EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 13

Results Generated From:
EMBASE <1980 to 2010 Week 38>
EMBASE (updates since 2010-09-16)

<1>
Accession Number
2010492992
Authors
Inaba Y. Chen J.A. Bergmann S.R.
Institution
(Inaba) Division of Cardiovascular Medicine, Oregon Health and Science
University, UHN62, 3181 SW Sam Jackson Park Rd., Portland, OR 97239,
United States
(Chen, Bergmann) Division of Cardiology, Beth Israel Medical Center, New
York, NY, United States
Title
Quantity of viable myocardium required to improve survival with
revascularization in patients with ischemic cardiomyopathy: A
meta-analysis.
Source
Journal of Nuclear Cardiology. 17 (4) (pp 646-654), 2010. Date of
Publication: August 2010.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Background: This meta-analysis was conducted to determine optimal cutoff
values for the assessment of viability using various imaging techniques
for which revascularization would offer a survival benefit in patients
with ischemic cardiomyopathy (ICM). Methods and Results: We searched five
electronic databases to identify relevant studies through December 2008.
Relative risks of cardiac death, both in patients with and without
viability, were calculated in each study. In order to estimate the optimal
threshold for the presence of viability, we assumed a linear relationship
between the amount of viable myocardium and survival benefit of
revascularization. Twenty-nine studies (4,167 patients) met the inclusion
criteria. The optimal threshold for the presence of viability was
estimated to be 25.8% (95% CI: 16.6-35.0%) by positron emission tomography
using 18F-fluorodeoxyglucose-perfusion mismatch, 35.9% (95% CI:
31.6-40.3%) by stress echocardiography using contractile reserve or
ischemic responses, and 38.7% (95% CI: 27.7-49.7%) by single photon
emission computed tomography using thallium-201 or technetium-99m MIBI
myocardial perfusion. Conclusions: The calculated amount of viable
myocardium determined to lead to improved survival was different among
imaging techniques. Thus, separate cutoff values for imaging modalities
may be helpful in determining which patients with ICM benefit from
revascularization. Copyright 2010 by the American Society of Nuclear
Cardiology.

<2>
[Use Link to view the full text]
Accession Number
2010477362
Authors
Dimitrova K.R. Hoffman D.M. Geller C.M. Decastro H. Dienstag B. Tranbaugh
R.F.
Institution
(Dimitrova, Hoffman, Geller, Decastro, Dienstag, Tranbaugh) Division of
Cardiac Surgery, Beth Israel Medical Center, 317 East 17th Street, New
York, NY 10003, United States
Title
Endoscopic radial artery harvest produces equivalent and excellent midterm
patency compared with open harvest.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 5 (4) (pp 265-269), 2010. Date of Publication: July-August
2010.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Objective: A recent multicenter study reported reduced patency of
aortocoronary bypass grafts when the saphenous vein was harvested by
endoscopic technique compared with patency of vein grafted after harvest
by the traditional "open" approach. Our aim was to compare the patency
rates of radial artery graft (RAG) harvested endoscopically with those
harvested using an open technique. Methods: Two cohorts were identified:
from January 1995 to January 2000, 724 consecutive patients had one or
both radial arteries harvested through an open technique, and from
February 2000 to January 2008, 727 consecutive patients had endoscopic
radial artery (RA) harvest. All patients who underwent symptom-indicated
angiography in our institution at any time after coronary artery bypass
grafting (CABG) surgery were identified. Results: Two hundred two patients
had angiograms for symptoms: 90 of these patients (119 RAG) had open RA
harvest and were studied 78.3 +/- 40 months (range, 1-156 months) after
CABG. The other 112 patients (148 RAG) had endoscopic RA harvest and
underwent angiography 36 +/- 24 months (range, 1-96 months) after CABG.
The two groups had identical demographics and risk profiles. Overall
patency of the "open" RAG was 78.9% versus 83.7% for the endoscopic group
(P = 0.3). Patency increased to 90% in both groups when the RAG was
anastomosed to a native coronary vessel with stenosis >80%. Conclusions:
Endoscopic and open RA harvesting techniques have equivalent and excellent
midterm and long-term patency rates in CABG patients studied by
angiography for recurrent symptoms of myocardial ischemia. The degree of
stenosis of the target vessel strongly influences the patency rate
independent of the harvesting technique. 2010 by the International
Society for Minimally Invasive Cardiothoracic Surgery.

<3>
[Use Link to view the full text]
Accession Number
2010477363
Authors
Schoenebeck J. Haddad M. Wegscheider K. Joubert-Huebner E. Reichenspurner
H. Detter C.
Institution
(Schoenebeck, Joubert-Huebner, Reichenspurner, Detter) Department of
Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse
52, 20246 Hamburg, Germany
(Haddad) Departments of Clinical Chemistry, University of Hamburg,
Hamburg, Germany
(Wegscheider) Medical Biometry and Epidemiology, University of Hamburg,
Hamburg, Germany
Title
Prospective, randomized study comparing two different minimized versus
conventional cardiopulmonary bypass systems.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 5 (4) (pp 270-277), 2010. Date of Publication: July-August
2010.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Objective: Conventional cardiopulmonary bypass (CCPB) is a major trigger
of inflammatory response. We aimed to assess the impact of two different
minimized cardiopulmonary bypass systems (mini-CPB) with and without
Bioline-coating compared with CCPB regarding organ function, inflammatory
response, and early clinical outcome. Methods: In a prospective,
randomized study, 120 patients underwent elective coronary artery bypass
grafting and were randomized into three groups: mini-CPB using a
Bioline-coated (group A, n = 40) or an uncoated (group B, n = 40) circuit,
or CCPB (group C, n = 40). Cytokines (interleukin-6, interleukin-8, and
tumor necrosis factor-alpha), myocardial markers (creatine kinase [CK],
CK-MB, and troponin-T), hematocrit, and platelet counts were measured up
to 48 hours postoperatively. Early clinical outcome was assessed at 3
months postoperatively. Results: Demographics, number of distal
anastomoses, ventilation time, blood loss, intensive care unit, and
hospital stay were comparable (P = not significant). Extracorporeal
circulation and cross-clamp time were significantly longer in group A and
B versus C (P < 0.005). No significant differences could be found in the
release of interleukin-6, interleukin-8, and tumor necrosis factor-alpha
among groups. Myocardial markers were significantly reduced in group A and
B versus group C (P < 0.001). Hematocrit and platelet counts did not
differ among the groups. No differences could be found in early clinical
outcome up to 3 months. Conclusions: This study showed significant better
myocardial preservation with lower CK-MB and troponin-T levels in both
mini-CPB groups. No significant differences could be found in terms of
inflammation, hematologic effects, and early clinical outcome. 2010 by
the International Society for Minimally Invasive Cardiothoracic Surgery.

<4>
Accession Number
2010483030
Authors
Yamaguchi J. Hagiwara N. Ogawa H. Koyanagi R. Kasanuki H. Takagi A. Mori
F. Nagashima M. Yagi M.
Institution
(Yamaguchi, Hagiwara, Ogawa, Koyanagi, Kasanuki, Takagi, Mori, Nagashima,
Yagi) Department of Cardiology, Heart Institute of Japan, Tokyo Women's
Medical University, Tokyo, Japan
Title
Effect of amlodipine + candesartan on cardiovascular events in
hypertensive patients with coronary artery disease (from the Heart
Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary
Artery Disease [HIJ-CREATE] study).
Source
American Journal of Cardiology. 106 (6) (pp 819-824), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Combination therapy with calcium channel blockers and angiotensin II
receptor blockers is recommended as one of the effective therapies for
hypertension. However, it remains unclear whether this combination reduces
major adverse cardiovascular events (MACEs) in patients with hypertension
with coronary artery disease (CAD). The purpose of the present study was
to examine the effects of amlodipine plus candesartan on MACEs in patients
with hypertension with CAD. The study population was drawn from The Heart
Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary
Artery Disease (HIJ-CREATE), which was a multicenter, prospective,
randomized controlled trial including 2,049 patients with hypertension
with angiographically documented CAD. Subgroup analysis was performed in
patients treated with amlodipine at baseline (n = 388). The median
follow-up period was 4.3 years. Treatment using amlodipine plus
candesartan reduced the risk for MACEs by 39% (p = 0.015) compared to that
using amlodipine without angiotensin II receptor blockers. Among the
individual events constituting MACEs, the incidence of unstable angina
pectoris requiring hospitalization was significantly lower, by 52% (p =
0.007). In conclusion, amlodipine plus candesartan demonstrated a more
favorable effect on reducing cardiovascular events in patients with
hypertension with CAD compared to amlodipine-based therapy without
candesartan. 2010 Elsevier Inc. All rights reserved.

<5>
Accession Number
2010486464
Authors
Sleeper L.A. Reynolds H.R. White H.D. Webb J.G. Dzavik V. Hochman J.S.
Institution
(Sleeper) New England Research Institutes, 9 Galen Street, Watertown, MA
02472, United States
(Reynolds, Hochman) Cardiovascular Clinical Research Center, New York
University School of Medicine, New York, NY, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Dzavik) University of Toronto, Toronto, ON, Canada
Title
A severity scoring system for risk assessment of patients with cardiogenic
shock: A report from the SHOCK Trial and Registry.
Source
American Heart Journal. 160 (3) (pp 443-450), 2010. Date of Publication:
September 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Early revascularization (ERV) is beneficial in the management
of cardiogenic shock (CS) complicating myocardial infarction. The severity
of CS varies widely, and identification of independent risk factors for
outcome is needed. The effect of ERV on mortality in different risk strata
is also unknown. We created a severity scoring system for CS and used it
to examine the potential benefit of ERV in different risk strata using
data from the SHOCK Trial and Registry. Methods: Data from 1,217 patients
(294 from the randomized trial and 923 from the registry) with CS due to
pump failure were included in a Stage 1 severity scoring system using
clinical variables. A Stage 2 scoring system was developed using data from
872 patients who had invasive hemodynamic measurements. The outcome was
in-hospital mortality at 30 days. Results: In-hospital mortality at 30
days was 57%. Multivariable modeling identified 8 risk factors (Stage 1):
age, shock on admission, clinical evidence of end-organ hypoperfusion,
anoxic brain damage, systolic blood pressure, prior coronary artery bypass
grafting, noninferior myocardial infarction, and creatinine >=1.9 mg/dL
(c-statistic = 0.74). Mortality ranged from 22% to 88% by score category.
The ERV benefit was greatest in moderate- to high-risk patients (P = .02).
The Stage 2 model based on patients with pulmonary artery catheterization
included age, end-organ hypoperfusion, anoxic brain damage, stroke work,
and left ventricular ejection fraction <28% (c-statistic = 0.76). In this
cohort, the effect of ERV did not vary by risk stratum. Conclusions:
Simple clinical predictors provide good discrimination of mortality risk
in CS complicating myocardial infarction. Early revascularization is
associated with improved survival across a broad range of risk strata.
2010 Mosby, Inc. All rights reserved.

<6>
Accession Number
2010486472
Authors
Van Kuijk J.-P. Voute M.T. Flu W.-J. Schouten O. Chonchol M. Hoeks S.E.
Boersma E.E. Verhagen H.J.M. Bax J.J. Poldermans D.
Institution
(Van Kuijk, Flu, Hoeks, Poldermans) Department of Anesthesiology, Erasmus
Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
(Voute, Schouten, Verhagen) Department of Vascular Surgery, Erasmus
Medical Center, Rotterdam, Netherlands
(Chonchol, Bax) Division of Renal Diseases and Hypertension, University of
Colorado Denver Health Sciences Center, Aurora, CO, United States
(Boersma) Department of Clinical Epidemiology, Erasmus Medical Center,
Rotterdam, Netherlands
(Boersma) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
Title
The efficacy and safety of clopidogrel in vascular surgery patients with
immediate postoperative asymptomatic troponin T release for the prevention
of late cardiac events: Rationale and design of the Dutch
Echocardiographic Cardiac Risk Evaluation Applying Stress Echo-VII
(DECREASE-VII) trial.
Source
American Heart Journal. 160 (3) (pp 387-393), 2010. Date of Publication:
September 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Major vascular surgery patients are at high risk for
developing asymptomatic perioperative myocardial ischemia reflected by a
postoperative troponin release without the presence of chest pain or
electrocardiographic abnormalities. Long-term prognosis is severely
compromised and characterized by an increased risk of long-term mortality
and cardiovascular events. Current guidelines on perioperative care
recommend single antiplatelet therapy with aspirin as prophylaxis for
cardiovascular events. However, as perioperative surgical stress results
in a prolonged hypercoagulable state, the postoperative addition of
clopidogrel to aspirin within 7 days after perioperative asymptomatic
cardiac ischemia could provide improved effective prevention for
cardiovascular events. Study design: DECREASE-VII is a phase III,
randomized, double-blind, placebo-controlled, multicenter clinical trial
designed to evaluate the efficacy and safety of early postoperative dual
antiplatelet therapy (aspirin and clopidogrel) for the prevention of
cardiovascular events after major vascular surgery. Eligible patients
undergoing a major vascular surgery (abdominal aorta or lower extremity
vascular surgery) who developed perioperative asymptomatic troponin
release are randomized 1:1 to clopidogrel or placebo (300-mg loading dose,
followed by 75 mg daily) in addition to standard medical treatment with
aspirin. The primary efficacy end point is the composite of cardiovascular
death, stroke, or severe ischemia of the coronary or peripheral arterial
circulation leading to an intervention. The evaluation of long-term safety
includes bleeding defined by TIMI criteria. Recruitment began early 2010.
The trial will continue until 750 patients are included and followed for
at least 12 months. Summary: DECREASE-VII is evaluating whether early
postoperative dual antiplatelet therapy for patients developing
asymptomatic cardiac ischemia after vascular surgery reduces
cardiovascular events with a favorable safety profile. 2010 Mosby, Inc.
All rights reserved.

<7>
Accession Number
20142215
Authors
Tchetche D. Dumonteil N. Sauguet A. Descoutures F. Luz A. Garcia O. Soula
P. Gabiache Y. Fournial G. Marcheix B. Carrie D. Fajadet J.
Institution
(Tchetche) Clinique Pasteur, Toulouse, France.
Title
Thirty-day outcome and vascular complications after transarterial aortic
valve implantation using both Edwards Sapien and Medtronic CoreValve
bioprostheses in a mixed population.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
5 (6) (pp 659-665), 2010. Date of Publication: Jan 2010.
Abstract
AIMS: Transcatheter aortic valve implantation (TAVI) is performed through
a transarterial approach with encouraging results in "one-type valve"
registries. We report 30-day data from a mixed population of patients
treated with either Medtronic CoreValve (MCV) or Edwards SAPIEN (ES)
valves. METHODS AND RESULTS: Forty-five patients had TAVI via the
transarterial approach (21 MCV and 24 ES). Mean age was 81.8+/-4.2 years,
Logistic EuroSCORE was 25.2+/-8.4%. Procedural success rate was 97.8%.
In-hospital death rate was 4.4%. Vascular complication rate was 8.9%. Of
MCV patients, 28.6% had a permanent pacemaker vs. 4.2% of ES patients;
p=0.02. No additional deaths were observed between discharge and 30 days.
NYHA functional class was improved at 30-days: 2.07+/-0.4 vs. 3.09+/-0.05,
p<0.0001. Mean transvalvular gradient was lower: 9.5+/-3.28 mmHg vs.
41.9+/-14 mmHg, p<0.0001. Overall 30-day MACE rate was 8.9%, similar
between MCV and ES patients. CONCLUSION: A routine policy of TAVI using
both MCV and ES valves is feasible without any worsening of procedural
success rates and 30-day outcomes. A wider population of high risk
patients with aortic stenosis can be offered a transarterial treatment.
This could be the next standard of care for teams performing TAVI.

<8>
Accession Number
20142220
Authors
Meredith I.T. Worthley S.G. Whitbourn R. Walters D. McClean D. Ormiston J.
Horrigan M. Wilkins G.T. Hendriks R. Matsis P. Muller D. Cutlip D.E.
Institution
(Meredith) MonashHEART Medical Centre, Melbourne, Australia.
Title
Long-term clinical outcomes with the next-generation Resolute Stent
System: a report of the two-year follow-up from the RESOLUTE clinical
trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
5 (6) (pp 692-697), 2010. Date of Publication: Jan 2010.
Abstract
AIMS: The 12-month results of RESOLUTE were favourable for the new
Resolute stent. Two-year safety and efficacy results from RESOLUTE have
been evaluated and are now reported. METHODS AND RESULTS: RESOLUTE was a
prospective, multicentre, non-randomised, single-arm, controlled trial of
the Resolute stent in 139 participants with symptomatic ischaemic heart
disease due to single de novo lesions in a native coronary artery. The
2-year rates of MACE (all-cause death, myocardial infarction, emergent
cardiac bypass surgery, and target lesion revascularisation [TLR]), death,
late stent thrombosis, target vessel revascularisation (TVR), and target
vessel failure (TVF) were assessed. Clinical events included two MACE (one
TLR; one non-cardiac death) occurring between year one and two resulting
in cumulative 2-year TLR, TVR, and TVF rates of 1.4%, 1.4%, and 7.9%,
respectively. One possible stent thrombosis event occurred in the first
year after stent implantation however no late or very late ARC-defined
definite and probable stent thromboses occurred through two years.
CONCLUSIONS: The 2-year data from RESOLUTE demonstrated no safety concerns
including no late stent thrombosis or loss of effectiveness with the
Resolute stent. The finding that few events occurred in year two is
encouraging, yet requires verification in a larger population.

<9>
Accession Number
2010483574
Authors
Voucharas C. Bisbos A. Moustakidis P. Tsilimingas N.
Institution
(Voucharas, Bisbos, Moustakidis) Division of Cardiothoracic Surgery,
Interbalkan Medical Center, Thessaloniki, Greece
(Tsilimingas) Department of Cardiovascular and Thoracic Surgery,
University of Thessaly, Larissa, Greece
Title
Open versus tunneling radial artery harvest for coronary artery grafting.
Source
Journal of Cardiac Surgery. 25 (5) (pp 504-507), 2010. Date of
Publication: September 2010.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
We present a less traumatic surgical technique for harvesting the radial
artery as a coronary artery bypass graft that does not require any special
equipment or skills. We prospectively randomized 40 patients undergoing
coronary artery bypass grafting with the radial artery into two groups on
the basis of harvest techniques: tunneling excision and conventional open
method. The less-invasive tunneling technique is safe, easily applicable,
and preferred by patients because of the superior cosmetic result. 2010
Wiley Periodicals, Inc.

<10>
Accession Number
2010483577
Authors
Alghamdi A.A. Singh S.K. Hamilton B.C.S. Yadava M. Holtby H. Van Arsdell
G.S. Al-Radi O.O.
Institution
(Alghamdi, Singh, Hamilton, Yadava, Van Arsdell, Al-Radi) Department of
Surgery, Divisions of Cardiovascular Surgery, United States
(Holtby) Department of Anesthesia, Hospital for Sick Children, University
of Toronto, Toronto, ON, Canada
Title
Early extubation after pediatric cardiac surgery: Systematic review,
meta-analysis, and evidence-based recommendations.
Source
Journal of Cardiac Surgery. 25 (5) (pp 586-595), 2010. Date of
Publication: September 2010.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Objective: To derive evidence-based recommendations regarding early
extubation strategy after congenital cardiac surgery. Outcomes: Incidence
of total mortality, morbidity, reintubation, length, and costs of
intensive care unit and hospital stay. Evidence: Medline, Embase, and the
Cochrane-controlled trial register on the Cochrane library were searched
from the earliest achievable date of each database to present. No language
restrictions were applied. Retrieved reprints were evaluated according to
a priori inclusion criteria, and those included were critically appraised
using established internal validity criteria. Benefits and Harms: Early
extubation (in the operating room or <=6 hours after surgery) was
associated with a lower early mortality. There was a trend toward lower
ICU and hospital length of stays, lower hospital costs, and less
respiratory morbidity. There was no difference in the rate of reintubation
in those extubated early versus late. Conclusion: Early extubation appears
safe and is associated with reduction in length of ICU and hospital stay
without adverse effects on mortality or morbidity. However, studies to
date are poor, heterogeneous, and not suitable to determine a causal
effect. Therefore, there is need for a well-designed randomized clinical
trial to demonstrate the potential significant benefits of early
extubation. 2010 Wiley Periodicals, Inc.

<11>
Accession Number
2010476305
Authors
Ohashi T. Shibata R. Morimoto T. Kanashiro M. Ishii H. Ichimiya S. Hiro T.
Miyauchi K. Nakagawa Y. Yamagishi M. Ozaki Y. Kimura T. Daida H. Murohara
T. Matsuzaki M.
Institution
(Ohashi, Kanashiro, Ichimiya) Department of Cardiology, Yokkaichi
Municipal Hospital, Yokkaichi, Japan
(Ohashi, Shibata, Ishii, Murohara) Department of Cardiology, Nagoya
University Graduate School of Medicine, Nagoya, Japan
(Morimoto) Center for Medical Education, Kyoto University Graduate School
of Medicine, Kyoto, Japan
(Hiro) Division of Cardiology, Department of Medicine, Nihon University
School of Medicine, Tokyo, Japan
(Miyauchi, Daida) Department of Cardiology, Juntendo University School of
Medicine, Tokyo, Japan
(Nakagawa) Department of Cardiology, Tenri Hospital, Nara, Japan
(Yamagishi) Division of Cardiovascular Medicine, Kanazawa University
Graduate School of Medicine, Kanazawa, Japan
(Ozaki) Department of Cardiology, Fujita Health University, Toyoake, Japan
(Kimura) Department of Cardiovascular Medicine, Kyoto University Graduate
School of Medicine, Kyoto, Japan
(Matsuzaki) Division of Cardiology, Department of Medicine and Clinical
Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
Title
Correlation between circulating adiponectin levels and coronary plaque
regression during aggressive lipid-lowering therapy in patients with acute
coronary syndrome: Subgroup analysis of JAPAN-ACS study.
Source
Atherosclerosis. 212 (1) (pp 237-242), 2010. Date of Publication:
September 2010.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objective: The Japan assessment of pitavastatin and atorvastatin in acute
coronary syndrome (JAPAN-ACS) study demonstrated that aggressive
lipid-lowering therapy with a statin resulted in a significant regression
of coronary atherosclerotic plaques in patients with ACS. Adiponectin is
an adipocyte-derived protein with anti-atherogenic properties. Here, we
investigated the association between adiponectin levels and the change in
the plaque volume in ACS patients. Methods: Intravascular ultrasound
(IVUS)-guided percutaneous coronary intervention (PCI) was undertaken,
followed by the initiation of statin treatment, in 238 patients with ACS.
Follow-up IVUS was performed between 8 and 12 months after the PCI. The
percent change in the plaque volume (%PV) in a non-culprit coronary artery
segment was evaluated. The serum adiponectin and lipid parameters were
measured both at baseline and at the follow-up. Results: At baseline,
adiponectin was correlated positively with HDL-cholesterol and negatively
correlated with triglyceride, but no correlation was observed with the PV.
Adiponectin levels increased significantly from 7.8 +/- 4.6 mug/mL at
baseline to 10.3 +/- 6.9 mug/mL at the 8-12 months follow-up. The increase
in adiponectin was also associated with an increase of HDL-cholesterol and
decrease of triglyceride, however, no significant correlation was observed
with the %PV. A significantly higher incidence of major adverse cardiac
events (MACE) was observed in patients with hypo-adiponectinemia at
baseline. A multiple logistic regression analysis identified adiponectin
as a significant independent predictor of MACE. Conclusion: Adiponectin
levels measured after PCI could serve as a marker of MACE in patients with
ACS. 2010 Elsevier Ireland Ltd.

<12>
Accession Number
2010478254
Authors
Singh I.M. Holmes Jr. D.R.
Institution
(Singh) Fellow of Interventional Cardiology, Mayo Clinic, 200 First Street
SW SMH MB 4-523, Rochester, MN 55905, United States
(Holmes Jr.) Division of Cardiovascular Diseases, Mayo Clinic, 200 First
Street SW SMH MB 4-523, Rochester, MN 55905, United States
Title
Left atrial appendage closure.
Source
Current Cardiology Reports. 12 (5) (pp 413-421), 2010. Date of
Publication: September 2010.
Publisher
Current Medicine Group LLC (5 Marine View Plaza, Suite 218, Hoboken NJ
07030, United States)
Abstract
Stroke prevention is the primary goal in atrial fibrillation (AF) given
its clinical and socioeconomic impact. With AF, the prevalence of
thromboembolic stroke continues to rise and there is an urgent need to
develop better strategies of stroke prevention. Warfarin, although
effective when used appropriately, is burdened by underutilization, narrow
therapeutic windows, and life-threatening bleeding complications. Novel
pharmacologic agents have been plagued by off-target toxicity and only
modest improvement in bleeding complications over warfarin. Because most
thromboemboli arise from the left atrial appendage (LAA), surgical
exclusion of the LAA is often used in AF patients undergoing cardiac
surgery. Percutaneous device LAA closure has now been developed as an
adjunct and as an alternative to pharmacotherapy in patients with AF.
Promising randomized data are available with the WATCHMAN device, while
several other devices are in various stages of clinical and preclinical
development. 2010 Springer Science+Business Media, LLC.

<13>
Accession Number
2010478262
Authors
Goldberg S.L. Feldman T.
Institution
(Goldberg) University of Washington Medical Center, Seattle, WA, United
States
(Goldberg) Cardiac Dimensions, Inc., Kirkland, WA, United States
(Feldman) Evanston Hospital, Evanston, IL, United States
Title
Percutaneous mitral valve interventions: Overview of new approaches.
Source
Current Cardiology Reports. 12 (5) (pp 404-412), 2010. Date of
Publication: September 2010.
Publisher
Current Medicine Group LLC (5 Marine View Plaza, Suite 218, Hoboken NJ
07030, United States)
Abstract
The percutaneous management of valvular heart disease has recently been
receiving a great deal of interest as an area of great potential.
Innovative technologies are now being developed to treat mitral
regurgitation. Although there are established surgical techniques for
treating organic mitral regurgitation, the surgical management of
functional mitral regurgitation remains controversial, and such patients
have a poor prognosis. Therefore, a percutaneous treatment for functional
mitral regurgitation holds great clinical potential. Having a nonsurgical
approach available may be attractive to patients with organic mitral valve
regurgitation as well. Several approaches and devices have been designed
to treat specifically functional mitral regurgitation, and some of these
have been applied to humans in early-stage evaluations. The MitraClip
device (Abbott Laboratories, Abbott Park, IL) has been used to treat both
functional and degenerative mitral valve regurgitation and has been
compared to surgery in the EVEREST II (Endovascular Valve Edge-to-Edge
Repair Study II) randomized trial. Although the field of percutaneous
management of mitral regurgitation is at an early stage, it has been
demonstrated that percutaneous approaches can reduce mitral regurgitation,
suggesting there is a great deal of potential for clinical benefit to
patients with mitral regurgitation. 2010 Springer Science+Business Media,
LLC.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 17

Results Generated From:
EMBASE <1980 to 2010 Week 37>
EMBASE (updates since 2010-09-09)

<1>
Accession Number
2010447797
Authors
Bignami E. Landoni G. Biondi-Zoccai G.G.L. Boroli F. Messina M. Dedola E.
Nobile L. Buratti L. Sheiban I. Zangrillo A.
Institution
(Bignami, Landoni, Boroli, Messina, Dedola, Nobile, Buratti, Zangrillo)
Department of Cardiothoracic Anesthesia and Intensive Care, Universit
Vita-Salute San Raffaele, Milano, Italia, Via Olgettina 60, Milano 20132,
Italy
(Bignami, Landoni, Boroli, Messina, Dedola, Nobile, Buratti, Zangrillo)
Istituto Scientifico San Raffaele, Milan, Italy
(Biondi-Zoccai, Sheiban) Department of Interventional Cardiology, Division
of Cardiology, Universit di Torino, Torino, Italy
Title
Epidural analgesia improves outcome in cardiac surgery: A meta-analysis of
randomized controlled trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24 (4) (pp 586-597),
2010. Date of Publication: 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The authors conducted a review of randomized studies to
determine whether there were any advantages for clinically relevant
outcomes by adding epidural analgesia in patients undergoing cardiac
surgery under general anesthesia. Design: Meta-analysis. Setting:
Hospitals. Participants: A total of 2366 patients from 33 randomized
trials. Interventions: None. Measurements and Main Results: Data sources
and study selection: PubMed, BioMedCentral, CENTRAL, EMBASE, Cochrane
Central Register of Controlled Trials, and conference proceedings were
searched (updated January 2008) for randomized trials that compared
general anesthesia with an anesthetic plan including general anesthesia
and epidural analgesia in cardiac surgery. Two independent reviewers
appraised study quality, with divergences resolved by consensus. Overall
analysis showed that epidural analgesia reduced the risk of the composite
endpoint mortality and myocardial infarction (30/1125 [2.7%] in the
epidural group v 64/1241 [5.2%] in the control arm, odds ratio [OR] = 0.61
[0.40-0.95], p = 0.03 number needed to treat [NNT] = 40), the risk of
acute renal failure (35/590 [5.9%] in the epidural group v 54/618 [8.7%]
in the control arm, OR = 0.56 [0.34-0.93], p = 0.02, NNT = 36), and the
time of mechanical ventilation (weighted mean differences =-2.48 hours
[-2.64,-2.32], p < 0.001). Conclusions: This analysis suggested that
epidural analgesia on top of general anesthesia reduced the incidence of
perioperative acute renal failure, the time on mechanical ventilation, and
the composite endpoint of mortality and myocardial infarction in patients
undergoing cardiac surgery. 2010 Elsevier Inc. All rights reserved.

<2>
Accession Number
2010447801
Authors
Ender J. Brodowsky M. Falk V. Baunsch J. Koncar-Zeh J. Kaisers U.X.
Mukherjee C.
Institution
(Ender, Brodowsky, Baunsch, Koncar-Zeh, Mukherjee) Department of
Anesthesiology and Intensive Care Medicine II, Heartcenter, University of
Leipzig, Struempellstr 39, 04289 Leipzig, Germany
(Kaisers) Department of Anesthesiology and Intensive Care Medicine,
Medical Facility, University of Leipzig, Leipzig, Germany
(Falk) Clinic for Cardiac Surgery, Heartcenter, University of Leipzig,
Leipzig, Germany
Title
High-frequency jet ventilation as an alternative method compared to
conventional one-lung ventilation using double-lumen tubes during
minimally invasive coronary artery bypass graft surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24 (4) (pp 602-607),
2010. Date of Publication: 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To optimize the conditions for the surgeon during minimally
invasive direct coronary artery bypass (MIDCAB) and totally endoscopic
coronary artery bypass (TECAB) procedures, one-lung ventilation (OLV) is
required using double-lumen tubes (DLT). This prospective study was
designed to compare high-frequency jet ventilation (HFJV) of both lungs
with the conventional method of OLV via DLT. Design: Prospective,
randomized, clinical study. Setting: University-affiliated heart center.
Participants: Forty patients with coronary artery disease and scheduled
for elective MIDCAB or TECAB procedures were equally randomized into a DLT
and an HFJV group. Interventions: In the DLT group, OLV of the right lung
was performed throughout the surgical procedure. In the HFJV group,
patients received a conventional single-lumen endotracheal tube and both
lungs were ventilated using HFJV. Measurements: Hemodynamic, oxygenation
and ventilation parameters were measured at the beginning of the
operation, then 5, 15, 30, and 60 minutes after OLV/HFJV, as well as
immediately before transfer to the ICU. Main Results: Regarding the view
of the surgical field, surgeons' comfort did not differ between methods.
The intraoperative PaO₂ was significantly higher in the HFJV
group compared with the DLT group at 5 (336.8 +/- 123.3 v 228.6 +/- 124.0;
p = 0.009) and 15 minutes (301.7 +/- 133.9 v 192.6 +/- 92.8; p = 0.012).
The PaCO ₂ was significantly higher in the HFJV group after 5
minutes and persisted through 60 minutes of ventilation. The peak
inspiratory pressure was significantly lower during HFJV (10.0 +/- 2.8
mbar v 32.1 +/- 5.9 mbar). Conclusions: HFJV in MIDCAB or TECAB procedures
appears to be a feasible alternative to OLV using a DLT, although study in
a larger population is required. 2010 Elsevier Inc. All rights reserved.

<3>
Accession Number
2010447808
Authors
Burkhart C.S. Dell-Kuster S. Gamberini M. Moeckli A. Grapow M. Filipovic
M. Seeberger M.D. Monsch A.U. Strebel S.P. Steiner L.A.
Institution
(Burkhart, Dell-Kuster, Gamberini, Moeckli, Filipovic, Seeberger, Strebel,
Steiner) Department of Anesthesia and Intensive Care Medicine, University
Hospital Basel, CH-4031 Basel, Switzerland
(Grapow) Division of Cardiac Surgery, University Hospital Basel, Basel,
Switzerland
(Monsch) Memory Clinic, University Hospital Basel, Basel, Switzerland
(Steiner) Department of Anaesthesia, University Hospital Center and
University of Lausanne, Lausanne, Switzerland
Title
Modifiable and nonmodifiable risk factors for postoperative delirium after
cardiac surgery with cardiopulmonary bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24 (4) (pp 555-559),
2010. Date of Publication: 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: Postoperative delirium after cardiac surgery is associated
with increased morbidity and mortality as well as prolonged stay in both
the intensive care unit and the hospital. The authors sought to identify
modifiable risk factors associated with the development of postoperative
delirium in elderly patients after elective cardiac surgery in order to be
able to design follow-up studies aimed at the prevention of delirium by
optimizing perioperative management. Design: A post hoc analysis of data
from patients enrolled in a randomized controlled trial was performed.
Setting: A single university hospital. Participants: One hundred thirteen
patients aged 65 or older undergoing elective cardiac surgery with
cardiopulmonary bypass. Interventions: None. Measurements and Mains
Results: Screening for delirium was performed using the Confusion
Assessment Method (CAM) on the first 6 postoperative days. A multivariable
logistic regression model was developed to identify significant risk
factors and to control for confounders. Delirium developed in 35 of 113
patients (30%). The multivariable model showed the maximum value of
C-reactive protein measured postoperatively, the dose of fentanyl per
kilogram of body weight administered intraoperatively, and the duration of
mechanical ventilation to be independently associated with delirium.
Conclusions: In this post hoc analysis, larger doses of fentanyl
administered intraoperatively and longer duration of mechanical
ventilation were associated with postoperative delirium in the elderly
after cardiac surgery. Prospective randomized trials should be performed
to test the hypotheses that a reduced dose of fentanyl administered
intraoperatively, the use of a different opioid, or weaning protocols
aimed at early extubation prevent delirium in these patients. 2010
Elsevier Inc. All rights reserved.

<4>
Accession Number
2010461647
Authors
Voute M.T. Winkel T.A. Poldermans D.
Institution
(Voute, Winkel) Department of Vascular Surgery, Erasmus MC, PO Box 2040,
3000 CA Rotterdam, Netherlands
(Poldermans) Department of Anesthesiology, Erasmus MC, PO Box 2040, 3000
CA Rotterdam, Netherlands
Title
Safety of fluvastatin in patients undergoing high-risk non-cardiac
surgery.
Source
Expert Opinion on Drug Safety. 9 (5) (pp 793-800), 2010. Date of
Publication: September 2010.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Importance of the field: In patients undergoing vascular surgery there is
a high incidence of adverse cardiac events, due to sudden coronary plaque
rupture. The non-lipid lowering or pleiotropic effects of statins can help
reduce adverse cardiovascular events associated with vascular surgery.
Areas covered in this review: The evidence for perioperative use of
fluvastatin, as well as other statins, in high-risk surgery patients is
summarized in this review. Data on pharmacokinetics and metabolism is
presented, together with considerations on possible drug interactions in
the perioperative period. What the reader will gain: The reader will gain
a comprehensive understanding of the existing safety and efficacy data for
fluvastatin and other statins in the perioperative period. The practical
considerations of perioperative fluvastatin therapy will be presented,
including potential side-effects and management of the early non-oral
phase immediately post surgery. Finally, advice on when to initiate
therapy and safety recommendations are offered. Take home message: In
patients scheduled for high-risk vascular surgery, fluvastatin improves
postoperative outcome, reducing the incidence of myocardial damage by ~
50% in the first 30 days following vascular surgery. In comparison with
placebo, fluvastatin was not associated with a rise in liver enzymes or
creatine kinase levels. To bridge the non-oral phase, an extended-release
formula is recommended. 2010 Informa UK, Ltd.

<5>
Accession Number
2010470846
Authors
Garg S. Serruys P.W.
Institution
(Garg, Serruys) Department of Interventional Cardiology, Thoraxcenter,
Erasmus Medical Center, 's-Gravendijkwal 230, Rotterdam 3015 CE,
Netherlands
Title
Coronary stents: Current status.
Source
Journal of the American College of Cardiology. 56 (10 SUPPL.) (pp
S1-S42), 2010. Date of Publication: 31 Aug 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Coronary artery stents revolutionized the practice of interventional
cardiology after they were first introduced in the mid-1980s. Since then,
there have been significant developments in their design, the most notable
of which has been the introduction of drug-eluting stents. This paper
reviews the benefits, risks, and current status of Food and Drug
Administration-approved drug-eluting stents. 2010 American College of
Cardiology Foundation.

<6>
Accession Number
2010468954
Authors
Komatsu T. Tachibana H. Satoh Y. Ozawa M. Kunugita F. Tashiro A.
Okabayashi H. Nakamura M.
Institution
(Komatsu, Tachibana, Satoh, Ozawa, Kunugita, Tashiro, Nakamura) Division
of Cardiology, Department of Internal Medicine, Iwate Medical University,
Morioka, Japan
(Okabayashi) Department of Cardiovascular Surgery, Iwate Medical
University, Morioka, Japan
Title
Prospective comparative study of intravenous cibenzoline and disopyramide
therapy in the treatment of paroxysmal atrial fibrillation after
cardiovascular surgery.
Source
Circulation Journal. 74 (9) (pp 1859-1865), 2010. Date of Publication:
2010.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: It has been reported that approximately one-third of patients
undergoing cardiovascular surgery experience paroxysmal atrial
fibrillation (AF) during the postoperative period. There is, however,
little information on the selection of anti-arrhythmic drugs for
terminating postoperative paroxysmal AF. Methods and Results: Between
April 2007 and March 2009, 118 patients (76 men, 42 women, mean age
68+/-10 years) who had postoperative paroxysmal AF lasting >=30 min were
randomly assigned to receive either iv cibenzoline (70 mg, n=60) or
disopyramide (50 mg, n=58) for terminating postoperative paroxysmal AF.
The success rate of iv cibenzoline therapy (47%) was significantly greater
than that of iv disopyramide therapy (24%; P<0.05). To identify clinical
factors to increase the termination efficacy of iv cibenzoline,
multivariate logistic regression was used to adjust for several covariates
and to generate adjusted odds ratios (OR). The significant variables for
the termination of paroxysmal AF after iv cibenzoline therapy were
pretreatment with oral beta-adrenergic blockers (OR =8.224, P=0.030) and
smaller left atrial dimensions (OR =0.879, P=0.039). Conclusions: The
efficacy of iv cibenzoline for the termination of postoperative paroxysmal
AF was significantly better than that of disopyramide, especially in
patients with pre-administration of oral beta-adrenergic blockers and
those with smaller left atrium.

<7>
Accession Number
2010468956
Authors
Ji Q. Mei Y. Wang X. Feng J. Wusha D. Cai J. Sun Y. Xie S.
Institution
(Ji, Mei, Wang, Feng, Wusha, Cai, Sun, Xie) Department of Thoracic
Cardiovascular Surgery, Tongji Hospital, Tongji University Medical School,
Shanghai, China
Title
Combination of irbesartan and amiodarone to maintain sinus rhythm in
patients with persistent atrial fibrillation after rheumatic valve
replacement.
Source
Circulation Journal. 74 (9) (pp 1873-1879), 2010. Date of Publication:
2010.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Atrial fibrillation (AF) after rheumatic valve replacement is
the most common arrhythmic complication. Previous studies reported
angiotensin-II receptor blocker can prevent AF. This study aimed to assess
the effect of a combination of irbesartan and amiodarone on the
maintenance of sinus rhythm after cardioversion of AF in patients with
post-rheumatic valve replacement in a randomized, controlled trial.
Methods and Results: Eighty-five consecutive patients undergoing rheumatic
valve surgery were enrolled and randomly assigned to an irbesartan plus
amiodarone (irbesartan 150 mg/d, n=43) or an amiodarone group (n=42)
starting 10 days before scheduled electrical cardioversion. The primary
end-point was recurrence of AF. Pharmacological conversion was documented
in 7 patients, and electrical conversion in 68 patients (87.2%). A higher
rate of maintenance of sinus rhythm (69.8% vs 40.5%, P=0.01) and a better
AF-free survival (chi²=7.466, P=0.006) were observed in the
irbesartan plus amiodarone group compared to the amiodarone group during
the 1-year follow-up period. Cox regression showed that use of irbesartan
was an independent factor associated with the maintenance of sinus rhythm
after cardioversion (OR=0.43, P=0.018), whereas increased left atrium
diameter was associated with increased risk (OR=1.54, P=0.005).
Conclusions: In patients with post-rheumatic valve replacement, the
combination of amiodarone and irbesartan demonstrated a lower rate of AF
recurrence after cardioversion than amiodarone alone, which might be due
to preventing the atrial remodeling.

<8>
[Use Link to view the full text]
Accession Number
20601450
Authors
Aouad M.T. Kanazi G.E. Abdallah F.W. Moukaddem F.H. Turbay M.J. Obeid M.Y.
Siddik-Sayyid S.M.
Institution
(Aouad) Department of Anesthesiology, American University of Beirut, P.O.
Box 11-0236, Beirut, Lebanon.
Title
Femoral vein cannulation performed by residents: a comparison between
ultrasound-guided and landmark technique in infants and children
undergoing cardiac surgery.
Source
Anesthesia and analgesia. 111 (3) (pp 724-728), 2010. Date of
Publication: Sep 2010.
Abstract
BACKGROUND: Percutaneous cannulation of the femoral vein, in the pediatric
age group, can be technically challenging, especially when performed by
residents in training. We examined whether the use of real-time ultrasound
guidance is superior to a landmark technique for femoral vein
catheterization in children undergoing heart surgery. METHODS: Patients
were prospectively randomized into 2 groups. In group LM, the femoral vein
was cannulated using the traditional method of palpation of arterial
pulse. In group US, cannulation was guided by real-time scanning with an
ultrasound probe. The time to complete cannulation (primary outcome),
success rate, number of needle passes, number of successful cannulations
on first needle pass, and incidence of complications were compared between
the 2 groups. RESULTS: Forty-eight pediatric patients were studied. The
time to complete cannulation was significantly shorter (155 [46-690] vs
370 [45-1620] seconds; P = 0.02) in group US versus group LM. The success
rate was similar in both groups (95.8%). The number of needle passes was
smaller (1 [1-8] vs 3 [1-21]; P = 0.001) and the number of successful
cannulations on first needle pass higher (18 vs 6; P = 0.001) in group US
compared with group LM. The incidence of femoral artery puncture was
comparable between the 2 groups. CONCLUSIONS: Ultrasound-guided
cannulation of the femoral vein, in pediatric patients, when performed by
senior anesthesia residents, is superior to the landmark technique in
terms of speed and number of needle passes, with remarkable improvement in
first attempt success.

<9>
Accession Number
2010470397
Authors
Vanni G. Tacconi F. Sellitri F. Ambrogi V. Mineo T.C. Pompeo E.
Institution
(Vanni, Tacconi, Sellitri, Ambrogi, Mineo, Pompeo) Department of Thoracic
Surgery, Fondazione Policlinico Tor Vergata University, Viale Oxford 81,
00133 Rome, Italy
Title
Impact of awake videothoracoscopic surgery on postoperative lymphocyte
responses.
Source
Annals of Thoracic Surgery. 90 (3) (pp 973-978), 2010. Date of
Publication: 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Surgical stress and general anesthesia can have detrimental
effects on postoperative immune function. We sought to comparatively
evaluate postoperative lymphocytes response in patients undergoing
video-assisted thoracoscopic surgery (VATS) under thoracic epidural or
general anesthesia. Methods: Between October 2008 and June 2009, 50
patients with nonmalignant pulmonary conditions were randomized to undergo
VATS through either sole epidural anesthesia and spontaneous ventilation
(awake group, n = 25) or general anesthesia with one-lung ventilation
(control group, n = 25). In both groups, assessment of total lymphocytes
count and changes in proportion of lymphocyte subsets including CD19+,
CD3+, CD4+, CD8+, CD4+:CD8+ ratio, and CD16+CD56+ (natural-killer cell)
were evaluated by two-way analysis of variance test for repeated measures
at baseline and postoperative days 1, 2, and 3. The Mann-Whitney test was
performed at each time point only for significant parameters at
between-group analysis of variance. Results: Comparisons of baseline data
showed relatively homogeneous groups. Between-group analysis of variance
was significant for proportion of natural-killer cells (p = 0.01). In
particular, the control group disclosed a significantly lower median
proportion of natural-killer cells as compared with the awake group on
postoperative day 1 (5% interquartile range [IQR]: 3% to 8%] vs 12% [IQR:
8% to 14%], p = 0.003) and 2 (7% [IQR: 4% to 10%] vs 11% [IQR: 8% to 21%],
p = 0.02). Total lymphocyte count was significantly decreased in the
control group only (p < 0.00001). No difference was found between groups
in the remaining lymphocyte subsets. Conclusions: In this randomized
study, awake VATS resulted in a lesser impact on postoperative lymphocyte
responses than procedures performed under general anesthesia, as shown by
the significant difference in postoperative proportion of natural-killer
cells. 2010 The Society of Thoracic Surgeons.

<10>
Accession Number
2010457213
Authors
Doddakula K.K. Neary P.M. Wang J.H. Sookhai S. O'Donnell A. Aherne T.
Bouchier-Hayes D.J. Redmond H.P.
Institution
(Doddakula, O'Donnell, Aherne) Department of Cardiac Surgery, University
College Cork, Cork University Hospital, Cork, Ireland
(Neary, Wang, Sookhai, Redmond) Academic Department of Surgery, University
College Cork, Cork University Hospital, Cork, Ireland
(Bouchier-Hayes) Department of Surgery, Royal College of Surgeons in
Ireland, Beaumont Hospital, Dublin, Ireland
(Redmond) FRCSI, Department of Academic Surgery, Cork University Hospital,
Wilton, Cork, Ireland
Title
The antiendotoxin agent taurolidine potentially reduces
ischemia/reperfusion injury through its metabolite taurine.
Source
Surgery. 148 (3) (pp 567-572), 2010. Date of Publication: September
2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Cardiopulmonary bypass results in ischemia/reperfusion
(I/R)-induced endotoxemia. We conducted a prospective randomized trial to
investigate the effect of taurolidine, an antiendotoxin agent with
antioxidant and membrane-stabilizing properties, on patients undergoing
coronary artery bypass grafting (CABG). Methods: A total of 60 patients
undergoing CABG were randomized into 4 groups. St Thomas' Hospital cold
crystalloid cardioplegia was used in groups A and B, and cold blood
cardioplegia in groups C and D. Groups A and C received a placebo infusion
of normal saline, whereas groups B and D were administered intravenous
taurolidine. Arrhythmias induced by pro- and anti-inflammatory cytokines
(interleukin [IL]-6 and IL-10), and I/R were assessed perioperatively.
Results: Administration of taurolidine in crystalloid cardioplegia
patients resulted in a significant decrease in serum IL-6 and an increase
in serum IL-10 at 24 hours postaortic unclamping compared to placebo (P <
.0001). Although not statistically significant, this trend in serum IL-6
decrease was mirrored in the blood cardioplegia patients (P = .068).
Taurolidine treatment also significantly decreased I/R-induced arrhythmias
compared to placebo in the crystalloid cardioplegia patients (P < .003).
There were fewer I/R-induced arrhythmias compared to placebo in the blood
cardioplegia patients; the difference, however, was marginal and not
statistically significant (P = .583). Conclusion: This study demonstrates
that administration of taurolidine in CABG patients induces a potent
anti-inflammatory response that is associated with a significant decrease
in arrhythmias. 2010 Mosby, Inc. All rights reserved.

<11>
Accession Number
2010457442
Authors
Dahl J.S. Videbaek L. Poulsen M.K. Pellikka P.A. Veien K. Andersen L.I.
Haghfelt T. Moller J.E.
Institution
(Dahl, Videbaek, Poulsen, Veien, Haghfelt) Department of Cardiology,
Odense University Hospital, Odense, Denmark
(Andersen) Department of Thoracic Surgery, Odense University Hospital,
Odense, Denmark
(Moller) Department of Cardiology, Heart Center, Copenhagen University
Hospital Rigshospitalet, Copenhagen, Denmark
(Pellikka) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
Title
Effect of candesartan treatment on left ventricular remodeling after
aortic valve replacement for aortic stenosis.
Source
American Journal of Cardiology. 106 (5) (pp 713-719), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
In hypertension, angiotensin receptor blockers can augment regression of
left ventricular (LV) hypertrophy. It is not known whether this also is
the case after aortic valve replacement (AVR) for severe aortic stenosis
(AS). To test the hypothesis that treatment with candesartan in addition
to conventional treatment is able to augment LV and left atrial (LA)
reverse remodeling in patients with AS undergoing AVR, we studied 114
patients scheduled for AVR. Patients were randomized to treatment with
candesartan 32 mg 1 time/day or conventional therapy immediately after
AVR. Patients were followed with echocardiographic evaluations 3, 6, and
12 months after surgery. Primary end point was change in LV mass index. At
baseline and during follow-up no differences in systolic, diastolic, and
pulse pressures were seen between groups. Baseline LV mass index was 134
+/- 41 g/m² with no difference between groups. Mean decrease in
LV mass index in the control group was 12 +/- 28 g/m² compared
to 30 +/- 40 g/m² in the candesartan group (p = 0.015) during
follow-up. After 12 months LV mass index was significantly lower in the
candesartan group (103 +/- 29 vs 119 +/- 31 g/m², p = 0.01). In
addition, the candesartan group had greater improvement in longitudinal LV
systolic function assessed by tissue Doppler S' wave (0.6 +/- 0.1-cm/s
increase in control group vs 1.4 +/- 0.1 cm/s in candesartan group, p =
0.01, p for trend = 0.02) and a decrease in LA volume (p for trend =
0.01). Treatment had no effect on diastolic E/e' ratio or B-type
natriuretic peptide. In conclusion, angiotensin receptor blockade with
candesartan after AVR in patients with AS is associated with augmented
reverse LV and LA remodeling compared to conventional management. 2010
Elsevier Inc. All rights reserved.

<12>
Accession Number
2010457454
Authors
Kim S.-H. Kim Y.-H. Kang S.-J. Park D.-W. Lee S.-W. Lee C.W. Hong M.-K.
Cheong S.-S. Kim J.-J. Park S.-W. Park S.-J.
Institution
(Kim, Kim, Kang, Park, Lee, Lee, Hong, Kim, Park, Park) Department of
Cardiology, College of Medicine, University of Ulsan, Seoul, South Korea
(Cheong) Department of Cardiology, College of Medicine, University of
Ulsan, Gangneung, South Korea
Title
Long-term outcomes of intravascular ultrasound-guided stenting in coronary
bifurcation lesions.
Source
American Journal of Cardiology. 106 (5) (pp 612-618), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Stenting for bifurcation lesions is still challenging, and the effect of
intravascular ultrasound (IVUS) guidance on long-term outcomes has not
been evaluated. We assessed the long-term outcomes of IVUS-guided stenting
in bifurcation lesions. We evaluated 758 patients with de novo nonleft
main coronary bifurcation lesions who underwent stent implantation from
January 1998 to February 2006. We compared the adverse outcomes (i.e.,
death, stent thrombosis, and target lesion revascularization) within 4
years, after adjustment using a multivariate Cox proportional hazard model
and propensity scoring. IVUS-guided stenting significantly reduced the
long-term all-cause mortality (hazard ratio [HR] 0.31, 95% confidence
interval [CI] 0.13 to 0.74, p = 0.008) in the total population and in the
patients receiving drug-eluting stents (DESs) (HR 0.24, 95% CI 0.06 to
0.86, p = 0.03), but not in the patients receiving bare metal stents (HR
0.41, 95% CI 0.13 to 1.26, p = 0.12). IVUS-guided stenting had no effect
on the rate of stent thrombosis (HR 0.48, 95% CI 0.16 to 1.43, p = 0.19)
or target lesion revascularization (HR 1.47, 95% CI 0.79 to 2.71, p =
0.21). In patients receiving DESs, however, IVUS guidance reduced the
development of very late stent thrombosis (0.4% vs 2.8%, p = 0.03,
log-rank test). In conclusion, in patients receiving DESs, IVUS-guided
stenting for treatment of bifurcation lesions significantly reduced the
4-year mortality compared to conventional angiographically guided
stenting. In addition, IVUS guidance reduced the development of very late
stent thrombosis in patients receiving DESs. 2010 Elsevier Inc. All
rights reserved.

<13>
Accession Number
2010467999
Authors
Casey E. Lane A. Kuriakose D. McGeary S. Hayes N. Phelan D. Buggy D.
Institution
(Casey, Lane, Kuriakose, McGeary, Hayes, Phelan, Buggy) Department of
Anaesthesia and Critical Care Medicine, Mater Misericordiae University
Hospital, Dublin, Ireland
Title
Bolus remifentanil for chest drain removal in ICU: A randomized
double-blind comparison of three modes of analgesia in post-cardiac
surgical patients.
Source
Intensive Care Medicine. 36 (8) (pp 1380-1385), 2010. Date of
Publication: August 2010.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: We compared 1 versus 0.5 mug/kg bolus remifentanil versus placebo
in alleviating pain due to chest drain removal. Effects on sedation,
respiratory rate (RR), oxygen saturation, heart rate (HR) and blood
pressure were also evaluated. Methods: Sixty patients following cardiac
surgery were enrolled in this prospective, randomized, double-blind
clinical trial. Patients were randomized to 1 or 0.5 mug/kg remifentanil
or placebo. All received standardized analgesia. Visual analog scale (VAS)
pain scores and cardio-respiratory data were recorded pre-procedure, at
drain removal and at 2 min intervals post procedure. Results: Patients
receiving remifentanil had statistically significantly less pain than
placebo at drain removal [median (25-75%) VAS: 0.5 mug/kg remifentanil 1
(0-2) versus placebo 5 (3-6), P = 0.001; 1.0 lg/kg remifentanil 0 (0-2)
versus placebo 5 (3-6), P = 0.0001]. VAS scores between remifentanil
groups were equivalent. Remifentanil 1 lg/kg versus placebo at drain
removal revealed significant reductions in HR [mean +/- standard deviation
(SD): 76 +/- 15 versus 92 +/- 10, P = 0.01], blood pressure [mean +/- SD:
103 +/- 22 versus 131 +/- 14, P = 0.01] and RR [median (25- 75%): 10
(8-12) versus 16 (14-18), P = 0.001]. Remifentanil 0.5 mug/kg versus
placebo at drain removal revealed significant reductions in blood pressure
[mean +/- SD: 116 +/- 19 versus 131 +/- 14, P = 0.02] and RR [median (25-
75%): 12 (10-13) versus 18 (16-18), P = 0.001]. SpO2 at drain removal was
significantly reduced when comparing 1 lg/kg remifentanil versus placebo
[median (25-75%): 94 (88- 97) versus 97 (96-98), P = 0.049] but not 0.5
mug/kg remifentanil versus placebo. Two patients became apnoeic following
1 lg/kg remifentanil, necessitating respiratory support. Sedation scores
in all groups were similar. Conclusions: Bolus remifentanil at the tested
doses delivers excellent analgesia, but 1 lg/kg remifentanil results in
respiratory depression. Remifentanil bolus at 0.5 mug/kg is safe and
effective for chest drain removal after heart surgery in ICU. 2010
jointly held by Springer and ESICM.

<14>
Accession Number
2010472589
Authors
Thielmann M. Kottenberg E. Boengler K. Raffelsieper C. Neuhaeuser M.
Peters J. Jakob H. Heusch G.
Institution
(Thielmann, Raffelsieper, Jakob) Department of Thoracic and Cardiovascular
Surgery, West-German Heart Center Essen, University Hospital Essen,
Hufelandstrae 55, 45122 Essen, Germany
(Kottenberg, Peters) Department of Anesthesiology and Intensive Care
Medicine, University Hospital Essen, Essen, Germany
(Boengler, Heusch) Institute for Pathophysiology, Center of Internal
Medicine, University Hospital Essen, Essen, Germany
(Neuhaeuser) Department of Mathematics and Technology, Koblenz University
of Applied Science, Remagen, Germany
(Neuhaeuser) Institute of Medical Informatics, Biometry, and Epidemiology,
University Hospital Essen, Essen, Germany
Title
Remote ischemic preconditioning reduces myocardial injury after coronary
artery bypass surgery with crystalloid cardioplegic arrest.
Source
Basic Research in Cardiology. 105 (5) (pp 657-664), 2010. Date of
Publication: September 2010.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Remote ischemic preconditioning (RIPC) with transient upper limb ischemia
reduces myocardial injury in patients undergoing on-pump coronary artery
bypass grafting (CABG) with cross-clamp fibrillation or blood cardioplegia
for myocardial protection. Whether or not such protection is still
operative when standard crystalloid cardioplegic arrest is used is
uncertain. Fifty-three consecutive, non-diabetic patients with
triple-vessel disease and 64 +/- 12 years of age (mean +/- SD), who
underwent elective CABG surgery with crystalloid (Bretschneider)
cardioplegic arrest, were allocated in a prospective, randomized,
single-blinded protocol to receive either a RIPC protocol (3 cycles of 5
min transient left upper arm ischemia induced by inflating a blood
pressure cuff to 200 mmHg with 5 min of reperfusion) or control,
respectively, after induction of anesthesia. Cardiac troponin I (cTnI)
concentration was measured preoperatively and over 72 h postoperatively,
and the area under the curve (AUC) was calculated. Peak postoperative cTnI
concentration was significantly reduced from 13.7 +/- 7.7 ng/mL in
controls to 8.9 +/- 4.4 ng/mL in RIPC (P = 0.008). Mean cTnI concentration
was significantly lower at 6, 12, 24, and 48 h after surgery (ANOVA; P <
0.0001) in the RIPC patients (N = 27) than in controls (N = 26), resulting
in a 44.5% reduction of cTnI (AUC at 72 h). RIPC by repetitive inflation
of a cuff around the left upper arm before surgery enhances myocardial
protection in patients undergoing CABG surgery with antegrade cold
crystalloid cardioplegia. 2010 Springer-Verlag.

<15>
Accession Number
70261920
Authors
Alston P. Grounds R. Haga K. Carter G. Clarke S. Loveless R. Glyde D.
McClymont K. Ng B.
Institution
(Alston, Grounds, Haga, Carter, Clarke, Loveless, Glyde, McClymont, Ng)
University of Edinburgh School of Medicine, Edinburgh, United Kingdom
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 24th
Annual Meeting of the European Association of Cardiothoracic
Anaesthesiologists, EACTA 2009 Athens Greece. Conference Start: 20090527
Conference End: 20090530. Conference Publication: (var.pagings). 23 (3
SUPPL. 1) (pp S6), 2009. Date of Publication: June 2009.
Publisher
W.B. Saunders
Abstract
Introduction. Tight blood glucose control in critical care has been
associated with improved outcomes but may result in more episodes of
hypoglycaemia [1]. The aim of this study was to systematically review the
literature to determine the efficacy and safety of tight blood glucose
control during heart surgery. Method. A literature search of the major
databases was performed and the reference lists of identified papers were
hand searched. Identified studies were critically appraised. Inclusion
criteria were randomized controlled trials (RCTs), patients undergoing
heart surgery and explicit definitions of 'tight' and 'normal' control of
blood glucose. Results. Nine of the 51 identified RCTs met the entry
criteria and only four outcomes were suitable for meta-analysis. Tight
blood glucose control reduced the incidences of atrial fibrillation (AF)
(odds ratio (OR) 0.76 [95%CI 0.58, 0.99]) and the use of epicardial pacing
(OR 0.32 [95%CI 0.17, 0.60]) as well as reducing the durations of
mechanical ventilation (mean difference (MD) -0.36 [95% CI -3.85, -3.54]
hours) and stay in the intensive care unit (ICU) (MD -0.57 [95%CI -0.60,
-0.55] days). Heterogeneity was high for the incidences of AF
(I² 55%) and pacing (I² 75%) and extremely high for
the durations of mechanical ventilation (I² 94%) and ICU stay
(I² 99%). Only one study found 'tight' blood glucose control to
be associated with significantly more episodes of hypoglycaemia.
Discussion. Tight blood glucose control during heart surgery appears to be
safe and to be associated with beneficial effects on outcome following
heart surgery. However, these findings are greatly limited by their high
levels of heterogeneity. Conclusion. A well-designed and conducted RCT is
required to determine efficacy and safety of tight blood glucose control
during heart surgery.

<16>
Accession Number
70261986
Authors
Nuzzi M. Bignami E. Testa V. Mizzi A. Turi S. Dedola E. Landoni G.
Zangrillo A.
Institution
(Nuzzi, Bignami, Testa, Mizzi, Turi, Dedola, Landoni, Zangrillo) Ospedale
San Raffaele - Universit Vita-Salute San Raffaele, Milano, Italy
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 24th
Annual Meeting of the European Association of Cardiothoracic
Anaesthesiologists, EACTA 2009 Athens Greece. Conference Start: 20090527
Conference End: 20090530. Conference Publication: (var.pagings). 23 (3
SUPPL. 1) (pp S33), 2009. Date of Publication: June 2009.
Publisher
W.B. Saunders
Abstract
Introduction. A recent meta-analysis [1] showed that desflurane and
sevoflurane reduce postoperative mortality and myocardial infarction
following cardiac surgery [1]. Whether halogenated anaesthetics improve
the outcome of cardiac surgical patients is still a matter of debate.
Method. A longitudinal study of 34,310 CABG interventions was performed
between 2002 and 2004 in 64 Italian cardiosurgical centres [2]. They
estimated a risk-adjusted mortality ratio (RAMR) for each centre. We
conducted a survey among the same 64 centres to investigate whether the
use of halogenated anaesthetics showed a correlation with the RAMR.
Results. Mortality was reduced in centres using volatile anaesthetics when
compared to centres using total intravenous anaesthesia. Graph Presented.
Discussion. Our regression analysis shows that risk-adjusted mortality is
significantly related to the use of halogenated agents during surgery and
to the duration of volatile anaesthetic administration. Our findings are
in agreement with the results of a recently published meta-analysis [1],
which found a favourable effect of halogenated anaesthetics on mortality
in cardiac surgical patients.

<17>
Accession Number
70261997
Authors
Bignami E. Nuzzi M. Landoni G. Mizzi A. Testa V. Belloni I. Como L.
Zangrillo A.
Institution
(Bignami, Nuzzi, Landoni, Mizzi, Testa, Belloni, Como, Zangrillo) Ospedale
San Raffaele - Universit Vita-Salute San Raffaele, Milano, Italy
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 24th
Annual Meeting of the European Association of Cardiothoracic
Anaesthesiologists, EACTA 2009 Athens Greece. Conference Start: 20090527
Conference End: 20090530. Conference Publication: (var.pagings). 23 (3
SUPPL. 1) (pp S37-S38), 2009. Date of Publication: June 2009.
Publisher
W.B. Saunders
Abstract
Introduction. We performed a meta-analysis to investigate the effects of
levosimendan in cardiac surgery. Inotropic drugs have never shown
beneficial effects on outcome in randomized controlled studies, with the
possible exception of levosimendan. Method. A total of 139 patients from 5
randomized controlled studies were included in the analysis. Four
investigators independently searched BioMedCentral and PubMed. Inclusion
criteria were random allocation to treatment, comparison of levosimendan
vs. control performed on cardiac surgery patients. Exclusion criteria were
duplicate publications, non-human experimental studies, no outcome data.
The endpoint was postoperative cardiac troponin release. Results.
Levosimendan was associated with a significant reduction in cTn peak
release (weighted mean difference = 2.5 ng/dl [-3.86,-1.14], P=0.0003.)
and in time to hospital discharge (weighted mean difference = -1.38 days
[-2.78,0.03], P=0.05). No other relevant outcome (mortality, myocardial
infarction, atrial fibrillation, duration of mechanical ventilation and
intensive care unit stay) was improved in those patients receiving
levosimendan. Discussion. Levosimendan has cardioprotective effects
resulting in reduced postoperative cardiac troponin release.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 19

Results Generated From:
EMBASE <1980 to 2010 Week 36>
EMBASE (updates since 2010-09-03)

<1>
Accession Number
2010443462
Authors
Klamt J.G. Vicente W.V.D.A. Garcia L.V. Ferreira C.A.
Institution
(Klamt, Garcia) Department of Biomechanics, Medicine, and Rehabilitation
of the Locomotor System, FMRP-USP, Brazil
(Vicente) Department of Surgery and Anatomy, FMRP-USP, Brazil
(Vicente) Cardiothoracic Surgery Department, FMRP-USP, Brazil
(Garcia) FMRP-USP, Brazil
(Ferreira) Hospital Das Clinicas, Brazil
(Ferreira) Surgery and Anatomy Department, FMRP-USP, Brazil
Title
Hemodynamic effects of the combination of dexmedetomidine-fentanyl versus
midazolam-fentanyl in children undergoing cardiac surgery with
cardiopulmonary bypass.
Source
Revista Brasileira de Anestesiologia. 60 (4) (pp 350-362), 2010. Date of
Publication: July-August 2010.
Publisher
Sociedade Brasileira de Anestesiologia (R. Prof. Alfredo Gomes 36, Rio de
Janeiro 22251-080, Brazil)
Abstract
Background and objectives: To evaluate the efficacy of the combined
infusion of dexmedetomidine and fentanyl on the hemodynamic response
during cardiac surgery with cardiopulmonary bypass (CPB) in children.
Methods: Thirty-two children, ages 1 month to 10 years, scheduled for
cardiac surgery with cardiopulmonary bypass were randomly divided in two
groups: the MDZ Group received midazolam 0.2
mg.kg^-1.h^-1, while the DEX group received
dexmedetomidine 1 mug.kg^-1.h^-1 during one hour
followed be a reduction by half in the rate of infusion in both groups.
Both groups received fentanyl 10 mug.kg^-1, midazolam 0.2 mg.h
^-1, and vecuronium 0.2 mg.kg^-1 for anesthesia
induction. The same doses of fentanyl and vecuronium used during induction
were infused during the first hour after induction, followed by a
reduction to half. Infusions were initiated immediately after induction
and maintained until the end of the surgery. Isoflurane was administered
for a short time to control the hyperdynamic response to incision and
sternotomy. Results: In both groups, systolic blood pressure and heart
rate reduced significantly after one hour of anesthetic infusion, but the
increase in systolic and diastolic pressure and heart rate to skin
incision were significantly lower in the DEX Group. A significantly lower
number of patients demanded supplementation with isoflurane in the DEX
Group. After CPB, patients in both groups had similar hemodynamic
responses. Conclusions: Infusion of dexmedetomidine without bolus seems to
be an effective adjuvant to fentanyl on the promotion of sedation and
control of hemodynamic responses during surgery for congenital
cardiopathies in children. Elsevier Editora Ltda.

<2>
Accession Number
2010456621
Authors
Ali N. Rizwi F. Iqbal A. Rashid A.
Institution
(Ali, Iqbal, Rashid) Department of Cardiac Surgery, Armed Forces Institute
of Cardiology, National Institute of Heart Diseases, Rawalpindi, Pakistan
(Rizwi) Department of Community Medicine, Islamabad Medical and Dental
College, Islamabad, Pakistan
Title
Induced remote ischemic pre-conditioning on ischemia-reperfusion injury in
patients undergoing coronary artery bypass.
Source
Journal of the College of Physicians and Surgeons Pakistan. 20 (7) (pp
427-431), 2010. Date of Publication: July 2010.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To determine the role of remote ischemic pre-conditioning
(rIPC) on myocardium, against ischemia reperfusion injury in patients
undergoing coronary artery bypass graft (CABG) surgery by measuring CKMB
levels. Study Design: A randomized controlled trial. Place and Duration of
Study: The Surgical Department of Armed Forces Institute of
Cardiology/National Institute of Heart Diseases, Rawalpindi, from January
to June 2008. Methodology: One hundred patients with double and triple
vessels coronary artery disease were randomized in two groups of 50 each.
rIPC protocol consisted of 3 x 5 minutes of forearm ischemia, induced by a
blood pressure cuff inflated to 200 mmHg, with an intervening 5 minutes of
reperfusion, during which the cuff was deflated. Patients in the control
group were not subjected to limb ischemia. The protocol of induced
ischemia was completed before placing patients on extracorporeal bypass
circuit. At the end of surgery serum CKMB levels were measured and
compared at 8, 16, 24 and 48 hours from both the groups. Written informed
consent was taken from patients. Study was approved by the hospital
ethical committee. Results: Remote ischemic pre-conditioning significantly
reduced CKMB levels at 8, 16, 24 and 48 hours after surgery with p-values
of 0.026, 0.021, 0.052 and 0.003 respectively. There was mean reduction of
3 iu/l in CKMB levels, in patients who underwent rIPC protocol prior to
CABG surgery, compared to control group. Conclusion: This study showed a
significant reduction of enzyme marker CKMB in patients subjected to rIPC
prior to CABG surgery. This suggests lesser degree of myocardial damage
compared to control group in CABG patients.

<3>
Accession Number
2010461414
Authors
Block A.J. McQuillen P.S. Chau V. Glass H. Poskitt K.J. Barkovich A.J.
Esch M. Soulikias W. Azakie A. Campbell A. Miller S.P.
Institution
(Block, Chau) Department of Pediatrics, University of British Columbia,
Vancouver, BC, Canada
(Poskitt, Soulikias, Campbell, Miller) Department of Radiology, University
of British Columbia, Vancouver, BC, Canada
(McQuillen, Glass, Esch) Department of Pediatrics, University of
California, San Francisco, 505 Parnassus Ave, San Francisco, CA
94143-0106, United States
(McQuillen, Glass, Barkovich, Miller) Department of Neurology, University
of California San Francisco, San Francisco, CA, United States
(Barkovich) Department of Radiology, University of California San
Francisco, San Francisco, CA, United States
(Azakie) Department of Surgery, University of California San Francisco,
San Francisco, CA, United States
Title
Clinically silent preoperative brain injuries do not worsen with surgery
in neonates with congenital heart disease.
Source
Journal of Thoracic and Cardiovascular Surgery. 140 (3) (pp 550-557),
2010. Date of Publication: September 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Preoperative brain injury, particularly stroke and white matter
injury, is common in neonates with congenital heart disease. The objective
of this study was to determine the risk of hemorrhage or extension of
preoperative brain injury with cardiac surgery. Methods: This dual-center
prospective cohort study recruited 92 term neonates, 62 with transposition
of the great arteries and 30 with single ventricle physiology, from 2
tertiary referral centers. Neonates underwent brain magnetic resonance
imaging scans before and after cardiac surgery. Results: Brain injury was
identified in 40 (43%) neonates on the preoperative magnetic resonance
imaging scan (median 5 days after birth): stroke in 23, white matter
injury in 21, and intraventricular hemorrhage in 7. None of the brain
lesions presented clinically with overt signs or seizures. Preoperative
brain injury was associated with balloon atrial septostomy (P = .003) and
lowest arterial oxygen saturation (P = .007); in a multivariable model,
only the effect of balloon atrial septostomy remained significant when
adjusting for lowest arterial oxygen saturation. On postoperative magnetic
resonance imaging in 78 neonates (median 21 days after birth), none of the
preoperative lesions showed evidence of extension or hemorrhagic
transformation (0/40 [95% confidence interval: 0%-7%]). The presence of
preoperative brain injury was not a significant risk factor for acquiring
new injury on postoperative magnetic resonance imaging (P = .8).
Conclusions: Clinically silent brain injuries identified preoperatively in
neonates with congenital heart disease, including stroke, have a low risk
of progression with surgery and cardiopulmonary bypass and should
therefore not delay clinically indicated cardiac surgery. In this
multicenter cohort, balloon atrial septostomy remains an important risk
factor for preoperative brain injury, particularly stroke. 2010 by The
American Association for Thoracic Surgery.

<4>
Accession Number
2010462184
Authors
Post P.N. Kuijpers M. Ebels T. Zijlstra F.
Institution
(Post) Dutch Institute for Healthcare Improvement CBO, PO Box 20064, 3502
LB Utrecht, Netherlands
(Kuijpers, Ebels, Zijlstra) Thorax Centre, University Medical Centre
Groningen, University of Groningen, Groningen, Netherlands
Title
The relation between volume and outcome of coronary interventions: A
systematic review and meta-analysis.
Source
European Heart Journal. 31 (16) (pp 1985-1992), 2010. Date of
Publication: August 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Although various studies reported better outcomes in centres
performing a high volume of procedures of coronary artery bypass grafting
(CABG) or percutaneous coronary interventions (PCIs), it is unclear how
strong this relation is and whether it pertains to today's practice.
Methods and results Medline, Embase, and conference reports were searched
for studies reporting the effect of high volume of CABG or PCI on
in-hospital mortality, adjusted for differences in case-mix. Of 140
potentially relevant papers, 15 were included, 2 of which reported data on
both CABG and PCI. Meta-analysis of 10 studies on PCI, comprising 1 322
342 patients in 1746 hospitals, indicated an odds ratio (OR) of
in-hospital mortality for patients treated in a high-volume hospital of
0.87 (95 confidence interval (CI) 0.83-0.91) compared to those treated in
a low-volume hospital. The 7 CABG studies taken together, comprising 1 470
990 patients in 2040 hospitals, also revealed a significant effect of high
volume (OR 0.85; CI 0.79-0.92). A differential effect for specific cut-off
points could not be identified. Meta-regression did not show notable
changes in the effect size over the years. Conclusion sPatients undergoing
CABG or PCI in a high-volume hospital exhibit lower in-hospital mortality
than those treated at low-volume hospitals. Our meta-analysis does not
support the view that this relation has attenuated over time. The Author
2010.

<5>
Accession Number
2010462190
Authors
Rubartelli P. Petronio A.S. Guiducci V. Sganzerla P. Bolognese L. Galli M.
Sheiban I. Chirillo F. Ramondo A. Bellotti S.
Institution
(Rubartelli, Bellotti) Dipartimento di Cardiologia, Ospedale Villa Scassi,
Corso Scassi 1, 16149 Genova, Italy
(Petronio) Dipartimento Cardio-Toracico, Ospedale Cisanello, Universit di
Pisa, Pisa, Italy
(Guiducci) Unit Operativa di Cardiologia Interventistica, Ospedale Santa
Maria Nuova, Reggio Emilia, Italy
(Sganzerla) Dipartimento Cardiovascolare, Ospedale Humanitas Gavazzeni,
Bergamo, Italy
(Bolognese) Dipartimento Cardiovascolare, Ospedale San Donato, Arezzo,
Italy
(Galli) Dipartimento Cardiovascolare, Ospedale sant'Anna, Como, Italy
(Sheiban) Divisione di Cardiologia Universitaria, Ospedale San Giovanni
Battista, Torino, Italy
(Chirillo) Dipartimento Cardiovascolare, Ospedale Ca' Foncello, Treviso,
Italy
(Ramondo) Dipartimento di Scienze Cardiovascolari, Universit di Padova,
Padova, Italy
Title
Comparison of sirolimus-eluting and bare metal stent for treatment of
patients with total coronary occlusions: Results of the GISSOC II-GISE
multicentre randomized trial.
Source
European Heart Journal. 31 (16) (pp 2014-2020), 2010. Date of
Publication: August 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Percutaneous coronary intervention with bare metal stent (BMS) in
chronic total coronary occlusions (CTOs) is associated with a higher rate
of angiographic restenosis and reocclusion than that observed in subtotal
stenoses. Preliminary reports have suggested a better performance of
drug-eluting stents in CTO. In this multicentre, randomized trial, we
compared the mid-term angiographic and clinical outcome of
sirolimus-eluting stent (SES) or BMS implantation after successful
recanalization of CTO. Methods and results Patients with CTO older than 1
month, after successful recanalization, were randomized to implantation of
SES (78 patients) or BMS (74 patients) in 13 Italian centres. Clopidogrel
therapy was prescribed for 6 months. The primary endpoint was in-segment
minimal luminal diameter (MLD) at 8-month follow-up. Secondary clinical
endpoints included death, myocardial infarction (MI), target lesion
revascularization (TLR), and target vessel revascularization (TVR) at 24
months. Patients treated with SES showed, at in-segment analysis, a larger
MLD (1.98 +/- 0.57 vs. 0.98 +/- 0.80 mm, P < 0.001), a lower late luminal
loss (-0.06 +/- 0.49 vs. 1.11 +/- 0.79 mm, P < 0.001), and lower
restenosis (9.8 vs. 67.7, P < 0.001) and reocclusion (0 vs. 17, P = 0.001)
rates. At 24-month follow-up, patients in the SES group experienced fewer
major adverse cardiac events (50.0 vs. 17.6, P < 0.001) mainly due to a
lower rate of both TLR (44.9 vs. 8.1, P < 0.001) and TVR (44.9 vs. 14.9, P
< 0.001). Conclusion In CTO, SES is markedly superior to BMS in terms of
restenosis and reocclusion rate, and incidence of repeat revascularization
at 24 months. The Author 2010.

<6>
Accession Number
2010462301
Authors
Cruz F.D.D. Issa V.S. Ayub-Ferreira S.M. Chizzola P.R. Souza G.E.C.
Moreira L.F.P. Lanz-Luces J.R. Bocchi E.A.
Institution
(Cruz, Issa, Ayub-Ferreira, Chizzola, Souza, Moreira, Lanz-Luces, Bocchi)
Heart Institute (InCor), Sao Paulo University Medical School, Sao Paulo,
Brazil
(Bocchi) Rua Dr Melo Alves 690 apto 41, Sao Paulo CEP 01410-010, Brazil
Title
Effect of a sequential education and monitoring programme on
quality-of-life components in heart failure.
Source
European Journal of Heart Failure. 12 (9) (pp 1009-1015), 2010. Date of
Publication: September 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Trials of disease management programmes (DMP) in heart failure (HF)
have shown controversial results regarding quality of life. We
hypothesized that a DMP applied over the long-term could produce different
effects on each of the quality-of-life components. Methods and results We
extended the prospective, randomized REMADHE Trial, which studied a DMP in
HF patients. We analysed changes in Minnesota Living with Heart Failure
Questionnaire components in 412 patients, 60.5 male, age 50.2 +/- 11.4
years, left ventricular ejection fraction 34.7 +/- 10.5. During a mean
follow-up of 3.6 +/- 2.2 years, 6.3 of patients underwent heart
transplantation and 31.8 died. Global quality-of-life scores improved in
the DMP intervention group, compared with controls, respectively: 57.5 +/-
3.1 vs. 52.6 +/- 4.3 at baseline, 32.7 +/- 3.9 vs. 40.2 +/- 6.3 at 6
months, 31.9 +/- 4.3 vs. 41.5 +/- 7.4 at 12 months, 26.8 +/- 3.1 vs. 47.0
+/- 5.3 at the final assessment; P < 0.01. Similarly, the physical
component (23.7 +/- 1.4 vs. 21.1 +/- 2.2 at baseline, 16.2 +/- 2.9 vs.
18.0 +/- 3.3 at 6 months, 17.3 +/- 2.9 vs. 23.1 +/- 5.7 at 12 months, 11.4
+/- 1.6 vs. 19.9 +/- 2.4 final; P < 0.01), the emotional component (13.2
+/- 1.0 vs. 12.1 +/- 1.4 at baseline, 11.7 +/- 2.7 vs. 12.3 +/- 3.1 at 6
months, 12.4 +/- 2.9 vs. 16.8 +/- 5.9 at 12 months, 6.7 +/- 1.0 vs. 10.6
+/- 1.4 final; P < 0.01) and the additional questions (20.8 +/- 1.2 vs.
19.3 +/- 1.8 at baseline, 14.3 +/- 2.7 vs. 17.3 +/- 3.1 at 6 months, 12.4
+/- 2.9 vs. 21.0 +/- 5.5 at 12 months, 6.7 +/- 1.4 vs. 17.3 +/- 2.2 final;
P < 0.01) were better (lower) in the intervention group. The emotional
component improved earlier than the others. Post-randomization quality of
life was not associated with events. ConclusionComponents of the
quality-of-life assessment responded differently to DMP. These results
indicate the need for individualized DMP strategies in patients with HF.
2010 The Author.

<7>
Accession Number
2010463040
Authors
Schellings D.A.A.M. Dambrink J.-H.E. Hoorntje J.C.A. de Boer M.J. van't
Hof A.W.J. Suryapranata H.
Institution
(Schellings, Dambrink, Hoorntje, de Boer, van't Hof, Suryapranata)
Department of Cardiology, Isala Klinieken, Zwolle, Netherlands
Title
Long-term comparison of balloon angioplasty with provisional stenting
versus routine stenting in patients with non-ST-elevation acute coronary
syndrome.
Source
Netherlands Heart Journal. 18 (6) (pp 307-313), 2010. Date of
Publication: June 2010.
Publisher
Bohn Stafleu van Loghum (P.O. Box 246, Houten 3990 GA, Netherlands)
Abstract
Background. In patients with unstable angina or non-ST-elevation acute
coronary syndrome (NSTE-ACS) who are eligible for PCI, routine stenting is
the recommended treatment strategy, based on the opinion of experts.
Provisional stenting may provide a viable alternative by retaining the
early benefits of stenting without its potential late hazards. Method.
Patients with NSTE-ACS were randomized to provisional or routine stenting
after coronary angiography. Patients were followed for up to ten years.
The occurrence of major adverse cardiac events (MACE) was recorded.
Results. 237 consecutive patients with NSTEACS were randomly assigned to
routine stenting (n=116) or provisional stenting (n=121). No difference in
the incidence of MACE at 30 days was observed. At six months, angiographic
restenosis was lower in the routine stenting group (41 vs. 20%, p=0.02),
paralleled by more MACE in the provisional stenting group at one year
(40.5 vs. 27.6%, p=0.036). At complete follow-up the difference in MACE
was not significant (61.2 vs. 50%, p=0.084) because of relatively more
target lesion revascularizations in the routine stent group. There was no
difference in the incidence of very late stent thrombosis (1.7 vs. 3.4%,
p=0.439). The only independent predictor of MACE was beta-blocker use (RR
0.62 [0.431; 0.892] p=0.010). Conclusion. In selective patients with
NSTEACS, routine stenting was more beneficial than provisional stenting
for a period of up to five years, driven by a reduction in repeat
revascularization procedures. After this period, the benefit was no longer
significant. Beta-blocker use was the only independent predictor of MACE
throughout the complete follow-up period.

<8>
[Use Link to view the full text]
Accession Number
2010461756
Authors
Ettema R.G.A. Peelen L.M. Schuurmans M.J. Nierich A.P. Kalkman C.J. Moons
K.G.M.
Institution
(Ettema, Schuurmans) University of Applied Science Utrecht, Faculty of
Health Care, Bolognalaan 101, 3584 CJ Utrecht, Netherlands
(Peelen, Moons) Julius Center for Health Sciences and Primary Care,
Nursing Science and Sports, Utrecht, Netherlands
(Schuurmans, Kalkman) Division of Perioperative Care and Emergency Aid,
Nursing Science and Sports, Utrecht, Netherlands
(Kalkman) Department of Rehabilitation, Nursing Science and Sports,
Utrecht, Netherlands
(Nierich) University Medical Center Utrecht, Utrecht, Netherlands
(Nierich) Department of Anesthesiology and Intensive Care, Isala Clinics,
Zwolle, Netherlands
Title
Prediction models for prolonged intensive care unit stay after cardiac
surgery: Systematic review and validation study.
Source
Circulation. 122 (7) (pp 682-689), 2010. Date of Publication: 17 Aug
2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background: Several models have been developed to predict prolonged stay
in the intensive care unit (ICU) after cardiac surgery. However, no
extensive quantitative validation of these models has yet been conducted.
This study sought to identify and validate existing prediction models for
prolonged ICU length of stay after cardiac surgery. Methods and Results:
After a systematic review of the literature, the identified models were
applied on a large registry database comprising 11 395 cardiac surgical
interventions. The probabilities of prolonged ICU length of stay based on
the models were compared with the actual outcome to assess the
discrimination and calibration performance of the models. Literature
review identified 20 models, of which 14 could be included. Of the 6
models for the general cardiac surgery population, the Parsonnet model
showed the best discrimination (area under the receiver operating
characteristic curve=0.75 [95% confidence interval, 0.73 to 0.76]),
followed by the European system for cardiac operative risk evaluation
(EuroSCORE) (0.71 [0.70 to 0.72]) and a model by Huijskes and colleagues
(0.71 [0.70 to 0.73]). Most of the models showed good calibration.
CONCLUSIONS-: In this validation of prediction models for prolonged ICU
length of stay, 2 widely implemented models (Parsonnet, EuroSCORE),
although originally designed for prediction of mortality, were superior in
identifying patients with prolonged ICU length of stay. 2010 American
Heart Association, Inc.

<9>
Accession Number
2010442309
Authors
Locali R.F. Matsuoka P.K. Cherbo T. Gabriel E.A. Buffolo E.
Institution
(Locali, Matsuoka, Cherbo, Gabriel, Buffolo) Universidade Federal de Sao
Paulo, Sao Paulo, SP, Brazil
Title
Should biatrial heart transplantation still be performed? A meta-analysis.
Source
Arquivos Brasileiros de Cardiologia. 94 (6) (pp 829-840+778-788), 2010.
Date of Publication: June 2010.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
The outcomes of total and bicaval heart transplantation techniques are
better than those of the biatrial technique; however, the latter is still
considered the gold-standard. The objective of this study was to determine
whether the total and bicaval heart transplantation techniques are, in
fact, better than the biatrial technique. A systematic review with
meta-analysis was carried out. Studies were retrieved from Pubmed, Lilacs,
Web of Science, Scirus, Scopus, Google Scholar, and Scielo databases,
identified by sensitive strategy. Randomized, prospective, and
retrospective controlled studies were selected for inclusion. Intra and
postoperative parameters were assessed. A total of 11,602 studies were
identified and 36 were included in our review. The number of atrial
arrhythmias, tricuspid valve regurgitation, deaths, and embolic events, as
well as bleeding volume; temporary and permanent pacemaker requirement;
and length of stay in the intensive care unit are significantly lower for
the total and bicaval techniques than for the biatrial technique. Also,
hemodynamic variables such as pulmonary capillary pressure, mean pulmonary
artery pressure, and right atrial pressure are lower in total and bicaval
transplantation. In prognostic terms, total and bicaval orthotopic heart
transplantations are better, than the biatrial transplantation. Therefore,
indication of the biatrial technique for transplantation should be the
exception, not the rule.

<10>
Accession Number
2010442769
Authors
Berger K. Sander M. Kohlar A. Meisel C. Konertz W. Volk T.
Institution
(Berger, Sander, Kohlar) Department of Anesthesiology and Intensive Care
Medicine, Charite-Universitatsmedizin Berlin, Campus Charite Mitte,
Berlin, Germany
(Meisel) Department of Immunology, Charite-Universitatsmedizin Berlin,
Campus Charite Mitte, Berlin, Germany
(Konertz) Department of Cardiovascular Surgery,
Charite-Universitatsmedizin Berlin, Campus Charite Mitte, Berlin, Germany
(Volk) Department of Anaesthesiology, Intensive Care and Pain Therapy,
Saarland University Hospital, Universitatsklinikum des Saarlandes,
Kirrberger Strase 100, Homburg, Saarland 66424, Germany
Title
Inadequate cytoplasmatic calcium signals in alveolar macrophages after
cardiac surgery.
Source
Inflammation Research. 59 (9) (pp 767-773), 2010. Date of Publication:
September 2010.
Publisher
Birkhauser Verlag Basel (Klosterberg 23, P.O. Box 133, Basel CH-4010,
Switzerland)
Abstract
Objective and design: Patients undergoing cardiac surgery have an elevated
risk for pulmonary complications. A dysfunction of alveolar macrophages
(AM) might promote postoperative infections. Therefore intracellular
calcium [Ca ²⁺]_i as an important second messenger in
cellular signaling was assessed in AM. Materials and methods: Twelve
patients undergoing elective coronary artery bypass graft surgery (CABG)
were enrolled in this clinical trial. After anesthesia induction and 2 h
after cardiopulomary bypass (CPB) declamping, the bronchoalveolar lavage
(BAL) fluid was collected preoperatively from the right middle lobe and
postoperatively from the left lingula of the lung. Cell subpopulations and
[Ca²⁺]_i signals were assessed via flow cytometry. To
express the changes of [Ca ²⁺]_i signals the
Fluo4/FuraRed-Ratio was used. Results: After surgery the
[Ca²⁺]_i baseline in unstimulated AMs were
significantly reduced (p < 0.001). A significant signal reduction after
fMLP (p = 0.021) and C5a (p = 0.028) stimulation was found in FSC high AMs
after surgery, even though all populations showed a trend of less
responsiveness. Conclusion: We suggest that the reduced
[Ca²⁺]_i signaling in postoperative AMs is caused by
a reduced coupling to membrane channels. These preliminary data suggest an
inadequate [Ca²⁺]_i signal of AM after surgery, which
may contribute to a local immune dysfunction in the lung. 2010 Springer
Basel AG.

<11>
[Use Link to view the full text]
Accession Number
2010456859
Authors
Weir R.A.P. Murphy C.A. Petrie C.J. Martin T.N. Balmain S. Clements S.
Steedman T. Wagner G.S. Dargie H.J. McMurray J.J.V.
Institution
(Weir, Murphy, Petrie, Martin, Balmain, Clements, Steedman, Dargie,
McMurray) Cardiology Department, Western Infirmary, Glasgow G11 6NT,
United Kingdom
(Wagner) Duke University Medical Center, Durham, NC, United States
Title
Microvascular obstruction remains a portent of adverse remodeling in
optimally treated patients with left ventricular systolic dysfunction
after acute myocardial infarction.
Source
Circulation: Cardiovascular Imaging. 3 (4) (pp 360-367), 2010. Date of
Publication: July 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-Microvascular obstruction (MO) is associated with large acute
myocardial infarction and lower left ventricular (LV) ejection fraction
and predicts greater remodeling, but whether this effect is abolished by
contemporary antiremodeling therapies is subject to debate. We examined
the influence of several infarct characteristics, including MO, on LV
remodeling in an optimally treated post-acute myocardial infarction
cohort, using contrast-enhanced cardiac magnetic resonance. Methods and
Results-One hundred patients (mean age, 58.9+/-12 years, 77% men)
underwent contrast-enhanced cardiac magnetic resonance at baseline (4
days) and at 12 and 24 weeks. The effects on LV remodeling (ie, change in
LV end-systolic volume index [LVESVi]) of infarct site, transmurality,
endocardial extent, and the presence of early and late MO were analyzed.
Mean baseline infarct volume index decreased from 34.0 (21.2)
mL/m² to 20.9 (12.9) mL/m² at 24 weeks (P<0.001).
Infarct site had no influence on remodeling, but greater baseline infarct
transmurality (r=0.47, P<0.001) and endocardial extent (r=0.26, P<0.01)
were associated with higher LVESVi. Early MO was seen in 69 patients (69%)
and persisted as late MO in 56 patients (56%). Patients with late MO
underwent significantly greater remodeling than those without MO (LVESVi,
+4.1 [13.4] versus 7.0 [12.7] mL/m², respectively, P=0.001);
those with early MO only displayed an intermediate LVESVi ( -4.9 [13.0]
mL/m²). Importantly, late MO was seen frequently despite
optimal coronary blood flow having been restored at angiography.
Conclusions-Late MO on predischarge contrast-enhanced cardiac magnetic
resonance remains an ominous predictor of adverse LV remodeling despite
powerful antiremodeling therapy and may be useful in the risk
stratification of survivors of acute myocardial infarction. 2010 American
Heart Association, Inc.

<12>
Accession Number
2010458738
Authors
Levy M.S. Creager M.A.
Institution
(Levy, Creager) Cardiovascular Division, Brigham and Women's Hospital, 75
Francis Street, Boston, MA 02115, United States
Title
Revascularization versus medical therapy for renal-artery stenosis. The
ASTRAL investigators. The New England Journal of Medicine 2009; 361:
1953-1962.
Source
Vascular Medicine. 15 (4) (pp 343-345), 2010. Date of Publication:
August 2010.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Study objective: The objective of ASTRAL was to determine whether
percutaneous revascularization combined with medical therapy compared to
medical therapy alone improves renal function and other outcomes, such as
blood pressure, time to first renal event, time to first major
cardiovascular event, and mortality. Study population: ASTRAL enrolled 806
patients with atherosclerotic renovascular disease from 57 centers.
Patients were screened if treating clinicians felt they had clinical
features suggestive of underlying atherosclerotic renovascular disease
(i.e. hypertension refractory to medical therapy, or renal impairment as
suggested by laboratory measurements). All patients had to have an imaging
modality (i.e. computed tomographic angiography (CTA), magnetic resonance
angiography (MRA) or renal artery ultrasound). This imaging had to convey
that the patient had 'substantial' anatomical atherosclerotic stenosis in
at least one renal artery that was suitable for endovascular therapy.
Also, the treating clinician had to be 'uncertain' that the patient would
benefit from revascularization. Fifty-nine percent of patients were
reported to have renal artery stenosis of > 70%, and 60% had a serum
creatinine of >= 150 mmol per liter. Design and methods: ASTRAL was a
randomized, unblinded study of patients with atherosclerotic renal artery
disease who were assigned to percutaneous revascularization plus best
medical therapy or best medical therapy alone. The primary outcome of the
ASTRAL trial was the change of renal function over time, as determined by
the mean slope of the reciprocal of serum creatinine. Secondary outcomes
included blood pressure, time to first renal event (defined as: new onset
of kidney injury, dialysis, renal transplantation, nephrectomy, or death
from renal failure), time to first major cardiovascular event (defined as:
myocardial infarction, stroke, death from cardiovascular cause,
hospitalization for angina, fluid overload or congestive heart failure,
coronary artery revascularization, or another peripheral arterial
procedure), and all-cause mortality. Randomization was 1:1 via computer
algorithm and was stratified by serum creatinine, glomerular filtration
rate (GFR), severity of renal artery stenosis, kidney length on
ultrasound, and rate of progression of renal impairment. Patients who were
assigned to the revascularization plus medical therapy arm underwent
percutaneous revascularization within 4 weeks. The procedure type
(angioplasty alone or with stenting), was left to the discretion of the
local operator. Distal protection devices were not used. Medical therapy
in both arms consisted of antihypertensive drugs, statins, and
antiplatelet agents. The trial was powered to detect a 20% reduction in
the mean slope of the reciprocal of serum creatinine. Based on low
crossover rates, it was determined that at least 750 patients would have
to be enrolled. Analysis was by intention to treat. Continuous variables
were subject to repeated measures analysis. Time-to-event data were
expressed via Kaplan Meier curves and compared via log-rank testing.
Prespecified subgroup analyses included baseline serum creatinine, GFR,
severity of renal artery stenosis, kidney length, and progression of renal
disease. Results: Of the 806 patients included, 403 were randomized to the
revascularization arm and 403 to medical therapy only. The median
follow-up was 34 months. Only 337 (83%) patients randomized to
revascularization underwent the procedure, whereas 24 patients (6%)
randomized to the medical therapy arm underwent revascularization. The
number of antihypertensive medications used was greater in the medical
therapy group than in the revascularization group at the 12-month
follow-up: 2.97 versus 2.77 (p = 0.03). The mean slope of the reciprocal
of the serum creatinine concentration was -0.07 x 10 ^-3 liters
per micromole per year in the revascularization group versus -0.13 x
10^-3 liters per micromole per year in the medical-therapy group
(difference of 0.06 x 10^-3 liters per micromole per year) (95%
confidence interval [CI], -0.002 to 0.13, p = 0.06) with a trend favoring
revascularization. After 5 years of follow-up, there was a trend toward
lower mean systolic blood pressure (1.6 mmHg lower, p = 0.06) in the
revascularization group. However, the mean diastolic blood pressure was
significantly lower in the medical therapy group at long-term follow-up
(divergence of slope of mean diastolic blood pressure: 0.61 mmHg per year,
p = 0.03). There was no significant difference between renal events, time
to first renal event, acute kidney injury, or development of end-stage
renal disease in either group. Further, there was no difference in major
cardiovascular events or overall survival in either group. The
periprocedural complication rate within the revascularization group was 9%
(31/359 patients). Fifty-five out of 280 patients (20%) had an adverse
event by 1 month post procedure. Overall, there were 31 serious
complications of revascularization in 23 patients. Per protocol analysis
of patients suggested that there was no significant difference in outcomes
between patients who received revascularization versus medical therapy. No
differences between treatment groups were identified in any of the
pre-specified subgroup analyses. Conclusions: Renal artery stenting
combined with medical therapy did not improve renal function compared to
medical therapy alone in patients with atherosclerotic renal artery
disease.

<13>
Accession Number
19649758
Authors
Woodfield J.C. Beshay N. van Rij A.M.
Institution
(Woodfield) Department of Surgery, University of Otago Medical School, PO
Box 913, Dunedin, New Zealand.
Title
A meta-analysis of randomized, controlled trials assessing the
prophylactic use of ceftriaxone. A study of wound, chest, and urinary
infections.
Source
World journal of surgery. 33 (12) (pp 2538-2550), 2009. Date of
Publication: Dec 2009.
Abstract
BACKGROUND: Ceftriaxone is an effective prophylactic antibiotic. However,
there is no consensus about whether ceftriaxone should be used as a
first-line antibiotic for the prevention of incisional surgical site
infection (SSI). Its role in preventing urinary tract infection (UTI) and
pneumonia also is controversial. METHODS: A meta-analysis of randomized,
controlled trials assessing the prophylactic use of ceftriaxone between
1983 and 2005 was performed. Medline, Embase, and Cochrane registers were
reviewed. Additional references, review papers, and proceedings from
meetings were searched. The Jadad score was used to assess study quality.
A meta-analysis with sensitivity analyses was performed for SSI, UTI, and
pneumonia. RESULTS: Of 231 reviewed papers, 90 were included. Ceftriaxone
prophylaxis was superior to other antibiotics in each category. Sixty-one
studies assessed the prevention of SSI (odds ratio (OR), 0.68; 95%
confidence interval (CI), 0.53-0.7, p < 0.001; Cochran's Q statistic, p =
0.93). The difference was greatest for abdominal surgery. There was no
difference for cardiac surgery. Thirty-five studies assessed the
prevention of UTI (OR 0.53; 95% CI 0.43-0.63, p = 0; Cochran's Q
statistic, p = 0.97). The difference was greatest in obstetric and
gynecological and colorectal surgery. Thirty-seven studies assessed the
prevention of pneumonia (OR 0.66; 95% CI 0.54-0.81, p = 0; Cochran's Q
statistic, p = 0.65). The difference was greatest in upper abdominal
surgery. CONCLUSIONS: The meta-analysis confirms that prophylactic
ceftriaxone is more effective than most other prophylactic antibiotics.
This reduces SSI, UTI, and pneumonia in procedures where there is an
increased risk of these infections. In such procedures, the data support
using ceftriaxone as a first-line prophylactic antibiotic.

<14>
Accession Number
2010454540
Authors
Gagnon J. Laporta D. Beique F. Langlois Y. Morin J.-F.
Institution
(Gagnon) Service of Perfusion, Division of Cardiac Surgery, Department of
Surgery, Australia
(Laporta) Department of Adult Critical Care, Australia
(Beique) Division of Cardiac Anesthesia, Department of Anaesthesia,
Australia
(Langlois, Morin) Department of Surgery, Jewish General Hospital, A Mcgill
University Teaching Hospital, Montreal, QC, Canada
Title
Clinical relevance of ventilation during cardiopulmonary bypass in the
prevention of postoperative lung dysfunction.
Source
Perfusion. 25 (4) (pp 205-210), 2010. Date of Publication: July 2010.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
The current clinical study is the continuity of previous experimental
findings in which ventilation during cardiopulmonary bypass (CPB)
prevented reperfusion injury of the pulmonary arterial tree as
demonstrated by preservation of vasorelaxation to acetylcholine (ACh) in
swine. The aim of this prospective randomized study is to determine: 1) if
ventilation during CPB prevents the selective endothelium-mediated lung
dysfunction in humans and, 2) the clinical relevance of ventilation during
CPB. Forty patients scheduled for primary coronary artery bypass grafting
(CABG) were randomized into two groups: Group 1: Usual care (defined as no
ventilation during CPB) and Group 2: CPB with low tidal volume ventilation
(3 ml.kg^-1) without positive end expiratory pressure (PEEP). To
evaluate endothelial function, ACh was injected into the pulmonary artery
and the changes in pulmonary vascular resistance index (PVRI) were
measured at: (1) induction of anesthesia prior to surgery, (2) immediately
after weaning from CPB and (3) 1 hour after CPB. In addition, secondary
endpoints, such as PaO₂/FiO₂ ratio, mean pulmonary
artery pressure (MPAP), postoperative length of stay (LOS) and
postoperative pulmonary complications were measured to evaluate the effect
of ventilation during CPB. To assess pulmonary complications, a chest
x-ray was taken on the first and third postoperative days. There were no
statistically significant changes in PVRI, PaO₂
/FiO₂ ratio, MPAP, postoperative LOS and postoperative
pulmonary complications when comparing the non-ventilated and the
ventilated groups during CPB. The ventilated group appears to obtain a
greater vasorelaxation to ACh, as shown by the more pronounced change in
PVRI when compared to the non-ventilated group. However, the difference in
PVRI between the two groups was not statistically significant after
weaning (p= 0.32) and 1hr after CPB (p= 0.28). Contrary to our hypothesis
and due to larger than expected variability in the data, the hemodynamic
and clinical changes seen were not statistically significant. The
Author(s) 2010.

<15>
Accession Number
2010454541
Authors
Anastasiadis K. Asteriou C. Deliopoulos A. Argiriadou H. Karapanagiotidis
G. Antonitsis P. Grosomanidis V. Misias G. Papakonstantinou C.
Institution
(Anastasiadis, Asteriou, Deliopoulos, Argiriadou, Karapanagiotidis,
Antonitsis, Grosomanidis, Misias, Papakonstantinou) Department of
Cardiothoracic Surgery, AHEPA University Hospital, Thessaloniki, Greece
Title
Haematological effects of minimized compared to conventional
extracorporeal circulation after coronary revascularization procedures.
Source
Perfusion. 25 (4) (pp 197-203), 2010. Date of Publication: July 2010.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
During the last decade, minimized extracorporeal circulation (MECC)
systems have shown beneficial effects to the patients over the
conventional cardiopulmonary bypass (CECC) circuits. This is a prospective
randomized study of 99 patients who underwent coronary artery bypass
grafting (CABG) surgery, evaluating the postoperative haematological
effects of these systems. Less haemodilution (p=0.001) and markedly less
haemolysis (p<0.001), as well as better preservation of the coagulation
system integrity (p=0.01), favouring the MECC group, was found. As a
clinical result, less bank blood requirements were noted and a quicker
recovery, as far as mechanical ventilation support and ICU stay are
concerned, was evident with the use of MECC systems. As a conclusion,
minimized extracorporeal circulation systems may attenuate the adverse
effects of conventional circuits on the haematological profile of patients
undergoing CABG surgery. The Author(s) 2010.

<16>
Accession Number
70254970
Authors
Wechsler M. Cox G. Niven R. Zoratti E. Hanania N.
Institution
(Wechsler) BostonMAUnited States
(Cox) HamiltonCanada
(Niven) ManchesterUnited Kingdom
(Zoratti) DetroitMIUnited States
(Hanania) HoustonTXUnited States
Source
Annals of Allergy, Asthma and Immunology. Conference: 2009 Annual
Scientific Meeting of the American College of Allergy, Asthma and
Immunology, ACAAI Miami, FL United States. Conference Start: 20091105
Conference End: 20091110. Conference Publication: (var.pagings). 103 (5
SUPPL. 3) (pp A71), 2009. Date of Publication: November 2009.
Publisher
American College of Allergy, Asthma and Immunology
Abstract
Introduction: BT is a procedure designed to improve asthma control by
reducing airway smooth muscle mass. Three randomized controlled trials
(RCT) evaluated the effect of BT in patients with asthma. The most recent
trial was a double-blind, sham-controlled study (AIR2 Trial) to evaluate
the effectiveness and safety of BT for the treatment of severe,
symptomatic asthma. Methods: 297 subjects with severe asthma [symptomatic
despite taking high doses of ICS (>= 1000mcg BDP equiv.) and LABA] were
enrolled with a 2:1 randomization (BT:Sham control) at 30 sites. The
primary endpoint was the difference between groups for the change from
baseline in the AQLQ score. Results: 79% of BT subjects achieved a
statistically significant and clinically meaningful AQLQ improvement of
>=0.5 compared to 64% of the Sham group. This was consistent with findings
from the two prior RCTs. BT subjects with lower AQLQ tended to have
greater improvements in AQLQ. The cumulative rate of ER visits over the
entire study was 0.13/subject in the BT group and 0.45/subject in the sham
group. As in previous RCTs, an increased rate of respiratory AEs was
observed in the BT group compared to Sham during the Treatment period.
3.1% of BT bronchoscopies were associated with a hospitalization in the
Treatment period vs. 0.7% in the sham group (ppsuperiority 99.4%). This
rate was consistent with the previous AIR Trial. The median time to onset
and time to resolution of respiratory AEs were 1 day and 1 week,
respectively. Short-term AEs were related to transient worsening of asthma
symptoms, were reversible, and managed with standard care. During the
post-treatment period out to 12 months, the rate of respiratory AE's was
lower in the BT group than in the Sham group, and resulted in fewer ER
visits for BT subjects. There were no procedure-related pneumothoraces,
cardiac arrhythmias, intubations, or death over the course of the 3 RCTs.
Conclusions: Clinical experience in 3 RCTs demonstrates BT may be an
effective new treatment approach. While the risks of BT include transient
worsening of asthma, patients on high doses of ICS+LABA, with impaired
quality of life, experience meaningful improvements in their overall
asthma status. Referral for BT may be considered when standard medications
are not sufficient to control severe asthma.

<17>
Accession Number
70255331
Authors
Pugh R.J. Rathbone P.
Institution
(Pugh, Rathbone) Glan Clwyd Hospital, Rhyl, United Kingdom
Source
Critical Care. Conference: 30th International Symposium on Intensive Care
and Emergency Medicine, ISICEM Brussels Belgium. Conference Start:
20100309 Conference End: 20100312. Conference Publication: (var.pagings).
14 (pp S30), 2010. Date of Publication: 2010.
Publisher
BioMed Central Ltd.
Abstract
Introduction: This systematic review aims to evaluate evidence from
randomised controlled trials (RCTs) for oral chlorhexidine in preventing
nosocomial pneumonia in intubated mechanically ventilated critically ill
adults. Use of oral chlorhexidine appeals since it should reduce bacterial
aspiration from the orophayrnx. A number of RCTs have recently been
published on this topic. Methods: Search of Medline, Embase, Cochrane
library, grey literature registers, conference proceedings and reference
lists for RCTs comparing chlorhexidine with placebo or standard care for
prevention of pneumonia in the critically ill. Outcomes: episode of
nosocomial respiratory tract infection (RTI), mortality, duration of
mechanical ventilation (MV) and length of ITU stay (ITU LOS). Review
Manager 4.2 (Nordic Cochrane Centre) was used for data synthesis. Effect
estimates (odds ratio for dichotomous and weighted mean difference for
continuous data) were calculated using a random effects model. Results:
Fourteen studies were identified, three involving patients undergoing
cardiac surgery (1,841 patients) and 11 involving patients in
noncardiothoracic ITUs (1,497 patients; see Table 1). Five studies
(including two cardiac studies) found a significant reduction in episodes
of nosocomial RTI in the chlorhexidine-treated group versus placebo or
standard care. Pooled data indicated a significant reduction in nosocomial
RTI in the treatment group among all patients, and among cardiac and
noncardiac sub-groups (odds ratio 0.57 (95% CI 0.42 to 0.77), 0.52 (0.37
to 0.75) and 0.6 (0.4 to 0.89), respectively). However, no significant
differences in mortality, duration of mechanical ventilation or ITU stay
were demonstrated. Significant heterogeneity (I2 statistic >40%) was
detected for all outcomes except mortality. {Table presented}.
Conclusions: Use of oral chlorhexidine is associated with reduction in
nosocomial respiratory tract infection in intubated mechanically
ventilated critically ill adults.

<18>
Accession Number
70255619
Authors
Hajjar L. Galas F. Sundin M. Nakamura R. Silva C. Mauad T. Pomerantzeff P.
Bueno P. Kalil Filho R. Vincent J.L. Auler J.
Institution
(Hajjar, Galas, Sundin, Nakamura, Silva, Pomerantzeff, Bueno, Kalil Filho,
Auler) Heart Institute, So Paulo, Brazil
(Mauad) So Paulo University, So Paulo, Brazil
(Vincent) Erasme Hospital, Brussels, Belgium
Source
Critical Care. Conference: 30th International Symposium on Intensive Care
and Emergency Medicine, ISICEM Brussels Belgium. Conference Start:
20100309 Conference End: 20100312. Conference Publication: (var.pagings).
14 (pp S126-S127), 2010. Date of Publication: 2010.
Publisher
BioMed Central Ltd.
Abstract
Introduction: There are no prospective studies comparing outcomes between
restrictive or liberal strategies in cardiac surgery. This study is a
double-blind randomized study to determine whether a restrictive strategy
of red cell transfusion and a liberal strategy produced equivalent
Results: in patients submitted to cardiac surgery. Methods: Until November
2009 we enrolled 380 patients undergoing elective cardiac surgery and
randomly assigned 185 patients to a restrictive strategy of transfusion,
in which red cells were transfused if the hematocrit concentration dropped
below 24%, and 195 patients to a liberal strategy, in which transfusions
were given when the hematocrit fell below 30%. Both transfusion strategies
were followed into the operative room and during the ICU stay. We compared
the rates of complications and death from all causes during the hospital
stay and clinical outcomes of patients after 90 days. Adult patients,
after written informed consent, were allocated if they would be submitted
to elective primary surgery or were redone adult cardiac surgical patients
for coronary artery bypass grafting, valve procedure or combined
procedures. Results: Overall, hospital mortality was similar in the two
groups (4.7% vs 5.3%, P = 0.11). The rates of complications were similar
in the two groups (28.3% in the restrictive-strategy group and 26.1% in
the liberal-strategy group, P = 0.33). The ICU stay was significantly
lower in the restrictivestrategy group (2.2 days vs 4.1 days, P = 0.05).
There was no difference in 90-day mortality between groups. Conclusions: A
restrictive strategy of red cell transfusion is at least as effective as
and possibly superior to a liberal transfusion strategy in patients
submitted to cardiac surgery.

<19>
Accession Number
70248879
Authors
Yank V. Logan A.C. Vaughan Tuohy C. Bravata D.M. Staudenmayer K. Eisenhut
R. Sundaram V. McMahon D. McDonald K.M. Owens D. Stafford R.S.
Institution
(Yank) Department of Medicine, Division of General Internal Medicine,
Stanford University, Stanford, CA, United States
(Logan) Department of Medicine, Divisions of Hematology and Blood and
Marrow Transplantation, Stanford University, Stanford, CA, United States
(Vaughan Tuohy, Bravata, Eisenhut, Sundaram, McDonald, Owens, Stafford)
Department of Medicine, Stanford Prevention Research Center, Stanford
University, Stanford, CA, United States
(Staudenmayer) Department of Surgery, Trauma and Surgical Critical Care,
Stanford University, Stanford, CA, United States
(McMahon) Department of Statistics, Stanford University, Stanford, CA,
United States
Source
Blood. Conference: 51st Annual Meeting of the American Society of
Hematology, ASH New Orleans, LA United States. Conference Start: 20091205
Conference End: 20091208. Conference Publication: (var.pagings). 114
(22) , 2009. Date of Publication: 20 Nov 2009.
Publisher
American Society of Hematology
Abstract
Background: Recombinant factor VIIa (rFVIIa) is a potent hemostatic agent
licensed for treatment of bleeding in hemophiliac patients with inhibitors
but has been increasingly used off-label to treat or prevent bleeding,
despite sparse data to support its efficacy and a possible increase in
thromboembolic events. While randomized controlled trials (RCTs) provide
the best evidence regarding efficacy, they may not identify rare but
important adverse events. Observational studies may capture the rate of
such events in clinical practice more accurately. Objectives: To compare
rates of thromboembolic events associated with off-label use of rFVIIa in
RCTs and observational studies. Methods: Studies of off-label application
of rFVIIa were identified by review of 10 literature and clinical trial
databases through February, 2009. The off-label indications examined were
trauma, non-traumatic intracranial hemorrhage (ICH), and adult cardiac
surgery. When an appropriate number and quality of studies were available,
data from RCTs and higher quality comparative observational studies were
combined via meta-analysis using the arc sine statistical method, a method
that characterizes uncommon events more accurately than more conventional
methods. To describe the absolute rate of thromboembolism for patients
treated with rFVIIa in RCTs versus observational studies, we analyzed data
from the interventional arms of RCTs and comparative observational
studies, as well as data from non-comparative observational studies with
15 or more patients. Results: Included Studies Our search identified 4
RCTs and 4 observational studies of rFVIIa use in ICH. Two RCTs and 5
observational studies were identified for trauma. For cardiac surgery, 2
RCTs, 2 higher quality comparative observational studies (included in the
meta-analysis), and 8 additional observational studies were identified.
Meta-analyses The meta-analysis of the RCTs investigating use of rFVIIa in
ICH showed a trend toward increased thromboembolic risk with rFVIIa
(arcsine summary effect size 0.100, 95% CI -0.072-0.272). For trauma, the
two RCTs did not provide sufficient data to perform meta-analysis.
Individually, they did not demonstrate significantly different incidences
of thromboembolic events with rFVIIa compared to placebo but may have been
underpowered to detect such differences. For cardiac surgery, the
meta-analysis of the 4 studies showed a significant increase in
thromboembolic events in the rFVIIa group (arcsine summary effect 0.14;
95% CI 0.038- 0.242). Absolute rates of thromboembolic events in RCTs
versus observational studies In ICH, thromboembolic event rates in the
treatment arms of the RCTs ranged from 0.07-0.11, while those in the
observational studies ranged from 0-0.20. In trauma, thromboembolic event
rates in the RCT treatment arms ranged from 0.03-0.06, whereas those in
the observational studies ranged from 0.02-0.11. In cardiac surgery,
thromboembolic event rates in the RCTs ranged from 0.07-0.22 compared to a
range of 0-0.25 in the observational studies. For all three indications,
Figure 1 shows that the weighted mean thromboembolic event rates
associated with rFVIIa use are higher in the observational studies than in
the RCTs. Patients in the observational studies tended to be older and
have a worse prognosis than those enrolled in the RCTs. (Figure presented)
Conclusions: We identified a trend toward significantly higher rates of
thromboembolic adverse events with off-label use of rFVIIa compared to
placebo in our meta-analyses of ICH and cardiac surgery, but no similar
pattern in trauma trials. For each of these indications, we identified a
higher rate of thromboembolic adverse events associated with the use of
rFVIIa in observational trials compared to RCTs. This finding suggests
that patients receiving off-label rFVIIa for these off-label indications
in real-world practice may be at higher risk of thromboembolic events than
patients enrolled in clinical trials and may caution against widespread
use, especially in the absence of convincing data on efficacy.