EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2010241144
Authors
Jokinen J.J. Hippelainen M.J. Turpeinen A.K. Pitkanen O. Hartikainen
J.E.K.
Institution
(Jokinen) Department of Cardiothoracic Surgery, Helsinki University
Hospital, PO Box 340, FI-00029 Helsinki, Finland.
(Hippelainen) Department of Surgery, Kuopio University Hospital,
Puijonlaaksonkatu 2, FI-70211 Kuopio, Finland.
(Turpeinen, Hartikainen) Department of Medicine, Kuopio University
Hospital, Puijonlaaksonkatu 2, FI-70211 Kuopio, Finland.
(Pitkanen) Department of Anesthesiology, Kuopio University Hospital,
Puijonlaaksonkatu 2, FI-70211 Kuopio, Finland.
Title
Health-related quality of life after coronary artery bypass grafting: A
review of randomized controlled trials.
Source
Journal of Cardiac Surgery. 25(3)(pp 309-317), 2010. Date of Publication:
May 2010.
Publisher
Blackwell Publishing Inc.
Abstract
Objective outcome measures (i.e., survival, mortality, morbidity,
complication rate, symptom recurrence, and need for re-interventions) have
long been used as benchmarks for successful cardiac surgery, including
coronary artery bypass grafting (CABG). Along with these objectively
measurable outcome indicators, acquired improvement by cardiac surgery in
subjectively experienced health-related quality of life (HRQoL) has gained
importance during the last decade in cardiac surgical research. If an
increasing proportion of adult patients referred for CABG are elderly,
octogenarians or even nonagenarians, the acquired HRQoL benefit from
bypass surgery should be considered to be at least as important an outcome
measure as potentially marginal improvement in life expectancy or
longevity alone. To achieve the maximal HRQoL benefit and to optimize
patient selection, a comprehensive analysis and understanding of
contributors that affect pre- and postoperative self-perceived HRQoL is
essential. These include patient-related characteristics (e.g.,
demographics and underlying comorbidities), surgical technique-related
factors, and healthcare-related attributes. In this paper we review the
randomized controlled trials published during the last ten years to
analyze the effect of CABG on HRQoL. Specifically, we focus on the
differences between the on-pump and off-pump (OPCAB) bypass techniques,
investigate the factors that contribute to post-CABG HRQoL, and study
post-CABG HRQoL in elderly patients. copyright 2010 Wiley Periodicals,
Inc.

<2>
Accession Number
2010235023
Authors
Van Breugel H.N.A.M. Nieman F.H.M. Accord R.E. Van Mastrigt G.A.P.G. Nijs
J.F.M.A. Severens J.L. Vrakking R. Maessen J.G.
Institution
(Van Breugel, Accord, Nijs, Maessen) Department of Cardiothoracic Surgery,
University Hospital Maastricht, P. Debeyelaan 25, 6202 AZ Maastricht,
Netherlands.
(Nieman, Van Mastrigt) Clinical Epidemiology and Medical Technology
Assessment, University Hospital Maastricht, Maastricht, Netherlands.
(Severens) Department of Health Organisation, Policy and Economics, Public
Health and Primary Care (CAPHRI) Research Institute, Maastricht
University, Maastricht, Netherlands.
(Vrakking) Department of Cardiothoracic Surgery, Amphia Hospital Breda,
Breda, Netherlands.
Title
A prospective randomized multicenter comparison on health-related quality
of life: The value of add-on arrhythmia surgery in patients with
paroxysmal, permanent or persistent atrial fibrillation undergoing
valvular and/or coronary bypass surgery.
Source
Journal of Cardiovascular Electrophysiology. 21(5)(pp 511-520), 2010.
Date of Publication: May 2010.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: This is a multicenter, prospective, randomized controlled
trial to determine the effect of add-on arrhythmia surgery on
health-related quality of life during 1-year follow-up of cardiac surgery
patients with atrial fibrillation. Methods: 150 patients with documented
atrial fibrillation were randomly assigned to undergo cardiac surgery with
or without add-on surgery. Patients completed quality of life
questionnaires, comprising the RAND 36-item Health Survey 1.0 (SF-36),
Multidimensional Fatigue Inventory-20 (MFI-20) and EuroQoL (EQ-5D and VAS)
at baseline and 3, 6, and 12 months following operation. Results: 132
patients completed the questionnaires at a minimum of one time-point
during follow-up. At baseline patient characteristics, operative data and
health-related quality of life were comparable. At 12-month follow-up 62
patients were free of atrial fibrillation without significant differences
between groups (P = 0.28). Conversion to SR occurred in 69.8% (37/53) of
patients with paroxysmal AF, in 28.2% (11/39) of patients with permanent
AF and in 44.4% (12/27) of patients in persistent AF. Cardiac surgery in
general resulted in an overall improvement of the RAND SF-36 and the
MFI-20. However, the EQ-5D showed a significant deterioration in the
subscale Pain/Discomfort for both groups (P < 0.001), with a significant
worse outcome for the control group (P = 0.006). Conclusions:
Health-related quality of life in patients with paroxysmal, permanent and
persistent atrial fibrillation improves after cardiac surgery regardless
of giving add-on surgery or not, but this improvement is presumably more
affected by treating the underlying heart disease than by restoring sinus
rhythm. copyright 2009 Wiley Periodicals, Inc.

<3>
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Accession Number
2010229279
Authors
Breukers R.-M.B.G.E. De Wilde R.B.P. Van den Berg P.C.M. Jansen J.R.C.
Faes T.J.C. Twisk J.W.R. Groeneveld A.B.J.
Institution
(Breukers, Groeneveld) Department of Intensive Care, Institute for
Cardiovascular Research, Amsterdam, Netherlands.
(De Wilde, Van den Berg, Jansen) VU University Medical Center, Amsterdam,
Netherlands.
(De Wilde, Van den Berg, Jansen) Department of Intensive Care, Leiden
University Medical Center, Leiden, Netherlands.
(Faes) Department of Physics and Medical Technology, Leiden University
Medical Center, Leiden, Netherlands.
(Twisk) Department of Clinical Epidemiology and Biostatistics, Leiden
University Medical Center, Leiden, Netherlands.
Title
Assessing fluid responses after coronary surgery: Role of mathematical
coupling of global end-diastolic volume to cardiac output measured by
transpulmonary thermodilution.
Source
European Journal of Anaesthesiology. 26(11)(pp 954-960), 2009. Date of
Publication: November 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background Mathematical coupling may explain in part why cardiac filling
volumes obtained by transpulmonary thermodilution may better predict and
monitor responses of cardiac output to fluid loading than pressures
obtained by pulmonary artery catheters (PACs). Methods Eleven consecutive
patients with hypovolaemia after coronary surgery and a PAC, allowing
central venous pressure (CVP) and continuous cardiac index (CCIp)
measurements, received a femoral artery catheter for transpulmonary
thermodilution measurements of global end-diastolic blood volume index
(GEDVI) and cardiac index (CItp). One to five colloid fluid-loading steps
of 250 ml were done in each patient (n=48 total). Results Fluid responses
were predicted and monitored similarly by CItp and CCIp, whereas CItp and
CCIp correlated at r=0.70 (P<0.001) with a biasof 0.40 l min-1m-2.Changes
in volumes(and not inCVP) related to changes in CItp and not in CCIp.
Changes in CVP and GEDVI similarly related to changes in CItp, after
exclusion of two patients with greatest CItp outliers (as compared to
CCIp). Changes in GEDVI correlated better to changes in CItp when derived
from the same thermodilution curve than to changes in CItp of unrelated
curves and changes in CCIp. Conclusions After coronary surgery, fluid
responses can be similarly assessed by intermittent transpulmonary and
continuous pulmonary thermodilution methods, in spite of overestimation of
CCIp by CItp. Filling pressures are poor monitors of fluid responses and
superiority of GEDVI can be caused, at least in part, by mathematical
coupling when cardiac volume and output are derived from the same
thermodilution curve. Eur J Anaesthesiol 26:954-960 copyright2009 European
Society of Anaesthesiology.

<4>
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Accession Number
2010229259
Authors
Ayouba C.M. Sfeirb P.M. Pierre B.-K. Azara M. Haddadind A.S. Harfoucha D.
Nasra V.G. El-Khatiba M.F.
Institution
(Ayouba, Azara, Harfoucha, Nasra, El-Khatiba) Department of
Anaesthesiology, American University, Beirut Medical Center, Hamra Street,
Beirut 1107-2020, Lebanon.
(Sfeirb) Department of Surgery, American University, Beirut Medical
Center, Beirut, Lebanon.
(Pierre) Department of Internal Medicine, American University, Beirut
Medical Center, Beirut, Lebanon.
(Haddadind) Department of Anaesthesiology, Yale University School of
Medicine, New Haven, CT, United States.
Title
Prophylactic amiodarone versus lidocaine for prevention of reperfusion
ventricular fibrillation after release of aortic cross-clamp.
Source
European Journal of Anaesthesiology. 26(12)(pp 1056-1060), 2009. Date of
Publication: December 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and objective Ventricular fibrillation is common after aortic
cross-clamp release in patients undergoing open-heart surgeries. The aim
of the study was to evaluate the efficacy of the prophylactic
administration of 150mg amiodarone by way of the pump 2 min before release
of aortic cross-clamp in preventing ventricular fibrillation. Methods The
present study is a prospective, randomized, controlled and blinded study
performed at a teaching university hospital where 120 patients undergoing
coronary bypass graft surgery were randomly assigned to three groups. Each
group received either 150mg of amiodarone or 100mg lidocaine or isotonic
saline by way of pump 2 min before release of the aortic cross-clamp. The
frequency of occurrence of ventricular fibrillation and the subsequent
required defibrillation counter shocks were determined in all groups.
Results The frequency of occurrence of ventricular fibrillation was
significantly higher in both the amiodarone (48%) and the control group
(45%) as compared with the lidocaine group (20%) with no statistically
significant difference between the amiodarone and the control groups.
Furthermore, when ventricular fibrillation occurred, the percentage of
patients requiring defibrillation counter shocks was significantly higher
in both the amiodarone (58%) and control (61%) groups as compared with the
lidocaine group (13%) with no difference between the amiodarone and the
control groups, despite a significant decrease in the defibrillation
counter shocks energy requirements in the amiodarone group. Conclusion The
present study showed no difference between amiodarone (150 mg) and placebo
in preventing ventricular fibrillation after release of aortic
cross-clamp. In addition, the use of lidocaine was able to reduce the
incidence of ventricular fibrillation as compared with both amiodarone and
placebo. Eur J Anaesthesiol 261056-1060 copyright 2009 European Society of
Anaesthesiology.

<5>
Accession Number
2010224514
Authors
Sezai A. Hata M. Niino T. Yoshitake I. Unosawa S. Wakui S. Fujita K.
Takayama T. Kasamaki Y. Hirayama A. Minami K.
Institution
(Sezai, Hata, Niino, Yoshitake, Unosawa, Wakui, Fujita, Minami) Department
of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo,
Japan.
(Takayama, Kasamaki, Hirayama) Department of Cardiology, Nihon University
School of Medicine, Tokyo, Japan.
Title
Continuous Low-Dose Infusion of Human Atrial Natriuretic Peptide in
Patients With Left Ventricular Dysfunction Undergoing Coronary Artery
Bypass Grafting. The NU-HIT (Nihon University working group study of
low-dose Human ANP Infusion Therapy during cardiac surgery) for Left
Ventricular Dysfunction.
Source
Journal of the American College of Cardiology. 55(17)(pp 1844-1851),
2010. Date of Publication: 27 Apr 2010.
Publisher
Elsevier USA
Abstract
Objectives: Continuous low-dose infusion of human atrial natriuretic
peptide (hANP) in patients undergoing cardiac surgery on cardiopulmonary
bypass (CPB) inhibits the renin-angiotensin-aldosterone system and
compensates for the adverse effects of CPB. Background: We examined the
influence of hANP infusion on cardiac and renal function in patients with
left ventricular dysfunction undergoing coronary artery bypass grafting
(CABG). Methods: The subjects were 133 patients who underwent CABG and had
a pre-operative ejection fraction [less-than or equal to]35%. They were
randomized to receive 0.02 mug/kg/min of hANP from the initiation of CPB
(hANP group) or placebo (saline) infusion. Results: Early post-operative
mortality did not show a significant difference between the 2 groups, but
perioperative complications were significantly less frequent in the hANP
group (p = 0.015). Long-term all-cause mortality showed no difference, but
the cardiac death-free rate at 5 or 8 years post-operatively was 98.5% in
the hANP group and 85.5% in the placebo group (p = 0.0285). Post-operative
ejection fraction was significantly larger and the post-operative brain
natriuretic peptide level was significantly lower in the hANP group. Serum
creatinine was significantly lower in the hANP group than the placebo
group at 1 month, 6 months, and 1 year post-operatively, whereas the
estimated glomerular filtration rate was significantly higher in the hANP
group at these times. Conclusions: In patients with left ventricular
dysfunction undergoing CABG, hANP showed renal- and cardio-protective
effects and reduced post-operative complications. It also improved the
long-term prognosis. We suggest that hANP should be considered as part of
perioperative management of patients with cardiac dysfunction undergoing
cardiac surgery. (NU-HIT trial for LVD; UMIN000001652). copyright 2010
American College of Cardiology Foundation.

<6>
Accession Number
2010224503
Authors
Colmenarez H.J. Escaned J. Fernandez C. Lobo L. Cano S. del Angel J.G.
Alfonso F. Jimenez P. Banuelos C. Gonzalo N. Garcia E. Hernandez R. Macaya
C.
Institution
(Colmenarez, Escaned, Lobo, del Angel, Alfonso, Jimenez, Banuelos,
Gonzalo, Garcia, Hernandez, Macaya) Cardiovascular Institute, Hospital
Clinico San Carlos, Madrid, Spain.
(Fernandez, Cano) Preventive Medicine Unit, Hospital Clinico San Carlos,
Madrid, Spain.
Title
Efficacy and Safety of Drug-Eluting Stents in Chronic Total Coronary
Occlusion Recanalization. A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. 55(17)(pp 1854-1866),
2010. Date of Publication: 27 Apr 2010.
Publisher
Elsevier USA
Abstract
Objectives: The aim of this study was to compare the efficacy and safety
of drug-eluting stent (DES) and bare-metal stent (BMS) use in chronic
total occlusion (CTO) recanalization. Background: The long-term
effectiveness and safety of DES use in CTO recanalization are unclear, and
performance of randomized clinical trials in the field is complex.
Methods: Major electronic information sources were explored for articles
comparing outcomes with DES and BMS use among patients with CTO. Assessed
clinical outcomes were death, myocardial infarction, target vessel
revascularization, major adverse cardiac events, and stent thrombosis;
angiographic outcomes were stent restenosis and stent reocclusion.
Results: Fourteen comparative studies were identified (a total of 4,394
patients). When compared with BMS, DES significantly reduced risk of major
adverse cardiac events (relative risk [RR]: 0.45, 95% confidence interval
[CI]: 0.34 to 0.60, p < 0.001) and TVR (RR: 0.40, 95% CI: 0.28 to 0.58, p
< 0.001) without increasing death (RR: 0.87, 95% CI: 0.66 to 1.16, p =
0.88) or myocardial infarction (RR: 0.89, 95% CI: 0.54 to 1.46, p = 0.80).
This benefit was sustained at [greater-than or equal to]3 years of
follow-up. Lower RRs for restenosis (RR: 0.25, 95% CI: 0.16 to 0.41, p <
0.001) and stent reocclusion (RR: 0.30, 95% CI: 0.18 to 0.49, p < 0.001)
were also observed in the DES group. A strong trend toward a higher rate
of stent thrombosis was documented in DES-treated patients (RR: 2.79, 95%
CI: 0.98 to 7.97, p = 0.06). Conclusions: DES use in CTO recanalization is
associated with significantly fewer major adverse cardiac events and fewer
occurrences of target vessel revascularization, restenosis, and stent
reocclusion than with BMS. Although a statistical trend toward a higher
risk of stent thrombosis was observed, the use of DES in this context
seems to be safe, with an overall benefit sustained in the long term.
copyright 2010 American College of Cardiology Foundation.

<7>
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Accession Number
2010225950
Authors
Gullestad L. Iversen M. Mortensen S.-A. Eiskjaer H. Riise G.C. Mared L.
Bjortuft O. Ekmehag B. Jansson K. Simonsen S. Gude E. Rundqvist B.
Fagertun H.E. Solbu D. Bergh C.-H.
Institution
(Gullestad) Department of Cardiology, Oslo University Hospital, University
of Oslo, Oslo, Norway.
(Iversen) Division of Lung Transplantation, Department of Cardiology,
Rigshospitalet, Copenhagen, Denmark.
(Mortensen) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
(Eiskjaer) Department of Cardiology B, Aarhus University Hospital, Skejby,
Aarhus, Denmark.
(Riise) Department of Respiratory Medicine, Sahlgrenska University
Hospital, Goteborg, Sweden.
(Mared) Department of Respiratory Medicine, Lund University Hospital,
Lund, Sweden.
(Bjortuft) Department of Respiratory Medicine, Oslo University Hospital,
Rikshospitalet, Oslo, Norway.
(Ekmehag) Department of Cardiology, Lund University Hospital, Lund,
Sweden.
(Jansson) Department of Cardiology, Heart Center, University Hospital,
Linkoping, Sweden.
(Simonsen, Gude) Department of Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway.
(Rundqvist, Bergh) Department of Cardiology, Sahlgrenska University
Hospital, University of Goteborg, Goteborg, Sweden.
(Fagertun) Capturo AS (Statistics) Kjeller, Norway.
(Solbu) Novartis Norge AS, Oslo, Norway.
Title
Everolimus with reduced calcineurin inhibitor in thoracic transplant
recipients with renal dysfunction: A multicenter, randomized trial.
Source
Transplantation. 89(7)(pp 864-872), 2010. Date of Publication: April
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND.: The proliferation signal inhibitor everolimus offers the
potential to reduce calcineurin inhibitor (CNI) exposure and alleviate
CNI-related nephrotoxicity. Randomized trials in maintenance thoracic
transplant patients are lacking. METHODS.: In a 12-month, open-labeled,
multicenter study, maintenance thoracic transplant patients (glomerular
filtration rate [greater-than or equal to]20 mL/min/1.73m2 and <90
mL/min/1.73 m2) >1 year posttransplant were randomized to continue their
current CNI-based immunosuppression or start everolimus with predefined
CNI exposure reduction. RESULTS.: Two hundred eighty-two patients were
randomized (140 everolimus, 142 controls; 190 heart, 92 lung transplants).
From baseline to month 12, mean cyclosporine and tacrolimus trough levels
in the everolimus cohort decreased by 57% and 56%, respectively. The
primary endpoint, mean change in measured glomerular filtration rate from
baseline to month 12, was 4.6 mL/min with everolimus and-0.5 mL/min in
controls (P<0.0001). Everolimus-treated heart and lung transplant patients
in the lowest tertile for time posttransplant exhibited mean increases of
7.8 mL/min and 4.9 mL/min, respectively. Biopsy-proven treated acute
rejection occurred in six everolimus and four control heart transplant
patients (P=0.54). In total, 138 everolimus patients (98.6%) and 127
control patients (89.4%) experienced one or more adverse event (P=0.002).
Serious adverse events occurred in 66 everolimus patients (46.8%) and 44
controls (31.0%) (P=0.02). CONCLUSION.: Introduction of everolimus with
CNI reduction offers a significant improvement in renal function in
maintenance heart and lung transplant recipients. The greatest benefit is
observed in patients with a shorter time since transplantation. copyright
2010 by Lippincott Williams & Wilkins.

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Accession Number
2010225938
Authors
Tong A. Howard K. Jan S. Cass A. Rose J. Chadban S. Allen R.D. Craig J.C.
Institution
(Tong, Craig) Centre for Kidney Research, Children's Hospital at Westmead,
Sydney, NSW 2145, Australia.
(Tong, Howard, Craig) School of Public Health, Sydney Medical School,
University of Sydney, Sydney, NSW, Australia.
(Jan, Cass) Renal Division, George Institute for International Health,
Camperdown, Sydney NSW, Australia.
(Cass) Poche Centre for Indigenous Health, University of Sydney, Sydney,
NSW, Australia.
(Rose) Faculty of Economics and Business, Institute of Transport and
Logistics Studies, University of Sydney, Sydney, NSW, Australia.
(Chadban, Allen) Central Clinical School, Bosch Institute, University of
Sydney, Sydney, NSW, Australia.
(Chadban) Department of Renal Medicine, Royal Prince Alfred Hospital,
Camperdown, Sydney NSW, Australia.
Title
Community preferences for the allocation of solid organs for
transplantation: A systematic review.
Source
Transplantation. 89(7)(pp 796-805), 2010. Date of Publication: April
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND.: Organs for transplantation are a scarce community resource
but community preferences and how they are incorporated into allocation
policies are unclear. This systematic review aimed to ascertain community
preferences for organ allocation and the principles underpinning these
preferences. METHODS.: Medline, Embase, PsycINFO, EconLit, and gray
literature databases were searched. Quantitative data were extracted, and
a qualitative textual synthesis of the results and conclusions reported in
each included study was performed. RESULTS.: Fifteen studies involving
more than 5563 respondents were included. Seven themes describing
community preferences for organ allocation were identified: (1) maximum
benefit, to achieve maximum health gain in recipient survival and quality
of life; (2) social valuation, to base preferences on societal gain; (3)
moral deservingness, to consider the "worthiness" of recipients based on
their social standing and lifestyle decisions; (4) prejudice, to make a
judgement based on personal ideologic viewpoints; (5) "fair innings," to
provide an organ preferentially to the younger recipient giving
opportunity for a "normal" life span and to those waiting for a first
organ rather than a retransplant; (6) "first come, first served," to
allocate the organ to recipients wait-listed the longest; and (7) medical
urgency, to allocate based on illness severity and saving life.
CONCLUSIONS.: Community preferences for organ allocation hinge on a
complex balance of efficiency, social valuation, morality, fairness, and
equity principles. Being a community-held resource, effective ways to
identify and incorporate community preferences into allocation algorithms
for solid organ transplantation are warranted. copyright 2010 by
Lippincott Williams & Wilkins.

<9>
Accession Number
2010209518
Authors
Ussia G.P. Capodanno D. Barbanti M. Scarabelli M. Imme S. Cammalleri V.
Mule M. Pistritto A. Aruta P. Tamburino C.
Institution
(Ussia, Capodanno, Barbanti, Scarabelli, Imme, Cammalleri, Mule,
Pistritto, Aruta, Tamburino) Department of Cardiology, Ferrarotto
Hospital, University of Catania, via Citelli 6, 95124 Catania, Italy.
(Capodanno, Tamburino) ETNA Foundation, Catania, Italy.
Title
Balloon aortic valvuloplasty for severe aortic stenosis as a bridge to
high-risk transcatheter aortic valve implantation.
Source
Journal of Invasive Cardiology. 22(4)(pp 161-166), 2010. Date of
Publication: April 2010.
Publisher
HMP Communications
Abstract
OBJECTIVES: To provide data on feasibility, safety and efficacy of balloon
aortic valvuloplasty (BAV) as a bridge to transcatheter aortic valve
implantation (TAVI). Background. There are no data on BAV use as a bridge
to TAVI in patients at high risk of periprocedural complications. Methods:
Between June 2007 to May 2009, 83 consecutive patients with symptomatic
severe aortic stenosis (48 female, 35 male) aged from 65 to 88 years (mean
age 81 +/- 5 years) were treated with TAVI. Early hemodynamic and clinical
outcomes of patients undergoing palliative BAV before TAVI (BAV Group, n =
43) were compared with those of patients who directly underwent TAVI
(no-BAV Group, n = 40). Results: Patients in the BAV group had worse
baseline clinical characteristics than those in the no-BAV group, with
higher rates of congestive heart failure, New York Heart Association
(NYHA) functional class III or IV and a higher EuroSCORE. In the BAV
group, significant changes were found after valvuloplasty with regard to
NYHA functional class, mean pressure gradient and aortic valve area.
Peak-to-peak transvalvular pressure gradient and left ventricular systolic
pressure also decreased immediately after BAV. Before TAVI, no differences
in either clinical status or hemodynamic data were observed between
patients who underwent BAV and those who did not. Conclusions: Bridging to
TAVI with BAV is a feasible and reasonably safe approach to offer
temporary relief in selected high-risk patients with symptomatic severe
aortic stenosis and a high chance of periprocedural complications.

<10>
Accession Number
2010188526
Authors
Tetik S. Ak K. Isbir S. Eksioglu-Demiralp E. Arsan S. Iqbal O. Yardimci T.
Institution
(Tetik, Yardimci) Department of Biochemistry, Faculty of Pharmacy, Marmara
University, Istanbul, Turkey.
(Ak, Isbir, Arsan) Department of Cardiovascular Surgery, School of
Medicine, Marmara University, Istanbul, Turkey.
(Eksioglu-Demiralp) Department of Haematology and Immunology, School of
Medicine, Marmara University, Istanbul, Turkey.
(Iqbal) Department of Pathology, Loyola University, Medical Center,
Maywood, IL, United States.
Title
Clopidogrel provides significantly greater inhibition of platelet activity
than aspirin when combined with atorvastatin after coronary artery bypass
grafting: A prospective randomized study.
Source
Clinical and Applied Thrombosis/Hemostasis. 16(2)(pp 189-198), 2010. Date
of Publication: April 2010.
Publisher
SAGE Publications Inc.
Abstract
Objective: We aimed to compare the effects of 2 different antiplatelet
agents on platelet activity in patients receiv- ing atorvastatin after
coronary artery bypass grafting (CABG). Methods: We prospectively
randomized 50 patients undergoing CABG into 2 groups; group 1 started to
receive atorvastatin (10 mg) plus clopidogrel (75 mg; C + A, n = 25) and
group 2 atorvastatin (10 mg) and acetylsalicylic acid (ASA; 300 mg, ASA +
A, n = 25) daily on postoperative day 1 and continued for 6 months after
operation. Adenosine diphosphate (ADP)-induced pla- telet aggregation and
the expressions of glycoprotein (Gp) IIb, GpIIIa, P-selectin, and
fibrinogen (Fg) and low-density lipoprotein (LDL) binding to platelets
were assessed preoperatively and at postoperative days 7, 90, and 180.
Results: The mean age of the patients was 59.6 +/- 7.6 years, and 82% of
the patients were males. The combination of C + A markedly inhibited
ADP-induced platelet aggregation compared with ASA + A at postoperative
days 90 and 180 (52% +/- 6.0% vs 56% +/- 7.25% and 19.6% +/- 3.2% vs 37%
+/- 4.1%, P =.039 and P =.0001, respectively). The therapy of C + A
significantly suppressed the expressions of GpIIIa at postoperative days
7, 90, and 180 (P =.0001, P =.0001, and P =.0001, respectively) and
P-selectin at postoperative days 90 and 180 (P =.035 and P =.002,
respectively) when compared to ASA + A. The expression of GpIIb was also
significantly depressed at postoperative day 180 in group 1 when compared
to group 2 (P =.0001). Low-density lipoprotein binding was significantly
increased at day 180 postoperatively in both the groups (basal: 42.9% +/-
5.6% vs 45.3% +/- 4.4% and day 180: 60.3% +/- 4.6% vs 61.8% +/- 5.7%, P
=.0001). Conclusions: Our results demonstrate that the combination of C +
A is more effective than that of ASA + A in inhibiting ADP-mediated
platelet aggregation and expression of major platelet receptors after
CABG.

<11>
Accession Number
2010069527
Authors
De Arenaza D.P. Pepper J. Lees B. Rubinstein F. Nugara F. Roughton M.
Jasinski M. Bazzino O. Flather M.
Institution
(De Arenaza, Bazzino) Cardiology Department, Hospital Italiano, Buenos
Aires, Argentina.
(Pepper, Roughton, Flather) Royal Brompton and Harefield NHS Trust,
London, United Kingdom.
(Pepper, Roughton, Flather) Imperial College, London, United Kingdom.
(Lees, Nugara) Clinical Trials and Evaluation Unit, Royal Brompton and
Harefield NHS Trust, London, United Kingdom.
(Rubinstein) Family Medicine Department, Hospital Italiano, Buenos Aires,
Argentina.
(Jasinski) Medical University of Silesia, Katowice, Poland.
Title
Preoperative 6-minute walk test adds prognostic information to Euroscore
in patients undergoing aortic valve replacement.
Source
Heart. 96(2)(pp 113-117), 2010. Date of Publication: January 2010.
Publisher
BMJ Publishing Group
Abstract
Aims: The authors investigated the additive prognostic value of the
6-minute walk test (6MWT) to Euroscore in patients with severe aortic
stenosis undergoing aortic valve replacement (AVR) Methods and results:
208 patients with severe AS underwent the 6MWT before AVR, as part of a
randomised trial (ASSERT) comparing stented and stentless aortic valves.
Clinical follow-up was available for 200 patients up to 12 months. The
rate of death, myocardial infarction (MI) or stroke (time to first event)
was 13% (n=14) in patients walking <300 metres compared to 4% (n=4) in
those who walked [greater-than or equal to]300 metres (p=0.017). When rate
of death, MI or stroke by Euroscore risk was stratified by 6-minute
walking distance, the 6MWT added prognostic information. In a Cox
regression analysis 6MWT distance was the only variable retained as an
independent predictor of the composite outcome of death, MI or stroke at
12 months (HR 0.28 95% CI 0.09 to 0.85, p=0.025). Conclusions: The 6MWT is
safe and feasible to carry out in patients with severe aortic stenosis
before AVR, and provides potentially important functional and prognostic
information to clinical assessment and the Euroscore risk score.

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Accession Number
2010065694
Authors
Gajarski R.J. Stefanelli C.B. Graziano J.N. Kaciroti N. Charpie J.R.
Vazquez D.
Institution
(Gajarski, Stefanelli, Graziano, Charpie) Department of Pediatrics,
Divisions of Cardiology,
(Vazquez) Department of Endocrinology,
(Kaciroti, Vazquez) Center for Growth and Development, University of
Michigan Health Center, Ann Arbor, MI, United States.
Title
Adrenocortical response in infants undergoing cardiac surgery with
cardiopulmonary bypass and circulatory arrest*.
Source
Pediatric Critical Care Medicine. 11(1)(pp 44-51), 2010. Date of
Publication: 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To detail changes in adrenocorticotropic hormone (ACTH),
cortisol, and aldosterone levels following cardiac surgery and to test the
hypothesis that postcardiotomy infants requiring excessively high-dose
vasopressor support will demonstrate adrenal insufficiency which will be
proportional to cardiopulmonary bypass (CPB)/circulatory arrest times and
vasopressor requirements. Design: Prospective observational pilot study.
Setting: A tertiary care pediatric cardiac intensive care unit. Patients:
Prospectively enrolled infants were divided into three subgroups: CPB, CPB
with deep hypothermic circulatory arrest (DHCA), and control subjects.
Interventions: None. Measurements and Main Results: A representative
patient sample from each surgical group underwent preoperative synthetic
ACTH testing. Postoperative serum samples for cortisol, ACTH, and inotrope
score (IS) were collected at discrete intervals over 48 hrs along with
patient demographics, surgical procedure, and CPB/DHCA times. Fifty-eight
patients were classified by subgroup: 31 CPB, 22 DHCA, and 5 controls. Ten
patients with DHCA, analyzed separately, received intraoperative steroids.
Tested patients demonstrated preoperative adrenal competence. Cortisol
peaked within 2 hrs of surgery without differences among groups. ACTH
inversely correlated with bypass time in patients with DHCA (p = .03) but
not with circulatory arrest time. Peak cortisol level did not correlate
with simultaneous IS. Although not noted in any DHCA-steroid patients,
nine patients had increased ACTH/cortisol ratios in association with
elevated ISs suggesting inadequate adrenal responsiveness to endogenous
ACTH. Conclusions: The majority of infants with congenital heart disease
and intact hypothalamic-pituitary-adrenal axes demonstrated an appropriate
adrenocortical stress response to cardiac surgery. Peak serum cortisol was
unrelated to CPB/DHCA time and did not predict the level of inotrope
support. However, a subset of patients with elevated ACTH/cortisol ratios
seemed to have a clinical status consistent with adrenal insufficiency and
may be a target group for early postoperative steroid therapy. copyright
2010 by the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies.