EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2010497994
Authors
Mantovani V. Kennergren C. Bugge M. Sala A. Lonnroth P. Berglin E.
Institution
(Mantovani, Sala) Dept. of Cardiac Surgery, University of Insubria,
Ospedale di Circolo-Fondazione Macchi, I-21100 Varese, Italy
(Kennergren, Bugge, Berglin) Dept. of Cardiothoracic Surgery, Sahlgrenska
University Hospital, SE-413 45 Goteborg, Sweden
(Lonnroth) Dept. of Medicine, Sahlgrenska University Hospital, SE-413 45
Goteborg, Sweden
Title
Myocardial metabolism assessed by microdialysis: A prospective randomized
study in on- and off-pump coronary bypass surgery.
Source
International Journal of Cardiology. 143 (3) (pp 302-308), 2010. Date of
Publication: 2010.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objective: The aim of the study was to compare energetic metabolism in the
myocardium during coronary surgery with and without cardiopulmonary bypass
by means of microdialysis. Methods: Twenty-six low-risk patients were
prospectively randomized to off-pump versus on-pump surgery. Microdialysis
was used to sample myocardial interstitial fluid during and for 23 hours
after surgery. Results: Preoperative characteristics and clinical outcome
were similar in both groups. Blood glucose and lactate did not differ
between groups throughout the observation time. During surgery,
intramyocardial levels of glucose, pyruvate and urea were unaffected in
off-pump patients, while the same substances significantly decreased (p <
0.05) in on-pump patients during cardioplegic arrest, and increased during
reperfusion. Interstitial lactate levels were higher during off-pump
surgery (p < 0.05). From 3 to 15 hours after surgery, intramyocardial
concentrations of glucose, urea and lactate were higher in off-pump
patients (p < 0.001), while pyruvate was higher in on-pump patients (p <
0.01). Intramyocardial lactate/pyruvate ratio never differed between
groups. Postoperatively, cumulative blood release of troponin-T was
significantly higher in the on-pump group (p < 0.005). Conclusions:
Microdialysis could demonstrate significant differences in energetic
metabolism between the two groups. Our data confirm and might help in
explaining the lower release of myocardial ischemic markers after off-pump
surgery. 2009 Elsevier Ireland Ltd.

<2>
Accession Number
2010507613
Authors
Elmistekawy E. Lapierre H. Mesana T. Ruel M.
Institution
(Elmistekawy, Lapierre, Mesana, Ruel) University of Ottawa Heart
Institute, Division of Cardiac Surgery, 40 Ruskin Street, Suite 3403,
Ottawa, ON K1Y 4W7, Canada
Title
Apico-Aortic Conduit for severe aortic stenosis: Technique, applications,
and systematic review.
Source
Journal of the Saudi Heart Association. 22 (4) (pp 187-194), 2010. Date
of Publication: October 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Patients referred for aortic valve replacement are often elderly and may
have increased surgical risk associated with ascending aortic
calcification, left ventricular dysfunction, presence of coronary artery
disease, previous surgery, and/or presence of several co-morbidities. Some
of these patients may not be considered candidates for conventional
surgery because of their high risk profile. While transcatheter aortic
valve replacement constitutes a widely accepted alternative, some patients
may not be eligible for this modality due to anatomic factors.
Apico-Aortic Conduit (AAC) insertion (aortic valve bypass surgery)
constitutes a possible option in those patients. Apico-Aortic Conduit is
not a new technique, as it has been used for decades in both pediatric and
adult populations. However, there is a resurging interest in this
technique due to the expanding scope of elderly patients being considered
for the treatment of aortic stenosis. Herein, we describe our surgical
technique and provide a systematic review of recent publications on AAC
insertion, reporting that there is continued use and several modifications
of this technique, such as performing it through a small thoracotomy
without the use of the cardiopulmonary bypass. 2010.

<3>
Accession Number
2010492007
Authors
Gupta A. Hote M.P. Choudhury M. Kapil A. Bisoi A.K.
Institution
(Gupta, Hote, Bisoi) Department of Cardiothoracic and Vascular Surgery,
All India Institute of Medical Sciences, Cardiothoracic Sciences Centre,
New Delhi 110 029, India
(Choudhury) Department of Cardiac Anaesthesia, All India Institute of
Medical Sciences, New Delhi, India
(Kapil) Department of Microbiology, All India Institute of Medical
Sciences, New Delhi, India
Title
Comparison of 48 h and 72 h of prophylactic antibiotic therapy in adult
cardiac surgery: A randomized double blind controlled trial.
Source
Journal of Antimicrobial Chemotherapy. 65 (5) (pp 1036-1041), 2010.
Article Number: dkq080. Date of Publication: May 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: To determine whether the duration of antibiotic prophylaxis
influences the rate of surgical site infection in patients undergoing
coronary bypass grafting or valve replacement. Patients and methods: Adult
patients undergoing elective coronary artery bypass grafting (CABG) and
valve surgery were included in this randomized double blind study. Between
April 2007 and April 2008, 235 patients were randomly assigned to one of
two groups using random number table and sealed envelope technique. The
groups received prophylactic antibiotic therapy for either 48 h (the 48 h
group) or 72 h (the 72 h group). These patients were monitored for
surgical site infection. Results: The mean age was 52.94+/-16.30 and
55.27+/-16.63 years, respectively, in the two groups. The incidence of
co-morbid conditions as well as operative conditions was similar between
the groups. During the study period 20 patients developed surgical site
infections and 7 patients other infections. In modified treatment
analysis, the infection rates were 7.6% (9 patients, n=119) in the group
receiving 48 h of prophylactic antibiotic therapy and 10.2% (11 patients,
n=108) in the group receiving 72 h of prophylactic antibiotic therapy, and
the difference was statistically non-significant (P>0.05). In the per
protocol analysis the infection rates were 5% (5 patients, n=100) in the
group receiving 48 h of prophylactic antibiotic therapy and 8% (8
patients, n=100) in the group receiving 72 h of prophylactic antibiotic
therapy, and the difference was again statistically non-significant
(P>0.05). The results of Fisher's exact test revealed that the duration of
surgery lasting for >5 h is an independent risk factor for surgical site
infection. Conclusions: Forty-eight hours of a prophylactic antibiotic
combination using a third-generation cephalosporin and an aminoglycoside
is as effective as a 72 h regimen for preventing surgical site infection
in patients undergoing CABG and valve surgery. The Author 2010. Published
by Oxford University Press on behalf of the British Society for
Antimicrobial Chemotherapy. All rights reserved.

<4>
Accession Number
2010467289
Authors
Kim S.Y. Shim J.K. Shim Y.H. Hong S.W. Choi K.H. Kwak Y.L.
Institution
(Kim, Choi) Department of Anesthesiology and Pain Medicine, Yonsei
University College of Medicine, Seoul, South Korea
(Shim, Shim, Kwak) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Yonsei University College of
Medicine, 250 Seongsan-no, Seodaemun-Gu, Seoul, 120-752, South Korea
(Hong) Department of Anesthesiology and Pain Medicine, Gyungbook
University College of Medicine, Daegu, South Korea
Title
Sildenafil and beraprost combination therapy in patients with pulmonary
hypertension undergoing valvular heart surgery.
Source
Journal of Heart Valve Disease. 19 (3) (pp 333-340), 2010. Date of
Publication: May 2010.
Publisher
ICR Publishers Ltd (12/A South Approach, Moor Park, Northwood HA6 2ET,
United Kingdom)
Abstract
Background and aim of the study: Sildenafil and beraprost, as orally
available pulmonary vasodilators, are used increasingly to treat pulmonary
hypertension (PH). An evaluation was made, in patients with PH undergoing
valvular heart surgery, as to whether preoperative combined oral
sildenafil and beraprost treatment could induce synergistic and prolonged
pulmonary vasodilation, or result in a loss of pulmonary selectivity.
Methods: Fifty patients scheduled for valvular heart surgery with a mean
pulmonary arterial pressure (PAP) >30 mmHg were randomly assigned to
receive either 50 mg oral sildenafil + 40 mug beraprost, or a placebo, 15
min before the induction of anesthesia. Hemodynamic variables were
measured intraoperatively. Results: The treatment group had a
significantly lower systemic vascular resistance index at 60 min after
medication. No other significant intergroup differences in hemodynamic
variables were observed. In addition, significantly more patients in the
treatment group required vasopressor therapy. In both groups, the PAP was
significantly reduced by general anesthesia, and almost normalized after
valvular heart surgery. Conclusion: Preoperative oral sildenafil and
beraprost treatment resulted in a loss of pulmonary selectivity, and did
not provide any additional pulmonary vasodilation or favorable
perioperative hemodynamics in patients with PH undergoing valvular heart
surgery. Copyright by ICR Publishers 2010.

<5>
Accession Number
2010467296
Authors
Sultan F.A.T. Moustafa S.E. Tajik J. Warsame T. Emani U. Alharthi M.
Mookadam F.
Institution
(Sultan) Section of Cardiology, Aga Khan University Hospital, Karachi,
Pakistan
(Tajik) Aurora Cardiovascular Division, Aurora-St. Lukes Hospital,
Milwaukee, WI, United States
(Moustafa, Warsame, Emani, Alharthi, Mookadam) Department of
Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, United States
Title
Rheumatic tricuspid valve disease: An evidence-based systematic overview.
Source
Journal of Heart Valve Disease. 19 (3) (pp 374-382), 2010. Date of
Publication: May 2010.
Publisher
ICR Publishers Ltd (12/A South Approach, Moor Park, Northwood HA6 2ET,
United Kingdom)
Abstract
Background and aim of the study: Right-sided valve abnormalities are less
common than their left-sided counterparts. Furthermore, whilst organic
rheumatic involvement of the tricuspid valve is not uncommon, it receives
less attention than left-sided heart valves. An evidence-based systematic
overview was carried out to assess the epidemiology, diagnosis and
management of organic rheumatic tricuspid valve disease (RTVD) over the
past half century. Methods: A computed search spanning more than four
decades was conducted to identify articles on various aspects of RTVD. The
bibliographies of all relevant articles were also searched. Results: A
total of 2,497 rheumatic heart disease patients (mean age 25.5 years;
female:male ratio 1.3:1) was included. RTVD was detected in 193 patients
(7.7%). Echocardiography was used to detect tricuspid valve involvement in
all patients. Associated mitral valve disease was present in 99.3% of the
patients with RTVD. A total of 1,092 patients (mean age 45.4 years) was
included from six studies on surgical correction of the tricuspid valve.
Of these patients, 278 (25.4%) underwent tricuspid valve replacement,
while 814 (74.5%) had tricuspid valve repair. The in-hospital mortality
was 9.9%, and late mortality 33.2% Conclusion: RTVD is not uncommon among
patients with rheumatic heart disease, but attracts less attention and
might, therefore, be overlooked. Echocardiography is the most common
diagnostic tool. Although indications for surgical intervention are not
well defined, valve repair may have a better outcome than replacement.
Copyright by ICR Publishers 2010.

<6>
Accession Number
2010488028
Authors
Kong M.H. Lopes R.D. Piccini J.P. Hasselblad V. Bahnson T.D. Al-Khatib
S.M.
Institution
(Kong, Lopes, Piccini, Hasselblad, Bahnson, Al-Khatib) Duke University
Medical Center, Box 31294, Durham, NC 27710, United States
Title
Surgical maze procedure as a treatment for atrial fibrillation: A
meta-analysis of randomized controlled trials.
Source
Cardiovascular Therapeutics. 28 (5) (pp 311-326), 2010. Date of
Publication: October 2010.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Surgical or modified Maze procedures have been promoted to treat atrial
fibrillation (AF); however, few randomized controlled clinical trials
(RCTs) examine their outcomes. The purpose of this meta-analysis is to
compare the efficacy of surgical Maze procedures performed concomitantly
with referral cardiac surgery versus pharmacologic therapy for the
treatment of AF. We searched MEDLINE, Cochrane database, FDA web-portal,
and clinicaltrials.gov for all RCTs comparing surgical Maze procedures
with medical therapy for sinus rhythm maintenance. Primary outcomes were
either freedom from AF within 12 months postprocedure off antiarrhythmic
drug (AAD), or freedom from AF while taking an AAD. Secondary outcomes
included operative mortality, all-cause mortality, hospital length of
stay, and postoperative complications. Both fixed- and random-effects
models were used for a meta-analysis of 9 randomized controlled trials (n
= 472, of which 249 underwent a Maze procedure and 213 underwent referral
surgery alone). The surgical Maze procedure significantly increased the
odds of freedom from AF within 12 months compared with cardiac surgery
alone (OR 5.22, 95% CI 1.71-15.88). There was significant heterogeneity
among the trials for freedom from AF (chi-square = 15.98 for 4 degrees of
freedom, P = 0.003). Among the two studies that fully reported AAD use,
there was no evidence of improved survival free from AF and AAD therapy
(OR 1.78, 95% CI 0.73-4.34). Among patients with valvular AF, surgical
Maze procedures are associated with a decrease in AF one year
postprocedure without significant increase in mean length of hospital
stay, perioperative complications, operative, or all-cause mortality.
Large RCTs defining rates of freedom from AF without AADs postprocedure,
are still needed to evaluate outcomes and determine the appropriate role
for surgical Maze procedures in the management of AF. 2010 Blackwell
Publishing Ltd.

<7>
Accession Number
2010489843
Authors
Ahmed F. Shafeeq A.M. Moiz J.A. Geelani M.A.
Institution
(Ahmed) Hamdard University (Jamia Hamdard), New Delhi, India
(Shafeeq) Pushpanjali Crosslay Hospital, Vaishali, UP, India
(Moiz) Jamia Millia Islamia University, New Delhi, India
(Geelani) Department of Cardiothoracic and Vascular Surgery, Govind
Ballabh Pant Hospital, University of Delhi, New Delhi, India
Title
Comparison of effects of manual versus ventilator hyperinflation on
respiratory compliance and arterial blood gases in patients undergoing
mitral valve replacement.
Source
Heart and Lung: Journal of Acute and Critical Care. 39 (5) (pp 437-443),
2010. Date of Publication: September 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: To compare the effects of manual hyperinflation (MHI) and
ventilator hyperinflation (VHI) delivered to completely sedated and
paralyzed patients undergoing mitral valve replacement (MVR) while
maintaining minute ventilation. Methods: This was a randomized study with
a 2-group, pre-test, post-test experimental design. Effects of
hyperinflation were studied on static compliance (C_stat),
dynamic compliance (C_dyn), oxygenation
(Pao₂:Fio₂), partial pressure of carbon dioxide in
arterial blood (Paco₂), and cologarithm of activity of
dissolved hydrogen ions in arterial blood (pH). A sample of 30 patients in
the immediate postoperative phase of MVR surgery were included in the
study. Results: No significant differences were found between the groups.
Significant improvements were found in oxygenation at both 1minute and
20minutes after MHI, but only at 1minute after VHI (P < .05). VHI led to
improved C_dyn (P < .05). Conclusion: In the immediate
postoperative phase of MVR, both techniques produced similar effects on
respiratory compliance and oxygenation. MHI produced longer lasting
improvements in oxygenation than VHI, whereas VHI produced better
improvements in dynamic compliance. Paco₂ and pH were
maintained by both. 2010 Elsevier Inc.

<8>
Accession Number
2010491362
Authors
Hong D.M. Min J.J. Kim J.H. Sohn I.S. Lim T.W. Lim Y.J. Bahk J.-H. Jeon Y.
Institution
(Hong, Min, Kim, Sohn, Lim, Lim, Bahk, Jeon) Department of Anaesthesiology
and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
Title
The effect of remote ischaemic preconditioning on myocardial injury in
patients undergoing off-pump coronary artery bypass graft surgery.
Source
Anaesthesia and Intensive Care. 38 (5) (pp 924-929), 2010. Date of
Publication: September 2010.
Publisher
Australian Society of Anaesthetists (P.O. Box 600, Edgecliff NSW 2027,
Australia)
Abstract
In several recent clinical trials on cardiac surgery patients, remote
ischaemic preconditioning (RIPC) showed a powerful myocardial protective
effect. However, the effect of RIPC has not been studied in patients
undergoing off-pump coronary artery bypass graft surgery. We evaluated
whether RIPC could induce myocardial protection in off-pump coronary
artery bypass graft surgery patients. Patients undergoing elective
off-pump coronary artery bypass graft surgery were randomly allocated to
the RIPC (n=65) or control group (n=65). After induction of anaesthesia,
RIPC was induced by four cycles of five-minute ischaemia and reperfusion
on the upper limb using a pneumatic cuff. Anaesthesia was maintained with
sevoflurane, remifentanil and vecuronium. Myocardial injury was assessed
by troponin I before surgery and 1, 6, 12, 24, 48 and 72 hours after
surgery. There were no statistical differences in troponin I levels
between RIPC and control groups (P=0.172). Although RIPC reduced the total
amount of troponin I (area under the curve of troponin increase) by 26%,
it did not reach statistical significance (RIPC group 53.2+/-72.9
hours.ng/ml vs control group 67.4+/-97.7 hours.ng/ml, P=0.281). In this
study, RIPC by upper limb ischaemia reduced the postoperative myocardial
enzyme elevation in off-pump coronary artery bypass graft surgery
patients, but this did not reach statistical significance. Further study
with a larger number of patients may be needed to fully evaluate the
clinical effect of RIPC in off-pump coronary artery bypass graft surgery
patients.

<9>
Accession Number
2010499776
Authors
Yin L. Wang Z. Wang Y. Ji G. Xu Z.
Institution
(Yin, Wang, Wang, Ji, Xu) Cardiothoracic Surgery Department of Changhai
Hospital, The First Affiliated Hospital of the Second Military Medical
Univ. of PLA, Shanghai 200433, China
Title
Effect of Statins in Preventing Postoperative Atrial Fibrillation
Following Cardiac Surgery.
Source
Heart Lung and Circulation. 19 (10) (pp 579-583), 2010. Date of
Publication: October 2010.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: Postoperative occurrence of AF has been associated with less
favourable outcomes in patients undergoing cardiac surgery and may result
in increased postoperative morbidity and mortality. Objectives: A focused
clinical question was designed and a meta-analysis of published studies
was performed to identify the effect of preoperative use of statins on the
occurrence of AF after cardiac surgery. Methods: Using the Medline
database, the Cochrane clinical trials database and online clinical trial
databases, we reviewed all RCTs and observational studies examining the
effect of statins on AF occurrence following cardiac surgery. We searched
for the literature published before April 2009 and earlier. Results: This
analysis identified six studies (observational studies) which examined the
effect of preoperative use of statins on AF occurrence following cardiac
surgery, involving 10,165 patients. Contradictory to most of previous
studies, the overall outcomes suggested that the statins group did not
have a significant decrease in AF occurrence following cardiac surgery
comparing to control group (P=0.19). Conclusions: The preoperative
medication of statins showed no significant decrease in AF occurrence
following cardiac surgery in this meta-analysis result. More prospective
studies and researches are needed to explore and demonstrate the accurate
mechanism and effect of statins on postoperative AF. 2010 .

<10>
Accession Number
2010499777
Authors
Leong J.-Y. van der Merwe J. Pepe S. Bailey M. Perkins A. Lymbury R.
Esmore D. Marasco S. Rosenfeldt F.
Institution
(Leong, van der Merwe, Pepe, Esmore, Marasco, Rosenfeldt) Cardiac Surgical
Research Unit, Alfred Hospital, Department of Surgery Monash University,
Baker IDI Institute, Melbourne, Australia
(Bailey, Rosenfeldt) Department of Epidemiology and Preventive Medicine,
School Public Health and Preventive Medicine, Monash University Alfred
Hospital, Melbourne, Australia
(Perkins, Lymbury) Heart Foundation Research Centre, School of Medical
Science, Griffith University Gold Coast Campus, Qld, Australia
Title
Perioperative metabolic therapy improves redox status and outcomes in
cardiac surgery patients: A randomised trial.
Source
Heart Lung and Circulation. 19 (10) (pp 584-591), 2010. Date of
Publication: October 2010.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Objective: Perioperative therapy with antioxidants and metabolic
substrates has the potential to reduce oxidative stress and improve
recovery from cardiac surgery, particularly in elderly and high risk
cases. The aim of this study was to assess the effect of perioperative
metabolic therapy at a biochemical, clinical and economic level in cardiac
surgical patients. Methods: Patients (n=117, mean age 65+/-1.0 years, 74%
male) undergoing elective coronary artery bypass graft (CABG) and/or valve
surgery in 2004-2006 were randomised to receive in double blinded fashion,
while on the waiting list for surgery (approximately two months) and one
month after surgery, either metabolic therapy (coenzyme Q₁₀,
magnesium orotate, lipoic acid, omega-3 fatty acids and selenium) or
placebo. Biochemical and clinical outcomes were assessed. Results: Cardiac
surgery increased oxidative stress and decreased plasma levels of key
antioxidants. Metabolic therapy for a mean of 76 +/- 7.5 days increased
antioxidant levels preoperatively so that the adverse effect of surgery on
redox status was attenuated. Metabolic therapy reduced plasma troponin I,
24 hours postoperatively from 1.5 (1.2-1.8) (geometric mean 95% CI) mug/L,
to 2.1 (1.8-2.6) mug/L (P=0.003) and shortened the mean length of
postoperative hospital stay by 1.2 days from 8.1 (7.5-8.7) to 6.9
(6.4-7.4) days (P=0.004) and reduced hospital costs. Metabolic therapy was
inexpensive and had no clinically significant side effects. Conclusions:
Perioperative metabolic therapy for cardiac surgery is safe and
inexpensive and is associated with improved redox status, reduced
myocardial damage, and shortened length of postoperative hospital stay.
2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac
Society of Australia and New Zealand.