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<1>
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Accession Number
2010608572
Authors
Brooks M.M. Chung S.-C. Helmy T. Hillegass W.B. Escobedo J. Melsop K.A.
Massaro E.M. McBane R.D. Hyde P. Hlatky M.A.
Institution
(Brooks, Chung) Department of Epidemiology, University of Pittsburgh,
GSPH, 130 DeSoto St, Pittsburgh, PA 15261, United States
(Helmy) University of Cincinnati, Cincinnati, OH, United States
(Hillegass) University of Alabama, Birmingham, United States
(Escobedo) Mexican Institute of Social Security, Mexico City, Mexico
(Melsop, Hlatky) Stanford University School of Medicine, Stanford, CA,
United States
(Massaro) Northwestern University Medical Center, Chicago, IL, United
States
(McBane) Mayo Clinic, Rochester, MN, United States
(Hyde) Emory University, Atlanta, GA, United States
Title
Health status after treatment for coronary artery disease and type 2
diabetes mellitus in the bypass angioplasty revascularization
investigation 2 diabetes trial.
Source
Circulation. 122 (17) (pp 1690-1699), 2010. Date of Publication: 26 Oct
2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
BACKGROUND-: Health status is a key outcome for comparing treatments,
particularly when mortality does not differ significantly. METHODS AND
RESULTS-: Bypass Angioplasty Revascularization Investigation 2 Diabetes
(BARI 2D) randomized 2368 patients with type 2 diabetes mellitus and
stable ischemic heart disease to (1) prompt revascularization versus
medical therapy and (2) insulin sensitization versus insulin provision.
Randomization was stratified by the intended method of revascularization,
coronary artery bypass graft surgery or percutaneous coronary
intervention. The Duke Activity Status Index and RAND Energy, Health
Distress, and Self-Rated Health scales were assessed at study entry and
annually thereafter; linear mixed models were used to evaluate the effect
of randomized treatment on these measures. Health status improved
significantly from baseline to 1 year (P<0.001) in each randomized
treatment group. Compared with medical therapy, prompt revascularization
was associated with significantly greater improvements in Duke Activity
Status Index (1.32 points; P<0.001), Energy (1.36 points; P=0.02), and
Self-rated Health (1.77 points; P=0.007) but not Health Distress (-0.47;
P=0.46). These treatment effects were largely maintained over 4 years of
follow-up. The effect of revascularization on the Duke Activity Status
Index was significantly larger in the subgroup of patients intended for
coronary artery bypass graft surgery compared with the subgroup intended
for percutaneous coronary intervention. Health status did not differ
significantly on any of the 4 measures between the insulin provision and
insulin sensitization strategies. CONCLUSIONS-: Prompt coronary
revascularization was associated with small yet statistically significant
improvements in health status compared with initial medical therapy among
patients with diabetes mellitus and stable ischemic heart disease. 2010
American Heart Association, Inc.

<2>
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Accession Number
2010608575
Authors
Ensrud K. Lacroix A. Thompson J.R. Thompson D.D. Eastell R. Reid D.M.
Vukicevic S. Cauley J. Barrett-Connor E. Armstrong R. Welty F. Cummings S.
Institution
(Ensrud) VA Medical Center, Minneapolis, MN, United States
(Ensrud) University of Minnesota, Minneapolis, United States
(Lacroix) Fred Hutchinson Cancer Research Center, Seattle, WA, United
States
(Thompson, Thompson, Armstrong) Pfizer Global Research and Development,
New London, CO, United States
(Eastell) University of Sheffield, Sheffield, United Kingdom
(Reid) University of Aberdeen, Aberdeen, United Kingdom
(Vukicevic) University of Zagreb, Zagreb, Croatia
(Cauley) University of Pittsburgh, Pittsburgh, PA, United States
(Barrett-Connor) University of California-San Diego, San Diego, United
States
(Welty) Harvard University, Boston, MA, United States
(Cummings) California Pacific Medical Center Research Institute, San
Francisco, United States
Title
Lasofoxifene and cardiovascular events in postmenopausal women with
osteoporosis: Five-year results from the Postmenopausal Evaluation and
Risk Reduction with Lasofoxifene (PEARL) trial.
Source
Circulation. 122 (17) (pp 1716-1724), 2010. Date of Publication: 26 Oct
2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
BACKGROUND-: In the Postmenopausal Evaluation and Risk Reduction With
Lasofoxifene (PEARL) trial, women assigned to lasofoxifene 0.5 mg/d had a
lower risk of major coronary heart disease (CHD) events and stroke,
whereas women assigned to lasofoxifene 0.25 mg/d had a lower risk of
stroke. Both doses of lasofoxifene increased the risk of venous
thromboembolic events. In this report, we provide comprehensive
cardiovascular end-point data, including component events comprising the
composite end point of major CHD events, and evaluate whether the effect
of lasofoxifene 0.5 mg/d is consistent across different categories of CHD
risk. METHODS AND RESULTS-: In this study, 8556 women 59 to 80 years of
age with osteoporosis received lasofoxifene 0.25 mg/d, lasofoxifene 0.5
mg/d, or placebo for 5 years. Cardiovascular events, including major CHD
events, were prespecified secondary end points. Compared with placebo,
lasofoxifene 0.5 mg/d reduced the risk of major CHD events 32% (hazard
ratio, 0.68; 95% confidence interval, 0.50 to 0.93), including the risk of
coronary revascularization (hazard ratio, 0.56, 95% confidence interval,
0.32 to 0.98). Reductions in risk of hospitalization for unstable angina
(hazard ratio, 0.55; 95% confidence interval, 0.29 to 1.04) and diagnosis
of new ischemic heart disease (hazard ratio, 0.52; 95% confidence
interval, 0.26 to 1.04) nearly reached significance (P=0.06 for both
comparisons). Although both hazard ratios were <1.0, no significant effect
of lasofoxifene at 0.5 mg/d was demonstrated for coronary death or
nonfatal myocardial infarction. The reduction in CHD events with
lasofoxifene 0.25 mg/d was not significant (hazard ratio, 0.76; 95%
confidence interval, 0.56 to 1.03; P=0.08). The effectiveness of
lasofoxifene 0.5 mg/d in reducing CHD events was similar across strata of
major cardiovascular risk factors. CONCLUSIONS-: In postmenopausal women
with osteoporosis, lasofoxifene 0.5 mg/d for 5 years reduced the risk of
CHD events, regardless of the presence or absence of risk factors for
cardiovascular disease. The significant reduction in risk of CHD events
with lasofoxifene 0.5 mg/d was due primarily to lower risks of coronary
revascularization procedures, hospitalization for unstable angina, and
diagnosis of new ischemic heart disease. 2010 American Heart Association,
Inc.

<3>
Accession Number
2010612347
Authors
Liu X. Tan H.-W. Wang X.-H. Shi H.-F. Li Y.-Z. Li F. Zhou L. Gu J.-N.
Institution
(Liu, Tan, Wang, Shi, Zhou, Gu) Department of Cardiology, Shanghai Chest
Hospital Affiliated, Shanghai Jiaotong University, 241 West Huaihai Road,
Shanghai 200030, China
(Li, Li) Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai
Jiaotong University, Shanghai 200030, China
Title
Efficacy of catheter ablation and surgical CryoMaze procedure in patients
with long-lasting persistent atrial fibrillation and rheumatic heart
disease: A randomized trial.
Source
European Heart Journal. 31 (21) (pp 2633-2641), 2010. Date of
Publication: November 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Catheter ablation and surgical Maze procedure are effective in
treating atrial fibrillation (AF) patients. However, there is no study
that compares the effect of circumferential pulmonary vein isolation
(CPVI) combined with substrate ablation after valvular surgery and the
concomitant Maze procedure for the treatment of AF in patients with
rheumatic heart disease (RHD). The aim of this study was to compare the
effectiveness of CPVI combined with substrate modification and surgical
Maze procedure using Saline-Irrigated Cooled-tip Radiofrequency Ablation
(SICTRA) system for the treatment of long-lasting persistent AF in
patients with RHD. Methods and resultsBetween January 2006 and June 2008,
99 patients with long-lasting persistent AF and RHD were randomly assigned
to undergo valvular operation and CPVI combined with substrate
modification 6 months after the surgery (Group A, 49 patients) or valvualr
operation and concomitant Maze procedure (Group B, 50 patients). The mean
follow-up periods were 15 +/- 5 and 20 +/- 8 months in Groups A and B,
respectively. After one procedure, Group B had a significantly higher
freedom from artial arrhythmias compared with Group A (82 in Group B vs.
55.2 in Group A, P < 0.001). Fifteen patients in Group A underwent a redo
procedure. Six patients in Group B underwent catheter ablation and four
were treated successfully. The cumulative rates of sinus rhythm were 71 in
Group A and 88 in Group B (P < 0.001). Conclusion The concomitant Cox Maze
procedure using SICTRA is more effective than subsequent CPVI combined
with substrate modification in treating patients with long-lasting
persistent AF and RHD. 2010 The Author.

<4>
Accession Number
2010618295
Authors
Cheng J.M. Onuma Y. Piazza N. Nuis R.-J.M. Van Domburg R.T. Serruys P.W.
Institution
(Cheng, Onuma, Piazza, Nuis, Van Domburg, Serruys) Thoraxcenter,
Department of Cardiology, Erasmus University Medical Center, Rotterdam,
Netherlands
Title
Comparison of five-year outcome of octogenarians undergoing percutaneous
coronary intervention with drug-eluting versus bare-metal stents (from the
RESEARCH and T-SEARCH Registries).
Source
American Journal of Cardiology. 106 (10) (pp 1376-1381), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Although octogenarians are increasingly referred for percutaneous coronary
intervention (PCI), data are lacking on long-term safety and efficacy of
drug-eluting stents in this high-risk subpopulation. The aim of this study
was to evaluate 5-year clinical outcome of octogenarians who underwent PCI
using sirolimus-eluting stents (SESs) or paclitaxel-eluting stents (PESs)
compared to bare-metal stents (BMSs). From January 2000 to December 2005,
319 consecutive octogenarian patients who underwent PCI with BMSs (n = 93,
January 2000 to April 2002), SESs (n = 52, April 2002 to February 2003),
or PESs (n = 174, February 2003 to December 2005) were included
prospectively. Primary study end points were all-cause mortality and major
adverse cardiac events (MACEs), defined as all-cause death, any myocardial
infarction, or any revascularization. Mean age of the study population was
83 +/- 2 years and 51% of patients were men. Median follow-up duration was
5.4 years (range 3 to 9). Five-year mortality rates in the BMS, SES, and
PES cohorts were similar (41%, 42%, and 41%, respectively). Cumulative
5-year MACE-free survival in the BMS, SES, and PES cohorts were 44%, 52%,
and 48%, respectively. Compared to the BMS cohort, adjusted hazard ratios
for MACEs in the SES and PES cohorts were 0.5 (95% confidence interval
[CI] 0.3 to 0.9, p <0.05) and 0.5 (95% CI 0.2 to 1.4, p = 0.2),
respectively. Overall, use of drug-eluting stents was associated with
fewer MACEs (adjusted hazard ratio 0.5, 95% CI 0.3 to 0.9, p <0.05) and a
trend toward less target vessel revascularization (adjusted hazard ratio
0.5, 95% CI 0.2 to 1.2, p = 0.1). In conclusion, PCI with drug-eluting
stents in octogenarians was found to be safe and more effective compared
to PCI with BMSs. 2010 Elsevier Inc. All rights reserved.

<5>
Accession Number
2010618296
Authors
Sarno G. Garg S. Onuma Y. Gutirrez-Chico J.-L. Van Den Brand M.J.B.M.
Rensing B.J.W.M. Morel M.-A. Serruys P.W.
Institution
(Sarno, Garg, Onuma, Gutirrez-Chico, Serruys) Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
(Van Den Brand, Morel) Cardialysis BV, Rotterdam, Netherlands
(Rensing) Antonius Hospital, Nieuwegein, Netherlands
Title
Impact of completeness of revascularization on the five-year outcome in
percutaneous coronary intervention and coronary artery bypass graft
patients (from the ARTS-II Study).
Source
American Journal of Cardiology. 106 (10) (pp 1369-1375), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The aim of this study was to compare clinical outcome at 5 years in
patients with complete and incomplete revascularization treated with
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) with drug-eluting stents. Baseline and procedural
angiograms and surgical case-record forms were centrally assessed for
completeness of revascularization. Patients treated with PCI for
incomplete revascularization were stratified according to Synergy between
Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX)
score tertiles. Complete revascularization was achieved in 360 of 588
patients (61.2%) in the PCI with sirolimus-eluting stent group and 477 of
567 patients (84.1%) in the CABG group (p <0.05). There was no significant
difference in 5-year survival without major adverse cardiac and
cerebrovascular events (MACCEs; death, cerebrovascular accident,
myocardial infarction, and any revascularization) between patients with
complete and incomplete revascularization treated with PCI or CABG.
Survival free from MACCEs in patients with incomplete revascularization
treated with PCI was significantly lower than those with complete
revascularization treated with CABG (hazard ratio 1.66, 0.96 to 1.80,
log-rank p = 0.001). The 5-year MACCE-free survival in patients with
incomplete revascularization treated with PCI stratified according to
SYNTAX score tertiles showed a significantly lower MACCE survival in the
higher SYNTAX tertile compared to the low (hazard ratio 0.56, 0.32 to
0.96, log-rank p = 0.04) and intermediate (hazard ratio 0.50, 0.28 to
0.91, log-rank p = 0.02) tertiles, whereas survival between the low and
intermediate SYNTAX tertiles was not significantly different (hazard ratio
1.13, 0.60 to 2.13, log-rank p = 0.71). In conclusion, this study suggests
that patients with complex coronary disease, in whom complete
revascularization cannot be achieved with PCI, should be offered surgical
revascularization. However, in those patients with less complex disease,
PCI is a valid alternative even if complete revascularization cannot be
achieved. 2010 Elsevier Inc. All rights reserved.

<6>
Accession Number
2010618297
Authors
Hutchinson-Jaffe A.B. Goodman S.G. Yan R.T. Wald R. Elbarouni B. Rose B.
Eagle K.A. Lai C.C. Baer C. Langer A. Yan A.T.
Institution
(Hutchinson-Jaffe, Goodman, Yan, Elbarouni, Langer, Yan) Terrence Donnelly
Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Wald) Division of Nephrology, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Goodman, Langer, Yan) Canadian Heart Research Centre, Toronto, ON, Canada
(Lai) Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
(Rose) Health Sciences Centre, St. John's, NL, Canada
(Baer) Moncton Hospital, SE Regional Health Authority, Moncton, NB, Canada
(Eagle) University of Michigan Health System, Ann Arbor, MI, United States
Title
Comparison of baseline characteristics, management and outcome of patients
with nonst-segment elevation acute coronary syndrome in versus not in
clinical trials.
Source
American Journal of Cardiology. 106 (10) (pp 1389-1396), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Previous studies have questioned the external validity of randomized
controlled trial results of acute coronary syndrome (ACS) because of
potential selection bias toward healthier patients. We sought to evaluate
differences in clinical characteristics and management of patients
admitted with nonST-elevation ACS according to participation in clinical
trials over the previous decade. The Canadian ACS I (1999 to 2001), ACS II
(2002-2003), GRACE (2004-2007), and CANRACE (2008) were prospective,
multicenter registries of patients admitted to hospitals with ACS. We
examined 13,556 patients with nonST-elevation ACS, of whom 1,126 (8.3%)
participated in clinical trials. Data were collected on baseline
characteristics, medication use at admission and discharge, in-hospital
procedures, and in-hospital adverse events. Patients enrolled in clinical
trials were younger, more likely to be men, and had fewer co-morbidities.
They were significantly more likely to be on several guideline-recommended
medications and were significantly more likely to undergo invasive
procedures, including coronary angiography, percutaneous coronary
intervention, and coronary bypass surgery (all p values <0.001).
Unadjusted in-hospital (2.1% vs 0.7%, p = 0.001) and 1-year (8.9% vs 6.3%,
p = 0.037) mortality rates were higher in non-enrolled patients. In
multivariable analysis, patients who were older, women, had a history of
heart failure, and increased creatinine levels on presentation were less
likely to be enrolled into clinical trials. In conclusion, significant
differences persist in baseline characteristics, treatment, and outcomes
between patients enrolled and those not enrolled in clinical trials.
Consequently, generalization of ACS clinical trials over the previous
decade to the "real-world" patient may remain in question. 2010 Elsevier
Inc. All rights reserved.

<7>
Accession Number
2010620217
Authors
Ariyaratnam P. Bland M. Loubani M.
Institution
(Ariyaratnam, Loubani) Department of Cardiothoracic Surgery, Castle Hill
Hospital, Cottingham, East Yorkshire HU16 5JQ, United Kingdom
(Bland) Department of Health Sciences, University of York, York, United
Kingdom
Title
Risk factors and mortality associated with deep sternal wound infections
following coronary bypass surgery with or without concomitant procedures
in a UK population: A basis for a new risk model?.
Source
Interactive Cardiovascular and Thoracic Surgery. 11 (5) (pp 543-546),
2010. Date of Publication: November 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Deep sternal wound infection (DSWI) is a rare but serious complication
following coronary artery bypass surgery. Our study investigates the risk
factors and mortality associated with DSWI with other risk models for
DSWI. Data was collected prospectively on 7602 patients undergoing
coronary artery bypass grafting+/-concomitant surgery between April 1999
and September 2009 including DSWI. All 13 Society for Thoracic Surgeons
(STS) risk scoring variables were assessed using logistic regression in
relation to developing DSWI. The STS risk scores were evaluated using the
area under the receiver operating curve. A total of 44 (0.59%) patients
developed DSWI. These patients had a higher mortality (9.1%) than patients
without DSWI (2.6%) (P=0.03). The mean preoperative and combined STS
scores were significantly higher in the DSWI patient group compared to the
non-DSWI group (9.46+/-4.30 and 8.76+/-3.86 vs. 7.07+/-4.25 and
6.51+/-4.11, P=0.0003 and P=0.0005, respectively). Logistic regression
identified age [odds ratio (OR)=1.055], body mass index (OR=1.076),
diabetes (OR=2.00) and chronic lung disease (OR=2.47) as the significant
independent determinants of DSWI from the variables considered. Mortality
rates and mean STS scores are higher in patients requiring re-opening for
DSWI. Not all the STS risk factors were predictors of DSWI in our
population. 2010 Published by European Association for Cardio-Thoracic
Surgery.

<8>
Accession Number
2010620223
Authors
Verma Y.S. Chauhan S. Gharde P. Lakshmy R. Kiran U.
Institution
(Verma, Chauhan, Gharde, Kiran) Department of Cardiac Anaesthesia, AIIMS,
New Delhi, India
(Lakshmy) Department of Cardiac Biochemistry, AIIMS, New Delhi, India
Title
Role of magnesium in the prevention of postoperative arrhythmias in
neonates and infants undergoing arterial switch operation.
Source
Interactive Cardiovascular and Thoracic Surgery. 11 (5) (pp 573-576),
2010. Date of Publication: November 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
The objectives of the study were to measure magnesium levels in neonates
and infants undergoing arterial switch operation and to ascertain the role
of magnesium supplementation in the prevention of postoperative
arrhythmias. Group I (ns25): magnesium was administered in the dose of 30
mgykg over 10 minutes in normal saline (5 ml) immediately after cessation
of cardiopulmonary bypass (CPB). Group II (ns25): normal saline (5 ml) was
administered over 10 minutes immediately after cessation of CPB. Samples
of arterial blood were collected at four time points: 1) after induction
of anaesthesia; 2) 10 minutes after initiation of CPB; 3) at rewarming
during CPB; and 4) 4 hours after shifting the patient to the intensive
care unit. Samples were measured for ionized magnesium (iMg), blood gases,
haematocrit level, electrolytes, ionized calcium and glucose. Continuous
ECG rhythm analysis and documentation of arrhythmias was performed for 24
hours after surgery. The mean preoperative iMg levels were below the
normal level in both the groups. A significant increase in iMg levels
(Ps0.00) was seen in both groups during rewarming. There is no
statistically significant difference in the incidence of arrhythmias
between the magnesium supplemented group (4%) and the control group (20%)
in the postoperative period, a tendency towards reduction in arrhythmias
was only observed in the magnesium supplemented group.

<9>
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Accession Number
2010608630
Authors
Magder S. Potter B.J. Varennes B.D. Doucette S. Fergusson D.
Institution
(Magder) McGill University, Montreal, QC, Canada
(Magder) McGill University Health Centre, Montreal QC, Canada
(Potter) Montreal Heart Institute, Montreal, QC, Canada
(Varennes) Division of Cardiac Surgery, McGill University, McGill
University Health Centre, Montreal, QC, Canada
(Doucette) Ottawa Hospital, Research Institute, Methods Centre, Ottawa,
ON, Canada
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Fergusson) University of Ottawa, Centre for Transfusion Research, Ottawa,
ON, Canada
(Fergusson) Department of Medicine, Surgery, Epidemiology and Community
Health, University of Ottawa, Ottawa Hospital Research Institute, Ottawa,
ON, Canada
Title
Fluids after cardiac surgery: A pilot study of the use of colloids versus
crystalloids.
Source
Critical Care Medicine. 38 (11) (pp 2117-2124), 2010. Date of
Publication: November 2010.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Objectives: To determine whether a starch solution for volume
resuscitation in a flow-based protocol improves circulatory status better
than a crystalloid solution, as defined by the need for catecholamines in
patients the morning after cardiac surgery, and whether this can be
performed without increased morbidity. Design: Concealed, randomized,
double-blind, controlled trial. PARTICIPANTS: Two hundred sixty-two
patients who underwent cardiac surgery at a tertiary care hospital.
InterventionS: Based on predefined criteria indicating a need for fluids,
and a nurse-delivered algorithm that used central venous pressure and
cardiac index obtained from a pulmonary artery catheter, patients were
allocated to receive 250-mL boluses of 0.9% saline or a 250-molecular
weight 10% solution of pentastarch. Results: Two hundred thirty-seven
patients received volume boluses: 119 hydroxyethyl starches and 118
saline. Between 8:00 am and 9:00 am the morning after surgery, 13 (10.9%)
of hydroxyethyl starch patients and 34 (28.8%) saline patients were using
catecholamines (p = .001). Hydroxyethyl starch patients had less pneumonia
and mediastinal infections (p = .03) and less cardiac pacing (p = .03).
There were two deaths in each group. There was no difference in the daily
creatinine, development of RIFLE risk criteria during hospital stay, or
new dialysis. The numbers and volumes of packed red blood cells were
similar in the two groups, but more hydroxyethyl starch patients received
plasma transfusions (p = .05). Conclusions: Use of a colloid solution for
volume resuscitation in a nurse-delivered flow-based algorithm, which
included a pulmonary artery catheter, significantly improved hemodynamic
status, an important factor for readiness for discharge from the intensive
care unit. Copyright 2010 by the Society of Critical Care Medicine and
Lippincott Williams & Wilkins.

<10>
Accession Number
2010611487
Authors
Imakiire N. Omae T. Matsunaga A. Sakata R. Kanmura Y.
Institution
(Imakiire, Omae, Matsunaga, Kanmura) Department of Anesthesiology and
Critical Care Medicine, Kagoshima University Graduate School of Medical
and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
(Sakata) Department of Thoracic and Cardiovascular Surgery, Kagoshima
University Graduate School of Medical and Dental Sciences, Kagoshima,
Japan
Title
Can a NICO monitor substitute for thermodilution to measure cardiac output
in patients with coexisting tricuspid regurgitation?.
Source
Journal of Anesthesia. 24 (4) (pp 511-517), 2010. Date of Publication:
August 2010.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose The validity of measuring cardiac output (CO) using thermodilution
via pulmonary artery catheterization in the presence of tricuspid
regurgitation (TR) remains controversial. Methods We compared the accuracy
and precision of a non-invasive cardiac output (NICO) monitor and of
thermodilution with those of transesophageal echocardiography (TEE) to
measure CO in 50 patients who underwent elective valvoplasty to treat TR
(26 mild and 24 moderateto- severe) and in 25 normal controls (without
TR). We used TEE as a reference method to measure CO and to
intraoperatively grade TR. Results The differences between NICO monitor
and TEE measurements in patients without TR and in those with mild and
with moderate-to-severe TR were -0.17 +/- 0.88 (n = 150, r² =
0.75), -0.16 +/- 0.82 (n = 158, r² = 0.78), and 0.17 +/- 0.91
L/min (n = 155, r² = 0.78), respectively. The differences
between bolus thermodilution cardiac output and TEE measurements in
patients without TR and in those with mild and with moderate-to-severe TR
were -0.08 +/- 0.55 (r² = 0.88), 0.05 +/- 0.61 (r² =
0.86), and 0.43 +/- 1.37 L/min (r² = 0.58), respectively.
Conclusion These findings demonstrate that measuring CO using the
thermodilution technique is less accurate in patients with
moderate-to-severe TR and that the NICO monitor is more accurate for such
patients. We postulate that the NICO monitor measures CO more accurately
and reproducibly than thermodilution in patients with coexisting TR.
Japanese Society of Anesthesiologists 2010.

<11>
Accession Number
2010615130
Authors
Shimizu T. Kyo S. Imanaka K. Nakaoka K. Nishimura E. Okumura T. Ishii M.
Hisagi M. Nishimura T. Motomura N. Ono M. Takamoto S.
Institution
(Shimizu, Kyo, Ishii, Hisagi, Nishimura) Department of Therapeutic
Strategy for Heart Failure, Graduate School of Medicine, University of
Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
(Imanaka) Department of Cardiovascular Surgery, Saitama Medical Center,
Saitama, Japan
(Nakaoka, Nishimura) Nishimura Kikai Co. Ltd, Tokyo, Japan
(Okumura) School of Biomedical Engineering, Faculty of Health and Medical
Care, Saitama Medical University, Saitama, Japan
(Motomura, Ono) Department of Cardiac Surgery, University of Tokyo, Tokyo,
Japan
(Takamoto) Department of Cardiovascular Surgery, Mitsui Memorial Hospital,
Tokyo, Japan
Title
A novel external counterpulsation system for coronary artery disease and
heart failure: Pilot studies and initial clinical experiences.
Source
Journal of Artificial Organs. 13 (3) (pp 161-169), 2010. Date of
Publication: September 2010.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
External counterpulsation (ECP) is a beneficial and noninvasive treatment
for coronary artery disease or heart failure; however, it still has a lot
of limitations. We used a novel ECP system, Compact CP, the main feature
of which is the double-lumen cuff that reduces the impact of cuff
inflation and the size of the air compressor. The first lumen was a
contact cuff that was attached to the legs with a constant pressure (8
kPa). The second lumen was a main cuff that was inflated and deflated with
a driving pressure and synchronized to the cardiac cycle. In this report,
we describe the results of four pilot studies in a total number of 39
healthy volunteers and initial clinical experiences of this system in
three patients. The pilot studies demonstrated that the ECP system
provided significant diastolic augmentation and systolic unloading. It
also achieved a satisfactory diastolic/systolic pressure ratio (1.00 +/-
0.06) with a high comfort level at a driving pressure of 40 kPa. Higher
pressure (50-70 kPa) increased the assist performance but decreased the
comfort level. ECP was also applied with a patient with chronic refractory
angina and two patients with postoperative heart failure following cardiac
surgery. The clinical conditions improved. No adverse effect was observed.
Our novel ECP system is safe, effective, and promising in the treatment of
coronary artery disease or heart failure. Further clinical investigations
are needed to support the significance of this system. 2010 The Japanese
Society for Artificial Organs.

<12>
Accession Number
20395003
Authors
Emam I.A. Allan A. Eskander K. Dhanraj K. Farag S. El-Kadi Y. Khalaf W.
Riad S.R. Somia R.
Institution
(Emam) Department of Cardiac Surgery, King Fahd Military Medical Complex,
Dhahran, Saudi Arabia.
Title
Our experience of controlling diabetes in the peri-operative period of
patients who underwent cardiac surgery.
Source
Diabetes research and clinical practice. 88 (3) (pp 242-246), 2010. Date
of Publication: Jun 2010.
Abstract
AIMS: We have different protocols applied in our cardiac center for
control of blood glucose (BG), we like to see which protocol can achieve
our goal. METHODS: From a prospective study of 120 diabetic patients
randomly assigned to either simple sliding scale or Braithwaite protocol
who underwent open heart surgical procedures between 2005 and 2008. The
study group included 80 patients treated with Braithwaite protocol; the
control group included 40 patients treated with simple sliding scale in an
attempt to maintain BG level less than 200 mg/dl. RESULTS: In the study
group all the patients were under 200 mg/dl at the end of 48 h
postoperatively, which was not achieved in the control group (P<0.01).
There was a significant reduction in hospital stay in the study group
compared to the control group (mean in days 9.1+/-2.3/12.3+/-7.6)
(P<0.001) and also there was no wound infection compared to the control
group (0/5 cases). CONCLUSION: The study showed that control of DM in
peri-operative period using Braithwaite regimen was of great benefit and
safety. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

<13>
Accession Number
2010595727
Authors
Kramer R.S. Quinn R.D. Groom R.C. Braxton J.H. Malenka D.J. Kellett M.A.
Brown J.R.
Institution
(Kramer, Quinn, Groom, Braxton, Malenka, Kellett) Division of
Cardiothoracic Surgery, Maine Medical Center R8, 22 Bramhall St, Portland,
ME 04102, United States
(Brown) Dartmouth Institute for Health Policy and Clinical Practice,
Hitchcock Medical Center, Dartmouth Medical School and Dartmouth, Lebanon,
NH, United States
(Brown) Dartmouth Institute for Health Policy and Clinical Practice,
Lebanon, NH, United States
Title
Same admission cardiac catheterization and cardiac surgery: Is there an
increased incidence of acute kidney injury?.
Source
Annals of Thoracic Surgery. 90 (5) (pp 1418-1423), 2010. Date of
Publication: 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Acute kidney injury (AKI) is predictive of increased long-term
mortality after cardiac surgery. Patients often undergo surgery after
cardiac catheterization during the same admission for reasons of
instability and threatening anatomy as well as nonurgent reasons such as
patient convenience. We hypothesized that patients undergoing cardiac
catheterization and cardiac surgery during the same admission are more
likely to develop AKI after cardiac surgery than patients for whom surgery
is performed on a later admission. Methods: We prospectively enrolled 668
nonemergent adult cardiac surgical cases. Patients having heart
catheterization were divided into two groups: cardiac catheterization
followed by cardiac surgery during the same hospital admission (same
admission) or catheterization followed by surgery during a later admission
(later admission). The AKI was defined by an increase in serum creatinine
from baseline by 50% or greater or 0.3 (mg/dL) or greater. Univariable and
multivariable logistic regression and propensity-matched analyses were
conducted. Results: The incidence of AKI was significantly higher in the
patients who had same admission cardiac catheterization and surgery
(50.2%) compared with patients who had surgery on a later admission
(33.7%, p = 0.009). The adjusted odds ratio for surgery on a later
admission was 1.54 (95% confidence interval: 1.11 to 2.13) suggesting a
54% increased risk of AKI. Propensity-matched results were similar with
1.58 (95% confidence interval: 1.13 to 2.22). Conclusions: When cardiac
catheterization and cardiac surgery occur during the same hospitalization,
there is an increased risk for postoperative AKI. After cardiac
catheterization, discharge and readmission for nonurgent surgery should be
considered as such an approach might reduce the risk of AKI. 2010 The
Society of Thoracic Surgeons.

<14>
Accession Number
2010595762
Authors
Koertke H. Zittermann A. Wagner O. Ennker J. Saggau W. Sack F.-U. Cremer
J. Huth C. Braccio M. Musumeci F. Koerfer R.
Institution
(Koertke, Zittermann, Wagner, Koerfer) Clinic for Thoracic and
Cardiovascular Surgery, Heart Center North Rhine-Westphalia, Ruhr
University Bochum, Bad Oeynhausen, Germany
(Ennker) Clinic for Thoracic and Cardiovascular Surgery, Heart Center
Lahr, Lahr, Germany
(Saggau, Sack) Clinic Ludwigshafen, Ludwigshafen, Germany
(Cremer) Clinic for Cardiovascular Surgery,
Christian-Albrechts-University, Kiel, Germany
(Huth) Clinic for Thoracic and Cardiovascular Surgery, Otto von Guericke
University Magdeburg, Magdeburg, Germany
(Braccio) Santa Anna Hospital, Cattanzaro, Italy
(Musumeci) Azienda Ospedaliera S. Camillo Forlani Hospital, Rome, Italy
Title
Efficacy and safety of very low-dose self-management of oral
anticoagulation in patients with mechanical heart valve replacement.
Source
Annals of Thoracic Surgery. 90 (5) (pp 1487-1493), 2010. Date of
Publication: 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Self-management improves oral anticoagulation control. Here we
provide data of a preplanned interim analysis of very low-dose early
self-controlled anticoagulation. Methods: In a prospective, randomized,
multicenter trial, 1,137 patients performed low-dose international
normalized ratio (INR) self-management with a target INR range of 1.8. to
2.8 for aortic valve replacement recipients and 2.5 to 3.5 for mitral or
double valve replacement recipients for the first six postoperative
months. Thereafter, 379 patients continued to achieve the aforementioned
INR target range (LOW group), whereas the INR target value was set at 2.0
(range, 1.6 to 2.1) for the remaining patients with aortic valve
replacement and 2.3 (range, 2.0 to 2.5) for the remaining patients with
mitral valve or double valve replacement. One half of this latter group
had to check their INR values once a week (VL1 group) the other half twice
a week (VL2 group). Patients were followed up for 24 months. Results:
Beyond study month six, the incidence of thromboembolic events that
required hospital admission was 0.58%, 0.0%, and 0.58% in the LOW, VL1,
and VL2 groups, respectively (p = 0.368). The incidence of bleeding events
per patient-year was 1.16%, 1.07%, and 0.58% in the LOW, VL1, and VL2
groups, respectively (p = 0.665). Mortality rate did not differ among
study groups. Conclusions: Data demonstrate the efficacy and safety of
very low-dose INR self-management. 2010 The Society of Thoracic Surgeons.

<15>
Accession Number
2010608028
Authors
Theuns D.A.M.J. Smith T. Hunink M.G.M. Bardy G.H. Jordaens L.
Institution
(Theuns, Smith, Jordaens) Department of Cardiology, Erasmus MC, Rotterdam,
Netherlands
(Smith, Hunink) Department of Epidemiology, Erasmus MC, Rotterdam,
Netherlands
(Hunink) Department of Health Policy and Management, Harvard School of
Public Health, Boston, MA, United States
(Bardy) Seattle Institute for Cardiac Research, Seattle, WA, United States
Title
Effectiveness of prophylactic implantation of cardioverter-defibrillators
without cardiac resynchronization therapy in patients with ischaemic or
non-ischaemic heart disease: A systematic review and meta-analysis.
Source
Europace. 12 (11) (pp 1564-1570), 2010. Date of Publication: November
2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims: Much controversy exists concerning the efficacy of primary
prophylactic implantable cardioverter-defibrillators (ICDs) in patients
with low ejection fraction due to coronary artery disease (CAD) or dilated
cardiomyopathy (DCM). This is also related to the bias created by function
improving interventions added to ICD therapy, e.g. resynchronization
therapy. The aim was to investigate the efficacy of ICD-only therapy in
primary prevention in patients with CAD or DCM.Methods and results: Public
domain databases, MEDLINE, EMBASE, and Cochrane Central Register of
Controlled Trials, were searched from 1980 to 2009 for randomized clinical
trials of ICD vs. conventional therapy. Two investigators independently
abstracted the data. Pooled estimates were calculated using both
fixed-effects and random-effects models. Eight trials were included in the
final analysis (5343 patients). Implantable cardioverter-defibrillators
significantly reduced the arrhythmic mortality [relative risk (RR): 0.40;
95 confidence interval (CI): 0.27-0.67] and all-cause mortality (RR: 0.73;
95 CI: 0.64-0.82). Regardless of aetiology of heart disease, ICD benefit
was similar for CAD (RR: 0.67; 95 CI: 0.51-0.88) vs. DCM (RR: 0.74; 95 CI:
0.59-0.93).Conclusions: The results of this meta-analysis provide strong
evidence for the beneficial effect of ICD-only therapy on the survival of
patients with ischaemic or non-ischaemic heart disease, with a left
ventricular ejection fraction <=35, if they are 40 days from myocardial
infarction and >=3 months from a coronary revascularization procedure.
The Author 2010.

<16>
Accession Number
20636552
Authors
Frey J.M. Svegby H.K. Svenarud P.K. van der Linden J.A.
Institution
(Frey) Department of Molecular Medicine, Karolinska Institute, Karolinska
University Hospital, Stockholm, Sweden.
Title
CO2 insufflation influences the temperature of the open surgical wound.
Source
Wound repair and regeneration : official publication of the Wound Healing
Society [and] the European Tissue Repair Society. 18 (4) (pp 378-382),
2010. Date of Publication: Jul 2010.
Abstract
In open surgery, heat is lost due to radiation and evaporation through the
wound. Hypothermia causes tissue hypoxia and impairs various cellular
immune functions that increases the risk for postoperative wound
infections and delayed wound healing. The patient's body is usually well
protected with heating arrangements, but the open wound is left
unprotected and until now no practical method has been available to
protect it thermically. We therefore investigated if insufflation of an
open surgical wound with carbon dioxide would affect wound temperature. In
10 patients undergoing cardiac surgery, the sternotomy wound was
insufflated with dry, room temperature carbon dioxide via a gas diffuser
for 2 minutes. A heat-sensitive camera measured the wound temperature
before, during, and after insufflation. Exposure to carbon dioxide
increased the median temperature of the whole wound by 0.5 degrees C
(p=0.01). The temperature of the area distant to the diffuser increased by
1.2 degrees C (p<0.01) whereas in the area close to the diffuser it
decreased by 1.8 degrees C (p<0.01). In conclusion, short-term
insufflation of dry room temperature carbon dioxide in an open wound
increases the surface temperature significantly. Although a small
increase, it may reduce the incidence of postoperative wound infections in
the future.

<17>
Accession Number
20668034
Authors
Kaptein E.M. Sanchez A. Beale E. Chan L.S.
Institution
(Kaptein) Department of Medicine, University of Southern California, Los
Angeles, California 90033, USA.
Title
Clinical review: Thyroid hormone therapy for postoperative nonthyroidal
illnesses: a systematic review and synthesis.
Source
The Journal of clinical endocrinology and metabolism. 95 (10) (pp
4526-4534), 2010. Date of Publication: Oct 2010.
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
T(3) therapy in adults. DATA SOURCES: Electronic databases and reference
lists through March 2010 were searched. STUDY SELECTION: Studies with
comparable control groups comparing T(3) 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 T(3) was given in
high doses (0.175-0.333 mug/kg h) for 6 to 9 h, in four studies iv T(3)
was given in low doses (0.0275-0.0333 mug/kg h for 14 to 24 h), and in
three studies T(3) was given orally in variable doses and durations. DATA
SYNTHESIS: Both high- and low-dose iv T(3) therapy increased cardiac index
after coronary artery bypass surgery. Mortality was not significantly
altered by high-dose iv T(3) therapy and could not be assessed for
low-dose iv or oral T(3). Effects on systemic vascular resistance, heart
rate, pulmonary capillary wedge pressure, new onset atrial fibrillation,
inotrope use, serum TSH and T(4) were inconclusive. LIMITATIONS: Numbers
of usable unique studies and group sizes were small. Duration of T(3)
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.