EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2010527003
Authors
Chan A.W.
Institution
(Chan) Department of Cardiac Services, Royal Columbian Hospital, New
Westminster, United States
(Chan) Department of Medicine, University of British Columbia, Vancouver,
BC, Canada
Title
Current perspectives on carotid revascularization among patients who need
cardiac surgery.
Source
Journal of Invasive Cardiology. 22 (8) (pp 386-390), 2010. Date of
Publication: August 2010.
Publisher
HMP Communications (83 General Warren Blvd. Suite 100, Malven PA 19355,
United States)
Abstract
Carotid stenosis is often present in patients who need cardiac surgery and
is predictive of post-operative stroke. A strategy of combined carotid
endarterectomy and cardiac surgery had been adopted in the past. Staged
carotid artery stenting prior to cardiac surgery is a less invasive
alternative and seems to be associated with a lower incidence of stroke
and myocardial infarction as compared to the combined surgical approach.
This article provides a systemic review of the management of patients with
concomitant carotid and cardiac disease requiring cardiac surgical
procedure, and will discuss some management issues related to carotid
stenting in this group of patients. Based on the available data, it is
perhaps time to revise our practice guidelines by replacing the combined
surgical strategy with the staged carotid stenting and cardiac surgery
approach.

<2>
Accession Number
2010549774
Authors
Prapas S.N. Panagiotopoulos I.A. Salama Ayyad M.A.K. Protogeros D.A.
Linardakis I.N. Kotsis V.N. Katinioti A.A. Michalopoulos A.S.
Institution
(Prapas, Panagiotopoulos, Protogeros, Linardakis, Kotsis) Department of
Cardiac Surgery, Henry Dunant Hospital, Athens, Greece
(Salama Ayyad) Faculty of Medicine, Department of Cardio-Thoracic Surgery,
Assiut University, Assiut, Egypt
(Katinioti) Department of Cardiology, Henry Dunant Hospital, Athens,
Greece
(Michalopoulos) ICU, Henry Dunant Hospital, Athens, Greece
Title
Impact of obesity on outcome of patients undergoing off-pump coronary
artery bypass grafting using aorta no-touch technique.
Source
Interactive Cardiovascular and Thoracic Surgery. 11 (3) (pp 234-237),
2010. Date of Publication: September 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
We prospectively examined 1359 adult patients undergoing isolated coronary
revascularization with the P-circuit technique, consisting of beating
heart, aorta no-touch, use of composite grafts, and off-pump arterial
revascularization. Patients were divided into two groups based on body
weight; Group A consisting of 295 (21.7%) obese patients [body mass index
(BMI) >=30 kg/m²] and Group B of 1064 (79.3%) non-obese
patients (BMI <30 kg/m²). Advanced age and emergency surgery
favored the non-obese group [63.0+/-10.4 vs. 65.3+/-9.6 years (P<0.0005)
and 10.2% vs. 17.1% (P=0.004), with an increase in the number of
octogenarians among them (1.7% Group A vs. 5.4% in Group B, P=0.11)]. The
use of double internal mammary arteries (90.5% in Group A vs. 86.9% in
Group B, P=0.109), the mean number of distal anastomoses (2.8+/-0.9 in
Group A vs. 2.7+/-0.9 in Group B, P=0.5) and the number of sequential
anastomoses performed (28.1% in Group A vs. 31% in Group B, P=0.3) were
similar. No difference in morbidity rates was detected. All cause
in-hospital mortality was comparable. Survival was similar in both groups
also. Obesity is not a risk factor for morbidity and mortality in this
group of patients. 2010 Published by European Association for
Cardio-Thoracic Surgery.

<3>
Accession Number
2010550703
Authors
Reyes G. Allen K.B. Alvarez P. Alegre A. Aguado B. Olivera M. Caballero P.
Rodriguez J. Duarte J.
Institution
(Reyes, Alvarez, Duarte) Department of Cardiovascular Surgery, Hospital
Universitario La Princesa, c/Diego de Leon 62, Madrid 28006, Spain
(Allen) Department of Cardiothoracic Surgery, Mid America Heart Institute,
St Luke 's Hospital, Kansas City, MO, United States
(Alegre, Aguado) Department of Haematology, Hospital Universitario La
Princesa, c/Diego de Leon 62, Madrid 28006, Spain
(Olivera, Caballero) Department of Radiology, Hospital Universitario La
Princesa, c/Diego de Leon 62, Madrid 28006, Spain
(Rodriguez) Department of Nuclear Medicine, Hospital Universitario La
Princesa, c/Diego de Leon 62, Madrid 28006, Spain
Title
Mid term results after bone marrow laser revascularization for treating
refractory angina.
Source
BMC Cardiovascular Disorders. 10 , 2010. Article Number: 42. Date of
Publication: 17 Sep 2010.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Background: To evaluate the midterm results of patients with angina and
diffuse coronary artery disease treated with transmyocardial
revascularization in combination with autologous stem cell
therapy.Methods: Nineteen patients with diffuse coronary artery disease
and medically refractory class III/IV angina were evaluated between June
2007 and December 2009 for sole therapy TMR combined with intramyocardial
injection of concentrated stem cells. At the time of surgery, autologous
bone marrow (120cc) was aspirated from the iliac crest. A cardiac MRI and
an isotopic test were performed before and after the procedure. Follow-up
was performed by personal interview.Results: There were no perioperative
adverse events including no arrhythmias. Mean number of laser channels was
20 and the mean total number of intramyocardially injected cells per
milliliter were: total mononuclear cells(83.6 x 10⁶), CD34+
cells(0.6 x 10⁶), and CD133+ cells(0.34 x 10⁶). At
12 months mean follow-up average angina class was significantly improved
(3.4 +/- 0.5 vs 1.4 +/- 0.6; p = 0.004). In addition, monthly
cardiovascular medication usage was significantly decreased (348 +/- 118
vs. 201 +/- 92; p = 0.001). At six months follow up there was a reduction
in the number of cardiac hospital readmissions (2.9 +/- 2.3 vs. 0.5 +/-
0.8; p < 0.001). MRI showed no alterations regarding LV volumes and a 3%
improvement regarding ejection fraction.Conclusions: The stem cell
isolator efficiently concentrated autologous bone marrow derived stem
cells while the TMR/stem cell combination delivery device worked
uneventfully. An improvement in clinical status was noticed in the midterm
follow-up. Images test showed no morphological alterations in the left
ventricle after the procedure. 2010 Reyes et al; licensee BioMed Central
Ltd.

<4>
[Use Link to view the full text]
Accession Number
20810675
Authors
Dongelmans D.A. Veelo D.P. Binnekade J.M. de Mol B.A. Kudoga A. Paulus F.
Schultz M.J.
Institution
(Dongelmans) Department of Intensive Care Medicine, G3-212, Academic
Medical Center, Amsterdam, The Netherlands.
Title
Adaptive support ventilation with protocolized de-escalation and
escalation does not accelerate tracheal extubation of patients after
nonfast-track cardiothoracic surgery.
Source
Anesthesia and analgesia. 111 (4) (pp 961-967), 2010. Date of
Publication: Oct 2010.
Abstract
BACKGROUND: It is uncertain whether adaptive support ventilation (ASV)
accelerates weaning of nonfast-track cardiothoracic surgery patients. A
lower operator set %-minute ventilation with ASV may allow for an earlier
definite switch from controlled to assisted ventilation, potentially
hastening tracheal extubation. We hypothesized that ASV using protocolized
de-escalation and escalation of operator set %-minute ventilation (ASV-DE)
reduces time until tracheal extubation compared with ASV using a fixed
operator set %-minute ventilation (standard ASV) in uncomplicated patients
after nonfast-track coronary artery bypass graft. METHODS: We performed a
randomized controlled trial comparing ASV-DE with standard ASV. With
ASV-DE, as soon as body temperature was >35.0degreeC with pH >7.25,
operator set %-minute ventilation was decreased stepwise to a minimum of
70%. RESULTS: Sixty-three patients were randomized to ASV-DE, and 63
patients to standard ASV. The duration of mechanical ventilation was not
different between groups (10.8 [6.5-16.1] vs 10.7 [6.6-13.9] hours, ASV-DE
versus standard ASV; P = 0.32). Time until the first assisted breathing
period was shorter (3.1 [2.0-6.7] vs 3.9 [2.1-7.5] hours) and the number
of assisted ventilation episodes was higher (78 [34-176] vs 57 [32-116]
episodes), but differences did not reach statistical significance. The
duration of assisted ventilation episodes that ended with tracheal
extubation was different between groups (2.5 [0.9-4.6] vs 1.4 [0.3-3.5]
hours, ASV-DE versus standard ASV; P < 0.05). CONCLUSION: Compared with
standard ASV, weaning of patients after nonfast-track coronary artery
bypass graft using ASV with protocolized de-escalation and escalation does
not shorten time to tracheal extubation.

<5>
Accession Number
2010535967
Authors
Edelman J.J. Yan T.D. Padang R. Bannon P.G. Vallely M.P.
Institution
(Edelman, Yan, Bannon, Vallely) Cardiothoracic Surgical Unit, Royal Prince
Alfred Hospital, University of Sydney, Sydney, Australia
(Padang) Department of Cardiology, Royal Prince Alfred Hospital, Sydney,
Australia
Title
Off-pump coronary artery bypass surgery versus percutaneous coronary
intervention: A meta-analysis of randomized and nonrandomized studies.
Source
Annals of Thoracic Surgery. 90 (4) (pp 1384-1390), 2010. Date of
Publication: 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
We performed a meta-analysis of all studies comparing off-pump coronary
artery bypass graft surgery (OPCABG) and percutaneous coronary
intervention (PCI) for patients with coronary artery disease. Ten studies
were included in the meta-analysis and 4,821 patients were compared, of
whom 3,450 patients underwent PCI and 1,371 patients underwent OPCABG. The
rates of stroke, myocardial infarction, cardiac mortality, and all-cause
mortality were similar. The 12-month rate of major adverse cardiac or
cerebrovascular events and need for repeat revascularization was
significantly lower in the OPCABG group when compared with the PCI group.
2010 The Society of Thoracic Surgeons.

<6>
[Use Link to view the full text]
Accession Number
2010539681
Authors
Hueb W. Lopes N.H. Pereira A.C. Hueb A.C. Soares P.R. Favarato D.
D'Oliveira Vieira R. Gomes Lima E. Larrosa Garzillo C. Da Silva Paulitch
F. Cesar L.A.M. Gersh B.J. Ramires J.A.F.
Institution
(Hueb, Lopes, Pereira, Hueb, Soares, Favarato, D'Oliveira Vieira, Gomes
Lima, Larrosa Garzillo, Da Silva Paulitch, Cesar, Ramires) Heart
Institute, University of Sao Paulo, Sao Paulo, Brazil
(Gersh) Mayo Clinic, Rochester, MN, United States
Title
Five-year follow-up of a randomized comparison between off-pump and
on-pump stable multivessel coronary artery bypass grafting. The MASS III
Trial.
Source
Circulation. 122 (11 SUPPL. 1) (pp S48-S52), 2010. Date of Publication:
14 Sep 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: Coronary artery bypass graft surgery with cardiopulmonary
bypass is a safe, routine procedure. Nevertheless, significant morbidity
remains, mostly because of the body's response to the nonphysiological
nature of cardiopulmonary bypass. Few data are available on the effects of
off-pump coronary artery bypass graft surgery (OPCAB) on cardiac events
and long-term clinical outcomes. Methods and results-: In a single-center
randomized trial, 308 patients undergoing coronary artery bypass graft
surgery were randomly assigned: 155 to OPCAB and 153 to on-pump CAB
(ONCAB). Primary composite end points were death, myocardial infarction,
further revascularization (surgery or angioplasty), or stroke. After
5-year follow-up, the primary composite end point was not different
between groups (hazard ratio 0.71, 95% CI 0.41 to 1.22; P=0.21). A
statistical difference was found between OPCAB and ONCAB groups in the
duration of surgery (240+/-65 versus 300+/-87.5 minutes; P<0.001), in the
length of ICU stay (19.5+/-17.8 versus 43+/-17.0 hours; P<0.001), time to
extubation (4.6+/-6.8 versus 9.3+/-5.7 hours; P<0.001), hospital stay
(6+/-2 versus 9+/-2 days; P<0.001), higher incidence of atrial
fibrillation (35 versus 4% of patients; P<0.001), and blood requirements
(31 versus 61% of patients; P<0.001), respectively. The number of grafts
per patient was higher in the ONCAB than the OPCAB group (2.97 versus 2.49
grafts/patient; P<0.001). Conclusions-: No difference was found between
groups in the primary composite end point at 5-years follow-up. Although
OPCAB surgery was related to a lower number of grafts and higher episodes
of atrial fibrillation, it had no significant implications related to
long-term outcomes. 2010 American Heart Association, Inc.

<7>
[Use Link to view the full text]
Accession Number
2010539682
Authors
Rahman I.A. Mascaro J.G. Steeds R.P. Frenneaux M.P. Nightingale P. Gosling
P. Townsend P. Townend J.N. Green D. Bonser R.S.
Institution
(Rahman, Mascaro, Bonser) Department of Cardiothoracic Surgery, University
Hospital Birmingham NHS Trust, Edgbaston, Birmingham B15 2TH, United
Kingdom
(Steeds, Townend) Department of Cardiology, University Hospital Birmingham
NHS Trust, Birmingham, United Kingdom
(Frenneaux, Bonser) Department of Cardiovascular Medicine, University of
Birmingham, Birmingham, United Kingdom
(Nightingale) Wellcome Trust Clinical Research Facility, Birmingham,
United Kingdom
(Gosling) Department of Clinical Biochemistry, United Kingdom
(Townsend, Green) Department of Anesthetics, University Hospital
Birmingham NHS Trust, Birmingham, United Kingdom
Title
Remote ischemic preconditioning in human coronary artery bypass surgery:
From promise to disappointment?.
Source
Circulation. 122 (11 SUPPL. 1) (pp S53-S59), 2010. Date of Publication:
14 Sep 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: We assessed whether remote ischemic preconditioning (RIPC)
improves myocardial, renal, and lung protection after on-pump coronary
surgery. Methods and results-: This was a single-center, prospective,
randomized (1:1), placebo-controlled trial. Patients, investigators,
anesthetists, surgeons, and critical care teams were blinded to group
allocation. Subjects received RIPC (or placebo) stimuli (x3 upper limb (or
dummy arm), 5-minute cycles of 200 mm Hg cuff inflation/deflation) before
aortic clamping. Anesthesia, perfusion, cardioplegia, and surgical
techniques were standardized. The primary end point was 48-hour area under
the curve (AUC) troponin T (cTnT) release. Secondary end points were
6-hour and peak cTnT, ECG changes, cardiac index, inotrope and
vasoconstrictor use, renal dysfunction, and lung injury. Hospital survival
was 99.4%. Comparing placebo and RIPC, median (interquartile range) AUC
48-hour cTnT (ng/mL^-1/48 h^-1); 28 (19, 39) versus 30
(22, 38), 6-hour cTnT (ng/mL^-1); 0.93(0.59, 1.35) versus
1.01(0.72, 1.43), peak cTnT (ng/mL^-1); 1.02 (0.74, 1.44) versus
1.04 (0.78, 1.51), de novo left bundle-branch block (4% versus 0%) and Q
waves (5.3% versus 5.5%), serial cardiac indices, intraaortic balloon pump
usage (8.5% versus 7.5%), inotrope (39% versus 50%) and vasoconstrictor
usage (66% versus 64%) were not different. Dialysis requirement (1.2%
versus 3.8%), peak creatinine (median [interquartile range], 1.2
mg/dL^-1 (1.1, 1.4) versus 1.2 (1.0, 1.4)), and AUC urinary
albumin-creatinine ratios 69 (40, 112) versus 58 (32, 85) were not
different. Intubation times; median (interquartile range), 937
minutes(766, 1402) versus 895(675, 1180), 6-hour; 278 (210, 338) versus
270 (218, 323) and 12-hour pO₂:FiO₂ ratios 255 (195,
323) versus 263 (210, 308) were similar. Conclusions-: In contrast to
prior smaller studies, RIPC did not reduce troponin release, improve
hemodynamics, or enhance renal or lung protection. 2010 American Heart
Association, Inc.

<8>
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Accession Number
2010539684
Authors
Antoniades C. Bakogiannis C. Tousoulis D. Reilly S. Zhang M.-H. Paschalis
A. Antonopoulos A.S. Demosthenous M. Miliou A. Psarros C. Marinou K.
Sfyras N. Economopoulos G. Casadei B. Channon K.M. Stefanadis C.
Institution
(Antoniades, Reilly, Zhang, Casadei, Channon) Department of Cardiovascular
Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU,
United Kingdom
(Antoniades, Bakogiannis, Tousoulis, Paschalis, Antonopoulos,
Demosthenous, Miliou, Psarros, Marinou, Stefanadis) First Department of
Cardiology, University of Athens, Hippokration Hospital, Greece
(Paschalis, Sfyras, Economopoulos) Department of Cardiac Surgery,
Hippokration Hospital, Athens, Greece
Title
Preoperative atorvastatin treatment in CABG patients rapidly improves vein
graft redox state by inhibition of Rac1 and NADPH-oxidase activity.
Source
Circulation. 122 (11 SUPPL. 1) (pp S66-S73), 2010. Date of Publication:
14 Sep 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: Statins improve clinical outcome of patients with
atherosclerosis, but their perioperative role in patients undergoing
coronary artery bypass grafting (CABG) is unclear. We hypothesized that
short-term treatment with atorvastatin before CABG would improve the redox
state in saphenous vein grafts (SVGs), independently of low-density
lipoprotein cholesterol (LDL)-lowering. Methods and results-: In a
randomized, double-blind controlled trial, 42 statin-naive patients
undergoing elective CABG received atorvastatin 40 mg/d or placebo for 3
days before surgery. Circulating inflammatory markers and malondialdehyde
(MDA) were measured before and after treatment. SVG segments were used to
determine vascular superoxide (O ₂^.-) and Rac1
activation. For ex vivo studies, SVG segments from 24 patients were
incubated for 6 hours with atorvastatin 0, 5, or 50 mumol/L. Oral
atorvastatin reduced vascular basal and NADPH-stimulated
O₂^.- in SVGs (P<0.05 for all versus placebo) and
reduced plasma MDA (P<0.05), independently of LDL-lowering and of changes
in inflammatory markers. In SVGs exposed to atorvastatin ex vivo, without
exposure to LDL, basal and NADPH-stimulated O₂^.-
were significantly reduced (P<0.01 for both concentrations versus 0
mumol/L) in association with a striking reduction in Rac1 activation and 1
membrane-bound Rac1 and p67 subunit. The antioxidant effects of
atorvastatin were reversed by mevalonate, implying a dependence on
vascular HMG-CoA reductase inhibition. Conclusions-: Short-term treatment
with atorvastatin 40 mg/d before CABG improves redox state in SVGs, by
inhibiting vascular Rac1-mediated activation of NADPH-oxidase. These novel
findings suggest that statin therapy should be maintained or initiated in
patients undergoing CABG, independently of LDL levels. 2010 American
Heart Association, Inc.

<9>
[Use Link to view the full text]
Accession Number
2010539702
Authors
Geva T. Gauvreau K. Powell A.J. Cecchin F. Rhodes J. Geva J. Del Nido P.
Institution
(Geva, Gauvreau, Powell, Cecchin, Rhodes, Geva) Department of Cardiology,
Children's Hospital Boston, Harvard Medical School, Boston, MA, United
States
(Del Nido) Department of Cardiac Surgery, Children's Hospital Boston,
Harvard Medical School, Boston, MA, United States
Title
Randomized trial of pulmonary valve replacement with and without right
ventricular remodeling surgery.
Source
Circulation. 122 (11 SUPPL. 1) (pp S201-S208), 2010. Date of
Publication: 14 Sep 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: Although pulmonary valve replacement (PVR) is effective in
reducing right ventricular (RV) volume overload in patients with chronic
pulmonary regurgitation, persistent RV dysfunction and subsequent adverse
clinical outcomes have been reported. This trial was conducted to
investigate whether the addition of surgical RV remodeling with exclusion
of scar tissue to PVR would result in improved RV function and laboratory
and clinical parameters, as compared with PVR alone. Methods and results-:
Between February 2004 and October 2008, 64 patients who underwent RV
outflow tract procedures in early childhood had more than or equal to
moderate pulmonary regurgitation, and fulfilled defined criteria for PVR
were randomly assigned to undergo either PVR alone (n=34) or PVR with
surgical RV remodeling (n=30). No significant difference was observed in
the primary outcome (change in RV ejection fraction,-2+/-7% in the PVR
alone group and-1+/-7% in the PVR with RV remodeling group; P=0.38) or in
any of the secondary outcomes at 6-month postoperative follow-up.
Multivariable analysis of the entire cohort identified preoperative RV
end-systolic volume index <90 mL/m² and QRS duration <140 ms to
be associated with optimal postoperative outcome (normal RV size and
function), and RV ejection fraction <45% and QRS duration >=160 ms to be
associated with suboptimal postoperative outcome (RV dilatation and
dysfunction). Conclusion-: The addition of surgical remodeling of the RV
to PVR in patients with chronic pulmonary regurgitation did not result in
a measurable early benefit. Referral to PVR based on QRS duration, RV
end-systolic volume, or RV ejection fraction may be beneficial. 2010
American Heart Association, Inc.

<10>
[Use Link to view the full text]
Accession Number
2010539705
Authors
Portman M.A. Slee A. Olson A.K. Cohen G. Karl T. Tong E. Hastings L. Patel
H. Reinhartz O. Mott A.R. Mainwaring R. Linam J. Danzi S.
Institution
(Portman, Olson, Cohen) Seattle Children's Hospital, University of
Washington, Seattle, WA, United States
(Karl) University of California San Francisco, San Francisco, CA, United
States
(Hastings) Children's Hospital of Los Angeles, Los Angeles, CA, United
States
(Patel, Reinhartz) Children's Hospital, Research Center Oakland, Oakland,
CA, United States
(Mott) Baylor College of Medicine, Houston, TX, United States
(Mainwaring) Sutter Medical Center, Sacramento, CA, United States
(Slee) Axio Research, Seattle, WA, United States
(Danzi) North Shore University Health Systems, Manhasset, NY, United
States
Title
Triiodothyronine supplementation in infants and children undergoing
cardiopulmonary bypass (TRICC): A multicenter placebo-controlled
randomized trial: Age analysis.
Source
Circulation. 122 (11 SUPPL. 1) (pp S224-S233), 2010. Date of
Publication: 14 Sep 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: Triiodothyronine levels decrease in infants and children
after cardiopulmonary bypass. We tested the primary hypothesis that
triiodothyronine (T3) repletion is safe in this population and produces
improvements in postoperative clinical outcome. Methods and results-: The
TRICC study was a prospective, multicenter, double-blind, randomized,
placebo-controlled trial in children younger than 2 years old undergoing
heart surgery with cardiopulmonary bypass. Enrollment was stratified by
surgical diagnosis. Time to extubation (TTE) was the primary outcome.
Patients received intravenous T3 as Triostat (n=98) or placebo (n=95), and
data were analyzed using Cox proportional hazards. Overall, TTE was
similar between groups. There were no differences in adverse event rates,
including arrhythmia. Prespecified analyses showed a significant
interaction between age and treatment (P=0.0012). For patients younger
than 5 months, the hazard ratio (chance of extubation) for Triostat was
1.72. (P=0.0216). Placebo median TTE was 98 hours with 95% confidence
interval (CI) of 71 to 142 compared to Triostat TTE at 55 hours with CI of
44 to 92. TTE shortening corresponded to a reduction in inotropic agent
use and improvement in cardiac function. For children 5 months of age, or
older, Triostat produced a significant delay in median TTE: 16 hours (CI,
7-22) for placebo and 20 hours (CI, 16-45) for Triostat and (hazard ratio,
0.60; P=0.0220). Conclusions-: T3 supplementation is safe. Analyses using
age stratification indicate that T3 supplementation provides clinical
advantages in patients younger than 5 months and no benefit for those
older than 5 months. 2010 American Heart Association, Inc.

<11>
Accession Number
2010539640
Authors
Achilli F. Malafronte C. Lenatti L. Gentile F. Dadone V. Gibelli G.
Maggiolini S. Squadroni L. Di Leo C. Burba I. Pesce M. Mircoli L.
Capogrossi M.C. Di Lelio A. Camisasca P. Morabito A. Colombo G. Pompilio
G.
Institution
(Achilli, Malafronte, Lenatti, Mircoli) Cardiology Department, A. Manzoni
Hospital, via dell'Eremo 9/11, 23900 Lecco, Italy
(Gentile, Dadone) Cardiology Department, Bassini Hospital, Cinisello
Balsamo, Milan, Italy
(Gibelli) Cardiology Unit, Clinica San Carlo, Paderno Dugnano, Italy
(Maggiolini) Cardiology Department, San L. Mandic Hospital, Merate, Lecco,
Italy
(Squadroni) Cardiology Department, San Carlo Hospital, Milan, Italy
(Di Leo) Nuclear Medicine Department, A. Manzoni Hospital, Lecco, Italy
(Burba, Pesce) Laboratory of Vascular Biology and Regenerative Medicine,
Centro Cardiologico Monzino IRCCS, Milan, Italy
(Capogrossi) Laboratory of Vascular Pathology, Istituto Dermopatico
dell'Immacolata IRCCS, Rome, Italy
(Di Lelio) Radiology Department, San Gerardo Hospital, Monza, Italy
(Camisasca) Cardiology Department, San Gerardo Hospital, Monza, Italy
(Morabito) Medical Statistics, University of Milano, Milan, Italy
(Colombo) Laboratory of Immunology and Functional Genomics, Centro
Cardiologico Monzino IRCCS, Milan, Italy
(Pompilio) Cardiovascular Surgery Department, Centro Cardiologico Monzino
IRCCS, Milan, Italy
Title
Granulocyte colony-stimulating factor attenuates left ventricular
remodelling after acute anterior STEMI: Results of the single-blind,
randomized, placebo-controlled multicentre STem cEll Mobilization in Acute
Myocardial Infarction (STEM-AMI) Trial.
Source
European Journal of Heart Failure. 12 (10) (pp 1111-1121), 2010. Date of
Publication: October 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsThe aim of this study was to assess the effect of granulocyte
colony-stimulating factor (G-CSF) on left ventricular (LV) function and
volumes in patients with anterior ST-elevation myocardial infarction
(STEMI) and depressed LV ejection fraction (EF).Methods and resultsSixty
consecutive patients with anterior STEMI, undergoing primary angioplasty
percutaneous coronary intervention (PCI), with symptom-to-reperfusion time
of 2-12 h and EF <=45 after PCI, were randomized to G-CSF 5 g/kg b.i.d.
subcutaneously (n = 24) or placebo (n = 25) for 5 days, starting <12 h
after PCI. The primary endpoint was an increase from baseline to 6 months
of 5 in left ventricular ejection fraction (LVEF), as measured by magnetic
resonance imaging (MRI). Co-primary endpoint was a >=20 mL difference in
end-diastolic volume (EDV). Infarct size and perfusion were evaluated with
late gadolinium enhancement (LGE) and gated ^99mTechnetium
Sestamibi single-photon emission computed tomography (SPECT). Left
ventricular EDV and end-systolic volume (ESV) increased from baseline to 6
months in the placebo group (81.7 +/- 24.4 to 94.4 +/- 26.0
mL/m², P < 0.00005 and 45.2 +/- 20.0 to 53.2 +/- 23.8
mL/m², P = 0.016) but were unchanged in the G-CSF group (82.2
+/- 20.3 to 85.7 +/- 23.7 mL/m², P = 0.40 and 46.0 +/- 18.2 to
48.4 +/- 20.8 mL/m², P = 0.338). There were no significant
differences in EF or perfusion between groups. A significant reduction in
transmural LGE segments was seen at 6 months in the G-CSF vs. placebo
groups (4.38 +/- 2.9 to 3.3 +/- 2.6, P = 0.04 and 4.2 +/- 2.6 to 3.6 +/-
2.7, P = 0.301, respectively). Significantly more placebo patients had a
change in left ventricular end-diastolic volume abovethe median (9.3
mL/m²) when reperfusion time exceeded 180 min (median
time-to-reperfusion) (P = 0.0123). Severe adverse events were similar
between groups.ConclusionEarly G-CSF administration attenuates ventricular
remodelling in patients with anterior STEMI and EF <=45 after successful
PCI. 2010 The Author.

<12>
[Use Link to view the full text]
Accession Number
2010541760
Authors
Hueb W. Lopes N. Gersh B.J. Soares P.R. Ribeiro E.E. Pereira A.C. Favarato
D. Rocha A.S.C. Hueb A.C. Ramires J.A.F.
Institution
(Hueb, Lopes, Soares, Ribeiro, Pereira, Favarato, Rocha, Hueb, Ramires)
Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
(Gersh) Mayo Clinic, Rochester, MN, United States
Title
Ten-year follow-up survival of the medicine, angioplasty, or Surgery Study
(MASS II): A randomized controlled clinical trial of 3 therapeutic
strategies for multivessel coronary artery disease.
Source
Circulation. 122 (10) (pp 949-957), 2010. Date of Publication: 07 Sep
2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: This study compared the 10-year follow-up of percutaneous
coronary intervention (PCI), coronary artery surgery (CABG), and medical
treatment (MT) in patients with multivessel coronary artery disease,
stable angina, and preserved ventricular function. Methods and results-:
The primary end points were overall mortality, Q-wave myocardial
infarction, or refractory angina that required revascularization. All data
were analyzed according to the intention-to-treat principle. At a single
institution, 611 patients were randomly assigned to CABG (n=203), PCI
(n=205), or MT (n=203). The 10-year survival rates were 74.9% with CABG,
75.1% with PCI, and 69% with MT (P=0.089). The 10-year rates of myocardial
infarction were 10.3% with CABG, 13.3% with PCI, and 20.7% with MT
(P<0.010). The 10-year rates of additional revascularizations were 7.4%
with CABG, 41.9% with PCI, and 39.4% with MT (P<0.001). Relative to the
composite end point, Cox regression analysis showed a higher incidence of
primary events in MT than in CABG (hazard ratio 2.35, 95% confidence
interval 1.78 to 3.11) and in PCI than in CABG (hazard ratio 1.85, 95%
confidence interval 1.39 to 2.47). Furthermore, 10-year rates of freedom
from angina were 64% with CABG, 59% with PCI, and 43% with MT (P<0.001).
Conclusions-: Compared with CABG, MT was associated with a significantly
higher incidence of subsequent myocardial infarction, a higher rate of
additional revascularization, a higher incidence of cardiac death, and
consequently a 2.29-fold increased risk of combined events. PCI was
associated with an increased need for further revascularization, a higher
incidence of myocardial infarction, and a 1.46-fold increased risk of
combined events compared with CABG. Additionally, CABG was better than MT
at eliminating anginal symptoms. 2010 American Heart Association, Inc.

<13>
[Use Link to view the full text]
Accession Number
2010541780
Authors
Guo N. Maehara A. Mintz G.S. He Y. Xu K. Wu X. Lansky A.J. Witzenbichler
B. Guagliumi G. Brodie B. Kellett M.A. Dressler O. Parise H. Mehran R.
Stone G.W.
Institution
(Guo, Maehara, Mintz, He, Xu, Wu, Lansky, Dressler, Parise, Mehran, Stone)
Columbia University Medical Center, Cardiovascular Research Foundation,
New York, NY 10022, United States
(Witzenbichler) Charite University Medicine, Campus Benjamin Franklin,
Berlin, Germany
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Brodie) LeBauer CV Research Foundation, Moses Cone Hospital, Greensboro,
NC, United States
(Kellett) Maine Medical Center, Portland, MI, United States
Title
Incidence, mechanisms, predictors, and clinical impact of acute and late
stent malapposition after primary intervention in patients with acute
myocardial infarction: An intravascular ultrasound substudy of the
harmonizing outcomes with revascularization and stents in acute myocardial
infarction (HORIZONS-AMI) trial.
Source
Circulation. 122 (11) (pp 1077-1084), 2010. Date of Publication: 14 Sep
2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: The incidence and mechanisms of acute and late stent
malapposition after primary stent implantation in ST-segment elevation
myocardial infarction remain unclear. Methods and Results-: The
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction (HORIZONS-AMI) trial was a dual-arm, factorial, randomized
trial comparing paclitaxel-eluting stents (PES) and otherwise equivalent
bare metal stents (BMS) in ST-segment elevation myocardial infarction
patients. The intravascular ultrasound substudy enrolled 241 patients with
263 native coronary lesions (201 PES, 62 BMS) with baseline and 13-month
follow-up imaging. Postintervention acute stent malapposition (ASM)
occurred in 34.3% PES-and 40.3% BMS-treated lesions. Of these, 39.1%
PES-and 40.0% BMS-treated lesions resolved at follow-up, especially within
the stent body (66.7%); complete resolution was accompanied by a reduction
in external elastic membrane area. An ASM area >1.2 mm best separated
persistent from resolved ASM. At follow-up, a higher frequency of late
stent malapposition was detected in PES-treated lesions (46.8%) mainly
because of more late acquired stent malapposition (30.8%) compared with
BMS-treated lesions. Late acquired stent malapposition area correlated to
the decrease of peri-stent plaque in the subset of lesions without
positive remodeling and only to change in external elastic membrane in the
group with positive remodeling. Independent predictors of late acquired
stent malapposition were plaque/thrombus protrusion (odds ratio, 5.60; 95%
confidence interval [CI], 2.32 to 13.54) and PES use (odds ratio, 6.32;
95% CI, 2.15 to 18.62). Conclusions-: The incidence of ASM was similar in
PES-and BMS-treated lesions, but late acquired stent malapposition was
more common in PES-treated lesions. The reason for resolved ASM was
negative remodeling, with larger ASM areas separating persistent from
resolved ASM. Late acquired stent malapposition was due mainly to positive
remodeling and plaque/thrombus resolution. 2010 American Heart
Association, Inc.

<14>
Accession Number
2010543576
Authors
Kappetein A.P.
Institution
(Kappetein) Department of Cardio-thoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
Title
Editorial comment. Is there enough evidence that proves clinical equipoise
between stenting and coronary surgery for patients with left main coronary
artery disease?.
Source
European Journal of Cardio-thoracic Surgery. 38 (4) (pp 428-430), 2010.
Date of Publication: October 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)

<15>
Accession Number
2010543599
Authors
Korb-Savoldelli V. Sabatier B. Gillaizeau F. Guillemain R. Prognon P.
Begue D. Durieux P.
Institution
(Korb-Savoldelli, Sabatier, Prognon, Begue) Pharmacy Department, AP-HP
Georges Pompidou European Hospital, Paris, France
(Korb-Savoldelli) Clinical Pharmacy and Pharmacokinetic, Faculty of
Pharmacy, Paris Descartes University, Paris, France
(Sabatier) Paris Descartes University, INSERM U765, Paris, France
(Gillaizeau, Durieux) Department of Hospital Informatics, Evaluation and
Public Health, AP-HP, Georges Pompidou European Hospital, Paris, France
(Gillaizeau, Durieux) Cordeliers Research Centre, University Paris
Descartes, INSERM UMRS 872, Paris, France
(Guillemain) Cardiovascular Surgery Department, European Georges Pompidou
Hospital, Paris, France
(Prognon) Faculty of Pharmacy, GCA, EA 40-41, Paris XI, Chatenay-Malabry,
France
Title
Non-adherence with drug treatment after heart or lung transplantation in
adults: A systematic review.
Source
Patient Education and Counseling. 81 (2) (pp 148-154), 2010. Date of
Publication: November 2010.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objective: Heart or lung transplantation is a complex intervention
requiring medication adherence. The objective of this systematic review is
to estimate the prevalence of non-adherence (NA) with post-transplantation
medication in heart or lung recipients and to assess its clinical impact.
We examined in the selected studies if the authors considered the
patient's perspective in their evaluations. Methods: The electronic
database MEDLINE, EMBASE and The Cochrane Central Register were searched.
Only studies that reported the number of non-adhere subjects were
eligible. The different methods of measurement, the ways in which authors
defined NA and if authors had integrated patient's perspective in their
secondary objectives were also assessed. Results: The range frequency of
NA was 1-42.9% for all drugs. Non-adherent patients tend to experience
worse outcomes compared to adherent patients. The patient's perception of
drug side-effects is the most reported patient-related factor for
impairing adherence. Conclusion: NA after heart or lung transplantation is
an important issue and concerns not only immunosuppressant treatments. The
main striking point of the selected studies is the lack of patient
perspective and the omission of patients-healthcare providers'
relationship. Practice implications: Future research must focus on
patients' motivation for the medication-taking behaviour. 2010 Elsevier
Ireland Ltd.

<16>
[Use Link to view the full text]
Accession Number
2010317978
Authors
Karkouti K. McCluskey S.A. Syed S. Pazaratz C. Poonawala H. Crowther M.A.
Institution
(Karkouti, McCluskey, Poonawala) Department of Anesthesia, Toronto General
Hospital, University of Toronto, 200 Elizabeth St., Toronto, ON M5G 2C4,
Canada
(Karkouti) Department of Health Policy, Management, and Evaluation,
University of Toronto, Toronto, Canada
(Syed, Pazaratz) Department of Anesthesia, Hamilton General Hospital,
McMaster University, Hamilton, Canada
(Crowther) Department of Medicine, Division of Hematology, McMaster
University, Hamilton, ON, Canada
Title
The influence of perioperative coagulation status on postoperative blood
loss in complex cardiac surgery: A prospective observational study.
Source
Anesthesia and Analgesia. 110 (6) (pp 1533-1540), 2010. Date of
Publication: June 2010.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
INTRODUCTION: Coagulopathy leading to excessive blood loss is a serious
complication of cardiac surgery. In this prospective cohort study, we
measured patients' coagulation status before and after cardiopulmonary
bypass (CPB) and examined their relationships with postoperative blood
loss. METHODS: Patients undergoing complex cardiac surgery with CPB who
did not have preexisting coagulopathy were eligible. Detailed clinical and
coagulation data were prospectively collected on all patients. Coagulation
testing was performed before and after CPB, and included measures of
thrombin generation, clotting factor consumption and dilution, clot
stabilization, and fibrinolysis. The associations of variables with
post-CPB blood loss (estimated loss from CPB to intensive care unit
admission and 24-hour chest tube drainage) were assessed with the Spearman
rank correlation test and multivariable linear regression. RESULTS: The
median blood loss among the 101 study patients was 952 mL (interquartile
range, 601-1553 mL). Variables independently associated with increasing
blood loss were as follows: previous sternotomies (P = 0.01), lower
pre-CPB prothrombin fragment F1 + 2 levels (measure of thrombin
generation; P = 0.001), lower post-CPB platelet counts (P = 0.01), larger
percent decrease in fibrinogen levels (P = 0.05), and higher post-CPB
soluble fibrin monomer levels (measure of thrombin activity and clot
stabilization; P < 0.0001) (model R² = 0.43). CONCLUSIONS: In
complex cardiac surgery, blood loss is directly influenced by reduced
pre-CPB thrombin generation rate, increased post-CPB consumption and
dilution of clotting factors, as well as inadequate post-CPB clot
stabilization. This information can aid in identifying patients at high
risk for excessive blood loss and testing new interventions aimed at
reducing the burden of this complication. The validity and
generalizability of these findings need to be assessed by other studies.
Copyright 2010 International Anesthesia Research Society.

<17>
Accession Number
2010501984
Authors
Rahman Mohd A.R. Ghani M.K. Awang R.R. Ooi Su Min J. Dimon M.Z.
Institution
(Rahman Mohd, Ghani, Awang, Ooi Su Min, Dimon) Heart and Lung Centre,
Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre,
Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
Title
Dermacyn irrigation in reducing infection of a median sternotomy wound.
Source
Heart Surgery Forum. 13 (4) (pp E228-E232), 2010. Date of Publication:
August 2010.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Sternal wound infection is an infrequent yet potentially
devastating complication following sternotomy. Among the standard
practices used as preventive measures are the use of prophylactic
antibiotics and povidone-iodine as an irrigation agent. A new antiseptic
agent, Dermacyn superoxidized water (Oculus Innovative Sciences), has
recently been used as a wound-irrigation agent before the closure of
sternotomy wounds. Methods: This prospective, randomized clinical trial
was conducted to compare the effectiveness of Dermacyn and povidone-iodine
in reducing sternotomy wound infection in patients undergoing coronary
artery bypass graft surgery. Upon chest closure and after insertion of
sternal wires, wounds were soaked for 15 minutes with either Dermacyn or
povidone-iodine. Subcutaneous tissue and skin were then closed routinely.
Patients were followed up, and any wound infection was analyzed. Results:
Of the 178 patients, 88 patients were in the Dermacyn group, and 90 were
in the povidone-iodine group. The mean (+/-SD) age of the patients was
61.1 +/- 7.6 years. The incidence of sternotomy wound infection was 19
cases (10.7%). Five (5.7%) of these cases were from the Dermacyn group,
and 14 (15.6%) were from the povidone-iodine group (P = .033). No
Dermacyn-related complication was identified. Conclusion: We found
Dermacyn to be safe and more effective as a wound-irrigation agent than
povidone-iodine for preventing sternotomy wound infection. 2010 Forum
Multimedia Publishing, LLC.

<18>
Accession Number
2010501987
Authors
Sasmazel A. Baysal A. Fedekar A. Buyukbayrak F. Bugra O. Erdem H. Aydin C.
Caliskan A. Sunar H.
Institution
(Sasmazel, Fedekar, Buyukbayrak, Bugra, Erdem, Aydin, Caliskan, Sunar)
Department of Cardiac Surgery, Kosuyolu Heart and Research Center, 34846
Kartal, Istanbul, Turkey
(Baysal) Department of Anaesthesiology, Kartal Kosuyolu Heart and Research
Center, Istanbul, Turkey
Title
The effect of statin therapy on stimulation of endothelium-derived nitric
oxide before and after coronary artery bypass surgery.
Source
Heart Surgery Forum. 13 (4) (pp E243-E246), 2010. Date of Publication:
August 2010.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: The purpose of this study was to determine the effects of
statins on endothelium-derived nitric oxide (NO) levels during coronary
artery bypass grafting (CABG) surgery. Methods: In a prospective study,
130 patients with coronary artery disease were randomized according to
preoperative atorvastatin treatment. The patients in group 1 took 40 mg
atorvastatin daily for at least 1 month preoperatively, and those in group
2 took no atorvastatin preoperatively. Plasma nitrite and nitrate were
measured at baseline and after inducing reactive hyperemia, both before
and after surgery. Reactive hyperemia was induced by placing a blood
pressure cuff on the upper forearm, inflating it for 5 minutes at 250 mm
Hg, and then rapidly deflating the cuff. Blood was collected from the
radial artery on the same side 2 minutes after cuff deflation. Plasma
levels of total cholesterol, triglycerides, and high- and low-density
lipoproteins were measured and analyzed for correlations with NO. Results:
The mean (+/-SD) baseline plasma NO levels before operation were as
follows: group 1, 33.97 +/- 18.27 nmol/L; group 2, 24.24 +/- 8.53 nmol/L
(P < .001). A significant difference between the 2 groups in plasma NO
levels was observed after preoperative reactive hyperemia induction: group
1, 56.43 +/- 15.03 nmol/L; group 2, 43.12 +/- 10.67 nmol/L (P < .001). Two
hours after cardiopulmonary bypass (CPB), we observed no significant
differences in plasma NO levels, either at baseline (group 1, 11 +/- 3.41
nmol/L; group 2, 9 +/- 5.51 nmol/L) or after reactive hyperemia (group 1,
17.98 +/- 6.77 nmol/L; group 2, 18.00 +/- 6.47 nmol/L). A correlation with
preoperative nitroglycerine use was observed (P = .007; r = 0.23). Linear
regression analysis (F = 1.463; R = 0.314; R² = 0.099; P = .16)
indicated that the only significant correlation was with preoperative
nitroglycerine use (P = .007; t = 2.746). Conclusions: Preoperative
atorvastatin treatment in patients with coronary artery disease increases
plasma NO levels before and after reactive hyperemia prior to surgery.
CABG surgery with CPB significantly impairs endothelial-derived NO levels,
with or without preoperative atorvastatin treatment. Preoperative
nitroglycerine use is correlated with higher NO levels after CABG. 2010
Forum Multimedia Publishing, LLC.

<19>
Accession Number
2010502275
Authors
Demeyere R. Gillardin S. Arnout J. Strengers P.F.W.
Institution
(Demeyere, Gillardin) Department of Anaesthesiology, University Hospital
Gasthuisberg, Leuven, Belgium
(Arnout) Centre for Molecular and Vascular Biology, University Hospital
Gasthuisberg, Leuven, Belgium
(Strengers) Medical Department, CAF-DCF, Brussels, Belgium
(Strengers) Sanquin, Amsterdam, Netherlands
Title
Comparison of fresh frozen plasma and prothrombin complex concentrate for
the reversal of oral anticoagulants in patients undergoing cardiopulmonary
bypass surgery: A randomized study.
Source
Vox Sanguinis. 99 (3) (pp 251-260), 2010. Date of Publication: October
2010.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background Fresh frozen plasma (FFP) and prothrombin complex concentrates
(PCC) reverse oral anticoagulants. We compared PCC and FFP intraoperative
administration in patients undergoing heart surgery with cardiopulmonary
bypass (CPB). Methods Forty patients [with international normalized ratio
(INR) >= 21] assigned semi-urgent cardiac surgery were randomized to
receive either FFP (n = 20) or PCC (n = 20). Prior to CPB, they received
either 2 units of FFP or half of the PCC dose calculated according to body
weight, initial INR and target INR (<= 15). After CPB and protamine
administration, patients received either another 2 units of FFP or the
other half PCC dose. Additional doses were administered if INR was still
too high (>= 15). Results Fifteen minutes after CPB, more patients reached
INR target with PCC (P = 0007): 7/16 patients vs. 0/15 patients with FFP;
there was no difference 1 h after CPB (6/15 patients with PCC vs. 4/15
patients with FFP reached target). Fifteen minutes after CPB, median INR
(range) decreased to 16 (12-22) with PCC vs. 23 (15- 35) with FFP; 1 h
after CPB both groups reached similar values [16 (13-22) with PCC and 17
(13- 27) with FFP]. With PCC, less patients needed additional dose (6/20)
than with FFP (20/20) (P < 0001). Both groups differed significantly on
the course of factor II (P = 00023) and factor X (P = 0008) over time.
Dilution of coagulation factors was maximal at CPB onset. Safety was good
for both groups, with only two related oozing cases with FFP. Conclusion
PCC reverses anticoagulation safely, faster and with less bleeding than
FFP. 2010 International Society of Blood Transfusion.

<20>
Accession Number
19377437
Authors
Islam M.T. Rahman Z. Rahman M.S.
Institution
(Islam) Department of Anesthesia, Sir Salimullah Medical College Hospital,
Mitford, Dhaka, Bangladesh.
Title
Comparative study of stress response to central venous cannulation under
local anesthesia and general anesthesia in patients undergoing open heart
surgery.
Source
Mymensingh medical journal : MMJ. 18 (1 Suppl) (pp S82-92), 2009. Date
of Publication: Jan 2009.
Abstract
The open heart surgery like coronary artery bypass graft (CABG), repair of
ventricular septal defect (VSD) and atrial septal defect (ASD), valve
replacement need a circulatory arrest, which is normally safe under
conventional hypothermia. During this time not only the heart and lungs
are bypassed but also a wide range of haemodynamic manipulation is
necessary. For this reason continuous arterial and central venous pressure
monitoring are mandatory. Arterial pressure is monitored by cannulation of
the radial or femoral artery and central venous pressure is monitored from
internal jugular, subclavian or femoral vein by inserting/placing a
central venous access device (CVAD) in any of these veins. The study was
designed to observe preoperatively the haemodynamic and humoral effects of
central venous access device insertion under local anesthesia with
premedication in patients of open heart surgery. In this study we compared
the haemodynamic and humoral stress responses during central venous access
device insertion under local anesthesia with those of under general
anaesthesia. A total of 60 patients both male and female, age ranging from
20-65 years, having ASA grade I and II were randomly selected by a card
selection method. They were equally divided into two groups (group-A and
B) of 30 patients each. Again each group was subdivided into subgroup-I
(20-40y) and II (>40-65y) according to their age distribution. Group-A was
cannulated under local anesthesia with premedication and group-B was
cannulated under standard general anesthesia. Before and after
cannulation, the haemodynamic and humoral variables like blood pressure,
heart rate, rate pressure product, ST segment changes were observed and
serum cortisol levels were measured at a predefined time interval before
and after completion of central venous cannulation. These values were
compared between two groups in similar age group before and after
cannulation. Data were recorded carefully at different time intervals. For
estimation of serum cortisol level the sample was preserved at -30 degree
celsius for estimation by Abbott AXSYM system (USA) in the Department of
Biochemistry, BSMMU. All data were analyzed by using Student's 't' test in
Statistical Program for Scientific Study (SPSS). From the study, we can
conclude that central venous cannulation under local anesthesia in
patients for open heart surgery has no significant changes of haemodynamic
and humoral stress response in comparison to those of under general
anesthesia. So, central venous access device can be placed under local
anesthesia supported by premedication and it produces no significant
changes in preoperative stress response in patients for open heart
surgery.

<21>
[Use Link to view the full text]
Accession Number
2010318002
Authors
Sato H. Lattermann R. Carvalho G. Sato T. Metrakos P. Hassanain M.
Matsukawa T. Schricker T.
Institution
(Sato, Lattermann, Carvalho, Sato, Schricker) Department of Anaesthesia,
Royal Victoria Hospital, McGill University Health Center, Montreal, Canada
(Metrakos, Hassanain) Department of Surgery, Royal Victoria Hospital,
McGill University Health Center, Montreal, Canada
(Matsukawa) Department of Anesthesiology, Yamanashi University, Yamanashi,
Japan
Title
Perioperative glucose and insulin administration while maintaining
normoglycemia (Gin therapy) in patients undergoing major liver resection.
Source
Anesthesia and Analgesia. 110 (6) (pp 1711-1718), 2010. Date of
Publication: June 2010.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
BACKGROUND: Although hyperglycemia is a well-recognized risk factor in the
context of cardiac surgery, the relevance of perioperative glycemic
control for patients undergoing major noncardiac operations has received
little attention. We designed this study to assess the hyperglycemic
response to liver resection, and to test the hypothesis that perioperative
glucose and insulin administration while maintaining normoglycemia (GIN
therapy) provides glycemic control superior to that achieved by the
conventional use of insulin. METHODS: Patients were randomly assigned to
GIN therapy or standard therapy (control group). In the GIN therapy group,
insulin was administered at 2 mU * kg * min during surgery. At the end of
surgery, the insulin infusion was decreased to 1 mU * kg * min and
continued for 24 hours. Dextrose 20% was infused at a rate adjusted to
maintain blood glucose within the target range of 3.5 to 6.1 mmol * L
(63-110 mg * dL). Patients in the standard therapy group received a
conventional insulin sliding scale during and after surgery. The mean and
SD of blood glucose as well as the percentage of blood glucose values
within the target range were calculated. To evaluate intrasubject
variability, the coefficient of variability (CV) of blood glucose was
calculated for each patient. Episodes of severe hypoglycemia, i.e., blood
glucose <2.2 mmol * L (40 mg * dL), were recorded. The primary outcome was
the proportion of normoglycemic measurements. RESULTS: We studied 52
patients. The mean blood glucose value in patients receiving GIN therapy
always remained within the target range. The blood glucose levels were
lower in the GIN therapy group than in the standard therapy group (during
surgery, P < 0.01; after surgery, P < 0.001). In nondiabetic patients
receiving GIN therapy (n = 19), target glycemia was achieved in 90.1% of
the blood glucose measurements during surgery and in 77.8% of the
measurements after surgery. In diabetic patients receiving GIN therapy (n
= 7), target glycemia was achieved in 81.2% of the blood glucose
measurements during surgery and in 70.5% of the measurements after
surgery. In nondiabetic patients receiving standard therapy (n = 19),
target glycemia was achieved in 37.4% of the blood glucose measurements
during surgery and in 18.3% of the measurements after surgery. In diabetic
patients receiving standard therapy (n = 7), target glycemia was achieved
in 4.3% of the blood glucose measurements during surgery and in 2.9% of
the measurements after surgery. The SD and CV of blood glucose were
smaller in the GIN therapy group than in the standard therapy group,
especially in nondiabetic patients after surgery (SD, P < 0.001; CV, P =
0.027). No patients receiving GIN therapy experienced severe hypoglycemia
during surgery. One patient receiving GIN therapy experienced hypoglycemia
in the intensive care unit after surgery without neurological sequelae.
CONCLUSIONS: GIN therapy effectively provides normoglycemia in patients
undergoing liver resection (clinicaltrials.gov, NCT00774098). Copyright
2010 International Anesthesia Research Society.

<22>
Accession Number
70273450
Authors
Glower D. Young N. Alexander J. Gangahar D. Skipper E. Cleveland J. Trento
A. Feldman T.
Institution
(Glower) Duke University, Medical Center, Durham, NC, United States
(Young) UC Davis, Medical Center, Sacramento, CA, United States
(Alexander) NorthShore University Health System, Aka Evanston Northwestern
Hospital, Evanston, IL, United States
(Gangahar) Nebraska Heart Institute, Lincoln, NE, United States
(Skipper) Carolina Medical Center, Sanger Clinic, Charlotte, NC, United
States
(Cleveland) University of Colorado, Health Sciences Center, Aurora, CO,
United States
(Trento) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Feldman) NorthShore University Health System, Evanston, IL, United States
Source
Journal of the American College of Cardiology. Conference: 22nd Annual
Symposium of the Transcatheter Cardiovascular Therapeutics, TCT 2010
Washington, DC United States. Conference Start: 20100921 Conference End:
20100925. Conference Publication: (var.pagings). 56 (13 SUPPL. 1) (pp
B24), 2010. Date of Publication: 21 Sep 2010.
Publisher
Elsevier USA
Abstract
Background: EVEREST II is a prospective, multi-center, randomized
controlled trial designed to compare the safety and effectiveness of the
MitraClip System with mitral valve surgery in the treatment of mitral
regurgitation (MR). The study was designed to demonstrate the safety and
effectiveness of the MitraClip device compared to surgery. Patients were
randomized to treatment with the MitraClip device (Device) or mitral valve
repair or replacement surgery (Control). Patients randomized to the Device
group could convert to M V Surgery if clinically necessary. A critical
analysis was performed to determine patient characteristics which predict
the likelihood of de novo MV replacement in patients randomized to
Control, and in patients referred to surgery following the MitraClip
procedure. Methods: 279 patients were enrolled at 37 sites in North
America and randomized 2:1 (Device vs. Control). Eighty Control patients
underwent MV Surgery and 37 Device patients underwent MV Surgery during
the first year following the MitraClip procedure. We hypothesized that the
decision to replace or repair the valve in either the Control or Device
Group was related to specific pathological characteristics. A composite
score of specific factors including etiology, presence of
anterior/bileaflet disease, leaflet/annular calcification, number of
scallops with pathology, and endocarditis was determined. Each factor was
counted as one. A mean score per patient was determined. In addition, age,
and surgeon experience was assessed. Subsequently, a logistic regression
model was used to predict repair or replacement. Details and results of
this analysis will be presented. Results: In the Control group 11 patients
had MV Replacement with a mean pathology score of 1.12. In the Device
group, patients who underwent MV Replacement following the MitraClip
procedure had a mean score of 0.91. In contrast, patients who underwent MV
Repair in either the Control group or the Device Group had mean predictive
composite scores of 0.55, and 0.52, respectively. Patients were slightly
older in the M V Replacement group. Surgeon experience, defined as number
of surgeries performed annually, was greater in the MV Replacement arm
(67.1 cases/year vs 59.2 cases/yr for Repair). Conclusion: Patient anatomy
and pathology are the primary drivers in the decision to replace versus
repair the mitral valve. A detailed analysis of the anatomical and
pathological characteristics contributing to MV Replacement versus MV
repair in the EVEREST II Randomized Clinical Trial will be presented.

<23>
Accession Number
70273451
Authors
Lim S. Feldman T. Kar S. Rinaldi M. Fail P. Hermiller J. Smailing R. Gray
W. Wang A. Herrmann H. Rogers J. Lasala J. Bajwa T. Grayburn P. Pedersen
W. Whisenant B. Berke A. Donnell M.O. Whitlow P. Siegel R. Trento A.
Glower D. Foster E.
Institution
(Lim) University of Virginia, Charlottesville, VA, United States
(Feldman) Northshore University Health System, Chicago, VA, United States
(Kar) University of California Los Angeles, Los Angeles, CA, United States
(Rinaldi) Carolina Medical Center, Charlotte, NC, United States
(Fail) Terrebonne General Medical Center, Houma, LA, United States
(Hermiller) Care Group, Indianapolis, IN, United States
(Smailing) Memorial Hermann Hospital, Houston, TX, United States
(Gray) Columbia University, Medical Center, New York, NY, United States
(Wang, Glower) Duke University, Medical Center, Durham, NC, United States
(Herrmann) Hospital of The University of Pennsylvania, Philadelphia, PA,
United States
(Rogers) University of California, Davis Medical Center, Sacramento, CA,
United States
(Lasala) Washington University, St. Louis, MO, United States
(Bajwa) St. Luke's Medical Center, Milwaukee, WI, United States
(Grayburn) Baylor Heart and Vascular Institute, Dallas, TX, United States
(Pedersen) Minneapolis Heart Institute, Minneapolis, MN, United States
(Whisenant) LDS Hospital, Salt Lake City, UT, United States
(Berke) St. Francis Hospital Heart Center, Roselyn, NY, United States
(Donnell) St. Joseph Mercy Hospital, Ypsilanti, MI, United States
(Whitlow) Cleveland Clinic Foundation, Cleveland, OH, United States
(Siegel, Trento) Cedars Sinai Health System, Los Angeles, CA, United
States
(Foster) University of California, San Franscisco, San Francisco, CA,
United States
Source
Journal of the American College of Cardiology. Conference: 22nd Annual
Symposium of the Transcatheter Cardiovascular Therapeutics, TCT 2010
Washington, DC United States. Conference Start: 20100921 Conference End:
20100925. Conference Publication: (var.pagings). 56 (13 SUPPL. 1) (pp
B24), 2010. Date of Publication: 21 Sep 2010.
Publisher
Elsevier USA
Abstract
EVEREST II: is a prospective, multi-center, randomized controlled trial
designed to compare the safety and effectiveness of the MitraClip System
with mitral valve surgery in the treatment of mitral regurgitation (MR).
Patients were randomized to treatment with the MitraClip device (Device)
or mitral valve repair or replacement surgery (Control). Measures of 12
month effectiveness included an analysis of echocardiographic determinants
of left ventricular (LV) function. Methods: 279 patients were enrolled at
37 sites in North America and randomized 2:1 (Device vs. Control).
Echocardiographic measures of LV function were determined by the
Echocardiographic Core Lab at UCSF at baseline, discharge, 30days, 6, and
12 months for all patients. Measured LV parameters include LV end
diastolic volume, LV end systolic volume, LV internal diastolic diameter,
LV internal systolic diameter, and LV ejection fraction. Calculated
parameters of LV function include cardiac output (CO), and forward stroke
volume (FSV). Additionally, septal-lateral annular dimensions were
measured at follow-up in patients who underwent the MitraClip procedure.
Results: Significant reverse LV remodeling at 12 months was observed
following successful MitraClip Therapy, defined as acute procedural
success (MR<2+ at discharge), and following MV surgery Twelve month
matched LV remodeling data for both therapies is presented in Table 1. A
detailed discussion of these data and other LV function data will be
presented. (Table Presented) Conclusion: Significant reverse LV remodeling
occurred one year following MV surgery and MitraClip treatment. A detailed
analysis of the LV function data from the EVEREST II Randomized Clinical
Trial will be presented.

<24>
Accession Number
70273533
Authors
Vijayalakshmi K. Qiu W.
Institution
(Vijayalakshmi) James Cook University Hospital, Middlesbrough, United
Kingdom
(Qiu) Channing Laboratory, Department of Medicine, Harvard Medical School,
Boston, MA, United States
Source
Journal of the American College of Cardiology. Conference: 22nd Annual
Symposium of the Transcatheter Cardiovascular Therapeutics, TCT 2010
Washington, DC United States. Conference Start: 20100921 Conference End:
20100925. Conference Publication: (var.pagings). 56 (13 SUPPL. 1) (pp
B43), 2010. Date of Publication: 21 Sep 2010.
Publisher
Elsevier USA
Abstract
Coronary artery bypass surgery (CABG) is the standard of care for the
management of patients with severe three vessel and left main coronary
artery disease. However, the best strategy for the management of patients
with severe coronary artery disease (CAD) and severely impaired left
ventricular (LV) systolic function is not clear. A meta-analysis of
observational studies to determine the operative mortality (OM) and
long-term (5-year survival) outcomes among patients with severely impaired
LV systolic function undergoing CABG was performed. Methods: A systematic
computerized literature search was performed on PubMed using the search
terms poor left ventricle, coronary artery bypass surgery,
revascularization, LV dysfunction and heart failure. Observational studies
published in English language consisting of patients undergoing isolated
CABG for CAD and severely impaired LV systolic function [ejection fraction
(EF) <35%] were included. Results: Twenty six published observational
clinical studies consisting of 4119 patients were identified and included.
The mean (estimate) age of study patients was 63.54 years [95% confidence
interval (CI) 62.44, 64.65]. The mean (estimate) EF was 24.7% (95% CI
22.5%, 27.0%). The OM among patients (n=3621) who underwent on-pump CABG
was 5.4%, n=189 (95% CI 4.5%, 6.4%), Figure. The longterm actuarial
survival among patients (13 studies, n=1980) who underwent on-pump CABG
was 73.4%, n=1483 (95% CI 68.7%, 77.7%). Patients who underwent off-pump
CABG (7 studies, n=498) tended to have reduced OM of 4.4%, n=20 (95% CI
2.8%, 6.4%). (Figure Presented) Conclusion: This meta-analysis
demonstrates that based on currently available observational studies, CABG
among patients with severely impairedLV systolic function can be performed
with acceptable operative mortality and improved long-term (5-year)
actuarial survival.

<25>
Accession Number
70273872
Authors
Leon M.B. Smith C.R. Mack M. Miller D.C. Moses J.W. Svensson L.G. Tuzcu
E.M. Webb J.G. Fontana G. Makkar R. Brown D. Block P. Guyton R. Pichard
A.D. Bavaria J. Herrmann H. Douglas P. Petersen J. Akin J.J. Anderson W.N.
Wang D. Pocock S.
Source
Journal of the American College of Cardiology. Conference: 22nd Annual
Symposium of the Transcatheter Cardiovascular Therapeutics, TCT 2010
Washington, DC United States. Conference Start: 20100921 Conference End:
20100925. Conference Publication: (var.pagings). 56 (13 SUPPL. 1) (pp
xii), 2010. Date of Publication: 21 Sep 2010.
Publisher
Elsevier USA
Abstract
Background: Many patients with severe aortic stenosis (AS) and advanced
age or multiple co-morbidities may not be candidates for surgical aortic
valve replacement. Recently, transcatheter aortic valve implantation
(TAVI) has been suggested as a less invasive treatment in some high risk
AS patient subgroups. Although TAVI registry reports suggest improved
30-day clinical outcomes, thus far, there have been no studies in
carefully selected non-operable AS patients and no randomized controlled
trials using TAVI therapy in any AS patient population. Methods: The
PARTNER (Placement of AoRTic TraNscathetER Valves) trial randomized (1:1)
patients with severe AS (AVA <0.8cm²), cardiac symptoms, and
acceptable vascular access, who were deemed non-operable by cardiac
surgeons (predicted >=50% 30-day operative mortality or serious
irreversible morbidity) to either standard therapy or trans-femoral TAVI
using a balloon-expandable Edwards-SAPIEN bovine pericardial
valve. The primary endpoint was superiority in freedom from all-cause
mortality (>= 1 year follow-up in all patients), over the duration of the
study and the co-primary endpoint was a hierarchical multiple pair-wise
comparison of time to all-cause mortality and time tofirst occurrence of
repeat hospitalization due to valve or procedure-related clinical
deterioration (Finklestein-Schoenfeld method). Results: 358 non-operable
patients with severe AS were enrolled at 21 investigator sites (17 in the
U.S. and 4 outside the U.S.) and were assigned to be treated with TAVI
(179 patients) or standard therapy (179 patients). The patient population
was extremely high risk for surgery: STS risk score wasll.8+/-6.2% and
there were many clinical co-morbidities which contributed to the
determination of non-operable status, including porcelain aorta (15.1%),
chest wall radiation or deformity (14.7%), oxygen-dependent respiratory
insufficiency (23.8%), and severe frailty (27.9%). In addition to the
primary endpoints, all secondary endpoints (including NYHA functional
class, core lab serial echo findings, 6-minute walk tests, and
procedure-related complications) will be available and reported at the
time of presentation. Conclusions: PARTNER is the first randomized TAVI
trial worldwide and should address the important question of whether less
invasive trans-femoral TAVI is the preferred therapy in non-operable
patients with severe AS.