EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2010555606
Authors
Shroff P.P. Kaushal V. Kamdar B.M.
Institution
(Shroff, Kaushal, Kamdar) Department of Anaesthesiology, TN Medical
College, BYL Nair Charitable Hospital, Mumbai 400008, India
Title
Comparative study of postoperative analgesia and sedation after upper
abdominal surgery with thoracic epidural administration of bupivacaine
with/without midazolam.
Source
Journal of the Indian Medical Association. 107 (1) (pp 26-29), 2009.
Date of Publication: January 2009.
Publisher
Indian Medical Association (53 Creek Row, Calcutta 700014, India)
Abstract
Currently continuous epidural administration of local anaesthetics with
opioids is widely used for postoperative analgesia. To avoid the
side-effects of opioids a drug that can replace opioids is most welcome.
Midazolam not only has no side-effects but also has the advantages of
sedation and amnesia. In a prospective randomised clinical study ASA class
1 or 2 patients undergoing upper abdominal surgeries were studied to
compare the analgesic and sedative effect of continuous thoracic epidural
infusion of bupivacaine versus continuous thoracic epidural administration
of bupivacaine with midazolam postoperatively. They were divided into 2
groups. Via thoracic epidural route patients in group A (n=24) were given
60 ml of 0.25% bupivacaine while those in group B (n=25) were given 58 ml
of 0.25% bupivacaine + midazolam 2 ml (10mg). Each patient was infused
using a syringe pump at the rate of 5 ml/hour. Variables studied
postoperatively were pulse, BP, RR, SpO₂, analgesia score and
sedation score. Statistically significant differences in pulse, BP, RR and
SpO₂ were not seen. Better sedation, analgesia scores and
amnesia were noted in patients belonging to group B as compared to
patients of group A. This combination may thus replace routinely used
combinations of opioids and local anaesthetics.

<2>
Accession Number
2010560671
Authors
Chakravarty T. White A.J. Buch M. Naik H. Doctor N. Schapira J. Kar S.
Forrester J.S. Weiss R.E. Makkar R.
Institution
(Chakravarty, White, Buch, Naik, Doctor, Schapira, Kar, Forrester, Makkar)
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Weiss) Department of Biostatistics, University of California Los Angeles,
School of Public Health, Los Angeles, CA, United States
Title
Meta-analysis of incidence, clinical characteristics and implications of
stent fracture.
Source
American Journal of Cardiology. 106 (8) (pp 1075-1080), 2010. Date of
Publication: 15 Oct 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
A meta-analysis of published studies was conducted to evaluate the
incidence, predictors, and clinical outcomes of stent fractures. Eight
studies with 108 stent fractures in 5,321 patients were analyzed using the
Bayesian method. Study end points included in-stent restenosis (ISR) and
target lesion revascularization (TLR). The mean incidence of stent
fracture per patient was 4.0% (95% confidence interval 0.4% to 16.3%). All
cases, except 1, were reported with sirolimus-eluting stents. The
incidence of stent fracture was 30.4% in the left anterior descending
coronary artery, 10.9% in the left circumflex coronary artery, 56.4% in
the right coronary artery, <0.01% in the left main coronary artery, and
1.7% in saphenous vein grafts. The probability of stent fracture was
significantly higher in the right coronary artery than in the left
anterior descending and left circumflex lesions (p <0.01). Left main
stents were less likely to fracture compared to those in all other vessels
(p <0.01). The probability of stent fracture was significantly increased
in overlapping stents (7.5% vs 2.1%, p = 0.01) and long stents (46 vs 32.5
mm, p <0.01). Lesions with stent fractures had higher rates of ISR (38% vs
8.2%, p <0.01) and TLR (17% vs 5.6%, p <0.01). Conversely, the probability
of stent fractures was higher in patients with ISR (12.8% vs 2.1%, p
<0.01) and TLR (8.8% vs 2.7%, p <0.01). In conclusion, although not always
associated with clinical sequelae, the probability of ISR and TLR is
increased with stent fracture. Conversely, the probability of stent
fractures is increased in lesions with ISR or TLR, thus raising the need
for surveillance and management guidelines for at-risk patients. 2010
Elsevier Inc. All rights reserved.

<3>
Accession Number
2010567413
Authors
Spinler S.A. Mahaffey K.W. Gallup D. Levine G.N. Ferguson III J.J. Rao
S.V. Gallo R. Ducas J. Goodman S.G. Antman E. White H.D. Biasucci L.
Becker R.C. Col J.J. Cohen M. Harrington R.A. Califf R.M.
Institution
(Spinler) Department of Pharmacy Practice and Pharmacy Administration,
Philadelphia College of Pharmacy, University of the Sciences in
Philadelphia, Philadelphia, PA, United States
(Spinler) Department of Medicine, Cardiovascular Division, University of
Pennsylvania, Philadelphia, PA, United States
(Mahaffey, Gallup, Rao, Becker, Harrington, Califf) Duke Clinical Research
Institute, Duke University Medical Center, Durham, NC, United States
(Levine) Baylor College of Medicine, Houston, TX, United States
(Ferguson III) Medicines Company, Parsippany, NJ, United States
(Gallo) Montreal Heart Institute, Montreal, QC, Canada
(Ducas) University of Manitoba, Winnipeg, MN, Canada
(Goodman) Division of Cardiology, University of Toronto, St. Michael's
Hospital, Toronto, ON, Canada
(Antman) Brigham and Women's Hospital, Boston, MA, United States
(White) Green Lane Cardiovascular Service, Auckland, New Zealand
(Biasucci) Institute of Cardiology, Catholic University of the Sacred
Heart, Rome, Italy
(Col) Clinique Universitaire St. Luc, Bruxelles, Belgium
(Cohen) Newark Beth Israel Medical Center, Newark, NJ, United States
Title
Relationship between renal function and outcomes in high-risk patients
with non-ST-segment elevation acute coronary syndromes: Results from
SYNERGY.
Source
International Journal of Cardiology. 144 (1) (pp 36-41), 2010. Date of
Publication: 2010.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Chronic kidney disease (CKD) is a risk factor for coronary
heart disease and bleeding with antithrombotic therapy in patients with
acute coronary syndromes (ACS). We evaluated the effect of renal function
on efficacy and outcomes in high-risk patients with NSTE ACS in the
SYNERGY trial. Methods: Creatinine clearance (CrCl) at the time of
randomization was analyzed as a continuous variable added to multivariable
logistic regression models for 30-day death or MI, non-CABG-associated
TIMI major bleeding, GUSTO severe bleeding, and transfusion in the overall
study population, patients undergoing coronary angiography, and patients
undergoing PCI. Results: Of 9838 patients with a CrCl value, 70.6% (N =
6950) had CrCl >= 60 mL/min, 27.8% (N = 2732) had CrCl 30-59 mL/min, and
1.6% (N = 156) had CrCl < 30 mL/min. No randomized treatment by CrCl
interaction test was found to be statistically significant, suggesting
renal insufficiency affected enoxaparin and unfractionated heparin
outcomes similarly. After adjustment, CrCl was an independent predictor of
30-day death or MI (OR 1.06, 95% CI 1.03-1.09), TIMI major bleeding (OR
1.06, 95% CI 1.02-1.10), GUSTO severe bleeding (OR 1.10, 95% CI
1.03-1.17), and transfusion (OR 1.07, 95% CI 1.04-1.11). Conclusions:
Patients with CKD had higher rates of 30-day death or MI and bleeding than
those without CKD, regardless of randomized antithrombin therapy. While
this analysis suggests that there is a rise in bleeding events as CrCl
falls for patients in either treatment group, it is unknown whether a
reduction in dose would decrease bleeding risk. 2009 Elsevier Ireland
Ltd. All rights reserved.

<4>
Accession Number
2010567457
Authors
Engelmann M.G. Theiss H.D. Theiss C. Henschel V. Huber A. Wintersperger
B.J. Schoenberg S.O. Steinbeck G. Franz W.-M.
Institution
(Engelmann, Theiss, Theiss, Steinbeck, Franz) Medical Department I,
Cardiology, University of Munich, Campus Grosshadern, Munich, Germany
(Henschel) Institute of Medical Informatics, Biometry and Epidemiology,
University of Munich, Campus Grosshadern, Munich, Germany
(Huber, Wintersperger, Schoenberg) Department of Clinical Diagnostic
Radiology, University of Munich, Campus Grosshadern, Munich, Germany
(Schoenberg) Department of Clinical Diagnostic Radiology, Medical Faculty
Mannheim of the University Heidelberg, Germany
(Engelmann) Kardiologische Praxis im Wurmtal, Gauting-Stockdorf, Germany
Title
G-CSF in patients suffering from late revascularised ST elevation
myocardial infarction: Final 1-year-results of the G-CSF-STEMI Trial.
Source
International Journal of Cardiology. 144 (3) (pp 399-404), 2010. Date of
Publication: 2010.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Aims: The aims of this trial were to investigate the effect of granulocyte
colony-stimulating factor (G-CSF) on left-ventricular ejection fraction
and event-free survival in patients suffering from sub-acute myocardial
infarction (STEMI). Methods: We enrolled 44 patients suffering from
sub-acute STEMI with late revascularization achieved by percutaneous
coronary intervention (PCI). Patients were randomized to receive either
G-CSF (Filgrastim) at a dose of 10 mug/kg body weight/day subcutaneously
or placebo. Changes of global and regional cardiac function from baseline
(1 week after PCI) over 1 and 3 months to 12 months of follow-up were
analyzed by magnetic resonance imaging. Results: Ejection fraction
improved in G-CSF treated patients from 41.1 +/- 11.9% to 47.1 +/- 11.9%
(3 months) and decreased slightly to 45.7 +/- 15.1% after 1 year. Ejection
fraction also improved in the placebo group from 43.8 +/- 9.0% to 49.5 +/-
11.8% (3 months) and decreased slightly to 42.9 +/- 15.4% after 1 year (1
year MRI follow-up was performed in 23 out initial 44 patients). There was
no significant difference between the two groups at any time point. Other
parameters such as infarct size, myocardial perfusion, left ventricular
end-diastolic and end-systolic volumes were not different between the two
groups. Event-free survival of such as death, (re) myocardial infarction
or acute coronary syndromes, coronary artery bypass grafting and target
lesion revascularization was not significantly different between both
groups. Conclusions: G-CSF administration after sub-acute STEMI is
feasible and safe but does not improve myocardial function or survival
when used as a single substance. 2008 Elsevier Ireland Ltd. All rights
reserved.

<5>
Accession Number
2010570923
Authors
Den Hengst W.A. Van Putte B.P. Hendriks J.M.H. Stockman B. van Boven
W.-J.P. Weyler J. Schramel F.M.N.H. Van Schil P.E.Y.
Institution
(Den Hengst, Hendriks, Van Schil) Department of Thoracic and Vascular
Surgery, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem,
Belgium
(Stockman) Department of Cardiac Surgery, Antwerp University Hospital,
Edegem, Belgium
(Van Putte, van Boven) Department of Thoracic Surgery, St. Antonius
Hospital, Nieuwegein, Netherlands
(Schramel) Department of Pulmonary Medicine, St. Antonius Hospital,
Nieuwegein, Netherlands
(Weyler) Department of Epidemiology and Community Medicine, University of
Antwerp, Edegem, Belgium
Title
Long-term survival of a phase I clinical trial of isolated lung perfusion
with melphalan for resectable lung metastases.
Source
European Journal of Cardio-thoracic Surgery. 38 (5) (pp 621-627), 2010.
Date of Publication: November 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Surgical resection of lung metastases is a widely accepted
procedure but 5-year survival rates remain low and vary between 20% and
50%. Isolated lung perfusion (ILuP) is an experimental technique to
deliver a high dose of chemotherapy to the lung, without systemic
toxicity. Long-term survival of ILuP has not been reported yet and was
determined in a phase I clinical trial. Methods: From May 2001 to December
2004, a phase I clinical trial was conducted to define the maximum
tolerated dose (MTD) of ILuP with melphalan. Twenty-nine procedures were
performed in 23 patients. The primary tumour was colorectal in 10
patients, renal in eight, sarcoma in four and salivary gland in one.
Toxicity results were previously reported and the MTD of melphalan was
determined at 45. mg when given at 37 degreeC. Follow-up was updated and
long-term survival is reported. Results: Follow-up was complete, except
for one patient who was lost to follow-up after 8 months. After a median
follow-up of 62 months, 6 out of 23 patients were alive and free of
recurrent disease. One patient died after a subsequent operation. Sixteen
patients developed recurrent disease, of whom 11 died. Nine patients had
intrathoracic recurrent disease only, one intra- and extrathoracic
recurrences each and five extrathoracic only. In one patient, the location
of recurrence was not known. Overall- and disease-free 5-year survival
rates were 54.8 +/- 10.6% and 27.5 +/- 9.5%, respectively with an overall
median survival time (MST) of 84 months (95% confidence interval (CI):
41-128) and disease-free MST of 19 months (95% CI: 4-34). Lung function
and diffusion capacity initially dropped 1 month after perfusion, slightly
improving afterwards. Radiographic follow-up with chest computed
tomography showed no long-term toxicity from ILuP. Conclusion: ILuP can be
applied without major long-term pulmonary toxicity. Five-year survival
rate, overall and disease-free MST in this phase I clinical trial are
promising. This is another incentive to perform further studies with ILuP.
2010 European Association for Cardio-Thoracic Surgery.

<6>
Accession Number
2010573094
Authors
Pittarello D. Bonato R. Falasco G. Tiberio I. Gasparetto M. Ori C.
Institution
(Pittarello, Bonato, Falasco, Tiberio, Gasparetto, Ori) Unit of Anesthesia
and Intensive Care, Department of Pharmacology and Anesthesiology,
University of Padua, Italy
Title
Effects of fenoldopam on myocardial function (strain rate) in patients
with coronary artery disease undergoing cardiac surgery.
Source
Minerva Anestesiologica. 76 (9) (pp 707-713), 2010. Date of Publication:
September 2010.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Background. This study aimed to assess the effects of fenoldopam, an
antihypertensive agent with nephroprotective properties, on myocardial
function. The global systolic and diastolic function and the strain rate,
a new parameter used to quantify regional myocardial function, were
measured with transesophageal echocardiography. Methods. Forty patients
undergoing elective coronary artery surgery were analyzed in a prospective
nonrandomized clinical trial. Patients were divided into two groups, a
group that received 0.05-mcg/kg/min fenoldopam (20 patients) and a control
group (20 patients). Only patients with serum creatinine levels >=120
mumol/L and critical coronary stenosis were selected. The ejection
fraction (EF), the E and A waves, and the E/A ratio were measured with
transesophageal echocardiography, and the strain rate was calculated using
a strain quantification program to measure the peak systolic strain rate
(PSSR) and the peak diastolic strain rate (PDSR). Results. Fenoldopam did
not change the systolic and diastolic global function (EF, E wave, A wave
and E/A). Regarding regional myocardial function, fenoldopam significantly
increased the PSSR from -1.09+/-0.8 1/s to -2.24+/-2.26 1/s (P=0.038) and
the PDSR from 1.04+/-0.69 1/s to 1.69+/-0.87 1/s (P=0.012). Conclusion.
Low doses of fenoldopam increased the regional myocardial function, as
assessed by the myocardial strain rate, in patients undergoing cardiac
surgery.

<7>
Accession Number
70279714
Authors
Yamashita M. Cook R. Kearns M. Ramanathan K. Gin K. Humphries K.
Institution
(Yamashita, Cook, Kearns, Ramanathan, Gin, Humphries) University of
British Columbia, Vancouver, Canada
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2010 Stockholm Sweden. Conference Start: 20100828 Conference End:
20100901. Conference Publication: (var.pagings). 31 (pp 59), 2010.
Date of Publication: September 2010.
Publisher
Oxford University Press
Abstract
Background: Atrial fibrillation (AF) after cardiac surgery is a common
complication that is associated with an increased risk of death and stroke
and longer lengths of stay in hospital. Previous trials have shown widely
divergent results, while meta-analyses have concluded that magnesium
prevents postoperative AF, although with a significant degree of
heterogeneity. Recently, the largest randomized controlled trial (RCT)
published to date concluded that magnesium sulphate is not protective
against AF following cardiac surgery. The objective of this study was to
conduct a new meta-analysis to include the results of this large RCT, as
well as other trials not previously included, and to investigate the
previously documented heterogeneity in the meta-analyses. Methods: The
MEDLINE, EMBASE and CENTRAL databases were searched to retrieve relevant
studies published up until December 2009. Only RCTs in adults which
compared magnesium to placebo for the prophylaxis of AF after cardiac
surgery were included. Pooled effect estimates for the odds ratio of
incidence of AF, incidence of stroke and 30 day all-cause mortality were
calculated using the random and fixed effects models. A pooled effect
estimate for the weighted mean difference (WMD) of length of hospital stay
was also calculated. Heterogeneity was assessed using the I2 statistic and
publication bias was evaluated. Several sensitivity analyses were
performed to examine the effects of study design parameters on outcomes.
Results: Nineteen studies were initially included in this analysis.
Overall, there was 43% risk reduction in incidence of AF associated with
magnesium (OR=0.57, p=0.001). However, there was a significant amount of
heterogeneity (I²=66.6%, p<0.001) and evidence of publication
bias. A second analysis of the five doubleblind, intention to treat
studies, where AF was the primary outcome, revealed magnesium does not
protect against postoperative AF (OR=0.94, p=0.77), with a reduced amount
of heterogeneity (I2=40.4%, p=0.15). The incidence of postoperative stroke
(OR=0.72, p=0.64), early death (OR=1.07, p=0.86) and length of hospital
stay (WMD=-0.20 days, p=0.14) were not different between the magnesium and
placebo control groups. Conclusions: When the evidence is restricted to
high quality RCTs, prophylactic intravenous magnesium is not effective in
preventing AF following cardiac surgery.

<8>
Accession Number
70280379
Authors
Lie I. Bunch E.H. Smeby N.A.A. Arnesen H. Hamilton G.
Institution
(Lie, Smeby, Arnesen, Hamilton) Oslo University Hospital, Ulleval, Oslo,
Norway
(Bunch) University of Oslo, Oslo, Norway
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2010 Stockholm Sweden. Conference Start: 20100828 Conference End:
20100901. Conference Publication: (var.pagings). 31 (pp 229), 2010.
Date of Publication: September 2010.
Publisher
Oxford University Press
Abstract
Background: Patients' experiences after CABG reveal unmet physical,
psychological and educational needs after surgery. Foremost are symptoms
of anxiety and depression that significantly predict increased morbidity
and mortality. A structured information and psychological supportive
psycho-educative method to perform health education and teaching coping
skills are warranted. Purpose: To implement an individualized intervention
that explores the CABG patients' symptoms, and promotes symptom management
in the early rehabilitation. Method: A randomized controlled trial
recruited 101 patients (n = 101) to a homebased intervention at 2 and 4
weeks after surgery. The psycho-educative intervention consisted of an
intervention protocol with 7 predefined themes known to be important. The
narrative interviews were analyzed using thematic content analysis before
sub-themes were quantified to give a background on how often specific
experiences were addressed in the interviews. Results: A total of 93
patients completed the intervention. Patients' experiences revealed 16 sub
themes related to the 7 predefined themes. 1. Physical theme:
postoperative pain (84% at 2 weeks/66% at 4 weeks), assessment of surgical
site (55%/53%), numb feeling at chest surgery site (23%/22%), physical
activity/exercise (almost 100%) and issues with compression stocking
(7%/13%). 2. Prescribed discharge medication theme: uncertainty about
medications (15%/12%). 3. Anxiety and/or depression themes: living alone
(12%/5%), changed sleep pattern (11%/9%), irritability short fuse
(15%/7%), postoperative complications (16%/13%), security of grafts after
CABG (10%/15%), return to work (13%/3%) and driving a car (7%/15%). 5.
Sexuality theme: impotence (erectile dysfunction) (20% at 4 weeks). 7.
Open themes: discharge phase (15% at 2 weeks) and missing link to hospital
(6%/28%). Conclusion: This study indicates the need to extend hospitals'
discharge care for CABG patients to the first month after surgery for
specific symptoms to enhance the patients' symptom management.

<9>
Accession Number
70280969
Authors
Busch J.C. Willemsen D. Bjarnason-Wehrens B.
Institution
(Busch, Willemsen) Schuchtermann Clinic, Bad Rothenfelde, Germany
(Bjarnason-Wehrens) German Sport University Cologne, Institute of
Cardiology and Sports Medicine, Cologne, Germany
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2010 Stockholm Sweden. Conference Start: 20100828 Conference End:
20100901. Conference Publication: (var.pagings). 31 (pp 382-383), 2010.
Date of Publication: September 2010.
Publisher
Oxford University Press
Abstract
Purpose: to evaluate the effects of additional daily functional training
compared to the standard exercise training on 6 minute walking distance
(6MWD) and quality of life (QoL) in very old patients who participate in
phase II cardiac rehabilitation (CR) early after CABG surgery. Methods:
single centre randomized controlled trial. A sample of 107 patients, 74
men, 33 women, >= 75 years old was randomly assigned to either an
intervention group (IG) (n = 51, m/f; 34/17; mean age 78.47+/-3.38 years)
or a control group (CG) (n = 56, m/f; 40/16, mean age 78,48+/-2,98 years).
All patients participated in an in-patient CR (mean length of stay IG
20.8+/-2.8 vs. CG 20.1+/-3.5 days; p= 0.27) early after surgery (IG
13.4+/-4.1 vs. CG 12.7+/-6.9 days; p=0.5). The CG participated in the
usual exercise regime including endurance exercise training on bicycle
ergometer and gymnastics. The IG participated in additional functional
training including resistance training (10,6+/-2,4 exercise units with
four exercises, one set of 8 - 12 repetitions at 60% 1RM) and special
balance training (9,4+/-2,1 units). Six minute walking test was used to
access functional capacity, the Mac- New questionnaire to evaluate Quality
of life. Results: in both groups 6MWD was significantly improved by the
CR, IG from 298.3+/-79.7 to 365.3+/-82,1 m; p<0.001, 67,6m and CG from
306+/-77.5 to 350.9+/-82.3 m; p<0,001, 44,9m.The difference between the
group was not significant (p=0,371) but the most clinically important
difference of >50m for 6MWD was only achieved in IG. In both groups all
dimensions of QoL were significantly improved: physical dimen sion, IG
(4.75+/-1.10 to 5.98+/-0.83 p<0.001) vs. CG (4.92+/-1.16 to 5.97+/-0.75;
p<0.001) emotional dimension IG (5.12+/-1.03 to 6.07+/-0.72 p<0.001) vs.
CG (5.35+/-1.16 to 6+/-0.74 p<0.001), social dimension IG (5.15+/-1.11 to
6.28+/-0.7 p<0.001) vs. CG (5.33+/-1.16 to 6.27+/-0.72 p<0.001) and global
IG (5.00+/-0.99 to 6.07+/-0.66 p<0.001) vs. CG (5.10+/-1.05 to
6.05+/-0.66) p<0.001). No significant differences were seen between the
two groups. Conclusion: cardiac rehabilitation is highly efficient in very
old patients after CABG surgery to improve 6MWD and QoL. An additional
resistance and balance training did not enhance additional benefits, but
the most clinically important difference of >54m for 6MWD improvement was
only reached in IG.

<10>
Accession Number
70281155
Authors
Felker G.M. Fiuzat M. Shaw L.K. Donahue M. Adams K.F. Zannad F. Whellan D.
Kitzman D. Pina I. O'connor C.M.
Institution
(Felker, Fiuzat, Shaw, Donahue, O'connor) Duke University Medical Center,
Durham, NC, United States
(Adams) University of North Carolina, Chapel Hill, United States
(Zannad) University Hospital of Nancy, Nancy, France
(Whellan) Thomas Jefferson University, Philadelphia, United States
(Kitzman) Wake Forest Medical Center, Winston-Salem, United States
(Pina) Case Western Reserve University, Cleveland, United States
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2010 Stockholm Sweden. Conference Start: 20100828 Conference End:
20100901. Conference Publication: (var.pagings). 31 (pp 429), 2010.
Date of Publication: September 2010.
Publisher
Oxford University Press
Abstract
Background and Purpose: Galectin-3 (Gal3) is a novel biomarker that
reflects ongoing fibrosis and ventricular remodeling. Data on Gal3 in
ambulatory heart failure (HF) patients are sparse. We evaluated the
association of baseline Gal3 levels with clinical outcomes in a cohort of
ambulatory HF patients enrolled in the HF-ACTION Study. Methods: HF-ACTION
was an international randomized controlled trial of exercise training in
patients with chronic HF due to LV systolic dysfunction (NYHA Class II-IV,
LVEF < 0.35, median follow-up 2.5 years). The primary endpoint was
hospitalization free survival. Gal3 was assessed by ELISA in a cohort of
895 HFACTION patients with stored plasma samples available. The
relationship between NTproBNP, Gal3, and outcomes was assessed by creating
4 groups defined by the median of each variable. Results: Mean age of the
study cohort was 58 yrs, 64% were Caucasian and 71% were male. Median
NT-pro BNP level was 848 pg/mL, and mean LVEF was 25%. The mean Gal3 level
was 15.8 ng/mL +/-7.7 ng/mL. In unadjusted analysis, there was a
significant association between elevated Gal3 levels and outcome
(unadjusted hazard ratio (HR) = 1.10 per 5 ng/mL increase in Gal3,
p<0.0001). High Gal3 levels added to risk stratification provided by
NTproBNP alone (Figure). Compared to a reference group with low
NTproBNP-low Gal3, there was a progressively increased hazard for low
NTproBNP-high Gal3 (HR=1.31), high NTproBNP-low Gal3 (HR=1.75), and high
NTproBNP-high Gal3 (HR =2.19).(Figure presented) Conclusions: Elevated
Gal3 is associated with adverse outcomes in patients with chronic HF due
to LV systolic dysfunction and appeared to reclassify risk assessment
based on NTproBNP alone.

<11>
Accession Number
70281810
Authors
Bavry A. Winchester D.
Institution
(Bavry, Winchester) University of Florida, Gainesville, United States
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2010 Stockholm Sweden. Conference Start: 20100828 Conference End:
20100901. Conference Publication: (var.pagings). 31 (pp 600), 2010.
Date of Publication: September 2010.
Publisher
Oxford University Press
Abstract
Background: Invasive procedures can result in adverse cardiovascular
events, such as myocardial infarction (MI) and death. We hypothesized that
statins might improve clinical outcomes when used before invasive
procedures. We sought to summarize the evidence of pre-procedural statin
therapy to reduce peri-procedural cardiovascular complications. Methods:
We searched the Medline, Cochrane, and clinicaltrials.gov databases from
inception to February 2010 for randomized controlled trials that examined
statin therapy during invasive procedures. Invasive procedure was defined
as percutaneous coronary intervention (PCI), coronary artery bypass
grafting (CABG), and non-cardiac surgery. We required that studies
initiated statins prior to the procedure and reported clinical outcomes. A
DerSimonian-Laird model was used to construct random effects summary risk
ratios. Results: Eight percent of the screened trials (21 of 270) met our
selection criteria which included 4805 patients. The use of pre-procedural
statins significantly reduced post-procedural MI (risk ratio = 0.57, 95%
confidence interval 0.46 to 0.70, p < 0.0001). This benefit was seen after
both PCI (RR = 0.59, 95% CI 0.47-0.74, p < 0.0001) and non-cardiac
surgical procedures (RR = 0.47, 95% CI 0.28-0.78, p = 0.004), but not CABG
(RR = 0.65, 95% CI 0.24-1.74, p = 0.40). By limiting the analysis to only
the placebo controlled trials, the effect was strengthened (RR= 0.43, 95%
CI 0.30-0.61). All-cause mortality was non-significantly reduced by statin
therapy (p = 0.15). Pre-procedural statins also reduced post-CABG atrial
fibrillation from 37% to 19% (RR = 0.54, 95% CI 0.43-0.68, p < 0.0001).
Heterogeneity by I2 statistic for all analyses was 0%. Univariate
metaregression confirmed no evidence of heterogeneity for MI when
regressed against the type of statin, mean reduction in low density
lipolrotein, and duration of preprocedure statin therapy. Conclusions:
Statins administered before invasive procedures significantly reduce the
hazard of post-procedural MI. Additionally, statins reduce the risk of
atrial fibrillation after CABG. Current guidelines for peri-operative
riskmodification recommend statin use for secondary prevention or for high
risk patients. Our analysis suggests that the routine use of statins prior
to invasive procedures should be considered.

<12>
Accession Number
70281856
Authors
Hueb W. Lopes N.H. Soares P. Favarato D. Pereira A.C. Vieira R.D.O. Lima
E.G. Garzillo C.L. Hueb A. Ramires J.A.
Institution
(Hueb, Lopes, Soares, Favarato, Pereira, Vieira, Lima, Garzillo, Hueb,
Ramires) Heart Institute of University of Sao Paulo, Sao Paulo, Brazil
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2010 Stockholm Sweden. Conference Start: 20100828 Conference End:
20100901. Conference Publication: (var.pagings). 31 (pp 612), 2010.
Date of Publication: September 2010.
Publisher
Oxford University Press
Abstract
Background: This study compared 10-year follow-up of percutaneous coronary
intervention (PCI), coronary artery surgery (CABG), and medical treatment
(MT) in patients with multivessel coronary artery disease (CAD), stable
angina, and preserved ventricular function. Methods: At a single
institution, 611 patients were randomly assigned to CABG (n=203), PCI
(n=205), or MT (n=203). All data were analyzed according to the
intention-to-treat principle. The primary end points were overall
mortality, Q-wave myocardial infarction (MI), or refractory angina
requiring revascularization. Results: The 10-year survival rates were CABG
74.9%, PCI 75.9%, and MT 69% (P=0.089). 10-year rates of MI were CABG
10.3% PCI 13.3% and MT 20.7% (P<0.001). 10-year rates of additional
revascularization were CABG 7.4%, PCI 41.9% and MT 39.4% (P<0.001).
Regarding the composite end-point, Cox regression analysis showed an
independent protective effects of CABG compared with MT (HR,-1.60; 95%CI
1.78 to 3.25, P<0.001) and CABG compared with PCI (HR, 0.43; 95%CI 1.57 to
1.14, P<0.001) on combined eevents. The CABG also showed protective
effects on overall mortality over MT (HR, 0.38; 95%CI 1.11 to 2.35,
P=0.012). Furthermore, 10-year rates of freedom from angina were CABG 64%
PCI 59% and MT 43% (P<0.001). Conclusions: Compared with CABG, MT was
associated with a significantly higher incidence of subsequent MI, higher
rate of additional revascularization and higher incidence of cardiac death
and overall mortality, and consequently a 2.4 fold increased risk of
combined events. PCI was associated with an increased need for further
revascularization, a higher incidence of MI and a 1.57 fold increased risk
of combined events compared with CABG. Additionally, CABG was better than
MT at eliminating anginal symptoms.

<13>
Accession Number
70282297
Authors
Zhang S. Zhang L. Jiang H. Sun A. Wang K. Zou Y. Ge J.
Institution
(Zhang, Zhang, Jiang, Sun, Wang, Zou, Ge) Zhongshan Hospital of Fudan
University, Department of Cardiology, Shanghai, China
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2010 Stockholm Sweden. Conference Start: 20100828 Conference End:
20100901. Conference Publication: (var.pagings). 31 (pp 725), 2010.
Date of Publication: September 2010.
Publisher
Oxford University Press
Abstract
Purpose: Whether additional benefit can be achieved with the use of statin
in patients with chronic heart failure (CHF) remains undetermined. The
purpose of this meta-analysis is to evaluate the beneficial role of statin
on cardiac function in CHF patients. Methods: Pubmed, MEDLINE, EMBASE, and
EBM Reviews databases were searched for randomized controlled trials
comparing statin treatment with nonstatin treatment in patients with CHF.
Additional studies from cited references were also identified. Two reviews
independently assessed studies for inclusion and performed data
extraction. Weighted mean differences (WMD) with 95% confidence intervals
(CI) were calculated using random effects models. Results: Eleven trials
with 590 patients were included. Pooled analysis showed that statin
therapy was associated with significant increase in left ventricular
ejection fraction (LVEF) (WMD=3.35%, 95% CI 0.80% to 5.91%, P=0.01). The
beneficial effects of statin treatment were also demenstrated by the
reduction of left ventricular end-diastolic diameter (LVEDD) (WMD = -3.77
mm, 95% CI -6.24 to -1.31 mm, P=0.003), left ventricular end-systolic
diameter (LVESD) (WMD = -3.57 mm, 95% CI -6.37 to -0.76 mm, P=0.01),
B-type natriuretic peptide (BNP) (WMD = -83.17 pg/ml, 95% CI -121.29 to
-45.05 pg/ml, P<0.0001), and NYHA functional class (WMD = -0.30, 95% CI
-0.37 to -0.23, P<0.00001). Meta-regression showed statistically
significant association between LVEF improvement and follow-up duration
(p=0.03). No potential publication bias was found. Conclusions: The
current cumulative evidence suggests that use of statin in CHF patients
resulted in the improvement of left ventricular systolic function, as well
as the amelioration of left ventricular remodeling.

<14>
Accession Number
70283020
Authors
Crijns H.J.G.M. Borggrefe M. De Ferrari G.M. Milasinovic G. Smid J. Zabel
M. Gavazzi A. Klein H. Schwartz P.J.
Institution
(Crijns) Maastricht University Medical Center, Department of Cardiology,
Maastricht, Netherlands
(Borggrefe) University Hospital Mannheim, Mannheim, Germany
(De Ferrari, Schwartz) Foundation IRCCS Polyclinic San Matteo, Department
of Cardiology, Pavia, Italy
(Milasinovic) Clinical Center of Serbia, Belgrade, Serbia
(Smid) Otto-von-Guericke University of Magdeburg, Departement of
Cardiology, Magdeburg, Germany
(Zabel) Georg-August University Hospital Gttingen, Gttingen, Germany
(Gavazzi) Hospital Riuniti of Bergamo, Department of Cardiovascular,
Bergamo, Italy
(Klein) University Hospitals Rochester, Division of Cardiology, Rochester,
United States
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2010 Stockholm Sweden. Conference Start: 20100828 Conference End:
20100901. Conference Publication: (var.pagings). 31 (pp 917), 2010.
Date of Publication: September 2010.
Publisher
Oxford University Press
Abstract
Purpose: Chronic Vagus Nerve Stimulation (CVNS) has been proposed as a new
therapeutic option for patients with congestive heart failure (CHF). We
recently showed promising 6-month results for CVNSuse of the system in a
multicentre trial, which included significant improvement in NYHA class,
Quality of Life (QoL; Minnesota Living with HF), 6-min walk test (WT),
resting heart rate, HRV and left ventricular ejection fraction (LVEF). The
goal of the present analysis was to assess durability of the beneficial
effects of CVNS. Methods: Stable NYHA II-IV class CHF patients (n=32, age
56+/-11 years) were implanted with the CardioFit CVNS system consisting of
a nerve stimulator, a multipolar stimulation lead placed around the right
cervical vagus and a right ventricular sensing lead. Optimization of CVNS
occurred during a 3-week run-in period post-implant and patients were
followed for 12 months with continuous vagus nerve stimulation. Results:
At 6 months data were collected in 29 patients (3 died); and at 12 months
in 25 (3 additional deaths, 1 heart transplant). Using ANOVA followed by
Tukey HSD test, we found that all improvements shown at 6-months were
either maintained and still significant at 12-months; or further improved
during the 6-12 month interval (see table). Other parameters, such as left
ventricular end systolic volume (ESV) showed improvement at the latter
interval. (Table presented). Conclusions: Data from the CardioFit pilot
study indicate that the favorable effects of CVNS therapy in patients with
CHF are maintained, or even further magnified over long-term use of the
system. These findings need to be confirmed in larger controlled clinical
trials.

<15>
Accession Number
2010550730
Authors
van der Schaaf R.J. Claessen B.E. Hoebers L.P. Verouden N.J. Koolen J.J.
Suttorp M.J. Barbato E. Bax M. Strauss B.H. Olivecrona G.K. Tuseth V.
Glogar D. Ramunddal T. Tijssen J.G. Piek J.J. Henriques J.P.S.
Institution
(van der Schaaf, Claessen, Hoebers, Verouden, Tijssen, Piek, Henriques)
Department of Cardiology, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(van der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Koolen) Department of Cardiology, Catharina Ziekenhuis, Eindhoven,
Netherlands
(Suttorp) Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein,
Netherlands
(Barbato) Department of Cardiology, Onze Lieve Vrouwe Ziekenhuis, Aalst,
Belgium
(Bax) Department of Cardiology, Haga Teaching Hospital, The Hague,
Netherlands
(Strauss) Department of Cardiology, Sunnybrook Health Sciences Centre,
Toronto, Canada
(Olivecrona) Department of Cardiology, Lund University Hospital, Lund,
Sweden
(Tuseth) Department of Cardiology, Helse Bergen Hospital, Bergen, Norway
(Glogar) Department of Cardiology, Medical University of Vienna, Vienna,
Austria
(Ramunddal) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
Title
Rationale and design of EXPLORE: A randomized, prospective, multicenter
trial investigating the impact of recanalization of a chronic total
occlusion on left ventricular function in patients after primary
percutaneous coronary intervention for acute ST-elevation myocardial
infarction.
Source
Trials. 11 , 2010. Article Number: 89. Date of Publication: 21 Sep
2010.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Background: In the setting of primary percutaneous coronary intervention,
patients with a chronic total occlusion in a non-infarct related artery
were recently identified as a high-risk subgroup. It is unclear whether
ST-elevation myocardial infarction patients with a chronic total occlusion
in a non-infarct related artery should undergo additional percutaneous
coronary intervention of the chronic total occlusion on top of optimal
medical therapy shortly after primary percutaneous coronary intervention.
Possible beneficial effects include reduction in adverse left ventricular
remodeling and preservation of global left ventricular function and
improved clinical outcome during future coronary events.Methods/Design:
The Evaluating Xience V and left ventricular function in Percutaneous
coronary intervention on occLusiOns afteR ST-Elevation myocardial
infarction (EXPLORE) trial is a randomized, prospective, multicenter,
two-arm trial with blinded evaluation of endpoints. Three hundred patients
after primary percutaneous coronary intervention for ST-elevation
myocardial infarction with a chronic total occlusion in a non-infarct
related artery are randomized to either elective percutaneous coronary
intervention of the chronic total occlusion within seven days or standard
medical treatment. When assigned to the invasive arm, an
everolimus-eluting coronary stent is used. Primary endpoints are left
ventricular ejection fraction and left ventricular end-diastolic volume
assessed by cardiac Magnetic Resonance Imaging at four months. Clinical
follow-up will continue until five years.Discussion: The ongoing EXPLORE
trial is the first randomized clinical trial powered to investigate
whether recanalization of a chronic total occlusion in a non-infarct
related artery after primary percutaneous coronary intervention for
ST-elevation myocardial infarction results in a better preserved residual
left ventricular ejection fraction, reduced end-diastolic volume and
enhanced clinical outcome.Trial registration: trialregister.nl NTR1108.
2010 van der Schaaf et al; licensee BioMed Central Ltd.

<16>
Accession Number
2010553006
Authors
Chambers D. Worthy G. Myers L. Weatherly H. Elliott R. Hawkins N. Sculpher
M. Eastwood A.
Institution
(Chambers, Worthy, Myers, Eastwood) Centre for Reviews and Dissemination,
University of York, Heslington, York YO10 5DD, United Kingdom
(Worthy, Weatherly, Hawkins, Sculpher) Centre for Health Economics,
University of York, Heslington, York, United Kingdom
(Elliott) School of Pharmacy, University of Manchester, Manchester, United
Kingdom
(Elliott) Leeds Clinical Trials Unit, 71-75 Clarendon Road, Leeds LS2 9PH,
United Kingdom
(Chambers) School of Pharmacy, University of Nottingham, Nottingham NG7
2RD, United Kingdom
Title
Glycopeptide vs. non-glycopeptide antibiotics for prophylaxis of surgical
site infections: A systematic review.
Source
Surgical Infections. 11 (5) (pp 455-462), 2010. Date of Publication: 01
Oct 2010.
Publisher
Mary Ann Liebert Inc. (140 Huguenot Street, New Rochelle NY 10801-5215,
United States)
Abstract
Background: Patients receive prophylactic antibiotics against surgical
site infections (SSIs) before or during many procedures. Glycopeptide
antibiotics are effective against most strains of methicillin-resistant
Staphylococcus aureus (MRSA), but their wider use risks increasing
resistance. Our objective was to review the evidence for clinical
effectiveness that might help to determine whether there is a threshold of
MRSA prevalence at which switching from non-glycopeptide to glycopeptide
antibiotic prophylaxis might be justified. Methods: We performed a
systematic review of randomized trials comparing a glycopeptide with an
alternative antibiotic regimen for SSI prophylaxis in adults undergoing
clean or clean-contaminated surgical procedures. The evidence was used to
inform development of a decision-analytic model. We subsequently updated
the review to May 2008. Results: Fourteen studies were identified that
provided evidence concerning clinical effectiveness. The studies were too
heterogeneous clinically for meta-analysis. Only one of 12 trials found
that glycopeptides reduced SSIs significantly at 30 days compared with
non-glycopeptide antibiotics. Of the two trials that reported on MRSA
infection, neither found a significant difference between glycopeptide and
comparator drugs. Conclusions: This systematic review did not find any
evidence to support the use of glycopeptides in preference to other
antibiotics for the prevention of MRSA infections and SSIs. The
limitations of the evidence make it difficult to identify a threshold at
which a switch from non-glycopeptide to glycopeptide prophylaxis should be
recommended. Given the difficulties of addressing this issue through
randomized trials, further research should focus on hospital infection
control policies, MRSA screening, and the isolation and treatment of
anyone infected with MRSA prior to surgery. 2010, Mary Ann Liebert, Inc.

<17>
Accession Number
2010560640
Authors
Safian R.D. Jaff M.R. Bresnahan J.F. Foster M. Bacharach J.M. Yadav J.
Joye J. Myla S. Kassab E. Mann J.T. Ansel G.M.
Institution
(Safian) Department of Interventional Cardiology and Vascular Medicine,
William Beaumont Hospital, Heart Center, Royal Oak, MI 48073, United
States
(Jaff) Mayo Clinic, Rochester, MN, United States
(Bresnahan) Massachusetts General Hospital, Boston, MA, United States
(Foster) Baptist Heart Institute, Nashville, TN, United States
(Bacharach) North Central Heart Hospital of South Dakota, Sioux Falls, SD,
United States
(Yadav) Cleveland Clinic Foundation, Cleveland, OH, United States
(Joye) El Camino Hospital, Mountainview, CA, United States
(Myla) Hoag Memorial Hospital, Newport Beach, CA, United States
(Kassab) Oakwood Hospital, Dearborn, MI, United States
(Mann) Wake Heart Associates, Raleigh, NC, United States
(Ansel) Riverside Methodist Hospital, Columbus, OH, United States
Title
Protected carotid stenting in high-risk patients: Results of the SpideRX
arm of the carotid revascularization with ev3 arterial technology
evolution trial.
Source
Journal of Interventional Cardiology. 23 (5) (pp 491-498), 2010. Date of
Publication: October 2010.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Purpose: A prospective nonrandomized multicenter registry of 160 patients
with severe carotid stenosis and high-risk features for carotid
endarterectomy was conducted during the 3-month period from March to May
2005. Methods: Carotid artery stenting (CAS) was performed with the
SpideRX Embolic Protection System (ev3, Inc., Plymouth, MN, USA) as part
of an investigational device exemption from the Food and Drug
Administration. Results: The primary end-point of major adverse cardiac
and cerebrovascular events at 30 days after CAS was observed in nine
patients (5.6%), including death in four patients (2.5%), nonfatal stroke
in five patients (3.1%), and nonfatal myocardial infarction in one patient
(0.6%). A secondary end-point of technical success (defined as successful
deployment of all devices, filter retrieval, and final diameter stenosis
<50%) was achieved in 156 of 160 patients (97.5%). The only independent
predictor of death or stroke at 30 days was baseline stenosis severity (P
< 0.05). Conclusion: CAS with distal embolic protection using the SpideRX
Embolic Protection System is a reasonable alternative for
revascularization of some high-risk patients with severe carotid stenosis.
2010, Wiley Periodicals, Inc.

<18>
Accession Number
2010563796
Authors
Kaptein E.M. Sanchez A. Beale E. Chan L.S.
Institution
(Kaptein, Sanchez, Beale) Department of Medicine, University of Southern
California, Los Angeles, CA 90033, United States
(Chan) Department of Biostatistics and Outcomes Assessment, Los Angeles
County, University of Southern California Medical Center, Los Angeles, CA
90033, United States
Title
Thyroid hormone therapy for postoperative nonthyroidal illnesses: A
systematic review and synthesis.
Source
Journal of Clinical Endocrinology and Metabolism. 95 (10) (pp 4526-4534),
2010. Date of Publication: October 2010.
Publisher
Endocrine Society (8401 Connecticut Ave. Suite 900, Chevy Chase MD 20815,
United States)
Abstract
Context: Effects of thyroid hormone therapy on postoperative morbidity and
mortality in adults remain controversial. Objective: The aim was to
conduct a systematic review evaluating effects and risks of postoperative
T₃ therapy in adults. Data Sources: Electronic databases and
reference lists through March 2010 were searched. Study Selection: Studies
with comparable control groups comparing T₃ to placebo therapy
in randomized controlled trials were selected. Data Extraction: Two
reviewers independently screened and reviewed titles, abstracts, and
articles. Data were abstracted from 14 randomized controlled trials (13
cardiac surgery and one renal transplantation). In seven studies, iv
T₃ was given in high doses (0.175-0.333 mug/kgh) for 6 to 9 h,
in four studies iv T₃ was given in low doses (0.0275-0.0333
mug/kgh for 14 to 24 h), and in three studies T₃ was given
orally in variable doses and durations. Data Synthesis: Both high- and
low-dose iv T₃ therapy increased cardiac index after coronary
artery bypass surgery. Mortality was not significantly altered by
high-dose iv T₃ therapy and could not be assessed for low-dose
iv or oral T₃. Effects on systemic vascular resistance, heart
rate, pulmonary capillary wedge pressure, new onset atrial fibrillation,
inotrope use, serum TSH and T₄ were inconclusive. Limitations:
Numbers of usable unique studies and group sizes were small. Duration of
T₃ therapy was short, and dosages and routes of administration
varied. Conclusions: Short duration postoperative iv T ₃
therapy increases cardiac index and does not alter mortality. Effects on
other parameters are inconclusive. Copyright 2010 by The Endocrine
Society.

<19>
Accession Number
2010561604
Authors
Goncu M.T. Sezen M. Toktas F. Ari H. Gunes M. Tiryakioglu O. Yavuz S.
Institution
(Goncu, Sezen, Toktas, Gunes, Tiryakioglu, Yavuz) Department of
Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research
Hospital, Bursa, Turkey
(Ari) Department of Cardiology, Bursa Yuksek Ihtisas Education and
Research Hospital, Bursa, Turkey
Title
Effect of antegrade graft cardioplegia combined with passive graft
perfusion in on-pump coronary artery bypass grafting.
Source
Journal of International Medical Research. 38 (4) (pp 1333-1342), 2010.
Date of Publication: 2010.
Publisher
Field House Publishing LLP (6 Sompting Avenue, Worthing BN14 8HN, United
States)
Abstract
Patients undergoing on-pump coronary artery bypass graft (CABG) with
proximal graft anastomosis were randomly divided into groups that received
antegrade cardioplegic infusion only via the aortic root (group A) or
antegrade cardioplegic infusion via the aortic root and additional
cardioplegia via vein or free arterial grafts after completion of each
distal anastomosis (group B). The group B patients also received bypass
graft perfusion with warm arterial blood just after removal of the
cross-clamp until the proximal graft anastomosis was completed. The need
for defibrillation and inotropic support during separation from
cardiopulmonary bypass (CPB), and total CPB time were significantly lower
in group B than in group A. Group B also had significantly lower peak
cardiac troponin I levels 12 h after operation compared with group A and
this was more pronounced in subgroups with severe right coronary artery
stenosis and poor left ventricular ejection fraction than in the whole
population. It is concluded that antegrade graft cardioplegia and graft
perfusion with warm blood during proximal graft anastomosis may improve
myocardial protection. 2010 Field House Publishing LLP.