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<1>
Accession Number
2011004865
Authors
Mohr F.W. Rastan A.J. Serruys P.W. Kappetein A.P. Holmes D.R. Pomar J.L.
Westaby S. Leadley K. Dawkins K.D. MacK M.J.
Institution
(Mohr, Rastan) Department of Cardiac Surgery, Heart Center, University of
Leipzig, Germany
(Serruys, Kappetein) Erasmus University Medical Center, Rotterdam,
Netherlands
(Holmes) Mayo Clinic, Rochester, MN, United States
(Pomar) Department of Cardiovascular Surgery, Hospital Clinico de
Barcelona, Spain
(Westaby) John Radcliffe Hospital, Oxford, United Kingdom
(Leadley, Dawkins) Boston Scientific Corporation, Marlborough, MA, United
States
(MacK) Medical City Hospital, Dallas, TX, United States
Title
Complex coronary anatomy in coronary artery bypass graft surgery: Impact
of complex coronary anatomy in modern bypass surgery? Lessons learned from
the SYNTAX trial after two years.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (1) (pp 130-140),
2011. Date of Publication: January 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: SYNTAX study compares outcomes of coronary artery bypass
grafting with percutaneous coronary intervention in patients with 3-vessel
and/or left main disease. Complexity of coronary artery disease was
quantified by the SYNTAX score, which combines anatomic characteristics of
each significant lesion. This study aims to clarify whether SYNTAX score
affects the outcome of bypass grafting as defined by major adverse
cerebrovascular and cardiac events (MACCE) and its components over a
2-year follow-up period. Methods: Of the 3075 patients enrolled in SYNTAX,
1541 underwent coronary artery bypass grafting (897 randomized controlled
trial patients, and 644 registry patients). All patients undergoing bypass
grafting were stratified according to their SYNTAX score into 3 tertiles:
low (0-22), intermediate (22-32), and high (>=33) complexity. Clinical
outcomes up to 2 years after allocation were determined for each group and
further risk factor analysis was performed. Results: Registry patients had
more complex disease than those in the randomized controlled trial (SYNTAX
score: registry 37.8 +/- 13.3 vs randomized 29.1 +/- 11.4; P < .001). At
30 days, overall coronary bypass mortality was 0.9% (registry 0.6% vs
randomized 1.2%). MACCE rate at 30 days was 4.4% (registry 3.4% vs
randomized 5.2%). SYNTAX score did not significantly affect overall 2-year
MACCE rate of 15.6% for low, 14.3% for medium, and 15.4% for high SYNTAX
scores. Compared with randomized patients, registry patients had a lower
rate of overall MACCE rate (registry 13.0% vs randomized 16.7%; P = .046)
and repeat revascularization (4.7% vs 8.6%; P = .003), whereas other event
rates were comparable. Risk factor analysis revealed left main disease (P
= .049) and incomplete revascularization (P = .005) as predictive for
adverse 2-year outcomes. Conclusions: The outcome of coronary artery
bypass grafting was excellent and independent from the SYNTAX score.
Incomplete revascularization rather than degree of coronary complexity
adversely affects late outcomes of coronary bypass.
<2>
Accession Number
2011000421
Authors
Thomassen S.A. Larsson A. Andreasen J.J. Bundgaard W. Boegsted M.
Rasmussen B.S.
Institution
(Thomassen, Rasmussen) Department of Anaesthesia, Aalborg Hospital, Aarhus
University Hospital, Hobrovej 18-22, DK-9100 Aalborg, Denmark
(Larsson) Department of Anaesthesiology and Intensive Care, Uppsala
University, Sweden
(Andreasen, Bundgaard) Department of Cardiothoracic Surgery, Aalborg
Hospital, Aarhus University Hospital, Denmark
(Boegsted) Department of Haematology, Aalborg Hospital, Aarhus University
Hospital, Denmark
Title
Should blood flow during cardiopulmonary bypass be individualized more
than to body surface area?.
Source
Perfusion. 26 (1) (pp 45-50), 2011. Date of Publication: January 2011.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Blood flow during cardiopulmonary bypass (CPB) is calculated on body
surface area (BSA). Increasing comorbidity, age and weight of today's
cardiac patients question this calculation as it may not reflect
individual metabolic requirement. The hypothesis was that a measured
cardiac index (CI) prior to normothermic CPB is a better estimate. A
cross-over study, with random allocation to CPB blood flow for 20 minutes
based on either a calculation (2.4 L/min/m<sup>2</sup>) or on CI, with a
switch to the opposite flow for another 20 minutes, was performed.
Twenty-two elective cardiac surgery patients with normal ventricular
function were included. Effect parameters were cerebral oxygenation, mixed
venous saturation and arterial lactate. CI varied from 1.9 to 3.1
L/min/m<sup>2</sup> (median 2.4 L/min/m<sup>2</sup>). No differences in
effect parameters were seen. In conclusion, a CPB blood flow based on an
individual estimate did not improve cerebral and systemic oxygenation
compared to a blood flow based on BSA. The Author(s) 2011.
<3>
Accession Number
2011000429
Authors
Vukovic P.M. Maravic-Stojkovic V.R. Peric M.S. Jovic M.D. Cirkovic M.V.
Gradinac S.D. Djukanovic B.P. Milojevic P.S.
Institution
(Vukovic, Maravic-Stojkovic, Jovic, Cirkovic, Gradinac, Djukanovic,
Milojevic) Department of Cardiac Surgery, School of Medicine, University
of Belgrade, Serbia
(Peric) Department of Anesthesia, School of Medicine, University of
Belgrade, Serbia
Title
Steroids and statins: An old and a new anti-inflammatory strategy
compared.
Source
Perfusion. 26 (1) (pp 31-37), 2011. Date of Publication: January 2011.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Objectives: This study compared the anti-inflammatory effects of
methylprednisolone (MP) and atorvastatin and analysed their influences on
clinical variables in patients undergoing coronary revascularization.
Methods: Ninety patients with compromised left ventricular ejection
fraction (<=30%) undergoing elective coronary surgery were equally
randomized to one of three groups: statin group, treatment with
atorvastatin (20 mg/day) 3 weeks before surgery; methylprednisolone group,
a single shot of methylpredniosolone (10mg/kg); and control group.
Results: Postoperative IL-6 was higher in the control group when compared
to the methylprednisolone and statin groups (p<0.01). IL-6 was higher in
the statin-treated patients (p<0.05 versus methylprednisolone).
Administration of methylprednisolone as well as statin treatment increased
postoperative cardiac index, left ventricular stroke work index, decreased
postoperative atrial fibrilation rate and reduced ICU stay (p<0.05 versus
control). The number of patients requiring inotropic support was lower in
the methylprednisolone group when compared with the other two groups
(p<0.01). Tracheal intubation time was reduced in patients who received
methylprednisolone (p<0.01 versus control). Conclusions: Preoperative
administration of either methylprednisolone or atorvastatin reduced
pro-inflammatory cytokine release, improved haemodynamics, decreased
postoperative atrial fibrilation rate and reduced ICU stay in patients
with significantly impaired cardiac function undergoing coronary
revascularization. Treatment with methylprednisolone was associated with
less inotropic support requirements and reduced mechanical ventilation
time. The Author(s) 2011.
<4>
Accession Number
2011000612
Authors
Garcia S. Rider J.E. Moritz T.E. Pierpont G. Goldman S. Larsen G.C. Shunk
K. Littooy F. Santilli S. Rapp J. Reda D.J. Ward H.B. McFalls E.O.
Institution
(Garcia, Rider, Pierpont, McFalls) Department of Medicine, Minneapolis VA
Medical Center, University of Minnesota, Minneapolis, MN, United States
(Moritz, Reda) VA Cooperative Studies Program, Hines, IL, United States
(Goldman) Southern Arizona VA Health Care System, University of Arizona
Sarver Heart Center, Tucson, AZ, United States
(Larsen) Division of Cardiology, Portland VA Medical Center, Portland, OR,
United States
(Santilli) Department of Surgery, Minneapolis VA Medical Center,
University of Minnesota, Minneapolis, MN, United States
(Ward) Minneapolis VA Medical Center, University of Minnesota, Division of
Cardiovascular and Thoracic Surgery, Minneapolis, MN, United States
(Shunk, Rapp) University of California, San Francisco, San Francisco
Veterans Affairs Medical Center, San Francisco, CA, United States
(Littooy) Edward Hines VA Medical Center, Division of Peripheral Vascular
Surgery, Hines, IL, United States
Title
Preoperative coronary artery revascularization and long-term outcomes
following abdominal aortic vascular surgery in patients with abnormal
myocardial perfusion scans: A subgroup analysis of the coronary artery
revascularization prophylaxis trial.
Source
Catheterization and Cardiovascular Interventions. 77 (1) (pp 134-141),
2011. Date of Publication: 01 Jan 2011.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background: Abdominal aortic operations have the highest perioperative
cardiac risk. To test the impact of preoperative coronary artery
revascularization (PR) in this high-risk subset, a post hoc analysis was
performed in patients undergoing aortic surgery within the Coronary Artery
Revascularization Prophylaxis (CARP) trial. Methods: The study cohort was
a subset of 109 CARP patients with myocardial ischemia on nuclear imaging
randomized to a strategy of PR (N = 52) or no PR (N = 57) before their
scheduled abdominal aortic vascular operation. The clinical indications
for vascular surgery were an expanding aneurysm (N = 62) or severe
claudication (N = 47). The composite end-point of death and nonfatal
myocardial infarction (MI) was determined by an intention-to-treat
analysis following randomization. Results: The median time
(Interquartiles) from randomization to vascular surgery was 56 (40, 81)
days in patients assigned to PR and 19 (10, 43) days in patients assigned
to no PR (P < 0.001). At 2.7 years following randomization, the
probability of remaining free of death and nonfatal MI was 0.65 with PR
and 0.55 with no PR [unadjusted P = 0.08, odds ratio = 1.67, 95%
confidence interval (0.93, 2.99)]. Using a Cox proportional hazard model,
predictors of the composite of death and nonfatal MI (odds ratio; 95%
confidence interval) were no PR (1.90; 1.06-3.43; P = 0.03) and anterior
ischemia on preoperative imaging (1.79; 0.99-3.23; P = 0.07). Conclusions:
In patients with an abnormal cardiac imaging before abdominal aortic
vascular surgery, PR was associated with a reduced risk of death and
nonfatal MI while anterior ischemia was an identifier of poor outcome
independent of the revascularization status. Copyright 2010 Wiley-Liss,
Inc.
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Accession Number
2011009693
Authors
Gullestad L. Mortensen S.-A. Eiskjaer H. Riise G.C. Mared L. Bjortuft O.
Ekmehag B. Jansson K. Simonsen S. Gude E. Rundqvist B. Fagertun H.E. Solbu
D. Iversen M.
Institution
(Gullestad, Simonsen, Gude) Department of Cardiology, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Gullestad) Faculty of Medicine, University of Oslo, Oslo, Norway
(Mortensen) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology B, Aarhus University Hospital, Skejby,
Aarhus, Denmark
(Riise) Department of Respiratory Medicine, Sahlgrenska University
Hospital, Goteborg, Sweden
(Mared) Department of Respiratory Medicine, Lund University, Skane
University Hospital, Lund, Sweden
(Bjortuft) Department of Respiratory Medicine, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Ekmehag) Department of Cardiology, Lund University, Skane University
Hospital, Lund, Sweden
(Jansson) Department of Cardiology, Heart Center, University Hospital,
Linkoping, Sweden
(Rundqvist) Department of Cardiology, Sahlgrenska University Hospital,
University of Goteborg, Goteborg, Sweden
(Fagertun) Capturo AS (Statistics), Kjeller, Norway
(Solbu) Novartis Norge AS, Oslo, Norway
(Iversen) Division of Lung Transplantation, Department of Cardiology,
Rigshospitalet, Copenhagen, Denmark
Title
Two-year outcomes in thoracic transplant recipients after conversion to
everolimus with reduced calcineurin inhibitor within a multicenter,
open-label, randomized trial.
Source
Transplantation. 90 (12) (pp 1581-1589), 2010. Date of Publication: 27
Dec 2010.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background. Use of the mammalian target of rapamycin inhibitor everolimus
with an accompanying reduction in calcineurin inhibitor (CNI) exposure has
shown promise in preserving renal function in maintenance thoracic
transplant patients, but robust, long-term data are required. Methods. In
a prospective, open-label, multicenter study, thoracic transplant
recipients more than or equal to 1 year posttransplant with
mild-to-moderate renal insufficiency were randomized to continue their
current CNI-based immunosuppression or convert to everolimus with
predefined CNI exposure reduction. After a 12-month core trial, patients
were followed up to month 24 after randomization. Results. Of 245 patients
who completed the month 12 visit, 235 patients (108 everolimus and 127
controls) entered the 12-month extension phase. At month 24, mean measured
glomerular filtration rate had increased by 3.2+/-12.3 mL/min from the
point of randomization in everolimus-treated patients and decreased by
2.4+/-9.0 mL/min in controls (P<0.001), a difference that was significant
within both the heart and lung transplant subpopulations. During months 12
to 24, 5.6% of everolimus patients and 3.1% of controls experienced
biopsy-proven acute rejection (P=0.76). There were no significant
differences in the rate of adverse events or serious adverse events
(including pneumonia) between groups during months 12 to 24. Conclusions.
Converting maintenance thoracic transplant recipients to everolimus with
low-exposure CNI results in a renal benefit that is sustained to 2 years
postconversion, with significantly improved measured glomerular filtration
rate in both heart and lung transplant patients. Despite reductions of
more than 50% in CNI exposure, there was no marked loss of efficacy. The
safety profile of the everolimus-based regimen was acceptable. 2010 by
Lippincott Williams & Wilkins.
<6>
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Accession Number
2011009720
Authors
Maiorana A.J. Naylor L.H. Exterkate A. Swart A. Thijssen D.H.J. Lam K.
O'Driscoll G. Green D.J.
Institution
(Maiorana, Lam, O'Driscoll) Advanced Heart Failure and Cardiac Transplant
Service, Royal Perth Hospital, GPO Box X2213, Perth, WA 6847, Australia
(Maiorana) School of Physiotherapy, Curtin Health Innovation Research
Institute, Curtin University, Perth, WA, Australia
(Naylor, Green) School of Sport Science, Exercise, and Health, University
of Western Australia, Perth, WA, Australia
(Exterkate, Swart, Thijssen) Department of Physiology, Radboud University
Nijmegen Medical Centre, Nijmegen, Netherlands
(Thijssen, Green) Research Institute for Sport and Exercise Science,
Liverpool John Moores University, Liverpool, United Kingdom
(O'Driscoll) School of Medicine, University of Notre Dame, Fremantle, WA,
Australia
Title
The impact of exercise training on conduit artery wall thickness and
remodeling in chronic heart failure patients.
Source
Hypertension. 57 (1) (pp 56-62), 2011. Date of Publication: January
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Exercise training is an important adjunct to medical therapy in chronic
heart failure, but the extent to which exercise impacts on conduit artery
remodeling is unknown. The aim of this study was to evaluate the impact of
aerobic and resistance exercise training modalities on arterial remodeling
in patients with chronic heart failure. We randomized 36 untrained
subjects with chronic heart failure to resistance training (58.8+/-3.5
years), aerobic training (61.3+/-2.8 years), or an untrained control group
(64.4+/-2.4 years). Peak oxygen consumption during cycle ergometry
increased after 12 weeks in both the resistance and aerobic training
(P<0.001) groups, but not in controls, whereas leg strength only increased
after resistance training (P<0.05). Brachial artery wall thickness
decreased in the resistance training group (475+/-10 versus 443+/-13 mum;
P<0.01), whereas no changes were apparent in the aerobic or control
groups. Brachial diameter increased by >=6% and >=5% in the aerobic
training and resistance training groups (P<0.01), with no change evident
in the control group. The wall:lumen ratio consequently declined in the
resistance training group at 12 weeks (0.121+/-0.004 versus 0.107+/-0.004;
P<0.01) and increased in the control group (0.111+/-0.006 versus
0.121+/-0.009; P<0.05). No wall:lumen change was evident in the aerobic
training group. Our findings suggest that exercise has a systemic impact
on remodeling of conduit arteries in humans and that resistance exercise
training may be advantageous in subjects with chronic heart failure in
this regard. 2010 American Heart Association, Inc.
<7>
Accession Number
2010703804
Authors
Dixon B. Opeskin K. Stamaratis G. Nixon I. Yi M. Newcomb A.E. Rosalion A.
Zhang Y. Santamaria J.D. Campbell D.J.
Institution
(Dixon, Santamaria) Department of Intensive Care, St. Vincent's Hospital,
Melbourne, VIC 3065, Australia
(Opeskin, Stamaratis) Department of Pathology, St. Vincent's Hospital,
Melbourne, Australia
(Nixon, Yi, Newcomb, Rosalion) Department of Cardiac Surgery, St.
Vincent's Hospital, Melbourne, Australia
(Zhang) University of Melbourne, Department of Medicine, St. Vincent's
Hospital, Melbourne, Australia
(Campbell) St. Vincent's Institute of Medical Research, Melbourne,
Australia
Title
Pre-operative heparin reduces pulmonary microvascular fibrin deposition
following cardiac surgery.
Source
Thrombosis Research. 127 (1) (pp e27-e30), 2011. Date of Publication:
January 2011.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
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