EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2010361733
Authors
Fleckenstein J. Kramer S. Offenbacher M. Schober G. Plischke H. Siebeck M.
Mussack T. Hatz R. Lehmeyer L. Lang P.M. Heindl B. Conzen P. Irnich D.
Institution
(Fleckenstein, Kramer, Schober, Lehmeyer, Lang, Heindl, Conzen, Irnich)
Department of Anaesthesiology, University of Munich, Germany
(Offenbacher, Plischke) Generation Research Project, University of Munich,
Bad Tolz, Germany
(Siebeck, Mussack) Department of General Surgery, Campus Innenstadt,
University of Munich, Germany
(Hatz) Department of Surgery and General Thoracic Surgery, Campus
Groshadern, University of Munich, Germany
(Lehmeyer) Department for Anesthesia, Hawkes Bay Hospital, Hastings, New
Zealand
Title
Etoricoxib - preemptive and postoperative analgesia (EPPA) in patients
with laparotomy or thoracotomy - design and protocols.
Source
Trials. 11 , 2010. Article Number: 66. Date of Publication: 27 May
2010.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Background and Objective: Our objective was to report on the design and
essentials of the Etoricoxib protocol- Preemptive and Postoperative
Analgesia (EPPA) Trial, investigating whether preemptive analgesia with
cox-2 inhibitors is more efficacious than placebo in patients who receive
either laparotomy or thoracotomy.Design and Methods: The study is a 2 x 2
factorial armed, double blinded, bicentric, randomised placebo-controlled
trial comparing (a) etoricoxib and (b) placebo in a pre- and postoperative
setting. The total observation period is 6 months. According to a power
analysis, 120 patients scheduled for abdominal or thoracic surgery will
randomly be allocated to either the preemptive or the postoperative
treatment group. These two groups are each divided into two arms.
Preemptive group patients receive etoricoxib prior to surgery and either
etoricoxib again or placebo postoperatively. Postoperative group patients
receive placebo prior to surgery and either placebo again or etoricoxib
after surgery (2 x 2 factorial study design). The Main Outcome Measure is
the cumulative use of morphine within the first 48 hours after surgery
(measured by patient controlled analgesia PCA). Secondary outcome
parameters include a broad range of tests including sensoric perception
and genetic polymorphisms.Discussion: The results of this study will
provide information on the analgesic effectiveness of etoricoxib in
preemptive analgesia and will give hints on possible preventive effects of
persistent pain.Trial registration: NCT00716833. 2010 Fleckenstein et al;
licensee BioMed Central Ltd.

<2>
Accession Number
20370923
Authors
Dural K. Gulbahar G. Kocer B. Sakinci U.
Institution
(Dural) Numune Teaching and Research Hospital, Division of Thoracic
Surgery, Ankara, Turkey.
Title
A novel and safe technique in closed tube thoracostomy.
Source
Journal of cardiothoracic surgery. 5 (pp 21), 2010. Date of
Publication: 2010.
Abstract
BACKGROUND: Tube thoracostomy (TT) is the most commonly performed surgical
procedure in thoracic surgery clinics. The procedure might have to be
repeated due to ineffective drainage in patients with tube malposition
(TM), in whom the drain is not directed to the apex or located in the
fissure. Trocar technique, which is used to prevent TM, is not recommended
because of its potential for severe complications. METHODS: The study
involved 180 patients who required TT application for any etiology within
one year. The patients were divided into two groups as Group A, who had
undergone classical surgical technique (n = 90) and Group B, who had
undergone a combination of surgery and trocar techniques (n = 90). The
groups were compared for TM, the effect of TM on the drain removal, and
other insertion related complications. RESULTS: In Group A, 23 patients
had TM, 4 of whom developed associated ineffective drainage, while the
patients in Group B had no insertion related complications (p = 0.001).
The mean drain removal time of the patients with TM was 5 +/- 2.25 days.
In the patients who did not develop TM, it was 3.39 +/- 1.18 days (p =
0.001). CONCLUSIONS: The modified combination technique is a reliable
method in preventing TM and its potential complications.

<3>
Accession Number
2010331166
Authors
Ali M.W. Bolling S.F.
Institution
(Ali, Bolling) Department of Surgery, Section of Cardiac Surgery,
University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI
48109, United States
Title
Mitral valve repair: What the ACORN trial taught us.
Source
Current Cardiology Reports. 12 (2) (pp 116-121), 2010. Date of
Publication: March 2010.
Publisher
Current Medicine Group LLC (5 Marine View Plaza, Suite 218, Hoboken NJ
07030, United States)
Abstract
Progressive left ventricular remodeling is characterized by dilation of
the left ventricle with a change in the heart from an elliptical shape to
a more spherical shape. This change is part of the unfavorable natural
history in patients with heart failure. The CorCap Cardiac Support Device
(Acorn Cardiovascular, St. Paul, MN) is a mesh device that is implanted
around the heart to reduce wall stress and the first therapy specifically
designed to address left ventricular remodeling. The CorCap was studied in
a large, prospective, randomized, multicentered trial. This study
demonstrated safety and effectiveness of the CorCap in patients with
advanced heart failure and remodeled ventricles. Moreover, it provided
interesting insights into mitral valve surgery in patients with heart
failure. These insights and a review of the ACORN (Assessment of a Cardiac
Support Device [CSD] in Patients With Heart Failure) trial are discussed
in this article. Springer Science+Business Media, LLC 2010.

<4>
Accession Number
2010358560
Authors
Ostadal P. Alan D. Vejvoda J. Kukacka J. Macek M. Hajek P. Mates M. Kvapil
M. Kettner J. Wiendl M. Aschermann O. Slaby J. Holm F. Telekes P. Horak D.
Blasko P. Zemanek D. Veselka J. Cepova J.
Institution
(Ostadal, Mates, Aschermann) Heart Center, Department of Cardiology, Na
Homolce Hospital, Prague, Czech Republic
(Alan, Vejvoda, Hajek, Zemanek, Veselka) Department of Cardiology,
University Hospital Motol, Prague, Czech Republic
(Kukacka, Cepova) Department of Clinical Biochemistry and
Pathobiochemistry, University Hospital Motol and Charles University, 2nd
Faculty of Medicine, Prague, Czech Republic
(Macek) Institute of Biology and Medical Genetics, University Hospital
Motol and Charles University, 2nd Faculty of Medicine, Prague, Czech
Republic
(Kvapil) Department of Internal Medicine, University Hospital Motol and
Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
(Kettner, Wiendl) Department of Cardiology, Institute for Clinical and
Experimental Medicine, Prague, Czech Republic
(Slaby) Department of Medicine, Hospital Kolin, Kolin, Czech Republic
(Holm, Telekes, Horak) Department of Cardiology, Regional Hospital
Liberec, Liberec, Czech Republic
(Blasko) Internal Medicine Department, Faculty Hospital Nitra, Nitra,
Slovakia
Title
Fluvastatin in the first-line therapy of acute coronary syndrome: Results
of the multicenter, randomized, double-blind, placebo-controlled trial
(the FACS-trial).
Source
Trials. 11 , 2010. Article Number: 61. Date of Publication: 25 May
2010.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Background: Statins have been proved to be effective in reduction of
mortality and morbidity when started in the early secondary prevention in
stabilized patients after acute coronary syndrome (ACS). The safety and
efficacy of statin administration directly in the first-line therapy in
unstable ACS patients is not clear. The aim of our study was, therefore,
to assess the effect of statin treatment initiated immediately at hospital
admission of patients with ACS.Methods: The trial was stopped prematurely
after enrollment of one hundred and fifty-six patients with ACS that were
randomized at admission to fluvastatin 80 mg (N = 78) or placebo (N = 78).
Study medication was administered immediately after randomization and then
once daily for 30 days; all patients were then encouraged to continue in
open-label statin therapy and at the end of one-year follow-up 75% in the
fluvastatin group and 78% in the placebo group were on statin
therapy.Results: We did not demonstrate any difference between groups in
the level of C-reactive protein, interleukin 6, and pregnancy-associated
plasma protein A on Day 2 and Day 30 (primary endpoint).
Fluvastatin-therapy, however, significantly reduced one-year occurrence of
major adverse cardiovascular events (11.5% vs. 24.4%, odds ratio (OR)
0.40, 95% CI 0.17-0.95, P = 0.038). This difference was caused mainly by
reduction of recurrent symptomatic ischemia (7.7% vs. 20.5%, OR 0.32, 95%
CI 0.12-0.88, P = 0.037).Conclusions: This study failed to prove the
effect of fluvastatin given as first-line therapy of ACS on serum markers
of inflammation and plaque instability. Fluvastatin therapy was, however,
safe and it may reduce cardiovascular event rate that supports immediate
use of a statin in patients admitted for ACS. 2010 Ostadal et al;
licensee BioMed Central Ltd.

<5>
Accession Number
2010394707
Authors
Ulrich C. Johannsen A. Rowert-Huber J. Ulrich M. Sterry W. Stockfleth E.
Institution
(Ulrich, Johannsen, Rowert-Huber, Ulrich, Sterry, Stockfleth) Skin Cancer
Centre Charite, Department of Dermatology, Charite Universitatsmedizin,
Charite-Platz 1, 10117 Berlin, Germany
Title
Results of a randomized, placebo-controlled safety and efficacy study of
topical diclofenac 3% gel in organ transplant patients with multiple
actinic keratoses.
Source
European Journal of Dermatology. 20 (4) (pp 482-488), 2010. Date of
Publication: July-August 2010.
Publisher
John Libbey Eurotext (127, avenue de la Republique, Montrouge 92120,
France)
Abstract
Increasing incidence rates of cutaneous malignancies, paralleling rising
survival times of grafts and patients in organ transplant recipients,
represents an escalating challenge for dermatologists worldwide.
Especially, invasive squamous cell carcinomas (SCC) in immunocompromised
patients are characterized by significantly increased morbidity and
mortality and characteristically outnumber basal cell carcinoma in this
population. Effective management of actinic keratoses (AK) could help to
prevent the further development of invasive SCC. Diclofenac in hyaluronic
acid has previously shown to be an effective and well tolerated option for
the treatment of AK in immuno-competent patients. However, its safety and
efficacy in organ-transplant patients has not been evaluated in a
controlled study so far. 32 organ transplant patients (kidney (+/-
pancreas), liver, heart) screened at our specialized transplant
dermatology outpatient clinic were found eligible and were randomized to
either active treatment (24) or vehicle (8). Patients who had stable
status of the transplanted graft in the 12 months prior to entering the
study and >= 3 AK lesions in a contiguous 50 cm2 area on the face,
forehead, hands or balding scalp were eligible for inclusion in the study.
Treatment of AK with 3% diclofenac in 2.5% hyaluronic acid or placebo
twice daily was conducted over a total of 16 weeks, followed by a final
evaluation 4 weeks after last application of the study drug. Biopsies were
taken from the treated areas at the final visit to verify clinical
clearance. Patients were assessed for safety variables that included
adverse events, local skin reactions, laboratory results, dosage of
immunosuppressive medication and indication of graft rejection. A 24
months follow up was conducted after the end of treatment. 87% (n = 28/32)
of the patients completed the 16 week treatment phase and presented for
final evaluation 4 weeks after end of treatment. In the diclofenac 3% gel
treatment group, a complete clearance of AK lesions was achieved in 41%
(9/22) compared to 0% (0/6) in the vehicle group. Side effects in most of
the patients included a mild erythema and a mild to moderate swelling of
the areas treated. No graft rejections or trends for a deterioration of
graft function were detected. No meaningful trends were observed in
laboratory results. In 55% of the previously cleared patients, new AK
developed in the study area after an average of 9.3 months. None of these
patients developed invasive SCC in the study area within 24 months of
follow-up. This study demonstrated a greater lesion clearance rate of AKs
in OTRs treated with diclofenac 3% gel than with vehicle. Despite
recurrent AK in 55% of the previously cleared patients, the 24 month
results showed no invasive SCC in this group. This study suggests that
diclofenac 3% gel is not only an efficient and well tolerated treatment
for multiple AKs in OTRs but also may prevent invasive SCC in these
high-risk patients.

<6>
Accession Number
2010395976
Authors
Akhlagh S.H. Zeighami D. Khosravi M.B. Maghsoodi B. Azemati S. Alipour A.
Institution
(Akhlagh, Zeighami, Khosravi, Maghsoodi, Azemati) Shiraz Anesthesiology
and Critical Care Research Center, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
(Alipour) Nutrition and Health School, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Title
The effect of low-dose of ketamine infusion on stress responses in
coronary artery bypass graft surgery.
Source
Iranian Cardiovascular Research Journal. 4 (1) (pp 28-32), 2010. Date of
Publication: March 25, 2010.
Publisher
Iranian Cardiovascular Research Journal (Zand Ave., Shiraz, Iran, Islamic
Republic of)
Abstract
Background: Open heart surgery is associated with acute perioperative
changes in plasma levels of neurohormonal stress
factors,cortisol,interleukin-6 and C-reactive protein. Human studies
involving cardiopulmonary bypass have shown that very low doses of
ketamine can attenuate the markers of inflammation without adverse
effects. The aim of this study was to investigate whether, low dose
infusion of ketamine when administered during 48 hours after induction
have anti-inflammatory effect and attenuate stress factors, in on-pump
coronary artery bypass graft surgery. Methods: In this prospective
randomized-controlled trial, 50 patients undergoing on-pump coronary
artery bypass graft were randomly assigned to receive either
1.25mcg/kg/min of ketamine (Ketamine group, n=25) or normal saline
(Control group, n=25) infusion during and for 48 hours after surgery.
Inflammatory and stress response markers including C-reactive protein,
cortisol, White blood cell count and differential, glucose and lactate
level were measured before induction (T1), 4 hours after surgery (T2), and
on the first and the second days after surgery (T3 and T4). Results: The
level of lactate were higher in ketamine compared with control group four
hours after operation (P< 0.05) without any significant differences
detected in other measurements. Conclusion: Low dose ketamine did not
cause any change in C-reactive protein, cortisol, White blood cell count
and glucose level, however lactate level was higher compared to control
group.

<7>
Accession Number
2010396011
Authors
Mahjoubifar M. Boroojeny S.B.
Institution
(Mahjoubifar, Boroojeny) Clinical Research Development Center,
Ali-ebn-Abitaleb Hospital, Zahedan University of Medical Sciences,
Zahedan, Iran, Islamic Republic of
Title
Hemodynamic changes during orotracheal intubation with the glidescope and
direct laryngoscope.
Source
Iranian Red Crescent Medical Journal. 12 (4) (pp 406-408), 2010. Date of
Publication: 2010.
Publisher
Iranian Red Crescent Society (PO Box: 2330, Dubai , UAE, United Arab
Emirates)
Abstract
Background: Hemodynamic changes during intubation are extremely important
especially in patients with a history of coronary artery disease and
arrhythmia. The aim of this study was to compare the hemodynamic changes
during video laryngoscopy (glidescope) and the conventional method of
direct laryngoscopy. Methods: This randomized double-blind clinical trial
recruited 200 male patients undergoing elective orthopaedic surgery. Heart
Rate (HR) and Mean Arterial Blood Pressure (MABP) were measured before, at
the time of induction and every minute for 10 minutes following
intubation. Results: Changes of MABP were significantly less in the
glidescopy group as compared to direct laryngoscopy group. No significant
change was observed between the HR in the two groups. Conclusion:
Glidescopic method of orotracheal intubation is considered advantageous
over the conventional method for its less alteration of MABP. Iranian Red
Crescent Medical Journal.

<8>
Accession Number
2010398381
Authors
Jensen L.O. Thayssen P. Tilsted H.H. Ravkilde J. Junker A. Hansen H.S.
Hansen K.N. Pedersen K.E. Sorensen H.T. Thuesen L. Lassen J.F.
Institution
(Jensen, Thayssen, Junker, Hansen, Hansen, Pedersen) Department of
Cardiology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense
C, Denmark
(Thuesen, Lassen) Department of Cardiology, Aarhus University Hospital,
Skejby Hospital, Aarhus, Denmark
(Tilsted, Ravkilde) Department of Cardiology, Aarhus University Hospital,
Aalborg Hospital, Aalborg, Denmark
(Sorensen) Department of Clinical Epidemiology, Aarhus University
Hospital, Aarhus, Denmark
Title
Rationale and design of a randomized clinical comparison of
everolimus-eluting (Xience V/Promus) and sirolimus-eluting (Cypher
Select+) Coronary Stents in unselected patients with coronary heart
disease.
Source
Cardiology. 116 (2) (pp 73-78), 2010. Date of Publication: July 2010.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Background: The sirolimus-eluting stent has demonstrated the least amount
of late lumen loss among previously released drug-eluting stents, but its
safety and efficacy has not been compared head-to-head with the
everolimus-eluting stent. Method: The Scandinavian Organization for
Randomized Trials with Clinical Outcome (SORT OUT) IV trial was designed
as a prospective, multi-center, open-label, all-comer, two-arm,
randomized, non-inferiority study comparing the everolimus-eluting stent
with the sirolimus-eluting stent in the treatment of atherosclerotic
coronary artery lesions. Based on a non-inferiority design, power
calculations estimated a needed enrolment of 2,678 patients. The primary
endpoint is a composite of cardiac death, myocardial infarction, and stent
thrombosis or target vessel revascularization after 9 months. Data on
clinical events and mortality for all randomized patients will be obtained
from national databases at 9 months. No clinical follow-up examination is
scheduled. Conclusion: The SORT OUT IV trial will directly compare
clinically relevant differences in efficacy and safety in two drug-eluting
stents: a first-generation sirolimus-eluting stent versus a
second-generation everolimus-eluting stent. The study makes use of
clinical endpoints routinely collected in computerized healthcare
registries, allowing complete follow-up of a large, well-defined
population without scheduled angiographic examinations. 2010 S. Karger
AG.

<9>
Accession Number
2010398392
Authors
Tarantini G. Favaretto E. Napodano M. Perazzolo Marra M. Cacciavillani L.
Babuin L. Giovagnoni A. Renda P. De Biasio V. Plebani M. Mion M. Zaninotto
M. Mistrorigo F. Panfili M. Isabella G. Bilato C. Iliceto S.
Institution
(Tarantini, Favaretto, Napodano, Perazzolo Marra, Cacciavillani, Babuin,
Mistrorigo, Panfili, Isabella, Bilato, Iliceto) Departments of Cardiac,
Thoracic and Vascular Sciences, University of Padua, Padua, Italy
(Plebani, Mion, Zaninotto) Laboratory Medicine, University of Padua,
Padua, Italy
(Giovagnoni, Renda, De Biasio) Department of Cardiology, Abano Terme
Hospital, Abano Terme, Italy
(Tarantini) Division of Cardiology, Department of Cardiac, Thoracic and
Vascular Sciences, University Hospital, Via Giustiniani, 2, IT-35128
Padua, Italy
Title
Design and methodologies of the postconditioning during coronary
angioplasty in acute myocardial infarction (POST-AMI) trial.
Source
Cardiology. 116 (2) (pp 110-116), 2010. Date of Publication: July 2010.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Background: Reperfusion remains the definitive treatment for acute
myocardial infarction (AMI), but restoring blood flow carries the
potential to exacerbate the ischemia-related injury. Postconditioning
might modify reperfusion-induced adverse events. Study Design: The
POSTconditioning during Coronary Angioplasty in Acute Myocardial
Infarction (POST-AMI) trial is a single-center, prospective, randomized
study, with a planned inclusion of 78 patients with ST-elevation AMI.
Patients will be randomly assigned to the postconditioning arm [primary
angioplasty (PA) and stenting followed by brief episodes of
ischemia-reperfusion early after recanalization] or non-postconditioning
arm. All patients will be treated medically according to current
international guidelines, including glycoprotein IIb/IIIa inhibitors
before PA. The primary end point is to evaluate whether postconditioning,
compared to plain PA, reduces infarct size estimated by cardiac magnetic
resonance (CMR) at 30 +/- 10 days after the AMI. Secondary end points are
microvascular obstruction observed at CMR, ST-segment resolution,
angiographic myocardial blush grade <2, non-sustained/sustained
ventricular tachycardia in the 48 h following PA, left ventricular
remodeling and function at follow-up CMR, and the reduction of major
adverse cardiac events at 30 days and 6 months. Conclusion: The POST-AMI
trial will evaluate the usefulness of postconditioning in limiting infarct
size during the early and late phases after AMI. 2010 S. Karger AG.

<10>
Accession Number
2010400536
Authors
Bartnes K. Hermansen S.E. Dahl-Eriksen O. Iqbal A. Mannsverk J.T. Steigen
T.K. Trovik T. Busund R. Dahl P.E. Sorlie D.G. Myrmel T.
Institution
(Bartnes, Busund, Dahl, Sorlie, Myrmel) Department of Cardiothoracic and
Vascular Surgery, University Hospital North Norway, N-9038 Tromso, Norway
(Hermansen, Steigen, Busund, Sorlie, Myrmel) Institute of Clinical
Medicine, University of Tromso, Tromso, Norway
(Dahl-Eriksen, Iqbal, Mannsverk, Steigen, Trovik) Department of
Cardiology, University Hospital North Norway, Tromso, Norway
Title
Radial artery graft patency relates to gender, diabetes mellitus and
angiotensin inhibition.
Source
Scandinavian Cardiovascular Journal. 44 (4) (pp 230-236), 2010. Date of
Publication: August 2010.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
The radial artery is resistant to atherosclerotic degeneration and
therefore appears more attractive for coronary artery bypass grafting than
the saphenous vein. However, the patency of radial artery grafts varies
widely among studies. Therefore, before deciding whether to adopt this as
the conduit of choice second to internal mammary artery grafts, we have
prospectively monitored our first cohort of patients with
radial-to-coronary bypasses. Design. Angiographic and clinical outcome
parameters were registered for the 119 patients receiving radial artery
grafts at our institution during April 4, 2001 to October 7, 2003.
Results. Reangiography of 102 patients (86%) showed that after two to
three years, 79% of the radial artery and 87% of the saphenous vein grafts
remained patent. Radial artery harvesting was well tolerated. Patency of
radial artery grafts was correlated to diabetes mellitus (detrimental),
gender (women had higher occlusion rates), and use of angiotensin
inhibiting medication (beneficial). Conclusions. The pre-study assumption
that radial artery grafts would out-perform those of saphenous vein at
mid-term is not borne out. The propensity of radial artery graft failure
in diabetics and the higher patency associated with angiotensin inhibition
might both relate to endothelial modulation of the muscular tone of the
graft. 2010 Informa UK Ltd.

<11>
[Use Link to view the full text]
Accession Number
2010394078
Authors
Di Biase L. Burkhardt J.D. Mohanty P. Sanchez J. Mohanty S. Horton R.
Gallinghouse G.J. Bailey S.M. Zagrodzky J.D. Santangeli P. Hao S. Hongo R.
Beheiry S. Themistoclakis S. Bonso A. Rossillo A. Corrado A. Raviele A.
Al-Ahmad A. Wang P. Cummings J.E. Schweikert R.A. Pelargonio G. Dello
Russo A. Casella M. Santarelli P. Lewis W.R. Natale A.
Institution
(Di Biase, Burkhardt, Mohanty, Sanchez, Mohanty, Horton, Gallinghouse,
Bailey, Zagrodzky, Natale) Texas Cardiac Arrhythmia Institute, St. David's
Medical Center, 1015 E 32nd St, Austin, TX 78705, United States
(Di Biase) Department of Cardiology, University of Foggia, Foggia, Italy
(Di Biase, Hongo, Natale) Department of Biomedical Engineering, University
of Texas, Austin, United States
(Santangeli, Pelargonio, Dello Russo, Casella, Santarelli) Catholic
University, Rome, Italy
(Hao, Hongo, Beheiry, Natale) California Pacific Medical Center, San
Francisco, United States
(Themistoclakis, Bonso, Rossillo, Corrado, Raviele) Hospital dell'Angelo,
Mestre/Venice, Italy
(Al-Ahmad, Wang, Natale) Stanford University, Palo Alto, CA, United States
(Cummings, Schweikert, Natale) Akron General Hospital, Akron, OH, United
States
(Lewis, Natale) Case Western Reserve University School of Medicine,
Cleveland, OH, United States
Title
Left atrial appendage: An underrecognized trigger site of atrial
fibrillation.
Source
Circulation. 122 (2) (pp 109-118), 2010. Date of Publication: 13 Jul
2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: Together with pulmonary veins, many extrapulmonary vein areas
may be the source of initiation and maintenance of atrial fibrillation.
The left atrial appendage (LAA) is an underestimated site of initiation of
atrial fibrillation. Here, we report the prevalence of triggers from the
LAA and the best strategy for successful ablation. Methods and results-:
Nine hundred eighty-seven consecutive patients (29% paroxysmal, 71%
nonparoxysmal) undergoing redo catheter ablation for atrial fibrillation
were enrolled. Two hundred sixty-six patients (27%) showed firing from the
LAA and became the study population. In 86 of 987 patients (8.7%; 5
paroxysmal, 81 nonparoxysmal), the LAA was found to be the only source of
arrhythmia with no pulmonary veins or other extrapulmonary vein site
reconnection. Ablation was performed either with focal lesion (n=56; group
2) or to achieve LAA isolation by placement of the circular catheter at
the ostium of the LAA guided by intracardiac echocardiography (167
patients; group 3). In the remaining patients, LAA firing was not ablated
(n=43; group 1). At the 12+/-3-month follow-up, 32 patients (74%) in group
1 had recurrence compared with 38 (68%) in group 2 and 25 (15%) in group 3
(P<0.001). Conclusions-: The LAA appears to be responsible for arrhythmias
in 27% of patients presenting for repeat procedures. Isolation of the LAA
could achieve freedom from atrial fibrillation in patients presenting for
a repeat procedure when arrhythmias initiating from this structure are
demonstrated. 2010 American Heart Association, Inc.

<12>
[Use Link to view the full text]
Accession Number
2010394081
Authors
Flett A.S. Hayward M.P. Ashworth M.T. Hansen M.S. Taylor A.M. Elliott P.M.
McGregor C. Moon J.C.
Institution
(Flett, Hayward, Elliott, McGregor, Moon) Heart Hospital, University
College, London Hospitals National Health Service Trust, United Kingdom
(Flett, Elliott, McGregor, Moon) Department of Medicine, University
College London, United Kingdom
(Ashworth) Department of Histopathology, Great Ormond Street Hospital for
Children National Health Service Trust, United Kingdom
(Hansen, Taylor) Cardiovascular Unit, University College London Institute
of Child Health, United Kingdom
(Hansen, Taylor) Great Ormond Street Hospital for Children, London, United
Kingdom
Title
Equilibrium contrast cardiovascular magnetic resonance for the measurement
of diffuse myocardial fibrosis: Preliminary validation in humans.
Source
Circulation. 122 (2) (pp 138-144), 2010. Date of Publication: 13 Jul
2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: Diffuse myocardial fibrosis is a final end point in most
cardiac diseases. It is missed by the cardiovascular magnetic resonance
(CMR) late gadolinium enhancement technique. Currently, quantifying
diffuse myocardial fibrosis requires invasive biopsy, with inherent risk
and sampling error. We have developed a robust and noninvasive technique,
equilibrium contrast CMR (EQ-CMR) to quantify diffuse fibrosis and have
validated it against the current gold standard of surgical myocardial
biopsy. Methods and results-: The 3 principles of EQ-CMR are a bolus of
extracellular gadolinium contrast followed by continuous infusion to
achieve equilibrium; a blood sample to measure blood volume of
distribution (1-hematocrit); and CMR to measure pre-and postequilibrium T1
(with heart rate correction). The myocardial volume of distribution is
calculated, reflecting diffuse myocardial fibrosis. Clinical validation
occurred in patients undergoing aortic valve replacement for aortic
stenosis or myectomy in hypertrophic cardiomyopathy (n=18 and n=8,
respectively). Surgical biopsies were analyzed for picrosirius red
fibrosis quantification on histology. The mean histological fibrosis was
20.5+/-11% in aortic stenosis and 17.1+/-7.4% in hypertrophic
cardiomyopathy. EQ-CMR correlated strongly with biopsy histological
fibrosis: aortic stenosis, r=0.86, Kendall Tau coefficient (T)=0.71,
P<0.001; hypertrophic cardiomyopathy, r=0.62, T=0.52, P=0.08; combined
r=0.80, T=0.67, P<0.001. Conclusions-: We have developed and validated a
new technique, EQ-CMR, to measure diffuse myocardial fibrosis as an add-on
to a standard CMR scan, which allows for the noninvasive quantification of
the diffuse fibrosis burden in myocardial diseases. 2010 American Heart
Association, Inc.

<13>
Accession Number
2010398498
Authors
Stramba-Badiale M.
Institution
(Stramba-Badiale) Department of Rehabilitation Medicine, IRCCS Istituto
Auxologico Italiano, Via Mos Bianchi, 90, 20149 Milan, Italy
Title
Women and research on cardiovascular diseases in Europe: A report from the
European Heart Health Strategy (EuroHeart) project.
Source
European Heart Journal. 31 (14) (pp 1677-1681+1681a-1681d), 2010. Date
of Publication: July 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)

<14>
Accession Number
2010398504
Authors
Toma M. Buller C.E. Westerhout C.M. Fu Y. O'Neill W.W. Holmes D.R. Hamm
C.W. Granger C.B. Armstrong P.W.
Institution
(Toma, Westerhout, Fu, Armstrong) Canadian VIGOUR Centre, University of
Alberta, 2-51 Medical Sciences Building, Edmonton, AB T6G 2H7, Canada
(Buller) University of British Columbia, Vancouver, BC, Canada
(O'Neill) Miller School of Medicine, Miami, FL, United States
(Holmes) Mayo Clinic, Rochester, MN, United States
(Hamm) Kerckhoff Heart Center, Bad Nauheim, Germany
(Granger) Duke Clinical Research Institute, Durham, NC, United States
Title
Non-culprit coronary artery percutaneous coronary intervention during
acute ST-segment elevation myocardial infarction: Insights from the
APEX-AMI trial.
Source
European Heart Journal. 31 (14) (pp 1701-1707), 2010. Date of
Publication: July 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims To examine the incidence of and propensity for non-culprit
interventions performed at the time of the primary percutaneous coronary
intervention (PCI) and its association with 90-day outcomes.Methods and
resultsWe examined the incidence, propensity for, and associated 90-day
outcomes following non-culprit interventions performed at the time of
primary PCI among ST-elevation myocardial infarction patients with
multi-vessel coronary artery disease (MVD). Of the 5373 patients who
underwent primary PCI in the APEX-AMI trial, 2201 had MVD. Of those, 217
(9.9) underwent non-infarct-related arteries (IRA) PCI, whereas 1984
(90.1) underwent PCI of the IRA alone. Ninety-day death and
death/CHF/shock were higher in the non-IRA group compared with the
IRA-only PCI group (12.5 vs. 5.6, P (log-rank) < 0.001 and 17.4 vs. 12.0,
P (log-rank) = 0.020, respectively). After adjusting for patient and
procedural characteristics as well as propensity for performing non-IRA
PCI, this procedure remained independently associated with an increased
hazard of 90-day mortality [adjusted hazard ratio 2.44, 95 CI (1.55-3.83),
P < 0.001]. Conclusion Non-culprit coronary interventions were performed
at the time of primary PCI in 10 of MVD patients and were significantly
associated with increased mortality. Our data support current guideline
recommendations discouraging the performance of such procedures in stable
primary PCI patients. Prospective randomized study of this issue may be
warranted. 2010 The Author.

<15>
Accession Number
2010398560
Authors
Caliskan Y. Demirturk M. Ozkok A. Yelken B. Sakaci T. Oflaz H. Unsal A.
Yildiz A.
Institution
(Caliskan, Demirturk, Ozkok, Yelken, Yildiz) Department of Internal
Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul,
Turkey
(Sakaci, Unsal) Division of Nephrology, Sisli Etfal Training and Research
Hospital, Istanbul, Turkey
(Oflaz) Department of Cardiology, Istanbul Faculty of Medicine, Istanbul
University, Istanbul, Turkey
Title
Coronary artery calcification and coronary flow velocity in haemodialysis
patients.
Source
Nephrology Dialysis Transplantation. 25 (8) (pp 2685-2690), 2010. Date
of Publication: August 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Background. Decreased coronary flow reserve (CFR) is a marker of
endothelial dysfunction, coronary artery calcification and inflammation,
well-known cardiovascular risk factors in haemodialysis (HD) patients. In
this study, we aimed to investigate the correlation of coronary artery
calcification scores (CACS) with CFR in HD patients.Methods. Sixty-four
end-stage renal failure patients were enrolled in this study (38 males, 26
females). Thirty-nine healthy subjects (22 males, 17 females) were
included in the control group. Biochemical parameters and acute-phase
inflammation marker [high-sensitivity C-reactive protein (hs-CRP)] of
patients were recorded before dialysis. The CACS were measured by electron
beam computerized tomography method. CFR recordings were performed by
trans-thoracic Doppler echocardiography. The relationship between CACS and
CFR was evaluated.Results. The mean CACS was 281 +/- 589 and 29 patients
had CACS < 10. Patients with CACS > 10 had significantly lower CFR values
compared to patients with CACS < 10 (1.56 +/- 0.38 vs 1.84 +/- 0.53, P =
0.024). However, there was no difference in hs-CRP values between the
groups. CFR was negatively correlated with CACS (r = -0.276, P = 0.030).
In multiple stepwise regression analysis, CACS was found to be an
independent variable for predicting CFR (P = 0.048). During a follow-up of
18 months, 10 patients had experience of cardiovascular events. Patients
with CACS > 10 had significantly higher event rate [34.5% (10/29) vs 0%
(0/24)] compared to those with CACS < 10 (P = 0.001). Patients who
developed cardiovascular events had significantly higher mean CACS and
lower CFR values than the remaining group (P = 0.019 and P = 0.039). All
of four patients who died during follow-up were in the CFR < 2 and CACS >
10 groups.Conclusions. CACS was associated with CFR in HD patients.
However, we did not find any association of inflammation with CACS and
CFR. This association between CFR and CACS might indicate two different
(anatomical and functional) aspects of the common pathophysiology of the
arterial system in HD patients. The Author [2009]. Published by Oxford
University Press on behalf of ERA-EDTA. All rights reserved.

<16>
Accession Number
20370916
Authors
Verma K. Errico T.J. Vaz K.M. Lonner B.S.
Institution
(Verma) Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases
- Langone Medical Center, 301 East 17th St, New York, NY 10003, USA.
Title
A prospective, randomized, double-blinded single-site control study
comparing blood loss prevention of tranexamic acid (TXA) to epsilon
aminocaproic acid (EACA) for corrective spinal surgery.
Source
BMC surgery. 10 (pp 13), 2010. Date of Publication: 2010.
Abstract
BACKGROUND: Multilevel spinal fusion surgery has typically been associated
with significant blood loss. To limit both the need for transfusions and
co-morbidities associated with blood loss, the use of anti-fibrinolytic
agents has been proposed. While there is some literature comparing the
effectiveness of tranexamic acid (TXA) to epsilon aminocaproic acid (EACA)
in cardiac procedures, there is currently no literature directly comparing
TXA to EACA in orthopedic surgery. METHODS/DESIGN: Here we propose a
prospective, randomized, double-blinded control study evaluating the
effects of TXA, EACA, and placebo for treatment of adolescent idiopathic
scoliosis (AIS), neuromuscular scoliosis (NMS), and adult deformity (AD)
via corrective spinal surgery. Efficacy will be determined by
intraoperative and postoperative blood loss. Other clinical outcomes that
will be compared include transfusion rates, preoperative and postoperative
hemodynamic values, and length of hospital stay after the procedure.
DISCUSSION: The primary goal of the study is to determine perioperative
blood loss as a measure of the efficacy of TXA, EACA, and placebo. Based
on current literature and the mechanism by which the medications act, we
hypothesize that TXA will be more effective at reducing blood loss than
EACA or placebo and result in improved patient outcomes. TRIAL
REGISTRATION: ClinicalTrials.gov ID: NCT00958581.

<17>
Accession Number
20398378
Authors
Cuthbertson B.H. Campbell M.K. Stott S.A. Vale L. Norrie J. Kinsella J.
Cook J. Brittenden J. Grant A. FOCCUS Study Group
Institution
(Cuthbertson) Department of Critical Care Medicine, Sunnybrook Health
Sciences Centre, Toronto, Ontario, Canada.
Title
A pragmatic multi-centre randomised controlled trial of fluid loading and
level of dependency in high-risk surgical patients undergoing major
elective surgery: trial protocol.
Source
Trials. 11 (pp 41), 2010. Date of Publication: 2010.
Abstract
BACKGROUND: Patients undergoing major elective or urgent surgery are at
high risk of death or significant morbidity. Measures to reduce this
morbidity and mortality include pre-operative optimisation and use of
higher levels of dependency care after surgery. We propose a pragmatic
multi-centre randomised controlled trial of level of dependency and
pre-operative fluid therapy in high-risk surgical patients undergoing
major elective surgery. METHODS/DESIGN: A multi-centre randomised
controlled trial with a 2 * 2 factorial design. The first randomisation is
to pre-operative fluid therapy or standard regimen and the second
randomisation is to routine intensive care versus high dependency care
during the early post-operative period. We intend to recruit 204 patients
undergoing major elective and urgent abdominal and thoraco-abdominal
surgery who fulfil high-risk surgical criteria. The primary outcome for
the comparison of level of care is cost-effectiveness at six months and
for the comparison of fluid optimisation is the number of hospital days
after surgery. DISCUSSION: We believe that the results of this study will
be invaluable in determining the future care and clinical resource
utilisation for this group of patients and thus will have a major impact
on clinical practice. TRIAL REGISTRATION: Trial registration number -
ISRCTN32188676.

<18>
Accession Number
20401289
Authors
Sirlak M. Akar A.R. Eryilmaz S. Cetinkanat E.K. Ozcinar E. Kaya B. Elhan
A.H. Ozyurda U.
Institution
(Sirlak) Department of Cardiovascular Surgery, Ankara University School of
Medicine, Dikimevi-Ankara 06340, Turkey.
Title
Micronized purified flavonoid fraction in pretreating CABG patients.
Source
Texas Heart Institute journal / from the Texas Heart Institute of St.
Luke's Episcopal Hospital, Texas Children's Hospital. 37 (2) (pp
172-177), 2010. Date of Publication: 2010.
Abstract
The aim of the present study was to determine whether oral pretreatment
with micronized purified flavonoid fraction (Daflon) has beneficial
effects on cardiac function and outcome after cardiac operations. This
prospective, randomized trial enrolled 43 patients who had an impaired
preoperative left ventricular ejection fraction of less than 0.50 (mean,
0.45 +/- 0.04) and a mean New York Heart Association functional class
status of 2.30 +/- 0.74; all were scheduled for elective coronary artery
bypass grafting. Patients who were randomized to the Daflon group (n=21)
received oral Daflon 500 mg (6 tablets daily for 4 days, followed by 2
tablets for 3 days) preoperatively. Outcome variables included
perioperative hemodynamic data, inotropic requirements, morbidity, and
death, as well as cardiac ischemia and various outcome markers.
Hemodynamic and biochemical data were collected before induction of
anesthesia, perioperatively before starting cardiopulmonary bypass,
immediately after bypass, and at the 24th postoperative hour. There was
only 1 death (in the Daflon group). During the post-cardiopulmonary bypass
period, troponin I and lactate dehydrogenase levels were significantly
lower in the Daflon group. Also, the New York Heart Association status of
the patients in the Daflon group was significantly lower postoperatively.
Differences between the 2 groups in lengths of stay in the intensive care
unit and hospital, inotropic requirements, and left ventricular ejection
fraction levels did not reach statistical significance. Orally
administered Daflon might provide better outcomes for patients who have
impaired cardiac function before undergoing cardiac operations that
require cardiopulmonary bypass.

<19>
Accession Number
20504378
Authors
Fleckenstein J. Kramer S. Offenbacher M. Schober G. Plischke H. Siebeck M.
Mussack T. Hatz R. Lehmeyer L. Lang P.M. Heindl B. Conzen P. Irnich D.
Institution
(Fleckenstein) Department of Anaesthesiology, University of Munich,
Munich, Germany.
Title
Etoricoxib--preemptive and postoperative analgesia (EPPA) in patients with
laparotomy or thoracotomy--design and protocols.
Source
Trials. 11 (pp 66), 2010. Date of Publication: 2010.
Abstract
BACKGROUND AND OBJECTIVE: Our objective was to report on the design and
essentials of the Etoricoxib protocol- Preemptive and Postoperative
Analgesia (EPPA) Trial, investigating whether preemptive analgesia with
cox-2 inhibitors is more efficacious than placebo in patients who receive
either laparotomy or thoracotomy. DESIGN AND METHODS: The study is a 2 x 2
factorial armed, double blinded, bicentric, randomised placebo-controlled
trial comparing (a) etoricoxib and (b) placebo in a pre- and postoperative
setting. The total observation period is 6 months. According to a power
analysis, 120 patients scheduled for abdominal or thoracic surgery will
randomly be allocated to either the preemptive or the postoperative
treatment group. These two groups are each divided into two arms.
Preemptive group patients receive etoricoxib prior to surgery and either
etoricoxib again or placebo postoperatively. Postoperative group patients
receive placebo prior to surgery and either placebo again or etoricoxib
after surgery (2 x 2 factorial study design). The Main Outcome Measure is
the cumulative use of morphine within the first 48 hours after surgery
(measured by patient controlled analgesia PCA). Secondary outcome
parameters include a broad range of tests including sensoric perception
and genetic polymorphisms. DISCUSSION: The results of this study will
provide information on the analgesic effectiveness of etoricoxib in
preemptive analgesia and will give hints on possible preventive effects of
persistent pain. TRIAL REGISTRATION: NCT00716833.

<20>
Accession Number
20583396
Authors
Kim S.Y. Shim J.K. Shim Y.H. Hong S.W. Choi K.H. Kwak Y.L.
Institution
(Kim) Department of Anesthesiology and Pain Medicine, Yonsei University
College of Medicine, Seoul, Korea.
Title
Sildenafil and beraprost combination therapy in patients with pulmonary
hypertension undergoing valvular heart surgery.
Source
The Journal of heart valve disease. 19 (3) (pp 333-340), 2010. Date of
Publication: May 2010.
Abstract
BACKGROUND AND AIM OF THE STUDY: Sildenafil and beraprost, as orally
available pulmonary vasodilators, are used increasingly to treat pulmonary
hypertension (PH). An evaluation was made, in patients with PH undergoing
valvular heart surgery, as to whether preoperative combined oral
sildenafil and beraprost treatment could induce synergistic and prolonged
pulmonary vasodilation, or result in a loss of pulmonary selectivity.
METHODS: Fifty patients scheduled for valvular heart surgery with a mean
pulmonary arterial pressure (PAP) > 30 mmHg were randomly assigned to
receive either 50 mg oral sildenafil + 40 microg beraprost, or a placebo,
15 min before the induction of anesthesia. Hemodynamic variables were
measured intraoperatively. RESULTS: The treatment group had a
significantly lower systemic vascular resistance index at 60 min after
medication. No other significant intergroup differences in hemodynamic
variables were observed. In addition, significantly more patients in the
treatment group required vasopressor therapy. In both groups, the PAP was
significantly reduced by general anesthesia, and almost normalized after
valvular heart surgery. CONCLUSION: Preoperative oral sildenafil and
beraprost treatment resulted in a loss of pulmonary selectivity, and did
not provide any additional pulmonary vasodilation or favorable
perioperative hemodynamics in patients with PH undergoing valvular heart
surgery.

<21>
Accession Number
2010341921
Authors
Ozaydin M. Varol E. Tuker Y. Peker O. Erdogan D. Dogan A. Ibrisim E.
Institution
(Ozaydin, Varol, Erdogan, Dogan) Departments of Cardiology, Faculty of
Medicine, Suleyman Demirel University, Isparta, Turkey
(Tuker) Departments of Cardiovascular Surgery, Faculty of Medicine,
Sueyman Demirel University, Isparta, Turkey
(Peker, Ibrisim) Clinic of Cardiology, Gulkent State Hospital, Isparta,
Turkey
Title
Association between renin-angiotensin aldosterone system blockers and
postoperative atrial fibrillation in patients with mild and moderate left
ventricular dysfunction.
Source
Anadolu Kardiyoloji Dergisi. 10 (2) (pp 137-142), 2010. Date of
Publication: April 2010.
Publisher
Aves Yayincilik (Kizilelma CAD. 5/3, Findikzade- Istanbul 34096, Turkey)
Abstract
Objective: The aim of the study was to evaluate the association between
renin - angiotensin - aldosterone system blockers and risk of
postoperative atrial fibrillation (AF) development in patients with mild
and moderate left ventricular systolic dysfunction. Methods: The
population of this prospective and observational study consisted of 269
patients with an ejection fraction of <= 50% undergoing coronary artery
bypass and/or valve surgery. Use of renin -angiotensin-aldosterone system
blockers (angiotensin converting enzyme inhibitors (ACEI), angiotensin
receptor blockers (ARB) and spironolactone) and their association with
postoperative AF (AF episode lasting > 5 min) were evaluated. In
statistical analysis t test for independent samples, Chi-square test and
Mann Whitney U test were used for comparison of variables between groups.
Predictors of postoperative AF were determined by multiple logistic
regression analysis. Results: During follow-up, 50 patients (13%)
developed postoperative AF. With multiple logistic regression analysis,
risk factors for postoperative AF were determined: left atrial diameter
(OR- 1.09; 95%CI 1.01-1.16, p=0.02), age (OR-1.04; 95%CI 1.002- 1.08,
p=0.04), aortic cross-clamp duration (OR- 1.03, 95%CI -1.00-1.05, p=0.01),
use of left internal mammarian artery (OR-0.33; 95%CI 0.13-0.88, p=0.03),
ACEIs treatment (OR-0.27; 95%CI 0.12-0.62, p=0.002), and ARBs treatment
(OR - 0.21, 95%CI 0.07-0.62, p=0.005). Conclusions: Our results indicate
that although treatments with ACEIs and ARBs are associated with low
incidence of postoperative AF in patients with mild and moderate left
ventricular systolic dysfunction, treatment with spironolactone is not.
Copyright 2010 by AVES Yayincilik Ltd.

<22>
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, Australia
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.

<23>
Accession Number
2010393918
Authors
Schaarschmidt J. Seeburger J. Borger M.A. Grosse F.O. Kraemer K. Mohr F.W.
Institution
(Schaarschmidt, Grosse, Kraemer) Department of Cardiovascular Perfusion,
University of Leipzig - Heart Center, Struempellstr. 39, 04289 Leipzig,
Germany
(Seeburger, Borger, Mohr) Department of Cardiac Surgery, University of
Leipzig - Heart Center, Germany
Title
Clinical evaluation of the new BMU 40 in-line blood analysis monitor.
Source
Perfusion. 24 (4) (pp 277-286), 2009. Date of Publication: July 2009.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Background: Accurate information about different blood parameters is
essential in maintaining haemodynamics, perfusion and gas exchange during
cardiopulmonary bypass (CPB). For this purpose, precise, accurate and
continuous measurement and monitoring, preferably visually available, is
needed.The objective of this clinical study was to compare the newly
developed continuous in-line blood parameter monitoring system (CIBPMS)
BMU 40 with a reference laboratory analyser with regards to the precision
and accuracy of blood parameter measurement. Methods: Thirty adult
patients underwent elective cardiac surgery, CPB and mild hypothermia
(32degreeC). At five predetermined time points (S1 " S5) arterial and
venous blood samples were analysed using the BMU 40 for five different
parameters (PaO₂(37degreeC), PaO₂(act),
SvO₂, Hb(ven) and Hct(ven)) and these results were compared to
the gold standard laboratory analyser, the ABL 700. Results: A total of
150 paired blood samples were included to compare means, to analyse
correlation, and to calculate measures of bias, precision, limits of
agreement and 95% confidence intervals. Results revealed good agreement
between the two devices for all parameters. Bias +/- precision of S2 " S5
PaO₂(37degreeC) were: 2.17 +/- 9.61; PaO₂(act) 2.58
+/- 9.54; SvO ₂ -1.44 +/- 2.35; Hb(ven) 0.01 +/- 0.42; Hct(ven)
0.04 +/- 1.29. Statistically significant differences were detected for SvO
₂ (p<0.00001) at S1. Correlations after this first time point
(S1) improved following an in vivo calibration. Conclusion: The BMU 40 is
a precise, accurate and reliable continuous in-line blood parameter
measuring system that can easily be used within a standard CPB setup.
However, present data suggest an in vivo calibration of the BMU 40 should
be performed. 2009 The Author(s).

<24>
Accession Number
2010393919
Authors
Sohn N. Marcoux J. Mycyk T. Krahn J. Meng Q.
Institution
(Sohn, Krahn, Meng) Department of Pathology and Laboratory Medicine, Royal
University Hospital, University of Saskatchewan, 103 Hospital Drive,
Saskatoon, SK S7N 0W8, Canada
(Marcoux, Mycyk) Department of Surgery, University of Saskatchewan, Royal
University Hospital, Saskatoon, SK, Canada
Title
The impact of different biocompatible coated cardiopulmonary bypass
circuits on inflammatory response and oxidative stress.
Source
Perfusion. 24 (4) (pp 231-237), 2009. Date of Publication: July 2009.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
This study was to compare the impact of different biocompatible coated
circuits on inflammatory response and oxidative stress induced during
cardiopulmonary bypass (CPB). Seventy-eight patients undergoing elective
coronary artery bypass grafting (CABG) with CPB were randomly assigned to
five groups with different biocompatible coated circuits: Trillium,
Bioline, Phosphorylcholine, Polymethoxyethyl acrylate (PMEA), and the
uncoated control group. Blood was drawn at three different time points:
before CPB, 6 and 72 hours post CPB. Unlike the Trillium group, serum
levels of TNF-+/- in the Bioline and Phosphorylcholine groups
significantly increased only at 72 hours post CPB (p < 0.05). Serum levels
of IL-6 significantly increased at 6 and 72 hours post CPB in all groups
(p < 0.01). The Trillium group showed a significant increase of IL-10
compared to the control group at 72 hours post CPB (p < 0.05). Serum
levels of NOx in the Phosphorylcholine group significantly decreased at 6
hours post CPB compared to baseline (p < 0.05). Both the Bioline and
Phosphorylcholine groups showed statistical decreases in serum NOx levels
compared with other groups at 6 hours post CPB (p < 0.05). A significant
difference in NOx levels between the Bioline and the control group was
also observed at 72 hours post CPB. Myeloperoxidase levels were
significantly elevated at 6 and 72 hours post CPB in all groups (p <
0.05). Inflammatory response and oxidative stress are elevated during CABG
with CPB. Heparin-coated and the Phosphorylcholine-coated circuits induce
less inflammatory responses and oxidative stress compared to other
circuits. 2009 The Author(s).