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<1>
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Accession Number
2010275292
Authors
Leonardi R.A. Kransdorf E.P. Simel D.L. Wang A.
Institution
(Leonardi) Medical University of South Carolina, Charleston, SC, United
States
(Kransdorf, Wang) Duke University, Medical Center, Durham, NC, United
States
(Simel) Durham Veterans Affairs Medical Center, Duke University, Medical
Center, Durham, NC, United States
Title
Meta-analyses of septal reduction therapies for obstructive hypertrophic
cardiomyopathy comparative rates of overall mortality and sudden cardiac
death after treatment.
Source
Circulation: Cardiovascular Interventions. 3 (2) (pp 97-104), 2010. Date
of Publication: April, 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background:Septal reduction for obstructive hypertrophic cardiomyopathy
may be performed by surgical myectomy or alcohol septal ablation (ASA).
Unlike surgical myectomy, ASA creates an intramyocardial scar that may
potentiate the risk of ventricular arrhythmias and sudden cardiac death
(SCD). Methods and Results:Systematic reviews for ASA and surgical
myectomy were performed. Study selection and data extraction were
completed independently by 2 investigators. Comparative data analyses were
completed using a random effects model and regression analysis. Kappa
statistics for agreement on initial study inclusion were high for both ASA
(0.78; 95% CI, 0.68 to 0.88) and surgical myectomy studies (0.95; 95% CI,
0.84 to 1.0). Nineteen ASA studies (2207 patients) and 8 surgical myectomy
studies (1887 patients) were included. Median follow-up was shorter for
ASA than for myectomy studies (51 versus 1266 patient-years; P<0.001). For
ASA and surgical myectomy, unadjusted rates (events/patient-years) of
all-cause mortality (0.021 versus 0.018, respectively; P=037) and SCD
(0.004 versus 0.003, respectively; P=036) were similar. Patients treated
with ASA were older (weighted mean, 55 versus 44 years; P<0.001) and had
less septal hypertrophy (weighted mean, 21 versus 23 mm; P<0.001) compared
with those treated with myectomy. After adjustment for available baseline
characteristics, odds ratios for treatment effect on all-cause mortality
and SCD were 0.28 (95% CI, 0.16 to 0.46) and 0.32 (95% CI, 0.11 to 0.97),
respectively, favoring ASA. Conclusions:Rates of all-cause mortality and
SCD after both ASA and surgical myectomy were similarly low. Adjusted for
baseline characteristics, the odds ratios for treatment effect on
all-cause mortality and SCD were lower in ASA cohorts compared with
surgical myectomy cohorts. 2010 American Heart Association, Inc.

<2>
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Accession Number
2010303935
Authors
Niiranen T.J. Hanninen M.-R. Johansson J. Reunanen A. Jula A.M.
Institution
(Niiranen, Hanninen, Johansson, Jula) Population Studies Unit, National
Institute for Health and Welfare, Peltolantie 3, 20720 Turku, Finland
(Niiranen) Department of Medicine, Turku University Hospital, Turku,
Finland
(Reunanen) Living Conditions, Health and Wellbeing Unit, National
Institute for Health and Welfare, Helsinki, Finland
Title
Home-measured blood pressure is a stronger predictor of cardiovascular
risk than office blood pressure: The finn-home study.
Source
Hypertension. 55 (6) (pp 1346-1351), 2010. Date of Publication: June
2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Previous studies with some limitations have provided equivocal results for
the prognostic significance of home-measured blood pressure (BP). We
investigated whether home-measured BP is more strongly associated with
cardiovascular events and total mortality than is office BP. A prospective
nationwide study was initiated in 2000 to 2001 on 2081 randomly selected
subjects aged 45 to 74 years. Home and office BP were determined at
baseline along with other cardiovascular risk factors. The primary end
point was incidence of a cardiovascular event (cardiovascular mortality,
nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart
failure, percutaneous coronary intervention, or coronary artery bypass
graft surgery). The secondary end point was total mortality. After a mean
follow-up of 6.8 years, 162 subjects had experienced a cardiovascular
event, and 118 subjects had died. In Cox proportional hazard models
adjusted for other cardiovascular risk factors, office BP
(systolic/diastolic hazard ratio [HR] per 10/5 mm Hg increase in BP,
1.13/1.13; systolic/diastolic 95% confidence interval [CI], 1.05 to
1.22/1.05 to 1.22) and home BP (HR, 1.23/1.18; 95% CI, 1.13 to 1.34/1.10
to 1.27) were predictive of cardiovascular events. However, when both BPs
were simultaneously included in the models, only home BP (HR, 1.22/1.15;
95% CI, 1.09 to 1.37/1.05 to 1.26), not office BP (HR, 1.01/1.06; 95% CI,
0.92 to 1.12/0.97 to 1.16), was predictive of cardiovascular events.
Systolic home BP was the sole predictor of total mortality (HR, 1.11; 95%
CI, 1.01/1.23). Our findings suggest that home-measured BP is
prognostically superior to office BP. On the basis of the results of this
and previous studies, it can be concluded that home BP measurement offers
specific advantages more than conventional office measurement. 2010
American Heart Association, Inc.

<3>
Accession Number
2010580424
Authors
Leal-Noval S.R. Munoz-Gomez M. Arellano V. Adsuar A. Jimenez-Sanchez M.
Corcia Y. Leal M.
Institution
(Leal-Noval, Arellano, Jimenez-Sanchez, Corcia) Critical Care Division,
School of Medicine, University of Malaga, Spain
(Munoz-Gomez) Transfusion Medicine, School of Medicine, University of
Malaga, Spain
(Adsuar) Cardiac Surgery Division, Hospital Universitario Virgen Del
Rocio, Seville, Spain
(Leal) Service of Infectious Diseases, Hospital Universitario Virgen Del
Rocio, Seville, Spain
Title
Influence of red blood cell transfusion on CD4+ T-helper cells immune
response in patients undergoing cardiac surgery.
Source
Journal of Surgical Research. 164 (1) (pp 43-49), 2010. Date of
Publication: November 2010.
Publisher
Academic Press Inc. (6277 Sea Harbor Drive, Orlando FL 32887-4900, United
States)
Abstract
Background: Both surgical insult and red blood cell transfusion (RBCT)
induce alterations in type-1/type-2, CD4 T-helper cell balance. This study
was aimed to determine the influence of RBCT on Th1 and Th2 function
immune response in cardiac surgery patients. Material and Methods: Three
blood samples were prospectively drawn from 81 cardiac surgery patients
with cardiopulmonary bypass (CPB): preoperatively (preOP), during CPB,
before RBCT (intraOP), and on postoperative day 1 (postOP). Immune
response was assessed by flow cytometry measurement of the proportion of
CD4⁺ T-helper cells producing tumor necrosis factor (TNF)-alpha
[Th1 response] and interleukin (IL)-10 [Th2 response]. Results: Sixty-two
patients were transfused (3.4 +/- 2.3 units/patient), whereas 19 did not.
Both groups were homogeneous, both at baseline and during surgery,
regarding multiple perioperative clinical and laboratory variables, but
postoperative blood loss and transfused RBC units were significantly
higher in transfused versus nontransfused patients. In contrast,
preoperative hemoglobin was significantly higher in nontransfused
patients. CD4⁺ T-helper cells significantly decreased in both
groups of patients from preOP to intraOP 1 and from intraOP to postOP. In
nontransfused patients, there were no significant changes in
CD4⁺ T-helper cells expressing TNFalpha or IL-10 among
different sampling times. In contrast, RBCT resulted in a significant
increment in Th2 response from intraOP to postOP (P = 0.01), without
affecting Th1 response. Conclusion: RBCT, but not surgery or CPB, induces
a shift of the Th1/Th2 balance toward Th2 dominance. 2010 Elsevier Inc.
All rights reserved.

<4>
Accession Number
2010580462
Authors
Li L. Luo W. Huang L. Zhang W. Gao Y. Jiang H. Zhang C. Long L. Chen S.
Institution
(Li, Luo, Huang, Zhang, Gao, Jiang, Zhang, Long, Chen) Department of
Cardiothoracic Surgery, Xiangya Hospital, Central South University,
Changsha, Hunan, 410008, China
Title
Remote perconditioning reduces myocardial injury in adult valve
replacement: A randomized controlled trial.
Source
Journal of Surgical Research. 164 (1) (pp e21-e26), 2010. Date of
Publication: November 2010.
Publisher
Academic Press Inc. (6277 Sea Harbor Drive, Orlando FL 32887-4900, United
States)
Abstract
Background: Remote perconditioning has been proved to reduce myocardial
infarction and improve ventricular function in vivo. This study aims to
determine the protection of remote perconditioning against cardiac
reperfusion injury in patients undergoing valve replacement. Methods:
Eighty-one patients admitted for selective valve replacement were divided
into three groups randomly. Control patients (con. n = 27) underwent sham
placement of the tourniquet around the right thigh without inflation; the
remote preconditioning group (pre. n = 26) received three cycles of 4/4
min right lower limb ischemia and reperfusion after induction of
anesthesia, the limb ischemia was induced by the tourniquet inflated to
600 mmHg; the remote perconditioning group (per. n = 28) received the same
stimulus immediately after aortic cross-clamping. Venous blood samples
were obtained preoperatively, 5 min before declamping, 30 min, 4, 12, and
72 h after declamping for detecting troponin I (cTnI) concentration. The
clinical data of inotrope requirement, drainage, ventilation. and
intensive care time were routinely recorded. Results: The remote
perconditioning group had significantly lower release of cTnI 5 min before
declamping (con. versus pre. versus per., 0.15 +/- 0.10 versus 0.13 +/-
0.08 versus 0.10 +/- 0.04 ng/mL, P = 0.050) and 30 min after declamping
(con. versus pre. versus per., 0.40 +/- 0.24 versus 0.41 +/- 0.40 versus
0.24 +/- 0.13 ng/mL, P = 0.043). Less incidence of defibrillation were
observed in the remote perconditioning groups. Conclusions: Remote
perconditioning, which is induced by transient lower limb ischemia after
aortic cross-clamping, reduces myocardial injury over cardioplegia in
adults undergoing selective valve replacement. 2010 Elsevier Inc. All
rights reserved.

<5>
Accession Number
70287878
Authors
Doree C. Brunskill S.J. Stanworth S. Murphy M.F.
Institution
(Doree, Brunskill) Systematic Review Initiative, John Radcliffe Hospital,
Oxford, United Kingdom
(Stanworth, Murphy) NHSBT John Radcliffe Hospital, NHSBT Oxford Radcliffe
Hospitals Trust, United Kingdom
Source
Transfusion Medicine. Conference: 28th Annual Scientific Meeting of the
British Blood Transfusion Society Bournemouth United Kingdom. Conference
Start: 20100909 Conference End: 20100911. Conference Publication:
(var.pagings). 20 (pp 41), 2010. Date of Publication: October 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Background As systematic reviews are generally considered to be the
optimal method for summarising evidence of effectiveness, it is important
that they are readily accessible to practitioners considering blood
component transfusion. However, until recently, finding up-to-date,
high-quality systematic reviews relevant to transfusion medicine often
meant searching multiple medical databases - a highly-skilled,
time-consuming procedure inevitably resulting in a large number of search
results. Methods As a solution, NHSBT's Systematic Review Initiative
(SRI), in association with the UK Blood Transfusion Services (UKBTS), has
developed a comprehensive online library of systematic reviews relevant to
transfusion medicine. The resulting Transfusion Evidence Library (TEL) has
been compiled according to strict methodological criteria, with
tried-and-tested strategies and filters used for systematically searching
the major medical databases for all transfusion-related systematic
reviews. In addition, the proceedings of all major transfusion-related
conferences were retrospectively handsearched for unpublished systematic
reviews. All relevant systematic reviews were then quality appraised,
indexed in-house for ease of searching, given abstract and full text links
(where available) and imported into a bespoke database with advanced
searching functionality. Results Launched in September 2009, the TEL now
contains more than 430 systematic reviews covering such topics as red
cells in cardiac surgery, critical care and obstetrics; autologous
transfusion (including cell salvage, PAD and ANH); stem cells for
haematological malignancies; volume replacement in surgery; and the use of
immunoglobulins, anti-fibrinolytics, recombinant erythropoietin and factor
VIIa in a variety of clinical settings. The TEL offers simple and advanced
searching options, including the ability to combine, edit and delete
searches using the Search History, and to email, save and print search
results. Conclusion Rather than having to search a number of different
databases in order to access the best evidence relating to a clinical or
research question, the TEL provides a 'one-stop shop' for all current,
high-quality systematic reviews relevant to transfusion medicine. The TEL
is updated monthly and can be freely accessed at:
http://www.transfusionguidelines.org.uk.

<6>
Accession Number
70288641
Source
Transfusion. Conference: AABB Annual Meeting and CTTXPO Baltimore, MD
United States. Conference Start: 20101009 Conference End: 20101012.
Conference Publication: (var.pagings). 50 , 2010. Date of Publication:
September 2010.
Publisher
Blackwell Publishing Inc.
Abstract
The proceedings contain 725 papers. The topics discussed include: blood
donation screening for Hepatitis B virus markers in the era of nucleic
acid testing: all tests are of value but no one alone is sufficient;
evidence for the existence of a functional Fas receptor signaling pathway
in blood platelets; a randomized controlled trial comparing autologous
radio-labeled in vivo platelet recoveries and survivals of 7-day stored
PRP and buffy coat platelets from the same donors; transfusion-related
acute lung injury in cardiac surgery patients is hemerus characterized by
systemic inflammation prior to onset of disease, followed by pulmonary
activation of inflammation and coagulopathy; the effect of platelet
characteristics on the platelet increment and HLA alloimmunization in
hypoproliferative thrombocytopenia; improved safety for young whole blood
donors with new selection criteria for total blood volume; and
distribution of HIV viral loads in US (Clade B) and South Africa (Clade C)
NAT yield donors.

<7>
Accession Number
70288723
Authors
Rousseau H. Chabbert V. Marcheix B.
Institution
(Rousseau, Chabbert) Dept. of Radiology, CHU Rangueil, Toulouse, France
(Marcheix) Cardiovascular Surgery, CHU Rangueil, Toulouse, France
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2010 Valencia
Spain. Conference Start: 20101002 Conference End: 20101006. Conference
Publication: (var.pagings). 33 (pp 85-87), 2010. Date of Publication:
September 2010.
Publisher
Springer New York
Abstract
Endovascular treatment for aortic disease has emerged as an alternative
mode of treatment that is particularly attractive for patients with severe
comorbidities who would not be ideal candidates for open surgery. Although
endoluminal interventions are minimally invasive, they are associated with
complications, as are all surgical methods. The aim of this paper is to
give an overview on thoracic aortic stent-graft complications with focus
on failure modes and potential improvements. Procedure-Related Problems
Successful thoracic aneurysm repair could be attained today in 98% to 100%
of cases. Adverse events will occur after stent-graft placement in a
minority of cases, and many of these complications can be diagnosed and
managed with minimally invasive techniques. Access Vessel Issues Access
related issues comprise a major reason for failure or conversion to open
repair and can contribute to a significant amount of morbidity and
mortality. Iliac artery trauma may occur when a stentgraft is forced
through a small or tortuous iliac artery. Vascular trauma is especially
likely in cases involving small, heavily or circumferentially calcified
iliac arteries. Most iliac artery traumas may be treated with stents or
stent-grafts, although surgical endarterectomy or bypass may also be
required. Preoperative imaging is paramount to the success of endovascular
procedures. Occasionally, challenging iliac or femoral anatomy may
preclude access through these vessels and may need to gain direct access
through the aorta or via the carotid or subclavian artery. Stent-Graft
Misplacement Stent-graft misplacement may occur when: (a) the blood
pressure is too high during deployment or balloon dilation of the
stent-graft and caused a wind sock effect, particularly when proximal
fixation is at or near the aortic arch. To avoid this problem, blood
pressure must be lowered with vasodilator or beta-blocker drugs, or (b)
the stent-graft is positioned across an angulated arterial segment, which
may cause the introducer sheath to kink. Stent-graft misplacement can be
prevented by using a more flexible stent-graft and by covering a longer
segment in an angulated anatomic structure. Whenever insufficient lesion
coverage results from stent-graft misplacement, a stent-graft extension
should be put in place to adequately cover the landing zone. Accidental
coverage of a branch vessel with the stentgraft is more difficult to
manage. However, treatment may consist of positioning a bare stent so that
it protrudes from within the origin of the covered vessel, thereby
displacing the covering stent-graft membrane and restoring blood flow to
the branch vessel. Aortic Perforation Aortic perforation may occur during
stent-graft insertion and is easily recognized as a rapidly enlarging
hematoma or hemothorax. Rapid covering of the perforation with a
stent-graft is the first treatment option. Aortic perforation may also
occur after stent-graft insertion due to erosion of the aortic wall by
stent-graft struts. These perforations may be asymptomatic or may lead to
aortic rupture or fistula formation. Endoleaks Type 1 endoleaks result
from incomplete sealing of the stent-graft at the proximal or distal
attachment site. They occur more frequently when: (a) the stent-graft
landing zones are short, irregular, or ulcerated, (b) a suboptimal
stent-graft diameter has been selected, or (c) the stent-graft is
positioned across an angulated neck or in a narrow aortic arch and does
not conform to the curved aortic contour. To maximize the neck length, we
can use the distance between the origins of the left common carotid artery
and left subclavian artery, occluding the LSA when necessary. In our
experience, overstenting the left subclavian artery has not led so far to
any particular complications. However, prior to doing so, we make sure
that there is no right vertebral artery stenosis or absent vertebral
collateral pathway. Secondary to obstruction of the LSA, if there is
reduced perfusion of the left arm, surgical bypass can be performed
electively in a second procedure. Type 2 endoleaks result from persistent
circulation in the aneurysm from a tributary to the aortic lumen excluded
by the stent-graft. These endoleaks are less common in the region of the
thoracic aorta than in the abdominal aortic region. In case of aortic
diameter increase, selective embolisation by the collaterals or injection
of thrombin by a direct puncture of the aorta can be proposed. Type 3
endoleaks arise from a defect of the stent-graft membrane itself or from
the separation of components in modular stent-grafts. These endoleaks
often result from stent-graft disconnection, which is more likely to occur
when multiple stent-grafts with short overlapping areas are used. Type 1
and type 3 endoleaks may be treated with insertion of another stent-graft.
Retrograde Dissection The most alarming complication is the retrograde
type A dissection after implantation of the stent-graft. Bare springs of
the stent-graft could perforate the medial layer of the aortic wall during
the implantation in a very kinked arch but cases of secondary dissection
were also described with other devices. For these reasons, some prefer not
to use stent-grafts that are too rigid or with bare-springs. Also,
ballooning for stent-graft apposition is one of the possible etiologic
factors of intimal tear. In a recent European Registry on EVAR
Complications, it was demonstrated that incidence of retrograde dissection
was low (1.33%) and was associated with significant mortality (42%) (H.
Eggebrecht et al., Circulation, 2009). Patients undergoing TEVAR for
(acute) type B dissection appeared to be most prone for the occurrence of
this complication which occurred during the index hospital ization as well
as after discharge and during mid-term follow-up. Recently, many authors
reported the late formation of new intimal tear resulting in
pseudoaneurysm or dissection at the margin of the stent-graft. Many
articles suggested that the causes of intimal tears were mechanical injury
secondary to sharp stent tip, inflexibility of the stent-graft and the
pulsatile forces in the aorta normally at curved portion of aorta where
stent-graft and intima meet at an angle. If found, additional stent-graft
placement must be performed for the management of these patients. To avoid
these complications, many authors suggest covering longer portions of the
descending aorta until it fits the parallel portion of the aortic wall or
intima and the development of stent-grafts with smoother edges and more
flexible bodies. Mortality Mortality is the most important criterion in
appraising the results of TAA treatment. Conventional intervention carries
a mortality rate that ranges between 3 and 26%, up to 75% for emergency
repair. In a recent meta-analysis of thoracic stent grafts (Walsh S et al.
JVS 2008), the thirty-day mortality was 5.57% in elective situation versus
16% in emergency. Post Implantation Syndrome The incidence of transient
post-implantation syndrome (fever, leukocytosis and elevated C-reactive
protein) is known to be 20 to 60%. The syndrome is suggested to be a
nonspecific systemic inflammatory reaction rather than a true infection.
Patients usually recover with conservative treatments in 2 to 10 days.
Pleural effusion and platelet count drop are frequent but mysterious
complications of stent-graft in aortic dissection. It could originate from
foreign body irritation to the adjacent pleura. It usually resolves
spontaneously within 3 months after the intervention. The platelet count
drop is observed in 1/3 of cases 1 to 3 days after stent-graft insertion.
It returned to initial base line values in 5 to 10 days without
transfusion or any other treatment. Because all cases of platelet count
drop occurred in patients whose former patent false lumen had been
obliterated by thrombus formation, consumptive coagulopathy is suggested
to be the cause of this transient complication. Paraplegia and
Cerebrovascular Accidents Although no randomized trials have been
conducted comparing stent-graft placement with surgery for thoracic aortic
disease, paraplegia seems less likely with stent-graft placement than with
surgery. Paraplegia is crucially influenced by the duration of aortic
clamping in the open thoracic aortic operation. Despite many improvements
in the technique, the rates of paralysis in conventional open surgery
range from 1.5 to 19% in high-volume centers. Absence of thoracotomy and
cross-clamping of the aorta are the main advantages of endovascular
repair. However, since a large number of intercostal arteries are acutely
occluded, especially when long stent-grafts are implanted, paralysis can
still occur. In the largest meta-analysis of endovascular TAA repairs
reported, the rate of paraplegia is 5.4% (Walsh S et al. JVS 2008). This
complication seems to be significantly more frequent in patients
undergoing concurrent AAA repair or who had undergone AAA repair earlier.
Successful treatment of stent-graft-induced paralysis with drainage of
cerebrospinal fluid has been reported. The neurological complications are
less frequent in case of dissection (0.8% of paraplegia and 1.9% of stroke
in the meta-analysis of H. Eggebrecht et al., Eur Heart J 2006) Strokes
are caused by the manipulation of wires and catheters in an
atherosclerotic aortic arch. The incidence of this complication is
actually now lower with the new endografts. To keep the embolic risk low,
the tip of the delivery system should be as short and flexible as
possible, no manipulation on artificial aortic valves should be done where
clots could be present and good anticoagulation is mandatory.

<8>
Accession Number
70288922
Authors
Das R. Ahmed K. Athanasiou T. Morgan R.A. Belli A.-M.
Institution
(Das, Morgan, Belli) Department of Radiology, St George's Hospital,
London, United Kingdom
(Ahmed, Athanasiou) Academic Department of Surgery, St Mary's Hospital,
Imperial College Healthcare NHS Trust, London, United Kingdom
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2010 Valencia
Spain. Conference Start: 20101002 Conference End: 20101006. Conference
Publication: (var.pagings). 33 (pp 205-206), 2010. Date of Publication:
September 2010.
Publisher
Springer New York
Abstract
Purpose: The use of arterial closure devices (ACDs) in interventional
radiological (IR) procedures has not yet been validated by largescale
randomised trial or meta-analysis. Improved haemostasis and early
mobilisation are publicised advantages; however, anecdotal evidence of
haemorrhagic and ischaemic complications is also apparent. Meta-analysis
from interventional cardiology cannot be directly extrapolated for IR
patients. Materials and Methods: Literature search was performed using
MEDLINE, Cochrane and Google Scholar databases to assess 4 ACDs:
Angioseal; Starclose; Perclose; and Duett versus manual compression.
Included interventions were: peripheral vascular interventions; uterine
artery embolisation; transhepatic chemoembolisation and
neurointerventional procedures. Cardiac and non-femoral procedures were
excluded. Outcomes assessed were: device failure; haematoma; bleeding;
groin pain; retroperitoneal haematoma; arteriovenous fistula; infection;
distal ischaemia; need for vascular surgery and for manual compression.
Random-effects models were used for meta-analysis with tests of
heterogeneity performed. Results: A total of 32 studies were analysed. 19
non-comparative (3304 patients) and 13 comparative studies were analysed
separately with meta-analysis performed on 10 studies (2373 patients).
Metaanalysis demonstrated total complication rates of all 4 ACDs versus
manual compression of (odds ratio (OR) 0.87: 95%CI 0.52-1.48, p=0.13).
Total complication rates of Angioseal versus manual compression were (OR
0.84: 95%CI 0.53-1.34, p=0.49) and Perclose versus manual compression were
(OR 1.29: 95%CI 0.19-8.96, p=0.01). Conclusion: Meta-analyses demonstrate
no statistically significant difference between ACDs and manual
compression. A marginal trend favouring Angioseal over manual compression,
and favouring manual compression over Perclose was seen, but heterogeneity
factors make conclusion difficult. Adequately powered randomised
controlled trials are required to further elucidate the efficacy of ACDs.

<9>
Accession Number
70290748
Authors
Rahman J. Stacey S. Catolico M. Mir F.A.
Institution
(Rahman, Mir) Royal London Hospital, London, United Kingdom
(Stacey, Catolico) London Chest Hospital, London, United Kingdom
Source
Intensive Care Medicine. Conference: 23rd Annual Congress of the European
Society of Intensive Care Medicine, ESICM Barcelona Spain. Conference
Start: 20101009 Conference End: 20101013. Conference Publication:
(var.pagings). 36 (pp S218), 2010. Date of Publication: September 2010.
Publisher
Springer Verlag
Abstract
INTRODUCTION. The prevalence of diabetes mellitus in patients requiring
cardiac surgery is rapidly increasing. These patients have higher
perioperative morbidity and mortality, significantly reduced long-term
survival, and less freedom from recurrent episodes of angina. The
postoperative care is complicated by the glucose control regimes
maintaining optimal levels of blood glucose and avoiding the harmful
effects of hypoglycaemia. Trials examining the effects of tighter glucose
control have had conflicting results. Systematic reviews and meta-analyses
have also led to differing conclusions and there is currently no clearly
defined optimal blood glucose level peri operatively. OBJECTIVES. Our
survey aimed to assess whether the blood glucose level at which sliding
scale insulin was started had any relation to increased episodes of
hypoglycaemia in cardiac surgical patients. METHODS. We conducted
prospective survey on patients having cardiac surgery, operated during a
period of 2 months.Atotal of 59 patients were operated on and included 58
on pump and 1 off pump surgeries. Out of these 11(18.64%) were known
diabetics. RESULTS. None of the patients who were put on the sliding scale
with the blood glucose level greater than 8 mmol/l as per protocol in our
hospital, developed hypoglycaemia. CONCLUSION. The results of our survey
suggested that the optimal blood glucose level for starting sliding scale
insulin is between 8 and 10 mmol/l as opposed to the previously used level
of 4-6 mmol/l in our unit.Our previous survey conducted a year ago, using
4-6 mmol/l as the optimal range for blood glucose level showed a higher
incidence of hypoglycaemic episodes during the peri operative period.

<10>
Accession Number
70290765
Authors
Bachleda T. Firment J. Tassani-Prell P.
Institution
(Bachleda, Tassani-Prell) German Heart Centre Munich, Technical University
Munich, Institute of Anaesthesiology, Munich, Germany
(Firment) Faculty of Medicine, Pavol Jozef Safarik University, 1st
Department of Anaesthesiology and Intensive Medicine, Kosice, Slovakia
Source
Intensive Care Medicine. Conference: 23rd Annual Congress of the European
Society of Intensive Care Medicine, ESICM Barcelona Spain. Conference
Start: 20101009 Conference End: 20101013. Conference Publication:
(var.pagings). 36 (pp S222), 2010. Date of Publication: September 2010.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Before the era of modern opioids, electroacupuncture was
used to provide analgesia for many types of surgery, including open heart
surgery. OBJECTIVES. To compare electroacupuncture-anaesthesia (EAA) and
conventional opioidanalgesia (OA) with respect to the duration of
postoperative mechanical ventilation (MV) and early postoperative pain
scores following open heart surgery. METHODS. Prospective blinded
randomized controlled trial involving 34 patients undergoing primary
elective coronary artery bypass graft (CABG) or valve surgery. Exclusion
criteria were: BMI[35, diabetes, age[75 years, ejection fraction (EF)<30%,
ASA[III, reduced pulmonary function (FEV1 and FVC<50%), combination
operations (e.g. CABG + valve surgery), pre-operative alcohol or drug
abuse, severe neurological or psychiatric disease, inability to give
informed consent. In both groups anaesthesia was induced in a standard
manner with etomidate, sufentanil, midazolam and rocuronium. In the EAA
group 3 acupuncture points were routinely used bilaterally: Ssu-Tu (Tb-9;
extensor side of forearm between ulna and radius), Shuei-Tu (St-10; medial
border of sternocleidomastoid muscle) and the Heart (100) to Trachea (103)
ear point. The acupuncture needles were stimulated with asymetrical
biphasic impulses at a rate of 15-20 Hz generated by the Chinese
Acupuncture Analgesia Set Type 71-3 until closure of the thorax.
Anaesthesia was maintained with propofol and isoflurane under BIS
monitoring. The OA group additionally received a continuous sufentanil
infusion intra-operatively. Sedation with propofol was discontinued after
1 h on the ICU provided that the patient was hemodynamically stable.
Following extubation numerical analog pain scale (NAS) scores[3 were
treated with i.v. piritramid. After discharge from the ICU, patients
interviewed regarding their level of satisfaction with their anaesthesia
and postoperative analgesia. RESULTS. Three patients were removed from the
EAA group due to postoperative sedation of greater than 24 h duration (due
to hemodynamic instability, bleeding, and requirement for rethoracotomy).
The two groups were comparable concerning sex, age, NYHA, BMI, EF, ASA.
Data are presented as mean +/- SD. A non parametric test (Mann-Whitney)
was used in the statistical analysis. A p value<0.05 was considered
statistically significant.(Table presented) CONCLUSIONS.EAA significantly
reduces the duration of postoperativeMVand seems to be a reliable method
for intraoperative pain therapy. Patients who received EAA were more
satisfied with their early postoperative analgesia than patients in the OA
group.

<11>
Accession Number
70291181
Authors
Schadler D. Elke G. Pulletz S. Haake N. Frerichs I. Scholz J. Zick G.
Weiler N.
Institution
(Schadler, Elke, Pulletz, Frerichs, Scholz, Zick, Weiler) University
Medical Centre Schleswig-Holstein, Campus Kiel, Department of
Anaesthesiology and Intensive Care Medicine, Kiel, Germany
(Haake) University Medical Centre Schleswig-Holstein, Campus Kiel,
Department of Cardiovascular Surgery, Kiel, Germany
Source
Intensive Care Medicine. Conference: 23rd Annual Congress of the European
Society of Intensive Care Medicine, ESICM Barcelona Spain. Conference
Start: 20101009 Conference End: 20101013. Conference Publication:
(var.pagings). 36 (pp S327), 2010. Date of Publication: September 2010.
Publisher
Springer Verlag
Abstract
INTRODUCTION. The automated weaning system SmartCare/PS (SC, Drager
Medical AG and Co. KG, Lbeck, Germany) provides an automatic control of
the pressure support level. It has already been shown that this system may
be equal efficient [1, 2] or even faster [3] in weaning patients from
mechanical ventilation when compared to usual care or weaning protocols.
In this a priori defined subgroup analysis of a randomized controlled
trial [1] we analyzed patients after cardiac surgery (clinicaltrials.gov
ID00445289). OBJECTIVE. To assess the association of SC with total
ventilation time in patients following cardiac surgery. METHODS. After IRB
approval and written informed consent, patients were included into the
study when being ventilated for longer than 9 h and when none of the
following exclusion criteria were fulfilled: cerebral surgery/trauma, age
<18 years, do-not-resuscitate-order, preventilation time [24 h. After
inclusion patients were randomly assigned either to be weaned by SC or
according to a weaning protocol. RESULTS. Baseline characteristics of the
132 included patients showed no significant differences between groups.
Total ventilation time was 24 (18-57) h [median (25th-75th interquartile
range)] compared to 34 (20-94) h in the protocol group respectively (p =
0.037) (Fig. 1).(Figure presented) (Table presented) CONCLUSIONS. Patients
after cardiac surgery may profit from weaning with SC. This has to be
reevaluated in a further randomized controlled trial.

<12>
Accession Number
70291199
Authors
Amrein K. Amrein S. Holl A. Wagner G. Schnedl C. Mnch A. Smolle K.H.
Pieber T.R. Dobnig H.
Institution
(Amrein, Schnedl, Smolle, Pieber, Dobnig) Medical University Graz,
Department of Internal Medicine, Graz, Austria
(Amrein, Mnch) Medical University Graz, Department of Anesthesiology,
Intensive Care Medicine, Graz, Austria
(Holl) Medical University Graz, Department of Neurology, Graz, Austria
(Wagner) Medical University Graz, Department of Medical Informatics,
Statistics and Documentation, Graz, Austria
Source
Intensive Care Medicine. Conference: 23rd Annual Congress of the European
Society of Intensive Care Medicine, ESICM Barcelona Spain. Conference
Start: 20101009 Conference End: 20101013. Conference Publication:
(var.pagings). 36 (pp S331), 2010. Date of Publication: September 2010.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Whether widespread vitamin D deficiency which is mainly due
to geographic latitude, diet and life-style contributes to clinical
outcome in the hospital is unclear. Because of the pleiotropic effects
that vitamin D may have on immune function, calcium metabolism, muscle and
cardiac function, the role of low vitamin D baseline levels as well as
that of vitamin D supplementation in an ICU setting has recently attracted
interest. OBJECTIVES. Aim of the present study was to investigate a
possible relationship between hospital mortality and vitamin D status of
patients at different intensive care units of our institution. METHODS.
From September 2008 until April 2010, 25-hydroxyvitamin D [25(OH)D], serum
calcium and parathyroid hormone (PTH) levels were assessed in 577 patients
at different ICUs of our tertiary care center (medical, cardiothoracic,
mixed surgical and neurological ICUs). Because of seasonal variations of
25(OH)D levels we formed month-specific tertiles with the highest 25(OH)D
tertile being the reference category. RESULTS. Mean serum 25(OH)D level
was 18.9 +/- 10.9 ng/ml. By current definitions the majority of patients
(62.5%) were vitamin D deficient (<20 ng/ml) and 24.9% were vitamin D
insufficient (>=20 and<30 ng/dl). Normal 25(OH)D levels (>30 ng/ml) were
present in 12.6%. Table 1 provides information on clinical and laboratory
findings in the three 25(OH)D groups. Both lower 25(OH)D tertiles were
associated with increased hospital mortality after adjustment for age, sex
and SAPS II. For 330 patients both 25(OH)D and PTH levels were available.
Adjusting the Cox regression analysis also for PTH and dialysis status
increased the HR for hospital mortality to 2.3 (1.1-4.7) and 2.1 (0.99 and
4.4) for the two lower 25(OH)D tertiles. In addition tertiles of PTH and
serum calcium levels suggested higher mortality rates(Table presented)
CONCLUSIONS. Our results demonstrate that independent of baseline SAPS II,
age and sex, critically ill patients with low 25(OH)D levels seem to be at
increased risk for hospital mortality. Whether a rapid correction of
vitamin D status may be beneficial in the ICU setting remains to be
further explored in randomized controlled trials.

<13>
Accession Number
70291405
Authors
Penn J.W. Vizcaychipi M.P. Zhuang L. Pac-Soo C. Ma D.
Institution
(Penn, Vizcaychipi, Zhuang, Pac-Soo, Ma) Imperial College London, Chelsea
and Westminster Hospital, London, United Kingdom
Source
Intensive Care Medicine. Conference: 23rd Annual Congress of the European
Society of Intensive Care Medicine, ESICM Barcelona Spain. Conference
Start: 20101009 Conference End: 20101013. Conference Publication:
(var.pagings). 36 (pp S383), 2010. Date of Publication: September 2010.
Publisher
Springer Verlag
Abstract
INTRODUCTION. The existence of postoperative cognitive dysfunction (POCD)
as a complication of non-cardiac surgery in the elderly has been
demonstrated with a rate of 25.8% at 1 week and 9.9% at 3 months
postoperatively1. It is indicated that the pathophysiology consists of a
hippocampal neuroinflammatory response to the trauma associated with
surgery2. Aside from the cholesterol lowering effects of statins, as a
class of drugs they have been shown to exert anti-inflammatory effects and
have the potential to be therapeutic in neuroinflammatory disorders3.
OBJECTIVES. We tested the hypothesis that atorvastatin improves memory
retrieval post unilateral nephrectomy in a murine model. METHODS. C57/BL6
mice were randomly allocated into 4 groups (n = 8-10/group): control plus
placebo, control plus atorvastatin, nephrectomy plus placebo and
nephrectomy plus atorvastatin. Animals were given either a placebo (0.4 ml
normal saline) or 250 mug in 0.4 ml normal saline of atorvastatin by
gavage once a day for 5 days. On day 4 all animals underwent fear
conditioning training using a conditional stimulus of a 70 dB tone and an
unconditional stimulus of a 0.70 mA electric shock. On day 5 the surgical
animals underwent unilateral nephrectomy, whilst the control animals
received no surgery. At post-surgical day 3 all animals were tested for
hippocampal dependent memory retrieval using the fear conditioning
paradigm, with freezing response to the 70 dB tone as a marker of memory
retrieval. All animals were then terminated. RESULTS. Surgery evoked a
reduction in hippocampal dependent memory retrieval in the nephrectomy
plus placebo group as measured by % freezing time (mean +/- SD: 40 +/- 16)
when compared to the control plus placebo group (70 +/- 19; p<0.01); a
situation mimicking POCD. This change was obviated in the nephrectomy plus
atorvastatin group (59 +/- 16; p>0.05 vs. control plus placebo).
CONCLUSIONS. Our data suggested that atorvastatin has the potential to
improve postoperative cognitive performance in a murine model of POCD. The
proven safety of the drug along with its already widespread use and cost
effectiveness would permit rapid instigation of a human randomized
controlled trial to explore efficacy in the clinical setting.

<14>
Accession Number
2010574157
Authors
Pan X.-H. Chen Y.-X. Xiang M.-X. Xu G. Wang J.-A.
Institution
(Pan, Chen, Xiang, Xu, Wang) Department of Cardiology, Second Affiliated
Hospital, Zhejiang University, Hangzhou 310009, China
Title
A meta-analysis of randomized trials on clinical outcomes of
paclitaxel-eluting stents versus bare-metal stents in ST-segment elevation
myocardial infarction patients.
Source
Journal of Zhejiang University: Science B. 11 (10) (pp 754-761), 2010.
Date of Publication: October 2010.
Publisher
Zhejiang University Press (Hangzhou Post Bureau, Hangzhou 310000, China)
Abstract
A meta-analysis was performed to address the efficacy and safety of
paclitaxel-eluting stent (PES) in ST-segment elevation myocardial
infarction (STEMI) patients. A systematic literature search was conducted
to identify all randomized clinical trials in mortality, recurrent
myocardial infarction (rMI), repeat revascularization (RR), and stent
thrombosis (ST). A total of 4190 STEMI patients were enrolled in six
randomized trials comparing PES with bare-metal stent (BMS). The pooled
repeat revascularization rate was 5.7% in PES group, significantly lower
than 10.0% in BMS group with an odds ratio (OR) of 0.56, 95% confidence
interval (CI) [0.44, 0.72] (P<0.00001). No significant difference was
found between PES and BMS groups in mortality at one year after the
indexing procedure (3.9% vs. 5.1%, OR 0.88, 95% CI [0.63, 1.21], P=0.42).
Similarly, rMI rate did not differ significantly between the two groups
(3.4% vs. 4.1%, OR 0.80, 95% CI [0.56, 1.13], P=0.21). PES was also
associated with the comparable pooled rate of definite stent thrombosis
with BMS (2.3% vs. 2.4%, OR 0.81, 95% CI [0.52, 1.26], P=0.35). The
results show that PES improved clinical outcomes in STEMI patients with a
decreased need for repeat revascularization and no concerns for safety.
2010 Zhejiang University and Springer-Verlag Berlin Heidelberg.

<15>
[Use Link to view the full text]
Accession Number
2010574597
Authors
Dongelmans D.A. Veelo D.P. Binnekade J.M. De Mol B.A.J.M. Kudoga A. Paulus
F. Schultz M.J.
Institution
(Dongelmans, Veelo, Binnekade, Kudoga, Paulus, Schultz) Departments of
Intensive Care Medicine, Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Veelo) Departments of Anesthesiology, Academic Medical Center, University
of Amsterdam, Amsterdam, Netherlands
(De Mol) Departments of Cardiothoracic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Veelo, Schultz) Laboratory of Experimental Intensive Care and
Anesthesiology (L.E.I.C.A.), Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Schultz) HERMES Critical Care Group, Amsterdam, 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: October 2010.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
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. Copyright 2010 International
Anesthesia Research Society.

<16>
Accession Number
2010581675
Authors
Perera D. Stables R. Thomas M. Booth J. Pitt M. Blackman D. De Belder A.
Redwood S.
Institution
(Perera, Thomas, Redwood) Cardiovascular Division, St Thomas' Hospital
Campus, King's College London BHF Centre of Excellence, London SE1 7EH,
United Kingdom
(Stables) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
(Booth) Clinical Trials and Evaluation Unit, Royal Brompton Hospital,
London, United Kingdom
(Pitt) Birmingham Heartlands Hospital, Birmingham, United Kingdom
(Blackman) Leeds Teaching Hospitals, Leeds, United Kingdom
(De Belder) Brighton and Sussex University Hospital, Brighton, United
Kingdom
Title
Elective intra-aortic balloon counterpulsation during high-risk
percutaneous coronary intervention: A randomized controlled trial.
Source
JAMA - Journal of the American Medical Association. 304 (8) (pp 867-874),
2010. Date of Publication: 25 Aug 2010.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Observational studies have previously reported that elective
intra-aortic balloon pump (IABP) insertion may improve outcomes following
high-risk percutaneous coronary intervention (PCI). To date, this
assertion has not been tested in a randomized trial. Objective: To
determine whether routine intra-aortic balloon counterpulsation before PCI
reduces major adverse cardiac and cardiovascular events (MACCE) in
patients with severe left ventricular dysfunction and extensive coronary
disease. Design, Setting, and Patients: The Balloon Pump-Assisted Coronary
Intervention Study, a prospective, open, multicenter, randomized
controlled trial conducted in 17 tertiary referral cardiac centers in the
United Kingdom between December 2005 and January 2009. Patients (n=301)
had severe left ventricular dysfunction (ejection fraction <=30%) and
extensive coronary disease (Jeopardy Score >=8/12); those with
contraindications to or class I indications for IABP therapy were
excluded. Intervention: Elective insertion of IABP before PCI. Main
Outcome Measures: Primary end point was MACCE, defined as death, acute
myocardial infarction, cerebrovascular event, or further revascularization
at hospital discharge (capped at 28 days). Secondary end points included
all-cause mortality at 6 months, major procedural complications, bleeding,
and access-site complications. Results: MACCE at hospital discharge
occurred in 15.2% (23/151) of the elective IABP and 16.0% (24/150) of the
no planned IABP groups (P=.85; odds ratio [OR], 0.94 [95% confidence
interval {CI}, 0.51-1.76]). All-cause mortality at 6 months was 4.6% and
7.4% in the respective groups (P=.32; OR, 0.61 [95% CI, 0.24-1.62]). Fewer
major procedural complications occurred with elective IABP insertion
compared with no planned IABP use (1.3% vs 10.7%, P<.001; OR, 0.11 [95%
CI, 0.01-0.49]). Major or minor bleeding occurred in 19.2% and 11.3%
(P=.06; OR, 1.86 [95% CI, 0.93-3.79]) and access-site complications in
3.3% and 0% (P=.06) of the elective and no planned IABP groups,
respectively. Conclusions: Elective IABP insertion did not reduce the
incidence of MACCE following PCI. These results do not support a strategy
of routine IABP placement before PCI in all patients with severe left
ventricular dysfunction and extensive coronary disease. Trial Registration
isrctn.org Identifier: ISRCTN40553718; clinicaltrials.gov Identifier:
NCT00910481 2010 American Medical Association. All rights reserved.

<17>
Accession Number
2010582168
Authors
Sousa Uva M. Cavaco S. Oliveira A.G. Matias F. Silva C. Mesquita A. Aguiar
P. Bau J. Pedro A. Magalhaes M.P.
Institution
(Sousa Uva, Matias, Mesquita, Bau, Pedro, Magalhaes) Department of Cardiac
Surgery, Hospital da Cruz Vermelha Portuguesa, Lisbon 1549-008, Portugal
(Cavaco) Laboratory of Neurobiology of Human Behaviour, Centro Hospitalar
Do Porto, Porto, Portugal
(Oliveira) Faculdade de Ciencias Medicas, Department of Biostatistics,
Universidade Nova de Lisboa, Lisboa, Portugal
(Silva, Aguiar) Eurotrials Scientific Consultants, Lisbon, Portugal
Title
Early graft patency after off-pump and on-pump coronary bypass surgery: A
prospective randomized study.
Source
European Heart Journal. 31 (20) (pp 2492-2499), 2010. Date of
Publication: October 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Uncertainty persists regarding the impact of the off-pump technique
on coronary bypass graft patency. The primary objective of this study was
to assess coronary artery bypass graft patency in patients randomized to
off-pump and on-pump multivessel coronary artery bypass grafting (CABG).
Secondary objectives were clinical outcomes and neuropsychological
functioning. Methods and resultsOne hundred and fifty patients were
randomized to off-pump (n = 75) or on-pump CABG (n = 75). Graft patency
was assessed by multidetector computed tomography 5 weeks after surgery.
The two groups were similar regarding patients' characteristics and
logistic Euroscore (3.6 vs. 3.7). Mean number of grafts performed was 3.5
+/- 0.6 and 3.5 +/- 0.6 in off-pump and on-pump, respectively (P = 0.7).
Raw graft patency rate was 89.9 in off-pump and 95.0 in on-pump (OR 2.2,
95 CI 1.07-4.44; P = 0.03). Nineteen (27) off-pump and 9 (13) on-pump
patients had at least one occluded graft (P = 0.04) and the proportion of
patent grafts per patient was 0.91 +/- 0.2 in off-pump vs. 0.96 +/- 0.1 in
on-pump (P = 0.06). However, after adjusting by heparin dose, graft
patency was not statistically different between groups (OR 0.87, 95 CI
0.25-2.98, P = 0.83). At 30 days, there was no statistically significant
difference in major adverse events and neuropsychological functioning
between off-pump and on-pump groups. One-year follow-up showed similar
functional class and positive treadmill exercise tests. Conclusions Under
the conditions this trial was conducted, CABG performed off-pump had lower
overall graft patency rate than on-pump, which was not statistically
different after controlling for total heparin dose. Thirty-day
complications, neuropsychological functioning, and one-year clinical and
functional outcomes were not statistically different between the two
techniques. 2010 The European Society of Cardiology. All rights reserved.

<18>
Accession Number
2010582174
Authors
Taggart D.P. Altman D.G. Gray A.M. Lees B. Nugara F. Yu L.-M. Campbell H.
Flather M.
Institution
(Taggart) Nuffield Department of Surgery, University of Oxford, John
Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
(Altman, Yu) Centre for Statistics in Medicine, University of Oxford,
Wolfson College, Linton Road, Oxford OX2 6UD, United Kingdom
(Gray, Campbell) Department of Public Health, Health Economics Research
Centre, University of Oxford, Headington, Oxford OX3 7LF, United Kingdom
(Lees, Nugara, Flather) Clinical Trials and Evaluation Unit, Royal
Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, United
Kingdom
(Lees, Flather) National Heart and Lung Institute, Imperial College
London, London SW7 2AZ, United Kingdom
Title
Randomized trial to compare bilateral vs. single internal mammary coronary
artery bypass grafting: 1-year results of the Arterial Revascularisation
Trial (ART).
Source
European Heart Journal. 31 (20) (pp 2470-2481), 2010. Date of
Publication: October 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Observational data suggest that the use of bilateral internal mammary
arteries (BIMA) during coronary artery bypass graft surgery provides
superior revascularization to a single internal mammary artery (SIMA), but
concerns about safety have prevented the widespread use of BIMA. The
Arterial Revascularisation Trial (ART) is a randomized trial of BIMA vs.
SIMA, with a primary outcome of survival at 10 years. This paper reports
mortality, morbidity, and resource use data at 1 year. Methods and
resultsCoronary artery bypass graft patients were enrolled in 28 hospitals
in seven countries. Three thousand one hundred and two patients were
randomly assigned to SIMA (n = 1554) or BIMA (n = 1548). The mean number
of grafts was 3 for both groups. Forty per cent of the SIMA procedures and
42 of the BIMA were performed off-pump. Mortality at 30 days was 18 of
1548 (1.2) for SIMA and 19 of 1537 (1.2) for BIMA, and at 1 year was 36 of
1540 (2.3) and 38 of 1529 (2.5), respectively. The rates of stroke,
myocardial infarction, and repeat revascularization were all <=2 at 1 year
and similar between the two groups. Sternal wound reconstruction was
required in 0.6 and 1.9 of the SIMA and BIMA groups, respectively.
Conclusion Data from ART demonstrate similar clinical outcomes for SIMA
and BIMA at 1 year but BIMA grafts are associated with a small absolute
increase (1.3) in the need for sternal wound reconstruction. The results
suggest that the use of BIMA grafts is feasible on a routine basis. The
10-year results of the ART will confirm whether BIMA grafting results in
lower mortality and the need for repeat intervention.Trial registration:
Controlled-trials.com (ISRCTN46552265). 2010 The European Society of
Cardiology. All rights reserved.

<19>
Accession Number
2010582175
Authors
Schulz S. Mehilli J. Neumann F.-J. Schuster T. Massberg S. Valina C.
Seyfarth M. Pache J. Laugwitz K.-L. Buttner H.-J. Ndrepepa G. Schomig A.
Kastrati A.
Institution
(Schulz, Mehilli, Massberg, Seyfarth, Pache, Ndrepepa, Schomig, Kastrati)
Deutsches Herzzentrum Munchen, Technische Universitat, Lazarettstr. 36,
80636 Munich, Germany
(Neumann, Valina, Buttner) Herz-Zentrum, Bad Krozingen, Germany
(Schuster) Institut fur Medizinische Statistik und Epidemiologie, Klinikum
Rechts der Isar, Munich, Germany
(Laugwitz, Schomig) 1. Medizinische Klinik, Klinikum Rechts der Isar,
Technische Universitat, Munich, Germany
Title
ISAR-REACT 3A: A study of reduced dose of unfractionated heparin in
biomarker negative patients undergoing percutaneous coronary intervention.
Source
European Heart Journal. 31 (20) (pp 2482-2491), 2010. Date of
Publication: October 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Although a 140 U/kg dose of unfractionated heparin (UFH) was
comparable with bivalirudin in terms of net clinical outcome in the
Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for
Coronary Treatment (ISAR-REACT) 3 trial, it was associated with a higher
risk of bleeding. We designed this study to assess whether a reduction in
the UFH dose from 140 to 100 U/kg is associated with improved net clinical
outcome. Methods and resultsA total of 2505 biomarker negative patients
undergoing percutaneous coronary intervention (PCI) after clopidogrel
pre-treatment received a single bolus of 100 U/kg UFH. The primary
endpoint was net clinical outcome-a quadruple endpoint of death,
myocardial infarction, urgent target-vessel revascularization within 30
days, or in-hospital REPLACE 2 defined major bleeding. The primary
comparison was with the historical UFH group of ISAR-REACT 3 (2281
patients). In a second analysis, we checked for non-inferiority against
the historical bivalirudin arm of ISAR-REACT 3 (2289 patients). The
incidence of the primary endpoint was 7.3 in the lower UFH dose group
compared with 8.7 in the higher UFH dose group [hazard ratio (HR) 0.81; 95
confidence interval (CI) 0.67-1.00; P = 0.045]. The incidence of major
bleeding was 3.6 in the lower UFH dose group and 4.6 in the higher UFH
dose group (HR 0.79; 95 CI 0.59-1.05; P = 0.11). The lower UFH dose met
the criterion of non-inferiority compared with bivalirudin (P < 0.001).
Conclusion In biomarker negative patients undergoing PCI after clopidogrel
loading, a reduced dose of 100 U/kg UFH provided net clinical benefit
compared with the historical control of 140 U/kg UFH in the ISAR-REACT 3
trial. The benefit was mostly driven by reduction in bleeding.Clinical
trial registration informationURL www.clinicaltrials.gov; Unique
identifier NCT00735280. 2010 The European Society of Cardiology. All
rights reserved.

<20>
Accession Number
2010583082
Authors
Reich J. Schatzberg A.
Institution
(Reich) Department of Psychiatry, UCSF Medical School, United States
(Reich, Schatzberg) Department of Psychiatry and Behavioral Health,
Stanford Medical School, United States
Title
Personality traits and medical outcome of cardiac illness.
Source
Journal of Psychiatric Research. 44 (15) (pp 1017-1020), 2010. Date of
Publication: November 2010.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Objective: Our goal was to examine the empirical literature on the effect
of personality traits on the medical outcome of cardiac illness. Method:
Pub Med and Psychological Abstracts were searched for the years 1990 to
September 2009 using the terms personality, personality traits,
personality disorder, health, recovery from illness, cardiac illness and
surgical recovery. Articles were then selected that were prospective, had
a peer review published measure of personality, a standardized measure of
outcome of physical illness and at least one year follow up. Results:
Seven articles were identified that met our criteria. All seven had a
significant finding that personality traits predicted medical outcomes. Of
these seven articles six had similar enough measures of personality to be
included in a meta analysis. (All used Type D personality.) Meta analysis
found an odds ratio of 3.76 for Type D personality traits predicting
poorer medical outcome. This indicated that patients with Type D
personality had a 276% increase in the odds of a poor medical outcome
compared to patients without Type D personality. Conclusions: These
findings indicate that personality traits are a strong predictor of
medical outcome of cardiac disease. 2010 Elsevier Ltd.

<21>
Accession Number
2010583709
Authors
Gaziano J.M. Cincotta A.H. O'Connor C.M. Ezrokhi M. Rutty D. Ma Z.J.
Scranton R.E.
Institution
(Gaziano, Scranton) Massachusetts Veterans Epidemiology Research and
Information Center, VA Cooperative Studies Programs, VA Boston Healthcare
System, Boston, MA, United States
(Gaziano, Scranton) Brigham and Women's Hospital, Division of Aging,
Boston, MA, United States
(Gaziano, Scranton) Harvard Medical School, Boston, MA, United States
(Cincotta, Ezrokhi, Scranton) Vero-Science, LLC, Tiverton, RI, United
States
(O'Connor) Duke Clinical Research Institute, Durham, NC, United States
(Rutty) Everest Clinical Research Services, Inc., ON, Canada
(Ma) Department of Statistics, Columbia University, New York, NY, United
States
Title
Randomized clinical trial of quick-release bromocriptine among patients
with type 2 diabetes on overall safety and cardiovascular outcomes.
Source
Diabetes Care. 33 (7) (pp 1503-1508), 2010. Date of Publication: July
2010.
Publisher
American Diabetes Association Inc. (1701 North Beauregard St., Alexandria
VA 22311, United States)
Abstract
OBJECTIVE - Quick-release bromocriptine (bromocriptine-QR), a D2 dopamine
receptor agonist, is indicated as a treatment for type 2 diabetes. The
Cycloset Safety Trial, a 52-week, randomized, double-blind, multicenter
trial, evaluated the overall safety and cardiovascular safety of this
novel therapy for type 2 diabetes. RESEARCH DESIGN AND METHODS - A total
of 3,095 patients with type 2 diabetes were randomized 2:1 to
bromocriptine-QR or placebo in conjunction with the patient's usual
diabetes therapy (diet controlled only or up to two antidiabetes
medications, including insulin). The all-cause-safety end point was the
occurrence of any serious adverse event (SAE), with a hazard ratio (HR)
noninferiority margin of 1.5. In a prespecified analysis, the frequency of
cardiovascular disease (CVD) events defined as a composite of myocardial
infarction, stroke, coronary revascularization, and hospitalization for
angina or congestive heart failure was evaluated using modified
intent-to-treat analysis (clinicaltrials.gov, NCT00377676). RESULTS - In
the bromocriptine-QR group, 176 (8.6%) people reported SAEs compared with
98 (9.6%) in the placebo group (HR 1.02 [96% one-sided CI 1.27]). Fewer
people reported a CVD end point in the bromocriptine-QR group versus the
placebo group (37 [1.8%] vs. 32 [3.2%], respecively) (HR 0.60 [95%
two-sided CI 0.35- 0.96]). Nausea was the most commonly reported adverse
event in the bromocriptine-QR group. CONCLUSIONS - The frequency of SAEs
was comparable between the treatment arms. Compared with patients in the
placebo arm, fewer patients taking bromocriptine-QR experienced a
cardiovascular end point. 2010 by the American Diabetes Association.

<22>
Accession Number
2010569688
Authors
Winterhalter M. Malinski P. Danzeisen O. Sixt S. Monaca E. Juttner T.
Peiper M. Kienbaum R. Koester A. Rahe-Meyer N.
Institution
(Winterhalter, Danzeisen, Sixt, Monaca, Juttner, Kienbaum, Koester)
University of Dusseldorf, Dept. of Anaesthesiology, Moorenstr.5, 40225
Dusseldorf, Germany
(Malinski, Rahe-Meyer) Department of Anaesthesiology, Hannover Medical
School, Germany
(Peiper) Department of Surgery, University of Dusseldorf, Germany
Title
Prospective observational study for perioperative volume replacement with
6% HES 130/0,42, 4% gelatin and 6% HES 200/0,5 in cardiac surgery.
Source
European Journal of Medical Research. 15 (9) (pp 383-389), 2010. Date of
Publication: 24 Sep 2010.
Publisher
Holzapfel Publishers Munich (Harthauser Str. 105, Munich 81545, Germany)
Abstract
Background: The constantly growing amount of different kinds of colloid
fluids necessitates comparative investigations with regards to the safety
and effectivity in clinical use of these preparations. Hence we compared
three colloid fluids in an observational study. The objective was the
exploration of the influence of these three colloids on blood coagulation,
hemody-namics and renal function of the cardiac surgical patient. Methods:
We included 90 patients undergoing an elective open-heart surgery with the
use of the heart-lung machine and observed them consecutively. Group 1
[gelatin 4% (n = 30)], Group 2 [HES 200/0,5 (n = 30)] and Group 3 [HES
130/0,42 (n = 30)]. We measured the perioperative volume replacement, the
administration of blood- and coagulation-products, the application of
catecholamines, the renal function, blood gas and the platelet aggregation
using multiplate electrode analyzer (Multiplate, Dynabyte medical, Munich,
Germany). Results: The gelatin-group needed significantly more
norepinephrine than the HES 130/0.42 group. The responsible surgeon
considered the blood coagulation in the HES 200/0.5 group most frequently
as impaired. Furthermore we saw a significant decrease in platelet
function in the HES 200/0.5 group when performing the multiplate-analysis
(ADP-and COL-test). HES 130/0.4 as well as gelatin 4% showed no
significant change in platelet function. The gelatin-group and the HES
200/0.5 needed significantly more aprotinine than the HES 130/0.4 group.
We saw no significant difference with regards to administration of blood
and coagulation products between the three groups. The urinary excretion
during the intervention was significantly higher in the HES 200/0.5 group
and in the gelatin group than in the HES 130/0.4 group. Conclusions: Our
results confirm the lower stabilizing effect of gelatin on circulation
during fluid resuscitation. The blood coagulation was mostly impaired due
to HES 200/0.5 confirmed by the multiplate-analysis as well as by
different clinical findings. I. Holzapfel Publishers 2010.

<23>
Accession Number
2010570301
Authors
Janig W.
Institution
(Janig) Department of Physiology, Christian-Albrechts-Universitat zu Kiel,
Physiologisches Institut, Olshausenstr. 40, 24098 Kiel, Germany
Title
Visceral pain - Still an enigma?.
Source
Pain. 151 (2) (pp 239-240), 2010. Date of Publication: 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)

<24>
Accession Number
2010559081
Authors
Wong G.T.C. Huang Z. Ji S. Irwin M.G.
Institution
(Wong, Irwin) Department of Anaesthesiology, University of Hong Kong, Hong
Kong, Hong Kong
(Huang) Department of Anesthesiology, Sun Yat-Sen Cardiovascular Hospital,
Shenzhen, China
(Ji) Department of Cardiovascular Surgery, Sun Yat-Sen Cardiovascular
Hospital, Shenzhen, China
Title
Remifentanil reduces the release of biochemical markers of myocardial
damage after coronary artery bypass surgery: A randomized trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24 (5) (pp 790-796),
2010. Date of Publication: October 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: Opioids, including remifentanil, have been demonstrated to
confer cardiac protection against ischemia reperfusion injury in animals.
This study evaluated whether remifentanil preconditioning is protective in
first-time elective on-pump coronary artery bypass surgery patients
receiving a standardized fentanyl (25 mug/kg in total) and propofol
anesthetic. Design: A prospective, double blind, randomized, controlled
study. Setting: University hospital; single institution. Participants:
Forty patients scheduled for first-time elective, on-pump coronary artery
bypass surgery for at least 3 diseased vessels. Interventions: Patients
randomized to the remifentanil group (n = 20) received a 1 mug/kg bolus
followed by a 0.5 mug/kg/min infusion for 30 minutes after induction but
before sternotomy, while the control group (n = 20) received normal
saline. Serial samples for measurement of creatine kinase (CK-MB), cardiac
troponin I (cTnI), ischemia-modified albumin (IMA) and heart-type
fatty-acid-binding protein (hFABP) were taken at baseline, prebypass, T =
10 minutes, 2, 6, 12, and 24 hours after cross-clamp release, to assess
the degree of myocardial damage. Measurements and Main Results: Patients
in the remifentanil group had lower levels of CK-MB from T = 2 hours to 24
hours, cTnI from T = 10 minutes to T = 12 hours, IMA from T = 10 minutes
to T = 2 hours and h-FABP from T = 10 minutes to T = 12 hours (p < 0.05).
The time to tracheal extubation was shorter in patients in the
remifentanil group. The overall lengths of ICU and hospital stays were not
different. Conclusions: The addition of remifentanil to the anesthesia
regimen reduced the degree of myocardial damage. This incremental benefit
may be attributable either to remifentanil itself or to an overall
increased opioid dose, the latter may be necessary to trigger cardiac
protection. 2010 Elsevier Inc. All rights reserved.

<25>
Accession Number
2010559089
Authors
Menda F. Koner O. Sayn M. Ergenoglu M. Kucukaksu S. Aykac B.
Institution
(Menda, Koner, Sayn, Aykac) Department of Anesthesiology and Intensive
Care, Yeditepe University, Istanbul, Turkey
(Ergenoglu, Kucukaksu) Department of Cardiovascular Surgery, Yeditepe
University, Istanbul, Turkey
Title
Effects of single-dose gabapentin on postoperative pain and morphine
consumption after cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24 (5) (pp 808-813),
2010. Date of Publication: October 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The purpose of this study was to evaluate the analgesic effect
of single-dose preoperative gabapentin on postoperative pain and morphine
consumption after cardiac surgery. Design: A randomized, double-blind,
placebo-controlled, clinical study. Setting: A single university hospital.
Participants: Sixty patients undergoing coronary artery bypass graft
surgery. Interventions: Patients were randomly allocated into 2 groups
preoperatively either to receive 600 mg of oral gabapentin (GABA) or
placebo (PLA) 2 hours before the operation. After extubation, an
anesthesiologist blinded to the groups recorded pain scores both at rest
and with cough with a 10-point verbal rating scale and sedation scores at
2, 6, 12, 18, 24, and 48 hours. Cumulative morphine consumption and the
incidence of side effects were recorded during the study period.
Measurements and Main Results: The total morphine consumption was lower in
the GABA group (6.7 +/- 2.5 mg) than in the PLA group (15.5 +/- 4.6 mg, p
< 0.01). Pain scores at rest were significantly lower in the GABA group
than in the PLA group throughout the study period (p < 0.05 in all
measurement times). Pain scores at 2, 6, and 12 hours during coughing were
significantly lower in the GABA group (p < 0.05). The number of
oversedated patients was significantly higher in the GABA group at 2, 6,
and 12 hours of study compared with PLA (p < 0.001 at 2 and 6 hours and p
< 0.02 at 12 hours). The postoperative mechanical ventilation period was
significantly prolonged in the GABA group (6.6 +/- 1.2 hours) compared
with the PLA group (5.5 +/- 1 hours, p < 0.01). Nausea incidence was
significantly lower in the GABA group (n = 9) than in the PLA group (n =
18, p = 0.02). Conclusions: Oral GABA at a dose of 600 mg given before
cardiac surgery significantly reduced postoperative morphine consumption
and postoperative pain both at rest and with cough. 2010 Elsevier Inc.
All rights reserved.

<26>
Accession Number
2010559091
Authors
Landoni G. Virzo I. Bignami E. Zangrillo A.
Institution
(Landoni, Virzo, Bignami, Zangrillo) Department of Anesthesia and
Intensive Care, Universita Vita-Salute San Raffaele, Milan, Italy
Title
Any rationale for propofol use in cardiac surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24 (5) (pp 903), 2010.
Date of Publication: October 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)

<27>
Accession Number
2010559109
Authors
Singh N. Patel P. Wyckoff T. Augoustides J.G.T.
Institution
(Singh, Patel, Wyckoff, Augoustides) Department of Anesthesiology and
Critical Care, University of Pennsylvania School of Medicine,
Philadelphia, PA, United States
Title
Progress in perioperative medicine: Focus on statins.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24 (5) (pp 892-896),
2010. Date of Publication: October 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Beyond cholesterol reduction, statins have multiple beneficial influences
on vascular endothelial function, atherosclerotic plaque stability,
inflammation, and thrombosis. These favorable pleiotropic effects may be
the basis for their perioperative risk reduction in cardiothoracic and
vascular procedures. The published evidence suggests that statins offer
significant outcome benefits throughout perioperative practice. Because
statin therapy significantly reduces the perioperative risk for patients
undergoing cardiovascular procedures, they already are recommended in
published guidelines. Beyond cardiac risk reduction, statin therapy also
may protect the brain and the kidney in the perioperative setting, both in
cardiac and vascular surgery. The pleiotropic effects of statins also
appear to have therapeutic roles in the progression of valve disease,
sepsis, and venous thrombosis. Further trials are required to provide data
to drive their safe and comprehensive perioperative application for
optimal patient outcome both in the short term and the long term. Because
there are multiple randomized trials currently in progress throughout
perioperative medicine, it is very likely that the indications for statins
will be expanded significantly. 2010 Elsevier Inc. All rights reserved.

<28>
Accession Number
2010570387
Authors
Hajjar L.A. Vincent J.-L. Galas F.R.B.G. Nakamura R.E. Silva C.M.P. Santos
M.H. Fukushima J. Kalil Filho R. Sierra D.B. Lopes N.H. Mauad T. Roquim
A.C. Sundin M.R. Leao W.C. Almeida J.P. Pomerantzeff P.M. Dallan L.O.
Jatene F.B. Stolf N.A.G. Auler Jr. J.O.C.
Institution
(Hajjar, Galas, Nakamura, Silva, Santos, Fukushima, Kalil Filho, Sierra,
Lopes, Mauad, Roquim, Sundin, Leao, Almeida, Pomerantzeff, Dallan, Jatene,
Stolf, Auler Jr.) Department of Anesthesiology, Hospital Das Clinicas,
Universidade de Sao Paulo, Sao Paulo, Brazil
(Vincent) Department of Intensive Care, Erasme Hospital, Universite Libre
de Bruxelles, Brussels, Belgium
Title
Transfusion requirements after cardiac surgery: The TRACS randomized
controlled trial.
Source
JAMA - Journal of the American Medical Association. 304 (14) (pp
1559-1567), 2010. Date of Publication: 13 Oct 2010.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Perioperative red blood cell transfusion is commonly used to
address anemia, an independent risk factor for morbidity and mortality
after cardiac operations; however, evidence regarding optimal blood
transfusion practice in patients undergoing cardiac surgery is lacking.
Objective: To define whether a restrictive perioperative red blood cell
transfusion strategy is as safe as a liberal strategy in patients
undergoing elective cardiac surgery. Design, Setting, and Patients: The
Transfusion Requirements After Cardiac Surgery (TRACS) study, a
prospective, randomized, controlled clinical noninferiority trial
conducted between February 2009 and February 2010 in an intensive care
unit at a university hospital cardiac surgery referral center in Brazil.
Consecutive adult patients (n=502) who underwent cardiac surgery with
cardiopulmonary bypass were eligible; analysis was by intention-to-treat.
Intervention: Patients were randomly assigned to a liberal strategy of
blood transfusion (to maintain a hematocrit >=30%) or to a restrictive
strategy (hematocrit >=24%). Main Outcome Measure: Composite end point of
30-day all-cause mortality and severe morbidity (cardiogenic shock, acute
respiratory distress syndrome, or acute renal injury requiring dialysis or
hemofiltration) occurring during the hospital stay. The noninferiority
margin was predefined at -8% (ie, 8% minimal clinically important increase
in occurrence of the composite end point). Results: Hemoglobin
concentrations were maintained at a mean of 10.5 g/dL (95% confidence
interval [CI], 10.4-10.6) in the liberal-strategy group and 9.1 g/dL (95%
CI, 9.0-9.2) in the restrictive-strategy group (P < .001). A total of 198
of 253 patients (78%) in the liberal-strategy group and 118 of 249 (47%)
in the restrictive-strategy group received a blood transfusion (P < .001).
Occurrence of the primary end point was similar between groups (10%
liberal vs 11 % restrictive; between-group difference, 1% [95% CI,-6% to
4%]; P=.85). Independent of transfusion strategy, the number of transfused
red blood cell units was an independent risk factor for clinical
complications or death at 30 days (hazard ratio for each additional unit
transfused, 1.2 [95% CI, 1.1-1.4]; P=.002). Conclusion: Among patients
undergoing cardiac surgery, the use of a restrictive perioperative
transfusion strategy compared with a more liberal strategy resulted in
noninferior rates of the combined outcome of 30-day all-cause mortality
and severe morbidity. 2010 American Medical Association. All rights
reserved.

<29>
Accession Number
2010575716
Authors
Girdauskas E. Kempfert J. Kuntze T. Borger M.A. Enders J. Fassl J. Falk V.
Mohr F.-W.
Institution
(Girdauskas, Kempfert, Kuntze, Borger, Falk, Mohr) Department of Cardiac
Surgery, Heart Center Leipzig, Leipzig, Germany
(Enders, Fassl) Department of Anesthesiology/Intensive Care, Heart Center
Leipzig, Leipzig, Germany
Title
Thromboelastometrically guided transfusion protocol during aortic surgery
with circulatory arrest: A prospective, randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 140 (5) (pp
1117-1124.e2), 2010. Date of Publication: November 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Aortic surgical procedures requiring hypothermic circulatory
arrest are associated with altered hemostasis and increased bleeding. In a
randomized clinical trial, we evaluated effects of thromboelastometrically
guided algorithm on transfusion requirements. Methods: Fifty-six
consecutive patients (25 with acute type A dissection) undergoing aortic
surgery with hypothermic circulatory arrest were enrolled in a randomized
trial during a 6-month period. Patients were randomly allocated to
treatment group (n = 27) with thromboelastometrically guided transfusion
algorithm or control group (n = 29) with routine transfusion practices
(clinical judgment-guided transfusion followed by transfusion according to
coagulation test results). Primary end point was cumulative allogeneic
blood units (red blood cells, fresh-frozen plasma, and platelets)
transfused. Results: Transfusion of allogeneic blood was significantly
reduced in the thromboelastometry group: median 9.0 units (interquartile
range, 2.0-30.0 units) versus. 16.0 units (9.0-23.0 units, P = .02). Most
significant decrease was in the use of fresh-frozen plasma (3.0 units,
0-12.0 units, vs 8.0 units, 4.0-18.0 units, P = .005). Postoperative blood
loss (890 mL/d, 600-1250 mL/d vs 950 mL/d, 650-1400 mL/d, p = 0.5) and
rate of surgical re-exploration (19% vs 24%, P = .7) were similar between
groups. Thromboelastometrically guided algorithm significantly decreased
need for massive perioperative transfusion (odds ratio, 0.45; 95%
confidence interval, 0.2-0.9; P = .03) in multivariable logistic
regression analysis. Conclusions: Thromboelastometrically guided
transfusion is associated with a decreased use of allogeneic blood units
and reduced incidence of massive transfusion in patients undergoing aortic
surgery with circulatory arrest. 2010 by The American Association for
Thoracic Surgery.

<30>
Accession Number
2010575764
Authors
Campo G. Fileti L. De Cesare N. Meliga E. Furgieri A. Russo F. Colangelo
S. Brugaletta S. Ferrari R. Valgimigli M.
Institution
(Campo, Fileti, Ferrari, Valgimigli) Cardiovascular Institute, AOU S.
Anna, Ferrara, Italy
(Campo, Fileti, Ferrari, Valgimigli) Fondazione Salvatore Maugeri, IRCCS,
Lumezzane, Italy
(De Cesare) UO Cardiologia, Policlinico S. Marco, Zingonia, Bergamo, Italy
(Meliga) Interventional Cardiology Department, ASO Mauriziano Umberto i,
Turin, Italy
(Furgieri) Department of Cardiology, Villa Maria Cecilia Hospital,
Cotignola, Ravenna, Italy
(Russo) Laboratorio di Emodinamica, Policlinico San Matteo, IRCCS, Pavia,
Italy
(Colangelo) Unit of Cardiology, Bosco Hospital, Azienda Ospedaliera S.
Giovanni, Turin, Italy
(Brugaletta) Interventional Cardiology Unit, Saint Paul University
Hospital, Barcelona, Spain
Title
Long-term clinical outcome based on aspirin and clopidogrel responsiveness
status after elective percutaneous coronary intervention: A 3T/2R
(Tailoring Treatment with Tirofiban in Patients Showing Resistance to
Aspirin and/or resistance to Clopidogrel) trial substudy.
Source
Journal of the American College of Cardiology. 56 (18) (pp 1447-1455),
2010. Date of Publication: October 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives The purpose of this study was to investigate the long-term
outcome after elective percutaneous coronary intervention in low-risk
patients screened for aspirin and/or clopidogrel responsiveness in the
3T/2R (Tailoring Treatment With Tirofiban in Patients Showing Resistance
to Aspirin and/or Resistance to Clopidogrel) trial. Background The impact
of aspirin and/or clopidogrel poor response on long-term outcome is
debated. Methods Aspirin and clopidogrel response was measured with the
VerifyNow system aspirin and P2Y12 assays. After percutaneous coronary
intervention (PCI), death, stroke, and myocardial infarction were assessed
up to 1 year. Results Overall, 1,277 patients were screened, and 826 (65%)
were treated with PCI. In all, 124 patients were found to be aspirin poor
responders, and there were 179 clopidogrel poor responders (totally, 278
poor responders). The 1-year end point was significantly higher in poor
responders as compared to full responders (15.8% vs. 8.6%, p = 0.002),
which is principally due to more myocardial infarction occurrence. At
multivariable analysis, clopidogrel poor response emerged as an
independent predictor (hazard ratio: 1.15, 95% confidence interval: 1.03
to 1.28). Receiver-operator characteristic analysis identifies <=23 of
percentage of platelet inhibition and <208 of P2Y₁₂ reactivity
units as optimal cut offs to predict 1-year end point. Excluding
periprocedural events, also peri-PCI myocardial infarction, which is
strongly related to aspirin/clopidogrel poor response, was an independent
predictor (hazard ratio: 1.25, 95% confidence interval: 1.14 to 1.37).
Glycoprotein IIb/IIIa inhibitor administration reduces this risk in poor
responders (21.2% vs. 34.7%, p = 0.02), but not in full responders (6.3%
vs. 6.5%, p = 0.8). Conclusions Poor response to clopidogrel is an
independent predictor of periprocedural myocardial infarction and worse
1-year outcome in low-risk patients undergoing PCI, whereas poor response
to aspirin failed to predict a worse outcome. Contrary to what was
observed in poor responders, glycoprotein IIb/IIa inhibitor therapy failed
to provide a benefit in aspirin and/or clopidogrel full responders. 2010
American College of Cardiology Foundation.

<31>
Accession Number
20428621
Authors
Ferreira G.M. Haeffner M.P. Barreto S.S. Dall'Ago P.
Institution
(Ferreira) HCPA, UFRGS, Porto Alegre, RS, Brasil.
Title
[Incentive spirometry with expiratory positive airway pressure brings
benefits after myocardial revascularization].
Source
Arquivos brasileiros de cardiologia. 94 (2) (pp 230-235, 246-251,
233-238), 2010. Date of Publication: Feb 2010.
Abstract
BACKGROUND: Patients undergoing coronary artery bypass graft (CABG)
surgery have higher risk to develop pulmonary complications (PCs) such as
atelectasis, pneumonia and pleural effusion. These complications could
increase the length of hospital stay, resources utilization and also are
associated with reduced quality of life and functional capacity a long
term. OBJECTIVE: To test if the use of incentive spirometry (IS)
associated with expiratory positive airway pressure (EPAP), after CABG
surgery improves dyspnea, effort perceived and quality of life 18 months
after CABG. METHODS: Sixteen patients submitted to a CABG, were randomized
to a control group (n=8) or IS+EPAP group (n=8). The protocol of IS+EPAP
was applied in the immediate postoperative period and following for more 4
weeks in the patient's home. Eighteen months after CABG, the strength of
the respiratory muscle, the functional capacity, the lung function, the
quality of life and the level of physical activity were evaluated.
RESULTS: After six minute walk test (6-MWT), the score of the dyspnea
(1.6+/-0.6 vs 0.6+/-0.3, P<0.05) and the perceived effort (13.4+/-1.2 vs
9.1+/-0.7, P<0.05) were higher in the control group, when compared with
the IS+EPAP group. In quality of life evaluation, the domain related to
the physical aspects limitations was better in IS+EPAP group (93.7+/-4.1
vs 50+/-17, P<0.02). CONCLUSION: Patients that were submitted to IS+EPAP
present reduction of dyspnea and lower effort sensation after the 6-MWT,
and also a better quality of life 18 months after CABG.