transfusion. Assessment of blood loss following CPB may be improved by
calculating change in Hb or RBC volume, since these reflect the result of
both blood loss and transfusion and may be less affected by differences in
blood volume.

<11>
Accession Number
70601611
Authors
Hartog C.S. Vlasakov V. Thomas-Rueddel D.O. Rueddel H. Hutagalung R.
Reinhart K.
Institution
(Hartog, Vlasakov, Thomas-Rueddel, Rueddel, Hutagalung, Reinhart)
Department of Anesthesiology and Intensive Care Medicine, Jena University
Hospital, Jena, Germany
(Hartog, Thomas-Rueddel, Rueddel, Reinhart) Center for Sepsis Control and
Care, Jena University Hospital, Jena, Germany
Title
Efficacy and safety of gelatin for fluid therapy in hypovolemia: A
systematic review and meta-analysis.
Source
Critical Care. Conference: Sepsis 2011 Beijing China. Conference Start:
20111026 Conference End: 20111028. Conference Publication: (var.pagings).
15 (pp S24), 2011. Date of Publication: 27 Oct 2011.
Publisher
BioMed Central Ltd.
Abstract
Introduction Gelatin is frequently used as volume expander. There are
growing concerns about safety. Objective To systematically assess clinical
evidence concerning mortality, coagulation and renal function. Methods
Systematic review of randomised controlled trials (RCT) on gelatin in
hypovolemia in comparison to any other fluid with a comprehensive search
strategy (Ovid Medline (1948 to May 2011), EMBASE (1947 to May 2011),
Cochrane Library). Data were independently extracted and risk of bias
assessed using the 2010 Cochrane tool. Primary outcome was overall
mortality. Secondary outcomes were the number of patients exposed to
allogeneic transfusion, frequency of renal replacement therapy (RRT) or
acute renal failure (ARF). Albumin and crystalloid solutions were defi ned
as suitable, and other synthetic colloids as unsuitable control fluids
since they carry similar risk of side effects. Relative risks (RR) and
weighted mean differences with 95% CIs were calculated. Data were pooled
using a random-effects model (RevMan 5.1, Cochrane Collaboration). Results
The search yielded 1,288 citations, 210 reports were read in full. The fi
nal sample contained 72 RCT in English, German, French and Italian,
published between 1975 and 2010, with 5,915 patients overall, 2,523 of
which received gelatin. The median sample size in the gelatin groups was
20 patients (range 10 to 249). In 53 RCT (74%), the study period was
<=24.0 hours. Total gelatin dose was 20 ml/kg (median, range 6 to 62).
Only 38 RCT (53%) used suitable control fluids. Fortynine RCT (68%)
investigated elective surgical patients, mostly from cardiac surgery (32
RCT, 44%). Nine RCT (13%) investigated critically ill patients, six RCT
(8%) were in emergency patients and seven RCT (10%) were in children. The
RR for mortality was 1.02 (CI 0.87 to 1.19, data from 23 RCT with 2,694
patients which reported mortality). Numbers of patients exposed to
allogeneic transfusions were provided in 11 RCT, n = 1,148 patients and
the RR was 1.16 (0.94 to 1.44). When only studies with suitable control
fluids were included, the RR for mortality was 1.13 (0.88 to 1.46, 10 RCT,
1,392 patients) and risk for transfusion exposure was 1.35 (0.88 to 2.08,
seven RCT, n = 672), tending towards control. Only six RCT (n = 662
patients) reported the occurrence of RRT or ARF, fi ve of them in
comparison with HES solutions. Three RCT reported anaphylactoid events.
Conclusion Most published studies on gelatin are small and shorttime, use
unsuitable control fluids and report too few events to reliably assess the
safety of gelatin.