Saturday, April 10, 2010

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2010177064
Authors
Assmus B. Tonn T. Seeger F.H. Yoon C.-H. Leistner D. Klotsche J.
Schachinger V. Seifried E. Zeiher A.M. Dimmeler S.
Institution
(Assmus, Seeger, Leistner, Schachinger, Zeiher) Cardiology, Department of
Medicine III, Goethe University, Frankfurt, Germany.
(Seeger, Yoon, Dimmeler) Institute for Cardiovascular Regeneration, CMM,
Goethe University, Frankfurt, Germany.
(Tonn, Seifried) Institute for Transfusion Medicine and Immunohematology,
Red Cross Blood Donor Service Baden-Wurttemberg-Hessen, Frankfurt,
Germany.
(Klotsche) Institute of Clinical Psychology and Psychotherapy, Centre of
Clinical Epidemiology and Longitudinal Studies, Faculty of Mathematics and
Natural Sciences, Dresden, Germany.
Title
Red Blood Cell Contamination of the Final Cell Product Impairs the
Efficacy of Autologous Bone Marrow Mononuclear Cell Therapy.
Source
Journal of the American College of Cardiology. 55(13)(pp 1385-1394),
2010. Date of Publication: 30 Mar 2010.
Publisher
Elsevier USA
Abstract
Objectives: The aim of this study was to identify an association between
the quality and functional activity of bone marrow-derived progenitor
cells (BMCs) used for cardiovascular regenerative therapies and
contractile recovery in patients with acute myocardial infarction included
in the placebo-controlled REPAIR-AMI (Reinfusion of Enriched Progenitor
cells And Infarct Remodeling in Acute Myocardial Infarction) trial.
Background: Isolation procedures of autologous BMCs might affect cell
functionality and therapeutic efficacy. Methods: Quality of cell isolation
was assessed by measuring the total number of isolated BMCs, CD34+ and
CD133+ cells, their colony-forming unit (CFU) and invasion capacity, cell
viability, and contamination of the final BMC preparation with
thrombocytes and red blood cells (RBCs). Results: The number of RBCs
contaminating the final cell product significantly correlated with reduced
recovery of left ventricular ejection fraction 4 months after BMC therapy
(p = 0.007). Higher numbers of RBCs in the BMC preparation were associated
with reduced BMC viability (r = -0.23, p = 0.001), CFU capacity (r =
-0.16, p = 0.03), and invasion capacity (r = -0.27, p < 0.001). To assess
a causal role for RBC contamination, we coincubated isolated BMCs with
RBCs for 24 h in vitro. The addition of RBCs dose-dependently abrogated
migratory capacity (p = 0.003) and reduced CFU capacity (p < 0.05) of
isolated BMCs. Neovascularization capacity was significantly impaired
after infusion of BMCs contaminated with RBCs, compared with BMCs alone (p
< 0.05). Mechanistically, the addition of RBCs was associated with a
profound reduction in mitochondrial membrane potential of BMCs.
Conclusions: Contaminating RBCs affects the functionality of isolated BMCs
and determines the extent of left ventricular ejection fraction recovery
after intracoronary BMC infusion in patients with acute myocardial
infarction. These results suggest a bioactivity response relationship very
much like a dose-response relationship in drug trials. (Reinfusion of
Enriched Progenitor cells and Infarct Remodeling in Acute Myocardial
Infarction [REPAIR-AMI]; NCT00279175). copyright 2010 American College of
Cardiology Foundation.

<2>
Accession Number
2010154296
Authors
Heidarsdottir R. Arnar D.O. Skuladottir G.V. Torfason B. Edvardsson V.
Gottskalksson G. Palsson R. Indridason O.S.
Institution
(Heidarsdottir, Skuladottir) Department of Physiology, School of Health
Sciences, University of Iceland, Reykjavik, Iceland.
(Heidarsdottir, Arnar, Skuladottir, Torfason, Edvardsson, Palsson) Faculty
of Medicine, School of Health Sciences, University of Iceland, Reykjavik,
Iceland.
(Arnar, Gottskalksson, Palsson, Indridason) Division of Nephrology,
Department of Medicine, Landspitali University Hospital, Reykjavik,
Iceland.
(Arnar, Gottskalksson) Cardiovascular Research Center, Landspitali
University Hospital, Reykjavik, Iceland.
(Torfason) Department of Cardiothoracic Surgery, Landspitali University
Hospital, Reykjavik, Iceland.
(Edvardsson) Children's Medical Center, Landspitali University Hospital,
Reykjavik, Iceland.
Title
Does treatment with n-3 polyunsaturated fatty acids prevent atrial
fibrillation after open heart surgery?.
Source
Europace. 12(3)(pp 356-363), 2010. Date of Publication: March 2010.
Publisher
Oxford University Press
Abstract
Aims To examine the effect of n-3 polyunsaturated fatty acid (PUFA)
treatment on the incidence of post-operative atrial fibrillation (POAF).
Methods and results A prospective, randomized, double-blinded,
placebo-controlled trial was conducted in patients admitted for coronary
artery bypass grafting and/or valvular repair surgery. The patients
received either n-3 PUFA capsules, containing a daily dose of 1240 mg
eicosapentaenoic acid and 1000 mg docosahexaenoic acid, or olive oil
capsules for 5-7 days prior to surgery and post-operatively until hospital
discharge. The endpoint was POAF, defined as an episode detected by
continuous electrocardiographic monitoring, lasting >5 min. A total of 170
patients were enrolled in the study, and 168 patients underwent surgery.
Their median age was 67 (range 43-82) years, and 79.2 were males. There
was no difference in baseline characteristics between the n-3 PUFA group
(n = 83) and the placebo group (n = 85), and the incidence of POAF was
54.2 and 54.1% (P = 0.99), respectively. Factors associated with POAF
included advanced age, peak post-operative C-reactive protein level,
valvular surgery, lower body mass index, and non-smoking, but n-3 PUFA
concentration in plasma lipids was not associated with POAF. Conclusion
There is no evidence for a beneficial effect of treatment with n-3 PUFA on
the occurrence of POAF in patients undergoing open heart surgery.

<3>
Accession Number
2010129007
Authors
Ali M. Winter D.C. Hanly A.M. O'Hagan C. Keaveny J. Broe P.
Institution
(Ali, Winter, Hanly, Broe) Department of Surgery and, Beaumont Hospital,
Institute for Clinical Outcomes and Education (ICORE), Elm Park, Dublin 9,
Ireland.
(O'Hagan, Keaveny) Department of Anaesthesia, Beaumont Hospital, Institute
for Clinical Outcomes and Education (ICORE), Elm Park, Dublin 9, Ireland.

Title
Prospective, randomized, controlled trial of thoracic epidural or
patient-controlled opiate analgesia on perioperative quality of life.
Source
British Journal of Anaesthesia. 104(3)(pp 292-297), 2010. Date of
Publication: March 2010.
Publisher
Oxford University Press
Abstract
BackgroundPerioperative epidural analgesia provides continuous pain
control and may have advantages over parenteral opiate administration.
This study assessed the impact of epidural analgesia on quality of life
(QOL) of patients undergoing major surgery.MethodsSixty patients
undergoing thoracic or thoraco-abdominal surgery were studied
prospectively. Patients were randomly assigned to receive either thoracic
epidural analgesia or patient-controlled i.v. opiate analgesia (PCA) after
operation. Visual analogue pain and sedation scores were recorded for the
period of the study. QOL health surveys at 24 h (SF-8 acute form) and at 1
week (SF-36) were recorded. Results were examined by uni- and multivariate
analyses corrected for the effect of multiple comparisons.ResultsMean pain
scores were significantly lower in the epidural group at most time points.
Physical and mental scores in the epidural group were significantly better
than the PCA group for both SF-8 and SF-36 QOL health surveys
(P<0.001).ConclusionsEpidural analgesia with local anaesthetic and opioid
improves QOL and delivers better analgesia compared with PCA in patients
undergoing major thoraco-abdominal surgery.

<4>
Accession Number
2010129004
Authors
Oscarsson A. Gupta A. Fredrikson M. Jarhult J. Nystrom M. Pettersson E.
Darvish B. Krook H. Swahn E. Eintrei C.
Institution
(Oscarsson, Gupta, Nystrom, Pettersson, Eintrei) Division of
Anaesthesiology and, Department of Medical and Health Sciences, Linkoping
University, Linkoping, Sweden.
(Swahn) Division of Cardiology, Department of Medical and Health Sciences,
Linkoping University, Linkoping, Sweden.
(Fredrikson) Division of Occupational and Environmental Medicine,
Department of Clinical and Experimental Medicine, University Hospital,
Linkoping, Sweden.
(Jarhult) Department of Surgery, Ryhov Hospital, Jonkoping, Sweden.
(Gupta, Darvish) Department of Anaesthesia, Intensive Care University
Hospital, Orebro, Sweden.
(Krook) Department of Anaesthesia and Intensive Care, Vrinnevi Hospital,
Norrkoping, Sweden.
Title
To continue or discontinue aspirin in the perioperative period: A
randomized, controlled clinical trial.
Source
British Journal of Anaesthesia. 104(3)(pp 305-312), 2010. Date of
Publication: March 2010.
Publisher
Oxford University Press
Abstract
BackgroundMajor adverse cardiac events (MACEs) are a common cause of death
after non-cardiac surgery. Despite evidence for the benefit of aspirin for
secondary prevention, it is often discontinued in the perioperative period
due to the risk of bleeding.MethodsWe conducted a randomized,
double-blind, placebo-controlled trial in order to compare the effect of
low-dose aspirin with that of placebo on myocardial damage,
cardiovascular, and bleeding complications in high-risk patients
undergoing non-cardiac surgery. Aspirin (75 mg) or placebo was given 7
days before surgery and continued until the third postoperative day.
Patients were followed up for 30 days after surgery.ResultsA total of 220
patients were enrolled, 109 patients received aspirin and 111 received
placebo. Four patients (3.7%) in the aspirin group and 10 patients (9.0%)
in the placebo group had elevated troponin T levels in the postoperative
period (P=0.10). Twelve patients (5.4%) had an MACE during the first 30
postoperative days. Two of these patients (1.8%) were in the aspirin group
and 10 patients (9.0%) were in the placebo group (P=0.02). Treatment with
aspirin resulted in a 7.2 absolute risk reduction [95 confidence interval
(CI), 1.3-13%] for postoperative MACE. The relative risk reduction was 80%
(95% CI, 9.2-95%). Numbers needed to treat were 14 (95% CI, 7.6-78). No
significant differences in bleeding complications were seen between the
two groups.ConclusionsIn high-risk patients undergoing non-cardiac
surgery, perioperative aspirin reduced the risk of MACE without increasing
bleeding complications. However, the study was not powered to evaluate
bleeding complications.

<5>
Accession Number
2010147434
Authors
Mohiddin S.A. Page S.P.
Institution
(Mohiddin) Department of Cardiology, London Chest Hospital, Bonner Road,
London E2 9JX, United Kingdom.
(Page) Department of Cardiology, St. Bartholomew's Hospital, West
Smithfield, London, United Kingdom.
Title
Long-term benefits of pacing in obstructive hypertrophic cardiomyopathy.
Source
Heart. 96(5)(pp 328-330), 2010. Date of Publication: March 2010.
Publisher
BMJ Publishing Group

<6>
Accession Number
2010145269
Authors
Kvalheim V.L. Farstad M. Steien E. Mongstad A. Borge B.A. Kvitting P.M.
Husby P.
Institution
(Kvalheim, Mongstad, Kvitting) Department of Heart Disease, University of
Bergen, Haukeland University Hospital, Bergen, Norway.
(Farstad, Steien) Department of Anesthesia and Intensive Care, University
of Bergen, Haukeland University Hospital, 5021 Bergen, Norway.
(Borge) Department of Biomedicine, University of Bergen, Haukeland
University Hospital, Bergen, Norway.
(Husby) Institute of Surgical Sciences, University of Bergen, Haukeland
University Hospital, Bergen, Norway.
Title
Infusion of hypertonic saline/starch during cardiopulmonary bypass reduces
fluid overload and may impact cardiac function.
Source
Acta Anaesthesiologica Scandinavica. 54(4)(pp 485-493), 2010. Date of
Publication: April 2010.
Publisher
Blackwell Munksgaard
Abstract
Objective: Peri-operative fluid accumulation resulting in myocardial and
pulmonary tissue edema is one possible mechanism behind post-operative
cardiopulmonary dysfunction. This study aimed to confirm an improvement of
cardiopulmonary function by reducing fluid loading during an open-heart
surgery. Materials and methods: Forty-nine elective CABG patients were
randomized to an intraoperative infusion of hypertonic saline/hydroxyethyl
starch (HSH group) or Ringer's solution (CT group). Both groups received 1
ml/kg/h of the study solution for 4 h after baseline values were obtained
(PICCO transpulmonary thermodilution technique). Net fluid balance (NFB),
hemodynamic and laboratory parameters were measured. Results: NFB was four
times higher in the CT group compared with the HSH group during the first
6 h post-operatively. The total fluid gain until the next morning was
lower in the HSH group, 2993.9 (938.6) ml, compared with the CT group,
4298.7 (1059.3) ml (P<0.001). Normalized values (i.e., %-changes from the
baseline) of the cardiac index and the global end diastolic volume index
increased post-operatively in both groups. Both parameters were
significantly higher at 6 h in the HSH group compared with CT group
(P=0.002 and 0.005, respectively). Normalized values of the intrathoracic
blood volume index were lower in the HSH group at 6 h post-operatively
when compared with the CT group. The PaO2/FiO 2 ratio decreased similarly
in both groups early post-operatively, but recovery tended to be more
rapid in the HSH group. Although serum-sodium and serum-chloride levels
were significantly higher in the HSH group, the acid-base parameters
remained similar and within the normal range. Conclusions: An
intraoperative infusion of HSH during cardiac surgery contributes to
reduced fluid loading and an improvement in the post-operative cardiac
performance. No adverse effects of the HSH infusion were observed.
copyright 2009 The Acta Anaesthesiologica Scandinavica Foundation.

<7>
Accession Number
2010127287
Authors
Yildirim V. Doganci S. Aydin A. Bolcal C. Demirkilic U. Cosar A.
Institution
(Yildirim, Cosar) Department of Anesthesiology and Reanimation, Gulhane
Military Academy of Medicine, Ankara, Turkey.
(Doganci, Bolcal, Demirkilic) Department of Cardiovascular Surgery,
Gulhane Military Academy of Medicine, Ankara, Turkey.
(Aydin) Department of Pharmaceutical Toxicology, Gulhane Military Academy
of Medicine, Ankara, Turkey.
Title
Cardioprotective effects of sevoflurane, isoflurane, and propofol in
coronary surgery patients: A randomized controlled study.
Source
Heart Surgery Forum. 12(1)(pp E1-E9), 2009. Date of Publication: February
2009.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Background: This study was undertaken to compare the in vivo effects of
isoflurane, sevoflurane, and propofol anesthesia on ischemia- and
reperfusion-mediated free-radical injury and oxidative stress during
coronary arety bypass graft surgery. We also compared the effects of these
anesthetic agents on levels of end products of lipid peroxidation and
nitric oxide (NO) in human right atrial tissue and blood. Methods: Sixty
patients scheduled to undergo elective coronary surgery with
cardiopulmonary bypass (CPB) were enrolled. Patients were randomly
allocated to receive 1 of 3 different anesthetic protocols: propofol
(group A), isoflurane (group B), or sevoflurane (group C). We recorded
global hemodynamic data (mean arterial pressure, mean pulmonary artery
pressure, central venous pressure, pulmonary capillary wedge pressure,
cardiac output, cardiac index, and systemic vascular resistance index)
just before the start of surgery, before the start of CPB, 15 minutes
after the end of CPB, at the end of the operation, 6 hours after
installation in the intensive care unit, and 12 and 24 hours later.
Samples of the right atrial appendage were harvested before and after
exposure of the heart to blood cardioplegia and short-term reperfusion
under conditions of CPB. Biochemical and oxidative stress parameters were
analyzed in both blood and tissue. Results: Hemodynamic parameters were
kept stable throughout in all groups. Troponin I increased transiently
with all used anesthetic regimens, but this increase was significantly
lower in groups B and C. After clamp removal, lipid peroxidation in
patients who received propofol (group A) was less than in patients who
received isoflurane (group B) or sevoflurane (group C) (P = .001, P =
.005, respectively). Although the 3 groups showed no statistically
significant differences in tissue levels of thiobarbituric acid-reactive
substances and superoxide dismutase, propofol significantly lowered NO
production in atrial tissue after clamp removal and induced less NO
production than sevoflurane (P < .05). Conclusion: Inhalation anesthetics
such as isoflurane and sevoflurane preserved cardiac function in coronary
surgery patients after CPB with less evidence for myocardial damage than
propofol. Furthermore, propofol induced lower blood levels of lipid
peroxidation than isoflurane and sevoflurane. Propofol also increased
glutathione peroxidase activity but induced less NO production compared to
sevoflurane. These findings also support the cardioprotective properties
that are demonstrated by hemodynamic parameters. copyright 2009 Forum
Multimedia Publishing, LLC.

<8>
Accession Number
2010115474
Authors
Yang L. Yang J. Wang Q. Chen M. Lu Z. Chen S. Xiong L.
Institution
(Yang, Wang, Chen, Lu, Chen, Xiong) Department of Anesthesiology, Xijing
Hospital, Fourth Military Medical University, Xi'an, China.
(Yang) Department of Cardiovascular Surgery, Xijing Hospital, Fourth
Military Medical University, Xi'an, China.
Title
Cardioprotective Effects of Electroacupuncture Pretreatment on Patients
Undergoing Heart Valve Replacement Surgery: A Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. 89(3)(pp 781-786), 2010. Date of Publication:
March 2010.
Publisher
Elsevier USA
Abstract
Background: Cardiac ischemia-reperfusion injury after cardiopulmonary
bypass contributes to postoperative morbidity and mortality in patients
with open-heart surgery. This randomized controlled trial was designed to
address the protective effects of electroacupuncture (EA) pretreatment on
myocardial injury in patients undergoing heart valve replacement surgery.
Methods: Sixty patients with acquired heart valve disease were randomly
allocated to the EA pretreatment group or the control group. Patients in
the EA group received EA stimulus at bilateral Neiguan (PC 6), Lieque (LU
7), and Yunmen (LU 2) for 30 minutes each day for five consecutive days
before surgery. Hemodynamic data, mechanical ventilation time, inotropic
drug use in the intensive care unit, serum cardiac troponin I
concentrations, morbidities, and mortalities were compared between the two
groups. This trial is registered with ClinicalTrials.gov, number
NCT00732459. Results: At 6 hours, 12 hours, and 24 hours after
reperfusion, levels of serum cardiac troponin I were significantly
decreased in the EA group (5.74 +/- 0.67, 6.22 +/- 0.66, and 5.21 +/-
0.58) compared with that in the control group (7.89 +/- 0.74, 8.34 +/-
1.08, and 7.57 +/- 0.89, p < 0.05). The EA pretreatment significantly
reduced overall serum troponin I release at 6 hours, 12 hours, and 24
hours after aortic cross-clamp removal. Meanwhile, EA pretreatment also
reduced the inotrope score at 12 hours, 24 hours, and 48 hours after the
intensive care unit arrival and shortened intensive care unit stay time (p
< 0.05). Conclusions: The present study demonstrated that EA pretreatment
may alleviate cardiac ischemia-reperfusion injury in adult patients
undergoing heart valve replacements. This simple and convenient treatment
has the potential to be used in the clinic for reducing myocardial injury
in patients with heart valve replacement surgery. copyright 2010 The
Society of Thoracic Surgeons.

<9>
Accession Number
2010177193
Authors
Sato A. Ohigashi H. Nozato T. Hikita H. Tamura M. Miyazaki S. Takahashi Y.
Kuwahara T. Takahashi A. Hiroe M. Aonuma K.
Institution
(Sato, Aonuma) Cardiovascular Division, Institute of Clinical Medicine,
University of Tsukuba Graduate School of Comprehensive Human Sciences,
Tsukuba, Japan.
(Ohigashi, Nozato, Hikita, Tamura, Miyazaki, Takahashi, Kuwahara,
Takahashi) Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka,
Japan.
(Hiroe) Department of Cardiology, International Medical Center of Japan,
Tokyo, Japan.
Title
Coronary Artery Spatial Distribution, Morphology, and Composition of
Nonculprit Coronary Plaques by 64-Slice Computed Tomographic Angiography
in Patients With Acute Myocardial Infarction.
Source
American Journal of Cardiology. 105(7)(pp 930-935), 2010. Date of
Publication: 01 Apr 2010.
Publisher
Elsevier Inc.
Abstract
Noninvasive identification of nonculprit lesions could improve preventive
strategies for acute myocardial infarction (AMI). We assessed the
morphology, composition, and spatial distribution of nonculprit coronary
plaques in patients with AMI using computed tomographic angiography (CTA).
A total of 64 patients with AMI underwent 64-slice CTA within 2 weeks
after admission, and 162 symptomatic patients with stable angina pectoris
(SAP) underwent CTA and stress myocardial perfusion imaging (MPI). Of
these 226 patients, 16 were excluded from the analysis because of image
artifacts. The mean number of nonculprit plaques per patient was 5.0 +/-
2.6 in the AMI group (n = 60), 4.2 +/- 2.6 in the SAP group with abnormal
MPI findings (n = 67), and 1.1 +/- 1.3 in the SAP group with normal MPI
findings (n = 83; p <0.01). Positive remodeling and low-attenuation
plaques (<30 Hounsfield units) were more frequently observed in the AMI
group (1.9 +/- 1.8) than in the SAP groups (0.6 +/- 0.9 with abnormal MPI
findings and 0.2 +/- 0.4 with normal MPI findings; p <0.01). Within the
AMI group, positive remodeling and low-attenuation plaques were present
significantly more frequently in patients with metabolic syndrome than in
those without (2.6 +/- 2.2 vs 1.4 +/- 1.4; p = 0.03) and was significantly
more frequently distributed in the proximal segments of the left anterior
descending artery (p <0.01). In conclusion, 64-slice CTA could provide
promising information for preventive strategies by identifying nonculprit
plaque morphology and zones at high risk of future events. copyright 2010
Elsevier Inc. All rights reserved.

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