EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2011107665
Authors
Hakeem A. Helmy T. Munsif S. Bhatti S. Mazraeshahi R. Cilingiroglu M.
Effat M. Leesar M. Arif I.
Institution
(Hakeem, Helmy, Munsif, Bhatti, Mazraeshahi, Cilingiroglu, Effat, Leesar,
Arif) Department of Medicine, College of Medicine, University of
Cincinnati, Cincinnati, OH, United States
Title
Safety and efficacy of drug eluting stents compared with bare metal stents
for saphenous vein graft interventions: A comprehensive meta-analysis of
randomized trials and observational studies comprising 7,994 patients.
Source
Catheterization and Cardiovascular Interventions. 77 (3) (pp 343-355),
2011. Date of Publication: 15 Feb 2011.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background: Saphenous vein graft (SVG) lesions remain amongst the most
challenging lesions for percutaneous coronary intervention (PCI). It is
unknown whether drug eluting stents (DES) are superior to bare metal
stents (BMS) for such lesions. Our objective is to determine the safety
and efficacy of DES compared with BMS for SVG lesions by performing a
meta-analysis of clinical trials and observational studies. Data Sources:
PubMed, Cochrane Register of Controlled Trials, conference proceedings,
and internet-based resources of clinical trials. Study Selection:Studies
comparing DES vs. BMS for SVG lesions with at least > 30 patients in each
study reporting the outcomes of interest [death, myocardial infarction
(MI), target vessel revascularization (TVR), stent thrombosis (ST), and
the composite of death, TVR and MI (major adverse cardiac events; MACE)]
with at least 6 months clinical follow-up. The primary outcome of interest
was death. Results:Two randomized trials, one subgroup analysis of a
randomized trial and 26 observational studies comprising a total of 7,994
patients (4,187 patients in DES and 3,807 patients in BMS group) were
included in the analysis.Mean follow-up duration was 21 +/- 11 months
(6-48 months). In the overall population, MACE events were 19% in DES and
28% in BMS with a risk ratio (RR) of 0.7 (0.6, 0.8) P < 0.00001. This
effect of MACE was sustained in studies with >2 years follow-up with RR of
0.77 (0.65, 0.91) P = 0.003. Death rate was 7.8% in DES and 9% in BMS with
a RR of 0.82 (0.7, 0.97) P = 0.02. MI rate was 5.7% in DES and 7.6% in BMS
with RR of 0.72 (0.57, 0.91) P = 0.007. TVR was 12% in DES and 17% in BMS
with RR of 0.71 (0.59, 0.85) P = 0.0002. ST was 1% in DES and 1.7 % in BMS
RR of 0.61 (0.35, 1.06) P = 0.08. Specifically in randomized controlled
trials, DES were associated with no significant differences in overall
mortality [RR = 1.97; 95% confidence interval (CI), 0.17-23; P = 0.58] or
MI (RR = 1.24; 95% CI, 0.3-5.5; P = 0.78) compared with BMS.
Conclusions:Based on the results of this meta-analysis, DES may be
considered as a safe and efficacious option for the percutaneous
intervention of SVG lesions. 2010 Wiley-Liss, Inc.

<2>
Accession Number
2011107667
Authors
Rodriguez A.E. Vigo C.F. Delacasa A. Mieres J. Fernandez-Pereira C.
Bernardi V. Bettinoti M. Rodriguez-Granillo A.M. Rodriguez-Granillo G.
Santaera O. Curotto V. Rubilar B. Tronge J. Palacios I.F. Antoniucci D.
Institution
(Rodriguez, Mieres, Fernandez-Pereira, Curotto, Rubilar) Sanatorio
Otamendi, Cardiac Unit, Capital Federal, Buenos Aires, Argentina
(Vigo) Sanatorio Del Salvador, Interventional Cardiology, Cordoba,
Argentina
(Delacasa) Sanatorio Belgrano, Interventional Cardiology, Mar del Plata,
Buenos Aires, Argentina
(Mieres) Sanatorio Las Lomas, Interventional Cardiology, San Isidro,
Buenos Aires, Argentina
(Fernandez-Pereira, Tronge) Clinica IMA, Interventional Cardiology and
Cardiology Department, Adrogue, Buenos Aires, Argentina
(Bernardi) Clinica Del Sol, Interventional Cardiology, Capital Federal,
Buenos Aires, Argentina
(Bettinoti) Sanatorio Guemes, Interventional Cardiology, Capital Federal,
Buenos Aires, Argentina
(Rodriguez, Rodriguez-Granillo, Rodriguez-Granillo) Centro de Estudios en
Cardiologia Intervencionista (CECI), Capital Federal, Buenos Aires,
Argentina
(Santaera) Argentina Society for Cardiovascular Interventions, Argentina
(Palacios) Massachusetts General Hospital, Cardiac Unit, Boston, MA,
United States
(Antoniucci) Careggi Hospital, Cardiovascular Division, Florence, Italy
Title
Efficacy and safety of a double-coated paclitaxel-eluting coronary stent:
The EUCATAX trial.
Source
Catheterization and Cardiovascular Interventions. 77 (3) (pp 335-342),
2011. Date of Publication: 15 Feb 2011.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objectives: The aim of this study was the comparison of a new
double-coated paclitaxel-eluting coronary stent with bare-metal stent
(BMS) in patients undergoing percutaneous coronary intervention.
Background: Stent coating with biodegradable polymers as a platform for
elution of drugs has the potential for complete elution of drugs and for
decreasing the risk of late complications. Methods: Multicenter randomized
trial comparing a paclitaxel-eluting stent (PES) coated with a
biodegradable polymer and glycocalyx with the equivalent BMS. We randomly
assigned 422 patients with de novo coronary lesions to PES (211 patients)
or to BMS (211 patients). Primary end point was target vessel failure
(TVF) defined as cardiac death, myocardial infarction, and target vessel
revascularization. Clinical secondary end points were target vessel
revascularization, target lesion revascularization, stent thrombosis (ST),
and major adverse cardiovascular events (MACE). Angiographic secondary end
points were late loss and binary restenosis. Results: At 1 year of
follow-up, TVF rate was 9.5% in the PES group and 17.1% in the BMS group
(P = 0.02), and MACE rate was 10% in PES and 19% in BMS arm (P = 0.009).
All other secondary end points were reached but ST. ST rate was low and
similar in both study arms. Conclusions: The study shows that patients
treated with PES with dual coating technology had significantly lower
incidence of TVF and MACE than those treated with BMS design; however,
longer follow-up should be necessary to assess true advantages of this
technology compared with the previous one. 2010 Wiley-Liss, Inc.

<3>
Accession Number
2011112373
Authors
Hermann T.S. Dall C.H. Christensen S.B. Goetze J.P. Prescott E. Gustafsson
F.
Institution
(Hermann, Christensen, Gustafsson) Rigshospitalet, Department of
Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
(Dall, Prescott) Bispebjerg Hospital, Department of Cardiology, Copenhagen
University Hospital, Copenhagen, Denmark
(Goetze) Rigshospitalet, Department of Clinical Biochemistry, Copenhagen
University Hospital, Copenhagen, Denmark
Title
Effect of high intensity exercise on peak oxygen uptake and endothelial
function in long-term heart transplant recipients.
Source
American Journal of Transplantation. 11 (3) (pp 536-541), 2011. Date of
Publication: March 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Coronary allograft vasculopathy is a well-known long-term complication
after cardiac transplantation. Endothelial dysfunction is involved andmay
be prevented by aerobic exercise. The purpose of this study was to examine
whether high intensity aerobic exercise improves peak oxygen uptake (VO
_{2 peak}) and endothelial function in heart transplant (HT)
recipients. Twenty-seven long-term HT recipients were randomized to either
8-weeks high intensity aerobic exercise or no training. Flow mediated
dilation of the brachial artery (FMD) was measured by ultrasound and
VO_{2 peak} by the analysis of expired air. Blood pressure and
biomarkers were measured before and after 8 weeks. VO_{2 peak}
increased significantly in the exercise group (VO_{2 peak} 23.9
+/- 1.79 to 28.3 +/- 1.63 mL/kg/min compared to controls (VO_2
peak 24.6 +/- 1.38 to 23.4 +/- 1.58, p < 0.001 exercise vs.
control). FMD increased in the exercise group compared to controls (8.3
+/- 1.1% to 11.4 +/- 1.2% vs. 5.6 +/- 1.0% to 5.3 +/- 1.7%, p = 0.024). No
increase in nitroglycerin-induced vasodilation was observed. Systolic
blood pressure fell in the exercise group (142 +/- 4.2 mmHg to127 +/- 3.4
mmHg, p = 0.01) and was unchanged in controls (141 +/- 4.2 mmHg to 142 +/-
6.4 mmHg, NS). High intensity aerobic exercise reduces systolic blood
pressure and improves endothelial function in HT recipients. 2011 The
Authors Journal compilation 2011 The American Society of Transplantation
and the American Society of Transplant Surgeons.

<4>
Accession Number
21249650
Authors
Henry D.A. Carless P.A. Moxey A.J. O'Connell D. Stokes B.J. Fergusson D.A.
Ker K.
Institution
(Henry) Institute of Clinical Evaluative Sciences, 2075 Bayview Avenue, G1
06, Toronto, Ontario, Canada, M4N 3M5.
Title
Anti-fibrinolytic use for minimising perioperative allogeneic blood
transfusion.
Source
Cochrane database of systematic reviews (Online). 1 (pp CD001886), 2011.
Date of Publication: 2011.
Abstract
Concerns regarding the safety of transfused blood have led to the
development of a range of interventions to minimise blood loss during
major surgery. Anti-fibrinolytic drugs are widely used, particularly in
cardiac surgery, and previous reviews have found them to be effective in
reducing blood loss, the need for transfusion, and the need for
re-operation due to continued or recurrent bleeding. In the last few years
questions have been raised regarding the comparative performance of the
drugs. The safety of the most popular agent, aprotinin, has been
challenged, and it was withdrawn from world markets in May 2008 because of
concerns that it increased the risk of cardiovascular complications and
death. To assess the comparative effects of the anti-fibrinolytic drugs
aprotinin, tranexamic acid (TXA), and epsilon aminocaproic acid (EACA) on
blood loss during surgery, the need for red blood cell (RBC) transfusion,
and adverse events, particularly vascular occlusion, renal dysfunction,
and death. We searched: the Cochrane Injuries Group's Specialised Register
(July 2010), Cochrane Central Register of Controlled Trials (The Cochrane
Library 2010, Issue 3), MEDLINE (Ovid SP) 1950 to July 2010, EMBASE (Ovid
SP) 1980 to July 2010. References in identified trials and review articles
were checked and trial authors were contacted to identify any additional
studies. The searches were last updated in July 2010. Randomised
controlled trials (RCTs) of anti-fibrinolytic drugs in adults scheduled
for non-urgent surgery. Eligible trials compared anti-fibrinolytic drugs
with placebo (or no treatment), or with each other. Two authors
independently assessed trial quality and extracted data. This review
summarises data from 252 RCTs that recruited over 25,000 participants.
Data from the head-to-head trials suggest an advantage of aprotinin over
the lysine analogues TXA and EACA in terms of reducing perioperative blood
loss, but the differences were small. Compared to control, aprotinin
reduced the probability of requiring RBC transfusion by a relative 34%
(relative risk [RR] 0.66, 95% confidence interval [CI] 0.60 to 0.72). The
RR for RBC transfusion with TXA was 0.61 (95% CI 0.53 to 0.70) and was
0.81 (95% CI 0.67 to 0.99) with EACA. When the pooled estimates from the
head-to-head trials of the two lysine analogues were combined and compared
to aprotinin alone, aprotinin appeared more effective in reducing the need
for RBC transfusion (RR 0.90; 95% CI 0.81 to 0.99).Aprotinin reduced the
need for re-operation due to bleeding by a relative 54% (RR 0.46, 95% CI
0.34 to 0.62). This translates into an absolute risk reduction of 2% and a
number needed-to-treat (NNT) of 50 (95% CI 33 to 100). A similar trend was
seen with EACA (RR 0.32, 95% CI 0.11 to 0.99) but not TXA (RR 0.80, 95% CI
0.55 to 1.17). The blood transfusion data were heterogeneous and funnel
plots indicate that trials of aprotinin and the lysine analogues may be
subject to publication bias.When compared with no treatment aprotinin did
not increase the risk of myocardial infarction (RR 0.87, 95% CI 0.69 to
1.11), stroke (RR 0.82, 95% CI 0.44 to 1.52), renal dysfunction (RR 1.10,
95% CI 0.79 to 1.54) or overall mortality (RR 0.81, 95% CI 0.63 to 1.06).
Similar trends were seen with the lysine analogues, but data were sparse.
These data conflict with the results of recently published non-randomised
studies, which found increased risk of cardiovascular complications and
death with aprotinin. There are concerns about the adequacy of reporting
of uncommon events in the small clinical trials included in this
review.When aprotinin was compared directly with either, or both, of the
two lysine analogues it resulted in a significant increase in the risk of
death (RR 1.39, 95% CI 1.02, 1.89), and a non-significant increase in the
risk of myocardial infarction (RR 1.11 95% CI 0.82, 1.50). Most of the
data contributing to this added risk came from a single study - the BART
trial (2008). Anti-fibrinolytic drugs provide worthwhile reductions in
blood loss and the receipt of allogeneic red cell transfusion. Aprotinin
appears to be slightly more effective than the lysine analogues in
reducing blood loss and the receipt of blood transfusion. However, head to
head comparisons show a lower risk of death with lysine analogues when
compared with aprotinin. The lysine analogues are effective in reducing
blood loss during and after surgery, and appear to be free of serious
adverse effects.

<5>
Accession Number
21249662
Authors
Theologou T. Bashir M. Rengarajan A. Khan O. Spyt T. Richens D. Field M.
Institution
(Theologou) Department of Cardiothoracic Surgery, Nottingham City
Hospital, Hucknall Road, Nottingham, UK, NG5 1PB.
Title
Preoperative intra aortic balloon pumps in patients undergoing coronary
artery bypass grafting.
Source
Cochrane database of systematic reviews (Online). 1 (pp CD004472), 2011.
Date of Publication: 2011.
Abstract
The intra aortic balloon pump (IABP) is a mechanical assist device which
improves cardiac function. The device has a well-established place in
algorithms for managing low cardiac output following cardiac surgery.
There is increasing evidence that certain cardiac surgery patients benefit
from a period of preoperative augmentation with the intra aortic balloon
pump. To determine the effect of the preoperative intra aortic balloon
pump on mortality and morbidity in a number of different patients groups
undergoing coronary artery bypass grafting. The Cochrane Central Register
of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 3, 2009),
MEDLINE (2000 to August 2009), EMBASE (1998 to August 2009), BIOSIS
previews (1969 to August 2009) and ISI Proceedings (1990 to August 2009)
were searched. References and ongoing registers of studies were checked.
No language restrictions were applied. Randomised controlled trials (RCTs)
of any size or length were included. Papers were assessed for inclusion by
two authors independently and differences were settled by consensus with a
third author. Date are presented in the form of odds ratios (OR) and 95%
confidence intervals (CI). Six trials were included (five on-pump and one
off-pump). This update adds the results of one further trial. Data from a
total of 255 patients were included in the meta-analysis of mortality
outcomes; all on-pump. Generally, the patients were considered as "high
risk" and 132 were treated preoperatively with IABP and 123 served as
controls. There were four hospital deaths in the intervention arm and 23
in the non-intervention arm (OR 0.18, 95% CI 0.08 to 0.41; P<0.0001). In a
subgroup analysis, low cardiac index (<2.0 L/min/m(2)) was noted in 21 out
of 105 patients in the treatment arm and 59 patients out of 88 in the
non-treatment arm (OR 0.14, 95% CI: 0.08 to 0.25; P<0.00001). An off-pump
versus on-pump analysis was not possible due to the limited number of
off-pump studies. However a single well-conducted RCT suggested favourable
effect of the preoperative IABP in off-pump patients. Evidence suggests
that preoperative IABP may have a beneficial effect on mortality and
morbidity in specific high risk patient groups undergoing coronary artery
bypass grafting, however there are many problems with the quality,
validity and generalisability of the trials. However, the available
evidence is not robust enough to extend the use of IABP to truly elective,
high risk patients. Defining more precisely which patient groups may
benefit would be the challenge for the future.

<6>
Accession Number
21302724
Authors
Medved I. Anic D. Ostric M. Zrnic B. Ivancic A. Tomulic V.
Institution
(Medved, Ostric, Zrnic) Department of Cardiac Surgery, University Hospital
Rijeka, Tome Strizica 3, 51000 Rijeka, Croatia
(Anic) Department of Cardiac Surgery, University Hospital Zagreb, Zagreb,
Croatia
(Ivancic) Department of Thoracic and Vascular Surgery, University Hospital
Rijeka, Rijeka, Croatia
(Tomulic) Department of Cardiology, University Hospital Rijeka, Rijeka,
Croatia
Title
Is mitral valve repair safe procedure in elderly patients?.
Source
Collegium Antropologicum. 34 (SUPPL. 2) (pp 213-215), 2010. Date of
Publication: April 2010.
Publisher
Croatian Anthropological Society (Ulica grada Vukovara 72, Zagreb 10000,
Croatia)
Abstract
The aim of this randomized, prospective, study was to evaluate
postoperative hospital mortality and morbidity after mitral valve repair
by comparing two surgical techniques for resolving mitral valve
insufficiency in elderly patients. In comparison were: mitral valve repair
vs. mitral valve replacement in patients older than 70 years. In period
from January 1 ^st 2006 until August 30^th 2009.
Eighty patients with mitral valve disease, isolated or associated with
other co morbidities, were scheduled for mitral valve repair or mitral
valve replacement in our institution. Patients were randomized in two
groups, one scheduled for mitral valve repair and another one for mitral
valve replacement using the envelope method with random numbers. Results
show no difference in hospital mortality and morbidity postoperatively in
both groups. In group undergoing valve replacement we had one significant
complication of ventricle rupture in emphatically calcified posterior part
of mitral valve annulus. In conclusion we found no distinction in
postoperative hospital mortality and morbidity after using one of two
surgical techniques.

<7>
Accession Number
70353229
Authors
Golukhova E.Z. Bockeria L.A. Kakuchaya T.T. Eremeeva M.V. Chigogidze N.A.
Aslanidi I.P. Nikitina T.G. Shurupova I.V. Serov R.A. Svobodov A.V.
Institution
(Golukhova, Bockeria, Kakuchaya, Eremeeva, Chigogidze, Aslanidi, Nikitina,
Shurupova, Serov, Svobodov) Bakoulev Scientific Center for Cardiovascular
Surgery RAMS, Moscow, Russian Federation
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2009 Barcelona Spain. Conference Start: 20090829 Conference End:
20090902. Conference Publication: (var.pagings). 30 (pp 33-34), 2009.
Date of Publication: September 2009.
Publisher
Oxford University Press
Abstract
Purpose of our study included assessment of paracrine effects of stem cell
(SC) therapy on cardiac remodelling processes in patients with congestive
heart failure (CHF) of different origin. Methods: Overall 53 patients with
CHF were enrolled in our study. Patients were divided into groups
according to the SC/placebo (NaCl solution) delivery method: selectively
percutaneously intracoronary or transendocardially into the regions of
interest and transepicardially during open heart surgery based on the
noninvasive/ invasive methods of investigation. We applied autologous
bone-marrow stem (BMS) cell progenitors CD133+ in the treatment of
patients with CHF due to advanced coronary artery disease [CAD] (n=27) and
non-ischemic dilative cardiomyopathy patients (NICMP; n=26). Results:
Single isolated SC therapy with autologous CD133+ progenitors at average
dosage 2mln, performed transendocardially, resulted in the significant
reduction of left ventricular (LV) end-diastolic volume with moderate
increase of ejection fraction in short-term follow-up (3-6 months) in
patients with CHF due to CAD in comparison to placebo group. Alongside
during this period was observed moderate reduction of perfusion defects in
SC treated regions with viable my ocardium according to single photon
emission computed tomography. These positive changes eliminated in 1 year
follow-up. Other main LV remodeling indexes such as myocardial mass and
left atrial volume did not change in 3-6 months follow-up. In NICMP
patients we observed no changes in any of the LV remodeling indexes. In
order to evaluate biochemical processes and paracrine effects of stem
cells we performed enzyme-linked immunoelectrodiffusion assay of patients
plasma samples for VEGF, bFGF, angiogenin, angiopoetins-1,2, MMP-9, PlGF,
endostatin, TNF-alpha, SDF-1alpha and NT-proBNP levels before and after
elective SC therapy. In NICMP patients at 14 days after single isolated
transendocardial SC delivery we noted significant increase of SC homing
factor SDF-1alpha plasma concentration, whereas in patients with ischemic
CHF - significant decrease of PlGF (placenta growth factor) concentration
in comparison with placebo group. There were no changes in plasma
NT-proBNP levels in both groups. These alterations meant that SC paracrine
effects exerted transiently in ischemic scarred, but viable myocardium and
did not exert in non-ischemic dilated myocardium. Conclusions: Isolated
transendocardial delivery of BMS progenitors CD133+ at average dosage 2mln
may have some positive effects if it is used in combination with gene
therapy and repeated in 6 months in patients with CHF secondary to CAD.

<8>
Accession Number
70353398
Authors
Edstrom-Pluss C. Billing E. Held C. Henriksson P. Kiessling A. Rydell
Karlsson M. Wallen N.H.
Institution
(Edstrom-Pluss, Henriksson, Kiessling, Rydell Karlsson, Wallen) Karolinska
Institutet, Dept of Clinical Sciences, Danderyd Hospital, Stockholm,
Sweden
(Billing) Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
(Held) Uppsala Clinical Research Centre, Department of Cardiology,
University Hospital, Uppsala, Sweden
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2009 Barcelona Spain. Conference Start: 20090829 Conference End:
20090902. Conference Publication: (var.pagings). 30 (pp 75-76), 2009.
Date of Publication: September 2009.
Publisher
Oxford University Press
Abstract
Background: Current guidelines broadly recommend comprehensive cardiac
rehabilitation after an acute myocardial infarction (MI) or post coronary
artery bypass grafting (CABG). However, the evidence of the effects of
cardiac rehabilitation on cardiovascular morbidity is limited. There are
few long term randomized trials comparing expanded cardiac rehabilitation
and usual care. Material and methods: A single centre prospective
randomized controlled clinical trial was performed which included 224
patients with a recent MI or who were planned for CABG. Patients were
randomized to either expanded cardiac rehabilitation (intervention group
n=111) including a 5 days stay at a Patient Hotel after discharge,
increased physical training, cooking sessions and, importantly, a one year
stress management program, or to routine rehabilitation (control group n=
113). Five-year follow-up data were obtained on all included patients from
the registry of the Swedish National Board of Health and Welfare. The
primary endpoint was first cardiac event, including cardiovascular (CV)
death, myocardial infarction or readmission for CV disease. Results: The
primary endpoint occurred in altogether 121 patients (54%). There was a
significant reduction in CV events in the expanded rehabilitation group
compared to the control group when data were collected from the start
point of rehabilitation (47.7% vs. 60.2%; hazard ratio 0.69; 95% CI 0.48
-0.99; p=0.049). This was mainly due to a reduction in MI in the
intervention group compared to the control group (4.5% vs. 13.3%; hazard
ratio 0.47; 95% CI 0.21-0.97; p=0.047). The days at hospital during the
5-year follow-up were significantly less in patients who received expanded
rehabilitation as compared to patients in the control group (p=0.02).
Conclusion: An expanded multifactorial cardiac rehabilitation program
after an acute myocardial infarction or coronary artery by-pass grafting
reduced cardiovascular morbidity and days at hospital for cardiovascular
reasons.

<9>
Accession Number
70354027
Authors
Van Pelt N. Ruygrok P. Bolland M.J. Gambl G.D. Mason B. Ames R. Reid I.R.
Institution
(Van Pelt, Ruygrok, Bolland) Auckland City Hospital, Auckland, New Zealand
(Gambl, Mason, Ames, Reid) University of Auckland, Auckland, New Zealand
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2009 Barcelona Spain. Conference Start: 20090829 Conference End:
20090902. Conference Publication: (var.pagings). 30 (pp 235), 2009.
Date of Publication: September 2009.
Publisher
Oxford University Press
Abstract
Purpose: To investigate the effect of calcium supplements (Ca) on the
coronary calcium score (CAC) in healthy men who had previously taken Ca or
placebo in a randomized controlled trial. Methods: Ca are commonly used to
increase bone density and reduce fracture risk. However their use has been
recently been linked with increased cardiovascular events. A potential
mechanism for this is an acceleration of coronary calcification, which is
a predictor of major cardiovascular events (MACE) independent of
traditional risk factors. We performed a calcium score scan, using a 64
slice CT scanner, on 163 healthy men 1.7 years (SD 0.41) after taking
either 1200 mg of supplemental calcium or placebo for a period of 2 years,
as part of a randomized clinical trial to investigate the effect on bone
density. Results: The mean age was 57 years (+/-10 yrs). There was no
significant difference in the mean CAC between men who had taken Ca (223
Agatston Units) and those taking placebo (238, p= 0.88). The number of men
taking Ca compared with those taking placebo who had a zero calcium score
was not significantly different (20 vs. 24, p=0.54) although there was an
increase in those on Ca with minimal calcium (CAC <10, 17 vs. 7, p=0.04).
However, there was no difference in the number of men with mild calcium
(CAC - 10-100), moderate calcium (CAC - 101-300) or extensive
calcification (CAC >300) between the two groups. In this study cohort, 2
men (2.4%) taking Ca suffered a MACE (myocardial infarction (MI) and
coronary artery bypass surgery) compared to 1 man in the placebo group
(percutaneous coronary intervention) (1.3%). The median CAC in the men who
had a MACE was 1094 (1094, 2658) compared to 39 for the 160 men taking CS
or placebo with no MACE (p=0.0063). In men taking Ca, those who had a MACE
had a higher median CAC than those without a MACE (1667 (677, 2658) vs. 24
(1, 81) p=0.031. The CAC was strongly correlated with risk of having a
MACE (area under the curve 0.96, p=0.0068). Conclusion: Calcium
supplementation was not associated with an increase in coronary
calcification in healthy men. An increased calcium score was strongly
associated with myocardial infarction in this study cohort.

<10>
Accession Number
70354597
Authors
Singh P. Adigopula S. Bedi U. Singh M. Molnar J. Arora R. Khosla S.
Institution
(Singh, Adigopula, Bedi, Singh, Molnar, Arora, Khosla) Rosalind Franklin
University of Medicine and Science, North Chicago, United States
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2009 Barcelona Spain. Conference Start: 20090829 Conference End:
20090902. Conference Publication: (var.pagings). 30 (pp 382-383), 2009.
Date of Publication: September 2009.
Publisher
Oxford University Press
Abstract
Purpose: Previous studies comparing pre-operative coronary artery bypass
grafting (CABG) with medical management in patients undergoing elective
high risk non-cardiac surgery have shown conflicting results. Hence, a
meta-analysis was performed to evaluate the incidence of all-cause
mortality and myocardial infarction (MI). Methods: A systematic review of
literature identified six retrospective studies involving 1345 patients.
As the studies were homogenous for both outcomes, combined relative risks
(RR) and the 95% confidence intervals (CI) were computed using the
Mantel-Haenszel fixed-effect model. A two-sided alpha error <0.05 was
considered statistically significant. Results: There were no differences
in baseline demographics of patients in both groups. Compared to control
group, the risk of all-cause mortality (RR: 0.38, CI: 0.23 - 0.62;
p<0.001) and MI (RR: 0.26, CI: 0.14 - 0.47; p<0.001) was significantly
lower in patients who had previous CABG. Conclusions: Pre-operative CABG
before elective high risk non-cardiac surgery (Graph presented). may be
superior to medical management in reducing the incidence of all-cause
mortality and MI.

<11>
Accession Number
70354684
Authors
Kocka V. Widimsky P. Penicka M. Linkova H. Budesinsky T. Dvorak J. Lisa L.
Tousek P.
Institution
(Kocka, Widimsky, Penicka, Linkova, Budesinsky, Dvorak, Lisa, Tousek)
Cardiac Center, Teaching Hospital Krlovske Vinohrady, 3rd Medical School
of Charles University, Prague, Czech Republic
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2009 Barcelona Spain. Conference Start: 20090829 Conference End:
20090902. Conference Publication: (var.pagings). 30 (pp 403-404), 2009.
Date of Publication: September 2009.
Publisher
Oxford University Press
Abstract
Purpose: We aimed to characterize group of patients indicated for coronary
revascularization, who have simultaneously ischemic mitral regurgitation
(IMR). This was studied in population where primary percutaneous coronary
intervention (PCI) is routine therapy of acute ST elevation myocardial
infarction for at least 10 years. Best therapeutic approach to similar
patients is not well established. Methods: 2408 patients undergoing
cardiac catheterization at our institution from1.1. till 31.12.2007 were
screened. 63 patients who were considered for coronary revascularization
(percutaneous and/or surgical) and had at least mild to moderate (2+)
ischemic mitral regurgitation were included. IMR was defined by detailed
echocardiography evaluation of mitral valve morphology, excluding
rheumatic heart disease, m.Barlow and severe calcification. All patients
were followed for one year. Population of Czech Republic is approx. 10
million and there were 56.106 cardiac catheterizations performed in year
2007. Results: Clinical characteristics are: average age 69 years, 68%
being of male sex, NYHA class 2.5, diabetes mellitus 44%, hypertension 78%
(mean blood pressure at inclusion was 133/77mmHg, 2.2 antihypertensive
medication per patient), positive troponin at inclusion 32%, prior
revascularization 25%. In agreement with literature physical examination
is not too helpful - 38% of patients have no detectable murmur, only 36%
of patients have clearly audible murmur >= grade 2/6. Echocardiography
showed mean left ventricle (LV) diastolic dimension 59mm, LV ejection
fraction 41%, left atrium size 45mm. IMR severity was graded by
experienced echocardiographer and there was statistically significant
difference in LV diastolic dimension between mild to moderate (2+/4) and
severe (4/4) IMR (p=0.01). Mean logistic Euroscore was 14. 48 patients
underwent coronary revascularization (26 by PCI, 22 surgically with mitral
valve repair in 13 cases), 14 were treated medically and 1 patient was
referred for cardiac transplantation. There was no significant difference
in mortality between patients treated medically (7%) and revascularized
patients (19%) due to small sample size and small number of events,
overall mortality was 16%. Conclusion: Incidence of patients with ischemic
mitral regurgitation who are considered for coronary revascularization is
147 patients per 1 million per year, even in the era of primary PCI. These
patients have high estimated surgical risk. One year mortality is also
high at 16%. Our data might be useful for meta-analysis and planning
future research.

<12>
Accession Number
70355172
Authors
Testa L. Agostoni P. Biondi Zoccai G.G.L. Latini R.A. Laudisa M.L.
Pizzocri S. Lanotte S. Brambilla N. Banning A.P. Bedogni F.
Institution
(Testa, Latini, Laudisa, Pizzocri, Lanotte, Brambilla, Banning, Bedogni)
S. Ambrogio Clinical Institute, Milan, Italy
(Agostoni) University Medical Center Utrecht, Utrecht, Netherlands
(Biondi Zoccai) University of Turin, Turin, Italy
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2009 Barcelona Spain. Conference Start: 20090829 Conference End:
20090902. Conference Publication: (var.pagings). 30 (pp 528), 2009.
Date of Publication: September 2009.
Publisher
Oxford University Press
Abstract
Aim: Elevation of Troponin after scheduled percutaneous coronary
intervention (PCI) is a recognised consequence. We sought to evaluate the
prognostic significance and impact of the newly published definition of
PCI-related myocardial infarction (MI) according to which any troponin
elevation > 3x the upper reference limit identify a peri-procedural MI.
Methods: Search of BioMedCentral, CENTRAL, mRCT, and PubMed (updated May
2008). Outcomes of interest were: MACE (the composite of all cause death,
MI, repeat target vessel PCI (re-PCI) and coronary artery bypass grafting
(CABG)); single end points were also assessed. Results: Fifteen studies
have been included totalling 7578 patients. Troponin elevation, occurred
in 28.7% of the procedures. The incidence of PCI-related MI according to
the new definition was 14.5%. During the hospitalisation, any level of
raised troponin was associated with an increased risk of MACE [OR 11.29
(3.00-42.48), Number needed to harm (NNH) 5], death [OR 7.16 (1.95-26.27),
NNH=100], MI [OR 30.85 (6.05-157.38), NNH=4], re-PCI [OR 4.13
(1.23-13.88), NNH=50]. Patients with PCI-related MI had an increased risk
of death [OR 17.25 (2.71-109.96), NNH=100] and re-PCI [OR 10.86
(3.2-36.94), NNH=25]. At follow up of 18 months any troponin elevation was
associated with an increased risk of MACE [OR 1.48 (1.12-1.96), NNH=20],
death [OR 2.19 (1.59- 3.00), NNH=50], MI [OR 3.29 (2.71-6.31), NNH=33],
and re-PCI [OR 1.47 (1.06- 2.03), NNH=25]. In patients with PCI-related MI
the risk of MACE was further increased: OR 2.25 (1.26-4.00), NNH=3. An
increase of the troponin level below the cut-off was not associated with
MACE. Conclusion: A diagnosis of MI according to the new guidelines
applies to 15% of patients undergoing PCI and these patients are at high
risk of further adverse events both during the hospital stay and at 18
months.

<13>
Accession Number
70356507
Authors
Van Gaa W.J. Arnold R. Testa L. Lim C.C.S. Ponnuthurai F.A. Karamitsos T.
Selvanayagem J. Westaby S. Neubauer S. Banning A.P.
Institution
(Van Gaa, Arnold, Testa, Lim, Ponnuthurai, Karamitsos, Selvanayagem,
Westaby, Neubauer, Banning) John Radcliffe Hospital, Oxford, United
Kingdom
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2009 Barcelona Spain. Conference Start: 20090829 Conference End:
20090902. Conference Publication: (var.pagings). 30 (pp 872-873), 2009.
Date of Publication: September 2009.
Publisher
Oxford University Press
Abstract
Purpose: Percutaneous coronary intervention (PCI) and coronary artery
bypass grafting (CABG) are widely used to treat patients with coronary
artery disease (CAD). Late gadolinium enhancement on magnetic resonance
imaging (MRI) is the most sensitive imaging technique available for
detection of peri-procedural myocardial injury (PPI). We compared injury
during revascularisation detected by enzyme release and MRI imaging and
applied recent ESC/ACCF/AHA/WHF Task Force definitions of peri-procedural
necrosis and myocardial infarction. Frequency of Troponin I and MRI
defined PPI following PCI was compared with CABG for multi-vessel and/or
left main CAD. Methods: Prospective, single centre randomised controlled
trial (ISRCTN25699844). Patients with 3 vessel CAD (>=50% stenoses), or 2
vessel CAD including a type C lesion in the left anterior descending,
and/or left main disease (>=50%) were eligible. MRI was performed before
and 1 week post revascularisation. Troponin I was performed before, 1,6,
12 and 24 hours after treatment. Results: Eighty patients were enrolled
(average age of 64 years). Diabetes was present in 14/80 (17.5%). Severity
of CAD and risk were assessed using syntax and Logistic Euro scores
respectively. Mean syntax scores were 23.3 vs. 21.9 (p=0.39) and mean Euro
scores 1.85 vs. 2.31 (p=0.21) for PCI and CABG groups respectively. Forty
patients underwent PCI with drug eluting stents and 39 had on-pump CABG (1
died prior to CABG). Of those remaining, 3 PCI and 7 CABG patients did not
undergo MRI (5 claustrophobia, 3 renal impairment postrevascularisation, 2
inadequate images). In the PCI group 6/37 (16.2%) patients had late
gadolinium enhancement, compared with 9/32 (28.1%) in the CABG group
(p=0.25). Applying the new universal definition of peri-procedural
necrosis and myocardial infarction, necrosis occured in 29/40 (72.5%) PCI
patients and 35/35 (100%) CABG patients (p<0.0005), and myocardial
infarction occurred in 19/40 (47.5%) PCI patients and 9/35 (25.7%) CABG
patients (p=0.06). However only 6/19 (31.6%) patients in the PCI group who
fulfilled the new criteria for periprocedural myocardial infarction had
late gadolinium enhancement on MRI. Conclusion: The incidence of MRI
defined infarction did not differ according to treatment assignment.
Peri-procedural necrosis according to the new definition was universal in
the CABG group and lower in the PCI group. Applying the new universal
definition of PCI related myocardial infarction overestimates the number
of patients with infarction detectable by MRI.

<14>
Accession Number
70357123
Authors
Souza G.E.C.S. Pego-Fernandes P.M. Moreira L.F.P. Vieira M.L.C. Guimaraes
G.V. Bacal F. Issa V.S. Ferreira S.M.A. Chizzola P.R. Bocchi E.A.
Institution
(Souza, Pego-Fernandes, Moreira, Vieira, Guimaraes, Bacal, Issa, Ferreira,
Chizzola, Bocchi) Heart Institute -InCor, So Paulo, Brazil
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2009 Barcelona Spain. Conference Start: 20090829 Conference End:
20090902. Conference Publication: (var.pagings). 30 (pp 1031), 2009.
Date of Publication: September 2009.
Publisher
Oxford University Press
Abstract
Purpose: To investigate feasibility and safety of endoscopic clipping
videoassisted thoracoscopy sympathetic blockade (ECVTSB) in symptomatic
systolic heart failure (SHF) patients either refractory or intolerant to
beta-blockers (BB). Secondly, we sought to evaluate its cardiovascular
effects per-operatively and after a one month follow-up. Methods:
Randomized controlled trial with concealed allocation. Patients with
dilated cardiomyopathy and severe heart failure (LVEF<40%), NYHA
functional class II or III, sinus rythm and HR > 64 bpm despite either
adequate BB use or intolerant to it were included. Patients with Chagas
cardiomyopathy, atrial fibrilation, NYHA functional class I or IV, bearing
conditions which could limit short term survival or with pacemakers were
excluded. Every three patients included were randomized to either
treatment group (G1) or control group (G2) in a 2:1 basis. All of them
underwent clinical and echocardiographic evaluation before and two months
after procedure or randomization. G1 patients were placed in a
semi-sitting position, under one-lumen intubation under general anesthesia
and invasive hemodynamic monitoring. The procedure consisted of lower left
stellar ganglion plus left T1-T4 interspinal space clipping through
videothoracoscopy. All patients were closely monitored in ICU for 24h and
then in ward for more 24h. Study interruption and surgery reversal (clip
removal) criteria was death or severe worsening of SHF symptoms in the
per-operative period. Results: From January 2007 to december 2008, twelve
consecutive patients had been included (average age 49,8 years). Eight
patients underwent ECVTSB.Maximum procedure duration was 33 minutes. None
had any procedure-related adverse cardiovascular event in the
per-operative period or in the one month followup. Only one patient in G1
did not improve NYHA functional class (maintained functional class III)
while patients in G2 either maintained or worsened NYHA functional class.
There was a trend in improving LV ejection fraction in G1 in comparison to
G2. Conclusions: ECVTSB is feasible and appears to be safe in severe SHF
patients refractory or intolerant to BB. Exploratory data from this sample
suggest that this might be an effective alternative approach to
sympathetic blockade in SHF in this particular setting.

<15>
Accession Number
2011112164
Authors
Habara S. Mitsudo K. Kadota K. Goto T. Fujii S. Yamamoto H. Katoh H. Oka
N. Fuku Y. Hosogi S. Hirono A. Maruo T. Tanaka H. Shigemoto Y. Hasegawa D.
Tasaka H. Kusunose M. Otsuru S. Okamoto Y. Saito N. Tsujimoto Y. Eguchi H.
Miyake K. Yoshino M.
Institution
(Habara, Mitsudo, Kadota, Goto, Fujii, Yamamoto, Katoh, Oka, Fuku, Hosogi,
Hirono, Maruo, Tanaka, Shigemoto, Hasegawa, Tasaka, Kusunose, Otsuru,
Okamoto, Saito, Tsujimoto, Eguchi, Miyake, Yoshino) Department of
Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki-shi, Okayama
710-8602, Japan
Title
Effectiveness of paclitaxel-eluting balloon catheter in patients with
sirolimus-eluting stent restenosis.
Source
JACC: Cardiovascular Interventions. 4 (2) (pp 149-154), 2011. Date of
Publication: February 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives The aim of this study was to investigate the efficacy of a
paclitaxel-eluting balloon (PEB) for the treatment of sirolimus-eluting
stent (SES) restenosis. Background Because drug-eluting stents (DES) are
being used in increasingly complicated settings, DES restenosis is no
longer an uncommon phenomenon, and its optimal treatment is unknown.
Methods This study was a prospective single-blind randomized trial
conducted in 50 patients with SES restenosis. Patients were randomly
assigned to a PEB group (n = 25) or a conventional balloon angioplasty
(BA) group (n = 25). The primary end point was late lumen loss at 6-month
follow-up. Secondary end points included the rate of binary restenosis
(in-segment analysis) and major adverse cardiac events (MACE) at 6-month
follow-up. Results At 6-month angiographic follow-up (follow-up rate:
94%), in-segment late lumen loss was lower in the PEB group than in the BA
group (0.18 +/- 0.45 mm vs. 0.72 +/- 0.55 mm; p = 0.001). The incidence of
recurrent restenosis (8.7% vs. 62.5%; p = 0.0001) and target lesion
revascularization (4.3% vs. 41.7%; p = 0.003) was also lower in the PEB
group than in the BA group. The cumulative MACE-free survival was
significantly better in the PEB group than in the BA group (96% vs. 60%; p
= 0.005). Conclusions In patients with SES restenosis, PEB provided much
better clinical, angiographic outcomes than conventional BA. 2011
American College of Cardiology Foundation.

<16>
Accession Number
2011112679
Authors
Shemesh E. Annunziato R.A. Weatherley B.D. Cotter G. Feaganes J.R. Santra
M. Yehuda R. Rubinstein D.
Institution
(Shemesh) Division of Developmental and Behavioral Health, Department of
Pediatrics, Mount Sinai Medical Center, Box 1198, One Gustave L. Levy
Place, New York, NY 10029, United States
(Shemesh, Annunziato, Yehuda) Department of Psychiatry, Mount Sinai
Medical Center, New York, NY, United States
(Annunziato) Department of Psychology, Fordham University, Bronx, NY,
United States
(Annunziato, Santra, Rubinstein) Department of Cardiology, Elmhurst
Hospital Center, Queens, NY, United States
(Weatherley, Cotter, Feaganes) Momentum Research, Inc, Durham, NC, United
States
Title
A randomized controlled trial of the safety and promise of
cognitive-behavioral therapy using imaginal exposure in patients with
posttraumatic stress disorder resulting from cardiovascular illness.
Source
Journal of Clinical Psychiatry. 72 (2) (pp 168-174), 2011. Date of
Publication: February 2011.
Publisher
Physicians Postgraduate Press Inc. (P.O. Box 752870, Memphis TN
38119-2870, United States)
Abstract
Objective: We investigated the physical safety of cognitive-behavioral
therapy (CBT) utilizing imaginal exposure in patients who suffered from
posttraumatic stress disorder (PTSD) following a life-threatening
cardiovascular event. Method: In this phase I, prospective, single-blind
trial conducted from April 2006 through April 2008, we randomly assigned
60 patients to receive either 3 to 5 sessions of imaginal exposure therapy
(experimental group) or 1 to 3 educational sessions only (control group).
Criteria for PTSD and other mental health disorders were evaluated
according to DSM-IV using the full Structured Clinical Interview for
DSM-IV (SCID). Safety assessments included patients' blood pressure and
pulse before and after each study session and the occurrence of deaths,
hospitalizations, repeat myocardial infarctions, or invasive procedures.
We also investigated the effects of the treatment on PTSD symptoms (Impact
of Event Scale and Posttraumatic Stress Disorder Scale), depression (Beck
Depression Inventory-II), and the Clinical Global Impressions-Severity of
Illness (CGI-S) scale. Results: There were no significant differences
between the experimental and control groups and between exposure and
nonexposure sessions in any of the safety measures. In addition,
confidence intervals were such that the nonsignificant effects of exposure
therapy were not of clinical concern. For example, the mean difference in
systolic pressure between control and exposure sessions was 0.5 mm Hg (95%
CI, -6.1 to 7.1 mm Hg). Nonsignificant improvements were found on all
psychiatric measures in the experimental group, with a significant
improvement in CGI-S in the entire cohort (mean score difference, -0.6;
95% CI, -1.1 to -0.1; P = .02) and a significant improvement in PTSD
symptoms in a subgroup of patients with acute unscheduled cardiovascular
events and high baseline PTSD symptoms (mean score difference, -1.2; 95%
CI, -2.0 to -0.3; P = .01). Conclusions: Cognitive-behavioral therapy that
includes imaginal exposure is safe and promising for the treatment of
posttraumatic stress in patients with cardiovascular illnesses who are
traumatized by their illness. Trial Registration: clinicaltrials.gov
Identifier: NCT00364910. Copyright 2010 Physicians Postgraduate Press,
Inc.

<17>
[Use Link to view the full text]
Accession Number
2011101028
Authors
Lapar D.J. Kron I.L.
Institution
(Lapar, Kron) Department of Surgery, School of Medicine, University of
Virginia, Charlottesville, VA, United States
Title
Should all ischemic mitral regurgitation be repaired? When should we
replace?.
Source
Current Opinion in Cardiology. 26 (2) (pp 113-117), 2011. Date of
Publication: March 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Purpose of Review: Ischemic mitral regurgitation (IMR) is a major source
of morbidity and mortality. Although mitral valve repair has become
recently popularized for the treatment of IMR, select patients may derive
benefits from replacement. The purpose of this review is to describe
current surgical options for IMR and to discuss when mitral valve
replacement (MVR) may be favored over mitral valve repair. RECENT
FINDINGS: Current surgical options for the treatment of IMR include
surgical revascularization alone, mitral valve repair, or MVR. Although
surgical revascularization alone may benefit patients with mild-moderate
IMR, most surgeons advocate the performance of revascularization in
combination with either mitral valve repair or replacement. In the current
era, mitral valve repair has proven to offer improved short-term and
long-term survival, decreased valve-related morbidity, and improved left
ventricular function compared with MVR. However, MVR should be considered
for high-risk patients and those with specific underlying mechanisms of
IMR. SUMMARY: In the absence of level one evidence, mitral valve repair
offers an effective and durable surgical approach to the treatment of
mitral insufficiency and remains the operation of choice for IMR. MVR,
however, is preferred for select patients. Future randomized, prospective
clinical trials are needed to directly compare these surgical techniques.
2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

<18>
Accession Number
20875883
Authors
Dabbagh A. Rajaei S. Shamsolahrar M.H.
Institution
(Dabbagh) Anesthesiology Research Center, Shahid Beheshti University of
Medicine, Tehran, Iran, Islamic Republic of
(Rajaei) Immunology Dept. School of Medicine, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Shamsolahrar) Anesthesiology Research Center, Shahid Beheshti University
of Medicine, Tehran, Iran, Islamic Republic of
Title
The effect of intravenous magnesium sulfate on acute postoperative
bleeding in elective coronary artery bypass surgery.
Source
Journal of Perianesthesia Nursing. 25 (5) (pp 290-295), 2010. Date of
Publication: October 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Postoperative blood drainage is a great concern for health care providers
when monitoring patients after cardiac surgery. In this study, the effect
of intravenous magnesium sulfate infusion on postoperative bleeding in
patients undergoing elective coronary artery bypass graft (CABG) surgeries
was assessed. In a double-blind, randomized placebo-controlled clinical
trial, 140 patients scheduled for elective CABG were randomly assigned
into two groups; one group receiving intravenous magnesium sulfate and one
receiving placebo. All the cases were similar regarding anesthesia and
surgery. The magnesium group had less postoperative bleeding (465 +/- 130
mL vs 680 +/- 190 mL in the placebo group; P = .00) and less packed cell
use (2.1 +/- 0.6 packs vs 3.2 +/- 0.8 packs in the placebo group; P < .05)
as compared with placebo. The results demonstrated significantly less
postoperative bleeding and packed cell use in the group receiving
intravenous magnesium sulfate infusion during elective CABG surgery. 2010
American Society of PeriAnesthesia Nurses.

<19>
Accession Number
20728066
Authors
Chazan S. Buda I. Nesher N. Paz J. Weinbroum A.A.
Institution
(Chazan, Buda) Acute Pain Service, Tel Aviv Sourasky Medical Center and
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
(Buda, Nesher, Paz) Department of Cardiothoracic Surgery, Tel Aviv
Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel
(Weinbroum) Department of Anesthesia and Critical Care Medicine, Tel Aviv
Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel
(Weinbroum) Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center
and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Title
Low-Dose Ketamine via Intravenous Patient-Controlled Analgesia Device
after Various Transthoracic Procedures Improves Analgesia and Patient and
Family Satisfaction.
Source
Pain Management Nursing. 11 (3) (pp 169-176), 2010. Date of Publication:
September 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Ketamine was recently shown to attenuate postoperative pain when used in
combination with morphine in patients who had undergone general and
orthopedic surgery. We assessed its effects in 46 patients undergoing
minimally invasive direct coronary artery bypass, off-pump coronary artery
bypass, or thoracotomy and correlated them with patient and family
satisfaction. Patient-controlled analgesia (PCA) was available for 72
hours. One group received 2mg/bolus morphine randomly and double-blindly
(group MO), and another group received 1mg morphine plus 5mg
ketamine/bolus (group MK), both using IV-PCA. The patients' pain and
satisfaction rates were assessed three times daily during hospitalization
using a visual analog scale. Their families' satisfaction was assessed as
well. Although the 3-day mean amount of morphine used by the MK patients
was approximately 60% of that used by the MO patients, their levels of
pain and satisfaction were better than those of the MO group. There was an
inverted and statistically significant correlation between the patients'
level of satisfaction on the second postoperative day (POD) and the
satisfaction of their families on POD 2, 3, and 7 and the POD 3 patients'
pain assessment in the MK group but not in the MO group. There were no
differences in hemodynamic, respiratory, side effects, or complication
rates between the groups. The conclusion is that the effects of adding a
small ketamine dose to half of the standard morphine dose via IV-PCA after
thoracotomy was superior to the standard morphine dose in terms of the
patients' self-reported pain score and satisfaction, as well as the family
satisfaction rate. 2010 American Society for Pain Management Nursing.

<20>
Accession Number
20728068
Authors
Demir Y. Khorshid L.
Institution
(Demir) Abant Izzet Baysal University School of Health, Bolu, Turkey
(Khorshid) School of Nursing, Ege University, Izmir, Turkey
Title
The Effect of Cold Application in Combination with Standard Analgesic
Administration on Pain and Anxiety during Chest Tube Removal: A
Single-Blinded, Randomized, Double-Controlled Study.
Source
Pain Management Nursing. 11 (3) (pp 186-196), 2010. Date of Publication:
September 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
The aim of this study was to investigate the effect of cold application on
pain and anxiety during chest tube removal (CTR) in patients who had
undergone cardiac surgery. A single-blinded randomized design was used in
this study. Ninety patients aged 18-74 years, hospitalized in the
intensive care unit (ICU), who had a chest tube for a duration of at least
24hours were used for this convenience sample. The application of cold,
placebo, or control therapies was randomized into three different groups.
Sixty minutes before CTR was scheduled, an ICU nurse administered 10mg/kg
paracetamol intravenously to all study subjects. Cold and warm packs
covered with gauze dressing were applied to the area surrounding the chest
tubes for 20minutes. Pain intensity, pain quality and situational anxiety
for CTR were measured. Variance analysis and the latent growth model were
used in the analysis of the data. Patients in the cold group had
significantly lower pain intensity than the placebo group. The perception
of pain intensity measured by visual analog scores of patients in the cold
group showed the least variation. There was no statistically significant
difference in McGill Melzack Pain Questionnaire scores or in change of
anxiety level between the three groups. The application of cold prolonged
the length of time until analgesics were needed after CTR. Results showed
that cold application reduced patients' intensity of pain due to CTR but
did not affect anxiety levels or the type of pain. Cold application is
recommended as a pain-relieving technique during CTR. 2010 American
Society for Pain Management Nursing.