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<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.