EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 10

Results Generated From:
EMBASE <1980 to 2010 Week 51>
EMBASE (updates since 2010-12-16)

<1>
Accession Number
2010677094
Authors
Luciani G.B. Forni A. Rigatelli G. Chiominto B. Cardaioli P. Mazzucco A.
Faggian G.
Institution
(Luciani, Forni, Chiominto, Mazzucco, Faggian) Division of Cardiac
Surgery, University of Verona, O.C.M. Piazzale Stefani 1, 37126 Verona,
Italy
(Rigatelli, Cardaioli) Division of Cardiology, Regional Hospital Rovigo,
Rovigo, Italy
Title
Myocardial protection in heart transplantation using blood cardioplegia:
12-year outcome of a prospective randomized trial.
Source
Journal of Heart and Lung Transplantation. 30 (1) (pp 29-36), 2011. Date
of Publication: January 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background Blood cardioplegia yields a lower prevalence of right heart
failure, arrhythmias, and myocardial ischemia early after heart
transplantation (HTx). Because depolarizing (high [K⁺])
cardioplegic solutions may alledgedly cause endothelial damage, the
12-year outcome of a prospective randomized trial was reviewed. Methods
Between January 1997 and March 1998, 47 consecutive patients received
crystalloid (Group 1, n = 27) or blood cardioplegia (Group 2, n = 20). The
groups were similarly matched: recipient age (54 +/- 11 vs 55 +/- 7 years,
p = 0.9), sex (89% vs 90% males, p = 0.9), diagnosis (63% vs 65% dilated
cardiomyopathy, p = 0.8), elevated (>4 WU) pulmonary vascular resistance
(30% vs 30%, p = 0.9), prior operations (22% vs 30%, p = 0.5), urgent HTx
(7% vs 20%, p = 0.2), donor age (32 +/- 11 vs 31 +/- 13 years, p = 0.7),
donor sex (78% vs 70% males, p = 0.5), donor cause of death (33% vs 40%
vascular, p = 0.5), and global myocardial ischemia (176 +/- 51 vs 180 +/-
58 minutes p = 0.5). Hemodynamically unstable donors were more prevalent
in Group 2 (15% vs 45%, p = 0.02). The 45 hospital survivors underwent
yearly echocardiography, coronary angiography, and coronary intravascular
ultrasound (IVUS) imaging during follow-up. Results During follow-up (10.4
+/- 5.2, range, 0.912.7 years), Groups 1 and 2 had comparable mortality
(46% vs 42%, p = 0.7) and cause of death (chronic rejection: 50% vs 50%;
neoplasia: 33% vs 25%, p = 0.8). Survival at 12 years was 50% +/- 12% vs
52% +/- 11% (p = 0.9). Follow-up echocardiogram showed similar mean left
ventricular ejection fraction (LVEF; 47% +/- 12% vs 49% +/- 11%, p = 0.7)
and prevalence of LVEF < 35% (21% vs 18%, p = 0.8). Prevalence of chronic
rejection was comparable (42% vs 32%, p = 0.1), yet severe allograft
vasculopathy (International Society for Heart and Lung Transplantation
cardiac allograft vasculopathy 3) was more prevalent in Group 1 (64% vs
17%, p = 0.04). Freedom from chronic rejection was higher in Group 2 (44%
+/- 15% vs 63% +/- 13%), albeit not significantly (p = 0.5). A trend
toward greater prevalence of intimal disease at IVUS (thickness > 0.5 mm)
in the proximal and distal left anterior descending artery (67% vs 40%;
58% vs 45%) and higher number of percutaneous coronary interventions (2.7
+/- 0.5 vs 1.8 +/- 0.3, p = 0.3) was noted in Group 1. Conclusions Use of
blood cardioplegia is safe and results in comparable survival and
prevalence of adverse events late after HTx. The trend towards greater
freedom from chronic rejection and more limited extent of coronary artery
disease in grafts protected with blood cardioplegia awaits confirmation.
2011 International Society for Heart and Lung Transplantation.

<2>
Accession Number
70313211
Authors
Jett J.R.
Institution
(Jett) Mayo Clinic, College of Medicine, Rochester, MN, United States
Source
Respirology. Conference: 15th Congress of the Asian Pacific Society of
Respirology Manila Philippines. Conference Start: 20101122 Conference End:
20101125. Conference Publication: (var.pagings). 15 (pp 22), 2010.
Date of Publication: November 2010.
Publisher
Blackwell Publishing
Abstract
Screening for lung cancer is not currently recommended by any major
medical organization. Multiple Phase II non-randomized trials of computed
tomography (CT) screening have yielded enticing results. They have
demonstrated that CT screening detects smaller size lung cancer of 12-15
mm in diameter. It has been documented that the chest radiographs miss
70-80% of the cancers detected by screening CT. In prevalence studies,
60-80% of detected cancers are stage I. When CT screening results were
compared to a validated control group, CT has been shown to detect 3 times
more lung cancer than would be expected and results in ten times more
thoracic operation than would be expected. Additionally, no decrease in
advanced stage cancers or decrease in lung cancer deaths were observed. To
date, multiple small randomized controlled screening trials (RCT) have
been reported, but they have been too small to assess if CT screening
reduces mortality. A meta-analysis of baseline findings from six small
randomized controlled trials observed more stage I and more total lung
cancers in the CT screened group. For every 1000 individuals screened with
low dose CT, 9 stage I NSCLC and 235 false positive nodules were detected
and 4 thoracic operations were performed for benign nodules. The two large
RCT of CT screening that may definatively answer the question of CT
screening and its ability to decrease lung cancer mortality are the
National Cancer Screening Trial (NLST) and the Nederlands-Leuvens
Longkanker Screenings Onderzoek (NELSON) trial. Mortality results from
those two trials are anticipated in 2011 and 2015 respectively. A recent
report from the NELSON trial validated the use of CT volumetric assessment
of nodules to assess malignancy and determine which nodules should be
treated surgically. Currently, there is considerable effort to identify
susceptibility genes for lung cancer with particular interest in 15q 24-25
which is strongly associated. This region contains several genes of
interest, including three genes that encode nicotinic acetylcholine
receptor subunits. However, these genes may just be associated with
nicotine dependence. A recent report utilizing GWAS (genome wide
association scan) methodology identified 2 SNPs at 13q31.3 associated with
lung cancer susceptibility in never smokers. An enormous research effort
is underway related to biomarkers in airway epithelial cells, blood,
sputum, breath, and urine for early diagnosis or prediction of high risk.
Intense efforts are devoted to develop models of risk for determining
which individuals should be offered screening.

<3>
Accession Number
2010656509
Authors
Guo S.-Z. Wang N.-F. Zhou L. Ye X.-H. Pan H. Tong G.-X. Yang J.-M. Xu J.
Institution
(Guo, Wang, Zhou, Ye, Pan, Tong, Yang, Xu) Department of Cardiology, First
Municipal Hospital of Hangzhou, Affiliated Hangzhou Hospital of Nanjing
Medical University, Hangzhou, Zhejiang, 310006, China
Title
Influence of Granulocyte colony-stimulating factor on cardiac function in
patients with acute myocardial infarction and leukopenia after
revascularization.
Source
Chinese Medical Journal. 123 (14) (pp 1827-1832), 2010. Date of
Publication: July 2010.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Granulocyte colony-stimulating factor (G-CSF) seems to improve
cardiac function and perfusion when used systemically through mobilization
of stem cells into peripheral blood, but results of previous clinical
trials remain controversial. This study was designed to investigate safety
and efficacy of subcutaneous injection of G-CSF on left ventricular
function in patients with impaired left ventricular function after
ST-segment elevation myocardial infarction (STEMI). Methods Thirty-three
patients (22 men; age, (68.5+/-6.1) years) with STEMI and with comorbidity
of leukopenia were included after successful primary percutaneous coronary
intervention within 12 hours after symptom onset. Patients were randomized
into G-CSF group who received G-CSF (10 mug/kg of body weight, daily) for
continuous 7 days and control group. Results of blood analyses,
echocardiography and angiography were documented as well as possibly
occurred adverse events. Results No severe adverse events occurred in both
groups. Mean segmental wall thickening in infract segments increased
significantly at 6-month follow up compared with baseline in both groups,
but the longitudinal variation between two groups had no significant
difference (P >0.05). The same change could also be found in longitudinal
variation of wall motion score index of infarct segments (P >0.05). At
6-month follow-up, left ventricular end-diastolic volume of both groups
increased to a greater extent, but there were no significant differences
between the two groups when comparing the longitudinal variations (P
>0.05). In both groups, left ventricular ejection fraction measured by
echocardiography ameliorated significantly at 6-month follow-up (P <0.05),
but difference of the longitudinal variation between two groups was not
significant (P >0.05). When pay attention to left ventricular ejection
fraction measured by angiocardiography, difference of the longitudinal
variation between groups was significant (P=0.046). Early diastolic mitral
flow velocity deceleration time changed significantly at 6- month
follow-up in both groups (P=0.05). Conclusions Mobilization of stem cells
by G-CSF after reperfusion of infarct myocardium is safe and seems to
offer a pragmatic strategy for recovery of myocardial global function.

<4>
Accession Number
2010663554
Authors
Bilinska M. Kosydar-Piechna M. Gasiorowska A. Mikulski T. Piotrowski W.
Nazar K. Piotrowicz R.
Institution
(Bilinska, Kosydar-Piechna, Piotrowicz) Department of Cardiac
Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology,
Warsaw, Poland
(Gasiorowska, Mikulski, Nazar) Department of Applied Physiology,
Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw,
Poland
(Piotrowski) Department of Epidemiology, Cardiovascular Disease Prevention
and Health Promotion, Institute of Cardiology, Warsaw, Poland
Title
Influence of dynamic training on hemodynamic, neurohormonal responses to
static exercise and on inflammatory markers in patients after coronary
artery bypass grafting.
Source
Circulation Journal. 74 (12) (pp 2598-2604), 2010. Date of Publication:
2010.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Little is known about the influence of dynamic training on the
hemodynamic and neurohormonal responses to static exercise and on
inflammatory markers in optimally treated post-coronary artery bypass
grafting (CABG) patients. Methods and Results: One hundred and twenty male
patients, aged 55+/-6 years, 3 months after receiving CABG, were
randomized to either 6 weeks of aerobic training on a cycloergometer, 3
times a week, at a 70-80% of the maximum tolerated heart rate (HR)
(training group, n=60) or to a control group (n=60). At baseline and at
the end of the study, all patients underwent: (1) a cardiopulmonary test;
(2) handgrip at 30% of maximal voluntary contraction for 3 min in a
sitting position during in which HR, blood pressure (BP), stroke volume
(SV, by impedance cardiography), cardiac output (CO) and total peripheral
resistance (TPR) were monitored; and (3) plasma level assessment of
catecholamines, nitric oxide and inflammatory markers. During the final
tests, handgrip- induced increases in HR, BP, and TPR (14% vs 27%, P<0.01)
were lower, whereas SV and CO were higher (by 13% and 15%, respectively,
P<0.05) in trained patients compared with controls. Moreover, a higher
increase in nitric oxide level (46% vs 14%, P<0.01) and a lower increase
in noradrenaline (11% vs 20%, P<0.05) were observed in trained patients
compared with controls. Accordingly, training caused significant
improvement in peak oxygen uptake per kilogram body weight (peak
VO₂) and inflammatory markers. Conclusions: Short-term dynamic
training caused significant improvement of hemodynamic and neurohormonal
responses to handgrip, cardiovascular fitness and inflammatory state.

<5>
Accession Number
2010663578
Authors
Takagi H. Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Title
Effect of preoperative statin therapy on postoperative atrial fibrillation
in cardiac surgery.
Source
Circulation Journal. 74 (12) (pp 2788-2789), 2010. Date of Publication:
2010.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)

<6>
Accession Number
2010676704
Authors
Alton G.Y. Rempel G.R. Robertson C.M.T. Newburn-Cook C.V. Norris C.M.
Institution
(Alton) Glenrose Rehabilitation Hospital, Stollery Childrens Hospital,
Edmonton, AB, Canada
(Rempel, Newburn-Cook, Norris) Faculty of Nursing, University of Alberta,
Edmonton, AB, Canada
(Robertson) Outcome Evaluation and Research, Glenrose Rehabilitation
Hospital, Edmonton, AB, Canada
(Rempel, Robertson) Department of Pediatrics, Edmonton, AB, Canada
(Norris) Department of Cardiovascular Surgery, Faculty of Medicine,
University of Alberta, Edmonton, AB, Canada
Title
Functional outcomes after neonatal open cardiac surgery: Comparison of
survivors of the Norwood staged procedure and the arterial switch
operation.
Source
Cardiology in the Young. 20 (6) (pp 668-675), 2010. Date of Publication:
December 2010.
Publisher
Cambridge University Press (Shaftesbury Road, Cambridge CB2 2RU, United
Kingdom)
Abstract
Background: Improvements in long-term survival of children undergoing the
Norwood staged procedure and the arterial switch operation have resulted
in the need to prepare these at-risk children for each stage of their
developmental trajectory, including school readiness. This study describes
and compares functional outcomes following the Norwood staged procedure
and arterial switch operations.Methods This prospective inception cohort
study comprised a sample of 73 children (71% boys) who had the Norwood
staged procedure (n = 28) or the arterial switch operation (n = 45) at the
age of 6 weeks or younger at the Stollery Childrens Hospital, Edmonton,
Alberta, between 2002 and 2005. We excluded children who had chromosomal
abnormalities or cerebral palsy. When children were 18-24 months of age,
parents completed the Adaptive Behavioral Assessment System II. Standard
scores for the domains are mean 100, standard deviation (15); skill area
scaled scores, 10 (3). Students t-test with Bonferonni correction was used
to compare groups.Results This population has greater than four times the
number of children delayed on the General Adaptive Composite than the
normative group. Functional outcomes were similar in the two groups other
than those of home living (Norwood: 8.8 (2.8) compared with arterial
switch: 11.2 (3.1), t = 3.389, p = 0.001) and self-care (Norwood: 5.9
(3.5) versus arterial switch: 8.1 (2.6), t = 3.140, p = 0.002).Conclusion
These survivors are at increased risk for delayed functional abilities.
Self-care, necessary for independence and confidence as children reach
school age, was particularly low in the Norwood group. Reasons for low
self-care abilities require further study. Copyright Cambridge University
Press 2010.

<7>
Accession Number
2010677455
Authors
El-Sobkey S.B. Salem N.A.
Institution
(El-Sobkey) King Saud University, College of Applied Medical Sciences,
Rehabilitation Health Sciences Department, Riyadh, Saudi Arabia
(Salem) Faculty of Physical Therapy, Cairo University, Cairo, Egypt
Title
Can lung volumes and capacities be used as an outcome measure for phrenic
nerve recovery after cardiac surgeries?.
Source
Journal of the Saudi Heart Association. 23 (1) (pp 23-30), 2011. Date of
Publication: January 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Phrenic nerve is the main nerve drive to the diaphragm and its injury is a
well-known complication following cardiac surgeries. It results in
diaphragmatic dysfunction with reduction in lung volumes and capacities.
This study aimed to evaluate the objectivity of lung volumes and
capacities as an outcome measure for the prognosis of phrenic nerve
recovery after cardiac surgeries. In this prospective experimental study,
patients were recruited from Cardio-Thoracic Surgery Department,
Educational-Hospital of College of Medicine, Cairo University. They were
11 patients with right phrenic nerve injury and 14 patients with left
injury. On the basis of receiving low-level laser irradiation, they were
divided into irradiated group and non-irradiated group. Measures of
phrenic nerve latency, lung volumes and capacities were taken pre and
post-operative and at 3-months follow up. After 3. months of low-level
laser therapy, the irradiated group showed marked improvement in the
phrenic nerve recovery. On the other hand, vital capacity and forced
expiratory volume in the first second were the only lung capacity and
volume that showed improvement consequent with the recovery of right
phrenic nerve (P value <0.001 for both). Furthermore, forced vital
capacity was the single lung capacity that showed significant statistical
improvement in patients with recovered left phrenic nerve injury (P value
<0.001). Study concluded that lung volumes and capacities cannot be used
as an objective outcome measure for recovery of phrenic nerve injury after
cardiac surgeries. 2010.

<8>
Accession Number
2010674449
Authors
Ikonomidis I. Iliodromitis E.K. Tzortzis S. Antoniadis A. Paraskevaidis I.
Andreadou I. Fountoulaki K. Farmakis D. Kremastinos D.T. Anastasiou-Nana
M.
Institution
(Ikonomidis, Iliodromitis, Tzortzis, Antoniadis, Paraskevaidis,
Fountoulaki, Farmakis, Kremastinos, Anastasiou-Nana) Second Department of
Cardiology, Athens University Medical School, University Hospital, Athens,
Greece
(Andreadou) Department of Pharmaceutical Chemistry, University of Athens
School of Pharmacy, Athens, Greece
Title
Staccato reperfusion improves myocardial microcirculatory function and
long-term left ventricular remodelling: A randomised contrast
echocardiography study.
Source
Heart. 96 (23) (pp 1898-1903), 2010. Date of Publication: December 2010.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To investigate the effects of staccato reperfusion (SR) during
percutaneous coronary intervention (PCI) on myocardial microcirculatory
function as assessed by myocardial contrast echocardiography. Setting:
Tertiary centre. Methods: Thirty-nine patients were randomised to SR
(n=20) or abrupt reperfusion (AR, n=19) within 48 h of an acute coronary
syndrome. Contrast intensity replenishment curves were constructed to
assess the blood volume (An), velocity (beta) and flow (AXbeta) of the
segments associated with the PCI-treated artery before, 48 h, 1 and 12
months after PCI. Left ventricular (LV) end-diastolic (EDVs) and systolic
volumes (ESVs) were evaluated. Plasma malondialdehyde (MDA) was determined
immediately before and 18 min after PCI to assess oxidative stress.
Results: SR was related to a greater improvement in A_n, beta
and AXbeta at 48 h, 1 and 12 months after intervention compared with AR
(mean AXbeta: 0.91, 5.5, 7.14, 6.9 for SR vs 1.02, 3.34, 4.28, 3.71 for
AR, p<0.01). After PCI, the mean MDA change was -27% in SR patients and
+55% in the AR patients (p<0.05). The percentage change in MDA correlated
with the percentage change in A_n at all time points (r=0.468,
r=0.682, r=0.674, p<0.01). Compared with AR, SR was related to a greater
percentage decrease in EDV (-11.61% vs -4.13%) and ESV (-34.68% vs
-14.83%) at 12 months after PCI (p<0.05). The percentage change in ESV at
12 months correlated with the corresponding percentage changes in
A_n, beta and AXbeta (r=-0.410, r=-0.509, r=-0.577,
respectively, p<0.05). Conclusions: SR improves myocardial
microcirculatory function after PCI, leading to a concomitant improvement
in LV geometry, probably through reduction of oxidative stress.

<9>
Accession Number
2010662800
Authors
Grossi E.A. Patel N. Woo Y.J. Goldberg J.D. Schwartz C.F. Subramanian V.
Feldman T. Bourge R. Baumgartner N. Genco C. Goldman S. Zenati M. Wolfe
J.A. Mishra Y.K. Trehan N. Mittal S. Shang S. Mortier T.J. Schweich Jr.
C.J.
Institution
(Grossi, Goldberg, Schwartz, Shang) New York University, School of
Medicine, New York Harbor Veterans Healthcare System, New York, NY, United
States
(Patel, Subramanian) Lenox Hill Hospital, New York, NY, United States
(Woo) Hospital of the University of Pennsylvania, Philadelphia, PA, United
States
(Feldman) Evanston Hospital, Evanston, IL, United States
(Bourge) University Alabama at Birmingham, Birmingham, AB, United States
(Baumgartner, Genco) Covenant Health Center, Saginaw, MI, United States
(Goldman) Lankenau Hospital, Lancaster, PA, United States
(Zenati) Veterans Administration Hospital, Pittsburgh, PA, United States
(Wolfe) St. Joseph's Hospital, Atlanta, GA, United States
(Mishra) Escorts Heart Institute, New Delhi, India
(Trehan, Mittal) Indrapratha Apollo, New Delhi, India
(Mortier, Schweich Jr.) Myocor, Inc. (Dissolved), Maple Grove, MN, United
States
Title
Outcomes of the RESTOR-MV trial (Randomized Evaluation of a Surgical
Treatment for Off-Pump Repair of the Mitral Valve).
Source
Journal of the American College of Cardiology. 56 (24) (pp 1984-1993),
2010. Date of Publication: 07 Dec 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives We sought to determine whether patients with functional mitral
regurgitation (FMR) would benefit from ventricular reshaping by the
Coapsys device (Myocor, Inc., Maple Grove, Minnesota). Background FMR
occurs when ventricular remodeling impairs valve function. Coapsys is a
ventricular shape change device placed without cardiopulmonary bypass to
reduce FMR. It compresses the mitral annulus and reshapes the ventricle.
We hypothesized that Coapsys for FMR would improve clinical outcomes
compared with standard therapies. Methods RESTOR-MV (Randomized Evaluation
of a Surgical Treatment for Off-Pump Repair of the Mitral Valve) was a
randomized, prospective, multicenter study of patients with FMR and
coronary disease with core laboratory analysis. After enrollment, patients
were stratified to the standard indicated surgery: either coronary artery
bypass graft alone or coronary artery bypass graft with mitral valve
repair. In each stratum, randomization was to either control (indicated
surgery) or treatment (coronary artery bypass graft with Coapsys
ventricular reshaping). Results The study was terminated when the sponsor
failed to secure ongoing funding; 165 patients were randomized. Control
and Coapsys both produced decreases in left ventricular (LV) end-diastolic
dimension and MR at 2 years (p < 0.001); Coapsys provided a greater
decrease in LV end-diastolic dimension (p = 0.021). Control had lower MR
grades during follow-up (p = 0.01). Coapsys showed a survival advantage
compared with control at 2 years (87% vs. 77%) (hazard ratio: 0.421; 95%
confidence interval: 0.200 to 0.886; stratified log-rank test; p = 0.038).
Complication-free survival (including death, stroke, myocardial
infarction, and valve reoperation) was significantly greater with Coapsys
at 2 years (85% vs. 71%) (hazard ratio: 0.372; 95% confidence interval:
0.185 to 0.749; adjusted log-rank test; p = 0.019). Conclusions Analysis
of RESTOR-MV indicates that patients with FMR requiring revascularization
treated with ventricular reshaping rather than standard surgery had
improved survival and a significant decrease in major adverse outcomes.
This trial validates the concept of the ventricular reshaping strategy in
this subset of patients with heart failure. (Randomized Evaluation of a
Surgical Treatment for Off-Pump Repair of the Mitral Valve [RESTOR-MV];
NCT00120276) 2010 American College of Cardiology Foundation.

<10>
Accession Number
2010650489
Authors
Dekker R.L.
Institution
(Dekker) University of Kentucky, College of Nursing, 760 Rose Street,
Lexington, KY 40536-0232, United States
Title
Cognitive Therapy for Depression in Patients with Heart Failure: A
Critical Review.
Source
Heart Failure Clinics. 7 (1) (pp 127-141), 2011. Date of Publication:
January 2011.
Publisher
Elsevier Inc. (170 S Independence Mall W 300 E, Philadelphia PA
19106-3399, United States)
Abstract
Depression is a significant problem in patients with heart failure (HF).
This article examines the evidence for the use of cognitive therapy (CT)
in treating depression and depressive symptoms in patients with HF and
cardiovascular related illnesses. In 8 of the 14 studies reviewed,
researchers found that CT reduced depressive symptoms; however, the
limitations of the studies prevent wide generalization of the results.
Evidence to support the use of CT for the treatment of depressive symptoms
in patients with cardiovascular illness is insufficient at this time.
Large randomized controlled trials that demonstrate the efficacy of CT are
needed before clinicians routinely refer patients with HF to CT for the
purpose of improving depression or depressive symptoms. 2011 Elsevier
Inc.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 10

Results Generated From:
EMBASE <1980 to 2010 Week 50>
EMBASE (updates since 2010-12-09)

<1>
Accession Number
2010651888
Authors
Faggian G. Forni A. Milano A.D. Chiominto B. Walpoth B.H. Scarabelli T.
Mazzucco A.
Institution
(Faggian, Forni, Milano, Chiominto, Mazzucco) Division of Cardiac Surgery,
University of Verona, Verona, Italy
(Walpoth) Division of Cardiac Surgery, University of Geneva, Geneva,
Switzerland
(Scarabelli) Department of Internal Medicine and Pharmacology, Wayne State
University School of Medicine, Detroit, MI, United States
Title
Antithymocyte globulin induction therapy in heart transplantation:
Prospective randomized study of high vs standard dosage.
Source
Transplantation Proceedings. 42 (9) (pp 3679-3687), 2010. Date of
Publication: November 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background In cardiac transplantation, high-dose antithymocyte globulin
(ATG) induction therapy as short-term rejection prophylaxis has not been
used. Objective To evaluate the efficacy and safety of intraoperative use
of single high-dose ATG induction therapy after heart transplantation.
Patients and Methods Fourteen patients received single high-dose ATG
therapy plus shortened standard therapy (group1), and 16 patients received
ATG standard therapy (group2). Results No perioperative deaths were
reported. During follow-up, 3 deaths were recorded. Five- year patient
survival was 92.8% in groupl vs 85.7% in group2 (P = .34). The mean (SD)
number of acute rejection episodes per patient was 2.5 (2.2) in the
high-dose ATG group vs 2.7 (2.5) in the standard therapy group (P = .83),
with 5-year freedom from acute rejection of 45.5% in group 1 vs 35.6% in
group 2 (P = .85). Infections were observed in 6 patients in group1 and in
8 patients in group2 (P = .69). Malignant disease was diagnosed in 1
patient in the high-dose group and 3 patients in the standard therapy
group (P = .35). Chronic allograft vasculopathy was recognized in 4
patients (28%) in group1 and 8 (50%) in group2 (P = .05). Five-year
actuarial freedom from allograft vasculopathy was 69.2% in the high-dose
ATG group vs 50.0%% in the standard therapy group (P = .35). Conclusions
High-dose ATG for prevention of rejection episodes is safe and
efficacious, with a lower rate of early and late complications, in
particular, graft vasculopathy. 2010 by Elsevier Inc. All rights
reserved.

<2>
Accession Number
2010642199
Authors
Yin L. Wang Z.-N. Wang Y.-F. Wang W.-T. Ji G.-Y. Yang X.-W. Xu Z.-Y.
Institution
(Yin, Wang, Wang, Wang, Ji, Yang, Xu) Department of Cardiothoracic
Surgery, Changhai Hospital, Second Military Medical University of PLA,
Shanghai 200433, China
Title
Predictors of atrial fibrillation after coronary artery bypass graft: A
meta-analysis.
Source
Journal of Geriatric Cardiology. 6 (3) (pp 162-167), 2009. Date of
Publication: September 2009.
Publisher
Institute of Geriatric Cardiology (28 Fuxing Road, Beijing 100853, China)
Abstract
Objectives: Postoperative atrial fibrillation (AF) has been associated
with less favorable outcomes in patients undergoing coronary artery bypass
graft surgery (CABG) and may result in increased post-operative morbidity
and mortality. A systematic review and meta-analysis of published studies
was conducted to examine the risk factors of occurrence AF after CABG.
Methods: Using the Medline database, the Cochrane clinical trials database
and online clinical trial databases, we reviewed all randomized controlled
trials (RCTs) and observational studies examining the risk factors of
occurrence of AF after CABG. We searched for literature published April
2009 or earlier. Results: Our review identified 8 studies (observational
studies), involving 14548 patients, that examined the risk factors of
occurrence of AF after CABG. Although studies provide conflicting results,
the overall outcomes suggests that advanced age, previous hypertension,
numbers of bridge vessels may increase the occurrence of AF after CABG,
while no significant difference of diabetes, preoperative myocardial
infarction, and preoperative medication of beta-Blocker have been observed
between the AF patients and no-AF patiens. Conclusions: Patients with
advanced age, previous hypertension and more numbers of bridge vessels had
higher risk for the occurrence of AF after CABG, and perioperative
medication and care must be intensified to decrease the postoperative
occurrence of AF.

<3>
Accession Number
2010659524
Authors
Schulz S. Birkmeier K.A. Ndrepepa G. Moshage W. Dotzer F. Huber K.
Dirschinger J. Seyfarth M. Schomig A. Kastrati A. Mehilli J.
Institution
(Schulz, Birkmeier, Ndrepepa, Seyfarth, Schomig, Kastrati, Mehilli)
Deutsches Herzzentrum, Technische Universitat, Lazarettstrasse 36, Munich
80636, Germany
(Dirschinger, Schomig) Medizinische Klinik Rechts der Isar, Technische
Universitat, Munich, Germany
(Moshage) Klinikum Traunstein, Traunstein, Germany
(Dotzer) Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
(Huber) Medizinische Klinik, Wilhelminenspital, Vienna, Austria
Title
One-year clinical outcomes with abciximab in acute myocardial infarction:
Results of the BRAVE-3 randomized trial.
Source
Clinical Research in Cardiology. 99 (12) (pp 795-802), 2010. Date of
Publication: December 2010.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Purpose: In the Bavarian Reperfusion Alternatives Evaluation (BRAVE)-3
study upstream administration of abciximab additional to 600 mg
clopidogrel loading did not reduce the infarct size in patients with acute
ST-segment elevation myocardial infarction (STEMI) undergoing primary
percutaneous coronary interventions. The aim of this study was to
investigate 1-year clinical outcomes in the BRAVE-3 study patients.
Methods: A total of 800 patients with acute STEMI within 24 h from symptom
onset, all treated with 600 mg of clopidogrel were randomized in a
double-blind fashion to receive either abciximab (n = 401) or placebo (n =
399) in the intensive care unit before being sent to the catheterization
laboratory. Results: The main outcome of interest of the present study,
the composite of death, recurrent myocardial infarction, stroke or
revascularization of the infarct-related artery (IRA) at 1 year, was 23.0%
(92 patients) in the abciximab versus 25.7% (102 patients) in the placebo
group [relative risk (RR) = 0.90, 95% confidence interval (CI) 0.67-1.20;
P = 0.46]. The combined incidence of death, recurrent myocardial
infarction or stroke was 9.3% in the abciximab group versus 6.0% in the
placebo group (RR = 1.55, 95% CI 0.93-2.58; P = 0.09). There was a
significant reduction of the IRA revascularization with abciximab compared
to placebo (16.3 vs. 22.3%, RR = 0.71, 95% CI 0.52-0.98; P = 0.04).
Conclusion: In patients with STEMI, all receiving 600 mg clopidogrel,
abciximab did not improve overall clinical outcomes at 1 year after
primary coronary stenting. 2010 Springer-Verlag.

<4>
Accession Number
2010660749
Authors
Ariff B.B. Glor F.P. Crowe L. Xu X.Y. Vennart W. Firmin D.N. Thom S.M.
Hughes A.D.
Institution
(Ariff, Thom, Hughes) International Centre for Circulatory Health,
National Heart and Lung Institute Division, Imperial College Healthcare
National Health Service Trust, London, United Kingdom
(Ariff) Department of Imaging, Imperial College National Health Service
Trust, Hammersmith Hospital, London W12 0HS, United Kingdom
(Glor, Xu) Department of Chemical Engineering, Faculty of Engineering,
Imperial College London, London, United Kingdom
(Crowe, Firmin) Cardiovascular Magnetic Resonance Unit, Royal Brompton
Hospital, Imperial College London, London, United Kingdom
(Vennart) Global Research and Development, Pfizer, Sandwich Laboratories,
Sandwich, Kent, United Kingdom
Title
Carotid artery hemodynamics: Observing patient-specific changes with
amlodipine and lisinopril by using MR imaging computation fluid dynamics.
Source
Radiology. 257 (3) (pp 662-669), 2010. Date of Publication: December
2010.
Publisher
Radiological Society of North America Inc. (820 Jorie Boulevard, Oak Brook
IL 60523-2251, United States)
Abstract
Purpose: To assess whether using magnetic resonance (MR) imaging combined
with computational fluid dynamics (CFD) could reveal changes in common
carotid artery (CCA) flow and wall shear stress (WSS) that might
contribute to differences in CCA remodeling between amlodipine, a calcium
channel blocker, and lisinopril, an angiotensin-converting enzyme
inhibitor, despite similar reductions in blood pressure (BP). Materials
and Methods: Institutional review board approval was obtained, and
participants gave informed consent. Nine subjects with hypertension were
recruited into a double-blind placebo-controlled randomized three-way
crossover study to compare the hemodynamic effects of 7 days of treatment
with placebo, amlodipine, or lisinopril. After each treatment period,
patients underwent CCA ultrasonography, BP measurement, and MR imaging
with CFD. Analyses were performed by using repeated-measures analysis of
variance, followed by the Tukey test or the Wilcoxon matched-pairs test.
Results: Amlodipine and lisinopril lowered BP similarly, but CCA flow rate
was significantly higher (P < .01) and distal vascular resistance was
lower (P =.016) after amlodipine treatment than after lisinopril
treatment. WSS on the inner wall of the CCA was significantly lower after
lisinopril treatment than after amlodipine treatment (P =.03). The change
in WSS in the CCA correlated with the change in vascular resistance (r =
-0.85, P < .001). Conclusion: Amlodipine causes increased blood flow and
increased time-averaged WSS in the CCA compared with lisinopril, despite
similar reductions in BP. Differences in the sub-acute hemodynamic effects
of amlodipine and lisinopril could contribute to the differences in CCA
remodeling seen in long-term studies. RSNA, 2010.

<5>
Accession Number
2010640044
Authors
Wang S. Cui J. Peng W. Lu M.
Institution
(Wang, Cui, Peng, Lu) Department of Cardiovascular Medicine, General
Hospital of Beijing Military Region of PLA, Nan Men Cang 5, Dongcheng
District, Beijing 100700, China
Title
Intracoronary autologous CD34+ stem cell therapy for intractable angina.
Source
Cardiology. 117 (2) (pp 140-147), 2010. Date of Publication: November
2010.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Background/Objectives: A large number of patients with coronary artery
disease experience angina that is not suitable for revascularization and
is refractory to conventional medical therapy. Laboratory and preclinical
studies have provided evidence for the safety and potential efficacy of
autologous CD34+ stem cell therapies as treatment for angina. Clinical
studies investigating intramyocardial transplantation of autologous CD34+
stem cells by catheter injection for patients with refractory angina show
that this is safe and feasible. It remains unclear whether intracoronary
infusion of CD34+ stem cells exerts beneficial effects in patients with
angina as well. We addressed this question with a controlled clinical
trial by enrolling 112 patients with refractory angina. Previous trials
have investigated the safety and beneficial effects of CD34+ cells
isolated from granulocyte colony-stimulating factor-mobilized peripheral
blood; in our trial, we isolated CD34+ cells directly from the patient's
bone marrow. Methods: One hundred and twelve patients with diffuse
triple-vessel disease and Canadian Cardiovascular Society class III or IV
angina were enrolled in a double-blind, randomized (1:1),
placebo-controlled study. Patients received optimal medical treatment but
were not candidates for mechanical revascularization (percutaneous
coronary intervention or coronary artery bypass grafting). Fifty-six
patients (27 women and 29 men aged 42-80 years) were enrolled in the
treatment group, and 56 patients (28 women and 28 men aged 43-80 years)
who received optimal medical treatment and intracoronary saline injections
were enrolled in the placebo control group. Bone marrow was collected from
all enrolled patients at a volume of 120-150 ml each in both groups.
Selections of CD34+ cells were performed by a CE-marked device approved by
the Security, Food and Drug Administration of China. Coronary angiography
had been performed before enrollment in this study. Results: No myocardial
infarction was observed during intracoronary infusion. The intracoronary
infusion of cells or saline did not result in cardiac enzyme elevation,
cardiac perforation or pericardial effusion. No arrhythmia, such as
ventricular tachycardia or ventricular fibrillation, was induced by
intracoronary infusion. No serious adverse events occurred in either
group. The reduction in the frequency of angina episodes per week 3 and 6
months after infusion was significantly higher in the treatment group
(-14.6 +/- 4.8 at 3 months and -15.6 +/- 4.0 at 6 months) than in the
control group (-4.5 +/- 0.3 and -3.0 +/- 1.2, respectively; p < 0.01).
Other efficacy parameters such as nitroglycerine usage, exercise time and
the Canadian Cardiovascular Society class also showed an improvement in
the treatment group compared to the control group. A significant
improvement in myocardial perfusion was noted in the treatment group
compared to the control group, as measured by single-photon emission
computed tomography. Conclusions: This randomized trial investigating
intracoronary infusion of autologous CD34+ cells in patients with
intractable angina shows the safety and feasibility of this therapy and
provides evidence for efficacy. Copyright 2010 S. Karger AG, Basel.

<6>
Accession Number
2010659232
Authors
Simpson Jr. R.J. Mendys P.
Institution
(Simpson Jr.) Division of Cardiology, University of North Carolina at
Chapel Hill, 6033 Burnett-Womack Building, 160 Dental Circle, Chapel Hill,
NC 27599-7075, United States
(Mendys) Pfizer Inc., University of North Carolina, Chapel Hill, NC,
United States
Title
The effects of adherence and persistence on clinical outcomes in patients
treated with statins: A systematic review.
Source
Journal of Clinical Lipidology. 4 (6) (pp 462-471), 2010. Date of
Publication: November-December 2010.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: In clinical practice, medication adherence and persistence are
important for disease management and can significantly improve outcomes
and enhance the quality of patient care. Quantifying the relationship
between medication adherence/persistence and clinical outcomes with
statins can serve as an important therapeutic model and complement our
understanding of the critical relationship between medication use and
improved patient care. Methods and Results: A PubMed search was conducted
for literature published between 1999 and 2009 using the terms adherence,
compliance, HMG CoA, nonadherence, noncompliance, persistency,
persistence, and statin. Data on the direct relationship between adherence
or persistence to statin monotherapy and clinical outcomes were extracted.
A total of 19 articles met the inclusion criteria, including the clinical
impact of adherence (n = 15) and persistence (n = 4). High levels of
adherence were associated with reductions in adverse clinical outcomes,
including all-cause mortality and fatal and nonfatal cardiovascular
events; the most consistent benefits were witnessed at adherence levels
80% or greater. In primary prevention cohorts, clinical benefits were seen
after 1 year of therapy. Longer durations of treatment were associated
with incremental improvements in clinical outcomes as length of therapy
increased. Conclusions: High levels of adherence and longer durations of
persistence with statins are associated with progressively increasing
clinical benefits in primary and secondary prevention patient populations
at risk for cardiovascular events. Efforts to improve adherence and
persistence are warranted. 2010 National Lipid Association. All rights
reserved.

<7>
Accession Number
2010656615
Authors
Wagner R. Piler P. Bedanova H. Adamek P. Grodecka L. Freiberger T.
Institution
(Wagner, Adamek) Department of Cardiac Anaesthesia, Centre for
Cardiovascular and Transplant Surgery (CKTCH), St. Anne's University
Hospital, Brno, Czech Republic
(Piler) Department of Cardiosurgery, Centre for Cardiovascular and
Transplant Surgery (CKTCH), St. Anne's University Hospital, Brno, Czech
Republic
(Bedanova) Department of Cardiology, Centre for Cardiovascular and
Transplant Surgery (CKTCH), St. Anne's University Hospital, Brno, Czech
Republic
(Grodecka, Freiberger) Department of Molecular Genetics, Centre for
Cardiovascular and Transplant Surgery (CKTCH), St. Anne's University
Hospital, Brno, Czech Republic
Title
Myocardial injury is decreased by late remote ischaemic preconditioning
and aggravated by tramadol in patients undergoing cardiac surgery: A
randomised controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 11 (6) (pp 758-762),
2010. Date of Publication: December 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
The purpose of this study was to test, whether the late phase of remote
ischaemic preconditioning (L-RIPC) improves myocardial protection in
coronary artery bypass grafting (CABG) with cold-crystalloid cardioplegia
and whether preoperative tramadol modifies myocardial
ischaemia-reperfusion injury using the same group of patients in a
single-blinded randomized controlled study. One hundred and one adult
patients were randomly assigned to either the L-RIPC, control or tramadol
group. L-RIPC consisted of three five-minute cycles of upper limb
ischaemia and three five-minute pauses using blood pressure cuff inflation
18 hours prior to the operation. Patients in the tramadol group received
200 mg tramadol retard at 19:00 hours, the day before the operation and at
06:00 hours. Serum troponin I levels were measured at eight, 16 and 24
hours after surgery. Myocardial samples for inducible and endothelial
nitric oxide synthases (iNOS, eNOS) estimation were drawn twice: before
and after cannulation for cardiopulmonary bypass from the auricle of the
right atrium. We found that L-RIPC can reduce injury beyond the myocardial
protection provided by cold-crystalloid cardioplegia, and tramadol
worsened myocardial injury after CABG. Expressions of iNOS were increased
in the control (significantly) and L-RIPC groups and dampened in the
tramadol group. 2010 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<8>
Accession Number
2010656616
Authors
Grauhan O. Navasardyan A. Hofmann M. Muller P. Hummel M. Hetzer R.
Institution
(Grauhan, Navasardyan, Hofmann, Muller, Hetzer) Department of
Cardiothoracic and Vascular Surgery, German Heart Institute Berlin,
Berlin, Germany
(Hummel) Department of Internal Medicine and Cardiology, Paulinen
Hospital, Berlin, Germany
Title
Cyanoacrylate-sealed Donati suture for wound closure after cardiac surgery
in obese patients.
Source
Interactive Cardiovascular and Thoracic Surgery. 11 (6) (pp 763-767),
2010. Date of Publication: December 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
The majority of wound infections after median sternotomy in obese patients
are triggered by the breakdown of skin suture and subsequent seepage of
skin flora into the deeper tissue layers. In a prospective study, 90
patients (body mass index >=30) who had cardiac surgery via median
sternotomy were enrolled. In 45 patients, skin closure was performed
according to the Donati technique (vertical interrupted mattress suture)
and sealed with octylcyanoacrylate (group A). In 45 patients,
intracutaneous running technique without sealed was performed (group B).
The endpoint was wound infection within 90 days. Degree of obesity and
other risk factors for wound infection were equally distributed between
groups A and B (all P>0.05). In group A only two superficial infections
occurred, whereas in group B there were nine wound infections including
two deep infections (P=0.026). In 10 of 11 infections (both groups)
coagulase-negative staphylococci were isolated. In eight of 11 wound
infections the caudal third of the incision was affected. Intertrigo in
inframammary skin folds was found in 20.0% (18/90) of all patients but in
63.6% (seven of 11) of cases with infection. We conclude, that
cyanoacrylate-sealed Donati suture is superior to intracutaneous suture
technique since it offers tension-resistant closure with immediate
microbial barrier properties. 2010 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<9>
Accession Number
2010656619
Authors
Memetoglu M.E. Kurtcan S. Kalkan A. Ozel D.
Institution
(Memetoglu, Kurtcan, Kalkan, Ozel) Department of Cardiovascular Surgery,
Gumushane State Hospital, 29000 Gumushane, Turkey
Title
Combination technique of tumescent anesthesia during endovenous laser
therapy of saphenous vein insufficiency.
Source
Interactive Cardiovascular and Thoracic Surgery. 11 (6) (pp 774-777),
2010. Date of Publication: December 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objective: This study aimed at evaluating the efficiency of applying
tumescent anesthesia before an ablation procedure and continuously during
endovenous laser treatment (EVLT) (combined tumescent technique) of
saphenous vein insufficiency to reduce the patients pain and discomfort.
Methods: Twenty-five patients with 31 duplex-confirmed great saphenous
vein insufficiency underwent endovenous laser (940 nm) varicose vein
treatment between December 2009 and April 2010. The patients were
randomized in two groups. In group A (15 patients) tumescent anesthesia
was used before the ablation procedure and in group B (10 patients)
tumescent anesthesia was used before and continuously during the
procedure. Patients were scheduled for a three-day examination after EVLT
to assess the level of pain experienced. Results: According to the
statistic analysis we observed that the mean level of pain score for the
patients given classical tumescent anesthesia showed a higher level
(P=0.003) compared with the patients given tumescent anesthesia in the
combined procedure. Conclusion: Combination technique of administering
tumescent anesthesia before ablation and continuously during the EVLT
procedure may be an alternative way to reduce the patient's peroperative
pain and discomfort. 2010 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<10>
Accession Number
2010645092
Authors
Imazio M. Trinchero R. Brucato A. Rovere M.E. Gandino A. Cemin R. Ferrua
S. Maestroni S. Zingarelli E. Barosi A. Simon C. Sansone F. Patrini D.
Vitali E. Ferrazzi P. Spodick D.H. Adler Y.
Institution
(Imazio, Trinchero) Department of Cardiology, Maria Vittoria Hospital, Via
Cibrario 72, 10141 Torino, Italy
(Brucato, Maestroni, Simon, Ferrazzi) Ospedali Riuniti, Bergamo, Italy
(Rovere, Zingarelli, Sansone) Cardiac Surgery, Ospedale Mauriziano,
Torino, Italy
(Gandino, Barosi, Patrini, Vitali) Ospedale Niguarda, Milano, Italy
(Cemin) Department of Cardiology, San Maurizio Regional Hospital, Bolzano,
Italy
(Ferrua) Ospedale Degli Infermi, Rivoli, Italy
(Spodick) Department of Medicine, St Vincent Hospital, University of
Massachusetts, Worcester, MA, United States
(Adler) Sackler Faculty of Medicine, Tel-Aviv, Misgav Ladach Hospital,
Jerusalem, Kupat Holim Meuhedet, Israel
(Patrini, Vitali) Humanitas Gavazzeni, Bergamo, Italy
Title
COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS):
A multicentre, randomized, double-blind, placebo-controlled trial.
Source
European Heart Journal. 31 (22) (pp 2749-2754), 2010. Date of
Publication: November 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsNo drug has been proven efficacious to prevent the post-pericardiotomy
syndrome (PPS), but colchicine seems safe and effective for the treatment
and prevention of pericarditis. The aim of the COlchicine for the
Prevention of the Post-pericardiotomy Syndrome (COPPS) trial is to test
the efficacy and safety of colchicine for the primary prevention of the
PPS.Methods and resultsThe COPPS study is a multicentre, double-blind,
randomized trial. On the third post-operative day, 360 patients (mean age
65.7 +/- 12.3 years, 66 males), 180 in each treatment arm, were randomized
to receive placebo or colchicine (1.0 mg twice daily for the first day
followed by a maintenance dose of 0.5 mg twice daily for 1 month in
patients >=70 kg, and halved doses for patients <70 kg or intolerant to
the highest dose). The primary efficacy endpoint was the incidence of PPS
at 12 months. Secondary endpoint was the combined rate of disease-related
hospitalization, cardiac tamponade, constrictive pericarditis, and
relapses. Baseline characteristics were well balanced between the study
groups. Colchicine significantly reduced the incidence of the PPS at 12
months compared with placebo (respectively, 8.9 vs. 21.1; P = 0.002;
number needed to treat = 8). Colchicine also reduced the secondary
endpoint (respectively, 0.6 vs. 5.0; P = 0.024). The rate of side effects
(mainly related to gastrointestinal intolerance) was similar in the
colchicine and placebo groups (respectively, 8.9 vs. 5.0; P =
0.212).ConclusionColchicine is safe and efficacious in the prevention of
the PPS and its related complications and may halve the risk of developing
the syndrome following cardiac surgery. ClinicalTrials.gov number,
NCT00128427. 2010 The Author.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 13

Results Generated From:
EMBASE <1980 to 2010 Week 49>
EMBASE (updates since 2010-12-02)

<1>
Accession Number
2010640240
Authors
Shiga T. Kasanuki H. Hagiwara N. Sumiyoshi T. Honda T. Haze K. Takagi A.
Kawana M. Origasa H. Ogawa H.
Institution
(Shiga, Kasanuki, Hagiwara, Takagi, Kawana, Ogawa) Department of
Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku,
Tokyo 162-8666, Japan
(Sumiyoshi) Sakakibara Heart Institute, Tokyo, Japan
(Honda) Saisei-kai Kumamoto Hospital, Kumamoto, Japan
(Haze) Osaka City General Hospital, Osaka, Japan
(Origasa) Division of Clinical Epidemiology and Biostatistics, Toyama
University, Toyama, Japan
Title
Angiotensin receptor blocker-based therapy and cardiovascular events in
hypertensive patients with coronary artery disease and impaired renal
function.
Source
Blood Pressure. 19 (6) (pp 359-365), 2010. Date of Publication: December
2010.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
The aim of this study was to assess the effects of angiotensin receptor
blocker (ARB)-based therapy on cardiovascular events in high-risk
hypertensive patients with coronary artery disease (CAD) and impaired
renal function in post hoc analysis of HIJ-CREATE (Heart Institute of
Japan Candesartan Randomized Trial for Evaluation in Coronary Artery
Disease). Patients (n=2049) were randomly assigned to candesartan-based or
non-ARB treatment arms; 1022 patients (age 70+/-6 years, 28% female) with
impaired renal function, defined as creatinine clearance <60 ml/min at
baseline. There was no difference in major adverse cardiac event (MACE), a
composite of cardiovascular death, non-fatal myocardial infarction,
unstable angina, heart failure, stroke and other cardiovascular events
requiring hospitalization between the two arms in patients without
impaired renal function. However, there was a lower incidence of MACE in
the candesartan-based treatment arm than in the non-ARB treatment arm
(HR0.79, 95% CI 0.630.99, p0.039) in patients with impaired renal
function. Among the MACE, candesartan-based treatment reduced
hospitalization for unstable angina (HR=0.71, 95% CI 0.52-0.96, p=0.028).
Although candesartan-based treatment was not superior to non-ARB treatment
in prevention of cardiac mortality, ARB-based therapy may be beneficial in
reducing risk of coronary events in hypertensive patients with CAD and
impaired renal function. 2010 Scandinavian Foundation for Cardiovascular
Research.

<2>
Accession Number
2010648875
Authors
Benedetto U. Melina G. Refice S. Di Bartolomeo R. Roscitano A. Angeloni E.
Sinatra R.
Institution
(Benedetto, Melina, Refice, Di Bartolomeo, Roscitano, Angeloni, Sinatra)
Department of Cardiac Surgery, II School of Medicine, University of Rome
la Sapienza, Via di Grottarossa 1039, Rome, 00181, Italy
Title
Dual renin-angiotensin system blockade for patients with
prosthesis-patient mismatch.
Source
Annals of Thoracic Surgery. 90 (6) (pp 1899-1903), 2010. Date of
Publication: December 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background Patients with prosthesis-patient mismatch (PPM) continue to
show some degrees of left ventricular hypertrophy after aortic valve
replacement for aortic stenosis. The renin-angiotensin system plays a
major role in promoting and sustaining hypertrophy. In a controlled,
randomized study, we tested the hypothesis that the combination of
angiotensin-converting enzyme inhibitors (ACEi) plus angiotensin II
receptor blocker (ARB) can be more effective in decreasing hypertrophy
than a largely employed association such as ACEi plus s-blockers in PPM
patients. Methods We enrolled a total of 72 patients with aortic valve
replacement and evidence of PPM (effective orifice area <0.85
cm²/m²) at postoperative echocardiography. At
discharge, they were randomly assigned to ramipril plus candesartan (n =
36) or ramipril plus metoprolol (n = 36). Results At baseline, age,
24-hour blood pressure, left ventricular measurements, and transprosthetic
gradients were similar between the two groups. After 12 months, the extent
of 24-hour systolic and diastolic blood pressure decrease was similar
between the two groups (-13.3% and 16.3% versus -12.3% and 15.8%,
respectively; p = 0.7 and 0.8, respectively). Left ventricular mass index
significantly decreased in both groups (ACEi plus ARB 165 +/- 19
g/m² to 117 +/- 17 g/m²; p < 0.0001; ACEi plus
beta-blockers 161 +/- 15 g/m² to 128 +/- 20 g/m²; p
< 0.0001). However, patients receiving ACEi plus ARB had a higher decrease
of left ventricular mass (-46 +/- 15 g/m² versus -35 +/- 12
g/m²; p = 0.001) and a lower rate of residual left ventricular
hypertrophy (22% versus 47%; p = 0.04). Conclusions This study shows that
in patients with PPM, the association ACEi and ARB has a greater
antiremodeling effect compared with ACEi and beta-blockers, and is
independent of blood pressure. 2010 The Society of Thoracic Surgeons.

<3>
Accession Number
2010652668
Authors
Torgersen C. Luckner G. Morgenthaler N.G. Jochberger S. Schmittinger C.A.
Wenzel V. Hasibeder W.R. Grander W. Dunser M.W.
Institution
(Torgersen, Schmittinger, Dunser) Department of Intensive Care Medicine,
Bern University Hospital, Bern, Switzerland
(Luckner, Jochberger, Wenzel) Department of Anesthesiology and Critical
Care Medicine, Innsbruck Medical University, Innsbruck, Austria
(Morgenthaler) Department of Research, B.R.A.H.M.S. Aktiengesellschaft,
Berlin, Germany
(Hasibeder) Department of Anesthesiology and Critical Care Medicine,
Krankenhaus derv Barmherzigen Schwestern, Ried im Innkreis, Austria
(Grander) Department of Internal Medicine, Community Hospital Hall in
Tirol, Hall in Tirol, Austria
Title
Plasma copeptin levels before and during exogenous arginine vasopressin
infusion in patients with advanced vasodilatory shock.
Source
Minerva Anestesiologica. 76 (11) (pp 905-912), 2010. Date of
Publication: November 2010.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Background. Plasma copeptin levels before and during exogenous arginine
vasopressin infusion (AVP) were evaluated, and the value of copeptin
levels before AVP therapy to predict complications during AVP therapy and
outcome in vasodilatory shock patients was determined. Methods. This
prospective, observational study was nested in a randomized, controlled
trial investigating the effects of two AVP doses (0.033 vs. 0.067 IU/min)
on the hemodynamic response in patients with advanced vasodilatory shock
due to sepsis, systemic inflammatory response syndrome or after cardiac
surgery. Clinical data, plasma copeptin levels and adverse events were
recorded before, 24 hours after and 48 hours after randomization. Results.
Plasma copeptin levels were elevated before AVP therapy. During AVP,
copeptin levels decreased (P<0.001) in both groups (P=0.73). Copeptin
levels at randomization predicted the occurrence of ischemic skin lesions
(AUC ROC, 0.73; P=0.04), a fall in platelet count (AUC ROC, 0.75; P=0.01)
during AVP and intensive care unit mortality (AUC ROC, 0.67; P=0.04).
Twenty-five patients (64.1%) exhibited a decrease in copeptin levels.
Patients experiencing a decrease in copeptin levels were older (P=0.04),
had a higher Sequential Organ Failure Assessment score count before
(P=0.03) and during AVP therapy (P=0.04), had a longer intensive care unit
stay (P<0.001) and required AVP therapy longer (P=0.008) than patients
without a decrease in copeptin levels during AVP. Conclusion. Plasma
copeptin levels are elevated in patients with advanced vasodilatory shock.
During exogenous AVP therapy, copeptin levels decrease, suggesting
suppression of the endogenous AVP system.

<4>
Accession Number
2010643230
Authors
Marta G.M. Facciolo F. Ladegaard L. Dienemann H. Csekeo A. Rea F. Dango S.
Spaggiari L. Tetens V. Klepetko W.
Institution
(Marta, Klepetko) Vienna University Hospital, Vienna, Austria
(Facciolo) Regina Elena National Cancer Institute of Rome, Rome, Italy
(Ladegaard) Odense University Hospital, Odense, Denmark
(Dienemann) University Thoracic Clinic Heidelberg, Heidelberg, Germany
(Csekeo) Koranyi National Institute, Budapest, Hungary
(Rea) Thoracic Surgery University of Padua, Padua, Italy
(Dango) Albert Ludwigs University Freiburg, Freiburg, Germany
(Spaggiari) European Institute of Oncology, Milan, Italy
(Tetens) Nycomed, Roskilde, Denmark
Title
Efficacy and safety of TachoSil versus standard treatment of air leakage
after pulmonary lobectomy.
Source
European Journal of Cardio-thoracic Surgery. 38 (6) (pp 683-689), 2010.
Date of Publication: December 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objectives: Alveolar air leakage remains a serious problem in lung
surgery, being associated with increased postoperative morbidity,
prolonged hospital stay and greater health-care costs. The aim of this
study was to evaluate the sealing efficacy and safety of the surgical
patch, TachoSil, in lung surgery. Methods: Patients undergoing
elective pulmonary lobectomy who had grade 1 or 2 air leakage (evaluated
by the water submersion test) after primary stapling and limited suturing
were randomised at 12 European centres to open-label treatment with
TachoSil or standard surgical treatment (resuturing, stapling
or no further treatment at the surgeons' discretion). Randomisation was
performed during surgery using a centralised interactive voice response
system. Duration of postoperative air leakage (primary end point),
reduction of intra-operative air leakage intensity (secondary end point)
and adverse events (AEs), including postoperative complications, were
assessed. Results: A total of 486 patients were screened and 299 received
trial treatment (intent-to-treat (ITT) population: TachoSil,
n=148; standard treatment, n=151). TachoSil resulted in a
reduction in the duration of postoperative air leakage (p=0.030). Patients
in the TachoSil group also experienced a greater reduction in
intra-operative air leakage intensity (p=0.042). Median time until chest
drain removal was 4 days with TachoSil and 5 days in the
standard group (p=0.054). There was no difference between groups in
hospital length of stay. AEs were generally similar in both groups,
including postoperative complications. Conclusions: TachoSil
was superior to standard surgical treatment in reducing both postoperative
air leakage duration and intra-operative air leakage intensity in patients
undergoing elective pulmonary lobectomy. 2010 European Association for
Cardio-Thoracic Surgery.

<5>
Accession Number
2010643241
Authors
Ovrum E. Tangen G. Tollofsrud S. Oystese R. Ringdal M.A.L. Istad R.
Institution
(Ovrum, Tangen, Tollofsrud, Oystese, Ringdal, Istad) Oslo Heart Center,
Division of Cardiovascular and Respiratory Medicine and Surgery, Oslo
University Hospital, Rikshospitalet, Box 2684, St. Hanshaugen, 0131 Oslo,
Norway
Title
Cold blood versus cold crystalloid cardioplegia: A prospective randomised
study of 345 aortic valve patients.
Source
European Journal of Cardio-thoracic Surgery. 38 (6) (pp 745-749), 2010.
Date of Publication: December 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Although experimental studies have indicated that blood
cardioplegia may be superior to crystalloid cardioplegia for myocardial
protection, clinical data still remain uncertain. In a previous randomised
study from our institution, including 1440 patients undergoing coronary
artery bypass grafting (CABG), no beneficial effects of blood cardioplegia
were seen in any relevant outcome variables. The investigation was
therefore extended to a patient population having longer pump times and
ischaemic periods. Methods: Over a 48-month period, all patients
undergoing aortic valve replacement with or without CABG performed by two
surgeons, were prospectively randomised to receive either intermittent
cold retrograde blood cardioplegia (group B) or intermittent cold
retrograde crystalloid cardioplegia (group C) during aortic
cross-clamping. Results: A total of 345 patients aged 28-90 years (median,
72 years) entered the study (group B, n= 172, group C, n= 173). All
relevant demographic and operative variables were similar for both groups.
As for the clinical course, no statistically significant differences were
seen concerning spontaneous sinus rhythm after aortic declamping, use of
inotropic drugs, duration of ventilatory support, bleeding and rate of
allogeneic blood transfusions, perioperative myocardial infarction,
episodes of atrial fibrillation, stroke or minor neurological dysfunction,
renal function, infections, physical rehabilitation or mortality. Further,
in the patients with the longest ischaemic times, no statistically
significant differences between the groups could be demonstrated.
Conclusions: There were no indications that retrograde cold blood
cardioplegia was superior to retrograde cold crystalloid cardioplegia
patients undergoing aortic valve replacement, with or without CABG. 2010
European Association for Cardio-Thoracic Surgery.

<6>
Accession Number
2010643244
Authors
Marberg H. Jeppsson A. Brandrup-Wognsen G.
Institution
(Marberg, Jeppsson, Brandrup-Wognsen) Department of Cardiovascular Surgery
and Anesthesia, Sahlgrenska University Hospital, Gothenburg, Sweden
(Jeppsson, Brandrup-Wognsen) Department of Molecular and Clinical
Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska
Academy, Gothenburg, Sweden
Title
Postoperative autotransfusion of mediastinal shed blood does not influence
haemostasis after elective coronary artery bypass grafting.
Source
European Journal of Cardio-thoracic Surgery. 38 (6) (pp 767-772), 2010.
Date of Publication: December 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objectives: The rationale of using autotransfusion of mediastinal shed
blood after cardiac surgery is to preserve haemoglobin levels and reduce
the need for allogenic blood transfusions. However, the method is
controversial and its clinical value has been questioned. We hypothesised
that re-transfusion of mediastinal shed blood instead impairs haemostasis
after routine coronary artery bypass grafting and thus increases
postoperative bleeding. Methods: Seventy-seven consecutive elective
coronary artery bypass surgery patients (mean age 67+/-9 years, 77% men)
were included in a prospective, randomised controlled study. The patients
were randomised to postoperative re-transfusion of mediastinal shed blood
(n=39) or to a group where mediastinal shed blood was discarded (n=38).
Primary end point was bleeding during the first 12 postoperative hours.
Secondary end points were postoperative transfusion requirements,
haemoglobin levels, thrombo-elastometric variables and plasma
concentrations of interleukin-6, thrombin-anti-thrombin complex and
D-dimer. Results: Mean re-transfused volume in the autotransfusion group
was 282+/-210ml. There was no difference in postoperative bleeding (median
394ml (interquartile range 270-480) vs 385 (255-430) ml, p=0.69),
proportion of patients receiving transfusions of blood products (11/39 vs
11/38, p=0.95), haemoglobin levels 24h after surgery (116+/-13 vs
116+/-14gl^-1, p=0.87), thrombo-elastometric variables,
interleukin-6 (219+/-144 vs 201+/-144 pgml^-1, p=0.59),
thrombin-anti-thrombin complex (11.0+/-9.1 vs 14.8+/-15, p=0.19) or
D-dimer (0.56+/-0.49 vs 0.54+/-0.44, p=0.79) between the autotransfusion
group and the no-autotransfusion group. Conclusions: Autotransfusion of
small-to-moderate amounts of mediastinal shed blood does not influence
haemostasis after elective coronary artery bypass grafting. 2010.

<7>
Accession Number
2010645188
Authors
Melloni C. Rao S.V. Povsic T.J. Melton L. Kim R.J. Kilaru R. Patel M.R.
Talan M. Ferrucci L. Longo D.L. Lakatta E.G. Najjar S.S. Harrington R.A.
Institution
(Melloni, Rao, Povsic, Kim, Patel, Harrington) Department of Medicine,
School of Medicine, Duke University, Durham, NC, United States
(Melloni, Rao, Povsic, Melton, Kim, Kilaru, Patel, Harrington) Duke
Clinical Research Institute, Duke University Medical Center, Durham, NC,
United States
(Rao) Durham Veterans Affairs Medical Center, Durham, NC, United States
(Talan, Ferrucci, Longo, Lakatta, Najjar) Intramural Research Program,
National Institute on Aging, National Institutes of Health, Baltimore, MD,
United States
(Najjar) MedStar Health Research Institute, Washington, DC, United States
Title
Design and rationale of the Reduction of Infarct Expansion and Ventricular
Remodeling with Erythropoietin after Large Myocardial Infarction (REVEAL)
trial.
Source
American Heart Journal. 160 (5) (pp 795-803.e1-e2), 2010. Date of
Publication: November 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Acute myocardial infarction (MI) remains a leading cause of
death despite advances in pharmacologic and percutaneous therapies. Animal
models of ischemia/reperfusion have demonstrated that single-dose
erythropoietin may reduce infarct size, decrease apoptosis, and increase
neovascularization, possibly through mobilization of endothelial
progenitor cells. Study Design: REVEAL is a randomized, double-blind,
placebo-controlled, multicenter trial evaluating the effects of epoetin
alpha on infarct size and left ventricular remodeling in patients with
large MIs. The trial comprises a dose-escalation safety phase and a
single-dose efficacy phase using the highest acceptable epoetin alpha dose
up to 60,000 IU. Up to 250 ST-segment elevation myocardial infarction
patients undergoing primary or rescue percutaneous coronary intervention
will be randomized to intravenous epoetin alpha or placebo within 4 hours
of successful reperfusion. The primary study end point is infarct size
expressed as a percentage of left ventricular mass, as measured by cardiac
magnetic resonance imaging 2 to 6 days post study medication
administration. Secondary end points will assess changes in endothelial
progenitor cell numbers and changes in indices of ventricular remodeling.
Conclusion: The REVEAL trial will evaluate the safety and efficacy of the
highest tolerated single dose of epoetin alpha in patients who have
undergone successful rescue or primary percutaneous coronary intervention
for acute ST-segment elevation myocardial infarction. 2010 Mosby, Inc.

<8>
Accession Number
2010648535
Authors
Elmorsy G.Z. El Gamal M.-A.F.
Institution
(Elmorsy) Anesthesia and Surgical Intensive Care Department, Faculty of
Medicine, Mansoura University, Egypt
(El Gamal) Department of Pediatric and Congenital Cardiothoracic Surgery,
Faculty of Medicine, Mansoura University, Egypt
Title
Effect of different doses of cisatracurium on intubating conditions during
inhalation induction with sevoflurane in pediatric cardiac surgery.
Source
Egyptian Journal of Anaesthesia. 25 (2) (pp 107-114), 2009. Date of
Publication: 2009.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Background: This prospective, randomized, double-blind study was designed
to study the effect of different doses of cisatracurium on intubation
conditions in children during induction with sevoflurane anesthesia in
cases scheduled for elective cardiac surgery at Mansoura Children's
University Hospital. Methods: One hundred children, ASA II-III, aged (2-6)
years subjected for elective cardiac surgery at mansoura children's
university hospital were enrolled in this study. The patients were
randomly allocated using closed envelop method to receive cisatracurium
(0.1(2xED95), 0.05(ED95), 0.025(0.5xED95) mg/kg) or placebo, each one
consisted of 25 patients. Intubation conditions were assessed 3 min after
drug injection. Hemodynamic variables (heart rate and mean arterial
pressure) were recorded. Results: Intubating conditions were considered
good only in 20% of patients with inhalational induction only,
cisatracurium 0.025mg/kg results in good intubating conditions in 52% of
patients, cisatracurium 0.05mg/kg results in good intubating conditions in
60% of patients and excellent intubating conditions in 12% of patients,
while cisatracurium 0.1mg/kg results in excellent intubating condition in
80% of patients and good intubating conditions in 20% of patients.
Conclusion: We concluded that after 3 min after injection of cisatracurium
or placebo, intubation conditions were acceptable in 100, 70, 50, 20% of
children according to the dose of cisatracurium (0.1, 0.05, 0.025 mg/kg or
saline) respectively. Cisatracurium in a dose of 0.1mg/kg considered to be
the proper intubating dose with better hemodynamic stability in pediatric
cardiac surgery.

<9>
Accession Number
2010648540
Authors
Asaad O.M. El Menesy T.M. Hamden G.A. Abdou S.A. Labib D.A. Al Abd N.E.
Abdallah T.S. Hanafy M.S.
Institution
(Asaad, Hamden, Abdou) Department of Anesthesia, Cairo University, Egypt
(Abdallah) Department of Cardiothoracic Surgery, Cairo University, Egypt
(Labib, Al Abd) Department of Clinical Pathology, Cairo University, Egypt
(El Menesy) Department of Anesthesia, Beni Suef University, Egypt
(Hanafy) Department of Cardiothoracic Surgery, Zagazeg University, Egypt
Title
Dexamethasone in a fixed multimodal analgesic regimen following OPCAB
surgery. A randomized, double-blind, comparative study on pain and
neuroendocrine stress hormones control.
Source
Egyptian Journal of Anaesthesia. 25 (2) (pp 161-172), 2009. Date of
Publication: 2009.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Objective: In this study, the efficacy of including dexamethasone 8 mg in
a fixed multimodal analgesic regimen on postoperative neuroendocrine
hormonal assay and pain control was evaluated by using the parasternal
block together with both morphine and paracetamol supplements in cardiac
surgical patients. Methods: Forty five patients undergoing Off pump
coronary artery bypass graft surgery (OPCAB) were randomly allocated into
three groups (15 patients in each); Bupivacaine (B group), Bupivacaine and
dexamethasone 8 mg (BD group) and control (C group). The studied drugs
were injected in both parasternal block (30 ml) and around chest tube
sites (10 ml). The study was designed to supplement the block with both
morphine boluses when Prince Henry score exceeds 2 and paracetamol
infusion every 6 hours. The changes in hormonal levels including both
cortisol and epinephrine were traced before the block and at 12 hour
postoperatively. Also, the time to first morphine request and its total
dose used were calculated in 24 hours and compared between the studied
groups. Results: Both cortisol and epinephrine values were higher in the
control group at 12 hour when compared to the bupivacaine treated groups.
The time to first analgesic request was prolonged and the total morphine
consumption was reduced in BD group when compared to the other two groups.
Also, the prince Henry scores for pain were lower at 6 and 8 hours in BD
and B groups when compared to control group. The mean arterial blood
pressure MAP was higher in the control group in comparison to the other
two groups at 6 and 8 hours. No side effects were detected among studied
groups. Conclusions: The multimodal approach using
dexamethasone-bupivacaine parasternal block together with both morphine
boluses according to PHS and regular paracetamol infusion resulted in less
neuroendocrine hormonal levels, postoperative pain and morphine
consumption with stable hemodynamics following OPCAP surgery.

<10>
Accession Number
2010640434
Authors
Parsaik A.K. Murad M.H. Sathananthan A. Moorthy V. Erwin P.J. Chari S.
Carter R.E. Farnell M.B. Vege S.S. Sarr M.G. Kudva Y.C.
Institution
(Parsaik, Sathananthan, Moorthy, Kudva) Endocrinology, Mayo Clinic,
Rochester, MN, United States
(Murad) Preventive Medicine, Mayo Clinic, Rochester, MN, United States
(Erwin) Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, MN,
United States
(Chari) Gastroenterology, Mayo Clinic, Rochester, MN, United States
(Carter, Vege) Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MN, United States
(Farnell, Sarr) Gastroenterologic and General Surgery, Mayo Clinic, 200
First Street SW, Rochester, MN 55902, United States
Title
Metabolic and target organ outcomes after total pancreatectomy: Mayo
Clinic experience and meta-analysis of the literature.
Source
Clinical Endocrinology. 73 (6) (pp 723-731), 2010. Date of Publication:
December 2010.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Total pancreatectomy (TP) has been associated with substantial metabolic
abnormalities and poor glycaemic control limiting its use. Because data
reported to date are limited, we evaluated outcomes related to the
diabetes mellitus obligated by TP. Methods: A case series study of all
patients who underwent TP from 01/01/1985 to 12/31/2006 at Mayo Clinic was
conducted. TP cases were summarized according to perioperative procedures,
mortality and morbidity after TP. To complement this retrospective
examination, a survey was developed to measure DM treatment modality,
target organ failure and complications in patients alive in 2007. We
performed a meta-analysis to compare our results with similar previous
studies and provide overall estimates of outcomes. Results: A total of 141
cases were studied (97 malignant diseases, 44 benign diseases). The median
survival was much less for malignant pathology (22 vs 87 years, Log rank P
= 00009). In 2007, there were 59 patients that were presumed alive and 47
(80%) responded to the survey. Mean HbA1c at last follow-up was 75% with
89% of respondents on a complex insulin programme (mean daily insulin
requirement 35 +/- 13 units). Episodic hypoglycaemia was experienced by 37
(79%); 15 (41%) experienced severe hypoglycaemia. In contrast, diabetic
ketoacidosis developed in only 2 (4%). Target organ complications and
chronic diarrhoea developed in 13 patients (28%) each. Conclusion: The
primary factor determining survival after TP is the aetiology
necessitating TP, i.e. pancreatic malignancy. Most respondents used
complex insulin programmes, but hypoglycaemia continues to be a problem.
2010 Blackwell Publishing Ltd.

<11>
Accession Number
2010640954
Authors
Mantovani V. Lepore V. Mira A. Berglin E.
Institution
(Mantovani) Department of Cardiac Surgery, University of Insubria,
Ospedale di Circolo di Varese, Viale Borri 57, 21100 Varese, Italy
(Lepore, Berglin) Department of Cardio-Thoracic Surgery, Sahlgrenska
University Hospital, Goteborg, Sweden
(Mira) Department of Economics, University of Insubria, Varese, Italy
Title
Non-inferiority randomized trials, an issue between science and ethics:
The case of the SYNTAX study.
Source
Scandinavian Cardiovascular Journal. 44 (6) (pp 321-324), 2010. Date of
Publication: December 2010.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Non-inferiority trials are questionable when death and serious
complications are included among outcomes. The term itself "non-
inferiority" is misleading, since such a study would not demonstrate that
a new treatment is non-inferior to a control treatment, but simply that
the inferiority would not reach a pre-specified level, deemed as
acceptable by the designers of the trial. Group cross-over,
assay-sensitivity and the need of a placebo arm are major issues for the
reliability of non-inferiority trials. The SYNTAX trial for severe
coronary artery disease was designed on a non-inferiority margin of 6.6%.
In this paper we show that the SYNTAX designers were ready to accept up to
30% higher rate of death and major adverse events to claim the
non-inferiority of percutaneous coronary intervention versus coronary
artery bypass grafting. Eventually the SYNTAX study failed because
percutaneous patients sustained an even higher rate of adverse events. We
propose major caution in performing non-inferiority randomized trials.
2010 Informa Healthcare.

<12>
Accession Number
2010628870
Authors
Nishihira K. Shibata Y. Ishikawa T. Nomura K. Nakama T. Mine D. Inoue Y.
Ashikaga K. Kuriyama N. Matsuyama A. Imamura T. Asada Y. Kitamura K.
Institution
(Nishihira, Shibata, Nomura, Nakama, Mine, Inoue, Ashikaga, Kuriyama,
Matsuyama) Department of Cardiology, Medical Association Hospital
University of Miyazaki, Miyazaki, Japan
(Nishihira, Ishikawa, Matsuyama, Imamura, Kitamura) Division of
Circulatory and Body Fluid Regulation, Department of Internal Medicine,
University of Miyazaki, Miyazaki, Japan
(Asada) Department of Pathology, Faculty of Medicine, University of
Miyazaki, Miyazaki, Japan
Title
Repeated sirolimus-eluting stent implantation to treat sirolimus-eluting
stent and bare-metal stent restenosis.
Source
Circulation Journal. 74 (11) (pp 2329-2333), 2010. Date of Publication:
November 2010.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: In-stent restenosis (ISR) remains a persistent, unresolved
issue even in the era of percutaneous coronary intervention (PCI) using
drug-eluting stents. The present study compares the clinical and
angiographic outcomes of using sirolimus-eluting stents (SES) for
re-intervention against ISR that was originally treated with
sirolimus-eluting or bare-metal (BMS) stents. Methods and Results: This
prospective single-center registry investigated 179 ISR lesions in 158
consecutive patients (53 lesions in 49, and 126 in 109 patients originally
treated with SES and BMS, respectively), who had undergone re-intervention
with SES. The patients were clinically and angiographically followed up at
8 months after re-PCI. The incidence of re-restenosis (29 vs 12%, P<0.01),
ischemia-driven target lesion revascularization (TLR; 21 vs 8%, P<0.05)
and major adverse cardiac events (MACE; 21 vs 9%, P<0.05) were
significantly greater in ISR lesions originally treated with SES than in
those originally treated with BMS at 8 months after re-PCI. Moreover, late
luminal loss was significantly greater in the group with post-SES
restenosis (P<0.05). Even after adjustment, post-SES restenosis was the
only independent predictor of re-restenosis and MACE (P<0.05, each).
Conclusions: Although the re-restenosis rate is acceptable, the incidence
rates of late restenosis, ischemiadriven TLR and MACE are higher after
repeated SES implantation to treat SES, than BMS restenosis. These results
might affect the mid-term clinical outcomes of re-intervention with SES.

<13>
Accession Number
2010641759
Authors
Penninga L. Moller C.H. Gustafsson F. Steinbruchel D.A. Gluud C.
Institution
(Penninga, Moller, Gluud) Department 3344, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
(Penninga) Department of Surgery and Transplantation C2122,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Moller, Steinbruchel) Department of Cardiothoracic Surgery RT 2152,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Gustafsson) Department of Cardiology, B2142, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
Title
Tacrolimus versus cyclosporine as primary immunosuppression after heart
transplantation: Systematic review with meta-analyses and trial sequential
analyses of randomised trials.
Source
European Journal of Clinical Pharmacology. 66 (12) (pp 1177-1187), 2010.
Date of Publication: December 2010.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: We conducted a systematic review of randomized trials to compare
the benefits and harms of tacrolimus versus cyclosporine as primary
immunosuppression after heart transplantation. Methods and results: We
searched electronic databases and bibliographies up to April 2010. Our
review followed the Cochrane and PRISMA guidelines. The meta-analysis
included 10 randomized trials with 952 patients. Tacrolimus was
significantly superior to cyclosporine (both formula-combined) with regard
to hypertension (relative risk [RR] 0.8; 95% confidence interval [CI]
0.69-0.93, p = 0.003), hyperlipidaemia (RR 0.57; 95% CI 0.44-0.74, p <
0.0001), hirsutism (RR 0.17 95% CI 0.04-0.62, p = 0.008), and gingival
hyperplasia (RR 0.07 95% CI 0.01-0.37, p = 0.002). No significant
differences between the two calcineurin inhibitors were found with regard
to acute rejections causing haemodynamic instability, diabetes, renal
dysfunction, infection, malignancy, or neurotoxicity. Tacrolimus was
significantly superior to microemulsion cyclosporine with regard to
mortality (RR 0.64; 95% CI 0.42-0.96, p = 0.03), acute severe
biopsy-proven rejection (RR 0.71; 95% CI 0.56-0.90, p = 0.004),
hyperlipidaemia (RR 0.57; 95% CI 0.41-0.79, p = 0.0009), hirsutism (RR
0.17 95% CI 0.04-0.62, p = 0.008), and gingival hyperplasia (RR 0.07; 95%
CI 0.01-0.37, p = 0.002). Tacrolimus was significantly superior to
oil-based cyclosporine with regard to hypertension (RR 0.66; 95% CI
0.54-0.80, p < 0.0001), and hyperlipidaemia (RR 0.57; 95% CI 0.38-0.87, p
= 0.009). Conclusion: Tacrolimus seems to be superior to cyclosporine in
heart transplant patients with regard to hypertension, hyperlipidaemia,
gingival hyperplasia and hirsutism. In addition, tacrolimus seems to be
superior to microemulsion cyclosporine in heart transplant patients with
regard to a number of outcomes, including death. More trials with a low
risk of bias are needed to determine if the results of the present
meta-analysis can be confirmed. 2010 Springer-Verlag.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 18

Results Generated From:
EMBASE <1980 to 2010 Week 48>
EMBASE (updates since 2010-11-29)

<1>
Accession Number
2010633388
Title
Efficacy and safety of more intensive lowering of LDL cholesterol: A
meta-analysis of data from 170 000 participants in 26 randomised trials.
Source
The Lancet. 376 (9753) (pp 1670-1681), 2010. Date of Publication: 13 Nov
2010.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Lowering of LDL cholesterol with standard statin regimens reduces the risk
of occlusive vascular events in a wide range of individuals. We aimed to
assess the safety and efficacy of more intensive lowering of LDL
cholesterol with statin therapy. We undertook meta-analyses of individual
participant data from randomised trials involving at least 1000
participants and at least 2 years' treatment duration of more versus less
intensive statin regimens (five trials; 39 612 individuals; median
follow-up 51 years) and of statin versus control (21 trials; 129 526
individuals; median follow-up 48 years). For each type of trial, we
calculated not only the average risk reduction, but also the average risk
reduction per 10 mmol/L LDL cholesterol reduction at 1 year after
randomisation. In the trials of more versus less intensive statin therapy,
the weighted mean further reduction in LDL cholesterol at 1 year was 051
mmol/L. Compared with less intensive regimens, more intensive regimens
produced a highly significant 15 (95 CI 11-18; p<00001) further reduction
in major vascular events, consisting of separately significant reductions
in coronary death or non-fatal myocardial infarction of 13 (95 CI 7-19;
p<00001), in coronary revascularisation of 19 (95 CI 15-24; p<00001), and
in ischaemic stroke of 16 (95 CI 5-26; p=0005). Per 10 mmol/L reduction in
LDL cholesterol, these further reductions in risk were similar to the
proportional reductions in the trials of statin versus control. When both
types of trial were combined, similar proportional reductions in major
vascular events per 10 mmol/L LDL cholesterol reduction were found in all
types of patient studied (rate ratio [RR] 078, 95 CI 076-080; p<00001),
including those with LDL cholesterol lower than 2 mmol/L on the less
intensive or control regimen. Across all 26 trials, all-cause mortality
was reduced by 10 per 10 mmol/L LDL reduction (RR 090, 95 CI 087-093;
p<00001), largely reflecting significant reductions in deaths due to
coronary heart disease (RR 080, 99 CI 074-087; p<00001) and other cardiac
causes (RR 089, 99 CI 081-098; p=0002), with no significant effect on
deaths due to stroke (RR 096, 95 CI 084-109; p=05) or other vascular
causes (RR 098, 99 CI 081-118; p=08). No significant effects were observed
on deaths due to cancer or other non-vascular causes (RR 097, 95 CI
092-103; p=03) or on cancer incidence (RR 100, 95 CI 096- 104; p=09), even
at low LDL cholesterol concentrations. Further reductions in LDL
cholesterol safely produce definite further reductions in the incidence of
heart attack, of revascularisation, and of ischaemic stroke, with each 10
mmol/L reduction reducing the annual rate of these major vascular events
by just over a fifth. There was no evidence of any threshold within the
cholesterol range studied, suggesting that reduction of LDL cholesterol by
2-3 mmol/L would reduce risk by about 40-50. UK Medical Research Council,
British Heart Foundation, European Community Biomed Programme, Australian
National Health and Medical Research Council, and National Heart
Foundation. 2010 Elsevier Ltd.

<2>
Accession Number
2010636379
Authors
Nienaber C.A. Kische S. Akin I. Rousseau H. Eggebrecht H. Fattori R.
Rehders T.C. Kundt G. Scheinert D. Czerny M. Kleinfeldt T. Zipfel B.
Labrousse L. Ince H.
Institution
(Nienaber, Kische, Akin, Rehders, Kundt, Kleinfeldt, Ince) Divisions of
Cardiology and Biomedical Statistics, University of Rostock, Rostock,
Germany
(Eggebrecht) University of Duisburg-Essen, Essen, Germany
(Scheinert) University Heart Center Leipzig, Leipzig, Germany
(Zipfel) German Heart Institute Berlin, Berlin, Germany
(Rousseau) Centre Hospitalire Universitaire, Hopital de Rangueil,
Toulouse, France
(Fattori) Universita St. Orsola Malpighi, Bologna, Italy
(Czerny) Department of Cardiothoracic Surgery, University of Vienna,
Vienna, Austria
(Labrousse) Bordeaux Heart University Hospital, Bordeaux, France
Title
Strategies for subacute/chronic type B aortic dissection: The
Investigation of Stent Grafts in Patients with Type B Aortic Dissection
(INSTEAD) trial 1-year outcome.
Source
Journal of Thoracic and Cardiovascular Surgery. 140 (6 SUPPL.) (pp
S101-S108), 2010. Date of Publication: December 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Endovascular stent grafting represents a novel concept for type
B aortic dissection both in the acute and subacute/chronic setting, with
an unknown effect on outcomes. Methods: In a prospective trial 140
patients with stable type B dissection were randomly subjected to elective
stent-graft placement in addition to optimal medical therapy (n = 72) or
to optimal medical therapy (n = 68) with surveillance (arterial pressure
according to World Health Organization guidelines <=120/80 mm Hg). The
primary end point was 1-year all-cause mortality, whereas aorta-related
mortality, progression (with need for conversion or additional
endovascular or open surgical intervention), and aortic remodeling were
secondary end points. Results: There was no difference in all-cause
mortality: cumulative survival was 97.0% +/- 3.4% with optimal medical
therapy versus 91.3% +/- 2.1% with thoracic endovascular aortic repair (P
= .16). Moreover, aorta-related mortality was not different (P = .42), and
the risk for the combined end point of aorta-related death (rupture) and
progression (including conversion or additional endovascular or open
surgical intervention) was similar (P = .86). Three neurologic adverse
events occurred in the thoracic endovascular aortic repair group (1
paraplegia, 1 stroke, and 1 transient paraparesis) versus 1 episode of
paraparesis with medical treatment. Finally, aortic remodeling (with
true-lumen recovery and thoracic false-lumen thrombosis) occurred in 91.3%
with thoracic endovascular aortic repair versus 19.4% with medical
treatment (P < .001), which is suggestive of continued remodeling.
Conclusions: In survivors of uncomplicated type B aortic dissection,
elective stent-graft placement does not improve 1-year survival and
adverse events, despite favorable aortic remodeling. Copyright 2010 by
The American Association for Thoracic Surgery.

<3>
Accession Number
2010636400
Authors
Lansman S.L. Saunders P.C. Malekan R. Spielvogel D.
Institution
(Lansman, Saunders, Malekan, Spielvogel) Westchester Medical Center, New
York Medical College, Macy Pavilion 114W, Valhalla, NY, United States
Title
Acute aortic syndrome.
Source
Journal of Thoracic and Cardiovascular Surgery. 140 (6 SUPPL.) (pp
S92-S97), 2010. Date of Publication: December 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
The term acute aortic syndrome refers to a heterogeneous group of
conditions that cause a common set of signs and symptoms, the foremost of
which is aortic pain. Various pathologic entities may give rise to this
syndrome, but the topic has come to focus on penetrating aortic ulcer and
intramural hematoma and their relation to aortic dissection. Penetrating
aortic ulcer is a focal atherosclerotic plaque that corrodes a variable
depth through the intima into the media. Intramural hematoma is a blood
collection within the aortic wall not freely communicating with the aortic
lumen, with restricted flow. It may represent a subcategory of aortic
dissection that manifests different behavior by virtue of limited flow in
the false lumen. This article reviews the current literature regarding
acute aortic syndrome, focusing on management options. Copyright 2010 by
The American Association for Thoracic Surgery.

<4>
Accession Number
2010622493
Authors
Nosotti M. Baisi A. Mendogni P. Palleschi A. Tosi D. Rosso L.
Institution
(Nosotti, Mendogni, Palleschi, Tosi, Rosso) Thoracic Surgery and Lung
Transplant Unit, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico,
University of Milan, Via Francesco Sforza, 35, 20122 Milan, Italy
(Baisi) Thoracic Surgery Unit, Ospedale San Paolo, University of Milan,
Milan, Italy
Title
Muscle sparing versus posterolateral thoracotomy for pulmonary lobectomy:
Randomised controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 11 (4) (pp 415-419),
2010. Date of Publication: October 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Muscle sparing thoracotomy (MST) has been proposed as an alternative to
posterolateral thoracotomy (PLT) for pulmonary lobectomy. This issue has
been addressed by few clinical reports. To explore that subject, a
prospective, controlled randomised, double-blind trial comparing MST
through the auscultatory triangle and PLT was planned. The study included
patients scheduled for pulmonary lobectomy for stage I or II
non-small-cell lung cancer and were followed for three years. The primary
endpoints were pain, analgesic consumption and post-thoracotomy pain
syndrome. The secondary endpoints included morbidity plus shoulder and
pulmonary functions. The trial randomised 100 patients into two groups.
Postoperative pain results were similar, although analgesic consumption
was higher in the PLT group (Ps0.001). The MST group had a shorter
hospital stay (Ps0.003). Three years post-thoracotomy syndrome was
unaffected by the type of incision. The women suffered more than men
during the early and late postoperative time. An inverse correlation
between incision length and pain was found. Immediate shoulder strength
was significantly better in the MST group (Ps0.004) but postoperative
pulmonary function and complications were comparable. The two incisions
results were very similar in the patient outcome, however, few aspects
indicated the MST as the more suitable incision for pulmonary lobectomy.
2010 Published by European Association for Cardio-Thoracic Surgery.

<5>
Accession Number
2010625414
Authors
He J. Li S. Shao W. Wang D. Chen M. Yin W. Wang W. Gu Y. Zhong B.
Institution
(He, Li, Shao, Wang, Chen, Yin, Wang, Zhong) Department of Cardiothoracic
Surgery, First Affiliated Hospital, Guangzhou Medical College, No. 151,
Yanjiang Rd, Guangzhou 510120, Guangdong Province, China
(He, Li, Shao, Wang, Chen, Yin, Wang, Zhong) Guangzhou Research Institute
of Respiratory Disease, China State Key Laboratory of Respiratory Disease,
Guangzhou, China
(Gu) Department of Pathology, First Affiliated Hospital, Guangzhou Medical
College, Guangzhou, China
Title
Activated carbon nanoparticles or methylene blue as tracer during
video-assisted thoracic surgery for lung cancer can help pathologist find
the detected lymph nodes.
Source
Journal of Surgical Oncology. 102 (6) (pp 676-682), 2010. Date of
Publication: 01 Nov 2010.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background To assess whether using methylene blue (MB) or activated carbon
nanoparticles as tracer can increase the detected number of lymph nodes in
the systematic nodal dissected tissue during Video-Assisted Thoracic
Surgery (VATS) for non-small cell lung cancer. Methods Three groups of 20
patients each were obtained from randomization of 60 patients with NSCLC
requiring VATS with systematic nodal dissection (SND) from February 2007
and December 2008, there were 17, 16, and 17 patients in group A
(injection activated carbon nanoparticles), group B (injection MB), and
group C (controls), respectively. Results There was difference of the
total number of dissected lymph nodes per patient among three groups (P <
0.001). The total number of dissected LNs and mediastinal nodes per
patient in group A and group B was more than in group C (P < 0.001). There
were 20, 18, and 14 metastatic LNs dissected in 6, 6, and 7 patients of
group A, B, and C, respectively. There was difference of total number of
dissected metastatic LNs per patient among three groups (P = 0.002).
Conclusions MB can be as effective as activated carbon nanoparticles being
tracer to increase the detected number of LNs in the systematic nodal
dissected tissue during VATS for NSCLC. 2010 Wiley-Liss, Inc.

<6>
[Use Link to view the full text]
Accession Number
2010627363
Authors
Patel M.R. Jneid H. Derdeyn C.P. Klein L.W. Levine G.N. Lookstein R.A.
White C.J. Yeghiazarians Y. Rosenfield K.
Title
Arteriotomy closure devices for cardiovascular procedures: A scientific
statement from the american heart association.
Source
Circulation. 122 (18) (pp 1882-1893), 2010. Date of Publication: 02 Nov
2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)

<7>
Accession Number
2010628756
Authors
Friberg O. Svedjeholm R. Soderquist B.
Institution
(Friberg) Department of Cardiothoracic Surgery and Anesthesiology, Orebro
University Hospital, Orebro, Sweden
(Svedjeholm) Department of Cardiothoracic Surgery, Linkoping University
Hospital, Linkoping, Sweden
(Soderquist) Department of Laboratory Medicine, Clinical Microbiology,
Orebro University Hospital, Sweden
Title
To the editor.
Source
JAMA - Journal of the American Medical Association. 304 (19) (pp
2123-2124), 2010. Date of Publication: 17 Nov 2010.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)

<8>
Accession Number
2010629202
Authors
Alfredsson J. Swahn E.
Institution
(Alfredsson, Swahn) Division of Cardiology, Department of Medical and
Health Sciences, University Hospital, Linkoping, Sweden
Title
Management of acute coronary syndromes from a gender perspective.
Source
Fundamental and Clinical Pharmacology. 24 (6) (pp 719-728), 2010. Date
of Publication: December 2010.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Acute Coronary Syndromes are the most frequent manifestations of coronary
heart disease (CHD). Gender differences in treatment intensity, including
differences in level of care, have been reported. Also differences in
benefit from certain treatments, especially invasive treatment, have been
discussed. Finally, differences in outcome between men and women have been
proposed. Results have been inconsistent, partly depending on if and how
adjustment for differences in background characteristics has been made.
2010 The Authors Fundamental and Clinical Pharmacology 2010 Societe
Francaise de Pharmacologie et de Therapeutique.

<9>
Accession Number
2010634127
Authors
Gruenwald C.E. Manlhiot C. Chan A.K. Crawford-Lean L. Foreman C. Holtby
H.M. Van Arsdell G.S. Richards R. Moriarty H. McCrindle B.W.
Institution
(Gruenwald, Manlhiot, Crawford-Lean, Foreman, Holtby, Van Arsdell,
McCrindle) Department of Pediatrics, University of Toronto, Hospital for
Sick Children, Toronto, ON, Canada
(Chan) Department of Pediatrics, McMaster University, McMaster Children's
Hospital, Hamilton, ON, Canada
(Gruenwald, Richards, Moriarty) Faculty of Science, School of Community
Health, Charles Sturt University, Wagga Wagga, NSW, Australia
Title
Randomized, controlled trial of individualized heparin and protamine
management in infants undergoing cardiac surgery with cardiopulmonary
bypass.
Source
Journal of the American College of Cardiology. 56 (22) (pp 1794-1802),
2010. Date of Publication: 23 Nov 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives We sought to determine whether infants (younger than 1 year
old) had similar clinical benefits with individualized anticoagulation
management as older children and adult undergoing cardiopulmonary bypass
(CPB). Background Individualized heparin and protamine management in older
children and adults undergoing CPB has been associated with improved
clinical outcomes. Methods Ninety infants younger than 1 year of age
undergoing CPB were enrolled in a randomized, controlled trial comparing
weight-based anticoagulation management using activated clotting time
(ACT) to individualized management with Hemostasis Management System Plus.
Manufacturer's guidelines were followed for the first 33 patients. A
modified protocol was used for the last 57 patients with adjustments for
coagulation system immaturity and hemodilution on CPB. Results The
hemostasis management system (HMS) device consistently underestimated
plasma anti-Xa levels, leading to an overestimated required heparin dose.
After a blinded interim analysis revealed poor outcomes in the
experimental HMS group using manufacturer guidelines, the safety committee
suspended the study pending protocol modifications. The use of the HMS
device following the modified protocol resulted in more stable anti-Xa
levels during CPB with improved post-operative outcomes including reduced
need for transfusions (71 ml/kg vs. 80 ml/kg; p = 0.003), ventilation time
(33 h vs. 49 h; p = 0.04), intensive care (88 h vs. 99 h; p = 0.003), and
hospital length of stay (192 h vs. 216 h; p < 0.001), compared with the
weight-based protocol. Conclusions This study supports the use of the HMS
device, with a modified protocol for infants younger than 1 year of age,
for anticoagulation management during CPB. Clinical guidelines for the use
of the HMS device should be modified for infants younger than 1 year of
age. 2010 American College of Cardiology Foundation.

<10>
Accession Number
2010622491
Authors
Modine T. Zannis C. Salleron J. Provot F. Gourlay T. Duhamel A. Koussa M.
Fayad G.
Institution
(Modine, Zannis, Koussa, Fayad) Hopital Cardiologique, Department of
Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de
Lille, 59037 Lille Cedex, France
(Salleron, Duhamel) Department of Biostatistics, Centre Hospitalier
Regional et Universitaire de Lille, Lille, France
(Provot) Department of Nephrology, Centre Hospitalier Regional et
Universitaire de Lille, Lille, France
(Gourlay) University of Strathclyde, Glasgow, United Kingdom
Title
A prospective randomized study to evaluate the renal impact of surgical
revascularization strategy in diabetic patients.
Source
Interactive Cardiovascular and Thoracic Surgery. 11 (4) (pp 406-410),
2010. Date of Publication: October 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Acute kidney injury (AKI) is a major postoperative complication following
cardiac surgery. Diabetes mellitus is a major cause of nephropathy and
end-stage renal failure. We aimed to evaluate the occurrence of adverse
renal outcomes, in diabetic patients, between on-pump (CPB) and off-pump
(OPCAB) coronary artery bypass graft (CABG). Seventy-one diabetic patients
(36 and 35 patients in the CPB and OPCAB groups, respectively) were
enrolled in a prospective randomized study. Renal tubular and glomerular
functions, were monitored preoperatively and over five consecutive days.
There was no significant difference between the groups in terms of age,
gender, New York Heart Association class, Canadian Cardiovascular Society
functional classification of angina grade and number of CABG. Intensive
care unit stay, duration of intubation, hospital stay and bleeding were
significantly higher in the CPB group. No significant differences in
plasmatic creatinine, urinary creatinine, creatinine clearance,
proteinuria or osmolality were detected. A significant rise in urinary
albumine excretion occurred in both groups peaking on the operative day;
for the on-pump CABG group (105 vs. 4857; Ps0.015) and for the OPCAB group
(116 vs. 3759; Ps0.04). Values were less important in the OPCAB group and
return to the baseline was faster than in the CPB group. OPCAB attenuates
sub-clinical AKI, in diabetic patients. 2010 Published by European
Association for Cardio-Thoracic Surgery.

<11>
[Use Link to view the full text]
Accession Number
2010624840
Authors
Prasad A. Banakal S. Muralidhar K.
Institution
(Prasad, Banakal, Muralidhar) Department of Anaesthesiology, Narayana
Hrudayalaya Institute of Medical Sciences, No 258/A, Bommasandra
Industrial Area, Anekal Taluk, Bangalore 560099, India
Title
N-Acetylcysteine does not prevent renal dysfunction after off-pump
coronary artery bypass surgery.
Source
European Journal of Anaesthesiology. 27 (11) (pp 973-977), 2010. Date of
Publication: November 2010.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Background and objective Coronary artery bypass graft surgery in high-risk
patients may be associated with postoperative renal dysfunction.
N-Acetylcysteine is a powerful antioxidant and has been used to prevent
contrast-induced renal dysfunction. The efficacy of N-acetylcysteine in
preventing postoperative renal dysfunction following off-pump coronary
artery bypass graft surgery was studied. Methods A prospective,
randomized, controlled study was conducted in patients undergoing off-pump
coronary artery bypass graft. The study group (37 patients) received
N-acetylcysteine in the perioperative period, whereas the control group
(37 patients) did not. The data obtained were analysed using the
independent sample t-test (Student's t-test) and x²-test.
Results There was no significant difference in the incidence of renal
dysfunction between the two groups. Three patients (8.6%) in the
N-acetylcysteine group and four (11.4%) in the control group developed
renal dysfunction (P value was 1.00). Conclusion N-Acetylcysteine does not
have any beneficial effect on renal function in high-risk patients
undergoing offpump coronary artery bypass graft. Copyright European
Society of Anaesthesiology.

<12>
Accession Number
70304950
Authors
Sontag M.K. Sagel S.D. Wagener J. Accurso F.J.
Institution
(Sontag) Epidemiology, University of Colorado at Denver, Aurora, CO,
United States
(Sagel, Wagener, Accurso) Pediatrics, University of Colorado at Denver,
Aurora, CO, United States
Source
Pediatric Pulmonology. Conference: 24th Annual North American Cystic
Fibrosis Conference Baltimore, MD United States. Conference Start:
20101021 Conference End: 20101023. Conference Publication: (var.pagings).
45 (pp 396), 2010. Date of Publication: September 2010.
Publisher
Wiley-Liss Inc.
Abstract
Background: Colorado adopted newborn screening (NBS) for cystic fibrosis
in 1982, using an algorithm of two immunoreactive trypsinogen
determinations (IRT/IRT). We have previously reported a sensitivity of
94.6% (90.0-96.2%). Reports from other programs suggest sensitivity of
this approach with initial cutoffs >100 ng/ml may be as low as 80%. We
identified individuals in the Cystic Fibrosis Foundation (CFF) Registry
who may have been missed by the Colorado NBS in order to further refine
our sensitivity estimates. Methods: Names and current CF centers were
requested from the CFF on individuals born in Colorado between 1982 and
2007 that have CF but not seen by the Colorado Center. Local CF centers
were contacted and asked to confirm state of birth with families. The
additional missed cases were added to the number of missed cases
previously known. Infants with meconium ileus (n=67) were not included.
False negative rate and 95% confidence intervals are reported. Results:
Twenty infants were previously known missed cases followed in Colorado,
(median age of diagnosis 1 year: range 0.1-13.4 years), and 332
non-meconium ileus infants were identified by NBS (missed case rate 6.0%,
3.9-9.1%). Eight missed cases (40%) had genotypes associated with
pancreatic sufficiency. An additional 27 patients were identified from the
CFF query, however only 2 have been confirmed as missed cases on the
Colorado NBS. Of the remaining infants, 21 were confirmed as not missed on
NBS, and 4 individuals have not yet been located. The 2 confirmed missed
cases were diagnosed in other states: one diagnosed at 6 months due to
failure to thrive and electrolyte imbalance (Cl=120, F508del/ F508del) and
one diagnosed at 3 years of age (Cl=74, not genotyped). Three babies were
reported who have CF identified by Colorado NBS. One infant moved
following an elevated IRT, sweat test performed in infancy in another
state was negative, and the child was diagnosed at 14 years (Cl=111,
F508del/ F508del). One moved to another state after birth and diagnosis at
1.2 months was prompted by elevated IRT; another lived in a neighboring
state and diagnosis was prompted by elevated IRT at 1.4 months. Four
infants had been diagnosed by the Colorado NBS but not reported to the
CFF. Eight infants were a duplication of records (names
changed/misspelled). The birth state was misreported in four cases. One
case was concluded to be Munchausen's by proxy (CFTR mutations not
identified) and one child had a heart transplant, with no further mention
of CF (CFTR mutations not identified). The missed case rate using infants
with known state of birth is 22/337 (6.5%, 4.4-9.7%). Assuming all four
infants who have not been located were born in Colorado and missed on NBS,
the missed case rate is 26/341 (7.6% 5.6-10.9%). Conclusions: A systematic
review of national data reflecting potential missed cases from the
Colorado NBS program resulted in only two additional cases missed by NBS,
and one case missed by a negative sweat test in another state. These data
suggest the sensitivity of IRT/IRT in Colorado was 92.3% (89.1-94.7%).
This systematic approach should be considered in evaluating other CF NBS
protocols.

<13>
Accession Number
2010609719
Authors
Poyet R. Cuisset T. Frere C. Quilici J. Gaborit B. Moro P.-J. Camoin L.
Morange P.-E. Bonnet J.-L. Alessi M.-C.
Institution
(Poyet, Cuisset, Quilici, Moro, Bonnet) Departement de Cardiologie, CHU
Timone, Marseille, F-13385, France
(Cuisset, Frere, Gaborit, Morange, Alessi) Inserm, U626, Marseille,
F-13385, France
(Frere, Gaborit, Morange, Alessi) Laboratoire d'Hematologie, CHU Timone,
Marseille, F-13385, France
(Camoin) Laboratoire d'Hematologie, CHU Conception, Marseille, F-13385,
France
(Cuisset, Frere, Gaborit, Morange, Alessi) Faculte de Medecine, Marseille
F-13385, France
Title
Comparison of rosuvastatin and atorvastatin on clopidogrel response and
lipidic and inflammatory parameters after coronary stenting for acute
coronary syndrome: The prospective, randomized OSCAR study (optimal statin
therapy with clopidogrel after coronary revascularisation).
Source
Thrombosis Research. 126 (5) (pp e397-e399), 2010. Date of Publication:
2010.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)

<14>
Accession Number
2010620211
Authors
Macia I. Gossot D.
Institution
(Macia, Gossot) Department of Thoracic, Institut Mutualiste Montsouris, 42
Boulevard Jourdan, F-75014 Paris, France
Title
Maintaining a clear vision during long-lasting thoracoscopic procedures.
Source
Interactive Cardiovascular and Thoracic Surgery. 11 (5) (pp 522-524),
2010. Date of Publication: November 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Performing complex and long-lasting thoracoscopic procedures presupposes
that a perfectly clear vision is maintained. We have evaluated the use of
a lens cleaner system (EndoClear) which can be released inside the chest
cavity, thus avoiding the need for removing the scope. Forty-three
patients underwent a totally endoscopic major pulmonary resection. The
study group consisted of 13 patients whose surgery was performed using the
lens cleaner (group Lens Cleaner, LC). The control group (group C)
consisted of 30 patients operated without the assistance of EndoClear.
Both groups were similar in terms of age, gender, type and duration of
surgery. In group LC, the thoracoscope was cleaned using EndoClear a mean
of 8.6+/-2.5 times per operation and a mean of 1.3+/-1.3 times outside the
cavity (P<0.001). In group C, the thoracoscope had to be removed for
cleaning a mean 9.5+/-3.9 times significantly more often than in the group
LC (P<0.001). The EndoClear lens cleaning system is an efficient method
for cleaning the scope inside the chest cavity. 2010 Published by
European Association for Cardio-Thoracic Surgery.

<15>
Accession Number
2010623177
Authors
Schiariti M. Saladini A. Papalia F. Grillo P. Nesta C. Cuturello D.
Missiroli B. Puddu P.E.
Institution
(Schiariti, Saladini, Grillo, Nesta, Missiroli) S. Anna Hospital,
Catanzaro, Italy
(Schiariti, Papalia, Cuturello, Puddu) Department of the Heart and Great
Vessels A. Reale, University La Sapienza, Viale del Policlinico, 155, Rome
00161, Italy
Title
GPIIb/IIIa receptor antagonism using small molecules provides no additive
long-term protection after percutaneous coronary intervention as compared
to clopidogrel plus aspirin.
Source
Open Cardiovascular Medicine Journal. 4 (pp 151-156), 2010. Date of
Publication: 2010.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: There is some controversy as to whether tirofiban or
eptifibatide, two small anti-aggregating drugs (AAD), may reduce the
incidence of composite ischemic events within one year in patients
undergoing percutaneous coronary intervention (PCI) in the real clinical
world. Methods: We compared consecutive patients on oral double AAD (with
clopidogrel and aspirin) who underwent PCI (n=207) and patients who were
on single AAD and received a second AAD, just prior to PCI, and either
high-dose tirofiban or double-bolus eptifibatide (double AAD plus small
molecules group, n=666). The primary end point (incidence of composite
ischemic events within one year) included death, acute myocardial
infarction, unstable angina, stent thrombosis or repeat PCI or coronary
bypass surgery (related to the target vessel PCI failure) and was modelled
by Cox's regression. Results: There were 89 composite ischemic events: 24
(11.6%) in double AAD alone and 65 (9.8%) in double AAD plus small
molecules groups (log-rank test: p=0.36). Incidences by type of ischemic
events were similar between the 2 groups. Based on 21 potential covariates
fitted simultaneously, adjusted hazard ratios (HR and 95% confidence
intervals) showed that age (HR 1.03, 1.01-1.06, p=0.01), diabetes (HR
1.68, 1.01-2.79, p=0.05) and intra aortic balloon pump (HR 5.12,
2.36-11.10, p=0.0001) were significant risk factors whereas thrombolysis
by tenecteplase (HR 0.35, 0.13-0.98, p=0.05) and having had hypertension
or anti-hypertensive treatment (HR 0.58, 0.36-0.93, p=0.03) were
significant protectors for events. Whether small molecules were present
provided a non significant additional benefit as compared to double AAD
alone (HR 0.83, 0.51-1.36, p=0.46). Pre-PCI CK-MB were not useful to
predict events (HR 1.01, 0.99-1.01, p=0.17). Conclusions: In clinical
world patients undergoing PCI (rescue plus primary <13%) while on double
AAD, based on clopidogrel plus aspirin, small molecules (tirofiban or
eptifibatide) provided no additive long-term protection against the
occurrence of composite ischemic events whereas thrombolysis by
tenecteplase did. Schiariti et al.

<16>
Accession Number
2010624744
Authors
Bystron M. Cervinka P. Spacek R. Kvasnak M. Jakabcin J. Cervinkova M. Kala
P. Widimsky P.
Institution
(Bystron, Cervinka, Spacek, Kvasnak, Jakabcin, Cervinkova) Krajska
Zdravotni A.s., Masaryk Hospital, Department of Cardiology, Socialni pece
3316/12A, 401 13 Usti nad Labem, Czech Republic
(Kala) Department of Cardiology, Faculty Hospital Brno Bohunice, Czech
Republic
(Widimsky) Cardiocenter, Third Faculty of Medicine, Charles University,
Prague, Czech Republic
Title
Randomized comparison of endothelial progenitor cells capture stent versus
cobalt-chromium stent for treatment of ST-elevation myocardial infarction.
Six-month clinical, angiographic, and IVUS follow-up.
Source
Catheterization and Cardiovascular Interventions. 76 (5) (pp 627-631),
2010. Date of Publication: 01 Nov 2010.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Purpose: The aim of this trial was to assess the feasibility and safety of
endothelial progenitor cells capture (EPC) stent in the treatment of acute
ST-elevation myocardial infarction (STEMI) when compared with
cobalt-chromium stents (CoCr). Methods: Between July 2006 and May 2008,
100 patients with single vessel disease undergoing primary PCI for STEMI
were randomly assigned to receive either EPC stent (N = 50) or CoCr stent
(N = 50). High-pressure stent implantation was carried out in both groups.
Dual antiplatelet treatment was administered for 30 days in both groups.
All patients underwent 6-month clinical, angiographic, and IVUS follow-up.
Results: The rate of major adverse cardiovascular events (MACEs) at 30
days was comparable in both groups. At 6-month follow-up, the rates of
MACEs and TLR in the EPC stent group when compared with CoCr stent were
24% vs.10%; P = 0.06 and 14% vs. 4%; P = 0.08, respectively. There were
three cases (6%) of stent thrombosis (ST) in the EPC stent group versus
none in CoCr group. Conclusion: The use of EPC capture stents in the
setting of STEMI is feasible and safe in terms of 30-days outcome.
However, at the 6-month follow-up, we found a trend of higher rates of
MACE and TLR in the EPC stent capture group compared to CoCr stents. The
study does not support the use of EPC capture stents with short duration
dual antiplatelet therapy in patients with STEMI. Future randomized
studies with large sample sizes would be necessary to demonstrate the
safety of such approach. Copyright 2010 Wiley-Liss, Inc.

<17>
[Use Link to view the full text]
Accession Number
2010609796
Authors
Aouad M.T. Kanazi G.E. Abdallah F.W. Moukaddem F.H. Turbay M.J. Obeid M.Y.
Siddik-Sayyid S.M.
Institution
(Aouad, Kanazi, Abdallah, Moukaddem, Turbay, Obeid, Siddik-Sayyid)
Department of Anesthesiology, American University of Beirut, P.O. Box
11-0236, Beirut, Lebanon
Title
Femoral vein cannulation performed by residents: A comparison between
ultrasound-guided and landmark technique in infants and children
undergoing cardiac surgery.
Source
Anesthesia and Analgesia. 111 (3) (pp 724-728), 2010. Date of
Publication: September 2010.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
BACKGROUND: Percutaneous cannulation of the femoral vein, in the pediatric
age group, can be technically challenging, especially when performed by
residents in training. We examined whether the use of real-time ultrasound
guidance is superior to a landmark technique for femoral vein
catheterization in children undergoing heart surgery. METHODS: Patients
were prospectively randomized into 2 groups. In group LM, the femoral vein
was cannulated using the traditional method of palpation of arterial
pulse. In group US, cannulation was guided by real-time scanning with an
ultrasound probe. The time to complete cannulation (primary outcome),
success rate, number of needle passes, number of successful cannulations
on first needle pass, and incidence of complications were compared between
the 2 groups. RESULTS: Forty-eight pediatric patients were studied. The
time to complete cannulation was significantly shorter (155 [46-690] vs
370 [45-1620] seconds; P = 0.02) in group US versus group LM. The success
rate was similar in both groups (95.8%). The number of needle passes was
smaller (1 [1- 8] vs 3 [1-21]; P = 0.001) and the number of successful
cannulations on first needle pass higher (18 vs 6; P = 0.001) in group US
compared with group LM. The incidence of femoral artery puncture was
comparable between the 2 groups. CONCLUSIONS: Ultrasound-guided
cannulation of the femoral vein, in pediatric patients, when performed by
senior anesthesia residents, is superior to the landmark technique in
terms of speed and number of needle passes, with remarkable improvement in
first attempt success. (Anesth Analg 2010;111:724-8) Copyright 2010
International Anesthesia Research Society.

<18>
Accession Number
2010620725
Authors
Barnett H.J.M. Pelz D.M. Lownie S.P.
Institution
(Barnett) Robarts Research Institute, University of Western Ontario,
London, ON, Canada
(Pelz) Department of Medical Imaging, University of Western Ontario,
London, ON, Canada
(Lownie) Department of Clinical Neurological Sciences, University of
Western Ontario, London, ON, Canada
Title
Reflections by contrarians on the post-CREST evaluation of carotid
stenting for stroke prevention.
Source
International Journal of Stroke. 5 (6) (pp 455-456), 2010. Date of
Publication: December 2010.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Carotid angioplasty and stenting has become a popular alternative to
carotid endarterectomy for the treatment of carotid stenosis in stroke.
Evidence from early randomized controlled trials comparing these
interventions revealed mixed results. The largest such trial, the Carotid
Revascularization Endarterectomy vs. Stenting Trial recently showed
equivalence of the procedures in a mixed cohort of both symptomatic and
asymptomatic patients. These results have been heralded in North America
as definitively demonstrating the safety and efficacy of carotid
angioplasty and stenting, making it an attractive alternative to carotid
endarterectomy. It is therefore probable that many more asymptomatic
patients will be subjected to Carotid angioplasty and stenting, perceived
by many to be less invasive than carotid endarterectomy. The authors argue
that the design of Carotid Revascularization Endarterectomy vs. Stenting
Trial was flawed by the mixture of two dissimilar patient groups, thus
violating the principle of ceteris paribus, essential for the validity of
a randomized controlled trials. The evidence for any invasive treatment of
asymptomatic carotid disease is weak, with recent data favouring purely
medical management. The authors believe that carotid angioplasty and
stenting in asymptomatic patients should cease until better evidence is
available. 2010 The Authors. International Journal of Stroke 2010 World
Stroke Organization.