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<1>
Accession Number
2009611352
Authors
Abid A.R. Farogh A. Naqshband M.S. Akhtar R.P. Khan J.S.
Institution
(Abid) Department of Cardiology, Punjab Institute of Cardiology, Lahore,
Pakistan.
(Farogh, Akhtar, Khan) Department of Cardiac Surgery, Punjab Institute of
Cardiology, Lahore, Pakistan.
(Naqshband) Department of Research and CME, Punjab Institute of
Cardiology, Lahore, Pakistan.
Title
Hospital outcome of coronary artery bypass grafting and coronary
endarterectomy.
Source
Asian Cardiovascular and Thoracic Annals. 17(1)(pp 59-63), 2009. Date of
Publication: 2009.
Publisher
SAGE Publications Inc.
Abstract
To compare hospital mortality and postoperative complications in patients
with severe coronary artery disease undergoing coronary artery bypass
grafting with or without coronary endarterectomy, 100 consecutive patients
were divided into 2 groups of 50 patients each. Group 1 had coronary
endarterectomy, and group 2 had no coronary endarterectomy. There were 87
men and 13 women, with a mean age of 54.79+/-7.8 years; 48% had stable
angina. The right coronary artery was endarterectomized in 22 patients,
the left anterior descending artery in 21, and the left circumflex in 7.
There were no significant differences in outcomes. There was 1 hospital
death in each group. Perioperative myocardial infarction occurred in 2
patients in group 1 and 1 in group 2. Endarterectomy is a suitable option
to achieve complete revascularization in patients with refractory angina
and severe diffuse disease. copyright SAGE Publications 2009.
<2>
Accession Number
2009592387
Authors
Kojuri J. Mahmoodi Y. Jannati M. Shafa M. Ghazinoor M. Sharifkazemi M.B.
Institution
(Kojuri, Mahmoodi, Sharifkazemi) Deapartment of Cardiology, Shiraz
University of Medical Sciences, Namazi Hospital, Shiraz, Iran, Islamic
Republic of.
(Jannati, Shafa, Ghazinoor) Cardiac Surgery Ward, Namazi Hospital, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of.
Title
Ability of amiodarone and propranolol alone or in combination to prevent
post-coronary bypass atrial fibrillation.
Source
Cardiovascular Therapeutics. 27(4)(pp 253-258), 2009. Date of
Publication: Winter 2009.
Publisher
Blackwell Publishing Ltd
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in coronary artery
bypass grafting (CABG) patients. The purpose of this study was to
determine the best prophylaxis for AF prior to CABG. In this double-blind
randomized study, 240 consecutive patients underwent elective CABG. They
were then divided randomly into three groups to receive propranolol (n =
80), amiodarone (n = 80), or both drugs (n = 80). All groups received
their medications from preoperative day 7 to post-CABG day 5. The patients
were well matched for age, sex, risk factors, comorbidities, ejection
fraction, and cardioplegic technique. Post-CABG AF developed in 22
patients (9.2%) of whom 13 (16.3%) had received propranolol, 5 (6.3%) had
received amiodarone, and 4 (5%) had received both drugs. The difference
between the propranolol group and the other two groups was statistically
significant (P = 0.02), but that between the amiodarone and amiodarone +
propranolol group was not significant. Age was a significant predictor of
post-CABG AF (P = 0.034). Other factors such as diabetes, sex,
hyperlipidemia, smoking, hypertension, family history, cerebrovascular
accidents, left atrial size, and ejection fraction were not significant
predictors of post-CABG AF. Preoperative amiodarone or amiodarone with
propranolol were more effective than propranolol in reducing the frequency
of AF. There was a strong relationship between age and the development of
AF. (Clinicaltrial.gov registration NCT00654290.) copyright 2009 Blackwell
Publishing Ltd.
<3>
Accession Number
2009605548
Authors
Moreira D.M. Vieira J.L. Mascia Gottschall C.A.
Institution
(Moreira, Vieira, Mascia Gottschall) Instituto de Cardiologia do Rio
Grande do Sul, Porte Alegro, Brazil.
Title
The Effects of METhotrexate Therapy on the Physical Capacity of Patients
With ISchemic Heart Failure: A Randomized Double-Blind, Placebo-Controlled
Trial (METIS Trial).
Source
Journal of Cardiac Failure. 15(10)(pp 828-834), 2009. Date of
Publication: December 2009.
Publisher
Churchill Livingstone Inc.
Abstract
Background: The cytokine hypothesis suggests that there is an association
between chronic heart failure (CHF) and inflammation. Methotrexate could
improve CHF patients' clinical status, especially those with ischemic
etiology. Methods and Results: METIS is a randomized, double-blinded trial
studying 50 patients with ischemic CHF given methotrexate (7.5 mg) or
placebo, plus folic acid (5 mg), for 12 weeks. The primary end point was
the difference in 6-minute walk test (6MWT) distance before and after
treatment. We also evaluated functional class (NYHA), Short-Form 36
protocol quality of life, C-reactive protein (CRP), incidence of adverse
effects, and the combined incidence of death, myocardial infarction,
stroke, hospitalization, and need for myocardial revascularization. There
was no significant difference between groups in distance covered in the
6MWT: the methotrexate group improved by 24.5 +/- 39.5 m, the placebo
group by 21.3 +/- 43.7 m (P = .80). The NYHA scores improved in 66.7% of
the methotrexate group patients and in 50.0% of the placebo group (P =
.2). SF-36 scores indicated improved mental health in the placebo group.
There were no significant differences in CRP levels, the combined outcome,
or adverse events. Conclusions: These results show that the methotrexate
group tended toward improved NYHA scores and that there were no
significant changes in 6MWT results or secondary assessments. copyright
2009 Elsevier Inc. All rights reserved.
<4>
Accession Number
2009584886
Authors
Fleischer S. Berg A. Neubert T.R. Koller M. Behrens J. Becker R. Horbach
A. Radke J. Rothmund M. Kuss O.
Institution
(Fleischer, Berg, Behrens) Institute of Health and Nursing Science,
Medical Faculty, Martin-Luther-University Halle-Wittenberg, Germany.
(Neubert, Becker) Department of Nursing Research, University Hospital
Giessen and Marburg, Marburg, Germany.
(Koller) Center for Clinical Trials, University Hospital Regensburg,
Germany.
(Horbach) Sana Herzchirurgische Klinik Stuttgart, Germany.
(Horbach) Department 4: Health and Social Work, University of Applied
Sciences, Frankfurt/Main, Germany.
(Radke) Department of Anesthesiology and Intensive Care Medicine,
University Hospital, Martin-Luther-University Halle-Wittenberg, Germany.
(Rothmund) Institute for Theoretical Surgery/Department of Visceral,
Thoracic and Vascular Surgery, University Hospital Giessen and Marburg,
Location Marburg, Germany.
(Kuss) Institute of Medical Epidemiology, Biostatistics, and Informatics,
Medical Faculty, Martin-Luther-University Halle-Wittenberg, Germany.
Title
Structured information during the ICU stay to reduce anxiety: Study
protocol of a multicenter randomized controlled trial.
Source
Trials. 10(pp 84), 2009. Article Number: 1745. Date of Publication: 14
Sep 2009.
Publisher
BioMed Central Ltd.
Abstract
Background: ICU stay is often associated with negative experiences for the
individual patient. Many patients are disabled and their communication is
restricted during the ICU stay. Specific information on procedures,
sensations and coping behavior are thought to reduce anxiety on the ICU.
Until now information programs to reduce anxiety were mainly delivered
preoperatively, completely neglecting informational needs of non-elective
ICU patients. Methods: The trial is designed as a prospective multicenter
randomized controlled trial in the cities of Marburg, Halle and Stuttgart.
Elective and non-elective ICU patients will be included. The trial
includes an intervention and a control group on the ICU. The control group
receives a trivial conversation without any ICU-specific information. The
intervention group receives an information program with specific
procedural, sensory and coping information about their ICU stay. Both
conversations take place in the ICU and are planned to take about 10
minutes. Discussion: In contrast to former trials on information programs
on the ICU-stay our intervention will take place in the ICU itself. This
approach will ensure to compensate for memory effects due to anesthesia or
preoperative stress. Further the results will be applicable to
non-elective ICU-patients. Trial Registration: ClinicalTrials NCT00764933.
copyright 2009 Fleischer et al; licensee BioMed Central Ltd.
<5>
Accession Number
2009598172
Authors
Goland S. Czer L.S.C. Siegel R.J. DeRobertis M.A. Mirocha J. Zivari K.
Kass R.M. Raissi S. Fontana G. Cheng W. Trento A.
Institution
(Goland, Czer, Siegel, DeRobertis, Mirocha, Zivari, Kass, Raissi, Fontana,
Cheng, Trento) Divisions of Cardiology and Cardiothoracic Surgery,
Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
Title
Coronary revascularization alone or with mitral valve repair: Outcomes in
patients with moderate ischemic mitral regurgitation.
Source
Texas Heart Institute Journal. 36(5)(pp 416-424), 2009. Date of
Publication: 2009.
Publisher
Texas Heart Institute
Abstract
We sought to evaluate retrospectively the outcomes of patients at our
hospital who had moderate ischemic mitral regurgitation and who underwent
coronary artery bypass grafting (CABG) alone or with concomitant mitral
valve repair (CABG+MVr). A total of 83 patients had a reduced left
ventricular ejection fraction and moderate mitral regurgitation: 28
patients underwent CABG +MVr, and 55 underwent CABG alone. Changes in
mitral regurgitation, functional class, and left ventricular ejection
fraction were compared in both groups. The mean follow-up was 5.1 +/- 3.6
years (range, 0.1-15.1 yr). Reduction of 2 mitral-regurgitation grades was
found in 85% of CABG+MVr patients versus 14% of CABG-only patients (P
<0.0001) at 1 year, and in 56% versus 14% at 5 years, respectively
(P=0.1), as well as improvements in left ventricular ejection fraction and
functional class. One- and 5-year survival rates were similar in the CABG
+MVr and CABG-only groups: 96% +/- 3% versus 96% +/- 4%, and 87% +/- 5%
versus 81% +/- 8%, respectively (P=NS). Propensity analysis showed similar
results. Recurrent (3+ or 4+) mitral regurgitation was found in 22% and
47% at late follow-up, respectively. In patients with moderate ischemic
mitral regurgitation, either surgical approach led to an improvement in
functional class. Early and intermediate-term mortality rates were low
with either CABG or CABG +MVr. However, an increased rate of late
recurrent mitral regurgitation in the CABG+MVr group was observed.
copyright 2009 by the Texas Heart Institute.
<6>
Accession Number
2009592069
Authors
Levy J.H. Gill R. Nussmeier N.A. Olsen P.S. Andersen H.F. Booth F.V.McL.
Jespersen C.M.
Institution
(Levy) Department of Cardiothoracic Anesthesiology and Critical Care,
Emory University School of Medicine, Emory Healthcare, Atlanta, GA, United
States.
(Gill) Southampton Hospital, Southampton, United Kingdom.
(Nussmeier) Department of Anesthesiology, SUNY Upstate Medical University,
Syracuse, NY, United States.
(Olsen) Department of Cardiothoracic Surgery, Rigshospitalet, University
of Copenhagen, Denmark.
(Andersen, Jespersen) Novo Nordisk A/S, Bagsvaerd, Denmark.
(Booth) Novo Nordisk, Princeton, NJ, United States.
Title
Repletion of factor XIII following cardiopulmonary bypass using a
recombinant A-subunit homodimer: A preliminary report.
Source
Thrombosis and Haemostasis. 102(4)(pp 765-771), 2009. Date of
Publication: October 2009.
Publisher
Schattauer GmbH
Abstract
Bleeding following cardiac surgery involving cardiopulmonary bypass (CPB)
remains a major concern. Coagulation factor XIII (FXIII) functions as a
clot-stabilising factor by cross-linking fibrin. Low post-operative levels
of FXIII correlate with increased post-operative blood loss. To evaluate
preliminary safety and pharmacokinetics of recombinant FXIII (rFXIII-A2)
in cardiac surgery, patients scheduled for coronary artery bypass grafting
were randomised to receive a single dose of either rFXIII-A2 (11.9, 25, 35
or 50 IU/kg) or placebo in a 4:1 ratio. Study drug was given post-CPB
within 10 to 20 minutes after first protamine dose. Patients were
evaluated until day 7 or discharge, with a follow-up visit at weeks 5-7.
The primary end-point was incidence and severity of adverse events.
Thirty-five patients were rando-mised to rFXIII-A2 and eight to placebo.
Eighteen serious adverse events were reported. These were all
complications well recognised during cardiac surgery. Although one patient
required an implantable defibrillator, all recovered without sequelae. One
myocardial infarction in a patient receiving 35 IU/ kg rFXIII-A2 was
identified by the Data Monitoring Committee after reviewing ECGs and
cardiac enzymes. No other thromboembolic events were seen. Dosing with
25-50 IU/kg rFXIII-A2 restored levels of FXIII to pre-operative levels,
with a tendency towards an overshoot in receiving 50 IU/kg. rFXIII-A2, in
doses from 11.9 IU/kg up to 50 IU/kg, was well tolerated. For
post-operative FXIII replenishment, 35 IU/kg of rFXIII-A 2 may be the most
appropriate dose. copyright 2009 Schattauer GmbH.
<7>
Accession Number
2009579363
Authors
Bernhardt P. Spiess J. Levenson B. Pilz G. Hofling B. Hombach V. Strohm O.
Institution
(Bernhardt, Spiess, Hombach) Department of Internal Medicine II,
Cardiovascular MRI Unit, University of Ulm, Ulm, Germany.
(Bernhardt, Pilz, Hofling) CMR-Center at the Hospital Agatharied, Academic
Teaching Hospital, the University of Munich, Hausham, Germany.
(Levenson) Cardiac Praxis, Catheterization Laboratory at the
St.-Gertrauden-Hospital, Berlin, Germany.
(Strohm) Stephenson Cardiovascular MR Centre, University of Calgary,
Calgary, Canada.
Title
Combined Assessment of Myocardial Perfusion and Late Gadolinium
Enhancement in Patients After Percutaneous Coronary Intervention or Bypass
Grafts. A Multicenter Study of an Integrated Cardiovascular Magnetic
Resonance Protocol.
Source
JACC: Cardiovascular Imaging. 2(11)(pp 1292-1300), 2009. Date of
Publication: November 2009.
Publisher
Elsevier Inc.
Abstract
Objectives: We sought to assess the accuracy of an integrated cardiac
magnetic resonance (CMR) protocol for the diagnosis of relevant coronary
artery or bypass graft stenosis in patients with suspected coronary artery
disease (CAD) or with previously performed percutaneous coronary
intervention (PCI) or coronary bypass graft surgery (CABG). Background:
CMR is suitable for diagnosing inducible myocardial ischemia in patients
with suspected CAD and has been proven to be a helpful diagnostic tool for
decision of further treatment. However, little is known about its
diagnostic accuracy in patients with known CAD who previously were treated
by PCI or CABG. Methods: A total of 477 patients with suspected CAD, 236
with previous PCI, and 110 after CABG referred for coronary X-ray
angiography (CXA) underwent an integrated CMR examination before CXA.
Myocardial ischemia was assessed using first-pass perfusion after
vasodilator stress with adenosine (140 mug/kg/min for 3 min) using
gadolinium-based contrast agents (0.1 mmol/kg). Late gadolinium
enhancement (LGE) was assessed 10 min after a second contrast bolus.
Results: CXA demonstrated a relevant coronary vessel stenosis
([greater-than or equal to]70% luminal reduction) in 313 (38%) patients
using quantitative coronary analysis. The combination of CMR perfusion and
LGE assessment for detecting a relevant coronary stenosis in patients with
suspected CAD yielded sensitivity and specificity of 0.94 and 0.87, in PCI
patients 0.91 and 0.90, and in CABG patients 0.79 and 0.77, respectively.
Conclusions: A combined CMR protocol for the assessment of myocardial
perfusion and LGE is feasible for the detection of relevant coronary
vessel stenosis even in patients who previously were treated by PCI or CAG
in a routine clinical setting. However, diagnostic accuracy is reduced in
patients with CABG. This could be due to different flow and perfusion
kinetic. Further studies are needed to optimize the clinical protocols
especially in post-surgical patients. copyright 2009 American College of
Cardiology Foundation.
<8>
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Accession Number
2009574091
Authors
Wang G. Bainbridge D. Martin J. Cheng D.
Institution
(Wang, Bainbridge, Martin, Cheng) Department of Anesthesia and
Perioperative Medicine, London Health Sciences Centre, University of
Western Ontario, London, ON, Canada.
(Wang) Department of Anesthesiology, Cardiovascular Institute and Fuwai
Hospital, Chinese Academy of Medical Sciences, Beijing, China.
(Bainbridge, Martin, Cheng) Department of Anesthesiology and Perioperative
Medicine, Evidence-Based Perioperative Clinical Outcomes Research Group
(EPiCOR),
(Martin) Department of Pharmacy, Physiology, and Pharmacology, High Impact
Technology Evaluation Centre, Pharmacy, Physiology and Pharmacology,
University of Western Ontario, London, ON, Canada.
Title
The efficacy of an intraoperative cell saver during cardiac surgery: A
meta-analysis of randomized trials.
Source
Anesthesia and Analgesia. 109(2)(pp 320-330), 2009. Date of Publication:
August 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Cell salvage may be used during cardiac surgery to avoid
allogeneic blood transfusion. It has also been claimed to improve patient
outcomes by removing debris from shed blood, which may increase the risk
of stroke or neurocognitive dysfunction. In this study, we sought to
determine the overall safety and efficacy of cell salvage in cardiac
surgery by performing a systematic review and meta-analysis of published
randomized controlled trials. METHODS: A comprehensive search was
undertaken to identify all randomized trials of cell saver use during
cardiac surgery. MEDLINE, Cochrane Library, EMBASE, and abstract databases
were searched up to November 2008. All randomized trials comparing cell
saver use and no cell saver use in cardiac surgery and reporting at least
one predefined clinical outcome were included. The random effects model
was used to calculate the odds ratios (OR, 95% confidence intervals [CI])
and the weighted mean differences (WMD, 95% CI) for dichotomous and
continuous variables, respectively. RESULTS: Thirty-one randomized trials
involving 2282 patients were included in the meta-analysis. During cardiac
surgery, the use of an intraoperative cell saver reduced the rate of
exposure to any allogeneic blood product (OR 0.63, 95% CI: 0.43-0.94, P =
0.02) and red blood cells (OR 0.60, 95% CI: 0.39-0.92, P = 0.02) and
decreased the mean volume of total allogeneic blood products transfused
per patient (WMD -256 mL, 95% CI: -416 to -95 mL, P = 0.002). There was no
difference in hospital mortality (OR 0.65, 95% CI: 0.25-1.68, P = 0.37),
postoperative stroke or transient ischemia attack (OR 0.59, 95% CI:
0.20-1.76, P = 0.34), atrial fibrillation (OR 0.92, 95% CI: 0.69-1.23, P =
0.56), renal dysfunction (OR 0.86, 95% CI: 0.41-1.80, P = 0.70), infection
(OR 1.25, 95% CI: 0.75-2.10, P = 0.39), patients requiring fresh frozen
plasma (OR 1.16, 95% CI: 0.82-1.66, P = 0.40), and patients requiring
platelet transfusions (OR 0.90, 95% CI: 0.63-1.28, P = 0.55) between cell
saver and noncell saver groups. CONCLUSIONS: Current evidence suggests
that the use of a cell saver reduces exposure to allogeneic blood products
or red blood cell transfusion for patients undergoing cardiac surgery.
Subanalyses suggest that a cell saver may be beneficial only when it is
used for shed blood and/or residual blood or during the entire operative
period. Processing cardiotomy suction blood with a cell saver only during
cardiopulmonary bypass has no significant effect on blood conservation and
increases fresh frozen plasma transfusion. Copyright copyright 2009
International Anesthesia Research Society.
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