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<1>
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Accession Number
2011046747
Authors
Cholette J.M. Rubenstein J.S. Alfieris G.M. Powers K.S. Eaton M. Lerner
N.B.
Institution
(Cholette, Rubenstein, Powers, Lerner) Department of Pediatrics, Golisano
Children's Hospital at Strong, University of Rochester Medical Center,
Rochester, NY, United States
(Alfieris) Department of Cardiac Surgery, Golisano Children's Hospital at
Strong, University of Rochester Medical Center, Rochester, NY, United
States
(Eaton) Department of Anesthesia, Golisano Children's Hospital at Strong,
University of Rochester Medical Center, Rochester, NY, United States
Title
Children with single-ventricle physiology do not benefit from higher
hemoglobin levels post cavopulmonary connection: Results of a prospective,
randomized, controlled trial of a restrictive versus liberal red-cell
transfusion strategy.
Source
Pediatric Critical Care Medicine. 12 (1) (pp 39-45), 2011. Date of
Publication: January 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Objective: To examine the impact of a restrictive vs. liberal transfusion
strategy on arterial lactate and oxygen content differences in children
with single-ventricle physiology post cavopulmonary connection. Children
with single-ventricle physiology are routinely transfused postoperatively
to increase systemic oxygen delivery, and transfusion thresholds in this
population have not been studied. Design: Prospective, randomized,
controlled, clinical trial. Setting: Pediatric cardiac intensive care unit
in a teaching hospital. Patients: Infants and children (n = 60) with
variations of single-ventricle physiology presenting for cavopulmonary
connection. Interventions: Subjects were randomized to a restrictive
(hemoglobin of <9.0 g/dL), or liberal (hemoglobin of >=13.0 g/dL)
transfusion strategy for 48 hrs post operation. Primary outcome measures
were mean and peak arterial lactate. Secondary end points were
arteriovenous (C(a-v)o2) and arteriocerebral oxygen content (C(a-c)o2)
differences and clinical outcomes. Measurements and Main Results: A total
of 30 children were in each group. There were no significant preoperative
differences. Mean hemoglobin in the restrictive and liberal groups were 11
+/- 1.3 g/dL and 13.9 +/- 0.5 g/dL, respectively (p < .01). No differences
in mean (1.4 +/- 0.5 mmol/L [Restrictive] vs. 1.4 +/- 0.4 mmol/L
[Liberal]) or peak (3.1 +/- 1.5 mmol/L [Restrictive] vs. 3.2 +/- 1.3
mmol/L [Liberal]) lactate between groups were found. Mean number of red
blood cell transfusions were 0.43 +/- 0.6 and 2.1 +/- 1.2 (p < .01), and
donor exposure was 1.2 +/- 0.7 and 2.4 +/- 1.1 to (p < .01), for each
group, respectively. No differences were found in C(a-v)o2, C(a-c)o2, or
clinical outcome measures. Conclusion: Children with single-ventricle
physiology do not benefit from a liberal transfusion strategy after
cavopulmonary connection. A restrictive red blood cell transfusion
strategy decreases the number of transfusions, donor exposures, and
potential risks in these children. Larger studies with clinical outcome
measures are needed to determine the transfusion threshold for children
post cardiac repair or palliation for congenital heart disease. Copyright
2011 by the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies.

<2>
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Accession Number
2011046749
Authors
Kipps A.K. Wypij D. Thiagarajan R.R. Bacha E.A. Newburger J.W.
Institution
(Kipps) Department of Pediatrics, University of California, San Francisco,
UCSF Children's Hospital, San Francisco, CA, United States
(Wypij, Thiagarajan, Newburger) Department of Cardiology, Children's
Hospital, Boston, United States
(Wypij, Thiagarajan, Newburger) Department of Pediatrics, Harvard Medical
School, Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard School of Public Health,
Boston, MA, United States
(Bacha) Department of Cardiovascular Surgery, Children's Hospital, Boston,
United States
(Bacha) Department of Surgery, Harvard Medical School, Boston, MA, United
States
Title
Blood transfusion is associated with prolonged duration of mechanical
ventilation in infants undergoing reparative cardiac surgery.
Source
Pediatric Critical Care Medicine. 12 (1) (pp 52-56), 2011. Date of
Publication: January 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Objective: Perioperative transfusion has adverse effects in adults
undergoing cardiac surgery. We sought to investigate whether greater use
of blood and blood products might be an independent predictor of prolonged
postoperative recovery, indicated by duration of mechanical ventilation
(DMV), after reparative infant heart surgery. Design: Secondary analysis
of prospectively collected data from two randomized trials of hematocrit
strategy during cardiopulmonary bypass in infant heart surgery to explore
the association of DMV with perioperative transfusion and other variables.
Setting: Tertiary pediatric hospital. Patients: Two hundred seventy
infants undergoing two ventricle corrective cardiac surgery without aortic
arch reconstruction. Measurements and Main Results: In univariable
analyses, longer DMV was associated with younger age and lower weight at
surgery, diagnostic group, and higher intraoperative and postoperative
blood product transfusion (each p < .001). In multivariable proportional
hazard regression, longer total support time and greater intraoperative
and early postoperative blood products per kg were the strongest
predictors of longer DMV. Patients in the highest tertile of
intraoperative blood products per kg had an instantaneous risk of being
extubated approximately half that of patients in the lowest tertile
(hazard ratio, 0.51; 95% confidence interval, 0.35, 0.73). Patients who
received any blood products on postoperative day 1, compared with those
who did not, had a hazard ratio for extubation of 0.65 (95% confidence
interval, 0.50, 0.85). Conclusions: In this exploratory secondary analysis
of infants undergoing two ventricular repair of congenital heart disease
without aortic arch obstruction, greater intraoperative and early
postoperative blood transfusion emerged as potential important risk
factors for longer DMV. Future prospective clinical trials are needed to
determine whether reduction in blood product administration hastens
postoperative recovery after infant heart surgery. Copyright 2011 by the
Society of Critical Care Medicine and the World Federation of Pediatric
Intensive and Critical Care Societies.

<3>
Accession Number
2011062353
Authors
Hatada A. Okamura Y. Kaneko M. Hisaoka T. Yamamoto S. Hiramatsu T.
Nishimura Y.
Institution
(Hatada, Okamura, Kaneko, Hisaoka, Yamamoto, Hiramatsu, Nishimura)
Department of Thoracic and Cardiovascular Surgery, Wakayama Medical
University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan
Title
Comparison of the waveforms of transit-time flowmetry and intraoperative
fluorescence imaging for assessing coronary artery bypass graft patency.
Source
General Thoracic and Cardiovascular Surgery. 59 (1) (pp 14-18), 2011.
Date of Publication: January 2011.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose: An intraoperative fluorescence imaging (IFI) system, which can
provide visual images, could be the common method for assessing graft
patency intraoperatively. We conducted a prospective comparison of the
diagnostic accuracy of both the fast Fourier transformation (FFT) analysis
of transit-time flowmetry (TTFM) waveform and the IFI system to determine
graft failure. Methods: The study included 10 saphenous vein grafts
(SVGs), all of which were aortocoronary grafts. Each patient underwent
isolated coronary artery bypass grafting (CABG), including conventional
CABG or off-pump CABG, and then underwent X-ray angiography after CABG.
When intraoperative hemodynamics had stabilized, the grafts were evaluated
with both the IFI system and TTFM. Based on the obtained flow profile of
TTFM, certain variables were calculated. The waveforms of TTFM were
analyzed with the FFT series. Harmonic distortion (HD) was calculated from
the amplitudes, and the fundamental frequency was thus determined using
the FFT series. Results: The IFI system demonstrated a satisfactory flow
of all grafts. X-ray angiography demonstrated that one SVG was 75%
stenosed, and the others were patent. The mean graft flow (MGF) and the
pulsatility index (PI) of the patent SVGs were not significantly different
from those of the stenosed SVG. The HD of the patent SVGs was
significantly different from that of the stenosed SVG. Conclusion: The HD
of the TTFM waveform can provide better diagnostic accuracy for detecting
clinically significant grafts than MGF and PI of TTFM and the IFI system.
2011 The Japanese Association for Thoracic Surgery.

<4>
Accession Number
2011064171
Authors
Boudriot E. Thiele H. Walther T. Liebetrau C. Boeckstegers P. Pohl T.
Reichart B. Mudra H. Beier F. Gansera B. Neumann F.-J. Gick M. Zietak T.
Desch S. Schuler G. Mohr F.-W.
Institution
(Boudriot, Thiele, Liebetrau, Desch, Schuler) Department of Internal
Medicine/Cardiology, University of Leipzig-Heart Center, Strmpellstrasse
39, 04289 Leipzig, Germany
(Walther, Mohr) Department of Cardiac Surgery, University of LeipzigHeart
Center, Leipzig, Germany
(Boeckstegers, Pohl) Medical Clinic and Policlinic i, University Munich
Groshadern, Munich, Germany
(Reichart) Department of Cardiothoracic Surgery, University Munich
Groshadern, Munich, Germany
(Mudra, Beier) Department of Cardiology/Pneumology and Internal Intensive
Care Medicine, Stadtisches Klinikum Munich, Klinikum Neuperlach, Munich,
Germany
(Gansera) Department of Cardiothoracic Surgery, Stadtisches Klinikum
Munich, Klinikum Neuperlach, Munich, Germany
(Neumann, Gick) Department of Cardiology, Heart Center Bad Krozingen, Bad
Krozingen, Germany
(Zietak) Department of Cardiosurgery, Heart Center Bad Krozingen, Bad
Krozingen, Germany
Title
Randomized comparison of percutaneous coronary intervention with
sirolimus-eluting stents versus coronary artery bypass grafting in
unprotected left main stem stenosis.
Source
Journal of the American College of Cardiology. 57 (5) (pp 538-545), 2011.
Date of Publication: 01 Feb 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives The purpose of this randomized study was to compare
sirolimus-eluting stenting with coronary artery bypass grafting (CABG) for
patients with unprotected left main (ULM) coronary artery disease.
Background CABG is considered the standard of care for treatment of ULM.
Improvements in percutaneous coronary intervention (PCI) with use of
drug-eluting stents might lead to similar results. The effectiveness of
drug-eluting stenting versus surgery has not been established in a
randomized trial. Methods In this prospective, multicenter, randomized
trial, 201 patients with ULM disease were randomly assigned to undergo
sirolimus-eluting stenting (n = 100) or CABG using predominantly arterial
grafts (n = 101). The primary clinical end point was noninferiority in
freedom from major adverse cardiac events, such as cardiac death,
myocardial infarction, and the need for target vessel revascularization
within 12 months. Results The combined primary end point was reached in
13.9% of patients after surgery, as opposed to 19.0% after PCI (p = 0.19
for noninferiority). The combined rates for death and myocardial
infarction were comparable (surgery, 7.9% vs. stenting, 5.0%;
noninferiority p < 0.001), but stenting was inferior to surgery for repeat
revascularization (5.9% vs. 14.0%; noninferiority p = 0.35). Perioperative
complications including 2 strokes were higher after surgery (4% vs. 30%; p
< 0.001). Freedom from angina was similar between groups (p = 0.33).
Conclusions In patients with ULM stenosis, PCI with sirolimus-eluting
stents is inferior to CABG at 12-month follow-up with respect to freedom
from major adverse cardiac events, which is mainly influenced by repeated
revascularization, whereas for hard end points, PCI results are favorable.
A longer follow-up is warranted. (Percutaneous Coronary Intervention [PCI]
With Drug-Eluting Stents [DES] Versus Coronary Artery Bypass Graft [CABG]
for Patients With Significant Left Main Stenosis; NCT00176397) 2011
American College of Cardiology Foundation.

<5>
Accession Number
70338319
Authors
Turina M. Cheng D. Martin J. Dunning J. Muneretto C. Schueler S. Von
Segesser L. Sergeant P. Shenib H.
Source
Heart Surgery Forum. Conference: 20th World Congress of the World Society
of Cardio-Thoracic Surgeons, WSCTS Chennai India. Conference Start:
20101020 Conference End: 20101023. Conference Publication: (var.pagings).
13 (pp S34), 2010. Date of Publication: October 2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Background: The role of thoracic endovascular aortic repair (TEVAR) versus
open surgery remains unclear. Meta-regression guides uptake of new
technologies by utilizing evidence from existing trials. Objective: Does
TEVAR reduce death and morbidity compared to open surgical repair for
thoracic aortic disease? Methods: All data from controlled trials of TEVAR
versus open repair of thoracic aortic pathologies was ascertained from
medical databases plus conference abstracts up to October 2008, and
combined through meta-analyses. Meta-regression was performed to evaluate
the impact of baseline risk factor imbalances, study design, and thoracic
pathology. Results: Forty-one studies involving 4918 patients were
included [4 multicentre (MC) studies, 32 single-centre studies (SC), 5
registries]. Characteristics were balanced except for age [TEVAR patients
were average 1.3 years older than open re-pair patients (P = .001)]. Due
to significant heterogeneity across study designs, results were analyzed
by study type. Death at 30 days was reduced for TEVAR versus open surgery
in MC trials (OR 0.24, 95% CI 0.13 to 0.44) and SC studies (OR 0.52, 95%
CI 0.38 to 0.73), but did not reach significance in registries (OR 0.30,
95% CI 0.09 to 1.04). Survival differences did not persist at 1 year and 3
years. Paraplegia was reduced for TEVAR versus open surgery in MC studies
(OR 0.44, 95% CI 0.23 to 0.84) and SC studies (OR 0.46, 95%CI 0.29 to
0.74), and was insufficiently reported in registries. Stroke was reduced
in MC studies (OR 0.46, 95% CI 0.25 to 0.85), but not in SC studies or
registries. Arrhythmias, myocardial infarction, transfusion, renal
insufficiency, and overall ischemic events were reduced for TEVAR versus
open surgery, but aortic reinterventions did not differ. Meta-regression
by baseline age imbalance and aortic pathology did not materially change
these results. Analysis by type of stent showed non-commercial stents
tended to have worse outcomes versus commercial stents. Conclusion:
Current data suggest that TEVAR, regardless of type of pathology, reduces
early death and ischemic events including stroke, paraplegia, renal
insufficiency, and myocardial infarction compared with open surgery.
Sustained benefits on survival have not been proven.

<6>
Accession Number
70338330
Authors
Jansen E.W.L.
Institution
(Jansen) Netherlands
Source
Heart Surgery Forum. Conference: 20th World Congress of the World Society
of Cardio-Thoracic Surgeons, WSCTS Chennai India. Conference Start:
20101020 Conference End: 20101023. Conference Publication: (var.pagings).
13 (pp S38), 2010. Date of Publication: October 2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
The clinical introduction of the heart-lung machine was in the fifties of
last century. John Gibbon performed the first procedure on total
cardiopul-monary bypass in 1953. Since that time, there was an enormous
technological evolution, which enabled the evolution of cardiovascular
surgery. At the present time, cardiac surgery can be performed safely,
while relying on total or partial cardiopulmonary bypass, while
maintaining perfect homeostasis during the procedure. This enables total
correction of complex and multiple lesions, up to anastomotic microsurgery
of bloodvessels by creating the perfect conditions for handicraft (or
automated-craft or robot-craft) with smooth recovery. In the future, this
modality will guarantee proceeding evolution of all new technologies. In
the mid-1990s, interest emerged in performing coronary artery
revascularization without cardiopulmonary bypass, in order to reduce the
complications associated with the use of the heart-lung machine and to
facilitate and improve recovery of the procedure for the patient. To
position OPCAB, cardiac surgeons performed a unique summit of scientific
work in centres all over the world, including randomized trials and
finally the meta-analyses. As we all know, the outcome did not show major
differences. Actually, the trials are still going on, ie now 15 years! The
key is that we wish to salvage myocardium for the patient, in the elective
but also in the acute situation: it is a 'take the chance', considering
even pathophysiology in some patients, ie stunning and hibernating of
myocardium. It is all about an optimal revascularization, a perfect
patency rate. Nevertheless, in all patients we have to evaluate the impact
of a procedure, considering associated risks. The most obvious risk for a
stroke caused by cardiopulmonary bypass is a severe atheroma-tous
ascending aorta. Therefore, extensive pre- and intraoperative analysis by
the cardiologist, anaesthesiologist and surgeon should be among the
protocol: just to adapt the strategy at any time. Finally, and obviously,
also considered must be individual factors such as surgical expertise,
team expertise including anaesthe-siologist and perfusionist, and
economical factors. It is clear that in a dedicated heart clinic off-pump
coronary revascularization can be performed with a favourable cost-benefit
ratio, in a selected group of patients. Indeed, the surgical armamentarium
has grown enormously. A proper application of the surgical tool is the new
challenge.

<7>
Accession Number
70338344
Authors
Deslauriers J.
Institution
(Deslauriers) Department of Surgery, Laval University, Quebec City, QC,
Canada
Source
Heart Surgery Forum. Conference: 20th World Congress of the World Society
of Cardio-Thoracic Surgeons, WSCTS Chennai India. Conference Start:
20101020 Conference End: 20101023. Conference Publication: (var.pagings).
13 (pp S47), 2010. Date of Publication: October 2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Worldwide, lung cancer is the leading cause of cancer deaths as it
accounts for more deaths than colon, breast, and prostate cancers
combined. Although surgery is generally regarded as the best treatment
option, less than 25% of NSCLC are suitable for complete resection, and of
these, only about 30% are expected to be long-term (> 5 years) survivors.
In this population, treatment failures are mainly due to the development
of distant metastasis. There is thus considerable interest in determining
wether induction or adjuvant therapies added to pulmonary resection give
any survival advantage over resection alone. We now know that induction
chemotherapy or chemoradio-therapy benefit selected patients with
CN₂ disease by downstag-ing the tumor, reducing tumor size, and
possibly eradicating clinically undetectable distant metastasis. In a
recently published meta analysis (2006), preoperative chemotherapy was
shown to improve survival over resection alone with a hazard ratio of 0.82
(95% confidence interval, 0.69-0.97; P = .02) which is the equivalent of
an absolute benefit of 6 %. The overall results strategies are better in
patients with smaller primary tumors (lower T status), in patients with
complete pathological response to induction treatments, and in patients
where a complete resection was possible. The need for adjuvant
postoperative chemotherapy is also based on the fact that multiple studies
have shown that the incidence of patients developing extrathoracic
metastasis within 2-3 years after curative resection was in the range of
60% to 80% even in stage I and II tumors. Unfortunately, earlier trials
comparing adjuvant chemotherapy to best supportive care following surgery
failed to show a survival benefit. In there trials, an inability to
deliver the planned chemotherapy in the postoperative setting was also
thought to contribute to the negative findings. Several recent phase III
trials have, however, established adjuvant chemotherapy as the standard of
care in completely resected early-stage NSCLC. The JBR.10 study conducted
by the National Institute of Canada randomized 482 patients with
completely resected stage IB or II NSCLC to either observation or adjuvant
chemotherapy. The 5-year overall survival rates were 69% in the
chemotherapy arm compared with 54% in the surgery alone arm (P = .03). In
subset analyses, patients with stage II disease had a more signifi-cant
survival benefit than did patients with T2N0 disease. Postoperative
radiation therapy in completely resected patients may improve local
control but a study carried out by the Lung Cancer Study Group reported no
survival advantage over surgery alone. In conclusion and based on the
results of recent induction and adjuvant trials, the addition of
preoperative chemotherapy in selected patients with CN₂ disease
and of chemotherapy following surgery for patients with stage II NSCLC
provides an overall survival benefit.

<8>
Accession Number
70338533
Authors
Kakuchaya T.
Institution
(Kakuchaya) Bakoulev Scientific Center for Cardiovascular Surgery RAMS,
Russian Federation
Source
Heart Surgery Forum. Conference: 20th World Congress of the World Society
of Cardio-Thoracic Surgeons, WSCTS Chennai India. Conference Start:
20101020 Conference End: 20101023. Conference Publication: (var.pagings).
13 (pp S121), 2010. Date of Publication: October 2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Objective of our trial was to assess effects of autologous bone-marrow
(BM) derived CD133+ progenitors on cardiac remodelling in patients with
congestive heart failure (CHF). Methods: Fifty CHF patients (24 patients
with ischemic dilative cardiomyopathy [ICMP] and 26 patients with
idiopathic dilative cardiomyopathy [IDCMP]) were divided into groups by
CD133+/ placebo transcatheter delivery technique: selectively
percutane-ously intracoronary or transendocardially. Results: Single
isolated transendocardial delivery of CD133+ at average dosage 2mln
resulted in moderate increase of left ventricular (LV) ejection fraction
in 3-6 months in ICMP patients compared to placebo group. At that time was
observed moderate reduction of perfusion defects in CD133+ treated
segments with viable myocardium according to single photon emission
computed tomography. These positive changes were offset in 1 year
follow-up. Other key LV remodelling indexes such as myo-cardial mass and
left atrial volume did not change in 3-6 months follow-up. In order to
evaluate stem cells paracrine effects we performed enzyme-linked
immunoelectrodiffusion assay of plasma samples for 11 biological markers
before and after elective CD133+ treatment. Paracrine effects exerted
transiently in ischemic scarred, but viable myocardium and did not exert
in non-ischemic dilated myocardium. Conclusions: CD133+ progenitors were
more efficient, though temporarily, in ICMP patients than in IDCMP
patients. This phenomenon is due to more significant expression and
up-regulation of stem cell homing factors in scarred ischemic myocardium.

<9>
Accession Number
70338641
Authors
Rahnavardi M. Yan T.D. Cao C. Vallely M.P. Bannon P.G. Wilson M.K.
Institution
(Rahnavardi, Yan, Cao, Vallely, Bannon, Wilson) Royal Prince Alfred
Hospital, Sydney, Australia
Source
Heart Surgery Forum. Conference: 20th World Congress of the World Society
of Cardio-Thoracic Surgeons, WSCTS Chennai India. Conference Start:
20101020 Conference End: 20101023. Conference Publication: (var.pagings).
13 (pp S162-S163), 2010. Date of Publication: October 2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Objective: Pulmonary thromboendarterectomy is a treatment option for
patients with chronic thromboembolic pulmonary hypertension. The present
systematic review was performed to assess the safety and efficacy of this
treatment option. Methods: A systematic review was performed and six
electronic databases were searched for published studies from January 1999
to February 2010. All articles that presented morbidity and mortality
data, survival data or preoperative and postoperative pulmonary
hemodynamic indices were included. The major outcome measures extracted
were early morbidity and mortality, pulmonary hemodynamic and functional
outcome indices prior to and after operation, and survival data. Results:
Of the 654 publications retrieved, 19 relevant papers (total number of
2,729 patients) representing the most recent and the most complete data
set from each institute were included for appraisal and data extraction.
No randomized controlled trials or matched comparative studies were
identified. Thirty-day mortality ranged 1.3%-24% (median 8%). Residual
pulmonary hypertension was reported in 11%-35% of patients after
operation. Pulmonary artery pressure and pulmonary vascular resistance
sig-nificantly decreased after surgery in all studies. Before operation,
60%-100% of patients were in NYHA functional class III or IV. This
percentage decreased to 0%-21% after operation. Five-year survival ranged
74%-89%. Conclusions: The current literature suggests that pulmonary
thromboendarterectomy for patients with chronic thromboem-bolic pulmonary
hypertension is associated with acceptable perioperative morbidity and
mortality rates and improved hemo-dynamic indices and survival when viewed
against the prognosis associated with historical controls using medical
therapy.

<10>
Accession Number
70338656
Authors
Pdua L.M.S. Garcia L.C. Rubira C.J. Rodrigues O.R. Cataneo A.J.M. Carvalho
P.E.D.O.
Institution
(Pdua, Garcia, Rubira) Department of Evidence Based Health Action, Marilia
Medical School, Marilia SP, Brazil
(Rodrigues) Department of Thoracic Surgery, University of Mogi das Cruses
S P, Brazil
(Cataneo) Department of Thoracic Surgery, So Paulo State University,
Botucatu SP, Brazil
(Carvalho) Department of Thoracic Surgery and Evidence Based Health
Actions, Marilia Medical School, Marilia SP, Brazil
Source
Heart Surgery Forum. Conference: 20th World Congress of the World Society
of Cardio-Thoracic Surgeons, WSCTS Chennai India. Conference Start:
20101020 Conference End: 20101023. Conference Publication: (var.pagings).
13 (pp S168), 2010. Date of Publication: October 2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Introduction: Coarctation of the aorta (CoA) accounts for 5% to 7% of
congenital heart disease, with an incidence of 0.3 to 0.4 / 1000 live
births. Surgery was the only choice of therapy for CoA until 1982 when the
balloon angioplasty has become a rational alternative to treat.
Re-coarctation, aneurysm and aortic dissection remain disadvantages of
balloon angioplasty. In 1990s, endovascular stents were introduced for
native coarctation and re-coarctation and since then is demonstrated to be
a safe and effective alternative approach to surgical repair. Currently,
questions related to both the techniques of surgery or stent remain
unsolved such as pos-operative, outcomes and costs. Objective: To analyze
the effectiveness and safety of open surgery compared with stent placement
in patients with CoA. Methods: This is a systematic review of randomized
clinical trials in patients with CoA undergoing open surgery or placement
of a stent. Children and adults of both sexes with CoA alone or associated
with other congenital heart defects were analyzed. Survival, quality of
life and cardiovascular complications after intervention were available.
For the search, a combination of controlled vocabulary terms was used in
The Cochrane Library, MEDLINE, EMBASE and Web of Science. Results: There
aren't studies that fill the criteria for inclusion. In the analyzed
studies (reports, series, trials without comparison), the short follow-up
and late complications were observed. Conclusions: There is insufficient
evidence about the best treatment for CoA. There is need for prospective
clinical trials comparing with long follow-up where the main outcomes will
be analyzed.

<11>
Accession Number
2011022041
Authors
Almdahl S.M. Veel T. Halvorsen P. Vold M.B. Molstad P.
Institution
(Almdahl, Veel, Halvorsen, Vold, Molstad) Feiring Heart Clinic, 2093
Feiring, Norway
Title
Randomized prospective trial of saphenous vein harvest site infection
after wound closure with and without topical application of autologous
platelet-rich plasma.
Source
European Journal of Cardio-thoracic Surgery. 39 (1) (pp 44-48), 2011.
Date of Publication: January 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Wound infection is still a common problem after open long
saphenous vein harvesting. Platelets are important for the healing
process. The hypothesis was that spraying of the wounds with platelet-rich
plasma might reduce the frequency of harvest site infections. Methods:
From January to October 2008, 140 patients undergoing first-time coronary
artery bypass grafting were randomized into two groups of 70 patients.
Both groups had standard surgical leg wound closure and care except
topical application of platelet-rich plasma as adjunctive treatment in the
active treatment group. End points were wound infection and cosmetic
result at 6 weeks. Results: The follow-up was 100% complete. Nine patients
(13%) in the treatment group and eight (11%) in the control group
experienced harvest site infection (p=0.80). The overall cosmetic result
was also similar between the groups (p=0.34), but the top score was
borderline and more frequent in the treatment group (p=0.050). Conclusion:
Topical application of autologous platelet-rich plasma on vein harvest
wounds did not reduce the rate of surgical site infection. 2010 European
Association for Cardio-Thoracic Surgery.

<12>
Accession Number
2011022053
Authors
Zhang C. Wu Q.-C. Hou P.-Y. Zhang M. Li Q. Jiang Y.-J. Chen D.
Institution
(Zhang, Wu, Hou, Zhang, Li, Jiang, Chen) Department of Cardiothoracic
Surgery, The First Affiliated Hospital, Chongqing Medical University,
Chongqing 400016, China
Title
Impact of the method of reconstruction after oncologic oesophagectomy on
quality of life - a prospective, randomised study.
Source
European Journal of Cardio-thoracic Surgery. 39 (1) (pp 109-114), 2011.
Date of Publication: January 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: For patients undergoing oncologic surgery, the quality of life
(QoL) is generally accepted as an important outcome parameter in addition
to long-term survival, mortality and complication rates. This study
focussed on the QoL in patients after oesophagectomy for cancer, comparing
the method of reconstruction (narrow gastric tube vs whole stomach).
Methods: In a prospective randomised single-centre study from 2007 to
2008, 104 patients underwent oesophagectomy for cancer. To assess the QoL,
a questionnaire in reference to the EORTC-QLQ-C30 and the QLQ-OES24 was
administered at 3 weeks, 6 months and 1 year after surgery. Clinical data
were collected prospectively, and follow-up was performed regularly.
Results: There were no significant differences between the narrow gastric
tube group (NGT group, n=52) and the whole-stomach group (WS group, n=52)
with regard to patient and cancer characteristics, operative procedure,
postoperative intensive care unit (ICU) hospitalisation, and overall
survival at 1 year. Regarding the postoperative complication, there were
more cases of postoperative reflux oesophagitis and impairment of
pulmonary function in the WS group (P< 0.05). Regarding the QoL
investigation, the scores of QoL dropped for all patients at 3 weeks after
surgery. Slowly, recovery was found at both 6 months and 1 year in both
groups. Patients in the NGT group reported significantly (P< 0.05) better
scores of QoL at both 6 months and 1 year. Conclusions: Patients who
underwent gastric tube reconstruction develop less postoperative digestive
tract complications, and have a quicker recovery and a better QoL during
the follow-up period. Further investigation and data collection will allow
the assessment of this procedure beyond 1 year after operation. 2010
European Association for Cardio-Thoracic Surgery.

<13>
Accession Number
2011025083
Authors
Sarullo F.M. Fazio G. Puccio D. Fasullo S. Paterna S. Novo S. Di Pasquale
P.
Institution
(Sarullo, Puccio) Division of Cardiology, Buccheri la
Ferla-Fatebenefratelli Hospital, Via Salvatore Puglisi n. 15, 90143
Palermo, Italy
(Fazio, Novo) Department of Cardiology, University of Palermo, Italy
(Fasullo, Di Pasquale) Division of Cardiology P. Borsellino, G.F.
Ingrassia Hospital, Palermo, Italy
(Paterna) Department of Emergency Medicine, University of Palermo, Italy
Title
Impact of "off-Label" Use of ivabradine on exercise capacity, gas
exchange, functional class, quality of life, and neurohormonal modulation
in patients with ischemic chronic heart failure.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 15 (4) (pp
349-355), 2010. Date of Publication: December 2010.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Background: Epidemiologic studies indicate that elevated heart rate (HR)
is an independent risk factor for mortality and morbidity in patients
(pts) with chronic heart failure (CHF). Clinical trials with beta-blockers
suggest that HR reduction is an important mechanism of their benefit in
pts with stable CHF. Pharmacologic inhibition of the I_f current
now provides the opportunity of pure HR reduction. The purpose of this
study was to evaluate the impact of "Off-Label" use of ivabradine on
exercise capacity, gas exchange, functional class, quality of life, and
neurohormonal modulation in pts with ischemic CHF. Methods: Between
January 2008 and June 2008, a graded maximal exercise test with
respiratory gas analysis and an endurance test with constant workload
corresponding to 85% of the peak VO₂ at the baseline and after
3 months were performed, and at the same times, N-terminal probrain
natriuretic peptide (NT-proBNP) levels were also measured, in 60 pts (45
M, 15 F, mean age 52.7 +/- 5.3 years), with stable ischemic CHF, New York
Heart Association (NYHA) functional classes II (n = 35)-III (n = 25), with
left ventricular ejection fraction (LVEF) <= 40%, randomized to a
"off-label" ivabradine use (n = 30) and a control group (n = 30). Results:
The exercise capacity increased from 14.8 +/- 2.5 to 28.2 +/- 3.5 min (P
<.0001) and the peak oxygen consumption tended to improve from 13.5 +/-
1.3 to 17.9 +/- 2.4 mL/kg per minute (P <.0001) in ivabradine group.
Oxygen consumption at the anaerobic threshold (AT) increased from 11.9 +/-
1.4 to 15.3 +/- 1.4 mL/kg per minute (P <.0001). NTproBNP levels decreased
from 2356 +/- 2113 pg/mL to 1434 +/- 1273 pg/mL (P =.045). No significant
differences were found in control group at 3 months. The positive
ivabradine effects were also associated with an improvement in the NYHA
functional class and quality of life. Conclusion: The "Off-Label" use of
ivabradine significantly improves the exercise capacity, gas exchange,
functional heart failure class, quality of life, and neurohormonal
modulation in pts with ischemic CHF. 2010 The Author(s).

<14>
Accession Number
2011025088
Authors
Devendra G.P. Whitney E.J. Krasuski R.A.
Institution
(Devendra, Krasuski) Division of Clinical Cardiology, Department of CV
Medicine, Cleveland Clinic, Cleveland, OH, United States
(Whitney) Heart and Vascular Institute of San Antonio, San Antonio, TX,
United States
Title
Impact of increases in high-density lipoprotein cholesterol on
cardiovascular outcomes during the armed forces regression study.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 15 (4) (pp
380-383), 2010. Date of Publication: December 2010.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Introduction: High-density lipoprotein (HDL) cholesterol is a
well-established inverse risk factor for cardiovascular disease. The
extent to which cardiovascular risk can be modified through changes in
HDL, however, is less clear. We further examined the role of aggressive
HDL raising therapy on cardiovascular outcomes in the 143 patients
enrolled in the Armed Forces Regression Study (AFREGS). Methods:
Reanalysis of the AFREGS population. Patients with stable coronary disease
were randomized to receive gemfibrozil, niacin, and cholestyramine in
combination or matching placebos, on top of aggressive dietary and
exercise modification for a 30-month period. Blood work was performed at
baseline and repeated after 1 year of therapy. Results: Patients were
divided into 3 groups based on their therapeutic response: no HDL
increase, mild HDL increase, and large HDL increase (% change in HDL <=0,
<= the lower 2 tertiles of HDL increase, and > the upper tertile of HDL
increase, respectively). A progressive decrease in cardiovascular events
was noted across these groups (30.4%, 19.4%, and 3.2%, respectively, P
=.01). Kaplan-Meier analysis according to percentage change in HDL
demonstrated a similar improvement in event-free survival (P =.01).
Proportional hazards modeling also demonstrated that increasing HDL
predicted a lower hazard of cardiovascular events, even after adjusting
for changes in low-density lipoprotein ([LDL] P <.01). For every 1%
increase in HDL achieved, a 2% decrease in events was recognized.
Conclusions: These data suggest that in a population of patients with
stable atherosclerosis, the greater the percentage increase in HDL
achieved, the greater the cardioprotective benefit. This further supports
HDL raising as a beneficial therapeutic strategy. 2010 The Author(s).

<15>
Accession Number
2011028129
Authors
Brilakis E.S. Lasala J.M. Cox D.A. Berger P.B. Bowman T.S. Starzyk R.M.
Dawkins K.D.
Institution
(Brilakis) VA North Texas Healthcare System, University of Texas
Southwestern Medical Center at Dallas, Division of Cardiology (111A), 4500
South Lancaster Road, Dallas, TX 75216, United States
(Lasala) Washington University School of Medicine, St. Louis, MO, United
States
(Cox) Lehigh Valley Hospital, Allentown, PA, United States
(Berger) Geisinger Center for Health Research, Danville, PA, United States
(Bowman, Starzyk, Dawkins) Boston Scientific Corporation, Natick, MA,
United States
Title
Outcomes after implantation of the taxus paclitaxel-eluting stent in
saphenous vein graft lesions: Results from the ARRIVE (TAXUS Peri-Approval
Registry: A Multicenter Safety Surveillance) program.
Source
JACC: Cardiovascular Interventions. 3 (7) (pp 742-750), 2010. Date of
Publication: July 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives The aim of this study was to examine the incidence of clinical
events after implantation of the TAXUS Express (Boston Scientific
Corporation, Natick, Massachusetts) paclitaxel-eluting stent in saphenous
vein graft (SVG) lesions in an unselected patient population. Background
Saphenous vein grafts have 1-year occlusion rates of 12% to 20%, with 50%
failure by 7 to 10 years. Many diseased SVGs are treated by percutaneous
coronary intervention to avoid higher-risk reoperation, but bare-metal
stents have 35% to 40% historical SVG restenosis rates by 18 months.
Reported outcomes of drug-eluting stents in SVG lesions are limited and
mainly retrospective. Methods The ARRIVE (TAXUS Peri-Approval Registry: A
Multicenter Safety Surveillance) program compiled data on 7,492 patients
receiving >=1 TAXUS Express (Boston Scientific) stent, including 474
patients with SVG. All cardiac events were monitored with independent
adjudication of end points. Patients enrolled at procedure start with no
mandated inclusion/exclusion criteria. Results The ARRIVE SVG patient
2-year follow-up was 96% complete (457 of 474). The SVG patients had
significantly more baseline comorbidities/complex disease than simple-use
patients (n = 2,698) undergoing native coronary intervention or other
expanded-use patients (n = 4,320 without SVG patients). They had higher
2-year rates of mortality (10.9% vs. 4.2%, p < 0.001), myocardial
infarction (5.3% vs. 2.2%, p < 0.001), and Academic Research Consortium
definite/probable stent thrombosis (4.7% vs. 1.4%, p < 0.001) than the
simple-use group. They also had higher 2-year adverse event rates,
including significantly more mortality (10.9% vs. 7.5%, p = 0.008) than
other expanded-use patients. Conclusions The ARRIVE SVG patients have
significantly different baseline risk and higher clinical risk through 2
years than simple-use and other expanded-use patients. Nonetheless,
compared with historical SVG revascularization rates, treatment with
paclitaxel-eluting stent seems to offer a reasonable therapeutic option in
this high-risk group. (TAXUS ARRIVE: TAXUS Peri-Approval Registry: A
Multicenter Safety Surveillance Program; NCT00569491) and (TAXUS ARRIVE 2:
A Multicenter Safety Surveillance Program; NCT00569751) 2010 BY THE
AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION.

<16>
Accession Number
2011044617
Authors
Merugu S.
Institution
(Merugu) St. Vincent Charity Medical Center, Cleveland, OH, United States
Title
Benazepril plus amlodipine reduced CV events more than benazepril plus
hydrochlorothiazide in hypertension with or without diabetes: Commentary.
Source
Annals of Internal Medicine. 153 (8) (pp JC42), 2010. Date of
Publication: 19 Oct 2010.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<17>
[Use Link to view the full text]
Accession Number
2011044842
Authors
Mokhles M.M. Kortke H. Stierle U. Wagner O. Charitos E.I. Bogers A.J.J.C.
Gummert J. Sievers H.-H. Takkenberg J.J.M.
Institution
(Mokhles, Bogers, Takkenberg) Department of Cardiothoracic Surgery,
Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, Netherlands
(Kortke, Wagner, Gummert) Department of Thoracic and Cardiovascular
Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen,
Germany
(Stierle, Charitos, Sievers) Department of Cardiac and Thoracic Vascular
Surgery, University of Luebeck, Luebeck, Germany
Title
Survival comparison of the ross procedure and mechanical valve replacement
with optimal self-management anticoagulation therapy: Propensity-matched
cohort study.
Source
Circulation. 123 (1) (pp 31-38), 2011. Date of Publication: January
4-11, 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: It is suggested that in young adults the Ross procedure
results in better late patient survival compared with mechanical
prosthesis implantation. We performed a propensity score-matched study
that assessed late survival in young adult patients after a Ross procedure
versus that after mechanical aortic valve replacement with optimal
self-management anticoagulation therapy. Methods and results-: We selected
918 Ross patients and 406 mechanical valve patients 18 to 60 years of age
without dissection, aneurysm, or mitral valve replacement who survived an
elective procedure (1994 to 2008). With the use of propensity score
matching, late survival was compared between the 2 groups. Two hundred
fifty-three patients with a mechanical valve (mean follow-up, 6.3 years)
could be propensity matched to a Ross patient (mean follow-up, 5.1 years).
Mean age of the matched cohort was 47.3 years in the Ross procedure group
and 48.0 years in the mechanical valve group (P<=0.17); the ratio of male
to female patients was 3.2 in the Ross procedure group and 2.7 in the
mechanical valve group (P<=0.46). Linearized all-cause mortality rate was
0.53% per patient-year in the Ross procedure group compared with 0.30% per
patient-year in the mechanical valve group (matched hazard ratio, 1.86;
95% confidence interval, 0.58 to 5.91; P<=0.32). Late survival was
comparable to that of the general German population. Conclusions-: In
comparable patients, there is no late survival difference in the first
postoperative decade between the Ross procedure and mechanical aortic
valve implantation with optimal anticoagulation self-management. Survival
in these selected young adult patients closely resembles that of the
general population, possibly as a result of highly specialized
anticoagulation self-management, better timing of surgery, and improved
patient selection in recent years. Copyright 2011 American Heart
Association. All rights reserved.

<18>
[Use Link to view the full text]
Accession Number
2011044843
Authors
Williams J.B. Delong E.R. Peterson E.D. Dokholyan R.S. Ou F.-S. Ferguson
Jr. T.B.
Institution
(Williams, Delong, Peterson, Dokholyan, Ou) Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC, United States
(Ferguson Jr.) Department of Cardiovascular Sciences, Brody School of
Medicine, East Carolina University, Greenville, NC, United States
Title
Secondary prevention after coronary artery bypass graft surgery: Findings
of a national randomized controlled trial and sustained society-led
incorporation into practice.
Source
Circulation. 123 (1) (pp 39-45), 2011. Date of Publication: January
4-11, 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: Despite evidence supporting the use of aspirin,
beta-blockers, angiotensin-converting enzyme inhibitors, and
lipid-lowering therapies in eligible patients, adoption of these secondary
prevention measures after coronary artery bypass grafting has been
inconsistent. We sought to rigorously test on a national scale whether
low-intensity continuous quality improvement interventions can be used to
speed secondary prevention adherence after coronary artery bypass
grafting. Methods and results-: A total of 458 hospitals participating in
the Society of Thoracic Surgeons National Cardiac Database and treating
361 328 patients undergoing isolated coronary artery bypass grafting were
randomized to either a control or an intervention group. The intervention
group received continuous quality improvement materials designed to
influence the prescription of the secondary prevention medications at
discharge. The primary outcome measure was discharge prescription rates of
the targeted secondary prevention medications at intervention versus
control sites, assessed by measuring preintervention and postintervention
site differences. Prerandomization treatment patterns and baseline data
were similar in the control (n<=234) and treatment (n<=224) groups.
Individual medication use and composite adherence increased over 24 months
in both groups, with a markedly more rapid rate of adherence uptake among
the intervention hospitals and a statistically significant therapy hazard
ratio in the intervention versus control group for all 4 secondary
prevention medications. Conclusions-: Provider-led, low-intensity
continuous quality improvement efforts can improve the adoption of care
processes into national practice within the context of a medical specialty
society infrastructure. The findings of the present trial have led to the
incorporation of study outcome metrics into a medical society rating
system for ongoing quality improvement. Copyright 2011 American Heart
Association. All rights reserved.

<19>
[Use Link to view the full text]
Accession Number
2011044848
Authors
Niemela M. Kervinen K. Erglis A. Holm N.R. Maeng M. Christiansen E.H.
Kumsars I. Jegere S. Dombrovskis A. Gunnes P. Stavnes S. Steigen T.K.
Trovik T. Eskola M. Vikman S. Romppanen H. Makikallio T. Hansen K.N.
Thayssen P. Aberge L. Jensen L.O. Hervold A. Airaksinen J. Pietila M.
Frobert O. Kellerth T. Ravkilde J. Aaroe J. Jensen J.S. Helqvist S.
Sjogren I. James S. Miettinen H. Lassen J.F. Thuesen L.
Institution
(Niemela, Kervinen, Romppanen) Division of Cardiology, Department of
Internal Medicine, University of Oulu, Oulu, Finland
(Erglis, Kumsars, Jegere, Dombrovskis) Latvian Center of Cardiology, Paul
Stradins Clinical Hospital, Riga, Latvia
(Holm, Maeng, Christiansen, Lassen, Thuesen) Department of Cardiology,
Aarhus University Hospital, Skejby, Aarhus, Denmark
(Gunnes, Stavnes) Department of Cardiology, Feiring Clinic, Feiring,
Norway
(Steigen, Trovik) Department of Cardiology, University Hospital of
Tromsoe, Tromsoe, Norway
(Eskola, Vikman) Heart Center, Tampere University Hospital, Tampere,
Finland
(Makikallio) Department of Cardiology, Kainuu Central Hospital,
Lansi-Pohja Central Hospital, Kemi, Finland
(Hansen, Thayssen, Jensen) Department of Cardiology, Odense University
Hospital, Odense, Denmark
(Aberge, Hervold) Department of Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Airaksinen) Division of Cardiology, Turku University Hospital, Turku,
Finland
(Frobert, Kellerth) Department of Cardiology, Orebro University Hospital,
Orebro, Sweden
(Ravkilde, Aaroe) Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
(Jensen) Department of Cardiology, Gentofte University Hospital, Gentofte,
Denmark
(Helqvist) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Sjogren) Department of Cardiology, Falun Hospital, Falun, Sweden
(James) Department of Cardiology, Uppsala University Hospital, Uppsala,
Sweden
(Miettinen) Division of Cardiology, Kuopio University Central Hospital,
Kuopio, Finland
Title
Randomized comparison of final kissing balloon dilatation versus no final
kissing balloon dilatation in patients with coronary bifurcation lesions
treated with main vessel stenting: The nordic-baltic bifurcation study
III.
Source
Circulation. 123 (1) (pp 79-86), 2011. Date of Publication: January
4-11, 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: It is unknown whether the preferred 1-stent bifurcation
stenting approach with stenting of the main vessel (MV) and optional side
branch stenting using drug-eluting stents should be finalized by a kissing
balloon dilatation (FKBD). Therefore, we compared strategies of MV
stenting with and without FKBD. Methods and results-: We randomized 477
patients with a bifurcation lesion to FKBD (n<=238) or no FKBD (n<=239)
after MV stenting. The primary end point was major adverse cardiac events:
cardiac death, non-procedure-related index lesion myocardial infarction,
target lesion revascularization, or stent thrombosis within 6 months. The
6-month major adverse cardiac event rates were 2.1% and 2.5% (P<=1.00) in
the FKBD and no-FKBD groups, respectively. Procedure and fluoroscopy times
were longer and more contrast media was needed in the FKBD group than in
the no-FKBD group. Three hundred twenty-six patients had a quantitative
coronary assessment. At 8 months, the rate of binary (re)stenosis in the
entire bifurcation lesion (MV and side branch) was 11.0% versus 17.3%
(P<=0.11), in the MV was 3.1% versus 2.5% (P<=0.68), and in the side
branch was 7.9% versus 15.4% (P<=0.039) in the FKBD versus no-FKBD groups,
respectively. In patients with true bifurcation lesions, the side branch
restenosis rate was 7.6% versus 20.0% (P<=0.024) in the FKBD and no-FKBD
groups, respectively. Conclusions-: MV stenting strategies with and
without FKBD were associated with similar clinical outcomes. FKBD reduced
angiographic side branch (re)stenosis, especially in patients with true
bifurcation lesions. The simple no-FKBD procedures resulted in reduced use
of contrast media and shorter procedure and fluoroscopy times. Long-term
data on stent thrombosis are needed. Copyright 2011 American Heart
Association. All rights reserved.

<20>
[Use Link to view the full text]
Accession Number
2011044864
Authors
Howell N.J. Ashrafian H. Drury N.E. Ranasinghe A.M. Contractor H. Isackson
H. Calvert M. Williams L.K. Freemantle N. Quinn D.W. Green D. Frenneaux M.
Bonser R.S. Mascaro J.G. Graham T.R. Rooney S.J. Wilson I.C. Pagano D.
Institution
(Howell, Drury, Ranasinghe, Quinn, Bonser, Mascaro, Graham, Rooney,
Wilson) Department of Cardiothoracic Surgery, University Hospital
Birmingham, Edgbaston, Birmingham B15 2TH, United Kingdom
(Williams, Frenneaux) Department of Cardiology, Birmingham, United Kingdom
(Green) Department of Anaesthetics, Birmingham, United Kingdom
(Pagano) Department of Quality, Outcomes Research Unit, University
Hospital Birmingham NHS FT, Birmingham, United Kingdom
(Howell, Drury, Ranasinghe, Williams, Frenneaux, Bonser, Pagano) Schools
of Experimental and Clinical Medicine, Birmingham, United Kingdom
(Calvert, Freemantle) Schools of Health and Population Science, University
of Birmingham, Birmingham, United Kingdom
(Ashrafian, Contractor, Isackson) Department of Cardiovascular Medicine,
BHF Centre of Research Excellence, University of Oxford, Oxford, United
Kingdom
Title
Glucose-insulin-potassium reduces the incidence of low cardiac output
episodes after aortic valve replacement for aortic stenosis in patients
with left ventricular hypertrophy: Results from the hypertrophy, insulin,
glucose, and electrolytes (HINGE) trial.
Source
Circulation. 123 (2) (pp 170-177), 2011. Date of Publication: 18 Jan
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: Patients undergoing aortic valve replacement for critical
aortic stenosis often have significant left ventricular hypertrophy. Left
ventricular hypertrophy has been identified as an independent predictor of
poor outcome after aortic valve replacement as a result of a combination
of maladaptive myocardial changes and inadequate myocardial protection at
the time of surgery. Glucose-insulin-potassium (GIK) is a potentially
useful adjunct to myocardial protection. This study was designed to
evaluate the effects of GIK infusion in patients undergoing aortic valve
replacement surgery. Methods and results-: Patients undergoing aortic
valve replacement for aortic stenosis with evidence of left ventricular
hypertrophy were randomly assigned to GIK or placebo. The trial was
double-blind and conducted at a single center. The primary outcome was the
incidence of low cardiac output syndrome. Left ventricular biopsies were
analyzed to assess changes in 5' adenosine monophosphate-activated protein
kinase (AMPK), Akt phosphorylation, and protein O-linked
beta-N-acetylglucosamination (O-GlcNAcylation). Over a 4-year period, 217
patients were randomized (107 control, 110 GIK). GIK treatment was
associated with a significant reduction in the incidence of low cardiac
output state (odds ratio, 0.22; 95% confidence interval, 0.10 to 0.47;
P=0.0001) and a significant reduction in inotrope use 6 to 12 hours
postoperatively (odds ratio, 0.30; 95% confidence interval, 0.15 to 0.60;
P=0.0007). These changes were associated with a substantial increase in
AMPK and Akt phosphorylation and a significant increase in the
O-GlcNAcylation of selected protein bands. Conclusions-: Perioperative
treatment with GIK was associated with a significant reduction in the
incidence of low cardiac output state and the need for inotropic support.
This benefit was associated with increased signaling protein
phosphorylation and O-GlcNAcylation. Multicenter studies and late
follow-up will determine whether routine use of GIK improves patient
prognosis. Copyright 2011 American Heart Association. All rights
reserved.

<21>
[Use Link to view the full text]
Accession Number
2011050553
Authors
Beckie T.M. Beckstead J.W.
Institution
(Beckie, Beckstead) University of South Florida, MDC 22, 12901 Bruce B.
Downs Blvd, Tampa, FL 33612, United States
Title
The effects of a cardiac rehabilitation program tailored for women on
their perceptions of health: A randomized clinical trial.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 31 (1) (pp
25-34), 2011. Date of Publication: January-February 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Purpose: The aim of this study was to compare the effects of a cardiac
rehabilitation (CR) program tailored for women with a traditional program
on perceptions of health among women with coronary heart disease.
METHODS:: This 2-group randomized clinical trial compared the perceptions
of health among 92 women completing a traditional 12-week CR program with
those of 133 women completing a tailored program that included
motivational interviewing guided by the transtheoretical model of behavior
change. Perceptions of health were measured using the SF-36 Health Survey
at baseline, postintervention, and at 6-month follow-up. Analysis of
variance was used to compare changes in SF-36 Health Survey subscale
scores over time. RESULTS:: The group-by-time interaction was significant
for the general health (F_2,446 = 3.80, P = .023), social
functioning (f_2,446 = 4.85, P = .008), vitality (F
_2,446 = 5.85, P = .003), and mental health (F_2,446 =
3.61, P = .028) subscales, indicating that the pattern of change was
different between the 2 groups. Of the 4 subscales on which there were
significant group-by-time interactions, the tailored group demonstrated
improved scores over time on all 4 subscales, while the traditional group
improved on only the emotional role limitations and vitality subscales.
CONCLUSIONS:: A tailored CR program improved general health perceptions,
mental health, vitality, and social functioning in women when compared
with traditional CR. To the extent that perceptions of health contribute
to healthy behaviors fostered in CR programs, tailoring CR programs to
alter perceptions of health may improve adherence. 2011 Lippincott
Williams & Wilkins, Inc.

<22>
Accession Number
2011050259
Authors
Santangeli P. Di Biase L. Dello Russo A. Casella M. Bartoletti S.
Santarelli P. Pelargonio G. Natale A.
Institution
(Santangeli, Bartoletti, Santarelli, Pelargonio) Cardiology Department,
Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome,
Italy
(Di Biase, Natale) Texas Cardiac Arrhythmia Institute, St. David's Medical
Center, 1015 East 32nd Street, Austin, TX 78705, United States
(Dello Russo, Casella) Cardiac Arrhythmia Research Center, Monzino
Cardiological Center, University of Milan, Via Parea 4, 20038 Milan, Italy
Title
Meta-analysis: Age and effectiveness of prophylactic implantable
cardioverter-defibrillators.
Source
Annals of Internal Medicine. 153 (9) (pp 592-599), 2010. Date of
Publication: 02 Nov 2010.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Implantable cardioverter-defibrillators (ICDs) for the primary
prevention of sudden cardiac death have been proven effective in several
clinical trials. Purpose: To summarize evidence about the effectiveness of
ICDs versus standard medical therapy for the primary prevention of sudden
cardiac death in different age groups of patients with severe left
ventricular dysfunction. Data Sources: MEDLINE, Embase, CENTRAL, BioMed
Central, Cardiosource, ClinicalTrials.gov, and ISI Web of Science (January
1970 to April 2010) were searched with no language restrictions. Study
Selection: Two independent reviewers screened titles and abstracts to
identify randomized, controlled trials of prophylactic ICD versus medical
therapy in patients with severe left ventricular dysfunction that provided
data about mortality outcomes for different age groups. Data Extraction:
Two independent reviewers assessed risk for bias of trials and extracted
patient and study characteristics and hazard ratios (HRs) relevant to
all-cause mortality. Data Synthesis: Five trials (MADIT-II, DEFINITE,
DINAMIT, SCDHeFT, and IRIS) that enrolled 5783 patients (44% were elderly)
were included. The primary analysis, which excluded the 2 trials enrolling
patients early after acute myocardial infarction (DINAMIT and IRIS), found
that prophylactic ICD therapy reduced mortality in younger patients (HR,
0.65 [95% Cl, 0.50 to 0.83]; P < 0.001). A smaller and statistically
nonsignificant survival benefit was found in elderly patients (HR, 0.81
[Cl, 0.62 to 1.05]; P = 0.11). The inclusion of data from DINAMIT and IRIS
did not change these results. Limitations: Four potentially eligible
trials were not included in the meta-analysis because mortality data by
age group were not available. Adjustment for differences in comorbid
conditions and medical therapies among patients enrolled in the trials was
not possible. Conclusion: Available data do not conclusively show that
prophylactic ICD therapy improves survival in elderly patients with severe
left ventricular dysfunction. Primary Funding Source: None. 2010 American
College of Physicians.

<23>
Accession Number
2011051153
Authors
Parise H. Maehara A. Stone G.W. Leon M.B. Mintz G.S.
Institution
(Parise, Maehara, Stone, Leon, Mintz) Cardiovascular Research Foundation,
Columbia University, Medical Center, New York, NY, United States
Title
Meta-analysis of randomized studies comparing intravascular ultrasound
versus angiographic guidance of percutaneous coronary intervention in
predrug-eluting stent era.
Source
American Journal of Cardiology. 107 (3) (pp 374-382), 2011. Date of
Publication: 01 Feb 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
We conducted a formal meta-analysis of peer-reviewed, published,
randomized studies comparing intravascular ultrasound (IVUS)-guidance and
angiographic-guided bare metal stent implantation. A total of 8 studies
were identified. Because the Balloon Equivalent to Stent (BEST) study was
a noninferiority trial designed to compare 2 very different percutaneous
coronary intervention strategiesIVUS-guided aggressive balloon angioplasty
(with bail-out stenting) and angiographic-guided deliberate bare metal
stent implantationit was eliminated. An unadjusted random-effects
meta-analysis was used to compare the IVUS-guided and nonIVUS-guided
stenting in the 7 remaining studies. A total of 2,193 patients were
randomized in 5 multicenter and 2 single-center studies. IVUS guidance was
associated with a significantly larger postprocedure angiographic minimum
lumen diameter. The mean difference was 0.12 mm (95% confidence interval
[CI] 0.06 to 0.18, p <0.0001). IVUS guidance was also associated with a
significantly lower rate of 6-month angiographic restenosis (22% vs 29%,
odds ratio 0.64, 95% CI 0.42 to 0.96, p = 0.02), a significant reduction
in the revascularization rate (13% vs 18%, odds ratio 0.66, 95% CI 0.48 to
0.91, p = 0.004), and overall major adverse cardiac events (19% vs. 23%,
odds ratio 0.69, 95% CI 0.49 to 0.97, p = 0.03). However, no significant
effect was seen for myocardial infarction (p = 0.51) or mortality (p =
0.18). In conclusion, IVUS guidance for bare metal stent implantation
improved the acute procedural results (angiographic minimum lumen
diameter) and thereby reduced angiographic restenosis and repeat
revascularization and major adverse cardiac events, with a neutral effect
on death and myocardial infarction during a follow-up period of 6 months
to 2.5 years. 2011 Elsevier Inc. All rights reserved.

<24>
Accession Number
2011038238
Authors
Hoekstra M. Vogelzang M. van der Horst I.C.C. Lansink A.O. van der Maaten
J.M.A.A. Ismael F. Zijlstra F. Nijsten M.W.N.
Institution
(Hoekstra, van der Maaten) Department of Anesthesiology, University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB,
Groningen, Netherlands
(Hoekstra, Vogelzang, van der Horst, Zijlstra) Department of Cardiology,
University Medical Center Groningen, University of Groningen, Hanzeplein
1, 9700 RB, Groningen, Netherlands
(Lansink, van der Maaten, Ismael, Nijsten) Department of Critical Care,
University Medical Center Groningen, University of Groningen, Hanzeplein
1, 9700 RB, Groningen, Netherlands
Title
Trial design: Computer guided normal-low versus normal-high potassium
control in critically ill patients: Rationale of the GRIP-COMPASS study.
Source
BMC Anesthesiology. 10 , 2010. Article Number: 23. Date of
Publication: 31 Dec 2010.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Background: Potassium depletion is common in hospitalized patients and can
cause serious complications such as cardiac arrhythmias. In the intensive
care unit (ICU) the majority of patients require potassium suppletion.
However, there are no data regarding the optimal control target in
critically ill patients. After open-heart surgery, patients have a
strongly increased risk of atrial fibrillation or atrial flutter (AFF). In
a novel trial design, we examined if in these patients different potassium
control-targets within the normal range may have different effects on the
incidence of AFF.Methods/Design: The "computer-driven Glucose and
potassium Regulation program in Intensive care Patients with COMparison of
PotASSium targets within normokalemic range (GRIP-COMPASS) trial" is a
single-center prospective trial in which a total of 1200 patients are
assigned to either a potassium control-target of 4.0 mmol/L or 4.5 mmol/L
in consecutive alternating blocks of 50 patients each. Potassium levels
are regulated by the computer-assisted potassium suppletion algorithm
called GRIP-II (Glucose and potassium regulation for Intensive care
Patients). Primary endpoint is the in-hospital incidence of AFF after
cardiac surgery. Secondary endpoints are: in-hospital AFF in medical
patients or patients after non-cardiac surgery, actually achieved
potassium levels and their variation, electrolyte and glucose levels,
potassium and insulin requirements, cumulative fluid balance, (ICU) length
of stay, ICU mortality, hospital mortality and 90-day
mortality.Discussion: The GRIP-COMPASS trial is the first controlled
clinical trial to date that compares potassium targets. Other novel
methodological elements of the study are that it is performed in ICU
patients where both targets are within the normal range and that a
computer-assisted potassium suppletion algorithm is used.Trial
registration: NCT 01085071 at ClinicalTrials.gov. 2010 Hoekstra et al;
licensee BioMed Central Ltd.

<25>
Accession Number
2011047039
Authors
Spaulding C. Teiger E. Commeau P. Varenne O. Bramucci E. Slama M. Beatt K.
Tirouvanziam A. Polonski L. Stella P.R. Clugston R. Fajadet J. De
Boisgelin X. Bode C. Carri D. Erglis A. Merkely B. Hosten S. Cebrian A.
Wang P. Stoll H.-P. Henry P.
Institution
(Spaulding, Varenne) Cochin Hospital, Assistance-Publique Hopitaux de
Paris, Paris Descartes University, Paris, France
(Teiger) Henri Mondor Hospital, Assistance-Publique Hopitaux de Paris,
France
(Commeau) Polyclinique des Fleurs, Ollioules, France
(Bramucci) Policlinico S. Matteo di Pavia, Pavia, Italy
(Slama) Hopital Antoine Beclere, Clamart, France
(Beatt) Mayday University Hospital, London, United Kingdom
(Tirouvanziam) Hopital Guillaume et Ren LaennecCHU de Nantes, Nantes,
France
(Polonski) Slaskie Centrum Chorob Serca, Zabrze, Poland
(Stella) University Medical Center, Heart Lung Center, Utrecht,
Netherlands
(Clugston) Royal Perth Hospital, Perth, Australia
(Fajadet) Clinique Pasteur, Toulouse, France
(De Boisgelin) Clinique du Millnaire, Montpellier, France
(Bode) Universittsklinikum Freiburg, Freiburg, Germany
(Carri) Hopital Rangueil, Toulouse, France
(Erglis) Pauls Stradins University Hospital, Riga, Latvia
(Merkely) Semmelweis University, Budapest, Hungary
(Hosten, Cebrian, Wang, Stoll) Cordis Corporation (Johnson and Johnson),
Waterloo, Belgium
(Henry) Hopital Lariboisiere, Paris, France
Title
Four-year follow-up of TYPHOON (Trial to assess the use of the CYPHer
sirolimus-eluting coronary stent in acute myocardial infarction treated
with BallOON angioplasty).
Source
JACC: Cardiovascular Interventions. 4 (1) (pp 14-23), 2011. Date of
Publication: January 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives The aim of this study was to assess the long-term safety and
efficacy of the CYPHER (Cordis, Johnson and Johnson, Bridgewater, New
Jersey) sirolimus-eluting coronary stent (SES) in percutaneous coronary
intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
Background Concern over the safety of drug-eluting stents implanted during
PCI for STEMI remains, and long-term follow-up from randomized trials are
necessary. TYPHOON (Trial to assess the use of the cYPHer
sirolimus-eluting stent in acute myocardial infarction treated with
ballOON angioplasty) randomized 712 patients with STEMI treated by primary
PCI to receive either SES (n = 355) or bare-metal stents (BMS) (n = 357).
The primary end point, target vessel failure at 1 year, was significantly
lower in the SES group than in the BMS group (7.3% vs. 14.3%, p = 0.004)
with no increase in adverse events. Methods A 4-year follow-up was
performed. Complete data were available in 501 patients (70%), and the
survival status is known in 580 patients (81%). Results Freedom from
target lesion revascularization (TLR) at 4 years was significantly better
in the SES group (92.4% vs. 85.1%; p = 0.002); there were no significant
differences in freedom from cardiac death (97.6% and 95.9%; p = 0.37) or
freedom from repeat myocardial infarction (94.8% and 95.6%; p = 0.85)
between the SES and BMS groups. No difference in definite/probable stent
thrombosis was noted at 4 years (SES: 4.4%, BMS: 4.8%, p = 0.83). In the
580 patients with known survival status at 4 years, the all-cause death
rate was 5.8% in the SES and 7.0% in the BMS group (p = 0.61). Conclusions
In the 70% of patients with complete follow-up at 4 years, SES
demonstrated sustained efficacy to reduce TLR with no difference in death,
repeat myocardial infarction or stent thrombosis. (The Study to Assess AMI
Treated With Balloon Angioplasty [TYPHOON]; NCT00232830) 2011 American
College of Cardiology Foundation.

<26>
Accession Number
2011047044
Authors
George J.C. Varghese V. Dangas G. Popma J.J.
Institution
(George, Varghese) Department of Clinical Research, Division of
Interventional Cardiology and Endovascular Medicine, Deborah Heart and
Lung Center, 200 Trenton Road, Browns Mills, NJ 08015, United States
(Dangas) Division of Interventional Cardiology, Mount Sinai Medical
Center, New York, NY, United States
(Popma) Interventional Cardiology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
Title
Transcatheter aortic valve implantation.
Source
JACC: Cardiovascular Interventions. 4 (1) (pp 132-133), 2011. Date of
Publication: January 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)

<27>
Accession Number
2011048378
Authors
Halonen J. Loponen P. Jarvinen O. Karjalainen J. Parviainen I. Halonen P.
Magga J. Turpeinen A. Hippelainen M. Hartikainen J. Hakala T.
Institution
(Halonen, Karjalainen, Parviainen, Magga, Turpeinen, Hippelainen,
Hartikainen) Kuopio University Hospital, PO Box 1777, 70211 Kuopio,
Finland
(Loponen) Vaasa Central Hospital, Hietalahdenkatu 2-4, 65100 Vaasa,
Finland
(Jarvinen) Tampere Heart Center, PO Box 2000, 33 521 Tampere, Finland
(Halonen) University of Jyvaskyla, PO Box 35, 40014 Jyvaskyla, Finland
(Hakala) North Karelia Central Hospital, Tikkamaentie 16, 80210 Joensuu,
Finland
Title
Metoprolol versus amiodarone in the prevention of atrial fibrillation
after cardiac surgery: A randomized trial.
Source
Annals of Internal Medicine. 153 (11) (pp 703-709), 2010. Date of
Publication: 07 Dec 2010.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Current guidelines recommend beta-blockers as the firstline
preventive treatment of atrial fibrillation (AF) after cardiac surgery.
Despite this, 19% of physicians report using amiodarone as firstline
prophylaxis of postoperative AF. Data directly comparing the efficacy of
these agents in preventing postoperative AF are lacking. Objective: To
determine whether intravenous metoprolol and amiodarone are equally
effective in preventing postoperative AF after cardiac surgery. Design:
Randomized, prospective, equivalence, open-label, multicenter study.
(ClinicalTrials.gov registration number: NCT00784316) Setting: 3 cardiac
care referral centers in Finland. Patients: 316 consecutive patients who
were hemodynamically stable and free of mechanical ventilation and AF
within 24 hours after cardiac surgery. Intervention: Patients were
randomly assigned to receive 48-hour infusion of metoprolol, 1 to 3 mg/h,
according to heart rate, or amiodarone, 15 mg/kg of body weight daily,
with a maximum daily dose of 1000 mg, starting 15 to 21 hours after
cardiac surgery. Measurements: The primary end point was the occurrence of
the first AF episode or completion of the 48-hour infusion. Results:
Atrial fibrillation occurred in 38 of 159 (23.9%) patients in the
metoprolol group and 39 of 157 (24.8%) patients in the amiodarone group (P
= 0.85). However, the difference (-0.9 percentage point [90% CI, -8.9 to
7.0 percentage points]) does not meet the prespecified equivalence margin
of 5 percentage points. The adjusted hazard ratio of the metoprolol group
compared with the amiodarone group was 1.09 (95% CI, 0.67 to 1.76).
Limitations: Caregivers were not blinded to treatment allocation, and the
trial evaluated only stable patients who were not at particularly elevated
risk for AF. The withdrawal of preoperative beta-blocker therapy may have
increased the risk for AF in the amiodarone group. Conclusion: The
occurrence of AF was similar in the metoprolol and amiodarone groups.
However, because of the wide range of the CIs, the authors cannot conclude
that the 2 treatments were equally effective. Primary Funding Source: The
Finnish Foundation for Cardiovascular Research and the Kuopio University
EVO Foundation. 2010 American College of Physicians.

<28>
Accession Number
70336294
Authors
Turina M. Martin J. Cheng D.
Institution
(Turina, Martin, Cheng) EACTS Endovascular Surgical Resources Group,
United States
Source
Heart Surgery Forum. Conference: 5th International Meeting of the Onassis
Cardiac Surgery Center Athens Greece. Conference Start: 20100916
Conference End: 20100918. Conference Publication: (var.pagings). 13 (pp
S15), 2010. Date of Publication: September 2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Background: The role of thoracic endovascular aortic repair (TEVAR) vs.
open surgery remains unclear. Meta-regression guides uptake of new
technologies by utilizing evidence from existing trials. Objective: Does
TEVAR reduce death and morbidity compared to open surgical repair for
thoracic aortic disease? Methods: All data from controlled trials of TEVAR
vs. open repair of thoracic aortic pathologies was ascertained from
medical databases plus conference abstracts up to October 2008, and
combined through meta-analyses. Metaregression was performed to evaluate
the impact of baseline risk factor imbalances, study design, and thoracic
pathology. Results: Forty-one studies involving 4918 patients were
included [4 multiCenter (MC) studies, 46 single-Center studies (SC), 4
registries]. Characteristics were balanced except for age (TEVAR patients
were average 1.3 years older than open repair patients (p=0.001)). Due to
significant heterogeneity across study designs, results were analyzed by
study type. Death at 30 days was reduced for TEVAR vs. open surgery in MC
trials (OR 0.24, 95%CI 0.13 to 0.44) and SC studies (OR 0.52, 95%CI 0.38
to 0.73), but did not reach significance in registries (OR 0.30, 95%CI
0.09 to 1.04). Survival differences did not persist at 1 year and 3 years.
Paraplegia was reduced for TEVAR vs. open surgery in MC studies (OR 0.44,
95%CI 0.23 to 0.84) and SC studies (OR 0.46, 95%CI 0.29 to 0.74), and was
insufficiently reported in registries. Stroke was reduced in MC studies
(OR 0.46, 95%CI 0.25 to 0.85), but not in SC studies or registries.
Arrhythmias, myocardial infarction, transfusion, renal insufficiency, and
overall ischemic events were reduced for TEVAR vs. open surgery, but
aortic reinterventions did not differ. Metaregression by baseline age
imbalance and aortic pathology did not materially change these results.
Analysis by type of stent showed non-commercial stents tended to have
worse outcomes vs. commercial stents. Conclusion: Current data suggest
that TEVAR, regardless of type of pathology, reduces early death and
ischemic events including stroke, paraplegia, renal insufficiency, and
myocardial infarction compared with open surgery. Sustained benefits on
survival have not been proven.

<29>
Accession Number
70336297
Authors
Edmunds L.H.
Institution
(Edmunds) University of Pennsylvania, PA, United States
Source
Heart Surgery Forum. Conference: 5th International Meeting of the Onassis
Cardiac Surgery Center Athens Greece. Conference Start: 20100916
Conference End: 20100918. Conference Publication: (var.pagings). 13 (pp
S17-S18), 2010. Date of Publication: September 2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Introduction: In the majority of patients, who have cardiac surgery with
cardiopulmonary bypass (CPB), native platelets, natural procoagulants and
plasma inhibitors are sufficient to sustain wound clotting after heparin
is neutralized by protamine. Nevertheless, CPB increases postoperative
wound bleeding and the need for transfusion of blood products. Blood
losses were 27% higher in the on pump group versus off pump in a
randomized controlled trial of 200 first-time CABG patients. In a
meta-analysis of 52 studies mean blood losses ranged from 750-1250 mL in
placebo treated cardiac surgical patients. Reoperations, complex
procedures and many aortic operations with or without deep hypothermia are
associated with increased postoperative bleeding. Bleeding is a frequent,
adverse event during and after implantation of circulatory assist devices.
Causes of Bleeding: Blood contact with non-endothelial cell surfaces in
the surgical wound and CPB circuit initiates clotting by generation of
thrombin. Thus standard, unfractionated heparin, which can be reversed by
protamine, is required for CPB. Heparin accelerates inactivation of
thrombin, which is the enzyme that converts fibrinogen to fibrin. During
CPB thrombin is generated continuously in the wound and circuit, as proved
by the steady increase in prothrombin fragment F1.2. This marker is
produced when prothrombinase converts alpha-thrombin to thrombin and peaks
at the time protamine is given. Thrombin stimulates endothelial cells to
produce tissue-type plasminogen activator (t-PA), which binds fibrin and
cleaves plasminogen to initiate fibrinolysis. D-dimer is a protein marker
of fibrinolysis and steadily increases during cardiopulmonary bypass. The
simultaneous production of thrombin and fibrinolysis is the definition of
consumptive coagulopathy, which is the hallmark of disseminated
intravascular coagulation. D-dimer concentrations also peak at the time
protamine is given. Thrombin is primarily generated in the surgical wound
during cardiac surgery using CPB; the amount generated in the perfusion
circuit is relatively small. The wound is also the primary site of
extensive fibrinolysis. Tabuchi found 23.5 times more fibrin split
products in the surgical wound than in simultaneous samples of perfusate.
High concentrations of fibrin and fibrinogen degradation products are also
present in blood shed after wound closure. Blood contact with non
endothelial cell surfaces activates platelets. During CPB platelet numbers
and function decrease; bleeding times increase; and platelet transfusions
may be required when bleeding is excessive. This essay does not address
the important role of platelets, but intentionally focuses on methods to
control fibrinolysis to reduce postoperative bleeding. Aprotinin and
Lysine Analogs: Aprotinin and the lysine analogs, tranexamic acid (TA) and
epsilon amino caproic acid (EACA), inhibit fibrinolysis by different
mechanisms. In well designed, randomized studies of first time CABG
operations, which are rarely associated with severe bleeding, both drugs
are effective and neither is superior to the other. However, in some
patients, but not all, who have re-operations, complex procedures, aortic
operations or circulatory assist device implantations, neither aprotinin
nor the lysine analogs satisfactorily control bleeding Both drug types
reduce bleeding compared to placebo, but the belief of many surgeons that
aprotinin is more effective than the lysine analogs has never been
verified by a well designed study. Aprotinin is no longer available
because of toxicity concerns and recently TA, but not EACA, have been
connected to increases in postoperative seizures. EACA has been widely and
safely used in total doses up to 30 gm and the upper limits of safe doses
are not known. These events and facts prompt a reassessment of the use and
merits of EACA to control postoperative fibrinolysis in patients who have
cardiac surgery with CPB. Typically, EACA is given in a loading dose
before incision; is added to the pump prime; and is infused during
extracorporeal perfusion in dosing schedules similar to those used for
aprotinin. High concentrations of anti-fibrinolytic drugs circulate when
clot formation, thrombin generation and fibrinolysis are minimal. These
front loaded dosing schemes are not synchronous with the progressive
generation of thrombin and plasmin during CPB and do not attempt to
inhibit fibrinolysis in the wound. Several studies report reduced
postoperative bleeding when either aprotinin or a lysine analog is used in
the surgical wound. Logic dictates a revision of dosing protocols to
better match administration of anti-fibrinolytic drugs with the location
and timing of plasmin activity. Systemic doses of EACA should be
back-loaded and peak at the time F1.1 and D-dimer peak, which is when
protamine is given and hemostasis is desired. Perhaps more important the
surgical wound - the major source of fibrinolysis - should be topically
and aggressively treated with EACA at the same time. Once CPB ends, the
wound is the only source of fibrinolysis. However, following wound closure
systemic D-dimer levels remain elevated for many hours indicating that
fibrinolysis continues in the closed wound. Thus logically EACA should
continue for 12 or so hours after CPB has ended.

<30>
Accession Number
70336303
Authors
Nasioulas G.
Institution
(Nasioulas) Genekor S.A., Athens, Greece
Source
Heart Surgery Forum. Conference: 5th International Meeting of the Onassis
Cardiac Surgery Center Athens Greece. Conference Start: 20100916
Conference End: 20100918. Conference Publication: (var.pagings). 13 (pp
S23-S24), 2010. Date of Publication: September 2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Introduction: Cardiovascular disease (CVD), involve complex interactions
between genetic (inherited susceptibility) and environmental (potentially
modifiable) factors. Although the genetic factors, alone, may not be able
to give a clear and direct explanation of these diseases or their
underlying mechanisms, understanding them will be essential in
understanding the details of CVD. Genetic patterns of CVD involve both
Mendelian and multifactorial patterns of inheritance. Mendelian
Cardiovascular Disorders: Elevated Levels of Low-Density Lipoprotein
Cholesterol and Coronary Artery Disease. Low-density lipoprotein (LDL) is
the major cholesterolcarrying lipoprotein in plasma and is the causal
agent in many forms of coronary heart disease. Four monogenic diseases
elevate plasma levels of LDL by impairing the activity of hepatic LDL
receptors, which normally clear LDL from the plasma. These are, Familial
hypercholesterolemia, Familial ligand-defective apolipoprotein-100,
Sitosterolemia and Autosomal Recessive hypercholesterolemia. Hypertension:
Hypertension imparts an increased risk of stroke, myocardial infarction,
heart failure, and renal failure; many clinical trials have shown that
reductions in blood pressure reduce the incidence of stroke and myocardial
infarction. Multiple environmental and genetic determinants complicate the
study of blood-pressure variations in the general population. In contrast,
the investigation of rare mendelian forms of blood-pressure variation in
which mutations in single genes cause marked extremes in blood pressure
has been very informative. These mutations, which impair renal salt
handling, provide a molecular basis for understanding the pathogenesis of
hypertension. The blood-clotting system requires precise control of
factors within and outside the coagulation cascade to prevent fatal
bleeding or unwanted thrombosis. A common variant in the factor V gene,
(Arg506Gln), prevents the degradation of factor V and promotes clot
formation. This substitution, also known as factor V Leiden, has an allele
frequency of 2 to 7 percent in European populations and has been observed
in 20 to 50 percent of patients with venous thromboembolic disease. Factor
V Leiden has incomplete penetrance and variable expression. Approximately
80 percent of persons who are homozygous for the mutation and 10 percent
of those who are heterozygous will have thrombosis at some point in their
lifetime. Factor V Leiden increases the risk of myocardial infarction,
stroke, and venous thrombosis in men. In a subgroup of patients,
thrombosis is associated with coinheritance of gene mutations that modify
the factor V Leiden phenotype. Identification of gene modifiers is an area
of active research and is essential for distinguishing, among persons who
are heterozygous for factor V Leiden, the 10 percent in whom serious
thrombosis will develop from the 90 percent who will have no symptoms.
Hypertrophic Cardiomyopathy: Familial hypertrophic cardiomyopathy is a
heterogenous disorder. Approximately 35% of cases have been shown to be
caused by one or more than 70 mutations in the gene encoding beta myosin
heavy chain (MYH7). Cardiac Arrhythmias: The primary arrhythmogenic
disorders are caused by mutations involving ion channels. Long QT
syndromes, Brugada syndrome and catecholaminergic ventricular tachycardia
are distinct clinical entities that result from unique ion channel
mutations. Multifactorial Disorders: The majority of CVD including
atherosclerosis and acute coronary syndrome are multifactorial processes
that include inflammation, endothelial dysfunction and vascular
reactivity. They result from the interactions of many genes with the
environment. The genetic component of any multifactorial disease is
difficult to determine. Although more than 1400 genes for approximately
1200 Mendelian traits have been identified only about 10 to 50 causative
genetic variants have been identified for complex diseases. Some of the
most interesting results of the genetic association studies on
multifactorial diseases are the reported difference by sex, race, and
ethnicity in both pathobiology of CVD and hypertension, along with
response to drug treatment in these diseases. Several meta-analysis on
genetic association studies have indicated significant associations
between genetic variants and CVD. For example, a meta analysis conducted
on 30 case control studies on the association of APO B gene showed that a
variation of SpIns/Del polymorphisms significantly increased the risk of
an MI and coronary artery disease. The Ins/Ins genotype has significantly
higher LDL levels of cholesterol. microRNAs in Vascular Diseases: Although
multiple growth factors have been shown to regulate angiogenesis and
vascular development, little is known about the complex upstream
regulation of gene expression and translation. MicroRNAs (miRNAs) are an
emerging class of highly conserved, non-coding small RNAs that regulate
gene expression on the post-transcriptional level by inhibiting the
translation of protein from mRNA or by promoting the degradation of mRNA.
More than 500 human miRNAs have been identified so far, and increasing
evidence indicates that miRNAs have distinct expression profiles and play
crucial roles in various physiological and pathological processes such as
cardiogenesis, haematopoietic lineage differentiation, and oncogenesis.
Bone Marrow-Derived Progenitor Cells In Acute Coronary Syndromes: Two
hypotheses explain the role of adult progenitor cells in myocardial
regeneration. Stem cell plasticity which involves mobilization of stem
cells from the bone marrow and other niches, homing to the area of tissue
injury and transdifferentiation into functional cardiomyocytes.
Alternative hypothesis is based on the observations that bone marrow
harbors a heterogenous population of cells positive for CXCR4 - receptor
for chemokine SDF-1. This population of non-hematopoietic cells expresses
genes specific for early muscle, myocardial and endothelial progenitor
cells (EPC). These tissue-committed stem cells circulate in the peripheral
blood at low numbers and can be mobilized by hematopoietic cytokines in
the setting of myocardial ischemia. The significance of autologous stem
cells mobilization in terms of cardiac salvage and regeneration needs to
be proved in humans but it seems to be a reparative mechanism triggered
early in the course of acute coronary syndromes. Molecular and Clinical
Diagnosis: Genetic diagnosis - that is, primary classification on the
basis of the presence of a mutation, with subsequent stratification
according to risk - is not widely available for the diagnosis of monogenic
cardiovascular disorders. Today, physical examination and routine testing,
such as echocardiography to detect hypertrophic cardiomyopathy or
electrocardiographic analysis of the long-QT syndrome, establish clinical
diagnoses. Genetic diagnoses are then made by research-oriented genotyping
of selected pedigrees. Current initiatives focus on the natural history of
monogenic disorders in large numbers of patients with specific mutations,
in order to identify persons at high risk for cardiovascular events,
asymptomatic carriers in whom pharmacologic interventions will retard or
prevent disease, and nonaffected family members whose concern about their
health can be addressed. With regard to complex traits in more common
cardiovascular diseases, current research is identifying functionally
significant variations in DNA sequences that can establish a molecular
diagnosis and influence patients' outcome.

<31>
Accession Number
70336325
Authors
Petsios K.
Institution
(Petsios) Onassis Cardiosurgical PICU, Athens, Greece
Source
Heart Surgery Forum. Conference: 5th International Meeting of the Onassis
Cardiac Surgery Center Athens Greece. Conference Start: 20100916
Conference End: 20100918. Conference Publication: (var.pagings). 13 (pp
S40), 2010. Date of Publication: September 2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Introduction: Clinical guidelines and care protocols are intended to
provide information, based on an appraisal of the current best evidence of
clinical and cost-effectiveness, regarding therapeutic interventions for
given conditions. Nowadays, nursing science is undergoing a continuous and
dynamic development. More specifically, the nursing education with the
introduction of nursing process in the everyday clinical practice and the
development of nursing research provides nursing with evidence based data.
Simultaneously, the technological development along with the turn to the
provision of safer and better quality care lead to a new need for more
systemization, rationalism and update of nursing care. Objectives: To
explore how nurses contribute to the development, implementation and audit
of protocol-based care. Protocol-based care refers to the use of documents
that set standards for clinical care processes with the intent of reducing
unacceptable variations in practice. Documents such as protocols, clinical
guidelines and care pathways underpin evidence-based practice throughout
the world. To explore and present the experience from the use of nursing
protocols in the Onassis Cardiac Center from its onset until today was a
challenge. Methods: An interpretative systematic review of recent nursing
literature was conducted. Data was obtained through CINAHL, PUBMED and Web
of Science from 2000 to 2010. Results: Most papers were descriptive,
offering practitioner knowledge and positive findings about a locally
developed and owned protocol-based care. The majority were instigated in
response to clinical need or service re-design. The context and the
multiple purposes of protocol-based care influenced the development
process. Implementation and sustainability were rarely mentioned. There
were notable gaps in the literature about the engagement of patients in
the decision-making process and the impact of new roles on
inter-professional relations. Concerning Onassis Cardiac Center the
nursing care is protocol based. Especially in the adult and pediatric
cardiosurgical intensive care unit, the whole nursing care is based on
structured protocols and clinical pathways or guidelines. Conclusions:
Documents that standardize clinical care are part of the history of
nursing as well as contemporary evidence-based care and expanded roles.
According to our findings and our experience, nursing care via protocols
is vital for the provision of safe and high quality care. Protocols offer
a well structured frame for clinical use, allowing nurse's autonomy
through nursing process and enhancing homogeneity of care. Extensive
clinical experience and higher education is acknowledged through this
process since it's a dynamic process that presupposes critical thinking
and decision making.

<32>
Accession Number
70336337
Authors
Karamitsos T.D.
Institution
(Karamitsos) University of Oxford, Department of Cardiovascular Medicine,
John Radcliffe Hospital, United Kingdom
Source
Heart Surgery Forum. Conference: 5th International Meeting of the Onassis
Cardiac Surgery Center Athens Greece. Conference Start: 20100916
Conference End: 20100918. Conference Publication: (var.pagings). 13 (pp
S50-S51), 2010. Date of Publication: September 2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Diabetes mellitus is one of the well established risk factors for coronary
artery disease. Indeed, diabetic patients may develop myocardial ischaemia
at stress due to either epicardial coronary stenoses or microvascular
dysfunction. Cardiovascular Magnetic Resonance (CMR) using the cine and
late gadolinium enhancement techniques provides a comprehensive assessment
of regional/global ventricular function and viability.¹
Furthermore, CMR can be used to identify the presence of ischaemia in
these patients using either vasodilators such as adenosine and
dypiridamole to assess perfusion or dobutamine to assess regional wall
motion. Dobutamine stress CMR (DSCMR) is performed in a manner analogous
to dobutamine stress echo². Dobutamine is infused intravenously
during 3-minute stages at dosages of 10, 20, 30 and 40 mug/kg/min. If the
target heart rate [(220-age) x 0.85] is not reached, additional atropine
doses are administered (maximal dose 1.0 mg i.v.). At each stress level, 3
short-axis (basal, midequatorial and apical) and 3 long axis (2-, 3-,
4-chamber view) cines are acquired. These are compared to the rest cine
images (which were acquired before dobutamine) for evidence of new or
worsened wall motion abnormalities. A pathologic response is characterised
by stress-induced wall motion abnormalities (hypokinesis, akinesis, or
dyskinesis) in at least one segment that was graded normal at rest. The
diagnostic accuracy of DSCMR is similar with dobutamine stress echo,
however, the application of DSCMR is particularly advantageous in patients
with poor acoustic windows². Recently, the prognostic role of
DSCMR in patients with IHD has been demonstrated³. To date
there are no DSCMR studies performed on entirely diabetic cohorts. In
first-pass perfusion CMR, the dynamic passage of a bolus of
gadolinium-based contrast agent is followed through the cardiac chambers
and the myocardium. Most CMR Centers prefer adenosine as the stressor
agent because it is generally well tolerated, easily controlled and
safe⁴. After 3-4 minutes of adenosine infusion at a rate of
140mug/kg/min, an intravenous bolus of gadolinium (0.05 - 0.1 mmol/kg) is
injected through a peripheral vein in the antecubital fossa, and a set of
at least three short-axis slices (one basal, one equatorial and one
apical) is acquired every cardiac cycle during the first pass of the
contrast.⁵ Images are analysed qualitatively (visually) for the
presence of perfusion defects (dark areas). This technique has high
diagnostic accuracy and according to a recent meta-analysis sensitivity
and specificity are 91% and 81% respectively. Recently, MR-IMPACT, a
multiCenter-multivendor trial compared CMR perfusion with single-photon
emission computed tomography (SPECT) in 234 patients and showed at least
equivalent diagnostic performance of CMR (area under the receiver operator
characteristic curve 0.86 for CMR vs 0.75 for SPECT, p=0.12).⁶
Vasodilator perfusion CMR provides also prognostic information in patients
with ischaemic heart disease³. To date there are no perfusion
CMR studies performed on entirely diabetic cohorts.